Sunday 4 December 2016

Elements of post-natal care before baby's death 'not acceptable' - inquest hears

Laura Larkin

Published 21/09/2016 | 11:27

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An inquest into a newborn baby who died shortly after birth heard on Wednesday that elements of his postnatal care was “not acceptable”.

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Baby Conor Whelan died shortly before 7.30am on May 14, 2014, around 17 and a half hours after he was born in Cavan General Hospital.

Dr Ann Katherine Leahy, a consultant paediatrician, who was called to the theatre after baby Conor was born showing “no signs of life” gave testimony of extensive efforts to save him.

A blood transfusion was given to Conor 85 minutes after he was delivered. Dr Leahy told the court today that she did not find this timeline acceptable.

The court also heard that the rate of transfusion to Conor in Cavan General Hospital was 40mls over two hours, which compares to the Rotunda where the rate was 60mls in half an hour.

Dr Leahy also said she did not find the rate of transfusion in Cavan acceptable.

She said in reviewing the case one of the factors the Cavan team considered the timing when blood was administered and that it would have been “more correct” to administer blood earlier although she said she didn’t think it would have made a difference [to the outcome].

Guidelines from the Rotunda Hospital in relation to postpartum care in high risk cases were read in court by Roger Murray, counsel for the Whelan family. These guidelines state that a consultant paediatrician should be present at time of delivery if certain risks are identified, including the need for an emergency caesarean.

Dr Leahy did not arrive to treat Conor until after his delivery.

When asked by Mr Murray if this was contrary to those guidelines she agreed it was.

However a doctor, Dr Foran, who works in the Rotunda later said the guidelines indicate a paediatric team and not necessarily a consultant need to be present depending on the risk factors.

The baby had no heartbeat initially which would have moved the blood around his body, but a heartbeat was recovered. He was never able to breathe on his own.

Dr Leahy said she believed the baby was deceased at birth and that successive adrenaline may have been why his heart began beating.

Earlier the inquest heard that Ms Whelan had been suffering from an undiagnosed condition called vasa praevia.

This is an obstetric complication in which foetal blood vessels cross or run near the internal orifice of the uterus.

The court heard that the placenta was divided into two discs, joined by vital arteries and veins via the membrane. 

Concerns were raised about a low-lying placenta, which could have been an indicator of this condition, in March and the expectant mum underwent an ultrasound on March 21.

Ms Whelan has claimed that she was told during following that scan that her consultant, Dr Azhar Syed, would likely do a follow up internal exam to follow up on concerns about her placenta.

This exam never took place and staff at the hospital have disputed her recollection in court.

On Wednesday Dr Syed told the court that he was not aware of the report from the March 21 scan and that he was also not aware about concerns about a possible low-lying placenta at any stage during her pregnancy.

He also said that radiologists said they did not feel skilled enough to prepare maternal scan reports and requested a new process to be put in place, in May 2014.

There is nobody at Cavan General Hospital at the moment who specialises in maternal ultrasounds for pregnant women. Work is underway to recruit a specialist in obstetric ultrasounds and a 20 week scan will be given as routine to all women when this happens. If a concern is raised now Dr Syed said he assists by performing a scan and preparing a report himself.

The court heard on Tuesday that a 20 week scan, something mum Siobhan has said she believes all pregnant women in Ireland should get, is safer for women. It is a scan most likely to diagnose abnormalities and also any problems with the placenta.

Dr Syed said today that vasa praevia, a rare condition, is difficult to diagnose but has good outcomes when it is diagnosed.

Following the death of Conor Whelan Dr Syed said there had been learning in the obstetrics department in Cavan General Hospital.

Baby Conor Whelan had to be revived after his delivery and was transferred to the Rotunda for emergency care before he was returned to Cavan to spend his final hours with his family.

The inquest into Conor’s death continues today before Coroner Mary Flanagan in Cavan Court.

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