A West Australian coroner has raised concerns about the risk posed by some oral contraceptives in an inquest into the death of a 28-year-old woman who collapsed with a blood clot at Fremantle hospital in 2010.
The coroner Sarah Linton found it was likely the pill, combined with an apparent genetic predisposition to deep vein thrombosis (DVT), put Petra Zele at higher risk of having the pulmonary embolism that killed her.
Zele died on 1 June 2010, four days after collapsing in the hospital’s emergency department. She had been taking the contraceptive pill Yasmin since the previous November.
The doctor who attended Zele when she first went to the emergency department of Fremantle hospital, on 9 May, did not know she was taking the pill.
In findings handed down this month, Linton said the box on Zele’s triage form listing any medications she was taking was marked “nil”, and neither the nurses who attended Zele nor the emergency department doctor specifically asked her if she was on the contraceptive pill.
“Simply taking the oral contraceptive pill increased the deceased’s risk of developing venous thrombosis,” Linton said.
Studies linking oral contraceptive pills containing drospirenone to a higher risk of DVT prompted the Therapeutic Goods Administration to issue an advisory on 6 July 2011.
The only contraceptive pills containing drospirenone sold in Australia are Yasmin and Yaz.
The inquest heard that women taking Yasmin were 6.3 times more likely to develop a pulmonary embolism than women not on any form of medication. Contraceptives using a different type of progesterone increased the risk of DVT by 3.6 times.
“For the ordinary young woman with no risk factors other than being prescribed the oral contraceptive pill, that risk is generally considered to be very low,” Linton said.
But for women like Zele, who took the contraceptive pill and had a genetic predisposition to DVT, the risk was 30 times greater.
Linton said the emergency department also appeared to have either lost or failed to correctly label the transfer of an echocardiogram taken of Zele on 9 May.
Instead Zele was diagnosed with muscle pain and given some ibuprofen.
The notes of Dr Susan Hinsley, the emergency department doctor who saw Zele on that day, said “No PE risks”. Hinsley told the inquest that meant no pulmonary embolism risks.
Hinsley has since been taken before the Australian Health Practitioner Regulation Agency and found to have given an “unsatisfactory professional performance” in this case, but no disciplinary action was taken.
On 27 May Zele went to her GP complaining of chest pains and shortness of breath. The next day her father drove her to Fremantle hospital after she suffered from chest pains so severe she struggled to breathe. She collapsed on the way to hospital and was revived after 58 minutes of CPR, before being transferred to the intensive care unit.
On 31 May doctors declared her brain dead and the next day her ventilator was switched off, at her family’s request.
Linton said that had the correct diagnosis been made when Zele first went to the hospital, she would not have collapsed three weeks later.
She recommended all GPs should advise patients whenever they filled a new script for the contraceptive pill that they should declare it when asked if they were taking any medication or asked to provide a medical history.