Tutorial 14 July 2014

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10	Maternal mortality definitions.
35	A 25-year-old primigravida attends for a routine scan and echogenic bowel is noted. 1. What is the advice of the National Screening Committee in relation to “soft markers”?                                                6 marks. 2. What conditions are linked to echogenic bowel?     6 marks. 3. Justify your management.                                           12 marks.
36	A 41-year-old woman attends for review after a normal hysteroscopy. She now wishes treatment for her incapacitating heavy periods which have not responded to medical management. 1. Outline the history you will take.                          4 marks.    2. Outline the investigations you will consider.      4 marks. 3. Critically evaluate your advice on the available management options.                                                                         12 marks
37	With regard to breastfeeding. a. what are the benefits of breastfeeding?                          8 marks b. what are the contraindications to breastfeeding?         4 marks c. what are the WHO recommendations about duration of breastfeeding?    2 marks d. What can be done to promote breastfeeding?                6 marks
38	Critically evaluate Down’s syndrome screening.

Maternal Mortality.

Lead-in.

The following scenarios relate to maternal mortality.

Pick the option that best answers the task in each scenario from the option list.

Each option can be used once, more than once or not at all.

Option List.

Death of a woman during pregnancy and up to 6 weeks later, including accidental and incidental causes.

Death of a woman during pregnancy and up to 6 weeks later, excluding accidental and incidental causes.

Death of a woman during pregnancy and up to 52 weeks later, including accidental and incidental causes.

Death of a woman during pregnancy and up to 52 weeks later, excluding accidental and incidental causes.

A pregnancy going to 24 weeks or beyond.

A pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.

Maternal deaths per 100,000 maternities.

Maternal deaths per 100,000 live births.

Direct + indirect deaths per 100,000 maternities.

Direct + indirect deaths per 100,000 live births.

Direct death.

Indirect death.

Early death.

Late death.

Extra-late death.

Fortuitous death.

Coincidental death.

Accidental death.

Maternal murder.

Not a maternal death.

Yes

No.

I have no idea.

None of the above.

Abbreviations.

MMR:   Maternal Mortality Rate.

MMRat:               Maternal Mortality Ratio.

SUDEP: Sudden Unexplained Death in Epilepsy.               

Option list.

Scenario 1.

What is a Maternal Death?

Scenario 2.

A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?

Scenario 3.

A woman dies from a ruptured appendix at 10 weeks’ gestation. What kind of death is it?

Scenario 4.

A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?

Scenario 5.

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?

Scenario 6.

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?

Scenario 7

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?

Scenario 8

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?

Scenario 9

What is a “maternity”.

Scenario 10

What is the definition of the Maternal Mortality Rate?

Scenario 11

What is the Maternal Mortality Ratio?

Scenario 12

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?

Scenario 13

A woman who has been the subject of domestic violence is killed at 12 weeks’ gestation by her partner. What kind of death is it?

Scenario 14

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 abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?

Scenario 15

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?

Scenario 16

Could a maternal death from malignancy be classified as “Direct”.

Scenario 17

Could a maternal death from malignancy be classified as “Indirect”.

Scenario 18

Could a maternal death from malignancy be classified as “Coincidental”?