Pregnant woman aged 20 died of 'extraordinarily rare, catastrophic cascade of events'

By Louise Roseingrave

A woman who was 39 weeks pregnant collapsed and died from an extremely rare condition for which no cause is known, an inquest heard.

Shannon Burke (aged 20) from School Street Flats in Dublin 8 was found unresponsive in bed by her partner on January 14, 2014.

She and her baby boy died died following "a cascade of events" believed to have been triggered by amniotic fluid entering the blood stream.

Miss Burke went to the Coombe Hospital around noon the day before her death complaining of stomach pains, Dublin Coroner’s Court heard.

The woman, who had had an emergency Caesarean-section on her first child, was admitted and fully examined. The baby’s heart rate was reassuring and she was discharged, the court heard.

In the early hours of January 14, the woman’s partner Patrick Davis found her unresponsive in their bed and he called emergency services.

Paramedics began resuscitation and Miss Burke was rushed in cardiac arrest directly to the operating theatre at the Coombe Hospital. There was no obvious cause for her collapse, there was no obvious rupture of her previous scar or bleeding into the uterus, the court heard.

Her baby boy was resuscitated at birth but later died. Miss Burke was haemorrhaging and was transferred to St James’s Hospital where a laparotomy was performed in a bid to identify the source of bleeding, but no cause was found.

CPR was continued throughout but Miss Burke died despite all medical efforts to save her life.

The cause of death was cardiac respiratory collapse and disseminated intravascular coagulopathy due to amniotic fluid embolism (AFE) syndrome at 39 weeks plus three days gestation, an autopsy found.

Pathologist Dr Siobhan Nicholson said amniotic fluid had escaped into the blood stream triggering disseminated intervascular coagulopathy or the widespread activation of blood clotting.

Dr Nicholson identified a small defect at the site of the previous C-section scar which may have been where the amniotic fluid entered the blood stream but Dr Nicholson said that was not definitive.

She identified fetal squamous cells at site of the old scar, in the pelvic region and in the lung.

“This cascade of events best supports a diagnosis of AFE. It is an extraordinarily rare, catastrophic and unpredictable event for which there is no definitive cause,” Dr Nicholson said.

“It’s likely to have been something very sudden that happened in the middle of the night,” she said.

Consultant Obstetrician at the Coombe Hospital Dr Tom D’arcy said he had never experienced AFE before.

Coroner Dr Myra Cullinane returned a verdict of death due to natural causes and sympathised with the woman’s mother, brother and aunt who were present in court.

“It’s very difficult for you. That was such a tragic occurrence for the family, to lose a young girl in those circumstances. I hope in some way the facts have been clarified for you through this process,” Dr Cullinane said.


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