Deceased
Lesley Anne Galea
Demographics
30y, female
Date of death
1999-04-30
Finding date
2002-02-28
Cause of death
respiratory failure related to bronchopneumonia following cerebral anoxia due to amniotic fluid embolism following uterine rupture during labour
AI-generated summary
A 30-year-old woman with a previous caesarean section attempted a trial of vaginal delivery. She received Syntocinon augmentation at 6:45 AM without prior cervical assessment and epidural analgesia at 7:35 AM. No vaginal examinations were performed between 1:00 AM and 9:30 AM despite these interventions. Continuous electronic fetal monitoring was delayed until 8:00 AM. She collapsed at 9:30 AM with amniotic fluid embolism following uterine rupture, suffering catastrophic cerebral hypoxia, cardiac arrest, coagulopathy, and eventual death from bronchopneumonia 4 months later. The coroner found inadequate labor progress assessment, insufficient fetal heart monitoring given multiple risk factors (trial of scar, Syntocinon, epidural), and poor communication between midwifery and medical staff. While the amniotic fluid embolism itself was unpredictable, earlier delivery through appropriate fetal monitoring and labor assessment might have prevented uterine rupture.
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Specialties
Error types
Drugs involved
Clinical conditions
Procedures
0y · Male·hypoxic ischaemic encephalopathy due to intrapartum asphyxia
Bodhi Leo Searle, aged 36 hours, died from hypoxic ischaemic encephalopathy due to intrapartum asphyxia. He was born to a woman in low-risk labour managed initially by independent midwife Stephanie Geyer. When labour did…
0y · Female·hypoxic ischaemic encephalopathy secondary to intrapartum hypoxia
A 2-day-old neonate, Laura Angela Willmett, died from hypoxic-ischaemic encephalopathy following intrapartum hypoxia. She was born by emergency caesarean section after a planned vaginal birth after caesarean (VBAC) at a …
25y · Female·ruptured splenic artery aneurysm with haemorrhage and internal blood loss
A 25-year-old pregnant woman (23 weeks) presented to hospital with sudden left upper quadrant abdominal pain and loss of consciousness. Clinical assessment identified renal colic and gallstones as likely diagnoses. She r…
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