Key issue showed newborn was in 'severe strife'

READINGS of a foetal heart rate monitor have been labelled as "the key issue" by a specialist doctor at the coronial inquest in Ballina investigating the death of a newborn.

Obstetrics registrar, Dr Vasukhi Sivagnanam said the last section of little Jack Brandao-Magalhaes' heart trace was "not very good" as she re-assessed the cardiotocography (CTG) monitor graph from Murwillumbah District Hospital when she have evidence to the court yesterday.

During the fourth day of the inquest, specialist doctors presented evidence to help determine how baby Jack died two years ago.

Dr Sivagnanam identified "atypical, complicated" heart decelerations from 9.40pm on January 1, 2014 until the end of the trace.

"If I knew this was how the baby was leaving Murwillumbah, we would have been ready for an emergency c-section," Dr Sivagnanam said.

In her initial phone call with Murwillumbah hospital midwife Robyn Brazel at 9.43pm, Dr Sivagnanam, who was the Tweed Hospital obstetrics registrar at the time, said she was informed that expectant mum, Amylee Brandao-Magalhaes, was experiencing early intermittent decelerations with no other concerning features.

Based on Ms Brazel's interpretation of the CTG trace, Dr Sivagnanam said she recommended the midwife maintain continuous heart monitoring and start IV hydration fluids.

A second phone call by Ms Brazel at 10.23pm prompted Dr Sivagnanam to ask for a faxed copy of the trace, of which she wasn't 100% sure she received.

Dr Sivagnanam said Ms Brazel didn't mention baby Jack's worsening heart rate or any signs of distress during the second phone call when quizzed by barrister for the Crown, Adam Casselden SC.

The obstetrics registrar was informed of the transfer but said she wasn't told when Mrs Brandao-Magalhaes left Murwillumbah for The Tweed Hospital.

According to Dr Sivagnanam, it was only after she enquired into noise from a CTG machine in the birth suite that she discovered Mrs Brandao-Magalhaes had been admitted.

Dr Sivagnanam said she started an emergency c-section following tests of Jack's oxygen levels and heart rate.

Visiting consultant paediatrician at the Tweed Hospital, Dr Gregory Carman, said he arrived just as Jack was being pulled from the womb.

In his evidence, Dr Carman said he saw "green" meconium on Jack that he called "a response to foetal distress which is consistent with this situation".

Dr Carman said Jack's oxygen levels and heart rate results from the foetal scalp blood sample and electrode test indicated the newborn was "in severe strife".

Mrs Brandao-Magalhaes' sister, Katie Carter, wrapped her arm around Mrs Brandao-Magalhaes in comfort as Dr Carman described reviving Jack as "very difficult" and removing meconium from his trachea.

The final day of the inquest will be heard in Ballina today.



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