CBL 2 – T1 Bleeding and Genetic Screening Flashcards
DDx T1 bleeding? (7)
Non obs bleeding – polyps, penetrative sex, rectal
Ectopic pregnancy
Spontaneous/threatened miscarriage
Subchorionic hemorrhage
Implantation bleeding
Infection
Gestational trophoblast disease (molar preg etc)
Incidence of T1 bleeding?
25 % all pregnancies
How much of T1 bleeding results in miscarriage?
50 %
Incidence of Ectopic pregnancy?
1-2 %, leading cause of maternal T1 death
Possible symptoms of ectopic pregnancy? (7)
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
Timeline of expectant mgmt for T1 loss?
50 % 7 days
80 % 14 days
Timeline of medical mgmt. of T1 loss?
90 % complete within 7 days
Recommendations for WinRho T1 bleeding?
-Do not give winRho before 8 weeks
-Do not give winRho before 12 weeks unless client nervous
What can be offered in T1 bleeding?
US (location of pregnancy and HR)
HcGs
Spec exam
When are HcGs most helpful in T1 bleeding?
Before 8 weeks
When can an US confirm heartbeat for fetus?
CRL 7 mm, around 6+3
What does NIPT look for?
T21, T18, T13
What does IPS/SIPS look for?
NT, T21, T18
Symptoms of T18?
Life expectancy 2 weeks, SGA, IUGR, small chin, club feet, heart/brain differences, miscarriage
What are possible NT defects?
Anencephaly (incompatible w life)
Spina bifidida (spine doesn’t close properly)
What are the blood tests for SIPS/IPS measuring? (5
PAPP-A
AFP
UE3
hCG
Inhibin A
What is IPS US measuring?
Fluid at back of baby’s neck
What does NIPT measure?
Amount of cell-free fetal DNA in maternal blood
What are soft markers?
Presence of fetal factors in detailed US that may indicate T21
What are the most noted T21 soft markers?
Increased NT
Echogenic bowel
Ventriculomegaly
Absent nasal bone
Aberrant right subclavian artery
What test 1 SIPS looking for?
PAPP-A
What is SIPS 2 looking for?
AFP
uE3
hCG
Inhibin-A
Who is offered SIPS?
Less than 35 yo
Who is offered IPS?
35-39
Twin gestation
Pregnant following IVF without genetic screening
What is 40+ offered for genetic screening?
IPS or CVS or Amnio without screening
Who is offered funded NIPS (or amnio/cvs without prior screening)?
Personal/family history that increases risk of fetus with down syndrome, trisomy 18 or trisomy 13
What is choroid plexus cyst?
Cyst in brain from small buildup of spinal fluid
Not considered abnormal
Sometimes associated w T18
What are the soft markers? (8)
Abnormal femur/foot
Absent nasal bone
Choroid plexus cyst
Echogenic Intracardiac focus
Echogenic bowel
Increased Nuchal Thickness
Pyelactasis
Ventricumulagory
Recommendation for 1 abnormal analyte?
Consider ASA
T3 US
Recommendation for 2 abnormal analytes?
Consider ASA
Consult OB/MFM for increased monitoring
What increases someones chance of loss (3)?
- Increase in age
- BMI extremes (underweight/overweight)
- History of infection: STISs
