Muddled guidelines dictated course of action by medical team
IRISH abortion law – particularly the lack of clear guidelines on its implemention – was a contributory factor in the decision-making of the medical team entrusted with caring for Savita Halappanavar, according to the draft report.
The review team pointed to the over-emphasis on the need not to intervene until the heartbeat of Ms Halappanavar's unborn child has stopped.
This was combined with an under-emphasis on the need to fully monitor and manage the risk of infection in the patient.
The senior doctor caring for Ms Halappanavar recalled being asked for a termination by both his patient and her husband, Praveen, and telling them it was not possible under Irish law.
The couple made the request after they were told Ms Halappanavar would suffer an "inevitable miscarriage".
The consultant later told the review group that the law on abortion means that "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 was not clear... there are no guidelines for inevitable miscarriages."
However, the review group said that by the time the discussion with Ms Halappanavar and her husband took place, there had already been suggestions she had underlying infection.
The group said at that stage it was over 24 hours since the spontaneous rupture of her membranes. There was a need for antibiotic therapy and the "need for the removal of the source of infection, ie: emptying the uterus should have been considered much earlier".
This action would be in keeping with guidelines on the management of suspected sepsis in obstetric care.
The review group said the clinical evidence is that sepsis was present in Ms Halappanavar in the early hours of Wednesday, October 24.
The patient went from sepsis to severe sepsis in two hours and had progressed to septic shock by 8.30am.
The mortality rate with severe sepsis can be as high as 60pc, even with treatment. Her progression to septic shock within four hours could have been avoided by earlier termination of the pregnancy.
The review team said they were aware of the larger moral, ethical and legal issues associated with the case – but the aim of its investigation was to focus on the clinical management of the patient.
The X case ruling allows abortion where there is a real and substantial risk to the life of the mother. Proposed legislation, to be followed by regulations, has yet to be published.
Obstetricians have told the Oireachtas commitee on health it needs to allow doctors to intervene in grey areas.