DIAGNOSTIC TEST (MONITORING A 
HEALTHY PREGNANCY)
1. Prenatal Testing
 are medical tests done during pregnancy
 test that provides valuable information about
the baby's health
 first 3 months are crucial
Reasons for testing:
 To confirm pregnancy
 Predict outcome of pregnancy
 Manage remaining weeks of pregnancy
 Plan for possible complications at birth
 Decide whether to continue the pregnancy
 Plan for possible complications that may occur
in newborn
 Find conditions that may affect future
pregnancies
What does the screening test do?
 identify patient at risk for a disorder in an
unsuspected population
 Filters patient for further diagnostic testing
 Results are given as 'high risk' or low risk
based on a "cut off" value
When are prenatal screening tests done?
 First trimester screening tests can begin as
early as 10 weeks
 Need to test your baby's overall development
and check to see if your baby is at risk of
genetic conditions
 Need to check for baby's abnormalities
 Determine baby's sex
Maternal Diagnostic Test
 HCG (human chorionic gonadotropin)
 CBC, Blood Grouping, RH Factor and
Antibody Screen
 hemogoblin, hematocrit and platelets are taken
 blood grouping (dapat alam ang blood types)
 VDRL/RPR
 Rubella Titer
 Skin Test/Tuberculin Test, Hemoglobin
Electrophoresis
 Hepatitis B Screening
 Urinalysis
 Papanicolaou Test (Pap Smear)
 Cervical Culture
Maternal Blood Glucose
 Alpha Fetoprotein Test (AFP)
 Ultrasound
 Non-stress Test
Main Types of Testing
1. Routine Test
2. Screening Test
- can identify whether the baby is more
likely to have certain conditions
- can't make definitive diagnosis
- cause no risk for both the baby and the
mother
3. Diagnostic Test
- a more invasive prenatal diagnostic test
- only way to be sure of the diagnosis
- some tests carry a slight risk of
miscarriage
2. Maternal Diagnostic Test
 HCG (Human Chorionic Gonadotropin)
- found in the placenta of the mother. placenta is
formed if the mother is pregnant, the baby creates
HCG through the umbilical cord.
- a pregnancy test that measures a hormone in
the body
Specimen: blood and urine (blood takes weeks and
urine takes minutes)
Urine: 1 line (negative) 2 line (positive)
Blood: the most accurate
Purpose:
- to check or confirm pregnancy
- identify or rule out ectopic pregnancy
- check for pregnancy prior to surgery or other
medical treatments
- screen for down syndrome
 HCG has acceptable value. If the value is low it
may lead to miscarriage or down syndrome
- monitor pregnancy that maybe at risk of
miscarriage
- help diagnose gestational trophoblastic
diseases (GTD)
 CBC
- the blood test used to look at overall health and
find a wide range of conditions including anemia,
infections and leukemia
 Hemoglobin - the most important component of
the RBC responsible in carrying oxygen
- oxygen carrying
- normal hemoglobin in women is 12.5
  Hematocrit - volume percentage of RBC in the
blood
- indicative - pag mataas may
hemoconcentration or dehydrated ang nanay
 Platelet - small colorless cell fragments in our
blood that form clots and stop or prevent
bleeding
- low platelet may lead to continuous
bleeding that may result to fetal
deformity or miscarriage
- the mother shouldn't experience
bleeding throughout the pregnancy
- pag detached ang placenta (placenta
abrup
- pag nahulog ang placenta (placenta
previa)
 WBC Differential Count
- are group of immune cells that help our body
fight against an infection
- Normal WBC IS 5-10
Purpose:
- to detect infection, anemia or cell
abnormalities
Significance:
- Hgb < 11 g/dl in the first and third trimester or
< 10.5 dl in the second trimester may indicate a need
for iron supplementation
- CBC 12,000/ mm3 or more WBC
- Low platelet count may require follow up
Nursing interventions:
- explain the blood count purpose and procedure
- inform that no fasting is required
- apply manual pressure and dressing over
puncture site
- monitor the puncture site for oozing or
hematoma formation
- instruct the patient to resume normal activities
and diet
 Blood Typing/ Grouping/ RH Factor and
Antibody Screen
- usually done during the first prenatal visit to
determine blood group and check the incompatibility
- A+, A-, B+, B-, AB+, AB-, O+, O-
- If Rh- negative, baby will have disruption
Purpose:
- determine blood type and RH
- check for possible maternal-fetal blood
incompatibility
Significance:
- identifies possible causes of incompatibility
with the fetus that may cause jaundice
- if mother is Rh- and father is Rh+ or
antibodies are present, additional testing and treatment
are required, if Rh- and unsensitized Rhogam will be
given at 28th week.
- Mother should be Rh+
 VDRL (Veneral Disease Research
Laboratory) and RPR (Rapid Plasma
Reagin)
- test for sexually transmitted disease. the std
will be transferred to the baby.
- screening test for syphilis measuring
substances (proteins), called antibodies, which one
body may produce if it had come in contact with the
bacteria that causes syphilis
- (-) means normal and (+) is otherwise
Specimen:
- blood sample/spinal fluid
 Rubella Titer
- used to diagnose current or prior infection with
rubella virus
- Rubella virus causes fetal deformity
Specimen: blood or urine
Purpose:
- To determine immunity/ prior vaccination
Significance:
- if titer is 1:8 or less, mother is not immuned.
 Immunize post-partum
 Skin Test/ Tuberculin Test
- test for tuberculosis in pregnant women using
purified protein derivative (PPD)
- safe and accurate during pregnancy and is
recommended for pregnant women who have tb
symptoms or at high risk of tb
Positive: red and rashes around the wheel
Purpose:
- to screen for tuberculosis
Significance:
- if result is positive, refer for additional testing
or therapy
 Hemoglobin Electrophoresis
- a test that measures the different types of
hemoglobin in the blood
- done to detect hemoglobinopathies
(HbA, HbA2, HbF, HbS, HbC, HbH, HbM)
Purpose:
 - to screen sickle cell trait if clients are of - to screen cervical neoplasia/cell abnormality
African-American descent and cancerous processses in the colon

