I definitely agree with Tina and Thea, because the doctor also plays a role in terms of the appropriate care to be given. He could have referred Amrapali's case as soon as it was detected.

yes indeed. the competency of the health care professionals at the prenatal clinic should be questioned because again, the reason for prenatal check up is to promote safe pregnancy, both for the mother and infant, which is the opposite of what happened to Amparali.

common themes that occur in your responses in question 1 are as follows:
-economic status of the family (lack of adequate funds for emergency health needs) is a factor since the husband brought his wife to the less equipped, farther health facility
-social and medical factors: delays in the care given which occur in the decision making of the husband as to where to bring amparali, delays in arrival at health facility and delays in providing quality care and immediate referral; social factors is the patriarchal decision making of the husband..

let us answer the second question.. or do u want to add anything?..

Yes Tina, I agree with you. In addition, there was also a delay in the decision of the doctor to refer Amparali to the other hospital. If only proper assessment and decision making was done, appropriate interventions should have been given to Amparali.

i agree with thea to question why is the high BP not diagnosed in the prenatal care. maybe it's in the system and the facilities. agree thea?

I agree with ara, but even if they have WHO prototype of the HBMR, the question is, are the health care providers in their community skilled or competent to even perform such kind of pre-natal assessment?

I think, the main reason why all of this happened may be related to poverty. The lack of health care resources, both the family as well as the community they lived in. They can’t afford to rush her to the hospital nearest to them, but instead, they went to the 8km affordable hospital, meaning—less health facilities.

I just wondered why the BP of Amrapali wasn’t diagnosed during pregnancy. Lack of facilities? Or was it because lack of skilled workers to be able to determine even the simplest test?

What should have happen? The health workers, even in far-flung areas must be trained appropriately. Government fundings are important also for people who cannot afford to go to decent hospitals and receive quality care. Early detection of potentially health risk factors during the ante-natal period.

I think the case is Eclampsia..

Eclampsia, defined as the occurrence of one or more convulsions (fits) in association with the syndrome of pre-eclampsia, is a rare but serious complication" (Duley, Gulmezoglu & Henderson-Smart, 2000:1). Eclampsia is a condition peculiar to pregnant or newly delivered patients. It is characterised by convulsions, which occur as a result of raised blood pressure associated with pregnancy (WHO, 1996:14)

Reference:
C. Mudokwenuy-Rawdon, M.C. Bezuidenhout, V.J. Ehlers, 2003 Factors influencing pre-eclampsia/eclampsia outcomes in high-risk patients in Zimbabwe Available at: http://findarticles.com/p/articles/mi_6820/is_1_8/ai_n28173305/

yes. if the woman has pre-existing undiagnosed HTN during the pregnancy, and this condition is not known during the duration of pregnancy, the woman can just suddenly suffer from worsening condition like eclampsia... close monitoring and persistent prenatal should be done and should have been instituted in her case.

yes ara, i absolutely remember. i must say that it is a delay on the decision of the patient's family. although i must point out that the husband made the decision but it's on the weight of the decision that matters, the husband chose to go to a small clinic than a hospital which made the delay of care longer. Two of the factors that influence the husband to make such decision is 1st, poverty, in which the husband considered the expenses in making a decision; and the 2nd is, maybe on the health education for the husband. If the husband just knew that sign such as labor pain should be consulted to the nearest hospital, then Amparali should have been saved.

I agree with you ara. It's really a big question if she has been regularly attending prenatal check-ups and then they weren't able to detect her high blood pressure... I guess, they are not that keen in providing proper antenatal care.

hmm..delays in decision making? I guess it's because maybe her husband was not sure if he can shoulder the hospital fees.

yes.. ate rai. just as what tina mentioned also, we can trace it back on the adequacy or quality of the prenatal care given.. however, if they are using the same HBMR prototype of the WHO, somehow, the danger signs of pregnancy can be assessed by using that tool...

1. What were the social, economic, and medical factors that contributed to Amrapali’s death?

Preeclampsia is a frequent disease with an incidence of 5 to 7% among the general population; however, geographic, social, economic and racial differences are responsible for an incidence that is up to three times higher in some populations Lopez-Mayorga & López-Jaramillo P (1993)

he decision of the husband to bring Amparali in a small clinic that is 8 km away rather than in hospital that is only 5 km away, indicates that they have financial constraint. This factor caused not just a delay on the management that should have been provided to Amparali, but also on the quality of services that she should have received if she was brought to the hospital.

Another factor that should be considered is the antenatal check-up of Amparali. Why is it that the health care provider was not able to determine and assessed the increase in blood pressure of Amparali considering the fact that she visits regularly for the antenatal care? There must be a problem with the health facility and the performance of the health care providers in diagnosing the disease.

Last consideration would be the timing for the referral to the hospital. Immediate intervention should have been provided if only she was transferred earlier into the hospital where complete medical services are available.

Reference:
J.P. Casas Brazilian Journal of Medical and Biological Research October 2001, Volume 34(10) 1227-1235 Available at: (Review

yes.. i agree with what tina posted... remember the discussion we have in women's health? One of the causes of maternal mortality is delayed care which occurs in the household, community and hospital facility (Thadeus, 1994). Ref: Thaddeus S, Maine D. 1994. Too far to walk: maternal mortality in context. Social Science Medicine 38:1091-110.
>>In amparalis case, where are the delays of care occurred?