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2.1) My Cards > 1.2 MTB Step 3 - The Uncomplicated Pregnancy (2nd & 3rd Trimester Prenatal Screening) > Flashcards

1.2 MTB Step 3 - The Uncomplicated Pregnancy (2nd & 3rd Trimester Prenatal Screening) Flashcards

Cards Complete:

1
Q

SECOND TRIMESTER SCREENING

SAMPLE QUESTION

“A 23-yo woman (G3P1 Abortion 1) is seen at 17 weeks gestation. She recently underwent a triple marker screen with the maternal serum alpha-fetoprotein (normal < 2.5 MoM). Her test showed an elevation in maternal serum alpha-fetoprotein. On exam, her uterus is at the umbilicus.”

What is the Next Step in management?

A

Ultrasound

  • The first step in evaluating any pregnancy with an abnormal MS-AFP is to get an Obstetric Ultrasound to confirm the gestational date.
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2
Q

SECOND TRIMESTER SCREENING

DEFINITION

  1. What do MS-AFP and MoM stand for?
  2. What is the combined significance in diagnostic testing?
A

Maternal Serum Alpha FetoProtein (MS-AFP) - increases with gestational age.

Multiples of the Median (MoM) - units for MS-AFP

  • MS-AFP > 2.5 MoM = Elevated (abnormal)
  • MS-AFP < 2.5 MoM = Normal
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3
Q

SECOND TRIMESTER SCREENING

DEFINITION

  1. What is the Importance of Inhibin A in pregnancy?
  2. What disorder is and abnormal Inhibin A level associated with, and is the level abnormal Increased or Decreased?
A
  1. Inhibin A - made by the Placenta during pregnancy and normally remains constant during 15th - 18th week of pregnancy.
  2. Inhibin A level is INCREASED in the Blood of Mothers of Fetuses with DOWN SYNDROME.
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4
Q

SECOND TRIMESTER SCREENING

GENERAL

What is the Most COMMON Cause of an Abnormal Maternal Serum Alpha FetoProtein (MS-AFP)?

A

Gestational Dating Error

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5
Q

SECOND TRIMESTER SCREENING

What is the (1) optional Second Trimester Screening test?

A

Quadruple Marker Screen

  1. MS-AFP (never test alone; only 20% sensitive by itself)
  2. Beta-hCG
  3. Estriol
  4. Inhibin A (only add in high-risk women. Increases sensitivity to 80%)
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6
Q

SECOND TRIMESTER SCREENING

What are (6) disorders associated with an Elevated MS-AFP?

A

Elevated MS-AFP:

  1. Neural Tube Defect (NTD)
  2. Ventral Wall Defect
  3. Twin Pregnancy
  4. Placental Bleeding
  5. Renal Disease
  6. Sacrococcygeal Teratoma
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7
Q

SECOND TRIMESTER SCREENING

What are (2) disorders associated with a Decreased MS-AFP and what are the Quadruple Marker Screening levels for each (MS-AFP, Estriol, Beta-hCG, Inhibin A)?

A
  1. Trisomy 21 (Down Syndrome):
    • Decreased MS-AFP
    • Decreased Estriol
    • Increased Beta-hCG
    • Increased Inhibin A
  2. Trisomy 18:
    • Decreased MS-AFP
    • Decreased Estriol
    • Decreased Beta-hCG
    • Decreased Inhibin A
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8
Q

SECOND TRIMESTER SCREENING

What is the First Step in Management for an Abnormal MS-AFP?

A

Ultrasound

  • Perform Ultrasound to confirm dating.
    • If dating error, repeat MS-AFP.
    • A normal repeat MS-AFP is reassuring.

Note: Accurate gestational dating is needed for interpretation of results.

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9
Q

SECOND TRIMESTER SCREENING

What is the Next Step in Management for an Abnormal MS-AFP if gestational age is confirmed on Ultrasound?

A

For an Abnormal ELEVATION in MS-AFP, perform:

  • Amniocentesis for Amniotic Fluid Alpha-FetoProtein (AF-AFP) level and Acetylcholinesterase activity.
    • ELEVATED levels of Amniotic Fluid Acetylcholinesterase activity are specific to Open NTD.

