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WHAT?

BIOCHEMICAL ASSESSMENT

ASSESSMENT OF

• A high-risk pregnancy is defined as a pregnancy in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy
• Maternal high-risk status extends 30 days into the postpartum period​​ ​

High-Risk Pregnancy​

Quantitative Beta HCG testing

Progesterone Levels

NURSING CARE FOR ANTENATAL TESTING

Cell-free DNA

Sequential/Integrated screen

INDICATIONS FOR ANTENATAL TESTING

FETALINDICATIONS

Chorionic Villi Sampling

MATERNALINDICATIONS

Amniocentesis

HISTORY

WHAT NOW?

PREGNANCY IS HIGH RISK

ANTENATAL TESTING

1970

Testing began in 1970's​​ ​

EARLY TESTING

• 1st and 2nd trimester

FETAL KICKS

FETAL MONITORING

BIOPHYSICAL PROFILE

LATER TESTING

• 2nd and 3rd trimester ​​ ​

Quantitative Beta HCG Testing

• Provides information on viability of pregnancy; level should double every 48 hours​

Free-cell DNA

• Screening tool only
• Offered to high-risk women (AMA, previous child with chromosome abnormality; first degree relative/sibling with chromosome abnormality)
• Maternal blood draw as early as 10 weeks (can identify gender)​
• Can identify > 99% of Down syndrome pregnancies; 97% of trisomy 18 pregnancies; and 87% of trisomy 13 pregnancies.​

Fetal Kicks

• Frequently used to monitor pregnancies with conditions that could impact fetal oxygenation​
• Varying protocols​
• Follow Up needed:​
• if <12 movements in 24 hours​
• A change in fetal movement as reported by mom​
• Any concern about fetal movement as reported by mom

Maternal Indications

• Hypertensive disorders of pregnancy (Preeclampsia/HELLP, chronic, gestational)​​
• Type 1 diabetes mellitus​​
• Chronic disease in mother – renal, heart, autoimmune, clotting disorders, thyroid disease​​
• AMA (over age 40)​
• Psychosocial factors​
• Sociodemographic factors​

Fetal Indications

• Postdates​ (>41 weeks)​
• Decreased fetal movement​​
• IUGR, Abnormal dopplers​​
• Previous fetal demise​​
• Known fetal anomaly​​
• Multiple gestation​​
• Isoimmunization​​
• Hydramnios (poly/oligo)​

Progesterone Levels

• A tool for screening women at risk for spontaneous abortion; offer supplementation if low (debatable) ​

Chorionic Villi Sampling

• Invasive; risk of 1 in 500 of miscarriage; performed between 10-13 weeks by specialist

Biophysical Profile

Biophysical profile: A noninvasive test to evaluate the health of the fetus. A provider performs the test with an ultrasound and uses a scoring system to rate the fetus in the following areas: body movement, muscle tone, breathing movements, amniotic fluid volume.

Fetal Indications

• Postdates​ (>41 weeks)​
• Decreased fetal movement​​
• IUGR, Abnormal dopplers​​
• Previous fetal demise​​
• Known fetal anomaly​​
• Multiple gestation​​
• Isoimmunization​​
• Hydramnios (poly/oligo)​

Amniocentesis

• Invasive; risk of 1 in 500 of miscarriage; performed after 15 weeks by specialist or OB-GYN

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Terminology

Sequential/Integrated screen

• PAPP-A (protein produced by the placenta in early pregnancy. Abnormal levels are associated with an increased risk for chromosomal abnormalities.
• Total B-hCG (total beta-human chorionic gonadotropin)
• MSAFP (Maternal serum alpha-fetoprotein)- Screens for “open neural tube” defects. Spina bifida and anencephaly are examples.
• Chorionic villi sampling- chorionic villi are tiny projections of placental tissue that look like fingers and contain the same genetic material as the fetus. This test involves taking a sample of this tissue from the placenta to test of chromosomal abnormalities.
• Amniocentesis- procedure used to take out a small sample of the amniotic fluid for testing. The fluid contains cells that have genetic information that can be used to diagnose genetic disorders.

• Screening tool only
• US between 11-13 weeks for measurement of Nuchal translucency
• 1st maternal assay drawn (PAPP-A and HCG)
• 2nd maternal assay drawn between 15-18 weeks (MSAFP) Screens for Trisomy 21 (Down's syndrome), Trisomy 18 (Edward's syndrome), Trisomy 13 (Patau syndrome) and neural tube defect (spina bifida)