MRCOG tutorial 23rd. November 2023

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Maternal Mortality.

Abbreviations.

AFE:                    Amniotic Fluid Embolism.

APH:                    Antepartum haemorrhage.

CER:                    Confidential Enquiry Report (MBRRACE).

EPNMR:              Extended Perinatal Mortality Rate.

MBRRACE:         NPEU: “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK”.

MCS:                   Medical Certificate of Stillbirth.

MMR:                 Maternal Mortality Rate.

MMRat:              Maternal Mortality Ratio.

MMRpt:             Maternal Mortality Report.

NESST:                UKARCOG’s “National Evaluation of Accuracy of Stillbirth Certificates”.

NMR:                  Neonatal Mortality Rate

NPEU:                 National Perinatal Epidemiology Unit

PNMR:                Perinatal Mortality Rate.

SBR:                    Stillbirth Rate.

NMR:                  Neonatal Mortality Rate.

PPH:                    Postpartum haemorrhage.

SBR:                    Stillbirth rate.

SUDEP:               Sudden Unexplained Death in Epilepsy.

 

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?