Prenatal Screening

Question 1

What blood labs and tests are done at a new OB visit?

Answer 1

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

Question 2

What test is done or offered 14-25 weeks?

Answer 2

PACE triple screen
assess for quickening
US for fetal anatomy and GA confirmation (18-22 to be exact)

Question 3

What tests/assessment are done 24-26 weeks?

Answer 3

repeat CBC (hgm, hct), repeat syphillis*, glucose tolerance, if rh negative reevaluate antibody screen and give rhogam

fetal kicks counts daily at 28 weeks*

Question 4

What tests/assessment are done 35-37 weeks?

Answer 4

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)

Question 5

When is the US done?

Answer 5

16-20 weeks

Question 6

When is the NT/Sequential screen?

Answer 6

10-13 weeks

Question 7

When is the triple/Quad screen or part 2 of sequential screen done?

Answer 7

15-20 weeks

Question 8

When is the 1 hr glucose tolerance test done?

Answer 8

first visit if high risk

or 24-28 weeks

Question 9

repeat labs after 28 weeks?

Answer 9

CBC & RPR (rhogam if indicated)

Question 10

What dx does Quad/triple screen test for?

Answer 10

trisomy 21, 18, NTD, SLOS, abdominal wall defects

Question 11

What blood tests are in the quad/triple screen?

Answer 11

AFP (alpha fetoprotein)
human chorionic gonadtropin
inhibin A
conjugated estriol
*offer to those who did not get 1st trimester screening.

Question 12

What are the main diagnostics tests for fetal disorders?

Answer 12

amniocentesis and chorionic villi, can do US level II if want another option

Question 13

What labs show risk of NTD?

Answer 13

elevated AFP

US abnormalities

Question 14

What does elevated AFP indicate?

Answer 14

NTD, fetal nephrosis, aptichygroma

Question 15

What labs show risk of trisomy 18 or 21?

Answer 15

decreased estriol and AFP, increased HCG

inhibin A elevated (21)

Question 16

what is the difference between triple screen and quad screen?

Answer 16

quad has inhibin A included

Question 17

Cell-free DNA testing

Answer 17

trisomy 18, 21, 13 (patau syndrome), and chromosome aneuploidy, done after 10 weeks (not covered by many insurances as it is optional)

Question 18

What are the steps in sequential testing?

Answer 18

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

Question 19

assessment at 40+

Answer 19

discuss postdate pregnancy protocol.
perform cervical assessment and membrane sweeping

fetal surv: NST or BPPs

Question 20

Fetal Heart tones heard at what week?

Answer 20

16-20 weeks, audible w/US 10-12 weeks

Question 21

normal HT range?

Answer 21

110-160

Question 22

when perform leopolds?

Answer 22

35 weeks to check position and presentation.

Question 23

vaccinations given during pregnancy?

Answer 23

hep B
influenza optional 
Tdap (27-36 weeks) mandatory
rubella (if no immunity should vaccinate PP)
varicella (if no immunity, vaccinate PP)

Question 24

exercise recommendations?

Answer 24

moderate, 30 min, large muscle groups, hydration, avoid falling or high impact, avoid supine position, listen to body

Question 25

Danger signs 1st Trimesters?

Answer 25

spotting, bleeding, cramping, dysuira, severe vomiting or diarrhea, fever >100.4, vaginal infection signs, dizziness, depression

Question 26

danger signs trimester?

Answer 26

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.

Question 27

3rd trimester danger signs?

Answer 27

all those 2nd and 3rd + decreased fetal movement daily

Question 28

how frequent Schedule visits?

Answer 28

1st visit within 12 weeks

meet Q4 weeks until 28 weeks
meet Q2 weeks until 36 weeks
36 + meet weekly

Question 29

BBP is what?

Answer 29

biophysical profile, assesses fetal wellbeing in later stafes. breathing, movement. tone, and AFV (amnoitic fluid volume)

Question 30

What does the US look at?

Answer 30

fetal wellbeing, fetal anatomy, placenta location, cervical eval, AFV, fetal growth, done often 18-22 weeks.

Question 31

NST is what?

Answer 31

nonstress test and AFV - peformed if complaint of decreased fetal movement

also for post dates and if indicated due to comborbid illenss.

Question 32

Waht is CVS?

Answer 32

tests chronic villi obtained by endoscopic needle biopsy or aspiration. direct DNA info.

between 10-12 week if screening indicates needed.

Question 33

what is amnoicentesis?

Answer 33

screen amniotic fluid and cells

between 15-20th week and by transabomdinal approach if screen indicates necessary.

Question 34

cystic fibrosis indicated when?

Answer 34

carrier screen. causions and done at initial visit

Question 35

tay sachs indicated when?

Answer 35

carrier screne, ashkenazi jewish, cajun, french, and canadian. done at initial visit.

Question 36

when is canavan’s disease indicated?

Answer 36

ashkenazi jewish - at initial visit

Question 37

when is familial dysautonomia indicateD?

Answer 37

ash jewish, at initial visit.

Question 38

positive result for GD?

Answer 38

1 hour glucose tolerance test result > 139 . if positive order 3 hour glucose tolerance test.