The document details a maternal mortality case, highlighting the patient's history of hypertension and eclampsia, alongside her presenting symptoms which included seizures and elevated blood pressure. Despite treatment efforts, including medication and monitoring, the patient ultimately passed away, with contributing factors identified as late booking, transport delays, and lack of resources. Recommendations include improving patient education, standardizing care practices, and enhancing hospital resource availability.

1. Maternal mortality meeting
3/8/23

2. • TM
• P3G4(3 alive), LNMP 7/9/22, EDD 15/6/23, EGA 39w
• DOA 15/6/23
• DOD 24/6/23
• REFFERAL FROM: RUWA CLINIC
• Booked at Ruwa clinic at 21/40, 4 ANC visits, HIV neg, RPR ND, USS done no
record
• Dx G. HTN at 28/40 commenced on methyldopa 500mg po tds
• NB: Hx hypertension in all prior pregnancies

3. At clinic
• Presented at 3.15 with a hx of fitting about 10 times since 2300
• 3 day hx of headache and blurry vision
• O/E BP 134/94 P 100 depressed LOC
• ABD- HOF 39 long ceph FHNH with pinard VE-not documented
• MgSO4 4g in each buttock
• Catheterized
• Transfer to MNMH (ambulance contacted)
• 54mins later delivered LGI BWT 2750g in thick msl APGAR 9-10 EBL +/-120ml
• Left clinic at 4.35

4. At PGH
• Arrived at 5.30 (1hr)
• BP 234/117 P 89 depressed LOC
• Uterus not well contracted, VE expelled clots
• IMP: eclampsia and PPH
PLAN
• Admit ELW
• Misoprostol 800mcg pr stat
• Ct mgso4 course
• Input-output
• Nifedipine 20mg po bd
• Hydralazine 12.5mg IM stat if bp >/= 160/110
• Oxytocin 40iu/l infusion
• FBC, U&E, LFT, G&R

5. • Seen at handover
• BP 164/102 P116 LOC V1 E4 M5 (10/15) swollen tongue
• Reduced urine output(<100ml in ?time, concentrated)
• Uterus well contracted, moderate pv loss
• Added oral and pressure point care
• Fit chart
• TED stockings

6. Results
• FBC WCC.25 HB.13 PLT.105 MCV.78
• U&E Na144 K4.4 Ur4 Cr92.8 Cl107 eGFR75
• LFT TP68.7 Alb 33.9 AST 826 ALT453 ALP234 GGT25 Tbil 75
Dbil27

7. Problems
• Depressed LOC
• Seizures
• Elevated blood pressures
• Acute kidney injury

8. DAY PROGRESS PLAN
1 BP 159/108 P125 Spo2 100% OFA LOC (V2 E3
M5=10/15)
o10.32: matron concerned about patient’s depressed
LOC and possible need for ICU admission contacted
consultant on cover who advised to reach anasthetist.
11.16: seen by Anasthetics SHO
Dexamethasone 8mg iv tds
Informed senior
No current need of ICU bed
TX feeds 200ml 4hrly
Physiotherapy
R/V in 4hrs
2 01.44: added HCT 12.5mg po od
7:00: LOC M3 V2 E2=7/10, had secretions needing
suctioning to breath
7.47: Ana r/v- ?Mg toxicity,
14.54 LOC E2 V2 M1 5/10 gluc 4.9 BP130/62
U&E Ur12.2 Cr141 K3.6 Na141. FBC WCC14.6 Hb11.5
MCV79 PLT 131 NO MPs
admit ICU (no bed, another patient with LOC 5/15
in ELW being prioritized, mg levels, ct brain
3 14.56 Admitted into ICU- no intubation
Ct scan brain in pvt- no bleed
CT
4 LOC E4 V2 M4 10/15, paucity of mvt of left upper limb
BP 163/92 Gluc 8.7-12.4 Temp 35.8-39.2
Neurosurgeons mild effacement of sulci and gyri in
parietal and occipital regions with open basal cisterns,
no intracranial bleeds or hydrocephalus
Discharged to CCU- no bed so went to ELW
CXR

9. Day 5
• Seen by gyn reg
• Saturating 73% OFA
• LOC E4 M1 V1= 6/15
• Noted U&E Na152 K4.1 Ur12.9 Cr 127
• FBC WCC16.5 Hb10.3 PLT 219 MCV86.7
• ½ N/S 42ml/hr
• Concern for aspiration pneumonia

10. Day 6
• BP 160-170/80-111
• LOC E4 V2 M3 9/10
• Consult ana for readmission into icu
• Physician to review

11. Day 8
• CCU bed now available
• Yet to be r/v by physicians
• 16.13 transferred to CCU
• Unfortunately day 9 at 1.30 patient certified dead

12. Delays
• 1: late booking, symptomatic for 3/7 prior to presentation,
fitted 10 times before presentation
• 2: transport between clinic and hospital
• 3: no ct scan in gvt, no icu bed, rv by physicians, no mannitol or
dexamethasone given, no documented physiotherapist
involvement

13. Cause of death
• Eclampsia
• Group 2
• ICD code O15.1

14. Avoidable/ Unavoidable
• Educate patients on early booking
• Standardize management across all healthcare facilities
• Improve availability of imaging and medication in public
hospitals