Tests In Pregnancy/obgyn

Front 1

B-HCG

Back 1

used to detect pregnancy
Syncytiotrophoblasts begins producing hCG 8 days after fertilization
detected in serum 9 days after fertilization or in urine within 4 days of the missed period
HCG doubles every 2 days peaking at 65 days after conception

Front 2

qualitative vs quantitative HCG test

Back 2

urine and qualitiative tests used to confirm pregnancy
Quantitative test: measures amount of HCG in serum tells you three things:
confirm viablilty of early pregn, confirm return to normal after abortion, follow therapy of hydidatidiform mole (malignant or non-malignant proliferation of placental tissue looks like grapes)

Front 3

Vaginal Bleeding in First trimester

Back 3

occurs in 1 of 6 pregnancies, about half will have miscarriage
hCG should double every 2 days in viable pregnancy
chorionic sac seen on US at 1800-2000 mIU/ml

Front 4

Progesterone

Back 4

secreted by corpus luteum and placenta
Luteal phase prog is 10 ng/ml
Early pregnancy it is 25 ng/ml

Front 5

Routine tests for preggos

Back 5

CBC, RPR, Rubella titer, blood type and RH (those that are RH - receive rho-gam at 28 weeks to decrease risk of iso-immunization
Indirect Coombs: identify any antibodies in present in maternal serum
HBsAG-identify women who need furrther testing to identify have chronic hepatiis B
HIV: prevent ttransfer to fetus

Front 6

Hemoglobinopathy

Back 6

if AA negative for SS trait no more tests
if Mediterannean, asian HGb <11, MC <80, or MCH <27% get hemoglobin electrophoresis

Front 7

Hgb electrophoresis

Back 7

if mothers hgb electro is abnormal fathers hould be done if fathers abnormal do amniocentesis
If mothers Hgb electrophoresis is normal and she is of asian descent perform DNA analysis for alpha-globulin abnormalitites

Front 8

When is amniocentesis perforemd?

Back 8

13-16 weeks of pregnancy

Front 9

Tay Sachs disease

Back 9

autosomal recessive disorder leads to lysosomal storage disorder leading to neurologic disease and death
Eastern european jewish descent, french canadians and cajuns
Test on leukocytes when patient is neither pregnant nor on oral contraceptives

Front 10

other tests

Back 10

CF, duchenne muscular dystrophy, hemophilia, huntington's chorea, adrenal 21 hydroxylase deficiency, adult onset polycystic disease, alpha beta thalasemia

Front 11

Alpha fetoprotein

Back 11

produced by fetus
Present in amniotic fluid and maternal serum
HIgh levels of AFP indicate fetus with nerual tube defect (spina bifida, anencephaly)
Measure at 15-18 weeks of age

Front 12

Magnitude of MSAFP Maternal Serum Alpha Feto Protein

Back 12

depends on gestational age of pregancy and # of fetus
IF intial MSAFP is elevated another level is drawn and an ultrasound is performed.
Elevation confirmed amniocentesis is done to confirm elevated levels

Front 13

What is low MSAFP high HCG and low unconjugated estriol associated with?

Back 13

down syndrome

Front 14

Quad screen

Back 14

adds inhibin A to markers in triple screen
Inhibin A produced by placenta and ovaries
increases ability to screen for down syndrome
Overall low MSAFP, high hCg, Low uncon Estriol, and high inhibin a associated with downs syndrome

Front 15

Glucose Screening recommended time

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Recommended at 24-48 weeks, high risk women screen earlier.
do 50 gram glucose load and draw serum 1 hour later

Front 16

When do you do a 3 hour glucose tolerance test?

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if 1 hour 50 g glucose test is greater than 130-140 mg/dl
If 2 of 4 glucoses in 3 hour test are abnormal woman has gestational diabetes.
in the 3 hour test person drinks 100g glucose.
if only 1 of 4 abnormal still risk for macrosomia. If test was done at 24 weeks may repeat in 4-6 weeks

Front 17

Test of Fetal Lung Maturity

Back 17

Lecithin (L) and sphingomyelin (S) are phospholipids in amniotic fluid
L increased dramatically at 35 weeks gestation while S remains fairly common
L/S ratio will predict risk of RDS in in premature infants

Front 18

L/S ratio and what it tells you

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L/S <1.5 risk for RDS is 73%
L/S 1.5-1.9 RDS is 50%
L/S >2 RDS is negligible
L/S less reliable when pt diabetic

Front 19

What is phosphatidylglycerol?

