Term
| What are warning signs in the early pregnancy history? |
|
Definition
| abdominal pain and vaginal bleeding |
|
|
Term
| What are the warning signs on physical exam in early pregnancy? |
|
Definition
| increased uterine size for gestational age |
|
|
Term
| What are the findings on physical exam for early pregnancy? |
|
Definition
| cervical changes, breast tenderness, enlarged uterus |
|
|
Term
|
Definition
| cervical softening at more than 6 WGA |
|
|
Term
|
Definition
| bluish discoloration at more than 8-10 WGA |
|
|
Term
| How big is the uterus at 40 WGA? |
|
Definition
|
|
Term
| How big is the uterus at 20 WGA? |
|
Definition
|
|
Term
| How big is the uterus by 36 WGA? |
|
Definition
|
|
Term
| What is the first identifiable structure on ultrasound? |
|
Definition
| gestational sac (4-5 WGA) |
|
|
Term
| When can you see the yolk sac via US? |
|
Definition
|
|
Term
| When can you see the embryonic pole on US? |
|
Definition
|
|
Term
| You have a 97% chance of a successful pregnancy if you have _____ on US. |
|
Definition
|
|
Term
| When do hCG levels rise during pregnancy? |
|
Definition
| detectable levels after implantation |
|
|
Term
|
Definition
|
|
Term
| What kind of molecule is hCG? |
|
Definition
|
|
Term
| What part of hCG indicates pregnancy? |
|
Definition
|
|
Term
| Name a qualitative hCG measurement. |
|
Definition
| home pregnancy test (pregnant/not pregnant) |
|
|
Term
| Name a quanitative hCG test. |
|
Definition
|
|
Term
| How sensitive is the urine pregnancy test? |
|
Definition
|
|
Term
| How sensitive is the serum hCG? |
|
Definition
|
|
Term
| Describe the course of hCG levels throughout pregnancy? |
|
Definition
| rapid rise (doubles every 2-3 days) until 13 WGA, peak at end of 1st trimester, then declines and plateaus. Doesn't disappear until after delivery |
|
|
Term
| Besides pregnancy, elevated hCG can also be detected in... |
|
Definition
| spontaneous abortion, ectopic pregnancy, molar pregnancy, ovarian germ cell tumors |
|
|
Term
| How do you determine what is causing elevated levels of hCG? |
|
Definition
| quantifying hCG and calculating the doubling time |
|
|
Term
| What's the difference in hCG changes in an ectopic pregnancy compared to a normal pregnancy? |
|
Definition
| lower than normal (<10%) and slower doubling time |
|
|
Term
| What's the difference between hCG levels in a normal pregnancy and a SAB? |
|
Definition
| lower than normal, slower doubling time, may see rapid fall in serial hCGs |
|
|
Term
|
Definition
|
|
Term
| What are the hCG levels in molar pregnancies? |
|
Definition
| higher than normal levels, same or faster doubling time, no decrease or plateau after 1st trimester |
|
|
Term
| What is the schedule of OB visits during a pregnancy? |
|
Definition
| first visit at 8 WGA; every 4 weeks until 28 WGA every 2 weeks from 28 to 36; weekly after 36 WGA |
|
|
Term
| What is measured at every obstetrical visit? |
|
Definition
| weight, blood pressure and urine dipstick |
|
|
Term
| What is the routine prenatal lab schedule? |
|
Definition
| at first visit, at 24-28 WGA, and at 35-37 WGA |
|
|
Term
| What are the initial (8 WGA) visit OB labs? |
|
Definition
| CBC, urinalysis, blood type with antibody screen, rubella antibodies, syphilis serology (RPR), GC/chlamydia cervical cx, hepatitis B serology, HIV testing |
|
|
Term
| What is the #1 cause of HDN? |
|
Definition
| Rh incompatibility bewteen mother and fetus |
|
|
Term
| Sensitization happens in ___% of pregnancies with a Rh- mom and an RH+ fetus. |
|
Definition
|
|
Term
| What percent of sensitized pregnancies end up causing HDN? |
|
Definition
|
|
Term
| When is RhoGam administered? |
|
Definition
| IM maternal injection at 28 WGA and postpartum |
|
|
Term
|
Definition
| results in <1% risk for sensitization and HDN |
|
|
Term
| How do you diagnose HDN prenatally? |
|
Definition
| spectrophotometric test based on absorption point of light (450nm) by bilirubin on amniotic fluid; called delta OD450, units are "delta" OD (change in optical density) |
|
|
Term
