Indian Kanoon - Search engine for Indian Law

8.         After the operation the patient was shifted to postoperative recovery ward.  The patient complained of Palpitation and Ghabrahat at 9.15 am. Immediately senior Obstetric Consultant and Associate Professor on duty Dr. Godawari Joshi ( OP2) examined the patient and  diagnosed it as a case of Atonic PPH. Then OP2 informed the HOD Dr. R.C. Purohit (OP-6) and all conservative measures were tried to control PPH. The l ifesaving B-negative blood, was transfused as arranged from the hospital. When all conservative Medical and surgical methods failed to control bleeding, therefore  emergency Hysterectomy was performed.  

The learned Counsel for the OP-3 vehemently argued that Dr. Monika (OP-3) was a Post Graduate, Senior Resident and not an employee of the OP No. 1 hospital as such would not fall under the ambit of Section 2(1)(d). Her role was very limited.  The learned Counsel placed reliance upon the judgments of the Hon'ble Supreme Court in Samira Kohli v. Dr. Prabha Machanda[1]  and  Martin F. D'Souza v. Mohd. Ishfaq [2] FINDINGS & DISCUSSION:

13.     I have gone through Medical literature on the subject of normal delivery, the PPH and its management. Also perused   William's Obstetrics  and Text book by Dr. D.C. Dutta.

Postpartum haemorrhage (PPH):

Obstetric haemorrhage is associated with increased risk of serious maternal morbidity and mortality. Postpartum haemorrhage (PPH) is the commonest form of obstetric haemorrhage, and worldwide, approximately every 4 min a woman dies due to massive PPH. As per WHO the PPH is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. Most cases of morbidity and mortality due to PPH occur in the first 24 hours following delivery and these are regarded as primary PPH whereas any abnormal or excessive bleeding from the birth canal occurring between 24 hours and 12 weeks post-natally is regarded as secondary PPH.

PPH may result from failure of the uterus to contract adequately (atony), genital tract trauma (i.e. vaginal or cervical lacerations), uterine rupture, retained placental tissue, or maternal bleeding disorders. Uterine atony is the most common cause and consequently the leading cause of maternal mortality worldwide. As per the WHO recommendation if the bleeding does not stop in spite of treatment with uterotonics, other conservative interventions (e.g. uterine massage), and external or internal pressure on the uterus, surgical interventions the  utero-ovarian and hypogastric vessel ligation may be tried. If life-threatening bleeding continues subtotal or total hysterectomy should be performed.