Pregnancy and prenatal testing Flashcards
normal human pregnancy
40wks starting at first day of missed period/last
describe the 3 stages of pregnancy
1st day of conception 12 wks
2nd 13-26wks
3rd 26wks - delivery
Describe gestation
indication of fetal development from the last period
Describe conception
indication of …
indication of development from the date the sperm fertilizes the ovum
Ovulation
egg into the fallopian tube
Zygote
ovum is fertilized
Blastocyte
cluster of cells 5 days past fertilization
placenta
made to support fetus
embryo
im
implantation
organogenesis
time?
organs of embryo 10 wks
what develops at 10wks
heart beats, arms legs
What develops during the 2nd trimester
hiccups/genitalia
can babies survive being born at 26 wks
most premature babies can survive
what happens during 3rd trimester
e/b/oz
eyes open and blink, 7 oz, breathing
what happens during the last 4 weeks
muscle developement, fat storage, life after delivery
Describe delivery
wks
what inc?
what rises?
what triggers?
38-42 wks
progesterone inc throughout preg until close to term then they drop
estrogen rises as progesterone drops
oxytocin triggers uterine contactions (PITOCIN)
Describe transformation
inc ….. proportional to…
what vol inc?
what effect on ….?
inc plasma vol steady prop to 3rd tri
extracellular vol inc
dilutional effect on BP
Describe Renin-angiotensisn
affected during?
releases?
hypoth releases?
what happens with aldosterone secretion?
affected during pregnancy, arteries, release relaxin
hypoth releases AVP/ADH
aldosterone sec - inc plasma vol
Describe natural decrease in analytes
I
I
P
C
iron - hgb synth
iodione
protein catabolism dec - increased LDL
calcium - taken from bones
Describe upreg. of hormones/steriods
upreg of e/p/e.D
cardiac output?
maternal hr?
what is increased?
upreg of estradiol, prostagland/endo peripheral dilation
cardiac output 20% 8wks
maternal hr 10-20bpm
relaxin/prolactin incr
Describe GFR
inc/dec?
causes what to arteries?
volume?
what causes decreased plasma?
Increased
vasodilation
inc plasma vol
increased creat/BUN = dec plasma
Describe hyperventilation
inc O2 demand
atrium po2 in
pco2 dec
fully compensated respiratory alk
Describe cholesterol
increased …..
inc trig/LDL
Describe endocrine
inc
HCG stims?
TSH decreases?
Inc A…?
TBG incr (T4/T3)
HCG stim TSH
TSH dec negative feedback
inc ACTH/Cortisol
Describe immune response
altered…
what is dec
altered paternal Ag
pro-inflamm dec
Describe neuroactive
k….secretor
TRh stimulates?
kisspeptin - insulin secretor
TRH stimulates TSH
Describe HCG
early detect
measuremnt type (s)?
doubles?
dec
early det. of preg
serial measurment
doubles every 24hr peak at 10wk
dec until 16wk
What does the placental hormone look like (HCG)
hetero….glyco
in?
units?
heterodimer glycoprotein
in urine and blood
4 sub units (alph and beta)
When do HCG levels return to normal after pregnancy
7-60days
T/F downsyndrom HCG levels are 3x higher
false they are 2x higher
T/F before placenta is developed prim HCG is hyperglycolsated
true
Describe point of care testing
CLIA ….. what kind of test
hyper…..is detected or not?
lower levels?
CLIA waved testing qualitiative
hyperglycated HCG not detected
lower levels 20mil/mL
What creates false negatives in Point of care tests
t
d
h
False positives
m
sotl
false Neg: too early
diluted
hook effect of HCG
False post: Medications, sit out too long
Describe analytes for assessment
serum immunoassay
mon/tra/radio
Quantitative….
Hormones per..
No ref
Estimated
serum immunoassay:
monoclonal/tracer/radiography Ag
Quantitative HCG serum
hormones per mL of blood
no ref range of B-HCG
estimated gestational age
False positives for for analytes for assessment
H
RF
Igs
Ch
End-stg
Examples:?
