Inquest hears doctor stayed on at meeting before ‘semi-emergency’

The on-call obstetrician at Cavan General Hospital stayed on at a weekly statistics meeting before attending a “semi-emergency” in the labour ward that ended in the death of a newborn, an inquest has heard.

Three calls were made by medical staff to Dr Rita Mehta over a half-hour period in relation to Siobhan Whelan, whose condition was of growing concern to midwives in the ward, the inquest into the death of Conor Whelan in May 2014 was told. Dr Mehta was attending a weekly audit meeting at the time.

Clinical midwifery manager Ann Arnott said she took responsibility for telling Dr Mehta she should stay at the meeting for another 10 minutes before coming to the ward.

She said she agreed this with Dr Mehta as Ms Whelan was not actively bleeding at the time and her case was “a semi-emergency”.

Conor was born on May 13th, 2014 following an emergency caesarean but died after 17 hours. He suffered a brain injury caused by vasa previa, a rare condition which occurs when the blood vessels from the placenta or umbilical cord block the birth canal and tear.

Dr Mehta said she agreed to buy time with Ms Arnott because at that stage there was no immediate urgency for her to rush to the labour ward. Ms Whelan was not actively bleeding and the baby’s heart trace was normal.

She never suspected that vasa previa was involved or that the bleeding was from the foetus.

Ms Arnott told the second day of the inquest Ms Whelan seemed unusually anxious when she helped her onto a bed at about 12.55pm on May 13th 2014.

“I was baffled. I did start to get concerned more from the reaction of the parents than anything else.” This may have been due to a “sixth sense” or “mother’s instinct” on the part of Ms Whelan, she said.

At 1pm she asked a junior doctor to contact Dr Mehta, who instructed her colleague to perform an artificial rupture of Ms Whelan’s membranes.

Ms Arnott said she told the junior doctor she wanted Dr Mehta, the consultant, to carry out the procedure.

She told Roger Murray, for Ms Whelan, she put a halt to the junior doctor carrying out the rupture as she was beginning to get concerned and she did not want to take any risks when the consultant was present in the hospital.

She agreed with Mr Murray she did not have confidence in the two junior doctors on the ward to perform the rupture.

At 1.15pm, she contacted Dr Mehta to say she wanted her to rupture the membranes. Dr Mehta agreed to come after 10 minutes but when the fetal heart trace worsened after 1.23pm Ms Arnott got the junior doctor to contact Dr Mehta again.

Dr Mehta arrived at 1.30pm and performed the rupture.

Ms Arnott said the situation was now a full-blown emergency. It could have been “a cervical or vaginal thing”.

“Or from the baby,” Mr Murray asked.

“Unfortunately, I didn’t think of that on the day,” Ms Arnott said. “Vasa previa wasn’t on my radar. It is so rare, I’ve only seen it a few times in a long career.”

Earlier, Dr Angela Mortimer, a consultant radiologist, said the ultrasound carried out on Ms Whelan at 33 weeks failed to "see" a bilobed placenta which was later identified after Conor died. In this condition, the placenta is divided into two discs, joined by arteries via the membrane.

The abnormality would have been present at the time the scan was carried out in March 2014, she told Mr Murray.

Ms Whelan, from Ballyjamesduff, says her son died after her membranes were ruptured against her will. The hospital says Conor's blood loss occurred before the rupture.

On March 21st, obstetrician Dr Irina Samachis carried out a scan on Ms Whelan and found that the placenta looked low-lying. She booked the patient for a scan in the radiology department.

Dr Mortimer said the results of this scan, carried out later in the day, were normal and there were no signs of any abnormalities

She said a bilobed placenta was a risk factor for vasa previa. There was no internationally agreed screening programme for this condition.

Mr Murray said the survival rate where vasa previa was diagnosed prenatally was 97 per cent, according to Ausralian guidelines. Where the condition was not diagnosed, the survival rate fell to 44 per cent.

Ultrasound specialist Anne Emmo, who carried out the scan, said Conor's death had caused her great upset and she had since ceased performing obstetric ultrasounds.

She said she merely took the images, while the job of the radiologist was to prepare a report based on the scan.

In her evidence, Ms Whelan has said she was told she had a low-lying placenta, but she was “in great hands” and a further scan would be carried out by her consultant, though this never happened.

Ms Emmo said categorically she would not tell a patient whether or not they had a low-lying placenta.

Dr Mortimer said it would be inappropriate to say a pregnancy was normal and no radiologist would say this. “Our role is solely to interpret the issues,” she said, giving evidence by Skype.

The inquest continues on Wednesday.