Attempt to perform vacuum delivery 'more than likely' led to fatal bleed in baby, inquest hears
An attempt to perform a vacuum delivery on a baby after her mother’s labour had slowed had “more than likely” led to a bleed which led to the baby’s death, an inquest has heard.
Baby Livia 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 inquest at Kilkenny coroner’s court into Livia’s death was adjourned this evening to allow written submissions be made by her family’s legal team on possible verdicts and recommendations.
The inquest was 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 because the mother’s cervix was not 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 said the 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.
“That’s when the vessels would have torn and that’s when the bleeding would have happened,” he said.
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, 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.
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 obstetrician Dr Yuddandi Nagavini told the inquest today that she arrived to Ms Ukova at 11.56am, did an ultrasound scan and when she found a “feeble” foetal heart-rate, decided on an emergency caesarean section. This was performed in theatre and the baby was delivered at 12.04pm.
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.
After 17 minutes and some administration of adrenalin and saline, the first heartbeat was detected and the rate was 54bpm, but in a newborn baby any rate under 100bpm will need assistance, Dr Asif said.
They continued working on baby Livia and the heart rate increased to 137bpm and she was placed in an incubator in the baby special care unit. He was told by someone on the obstetric team that the mother had a vasa previa and a blood vessel had torn, he said.
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”.
Respiration stopped at 6.45pm and she was pronounced dead at 7pm.
