Conor Kane
The mother of a baby who died just six hours after being born had a condition which affects just one in every 6,000 pregnancies and can lead to fatal blood loss in the baby, an inquest has heard.
Livia Ukova-Marini was born at 12.04pm on May 18th, 2014 at St Luke's Hospital in Kilkenny, but died at 6.45pm. She was the only child of her parents, Ludmila Ukova and Aldo Marini of Carlow town.
A Coroner’s Court in Kilkenny heard Ludmila Ukova had a condition called vasa previa, which involves the baby’s head pressing down on the womb membrane and on the blood vessels running between the baby and the placenta.
Former Master of the National Maternity Hospital, Dr Peter Boylan, told the inquest that when the blood vessels are lying near the neck of the womb, there is a risk of a tear once labour starts and the womb neck opens.
If there is a tear, foetal blood will be lost and there is a 60 per cent mortality rate among babies when this happens, Dr Boylan said.
If vasa previa is diagnosed ante-natally, before labour, there is a 97 per cent survival rate, but the only way to diagnose it before labour is to use an ultrasound colour doppler scan, according to Dr Boylan. However, “you have to be very skilled and highly trained in order to make a diagnosis of vasa previa using a colour doppler” and it is not recommended for screening purposes by the Royal College of Obstetricians in London, he said.
“It’s an extremely difficult diagnosis to make.”
Not all cases of vasa previa involve a bleed, he said, but when they do the mortality rate is 60 per cent. It is not a common condition and the large maternity hospitals might see one case in a year.
Coroner Tim Kiely said Ms Ukova had several scans during her pregnancy and there was reference to a low-lying placenta. Dr Boylan said low-lying placenta is often diagnosed early in pregnancy but the placenta can then move upwards as the uterus grows.
Dr Boylan said he had reviewed the figures at the National Maternity Hospital, where there were 99,128 births between 2005 and 2015 and there were no deaths among babies due to a ruptured vasa previa.
If a diagnosis was made, the woman would be admitted to hospital at 38 weeks pregnancy and a caesarian section would subsequently be carried out.
The inquest heard that doctors performing resuscitation on baby Livia after she was born were told that there was vasa previa, with a tear to one blood vessel.
Dr Boylan said that there wasn’t a tear “clearly visible” from photographs of the case he had seen.
Consultant obstetrician and gynaecologist Dr David McMurray said he performed a trans-abdominal scan on Ms Ukova at the Carlow maternity clinic when she was 34 weeks pregnant, and again in St Luke’s Hospital a week later after she was admitted.
He found a "minor degree" of placenta previa, or low-lying placenta, but it wasn't of clinical significance as the baby's head was below the edge of the placenta, so the placenta would not have blocked the baby's head. He agreed with Raymond Bradley, solicitor for the family, he decided at the time there was "no need" for a different type of scan, a trans-vaginal scan using a different machine.
The inquest continues.