NYANGAO HOSPITAL PERINATAL DEATH SUMMARY.pptx

Nyangao hospital perinatal death report

1. NYANGAO HOSPITAL PERINATAL DEATH NARRATIVE SUMMARY Prepared by Obstetric and gynecology department team

2. PERINATAL DEATH NARRATIVE SUMMARY Mother “Y” P1L0 aged 18 years old from Mtopwa village her baby died 5 day post delivery She booked RCH at 24 weeks of gestation age and she has attended 3 visits in which received 3 SP Doses, 3 dose of fefo, mebendazole 500mg stat, 2 TD, she was PMTCT 2, with VDRL and MRDT negative.

3. Summary cont..... Blood group and HB not tested. BP was tested on booking only 110/78 mmHg. She stated to complain labour like pain at home since morning on 01st April 2024, but she didn’t go to hospital until 19:00hrs when her family decided to send her to the hospital

4. Summary cont.. She attended at the facility around 20:00hrs, at 20:54hrs by svd she delivered male baby who scored 2 at 1st minute then 5 after 5th minutes respectively after prolonged 2nd stage of labor of labor, baby delayed crying and resuscitation done by bag and mask then baby kept on oxygen therapy 2litres via nasal pronges, Bwt 2.5kgs

5. Summary cont.. On 2nd april 2024 Around 15:30hrs baby received at NICU at Nyangao hospital as referral case from Kitangali H/c due to severe birth asphyxia. On admission baby presented with fast breathing associated with severe chest in drawings de-saturating out of o2 with spo2 50% with episodes of convulsions, the baby kept on oxygen 2l and saturation went to 61-90%, also was given phenobarbital 54mg stat. RBG tested was 4.0mmol/l.

6. Summary cont.. O/E- Alert, poor cry, dyspoenic with severe chest wall in-drawings, afebrile, not pale, not jaundiced, not cyanosed. Vitals spo2 61-90%, temp 34.4c, PR 162bpm, RR 28C/M, weight 2.63kg, No primitive reflexes WDX: Moderate birth asphyxia hie 13 Plan Ct with O2 Therapy at 2l, Neonatal fluids 158mls of D10 via infusion for 24 hours, iv ceftriaxone 263mg od 5/7, iv phenobarbital 54mg stat then 13mg od, close monitoring.

7. Summary cont.. Around 19:50hrs vitals PR 170b/m, spo2 81%, temp 36.6c, RBG 4.2mmol/l. plan was changes oxygen cylinder and stat local CPAP (3L of O2, 7l of Air). He continue with above management until on 05th april 2024 around 21:00hrs day 4 of life day 3 in ward with wdx of severe birth asphyxia hie 18 when baby started to DE saturating to 63% on oxygen via local CPAP therapy (3L of O2, 7l of Air). RBG 2.9mmol/l

8. Summary cont.. Plan Aminophylline 13mg stat, iv D10% 5.2mls, then continue with iv infusion pump TNF 256 (D10 205mls, NS 51mls) for 24hrs. Monitor RBG and vitals closely and local CPAP (3L-4l of O2, 7l of Air). On 06th April 2024 at 11:00hrs during ward round, WDX severe birth asphyxia hie 20 OE- Afebrile, not pale, not jaundiced, not cyanosis Vital signs- temperature 36c, PR- 123bpm, spo2 98% on 3liter of oxygen concentrators, Weight- 2.63kg No primitive reflexes

9. Summary cont.. Plan Continue with improvised CPAP, continue with ceftriaxone and phenobarbital , TNF 368mls (D10%- 295mls & NS 74mls) via infusion pump for 24hrs, then monitor vital signs closely. On 07th April 2024 around 16:00hrs the patient stated to change vitals PR 135bpm, SPO2 65% On local CPAP, TEMP 36.8c, RBR tested 10.9mmol/l Plan was to stop infusion, to increase oxygen percent to 4L of CPAP, then saturation went to 80%-90%

10. Summary cont.. At 18:00hrs reviewed patient vital signs SPO2 80-90% on local CPAP, PR 120bpm, temp 36.4c, RBG 18mmol/l Around 19:30hrs all dropped suddenly were SPO2 30-45% On local CPAP, PR 45bpm, temp 34.8c Resuscitation by bag and mask ,CPR, adrenaline inj, but no any improvement the patient still deteriorating

11. Summary cont.. At 20:00hrs all vital was un recordable, hence death certified with direct cause RESPIRATORY DISTRESS underlying cause SEVERE BIRTH ASPHYXIA.

12. Action Plan Problem identified Causes of the problem identified Action to be taken Responsible person Completion date Expected outcome Required resource Delayed referral from primary facility to high facility Gaps on management of asphyxiated baby and timely referralFamily awareness on early medical help seeking To insist on timely referral from low facility to high facility when neededTo incraese community awareness through health education on importance of early medical help seeking DRCHCO RCH I/C Ongoing process(done on 25 April 2024 as constructive MPDSR Meeting) Timely when needed Human resource

13. THANK YOU