1.2 Saving Mothers' Lives

Question 1

Direct Maternal Death

Commonest causes

Answer 1

Resulting from obstetric complications of the pregnancy state

1. VTE
2. Haemorrhage
3. Sepsis
4. Suicide
5. PET/ Eclampsia
6. Anaesthesia
7. Early preg complication (ectopic / miscarriage)

Question 2

Risk factors increase likelihood maternal mortality

Answer 2

1. Older Mothers:
   increase comorbs - eg cardiac diz
2. Improvement cardiac surgery
   - congen cardiac disease survival to child bearing age
3. Increase incidence of assisted conception
   complications multiple pregnancies
4. Obesity
5. Lifestyle
   - smoking / drinking / substance / domestic abuse
6. Immigration
   communication / poorer health conditions undx / tb hiv aids
7. Poverty / unemployment / education
8. Prenatal counselling lack
9. Psych dis

Question 3

Anaethetic related recommendations

improve perinatal safety

Answer 3

1. Prenatal assessment for high risk
2. Involvement of obstetric care high risk patients
3. Unwell parturient
4. Guidelines for management:
5. Senior involvement

Question 4

1. Prenatal assessment for high risk

Answer 4

MDT approach

Obesity 
Cardiac disease
Epilepsy
DM
Autoimmune disease

Dedicated preassessment clinic for hx exam cvs resp airway back

Perinatal plan
Risks / regional techniques

Question 5

2. Involvement of obstetric care high risk patients

Answer 5

1. Clinical advice + support for mothers with high
   PIH or P-Eclamp
   Active involvement in delivery plan
2. Awareness of placental location in high risk mothers
   eg PP w/ previous section
   potential risk haemorrhage
3. ID of pregnant patients
   High risk VTE and initiation of prophylaxis

Question 6

3. Unwell parturient

Answer 6

Provide teaching and training to delivery suite staff
ALS
and recognition + Mx unwell pregnant patients

IMEWS
Detection and prevention of deterioration
Approp r/f to anaes / intensivist

Active clinic leadership
early recognition unwell patient
management plan to prevent collapse

Question 7

4. Guidelines

Answer 7

Rx obese pregnant woman

Rx sepsis pregnancy

MOH protocol

Failed ETT

Epidural device drug delivery

Question 8

5. Senior involvement

Answer 8

Trainee anaesthetist recognise and accept limitation

Direct 24h access to consultant for advice + help

Senior input for management of complex patients