maternal mortality is defined as death of a women while being pregnant or within 42 days of pregnancy

1. Maternal mortality from July
to Febuaray

2. Data from January to feb
month No of
admissio
n
Vaginal
delivery
Total no
of lscs
Alive
baby
IUDB STILLBO
RN
MATERN
AL
DEATH
NEAR TO
MISS
JULY 440 215 119 322 10 2 5 86
AUGUST 550 270 167 421 08 3 5 143
Septemb
er
580 232 130 334 26 3 9 152
October 500 224 112 325 07 4 5 116
Novemb
er
490 211 127 327 10 1 7 121
Decemb
er
550 293 125 417 1 0 3 117
January 407 122 120 213 11 0 3 116
febuaray 259 58 68 43 9 3 3 95

3. S
R
#
PATIENT
NAME
BOOKING RESIDENCE PARITY RISK FACTORS CAUSE OF
DEATH
DATE OF DECLARATION
1 FATIMA UNBOOKED KANDIARO P1+0 POG and ANEMIA P. SEPSIS + PPE 14/7/2023 @ 11 :45 pm
2. SOBIA UNBOOKED NAWABSHAH P2 + 0 ANEMIA +
PLACENTA PREVIA
Blood reaction 17/7/23@ 07:30 pm
3. SHAISTA UNBOOKED 11 CHAK PG PG + ANEMIA PPH (DIC) 28/7/23@ 08:45 am
4 UROOJ UNBOOKED NAWABSHAH PG PG + Diabetes +
HTN
PP (CMP) 30/7/23 @ 12: 40 pm
5 Hajra UNBOOKED Moro G4P3+0 HTN+TWIN Pulmonary
edema
15/7/23@5:30

5. Zaibu
Pre
eclampsia
ARF
Previousthree
Grand multi
Multi gravida

6. s/no name booked parity residens
e
riskfacto
r
Cause of
death
Date of
declarati
on
01 Shamem
w/o
sodho
unbooke
d
P5+0 n.feroz Multygra
vida,
pprom
Renal
failure,
p,sepsis,
dic
06,10,23
02 Aneeta
w/o
kalesh
unbooke
d
PG N,shah PG,s.ane
mia
Pulmona
ry
embolis
m
21,10,23
03 Shehzadi
w/o
qadir
unbooke
d
P5+0 dadu Multygra
vida,s.an
emia
pph 22,10,23
04 Sodhi
w/o
govind
unbooke
d
P2+0 Qazi
ahmed
iudb Brought
dead
28,10,23

7. Sn# PATIENT NAME BOOKING RESIDENCE PARITY RISK
FACTOR
CAUSE OF DEATH DATE OF
DECLARATIO
N
1 TAMINA UNBOOK SAKRAND (P4C/SEC) (P4C/SEC)
APH PPIV
APH PPIV ACRETA
FPLLOWED BY
PPH
22/11/23
@10:30
2 KHANZADI UNBOOK MORO P2+0 C
SECTION
BLOOD
REACTION
17/11/23@1
1:00
3 MARIUM UNBOOK NAWABSHAH PG PG
CARDIC
DISEASE
PULMONARY
EDEMA
29.11.24@12
4 AZEEMA UNBOOK SANGHAR G6P5+0 ALOC+TW
IN
pregnanc
y
Pph .DIC .hepatic
encephalopathy
18/11/23
5 amna unbook N.FEROZ P6+0 grandmut
ly
.retained
placenta
Anemic failure 7/11.24@

8. SNO# PATIENT
NAME
BOOKED RESIDENC
E
PARITY RISK
FACTOR
CAUSE OF
DEATH
DATE OF
DECLARAT
ION
1 DEELI UNBOOK Shahdadp
ur
P5+0 Hepatitis c
Pph
followed
by
hysterecto
my
pph 6.12.23@
12.30
2 amna unbook sakrand G10p9+0 Grandmult
y.
Rupture
uterus
12.30
1.1.24
3 perizaad unbook sakrand G6p5+0(p
1csec)
multigravi
da
Rupture
uterus
13.12.23

9. SN# PATIENT
NAME
BOOKING RESIDENCE PARITY RISK FACTOR CAUSE OF
DEATH
DATE OF
DECLARATION
1 AZRA UNBOOK N.FEROZ P1+0(PRE1Cse
c)
P1 C sec PPH+ANEMIA 25/1/24@1:0
0
2 ANWARI UNBOOK DAUR PG 9MONTH
APE
HTN PG ASPIRATION
Antepartum
eclampsia
23/1/24@12:
15
3 WAHEEDA UNBOOK NAWABSHAH P2+0(SVD) HTN
ANAEMIC
PULMPNARY
EDEMA
PPCMP
BLOOD
REACTION
5/1/24@10:1
0

10. CASE NO 1
• A 35yrs old zebo w/o Sumer G8P5+2(p1c/sec) came in ER
through emergency at 4:10am on 16-9-23 with
•
H/O =9 months GA
•
C/O= Shortness of breath since night
• Patient have history of raise bp from 5 days for that she take tab
Aldomet 250mg 1×od
• According to patient attendant patient was in her usual state of
health 10days back then she develop generalize weakness
for which she went to nearby private hospital ..they advise
her for blood transfusion after transfusion of blood in civil
hospital sakrand patient develope shortness of breath initially it
was mild but from last night it becomes severe..

