The pathologist who carried out the postmortem on Dhara Kivlehan said it was the only case he had come across in his 27-year career where a mother had died from multi-organ failure due to Hellp syndrome.
At the Coroner’s Court in Ca- rrick-on-Shannon yesterday, Belfast-based Dr Brian Herron agreed with Damien Tansey, solicitor for the Kivlehan family, that in the western world the mortality rate due to this condition was less than 1 per cent.
Ms Kivlehan died in Belfast’s Royal Victoria Hospital in 2010, four days after being transferred from Sligo hospital, where she had given birth to her first baby.
Dr Herron told Mr Tansey that all the woman’s principal organs had failed. Her kidneys, liver, lungs, heart and blood had failed and her colon had been removed, he confirmed.
The pathologist told the jury of five men and two women that nothing unexpected was found during the autopsy. Sepsis was not identified.
Midwife Catherine Mulhern, who was looking after Ms Kivlehan on the labour ward on September 21st, told the inquest that she administered pethidine after getting a verbal prescription from a doctor on the phone. She later saw blood-test results that suggested liver damage.
Liver
The midwife said she had become aware since that pethidine may affect the liver. Mr Tansey put it to her that pethidine is contraindicated when liver pathology is in the background.
The witness told the inquest that she spoke to the doctor who prescribed pethidine at 2.45am, and saw the blood-test results at 3.27am. Asked whether alarm bells had rung when she saw the results relating to the liver, which were “grossly out of whack”, she said she had told the registrar about the blood results.
Ms Mulhern told Mr Tansey that her statement to the inquest had been prepared at a meeting with her midwifery manager, Una McDermott, and a solicitor. She also confirmed that she heard a doctor telling Michael Kivlehan that his wife would be brought to ICU after the C section.
Coroner Eamon MacGowan heard that Ms Kivlehan was “specialled” and put in a room close to the nurses’ station in the maternity ward, where she was constantly monitored.
According to Ms Mulhern’s statement, Ms Kivlehan was “distressed with pains” when she arrived in the ward at 2.20am. The witness agreed she was very worried about the patient and conveyed that to the register. She said the consultant, Dr Raouf Sallam, who was at home, had been contacted by the register.
In her statement, Ms Mulhern said a decision was made that an immediate Caesarean section was needed.
Asked whether Dr Sallam was there for the operation, she said he was in the theatre. She did not know if he was there at the beginning or at what stage he arrived.
The baby was born at 5.56am. She noted that the baby was pale and floppy.
After care by the medics, she recorded that the baby “responded well”.
