Mortality, death

2. LM
• 17 year old para 0 gravida 1 EGA ?16w
• Referral from concession hospital where she
presented with a 3 day history of headache, sore
throat and fever. Also had 1 day history of not
communicating and started fitting on arrival
• 4 episodes of seizures prior to arrival to MNMH
• Unbooked pregnacy HIV status unknown
• FBC done at concession WCC 2.7 Hb 2.4 PLT 47
MCV 67

3. Examination
• Ill patient, pale. LOC 10/15 BP 163/89 P 89 T
36.7 SpO2 95%
• ABD –HOF 18
• CHEST – clear
• CVS – unremarkable

4. Diagnosis:
1. New onset seizures ?cause
2. ?eclampsia ?meningoencephalitis rule out malaria
Plan
1. Admit c3
2. Fbc, u and e, lft, MPS, RDT, Iron studies, ESR, CRP, HIV, serum CRAG
3. Mgso4 course
4. Ceftriaxine 1g iv bd
5. Metronidazole 500mg po tds
6. Fit chart
7. Methyl dopa 500mg po tds
8. Consult physicians who ordered
9. Larmotrigine 50mg po od
10. EEG, CT brain
11. Transfuse 4 packed cells- 1 unit transfused in casualty

5. Results
• Fbc WCC 11.7 HB 11.6 PLT 183 MCV 63.6
• U and E Na 148 K 3.1 Cr 49 Ur… Cl…
• LFT AST 18 GGT 11 ALB 32 ALP 43 TBIL 17 ALT
….
• Glucometer 8.5
• Malaria parasites negative
• Serum crag negative

6. PROBLEMS
• New onset seizures
• Depressed LOC
• Unbooked pregnancy of unknown gestation
• Discrepancy in FBC results
• No funds for private EEG and CT brain

7. PROGRESS
Day Progress Plan
1 o2 episodes of fitting
oLOC 7/15
oBPs 125 to 167 on 78 to 98 P 97 to 115
ICU admission NO ICU BED
AVAILABLE
2 Critically ill patient LOC 7 on 15
BP 106 to 136 on 67 to 80
Hypertonia noted
1530hrs certified dead
Chase relatives to organize
CT scan

8. DELAYS
DELAY 1
• Delay in booking pregnancy
• Delay in seeking health care after noting symptoms
DELAY 3
• Discrepancies between Concession and Parirenyatwa
FBC
• Delay in securing ICU bed
• Delay in getting imaging (CT scan brain and EEG)
• Delay in doing lumber puncture

9. ICD CODE
• O95
• Obstetric death of unspecified cause

10. AVOIDABLE OR UNAVOIDABLE
• AVOIDABLE