When Sarah Read and Andy MacDonald met by pure chance outside a bar in Sarah's hometown of Burnley, the pair shared an instant connection. They bonded over their love of the great outdoors and eventually shared dreams to one day move to the wilderness of Andy's native Scotland.
After moving in together in Preston, the couple set on buying a hotel in Scotland and began to talk about having children. They dreamed of owning a motorhome which they planned to tour the country with their "travel baby".
When Sarah fell pregnant in 2022 the couple's dream family life together was in reach, but it all came crashing down in a cruel twist of fate. It should have been a time of hope and happiness, but Sarah spent much of her pregnancy 'living each day as if it could be her last'.
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Having had a prosthetic valve fitted to her heart when she was just a few months old, Sarah needed daily injections of blood-thinning medication and regular check-ups, Lancs Live reports.
Due to her heart condition the couple went for a pre-conception consultation, at Manchester Royal Infirmary in December 2021, to discuss any risks in pregnancy. It came after a previous pregnancy, in 2019, had caused a blood clot to form in her arm.
Andy had been worried that Sarah's heart condition would put her life in danger, but the couple were reassured that Sarah would be closely monitored and she was told she could carry a child.
But whilst pregnant, and just days after signing the contract for their hotel in Scotland, Sarah suffered a stroke at the age of 30. She was left "terrified" and not knowing "if she was going to live or die".
Although she recovered well from the stroke, the couple were advised to have an abortion. Sarah's lifelong dream of having a baby were dashed and, after the procedure, the couple couldn't bring themselves to find out if it had been a boy or a girl.
Just three days after the termination Sarah began to suffer a series of increasingly severe seizures. Andy watched on in horror as his "perfect" Sarah deteriorated to the point where he was pleading with doctors to give her anti-seizure medication. After initially adopting a 'watch and wait' approach they finally did - some 27 hours later.
Sarah was left in a partially-comatose state but, despite the odds, did start to show some signs of improvement, following people walking around her hospital room with her eyes although she was still unable to talk.
Then, Sarah became progressively unwell and she died on August 7 last year at the Royal Preston Hospital, aged 31, having suffered another stroke, an inquest into her death, at Preston Coroner's Court, heard this week.
According to a study carried out in 2016 the risk of serious complications in pregnant women who have a mechanical heart valve is around 40 per cent, while the risk of death is around nine per cent. However, the couple say they weren't told that and came away from their pre-conception appointment feeling "reassured" that Sarah would be well looked after and that steps had been taken to increase monitoring.
A tragic timeline
As previously reported in the M.E.N, the inquest into Sarah's death heard that in February 2022, after Sarah became pregnant, her blood thinning medication - taken to reduce the risk of a clot forming around her prosthetic valve - was switched from warfarin to tinzaparin. Warfarin can cause foetal abnormalities and resistance to anticoagulation medication increases during pregnancy so her dose was gradually increased.
However, as her pregnancy progressed Sarah began to notice symptoms she associated with a blood clot, such as pains in her hands and legs. She visited the Royal Preston Hospital on several occasions in March.
By April 2022, Sarah had begun reporting headaches. And, after going once more to A&E on April 5 of that year, she was diagnosed with having had a stroke. She needed a procedure called a thrombectomy, to manually remove the clot, but the service is not provided out-of-hours at Royal Preston Hospital.
Preston is one of three hospitals across the North West which offers the service. Doctors at RPH called one of the other two hospitals; Salford Royal, who initially refused to accept her transfer but eventually agreed.
Sarah was taken by ambulance, under blue lights, to Salford Royal. She was later advised to terminate the pregnancy as the risk of having another stroke was increased. The termination was carried out on May 6 but three days later, while in hospital, she began to suffer the seizures that preceded her death from severe stroke.
Dr Jordi Morell, a consultant in stroke medicine at Manchester Royal Infirmary, told the inquest that he didn't believe the seizures Sarah suffered after the termination had contributed to her death. He said: "The sooner anti-epileptic medication is started the better but I don't think it had a material impact on the outcome. I don't believe the seizures impacted on the outcome for Sarah."
Referring to the 'watch and wait' approach to administering anti-seizure medication Andy said in his statement that he "couldn't understand why they were doing this". He added: "Her condition then substantially deteriorated; I had to go and plead with the doctor to go and see Sarah. The doctor said we were owed an apology and they felt it was now too late for her to recover. Sarah went 27 hours without anti-seizure medication."
The inquest heard from Professor Charles Hay, a consultant haematologist at Manchester Royal Infirmary, who said that he believed Sarah had not been taking her anti-coagulation medication properly. However, he added that, even if her clotting levels were satisfactory she was still at an increased risk of having another stroke. However, Sarah's family were "adamant" she had been injecting the blood thinning drugs correctly.
Professor Bernard Clarke, a consultant cardiologist at Manchester Heart Centre based within Manchester Royal Infirmary, said that managing pregnancy in women who have a prosthetic valve is "very difficult". "We suggested a termination because the risk of another stroke would only increase," he added.
"She had already shown by her past history that she was predisposed to strokes. Despite the best efforts to manage the risk, unfortunately there are women where it is almost impossible to manage."
Area Coroner Chris Long said he was considering making what is known as a Prevention of Future Deaths report. Coroners can make reports to a person, organisation, local authority or government department or agency where they believe that action should be taken to prevent future deaths. The inquest conclusion, along with any Prevention of Future Deaths report, will be given at a later date to be confirmed.
'She was perfect'
Recalling the first time he met Sarah, Andy told LancsLive: "I was viewing a bar in Burnley and met Sarah for the first time outside and we got talking. I was heading to Edinburgh the following weekend and asked if she wanted to come. She said yes.
"I then went to Lossiemouth to visit my dad for a week. When I came back down south I moved in with Sarah in Burnley immediately." Andy described Sarah as "living life to the full". Her mechanical valve never slowed her down. She was "perfect," he added.
As the process of buying their Scottish hotel was already complete by the time of Sarah's tragic death Andy was tied into the purchase.
Andy also went ahead with the purchase of the motorhome, adding a tribute to Sarah by way of a decal of her signature glasses and autograph, so he could "drive her to her final resting place". After Sarah's death Andy had some of her ashes made into a ring - which he hasn't taken off since.
