Pregnant woman died after uterus ruptured

A verdict of medical misadventure was returned at the inquest into the death of a woman whose uterus ruptured after she was medically induced at the Rotunda Hospital to deliver her stillborn baby.

Bimbo Onanuga, aged 32, a Nigerian-born mother of one who lived in Finglas, Dublin 11, died on Mar 4, 2010, having suffered massive internal bleeding.

Doctors at the Rotunda discovered the rupture when they carried out an emergency caesarean section after she went into cardiac arrest.

The court heard that the baby had delivered through the rupture into the abdominal cavity. She was subsequently transferred to the Mater Hospital where she died later that day.

On the final day of the inquest, the Master of the Rotunda, Dr Sam Coulter-Smith, denied claims by Ms Onanuga’s partner Abiola Adesina that he told the family her death was “due to a series of mistakes”.

He said when he spoke to the family he did not have sufficient information to say there had been errors.

The inquest had previously heard that the autopsy found that the placenta had implanted at a part of the uterus which had previously been weakened and thinned by scarring. This was the site of the rupture.

Ms Onanuga had previously had a termination and Dr Coulter-Smith said it was “probably reasonably safe to assume” that the scarring had been caused by an unrecognised perforation during that procedure which predisposed her to rupture.

Doctors at the Rotunda were aware of the termination but there was no information in relation to any complication that may have occurred, he said.

The family had raised concerns about the use of the ulcer medication misoprostal in the induction of Ms Onanuga’s labour.

The court heard from Dr JM Morris, director of scientific affairs at the Irish Medicines Board, that the drug is not licenced for this purpose in Ireland but that such off-label use of medication is common.

Dr Ciaran Craven, barrister for the family, asked Dr Coulter-Smith why misoprostal is used for induction rather than a licenced medication.

He noted that misoprostal is much cheaper than the available licenced medication. Dr Coulter-Smith said the licenced drug is not “particularly useful in induction of labour” in this situation.

The court heard that the Rotunda has adopted a number of recommendations following a review of the incident. The protocol for induction of labour in foetal deaths has also since been changed.

Returning a verdict of medical misadventure, coroner Dr Brian Farrell said the main risk factors were the pre-existing scar and the misoprostal which caused the uterine contractions.

He said the intention of the doctors was to induce delivery because the baby had died and the unintended action was the death of Ms Onanuga. He will write to the Irish Medicines Board raising the family’s concerns about misoprostal.

Tragically, Ms Onanuga’s daughter, who was born with disabilities, died a few months after her mother, the court heard.

Speaking following the verdict, Mr Adesina said that the last three-and-a-half years have been “very difficult”.

“It is a tragedy that the recommendations made today were not in place during the time that Bimbo was in the hospital with them. It has been the most stressful period of my life so far and I am just glad it is over,” he said.