CBL 2 – T1 Bleeding and Genetic Screening

Question 1

DDx T1 bleeding? (7)

Answer 1

Non obs bleeding – polyps, penetrative sex, rectal
Ectopic pregnancy
Spontaneous/threatened miscarriage
Subchorionic hemorrhage
Implantation bleeding
Infection
Gestational trophoblast disease (molar preg etc)

Question 2

Incidence of T1 bleeding?

Answer 2

25 % all pregnancies

Question 3

How much of T1 bleeding results in miscarriage?

Answer 3

50 %

Question 4

Incidence of Ectopic pregnancy?

Answer 4

1-2 %, leading cause of maternal T1 death

Question 5

Possible symptoms of ectopic pregnancy? (7)

Answer 5

Many asymptomatic (1/3)
Most common: bleeding and one sided adnexal tenderness

Other symptoms:
GI upset
Shoulder tip pain
Rectal pressure
Dizziness
Cervical motion tenderness

Question 6

Timeline of expectant mgmt for T1 loss?

Answer 6

50 % 7 days
80 % 14 days

Question 7

Timeline of medical mgmt. of T1 loss?

Answer 7

90 % complete within 7 days

Question 8

Recommendations for WinRho T1 bleeding?

Answer 8

-Do not give winRho before 8 weeks
-Do not give winRho before 12 weeks unless client nervous

Question 9

What can be offered in T1 bleeding?

Answer 9

US (location of pregnancy and HR)
HcGs
Spec exam

Question 10

When are HcGs most helpful in T1 bleeding?

Answer 10

Before 8 weeks

Question 11

When can an US confirm heartbeat for fetus?

Answer 11

CRL 7 mm, around 6+3

Question 12

What does NIPT look for?

Answer 12

T21, T18, T13

Question 13

What does IPS/SIPS look for?

Answer 13

NT, T21, T18

Question 14

Symptoms of T18?

Answer 14

Life expectancy 2 weeks, SGA, IUGR, small chin, club feet, heart/brain differences, miscarriage

Question 14

What are possible NT defects?

Answer 14

Anencephaly (incompatible w life)
Spina bifidida (spine doesn’t close properly)

Question 15

What are the blood tests for SIPS/IPS measuring? (5

Answer 15

PAPP-A
AFP
UE3
hCG
Inhibin A

Question 16

What is IPS US measuring?

Answer 16

Fluid at back of baby’s neck

Question 17

What does NIPT measure?

Answer 17

Amount of cell-free fetal DNA in maternal blood

Question 18

What are soft markers?

Answer 18

Presence of fetal factors in detailed US that may indicate T21

Question 19

What are the most noted T21 soft markers?

Answer 19

Increased NT
Echogenic bowel
Ventriculomegaly
Absent nasal bone
Aberrant right subclavian artery

Question 20

What test 1 SIPS looking for?

Answer 20

PAPP-A

Question 21

What is SIPS 2 looking for?

Answer 21

AFP
uE3
hCG
Inhibin-A

Question 22

Who is offered SIPS?

Answer 22

Less than 35 yo

Question 23

Who is offered IPS?

Answer 23

35-39
Twin gestation
Pregnant following IVF without genetic screening

Question 24

What is 40+ offered for genetic screening?

Answer 24

IPS or CVS or Amnio without screening

Question 25

Who is offered funded NIPS (or amnio/cvs without prior screening)?

Answer 25

Personal/family history that increases risk of fetus with down syndrome, trisomy 18 or trisomy 13

Question 26

What is choroid plexus cyst?

Answer 26

Cyst in brain from small buildup of spinal fluid
Not considered abnormal
Sometimes associated w T18

Question 27

What are the soft markers? (8)

Answer 27

Abnormal femur/foot
Absent nasal bone
Choroid plexus cyst
Echogenic Intracardiac focus
Echogenic bowel
Increased Nuchal Thickness
Pyelactasis
Ventricumulagory

Question 28

Recommendation for 1 abnormal analyte?

Answer 28

Consider ASA
T3 US

Question 29

Recommendation for 2 abnormal analytes?

Answer 29

Consider ASA
Consult OB/MFM for increased monitoring

Question 30

What increases someones chance of loss (3)?

Answer 30

• Increase in age
• BMI extremes (underweight/overweight)
• History of infection: STISs