Case assessments: In its assessment of the 10 cases before it, the Fitness to Practise Committee (FTPC) of the Medical Council, set up to look into Dr Michael Neary's professional conduct, found that "in a substantial number of cases" it was unable to accept his testimony.
Its assessment of his clinical notes was also damning.
"The committee considered that the notes taken by Dr Neary were disjointed in nature, incomplete, disorderly and not adequate for operations of such seriousness," the report states.
In some cases it considered that the notes did not seem to represent what had transpired in the theatre and "tended to exaggerate or over-dramatise blood loss and/or the risk to the patient".
Noting that a number of the patients were young, the FTPC said it found little evidence of substantial dialogue between Dr Neary and consultant pathologists after the Caesarean hysterectomies.
"[This is] surprising having regard to the highly unusual nature of some of the findings and diagnosis that Dr Neary stated he was encountering in these cases."
In the case of the four women having their first baby, the FTPC said "it did not find that major efforts were taken in order to preserve their fertility".
When considering the pathological findings, the report notes "a substantial and continuing pattern of discrepancy between the pathological and clinical findings".
In six of the cases, Dr Neary had diagnosed a rare condition - morbidly adherent placenta. The FTPC found that in four of these six cases there was a substantial discrepancy between the clinical findings and those found on subsequent pathological examination of the uterus and placenta.
The issue of blood loss also featured prominently in the committee's findings.
"The delivery notes frequently do not contain mention of adequate measures to control haemorrhage," it notes, adding that it found the omission of such details in the surgical notes "very surprising".
The FTPC said it found a thread running through the evidence in the form of "an overreaction to what was perceived by Dr Neary to be copious bleeding".
Noting that there was relatively small blood loss recorded in the cases before it, the FTPC concluded there was an average 1,581 millilitres (mls) loss.
Published medical evidence considered by the committee found a typical blood loss in cases of Caesarean section requiring hysterectomy to be 3,500 mls. International evidence found that a woman requiring Caesarean hysterectomy required 9.5 units (4,750 mls) of blood products as part of the resuscitation process.
In the cases treated by Dr Neary before the committee, the average total transfusion was found to be 1,000 mls.
"In none of the cases did the anaesthetic record give any particular cause for alarm during the time of haemorrhage," according to the report.
Two expert witnesses called by the Medical Council both stated that the absence of clear cause for alarm on the anaesthetic record was a "clear basis for believing that Dr Neary had resorted to hysterectomy too quickly".
The committee also noted that Dr Neary had a tendency to grossly exaggerate the true position: phrases such as "the most difficult case I have ever seen" and "I felt it was fortunate that the patient survived" were singled out in the report.
In a summary of the cases it had considered, the Fitness to Practise Committee concluded: "There is a pattern of rapid recourse to Caesarean hysterectomy, discrepancy between clinical notes and pathological findings, findings of \ defect which appear unjustified and a tendency to exaggerate events."