Prenatal Screening Flashcards
What blood labs and tests are done at a new OB visit?
Blood: Blood type (rh factor, antibody screen), rubella, RPR, hepatis B, HIV, CBC, glucose tolerance test if hx DM and 35+ , hemoglobin electrophoresis, PPD if indicated
Tests: pap (if indicated), gon, chlamdydia, urine culture
What test is done or offered 14-25 weeks?
PACE triple screen
assess for quickening
US for fetal anatomy and GA confirmation (18-22 to be exact)
What tests/assessment are done 24-26 weeks?
repeat CBC (hgm, hct), repeat syphillis*, glucose tolerance, if rh negative reevaluate antibody screen and give rhogam
fetal kicks counts daily at 28 weeks*
What tests/assessment are done 35-37 weeks?
US (additional if needed) GBBS retest syphillis reassess for HPV outbreak restest for STIS if high risk review signs of labor: 411 (4 min apart, lasting 1 minute for one hour)
When is the US done?
16-20 weeks
When is the NT/Sequential screen?
10-13 weeks
When is the triple/Quad screen or part 2 of sequential screen done?
15-20 weeks
When is the 1 hr glucose tolerance test done?
first visit if high risk
or 24-28 weeks
repeat labs after 28 weeks?
CBC & RPR (rhogam if indicated)
What dx does Quad/triple screen test for?
trisomy 21, 18, NTD, SLOS, abdominal wall defects
What blood tests are in the quad/triple screen?
AFP (alpha fetoprotein) human chorionic gonadtropin inhibin A conjugated estriol *offer to those who did not get 1st trimester screening.
What are the main diagnostics tests for fetal disorders?
amniocentesis and chorionic villi, can do US level II if want another option
What labs show risk of NTD?
elevated AFP
US abnormalities
What does elevated AFP indicate?
NTD, fetal nephrosis, aptichygroma
What labs show risk of trisomy 18 or 21?
decreased estriol and AFP, increased HCG
inhibin A elevated (21)
what is the difference between triple screen and quad screen?
quad has inhibin A included
Cell-free DNA testing
trisomy 18, 21, 13 (patau syndrome), and chromosome aneuploidy, done after 10 weeks (not covered by many insurances as it is optional)
What are the steps in sequential testing?
1st step - free BhCG and PAPP-A and in combination with Nuchal translucency testing (aka US) at 10-13 weeks
2nd step - maternal serum AFP, (screens for NTD) 15-21 weeks
assessment at 40+
discuss postdate pregnancy protocol.
perform cervical assessment and membrane sweeping
fetal surv: NST or BPPs
Fetal Heart tones heard at what week?
16-20 weeks, audible w/US 10-12 weeks
normal HT range?
110-160
when perform leopolds?
35 weeks to check position and presentation.
vaccinations given during pregnancy?
hep B influenza optional Tdap (27-36 weeks) mandatory rubella (if no immunity should vaccinate PP) varicella (if no immunity, vaccinate PP)
exercise recommendations?
moderate, 30 min, large muscle groups, hydration, avoid falling or high impact, avoid supine position, listen to body
Danger signs 1st Trimesters?
spotting, bleeding, cramping, dysuira, severe vomiting or diarrhea, fever >100.4, vaginal infection signs, dizziness, depression
danger signs trimester?
same 1st trimester + regular uterine contractions 6 + per hour
unilateral leg pain, gush of fluid, absence of fetal movement for 24 hour, sudden weight gain, edema of ankles, hands or feet. severe upper abdominal pain, HA w/visual changes or photophobia.
3rd trimester danger signs?
all those 2nd and 3rd + decreased fetal movement daily
how frequent Schedule visits?
1st visit within 12 weeks
meet Q4 weeks until 28 weeks
meet Q2 weeks until 36 weeks
36 + meet weekly
BBP is what?
biophysical profile, assesses fetal wellbeing in later stafes. breathing, movement. tone, and AFV (amnoitic fluid volume)
What does the US look at?
fetal wellbeing, fetal anatomy, placenta location, cervical eval, AFV, fetal growth, done often 18-22 weeks.
NST is what?
nonstress test and AFV - peformed if complaint of decreased fetal movement
also for post dates and if indicated due to comborbid illenss.
Waht is CVS?
tests chronic villi obtained by endoscopic needle biopsy or aspiration. direct DNA info.
between 10-12 week if screening indicates needed.
what is amnoicentesis?
screen amniotic fluid and cells
between 15-20th week and by transabomdinal approach if screen indicates necessary.
cystic fibrosis indicated when?
carrier screen. causions and done at initial visit
tay sachs indicated when?
carrier screne, ashkenazi jewish, cajun, french, and canadian. done at initial visit.
when is canavan’s disease indicated?
ashkenazi jewish - at initial visit
when is familial dysautonomia indicateD?
ash jewish, at initial visit.
positive result for GD?
1 hour glucose tolerance test result > 139 . if positive order 3 hour glucose tolerance test.
