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OB6 Obstetrics
Antepartum Care Toronto Notes 2019
Leopold’s Maneuvers
• performedafter30-32wkgestation
• firstmaneuver:todeterminewhichfetalpartislyingfurthestawayfromthepelvicinlet • secondmaneuver:todeterminethelocationofthefetalback
• thirdmaneuver:todeterminewhichfetalpartislyingabovethepelvicinlet
• fourthmaneuver:tolocatethefetalbrow
A. First B. Second C. Third D. Fourth
Figure 2. Leopold’s maneuvers (T3)
Reprinted with permission from Essentials of Clinical Examination Handbook, 6th ed. Lincoln, McSheffrey, Tran, Wong
Prenatal Screening and Diagnostic Tests
Screening Tests
• testingshouldonlyoccurfollowingcounsellingandwithinformedconsentfromthepatient
Table 2. High-Risk Population Screening Tests
Disease (Inheritance)
Thalassemia (AR)
Sickle Cell (AR)
Cystic Fibrosis (CF) (AR)
Tay Sachs Disease (AR) Fragile X Syndrome (X-linked)
Population(s) at Risk
Mediterranean, South East Asian, Western Pacific, African, Middle Eastern, Caribbean, South American
African, Caribbean, Mediterranean, Middle Eastern, Indian, South American
Family history of CF in patient or partner or medical condition linked to CF like male infertility
Ashkenazi Jewish*, French Canadians, Cajun
Family history – confirmed or suspected
Screening Test(s)
CBC (MCV and MCH), Hb electrophoresis, or HPLC
CBC (MCV and MCH), Hb electrophoresis, or HPLC
CFTR gene DNA analysis
Enzyme assay HEXA, or DNA analysis HEXA gene
DNA analysis: FMR-1 gene
AR = autosomal recessive; HEXA = hexosaminidase A; HPLC = high performance liquid chromatography
*If both partners are Ashkenazi Jewish, test for Canavan disease and Familial Dysautonomia (FD); if family history of a specific condition, look for carrier status: e.g. Gaucher, CF, Bloom syndrome, Niemann-Pick disease, etc. In all cases, if both partners are positive, refer for genetic counselling.
Table 3. Gestation-Dependent Screening Investigations
Routine T2 U/S at 18-22 wk Helps Determine
• Number of fetuses
• GA (if no prior U/S)
• Location of placenta • Fetal anomalies
Gestational Age (wk)
8-12
>10
10-12 11-14
11-14
15-16 to term 15-20
Investigations
Dating U/S, possible Pap smear, chlamydia/gonorrhea testing, urine C&S, HIV, VDRL, HepBSAg, Rubella IgG, Parvovirus IgM or IgG if high risk (small child at home or daycare worker/primary teacher), Varicella IgG if no history of disease/immunization, CBC, blood group and screen, urine cultures to detect asymptomatic bacteriuria
NIPT
CVS
Enhanced FTS IPS Part 1
Nuchal translucency U/S Amniocentesis
IPS Part 2
Details
Measures cell free fetal DNA in maternal circulation
Measures
1. Nuchal translucency on U/S 2. β-hCG
3. PAPP-A
4. PlGF (enhanced FTS only)
5. MSAFP (enhanced FTS only)
Measures
1. MSAFP
2. β-hCG
3. Unconjugated estrogen
(estriol or μE3) 4. Inhibin A
© Emilie McMahon 2004