The consultant obstetrician who treated Savita Halappanavar told her she could not have a termination due to the "legal position in Ireland", but the following day said there was no option but to perform one, she has told the inquest.
Dr Katherine Astbury’s evidence yesterday was her first public statement on her recollection of the events leading up to the death of Ms Halappanavar. Her evidence conflicts with that of Praveen Halappanavar in a number of areas.
The last witness to take the stand on the second day of this inquest, Dr Astbury said she first saw Ms Halappanavar on October 11th last at her public ante-natal clinic, 17 days before her death. “She was a fit and healthy 31-year-old in her first pregnancy,” she said.
She next saw Ms Halappanavar on Monday morning, October 22nd, at Galway University Hospital. "Her membranes had ruptured during the night at 00.30 but she had not delivered the foetus spontaneously . . .
Risk of sepsis
"I sent her for an ultrasound scan to confirm the presence of the foetal heartbeat and I discussed the rationale for this in terms of the risk of sepsis with ruptured membranes and therefore the need to avoid her sitting on the ward undelivered for a protracted period after foetal demise.
“The scan confirmed the presence of the foetal heart and there in the absence of a risk to Ms Halappanavar’s life the plan remained to await events.”
She reviewed Ms Halappanavar at 8.20am on Tuesday 23rd and she was very upset and asked about a termination.
“I recall informing Ms Halappanavar that the legal position in Ireland did not permit me to terminate the pregnancy in her case at that time.”
At 8.25am on Wednesday, she reviewed Ms Halappanavar and noted during the early morning she had spiked a temperature of 39.6 degrees, with a heart rate of 160 and blood pressure of 95/55.
At this point her temperature had come down to 37.9 degrees and her pulse to 144bpm. She said she discussed with Ms Halappanavar the concern that she had inflamed foetal membranes due to infection.
“I also informed Ms Halappanavar that if we did not identify another source of infection or if she did not continue to improve we might have no option but to consider a termination regardless of the foetal heart.”
Mr Halappanavar has said he had no knowledge this discussion had taken place. In his statement he said he was at the hospital with his wife throughout Wednesday.
Dr Astbury got a call from the ward after 1pm on Wednesday saying Ms Halappanavar had deteriorated. She returned to the ward and found Ms Halappanavar with a temperature of 37.3, a pulse of 140bpm and blood pressure of 60/30.
She discussed the situation with a colleague in obstetrics, Dr Geraldine Gaffney, and they agreed delivery of the foetus was medically necessary. She carried out a scan on Ms Halappanavar and “confirmed foetal demise”. She was taken to theatre at 3.15pm where she delivered a female foetus.
“Ms Halappanavar was transferred to the HDU [high dependency unit] at approximately 16.45. Ms Halappanavar’s condition deteriorated during the night and she was transferred to ICU at approximately 03.00 on Thursday, 25th October.”
She said she reviewed her at 8.40am on Thursday and again at 5.25pm. She was at Ballinasloe Hospital on Friday 26th and got a call at about 1.30pm telling her that Ms Halappanavar had deteriorated.
“I reviewed Ms Halappanavar at 20.00 on my return to Galway and discussed her care with Dr Paul Naughton, consultant anaesthetist on call. Ms Halappanavar remained critically ill.
“On the way out of ICU, I spoke to Mr Halappanavar and explained that his wife was critically ill. We discussed that her initial and subsequent blood cultures had shown septicaemia due to E.coli Extended Spectrum Beta Lacatamase, which is resistant to many commonly used first-line antibiotics . . .
“I informed him I was due to take annual leave [when asked if she would return the following morning].”
She got a call from Dr Una Conway on Saturday 27th to let her know Ms Halappanavar had deteriorated further and was not expected to recover.
“Ms Halappanavar suffered a cardiac arrest at 00.45 on Sunday, 28th October 2012 and resuscitation was unsuccessful. I would like to offer my condolences to Mr Halappanavar and his family at this difficult time.”
Dr Astbury will be cross-examined this morning.