A pregnant woman died in hospital due to a rare, life-threatening condition, according to a Fatal Accident Inquiry.
Jacqui Hunter was admitted to Ninewells Hospital in Dundee on May 13, 2020, to give birth to her baby, who had died in utero a day prior.
The previous day, the mum-to-be called the maternity triage and said she was experiencing reduced foetal movement.
It was also found that Ms Hunter had also discussed her concerns with her community midwife at Lochee Medical Practice the day before.
Ms Hunter and her husband Lori-Mark Quate, from Angus, were told to make their way to the Dundee hospital immediately to undergo an ultrasound scan.
The couple were later informed that their unborn child had died.
The 39-year-old was offered an induction of labour to deliver the baby.
Ms Hunter was prescribed misoprostol, which can start the labour process. The couple were allowed to return home to process the news before returning to Ninewells at 8am the next morning.
During the day, medical teams noted that Ms Hunter had been given more misoprostol than the guideline dose.
As an epidural was about to be administered at around 2.25pm, the 39-year-old fainted. Ms Hunter was transported to the theatre after she became unresponsive.
Medical teams attempted to revive the Angus woman, but she suffered a cardiac arrest at 2.52pm. She was pronounced dead at 4.29pm in Ninewells Hospital.
A post-mortem determined that an amniotic fluid embolism, which is a life-threatening childbirth emergency where amniotic fluid enters the bloodstream, was the cause of Ms Hunter’s death.
After receiving expert opinion regarding the dosage of misoprostol, Sheriff Jillian Martin-Brown “made no formal findings in respect of the effect of the overdose” on the death.
However, following the error made by medical teams in Ms Hunter’s case, a change in prescription practice at Ninewells Hospital has taken place to ensure a similar mistake doesn’t occur.
In conclusion, Sheriff Martin-Brown said: “Ms Hunter’s death and that of her baby Olivia were utterly tragic, and I wish to express my sincere condolences to Mr Quate and to Ms Hunter’s family, which were echoed in the submissions made by all parties.”
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