According to the guidelines formulated by Perinatal Branch of Chinese Medical Association, it is suggested that those who have no pregnancy complications should have their first prenatal examination at 10 week of pregnancy and register the information. After that, they need to undergo seven standardized prenatal examinations during pregnancy, namely 16, 18 ~ 20, 28, 34, 36, 38 and 4 1 week. Those who have never given birth in the past should also increase 1 time at 25 weeks, 3 1 week and 40 weeks, respectively, * * * *1time. The number of prenatal check-ups for low-risk pregnant women is 7-8 times during the whole pregnancy, while the number of prenatal check-ups for high-risk pregnant women is increasing, and the specific situation varies greatly according to different conditions.
Check content
1. Ask the medical history in detail.
The contents include age, parity, occupation, menstrual history, understanding the age of menarche and menstrual cycle. If it is a multipara, it is necessary to know the previous delivery situation, whether there is a history of dystocia or stillbirth, the mode of delivery, the date of the last delivery or abortion, the situation of the newborn, and whether there is hypertension or heart disease in the past medical history. During this pregnancy, the time and degree of early pregnancy reaction, whether there is any discomfort such as fever and virus infection, and the medication situation. ; For the health of the husband, both parties need to pay attention to whether there are birth defects and genetic diseases in his family history, and record related diseases.
Calculate the expected delivery date
According to the first day of last menstruation, the number of months decreased by 3 or increased by 9, and the number of days increased by 7. If the last menstrual period is March 5, the expected date of delivery is 65438+February 65438+February. It should be noted that pregnant women with irregular menstruation cannot mechanically determine the expected date of delivery because of abnormal ovulation time, and can be judged according to the time of early pregnancy reaction, the start time of fetal movement, and the height of the fundus. If necessary, ultrasound should be done to check the gestational age.
Have a general examination
(1) Height and weight/body mass index (body mass index) Generally speaking, short pregnant women have an increased chance of pelvic stenosis, and body mass index is related to pregnancy prognosis. People with high body mass index need to be alert to complications such as pregnancy-induced hypertension and gestational diabetes.
(2) Knowing the patient's basic blood pressure by blood pressure measurement is of great significance for evaluating and judging the tolerance of the circulatory system during pregnancy. For example, patients with chronic hypertension need to actively control their blood pressure at an early stage and need more professional guidance in life and diet.
(3) Oral examination The current research shows that periodontitis is closely related to infectious premature delivery, so oral health care during pregnancy is very important. Of course, it is very important to plan a thorough treatment of oral diseases before pregnancy.
(4) Cardiopulmonary auscultation, to know whether there is murmur in the heart and whether there is basic disease in the lungs. Especially for pregnant women with a history of heart and lung diseases, the burden during pregnancy is obviously increased, and further evaluation of heart and lung function is needed.
(5) Normal pregnant women with edema of lower limbs often have edema below the knee, which subsides after rest. If it does not disappear and is accompanied by excessive weight gain, we should be alert to the occurrence of hypertensive disorder complicating pregnancy.
4. Obstetric examination
(1) Measuring uterine height and abdominal circumference refers to the distance from the upper edge of pubic symphysis to the bottom of uterus. When the fundus exceeds the normal gestational age, we should consider whether it is twin pregnancy, macrosomia, polyhydramnios, especially the abnormal increase of amniotic fluid caused by fetal malformation. If the abdomen is too small, we should pay attention to whether there is intrauterine growth restriction and fetal malformation.
(2) Fetal heart sounds are often clearly auscultated on the back of the fetus, which is helpful when the uterine wall is sensitive, or when obesity has made it difficult to evaluate the fetal position.
(3) Vaginal and cervical examination Vaginal examination is often performed in the first 6-8 weeks of pregnancy. It should be noted that pregnant women who have not undergone pre-pregnancy examination need routine cervical cytology examination to exclude cervical lesions. If cervical cytology is abnormal, colposcopy should be performed as appropriate. In the third trimester of pregnancy, pelvic measurement can be performed at the same time as vaginal examination. The most important diameter line in pelvic measurement is the diameter between ischial tubercles, which is the transverse diameter of pelvic outlet plane. If the exit plane is normal, you can choose vaginal trial delivery. Extrapelvic measurement has been abandoned at present.
