LABORATORY AND

DIAGNOSTIC
EXAMINATIONS
Here is where your MCN skills journey begins
LABORATORY AND
DIAGNOSTIC
EXAMINATIONS
Here is where your MCN skills journey begins
WHY ARE TESTS
DONE DURING
PREGNANCY?
ideas please..
WHY ARE TESTS DONE DURING PREGNANCY?
Certain lab tests are part of routine care
during pregnancy.
- Some of these tests are done with a
blood, use a urine sample or a tissue
taken from vagina, cervix, or rectum.
-These tests can help find conditions that
may increase complications for the
mother and the fetus.
- Many problems found by these tests
can be treated during pregnancy.
 Common test for determination of genetic
abnormalities
Karyotyping

• a visual presentation
of the
chromosome pattern
of an individual
 Question
The normal human karyotypes
contain ?? pair/s of autosomal
chromosomes and __ pair/s of
sex chromosomes (allosomes).

XX is ?? and XY is ??
Down’s Syndrome or Trisomy 21
Klinefelter syndrome

Klinefelter syndrome, the most common male

chromosomal disease, otherwise known as
47,XXY, is caused by an extra X chromosome.

*primary features are infertility and small poorly

functioning testicles
Turner’s Syndrome
 TURNER’S SYNDROME

Turner syndrome PRESENTATION

results from a single X
01 chromosome (45,X or
02 a short and webbed
neck, low-set ears,
45,X0).

low hairline at the back

of the neck, short and swollen hands and
03 stature,
04 feet are seen at birth
Edwards syndrome (trisomy 18). A baby has an extra
18th chromosome. These babies usually have many
problems, and most don’t live longer than a year.
Patau syndrome (trisomy 13). A baby has an extra
13th chromosome. These babies usually have heart
problems and severe mental impairment. Most won’t
live more than a year.
 Alpha-fetoprotein testing

↑ level of alpha-
fetoprotein
• Alpha-fetoprotein • An open spinal and
produced by the fetal abdominal wall defects,
liver openings allows more
• Found both in AFP to enter the
amniotic fluid and mother’s circulation
maternal serum than usual
(MSAFP) • open neural tube
• a glycoprotein defects ex.
Spina bifida,
anencephaly.
 Alpha-fetoprotein testing

↑ level of alpha-
• Alpha-fetoprotein
fetoprotein
testing measures the
quantity of fetal
serum protein.
• Significant ↓
chromosomal defects
such as Down’s
Syndrome.
• 15-18 weeks of
gestation.
 Chorionic Villi Sampling (CVS)

 Is retrieval and analysis of

chorionic villi for chromosome
analysis.
 Tissue of fetal origin
◦ Use to obtain samples of
chorionic villi to test for
genetic disorder in the fetus.
 Timing at 10 to 12 weeks
◦ may be done as early as 5th
week of pregnancy
Chorion cells are located
by ultrasound.
A thin cathether is
inserted vaginally or a
biopsy needle is inserted
abdominally or
intravaginally, and a
number of chorionic cells
are removed for analysis.
Following CVS, the woman
needs to be instructed to
report chills and fever
suggestive of infection or
symptoms of threatened
abortion (uterine contraction
and vaginal bleeding)
The cells removed by CVS are
karyotyped or submitted for
DNA analysis.
AMNIOCENTESIS

-Aspiration of 20 cc
amniotic fluid from the
pregnant uterus through
the abdominal wall
-15th to 18th week,
amniotic fluid has
reached about 200ml at
this point
-determine genetic
disorder, sex, and fetal
maturity.
 ADVANTAGE OVER CVS

✓Women need to
be observed for complication:
about 30 minutes ✓ hemorrhage from
afterward to be penetration of the
certain that labor placenta
✓ only a 0.5% risk of contractions are ✓ infection of the
spontaneous
not beginning amniotic fluid
abortion
and fetal heart rate ✓ puncture of the
occurring from the
remains within fetus
procedure.
normal limits.
 PREPARATION

1 3

2 place a 4
ask her to void trochanter roll
(Rt) side

Attach FHR
supine, drape and uterine
contraction
monitor
 PREPARATION

5 7

8
take BP and 6
FHR for do antiseptic
baseline wash, then warn her that
anesthetic will she may feel a
be given pressure
explain UTZ
sensation as
will be done
the needle is
being
introduced
 Do not suggest to take a
deep breath and hold it as
a distraction against
discomfort.

