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DTM&H > Reproductive and Maternal Health > Flashcards

Reproductive and Maternal Health Flashcards

1
Q

Which groups of people have unmet needs for contraception?

A

– Adolescents
– Migrants
– Urban slum dwellers
– Refugees
– Women in the postpartum period

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2
Q

What guideline outlines the advice on contraception use?

A
  • MECC –> medical eligibility criteria for contraception use
    >2000 recommendations
  • Family Planning: a global handbook for practitioners
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3
Q

Define Maternal Death

A

the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes

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4
Q

Define maternal mortality ratio (MMR)

A

the number of maternal deaths during a given time period per 100000 live births during the same time period

it quantifies the risk of maternal death relative to the number of live births.

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5
Q

What is the global burden of maternal deaths?

A

Sub-Saharan Africa, South East Asia, Central America

90% of maternal deaths occur in LMICs

300 000 women die per year due to pregnancy related causes

NOTE: for every maternal death there are 20-30 women who have significant morbidity

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6
Q

What is the Three Delays Model?

A
  1. Delays in the decision to seek medical care
  2. Delays in reaching healthcare
  3. Delays in receiving appropriate health care
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7
Q

What percentage of women (globally) will have an obstetric complication?

What percentage need emergency obstetric care?

A

40%

15% - difficult to predict

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8
Q

What is FNAC and what are its components?

A

Focussed Antenatal Care

Includes: Pregnancy, Bird, Post-Natal, Neonatal period

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9
Q

How many antenatal clinic visits are recommended by FNAC?

A

8 (previously 4 but found that increasing to 8 reduced maternal and foetal deaths by 8:1000)

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10
Q

What is advised in the first ANC visit?

A

Should happen before 16 weeks

Antenatal card
Take history
Physical exam
Consent for screening
Iron/folate
1st dose TT (tetanus toxoid)
ITN
Give 2nd appointment

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11
Q

What is advised in the second ANC visit?

A

24-28 weeks

Action lab results
Correct anaemia
Treat syphilis
Start ART
Repeat HIV test if negative
2nd dose TT
1st dose malaria prophylaxis (SP)
1st dose anthelminthic (Albendazole)

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12
Q

What is advised in the third ANC visit?

A

32 Weeks

Recheck Hb
Check uterine size
Palpate fetus
2nd dose malaria prophylaxis
2nd dose anthelminthic
Discuss emergency preparedness

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13
Q

What is advised in the fourth ANC visit?

A

36 weeks

Check uterine size
Palpate fetus
Hb level
? pelvic exam
Counsel signs of labour
Review birth plan

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14
Q

How many stillbirths occur globally each year?

A

2.6 million, 50% of which occur in areas of conflict/emergency

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15
Q

Which three infectious diseases are most associated with stillbirth?

A

HIV
Malaria
Syphillis

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16
Q

What are the Global health agendas focussed on improving maternal health?

A

Sustainability Development Goals

Global Strategy for Women’s,
Children’s and Adolescents’ Health
(2016–2030)

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17
Q

How does the WHO Sustainability Development Goal #3 aim to reduce maternal mortality?

A
  • Aims to provide universal health care access to all, including pregnant women
  • Skilled healthcare professional available to pregnant women
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18
Q

What are the WHO recommendations on iron and folic acid supplementation in pregnancy?

A

Daily oral iron and folic acid supplementation with 30 mg to 60 mg
of elemental iron and 400 g (0.4 mg) of folic acid is recommended
for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

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19
Q

What are the WHO recommendations on calcium supplementation in pregnancy?

A

In populations with low dietary calcium intake, daily calcium supplementation (1.5–2.0 g oral elemental calcium) is recommended for pregnant women to reduce the risk of pre-eclampsia.

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20
Q

What are the WHO recommendations on Vitamin A supplementation in pregnancy?

A

Vitamin A supplementation is only recommended for pregnant women in areas where vitamin A deficiency is a severe public health problem, to prevent night blindness.

