'Normal' labour followed by onset of uncommon bleeding condition, inquest told
The coroner’s court in Swinford, Co Mayo, heard Nayyab Tariq, 28, gave birth to a baby girl on March 22 last year, following a normal pregnancy under Mayo University Hospital.
A woman who died four hours after giving birth was “a well woman” on leaving the delivery room for the operating theatre, an inquest heard on Monday.
The coroner’s court in Swinford, Co Mayo, heard Nayyab Tariq, 28, gave birth to a baby girl on March 22 last year, following a normal pregnancy under Mayo University Hospital.
Her husband Ayaz Ul Hassan attended, and gave evidence as to what he saw.
Midwife Mary O’Connor told coroner Patrick O’Connor that Ms Tariq’s labour was “normal”.
When she delivered a baby girl at 6:09pm, the midwife noticed “a sudden gush of blood”, and queried a tear with obstetric registrar Dr Ike Uzochukwu.
At 6.16pm, blood loss of 500ml was recorded, treatment was ongoing as they awaited delivery of the placenta.
Witnesses agreed with solicitor Johan Verbruggen acting for Mr Ul Hassan, that Ms Tariq experienced an irregular heartbeat or tachycardia but did not agree it was “persistent”.
Mr Verbruggen noted a gap in blood pressure records when HSE guidelines for prevention and management of primary postpartum haemorrhage advise 15-minute checks.
Ms O’Connor did not know why this happened, but it could correlate with efforts to deliver the placenta, she said.
“In my opinion she left the delivery room to go to the operating theatre a well lady,” she said.
Ms O’Connor told Conor Halpin, senior counsel, representing the HSE and the SAOLTA hospital group, which includes Mayo University Hospital, she returned to the hospital that night after hearing of the tragedy and checked the electronic records.
Obstetrician Dr Anca Trulea told the court Ms Tariq’s blood pressure was low on arrival in theatre, and it was decided to remove the placenta under general anaesthetic and begin other treatments.
The placenta was successfully removed by Dr Uzochukwu, supervised by Dr Trulea. Also in attendance was anaesthetist Dr Aidan O’Shea.
It was noted Ms Tariq’s uterus had not contracted, a condition known as atonic uterus. Dr Trulea told the court they discussed the continued blood loss, saying: “We agreed that it is not matching with the clinical picture.” Ms Tariq’s “haemodynamic condition”, her heart-rate and blood circulation, continued to deteriorate and internal haemorrhage was suspected.
Dr O’Shea called a “code-red “at 8.22pm. A second obstetrician, Dr Meabh Ní Bhuinneain, was called.
In the following minutes, a number of treatments including a Bakri balloon were applied, and laparotomy surgery was performed on the abdominal cavity.
Dr Ní Bhuinneain said between 8:47pm and 8:57pm she examined Ms Tariq and found “no immediate source of active bleeding”, The team found she had responded and was “stabilising”. It was planned she would stay in a high-dependency bed.
However at 21:11 she had a sudden cardiac arrest. She required three shock-cycles and a full advanced cardiac life support (ACLS) protocol.
As her circulation began to stabilise, Dr Ní Bhuinneain carried out a “sub-total hysterectomy” as she did not believe Ms Tariq would survive further bleeding.
The total blood lost between giving birth at 6:09pm to 10:13pm was calculated to be 2,795 ml, according to medical witnesses. They agreed with the family’s solicitor this came to 40% of Ms Tariq’s blood volume.
However, Ms Tariq went into cardiac arrest again. When Dr Ní Bhuinneain realised she was failing, she went to fetch Mr Ul Hassan.
“He moved to the open theatre door,” she said. “When he saw the situation he asked if he could enter to hold Ms Tariq’s hand, which he did, and remained with her for the last 20 minutes of her life.”
She died after a cardiac arrhythmia arrest following post-partum haemorrhage, retained placenta, bleeding arising from ectopic deciduosis and shock, Dr Ní Bhuinneain told the court.
The court heard ectopic deciduosis is an uncommon type of internal bleeding, rarely seen in international literature.
Originally from Pakistan, Ayaz Ul Hassan and his parents have lived in Ballyhaunis since 2002. After he met Ms Tariq on a trip to Pakistan in 2014, they became engaged and were married in 2017.
Travelling between Mayo and Cork after moving here, she studied a post-graduate course in biopharma processing at University College Cork.
The court heard she was excited about her new life and hoped to take up work after giving birth.
The inquest continues on Tuesday and is expected to conclude on Wednesday.
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