1

THE SILENT CRY

Dr. Pushpa Nusair

Assist. Professor

Obstetric and Gynecology

Department of Medical Sciences

College of Medicine Nursing and Health Sciences

Fiji National University

2

Outline

1. A case study : An unbooked mother

2. Audit of unbooked mothers at CWM hospital

(maternity Unit) from 2010 to June, 2013

3

Introduction

• Global statistics

• Developing countries studies

•Local: None located

4

Case Study

5

Case study

• Name: MS

• Age: 32 years (December, 1979)

• Ethnicity: iTaukei

• Marital Status: Single

• Gravida 2, Para 1

• Social background: living with parents/disabled mother

6

Case Study

• Had a previous cesarean delivery in May, 2011

• Presented on 26/12/12 at 00:35 hours

• Delivered to a very foul smelling fetus (birth weight : 3.2 kg),

and placenta infarcted 400g

• Denied sexual intercourse

• Refused to acknowledge her pregnancy

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Case Study

• All bloods including coagulation and blood cultures

• Broad spectrum antibiotics

• Awaiting coagulation profile

• Collapsed midday informed by nurse

• Active resuscitation ABC

• Anesthetic and medical informed

8

Case Study

• D.I.C

• Intensive care unit jointly managed by obstetrics, anesthetics

and medical

• Massive blood transfusion, FFP and Cryo

• Multi-organ failure and irreversible D.I.C

• Despite all measures, patient DIED on 26/12/12 at 11.30pm

9

AUDIT

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Methods

1. Descriptive audit

2. Yearly stats: 2010 - June, 2013

3. Monthly stats :

• 2012 (Oct - Dec)• 2013 (Jan – June)

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Methods

Characteristics of unbooked mothers:

1. Age

2. Ethnicity

3. Marital status

4. Gravida

5. Parity

6. Gestation

7. Mode of delivery

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Results

00.20.40.60.8

11.21.41.61.8

1.6

1.31.4

2010 2011 2012

150/9187

99/7920 118/9187

Percentage of unbooked mothers at CWM Hospital, Suva, Fiji

%

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ResultsPercentage of unbooked mothers by ethnicity

%

Fijian (iTaukei) Fijians(Indians) Fijians(Others)0

10

20

30

40

50

60

70

80

90

10088

9.32.7

79.8

7.113.1

78

14.47.6

201020112012

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ResultsPercentage of unbooked mothers by ethnicity and month

%

Oct'12 Nov'12 Dec'12 Jan'13 Feb'13 Mar'130

1

2

3

4

5

6

7

2.4

3.3

2.2

2.9

1.2 1.1

0

0.91.7 0.8

1.7

0.7

2.9

0

2.22.9

0

1.8 Fijians(Others)Fijians(Indians)Fijian (iTaukei)

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Unbooked mother for Oct-Dec 2012 by age groups

Oct Nov Dec0

1

2

3

4

5

6

7

8

9

10

18-2425-3233-49

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Marital Status of unbooked mothers between Oct-Dec 2012

Oct Nov Dec0

2

4

6

8

10

12

Married

Single

Defacto

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Gravidity at Parity of unbooked mothers from Oct-Dec 2012

Oct Nov Dec0

2

4

6

8

10

12

14

16

>G4

G2

Primp

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Conclusion

•How do we hear the silent cry?

•What can we do for these women?

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Thank You!