Corner adjourns inquest into baby girl's death at Altnagelvin Hospital

A Coroner has delayed his findings for the first time in his career to collect more information on what took place leading up to the death of a baby girl from Derry.

The decision was made by Coroner Joe McCrisken on Tuesday at the inquest into the death of Hannah Coyle.

Hannah was born on January 20, 2015, at 9.52am but died just hours later at 2.15pm.

The inquest into her death began at Derry courthouse on Monday but was adjourned on Tuesday.

In the evidence given to this point, a number of medical professionals have stated that, ‘on balance’, they believe Baby Hannah’s death was caused by ‘placental abruption’.

Placental abruption is the partial or total detachment of the placenta from the uterus before a baby is born.

This can result in starving the baby of oxygen and nutrients and can be fatal to both mother and baby.

However, there are a number of anomalies that are frustrating a clear finding at this point.

After hearing from expert witness, Dr David Boyle, who said that ‘a step was missed with the poor foetal heart monitoring prior to 9am’, Coroner McCrisken adjourned the inquest and requested further information from the medics.

Melanie and Kieran Coyle, Hannah’s parents, were first to give evidence at the inquest.

Mrs Coyle told the court that she was 38 weeks and 1 day pregnant when her waters had broken at home at 6.30am.

Mrs Coyle said she had been throwing up the night before her waters had broken but she was told there was no need for her to attend the hospital at this point.

She also said she had suffered bleeding in the earlier half of her pregnancy and had also been diagnosed with a low-lying placenta when she was 32 weeks pregnant.

Mrs Coyle arrived at the hospital at 7.25am, she was taken through the A&E entrance and put in a wheelchair and given a towel for the blood.

When she was brought in for assessment, her trousers were stained with blood and as she removed them she said she passed a large blood clot described as ‘half the size of the palm of your hand’.

She said she had asked the midwife admitting her, Rachel Byrne, if this was normal as it hadn’t happened with her daughter, Emma, and she was told that it was.

Mr Coyle said: “When we came into the foetal assessment unit, Melanie was in clear distress; I think how we were perceiving it and how it was being perceived were two different things. We were thinking if she was bleeding and in constant pain something was not right but it didn’t feel like it was being understood.”

Mr Coyle said that they realised when they got to the hospital that Mrs Coyle’s antenatal notes had been left behind and he went back to get them and was back at the hospital just after 8am.

He said she was just being examined as he returned.

When Mrs Coyle was told that Midwife Byrne said that her waters had been ‘slightly bloodstained’ on admission at around 8.30am and that there was no blood clot, she replied: “There was a lot of blood; it wasn’t light pink or a few spots, it was red.”

Midwife Byrne said she asked for a second opinion when the blood became ‘redder’ but that she believed the increased blood loss could have been due to a vaginal exam.

However, Midwife Byrne could not say what time this exam was performed as she had not made a contemporaneous note.

Mrs Coyle was told she would be left for 10 minutes to ‘see if the blood settles’ but was actually left 25 minutes

When asked why she had not carried out continued tracing of the baby’s heartbeat and that the threshold to do this was quite low, Midwife Byrne replied there was ‘no cause to carry on continuous monitoring’.

At 9.05am, Mrs Coyle was taken to the labour ward and a heart trace was commenced on the baby showing a heart rate over 160 beats per minute (bpm), where 140 to 160 bpm is considered normal and anything higher is a cause for some concern.

Midwife Laura Clarke called Midwife Claire Lynch to assist and she, in turn, called Dr Caroline Gallagher.

At 9.39am the baby’s heartrate dropped to 80 bpm and went down to 72 bpm at 9.42am.

Midwife Clarke said that from meeting Mrs Coyle at 9.05 she had concerns within 16 minutes at 9.21am.

Midwife Lynch examined Mrs Coyle’s abdomen for 11 minutes finding that she was having four contractions every 10 minutes, each lasting a minute.

She said that her stomach was soft between contractions and that she would have expected it to feel firmer if there was a placental abruption but that this was at the forefront of her mind.

Midwife Lynch then made the decision to transfer Mrs Coyle to theatre for caesarean section. The timeline from the decision to delivery was 9.39 am to 9.52am - total of 13 minutes.

Midwife Lynch said that the baby’s heart rate appeared to recover to 129 bpm dropping to 93 bpm just before birth and she ‘wasn’t expecting the baby to come out how she came out’.

Dr Gallagher, who assisted in the section said placental abruption was at the front of her mind but that it was one of her differential diagnosis.

However, given Mrs Coyle’s stomach was soft between contractions, she didn’t think it was at that time.

Dr Niamh Doherty, who performed the section, said that the heart trace on the baby had been ‘suspicious’ and that Mrs Coyle had heavy blood loss.

She said that she ‘couldn’t completely exclude’ the possibility that Mrs Coyle had suffered a placental abruption and that the matter was down to a clinical judgement.

Dr Colin Prendergast, obstetric paediatrician, said that he had never seen a case where a baby had been deprived of oxygen and the reading of blood gas from the umbilical cord registered as normal.

He said he ‘struggles with the cause of death’ but that ‘some things point towards placental abruption’.

Dr Damien Armstrong, consultant paediatrician, said that he became involved with Hannah being resuscitated when she was six minutes old.

He said she was 16 minutes old before they managed to get a heartbeat.

He said her heart rate had gone up to over 100 bpm when she was 18 minutes old but she was still ‘pale and floppy’.

He said that it appeared the baby had been deprived of oxygen, despite normal blood gas levels, and could not recover and that her haemoglobin levels were half what they should have been.

Dr Damien Hurrell, the paediatric pathologist who carried out the post mortem, said Hannah was a normally developed baby and that there was evidence that she had suffered a lack of oxygen.

He said that ‘acute placental abruption, on balance of probabilities, was the cause of death’.

Dr David Boyle, who wrote an independent report on the case, said he believed ‘a step was missed with the poor foetal heart monitoring prior to 9am’ and that ‘vital minutes’ were lost.

Following the final evidence, Coroner Joe McCrisken said he didn’t feel he was in the position to deliver his findings.

“This is the only time I’ve ever done this, to adjourn without providing findings, but I’m just not sure I’m there yet.

“Once an inquest has closed, you don’t get a second chance. I want to give a proper, full, fair and fearless inquest and I think I need some more material and further consideration.”

A date has yet to be set for the conclusion of the inquest.