IRELAND: Inquest into death of Zim mum at Kerry hospital hears of nurses’ concerns

By RTE News

The third day of the inquest into the death of a 34-year-old woman who died after giving birth by Caesarian Section at University Hospital Kerry last year has heard there were four C-sections on the night she died.

It also heard it was “a challenging shift” for nurses and nursing teams had to be split, work beyond their normal shift and extra staff called in.

Zimbabwe-born Tatenda Mukwata, a mother of three, died hours after giving birth to her fourth daughter, Eva, by Caesarean section.

Nurses raised concern about Ms Mukwata’s dramatic drop in blood pressure and condition, and raised the possibility she was bleeding with clinicians, the inquest was told.

However the nurses’ suspicion “was overruled” by the clinicians the inquest heard, and that instead the obstetrics gynaecologists and anaesthetists all decided it was sepsis.

In an apology read out at the start of the resumed inquest yesterday, the hospital apologised to the family of Ms Mukwata “for the failings of care afforded to Tatenda at this hospital on 20th and 21st April 2022”.

Earlier intervention would probably have prevented Ms Mukwata’s death, the hospital acknowledged.

The inquest heard that Ms Mukwat had bled to death but the fact she was hemorrhaging after the Caesarian went undetected.

A key indicator of postpartum maternal hemorrhage – dropped levels of hemoglobin which indicate blood volume had not been recognised and the surgical team went on suspicion of sepsis, based on no sign of external bleeding.

The severe internal bleeding had not been recognised.

But the laboratory records later showed this had dropped from an acceptable level of 10.8 grams at the time of delivery at 7.33 to 7.7 grams three hours later. It dropped gain to just 2.8 grams during attempts to resuscitate her later.

The obstetrician who carried out the Caesarian section had found no external evidence of bleeding and suspected sepsis.

Obstetrician gynaecologist Dr Fahad Hendricks was assigned to the high risk ante-natal clinic and was working his third 24-hour shift in less than a week on 20 April.

At 5.30pm he went to meet Ms Mukwata with whom he had “a good rapport”. He was excited to see her as both were from, Southern Africa Dr Hendricks said, breaking down and pausing in reading his deposition.

The Caesarian section had been “uncomplicated” and there was normal blood loss and no haemorrhage, the inquest heard.

At 10.55pm when paged by concerned nurses, he noticed Ms Mukwata’s low pallor and suspected septic shock. He had thought there might be a surgical bleed but found no evidence and nothing to indicate it.

The wound dressing was clean, there was no vaginal bleeding and the uterus was contracting.

The inquest heard that Ms Mukwata was awake and smiling.

Dr Hendricks suspected clinical shock and sepsis. He had based this on the fact that she had two spikes in temperature and she was immunocompromised.

“I trained in South Africa, 30% of women in ante-natal clinics are HIV positive, immuno- suppressed,” he said.

He was not aware of the drop in haemoglibin.

“In all honesty, I did not check,” Dr Hendricks replied to Dr John O’Mahony, SC, for the Mukwata family.

But had he been aware of the drop, probably would have repeated the blood sample, and his suspicion of intra-abdominal bleeding strengthened and he would probably have taken steps to have her taken to theatre for operation, he told the inquest.

He was working in Ireland just three months at the time.

The inquest also heard that the lab had not paged or alerted clinicians about the haemoglibin drops and they normally would.

ICU nurse Siobhan O Nuallain in her deposition read to the inquest how there was high hospital activity on the night and five wards were working with a deficit of one nurse.

Staff were being redeployed and she and another nurse queried if there was a possibility that Ms Mukwata was bleeding after seeing her vital signs were not stable and blood pressure was dropping. Theatre staff also escalated the concerns.

However, the “anaesthetic, obs and Gynae team” ruled bleeding out in favour of sepsis and decided “collectively” the patient required ICU care. Dr Mary McCaffrey the senior consultant had been informed.

Other nurses too gave similar evidence of having escalated their concerns about internal bleeding with the clinicians, to no avail.

Charmaine Dennehy, senior staff nurse, said there had been “real concern” about Ms Mukwata, but it was out of their remit to do anything.

She reassured the family they had ensured Ms Mukwata was comfortable and cared for and had never been left alone.

Asked about the impact on them as nurses, Ms Dennehy said: “It was a major blow. We were all very very upset.”

The inquest continues.