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Table 7 Example of missed opportunities linked with sepsis and postpartum haemorrhage

From: Afghan migrants face more suboptimal care than natives: a maternal near-miss audit study at university hospitals in Tehran, Iran

Case 3

A 24-year-old Afghan mother, 3P, was admitted to hospital one week after home delivery with long-lasting bleeding, weakness, and high fever. She was in pre-shock status and the reported haemoglobin level was 5.6 g/dl. She was resuscitated with blood transfusion and was treated with intravenous antibiotic due to postpartum endometritis. Ultrasound examination was done after three days and retained placenta was detected. Fever went down after evacuation and curettage and she chose to leave the hospital before doctor’s recommendation. She was interviewed afterward and said that the family could not afford the cost of hospital obstetric services.

Care items

Audit findings

Initial assessment

Despite home delivery and the risk of retained placenta, history taking and initial examination of uterus cavity were incomplete.

Recognition

Delayed recognition of retained placenta in a mother with anaemia and postpartum endometritis was identified.

Care plan

The management of postpartum endometritis and retained placenta were inappropriate.

Documentation

Previous obstetric history and risk of postpartum haemorrhage, antenatal visits and delivery process at home for index pregnancy were not documented.

Preventability

The near-miss events could have potentially prevented by affordable safe childbirth (health system) and timely care-seeking (patient). Hospital care was also suboptimal.