A nurse who became the 10th woman to die after giving birth at Northwick Park Hospital's maternity unit may have been saved if her doctor had 'paid more attention,'an inquest has heard.
Ana Maria Denzo, 30, who also worked at the hospital, suffered severe bleeding after a caesarean section in 2005. Her daughter and only child, Areanne, survived.
An investigation led by the Health-care Commission was launched after her death, and the hospital's maternity unit was placed on 'special measures' until it was deemed up to scratch a year later.
However, the hospital in Watford Road, Harrow, hit the headlines again last month when the Observer reported three more women had lost their lives in the past year, bringing the total to 13.
At Hornsey Coroner's Court this week, Mrs Denzo's consultant, Dr John O'Riordan, admitted he failed to examine her and instead left her to be treated by a midwife.
Lawyers also said Mrs Denzo, from Ealing, was given too much of the drug Syntocinon, which could have lead to her haemorrhaging.
Midwife, Florence Okpara, admitted she should have told the doctor what was happening and reduced the drug.
Speaking at the court, Dr O'Riordan, a consultant obstetrician, said the baby was big, and there was a chance she would have been too big to have been delivered naturally. He said: "I should have paid more attention to the fact it was a big baby. I am obviously disappointed with myself. As you know the unit had been going through quite a tough time and generally there was no worry whatsoever about calling people."
Dr O'Riordan also said he missed a second chance to save Mrs Denzo when he left two other surgeons to deal with her bleeding after the caesarean section was finally carried out.
The Healthcare Commission has already criticised Dr O'Riordan for failing to assess her during a slow and difficult labour and coroner, Andrew Walker, slammed the standards at the hospital.
He said: "If you had been back you might have been able to stop this.
"Had you gone into theatre you might have had an advantage in dealing with the haemorrhage because of your experience."
The first nine deaths at Northwick Park Hospital occurred between April 2002 and September 2004 but the hospital insisted there was nothing linking them.
It was only when the Healthcare Commission report was released and special measures imposed that problems began to be addressed.
Special measures were lifted in 2006 but nine months later another mother had died, followed by the two most recent deaths, in September last year and on March 20 this year.
The hospital categorically denies there is any link between the three recent deaths and says the maternity unit is safe.
* The inquest continues.