Antenatal Care: Laboratory Investigations SBA - Presentation 3 (a) Maternal Health Division Ministry of Health & Family Welfare Government of India

Antenatal Care: Laboratory Investigations2 Laboratory Investigations At Sub-centre Pregnancy detection test Hemoglobin test Urine test for sugar and proteins Rapid malaria test At PHC / CHC / FRU Blood group and Rh type VDRL / RPR (Rapid Plasma Reagin) Offering rapid testing for HIV screening Tie up with nearest ICTC / PPTCT centre for: – Rapid testing kits for HIV screening – Referral and management of +ve cases HBsAg testing Blood sugar testing

Antenatal Care: Laboratory Investigations3 Pregnancy Detection Test The kit is supplied free by GoI Procedure i. Remove the pregnancy test card from the pregnancy kit. Keep this card on a flat surface. ii. Use the dropper to take morning sample of urine. Put 2-3 drops in the well marked ‘S’. iii. Wait for 5 minutes. Result: If one red band appears in the result window ‘R’, the pregnancy test is negative. If two parallel red bands appear, the pregnancy test is positive.

Antenatal Care: Laboratory Investigations4 Haemoglobin Test Procedure i. Clean the tip of the woman’s ring finger with an alcohol swab. ii. Prick the finger using the lancet and discard the first drop of blood. iii. Allow a large drop of blood to form on the fingertip (do not press the finger tip to take out blood). Dip the tip of the Hb pipette into the blood drop and suck blood up to the 20 cmm mark on the pipette. iv. Wipe the tip of the pipette with cotton. Immediately transfer the 20 cmm (0.02 ml) of blood from the pipette into the Hb tube containing N/10 HCl. v. After 10 minutes, dilute the acid by adding distilled water drop by drop. Mix it with the stirrer. vi. Note down the reading (lower meniscus) when the colour of the solution exactly matches that of the comparator on both sides of the haemoglobinometer. This expresses the Hb content as g%.

Antenatal Care: Laboratory Investigations5 Laboratory Investigations Hemoglobin estimation What is the importance of Hb estimation? To detect presence of anemia and it’s severity Helps in the management and treatment of anemia Done at every antenatal visit Initial Hb level serves as the baseline to compare the Hb levels at subsequent antenatal visits

Antenatal Care: Laboratory Investigations6 Laboratory Investigations Anemia is defined as a Hb level of < 11gm% at any time during pregnancy Refer to FRUSevere anemia< 7gm/dl 1 tab of IFA twice a day Moderate anemia7 – 11gm/dl 1 tab of IFA ODNo anemia> 11gm/dl ActionDegree of anemiaHb level Classification

Antenatal Care: Laboratory Investigations7 Laboratory Investigations Hemoglobin estimation If Hb level of < 11gm% at any time during pregnancy – Start on therapeutic dose of IFA – Estimate Hb again after 1 month – If no rise in Hb level refer the woman to a higher centre

Antenatal Care: Laboratory Investigations8 Urine test for proteins and sugar Urine test for proteins Procedure using dipstick i. Remove one strip from the bottle of dipsticks and replace the cap. ii. Completely immerse the regent area of the strip in urine and remove immediately to avoid dissolving the reagent. When removing the strip from the urine, run the edge against the rim of the urine container to remove excess urine. iii. Hold the strip horizontally. iv. Compare the colour of the reagent area to the colour chart on the label of the bottle, after the time specified (usually 60 seconds)

Antenatal Care: Laboratory Investigations9 Urine test for proteins and sugar Urine test for proteins Procedure using hot test (boiling) i. Fill three-fourths of the test-tube with urine and heat the upper third of the urine over the spirit-lamp and allow it to boil. Keep the mouth of the test tube away from your face to prevent scalding. ii. Turbidity of the sample indicates the presence of either phosphate or albumin. Add 2-3 drops of 2%-3% acetic acid drop by drop into the test-tube. iii. If the sample remains turbid, it indicates the presence of proteins. iv. If the turbidity clears, it indicates the absence of proteins.

Antenatal Care: Laboratory Investigations10 Urine test for proteins and sugar Urine test for sugar Procedure using dipstick Follow the same steps as for protein and match the colour with the label on the bottle. Procedure using the boiling method (Benedict test) i. Take 5 ml of Benedict solution in a test-tube. Boil it over the spirit lamp, holding the test-tube away from your face. ii. If the colour of the solution does not change on heating, it is pure. iii. Add 8 drops of urine with the help of dropper. Shake it well and boil. iv. Allow it to cool and observe the colour.

Antenatal Care: Laboratory Investigations11 Laboratory Investigations Urine for proteins and sugar Done at every antenatal visit Presence of protein in urine, accompanied by high BP indicates pre-eclampsia Presence of sugar in urine helps in detection of Gestational Diabetes Mellitus (GDM) but needs to be confirmed by Glucose Tolerance Test (GTT)

Antenatal Care: Laboratory Investigations12 Laboratory Investigations Blood group and Rh factor Essential for all primigravidae Required to arrange blood for transfusion in emergency

Antenatal Care: Laboratory Investigations13 Thank you