Significance: Significance:
- if mother is positive, check partner; infants at - treat and refer if abnormal cells are present
risk only if both parents are positive * Every year or every 2 years
Signs & Symptoms:
- painful swelling of the hands and feet known  Cervical Culture
as the Dactylitis - a cervical screening taking a sample cell from
- fatigue the cervix
- skin and eyes are yellowish (Icteris) - result is 2-6 weeks
- no intercourse prior to the procedure
 Hepatitis B Screening Purpose:
- principal screening test for Hepa B is the - to detect Group B streptococci and sexually
serologic identification of HBsAg (the first marker to transmitted disease
appear after infection and can be detected 8-12 weeks - result: 2-6 weeks
after exposure and often precedes symptoms What to instruct:
Purpose: - avoid intercourse for a few days beforehand
- to detect presence of antigen in maternal blood - avoid using any vaginal product or douching
Indications: beforehand
- To detect exposure to HBV - avoid using vaginal medication beforehand
- Detect possible carrier status Significance:
- Pre and post vaccination testing - Treat and retest as necessary, treat group B
- Routine prenatal testing streptococci during labor
- Screen donated blood before transfusion
Significance:  Maternal Blood Glucose
- if present, infants should be given hepatitis - a test during pregnancy to screen gestational
immune globulin and vaccine soon after birth diabetes
- fasting is not needed
Purpose:
Urinalysis - to screen for possible gestational diabetes
- a visual, chemical, microscopic test that checks Significance:
several components of a urine sample - if elevated, a 3-hour glucose tolerance test is
- done in the first prenatal appointment then recommended
several times throughout pregnancy Steps:
Purpose: - papainumin ng sugary solution (water and 50g
- to detect renal disease or infection, as well as sugar)
diabetes, dehydration and possibility of eclampsia - one hour later, measure the sugar level
Urine: - if elevated will refer to another test
- Glucose (+) - diabetes
- CHON - kidney (gestational - lalaki si bata,  Alpha Fetoprotein Test (AFP)
lapitin ng infection) - a test that is mainly used to measure the level
Significance of Alpha-Fetoprotein (AFP) in the blood of a pregnant
- reassess if positive for more than a trace to check baby's risk for having certain genetic
protein (renal damage, pre-eclampsia, or normal), problems and birth defects
ketones (fasting on dehydration) or bacteria (infection) - Done during the 15-18 weeks of pregnancy
- Produced by the liver of the baby
 Papanicolaou Test (Pap Smear) Two ways to test:
- a method of cervical screening which involves - through the mother's blood
collecting cells from the cervix - through the amniotic fluid
- result is 1-3 weeks Too high or too low result may indicate:
Purpose:
 - ONTD (open neutral tube defects) such as
spina bifida
- deformity in the spinal column (hindi
magiging maganda ang development ng brain)
- Anencephaly (absence of all or part of the
brain)
- Down syndrome
- Other chromosomal abnormalities
- Defects in the abdominal wall of the baby
- Twins
- Miscalculated due dates
 Ultrasound
- is an imaging test that uses sound waves to
make pictures of organs, tissues, and other structures
inside the body
Purpose:
- to check baby's development
- to detect abnormalities in the baby
- confirm the presence, size, and location of the
placenta and amniotic fluid
- to know the AOG (age of gestation by weeks:
38-40 weeks)
- predict maturity
- to determine baby's gender
- to detect presentation and position
Accuracy:
- depends on clarity of image
- Technician's ability to read image
Nursing responsibilities:
- explain procedures
- instructor encourage fluid intake
- instruct not to void before the trest
- full bladder is necessary after 20 weeks of
gestation
 Biparietal Diameter
 Doppler Umbilical Velocimetry
 Placental Grading
 Amniotic Fluid Volume Assessment
 Ultrasonography
AMNIOTIC FLUID VOLUME ASSESMENT
Guidelines for measuring AFI:
 For gestations < 20 wks, uterus is divided into
2 vertical halves
 Measure the vertical diameter of the largest
pocket of amniotic fluld present on each side in
cm, then add
 For gestations > 20 wks., uterus is divided into
4 quadrants
 Measure the vertical diameter of the largest
