Controversy over real cause of Chiamaka's death
Controversy over real cause of Chiamaka’s death
Following the gruesome death of 24-year-old Chiamaka De-Freitas after a Caesarian Section (CS) at Medical Art Centre, Lagos (MART), an autopsy have indicated cause of death to concealed haematoma (collection of blood), which may have presented due to bladder injury sustained during the CS.
The autopsy, signed by Consultant Pathologist at the Lagos State University Teaching Hospital (LASUTH), Dr. Francis Faduyile, stated that Chiamaka died from haemorrhagic shock and concealed haematoma (collection of blood) following a CS).
The report also stated that Chiamaka had sustained a large bladder injury (4cm) during the CS, which was stitched up with four vicryl sutures. “There is a horizontal laceration on the anterior wall measuring 4.0cm and is held together by four vicryl sutures.
“The urinary wall is covered by haematoma. The urinary bladder contains 50ml of clotted blood,” the repot noted. On how a bladder could get such cut during a pelvic CS remains a puzzle that a medical expert tried to explain.
A Consultant Gynaecologist at the Lagos University Teaching Hospital (LUTH), Dr. Kehinde Okunade, while providing an insight, said the commonest cause of concealed bleeding or blood collection after a CS delivery is broad ligament haematoma, a condition he said usually results due to the inadvertent (accidental) extension of incisions made in the womb to its angles, thus causing a severance of the uterine artery either on one side, or very rarely, to both sides.
“The bleeding may get concealed within the broad ligament space and in most cases, will stop on its own or on rare occasions, may require a secondary surgery, especially if the patient is going into a state of shock,” he said.
According to him, an inexperienced doctor can physically cause the bleeding through surgical errors or through the use of instruments, such as forceps or vacuums.
“Bleeding as a result of lacerations or tears to genital organs can occur from the use of obstetric instruments, such as forceps and ventouse, but this usually occurs in the hands of untrained or inexperienced medical personnel,” he explained.
Okunade, who is also the Secretary, Society of Gynaecology and Obstetrics of Nigeria (SOGON), Lagos chapter, said concealed haematoma is a blood collection within any space in the body that may or may not become clinically obvious.
“There are various reasons why a woman who recently had caesarean delivery can bleed internally. This may be regarded as post-operative haemorrhage. This bleeding can be classified as reactionary or secondary haemorrhage.
“The one that can occur immediately within the first 48 hours of surgery is reactionary haemorrhage, and this usually occurs as a result of the loosening of stitches used to stop bleeding from blood vessels at the initial surgery.
“It may also be because of a sudden increase in the blood pressure of the patient, which may subsequently result in increased blood loss, which may otherwise not be obvious at the time of surgery.
“The other entirely pregnancy-related reason for any form of bleeding after a caesarean delivery is postpartum haemorrhage (PPH), and if this occurs within the first 24 hours after delivery, it is called primary PPH.
“The commonest cause of this is what we called uterine atony, which is the inability of a womb to regain its ability to contract and thus stop bleeding from vessels that open into its inner surface.”He continued: “Another important cause of this, which may even be a commoner reason for internal bleeding after surgery, is laceration or tear in any part of the genital tract that may not be readily obvious or recognised at the time of the initial surgery.
“When such bleeding becomes clinically obvious, the patient may present with features of anaemia or hypovolaemic shock.”It would be recalled that Chiamaka, an indigene of Imo State, died on March 24 after giving birth.
Following the gruesome death of 24-year-old Chiamaka De-Freitas after a Caesarian Section (CS) at Medical Art Centre, Lagos (MART), an autopsy have indicated cause of death to concealed haematoma (collection of blood), which may have presented due to bladder injury sustained during the CS.
The autopsy, signed by Consultant Pathologist at the Lagos State University Teaching Hospital (LASUTH), Dr. Francis Faduyile, stated that Chiamaka died from haemorrhagic shock and concealed haematoma (collection of blood) following a CS).
The report also stated that Chiamaka had sustained a large bladder injury (4cm) during the CS, which was stitched up with four vicryl sutures. “There is a horizontal laceration on the anterior wall measuring 4.0cm and is held together by four vicryl sutures.
“The urinary wall is covered by haematoma. The urinary bladder contains 50ml of clotted blood,” the repot noted. On how a bladder could get such cut during a pelvic CS remains a puzzle that a medical expert tried to explain.
A Consultant Gynaecologist at the Lagos University Teaching Hospital (LUTH), Dr. Kehinde Okunade, while providing an insight, said the commonest cause of concealed bleeding or blood collection after a CS delivery is broad ligament haematoma, a condition he said usually results due to the inadvertent (accidental) extension of incisions made in the womb to its angles, thus causing a severance of the uterine artery either on one side, or very rarely, to both sides.
“The bleeding may get concealed within the broad ligament space and in most cases, will stop on its own or on rare occasions, may require a secondary surgery, especially if the patient is going into a state of shock,” he said.
According to him, an inexperienced doctor can physically cause the bleeding through surgical errors or through the use of instruments, such as forceps or vacuums.
“Bleeding as a result of lacerations or tears to genital organs can occur from the use of obstetric instruments, such as forceps and ventouse, but this usually occurs in the hands of untrained or inexperienced medical personnel,” he explained.
Okunade, who is also the Secretary, Society of Gynaecology and Obstetrics of Nigeria (SOGON), Lagos chapter, said concealed haematoma is a blood collection within any space in the body that may or may not become clinically obvious.
“There are various reasons why a woman who recently had caesarean delivery can bleed internally. This may be regarded as post-operative haemorrhage. This bleeding can be classified as reactionary or secondary haemorrhage.
“The one that can occur immediately within the first 48 hours of surgery is reactionary haemorrhage, and this usually occurs as a result of the loosening of stitches used to stop bleeding from blood vessels at the initial surgery.
“It may also be because of a sudden increase in the blood pressure of the patient, which may subsequently result in increased blood loss, which may otherwise not be obvious at the time of surgery.
“The other entirely pregnancy-related reason for any form of bleeding after a caesarean delivery is postpartum haemorrhage (PPH), and if this occurs within the first 24 hours after delivery, it is called primary PPH.
“The commonest cause of this is what we called uterine atony, which is the inability of a womb to regain its ability to contract and thus stop bleeding from vessels that open into its inner surface.”He continued: “Another important cause of this, which may even be a commoner reason for internal bleeding after surgery, is laceration or tear in any part of the genital tract that may not be readily obvious or recognised at the time of the initial surgery.
“When such bleeding becomes clinically obvious, the patient may present with features of anaemia or hypovolaemic shock.”It would be recalled that Chiamaka, an indigene of Imo State, died on March 24 after giving birth.
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