Medical teams focus first on pregnant woman's health, obstetricians say

Paul Cullen, Health Correspondent of the Irish Times. Read the article on the Times' website here. 

The main focus of medical teams treating a seriously ill pregnant woman is on maintaining the health of the mother, according to leading obstetricians.

Although there are no fixed rules governing practice in such cases, interventions to deal with the cause of the illness are not considered a therapeutic termination of pregnancy, one Dublin-based practitioner told The Irish Times.

In his hospital, intervention took place in cases where a mother’s life was in danger such as was required by the maternal interest, he said.

The cause of this intervention could relate to an independent condition such as cancer or a condition arising during pregnancy but in either case this intervention was not considered a therapeutic termination of pregnancy.

In all cases, the medical options would be discussed in detail with the mother where this was possible.

Septicaemia was an unpredictable event which could happen acutely and prove devastating for the affected person, he said. The existence of a foetal heartbeat could lead to a situation where it might not be considered that septicaemia was a possible complication.

Voluntary hospital 

Another obstetrician working in a voluntary hospital said that in situations where a pregnancy would never attain viability and the mother was critically ill, the main concentration of the medical team treating the woman would be on maintaining her health.

“In such situations, you expedite delivery,” he said. However, problems such as septicaemia could “creep up” very quickly and have devastating effects. Infection was one of the major causes of maternal death, he added.

“Decisions like this are usually clinically led. It’s easier in voluntary hospitals with clear clinical leadership. Where governance is more complex and bureaucratic it can be harder to get decisions.”

Under the Constitution, as interpreted by the Supreme Court in 1992, it is lawful to terminate a pregnancy if it is established “as a matter of probability” that there is a real and substantial risk to the life, as opposed to the health, of the mother.

The Medical Council advises doctors to undertake a full assessment of any risk “in light of the clinical research on this issue”.

According to its guidelines: “In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving.”

“In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.”

Maternal death is defined by the World Health Organisation as the death of a woman while pregnant or within 42 days of termination of pregnancy.

Death is due either to indirect causes or to a cause that can be directly linked to the pregnancy.

Ireland’s rate of maternal death, at six per 100,000, is extremely low by international standards.