Royal College says deaths of two women from herpes after they had caesareans six weeks apart should be ‘fully investigated’ with surgical infection a ‘significant possibility’
The deaths of two new mothers from herpes should be fully investigated, the Royal College of Obstetricians and Gynaecologists has announced.
The cases of Kimberly Sampson, 29, and Samantha Mulchay, 32, need to be looked into because ‘surgical infection appears to be a significant possibility’.
The professional association also said advice on how women who have just given birth are treated for sepsis will change.
Ms Sampson died after complications following a C-section at Queen Elizabeth The Queen Mother Hospital in Margate, Kent.
Ms Mulchay died six weeks later at William Harvey Hospital in Ashford, which is run by the same NHS Trust.
There are fears the same surgeon may have infected both mothers while performing the operations.
Kimberly Sampson, 29, was a ‘brilliant mummy’ who was ‘fun’, ‘loving’, and had ‘lots of friends’, her mother Yvette Sampson said
Samantha Mulchay, pictured with her husband Ryan, went into labour four weeks ahead of her due date and went into the William Harvey Hospital in Ashford, run by the same Trust as Ms Sampson’s hospital, in July 2018
How pregnant women are at a higher risk of dying from herpes because their immune systems are compromised
The survival rate of herpes patients is 80 per cent in those who are given treatment.
But for those with compromised immune systems, this can drop to as low as 40 per cent, according to some estimates.
Pregnant women are at a higher risk of serious illness because they fall into the immunocompromised category.
Individuals undergoing chemotherapy or recovering from an organ transplant can also be at high risk.
The risk of serious illness is higher in those who are not treated, with survival rates just 30 per cent.
Severe herpes infections can cause serious health conditions like encephalitis and meningitis, types of inflammation of brain tissues in response to the infection.
Disseminated infection can also occur which is where an infection from the herpes virus spreads from a localised area, (such as the mouth) to other parts of the body, leading to potential organ failure.
There are two types of herpes, herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2.
HSV-1 is mainly transmitted by oral-to-oral contact and causes blisters commonly called ‘cold sores’ , but it can also cause genital herpes.
HSV-2 is the solely sexually transmitted infection that causes genital herpes.
Both types of herpes are lifelong conditions which are incurable but manageable.
President of the RCOG Edward Morris today said their deaths should be ‘fully investigated’ as ‘surgical infection appears to be a significant possibility’.
He told the BBC routine investigation and management of maternal sepsis ‘should always consider viral sources of infection, and appropriate changes should be instituted to support earlier diagnosis and treatment’.
HSV-1, one of two strains of the herpes virus, only very rarely leads to death in healthy people.
But Ms Sampson and Ms Mulchay died from an infection caused by the virus just six weeks apart, in May and July 2018.
The East Kent Hospitals Trust said it could not identify the source of the infection and the surgeon did not have a history of the virus.
A pathologist who investigated the deaths believed the women had been infected before they were admitted to hospital.
But sexual health consultant Peter Greenhouse said it was ‘very unlikely they acquired it before they got into hospital’.
He added it was most likely that the infection was given to the two women by the surgeon accidentally in the C-section.
He said it was possible the surgeon might have had a herpes infection on the finger which could have ‘directly seeded the herpes into the abdomen of the women’.
Ms Sampson, a barber who lived in Whitstable, Kent, with her three-year-old daughter, was a ‘brilliant mummy’ who was ‘fun’, ‘loving’, and had ‘lots of friends’, her mother Yvette Sampson said.
After a smooth pregnancy Ms Sampson went on to Queen Elizabeth the Queen Mother Hospital’s labour ward in Margate thinking ‘everything was going to be fine’, but her labour was not proceeding quickly and she kept saying the baby was stuck, her mother said.
Doctors performed a C-section and her son was delivered, but Ms Sampson needed a blood transfusion following injuries sustained in the operation.
She asked to be discharged with her baby after two days, but was in a lot of pain and could barely walk.
