GYN 2 Flashcards
Urine pregnancy test evaluates for pregnancy by looking for ?
HcG
Urine pregnancy test are _______, rapid and inexpensive, with a positive test threshold __________ ( of HcG in the serum), characterized by a color change.
reliable
between 5 and 50 mIU/mL
**not a lot of false positives
✪most common method to confirm pregnancy ?
Urine pregnancy test
**MC method is the urine test **
Urinalysis evaluates for ?
glucose and protein
** glucose for gestational diabetes
protein for preeclampsia - kidney damage - make sure we are not missing it **
Serum Beta-HCG testing qualitative ?
Measures whether the hormone is present
**yes or no
Serum Beta-HCG testing quantitative ?
Measures how much is present
infertility, in vito fertilization, twin gestation ( part of trisomy 21 screening exam )
3-4 weeks - average HcG is a big range ?
500-10,000
week _ of pregnancy is week of menses,
1
between _______ is ovulation and fertilization ( so when you get pregnancy you are already in week three of your pregnancy)
11-14 days
** week 4 is when you can finally start testing **
Landmarks for gestational age and beta-HCG by TV sonography: Discriminatory zone - weeks from LMP? Beta HCG ?
5-6
1500-200
- *“discriminatory zone” - you can see something there
- *
Landmarks for gestational age and beta-HCG by TV sonography: own notes ?
these tests are used in conjunction with US to look for ectopic , etc.
Landmarks for gestational age and beta-HCG by TV sonography: yolk sac - weeks from LMP? Beta HCG ?
6
2500
Landmarks for gestational age and beta-HCG by TV sonography: Upper discriminatory zone - weeks from LMP? Beta HCG ?
6-7
3000
Landmarks for gestational age and beta-HCG by TV sonography: Fetal pole - weeks from LMP? Beta HCG ?
7
5000
Landmarks for gestational age and beta-HCG by TV sonography: Fetal heart motion - weeks from LMP? Beta HCG ?
8
17,000
quant is 3000 and nothing on the US or in fallopian tubes - get a ?
Lap to look for the ectopic
high quant (20,000) and no fetal activity ( still yolk sac) then is will probably be a ?
miscarriage
Cervical Preps: Specific to use during pregnancy ?
Group B strep
Fern test
Fetal fibronectin
Group B strep:_____ of all pregnant women are colonized
10-30%
GBS screening between _______ weeks’ gestation.
35 and 37
_ GBS culture at 35–37 weeks, or _ urine culture for GBS anytime during the pregnancy, the patient is treated with abx at the time of ?
+
+
admission in labor
- *to prevent infection in the newborn
- *
Fern test: Assessment for ?
rupture of membranes (ROM) - water breakage
Fern test uses ________ paper or just a glass slide
nitrazine
Normal vaginal pH in pregnancy is ?
4.5-6.0
Amniotic fluid pH is ?
7.0-7.5 ( close to water)
NL pH of urine ?
pH of urine - 6-7.5 something ( more acidic then the amniotic fluid)
Fern Test own notes ?
this is good to evaluated for fluid secretions etc. or ig you thing there might be ROM
electrolytes and protein in the fluid on a glass slide and dried up will make a ferrying pattern
what is Fetal Fibronectin?
May help with implantation of fertilized egg
Fetal Fibronectin NL cannot be identified in vaginal secretions after ?
22 weeks gestation
Fetal Fibronectin Concentrations are ____ in amniotic fluid
high
Fetal Fibronectin own notes ?
this is a protein , glue that holds the amniotic sac to the Uterus
Fetal Fibronectin: when is it used ?
Pregnant women whose membranes are intact and cervical dilation is less than 3 cm.
Women who have signs or symptoms of labor
**if we think a women at risk of preterm labor
27 weeks and they start to dilate - run this test - when you get the ungluing of the U then the protein will be elevated\
not a good predictive value , it is a clue not a definitive answer **
Negative Fetal Fibronectin means ?
labor is unlikely within the next 2 weeks
**better for sure answer then a positive
Positive Fetal Fibronectin means ?
If positive- indeterminate
**heighten suspicion of early labor so maybe make them have bed rest or steroid for fetus lung development
Routine Prenatal Tests: early pregnancy - initial visit ?
Blood type and Rh status Rh antibody screen Hemoglobin/ Hgb electrophoresis Cystic fibrosis screening (not universal) HIV (offered) RPR Rubella titer Hepatitis B Chlamydia/Gonorrhea
Rh antibodies own notes ?
during birth some of the Rh + blood goes into the mother blood stream and form maternal ABS and during the second preg the ABS from the mother attack the fetus if it is Rh +
Rh Testing initial material blood type, Rh + ?
Done
- *blood can tolerate a - fetus - your good
- *
Rh Testing initial material blood type, Rh - ?
