2nd Trimester Screening/Diagnostic Tests

Procedure for Amniocentesis?

Needle through abdominal wall--->uterine cavity--->obtain amniotic fluid

Advantages of the Multiple Marker Test?

60-80% Trisomy 21 identified 85-90% open NTDs detected

Risks of Amniocentesis?

<1% fetal loss after 15 wks. (2-5% risk before 15 wks.) Placental or Fetal Trauma, Bleeding, Maternal Infection PTL/ROM

What does the Triple Marker test?

AFP hCG Estriol levels

What is the Multiple Marker Screening?

Blood test that combines multiple hormones and proteins along with maternal age to detect Trisomy 13, 18, 21 and NTDs. Blood is drawn @ 15-22wks (15-16wks. most accurate) Offers Integrated screening - 1st , 2nd trimester screening, ultrasound & maternal age

Second Trimester WARNING SIGNS: Absent FHT

Fetal death or distress

Second Trimester WARNING SIGNS: Prolonged Nausea & Vomiting

Hyperemesis Gravidarium - More serious in the second trimester because it can lead to dehydration and other issues

Interpretation of the Multiple Marker Test?

Inc. levels of hCG and inhibin-A = levels 2x as high in Trisomy 21 Dec. levels of MSAFP and Estriol =suggest abnormality

Second Trimester WARNING SIGNS: Severe Back Pain

PTL Pyelonephritis

Second Trimester WARNING SIGNS: Pelvic/Abdominal Pain

PTL Appendicitis UTI Ovarian Torsion

Second Trimester WARNING SIGNS: Vaginal Bleeding/Spotting/Fluid

Placenta Previa Friable cervix Vaginal Infection PTL

What is the Maternal Serum Alpha-Fetoprotein (MSAFP)?

Procedure when blood is drawn @ 15-20wks to detect NTD and abdominal wall defects

What is Amniocentesis?

Used to obtain amniotic fluid and fetal cells for: Genetic testing Fetal Lung Maturity (FLM) Assessment of hemolytic disease in fetus Intrauterine infection (CMV, Rubella, Listeria)

What does the Quad Marker test?

AFP hCG Estriol levels Inhibit A - inc. detection of Trisomy 21 to 80%

Interpretations of Maternal Serum Alpha-Fetoprotein (MSAFP)

-Inc. levels: NTDs, anencephaly, omphalocele, gastroschesis, multiples, dating error -Dec. levels: Trisomy 21 -If positive additional testing is required (CVS and Amniocentesis)

Risks/Advantages of Maternal Serum Alpha-Fetoprotein (MSAFP)?

Advantages - 80-85% NTD or abdominal defect & 90% anencephalies can be detected in early pregnancy. Risks - High False-Positive rate >>Anxiety

Advantages of Amniocentesis?

Completed between 14-20 wks. (genetic) > 20 weeks (FLM) > 99% accuracy

Name all 2nd Trimester Screening/Diagnostic Tests

Maternal Serum Alpha-Fetoprotein (MSAFP) - Screening Multiple Marker Screening - Screening Amniocentesis - Diagnostic

Second Trimester WARNING SIGNS: Dysuria, Urinary Urgency

UTI Vaginal Infection