Case studies – The Role of Pathology in Our Lives
Case Study 1 – An example of prenatal and postnatal testing
Sarah and Steven are the proud parents of two week old Benjamin. This is their first child. Sarah’s pregnancy was relatively easy, but her gynaecologist requested a number of routine tests to be performed to ensure the health and well being of Sarah and her unborn baby. These tests were all performed by the pathology laboratory.
Sarah and Steven had planned for this pregnancy, and thus a number of checks were performed before conception occurred.
Before pregnancy her rubella status was checked to ensure adequate immunisation against German measles, which can be dangerous if it occurs during pregnancy.
Sarah’s sister has cystic fibrosis and they were worried the disease may be passed onto the baby. They visited a specialist who sent them for genetic testing. Sarah is not a carrier of this gene and hence cannot pass it onto her child.
After she became pregnant, Sarah was given a number of other tests to ensure the health of mother and babe.
- At 12 weeks Sarah had her haemoglobin levels checked for possible anaemia, her iron levels done for iron deficiency and also a blood group and screen performed, to determine if her Rhesus status was negative. Sarah’s haemoglobin and iron were at the lower end of the normal range so her gynaecologist suggested eating more red meat during her pregnancy. Her blood group is O Rhesus (D) negative. This means she is lacking a substance called the D antigen on the surface of her red cells and if the baby is Rhesus (D) positive and has the D antigen, the mother will recognise the baby’s blood as foreign and produce antibodies which can destroy the baby’s red blood cells. To counteract this, Sarah was given Rh (D) immunoglobulin at several stages during pregnancy. Destruction of the baby’s red cells can lead to foetal death.
- At 28 weeks, Sarah had a glucose tolerance test to determine whether she has gestational diabetes. She herself does not have diabetes but she may have high glucose levels during pregnancy. If this occurs, it can cause the baby health problems. There may be damage to the baby’s shoulders during delivery as the baby could be uncommonly fat. There is a higher risk of breathing problems and they baby’s have a greater risk of obesity and type 2 diabetes (non-insulin dependant). Sarah did have gestational diabetes so the doctor advised her to follow a special meal plan and scheduled routine physical activity into her day. This kept the glucose levels at a reasonable level.
During her pregnancy Sarah had her urine regularly checked for glucose and protein. Should either of these have shown up in the urine it would have indicated possible renal impairment. Fortunately these were negative.
Sarah had a 12 hour labour and then delivered Benjamin with the proud father Steven at her bedside.
Sarah’s care during her pregnancy has relied on the results of tests performed by pathology professionals.
Pathology professionals – from the blood collector to the scientist who performs the tests, to the pathologist reviews unexpected abnormal results and liaises with the patient’s clinician – have ensured the best possible care for Sarah and her babe.
This is not unusual, it is estimated that approximately 85% of all physician decisions regarding diagnosis and treatment are based on laboratory test results.