Republic of the Philippines

City Government of Tacloban

Tacloban City
-o-
CITY HEALTH OFFICE

Neonatal Death Investigation Report

INTRODUCTION:

Hypoxic-ischemic encephalopathy (HIE) is a type of brain damage caused by insufficient

oxygenated blood flow during or near the time of birth. Terms that are sometimes used as
synonyms for HIE include birth asphyxia and neonatal encephalopathy.
There are many potential causes of HIE, including high-risk pregnancy conditions, labor
and delivery issues, and medical mistakes. Usually, HIE can be prevented through careful fetal
monitoring and timely intervention in response to complications. However, medical
professionals may miss opportunities to prevent HIE, or perform negligent actions that cause
HIE.
It is estimated to occur in about 1.5 per 1,000 live births, although this estimate may be
imprecise. It accounts for 23% of neonatal death worldwide, and babies that survive may
develop cerebral palsy (CP), intellectual and developmental disabilities (I/DDs), epilepsy, and
many other associated conditions.

MATERNAL INFORMATION:

General Information

Name: MJP
Age: 37 years old
Civil Status: Single
Educational Level: Highschool Level
Occupation: Housewife
Insurance Coverage: Philhealth
Socioeconomic Status: Middle Class

Medical History:

History of chronic illness, allergies, asthma & hypertension: with history of asthma and
gestational hypertension on the 5th and last pregnancy
History of operations and hospitalizations: None
Smoker: None smoker and never smoked
Alcohol Intake: Drinks alcohol occasionally
Assess Nutritional Status: Obesity due to eating unhealthy food; daily consumption of pork and
chicken every meal and canned goods.

Obstetric History:

OB Score: G6 P6 T6 A0 L5

Year of Type of Place of Attendant Complications Outcome Alive Remarks

Delivery Delivery Delivery at Birth of (yes/no) (if baby
(start Pregnancy died put
with first age at
child) death
and
cause of
death)
08-26-04 NSVD Tagbilara Doctor None Female Yes
n City
Hosital
07-05-05 NSVD Mangagoy Doctor None Male Yes
Surigao
Hospital
06-23-08 NSVD Mangagoy Doctor None Male Yes
Surigao
Hospital
06-03-11 NSVD Tagbilara Doctor None Female Yes
n City
Hospital
09-20-16 NSVD EVRMC Doctor Asthma attack Male Yes
and
Gestational
Hypertension
03-11- NSVD EVRMC Doctor Asthma attack Female No
2019 and
Gestational
Hypertension,
Obesity

Prenatal History:

# of prenatal visits: 6 Prenatal visits at San. Pio Birthing Clinic Brgy. 105 Purok 5
Laboratories: CBC, U/A, 3 times UTZ during course of pregnancy
Medications/vitamins taken during the pregnancy: Prenatal vitamins ( FeSO4+FA)
# of postpartum visits: no followup checkup
Labor and Birth History (based on mother’s recollection):

As per mothers recollection, prior to the day of delivery, she experienced 2 days labor at
home. In the morning of the following day she decided to go to a private birthing clinic where
she had her prenatal checkups for admission and delivery because she was experiencing labor
pains. During assessment of the primary health care on duty her blood pressure was elevated.
As a first aid to her current situation the healthcare provider gave a medication sublingually to
lower her blood pressure twice as medical management. However, despite of the intervention
given her blood pressure was still elevated. Hence, she decided to seek further medical
management and evaluation on the afternoon of the same day at Eastern Visayas Regional
Medical Center (EVRMC). When she arrived at the said facility she was admitted at the
Reproductive Health and Neonatal Care of EVRMC. She delivered a baby girl via NSVD at 6Am
of March 11,2019.

Chronology of events: (Bigen with initial complaint and record until death)

During admission at the Emergency room the resident on duty assessed and advised her
to be admitted at the hospital because she was having true labor and will delivered her baby
soon. When she was at the hospital doctor performed an internal examination (IE) many times
that she cannot remember how often it was just to check the progress of her labor. On the night
of March 10,2019 at 8pm the doctor performed again an internal examination where the doctor
told her as verbalized by the mother “kayano mo ako ginihian?” and she relied saying “waray
man ako umihi doc”. After that, she noticed that her diaper gets soaked immediately even
though she was not urinating. However, she was afraid to inform the doctor about her concern
because as she verbalized “nagiinisog an doctor ky damo an mga pasyente”. Because of the
thinking she might be yelled too by the doctor she kept silent until 6 am of March 11, 2019 she
called the attention of the doctor and other medical staff that her baby was coming out. On that
event while she was delivering her baby, a medical staff performed a fundal push to help the
baby comes out. And when the baby was out, she noticed the baby did not cry. As the
immediate response of the medical staff, the newborn was brought immediately at the ICU. But
prior to that she was able to had “Unang Yakap” with her newborn child. The next day, her SO
was called by a doctor and she thought that the baby will be brought to her for breastfeeding.
Unfortunately it did not happen, because when the SO returned she announces the death of her
newly born child.

Baby and mothers condition

When the newborn was delivered, she did not cry and was brought at the ICU. On the
next day, the doctor announces that the newborn child was dead. However, the mother’s
condition was stable. After 3 days at the hospital, she was discharged without any
complications.

Actions Taken (Treatment, medicines)

The day that the mother was discharge, there were medicines that was given to her that
was written at her “Tagubilin”.
 Co-Amoxiclav 625mg/tab 3 x a day for 3 days
 Methyldopa 250mg/tab 2 x a day for 2 weeks
 Tramadol 500mg/tab 3 x a day for pain
 Ferrous sulphate once a day for 3 months
A followup checkup on March 19, 2019 @ 8 AM

Place of death : Eastern Visayas Regional Medical Center

Date of death : March 12, 2019
Cause of death : Hypoxic Ischemic Encephalopathy

Analysis and Findings

Proper referral system plays a vital role in every health facility. It ensures that the patient
will receive the best possible care or treatment she/he can get. Some facility may overlook this
because of personal interest that they don’t even think the welfare of their patients as long as
they can get something to them. Like for instance to this patient, that she gave her trust to the
personnel she knew at the birthing clinic. She had her prenatal check-ups there even if she had
her prenatal checkups at the barangay health center on her previous pregnancy, thinking that
her friend will ensure the safety of her unbornchild. But unfortunate things happen.
As to my recommendation, the city government should ensure that every birthing clinic is
following rules in properly operating there businesses. And that there should be seminars or
orientation to private health practitioner on how to manage and refer their patient.

Prepared by:
Japhet A. Gonzales - NDP

Noted by:
Mel Tirso G. Maravilles