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21
Q

Which maternal diseases/conditions should be tested/enquired about in pregnancy?

A

GDM
Alcohol
Smoking
HIV
Syphillis

+/- Anaemia
+/- TB

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22
Q

What is the minimum number of USS scans a woman should have during her pregnancy, according to the WHO?

A

1

One ultrasound scan before 24 weeks of gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience.

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23
Q

What is considered a ‘good delivery’ according to the WHO?

A
  • spontaneous
  • low risk
  • vertex position
  • delivery between 37 and 42 weeks
  • mother and baby are in good condition post-nataly
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24
Q

Define Latent stage of labour

A

Painful uterine contractions, cervical changes and dilation <5 cm

One contraction at least every 10 minutes

** Intervening at this time is inappropriate, unless you have concerns about maternal/foetal well-being. Labour only really starts to progress at >5cm

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25
Q

Define Active First Stage of Labour

A

from 5cm cervical dilatation to full cervical dilatation.

Does not usually extend beyond 12 hours in first labours and 10 hours in subsequent labours

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26
Q

Define the second stage of labour?

A

The second stage is the period of time between full cervical dilatation and birth of the baby, during which the woman has an involuntary urge to bear down, as a result of expulsive uterine contractions.

Women should be informed that the duration of the second stage varies from one woman to another. In first labours, birth is usually completed within 3 hours whereas in subsequent labours, birth is usually completed within 2 hours.

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27
Q

How often should PV examinations be carried out to monitor the progress of labour?

A

4 hourly

** if concerned about OL then re-examine every 2 hours

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28
Q

When should the foetal heart rate be recorded during labour?

A
  • Active 1st stage: every 15 - 30 minutes for 60 seconds during a contraction and for at least 30 seconds thereafter
  • 2nd stage: every 5 minutes
  • Good practice to record maternal pulse with every FH recording
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29
Q

When should you consider applying fundal pressure to help labour progress?

A

never!!

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30
Q

Is membrane rupture recommended during normal labour? Why?

A

No

Not part of normal labour.
* Increase risk of MTCT
* Increase risk of infection
It is not an effective method of shortening spontaneous labour and ↑ risk of CS and FH abnormalities

If labour slowing down use “benign” methods first – change of position, movement.

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31
Q

When should you start using a partograph

A

> 4cms or whenever the mother presents, if she is >4 cm

Measure the number and intensity of contractions along a graph, which helps you to determine how the labour is progressing

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32
Q

What document can be used as a good alternative to the partograph?

A

The WHO Labour Care Guide

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33
Q

What are the Pros and Cons of using a partograph?

A

CONS
- labour intensive
- aims for 1cm dilation per hour, but guidelines state that this is probably too fast for most women
- assumes that labour is a linear progression

PROS
- can help you make a decision about low progression/identification of OL

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34
Q

What medication can be given to reduce the risk of PPH

A

Oxytocin (10 IU IV/IM)

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35
Q

What is the suggested immediate newborn care in a normal delivery?

A
  • Deliver baby onto abdomen or into arms of mother
  • Delay cord clamping (1-3 mins)
  • Immediate and thorough drying with warm, clean towel
  • Assess breathing and if required manage resuscitation
  • Wipe eyes
  • Skin to skin contact (keep warm) plus hat or head cover for baby
  • Early initiation of breastfeeding and exclusive breastfeeding
  • Vitamin K (1mg) IM
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36
Q

What are the main causes of Maternity death?

