Puerperium Flashcards
What is the maternal mortality ratio?
Number of maternal deaths/100,000 livebirths
What is MBRRACE?
Confidential enquiries into maternal death
What is maternal death defined as?
Death during/up to 6 weeks after the end of pregnancy
Are direct or indirect maternal deaths more common?
Indirect maternal deaths
What is the leading cause of maternal death?
Cardiac disease
What is the most important factor associated with maternal death?
Medical comorbidites
Name 3 important risk factors for maternal mortality
- Black/Asian race
- Older age
- Overweight/obese
Is persistent breathlessness when lying flat normal in pregnancy?
No - may mean heart problems
Name 3 causes of maternal near-misses
Haemorrhage
Hypertension
Sepsis
Where in the world is maternal mortality highest?
Central Africa (up to 1 per 100 women giving birth)
Which country has the highest risk of maternal death?
Chad (1 in 15 lifetime risk)
How is the perinatal period defined?
During pregnancy and up to a year after the birth
What are ‘baby blues’?
Different to post partum depression/psychosis
May be hormonal - reduction in oestrogen following birth
How common are mental health issues during pregnancy?
1 in 4 women
What are the clinical features of perinatal depression?
Broken sleep Extreme tiredness Anhedonia Lack of interest Low mood (at least one most days etc for at least 2 weeks)
What are risk factors for perinatal depression?
Social risk factors/socioeconomic
Psychological (personality traits)
Biological (genetic, young age)
What percentage of pregnancies result in miscarriage?
15%
What are the 3 types of chromosome abnormality?
Aneuploidy
Rearrangements
Deletions/duplications
What are the 3 viable aneuploidy chromosomes?
13 = Patau 18 = Edwards 21 = Downs
What are the 2 types of chromosome translocations?
Robertsonian
Reciprocal
What are Robertsonian translocations?
Fusion of 2 acrocentric chromosomes (14, 15, 21, 22)
What are reciprocal translocations?
Exchange of material between 2 non-homologous chromosomes
If abnormality is detected on ultrasound scans, what genetic test is done first?
- QF-PCR for trisomies
2. If normal, tested with aCGH
Which vitamin can cause problems both in deficiency and excess during pregnancy?
Vitamin A
Which supplements should all pregnant women take?
- folate before and up to 12 weeks
- vitamin D (through breastfeeding too)
Why are vitamin D supplements recommended?
Prevent congenital rickets in newborn
Why are calcium supplements NOT recommended?
Mother adapts to meet increased calcium requirement through increasing intestinal absorption
When are iron supplements necessary in pregnancy?
If entering pregnancy with low iron stores
What are the current breastfeeding guidelines?
Exclusive breastfeeding up to 6 months
Then complementary foods plus breastfeeding for up to 2 years or beyond
Which vitamin supplements should be given from 6 months if not much infant formula is being given (<500ml per day)?
Vitamins A, C and D
What does infant formula lack compared to breast milk?
Immunological factors
Quantity and quality of macronutrients
Why is weaning at 6 months important?
Nutritional and developmental reasons
What are 3 signs that a baby is ready for solid food?
- Can sit and hold head up
- Can co-ordinate putting food in its mouth
- Can swallow food
