AN INQUEST heard yesterday that a baby boy suffered severe head injuries from a failed attempt at delivery using medical instruments at the National Maternity Hospital, Holles Street, in Dublin.
Parker Meredith Doyle died just one day and 10 hours after his birth by emergency Caesarean section on April 18th, 2008.
The inquest at Dublin City Coroner’s Court heard that the baby was left severely brain damaged due to brain haemorrhage as a result of “an attempted instrumental vaginal delivery” using a vacuum cup and forceps.
The hospital accepts there were shortcomings in the management of the baby’s delivery, and that these shortcomings led to his death, John Gleeson, solicitor for the hospital, told the court.
Caroline Meredith, of Hogan Place, Dublin, the baby’s mother, who had a failed forceps delivery 13 years earlier which had resulted in injuries to her baby, was admitted to the delivery ward at 10pm on April 17th and was later administered an epidural.
About 2.40am on April 18th, registrar in obstetrics Dr Rita Mehta attempted to deliver the baby with a vacuum device (ventouse cup), but delivery was not achieved. She then applied a forceps before using another type of vacuum cup, to no effect.
At that point, midwife Martina Cronin, who was “very concerned that the attempts at instrument deliveries had failed”, suggested to Dr Mehta to contact consultant in obstetrics Dr Orla Sheil.
Ms Cronin contacted Dr Sheil by telephone and when she returned to Ms Meredith, Dr Mehta had reapplied the forceps to deliver the baby.
Dr Mehta said she stopped this attempt after two “pulls”.
Dr Sheil arrived in the delivery ward between 3.15am and 3.20am, where she found Ms Meredith “distressed”. Upon examination, she decided to proceed to emergency Caesarean section.
“Baby Parker was very seriously ill at birth,” said Dr Sheil, who found the position of the baby’s head was different to Dr Mehta’s finding.
She said the position was not suitable for a forceps delivery, the inquest heard. Asked by coroner Dr Brian Farrell whether a previous Caesarean section with a failed forceps delivery would have any implications for any future deliveries, Dr Sheil said that “it would raise the concern as to whether the patient is suitable for another instrumental delivery”.
Dr Sheil said that for a baby whose head is in the same position as Parker’s was, if an attempted vaginal delivery was appropriate, the head would be rotated manually or a suction cup would be used to try and rotate the head.
Consultant perinatal pathologist Dr Peter Kelehan said there was haemorrhage, which can be a recognised complication of the ventouse (vacuum device), and another type of haemorrhage, which he had never seen in a baby before, but had sometimes seen in adult victims of road traffic accidents. It indicates “severe application of trauma to the baby’s head”, he said.
Dr Kelehan said the injuries were consistent with the application of forceps and ventouse.
The baby had no congenital abnormalities.
Coroner Dr Brian Farrell recorded a verdict of death by medical misadventure.
He said there were a number of risk factors including the previous obstetrical history (Ms Meredith’s previously failed forceps delivery), assessment of progress of delivery and assessment of the position of the head.
“Failed instrumentation resulted in severe head injuries to the baby,” he said.
He expressed his condolences to the baby’s father, John Doyle, and mother, Ms Meredith, who was in court.
The couple have two sons.