Needs Rh antibody tests ( to see if they have other ABS circulating)
** but a neg woman will make the ABS **
Rh antibody testing: ICT - Rh- women without Rh Ab should receive _____ at __ wks gestation
RhoGam
28
**Rogam at 28 weeks so they dont form ABS during labor and birth **
Rh antibody testing: IDCT - Rh- women with _____ should be followed closely to ensure that the fetus does not develop ______
Rh Ab
hemolytic anemia
Direct coombs test: own notes ?
testing the baby sample ( baby already has hemolytic anemia and has M ABS attacking RBC and we put it in reagent that has anti-ABS and they cause agglutination)
Indirect coombs test: own notes ?
test the maternal sample (maternal blood has ABS circulating, we take Rh+ RBC and mix it with her blood and the ABS will stick, it is then mixed with anti-ABS - agglutination)
H&H: Women with anemia should receive __ supplementation and repeat testing after ?
Fe
6 weeks
**cause iron deficit anemia is common during pregnancy **
H&H: Consider_______ with women at high risk of genetic hemoglobinopathy
Hgb electrophoresis
CF screening ?
Option for screening available
Genetic test looking for 23 of the most common CF gene mutations
HIV testing ?
Offered at initial visit
Pt has to consent
Repeat at 36 weeks for women at high risk
Women with no prenatal care; rapid HIV while in labor
HIV testing repeat at __ weeks for women at high risk
36
HIV testing: ______ of women can pass HIV to fetus during pregnant, delivery, or breastfeeding
25-30%
Syphilis: initial screening exam ?
RPR
Prevention of congenital syphilis
Syphilis: repeat at _____ weeks if high risk
26-28
Syphilis teeth sign ?
hutchinson sign
Rubella Antibody Titer: Dx of Fetal Infxn ?
CVS
US for CRS
Rubella Antibody Titer: Dx of Maternal infxn ?
+ IgM
4-fold rise in IgG
Done 7-10 days after rash onset
Hepatitis B ?
Prevention of neonatal Hepatitis B infection
Infants born to carriers should get HBIg and vaccination within 12 hours of birth
Gonorrhea/Chlamydia ?
Done at initial visit and then repeated at 36 weeks for women at high risk
Glucose Screening ?
OGTT (24-28 weeks gestation)
late screening
Urinalysis ?
every visit
late screening
Group B strep
?
35-37 weeks gestation
late screening
First Trimester screening tests ?
Nuchal Translucency
Β-hCG
AFP (α-fetoprotein)
Pregnancy associated plasma protein A (PAPP-A)
1st trimester screening: Nuchal translucency is measured between ____ weeks gestation ?
11-14
**nuchal fold behind the neck and it is measure ( 11-14 weeks gestation) - done on routine US **
Nuchal translucency increased ?
fetal aneuploidy 13, 18, 21, heart defects
1st trimester screening: Alpha-fetoprotein: Glycoprotein synthesized by the ________ and then by the _________.
fetal yolk sac
fetal GI tract and liver
AFP: Increases steadily in fetal serum and amniotic fluid until _______ gestation and then rapidly _______.
13 weeks
declines
AFP: Conversely, _______ after 13 weeks gestation in maternal serum
increases
AFP: Found in higher levels in maternal serum and amniotic fluid with ____.
NTD
** spina bifida, lymphfallocele, trsimoy 18,21**
**25/50 come back abnormal - a lot of false negatives
woman can opt in or out of this screening **
PAPP-A is a product of the ?
placenta and endometrium and how health and able they are to support a pregnancy
PAPP-A: Women with low levels have increased risk of ?
Stillborn birth
Trisomy 21
Intrauterine growth
restriction
Premature delivery
Fetal death in utero
Second trimester screening ?
maternal serum quad screen
Maternal serum quad screen involves ?
Serum β-hCG - increased with downs markedly
Unconjugated estriol - idea of placental health or any fetal distress, takes a devastating placental abnormality or stress so if it found it is usually a devastating diagnosis
AFP
Inhibin - secreted by O and inhibits FSH and it is 2x as high in Trisomy-21 (T21)
Maternal serum quad screen:
Detection rates ?
Trisomy 21,18,13 (65-75%)
Open neural tube defects (80-85%)
Inhibin secreted by ?
ovaries and inhibits FSH
Inhibin originated in the ?
Placenta
Inhibin is 2x as high in ?
Trisomy 21
Inhibin is higher in women with ?
spontaneous abortions
Amniocentesis what is it ?
Placing a needle through the abdominal wall into the amniotic cavity to withdraw fluid for analysis
- *area not through the placenta!
- *
When is Amniocentesis used to gather information ?
fetal maturity, fetal distress, and risk for respiratory distress ( tell how mature the lungs are)
Genetic and chromosomal abnormalities
Maternal-fetal Rh incompatibility
Gender (sex-linked genetic disorders), Turners, etc.
