Ob/Gyne 3 > Module 3 : Maternal Testing > Flashcards

Module 3 : Maternal Testing Flashcards

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1
Q

what are the ultrasound exams done for obstetrics

A
  • dating first trimester
  • 1st trimester scan
  • 2nd trimester detailed
  • FAS and BPP
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2
Q

what test is done fro early pregnancy testing

A
  • serum beta guman chorionic gonadotropin
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3
Q

what is bHCG produced by

A
  • trophoblast
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4
Q

what is bHCG and indicator of and how is it tested

A
  • early indicator of pregnancy

- blood test or urine test

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5
Q

how do bHCG levels change

A
  • double every 2 days
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6
Q

at what week does bHCG levels plateau

A
  • 8 weeks
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7
Q

what three things could a decreased bHCG suggest

A
  • missed abortion/ fetal demise
  • ectopic pregnancy
  • wrong dates
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8
Q

what two things could an increased in bHCG indicate

A
  • trophoblastic disease (molar pregnancy)

- multiple pregnancies

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9
Q

what is a NIPT

A
  • non invasive prenatal testing

- maternal blood test taken at 10 weeks LMP

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10
Q

what does a NIPT test for

A
  • cell free DNA in maternal plasma

+ placental DNA in maternal blood

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11
Q

is the NIPT test accurate and what does it screen for

A
  • 100% detection rate

- T21 T13 T18

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12
Q

in what 5 situations is a NIPT less effective

A
  • obese patients
  • pregnant with multiples
  • pregnant via donor egg
  • less than 10 weeks pregnant
  • taking blood thinners
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13
Q

what is the purpose of prenatal testing

A
  • offers early information about a baby’s risk for certain chromosomal conditions
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14
Q

what is prenatal testing a combination of

A
  • nuchal translucency
  • first trimester blood tests
    + bHCG
    + PAPP-A
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15
Q

what is the nuchal translucency test

A
  • measurement of the collection of fluid under the skin at the back of the baby’s neck
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16
Q

what does in increase in nuchal size correspond to

A
  • increased risk of chromosomal and other abnormalities
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17
Q

when is the nuchal measured

A
  • only between 11 weeks (CRL 45mm) and 13 weeks (CRL 84mm)
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18
Q

what is the max AP measurement of the nuchal translucency

A

< 3.5mm

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19
Q

what does an increase in bHCG between 11-14 weeks possibly indicate

A
  • trisomy 21
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20
Q

what does a decrease in bHCG between 11-14 weeks possibly indicate

A
  • trisomy 18 and 13
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21
Q

what produces the pregnancy associated plasma protein A and what is it

A
  • placental syncytiotrophoblast and deciduas

- glycoprotein

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22
Q

how does PAPP-A change with pregnancy

A
  • rapid increase in levels during first trimester
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23
Q

what dose a decreased PAPP-A between 11-14 weeks possibly indicate

A
  • trisomy 21 and 18
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24
Q

what is the detection rate of the NT and biochemical tests in the first trimester

