MRCOG Part 2 – MBRRACE

Option List
A. Sudden unexplained death
B. Ischemic heat disease
C. Vulvular heart disease
D. Aortic dissection
E. Cardiomyopathy
F. Carotid stenosis
G. Acute coronary syndrome
H. Atrial fibrillation
I. Ventricular tachyarrythmia
J. Paripartum cardiomyopathy
K. Marfan syndrome
Which of the above is the correct diagnosis for the conditions mentioned below? Each of the above options can be used once, more than once or not at all.

1. 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 itas 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. Two days 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 died from complications of her extensive aortic dissection.

2. An obese woman who smoked consulted her GP in the second trimester with severe central anterior chest pain radiating to the jaw and left arm and associated with sweating, nausea and dry retching. The pain came on at rest and lasted an hour. It was different from her preg-nancy-related heartburn. The GP referred her to the emergency department. Cardiovascular examination was normal and two ECGs showed no ischaemic changes, but serum troponin was raised on two separate samples. She was discussed with a locum emergency medicine consultant and sent home with a diagnosis of reflux oesophagitis. She sought medical help from her GP for the same chest pain on two further occasions over the next three days, but no further action was taken. She was found dead in bed the morning after a further episode of pain.

3. A woman with a complex social situation and previous mental health problems attended three times in late pregnancy with different concerns, and on each occasion was noted to have a tachycardia. She was reported to be very anxious. She attended in labour and was again noted to be tachycardic. She remained tachycardic postpartum and was thought to have signs of sepsis. She had a raised CRP. Her anxiety was causing concern and she had two mental health reviews. After 6 days of IV antibiotics she remained tachycardic. She was discussed with but not reviewed by the medical registrar in view of the tachycardia and it was assumed to be due to sepsis. She subsequently took her own discharge. She remained tachycardic at each post-natal visit. Three weeks later she was admitted with acute breathlessness at which point the peripartum cardiomyopathy from which she subsequently died was diagnosed.

Option List
A. Indirect death
B. Avoidable death
C. Coroner’s death
D. Critical death
E. Coincidental death
F. Direct death
G. Early death
H. Fetal death
I. Fortuitous death
J. Late death
K. Unavoidable death

4. A 25-year-old woman Nigerian is a poor attender at the antenatal clinic. She is para-1 had an uneventful delivery where the labour was augmented with oxytocin (Syntocinon). Though she dint revealed but seems to have some problem at home. Four weeks after delivery, is complaints of spotting since the day after delivery. She was managed by medical management, but still bleeding evacuation was planned and products sent for histopathological examination revels choriocarcinoma. Despite of treatment she died after 2 months. How would this maternal death be classified according to World Health Organization (WHO) criteria?

5. A para 2, Arabic lady , named Saima just moved to UK. She found this morning that she is pregnant and comes for GP visit for booking. She is a known case of epilepsy on sodium valproate. As a risk of fetal malformation GP wrote a referral letter and asked Saima to visit physician for consultation with regard to epilepsy medication. Saima didn’t follow the advice and didn’t return to Gp as well. She stopped her medication as she felt foetal risk of medication. In second trimester she was found dead at home. How would this maternal death be classified according to World Health Organization (WHO) criteria?

6. A woman who is 2 days postpartum develops an aspiration pneumonia after an epileptic fit and, despite intensive care treatment, she dies. How would this maternal death be classified according to World Health Organization (WHO) criteria?

Option List
A. Late fetal loss
B. Stillbirth
C. Antenatal stillbirth
D. Intarpartum stillbirth
E. Neonatal death
F. Early neonatal death
G. Late neonatal death
H. Perinatal death
I. Late perinatal death
Match the given scenerios with options above.
Each option can be used one more than once or not at all.

7. A baby delivered at or after 24+0 weeks gestational age showing no signs of life and known to have been alive at the onset of care in labour.

8. A stillbirth or early neonatal death.

9. A baby delivered at or after 24+0 weeks gestational age showing no signs of life, irrespective of when the death occurred.

10. A baby delivered between 22+0 and 23+6 weeks gestational age showing no signs of life, irrespective of when the death occurred.