II. Labs: Initial - General
- Complete Blood Count
- Urine sample
- Urine Culture
- Urinalysis
- Asymptomatic Bacteriuria complicates 15% of pregnancies (Pyelonephritis develops in 30% of cases)
- Blood Type
- Rubella Antibody
- MMR contraindicated during pregnancy
- Administer postpartum MMR if negative
- Screen prior to pregnancy and immunize if negative
-
Syphilis Serology
- Universal screening recommended with automated Treponemal test
-
Hepatitis B Surface Antigen (HBsAg)
- Universal screening recommended in U.S.
- If at risk, Hepatitis B Vaccine (safe in pregnancy)
-
Hepatitis C Antibody
- ACOG recommends screening as part of Prenatal Labs
- Pelvic Exam Initial Labs
- Pap Smear
- Gonorrhea PCR and Chlamydia PCR
- Universal screening recommended
-
HIV Test
- Universal screening recommended
-
Thyroid Stimulating Hormone (TSH, with reflex Free T4)
- See Pregnancy Risk Assessment regarding Thyroid disease risk in pregnancy
- See Thyroid Dysfunction in Pregnancy
- HIstorically has been a part of routine pregnancy labs in U.S.
- However no evidence that universal screening improves pregnancy outcomes
- Obtain if history of Thyroid disease or as clinical findings dictate
- References
III. Labs: Initial - Specific risk factor directed tests
- Vaginitis testing if symptomatic
-
Group B Streptococcus Culture
- Culture both vagina and anus
-
Sickle Cell Anemia or Sickle Cell Trait screen
- Predisposes to Pyelonephritis
- Glucose Challenge Test (50 g Glucola drink)
- If no maternal history of Varicella infection
- Obtain varicella zoster IgG and if negative
- Avoid Varicella exposure
- If exposed, consider varicella Immunoglobulin
- Offer postpartum Varicella Vaccine
- Wait 3 months after last RhoGAM shot
- Varicella Vaccine is contraindicated in pregnancy
- Screen prior to pregnancy and immunize if negative
- Obtain varicella zoster IgG and if negative
IV. Labs: Second Trimester (16-18 weeks)
- See Triple Analyte Screen
- Consider first trimester screening of trisomy 16, 18
- Urine Culture
V. Labs: Early Third Trimester (26-28 weeks)
- Glucose Challenge Test (50 g Glucola drink)
- Hemoglobin
- If Rh Negative mother
- If mother at risk for Sexually Transmitted Disease (e.g. incarceration, multiple sex partners, Illicit Drug use)
- Repeat RPR for Syphilis Testing
- Repeat Gonorrhea Culture or Gonorrhea Antigen
- Repeat Chlamydia Antigen
- Repeat Hepatitis B Surface Antigen (HBsAg)
- Repeat HIV Test
- If high risk for Preterm Labor
- Consider Bacterial Vaginosis screening
- Consider Fetal Fibronectin
VI. Labs: Late Third Trimester (35-37 weeks)
- Group B Streptococcus screening