Savita Halappanavar: Chronology of Key Events

Thursday 13 June 2013 14.31
Savita Halappanavar was 17 weeks pregnant with her first child (Pic: The Irish Times)
Savita Halappanavar was 17 weeks pregnant with her first child (Pic: The Irish Times)

CHRONOLOGY OF KEY EVENTS*

Sunday 21 October

09.35: Savita Halappanavar and her husband Praveen attend Galway University Hospital gynaecology ward, 17 weeks’ pregnant with her first child, complaining of back pain. Tests show no active infection in the urine.

Foetal heartbeat heard.

Patient reassured and went home.

15:30: Mrs Halappanavar re-attends gynaecology ward upset and crying as she felt something coming down. Reviewing doctor concludes that pregnancy loss was inevitable and impending and it was too late to stitch the cervix to try and prevent miscarriage.

Decision is to admit and 'await events'. Pain killer was administered and blood was taken for lab tests. Ms Halappanavar's white blood cell count was raised.

Monday 22 October

00.30: Mrs Halappanavar vomits and has a spontaneous rupture of membranes during a visit to the bathroom.

08.20: Obstetrics & Gynaecology consultant reviews case on ward round.

Decision made for Mrs Halappanavar to have ultrasound scan to check for foetal heart and to 'await events'.

Scan result suggests a normally grown and alive foetus.

22.00: Mrs Halappanavar administered first dose of antibiotic, Erythromycin.

This to be administered every six hours.

Tuesday 23 October

08.20: While being reviewed by the Obstetric & Gynaecology consultant, Ms Halappanavar and her husband inquire about the possibility of a medically induced termination, to avoid a protracted waiting time given miscarriage was inevitable.

Consultant tells couple: "Under Irish law, if there is no evidence of risk to life of the mother, our hands are tied so long as there's a foetal heart'".

Consultant says that if the risk to the mother was to increase, a termination would have been possible, but that would be based on actual risk and not a theoretical risk of infection.

Consultant says: "We can't predict who is going to get an infection".

21:00: Staff midwife asks Senior House Officer to see Mrs Halappanavar as she is complaining of weakness.

Raised heart rate reported.

SHO is busy at this time with other patients.

Wednesday 24 October

01:00: It is not documented in the clinical records, but the Senior House Officer said at interview he came to the ward at this time as requested by the nursing staff when he was less busy.

Mrs Halappanavar was asleep (Praveen was asleep on a camp bed) and he made a decision not to wake her.

SHO says he was advised by staff midwife patient's condition was stable.

04:15: Mrs Halappanavar rings call bell.

Her teeth were chattering.

She had vomited.

Temperature only taken, not blood pressure or heart rate.

06:30: Mrs Halappanavar reports feeling weak with general body aches.

All vital signs raised.

Senior House Officer contacted immediately to review.

07:00: Senior House Officer diagnoses probable Sepsis.

Blood samples taken for checks.

Further antibiotics given.

08:25: Consultant Obstetrician & Gynaecologist reviews case on ward round.

Consultant advised Mr & Mrs Halappanavar that if the source of infection can not be found, a termination may have to be considered.

13.20: Diagnosis of septic shock is made.

Further treatment provided.

15:00: Scan shows no foetal heartbeat.

15:15: Mrs Halappanavar has a spontaneous delivery while lines were being inserted in theatre to assess fluid requirements and to deliver drugs to help blood pressure.

16:45: Mrs Halappanavar transferred to the High Dependency Unit.

Thursday 24 October

03:00: Mrs Halappanavar transferred to the Intensive Care Unit.

Despite best efforts of staff, she continues to deteriorate.

Sunday 28 October

00:45: Mrs Halappanavar suffers a cardiac arrest.

She dies at 01:09

Friday 19 April - Inquest Verdict

Medical misadventure.

Cause of Death: Fulminant septic shock from E. coli bacteremia.

Ascending genital tract sepsis.

Miscarriage at 17 weeks gestation associated with chorioamniontis.

* This chronology was prepared by RTÉ based on key aspects of the report and the inquest verdict.