Maternity services are again under the spotlight with the start of a formal inquiry into the management of women in labour at Ballinasloe’s Portiuncula Hospital. It follows the discovery of a spike in the number of newborns referred to Dublin maternity units for specialist treatment.
The treatment involved “head cooling”, an established intervention designed to reduce the extent of brain injury in a baby found to have suffered hypoxia (a lack of oxygen) during delivery. It is available in the three Dublin maternity hospitals and in a unit in Cork. Ideally the treatment starts within six hours of birth and continues for 72 hours.
“Head cooling” is designed to prevent the further death of brain cells after the initial hypoxic insult.The second stage of damage is called “reperfusion injury” which occurs after restoration of normal blood flow and oxygen to the brain, and is due to toxins released from the damaged cells.
By cooling down the brain, doctors are essentially trying to get the brain cells to rest. After 72 hours of cooling the brain cells wake up, ideally undamaged, and long-term neurodevelopment is improved.
Brain damage
According to the World Health Organisation, therapeutic cooling of newborn infants with moderate to severe hypoxic brain damage reduces the risk of death and of long-term neurological disability by the time the child reaches 18 months.
Apart from the risk of unintentionally inducing hypothermia, there are no serious side-effects associated with cooling when carried out in a specialist unit.
A lack of oxygen in the brain at about the time of birth affects about three infants per 1,000 live births; less than one of these develops brain damage. However, up to 60 per cent of infants with hypoxic brain damage die while about one-quarter of survivors are left with a significant handicap.
Early signs of hypoxia can often be picked up by a CTG test. The Portiuncula review will look at how doctors and midwives interpreted these and whether timely action was taken in response to abnormal readings.
Certain drugs given to speed up labour can induce hypoxia and so this will be another area to examine. The review will also look closely to see if forceps deliveries were carried out according to established guidelines.
