A neonatal death with two crucial issues: The identity of the child and whether there was any therapeutic mismanagement

Abstract

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Introduction: Every neonatal death causes much distress to parents making the ward-staff vulnerable to accusations of medical mismanagement. JMO was confronted with two main issues: the possibility of malicious exchange and whether the life would have been saved with early intervention Case Report:: A 17 year old primi with a 36 week POA was admitted with dribbling on the same day. She was! managed conservatively for three days. On the third day she developed a mild fever and a lower abdominal pain and ' went into spontaneous labour to deliver a severely asphyxiated baby girl of 2.5 kg. who died 7 hrs 30 nits after delivery. The parents were preoccupied with the gender of their unborn child preparing blue clothing anticipating a baby boy. The labour-room staff has clad the child with pink clothing for genuine reasohs creating"a grave suspicion in the bereaved mother of malicious exchange of her healthy boy for a sick girl. The medico-legal* investigation concluded the cause of death as birth asphyxia (peripartum hypoxia) with intra-cerebral haemorrhages. , Discussion: Simple measures of effective communication such as showing the gender of the newborn to the mother at the time of delivery would certainly have prevented issues regarding wrongful identity. Birth asphyxia has 1 numerous causes most of which cannot be established at a routine autopsy, Whether there was an element of ehorio- j amnionitis is a clinical decision beyond the purview of JMO. Serious consideration should be given to the fact 1 whether the outcome could have been better if the baby had been delivered early through Caesarian section in the context of marginal prematurity, teenage pregnancy and possibility of uterine infection.