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Question 646
Clinical Management → Clinical Practice
Classification
Question
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Maternal death classification
Question Stem
Four maternal deaths are reviewed: (1) fatal obstetric haemorrhage; (2) pre-existing cardiac disease aggravated by pregnancy; (3) a pregnancy-related death 4 months after pregnancy; and (4) death from an unrelated cause during the puerperium. Which sequence correctly classifies them?
Options
A
Direct — indirect — late — coincidental
B
Indirect — direct — late — coincidental
C
Direct — coincidental — late — indirect
D
Direct — indirect — coincidental — late
E
Coincidental — indirect — direct — late
Explanation
Obstetric haemorrhage is a direct cause. Pre-existing cardiac disease aggravated by pregnancy is indirect. A direct or indirect pregnancy-related death between 42 days and 1 year is late. An unrelated death during pregnancy or puerperium is coincidental.
Option Validity
B) Haemorrhage is direct and cardiac disease aggravated by pregnancy is indirect, so the first two classifications are reversed here.
C) The second death is pregnancy-aggravated cardiac disease and is therefore indirect, not coincidental.
D) A pregnancy-related death four months after pregnancy is late, while an unrelated puerperal death is coincidental; these final two are reversed here.
E) The sequence conflicts with all four definitions: haemorrhage is direct, cardiac disease aggravated by pregnancy indirect, four-month pregnancy-related death late, and unrelated puerperal death coincidental.
Further Reading
Saxena MRCOG-1 Basic Sciences — Principles of Clinical Practice, printed p. 6.