MATERNAL DEATH
REVIEW CASE
DISCUSSION
PRESENTED BY DEPARTMENT OF OBSTERTICS AND GYNECOLOGY
FM MEDICAL COLLEGE AND HOSPITAL
DR ANKITA PRIYADRASHINI
PATIENT DETAILS:
Pt Monalisha Mohapatra w/o Jayanta Kumar Sethi 25 yrs from Soro was admitted to labor room on
16.03.2025, 7:40 PM FMMCH,under 2nd unit.
HISTORY OF PRESENT ILLNESS:
There was pain abdomen which was intermittent
H/O leaking PV since 1 day
No H/O PV bleeding or abdomen vaginal discharge
No H/O urinary symptoms
MENSTRUAL HISTORY:
Menarche-13yrs
Cycles-5-6d/28-30d, regular, average flow
LMP-15/6/24
EDD-22/3/25
GA-39 weeks
OBSTERTIC HISTORY:
Married for 5 years
G1-MCH/2.8KG/NVD/4 YEARS BACK which was uneventful
G2- spontaneous continuing
FIRST TRIMESTER:
No H/O hyperemesis gravidarum, bleeding
No H/O exposure to teratogenic drugs, radiation
T-FA taken till 14 weeks , 1 ANC visit
SECOND TRIMESTER:
2 Antenatal visit, 4 VHSND
Started IFA and calcium
Quickening at 20 weeks
Received 2 doses of Td, investigations were done
No H/O bleeding PV, no HDP
BLOOD GROUP-A+VE
VDRL, TOXOPLASMA-NEGATIVE
HIV, HBsAg, HCV-NEGATIVE
Hb-11gm%
TIFFA scan- Not done
THIRD TRIMESTER:
2 Antenatal visits, 3 VHND
Regular intake of IFA and calcium
Daily fetal movement count was good
No Bleeding PV , urinary symptoms
Hb-10.6 g/dl
PAST HISTORY:
Not a K/C/O Diabetes, HTN, Hypothyroidism, Asthma, Cardiac disease, Epilepsy, TB, Liver disease.
No H/O drug allergy
FAMILY HSITORY:
No family H/O Diabetes, HTN, Hypothyroidism, Asthma, Cardiac disease, Epilepsy, TB, Liver disease,
Malignancy
PERSONAL HISTORY:
•Rural background
•Mixed Indian average diet
•Sleep appetite- Normal
•No H/O prior contraception
•No addiction to tobacco
ON ADMISSION AT 7:40PM 16/03/2025
•Pt was conscious , oriented and afebrile
•PALLOR- ICTERUS- EDEMA-
•Temperature-98.6 F
•Pulse Rate- 84/min
•BP-110/70 mmHg
• Respiratory rate-16 breaths/min
• Spo2-99% under Room Air
• Chest-B/L VBS, Lungs Clear
• CVS-S1 S2 +, No Murmur
OBSTERTIC EXAMINATION:
• P/A- utts, relaxed, cephalic
• FHR- 134/min
• PV- cervix short, soft, OS admit tip, posterior
• IOV- No active leaking
• USG scan was advised for AFI status
• Urine routine and microscopy done
• High vaginal swab was taken
• TREATMENT-
• Prophylactically
• Inj C+S 1.5 GM IV BD
• Inj PANTOP 40mg IV OD
ON 17/1/2025, 9:45AM:
•Pt was conscious and oriented
•P- I- E-
•Temp- 98.6F
•BP- 110/70 mm Hg
•PR- 86/min
•Chest- B/L VBS heard, Lungs Clear
•CVS- S1 S2+, No Murmur
•P/A-utts, cephalic
•FHR-150/min
•PV-cervix short , soft . OS closed
•Pt was planned for LSCS with indication of PROM>24 hrs associated with CPD
OT NOTE:
•On 17/03/2025 at 10:00 am she underwent LSCS under spinal anesthesia for PROM> 24 hrs
associated with CPD.
•A term female baby weighing 3300 gms was delivered at 2:27pm , 17/03/2025
•Placenta was removed spontaneously
•Intraop Inj Syntocin 30 IU in 1 RL IV and 10 U IM given prophylactically.
