Family suggest baby's death highlights 'dichotomy of consultant-led care' between public and private patients
A verdict of medical misadventure into the death of a baby girl following an attempt to perform a vacuum delivery due to her mother’s labour slowing has been returned by an inquest.
Baby Livia Angel Urkova-Marini was the only daughter of parents Ludmila Ukova and Aldo Marini, from Carlow town. She was born at 12.04pm in St Luke’s Hospital in Kilkenny on May 18, 2014, and died at 7pm that evening.
The 11-member jury at the inquest in Kilkenny coroner’s court made four recommendations that anomaly scans ought to be considered in such cases and it is essential that good communications between medical staff in maternity care and particularly with parents.
The jury also found that good, timely and appropriate care for both public and private patients should be given.
The jury of five women and six men also found that the HSE should provide training in cases of Vasa Previa and communication protocols within the hospital.
Vasa Previa is a rare condition which involves the baby’s head pressing down on the umbilical cord and which is dangerous for the baby if a tear occurs in the cord and its blood vessels.
Solicitor for the parents, Raymond Bradley, told the inquest that the family hopes that St Luke’s General Hospital and the HSE takes away each of the recommendations and acts on them in an appropriate manner.
“Prevention is always better than cure. It is important that there is not a repetition for other (women). The eyes of the jury have been opened to what occurred.
“However, most worryingly for the baby’s parents over the past five years were the communication or interpersonal difficulties (during the labour period).
“The communication (on the day) was inappropriate and unhelpful in such an emergency situation. My client was in dire straits. One lesson that needs to be learned from this is that there should not be any re-occurrence of this in any other hospital in this State.
This has highlighted a dichotomy between public and private patients. That is wrong. There are no second-class citizens in Ireland or there ought not to be.
“It is incumbent on the HSE to ensure that there is a change of policy by the HSE when dealing with cases (of this nature and communication concerns). It is a right, not an option, when dealing with consultant-led care.”
Barrister for the HSE, Paul McGinn SC, told the inquest that medical and professional guidelines should be implemented around communication and cases of Vasa Previa.
The inquest was previously told by Dr Peter Boylan, chairman of the Institute of Obstetricians and Gynaecologists who reviewed the hospital records, that an attempt at vacuum delivery of baby Livia by the registrar on call after labour had slowed “should not have been done”. This was due to the mother’s cervix not being fully dilated.
Coroner Tim Kiely put it to Dr Boylan that there was evidence that a bleed occurred during the first attempt by registrar Dr Ali Gewash at a vacuum delivery.
Dr Boylan explained that a vacuum cup is attached to the baby’s head and then the doctor tries to hand-pump the vacuum but if there are blood vessels running across the baby’s head, the pulling of the vacuum cup when it is detached can cause a bleed.
The coroner asked him: “Are you saying the performance of the suction ultimately led to the bleed that led to the death?”
“More than likely, yes,” Dr Boylan said. “On the balance of probabilities, that’s the most likely explanation.” The mother “more than likely” had a case of vasa previa,
Under questioning from Paul McGinn SC, for the hospital, Dr Boylan agreed that vasa previa was “undiagnosed” prior to delivery.
It’s an extremely difficult diagnosis to make.
Asked if it could have been suspected prior to the vacuum cup being applied at 11.22am on May 18, 2014, in the labour ward, Dr Boylan said: “I think not, in a practical sense”.
Consultant paediatrician Dr Wasim Asif had a resuscitation team on duty at the time and when the baby was born she was anaemic, there was no blood in the umbilical cord and the baby did not have a heartbeat or any respiratory efforts. She weighed 2.73kg.
Baby Livia Angel was placed in an incubator in the baby special care unit after 17 minutes of medical intervention.
They contacted the national neo-natal transport team to discuss transporting Livia to the National Maternity Hospital in Dublin, he said, but the baby “collapsed” again and her heart-rate went down to zero.
Dr Asif spoke to Livia’s parents, Ludmila and Aldo, and they decided it would be in the baby’s best interests to withdraw ventilation support.
The baby was baptised, at 4pm the mechanical ventilation was discontinued and she was placed with her mother for skin-to-skin contact. “She had very shallow breathing”. Baby Livia Angel was pronounced dead at 7pm.
Coroner Tim Kiely said it was one of the “most difficult” cases he had dealt with and that the loss of a child at such a “young and tender age” was “indescribable”.
Mr Kiely returned a verdict of death by birth asphysxia, haemorrhagic shock secondary to Vesa Previa.
Sympathies to the baby Livia Angel’s parents was extended by Mr McGinn on behalf of the HSE.
In a statement on behalf of Baby Livia Angel’s parents following the inquest ruling, Mr Bradley said: “The family are of the strong belief that there should not be any dichotomy of consultant-led care for either public and private patients in emergency situations and at all crucial times."
Mr Bradley added that interpersonal relationships between medical staff needed to be put aside in emergency cases.
