Wednesday 18 October 2017

More women could suffer Savita's fate, warns expert

Eilish O'Regan and Dearbhail McDonald

A hard-hitting review into the death of tragic mum-to-be Savita Halappanavar found major failures in her care led staff at University Hospital Galway to underestimate the seriousness of her condition while she progressed to septic shock due to an aggressive form of E. coli infection.

The findings came as a top UK obstetrician warned that more pregnant women could suffer the same tragic fate if doctors continued to differ on when to carry out an abortion for some potentially life-threatening conditions.

Prof Sabaratnam Arulkumaran, who chaired the independent inquiry into her death, said certain conditions that could rapidly lead to a life-threatening condition should be subject to clear guidelines.

Doctors and "lawmakers" should make it clear how soon medics can intervene to save the life of a woman by terminating the pregnancy, he added.

The report found that doctors had decided on a conservative approach, waiting for the foetal heartbeat to stop before considering early delivery – but crucially also failing to properly investigate and monitor her at the same time.

Prof Arulkumaran said "sometimes intervening late means it is difficult to bring the patient back" and he concluded the manner in which the doctors in Galway interpreted the law was a "material contributory factor" in her case.

Health Minister Dr James Reilly said the report "lays bare a set of unacceptable factors that led to the tragic death of a young woman".

He is sending it to the Medical Council, which regulates doctors, and An Bord Altranais, which oversees the conduct of nurses.

The report said the risks to Savita could have been reduced by an early delivery, and continuing a pregnancy put the mother at increasing risk.

Instead, the management plan at the hospital, led by consultant Dr Katherine Astbury, was to "await events" and monitor the foetal heartbeat.

It unveiled a catalogue of bad practice in relation to her care, including failure of staff to follow up on a blood test, showing an elevated while cell count, on the day of her admission.

A pulse rate greater than 100 should have triggered tests, which would have helped the doctors to diagnose a case of blood poisoning.

Savita's vital signs were not properly monitored to alert staff to her deterioration and doctors and nurses looking after her did not pass on important information on her condition to each other.

The investigation found that appropriate tests were not carried out to confirm the presence of infection, despite clinical signs.

Savita and her husband Praveen had repeatedly asked for a termination early on in the week but were told this was not possible because her life was not at risk and the foetus had a heartbeat.

INFECTION

The care of Savita fell short of the hospital's own guidelines on sepsis, which highlighted the importance of trying to establish the focus of infection and treating any obvious source.

"This guideline states that it is imperative that any infective focus should be identified with the removal of the source of infection to be completed as quickly as possible.

"In this clinical context, that would be termination of pregnancy. Sepsis in pregnancy is rare," the report said.

The report quoted Dr Astbury saying: "If there is a threat to the mother's life, you can terminate.

"If there is a potential major hazard to the mother's life, the law is not clear . . . there are no guidelines for inevitable miscarriages."

Irish Independent

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