CORRECT OR NOT?
 03
ANALYSIS
Information from Amniocentesis
 1. COLOR

colorless strong yellow

blood
normal
incompatibility

yellow tinge Green

normal in late meconium stain
pregnancy fetal distress
2. LS RATIO ( Lecithin / Sphingomyelin ratio)
They are protein Note: ratio of
component of the Determine by 2.5:1 or 3:1 a
a shake mature
lung enzyme test indicator in sugar
surfactant that infants whose
alveoli begin to mother is surfactant
form about 22nd diabetic
to 24th week of Normal ratio is 2:1 or marker of fetal
pregnancy greater which
signifies lung maturity Lung maturity.
3. BILIRUBIN DETERMINATION
NORMAL POSITIVE
Negative for 65%
blood or should The presence of
have no false- 80% bilirubin may be
positive 45% analyzed if a blood
reading. incompatibility is
suspected
50%
4. CHROMOSOME ANALYSIS
GENDER
Male • A few fetal skin cells are always
present in amniotic fluid.
• This cell may be cultured and
stained for karyotyping.
• Chromosomal study of fetal tissues
40% should be free of diseases.
5. INBORN ERROR OF
METABOLISM
➢ Inherited diseases
➢ The enzyme defect must be
present in amniotic as early as
14-16th weeks to have a
diagnosis
An example of illnesses that can
be detected
Sickle cell disease, cystic
fibrosis, muscular dystrohpy,
Tay-Sachs disease,
maple syrup urine disease
(amino acid disorders).
Percutaneous Umbilical Blood Sampling
- the aspiration of blood from the
umbilical cord using amniocentesis
technique for analysis

CORDOCENTESIS - Studies such as: CBC, Direct

Coombs test, Blood Gases and
Karyotyping

NOTE!
FUNICENTESIS monitor FHT and
uterine contractions
before and after the
procedure
 ULTRASONOGRAPHY (UTZ)
✓ Diagnose pregnancy as early
as 6 weeks
✓ Confirm the presence, size,
location, of the placenta and
amniotic fluid
✓ Establish fetus is growing and
no gross anomalies
✓ Establish the sex
 ULTRASONOGRAPHY (UTZ)
✓ Establish presentation and
position of the fetus
✓ Predict gestational age
✓ Discover complication of
pregnancy and genetic
disorders
✓ Detect fetal death
✓ Detect retained placenta or
poor uterine involution after
birth
 ULTRASONOGRAPHY (UTZ)
✓ Explain the procedure
✓ Ask patient to drink a full glass of water every 15 minutes
beginning 90 minutes before the procedure
✓ Ensure full bladder
✓ Instructed the patient not to void until after the procedure
✓ Assist the patient on the examining table and drape exposing
the abdomen
✓ Place towel under right buttock to tip the body slightly so the
uterus will roll away from the vena cava, thus will prevent
SUPINE HYPOTENSION SYNDROME

Note: UTZ can be performed using intravaginal technique, but

this is not necessary for routine testing
 FETOSCOPY
- Visualization of the fetus thru a fetoscope
an extremely narrow, hollow tube inserted
by amniocentesis technique thru minor
abdominal incision
- Long tube with a camera on one end,
inserted thru a small abdominal incision
- Can be performed approximately 16th -
17th week
 FETOSCOPY
✓ To confirm the intactness of the spinal column
✓ To obtain biopsy sample
✓ To determine meconium staining
✓ To perform elemental surgery such as insertion of
shunt to relieve hydrocephalus
Complication:
✓ Carries small risk of premature labor
✓ Amnionitis
✓ Infection
LABORATORY TESTS p250
Urinalysis
✓ urine is tested for the ff:
- proteinuria (protein)
- glycosuria (sugar)
- nitrites (bacteria)
- pyuria (WBC)
Blood Serum Studies
CBC (Complete Blood Count)

-hemoglobin, hematocrit,
and red cell index for
anemia,
-white blood cell for
infection
-platelet count to
estimate clotting ability
 HEMOGLOBIN

Hemoglobin is protein that is found in red

blood cells.
When the hemoglobin is carrying lots of
oxygen, it appears bright red.
Low levels of hemoglobin can be a sign
of cancer, blood loss or kidney failure.
High levels of hemoglobin could mean
lung disease, tumor growth or
dehydration.
White Blood cell

symptoms of inflammation.
What is Lymphocyte Count?
- measures the number of lymphocytes, a type of white
blood cell, in a given blood sample.
- If numbers are elevated it could indicate an abnormal
immune system response.
- increased lymphocytes include leukemia, severe
acute respiratory syndrome and mononucleosis.
- A lymphocyte test is typically run as a series of tests
to detect problems with immune system response.
 5 WBC
- Neutrophils
- Basophils
- eosinophils
- Lymphocytes
- Monocytes

