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Wednesday 23 May 2018

Antibiotic treatment for Savita was ineffective for several hours, expert tells inquest

THE antibiotic treatment Savita Halappanavar received from 7am to 1pm on Wednesday was not effective, an expert witness has told the inquest into her death.

Dr Susan Knowles, a consultant microbiologist with the National Maternity Hospital,  agreed with Eugene Gleeson, counsel for Praveen Halappanavar, that the protocol on antibiotic cover had not been adhered to up until 1pm.

Once Savita's condition was diagnosed, it was clear the antibiotic cover she was on was not effective.

Mr Gleeson put it to Ms Knowles that the problem she had in this case was the antibiotics chosen to treat Ms Halappanavar, to which she replied: "Yes, I wouldn't have used these choices."

Speaking about the delay in sending a blood sample to the lab, Dr Knowles said that while there were no clinical signs of infection at that time, "nonetheless it's important that if a sample is taken that it is followed up."

"The result that was found was unexpected in the clinical context but the team looking after Ms Halappanavar should have been aware of the result sooner," she said, adding that if the test result was unexpected it should have been repeated.

This morning, the coroner recalled two witnesses Dr  Ikechkwu Uzockwu and midwife Ann Maria Burke in a bid to look at the  "irreconcilable differences" between their evidence. The issue revolves around  the time and content of a telephone call on the evening of Tuesday 23 October.

Earlier this week Dr Uzockwu also told the court that he was never informed about Ms Halappanavar's raised temperature on Tuesday, adding that he would have acted on this. This was despite the fact that a statement from midwife Ann Maria Burke read into the court said that she had informed Dr Uzockwu of the elevated temperature. Dr Uzockwu disputed this insisting he had not been made aware.

Earlier, Dr Knowles said her medical team should have got an earlier second opinion on when to deliver the foetus

She also highlighted that there was no note on the charts of a plan to deliver the baby.

Dr Knowles described the decision-making regarding induction of labour as "a critical part" of the management of this case.

She also raised concerns that not all vital signs were checked when Ms Halappanavar complained of feeling cold and was found to be shivering in the early hours of Wednesday morning. At that stage Ms Halappanavar's temperature was taken but Dr Knowles stressed that all vital signs should have been recorded at this stage which may have indicated other vital signs of concern.

Dr Knowles also pointed to the poor documentation of Ms Halappanavar's notes.

She added that the medical team should have been aware earlier that Savita Halappanavar was deteriorating and the sepsis was more severe than thought.

She also said that a broader range of antibiotics should have been considered as Ms Halappanavar deteriorated, but she accepted that the antibiotics being given were acceptable under certain guidelines.

The condition that Savita Halappanavar was suffering from required the quick delivery of the foetus, an expert has told her inquest.

Ms Halappanavar was diagnosed with chorioamnionitis, an infection of the membrane, on Wednesday.

Dr Knowles agreed that delivery of the foetus would be essential in such cases.

"Delivery will naturally happen but if you suspect chorioamnionitis you may have to expedite that," she said.

Dr Knowles told the inquest that delivery of the foetus was not warranted before chorioamnionitis was suspected on Wednesday, October 24. She added that it was her understanding that there was no substantial risk to Savita's life before the Wednesday.

The doctor also said that the management of Mrs Halappanavar's condition from 1pm that day was of a high standard.

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