Coroner calls for prostaglandin gel review after death of baby

SA deputy state coroner Anthony Schapel also recommended findings from the inquest into the child’s death in 2011 be brought to the attention of senior government health authorities and doctors’ organisations. 

Baby Aurora Doreen Maureen Sleep died four days after she was born by emergency caesarean section on 17 November 2011 at Mount Gambier Hospital, after the birth was induced in anticipation of a vaginal delivery. 

In the procedure, her 22-year-old mother Ashlee Brown underwent a subtotal hysterectomy, leaving her unable to have more children.

Mr Schapel found Aurora died from irreversible hypoxic brain damage sustained when Ms Brown experienced a uterine rupture during labour, which resulted in the placenta and baby being displaced into the maternal abdominal cavity.

The coroner found the use of prostaglandin gel had triggered excessively strong and frequent contractions, which led Ms Brown’s uterus to