PACES: Obstetric Monitoring

Question 1

What screening occurs at booking, for those women who choose to have it?

Answer 1

Blood tests: blood group, RhD status, FBC (?anaemia), Hb electrophoresis (SCA/Thal), infection (hep B, HIV, syphilis)

Urine dip and MC&S: proteinuria? Asymptomatic bacteriuria?

Question 2

When is the dating scan, and what can it screen for?

Answer 2

12 weeks

Viability, gestation, multiple pregnancy (and chorionicity), nuchal translucency

Question 3

What are the 3 elements of the ‘triple test’?

Answer 3

USS (for nuchal translucency)

Blood test for B-hCG and PAPP-A

Question 4

During which weeks of gestation can the combined test be carried out?

Answer 4

11+0 - 13+6

Question 5

At how many weeks is the anomaly scan?

Answer 5

18-20w

Question 6

What is looked for on the anomaly scan?

Answer 6

Structural anomalies
Placental location
Amniotic liquor volume
Gender and growth of foetus

Question 7

If the placenta is low at the anomaly scan, when should a repeat scan be offered?

Answer 7

32w

Question 8

When is the first GP review during pregnancy, and which women should attend?

Answer 8

25 weeks - only those who are nulliparous

Question 9

When is the OGTT if indicated?

Answer 9

28w

Question 10

When is the first dose of anti-D prophylaxis given to women who are RhD negative?

Answer 10

28 weeks

Question 11

At how many weeks gestation is ECV offered to women with an uncomplicated singleton breech pregnancy?

Answer 11

36w

Question 12

Recall the frequency and start date of serial growth scans in mothers with pre-existing hypertension

Answer 12

Scans at 28w, 32w and 36w

Question 13

How often is BP measured in mothers with pre-existing hypertension?

Answer 13

Weekly if poorly-controlled

Every 2-4 weeks if well-controlled

Question 14

Recall the timeline of BP monitoring post-partum in mothers with pre-existing hypertension

Answer 14

Day 1
Day 2
Once on day 3-5
F/U with GP at 2w

Question 15

What extra scans are done in women with CMV infection?

Answer 15

USS every 2w from diagnosis

Foetal MRI at 28w

Question 16

What extra scans do women with pre-existing gestational diabetes mellitus have?

Answer 16

Foetal cardiac scan at 20w

Serial growth scans at 28w, 32w and 36w

Question 17

Recall the timeline of screening for complications of diabetes mellitus in women with pre-existing diabetes?

Answer 17

Retinal and renal screening at booking
If abnormal: repeat at 16w
If normal: repeat at 28w

Question 18

What extra visits will mothers with epilepsy have?

Answer 18

Obs med clinic every 2w

Serial growth scans at 28w, 32w and 36w

Question 19

In severe gestational hypertension (BP >160/110), how often should BP be measured on the ward?

Answer 19

EVery 15-30 mins

Question 20

How often should a urine dip be performed in gestational hypertension?

Answer 20

Once or twice a week in moderate HTN

Daily whilst admitted

Question 21

What extra blood tests are done in gestational hypertension?

Answer 21

Weekly FBC, LFT and U&E

Question 22

What extra scans do women with gestational hypertension have?

Answer 22

US foetal surveillance every 2w

Question 23

Recall the timeline of obs med appointments for women with pre-existing cardiac disease

Answer 23

Every 2w until 24w, weekly thereafter

Question 24

When are maternal echocardiograms performed in women with pre-existing cardiac disease?

Answer 24

1. Booking

2. 28w

Question 25

What extra scans do women with pre-existing cardiac disease have during pregnancy?

Answer 25

Specialist foetal cardiac scan at 22w (nb this is at 20w in pre-existing DM)

Question 26

Recall the extra monitoring given to mothers who are HIV+

Answer 26

Joint obs med clinic every 2w | Viral load every 2w, at 36w and delivery

Question 27

Recall all of the extra monitoring offered to women with multiple pregnancies

Answer 27

FBC at 20-24w Regular BP monitoring (increased risk of eclampsia) OGTT at 28w (at higher risk) TTTS monitoring/ growth scans: - every 2w starting at 16w for MCDA twins - every 4w starting at 20w for DCDA twins

Question 28

What extra monitoring is done in obstetric cholestasis?

Answer 28

Weekly LFTs | Doppler and CTG every 2w

Question 29

Recall the timeline of scans in suspected placenta praevia

Answer 29

If detected at 20w, rescan at 32w If still low, rescan at 36w If still low at 36w, offer C section

Question 30

Recall the schedule of extra monitoring in PPROM

Answer 30

Admit until 28w | After 28w, monitor 3 times/week for signs of chorioamnionitis

Question 31

What extra monitoring is available for mothers whose foetus is SGA?

Answer 31

SFH at booking and at every antenatal appointment (for everyone) If appears SGA, confirm this with foetal biometry at 20w If confirmed SGA, do uterine artery doppler at 20-24w If abnormal, serial scans weekly from 26w onwards

Question 32

Recall the timeline of TFTs in women with pre-existing thyroid disease in pregnancy

Answer 32

Every 2 weeks at obs med clinic to ensure euthyroidism Postnatally, 6w check with GP