On Michael Nugent’s post about Savita, a midwife named Clare insisted that an abortion wouldn’t have saved Savita’s life.
This case is very clearly nothing to do with abortion. Pro “choicers” have simply seized upon it and dishonestly pretended that abortion would have saved her life. This scenario is not unusual in obstetrics and whether she aborted or not, what she needed was close monitoring and timely, effective prophylactic antibiotics. There are a number of similar cases of women who have also died of septicaemia following legal abortion. Had this unfortunate woman aborted, precisely the same risks of infection would have remained.
The miscarriage didn’t kill Savita, septicaemia did. Septicaemia is also a major risk following abortion. Abortion does not stop people dying of septicaemia.
As to your descibing Savita as being ” in the middle of a long miscarriage” the likelihood is that she was in the middle of a *threatened” miscarriage. Obstetric terminology does not refer to a pregnancy as a miscarriage until fetal demise. Until that point miscarriage is *threatened*. Under ordinary circumstances a woman with a threatened miscarriage is given appropriate care and monitoring in order to prevent such needless death. Here in the UK where abortion is perfectly legal, women with ruptured membranes and threatened misc are not offered abortion in case they might develop septicaemia and die. That would be absurd.
She got her head handed to her, along with an even clearer picture of what happened to Savita.
From EL –
As a medical person, you should know the difference between premature rupture of membranes in a viable fetus, and in a 17 wk pregnancy. Finally, you know, or should know if you are a midwife as you claim, that an open cervix and leaking amniotic fluid is a risk for amnionitis, and the longer the duration, the more increased risk. Remember the old saying “never let the sun set twice on a laboring woman”? Since there was no chance of viability, antibiotics along with evacuation of the uterus was the correct treatment. Especially for someone in severe pain.
From Dr Kitty –
Clare, she had PPROM at 17 weeks with cervical dilation. BY DEFINITION this pregnancy was not viable. Even if the cervix was not dilated, second trimester ROM leads to fatal lung hypoplasia. Even if there was no ROM an open cervix will not close. It was an incomplete miscarriage.
Whether FH was present or not is IRRELEVANT, the treatment of a second trimester incomplete miscarriage is to evacuate the uterus ASAP to reduce the risk of bleeding and infection. The longer the cervix is dilated with ROM the higher the risk of chorioamnionitis developing and the greater the chance of sepsis. She was septic well before ERPOC was even performed, so it was too little, too late by then.
The treatment of chorioamnionitis requires prompt removal of the infected tissue, i.e. the membranes and placenta. IV antibiotics alone do not cut it.
She requested the pregnancy be ended. Her life was at greater risk the longer she remained pregnant.
If she had had a D&E or medically induced miscarriage the day the pregnancy was found to be non viable there is EVERY chance she would still be alive.
And a followup –
Clare you’re a MW, so your field is normal, uncomplicated, birth. I assume you’re quite good at that.
Your knowledge of pregnancy complications is not as good, so I’ll help a little.
A threatened miscarriage is when there is bleeding in the fist trimester without cervical dilation. Bleeding in the second or third trimester without cervical dilation is a placental abruption. When the cervix is dilated it is an inevitable miscarriage. When there is a significant ROM before 24 weeks there usually isn’t sufficient amniotic fluid to allow foetal lung development, leading to lung hypoplasia and death.
Women with second trimester ROM in the UK are absolutely offered TOP, because the pregnancy is considered non viable and the risk of developing chorioamnionitis is high.
Women with second trimester cervical dilation and prolonged very preterm labour ARE offered TOP, because the cervix is not designed to stay open for days on end, the uterus is not designed to contract for days on end, they are in pain, and the pregnancy is going to end before viability regardless.
Do feel free to double check everything I’ve typed against your gynaecology textbook and the RCOG green tops.
Decisive, I think.