Medical View: Postmortem found highly toxic E.coli strain

Rarity of such severe sepsis was underlined by the evidence of Dr Peter Kelehan

Dr Peter Kelehan,  retired Paediatric Pathologist National Maternity Hospital, and Pathologist Professor Grace Callagy photographed at Galway County Hall for the inquest into the death of Savita Halappanavar

Dr Peter Kelehan, retired Paediatric Pathologist National Maternity Hospital, and Pathologist Professor Grace Callagy photographed at Galway County Hall for the inquest into the death of Savita Halappanavar

 

Hearing the details of postmortem reports is probably the most sobering part of any inquest. Praveen Halappanavar wisely absented himself from yesterday’s description of the autopsy carried out on his wife.

Prof Grace Callagy, who carried out the autopsy on Savita Halappanavar at University Hospital Galway outlined her findings. Clearly the deceased was a strong and healthy 31-year-old; the only abnormal findings were from the effects of sepsis and the efforts made to resuscitate her.

Ms Halappanavar had acute injuries to both her lungs; her kidneys bore the evidence of having failed; and clots and haemorrhages in various organs were the result of a condition called Disseminated Intravascular Coagulation (DIC). This represents a cascade of failures in the body’s clotting system. DIC is not itself a specific illness; rather it is the effect of the severity and progression of other illnesses with the result that uncontrolled clotting and bleeding occur simultaneously.


Extremely rare
The rarity of such severe sepsis was underlined by the evidence of Dr Peter Kelehan, a retired consultant pathologist at the National Maternity Hospital in Dublin. In long professional experience, he said he had seen fewer than five cases of septic abortion that were as severe as Ms Halappanavar’s. Explaining the findings in her placenta, he noted that it was extremely rare to find such severe inflammation at postmortem.

It is reasonable to conclude, therefore, on the basis of the expert evidence, that she died from a rapidly evolving fulminant septicaemia due to a highly toxic strain of the E.coli bacterium.

It is almost certain that the microbe was present in the deceased’s bowel, from where it migrated into her genital tract after her foetal membranes ruptured.