Child O

Pathology

Panel conclusion: Baby 15 died from a subcapsular liver haematoma caused by traumatic delivery, resulting in haemorrhage into the peritoneal cavity and profound shock, which was not recognised ante-mortem. A subcapsular liver haematoma results from traction or shear forces on the fragile liver capsule; in this case the Panel finds it was highly likely caused by the extremely rapid delivery — the triplets were extracted a minute apart — which is a well-recognised cause of birth injury. Such bleeding is initially slow and insidious because it is contained by the liver capsule, then produces acute collapse when the capsule ruptures; his haemoglobin nearly halved (168 to 86 g/l). High-pressure ventilation reduced venous return and contributed to liver congestion, and the blind needle aspiration of the abdomen during resuscitation may have penetrated the liver, causing the further parenchymal haematoma and laceration the pathologist noted. The Panel considers blunt direct trauma implausible: it is very difficult to generate the necessary forces against a liver protected by the lower chest wall. The gaseous intestinal distension was likely air swallowing and insufflation during non-invasive respiratory support.