Module 7 Flashcards
CBC may be ordered when in pregnancy
1st prenatal visit
Repeated @ 28 weeks
Why CBC is ordered again at 28 weeks:
this is the time that the blood is most hemodiluted and thus the pregnant woman is most likely to be anemic
the average amount of oxygen-carrying hemoglobin inside a red blood cell
MCH (mean corpuscular hemoglobin)
calculation of the average concentration of Hgb inside a red cell
MCHC (mean corpuscular hemoglobin concentration)
macrocytic RBC= _____ MCH
high
microcytic RBC= ______ MCH
low
hypochromia which is seen in conditions where the Hgb is abnormally diluted inside the RBC, such as iron deficiency anemia and thalassemia = _____ MCHC
low
hyperchromia which is seen in conditions where the Hgb is abnormally concentrated inside of cells, such as in burn patients = ______ MCHC
high
a measurement of the average size of RBCs
MCV
macrocytic RBCs as in vitamin B12 deficiency (pernicious anemia) = _____ MCV
high
microcytic RBCs as in IDA or thalassemia= ______ MCV
low
measures the amount of oxygen-carrying protein in the blood
Hgb
measures the percentage of red blood cells in a given volume of whole blood
Hct
maternal plasma volume increases _____% on average, achieving a maximum level at approximately _____ weeks gestation
45% @ 32 weeks
Peak hemodilution occurs at ____-____ weeks
24 to 26
describes the proportionately greater increase in plasma volume as compared to the rise in RBCs
physiologic anemia
increased ____________ along with increase in _____________ ultimately expands the maternal blood volume by as much as 35 to 40%.
plasma volume; RBC mass
________ and __________ anemias can occur in pregnancy
acquired and hereditary
In ______________ anemia, the MCH, MCHC, and MCV are decreased
iron deficiency
These are known as \_\_\_\_\_\_\_\_\_\_\_\_: Hgb- hemoglobin Hct- hematocrit MCH- mean corpuscular hemoglobin MCHC- mean cell hemoglobin concentration MCV- mean corpuscular volume
RBC indices
reflect Hgb amount and characteristics
RBC indices
a microscopic examination that screens for abnormalities in the size, shape, color, or structure of RBCs
stained red cell smear
IDA causes ___________ and ___________ RBC which can be seen on a stained red cell smear
microcytic and hypochromic
assesses the body’s ability to defend itself and helps to determine if the body is threatened by infections, inflammation, or hematopoietic and hemolytic disease
WBC
identifies the percentage of each type of white blood cell
differential smear
eosinophils and basophils may ________ slightly in pregnancy
decrease
neutrophils may _________ slightly in pregnancy
increase
increased neutrophils in pregnancy are more __________ cells and the differential smear will show a shift to the ______
immature; left
measures the number of platelets in a given volume of blood
platelet (Plt) count
during normal pregnancy Plt count usually ___________ progressively with gestation
decreases
decreased platelet count is due to an ___________utilization of platelets during pregnancy
increased
__________ count is associated with HELLP syndrome, immunologic thrombocytopenia purpura, disseminated intravascular coagulation (DIC), acquired hemolytic anemia, septicemia, and lupus erythematosus
low platelet
At 1st prenatal visit, most often an_____________ test is used for the initial antibody screen, since this test is sensitive to anti-Rh antibodies
indirect Coombs
Women who test indirect Coombs positive are then tested for the specific __________ and _________
antibody and titer
done at the first visit to detect antibodies to Rh positive blood
indirect Coombs
women at increased risk for Syphillis should undergo a repeat test @ ____ weeks and @ ___________
28 weeks and delivery
VDRL (Venereal Disease Research Laboratories) or the RPR (rapid plasma reagin) is used to test for:
Syphillis
if VDRL/RPR is positive, a ________ is also drawn
titer
______ titer indicates active Syphilitic disease
high (>1:16)
______ titer indicates false positive for Syphilis in 90% of cases or late or latent syphilis or early primary syphilis
low (<1:8)
Treatment of primary syphilis usually causes a progressive decline to a negative VDRL/RPR titer within ___ years
2
In secondary, late, or latent syphilis, low titers persist in about ____% of cases 2 years after treatment, despite a fall in titer
50%
does not indicate treatment failure or reinfection because these patients are likely to remain positive even if retreated.
