Pregnancy associated breast cancer (PABC) is rare, accounting for 40 per 100 000 cases of breast cancer in the UK and 4% in women diagnosed under 45 years of age. It includes breast cancer diagnosed during pregnancy and the 12 months after delivery. Diagnosis is often delayed as changes in the breast can be ascribed to pregnancy, rather than malignancy. Prognosis is worse than in non-pregnant women. In addition to the severe psychological distress caused by the diagnosis during or soon after pregnancy, there are a number of differences in the management of breast cancer regarding the health of the pregnancy and the unborn child. In general, most treatments should be avoided in the first trimester, but thereafter surgery and chemotherapy may be administered with relative safety, albeit with some modifications to normal practice. Radiotherapy, biological and hormonal therapies must be avoided until after delivery. In the small percentage of women who are diagnosed with de novo stage IV disease or who become pregnant whilst undergoing treatment for secondary metastatic disease, management may be challenging, with limits to the agents that may be safely used if the pregnancy proceeds.

The claimant was the second child of his mother who had delivered her first pregnancy by caesarean section (CS). It was claimed that the mother was not adequately counselled about the risk of uterine rupture in the antenatal period, if she opted for a vaginal delivery, and subsequently, when she went into labour, was not informed of the desirability of continuous fetal monitoring or of the risks inherent to intermittent auscultation (IA).

The claimant, a 38-year-old, suffered a stillbirth while under the care of the defendant trust. She claimed that it was negligent in failing to recognise that the baby was not growing normally and in failing to carry out a growth scan in spite of hospital attendances for reduced fetal movements and. Had this been performed it would have been identified that there was reduced liquor and the baby was small and a delivery expedited earlier preventing the still birth. She claimed for damages on the grounds of suffering psychiatric injury and also suffered a loss of self-confidence and was unable to return to work.

During the claimant’s delivery, labour was obstructed and a caesarean section (CS) performed by the registrar. The claimant’s head was deeply impacted in the maternal pelvis and it was alleged that in the course of delivering and freeing the head, there was significant damage resulting in a depressed fracture of the skull and a subgaleal haemorrhage (bleeding between the scalp and the skull) as well as intracranial haemorrhage (bleeding into the cavern of the skull). These in turn caused permanent brain damage. It was claimed that this trauma was due to the use of undue force that was unnecessary for the purpose.