'Persistent' elevated heart-rate recorded before Nayyab Tariq's death, inquest hears

Nayyab Tariq, 28, gave birth to a baby girl on Saturday March 22 last year at Mayo University Hospital.

A “persistent” elevated heart-rate was recorded in medical records for a woman who died four hours after giving birth, an inquest heard on Tuesday. 

Coroner Patrick O'Connor heard at Swinford Courthouse that Nayyab Tariq, 28, gave birth to a baby girl on Saturday March 22 last year at Mayo University Hospital.

The court heard Dr Ikechukwu Uzochukwu was the specialist registrar obstetrician on call. He was bleeped to attend, arriving three minutes after Ms Tariq gave birth at 6:09 pm.

Evidence was given on Monday that midwives and Ms Tariq’s husband Ayaz Ul Hassan saw “a gush of blood” at the birth following a normal labour.

Sean Rowlette from Sligo, whose wife Sally died in Sligo hospital in 2013, supported Ayaz Ui Hassan at the inquest in Swinford.

The obstetrician commenced treatment and told the inquest records show blood loss of 500ml.

He said, referring to a heart rate of over 100 beats per minute: “There had been intermittent readings of maternal tachycardia which reverted to normal on subsequent readings.” 

he inquest heard records show at 6:40pm Ms Tariq's heart rate was 120, then it fluctuated between 87 and 127, reading 112 when she was being transferred to the operating theatre at 7:02pm and 148 at 7:20pm.

Dr Uzochukwu described delivery room readings as “intermittent tachycardia”.

He said movements, including the attempt to deliver the retained placenta at 6:40pm which could be “painful”, can affect the heart-rate temporarily.

Solicitor for the family Johan Verbruggen from Callan Tansey Solicitors, referring to readings in both rooms, said: “For 30 minutes, there are seven out of eight readings at over 100, is that not persistent?” Dr Uzochukwu replied: “Yes, you could say that was persistent.” 

He told Conor Halpin, senior counsel, and solicitor Padraig Brennan, representing the hospital, that this would not have changed the decision to take Ms Tariq to the operating theatre. There was a clinical need to deliver the placenta. HSE guidelines advise retained placenta should be delivered within 30 minutes of birth.

Specialist registrar obstetrician Dr Ikechukwu Uzochukwu and consultant obstetrician Dr Meabh Ní Bhuinneain from Mayo University Hospital gave evidence at the inquest.

Dr Uzochukwu and other medical witnesses accepted there was a 25-minute gap between blood pressure tests in the delivery room when HSE guidelines say it should be 15-minute intervals.

He said Ms Tariq was not showing visible signs of bleeding before she was transferred.

He said between 8:10pm and 8:50pm the obstetric team, including obstetrician Dr Anca Trulea, discussed total blood loss with anaesthetist Dr Aidan O’Shea.

“At this time it was felt the revealed loss did not match the clinical situation,” he said.

At 8:50pm, a laparotomy surgery was performed by Dr Meabh Ní Bhuinneain after she was called to assist.

Dr Uzochukwu said “no evidence of fresh bleeding was seen” and “an impression of possible endometriosis was made”. 

Ms Tariq went into sudden cardiac arrest at 9:11pm, he told the court.

The inquest heard midwife Marcella Gavin say Ms Tariq’s husband and daughter were in a room on the empty labour ward, accompanied by midwives, during this time.

She said that about 9:07pm she asked if a member of the obstetric team could speak with Mr Ul Hassan.

The inquest heard she was told they decided it was ‘inappropriate’ at that time.

Giving evidence on Monday Mr Ul Hassan said communication was “limited”.

Coroner Patrick O'Connor.

Ms Gavin said: “At approximately 21:50, I was requested by Dr Ní Bhuinneain to inform Mr Ul Hassan his wife had no pulse and to ask if he wanted to attend the operating theatre.” 

She said in the theatre, he “held his wife’s hand and spoke to her”. 

Ms Tariq was pronounced dead at 10:13pm and he remained with her until 10:40pm, when his brother and parents arrived.

The inquest heard on Monday Ms Tariq died after this cardiac arrest which followed post-partum haemorrhage, retained placenta, bleeding in the abdominal cavity arising from ectopic deciduosis and shock.

Ms Gavin also said she entered the delivery room where Ms Tariq had given birth after 8:30pm.

She removed a sheet from the floor, and estimated blood on this sheet came to 10ml, covering a space “smaller than the palm of my hand”. She said she requested an assistant to wipe the floor. To her knowledge the floor had not been cleaned before this due to a limited weekend cleaning roster and other rooms being empty.

On Monday, Mr Ul Hassan told the court he saw "a pool" of blood on the floor, and after his wife was taken to theatre “a nurse in attendance must have noticed my anxious expression because she told me it was okay and not to worry about the blood”. Photographs were submitted.

Midwife Claire Larkin giving testimony on Tuesday said she did not recall seeing blood on the floor.

Midwife Phyl Kerrigan said at the time she did not think the initial 500ml blood loss met the definition of primary post-partum haemorrhage as she understood it included other birthing liquids.

In court, Mr Ul Hassan was accompanied by Sean Rowlette from Sligo, whose wife Sally died after giving birth in Sligo Hospital eight years ago. The inquest is expected to conclude on Wednesday.