Forceps blamed for baby’s fracture

AN inquest has heard that a forceps used in a delivery “most probably” caused a skull fracture and bleeding in a newborn boy, who died a week later.

A paediatrician who treated the baby, Daniel McGovern, who suffered a massive bleed between his skull and scalp, said he had seen a case like it just once in his 12 years in neonatology.

A subgaleal haemorrhage (bleeding between the skull and scalp) is a very rare condition, is difficult to recognise and has a very high mortality rate, Dr Colm O’Donnell, a consultant neonatoloist at the National Maternity Hospital, told the inquest at Dublin City Coroner’s Court.

The inquest also heard the forceps used during delivery “most probably” caused the fracture to his skull.

Baby Daniel, of Leinster Park, Harold’s Cross, Dublin, died at the National Maternity Hospital on November 23, 2010, a week after his birth via emergency caesarean section.

Dublin City Coroner Dr Brian Farrell, adjourning the inquest, said he needed to consider the evidence before delivering a verdict.

“Issues have been raised during the examination of witnesses which I’d like to look at myself,” Dr Farrell said. “This is an important matter. I want to do justice to the situation.”

An autopsy carried out by Dr Paul Downey, consultant histopathologist at NMH, found Daniel suffered a non-depressed fracture of the skull and a subgaleal haemorrhage.

Dr Downey said cause of death was hypoxic ischemic encephalopathy, where the brain is deprived of oxygen.

Daniel’s mother, Claire McGovern, presented to the hospital on November 16, 2010, with painful uterine contractions. She was nearly 40 weeks pregnant. Her baby had a slow heart rate in the womb and the labour failed to advance beyond the second stage.

Daniel weighed 10lb 2oz when born. He was motionless and no heart rate was detected. He did not breathe, withdraw from painful stimuli or cry.

He had a significant brain injury and showed no signs of brain function, Dr Catherine Gibbons told the hearing. A subgaleal haemorrhage was also discovered.

Dr Declan Keane, consultant obstetrician gynaecologist at the National Maternity Hospital, told the inquest he made the decision to opt for a caesarean section after the labour failed to progress.

“I’ve no doubt the fracture was most probably due to forceps,” he said.

He added that it would be preferable for the delivery suite and the operating theatre where caesarean sections are carried out to be on the same floor.

Counsel for the family, Dr Simon Mills, said “evidence of distress in the infant only began after attempted instrumental delivery/application of forceps”.

He said the foetal heartbeat was normal running up to the birth, suggesting the infant was normal and not in distress, with a slowdown in the heart rate only occurring after the application of forceps.

“The only objective evidence is an instrumental delivery and injuries associated with an instrumental delivery,” he added.

The case was adjourned until September 27.