An independent expert has suggested that a young woman who died in childbirth after suffering major bleeding may have had a toxic reaction to drugs administered as doctors tried to save her, an inquest has heard.
Nora Hyland (31), a Malaysian woman living at Charlotte Quay, Dublin, died in theatre at the National Maternity Hospital (NMH), Holles Street, on February 13th, 2012, within three hours of undergoing an emergency Caesarean section to deliver her son Frederick, now over two years of age.
The inquest at Dublin Coroner’s Court had heard that a labelling error in the lab contributed to a 37-minute delay in Ms Hyland receiving a blood transfusion. No emergency supply units of O negative, the universal blood type, were kept in Holles Street theatres at the time.
Holles Street master Dr Rhona Mahony gave evidence that she did not believe that Ms Hyland had a heart attack as a result of a drop in blood volume.
Report commissioned
Coroner Dr Brian Farrell adjourned the inquest in March and commissioned an independent expert report from Dr Michael O’Hare, consultant obstetrician and former chairman of the Institute of Obstetrics and Gynaecology at the Royal College of Physicians of Ireland.
Updating the legal representatives for the Hyland family and the NMH, Dr Farrell said Dr O’Hare had identified a new issue. “This report has identified a new issue which we had not considered, I think, at the inquest and that is the effect of the drugs that were administered – ergometrine and oxytocin – in relation to the pulseless electrical activity arrest.”
Ergometrine and oxytocin are used in combination to contract the uterus to prevent post- partum bleeding. The inquest previously heard that Ms Hyland was given a number of doses following the C section, having lost a substantial amount of blood. Doctors eventually carried out a laparotomy to stop the bleeding. She then went into cardiac arrest and died an hour later despite extensive attempts to save her.
The focus of the evidence heard at the inquest had been on the blood loss incurred by Ms Hyland and the delay in administering the transfusion, which the hospital attributed to the labelling error. However, Dr O’Hare’s report has raised the possibility that she died from ergometrine toxicity. The National Maternity Hospital believed this was highly unlikely, solicitor John Gleeson told the coroner.
“Their view is that ergometrine toxicity, which is what Dr O’Hare is suggesting, is highly unlikely to be the cause of death or the cause of the cardiac arrest,” he said.
Ergometri
ne toxicity None of the “classical” findings for ergometri
ne toxicity was present, Mr Gleeson told the court. He said the hospital questioned whether Dr O’Hare was the “correct expert” to give evidence on ergometrine toxicity and if an opinion should be sought from an anaesthesiologist or a toxicologist.
“Ergometrine has been in common use for many, many years and obstetricians have enormous experience of its use but in terms of its actual toxicity they may not,” he said.
Dr Farrell adjourned the inquest to October 1st to hear evidence from Dr O’Hare.