The Indian dentist was undergoing surgery for the insertion of a central line when the foetus she had been miscarrying for three days “spontaneously delivered”.
Nurse Noreen Hannegan said she held the 31-year-old, who was awake, distressed and aware of what was happening as the line for the administration of fluids and drugs was being inserted.
“As the procedure got under way she said she felt pressure below,” the nurse told Mrs Halappanavar’s inquest.
“A nurse checked and she had passed the foetus. It was spontaneous. None of us were anticipating that to happen,” she said.
A senior house manager in anaesthetics said he had been unaware of a planned termination on Ms Halappanavar as he inserted the line at around 3.30pm on Wednesday, Oct 24.
Ms Halappanavar’s obstetrician Dr Katherine Astbury was alerted and came in, the nurse said.
The consultant had decided to terminate the pregnancy because of the risk to Ms Halappanavar’s life from suspected sepsis two hours earlier and had contacted microbiologist Dr Deirbhile Keady for antibiotic advice on sepsis at 2pm. “I asked at that stage if the uterus was empty,” the nurse told coroner Dr Ciaran MacLoughlin.
“I was told it wasn’t, but she was going to theatre.”
Ms Hannegan said the patient asked for her husband Praveen and they were given time to grieve before “a weak and distressed” Ms Halappanavar was taken to the high dependency unit.
“I held her hand and wished her well, and she thanked me,” added the nurse, based at University Hospital Galway.
Ms Halappanavar’s condition deteriorated and in the early hours of Thursday morning she was moved to intensive care where she was intubed, ventilated and sedated. Staff who nursed her through her final hours said she was unresponsive while her husband and friends spent time by her side on Saturday, Oct 27.
When airway pressure alarms triggered on the ventilator at 10pm, nurse Jacinta Gately said drugs were given to relax muscles and help breathing and blood and dialysis ordered.
An hour later her patient was still unresponsive.
“Monitoring system had been applied to evaluate her ‘wakefulness’,” Ms Gately added.
“Values were from one to four, patients normally awake at 100.”
Attempts by doctors and nurses to resuscitate Ms Halappanavar failed and she died of a heart attack, with her husband near by.