Warrington and Halton Hospitals NHS Foundation Trust

3. Miss X complains about the care and treatment she received from the Trust. In particular she says that, • Following the birth of her daughter A, who died in the womb, in June 2022 the Trust failed to tell her about or address her high thyroid levels. Miss X believes that this resulted in her suffering two further losses, including her baby B in September 2023. Miss X wonders if the Trust contributed to these losses by not addressing her thyroid levels.

• There was poor communication regarding the cause of her baby A’s death. Miss X says she still does not know the cause of her daughter’s death.

• A consultant obstetrician made assumptions in September 2024 about her mental health without physically examining her.

• A consultant obstetrician failed to provide all information and fully discuss the results of her baby C’s post-mortem in September 2024. Miss X says this meant she had to look into the cause of baby C’s death to find the answers she was seeking.

4. Miss X says the above failings in her care have caused her upset and trauma which has impacted her life.

5. Miss X is seeking an apology, service improvements, and a financial remedy.

6. Miss X has very sadly experienced the loss of four babies since June 2022. These included her baby A, baby B and baby C.

7. Miss X has complained about several aspects of her care to the Trust which responded in April 2025.

Thyroid levels

11. Miss X complains that the Trust failed to manage her high thyroid levels in 2022. She believes that if she had been properly investigated for this she would not have suffered subsequent miscarriages in March and September 2023. The Trust said in its letter 1 April 25 that the care and treatment provided regarding Miss X’s thyroid levels was appropriate.

12. Our obstetrician adviser said all available thyroid function tests during the relevant period were within the laboratory reference ranges. There is no documentary evidence of biochemical hyperthyroidism (increased thyroid hormone production) or hypothyroidism (underactive thyroid) during this time.

13. The Royal College of Obstetricians and Gynaecologists (RCOG) guidance on thyroid disease in pregnancy states that where abnormal thyroid function normalises, it is common clinical practice to discontinue antithyroid medication and continue monitoring, provided results remain within the normal range. This guidance was introduced in 2025 and is a reflection of the best practice which preceded it. Our obstetrician adviser said ongoing management is guided by biochemical results in the blood rather than historical diagnoses alone.

14. Our obstetrician adviser confirmed the available laboratory evidence shows normal thyroid function for Miss X throughout the period under review, so we have seen no indication that abnormal thyroid function levels were present or inappropriately managed. In the absence of documented abnormal results, and in line with guidance, there is no clinical basis which indicates that thyroid disease was untreated or mismanaged during this period.

15. Taking into account the available information and our obstetrician adviser’s advice, there is no indication of failings on the part of the Trust regarding this aspect of Miss X’s care. Therefore, we do not consider we need to take any further action.

Poor communication about the cause of baby A’s death

16. Miss X complains there was poor communication on the part of her consultant obstetrician regarding the cause of her baby A’s death in June 2022. Miss X says she still does not know the cause of her daughter’s death.

17. The Trust response dated 1 April 2025 said a consultant obstetrician met with Miss X on 19 August 2022 for an initial debrief. Miss X was then visited by a bereavement midwife on 27 September. The Trust’s consultant obstetrician spoke to Miss X late in the evening on 3 November 2022 and wrote to her the following day. This letter explained that a fetal genetics meeting had taken place on 12 October and that no further genetics tests or referral were required. It said the doctors at the meeting did not think baby A had a genetic syndrome and the indication was there was no definitive cause of baby A’s death. This view was supported by the available clinical evidence at that time.

18. On 11 September 2024 Miss X attended a clinical appointment with her consultant obstetrician for a debrief regarding her baby C. The clinic letter dated 26 September indicates that it is likely that Miss X and her partner carry the gene which causes autosomal recessive polycystic kidney disease (ARPKD). This is a serious inherited condition where the development of the kidneys and liver is abnormal. However, the letter states there was no pathological relationship between the post-mortems of baby A and baby C. The letter reflected what was clinically known at that time.

19. Our obstetrician adviser explained that following the termination of Miss X’s pregnancy in 2024 for fetal anomalies, genetic investigations were undertaken. These showed features on ultrasound and post-mortem examination consistent with ARPKD. Our obstetrician adviser said these genetic results prompted a retrospective review of Miss X’s 2022 pregnancy. This later suggested that baby A was also affected by ARPKD. However, this information was not known to the Trust at the time of its discussions with Miss X in November 2023 and September 2024 or at the time of the Trust response in April 2025. In the circumstances, the indications are that communication appears to have been in line with the GMC’s ‘Good Medical Practice’ which says ‘You must listen to patients, take account of their views, and respond honestly to their questions’.

