Baby’s inquest hears doctor’s manner was ‘inappropriate and unhelpful’

A maternity doctor’s manner was “inappropriate and unhelpful” and he did not communicate his findings to midwives when he examined a pregnant woman whose baby died less than seven hours later, an inquest has heard.

Kilkenny Coroner’s Court was told that Livia Ukova-Marini was delivered by emergency caesarean section at 12.04pm on May 18, 2014, at St Luke’s Hospital in Kilkenny but died at 6.45pm. She was the only child of Ludmila Ukova and Aldo Marini of Carlow town.

A midwife told the inquest she initially consulted with the registrar on call to review Ms Ukova, rather than the more senior consultant, as Ms Ukova was a public patient.

“If it’s a private patient you would contact the consultant,” Emma Murphy told coroner Tim Kiely.

She did contact the consultant when the registrar initially declined to review the patient and said “you can go to the consultant but usually you start with the registrar and they contact the consultant” when it is a public patient.

Ms Murphy, a staff midwife, earlier told the e inquest that she came on duty on the morning of May 18, 2014. Ms Ukoka’s cervix was found to be dilated by 8-9cm by 8.45am.

The CTG monitor to assess her baby’s heart rate was finding “decelerations” in the amount of heartbeats per minute.

The consultant on duty, Dr Yuddandi Nagavini, told the midwife to start the patient on syntocinon, used to stimulate the uterus.

At 11.10am, the baby’s heart rate was 60bpm — it was earlier 130bpm— and Ms Ukova was draining a blood-stained liquid and her cervix was “almost fully dilated”.

Between 11.11am and 11.19am, Ms Murphy called Dr Ali Gewash, the registrar, to tell him of the patient’s condition. Dr Ali declined to come and told her to inform the consultant as she had prescribed syntocinon.

Dr Nagavini said she was busy with a patient and told her to ring Dr Ali again. He again declined to come to the ward.

Ms Murphy said he was saying she had “gone over his head” and should ring the consultant again, before hanging up the phone. She again rang the consultant and the consultant told her she would ring Dr Ali.

Dr Ali arrived at 11.22am. He examined Ms Ukova and said “I didn’t start syntocinon in the first place”.

Ms Murphy said: “At this time I felt his manner to us in the room was inappropriate and unhelpful.” By now, both Ms Murphy and her colleague found it difficult to pick up the baby’s heartbeat.

Dr Ali asked for a scanning machine. Ms Murphy rang the consultant to ask her to come to the labour ward “urgently,” while her colleague rang the emergency bell. Dr Ali performed an ultrasound scan “and didn’t voice his findings”, Ms Murphy said.

The “crash team” arrived and Dr Nagavini arrived at 11.56, performed a scan and said she could pick up a “faint heartbeat”. In an operating theatre, the consultant carried out an emergency caesarean section.

While being questioned by solicitor Raymond Bradley, for the family, Ms Murphy said syntocinon was stopped at 11.10am.

Dr Ali said in evidence that he “did not ignore” calls made to him by the midwife. He told Ms Murphy to contact the consultant.

“My plan of management had changed without being informed... If I had been informed, that’s fine with me, I didn’t get informed about that decision.”

Asked if he agreed with the prescription of syntocinon, he said that “according to my assessment and management, I didn’t see any reason for syntocinon” because the patient was “making good progress” with her labour.

He denied he had “declined” to review the patient, but had told the midwife she should call the consultant, and whatever decision was made for the patient’s treatment, “I would do it”.

When he arrived at 11.25am he tried to perform a “kiwi vacuum delivery,” twice after 11.40am, but this was unsuccessful.

Asked by Mr Bradley why the decision was not made earlier to perform a caesarian section, Dr Ali replied: “There was no indication for that. There was no indication for a caesarean section.”

The inquest continues.