THE DOCTOR at the heart of the Savita Halappanavar inquest has revealed that she had planned to go ahead with a termination just hours before the young woman eventually miscarried.
Dr Katherine Astbury had finally decided to carry out a termination, regardless of foetal heartbeat, on Wednesday, October 24, 2012.
Just one day earlier, she had refused Savita's request for a termination, despite informing her that a miscarriage was inevitable.
Giving testimony on her conversation with Savita on the Tuesday morning, Dr Astbury said the 31-year-old had been "very upset" at news of the inevitable miscarriage and had asked was there any medicine that could bring on a termination quicker.
"I informed her the legal position in Ireland did not permit me to terminate the pregnancy in her case at that time," she said.
However, as Savita's condition deteriorated, Dr Astbury took the decision on the Wednesday to go ahead with a termination because she believed there was a "real and substantial risk" to the life of Savita. She had developed sepsis and was noted to be sweaty and having trouble breathing.
"I also informed Ms Halappanavar if the source of the infection was not identified we would have no option but to consider termination regardless of foetal heartbeat," she said.
On the Wednesday, Dr Astbury approached a colleague, Dr Geraldine Gaffney, to discuss her view that they needed to go ahead with a termination regardless of foetal heartbeat. Dr Gaffney agreed, and offered to write a note to be included in the medical records to this effect.
Dr Astbury took a portable scanner back to the ward where she discovered the foetus had already died.
Ms Halappanavar was suffering from septic shock and Dr Astbury spoke to colleagues about moving her to the intensive care unit. Because a bed was not immediately available, Savita was taken to theatre.
There she spontaneously delivered a female foetus. The baby had "six toes on each hand," Ms Astbury told the inquest.
Dr Astbury remained part of Savita's care during her time in ICU, where it was discovered Savita had contracted e-coli.
Then while she was on annual leave Dr Astbury was called on Saturday and informed that Savita's condition had deteriorated further and she was unlikely to survive. Completing her testimony, Dr Astbury offered her condolences to Praveen and his family.
Earlier in the inquest, a number of questions were raised regarding the detection of early warning signs, including an elevated temperature and the raised white cell count.
The coroner Dr Ciaran McLoughlin queried why a bracket had been written onto Savita's notes. He was informed by Mr Buckley that the mark had been made during the internal HSE review into Ms Halappanavar's death.
The coroner requested an explanation as to why any marks were made on the notes, which Mr Buckley agreed to provide.
Dr McLoughlin also raised questions as to why a senior registrar – who was made aware of concerns of sepsis in Savita - had not made a statement.
Specialist registrar Dr Sarah Campbell was made aware of possible sepsis in the patient by Dr Ikechukwu Uzockwu, a senior house registrar who treated Ms Halappanavar on the Tuesday and Wednesday.
By Wednesday she had been suffering from ruptured membrane for close to 54 hours and had seen her heart rate almost doubled from 89 to 160, the inquest heard.
"My opinion was the source of sepsis was the membrane," he told the inquest.
Dr Uzockwu told the inquest he called the specialist registrar, Dr Campbell, to inform her of his concerns.
However, Dr Campbell did not attend to Savita. Dr Uzockwu said he could not say why Dr Campbell did not attend.
Coroner Dr McLoughlin pointed out that no statement had been taken from Dr Campbell and asked that this be rectified immediately to see what she understood from the call.
Dr Uzockwu also told the court that he was never informed about Savita's raised temperature on Tuesday, adding that he would have acted on this. This was despite the fact that a statement from midwife Anne 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. "I was told the vital signs were stable, I wasn't told there was an elevated pulse," he added.