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Human Chorionic Gonadotropin (hCG)
  • Measured in urine or blood
    • blood test more sensitive
  • Produced by 
    • placenta after implantation 
  • Used to detect pregnancy
    • can see pregnancy on transvaginal ultrasound after hCG reaches 1,500-2,000 mIU/mL
Urine Estriol
  • Measured in maternal urine
  • Produced by
    • fetal adrenal gland
    • maternal liver
    • placenta
  • Sign of fetal growth
    • ↓ estriol is sign of fetal-maternal-placental dysfunction
α-Fetoprotein (AFP)
  • Measured in maternal serum
  • ↑ AFP
    • associated with open neural tube defects
  • ↓ AFP
    • associated with Down syndrome
Lecithin/Sphingomyelin (L:S) Ratio
  • Measured in amniotic fluid
    • lecithin is a surfactant produced by fetal lungs
    • used to determine maturity of fetal lungs
  • L:S ratio > 2 indicates maturity
  • L:S ratio < 2
    • administration of cortisol ↑ lecithin production 
      • fetus normally produces during the stress of vaginal delivery
    • thyroxine also ↑ lethicin production
    • insulin ↓ production
First Trimester Screen (10-13 weeks)
  • Serum labs
    • serum free β-hCG or total hCG
      • ↑ trisomy 21
      •  trisomy 18 
      • ↓ trisomy 13 
    • pregnancy-associated plasma protein A (PAPP-A)
      •  trisomy 21
      •  trisomy 18 
      • ↓ trisomy 13 
  • Imaging
    • nuchal translucency measurement 
      • ↑ trisomy 21
      • ↑ trisomy 18 
Quadruple Screen (15-22 weeks)
  • Test for aneuploidy  
    • hCG
      • ↑ trisomy 21
      •  trisomy 18
    • alpha fetoprotein (AFP)
      •  trisomy 21
      •  trisomy 18
    • dimeric inhibin A
      • ↑ trisomy 21
      • no change or  trisomy 18
    • unconjugated estriol
      •  trisomy 21
      • ↓ trisomy 18



 

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