產(chǎn)前診斷和監(jiān)護(hù)

1、1DIAGNOSIS OF PREGNANC ANTENATAL CARELuo Xiaodong2First-trimester of pregnancy before the 12th weekSecond- trimester of pregnancy 13th to 27th weekThird- trimester of pregnancy after the 28th weekStage of pregnancy3First-trimesterSymptoms and signs:Cessation of menstruation (amenorrhea)Morning sickn

2、essUrinary frequency and urgencyBreast symptoms4First-trimesterCessation of menstruation: Amenorrhea is the earliest and the most important symptoms of pregnancy, but not the differential one5First-trimesterMorning sickness:(6w-12w) About 60% pregnant women nausea, vomiting, sleepy, acidophilus and

3、so on. last for 2 months and then disappear6First-trimesterUrinary frequency and urgency : Appears during the early pregnancy Disappear after the uterus enlarges so much and reaches out the pelvic cavity 7 Pelvic organsEnlargement of uterusCevixcongestive vaginaSoftening of the cervixFirst-trimester

4、8 Pelvic organsHegar sign 6th -8th week softening isthmusFirst-trimester9 BreastSome tenderness and fullness of the breast Engorgement of the surface veinsPigmentation of the primary areola and nippleMontgomerys tuberclesFirst-trimester10Laboratory examinations: Pregnancy test Cervical mucus examina

5、tion Basal body temperature (BBT) Ultrasound diagnosis of pregnancyProgesterone testFirst-trimester11Pregnancy test: large quantities of human chorionic gonadotrophin (hCG) trophoblast 12Cervical mucus examinationFern-like crystals and Ellipsoid13Basal body temperature14Ultrasound diagnosis of pregn

6、ancy15Ultrasound diagnosis of pregnancy16Progesterone test 20mg im qd *3-5 vaginal bleeding ( 2-7d)17 Second and third-trimester Symptoms and signsUterine enlargementFetal movementFetal heart soundFetal body1812:above symphysis16:between symphysis and umbilicus20:1 trans-finger below umbilicus24:1 t

7、rans-finger above umbilicus28:3 trans-finger above umbilicus3240 :between umbilicus and xiphisternum36:2 trans-finger below xiphisternum 19 Fetal movementFirst appreciated at the 20th week32th34th week After 38th weekAn absolute sign, can be felt and seenNormal frequency:30/12h Disappear Prior to fe

8、tal heart sound20 Fetal heart soundDoppler ultrasound usually detects it as early as 10 weeks Normal :120-160bpm per minuteuterine souffle ,sound of aorta abdominalis,sound of fetal movement ,umbilical souffle21 Palpation of fetal partsAfter 20 weeks, the fetal outline can be palpated through the ma

9、ternal abdominal wall.The head feels round, rough and has ballottementThe back feels broad, flatnessThe ass feels broad and irregularThe limbs feels small and move sometime22numberfetal lie ,fetal presentation ,fetal positionheart beatplacentaBPD (biparietal )CRL AC HC FL Amniotic fluidUmbilical cor

10、d 1820w,malformation Second and third-trimester Ultrasound diagnosis of pregnancy23 Second and third-trimester Ultrasound diagnosis of pregnancy24 Second and third-trimester Ultrasound diagnosis of pregnancy25Fetal attitudeFetal attitudeFetal lie longitudinal lie 99.75% transverse lie 0.25%Fetal pre

11、sentation cephalic breech shoulder Fetal position anterior, posterior, transverse left, right occiput , mentum (頦骨) scapula(肩胛)，sacrum2627 Fetal lie Cephalic presentation longitudinal lieBreech presentationlongitudinal lieShoulder presentationTransverse lie28 head presentationFetal presentationoccip

12、ito bregma brow facepresentation presentation presentation presentation 29Breech presentationFetal presentationcomplete breech frank breech foot or feet presentation presentation presentation30 Fetal position31 Fetal positionLOALOP32 LOA Fetal position33 LOT Fetal position34LOP Fetal position35ROA F

13、etal position36ROT Fetal position37 ROP Fetal position38Antenatal care39perinatal period (圍生期)From 28w to 1w postpartumW more than 1000gH more than 35cm40Schedule of regular prenatal care 0-28 weeks every 4 weeks 28-36 weeks every 2 weeks after 36 weeks every week41The first prenatal visit History P

14、hysical examination Obstetric physical examination Auxiliary examination 42HistoryAge, occupation,native place,Menstrual history, LMP-3 months, +7days=EDCPregnancy historyReproductive historyMedical history , surgical history Family historyHistory of childhood varicella, prior STDs or risks for HIV

15、infection43General physical examination44Obstetric physical examinationfetal examination birth canal examination45 Fetal examinationGestational age and fetal weightFetal presentation and fetal lie Fetal heart sound46Height of fundusCircular length of the abdomen47Leopold maneuver4849Fetal heart soun

16、d50 Bony birth canalExternal pelvimetryInternal pelvimetry51External pelvimetryPelvic-inletTransverse diameterInterspinal diameter:23-26cmIntercristal diameter:25-28cmAnterior diameter:External conjugate:18-20cm52Midpelvic interspinous diameter:10 cm Estimate the distance by noting the prominence an

17、d relative closeness of the ischial spines.53Pelvic outletTransverse outlet:8.5-9.5cmPosterior sagittal diameter of outlet :8-9cmAngle of subpubic arch:normal value 900 54Interspinal diameter（2326cm）Intercristal diameter （2528cm）55External conjugate （1820cm）Michaelis rhomboidSpinous process of 5th l

18、umbar 56Transverse outlet(8.5-9.5)Ischial tuberosityIntertuberal diameter57Angle of pubic arch 900 58Posterior sagittal diameter of outlet (8-9cm)sacrococcygeal joint59Internal pelvimetryDiagonal conjugateBi-ischial diameterWidth of sciatic notch 60Diagonal conjugate（12.513cm)conjugate vera(11cm)pro

19、montory61Bi-ischial diameter （10cm）62Width of sciatic notch （5.56cm）63Fetal assessmentAntepartum fetal assessmentfetal maturity assessmentDiagnose of congenital malformations64 Antepartum fetal assessmentFetal movement (30/12h)FECG and Doppler Fetal electronic monitoring Biophysical profile Amniosco

20、pyPlacental function65Fetal electronic monitoring66Fetal electronic monitoringRelationship:Fetal heart beat Fetal movementContraction of uterus67Fetal electronic monitoringbaseline fetal heart rate : no movement ,no contraction,20minsRange: 110-160bpmamplitude : 10-25bpmfrequency of mutation :6 time

21、s68Fetal electronic monitoringvariation of fetal heart rate: FHR - contractionAcceleration: 15bpm ,15s body or umbilical cord are pressedDeceleration: ED : head is pressed VD : umbilical cord are pressed LD : fetal anoxia ,poor function of placeta 69ED70VD71LD72TESTNST(no stress test): fetal movement -FHRReactive type:15bpm,15s while movement (1week)Nonreactive type : 15bpm,15s OCT OCT(oxytocin challenge test): 20mins with contraction FHRPositive: poor function of placetaNega