Hospital at odds over cause of death

 Authorities have drawn different conclusions about the death of a pregnant woman at Nopparatrajathanee Hospital.

While the hospital said Nam-oy Tumthab, 22, died early on Sunday from "amniotic fluid embolism", the Police General Hospital autopsy doctor said she had died from a fatal shock due to internal bleeding and uterine rupture.

Medical Services Department chief Rewat Wishsanuwet told a press conference that, while what went wrong had not yet been determined, he had however contacted the Nation Health Security Office (NHSO) to pay Bt200,000 compensation to Nam-oy's family, as required by National Health Security Act 2002. He said a fact-finding committee was also assigned to probe this case in one week.

Rewat said the hospital had initially reported to him that Nam-oy had died from the anaphylactoid syndrome of pregnancy, which caused amniotic fluid to leak into the blood circulation system and led to a fatal shock.

Nopparatrajathanee Hospital deputy director Dr Uthai Thansalarak said such a condition could happen to any pregnant woman. He said Nam-oy went to the hospital at about 8am on Friday with suspected labour pain, but she was not ready yet and hence the doctor asked her to go home and seek prenatal care with a local clinic first, according to NHSO procedure. She later came back to the hospital but her uterus mouth opened one centimetre wider with no labour pain and uterus contraction. The doctor told her to lie down to check further development, he said. Since she had not sought prenatal care and could not remember when her last menstruation period was, the doctor could not decide to opt for caesarean operation, he said. The patient suffered a shock at 10pm on Saturday, he said, affirming that hospital staff tried their best to save her.

After the hospital staff meeting later yesterday, Uthai said the hospital would not give any more interviews about the case, pending the Public Health Ministry-assigned committee's result of a probe.

However, Pol Maj-General Dr Somyos Deemak said the autopsy found that Nam-oy's uterus ruptured and she died from shock with 3,000cc of blood in the abdominal cavity, causing the unborn baby to die too.

Ramathibodi Hospital lecturer Dr Apichat Jitcharoen explained that uterine rupture could occur from various causes, including an abnormally large baby, uterus injury, use of medical tools or spontaneous abortion.

The amniotic fluid embolism was caused by too much uterus contraction sending amniotic fluid to the blood circulation system and causing lung and heart failure, he said. The two symptoms were not related but could occur together in the case of hard child labour, he said, declining to comment on the different findings of the two hospitals.