Prenatal Care

Ⅰ.The Purpose of Prenatal Care

• Pregnancy is a normal physiological course that is only occasionally complicated by pathological processes threatening to the mother and fetus. However even a normal pregnancy may alter the pregnant woman’s physiological function, so that danger to the mother or fetus may occur.

• Therefore the purpose of prenatal care is to ensure an uncomplicated pregnancy for mother and baby.

• In addition, the early identification and treatment of the high-risk pregnancy is also very important.

Ⅱ.Definition of Perinatology

• In recent years perinatology has been established and there are 4 possible definition described by world health organization(WHO).

• 1. from the 28th week of pregnancy to the first week of postpartum

• 2. from the 20th week of pregnancy to the 4th week of postpartum

• 3. from the 28th week of pregnancy to the 4th week of postpartum

• 4. from the formation of embryo to the first week of postpartum

• At the present, the first definition has been used widely in clinic practice

Ⅲ.Date of the Prenatal Examination

• Prenatal examination begins on the early stage of pregnancy.

• At the 20-36th week of gestation performed once every 4 weeks.

• After the 36th week of gestation once a week.

• That is,at 20,24,28,32,36,37,38,39,40 week respectively,and the total number is 9.

Ⅳ.First Prenatal Visit

• 1. History * age * job * EDC(expected date of confinement) * menstrual and post obstetric history * history of present pregnancy

• The EDC is arrived at by counting back 3 months or adding 9 months from the first day of the LMP (Last Menstrual Period) and then adding 7 days.

• 2. Physical Examination

• 3. Obstetric Examination

• 1) Abdominal Examination

• *inspection:

• *palpation: four maneuvers of leopold

• *auscultation:

• 2) Pelvimetry

• *external pelvimetry

• **interspinal diameter 髂棘间径 23-26cm

• **intercristal diameter 髂嵴间径 25-28cm

• **intertrochanteric diameter 粗隆间径 28-31cm

• **extermal conjugate 骶耻外径 18-20cm

• **transverse outlet 出口横径 8.5-9.5cm

• **posterior sagittal diameter of outlet 出口 后矢状径 8-9cm

• 出口后矢状径 + 坐骨结节间径 >15cm

• **angle of subpubic arch 耻骨弓角度 >90

.• *internal pelvimetry

• **diagonal conjugate 对角径 12.5-13cm

• 对角径 - （ 1.5-2.0cm)= 真结合径 11cm

• **bi-ischial diameter 坐骨棘间径 10cm

• **diameter of sacrospinal ligament 坐骨切迹（骶棘韧带）宽度 5.5-6.0cm

• 3) Vaginal Examination

• 4) Rectal Examination

• 5) Pregnogram

• 4. Assistant Examination

• 1) laboratory determination

• 2) ultrasonic examination

• 3) amniotic fluid analysis

• 4) examination of the fetal genetic disease

• 5) examination of the functional capacity of the placenta

Ⅴ. Repeat Prenatal Visits

• Ⅵ. Monitoring for fetus and maturity

• 1. The high risk infant

• 2. Fetal monitoring in uterus 胎儿宫内监测

• 1) first trimester

• 2) second trimester

• 3) third trimester

• Fetal electronic monitoring 胎心电子监测• A. 胎心率的监测• a. 胎心率基线

• b. 一过性胎心率变化• acceleration

• deceleration

• early deceleration

variable deceleration

• late deceleration

• B. Assessment of intrauterine fetal reserve ability 预测胎儿储备能力

• a. NST(Non-stress test)

• b. CST(contraction stress test)

• OCT(oxytocin challenge test)

• 3. Placental function examination• 1) 胎动： fetal movement of counting• 12h>10 次 正常• 2) 孕妇尿雌三醇值： estriol in maternal

24h urine • >15mg/24h 正常• 10-15mg/24h 警戒值• <10mg/24h 危险值

• E/C 比值 (estriol/creatine)• >15 正常值• 10-15 警戒值• <10 危险值• 3 ） HPL (human placental lactogen in

maternal serum) 孕妇血清胎盘生乳素

• 妊娠足月 <4mg/L 胎盘功能低下• 突然下降 50% 胎盘功能低下• 4 ） others

• 4. Fetal maturity 胎儿成熟度检查• 1 ）正确推算预产期• 2 ）宫高、腹围预测胎儿大小• 3 ） B 超 BPD>8.5• 4 ）羊水 L/S 比值 (lecithin/sphingomyelin)>2• 5 ）其他