Petitioner:	Respondent:
Specialty: Obstretics & Gynecology	Jurisdiction: Original
State: Delhi	District: New 11

Anjana Mishra 23 yrs old primigravida admitted on 12.04.93 at MCKR Hospital as a case of postdated pregnancy (40wks+3days), for induction of labor. Examination by the treating consultant detected a Fetal Heart Rate (FHR) of 110/mt and Non-Stress Test (NST) tracing showed decreased variability. Artificial Rupture of Membranes (ARM) was done which revealed frank meconium stained liquor. Patient underwent an emergency Lower Segment Cesarean Section (LSCS) under General Anesthesia in view of postdated pregnancy with fetal distress. During surgery, more than average bleeding and oozing from operative sites were observed and patient had an episode of hypotension in the immediate post-operative period. Patient was reintubated and managed in the ICU with ionotrops, I/V fluids, blood replacement and transfusion of blood components alongwith broad spectrum antibiotics. Patient became hemodynamically stable after fluid and blood replacement, but developed epistaxis with deranged coagulation and liver functions. She was managed by a team of doctors including consultations by Cardiologist, Hepatologist, Gastroenterologist, Nephrologist, Neurologist and Otorhinolaryngologist as and when indicated. With Possible septicemia setting in, there was progressive deterioration of liver and renal functions and altered coagulation parameters. She was managed with blood component therapy, ventilator support and hemodialysis as and when required. Subsequently multisystem dysfunction and Disseminated Intravascular Coagulation (DIC) rendered the patient unresponsive to therapy and she could not be revived from the cardiac arrest which occurred on 22.04.1993. A summary of sequence of events: • LSCS for postdated pregnancy with fetal distress. • Postoperative hypotension requiring ventilator support and ICU stay. • Fluid replacement, blood transfusion and blood component therapy for correction of her hemodynamic instability. Possible septicemia, progressive liver and renal dysfunction, DIC, multisystem failure, not responding to supportive Myocardial dysfunction and cardiac arrest 10 days after surgery from which the patient could not be revived.