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OB > 12. Lab Testing and Antepartal Fetal Surveillance > Flashcards

12. Lab Testing and Antepartal Fetal Surveillance Flashcards

1
Q

Purpose of test: Blood Grouping

A

To determine blood type and Rh

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2
Q

Purpose of test: Hemoglobin or Hematocrit

A

To detect anemia. (Often checked several times during pregnancy)

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3
Q

Purpose of test: CBC

A

Complete Blood Count:

To detect infection, anemia, or cell abnormalities

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4
Q

Purpose of test: Rh Factor and Antibody Screen

A

To screen for possible maternal-fetal blood incompatibility

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5
Q

Purpose of test: VDRL or RPR

A

To screen for syphillis

Venereal Disease Research Laboratory, Rapid Plasma Reagin

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6
Q

Purpose of test: Rubella Titer

A

To determine immunity

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7
Q

Purpose of test: Tuberculin Skin Test

A

To screen for tuberculosis

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8
Q

Purpose of test: Hemoglobin Electrophoresis

A

To screen for sickle-cell trait (if client is African-American

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9
Q

Purpose of test: Hepatitis B

A

To detect presence of antigens in Maternal Blood

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10
Q

Purpose of test: HIV screen

A

Voluntary test encouraged to detect HIV antibodies

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11
Q

Purpose of test: Urinalysis

A

To detect renal disease or infection

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12
Q

Purpose of test: Papanicolau Test

A

To screen for cervical neoplasia

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13
Q

Purpose of test: Cervical Culture

A

To detect group B strep and STDs

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14
Q

Purpose of test: Triple Screen

A

To screen for fetal anomalies

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15
Q

What three tests comprise a “Triple Screen”

A
  • Maternal serum alpha-fetorotein
  • Human Chorionic Gonadotropin
  • Estriol
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16
Q

Purpose of test: Maternal Blood Glucose

A

To screen for gestational diabetes

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17
Q

Test Significance / Course of Action: Blood Grouping

A

Identifies possible causes of incompatibility with the blood of the fetus that may cause jaundice

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18
Q

Test Significance / Course of Action: Hemoglobin or Hematocrit

A

Hgb < 11 g/dL or Hct < 33% may indicate a need for iron supplementation

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19
Q

Test Significance / Course of Action: CBC

A

12,000 mm3 or more white blood cells or decreased platelets require follow-up

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20
Q

Test Significance / Course of Action: Rh Factor and antibody screen

A

If mother is Rh (-) and Father is Rh (+) or antibodies are present, additional testing and treatment are required.

(If mom is negative, RhoGAM will be given at 26-28 weeks)

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21
Q

Test Significance / Course of Action: VDRL and RPR

A

Treat if positive; retest at 36 weeks

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22
Q

Test Significance / Course of Action: Rubella Titer

A

If titer is 1:8 or less, mother is not immune. Immunize post-partum if not immune.

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23
Q

Test Significance / Course of Action: Hemoglobin Electrophoresis

A

If mother is positive, check partner. Infant is at risk only if both parents are positive.

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24
Q

Test Significance / Course of Action: Hepatitis B

A

If present, infants should be given hepatitis immune globulin and vaccine soon after birth.

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25
Q

HIV Screen

A

Positive results require retesting, counseling, and treatment to lower infant infection

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26
Q

Test Significance / Course of Action: Urinalysis

A

Requires further assessment if positive for more than trace:

  • Protein (renal damage, preeclampsia, or normal)
  • Glucose (diabetes or normal)
  • Ketones (Fasting or dehydration)
  • Bacteria (Infection)
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27
Q

Test Significance / Course of Action: Pap Test

A

Treat and refer ib abnormal cells are present

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28
Q

Test Significance / Course of Action: Cervical Culture

A
  • Treat and retest as necessary.

* Treat GBS during labor.

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29
Q

Test Significance / Course of Action: Triple Screen

A

Abnormal results may indicate Down Syndrome or neural tube defects.

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30
Q

Test Significance / Course of Action: Maternal Blood Glucose

A

If elevated, a 3-hour glucose tolerance test is recommended.

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31
Q

Test to be done in the 1st trimester

A

nuchal translucency screening +PAPP-A

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32
Q

When should the MSAFP Triple / Quad Screen be administered?

A

15-22 weeks

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33
Q

When should an ultrasound to check fetal anatomy be administered?

