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Block 4 - OBGYN > Clin Lab: Pregnancy > Flashcards

Clin Lab: Pregnancy Flashcards

1
Q

Pregnancy can be confirmed by:

A
  • Detection of hCG
  • Detection of pregnancy via US
  • Detection of fetal heartbeat
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2
Q

What do you use measure hCG?

A

serum or urine

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3
Q

When does hCG production begin?

A

21 - 23 days of cycle after fertilization of ova

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4
Q

Describe the testing for hCG?

A
  • Serum tests detect lower levels of HCG – can detect pregnancy earlier
  • Home urine tests are least sensitive
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5
Q

Qualitative test are done unless looking for…

A

ectopic pregnancy or threated abortion

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6
Q

With a normal pregnancy, what should happen to hCG levels?

A

double every 48 hours

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7
Q

HCG peaks around ____, then declines

A

10-12 weeks

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8
Q

Is a FU required?

A

No, unless concern for non-uterine pregnancy or if pt has an IUD

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9
Q

Reasons why HCG might not increase appropriately?

A
  • Ectopic pregnancy
  • Non-viable fetus
  • Molar pregnancy
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10
Q

List the imaging that can be done during pregnancy

A
  • US
  • MRI
  • CT or X-ray
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11
Q

Describe the USs that can be done during pregnancy

A
  • transvaginal
    –> done earlier in preg
  • transabdominal
    –> done later in preg
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12
Q

What can be evaluated with a transvag US?

A
  • presence of intrauterine preg
  • Measurement of crown-rump length
  • cardiac activity in 1st trimester
  • cervix length
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13
Q

What can be evaluated with a transvabdo US?

A
  • biometrics – growing appropriately
  • developmental issues, ex - neural tube defects; Hydrops fatalis
  • amniotic fluid volume
  • fetal growth / estimate weight (gestational DM; IUGR)
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14
Q

Are there any specific contraindication for a MRI during pregnancy?

A

No

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15
Q

Should you use MRI contrast when pregnant?

A

avoid if possible

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16
Q

Are CTs or X-rays radiation dangerous during pregnancy?

A

radiation likely too low to cause significant risk to the fetus, but discuss risks/benefits & alt if poss

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17
Q

Describe CT/X-ray contrast use in pregnancy?

A
  • oral contrast is okay
  • IV contrast if necessary
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18
Q

Labs typically ordered at first prenatal visit?

A
  • Blood type
  • CBC
  • UA w/ culture - infx
  • Serology testing for varicella & rubella (unless already done)
  • STD/Infx panel – HIV, syphilis, chlamydia, hepatitis B
  • As indicated – thyroid function, DM screening, lead screening, other infx dz
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19
Q

What are chromosomal disorders also called?

A

aneuploidy

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20
Q

What are the 2 types of genetic conditions tested for during pregnancy?

A
  • chromosomal disorders
  • carrier disorders
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21
Q

What are the 1st trimester screening tests of genetic disorders?

A
  • serum free β-hCG
  • pregnancy-associated plasma PRO (PAPP-A) + US of nuchal translucency (NT)
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22
Q

What are the 2nd trimester screening tests of genetic disorders?

A
  • serum tests for hCG
  • unconjugated estradiol
  • AFP
  • inhibin A
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23
Q

What are the integrated screening tests of genetic disorders?

A
  • Uses both 1st & 2nd trimester screening tests
  • Serum integrated test – uses all tests except US of NT
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24
Q

What are the diagnostic tests of genetic disorders?

A

Karyotyping

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25
Q

What are the 2 ways to get sampling for karyotyping?

A

Chorionic villus sampling –> sampling of placenta to obtain chromosomes
–> Amniocentesis –> sampling of amniotic fluid

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26
Q

What are the 2 most common chromosomal issues?

A
  • down syndrome (trisomy 21)
  • Trisomy 18
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27
Q

What test differentiates trisomy 21& trisomy 18 & describe the levels ?

A

hCG levels
–> elevated in trisomy 21 –> decr in trisomy 18

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28
Q

What carrier screening look for?

A

common genetic disorders

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29
Q

What are some examples of screened genetics disorders? & give ex/explain.

A
  • CF
  • Hemoglobinopathies (ex = SCA, thalassemias)
  • Tay-Sachs dz – can’t process lipids–>build up–>damage/death of neurons
  • Fragile X syndrome – alcohol ingestion early during pregnancy
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30
Q

What is fetoscopy?

