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The testing she needs for a healthy pregnancy · The testing she needs for a healthy ... the 1ST...
Transcript of The testing she needs for a healthy pregnancy · The testing she needs for a healthy ... the 1ST...
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Making the right choices for them
Appropriate prenatal testing is a crucial part of caring for your patients who are expecting. To make it
easier to give them the right tests at the right time throughout their pregnancy, we’ve designed this guide
based on recommendations from the American Congress of Obstetricians and Gynecologists (ACOG).
ACOG recommendations —
the 1ST Trimester
Recommended Laboratory Screening1 Corresponding Quest Test(s) Test Code(s)*
Can be ordered as a group panel or individually†
Cervical cytology screening, if indicated‡
OB Panel
Additional First Trimester Tests
Urinalysis
Obstetric Panel‡
Individual components:
CBC (includes Differential and Platelet
Count);
Antibody screen, RBC with Refl ex to ID
and Titer, and Androgen Typing§;
ABO group and Rh type;
RPR refl ex to Titer and Confi rmatory
Testing§;
Hepatitis B Surface Antigen (HBsAG)
with refl ex Confi rmation§;
Rubella Virus IgG Antibody
20210,
6399,
795,
7788,
36126,
498,
802
Image-Guided Pap with Age-Based
Screening Protocols;
Image-Guided Pap with Age-Based
Screening, Plus CT/NG;
Image-Guided Pap with Age-Based
Screening, Plus CT/NG/Trich;
Pap alone
91384‡,
91385‡,
91386‡,
See note below‡
Urinalysis, with Refl ex to Microscopic§;
Urinalysis, Macroscopic
7909(X),
6448(X)
Some patients may require additional screening to see if they are carriers for certain hereditary conditions. For more information, please see page 8.
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Recommended Laboratory Screening1 (cont’d)
Maternal Serum Screen (part 1)
Noninvasive prenatal screening
TB, if indicatedıı
Chlamydia¶
HIV testing
Gonorrhea, if indicated¶
Chlamydia and gonorrhea
Additional infectious diseases
Hepatitis C testing
One or both of the following screens for fetal
aneuploidy should be offered
First trimester screen, hCG (includes
PAPP-A, hCG, NT, Down syndrome risk
and interpretation);
Serum Integrated Screen, Part 1 (includes
PAPP-A);
Sequential Integrated Screen, Part 1
(includes PAPP-A, hCG, NT, Down
syndrome and trisomy 18 risk and
interpretation);
Integrated Screen, Part 1 (includes
PAPP-A and NT)
QNatal® Advanced
Corresponding Quest Test(s) (cont’d)
QuantiFERON®-TB Gold
Chlamydia trachomatis RNA, TMA
HIV-1/2 Antigen and Antibodies, Fourth
Generation, with Refl exes§
Neisseria gonorrhoeae RNA, TMA
Chlamydia trachomatis/Neisseria
gonorrhoeae RNA, TMA
Hepatitis C Antibody with refl ex
to HCV RNA§
92777(X)
16145,
16165,
16131,
16148
Test Code(s)* (cont’d)
11361(X)
11362(X)
11363(X)
91431(X)
19453(X),
16603(X) draw site incubated
8472(X)
*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/Test Center for more information. † If Antibody Screen is positive, Antibody Identifi cation, Titer, and Antigen Typing will be performed at an additional charge. If RPR screen is reactive, RPR Titer and FTA
Confi rmatory testing will be performed at an additional charge. When only a single test, Hepatitis B Surface Antigen, is ordered to diagnose Hepatitis B in a pregnant woman, additional tests such as liver enzymes should be ordered to confi rm the diagnosis.
‡ The age-based offerings are based on ACOG recommendations and include image-guided Pap tests. Non-imaged Paps as well as conventional Paps are also available at Quest Diagnostics. Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.
§ Refl ex testing may be performed at an additional charge.|| Risk factors include known HIV infection; close contact with individuals known or suspected to have TB; medical risk factors such as diabetes, lupus, cancer,
alcoholism, and drug addiction; birth in or emigration from countries with high prevalence; being medically underserved; homelessness; living or working in long-term care facilities, such as correctional institutions, mental health institutions, and nursing homes.
¶ If positive, test-of-cure should be performed within 3-4 weeks post-treatment.
1ST
Trimester
4
2ND
Trimester
Special considerations2-4
Obesity in pregnancy
More than half of pregnant women in the United States are overweight or obese, putting them at greater
risk of pregnancy complications, such as gestational diabetes, preeclampsia, cesarean delivery, and giving
birth to an infant with congenital anomalies.
ACOG recommendations for counseling obese patients include:
• Discussing the increased risks to their baby
• Measuring their height and weight at their initial prenatal visit
– ACOG guidelines recommend a total weight gain of 15-25lbs for overweight women (BMI=25-29.9) and
11-20lbs for obese women (BMI≥30)
• Providing information on diet and exercise
Zika virus and pregnancy
Zika virus is a growing public health concern that has been associated with serious birth defects such as
microcephaly. Recommendations include:
• PCR and/or antibody testing for all pregnant women who have traveled to or live in an affected area
• Counseling for women of reproductive age who have traveled to or live in an affected area on potential risks
associated with infection
This is an evolving area of practice, and information may change. Visit cdc.gov/zika/pregnancy and
QuestDiagnostics.com/Zika for the most up-to-date information.
