Central Luzon Center for Health Development Verification
Regional Epidemiology and Surveillance Unit
Event-based Surveillance and Response (ESR) Report
E-mail: esr.resu3@gmail.com 2024-02-22
Classified Document: Code: 2024-02
This document is distributed only to limited number of DOH and selected NGO staff in order to improve
common awareness on reports and rumours of events which may have national/ international implications.
Please send new or additional information on this or other public health events.
Document Status INTERNAL
Type of Internal Document
1 Report date and time February 21, 2024 11:00am
2 Verification date and time February 22, 2024 9:00am
3 Type of Health Event Check what is applicable:
Suspect Clustering Outbreak N/A
If an outbreak, who validated? EB-DOH DOH-RESU LGU
✘ Others, specify: ISOLATED CASE OF MATERNAL MORTALITY
Was a report made? No
Yes
4 Health event CASE OF MATERNAL MORTALITY
5 Location PRMMH, IBA, ZAMBALES
6 Start date October 29,2023 February 21, 2024
7 Number of cases 1
8 Description of cases . This is the case of Blessed Joy Sigalat, 31 years old, with hearing and
speech impairment, from Dirita, Iba, Zambales. On February 8, 2024, she was
scheduled for CS and was admitted at PRMMH with admitting diagnosis of G1P0, PU
37 5/7 weeks AOG, Breech in Beginning Labor. She delivered via LTCS I an alive
baby girl with AS-8,9, BW-2900grams BL-51cms. She had stable vital signs and no
untoward signs and symptoms were noted perioperatively. She was discharged on
February 9, 2024 and was advised for follow-up check up at OPD PRMMH after 2
weeks.
Patient Sigalat was readmitted on February 18, 2024 11:55pm, Day10 S/P CS
with chief complaint of difficulty of breathing. Admitting diagnosis was G1P1 (1001);
T/C Postpartum Cardiomyopathy; BAIAE. According to her mother, the patient was
diagnosed with Congenital Heart Disease in her childhood years and had received
medicines or treatments before but no follow-up checkup were done in later years.
Upon admission, initial vital signs were as follows: BP-80 palpatory, T-35.8, PR-111,
RR-26, O2sat-58%. She was hooked to oxygen inhalation via non rebreather mask
@15Lpm, nebulization with Salbutamol was done, Ceftriaxone IV started and IFC was
inserted. At 1am patient’s VS were as follows: BP-100/80, T-37, PR- 109bpm, RR-26,
O2sat-90%. CBC, HBSAG, HIV, RPR were requested and 12-Lead ECG and Chest
Xray were done. BUN, creatinine, SGPT, SGOT, TPAG were also requested. On
February 19,2024 8:30am, patient was referred to Medicine department for further
evaluation and co-management. Isoket drip was started and Furosemide 40mg was
administered. ProBNP, ABG, sputum GS CS, FT3, FT4, TSH, ABG, Na, K and 2D
echo were requested as ordered by MROD. 2D Echo was not done because patient
was unstable. IV antibiotic was shifted from Ceftiaxone to Piperacillin + Tazobactam
4.5 grams IV q 6. MROD also ordered oral meds including NAC, Coralan, Atorvastatin,
Empagliflozin and Sacubitril + Valsartan but it was not started since patient was on
NPO because of DOB. Patient was maintained on O2 inhalation and Isoket drip.
Patient’s BP ranges from 90-60 to 110/80 while patient’s oxygen saturation ranges at
DOH-EB-AEHMD-QMOP-03-Form2 Rev.5
74-88% at left hand and 92-100% at right hand.
On February 20, 2022 at 4:45 pm, patient became hypotensive with BP of
60/50 with labored breathing with O2 sat of 83-85%, thus, referred back to Medicine
department. Isoket drip was discontinued, Norepinephrine and Dopamine drip were
started as ordered. 12- Lead ECG was done. MROD’s assessment was Ischemic
Heart Disease, Cardiogenic Shock secondary to Postpartum Cardiomyopathy.
