Barking, Havering and Redbridge University Hospitals NHS Trust

3. Ms R complains about the care the Trust provided between December 2022 and January 2023. Specifically, she complains that between 11 and 14 December, emergency department staff did not arrange for a midwife to review her and sent her home with a dental infection.

4. Ms R says the Trust’s actions caused distress to her and her unborn baby. She explains the experience has left her with a lack of trust in medical professionals.

5. In bringing the complaint to us Ms R would like the Trust to acknowledge what went wrong, apologise, make service improvements and pay her a financial remedy.

6. What follows is a summary of events. We have not included all details as both parties are aware of this.

7. During the period of complaint Ms R was between 12 and 16 weeks pregnant. She had undergone wisdom tooth surgery on 7 December 2022.

8. On 11 December Ms R attended the emergency department as she had facial swelling and pain. Staff suspected she had a tooth abscess and referred her to the maxillofacial team. Staff discharged her around four hours later with a prescription for pain relief and a short course of antibiotics.

9. On 13 December Ms R returned to the emergency department with facial swelling and pain. Staff discussed Ms R with the maxillofacial team who recommended giving her IV (intravenous (via a drip) antibiotics, IV fluids and pain relief.

10. The maxillofacial team reviewed Ms R at around 10.13am on 14 December. She remained in hospital until 17 December when staff discharged her to await an outpatient maxillofacial review.

11. On 22 December Ms R attended the oral maxillofacial clinic and staff added her to the waiting list for tooth extraction.

12. On 30 December staff confirmed Ms R’s tooth extraction would take place on 9 January 2023.

Midwifery input

17. Ms R complains the Trust did not arrange for a midwife to review her in either of her hospital admissions. She says staff dismissed her concerns about having an infection whilst pregnant and the impact this may have on her unborn child.

18. Our adviser said there are no specific guidelines that stipulate midwifery review must take place in the emergency department. They referred us to the MBRRACE-UK report which suggests staff should discuss all pregnant women who attend an emergency department with maternity services. It also says clinicians should treat pregnant women in the same way as non-pregnant women.

19. Our adviser explained that in practice, clinicians will typically only discuss pregnant women who attend an emergency department with maternity services if they are significantly unwell or have complex conditions. This did not apply in Ms R’s case as she attended the emergency department on both occasions with a dental infection and not because of any pregnancy related issue.

20. We also reviewed Ms R’s clinical records from 11 December 2022 to 9 January 2023. We were unable to establish whether staff should have discussed her with maternity services during this admission, as we only have sight of a discharge summary that states ‘facial swelling – non traumatic, administration treatment not indicated’.

21. Documentation from the second admission shows Ms R presented with the same symptoms. On 14 December a maxillofacial consultant discussed Ms R with a gynaecology registrar who noted no pregnancy related concerns and provided advice on safe anaesthetic for dental surgery. This suggests that during the second admission clinicians acted in line with the MBRRACE-UK report as they discussed Ms R with maternity services.

22. It is clear from Ms R’s account of events that she found the lack of midwifery review distressing as she was worried about her baby. We understand how upsetting this was. Nowhere in guidance does it stipulate that clinicians must arrange midwifery review for patients with dental issues. Meaning we cannot say that this is an indicated failing.

23. We recognise that Ms R wanted to see a midwife during both hospital admissions. There is not enough independent evidence for us to say she needed midwifery input during either admission. Nor can we explore any claimed impact of this to her baby. For this reason, we are not continuing our consideration of this aspect of the complaint. We hope we have explained our decision clearly.

1. We have carefully considered Ms R’s complaint about the Trust. We are sorry to hear about the pain she experienced during and after her hospital admissions. We recognise how distressing this was.

2. We have not seen any indications of failings in respect of the Trust not arranging for Ms R to see a midwife when she attended hospital with dental issues. We have not been able to consider Ms R’s complaint about there being distress to her baby. We do not underestimate how worried she was. We have already advised her to explore legal action in relation to this part of her complaint.