Neural tube defects
After abnormal obstetric US
**usually done if parent have a genetic abnormality or if past child has had genetic problem - no part of poutine testing **
Amniocentesis: Fetal Maturity Status - Lecithin and sphingomyelin (L/S ratio) ?
surfactant (required for alveolar ventilation)
Immature lungs sphingomyelin ↑
At __ weeks gestation
Sphingomyelin ↓ and Lecithin ↑
35
later in preg S goes down and L goes up
✪An L/S ratio of ___ indicates a mature fetal lung
2:1
higher ratio so more L and S means the lungs are more mature
Amniocentesis: Fluorescence polarization ?
TDx fluorescence polarimeter
Fluorescence polarization: Fluorescent ________ ________ is added to the fluid and then tested ?
phospholipid analogue
Fluorescence polarization:Measures ________________ ratio
surfactant: albumin
Fluorescence polarization: Polarization values↓ = Maturity of the lungs _ (more surfactant there)
↑
- *meconium in the fluid - this test is less affected by that
- *
Minor component of surfactant
?
Phosphatidylglycerol (PG)
Phosphatidylglycerol (PG):
is synthesized almost entirely by ?
mature lung alveolar cells
**also less affected by blood or meconium
indicates a more mature type of surfactant than the other two **
Lamellar Body Count is produced by ?
type II pneuomcytes
Lamellar Body Count:
_______ & ________ are indistinguishable from one another to cell counters
Lamellar bodies and platelets
Lamellar Body Count: __________ has a 100% negative predictive value
> 30,000
- *they willl not have RDS when they are born
- *
Lamellar Body Count: _______ has a 67% of RDS
<10,000
Lamellar Body Count: own notes ?
represents storage of surfactant
higher the number the more mature neumocytes they have
Microviscosity is a measurement of ?
lipid aggregates
Microviscosity is it still used?
No
Microviscosity: ____ during early pregnancy and _____ as lungs mature in late pregnancy
High
lowers
Microviscosity depends on the ___ ratio ?
L:S
PG and Lamellar Body Count is unaffected by _____ or ________ contamination
blood
meconium
Amniocentesis contraindications ?
Abruptio placentae
Placenta Previa
Hx of premature labor
more relative not absolute
Contraindication
Incompetent cervix
Amniocentesis potential complications ?
Fetal injury
Miscarriage
Leakage of amniotic fluid
Infection
Premature labor
Inadvertent damage to the bladder or intestines
What is Chorionic Villus Sampling ?
Sample of chorionic villi are taken from the frondosum (origin of the placenta)
Present from 8-12 weeks and on.
Allow much earlier detection of abnormalities
** done early on to get alot of good information so the parent can make decisions ( maybe abort if they have genetic problem) **
When is CVS used ?
Women older than 35
Have had frequent SA
Previous chromosomal abnormalities
Have genetic defect personally
CVS potential complications ?
Accidental abortion
Infection
Bleeding
Amniotic fluid leakage
Fetal limb deformities
Imaging in Obstetrics - Evaluates the________ and _____ the fetus
anatomy and well-being of
Imaging in Obstetrics - Makes determinations about the ?
well-being or risks to the mother
early on in pregnancy and during no pregnancy then do a ?
TVUS
US: 1st trimester indications ?
Confirm IUP
-intraUterine pregnancy
Evaluate pelvic pain
Vaginal bleeding
Confirm gestational age
-measure quant with US
Uterine abnormalities
Genetic anomalies
Multiple gestation
Transvaginal US: Measure cardiac activity when the fetal pole measures ?
4-5 mm (about 6.5 wks gestation)
What can you see with US at the chest ?
4-chamber view of the heart
outflow tracts of the heart if feasible
What can you see with US at the abdomen ?
stomach
kidneys
bladder
umbilical cord insertion (fetal abdomen)
umbilical cord vessel number
What can you see with US at the spine ?
cervical, thoracic, lumber, and sacral
What can you see with US at the head, face, and neck ?
cerebellum
chord plexus
cisterna magna
lateral cerebral ventricles
medicine falx
cave septum pellucidi
upper lip
nuchal fold
US 2nd trimester evaluates for ?
anatomy ~ 14-18 weeks
**8-9 weeks = first US to confirm IUP and cardiac activity , dont look at the fetus in great detail **
US 2nd trimester: down syndrome ?
Cardiac abnormalities
Duodenal atresia
Short femur or humerus length
US fetal growth ?
Lack of growth associated with fetal demise
Macrosomia (large baby) is associated with shoulder dystocia, hemorrhage, and probability of cesarean delivery
**later on they try and measure how big the fetus is to see if it will fit throught the pelvis for birth **
