Twins' mum died after caesarean

A woman who died after a "model" Caesarean at a private hospital was not monitored for more than two and a half hours, during which time she suffered a fatal brain haemorrhage, an inquest heard today.

After giving birth to twins at the Portland Hospital for Women and Children, Laura Touche, 31, developed high blood pressure which led to the haemorrhage, the hearing was told.

Peter Touche, the great-grandson of the founder of the Touche Ross accountancy firm, told an inquest how his wife had been "healthy and alert" immediately after the Caesarean on 6 February 1999 but began complaining of a headache within hours.

Mr Touche, 32 - who went to the High Court to have the inquest heard - told St Pancras Coroner Dr Susan Hungerford that his New Yorkborn wife had been perfectly healthy following the operation to deliver Charles and Alexander but had later become gravely ill.

Dr Hungerford asked the consultant obstetrician Ursula Lloyd whether it was correct no observations were recorded for two and a half hours after delivery. She agreed and said: "I would expect a patient who had a Caesarean section to have her blood pressure taken quarter-hourly for at least one hour and then half-hourly, and if anything unusual had developed I would expect to be told about it." Dr Hungerford asked her: "Is it fair to describe post-operative monitoring as basic medical care?" Mrs Lloyd replied: "Basic nursing care? Yes." Asked if regular monitoring would have been expected to pick up the rise in blood pressure, Mrs Lloyd replied: "Yes."

It was only after Mrs Touche began vomiting and complaining of a severe headache that the resident medical officer at the Portland was alerted and in three readings between 1.35am and 1.55am on 7 February a high increase in Mrs Touche's blood pressure was noted.

By the time Mrs Lloyd was alerted at 4.30am, Mrs Touche had suffered a severe brain haemorrhage. Mrs Lloyd said she had spoken to the resident medical officer who said "her vomiting had worsened, she was shaky down one side. Clearly something serious had happened on one side of her brain. She looked extremely unwell, her speech was slurred; she'd had a stroke".

Earlier, Mr Touche told the nine-man inquest jury that his wife had had an uneventful pregnancy and that the operation itself "seemed to go without a hitch". Midwife Fiona Laird said of the birth: "I just recall her being so happy, completely delighted with the twins."

Mr Touche said: "It seemed like a model delivery." He added: "She seemed very, very healthy and very alert, given that she had had a major operation." The boys were delivered at 10.24 and

10.25pm but shortly before he left for home at 1am on 7 February, his wife complained of a mild headache.

He said: "We put it down to the side-effects of the spinal epidural. Laura was a very tough person and rarely had headaches. She seemed peaceful and with a mild headache but didn't seem too concerned about it."

However, when he reached home in Chelsea 20 minutes later he phoned her again. Mr Touche said: "She said she had the worst headache she'd ever had and I said, call the doctor as soon as possible." Nothing more was heard until 4am when the hospital called.

Mr Touche said: "They said my wife wasn't very well and I should come in. I saw Dr Kean (the anaesthetist) and Mrs Lloyd in a side room discussing what had happened."

His voice cracking briefly with emotion, he added: "I went into the room and saw several medical staff around her bed."

Mrs Touche was taken first to the Middlesex Hospital, where he was told she had suffered a brain haemorrhage, and then on to the National Hospital for Neurology and Neurosurgery, where she died on 15 February.

While she was in hospital Mr Touche said he, Laura's parents, Dr Kean and Mrs Lloyd - who had also delivered his brother's children - had a 40-minute meeting at the Portland. Mr Touche said: "It was really for us to get assurance that during-and after the operation Laura got the right treatment and there was nothing funny or unusual. Laura's parents wanted to know everything had been done by the book."

Mr Touche said during that meeting on 14 February the question of blood pressure had been raised. He added: "Dr Kean said that normally during a Caesarean the blood pressure goes down. In Laura's case, there was an unusual point when it wasn't down and he told me he had brought it back up again."

Mr Touche said he had not been aware his wife's blood pressure had been checked before she left the operating theatre, nor during the period that he had been with her in their private-room. He said most of the medical attention and advice being given at that period concerned breastfeeding.

Asked if Mrs Touche may have had the headache for some time but not mentioned it, he said: "Laura was a tough person who didn't want you to worry about her. She may have had it for half an hour before." But he added: "If she thought something was wrong, she would complain."

Mrs Touche's father Tom Coolidge, a biotech company executive in America, said "Laura was a very healthy child. I am not aware of any major medical problems. She had no history of high blood pressure."

The hearing continues.