PERINATAL

MORTALITY
16 SEPT 2020
DEMOGRAPHY 1/2
 Pn RH ∙∙ G4 P2+1 ∙∙ 36 weeks 2 days POG

Antenatally
 Overt DM  HPT Complicating Pregnancy
 MGTT at 17w 6.7/11.7  Dx during booking BP 143/98
 Hba1c @ 17w : 7.3%  Subsequently BP was normotensive
@ 30w : 5.5%  H/O admission at 33w 6d for uncontrolled BP
 BSP 19/8/20 : 4.2/6.6/4.9/5.0 TRO PE, not started on regular anti HPT
 T MTF 1g TDS  Started T Labetolol 100mg OD since 35w

 S/C Actrapid 0/0/6 U TDS  PE Profile taken 33w 6d

 Uric Acid 505
 S/C Insulatard 20U ON
 Protein 1+

DEMOGRAPHY 2/2
 Pn RH ∙∙ G4 P2+1 ∙∙ 36 weeks 2 days POG

Antenatally
 Proteinuria in Pregnancy  H/O Premature delivery
 Since 19 weeks  at 34 weeks in 2013
 Trace to +2  came with contraction pain
 Urine PCI 30w : 67.9  delivered baby girl 2.06kg
 24H Urine Prot 34w : 0.2g/day
 USG KUB 30w Normal

 Maternal obesity
 BMI 39
 Echo Normal
PRESENTING COMPLAIN
Date / Time Event
21/08/2020
• Referred from KKKP TRO Pre eclampsia • Assessment at HTAN
• 1730H • Noted BP at kk 145-180 / 86-99  TAS
• Given T Labetolol 100mg stat at KK - FH present
• No IE symptoms - 2709g
• Urine dipstick 2+ - Doppler Normal

At HTAN
No IE sx
BP ranging 126-168 / 63-90
Uric acid 539
Protein 1+
Served T Nifedipine 10mg at 1430H
T labetolol 100mg TDS
PE charting

21/08/2020 • Patient was sent to ward

• 1945H • Planned for induction at 37w
 O&G REVIEW 1/5
Date / Time Event
22/08/2020
• No IE sx • Daptone FHR 140-145
• Bp ranging 144-150 / 80-88
• Examinations unremarkable
• ↑ T labetolol 200mg TDS

23/08/2020 Vitals
• Noted BSP in ward • Bp 110/76
 5.4/6.8/5.5/6.2 • Pr 81
• T 37
• ↑ S/C Actrapid 4/0/8 U TDS • FHR 135-145
• ↑ S/C Insulatard 22u ON
• T MTF 1g BD
• Cont BSP monitoring
 O&G REVIEW 2/5
Date / Time Event
24/08/2020
• 1020H • No IE sx
• FHR 144bpm Vitals
• BP 138/84
• 1120H • Unable to detect FH by daptone • PR 84
• Confirmed by TAS no FH or fetal movement seen
• Last fetal kick felt at 1030H, completed 4 kicks so far,
normal intensity

• Breaking bad news done by Dr Azalea to patient and

husband
• Updated to Dr Marinah at 1240H

▲ Intrauterine death

Plan
Induce with Prostin today
Send to LR in active phase of labour
T carbegoline 1mg stat post partum
Bereavement at LR
 O&G REVIEW 3/5
Date / Time Event
24/08/2020
• 1930H • No IE sx
• Noted BP ranging 159-161 / 88-90
• Examinations unremarkable
• PE profile taken stat no significant changes
• Served T Labetolol 100mg stat

25/8/2020 • Pt complaint of strong contraction pain V

• 0810H • No IE sx
• VE active phase of labour

▲
Plan
Send to LR for delivery
T carbegoline 1mg stat post partum
Bereavement at LR
 O&G REVIEW 4/5
Date / Time Event
25/08/2020
• 0811H • Delivered baby boy at 0811H Vitals
• No signs of life BP 163-165 / 88-89
• BW 2610g PR 78
• Placenta 570g
• Baby generally looks normal
• Ambiguous genitalia

▲
Plan
T Nifedipine 10mg stat
T carbegoline 1mg stat
Bereavement at LR
 O&G REVIEW 5/5
Date / Time Event
26/08/2020
• No IE sx Vitals
• Patient keen for IM Depo BP 120-130 / 70-80
• VTE score 3 PR 76

▲
Plan
Off T labetolol
Off Insulin
T MTF 1g BD
S/C Clexane 60mg OD for 10 days
EOD BP at kk 2/52
Repeat BSP at KK in 2/52
TCA postnatal clinic 6/52 to review all investigations
INVESTIGATIONS
Date / Time Event

25/08/2020 TFT

Placenta Tissue CNS

Placenta swab CNS

FBC Wcc
Hb
Plt

Hba1c

Coagulation profile Inr

HVS CNS No
THANK YOU