Gave 'large' dose of drug to at-risk mother

Liz Farsaci

An obstetrician gave a “large” dose of a drug that increases risk levels to a mother who later required emergency surgery, an inquiry heard on Monday.

Dr Salah Aziz Ahmed, who worked at Cavan General Hospital, is the subject of the hearing, which has resumed at the Medical Council headquarters in Dublin. He denies allegations of poor professional performance and professional misconduct.
Dr Aziz faces claims in relation to the obstetric care he provided to three mothers, two of whom have chosen to remain anonymous and another, Deirdre Clarke, who has agreed to be named.
Ms Clarke’s baby boy, Roland, was born by emergency caesarean section on June 5, 2013, after her uterus ruptured. He was born in a very poor condition and the paediatric team had to resuscitate him in the operating theatre. He made an eventual recovery.
Nurse midwife Michelle Walsh, from Cavan General Hospital, gave evidence on Monday of providing care to Ms Clarke during her labour.
Ms Walsh said Ms Clarke was one of Dr Aziz’s private patients and, as such, he was the “key caregiver” for her.
She said that it was Dr Aziz’s practice to increase syntocinon - a drug used to progress labour, at the same rate for all labouring mothers.
However, other consultants at Cavan used a lower rate for mothers who had a previous C-section.
Ms Walsh said caution must be exercised when using syntocinon with mothers such as Ms Clarke, who was attempting a vaginal birth after a previous caesarean section (VBAC).
The inquiry heard that syntocinon can lead to hyper-stimulation of the uterus, which can distress the baby or, in the case of a VBAC mother, increase the risk of uterine rupture.
Ms Walsh said that on instructions from Dr Aziz, Ms Clarke was given a dose of syntocinon on the evening of June 5, 2013, that was higher than she felt comfortable with.
“[It] was a large dose of syntocinon for a lady with a VBAC,” she said.
Expert witness Dr Joanna Gillham, a consultant obstetrician based in St Mary’s Hospital in Manchester, also told the inquiry that using the syntocinon, as well as an earlier prostin gel to induce labour, increased the risk levels for Ms Clarke.
“[Syntocinon] is a good drug but it’s a dangerous drug and it has to be tailored to the woman and her risk factors,” said the expert.
Continuing her evidence yesterday, she expressed concern that Ms Clarke was given Syntocinon, per Dr Aziz’s instructions, despite the fact that the patient was showing signs of hyper-stimulation.
When the inquiry first began November last, it heard the case regarding the first mother, a 37-year-old woman whose baby passed away 32 hours after birth.
Dr Aziz provided care to the first mother, Patient One, at Cavan General Hospital in November 2012. It is alleged, amongst other claims, that Dr Aziz engaged in prolonged attempts at a vaginal delivery in inappropriate circumstances, and failed to proceed to a Caesarean section with adequate expedition.
Patient One’s baby boy was born in very poor condition on the night of November 22, 2012, and passed away on November 24, 32 hours after he was born.
The inquiry has not yet heard evidence regarding Patient Three, although Dr Aziz faces a number of allegations in relation to this mother. These include the claim that on 26 April 2014, he failed to diagnose in a timely manner that a catastrophic event was occurring in the womb.
Dr Aziz was placed on administrative leave following the events involving this mother.
The inquiry continued yesterday (Tuesday) afternoon with evidence expected from Dr Aziz.