PACES: Obstetric Monitoring Flashcards
What screening occurs at booking, for those women who choose to have it?
Blood tests: group, RhD status, FBC (anaemia), Hb electrophoresis (SCA/Thal), infection (hep B, HIV, syphilis)
Urine dip + MC&S: proteinuria? Asymptomatic bacteriuria?
What supplementation should women be on? (checked at the booking visit)
Folic acid 400 μg OD
Vitamin D 10 μg OP
In which patients should folic acid supplementation be increased? What is the dose?
5mg OD
Previous NTD
Sickle cell disease
BMI >30
Diabetic
Either parent has NTD
On Anti-epileptics
When is the dating scan, and what can it screen for?
11+2 - 14+1w
Viability
Gestation
Multiple pregnancy (+ chorionicity)
Nuchal translucency
What are the 3 elements of the ‘triple test’?
USS (for nuchal translucency)
Blood test for B-hCG + PAPP-A
What combined test result suggests Downs syndrome?
High NT
High B-hCG
Low PAPP-A
What combined test result suggests Edwards or Patau syndrome?
High NT
Low B-hGC
Low PAPP-A
During which weeks of gestation can the combined test be carried out?
11+0 - 13+6
When is NIPT offered on the NHS?
If combined or quadruple test indicate high risk >1/150
What does NIPT analyse?
Small DNA fragments circulating in blood of pregnant woman (cell free fetal DNA, cffDNA)
cffDNA derives from placental cells + is usually identical to fetal DNA
Sensitivity + specificity are very high for trisomy 21 (>99%) + similarly high for other chromosomal abnormalities
What diagnostic tests can confirm Down syndrome? When is each used?
Chorionic Villous Sampling: 10-15w
Amniocentesis: 15-20w
What can be offered if a woman books late and misses the opportunity for a combined test?
Quadruple test (used to be Triple)
What are the components measured in the quadruple test?
Alpha-fetoprotein (AFP)
Total human chorionic gonadotophin (hCG)
Unconjugated oestriol (uE3)
Inhibin-A (inhibin)
What results of the quadruple test indicate Down syndrome?
AFP: LOW
hCG: HIGH
Inhibin: HIGH
Oestradiol: LOW
What results of the quadruple test indicate Edward’s syndrome?
AFP: LOW
hCG: LOW
Inhibin: Normal
Oestradiol: LOW
What results of the quadruple test indicate Neural Tube defects?
AFP: HIGH
hCG: Normal
Inhibin: Normal
Oestradiol: Normal
At how many weeks is the anomaly scan?
18-20w
What is looked for on the anomaly scan?
Structural anomalies
Placental location
Amniotic liquor volume
Gender + growth of foetus
If the placenta is low at the anomaly scan, when should a repeat scan be offered?
32w
Which vaccines are offered during pregnancy and when?
Flu vaccine: Anytime September-January (e.g. booking)
Pertussis: 16-32w
COVID: Anytime
When is the first GP review during pregnancy, and which women should attend?
25w: only nulliparous
Measure SFH
Discuss baby’s movements + any concerns
When is the OGTT if indicated?
ASAP after booking if previous GDM
If high risk: 24-28w
When is anti-D prophylaxis given to women who are RhD negative?
28w
34w
At how many weeks gestation is ECV offered to women with an uncomplicated singleton breech pregnancy?
36w in Primip
37 in Multip
Recall the frequency and start date of serial growth scans in mothers with pre-existing hypertension
Scans at 28w, 32w + 36w
How often is BP measured in mothers with pre-existing hypertension?
Weekly if poorly-controlled
Every 2-4w if well-controlled
Recall the timeline of BP monitoring post-partum in mothers with pre-existing hypertension
Day 1
Day 2
Once on day 3-5
F/U with GP at 2w
What extra scans are done in women with CMV infection?
USS every 2w from dx
Foetal MRI at 28w
What extra scans do women with pre-existing gestational diabetes mellitus have?
Foetal cardiac scan at 20w
Serial growth scans at 28w, 32w and 36w
Recall the timeline of screening for complications of diabetes mellitus in women with pre-existing diabetes?
Retinal + renal screening at booking
If abnormal: repeat at 16w
If normal: repeat at 28w
What extra visits will mothers with epilepsy have?
Obs med clinic every 2w
Serial growth scans at 28w, 32w and 36w
In severe gestational hypertension (BP >160/110), how often should BP be measured on the ward?
Every 15-30 mins
How often should a urine dip be performed in gestational hypertension?
Once or twice a week in moderate HTN
Daily whilst admitted
What extra blood tests are done in gestational hypertension?
Weekly FBC, LFT and U&E
What extra scans do women with gestational hypertension have?
US foetal surveillance every 2w
Recall the timeline of obs med appointments for women with pre-existing cardiac disease
Every 2w until 24w, weekly thereafter
When are maternal echocardiograms performed in women with pre-existing cardiac disease?
- Booking
- 28w
What extra scans do women with pre-existing cardiac disease have during pregnancy?
Specialist foetal cardiac scan at 22w (nb this is at 20w in pre-existing DM)
Recall the extra monitoring given to mothers who are HIV+
Joint obs med clinic every 2w
Viral load every 2w, at 36w and delivery
Recall all of the extra monitoring offered to women with multiple pregnancies
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
What extra monitoring is done in obstetric cholestasis?
Weekly LFTs
Doppler and CTG every 2w
Recall the timeline of scans in suspected placenta praevia
If detected at 20w, rescan at 32w
If still low, rescan at 36w
If still low at 36w, offer C section
Recall the schedule of extra monitoring in PPROM
Admit until 28w
After 28w, monitor 3x/w for signs of chorioamnionitis
What extra monitoring is available for mothers whose foetus is SGA?
SFH at booking + at every antenatal appointment (for everyone)
If appears SGA, confirm with foetal biometry at 20w
If confirmed SGA, do uterine artery doppler at 20-24w
If abnormal, serial scans weekly from 26w onwards
Recall the timeline of TFTs in women with pre-existing thyroid disease in pregnancy
Every 2 weeks at obs med clinic to ensure euthyroidism
Postnatally, 6w check with GP
When are women screened for anaemia and red cell autoantibodies in pregnancy?
Booking 8-12w
28w
At what thresholds should women be given iron for anaemia in pregnancy?
First trim: <110
2nd + 3rd trim: <105
Post partum: <100
