|
47 |
EMQ. Maternal Mortality definitions |
|
48 |
Talk. Neonatal jaundice |
|
49 |
EMQ. Parvovirus |
47. Maternal
Mortality definitions.
Abbreviations.
EPNMR: Extended
Perinatal Mortality Rate.
MMR: Maternal
Mortality Rate.
MMRat: Maternal
Mortality Ratio.
MMRpt: Maternal
Mortality Report.
NMR: Neonatal
Mortality Rate
PNMR: Perinatal Mortality Rate.
NMR: Neonatal Mortality Rate.
Option List.
A. Death
of a woman during pregnancy and up to 6 weeks later, including accidental and
incidental causes.
B. Death
of a woman during pregnancy and up to 6 weeks later, excluding accidental and
incidental causes.
C. Death
of a woman during pregnancy and up to 52 weeks later, including accidental and
incidental causes.
D. Death
of a woman during pregnancy and up to 52 weeks later, excluding accidental and
incidental causes.
E. A
pregnancy going to 24 weeks or beyond.
F. A
pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.
G. Maternal
deaths per 100,000 maternities.
H. Maternal
deaths per 100,000 live births.
I. Direct
+ indirect deaths per 100,000 maternities.
J. Direct
+ indirect deaths per 100,000 live births.
K. Direct
death.
L. Indirect
death.
M. Early
death.
N. Late
death.
O. Extra-late
death.
P. Fortuitous
death.
Q. Coincidental
death.
R. Accidental
death.
S. Maternal
murder.
T. Not
a maternal death.
U. Yes
V. No.
W. I have no
idea.
X. None
of the above.
Question 1.
What is a Maternal Death?
Question 2.
Which categories are included in the definition of MD? >1 answer may be correct.
correct.
Option list.
|
A |
accidental
death |
|
B |
coincidental
death |
|
C |
direct
death |
|
D |
iatrogenic
death |
|
E |
incidental
death |
|
F |
indirect
death |
|
G |
late
death |
Question 3.
Which categories are included in the discussions in the
MMRs?
Option list.
|
A |
accidental
death |
|
B |
coincidental
death |
|
C |
direct
death |
|
D |
iatrogenic
death |
|
E |
incidental
death |
|
F |
indirect
death |
|
G |
late
death |
Question 4.
When was the latest Maternal Mortality Report published? Which
years did it cover?
Question 5.
What was the Maternal Mortality Rate in the most recent Report?
Question 6.
How did the MMR compare with that from the previous Report?
Question 7.
What was the leading cause of maternal death and how many deaths were
there?
Question 8.
What was the leading cause of direct death and how many deaths were
there?
Question 9.
When was the latest Perinatal Mortality Report published? Which
years did it cover?
Question 10.
EPNMR and PNMR are derived from the number of stillbirths + the
number of neonatal deaths. Why is the EPNMR used in preference to PNMR in most
publications?
|
A |
the
EPNMR includes NNDs up to 2 weeks; the NMR NNDs up to 1 week |
|
B |
the
EPNMR includes NNDs up to 4 weeks; the NMR NNDs up to 1 week |
|
C |
the
EPNMR includes NNDs up to 12 weeks; the NMR NNDs up to 1 week |
|
D |
the
EPNMR includes NNDs up to 6 weeks; the NMR NNDs up to 4 weeks |
|
E |
the
EPNMR includes NNDs up to 8 weeks; the NMR NNDs up to 4 weeks |
|
F |
the
EPNMR includes NNDs up to 12 weeks; the NMR NNDs up to 4 weeks |
|
G |
none
of the above |
Question 11.
A woman dies from a ruptured appendix at 10 weeks. What kind of
death is it?
Question 12.
A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation.
What kind of
death
is it?
Question 13.
A woman dies from a ruptured appendix at 10 weeks. What kind of
death is it?
Question 14.
A woman dies from chickenpox at 30 weeks’ gestation. What kind of
death is it?
Question 15.
How many categories are there for sepsis in the MMRpts?
Question 16.
