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Obstetrics > Antenatal Care - Maternal Mortality, VTE > Flashcards

Antenatal Care - Maternal Mortality, VTE Flashcards

1
Q

Define maternal mortality

A

Death of a women during pregnancy or up-to 42d afterwards from any cause related to or aggravated by the pregnancy or its management

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2
Q

What are direct deaths

A

Deaths due to obstetric complications from pregnancy, management, omissions or other

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3
Q

What are indirect deaths

A

Deaths due to pre-existing disease which is not due to obstetric causes by exacerbated by pregnancy (eg. epilepsy)

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4
Q

What are coincidental deaths

A

Deaths that may have occurred even if women was not pregnant (eg. RTA)

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5
Q

What is a late death

A

Death 42d - 1-year

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6
Q

What is the main cause of direct maternal death

A

VTE

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7
Q

What is the main cause of indirect maternal death

A

Cardiac co-morbidity

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8
Q

Define antepartum haemorrhage

A

Bleeding from 24W until labour

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9
Q

What are 3 severe causes of antepartum haemorrhage

A

Placental abruption
Placenta praevia
Vasa praevia

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10
Q

What are 2 other uterine causes of antepartum haemorrhage

A

Circumvallate placenta

Placental sinuses

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11
Q

What are cervical causes of antepartum haemorrhage

A

Cervical ectropion
Cervical cancer
Vaginitis
Cervicitis

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12
Q

How should mother with antepartum haemorrhage be approached

A

A-E

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13
Q

What should not be performed in antepartum haemorrhage and why

A

NEVER perform a speculum exam if pregnant women PV bleed -as if placenta praevia this can cause massive haemorrhage

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14
Q

If a severe antepartum haemorrhage what should be offered

A 
Admit 
IV Fluids 
Cross-match 
If shocked - compatible blood until systolic BP >100 
Monitor urine output 
Senior help 
Prepare for C-Section
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15
Q

If mild antepartum haemorrhage how is women managed

A

IV Infusion
FBC, Cross-match, U+E, Coagulation studies
If placenta praevia - keep in hospital until C-section at 37W
Otherwise, discharge home and monitor as high-risk pregnancy

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16
Q

If antepartum haemorrhage at terms and not placenta praaevia what is offered

A

IOL

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17
Q

What is the leading cause of maternal mortality in the UK

A

VTE

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18
Q

How much does pregnancy increase risk of VTE

A

4-5 times

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19
Q

What are 7 pre-existing risk factors for VTE in pregnancy

A
  • Smoking
  • BMI >30
  • > 35
  • Previous Cancer
  • Thrombophillia
  • Varicose veins
  • Paraplegia
  • Parity >3
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20
Q

What are 7 obstetric risk factors for VTE in pregnancy

A
  • Multiple pregnancy
  • C-Section
  • Prolonged labour
  • Pre-term
  • Still birth
  • Pre-eclampsia
  • PPH
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21
Q

What are 5 transient factors that increase risk VTE

A
  • Travel
  • Surgery
  • Dehydration
  • Ovarian hyperstimulation syndrome
  • Systemic infection
22
Q

When is the highest risk for VTE

A

Immediately post-partum

23
Q

How will DVT present in pregnancy

A

Unilateral Swelling Calf
Prominent superficial veins
Pitting oedema
Fever

24
Q

Where is DVT more common in pregnancy and why

A

Left leg, proximal veins = due to compression of left iliac by the uterus

25
How will PE present in pregnancy
Sudden onset dyspnoea and pleuritic chest pain | Haemoptysis
26
When should you suspect PE
If a pregnant women collapses
27
Why is there an increased risk of VTE in pregnancy
From first trimester until 6W postpartum there is a change in coagulation factors including: - Increase F8 - Increase F10 - Increase Fibrinogen - Decrease protein C and S
28
Why is a D-dimer not recommended for investigated VTE in pregnancy
d-dimer's are naturally raised in pregnancy and therefore will provide no additional information
29
If suspect a DVT, how should it be investigated in pregnancy
duplex US
30
If duplex US is negative, but DVT suspected what should be done
Treat with LMWH. | Repeat scan in 1W
31
What is used to investigate a PE in a pregnant women
CTPA or V/Q Scan
32
Explain risks and benefits of V/Q scan compared to CTPA
V/Q scan has a higher risk of childhood cancers. But, lower risk of breast cancer
33
Explain risks and benefits of CTPA, compared to V/Q scan
CTPA = higher risk of breast cancer. Lower risk of childhood cancers
34
Explain investigation in women with suspected DVT and PE
Perform duplex US first. If this is positive, women does not need CTPA (reduces unnecessary imaging)
35
How are all women with VTE managed
LMWH
36
What LMWH is used
Enoxaparin - Clexane
37
How long is LMWH continued for
6-12W post-partum
38
Explain LMWH in labour or C-Section
Omit dose 24h before labour or c-section
39
Explain LMWH if women are going into labour
do NOT take dose LMWH
40
If women has had a massive PE and entered shock what should be done
Resuscitation | IV UFH
41
What do RCOG say about assessing women risk of VTE
Assess at booking, each antenatal visit, intrapartum and postpartum
42
How can risk-factors for VTE be divided
1. Pre-existing 2. Intrapartum 3. Transient
43
What are 8 pre-existing RF for VTE
1. BMI >30 2. >35y 3. Paraplegic 4. Varicose veins 5. Cancer 6. Thrombophilia 7. Parity > 3 8. Smoking
44
What are 7 pregnancy-related RF for VTE
1. Multiparous 2. Multiple pregnancy 3. Prolonged labour 4. C-Section 5. Stillbirth 6. Pre-Term 7. Pre-eclampsia 8. PPH
45
What are 6 transient RF for VTE
1. Surgery 2. Inpatient 3. Dehydration 4. Long-distance 5. Ovarian hyperstimulation syndrome 6. Systemic infection
46
If a women has >4 risk factors, what thromboprophylaxis should be offered
LMWH throughout pregnancy until 6W post-partum
47
If a women has 3 risk factors, what thromboprophylaxis is offered
LMWH from 28W until 6W postpartum
48
If a women has 2 risk factors, what thromboprophylaxis is offered
10d post-partum LMWH
49
What should all women undergoing c-section be offered
10d course LMWH
50
What is the 'brand name' for enoxaparin
Clexane
51
What dose of enoxaparin is given if women is 50-90Kg
40mg
52
What dose of enoxaparin is given if women 90-130Kg
60mg

Obstetrics (27 decks)

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