THE CAUSE of death of a 38-year-old woman who died within hours of giving birth at Mayo General Hospital was "without a shadow of doubt" an amniotic fluid embolism, a pathologist told the inquest into her death in Castlebar yesterday.
Dr Fadel Bennani, consultant pathologist at the hospital, said he found evidence of particles from amniotic fluid in the pulmonary arteries of Evelyn Flanagan from Hollyhill, Castlebar, during a postmortem examination on October 19th, 2007.
The evidence he found included "foetal squamous" cells and mucin.
He said he found no evidence the woman had bled to death as suggested by John Jordan, counsel for the dead woman's husband Padraic Flanagan. Dr Bennani said there would have to be changes in the kidneys, heart and brain for him to find haemorrhage as the cause of death but these were not present.
He went on to tell the jury of six women and four men that Mrs Flanagan, who had given birth on October 18th, died "as a result of complications of pregnancy which was initiated by spontaneous uterine tear during vaginal delivery". He said this tear caused post partum haemorrhage which was controlled by hysterectomy and replacement of blood loss. But he said the amniotic fluid, which escaped through the tear into her system, caused a massive pulmonary thrombosis.
Cross-examined by Mr Jordan he said he personally had not diagnosed amniotic fluid embolism before but had come across it at conferences. He said it was rare. He said he discussed the case with two other pathologists at Mayo General and was "100 per cent" confident of his diagnosis.
Mr Jordan put it to him that it was very convenient to diagnose amniotic fluid embolism because it suggested "nobody fell short" in looking after Mrs Flanagan at Mayo General while she was alive. "Doesn't it let everybody off the hook?" Mr Jordan suggested.
Dr Bennani said he wasn't in a position to answer that. He stressed nobody in the hospital had put pressure on him to come to the conclusion he came to. He also said he had retained slides and photos of what he found and they could be examined by any third party. He confirmed Mrs Flanagan's womb was sent for incineration three months after he completed his report.
He said this was normal procedure in the hospital. Mr Jordan asked why, then, had he said in his postmortem report that no organs had been retained by the hospital. Dr Bennani stressed the womb was a "surgical specimen" removed in theatre and not an organ removed at autopsy.
Mr Jordan suggested it should have been retained until after the inquest so Mr Flanagan could have it examined by an independent expert.
Mr Flanagan told the inquest on Monday that his wife, who had gone private to have her child, suffered massive blood loss after giving birth. He claimed nothing was done about it until he drew the attention of a midwife to blood dripping on the floor from underneath her bed shortly after 2pm, 90 minutes after delivery.
He said that if his wife had received "the proper care and attention to which she was entitled", she would still be alive.
Dr Rudolph Bermel, who was a locum consultant anaesthetist at the hospital at the time, told the jury yesterday it was not bleeding that caused Mrs Flanagan's heart to stop in theatre during the hysterectomy. He said it was the fact that her heart was fighting against an amniotic fluid embolism. She never regained consciousness after the operation and was pronounced dead at 4.30am on October 19th. The inquest continues today.