Repro Test 2 - Lao - Prenatal Diagnosis

Front 1

Before a woman even CONCEIVES, what should we do?

Back 1

Blood type, Ab screen, CBC, Rubella titer, Varicella titer, STD screen, HSV Hx, Syphilis screen

Front 2

What are some of the things we need to look at pre-conception?

blah just read the list

Back 2

BMI, DM, HTN, AMA ie folic acid for neural tube defects, bariatrics - folic acid, nutrition, B12, calcium
Seizures - meds safe? candidate for single drug or weaning?

Front 3

What do we do on the initial OB visit?

Back 3

Hx, PE, Psychosocial Hx, vitals, pap, weight, urine, pelvic cultures (gonorrhea? chlamydia?)

Front 4

Whats the most important thing to do on initial OB visit?

Back 4

Confirm Gestational Age

w/ 1st day of last menstrual period and Ultrasound

Front 5

T/F: on initial 1st trimester OB visit, the US will show any bleeding, uterus inconsistent

Back 5

TRUE

Front 6

A pt comes in with a positive FHT at 6-8 weeks pregnant. She is worried she will have another spontaneous abortion like she did last year. What do you tell her?

Back 6

Her abortion risk with a positive FHT at 6-8 weeks is less than 5%

Front 7

Whats included in the first trimester OB screen?

Back 7

Blood type, Ab screen, CBC, MCV, Hb electrophoresis, Sickle cell, Cystic Fibrosis screen, Rubella, varicella, HIV, hepatitis, STD screen, Syphilis, HSV, DM, TSH

Front 8

Whats the most common chromo abnormality in US?

Back 8

Downs Trisomy 21

Front 9

Whats your Risk of having a Down's Syndrome baby at the age of 45? 20?

Back 9

45 = 1 in 55

20 = 1 in 1527

IE INCREASES WITH AGE

Front 10

What is the first screen for Downs Syndrome we can do?

Back 10

Nuchal translucency at 10-13 weeks = gives us risk of Downs by measuring the thickness of nape of neck of fetus

Pregnancy associated plasma protein A

Hcg

Front 11

What are the three things tested for in the Triple Screen detection of Downs?

Back 11

AFP, BHCG, Ue3 (estriol)

= 60-70% detection of Downs

Front 12

A woman who is 37 years old has a positive Triple screen (AFP, BHCG, Ue3 estriol). Whats the next step?

Back 12

US for dates and anatomy (ie proof at bridge of nose?) and possibly do an amniocentesis

Front 13

A woman who was recently transferred into your practice hands you her old chart that shows she tested positive for AFP last week. She is worried about the possibility of having a Downs baby. What do you tell her?

Back 13

AFP alone has a high false positive rate, and is a poor marker for Downs alone.

It can be falsely positive for many reasons including incorrect dating, multiple gestations, tissue necrosis, defect in fetal skin, and abortion

Front 14

What does the quadruple screen add to AFP, BHCG and Ue3 estriol?

Back 14

Inhibin A

Front 15

What does adding inhibin A do to our detection rate for Downs?

Back 15

Improves it to 82% (triple screen = 60-70%)

False positive rate = 5%

Studies show a link to adverse outcomes in pts with a false positive

Front 16

A 16 week gestation pt has the following: AFP = 4.2 MoM. Problem?

Back 16

Yep, AFP > 2.5 MoM = Open Neural Tube Defect

Front 17

A 14 week gestation pt comes in with Inc HCG and Inhibin A. Problem?

Back 17

Yep, Downs

Front 18

A pt of 12 week gestation comes in with Low HCG, AFP and Ue3. problem?

Back 18

Yep, Trisomy 18 ie Edwards

Front 19

How do we get a 93% detection rate of Downs?

Back 19

Integrated Sequential Contigent screening ie...:

10-13 weeks = nuchal translucency with
HCG, PAAP-A serum testing simultaneously
15 weeks = AFP

Front 20

A pt comes in and unfortunately had a false positive quad (AFP, BHCG, Ue3 estriol, Inhibin A) screen. What can you tell them they are at increased risk for?

Back 20

preeclampsia, growth restricted fetus, preterm birth, fetal demise

Front 21

Everything so far we've talked about have been SCREENING tests. What can we do to Actually DIAGNOSE prenatal issues?

Back 21

Chorionic villi sampling
Amniocentesis

Front 22

Define chorionic villi sampling

Back 22

Can be done after 10 weeks
transvaginal approach using spinal needle and US
Samples developing placenta rather than penetrating amniotic membrane

Front 23

What are the risks of chorionic villi sampling?

Back 23

Bleeding, Limb malformations

Front 24

Define Amniocentesis

Back 24

Transabdominal sampling of amniotic fluid with spinal needle and US

Done between 15-18 weeks

Front 25

Whats the earliest sampling diagnostic test we can do?

Back 25

chorionic villi sampling at 10 weeks.

then Amniocentesis at 15-18

Front 26

What are the risks associated with Amniocentesis?

Back 26

Risk of Abortion = 1 in 270, so only wanna do it if absolutely necessary

Front 27

When do we do an anatomical US?

Back 27

20 weeks

Front 28

A woman's chorionic villi sampling and Amniocentesis results produce an 82% chance of Aneuploidy. Her Anatomical US at 20 weeks is normal. What does this mean?

Back 28

Her risk of Anuploidy has now decreased by half, to 41%

Front 29

A pts Anatomicla US shows a banana sign and lemon sign. What cna we tell the pt about her risk?

Back 29

She may have an Open Neural Tube Defect (ONTD)

Front 30

T/F: genetic sonogram is not recommended for a screening test

Back 30

TRUE

Front 31

What is 4D US used for? (ie Live 3D image)

Back 31

Entertainment

Indicated in fetus has congenital anomalies

Front 32

When is the diabetes screen done, and how is it done?

Back 32

24-28 weeks

Give 50 grams and test 1 hr later,
If glu elevated, give 100 grams and test 3 hrs later

Front 33

What tests do we do 24 weeks to term?

Back 33

CBC, pelvic cultures, urine cultures, proteinuria, US as indicated