UK Reproductive Health

Question 1

Definition of fertility?

Answer 1

Measure of reproductive output usually expressed as a fertility rate: ie 2.4 births per woman

Question 2

What is fecundity?

Answer 2

Potential to reproduce (may have no children YET)

Question 3

What is a ‘maternal death’?

Answer 3

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

Question 4

What is a ‘direct’ maternal death?

Answer 4

Death resulting from obstetric complications of the pregnant state, from interventions, omissions, incorrect treatment etc

Question 5

What is an ‘indirect’ maternal death?

Answer 5

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

Question 6

What is a ‘late’ maternal death?

Answer 6

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

Question 7

What is ‘coincidental’ maternal death?

Answer 7

Death from unrelated causes which happen to occur in pregnancy or the puerperium

Question 8

What is puerperium?

Answer 8

Period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.

Question 9

What are major causes of direct maternal deaths?

Answer 9

Thrombosis
Haemorrhage
Amniotic Fluid Embolism
Genital tract sepsis
PET
Early pregnancy
Anaesthesia

Question 10

How is maternal mortality ratio measured?

Answer 10

Maternal deaths per 100,000 live births

Question 11

What is the maternal mortality ratio in the UK?

Answer 11

8.8

Question 12

What is postpartum endometrisis?

Answer 12

Infection travels up from vagina to uterus

Infection of the lining of the womb which can occur up to six weeks after childbirth.

Question 13

When is postpartum endometrisis more common?

Answer 13

After C section

Question 14

What are the symptoms of endometrisis?

Answer 14

• Fever, malaise, rigors, headache
• Abdominal pain
• Offensive lochia
• Secondary PPH

Question 15

What is secondary PPH?

Answer 15

Secondary postpartum haemorrhage is defined as excessive vaginal bleeding in the period from 24 hours after delivery to twelve weeks postpartum.

Question 16

What is lochia?

Answer 16

The vaginal discharge after giving birth, containing blood, mucus, and uterine tissue.

Question 17

Why are pregnant women at an increased risk of clots?

Answer 17

• 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

Question 18

Why are pregnant women in a hypercoaguable state?

Answer 18

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.

Question 19

Why is it possible for pregnant women to haemorrhage during birth?

Answer 19

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.

Question 20

What is the most common cause of indirect deaths?

Answer 20

Cardiac disease (e.g. had valve replacement)

Question 21

What are the symptoms of DVT/PE?

Answer 21

Unilateral calf pain
Redness or swelling
Shortness of breath or chest pain

Question 22

What is management for DVT/PE?

Answer 22

LMWH / warfarin

Question 23

What are symptoms of post partum haemorrhage?

Answer 23

• Sudden & profuse blood loss or persistent increased blood loss
• Faintness, dizziness
• Palpitations/tachycardia

Question 24

What are the causes of post partum haemorrhage?

Answer 24

• Tone
• Trauma
• Tissue / infection
• Thrombin

Question 25

What are the major complications that account for nearly 75% of all maternal deaths?

Answer 25

1. Haemorrhage
2. Sepsis
3. Hypertension during pregnancy (pre-eclampsia and eclampsia)
4. Complications from delivery
5. Unsafe abortion

The remained are associated with diseases such as malaria and AIDS during pregnancy

Question 26

What is the 3 delays model?

Answer 26

The three delays model proposes that maternal mortality is associated with delays in:

1. Decision to seek care
2. Reaching care
3. Receiving care

Question 27

What are reasons behind delay in seeking care?

Answer 27

• Acceptance of maternal death
• Low status of women
• Lack of understanding of complications
• Socio-cultural barriers to seeking care

Question 28

What are reasons behind delay in reaching care?

Answer 28

• Poor infrastructure
• Mountains, islands, rivers
• Lack of escalation pathway / fear

Question 29

What are reasons behind delay in receiving care?

Answer 29

• Supplies, personnel
• Poorly trained with punitive attitude
• Finances (personal and institutional)