New mothers who died of herpes may have been infected by surgeon.

Two mothers who died of herpes after giving birth could have been infected by a single surgeon, the BBC has found.

Their families, who were told there was no connection between the deaths of the women who underwent Caesarean sections by the surgeon in 2018, are calling for inquests to be opened.

In more than 2.1m UK births between 2017 and 2019 only 191 mothers died within six weeks of giving birth, making it a rare occurrence, according to official figures.

HSV-1 - one of two strains of the herpes simplex virus  - is a common infection that can cause sores around the mouth or genitals but deaths are almost unheard of in healthy people, making it surprising that the two young mothers should die from an infection caused by the virus, leading to a BBC investigation into how the two deaths happened and why neither family was told there was a link between them.

One of the women, Kimberley Sampson, 29, a barber, lived with her three-year-old daughter at her mother's home in Whitstable, Kent. Her pregnancy progressed smoothly and on 3 May 2018, she went on to the labour ward at Queen Elizabeth the Queen Mother Hospital, Margate.

Her mother, Yvette, says: "She thought everything was going to be fine but things started to go wrong. Her labour was not progressing quickly and Kimberley kept saying the baby was stuck. Eventually, doctors performed a Caesarean.”

After her son was born Ms Sampson needed a blood transfusion due to injuries during the operation. After two days, and despite being in a lot of pain and barely able to walk, she asked to be discharged with her baby.

Her mother says that the pain worsened and even a gentle touch was enough for her daughter to scream in agony.

Her GP suggested they call 999 and Ms Sampson went back to hospital. Doctors thought she was suffering from bacterial sepsis and she was returned to the maternity ward and given antibiotics but her condition worsened.

Ms Sampson underwent a series of operations as doctors struggled to identify and treat the infection and, after eight days, a consultant microbiologist suggested trying antiviral drug, Aciclovir, used for herpes infections.  She was transferred to intensive care at Kings College Hospital, London, diagnosed with a catastrophic herpes infection and died on May 22.

Six weeks later, the second ‘new’ mother, Samantha Mulcahy, 32, a nursery nurse, who lived 20 miles away, died from same condition.

She went into labour four weeks before her due date, and in July 2018, was admitted to William Harvey Hospital, Ashford, run by the same hospital trust as Queen Elizabeth the Queen Mother Hospital, Margate.

Samantha Mulcahy also underwent a Caesarean section and gave birth to a healthy daughter but, because doctors were concerned about signs of the blood pressure condition, pre-eclampsia, she was kept in for observation.

Despite no longer showing signs of pre-eclampsia, her condition deteriorated with a swollen stomach, high temperature, and raised blood pressure.

As with Kimberley Sampson, doctors thought she was suffering from bacterial sepsis and, once again, antibiotics, didn't work. As her condition worsened rapidly, her organs started to shut down. She was taken to intensive care where she stayed for four days before dying.

A post-mortem found She died from multi-organ failure following a "disseminated herpes simplex type 1 infection" caused by the same HSV-1 virus.

In each case it was the first time either woman had been infected by herpes so they had no antibodies - or natural protection - against the virus.  This, combined with the fact that women in late stages of pregnancy have reduced immune protection, would have made them more vulnerable to a serious HSV infection. Neither baby was infected.

More than a year later, both families received a letter from Kent Central and South East coroner, Katrina Hepburn, saying there would be not be an inquest for either woman.

Although the letters acknowledged a similar case  they said there was "no connection" between the two deaths. The letters also set out the pathologist’s belief that the women had been infected with herpes "prior to hospital admission.”

BBC News became aware of the two deaths in the spring of 2021, and, while reviewing requested documents, noticed that Public Health England (PHE) had considered the possible source being the herpes viruses but provided no detail.

Kimberley Sampson’s family subsequently made a request to PHE for access to that investigation and documents reveal a significant link between the two cases.

These include two email chains between staff at PHE, East Kent Hospitals Trust, some NHS bodies and a private laboratory, Micropathology, which show efforts to establish how the women became sick, if the two viruses were genetically identical, and whether there could have been a common source.

The emails were partly redacted by PHE to conceal names. In one, someone from the Trust reveals that the same two clinicians had taken part in the births, a midwife and the surgeon who carried out their Caesarean sections.

