Obstetric complications: Don't blame it on accident
Three of the deaths (in Ho Chi Minh City, Hung Yen and Dong Nai) were attributed to amniotic fluid embolism, a complication that is difficult to treat even abroad. However, reviewing the records of obstetric complications in recent times shows that it was not entirely accidental.
Heartbreaking endings
In the report dated May 3, 2012 sent to the Ministry of Health about the death of mother and child of NTMH (39 years old) admitted to Quang Ngai General Hospital on April 21, it was shown that at the time of admission, apart from vaginal bleeding, the health of mother H. was completely normal. The diagnosis at the time of admission was 36 weeks of pregnancy, threatened premature birth, preeclampsia/five-year old surgical wound.
After being admitted to the hospital for a day, the pregnant woman H. was still conscious. But about four hours later, at 0:35 on April 23, the patient had a headache, dizziness, high blood pressure and pulse, severe pre-eclampsia. At 5:00 on April 23, the pulse and blood pressure continued to increase. At 5:30, the blood pressure continued to be high, the fetal heartbeat was difficult to hear, the surgical wound was painful, the on-call staff unanimously diagnosed a ruptured old surgical wound, pre-eclampsia threatening eclampsia.
The mother was transferred to a cesarean section 20 minutes later, resulting in the birth of a baby girl weighing 1,700 grams, gasping for breath and dying after five minutes of resuscitation. The baby's mother was diagnosed with uterine rupture along the old surgical wound, bladder rupture, cervical tear, vaginal tear, severe preeclampsia and died on April 30.
Looking at the photo of Mr. BAC - the husband of NTTT (in Thong Nhat district, Dong Nai) holding his newborn son who had lost his mother, it was hard for anyone to hold back their tears. Previously on May 2, T. gave birth to a son at Dong Nai Rubber Hospital and died later due to hemorrhage, prolonged blood loss and failure to recover.
According to the conclusion of the Dong Nai Department of Health's professional council, while giving birth, the woman had complications causing blood loss. If treated promptly, the bleeding would have stopped and death could have been avoided. However, when the complication occurred, the patient's family was asked to run... to buy blood a few kilometers away!
In early May 2012, during the most recent ultrasound before giving birth, Ms. NTH (25 years old, Hanoi) received the prognosis results from the obstetrics hospital in Hanoi: her baby would weigh 4kg.
With a moderate build, the family was sure she would have to wait for a cesarean section. However, the doctor ordered a natural birth. The labor process began to encounter difficulties when the baby's head was too large to fit into the mother's pelvis. When trying to deliver the baby, the heavy newborn's shoulder tried to stretch out but got stuck and... broke. The post-birth results showed that the baby actually weighed 4.8kg, the doctor's medical record stated "broken due to large shoulder".
Is a safe labor for both mother and child too difficult in this era of advanced medicine? - Photo: TTD
Mainly takes place at night
According to statistics from the Department of Maternal and Child Health Protection (Ministry of Health), the maternal mortality rate per 100,000 live births in Vietnam is at 69 cases per 100,000 live births. Compared to 2002, this rate has decreased sharply (in 2002 it reached 165 maternal deaths per 100,000 live births). But Vietnam is still the country with the highest maternal mortality rate in the world. Why is that?
Is it due to lack of money?
According to many experts, due to the rugged terrain, lack of primary health care, and backward highland customs, people wanting to give birth in the forest or at home has caused the rate of obstetric complications in many regions to be high.
Ms. Luu Thi Hong, Deputy Director of the Department of Maternal and Child Health Protection (Ministry of Health), said that from 2009 to now, the budget has been spent on nine contents, of which safe motherhood and reproductive care contents are only a few hundred million VND/locality/year. However, there are opinions that the unreasonable, even backward, arrangement of human resources and shift assignment of the Vietnamese health sector, and the weakness of the primary health care system are the main factors leading to such a high number of medical accidents, especially obstetric accidents.
Rare accidents are common in Vietnam.
In fact, many obstetric complications that were once quite common have now gradually disappeared thanks to the development of modern medicine, but bleeding complications have emerged and recently the reason hospitals use to "explain" the cause of maternal and child deaths is sudden amniotic fluid embolism... There has been an opinion: "Amniotic fluid embolism is a rare complication, but it is common in Vietnam"!
According to the millennium goals, Vietnam is trying to reduce to 59.3 maternal deaths/100,000 live births by 2015, while Malaysia has reduced to 46 deaths/100,000 live births.
A 2011 survey by the Ministry of Health at 30 affiliated hospitals (including 27 special and first-class hospitals) showed that 93% of the surveyed hospitals were on duty 24/24 hours, allocating human resources mainly during the day. At this time, on average, a nurse had to directly care for 6.5 patients, but a nurse working at night had to care for 23 patients.
“The above distribution shows that the patient/nurse ratio is too high, leading to work overload, especially in emergency departments, oncology departments, and night care, which is unsafe for both patients and medical staff,” the report said. And perhaps coincidentally, most obstetric complications that occurred in the past month mainly occurred at night.
"From now until the end of the year, not many will die"!
The unprecedented answer above was from an official of the Department of Maternal and Child Health, Ministry of Health, when asked about the reason for the recent surge of obstetric complications. According to this official, the recent deaths must be attributed to mistakes from both sides: the hospital and the pregnant woman.
“Do you know that the mothers who died were all giving birth to a third child, the first two were girls, and they tried to have a third child? The mothers were also at fault, but we don’t want to talk about it because of sensitivity. The hospitals were also at fault, but they were small mistakes. Don’t ask where the cause was, or who caused it. That point of view is not constructive,” the official said calmly.
According to a survey conducted at 30 hospitals by the Ministry of Health, there are many professional errors that are considered normal in hospitals. Among them, patients' relatives are being "given" the responsibility of taking care of patients, including professional tasks such as changing IV bottles, squeezing balloons, feeding through catheters, while carelessness due to lack of expertise can lead to accidents for patients.
Looking back at the reports on maternal and child deaths in the past month, the most noticeable thing is the lack of accountability. People only see a “nice” report: the hospital has fulfilled its responsibilities and the patient’s death was unexpected. The things people want to see, such as whether there was a delay in diagnosis and treatment, which stage, which shift was responsible, why… are completely absent.
It is very difficult to determine responsibility in medical accidents in general and obstetric accidents in particular, except for an independent, strong and specialized professional council to evaluate, but it is difficult to have such a council!
The Law on Medical Examination and Treatment, which took effect in 2011, stipulates that hospitals purchase occupational insurance for doctors, and will eventually have independent third-party boards to determine the responsibilities of the parties, but so far no hospital has implemented it. The reason being mentioned is still money. But safety and responsibility to patients have not been mentioned.
- According to Tuoi Tre - H
