Sepsis and maternal death

It was disappointing that in ‘Stretching the truth’ (January 9), Isabel Stabile argues in favour of the availability of abortion by quoting a small series of cases of maternal deaths from several countries, because this moves the argument from a discussion of evidence-based medicine to simply making political propaganda.

For these deaths to be used as an argument in favour of abortion, one would need to show that if abortion had been available to these women, then they would not have died.

In fact, in all the cases quoted, sepsis was the correct cause of death, rather than the absence of the availability of abortion.

Furthermore, in all the cases quoted, the subsequent investigations have led to criticism of the management of these cases and that these medical human errors have led to tragic consequences.

All that can be concluded from this group of unfortunate cases is that, on occasion, some women do contract infection related to complications of pregnancy and that some women, on occasion, do die as a result. This, sadly, is not a new phenomenon at all and puerperal fever was, in the pre-antibiotic age, a common cause but certainly not the only cause, of maternal mortality.

Today, because of our routine aseptic precautions and the availability of antibiotics, wo­men can expect, and do receive, obstetric services in our wards and our operating suites, which are largely infection free and safe, as the Maltese statistics show. But we must not forget that infection is always an underlying risk in obstetrics, as in all surgical procedures. This risk may and does recur if our precautions are relaxed.

These cases are a salutary lesson that we should never let down our guard in carrying out obstetric procedures and allow infection to occur and that, when it does occur, we should be grateful for the availability of effective antibiotics and use them effectively.

Admittedly, also, more complex cases are more likely to be exposed to sepsis, which only means that precautions in such cases should be meticulous.

The fact that sepsis may occur within obstetrics is not an argument in favour of legalising abortion.

Mark Agius – Sliema

The scales of justice

Following the brutal killing of Bernice Cassar, two social behavioural circumstances have changed dramatically.

The first is that the number of women who are now reporting their spouses or partners for domestic violence has multiplied. This has been verified by the police. The most logical reason for this is that while, in the recent past, some cases were not reported to the police for fear of retribution by the perpetrators, that fear has now taken a new sinister turn as these same women now fear that their destiny will follow that of Bernice if they do not take legal action.

The other noticeable, albeit positive change, is that since Bernice’s killing, men being arraigned for domestic violence are not being released on police bail without exception.

The law gives the courts the liberty to decline release on bail. Photo: Shutterstock.com

The public’s question roars out like thunder. Why now? If the established law gives the courts the liberty to decline release on bail, why do they tend to go to the softer end of the leniency scale? The death of Pelin Kaya is a stark horrible reminder of that leniency.

If the powers that be continue to act in the perpetual belief that criminals will reform with leniency and kindness only, then innocent, God-fearing people are in for more hard and dangerous times ahead.

Victor Pisani – Santa Luċija