1) Ureter damage in laparoscopic hysterectomy

A patient underwent a laparoscopic hysterectomy due to prolonged menstruation, pain and uterine muscle tumour. After the operation, the patient had increasing pain and signs of inflammation. More detailed examinations indicated ureteral injury that had probably been caused in connection with the hysterectomy. An attempt was made to repair the damage by placing a stent in the site of injury, but ultimately it had to be repaired surgically.

The hysterectomy was medically indicated. The operation conditions were normal in the laparoscopic procedure. However, the level of professional competence of an experienced physician specialising in hysterectomy was not reached in the operation. The ureteral injury could have been avoided by using a more careful operating technique.

The patient was compensated for personal injury caused by the resurgery and prolonged recovery.

2) Parts of placenta remaining in the uterus after childbirth

A patient's delivery proceeded normally. After childbirth, the placenta was described to have separated normally and that the placenta was complete. However, the patient required curettage three times because pieces of placenta were found to remain in the uterine cavity.

It is always possible in vaginal delivery that parts of placenta tissue remain in the uterus. Curettage of the uterine cavity may be required several times to remove all placenta material, even if the procedures were carried out appropriately.

The case did not meet the criteria for an injury compensable under the Patient Injuries Act.

3) Intrauterine device dislodged outside the uterus

A patient had an intrauterine device inserted for contraception. The patient had abnormal pain after the intrauterine device insertion. She had an ultrasonography that indicated the intrauterine device to be in the myometrium. The intrauterine device was removed and the symptoms alleviated.

The insertion of an intrauterine device, similarly to all intrauterine procedures, involves the risk of the intrauterine device ending up inside the myometrium or even perforating the uterus. The insertion of an intrauterine device is a "blind procedure", i.e. performed without visual contact. Therefore, perforation of the uterus or the intrauterine device ending up in the wrong place in connection with its insertion is a consequence that cannot always be avoided in spite of the insertion being carried out appropriately.

The treatment of the patient had been medically indicated and the consequence could not be avoided. Therefore, the case did not meet the criteria for an injury compensable under the Patient Injuries Act.

15.06.2016