Ok lets talk LAB values and what they mean..

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Specializes in LDRP.

Hello all. I have been a frequent flyer on this forum for a few yrs but have been sort of a ghost reader. However, I have made an account finally and have decided to start posting :)

Anyway, I have been a labor Nurse for a few years. I feel like starting off I got an OK orientation but that for the most part I was thrown in and learned as I went. I am at a point where I feel like I am pretty confident in my skills overall. The one thing that does bother me though is that I don't feel like I have a really good understanding of various lab values during pregnancy/labor and what each mean. I never really had someone sit down and go through it all with me and I have yet to find a book or website that has lab value information specific to Pregnancy. I can easily look up the normal and abnormal ranges in pregnancy but I guess what I lack knowledge in is the physiology behind them. Even when it comes to doing a Urinalysis, what things should i be looking for? what means what?

I am posting on here because I have spoken up and asked some fellow labor nurses in the past about this topic and I usually just get the "well you should know already". So I just stopped asking questions because even though I know they do not know everthing either, I don't want to look incompetent.

I have worked in a lot of teaching facilities wherein I was just told right off the bat what to do by the doctors and residents and never really got a chance to do the critical thinking. I now work in a facility where i am a lot more independent and I can use my skills and actually recommend what should be done before the doctor even says anything. So I am at a point now where I just want to know more in depth what everything means when i am looking at a lab report.

Anyway, if anyone is willing to help me out I'd really appreciate it. Even like a one on one chat with me just to do a quick overview of different labs and what they mean in relation to pregnancy and diseases of pregnancy (i.e. Help syndrome, PIH labs, DIC, what to look for on a urinalysis, etc) would be great. I think I have an ok understanding of things but I know that there is a lot I do not know...Thanks

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Specializes in Pediatrics, ER.

Urinalysis you're mainly looking for protein. When the kidneys are stressed in pregnancy (weight gain, fluid retention) they tend to leak a little bit of protein. If you dip a UA and see trace to +1, this is normal. Anything higher can be indicative of pre-eclampsia. You also want to check for ketones and see what the specific gravity is. When a person is dehydrated their specific gravity is higher and they can sometimes spill ketones. It's a helpful tool to assess hydration in women who experience morning sickness.

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Specializes in Pediatrics, ER.

HELLP syndrome - you want to check the LFTs. (AST, ALT, alkaline phosphatase), check a CBC for hemolysis (premature red blood cell destruction causing release of bilirubin which both causes anemia and furthers liver dysfunction due to jaundice) and platelets for low counts which means the blood isn't clotting properly...because HELLP syndrome causes multiorgan system dysfunction, you really need a whole picture of the labs. You want to check coags too (bleeding time, PT/INR) since the dysfunction of HELLP syndrome can lead to DIC. This is life threatening in ANYONE, but is extremely life-threatening in pregnant women especially due to the risk of postpartum hemorrhage. DIC causes hemorrhage and abnormal clotting at the same time, your only hope is to keep transfusing and try to induce the body's normal clotting cascade, which is essentially to make them bleed more...

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Specializes in Pediatrics, ER.

PIH - You want a UA to check for protein. You want to basically shotgun your labs to see if the extreme hypertension has caused ischemia to any of the major organs. You want a CBC to check your H/H, BUN and creatinine to check for kidney dysfunction, as well as a uric acid (elevated with eclampsia. it's a waste product that your kidneys filter...with eclampsia you have dysfunction of the kidneys and they don't filter this out as well, therefore it builds in the blood stream(. The kidney tests basically confirm PIH. You want to check your coags for bleeding risk, and fibrinogen (which is helpful in letting you know whether or not you have full blown eclampsia vs. htn)

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Specializes in LDRP.

NeoPedi-thanks so much...

So you check the fibrinogen pt, ptt to rule out HTN versus Pre-eclampsia?

What exactly do ketones show?

What exactly is BUn and creatinine checking for? Can you just go in more depth on it..I know its for kidney function

LFT's are checked to rule of HELP correct? its not something that is checked for Pre-eclampsia? Can you explain in more depth what LFT's are? Meaning what does ALT test for? AST? Alk Phos? Sometimes when I am giving report to the doc I tell him/her all the values and they interrupt me to tell me to jsut give them the important stuff..so what is the MOST important values for Pre-eclampsia, HELP, DIC, etc?

