Coroner flags hospital communication failures after new mother’s death from liver complications

An inquest into the death of 30-year-old data analyst Gemma Robins, who passed away 40 days after delivering her first child, identified a missed opportunity to test for pre-eclampsia during an April antenatal visit. After presenting with persistent vomiting, she was admitted to Worthing Hospital, delivered by Caesarean section, and transferred to intensive care at Royal Sussex Hospital where she suffered internal bleeding and a serious liver condition.

Delays caused by fragmented communication between clinicians at University Hospitals Sussex NHS Foundation Trust and the hepato-pancreato-biliary team at Royal Surrey NHS Foundation Trust led to emergency surgery in Guildford, after which no further options were available. Senior Coroner Penelope Schofield criticised the “confused” lines of communication and called for a unified, real-time platform for clinicians across trusts.

The coroner issued prevention-of-future-deaths reports to both trusts, noting that while communication failures were not the direct cause of death, they pose a risk to future patients. The family, represented by Meg George of Leigh Day, continues to seek answers and campaign for improved antenatal screening and treatment of acute fatty liver of pregnancy.