A

Haemorrhage
Hypertension
Sepsis

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37
Q

What are the three main causes of neonatal death

A

Prematurity
Birth Asphyxia
Sepsis

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38
Q

What are appropriate timings for post-natal follow up

A

Day 1
Day 3
Day 7-14
6 weeks

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39
Q

What are the 7 major causes of maternal death and complications, which are targetted by EMOC (Emergency obstetric care)

A
  1. Sepsis and other maternal infections
  2. Haemorrhage
  3. Hypertensive conditions
  4. Indirect causes
  5. Complications of unsafe abortions
  6. Obstructed labour
  7. Other maternal disorders
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40
Q

What are the main components of simple EmOC? (so-called ‘Signal Functions”

A
  1. Parenteral oxytoics
  2. parenteral antibiotics
  3. Parenteral anticonvulsants
  4. Manual vacuum aspiration
  5. manual removal of placenta
  6. Assisted vaginal delivery
  7. Neonatal resus kit wtih bag and mask
    ± surgical cesarean options
    ± blood transfusion services
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41
Q

How quickly does mortality occur in an un-managed post-partum haemorrhage?

A

2 hours

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42
Q

What are the 6 UN EMOC care standards?

A
  1. Available EMOC facilities (basic and comprehensive) (1:4 per 500000 people)
  2. Evenly geographical spread of EMOC facilities
  3. A proportion of countries (individuallly determined) should have some births in an EMOC facility
  4. 100% of women with obstetric complications should recieve EMOC care
  5. 5-15% of all births should be done by c-section
  6. Direct case fatality rate should be <1
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43
Q

What EMOC facilities should be available in a population of 500000 people?

A

1 comprehensive EMOC package (EMOC + surgical campabilities + transfusion capabilities) and 4 basic EMOC packages

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44
Q

What is an SBA?
Why are they important?

A

Skilled Birth Attendant

Direct ocrrelation between presence of SBA at delivery and a reduction in maternal and child mortality

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45
Q

What percentage of maternal deaths occur due to haemorrhage?

A

25-30%

62% of these are post-partum

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46
Q

What is a post-partum haemorrhage (PPH)?

A

estimated blood loss of more than 500 mL within 24 hours of a vaginal birth or 1,000 mL after caesarean section, or any blood loss sufficient to
compromise haemodynamic stability

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47
Q

What is the definition of a massive PPH?

A

loss of 2000ml or more of blood from the genital tract within 24 hours of the birth of the baby or when the woman is haemodynamically compromised or showing signs of shock as a result of obstetric haemorrhage of any amount over 500 mls

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48
Q

What is secondary PPH?

A

Significant blood loss from the genital tract >24h after delivery, but within 6 weeks

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49
Q

How much blood loss does a woman need to lose acutely before she starts to show clinical signs

(tachycardia, tachypnoea, hypotension)

A

1500ml + (or 30% of her blood volume)

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50
Q

What are the 4 Ts of PPH?

A

Tone (>70%)
Thrombus
Tissue
Trauma

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51
Q

What are risk factors of decreased tone?

A

Multi-parity
Intra-amniotic infection
Functional / anatomical dysfxn of uterus
- Rapid labour, prolonged labour, fibroids, placenta praevia, uterine anomalies
Uterine relaxants
- magnesium, nifedipine
Bladder distension

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52
Q

How should you prevent hypotonic uterus post-partum?

A
  1. Oxytocin 10IU IM/IV
    - 2nd line: Carbotosin, misoprostol, ergometrine
  2. Delayed cord cramping (1-3 minutes)
  3. Cord tractions
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53
Q

What drug can be used to increase tone in the absence of SBAs?

A

Misoprostol 400-600mg PO

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54
Q

How does oxytocin/carbotecin work to increase tone?

A

Synthetic Mimic of naturally oxytocin

Binds to uterine wall muscles and increases sodium channel permeability, causing uterine contraction

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55
Q

When should you consider using TXA in PPH?

What is the dose?

