Details of the latest investigation into a higher-than-normal incidence of hypoxic ischemic encephalopathy (HIE) at Portiuncula University Hospital bear striking similarities to events at the same hospital, in relation to the same issues, a decade ago.
It is exactly 10 years since it emerged an inquiry into "serious deficiencies in maternity care" at the Ballinasloe hospital was under way.
In January 2015, the HSE's Saolta Group launched an independent probe after concerns were raised about the number of babies who had experienced oxygen deprivation - or hypoxia - during childbirth, over a ten-month period in 2014.
The investigation commenced after several infants born in Portiuncula were referred for neonatal head-cooling - a treatment given to reduce the risk of long-term damage in newborns who experience a lack of oxygen.
The inquiry took place at a time when the provision of maternity care in Ireland had been in the headlines, with concerns about services at several hospitals, including Cavan and Portlaoise.
And it came just over two years after the death of Savita Halappanavar in Galway.
A combination of tragedies had shone a spotlight on the care provided to expectant mothers, leading to enhanced guidelines, regulations and new early warning systems to detect clinical deterioration.
The Walker Report
Against this backdrop, management systems at Portiuncula were reviewed and the issues with a high number of cases of hypoxia were noted.
The initial inquiry took in a ten-month period in 2014 but was subsequently expanded to cover a six-year time frame from 2008.
Led by Professor James Walker, from the Department of Obstetrics and Gynaecology at the University of Leeds, it was due to be completed within months.
In the end, it took over three years before the findings were published.
As well as examining a total of 18 separate incidents, the review looked at all aspects of the maternity service at Portiuncula.
Management errors were identified in relation to specific cases, along with an absence of consultant supervision in the labour ward.
Professor Walker said errors were identified in 10 of the 18 specific cases his team looked at which, if avoided, could have made a difference to the eventual patient outcome.
But he also pointed out that the cases occurred over a ten-year period and "the majority of people coming through the hospital had very good and very safe care".
For its part, the Saolta hospital group said it was fully committed to ensuring all 154 recommendations as a result of the reviews would be implemented.
Staffing was increased, dedicated consultant cover was put in place and enhanced communication structures were introduced, to identify and escalate any high-risk cases.
Equipment was replaced, a multi-disciplinary team was put in place to review any incidents and refurbishment projects were announced.
All of these were part of a commitment by the hospital to provide the "highest standard of care to women using our services".
HIE described as 'an umbrella term for a brain injury’ before, during or after birth
The US-based National Institute of Neurological Disorders describes HIE as "an umbrella term for a brain injury" before, during or after birth, that happens "when oxygen or blood flow to the brain is reduced or stopped".
In some cases, there are no long-term impacts, in others it can cause mild to severe disability or death.
As a general yardstick, experts say maternity units here could expect to deal with an average of one case of hypoxia each year.
It’s understood that there were three cases of HIE at Portiuncula in 2019 but that over the following years, the situation was in line with international averages.
However more recently, and particularly in the last 12 months, there has been a notable increase.
The latest review takes in nine deliveries at the hospital, since late 2023, two of which were stillbirths.
In the other seven cases, babies experienced reduced blood flow to the brain around the time of their births.
While a new management team will be responsible for all aspects of maternity and gynaecology services at Portiuncula, ongoing reviews will examine all of the care provided to expectant mothers at the hospital.
HSE says all services at the maternity unit will operate as normal
Expectant mothers attending Portiuncula University Hospital are being contacted and anyone with concerns can contact a helpline on 1800 807 008, to arrange follow-up contact from the unit.
Staff and patients alike will be hoping this process can be completed in a timelier fashion than the previous exercise.
More importantly, those living in the vast hinterland Portiuncula serves will be seeking solid and long-lasting assurance that the maternity service there is as safe and of as high a standard as is possible.
