Final Diagnosis

“Sir, we have a case for discussion in today's maternal mortality meeting”. “OK. Is there anything unusual?” I asked. I had been on vacation and had just joined. So I did not know about any maternal deaths which occurred in my absence. “Yes, sir. The patient was transferred to our hospital in a bad shape, with systolic blood pressure of 70 mm Hg and semiconsciousness. She had had a convulsion before being transferred. Her fetus was alive and well at that time. She deteriorated despite all supportive treatment. The next day the fetus died. Then she died too.” “What is the point of discussion?” “The pathologists have given the cause of death as disseminated intravascular coagulation in a case of intrauterine fetal death.” “Did she have DIC?” “Yes, sir. Her coagulation profile was abnormal on admission.” “OK, I will discuss it in the meeting.” The pathologists were present for the meeting. I asked them why they had given that diagnosis. “Well, the fetus was dead and she had DIC” said the pathologist. “When you say DIC in a case of IUFD, it implies that the DIC was due to IUFD. But in this case the patient had DIC on admission, when the fetus was alive and well. It died the next day. So the fetal death was due to maternal illness including DIC rather than the cause of it” I explained. “Stating the diagnosis in the way you have done is like saying 'DIC in a case of vitiligo or leukoderma'. There should be a cause-effect relationship if you want to put the two together in the cause of death.” They seemed to have understood that. “The minutes of the meeting will be sent to higher offices, including state and central government. The people who will see the report may not be active clinicians and they may feel a woman with IUFD was not treated in time and hence developed DIC. That is the reason I want the diagnosis put correctly.” They promised they would do it that way in future. I hope they tell their colleagues too, because it is beyond me to tell all pathologists myself.