LABS AND DIAGNOSTICS

Urine Protein Test

- A test used to measure the amount of protein present in the urine
- This test is often used to help detect and diagnose kidney damage

NORMAL VALUES

NON-PREGNANT Less than 150 mg/day

PREGNANT Less than 300 mg/day

Case of the patient: 2nd Trimester

Positive for proteinuria - may be an indication of pre-eclampsia

Elevated level of protein in the urine may be seen temporarily during pregnancy but the range
should not exceed 300 mg/day. Any amount of protein in the urine over 300 mg/day may
indicate pre-eclampsia. It is normal to have an increased level of protein in the urine during
pregnancy due to increase in blood volume.

Blood Urea Nitrogen Test

- A test used to measure the amount of nitrogen in the blood that comes from the waste
product urea
- Done to see how well the kidneys are working

NORMAL VALUES

NON-PREGNANT 7 - 20 mg/dL

PREGNANT 3 - 13 mg/ dl
Creatinine Blood Test
- A test used to measure the level of creatinine in the blood
- High levels of creatinine may indicate kidney damage
- A high level of Creatinine in the blood indicates that the kidneys are not functioning well

NORMAL VALUES

NON-PREGNANT 0.6 - 1.2 mg/dL

PREGNANT 0.4 - 0.8 mg/dL

Case of the Patient: 2nd Trimester

- Serum Creatinine: 1.3 mg/dL

- Damage to the kidneys caused by preeclampsia may increase the creatinine level in the
blood because the kidneys are filtering less creatinine out of the blood.

Uric acid blood test

- This test measures the amount of uric acid present in the blood
- Also used to identify kidney damage
- High levels of uric acid in the blood indicates that the kidneys are damaged and unable
to filter uric acid from the body
- Uric acid is a waste product formed from the breakdown of some protein-rich foods and
the breakdown of cells in the body.
- It is normally filtered from the blood by the kidneys but if the kidneys have been
damaged by preeclampsia, uric acid levels in the blood may rise.

NORMAL VALUES

NON-PREGNANT 2.5 - 7.5 mg/dL

PREGNANT 3 - 5 mg/dL

Liver enzymes - elevated levels of these liver function tests may indicate organ damage from
pre-eclampsia

● Alanine Aminotransferase test

- A blood test used to check for liver damage
- Alanine aminotransferase is an enzyme found mostly in the cells of the liver and kidney.
 - When liver damage is present, the liver releases Alanine aminotransferase into the blood
- The function of Alanine Aminotransferase is to convert alanine, an amino acid found in
proteins, into pyruvate, an important intermediate in cellular energy production.

NORMAL VALUES

NON-PREGNANT 7 - 41 U/L

PREGNANT 2 - 33 U/L

● Aspartate aminotransferase test

- A blood test used to check for liver damage
- Aspartate aminotransferase is an enzyme found in cells throughout the body but it is
found mostly in the liver, kidneys, and heart
- Liver cells release AST into the blood when damaged

NORMAL VALUES

NON-PREGNANT 12-38 U/L

PREGNANT 3-33 U/L

Complete Blood Count

- A complete blood count is a blood test used to measure several components of the
blood such as red blood cells, white blood cells, hemoglobin, hematocrit, and platelets.
- It is used to review the overall health of a person an an abnormal increase or decrease
in cell counts may indicate an underlying medical condition such as anemia, infection, or
cell abnormalities that may require further evaluation.

Components Non-Pregnant Pregnant

Red blood cell count 4.5-5.4 million/mm3 3.8-4.4 million/mm3

Decreases slightly because
of hemodilution

Hemoglobin 12-16 g/dL 1st & 3rd trimester

: At least 11g/dL
2nd trimester: At least 10.5
g/dL

Hematocrit, packed cell 37% - 47% 33.8% - 39%

volume

White blood cell count 5000 - 10,000/mm3 5000 - 15,000/mm3

 Platelets 150,000 - 400,000/mm3 Slight decrease but within
normal range

Case of the Patient: 2nd Trimester

Hemoglobin 109 g/L Normal

Hematocrit 0.31 Low

White blood cell count 12 Normal

Coagulation Profile
- A screening test for abnormal blood clotting to examine the factors that are associated
with a bleeding problem. This includes prothrombin time (PT), activated partial
thromboplastin time (APTT), platelets, and fibrinogen.

Non-Pregnant Pregnant

PT 11 - 12.5 seconds Slight decrease

APTT 30 - 40 seconds Slight decrease

Platelets 150,000 - 400,000/mm3 Slight decrease but within

normal range

Fibrinogen 200 - 400 mg/dL 300 - 600 mg/dL

- Pregnancy is a hypercoagulable state because of an increase in factors that favor clotting

and a decrease in factors that inhibit clotting. Fibrinogen (factor I), fibrin split products, and
factors VII, VIII, IX, and X rise by 50%. These changes increase the ability to form clots.
These changes offer some protection from hemorrhage during childbirth but also increase
the risk of thrombus formation. The risk is a particular concern if the woman must stand
or sit for prolonged periods with stasis of blood in the veins of the legs.

