Alert system put in place after death of Savita Halappanavar

Obstetric guidelines not in place in Galway hospital last October

Dr Andrew Gaolebale, a specialist registrar in obstetrics, at the inquest into the death of Savita Halappanavar in Galway on Tuesday. Photograph: Eric Luke

Dr Andrew Gaolebale, a specialist registrar in obstetrics, at the inquest into the death of Savita Halappanavar in Galway on Tuesday. Photograph: Eric Luke

Tue, Apr 9, 2013, 23:26

An early-warning system to help identify problem cases in Galway University Hospital’s maternity ward was introduced just weeks after the death of Savita Halappanavar in the hospital, the inquest into her death has heard.

The modified obstetric early warning score, which formalises the tracking of symptoms such as blood pressure, temperature, heartbeat and breathing rate among pregnant patients was introduced as scheduled last November.

Ms Halappanavar died in the hospital on October 28st from septicaemia a week after being admitted when she was 17 weeks pregnant.

Dr Andrew Gaolebale, a specialist registrar in obstetrics, told the inquest that the guidelines were being rolled out in hospitals last year and were not used in the treatment of Ms Halappanavar. Coroner Ciarán McLoughlin asked where else would such guidelines be rolled out other than in maternity wards.

In his evidence, Dr Gaolebale, the senior doctor who treated Ms Halappanavar on the day she was admitted to the hospital, contradicted parts of the evidence given by her husband, Praveen.

A specialist registrar in obstetrics, he informed Ms Halappanavar her pregnancy was no longer viable when he saw her last October 21st.

Dr Gaolebale told the inquest that he was not informed of the results of a blood test on Ms Halappanavar and he was not told that her membrane had ruptured after he saw her, even though he was still on duty for another 12 hours.

Mr Halappanavar has said Dr Gaolebale told him his wife’s miscarriage would all be over in “a few hours” or in “four to five hours”. However, Dr Gaolebale said he would never say that as it was not possible to predict how long it would take a patient with her symptoms to deliver the foetus. He felt it would happen within 24 hours.

‘No going back’
Asked if he had told Ms Halappanavar there was “no going back” in relation to her pregnancy, as alleged by her husband, he replied: “That was not my phrase”.

Dr Olufoyeke Olatunbosun, a senior house officer who first examined Ms Halappanavar on admission, said she presented at the hospital with lower back pain on October 21st. There was no vaginal bleeding, her abdomen was soft and there was tenderness in the pubic area.

She was diagnosed with back pain, given pain relief and sent home but came back two hours later complaining of a “dragging sensation”.

Her membrane was found to be bulging and Dr Gaolebale was called.

Dr McLoughlin asked Dr Olatunbosun what in retrospect Ms Halappanavar was suffering from when she was initially diagnosed with back pain.

Dr Olatunbosun said it was most likely miscarriage. She said she did not examine the patient vaginally because she was not showing any symptoms there, neither did she carry out a test for leaking amniotic fluid.