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Mother who died after C-section had lost two litres of blood, inquest hears Mother who died after C-section had lost two litres of blood, inquest hears
(35 minutes later)
A mother who died just hours after giving birth to her second child had lost more than two litres of blood shortly before going into cardiac arrest following emergency surgery, an inquest has heard.A mother who died just hours after giving birth to her second child had lost more than two litres of blood shortly before going into cardiac arrest following emergency surgery, an inquest has heard.
Primary school teacher Frances Cappuccini, 30, from Offham, Kent, who had wanted an elective caesarian section having had a traumatic first birth, had agreed to try for a vaginal birth on admission to Tunbridge Wells hospital, before an emergency C-section had to be performed.Primary school teacher Frances Cappuccini, 30, from Offham, Kent, who had wanted an elective caesarian section having had a traumatic first birth, had agreed to try for a vaginal birth on admission to Tunbridge Wells hospital, before an emergency C-section had to be performed.
The inquest, at Gravesend, Kent, heard the surgeon left a piece of the placenta – measuring 60mm by 35mm by 30mm – in the uterine cavity, which had led to postpartum haemorrhage.The inquest, at Gravesend, Kent, heard the surgeon left a piece of the placenta – measuring 60mm by 35mm by 30mm – in the uterine cavity, which had led to postpartum haemorrhage.
The woman was rushed into surgery, and the remaining placenta was removed, but she did not come round from the general anaesthetic. Cappuccini was rushed into surgery, and the remaining placenta was removed, but she did not come round from the general anaesthetic.
The inquest has heard Cappuccini was “terrified” of having her second child following a traumatic birth with her first son four years earlier and wanted a C-section.The inquest has heard Cappuccini was “terrified” of having her second child following a traumatic birth with her first son four years earlier and wanted a C-section.
Her husband, Tom Cappuccini, has previously told the hearing she went into hospital on 8 October 2012 feeling certain she wanted a C-section on the advice of a consultant obstetrician at nearby Maidstone hospital.Her husband, Tom Cappuccini, has previously told the hearing she went into hospital on 8 October 2012 feeling certain she wanted a C-section on the advice of a consultant obstetrician at nearby Maidstone hospital.
She had booked the procedure for the following Monday – two days later – but had arrived at 8.30pm after going into labour. Her husband has told the inquest she was persuaded to have a vaginal birth.She had booked the procedure for the following Monday – two days later – but had arrived at 8.30pm after going into labour. Her husband has told the inquest she was persuaded to have a vaginal birth.
At 8.20am the following day, after 12 hours of labour, a C-section was performed.At 8.20am the following day, after 12 hours of labour, a C-section was performed.
Senior registrar Dr Gabriella Gray, who was caring for Cappuccini in the delivery suite following the C-section, agreed that between 10am and 11.30am she had lost two litres of blood, including during the procedure itself and through suffering a “gush of blood” and clots shortly after the birth.Senior registrar Dr Gabriella Gray, who was caring for Cappuccini in the delivery suite following the C-section, agreed that between 10am and 11.30am she had lost two litres of blood, including during the procedure itself and through suffering a “gush of blood” and clots shortly after the birth.
Gray described the blood loss as “significant but not life-threatening”. Cappuccini lost an additional 300ml during emergency surgery when the piece of placenta was found.Gray described the blood loss as “significant but not life-threatening”. Cappuccini lost an additional 300ml during emergency surgery when the piece of placenta was found.
Following that surgery, Gray said she was told there was a problem with Cappuccini “maintaining her airways” and that she was “breathing irregularly”. She was being ventilated but went into cardiac arrest and died at 4.20pm.Following that surgery, Gray said she was told there was a problem with Cappuccini “maintaining her airways” and that she was “breathing irregularly”. She was being ventilated but went into cardiac arrest and died at 4.20pm.
Cross-examined by Neil Sheldon, lawyer for the family, Gray agreed that the level of blood loss would have been categorised as a “severe postpartum haemorrhage” for which the hospital trust had protocols.Cross-examined by Neil Sheldon, lawyer for the family, Gray agreed that the level of blood loss would have been categorised as a “severe postpartum haemorrhage” for which the hospital trust had protocols.
She denied she had infused insufficient fluid replacement to counter the lost blood, saying the Trust’s protocols were for ongoing blood loss, and “this was not ongoing blood loss. It was a gush of blood”.She denied she had infused insufficient fluid replacement to counter the lost blood, saying the Trust’s protocols were for ongoing blood loss, and “this was not ongoing blood loss. It was a gush of blood”.
Sheldon put it to her that the fluid balance charts, which noted what fluid replacements had been administered, were “completely lacking in any useful information”. Gray agreed they were “poor” but said any other medical teams carrying out treatment on Cappuccini would have been given that information by the consultant in charge.Sheldon put it to her that the fluid balance charts, which noted what fluid replacements had been administered, were “completely lacking in any useful information”. Gray agreed they were “poor” but said any other medical teams carrying out treatment on Cappuccini would have been given that information by the consultant in charge.
The inquest has heard the young mother’s last words to her husband as she was taken into surgery were: “I love you and if anything happens make sure you look after the boys.”The inquest has heard the young mother’s last words to her husband as she was taken into surgery were: “I love you and if anything happens make sure you look after the boys.”
The family’s lawyer has said they believe that if a C-section had been undertaken at the earlier opportunity, Cappuccini’s death may have been avoided, something the Maidstone and Tunbridge Wells NHS Trust denies.The family’s lawyer has said they believe that if a C-section had been undertaken at the earlier opportunity, Cappuccini’s death may have been avoided, something the Maidstone and Tunbridge Wells NHS Trust denies.
The inquest was originally halted in 2014 when it became apparent that criminal charges could be brought. Maidstone and Tunbridge Wells NHS Trust made legal history by becoming the first NHS trust to face corporate manslaughter charges. But the case was dismissed by a judge at the Inner London crown court in February 2016.The inquest was originally halted in 2014 when it became apparent that criminal charges could be brought. Maidstone and Tunbridge Wells NHS Trust made legal history by becoming the first NHS trust to face corporate manslaughter charges. But the case was dismissed by a judge at the Inner London crown court in February 2016.
Dr Erroll Cornish, the consultant anaesthetist who treated her, was also told he had no case to answer with regards to gross negligence manslaughter charges against him. Another doctor, Nadeem Azeez, also had charges against him dropped. Dr Erroll Cornish, the consultant anaesthetist who treated Cappuccini, was also told he had no case to answer with regards to gross negligence manslaughter charges against him. Another doctor, Nadeem Azeez, also had charges against him dropped.
The inquest, which is due to last 10 days, continues.The inquest, which is due to last 10 days, continues.