low titers in secondary, late, or latent syphilis
_________ usually indicate relapse, reinfection, or treatment failure of syphilis
increasing titers
________________ can occur in women with acute and chronic illnesses such as TB, infectious mononucleosis, rheumatoid arthritis, collagen vascular diseases, chlamydia infection, and hepatitis
false positive VDRL/RPR
if ____________ is positive, either the fluorescent treponemal antibody-absorption test (FTA-ABS) or the microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA) is ordered
VDRL/RPR
tests that specifically determine if the individual has developed antibodies to the spirochete
treponemal antibody-absorption test (FTA-ABS)
microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA)
A seropositive VDRL/RPR result indicates that the woman has been exposed to the spirochete and has developed ___________
antibodies
Since the syphillis antibody tests frequently remain positive even after successful treatment, clinicians use the ______of the VDRL or RPR to monitor treatment
titers
groups @ “high” risk for syphillis
women who live in area of high syphilis morbidity
women who were not tested at 1st prenatal visit
a viral infection that produces a rash and fever in adults and children
rubella “German measles”
\_\_\_\_\_\_\_\_\_ has devastating fetal effects: Eye lesions Hearing defects Heart disease IUGR spleen and liver enlargement CNS disorders
Rubella
The incidence of congenital rubella is highest when the woman contracts it during:
first 1/2 of pregnancy or shortly before conception
The most frequently used test to detect rubella antibodies in serum
hemagglutination inhibition test (HAI or HI)
immunity is confirmed if the rubella titer is ____ or more
1:8
Women who have a rubella titer less than _____may be considered to be “equivocal” and should be considered susceptible to rubella unless there is evidence of adequate vaccination or a subsequent serologic test result indicating rubella immunity
1:8
when titer is less than _____, the woman and fetus are at risk for contracting rubella
1:8
If a rash occurs, repeat rubella titers are obtained __-__ weeks after the onset and again in ___ weeks
2-3; 2
significant ____________ in the titer level from the one test to the next indicates that the rash was due to Rubella. At this time there is no treatment. The woman should be counseled about the impact of rubella infection on the fetus
increase
women at risk for contracting rubella
women with negative tests
women with titers < 1:8
women at risk for conracting rubella should be __________ shortly after delivery
vaccinated
S/S of \_\_\_\_\_\_\_\_\_\_\_\_: *may have no overt symptoms nausea, vomiting RUQ abdominal pain enlarged and tender liver fever chills general weakness headache
Hep B
risk that the newborn will develop Hep B is ___-___% if the mother is positive for the Hep B surface antigen
10-20%
the risk for transmission of Hep B to newborns is as high as _____% if the mother is positive for Hep B surface antigen and also positive for the HbeAg
90%
Mothers with e antigen-positive blood are much _____ likely to transmit the Hep B surface antigen (HBsAg) to their children than those with HBsAgpositive, e antigen-negative blood
more
Hep B-Infected newborns usually become __________ and are at high risk for developing chronic liver disease.
Hep B carriers
test that screens for hepatitis B and is done routinely at the first prenatal visit
HBsAg
presence of _________ indicates that the patient either has a current acute Hep B infection or is a carrier
HBsAg
lab drawn to differentiate between Hep B infection and carrier state
HBeAg
presence in serum indicates Hep B acute infection
HBeAg
appears during acute or recent HBV infection and is present for about 6 months
(IgM) anti-HBc
becomes predominant late in normal recovery and, together with HBsAb, may persist in noncarriers for many years
(IgM) anti-HBc
a positive HBsAg test should be followed by a _______ test
HBeAg
Risk Factors for \_\_\_\_\_\_\_\_\_\_\_: current or past IV drug use history of multiple STIs being infected with HBV being a prison inmate being 22.5 years of age or older having a sexual partner who abuses IV drugs having 3 or more lifetime sexual partners.
