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Test 5: Finding solutions to maternal and perinatal mortality

  1. How can solutions best be found for maternal and perinatal deaths?
    • Look for answers in textbooks.
    • Follow standard protocols of management.
    • Identify avoidable factors.
    • Consult the nearest medical school.
  2. Which of the following is an example of a missed opportunity?
    • Failure to screen a pregnant woman for syphilis when she attended antenatal clinic.
    • Not predicting a placental abruption.
    • Using an incorrect method of listening to the fetal heart during labour.
    • Referring a patient without sending a referral letter.
  3. What is substandard care?
    • A midwife rather than a doctor performing a vaginal delivery.
    • Delivering a low risk mother at a level 2 hospital.
    • Not suctioning the mouth and throat of a meconium stained infant at delivery.
    • A mother failing to push properly during the second stage of labour.
  4. Why is it important to identify the specific avoidable factor?
    • Because only then can steps be taken to prevent similar deaths in future.
    • So that research can be directed at looking for better treatments.
    • In order that it can be added to the details recorded in the death certificate.
    • So that it can be recorded in the report of the perinatal meeting.
  5. How can changes be made to improve health care?
    • By disciplining staff who make mistakes.
    • By improving protocols.
    • By delivering as many women as possible in hospital.
    • By limiting the number of women who attend antenatal clinic.
  6. How can newborn care provided by health workers be improved?
    • By asking health workers to work longer hours.
    • By preventing preterm labour.
    • By paying health care workers more.
    • By creating clear referral criteria.
  7. What is a key recommendation to prevent maternal death?
    • Primary care clinics should perform Caesarean sections.
    • Midwife obstetric clinics should be established.
    • All HIV positive women should be delivered in hospital.
    • All women be observed in hospital for five days after delivery.
  8. Should every maternal death be reported?
    • Yes.
    • Only maternal deaths in hospital.
    • Only maternal deaths in hospitals or clinics.
    • Only women who are at least three months pregnant.
  9. What national HIV/AIDS policy is needed for pregnant women?
    • Terminate all pregnancies.
    • Refer all HIV mothers to a level 2 hospital.
    • Treat all HIV positive mothers prophylactically with co-trimoxazole and anti-tuberculosis medication.
    • Counselling, testing and antiretroviral drugs must be made available at all hospitals and clinics.
  10. What administrative related factor is often associated with perinatal death?
    • Not providing a CTG machine to every clinic that does deliveries.
    • Not providing an ultrasound machine to every level 1 hospital.
    • Not providing medical officers for every clinic that does deliveries.
    • Not providing adequate transport for referring women with labour complications from clinic to hospital.
  11. What health worker related factor is commonly associated with perinatal death?
    • Underestimating the size of the fetus.
    • No response to poor intrauterine growth.
    • Not clamping the umbilical cord immediately after delivery of the infant.
    • Giving the infant to the mother before delivering the placenta.
  12. What common cause of neonatal death can often be prevented with good, simple care?
    • Fetal hypoxia during labour.
    • Intrauterine growth restriction.
    • Congenital abnormalities.
    • Preterm labour.
  13. What can be done to reduce the perinatal mortality rate?
    • Encourage mothers to book for antenatal care as early as possible.
    • Treat all mothers for syphilis if screening is not possible.
    • Deliver all HIV positive women in hospital.
    • Instruct all HIV positive mothers to formula feed their infants.
  14. How can fetal hypoxia during labour be best detected?
    • Plot cervical dilatation on the partogram.
    • Regularly check the mother’s urine for ketones.
    • Monitor the fetal heart carefully at the end of contractions.
    • Monitor the fetal heart carefully between contractions.
  15. How should birth asphyxia be managed?
    • Dry the infant well and wait for respiration to start.
    • Rush the infant to hospital.
    • Give the infant oxygen via a nasogastric tube.
    • Give mask and bag ventilation even if oxygen is not available.
  16. How can the risk of hyaline membrane disease in the newborn infant be reduced if women go into preterm labour?
    • Suppress labour and give betamethasone.
    • Give an antibiotic such as tetracycline.
    • Rupture the membranes.
    • Give the mother oxygen.
  17. What can reduce the risk of neonatal mortality in small infants?
    • Teach mothers to give kangaroo mother care (skin to skin care).
    • Deliver mothers at home.
    • Give all small newborn infants antibiotics.
    • Do not give konakion (vitamin K) to small infants.
  18. How can infection of the fetus be prevented during labour?
    • Give all women prophylactic antibiotics in labour.
    • Do not perform vaginal examinations until the mother wants to push.
    • Use aseptic technique during vaginal examinations.
    • Deliver as many mothers as possible in hospital.
  19. How can bacterial infection of the newborn infant be prevented?
    • Wash the infant every day.
    • Do not allow family and friends to hold the infant.
    • Keep preterm infants in hospital for as long as possible.
    • Exclusively breastfeed infants for 6 months.
  20. How can the risk of mother to child transmission of HIV be reduced?
    • Deliver all HIV positive women in hospital.
    • Offer antiretrovirals to all HIV positive pregnant women.
    • Shorten labour by performing an episiotomy.
    • Rupture the membranes as soon as possible.