UNDER 5 MORTALITY

KKIA PARIT BUNTAR

Name B/O C

ic 920421-14-5104(27 years old)

Adress 20, JALAN SENANGIN, TAMAN
SRI TENGGARA, PARIT BUNTAR

Job PERAWATAN KECANTIKAN

Education SPM
Gravida G2 Para 1
LMP 21/8/2019
EDD 28/5/2020
Date of death 29/3/20 @2033 H
Cause of death FRESH STILLBIRTH
 Perihal kandungan Lalu
Bil tahun Hasil Jenis tempat jantina Berat
kandunga kelahiran lahir (kg)
n

1 2014 41/52 EMLSCS Hosp L 3.4kg

(poor Bagan
progress) Specialist
• Mother blood group o positive
• VDRL nonreactive
• HIV Rapid test non reactive
• Height: 157 cm
• Weight during booking 48kg. Weight increase during
antenatal period 4.2kg
• BMI 19.5
• BP during booking( Rt)100/70mmHg, range during antenatal
90-100/50-70 mm Hg
• Hb during booking 12.5 g/dL, range during antenatal 10.9-
12.5 g/dL
• MGTT done at 14weeks POA ; 4/8.2mmo/L.
• Clinic visit: 11x
• Home visit: 2x
• Seen by MO:5x
BSP
Date POG
29/10/119 9w 5d 1st booking
Summary
SOD, Regular menses,
ANC :1. 1 previous scar
.Hb: 12.5 wt : 48 kg
•Urine alb/sugar: -ve
•BP:100/70
•Scan done: intrauterine, 2 fetus seen with, 2 fetal heart
acivity seen. ( CRL 21.2mm 8w5d ), to follow EDD on
28/5/2020.
Plan :
To follow EDD
MGTT at 14/52
Refer ANC Taiping – twin pregnancy
Repeat scan at 18-20/52- 31/12/2019
13w5 d Scan at ANC hosp Taiping
MCDA twin
Date POG
17/12/19 16w5d Review MGTT at 14/52 = 4/8.2 mmol/L
Diagnosed : GDM on diet controlled.
Plan
1. For HbA1c = result 5.3%
2. BSP on 23/12/2019
3. Refer dietician hospital Parit Buntar
4. Diabetic diet.
5. Not allow post dat
23/12/19 18weeks 5 BSP: 4.7/4.6/6.8/4.6
day Scan done; parameter correspond to date, placenta post
not lower lying, both fetus activity seen.
7/1/2020 19weeks 5 Bsp : 4.8/5.7/5.2/5.7
ANC Hosp days No active complaint
Taiping Scan done:
Ut at 20 weeks
Plan; repeat scan 1/12 -4/2/2020
16/1/2020 22weeks Pt defaulted tca regular follow up on 7/1/2020, and
LR dietician TCA
Given new date dietician on 21/1/2020 2 pm.
Date POG
21/1/2020 21weeks 6 •Bsp; 5.2/4.6/6.8/5.3
days •Lunch: bihun and milo 3 in 1
•Plan; repeat bsp 2/52
4/2/20 23w6days ANC Hosp Taiping:
ANC hosp Uterus 24 weeks
Taiping Scan : 1st twin: cephalic EFW: 298g
2nd twin: breech, EFW 449 gram
Both fetal heart seen, placenta PUS, AFI 9cm
Plan:rpeat scan 2/52
Refer HRPB if having weight discrepency
18/2/20 25w 5days Bsp on17/2/2020: 5.1/5.8/6.1/5.3
ANC hospital Scan done: 1st twin: cephalic, EFW 718 gram
Taiping 2nd twin , breech , EFW 365gram
Twin weight discrepency 49%.
Placenta : posterior , not lower lying, separate membrane
seen.

Case was refer to MFM for detail scan on 26/2/2020

Plan: tca 1/52 after MFM-3/3/2020
Date POG
26/2/2020 27weeks •Diagnosed : MCDA with selective IUGR with fetal
MFM HRPB discepency 50% with normal doppler. Plan for Im
dexamethasone 12 mg OD for 2days next week
(5/3/2020 and 6/3/2020)
•Explained to both couple regarding scan finding. In
view of 1st twin is smaller 50%, then risk of IUD is there.
•Plan tca on 11/3/2020
3/3/2020 27weeks 5 Ut 28 week
ANC days No active complaint
hospital To cont plan given by HRPB
Taiping Tca 2/52-17/3/2020
Tca if reduce fetal movement
Date POG
11/3/2020 29 weeks Scan done: 1st twin: breech, EFW 460 gram, DVP 1.5,
MFM, HRPB 1day MCA /PSV 37cm absence end, diastolic flow DVPI 0.4
2nd twin, cephalic, EFW 1019 gram, DVP 7,
PI 0.99(normal wave), MCA /PSV 33cm/m2
Both bladder seen
Placenta post not lower lying.
Noted discrepency 55%. Counselled pt on scan findings.
Informed aim of delivery is around 30-32 weeks.
Explained risk of IUD and prematurity.need frequent
monitoring.
Imperession: MCDA twin with selective IUGR stage 2
Plan:
1.Repeat scan 1/52
2. Kiv delivery 30-32 weeks
3. IV MGSO4 for neuroprotection if reqire delivery <32
weeks.
Date POG
24/3/2020 30 weeks •Scan; 1st twin EFW 498gram (parameter 23-24 weeks) ,
MFM HRPB 5day DVP 2cm, growth <1% centile
• 2nd twin EFW 1347gram(parameter 29-30 weeks),
growth at 26 in centile, no hydrops, liquor normal.
•Both Fetal heart activity seen
•Plan, TCA 1/52 to repeat doppler
•Aim delivery at 32-34 weeks

29/3/2020 31 weeks She delivered via Emergency LSCS due to MCDA twin
hospital 3days with fetal distress. 1st twin delivered at 2032H and 2nd
Taiping twin delivered at 2033H. 2nd twin FSB with bwt 570
gram, 1st twin bwt 1.36kg.
Postpartum MGTT :
 Investigation
test result Referance range
Placenta swab C&S No growth
TORCHES:
VDRL Non-reactive
Herpes simplex virus (HSV) 33.8 U/mL <6
type 1 IgG
Herpes simple virus (HSV) non-reactive
type 2 lgG
Elisa value of HSV type 2 0.7 U/mL <5
lgG
Rubella IgG <0.2 IU/mL (non reactive) <10
Toxoplasma IgG 0.06 IU/mL( non reactive) <2.0
Cytomegalovirus(CMV) IgG >250 AU/mL (Reactive) < 15