Module 2 - MBRACE Updates 2019-2022

Question 1

Define early and late maternal mortality.

Answer 1

Early is <42 days.
Late is 42 days to 1 year.

Question 2

What was the overall leading cause of death in the UK in 2022?

Answer 2

Covid 19
(previously cardiac disease).

Question 3

What proportion of deaths were indirect in 2022?

Answer 3

27%

Question 4

What is the leading cause of direct maternal death?

Answer 4

VTE

Question 5

Is sepsis a cause of direct or indirect maternal deaths?

Answer 5

It can be both.
Direct if pupural (genital sepsis).
Indirect if other source such as chest etc.

Question 6

What is the overall maternal death rate in the UK?

Answer 6

10.9 / 100,000

Question 7

What is the maternal death rate in the UK when covid is excluded?

Answer 7

10.5 / 100,000

Question 8

How much higher is the maternal death rate in black women compared to white women?

Answer 8

4 fold higher in Black women.

Question 9

How much higher is the maternal death rate in asian women compared to white women?

Answer 9

2 fold higher in Asian women.

Question 10

How much higher is the maternal death rate in the 20% most deprived women in society compared to that of the 20% most affluent women?

Answer 10

2.5 fold higher in 20% most deprived women.

Question 11

What is the biggest red flag for maternal suicide post natally?

Answer 11

Severe insomnia.

Question 12

Why can DKA be harder to diagnose in pregnant women?

Answer 12

1. DKA can occur with lower BMs.
2. Can be the first presentation of diabetes.

Question 13

What medication can precipitate DKA in pregnancy?

Answer 13

Steroids for foetal lung maturity.

Question 14

What symptoms should prompt consideration of cardiac disease in pregnant women?

Answer 14

Persistent cough.
Wheeze that does not respond to inhalers (this pulmonary oedema).
SOB.
Exertional syncope.
Orthoporea.
Palpitations.
Chest pain.
Multiple attendance with non resolving chest symptoms.

Question 15

What proportion of maternal mortalities have multiple and severe disadvantages?

Answer 15

11%

Question 16

What is a possible effect on foetal growth in women affected by both diabetes and HTN?

Answer 16

Diabetes can make babies grow larger. HTN can cause IUGR.
Therefore, possible to have normal centile baby but that baby may struggle to cope with labour and may suffer hypoglycaemia PN.

Question 17

What is the most common reason for death in EPAU patinets?

Answer 17

Thrombolysis being given before a ruptured ectopic has been ruled out.

Every collapsed female patient of child baring age should have UPT and FAST scan before thombolysis.

Question 18

What factors may put older mothers at increased risk?

Answer 18

parous, unplanned, late to engage with services, IVF (donated eggs), multiple pregnancy, pre-existing medical problems and obesity.

Question 19

What proportion of older mothers received care in line with all applicable guidelines?

Answer 19

<1/3

Question 20

What proportion of women who committed suicide suffered a pregnancy or PN loss?

Answer 20

1:3

(1:2 if drug use also present).

Question 21

What is the recommended time period between completing cancer treatment and conceiving (for most cancers)?

Answer 21

2 years.

Question 22

When should imaging be carried out if cancer is suspected? Or for staging?

Answer 22

Imaging should not be delayed due to pregnancy, the risk to the foetus will be outweighed by the benefits to mum.

Question 23

When should breast cancer be suspect in pregnant or PN women?

Answer 23

Un-resolving mastitis.

Question 24

Can a patient develop a PE whilst on prophylactic clexane?

Answer 24

Yes, so PE symptoms need to be investigated.

Question 25

What should be carried out if a VQ scan is inconclusive?

Answer 25

CTPA.

Question 26

How much higher is the risk of SUDEP in women with epilepsy compared to women without?

Answer 26

2xHigher maternal mortality rates.

Question 27

What are red flags for SUPED in epileptic women?

Answer 27

Uncontrolled seizures.
Tonic-Clonic seizures.
Nocturnal seizures (these are a huge red flag).
Epilepsy since childhood.

Question 28

Are there any increased risks in women who have previously had bariatric surgery?

Answer 28

Overall women who have previously had gastric surgery have lower risks that obese women, but higher risk than women who never had bariatric surgery.

There is a risk of anastomotic leak.

Question 29

What proportion of maternal deaths from cardiac causes had a known underlying cardiac condition?

Answer 29

25% had a known cardiac cause.

75% had no previous known cardiac disease.

Question 30

What measures can be taken to treat SVT in pregnancy.

Answer 30

1. Vasovagal manoeuvres
2. Adenosine
3. Electric cardioversion

Question 31

Is early foetal delivery recommended to facilitate chemotherapy in pregnant cancer pateints?

Answer 31

Generally no.
Risk balance will generally always favour mum receiving chemotherapy and then delivering around 39/40.
Remember that chemotherapy can be safe in 2nd and 3rd trimester.

Question 32

When should babies be delivered after chemotherapy in pregnancy?

Answer 32

Allow approx 2 weeks after last chemo dose before delivery in order to allow for foetal WCC to recover.