(精编)【高血压英文教学精品课件】 Direct maternal deaths in the UK 2006-2008.pptVIP

* * * * Increase from previous triennium 0.66 (95% CI 0.39 -1.12) but not significant – Jim N to confirm please * * Should we leave this slide out ? * * * * * * Jim I have paraphrased for brevity – I hope this is ok * * * * * Direct deaths: causes Thromboembolism 41 18 Pre-eclampsia / eclampsia 18 19 Haemorrhage 14 8 AFE 17 13 Early pregnancy 14 11 Sepsis 18 26 Anaesthetic 6 7 Other 3 4 2003-5 2006-8 Postpartum haemorrhage 2,500 cases/year of bleeding 2.5 litres according to severe morbidity surveys 5 deaths from PPH in 2006-2008 50% reduction compared to last triennium In 3 of the 5 deaths, a major contributor was lack of routine observation in the postpartum period or failure to appreciate that bleeding was occurring MEOWs charts should be used Obstetric haemorrhage Selected recommendations Protocols and drills required in all areas Early senior multidisciplinary team involvement is essential including elective CS for placenta praevia Placental site identification is required for all with previous caesarean section. Regular observations of pulse and BP for the first 24 hours after CS should be recorded on a MEOWs, and abnormal scores acted upon. Inpatient care required after 34 weeks for women with praevia who have previously bled (RCOG) Direct deaths: causes Thromboembolism 41 18 Pre-eclampsia / eclampsia 18 19 Haemorrhage 14 8 AFE 17 13 Early pregnancy 14 11 Sepsis 18 26 Anaesthetic 6 7 Other 3 4 2003-5 2006-8 Deaths in early pregnancy Ectopic ………….. 6 (+ 1 anaesthetic death) - Three were from ethnic minorities Miscarriage ……... 5 (+ 2 from sepsis) - All died from haemorrhage - Three deaths at 16-18 weeks, associated with placenta adherent to previous CS scar - EPUs tend to manage persistent bleeding conservatively Termination .……. 0 (+ 2 from sepsis) Risk factors Migration and ethnicity Ectopic pregnancy vignette A woman was referred to hospital by her GP with diarrhoea, vomiting and abdominal pain. On admissi