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OB Labs
Obstetrics
| Question | Answer |
|---|---|
| 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
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