US doctors told Andrea Prudente it was "not an issue" when she consulted them after experiencing some spotting for 15 days before she was due to travel from Seattle to Malta, a court heard on Monday. 

Prudente’s case hit international headlines when she was denied an abortion in Malta after suffering a ruptured membrane while 16 weeks pregnant.

Doctors told her they could only intervene if her life was at imminent risk. Her pregnancy was medically terminated in Spain.

On Monday court heard that before travelling to Malta for her babymoon, Prudente had been told spotting was not an issue.

That information was divulged in libel proceedings instituted by Prudente’s lawyer, Lara Dimitrijevic, on her behalf against former Nationalist MP Jason Azzopardi over claims that the American tourist had conspired to introduce abortion in the country. 

Another libel case was instituted against academic and blogger Simon Mercieca over a similar story he uploaded on his blog about the expectant mother who experienced symptoms of miscarriage during her trip to Malta in June 2022. 

In a separate, constitutional case, Prudente is claiming that her fundamental rights were breached when doctors refused to terminate her pregnancy after her waters broke at 16 weeks.

The suit against Azzopardi concerns a Facebook post in which the former MP claimed that Prudente came to Malta purposely to stir controversy over the termination of her pregnancy. 

When the case resumed on Monday, Yves Muscat Baron, consultant head of the maternity and gynaecology department at Mater Dei Hospital, testified that he had never spoken to or examined Prudente but had checked her medical file after her gynaecologist consulted him about the case. 

The woman was 16 weeks pregnant when she was admitted to Mater Dei Hospital after her waters ruptured. 

Prudente later explained that she had been spotting for some 15 days before setting out on her trip to Malta with her partner, Jay Weeldreyer for their babymoon. 

'When there is spotting, we tell a patient to rest'

When testifying in separate breach of rights proceedings against the State, Prudente said that before travelling, she had consulted her health care providers who told her that such spotting was probably normal after intercourse, said Muscat Baron. 

“But that [spotting] could also indicate detachment of the placenta… So we tell them [patients] to rest, not travel half across the world.” 

Prudente travelled from Seattle to London and onto Malta, then crossed over to Gozo.

She consulted doctors at Gozo General Hospital after experiencing more spotting but the foetal heartbeat and waters were all in place. 

The couple then visited a consultant at a private hospital who confirmed that there were blood clots behind the placenta. 

Two days later, the patient’s waters ruptured and the consultant, Alberto Vella, referred her to Mater Dei Hospital where she was monitored for seven days. 

During that period, Prudente had contacted gynecologist Isabelle Stabile who, in turn, called Vella saying, “you know what to do”. 

That call was rather unusual and appeared to carry a “sort of threat”, prompting Vella to consult Muscat Baron who summoned a consultancy conference to discuss Prudente’s case with three other specialists. 

'Not in danger of dying'

Asked by Azzopardi’s lawyer, the witness said that Prudente was never in danger of dying. 

That was the line of discussion among the consultants. 

Asked by presiding Magistrate Rachel Montebello whether the baby could survive at the point when Prudente went to Gozo, Muscat Baron replied, “yes”. 

“Prudente herself was not at all in danger of dying,” went on the witness, when questioned by Prudente’s lawyer, Andrew Sciberras. 

The patient was given intravenous antibiotics for a urinary tract infection she had at the time, reducing the risk of that infection being transmitted to the baby. 

When waters rupture, there is a 1% risk of uterine infection too. 

But when pressed further about the detached placenta, Muscat Baron explained that although there were blood clots behind the placenta, an unborn child can survive even when the surface area of the placenta is only 25% attached. 

“It’s not a death sentence for the baby," he said.

In Prudente’s case, the placenta was protruding, pointed out the lawyer. 

But the consultant rebutted that if that were the case, the baby would not live. When Prudente was admitted to Mater Dei Hospital, an ultrasound showed that there was no liquid around the baby and there was prolapse of the umbilical cord.

However after the mother rested in hospital, the cord moved back up. 

“Had it remained outside [the mother’s body] it would have dried up and died.”

“How did you conclude that Prudente did not rest,” asked Sciberras. 

The expectant mother had travelled from Seattle to London and then to Malta and Gozo, Muscat Baron replied.

'Most at ward agree Prudente should not have travelled'

“So are you saying that a pregnant woman cannot travel,” asked Sciberras.

There was a difference when a pregnant mother was bleeding. “It’s only logical,” remarked Muscat Baron, drawing parallels with a “worse case” where a woman’s waters ruptured at 13 weeks. 

In that case, he said, the baby had survived. 

“Was it medically identical,” asked the lawyer. 

“It was even worse at 13 weeks," Muscat Baron replied.

The majority of those in the maternity department were of the view that it was not recommended for Prudente to travel, he added.

“This is not my opinion. The majority of people within our department all say the same: It’s an accepted medical opinion”. 

Asked whether he knew of any ulterior motive for Prudente to travel to Malta, the consultant replied, “she was on a babymoon”. 

Prudente’s medical file was presented in evidence by a Mater Dei representative. 

The case continues. 

Lawyers Lara Dimitrijevic and Andrew Sciberras are representing Prudente. 

Lawyer Joseph Zammit Maempel is assisting Azzopardi.