A woman who died hours after giving birth by Caesarean section suffered a “catastrophic” internal haemorrhage in which almost half the blood in her body pooled into one area.
An inquest in Tralee into the death of Tatenda Mukwata, who died at University Hospital Kerry on April 21st last year was told that two litres of blood had gathered in one part of her abdomen, where a body typically holds up to five litres.
Ms Mukwata (34) had been a resident at the Atlantic Lodge direct provision centre in Kenmare but had been granted permission to stay in Ireland shortly before her death.
She gave birth to her daughter, Eva, at the hospital at 7.48pm on April 20th last year, only to die in the early hours of the following day.
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Dr John O’Mahony, SC, for Ms Mukwata’s family, argued that warning signs were present in the hours prior to her death that would have indicated a huge internal bleed, namely plummeting haemoglobin levels, her pulse rate and an “alarming” drop in her blood pressure levels.
However, the inquest, before coroner Helen Lucey and an 11-strong jury, was told that Ms Mukwata suffered an arterial venous malformation (AVM) – a rare occurrence where a vein and an artery running closer to each other can be punctured or torn and results in the blood from one running into the other.
The inquest also heard that AVMs usually go unnoticed until they rupture and one witness, Dr Peter Kelehan, said he believed this was a pre-existing condition in Ms Mukwata, pre-dating not just the delivery of the baby but the entire pregnancy.
Dr Kelehan – a consultant perinatal pathologist who, alongside Assistant State Pathologist Dr Margot Bolster, reviewed the case – said one possibility was that sutures used to stitch Ms Mukwata following the Caesarean section may have ruptured the pre-existing AVM, causing the bleed.
Ms Mukwata’s mother, Catherine, and her children Munashe, Rutendo, Sherley and Eva were present for the opening of the inquest, with Rutendo confirming that she had identified her mother to the Garda following the death at the hospital.
Dr Kelehan said he had seen a number of AVMs in his professional life, beginning with one on the head of a person who had been hit at an earlier stage with a hurley.
He said AVM has been likened to “a bag of worms” due to its pulsing nature but that they are often only seen when they bleed.
He said his opinion was that in this case it was “the arterial venous malformation that pre-existed this pregnancy that caused haemorrhaging and the patient’s death”.
Dr Kelehan said it was very rare for an AVM to exist in the uterus, adding: “It can be discovered but you have to know to look for it.”
When they are close to the site of an incision, he said sutures – since they have to extend beyond the limits of any wound – could wrap themselves around a vein or artery in an AVM, causing it to rupture in what he described as a “pseudo aneurysm”.
The inquest was then adjourned and is set to resume at 10.30am on September 25th, with another three days after that set aside for it to be heard.