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obstetric - gynecol STEP 2 > pregnancy tests > Flashcards

pregnancy tests Flashcards

1
Q

prenatal care of 1st trimester

A

patients should be seen every 4-6 wks:

  • 11-14 wks: US to confirm gestational age + check nuchal translucency
  • fetal heart sound at the end of the trimester
  • blood tests, pap tests, pap smear, gonor/chl tests
  • 1st trimester screening may be offered
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2
Q

what is 1st trimester screening

A

noninvasive evaluation to identify risks of ch abnormalities –> it is a combination of blood tests + US that evaluates the fetus for possible Down syndrome

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3
Q

what is 2nd trimester screening

A
  • screen for genetic + congenital problems (triple or quad screen at 15-20 wks
  • auscultation of fetal heart rate
  • 16-20 wks: quickening (feelling fetal movement for the first time) - multiparous women earlier
  • 18-20 wks routine US for fetal malformation
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4
Q

triple vs quad screen

A

triple: maternal serum alpha fetoprotein (MSAFP), β-MCG, estriol.
quad: adds inhibin A

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5
Q

increase in MSAFP may indicate … / how to increase the sensitivity of the test

A
  1. dating error
  2. neutral tude defect
  3. abd wall defect
    The addition of beta-HCG estriol and inhibin A helps increase the sensitivity of MSAFP test
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6
Q

what is 3rd trimester screening

A
  • visits are every 2-3 wks until 36 wks
  • after 36 wks, visit every week
  • blood count at 27 wks
  • glucose load at 24-28
  • test for microorganisms in 36 wks
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7
Q

third trimester testing - complete blood count

A

27 wks: if Hb under 11 –> iron orally (with stool softeners)

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8
Q

third trimester testing - test for microorganisms

A

36 wks: Cervical culture for Chlamydia + gonorrhea –> treatment if positive
rectovagina culture for group B strep -> prophylactic antibiotic during labor

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9
Q

other screening test - types

A
  • Chorionic villus test
  • amniocentesis
  • fetal blood sampling
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10
Q

Chorionic villus test - when and indications

A

at 10-13 wks in:

  1. advance maternal age
  2. known genetic disease in parent
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11
Q

Chorionic villus test - technique / purpose

A

catheter into intrauterine cavity to aspirate chorionic villi from placenta (tranabdominally or transvaginally) –> obtains fetal karyotype

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12
Q

amniocentesis - when and indications

A

after 11-14 wk:

  1. advance maternal age
  2. known genetic disease in parent
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13
Q

amniocentesis - technique / purpose

A

needle transabdominally into the amniotic sac and withdraw amnitoci fluid –> obtains fetal karyotype

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14
Q

fetal blood sampling - indications

A

done in patients with Rh isoimmunization and where a fetal CBC is needed

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15
Q

fetal blood sampling - technique / purpose

A

needle tranabdominally into the uterus to get blood from the umbilical cord –> percutaneous umbilical blood sample

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16
Q

mother screening for Rh incompatibility

A

Rh antibody screening (during 1st prenatal visit)

    • –> no further screening
  2. Rh (-) –> antibody titer
    a. if sensitized (have antibodies)–> further monitor
    b. if unsensitized (no antibodies) –> repeat at 28 wks and if still (-) give Rhogam (anti-D) as indicated
    - At delivery: if newborn is Rh (+) –> again Rhogam to mother
17
Q

hemolytic disease of newborn - presentation and mechanism

A
  1. fetal anemia –> extramedullaty RBCs production (liver + spleen)
  2. hemolysis –> increased heme + bilirubin (neurotoxic)
  3. high fetal cardiac output
18
Q

some scenarios where fetal blood cells may cross into the mother’s blood (sensitising the mother)

A
  1. amniocentesis
  2. abortion
  3. vaginal bleeding
  4. placental abruption
  5. delivery
19
Q

further monitor in Rh (-) sensitized pregnant

A

antibody titer via indirect antiglobulin test:

  1. the patient is consedered sensitized if she has a titer level more than 1:4
  2. if less than 1:16 –> no further treatment / but if reaches 1:16 at any point during pregnancy, serial amniocentesis should be done (evaluation of fetal bilirubin level)
20
Q

pregnant’s antibody titer for Rh equals or more than 1:16

–> ….

