Opportunity missed on abortion shock death - report

Sir Sabaratnam Arulkumaran, who headed the review. Picture: PA
Sir Sabaratnam Arulkumaran, who headed the review. Picture: PA
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Medics missed an early opportunity to terminate the pregnancy of a woman who later died from septic shock when she suffered a miscarriage in an Irish hospital, a scathing report has found.

The chairman of the clinical inquiry into the death of 31-year-old Savita Halappanavar revealed that he would have ended her pregnancy when she showed initial signs of the fatal infection.

But the renowned British professor Sir Sabaratnam Arulkumaran, who headed the review on behalf of Ireland’s Health Service Executive, refused to state when he would have acted or whether it would have saved the dentist’s life.

“It is very difficult. It’s overall clinical judgment. I wasn’t there to see how Savita was,” he said.

The professor said that had Mrs Halappanavar had four-hourly pulse rate and temperature checks which recorded a rise, more tests could have been ordered and possibilities discussed.

“Unfortunately none of this was done so I can’t really say when would have been the ideal time,” he said.

The review team highlighted a litany of failings that made a significant contribution to the Indian woman’s death, including the interpretation of Ireland’s strict abortions laws that only allows termination when there is a real and substantial risk to a woman’s life.

Mrs Halappanavar’s waters broke in the early hours of a Monday last October and her condition deteriorated in the early hours of the following Wednesday. Her widower Praveen, who is out of the country, has maintained that she repeatedly requested a termination but was refused because a foetal heartbeat was present.

Professor Arulkumaran said the consultant’s plan to “await events” is appropriate when there is no risk to the mother or foetus, but stressed that monitoring, evaluation and clinical investigations would probably have led to reconsidering the need to expedite delivery.

By the Wednesday, a diagnosis of sepsis secondary to chorioamnionitis, an infection of the foetal membranes, was made which again would have merited expediting delivery to reduce the risk of infection to the mother, the review team said.

“The gravity of the situation was increasing but appears not to have been recognised and acted upon,” the report found.

It was almost another five hours before consultant Dr Katherine Astbury was called back on ward and a decision to terminate the pregnancy was taken. Mrs Halappanavar later delivered her dead baby daughter.

Within hours she was in a high-dependency unit and intensive care where she died four days later from multi-organ failure from septic shock and E coli.

The report found that there was an over-emphasis on the need not to intervene until the foetal heartbeat stopped and not enough emphasis on the need to monitor and manage the risk of infection.

The Irish government moved to introduce legislation for limited abortion, as required by a 1992 ruling in the Dublin Supreme Court, on the back of a public outcry over Mrs Halappanavar’s death.

Health minister James Reilly said he has serious concerns about the revelations.

“It is a hard-hitting report which spares nobody and doesn’t pull any punches,” he said.

“It lays bare a set of unacceptable factors that led to the tragic death of a young woman.”

The review team warned that similar incidents with a similar clinical context could happen again.

The long-awaited report has been published two months after a jury ruled that the death was by medical misadventure.