r Ike Uzochukwu has faced repeated questions about his care for Nayyab Tariq after her baby was delivered on March 22, 2020 at Mayo University Hospital in Castlebar.
Ms Tariq (28) of Ballyhaunis, Co. Mayo, died after suffering cardiac arrest following massive bleeding after the birth of her daughter.
Ms Tariq, a talented academic, was originally from Lahore, Pakistan but moved to Ireland after her marriage in 2017 to her husband, Ayaz Ul Hassan.
Ms Tariq gave birth to her daughter at 6:09 p.m. and at 6:12 p.m. Dr Uzochukwu was called to the delivery room due to midwives’ concerns about Ms Tariq’s blood loss.
At 6:49 p.m., it was decided to transfer Ms. Tariq to the operating room after unsuccessful attempts to deliver the placenta.
In his testimony, Dr Uzochukwu said that throughout the time he spent in the delivery room with Ms Tariq, he felt that she was doing well clinically despite what he believed. be a minor postpartum hemorrhage.
Today at the coroner’s court hearing, Dr Uzochukwu insisted, during sustained questioning of lawyer Johan Verbruggen acting for Mr Hassan, that he believed the intermittent tachycardia readings – a shock indicator – were not clinically significant.
Dr Uzochukwu agreed that he had not raised any concerns about a series of seven elevated heart rate readings, which began at 6:51 p.m., to Dr Anca Trulea when he informed her of the state of Mrs. Tariq.
In his testimony, Dr Uzochukwu noted a heart rate reading of 89 at 6:49 p.m. However, it did not include eight subsequent readings between 6:50 p.m. and 7:20 p.m. when Ms Tariq’s heart rate was above 100 on seven occasions.
Mr Verbruggen drew attention to the HSE’s clinical guidelines, which state that if a woman diagnosed with minor postpartum bleeding has tachycardia, her condition should be elevated to major postpartum bleeding.
Dr Uzochukwu said he was certain Ms Tariq was clinically stable before being transferred to the operating room to manually remove the placenta.
“I was with this lady all the time; she was conscious, not pale and breastfed her baby. “
He recognized a 25-minute discrepancy in the blood pressure recordings for Ms. Tariq between delivery at 6:09 p.m. and transfer to the theater at 7 p.m. when the HSE guidelines for the prevention and management of primary postpartum hemorrhage recommend 15-minute checks.
He also described a “communication problem” between him and midwife Mary O’Connor which resulted in a significant delay in ordering a complete blood count and coagulation screening for Ms Tariq.
“I assumed she had a complete blood count. It was said that blood had been drawn.
“It was a misunderstanding. “
When questioned by Coroner Pat O’Connor, Dr Uzochukwu said: “I immediately came to see this lady to help her. “
He agreed that it was his testimony that when Ms Tariq left the delivery room at 7:00 pm, other than the retained placenta, she was “in relatively good shape”.
At 7:05 p.m. after arriving at the theater, Ms. Tariq complained of abdominal cramps. The anesthesia team decided that Ms Tariq was unfit for spinal anesthesia and she was placed under general anesthesia at 7:10 p.m.
She never regained consciousness.
The court heard that at 7:35 p.m. the placenta had been delivered, but Ms. Tariq’s condition remained unstable.
Dr Maebh Ní Bhuinneáin told the inquest that she was called by Dr Uzochukwu at 8:20 p.m. and asked to go to the operating room immediately.
She told the coroner that she saw the medical team involved in a coordinated emergency response to postpartum shock when she arrived at the theater.
Ms. Tariq was receiving blood transfusions and other medications to stabilize her condition.
She observed that Ms Tariq had a heart rate of 140 to 150 beats per minute and systolic blood pressure of 75 mmHg, which indicated that she was in severe shock.
The medical team determined at this point that Ms Tariq’s condition did not match the recorded blood loss and that she must be bleeding inside.
An examination of her uterus revealed that it was empty and that the blood loss was minimal.
A decision was made to perform a laparotomy – a procedure to open and examine the inside of the abdominal cavity.
On examination, Dr Ní Bhuinneáin observed multiple blood clots but no immediate source of bleeding. She aspirated 650 ml of blood from the peritoneal cavity and 250 ml of blood clots were removed from the pelvis.
She said cumulatively; Ms. Tariq had lost 2,275 ml of blood at this point, or 40% of her total blood volume.
She said she found abnormal fibroid tissue at the back of the uterus that appeared to be responsible for low-flow bleeding into the abdominal cavity.
Dr Ní Bhuinneáin said she interpreted the abnormal tissue to be endometriosis-like which usually remains dormant during pregnancy.
The court heard the abnormal tissue, and the bleeding indicated the deciduous ectopic condition. An extremely rare type of internal bleeding, with few cases recorded in the international literature.
She told Mr. O’Connor that at 8:58 p.m. Ms. Tariq appeared to be stabilizing.
However, she decided to have a hysterectomy because she felt that Ms Tariq would not survive another episode of bleeding.
However, at 9:11 p.m., she suffered sudden cardiac arrest from ventricular fibrillation.
Repeated attempts to resuscitate Ms. Tariq failed. At 10:13 p.m., treatment was withdrawn and Ms. Tariq was declared dead.
The investigation continues tomorrow.
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