A

do 1st amnioncentiesis at 16-20 wks:

  1. fetal cells Rh (-) –> manage like normal pregnancy
  2. Rh (+) –> amniocentesis evaluated under spectrophotometer (to evaluate bilirubin):
    a. low bilirubin –> repeat amniocentesis in 2-3 wks
    b. medium –> repeat in 1-2 wks
    c. high –> fetus is anemic –> do percutaneus umbilical blood sample (for Hct) –> low Hct –> perform intrauterine transfusion
21
Q

fetal testing after 32 weeks

A
  • 32-36: weekly nonstress test (NST) for fetal well being and US (fetal size)
  • more than 36: twice weekly testing: 1 NST and 1 biphysical profile (amount of amniotic fluid + fetal well being)
  • 37 lecithin / sphingomyelin (assess lung maturity, if ok deliver)
  • 38-39: no test / labor induction
22
Q

Indications for prophylactic administration of anti-d immune globulin for Rh(D) negative patients

A
  1. at 28-32 weeks
  2. less than 72 h fter delivery of Rh (+) infant
  3. less than 72 hours after spontaneous abortion
  4. ectopic pregnancy
  5. threatened abortion
  6. hydatidiform mole
  7. chorionic villus sampling, amniocentesis
  8. 2nd + 3rd trimester bleeding
  9. external cephalic version (?)
23
Q

karyotyping of fetal tissue after 1 spontaneois miscarrieage

A

not indicated –> considered after recurrent pregnancy or loss in the 2nd trimesterb

24
Q

when to give anti-D (time) / dose

A

28 weeks and within 72 h of delivery
- a standard dose of anti-D immune globulin at 28 wks in uncomplicated pregnancy is adequate/ however if the patient developed placental abruption earlier in pregnancy, the Kleihauer-Betke test should performed to determine whether a higher dose is indicated for postpartum

25
Q

when to check folate acid in pregnancy

A

not recommended

26
Q

initial prenatal visit - labs

A
  1. Rh, antibodies
  2. Hb, MCV
  3. HIV, VDRL, HBsAg
  4. Rubella + varicella immunity
  5. Pap test
  6. Chlamydia PCR
  7. Urine culture
  8. Dipstick for urine protein
27
Q

24-28 wks - labs

A
  1. Hb
  2. antibody screen if Rh (-)
  3. 50 g 1 hour
28
Q

35-37 wks - labs

A

group B strep culture

29
Q

increased nuchal translucency - next step

A

amniocentesis in 15 week

30
Q

U/S assessment of gestational age - parameters

A
  1. Gestational sac diameter
  2. Crown-rump length
  3. Bi-parietal diameter, head circumference, femur length
31
Q

U/S assessment of gestational age - parameters and accuracy in days

A
  1. Gestational sac diameter 4.5-6 (+/- 6 days)
  2. Crown-rump length 7-10 (+/-3 days) or 11-14 (+/-5 days)
  3. Bi-parietal diameter, head circumference, femur length 14-20 (+/- 7), 21-30 (+/-14), more than 30 (+/- 25)
32
Q

trisomy 21 - quadruple screening

A

AFP: low
HCG: high
eastriol: low,
inhibin A: high

33
Q

trisomy 18 - quadruple screening

A

AFP: low
HCG: low
estriol: low
inhibin A: normal/low

34
Q

First trimester combined test - time / advantage / disadvantage

A

9-13 wks

  • early screening
  • not diagnostic
35
Q

cell-free fetal DNA - time / advantage / disadvantage

A

more than 10 weeks

  • high sens + specif for aneuploidy
  • not diagnostic
36
Q

chorionic villus sampling - time / advantage / disadvantage

A

10-13 wks

  • definitive for karyotypic diagnosis
  • invasive + risk for spontaneous abortion
37
Q

2nd trimester quadruple screen - time / advantage / disadvantage

A

15-22 wks

  • screens for neural tube defects + aneuploidy
  • not diagnostic
38
Q

amniocentesis - time / advantage / disadvantage

A

15-20

  • definitive karyotypic diagnosis
  • invasive, risk of membrane rupture, fetal injury, pregnancy loss
39
Q

2nd trimester U/S - time / advantage / disadvantage

A

18-20

  • Measures fetal growth, evaluates fetal anatomy, confirms placenta position
  • cannot identify all abnormalities, some findings are of uncertain significance

obstetric - gynecol STEP 2 (22 decks)

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