By: Akanksha
Majnu, a 28 years old, five month pregnant customer relationship manager living in Sheetla Colony, Sector-5, with her husband, Manoj Kumar, died following excessive bleeding during treatment.
She had received care at ESIC Hospital in Sector-9/9A and Park Hospital, a private hospital in Palam village, Gurugram. According to her family, she was admitted to ESIC Hospital at around 1:30 a.m. on Saturday after an ultrasound revealed that her five-month-old fetus had died in the womb. Doctors administered medication to expel the fetus, but the umbilical cord reportedly did not come out, causing heavy bleeding. Consequently, she underwent emergency surgery, during which the medical team allegedly left a surgical gown and a towel or strip of gauze inside her uterus and stitched her abdomen. She subsequently died on Sunday morning, and the autopsy took place on Monday evening.
The preliminary post-mortem findings indicated death due to excessive bleeding. The three-member medical board also recovered foreign objects, including a fragment of a surgical gown and medical gauze, from her abdomen. The objects were preserved as evidence for further investigation amid allegations of medical negligence.
Manju developed abdominal pain on Friday, and a private ultrasound revealed that her five month old unborn baby had died in the womb. Her family took her to ESIC Hospital early Saturday. Doctors administered medicine that expelled the fetus, but the umbilical cord did not come out, triggering heavy bleeding. On Sunday morning, she underwent emergency surgery to remove the cord, yet her bleeding could not be controlled and her blood pressure did not return to normal.
Manoj told the Hindustan Times that nurses and doctors were attempting a blood transfusion when he entered the operation theater. They referred her to a higher centre, after which he and his in-laws rushed her to a private hospital in Palam Vihar by 10:30 a.m. However, upon reaching there, doctors told them that his wife was already dead.
After the removal of the fetus during a second-trimester miscarriage or medical induction, the placenta and umbilical cord also need to be fully removed from the womb. If there is any placenta still attached within the womb, it is referred to as a “retained placenta.” According to the World Health Organization and the American College of Obstetricians and Gynaecologists states, this causes a physical obstruction, preventing the womb muscles from contracting to compress the blood vessels within the womb where the placenta was attached (uterine atony). This causes an acute obstetric hemorrhage. The lack of uterine contraction will cause the patient to have a rapid drop in blood pressure, leading to hypovolemic shock, disseminated intravascular coagulation, a failure to clot, and ultimately death if timely surgical removal and blood transfusions cannot be performed.
However, the specific mechanism responsible for Manju's bleeding has not been established in the preliminary findings. The reported cause of death was excessive bleeding, and the investigation is yet to establish whether retained pregnancy tissue, uterine atony, or another complication contributed to her condition.
On Monday evening, a three-member medical board comprising Dr. Deepak Mathur, Dr. Tony Jowel, and gynecologist Dr. Sarita Chaudhary, performed the autopsy. Jagran reported the recovery of a four-foot by two and a half foot blood stained surgical gown and a one-foot hand-wiping towel from her uterus or abdomen, while The Times of India reported the objects as part of a surgical gown and a strip of medical gauze, suspected to have been placed inside in a desperate last-moment attempt to stop the bleeding.
Speaking to Hindustan Times, Dr. Mathur stated that timely treatment to stop the bleeding would have saved the life of the victim. He added that foreign objects were recovered from the victim’s abdomen, which should not have been there at any cost. They have been preserved as exhibits and will be handed over to the police for further investigation.
A retained surgical item (RSI) refers to any surgical material or instrument unintentionally left inside a patient's body after a surgical procedure. These may include surgical sponges, gauze, towels, instruments, or fragments of medical devices. Gossypiboma is a related term generally used for a mass formed around a retained surgical sponge or cotton material.
Surgical teams are required to undertake standardized counting procedures for surgical sponges and instruments to ensure this does not happen during an abdominal closure. The World Health Organization's Guidelines for Safe Surgery recommend counting sponges, needles, instruments, and other items that could be retained inside a body cavity. They also recommend a systematic examination of the surgical wound before closure to prevent inadvertent retention. This is classified as a “Never Event” by the National Quality Forum (NQF) and should never occur, as it is preventable. The Federation of Gynaecology and Obstetrics (FIGO) recognizes that there may be circumstances where temporary packing of the womb or abdomen may be required to help control bleeding; however, specific sterilized, X-ray detectable surgical gauze or tamponade balloons should be used. Using non-standard items such as a surgical gown or a hand towel violates standard surgical practice and will put the patient at risk of trauma and infection. Furthermore, it will not apply even pressure to help stop the arterial bleeding.
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Manoj filed a complaint at the Sector-5 police station alleging medical negligence. “I have filed a police complaint… I want to ensure that no other family should get destroyed in such a way due to a doctor’s negligence again,” he told HT.
Meanwhile, ESIC Hospital medical superintendent Dr. Uma Verma told HT that whatever the autopsy findings are, they are facts, adding that she does not think any further reaction is needed on the entire matter.
Gurugram Civil Surgeon and CMO Dr. Virendra Baswana told TOI that the findings will be examined by the district medical negligence board and “action will be taken as per the law.”
ACP of Old Gurugram, Praveen Malik, told HT that an FIR will be registered once the medical negligence board submits its report. He added that even after the recovery of the towel, gown, and gauze from the woman’s abdomen during the autopsy, all legal steps need to be followed as per the law in such cases.
The post-mortem examination was conducted by a three-member medical board comprising Dr. Deepak Mathur, Dr. Tony Jowel, and Dr. Sarita Chaudhary. Its findings and the post-mortem report are to be submitted to the district medical negligence board, chaired by the Chief Medical Officer, for scrutiny.
Hindustan Times reported that the district medical negligence board comprises five members. The board is expected to examine the medical findings before the authorities proceed further. Therefore, the recovery of surgical material during the autopsy should not be treated as a final determination of medical or criminal negligence.
(Rh/APC/MSM)
