First, the time of prenatal examination
From the diagnosis of early pregnancy, perinatal health card should be established within l2 weeks of pregnancy, and comprehensive examination should be conducted. A series of prenatal examinations were carried out from the 20th week of pregnancy. During the period of 20-36 weeks of pregnancy, every 4 weeks 1 time, l times per week from the 36th week of pregnancy, that is, 20, 24, 28, 32, 36, 37, 38, 39, 40 weeks 1 time, * * 9 times respectively. If it is a high-risk pregnancy, the number of examinations should be increased appropriately.
Second, the content of the first prenatal examination
(1) Asking about medical history
Age and occupation.
2) Estimated expected date of delivery: From the 1 day of the last menstrual period, calculate the expected date of delivery (EDC) by subtracting 3 (or adding 9) and adding 7 (adding 15 to the number of days in the lunar calendar). If the last menstruation is not clear, the expected date of delivery can be estimated according to the reaction time of early pregnancy, the time of first fetal movement, the height of uterine bottom and the size of fetus.
3) Understand the pregnancy situation: whether there is vaginal bleeding, headache, palpitation, shortness of breath, edema of lower limbs, virus infection and medication history.
4) menstrual history and birth history: menstrual status, whether there is abortion, induced labor, premature delivery, dystocia, stillbirth, postpartum hemorrhage, infection, deformed children, etc.
5) Past history: Pay attention to important organ diseases related to pregnancy, such as heart disease, hepatitis, hypertension, diabetes, allergic diseases, etc.
6) Family history: infectious diseases, hypertension, diabetes, twins and other genetic diseases.
7) Husband's health status: whether there is alcohol and tobacco addiction, hereditary diseases and sexually transmitted diseases.
(2) General physical examination
1) nutritional development: pay attention to whether there is deformity or edema, listen to the heart and lungs, and check breast development.
2) Weight measurement: The weekly weight in the third trimester should not exceed 0.5kg. If it exceeds 0.5 kg, edema (dominant or recessive), twins or polyhydramnios should be considered.
3) Blood pressure measurement: The blood pressure of normal pregnant women should not exceed18.7/12 kPa (140/90 mmHg). Compared with the basic blood pressure, the systolic blood pressure should not exceed 4kPa(30mmHg) and the diastolic blood pressure should not exceed 2 kPa (65 65,438+05 mmHg).
4) Related laboratory tests: blood routine, urine routine, coagulation time, blood type, liver function, etc.
(3) Obstetric examination
1) Abdominal examination
① Examination: Observe the size, shape, stretch marks, surgical scars and edema of the abdomen.
② Palpation: Four-step palpation method was used to determine fetal presentation, fetal position, fetal size, uterine fundus height, etc.
Step 1: The examiner faces the pregnant woman's head and presses her hands on the bottom of the uterus to find out the height of the bottom of the uterus and judge whether the bottom of the uterus is the fetal head or the fetal hip. The fetal head is round and hard, with a sense of floating ball; Fetal arms are soft and wide with irregular shapes.
Step 2: The examiner puts his hands on both sides of the pregnant woman's abdomen. One hand is fixed, the other hand is lightly touched, and the two hands alternate to distinguish the position of the fetal back and limbs. The back of the fetus is flat and hard, and the limbs vary in size.
Step 3: The examiner separates the thumb of the right hand from the other four fingers, places it above the pubic symphysis of the pregnant woman, holds the exposed part, further finds out whether the exposed part is the head or the buttocks, and pushes it left and right to find out whether the exposed part is the human basin. If the first show is still active, it means that no one is in the basin and can't push it, which means that the first show is in the basin.
Step 4: The examiner faces the foot end of the pregnant woman, puts his hands on both sides of the presentation respectively, gently and deeply presses it, and checks the fetal presentation again to determine the degree of the presentation.
③ Auscultation: Fetal heart sounds are coming from the back of the fetus. Before 24 weeks, fetal heart sounds were mostly heard in the middle of umbilical cord or slightly to the left and right. After 24 weeks, different parts were selected according to fetal position. Listen to fetal heart sounds. Fetal heart sounds are heard on the left side (or right side) under the umbilical cord of the mother's abdomen during pillow, and on the upper and lower sides of the umbilical cord of the mother's abdomen during hip. When listening to fetal heart sounds, pay attention to frequency, intensity and rhythm.
2) Extrapelvic measurement: The following diameter lines are often measured.
① Diameter of iliac spine: Pregnant women take the straight leg supine position and measure the distance between the outer edges of the anterior superior iliac spine on both sides. Normal is 23 ~ 26 cm.
② Inter-iliac crest diameter: The pregnant woman's posture is the same as above, and the widest distance between the outer edges of bilateral iliac crests is measured. Normal is 25 ~ 28 cm.
③ Outside diameter of sacrum: Take the left position, with the thigh straight and the calf flexed, and measure the distance from the inferior spinous process of the fifth lumbar vertebra to the midpoint of the superior margin of pubic symphysis, which is normally L8 ~ 20 cm. The inferior spinous process of the fifth lumbar vertebra is equivalent to the upper corner of the rhombic fossa in lumbosacral region, or l.5cm below the midpoint of the connecting line between the two iliac ridges.
④ Diameter between ischial tubercles (outlet transverse diameter): Take supine position, bend your legs, and hold your knees with your hands, and measure the distance between the inner edges of two ischial tubercles. The normal value is 8.5 ~ 9.5 cm. ⑤ Angle of pubic arch: The fingertips of the two thumbs are inclined to each other, placed on the descending pubic branch, and the angle between the two thumbs is measured, and the normal value is 90.
Third, follow-up
Ask if there is any abnormality after the last examination, measure weight, blood pressure and obstetric abdominal examination, and do routine or special examinations as needed.
I hope it can be adopted!