Blood Grouping, Rh Factor, and Antibody Screen

- The test is done to determine the blood type to screen for maternal-fetal blood
incompatibility.
- Rhesus (Rh) factor is an inherited protein found on the surface of the red blood cells. If
the protein is found in one’s blood then the individual is considered Rh positive while the
individual who does not have the protein is Rh negative. Rh positive is the most common
blood type.
- If the woman is Rh negative, it does not affect her health but it can affect her pregnancy.
Since the woman is Rh negative, she can develop antibodies to an Rh positive. Even if a
 small amount of the baby’s blood gets mixed with the mother’s blood, the antibodies that
have been developed can cross the placenta and attack the baby’s blood resulting to
breaking down the fetus’s red blood cells thus the baby will be anemic. The condition is
called hemolytic anemia, which can cause serious illness, brain damage, or even death
to the fetus.
- The antibody screen is a test to show if an Rh negative woman has developed
antibodies to an Rh positive blood. An injection of Rh immunoglobulin (RhIg) is given to
the woman to prevent sensitization of an Rh negative woman, it is used during
pregnancy (around the 28th week) and after pregnancy.

Urinalysis
- A urine test is used to assess bladder or kidney infections, diabetes, dehydration,
proteins, ketones, and bacteria.
- Further assessment is needed if there is a trace of protein, ketones, or bacteria is found
in the patient’s urine.
Case of the Patient:
(+) Glucosuria It is normal that glucose in the urine.

(+) Proteinuria May indicate infection or a problem in the

kidneys. Protein found in the urine may
indicate preeclampsia.

(+) Polyuria and bubbly urine Polyuria is accompanied by diabetes, which is

manifested by the patient.
During pregnancy, the kidney’s of the woman
have to filter high amount of amino acid and
when the amount of amino acids are
excessive the kidneys does not absorb it all
thus the protein escape into the urine making
the urine to become bubbly.

(+) Intermittent dysuria and passage of
whitish amount of whitish to yellowish vaginal
discharge
During pregnancy, the woman is prone in
acquiring infections such as urinary tract
infection (UTI). this is due to the changes in
the urinary tract since the uterus is directly on
top of the bladder, as the uterus grows its
increased weight can block the drainage of
urine from the bladder.

Fasting Blood Sugar

- Glucagon and Insulin, two hormones from the pancreas, affect the blood glucose level.
- Insulin is needed for cellular membrane permeability to glucose and for transportation of
glucose into cells; without insulin glucose cannot enter the cells.
- Glucose is formed from dietary carbohydrates
- Glucose is stored as glycogen in liver and bones
- FBS greater than 125 mg/dL usually indicated diabetes. OGTT may be ordered for to
confirm the results.
Reference for FBS:
Fasting blood glucose 70-110 mg/dL
Post-Prandial (2 hours) 65-140 mg/dL

Prediabetes 110-125 mg/dL

Diabetes 126 mg/dL and above on two or more

samples

Purposes:
- To confirm a diagnosis of prediabetic

CBGM
-

GLYCOSYLATED HEMOGLOBIN TEST (Hemoglobin A1C)

- Hemoglobin A compromise 91 to 95% of total hemoglobin.
- Glucose molecule is attached to Hb A1, which is a portion of hemoglobin A; The process
of attachment is called glycosylation or glycosylated hemoglobin or simply hemoglobin
A1.
- Formation of Hb A1 occurs slowly over 120 days, the lifespan of red blood cells .
- Hb A1 is composed of three hemoglobin molecules: Hb A1a, HbA1b, and HbA1c of
which is 70% (which is glycosylated meaning it absorbs glucose)
- HbA1c is 70% glycosylated which means it absorbs glucose.
- The amount of glycosylated hemoglobin depends on the amount of blood glucose
available; when the blood glucose level is elevated over a prolonged period of time
glycohemoglobin will result meaning the RBC has become saturated with glucose.
-
Reference for HGB A1c
Nondiabetic 2-5%

Diabetic control 2.5-6%

High average 6.1-7.5%

Uncontrolled diabetes >8%

- Glycosylated hemoglobin represents an average blood glucose level during a 1-3month
period.
- This test is used mainly as a measurement of the effectiveness of diabetic therapy.
- Hb A1c is a better indicator of diabetes control. However, a false decreased HbA1c
level can be caused by a decrease blood level.

