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Womens health exam 2 > WH Labs and Imaging > Flashcards

WH Labs and Imaging Flashcards

1
Q

Estrogen types

A

*Estrone (E1),Estradiol (E2), Estriol (E3)
* Majority is produced by the placenta

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2
Q

causes of Low levels of estrogen

A
  • Possible problem w/ placenta
  • Can indicate some birth defects such as Down Syndrome
  • Difficulty w/ spontaneous labor if still low at term
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3
Q

Causes of high levels of estrogen

A
  • Increased risk of premature labor if sudden spike before week 37
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4
Q

Progesterone functions

A
  • Thickens uterine lining and prevents ovulation during pregnancy
  • Produced by the corpus luteum and then by the placenta
  • Should increase throughout pregnancy
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5
Q

Causes of low levels of progesterone

A
  • Infertility, higher risk of preterm labor/miscarriage and
    pre-eclampsia
  • Can signal ectopic pregnancy
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6
Q

Causes of high levels of progesterone

A

Multiples, molar pregnancy

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7
Q

Follicle Stimulating Hormone (FSH)

A
  • Produced by the pituitary gland
  • Stimulates estrogen production and maturation of follicles in the ovary
  • Suppressed by high levels of estrogen/progesterone
  • High levels (>25.8) = postmenopausal, infertility hypopituitarism
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8
Q

Luteinizing hormone (LH)

A
  • Produced by the pituitary gland
  • LH surge causes ovulation (so can be used to track ovulation)
  • Stimulates the corpus luteum to produce progesterone (supports early
    stages of pregnancy)
  • Low levels = postmenopausal, infertility, hypopituitarism
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9
Q

Prolactin

A
  • Produced by pituitary gland
  • Stimulates lactation
  • Elevated in pregnant and breastfeeding women
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10
Q

Causes of Low levels of prolactin

A

Infertility, lack of milk production, not pregnant or breastfeeding, hypopituitarism

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11
Q

High levels of prolactin causes

A

pregnancy/breastfeeding, prolactinoma, antipsychotics

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12
Q

ABO incompatibility

A
  • Often seen in firstborn infants (20%)
  • Most group O women have developed anti-A and anti-B isoagglutinins
    before pregnancy from exposure to bacteria
  • Rarely becomes progressive in future pregnancies
  • Anti-A and anti-B antibodies are IgM
  • Typically does not cause appreciable hemolysis in the fetus
  • improved results since the 1950s
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13
Q

Rh antibody screen

A
  • Indirect Coombs test to test for maternal alloimmunization
  • IgG antibodies = Rh incompatibility = fetal hemolytic anemia
  • Rh incompatibility is progressive, affects second and
    subsequent pregnancies
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14
Q

What is the grandmother effect?

A
  • It is possible for an Rh- female fetus exposed to maternal Rh+ red cells to develop
    sensitization (while still in the womb)
  • Means she may produce anti-D(Rh) antibodies before she is even born, so 1st pregnancy
    is already at risk
  • The fetus in the current pregnancy is jeopardized by maternal antibodies that were
    initially provoked by his or her grandmother’s erythrocytes
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15
Q

Rubella screening

A
  • Titer
  • Negative results are < 7 IU/mL IgG and < 0.9 IgM antibodies
  • Infection in the first trimester poses significant risk for abortion and severe congenital
    malformations
  • Rubella vaccination should be avoided 1 month before or during pregnancy
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16
Q

Syphilis screening (RPR)

A
  • Spirochetes cross the placenta to cause congenital infection, stillbirth
  • Delivery
  • Risk directly related to maternal spirochete load
  • Treat ASAP after Dx
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17
Q

HIV Screening

A
  • Checked also at a patient’s initial visit
  • Can lead to AIDS
  • Can pass to fetus
  • If positive, medications used to protect the fetus during delivery, and to baby after birth
  • Passed through breastmilk
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18
Q

Beta-HCG qualitative vs. quantitative testing

A

*Qualitative (You do this one at home)
*Detects the presence of HCG
*Urine

*Quantitative (β-hCG)
*Measures the amount present in
the blood
*Confirms pregnancy
*Doubles every 3 days and reach its
peak at 8-11 weeks of a normal
pregnancy
*US more accurate after 5-6 weeks
of gestation as this is more
accurate

19
Q

Quad screen: Screening test components

A

*Alpha-fetoprotein (AFP), made by baby
*Β-hCG, made by placenta
*Estriol, made by placenta and fetus
*Inhibin-A, made by placenta

20
Q

When is quad screening done and when should it be considered?