pocket of amniotic fluid present on each
quadrant in ers, then odd
 HIV SCREENING
 INDICATIONS
o Evaluate suspected HIV infection and
assessment of patients with a history of
exposure to HIV infected persons
through sexual or parenteral activities.
o Screen persons whose blood, plasma
products, tissues, and organs are being
donate transfusion and transplantation.
HIV SCREENING
 Test pregnant women and infants born to
infected women.
 Test sexual partners of HIV-infected persons.
 Test after needlestick exposure or bite by
infected person
HIV SCREENING ON PREGNANT WOMEN
- Recommended as a part of Prenatal care check
up
- If tested positive, medications are available to
prevent spread of virus to the unborn baby.
- Steps can be done during delivery to prevent
the spread during delivery.
- Cesarean Section Is advised to reduce th
transferring the virus before the water bred especially
if the viral load is high or unknown.
The HIV test will be done at the same time as other
routine antenatal blood tests (blood group and Rhesus
factor, full blood count, hepatitis B, rubella and
syphilis). One sample of blood can be used for all the
tests.
NURSING RESPONSIBILITIES:
 An informed consent must be signed by any
person who is being tested for HIV/AIDS.
 The consent must accompany the specimen to
the laboratory, or if the patient goes to the
laboratory for venipuncture, consent must
accompany the patient
Non-stress Test
- used to evaluate a baby's health before birth
 - the goal of a nonstress test is to provide useful
information about your baby's oxygen supply by
checking his or her heart rate and how it responds to
your baby's movement
- the test might indicate the need for further
monitoring, testing or delivery
- recommended when its believed that the baby
is at an increased risk of death
- a nonstress test may be done after 26 to 28
weeks of pregnancy
- certain nonstrss test results might indicate that
you and your baby need further monitoring, testing or
special care
Indication for Nonstress Test
- A multiple pregnancy with certain
complications
- An underlying medical condition, such as type
1 diabetes, heart disease or high blood pressure during
pregnancy
- A pregnancy that has extended two weeks past
your due date (post-term pregnancy)
- A history of complications in a previous
pregnancy
- A baby who has decreased fetal movements or
possible fetal growth problems
- Rh (rhesus) sensitization - a potentially
serious condition that can occur, typically during a
second or subsequent pregnancy, when your red cell
antigen blood group is Rh negative and your baby's
blood group is Rh positive.
- Low amniotic fluid (oligohydramnios)
- Blood pressure taken after the nonstress test.
- Notify the patient the procedure is done.
Vibroacoustic Stimulation
- Producing a sharp sound of approximately 80
decibels at a frequency of 80 Hz, startling and waking
the fetus
- Done in conjunction with a nonstress test
Biophysical Profile (BPP)
- Assess breathing movements, body
movements, tone, amniotic fluid volume and FHR
reactivity (NST)
- A score of 2 is assigned to each finding, with a
score of 8 to 10 indicating a healthy fetus
1. Used for fetus that may have intrauterine
compromise - a biophysical profile combines five
parameters:
1. fetal reactivity
2. fetal breathing movements
3. fetal body movement
4. fetal tone
5. amniotic fluid volume
Biophysical Profile
1. A result of 8-10 indicates that the fetus is doing
well
2. A score of 6 is considered suspicious
3. A score of 4 denotes a fetus probably in jeopardy

Before the procedure

- Blood pressure taken before the nonstress test
begins.
- Assessment of the FHR for whether a good
baseline rate and a degree of variability are present

During the procedure

- During the nonstress test, patient will sit on a
reclining chair. Blood pressure taken at regular
intervals during the test.
- A sensor will be place around the abdomen
that measures the fetal heart rate.
- Typically, a nonstress test lasts 20 minutes.
However, if the baby is inactive or asleep, you might
need to extend the test for another 20 minutes - with
the expectation that the baby will become active - to
ensure accurate results. The baby will be stimulated by
placing a noise-making device on your abdomen.

After the Procedure