Almost 40 minutes passed before a blood transfusion was given to a woman who suffered major blood loss following an emergency caesarean section at the National Maternity Hospital.
The inquest into Nora Hyland’s death heard that an emergency supply of blood was not kept in the operating theatre at the time.
Mrs Hyland, 31, a Malaysian woman living at Charlotte Quay in Dublin 4, died on the operating table on Feb 13 last year having suffered a cardiac event an hour after the caesarean was completed.
Sara Antoniotti, for the family, told coroner Brian Farrell that an internal review by the hospital following the incident made a number of recommendations all related to the availability of blood.
The court heard that an emergency caesarean section was carried out on Mrs Hyland on Feb 12, 2012, after a drop in the foetal heart rate was recorded at 11.05pm. Nikhil Purandare, then specialist registrar in obstetrics at the maternity hospital, successfully delivered the baby and closed up the abdomen.
At 12.03am, Dr Purandare noted Mrs Hyland had lost approximately one litre of blood. He requested that blood be ordered from the lab, starting with O-negative blood while units matching Mrs Hyland’s type were sourced. He told the court that he would have expected the O-negative blood to arrive quicker. Mrs Hyland continued to lose blood in the minutes that followed.
When consultant obstetrician Shane Higgins arrived at 12.28am, he decided a laparotomy was necessary to stop the bleeding. Blood loss was estimated at two litres at this time, said Mr Higgins.
The laparotomy began at 12.35am and took 10 minutes. Dr Purandare had earlier told the court that blood loss was estimated at 3.5 litres following this procedure. The blood transfusion began at 12.40am, 37 minutes after it had been ordered.
Mrs Hyland was considered stable following the laparotomy. However, at 1.05am she suffered a sudden and unexpected collapse. Resuscitation attempts failed and she was pronounced dead at 2.11am.
Mr Higgins said that Mrs Hyland’s blood pressure, pulse, and oxygen levels were normal before her collapse and she had received a blood transfusion. The hospital has been unable to establish the cause of death, he told the court.
Mrs Hyland was estimated to have had 5.5 to 6 litres of blood circulating in her system.
Under cross-examination, Mr Higgins conceded that a loss of 3.5 litres of blood would be “an enormous insult”. It would have been preferable to have hung the O-negative blood “much sooner”, he said, and probably before he had arrived in theatre.
At the time, a supply of O-negative blood was not kept in the theatre at the hospital, the court heard.
The court heard from Mrs Hyland’s husband Stephen that the baby, Frederick, was their first child and is doing well.
The inquest was adjourned for further hearing on Jan 27.
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