Maternal Mortality

Question 1

What causes maternal death?

Answer 1

Preexisting condition: DM, Heart disease, psych
Post-partum haemorrhage
Preeclampsia
Sepsis

Question 2

Direct maternal deaths

Answer 2

Amniotic fluid embolism

Post partum haemorrhage

Question 3

Incidental death?

Answer 3

MVAs
Homocide
Cancer

Question 4

Indirect death?

Answer 4

Cardiac death

H1N1

Question 5

What cardiac changes in preg?

Answer 5

CO increases by 50% by 32w

TPR: decreases

Question 6

What renal in preg changes?

Answer 6

GFR increases by 55%

Question 7

GI changes in preg?

Answer 7

Progesterone: relaxes uterus, reduced esophageal sphincter, more GI motility

Question 8

Haematologic all change in preg?

Answer 8

Anaemia of preg: dilution all due to increase volume, not as much as red cells.
Hypercoagulable state

Question 9

Consideration in preg for resus?

Answer 9

Left tilt
Increase blood volume
Increase risk of aspiration: cuffed endotracheal
Make sure adequate ventiliation
Alpha/beta agonists may reduce utero placental perfusion

Question 10

If preg mother arrests?

Answer 10

Defibrillation safe for fetus

Peri-mortem often C-section, decide at 4’, deliver at 5’

Question 11

Contraindication for preg?

Answer 11

Pulmonary HT or eisenmenger’s syndrome

Question 12

Risks of increased cardio output has implications for?

Answer 12

LV dysfunction: ischaemia, valvular, peri partum cardiomyopathy
Fixed output: (AS, MS)
Aneurysm

Question 13

What can reduce diastolic filling time?

Answer 13

Tachycardia

Question 14

Post partum cardio?

Answer 14

Get huge increase in preload, need good LV function

Question 15

Worse cardiac lesions to have while preg?

Answer 15

Pulmonary HT
Cyanotic heart disease
NYHA III, IV

Question 16

Prepare pre-preg Counselling of cardiac?

Answer 16

Determine lesion
Assess NYHA
Advise prog
Consider if 
SBE prophylaces
Consider anticoag

Question 17

Risk of what post partum with cardiac disease?

Answer 17

Pulmonary oedema, give diuretics

Question 18

Thromboembolism need to do what?

Answer 18

Prevention
Detection
Good Rx.

Question 19

Thromboembolism cause/inter current risk factors?

Answer 19

Immobilized

Inadequate hydration

Question 20

Where likely for preg woman to get DVT?

Answer 20

85% in left leg

PE

Question 21

PE Ix?

Answer 21

VQ, CTPA

CXR

Question 22

Anticoagulation choices in preg?

Answer 22

LMW heparin

Question 23

Gestation sensitivities?

Answer 23

D0-D9 post conception

Resorption (>10 rads) or survive undamaged

Question 24

W3-w11 post conception imaging?

Answer 24

no adverse fetal effect at

Question 25

CXR fetal dose?

Question 26

4Ms in DM1 for fetus?

Answer 26

Mortality
Macrosomia
Malformation
Miscarriage

Question 27

Risks of obesity in mother for baby?

Answer 27

growth restrictions

Stillbirth risk

Question 28

What to do when talking to woman of reproductive age?

Answer 28

ASK HER HER PLANS FOR PREGNANCY!