Sunday October 21st, 2012
AMSavita Halappanavar comes to Galway University Hospital and is diagnosed with back pain. Treating doctors accept now she was suffering contractions prior to miscarriage.
PM She returns to the hospital complaining of a dragging sensation. Doctors find her membranes are bulging and there is a foetal heartbeat. She is not given a vaginal examination and is not checked for leaking of amniotic fluid.
Blood tests are ordered; these later show an abnormally high white blood cell count but this result is not immediately relayed to her medical team.
The registrar tells her pregnancy loss is inevitable; her consultant, Dr Katherine Astbury, will later tell her the prognosis is poor but not non-existent.
Monday October 22nd
12:30am
Her waters break. Vital signs are normal.
Dr Astbury reviews her during her morning round. The plan is to “await events”.
She is put on antibiotics that evening to protect against infection.
Tuesday October 23rd
AM
: Savita asks Dr Astbury for a termination but this is refused because the foetal heartbeat is present and her life is not at risk. Midwife manager Ann Maria Burke tells Savita she can't have a termination "because Ireland is a Catholic country".
7.35pm
A student nurse finds Savita's pulse is elevated and tells Ms Burke. She says she tried to bring this information to the attention of senior house office Dr Ikechukwu Uzockwu. He denies being told this information and says he was told her vital signs were normal. No doctor examines Savita until the following morning.
Wednesday October 24th
During this period, when Savita is asleep, her condition is not checked every four hours, as required by hospital policy.
4.35am Savita, and her husband sleeping on the floor of her room, complains of cold. She is given a blanket but her heart rate is not taken.
6.30am
It is now 54 hours since Savita's membranes ruptured. Her temperature is raised and her heart beat is twice what it was on admission. Dr Uzockwu also notes a foul smelling discharge from her vagina, and diagnoses probably chorioamnionitis, an inflammation of the foetal membranes due to infection. He orders tests and puts her on a stronger antibiotic.
A midwife later tells the inquest she has never seen a patient deteriorate so rapidly as Savita did in the preceding two hours.
8.25am
Dr Astbury visits Savita. She does not read the notes herself and is not told by her team about the reference to the foul-smelling discharge. She expresses concern that she has chorioamnionitis, but orders tests to rule out a urinary tract infection. She tells Savita she might have to carry out a termination regardless of the foetal heartbeat. Further antibiotics are prescribed. She diagnoses sepsis, as opposed to severe sepsis, because Savita's blood pressure is not low. She tells the inquest that the information about the foul-smelling discharge is significant and had she known, she would have terminated sooner.
Savita’s lactate level – an indication that she is going into shock – is also tested but the test is rejected because it’s in the wrong bottle. The ward is not informed of his.
1pm Dr Astbury is told Savita’s condition has deteriorated. She decides, after consulting a senior colleague, to carry out a termination. However, a scan reveals the foetal heartbeat has stopped.
3.15pm Savita is moved to theatre. During insertion of a central line, she spontaneously delivers a dead baby girl.
4.45pm She is transferred to the high dependency unit.
Thursday October 25th
3am
Savita is transferred to intensive care suffering from septic shock.
Friday, October 26th
Savita's condition deteriorates. Blood tests reveal septicaemia due to E.coli ESBL, which is highly resistant to the first antibiotic on which she was placed.
8pm Dr Astbury reviews her for the last time. She is critically ill.
Saturday, October 27th
Her condition deteriorates further and doctors do not expect her to survive.
Sunday, October 28th
12.45am
She suffers cardiac arrest. Attempts at resuscitation are unsuccessful.
