Friday 20 January 2017

Medical inquiry hears details of treatment of woman whose baby died 32 hours after birth

Doctor faces allegations of poor professional performance and professional misconduct

Liz Farsaci

Published 10/11/2016 | 19:06

(Stock photo)
(Stock photo)

A Medical Counsel inquiry has heard allegations that a consultant gynaecologist failed to proceed to Caesarean section with adequate expedition.

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Dr Salah Aziz Ahmed faces allegations of poor professional performance and professional misconduct relating to the care provided to three mothers who gave birth at Cavan General Hospital.

On the first day of inquiry today details were given of the treatment of one women, aged 37, whose baby died 32 hours after birth. The disciplinary hearing is due to last ten days.

Two of the mother's have have not being named while the third is Deirdre Clarke.

Dr Aziz provided care to the first mother, Patient One, at Cavan General Hospital in November 2012. It is alleged that Dr Aziz engaged in prolonged attempts at a vaginal delivery in inappropriate circumstances, and failed to proceed to a Caesarean section with adequate expedition.

The inquiry heard that the baby of Patient One, referred to as Baby One, was born in very poor condition on the night of 22 November 2012, and passed away on 24 November.

After qualifying as a doctor in 1980 in Egypt, Dr Aziz came to Ireland in 1988 and worked in a number of hospitals. He was accepted as a member of the Royal College of Obstetrics and Gynaecologists in Ireland in 1992.

His legal counsel Eileen Barrington, SC, pointed out to the inquiry that Dr Aziz’s actions “were not causative” of the death of Baby One.

Patient One, whose pregnancy was considered high risk due to an increased BMI level, was admitted to Cavan General Hospital on 19 November 2012, 11 days past her due date.

She was given prostaglandin gel to help induce labour, and then later increasing levels of Syntocinon, which is used to strengthen and increase contractions.

Nurse midwife Breege Lavin, who provided care to Patient One throughout her labour and the birth of her baby, told the inquiry she began to provide care for Patient One at 8pm on the evening of 22 November, when her shift began.

Patient One continued to have Syntocinon, which is used to help progress labour by increasing contractions, and began active pushing at 9.30pm.

Ms Lavin said that at 10.25pm, birth was still not imminent, and Patient One was exhausted. Protocol dictates that after an hour of pushing, if nothing is happening, a midwife must obtain input from an obstetrician.

Ms Lavin said she was aware of this, and the fact that the obstetrician working in hospital that night was in theatre conducting a caesarean section.

Ms Lavin rang Dr Aziz at 22.30, as he was the consultant on call, and he arrived at the hospital at 22.45. He examined Patient One, and made a first attempt at an instrumental birth, using a vacuum.

Ms Lavin told the inquiry that there was no discussion of any other type of delivery at this time.

The vacuum extraction was unsuccessful.

Dr Aziz performed an episiotomy and then attempted a forceps delivery, which was also unsuccessful.

Ms Lavin told the inquiry a failed instrumental delivery would be a very rare occurrence.

She said Dr Aziz first enquired at 11.10pm about whether a theatre was available, adding that it would be a very rare occurrence to have two caesarean sections taking place at the same time.

Patient One was prepped for theatre, and Dr Aziz began the surgery at 11.32pm, and Patient One was put under general anaesthetic. The baby’s head was jammed in his mother’s pelvis, and so he was born feet first at 11.40pm.

The baby was in very poor condition, with Apgare scores of 1 (on a scale of ten), at one minute and five minutes after birth. He was resuscitated and ventilated, and later transferred to the Rotunda hospital in Dublin.

Baby One remained in very poor condition and tests showed very little, if any, cerebral activity. He passed away 32 hours after his birth.

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