LABORATORY VALUES FOR PREGNANT AND NONPREGNANT WOMEN VALUES NONPREGNANT PREGNANT HEMATOLOGIC COMPLETE BLOOD COUNT (CBC)

Hemoglobin, g/dl 12-16* >11* Hematocrit, packed cell volume (PCV), 37-47* >33* Red blood cell (RBC) volume, per ml 1600 1500-1900 Plasma volume, per ml 2400 3700 3 RBC count, million per mm 4.2-5.4 5-6.25 3 White blood cells, total per mm 5000-10,000 5000-1 5,000 Neutrophils, % 55-70 60-85 Lymphocytes, % 20-40 15-40 Erythrocyte sedimentation rate, mm/hr 20 Elevated in second and third trimesters Mean corpuscular hemoglobin concentration 32-36 No change in hemoglobin concentration (MCHC), g/dl packed RBCs Mean corpuscular hemoglobin (MCH), pg 27-31 No change per pg (less than I ng) Mean corpuscular volume (MCV), 80-95 No change per cubic micrometer cubic micrometer BLOOD COAGULATION AND FIBRINOLYTIC ACTIVITY Factor VII 65-140 Increase in pregnancy, return to normal in early puerperium Factor VIII 55-145 Increases during pregnancy and immediately after birth Factor IX 60140 See Factor VII Factor X 45155 See Factor VII Factor XI 65-135 Decrease in pregnancy Factor XII 50150 See Factor VII Prothrombin time (PT), sec 11-12.5 Slight decrease in pregnancy Partial Thromboplastin time (PTT), sec 6070 Slight decrease in pregnancy and decrease during second and third stage of labor (indicates dotting at placental Site) Bleeding time, min 1-9 (Ivy test) No appreciable" change Coagulation time, min 6-1 0 No appreciable change (Lee/white test) Platelets, per mm3 150,000-400,000 No Significant change until 3-5 days after birth and then a rapid increase (may predispose woman to thrombosis) and gradual return to normal

Fibrinolytic activity

Normal

Fibrinogen, mg/dl MINERAL AND VITAMIN CONCENTRATIONS Vitamin B12, folic acid, ascorbic acid SERUM PROTEINS Total, g/dl Albumin, g/dl Globulin, total, g/dl BLOOD GLUCOSE Fasting, mg/dl 2-hr postprandial, mg/dl ACID-BASE VALUES IN ARTERIAL BLOOD Po2.mm Hg Pco2, mm Hg Sodium bicarbonate (HCO3), mEq/L Blood pH HEPATIC Bilirubin. Total, mg/dl Serum cholesterol, mg/dl Serum alkaline phosphatase, units/L Serum albumin. g/dl RENAL Bladder capacity, ml Renal plasma flow (RPF), ml/min Glomerular filtration rate (GFR), ml/min Nonprotein nitrogen (NPN). mg/dl Blood urea nitrogen (BUN). mg/dl Serum creatinine. mg/dl Serum uric acid. mg/dl Urine glucose Intravenous pyelogram (IVP)

200400 Normal 6.4-8.3 3.5-5 2.3-3.4 70105 <140

Decreases in pregnancy and then abruptly returns to normal (protection against thromboembolism) Increased levels late in pregnancy Moderate decrease 5.5-7.5 Slight increase 3-4 Decreases < 140 after a 100-g carbohydrate meal is considered normal I04-1 08 (increased) 27-32 (decreased) 18-3 I (decreased) 7.40-7.45 (slightly increased, more alkaline) Unchanged Increases from 16 to 32 weeks of pregnancy; remains at this level until after birth Increases from week 12 of pregnancy to 6 weeks after birth Slight increase 1500 Increase by 25%-30% Increase by 30%-50% Decreases Decreases Decreases Decreases Present in 20% of pregnant women Slight to moderate hydroureter and hydronephrosis; right kidney larger than left kidney

80100 35-45 2128 7.35-7.45 <I 120-200 30-120 3.5-5 1300 490-700 88-128 25-40 10-20 0.5-1.1 2.7-7.3 Negative Normal