A

If a bleed occurs within 3h of birth

1g IV (1ml/min over 10 min)

A further dose can be repeated if the bleeding continues within 24h

56
Q

What is the management of Mild PPH (500-1000mls)

A
  1. ABCDE
  2. Oxytocin 10IU (consider repeat dose 40IU if already 10 units had been given with no improvement
  3. IV TXA 1g over 10min (if within 3 hours of delivery) ± repeat dose if bleeding ongoing after 30 minutes
57
Q

What is the management of Severe PPH? (>1000mls)

A
  1. ABCDE including fluid resus (crystalloids)
  2. Blood transfusion
  3. Repeat Oxytocin 10IU or misoprostol 600mcg STAT
  4. TXA 1g over 10mins
  5. Oxytocin infusion 40IU in 500ml 0.9% NaCl

±repeat dose TXA
±external aortic compression
± uterine balloon tamponade (UBT)
± broad spectrum abx
± bimanual uterine compression
± non-pneumatic anti-shock garment
± referral to specialist EMOC centre

58
Q

Is uterine packing recommended for atonicty?

A

No

59
Q

What suture is recommended for closing an atonic uterus?

A

B-Lynch suture

60
Q

What percentage of women suffer from pre-eclampsia globally?

Eclampsia?

A

5%

1.5%

61
Q

What are the 4 hypertensive disorders seen in pregnancy?

A

Chronic hypertension
Pregnancy hypertension
Pre-eclampsia super-imposed on chronic hypertension
Pre-Eclampsia (BP >140/90 + proteinuria after 20 weeks; Dipstick protein >2+)

62
Q

What is eclampsia?

A

Raised BP > 20 weeks + seizures

Consider eclampsia as the diagnosis of first seizures in any pregnant women >20 weeks until proven otherwise

Can be ante/intra/post partum
Post-partum has the poorest prognosis

63
Q

What are the risk factors for pre-eclampsia?

A
  • Primigravida
  • Previous history
  • Teenager or >40years
  • Family history
  • Multiple pregnancy
  • Multigravida + new partner
  • Obesity & medical comorbidities
  • > 10 years pregnancy interval
64
Q

What are the signs of severe pre-eclampsia?

A

**MULTI ORGAN INVOLVEMENT SECONDARY TO HYPERTENSION:

  • BP of ≥160 and/or ≥110 mm Hg - 2 occasions at least 4 hours apart or a single such reading level if antihypertensive drug treatment was initiated
  • “HELLP” syndrome (Heamolysis, elevated liver enzymes, low platelets)
  • Intrauterine growth restriction (IUGR)
  • Proteinuria >5g in a 24-hour collection or more than 3+ on 2 random urine samples collected at least 4 hours apart
  • Increased serum creatinine
  • Oliguria <500mls/24hrs
  • Cerebral or visual disturbances
  • Epigastric pain (hepatic)
  • Retinal Hemorrhages, exudates, papilledema
  • Pulmonary edema, presenting with cyanosis
  • Oligohydramnios, decreased fetal growth, or placental abruption
65
Q

What medication should you give in women who are considered high risk of pre-eclampsia?

A

Aspirin 75-150mg OD from Week 12 until Birth

66
Q

What are maternal complications of eclampisa?

A
  • Death
  • Disseminated Intravascular coagulation
  • Acute renal failure
  • Hepatocellular damage
  • Cerebrovascular accident
  • Aspiration, pulmonary edema
  • Temporary blindness
  • Mental health impact
67
Q

What are neonatal/foetal complications of eclampsia?

A
  • Intrauterine growth restriction (IUGR)
  • Small for gestational age (SGA)
  • Preterm birth
  • NICU admission
  • Abruption
  • Intrauterine Fetal Death (IUFD)
68
Q

What is the general management for eclampsia?

A
  1. ABC + seizure termination
  2. Reduce BP
  3. Consider other causes of seizure
  4. Delivery (ideally vaginal) –> definitive treatment!

(Recall: this spells out ABCD!!)

69
Q

How do you manage seizures in eclampsia?

A
  1. O2
  2. Maintain airway
  3. Recovery position
  4. MgSO4

** Diazepam NOT recommended due to profound impact on neonatal respiratory function

70
Q

How does MgSO4 work in eclaampsia?

