Originator: midwife@fensende.com
From: MMadrona@aol.com
Date: Mon, 7 Sep 1998 15:38:12 EDT
To: Birthmuse@aol.com, Keg504@aol.com
Subject: Re:    CDC: Maternal Deaths Remain Steady
From morgaine mehl madrona

PS we had a maternal death anesthesia related here in VT that was not reported as maternal death.  Mother 2nd babe, was having planned repeat cesarean, they attempted to do an epidural, could not get it in, not uncommon.  The doctor cursing that she seemed to have some anomally in her spinal development (hint). So they put her out...and began to intubate....low and behold she had some anomaly of her trachea so that they could not intubate....so they frantically attempted a tracheotomy and cut through her carotid artery while doing the tracheotomy as she had another "anomaly" causing her carotid artery to cross her throat at the exact spot where they cut for the tracheotomy, she was brain dead within minutes as blood shot up to the ceiling. They kept her on life support for more than 2 weeks..... she was not listed as a maternal death. (Does it come to any ones mind that this mother might be here today if she had planned a vbac - first baby was a breech, this one vertex) 


From: "Cunningham" <MidwifeCare@cpros.com>
To: <midwife-digest@fensende.com>
Subject: re:maternal death/planned hb but death in hospital
Date: Tue, 9 Dec 1997 00:16:46 -0800

I know of the birth/death of which you speak. The woman was postdates. I do believe there was prolonged ROM and that castor oil was tried but producing no labor.

I never attended as labor never got established at home. She was transported. She received pit at the hospital which got labor going. She did deliver vaginally and lived long enough to name her son. She soon started hemorrhaging which could not be stopped. She was taken to surgery for a hysterectomy which is where she died. She had an amniotic fluid embolism. I would imagine the stats would reflect that it was a hospital death, but I don't know anything from that end of the experience. I don't believe that the attending midwife does either. I do not believe that this was put in the papers at all except for the obituary.


Date: Fri, 17 Oct 1997 15:12:12 -0500
From: dahmd <dahmd@gate.net>
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Subject: Re: Death after C-Section
Comment: list for discussion of obstetrics and gynecology

Kunto Raharjo wrote:

> 4 hours post op patient become dyspneic, shocked, and then arrested.  CPR revived her, with good BP and SaO2 but she arrested again after 40 minutes, and then started to develop DIC and died.>  Any advice on possible cause?


This sounds like my last case of amniotic fluid embolism (except mine developed intrapartum and despite 3 different rounds of CPR, an emergency hysterectomy, and a few days in a coma actually lived and is thankfully doing well).  DIC usually develops with amniotic fluid embolism.  The overall mortality rate is about 80%, with over 1/2 of these patients dying immediately.  My understanding is that meconium, and perhaps thick vernix, makes treatment more difficult.  Even with rapid intubation and CPR the mortality rate is high.  I'm sure everyone did the best they could. 

Other causes would be emboli from cardiac vegetations (I had a patient die from this once, after sitting up in bed and saying "Dr. H..., I think my heart's going to stop"), regular pulmonary emboli, or cardiac arrest (which I would think unlikely).

D. Ashley H., M.D.        


Date: Sat, 24 May 1997 08:05:05 -0500
Sender: ob-gyn-l@obgyn.net
From: rbraun@indyunix.iupui.edu
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>

Subject: Re: gangrenous necrosis of uterus after cesarean

On Thu, 22 May 1997, Ed Miller, MD wrote:

> Has anyone ever heard of gangrenous necrosis and rupture of the uterus 10 days after a cesarean, leading to maternal death? This patient had her left uterine artery ligated because of its being torn, and this patient never once had a fever!! She didn't see any doctors in the 3 days before her death.  Has anyone ever heard of metritis without a fever?


I have had a similar case. She was an RN who turned out to have clostridial endomyometritis. She came to ER on PO day number 7 with abdominal pain and purulent discharge. On KUB, she had gas bubbles in the uterus. She was taken immediately to the OR for hyst. At induction of anesthesia, she went into shock and never got off the table alive. Cultures showed clostridium welchii.

R. Daniel Braun, MD FACOG  Clinical Professor OB/GYN  
Indiana University School of Medicine, Indianapolis,IN                                                          @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

Date: Mon, 6 Apr 1998 22:06:42 -0500
Sender: ob-gyn-l@obgyn.net
From: cougar1965@juno.com (William J Faulkner)
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Subject: Re: Balloon in lieu of cytotec

>R. Daniel Braun, M.D. wrote:
>I am aware of one case of clostridial  sepsis and death secondary to its use. [use of foly catheter ballon to mannually dilate the cervix]


I suspect that we could find a case of Clostridial sepsis and death secondary to "stripping the membranes", or with EASI  as well.  As we all know  "meconium happens"

Regards, Will

From: MMadrona@aol.com
Date: Sun, 6 Sep 1998 22:12:22 EDT
To: Keg504@aol.com
Cc: midwife@fensende.com
Subject: Re:  Maternal Deaths Remain Steady 

 In a message dated 9/6/98 2:34:09 PM, Keg504 wrote:

What is an anesthesia death? Is that from malignant hyperthermia? Allergic reaction? Respiratory distress?


epidural anesthesia deaths

* cardiac arrest (if not immediate death, brain damage and respiratory failure can lead to life support-which if maintained 2 weeks then the death is likely to be reported as a death from anesthetic complications.)

* anaphalactic shock from reaction to the medication which also result in delayed death-cause of death allergic reaction to anesthesia

* profound hypotension causes brain damage-delayed death could also fail to be reported as maternal death...

*rare complication called....uncalherniation-when the brain comes down through the foramen magnum into the spinal column and causes death....a rare complication caused by accidental dural puncture which occurs in .3 to 4.2% of epidurals. This could also result in life support/delayed death and failure to report as maternal death.

other anesthesia deaths. ie general anesthesia.....

* cardiac arrest, * profound hypertension, * failure to intubate, * anaphalactic shock, 

IV analgesia same risks....all of which can resu

GAIL Hart....appeared to disagree that maternal deaths due to anesthesia are not reported as maternal deaths...quoting the maternal death registry in the UK..which i did mention that this problem does not exist in the same way in UK and other European countries for that reason...here in the US the CDC does track them? but the underreporting is not pursued......Lewis adds..."I've worked in hospitals and have seen this done.  No hospital wants a maternal mortality.  Life support is used until necessary to avoid reporting.  It's not just an issue of looking good, but also of malpractice prevention in some people's minds.  The fact that maternal mortality has not changed in 15 years in the US, suggests to me it is probably on the rise, and probably related to the increasing use of cesareans and regional anesthetics.  In 1987, for example, 25-100 avoidable maternal deaths occurred related to unnecessary cesareans."