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Boards.CP.Chemistry > Pregnancy > Flashcards

Pregnancy Flashcards

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1
Q

The concentration of ________ in amniotic fluid is a reflection on the severity of fetal hemolysis.

A

Unconjugated bilirubin

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2
Q

What is the maximal absorbance of bilirubin, when assessing by scanning spectrophotometry?

A

450 nm

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3
Q

What are two important factors for Amniotic fluid specimen collection?

A
  • Blood contamination (absorbance peak of oxyhemoglobin at 410 nm can affect magnitude of peak at 450 nm)
  • Protected from light (causes degradation of bilirubin)
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4
Q

What produces Human chorionic gonadotropin?

A
  • Placenta
  • Tumors
  • Pituitary gland (small amounts during menopause)
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5
Q

What is the structure of hCG?

-What shares same structure?

A

Heterodimer of a alpha and a beta chain

  • Alpha chain same as TSH, FSH, LH
  • Beta chain is unique
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6
Q

A false positive hCG is most often due to what?

A

Heterophile antibody interference

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7
Q
  • When does hCG become detectable?

- What are the levels?

A
  • 6-8 days post-conception

- 10-50 mIU/mL

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8
Q
  • In normal pregnancy, hCG should double how often?

- When does it peak?

A
  • 48 hours
  • End of first trimester

*Decreases gradually and by early 2nd trimester plateus

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9
Q

An abnormal hCG dynamic is defined as what?

What does this suggest?

A
  • Failure to rise 66% in 48 hours
  • Ectopic or nonviable intrauterine pregnancy

*20% of ectopic show normal rise

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10
Q

After removal of an ectopic pregnancy, how long does hCG normally remain elevated?

A

Several weeks

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11
Q

An abnormally high hCG is seen in what condition?

A

Gestational Trophoblastic disease (GTD)

-Molar pregnancy

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12
Q

hCG is typically higher in complete or partial moles?

A

Complete moles have higher hCG

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13
Q

What is the management following evacuation of a molar pregnancy?

A
  • hCG levels monitored Weekly until undetectable for 3 consecutive weeks
  • Then measured monthly for 1 year
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14
Q

After evacuation of an uncomplicated molar pregnancy, how long does hCG remain detectable?
-When should persistent GTD be suspected?

A

10 weeks

-if hCG plateaus or rises, then persistent GTD is supected

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15
Q

Quad Screen:

-Markers

A

Markers:

  • Maternal serum hCG
  • a-fetoprotein (AFP)
  • unconjugated Estriol (uE)
  • Inhibin A (DIA)
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16
Q

Quad Screen:

  • When
  • How is risk calculated
  • Sensitivity for Downs
A
  • 2nd trimester (18 weeks)
  • Analytes and maternal age
  • 78%
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17
Q

1st Trimester Test:

  • Markers
  • Sensitivity
  • Time
A
  • hCG
  • PAPP-A
  • Nuchal fold translucency (NT) thickness
  • When combined with maternal age, overall sensitivity is 83%
  • 10-13 weeks
18
Q

In Downs, is the Nuchal Fold Transulcency Thickness increased or decreased?

A

Increased

19
Q

What is the serum Integrated Screen?

-Sensitivity

A

Combined 1st and 2nd trimester serum testing

-when combined with maternal age and NT, overall sensitivity is 88%

20
Q

Quad screen levels in trisomy 21 (Downs).

A
  • hCG - High
  • AFP - Low
  • Estriol - Low
  • Inhibin - High
21
Q

Quad screen levels in trisomy 18 (Edward syndrome).

A
  • hCG - Low
  • AFP - Low
  • Estriol - Low
22
Q

Quad screen levels in neural tube defect (NTD).

A
  • hCG - Normal
  • AFP - High
  • Estriol - Low
23
Q

T/F: Bacterial vaginosis is independently associated with preterm labor.

A

True

24
Q

What is true regarding Fetal Fibronectin and preterm birth.

A

Absence of FF has very high Negative Predictive value and can exclude impending preterm birth.

*A positive result suggests preterm labor, but the overall PPV is low

25
Q

Where is fetal fibronectin normally found?

A

Placental fetomaternal surface

26
Q

What other test has similar diagnostic accuracy to fetal fibronectin?

A

Cervical Length assessed by Transvaginal Cervical US

27
Q

When is fetal lung maturity (FLM) generally achieved?

A

37 weeks gestation

28
Q

What has an accelerating effect on FLM?

A

Excess corticosteroids

-stress of complicated pregnancy

29
Q

What effect does maternal DM have on FLM?

A

Delays

30
Q

What is the Lecithin/Sphingomyelin ratio that indicates FLM?

A

> 2.5:1 (F/S ratio)

31
Q

In pregnancies complicated by maternal diabetes, a ratio of 2.5:1 (L/S) is less predictive of FLM. WHat test is more reliable in this setting?

A

Phosphatidylglycerol concentration

32
Q

What effect does meconium have on the L:S ratio?

-Blood?

A

Falsely decreases

*Blood normalizes the L:S ratio to ~1.5

33
Q

When is Phosphatidylglycerol (PG) first detected? What is its significance?

A
  • 35-36 weeks

- Presence is indicative of FLM

34
Q

What effect does blood and meconium have on PG?

A

No effect

*however, PG is a late marker for FLM, which limits its utility in prematurity

35
Q

Surfactant Lamellar Bodies (LBC):

  • How are they counted?
  • What level is predictive of FLM?
  • Blood and Meconium effects?
A
  • Same size as platelets (use platelet channel of cell counter)
  • LBC >50,000
  • Blood - Decreases LBC
  • Meconium - Increases LBC
36
Q

T/F: Estrogen causes an increase in transport proteins such as thyroid binding globulin (TBG).

A

True

37
Q

When does relative insulin resistance emerge in pregancy? What causes this?

A
  • early 3 trimester

- human Placental Lactogen (hPL) has antiinsulin effects similar to growth hormone

38
Q

What happens to sodium and potassium levels throughout pregnancy?

A

remain relatively constant

39
Q

What happens to calcium levels in pregnancy?

A
  • Total calcium levels DECREASE (10%) d/t physiologic hypoalbuminemia
  • Ionized calcium levels remain unchanged
40
Q

What happens to Hct/Hb in pregnancy?

A
  • Hct - decreases (4-7%)

- Hb - decreases (1.5-2 g/dL)

41
Q

What happens to BUN in pregnancy?

A

Decreases (50%)

Boards.CP.Chemistry (17 decks)

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