JAISALMER (TNN, Jan 11, 2019): The Rajasthan health
minister Raghu Sharma ordered an inquiry into an incident in which the nursing
staff of a health centre in Jaisalmer pulled out a baby with brutal force,
severing its head.
Two male nurses have also been suspended. The incident
occurred on Monday at Ramgarh primary health centre (PHC) in Jaisalmer. The
compounder allegedly pulled out the baby during delivery using force, leaving
the baby’s head in the womb.
Late on Thursday night, the department sent Dr Nikhil
Sharma, in-charge of the Ramgarh PHC, to awaiting posting order. Health
minister Raghu Sharma said, “Those guilty will be punished and strict action
will be taken after investigation.” The incident happened on January 7, when two male nurses posted at Ramgarh PHC, pulled the
baby out so fiercely that the infant’s head remained inside the uterus of the
woman. The woman, 24-year-old Deeksha Kanwar, had to be rushed to Jodhpur,
where the doctors operated upon her and removed the baby’s head
Delivery conducted sans presence of a doctor
On Wednesday, a case was filed under IPC sections 304 A
(causing death by negligence) and 336 (act endangering life or personal safety)
against the two staffers of Ramgarh PHC. A mother of three kids, this was
Deeksha’s fourth delivery. The staff did not inform the family about her
situation and referred her first to Jaisalmer. She was then sent to Jodhpur in a
serious condition.
Despite being a high-risk case, the two nurses on
duty—Amritram and Jhunjhar Ram—tried to deliver the chid of seven-month
pregnant Deeksha without the presence of a doctor.
After the incident, they asked family members to take the
woman to Jaisalmer claiming that the opening of the womb had closed and it was
difficult to take the umbilical cord out. They hid the body of the baby and
handed it over only after a police complaint was registered by the family. The
family came to know about it after they were informed by the doctors in
Jodhpur, who surgically removed the baby’s head. The family reached Ramgarh
police station on Wednesday and lodged a case against the two nurses.
Chief medical health officer, Jaisalmer, Dr B L Bunkar
said, “I visited Ramgarh and investigated the matter. There were two male
nurses present when the woman was brought to the PHC before midnight, on the
intervening night of January 6 and 7. Since the gynaecologist was on
leave, the nursing staff handled the case. The baby was half out when the
pregnant woman was brought to the PHC.It was a pre-term baby,” he added.
Health department joint director (Jodhpur) Dr S K Parmar on Thursday rushed to
Jaisalmer from Jodhpur to investigate the matter. “I will prepare a complete
report on the incident and hand it over to health directorate,” he said.
Our views
Rare, cases of fetal decapitation, occurring intrauterine
or during delivery process have been reported in literature.
Fetal decapitation can be spontaneous or accidental
(occur by force). It can also be therapeutic (for a nonviable fetus),
where it has to be done only by an experienced obstetrician as it is
a radical procedure.
·
The case of decapitation of a live fetus during
vacuum-assisted delivery was reported in the American Journal of Forensic
Medicine in 2011, where excessive traction on the head of the full-term
macrosomic fetus with shoulder dystocia resulted in overstretching of the neck
up to the point of decapitation (Am J Forensic Med Pathol. 2011
Sep;32(3):245-7).
·
Congenital malformation may present as spontaneous
intrauterine decapitation as has been described in a case report of an
acephalic fetus in the Archives of Disease in Childhood. According to the
author, decapitation must occur during the 3rd month of gestation or later and
is thought to be due to strangulation by a band of tissue of amniotic or
chorionic origin (Arch Dis Child. 1967;42(226):636-41).
·
Ledall et al have also reported subtotal decapitation of
a fetus in the course of normal delivery with very peculiar bone dystrophy due
to disturbance of intrauterine metabolism of tissue polysaccharides. (Bull
Fed Soc Gynecol Obstet Lang Fr. 1964 Nov-Dec;16:549-51).
·
Lymphangioma of the axilla as an obstacle to delivery has
also been reported (Geburtshilfe Frauenheilkd. 1956 Aug;16(8):706-8).
Decapitation can also be therapeutic. Marsden et al
reported four cases of impacted transverse lie in late labor as illustrative of
clinical situations where decapitation of a dead fetus in a transverse lie is a
practical alternative to Caesarean section (Aust N Z J Obstet
Gynaecol. 1982 Feb;22(1):46-9).
We have discussed here the causes of fetal decapitation
and not gone into the merits of the case.
It may not be right to straightaway allege criminal
medical negligence in this case without ascertaining the facts.
The case needs to be examined in detail. A thorough
scrutiny of the facts and circumstances is required before ascribing blame. The
training and skill or competency of the doctor/nurses or the hospital has to be
taken into account.
However, this case re-emphasizes the significance of
transparency, documentation/video recording in day to day practice. If the
nursing staff has withheld information from the family, then this is a
blunder.
Fetal decapitation has been described in literature; this
means that it is a known complication of delivery. And, complications are
always lessons learned.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
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