maternal mortality FINAL presentation!.pptx

Mortality great presentation

1. 25 Now Para 0+1 DOA 26/13/23 DOD 30/12/23 Chronically unwell pTB and Stroke patient diagnosed and treated in South Africa. HIV neg. Had a miscarriage 3 weeks ago at home ?? Self induced. Presented in Casualty SMCH with a 2 week history of passing foul smelling PV discharge associated with abdominal pain and vomiting. JA

2. Normal size non gravid uterus measuring 7.3 x 3x 3.9 Echogenic material in endometrial cavity measuring 3.3x 1.95 cm Increased echogenicity around the uterus suggestive of infection No free fluid in POD Cervix long and closed. USS

3. Alert, pink BP 117/75 P 89 T 36.7 SpO2 95% ABD –soft, generalized tenderness Examination

4. Initially seen by physicians who made an impression of prev stroke on prophylaxis, TB on initiation phase and septic miscarriage. Seen by gynecology intern in Casualty who made a plan to Cytotec 800mcg SL stat Amoxyl 500mg po tds Metronidazole 400mg po tds x 2/52 CT rest of management as per physicians Review in room 20 in 1/52

5. Returned to room 20 4 days later with worsening lap and backache. Reported that she did not expel anything after the cytotec she received 4 days prior. On examination Stable, pink, Loc 15/15, Temp 36.2, bp 106/69 p 81 Abd Soft mildly tender , no masses VE foul smelling discharge IMP: SEPTIC MISCARRIAGE

6. Admit A2 Ceftriaxone 1g IV Bd Metronidazole 500mg iv tds Clindamycin 500mg iv bd 1l RL 4 hourly Blood culture (no bottles) Plan

7. RESULTS FBC:- WCC 5.6 HB 11.3 PLT 313 MCV 87 U&E:- Ur 2.5 Cr 75 Na 148 K3.6

8. DAY PROGRESS RESULTS PLAN 1 LOC 15/15 C/O Lap and back ache IV antibiotics and 6hrly RL Fbc and u and e 2 Patient remained stable Was noted to be bleeding from cannula site + epistaxis + hematuria Na 138 K 3.6 CL 123 Ur 3.0 Cr 292 Stop warfarin Consult physicians 3 Noted that patient hadn’t received cytotec Uterine evacuation withheld due to warfarin coagulopathy Patient collapsed and resus without success. Certified dead 1930s Cytotec reordered- given at 0900 Chase physicians Progress in ward

9. Septic miscarriage Pulmonary tuberculosis Post mortem

10. FIRST Delay in seeking health care after noting foul smelling PV discharge THIRD 4 day delay in getting inpatient care Delay in getting cytotec during admission Delay getting physicians on board during admission DELAYS

11. ICD-10 code O03. 37  - sepsis following incomplete spontaneous miscarriage ICD CODE

12. Recommendation Responsible person Timeline Educate women to identify danger symptoms post miscarriage ANC/PNC/A2 SIC as well as doctors during manning room 20 and Gynaecology OPD Immediate Equip clinicians in the protocols of management of sepsis with emphasis of surviving sepsis campaign Anaesthesia and critical care 3 months Swift implementation of orders given during rounds by nursing staff SICs Immediate RECOMMENDATIONS