A

18-20 weeks

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34
Q

What five tests should be done at the 28 week visit?

A
  • CBC
  • Antibody screen
  • RPR (Rapid plasma regain)
  • GCT
  • Rhogam
35
Q

What four tests should be done at the 36 week visit?

A
  • CBC
  • RPR (Rapid plasma regain)
  • GC/CT
  • GBS vaginal culture
36
Q

What does MSAFP stand for

A

Maternal screen for Alpha-Fetoprotein

37
Q

What is AFP?

A

Alpha-Fetoprotein: the main protein in fetal plasma

38
Q

Where is AFP?

A
  • Diffuses from fetal plasma into fetal urine and is excreted into the amniotic fluid.
  • Some AFP crosses placental membranes into the maternal circulation. Therefore, AFP can be measured both in maternal serum (MSAFP) and amniotic fluid (AFAPFP)
39
Q

Abnormal concentrations of AFP – implications

A

Associated with serious fetal anomalies, requiring additional testing to determine the reason for the abnormal concentration.

40
Q

Levels associated with neural tube defects

A

Elevated AFP indicates NFP

41
Q

Levels associated with down’s syndrome (3)

A
  • Low AFP
  • Low Estriol
  • Elevated hCG
42
Q

Recommendations: Abnormal triple screen (3)

A
  • Genetic counseling
  • Ultrasound
  • Amniocentesis

TRIPLE SCREEN IS NOT DIAGNOSTIC

43
Q

Amniocentesis (def)

A

Aspiration of amniotic fluid, wihch contains fetal cells

44
Q

When is an amniocentesis typically performed?

A

After 14 weeks, in 3rd trimester

45
Q

Purpose of amniocentesis (3)

A

DIAGNOSIS of prenatal anomalies
• Genetic disorders / anomalies
• Pulmonary maturity (3rd trimester)
• Fetal hemolytic disease

46
Q

Indications of amniocentesis (5)

A
  • Maternal age >35
  • History of child with chromosomal abnormality
  • Family history of chromosomal abnormalities
  • Inherited disorders of metabolism
  • Abnormal triple screen
47
Q

Complications involved with an amniocentesis: Prevalence

A

• Occur in <1% of cases

48
Q

Complications involved with an amniocentesis: Maternal

A

Hemorrhage

49
Q

Complications involved with an amniocentesis: Fetal (6)

A 
Fetal death secondary to...
•	Hemorrhage
•	Infection
•	Direct injury from needle
•	Miscarriage
•	PTL
•	Leakage of fluid
50
Q

Chorionic villus sampling: Purpose

A

DIAGNOSTIC TOOL

• Used to diagnose fetal chromosome or metabolic abnormalities

51
Q

Chorionic Villus sampling: What can it NOT diagnose?

A

• Cannot diagnose anomalies for which amniotic fluid is essential (eg open neural tube defects, which require measuring AFP levels)

52
Q

Chorionic Villus sampling: Method

A
  • Removal of small tissue specimen from fetal portion of the placenta
  • Performed transcervically or transabdominally
53
Q

Chorionic Villus sampling: Benefit

A

• Allows for early diagnosis and rapid results

54
Q

Chorionic Villus sampling:When performed

A

10-12 weeks

55
Q

Chorionic Villus sampling: Complications (6)

A
  • Vaginal spotting or bleeding
  • Miscarriage (0.3%)
  • Rupture of membranes (0.1%)
  • Chorioamnioitis (0.5%)
  • Maternal-fetal hemorrhage
  • Limb deformities
56
Q

Fetal movement counts (def)

A

Movements by the fetus, as assessed by the mother: “Kick counts”

57
Q

Fetal movement counts – Reason

A

Fetal movement is associated with fetal condition. Daily evaluation of these movements provides a way for evaluating the fetus.

58
Q

Fetal movement counts – Timing

A

Begins at 28 weeks; recommended daily.

