Use of a qualitative case study to learn lessons from severe preeclampsia causing a maternal near-miss: a case report

• Main Authors: Moti Tolera, Alula M. Teklu, Abdurahman Ahmed, Abdiwahab Hashi, Lemessa Oljira, Zerihun Abebe, Wondimagegn Gezahegn, Kahasse Gebre Kidan
• Format: Article
• Language: English
• Published: BMC 2018-09-01
• Series: Journal of Medical Case Reports
• Subjects: Maternal near-miss; Maternal complication
• Online Access: http://link.springer.com/article/10.1186/s13256-018-1821-x

Abstract Background Maternal mortality is a critical indicator in assessing the quality of services provided by a health care system. Approximately 99% of all maternal deaths occur in developing countries; where a majority of the causes of these deaths are preventable. Case presentation A 25-year-old, married, multigravida, black woman who has had six live births presented to a health center with the chief compliant of abnormal body swelling of 2 days’ duration and loss of consciousness. On arrival to the first contact health center her blood pressure was 170/105 mmHg and her temperature was 36.5 °C. She had generalized swelling, a history of blurred vision, and headache. She had no history of abortion, stillbirth, and cesarean section and no history of antenatal care follow-up. She gave birth to her previous children at home with no history of obstetric complications. The gestational age at the time of arrival was 37 weeks. She was referred to a general hospital for further management. At the general hospital she was diagnosed as having severe preeclampsia and she was managed with magnesium sulfate and an antihypertensive medication for 2 days. She was counseled to have induction of labor by the attending physician but refused to give consent and went home. She returned to the referral hospital 2 days later after labor had started spontaneously at home and the delivery was a spontaneous vaginal delivery with outcome of a live male baby, his Apgar score was 6/10 immediately after birth and he weighed 1.9 kg. Conclusions If there were no previous obstetric problems, the women perceived that she will not face complications in her future pregnancies and stay home until she had developed life-threatening complications. If women visit health facilities and if the health care providers are responsive and there is robust referral in place, maternal and fetal complications will be prevented.