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Review of post-mortem ordered

Padraig Flanagan

Independent review of post-mortem ordered by South Mayo coroner

Consultants assert that young mother did not bleed to death following baby’s birth

Anton McNulty

THE inquest into the death of a 38-year-old mother who died hours after giving birth has been adjourned to allow an independent expert from the Royal College of Pathology to review the records of the post-mortem carried out after her death.
The application for the adjournment was made at the end of the three-day inquest by Mr John Jordan BL, for Mr Padraic Flanagan, husband of the deceased, after it was revealed in evidence that slides and photographs from the post-mortem were still available in Mayo General Hospital. He asked for them to be reviewed by a third party.
Mr John O’Dwyer, Coroner for South Mayo, agreed to adjourn the inquest in the interest of ‘fairness’ and said he would contact the Royal College of Pathologists in London about providing a specialist with expertise in the area of maternal death and amniotic fluid embolism to review the case. Nearly 20 witnesses gave evidence during the inquest.
On the second day of the inquest, Dr Fadel Bennani, Consultant Pathologist said that ‘without a shadow of doubt’ he was 100 per cent certain that Mrs Evelyn Flanagan of Hollyhill, Ballyheane, Castlebar died from amniotic fluid embolism (AFE). He explained that when he examined the blood from Mrs Flanagan’s veins, he found it to be stained. When he tested the blood he found ‘foetal squamous’ cells (baby skin) and mucin, which he said was in the amniotic fluid which escaped into the blood stream following a tear in Mrs Flanagan’s uterus during labour. He said AFE was toxic and leads to acute respiratory and heart failure.
Dr Bennani said there was no evidence that she bled to death because, if she did, there would be changes to the kidneys, heart and brain, and this was not evident. He admitted that this was the first case of AFE he had come across, but was happy with his decision and would allow the slides and photographs of the post-mortem to be examined by a third party.
When Mr Jordan put it to Dr Bennani that it was convenient to diagnose AFE for the cause of death because it suggests that ‘nobody fell short’ in looking after Mrs Flanagan, he said he was not in a position to answer. He also stressed that nobody in the hospital put pressure on him to come up with the diagnosis of AFE.
Dr Kamel Elhami, Registrar Obstetrician, explained that he was called to the labour room at 2.05pm to review Mrs Flanagan, who was bleeding following the delivery. He said the amount of blood which Mrs Flanagan lost was significant but not lethal.
Midwife, Kathy Hegarty, denied claims by Mr Flanagan that she was in and out of the room but could not give an explanation why the alarm on the blood pressure monitor was not turned off for a period of 23 minutes. She said when she saw that the blood pressure was low she called the anaesthetist and administrated the medication.
Midwife, Mary Devers, said that at no time did she see blood dripping from Mrs Flanagan onto the floor. She agreed the bed and Mrs Flanagan’s legs were stained but did not feel the amount of blood was a cause of alarm. However, she said she knew Mrs Flanagan was haemorrhaging when she pulled back the sheets shortly after 2pm and called for help. She said the post partum haemorrhage protocol was followed.
Dr Rudolf Bermel, who was a locum Consultant Anaesthetist at Mayo General, said that while Mrs Flanagan had suffered severe bleeding, it did not cause her death. He admitted that she did not have the symptoms of AFE, but claimed the heart ‘stalled’ during the hysterectomy because it was fighting so hard against the embolism in the bloodstream. Dr Bermel said he was sure that if Mrs Flanagan did not have the AFE she would have recovered from the hysterectomy and the bleeding did not cause the cardiac arrest.
Dr Gunter Von Bunau told the inquest that he delivered the baby using a vacuum delivery because the heartbeat of the baby had dropped and there was no time to wait for Dr Mohammed. He said that while the bleeding was heavy that was normal and they were not really concerned because Mrs Flanagan was responding to treatment. Dr Von Bunau said he was now working in the Coombe Maternity Hospital and explained they would not have done anything different there.
Mr John O’Dwyer, Coroner, explained that because none of the consultants, including the pathologist, had ever seen AFE before or experienced it in this area, he would take it upon himself to retain the services of a pathologist with an interest in AFE to look over the post-mortem files. He said he would write to the Royal College of Pathologists in London to ask them to nominate someone and he would transfer the transcripts of the inquest and all the files and slides from the post-mortem to the expert pathologist.
He provisionally adjourned the inquest until December 1.