Crucial evidence yet to come from medics involved in care of Savita

The sharing of the draft Health Service Executive report into the death of Savita Halappanavar with her husband Praveen is the beginning of a process through which we should gain a better understanding of how the 31-year-old dentist died from blood poisoning.

Last October, Ms Halappanavar was admitted to University Hospital Galway with symptoms of an inevitable miscarriage when she was 17 weeks pregnant. She died one week later from sepsis.

Inevitable miscarriage occurs when, on medical examination, the neck of the woman’s womb is found to be open. Even where a foetal heartbeat is present, there is no chance of the pregnancy continuing to term.

In addition, when there is evidence of leaking amniotic fluid and the neck of the womb is open, then unless there is a full miscarriage within hours there is a risk of infection spreading into the womb and beyond.

Based on what The Irish Times has learned is contained in the draft final report, we know that blood tests done on her admission on the Sunday showed that Ms Halappanavar's white cell count was raised.

Early defence
This suggests her body was already defending itself against infection by the time she got to the hospital.

The draft report indicates the next blood test for white blood cells was not carried out until the following Wednesday.

What remains unclear is when the first tests to ascertain whether infection had spread to her bloodstream (septicaemia) were performed.

Another key issue is how closely Ms Halappanavar was monitored in terms of how often her pulse, blood pressure, temperature and other vital signs were measured. Changes in these parameters are the first clue that a patient’s condition may be deteriorating.

Then there is the issue of how quickly health professionals respond to any deterioration in the person’s vital signs. The draft report appears to suggest that Ms Halappanavar’s condition deteriorated on Tuesday evening, but might not have been acted on until Wednesday afternoon.

Praveen Halappanavar has maintained that, in his view, the hospital placed too much emphasis on the foetus and that there was an underemphasis on his wife's wellbeing.

He feels that, rather than the lack of viability of the foetus being recognised from the outset, the continuing presence of the foetal heartbeat led to the postponement of a surgical intervention to evacuate the contents of the womb.

Such a move would be consistent with the management of an infection that had reached the womb in order to prevent its spread to the bloodstream.

Staff evidence
However we have yet to hear from the nursing and medical staff who looked after Ms Halappanavar.

Their evidence to next week’s inquest will be crucial. In particular we should learn how slowly or quickly she deteriorated during her hospital admission.

When was it recognised that Ms Halappanavar had severe sepsis and how speedily did they respond?

How soon did staff consider the need for a surgical evacuation of her uterus (an abortion)? When and by what route were antibiotics for infection administered?

And was a full range of medical specialists involved in her intensive care?