2. LNMP :15/04/12
EDD : 22/01/13
GA : 37+1 wks
Partograph info @09:35pm
CD 4cm, descent 4/5
Membranes intact
FHR 140b/m
On 01/01/13 @01:30am
CD 9cm
descent 3/5
FHR 125b/m
membranes ruptured and stained with meconium
Contractions strong
On 01/01/13 @04:10am
Patient was C/sectioned with an indication of contracted pelvis
3. A foetus with APGAR score of 0 was extracted
Post op DX of IUFD
Pt put on
Cefatriaxone 1g 8hly x 24hrs ,metronidazole 500mg 8hly x24hrs
Diclofenac 75mg 8hly x3/7 , BTF 1 unit prescribed.
@ 07:45 pm pt reviewed
Adv oral sips , oral ampiclox , oral metronidazole , paracetamol and haemovit.
02/01/13 pt seen and adv to tranfer B7
03/01/13 pt seen 2days post op
c/o fever + GBW
P/A uterus almost 26cm
Plan remove catheter , abd uss , check HB + B/s , stop oral meds ampiclox +
metronidazole , give iv cefatriaxone + metronidazole x2/7 + Diclofenac im
4. 04/01/13 pt reviewed
O/E
Temp 38.4 , BP 113/68mmHg , PR 136b/m
pale , slightly jaundiced + pedal eodema
B/s 4/200wbc
Plan quinine iv then CST as above.
05/01/13 pt reviewed
c/o dizziness
O/E GC ill, severe palmer pallor +febrile temp 38.1 , BP 114/70mmHg PR136 b/m
HB 5.2g/dl
Plan CST + give 2 more units of blood.
5. 06/01/13 pt reviewed
Temp 37.3 still pale
Plan CST +BTF 1unit
07/01/13 pt reviewed
C/O vomiting
O/E pale and febrile temp 39 degrees centigrade
P/A abd distended + tender , uterus still above the umbilicus
Imp: RPOC
Plan cst iv cefatriaxone and flagyl start orall quinine the do HB
08/01/13 @ 04:30pm
Pt had a laparatomy with pre op DX of peritonitis
During the procedure subTAH was done due necrotic uterus
Rx iv cefatriaxone +metronidazole 8hly x 72hrs , 3l RL , diclofenac 75mg
8hly im , BT 2 units and send pt to ICU
6. 09/01/13 pt reviewed
O/E temp 39
Septic wound leaking from paraumbilical region
Needs relaparatomy and not evacuation
Plan prepare pt for relap , BG + X matching +RL 1ltr
10/01/13 pt reviewed
O/E temp 40
Still weak , pallor , dry mouth , drainage in situ + catheter in situ
P/A abd not distended wound is clean
Plan remove catheter , drainage , stop drip and transfer to B1
11/01/13 pt reviewed
O/E ill looking
Plan CST replace iv cefatriaxone/metronidazole with oral ampiclox + metronidazole
Change dressing of wound.
7. 12/01/13 pt reviewed @ 08:00hrs
O/E pale , lower limbs eodema, Temp 38.6 , BP 103/65mmHg , PR 157b/m
P/A pus discharge from the wound
DX septiceamia with anaemia
Investigations HB , B/s , pus for C/S , FBP , Serology
Plan BT , Restart iv cefatrixone + metronidazole 8hrly x 48hrs
Wound cleaning with povidone
Seen again at 3:20 pm
HB 3.5g/dl pale and febrile
Plan give 3units of blood
13/01/13 pt reviewed @ 11:30hrs
Wound septic and gapped abd not distended
Plan stitch the gapped wound , CST with iv Cefatrixone and metronidazole +flucomox
Give BT 3units
13/01/13 pt reviewed @16:06pm
Pt ill looking BP 92/52mmHg , temp 39.8 , PR 150b/m RR 56b/m
Plan pt transferred to ICU due unstable vitals , give 1.5ltr NS + 1.5ltrs RL within 24hrs
CST
8. 14/01/13 pt reviewed
Still ill looking with unstable vitals
Plan to feed though NG tube
Iv ciprofloxacin 400mg stat the 200mg 8hly x2/7
CST with iv cefatriaxone, flagyl , continue wound cleaning and dressing 3times /day
BT 1unit but give lasix 40mg iv before BT
9. 15/01/13 @ 04:10am
pt died.
Open for discussion
1. Start with the positive things done on this pt.
2. Any missed opportunities which could have saved her life?
3. What is there to learn from this case which should be avoided in the future?