Hep C
Vertical transmission rate of HCV
4%
Co-infection with HIV increases the chance of vertical HCV transmission by:
2-3x
chronic hepatitis may lead to this complication of pregnancy
preterm labor
useful test to detect hemoglobinopathies like Sickle cell anemia, thalassemia major, and hemoglobin C, which are common autosomal- recessive hemoglobinopathies
Hgb electrophoresis
If one parent carries the sickle cell trait and the other parent carries the trait for either thalassemia or hemoglobin C, an individual has a ____% chance of inheriting sickle-thalassemia or hemoglobin SC disease
25%
ethnicities at higher risk for hemoglobinopathies
African, Southeast Asian, and Mediterranean descent
low risk ethnicities for hemoglobinopathies
northern Europeans, Japanese, Native Americans, Inuit (Eskimo), and Koreans
________ individuals should be screened for hemoglobinopathies with a CBC, and _________ women should be screened with a CBC and hemoglobin electrophoresis
Non-African; Africa
test that is best used in cases where the immediate result is necessary for immediate patient care, not as a screening test because it does not yield enough information to assist with diagnosing a potential hemoglobinopathy
solubility test (i.e. Sickledex)
All women should be screened for Gestational Diabetes (GDM) in pregnancy between __________ weeks
24-28
Women at high risk (history of GDM, women with known impaired glucose metabolism, and women with a BMI > 30) should be screened for GDM at this time
first OB appt AND @ 24-28 weeks
amount of HIV infections in women caused by IV drug use
50%
amount of HIV infections in women caused by heterosexual sex
1/3
incubation period of HIV from infection to clinical disease
unknown but thought to be 2-3 months
HIV appears in plasma and circulating mononuclear cells _____-______ weeks after infection; HIV antibodies usually appear in ___-___ months
1-several weeks
1-3 months
_______ antibodies develop in all patients infected with HIV and are considered evidence of infection.
Anti-HIV
_________-positive patients can spread HIV
antibody
HIV Antibodies may appear by ____ days, but seroconversion may not occur for more than ____ months after infection
60 days; 12 months
perinatal transmission of HIV:
___% before 36 weeks
___% in the days before delivery
___% intrapartum
20%
50%
30%
Laboratory screening for HIV is highly specific. It usually consists of an _______ test, followed by a confirmatory test commonly the _________.
ELISA; Western blot
_____ restesting prior to 36 weeks is recommended for:
women who use illicit drugs
have STDs during pregnancy
have multiple sex partners during pregnancy
live in areas with high HIV prevalence
have HIV-infected partners
HIV
A false-positive result from the combination of the two tests is rare. More likely to occur is a __________ ELISA and an ___________ Western blot
positive; indeterminate or negative
The Western blot is a more complex test than the ELISA; it is less _________ but more __________ for HIV
less sensitive; more specific
An _____________ Western blot may be due to:
(1) recent HIV infection (usually positive within 6 weeks to 6 months)
(2) loss of antibodies in an AIDS patient with advanced immunodeficiency
indeterminate
alternative confirmatory test to the Western blot that detects HIV antibodies, but it is less expensive and easier to perform than the Western blot (HIV antibodies are detectable in at least 95 percent of patients within 3 months after infection)
immunofluorescent antibody (IFA) staining
_____ is now automatic routine testing in prenatal care but a woman can opt-out
HIV
The woman must understand that a positive HIV result does not necessarily mean a diagnosis of AIDS, but that a large percentage of seropositive individuals develop the disease within ___-____years
8-10
false positive rate of Western blot test
1-2%
chlamydia most common in women under age ____
25
chlamydia screening is recommended until age ___
30