A

Cerebral vasodilation
Neuro-endothelial protection against free radicals
Competitive antagonist to glutamate (which loves to cause seizures!!)

71
Q

What does of MgSO4 should you give in eclampsia?

A

4g loading dose –> 10g maintenance dose

72
Q

What are signs of MgSO4 toxicity?
How can you manage this?

A

Low UO
Poor patellar relfexes
Respiatory depression
Cardiac arrest

Management:
Stop MgSO4
Give Calcium Gluconate 1g IV over 10 min

Toxicity:
* 10 mEq/L [12 mg/dL]-Patellarreflex lost
* 12 mEq/L [ 14.4 mg/dL]-Respiration depression
* 14 mEq/L-Cardiac arrest

73
Q

What is a normal duration of foetal bradycardia after a meternal eclamptic seizure?

A

3-5 min

If the foetal brady lasts longer than this consider CS

74
Q

How should you manage hypertension in pre-eclampsia?

A
  • Hydralazine 5 mg bolus i.v q 20 min
    OR
  • Labetalol 10 – 20 mg i.v push, rpt 10 – 20 min with doubling doses, not to exceed 80 mg in any one dose
    OR
  • Nifedipine orally
75
Q

What is the definition of obstructed labour?

A

Established labour (5 cms onwards) that has ceased to progress or

Failure of the fetus to descend through the birth canal despite strong uterine contractions

76
Q

What are the 4 Ps (cuases) of obstructed labour?

A

Power

Passenger (foetus) –> brown presentation, shoulder presentation, hydrocephalus, e.g.

Passage

Psyche

77
Q

What are signs of obstructed labour?

A

*Maternal pyrexia
*Raised pulse and respiratory rate
*Raised fetal heart rate
*Signs of dehydration
*Oedematous cervix
*Moulding +++
*Excessive caput
*Bandl’s ring (precludes uterine rupture!!!)

78
Q

How do you manage obstructed labour?

A

Maternal A-E
Assess foetal well-being
PV examination ? Bandl’s ring ?concerns about uterine rupture?? cervical oedema?
Catheterise
IV abx (PROM!)
Birth
- CS if foetus is alive
- assisted vaginal delivery +/- epysiotomy

79
Q

When is CS appropriate in OL?

A

*During first stage of labour, cervix <10cms dilated
*During second stage if fetal head >1/5 palpable in maternal abdomen above pubic symphysis
*If evidence of excessive moulding
*If no staff available with requisite skill in conducting Assisted Vaginal Birth
*Woman gives informed consent
*All cases of obstructed labour where Assisted vaginal birth is contra-indicated

**NB caesareans in late second stage are associated with increased morbidity and mortality

80
Q

When is assisted vaginal delivery appropriate in OL?

A

*Must be in the second stage of labour, cervix must be fully dilated
*Presenting part must be descended such that a maximum of 1/5 or less of the fetal head is palpable above the pubic symphysis
*Presenting part at level of ischial spines or lower vaginally
*Excessive moulding excluded (NB: a degree of moulding is normal)
*Position of fetal head identified (Occipito-anterior, occipito-transverse, occipito-posterior, oblique)
*Malpresentations excluded, only vertex presentation suitable
*Fetus 36 weeks gestation or more
*Woman gives informed consent
*If Intra-uterine fetal death, must be recent (to avoid maceration)
*Trained operator available to do procedure and equipment in working order

81
Q

What are the main complications of obstructed labour?

A

*Maternal dehydration, ketosis and exhaustion

*Fetal distress, birth asphyxia, intrauterine death, neonatal HIE and death

*Maternal and neonatal infection

*Post partum haemorrhage

*Uterine rupture (5%)

*Obstetric fistula

*Maternal death

82
Q

Why does OL cause an obstetric fistula?

A

Pressure on the tissues between the foetal head and the maternal pelvis –> lack of O2 –> tissue death, necrosis and fistula formation

83
Q

What is the incidence of obstetric fistula?

