Examples of selective non-routine investigation

Timing

Plasma glucose

28weeks

Haemaglobin Electrophoresis

Booking

Mid stream specimen of urine

Booking/ positive urinalysis

HIV (non anonymous)

Booking

Cervical Smear

Booking/as appropriate

Primigravida (first time mothers) of <16 or >35 years of age

Multigravida (second and subsequent births) of > 40 years of age

Non pregnant BMI of <20 or >35

Weight of <50 kg or >100 kg

Diabetes, thyroid disease, asthma (on steroid therapy)

History of essential hypertension, heart disease, epilepsy, haematological disease, renal disease.

Previous mental health diagnosis of schizophrenia, manic depressive psychosis, puerperal psychosis, postnatal depression

Past history of thromboembolism, Pulmonary Thrombo-embolism or anticoagulation

A haematological morbidity

Pelvic floor repair surgery or cone biopsy of the cervix

History of pelvic trauma

Prolonged infertility or assisted reproduction

History of drug or alcohol abuse

Group B Streptococci carrier/previous Group B streptococci

Known HIV positive status

Genetic disorder or significant family history

Previous anaesthetic problems including difficult intubation, anaesthetic drug sensitivity or anaphylaxis

Abnormal facial, neck or spinal anatomy

Family or personal history of suxamethonium apnoea or malignant hypertension

High risk pregnancy with expected anaesthetic involvement

• The following previous Obstetric or Gynaecological criteria are suggested for specialist booking:

Three or more previous miscarriages

One previous mid trimester loss

Past stillbirth or neonatal death

Previous significant morbidity or congenital anomaly

Past history of preterm labour at <36 weeks

Significant pre-eclampsia or history of eclampsia

Previous low birth weight <2.5 kg at term

Intra-uterine growth restriction

Proteinuric hypertension

Previous gestational diabetes

Major Abuptio Placentae, with/without intra-uterine death

Caesarean section, complex assisted or forceps delivery

Shoulder dystocia

Previous baby of >4 kg

Previous postpartum haemorrhage >1500 mls

Previous significant peri-anal problem

Previous pelvic floor surgery or trauma

Previous hysterotomy, myomectomy or cone biopsy

Birth asphyxia requiring special care nursery admission

• The following current Obstetric factors are suggested for specialist bookings:

Multiple pregnancy

Booking Hb<10g/L

Rhesus Iso-immunisation

Problems which require specialist advice and possible ongoing management during pregnancy

Multiple pregnancy

Raised AFP with normal scan

Pre-eclampsia (BP >140/95 on 2 or more occasions)

Significant antepartum haemorrhage

Placenta Praevia

Preterm rupture of the membranes at <36 completed weeks

Breech presentation or oblique lie >36 weeks

Small for dates (<10th centile for gestation) by ultrasound

Suspected baby of > 4 kg

Hepatitis carrier (Hep B, Hep C)

Known HIV positive

Substance misuse

Evidence of depression or other major mental illness and past history of major mental disorder

Evidence of domestic violence

Large for dates (>90th centile for gestation) by Ultrasound

Abnormal cardiotocographic tracing

Intra-uterine death

Suspected fetal abnormality

Termination for fetal abnormalities

Newly diagnosed medical disease

Rhesus Iso-immunisation

Polyhydramnios (confirmed by ultrasound scanning)

Oligohydramnios (confirmed by ultrasound scanning)

Past 41 weeks for induction of labour

Common conditions associated with pregnancy for which local treatment and referal guidelines should be in place

Hyperemesis and Ketosis

Glycosuria >=1+

Random fasting and 2 hour postprandial blood glucose of >5.5 mmol/l or >7mmol/l

Haematuria

Proteinuria >=1+

Hypertension: Systolic blood pressure >=170mm Hg or Diastolic blood pressure >=100mm Hg

Severe hypertension: DBP >=110mm Hg at any time

Anaemia/haemoglobin<10.5 g/dl

Minor haemorrhage <24 weeks

Major and minor Antepartum haemorrhage

Deep venous thrombosis

Polyhydramnios

Decreased fetal movements

Intra-uterine death

Pre-term and prolonged rupture of membranes

Pre-term labour

Prolonged pregnancy (Term +7 days)

Small for dates

Symptomatic vaginal discharge

Rhesus Disease

Abnormal presentation at 36 weeks

High head/failure to engage - inappropriate for gestational age