Perinatal presentation baby anjela mfinanga.pptx

Perinatal death presentation power points

1. Perinatal presentation

2. Demographic data Name: A.M Age: 3 hours old Sex: Female. DOA: 28 May 24 , 10:30 am DOD:02 Jun 24 9:20 am Chief complain: -DIB 3hrs after delivery.

3. hpi seen a female baby transfer in from labor ward with a complain of difficult in breathing which started suddenly 3hrs post delivery this was associated with secretions from the mouth ,lower chest indrawing however there was no fever nor convulsions reported, at labor ward the secretions was removed via penguins and resuscitated for almost 30mins and they put baby on oxygen therapy but still the baby was desaturation and having severe lower chest indrawing . baby was born by CS due to eclampsia at 35+4days GA by date cried immediately after delivery scoring 8 and 10 in 1st and 10mins respectively weighing 2.0kg as labour ward nurse reported

4. ros GIT- no vomiting, no abdominal distension MSS- no obvious deformity , no joint swelling. HMT- no petechial hemorrhage

5. antinatal Mother booked at 14weeks of GA, attended 5 visits, PMTCT- 2 , VDRL-NR, given TT , MRDT- Neg ,given all supplemented and dewormed , was normotensive as per the RCH report and normoglycemic throughout pregnancy

6. Family hx . He is the first born in the family. Living with his parents, both are peasants No familial history of any chronic diseases

7. General examination Ill -looking, afebrile, not pale, not jaundiced, not cyanosed, dyspneic, no lymphadenopathy, no LLE Vitals: admission T=36.7 PR=106 RR=60 SPO2=96% on 02, RBG-3.9mmol/l

8. Systemic examination CNS Semi conscious, with, normal muscle bulkiness, poor primitive reflexes and pupils equally reactive to light   RESPIRATORY SYSTEM RR of 60cpm , normal chest contour, no any deformity, dyspneic, severe lower chest indrawing , with reduced bilateral air entry   CVS Warm extremities, capillary refill less than 3 seconds, no precordial bulging or hyperactivity, apex beat located at 4 th ICS along MCL, S1 and S2 were heard with no added sound   GIT Normal abdominal shape that moves with respiration, not distended, no superficial venous dilatation, umbilicus well clumped with no discharge or bleeding, normal bowel sounds heard on auscultation.  

9. pdx DX Preterm baby at 36weeks GA by FN with 2.0kg appropriate for GA risk of infections, hypoglycemia and hypothemia with respiratory distress syndrome -PLAN to do FBP Start ampiclox 200mg iv bd and gentamycin 6mg iv ad D10 160mls continue with oxygen therapy through CPAP

10. 1 st day post admission passed swr with DR KESSY MMED, DR MRINDOKO MD, INTERNS AND NURSES Subjective Chief Complaint: no new General examination Ill looking, floppy, afebrile,poor primitive reflex, fisting sign, dyspneic ,not pale, not cyanosed, not jaundiced, no lie spo2 OF 96% on CPAP, RR of 56bpm, pr of 144bpm, t of 36.5 Improvements; not good DX Preterm baby at 36weeks GA by FN with 2.0kg appropriate for GA with ENOS (WBC 32, PL 99) and severe birth asphyxia HIE stage 3 Plan Plan of management. on ampiclox 200mg iv bd and gentamycin 6mg iv od D10 106mls continue with oxygen therapy

11. 2 nd day /MAJOR WARD ROUND (CONTINUATION FORM) passed swr with DR KESSY MMED, DR MRINDOKO MD, INTERNS AND NURSES Chief Complaint: abdominal distention. Ill looking, floppy, afebrile, poor primitive reflex, fisting sign, dyspneic ,not pale, not cyanosed, not jaundiced, no lie spo2 OF 93% on CPAP, RR of 67 bpm, pr of 169 bpm, t of 36.9 Improvements; not good Improvements: Not good. DX Preterm baby at 36weeks GA by FN with 2.0kg appropriate for GA with ENOS (WBC 32, PL 99) and severe birth asphyxia HIE stage 3 IO sec to Suspected Hirschsprung disease??? Plan of management NGT ,on ampiclox 200mg iv bd and gentamycin 6mg iv ad D10 120mls continue with oxygen therapy to do abdominal x ray add metronidazol 15mg TDS

12. 3 rd passed swr with DR KESSY MMED, DR HARRY MD, INTERNS AND NURSES Subjective ward Chief Complaint: still have abdominal distention. General examination Ill looking, floppy, afebrile, poor primitive reflex, fisting sign, dyspneic, not pale, not cyanosed, not jaundiced, spo2 OF 95% on CPAP, RR of 72cpm , pr of 149bpm , t of 36.3c Improvement: bad Working diagnosis Preterm baby at 36weeks GA by FN with 2.0kg appropriate for GA with with ENOS (WBC 32, PL 99) and severe birth asphyxia HIE stage 3 Plan of management : Decompresive NGT On ciprofloxacin 20 bdD10 103mls RL-26Mlcontinue with oxygen therapy to do abdominal x ray add metronidazole 15mg TDS. 3 To cancel the mother about the condition of the baby and surgical consultation.

