SU5MR CR- 1/2020

STILLBIRTH & UNDER 5 MORTALITY CONSOLIDATION REPORT

STATE: Kedah DISTRICT: Pokok Sena

Name: Baby Of Nurul Husna Binti Idris Sex: M DOB: 25 September 2023

Age:

MyKid:- Race: Malay

MIC: 961223-14-5534 Others (state):

Date & Time of Death: 15:47H Home Address: No 3A, Kampung Lahar Dalam,
Mukim Lesong, Pokok Sena, Kedah.
Place of death: Hospital Sultanah Bahiyah, Labour Room

Antenatal History (list antenatal issues, medical problem, social concern)

LMP: 3/2/2023
EDD: 10/11/2023

ANC:

1. Pre Eclampsia
2. GDM on diet control
3. Early onset FGW with polyhydramnious highly likely lethal congenital anomaly - (enlarged cisterna magna,
right renal pyelectasis, enlarge lateral ventricle ( left) 9.4cm, echogenic bowel, Clenched fist , overlapping
fingers, cleft palate) and absent EDF since 27.8.23. Opted for conservative management
4. Primigravida
5. Maternal Overweight – booking BMI 29 kg/m2

Mother is a 27 years old lady, G1P0, Site Supervisor. Booking was done at KD Budi at 9 weeks POG. VDRL, HIV
results were normal. 1st OGTT done at 10 weeks POG was normal (4.46/4.89). Patient was diagnosed with GDM at
26 weeks POG when OGTT done were abnormal (4.71/7.84)

3 scans were done at KK Pokok Sena:

- RCU1
- 21 weeks 6 days POG
- 24 weeks 5 days POG: planned for repeat scan at 28 weeks POG

Patient was then admitted to HSB (18.8.23-21.8.23) at 28 weeks POG for TRO Pre Eclampsia in view of urine
albumin 3+ with BP of 120/90. During her admission there, growth scan was done and noted fetal growth
parameters were below 10th centile. Patient was referred to MFM specialist for detailed scan. Detailed scan done
on 21.8.23 noted Early onset FGR (Type I) with normal Doppler and AFI with underlying proteinuria with presence
of soft marker (enlarged cisterna magna ad right renal pyelectasis) – unable TRO Chromosomal abnormalities.
Mother was offered karyotyping, however mother refused. Mother was planned on weekly PE profile and BSP with
biweekly Doppler at ANC Clinic and 2 weekly growth scan at ANC cinic.

1st Doppler scan done on 24.8.23: normal

2nd Doppler scan done on 27.8.23: scan was done by MFM specialist, noted absent end diastolic flow with presence
of soft markers (enlarged cisterna magna, enlarged lateral ventricle, renal pyelectasis, echogenic bowel, clenched
fist, overlapping fingers, cleft palate). Possible of lethal congenital abnormality (eg Patau/Edward syndrome) was
suspected however unable to rule out as no karyotyping was done. Mother was offered for amniocentesis and
explained regarding conservative vs surgical management and risk of IUD. Mother was not decided yet.
During MFM Clinic at 30 weeks 3 days POG, both parents were counselled for amniocentesis, however both
refused. There were also counselled for active management by EMLSCS in view of abnormal Doppler, however,
both parents refused for delivery and opted for conservative management.

During MFM clinic at 31 weeks 3 days POG, patient was started on T. Methyldopa 250mg TDS in view of BP
143/96, UPCR: 42->110mg/mmol. PE profile and RP were within normal range. Patient was then planned for
weekly Doppler scan.

During MFM Clinic at 32 weeks 3days POG, noted reversed end diastolic flow on Doppler scan. Impression revised
as Early onset FGW with polyhydramnious highly lethal congenital anomaly. Mother was emphasized on diagnosis
and management, however, mother keen for conservative management.

On 23.9.23, patient was sent to PAC in view of reduced fetal movement. Scan showed IUGR with FH absent and AFI
27. Mother was planned for IOL, prostin x 2 was given. Mother successfully delivered on 25.9.2023 at 1547H via
SVD sustained 1st degree perineal tear.

Perinatal History (place of delivery, perinatal events, gestation, mode of delivery, BW, resuscitation, Apgar score,
NICU/SCN admission)

Delivered at 33 weeks 4 days via spontaneous vaginal delivery at Hospital Sultanah Bahiyah. History of reduced
fetal movement with no fetal heart activity seen on transabdominal scan.

Impression: IUD with underlying early onset FGR with polyhydramnious highly likely lethal congenital anomaly
unable TRO chromosomal abnormality

Delivered baby boy on 25.9.2023 at 1547H, macerated stillbirth, weight: 1140g

Neonatal History (comorbidity, postnatal visits, hospital admission, feeding issue, social concern)

Childhood History (main carer, immunization, comorbidity, hospital admission, growth, development, social
concern)

Events leading to death (timeline terminal events, investigation (laboratory/radiological, post mortem)

Induction of labour was performed in view of IUD. Baby was born macerated still birth.

IUD Workup

23/9/2023:

HVS C&S: No GBS Isolated

HSV IgM: Negative

CMV IgG: Reactive, CMV IgM: Non reactive
Rubella IgG: Reactive, Rubella IgM: Non reactive
Toxoplasma gondii IgG & IgM: Non Reactive
TPPA/TPHA: Negative

HPE placenta (25/9/2023): Features suggestive of maternal vascular malperfusion

Cause of death

1a: Macerated Stillbirth

1b:

1c:

1d:

Death category: Please tick ( / ) one column either A/B/C and choose (a) or (b) or both as appropriate:

A. Preventable B. Not preventable C. Undetermined

a) Medically treatable a) Palliative case a) Post-mortem done
b) Public health issue b) Non palliative case b) Pending special Ix

Shortfalls: (as determined during district U5M meeting)

Remedial Actions: (as determined during district U5M meeting)

Planned by MFM:

Folic acid 3 months before embark next pregnancy

For karyotyping next pregnancy
For detail scan next pregnancy
Medical Officer: (Name, designation) Verified By: (Name, designation)

Dr Nur Adlina Binti Yahya

Pegawai Perubatan UD 41

Neutral Assessor: (Name, designation)

Comment:

Recommendation.