choiseul province, western solomons. obstruction due to inadequate uterine contractions and...

Pacific Society of Reproductive Health 2013, Samoa

Cherrie Galo, Reproductive Health Coordinator, Choiseul Province

Case presentation: Near Miss Maternal Death

SOLOMON ISLANDS

Choiseul Province,Western Solomons.

Obstruction due to inadequate uterine contractions and malposition

Personal and Antenatal History

Biography• Mrs. X, 18yrs, married, Housewife, Melanesian,

United church, Sirovanga Village, Choiseul Province

• Level of education: Grade 6• referred from Sirovanga RHC to Taro Hospital for

safe delivery.Antenatal History: Present Pregnancy.• Gravida 2,Parity 1• LMP: 28/06/12. EDD: 04/04/13• Term Pregnancy (41/40gestation) • ANC at least six visits.Past History. - Teenage Pregnancy(15yrs) &Normal Vaginal

delivery at a Nurse aid post in 2011.

Admission

Date: 25/04/13Time: 10.30pm • Term Pregnancy - 41/40 gestation• Contractions: Mild to Moderate (2 : 10) : durations (20 – 40seconds)Time: 11:15pm• VE : cx- 100% effaced Os – 3cm dilated membranes intact PP – Ceph Station – 0• Mothers observations BP 120/70, Pulse 80/m, Resp 28/m, Temp 37c, FHR 140/m• In latent phase- continue to monitor progress of the

labor.• Herbal medicine

Progress Report

Date: 26/04/13 Time:12:30am (repeat VE)• Labor continued to moderate to strong contractions • Contractions 2 : 10 , duration 40 sec to 60secs• Observations stable (BP120/70,Pulse 80/m Resp 28,

Temp 37c FHR 140/m)• VE: cx Midline Position, 100% effaced , Os- 10cm

dilated, PP – ceph ,Station – 0• Membrane ARM with clear liquor. • Mother was encouraged to push with contractions

several times but failed.

• The mother was encouraged to mobilize and do rocking movements within the labour ward .

Progress ReportDate: 26/04/13 Time: 5:30am • Repeat VE – cx- fully dilated, PP- cephalic with

occiput posterior and caput ++, station O -+1• Contractions 2:10, duration 20 secs to 40secs (mild

to moderate)• Mothers observation is stable Delayed 2nd stage due poor uterine contractions and

OP position. Management• IV fluid Normal saline/D/saline for hydration• Commenced on Ampicillin 1gm IVI commenced 6hrly• IDC inserted.• Plans for emergency referral made• Bad weather (cyclone warning) unable to refer to

next level of care – Gizo Hospital • Sea ambulance (6hrs to 8 hrs)• monitor contractions and observations• Reassure mother and relatives on condition and

evacuation plans.

Limitations

• No Doctors• No Vacuum Extraction equipments• Augmentation

Evacuation Plans

• 27/04/13• Time:7am • Contacted Obstetrics Dr. Honiara thru

phone.• Ordered antibiotics – Flagyl 400mg iv

8hrly _ Gentamycin

240mg iv stat• Arranged for evacuation.• Plan A-Diversion of solair flight from

Gizo to Taro(unsuccessful)• Plan B- RAMSI Chopper (successful)

RAMSI CHOPPER

RAMSI - Evacuate

RAMSI - Evacuate

Total distance = 664 milesLeave Honiara = 11:30amArrive Munda = 1pm RefillArrive CHB = 2:45pm ReturnLeave CHB =3pmArrive Honiara at 7pm

CHB Airport

Munda Airport

HendersonAirport

Key Air port Transport Evacuation trip Escorting trip

Refill

National Referral Hospital

• NRH ambulance.• Seen by Registrar Dr. on call in

Labour ward• Augmentation• Vacuum Extraction done• Apgar score -• Bwt: 3’740gms• Both mother and baby well• Discharge from NRH (home by boat)

Return Home by boat

One Week Travelling

SOLOMON ISLANDS

Outcome

THANK YOU