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WAhospital2023-07-07

Inquest into the Death of Ashlee Jade REINDL

0y · Female·Fetal demise due to placental abruption and sepsis secondary to chorioamnionitis…

Ashlee Reindl died hours after birth in 2019 following a prolonged induction of labour complicated by fetal distress and chorioamnionitis. A catastrophic placental abruption occurred shortly before emergency caesarean se…

obstetricsmidwiferydiagnosticcommunicationoxytocin
VIChospital2022-07-28

Finding into death of H C

6y · Male·Global cerebral ischaemia secondary to perinatal asphyxia

HC was a neonate who died at 6 days old from global cerebral ischaemia secondary to perinatal asphyxia. He was born following an emergency caesarean section for obstructed labour and fetal distress. Key clinical lessons …

obstetricsneonatologydiagnosticcommunication
TAShospital2022-02-08

Coroner's Finding: KN - deidentified

0y · Male·global hypoxic ischaemic encephalopathy

A term breech baby was born at Launceston General Hospital following a traumatic vaginal delivery with instrumental assistance after failed initial extraction attempts. The infant suffered severe hypoxic-ischaemic enceph…

obstetricsmidwiferydiagnosticdelay
VIChospital2021-11-18

Finding into death of Pippa May Griffiths

0y · Female·Neonatal death in the setting of meconium aspiration

A term neonate died from meconium aspiration three hours after spontaneous labour onset. The mother had presented to hospital the previous day with decreased foetal movements and was discharged without comprehensive asse…

obstetricsmidwiferycommunicationdiagnosticbenzyl penicillin
QLDhome2021-09-17

Ely-Smith, Zamia

3y · Female·Hypoxic-ischaemic encephalopathy due to chorioamnionitis due to Gardnerella Vagi…

Zamia Ely-Smith died at 3 days of age from hypoxic-ischaemic encephalopathy due to chorioamnionitis following home birth at term. Clinical lessons include: (1) decreased fetal movements at 39+ weeks gestation and hospita…

midwiferyobstetricsdiagnosticcommunication
TAShospital2021-08-26

Coroner's Finding: PY

0y · Unknown·sepsis leading to multiple organ failure syndrome

A 48-day-old neonate with congenital heart defect presented to the ED with fever and vomiting on 20 September 2019. Initial triage as Category 3 was inappropriate; the child required urgent assessment. The ED intern saw …

paediatricsemergency medicinediagnosticdelayparacetamol
QLDhome2021-02-17

T, an eight week old infant - Non-inquest findings

0y · Male·Sudden infant death syndrome category II (SIDS) - accidental asphyxiation due to…

An 8-week-old infant died from SIDS category II, likely due to accidental asphyxiation when the mother fell asleep and slumped forward over him. The infant was born to a mother with a 12-year history of heroin addiction …

neonatologypaediatricssystemcommunicationheroin
VIChospital2020-10-13

Finding into death of BABY C

0y · Male·Myocarditis

Baby C, a 5-month-old infant, died from myocarditis (viral heart inflammation) after presenting to Sunshine Hospital Emergency Department with fever, breathing difficulty, and cyanosis. He waited 1 hour 52 minutes before…

emergency medicinepaediatricsdiagnosticdelayparacetamol
QLDhospital2020-08-26

Baby C - non-inquest findings

0y · Male·meconium aspiration syndrome complicated by persistent pulmonary hypertension

Baby C was born at 41 weeks and 2 days covered in thick meconium with respiratory distress. Key clinical failures included: (1) failure to respond to mother's request for induction at term+6 days; (2) failure to investig…

neonatologyobstetricsdiagnosticproceduralmorphine
SAhospital2020-08-04

Coroner's Finding: WILLMETT Laura Angela

0y · Female·hypoxic ischaemic encephalopathy secondary to intrapartum hypoxia

A 2-day-old neonate, Laura Angela Willmett, died from hypoxic-ischaemic encephalopathy following intrapartum hypoxia. She was born by emergency caesarean section after a planned vaginal birth after caesarean (VBAC) at a …

obstetricsmidwiferydiagnosticcommunicationparacetamol/codeine
VIChospital2020-07-02

