Savita Halappanavar died from septic shock resulting from an E.coli bacterial infection which had entered her bloodstream via the urinary tract. The Royal College of Obstetricians and Gynaecologists (RCOG) has attributed most of the deaths of pregnant women in the UK with a baby under 24 weeks gestation, from sepsis, as being due to “substandard care… in particular a lack of recognition of the signs of sepsis and a lack of guidelines on the investigation and management of genital track sepsis”…
Savita Halappanavar first presented at University College Hospital Galway on the afternoon of Sunday, October 21, with backache but she was sent home following an examination. Savita had a history of back problems. She returned later that evening having experienced blood loss and was admitted. A blood sample was taken.
Crucially, the results of the blood tests, which showed an elevated white blood cell count indicating that an infection was present, were never followed up. The inquest heard that though the results were processed almost instantaneously, the first time they were accessed was some 24 hours later by an unidentified member of staff, and later by Dr Katherine Astbury, the consultant in charge of her care, at 11.24 on the Wednesday morning. This was five hours after she had been diagnosed with sepsis and after her condition had rapidly deteriorated.
Speaking at the inquest, Dr Astbury stated that if she had had access to the blood results earlier, she would have taken measures to terminate Savita’s pregnancy on the Monday or the Tuesday. However, she had been judging Mrs Halappanavar on the basis of clinical signs only and it had been her opinion that Savita was “distressed, but not unwell”.
It seems like hospital staff committed one mistake after another, from failing to monitor Savita to taking fluid samples in the wrong tubes, which prevented the lab from running the appropriate tests.
Did her survival hinge on a termination?
Opinion is divided as to whether or not a termination would helped Savita. The presence of an infection is a contraindication to surgical intervention, because the clamps and forceps required in a procedure risk further infection.
Furthermore Savita’s unborn child was not the source of her bacterial infection, the uterus and membranes being a sterile environment. Use of the drug misoprostol to contract the uterus and expedite delivery would not have guaranteed that the process would have been any swifter nor ruled out the necessity for surgery.
Conservative management is the preferred clinical approach in cases of spontaneous miscarriage. In the absence of obvious signs of infection, masked by her painkillers, it is not surprising that the medical staff decided that intervention was unnecessary. With ruptured membranes and a dilated cervix, it was perfectly reasonable to assume that nature would soon take its course. The outcome for the baby would have been tragically inevitable, but there would have been no long term ill-effects for the mother.