Prenatal Care

1. Prenatal Care

2. 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.

3. 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.

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

5. 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

6. 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.

7. 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.

8. 2. Physical Examination

9. 3. Obstetric Examination • 1) Abdominal Examination • *inspection: • *palpation: four maneuvers of leopold • *auscultation:

14. 2) Pelvimetry • *external pelvimetry • **interspinal diameter 髂棘间径 23-26cm

15. **intercristal diameter 髂嵴间径 25-28cm

16. **intertrochanteric diameter 粗隆间径 28-31cm

17. **extermal conjugate 骶耻外径 18-20cm

18. **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

19. . • *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

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

21. 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

22. Ⅴ. Repeat Prenatal Visits

23. 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

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

25. b. 一过性胎心率变化 • acceleration • deceleration • early deceleration

26. variable deceleration

27. late deceleration

28. 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)

29. 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

30. 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

31. 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