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NCB > Prenatal Testing > Flashcards

Prenatal Testing Flashcards

1
Q

what 11 things must you test/screen for in a PG mom throughout the course of her pregnancy?

A 
ABO Rh and Ab screen
Hct or Hgb and MCV
cervical cytology
rubella immunity
syphilis testing
HBV surface antigen screening
GC/CT screening
thyroid fxn testing
HIV
urine culture
Down Syndrome
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2
Q

why do you need to test ABO Rh and Ab’s

A

need to know baby’s blood type and mom’s Rh type along with baby’s b/c if mom has ab’s to baby could cause hemolytic dz of the newborn

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3
Q

why are hct, hgb and MCV important to know?

A

can indicate anemia (IDA and pernicious anemia) or thallasemia

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4
Q

are PAPs a routine part of prenatal exams?

A

NO but can get one if due for a PAP

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5
Q

what are the screening recommendations for PAP screens (how often)? (USPSTF, ACS, ACOG)

A

varies on the resource you consult
USPSTF at least every 3 yrs
ACS annual screening (biennial if liquid-based)
ACOG biennial for women

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6
Q

what are 4 high risk groups that will require more frequent PAPs/screening?

A

HIV infected
immunosuppressed
in utero DES exposure
ACOG recommends annual screening for women who have been treated in the past for CIN2, CIN3 or cervical CA

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7
Q

if CIN 2 or 3 is found on a PAP during PG do you treat it?

A

no b/c most likely will regress in post partum period
monitor w/colposcopy w/o endocervical curettage once per trimester
post partum evaluation= colposcopy and cervical cytology at 6 and 12 weeks PP

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8
Q

if mom tests (+) for rubella infxn during PG what is the recommended course of action?

A

TAB esp if

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9
Q

if a PG mom is not immune to rubella what is the course of action?

A

counsel and administer PP immunization

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10
Q

what other vaccine does the CDC and ACOG recommend in conjuncture with rubella in vulnerable women?

A

MMR

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11
Q

why do we test for syphilis in PG mom’s?

A

to prevent perinatal transmission of treponema pallidum

tx appropriately w/(+) test result

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12
Q

why do we test for HBVsAg?

A

to prevent perinatal transmission

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13
Q

what can GC/CT cause in the infant? how is it transmitted? when do you screen for GC/CT? what kind of test is it?

A

can cause conjunctivitis or pneumonia in the infant
transmitted most commonly through birth canal but can happen w/C-section also
screen at 1st PN
NAAT test: endocervix or vaginal swab but urine testing appears to be as sensitive as swabs

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14
Q

what at risk populations are recommended to undergo thyroid function testing?

A 
symptomatic women
personal or family hx of thyroid problems
DM Type 1
head or neck radiation hx
goiter
amiodarone use
lithium use
iodine deficiency
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15
Q

what is the universal screening recommendation for thyroid function testing?

A

still recommended by some so as to not miss those w/o risk factors or asx women

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16
Q

untreated thyroid dz can result in what?

A

fetal neurological abn

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17
Q

PG women w/Thyroid peroxidase antibodies are how much more likely to have SABs? preterm birth risk? what other risk factors are assoc with a TPA (+) mom?

A

2-3 x’s higher if have (+) TPA
preterm birth risk doubled
perinatal mortality
LGA infants

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18
Q

for a woman with hypothyroidism, T4 can increase the risk of what? what can some TPA (+) develop as dz processes? untreated women with elevated TPA should have their TSA checked how often?

A

tx w/T4 can increase risk of SAB and preterm delivery
TPA (+) women can develop (subclinical) hypothyroidism
untx women w/elevated TPA should have TSH checked monthly in 1st half of PG and then at least once during 3rd trimester

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19
Q

how much can iodine levels be decreased in PG?

A

as much as 40% dt increased urinary excretion

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20
Q

is HIV testing an “opt-in” or “opt-out” test?

A

opt-out now

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21
Q

what are 4 advantages of universal HIV testing now?

A

PG termination option earlier (at all)
medical management
prevention of transmission and identification of infected partners
PN tx

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22
Q

what is the transmission rate w/and w/o tx of HIV in PG?

A

w/o intervention transmission is 15-40%

w/retroviral tx transmission is reduced to 2% along with avoiding breastfeeding and labor

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23
Q

when would you re-test for HIV and why?

