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Diagnosis of pregnancy and routine prenatal care Ai-Xia Liu Womens Hospital School of Medicine Zhejiang University.

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Presentation on theme: "Diagnosis of pregnancy and routine prenatal care Ai-Xia Liu Womens Hospital School of Medicine Zhejiang University."— Presentation transcript:

1 Diagnosis of pregnancy and routine prenatal care Ai-Xia Liu Womens Hospital School of Medicine Zhejiang University

2 Part I Pregnancy: defined as the maternal condition of having a developing embryo or fetus in the body.


4 Lennart Nilsson (born 1922) is a Swedish photographer and scientist. He is noted for his photographs of in vivo human embryos in 1965.Swedishphotographerin vivohuman embryos Oocyte and sperms


6 Implantation fertilization Only one sperm can penetrate through the zona pellucida of oocyte

7 20w old fetal is sucking his thumb 11w fetal

8 Embryo: 0-8weeks Fetus: 9-40weeks

9 The duration of pregnancy Gestational age: It is calculated from the first day of the last menstrual period (LMP, assuming a 28 day cycle) and expressed in completed age Fertilization age: the age of the offspring calculated from the time of fertilization

10 Gravidity: the total number of pregnancies (normal and abnormal) Parity: the state of having given birth to an infant or infants weighing 500g, alive or dead. (A multiple birth is a single parous experience) Live birth: the complete expulsion or extraction of a product of conception from the mother, which shows evidence of life

11 Pregnancy diagnosis Pregnancy is divided into three phases, called trimesters First trimester: 0 - 12 weeks Second trimester: 13 - 27 weeks Third trimester: 28 - 40 weeks

12 First trimester pregnancy Symptoms Amenorrhea: strongly suggestive of pregnancy Nausea morning sickness of pregnancy (4-12W) results from rapidly rising serum levels of HCG Fatigue: one of the earliest symptoms of pregnancy Frequent urination

13 Signs Increased basal body temperature Breast tenderness Chadwick's sign (darkening of the cervix, vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix), Hegar's sign (softening of the uterus isthmus),

14 chloasma linea nigra Skin change: increased pigmentation including chloasma, linea nigra, stretch marks stretch marks

15 First trimester pregnancy Bleeding (25%) Spontaneous abortion (25-50%) Uterine cramping with bleeding in the first trimester is suggestive of impending abortion

16 Pregnancy test Human chorionic gonadotropin (HCG) is produced by trophoblasts from 8 days after fertilization Urine pregnancy test Serum pregnancy test: more sensitive HCG may be detected in maternal serum in 9 days

17 Positive manifestations Fetal heart tone (120-160 BPM) Doppler device can detect at 10 weeks

18 Ultrasound examination of fetus is one of the most useful technical way Positive manifestations





23 Second trimester pregnancy Symptoms General well-being: the most comfortable time for a pregnant woman Pain: stretching of pelvic structures Uterine contraction (Braxton hicks contractions)

24 Second trimester pregnancy Abdominal enlargement: quickening: primigravida 16-20 w multigravidas 14-16 w Fetus: attains a size of almost 1000g by 28w Motion: begin at 16-20w Viability

25 Positive manifestations Palpation of fetus (22 weeks) Leopold Maneuver to determine the fetal presentation

26 In obstetrics, the presentation of a fetus about to be born refers to which anatomical part of the fetus is leading, that is, is closest to the pelvic inlet of the birth canal. According to the leading part, this is identified as a cephalic, breech, or shoulder presentation.

27 Transverse lie Longitudinal lie

28 Symptoms Contraction: more apparent Pain in the lower back and legs: pressure on muscles and nerves by the uterus and fetal head Lightening: descent of the fetal head weight gain: fetal grows rapidly Fetal movement: regularly, strong Third trimester pregnancy


30 Routine Prenatal care Part II

31 Prenatal care Preconception care Women who contemplate pregnancy should be evaluated for the conditions that could affect a future pregnancy Routine prenatal care Every 4 weeks during the first 28 weeks of gestation Every 2 weeks from 28 to 36 weeks Weekly from 36 weeks to delivery

32 The first prenatal visit Usually at the first trimester, most thorough History Physical examination Laboratory tests

33 History Obstetrical history Medical history Family history Social history

34 Complete obstetric history Present pregnancy and menstrual history Estimated gestational age(EGA), EDC The length and duration of menstruation Past pregnancies EGA at the time of delivery or abortion Fetal outcome Mode of delivery: vaginal or cesarean section Complications: GDM, preeclampsia

35 Medical history Previous and current medical disease Diabetes, chronic hypertension Medication Previous surgeries Blood transfusion history

36 General history Family history Diabetes Mental retardation Genetic disorders Social history and education

37 Physical examination Physical examinations generally consist of: Checking (mother's) blood pressure (Mother's) height and weight Pelvic exam Doppler fetal heart rate monitoring (Mother's) blood and urine tests

38 Physical examination Pelvic examination Evaluation for abnormal vaginal discharge Performance of cervical culture Assessment of pelvic soft tissue: cervix and uterine Bony pelvis Clinical pelvimetry pelvic inlet, midpelvis and pelvic outlet

39 Laboratory Tests Blood screening Blood routine test Blood type (ABO and RH) Detect diseases: rubella, syphilis, hepatitis B, HIV Screening test for certain diseases according family history Diabetes screen: glucose challenge test (GCT)

40 Laboratory tests Urinalysis: bacteria, sugar, and protein Pap smear :detection abnormal cells Infectious disease: gonorrhea, chlamydia, group B streptococcus, et al Stool test when indicated Tuberculin skin test for high risk patients

41 Laboratory tests Neural tube defects screening testing First trimester screening (10w3d-13w6d) Nuchal translucency(NT) measurement+serum analytes Second trimester screening(15-20w) Serum analyses: AFP+HCG+estriol (uE3) Diagnostic genetic testing Chorionic villus sampling (CVS) (10-12w ) Amniocentesis ( 16-18w ) Age>35 or abnormal pedigrees

42 Subsequent Visit Every 4w until 28(32)w Every 2w until 36w After 36 weeks, every 1 w until delivery Complicated pregnancies require closer surveillance

43 Subsequent Visit Weight gain Blood pressure Fundal height Abdominal examination Fetal heart tones Edema Urine test fetal size and position


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