| The value obtained from a delta OD450 test is plotted according to __________ on a __________. |
|
Definition
| gestational age; Liley plot |
|
|
Term
| What is the purpose of the Liley plot? |
|
Definition
| compares AF bilirubin versus gestational age to predict likelihood for fetal demise |
|
|
Term
| What is considered a high risk OD450 regardless of gestational age? |
|
Definition
|
|
Term
| What are the 3 zones of the Liley plot? |
|
Definition
| zone 3= high risk (fetal transfusion or delivery necessary), zone 2= intermediate risk; 1= little to no risk |
|
|
Term
| What are the labs performed at the 24-28 WGA OB visit? |
|
Definition
| CBC and glucose tolerance test |
|
|
Term
| Why might it be a good idea to perform a CBC at the 24-28 WGA OB visit? |
|
Definition
| >50% of pregnant women develop iron deficiency anemia in the 2nd trimester; treat with oral Fe |
|
|
Term
| What is the protocol for glucose tolerance test? |
|
Definition
| 75 mg of glucola drink with serum glucose measured at fasting and 1 and 2 hr post ingestion |
|
|
Term
| How do you diagnose gestational DM? |
|
Definition
| fasting glucose >92 mg/dL, OR 1 hr glucose >180 mg/dL, OR 2 hr glucose >153 mg/dL |
|
|
Term
| What do you do with 1 abnormal glucose tolerance test value? |
|
Definition
| manage with diet or medicine and every three years perform a post partal test for type 2 DM |
|
|
Term
| What percent of women get gestational diabetes? |
|
Definition
|
|
Term
| What are the risk factors for gestational diabetes? |
|
Definition
| family history, h/o prior stillbirth, macrosomic neonate, polyhydramnios, preeclampsia, HTN |
|
|
Term
| What are the complications of gestational diabetes? |
|
Definition
| fetal macrosomnia (delivery complications), neonata lhypoglycemia (seizures), stillbirth |
|
|
Term
| What labs are ordered at the 35-37 WGA OB labs? |
|
Definition
|
|
Term
| What percent of women have GBS in normal flora of GI/GU tract? |
|
Definition
|
|
Term
| What happens if neonates acquire GBS during vaginal delivery? |
|
Definition
| they MAY develop disease= within 1st week, pneumonia and sepsis; within 1st three months, meningitis and sepsis |
|
|
Term
| Hwo are women tested for GBS? |
|
Definition
| vaginal or rectal swab and culture |
|
|
Term
| When are fetal lung maturity (FLM) test indicated? |
|
Definition
| preterm (<37 WGA), intrauterine growth restriction (IUGR), macrosomic baby |
|
|
Term
| Respiratory distress syndrome is aka ___________________. |
|
Definition
|
|
Term
| How premature do infants have to be to get respiratory distress syndrome? |
|
Definition
| 80% at less than 27 WGA, 50% at 30 WGA, 5% at 37 WGA |
|
|
Term
| What are the CXR findings of respiratory distress syndrome? |
|
Definition
|
|
Term
| What are teh fetal lung maturity tests? |
|
Definition
| sphingomyelin, lecithin, phsphatidyl glyceral (PG) |
|
|
Term
| What is the course of lecithin over the course of a pregnancy? |
|
Definition
|
|
Term
| What is the course of phosphatidyl glycerol during pregnancy? |
|
Definition
| appears after 35 to 36 WGA |
|
|
Term
| What ratio is used to assess fetal lung maturity? |
|
Definition
| L:S ratio; 1:1 = <32 WGA; >2.5:1 = term/mature |
|
|
Term
| False positive/negative L:S ratios can occur with... |
|
Definition
| maternal disease or contaminated amniotic fluid |
|
|
Term
| What are the indications for prenatal diagnosis? |
|
Definition
| advanced maternal age (AMA) > 33-35 yoa; history of congenital malformation, single gene disorder, or cytogenetic defect, abnormal fetal ultrasound |
|
|
Term
| What is hte purpose of prenatal diagnosis? |
|
Definition
| early detection, to inform and educate |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the MC trisomy at conception? |
|
Definition
|
|
Term
| What is the prognosis of trisomy 16? |
|
Definition
|
|
Term
| What are the three most common trisomies at birth? |
|
Definition
|
|
Term
| What are the methods of prenatal diagnosis? |
|
Definition
noninvasive= ultrasound, maternal serum screening (MSS)
invasive= amniocentesis, chorionic villus sampling |
|
|
Term