A

in the 3rd trimester
for women at increased risk of infxn
areas of high HIV infxn
women who declined testing earlier in PG

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24
Q

why do a urine culture?

A

to dx asx bacterial infxns

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25
Q

PG women w/untreated bacteriuria are at an increased risk of what 3 things?

A

pyelonephritis
premature labor
low birth weight infants

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26
Q

if a urine test comes back (+) for bacteria what do you do?

A

retest 1 wk after tx
monthly testing until delivery (for those whose culture showed asx bacteriuria)
women w/increased risk of asx bacteriuria (sickle cell trait, urinary tract abn, diabetics)
can treat w/standard medical tx, naturopathic tx

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27
Q

what to do if GBS is (+)?

A

tx if present, even if minimal growth on culture!

prophylactic tx in labor

28
Q

what is ACOGs recommendations for Downs screening?

A

all women are offered aneuploidy screening

29
Q

what 5 tests are there to test for Down’s?

A 
first trimester combined test
integrated tests (full integrated, serum integrated, sequential and contingent)
quadruple test
genetic sonogram
new DNA test
30
Q

what test is best for women who desire early dx and privacy?

A

first trimester combined test

31
Q

how is a first trimester combined test done? management w/a (+) test? disadvantages?

A 
U/S for nuchal transnuchal and gestational age by crown-rump length along with serum pregnancy associated plasma protein-A (PAPP-A) and free or total human chorionic gonadotropin (b-hCG)
management for (+)= chorionic villi sampling
disadvantages: CVS carries more risk of PG loss than amniocentesis, does not screen for open neural tube defects
32
Q

what do integrated tests measure w/or w/o in what trimesters? what are the 3 integrated tests?

A

measures analytes w/or w/o US in 1st and 2nd trimesters
full integrated test
serum integrated test
sequential and contingent testing

33
Q

full integrated test has what rate of down syndrome detection (high or low)? what is being measured at what week range? what serum marker?

A

highest detection rate for Down’s syndrome
U/S measurement of NT at 10-13 wks
PAPP-A at 10-13 wks
quadruple test at 15-18 wks (AFP, unconjugated E3, hCG, inhibin A)

34
Q

the serum integrated test is the same as the full integrated test minus what procedure? why would you use this one?

A

U/S measurement of NT

use for women in areas where they do not have access to technicians who can adequately measure NT

35
Q

sequential and contingent testing give results faster or more slowly?

A

faster, sooner than the 2nd trimester

36
Q

stepwise sequential testing involves what? how does management vary for women of high vs low risk?

A

1st trimester portion of integrated testing
offer CVS to women at high risk
if normal risk perform in the 2nd trimester

37
Q

what are the 3 risk cut-offs for contingent testing?

A

very high risk for Down’s after 1st trimester testing- immediate invasive PN dx
low risk for Down’s are given their risk estimate and have no further testing
women w/intermediate testing get 2nd trimester marker testing and integrate all testing data

38
Q

quadruple test measures the serum level of what 4 markers? with whom do you use this test? during what weeks?

A

serum AFP, uE3, inhibin A, hCG
use w/women who began PN care in 2nd trimester
do b/w wks 15-18

39
Q

why would you do a genetic sonogram? is it as useful as primary screening?

A

for late timing (late to getting PNs), wks 18-20

not as useful

40
Q

what is the new DNA testing method? is it approved as a screening test?

A

test of maternal plasma DNA
not yet approved as a screening test; does not dx other chromosomal defects, will be an accurate test once it is approved for use

41
Q

for a mom who tests (-) for Down’s syndrome markers what does this mean? (2-fold)

A

means risk is less than cut-off

does NOT rule out Down’s syndrome infant

42
Q

for a mom who tests (+) what does this mean? what would you suggest? (3 fold)

A

means risk is higher than cut off level
suggest meeting w/genetic counselor
offer fetal karyotype testing (CVS in 1st trimester, amniocentesis in 2nd)
offer pts resources to help them make informed decisions (decision to maintain, end or adopt out; resources to raise a Down’s child)

43
Q

specifically, in at risk women, what 10 tests do you need to do? (aside from the normal)

A 
gonorrhea
thyroid dz
TB
toxoplasmosis
HCV ab's
varicella
bacterial vaginosis
herpes simplex virus
chagas dz 
lead level screening
44
Q

what are the CDC recommendations for screening for gonorrhea?