Risk of \_\_\_\_\_\_\_\_: antepartal bleeding pelvic inflammatory disease preterm labor premature rupture of membranes late postpartum infection
chlamydia
gonorrhea is damaging in _____ trimesters
all
Risk of \_\_\_\_\_\_\_\_: spontaneous abortion premature rupture of membranes chorioamnionitis premature delivery intrauterine growth restriction postpartum infection
gonorrhea
Newborns of ___________ infected mothers may develop: chlamydial conjunctivitis
pneumonia
nasopharyngeal infections
gonococcal neonatal opthalmia
chlamydia and gonorrhea
Tests for ________:
enzyme immunoassay tests
direct fluorescent antibody tests
DNA probe
chlamydia and gonorrhea
highly sensitive and specific test that has the ability to simultaneously identify Neisseria gonorrhoeae and Chlamydia trachomatis–clinically advantageous because both infections are present in about 40% of cases of gonorrhea and Chlamydia, and only one urogenital sample is required
DNA probe assay
CDC recommends diagnostic testing for C. trachomatis, at the _____ prenatal visit for all pregnant women
1st
Women < 25 years old and those who are at increased risk for chlamydia or gonorrhea should be:
retested in 3rd trimester
If a woman tests positive for chlamydia or gonorrhea and is treated, a repeat test (“test of cure”) should be completed within ___-____ months, preferably in the ____ trimester
3-6 months; 3rd
Women at risk for ______:
HIV positive women
Women in close contact with infected individuals
Foreign-born women from countries with high rates of this dx
Medically underserved women
Women who abuse alcohol and/or IV drugs
Women who are residents or employees of prisons
Women who are health care providers who give care to high-risk groups
TB
More than __% of childhood cases of tuberculosis occur in minority groups, most in children under 5 years of age
80
physical, chemical and microscopic evaluation of the urine used to screen for renal disease, UTI and metabolic disorders
urinalysis
Excess tissue fluid that accumulates during the day returns to the bloodstream and urine volume increases, thus producing __________ and ____________ in the morning.
nocturia; low specific gravity
common condition due to an increase in the glomerular filtration rate and sluggish tubular reabsorption of glucose
glucosuria
may occasionally appear, particularly after vigorous exercise and after the first void of the day…can also appear if a drop of vaginal discharge mixes with the urine
trace proteinuria
During a healthy, low-risk pregnancy, a complete urinalysis is usually performed generally at:
1st prenatal visit
Pregnancy-related anatomic, physiologic, and hormonal changes predispose a pregnant woman to __________, one of the most common medical problems of pregnancy.
pyelonephritis
Women with sickle cell trait or disease, high parity, and diabetes are more likely to develop:
bacteruria
a major risk factor for the development of pyelonephritis
asymptomatic bacteruria (ASB)
freshly voided, clean-catch, midstream specimen is required to screen for
symptomatic or asymptomatic bacteruria
diagnosis of ASB or symptomatic UTI is usually based on a colony count of ____________/ml of a particular organism, however, lower counts may also be significant
100,000
The pathogen responsible for 80-90% of infections is ______, followed by Klebsiella, Proteus, and the enterococci, Group B streptococcus and S. saprophyticus
E. coli
____________ for nitrites and leukocyte esterase is a less expensive way to screen for urinary tract infection
urine dipstick
this test alone is not sensitive enough to be used as a screening test for asymptomatic bacteruria
urine dipstick
by-products of bacterial growth that are frequently present and detected by dipstick with UTI
nitrites
the presence of this in urine is not necessarily positive for UTI because they can be due to vaginal contamination
leukocyte esterase
Patients at risk for UTI should have a urinalysis and a urine culture and sensitivity repeated at least ___________ or _____________
