Serial Maternal Deaths in a Tertiary Care Hospital

Abstract

"While these teams have been unable to clearly identify the causes of these deaths, the general background in which they have occurred is a matter of concern. We must take note of the complex of factors influencing healthcare in hospitals like Umaid and MG: absenteeism among senior doctors who are meant to be on duty, the lack of cleanliness, and the poor quality of care. These deaths also raise a number of questions. First, are so many deaths in this time period uncommon in a tertiary women’s hospital like Umaid Hospital? Or are these just routine? Did they just happen to catch the attention because of media reports? Umaid is a 200-bed specialty government hospital attached to the Dr SN Medical College. A number of well-qualified doctors are posted there and engaged in teaching medical students in addition to treating a large number of in-patients. The hospital has all the required equipment and facilities but it is poorly maintained, pathetically unhygienic and certainly a breeding ground for infections. There is no publicly available information on the record of post-surgical infections at the obstetrics/gynaecology departments of Umaid and MG hospitals. It is not known whether regular maternal death reporting and review processes are in place. Second, on what basis did the authorities conclude that contaminated IV fluids were the immediate cause of these deaths? In addition to the 18 women who died, countless others were given the IV fluid of the same batch. According to the company’s statement, there were approximately 25,000 bottles of IV fluid of this particular batch. 5,000 were supplied to the three government hospitals and some shops in Jodhpur, Out of these, 2,800 were already consumed in the hospital. The remaining 20,000 were sent all over India. But the same reaction has not been seen elsewhere. These fluids were also used in other departments of the same hospital where no adverse event has been reported. Further, deaths were reported of women who were admitted to the hospital after the IV fluids were withdrawn. Third, did the women get rational treatment? A review of available reports suggests that some of the procedures were not indicated. For example, it is a common practice in big hospitals like Umaid to give IV fluids even in an absolutely normal delivery. Likewise, not all the women may have needed caesarean sections and some of those interviewed by the PUCL team suggested that junior doctors may perform unnecessary C-sections in order to get experience in the procedure. What is the C-section rate of this hospital? Fourth, were routine standards of infection control being followed in the first place? This is the same hospital at which, about one and half years earlier, a number of children with thalessemia were infected with HIV, and others acquired hepatitis, through blood transfusion (6)."(pg 70-71)