MATERNAL NEAR MISS . . . ANOTHER ONE

I never thought that I would be writing so soon about one more 'maternal near miss' so soon. ZB could still end up as a maternal death.

ZB, married off to KA, who works as a dumper truck and forklift operator in a major company in Chennai had returned 2 months back to her husband's house in Palamu district - about 70 kms north to the district headquarters of Daltonganj. She had been doing well till today early morning. Since the pregnancy was uneventful, her in-laws did not think much about doing regular antenatal check-ups. Moreover, they believed that she had a clean chit given during her ante-natal check up at Chennai.

The spate of unfortunate events started at around 4 in the morning today. She threw a fit while she got up to drink some water. Her in-laws did not think that as something serious until she looked to become stupourous. They rushed her to a local non-qualified medical practitioner (called RMP - Registered Medical Practitioner) in the nearby railway town which was about 1 km away. The RMP gave her some intravenous fluids. In between, she had another 4 episodes of seizures. By now, they realised that they needed to take her further. Someone told them that the best treatment for such conditions is got in NJH.

Instead of hiring a vehicle, they bundled the semiconscious ZB into the Dehri-on-Sone to Barwadih passenger train which passes through Daltonganj. This is the first time I have heard of someone do that to an unconscious patient. The journey was about 2 hours long and by then she had convulsed another 2 more times. They reached Daltonganj by around 6 in the evening. They hired a tempo and reached NJH by around 7 pm. On the way from Daltonganj to NJH (35 kms), ZB had one more episode of convulsion.

I had just come back home from hospital after couple of Cesarian sections. Drs Johnson and Kumudh were taking their customary evening walk around the campus when ZB arrived and they were quite near to the labour room. The duty nurse noticed that ZB was convulsing and noticing my colleagues called out to them. By the time I arrived, they already had a line going on and anti-convulsant injections were on its way in.

ZB was in a pathetic state. Her blood pressure was a whopping 180/130 and her urine albumin was 4+. We knew that she would develop complications if the baby was not taken out fast. Meanwhile ZB's mother-in-law informed that she was not yet term. However, on examination, the cervix was very unfavourable. We discussed the situation with the ZB's family and a decision was taken to take out the baby by Cesarian section. Her saturation was just 85% and she had aspirated quite a lot. We could not wait for a normal delivery although we found that her baby was dead. We were encouraged by her platelets, liver and kidney function to go ahead with surgery.

The surgery was uneventful. ZB is presently on the ventilator. She is sedated and has been maintaining saturation quite well. I hope to have a positive update on both ZB as well as UD

http://jeevankuruvilla.blogspot.com/2011/08/maternal-near-miss.html). Sorry to keep you bored with these maternal health events. I have couple of other patients coming up soon... Just that I need some more background information before I put them on...