MRCOG Part 2 – MMBRACE SBA

1. Qunicy is 30 years old, para1 woman with 6 weeks of gestation. She reported a family history of aortic dissection at booking, but the significance of this was not recognised. In the late stages of pregnancy, she developed severe back pain and systolic hypertension and was assumed to have pre-eclampsia. She subsequently developed severe abdominal and lower limb wesknes, she collapse and died? Post-mortem confirmed diagnosis of aortic dissection. What is the risk of an undiagnosed inherited aortopathy in such cases?

2. Anna os second gravida previous normal delivery is in her third trimester attended the hospital as she was feeling dizzy since morning. On reaching emergency care, she suddenly collapsed. Bystander cardiopulmonary resuscitation was undertaken for 20 minutes. On arrival of consultant, perimortem caesarean section was undertaken. But it was very late and lost Anna. Perimortem caesarean section is an important part of the resuscitation of a pregnant woman. What is ideal time for carrying out peripartum CS, if no response to CPR?

3. Jessica is 23 years old, she had missed abortion for which she underwent suction evacuation yesterday. She is known case of Ehlers Danlos type IV. Today she attended the emergency department with chest and left arm pain. CTPA was performed demonstrating that the ascending aorta was dilated at 51mm diameter with some features of aortic syndrome such as oedema in the aortic wall, together with left ventricular hypertrophy, but no PE and no dissection flap. The woman declined further investigations. The following day she was found unresponsive at home and despite all attempts to resuscitate her she died from an aortic dissection and asso-ciated cardiac tamponade. Which of the following investigations were if performed would have made disgnosis more clear?

4. In 2015-17, 209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.
Considering all the causes contributing to maternal mortality which of the following statement is correct.

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. What is the likely cause of her death?

6. Among all the causes of cardiovascular disease contributing to maternal mortality. Which of tle following contributes to maximum.

7. Which of the following statements is not correct.

8. Emmy is 25 years old, she was on combined oral contraceptive pills since 4 years and has now stopped the oral contraceptive pill due to breast pain. She consulted her GP and was referred for further investigation, and diagnosis of her invasive breast cancer was made. She wanted to know what will be the ideal time for her to become pregnant?

9. Mortality rates still appear higher than the nadir in the over-all UK maternal mortality rate which was observed in 2012-14, and this highlights further the challenge of achieving the Government ambition of reducing maternal deaths in England by what percentage till which year?

10. Wenny is in the early second trimester of pregnancy was involved in a road trafic accident. Paramedics transported her rapidly to the Emergency Department where a number of consult-ants were already in attendance: anaesthetists, accident and emergency, intensive care and gynaecology. She had intraosseous access already inserted and central venous access was established very soon after arrival. She was resuscitated and a CT identified chest injuries following which she was transferred immediately to theatre. However, despite protracted resuscitation her bleeding could not be controlled and she died. At all stages of her care this woman was managed appropriately and rapidly and with senior involvement but the severity of her injuries led to her ultimate death. There were several other instances of exemplary resuscitation attempts which were ultimately unsuccessful, because the elements of resuscita-tion of pregnant women are not considered. With regard to pregnancy specific resuscita-tion measure which of the following statement is wrong?