Maternal Morbidity and Mortality Flashcards
What % of maternal deaths are direct and what % are indirect?
32% direct, 68% indirect
What are direct (pregnancy induced condition) causes of maternal mortality?
1) Thrombosis - PE
2) Sepsis (genital tract)
3) Haemorrhage
4) Pre-eclampsia (hypertensive disorders of pregnancy)
5) Amniotic fluid embolism
6) Early pregnancy deaths
7) Anaesthesia
What are indirect causes (pregnancy may have exacerbated a condition not caused by pregnancy) of maternal mortality?
1) Cardiac disease
2) Sepsis (influenza, pneumonia)
3) Neurological (epilepsy, stroke) - 11%
4) Psychiatric causes (⅔ die from a mental health condition)
5) Cancer
What percentage of maternal deaths are from a cardiac cause?
23% - never make the assumptions that symptoms are just caused by pregnancy
What are cardiac causes of persistent breathlessness or chest pain that can just be put down to pregnancy?
1) MI
2) Cardiomyopathy
3) Aortic dissection
4) Valvular heart disease
5) Sudden arrhythmic death syndrome
What is an urgent neurological situation in pregnancy?
- Worsening epilepsy
- First seizure in pregnancy
Should you stop neurological medication in pregnancy?
No
How can mental health problems in pregnancy be handled?
1) Pay special attention to women with complex social backgrounds, a history of substance abuse or pre-existing mental health problems
2) If communication is difficult, enlist the help of an interpreter
What investigations/treatments for PE are safe in pregnancy?
- CXR
- LMWH, thrombolysis
What investigation to exclude a PE is not safe or useful in pregnancy?
D-dimer
- Pregnancy is known to increase the D-dimer concentration above the conventional normal threshold of 0.50 mg/L, leading to an increased false-positive D-dimer test when VTE is clinically suspected in a pregnant patient
What extra letter is added onto the ABCDE approach and why?
F - fetus, aortocaval compression
What happens to airways in pregnancy?
They vasodilate - oedematous
How is blood glucose level in pregnancy different?
> 5.3 glucose not normal, but baby needs more sugar
What should you do if a pregnant woman faints?
Sit them up and move the uterus (aortic compression)
What should you do if a pregnant woman has a heart attack?
Remove the baby after a certain amount of time
What type of X ray should you not to in pregnancy?
Abdominal
What is the maximum recommended radiation exposure in pregnancy?
50,000 mGy
What investigations give low fetal radiation doses in pregnancy?
1) CXR - < 10 mGy
2) Perfusion scan - 60-120 mGy
3) Ventilating lung (technetium 99m) - 10-350 mGy
4) CTPA - < 500 mGy
What can pregnancy symptoms mask?
Pathology
What is the three delay model?
1) First delay is related to the recognition by women and families of the need to seek care
2) Second delay is related to accessing care - referral chain between facilities, barriers in the community (physical, cultural or financial), thinking it’s not important
3) Third delay is related to receiving appropriate care in the facility
What is a maternal death?
Death during or up to 6 weeks after the end of the pregnancy
What is a ‘late’ maternal death?
Covers the period from 6 weeks postpartum until 12 months after the end of the pregnancy
When may women present with a pre-existing disease?
In pregnancy
What are risk factors for direct maternal death?
1) Medical comorbidites
2) Previous pregnancy problems
3) Hypertensive disorders of pregnancy
4) Inadequate use of antenatal care
5) Indian ethnicity
6) Substance misuse
What makes a women at a higher risk of dying in pregnancy?
1) Afro-Caribbean origin
2) Older
What is a risk factor for blood clots incl. in early pregnancy?
Overweight or obesity
What symptom is not normal in pregnancy and may mean there are heart problems?
Persistent breathlessness when lying down (orthopnoea)
What type of chest pain may be cardiac?
Severe chest pain spreading to the left arm or back
How do you detect pre-eclampsia?
- Check BP and urine at every antenatal visit
- Pre-eclampsia can be asymptomatic even when BP is high and there is heavy proteinuria with low platelets and high liver enzymes
When do most pregnancy related deaths occur?
After delivery (not before or during)
Where do most pregnant women die?
In hospital (bc most women give birth in hospital)
Can you give the flu vaccine in pregnancy?
Yes bc it is not live
What type of vaccines can you not give in pregnancy?
Live vaccines
What is a maternal near miss?
A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy (either bc of good care or good luck)
Why are women seen more frequently near the end of pregnancy?
Events are more likely to happen near and at term so see women more frequently to prevent them from happening
What do you do if a mother is Rh negative?
If Rh negative then get RhoGAM injection which is Rho(D) immunoglobulin at 28 weeks and within 72h of birth
Should a women be encouraged if she wants to measure her own BP during pregnancy?
Yes
What is the test for gestational diabetes offered to at risk women?
- 75g 2hr oral glucose tolerance test at 24-28 weeks
- Do NOT use fasting plasma glucose, random blood glucose, HbA1c, glucose challenge test or urinalysis for glucose to assess risk of developing gestational diabetes
