Obstetrics Book


Prenatal Lab

Aka: Prenatal Lab
  1. Initial Labs: General
    1. Complete Blood Count
      1. Hemoglobin
      2. Platelets
    2. Urine sample
      1. Urinalysis
      2. Urine Culture
    3. Blood Type
      1. ABO and Rh
      2. Antibody screen (Coombs test)
    4. Rubella Antibody
      1. MMR contraindicated during pregnancy
      2. Administer postpartum MMR if negative
      3. Screen prior to pregnancy and immunize if negative
    5. Syphilis Serology (RPR)
    6. Hepatitis B Surface Antigen (HBsAg)
      1. If at risk, Hepatitis B Vaccine (safe in pregnancy)
    7. Hepatitis C Antibody
      1. ACOG recommends screening as part of Prenatal Labs
    8. Pelvic Exam Initial Labs
      1. Gonorrhea PCR
      2. Chlamydia PCR
      3. Pap Smear
    9. HIV Test
    10. Consider Thyroid Stimulating Hormone (TSH) in all women
  2. Initial Labs: Specific risk factor directed tests
    1. Group B Streptococcus Culture
      1. Culture both vagina and anus
    2. Sickle Cell Anemia or Sickle Cell Trait screen
      1. Predisposes to Pyelonephritis
    3. Glucose Challenge Test (50 g Glucola drink)
    4. Hepatitis C Antibody
    5. If no maternal history of Varicella infection
      1. Obtain varicella zoster IgG and if negative
        1. Avoid Varicella exposure
        2. If exposed, consider varicella Immunoglobulin
        3. Offer postpartum Varicella Vaccine
          1. Wait 3 months after last RhoGAM shot
      2. Varicella Vaccine is contraindicated in pregnancy
      3. Screen prior to pregnancy and immunize if negative
  3. Second Trimester Labs: 16-18 weeks
    1. See Triple Analyte Screen
    2. Consider first trimester screening of trisomy 16, 18
    3. Urine Culture
  4. Third Trimester Labs: 26-28 weeks
    1. Glucose Challenge Test (50 g Glucola drink)
    2. Hemoglobin
    3. If Rh Negative mother
      1. Repeat Antibody screen (Coombs test)
      2. Administer RhoGAM 300 mcg after blood draw
    4. If mother at risk for Sexually Transmitted Disease (e.g. incarceration, multiple sex partners, Illicit Drug use)
      1. Repeat RPR for Syphilis Testing
      2. Repeat Gonorrhea Culture or Gonorrhea Antigen
      3. Repeat Chlamydia Antigen
      4. Repeat Hepatitis B Surface Antigen (HBsAg)
      5. Repeat HIV Test
    5. If high risk for Preterm Labor
      1. Consider Bacterial Vaginosis screening
      2. Consider Fetal Fibronectin
  5. Third Trimester Labs: 35-37 weeks
    1. Group B Streptococcus screening

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