A

1-2 million cases in SSA alone, secondary to OP

84
Q

How can you prevent/manage obstetric fistulas?

A
  • urinary catheter insertion during/after OL. Leave in for 2/52 (unless evidence of fistula, in which case you should leave it in for 6 weeks
  • > 6 weeks and fistula still present? –> surgical referral
85
Q

How long should a woman remain catheterised in the evidence of a fistula?

A

6 weeks

86
Q

What are the complications of incorrectly managed fistula?

A

lifelong incontinence
social isolation

87
Q

What are the risk factors associated with uterine tupture?

A

Previous CS
Poor antenatal care
Parity ? 4
No partograph use
Use of herbs (?? due to lack of seeking out medical care)
Lack of maternal education

88
Q

What are the complications of uterine rupture?

A
  • Maternal death
  • Stillbirth
  • Hysterectomy
  • Repair ± bilateral tubal ligation (BTL) –> infertility
89
Q

What percentage of maternal deaths are due to sepsis?

A

30%

90
Q

Where are the main foci of maternal sepsis in the body?

A
  1. endometritis
  2. respiratory
  3. urinary tract
91
Q

What are the three most common bacteria assocaited with maternal sepsis?

A

E-Coli (antepartum)
GBS (intrapartum)
GAS (post partum)

92
Q

What are important obstetric surgical causes in maternal sepsis?

A

Infected retained products
Wound abscess (abdominal or perineal)
Pelvic abscess

93
Q

What are non-surgical obstetric causes of maternal sepsis?

A

Endometritis
Chorioamnioitis

94
Q

How does chorioamnionitis present?

A
  • Usually due to ascending infection especially
    after preterm or prolonged membrane rupture
  • Signs include pyrexia, green, foul smelling
    discharge
  • Pyrexia
  • Fetal tachycardia
95
Q

How do you manage chorioamnionitis?

A

IV Abx (Ampicillin + Gentamicin)
Delivery and removal of products of conception

**foetal detah imminent

96
Q

How does endometritis present?

A
  • Consider when postpartum fever, especially after CS
  • abdominal tenderness, fever, foul discharge,
    bleeding
  • May progress to pelvic abscess, peritonitis, septic shock or chronic pelvic infection with infertility
  • Risk of secondary PPH
97
Q

How should you manage endometritis?

A

IV Abx (Clindamycin + Gentamicin)
Consider evacuation if any concerns about retained products

98
Q

Should prophylactic abx be used in CS?

A

YES

They should also be administered prior to incision

99
Q

How can we reduce the number of complications from Group B Strep (GBS)?

A
  • Intrapartum antibiotic administration to women with confirmed GBS
100
Q

When should a woman get prophylactic antibiotics in the context of labour?

A
  1. Confirmed GBS infection
  2. Pre-PROM
  3. Prior to skin incision in CS
  4. After manual removal of placenta products
  5. 3rd/4th degree perineal tears
101
Q

What is the leading cause of maternal death worldwide?

A

PPH

102
Q

What percentage of maternal deaths occur within the first 24h of delivery?

A

50%

103
Q

What percentage of neonatal deaths occur within the first 24h?

A

40%

2.5 million babies die within the first 28 days of life

104
Q

What is the definition of the post natal period?

A

The period from the delivery of the
placenta and membranes up to six weeks (42 days) after delivery.

  • Early postnatal period - first 24 hours
    after delivery
  • Late postnatal period – after 24hrs up
    to six weeks.
105
Q

How many PN check ups are recommended? When are they?

A

4

  1. Immediately post-natal
  2. Day 3
  3. Days 7-14
  4. 6 weeks
106
Q

What are examples of maternal red flags in the PNC that would prompt further investigation?