13. 4 th passed swr with DR KESSY MMED, DR HARRY MD, INTERNS AND NURSES Chief Complaint: Still abdominal distention. General examiniation A febrile, ill looking fisting sign, flappy, absence of primitive reflexes, dyspneic, abdomen is distended not pale, not cyanosed, not jaundiced, no lie spo2 OF 94% on CPAP, RR of 66bpm , pr of 144bpm, t of 36.6c Improvements: Bad prognosis. Preterm baby at 36weeks GA by FN with 2.0kg appropriate for GA with ENOS (WBC 32, PL 99) and severe birth asphyxia HIE stage 3 IO sec to Suspected Hirschsprung disease ??? Plan of management 1.iv metronidazole 15mg tds 2.iv cefriaxone 20mg bd 3.010 123MLS, RL 32MLS consult surgical to review.

14. Cont …. Surgical review: reviewed a baby girl born by CS due to eclampsia preterm at 35week 2kg, scored 8 & 10, 3 hours later started to experience difficult in breathing associated with secretions and chest indrawing . yesterday suddenly abdominal swelling, vomiting but reported passing stools normally, x ray of the abdomen done and revealed bowel dilation, features suggestive of obstruction, patient is on iv fluid, NPO, NGT inserted, on oxygen via nasal prong 10L saturated 78% OE: ill looking, afebrile, dyspneic ,not pale, not cyanosed, not jaundiced, no lie spo2 oxygen via nasal prong 10L saturated 78% , RR of 61bpm, pr of 140bpm, t of 36.8c PA; distended abdomen, hypertympanic , reduced bowel sounds wdx ; SEVERE BIRTH ASPHYXIA, NEC???intestinal obstruction sec to Hirschsprung ,electrolyte??? DIAGNOSIS : 1. SEVERE BIRTH ASPHYXIA, NEC??? intestinal obstruction sec to Hirschsprung ???

15. plan continue with iv antibiotics operation cant be done now at this patient, stabilize first continue with NPO, iv fluid monitor closely Doctor's Name and Title: DR BENARD(MD ).

16. 5 TH SENIOUR REVIEW Reviewed a female baby who was a transfer in from labor delivered by CS due to eclampsia at 35+4days GA by date cried immediately after delivery scoring 8 and 10 in 1st and 10mins respectively weighing 2.0kg with transfer in diagnosis of IRDS   5 days of life, 5days in the ward  But upon examination of the baby in the ward with specialist, the baby have all features of Severe birth Asphyxia HIE stage 3 since day 1 due to fisting sign, flappy, absence of primitive reflexes Therefore, we come up with POX -Preterm female baby at GA of Preterm baby at 36weeks GA by FN AFG weighing 2.0kg with severe birth asphyxia HIE grade 3 , EONS, Suspected NEC IO sec to intestinal obstruction sec to Hirschsprung ??? O/E: Critically ill patients, afebrile, not pale, dyspneic, not cyanosed, no lower limb edema PA -severe distended abdomen, reduced bowel sounds, hyper tympanic note on percussions plan - NPO , Cont with management above,   prognosis is very poor.

17. Resuscitation Notes Time Condition Changed: 02 Jun 24,at around 830hrs Reviewed Baby Preterm baby at 36weeks GA by FN with 2.0kg appropriate for GA with respiratory distress syndrome severe birth asphyxia , EONS , Suspected NEC and hisprung suspisition condition changed into continues gasping state desaturation 40% on CPAP pulse rate 40s , caseation of breathing . CPR was done with adrenaline for 30 mins Outcome of CPR CPR was unsuccessful Cause of Death brain hypoxia secondary to cardiorespiratory arrest underlying cause being severe birth asphyxia HIE stage 2, EONS, suspected NEC , and suspicious of Hisprung Death Certified At 02 Jun 24 9:35 am

18. Cont … DAFTARI LA KIFO Death Date Death Certified At Uraia : 02 Jun 24 9:20 am Death Certified At : 02 Jun 24 9:35 am. Corpse Address : Mtanzania MWANGA Death Group Death h: New born Place Cause of Death: IPD Cause of death. Cerebral hypoxia secondary to cardiorespiratory arrest underlying cause being severe birth asphyxia HIE-3 , EONS, NEC, and suspicious of Hisprung .  

19. weekness Means to do electrolyte . Since in our facility we are not doing electrolyte. Means to diagnose hisprung disease also. Biopsy taking . Antenatal clinic delayment to start RCH clinic. RCH measurements of BP , GLYCEMICS. Discussion using the system registering system.

20. ACTION PLAN To the hospital management to fascilitate to do investigations- electrolyte biopsy.