For an Abnormal DECLINE in MS-AFP, perform:

  • Amniocentesis for Karyotyping
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10
Q

THIRD TRIMESTER SCREENING

SAMPLE QUESTION

“A 38-yo woman (G2P1) is at 27-weeks’ gestation. She weighs 227 lbs. She has gained 30 lbs. during her pregnancy but reports that most of this is “fluid retention.” She was diagnosed with gestational diabetes during her last pregnancy.”

What is the Next Step in management?

A

1-hr 50g OGTT

  • This is the First Step in evaluating for Gestational Diabetes.
  • Performed in weeks 24 - 28 weeks gestation.

Abnormal Result: 1-hr Blood Glucose > 130 - 140 mg/dL

OGTT = Oral Glucose Tolerance Test

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11
Q

THIRD TRIMESTER SCREENING

What are (4) disorders that are Screened for during the Third Trimester?

A
  1. Diabetes
  2. Anemia
  3. Atypical Antibodies
  4. GBS
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12
Q

THIRD TRIMESTER SCREENING

GESTATIONAL DIABETES

  1. What is the Best Third Trimester screening test for Gestational Diabetes?
  2. What is considered an Abnormal Result on this test?
A

1-hr 50g OGTT

  • This is the First Step in evaluating for Gestational Diabetes.
  • Performed in weeks 24 - 28 weeks gestation.

Abnormal Result: 1-hr Blood Glucose > 130 - 140 mg/dL

OGTT = Oral Glucose Tolerance Test

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13
Q

THIRD TRIMESTER SCREENING

GESTATIONAL DIABETES

What is the Next BEST Step in management for a Positive initial screening test for Gestational Diabetes?

A

3-hr 100g OGTT

  • The Confirmatory Test for Glucose Intolerance in pregnancy.
  • Requires an overnight fast.
  • Gestational Diabetes if 2 or more elevated values.
  • Impaired Glucose Tolerance if 1 elevated value.

Abnormal Results:

  • 1-hr Blood Glucose > 180 mg/dL
  • 2-hr Blood Glucose > 155 mg/dL
  • 3-hr Blood Glucose > 140 mg/dL

OGTT = Oral Glucose Tolerance Test

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14
Q

THIRD TRIMESTER SCREENING

ANEMIA

What is the Best Third Trimester screening test for Anemia?

A

CBC

  • Measured at 24 - 28 weeks gestation.
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15
Q

THIRD TRIMESTER SCREENING

ANEMIA

  1. What is the Hemoglobin (Hb) value for Anemia on Third Trimester Screening?
  2. What is the Most COMMON Cause of Anemia in the Third Trimester?
  3. What is the treatment?
A
  1. Anemia = Hb < 11 g/dL
  2. Iron Deficiency
  3. Iron Supplementation
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16
Q

THIRD TRIMESTER SCREENING

ATYPICAL ANTIBODIES

  1. What is the Best Third Trimester screening test for Atypical Antibodies?
  2. Who should receive this test?
A

INDIRECT Coombs Test

Performed in Rh-Negative women to look for the Atypical Antibodies (anti-D Ab) prior to giving RhoGAM.

17
Q

THIRD TRIMESTER SCREENING

ATYPICAL ANTIBODIES

What are the (5) situations when Rh(D) Immunoglobulin in Rh-Negative Mothers?

A
  • At 28 weeks gestation
  • Within 72 of delivery
  • After Miscarriage or Abortion
  • During Amniocentesis or CVS
  • With Heavy Vaginal bleeding
18
Q

THIRD TRIMESTER SCREENING

GBS

What is the Best Third Trimester screening test for GBS and when is it performed?

A

Vaginal & Rectal culture for Group B Streptococci

Perform at 35 - 37 weeks.

19
Q

THIRD TRIMESTER SCREENING

GBS

What is the Treatment for a Positive Third Trimester screening test for Group B Streptococci (GBS)?

A

Intrapartum Antibiotic:

  • IV Penicillin G
  • IV Clindamycin or Erythromycin in Penicillin-allergic patient if sensitivities available.
  • IV Vancomycin if sensitivities not available.

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