The widower of a young woman who died hours after giving birth to their first child broke down in tears following a verdict of medical misadventure at the inquest into her death.
Nayyab Tariq (28) from Ballyhaunis, Co Mayo, died at Mayo University Hospital, Castlebar, on March 22, 2020.
Originally from Pakistan, Ms Tariq was a gifted academic and a qualified bio-pharmacist.
She died four hours after giving birth to her first child, also named Nayyab.
Ms Tariq was initially identified by medical staff in the labour ward as suffering from a mild postpartum haemorrhage. She was transferred to the operating theatre after several attempts to deliver the placenta failed.
On the third day of the inquest, pathologist Dr Fadel Bennani said Ms Tariq suffered from an extremely rare condition called deciduosis, which led to major intra-abdominal bleeding.
She subsequently suffered a cardiac arrest and a pulmonary embolism. Extensive efforts to resuscitate and stabilise Ms Tariq failed.
During the proceedings at Swinford Coroner's Court, evidence was given that Ms Tariq lost a total of almost 2.8 litres of blood, 40pc of her total blood volume, after the birth.
The inquest also uncovered delays in ordering diagnostic blood readings, miscommunication between medical staff and missed periods where basic but essential observations like blood pressure and temperature were identified.
However, Dr Bennani said little could have been done before birth to identify and stop the abdominal bleeding, which he believed ultimately led to her death.
In returning a verdict of medical misadventure, coroner Pat O'Connor expressed his sincere sympathy to Ms Tariq's husband, Ayaz Ul Hassan, their daughter Nayyab and the couple’s extended family.
He noted that "despite the considerable advances in medical science over the decades, the giving of birth by any woman does involve risks to her and indeed the baby".
"Those risks should never be underestimated even though, thankfully, the incidence of deaths of mothers in childhood are historically low.
"Society owes a duty to all women who are expecting babies to provide the best possible care and facilities for them."
Mr O'Connor said he was not criticising any of the medical staff in Mayo University Hospital who are "undoubtedly affected in many ways" by tragic events.
"However, the effects on the medical and hospital staff pale when compared to the effects of a death of a young mother on her husband or partner, immediate family and loved ones."
In coming to his verdict of medical misadventure, Mr O'Connor said there were a number of reasons for Ms Tariq's death.
"The most significant factor appears to have been a concealed haemorrhage which despite monitoring of her vital medical signs and viewing her in person by a number of staff, such haemorrhaging did not become obvious such that she did, for a slight woman weighing 56kg, lose up to 40pc of her blood volume when collated in the operating theatre.
"Despite having a postpartum measure blood loss of 500mls, she did not seem to have any significant difficulties whilst in the labour ward. However, her blood pressure remained low whilst her heart rate was high, and she experienced nausea.
"The clinical medical findings in the labour ward were not fully communicated to the theatre staff.
"On transfer to the operating theatre, there were clinical findings of tachycardia, hypotension and increased respiratory rate."
Considering all of the evidence before the inquest, Mr O'Connor delivered a verdict of medical misadventure.
A statement read to the inquest on behalf of the hospital expressed sincere condolences to Ms Tariq's husband, daughter and family, following her "tragic and untimely death".
"Mayo University Hospital has apologised unreservedly for any failings or shortfalls in the standard of care provided, including poor communication updates during the time Ms Tariq was in theatre.”
Conor Halpin SC for the hospital said every issue that arose concerning the standard of care was being addressed.
Afterwards, Johan Verbruggen, solicitor for Mr Hassan, said it was clear that protocols for managing postpartum haemorrhage had not been followed, and basic measures were not taken soon enough, or at all. He said this resulted in a delay in recognising Ms Tariq's deterioration from massive blood loss.
"This naturally led to a delay in receiving life-saving intervention such as blood transfusion, and sadly Nayyab died four hours after the birth of this young couple's first child.
"What should have been the happiest day of their lives became the ultimate tragedy for Ayaz.
"He lost his wife, his soulmate. Their daughter will never get to meet her mother, and each birthday will carry a note of sadness marking the anniversary of her death."
Mr Hassan broke down in tears as Mr Verbruggen addressed the media and was comforted by his brothers.
A HSE review of the tragedy found that delays in recognising Ms Tariq was in shock after giving birth "may have contributed" to her death.
The review also noted that a key indicator of shock – skin pallor, was initially less obvious due to Ms Tariq’s ethnicity.
The internal review by the SAOLTA hospital group, seen by the Irish Independent, made eight recommendations for hospital management and staff.
“The review panel found that there were systems of care/service issues which may have contributed to Mrs A’s death. Earlier recognition and intervention may have altered the outcome in this case," it found.
“However the decisions made and actions taken should be considered in the context of the significant patient complexity and distractors which evolved that evening.”
It also found a “key causal factor” was the “delay in recognition and treatment of shock due to haemorrhage”.
“The significance of tachycardia was overlooked in the urgency to get to theatre when retained placenta was diagnosed,” it states.
The review notes that “this case revolves around the management of shock”.