Heart rate Blood pressure

Blood volume Red blood cell mass Hemoglobin Hematocrit White blood cell count Cardiac output

CARDIOVASCULAR CHANGES IN PREGNANCY Increases 10-15 beats/min Remains at pre pregnancy levels in first trimester (systolic) Slight decrease in second trimester (systolic and diastolic) Returns to pre pregnancy levels in late third trimester (diastolic) Increases by 1500 ml or 40%-50% above pre pregnancy level Increases 17% Decreases Decreases Increases in second and third trimesters Increases 30%-50%

Respiratory rate Tidal volume Vital capacity Inspiratory capacity Expiratory volume Total lung capacity Oxygen consumption

RESPIRATORY CHANGES IN PREGNANCY Unchanged or slightly increased Increased 30%-40% Unchanged Increased Decreased Unchanged to slightly decreased Increased 15%-20%

FREQUENCY OF DERMATOLOGIC DISORDERS OF PREGNANCY Cholestasis of pregnancy: Common-I.5%-2% Pruritic urticarial papules and plaques of pregnancy (PUPPP):Common-O.25% to 1% Pruritic of pregnancy: Uncommon-O.3% Herpes gestations: Rare-O.002% Impetigo herpetiformis: Very rare

KEY POINTS The biochemical, physiologic, and anatomic adaptations that occur during pregnancy are profound and revert to the non-pregnant state after birth and lactation. Maternal adaptations are attributed to the hormones of pregnancy and to mechanical pressures exerted by the enlarging uterus and other tissues ELISA testing, with monoclonal antibody technology, is the most popular method of pregnancy testing and is the basis for most over-the-counter home pregnancy tests. Presumptive, probable, and positive signs of pregnancy aid in the diagnosis of pregnancy; only positive signs (identification of a fetal heartbeat, verification of fetal movements, and visualization of the fetus) can establish the diagnosis of pregnancy Adaptations to pregnancy protect the woman's normal physiologic functioning, meet the metabolic demands pregnancy imposes, and provide for fetal development and growth needs. Although the pH of the pregnant woman's vaginal secretions is more acidic, she is more vulnerable to some vaginal infections, especially yeast infections. Increased vascularity and sensitivity of the vagina and other pelvic viscera may lead to a high degree of sexual interest and arousal. Some adaptations to pregnancy result in discomforts such as fatigue, urinary frequency, nausea, and breast sensitivity. As pregnancy progresses, balance and coordination are affected by changes in the woman's joints and her center of gravity.

TIME OF OCCURRENCE (GESTATIONAL AGE) PRESUMPTIVE SIGNS 3-4wk 4wk 4-14 wk 6-12 wk 12wk 16-20 wk PROBABLE SIGNS 5wk 6-8wk 6-12 wk 4-12 wk 6-12 wk 16wk 16-28 wk POSITIVE SIGNS 5-6 wk 6wk 16wk 8-17wk 17-19 wk 19-22 wk Late pregnancy

SIGNS OF PREGNANCY SIGN OTHER POSSIBLE CAUSE

Breast changes Amenorrhea Nausea, vomiting Urinary frequency Fatigue Quickening Goodell sign Chadwick sign Hegar sign Positive result of pregnancy test (serum) Positive result of pregnancy test (urine) Braxton Hicks contractions Ballottement Visualization of fetus by real-time ultrasound examination Fetal heart tones detected by ultrasound examination Visualization of fetus by radiographic study Fetal heart tones detected by Doppler ultrasound stethoscope Fetal heart tones detected by fetal stethoscope Fetal movements palpated Fetal movements visible

Premenstrual changes, oral contraceptives Stress, vigorous exercise, early menopause, endocrine problems, malnutrition Gastrointestinal virus, food poisoning Infection, pelvic tumors Stress, illness Gas, peristalsis Pelvic congestion Pelvic congestion Pelvic congestion Hydatidiform mole, choriocarcinoma False-positive results may be caused by pelvic infection, tumors Myomas, other tumors Tumors, cervical polyps No other causes No other causes No other causes No other causes No other causes No other causes No other causes

