MATERNAL MORTALITY

Patient name: jhamli bai

Wife of: bhou
Age: 40 years
Address: gram gunjan, kuwa badwani
Date of admission: 11/5/19 at 3:00 am
Date of death: 14/5/19 at 10.30 am
Duration of hospital stay: 3 days 7 hours 30 minutes
Cause of death: cardio respiratory arrest
pulmonary embolism

Patient was G6P5L5A0. She had previous 5 full term

vaginal deliveries. She underwent LTT 2 years back at a
camp at Badwani. This conception was a TT failure. She
was unaware of her pregnancy till 7 months when she
started perceiving fetal movement. She recieved a TT
at a local anganwadi and did not have any ANC visits.
On 10/5/19, she developed complaints of labour pain
and was taken to a local PHC, Badwani from where she
was referred to district hospital, Badwani. From there,
she was referred to MYH on 10/5/19 at 8:10 pm as full
term pregnancy with multigravida with labour pain
with severe anemia with IUD. Patient was referred in
second stage of labour. Transportation time was 7
hours. She was admitted at MYH on 11/5/19 at 3:00
am as grand multi term pregnancy with rupture uterus
with severe anemia with IUD with respiratory distress.
On admission, patient's GC was very poor, pallor
present, PR=130/Min, BP=110/70 Mm Hg, respiratory
rate= 48/Min Laboured breathing present, chest:
bilateral crepts present, PA: uterus- 36 weeks, cephalic,
abdominal tenderness present, uterine contour not
maintained. FHS not localised by stethoscope. PV: os
fully dilated, fully effaced , head at station zero,
membrane absent, liquor drained. 2 iv lines were
maintained, catheterization done, blood samples sent
for investigation. Patient immediately shifted to ICU.
Patient propped up, intranasal Oxygen started, 2 units
blood arranged. Patient was taken for laparotomy.
Exploratory laparotomy done on 11/5/19 at 4.35 am
under GA. Uterus was found rupture from right lateral
wall extending up to the cervix. Total obstetrical
hysterectomy was done. Patient shifted to ICU and put
on ventilator and was on ionotropic support.
Her investigations- Hb:9.8 gm%, platelets: 1.7
lacs/cu.mm BUN: 56mg/ dl, serum creatinine: 1.5
mg/dl , total bilirubin: 1.36mg/dl, SGOT, SGPT normal,
serum alkaline phosphatase raised.
Broad spectrum antibiotics were started. Respiratory
medicine call sent and attended. Advise tab
azithromycin and T piece trial after spontaneous
respiration. T piece trial was done but patient was not
maintaining oxygen saturation. Transfer respiratory
medicine call was sent. Patient was transferred to
department of respiratory medicine on 13/05/19 at
12:00 pm. On 14/5/19 condition of the patient
deteriorated and she certified on 14/5/19 at 10.30 am

Dr. H. Jhadbade Dr. M.Kaushal Dr. A.Dhakad

Associate Prof. Associate Prof. Assist. Prof.