Antenatal Care (ANC) Laboratory analysis

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Antenatal Care (ANC) Laboratory analysis

• ?????? ???????
• ?????????????????????????????????
• ????????????-??????????

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First visit 15-20 wks 24-28 wks 29-41 wks
????????????????????????? ?
?????????????????? ?
??????????????? ??????????? ? ? ? ?
???????????? FHS/position ? ? ? ?
Urine sugar/protein ? ? ? ?
CBC ? ?
Blood group, Rh ?
VDRL ? ?
HBsAg ?
Anti HIV ? ?
50 g GCT, Antibody screening
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????????????????????????

• ????????????

???? ???????? 28-32 ???????
CBC ? ?(HCT)
OF, DCIP ?
HBsAg ?
VDRL ? ?
Anti-HIV ? ?
Blood group, Rh ?
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1.Complete blood count(CBC)

• 1. Red blood cell ( RBC ) count
• 2. White blood cell ( WBC ) count
• 3. Hemoglobin ( Hb )
• 4. Hematocrit ( Hct )
• 5. Platelet ( Plt )
• 6. Red blood cell indices
• - Mean corpuscular volume ( MCV )
• - Mean corpuscular hemoglobin ( MCH )

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(No Transcript)
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White blood cell ( WBC ) count

• WBC ?????????????????????????????????
• ????????? 14,000 - 16,000/ mm3 (Taylor, 1981).
• ?????????????? 25,000/ mm3
• ????????
• ??? gt 25,000/mm3 ???????? leukocytosis ???????
  acute infections, uremia, steroid, hemorrhage,
  leukemia
• ??? lt 4,000/mm3 ???????? leukopenia ??????? ????
  ???????????????????, aplastic anemia, infectious
  mononucleosis, septicemia, compromise host

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Hemoglobin ( Hb ), Hematocrit ( Hct )

• Hct Hb x 3
• ???????
• 1st trimester 11 mg/dl (Hct 33 vol)
• 2nd trimester 10.5 mg/dl (Hct 31.5 vol)
• 3rd trimester 11 mg/dl (Hct 33 vol)
• Hct lt 25 vol ?????????????? 1 ???????????????????
  refer ????????????

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???????????? ???? Hb lt 11 gm ???? Hct lt 33

• ??????????????
• ?????????????????? ????? ???????????
• ?????????????
• DFIU
• ????????????
• ??????????????????????? ????????????????????
• ???????????????
• ?????????? PPH ??????????????????????????????
• ???????????????

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?????????????

• ????????????
• Triferdine ????? 1 ????
• ?????????
• Triferdine ????? 1 ???? FBC 1-2 ????
• Hct lt 33 vol ??? FBC 1 ????
• Hct lt 30 vol ??? FBC 2 ????
• ??????????????????
• Iodine GPO ????? 1 ???? Folic acid 4 mg
  ????? 1 ????

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Platelet ( Plt )

• ??????? 150,000 400,000/mm3
• ????? platelets lt 100,000/ mm3 ???????
  thrombocytopenia ???? refer ????????
• ????? platelets gt 400,000/ mm3 ???????
  thrombocytosis ???? refer ????????

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Red blood cell indices

• Mean corpuscular volume ( MCV )
• ??????? 80-98 fL
• ??????????? 80 fL ?????????????????
• Mean corpuscular hemoglobin ( MCH ) ???????
  27-31 pg
• ??????????? 27 pg ?????????????????

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2. ?????????????????????????????(MCV(OF),DCIP)

• ????? MCV ??? CBC ??? lt 80 fL ?????????????
• DCIP ????? positive ?????????????
• ????? MCV ??? DCIP ???????????????????????????????
  ????????? MCV,DCIP

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MCV
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3. ??????? VDRL(RPR)

• ??? ve ??????? FTA-ABS ???? TPHA
  ?????????????????????? Syphillis
• VDRL ???????? ve ?????? ????
• ????????????
• ?????????
• ?????????????????????? ??? ??????????
• ???????? treponema ????
• ???? ?????????????? ?????????????
  (?????????????), HIV, infectious mononucleosis
  ???????

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VDRL

• FTA-ABS ???? TPHA ????? ve ?????? ????
• ???????????????????????? ???????????????????
• ???????? treponema ?????
• Lyme disease

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VDRL

• ???????????????? ???????????
• (VDRL positive titer gt 11, TPHA positive)
• ??????????
• ??????????????
• Benzathine penicillin G 2.4 mU i.m. X 3 dose
• ??? penicillin ??? erythromycin
• ?? ultrasound ??????? ???????????????????????????
  (MFM)
• ???????????? 4 ??????????? VDRL titer ????????????

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4. Hepatitis B virus

• HBV ??????????????????????????????????????????????
  ??????????????
• HBsAg ??????????????????????????????????????????
  ???????????????????????????????????
• HBeAg ?????????????????????????????
  ?????????????????? ???????????????????????????????
  ???????????????????
• HBcAg ???????????????????????????????
  ???????????????? ???????????????????????????????

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Hepatitis B virus

• HBsAg ????????????????????????????????????? ????
  ?????? ????????
• HBsAg ???????????????????? ?????? ???????????
  ??????

