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Updated: Mar 7 2021

Pregnancy Labs

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  • Human Chorionic Gonadotropin (hCG)
    • Measured in urine or blood
      • blood test more sensitive
    • Produced by
      • syncytiotrophoblast of the 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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