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Women's Health 2 > OB Lab Med > Flashcards

OB Lab Med Flashcards

1
Q

Qualitative betahCG

A
  • urine ELISA test for b-hCG
  • home tests often NOT as sensitive as advertised
  • threshold: 10-100 mIU/ml (only 44% of brands are positive at 100)
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2
Q

quantitative beta-hCG

A
  • serum ELISA for b-hCG

- detectable as low as 1 mIU/ml threshold

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3
Q

what determines if a home pregnancy test is valid or not?

A
  • the control has to be positive for the test to be positive

- a positive or negative test with no control is INVALID

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4
Q

trend of hCG when looking at quantitative hCG testing

A

-per the book: doubles q 48-72 hours - but be conservative***

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5
Q

when does hCG peak?

A

between 8-11 weeks

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6
Q

when can transvaginal US usually find a gestational sac? (in terms of hCG levels)

A

> 1000-2000 mIU/ml

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7
Q

what could cause hCG levels to be too high?

A
  • incorrect dates (MC)
  • twins
  • molar pregnancy
  • Down syndrome
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8
Q

what could cause hCG levels to be too low?

A
  • incorrect dates
  • Trisomy 18
  • ectopic pregnancy (50%)
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9
Q

what is the discriminatory zone?

A
  • 1500-2000 mIU/ml

- if level is above the zone threshold, but cannot see IUP on TVS –> either non living or ectopic (possibly multiples)

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10
Q

yolk sac

  • what is it
  • when is it seen
A
  • circular, 3-5 mm diameter structure
  • typically seen w/i the gestational sac at about 5/5 weeks
  • should see embryo at 6 weeks and cardiac activity at 6.5 weeks
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11
Q

what does it mean when there is no IUP on TVS? and what is the next step?

A

= PUL (pregnancy of undetermined location)

-repeat hCG in 48 hrs

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12
Q

outcome of failure of hCG to rise as expected or a drop?

A

failing IUP or failing ectopic

-after SA, levels decline by 20-35% at 48hrs and 70-85% by 7 days

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13
Q

outcome of a rise of hCG but still no gestational sac on TVS?

A

ectopic

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14
Q

outcome of a rise of hCG and you see the gestational sac?

A

WHEW! IUP

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15
Q

summary of what is expected in serial hCG levels

A
  • early normal IUPs have about 50% rise at 48 hrs (it might double and that’s ok)
  • be conservative! Some nl IUPs have only a 35% rise at 48 hrs
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16
Q

what trend in hCG do you expect w/ multiples?

A

the same rate of rise as a nl IUP

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17
Q

what to keep in mind with serial hCG and ectopics

A
  • 30% of ectopics will have about a 50% rise at 48 hrs (like nl IUP)
  • an ectopic w/ declining hCG levels can still rupture!! (50%)
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18
Q

what progesterone level EXCLUDES ectopic?

A

-progesterone > 25 ng/ml (92% sens.)

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19
Q

what is progesterone levels in most ectopic pregnancies?

A

10-25 ng/mL

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20
Q

progesterone levels < 5 ng/mL could mean what?

A
  • non-living IUP

- ectopic

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21
Q

What are the standard initial labs for a pregnant pt?

A
  • blood type
  • D(Rh) type
  • antibody screen
  • CBC
  • PAP
  • confirm immunity to rubella
  • VDRL (syphilis)
  • UA
  • HBsAg
  • confirm no abs to HIV
  • GTT if hx of gDM
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22
Q

optional labs to run for pregnant pt

A
  • electrophoresis (for bleeding disorders)
  • PPD (TB screen)
  • G/C: chlamydia for all, G if RFs
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23
Q

what is Rh incompatibility

A
  • dad is Rh +
  • Rh+ fetal blood exchanged antenatal or at delivery
  • Rh- mom make Rh Rho(D) abs once exposed
  • 1st child unaffected
  • subsequent kids at risk for hemolytic anemia
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24
Q

who gets RhoGAM?

A

every Rh - mom, no matter what

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25
Q

what is the TORCH panel?

A 
T: toxoplasmosis gondii
O: other (including syphilis) 
R: rubella
C: cytomegalovirus
H: herpes simplex virus
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26
Q

complications of rubella infection in utero

A
  • stillbirth
  • miscarriage
  • congenital rubella syndrome: birth defects including heart problems, microcephaly, vision/hearing probs, intellectual disability, growth probs, and liver/spleen damage
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27
Q

GTT

A
  • screen for gestational DM
  • give 50mg glucose and draw blood in 1 hr
  • nl: < 140 mg/dl*** (know this)
  • if abnl, do 3 hr test w/ 100 g challenge
28
Q

RhoGAM injection

A

-at 28 weeks if mom is Rh - or w/i 72 hrs postpartum

29
Q

what is RhoGAM

A

IgG anti-Rho(D) antibody that binds to Rh+ cells, makes the “invisible” to maternal immune system

30
Q

RFs for impaired carb metabolism in pregnancy

A
  • strong fam hx of DM
  • prior delivery of a large newborn
  • persistent glucosuria
  • unexplained fetal losses
31
Q

abnl results of a 3 hr GTT (per ADA)

A
  • fasting: >95
  • 1 hr: >180
  • 2 hr: >155
  • 3 hr: >140
32
Q

maternal serum alpha fetoprotein (MSAFP) should be offered to who?

A

EVERYONE

33
Q

MSAFP

  • when to get
  • what is it
A
  • obtained b/w 14-22 weeks but most accurate 16-18 weeks

- a screening test for birth defects/ chromosomal abnormalities

34
Q

indications for MSAFP

A
  • personal or fam hx of birth defects
  • > 35
  • DM I
  • used harmful meds during pregnancy
35
Q

risk of chromosomal anomaly by maternal age

A
  • 20 yo: 1/525
  • 40 yo: 1/62
  • 45: 1/18
36
Q

when is an instance other than birth defect that MSAFP could be elevated?

