Woman, 9 Months Pregnant, and Baby Die in Rehovot Hospital

Incident is latest in spate of maternal deaths at childbirth.

A woman who had been nine months pregnant died at the Kaplan Medical Center in Rehovot yesterday after giving birth to a dead fetus, making this the fourth such incident in the past month.

Yafa Aitgev Almanesh, 27, was nine months pregnant with her first child when she fainted in her Ashdod home yesterday at about 5 A.M. She was brought to Kaplan suffering suffering from cardiac arrest, in a state of clinical death.

Dr. Yoram Klein, head of the hospital's Trauma and Emergency Surgery division, said that during the resuscitation process the fetus was delivered lifeless by caesarian section.

Hospital officials said the fetus died due to oxygen shortage in the blood before the woman arrived in the hospital.

During the operation it transpired the woman had suffered acute internal bleeding not originating in the uterus.

Almanesh was taken to an operating room where she was diagnosed with an aneurysm in the splenic artery.

Her condition deteriorated and she was taken to the recovery ward and attached to a respirator. At midday she was declared dead.

"The splenic artery is a wide, central blood vessel," Klein said. "The patient suffered from a weakness of the artery wall and its widening over the years until it burst."

"This is a rare structural flaw, apparently inborn. There is no way of tracing such a flaw during pregnancy and in existing check-ups. It can be effectively treated only if the bleeding begins when the woman is already in the hospital," he said.

A burst aneurysm in the splenic artery during pregnancy is mentioned in medical literature but is extremely rare. Tracing such an aneurysm is possible only in a CT photography taken for other purposes, such as after an appendix infection. "The whole occurrence is extremely irregular and the last time I came across such a case was 16 years ago," Klein said.

The Health Ministry heard of the incident from the media and said it was "being looked into."

A month ago a woman died in Eilat's Yoseftal Medical Center hours after giving birth to a dead fetus in similar circumstances.

Ayelet Eliad, 33, died following internal bleeding caused by a ruptured blood vessel in the chest.

A number of women died while giving birth in recent months in Israel.

Earlier this week Michal Atrushi, 22, of Betar Ilit, died of pre-eclampsia at Hadassah University Hospital, Ein Kerem within hours of giving birth to healthy twins in cesarean section.

In August a woman, 20, died in Hillel Yafe Medical Center after giving birth, after losing consciousness due to kidney failure.

In May, Anat Dotan-Amar, 33, of Moshav Shahar, died after giving birth to a son by caesarian section, hours before his circumcision. In February, Fanta Maherto, 26, died in Hillel Yafe Medical Center of internal bleeding after giving birth to a baby by caesarian section.

Gathering figures to determine a trend

The Israel Society of Obstetrics and Gynecology is gathering figures on the mortality of women giving birth to determine whether it is rising.

Professor Kobi Bar of Wolfson Medical Center said "there is no apparent connection between the recent mortality cases...the death of a woman giving birth from a ruptured artery could be caused by a known disease, for example Marfan syndrome (a genetic disorder of the connective tissue ), or when the aneurysm is not known to the woman and its first manifestation is just before giving birth or during it."

Such incidents usually occur in Israel once every few years.

In 1980 nine women died giving birth out of 100,000; in 1990 11 died out of 100,000; in 2000 8 died out of 100,000 and in 2008 6 women died out of 100,000 - marking a 43 percent decrease in mortality over 28 years, the leading general medical journal The Lancet reported in April.