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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