New guidelines on inducing births in early pregnancy
The new guidelines have been issued to all hospitals by the HSE as part of detailed safety measures in response to the death of Savita Halappanavar.
Under an updated version of the Irish Maternity Early Warning System, drawn up by the HSE and the Institute for Obstetricians and Gynaecologists, medics are under orders to consider the procedure when the circumstances emerge during weeks 12-24 of a pregnancy.
The second trimester rule relates to cases where a miscarriage is likely to take place imminently and where there is evidence of “chorioamnionitis”.
The condition occurs when the foetal membranes suffer from a bacterial infection, and was a key issue in the death of Ms Halappanavar in October 2012. She suffered a spontaneous rupture of her membranes the day after being admitted to Galway University Hospital.
Under the clearly stated advice, seen by www.irishhealth.com, doctors have been told that if this situation re-occurs they must consider inducing birth regardless of foetal viability, gestational age and even if a foetal heart beat is apparent due to the risk of the condition spreading and causing sepsis.
In further advice outside of the chorioamnionitis issue, the guidelines also state that if medics find two or more clinical criteria suggesting sepsis in a woman who has miscarried appropriate intervention, such as IV antibiotics and oxygen, should be initiated within one hour.
The advice document states that in this circumstance a full assessment of the patient’s clinical condition must also take place, with laboratory tests potentially also needed to properly assess and rule out any risk factor that may have contributed to the miscarriage.
The advice has been provided by the HSE and the Institute of Obstetricians and Gynaecologists as part of detailed new safety measures responding to the tragic death of Ms Halappanavar.
The HSE’s investigation into the Indian dentist’s death found inadequate assessment and monitoring of her deteriorating condition was a key causal factor.
It said her deteriorating condition was due to infection linked to a failure to devise and follow a plan of care that took into account how her inevitable miscarriage was caused by infection.
As such, the risk of sepsis increased following spontaneous rupture of her membranes due to chorioamnionitis the day after she was admitted to hospital.
Savita later miscarried spontaneously, a diagnosis of sepsis secondary to chorioamnionitis was eventually made and she was admitted to the high dependency unit.
A key controversy in the case was the hospital’s reported refusal to accede to Ms Halappanavar’s request for a termination.
A separate report on the high-profile incident by Ireland’s health watchdog the Health Information Quality Authority drew similar conclusions.
The inquiries into Ms Halappanavar’s death, which encompassed two independent reviews and a coroner’s inquest, all called for improvements in clinical procedures and for more specific maternity unit guidelines.
