3 Maternal Testing Part 1 Flashcards
What tests are included to check the Growth and fetal wellbeing? (later in pregnancy)
- Fetal assessment scan - FAS
- BPP
- Biometry
- usually Doppler
What Exams are performed by the sonographer? (4)
1) Dating
2) 1st trimester screen
3) 2nd trimester detailed scan
4) Growth and fetal wellbeing
When is the 2nd trimester detailed scan usually performed?
18-20 weeks
What is the point of fetal ultrasound scanning?
Maternal risk assessment or screen for anomalies
What is the earliest maternal testing done?
Serum Beta Human Chorionic Gonadotropin (beta HCG)
Beta hCG is produced by the ?
trophoblast
Early indicator of pregnancy in?
blood test or urine analysis
Normally beta hCG ____ every ___ days up to ___ weeks then plateaus.
doubles;2days;8weeks
When your see decreased beta hCG on req go into the exam room thinking of these DDX (3)
Missed abortion/fetal demise
ectopic pregnancy
wrong dates
When your see INCREASE beta hCG on req go into the exam room thinking of these DDX (2)
Trophoblastic disease
multiple pregnancies
What does NIPT stand for?
Non Invasive Prenatal Testing
What is anomalies is NIPT great for screening?
Trisomy, 13, 18, 21
When is NIPT performed and how?
After 10 weeks, by taking maternal blood
EXTREMELY accurate
What is NIPT measuring for?
cell free DNA (cfDNA) in maternal plasma (chromosomal test of fetus)
Why isn’t a NIPT scan just used on everyone?
only really looks at chromosomes
sonographic appearance more gives info during the NT scan
NIPT (not covered, $400 o do on own)
What is the Manufactures name of the NIPT test?
Harmony prenatal test
When is the NIPT testing less effective? (5)
Obese patients multiple pregnancy pregnant via donor egg less that 10 weeks pregnant certain blood thinners
1st Trimester screening offers early information about baby’s risk of certain_______
Chromosomal conditions
T13, 18, 21
1st Trimester screening (FTS) combines the results of what 2 tests?
Nuchal Translucency
First Trimester blood test (Beta hCG & PAPP-A)
What is Nuchal Translucency (NT)
collection of fluid under the skin at the back of the baby’s neck
What is the normal AP diameter the NT should be?
< 3.5 mm
The NT measurement is only accurate if ?
the CRL is between 45mm-84mm
What does the NT assessing the risk of?
Chromosomal and other abnormalities
How many gestational weeks is the NT measurement and blood work usually done between?
11-13 weeks
If you see a large NT what should you do?
look for other abnormalities, GS, Heart, etc.
Increased free beta hCG is associated with?
Trisomy 21
decreased free beta hCG is associated with?
Trisomy 13 & 18 or pregnancy loss
Low PAPP-A (pregnancy associated plasma protein) in 1st trimester is associated with
Trisomy 13, 18 & 21
and small for dates, preterm delivery IUGR and hypertension
What is PAPP-A produced by?
placental syncytiotrophoblast ( fetal portion of the placenta) and the Deciduas (maternal " ")
Does PAPPA-A increase more or less in first trimester?
rapidly increases in 1st trimester (doubling every 3-4 days)
continues through pregnancy
1st Trimester screen when combined with NT and Biochemical results has an ___% detection rate of T21, with False positive __%
85%;5%
1st Trimester screen (FTS) is an early ___ ____
Risk Assessment
Risk for chromosomal defects increase with?
Maternal age (>35)
There is a __% detection rate of an abnormality with the addition of the nasal bone being absent or
95%; 2.5mm (@ 11-14 weeks)
There is a __% detection rate of an abnormality with the addition of the nasal bone being absent or
95%; 2.5mm (@ 11-14 weeks)
2nd Trimester screening is also known as the ____screen
Quad
What are the 4 elements found in maternal blood assessed in the Quad screen
AFP
Beta hCG
uE3
Inhibin A
When is maternal serum testing done between?
week 15-20
What are the 3 elements found in maternal blood assessed in the Triple screen
AFP
Beta hCG
uE3
maternal serum AFP (MS AFP) is mainly produced by the
liver
MS AFP is also produced by the (4)
Yolk Sac
Kidneys
GI tract
Placenta
Level of MS AFP rise about ___ to ___ weeks
14-20
The most common cause for an abnormal level of MS AFP is?
WRONG DATES*
MS AFP can be increased in what type of patients? (3)
Athletes & Diabetics & fetal abruptions
Decreased MS AFP can be associated with (2)
T18, 21
Increased MS AFP can be associated with (6)
NTD, Abdo wall defects GI obstruction rH sensitivity placental abnormality Fetal death
Free Beta hCG produced by the ______ in early pregnancy and in later by the _____.
Trophoblast; placenta
Beta hCG increases with (4)
Multiples
Molar
Wrong dates
T 21
Beta hCG decreases with (2)
T18 & fetal demise
UE3 (Estriol) produced in large amount by the ?
Placenta
UE3 (Estriol) Found as early as __ weeks and should rise throughout pregnancy
9
Decreased levels of UE3 (Estriol) associated with (4)
T 18 & 21
Pregnancy loss
Adrenal insufficiency
Inhibin-A hormone produced by the?
placenta
Inhibin-A increased levels assocaited with?
T21
What happens to inhibin-A levels in Trisomy 18
No change
The second trimester screen only screens for Trisomy __ & __.
Trisomy__ is not predicted with Quad or triple screen
21; 18
13
In Trisomy 21 Which 2 values are increased___ & __
and decreased____ & ____
Beta hCG and Inhibin A
MS AFP and UE3
In Trisomy 18 all values are______ with no change in ___
decreased; Inhibin A
Normal structure of spin with skin rules out
spinabifida