Also, can you explain metabolic/resp acidosis and alkalosis in relation to the baby's health? What worse? What does it mean physiologically?

THANKS SO MUCH!!!!

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Specializes in Hospital nursing.

ALT and AST are enzymes found inside liver cells. When liver cells are damaged, the enzymes spill out, and the serum levels of ALT and AST are raised. AST can be in other cells of the body, so it's not ONLY liver-related, but ALT is pretty much only found in liver cells, so if ALT is elevated, you can be pretty darn sure it's from liver damage.

If a Dr is looking to see how someone's liver is functioning, look at the pt's LFTs (ALT, AST, Alk. Phos, GGT) as well as coags. If they're normal, just tell the Dr they're normal. If they're elevated, give the actual numbers. E.g. "Mrs.Smith's ALT is 75, AST is 61, Alk. Phos and GGT normal. INR is 1.0, PT 14.7, and PTT is 30"

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Specializes in Pediatrics, ER.
NeoPedi-thanks so much...

So you check the fibrinogen pt, ptt to rule out HTN versus Pre-eclampsia?

What exactly do ketones show?

What exactly is BUn and creatinine checking for? Can you just go in more depth on it..I know its for kidney function

LFT's are checked to rule of HELP correct? its not something that is checked for Pre-eclampsia? Can you explain in more depth what LFT's are? Meaning what does ALT test for? AST? Alk Phos? Sometimes when I am giving report to the doc I tell him/her all the values and they interrupt me to tell me to jsut give them the important stuff..so what is the MOST important values for Pre-eclampsia, HELP, DIC, etc?

Also, can you explain metabolic/resp acidosis and alkalosis in relation to the baby's health? What worse? What does it mean physiologically?

THANKS SO MUCH!!!!

Do your OBs basically order a full workup for abnormal vital signs or presentation? The docs I've worked with do because it's easier to piece together different labs than to play a guessing game what the patient has and order labs based on it.

Sometimes moms have a mixed condition. Sometimes what started off as PIH turns into HELLP then spirals into DIC.

BUN = blood urea nitrogen. It is a value (normal 10-20, may vary facility to facility) that indicates kidney function and hydration (a high BUN may indicate dehydration). A very low BUN may indicate liver problems.

Ketones are the product of metabolizing fat. When a pregnant woman doesn't eat or drink, her body kicks into overdrive and burns all the carbs first, then starts burning fat. When this process is prolonged ketones spill into the urine. It is a sign that the body is working on overdrive...you can also spill ketones in your urine by having a high blood sugar for a long period of time.

LFTS are checked for both HELLP and pre-eclampsia suspicions...AST/ALT basically show if you have insult to the liver....ALT is more specific to liver damage than AST. Alk phos shows if there's injury or obstruction along the biliary tract...has more to do with jaundice.

In resp alkalosis, the newborn is breathing rapidly and blowing off CO2. You will find their pH is elevated, and their CO2 is low. In TTN, sometimes you'll find this trend in their ABG. It's tricky though, because they can also be breathing rapidly to blow off a high CO2 level.

Respiratory acidosis occurs for many reasons, the most basic is the newborn is insufficiently ventilated to both oxygenate and blow off CO2. You will find a low pH and an elevated CO2. This tends to have more profound effects on the newborn if it's not quickly corrected, including brain damage.

In either event, you need to get an ABG first to see what's going on. It's more common to see acidosis. Sometimes alkalosis can occur from compensation.

Does this help?

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Hey

I'm a nursing student in OB, I have this page saved- very useful information

Thanks for starting this post

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Specializes in Aged Care, Midwifery, Palliative Care.

Hb and Iron levels, if these are on the low side then the mum is at a higher risk of having a PPH at a lower blood loss.

We usually double check these levels at 36 weeks so we can do something about it before the woman goes into labour.

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When I was in school I checked nursing made incredibly easy out of the library for OB and it had a chapter all about lab values. Go to local library website and see if they can order that book for you, those books are extremely helpful.

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