Parents ask for review of guidelines after baby’s death

Parents ask for review of guidelines after baby’s death


Verdict of natural causes recorded at inquest

Ciara Galvin

THE parents of a baby who died 47 minutes after being delivered at Mayo General Hospital have asked that the hospital and medical staff be ‘alert and more vigilant’.
Declan Kearney and Angela Pickwell, the parents of baby Layla Evangeline of Derryhick, Parke, Castlebar, who passed away on February 18, 2013, thanked the staff of the hospital for their care but asked that staff be more vigilant if pregnant women present to the hospital with similar conditions as which Ms Pickwell did, namely reduced fetal movement.
The inquest into the death of the baby girl heard that Ms Pickwell presented to Mayo General Hospital at 11.30pm on February 17 reporting reduced movement for over five hours. Ms Pickwell was eight days overdue and had her last ante natal check up on February 12 where she was advised to come back to the hospital if she experienced reduced movement.
A CTG (cardiotocography) was started in order to monitor the fetal heartbeat. Ms Pickwell said initially there was ‘relief all round’ when a strong heartbeat was heard, however a midwife soon expressed concern that there was no fluctuation of the heart beat.

Monitored
After a period of being monitored and receiving IV fluids, a midwife expressed her concerns to the registrar who in turn passed on the concerns to the on call consultant. The decision was then made that a Category 2 emergency caesarean section take place and Ms Pickwell decided to call her partner who was working in Dublin at the time. Mr Kearney arrived at the hospital 20 minutes after his daughter had passed away.
A decision was then taken to delay the surgery for a time in order to monitor the CTG further but subsequently it was deemed necessary that the surgery go ahead. The inquest heard that the decision to wait 90 minutes before performing surgery was taken in accordance with the National Institute for Health and Care Excellence (NICE) guidelines which advises this period be given in order to monitor a change in CTG.
Baby Layla was delivered at 1.53am and passed away at 2.40am after ongoing efforts of resuscitation.
Pathologist Dr John Gillen told the inquest that on performing a post mortem old meconium (the first stool of an infant, composed of materials ingested during the time the infant spends in the uterus) was present and was taken into the baby’s lungs filling them causing asphyxia.
Dr Gillen said the cause of death was ante natal hypoxia due to the coiling of the umbilical cord which then caused the meconium. He explained that it was evident that a ‘critically low oxygen episode’ occurred days or perhaps a week earlier resulting in the baby’s death after birth.
When asked by Coroner for Mayo South John O’Dwyer, if Ms Pickwell’s most recent check up would pick up any signs of this episode, Mr Gillen replied, ‘I expect not’.
Asked if he would have waited the 90 minute period before sending Ms Pickwell for an emergency caesarean section Consultant at the hospital Dr Ulrich Bartels said looking at it he might have, but that he might have had a different opinion if he was in attendance on the night. Dr Bartels told the inquest that reduced movement was an important sign but that he had seen many women with reduced movement who went on to have normal births.

Natural causes
The Coroner returned a verdict of natural causes and extended his sympathy to Ms Pickwell and Mr Kearney.
Solicitor for the parents, John Geary said his clients wished to thank the staff of Mayo General Hospital for their care, adding that although they were aware that the staff were alert and vigilant they asked them to be even more vigilant when women presenting similar signs as Ms Pickwell come to the hospital. They also asked for a review to be done in relation to the NICE guidelines.