Thursday 21 September 2017

Exclusive: 21 breech babies undiagnosed at Drogheda hospital over two years

Emergency Department - Our Lady of Lourdes Hospital, Drogheda
Emergency Department - Our Lady of Lourdes Hospital, Drogheda
Maeve Sheehan

Maeve Sheehan

Twenty one breech babies went undiagnosed over a two-year period at Our Lady of Lourdes Hospital in Drogheda, including one case in which a baby died, according to an internal audit.

The audit was prompted by the baby’s death in 2013 and two further complaints last year from parents unhappy that their babies’ breech position went “undiagnosed” by staff.

Our Lady of Lourdes Hospital has confirmed to Independent.ie that a baby died at birth in 2013 in a case that involved an undiagnosed breech at the time of delivery.

In a statement issued to Independent.ie, the Health Service Executive (HSE) said that undiagnosed breeches at the hospital have fallen significantly since the audit’s recommendations were put in place.

According to the statement, the hospital instigated a serious incident review following the baby’s death in 2013. According to the hospital, the review’s recommendations related to the length of time involved in getting emergency cases to surgery.

But a full scale audit was triggered after the hospital received two more complaints last year in which parents complained that their babies’ breech position was missed.

The hospital’s risk management committee conducted a retrospective two year audit of all births, which identified 21 cases of undiagnosed breeches.

The HSE said the number of undiagnosed breeches has “significantly reduced” since.

The audit involved “visits to the Rotunda Hospital” to review their experience of undiagnosed breeches" and recommended improved clinical practices,

Babies born in the breech position are born with the buttocks or feet first, as opposed to the head. Some studies have shown there is a risk to babies born in this position. Natural breech births are possible but many are delivered by Caesarean Section.

In a statement, the HSE said: “There will always be a percentage of women who present with an undiagnosed breech in labour.  Based on international evidence a percentage of breech cases will be missed.

“Clinicians still depend on clinical examination to make the diagnosis which is subsequently confirmed on scan. Given that presentation can change even up to shortly before the onset of labour, there is no scan schedule that will guarantee the prevention of breech presentation being made for the first time in labour.”

The HSE said that when a breech is identified, mothers are informed by senior staff and the situation and a care plan is discussed at the time of diagnosis.

“The Incident Review process in Our Lady of Lourdes Hospital provides for full involvement of the parents and all reports are provided to parents at the conclusion of all investigations,” the HSE said.

RTE's Prime Time tonight reported that following the 2013 and 2014 events, the hospital undertook a retrospective review of all births over a 26 month period, from May 1, 2012 to the June 30, 2014.

The total number of babies delivered during that period was 7,667, Prime Time reported. The total number of babies born in the breech position was 221. The total number of cases where breech was not diagnosed until after the onset of labour was 21, or almost 10pc.

The review found that 13 of the undetected breeches occurred in the Clinical Led Unit (CLU), while eight were undetected in the Midwifery Led Unit (MLU), it was revealed.

The eight cases discovered in the MLU were found to be “a disproportionally large number” for a unit where just 10pc of the total births in the hospital take place.

According to the HSE, breech diagnosed in early labour is not considered a critical incident and would not usually be reported. However, breech diagnosed in advanced labour is a “significant incident and would usually be reported”.

However the review found 13 of the 21 cases identified were only diagnosed in advanced labour.

When asked if the 13 cases had been reported as “significant incidents” a spokesperson told RTE's Prime Time “the HSE cannot confirm, this evening, how many of the 13 cases had incident reports completed.”

In a statement the HSE told Prime Time that the results of the clinical audit indicate the rate of undiagnosed breech in labour is below that which has been reported in the small number of international studies that exist on the topic.

The undiagnosed cases at Our Lady of Lourdes coincide with concerns over standards at some maternity units.

Last month, it emerged that seven births at Portiuncula hospital in Galway, two of which resulted in death and five involving oxygen deprivation, were being investigated. A panel appointed by the HSE is reviewing 170 complaints from patients about maternity units, including 30 baby deaths over several years.

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