Morbidity review

SITI NORAZIRAH SIRAT (920907136398)

I/O SITI NOR AZIRAH SIRAT

Address: Lot 3367 Taman Winspark

Occupation: PDK staf

Age: 24 years old

G1P0 @ 38 weeks POA

Antenatally:

Primigravida

History of laparotomy and cystectomy for right endometriotic cyst in 2014

at MGH

VTE score 3

c/o contraction pain since around 10pm on 1/9/2016

a/w show

Deny leaking liquor

Claimed FM good

No PV bleed

No fever

No foul smelling discharge

No history of fall or trauma

O/E Alert, conscious, pink, not tachypnoic, good pulse volume, warm peripheries,
good pulse volume

Bp: 124/80

P: 89

T 36.8

Spo2: 98% on air

Lung: clear, CVS DRNM

p/a: soft, non tender, no board like rigidity, no scar tenderness, singleton, cephalic,
Head at brim, EFW 3.90- 3.2 kg, liquor adequate

V/E: Os 6 cm, St 0, Cx efaced, MI, no cord, no placenta

Noted CTG during Examination shown sinosidal pattern, ARM done

Noted present of blot clots with lightly meconium stained liquor mixed with blood

Case was consulted with Dr Than at 0220H ( O&G Specialist) for EMLSCS in view of fetal
distress with ? Abruptio- to proceed as planned and to call experienced/ senior MO as to
anticipate adhesion and complicated LSCS

Plan noted to SN, and to activate OT urgently.

Case also informed to patient regarding her labor progress, need for EMLSCS and
indication, risks and complication was explained- consent acquired

Also noted to family members : Husband, Patients parents- understood, no further

question asked

Noted at 0250H, no OT call yet.

Informed that having difficulties to contact OT staf , however, already noted to

other staf

At 0320H, received OT call- to send to OT

0322H, patient was pushed to OT,FHR 130 bpm

Proceed with EMLSCS under GA at 0346H

LCSC uneventful

Noted mild adhesion of musles to rectus sheath, easily released

Baby was born at 0359H

No retroplacenta clot

Liquor clear, no blood clots / fresh blood seen

EBL: 350 cc

However, noted baby was born flat

Neonatal resuscitation

At birth, baby was pale, no spontaneous breathing, no cry, poor tone

HR 88 bpm APGAR 1

Initial steps was done, suction clear liquor

Given 2 cycles of PPV, no changes in HR, no spontaneous breathing, thus proceed with
intubation.

Intubated with ETT size 3 at 0402H, anchored ar 15 cm

Subsequently HR pick up to 132, Spo2 detectable, 80% on manual bagging

Lung: air entry equal bilaterally

DXT 5.2

At 5 minutes of life : APGAR score 4

HR > 100

Pink

Attempted for UVC, however, unable to cannulate, thus procedure was abandon

Peripheral line secured at right hand : started on IVD maintanence 8.8 cc/H D10%

Post intubation CXR

Noted that ETT was too deep.

Attempted to reanchored, but ETT

dislodged

Re-intubate using ETT size 3.5, anchored at

11 cm

Post intubation, lung equal air entry

HR 158, Spo2 99% on manual bagging

Apgar Score progression:

At 10 mins of life, 6: irregular gasp, HR >100, pink, some flexion of

limbs

At 15 mins of life, 6

At 20 minutes of life, 8 : HR > 100, pink, grimace, active movement

of bilateral limbs, irregular gasp

HR ranges : 130- 150 bpm

SpO2 fluctuating from 75% - 95 %

Case subsequently was referred to Paediatrician oncall, and was

transferred to MGH for further care.

Baby update:

At MGH, noted baby having right pneumothorax, most likely

iatrogenic

No chest tube was inserted.

Baby was extubated on day 2 of life, on supplemental oxygen via

NPO2