New mother’s death blamed on negligence

An internal probe in the death of a 34-year-old woman days after giving birth points to medical negligence at Nicosia General Hospital.

The case dates back several years in Larnaca, when 34-year-old Greek national Demetra Manarioti went into preterm labour on the 35th week of her gestation period. She had visited the Emergency Room at Larnaca General Hospital earlier that day after feeling dizzy, accordign to reports.

Local media said the gynecologist at Larnaca General, who delivered the baby, requested for the patient to be transferred to Nicosia, either Makarios Children’s Hospital or Nicosia General, due to pregnancy complications. Reports said Makarios hospital had refused the transfer, with the health minister getting involved and making arrangements with a phone call to Nicosia General.

Manarioti was taken to Nicosia General Hospital where she died a few days later, after going in and out of the Intensive Care Unit. Reports said doctors failed to identify correctly one of two syndromes most likely associated with her pregnancy, either HELLP or TTP. The two cases have similar symptoms but require different types of treatment.

An internal probe found that results from sample tissue tests were not evaluated properly, prompting doctors to administer overnight psychoactive drugs right after birth instead of performing surgery to remove blood plasma.

Manarioti was taken to the ICU but a day later she was transferred to the hematology department, then back to the ICU later that evening, on 10 November 2013. She reportedly died the following morning after a number of heart attacks, believed to have been caused by medical drugs.

Her private doctor, who saw the blood test results earlier that evening, reportedly told the doctors at the hospital that the patient needed surgery. But state doctors decided against surgery, citing high risks according to the probe.

The coroner wrote in his report that the gynecologist at Larnaca General, according to her testimony, following the C-section, she had relayed to the anesthesiologist at Nicosia General that the patient would need surgery to remove blood plasma.

“So that they wouldn't lose her,” she reportedly explained to her colleague, adding that “if I was in her shoes, I would be up all night too.”

Another doctor at Nicosia General, who oversaw the case, testified that the removal of blood plasma was ruled out because “it is a treatment that carries a lot of risk in and of itself.” The physician clarified that she was not in a position to rule out the possibility that the patient was still suffering from a case of HELLP, following her C-section on the 35th week of gestation.

It later turned out that no test was available in Cyprus to differentiate between HELLP and TTP while no such test had been ordered overseas between the birth on November 8 and the mother’s death on November 11. The investigation also found that Manarioti was given morphine among other substances the night before her passing.

The probe, according to the coroner, found that removing blood plasma would have been the only way to reduce risk. It also said that actions or omissions by other individuals may also have contributed to Manarioti’s death.