THE SILENT CRY Dr. Pushpa Nusair Assist. Professor Obstetric and Gynecology Department of Medical...
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Transcript of THE SILENT CRY Dr. Pushpa Nusair Assist. Professor Obstetric and Gynecology Department of Medical...
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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
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Case Study
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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
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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
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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
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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!