A
  • Feels generally ill
  • Swollen hands, face and legs with severe headache and blurred vision
  • Convulsions
  • Raised BP
  • Fever (temperature >37.5C)
  • Breathlessness, excessive tiredness or severe pallor
  • Breasts swollen, red or tender breasts/nipples
  • Foul smelling vaginal discharge
  • Severe abdominal pain
  • Perineal infection or pain
  • Increased bleeding especially if bright red or clots
  • Calf pain/ redness/ swelling or chest pain
107
Q

What are examples of neonatal red flags in the PNC that would prompt further investigation?

A
  • Convulsions
  • Lethargic or unconscious
  • Inability to breast feed
  • Vomits after every feed
  • High temperature 37.5°C or more or low temperature 36.4°C or less
  • Breathing at a rate of 60 breaths per
    minutes or more
  • Severe chest in-drawing or grunting
  • Infection on the umbilicus
  • Any jaundice in the first 24 hours of life
  • Yellow soles (severe jaundice) needs
    urgent referral
  • Low birth weight (<2.5kg)
108
Q

Is chlorhexadine wash useful in post-natal cord care?

A

Daily chlorhexidine (4%) application to the umbilical cord stump during the first week of life is recommended for newborns who are born at home in settings with high neonatal mortality (neonatal mortality rate >30 per 1000).

It is not recommended in babies who have had a birth in a health care facility and now have a clean, dry UC

109
Q

What were the burden findings of Benign Gynaecological Conditions (BGC) study?

A
  • Most comprehensive study of BGCs to date, looking at morbidity as an outcome

Aimed to highlight BGC as an important global health prioroity, comparing important BGC conditions against HIV/AIDS/malaria epidemiology

Endometriosis, PID, PCOS, fibroids, infertility, miscarige, ectopic pregnancy and ‘other’ (menstrual abnormalities)

Findings:
-BGC accounts for 5.05% of all DALYs/YLds (HIV/TB/Malaria account for just 1%)
-BGC affects women through their life course

110
Q

What are the 4 most common STIs?

A

Chlamydia
gonorrhoea
syphillis
trichomoniasis

111
Q

What is the prevalence of ectopic pregnancy globally?

A

1-5%

112
Q

What is the epidemiology of Molar Pregnancy?

A

Greater incidence in SSA and SEA
Extremes of age: teenage girls, ‘geriatric’ mums

113
Q

What percentage of maternal deaths occur due to abortion?

A

15%

114
Q

How many people are affecting by lack of adequate family planning?

A

222 million people

115
Q

Why is contraception important?

A

Could reduce maternal mortality by 1/3 by reducing the number of unsafe abortions and unsafe labour conditions

116
Q

What is the commonest cancer to affect women in SSA and SA?

A

Cervical Cancer

117
Q

What virus is assocaited with Cervical Cancer?

A

HPV

118
Q

How can we reduce the incidence of cervical ca?

A

HPV vax
Cervical screening programmes

119
Q

How does the 5th SDG focus on maternal health

A

‘Gender Equality’

120
Q

What is the management of COVID-19 in pregnant women?

A
  1. Oxygen – titrate supplemental oxygen to keep sats >94%
  2. Thromboprophylaxis – prophylactic LMWH dose according to weight
  3. Corticosteroids – if oxygen dependent give for a total of 10 days
  4. If steroids used for fetal lung maturation use Dexamethasone
  5. Check anti-spike (anti-S) SARS-CoV-2 antibodies
121
Q

For women who deliver in a healthcare facility, how long should they be monitored for in the post-natal period?

A

24h

122
Q

How long are women recommended to exclusively breastfeed for?

A

6 months (but mixed feeds for up to 2 years)

123
Q

How long should a mum wait before bathing her child?

A

24h
Important to keep the cord dry

124
Q

What maternal observations should be checked post-natally?

A

HR
BP (repeat in 6 hours if normal)
UO
Fundal height
PV bleeding
Uterine tonicity/contractions
Temperature

125
Q

How long should folic acid and iron supplements be continued in the post-natal period?

