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inquest latest Doctor tells inquest he did all he could to save mum (28) who died hours after giving birth

Ms Tariq (28) from Ballyhaunis, Co Mayo, died after she suffered a cardiac arrest following a massive haemorrhage after the birth of her daughter

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The late Nayyab Tariq. Photo Conor McKeown

The late Nayyab Tariq. Photo Conor McKeown

The late Nayyab Tariq. Photo Conor McKeown

A specialist registrar who treated a young woman who died hours after giving birth insisted at her inquest he did all he could to help her.

Dr Ike Uzochukwu faced repeated questions about his care of Nayyab Tariq following the delivery of her baby on March 22, 2020, at Mayo University Hospital, Castlebar.

Ms Tariq (28) from Ballyhaunis, Co Mayo, died after she suffered a cardiac arrest following a massive haemorrhage after the birth of her daughter.

Ms Tariq, a gifted academic, was originally from Lahore in Pakistan but moved to Ireland following her marriage in 2017 to her husband, Ayaz Ul Hassan.

Ms Tariq gave birth to her daughter at 6.09pm, and at 6.12 pm, Dr Uzochukwu was called to the delivery suite owing to concerns by the midwives over blood loss suffered by Ms Tariq.

At 6.49pm, a decision was made to transfer Ms Tariq to the operating theatre after unsuccessful attempts to deliver the placenta.

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Ayaz Ul Hassan attending the inquest into the death of his wife Nayyab Tariq in Swinford, Co Mayo. Photo: Conor McKeown

Ayaz Ul Hassan attending the inquest into the death of his wife Nayyab Tariq in Swinford, Co Mayo. Photo: Conor McKeown

Ayaz Ul Hassan attending the inquest into the death of his wife Nayyab Tariq in Swinford, Co Mayo. Photo: Conor McKeown

 

In his deposition, Dr Uzochukwu stated that throughout the period he spent in the delivery suite with Ms Tariq, he felt she was clinically well despite suffering what he believed was a minor postpartum haemorrhage.

Today at the coroner court hearing, Dr Uzochukwu insisted under sustained questioning by solicitor Johan Verbruggen acting for Mr Hassan that he believed intermittent readings of tachycardia – an indicator of shock - were not clinically significant.

Dr Uzochukwu agreed he did not communicate any concern over a series of seven elevated heart rate readings, which began at 6.51pm to Dr Anca Trulea when he informed her of Ms Tariq’s condition.

In his deposition, Dr Uzochukwu noted a heartrate reading of 89 at 6.49pm. However, he did not include eight subsequent readings between 6.50pm and 7.20pm when Ms Tariq's heart rate was above 100 on seven occasions.

Mr Verbruggen drew attention to the HSE clinical guidelines, which states that if a woman diagnosed with a minor bleed post-birth suffers tachycardia, her condition should be elevated to a major postpartum bleed.

Dr Uzochukwu said he was certain that Ms Tariq was clinically stable before being transferred to theatre to remove the placenta manually.

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"I was with this lady continuously; she was conscious, not pale and breastfed her baby."

He acknowledged a gap of 25 minutes in blood pressure recordings for Ms Tariq between delivery at 6.09pm and transfer to theatre at 7pm when HSE guidelines for prevention and management of primary postpartum haemorrhage advise 15-minute checks.

He also described a "miscommunication" between him and midwife Mary O'Connor that led to a significant delay in ordering a full blood count and coagulation screening for Ms Tariq.

"I assumed she had taken a full blood count. It was said blood had been taken.

"It was a miscommunication."

Under questioning from coroner Pat O'Connor, Dr Uzochukwu said: "I came immediately to this lady to help her.”

He agreed it was his evidence that when Ms Tariq left the delivery suite at 7pm that apart from the retained placenta, she was in "relatively good shape".

At 7.05pm following her arrival in theatre, Ms Tariq complained of abdominal cramps. A decision was taken by the anaesthetic team that Ms Tariq was unfit to undergo spinal anaesthesia, and she was placed under general anaesthetic at 7.10pm.

She never regained consciousness.

The court heard that at 7.35pm, the placenta was delivered, yet Ms Tariq's condition remained unstable.

Dr Maebh Ní Bhuinneáin told the inquest she was called by Dr Uzochukwu at 8.20pm and was asked to attend the operating theatre 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 theatre.

Ms Tariq was receiving blood transfusions and other medications to stabilise her condition.

She observed that Ms Tariq had a heart rate of 140-150 beats per minute and systolic blood pressure of 75mmHg, which indicated she was in severe shock.

The medical team felt at this point that Ms Tariq's condition did not align with the recorded blood loss, and she must be bleeding internally.

An examination of her uterus found it was empty, and 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 suctioned 650mls of blood from the peritoneal cavity, and 250mls of blood clots were removed from the pelvis.

She said cumulatively; Ms Tariq had lost 2,275mls of blood at this point - 40pc of her total blood volume.

She said she found abnormal fibroid tissue at the back of the womb 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-type which usually remains dormant in pregnancy.

The court heard the abnormal tissue, and the bleeding indicated the condition ectopic deciduous. An extremely rare type of internal bleeding, with few recorded cases seen in international literature.

She told Mr O'Connor that at 8.58pm, Ms Tariq appeared to be stabilising.

However, she decided to perform a hysterectomy as she felt Ms Tariq wouldn't survive another episode of bleeding.

However, at 9.11pm, she suffered a sudden ventricular fibrillation cardiac arrest.

Repeated attempts to resuscitate Ms Tariq failed. At 10.13pm, care was withdrawn, and Ms Tariq was pronounced dead.

The inquest continues tomorrow.
 

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