59
Q

Fetal movement counts– Advantages (3)

A
  • Inexpensive
  • Non-invasive
  • Convenient for client, encourages participation in care
60
Q

Fetal movement counts– Disadvantages (4)

A
  • Fetal resting state normally decreases movements
  • Maternal perception of fetal movement varies widely; even in the same woman at different times.
  • Time of day may affect movement (less in the morning, greater in evening)
  • Maternal use of drugs (sedative drugs, methadone, heroine, cocaine, alcohol, tobacco) may affect fetal activity.
61
Q

Non-Stress Test: Purpose

A

To assess fetal well-being:
• Evaluation of fetal response (fetal heart rate) to natural contractile uterine activity or an increase in fetal activity
• Fetus will produce characteristic heart rate patterns in response to fetal movement

62
Q

What causes a diminished fetal response? (4)

A
  • Hypoxia
  • Acidosis
  • Drugs
  • Fetal sleep cycle
63
Q

Benefits of Non-Stress Test (2)

A
  • Non-invasive

* No contraindications

64
Q

NST: Interpreting Results (3)

A
  • Reactive: Two accelerations in 20 minutes
  • Non-reactive: Doesn’t meet criteria for reactive
  • Unsatisfactory: Cannot identify baseline (marked variability) or technical problems / poor tracing
65
Q

Contraction Stress Test: Function (2)

A
  • Identifies the fetus who is compromised, under stress

* Used to identify the jeopardized fetus that was stable at rest, but showed evidence of compromise after stress

66
Q

Contraction Stress Test: What to identify (3)

A

o Must identify fetal baseline, moderate variability, and the possible occurrence of spontaneous contractions.

67
Q

Contraction Stress Test: Methodology

A
  • Uterine contractions are stimulated

* When adequate contractions or hyperstimulation occurs, stimulation is stopped

68
Q

Contraction Stress Test: What would indicate fetal distress?

A

LATE DECELERATION

o Uterine contraction decreases uterine blood flow and placental perfusion

• If the decrease is sufficient to produce hypoxia in the fetus, a deceleration in FHR will result, beginning at the peak of the contraction and persisting after its conclusion (late deceleration).

69
Q

Contraction Stress Test: Interpreting Results

A
  • Negative CST: No decelerations with contractions

* Positive CST: Repetitive decelerations with contractions

70
Q

Contraction Stress Test: How are uterine contractions stimulated? (2)

A
  • Nipple stimulation: Warm cloth applied to both breasts for 10 minutes, then massage the nipples for ten minutes
  • Oxytocin: Given IV to stimulate contractions
71
Q

Hyperstimulation (def)

A

Contractions lasting more than 90 seconds or five or more contractions in 10 minutes.

72
Q

Biophysical Profile: Methods (2 components)

A
  • Ultrasound – uses real-time ultrasound that enables monitoring of fetal biophysical responses to stimuli
  • External fetal monitoring
73
Q

What is the fetal response to central hypoxia? (BPP)

A

Alteration in movement, tone, breathing, HR

74
Q

Biophysical Profile: Five components measured

A
  • Fetal breathing movements
  • Gross body movements
  • Fetal tone
  • Fetal heart rate
  • Amniotic fluid volume
75
Q

Biophysical Profile: Results (3)

A

• Normal: 8-10 if AFV is WNL
Indicates CNS if functional, fetus is not hypoxemic

  • Equivocal: 6
  • Abnormal: <4 with abnormal AFV. Induction indicated.
76
Q

What tool is used to measure amniotic fluid?

A

Ultrasound

77
Q

What does the AFI measure?

A

Depth in cm of amniotic fluid in all four quadrants

78
Q

AFI: Normal / Abnormal (3)

A
  • Normal range: Between 5cm and 20 cm

* Oligohydraminos: 20cms

79
Q

Ultrasounds: 2 types

A

o Abdominal

o Transvaginal

80
Q

Abdominal ultrasound (2 characteristics)

A
  • More effective after 1st trimester

* Must have a full bladder

81
Q

Transvaginal ultrasound (2 characteristics)

A
  • Optimal during 1st trimester

* Bladder can be empty

82
Q

What does a first trimester sonogram indicate? (5)

A

o Number, size, location of gestational sacs
o Presence or absence of fetal cardiac and body movements
o Uterine abnormalities or adenexal masses
o Estimated gestational age (EGA)
o Presence and location of IUD

83
Q

What does a 2nd / 3rd trimester sonogram indicate?

A 
o	Fetal viability
o	Number of fetuses
o	Gestational age, growth pattern
o	Fetal anomalies
o	Amniotic fluid volume (AFV)
o	Placental location and maturity
o	Fetal position
o	Uterine fibroids and anomalies
o	Adnexal masses
o	Cervical length

OB (15 decks)

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