A
  • 85% detection rate
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25
what constitutes a positive first trimester screen test
- less than a 1:300 ratio
26
what three factors are used together to screen for abnormalities
- maternal age - nuchal translucency - maternal biochemistry
27
what other sonographic test/factor increases detection rate to 95%
- presence of a nasal bone
28
what is a hypo plastic nasal bone
- fetal NB appears smaller by varying degrees | - less tha 2.5mm
29
what is an absent nasal bone
- NB not visible at the 11-14 weeks scan
30
what is the 2nd trimester screen (triple/quad screen)
- maternal serum testing between 15 and 20 weeks
31
what is the triple screen
- assess 3 different elements (AFP, bHCG, uE3)
32
what is the quad screen
- asses 4 different elements found in the maternal blood | - AFP, bHCG, uE3, Inhibin A
33
where is MS AFP produced
- fetal liver - yolk sac - GI tract - Kidneys - placenta
34
how does MS AFP levels change
- levels will rise from about 14-20 weeks
35
how does AFP enter maternal circulation
- crosses the placental plate into maternal circulation
36
what is the most common cause for abnormal level of MS AFP
- wrong dates for gestational age
37
in what women can MS AFP be increased
- athletic women | - diabetic moms
38
what placental condition can cause increased AFP
- placental abruptions
39
what does a decrease in AFP possibly indicate
- trisomy 21 and 18
40
what does and increase in AFP possibly indicate
- open neural tube defect - abdominal wall defect - GI obstruction - RH sensitivity - placental abnormality - fetal death
41
in what four things will bHCG be increased in the quad screen
- multiples - molar pregnancy - wrong dates - T21
42
what 2 things will bHCG by decreased in quad screen
- fetal demise | - trisomy 18
43
what is uE3 (estriol)
- measured only in pregnancy | - produced by placenta
44
when is uE3 found how do levels change
- found as early as 9th week of pregnancy | - levels continue to rise throughout pregnancy
45
what are 3 things does a decrease in uE3 possibly indicate
- T21, 18 - pregnancy loss - adrenal insufficiency
46
what is inhibin A
- hormone produced by placenta
47
what are increased levels of inhibin A associated with
- trisomy 21
48
is there any change in inhibin A levels with trisomy 18
- no
49
what are the quad screen levels with trisomy 21
- AFP decrease - bHCG increase - uE3 decrease - Inhibin A increase
50
what are the quad screen levels with trisomy 18
- AFP decrease - bHCG decrease - uE3 decrease - inhibin A doesn't change
51
is trisomy 13 detected with triple or quad screen
- nope
52
what are the two types of chorionic villi sampling
- transcervical CVS | - transabdominal CVS
53
when is a transcervical CVS performed
- 11-12.5 weeks
54
how is a transcervical CVS performed
- catheter inserted through cervix to chorion frondosum | - with a negative pressure syringe moving catheter back and forth to capture chorionic villi cells
55
when is a transabdominal CVS performed
can be done beyond 12.5 weeks
56
how is a transabdominal CVS performed
- needle through abdomen to chorion frondosum | - performed when placenta cannot be accessed by transcervical approach
57
what determines the type of CVS performed
- depends on where the chorion frondosum lies (placenta)
58
which test obtains more DNA and and gets result faster amnio or CVS
- CVS
59
what is the risk with CVS
- possible spontaneous abortion
60
what is an amniocentesis
- amniotic fluid is aspirated from the amniotic sac via a needle through the maternal abdomen
61
what are the risks with amniocentesis
- bleeding - pre mature rupture of membranes - pre term labour - club feet - spontaneous abortion
62
when is club feet a risk from amniocentesis
- when performed earlier than 16wks
63
what is the scanning protocol for amniocentesis
- number of fetuses and position - amniotic fluid volume - placenta location - gestational age - limited anatomical survey - record M Mode heart rate before and after procedure
64
what are the 4 types of amniocentesis
- cytogenic amnio = chromosomes, most common - optical density determination = RH sensitized - L/S amnio = fetal lung maturity - therapeutic = for poly
65
when is a cytogenic amnio performed
- between 11x to term
66
how is a twin amnio performed
- after amnio aspirated from first gestational sac indigo carmine injected then second baby is sampled if it comes out wth dye then not in the right spot
67
what does a ODD amnio test for
- measure bilirubin level in RH sensitized pregnancy
68
what is the L/S ratio amnio test for
- lecithin and sphingomyelin are fairly equal up to 33 weeks - beyond this lecithin increases where S remains constant - if ratio is grater than 2:1 lungs are matured
69
why is a therapeutic amnio performed
- done for poly - done when the mother is not able to to tolerate pressure fo large uterus pressing on abdominal contents causing shortness of breath
70
what is PUBS
- percutaneous umbilical blood sampling | - CORDOCENTESIS
71
how is a PUBS performed
- needle into umbilical cord about 2-3cm from insertion into placenta - take sample from vein rather than artery
72
what are the indications for a PUBS procedure
- chromosomal analysis within 72 hours - fetal blood gas sampling in IUGR fetuses - fetal infection s - FETAL ANEMIA IN RH SENSITIZATION - FETAL BLOOD TRANSFUSIONS VIA PUBS - trat fetal arrhythmias with medication via PUBS
73
what are three risks from PUBS
- bleeding from puncture site - infection - rupture of membranes
74
what is a FISH Test
- fluorescence in situ hybridization | - looks for how many copies are present for a specific chromosome
75
what two things is not required with FISH
- does not require all the steps needed as in cytogenic aryotyping - does not give info on the structure of that chromosome
76
what can a FISH be performed on
- fetal blood - amniotic fluid - CVS
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