The inquest into the death of a pregnant woman who died during emergency surgery at the National Maternity Hospital, Holles Street in Dublin last year has heard her husband does not feel he is able to attend due to mental distress.
Malak Thawley, 35, died during emergency surgery for an ectopic pregnancy on 8 May 2016.
The inquest into her death resumed today at the Dublin Coroner's Court, without her husband Alan Thawley present, before Dr Myra Cullinane.
His solicitor, Caoimhe Haughey, said he was advised by his psychiatrist that it is not in his best interests to attend today.
She said he was anxious that a statement from him be read out after the inquest had finished, which she said had been prepared with great consideration.
Dr Cullinane was given the statement to consider.
She said she was very moved by it, but it could not form part of her inquiry in its current format.
The inquest heard from a number of doctors and nurses present on 8 May 2016.
It was told there were fewer staff as it was a Sunday, and only on-call people work at the weekend.
The inquest was told that surgery was under way when unexpected bleeding was discovered.
Dr David Crosby was working as a second year Specialist Registrar in Obstetrics and Gynaecology at Holles St and was on a 12 hour shift that day.
He told the inquest it was the first maternal death he had been involved in. He extended his sympathies to the family.
Prior to that date he had performed 92 laproscopy procedures and had been signed off as competent to perform them without supervision.
He told the inquest he met the couple that afternoon and was informed there was a suspected ectopic pregnancy. He said it would be likely that surgical intervention would be required and explained the risks. He discussed the matter with a consultant by phone as was routine procedure.
The operation started at 4.38pm.
When Dr Crosby made the incision with a spring-loaded needle he said he was conscious of blood vessels in the area. He told the inquest he did not believe he put the needle in too far, as readings from a monitor showed it was not touching anything.
He then inserted a surgical instrument to place a small camera in the area. But his vision was obscured. He thought there were specks of blood on the camera, so he removed it, wiped it and reinserted it. It was still obscured.
He then used a different instrument and saw about 200mls of blood. Dr Crosby said he believed at this point it was a ruptured ectopic pregnancy.
He then asked the scrub nurse to contact the Consultant Obstetrician on call - Dr Declan Keane - and ask him to attend theatre.
A team from St Vincent’s Hospital was called to assist.
The inquest also heard there were no vascular clamps at Holles Street. They had to be obtained from St Vincent's. Other medical instruments were brought to Holles Street by garda escort from Blackrock Clinic.
Anaesthetic nurse Auri Tavisora told the inquest Mrs Thawley was very anxious before the procedure. She held the nurse's hand very tightly and asked her to pray for her, which she did.
She said she had to leave the theatre at one point but as she returned she heard the word "ruptured".
She was asked by Dr Crosby for the cross match of six units of red blood cells. Nurse Tavisora said she bleeped the laboratory three times with no answer.
The Senior House Officer also bleeped the lab, they returned the call at 4.56pm and Major Obstetric Haemorrhage plan was activated.
Nurse Tavisora got two units of O Negative blood in the theatre fridge. There were four available. She said there was a delay for more blood to arrive.
Dr Maitiú Ó Tuathail told the inquest he was working as a Senior House Officer in the Emergency Department that day.
It was suggested to him he should observe the procedure as it was the first time he had seen one.
A doctor was called away and he was asked to scrub in. When the bleeding became evident he said he recalled Dr Crosby say it was either an erupted ectopic or a vascular injury.
He was asked to activate the Major Obstetric Haemorrhage plan.
The anaesthetic team requested ice but there was none in the hospital.
The inquest heard Dr Ó Tuathail managed to get some from a pub nearby.
Time of death for Mrs Thawley was recorded as 7.57pm.
The inquest is expected to hear from 16 witnesses in total.
