Deaths attributed to HELLP syndrome
Five mothers with postoperative complications after childbirth are battling for life in Osmania General Hospital. The women were shifted there after they failed to recover at Niloufer Hospital and Sultan Bazaar and their condition deteriorated.
The young mothers are suffering from profuse bleeding, sepsis shock, acute kidney failure and multi-organ complications.
Syeda Fareeda is on ventilator support at OGH and doctors say her condition is very critical. The other patient, 22year-old Samina from Yakutpura, has delivered twins and is suffering from renal failure and multi-organ complications. She is receiving blood transfusions.
Sreelata has also delivered twins and is experiencing heavy, abnormal bleeding, despite medication. It has made her very weak and her condition too is critical.
Sarwar Bee and Leela Vathi are also critically ill. Their blood count has not improved despite blood transfusions. Various diagnostic tests are being carried out to ascertain the cause.
A senior doctor in OGH said, “Three women are having infection which has to be controlled and it will take time. Till then we cannot declare them as stable as there are chances of complications. One of them has been put on a ventilator as her condition deteriorated despite treatment and we are watching how she responds.”
Patient Sreelata’s husband Ramesh explained, “My wife is critical in OGH and they are asking for tests. We have twins and one of them had to be admitted to Niloufer Hospital due to complications. Hence we are running from one hospital to the other.” Maternal deaths in government hospitals are suspected to be due to the HELLP Syndrome, so named after the three main features of the syndrome: Hemolysis, Elevated Liver enzymes and Low Platelet count.
Director of health and medical education, Dr M Ramani, says doctors are trying to evaluate the different causes of deaths and an audit team under Dr Neelima Singh is looking into all these aspects.
“The one thing which we have found in Nayapul Maternity Hospital is that patients are coming at the last minute and there has not been any follow-up done before. No history of check-up in any hospital. A mother who recently died at the hospital came with a blood count of 2.5. Due to this reason we are developing intensivists who will be in maternal intensive care units and will only look after these complicated cases,” Dr Ramani says.
The audit team is also looking into cases of HELLP. In the 11 maternal deaths there were complications like profuse bleeding, acute hepatitis, failure of contraction of uterus muscles, infections, sepsis and shock. Most of the mothers who died were between the ages of 19 and 30 years. In most of the cases, it was the delivery of the second or third child and the complications developed after childbirth.
Of the six lakh deliveries that take place in TS every year, it is estimated that 50,000 women suffer from this syndrome. The onset of this syndrome is sudden and hence post-operative monitoring is important to identify it and act on it.
Dr R. Srivedi, a gynaecologist at Nayapul says, “We are looking at HELLP in those critical cases where we have not been able to identify the exact cause of death. Our aim is to find out why the women went into cerebral shock and what are the early signs that we must look out for.”
All the three government maternity hospitals handle more than 50 deliveries per day. Ten to 12 of these are C-sections and require adequately trained paramedical staff and a special emergency team in case of any complications. The three maternity hospitals do not have such emergency facilities and so if complications do occur, the patient has to be moved to Osmania General Hospital.