Reflecting on a maternal death

While it's fresh, I wanted to post on an important but unpleasant topic. In the U.S. we do a pretty good with average maternal deaths around .01%. One of the top causes is maternal bleeding during labor & delivery. But it can also happen prior to labor due to improper implantation of the placenta.

In this case, the OB/Gyn group I worked with thought their patient had placenta previa where, by ultrasound, the placenta can be seen covering some of the cervix. This is a concern for bleeding but very rarely leads to a fatality. However, this patient had placenta acreta, where the placenta is implanted deep into the uterine muscle and its vasculature. There is currently no test or exam that diagnoses this condition. However, if placenta acreta is found incidentally, delivery is usually scheduled as early as possible (36-37 weeks) before contractions start.

This young lady of 28 was close to term with her second child. Previa bleeding was a concern at prenatal office visits, but she hadn't reported even any spotting. When she was admitted it was estimated that she'd lost almost half her blood volume. This was at 8am, not long after I had left Dr. Mourad in a C-section that ended my 7pm to 7am shift. He and ten or so other physicians from his group and perinatalogy rushed and frantically tried to get blood products into her hypotensive body, but could never gain on her profuse blood loss.

Resuscitation was attempted until 11am when the death of mother and child was called. I arrived that evening as scheduled at 7pm to find the entire labor & delivery unit in grief. Not tears, no one present at the bedside was still around, but real sadness from everyone coming on hearing the news like I did.

I talked to and overheard conversations from many nurses and several attending physicians from my group. I also heard from other physicians who made up a committee investigating the incident. My group even requested that the case be reviewed by an outside group of physicians (OB, perinatology and anesthesia) at a different hospital.

It sounds like the findings will be some minor procedural changes (chain of command, blood product availability) but nothing that would have changed the outcome. Now a five year old is left to be raised by his grandmother surely grieving for her daughter and unborn grandchild.

The whole case was an educational experience to go through, even from the outside. It showed a lot of care, humility and professionalism from my attendings. I don't look forward to experiencing my patient's death, but I feel a little more prepared for handling such an event.