J Death after Vaccination, during labour & Instrumental delivery 83. What are the questions which should be investigated in cases of death after vaccination? 1. Whether the injection was at correct site? 2. Whether vaccine storage, transport and administration were faulty? 3.Whether vaccines were found to be of standard quality by laboratory? 4. Whether any contraindication for vaccination was ignored? 5. Whether death was due to anaphylaxis? 6. Whether death was coincidental to vaccination? 7.Whether death was directly consequent/directly attributable to vaccination? 8. Whether cause of death was aggravated by vaccination? 84. Whether the progression of labour (child birth process) is always predictable even in an uncomplicated pregnancy? The progression of labour is commonly unpredictable. Due to prolonged 2nd stage of labour, there is always a chance of potential complications like fetal hypoxia & acidemia leading to birth asphyxia, failure of presenting part to rotate or descend appropriately leading to obstructed labour. Non-cooperation from the patient side may unnecessarily contribute to delay in smooth progression of labour. 85. Whether putting pressure upon the womb to facilitate the birth process (delivery) is still in practice? Practice of putting pressure on womb was commonly employed in the past in an attempt to assist spontaneous vaginal delivery and avoid prolonged 2nd stage of labour or the need for operative delivery. However some professionals do follow such practice now a day also. But as per the guidelines for standardization of labour rooms at delivery points (April 2016) MOHFW, Govt of India, application of fundal pressure is included in the “don'ts” list as it is now considered harmful practice. MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 60