5. Auxiliary examination and its clinical significance
(1) Routine blood tests are generally performed in the first and third trimesters. After hemodilution in pregnant women, the red blood cell count decreases and the hemoglobin value drops to 1 10g/L, which is anemia. White blood cells rose from 7 ~ 8 weeks of pregnancy to 30 weeks and reached the peak, sometimes reaching 15× 109/L, mainly neutrophils, which should be differentiated from clinical infectious diseases. Check the blood routine in the third trimester and pay attention to whether there is anemia, and supplement iron in time.
(2) Urine routine The urine routine during pregnancy is consistent with that during non-pregnancy, but the increase of vaginal secretions may interfere with the results to a certain extent, so it is necessary to pay attention to urine protein in the middle and late stages. Routine urine examination is required for every prenatal examination.
(3) Liver and kidney function examination The burden of liver and kidney is aggravated during pregnancy, so it is necessary to know the state of liver and kidney function in the early pregnancy. If there is a basic disease, further examination is needed to clarify the type of disease and assess the risk of pregnancy. Some pregnancy complications, such as preeclampsia and acute fatty liver during pregnancy, will affect liver and kidney function. It needs to be monitored twice in the first and third trimester.
(4) Serological examination of syphilis Pregnant women who are pregnant after syphilis need to have a pregnancy examination. If you are infected with syphilis in the early pregnancy, you need to treat it according to the situation to reduce the harm of syphilis pathogens to the fetus.
(5) Pregnant women with hepatitis B surface antigen can transmit hepatitis B virus from mother to fetus, so screening is needed in early pregnancy, and it is not recommended to inhibit hepatitis B immunoglobulin during pregnancy. Prevention of neonatal hepatitis after birth requires the combination of active immunity and passive immunity.
(6)ABO and Rh blood groups are mainly related to the judgment and prevention of maternal-fetal blood group incompatibility. Rh-negative blood is rare in China, with a ratio of 3-4 ‰. The blood type is determined because the husband of Rh-negative pregnant women is Rh-positive. When the fetal blood type is Rh-positive, there will be maternal-fetal Rh blood type incompatibility, which will cause intrauterine edema. In severe cases, the fetus will die in the uterus and need to be dealt with in time. The risk of fetal hemolysis in ABO blood group system is relatively small.
(7) HIV screening in early pregnancy, diagnosis of positive cases, and active treatment according to HIV infection treatment guidelines.
(8) Screening of gestational diabetes mellitus According to the requirements of the industry standard of gestational diabetes mellitus of the Ministry of Health, 75g glucose tolerance test should be conducted at 24-28 weeks of pregnancy, such as fasting blood glucose. As long as one of the 1 hour and 2-hour blood glucose after taking sugar exceeds the critical value, it is diagnosed as gestational diabetes mellitus, and the critical values are 5. 1mmol/L and10.2 mmol respectively. For pregnant women with high-risk pregnancy, screening can be carried out in advance or repeatedly according to the situation.
(9) Serological screening of pregnant women Various related serological screening tests are conducted in hospitals certified by provincial and municipal health bureaus according to the different conditions of each hospital. Early pregnancy screening test refers to 1 1 ~ 13+6 weeks of pregnancy. The thickness of transparent layer (nt) of fetal neck should be measured or the risk value of Down's syndrome should be obtained by comprehensive detection of NT, maternal blood β-HCG and pregnancy-associated plasma protein A(PAPP-A). For pregnant women with high screening results, chorionic villus biopsy (CVS) can be considered for prenatal diagnosis. The screening in the second trimester can wait until the second serological screening in the second trimester, and the prenatal diagnosis can be decided by combining the screening results in the first trimester or calculating the risk value independently. Pregnancy 14 ~ 20 weeks is the window period of second trimester screening, and most of them are serological double screening (AFP and free β-HCG) or triple screening (AFP, free β-HCG and free mE3). Serological screening results include the risk values of 2 1 trisomy, 18 trisomy and neural tube defects, of which the former two need further chromosome karyotype examination, while the latter only needs systematic ultrasound examination.