Note: Neutrophil levels will appear abnormal on the WBC

(white blood cell) count test if there is a condition of any
kind affecting the immune system.
What is Eosinophil
Count?
- The total number of eosinophils in
the blood can be used to determine
the severity of an allergic reaction
– more being associated with a
more acute reaction.
Eosinophil values are also abnormal in
patients with Cushing’s disease,
parasite infection and acute
hypereosinophilic syndrome.
What are neutrophils?
-Neutrophils are white blood
cells.
-The main function of
neutrophils is to fight off
fungal or bacterial
infections.
-When large numbers of
neutrophils die pus is formed.
-Pus is a common symptom of
infection.
Neutropenia

- an unusually low number of neutrophils,

and there are multiple types of
neutropenia:
Febrile
Cyclical (vary in a 21-day cycle)
Congenital (since birth)
Drug-Induced (ex.carbimazole, clozapine, penG)
Chronic
 what is HEMATOCRIT?

Hematocrit
levels represent
red blood cell
volume in the
given blood
sample. Size of
those red blood
cells is also
reported.

Size and number of red

blood cells are an
indication of overall
health and dietary
efficiency.
 REMEMBER
• hematocrit and hemoglobin
levels-to find evidence of anemia
such as sickle cell anemia
• white blood cell count
to determine infection
• platelet count
to estimate clotting ability
 Blood Serum Studies
Serologic test for Syphilis (VDRL
or Venereal Disease Research
Laboratory)
Blood typing and Rh factor
Culture for chlamydia and
gonorrhea
- if syphilis is present must be treated
early before fetal damage occur
to detect ABO and Rh
incompatibility
- blood must be available in case
bleeding occur
- should be collected at initial pelvic
examination
- often asymptomatic infections
- patient is treated with antibiotic
- test for repeat culture at 35 and
37 weeks
- all patient 25 years and under
must repeat the test at 35 and 37
weeks
✓ Maternal Serum ᾳ-Fetoprotein
(MSAF) and pregnancy
associated plasma protein A
- accurate at 16 to 18 weeks
Indirect Coombs test
(looks for antibodies that are floating in the
blood.(serum) )
- determination of whether the Rh
antibodies are present in Rh-
negative woman
- test repeated at 28 weeks
Serum antibody titer for:
(to check the levels of certain antibodies in
the blood.)
✓Rubella
✓Hepa B (HBsAg) – can be
repeated at about 36 weeks
✓Hepa C
✓Varicella (chicken pox)
Note: Vaccines for those
diseases can be offered in
the post partum period
 HIV Screening
- should be done in early
pregnancy
- high risk should be retested in the
3rd trimester
- ELISA (enzyme-linked
immunosorbent assay)- screening
test
- Western Blot a confirmatory test
once ELISA is positive
 50-g oral 1-hr
glucose loading or
tolerance test
- usually done if a patient has
(glucose challenge the ff:
test) - hx of unexplained fetal loss
-done at 12 weeks to r/o GDM - family history of diabetes
- this test will analyze how well the - babies were LGA (>9lbs
woman’s body is able to process
sugar
at term)
Note: normally a plasma glucose - BMI over 30
should not exceed 130-140mg/dl at 1 - with glycosuria
hour after GCT
Glycosylated
Home pregnancy
hemoglobin test
(HgA1C) 97%, degree of
- measure of the amount of sugar accuracy
attached to hemoglobin Convenient for
- reflects the average blood
glucose over the past 4 to 6 women
weeks
Note: if not high risk the patient should
have the test routinely at 24 to 28th
weeks of pregnancy (GCT and
HgA1C)
Tuberculosis Screening

● Mantoux Test
● PPD /tuberculin test
● 0.1 of tuberculin units are
injected by a needle and
syringe intradermally
● If induration area is at
least 10 cm in diameter,
the test is considered
positive.
 Types of Pelvimetry

– Clinical Pelvimetry – Imaging pelvimetry

Pelvic inlet X ray
Mid cavity Computerized
Pelvic outlet Tomography (CT)
-External Pelvimetry MRI
Pelvic inlet
pelvic outlet
 Internal pelvimetry

– Through vaginal
examination
– At first prenatal visit
screen for obvious
contractions
– In late pregnancy (after
37 weeks)
more accurate
less uncomfortable
Radiological Pelvimetry

– Xray – MRI (mehod of

Choice):
Limited Value, no role
in guiding management Lack of ionizing
radiation, higher
- CT:
resolution and contrast
Ease of performance, but also higher cost.
interpretation, & 100%
less radiation exposure to
the fetus
Can evaluate fetal lie
and position
 Cephalometry

– Ultrasonography : is safe, accurate and easy

method and can detect:
The biparietal diameter (BPD)
The occipito-frontal diameter
The circumference of the head

https://www.youtube.com/watch?v=XyIuYqAVaHI
 THANKS!
Do you have any questions?

jlblanco@lpubatangas.edu.ph

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