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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
Q

How will PE present in pregnancy

A

Sudden onset dyspnoea and pleuritic chest pain

Haemoptysis

26
Q

When should you suspect PE

A

If a pregnant women collapses

27
Q

Why is there an increased risk of VTE in pregnancy

A

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
Q

Why is a D-dimer not recommended for investigated VTE in pregnancy

A

d-dimer’s are naturally raised in pregnancy and therefore will provide no additional information

29
Q

If suspect a DVT, how should it be investigated in pregnancy

A

duplex US

30
Q

If duplex US is negative, but DVT suspected what should be done

A

Treat with LMWH.

Repeat scan in 1W

31
Q

What is used to investigate a PE in a pregnant women

A

CTPA or V/Q Scan

32
Q

Explain risks and benefits of V/Q scan compared to CTPA

A

V/Q scan has a higher risk of childhood cancers. But, lower risk of breast cancer

33
Q

Explain risks and benefits of CTPA, compared to V/Q scan

A

CTPA = higher risk of breast cancer. Lower risk of childhood cancers

34
Q

Explain investigation in women with suspected DVT and PE

A

Perform duplex US first. If this is positive, women does not need CTPA (reduces unnecessary imaging)

35
Q

How are all women with VTE managed

A

LMWH

36
Q

What LMWH is used

A

Enoxaparin - Clexane

37
Q

How long is LMWH continued for

A

6-12W post-partum

38
Q

Explain LMWH in labour or C-Section

A

Omit dose 24h before labour or c-section

39
Q

Explain LMWH if women are going into labour

A

do NOT take dose LMWH

40
Q

If women has had a massive PE and entered shock what should be done

A

Resuscitation

IV UFH

41
Q

What do RCOG say about assessing women risk of VTE

A

Assess at booking, each antenatal visit, intrapartum and postpartum

42
Q

How can risk-factors for VTE be divided

A
  1. Pre-existing
  2. Intrapartum
  3. Transient
43
Q

What are 8 pre-existing RF for VTE

A
  1. BMI >30
  2. > 35y
  3. Paraplegic
  4. Varicose veins
  5. Cancer
  6. Thrombophilia
  7. Parity > 3
  8. Smoking
44
Q

What are 7 pregnancy-related RF for VTE

A
  1. Multiparous
  2. Multiple pregnancy
  3. Prolonged labour
  4. C-Section
  5. Stillbirth
  6. Pre-Term
  7. Pre-eclampsia
  8. PPH
45
Q

What are 6 transient RF for VTE

A
  1. Surgery
  2. Inpatient
  3. Dehydration
  4. Long-distance
  5. Ovarian hyperstimulation syndrome
  6. Systemic infection
46
Q

If a women has >4 risk factors, what thromboprophylaxis should be offered

A

LMWH throughout pregnancy until 6W post-partum

47
Q

If a women has 3 risk factors, what thromboprophylaxis is offered

A

LMWH from 28W until 6W postpartum

48
Q

If a women has 2 risk factors, what thromboprophylaxis is offered

A

10d post-partum LMWH

49
Q

What should all women undergoing c-section be offered

A

10d course LMWH

50
Q

What is the ‘brand name’ for enoxaparin

A

Clexane

51
Q

What dose of enoxaparin is given if women is 50-90Kg

A

40mg

52
Q

What dose of enoxaparin is given if women 90-130Kg

A

60mg

Obstetrics (27 decks)

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