Helani’s death ‘highlights need for more education’

When Helani Sirianni died shortly after her suction delivery birth at Wollongong Hospital, her parents vowed they would fight for answers.Yesterday, more than two years later, when the findings of an inquest into her death were handed down, Michael and Marlissa Sirianni made a special trip to their daughter’s bright pink gravesite at Lakeside Cemetery, Kanahooka.”We wanted to let her know that fight may not yet be over,” an emotional Mrs Sirianni said last night.”In my heart I know she would have survived if she had been given a chance,” she added.Deputy Coroner Scott Mitchell found Helani died on February 10, 2008 from lack of oxygen to the brain following hypovolemic shock and multi-organ failure probably associated with vacuum extraction.Although her death exposed certain weaknesses in medical care she received at Wollongong Hospital, Mr Mitchell found no evidence any person was responsible.”Sadly the full story of how Helani came to die so young will never be known and there are many questions which cannot be answered with any clarity,” he said.He said cord blood may have assisted but it had been lost.The Siriannis pushed for the inquest, claiming their child had died through systematic failures at the hospital.The three-day hearing heard Mrs Sirianni had endured a long labour with slow progress and the baby in the wrong position.There was evidence from the Siriannis there were three requests for a caesarean but the obstetrics and gynaecological registrar on duty, Dr Monique Cebola, after consideration, decided a vaginal birth was achievable.When Dr Cebola decided a suction birth was necessary she said she warned the parents there would “be some risks”, but Mr Sirianni in court strongly denied this was ever done.Dr Cebola checked the CTG foetal monitoring at 10.30pm on February 7, again at 1.30am on February 8 and found them “reassuring” but made no immediate decision for an assisted delivery and invited Mrs Sirianni to start pushing. When she returned at 2.30am she found there was no progression and signs of foetal distress on the CTG trace, which the court heard had become apparent as early as 1.50am.This was not communicated to Dr Cebola.Expert witness and consultant Dr John Schmidt told the inquest the dips were indicative of danger and foetal distress and he found them particularly alarming, Mr Mitchell said yesterday.Because Dr Cebola alone was authorised to make decisions regarding delivery and she was engaged elsewhere, she was unaware things had taken a turn for the worse.”In Dr Schmidt’s opinion, she should have been summoned,” Mr Mitchell said.There was also evidence that paediatrician Dr Steve Hartman was called in at 3.30am when there were several attempts at inserting a cannula for fluid replacement, but when Helani began to stabilise he did not persist.He returned four hours later when Helani’s condition deteriorated markedly.Despite the boggy swelling, a clinical indicator of a brain bleed, Dr Hartman initially missed the diagnosis, explaining to the court it was the first of this type he’d seen in 32 years.Mr Mitchell said Dr Hartman’s difficulty in diagnosing Helani’s condition underlined the need for education regarding brain bleeds.The court heard the only hope in these types of bleeds was if the body repaired itself.”Had Dr Hartman recognised the bleeding when he first saw Helani at about 3.30am, then she could have enjoyed a longer period of circulation support and consequently a longer period during which the chances of spontaneous cessation might have been enhanced,” Mr Mitchell said.Mr Mitchell made no adverse findings against Dr Cebola or Dr Hartman.He said the need for continuing education was amplified in expert evidence regarding the failure of nursing staff to properly read Helani’s CTG trace, grasp its meaning and call for assistance.The court heard that since Helani’s death the health service had tightened and improved its protocol and education in neonatal.Mr Mitchell described those improvements as “significant”.Outside Glebe Coroner Court, the Siriannis said they were pleased with the changes.”But unfortunately there was not enough evidence to find out if Helani may or may not have survived … we don’t believe she was given a proper chance for a better outcome and we are considering our options for further action,” Mr Sirianni said.
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