Mortality/Morbidity Review

September 2023
• Guest is a G2P1+0, 1A. EGA: 20 WKS today. LMP: 22/4/23.
• First child: She delivered a live female neonate via Emergency C/S o/a of cord round baby's neck,
21 months ago.
• BW: 3.9 kg
• She said she has started feeling fetal movement but said its not frequent. she has started Tabs
FOLIC ACID 5MG DLY AND FERSOLATE 200MG DLY but said she is not regular on them.
• She has commenced TT1.
• She is yet to commence IPT.
• Nil hx of fever, abnormal vaginal discharge or itching, bleeding via vaginum, lower abdominal
pain, drainage of liquor, dysuria or LUTS.
• Nil new complaints.
• She complains of having recurrent muscle pull.
• HTN0, DM0, Asthma0, Epilepsy0, PUDx0.
• A young woman, conscious and alert, not ill looking, not in any obvious distress, not pale, anicteric, acyanosed,
not dehydrated, afebrile(36.6), nil pedal edema.
• WT: 89.1 KG
• PR: 80 b/m
• BP: 126/60mmhg
• HS: S1, S2
• RR: 22 c/m
• Chest: Clinically clear
• BS: Vesicular.
• ABD: Gravid, Uniformly enlarged, MWR, Soft.
• nil area of tenderness.
• nil renal angle tenderness.
• SFH: Palpable.
• FHR: 146 b/m
• Obstetric scan
• Tabs Folic acid 5mg dly ( guest said she has at home)
• Tabs Fersolate 200mg dly ( guest said she has at home)
• Counsel on drug adherence.
• counsel on ANC visits.
• TT2.
• Book for ANC
Guest returned the next day 10/09/2023 at
10pm
• MOWR- DRS TEMI/GANDU
G2P1+0 1A LMP- 22/04/23 EGA-20WKS 2DAYS EDD- 20/01/24 Guest seen
Admitted via the ER on a/c of Drainage of liquor X 15hrs duration.
She was said to be in her initial state of health until about 15hrs ago when she noticed drainage of fluid in her
undies while sleeping
Guest initially thought she was dripping urine because she was pressed as at that time, but drainage of fluids
persisted even after urinating
and not pressed necessitating her presentation to our facility.
Nil hx of headaches, blurring of vision or diziness
Nil hx of seizures
Nil hx of trauma or virgourous exercised
Nil hx of fever however there was hx of sexual intercourse a night before incidence.
She last felt fetal movement 3 days ago which was light.
Guest presented yesterday to book for ANC , however she is on routine drugs, she has taken 1 dose of TT but
have not started IPT Antimalarials.
Pregnancy was desired and spontanous
Pregnancy was Confirmed by PT test Last pregnancy was delivered via EMCS due to Nuchal cord.
No known underlying condition
• Young woman in mild painful distress, Afebrile 36.2, not pale, anicteric, acyanosed, nil pedal edema

• CVS-
• PR-103BPM
• BP-120/84mmHg
• HS S1S2 only
• REP-
• RR- 20CPM
• Vesicular breath sounds
• Nil added sounds.

• ABD- Gravid uterus, FMWR

• Palpable
• Nil area of undue tenderness
• SFH- 22CM
• FHR- ?

• VE- Bulging of placenta membrane

• Valsalva maneuver ++ drainage of liquor
Diagnosis:Premature rupture of membranes
(Query)
Diagnosis:Incomplete spontaneous abortion
without complication (Query)
• Plan:AS DISCUSSED WITH COC- DR TAIWO
• 1- ADMIT PATIENT
• 2- URGENT OBSTETRICS SCAN (CALLED RADIOLOGY DEPT. DR
KINSLEY)
• 3- FBC, URINALYSIS, URINE MCS.
• 4- IV CEFTRIAXONE 1G 12HRLY
• 5- COUNSEL PATIENT ON FINDINGS
• 6- COUNSEL FOR MEDICAL TERMINATION OF PREGNANCY IN VIEW OF
INEVITABLE MISCARRAIGE
• Counsel patient on possible outcomes
• - Ct mgt
• MOWR- DRS TEMI/GANDU
Guest seen.
Feels mild pain in the abdomen. Abdominal pain is said to be getting
intensed. Severity 4/10
Opted for conservative care.
Still hopes the fetus can be salvaged.
NFC Taking prescribed medications
Next day
• CWR - DR OKAFOR
Guest seen
A G2 P1 + 0 (1A) at 20 weeks + 3 days admitted on account of liquor
drainage and mild abdominal pains
Liquor drainage has been confirmed by pooling of liquor in the fornix
and valsalva manuever
USS showed - oligohydramnios and cervix open with membranes
bulging out of the os
She has been counselled on the prognosis and further care
management and she understands
Abdominal pains have reduced
• Examination:Afebrile, not pale, not dehydrated.
• PR - 104 b/min
• BP - 120/80 mmHg
• RR - 22 c/min
• SpO2 - 96% in RA
• UGS - Urinary catheter insitu draining concentrated urine
• ABD - Gravid, MWR
• VE - Not repeated

• ASS - Missed miscarriage

• Plan:- Counselled on the diagnosis, risk and management plan
• - Commence IVF N/S at maintenance
• - CT other line of care
4;30pm
EXPULSION NOTE
Guest was noticed to have more drainage of liquor on the ward at 3:44pm and said to feel a mass in her
vulva.
She was moved to the labor room and 10IU of oxytocin was set up.
She expelled a male fetus at 4:32 pm.
IV Oxytocin 30IU by infusion was commenced.
Rectal Misoprostol 800 mcg given.
Placenta has not fully expelled yet.
• Plan:- IV Ceftriaxone 1g 12 hrly
• - IV Metronidazole 500 mg 8 hrly
• - Supp Diclofenac 100mg stat then Tabs Diclofenac 50mg 12 hrly
• - IV PCM 900mg stat then Tabs PCM 1g TDS 8 hrly
• - Allow Placenta to deliver (No invasive removal); if placenta is not
delivered after 6 hrs then give 800mcg of misoprostol sublingually.
5:30pm
• Placenta has been delivered at 5:05pm

• PLAN:
• - Do PCV tomorrow
• - Ct oxytocin infusion
• - Ct other line of care
10:00pm
• Nothing new
Next day 12/09/2023
• CWR- No new complains
• Examination:Afebrile, not pale, not dehydrated.
• PR - 88 b/min
• BP - 100/70 mmHg
• ABD - UT - 18/52 - well contracted

• V/E- Normal Lochia

• Plan:- CT IV antibitotics for next 24 hours
• - For sick leave at discharge 1 week
• - CT other care
13/09/2023
• CWR-Nil fresh complains
• Examination-nil of note
• PLAN:
• DIscharge home on:
• Tabs Cefixime 400 mg OD x 5/7
• Tabs Metronidazole 400 mg TDS x 5/7
• Tabs PCM 1g TDS x 5/7
• - Give Excuse Duty for 1 week.
• - See OBGYN in 1 week.