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OB GYNE 4 > 3 Maternal Testing Part 1 > Flashcards

3 Maternal Testing Part 1 Flashcards

1
Q

What tests are included to check the Growth and fetal wellbeing? (later in pregnancy)

A
  • Fetal assessment scan - FAS
  • BPP
  • Biometry
  • usually Doppler
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2
Q

What Exams are performed by the sonographer? (4)

A

1) Dating
2) 1st trimester screen
3) 2nd trimester detailed scan
4) Growth and fetal wellbeing

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3
Q

When is the 2nd trimester detailed scan usually performed?

A

18-20 weeks

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4
Q

What is the point of fetal ultrasound scanning?

A

Maternal risk assessment or screen for anomalies

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5
Q

What is the earliest maternal testing done?

A

Serum Beta Human Chorionic Gonadotropin (beta HCG)

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6
Q

Beta hCG is produced by the ?

A

trophoblast

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7
Q

Early indicator of pregnancy in?

A

blood test or urine analysis

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8
Q

Normally beta hCG ____ every ___ days up to ___ weeks then plateaus.

A

doubles;2days;8weeks

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9
Q

When your see decreased beta hCG on req go into the exam room thinking of these DDX (3)

A

Missed abortion/fetal demise
ectopic pregnancy
wrong dates

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10
Q

When your see INCREASE beta hCG on req go into the exam room thinking of these DDX (2)

A

Trophoblastic disease

multiple pregnancies

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11
Q

What does NIPT stand for?

A

Non Invasive Prenatal Testing

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12
Q

What is anomalies is NIPT great for screening?

A

Trisomy, 13, 18, 21

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13
Q

When is NIPT performed and how?

A

After 10 weeks, by taking maternal blood

EXTREMELY accurate

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14
Q

What is NIPT measuring for?

A

cell free DNA (cfDNA) in maternal plasma (chromosomal test of fetus)

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15
Q

Why isn’t a NIPT scan just used on everyone?

A

only really looks at chromosomes
sonographic appearance more gives info during the NT scan

NIPT (not covered, $400 o do on own)

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16
Q

What is the Manufactures name of the NIPT test?

A

Harmony prenatal test

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17
Q

When is the NIPT testing less effective? (5)

A 
Obese patients
multiple pregnancy
pregnant via donor egg
less that 10 weeks pregnant
certain blood thinners
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18
Q

1st Trimester screening offers early information about baby’s risk of certain_______

A

Chromosomal conditions

T13, 18, 21

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19
Q

1st Trimester screening (FTS) combines the results of what 2 tests?

A

Nuchal Translucency

First Trimester blood test (Beta hCG & PAPP-A)

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20
Q

What is Nuchal Translucency (NT)

A

collection of fluid under the skin at the back of the baby’s neck

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21
Q

What is the normal AP diameter the NT should be?

A

< 3.5 mm

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22
Q

The NT measurement is only accurate if ?

A

the CRL is between 45mm-84mm

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23
Q

What does the NT assessing the risk of?

A

Chromosomal and other abnormalities

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24
Q

How many gestational weeks is the NT measurement and blood work usually done between?

A

11-13 weeks

25
Q

If you see a large NT what should you do?

A

look for other abnormalities, GS, Heart, etc.

26
Q

Increased free beta hCG is associated with?

A

Trisomy 21

27
Q

decreased free beta hCG is associated with?

A

Trisomy 13 & 18 or pregnancy loss

28
Q

Low PAPP-A (pregnancy associated plasma protein) in 1st trimester is associated with

A

Trisomy 13, 18 & 21

and small for dates, preterm delivery IUGR and hypertension

29
Q

What is PAPP-A produced by?

A 
placental syncytiotrophoblast ( fetal portion of the placenta)
and the Deciduas  (maternal  " ")
30
Q

Does PAPPA-A increase more or less in first trimester?

A

rapidly increases in 1st trimester (doubling every 3-4 days)

continues through pregnancy

31
Q

1st Trimester screen when combined with NT and Biochemical results has an ___% detection rate of T21, with False positive __%

A

85%;5%

32
Q

1st Trimester screen (FTS) is an early ___ ____

A

Risk Assessment

33
Q

Risk for chromosomal defects increase with?

A

Maternal age (>35)

34
Q

There is a __% detection rate of an abnormality with the addition of the nasal bone being absent or

A

95%; 2.5mm (@ 11-14 weeks)

35
Q

There is a __% detection rate of an abnormality with the addition of the nasal bone being absent or

A

95%; 2.5mm (@ 11-14 weeks)

36
Q

2nd Trimester screening is also known as the ____screen

A

Quad

37
Q

What are the 4 elements found in maternal blood assessed in the Quad screen

A

AFP
Beta hCG
uE3
Inhibin A

38
Q

When is maternal serum testing done between?

A

week 15-20

39
Q

What are the 3 elements found in maternal blood assessed in the Triple screen

A

AFP
Beta hCG
uE3

40
Q

maternal serum AFP (MS AFP) is mainly produced by the

A

liver

41
Q

MS AFP is also produced by the (4)

A

Yolk Sac
Kidneys
GI tract
Placenta

42
Q

Level of MS AFP rise about ___ to ___ weeks

A

14-20

43
Q

The most common cause for an abnormal level of MS AFP is?

A

WRONG DATES*

44
Q

MS AFP can be increased in what type of patients? (3)

A

Athletes & Diabetics & fetal abruptions

45
Q

Decreased MS AFP can be associated with (2)

A

T18, 21

46
Q

Increased MS AFP can be associated with (6)

A 
NTD, 
Abdo wall defects
GI obstruction
rH sensitivity
placental abnormality 
Fetal death
47
Q

Free Beta hCG produced by the ______ in early pregnancy and in later by the _____.

A

Trophoblast; placenta

48
Q

Beta hCG increases with (4)

A

Multiples
Molar
Wrong dates
T 21

49
Q

Beta hCG decreases with (2)

A

T18 & fetal demise

50
Q

UE3 (Estriol) produced in large amount by the ?

A

Placenta

51
Q

UE3 (Estriol) Found as early as __ weeks and should rise throughout pregnancy

A

9

52
Q

Decreased levels of UE3 (Estriol) associated with (4)

A

T 18 & 21
Pregnancy loss
Adrenal insufficiency

53
Q

Inhibin-A hormone produced by the?

A

placenta

54
Q

Inhibin-A increased levels assocaited with?

A

T21

55
Q

What happens to inhibin-A levels in Trisomy 18

A

No change

56
Q

The second trimester screen only screens for Trisomy __ & __.
Trisomy__ is not predicted with Quad or triple screen

A

21; 18

13

57
Q

In Trisomy 21 Which 2 values are increased___ & __

and decreased____ & ____

A

Beta hCG and Inhibin A

MS AFP and UE3

58
Q

In Trisomy 18 all values are______ with no change in ___

A

decreased; Inhibin A

59
Q

Normal structure of spin with skin rules out

A

spinabifida

OB GYNE 4 (11 decks)

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