The head of a baby got separated from its torso during delivery at a
primary health centre in Koovathur near Chennai, as per a recent report.
Doctors said the baby had died in the mother’s womb.
Allegation: Staff
nurses at the health care centre ignored her pleas for pain relief medication
and went ahead with vaginal delivery. There were no doctors at the PHC. Nurses
removed only the baby’s head from the mother’s womb, leaving the
torso inside. The woman was then rushed to the Chengalpattu Government Medical
College in Kancheepuram for an emergency surgery, where doctors extracted the
torso.
Defences
·
Delivery was done in an
emergency situation.
·
It was an intrauterine death.
·
The baby had to be removed to
save the life of a woman.
·
The baby weighed just 1.5 kg;
so, they decided that vaginal labour would not be a hazard. But during vaginal
delivery the head got separated.
A similar incident has been reported in January this year
from Rajasthan, where the delivery of a 24-year-old woman was conducted by the
nursing staff at Ramgarh primary health centre (PHC) in Jaisalmer without the
presence of a doctor despite her being a high-risk case. The nursing staff
pulled out the baby during delivery using force, leaving the
baby’s head in the womb. 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. The
woman had to be rushed to Jodhpur in a serious condition. 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.
What does the published literature say?
·
Blunt trauma to the head and
neck of a new-born during delivery process is a rare event.
A peculiar case of decapitation of a live fetus during vacuum-assisted delivery
is mentioned 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).
·
An interesting case of
complete fetal decapitation with uterine rupture due to a high-velocity motor
vehicle collision is described. The external examination of the fetus showed a
disconnection between the cervical vertebrae C3 and C4 (Am J Forensic Med
Pathol. 2015 Mar;36(1):6-9).
·
In a retrospective observational
study, the course of labor was analyzed in 10 stillborn fetuses with a varying
grade of maceration during the third trimester. In one case of macerated
stillborn fetus, head traction resulted in decapitation, therefore extraction
with Braun hooks placed into axillary fossae was done to extract the retained
macerated fetal body (Fetal Diagn Ther. 2008;24(1):42-6).
·
Traumatic fetal decapitation
has not been mentioned in the medical literature as a known complication of
spontaneous abortion. We report an extremely rare and unusual case of traumatic
fetal decapitation due to self‐delivery during spontaneous abortion in a 26‐year‐old
woman who presented at 15 weeks' gestation with gradually worsening vaginal
bleeding and lower abdominal pain and with the fetal head still lying in the
uterine cavity. During our search for similar cases, we came across just 1 other
case report describing traumatic fetal decapitation after spontaneous abortion,
although there are reports of fetal decapitation from amniotic band syndrome,
vacuum‐assisted deliveries, and destructive operations (J
Ultrasound Med. 2015 Oct;34(10):1913-4).
·
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).
Comments
·
Decapitation of the fetus
during delivery is a rare event but can happen. It is a known complication of
delivery.
·
Usually seen in intrauterine
deaths, premature babies, low birth babies, accidental trauma, excessive force
·
It is negligence, if it is
done intentionally or with the knowledge or by an untrained person.
·
It is an accident, when the
applied force is misjudged.
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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