MILESTONES IN HUMAN DEVELOPMENT BEFORE BIRTH SINCE LAST MENSTRUAL PERIOD 4 WEEKS 8 WEEKS 12 WEEKS
EXTERNAL APPEARANCE Body flexed, C-shaped; arm and leg buds present; head at right angles to body EXTERNAL APPEARANCE Body fairly well formed; nose flat, eyes far apart; digits well formed; head elevating; tail almost disappeared; eyes, ears, nose, and mouth recognizable CROWN-TORUMP MEASUREMENT WEIGHT 2.5-3 cm; 2 g GASTROINTESTINAL SYSTEM Intestinal villi developing; small intestines coil within umbilical cord; palatal folds present; liver very large MUSCULOSKELETAL SYSTEM First indication of ossification--occiput, mandible, and humerus; fetus capable of some movement; definitive muscles of trunk, limbs, and head well represented CIRCULATORY SYSTEM Main blood vessels assume final plan; enucleated red cells predominate in blood RESPIRATORY SYSTEM Pleural and pericardial cavities forming; branching bronchioles; nostrils closed by epithelial plugs RENAL SYSTEM Earliest secretory tubules differentiating; bladder-urethra separates from rectum NERVOUS SYSTEM Cerebral cortex begins to acquire typical cells; differentiation of cerebral cortex, meninges, ventricular foramina, cerebrospinal fluid circulation; spinal cord extends entire length of spine SENSORY ORGANS Primordial choroid plexuses develop; large relative to cortex; development progressing; eyes converging rapidly; internal ear developing; eyelids fuse GENITAL SYSTEM Testes and ovaries distinguishable; external genitalia sexless but begin to differentiate EXTERNAL APPEARANCE Nails appearing; resembles a human; head erect but disproportionately large; skin pink, delicate CROWN-TORUMP MEASUREMENT WEIGHT 6-9 cm; 19 g GASTROINTESTINAL SYSTEM Bile secreted; palatal fusion complete; intestines have withdrawn from cord and assume characteristic positions MUSCULOSKELETAL SYSTEM Some bones well outlined, ossification spreading; upper cervical to lower sacral arches and bodies ossify; smooth muscle layers indicated in hollow viscera CIRCULATORY SYSTEM Blood forming in marrow

CROWN-TORUMP MEASUREMENT WEIGHT 0.4-0.5cm;0.4 g GASTROINTESTINAL SYSTEM Stomach at midline and fusiform; conspicuous liver; esophagus short; intestine a short tube MUSCULOSKELETAL SYSTEM All somites present

CIRCULATORY SYSTEM Heart develops, double chambers visible, begins to beat; aortic arch and major veins completed RESPIRATORY SYSTEM Primary lung buds appear

RESPIRATORY SYSTEM Lungs acquire definite shape; vocal cords appear RENAL SYSTEM Kidney able to secrete urine; bladder expands as a sac NERVOUS SYSTEM Brain structural configuration almost complete; cord shows cervical and lumbar enlargements; fourth ventricle foramina are developed; sucking present SENSORY ORGANS Earliest taste buds indicated; characteristic organization of eye attained

RENAL SYSTEM Rudimentary ureteral buds appear NERVOUS SYSTEM Well-marked midbrain flexure; no hindbrain or cervical flexures; neural groove closed

SENSORY ORGANS Eye and ear appearing as optic vessel and otocyst

GENITAL SYSTEM Genital ridge appears (fifth week)

GENITAL SYSTEM Sex recognizable; internal and external sex organs specific

16 WEEKS
EXTERNAL APPEARANCE Head still dominant; face looks human; eyes, ears, and nose approach typica1 appearance on gross examination; arm/leg ratio proportionate; scalp hair appears CROWN-TORUMP MEASUREMENT WEIGHT 11.5-13.5 cm; 100 g GASTROINTESTINAL SYSTEM Meconium in bowel; some enzyme secretion; anus open MUSCULOSKELETAL SYSTEM Most bones distinctly indicated throughout body; joint cavities appear; muscular movements can be detected CIRCULATORY SYSTEM Heart muscle well developed; blood formation active in spleen RESPIRATORY SYSTEM Elastic fibers appear in lungs; terminal and respiratory bronchioles appear RENAL SYSTEM Kidney in position; attains typical shape and plan NERVOUS SYSTEM Cerebral lobes delineated; cerebellum assumes some prominence SENSORY ORGANS General sense organs differentiated GENITAL SYSTEM Testes in position for descent into scrotum: vagina open