Finding into death of Cai Wheeler-Trow

0y · Male·Head injury in the setting of labour

Baby Cai Wheeler-Trow was born at 36 weeks and 2 days following a failed instrumental delivery and emergency caesarean section. He developed a skull fracture and subgaleal haemorrhage, presenting with clinical deteriorat…

obstetricspaediatricsdiagnosticcommunication
VIChospital2020-06-29

Finding into death of Baby AA

0y · Female·Disseminated Herpes Simplex Virus (HSV 1)

An 11-day-old neonate died from disseminated HSV-1 infection acquired perinatally. She presented with sepsis-like symptoms including lethargy, poor feeding, fever and respiratory signs. Clinical management was appropriat…

neonatologypaediatricsdiagnosticcommunicationbenzyl penicillin
VIChospital2019-11-11

Finding into death of Finn Moser

1y · Male·Head injury in the setting of labour

Finn Moser was a one-day-old neonate who died from head injury sustained during labour and delivery at the Royal Women's Hospital. He was born to a mother with dichorionic diamniotic twins, induced at 36 weeks due to pre…

obstetricsneonatologydiagnosticcommunicationprostaglandin gel
VIChospital2018-10-26

Finding into death of Baby B

1y · Male·Hypoxic-ischaemic encephalopathy and multisystem failure in the setting of extre…

Baby B was born by emergency breech extraction in an ambulance after obstructed labour, sustaining severe hypoxic-ischaemic injury. The death was multifactorial. The mother had limited antenatal care despite known metham…

obstetricsneonatologydiagnosticsystemmethamphetamine
VIChospital2018-10-05

Finding into death of Baby W

Female·Intrauterine pneumonia and meconium aspiration complicating intrauterine growth …

Baby W was born at 37+5 weeks in an ambulance and died at Bendigo Hospital from intrauterine pneumonia and meconium aspiration secondary to intrauterine growth restriction related to maternal amphetamine use. The mother …

obstetricsneonatologydiagnosticsystemmethamphetamine
QLDhospital2018-09-21

Baby M

0y · Female·Intracranial and intrapulmonary haemorrhage due to traumatic head injury from fa…

Baby M died shortly after birth on 11 February 2016 at Gladstone Base Hospital from intracranial and intrapulmonary haemorrhage due to traumatic head injury from a fall, complicated by Group B Streptococcal sepsis. A nur…

obstetricsmidwiferydiagnosticmedicationantibiotics
WAhospital2018-06-25

Inquest into the Death of LCTM

0y · Male·complications of head injury

A premature newborn died from severe head injuries inflicted deliberately by his teenage father in hospital on 15 February 2014. The father had a well-documented history of violence, substance abuse, criminality and had …

neonatologypaediatricscommunicationsystem
QLDhospital2017-06-28

Langley, Archer

0y · Male·Amniotic fluid aspiration (severe); with contribution from thin umbilical cord a…

Archer Langley died at age 1 hour from severe amniotic fluid aspiration following delivery by emergency caesarean section for obstructed labour. His mother's labour was prolonged and difficult, but critical delays occurr…

obstetricsneonatologydiagnosticcommunicationprostin
QLDhospital2017-06-28

Tonkin, Nixon Martin

0y · Male·Head injuries (birth trauma) secondary to obstructed labour and fetal macrosomia…

Nixon Martin Tonkin died from head injuries sustained during caesarean delivery for obstructed labour at 38 weeks gestation. The infant's head became deeply impacted in the maternal pelvis after prolonged second-stage la…

obstetricsanaesthesiadiagnosticcommunicationoxytocin
QLDhospital2017-06-09

Baby L - Non-inquest findings

0y · Female·Group B Streptococcus meningitis and sepsis

An 18-day-old baby died from late-onset Group B Streptococcus (GBS) meningitis and sepsis. She was born at a regional private hospital after labour complicated by maternal fever (37.6°C), foetal tachycardia (160-170 bpm)…

obstetricsneonatologycommunicationdiagnostic

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