• ?????????????????????????? 3 ???
• ??????????? ??????????????????????????????????????
  ????????
• ??????? ????????????????????????????? ?????????
• ???????? ???????????? ??????????????

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Hepatitis B virus

• ??????????????????????? HBV ????????????????
• Hepatitis B vaccine
• Hepatitis B immunoglobulin
• ??????????????????

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5. Anti HIV

• ?????????????????????????? ELISA
• ????????????????????????????
• ??????????

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6.Blood group, Rh

• Rh negative ????????????????????????????
  ?????????????????? 2
• ???????? ????? Rh positive ??????????????
• anti-D immunoglobulin
• 28 weeks
• ????? 72 hrs ????????
• ?????????????? PND ????????? anti-D
  immunoglobulin ???????????????????????

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6.Blood group, Rh
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6.Blood group, Rh

• Rh negative ?????????? 2
• ??????? indirect Coombs test
• Positive -gt anti-D titer
• ?????????? 116 ???????????????????
• Negative -gt
• ??? anti-D immunoglobulin
• 28 weeks
• ????? 72 hrs ????????

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????????????????????????

• ????????????

???? ???????? 28-32 ???????
CBC ? ?(HCT)
OF, DCIP ?
HBsAg ?
VDRL ? ?
Anti-HIV ? ?
Blood group, Rh ?
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3.????????????

• ??????????????
• Ultrasound
• Amniocentesis
• Cordocentesis
• Non-stress test or fetal monitoring

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7.?????????????????????? albumin ??? glucose

• Albumin Negative, trace ??????????
• Albumin 1 ??????????????????????????????

???? Albumin ??? ??? 1 ??????? UA
???????????????????????????????????????????
??????????????????????????????????????????????????
?????
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7.?????????????????????? albumin ??? glucose

• Sugar Negative, trace ??????????
• Sugar 1 ??????????????????????????????

???? Glucose screening test ?????????????????????
140 mg/dl ?????? ????? oral glucose tolerance test
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8.50 gm CGT ???????????????????

• ???????????????????????????????
• ???????????????????????? ?????????????????????????
  ????????? 24-28 ??????? ?????????????????????????
  ???????????????
• ???????????????????????????? Mark obesity
  BMIgt27kg/m2
• ????????????????????? 2 ??????????
• ???????????????????????????????????????????
• ????????????????????????
• ?? impaired glucose metabolism
• Bad obstetric history

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????????????????????????????????? 2

• ???????????? 50 gm oral glucose challenge test
  ???????????? 24 - 28 ???????
• ??????????????????????????????????????????????????
  ??????????????????????????????????????
• ???????????????????????????? ????
• ??????????? 35 ??
• ???????????????????????????? 4000 ????
• ??????????????????????????????????? ????
  ????????????????????????? ????????????????????????
  ? ????????????????????????????? ????????????????
  ???????
• ?????????????????? AFI gt 25 ??.

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??????????????????????????????????????????????????
????????

• ??????????????????????????????????????????????????
  ??
• ???????????????????????????????(1st degree
  relatives)
• ???????????? 25 ??
• ????????????????????????
• ??????????????????????????????????
• ???????????? glucose metabolism ???????
• ?????????????????????????????

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2.?????????????????????? albumin ??? glucose

• 50g Glucose challenge test (50g GCT)
• gt140 mg/dl ??????? 100g OGTT
• 100g Oral glucose tolerance test (OGTT)
• FBS 105 mg/dl
• 1 ??????? 190 mg/dl
• 2 ??????? 165 mg/dl
• 3 ??????? 145 mg/dl

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NST or fetal monitoring
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Indications for the use of EFM

• Antenatal risk factors
• Maternal conditions
• Hypertension/Pre-eclampsia
• Diabetes
• Antepartum haemorrhage
• Other maternal medical diseases ?????? cardiac
  diseases, severe anemia, hyperthyroidism, renal
  disease ??? vascular disease ???????
• Fetal conditions
• Small fetus
• Prematurity
• Multiple pregnancy
• Breech presentation
• Abnormal umbilical artery Doppler velocimetry
• Isoimmunization
•  

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Indications for the use of EFM

• Intrapartum risk factors
• Maternal conditions
• Vaginal bleeding in labor
• Intrauterine infection
• Epidural analgesia
• Previous cesarean section
• Prolonged membrane rupture
• Induced labor
• Augmented labor
• Hypertonic uterus
• Fetal conditions
• Meconium staining of the amniotic fluid
• Suspicious non-reassuring fetal heart rate on
  auscultation
• Postterm pregnancy

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Amniocentesis

• Complication 0.5 (1200)
• GA 16-20 wks

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Cordocentesis

• Fetal loss 1-2
• GA 18-22 wks

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?????????????? prenatal diagnosis (PND)

• ???? 35 ?? ?????? EDC
• USG ??????????????????????????? fetal aneuploidy
• ????????????????? trisomy 21, 18, or 13
  ???????????
• ??????????????????????????????? balanced
  robertsonian translocation ?????????????????????
  trisomy 21 or 13
• ??????????????????????????????????????????????????
  ?????????????????

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Thank you