pregnancy diagnosis, prenatal care & genetic counseling

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Pregnancy diagnosis, Prenatal care & Genetic counseling Wei Jiang, M.D. Attending of Ob & Gyn Ob & Gyn Hospital, Fudan University 419 Fangxie Road, Shanghai [email protected] -----From textbook to application

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Pregnancy diagnosis, Prenatal care & Genetic counseling. -----From textbook to application. Wei Jiang, M.D. Attending of Ob & Gyn Ob & Gyn Hospital, Fudan University 419 Fangxie Road, Shanghai [email protected] Overview. Key points Case discussion. Pregnancy diagnosis. - PowerPoint PPT Presentation

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  • Pregnancy diagnosis, Prenatal care & Genetic counselingWei Jiang, M.D.

    Attending of Ob & GynOb & Gyn Hospital, Fudan University419 Fangxie Road, [email protected] textbook to application

  • OverviewKey points

    Case discussion

  • Pregnancy diagnosis

  • Pregnancy diagnosis Amenorrhea Other symptoms Pregnancy tests Fetal heart tones Fetal movements Ultrasound Estimated date of confinement Add 7 days to the 1st day of the LMPsubtract 3 months.Textbook

  • Pregnancy diagnosisHistoryBasic informationAgeGravidity ParityAbortuses

    LMP EDCGXPY, or T-P-A-LExample: 3-0-2-1,1-0-0-2 ???

  • Case 1A 28-year-old women, whose LMP was Aug 10, 2012, was refer to our out-patient department. Her menses is 14 5-6/30d.

    Clinical thinking What is the most likely diagnosis?What should be your next steps?How would you confirm the diagnosis?

  • Historymarried0-0-0-0Menstrual: regular, 5-6/30 d

  • Lab testUrine HCG: +Ultrasound

  • Prenatal care

  • Prenatal care PurposeEnsure an uncomplicated pregnancy for mother and babyIdentify and treat high risk pregnancy early

  • Prenatal care When and what?In our hospital:11-14W: NT (nuchal translucency) 14-20W: serum screening for genetic disease18-22W: ultrasound screening for fetal anomaly14-20W: amniocentesis22-26W: Screening for GDM30-34W: Fetal growth measurementsFrom 35W: NS

  • Loepolds maneuver

    Fetal electronic monitoring

  • Loepolds maneuverFirst maneuver: Perform the first loepolds maneuver to identify the fetal lie, which maybe longitudinal or transverse and fetal presentation, which may be cephalic or vertex or maybe breech. To do this,lightly palpate the womans upper abdomen to identify the fetal part in the fundus. A

  • Loepolds maneuverFirst maneuver: If the part is relatively soft and irregular, youre palpating the buttocks, if the part feels round and firm, freely moveable, youre palpating the fetal head. If you feel head or buttocks in the fundus, the lie is longitudinal. Otherwise, the lie is transverse.Prenatal careA

  • Loepolds maneuverSecond maneuver: Next, perform the second maneuver to further identify the fetal presentation. Using the palm of one hand, locate the fetal back by the smooth back convex contour. With the opposite palm, feel for the irregularities that are the feet, hands, and other small parts.Prenatal careB

  • Loepolds maneuverThird maneuver: Carry out the third maneuver to determine the presenting part, which is the part of the fetals over the pelvic inlet. With the nurse dominant hand, gently grasp the lower pole of the uterus between the nurses thumb and fingers, and press in slightly.Prenatal careC

  • Loepolds maneuverFourth maneuver: Face the womans feet, to perform the fourth maneuver to assess the descent of the presenting part. With the palmar surface of your fingertips, outline the presenting part, which is usually the fetal head. If the presenting part has descended deeply, you may be able to outline only a small portion of it.Prenatal careD

  • Fetal hypoxia

  • Genetic counseling

  • CAUSES OF CONGENITAL MALFORMATIONS*

  • Who does it?Masters-level genetic counselorsMD geneticistsGenetic nurse cliniciansother genetic sub-specialists (PhD geneticists, etc.)

  • Methods?UntrasoundSerum screeningAmniocentesisChorionic villus sampling, CVS

  • Down Syndrome (trisomy 21)

  • Umbilical hernia

  • ex utero intrapartum treatment, EXIT

  • Intrauterine transfusion

  • Case 2 Ms. zhang is a 28 year old woman. She is 17 weeks pregnant and this is her first pregnancy. She has a routine blood test at her OBs office. She is told that it screens for Down syndrome and some other conditions. A week after the test ,she receives a call from the nurse saying she came back screen positive for trisomy 18. The nurse tells her the chance her baby has trisomy 18 is 1 in 100. She is referred to a genetic counselor.What is the next step?

  • RolesReview results of screening testObtain pregnancy and family historyExplain the cause and features of trisomy 18Discuss further testing optionsFacilitate decision makingFollow-up with further testing resultsUse counseling skills to help patient cope with test results

  • Thank you