Digestive System Practice Test

                  Tests Performed During Pregnancy

BIOCHEMICAL TEST (early pregnancy)

HUMAN CHORIONIC GONADOTROPIN (HCG)

·       Tests for pregnancy.

·       HCG is produced by syncytiotrophoblast of placenta and secreted I both mother and fetus blood.

·       Half-life of HCG is 36hrs.

·       Radioimmunoassay method it detected in urine as early as 8-9 days of post fertilization.

·       The maximum level 100-200IU between 60-70 days of pregnancy.

·       Decrease level found in: - spontaneous abortion, ectopic pregnancy.

·       Increase Levels found in: - May indicate multiple pregnancies, hydatidiform mole, Down syndrome.

·       HCG disappears from circulation within 2 weeks of delivery.

CHORIONIC VILLUS SAMPLING

·       It is performed for prenatal diagnosis of genetic disorder.

·       It is done through trans-cervical (10-12 weeks) and trans-abdominal from 10weeks to term.

·       Few villi collected from the chorion frondosum.

·       Earlier testing time than amniocentesis permits earlier decision regarding termination

·       Also decrease risk of 1st trimester spontaneous abortion and costs less than amniocentesis but for confirmation required amniocentesis.

·       Complications: fetal loss (1-2%), limb reduction defect high are high when CVS was performed at less than 10weeks of gestation.

Nursing role:-

·       Full bladder to serve as acoustic window.

·       Assess vital signs and absence of uterine cramping.

·       Provide emotional support.

·       Teach spotting for 3 days is expected after trans-cervical route.

·       Report flulike symptoms and vaginal discharge of blood, clots, tissue, or amniotic fluid.

·       Avoid sexual activity, lifting, or strenuous activity until spotting resolves.

·       Ensure genetic counseling if appropriate.

 MATERNAL SERUM ALPHA-FETOPROTEIN (MS-AFP) SCREENING

·       Fetal protein used to screen for neural tube defects and abdominal wall defect.

·       AFP is an oncofetal protein.it is produced by yolk sac and fetal liver.

·       Test is done between 15-20 weeks.

·       MSAFP level is elevated: a.) wrong gestational age b.) Open neural tube defects c.) Multiple pregnancy, RH   isoimmunisation d.)   IUFD   e.) Anterior abdominal wall defects f.) Renal anomalies.

·       MSAFP Decrease Levels found in: - a.)Down syndrome b.)Gestational trophoblastic disease.

 

TRIPLE TEST:-

v  Is it a combined biochemical test which includes MSAFP, HCG, and UE3 .it is used for detection of Down syndrome?

v  It case of Down syndrome MSAFP AND UE3 level low and HCG level high.

v  It is performed at 15-18 weeks.

 

QUDRUPLE TEST:-

v  INHIBIN a glycoprotein .it is produced by corpus luteum and placenta. Serum level of inhibin A  raise in case of down syndrome

v  In quadrat test is combination of four MSAFP, HCG, UE3, inhibin A. all four level are determined for Down syndrome.

v  In Down syndrome MSAFP, UE3 level is low and HCG, inhibin level is elevated.

 

ACETYL CHOLINE ESTRASE:-

·       It level is elevated in case of Down syndrome.

 

PERCUTANEOUS UMBILICAL BLOODS SAMPLINGS (Cordocentesis)

·       Fetal cord blood assessed at 18-20 weeks.   it involves insertion of needle directly in to the fetal umbilical vein  under the ultrasound guidance .Identifies some maternal/fetal problems

·       Complications:-abortion, IUD, preterm labor

Nursing role:-

·       Obtain consent

·       Full bladder may be necessary

·       Assess uterine activity, FHR, and reactivity for at least 1 hour.

·       Teach to take antibiotics and temp 2 times daily and report increase temperature.

·       Do USG to find out any type of bleeding or hematoma after one hour the procedure.

AMNIOCENTESIS

·       It is invasive procedure .it is performed between 14 and 16 weeks under ultrasonic guidance (early amniocentesis done at 12-14 weeks of gestation) .the fetal cells obtained in this procedure for cytogenetic analysis.

·       It identifies chromosomal disorders (e.g., Down syndrome, neural tube defects), fetal lung maturity, and metabolic disorder.

·       14–16 weeks: - amniocentesis done along with Ultrasonic guidance to identify fetal parts and pockets of amniotic fluid.

·       Complications:- Preterm labor(later in pregnancy), amniotic fluid emboli, infection

Nursing role:-

·       Obtain consent

·       14–16 weeks :- Bladder must be full to raise uterus (means before 20 week)

·       Second half of pregnancy:- Empty bladder to decrease confusion with uterus (means after 20 week)

·       Hip roll to decrease hypotension.

·       Assess maternal vital signs, fetal cardiac activity.

·       Mild cramping is common.

·       Fluid leakage is usually self-limiting.

·       Tell patient to avoid intercourse, heavy lifting, and strenuous activity for 24hr after test.

·       Report increase temperature, persistent cramping, or vaginal discharge.

 

BIOPHYSICAL TEST (late pregnancy)

BIOPHYSICAL PROFILE

·       Biophysical profile in early pregnancy is done (10-14 weeks) to detect fetal anomalies .CRL smaller then gestational age is associated with Down syndrome .absence of nasal bone on USG at 10-12 weeks is associated with Down syndrome.

·       Biophysical profile is done under ultra-sonographic examination.

·       Biophysical profile in late pregnancy- screening test for utero-placental insufficiency.