20 WEEKS
EXTERNAL APPEARANCE Vernix caseosa appears; lanugo appears; legs lengthen considerably; sebaceous glands appear CROWN-TORUMP MEASUREMENT WEIGHT 16-18.5 cm; 300 g GASTROINTESTINAL SYSTEM Enamel and dentine depositing; ascending colon recognizable MUSCULOSKELETAL SYSTEM Sternum ossifies; fetal movements strong enough for mother to feel CIRCULATORY SYSTEM

24 WEEKS
EXTERNAL APPEARANCE Body lean but fairly well proportioned; skin red and wrinkled; vernix caseosa present; sweat glands forming CROWN-TORUMP MEASUREMENT WEIGHT 23 cm; 600 g GASTROINTESTINAL SYSTEM NONE SIGNIFICANT MUSCULOSKELETAL SYSTEM Astragalus (talus, ankle bone) ossifies; weak, fleeting movements CIRCULATORY SYSTEM Blood formation increases in bone marrow and decreases in liver RESPIRATORY SYSTEM Alveolar ducts and sacs present; lecithin begins to appear in amniotic fluid (Weeks 26 to 27) RENAL SYSTEM NONE SIGNIFICANT NERVOUS SYSTEM Cerebral cortex layered typically; neuronal proliferation in cerebral cortex ends SENSORY ORGANS Can hear GENITAL SYSTEM Testes at inguinal ring in descent to scrotum

RESPIRATORY SYSTEM Nostrils reopen; primitive respiratory-like movements begin RENAL SYSTEM NONE SIGNIFICANT NERVOUS SYSTEM Brain grossly formed; cord myelination begins; spinal cord ends at level of first sacral vertebra (5 I) SENSORY ORGANS Nose and ears ossify GENITAL SYSTEM NONE SIGNIFICANT

28 WEEKS
EXTERNAL APPEARANCE Lean body, less wrinkled and red; nails appear

30-31 WEEKS
EXTERNAL APPEARANCE Subcutaneous fat beginning to collect; more rounded appearance; skin pink and smooth; has assumed birth position

36 AND 40 WEEKS
EXTERNAL APPEARANCE 36 Weeks Skin pink, body rounded; general lanugo disappearing; body usually plump. 40Weeks Skin smooth and pink; scant vernix caseosa; moderate to profuse hair; lanugo on shoulders and upper body only; nasal and alar cartilage apparent CROWN-TORUMP MEASUREMENT WEIGHT 36 Weeks 35cm: 2200-2900 g 40 Weeks

CROWN-TORUMP MEASUREMENT WEIGHT 27 cm; 1100 g

CROWN-TORUMP MEASUREMENT WEIGHT 31cm; 1800-2100 g

GASTROINTESTINAL SYSTEM NONE SIGNIFICANT MUSCULOSKELETAL SYSTEM Middle fourth phalanxes ossify; permanent, minimum tone teeth primordia seen; can turn head to side

GASTROINTESTINAL SYSTEM NONE SIGNIFICANT MUSCULOSKELETAL SYSTEM NONE SIGNIFICANT

CIRCULATORY SYSTEM NONE SIGNIFICANT RESPIRATORY SYSTEM Lecithin forming on alveolar surfaces

CIRCULATORY SYSTEM NONE SIGNIFICANT RESPIRATORY SYSTEM LS ratio = 1.2: I

RENAL SYSTEM NONE SIGNIFICANT NERVOUS SYSTEM Appearance of cerebral fissures, convolutions rapidly appearing; indefinite sleep-wake cycle; cry weak or absent; weak suck reflex

RENAL SYSTEM NONE SIGNIFICANT NERVOUS SYSTEM NONE SIGNIFICANT

SENSORY ORGANS Eyelids reopen; retinal layers completed, light-receptive; pupils capable of reacting to light GENITAL SYSTEM NONE SIGNIFICANT

