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2.        The Complaint:  

2.1       Smt. Reena Bansal the Complainant No. 1( for short 'the patient')  a primi (first pregnancy) was under observation of  Dr. Meenakashi Mishra (OP No. 1) at her Jha Hospital ( OP No. 2). After Ultrasonography (USG) study it was diagnosed as twin pregnancy. It was alleged that  the OP No. 1 informed the patient about need for Caesarean  instead of a normal delivery. On 27.09.2001 OP No. 1 performed the caesarean operation under spinal Anaesthesia administered by Dr. Anupam Singh (OP No. 2). After the C-section, from OT she was shifted to her bed. It was further alleged that the patient's Peticot was soaked in blood due to heavy blood loss about 15 ounces. Patient's husband immediately informed OP No. 1, but no steps taken to stop the bleeding, but the doctor refused by stating that she was busy with another patient. As a result, the patient suffered from severe Post-Partum Haemorrhage (PPH). Her abdomen became distended, and she was taken to OT again for hysterectomy. It was allegedly performed without the consent of Complainant No. 2 & 3. But, the consent was given under fear by her husband.
2.2       The Complainants further alleged that due to heavy dosage of spinal anaesthesia, the uterus did not contract fully after delivery, thus caused PPH. It was wilful negligence of OP No. 1 & 2, who did not check full contraction of uterus before putting the stitches.  It further resulted into placental fragments and blood clots being left inside the uterine cavity. The several open sinuses at placental side led to  heavy bleeding. The surgeon might have injured the uterine artery during the caesarean.

5.5     In our view, the PPH was due to Atonic uterus. It was not due to any retained placental pieces. As a standard of practice after Cesarean delivery, the placenta as well as its membranes are removed manually and the uterine cavity is cleaned by suction & mopping. Therefore, no possibility of any placental fragments or its membranes being left behind within the uterus. The  Uterus was firmly contracted, therefore chances of retained fragments does not arise. Also, bleeding due to retained small placental fragments is uncommon in the immediate postpartum period.  The late PPH occurs  after 24 hrs or more after delivery and in that case the most common causes are retained fragments of placenta and sub involution of the placental implantation site[1].  In the instant case the bleeding was started at about only one hour after her delivery.

5.6     It is pertinent to note that, the complaints have filed complaints before MCI, DM & CMC, Hathras. We find that, the hospital is registered by CMO, Hathras as per the requirement of PNDT Act. Therefore OPs were   to carryout USG. 

5.7     Medical literature on the subject: We took reference from the William's Obstetrics a standard textbook. It dealt with   PPH and Postpartum Hysterectomy,  5.7.1 The Postpartum haemorrhage (PPH) is known as an Obstetric haemorrhage is associated with increased risk of serious maternal morbidity and mortality. The PPH is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth. If it's about 1 litre or more, it is known as severe PPH.  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 postnatal is known as secondary PPH. It may result due to  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.