The Malta Independent 18 June 2024, Tuesday
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Prudente had never been in danger of death, court told

Friday, 6 January 2023, 13:47 Last update: about 2 years ago

Andrea Prudente had never been in danger of death, a court was told on Friday.

Doctors began testifying before a court of law in the case filed by Prudente against the Maltese state over Mater Dei Hospital’s refusal to terminate her 16 week-old pregnancy during a stay in Malta.

Madam Justice Miriam Hayman is hearing testimony from medical personnel who dealt with the case, which led to the government moving to amend the country’s laws in a move that is being described as opening the door to abortion.

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First on the witness stand on Friday was Professor Yves Muscat Baron, an obstetrician and gynaecologist who chairs the Maternity and Gynaecology Department at Mater Dei Hospital.

Replying to questions by lawyer Lara Dimitrijevic, representing Prudente, Muscat Baron explained that when a mother’s membranes are ruptured and amniotic fluid is lost, a baby could survive in just 2cm of fluid. “To be detected on ultrasound, 10 to 14 days are needed. The baby can survive this.”

“As soon as the waters break we give intravenous antibiotics,” he said, explaining that the membranes may re-seal themselves.

He said that if all amniotic fluid were to be lost, it would form again “because the kidneys are still working and the membranes also secrete water.”

With regard to Prudente, Muscat Baron said the patient had suffered a prolapse of the umbilical cord protruding from her cervix. Mr Alberto Vella, the consultant treating Prudente, said he was “worried, because he had been contacted by Prof. Isabel Stabile, who had told him that the patient was potentially in danger, and had told him that ‘you know what you should do.’”

“He [Vella] appeared uncomfortable so I convened a case conference with two other specialists, to discuss the case and the file. We decided that the management was the same as we had been doing for the past 35-40 years, without incident.”

While doctors expected the foetus’s heart to stop due to the umbilical cord prolapse, a next-day ultrasound showed the cervix to be closed and no cord was visible. “It could be that this happened because we ordered her to rest in bed… many times, this solves the problem.”

Muscat Baron said a bereavement midwife had been asked to assist the patient as standard practice. “If there is a danger of losing the baby, she begins to start a relationship with the mother… Perinatal mental health services don’t stop at outpatients but also assist patients at emergency.”

The judge asked the witness at what point the decision, if any, had been taken that the pregnancy had to be terminated. “At that time there was no indication for this to take place,” Muscat Baron said.

“And after?” asked the judge.

“I don’t know, because she went to Spain to have an abortion. She was responding well to antibiotics… The patient had never been in danger of death.”

Dimitrijevic asked whether there any other dangers were faced by the patient. “The risk of sepsis (infection spreading to the blood) is 1% in cases of ruptured membranes. Over the past 20 years, the mortality rate was 0.1% and has probably reduced because we now administer intravenous antibiotics immediately,” Muscat Baron said.

Consultant Albert Vella

The next witness, Mr Alberto Vella, said upon seeing the scans presented in court that it was clear that Prudente’s cervix was very closed and “that the problem had resolved itself”, with an ultrasound confirming that the foetal heartbeat was there, despite the lack of fluid after the sac had been perforated.

“(In non-viable pregnancies), many times the body itself removes the baby,” he said.

“When you have conditions like these, you don’t know what is going to happen and often the patient miscarries on her own… If there is an infection which is dangerous to the mother the body disposes of the foetus.”

If the foetus is not viable it is removed by inducing labour to save the mother from septicaemia, Vella said. “We always work in the hope that a pregnancy could take longer [than normal] and still be viable”.

“But was she at a potential risk?” Dimitrijevic pressed on.

“It was minimal. She was in hospital, if anything happened it would be treated there. It wouldn’t snowball.”

The judge asked at what point there was a disagreement with the management of the pregnancy. “There was none... I had told them that I would take action if things started to go bad… They were very nice people,” he repeated. “The patient had been told that the doctors had no legal right to terminate a viable pregnancy.”

Vella however said there was “a chance – not a great one – that the baby could live”, when asked by State Advocate Fiorella Fenech Vella.

 

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