SENSORY ORGANS Sense of taste present; aware of sounds outside mother's body GENITAL SYSTEM Testes descending to scrotum

40 cm; 3200+ g GASTROINTESTINAL SYSTEM NONE SIGNIFICANT MUSCULOSKELETAL SYSTEM 36 Weeks Distal femoral ossification centers present; sustained, definite movements; fair tone; can turn and elevate head 40 Weeks Active, sustained movement; good tone; may lift head CIRCULATORY SYSTEM NONE SIGNIFICANT RESPIRATORY SYSTEM 36 Weeks LS ratio> 2: I 40Weeks Pulmonary branching only two thirds complete RENAL SYSTEM 36 Weeks Formation of new nephrons ceases NERVOUS SYSTEM 36 Weeks End of spinal cord at level of third lumbar vertebra (L3); definite sleep-wake cycle 40 Weeks Myelination of brain begins; patterned sleepwake cycle with alert periods; cries when hungry or uncomfortable; strong suck reflex SENSORY ORGANS NONE SIGNIFICANT GENITAL SYSTEM 40 Weeks Testes in scrotum; labia majora well developed

DAILY FOOD GUIDE FOR PREGNANCYAND LACTATION

FOOD GROUP GRAINS DAILY AMOUNT OF FOOD RECOMMENDED FOR WOMEN* 6 ounce-equivalents At least half of grain servings should be whole grains. Whole groins are those that contain the entire grain kernel (bran, germ, endosperm), e.g., whole wheat or cornmeal, oatmeal, and brown rice. Refined grains have been milled to remove the bran and germ, e.g., white flour, white bread. Degermed cornmeal, white rice, and corn or flour tortillas. 2.5 Cups Weekly intake should include at least the following: 3 cups dark green vegetables (e.g., spinach or greens, broccoli, bok choy, romaine lettuce); 2 cups orange vegetables (e.g., carrots; acorn, butternut, or hubbard squash; sweet potatoes); 3 cups dry beans or peas (e.g., black, navy, or kidney beans; chickpeas; black-eyed peas; split peas; lentils; soy beans; tofu); 3 cup starchy vegetables (corn, green peas, potatoes); and 6.5 cups of other vegetables (e.g., artichokes, asparagus. bean sprouts. Brussels sprouts green beans, cauliflower, cucumber, tomatoes, iceberg or head lettuce, vegetable juice). 1.5 cups 3 cups For nonpregnant and pregnant; 4 for lactation Most milk group choices should be fat-free or low-fat. 5 ounce-equivalents Most meat and poultry choices should be lean or low-fat. Fish, nuts, and seeds contain healthy oils. so choose these foods frequently instead of meat or poultry. 6 teaspoons (30 ml) Choose oils rather than solid fats. Solid fats are fats that are solid at room temperature, such as butter, shortening, stick margarine, and pork, chicken, or beef fat: Read the label: choose products with no trans fats. Limit intake of saturated fats, and choose oils high in monounsaturated and polyunsaturated Fats SERVING SIZE I ounce-equivalent = I slice bread. I cup readyto-eat cereal, or '12 cup cooked rice or pasta or cooked cereal

VEGETABLES Vary the vegetables consumed to take advantage of the different nutrients they offer.

I cup = 2 cups raw leafy greens; I cup of other vegetables, raw or cooked; or I cup of vegetable juice

FRUITS MILK, YOGURT, AND CHEESE (MILK GROUP)

MEAT, POULTRY, FISH, DRY BEANS, EGGS, AND NUTS (MEAT AND BEANS GROUPS)

I cup = I cup raw, frozen or canned fruit; I cup 100% juice; or 'h cup dried fruit I cup = I cup milk or yogurt; 1.5 ounces natural cheese; 2 ounces processed cheese (such as American); 2 cups cottage cheese; 1.5 cups ice cream (choose fat-free or low-fat most often) I ounce-equivalent = I ounce (30 g) meat, poultry, or fish; cup cooked dry beans, I egg; I tablespoon (15 ml) peanut butter; ounce nuts or seeds I teaspoon = I teaspoon liquid oil (olive, canola, sunflower, safflower. peanut, soybean, cottonseed, etc.) or soft margarine (tub or squeeze bottle); I tablespoon mayonnaise or Italian salad dressing; 3/4 tablespoon Thousand Island salad dressing; 8 large olives; 1/6 medium avocado; 1/3 ounce dry roasted peanuts, mixed nuts, cashews, sunflower seeds

