PACES: Obstetric Monitoring Flashcards

1
Q

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

A

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?

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2
Q

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

A

12 weeks

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

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3
Q

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

A

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

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4
Q

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

A

11+0 - 13+6

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5
Q

At how many weeks is the anomaly scan?

A

18-20w

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6
Q

What is looked for on the anomaly scan?

A

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

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7
Q

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

A

32w

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8
Q

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

A

25 weeks - only those who are nulliparous

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9
Q

When is the OGTT if indicated?

A

28w

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10
Q

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

A

28 weeks

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11
Q

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

A

36w

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12
Q

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

A

Scans at 28w, 32w and 36w

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13
Q

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

A

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

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14
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

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15
Q

What extra scans are done in women with CMV infection?

A

USS every 2w from diagnosis
Foetal MRI at 28w

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16
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

17
Q

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

A

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

18
Q

What extra visits will mothers with epilepsy have?

A

Obs med clinic every 2w

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

19
Q

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

A

EVery 15-30 mins

20
Q

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

A

Once or twice a week in moderate HTN

Daily whilst admitted

21
Q

What extra blood tests are done in gestational hypertension?

A

Weekly FBC, LFT and U&E

22
Q

What extra scans do women with gestational hypertension have?

A

US foetal surveillance every 2w

23
Q

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

A

Every 2w until 24w, weekly thereafter

24
Q

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

A
  1. Booking
  2. 28w
25
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)

26
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

27
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

28
Q

What extra monitoring is done in obstetric cholestasis?

A

Weekly LFTs
Doppler and CTG every 2w

29
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

30
Q

Recall the schedule of extra monitoring in PPROM

A

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

31
Q

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

A

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

32
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