Antepartum Testing

Question 1

WBC and H/H lab trends during pregnancy

Answer 1

WBC increase slightly, H/H decrease slightly

Question 2

lab tests done at 8-12 weeks X12

Answer 2

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

Question 3

What is in the Indirect Coomb’s test

Answer 3

blood type, Rh factor and antibody screen

Question 4

what should the rubella titer be

Answer 4

1:8 - vaccination occurs AFTER pregnancy

Question 5

what does the RPR/VDRL test look for

Answer 5

antibodies to cardiolipin antigens (syphilis)

Question 6

what does the treponemal antibody test for

Answer 6

active syphilis infection

Question 7

when are pap smears normally done

Answer 7

21+ even if pregnancy/sexually active

Question 8

when is pregnancy dating the most accurate

Answer 8

in the 1st 13 weeks

Question 9

lab tests done at 12-24 weeks X8

Answer 9

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

Question 10

when specifically is MSAFP done

Answer 10

16-18 weeks

Question 11

what do MSAFP/triple screen/quad screen test for

Answer 11

risk of neural tube defect

Question 12

what do Triple and Quad screens show that MSAFP doesnt

Answer 12

down’s

Question 13

lab tests done at 24-28 weeks X2

Answer 13

antibody screen on Rh negative patients, glucose screen

Question 14

what is abnormal in a glucose screen

Answer 14

140+

Question 15

if glucose screen is abnormal what happens next

Answer 15

Glucose tolerance test (GTT)

Question 16

if glucose screen and GTT are positive

Answer 16

mom has gestational diabetes

Question 17

3rd trimester tests X6 and X3 in hospital

Answer 17

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

in hospital: blood type and Rh, clotting tests

Question 18

test done at 35-36 weeks

Answer 18

GBS screening

Question 19

how do you treat GBS

Answer 19

2 doses of PCN 4 hours apart

Question 20

X3 other common tests during pregnancy

Answer 20

quantitative beta hCG, progesterone, TORCH

Question 21

what does the hCG test show

Answer 21

accurate marker of pregnancy and an indicator of placental health

Question 22

what is the function of progesterone

Answer 22

makes the pregnancy stick

Question 23

what is TORCH

Answer 23

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

Question 24

what is CVS

Answer 24

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

Question 25

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

Answer 25

RhoD immune globulin should be given

Question 26

pt education for CVS

Answer 26

24 hour bedrest, avoid heavy lifting and intercourse for several days

report cramping, bleeding, fluid leakage or fever

Question 27

disadvantages of CVS

Answer 27

loss of limb or loss of pregnancy

Question 28

what is an amniocentesis

Answer 28

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

Question 29

when can a CVS be done

Answer 29

10-13 weeks

Question 30

when can an amniocentesis be done

Answer 30

15-20 weeks

Question 31

when are amniocentesis results available

Answer 31

within 2 weeks

Question 32

L/S ratio should be

Answer 32

2:1+

Question 33

pt education for an amniocentesis

Answer 33

bedrest for 24 hours, avoid exercise, heavy lifting and sexual intercourse for several days

report cramping, bleeding, fluid leakage, and fever

Question 34

who gets antepartum fetal testing and when

Answer 34

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

Question 35

Kick count is

Answer 35

counting 10 distinct movements in a 1 hr time frame

Question 36

if no kicks are counted after an hour

Answer 36

drink something cold and try again

Question 37

how often should kick counts be done

Answer 37

daily

Question 38

what is a non stress test

Answer 38

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

Question 39

how is an NST performed

Answer 39

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

Question 40

what is a reactive NST

Answer 40

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

Question 41

what is a non-reactive NST

Answer 41

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

Question 42

what are persistent decels associated with

Answer 42

C-section and still births

Question 43

what is a contraction stress test negative

Answer 43

no late decels - ideal result

Question 44

what is a CST positive

Answer 44

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

Question 45

what is a BPP

Answer 45

combines EFM with US assessment over 30 minute period

Question 46

what are the parameters for BPP

Answer 46

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

Question 47

BPP scoring

Answer 47

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