once or at least each trimester
Evidence supports that ___________ women do not need to have a urine dip stick routinely performed at each prenatal visit
asymptomatic
testing for asymptomatic bacteruria should be routinely conducted:
at 1st prenatal visit
GBS infection occurs in about 1 in every ________ babies born in the United States
3,000
percentage of women who carry GBS in pregnancy
10-30%
gestation for GBS screening
35-37 weeks
Women that do not need GBS screening as they automatically qualify for treatment during labor and birth
who had a previous baby with GBS infection GBS in their urine in the current pregnancy
GBS culture results are usually ready in _____ hours
24-48
__________ during labor recommended for these women:
Had a previous baby with GBS infection
Had GBS in their urine during the current pregnancy
Had a screening test in the current pregnancy that was positive for GBS
Go into labor before GBS test results are available and have any of the following risk factors:
–Preterm labor (<37 weeks)
–Membranes ruptured >18 hours before delivering the baby
–Fever of at least 100.4° F during labor
Antibiotic Treatment
if a woman tests positive for GBS in the ________ at 1st prenatal visit there is no need to test at 35-37 weeks because she will automatically receive intrapartum abx
urine
anytime there is more than __________ colonies of GBS in the urine, you should treat it
100,000
indicated screening only for women who have vaginal infection symptoms
wet prep
age to start pap smear screening
21
recommendation for frequency of pap smear screening for women 21-65 years
q 3 years
labs ordered at 1st prenatal visit
H+H/ CBC ABO/ Rh/ antibody screen GC/CT RPR/VDRL Hep B Hep C HIV Rubella pap smear (if indicated) DMS (if indicated) urine culture
labs ordered at 24-28 weeks
repeat H+H/ CBC
GDM screening
antibody screen
RPR/VDRL (only if risk factors)
labs ordered at 36 weeks
GC/CT (only if risk factors)
GBS
labs ordered preconceptually if possible
Rubella
tests only ordered if there is indication (not routine)
hemoglobin electrophoresis GC/CT in 3rd trimester Early DMS TB skin test Thyroid studies
what to do if antibody screen (indirect Coombs) is positive at 1st prenatal visit
test for specific antibody and titer
value of 1hr GTT that indicates a 3 hr test
> 130
HBsAg – what does it mean?
Hep B surface antigen– means infectious
anti-HBs – what does it mean?
Hep B surface antibody– means recovery+immunity OR successful immunization
anti-HBc – what does it mean?
Hep B core antibody– previous or ongoing Hep B infection> appears at onset of symptoms and persists for life
Hep B lab that midwife orders for routine prenatal labs and a positive result means the person is infectious
Hep B surface antigen (HBsAg)
platelets normal pregnancy value
150-400K
test that determines the degree of fetomaternal hemorrhage and will help you decide how many vials of RhoGAM are needed
Kleihauer Betke
Regular RhoGAM (300 µg) (1500 IU) will protect against exposure to up to _____ mL of Rh-positive red blood cells
15.0
Reasons to administer___________:
- Delivery of an Rh-positive baby to an Rh negative mom
- Antepartum prophylaxis at 26 to 28 weeks of gestation
- Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g., version) or abdominal trauma
- Actual or threatened pregnancy loss at any stage of gestation
- Ectopic pregnancy
RhoGAM
Administration of Rhogam at 28 weeks should occur even if the ___________ screen is not known to be negative at the time of Rhogam administration
antibody
When should women who are at high risk for chlamydia and gonorrhea be screened?
at 1st prenatal visit AND in 3rd trimester
abnormal Rubella titer value
<1:8
abnormal RBC value
< 3 or > 4.5
abnormal Hgb in 1st trimester
<11.0
abnormal Hgb in 2nd trimester
<10.5
abnormal Hgb in 3rd trimester
<11.0
abnormal Hct in 1st trimester
<33.0
abnormal Hct in 2nd trimester
<32.0
abnormal Hct in 3rd trimester
<33.0
abnormal MCV
<80
abnormal MCH
<27
abnormal MCHC
<33
