Doctor 'shocked' to discover at-risk labouring mother was hyper-stimulating

A ruptured uterus is the “absolute emergency” that everyone is trying to avoid for a mother with a previous caesarean section, a Medical Council inquiry has been told, writes Liz Farsaci.

Dr Salah Aziz Ahmed, who worked at Cavan General Hospital, denies allegations of poor professional performance and professional misconduct in relation to the care he provided to three mothers. Two of the mothers cannot be named, and the third has been named as Deirdre Clarke. 

The inquiry today (Friday) heard evidence relating to Ms Clarke, who was admitted to Cavan for an induction on June 5, 2013. Ms Clarke was hoping to achieve a vaginal birth after a previous caesarean section (VBAC), although she was considered to be in the high-risk category because of her previous surgery.

The hearing was told Ms Clarke was given Syntocinon, a drug used to progress labour, but one that can lead to hyper-stimulation of the uterus and extra strong contractions, which can distress the baby and increase the risk of uterine rupture in a VBAC mother.

That night, Ms Clarke required an emergency caesarean section, after her uterus ruptured. She suffered from a postpartum haemorrhage and her baby boy was born in a very poor condition, although he made an eventual recovery.

Prof Richard Greene, from Cork University Maternity Hospital, said the potential for a uterine rupture was the biggest concern with a VBAC mother.

“If you have a rupture, it’s an absolute emergency for mother and baby,” he said. “This is something that can happen and, if it happens, it’s a real emergency.”

He said that opting for a VBAC “is a reasonable thing to do but the one thing you have to have in your head is that a rupture could happen”.

Prof Greene said he examined the medical notes to determine precisely the doses of Syntocinon that Ms Clarke received as she laboured with her second child.

He told the inquiry that she did not reach the dose of Syntocinon that would constitute an increased risk.

Giving evidence, Dr Aziz said he was “shocked” to later learn that Ms Clarke experienced a dangerously high number of contractions during labour.

Dr Aziz, who was at home on call the night Ms Clarke was labouring, said the midwives on duty never informed him that his patient was hyper-stimulating.

He said that, when he later reviewed the case with his Cavan colleagues, he was “shocked” to see reference to this in the medical notes.

“There was hyper-stimulation I was not informed about,” Dr Aziz said. “I was informed by the midwife that Ms Clarke was contracting well.

“I was shocked to see that when I reviewed this case.”

Dr Aziz said he would expect the midwives to adjust the levels of Syntocinon depending on the response of the mother and the baby to the drug, and to lower the dose if the mother’s contractions were occurring too frequently.

Prof Greene concurred that this was the standard throughout the country.

The inquiry resumes on Monday.