Expert highlights legislative vacuum faced by obstetricians

A leading US expert on treating high-risk pregnancies has said that the legislative vacuum in which Irish obstetricians have to work is “an enormous problem”.

Prof Mary E D’Alton of Columbia University’s College of Physicians and Surgeons in New York said the lack of legal clarity here on circumstances for terminating pregnancies was “very unsatisfactory”.

Prof D’Alton, who is due to receive an alumni award from NUI Galway this evening, is a north Mayo-born graduate of the university. She currently directs obstetrics and gynaecology services at New York-Presbyterian Hospital and Columbia University Medical Centre.

Prof D’Alton cautioned she had no knowledge of the details of the case of Savita Halappanavar, the Indian dentist who was 17 weeks pregnant when she died at University Hospital Galway last October.

Risks

Addressing medical staff at UHG yesterday, Prof D’Alton noted maternal mortality rates were rising in developed countries, including the US, where reported cases had risen from 10 to 14.5 per 100,000 between 1990 and 2006 in spite of medical advances.

In a “nutshell”, pregnant women in developed countries were tending to be “older” and “bigger”, with associated risks related to hypertension and diabetes, while a rising Caesarean delivery rate had increased the incidence of “placenta accreta” where the placenta is abnormally attached to the uterus.

Ireland, which has only had comprehensive statistics for the past there years, has a rate of eight deaths per 100,000, with 40 per cent of the fatalities being among women who were not born here.

In Britain, where the rate of maternal death is 11.4 per 100,000, the main cause was cardiovascular, but “worryingly”, sepsis was on the rise. There was no data on sepsis in the US, and infection was still a “rare cause”, she said.

The “big three” causes in the US were traditionally considered to be haemorrhage, pulmonary embolism and hypertensive disorders, she said.

While there had been a “significant reduction in deaths due to haemorrhage in the US, and a “modest” decline due to hypertensive disorders, an increase due to cardiac conditions reflected the fact women were becoming pregnant with “more risk, especially cardiac risk”.

She said Ireland was to be “congratulated” for having developed 20 clinical guidelines on maternal health since 2010.

The fact Ireland had handled an increase of more than 20 per cent in births in 20 maternity units, with the majority of units delivering more than 3,000 babies a year, was also a considerable advantage, she said.