EBCOG Part 1 2 Weeks Crash Course Labour and Delivery and Postpartum problems Day 3 EMQ

A. Angina
B. Aortic dissection
C. Aortic dissecting aneurysm
D.cardiac failure secondary to anemia
E. Ischaemic heart disease
F. Cardiomyopathy
G. Undiagnosed valve disease
H. Pleural effusion
I. Ruptured ectopic pregnancy
K. Pulmonary embolism
L. Aortic dissection of descending aorta
M. Pneumothorax
N.Right side Pnuemonia
O. Aortic dissection of ascending aorta
P.Early pregnancy related causes

The above options show various causes of maternal collapse and death .
The following scenarios from MMBRACE Uk reporting women who subsequently died, choose the most appropriate cause of their death ..


1. Mrs, x , A primiparous woman became hypertensive after a caesarean birth at term for fetal distress. Over the following few days she had severe abdominal pain, a numb foot, diarrhoea and an ongoing need for analgesia including opiates. Staff were aware of her pain but interpreted it as normal post caesarean discomfort and she was not seen by a consultant. She was discharged but was in too much pain to interact with her baby and family. 40 hrs later, she was seen by the community midwife, her pain was worse, her abdomen was bruised and her foot numb. After a phone call to the GP, more analgesia was prescribed but the GP did not review her. Later that day she had copious bloody diarrhoea and collapsed. She was taken to labour ward, where she was in extremis with rectal bleeding, a grossly distended and bruised abdomen, hypotension and acidosis.She was taken straight to theatre for emergency surgery but unfortunately she died

2.Mrs. X, with Ehlers Danlos type IV attended the emergency department with chest and left arm pain the day after discharge following first trimester loss of an unplanned pregnancy. She had received tertiary care at a different hospital, but as her aortic root was not dilated she was not thought to be at risk of aortic dissection. No discussion of contraception is recorded. Shortly after arrival in the emergency department she had a cardiac arrest  from which she could not be resuscitated.

3.Mrs.X, whose BMI is 50kg/m2,pregnant , presented with chest pain and breathlessness. On the second occasion she asso- ciated these symptoms with exertion. A family history of heart disease was documented at her booking visit. On both occasions she was investigated for presumed pulmonary embolism and discharged when investigations were negative. No other investigations ECG, Troponin were done ,A cardiac cause for her symptoms was never considered. She collapsed at home a few days after her caesarean birth she died was diagnosed.

4.Ms.X,  A young African woman had a normal birth followed by a one litre PPH. Her blood results were delayed and she was discharged home on day 1 before staff became aware of her low haemoglobin. The following day she was readmitted via the emergency department with breath- lessness when lying down, palpitations and dizziness which was attributed to her anaemia. She had a diastolic murmur on auscultation, but junior doctor thought of evaluating later ,as priority was to give blood transfusion .She was transfused two units of blood, but although she remained tachycardic, orthopneic and breathlessness post-transfusion, she was discharged home. She contacted the hospital again that night feeling breathless but was advised to remain at home. She collapsed and died shortly afterwards.

5.mrs. X ,  An obese woman presented in cardiac arrest at the Emergency Department. After cardiopul- monary resuscitation was commenced she was thrombolysed. Her haemoglobin was 50g/l. Shortly afterwards an abdominal scan identified significant free fluid, and then a catheter speci- men of urine was obtained and a pregnancy test was positive. Despite massive transfusion and surgery she died a few hours later.

A. pulmonary embolism
B. amniotic fluid embolism
C. eclamptic fit
D. massive placental abruption
E. epilepsy
F. postpartum haemorrhage
G. disseminated intravascular coagulation
H. subarachnoid haemorrhage
I. aortic stenosis
J. hyperventilation
K. migraine
L. vasovagal attack
M. hypoglycaemia
N. aortic dissection
O. cerebral haemorrhage
For each description below, choose the single most appropriate answer from the above list of
options. Each option may be used once, more than once, or not at all.

6.A 39-year-old woman in her first pregnancy is being induced for symphysis pubis dysfunction at 38 weeks. During the first stage of labour she was noted to have uterine hyperstimulation, which was corrected by reducing the oxytocin infusion. She was delivered later by lowersegment caesarean section for a sub- optimal cardiotocogram (CTG). Two hours post-delivery she complained of shortness of breath. On examination she was noted to be cyanotic and herpulse was 100 beats/minute. A chest X-ray was performed that demonstrated a bilateralground-glass appearance with an impaired coagulation profile.

7.A 22-year-old in her first pregnancy presents to Accident and Emergency at 14 weeks of gestation with severe sudden occipital headache. She had projectile vomiting prior to arrival. After admission her score on the Glasgow Coma Scale falls to 3.

8.A 26-year-old lady who had a spontaneous delivery 3 days ago is found collapsed at home. In her history she had been noted to have had pre-eclampsia in this pregnancy.

9.A 34-year-old woman is being transported by an ambulance to the A & E in a collapsed state 6 days after a normal delivery. Her hospital course prior to discharge was  uneventful. On examination, she is found to have a feeble pulse but no recordable BP.

10.30-year-old woman, on second post-operative day following a Caesarean section for failed induction, complains of severe myalgia and headache. She is dehydrated, febrile with a temperature of 104°F and shows signs of cerebral irritability. Diffuse tenderness is noted across lower abdomen with a contracted uterus.

11.A 26-year-old primigravida at 36 weeks gestation is seen at A & E with complaints of confusion and palpitation. She is a known type 1 diabetic and is on insulin. Examination reveals dehydration, tachycardia and tachypnoea. Urine examination shows ketonuria.

12.A 28-year-old in her third pregnancy is rushed to hospital emergency in a state of collapse. She is a known smoker at 32 week of gestation. She had earlier complained of severe abdominal pain. Abdominal examination shows a rigid uterus with fetal heart rate of 100 bpm. Initial resuscitative measures have been done.

13.A  primigravida is being induced at 2  weeks post-term. She  is on oxytocin infusion, and fetal heartbeat is being monitored continuously. Last examination showed 5 cm dilatation with a bag of membranes which was ruptured. Liquor was clear. She complains of severe chest pain and breathing difficulty. Her PR is 102 bpm and BP is 90/60 mmHG.