This apparent connection - and possible source of infection - caused concern among those on on the email chain and Micropathology was brought in to sequence the genome of the two viruses and see if they were the same.

In an email after Samantha Mulcahy died, someone working for the lab says both cases "look like surgical contamination" and asks the Trust to provide "a mouth swab/lesion swab from the suspect surgeon in O&G" but the BBC says that these samples were never provided and that none of this information was passed to either of the families at the time.

The emails also show that the parts of the virus tested were identical. In an email in October 2018, a Micropathology worker says "the most likely explanation is that these strains are probably the same which also adds weight to the idea that these two women were infected with the same virus."

An email from a member of PHE staff a year later says the type of virus was "rare" compared with the previous 10 years of herpes virus samples collected at its lab in north London.

This shows the investigation was continuing after the families received the letter from the coroner denying them inquests.

The BBC asked Peter Greenhouse, a sexual health consultant with a particular interest in the herpes viruses, to review the cases.

He contradicts the pathologist saying: "you can never be 100% certain what happened in these cases but, from all the evidence, it's very unlikely that they acquired the virus before they got into hospital."  

"It is more likely that they picked it up in the hospital and less likely that they picked it up in the community, or sexually, because there were no facial or genital lesions - obvious or even hidden signs - whatsoever."

After reviewing documentation uncovered by the BBC, Mr Greenhouse has developed a theory, supported by four other sexual health and virology experts, for the deaths, that it is most likely that the infection may have been given to the two women accidentally by the surgeon, as the only common source, during the Caesarean section.

He says the surgeon may have had a herpetic whitlow, a herpes infection on the finger, which could have "directly seeded the herpes into the abdomen of the women.”

He says that his would have allowed it to spread throughout the abdomen quickly and explains why the women had no external lesions, normally expected with a herpes infection. According to the NHS website, whitlow symptoms can vary from a small bump to open lesions, meaning they can go undetected.

Mr Greenhouse adds: "Many of these will occur without any obvious signs, or they'll be so miniscule that you can't identify them. It's a very rare but a very biologically plausible method of transmission."  

All surgeons wear gloves during surgery, but Mr Greenhouse says could have been that they split during the operations, allowing the virus to spread. A small study in 1990 suggested as many as 54% of gloves used in Caesarean sections had holes in them when tested with water after the operations.

East Kent Hospitals Trust says the surgeon underwent a verbal occupational health check where he said he had no history of herpes infection and had no hand lesions, although he was not tested for the virus at the time of the operations.

Referring to the email stating that the type of virus was "rare", compared with other samples collected at PHE's lab, Mr Greenhouse says this makes the likelihood that the women were infected by a common source in the hospital more likely and much less likely they were infected in the community.

East Kent Hospitals Trust points out that PHE's report says that, although there was a "high probability they are epidemiologically linked" for HSV, "this finding does not mean that the viral isolates have an immediate common source or are part of a transmission chain.”

In a statement chief medical officer for East Kent Hospitals, Dr Rebecca Martin, said: "East Kent Hospitals sought specialist support from Public Health England (PHE) following the tragic deaths of Kimberley and Samantha in 2018.

“The investigations led by the trust and the Healthcare Safety Investigation Branch took advice from a number of experts and concluded that it was not possible to identify the source of either infection. The surgeon who performed both Caesarean sections did not have any hand lesions that could have caused infection, or any history of the virus.

"Kimberley and Samantha's treatment was based on the different symptoms showed during their illness. Our thoughts are with their families, and we will do all we can to answer their concerns."

Peter Greenhouse is now carrying out further research into the deaths in the hope that it might mean new mothers with unexplained sepsis-like symptoms will be tested for herpes as a matter of course.

He said: "I hope that the research will change the guidelines, so more people will benefit from earlier diagnosis. It is the only constructive outcome that one could hope for, after such a tragic scenario."

According to the Herpes Virus Association, Herpes viruses are usually transmitted by skin-to-skin contact with someone with the virus. Herpes infections are common with almost 70% of adults having one of the two virus types by the age of 25. Some people will develop cold sores or genital herpes, but about two-thirds will have no, or mild, symptoms