Inquest into the death of Makushla NIKOLAEVSKY

43y · Female·pulmonary embolism

A 43-year-old woman died from pulmonary embolism after hysteroscopy for investigation of heavy menstrual bleeding. Following the procedure, she developed left leg swelling on day 3. A Venous Doppler Ultrasound was performed but did not extend above the inguinal ligament. She was reassured after negative imaging and the intrauterine balloons were removed. She collapsed the next morning with massive bilateral pulmonary embolism. Coroner found the failure to scan above the inguinal ligament was not unreasonable given the rare clinical presentation, though vascular surgeons believed extended imaging should have been performed to exclude iliofemoral thrombosis. The prescribing decisions (reduced Clexane dose and tranexamic acid) were considered reasonable given the competing risks of heavy bleeding versus thrombosis. No systemic recommendations were made due to the exceptional rarity of the case.