Baby had uncontrollable bleeding and died after instrumental delivery

A baby who became critically ill following an instrumental delivery developed bleeding so severe that doctors could not control it.

Baby Donatello Rapacka was born on July 20th, 2017, at the Coombe hospital in Dublin and died five days later.

A pathologist at an inquest into the baby’s death said he had never seen bleeding so severe following a vacuum-cup delivery.

Parents Mario and Fatima Rapacka, from Tallaght in Dublin 24, were initially expecting twins, but had experienced a miscarriage before eventually also losing Donatello.

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The baby, described as large with broad shoulders, was born with a swelling on his head following a delivery that involved a vacuum cup and a forceps.

The labour was considered high risk due to the size of the baby, his position and the mother’s diabetes.

The baby was healthy and showed no signs of distress during early stages of labour, Dublin Coroner’s Court heard.

But his progress in labour was slow and medics opted to assist him using the vacuum cup initially and later the forceps.

Following the birth he had a swelling at the back of his head. Doctors identified a haemorrhage between the baby’s skull and the scalp.

The bleeding was treated aggressively but the medical team was unable to control it. Despite extensive interventions the baby’s condition deteriorated and he died on July 24th, 2017.

“The bleeding was uncontrollable. It leads to a situation where all the organs in the body start to fail. His kidneys stopped working. His potassium level became very high. Then the heart stops working,” consultant neonatologist Dr Anne Doolan said.

Acute blood loss

An autopsy gave the cause of death as hypovolemic shock due to acute blood loss due to bleeding following instrumental delivery for failure to progress in the second stage of labour.

Pathologist Dr Peter Kelehan said he had never seen a haemorrhage so severe following a vacuum delivery and was concerned there might be a genetic reason for this. The pathologist recommended genetic testing for the parents to rule out any abnormality for the future.

“I thought there might be some other genetic abnormality that predisposed this baby, who became so sick, so quickly.

“I’ve never seen such damage to the liver and other organs resulting from what is a bleed, which was treated aggressively from early on. It should have worked,” the pathologist said.

Coroner Dr Myra Cullinane returned a narrative verdict.