11. as
a. Young aged femalef average built , height and weight,lying on a bed with
b. anxious look. And taking deep breaths A.V.P.U(VERBRAL) GCS 15/15
c. • Vitals on arrival
d. • BP 151/110 mmhg
e. • Pulse 126Bpm
f. • Temp =100f
g. • R/R =50 breaths /min
h. • So2 68%
i. • Subvitals A++
j. • O/E:
k. • Chest =B/L crepts
l. • CVS=S1+S2 audible
P/A
HOF
=36weeks
Lie=Longitudi
nal
P/P =
cephalic
FM =+ve
FHS= +ve
St = -ve
P/V
Vulva /vagina :
Normal
Os
=Multiparous
Station= -2
Membrane =
intact

12. Labs
LABS:
•
HB: 12.0g/dl
•
PLT: 413000
•
TLC : 35700cell/C.mm
•
VM = negative
•
Uric acid =5.9mg/dl
•
Urine dr shows
•
Albumin =1+
•
Pus cell=9-10 HPF
•
ESR=25
•
PT,APTT=C
•
Total bilirubin=1.4
•
Direct bilirubin =0.5
•
Indirect bilirubin =0.9
•
SGPT=179
•
Alk phosphate =456
•
Urea and creatinine=normal

13. Event note
Patient manage conservatively in HDU but Patient conditions detoriated
For that LSCS done at 10:15pm to 11:00pm on 16-9-23 under GA
Then patient still not maintaining saturation and went on vent support
Patients urine output is not adequate ..and not maintaining saturation and her
labs are derange so then patient shift from HDU to SICU at 12:28pm on 16-9-
23
Where her CARDILOGIST,nephrologist and medical call review
Cardiac opinion advice ECG and echo her echo shows
Heart failure, postpartum cardiomyopathy and ejection fraction of 10-15%
Mild mitral regurgitation and mild tricuspid regurgitation
for that they advice restrict iv fluids
INJ Lasix 60mg state
Tab digoxin 0.25mg (1×od)
Tab DAPTI 5mg(1×od)
Tab as card 75mg (od)
Tab valteral 1+ 1
Tab CARDINIT 1+0

14. EVENT NOTE
• Her urine output is only 100ml in 24hrs for that
• nephro opinion taken
• They advice enhance NG feed 50ml/hr
• Repeat Urea creatinine and electrolytes
• And stop medications like lasix cardtin and other
• cardiac medications and review cardiac opinion
• Her medical advice taken for derange LFTS they
• advice syp hepamerz 2+2+2

15. Management
Patient directly shifted to HDU
Prop up and give oxygen support
Maintain iv line
Send all baseline
Send pregnancy induced hypertension profile
Catheterized the Patient
Arrange 2 pints of blood
Take high risk + death risk consent
Inj hyzonate i/v state give
Antibiotic cover given
Nebulize with atem and clenil
Take ccu opinion
Take physician opinion
In Lasix 40mg i/v state give
Inj mgso4 loading given and maintenance start

16. Event Note
• On 18-9-23 patients condition detoriating
• • Attendant counseled
• • Her vitals are not maintaining
• • 8 cycles of Cpr done + given all life saving
• measures
• • But patient couldn’t revive
• • Having no bp and no pulse
• • Ecg leads shows flate
• • Pupils dilated
• • Patient declare death at 12:30pm on 18-9-23

17. Contributory factor
• HYPERTENTION
• GRANDMULTY

18. CAUSE OF DEATH ACCORDING TO ICD 7
Postpartem cardiomyopathy
Mitral and tricuspid regurgitation

19. GAPS
Unbooked patient
Delayed referral
Delayed multidisciplinary team

20. Recommendation
Family planning
Awareness about danger sign in pregnancy
24 hours MDT presence
Consultant led antenatal care
Establishment of high risk antenatal clinic at tertiary hospital
Involvement of stack holders

21. Case no 2
20 years old patient female primigrividea resident of Moro brought on stature on
9 /10 .23 with h/o of 9 month gestational amenorrhea
Fever for 4 days
c/o of short ness of breath and vomiting for 2 days

