LABS

Question 1

hyperandrogenism

Answer 1

17-hydroxyprogesteone 24 hour urine cortisol Prolactin/TSH Testosterone/DHEA

Question 2

AUB

Answer 2

Pregnancy test (number one) CBC coagulopathies panel (von willibrand factor) TSH Chlamydia trachomatis diagnostic imaging

Question 3

Not bleeding + no sexual development: next step

Answer 3

FSH/LH

Question 4

Not bleeding + sexual development traits: next step

Answer 4

US for uterus

Question 5

FSH and LH < 5, primary

Answer 5

hypo hypo

Question 6

FSH and LH, 20/40

Answer 6

hyper-hypo, turners, ovarian failure depending on karypt

Question 7

Prenatal labs at first visit

Answer 7

Pregnancy Test Complete blood count Type and screen Rh negative patients receive Rhogam at 28 weeks & anytime sensitization may occur Rubella‐vaccinate postpartum if not immune Syphilis (RPR) Hepatitis B surface Ag HIV Cervical cytology and gonorrhea and chlamydia Screen for diabetes based on risk factors Urine culture

Question 8

first trimester screening

Answer 8

1. Maternal age
2. Fetal (nuchal translucency (NT) thickness (echo free area at the back of the fetal neck between 10 and 14 weeks)- Increased thickness associated with both chromosomal and congenital anomalies
3. Maternal serum b‐human chorionic gonadotropin (b‐hCG)
4. Pregnancy associated plasma protein‐A (PAPP-A)

Question 9

Elevated Beta HCG and low PAPP‐A

Answer 9

associated with Down’s syndrome

Question 10

3 factors to achieve 93% detection rate for Down’s S in first trimester

Answer 10

1. nuchal translucancy
2. biochemical markers
3. nasal bone (absence indicates increased risk for Down’s)

Question 11

Answer 11

nuchal translucency

Question 12

“triple screen”

Answer 12

second semester: hCG, estriol, AFP

Question 13

quadruple screen

Answer 13

AFP, estriol, hCG, inhibin B

80% detection of Down’s

Question 14

elevated HCG, or AFP and low levels of PAPP‐A or estriol can be found with

Answer 14

preterm birth, intrauterine growth restriction, and preeclampsia

Question 15

Noninvasive Prenatal testing: Cell-Free DNA

when is it used, what can it detect?

Answer 15

1. 9 ‐ 10 weeks: can be performed in the 1st or 2nd trimester)
   
   1. Tests cell free fetal DNA
      
      1. Detection rates
2.  Trisomy 21 = 99.4%
3.  Trisomy 18,= 99.1%
4.  Trisomy 13= 91.7%
5. Sex chromosomes ( 45X, 47XXX, 47XXY, 47XYY)= 96.2% X & Y chromosomes​

Question 16

test for neuroal tube defects with CFDNA?

Answer 16

NO. Continue to evaluate for NTD with Maternal serum alpha0fetoprotein or ultrasound

Question 17

RFs indicating CFDNA should be ordered and subsequent labs if (+)

Answer 17

increased maternal age, previous trisomy, US suggestive of aneuploidy, confirmed chromosomal defects, or if a + with first tri, triple or quad testings—-> confirm with aminocentesis or CVS

Question 18

second trimester diagnostic testing

Answer 18

1. aminocentesis @ 16/20 wks (.3 % miscarriage)
2. chorionic villi sampling @ 11 wks (1% miscarriage)