A

Direct visualization of the fetus via scope inserted into amniotic sac

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31
Q

Can uses fetoscopy for procedures?

A

YES

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32
Q

Indications for fetoscopy

A
  • Repair of neural tube defects
  • Release of amniotic bands
  • Tx for twin-twin transfusion syndrome (TTTS)
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33
Q

In TTTS, explain risk for each baby?

A
  • extra BVs–> CHF
  • lacking BVs–> failure to thrive
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34
Q

If A1C is ___ in pregnancy on prenatal screening, what is the dx?

A
  • > /= 6.5
  • overt DM
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35
Q

What is used for the detection of gestational DM? At what weeks?

A

oral glucose tolerance test at 24 - 28 wks

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36
Q

Earlier screening if high suspicion/concern of…

A
  • Prior gestational DM
  • Strong FHx of gestational DM
  • Prior delivery of baby weighing > 4000 g (8.8 lbs)
  • A1C > 5.6
  • Obesity (BMI >30)
  • Known dyslipidemia
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37
Q

What is the screening test done for gestational DM?

A

Oral glucose tolerance test

38
Q

What are the types of oral glucose tolerance test?

A

1 step or 2 step

39
Q

Describe the 2 step oral glucose tolerance test.

A
  • Step 1 - 50 g 1hr screening test; if (+), 2nd step is done
  • Step 2 - Fasting 100 g 3hr tolerance test; if abnl at 2 checkpoints, dx of gestational GM is made
40
Q

Describe the 1 step oral glucose tolerance test.

A

Fasting 75 g 2hr tolerance test; if abnl at 2 checkpoints, dx of gestational DM is made

41
Q

What is fetal monitoring used for?

A

to monitor fetal health & development when there is concern for premature demise

42
Q

Indications/concerns for premature demise?

A
  • advanced age
  • decr fetal activity
  • maternal HTN
  • multiple fetuses
  • Oligo/polyhydramnios
  • Premature rupture of membranes
  • Prior fetal demise
  • Post-term preg (>40wks)
  • SLE, SCA, or Rh (-) mother
43
Q

What are the types of fetal monitoring?

A
  • HR monitoring
    –> Antepartum or Intrapartum
  • Biophysical profile (BPP)
44
Q

What are the 2 types of antepartum fetal monitoring?

A
  1. Non Stress test (NST)
  2. Contraction Stress Test (CST)
45
Q

What is normal fetal HR?

A

120 - 160

46
Q

What causes accelerations & are they good or bad?

A

due to changes in position, stimulation
- GOOD; baby is moving

47
Q

What causes decelerations & are they good or bad?

A

may be due to hypoxia from cord compression, umbilical cord strangulation or acidemia
- BAD; assoc. w/ contractions

48
Q

How long is a NST?

A

20 mins of external HR monitoring

49
Q

Possible grades for a NST

A

reactive or nonreactive

50
Q

What criteria needs to be met to be a normal reactive test?

A

At least 2 episodes of incr HR that meets criteria:
10-15 bpm above baseline & lasting at least 10-15 secs

51
Q

Does a NST have to take the entire 20 mins?

A

No, can end the test early if test is normal

52
Q

What are abnl results of a NST

A
  • nonreactive
  • doesn’t meet criteria for normal test at 20 mins
53
Q

What can be done if the normal criteria for a NST isn’t met in the 20 mins for a NST?

A
  • can extend to 40mins or repeat after 30mins
  • Can try fetal stimulation & retest
54
Q

You NST is extended, what happens next?

A

FU testing - US

55
Q

What is a CST?

A

contractions are induced via oxytocin or nipple stimulation

56
Q

What makes a normal CST?

A

see 3+ contractions w/n 10 mins

57
Q

When does fetal HR usually decelerate?

A

at the start of a contraction

58
Q

Late deceleration is a sign of…

A

hypoxia

59
Q

How is CST graded?

A
  • positive or negative
    AND
  • reactive or nonreactive
60
Q

What are the possible results of a CST?

A

DONE

61
Q

Dx tool used for a BPP

A

Ultrasound

62
Q

What are the 4 parameter of a BPP?

A
  • fetal movement
  • fetal tone
  • fetal breathing
  • amniotic fluid volume
63
Q

What is the 5th parameter of a BPP?

