Pregnancy and prenatal testing Flashcards by Kailea Boerste

normal human pregnancy

40wks starting at first day of missed period/last

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describe the 3 stages of pregnancy

1st day of conception 12 wks
2nd 13-26wks
3rd 26wks - delivery

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Describe gestation

indication of fetal development from the last period

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Describe conception
indication of …

indication of development from the date the sperm fertilizes the ovum

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Ovulation

egg into the fallopian tube

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Zygote

ovum is fertilized

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Blastocyte

cluster of cells 5 days past fertilization

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placenta

made to support fetus

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embryo
im

implantation

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organogenesis
time?

organs of embryo 10 wks

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what develops at 10wks

heart beats, arms legs

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What develops during the 2nd trimester

hiccups/genitalia

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can babies survive being born at 26 wks

most premature babies can survive

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what happens during 3rd trimester
e/b/oz

eyes open and blink, 7 oz, breathing

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what happens during the last 4 weeks

muscle developement, fat storage, life after delivery

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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)

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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

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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

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Describe natural decrease in analytes
I
I
P
C

iron - hgb synth
iodione
protein catabolism dec - increased LDL
calcium - taken from bones

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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

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Describe GFR
inc/dec?
causes what to arteries?
volume?
what causes decreased plasma?

Increased
vasodilation
inc plasma vol
increased creat/BUN = dec plasma

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Describe hyperventilation

inc O2 demand
atrium po2 in
pco2 dec
fully compensated respiratory alk

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Describe cholesterol
increased …..

inc trig/LDL

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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