Obs/Gyne

Question 1

Causes of maternal death types?

Answer 1

Direct
Indirect
Coincidental
Late

Question 2

Definition of direct maternal death?

Answer 2

Consequence of a disorder specific to pregnancy

Hemorrhage, pre-eclampsia, genital tract sepsis

Question 3

Definition of indirect pregnancy death

Answer 3

Deaths resulting from previous existing disease or diseases that developed during pregnancy and which were not due to direct obstetric causes but aggravated by pregnancy

Cardiac disease, other infections (sepsis)

Question 4

Definition of coincidental pregnancy deaths?

Answer 4

Incidental/accidental deaths not due to pregnancy or aggravated by pregnancy

Road traffic accident

Question 5

Definition of late pregnancy deaths?

Answer 5

Deaths occurring more than 42d but less than one year after the end of pregnancy

Question 6

What are the 5 most common causes of maternal deaths worldwide?

Answer 6

Severe bleeding (PPH)
Infections (usually after childbirth)
High blood pressure during pregnancy
Delivery complications
Unsafe abortion

Question 7

Ways to reduce maternal mortality?

Answer 7

• Stating nature of the emergency improves outcomes
  -Look after primips and the multips will look after themselves
  -Deliver only when the intrauterine environment is more hostile than the neonatal cot
  -Deliver within 24h

Question 8

Tools for use in labour?

Answer 8

Partogram - tracking stages of labour and specifics of labour

Question 9

What are 5 major obstetric emergencies?

Answer 9

1. Maternal collapse
2. Eclampsia
3. Antepartum hemorrhage (APH) - bleeding before delivery
4. Postpartum hemorrhage (PPH)
5. Sepsis

Question 10

Management of maternal collapse?

Answer 10

-Manual uterine displacement for inferior vena cava relief if >24 wks, tilt to left
-If cardiac arrest, consider peri-mortem C-section (try to do within 4 minutes) for better CPR if >24 wks

Question 11

Causes of maternal collapse?

Answer 11

-Hypovolemia
-Hypoxia
-Thromboembolism
-Toxicity (LA, MgSO4)
-Eclampsie + pre-eclampsie + ICH
-Amniotic fluid embolus
-High spinal anesthesia
-Peripartum cardiomyopathy
-Aortic dissection

Question 12

Approach to eclampsia + pre-eclampsia?

Answer 12

-Stabilize mother first - MgSO4 for seizures
-Only definitive cure, delivery of placenta
-Monitor Cr, Plt
-Seizure proph
-Prompt control of HTN
-Ensure fluid balance

Question 13

PPH management?

Answer 13

-Ensure uterus contraction
-Remove anything impeding contraction (tissue)
-Improve tone
-Repair trauma
-If coagulopathy, gi

Question 14

Methods to improve uterine atony?

Answer 14

Manual:
-Bimanual compression first
-Empty bladder
-EUA and intrauterine balloon
-Consider laparotomy

Meds:
-Slow 5U UV oxytocin
-Ergometrine IM or IV
-Oxytocin
-Carborprost
-Misoprostol