Woman's death in Kerry hospital after giving birth due to 'massive, catastrophic bleed'
The Daughter Her And On In Into Mukwata's Catherine Domnick Death Tatenda Picture: Tralee Tatenda's Mukwata Walsh Eva Mother Inquest Mukwata At Wednesday
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 21 last year, was told 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 20 last year, only to die in the early hours of the following day.
Dr John O’Mahony, senior counsel for Ms Mukwata’s family, argued 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 Ms Mukwata suffered an arterial venuous 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 arterial venuous malformations usually go unnoticed until they rupture, and one witness, Dr Peter Kelehan — a consultant perinatal pathologist who, alongside Assistant State Pathologist, Dr Margot Bolster, reviewed the case — 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.
Ms Mukwata’s mother, Catherine, and her children Munashe, Rutendo, Sherley and Eva, were present for the opening of the inquest, with Rutendo confirming she had identified her mother to gardaí following the death at the hospital.
Dr Bolster gave evidence from the autopsy, referring to the two-litre clot in the abdomen, centred in the pelvic region, with other clots also evident elsewhere in the abdomen. The woman had died from haemorrhage and shock, she said.
Dr Bolster said she found no evidence of sepsis or any other cause of the bleeding, which had taken place on the operative side of the abdomen.
Dr Bolster said she and Dr Kelehan had carried out a histological review of samples taken from Ms Mukwata, indicating the presence of an AVM that had ruptured.
“I knew there was an abnormal area and this is where the clot was centred,” she said. “It is my opinion that caused the bleeding.”
Dr O’Mahony, cross-examining, said the literature did not suggest an AVM causing death in such rapid circumstances and instead there was evidence they happened weeks or months afterwards.
Dr Bolster said they were rare, describing what occurred as a “massive, catastrophic bleed”.
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 venuous 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.”
The inquest was then adjourned and is set to resume at 10.30am on September 25, with another three days after that set aside for it to be heard.