Experts analyzing the death of Indian-origin dentist Savita Halappanavar, who lost her life after she was refused an abortion in Ireland, said that her life could have been saved if she had been offered a timely termination.
A 108-page report on the death of Halappanavar in October concluded that she should have also had her blood poisoning detected much sooner.
According to CBS News, experts looking into the case documented what the lead investigator described as a cascade of mistakes overshadowed by officials' refusal to remove the fetus until its heart stopped beating.
Dr. Sabaratnam Arulkumaran, a London professor of obstetrics and gynecology who led the seven-month probe, said that he would have terminated the pregnancy if the case had come to him.
The five investigators found that a chain of doctors and nurses all failed to take proactive steps to identify and stop the spread of infection throughout her body.
The report found that when Halappanavar was hospitalized for back pain 17 weeks into her pregnancy, doctors identified she was miscarrying and the fetus could not survive.
According to the report, but they consistently missed evidence for days pointing to an existing case of sepsis, or blood poisoning, as the cause.
The report found that doctors had laid too much emphasis on measuring the fetus' heartbeat and too little on investigating why Halappanavar's white blood-cell count was rising, her blood pressure was falling and her heart rate and temperature were rising.
All were signs that internal infection was growing and it was linked to a rupture in her uterus that a night-shift doctor identified in notes, but a day-shift doctor failed to read.
According to the report, Arulkumaran said Ireland's doctors and constitutional lawyers must draft regulations that specify when an abortion can be performed on a pregnant woman suffering sepsis.
Halappanavar delivered a dead fetus four days into her hospitalization, and fell into a coma and died of massive organ failure four days later, the report added.