Antepartum Testing Flashcards by Megan Pirtle

WBC and H/H lab trends during pregnancy

WBC increase slightly, H/H decrease slightly

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lab tests done at 8-12 weeks X12

CBC
H/H
Indirect Coomb's
HIV
Rubella
Hep B
UDS/UA
RPR/VDRL/Treponemal antibody
pap smear
Gonorrhea and Chlamydia
Ultrasound

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What is in the Indirect Coomb’s test

blood type, Rh factor and antibody screen

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what should the rubella titer be

1:8 - vaccination occurs AFTER pregnancy

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what does the RPR/VDRL test look for

antibodies to cardiolipin antigens (syphilis)

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what does the treponemal antibody test for

active syphilis infection

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when are pap smears normally done

21+ even if pregnancy/sexually active

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when is pregnancy dating the most accurate

in the 1st 13 weeks

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lab tests done at 12-24 weeks X8

genetic screens
MSAFP/triple screen/quad screen
genetic carrier testing
CVS/amniocentesis
ultrasound

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when specifically is MSAFP done

16-18 weeks

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what do MSAFP/triple screen/quad screen test for

risk of neural tube defect

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what do Triple and Quad screens show that MSAFP doesnt

down’s

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lab tests done at 24-28 weeks X2

antibody screen on Rh negative patients, glucose screen

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what is abnormal in a glucose screen

140+

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if glucose screen is abnormal what happens next

Glucose tolerance test (GTT)

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if glucose screen and GTT are positive

mom has gestational diabetes

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3rd trimester tests X6 and X3 in hospital

CBC, RPR/VDRL/Treponemal, HIV, hep B

in hospital: blood type and Rh, clotting tests

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test done at 35-36 weeks

GBS screening

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how do you treat GBS

2 doses of PCN 4 hours apart

X3 other common tests during pregnancy

quantitative beta hCG, progesterone, TORCH

what does the hCG test show

accurate marker of pregnancy and an indicator of placental health

what is the function of progesterone

makes the pregnancy stick

what is TORCH

Toxoplasma gondii, other viruses, rubella, cytomegalovirus, herpes simplex

what is CVS

chorionic villus sampling

a thin sterile catheter or syringe inserted through abdominal wall or cervix with ultrasound guidance. aspirates a small amount of placental tissue for chromosomal, metabolic or DNA testing

What needs to be done for an Rh negative mom following a CVS

RhoD immune globulin should be given

pt education for CVS

24 hour bedrest, avoid heavy lifting and intercourse for several days report cramping, bleeding, fluid leakage or fever

disadvantages of CVS

loss of limb or loss of pregnancy

what is an amniocentesis

a needle is inserted into the uterine cavity to obtain amniotic fluid. guided by US

when can a CVS be done

10-13 weeks

when can an amniocentesis be done

15-20 weeks

when are amniocentesis results available

within 2 weeks

L/S ratio should be

2:1+

pt education for an amniocentesis

bedrest for 24 hours, avoid exercise, heavy lifting and sexual intercourse for several days report cramping, bleeding, fluid leakage, and fever

who gets antepartum fetal testing and when

anyone with a viable gestation with a high risk pregnancy at 24+ weeks

Kick count is

counting 10 distinct movements in a 1 hr time frame

if no kicks are counted after an hour

drink something cold and try again

how often should kick counts be done

daily

what is a non stress test

a method for evaluating fetal status during antepartum period by observing response of fetal HR to movement

how is an NST performed

fetal monitor is placed for 20-40 minutes. stimulation can be applied for 1-2 seconds and repeated up to 3 times

what is a reactive NST

FHR increases 15 for 15 seconds 2-3 times in 20 minutes for 32+ weeks FHR increases 10 for 10 seconds 2-3 times in 20 minutes for <32 weeks

what is a non-reactive NST

fewer than 2 accels during 40 minutes, variable decels are observed (if not recurrent and last <30 seconds ignore)

what are persistent decels associated with

C-section and still births

what is a contraction stress test negative

no late decels - ideal result

what is a CST positive

late decels are present with 50% of contrations even if fewer than 3 contractions in 10 minutes

what is a BPP

combines EFM with US assessment over 30 minute period

what are the parameters for BPP

fetal movement - 3+ discrete body limb movements fetal tone - 1+ fetal extremity extension/flexion fetal breathing movement - 1+ episode of rhythmic breathing movements of 30 seconds w/n test amniotic fluid amount - pocket of amniotic fluid measuring 2 cm in 2 planes perpendicular to each other NST - reactive

BPP scoring

2 points given for normal, 0 for abnormal 8-10 is reassuring 6 is equivocal and may indicate need for delivery depending on gestational age 4 = delivery recommended d/t chronic asphyxia 2 or less = immediate delivery