·       Modified biophysical profile Consists NST and determined AFI. it done in late trimester (2^nd and 3^rd trimester)

·       Biophysical profile test include in late pregnancy: - 1).fetal movement count 2) NST 3.) CST 4.) Cardiotocography 5.) Fetal biophysical profile 6.) Doppler ultrasound 7.) Amniotic fluid volume 8.) vibroacoustic stimulation test

·       Nursing role: Same as ultrasonography; emotional support

Ultrasonography

·       It is performed for prenatal diagnosis of genetic disorder.

·       It is done though the trans-cervical (10-12weeks.) and trans-abdominal in mid and late pregnancy to assess gestation period.

·       Use to assess or diagnose Bi-parietal diameter (BPD), abdominal circumference (AC), head circumference (HC), femur length (FL), crown rump length (CRL) and amniotic fluid volume.

·       Fetal nutrition can assess through the abdominal circumference.

 

 AMNIOTIC FLUID TESTS

·       Tests for amniotic fluid with ruptured membranes.

·       Nitrazine test: -Positive test tape dark blue or gray/green

·       Fern test:-Fern like pattern under microscope by the effects of salts of amniotic fluid. It indicates the presence of amniotic fluid.

·       Using sterile technique, a specimen is obtained from the external OS of the cervix and vaginal pool and is examined on a slide under a microscope.

Nursing role: -

·       Dorsal lithotomy position

·       Encourage coughing to increase fluid expulsion

·       Touch nitrazine tape to vaginal secretions

·     For fern test, use cotton-tipped applicator to collect secretions and draw over glass slide.

 

 

FETAL FIBRONECTIN TEST (FFN)

 

·       Swab of vaginal/cervical secretions for fetal fibronectin.

·       Test is used if at risk for preterm labor, before 37 week’s gestation.

·       FFN leaks with amniotic sac separation.

·       Presence may predict labor onset

·       A positive result indicates the onset of labor in 1 to 3 week.

Nursing role:

·       Assist with dorsal recumbent or lithotomy position

·       Sample collection is obtained with cotton swab.

 NONSTRESS TEST (NST)

·       Test is done to assess the FHR acceleration with fetal movement (cardiotocography ), when present indicate healthy fetus.it identified the fetal wellness rather than illness .test done after 28weeks of pregnancy.

·       Interpretation: - 1. Reactive (reassuring) when two or more acceleration of more than 15 beats per minutes above the baseline and longer than 15 seconds in duration are present in a 20 minute observation.it means negative test.no need of further test.

·       2. Non-reactive (non-reassuring):- absence of any fetal activity.it means positive test needs CST.

·       3.Unsatisfactory: - Less than 2 accelerations in 20min; accelerations do not meet reactive criteria; inadequate quality recording for interpretation

Nursing role: -

·       Left lateral position to decrease vena cava compression

·       Transducer and toco-dynamometer to abdomen apply.

·       Teach to press event button with fetal movement.

·       Observe fetal monitor.

CONTRACTION STRESS TEST (CST)

·       Test assesses placental oxygenation and function.

·       Contractions stimulated (using oxytocin) and fetal response monitored and determines the fetal well-being.

·       Done after nonreactive NST

·       Negative: -

·       Normal baseline FHR, FHR accelerations with fetal movement, and no late decelerations with 3 contractions in 10min indicates healthy fetus

·       Oxytocin discontinued

·       IV continued until uterine activity returns to prior status

·       Fetus likely to survive labor if it occurs within 1wk with no maternal/fetal change

·       Positive: -

·       Late decelerations with 50% of contractions indicates fetal compromise; monitor mother/fetus; prepare for labor induction

·       Suspicious: -

·       Late decelerations with less than half the contractions

 

Nursing role: -

·       Obtain consent

·       semi-Fowler’s with lateral tilt

·       Doppler transducer to abdomen

·       30min baseline maternal vital signs and FHR

·       Assist with stimulation

·       Monitor IV and mother for signs and symptoms of preterm labor

FETAL MOVEMENT COUNT: - (kick counts)

·       The client sits quietly or lies down on her side and count fetal kicks are instructed.

·       Fetal movement count done by any of the two method:-

·       Cardiff’ counts 10’formula:-the patient counts fetal movement starting at 9 am. And counting end when 10 movements perceived.

·       She is instructed to report physician -1.less than 10 movements occurs during 12 hours on 2 successive days or 2.no movement is perceived even after 12 hrs. In a single day.

·       Daily fetal movement count (DFMC):- there counts each of one hour’s duration (morning, noon and evening) are recommended. The total counts multiplied by four gives daily (12hrs.) FMC.

·       If there is no. of kicks less than 10 in 12 hours. (Or less than 3 in each hour.)

·       After 28 weeks fetal movement counted by patient at same time daily

·       Less FMC indicate fetal compromise.

·       Nursing management:-

·       Teach pt. to assume a comfortable position

·       Hands on abdomen

·       Count movements for 1hr.

 DOPPLER STUDIES (UMBILICAL VESSEL VELOCIMETRY)

·       Measures blood flow velocity and direction in uterine/fetal structures

·       Decrease Umbilical vessel flow seen in IUGR, preeclampsia, eclampsia, and post term.

 

BIOCHEMICAL TEST IN LATE PREGNANCY

·       In late pregnancy biochemical test done for assessment of pulmonary maturity.

·       Pulmonary maturity confirmation reduces the RDS in newborn.

·       RDS is caused by deficiency of pulmonary surfactant which is synthesized by type 2 alveolar cells.

·       Estimation of pulmonary surfactant  by L:S (lecithin/sphingomyelin)

·       L: S ratio at 31-32 weeks – 1, at 35 weeks -2 and L/S ration > 2 indicate pulmonary maturation.

·       Shake test or bubble test.