In Sri Lanka, maternal mortality ratio is among the lowest when compared with other developing counties (1,2). Most deliveries take place in a health facility with the support of a skilled birth attendant. It is documented that during an hour, around 40 maternal deaths occur worldwide, whereas in Sri Lanka 40 women would die over a period of about 105 days (3). Once the common causes of maternal mortality have been controlled or eliminated, the uncommon causes come into picture
Introduction
In Sri Lanka, maternal mortality ratio is among the
lowest when compared with other developing
counties (1,2). Most deliveries take place in a health
facility with the support of a skilled birth attendant. It
is documented that during an hour, around 40
maternal deaths occur worldwide, whereas in Sri
Lanka 40 women would di~' 6~er a period of about
105 days (3). Once the common causes of maternal
mortality have been controlled or eliminated, the
uncommon causes come into picture.
Case 1: A 30-year-old pregnant mother with a
period of amenorrhoea (POA) of 32 weeks was
transferred from a peripheral hospital with vomiting
and icterus for three days. She was suspected of
having HELLP syndrome. Investigations showed
abnormal liver, renal and clotting profiles.
Emergency caesarian section was performed and
after the delivery she developed profuse post-partum
haemorrhage. Subtotal hysterectomy was done and
she was transfused with blood, plasma and platelets.
Her liver, renal functions and platelet count
continued to deteriorate.' A week after delivery she
died in spite ofICU care.
At autopsy, yellow discolouration of conjunctiva,
nail beds, pleural effusion and ascites was detected.
All the organs were. yello "ish. Lungs were
congested and heavy (Figure 1). Heart was flabby
and Liver was enlarged. Kidneys were soft and
enlarged with congested cortex. Histopathology
revealed extensive pulmonary haemorrhages (Figure
2) and focal hepatic necrosis Kidneys showed
evidence of acute renal tubular necrosis.