Purposes:
● To monitor the effectiveness of diabetic therapy
● To manage diabetic therapy
 ● To provide information regarding the presence of diabetes mellitus
● To determine the client’s compliance with diabetic therapy

Clinical Problems
Decreased level: Anemia, thalassemia, long-term blood loss, chronic renal failure
Increased level: Uncontrolled diabetic mellitus, hyperglycemia, alcohol ingestion,
pregnancy, hemodialysis

Procedure
 ● Schedule the lab HbA1c test 6-12 weeks after diabetic treatment.
● Food restricting prior to the test but sometimes can be suggested for accurate results

Factors affecting laboratory results:

● Anemia may cause a low value result
● Hemolysis of the blood specimen can cause inaccurate results
● Heparin therapy may cause false test result
Nursing implications:
● Monitor blood and/ or urine glucose levels. Compare monthly fasting blood sugar with
glycosylated hemoglobin test result.
● Check previous FBS results
● Determine compliance to diabetes
● Recognize clinical problem that can cause a false result

ORAL GLUCOSE TOLERANCE TEST

1. Glucose Challenge test/Oral Glucose Challenge Test (?)
FETAL AND MATERNAL ASSESSMENT

Ultrasound

Ultrasound is a test that uses high-frequency sound waves to view the developing baby to
check the fetal heartbeat, determine gestational age of the baby and estimate the due date, check
for multiple pregnancies, examine the placenta, uterus, ovaries, and cervix, diagnose an abnormal
complication, and check for any abnormal growth in the fetus. In the second trimester (12 to 24
weeks) and the third trimester (24 to 40 weeks or birth), an ultrasound may be done to monitor
the fetus’ growth and position, determine the sex of the baby, assess the placenta for any
complication, assess the fetus for any congenital defects, monitor the amniotic fluid, and to
measure the length of the cervix.

Doppler Assessment

A type of ultrasound which uses soundwaves to detect the movement of blood in the vessels. It
is used to assess the uterus, placenta and the blood circulation of the fetus inside the womb.

Alpha Fetoprotein Screening

Alpha Fetoprotein or the predominant protein in fetal plasma and is synthesized in the
embryonic yolk sac, developing fetal liver and GI tract diffuses from fetal plasma into fetal urine
while others cross the placental membranes into the maternal circulation. Abnormal concentration
of AFP in AFAFP and MSAFP may indicate serious fetal abnormalities. It is done by (1) Initial
screening is offered to women 16-18 weeks AOG where blood may be drawn for the concentration
of MSAFP. (2) Gestational age, maternal weight, multifetal pregnancy, race, maternal diabetes
and ethnicity can affect MSAFP and must be considered. Lastly, (3) Women with Type I diabetes
have a greater risk for a fetus with an NTD yet may have a lower MSAFP level.

Nonstress Test
This test identifies whether an increase in FHR occurs when the fetus moves which
indicates adequate oxygenation, a healthy neural pathway from the fetal CNS to the fetal heart
and the ability of the fetal heart to respond to stimuli. If the fetal heart fails to respond, acidosis
and fetal hypoxemia are concerns. It lasts for about 40 minutes. Before NST, patient must voids
and baseline VS should be taken. Seating position or HOB elevated at 45 degrees positions are
advised. An external electronic monitoring equipment to the abdomen is applied to detect FHR
and any contractions. A tocotransducer which detects uterine activity and fetal movement is
secured and FHR and activity are recorded on a moving electronic strip.

Biophysical Profile
It consists of five parameters namely; (1) Non-stress test, (2) fetal breathing movements,
(3) gross body movements, (4) fetal tone and (5) Amniotic fluid volume. The individual
components of the examination are a combination of acute and chronic markers of fetal well
being.
1. Non-stress test

Fundic height Assessment

Placental Grading
Doppler Assessment
Amniotic Fluid Index
Electrolyte test

Reference: (bukas ko na ayusin citation ko -ginelle)

https://www.aafp.org/afp/2000/0201/p713.html#ref-list-1
https://americanpregnancy.org/pregnancy-complications/urinary-tract-infections-during-
pregnancy/
https://labtestsonline.org/tests/complete-blood-count-cbc#
https://americanpregnancy.org/prenatal-testing/urine-test/
https://my.clevelandclinic.org/health/diagnostics/16790-blood-sugar-tests
https://labtestsonline.org/conditions/pre-eclampsia
https://healthengine.com.au/info/coagulation-profile-test
https://www.nhs.uk/conditions/antiphospholipid-syndrome/
https://www.preeclampsia.org/the-news/138-latest-news/637-making-sense-of-preeclampsia-
tests
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809617/
https://www.healthline.com/health/creatinine-blood
https://americanpregnancy.org/pregnancy-complications/rh-factor/
https://www.umcvc.org/health-library/hw20579