MBRACE October 2023 Flashcards
Rate/100,000 women died during pregnancy or postpartum
11.7/100,000
If covid excluded 10.1/100,000
3 leading cases of death
Covid-19
Cardiac disease
Blood clots
All 14%
What % deaths caused by mental health conditions and sepsis
10%
What % of deaths caused by epilepsy/stroke
9%
How much more likely were black women and asian women likely to die vd white women
Black 4 x (37)
Asian 2 x (18)
White 9
/100,000
Pulse rate and blood pressure are maintained until what blood loss?
30% circulating blood volume lost
Definition maternal death
Death while pregnant or within 42 days from of pregnancy but not accidental or incidental
Direct maternal death
Obstetric cmomplicaiotn of the pregnancy state
Indirect maternal death
Previous pre-existing disease, disease during pregnancy but not result of direct obstetric cause
Late maternal death
Between 42 days and 1 years post partum - direct or non direct
Leading cause direct deaths
VTE
When does the majority if maternal suicide occur?
6 weeks to a year PP
39% maternal deaths during this period
Leading cause indirect
Covid 19
Cardiac
What proportion of maternal deaths are still pregnant at time of death
26%
66% of those <20/40
Higesr rates in terms of timing of death in Maternal deaths
Postnatal
Highest risk factor for direct and indirect deaths
Pre-exisiting medical problems (not obesity)
56% had pre-existing medical problem, 37% mental heal problem
What proportion of women who died were born outside UK
25%
What proportion of the women who died were overweight or obese?
58%
What proportion of the women who died received the recommended AN Care
53%
What proportion of the women who died had a post mortar examination?
67%
Major leaning points PPH
- 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
What dose of misoporostol should be given for IUD
<26+6 100mcg 6 hourly
>27 25-50 mcg 4 hourly
Caution uterine scare consider dinoprostone more appropriate
Dose of mifepristone
200mg if non-scarred uterus
When should placenta accreta speculum be delivered
35-36+6 weeks
Chose of tracheal tube for pregnancy women should start at what size
7.0 then proceed to smaller tube
Below what GCS should someone undergo tracheal incubated and mechanical lung ventilation
GCS equal <8 ot deterioratinf conscious level, fall >2, or fall in 1 more motor score requiring transfer
What proportion of women have CS in England?
31%
Most frequent indicate for re-operation?
Surgical haemorrhage related to uterotomy
If low placenta and previous CS
Consider accreta, refer MRI
At CS incision should be above placenta
Maternal survival following ECMO and live brith rate
75% surgical
70% live birth rate
Which women are high risk of sepsis?
Pregnant women, have given birth or had a TOP within 6 weeks. Especially if vaginal bleeding or discharge.
PPROM
What to include in counselling for extreme PPROM
Explained irks of matneral mortality and morbidity, impact on future pregnancies
Options include ending presence
Red flags for Addisons
Vomiting
Weight Loss
Change in skin tone
Acidosis
Low Na
Give antiemetics so can tolerate medications
Causes of nausea and vomiting in pregnancy
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
When should women be admitted for nausea and vomiting in pregnancy?
- 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
What proportion of women with asthma require hospital admission? What % require hospitalisation?
11-18% have 1 x ED visit
62% require hospitalisation I
If woman of reproductive age present to ED, what should be included in their assessment particually if anaemia?
FAST scan ?intra-abdomninal bleeding
Seizure at what time of day are a red flag and require urgent referral to epilepsy service/obstetric physician
Nocturnal seizures
Suspected epilepsy related deaths should be investigated in what way?
a full post-mortem examination, including neuropathology, organ histology and toxicology, is required.
Toxicology of anti-seizure medication
Red flags for headache
- 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.
What % of women with VP shunt will show symptoms of raised ICP in Pregnancy due to malfunction of the shunt
59%
Symptoms raised ICP
headache often postural, vomiting, reduced consciousness level, gaze paresis (a sixth cranial nerve palsy), and seizures.
New or permitting neurological symptoms in VP shunt
CT/MRI
Neurosurgeon referral
Does a negative CT rule out ischaemic stroke
no poor early detect <3-6hr
MRI is more sensitive (consider DWI with SWI or T2 weighted)
Risk of stroke in postpartum period vs non pregnanct
3 times
What diagnostic tool should be used for suspected stroke or TIA
ROSIER (Recognition of Stroke in the Emergency Room).
If suspect stroke
Pregnancy should not alter standard chew
Admit to hyperactive stroke unit
