Doctor failed to decide immediate C-section was required

A doctor failed to decide that immediate delivery of a baby – who was delivered stillborn – by emergency Caesarean section was required, a Medical Council inquiry has heard.

The inquiry also found that Dr Salah Aziz Ahmed failed to attend at Cavan General Hospital in order to assess the baby's mother, referred to as Patient C, within an adequate time frame on April 26th, 2014.

The ongoing inquiry has examined the care Dr Aziz provided to Patient C, whose baby was born with no signs of life, as well as two other birthing women, a Patient A and Deirdre Clarke, who waived her right to anonymity.

On Thursday, the 23rd day of the hearing, the inquiry committee – which rules on the case – found seven out of the 14 allegations against Dr Aziz to be proven as to fact.

The inquiry will sit one final day, on May 30th, when it will be determined whether any of the factual findings amount to poor professional performance or professional misconduct.

On March 22nd of this year, Patient C told the hearing she met with Dr Aziz at 4.45pm on April 26th, 2014, and told him about her poor obstetric history. She had previously given birth to a stillborn baby, had three miscarriages, and had an emergency section for another child.

For two of her previous pregnancies, she had suffered from a placental abruption, a condition in which the placenta separates from the uterus, depriving a baby of blood and oxygen.

‘Hell broke loose’

On the day they met, Dr Aziz told Patient C he would return at 7pm to perform a Caesarean section.

But shortly after 6pm “all hell broke loose”, said Patient C, after a midwife could not find the baby’s heartbeat. Patient C was rushed to theatre and given a general anaesthetic.

“When I woke up, I knew something terrible had happened because [the nurse] was crying,” she said.

The stillborn baby did not respond to resuscitation, and it was later discovered Patient C had suffered from a third placental abruption.

Along with the two allegations relating to Patient C, three were proven in relation to Patient A whose baby died 32 hours after he was born.

Patient A’s baby boy was born in very poor condition by emergency Caesarean section on November 22nd, 2012. He required resuscitation before being transferred to the Rotunda Hospital in Dublin, where he died on November 24th, 2012.

A coroner’s court later found the infant died of extensive meconium aspiration as a result of hypoxic brain injury, the inquiry heard.

The inquiry committee found that on November 22nd, 2012, while Patient A was labouring, Dr Aziz instructed that the administration of labour drug syntocinon be increased from 90ml per hour at 9.40pm to 180ml per hour at 10.57pm in the presence of evidence of prior hyperstimulation.

‘Perfect little boy’

Dr Aziz also performed an episiotomy on Patient A in circumstances where it was not justified, and failed to catheterise her prior to attempting a Caesarean section delivery, the committee found.

The baby of the third patient, Ms Clarke, was born in very poor condition after her uterus ruptured on the night of June 5th, 2013. Her baby, Roland, did make an eventual recovery, and is “a perfect little boy”, Ms Clarke (37) told the inquiry in November.

In relation to the care Dr Aziz provided to Ms Clarke, the inquiry committee found he directed the administration of syntocinon be increased at or about 6.05pm, while Ms Clarke was in labour, and he instructed for syntocinon to remain infusing at 60ml at 10.30pm.

Syntocinon is a drug used to progress labour, but can lead to hyperstimulation of the uterus and extra strong contractions. This can distress a baby and increase the risk of uterine rupture in a mother such as Ms Clarke, who was trying for a vaginal birth after a Caesarean section.