Woman’s death after delivery of twins ruled accidental

Teacher died of amniotic fluid embolism after giving birth to twins, coroner rules

Fani Vlahova, the beloved Montreal teacher who died after giving birth to twin daughters at the McGill University Health Centre in December 2016, died of an amniotic fluid embolism, according to a report from the Quebec Coroner’s Office. Coroner Steeve Poisson ruled the death accidental in his July 23 report, made available to the Montreal Gazette on Monday.

Amniotic fluid embolism, an unpredictable, unpreventable and often-fatal complication of pregnancy, is so rare most medical professionals learn of it only in textbooks, according to the Amniotic Fluid Embolism Foundation. Its cause remains unknown.

In addition to her daughters, Vlahova, who had turned 43 less than a week before her death, left behind husband, Latchezar Anguelov, and their son, Christian, who was 11 when his mother died.

Although amniotic fluid embolism cannot be predicted, the medical literature recognizes certain risk factors, such as multiple pregnancy, placenta praevia — in this condition the placenta blocks the neck of the uterus partially or entirely — and advanced maternal age, Poisson observed in his report. “These risk factors were present in Madame Vlahova.”

She was followed closely throughout her pregnancy, the coroner wrote, because she had gestational diabetes and hypothyroidism and because she was carrying twins. A caesarean section had been scheduled because of the placenta praevia, he wrote.

Vlahova had been in hospital for five weeks when she gave birth on Dec. 29 at 36 weeks. According to media reports at the time, Anguelov was beside his wife as a nurse congratulated them — and then she said she didn’t feel well. He was rushed out, and waited and prayed with his son as doctors, nurses and the rest of the team worked on her.

According to Poisson’s report, Vlahova had complained of having difficulty breathing and, at noon, eight minutes after the second twin had been delivered, she lost consciousness. Sustained efforts to revive her were unsuccessful and she was declared dead shortly before 3 p.m. Doctors came out and told Anguelov that his wife was gone, and that they suspected her death had been caused by an amniotic fluid embolism.

When a doctor told Christian that his mother had died, “he started to cry,” Anguelov recalled the following week. “The doctor was crying, too. She had lots of tears.”

On Dec. 31, the coroner wrote, an external exam and an autopsy on Vlahova were performed at the MUHC. In his report, “the pathologist observed the presence of air in the pulmonary arteries and a pulmonary embolism caused by the amniotic fluid.”

Vlahova worked at a Jewish private school, Beth Rivkah Academy for girls, teaching French at the elementary school level. A gofundme.com campaign for the family started after her death has raised $36,640 from 555 people touched by the tragedy, including $490 added 10 months ago by the Église chrétienne d’Ahuntsic.

Vlahova and Anguelov met in Montreal in 2001, not long after each had arrived from Bulgaria. They had tried to have more children after Christian, but the pregnancies ended in miscarriage. At last, Anguelov said, his wife was able to carry to term — only for the birth of their daughters to be punctuated by tragedy.

He said on the day of his wife’s funeral at the Bulgarian Orthodox Church in Ahuntsic that he had found some comfort in his religion. “A woman who gives birth to twins and then dies is like an angel — more than an angel,” he said at the time. “For me, that’s a reason to go to heaven.”