22. ASSESMENT IN ER
• BP 95/53 mmhg
• Pulse 122
• R/R 35
• Temp 102f
• Sub vitally pale
• On systematic examination
• Cns 15/15 A .v.p.u
• Chest bilateral crept
• Cvs no added sound

23. ON EXAMINATION
Hof 32 weeks
Lie longtidinal
p/p cephalic
Fhs 134
Fm positive
On p/v
Not in labour

24. EVENT NOTE
Patient admitted IN E.R, give oxygen and all basic protocol taken
Arrange blood , Involve MDT including physician , cardiologist ,anesthetist, hematologist
Blood culture for typhoid ,ICT
Departmental scan
Patient shifted to HDU because of SOB
At HDU her BP was normal one spike of temperature arise up to 101 ,respiratory rate was
60 b/m urine output adequate after anesthetic review patient put on ventilator support
after informed consent at 12.45 am
Patient shifted to SICU at 2.10 am

25. -
Medicine opinion taken they advice antimalarial drugs
And hepamerz infusion
Cardiologist opinion taken ecg shows sinus tachycardia and echo show
ejection fraction 60%
Sinologist 32 weeks with alive fetus and liquor reduced
One pint is transfused at SICU
Lscs done at 13.10.23 under general anesthesia outcome was ABB
.another pint along with 4 ffp transfused
Patient condition did not improve and expire at 14.10.23

26. labs
• LABS:
• •hb
• Hb 8.3g/dl
• •
• PLT: 247000
• •
• TLC : 21900cell/C.mm
• •
• VM = negative
• •
Urine dr
• •
• Albumin trace
• •
• Pus cell=6 to 8 HPF
• •
• ESR=95
• •
• PT,APTT=C

27. labs
• Total bilirubin=4.2
• Direct bilirubin =3.1
• Indirect bilirubin =1.1
• SGPT 37
• Alk phosphate =312
• Urea 97,s creatinine 1.1,BUN 44
• D,DIMERS 7.16
• SERUM ELECTROLYTES NORMAL
• FALCIFARUM POSITIVE

28. ICD no 7
Malaria falciparum

29. Contributory factors
• Anemia
• Delays
• 2nd delay

30. GAPS
Unbooked patient
Delayed arrival in tertiary care
Unaware about danger signs

31. Recommendations
• Proper antenatal care
• Infection prevention methods
• Education about malaria morbidity and mortality

32. Case no 3
 35 years old hajra g4p3+0(SVD)from jhol came through emergency in state
of dyspnoea at 4.30 am 15/7.23
• h/o 9 month Gestational amenorrhoea
• c/o leaking since evening ,blurring of vision and headache since evening
• VITALSINE.R:
• BP:160/110
• PULSE:100 R/R:38b/min
• Temp:98f
• Subvitals=A+;E++

33. ASSESMENT
• PER ABDOMEN:
• hof:38wks
• Lie longitudinal(both)
• p/p cephalic (both)
• Fhs ?
• Fm ?
• Uc +
• PER VAGINAL:
• V/V:N
• OS:9 CM
• Station +1
• Membrane bulging

34. Management
• Iv line maintained, catheterized
• Vitals monitoring half hourly
• MGSO4 started tab labetalol 1 +1+1
• INJ hydralazine iv state
• UOP monitoring hourly
• High risk consent taken
• Attendant counselled regarding serious condition of patient
• Cardiologist opinion
Physician opinion

35. Event note
Patient shifted to HDU t 5 am 15/7/23
bp 160/110 ,pulse 90 b/m ,r/r 32 ,temp a/f
Uop clear ,so2 95 with oxygen (without 72)
At HDU labetalol infusion given inj Lasix given
Patient shifted to LROOM at 12.30 pm (15.7.23 )
Patient deliver via spontaneously
o/c (1) iudbb (2) ABG
I pint transfuse at 3.25 pm
Patient vital at 5 pm 80/35 ,pulse 60 ,r/r 50 b/m
Input 700 ,output nil ,chest b/l crepts
At 5.20 pm patient collapsed 5.20 pm cpr 5 cycle done patient did not revive

36. Labs
• HB: 10g/dl
• PLT: 233000/L
• TLC : 12100 /L
• Serum uric acid = 5.8 SERUM CREATININE 0.9,s urea 30
• Albumin =trace
• LFTS =Total bilirubin 0.94
• Direct 0.4
• SGPT 34 ( 221 on 11)
• ALP 215
• GGT 25

37. CAUSE OF DEATH ACCORDING
TO ICD-
• Pulmonary edema
• Contributory factors
• Twin pregnancy
• Severe preeclampsia
• Renal shut down
• Delays
• 2nd delay

38. Gaps

39. Recommandations