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ACOG recommendations —
the 2ND Trimester
Recommended Laboratory Screening1
CBC
Gestational diabetes screening
Differential and platelets:
Includes WBC, RBC, hemoglobin,
hematocrit, MCV, MCH, MCHC, RDW,
platelet count, MPV, and differential
(absolute and percent neutrophils,
lymphocytes, monocytes, eosinophils,
and basophils)
H/H, RBC, Indices, WBC, Plt:
Includes WBC, RBC, Hemoglobin,
Hematocrit, MCV, MCH, MCHC, RDW,
Platelet Count
Includes AFP, unconjugated
Estriol, hCG, Dimeric Inhibin A, UE3,
DIA (hyperglycosylated hCG), and
Maternal Risk Interpretation
Includes AFP, unconjugated Estriol,
hCG, Dimeric Inhibin A, and Maternal
Risk Interpretation
6399,
1759
8477,
19833,
6745
Maternal Serum Screen (part 2)†
Maternal Serum Alpha-Fetoprotein
Diagnostic Chromosomal Analysis via
amniocentesis or chorionic villus sampling,
if indicated†
Penta screen†
Quad screen†
Integrated screen, Part 2
(includes AFP, hCG, uE3, and DIA)
Maternal Serum AFP
Chromosome Analysis, Chorionic
Villus Sample;
Chromosome Analysis, Amniotic fl uid
Glucose Gestational Screen (50g),
135 Cutoff (ACOG supported 1st step
of 2-step GDM evaluation);
Glucose Gestational Screen (50g),
140 Cutoff (ACOG supported 1st step
of 2-step GDM evaluation);
Glucose Tolerance Test, Gestational,
4 specimens (100g) (ACOG supported
2nd step of 2-step GDM evaluation)
15934(X)
30294
16167
5059
14592(X),
14590(X)
Corresponding Quest Test(s) Test Code(s)*
One or more of the following should be offered
as appropriate
*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.† Our genetic advisors can provide assistance with diagnostic testing recommendations. Call 1.866.GENE.INFO (1.866.436.3463) to reach our
dedicated genetics hotline.
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ACOG recommendations —
the 3RD Trimester
Recommended Laboratory Screening1 Corresponding Quest Test(s) Test Code(s)*
CBC
H/H, RBC, Indices, WBC, Plt:
Includes WBC, RBC, Hemoglobin,
Hematocrit, MCV, MCH, MCHC, RDW,
Platelet Count
1759
Differential and platelets:
Includes WBC, RBC, hemoglobin,
hematocrit, MCV, MCH, MCHC, RDW,
platelet count, MPV, and differential
(absolute and percent neutrophils,
lymphocytes, monocytes, eosinophils,
and basophils)
6399,
D (Rh) antibody screen, if indicatedAntibody Screen, RBC with Refl ex to
Identifi cation, Titer, and Antigen Typing† 795
Group B streptococcal disease
Streptococcus Group B culture;
Streptococcus Group B with susceptibility
culture;
Streptococcus Group B DNA, PCR with
Broth Enrichment;
Streptococcus Group B DNA, PCR with
Broth Enrichment and Refl ex to
Susceptibility†
5617(X),
15090(X),
91768(X),
91770(X)
RPR (if patient tested positive or is high risk due to age
or lifestyle as indicated)
Chlamydia and gonorrhea (if patient tested positive or
high risk due to age or lifestyle)
HIV testing (if patient is high risk due to lifestyle)
Gonorrhea (if patient tested positive or
high risk due to age or lifestyle)
Chlamydia (if patient tested positive or
is high risk due to age or lifestyle)
RPR with refl ex to Titer and Confi rmatory
Testing†
Chlamydia trachomatis/Neisseria
gonorrhoeae RNA, TMA
HIV-1/2 Antigen and Antibodies,
Fourth Generation, with Refl exes†
Chlamydia trachomatis RNA, TMA
Neisseria gonorrhoeae RNA, TMA
11361(X)
11362(X)
36126
11363(X)
91431(X)
*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.†Refl ex testing may be performed at an additional charge.
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Genetic carrier screening for diverse patients
In addition to standard laboratory tests, additional screening may be offered for some patients based on their ethnic background to determine if they are carriers for certain hereditary conditions. This type of screening is ideally performed as part of preconception counseling but may also be done in the fi rst trimester.
Genetic Laboratory Screening1,5 Ethnic Background1,5,6 Corresponding Quest Test(s) Test Code(s)*
Cystic fi brosis
Caucasian; African descent;
Ashkenazi Jewish; Southeast
Asian; French Canadian; Cajun
Cystic Fibrosis Screen,
CFvantage® Cystic Fibrosis
Expanded Screen
10458(X),
92068(X)
Spinal Muscular Atrophy
Recommended by ACMG for
all patients who are pregnant
or planning a pregnancy,
regardless of ethnicity.
