maternal mortality

1. PRESENTER : Dr AKANKSHA
MODERATOR : Dr ANKITA NIGAM
MATERNAL
MORTILITY
AUDIT

2. PATIENT PARTICULARS
• Mrs . Pooja w/o Rohit
• Unbooked case
• Age – 24 years
• Resident of Loni, Ghaziabad
• Religion : Hindu
• P4L3D1 at PND 0 of PTVD with PPH

3. CHIEF COMPLAINTS
Patient presented in Sharda emergency on 23 / 8 / 23
Patient was referred from Krishna Hospital with complain of
bleeding P/V since delivery

4. HISTORY OF PRESENTING COMPLAINT :
• Patient was admitted at Krishna Lifeline Hospital at 34 week
with severe anemia
• Patient had PTVD on 23/8/23 at 04:03 am (still birth )
followed by Atonic PPH
• PPH was managed by Injection Oxytocin 20 unit , injection
prostaglandin 250 mcg , hemaceal 1 unit
• 2 unit PRBC transfused , uterine packing was done and
referred to Sharda Hospital for further management .

5. OBSTETRIC HISTORY :
P4 L3 D1-
P1- 7 yr female NVD, at home
P2- 5 yr female NVD, at home
P3 – 3 yr female NVD, at home
D1 – PTVD on 23/8/23, stillbirth female

6. PAST SURGICAL HISTORY :
• No history of hypertension , Diabetes, Heart disease,
Bleeding, Multifetal gestation
• No past significant history.

7. GENERAL PHYSICAL EXAMINATION :
• Pt was sick at time of presentation
• General condition- poor ,
• extremities cold ,
• pallor ++ ,
• PR – 120 /min. in right radial artery, feeble
• BP : 90 /50 mmHg in right arm in sitting position ,

8. ABDOMINAL EXAMINATION :
INSPECTION :
• Uniformly distended
• All quadrants moving well with respiration
• Linea nigra and stria gravidarum seen

9. ABDOMINAL EXAMINATION :
PALPATION :
• Soft
• Uterus 20 wk size

10. Local Examination:
Bleeding observed
No local lesion.
Per vaginal examination :
• Pack in situ ,
• Bleeding p/v present

11. INVESTIGATIONS :
INVESTIGATION
BLOOD GROUP :
CBC :
Hb –
TLC -
Platlet count –
TRIDOT / VDRL
S. TSH
RESULT
O POSITIVE
5.2 g/dl
23.86/cmm
71/cmm
NON REACTIVE
3.85 U/ml

12. LFT
KFT
GBP -
PROTHOMBIN TIME
INR
RBS
T .Bil -5.31mg/dl (Direct – 4.64 )
SGOT – 172 u/l
SGPT - 55 u/l
Urea - 27 mg/dl
Uric Acid – 5.9 mg/dl
Creatinine – 1.9 mg/dl
- Normocytic Normochromic Anemia with neutophilic
leucocytosis with thrombocytopenia
> 120
CANT BE ESTIMATED
125 mg/dl

13. COURSE IN HOSPITAL
• Patient was presented in emergency department
• Patient was examined in Emergency department.
• Risks and prognosis explained to the attendents
• Floor manager informed regarding need for multiple
transfusion and need for ICU admission

14. COURSE IN HOSPITAL
• High risk consent taken
• Anaesthologist informed
• All relevant investigations sent
• Attendent were asked to arrange blood and blood products.
• ICU with ventilator arranged
• Blood grouping done.

15. COURSE IN HOSPITAL
• Patient was taken on labor table
• 1 unit PRBC issued in live saving and transfused
• Since no other PRBC available at Shrada hospital , attendant
were asked to arrange from outside
• MOD was informed regarding non availability of blood.

16. COURSE IN HOSPITAL
• Per abdomen – uterus 20 week ,
• Vaginal pack removed - 8 interconnected mops removed s/o
uterine packing
• Bleeding present ,
• Inj oxytocin 20 unit , IV fast given in 1 unit RL
• Inj trenexa 1 gm IV STAT
• Balloon tamponade attempted , could not be done as uterus
was contracted and patient uncooperative .

17. COURSE IN HOSPITAL
• Pt was kept Propped up , kept on Oxygen 2 L/hr ,
• Tab misoprostol 1000mg P/R given ,
• IV fluids , 2 unit RL with 20 & 10 unit oxytocin given
• 3 intrauterine foley’s catheter inserted 16F , 16F , 14 F,
inflated with 45 ml , 45ml , 30 ml NS respectively .
• Poor prognosis explained to attendant

18. COURSE IN HOSPITAL
• At 8:30 am - patient felt restless , uncomfortable ,
• GC poor ,
• Pulse rate 120 per minute ,
• Bp not recordable ,
• Per abdomen – uterus contracted
• P/v – foleys tamponade felt
lower segment – flabby
• 70 cc bleeding present into 2 drain

19. COURSE IN HOSPITAL
• Patient was shifted to ICU, anesthesia team informed.
• Decision for intubation taken
• At 9:00 am , pt underwent CPR by ICU team ,
• Guarded and poor prognosis explained

20. COURSE IN HOSPITAL
At 9:29 am pt could not be revived after 5 attempt of CPR and
inotrope support
Patient declared dead by ICU team at 9:29 am
Cause of death – cardiac arrest

21. THANK
YOU
EVERYONE