A Medical Council inquiry into allegations of professional misconduct and poor professional performance against a consultant obstetrician at Cavan General Hospital has heard there was no consistent way of using oxytocin to speed up labour at the hospital.
On this third day of the inquiry against Dr Salah Aziz relating to three cases of childbirth between 2012 and 2014, expert evidence was given by Dr Joanna Gillham, consultant obstetrician at St Mary's Hospital in Manchester.
She discussed Patient 1, who was in labour on 22 November 2012 and had to be induced, and had a lengthy induction on her first baby.
Dr Gillham said there was no consistent way of using oxytocin to speed up labour at Cavan. Under cross examination, Dr Gillham said the dilution and increases in oxytocin were not in accordance with guidelines.
She said that good progress was made by Patient 1 in labour, although the baby's head was high.
Dr Gillham said the oxytocin was increased significantly, when this was unnecessary and is potentially fraught with increasing the chances of fetal compromise.
By 10.25pm, Patient 1 had been pushing for nearly an hour and was exhausted and Dr Aziz was contacted as the consultant on call and arrived at 10.45pm.
Dr Gillham said the CTG machine readings show ongoing fetal heart rate concerns for about an hour before Dr Aziz arrived.
She said she agreed with the decision of Dr Aziz that the delivery needed to be expedited.
The decision was then whether there should be an operative forceps delivery, or caesarean section.
Dr Gillham said that in her opinion the baby's head was too high in the abdomen for an operative vaginal delivery.
She also said that the doubling of the drug to speed up labour was not justified at this time and potentially exposed the baby to risk.
At the inquiry it is alleged that Dr Aziz engaged in a prolonged attempt an operative delivery and did not proceed to a caesarean section in good time.
Dr Aziz says he had concerns about a delay in getting a second theatre open for a C-section.
Dr Gillham said that if Dr Aziz had been told he could not get into theatre, he was in a difficult position but needed a back-up plan if the instrument delivery failed.
She said he could have switched off the drug being given to speed up delivery and carried out a fetal blood sample to see if the baby was compromised.
If there was reasonably quick access to a theatre, Dr Aziz should have abandoned the instrument delivery, Dr Gillham said.
She said the decision to call for a caesarean section should have been made about five to ten minutes after the initial assessment of Patient 1, when Dr Aziz arrived, if there was two fifths of the baby's head palpable.
Under cross examination by Eileen Barrington, senior counsel for Dr Aziz, Dr Gillham said she was critical of the midwifery management of Patient 1, up to about 8.00-8.30pm.
She said there were concerns with regard to CTG fetal monitoring at various points in the day.
The inquiry has heard that Patient 1 was in the consultant-led unit at Cavan as she was a high risk as she had a high body mass index.
Ms Barrington said Dr Aziz will say the theatre was busy with another C-Section, which was likely to take some time.
He considered it appropriate to do a trial instrument delivery and had a theatre been available, he would have performed it there.
The inquiry has adjourned until tomorrow, when Dr Aziz is due to give evidence.