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Nick Raine-Fenning · Posted: Wed Nov 22, 2006 10:03 am Post subject: Causes of Maternal Death

The following are recognised causes of maternal death

Select the single best option from the following list that fits the clinical description.

A Cardiac arrest
B Amniotic fluid embolus
C Sepsis
D Acute hypertension
E Abruption
F Pre-eclampsia
G Pulmonary embolus
H Drug related
I Bacterial endocarditis
J Ruptured ectopic pregnancy
K Intracerebral haemorrhage
L Splenic rupture
M Massive obstetric haemorrhage
N Upper respiratory tract infection
O Myocardial infarction
P Cardiomyopathy
Q HELLP syndrome
R Ketoacidosis
S Encephalopathy
T Acute renal failure
U Eclampsia
V Placenta praevia
W Subdural haematoma
X Anaphylaxis
Y Pulmonary hypertension
Z Subarachnoid haemorrhage

Other options could include:

Acute fatty liver of pregnancy
Thrombotic thrombocytopenic purpura
Hemolytic uremic syndrome
Meningo-encephalitis
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Nick Raine-Fenning · Posted: Wed Nov 22, 2006 10:05 am Post subject:

Now it's your turn Smile

I want you to create some clinical scenarios to match these causes of maternal death. Try to make us chose between 2 to 3 options i.e. more than one could be correct but one is the most correct.

Have a go. It does not matter if you are wrong or make a question too easy. We can modify them as we go and create some good answers.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Q.

34 yr old afro-caribbean lady, history of visit to asian subcontinent in 2nd trimester and febrile illness following this, 5 days post normal delivery, has a vehicular accident. on admission, tachycardiac, hypotensive, non responsive, distended abdo, cullen's sign positive.........

explanation ---

afro-caribbean --- sickle/ thal
asia visit and febrile illness -- malaria --- spleenomegaly
accident -- cause for spleen to rupture
cullen's sign --- peri umbilical bruising --- haemoperitoneum.
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Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Q

25 yr old, 34 wks pregnant, known cardiac murmur, history of fever with swelling of joints in child hood, had professional teeth cleaning, day 3 after this fever with chills, chest pain, dyspnoea, palpitations, oliguria, excessive tiredness, died day 5.

explanation --

cardiac murmur, fever with chills, joint pains - rheumatic fever, with valve involvement
teeth cleaning -- antecedant event for bacteremia
clinical picture of -- septicaemia
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Thu Nov 23, 2006 1:44 pm Post subject: Re: Spleenic rupture

Nick Raine-Fenning · Posted: Thu Nov 23, 2006 1:45 pm Post subject: Re: bacterial endocarditis

Nick Raine-Fenning · Posted: Thu Nov 23, 2006 1:49 pm Post subject:

A 29-year old parous woman is admitted to labour at 34 weeks with abdominal pain that followed vaginal bleeding. She has been a poor attender and has not been seen in the last 15 weeks. On examination she is tachycardic and has a tender abdomen. The fetus is lying transversely and there are palpable uterine contractions.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

usually there is a small antecedent trauma for spleenic rupture. and usually only diseased spleens rupture, so i guess 'spontaneous' may mislead the thought process.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Thu Nov 23, 2006 6:07 pm Post subject:

But you need to differentiate between abruption although having a choice is fine I guess. What I really wanted was to disguise the pre-existing risk a bit more but I amy not have spotted it unless I had read your explanation immediately after reading the question. In fact if you post anymore try and not post the naswer for a few days - make them work for their supper!!

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

22 yrs old, 35 wks pregnant, known VSD, history of haemoptysis, increasing dysponea and tiredness, collapses while trying to catch her 2 yr old who is running on the playground. clinical findings raised jvp, cool extremities, minimal urine output and marked hypotension???
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

hi nick,

it could not have been abruption as cullen's sign was positive hence haemoperitoneum was present we wont get that with abruption.

it cant be sepsis as history of rheumatic fever points to bact endocarditis.

Smile

raj
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Nick Raine-Fenning · Posted: Thu Nov 23, 2006 8:45 pm Post subject:

Spot on - well done Razz

I also agree with you about endocarditis and splenic rupture. Cullen's sign is a good surrogate for a haemaperitoneum but maybe we could disguise that as 'abdominal discolouration'?

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Q

36 yr old, 30 wks pregnant, works in a paints factory, history of febrile illness since 3 days, had progressive loss cognitive ability, subtle personality changes, inability to concentrate, lethargy, nystagmus, loss of ability to swallow, seizures and progressive loss of consciousness and sinks in the ITU.................

what is this??

come on guys, a lot of you are reading the posts, do participate, if every one contributes and makes an effort, learning will be more fun.....
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Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Q

40 yr old, 14 wks preganant, died before the ambulance could reach her home, history taken from her partner was of ... a sudden onset of severe headache, nausea, vomiting, photophobia and neck stiffness, progressively unresponsive, her mother had also died of a similar horrible headache, she was also an essential hypertensive, diagnosed only a month prior to her pregnancy..........

what's this folkes??????
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Sat Nov 25, 2006 1:06 pm Post subject:

Think I have got the second one sorted but not sure about the paint factory!

Nick Raine-Fenning · Posted: Sat Nov 25, 2006 1:13 pm Post subject:

A multiparous woman presents to her GP with malaise following a recent viral illness.

Question

Nick Raine-Fenning · Posted: Sat Nov 25, 2006 1:29 pm Post subject:

A 17-year old nulliparous student presents to her midwife at 34 weeks having just returned from travelling. She was scanned early on in her pregnancy and was shown to have a twin pregnancy. She develops a headache and becomes hypertensive.

Nick Raine-Fenning · Posted: Sat Nov 25, 2006 1:29 pm Post subject:

A 30-year old parous woman presents to the antenatal clinic with a weeks history of feeling generally unwell and exhausted. She is hypertensive with a blood pressure of 140/90 and has a plus of protein in her urine. She is admitted for observation and despite her blood pressure remaining only slightly elevated developes epigastric pain, nausea and vomiting, and a headache. Her uric acid is mildly elevated and her platelet count is reduced at 60 x 10(9). Her clotting profile and haematocrit are normal but her haptoglobin level is low.

Nick Raine-Fenning · Posted: Sat Nov 25, 2006 1:32 pm Post subject:

I've just added "acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome" to the list as possible other options.

If you can think of any other options please let us know as we can make another list or divide what we have into 3 or 4! The key is cover all options so we can get the answer right when it comes up.

Wink