maternal mortality

Question 1

maternal mortality

Answer 1

defined as the death of a women while pregnant or within 42 days of TOP, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
MMR- maternal mortality ratio

Question 2

perinatal deaths

Answer 2

o	Stillbirth – infant born after 28th week of pregnancy which did not breathe and show signs of life 
Early neonatal death
post neonatal
infant death
child death

Question 3

causes of maternal deaths

Answer 3

haemorrhage
hypertension
indirect malaria/HIV
Other direct
unsafe abortion
sepsis
embolism

Question 4

gestational trophoblastic disease

Answer 4

hydatidiform moles

common symptoms: vaginal bleeding, enlarged uterus, pelvic pain, hyperemesis

choriocarcinoma
-malignant, trophoblastic cancer, usually of the placenta. It is characterized by “early haematogenous spread” to the lungs. (SOB, pleuritic pain, haemoptysis)

Question 5

pathophysiology

Answer 5

o Each parent’s gametes carry a set number of genes of which some are methylated (inactivated).
♣ Mother’s changes promote early baby growth
♣ Father’s changes promote early placenta growth via trophoblast proliferation
o A complete mole is caused by a single sperm (90%) combining with an egg which has lost its DNA (the sperm then reduplicates forming a “complete” 46 chromosome set).

o A partial mole occurs when a haploid egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (tetraploid).

Complete hydatidiform moles account for 50% of all cases of choriocarcinoma
♣ Molar pregnancy trophoblast cells proliferate because they have too many of father’s methylated genes massive overgrowth of placenta

management:
suction curettage
anti-D prophylaxis is required following evacuation of a PHM

indications for chemotherapy
♣ Plateaued or rising hCG levels after evacuation.
♣ Histological evidence of choriocarcinoma.
Evidence of metastases
♣ Pulmonary, vulval, or vaginal metastases unless hCG concentrations are falling.
Heavy vaginal bleeding
Serum hCG greater than 20,000 IU/L more than four weeks after evacuation
advise not to conceive.