DETAILS of a draft report by the Health Service Executive into the death of Savita Halappanavar at University Hospital Galway last October have been revealed for the first time.
Here, a timeline compiled from the report reveals the events in the days leading up to the Indian woman’s death.
Sunday 21st October 09.35am
Savita Halappanavar attends the gynaecology ward at University Hospital Galway complaining of lower back pain. Tests are done and the heartbeat of her child is heard.
The expectant parents - Ms Halappanavar is accompanied by her husband Praveen - are reassured and return home.
Sunday 21st October 3.20pm (approx)
The couple return to the hospital. Savita is “upset and crying” as during a trip to the bathroom she “felt something coming down”.
Clinical examination indicates bulging membranes and no cervix to be felt. She is only 17 weeks pregnant.
In an interview, a staff midwife stated: “I immediately thought that she would miscarry and I brought her to the review room for an examination.”
Sunday 21st October
(incorrect record of the time of entry noted)
Doctor examines Savita - who is in pain - and decides it is too late to “stitch the cervix” in an attempt to prevent miscarriage. It is decided to wait and see what would happen naturally.
A full blood count is requested but at this time medical staff feel there are no infection concerns.
However, it would later emerge that the results of the blood tests, according to the draft report, were never followed up.
In subsequent interview, one of the attending doctors stated: “Looking back there was no reason I could find to suggest the patient could contract infection.”
Monday 22nd October 12.30am (approx)
Ms Halappanavar vomits following a trip to the bathroom and her waters break. Over the following few hours she experiences some vaginal bleeding.
Monday 22nd October 10.30am
She meets with a consultant. An ultrasound scan confirms presence of foetal heart.
Monday 22nd October 10pm
It is now nearly 22 hours since Ms Halappanavar's waters have broken. She has been started on oral antibiotics every six hours.
Tuesday 23rd October 8.20am
Mr and Ms Halappanavar enquire about the possibility of using medication to induce miscarriage. A consultant interview as part of the investigation stated: “Under Irish law, if there's no evidence of risk to the life of the mother, our hands are tied so long as there's a foetal heart.
According to the draft report, the consultant stated that if risk to the mother was to increase, a termination would have been possible, but that it would be based on actual risk and not a theoretical risk of infection: “We can't predict who is going to get an infection.”
Tuesday 23rd October - between 9pm and 10pm
A nurse makes a request for the junior doctor on duty to see Ms Halappanavar as she has complained of weakness and her pulse rate is 106 per minute (Resting heart rate is usually between 60 and 80).
However, the doctor in question has a busy caseload and says he will see the patient later.
Wednesday 24th of October 1am
The requested doctor comes to the ward to review Ms Halappanavar, however, she is asleep at the time, as is her husband, so a decision is taken not to wake her.
Wednesday 24th of October 4.15am
Ms Halappanavar calls the staff midwife on duty complaining of feeling cold and shivery. Her temperature is 37.7 degrees (normal temperature is 37 degrees Celsius.) It is now 48 hours since her waters broke.
At interview a staff midwife, recalled: “Both patient and her husband were cold and asked for extra blankets…as I covered her up her teeth were chattering so I took her temperature, just her temperature, no blood pressure or heart rate. There were no signs she was septic to me…I didn't think she was unwell enough.”
However, the investigation team found that the shivering and Ms Halappanavar's rising temperature warranted immediate medical review.
According to the draft report, the evidence is that infection/sepsis was present but not recognised at this time.
Wednesday 24th of October 6.30am
Ms Halappanavar's temperature has risen to 39.6 degrees Celsius. She is complaining of feeling weak with general body aches. Doctor on duty contacted immediately to review patient and advised paracetamol to reduce temperature.
Wednesday 24th of October 7am
Ms Halappanavar's temperature is 39.6 degrees Celsius.
Pulse rate is 160 per minute (Resting heart rate is usually between 60 and 80)
Blood pressure 100/60 mm/Hg (normal is 120/80)
In addition, discharge is present suggesting infection. Doctor on duty determines that Ms Halappanavar is suffering from probable sepsis.
Wednesday 24th of October 8.25am
Consultant and team review Ms Halappanavar at the start of ward rounds. Swabs are taken to determine what exact infection is present.
During interview, the consultant recalled advising Mr and Ms Halappanavar that if the source of the infection could not be found, a termination of the pregnancy might have to be considered. Fresh antibiotic had been administered and the consultant said: “We were giving it time to work.”
Wednesday 24th of October 12pm
Ms Halappanavar's blood pressure decreases to 76/46 (normal 120/80). She is transferred to another room to facilitate closer monitoring.
Pulse rate is high at 156 beats per minute. Blood pressure is 72/38.
An hour later Ms Halappanavar complains of difficulty in breathing.
Wednesday 24th of October 1.20pm
Following a review a diagnosis of septic shock – an overwhelming infection that can lead to life-threatening low blood pressure – is made.
Wednesday 24th of October 3.15pm
Ms Halappanavar suffers miscarriage.
Wednesday 24th of October 4.45pm
Ms Halappanavar transferred to High Dependency Unit. She is alert and responsive.
Thursday 25th of October 2012
During the night there was a clinical deterioration in Ms Halappanavar's condition with an increasing oxygen requirement, and worsening metabolic state.
Thursday 25th of October 3am
She is transferred to the Intensive Care Unit. Three hours later she is intubated and put on ventilation.
Friday 26th October 3.15pm
Ms Halappanavar is reviewed and is found to be deteriorating.
Saturday 27th 11.30am
CU notes describes the patient as critically unwell.
Ms Halappanavar's condition continues to deteriorate despite on-going measures.
Sunday 28th 1.09am
Ms Halappanavar suffers a cardiac arrest at 12.45am. Resuscitation continued to 1.09am when she is pronounced dead.
*Timeline compiled from extracts seen by Evening Herald from the draft report