17 November 2023 , 14:19
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A woman who felt "reassured" she would be fine to have a baby despite a heart condition died after suffering a stroke and seizures, an inquest heard.
Sarah Read, 31, and her partner Andy MacDonald, decided to have a baby and went for a pre-conception consultation at Manchester Royal Infirmary in December 2021, to discuss any risks in pregnancy.
She had been diagnosed with a heart defect just a few weeks after she was born in Burnley. She later underwent surgery to have a mechanical valve inserted and went on to have a full and happy childhood despite having to contend with regularly injecting blood thinning medication to reduce the risk of a clot developing around the mechanical valve.
They discussed with doctors the dangers of having a pregnancy after Sarah suffered a blood clot in her arm when she tried for a child previously in 2019. It was explained to Sarah and Andy that the risk of serious complications in pregnant women who have a mechanical heart valve is around 40 per cent while the risk of death is around nine per cent.
Sarah with her familyBut the couple came away from the appointment feeling "reassured" that Sarah would be well looked after and that steps had been taken to increase monitoring following the 2016 study which found the increased risk, Preston Coroner's Court heard.
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In February 2022, Sarah became pregnant and her blood thinning medication, taken to reduce the risk of a clot forming around her prosthetic valve, was switched from warfarin to tinzaparin. Warfarin can cause foetal abnormalities and resistance to anticoagulation medication increases during pregnancy so her dose was gradually increased.
As her pregnancy progressed Sarah began to notice symptoms she associated with a blood clot, such as pains in her hands and legs. By April, 2022, she also reported headaches and after going once more to A&E on April 5, she was diagnosed with having had a stroke.
Sarah needed a procedure called a thrombectomy, to manually remove the clot, but the service is not provided out-of-hours at Royal Preston Hospital. It is one of three hospitals across the north west of England offering the service and she was sent to another - Salford Royal - by ambulance, reported LancsLive.
She was later advised to terminate the pregnancy as the risk of having another stroke was increased, which was done on May 6, but three days afterwards she began to suffer seizures while in hospital due to a stroke. Sarah's partner Andy said he had "pleaded" with doctors for her to be given anti-seizure medication, and described seeing her fits as "absolutely horrific", but a 'wait and watch' approach was advised.
She continued to deteriorate and it was only 27 hours later that she was finally given anti-seizure medication. Sarah began to show signs of regaining consciousness. While she continued to "battle bravely" she remained in hospital and tragically died, at the age of 31, having been transferred to the Royal Preston Hospital, on August 7.
An inquest into her death heard emotional statements from both Mr MacDonald and Sarah's mum Gillian. In her statement Gillian, from Burnley, described her daughter as "an inspiration to all around her". She added: "She had an infectious laugh and smile and had a zest for life. She has left the biggest hole that can never be filled."
Andy said Sarah had been desperate to have children. Referring to the couple's preconception appointment in December 2021, Andy said in his statement: "I was against her having a baby herself at first but they said she could carry a child and assured me she would be in safe hands.
"We spoke about having children, she wanted a family and always wanted to be a mum. I was always in favour of surrogacy but after the consultation I was confident she would be well looked after. If we thought there had been a risk to her life we would have said no."
Dr Jordi Morell, a consultant in stroke medicine at Manchester Royal Infirmary, told the inquest that he didn't believe the seizures Sarah suffered after the termination had contributed to her death. He said: "The sooner anti-epileptic medication is started the better but I don't think it had a material impact on the outcome. I don't believe the seizures impacted on the outcome for Sarah."
Referring to the 'watch and wait' approach to administering anti-seizure medication Mr MacDonald said in his statement that he "couldn't understand why they were doing this". He added: "Her condition then substantially deteriorated; I had to go and plead with the doctor to go and see Sarah. The doctor said we were owed an apology and they felt it was now too late for her to recover. Sarah went 27 hours without anti-seizure medication."
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The inquest heard from Prof Charles Hay, a consultant haematologist at Manchester Royal Infirmary, said that he believed Sarah had not been taking her anti-coagulation medication properly. However, he added that, even if her clotting levels were satisfactory she was still at an increased risk of having another stroke.
Sarah's family were "adamant" she had been injecting the blood thinning drugs correctly. Mr MacDonald walked out of the inquest as Prof Hay said: "When Sarah was in hospital her [clotting] levels were very good. I concluded that drug compliance had to be the problem. It is a very common problem; the injections sting, it's not pleasant, and I do wonder whether she was taking every single [injection]. In hospital the levels were going up very satisfactorily and one wonders if she was always taking it twice a day; I can't think of another explanation."
Andy's mum Karen Elliott accused Prof Hay of "insulting Sarah's name", adding: "She wouldn't have missed a dose; I know that in my heart of hearts." Prof Bernard Clarke, a consultant cardiologist at Manchester Heart Centre based within Manchester Royal Infirmary, said that managing pregnancy in women who have a prosthetic valve is "very difficult". He added: "We suggested a termination because the risk of another stroke would only increase.
"She had already shown by her past history that she was predisposed to strokes. Despite the best efforts to manage the risk unfortunately there are women where it is almost impossible to manage."
Area Coroner Chris Long said he was considering making what is known as a Prevention of Future Deaths report. Coroners can make reports to a person, organisation, local authority or government department or agency where they believes that action should be taken to prevent future deaths. The inquest conclusion, along with any Prevention of Future Deaths report, will be given at a later date to be confirmed.