OILS

CULTURAL AND ETHNIC GROUPS Mexican

POPULAR FOODS OF VARIOUS CULTURAL AND ETHNIC GROUPS AND THEIR PLACE IN MYPYRAMID CULTURAL OR ETHNIC GROUP OR EATING PATIERN FOOD GROUPS GRAINS VEGETABLE FRUIT MILK Tortilla Taco shell Posole (corn soup) Rice Postres (pastries]" Other vegetables: Chayote (Mexican squash) Jicama (root vegetable) Nopales (cactus leaves) Tomato Corn Dark green: Collard, kale, mustard, or turnip greens Orange: Sweet potatoes Other: Okra Snap, pole, Lima, and butter beans Turnips Summer squash (yellow or zucchini) Coleslaw All Avocado Mango Papaya Plantano (cooking banana) Zapote (sweet, yellowish fruit) Blackberries Melons Muscadines (grapes)Peaches Queso Blanco (white Mexican cheese) Custard (I cup = I cup milk serving) Leche (milk)

MEAT AND BEANS

Chorizo (sausage)* Chicken, beef, goat, or pork Beans. Dry, cooked

African-American soul food (Southernstyle cooking)

Biscuit Cornbread Grits, rice, macaroni, or noodles Hominy Crackers Hush puppies

Buttermilk

Pork (cured ham and uncured cuts), chicken, beef, fish Peas or beans (black-eyed, crowder, purple-hull, or cream)

Vegetarian

Whole-grain bread Cereal, cooked or ready to-eat Brown rice Whole-grain pasta Bagel

All

Milk and cheese (Iactovegetarians) Soy milk, calcium-fortified Soy cheese

Cooked dry beans or peas Tofu (soybean curd) or tempeh (fermented soy) Nuts or seeds Peanut butter Egg (ovovegetarians) Veal or beef Fish Sausage* Luncheon meats* Lentils Squid Almonds, pistachios Pork, fish, chicken Shrimp, crab, lobster Tofu or tempeh

Italian

Bread sticks, breads Gnocchi (dumplings) Polenta (corn meal mush) Risotto (creamy rice dish) Pastas

Dark green: Spinach Other: Artichoke Eggplant Mushrooms Marinara sauce

Berries Figs Pomegranate

Cheeses (mozzarella, parmesan, Romano, ricotta, etc.) Gelato (Italian ice cream)

Chinese

Indian (south Asia)

Rice or millet Rice vermicelli (thin rice pasta) Cellophane noodles (bean thread) Steamed rolls Rice congee (soup) Rice sticks Breads: roti (chapati), naan, paratha, batura, puris, dosa, Idli Rice or rice pilau Pooha, upma, sabudana

Other: Pea pods Yardlong beans Baby corn Bamboo shoots Straw mushrooms Eggplant Bitter melon

Guava Lychee Persimmon Pummelo Kumquat Star fruit

Soy milk

Dark green: Saag (mixed greens and potatoes) Spinach Other: Green peppers Cabbage Eggplant Green beans Methi (fenugreek leaves) Cucumbers Chutney or vegetable pickles

Mango Dates Raisins Melons Figs Fruit juices and nectars

Yogurt

Dal (lentils, mung beans, other dried beans) Beef, chicken (some are vegetarian)

Native American

Bread Fry bread Wild rice or oats Popcorn Tortilla Mush (cooked cereal)

Orange: Winter squash (hard outer shell) Starchy: Potato Corn Other: Rhubarb Yellow: Pumpkin or winter squash (Butternut) Other: Peppers Tomatoes Grape leaves Cucumbers Fava beans Eggplant

Berries Cherries Plums Apples Peaches

Wild game (deer, rabbit, elk, beaver) Lamb Salmon and other fish Clams, mussels Crab Duck or quail

