Blood loss during birth ‘did not lead to fatal heart attack’

The master of The National Maternity Hospital, Holles Street, Rhona Mahony, told an inquest she does not believe that a woman who waited 37 minutes for a blood transfusion had a heart attack as a result of a drop in blood volume.

Nora Hyland, aged 31, a Malaysian woman living at Charlotte Quay in Dublin 4, died on the operating table at the National Maternity Hospital on February 13, 2012, within three hours of undergoing an emergency caesarean section to deliver her son, Frederick. The inquest into her death had previously heard that a labelling error in the laboratory 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 operating theatres at the NMH at the time. The specialist obstetrics registrar treating Ms Hyland made the request for the units at 12.03am after finding that she had lost approximately one litre of blood following the C-section. A docket showed the blood being requested from the lab at 12.13am. The blood was not administered until 12.40am, while Ms Hyland was undergoing a laparotomy to stop the bleeding, with her total blood loss estimated at 3.5 litres following that procedure. She suffered a drop in blood pressure at 1.05am and went into pulseless electrical activity arrest shortly afterward.

On the fourth day of the inquest at Dublin Coroner’s Court, Dr Mahony said that following a clinical review of the case, doctors at the NMH had been unable to ascertain the cause of death “with certainty”.

She agreed that Ms Hyland had suffered profound post-partum bleeding. The review considered the possibility that the cardiac arrest was caused by hypovolaemia (a decrease in blood volume) as a result of the 3.5 litre blood loss, but Dr Mahony said that the blood transfusion received prior to the collapse would have been adequate to compensate for this.

The inquest had previously heard from consultant obstetrician Shane Higgins, who was present on the night, that the loss of 3.5 litres of blood would be an “enormous insult” to Ms Hyland’s system. When asked by barrister for the family Sara Antoniotti if she disagreed with Dr Higgins, Dr Mahony said that she believed that the sudden drop in blood pressure was unanticipated and she could not draw that conclusion.

The inquest has been adjourned for completion on May 2.