Earlier this year, in May, The New Medical College Hospital, government hospital in Kota, reported 12 women developed acute kidney problems after childbirth, 5 of whom died.
Sudden death of two mothers within a 24-hour time span, due to similar causes to those in the May tragedy, triggered fresh concern, officials said on Sunday.
40-year-old Reshma, underwent her fourth Caesarean delivery on Wednesday, 14 October. After the procedure, she developed severe kidney-related complications and died during her treatment on Friday night. Her family alleges administrative apathy and medical negligence on the part of the staff at The New Medical College Hospital (NMCH).
According to The Indian Express, Reshma experienced a sudden drop in blood pressure and oxygen levels, followed by critically low urine output. Doctors were investigating possible pregnancy-related thrombotic microangiopathy (TMA) and HELLP syndrome. These were possibilities under investigation, not confirmed diagnoses.
The second fatality occurred on Saturday afternoon. Roshan Bairwa was a high-risk patient from Baran and was referred to NMCH by a private facility. She had severe anemia and underwent a C-section the night before her death. She died on Saturday afternoon from sudden complications.
NMCH Superintendent Ashutosh Sharma reported that Roshan was a high-risk patient who suffered severe postpartum hemorrhage (PPH) following her C-section delivery. The hospital did performed a blood transfusion but the doctors could not arrest the bleeding, and she died at 11:30 am on Saturday.
Sharma clarified that Roshan's death was caused by excessive blood loss due to severe PPH and was completely unrelated to any sort of acute kidney failure as seen in Reshma’s case. As per the officials, Roshan's family submitted a statement declining an autopsy and further action, after which her body was handed over to them.
On Wednesday, another woman, 30-year-old Anita, also reported kidney complications after her C-section. She has since remained under watch in the hospital's super-speciality block, where her condition was reported to be stable by the hospital officials.
On October 19, drug authorities reportedly halted the use and supply of six medicines at NMCH following the two maternal deaths and the deterioration of another woman's condition. According to Rajasthan NDTV, officials collected samples of the medicines and sent them to a laboratory for testing. The report also stated that preliminary information indicated that women experienced severe shivering after receiving an injection, while an intravenous fluid was also suspected earlier. However, the report did not establish whether any medicine or fluid caused the complications or deaths. The identities of the six medicines and the laboratory results were not confirmed in the report.
Postpartum hemorrhage (PPH) is excessive bleeding after vaginal or cesarean childbirth. WHO classifies it as a major cause of maternal mortality worldwide. Severe bleeding can often lead to a rapid drop in blood pressure in mothers, which further constitutes a hemorrhagic shock and reduced blood supply to vital organs.
The traditional definition of primary PPH is the loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby after vaginal birth and 1000 ml after cesarean birth. PPH can be minor (500–1000 ml) or major (more than 1000 ml). Major can be further subdivided into moderate (1001–2000 ml) and severe (more than 2000 ml). Secondary PPH is defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally. (1)
The World Health Organization's 2025 consolidated guidelines recommend initiating first-response treatment when objectively measured blood loss reaches 300 ml or more alongside an abnormal hemodynamic sign, or 500 ml or more, whichever occurs first within 24 hours after birth. Abnormal signs include a pulse rate above 100 beats per minute, a shock index above 1, systolic blood pressure below 100 mmHg or diastolic blood pressure below 60 mmHg. WHO recommends particular vigilance during the first two hours after birth. These criteria support earlier detection and treatment of potentially dangerous bleeding.
When a mother suffers from a postpartum hemorrhage, it triggers acute kidney injury (AKI). Extensive blood loss during childbirth reduces the amount of blood circulating through the body. This results in a drop in blood pressure that compromises blood flow to the kidneys, depriving kidney tissue of the oxygen required to function normally.
The kidneys eventually receive insufficient blood to filter waste products and maintain the body's fluid and electrolyte balance. If this reduced blood supply persists, kidney cells, particularly those in the renal tubules, can become injured. This may lead to acute tubular injury or necrosis, a serious form of AKI.
In severe cases of AKI, patients develop reduced urine output, rising blood creatinine levels and disturbances in electrolyte balance. Patients with severe AKI are treated with intensive care and temporary dialysis.
However, it should noted that not every case of postpartum AKI is caused by hemorrhage. Sepsis, hypertensive disorders of pregnancy, placental complications and pregnancy-associated thrombotic microangiopathy are some of the other reasons that result in AKI. Clinical evaluation, laboratory investigations and diagnostic testing are used to diagnose the cause of AKI.
Management involves assessing blood loss, monitoring the patient's vital signs and identifying the source of bleeding. Treatment includes uterine massage, uterotonic medicines to help the uterus contract, intravenous fluids, tranexamic acid, and blood products depending on the clinical condition of the patients. If bleeding doesn’t stop despite initial treatment, procedures to control the source of bleeding or emergency surgery may be required.
The World Health Organization (WHO) recommends coordinated, timely interventions for PPH. Delays in recognizing and treating severe bleeding increase the risk of serious complications and death.
1. World Health Organization. Guideline on Prevention and Management of PPH. n.d. https://platform.who.int/docs/default-source/mca-documents/policy-documents/operational-guidance/BRN-MN-32-03-OPERATIONALGUIDANCE-eng-Prevention-Management-PPH.pdf.
2. Etiology of Pregnancy-related Acute Kidney Injury among Obstetric Patients in India: A Systematic Review. 2023. Indian Journal of Critical Care Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9983668/.
3. World Health Organization. Consolidated Guidelines for the Prevention, Diagnosis and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization, 2025. https://www.who.int/publications/i/item/9789240115637.
(Rh/MF/MSM)
