Obs - morbidity & mortality

Question 1

define stillbirth

Answer 1

Stillbirth occurs when a fetus is delivered after 24

completed weeks’ gestation showing no signs of life.

Question 2

define neonatal death

Answer 2

Neonatal death is defined as death occurring within

28 days of delivery.

Question 3

define early neonatal death

Answer 3

Early neonatal death occurs within 7 days of delivery.

Question 4

define perinatal mortality rate

Answer 4

is the sum of stillbirths

and early neonatal deaths per 1000 total births.

Question 5

what are the principal causes of perinatal mortality?

Answer 5

Unexplained antepartum stillbirth - perhaps aortocaval compression due to sleeping position of mother

Intrauterine growth restriction (IUGR) and placental
failure

Preterm delivery - MOST COMMON cause

Congenital anomalies
Intrapartum hypoxia
Antepartum haemorrhage

others:
infection, pre-eclampsiia (contributes to some of above)

Question 6

define miscarriage

Answer 6

Miscarriage occurs when a fetus is born with no signs

of life before 24 weeks’ gestation

Question 7

define maternal mortality

Answer 7

A maternal death is the death of a woman during pregnancy,
or within 42 days of its cessation, from any cause
related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Question 8

define late maternal death

Answer 8

A late maternal death is when a woman dies from pregnancy related
causes but more than 42 days-6weeks - 6months
after cessation of the pregnancy.

Question 9

List the causes of maternal mortality ?

Answer 9

Direct:
Thromboembolism - Most common
Hypertensive disorders
Ectopic pregnancy - rupture n bleed
Haemorrhage
Anaesthesia - eg epidural haematoma 
Acute fatty liver
Sepsis - Group A strep

Indirect:
Cardiac disease
Neurological disease - eg epilepsy
Respiratory - flu, asthma 
Psychiatric disease and suicide
Others: domestic violence, drug/alcohol

Question 10

What are the causes of maternal collapse?

Answer 10

Reversible causes ; The 4 H’s and 4T’s:
o Hypoxia
o Hyper/Hypokalaemia
o Hypo/Hyperthermia
o Hydrogen ions (acidosis) o Hypoglycaemia
o Tension pneumothorax o Tamponade
o Toxins
o Trauma

Haemorrhage :
 Placental abruption/praevia
Eclampsia - intracranial bleed

Drugs - local anaesthetic or illicit drugs

Cardiac - arrhythmias, MI

Infectious - Sepsis

Question 11

How do you manage maternal collapse?

Answer 11

Responsive:
Call for senior help
Left lateral position, basic obs, fetal ctg

Unresponsive:
ABCDE
Oxygen, CPR (no pulse), get crash cart, call for senior help
No response -> perimortem csection
Responds -> post cardiac arrest treatment; oxygen, ecg, treat reversible causes eg hypothermia