An obstetrician treating an Indian woman who died in an Irish hospital after she miscarried should have got a second opinion to terminate the pregnancy sooner, an inquest heard.
An expert witness said Savita Halappanavar was also put on the wrong type of antibiotics for several hours for the strain of E coli she contracted.
Susan Knowles, consultant microbiologist at the National Maternity Hospital in Dublin, said there were “subtle” indicators the patient was showing signs of sepsis late on Tuesday October 23 last year and during the early hours of the following morning when she was found shivering in her bed.
Consultant obstetrician Katherine Astbury examined her patient at 8.30am and suspected sepsis caused by chorioamnionitis, an infection of the foetal membrane, but ordered tests.
“The decision-making regarding induction of labour or to await spontaneous events is a critical part of the management of this case,” Dr Knowles said in a statement.
“There is no mention in the note written after the ward round of a plan regarding delivery. One may infer the decision was to await.”
Dr Astbury said she decided to carry out a termination five hours after her morning rounds as Mrs Halappanavar’s condition deteriorated and she got a second opinion.
But Mrs Halappanavar naturally delivered a dead foetus at 3.30pm.
Dr Knowles said it was unclear when blood test results became available and said medical staff should have been called earlier when the patient’s blood pressure continued to fall mid morning.
“The team should have been actively managing [the patient] at that time, including asking for an earlier second opinion regarding the need to deliver,” she concluded.
Dr Knowles said Dr Astbury was right not to terminate the pregnancy on the Tuesday, as there was no risk to the patient’s life.
She told the coroner, Dr Ciaran MacLoughlin, there were no clinical indicators for intravenous antibiotics prior to the Wednesday morning, but said all of Mrs Halappanavar’s vitals should have been checked when she was found shivering in bed at 4.25am.
Dr Knowles revealed intravenous antibiotics prescribed by an on-call doctor at 7am, which Mrs Halappanavar took for several hours, were not sufficient to fight the strain of E coli.
Blood test results 24 hours later found the 31-year-old had been suffering from a type of E coli which is resistant to most antibiotics. The coroner asked if Mrs Halappanavar would have been put on effective treatment earlier if hospital guidelines had been followed. “That’s correct,” Dr Knowles added.
Mrs Halappanavar died of multi-organ failure four days after delivering the dead foetus.
Her widower Praveen is not at the hearing as he has found it so stressful, his lawyer said.