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YR5 Specialties > PACES: Obstetric Monitoring > Flashcards

PACES: Obstetric Monitoring Flashcards

1
Q

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

A

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

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

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2
Q

What supplementation should women be on? (checked at the booking visit)

A

Folic acid 400 μg OD
Vitamin D 10 μg OP

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3
Q

In which patients should folic acid supplementation be increased? What is the dose?

A

5mg OD
Previous NTD
Sickle cell disease
BMI >30
Diabetic
Either parent has NTD
On Anti-epileptics

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4
Q

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

A

11+2 - 14+1w

Viability
Gestation
Multiple pregnancy (+ chorionicity)
Nuchal translucency

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5
Q

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

A

USS (for nuchal translucency)
Blood test for B-hCG + PAPP-A

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6
Q

What combined test result suggests Downs syndrome?

A

High NT
High B-hCG
Low PAPP-A

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7
Q

What combined test result suggests Edwards or Patau syndrome?

A

High NT
Low B-hGC
Low PAPP-A

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8
Q

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

A

11+0 - 13+6

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9
Q

When is NIPT offered on the NHS?

A

If combined or quadruple test indicate high risk >1/150

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10
Q

What does NIPT analyse?

A

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

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11
Q

What diagnostic tests can confirm Down syndrome? When is each used?

A

Chorionic Villous Sampling: 10-15w
Amniocentesis: 15-20w

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12
Q

What can be offered if a woman books late and misses the opportunity for a combined test?

A

Quadruple test (used to be Triple)

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13
Q

What are the components measured in the quadruple test?

A

Alpha-fetoprotein (AFP)
Total human chorionic gonadotophin (hCG)
Unconjugated oestriol (uE3)
Inhibin-A (inhibin)

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14
Q

What results of the quadruple test indicate Down syndrome?

A

AFP: LOW
hCG: HIGH
Inhibin: HIGH
Oestradiol: LOW

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15
Q

What results of the quadruple test indicate Edward’s syndrome?

A

AFP: LOW
hCG: LOW
Inhibin: Normal
Oestradiol: LOW

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16
Q

What results of the quadruple test indicate Neural Tube defects?

A

AFP: HIGH
hCG: Normal
Inhibin: Normal
Oestradiol: Normal

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17
Q

At how many weeks is the anomaly scan?

A

18-20w

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18
Q

What is looked for on the anomaly scan?

A

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

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19
Q

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

A

32w

20
Q

Which vaccines are offered during pregnancy and when?

A

Flu vaccine: Anytime September-January (e.g. booking)
Pertussis: 16-32w
COVID: Anytime

21
Q

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

A

25w: only nulliparous
Measure SFH
Discuss baby’s movements + any concerns

22
Q

When is the OGTT if indicated?

A

ASAP after booking if previous GDM
If high risk: 24-28w

23
Q

When is anti-D prophylaxis given to women who are RhD negative?

A

28w
34w

24
Q

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

A

36w in Primip
37 in Multip

25
Q

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

A

Scans at 28w, 32w + 36w

26
Q

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

A

Weekly if poorly-controlled
Every 2-4w if well-controlled

27
Q

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

A

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

28
Q

What extra scans are done in women with CMV infection?

A

USS every 2w from dx
Foetal MRI at 28w

29
Q

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

A

Foetal cardiac scan at 20w
Serial growth scans at 28w, 32w and 36w

30
Q

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

A

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

31
Q

What extra visits will mothers with epilepsy have?

A

Obs med clinic every 2w

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

32
Q

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

A

Every 15-30 mins

33
Q

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

A

Once or twice a week in moderate HTN

Daily whilst admitted

34
Q

What extra blood tests are done in gestational hypertension?

A

Weekly FBC, LFT and U&E

35
Q

What extra scans do women with gestational hypertension have?

A

US foetal surveillance every 2w

36
Q

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

A

Every 2w until 24w, weekly thereafter

37
Q

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

A
  1. Booking
  2. 28w
38
Q

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

A

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

39
Q

Recall the extra monitoring given to mothers who are HIV+

A

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

40
Q

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

A

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

41
Q

What extra monitoring is done in obstetric cholestasis?

A

Weekly LFTs
Doppler and CTG every 2w

42
Q

Recall the timeline of scans in suspected placenta praevia

A

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

43
Q

Recall the schedule of extra monitoring in PPROM

A

Admit until 28w
After 28w, monitor 3x/w for signs of chorioamnionitis

44
Q

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

A

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

45
Q

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

A

Every 2 weeks at obs med clinic to ensure euthyroidism

Postnatally, 6w check with GP

46
Q

When are women screened for anaemia and red cell autoantibodies in pregnancy?

A

Booking 8-12w
28w

47
Q

At what thresholds should women be given iron for anaemia in pregnancy?

A

First trim: <110
2nd + 3rd trim: <105
Post partum: <100

YR5 Specialties (27 decks)

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