A

3/12

126
Q

Which one of the following is NOT a risk factor for uterine
atony?
A. Rapid/precipitate labour
B. Fever
C. Hypertension
D. Prolonged labour
E. A full bladder

A

C. Hypertension

127
Q

Which one of the following medications used to treat post-partum haemorrhage is correctly matched with its advantage?

A. Misoprostol – Multiple routes
of administration
B. Ergometrine – Safe in
hypertensive mothers
C. Oxytocin – No risk of fluid
retention
D. Carbetocin – shorter half-life
E. Tranexamic Acid – effective in
secondary PPH

A

A. Misoprostol has multiple routes of administration

128
Q

Identify a correct management approach for eclampsia from
the sequence below:

A. Delivery –> stop the convulsions –> control the BP –> treat other possible causes of convulsions

B. Control the BP –> delivery –> Stop the convulsions –> treat other possible causes of convulsions

C. Treat other possible causes of convulsions ؘ –> control the BP –> stop the convulsions –> delivery

D. Stop the convulsions –> control the BP –> treat other possible causes of convulsions –> delivery

E. Stop the convulsions –> treat other possible causes of convulsions –> control the BP –>
delivery

A

D. Stop the convulsions –> control the BP –> treat other possible causes of convulsions –> delivery

129
Q

Which one of the following will NOT prevent you from administering the next scheduled dose of MgSO4?

A. Severe Hypertension
B. Decrease patella reflex
C. Reduced respiratory rate
D. Reduced urine output
E. Unconsciousness

A

A. Severe Hypertension

130
Q

Which one of the following factors is NOT a HIGH RISK factor
for pre-eclampsia?

A. Chronic hypertension
B. Pre-eclampsia during the previous pregnancy
C. Family history of pre-eclampsia
D. Type 1 diabetes mellitus
E. Chronic kidney disease

A

C. Family history of pre-eclampsia

131
Q

Which one of the following statements is FALSE?

A. Urinary bladder catheterization
may help to heal small obstetric
fistulae spontaneously

B. Applying fundal pressure during
the second stage of labour is not
recommended

C. In general multiparous women
progress in labour faster than a primiparous women

D. Clinical pelvimetry is reliable in
predicting labour outcome

E. A companion during labour
improves labour outcomes

A

D. Clinical pelvimetry is reliable in
predicting labour outcome

132
Q

All of the following increase progressively during the active
phase of labour EXCEPT?
A. Fetal heart rate
B. Cervical dilatation
C. Frequency of uterine
contractions
D. Intensity of uterine contractions
E. Descent of the presenting part

A

A. Foetal HR

133
Q

Regarding the quick Sequential Organ Failure Assessment (qSOFA), which one of the
following is TRUE?

A. A qSOFA score ≥ 5 is suggestive
of sepsis

B. An altered mental state alone is
enough to diagnose sepsis

C. A respiratory rate ≥ 22
breaths/min is suggestive of
sepsis

D. A respiratory rate ≤ 22
breaths/min is suggestive of
sepsis

E. A systolic blood pressure (SBP) ≥
100 mm Hg is suggestive of
sepsis

A

C. A respiratory rate ≥ 22
breaths/min is suggestive of
sepsis

134
Q

When should antenatal steroids be given to the mother?

A

Antenatal corticosteroid therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:

gestational age assessment can be accurately undertaken

preterm birth is considered imminent

there is no clinical evidence of maternal infection

135
Q

When is magnesium sulphate recommended in pregnancy?

A
  • Eclampsia seizures
  • women at risk of imminent preterm birth before32 weeks of gestation for prevention of cerebral palsy in the infant and child.
136
Q

What antibiotic is recommended by the WHO in the event of preterm-ROM

A

Erythromycin

137
Q

what percentage of O2 therapy should you be using in very pre-term infants (<32 weeks) requiring respiratory support?

A

30% O2

DTM&H (29 decks)

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