A PAEDIATRICIAN treating a newborn baby who suffered a massive bleed between his skull and scalp following birth told an inquest in Dublin he had seen a case like it just once in his 12 years working in neonatology.
Consultant neonatologist Dr Colm O’Donnell told the inquest of baby Daniel McGovern that subgaleal haemorrhages were a very rare condition which terrified neonatologists as they have a very high mortality rate and are difficult to recognise.
The inquest heard forceps used during the attempted delivery of the baby “most probably” caused the fracture to his skull, discovered shortly after birth.
Daniel McGovern, of Leinster Park, Harold’s Cross, Dublin, died at the National Maternity Hospital, Holles Street, Dublin, on November 23rd, 2010, just one week after his birth via emergency Caesarean section.
An autopsy carried out by Dr Paul Downey, consultant histopathologist at the hospital, found Daniel had suffered a non-depressed fracture of the skull and a subgaleal haemorrhage.
Dr Downey gave the cause of death as hypoxic ischemic encephalopathy (where the brain is deprived of oxygen).
The baby’s mother, Claire McGovern, presented to the hospital on November 16th, 2010, with painful uterine contractions. She was at nearly 40 weeks of pregnancy. Her baby was noted to have a slow heart rate in the womb and the labour failed to advance beyond the second stage.
Daniel weighed 10lb 2oz when born. He was motionless following birth, a heart rate was not detected and he made no effort to breathe.
He was placed on a ventilator. He did not withdraw from painful stimuli, and did not cry.
He had a significant brain injury and showed no signs of brain function, Dr Catherine Gibbons told the hearing.
A subgaleal haemorrhage was also discovered shortly after birth.
Dr Declan Keane, consultant obstetrician gynaecologist at the hospital, told the inquest he made the decision to opt for a Caesarean section after the labour failed to progress. He said: “I’ve no doubt the fracture was most probably due to forceps.”
He added it would be preferable to have the delivery suite on the same floor as the operating theatre where Caesarean sections were carried out, and that the National Maternity Hospital had applied for funding to do so. However, he said that such a change was hampered by the hospital’s city centre location.
Counsel for the family, Dr Simon Mills, said “evidence of distress in the infant only began after attempted instrumental delivery/application of forceps”.
He said the foetal heartbeat was normal running up to the birth, suggesting the infant was normal and not in distress, with a slowdown in the heart rate only occurring after the application of forceps.
“The only objective evidence is an instrumental delivery and injuries associated with an instrumental delivery,” he added.
Dublin City Coroner Dr Brian Farrell said he needed time to consider the evidence before delivering a verdict.
Adjourning the inquest, he said: “Issues have been raised during the examination of witnesses which I’d like to look at myself. This is an important matter. I want to do justice to the situation.”
The case was adjourned until Tuesday, September 27th.
The couple have one other child, a son.