Toxic reaction to drugs may have led to new mother’s death

An independent expert has suggested that a young mother 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, aged 31, a Malaysian woman living at Charlotte Quay in Dublin, died on the operating table at the National Maternity Hospital (NMH), Holles St, on February 13, 2012, within three hours of undergoing an emergency caesarean section to deliver her son, Frederick.

The inquest at Dublin Coroner’s Court had heard that a labelling error in the laboratory contributed to a 37-minute delay in Mrs 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 master of the hospital, Dr Rhona Mahony, gave evidence that she did not believe Mrs Hyland had a heart attack as a result of a drop in blood volume.

Coroner Dr Brian Farrell had adjourned the inquest in March and commissioned an independent report from Dr Michael O’Hare, a consultant obs-tetrician 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 has identified a new issue in the case.

“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,” he said.

Ergometrine and oxytocin are used in combination to contract the uterus to prevent post-partum bleeding.

The inquest had heard that Mrs Hyland was given a number of doses following the caesarean section, having lost a substantial amount of blood. Doctors eventually carried out a laparotomy to stop the bleeding. She subsequently went into cardiac arrest and died an hour later.

Dr O’Hare’s report has raised the possibility that she died from ergometrine toxicity. The NMH believes this is 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.

None of the “classical” findings for ergometric toxicity are present, he told the court.

Dr Farrell adjourned the inquest to October 1.