(10) Ultrasound examination is the most important examination item during pregnancy. Ultrasound examination at 7 ~ 8 weeks of pregnancy is helpful to judge whether it is intrauterine pregnancy. If there are no abnormal conditions such as vaginal bleeding and abdominal pain at this stage, it is suggested that 1 ultrasound examination be arranged at1~13+6 weeks of pregnancy. The second ultrasound examination was performed at gestational age 18 ~ 24 weeks. At this time, the fetal organ structure and amniotic fluid volume are most suitable for systematic ultrasound examination, comprehensive screening of fetal anatomical abnormalities, systematic examination of fetal head, face, spine, heart, abdominal organs, limbs, umbilical artery and other structures. Ultrasound soft indicators of chromosomal abnormalities in the second trimester include the thickness of the transparent layer of the fetal neck, the absence or dysplasia of the fetal nasal bone, short humerus and femur, strong intestinal echo, abnormal heart structure, tricuspid regurgitation, strong echo spots in the ventricle, renal pelvis dilatation, choroidal cyst and so on. The above examination can improve the detection rate of fetal aneuploidy. The third ultrasound examination is in the 30 ~ 32 weeks of pregnancy, the purpose is to understand and observe the growth and development of the fetus, the position of the placenta and the presentation of the fetus. The fourth ultrasound examination was performed from 38 to 40 weeks of pregnancy to determine the position and maturity of placenta and amniotic fluid and estimate the fetal size. Under normal circumstances, it is enough to do 4 ~ 5 times of B-ultrasound examination according to the above four stages during pregnancy, but if abdominal pain, vaginal bleeding, frequent or reduced fetal movement, abnormal fetal development, unclear fetal position, etc. occur during pregnancy, it is necessary to increase the number of examinations as appropriate.
(1 1) electronic fetal heart monitoring should be performed 1 time every week from 34 to 36 weeks of pregnancy. After 37 weeks, according to the situation, 1 ~ 2 times a week. If it is a high-risk pregnant woman, especially if there is a risk of placental function decline, it is necessary to increase the frequency of fetal heart monitoring.
(12) Electrocardiogram 1 Electrocardiogram for the first prenatal examination and 32-34 weeks of pregnancy respectively. Because of the increase of blood volume in the third trimester, it is necessary to know the heart function of pregnant women and to have an echocardiogram if necessary.
Special population related examination
1. torch
Including rubella virus (RV), Toxoplasma gondii (TOX), cytomegalovirus (CMV), herpes simplex virus (HSV) and so on. If pregnant women have infection symptoms related to the above virus or abnormal fetal ultrasound examination, they can be examined. If TORCH~IgM is positive, it is necessary to judge whether it is a primary infection. What needs to be vigilant is that maternal infection is not equal to fetal infection. To confirm whether the fetus is infected, a clear diagnosis is needed.
2. Fetal fibronectin screening and ultrasound evaluation of cervical length.
Pregnant women at risk of late abortion or premature delivery can be tested to help predict the risk of adverse consequences. Cervical length less than 2.5cm combined with FFN positive can be used to screen real premature pregnant women.
3. Screening for hypothyroidism
The incidence of hypothyroidism in pregnancy is about 0.9%, which can screen high-risk cases, but there is no evidence to support hypothyroidism screening for all pregnant women.
prenatal diagnosis
On the basis of genetic counseling, it is of great significance to clearly diagnose high-risk fetus through genetic and imaging examination, which will reduce the rate of birth defects and perinatal mortality and improve the quality of the population.
According to the industry management regulations of the Ministry of Health, prenatal diagnosis clinics are set up in medical institutions recognized by the administrative department of health, and professionally trained doctors conduct genetic consultation or prenatal consultation in obstetrics and gynecology. Doctors should know the personal history, past history and prenatal diagnosis indications of pregnant women, so as to help pregnant women correctly understand the risk of fetal chromosomal diseases and the clinical manifestations of chromosomal diseases. At the same time, pregnant women should be made aware of the risks of various complications that may occur when taking interventional sampling surgery. It is recommended that pregnant women who are over 35 years old or meet other indications for prenatal diagnosis be diagnosed.
The indications of prenatal diagnosis of cytogenetics are: pregnant women over 35 years old; Prenatal screening of high-risk pregnant women with fetal chromosomal abnormalities; Pregnant women who have given birth to children with chromosomal diseases; Prenatal B-ultrasound examination for pregnant women who suspect that the fetus may have chromosomal abnormalities; One of the husband and wife is a chromosome abnormality carrier; Other circumstances that the doctor considers necessary for prenatal diagnosis. Commonly used interventional prenatal diagnosis operations: villus sampling, amniocentesis and percutaneous umbilical vein puncture. The gestational weeks were 10 ~ 13+6 weeks, 16 ~ 22+6 weeks and 18 weeks respectively. Doctors should choose the appropriate period and method for prenatal diagnosis. Preoperative doctors should correctly grasp the indications and contraindications of prenatal diagnosis and operation, and complete the necessary examinations.