Criticism over opinion delay and choice of antibiotics
An expert witness said the Indian woman 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, Oct 23, last year and during the early hours of the next morning when she was found shivering in her bed.
Consultant obstetrician, Katherine Astbury, examined her 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 once chorioamnionitis was clinically apparent is a critical part of the management of this case,” Dr Knowles said in conclusion in a statement to the inquest.
“There is no mention in the note written after the ward round of a plan regarding delivery. One may infer that that decision was to await.”
Dr Astbury has 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 Savita Halappanavar at that time, including asking for an earlier second opinion regarding the need to deliver, especially when systolic blood pressure dropped,” she concluded.
Dr Knowles said Dr Astbury was right not to terminate the pregnancy on the Tuesday, as there was no risk to Mrs Halappanavar’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 E.coli extended spectrum beta lactamase (ESBL), 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.
Praveen Halappanavar did not attend yesterday’s hearing and has been described as “overawed” by events at her inquest.
His solicitor said his client has been excused from attending yesterday’s hearing because he had found the last few days so stressful.
Gerard O’Donnell arrived for day five of the hearing without his client, whom he said was “overawed”.
“It’s been a stressful week for him and he just asked to be excused — we explained that to the coroner,” he said.
Mr O’Donnell said the inquiry was taking its toll on Mr Halappanavar, particularly the evidence from staff who nursed his wife through her final hours.
“While he is very composed at all times in the court, it’s very stressful for him hearing all these details,” he said.
“He found the episode very stressful, but as he had said, his version is and will be borne out and I think you can all see it being borne out.
“He has taken the view that he is looking at the truth and people and public are coming to realise this is what happened,” Mr O’Donnell said.
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