MBRACE October 2023

Question 1

Rate/100,000 women died during pregnancy or postpartum

Answer 1

11.7/100,000

If covid excluded 10.1/100,000

Question 2

3 leading cases of death

Answer 2

Covid-19
Cardiac disease
Blood clots

All 14%

Question 3

What % deaths caused by mental health conditions and sepsis

Answer 3

10%

Question 4

What % of deaths caused by epilepsy/stroke

Answer 4

9%

Question 5

How much more likely were black women and asian women likely to die vd white women

Answer 5

Black 4 x (37)
Asian 2 x (18)
White 9
/100,000

Question 6

Pulse rate and blood pressure are maintained until what blood loss?

Answer 6

30% circulating blood volume lost

Question 7

Definition maternal death

Answer 7

Death while pregnant or within 42 days from of pregnancy but not accidental or incidental

Question 8

Direct maternal death

Answer 8

Obstetric cmomplicaiotn of the pregnancy state

Question 9

Indirect maternal death

Answer 9

Previous pre-existing disease, disease during pregnancy but not result of direct obstetric cause

Question 10

Late maternal death

Answer 10

Between 42 days and 1 years post partum - direct or non direct

Question 11

Leading cause direct deaths

Answer 11

VTE

Question 12

When does the majority if maternal suicide occur?

Answer 12

6 weeks to a year PP
39% maternal deaths during this period

Question 13

Leading cause indirect

Answer 13

Covid 19
Cardiac

Question 14

What proportion of maternal deaths are still pregnant at time of death

Answer 14

26%
66% of those <20/40

Question 15

Higesr rates in terms of timing of death in Maternal deaths

Answer 15

Postnatal

Question 16

Highest risk factor for direct and indirect deaths

Answer 16

Pre-exisiting medical problems (not obesity)

56% had pre-existing medical problem, 37% mental heal problem

Question 17

What proportion of women who died were born outside UK

Answer 17

25%

Question 18

What proportion of the women who died were overweight or obese?

Answer 18

58%

Question 19

What proportion of the women who died received the recommended AN Care

Answer 19

53%

Question 20

What proportion of the women who died had a post mortar examination?

Answer 20

67%

Question 21

Major leaning points PPH

Answer 21

• Cat 4 CS list operate from EMCS
• Escalate in periods of high activity
• Give blood products early in MOH, not to base decision on single coagulation test (FFP)
• Consider if balloon is most appropriate, consider when to abandon
• Abnormal invasive placentation - deliver at specilist centre - blood productions, adult intensive care, neonatal intensive care and MDT team with expertise in complex pelvic surgery
• Main focus - control bleeding and replacing fluid volume
• Massive haemorrhage call
• Early escalation
• 1 member of team recording rime
• Protocol
• senior has helicopter view
• Estimated blood loss based on weight
• MOH better treated fluid replacement than vasopressors, warmed fluid

Question 22

What dose of misoporostol should be given for IUD

Answer 22

<26+6 100mcg 6 hourly
>27 25-50 mcg 4 hourly

Caution uterine scare consider dinoprostone more appropriate

Question 23

Dose of mifepristone

Answer 23

200mg if non-scarred uterus

Question 24

When should placenta accreta speculum be delivered

Answer 24

35-36+6 weeks

Question 25

Chose of tracheal tube for pregnancy women should start at what size

Answer 25

7.0 then proceed to smaller tube

Question 26

Below what GCS should someone undergo tracheal incubated and mechanical lung ventilation

Answer 26

GCS equal <8 ot deterioratinf conscious level, fall >2, or fall in 1 more motor score requiring transfer

Question 27

What proportion of women have CS in England?

Answer 27

31%

Question 28

Most frequent indicate for re-operation?

Answer 28

Surgical haemorrhage related to uterotomy

Question 29

If low placenta and previous CS

Answer 29

Consider accreta, refer MRI At CS incision should be above placenta

Question 30

Maternal survival following ECMO and live brith rate

Answer 30

75% surgical 70% live birth rate

Question 31

Which women are high risk of sepsis?

Answer 31

Pregnant women, have given birth or had a TOP within 6 weeks. Especially if vaginal bleeding or discharge. PPROM

Question 32

What to include in counselling for extreme PPROM

Answer 32

Explained irks of matneral mortality and morbidity, impact on future pregnancies Options include ending presence

Question 33

Red flags for Addisons

Answer 33

Vomiting Weight Loss Change in skin tone Acidosis Low Na Give antiemetics so can tolerate medications

Question 34

Causes of nausea and vomiting in pregnancy

Answer 34

Hyperemesis gravidarum Endocrine disorders (e.g. Addison’s disease, diabetes) Infection Gastrointestinal disorders (e.g. peptic ulcers, cholecystitis, gastroenteritis, pancreatitis, hepatitis) Neurological disorders (e.g. migraine, intracerebral haemorrhage, increased intracranial pressure Drug use

Question 35

When should women be admitted for nausea and vomiting in pregnancy?

Answer 35

* Continued nausea and vomiting and inability to keep down oral antiemetics * Continued nausea and vomiting associated with clinical dehydration or weight loss (greater than 5% of body weight), despite oral antiemetics * Confirmed or suspected comorbidity (such as urinary tract infection and inability to tolerate oral antibiotics) * Co-morbidities such as epilepsy, diabetes, or HIV, where symptoms and inability to tolerate oral intake and medication could present further complications

Question 36

What proportion of women with asthma require hospital admission? What % require hospitalisation?

Answer 36

11-18% have 1 x ED visit 62% require hospitalisation I

Question 37

If woman of reproductive age present to ED, what should be included in their assessment particually if anaemia?

Answer 37

FAST scan ?intra-abdomninal bleeding

Question 38

Seizure at what time of day are a red flag and require urgent referral to epilepsy service/obstetric physician

Answer 38

Nocturnal seizures

Question 39

Suspected epilepsy related deaths should be investigated in what way?

Answer 39

a full post-mortem examination, including neuropathology, organ histology and toxicology, is required. Toxicology of anti-seizure medication

Question 40

Red flags for headache

Answer 40

* Sudden-onset headache / thunderclap or worst headache ever * Headache that takes longer than usual to resolve or persists for more than 48 hours * Has associated symptoms – fever, seizures, focal neurology, photophobia, diplopia * Excessive use of opioids Headache PP should be investigated.

Question 41

What % of women with VP shunt will show symptoms of raised ICP in Pregnancy due to malfunction of the shunt

Answer 41

59%

Question 42

Symptoms raised ICP

Answer 42

headache often postural, vomiting, reduced consciousness level, gaze paresis (a sixth cranial nerve palsy), and seizures.

Question 43

New or permitting neurological symptoms in VP shunt

Answer 43

CT/MRI Neurosurgeon referral

Question 44

Does a negative CT rule out ischaemic stroke

Answer 44

no poor early detect <3-6hr MRI is more sensitive (consider DWI with SWI or T2 weighted)

Question 45

Risk of stroke in postpartum period vs non pregnanct

Answer 45

3 times

Question 46

What diagnostic tool should be used for suspected stroke or TIA

Answer 46

ROSIER (Recognition of Stroke in the Emergency Room).

Question 47

If suspect stroke

Answer 47

Pregnancy should not alter standard chew Admit to hyperactive stroke unit