These are the facts about an unfortunate event that occurred at Mitera in April 2020, where we lost a patient to a condition called AMNIOTIC FLUID EMBOLISM. We deeply mourn the loss, and acknowledge the loss to her family, and pray for her family.
This event has been grossly misrepresented in some online media. We would like to provide clarifications and state the actual medical facts of the case.
The diagnosis in the pathology report(no: PM/PM99/2020) dated 23/06/2020 mentions that “organ show features of shock with microthrombi and suspicious squames in vessels favouring DIC. (may be induced by amniotic fluid embolism)”
What is Amniotic Fluid Embolism?
Amniotic Fluid is the fluid surrounding the baby inside the uterus. Amniotic Fluid Embolism is a rare childbirth (Obstetric) complication in which amniotic fluid enters the blood stream of the mother to trigger a serious reaction. This reaction then results in cardiorespiratory collapse and massive bleeding (Coagulopathy). Though symptoms and signs can be profound, they also can be minimal. There is much variation in how each instance progresses. Fatal consumptive coagulopathy may be the initial presentation. This is characterised by massive haemorrhage with uterine atony and DIC. 11% occurs after vaginal delivery. There is a subset of patients in whom severe haemorrhage with DIC may be the first sign. The mortality and morbidity due to Amniotic Fluid Embolism is very high up to 90%. As many as 85% Amniotic Fluid Embolism survivors have been reported to have significant residual neurologic deficits.
ARC Journal of forensic science volume 4 issue I 2019,PP 32-34.
Indian J Crit Care Med July – September 2009 Vol13 Issue 3.
Journal of South Asian Federation Of Obstetrics and Gynaecology September – December 2014, 6(3) : 199-201.
Viswanathan M et al. Int J Reprod Contracept Obstet Gynecol. 2014 Jun; 3(2): 304-309.
There have been many false and defamatory statements and news that has been circulation regarding this incident. On behalf of the entire medical community, we feel it is imperative to make clear such misconceptions. The said patient, 41 years old, with Pregnancy Induced Hypertension(PIH), or gestational hypertension, had an assisted vaginal delivery, and gave birth to a healthy child. The patient started bleeding after 15 minutes of delivery, a condition known as Post-Partum Haemorrhage (PPH). All the initial treatment protocols for PPH was followed, taking into consideration her age, and history of PIH. As the bleeding continued, the patient was shifted to the OT, after informing the relatives of the probable need for a hysterectomy. In the OT it was decided to proceed for hysterectomy. The patient went in for a condition known as Disseminated Intravascular Coagulation (DIC), where the blood does not clot. In spite of giving blood, blood products and all other necessary medicines, the patient had repeated cardiac arrests (3 times), following which the patient passed away.
It has come to our attention that there are certain groups with an ulterior motive of corruption and blackmail, and damaging the reputation of the institution and the doctors, and are continually trying to endanger the livelihood of all our staff and over 300 families who depend on Mitera for their livelihood. The following are the faults that were pointed out alleging negligence.
1. NO BLOOD BANK AVAILABLE
- Mitera Hospital started its operations on 28 August 2017, and has a MOU (Memorandum of Understanding) with the Blood Bank of Matha Hospital (which is a sister concern of Mitera Hospitals Pvt.Ltd), since the beginning (Copy MOU dated: 01.08.2017, Attached).
- The blood bank is situated hardly 200 meters from the Mitera Hospital building and it takes hardly 5 minutes to bring the blood to the hospital for any transfusion requirement. Also, it is not a mandatory requirement that a maternity hospital should have a blood bank within the hospital.
- As per the hospital’s standing protocol, cross matching is done and blood is made available at the blood bank, one day prior to any surgery/delivery for all the patients. Same protocol was followed in this case as well.
- We have already done more than 6000 surgeries and had more than 4700 deliveries till date, and for no cases has the patient or relatives had to run around or search for blood or blood products. It is always made available at the hospital.
- 6 pints of PRBC and 9 pints of FFP were made available and transfused to the patient in a time span of 2 hours and 35 minutes.
- So, Non-availability of blood bank has no way affected/impacted the outcome of this maternal death case.
2. ONLY A MATERNITY HOSPITAL NO OTHER SPECIALISTS SERVICES AVAILABLE
- Mitera hospital is an NABH Accredited, multi-speciality hospital catering to specialities like Obstetrics and Gynaecology, General Medicine, Foetal Medicine, Neonatology, Paediatrics, Paediatric Surgery, Infertility, General Surgery, Plastic Surgery, ENT and Dentistry. So the sentence “Only a maternity hospital, No other specialists services available” is wrong.
There are also allegations of 18 neonatal deaths, which are still being carried in some corrupt online media floating around. This information was collected by the perpetrators from the local panchayats birth and death registry, and are falsely represented to give the reader the impression that it is a government document. The deaths mentioned in this document include premature born children born before 5 months, and weighing less than 500 grams. The NICU at Mitera, under the leadership of well qualified neonatologists has successfully treated babies born as early as 24 weeks and weighing 600 grams.
It is very unfortunate that we have to face such humiliation and insult in spite of working and doing our best. No medical institution will want to cause any harm the patients who place their trust them. This, unfortunately has probably become the norm for our profession where any mishap is automatically blamed on the medical and nursing staff. We would like to state that there has been no negligence or lack of care from the doctors, staff or management in this case.
After a year from this unfortunate incident, we are still under attack from these groups, who have also very cunningly not made public the post mortem and pathology report of the patient. It is only because of the circumstances, and the continued attack that we are facing, that with a heavy heart that we are forced to write this explanation here. Out of respect for the family, we are abstaining from putting up a copy of the reports.