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How negligence at Mama Lucy Kibaki Hospital caused the death of pregnant woman

The Senate Committee on Health has released a damning report on the case of Maureen Anyango, a young woman who lost her life due to medical negligence at Mama Lucy Kibaki Hospital in September 2022.

The committee’s investigation revealed a series of failures in the treatment and management of Anyango’s high-risk pregnancy, leading to her untimely demise. The report also called for a thorough investigation into Mama Lucy Kibaki Hospital and recommended reforms to strengthen the healthcare system.

On September 5, 2022, Anyango was admitted to Mama Lucy Kibaki Hospital with severe pre-eclampsia and malpresentation in her twin pregnancy. Despite being a high-risk patient, the committee found that she was not given appropriate advice during her ante-natal clinic visits.

The report further stated that Anyango should not have been allowed to progress to term given her condition.

Of major concern to the committee was the unjustifiable delay of at least eight hours from Ms Anyango’s admission to the emergency cesarean section.

The committee also found that the patient endured approximately 12 hours of active labour before the procedure took place, leading to unnecessary complications.

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Contrary to claims by the Nairobi City Council Government that the delays were necessary to stabilize Anyango’s pre-eclampsia, the committee discovered inconsistencies in the hospital’s documentation.

It was revealed that recommendations for an emergency cesarean section had been made on multiple occasions due to non-reassuring fetal status. The committee also noted the absence of standard tests for pre-eclampsia, raising serious concerns about the quality of care provided.

The report further highlighted the lack of monitoring and documentation of vital signs post-operatively. Despite being a high-risk patient, the hospital failed to produce evidence of vital sign observations or post-operative records during a crucial period.

This negligence was exemplified by the account of Robert Omondi, Anyango’s partner, who repeatedly sought assistance from a nurse during a period of severe bleeding but was ignored.

According to the committee’s findings, Anyango’s condition deteriorated rapidly, leading to her transfer to the Kiambu Level 5 Hospital for critical care.

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However, there was an unjustifiable delay of at least eight hours between the decision to refer her for critical care and her admission to the ICU facility. By the time she arrived at Kiambu Level 5 Hospital, Anyango was unconscious and in critical condition. She passed away six hours later.

The Maternity Mortality Audit conducted at Kiambu Level 5 Hospital concluded that Anyango’s cause of death was hypovolemic shock secondary to postpartum hemorrhage in severe pre-eclampsia with twin pregnancy.

A subsequent post-mortem revealed cerebral edema, pulmonary edema and anemia as contributing factors.

The committee’s report emphasized that Anyango’s death could have been prevented if proper procedures had been followed at Mama Lucy Kibaki Hospital. It called for investigations into the hospital by the relevant health regulatory bodies to determine the extent of medical negligence.

Additionally, the committee recommended that the Ministry of Health, in collaboration with the Kenya Medical Practitioners and Dentists Council, inspect the hospital and reassess its classification to ensure appropriate healthcare service delivery.

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