A DOCTOR accused of malpractice after a premature baby was decapitated during a bungled delivery at a Dundee maternity unit was wrong not to attempt a caesarean section, a tribunal has found.
An expert panel considering Dr Vaishnavy Laxman’s fitness to practice said that her decision to pursue a vaginal delivery “represented a failure in [her] clinical decision-making”.
Read more: Baby ‘accidentally decapitated’ in womb during botched delivery
However, they also stressed that the consultant obstetrician “was endeavouring to achieve the best outcome” for both mother and baby and that she had faced “a constellation of features which would rarely be encountered by any obstetrician”.
The Medical Practitioners Tribunal Service (MPTS) in Manchester previously heard that the mother’s waters had broken early, at 25 weeks.
The 30-year-old, a first-time mother known only as Patient A, was admitted to Ninewells Hospital in Dundee, but her baby boy died during birth on Sunday March 16 2014.
In its findings on the case, MPTS said the medics and midwives present in theatre faced “an increasingly desperate attempt to deliver baby B’s head” during the complex birth.
Read more: Doctor at Ninewells ‘worked nearly 24 hours’ before botched delivery tragedy
His heartbeat was abnormally low, the umbilical cord had prolapsed, he was in the breech position and crucially the mother’s cervix was no more than 4cm (two inches) dilated.
As a result, his head became trapped during delivery and, as Dr Laxman applied traction to his lower body, his head detached. It was retrieved from the birth canal by C-section and later re-attached to his body, but the tribunal concluded that he had already died prior to decapitation.
Dr Laxman, who qualified in India in 1999 and has worked in Stirling, Kirkcaldy and Dundee since coming to the UK in 2004, was cleared of claims that she ignored warnings from colleagues not to proceed with a vaginal delivery and that she was wrong to have pulled on the infant’s legs and trunk after his head became trapped.
The tribunal concluded that once the baby’s head became stuck, there was “no realistic alternative”.
However, it added: “This does not detract from the Tribunal’s finding that a vaginal delivery should not have been initiated”.
Dr Laxman, 43, told the tribunal that she feared the infant would not survive a C-section delivery, but the tribunal concluded that “if the priority was foetal wellbeing the only appropriate course in these circumstances was a caesarean section given the risks attendant upon a vaginal delivery, namely head entrapment”.
It said this was a risk which Dr Laxman “had not sufficiently addressed in her mind”.
The MPTS cleared Dr Laxman of failing to obtain adequate consent from the mother to proceed with a vaginal delivery.
The mother said she expected to undergo a C-section and was never told otherwise.
However, MPTS said “it was not possible to to have a detailed discussion with Patient A about the risks and benefits associated with a vaginal delivery as compared to a caesarean section due to the urgency of the situation and because of the speed at which events were unfolding”.
Read more: Medics ‘should not be prosecuted’ for mistakes that kill patients
It also rejected the accusation that Dr Laxman had told the mother to push before she was in established labour on the grounds that “there was no consensus between the experts as to what ‘established labour’ means”.
A claim that Dr Laxman may have accidentally cut the baby’s neck with scissors while making incisions into the mother’s cervix, possibly contributing to the decapitation, was thrown out after a pathology report showed “no evidence” of cuts to the boy’s neck or body.
Read more: Medic ‘cut baby’s neck with scissors’ in bungled delivery at Dundee maternity unit
The tribunal will consider sanctions against Dr Laxman at a later date.
The Crown Office in Scotland has already ruled out either a criminal prosecution or Fatal Accident Inquiry into the case, but the mother is understood to be suing NHS Tayside for medical negligence.
The tribunal previously heard that Dr Laxman had been working for nearly 24 hours by the time of the tragedy.
She had had started work at 8.30am the previous day, March 15, and went home at 6pm for five hours before returning to the hospital at 11pm.
Amid complications, she was paged at 8.30am on March 16 to help with the delivery of Patient A’s baby.
Source : HeraldScotland