Lawyer died after doctors gave 16 times correct dose of labour drug

RIP Suzanne Ballantyne, who died last year from drug overdose during labor in UK as reported by London Evening Standard .

NOTE: Drug Misoprostol is one of the drugs which are used for induction of labor(forcing labor to start) which was in this situation medically indicated, because of intrauterine death of the baby ( baby died in womb). Misoprostol use has certain risks, like overstimulation of uterus ( womb will contract very strongly which can cause rupture). Kindly scroll to the bottom of this article, where you will find adviced management. 

The family of a lawyer who died after being given 16 times the recommended dose of a labour-inducing drug could sue after a coroner voiced "grave concerns".

Suzanne Ballantyne, 47, was given 800 micrograms of misoprostol at St George's Hospital in Tooting to bring on delivery after her baby, a girl, died in the womb.

Mrs Ballantyne suffered multiple ruptures to her womb, causing vital organs to fail.
Four days previously, the Royal College of Obstetricians and Gynaecologists had recommend doses no higher than 50 micrograms - though at the time of Mrs Ballantyne's death there were no official guidelines from the Government's drug rationing watchdog, the National Institute for Clinical Excellence.

At the inquest yesterday, Westminster Coroner Dr Shirley Radcliffe ordered St George's Healthcare Trust to investigate what went wrong.

Today Mrs Ballantyne's husband Stephen, a landscape gardener, said his family, including sons Ned, five, and Will, six, were devastated by their loss. He said: "Suzanne was an incredible woman, brilliant mother, an exceptional wife.

"In light of the conclusion reached by the coroner... we are taking legal advice as to whether to take matters further."

Mrs Ballantyne, a partner and property lawyer at Capsticks, was taken to St George's after collapsing. She was told her unborn daughter had died, but rather than perform a Caesarean section, doctors decided to give her the drug.

Complications caused amniotic fluid to leak from her womb into her heart and lungs, causing her death on November 14 last year. A friend today said Mrs Ballantyne had cancelled a booked private Caesarean operation just weeks earlier. "She decided not to do it because everything was going so well.

"Suzanne did not have to die. Why did someone not step in and give her a Caesarean instead of drugs?"

An internal investigation at the trust apparently found the high dosage was recommended in a report by Nice, but bosses were unable to produce relevant documents showing the figure at the inquest. Today the trust admitted the recommendations had not come from Nice.

It said: "Nice guidance at the time did not make recommendations for the specific dosages on the administration of misoprostol, and advised that the choice and dose should take into account the clinical circumstances, availability of preparations and hospital protocol."

The trust has since published a new protocol based on the Royal College guidelines.

Recording a narrative verdict, Dr Radcliffe said: "I have grave concerns that the figure of 800 micrograms hasn't got any scientific evidence to show where it came from. That is considerably higher than is currently recommended and the trust has to accept that it is likely to have had a major contribution to the development of the uterine tear.

"I do think it would be helpful for the trust to make inquiries as to how that figure has come to be in their protocol."

NICE guidelines: Induction of Labor defines protocol of management :

1.2.9             Intrauterine fetal death

1.2.9.1          In the event of an intrauterine fetal death, healthcare professionals should offer support to help women and their partners and/or family cope with the emotional and physical consequences of the death. This should include offering information about specialist support.

1.2.9.2          In the event of an intrauterine fetal death, if the woman appears to be physically well, her membranes are intact and there is no evidence of infection or bleeding, she should be offered a choice of immediate induction of labour or expectant management.

1.2.9.3          In the event of an intrauterine fetal death, if there is evidence of ruptured membranes, infection or bleeding, immediate induction of labour is the preferred management option.

1.2.9.4          If a woman who has had an intrauterine fetal death chooses to proceed with induction of labour, oral mifepristone, followed by vaginal PGE₂ or vaginal misoprostol[1], should be offered. The choice and dose of vaginal prostaglandin should take into account the clinical circumstances, availability of preparations and local protocol.

1.2.9.5          For women who have intrauterine fetal death and who have had a previous caesarean section, the risk of uterine rupture is increased. The dose of vaginal prostaglandin[2] should be reduced accordingly, particularly in the third trimester.

---

[1] At the time of publication (July 2008), misoprostol was not licensed for use for labour induction in fetal death in utero in the UK. Informed consent should therefore be obtained and documented.

[2] Vaginal PGE₂ has been used in UK practice for many years in women with a history of previous caesarean section. However, the SPCs (July 2008) advise that the use of vaginal PGE₂ is not recommended in women with a history of previous caesarean section. Informed consent on the use of vaginal PGE₂ in this situation should therefore be obtained and documented.