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OB Labs

Obstetrics

QuestionAnswer
Hormone levels in PG: FSH/LH low; progesterone high
part of maternal serum quad test Estriol (tests looking for trisomy/Down syndrome)
Current hCG test is what type test: monoclonal Ab
Urine hCG tests may be negative even when: serum test is positive
hCG high: PG, ectopic, molar pregnancy, choriocarcinoma, germ cell tumors, hepatomas, lymphoma
hCG low: threatened or incomplete abortion, fetal demise
Half life of hCG: 3-7 days
Grp B Strep bacteruria indicates: Heavy colonization
Seen in babies born to mothers on AZT for HIV: Lower WBC counts & macrocytic anemia (will resolve over time)
If PG pt is pos for HBSAg: check acute/chronic (HBcAb,LFT); test partner, if neg, vax
Hep E antigen: increased risk of: infectivity (vertical trans in maternal chronic Hep B)
When do you screen with 1 hour glucose At 24-28 weeks in patients >25 or family history of DM or Ethnic risk; if >130, do 3 hr GTT
HbA1C can predict the risk for __ when measured in the first trimester Malformation; otherwise HbA1c not recommended to screen for GDM
optimal fasting glucose in pregnancy 70-95
optimal 1-hr postprandial glucose value during pregnancy Less than 140
optimal 2-hr postprandial glucose value during pregnancy Less than 120
Proteinuria in preeclampsia = Urinary excretion of >/= 0.3g protein in a 24 hr urine, usually correlates with 1+ or greater on dipstick
transvaginal scan: gestational sac visible at: 4.5 - 5 wks
transvaginal scan: fetal pole w/cardiac activity visible at: 5.5 - 6 wks
Spont Abortion: U/S dx Absence cardiac activity when crown-rump length (CRL) >5 mm; absent fetal pole when sac >18 mm(TVS) or >25 (AbUS)
The fetal fibronectin test has a high __ value in predicting delivery within the next 14 days Negative predictive
What is the best tool we have right now to determine patients not at risk for imminent delivery Fetal fibronectin and cervical length
1st tri: low PAPP-A (PG-assoc plasma pro A) & low free HCG may signify: trisomy 21 or other genetic dz
amniocentesis indication 10-13 wks if NTD risk
US for nuchal translucency & CVS: indications performed at 10-13 wks if: mom >35, FH or prior PG w/chromo abnl, abnl quad screen; CVS/amnio if nuchal fold abnl
quad screen in 2nd trimester for trisomy 21 & 13 & NTD; HCG, AFP, uE3 (unconjugated estriol), inhibin A (DIA)
normal (reactive) non stress test: Done in 3rd trimester. 2 accelerations of FHT (of 15 bpm), lasting 15 sec, within 20 min
3rd trimester: biophysical profile (BPP) components NST, amniotic fluid level, gross fetal movements, fetal tone, fetal breathing; best score=10
ectopic PG studies bHCG (s/b double q 48 hr; poss ectopic if less); TVUS should show intrauterine gestation if bHCG >1500
snowstorm pattern (or grapelike vesicles) on US = complete hydatidiform mole
complete hydatidiform mole: HCG: often >10,000 mU/mL
US & placental abruption vs placenta previa Placenta previa: US is TOC; abruption: US not reliable (dx is clinical)
Kleihauer-Betke test detects presence of fetal RBCs in maternal circulation
Tests for fetal anemia High bili in amniotic fluid. US of middle cerebral artery for peak velocity: increase in flow 2/2 decreased viscosity in anemia. PUBS for HCT
Indirect Coombs that is associated with fetal hemolysis titer of 1:8 to 1:32
Triple screen at 15-18 weeks to assess risk for Down, trisomy 13 & 18
Prenatal diagnostic studies Triple screen, AFP, HCG, PG-associated protein A, US, amniocentesis, chorionic villus sampling for DNA eval, PUBS, fetal blood sampling
Placental abruption dx studies Pelvis US of fetus, placenta, uterus. FHM & tocometry (may show hypertonic contractions w/elevated baseline). Coag studies
Elevated AFP is associated with: neural tube defects
Decreased AFP is associated with: Down syndrome
Contraction stress test (CST) result interpretation Reassuring: no late decelerations. Non-reassuring: late decelerations in >50% of contractions
When do US? at 18-20 weeks
3rd trimester mgmt TdAP at 28 weeks (whole family). Rhogam at 28 weeks and 72h postpartum if Rh neg. Gest DM 24-28 wks. Rectal-vaginal cx for GBS 35 wks (IV PCN if pos).
Created by: Abarnard