| How are the maternal serum screening (MSS) results reported? |
|
Definition
| observed value/expected value so normal = 1.00; units= MoM (multiple of the median) |
|
|
Term
| What is done for pregnant women who screen positive for maternal serum screening? |
|
Definition
| referred for genetic counseling |
|
|
Term
|
Definition
|
|
Term
| What are the components of MSS? |
|
Definition
| pregnancy associated plasma protein (PAPP-A) and hCG; always performed with U/S for nuchal thickness (NT) |
|
|
Term
| What is the MSS for Down's syndrome in the first trimester? |
|
Definition
| decreased PAPP-A, increased hCG, increased NT |
|
|
Term
| What is the detection rate for Down syndrome with MSS in the first trimester? |
|
Definition
|
|
Term
| What is the detection rate for trisomy 18 in the first trimester using MSS? |
|
Definition
|
|
Term
| What is the false positive rate for using MSS in the first trimester? |
|
Definition
|
|
Term
| What are the MSS values for trisomy 18 in the first trimester? |
|
Definition
| decreased PAPP-A, decreased hCG, increased NT |
|
|
Term
| What is the "quad screen" for MSS? |
|
Definition
| hCG, alpha-fetoprotein (MSAFP), unconjugated estriol (uE3), dimeric inhibin A (DIA) |
|
|
Term
| What are the MSS values for Down Syndrome in teh second trimester screen? |
|
Definition
| increased hCG, decreased UE3, decreased AFP, increased DIA |
|
|
Term
| What is the detection rate for Down syndrome using MSS in teh second trimester screen? |
|
Definition
|
|
Term
| What are the values for MSS for trisomy 18 in the second trimester screen? |
|
Definition
| decreased hCG, decreased UE3, decreased AFP, no chang ein DIA |
|
|
Term
| What is the detection rate for edwards syndrome using MSS in the second trimester screen? |
|
Definition
|
|
Term
| What are the MSS second trimester screen values for NTDs? |
|
Definition
|
|
Term
| What is the detection rate for NTDs using MSS second trimester screen? |
|
Definition
|
|
Term
| What is the false positive rate for teh second trimester MSS? |
|
Definition
|
|
Term
| What is the MSS detection rate for combined 1st and 2nd trimester screens? |
|
Definition
|
|
Term
| What is the MSS detection rate for trisomy 18 first and second trimester combined screen? |
|
Definition
| more than 97% detection rate |
|
|
Term
| What are the downsides to using MSS? |
|
Definition
| explanation fo results is time consuming and complex, calculation or risk relies on accurate maternal data, e.g. gestational age, diabetes, ethnicity, etc.; screens for only a few disorders |
|
|
Term
| When can amniocentesis be performed? |
|
Definition
|
|
Term
| How much amniotic fluid is aspirated in amniocentesis? |
|
Definition
|
|
Term
| What is the turn around time for amniocentesis? |
|
Definition
|
|
Term
| What is the miscarriage risk for amniocentesis? |
|
Definition
| 1/2 to 1% miscarriage risk |
|
|
Term
| How is amniocentesis performed? |
|
Definition
| outpatient procedure= ultrasound guided percutaneous needle into amniotic fluid |
|
|
Term
| How is chorionic villus sampling performed? |
|
Definition
| outpatient procedure= ultrasound guided percutaneous or transcervical catheter into villi of chorion (i.e. a tissue biopsy) |
|
|
Term
| What is the turn around time of a CVS? |
|
Definition
|
|
Term
| What is the miscarriage risk for chorionic villus sampling? |
|
Definition
|
|
Term
| What is done with the amniotic fluid to perform prenatal diagnosis? |
|
Definition
| DNA testing for single gene disorder, chromosomal testing, amniotic fluid AFP (AFAFP) |
|
|
Term
| What are the limitations of chromosomal testing on CVS? |
|
Definition
| 2% of CVS cytogenetic analysis are ambiguous and require a follow up amnio |
|
|
Term
| Both amniocentesis and CVS are limited in detecting... |
|
Definition
|
|
Term
| What is the percent ambiguity of CVS? |
|
Definition
|
|
Term
| T/F Both amniocentesis and CVS are good, reliable invasive testing options with comparable risks to the fetus and similar success rates. |
|
Definition
|
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