Antepartum rapid review, screen by screen

ANTEPARTUM RAPID REVIEW

Every prenatal test answers one question. Naming that question is what the item is testing.

STRIP 1 · FIRST VISIT PANEL Dating ultrasound, blood type with Rh status and antibody screen, complete blood count, rubella immunity, hepatitis B surface antigen, human immunodeficiency virus, syphilis, and urine culture. Hook: the Rh and antibody result drives the immune globulin plan. An unsensitized Rh-negative patient receives Rh immune globulin in the third trimester and again after birth if the newborn is Rh positive, and after any sensitizing event.

STRIP 2 · GENETIC SCREENING VERSUS DIAGNOSIS Cell-free DNA, the first-trimester combined screen with nuchal translucency, and the second-trimester quad screen are screening tests that return a risk estimate. Chorionic villus sampling and amniocentesis are diagnostic tests that return a karyotype. Hook: a positive screen is followed by a diagnostic test, never by a decision.

STRIP 3 · ANATOMY AND GROWTH The mid-second-trimester anatomy ultrasound surveys structure. Serial fundal height is the low-technology growth screen; a measurement that does not match gestational age prompts ultrasound. Hook: the exam tests what you do about the discrepancy, not how you take the measurement.

STRIP 4 · FETAL WELLBEING TESTING Nonstress test: reactive when the required number of accelerations of adequate height and duration appear within the observation window, with the criteria relaxed before thirty-two weeks because the immature fetus accelerates less. Biophysical profile: five components, each scored two points or zero, comprising the nonstress test, fetal breathing movements, gross body movements, fetal tone, and amniotic fluid volume. Contraction stress test: a negative result means no late decelerations occurred and is the reassuring one. Hook: negative is good news, and candidates reverse it.

STRIP 5 · HYPERTENSIVE SPECTRUM Chronic hypertension predates pregnancy or appears before twenty weeks. Gestational hypertension is new hypertension after twenty weeks without proteinuria or severe features. Preeclampsia adds proteinuria or, in its absence, any severe feature. Severe features: severe-range blood pressure on two occasions at least four hours apart, thrombocytopenia, impaired liver function or severe persistent right upper quadrant or epigastric pain unresponsive to medication, renal insufficiency, pulmonary edema, new headache unresponsive to medication, and visual disturbance. Eclampsia is a generalized seizure. HELLP is hemolysis, elevated liver enzymes, and low platelets. Hook: proteinuria is no longer required to make the diagnosis, and fetal growth restriction is no longer a severe feature.

STRIP 6 · MAGNESIUM SULFATE Given for seizure prophylaxis and, at early preterm gestations, for fetal neuroprotection. It is not an antihypertensive. Monitor level of consciousness, deep tendon reflexes, respiratory rate, urine output, and serum level. Calcium gluconate is the antidote and stays at the bedside. Hook: reflexes go before respirations do.

STRIP 7 · GESTATIONAL DIABETES Screened in the late second trimester by either the one-step or the two-step approach. Consequences: macrosomia and shoulder dystocia, neonatal hypoglycemia after birth, preeclampsia, and a persisting maternal risk that requires postpartum retesting. Hook: the newborn of a diabetic mother is the hypoglycemia question.

STRIP 8 · PRETERM LABOR Regular contractions with documented cervical change before thirty-seven weeks. Management buys time: antenatal corticosteroids for fetal lung maturity, magnesium sulfate for neuroprotection at early gestations, tocolysis for roughly forty-eight hours, and group B streptococcus prophylaxis. Hook: tocolysis exists to let the steroids work.

Watch outloss of deep tendon reflexes is the earliest sign of magnesium sulfate toxicity, and it appears before respiratory depression. Stop the infusion and notify the provider.

Margin notenegative test, good news. Say it twice. Every value → BOOK 07 · P4. Magnesium sulfate and oxytocin infusions → BOOK 06 · P3. Antihypertensive and tocolytic class logic → BOOK 05 · P9

Takeawayeach prenatal test has one question it answers, and the complications are recognized by the pattern they interrupt.