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MRCOG Maternal Medicine > MBRACE October 2023 > Flashcards

MBRACE October 2023 Flashcards

1
Q

Rate/100,000 women died during pregnancy or postpartum

A

11.7/100,000

If covid excluded 10.1/100,000

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2
Q

3 leading cases of death

A

Covid-19
Cardiac disease
Blood clots

All 14%

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3
Q

What % deaths caused by mental health conditions and sepsis

A

10%

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4
Q

What % of deaths caused by epilepsy/stroke

A

9%

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5
Q

How much more likely were black women and asian women likely to die vd white women

A

Black 4 x (37)
Asian 2 x (18)
White 9
/100,000

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6
Q

Pulse rate and blood pressure are maintained until what blood loss?

A

30% circulating blood volume lost

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7
Q

Definition maternal death

A

Death while pregnant or within 42 days from of pregnancy but not accidental or incidental

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8
Q

Direct maternal death

A

Obstetric cmomplicaiotn of the pregnancy state

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9
Q

Indirect maternal death

A

Previous pre-existing disease, disease during pregnancy but not result of direct obstetric cause

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10
Q

Late maternal death

A

Between 42 days and 1 years post partum - direct or non direct

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11
Q

Leading cause direct deaths

A

VTE

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12
Q

When does the majority if maternal suicide occur?

A

6 weeks to a year PP
39% maternal deaths during this period

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13
Q

Leading cause indirect

A

Covid 19
Cardiac

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14
Q

What proportion of maternal deaths are still pregnant at time of death

A

26%
66% of those <20/40

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15
Q

Higesr rates in terms of timing of death in Maternal deaths

A

Postnatal

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16
Q

Highest risk factor for direct and indirect deaths

A

Pre-exisiting medical problems (not obesity)

56% had pre-existing medical problem, 37% mental heal problem

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17
Q

What proportion of women who died were born outside UK

A

25%

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18
Q

What proportion of the women who died were overweight or obese?

A

58%

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19
Q

What proportion of the women who died received the recommended AN Care

A

53%

20
Q

What proportion of the women who died had a post mortar examination?

A

67%

21
Q

Major leaning points PPH

A
  • Cat 4 CS list operate from EMCS
  • Escalate in periods of high activity
  • Give blood products early in MOH, not to base decision on single coagulation test (FFP)
  • Consider if balloon is most appropriate, consider when to abandon
  • Abnormal invasive placentation - deliver at specilist centre - blood productions, adult intensive care, neonatal intensive care and MDT team with expertise in complex pelvic surgery
  • Main focus - control bleeding and replacing fluid volume
  • Massive haemorrhage call
  • Early escalation
  • 1 member of team recording rime
  • Protocol
  • senior has helicopter view
  • Estimated blood loss based on weight
  • MOH better treated fluid replacement than vasopressors, warmed fluid
22
Q

What dose of misoporostol should be given for IUD

A

<26+6 100mcg 6 hourly
>27 25-50 mcg 4 hourly

Caution uterine scare consider dinoprostone more appropriate

23
Q

Dose of mifepristone

A

200mg if non-scarred uterus

24
Q

When should placenta accreta speculum be delivered

A

35-36+6 weeks

25
Q

Chose of tracheal tube for pregnancy women should start at what size

A

7.0 then proceed to smaller tube

26
Q

Below what GCS should someone undergo tracheal incubated and mechanical lung ventilation

A

GCS equal <8 ot deterioratinf conscious level, fall >2, or fall in 1 more motor score requiring transfer

27
Q

What proportion of women have CS in England?

A

31%

28
Q

Most frequent indicate for re-operation?

A

Surgical haemorrhage related to uterotomy

29
Q

If low placenta and previous CS

A

Consider accreta, refer MRI
At CS incision should be above placenta

30
Q

Maternal survival following ECMO and live brith rate

A

75% surgical
70% live birth rate

31
Q

Which women are high risk of sepsis?

A

Pregnant women, have given birth or had a TOP within 6 weeks. Especially if vaginal bleeding or discharge.

PPROM

32
Q

What to include in counselling for extreme PPROM

A

Explained irks of matneral mortality and morbidity, impact on future pregnancies

Options include ending presence

33
Q

Red flags for Addisons

A

Vomiting
Weight Loss
Change in skin tone
Acidosis
Low Na

Give antiemetics so can tolerate medications

34
Q

Causes of nausea and vomiting in pregnancy

A

Hyperemesis gravidarum

Endocrine disorders (e.g. Addison’s disease, diabetes)

Infection

Gastrointestinal disorders (e.g. peptic ulcers, cholecystitis, gastroenteritis, pancreatitis, hepatitis)

Neurological disorders (e.g. migraine, intracerebral haemorrhage, increased intracranial pressure

Drug use

35
Q

When should women be admitted for nausea and vomiting in pregnancy?

A
  • Continued nausea and vomiting and inability to keep down oral antiemetics
  • Continued nausea and vomiting associated with clinical dehydration or weight loss (greater than 5% of body weight), despite oral antiemetics
  • Confirmed or suspected comorbidity (such as urinary tract infection and inability to tolerate oral antibiotics)
  • Co-morbidities such as epilepsy, diabetes, or HIV, where symptoms and inability to tolerate oral intake and medication could present further complications
36
Q

What proportion of women with asthma require hospital admission? What % require hospitalisation?

A

11-18% have 1 x ED visit
62% require hospitalisation I

37
Q

If woman of reproductive age present to ED, what should be included in their assessment particually if anaemia?

A

FAST scan ?intra-abdomninal bleeding

38
Q

Seizure at what time of day are a red flag and require urgent referral to epilepsy service/obstetric physician

A

Nocturnal seizures

39
Q

Suspected epilepsy related deaths should be investigated in what way?

A

a full post-mortem examination, including neuropathology, organ histology and toxicology, is required.

Toxicology of anti-seizure medication

40
Q

Red flags for headache

A
  • Sudden-onset headache / thunderclap or worst headache ever
  • Headache that takes longer than usual to resolve or persists for more than 48 hours
  • Has associated symptoms – fever, seizures, focal neurology, photophobia, diplopia
  • Excessive use of opioids

Headache PP should be investigated.

41
Q

What % of women with VP shunt will show symptoms of raised ICP in Pregnancy due to malfunction of the shunt

A

59%

42
Q

Symptoms raised ICP

A

headache often postural, vomiting, reduced consciousness level, gaze paresis (a sixth cranial nerve palsy), and seizures.

43
Q

New or permitting neurological symptoms in VP shunt

A

CT/MRI
Neurosurgeon referral

44
Q

Does a negative CT rule out ischaemic stroke

A

no poor early detect <3-6hr
MRI is more sensitive (consider DWI with SWI or T2 weighted)

45
Q

Risk of stroke in postpartum period vs non pregnanct

A

3 times

46
Q

What diagnostic tool should be used for suspected stroke or TIA

A

ROSIER (Recognition of Stroke in the Emergency Room).

47
Q

If suspect stroke

A

Pregnancy should not alter standard chew
Admit to hyperactive stroke unit

MRCOG Maternal Medicine (41 decks)

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