UK Reproductive Health Flashcards
Definition of fertility?
Measure of reproductive output usually expressed as a fertility rate: ie 2.4 births per woman
What is fecundity?
Potential to reproduce (may have no children YET)
What is a ‘maternal death’?
Death of a woman while pregnant or within 42 days of the end of the pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes
What is a ‘direct’ maternal death?
Death resulting from obstetric complications of the pregnant state, from interventions, omissions, incorrect treatment etc
What is an ‘indirect’ maternal death?
Death resulting from previous existing disease, or disease that developed during pregnancy and was not a result of direct obstetric causes, but which was aggravated by the effects of pregnancy
What is a ‘late’ maternal death?
Death occurring between 42 days and 1 year after the end of the pregnancy (includes giving birth, ectopic, miscarriage, abortion) that is result of direct or indirect maternal cause
What is ‘coincidental’ maternal death?
Death from unrelated causes which happen to occur in pregnancy or the puerperium
What is puerperium?
Period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.
What are major causes of direct maternal deaths?
Thrombosis Haemorrhage Amniotic Fluid Embolism Genital tract sepsis PET Early pregnancy Anaesthesia
How is maternal mortality ratio measured?
Maternal deaths per 100,000 live births
What is the maternal mortality ratio in the UK?
8.8
What is postpartum endometrisis?
Infection travels up from vagina to uterus
Infection of the lining of the womb which can occur up to six weeks after childbirth.
When is postpartum endometrisis more common?
After C section
What are the symptoms of endometrisis?
- Fever, malaise, rigors, headache
- Abdominal pain
- Offensive lochia
- Secondary PPH
What is secondary PPH?
Secondary postpartum haemorrhage is defined as excessive vaginal bleeding in the period from 24 hours after delivery to twelve weeks postpartum.
What is lochia?
The vaginal discharge after giving birth, containing blood, mucus, and uterine tissue.
Why are pregnant women at an increased risk of clots?
- Hypercoaguable state
- Enlarged uterus may increase the risk because it puts the veins of the lower body under additional pressure to return blood to the heart
Why are pregnant women in a hypercoaguable state?
Fibrinogen can rise up to three times its normal value. Thrombin levels increase.
Protein S, an anticoagulant, decreases. However, the other major anticoagulants, protein C and antithrombin III, remain constant.
This is probably a physiologically adaptive mechanism to prevent post partum haemorrhage.
Why is it possible for pregnant women to haemorrhage during birth?
Typically, the uterus continues to contract after a woman delivers the placenta. These contractions help to stop bleeding.
If something goes wrong, a lot of blood (that was previously supplying baby) is lost.
What is the most common cause of indirect deaths?
Cardiac disease (e.g. had valve replacement)
What are the symptoms of DVT/PE?
Unilateral calf pain
Redness or swelling
Shortness of breath or chest pain
What is management for DVT/PE?
LMWH / warfarin
What are symptoms of post partum haemorrhage?
- Sudden & profuse blood loss or persistent increased blood loss
- Faintness, dizziness
- Palpitations/tachycardia
What are the causes of post partum haemorrhage?
- Tone
- Trauma
- Tissue / infection
- Thrombin
What are the major complications that account for nearly 75% of all maternal deaths?
- Haemorrhage
- Sepsis
- Hypertension during pregnancy (pre-eclampsia and eclampsia)
- Complications from delivery
- Unsafe abortion
The remained are associated with diseases such as malaria and AIDS during pregnancy
What is the 3 delays model?
The three delays model proposes that maternal mortality is associated with delays in:
- Decision to seek care
- Reaching care
- Receiving care
What are reasons behind delay in seeking care?
- Acceptance of maternal death
- Low status of women
- Lack of understanding of complications
- Socio-cultural barriers to seeking care
What are reasons behind delay in reaching care?
- Poor infrastructure
- Mountains, islands, rivers
- Lack of escalation pathway / fear
What are reasons behind delay in receiving care?
- Supplies, personnel
- Poorly trained with punitive attitude
- Finances (personal and institutional)
