We saved Oniyelu's life twice – LUTH management

The management of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos has described the story of one Mrs Funmilola Oniyelu published in a national newspaper recently alleging wrongful operation on her by the hospital as false.

Reacting to the allegation at a press briefing recently, the Chief Medical Director of the hospital, Professor Chris Bode said it was the patient’s condition of severe pre-eclampsia that caused her kidney failure and not the surgery.

Meanwhile, a panel set up by LUTH management comprising the heads of Obstetrics & Gynaecology, Nephrology and Legal departments to investigate the claims of the patient, submitted that the complainant, Mrs Oniyelu came into the hospital in the evening of July 23, 2008; having been referred from a private hospital in her 8th month of a second pregnancy with severe hypertension and 2+ proteinuria, first noticed four months earlier.

Mrs Oniyelu had accused LUTH of misdiagnosing her in 2015 for a Caesarean Section to deliver her of her second child.

“After the surgery, I realised that my tummy was getting bigger. When the pains became unbearable, I went to my private hospital and explained to the doctor who later examined me. It was in the process of his inspection that he discovered that the doctors who performed the surgery on me at LUTH had made a terrible mistake by cutting through my navel which he said was not proper.

“He told me that in the process of conducting the surgery, the surgeons were meant to cover two holes in my stomach but failed to do so and that it was the reason why my tummy was protruding.

“After the inspection that day, he referred me back to LUTH to meet the doctors for them to cover the holes but instead, I was told that the only option left for me was to undergo another surgery which they weren’t even sure was going to solve the problem except I did a kidney transplant. I was heartbroken.

“How could I have suddenly developed kidney problem after the surgery when I never had any sign of the sickness before that time? Before the CS, I was able to pass out urine normally without any problem and nothing was wrong with my kidneys; but immediately after the surgery, I couldn’t urinate normally again. The doctors at LUTH have used their carelessness to destroy my kidneys.

“The painful part is that they don’t even realise their error and how this has affected my life. They pretend as if all is well and have simply abandoned me to my fate. I have tried on my own to bring the attention of the hospital’s management to my plight, but so far I have not heard anything positive from them. This is not fair, I don’t deserve this type of treatment from them,” she told the newspaper.

In defence of the hospital, Prof. Bode said, “In fact, a month before presenting herself at LUTH, Mrs. Oniyelu had been admitted at the referring hospital for treatment of severe pre-eclampsia but was said to have discharged herself against medical advice from that hospital three days later, citing pressing social problems while her Blood Pressure was still elevated in pregnancy,” Bode said.

He said, on admission at the Accident & Emergency (A&E) department in LUTH, her blood pressure was highly elevated and Mrs Oniyelu was generally puffy.

“She had proteins in her urine. Gallant efforts were made to control her blood pressure. Pre-operative assessment classified her as a high-risk for surgery but since delivery of the baby was essential to save her life, an emergency Caesarian Section was performed under professionally standard conditions within six hours of presentation.

“Paediatricians and anaesthetists were present to take care of her and the baby throughout the operation and the procedure went without a hitch. Two pints of blood were provided for her by LUTH Blood Bank while her relations were yet to donate blood. LUTH Pharmacy Department provided all drugs and consumables required because her doctors wrote a cover note promising relations would sort out the payment later.

“Her severe eclampsia continued post-operatively and she received appropriate medications throughout her stay in LUTH and after discharge five days later,” Bode stated.

According to LUTH management, after Mrs Oniyelu’s discharge from the hospital, she wasn’t seen for follow-up clinics until the 22nd of June, 2015 – seven years later.

The CMD further said Mrs Oniyelu “unbooked Gravida 4 Para 3+0 (1 alive) with 2 previous Caesarean sections was admitted into LUTH, through the A&E at about 9:10am. Again, she was referred from the same Sentinel Hospital, Isolo as a case of severe preeclampsia with drainage of liquor at 36 weeks, blood pressure of 170/120mmHg and a doubtful fetal heart beat. She was reviewed by the O&G Duty Senior Registrar at 9:15am.”

He said Mrs Oniyelu was a known hypertensive with history of severe pre-eclampsia in all her previous pregnancies presented with a history of abdominal pain and onset of uterine contractions of more than 4 hours duration, following rupture of her membranes with associated bleeding per vaginam with passage of clots.

