Midwife’s statement raises possibility infection spread with extraordinary speed

When Savita developed a fast heartbeat was the subject of some evidential disagreement

Tue, Apr 9, 2013, 23:10

Further medical details emerged at the inquest about the care Savita Halappanavar received during her admission to the obstetrics unit at Galway University Hospital last October.

Dr Olutoyele Olatunbosun, the senior house officer who saw her on admission, described finding bulging membranes from the foetal sac and a dilated cervix when she examined Savita. By definition, this means a miscarriage was inevitable and that the foetus could not survive.

In his questioning of the witness, coroner Dr Ciaran McLoughlin asked if she had carried out any test for the presence of amniotic fluid. Dr Olatunbosun said she had not. He also established that a full blood count had been sent to the hospital laboratory and that the result of this would have been available some hours later. Asked by the coroner if she felt a responsibility to follow up the test, the doctor said no.

The coroner stated that in his opinion, a junior doctor who orders a blood test has a responsibility to follow up the result. This is consistent with good professional medical practice. It subsequently emerged the blood test showed a raised white cell count.

When Savita Halappanavar first developed a fast heartbeat (tachycardia) was the subject of some evidential disagreement. A midwife maintained she phoned a senior house officer on call on the Tuesday evening to alert him to this finding; he says he was told the patient’s vital signs were normal. When it was put to the doctor whether a patient with a fast pulse, dilated cervix and rupture of the membranes would cause him to be concerned about sepsis, he said it would.

What is not in doubt is when the diagnosis of chorio-amnionitis was first made – on the Wednesday morning at about 6am. The doctor who saw Savita at this time said she had a raised temperature, a pulse of 166/min and low blood pressure. Ragged foetal membranes were visible, as was a foul-smelling vaginal discharge.

Chorio-amnionitis is the medical term for inflammation of the foetal membranes secondary to infection.

The coroner confirmed with counsel that no chart entries recording the patient’s pulse were made from 9pm on the Tuesday until 6.30 the following morning.

First staff evidence
The inquest heard its first evidence from a member of the nursing staff when staff midwife Miriam Dunleavy took the stand. She had been on night duty for part of Ms Halappanavar’s admission. She described finding Savita shivering with her teeth chattering at about 4.15 on the Wednesday morning. She stated that the patient was otherwise stable.

However in what the midwife described as “never seeing anyone get so sick so fast”, Ms Dunleavy said that some two hours later her patient was seriously unwell.

This statement raises the possibility that the infection travelled through Savita’s system with extraordinary speed. Evidence from experts in microbiology to the inquest later this week may shed further light on this.

Finally, the consultant obstetrician who looked after Savita, Dr Katherine Astbury, read her statement to the inquest. She gave a concise account of the patient’s progress from the time of admission, including her definitive diagnosis of chorio-amnionitis made on Wednesday. She described getting expert advice which resulted in the patient’s antibiotic treatment being strengthened that day.

Dr Astbury discussed the case with two consultant obstetrician colleagues that lunchtime and concluded that, notwithstanding the presence of a foetal heart beat she would have to perform a termination because of the threat to Savita’s life.

However before this could be done, her patient completed the miscarriage spontaneously. By the time Savita was admitted to ICU early on Thursday morning, the consultant said she was seriously ill with acute respiratory distress syndrome, and a condition where the body’s clotting system seriously malfunctions , as well as septic shock.