A
woman dies of sepsis secondary to pyelonephritis at 20 weeks’ gestation. What
kind of death is it?
Question 17.
A
woman dies from sepsis two weeks after C section. The sepsis was due to uterine
infection that started as chorioamnionitis. What kind of death is it?
Question 18.
A woman dies from hepatitis C at 40 weeks’ gestation. The infection
was transmitted
sexually. What kind of death is it?
Question 19.
A
woman dies from suicide at 10 weeks’ gestation. What kind of death is it?
Question 20.
A
woman with a 10-year-history of coronary artery disease dies of a coronary
thrombosis at 36 weeks’ gestation. What kind of
death is it?
Question 21.
A woman has gestational trophoblastic disease, develops choriocarcinomas
and dies
from
it 24 months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?
Question 22.
A woman develops puerperal psychosis from which she makes a poor
recovery. She
kills
herself when the baby is 18 months old. What kind of death is it?
Question 23.
A woman develops puerperal psychosis from which she makes a poor
recovery. She
kills
herself when the baby is 6 months old. What kind of death is it?
Question 24.
What is a “maternity”.
Question 25.
What
is the definition of the Maternal Mortality Rate?
Question 26.
What is the Maternal Mortality Ratio?
Question 27.
A woman is diagnosed with breast cancer. She has missed a period
and a pregnancy
test is +ve. She decides to continue with the
pregnancy. The breast cancer does not respond to treatment and she dies from
secondary disease at 38 weeks. What kind of death is it?
Question 28.
A woman who has been the subject of domestic violence is killed at
12 weeks
by her partner. What kind of death is it?
Question 29.
A woman is struck by lightning as she runs across a road. As a result,
she falls under
the wheels of a large lorry which runs over her
abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage,
mostly from the abruption. What kind of death is it?
Question 30.
A woman is abducted by Martians who are keen to study human
pregnancy. She dies
as a result of the treatment she receives. As
this death could only have occurred because she was pregnant, is it a direct
death?
Question 31.
Could a maternal death from malignancy be classified as “direct”?
Question 32.
Could a maternal death from malignancy be classified as “Indirect”?
Question 33.
Could a maternal death from malignancy be classified as “Coincidental”?
Question 34.
A pregnant woman is walking on the beach at 10 weeks when she is
struck by lightning
and dies. What kind of death is this?
Question 35.
A woman is sitting on the beach breastfeeding her 2-year old baby
when she is struck
by lightning and dies. What kind of death is this?
48. Neonatal
jaundice.
The slides I will show are on Dropbox in the ‘Programmes and materials’
folder. Print them so that you can annotate as we go along.
49. Parvovirus.
Abbreviations.
PvB19: parvovirus
B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option list.
There are no option lists apart
from the last few questions. Make up your own answers! In the exam it is best
if you decide the answer without reference to the option list and then identify
it on the list.
Scenario 1.
What type of virus
is parvovirus?
Scenario
2.
Is the title B19 something to do with the
American B19 bomber, its potentially devastating bomb load and the comparably
devastating consequences of the parvovirus on human erythroid cell precursors?
Scenario
3.
PVB19 in the UK occurs in mini-epidemics at
3 to 4-year intervals, usually during the summer.
Scenario 4.
Which animal acts
as the main reservoir for infection?
Scenario
5.
What is the approximate incidence of maternal
parvovirus infection in the UK?
Scenario 6.
What percentage of UK adults are immune to
parvovirus infection?
Scenario 7.
What names are
given to acute infection in the human?
Scenario 8.
What is the incubation period for parvovirus
infection?
Scenario 9.
What is the duration of infectivity for
parvovirus infection?
Scenario 10.
What are the usual symptoms of parvovirus
infection in the adult?
Scenario 11.
What is the incidence of parvovirus
infection in pregnancy?
Scenario 12.
How is recent infection diagnosed?
Scenario 13.
How long does PvIgM persist and why is this
important?
Scenario 14.
What is the rate of vertical transmission of
parvovirus infection?
Scenario
15.
Are women with parvovirus infection who are
asymptomatic less likely to pass the virus to their fetuses?