Middle Eastern

Rice or bulgur (cracked wheat) Couscous Bread Pita

Apricots Grapes Melons Dried fruits: dates, raisins, apricots

Yogurt

Lamb, goat, fish Almonds Pistachio nuts Dried beans and peas, lentils Egg

Calculating the Body Mass Index (BMI)

Example: Mrs. White is 54 tall and weighs 130 lbs. To determine her BMI: Convert weight into kilograms. (divide weight in 130 / 2.2 = 59 kg pounds by 2.2) Convert height into centimeters. (multiply height 5 x 12 = 60 + 4 = 64 inches (foot to inches) in inches by 2.5) 64 inches x 2.5 = 160 cm (inches to cm) Convert centimeters into meters. (divide result by 160 / 100 = 1.6 meters 100) Square height in meters. Divide weight in kilograms by height in meters squared. 1.6 x 1.6 = 2.56 59 / 2.56 = 23 BMI

Interpretation of Result: 23 BMI = Normal Weight, thus, Mrs. White enters pregnancy at normal weight.

LABORATORY TESTS IN PRENATAL PERIOD LABORATORY TEST PURPOSE Hemoglobin, hematocrit, WBC, differential Detects anemia; detects infection Hemoglobin electrophoresis Identifies women with hemoglobinopathies (e.g., sickle cell anemia, thalassemia) Blood type, Rh, and irregular antibody Identifies those fetuses at risk for developing erythroblastosis fetalis or hyperbilirubinemia in neonatal period Rubella titer Determines immunity to rubella Tuberculin skin testing; chest film after 20 weeks of gestation in Screens for exposure to tuberculosis women with reactive tuberculin tests Urinalysis, including microscopic examination of urinary Identifies women with unsuspected diabetes mellitus, sediment; pH, specific gravity, color, glucose, albumin, protein, renal RBCs, WBCs, casts, acetone; hCG disease, hypertensive disease of pregnancy; infection; occult hematuria Urine culture Identifies women with Asymptomatic bacteriuria Renal function tests: BUN, creatinine, electrolytes, creatinine Evaluates level of possible renal compromise in women clearance, total protein excretion with a history of diabetes, hypertension, or renal disease Pap test Screens for cervical intraepithelial neoplasia. herpes simplex type 2,and HPV Vaginal or rectal smear for Neisseria gonorrhea, Chlamydia, HPV, Screens high risk population for asymptomatic GBS infection; GBS done at 35-37 weeks RPR,VDRL, or FTA-ABS Identifies women with untreated syphilis HIV* antibody, hepatitis B surface antigen, toxoplasmosis Screens for specific infections l-hr glucose tolerance Screens for gestational diabetes; done at initial visit for women with risk factors; done at 24-28 weeks for all pregnant women 3-hr glucose tolerance Screens for diabetes In women with elevated glucose level after 1-hr test; must have two elevated readings for diagnosis Cardiac evaluation: ECG, chest x-ray film, and echocardiogram Evaluates cardiac function in women with a history of hypertension or cardiac disease

Nageles Rule

Nageles rule is used to determine the EDD on the basis of the first day of the last menstrual period or LMP. To calculate the date of birth in this rule, subtract 3 months from the first day of LMP then add 7 days and change the year. For example the last menstrual period (LMP) began July 30, 2010. To determine the EDD follow the following steps: Subtract 3 months (June 30, May 30, April 30) = April 30, 2010 Add 7 days then change the year = April 30 + 7 (April has 30 days only, thus, adding 7 days would make the EDD May 7) = May 7 (change the year) = May 7, 2011 Measuring the fundic height in McDonalds rule McDonalds Rule or method is used to determine the age of gestation by measuring from the fundus (obtaining the fundal height) to the symphysis pubis. The distance in centimeters will determine the age of gestation from 16-38 weeks. (From Benson and Pernolls handbook of obstetrics and gynecology) Johnsons rule is used to estimate the weight of the fetus in grams. To determine this, a standard formula is used. Formula: fundic height in cm n x k k is constant, it is always 155 n is 12 if the fetus is engaged. It is 11 if the fetus is not yet engaged. Example: A fundic height of 28 cm, and the fetus is not engaged.

