Novum Law supports Modar Mohammednour whose wife Rana died after giving birth at Gloucestershire Hospital

Novum Law is providing legal support to Modar Mohammednour, whose wife Rana (also known as Rana Abdelkarim) died at the Gloucestershire Royal Hospital after giving birth to their daughter (baby Rana) on 8 March 2021.

Rana, originally from Sudan, lived in Gloucestershire with her husband, Modar and their 3-year-old daughter, Reem. She tragically died of a significant post-partum haemorrhage (excessive bleeding after giving birth) at Gloucestershire Royal Hospital shortly after delivering the couple’s second child. She was just 38 years old.

Gloucestershire Hospitals NHS Foundation Trust has admitted liability for Rana’s death. An inquest into her sudden and unexpected death will take place next month on 7 March 2023.

Modar has been speaking to the BBC about his ordeal; you can read more here. An interview with Modar on BBC Points West was broadcast today (Tuesday, 7 February), and can be watched below.

Lead up to Rana’s death

Rana, who did not speak English as her first language, had undergone female genital mutilation (FGM), had hepatitis B and a history of gestational diabetes (GDM). Due to her GDM, the hospital decided to induce her labour at 39 weeks.

However, neither Rana nor Modar understood the hospital’s plans for her induction that day. The Trust provided no interpreter, so the couple, whose English was limited, were unaware of their options and were not fully supported to make an informed choice.

The language barrier also meant that Modar remained at home looking after their first child, not knowing that his wife was in labour.

Rana gave birth vaginally without her husband by her side. She started bleeding heavily within a minute of her daughter’s birth. Staff gave her medicines to stop the bleeding before applying bi-manual compressions to her uterus to stop the blood flow.

Unfortunately, Rana’s condition rapidly began to deteriorate as she continued to suffer significant blood loss. An emergency call for a ‘massive obstetric haemorrhage’ prompted more clinicians to attend, and staff administered further intravenous fluids.

After 47 minutes of continued heavy bleeding, Rana was transferred to the operating theatre for an examination under anaesthetic (EUA) to assess where the bleeding was coming from and to perform any required surgical procedures to stop the bleeding. At this point, she had lost over 2 litres of blood (2,021 ml).

More attempts were made to stop the bleeding, but Rana became unresponsive. Her heart stopped beating, and cardiopulmonary resuscitation (CPR) was started. Unfortunately, all attempts to stop the bleeding and resuscitate Rana failed and her death was confirmed. At the time of her death, she had lost over 6.6 litres of blood (6,621 ml).

Tragically her husband was not called until after her death and so had absolutely no idea that the couple’s second child had been born, let alone that his wife was critically unwell.

Healthcare Safety Investigation Board’s findings

 The Healthcare Safety Investigation Board (HSIB) is an independent body funded by the government to investigate serious incidents involving patient safety in the NHS in England. Its recommendations aim to improve healthcare systems and processes, reduce risk and improve safety.

Following Rana’s death, HSIB investigated the incident and published its findings in a report with key findings and  10 safety recommendations.  Findings include:

• Lack of interpreter – There was insufficient interpretation support at the time the Induction of Labour (IOL) was discussed, so when Rana was admitted to the hospital, she was uninformed. Interpretation services were not available during the IOL process, or once Rana was in labour, so her husband remained uninformed.  Furthermore, there was no effective communication with Rana when her condition became critical.
• Lack of regular assessments – The investigation also found that regular assessment of maternal and fetal wellbeing was not provided for over 3 hours, with a failure to document the presence of blood-stained liquor (amniotic fluid) on the handover of care between staff. There was no multi-disciplinary (MDT) involvement in Rana’s care until her condition deteriorated after birth.
• No emergency call bell – The emergency call bell was not activated when staff observed Rana’s heavy bleeding. This meant that for nearly 30 minutes, the obstetric emergency was unknown except to the people in the room.  Staff were also falsely reassured by an inaccurate reading of Rana’s blood pressure and pulse despite further readings showing she was tachycardic (heart beating faster than normal) and a failure to promptly repeat the blood pressure check.
• Lack of haemorrhage assessments – Ongoing assessments of the obstetric haemorrhage and Rana’s condition were not made. While the Consultant Anaesthetist was called to attend, it was 38 minutes after the major postpartum haemorrhage “code red” protocol was called, and there was a failure to call the Consultant Obstetrician at the same time.
• Delay in getting blood products – When transferred to the operating theatre for examination under general anaesthetic, there was a delay in requesting and administering blood products, with the first transfusion starting 53 minutes after the ongoing bleeding.
• Trust’s guidelines not followed – The investigation noted that the Trust’s Guidelines for massive obstetric haemorrhage and “code red” were not followed.

Expert view from Novum Law

Medical negligence solicitor Hannah Carr, who specialises in women’s health and pregnancy and birth claims and represents Modar and his family, says:

“This is a desperately sad and shocking case in which severe and multiple failures by maternity staff at the Royal Gloucestershire Hospital resulted in a man losing his wife and two young children being left without their mother in very distressing circumstances.

“The appalling lack of interpretation services meant that Rana and her husband were left entirely in the dark; Modar wasn’t even aware his wife was in labour. Staff only contacted him after the birth of his new baby when Rana’s condition deteriorated and her life was in danger. However, unimaginably, his wife’s critical condition was not communicated to him.  By the time he got to the hospital, tragically, it was too late, and Rana had died after losing over 6 litres of blood.

“Without her husband at her side and without interpretation services, I cannot begin to imagine the trauma that Rana must have experienced.  Similarly, Modar’s knowledge of the circumstances in which Rana tragically lost her life continues to traumatise him.

“The HSIB report reveals serious maternity care failings by the trust. The couple were repeatedly failed by the healthcare professionals they had put their faith in to deliver their baby safely and protect their family from harm.

“When Rana started bleeding, a systematic risk assessment was not carried out, and a referral to an obstetrician was not made. The emergency call bell was not activated while Rana continued to bleed heavily; there was an unforgivable 38-minute delay before the consultant anaesthetist was contacted after a major post-partum haemorrhage ‘code red’ was declared and a 53-minute delay in administering blood products.

“What happened to Rana highlights the importance of the need for appropriate interpretation services and a complete and proper blood loss assessment following a post-partum haemorrhage; and a multi-disciplinary approach to obstetric emergencies, including appropriate escalations to senior on-call staff and the prompt attention of the anaesthetic team.

“Nothing can make up for the tragic loss of Rana, a devoted wife and mother. But we will be supporting Modar throughout next month’s inquest and are determined to help him get the answers he desperately needs to understand why this happened and to ensure vital lessons are learned so that other families don’t have to suffer a similar devastating loss.”

Speaking to the BBC about his wife’s death, Modar said:

“He [the doctor] just came back and said to me: ‘I did the best to save her life, but I couldn’t.

“I was feeling – ‘I am dreaming’. She was talking to me yesterday. She was so in good health; what happened to my wife?”

Modar, who is now bringing up his two daughters alone, said his eldest daughter Reem asks him “all the time about her mum.”

“My excuse is just to say to her, ‘she is in paradise’,” he added.

If you have any concerns about the treatment you and your baby have received at the Royal Gloucestershire Hospital or another hospital or healthcare setting, Novum Law’s specialist medical negligence solicitors may be able to help on a No Win No Fee basis.

To find out more information about making a compensation claim, contact us at 0800 884 0777, email info@novumlaw.com or fill out our online enquiry form.