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1
Q

What is maternal mortality defined as in the UK?

A

Death whilst pregnant or within 42 days of pregnancy ending from any cause related to or aggravated by the pregnancy or its management
But not from accidental or incidental causes

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2
Q

Direct causes of maternal mortality

A

Cause of death is directly attributable to pregnancy

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3
Q

Indirect causes of maternal mortality

A

Resulting from pre-existing disease or disease developed during the pregnancy which therefore not directly due to pregnancy but aggravated by it

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4
Q

Late maternal mortality

A

From 42 days - 1 year by direct or indirect causes

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5
Q

Northern Europe rate of maternal mortality

A

1 in 30,000

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6
Q

Chief direct cause of maternal mortality 2006-2008

A

Genital sepsis

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7
Q

Chief cause of maternal mortality overall 2006-2008

A

Cardiac disease

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8
Q

What is perinatal mortality

A

Stillbirths and deaths in 1st week of life
Stillbirths only include post 24 weeks of gestation
If born with signs of life >24 weeks but then dies within 7 days

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9
Q

What is a neonatal death

A

Dies up to and including 28 days after birth

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10
Q

What does triad of abdominal pain, uterine rigidity and vaginal bleeding suggest?

A

Placental abruption

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11
Q

Consequences of placental abruption

A

Fetal loss is high if >50% of placenta is affected - fetal anoxia

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12
Q

What is placental abruption?

A

Part of the placenta becomes detached from the uterus

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13
Q

Associations of placental abruption

A

Pre-eclampsia, IUGR, smoking, PROM, multiple pregnancy, polyhydramnios, older maternal age, thrombophilia, abdominal trauma, assisted reproduction, cocaine/amphetamine use, infection, non-vertex presentation

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14
Q

What is the cause of tenderness in placental abruption

A

Compression of uterine muscles by the blood - may prevent good contraction during labour - therefore also PPH risk

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15
Q

How does uterine torsion present?

A

Mid-late pregnancy with abdominal pain, shock, a tense uterus and urinary retention (catheterisation may show displaced urethra in twisted vagina)
Fibroids, adnexal masses or congenital asymmetrical uterine anomalies are present in 90%

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16
Q

Name of normal c-section scars

A

Pfannensteil (bikini line)

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17
Q

When can fetal heart be heard with doppler and pinnard?

A

Doppler from 12 weeks and pinnard from 24 weeks

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18
Q

When are fetal movements first noticed by mother

A

Around 18-20 weeks

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19
Q

Rate of fetal movements

A

Increase until 32weeks then plateau at about 31/hr

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20
Q

When should CTG be done for reduced fetal movements

A

If less than 10 - same day CTG

21
Q

What is occiptoposterior fetal position?

A

Back (occiput) facing to the back - head and limbs forward

22
Q

What is occiptoanterior fetal position

A

Back to the front

23
Q

What is leftoccipto transverse position

A

Occiput and back on mothers left side - limbs on mothers right side

24
Q

What foods should be avoided in pregnancy due to risk of listeriosis infection?

A

Unpasteurised milk, ripened soft cheese, pate, undercooked meat

25
Q

What foods should be avoided in pregnancy due to risk of salmonella

A

Avoid raw or partially cooked eggs and meat especially poultry

26
Q

Folic acid for non-high risk women

A

400mcg until 12 weeks

27
Q

Folic acid for high risk women

A

5mg until 12 weeks

28
Q

Who are high risk women who need folic acid

A 
Previous NTD or fhx of NTD 
Antiepileptics
Coeliac
DM 
Thalassaemia
Obese BMI >30
29
Q

Painless bleeding after 24 weeks

A

placenta praevia

30
Q

Treatment for women at high risk of developing pre-eclampsia

A

Aspirin 75mg OD from 12weeks until birth

31
Q

Which women are high risk for pre-eclampsia

A

HTN during previous pregnancies
CKD
SLE antiphospholipid
T1 and T2DM

32
Q

4 T’s causing PPH

A

Tone
Tissue (retained placenta)
Thrombin (coag abnormalities)
Trauma

33
Q

What are indomethacin and salbutamol used for in labour

A

To suppress premature labour - tocolytics

34
Q

Management of primary herpes infection in pregnancy

A

Risk of transmission is highest within 6 weeks of delivery
Elective c-section if primary infection after 28weeks
oral aciclovir 400mg TDS given to treat primary infection during pregnancy
IV only needed if spontaneous ROM or delivery occurs

35
Q

First line for hyperemesis gravidarum

A

promethazine

36
Q

Cervical excitation and vaginal bleeding in early pregnancy

A

Ectopic!!!

37
Q

When are pregnant women screened for anaemia

A

Booking

28 weeks

38
Q

Highest risk factor for baby developing Group B strep growth

A

Previous baby who has grown it - causes x10 increased risk

39
Q

Management of Group B strep mothers

A

Intrapartum antibiotics

40
Q

What is syntocinon

A

Oxytocin - used to induce labour

41
Q

What is syntometrine

A

Oyxtocin + ergometrine - used to deliver placenta - shouldn’t be given until baby has been delivered

42
Q

Treatment of hyperthyroidism in pregnancy

A

Propylthiouracil instead of carbimazole - less likely to cross placenta

43
Q

Most common location of ectopic pregnancy

A

Ampulla of fallopian tube

44
Q

Management of postpartum endometritis

A

Admit for IV antibiotics - clindamycin and gentamicin until afebrile for 24hrs

45
Q

When is twin-twin transfusion syndrome identified and in whom

A

Scans at 16-24 weeks and in monochorionic twins

46
Q

Main purpose of scans post-24 weeks

A

To detect fetal growth restriction

47
Q

Management of rhesus D negative pregnant women

A

Anti-D at 28 and 34 weeks

48
Q

Signs of open neural tube defect on amniocentesis

A

2.5x increase in AFP (compared to mean)

Acetylcholinesterase in amniotic fluid

49
Q

Low AFP, low oestriol and low bHCG on bloods

A

Edwards syndrome - trisomy 18

Obstetrics (5 decks)

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