How bureaucracy killed a woman

I am not going to get into the debate of legalized abortion or not.

However, I am going to get into a practical discussion of how dangerous it is when common sense fails to exist and bureaucratic rules interfere with the practice of medicine.

As a high-risk obstetrician for more than 25 years who deals with life and death situations in pregnant women frequently, there is a very logical pathway to the treatment of a septic pregnancy.

As I read this story about a pregnant woman in Ireland, it appears that in her 17th week of pregnancy, she presented at the hospital with significant signs and symptoms of blood poisoning.

Savita Halappanavar, 31, who lived in Galway since 2008, was 17 weeks along in her pregnancy. University Hospital Galway in western Ireland declined to say whether doctors believed Halappanavar's blood poisoning could have been reversed had she received an abortion rather than wait for the fetus to die on its own.

Ireland's constitution officially bans abortion, but a 1992 Supreme Court ruling found it should be legalized for situations when the woman's life is at risk from continuing the pregnancy.

In a statement it described its own investigation into the death, and a parallel probe by the national government's Health Service Executive, as "standard practice" whenever a pregnant woman dies in a hospital. The Galway coroner also planned a public inquest.

Savita Halappanavar's husband, Praveen, said doctors determined that she was miscarrying within hours of her hospitalization for severe pain on Sunday, Oct. 21. He said that over the next three days doctors refused their requests for a termination of her fetus to combat her own surging pain and fading health.

The fetus died the following the day, and by Tuesday, Savita died, too.
You may ask: How does a 17-week pregnancy become infected? Even though I don’t have all the medical facts of this case, I will theorize: Most likely this woman had a premature rupture of the membranes, perhaps from an incompetent cervix; and when her water broke, bacteria from the vagina ascended into the uterus, creating an extreme infectious condition.

Now, all obstetricians know the only treatment to save this woman’s life is to induce the pregnancy irrespective of gestational age. If the baby is older than 24 weeks, of course the baby will have an opportunity to live – especially if the infant is delivered with intensive neonatal services.

Obstetricians also know that if you do not deliver a septic pregnancy, the death rate for that mother is astronomically high.

But, yet, after reading this story – it seems bureaucratic rules interfered with good medical practice. And, of course, this unfortunate patient died of septic shock.

For me, it is very sad. Maternal mortality was the leading cause of death centuries ago. But it seems in some part of the world, they have forgotten past history and many of these unfortunate events seem to repeat themselves.

The Associated Press contributed to this.