An experienced midwife feared Savita Halappanavar was a "septic abortion" when she saw her the morning she fell critically ill.
Nurse Patricia Gilligan made the diagnoses minutes before obstetrician Dr Katherine Astbury carried out her morning round, she told an inquest.
"I was very concerned about it, I thought she was a septic abortion," she told Galway's coroner court.
She agreed Mrs Halappanavar's vitals had made her "alarm bells ring", but she did not see the consultant about them as the observations were recorded on Mrs Halappanavar's chart.
Ms Gilligan said: "The doctor would have her chart. The doctor would be seeing what I was seeing. She had the same obs I was seeing and she saw the same patient in the bed that I saw."
The midwife described a "septic abortion" as a patient so overwhelmed with sepsis her foetus is not going to survive and would abort.
Mrs Halappanavar's pulse and temperature were high and she had earlier been found shivering and vomiting in bed, with an on call doctor ordering medication for suspected sepsis.
Ms Gilligan said she was so concerned when she started her shift on the morning of Wednesday October 24, she moved Mrs Halappanavar closer to the nurses' station and appointed two staff members to her care.
"It wouldn't be my normal miscarriage on a ward," added the midwife of 31 years. "They wouldn't normally have a temperature of 39.6."
Dr Astbury was called again at about 1pm as Mrs Halappanavar's blood pressure fell. She was taken to theatre where she delivered a dead foetus.