False Negatives
heterophile Abs
rheumatoid factors
IgA def
chronic renal failure
end-stage renal disease
Ex: HCG weight loss
False negative: hook effect
Describe Alpha-fetal protein
em, what type of cells
binds to
protects
passes
rise/fall?
embryonic yolk sac, parenchymal cells in liver of fetus
binds to estradiol
protects fetus from immune attack
Passes placenta
rise at the end of trimester/fall 32wks
Describe MS-AFP
fetal ab….
Anec
Omph
Low
De
fetal abnormal, distress, preg health
NTD
anecephaly
omphalocele
low birth weight
death
What does MS-AFP predict
g
Indicates
screening
generalized
indications of preclampsia
downsyndrome/trisomy 18
screening 15-20 wks
Describe MoM
RR
AFP serum to median of RR
Overcome variables
Mothers AFP/Mo RR
0.5-2.0
False positives in MoM
mult …
incorrect calc of
gest/tob
lab
multi parous preg
incorrect calc of fetal gestation
gestational diabetes/tobacco
lab tech error
Describe Fetal Amnoic fluid AFP
when..
Spina bifida
anecepahly
avoid, stable
can be tested in
when Ms-AFP high/ultrasound inconclusive
MoM open spina bifida = 7
MoM anecephaly = 20
Avoid contamination, stable for 7 days RT
can be tested in serum/urine/fluids
Describe Unconjugated estriol
what type of hormone
predicts?
tri…
stability
E3 - steroid hormone
predicts estrogen in pregnancy
Trisomy 21/trisomy 18 (downs/edwards)
NOT STABLE
Describe Inhibin A
what type of protein….suppliments
units
downs inc?
stability
glycoprotein supp. FSH
2 units: large alpha/small B
downsyndrom (21) inc during 2nd tri
MORE STABLE IN SERUM
Describe triple/quad screen tests
time period?
includes ?
estimates?
screen for?
16-20wks
includes AFP/HCG E3 inhibin A
risk estimates only, not diagnostic
screen for Tri 21
Describe Acetycholinesterase
Chol…. found in
diagn for
A
O
A
cholinergic enzyme found in neuro junction
diagn for anecephaly
open spinal bifinia
abnormal wall deficient
Describe PAPP-A
glyco
what type of screening
down…etc
glycoprotein in placenta
1st Tri screening test - low concentration
Pat/Ed/Do/turn
Describe progesterone
what type of hormone
healthy…
spontaneous
steriod hormone
healthy preg
spontaneous abortion susp. of high risk to natural fetal abortion
Describe glucose
macrso/low
body sites?
where do they test?
gestational diabetes
macrosomic/low blood sugar CNS, cardiac
oral testing
Describe fetal fibronectin
high conc in
used to asses
+ means
- means
high concentration in mucus lining of uterus/conc in amnoic fluid
used to asses if pt will go into labor w in 7-14 days
+ = labor
- = 24-32wks will not go into labor
Describe neural tube defects
myelomin
most common/neural tube doesnt close
myelominigocele
Describe down syndrome
extra copy of long arm region chrom 21
3 copies of chrom 21/ 5% trans location
maternal age increases risk
Describe Tris 18
hwo much dont live past 8wks
100 days?
extra chrom 18
80% dont live past 8wks
90% 100 days death
Describe Isoimmunization
fetal hemolysis disorder maternal ab against fetus, Mom Rh (-) baby Rh (+)
Describe pre-term delivery
resp dis
lack of ?
earlier than 37th wks
respiratory distress syndrome lack of pulm. surfactant
Describe pre-eclampsia
hyper/prot
trimesters?
hyperfension/proteinuria not understood 2/3rd Tri
Describe Hyperemesis gravidarium
70% morning sickness
Describe etopic pregancies
trophoblast cells attach to lining of fallopian tubes
Describe analyte deficiencies
calcium levels dec in 2/3rd tri
relative idodine deficiency
