An Indian dentist would probably still be alive if the law in Ireland allowed an abortion as she miscarried, an inquest was told.
A leading obstetrician claimed the inability to end Savita Halappanavar's pregnancy until there was a substantial and real risk of her death ultimately cost the 31-year-old her life.
Peter Boylan revealed that by the time she was sick enough to justify an abortion on the morning of Wednesday October 24 last year, she was already suffering from sepsis blood infection.
He said the real problem was the inability to terminate the pregnancy prior to Mrs Halappanavar developing a real and substantial risk to life.
"By that time it was, effectively, too late to save her life," he said.
Mrs Halappanavar was 17 weeks pregnant when admitted to University Hospital Galway on October 21 and died a week later from septicaemia and a rare strain of E.coli, four days after she lost her baby.
Mr Boylan, former Master of the National Maternity Hospital in Dublin, described the rules on limited abortion under which doctors are operating in Ireland as a vacuum.
He told the inquest into Mrs Halappanavar's death that had her pregnancy been terminated on the Monday or Tuesday it is "highly likely, on the balance of probabilities, that she would not have died".
"Termination of pregnancy at that time was not a practical proposition because of the law," he said.
"From the early hours of October 24 Mrs Halappanavar developed sepsis, severe sepsis and septic shock in rapid sequence.
"She developed an overwhelming infection and despite the best efforts of intensive care specialists she unfortunately died."
Mrs Halappanavar's obstetrician Dr Katherine Astbury decided to carry out an abortion on the Wednesday afternoon when told Mrs Halappanavar's condition had deteriorated further.
She was brought to theatre to be stabilised, but delivered her dead baby daughter - which she named Prasa - after 4pm that afternoon and fell critically ill.
Mr Boylan was questioned several times if the outcome would have been different if appropriate intervention had started in the early hours of the Wednesday, when the sepsis should have been spotted first.
"Given the fact that Mrs Halappanavar became critically ill over a relatively short period of time it is unlikely, on the balance of probabilities, that intervention, to terminate the baby from approximately 9.30am onwards, would have made a difference to the eventual outcome," he said, adding that it would have taken time for Dr Astbury to get a second opinion and start the termination.
Mr Boylan told Galway coroner's court there were a number of deficiencies in her care, none on their own which were likely to have resulted in Ms Halappanavar's death.
"Cumulatively however, they resulted in a delay in appropriate treatment of several hours," he continued.
"It is well known that each hour delay in appropriate treatment increases mortality rate by 6%."
He said hospital guidelines on antibiotics for sepsis were based on international standards, but were not good enough as they were resistant to the strain of E.coli she had.
He also criticised delays in following blood test results from the Sunday on admission and getting lactate tests on the Wednesday and the "conflict of evidence" between a medic and midwife.
Dr Boylan also agreed a doctor should have been called at 4.15am on the Wednesday morning when the patient was found shivering in bed.
He said that midwife Miriam Dunleavy "erred in judgement" when she prescribed paracetamol to take down her temperature instead of checking her pulse rate.
"Sometime between 9pm and the check at 4.15am things began to happen and then happened rapidly between 5.15am to 6.30am," he said.
"Things went severely wrong at that stage."
The inquest heard that Dr Astbury believed Mrs Halappanavar had sepsis during her morning round at 8.30am, but ordered more tests before opting on a termination.
Eugene Gleeson, senior counsel for widower Praveen, asked Dr Boylan if he felt that Dr Astbury should wait until patients develop severe sepsis - which has a mortality rate of 20% to 40% - before intervening.
He was also questioned on why a termination is not considered after a woman's waters break, leaving them vulnerable to infection.
"What normally happens in these circumstances, which is why death is so rare at one in 100,000 mothers, the membrane ruptures and the woman gets the beginning of chorioamnionitis, goes into labour and delivers," he added.
"Unfortunately, Savita had a very aggressive organism which resulted in a very severe and rapid onset of septic shock from which she didn't recover."
Mr Halappanavar left the packed courtroom with his solicitor as the pathologist who carried out the post-mortem examination on his daughter's remains took to the witness box.
Dr Michael Tan Chien Sheng said that despite an extra digit on the right hand, baby Prase had been perfect and did not show any obvious signs of infection.
Elsewhere, Dr Frans Colesky, a consultant pathologist with expertise in placenta pathology, confirmed chorioamnionitis had been present in the placenta for at least 12 hours and up to 36 hours before it was delivered.Suggest a correction