“On examination, she was in painful distress, afebrile with bilateral pitting pedal oedema. Her pulse rate was 98 bpm and blood pressure was 190/110mmHg. Fetal parts were easily palpated on abdominal examination and fetal heart tone was not heard. Vulva was smeared with blood and blood clot. A clinical assessment of suspected uterine rupture with severe preeclampsia was made by the Duty Senior Registrar on-call. She was resuscitated with intravenous fluids and parenteral Labetalol to control her blood pressure.

“The Consultant in charge was immediately informed and Mrs Lola Oniyelu was transferred to the Labour ward theatre for emergency exploratory laparotomy. Appropriate investigations rapidly done at presentation revealed PCV of 21 per cent and proteinuria of 3+.

“She was rushed into the theatre and surgery was commenced immediately. Intra-operative findings were uterine scar dehiscence, with herniating membranes, thinned and friable lower uterine segment, abruptio placenta with massive retroperitoneal clots, female fresh still birth weighing 1 kg, atonic Couvellaire’s uterus, with active bleeding and estimated blood loss of 3.5 litres. She had sub-total hysterectomy due to uncontrolled haemorrhage resulting from uterine atony secondary to Couvellaire’s uterus that was not responsive to parenteral oxytocics. An initial informed consent had been taken for possible hysterectomy prior to surgery. She was transfused with 5 units of blood intra-operatively.”

Bode said her post-operative period was co-managed with the Consultant Nephrologist on account of persistent elevated Blood Pressure and deranged renal function tests.

“On the 3rd post-operative day, she had elevated urea and creatinine levels. During this period, her urinary output was adequate, ranging between 1200 to 2350 mls but the abdominal drain was still active with the drainage of sero-sanguinous effluent. She was on oral antihypertensive, Aldomet 500mg 8 hourly and Nifedipine 40mg 12 hourly for blood pressure control.

‘She was closely monitored for symptoms of imminent eclampsia and her daily proteinuria which had reduced to 2+. Despite monitoring, she had an episode of post-partum eclampsia on 5th post-operative day which was aborted by the use of parenteral magnesium sulphate.

“Serial renal function tests done showed marked elevation in the urea and creatinine levels, necessitating the need for haemodialysis by the Nephrologist. Mrs Oniyelu was also co-managed with the Consultant Urologist and the Consultant Radiologist.  Abdomino-pelvic scan done revealed bilateral shrunken kidneys with increased cortical echogenicity and loss of corticomedullary differentiation indicative of grade III renal medical disease. There was mild ascites but no hydronephrosis and the urinary bladder through the urethral catheter did not result in coloured or increased effluent drainage from the equivalent to the volume instilled.

“The Urologists subsequently managed her conservatively with further retention of the urethral Foley’s catherer for additional 10 days. During this period, Mrs Lola Oniyelu had no abdominal pain or abdominal swelling or leakage fluid from the drain site. Her urinary output was satisfactory and the wound and drain site had healed completely. After three sessions of haemodialysis, the Consultant Nephrologist discharged her, on 13 July 2015 to the Medical Outpatient Clinic for follow-up. Her urethral catheter. She was subsequently discharged home and referred to the Urology, Nephrology and Post-natal Clinics for follow-up. However, Mrs Oniyelu did not come for her follow-up appointment at the Postnatal Clinic,” Bode revealed.

Responding to a question as to why Mrs Oniyelu was not contacted while the management of the hospital was investigating the issue, the CMD said, “we tried to reach her but couldn’t. We are still waiting for her to know why she would have made such allegations without contacting the hospital taking care of her.

“LUTH saved Mrs Oniyelu’s life twice as she was rushed to LUTH with two unbooked pregnancies that threatened her life.

“Each time, LUTH wasted no time in operating on her immediately, each time giving her the sort of treatment in keeping with internationally recommended protocols for her life-threatening conditions. LUTH and its teams are proud to have saved Mrs Oniyelu’s life each time she arrived at our door as an emergency in grave conditions with complications of pregnancies that had been managed elsewhere.”

Others present at the briefing include the Chairman, Medical Advisory Committee, Dr Olufemi Fasanmade; Director of Administration, Babajide Grillo; Dr Ayodeji Oluwole of the Department of O&G, LUTH and Professor Lara Mabayoje.