A

non stress test

64
Q

How long is a BPP?

A

30 mins but points can be assigned at any time

65
Q

Each parameter for a BPP can be scored as…

A

0 or 2

66
Q

What are the specific criteria points for a BPP?

A
  • Fetal movement – at least 3 discrete body or limb movements
  • Fetal tone – at least 1 extension of limb or spine w/ return to flexion
  • Fetal breathing – at least 1 episode of rhythmic breathing lasting at least 30 sec.
  • Amniotic fluid volume – at least one 2 cm x 1 cm pocket of fluid noted
67
Q

What are the possible interstation of a BPP?

A
  • 8/8 or 10/10 – very low risk of fetal death w/n 1 wk
  • 4/10 or less – consider emergent delivery
  • 8/10 – very low risk as long as amniotic fluid vol was +2
  • 6/10 but +2 amniotic fluid vol = equivocal. Repeat BPP in 24 hrs.

6/10 or 8/10 and +0 amniotic fluid vol – concerning – weigh risks/benefits of cont preg vs emerg delivery

68
Q

What are the types of intrapartum HR monitoring & examples?

A

External monitoring
–> doppler
–> fetal stethoscope
Internal monitoring
–> fetal scalp electrode

69
Q

Describe a Category I on intrapartum fetal monitoring

A
  • normal
  • HR 120-160
  • Some variability of HR
  • No late / variable decelerations
70
Q

Describe a Category II on intrapartum fetal monitoring

A
  • watchful waiting
  • Not Cat I, but doesn’t meet criteria for Cat III
71
Q

Describe a Category III on intrapartum fetal monitoring

A
  • VERY WORRISOME
  • No variability of HR AND
    –> Sustained bradycardia OR
    Recurrent late or variable decelerations
    –> Sinusoidal pattern
72
Q

What has be done if you see a Cat III on intrapartum fetal monitoring?

A

C-section

73
Q

How many weeks is considered preterm labor?

A

<37 weeks

74
Q

Diagnostics for preterm labor?

A
  • Visual Exam
  • Digital cervical exam
  • Transvag US
  • Transabdo US
  • Presence of contractions
75
Q

What are you looking for on visual examination?

A

assess bleeding & membrane rupture

76
Q

What are you looking for on digital cervical exam?

A

assess cervical dilation & effacement

77
Q

What are you looking for on Transvag US?

A

assess cervix length

78
Q

What are you looking for on Transabdo US?

A

assess amniotic fluid vol, fetal position, etc.

79
Q

What labs should be done for preterm labor?

A
  • Group B Strep
  • UA & Urine culture
  • Fetal fibronectin
80
Q

What can Group B strep lead to?

A

neonatal meningitis

81
Q

Describe a fibronectin test?

A
  • via vag swab
  • only found in ammonitic fluid
82
Q

What information does a fetal fibronectin lab tell us?

A

presence increases chances of labor within 1 wk.

83
Q

When is fetal fibronectin likely more useful?

A

<34 wks gestation & < 3cm dilation

84
Q

How is the diagnosis of preterm labor made?

A

Presence of contractions PLUS
- Cervical dilation >/= 3cm OR
- Cervix length < 20 mm OR
- Cervix length 20-30 mm & (+) fetal fibronectin test

85
Q

Diagnostics for Prelabor Rupture of Membranes

A
  • visual examination
  • Transadbo US
  • Presence IGF binding PRO or placental alpha microglobulin-1 in vaginal fluid
86
Q

What are the two older test done to assess for amniotic fluid?

A
  • Nitrazine pH test
  • Fern Test
87
Q

What is the normal pH of vaginal secretions?

A

4.5 - 5.5

88
Q

What is the normal pH of amniotic fluid?

A

7.0 - 7.5

89
Q

What will a fern test show if amniotic fluid is present?

A

will dry in fernlike pattern due to NaCl, PROs & CHO fluid

90
Q

What diagnostics are associated w/ labor?

A

fetal monitoring & labs

91
Q

What are we looking for on fetal monitoring during labor?

A

Category I - III & monitor HR

92
Q

What labs should be done during labor, if not already done?

A
  • Group B strep
  • Syphilis
  • Hep B
  • HIV
  • type & screen or type & crossmatch

Block 4 - OBGYN (5 decks)

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