Modified McDonalds Rule Johnsons Rule

Bartholome ws Rule of fourths

28 cm 11 x 155 = 17 x 155 = 2635 grams This method estimates the age of gestation relative to the height of the fundus of the uterus above the symphysis pubis. By 3rd lunar month (12 weeks), the fundus is slightly palpated above the above the symphysis pubis. By the 5th lunar month (20 weeks), the fundus is palpable at the level of the umbilicus. On the 9th lunar month, the fundus is at the level of the xiphoid process.

Haase rule

image from womenshealthapta.org The length of the fetus in centimeters, divided by 5, is the duration of pregnancy in months, the age of the fetus

INVASIVENESS
NON-INVASIVE

TEST
Fetal Cells in Maternal Blood (FCMB) Cell-free Fetal DNA in Maternal Blood

COMMENTS
Based on enrichment of fetal cells which circulate in maternal blood. Since fetal cells hold all the genetic information of the developing fetus they can be used to perform prenatal diagnosis. Based on DNA of fetal origin circulating in the maternal blood. Testing can potentially identify fetal aneuploidy (available in the United States, beginning 2011) and gender of a fetus as early as six weeks into a pregnancy. Fetal DNA ranges from about 2-10% of the total DNA in maternal blood. During in vitro fertilization (IVF) procedures, it is possible to sample cells from human embryos prior the implantation.[6] PGD is in itself non-invasive, but IVF usually involves invasive procedures such as transvaginal oocyte retrieval Examination of the woman's uterus from outside the body. Commonly dating scans (sometimes known as booking scans) from 7 weeks to confirm pregnancy dates and look for twins. The specialized nuchal scan at 1113 weeks may be used to identify higher risks of Downs syndrome. Later morphology scans from 18 weeks may check for any abnormal development. Listening to the fetal heartbeat (see stethoscope) Use of cardiotocography during the third trimester to monitor fetal wellbeing Cervical mucus aspiration, cervical swabbing, and cervical or intrauterine lavage can be used to retrieve trophoblast cells for diagnostic purposes, including prenatal genetic analysis. Success rates for retrieving fetal trophoblast cells vary from 40% to 90%.[7] It can be used for fetal sex determination and identify aneuploidies. Antibody markers have proven useful to select trophoblast cells for genetic analysis and to demonstrate that the abundance of recoverable trophoblast cells diminishes in abnormal gestations, such as in ectopic pregnancy or an embryonic gestation. Including -hCG, PAPP-A, alpha fetoprotein, intact or beta hCG, inhibin-A. See separate section below Involves getting a sample of the chorionic villus and testing it. This can be done earlier than amniocentesis, but may have a higher risk of miscarriage, estimated at 1%. This can be done once enough amniotic fluid has developed to sample. Cells from the fetus will be floating in this fluid, and can be separated and tested. Miscarriage risk of amniocentesis is commonly quoted as 0.06% (1:1600). By amniocentesis is also possible to cry

TIME First Trimester First Trimester Prior To Implantati on First Or Second Trimester First Or Second Trimester First Or Second Trimester Third Trimester

NON-INVASIVE

NON-INVASIVE

Preimplantation Genetic Diagnosis(PGD) External Examination

NON-INVASIVE

NON-INVASIVE

Ultrasound Detection

NON-INVASIVE

Fetal Heartbeat Non-Stress Test

NON-INVASIVE

LESS INVASIVE

Transcervical Retrieval Of Trophoblast Cells

First Trimester

LESS INVASIVE

Maternal Serum Screening Chorionic Villus Sampling

First Or Second Trimester After 10 Weeks After 15 Weeks

MORE INVASIVE

MORE INVASIVE

Amniocentesis

MORE INVASIVE

MORE INVASIVE

Embryoscopy and Fetoscopy Percutaneous Umbilical Cord Blood Sampling

preserve amniotic stem cells. Though rarely done, these involve putting a probe into a women's uterus to observe (with a video camera), or to sample blood or tissue from the embryo or fetus.