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Ob/Gyne 3 > Module 3 : Maternal Testing > Flashcards

Module 3 : Maternal Testing Flashcards

1
Q

what are the ultrasound exams done for obstetrics

A
  • dating first trimester
  • 1st trimester scan
  • 2nd trimester detailed
  • FAS and BPP
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2
Q

what test is done fro early pregnancy testing

A
  • serum beta guman chorionic gonadotropin
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3
Q

what is bHCG produced by

A
  • trophoblast
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4
Q

what is bHCG and indicator of and how is it tested

A
  • early indicator of pregnancy

- blood test or urine test

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5
Q

how do bHCG levels change

A
  • double every 2 days
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6
Q

at what week does bHCG levels plateau

A
  • 8 weeks
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7
Q

what three things could a decreased bHCG suggest

A
  • missed abortion/ fetal demise
  • ectopic pregnancy
  • wrong dates
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8
Q

what two things could an increased in bHCG indicate

A
  • trophoblastic disease (molar pregnancy)

- multiple pregnancies

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9
Q

what is a NIPT

A
  • non invasive prenatal testing

- maternal blood test taken at 10 weeks LMP

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10
Q

what does a NIPT test for

A
  • cell free DNA in maternal plasma

+ placental DNA in maternal blood

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11
Q

is the NIPT test accurate and what does it screen for

A
  • 100% detection rate

- T21 T13 T18

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12
Q

in what 5 situations is a NIPT less effective

A
  • obese patients
  • pregnant with multiples
  • pregnant via donor egg
  • less than 10 weeks pregnant
  • taking blood thinners
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13
Q

what is the purpose of prenatal testing

A
  • offers early information about a baby’s risk for certain chromosomal conditions
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14
Q

what is prenatal testing a combination of

A
  • nuchal translucency
  • first trimester blood tests
    + bHCG
    + PAPP-A
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15
Q

what is the nuchal translucency test

A
  • measurement of the collection of fluid under the skin at the back of the baby’s neck
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16
Q

what does in increase in nuchal size correspond to

A
  • increased risk of chromosomal and other abnormalities
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17
Q

when is the nuchal measured

A
  • only between 11 weeks (CRL 45mm) and 13 weeks (CRL 84mm)
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18
Q

what is the max AP measurement of the nuchal translucency

A

< 3.5mm

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19
Q

what does an increase in bHCG between 11-14 weeks possibly indicate

A
  • trisomy 21
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20
Q

what does a decrease in bHCG between 11-14 weeks possibly indicate

A
  • trisomy 18 and 13
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21
Q

what produces the pregnancy associated plasma protein A and what is it

A
  • placental syncytiotrophoblast and deciduas

- glycoprotein

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22
Q

how does PAPP-A change with pregnancy

A
  • rapid increase in levels during first trimester
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23
Q

what dose a decreased PAPP-A between 11-14 weeks possibly indicate

A
  • trisomy 21 and 18
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24
Q

what is the detection rate of the NT and biochemical tests in the first trimester

A
  • 85% detection rate
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25
Q

what constitutes a positive first trimester screen test

A
  • less than a 1:300 ratio
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26
Q

what three factors are used together to screen for abnormalities

A
  • maternal age
  • nuchal translucency
  • maternal biochemistry
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27
Q

what other sonographic test/factor increases detection rate to 95%

A
  • presence of a nasal bone
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28
Q

what is a hypo plastic nasal bone

A
  • fetal NB appears smaller by varying degrees

- less tha 2.5mm

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29
Q

what is an absent nasal bone

A
  • NB not visible at the 11-14 weeks scan
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30
Q

what is the 2nd trimester screen (triple/quad screen)

A
  • maternal serum testing between 15 and 20 weeks
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31
Q

what is the triple screen

A
  • assess 3 different elements (AFP, bHCG, uE3)
32
Q

what is the quad screen

A
  • asses 4 different elements found in the maternal blood

- AFP, bHCG, uE3, Inhibin A

33
Q

where is MS AFP produced

A
  • fetal liver
  • yolk sac
  • GI tract
  • Kidneys
  • placenta
34
Q

how does MS AFP levels change

A
  • levels will rise from about 14-20 weeks
35
Q

how does AFP enter maternal circulation

A
  • crosses the placental plate into maternal circulation
36
Q

what is the most common cause for abnormal level of MS AFP

A
  • wrong dates for gestational age
37
Q

in what women can MS AFP be increased

A
  • athletic women

- diabetic moms

38
Q

what placental condition can cause increased AFP

A
  • placental abruptions
39
Q

what does a decrease in AFP possibly indicate

A
  • trisomy 21 and 18
40
Q

what does and increase in AFP possibly indicate

A
  • open neural tube defect
  • abdominal wall defect
  • GI obstruction
  • RH sensitivity
  • placental abnormality
  • fetal death
41
Q

in what four things will bHCG be increased in the quad screen

A
  • multiples
  • molar pregnancy
  • wrong dates
  • T21
42
Q

what 2 things will bHCG by decreased in quad screen

A
  • fetal demise

- trisomy 18

43
Q

what is uE3 (estriol)

