The Ministry of Health after the death of Izabela from Pszczyna: the mother’s life and health are the most important

The Ministry of Health has published guidelines for doctors on how to deal with premature outflow of amniotic fluid. This is the ministry’s reaction to the death of a 30-year-old pregnant woman in a hospital in Pszczyna and subsequent protests related to it. “The Ministry of Health draws attention to the current legal regulations and medical recommendations in this area,” reads the release.

1. A 30-year-old woman died in Pszczyna County Hospital in September. She was 22 weeks pregnant
2. On admission to the ward, anhydrous was found, and previously diagnosed congenital defects of the fetus were confirmed.
3. At this stage, the doctors were to decide on the “expectant attitude”. This decision was to lead to the patient’s death
4. The tragic death of 30-year-old Izabela from Pszczyna sparked a wave of indignation throughout the country
5. On Saturday in many cities there were protests and marches under the slogan “Not one more”
6. On Sunday, the Ministry of Health published a communiqué in which it included recommendations on how doctors should act in such situations
7. More information can be found on the Onet homepage

Department of Health: pregnancy termination needs to be considered

On November 7, a message was published on the website of the Ministry of Health regarding the conduct of doctors in situations similar to the one in Pszczyna.

«In the event of a situation that threatens the life or health of a woman (e.g. suspected infection of the uterine cavity, hemorrhage, etc.), it is lawful to terminate the pregnancy immediately on the basis of the applicable provisions of the Act of January 7, 1993 on family planning and protection of the human fetus and conditions for the admissibility of termination of pregnancy (Journal of Laws No. 17, item 78, as amended). This act directly indicates that the mother’s life or health is at risk. It should be emphasized that these are disjoint premises. The occurrence of only one of them is a sufficient legal condition for a doctor to react. It is obvious that the patient must be informed about the current health and life risks at every stage of pregnancy »- we read on the website of the Ministry.

1. None of us want to go to prison for 25 years, say gynecologists

«In the standard defined by the National Obstetrics and Gynecology Consultant, in the case of determining the signs of a threat to the life of the fetus after 22 6/7 weeks of pregnancy, termination of pregnancy should be considered, leaving the decision to the woman, after providing comprehensive information about the threat to the life of the fetus and its chances of survival (taking into account the chances for proper development). Information should be provided by both the obstetrician and the pediatrician / neonatologist »- informs the Ministry of Health.

“It must be strongly emphasized that doctors must not be afraid of making obvious decisions based on their experience and available medical knowledge” – emphasizes the Ministry of Health.

Drainage of amniotic fluid – recommendations

The Ministry of Health, in consultation with the National Consultant for Obstetrics and Gynecology, has published recommendations on how to deal with premature outflow of amniotic fluid.

«Premature drainage of amniotic fluid, before the beginning of the first stage of labor, requires the following actions each time:

1. Confirmation of amniotic fluid outflow through vaginal examination, AFI assessment in ultrasound, confirmation of amniotic fluid outflow in biochemical tests.
2. Record the time and circumstances of amniotic fluid drainage, the patient’s general condition (heart rate, temperature, blood pressure), the fetal heart rate, its location (after 22/6 weeks of pregnancy) and size.
3. Blood collection from the mother to determine the complete blood count with white blood cell smear, CRP, or other markers of infection (e.g. procalcitonin), determination of the coagulation system with fibrinogen. The tests should be repeated depending on the actual clinical situation.
4. Taking a complete bacteriological smear with an antibiogram. If pregnancy continues, the test should be repeated depending on the current clinical situation.
5. The use of prophylactic, empirical, antibiotic therapy with a drug with a possibly broad spectrum of activity (including Escherichia coli, Enterococcus faecalis, Klebsiella, Streptococcus) in a dose as in the case of an infection. After obtaining the result of bacteriological examination, the antibiotic therapy used should be verified.

In pregnancy above 22 weeks and before the age of 36 weeks, aim for the administration of the full dose of steroids in order to increase the child’s chances of survival, provided there are no indications for early, early termination of pregnancy.

In the case of amniotic fluid drainage before the age of 22 6/7 weeks of pregnancy, it is necessary to inform the woman about the limited chances of the child’s survival and its proper development. The management should depend on the current clinical situation, the stage of pregnancy and the patient’s decision. Regardless of the decision made by the woman, it should be recorded in the medical records and certified by the patient and a specialist in obstetrics and gynecology. From the 23rd / 0th week of pregnancy, if there is no threat to the life and health of the mother, pregnancy should be continued. The patient should be hospitalized in accordance with the principles of three-stage perinatal care. »

Read also:

1. Alicja Wirwicka: don’t make us die!
2. The woman died of septic shock. What is sepsis?
3. Iza from Pszczyna had a septic shock. What is this?
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