Antenatal Flashcards
best screen for Down Syn?
when?
cell-free DNA screen
after 9 wks (until delivery)
combined test components?
when?
1st Tri Screen Quad Screen (2nd tri) DO BOTH, plan to do both from beginning. Do not wait for 1st results to then decide if doing the 2nd
1) nuchal translucency
2) ms PAPPA
3) free b-hCG
first trimester
glucose tolerance test:
how many abnormal values?
what next?
3/4 abnormal
diabetic diet, monitor glucose levels
blood glucose goals
fasting: below 90
1 hr post prandial: below 135
2 hr post: below 120
complications of GDM
shoulder dystocia metabolic disturbances preeclampsia polyhydramnios fetal macrosomia
IUGR (if preexisting DM)
explanation of elevated msAFP
(NT defects) *underestimation of gest age* fetal demise multiple gestation ventral wall defects tumor liver disease in mom
if elevated AFP, next step?
fetal US
assess gest age, viability, r/o multiple gestation, r/o fetal structural abnormality
assess for aneuploidy?
1st Tri Screen: NT, PAPPA, b-hCG
2nd Tri Quad Screen: unconj estradiol, AFP, B-hCG, inhibin A
amniocentesis: down + others
cell-free DNA: Down only
sequential screen?
when?
1st Tri Screen + Quad Screen
recommended weight gain
underweight: 28-40 lbs
normal: 25-35 lbs
overweight: 15-25 lbs
obese: 11-20 lbs
biophysical profile
NST Breathing Movement Muscle tone Amniotic Fluid
amniocentesis:
when?
what?
15-20 wks aneuploidies fetal lung maturity r/o infection check bilirubin
risks: pain, spotting, leakage, fetal loss (35 yo**
cordocentesis
when?
what?
> 17 wks
percutaneous umbilical blood sampling
karyotype, fetal hematocrit, fetal CBC
chorionic villous sample (CVS)
when?
what?
9-12 wks
transvaginal, transabdominal aspiration
karyotype
risks: PTL, PROM, fetal injury (limbs)
cell free DNA screen
when?
what?
9wks to delivery
detects 99% of Down