A

liver carcinoma

37
Q

MSAFP

  • how is it measured
  • specificity
A
  • measured in MOMs; allows for comparison of results based on pt. population
  • poor specificity: if abnl, only 2-3/100 will have a birth defect (just tells you to go looking, not diagnostic)
38
Q

what to do if MSAFP is abnl

A
  • send for US
  • repeat lab
  • amniocentesis
  • genetic counseling
  • and/or special testing
39
Q

MSAFP is high in:

A
  • NTDs
  • esophageal probs
  • omphalocele
  • gastroschisis
  • placental abruption
  • multiple gestation
  • liver dz in the mom
  • inaccurate gestational dating***** MC!
40
Q

MSAFP is low in:

A
  • Trisomy 21 (Down syndrome)
  • Trisomy 18 (edward’s)
  • other chromosomal abnormalities
  • insulin dependent diabetics
  • very low sensitivity
41
Q

what tests make up the triple screen?

A
  • AFP
  • UE3 (estriol)
  • hCG
42
Q

triple screen

  • when is it best?
  • sensitvity
A
  • best b/w 16-18 weeks

- 70% senstivity, 5% false +

43
Q

what results are expected in the triple screen in Trisomy 21?

A
  • AFP: low
  • UE3: low
  • hCG: high
44
Q

what results are expected in the triple screen in Trisomy 18?

A
  • AFP: low
  • UE3: low
  • hCG: low
45
Q

what results are expected in the triple screen in NTDs, abd wall defects, etc.?

A
  • AFP: high
  • UE3: NA
  • hCG: NA
46
Q

What tests make up the quad screen?

A
  • AFP
  • UE3
  • hCG
  • DIA (inhibin A)
47
Q

quad screen

  • when is it best?
  • sensitivity
A
  • best b/w 16-18 weeks

- 80% sensitivity, 5% false +

48
Q

Tri 21 quad screen

A
  • AFP: low
  • UE3: low
  • hCG: high
  • DIA: high
49
Q

Tri 18 quad screen

A
  • AFP: low
  • UE3: low
  • hCG: low
  • DIA: normal
50
Q

Tri 13 quad screen

A
  • AFP: high
  • UE3: nl
  • hCG: nl
  • DIA: nl
51
Q

Turner’s syndrome quad screen

A
  • AFP: low
  • UE3: low
  • hCG: very high
  • DIA: very high
52
Q

NTDs, abd wall defects, etc. quad screen

A
  • AFP: high
  • UE3: NA
  • hCG: NA
  • DIA: NA
53
Q

materniT21

A
  •   Tests maternal blood for fetal chromosome 21 •  Screening test
  •   Pros: Can be done as early as 9-10 weeks, high sensitivity and specificity, non-invasive •  Cons: Not diagnostic (still need CVS or amnio), $$$, only tests for Trisomy 21
54
Q

M aterniT21 PLUS

A
  1. detects chromosomal abnormalities: Tri 21, 18, 13
  2. Gender
  3. sex aneuploidies: Turner’s, Klinefelters
  4. selected microdeletions: DiGeorges, Prader willi, Cri du chat
55
Q

indications for MaterniT21

A
  •   Advanced maternal age
  •   Personal hx of chromosomal abnormalities
  •   Family hx of chromosomal abnormalities or birth defects
  •   Fetal US abnormality suggestive of chromosomal abnormalities
  •   Positive screening test
56
Q

what is chorionic villus sampling (CVS)?

A
  • uses US to aspirate chorionic villi from placenta
  • to detect chromosome abnormalities
  • transcervical or transabdominal
  • only paternity test prior to delivery
  • can be preformed at 10-14 weeks
57
Q

indications for CVS

A
  • AMA
  • abnl screening test
    • fam hx
58
Q

benefits of CVS over amnio

A
  • can be done earlier
  • larger samples
  • faster results (but higher risks)
59
Q

risks of doing CVS

A
  • miscarriage (1-5%)
  • infection
  • distal limb defects
  • premature rupture of membranes
60
Q

what is amniocentesis

A
  • US guided transabdominal aspiration of amniotic fluid (contains fetal cells)
  • done after 15 weeks to assess for chromosomal abnormalities or gender
61
Q

what is amniocentesis used for in the 3rd trimester?

A
  • fetal lung maturity
  • infection
  • hemolytic incompatibility
62
Q

indications for amniocentesis

A
  • AMA, >35 yo
  • prior pregnancies w/ birth defects
  • abnl blood tests or US
    • fam hx of genetic disorder
63
Q

risks of amniocentesis

A
  • miscarriage (less than CVS)
  • PTL
  • chorioamnionitis
64
Q

cordocentesis

A
  • done after 17 weeks
  • US guided, transabdominal aspiration of fetal blood from umbilical cord
  • last resort!
  • to detect chromosome abnormalities, blood disorders, infection
65
Q

risks of cordocentesis

A
  • miscarriage (1-2%)
  • bleeding
  • infection
  • PROM
  • fetal bradycardia
66
Q

lab testing in 3rd trimester

A
  • repeat CBC
  • if sexual RFs, check STIs again after 32 weeks
  • consider US if indicated
  • EVERYONE get group B strep swab
67
Q

group B strep swab

A
  • b/w 35-37 weeks
  • swab of vagina and anus
  • about 10-25% of women are colonized
  • helps prevent infection in newborns
  • # 1 infectious cause of morbidity/mortality among infants in the US

Women's Health 2 (9 decks)

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