A
  • measured only in pregnancy

- produced by placenta

44
Q

when is uE3 found how do levels change

A
  • found as early as 9th week of pregnancy

- levels continue to rise throughout pregnancy

45
Q

what are 3 things does a decrease in uE3 possibly indicate

A
  • T21, 18
  • pregnancy loss
  • adrenal insufficiency
46
Q

what is inhibin A

A
  • hormone produced by placenta
47
Q

what are increased levels of inhibin A associated with

A
  • trisomy 21
48
Q

is there any change in inhibin A levels with trisomy 18

A
  • no
49
Q

what are the quad screen levels with trisomy 21

A
  • AFP decrease
  • bHCG increase
  • uE3 decrease
  • Inhibin A increase
50
Q

what are the quad screen levels with trisomy 18

A
  • AFP decrease
  • bHCG decrease
  • uE3 decrease
  • inhibin A doesn’t change
51
Q

is trisomy 13 detected with triple or quad screen

A
  • nope
52
Q

what are the two types of chorionic villi sampling

A
  • transcervical CVS

- transabdominal CVS

53
Q

when is a transcervical CVS performed

A
  • 11-12.5 weeks
54
Q

how is a transcervical CVS performed

A
  • catheter inserted through cervix to chorion frondosum

- with a negative pressure syringe moving catheter back and forth to capture chorionic villi cells

55
Q

when is a transabdominal CVS performed

A

can be done beyond 12.5 weeks

56
Q

how is a transabdominal CVS performed

A
  • needle through abdomen to chorion frondosum

- performed when placenta cannot be accessed by transcervical approach

57
Q

what determines the type of CVS performed

A
  • depends on where the chorion frondosum lies (placenta)
58
Q

which test obtains more DNA and and gets result faster amnio or CVS

A
  • CVS
59
Q

what is the risk with CVS

A
  • possible spontaneous abortion
60
Q

what is an amniocentesis

A
  • amniotic fluid is aspirated from the amniotic sac via a needle through the maternal abdomen
61
Q

what are the risks with amniocentesis

A
  • bleeding
  • pre mature rupture of membranes
  • pre term labour
  • club feet
  • spontaneous abortion
62
Q

when is club feet a risk from amniocentesis

A
  • when performed earlier than 16wks
63
Q

what is the scanning protocol for amniocentesis

A
  • number of fetuses and position
  • amniotic fluid volume
  • placenta location
  • gestational age
  • limited anatomical survey
  • record M Mode heart rate before and after procedure
64
Q

what are the 4 types of amniocentesis

A
  • cytogenic amnio = chromosomes, most common
  • optical density determination = RH sensitized
  • L/S amnio = fetal lung maturity
  • therapeutic = for poly
65
Q

when is a cytogenic amnio performed

A
  • between 11x to term
66
Q

how is a twin amnio performed

A
  • after amnio aspirated from first gestational sac indigo carmine injected then second baby is sampled if it comes out wth dye then not in the right spot
67
Q

what does a ODD amnio test for

A
  • measure bilirubin level in RH sensitized pregnancy
68
Q

what is the L/S ratio amnio test for

A
  • lecithin and sphingomyelin are fairly equal up to 33 weeks
  • beyond this lecithin increases where S remains constant
  • if ratio is grater than 2:1 lungs are matured
69
Q

why is a therapeutic amnio performed

A
  • done for poly
  • done when the mother is not able to to tolerate pressure fo large uterus pressing on abdominal contents causing shortness of breath
70
Q

what is PUBS

A
  • percutaneous umbilical blood sampling

- CORDOCENTESIS

71
Q

how is a PUBS performed

A
  • needle into umbilical cord about 2-3cm from insertion into placenta
  • take sample from vein rather than artery
72
Q

what are the indications for a PUBS procedure

A
  • chromosomal analysis within 72 hours
  • fetal blood gas sampling in IUGR fetuses
  • fetal infection s
  • FETAL ANEMIA IN RH SENSITIZATION
  • FETAL BLOOD TRANSFUSIONS VIA PUBS
  • trat fetal arrhythmias with medication via PUBS
73
Q

what are three risks from PUBS

A
  • bleeding from puncture site
  • infection
  • rupture of membranes
74
Q

what is a FISH Test

A
  • fluorescence in situ hybridization

- looks for how many copies are present for a specific chromosome

75
Q

what two things is not required with FISH

A
  • does not require all the steps needed as in cytogenic aryotyping
  • does not give info on the structure of that chromosome
76
Q

what can a FISH be performed on

A
  • fetal blood
  • amniotic fluid
  • CVS

Ob/Gyne 3 (10 decks)

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