Mortality review

1. DEC 2023/JAN 2024 MORBIDITY AND MORTALITY CASE
PRESENTATION
OF
GYNAEONCOLOGY UNIT,
OBSTETRICS AND GYNAECOLOGY DEPARTMENT,
FEDERAL MEDICAL CENTER, KEFFI.
PRESENTED BY:
DR. ADEGOKE K.T.A

2. Biodata
• Name: H.J
• Age: 55Years
• Sex: Female
• Ethnicity: Fulani
• Religion: Moslem
• Occupation: unemployed
• Address: Lere area of kaduna State.
• Parity: P2+0(2A)
• 3yrs postmenopausal

3. History
• Presented with:
Bleeding PV x 3/12
•Bleeding was insidous in onset, bright red with
associated passage of blood clots .as well as history of
dizziness and easy fatiguability.
•Associated history of postcoital bleeding.

4. History
•Associated history of foul smelling vaginal
discharge which was copious
• Positive history of weight loss evidenced by
loose clothing.
• There is associated abdominal distention with
easy satiety and anorexia
•no hx of leg swelling, no hx of cough, no prior
hx of dysuria, haematuria,

5. History Continued
• for the above patient presented in a peripheral
hospital where she was seen and transfused with 2
units of blood ,patient was said to have felt better
and was discharged home
• she was readmitted and was transfused with 3 unit
of blood 1/52 prior to presenatation and was
subsequently referred to this facility for expert care
and management
• Age of menarche and her obstetric history could not
be ascertained. She is not a known HEADS

6. Physical examination
• O/E: cachectic ill looking middle aged woman, pale
,afebrile (35.7oc) with cold extremities, anicteric and
acyanosed.
• Vital signs. PR Thready. RR=32cpm. Spo2 81 % on
room air. Blood pressure: unrecordable
• Abdomen.full and moves with respiration.
suprapubic tenderness LoSoKo. Ascites demonstrable
by shifting dulness

7. Examination
• Vaginal examination:
Vulva smeared with altered blood. Fungating
mass at the vaginal introitus with necrotic
tissues
Digital Examination
mass occupying the vaginal cavity with
irregular surface bleeds on contact

8. Examination
• Chest: clinically clear
• CNS: lethargic. power in all limbs 5/5
• CVS:HS-S1S2 only

9. Assessment
• Advanced ca cervix with septic shock

10. Plan
• Counsel patient/relatives on condition and
line of management
• resuscitate with IVF Normal saline 1litre stat
to commence transfusion once blood is
available

11. • PCV,E/UCr,LFT,HBsag,HCV,RVS,FBC,Abdomino-
Pelvic scan
• -GXM 4unit and transfuse with 2unit of
packed cells slowly
• -pass urtehral catheter and monitor
input/output
• Ascitic tap for cytology

12. Plan
• -IV ceftriaone 1g 12hrly
• -Iv metronidazole 500mg 8hrly
• pack the vagina with formaline soaked gauze
and remove after 6hrs
• -Repack with Gauze impregnated with Flagyl
(compounded tablets )
• -INO2 at 5litre /min
• -plan for EUA once patient is stable

13. Update
• PCV of 26%.. commenced blood transfusion
•Repeat Blood pressure 80/60mmhg. pr 125bpm
• USS(abdominopelvic)
Liver is normal, spleen and Liver normal
Kidney -Right 9.0 by 4cm, Left9.5 by 4.2cm
Normal CMD and normal cortical parenchymal
echo-texture, no stones or features of hydronephrosis
seen. Normal bowel peristalsis, no intrabadominal
lymphadenopathy noted.

14. update
Marked intra-peritoneal fluid collection with
multiple low level echoes. Urinary bladder is
empty.
Bulky uterus and contains heterogenously
lobulated masses obliterating the endometrial
plate, cervix is not visualized.
Both adnexae appear free.

15. PROGREES REPORT

16. 12 Hours on Admission
• Urine bag contained 20mls of urine since admission
• Nephrology unit was invited.
• Made a diagnosis of CKD on background of
obstructive uropathy (CA Cervix). 2. Acute on CKD,
• placed on at IVF N/S 500mls daily
• -IV furosemide 40mg daily

17. 2nd Day on Admission
• Still not making adequate urine
• O/e. Acutely ill looking woman in respiratory distress,
dehydrated,pale anicteric, no significant peripheral
lymphadenopathy, bilateral pitting edema up to mid
shin, Temp.35 C
• CVS
• PR - 107 bpm Small volume, regular. Bp- 80/60mmhg
JVp- not raised
HS-S1S2

18. 2nd day admission
Chest.
• RR-32cpm
• SP02 92%
• Vessicular breath sounds heard. fine basal
crepitations.

19. 2nd Day on Admission
• PLAN:
•seen by nephrologist who couselled patient on
possible hemodialysis
•IVF N/S 1litre bolus then 5%Dextrose Saline to
alternate with N/S 1litre
•-IV furosemide 40mg 4 hourly

20. Continued
•He developed hypoglycemia at 1.3mmol/l and
corrected with iv 50% dextrose water and
maintained on 10% dextrose water
• pulse was not palpable and bp unrecordeable.
• CPR was commenced
•she was subsequently confirmed dead.

21. Thank you for Listening.