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07.01 Pregnancy Labs

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Overview

  1. Pregnancy labs
    1. Labs to consider for disease process
    2. Lab purposes
    3. Special Considerations

Nursing Points

General

  1. Pregnancy Labs
    1. Routine laboratory tests
      1. Comprehensive Metabolic Panel
      2. CBC
      3. Platelets
      4. Hemoglobin/Hematocrit
      5. Type & Screen
      6. Urinalysis
      7. Reactive plasma reagin
      8. Group B Strep swab
    2. Lab purposes
      1. CMP
        1. Evaluate kidney, electrolytes, other functions
          1. Kidneys impacted by pre-eclampsia
      2. CBC
        1. Platelets
          1. Clotting abilities considered for epidural
        2. Hemoglobin/Hematocrit
          1. Concerns for anemia
        3. CBC w/differential
          1. Signs of infection or inflammation
      3. Type & Screen
        1. Pregnancy/Labor at risk for bleeding
          1. Rh factor typing
          2. Blood typing for transfusion purposes
      4. Urinalysis
        1. Check for protein – pre-eclampsia
        2. Check for other abnormal biomarkers
          1. Infection
      5. Reactive plasma reagin
        1. Syphilis screen
      6. Group B Strep swab
        1. Group B Strep screen – necessary for reducing infection at delivery
    3. Special considerations
      1. CMP – Green top
      2. CBC – Lavender top
      3. T/S – Pink top
      4. RPR – Red/Green top
      5. GBS swab – bacterial swab (check facility or lab policy)

Nursing Concepts

  1. Lab Values
  2. Reproduction

Reference Links

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Video Transcript

Alright, in this lesson, we are going to take a look at the different types of labs for your pregnant patients or your patient’s going into labor.

The first thing we are going talk about is that there are going to be other lessons similar to this that focus on the different types of labs that you’re going to see with different types of diseases, or illness or conditions. And what we want to do is make sure that we’re providing you guys the information that you need to know, in order to predict the different types of labs or groups of labs that you’re going to see for each one of your patients with these different types of with conditions. So we’re going to start with pregnancy.

The first thing about pregnancy is that it’s a very common admission in the hospital and every patient is going to be different. The things that you need to understand is that labs are a necessary part of it. There’s different types of labs that we’re going to talk about. But, what their goal is to protect our patient.

Now, this is not a comprehensive list and it’s going to vary on a case-by-case basis, depending on what the providers are requesting or the condition that the patient may have. But these are just some general types of test that you’re going to see that are run of the mill.

You’ll start with something like the comprehensive metabolic panel, in addition to the CBC. You’re also probably going to see a type and screen in addition to a urinalysis. Now there are two different tests that are more specific to pregnancy, which are the reactive plasma reagin, or the RPR and the Group B strep test, or what’s called the GBS.

So why do we do all of these tests?

Well, first off let’s start off with the comprehensive metabolic panel. If you go into our lessons on lab panels, it goes through the nuances of them. But for the most part we are focusing on liver function, kidney function, and we also take a look at protein and electrolytes. Now this is really important in the pregnant patient, especially for patients that have pre-eclampsia. Their kidneys can be a little more stressed, so we can focus on the kidneys with this panel. The other thing that we want to look at is to see if there is any imbalance with the electrolytes due to kidney dysfunction.

The other thing we want to look at is a CBC, or a complete blood count. And we want to look at this for several reasons. The first is the differential. The differential is going to give you an indication of any type of infection because of the different types of white blood cells. It’ll also give an indication into different levels of inflammation. The other thing that we look at with a CBC is the hemoglobin and hematocrit, or H and H. This is going to tell us if our patient is having some type of anemia that might indicate if they’re going to need a blood transfusion. We want to see if our patient is baseline anemic. The most important value though on a CBC is your patient’s platelets. If you check out the lesson that talks about platelets, you’ll see that our normal values are 100 thousand to 400 thousand. When a patient has a decreased platelets and anything less than 100 thousand platelets, the patient is considered to be thrombocytopenic. This becomes a concern because pregnant patients often get epidurals, and if they don’t have that ability to clot, then they can eventually develop something called an epidural hematoma, which is dangerous. Pregnancy is already a difficult process and we don’t want to complicate it any further.

The next thing we want to talk about is a patient’s type and screen. Pregnant patients are at risk of bleeding so we want to make sure that we are prepared to give them blood transfusions. And what we do is a type and screen, which allows us to reduce the risk of a blood transfusion reaction. The type and screen can also help us identify any issues that your patient may run into with potential Rh factor mismatches between the mother and the fetus.

The other thing that you’ll also probably see in your patient’s labs are a urinalysis. This allows us to check out protein spilling into the urine. This is really important for our patients with pre-eclampsia. Also, a urinalysis will allow us to see if our patient’s potentially have a urinary tract infection.

The other two tests that you’ll probably see with pregnant patients are the reactive plasma reagin or RPR. This is a screening tool for pregnant patients to see if they have an infection of syphilis. The other test that we will also run on our pregnant patients is the Group B Strep screen. This a test for a potential infection that mothers can pass on to the baby at delivery. This is typically run between 35 and 37 weeks and if positive, the mother will need to be on IV antibiotics prior to delivery. While a low number of patients actually are positive or “colonized,” it’s important because it’s severe for the baby if passed on.

So what do you need to be looking at when you’re submitting your tests?

Well your CMP and and electrolytes are going to be sent in a green top. The CBC will be sent in the lavender top tube, which has EDTA in it. We want to make sure that all of the cells are free flowing, and not clumping, which is what the EDTA does. A type and screen is typically going to be sent in a pink top tube, but be sure to check your facility policy. The RPR and group b strep tests are swabs that will be sent to the lab.

For our nursing concepts for this lesson, we focus on lab values and reproduction for our pregnant patients.
So let’s recap.

First off, we want to monitor our kidney function with the comprehensive metabolic panel, in addition to electrolytes.

Our CBC is important for platelets and determining if our patient has anemia or an underlying infection.

You’ll commonly see a type and screen on a patient to determine Rh factor for both mom and baby, and also for any future transfusions.

And then the last two tests that you’ll see are the RPR which is for syphilis and then the Group B strep, because any patients that are considered positive need to receive IV antibiotics prior to delivery.

That’s it for our lesson on common labs that you’ll see for pregnant patients. Make sure you check out all of the resources attached to this lesson. Now, go out and be your best selves today. And as always, happy nursing!

  • Question 1 of 2

A nurse is caring for a mother who is 35 weeks’ pregnant. The client’s medical record states that she tested positive for group B Streptococcus infection. Which of the following precautions should be given in this situation?

  • Question 2 of 2

A pregnant client who is in labor has an epidural placed because she will be undergoing a cesarean section. The epidural remains in place for the next 24 hours after delivery. Which of the listed side effects is most commonly associated with an epidural following cesarean section?