Transfusion delay not to blame for wife's heart attack, inquest is told
The master of Holles Street, Dr Rhona Mahony, has told an inquest she does not believe that a woman who waited 37 minutes for a blood transfusion had a heart attack as a result of a drop in blood volume.
Nora Hyland (31), a Malaysian woman living at Charlotte Quay in Dublin 4, died on the operating table at the National Maternity Hospital (NMH) on February 13, 2012, within three hours of undergoing an emergency Caesarean-section to deliver her son Frederick.
The inquest into her death had previously 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 specialist obstetrics registrar treating Mrs Hyland made the request for the units at 12.03am after finding that she had lost about one litre of blood following the C-section.
A docket showed the blood being requested from the lab at 12.13am. The blood was not administered until 12.40am, while Mrs Hyland was undergoing a laparotomy to stop the bleeding with her total blood loss estimated at 3.5 litres following that procedure.
She suffered a drop in blood pressure at 1.05am and went into pulseless electrical activity (PEA) arrest shortly afterward.
On the fourth day of the inquest at Dublin Coroner's Court, Dr Mahony said that following a clinical review of the case, doctors at the NMH had been unable to ascertain the cause of death "with certainty".
She agreed that Mrs Hyland had suffered profound post-partum bleeding.
The review considered the possibility that the cardiac arrest was caused by hypovolaemia – a decrease in blood volume – as a result of the 3.5-litre blood loss, but Dr Mahony said that the blood transfusion received prior to the collapse would have been adequate to compensate for this.
When suggested by coroner Dr Brian Farrell that the arrest must be linked to the post-partum bleeding, Dr Mahony said that it was "difficult to be so prescriptive".
"I have been unable to make a conclusion on why this PEA arrest occurred but had it been due to hypovolaemia I would have expected some changes before then in terms of heart rate, blood pressure and pulse. It also happened subsequent to her receiving a transfusion of five units, which, given the blood loss, would seem like a reasonable replacement," she said.
The inquest had previously heard from consultant obstetrician Dr Shane Higgins, who was present on the night, that a 3.5-litre blood loss would be an "enormous insult" to Mrs Hyland's system. When asked by barrister for the family Sara Antoniotti if she disagreed with Dr Higgins, Dr Mahony said that she believed that the sudden drop in blood pressure was unanticipated and she could not draw that conclusion.
Dr Mahony said that she acknowledged there had been a delay in the administering of the blood transfusion. She told the court that when the blood was initially ordered, it was not urgently needed.
The inquest was adjourned for completion on May 2.