Back 19

It is also present in the amniotic fluid and is used to measure lung maturity. Pg is only present after lungs have matured at 35 weeks.
Non-diabetic women RDS is low if L/S >2 even if PG negative
Diabetic women it is preferable to wait till PG is positive if possible

Front 20

Primary Amenorrhea

Back 20

Primary: absence of menstural period by 15
Anatomically by vaginal/uterus absence
If no anatomical defect check testosterone and karyotype for testicular feminization

Front 21

Secondary Amenorrhea

Back 21

Absencse of menses in woman who previously has had periods.
Hyperprolictinema (pituitary tumor, anovulation by PCOS, Asherman's syndrome
MC cause is PCOS

Front 22

hyperprolactinemia

Back 22

present in amenorrhea, galactorrhea or both
Prolactin secreted by anterior pituitary
Effects prolactin: causes milk secretion and blocks the effects of gonadotropins on ovary
men with this have impotence

Front 23

Hyperprolactinemai and TSH

Back 23

if TSH is elevated present in hypothyroidism can cause an elevation in measuring of prolactin
If TSH normal take view of sella turcica, CT, or MRI to evaluate pituitary

Front 24

Anovulation

Back 24

comon at weight extremes, absent or irregular periods and infrequent heavy prolonged bleeding
Have estrogen but no progesterone: endometrial tissue builds up but corpus luteum never forms
DO a progesterone challenge in amenorrhea will cause vaginal bleeding

Front 25

Leutinizing Hormone (LH)

Back 25

Made by the anterior pituitary, acts with FSH to regulate cyclic secretion of ovarian hormones burst causes ovulation
half life is 60 minutes

Front 26

Follicle Stimulating Hormone (FSH)

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also produced by AP
Maturation of the ovarian follicle
Half life is 170 minutes
Release of FSH and Lh done by GnRH

Front 27

Low FSH

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hypogonadotropic anovulation
Cx: anorexia, stress, excess excecise, or primary pituitary failure
Panhypopituirtiraims may be present

Front 28

Normal FSH and have amenorrhea

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Most common cause is PCOS
Will bleed with progesterone challenge
LH Is normal or high
LH/FSH ratio often 3:1

Front 29

High FSH

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ovarian failure or ovarian resistance
no response to progesterone challenge
PT <40 premature ovarian failure
PT <30 karyotype to assess for prensence of Y chromosome

Front 30

Anovulation 1st visit and 2nd visit

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1st visit: TSH, prolactin, progesterone challenge, Consider FSH
2nd visit: if progesterone challenge is positive patient can be assumed to be anovulatory. If FSH was high menopause is likely. If progesterone challenge is negative need FSH for further evaluation

Front 31

infertility

Back 31

not beocming pregnant after 1 year unprotected intercourse
high prolactin levels, thyroid dysunction, and anovulation associated with infertility.

Front 32

What initial tests do you use with infertility

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FSH, TSH, and Prolactin

Front 33

Progetserone evaluation

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ovulation has occured progesterone will be in serum
Tested on day 21 of normal cycle
Level of progesteorne over 5 ovulation has occurred

Front 34

Hirsuitism

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Male pattern hair growth caused by action of androgens of androgen sensitive hair follicles
Increased androgens of ovarian, adrenal,
Cx: Hyperandrogenic chronic anovulation effects women in developed countries
Idiopathic in certain ethnicities and families
late onset 21 hydroxylase deficiency, androgen producing tumors, cushings syndrome, anabolic steriods

Front 35

Lab tests for hirsuitism

Back 35

Testosterone, DHEA-S (dehydroepiandrosterone, 17-hydroxyprogesteron (17-OHP)

Front 36

What do you look for if testosterone or DHEA-S is elevated?

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Pelvic mass/ovarian tumor

Front 37

if testosterone and DHEA-s is normal and menses normal what disease is present?

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idiopathic hirsuitism

Front 38

if testosterone and DHEA-S both normal and you have irregular menses what disease should you think of?

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Cushings, hyperandrogenic chronic anovulation, and late onset 17-hydroxylase deficiency

Front 39

Describe menopause and what is median age

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functional ovarian follicles are depleted
51 is median avg 47-55

Front 40

How do you diagnose menopause?

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elevated FSH is sufficient to diagnose menopause

Front 41

When should draw FSH on women taking OCPS?

Back 41

on days 5-7 of the placebo to avoid interference.

Front 42

What levels of estradiol are consistent with menopause?

Back 42

<20pg/ml