•No PPH
POST OP MEDICATION:
•NPO- 24 HRS INJ TRAMADOL IM BD
•IVF 2 UNIT RL, 2 UNIT NS, 1 UNIT DNS AT 100ML/HR INJ F+P IM SOS
•INJ SYNTO 10U IN 1ST 3 UNIT IV FLUIDS FOLEY’S CATHETRIZATION FOR 3 DAYS
•INJ TRANEXA 1 GM IV TDS FOR 24 HR
•INJ C+S 1.5GM IV BD
•INJ METROGYL 1 BOTTLE IV TDS
•INJ ONDEM 4 MG IV BD
•INJ PANTOP (40) IV OD
IN POSTNATAL WARD AT 3:30 PM:
•Patient had 1 episode of seizure, frothing from mouth was seen
•P- I- E-
•RBS -120mg/dl
•BP-120/80mm Hg
•Spo2- 65% on Room Air
•Chest- B/L VBS, lungs clear
•P/A- soft , ut retracted
•IOV- NAB
•TREATMENT-
• INJ MGSO4 LD GIVEN AS PER PRITCHARD’S REGIMEN
• INJ PHENYTOIN 6 AMP IN 1 UNIT RL AT 30 DROPS/MIN GIVEN
• INJ MIDAZOLAM 1.5 ml IV STAT OVER 5-10 MINS
• ANAESTHESIA CALL GIVEN
• CICU CALL GIVEN- PT SHIFTED TO CICU
PT RECEIVED IN CICU AT 4:30 PM ON 17.03.2025:
•Pt on ETT with MV
•Temp-98.6F
•Spo2- unrecordable
•BP- 149/88 mmHg
•PR- 178/ min
•RR-16/min
•Chest- B/L VBS, lungs clear
•CVS-S1S2+. NO MURMUR
•P/A-soft, uterus contracted
•IOV-NAB
•TREATMENT-
• IVF AT 80-90 ML/HR 1UNIT RL, 1UNIT NS, 1 UNIT 5D
• INJ VECURONIUM 4MG/HR
• INJ LEVERA 1 GM IV STAT
• INJ PANTOPRAZOLE 40MG IV STAT
• INJC+S 1.5GM IV BD FOR 5 DAYS
• INJ METRONIDAZOLE (500GM) IV TDS
• INJ AMIKACIN IV BD
• INJ TRANEXA 1 GM IV TDS
• INJ ONDANSETRON 4MG IV BD
• INJ PCM 1GM IV TDS
• INJ MIDAZOLAM 1.5GM IV SOS
• INJ TRAMADOL 500MG IV SOS
• INJ MGSO4 MD TO BE CONTINUED FOR 24 HRS AT 30ML/KG/HR
CICU NOTE 17/03/25 AT 4:30PM:
• Pt on ventilator
• BP-138/82mm Hg
• PR- 90/ min
• Spo2- 100 under MV
• P/A- soft, nontender
• IOV- NAB
• TREATMENT-
• INJ MGSO4 MD 4HRLY
• INJ ONDEM IV TDS
• INJ TRANEXA IV TDS
• INJ OXYTOCIN
• INJ PANTOP IV OD
• INJC+S IV BD
• INJ METRONIDAZOLE IV TDS
• INJ AMIKACIN (HOLD)
• INJ MIDAZOLAM 1.5 GM IV SOS
• IN CICU 18/3/25, 9:30 AM:
• PT on ventilator
• BP-153/89 mmHg
• PR-130/min
• Spo2-100% under MV
• CVS-S1 S2+, No murmur
• RS-B/L VBS, LUNGS CLEAR
• Pt was unconscious, ongoing seizure
• Pallor-
• Peripheral pulses palpable
• P/A- soft, Bowel Sound +, ut contracted
• TREATMENT-
• MECHANICAL VENTILATION WAS CONTINUED
• INJ MIDAZOLAM 2ML SOS
• INJ MGSO4 MD 4HRLY
• INJ ONDEM IV TDS
• INJ PANTOP IV OD
• INJ C+S 1.5 GM IV BD
• INJ TRANEXA IV TID
• INJ METRON IV TID
• INJ LORAZEPAM 2ML BD
• IN CICU 18/3/25, 2:20PM:
• Pt was on mechanical ventilation
• Pt was unconscious, ongoing seizure
• BP-60/30 mmHg
• PR-111/ min
• CVS- S1 S2+
• RS-B/L VBS+, lungs clear
• SPO2- 100% UNDER MV
• P/A- soft, ut contracted
• TREATMENT-
• INJ MEROPENEM 1V BD
• INJ MIDAZ 2ML SOS
• INJ ONDEM IV BD
• INJ PANTOP IV OD
• IN TRANEXA IV TDS