A

*Weeks 16-18
* Most accurate timing (can be done 15-22 wks)
*Consider if family history of birth defects, ≥ 35 years, diabetes with insulin, radiation exposure, viral infection during pregnancy, harmful medication or drugs use

21
Q

Alpha-fetoprotein (AFP)

A

*Most common reason for elevated levels is
inaccurate dating of pregnancy
*High levels may indicate a neural tube
defect
*Low levels AFP with abnormal hCG, inhibin
A, and estriol may indicate Trisomy 21 or 18

22
Q

Noninvasive prenatal testing (NIPT)

A

*Prenatal cell-free DNA (cfDNA)
*Screening blood test
*≥10 weeks
*Trisomy 21, trisomy 18, trisomy 13, fetal “Y” chromosome

23
Q

Noninvasive prenatal testing (NIPT) process

A

*DNA from the mother and fetus is extracted from a maternal blood sample and screened for the increased chance for specific chromosome problems
*97 to 99% accuracy for negative predictive values
*Chorionic villus sampling (CVS) or amniocentesis to confirm

24
Q

Oral Glucose Tolerance Test

A

OGTT
*50 grams
*1-hour glucose challenge (step 1)
*>140mg/dL is abnormal
*Diagnostic 3-hour oral glucose tolerance test (move to 3 hour if abnormal in 1 hour)

*Fasting: > 95 mg/dL
*1 hour: > 180 mg/dL
*2 hour: > 155 mg/dL
*3 hour: > 140 mg/dL
*If more than 1 is higher than
normal = gestational diabetes

25
Q

Amniocentesis

A

Removal of amniotic fluid by a needle through the maternal abdomen with ultrasound guidance

26
Q

Used to diagnose fetal chromosomal abnormalities or neural tube defects after an
abnormal screening test

A

Amniocentesis

27
Q

Cordocentesis

A

*Percutaneous umbilical cord blood sampling
*Usually done after week 17/18
*Can detect anemia, chromosome abnormalities, infections,
blood disorders
*Can’t detect neural tube defects

28
Q

Blood transfusions or medication can be given directly to the fetus through ______

A

the umbilical cord

29
Q

Chorionic Villus Sampling (CVS)

A
  • Chorionic villi have the same genetic
    material as the baby
  • Transabdominal or transcervical
  • Can be used to detect chromosome
    abnormality or other genetic disorders
  • Can’t detect neural tube defects
  • Miscarriage risk of 0.7%
  • Limb defects (esp if done before 9 wks)
30
Q

L/S Ratio

A

Lecithin–sphingomyelin ratio in amniotic fluid
* Surfactants
* Higher lecithin/sphingomyelin ratio = more mature lungs
* Test done 32-39 weeks if at risk of premature delivery

31
Q

Ranges for L/S ratio

A

<1.5:1 = immature lungs
1.5:1 – 1.9:1 = risk for immature lungs
≥2.1:1 = mature lungs

32
Q

Kleihauer-Betke (KB) Test

A
  • Fetomaternal hemorrhage screening
  • Quantifies the amount of fetal hemoglobin in
    maternal circulation
  • Maternal trauma/placental disruption
  • Additional RhoGAM given if mother RhD negative
33
Q

Kleihauer-Betke (KB) Test process

A
  • A peripheral blood smear is made from the maternal
    sample and treated with acid. The slides are
    washed, stained, and examined microscopically
  • The number of fetal cells are counted per number of
    maternal cells to give % fetal cells
  • Cannot be detected if less than 5mL blood shared
34
Q

Nitrazine Test process

A

*Premature rupture of membranes
(PROM)
*Prior to 37 weeks
*Place a drop of fluid obtained from the
vagina onto paper strips containing
Nitrazine dye
*The strips turn blue if the pH is greater
than 6.0
*A blue strip means it’s more likely the
membranes have ruptured

35
Q

When allowed to dry,
amniotic fluid results in
a ______

A

fern pattern (ferning)

36
Q

Obstetric Ultrasound

A

*Transvaginal or abdominal
*Initial US to confirm intrauterine
pregnancy
*Embryo can be observed at about
6 weeks
*Heartbeat visible 6-7 weeks
*If observed, probability of
continued pregnancy high

37
Q

18-20 week scan

A

*Determine gestational age
* Crown-to-rump length
* Biparietal diameter
* Femur length
*Abdominal circumference
*Amount of amniotic fluid
*Placenta location
*Number of fetuses
*Malformations

38
Q

Other indications for US

A

*Preterm labor
*PROM
*Vaginal bleeding
*Determine fetal presentation
*Decreased fetal movement
*Most offices do 1-2 during
1st trimester, one at 20
weeks, and then PRN to
assess.

39
Q

Doppler US use in pregnancy

A

*10 weeks (can hear heartbeat)
*110-160 beats per minute on
average

40
Q

What does an External fetal heart rate monitor do?

A

Heart rate and contractions

41
Q

Internal fetal monitor indications for use

A
  • Electrode wire on baby’s scalp
  • Only used if amniotic sac is
    ruptured and cervix is open
  • DON’T use in HIV+ moms
42
Q

Hysterosalpingogram

A
  • Fluoroscopy of the uterus and fallopian
    tubes
  • Contrast injected through the cervix
  • Most commonly used in the evaluation of
    infertility
43
Q

Group B Strep Testing importance

A
  • GBS typically harmless in healthy adults, normal bacteria in
    lower GI tract
  • Can cause serious illness in newborns
  • pneumonia, meningitis, sepsis
    ● Test in the 3rd trimester at 36-37 weeks of
    pregnancy
    ● Vaginal and Rectal swab
    ● If (+) then Abx treatment during labor (penicillin)

Womens health exam 2 (5 decks)

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