Recommended by ACOG for
patients with a family history
of SMA
SMA Carrier Screen 18041
Fragile X
Recommended by ACOG for
women with a family history
of fragile X-related disorders,
unexplained mental
retardation or developmental
delay, autism, or premature
ovarian insuffi ciency
XSense® Fragile X with Refl ex and
Chromosome Analysis, Blood† 16326(X)
Sickle hemoglobinopathies African descent
Sickle Cell Screen,
Sickle Cell Screen with Refl ex to
Hemoglobinopathy Evaluation
(includes Hemoglobin A1, Fetal
Hemoglobin, Hemoglobin A2 and
any hemoglobin variants)†
825,
37679
Tay-Sachs disease
Familial dysautonomia
Ashkenazi Jewish;
French Canadian; CajunTay Sachs Mutation
Ashkenazi Jewish Familial dysautonomia mutation
90903(X)
90912(X)
ACMG = American College of Medical Genetics and Genomics
*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.† Refl ex testing may be performed at an additional charge.‡ All diseases within this panel can also be ordered individually: Cystic Fibrosis 92068(X), Canavan Disease 90905(X), Gaucher Disease 90907(X),
Fanconi Anemia 90897(X), Bloom Syndrome 90872(X), Tay-Sachs Mutation 90903(X), Familial Dysautonomia 90912(X), Nieman-Pick Disease 90893(X), Mucolipidosis Type IV 90899(X), Glycogen Storage Disease 90915(X), and MSUD Mutation 90909(X).
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Visit the Genetics section within QuestDiagnostics.com for
more information about our genetic testing offerings, including
our selection of over 700 tests.
Genetic Laboratory Screening1,5
(cont’d)
Ethnic Background1,5,6
(cont’d)
Corresponding Quest Test(s)
(cont’d)
Test Code(s)*
(cont’d)
Canavan disease Ashkenazi Jewish Canavan disease mutation 90905(X)
Ashkenazi JewishExpanded Ashkenazi Jewish Panel
Ashkenazi Jewish Panel (includes
Cystic Fibrosis, Canavan Disease,
Gaucher Disease, Fanconi Anemia,
Bloom Syndrome, Tay-Sachs
Mutation, Familial Dysautonomia,
Niemann-Pick Disease,
Mucolipidosis Type IV, Glycogen
Storage Disease, and MSUD
Mutation)‡
90891(X)
Beta-thalassemia, alpha-thalassemia
African descent; Southeast
Asian (if microcytic anemia);
Mediterranean
Thalassemia and
Hemoglobinopathy
Comprehensive, includes
Hemoglobin A2 and any
hemoglobin variants, Hemoglobin
F, Ferritin, Hemogram (WBC, RBC,
Hemoglobin, Hematocrit, MCV,
MCH, MCHC, RDW)
17365
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Delivering support
across every stage of pregnancy
Quest Diagnostics is committed to helping you ensure the healthiest possible outcomes for both mother and baby.
With our broad range of tests, as well as an extensive array of tools and educational materials for both you and your
patients, you can manage their care more effectively.
Comprehensive test menu
We provide a wide range of prenatal testing options backed by proven science, from routine to
highly specialized, including over 700 genetic tests—more than any other laboratory.
Expert review and consultation
We offer one-on-one consultations and professional reviews with our team of medical
experts, including highly trained genetic counselors, geneticists, and toxicologists, to
support your decision-making when you need it—no matter what the case.
Tools for your practice and your patients
With offerings such as QuestConnect™, you can add or cancel tests and request test information,
as well as pay invoices and order supplies—anytime, anywhere you’re online.
Resources for her
Help her stay informed
We offer educational content in multiple languages—both online and in printed materials—for patients on a
wide range of topics. Encourage them to take advantage of these resources and stay informed throughout their
pregnancy by visiting QuestDiagnostics.com/Patients.
Give her the tools to make better health decisions
MyQuest™ by Care360® helps patients to become advocates for their own care. In addition to getting test
results anytime, anywhere on their computer, tablet, or smartphone, they can share information with healthcare
providers, schedule testing appointments, and track their health conditions.
Your patients can sign up at QuestDiagnostics.com/MyQuest.
References: 1. Riley L, Stark A, eds. Guidelines for Perinatal Care. 7th ed. Elk Grove Village, IL/Washington, DC: American Academy of Pediatrics and The American
College of Obstetricians and Gynecologists; 2012:129-139; 483-484. 2. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. 2007;109:419-433.
3. The American College of Obstetricians and Gynecologists. ACOG committee opinion No. 548: Weight gain during pregnancy. Obstet Gynecol. 2013;121:210-212.
4. The American College of Obstetricians and Gynecologists. Practice advisory: updated interim guidance for care of obstetric patients and women of reproductive
age during a Zika virus outbreak. http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-
Patients-During-a-Zika-Virus-Outbreak. Accessed March 14, 2016. 5. The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 432:
Spinal muscular atrophy. Obstet Gynecol. 2009;113:1194-1196. 6. The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 469:
Carrier screening for fragile X syndrome. Obstet Gynecol. 2010;116:1008–1010.
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