A 30-year-old woman, gravida 4 para 3 living 3, presented at 41 weeks and 2 days gestation with severe oligohydramnios. She had only two antenatal visits. She underwent an emergency lower segment cesarean section and delivered a 1.9 kg male infant with thick meconium stained liquor who died shortly after from respiratory distress. The mother developed postpartum hemorrhage and hypovolemic shock requiring intensive resuscitation measures, but her condition continued to deteriorate and she expired.

1. MATERNAL MORTALITY MEET
MGMH
Junior Resident
Date
Senior Resident
Consultant Incharge

2. HISTORY
 30yr old G4P3L3 with 41wk 2d GA with FGR with severe oligohydramnios.
 LMP: 18/1/22 EDD:25/10/22 SEDD:15/10/22(29wk).
 She is a booked case of MGMH with only one ANC visit at 35wks GA on 24/9/22. MCP
card at UPHC Yakatpura.
 Pt had 2 Antenatal visits at UPHC
1st visit -6/5/22 Bp 100/60mmhg P/A 14-16wks wt 45kg
2nd visit -30/7/22 Bp 110/70mmhg P/A 28-30wks wt 50kg

3. HISTORY
 Investigations at UPHC: Hb 9.5gm%, B/G/T B+ve, RBS 103mg/dl,
HIV,HBSAG, VDRL - Non reactive.
 On 24/9/22 admitted in ANW in/v/o G4P3L3 with 35wk3d GA with Moderate Anemia
8gm%.
o At admission: Pallor + Pedal edema absent
o Pt is c/c/c Afebrile
• BP- 120/70mmHg
• PR- 94/min
• H/L - S1S2+, BAE+ lungs clear
• P/A- Ut- 34wks , cephalic, relaxed,FHS+136bpm, clinically liquor adequate

4. HISTORY
 Investigations at MGMH(26/9): Hb-8.9gm%,TLC -12000, Plt-3.6lakh
 Smear - Microcytic , hypochromic, Anisocytosis,leukocutosis
 OGTT 70/120/83(30/9)
 5 doses of Inj iron sucrose were given on 12/10/22
 Repeat Hb -9.5gm%,TLC -9000, plt -3lakh
 Scan(30/9) – Single, cephalic, FHR good, liq-17-18cm, EFW-2.6kh, Placenta -post
upper segment gr 2, Doppler normal.

5. HISTORY
 Patient was discharged at request at 37 wk GA.
o Condition at discharge(12/10/22):
 Pallor(-) Pedal edema(-)
 No S/S of CCF
 Pt is C/C/C Afebrile
• BP- 120/80
• PR -80bpm
• H/L - S1S2+, BAE+
• P/A -Ut-TG, cephalic, relaxed,FHS+134bpm, clinically liq adequate, EFW-
2.5kg.

6. HISTORY
• ADR scan 11-12cm NST reactive.
• So pt was discharged at request on following treatment:
• T Fe BD
• T.BC/Ca
• High Protein diet and was advised to reviews to ANC OPD after 1week
but patient did not turn up to ANOP.
• She came to ADR on 31/10/22 (no complaints written). She was advised
admission to 1st stage in/v/o AFI 4-5cm (ADR scan ) but pt didn’t get
admitted.
Again patient reported to ADR on 2/11/22 with C/o pain abdomen since 2days at
41wk2d GA

7. HISTORY
PAST H/O: No h/o HTN, DM,Asthma,TB, epilepsy,CAD,CKD,thyroid, no h/o surgery, no
h/o blood transfusion.
FAMILY HISTORY: Not significant
MARITAL LIFE: 11yrs, NCM
MENSTRUAL H/O : Regular, normal flow,5/30 days
OBSTETRIC HISTORY :
G1: female, 2.5kg,FTNVD, at Kolkata govt hsptl, A,H,I.
G2: female ,2.4kg,9yr,FTNVD,Kolkata govt hsptl, A,H,I.
G3: female ,FTNVD, 2.5kg ,6yr. Kolkata Active healthy immunised

8. EXAMINATION
Pallor Icterus Cyanosis Clubbin
g
Lymphaden
opathy
Edema
Absent Absent Absent Absent Absent Present
General physical examination:
At admission GCS E1 V1M4, not oriented to time place and person
BP-130/80 mm Hg
Pulse-84/min, Regular
RR: 18/min
Temperature: AfebrileLeft periorbital edema present, sinus inflammation of rt side of
face, conjunctival edema and corneal opacity of lt eye present.

9. EXAMINATION
Heart & Lungs • B/L air entry equal
• S1,S2 heard
Per Abdomen • Ut-TG, Cephalic, Relaxed
• FHS+ Good
• Clinically liquor less.
Per Vaginum 3/4"long, MC, MP
Os - 1f loose, M+
PP Vx,-2, pelvis gynecoid adequate

10. COURSE DURING MGMH STAY
 ADR scan - SLIUG, cephalic, liq 3-4cm,FHR 140bpm.
 Case shifted to active LR at 9:40pm, NST done @9:40pm non-reactive. Baseline FHR 110-114bpm,
beat - beat variability absent. Accelerations absent. No deceleration. So pt was taken up for
EmLSCS in/v/o G4P3L3 with past dates by 9days with severe oligo (3-4)cm with non reactive FHR
with corrected Anemia.
 Call made to paediatrician. EmLSCS done on 2/11/22 10:52pm and delivered an alive male baby
of wt 1.9kg with APGAR - 5 at 1min, 6 at 5 min. Liq -thick MSL, Placenta ant upper segment B/L
tubectomy done by modified pomeroys method.
 Baby was shifted to nursery immediately (paediatrician noted not in casesheet). Baby died at
nursery @8:20am (in/v/o thick MSL, RD).

11. THANK YOU