R
ecent times have been very trying
in terms of personal loss. I don’t
know if age is catching up with us
and we are at that stage when we see our
parents’ transition. What is more shocking
is the number of people my age and even
younger who are dying.
I have lost several friends of late and the
saddest for me is my university school
mate who was just found unresponsive in
bed. I have two other friends who have
succumbed to cancer and another who
lost his mother after a long battle with a
heart disease.
As I pen this down I currently have
another friend who has a critically ill
patient in ICU and it was in conversation
with her that spurred the current topic. I
know these are not my clinical losses but
as we were discussing she asked me how
we as health workers cope with bad news
all the time and still go on to work. This
article is dedicated to them even though I
will be discussing issues more in my line
of work.
In a certain way I am lucky by virtue of the
fact that I do obstetrics and gynaecology.
For us unless we deal with oncology cases
our patients are generally well. My aunty
made the quip that we are the happy
doctors! I had just bumped into her and
her in-law as she was visiting a relative in
ICU. They were shocked when I told them
I hadn’t been to ICU in private practice
for some time and they said that the only
part of the hospital where people come
out of the ward smiling is maternity.
This may be true but we also get a dose
and in obstetrics that dose is a powerful
blow. Patient walks into hospital and
everyone expects her to walk out with a
baby and well. After all she just came to
deliver what could go wrong.
Let me dwell a little bit on Maternal
Mortalilty. According to the World
Health Organization (WHO) this is
defined as death of a woman while
pregnant or within 42 days after
termination of pregnancy, irrespective of
the duration and site of the pregnancy,
from any cause related to or aggravated by
the pregnancy or its management but not
from accidental or incidental causes.
To expound on this accidental causes
would be if a pregnant lady was involved
in a road traffic accident and dies due
to this that would not be considered a
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maternal death.
Unfortunately around the world 830
women die daily from preventable causes
related to pregnancy and childbirth.
This equates to about every 2 minutes a
woman somewhere has lost their life due
to pregnancy. I usually tell my clients that
they are walking time bombs and I only
exhale about them once we’ve done the 6
week visit and they are well.
Even for maternal deaths there are both
direct and indirect causes. Direct causes
of maternal mortality are: haemorrhage
(heavy bleeding); infections, preeclampsia
(high blood pressure associated with
pregnancy and this can even develop
after delivery), obstructed labor and
complications of abortions.
completely convering the cervix), abruptio
placentae (when placenta detaches from
uterus prior to delivery), vasa previa
(fetal vessels run in the membranes of the
placenta).
There are other causes such as cervical or
vaginal lesions such as cancer, polyps or
infections but these should they result in
death would be indirect causes.Infections
can develop at any time during pregnancy
or after termination of pregnancy. Severe
cases can lead to sepsis and this is one of
the leading causes of death.
Haemorrhage can be in early pregnancy
such as an ectopic pregnancy, heavy
bleeding following an abortion or molar
pregnancy. Molar pregnancies or should
I say Gestational Trophoblastic Disease –
GTD is a group of diseases where proper
development of the foetus or baby does
not take place due to growth of abnormal
cells - abnormal trophoblast cells inside
the uterus. Preeclampsia is a special entity as this is
the high blood pressure of pregnancy. It
differentiates itself from hypertension in
that this only occurs in pregnant women
due to presence of the placenta and has
certain key features such a protein in the
blood and affects almost all organs in
the body. One of the few patients I have
lost was due to this. The most common
cause would be due to development of
ecclampsia (fits or convulsions in a patient
with preeclampsia). We commonly see
this in public hospitals and it is very
distressful to see and manage and the
worst is losing the patient and having to
inform the relatives about the death.
Heavy bleeding also occurs in late
pregnancy and this can be from a
placenta praevia (placenta located near or Obstructed labor: In our country about
40% of deliveries are still home deliveries.
I thank God for free maternity services
More and more women are dying due to
clots in the lungs (pulmonary thrombo-
embolism). This is the most severe form
of clots and only about 50% survive and
this is in developed countries. Have you
heard of a woman as there are many in
the media who delivered well especially
after caesarean section went home and
developed cough or difficulty breathing
rushed back to hospital and died?. This
is a real threat and warrants everyone
to be vigilant and consider use of blood
thinners especially after surgery and the
worst is caesarean sections as pregnan-
cies make getting clots easier.