Saving Mothers' Lives: - Public Health Agency for Northern Ireland

A woman who had not been long in the UK, but who spoke English well, requested termination
of an early pregnancy because of her social circumstances. She was referred from a community
clinic to a hospital clinic for a surgical termination. In the meantime, she attended an Emergency
Department with rigors and severe low abdominal pain, where she was found to be markedly
pyrexial and tachycardic. She declined admission and was discharged by a junior gynaecologist
on a broad spectrum antibiotic for what was thought to be a urinary tract infection. She returned
to the hospital the next day, still very pyrexial, and intravenous fl uids and antibiotics were given
after signifi cant delay. Shortly after a pelvic ultrasound examination, which showed free fl uid in
her pelvis, she suffered a cardiac arrest from which she could not be resuscitated. A laparotomy
was done in case she had an ectopic pregnancy. Although there was blood in the pelvis there
was no ectopic pregnancy. Microbiological cultures grew an unusual organism, usually found
in water, from several tissues, and careful inspection at autopsy showed evidence of unusual
trauma in her genital tract.
It is not known why this woman opted for an unsafe abortion, having already engaged with NHS services.
One can only speculate if there may have been cultural issues, or coercion. Globally, unsafe, illegal
abortion is very common and is one of the leading causes of maternal death. With increasing migration,
this sad case is an important reminder to clinicians that this can happen in the UK too. Another woman died
following a legal termination of pregnancy:
A young woman who underwent a medical termination of pregnancy was subsequently
readmitted to hospital with vaginal bleeding. Because the bleeding settled and because
ultrasound examination showed no evidence of retained tissues, she was discharged without
further treatment. She re-presented again with a pounding headache and breathlessness
on exertion, and was found to be pale and tachycardic. She was given a large amount of
intravenous crystalloid and colloid while a blood count was analysed and re-analysed. The
haemoglobin concentration indicated severe anaemia. She had a cardio-respiratory arrest before
a blood transfusion was started. Although she was resuscitated, she developed overwhelming
pulmonary oedema. Profound cerebral damage became evident. Her death was attributed to
severe anaemia from haemorrhage from retained products (found at autopsy), exacerbated by
intravenous fl uid infusion.
This case again illustrates a failure to recognise basic clinical signs and symptoms. The initial extremely
low haemoglobin result should have prompted a re-inspection of the conjunctivae, urgent blood
transfusion, and senior review rather than additional venepuncture and further delay whilst awaiting reanalysis
in the haematology laboratory.
Ovarian hyperstimulation
There has been debate as to whether deaths from ovarian hyperstimulation should be included in this
Report. As discussed in Chapter 1, in the view of the assessors these deaths should be reported to,
and assessed by this Enquiry, as they occurred as a direct consequence of a woman trying to become
pregnant. Further, they contain important lessons for the provision of infertility treatment, a growing area of
medical intervention which is not currently subject to such critical review.
One death reported to the Enquiry was of a woman who had undergone ovarian hyperstimulation and
intrauterine insemination. There are confl icting reports about whether a pregnancy test was positive, or not,
at the time of her death. She was admitted with ovarian hyperstimulation syndrome and deteriorated over
three days in the gynaecology ward before being transferred to Critical Care Unit, extremely ill. She did not
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