A

women aged 15-24 yo
increased risk for gonorrheal infxn or other STD
new or multiple sex partners
inconsistent condom use
those who engage in commercial sex work
those who live in communities w/high prevalence of dz

45
Q

is congenital TB common or rare?

A

rare

test at risk populations

46
Q

transmission routes of toxoplasmosis?

A 
environmental exposure (litter boxes)
undercooked meat from infected animals
47
Q

CDC recommendations for HCV testing?

A 
ever injected illegal drugs
received clotting factors made before '87
received blood/organs before july '92
were every on chronic hemodialysis
have evidence of liver dz (elevated ALT)
are infected w/HIV
48
Q

if a woman is not immune and exposed to varicella during PG what is the protocol?

A

administer varicella immune globulin product, VariZIG prophylaxis and immunize after pregnancy

49
Q

cause of BV? risk factors? is screening recommended?

A

caused by reduction of lactobacillus= anaerobic (-) rods can flourish
risk factors: sexual activity, douching, cigarette smoking
screening not recommended in routine PN care

50
Q

is trich recommended as a routine part of PN care?

A

NO

51
Q

is routine HSV testing indicated in asx women?

A

no but can be reasonable to test if partner is (+) even if woman is asx

52
Q

what is Chagas dz?

A

parasitic dz endemic to Latin America, can be asx but can also be transmitted to the fetus

53
Q

who should you consider screening for lead? dx of >5 mgc/dL?

A 
recent immigrants where ambient lead levels were high
resides near high lead sources 
pica
occupational exposure
environmental exposure
use of lead containing cosmetics
use of lead glazed pottery
some Chinese and Ayurvedic medicines 
dx: lead levels >5 mcg/dL need follow up dependent on how much above, but pediatrician should be told of mother's lead levels at birth
54
Q

can lead cross the placenta? what are high lead levels associated with?

A

yes it crosses the placenta
can be assoc w/miscarriage and still-birth
breastmilk will also need to be evaluated before breast feeding

55
Q

what test do you do to test for thallasemias and hemoglobinopathies?

A

red cell indicies

56
Q

what other test can you do specifically for hemoglobinopathies?

A

hemoglobin electrophoresis

57
Q

what special population do you always need to test for heritable disorders?

A

Ashkenazi Jews

58
Q

just because you get a (-) CF test does that mean the baby is 100% in the clear of having CF?

A

NO, it means the infant is only free of the CF mutations we know of currently

59
Q

what procedure can be useful to determine EDD?

A

U/S in early PG

1st trimester U/S can detect fetal malformations and multiple PGs earlier

60
Q

what 7 tests/procedures are done during the 2nd and 3rd trimesters?

A 
NTD screening and Down's syndrome screening
gestational diabetes
STDs
CBC and Ab screening
GBS screening 
U/S
61
Q

when is a PG mom screened for gestational diabetes? when would you consider screening in the 1st trimester?

A

24-28 wks gestation

consider screening in the 1st trimester if mom is obese, previous hx of GD, previous macrosomia

62
Q

when does the CDC recommend screening again for STDs? what test should you re-do in mom’s 25 and younger? in certain areas what two other STDs will you test for?

A

repeat testing at 28-36 wks in women w/prior PN dx of STD or continued risk factors
CDC recommends retesting chlamydia in mom’s 25 and younger
in some areas repeat syphilis and HIV testing

63
Q

when do you repeat a CBC and Rh ab screen?

A

3rd trimester for anemia

repeat Rh screening in unsensitized Rh (-) women and administer Rhogam if have a rxn

64
Q

when should all women be screened for GBS? what two populations will you treat w/intrapartum antibiotic prophylaxis regardless of GBS colonization?

A

35-37 wks test for GBS

tx prophylactically: women who previously birthed an infant w/invasive GBS dz or women w/GBS bacteriuria in current PG

65
Q

what do 2nd and 3rd trimester U/Ss look for?

A 
presence or absence of fetal cardiac activity
cardiac rate and rhythm
fetal number
fetal presentation
assessment of amniotic fluid volume
placental appearance and location 
fetal biometry
evaluation of uterus, cervix, adnexa when clinically appropriate 
fetal anatomic survey
66
Q

what are you looking for specifically in a 3rd trimester U/S?

A

IUGRs

67
Q

what is the biophysical profile to assess fetal well-being seen on an U/S?

A 
fetal movement 
fetal tone
fetal breathing
amniotic fluid volume
results of non-stress testing

NCB (9 decks)

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