Scenario 16.
To what degree is parvovirus infection teratogenic?
Scenario 17.
What proportion of pregnancies infected with
parvovirus are lost?
Scenario 18.
What is the timescale for the onset of
hydrops?
Scenario
19.
Laboratories are advised to retain bloods
obtained at booking for at least 2 years for possible future reference. True or
false?
Scenario 20.
What ultrasound features would trigger
consideration of cordocentesis?
Scenario 21.
Must suspected parvovirus infection be
notified to the authorities?
Scenario
22.
Possible
parvovirus infection does not need to be investigated after 20 week’s
gestation. True or false?
Scenario
23.
If serum is sent to
the laboratory from a woman with a rash in pregnancy for screening for rubella,
the laboratory should automatically test for parvovirus infection too?
Scenario
24.
A woman attends the pre-pregnancy
counselling clinic as she is planning her first pregnancy. She wants to know what
screening for parvovirus is recommended.
Scenario
25.
A pregnant woman
has had a significant contact with a child with PARV infection. She has had
urgent tests for PvIgG and PvIgM. Both results were -ve. Which of the options
best fits the advice she should be given?
Option list.
|
1 |
the tests show acute
parvovirus infection |
|
2 |
the tests show chronic
parvovirus infection |
|
3 |
the tests show that she has
not had PARV infection and is susceptible to it |
|
4 |
the tests show no evidence of
PARV infection but she should have repeat tests in 1 month |
|
5 |
the tests show old PARV
infection and immunity |
|
6 |
the tests show recent PARV infection |
|
7 |
none of the above |
Scenario
26.
A pregnant woman
has had a significant contact with a child with PARV infection. She has had
urgent tests for PvIgG and PvIgM. Both results were +ve. Which of the options
best fits the advice she should be given?
Option list.
|
1 |
the tests show acute
parvovirus infection |
|
2 |
the tests show chronic
parvovirus infection |
|
3 |
the tests show that she has
not had PARV infection and is susceptible to it |
|
4 |
the tests show no evidence of
PARV infection but she should have repeat tests in 1 month |
|
5 |
the tests show old PARV
infection and immunity |
|
6 |
the tests show recent PARV
infection |
|
7 |
none of the above |
Scenario
27.
A pregnant woman
has had a significant contact with a child with PARV infection. She has had
urgent tests for PvIgG and PvIgM. The results were PvIgG +ve and PvIgM -ve.
Which of the options best fits the advice she should be given?
Option list.
|
1 |
the tests show acute parvovirus
infection |
|
2 |
the tests show chronic
parvovirus infection |
|
3 |
the tests show that she has
not had PARV infection and is susceptible to it |
|
4 |
the tests show no evidence of
PARV infection but she should have repeat tests in 1 month |
|
5 |
the tests show old PARV infection
and immunity |
|
6 |
the tests show recent PARV
infection |
|
7 |
none of the above |
Scenario
28.
A pregnant woman
has had a significant contact with a child with PARV infection. She has had urgent
tests for PvIgG and PvIgM. The results were PvIgG -ve and PvIgM +ve. Which of
the options best fits the advice she should be given?
Option list.
|
1 |
the tests show acute
parvovirus infection |
|
2 |
the tests show chronic
parvovirus infection |
|
3 |
the tests show that she has
not had PARV infection and is susceptible to it |
|
4 |
the tests show no evidence of
PARV infection but she should have repeat tests in 1 month |
|
5 |
the tests show old PARV
infection and immunity |
|
6 |
the tests show recent PARV
infection |
|
7 |
none of the above |
Scenario
29.
A pregnant woman
has had a significant contact with a child with PARV infection. What
prophylaxis should be offered?
Option list.
|
1 |
acyclovir orally |
|
2 |
acyclovir i.m. |
|
3 |
acyclovir i.v. |
|
4 |
hand-washing and avoiding
small children |
|
5 |
i.v. hyperimmune globulin |
|
6 |
PVV vaccine |
|
7 |
there is no proven prophylaxis |