She left the hospital with her mother, but the pain got worse, to the point where even a slight touch would cause her to scream in pain, Yvette said.
Ms Sampson was rushed back to hospital in an ambulance.
Ms Mulchay went into labour four weeks ahead of her due date and attended the William Harvey Hospital (pictured) in Ashford, run by the same Trust as Ms Sampson’s hospital
Doctors believed she had bacterial sepsis, so Ms Sampson was sent back to the maternity ward and given antibiotics, but her condition became worse.
Doctors struggled to identify and treat the infection amid a series of operations, and eight days after she was readmitted a consultant microbiologist suggested trying Acyclovir – an antiviral drug used to treat herpes infections.
Trust’s record of failures
The trust at the centre of both women’s deaths has previously been criticised for failures in maternity care.
In June this year, the East Kent Hospitals Trust was fined £733,000 over the death of baby Harry Richford in 2017 after admitting failing to provide safe care and treatment. A coroner said it was ‘wholly avoidable’.
Up to 15 babies have died at the trust’s hospitals since 2011 and ministers have ordered an independent review.
Last month an inspection revealed the trust did not have enough maternity staff to keep mothers and newborns safe.
Numbers were sometimes so low that women had to be transferred to different hospitals during labour, the Care Quality Commission said. Midwives often had to care for two women at once.
Ms Sampson was transferred to Kings College Hospital in London and diagnosed with a catastrophic herpes infection. She died on May 22.
Six weeks later nursery nurse Ms Mulchay, who lived just 20 miles from Ms Sampson, died of the same condition.
Ms Mulchay went into labour four weeks ahead of her due date and went into the William Harvey Hospital in Ashford, run by the same Trust as Ms Sampson’s hospital, in July 2018.
She was left exhausted and in pain following 17 hours of contractions and was taken for a C-section following some worrying blood test results.
Ms Mulchay gave birth to a healthy baby girl, but doctors kept the new mother in for observation.
She started to deteriorate after three days, with a swollen stomach, high blood pressure and a temperature.
Doctors also though Ms Mulchay had bacterial sepsis, but, like Ms Sampson, antibiotics did not work.
Ms Mulchay stayed for four days in intensive care, where a doctor suggested antiviral medication, but the microbiology department advised them to continue with antibiotics.
Doctors called a London hospital for support and surgeons attempted to stabilise her, but they could not save her.
A post-mortem revealed that Ms Mulchay died from multi-organ failure following a ‘disseminated herpes simplex type 1 infection’, meaning an overwhelming infection caused by HSV-1.
Neither mother’s child was found to have been infected.
Both woman had a ‘primary infection’, meaning it was their first time being infected by herpes.
Ms Sampson’s family requested documents from Public Health England which revealed two email chains between the East Kent Hospitals Trust, some NHS bodies, staff at PHE, and a private lab called Micropathology.
In the emails, which are partly redacted by PHE to hide names of those involved, someone from the Trust reveals that the same two clinicians – a midwife and the surgeon who carried out the C-sections – had taken part in the deliveries of both babies.
But more than a year after their deaths, the families received a letter from coroner Katrina Hepburn saying there would not be an inquest for either case, acknowledging the similarities but saying there was ‘no connection’.
Dr Rebecca Martin, Chief Medical Officer for East Kent Hospitals, said: ‘Our deepest sympathies are with the families and friends of Kimberley and Samantha.
‘East Kent Hospitals sought specialist support from Public Health England (PHE) following the tragic deaths of Kimberley and Samantha in 2018.
‘The investigations led by the Trust and the Healthcare Safety Investigation Branch took advice from a number of experts and concluded that it was not possible to identify the source of either infection.
‘The surgeon who performed both caesarean sections did not have any hand lesions that could have caused infection, or any history of the virus.
‘Kimberley and Samantha’s treatment was based on the different symptoms showed during their illness.
‘Our thoughts are with their families and we will do all we can to answer their concerns.’