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. 2021 Mar 22;11(3):e042909. doi: 10.1136/bmjopen-2020-042909

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Delayed referral and bypassing non-functional facility. The mother experienced headache for 2 weeks at home before going to H/C II, where a diagnosis of severe pre-eclampsia was made. There were no antihypertensives and anticonvulsants. She was referred to nearby H/C IV, but after calling the midwife in charge they were told that the theatre is closed because there were no anaesthetic drugs. They decided to bypass this H/C and move to Lacor Hospital, about 90 km away. At Lacor Hospital, she received anticonvulsants and antihypertensives. She was taken to the operating room for an emergency caesarean section where a live baby was delivered. The mother was discharged alive but had a stroke (MNM1). BP, blood pressure; H/C, health centre; MNM, maternal near-miss.