Mother succumbed to rare blood clot disorder after stillborn delivery

-preliminary report

Preliminary reports have indicated that Evita Singh, the mother who recently died days after she delivered a stillborn baby by caesarian-section at the Georgetown Public Hospital (GPH), succumbed as a result of disseminated intravascular coagulation (DIC), a rare, life-threatening condition that prevents blood from clotting normally.

This is according to Chief Medical Officer in the Ministry of Health Dr Shamdeo Persaud, who has confirmed that Singh, 34, was forced to wait a while to undergo surgery because the only operating table in the maternity ward was occupied at the time and it took some time to prepare one of the five tables in the main theatre of the hospital.

While relatives of the mother of two are clamouring for answers, the GPH continued to remain silent about her death yesterday. The woman’s family yesterday continued to blame the hospital for her death, which they said was caused by care providers inserting some six Cytotec tablets over a two-day period to induce labour.

DIC is described by online medical sources as a condition in which blood clots form throughout the body’s small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body’s organs, the US National Heart, Lung, and Blood Institute says on its website. It is stated that DIC that develops suddenly usually causes bleeding, which may be very severe. If the condition follows surgery or childbirth, as in the case of Singh, bleeding may be uncontrollable. Bleeding may occur at the site of an intravenous injection or in the brain, digestive tract, skin, muscles, or cavities of the body.

Speaking to Stabroek News yesterday, Dr Persaud indicated that he was notified of the woman’s death on Sunday and he received a preliminary report on Monday morning from the hospital. The report indicated that Singh was being managed for a number of symptoms, including elevated blood pressure.


Due date

While the woman’s mother Chandra Ramjit said Singh’s due date was at the end of this month, Persaud said the report from the hospital indicated that she was 38 weeks into her pregnancy. Yesterday Ramjit said her daughter attended a clinic at Plaisance and the nurses and doctor there had told her that her due date was the end of September. She said they also managed her high blood pressure. She maintained that her daughter was taken to the hospital not because she was in labour but because she displayed symptoms of the Chikungunya virus and her pressure was high.

According to Dr Persaud, a decision was taken to induce labour but subsequently Singh “deve-loped complications” and a decision was taken to perform a caesarian-section. But when the woman was taken to the maternity operating room, a referral patient who was also critical was being operated on. She was then taken to GPH’s main operating theatre but it took some time to prepare the operating table. “They had to move her over and there was some usual challenges but they were finally able to operate on her… she bled extensively and she used up a lot of her clotting factor and she developed disseminated intravascular coagulation,” Dr Persaud said.

The young woman’s parents have complained about her waiting for about 15 minutes before she was operated on and during that time she was bleeding heavily.

Following the woman’s death, Dr Persaud said he and Director of Maternal and Child Health Dr Janice Woolford on Monday met with the hospital staff.

He explained that the usual procedure after a maternal death will be followed and this includes the hospital convening its maternal mortality committee, which, after an investigation, would prepare a report within seven days. This investigation by the committee does not bar Dr Persaud, according to him, from doing his own investigation. Following the investigations a report would then be passed to the national expert committee, which would then decide what went wrong and whether disciplinary actions should be taken and against whom.

“So it is not a one-man something; the national committee would advise me,” Dr Persaud said.

Families of victims of maternal deaths have repeatedly complained that they are never informed of the findings of the investigations.



Asked about the allegations that the woman was administered some six Cytotec tablets, Dr Persaud said from the report he received it appears as if the hospital used the correct dosage although he stated that he could not say how many tablets was given to the woman.

Dr Persaud was questioned on whether the tablet should be used at all as some international experts are advising against its use. But he said that it is a prescription drug and it is being used worldwide. He said that the drug should be used only when prescribed and not be purchased as an over-the-counter drug.

“It is being used internationally… as part of the process to induce labour to help patients to dilate and create a passage for the baby,” he said.

But according to the DailyMed, a website that provides high quality information about marketed drugs, Cytotec or misoprostol as the drug is known as, can induce or augment uterine contractions. It said that vaginal administration of the drug, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labour and for treatment of serious postpartum haemorrhage in the presence of uterine atony. It said that the use of Cytotec outside of its approved indication may also be associated with meconium passage, meconium staining of amniotic fluid, and Caesarian delivery. Maternal shock, maternal death, fetal bradycardia, and fetal death have also been reported with the use of misoprostol.

“The effect of Cytotec on later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labour has not been established,” the website said.

Singh’s mother said when the woman informed her that she was being administered the drug, she asked the nurse why the tablet was being used as she was told that it was not good and had severe side effects. The doctor was standing close by and the nurse immediately told him what the mother had said.

“The doctor turn and say they have more doctors outside than inside, meaning that I playing a doctor. I just shut up and move away because I didn’t want them ill treat me daughter,” the woman said.

She noted that her daughter was in a lot of pain and bleeding, hours before a decision was taken to have the caesarian-section and this she said was wrong. “They kill me child. It is cold-blooded murder,” the woman cried again yesterday, while pointing out that since Saturday night when they received the news of her daughter’s death the hospital has made no effort to contact the family.

She explained that her daughter was the mother of two children-ages 13 and six-both of whom she delivered normally at the GPH. As a result, she had confidence in the hospital. Even though she was advised to go to a private hospital, Ramjit said her daughter insisted she be taken to GPH. “I know we would get no satisfaction but we would not stop speaking. Let other young mothers see and read about this and know what they have to do…” the woman said.