Enoxaparin was administered. Patient remained hypotensive with BP of 60/50 to 90/60
and unappreciated at times with weak peripheral pulses. On February 21, 2024,
patient was planned to be transferred at ICU. At 10:20 am patient went on CP arrest.
Resuscitation was done but unsuccessful. Patient was pronounced dead at 11:00am.
9 Number of deaths 1
10 Description of deaths
Patient Sigalat was admitted on February 18, 2024 with chief complaint of DOB. Patient
was referred to Medicine Department for co-management. On February 20, 2022,
patient started to became hypotensive, with labored breathing and oxygen saturation of
83-85%. Norepinephrine drip and Dopamine drip was started and titrated until
maximum dose but no changes in patient’s BP was noted. Patient was also hooked to
High Flow Nasal Cannula at 30Lpm. On February 21, 2024 at 10:20 am, patient
became apneic and pulseless. CPR and ambubagging were started. Patient was
administered with Epinephrine 5doses every 2-3 minutes. Patient was also intubated.
After continuous CPR and 5 doses of epinephrine, patient has still no pulse, no BP and
no spontaneous breathing. 12-L ECG was done revealing asystole. Patient was
pronounced dead at February 21, 2024 at 11:00 am with final diagnosis of G1P1
(1001), Ischemic Heart Disease, Cardiogenic Shock secondary to Postpartum
Cardiomyopathy Day 13.
11 Laboratory Examination Is there a procedure done? None CSF
Yes
Specimen collected
✘ Blood/serum Stool/Rectal Swab
02/19/2024
CBC HBSAg-Non reactive
Hgb- 13.4g/dL HIV- Non reactive
Hct- 41.4%
WBC-13.10 Pro-BNP- 7,270 pg/ml (High)
Platelt-111
T3-35.06ng/dl
T4-108.94 nmol/L
Na-133.6 mEq/L TSH-1.0309 uIU/ml
K-4.20 mEq/L
ABG
pH-7.492
BUN-18.0 pCO2-27.2
Crea-0.62 pO2-73
SGOT-60.0 sO2-95.61%
SGPT-52.0 HC03- 20.6
February 21, 2024
ESR- 5mm/hr
Others:
Chest Xray- Cardiomegaly with Pulmonary Congestive Changes
12 IHR Notification decision questions Is the public health impact serious? Yes No
Is the event unusual or unexpected? No
Yes
Is there a significant risk of international spread?
Is there a significant risk of international travel or Yes No
trade restriction? Yes No
Assessment done by:
13 Assessment PHELC PHELC/PHERC/PHENC/PHEIC
DOH-EB-AEHMD-QMOP-03-Form2 Rev.5
14 Status of health event CLOSED
15 Actions taken Reported to PESU PHO Zambales
16 Assistance needed NONE Continue health teachings to pregnant mothers regarding importance of prenatal
check-ups and compliance to diagnostic examinations.
ESRU Action NONE To just continue monitoring or will assistance be provided.
18 Remarks The case was closed
19 Who has been informed? DOH-Region III
20 Source(s) of information Hospital staff and patient’s relatiives
21 Prepared by LENY D. REYES, RN
22 Reviewed by: DALISAY M. SAHAGUN, RN, MAN
23 Noted by: DR. JOANNE CALLO-FERMANTEZ, MD
24 Approved by: DR. EILEEN ROSE C. GARRIDO, MD
*Public Health Event of Local (L), Regional (R), National (N) Concern
** Public Health Emergency of International Concern (PHEIC); according to WHO-International Health Regulation Definition
***Captured by National ESR Staff
^Entries should be signed prior to release of verification form
DISCLAIMER: Every effort has been made to provide accurate, up-to-date information. However, the knowledge base is dynamic
and errors can occur. By using the information contained in this list, the reader assumes all risks in connection with such
use. The EB shall not be held responsible for errors, omissions nor liable for any special, consequential or exemplary
damages resulting, in whole or in part, from any reader's use or reliance upon this material.
DOH-EB-AEHMD-QMOP-03-Form2 Rev.5
