A 31-year-old woman is dead after doctors in Ireland reportedly refused to give her an abortion as she languished in pain from an ongoing miscarriage.
Even as medically necessary abortions remain a contentious topic on this side of the Atlantic, doctors in the United States said the death was preventable.
"I don't do abortions, I'll tell you right now. ... But I'd have to tell the mother, 'Your baby doesn't have a chance and to save your life, I have to do this,'" said Dr. John Coppes, the medical director at Austin Medical Center-Mayo Health System in Minnesota.
Savita Halappanavar was 17-weeks pregnant when she arrived at University Hospital Galway in Ireland, complaining of back pain, her husband told the Irish Times. Doctors told Halappanavar she was miscarrying.
A day into her hospital stay, Halappanavar asked doctors to terminate the pregnancy because she was in "agony," her water had broken and she was shivering and vomiting. However, they said they couldn't perform the operation if a fetal heartbeat was present because Ireland is a "Catholic country," Praveen Halappanavar, her husband, told the Irish Times.
Abortion is illegal in Ireland unless a woman's life is in danger if she continues her pregnancy.
In the United States, a Supreme Court decision, Roe v. Wade, made abortion safe and legal in 1973, but the abortion debate has continued to find its way into political discussions, with Republican presidential candidate Mitt Romney declaring himself a "pro-life president" in October after telling an Iowa newspaper he would not legislate on abortion if he won.
At the Galway University Hospital, Halappanavar's fetal heartbeat stopped nearly three days after she arrived on Oct. 21. Doctors evacuated Halappanavar's uterus, but she died of septicemia, or blood poisoning, on Oct. 28, according the Irish Times, which cited the autopsy report.
The Galway Roscommon University Hospitals Group confirmed Halappanavar was a pregnant patient who died in its care. It released a statement extending its sympathies to Halappanavar's husband and explaining that it would be reviewing the "unexpected death" as per the national incident management policy of Ireland's public health care provider, called Health Service Executive, or HSE.
"The process of incident review seeks to ascertain the facts relating to the incident, draw conclusions and make recommendations in relation to any steps that may need to be taken to prevent a similar incident occurring again," HSE said in a statement, adding that it will seek an external obstetrician to join its team of investigators.
Coppes, who has never met Halappanavar, said that when a woman's water, or amniotic sac, breaks during early pregnancy, she is at risk for infection because the barrier between the baby and the outside world is broken. The fetus's environment is also no longer sterile, putting it at risk for "horrible malformations."
Coppes said the fact that Halappanavar's husband reported she was ill and vomiting suggested a serious infection had set in, and it's possible that it spread to her blood, resulting the septicemia that killed her. When asked how long it takes for an infection in the uterus to spread to the blood, Coppes said it can vary.
"Let's put it this way, the clock starts ticking when the membrane ruptures," he said. "It can be pretty fast. That's why you don't sit and watch."
When an infection occurs in a pregnant woman's uterus, Dr. Kimberly Gecsi, an obstetrician at University Hospitals in Cleveland, said the only way to treat it is to terminate the pregnancy.
"Antibiotics are part of the process, but once an infection develops inside the uterus, antibiotics alone aren't going to treat the infection," Gecsi said. "The infection will continue until the products of pregnancy are removed, either by natural procedure or with surgical procedure."