Monday, June 11, 2012

Anatomy of a Post-Partum Eclampsia

I just returned from work. It has been a heavy day . . .  2 rupture uteruses, 1 previous Cesarian and a Eclampsia with Chickenpox . . . Enough to learn complicated obstetrics . . . And then we had a maternal death . . . Humanly, there was hardly any chance of her surviving. 



MD1 had come in yesterday, Sunday sometime around late afternoon. We were not expected more eclampsias and rupture uteruses and the recent heavy day that we had of complicated obstetrics . . .



The history has been unbelievable . . .  Before that snaps of the slips of papers her relatives had with them . . . It was very difficult to find out who gave the first 2 slips . . . The next 2 slips have the names clearly written. . .  Please go through them. The history is given after the photographs . . .


Inj Calmpose, most probably received after she had her first dose of seizures . . .

Febrinil is Paracetamol . . . I'm not sure where she got it . . .

This is from the district hospital, from where she was referred. However, there is no name/address or any time or date . . . So, we cannot say whose this is . . .

This is the discharge summary from the hospital where she delivered . . .

Now, for the history . . . 



MD1 had a very uneventful pregnancy except for the last week, when she had some amount of headache and swelling of the legs . . . She had regular Ante-Natal check ups at the local Anganwadi. However, nothing much went wrong. She started labour pains last Friday evening. . .  The Sahiya (ASHA worker) took her to the local Community Health Centre . . . 



As you can see from the last snap, she delivered at 3:20 AM on Saturday, the 9th of June. According to the relatives, the Sahiya made them take a discharge against medical advice at around 10:00 AM the same day. Everything went fine till around 4:00 pm when she suddenly had multiple episodes of seizures. 



The local villagers told the family that most probably an evil spirit has attacked the women in her weak post-partum state. A witch doctor (ojha) was promptly called and ceremonies were held for around 5 hours. She continued to have multiple episodes of seizures. And she was unconscious soon after. 



When no relief was forthcoming, one of the relatives suggested that she be taken to the place where she delivered. She was immediately referred from there to the district hospital. If the 3rd snap is hers, that is what she recieved . . . No Magsulf, no blood pressure taken, no nifidipine . . . But, intravenous fluids, Injection Taxim and Inj Pantoprazole. 



By around afternoon of Sunday, the 10th of July, the relatives were asked to her to us . . .When she reached us, she had a Glasgow Coma Scale of 3, a saturation of 60% and blood colored urine. There was nothing much . . . However, the relatives requested us to do something. 



She was put on the ventilator. Soon after, the blood pressure started to crash. She was on dopamine . . . I wondered later whether dobutamine would be a better option . . . However, I did not have to worry much. She had a cardiac arrest from which she could not be resuscitated . . .  It was sad . . . You can get all the causes of poor maternal care from the MD1's story . . . 



After MD1 came, we had 2 rupture uterus. The first one gave us a wrong history . . . She came early in the morning. . . We thought of giving her a trial . . . but our doctors were quick enough to diagnose a probable rupture uterus by around 8 am. . The baby was a bit sick. . . Later, we came to know that the labor pains were more prolonged than actually told. . . 



As soon as finished the surgery, we had one previous Cesarian Section who came in early labour . . . As we rolled her in, came one more severely obstructed labour . . . We had to wait till the former's surgery was over. . . By then, she had ruptured . . . 



As soon as we finished suturing up the Rupture Uterus came in MD2, with Severe Eclampsia and Chicken-pox . . . I just finished the surgery . . . She is on the ventilator . . . We pray that she'll make it. . . 



As I mentioned earlier, when we have unfortunate occurances like rupture uteruses and eclampsias happening, we expect things to improve as time passes . . . The sad part is that does not seem happening. I hope it worries us . . .

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