• INJ LORAZEPAM 2ML BD
• ON 18/3/25 AT 7:00PM
• ETT tube was changed under thiopentone – 250mg IV
• IPPV
• 7nm of ET tube reintroduced
• INJ VECURONIUM 4MG IV STAT
• INJ HYDROCORTISONE 100MG IV STAT
• INJ MIDAZOLAM 2MG IV 8 HRLY
• INJ LEVERA- 500MG IV BD
• INJ CISATRA-0.1 MG/KG/HR
• INJ MEROPENEM 1GM IV BD
• INJ TRANEXA 1GM IV TDS
• INJ PANTOP 1 VIAL IV OD
• INVESTIGATIONS ON 18/3/25:
• LFT-
• S. BILLIRUBIN(T)- 1.1 MG/DL
• [Link](D)-0.5 MG/DL
• SGOT-1229 U/L
• SGPT-422U/L
• ALKALINE PHOSPATASE-244 IU/L
• [Link]-2.5 G/DL
• [Link]-5.6 G/DL
• RFT-
• [Link] ACID-13.1 MG/DL
• SR UREA-35MG/DL
• SR CREATININE-1.2 MG/DL
• SR Na+-142 MMOL/L
• SR K+-3.8 MMOL/L
• TOTAL WBC COUNT-32.99 X 10^3 / UL
• TOTAL RBC COUNT-4.4 X 10^6 / UL
• TOTAL PLATELET COUNT-334 X 10^3 / UL
• IN CICU ON 19/3/25 (9:45 AM):
• Pt on ventilation CMV mode
• RR-16 BREATHS/ MIN
• BP- 68/30 MM HG
• PR 16/MIN
• SPO2-100% UNDER MV
• CVS-S1 S2+ NO MURMUR
• R/S- B/L VBS+
• P/A- SOFT BOWEL SOUNDS HEARD
• I/O- 2100/1100
• TREATMENT-
• INJ PANTOP 40 IV OD
• INJ PCM 1GM IV TDS
• INJ ONDEM 4MG IV BD
• INJ METRONIDAZOLE IV TDS
• INJ AMIKACIN 500MG IV BD
• INJ TRANEXA 500 IV TDS
• INJ TRAMADOL IM SOS
• INJ MIDAZOLAM 2ML IV TDS
• INJ LEVERA 500MG IV BD
• INJ MEROPENEM 1GM IV TDS
• INJ NORAD 16MG(10ML/HR)
• INJ VASOPRESSIN 2 AMP (1.5ML/HR)
• IN CICU 19/3/25 AT 10:00AM:
• Pt on ventilator, not responding to pain
• BP-68/30 MMHG
• PR- 16/ MIN
• P/A- soft, uterus contracted
• I/O-3500/1400
• TREATMENT-
• NPO
• INJ NORAD 2 AMP @ 10ML/HR
• INJ MEROPENEM 2.5 GM IV TDS
• INJ METROGYL 1 BOTTLE TID
• INJ LEVERA 500MG IV BD
• INJ PANTOP IV OD
• INJ TRAMADOL IM BD
• INJ LORAZEPAM IM BD
• INJ H. ALBUMIN 1 BOTTLE STAT
• MGSO4 MD COMPLETED
DT-19/3/2025
11:10 AM • Pt gasping on MV • CPR STARTED
• BP-60/50 mmHg with NORAD@ • INJ ADR 1 AMP IV STAT
30microdrops/min
• PR-16/min
• SPO2- Not recordable
• Chest- B/L AE+
• CVS-muffled
11:20 AM • Pt on MV • CPR CONTINUED
• BP- NOT RECORDABLE • INJ ADR 1 AMP IV STAT
• PR- NOT RECORDABLE
• SPO2- NOT RECORDABLE
• CHEST- B/L AE+
• CVS- MUFFLED HEART SOUNDS
11:35 AM • Pt on ETT • CPR STOPPED
• Bp- NOT RECORDABLE
• PR-NOT RECORDABLE
• SPO2- NOT RECORDABLE
• CHEST- B/L AE+
• CVS-S1 S2 NOT HEARD
• CORNEAL REFLEX ABSENT
• B/L PUPIL FIXED AND DILATED
• Despite all resuscitative measures, patient could
not be revived and the patient was declared
dead at 11:35 am on 19/03/2025
• Admission death interval- 2days 15hours 55min
• Ceasrean delivery death interval- 1day 19hours
• Duration of ICU stay- 1day 21 hours 20minutes
• CAUSE OF DEATH-POST PARTUM ECLAMPSIA
WITH ACUTE FATTY LIVER IN PREGNANCY