20. In summary, having considered the available evidence and our obstetrician adviser’s advice, there is no indication that there were failings regarding the communication about the cause of baby A’s death at the time of discussions and the Trust response in April 2025. Therefore, we will not be taking any further action.

Assumptions about Miss X’s mental health without a physical examination

21. Miss X complains her consultant obstetrician made assumptions in September 2024 about her mental health following a telephone call without physically examining her. The Trust said it was sorry for any upset caused by the consultant obstetrician’s telephone call. It said this was a welfare call and the consultant had not intended to cause any further distress and was deeply sorry this was the case. The Trust said the consultant had no availability for a face-to-face appointment for several weeks and this was the reason she made the call.

22. The NICE guideline ‘Antenatal and postnatal mental health’ recommends that women who have experienced traumatic births, stillbirth, or pregnancy loss should be assessed for mental health conditions such as anxiety, depression, and post-traumatic stress disorder. Such assessments can be conducted either face-to-face or remotely and do not require a physical examination. Instead, they rely on clinical interview and, where appropriate, validated screening tools which are used to screen for anxiety disorders.

23. The above guidance indicates there is no clinical requirement for a ‘physical examination’ to assess mental health. The records suggest that a discussion regarding mental health was initiated during the telephone call. However, there is no clear documentation that a structured or completed mental health assessment (for example, using validated screening tools or a full clinical assessment) was undertaken or concluded.

24. Given that mental health assessment does not rely on physical examination, the absence of a physical examination does not, in itself, indicate inappropriate practice or that the Trust failed to act in line with the NICE guideline.

25. Taking into account the available information and our obstetrician adviser’s advice there is no indication of failings regarding the lack of a physical assessment. Therefore, we will not be taking any further action.

A consultant obstetrician failed to provide all information and fully discuss the results of baby C’s post-mortem in September 2024

26. Miss X complains the consultant obstetrician failed to provide all information and fully discuss the results of her baby C’s post-mortem in September 2024. She says this meant she had to look into the cause of her baby’s death to find the answers she was seeking.

27. Our obstetrician adviser explained Miss X’s 2024 pregnancy loss of baby C showed features on ultrasound and post-mortem examination consistent with ARPKD. At the time, genetic confirmation was pending, which is recognised to be a lengthy process. Initial genetic testing from the cord sample was inconclusive, but subsequent testing from a skin biopsy confirmed the diagnosis. This result also prompted review of the 2022 pregnancy loss of baby A.

28. As stated above, ARPKD is a serious inherited condition, and when both parents are carriers, there is a 25% risk in each pregnancy of the fetus being affected. The records indicate that the diagnostic process was evolving over time, with definitive confirmation only occurring after further testing.

29. Miss X and her partner met with the consultant obstetrician on 11 September 2024. The consultant obstetrician’s clinic letter dated 26 September 2024 said that the post-mortem report indicated baby C had ARPKD. The letter said it was also likely Miss X and her partner carried the gene for this abnormality. The letter also confirmed the consultant obstetrician was referring them for genetic testing. It further explained that her thyroid function did not cause the condition.

30. Our obstetrician adviser said, given the inherent delays in genetic testing and the stepwise nature of reaching a definitive diagnosis, the process described in the records is consistent with standard clinical practice. The precise content, depth, and clarity of the discussions with Miss X cannot be fully assessed from the available documentation. However, it does appear that there was sufficient information provided regarding the cause of the problems with the pregnancy and the next steps, in line with the GMC’s ‘Good Medical Practice’ guidance as set out above.

31. In the circumstances, we do not consider there are any indications of failings on the part of the Trust regarding this issue. Therefore, we will not be taking any further action.

Conclusion

32. We are sorry for the sadness and distress Miss X has suffered following the loss of her babies. We have carefully considered Miss X’s complaint and have not seen any indication of failings which means we need to take further action. We recognise the importance of this matter to Miss X and we hope we have clearly explained the reasons for our decision.

1. We have carefully considered Miss X’s complaint about Warrington and Halton Hospitals NHS Foundation Trust (the Trust). We recognise the devastating impact that the loss of Miss X’s babies has had on her and we were very sorry to learn of those sad events.

2. Having considered the available evidence we have not seen any indication of failings. For this reason, we have decided to take no further action with Miss X’s complaint. We have set out the reasons for our decision below.