Savita’s level of infection was ‘exceedingly rare’

Savita Halappanavar had one of the most severe cases of septic abortion ever seen, an inquest has heard.

Tests showed that Mrs Halappanavar suffered multi-organ failure due to septic shock, a rare strain of the E.coli bug, and a miscarriage at 17 weeks gestation with severe chorioamnionitis, an infection of the foetal membranes.

She had been admitted to University Hospital Galway on Sunday, Oct 21, when an inevitable miscarriage was diagnosed, and died a week later in intensive care, four days after she delivered a dead foetus.

Pathologist Peter Kelehan revealed of the 700 to 800 miscarriages he would see each year, it was “exceedingly rare” to come across the level of infection in Mrs Halappanavar’s case.

He said the placenta showed findings of severe sepsis, with extensive overgrowth of bacteria and acute chorioamnionitis.

“These are classic appearance of ‘septic abortion’ in the second trimester of pregnancy,” said the consultant, who recently retired from the National Maternity Hospital. “This is rarely seen by pathologists.”

The consultant maintained in his 40-year career of examining placentas post miscarriage, he had only seen four or five cases as bad, but that Mrs Halappanavar was the only woman who had died. “Each time I made the diagnoses, I would pick up the phone,” he added. “It’s an alarming situation.”

He told coroner Ciaran MacLoughlin that the infection grew so quickly as a result of the death of placenta tissues.

For over an hour, Dr Kelehan and Professor Grace Callagy, who carried out the autopsy on Mrs Halappanavar, outlined in detail how the infection attacked her body and shut down her organs one by one.

Prof Callagy said the cause of death was septic shock, E.coli in the bloodstream — the ESBL strain which is resistant to most antibiotics — and miscarriage.

“While we see findings of sepsis and sepsis shock in autopsy, it’s rare in maternal deaths,” she added.

A short statement by Sebastian Lucas, one of Britain’s top experts on sepsis who backed the findings of both pathologists, was also read into the record.

Prof Callagy agreed with the coroner that when Mrs Halappanavar’s membranes ruptured, she was vulnerable to infection.

The coroner also asked if prior to the infection, had Mrs Halappanavar been a strong and healthy 31-year-old woman.

“Yes,” Prof Callagy replied. “No other abnormalities.”

On Wednesday, obstetrician Peter Boylan claimed the dentist would probably still be alive if the law allowed an abortion as she miscarried before there was a real risk to her life, by which time it was too late to save her.

Consultant obstetrician Katherine Astbury, who was in charge of Mrs Halappanavar’s care, previously admitted there were “system failures” but claims she could not carry out an abortion because of Irish law.

Mrs Halappanavar’s widower Praveen did not attended the seventh day of her inquest, the last day of evidence, as the details of the reports were too upsetting, his solicitor said.

Gerard O’Donnell said evidence given on Ireland’s abortion laws was “taking its toll” on his client, who was preparing himself for a verdict today.

“It will be very, very difficult for him, very tough.”

The 11 jury members are due to return a verdict today.

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