Presentation on theme: "Women’s Hospital School of Medicine"— Presentation transcript:
1Women’s Hospital School of Medicine Diagnosis of pregnancy and routine prenatal careAi-Xia LiuWomen’s Hospital School of MedicineZhejiang University
2Part IPregnancy: defined as the maternal condition of having a developing embryo or fetus in the body.
3A pregnancy is defined as the maternal condition of having a developing embryo or fetus in the body.
4Oocyte and spermsMillions of sperm entering the vagina and swim towards the opening of the cervix.Lennart Nilsson (born 1922) is a Swedish photographer and scientist. He is noted for his photographs of in vivo human embryos in 1965.
9The 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 ageFertilization age: the age of the offspring calculated from the time of fertilization
10Gravidity: 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
11Pregnancy diagnosisPregnancy is divided into three phases, called trimestersFirst trimester: weeksSecond trimester: weeksThird trimester: weeksPregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time. The first 12 weeks of pregnancy are considered to make up the first trimester . Weeks 13 to 27 of the pregnancy are called the second trimester .
12First trimester pregnancy SymptomsAmenorrhea: strongly suggestive of pregnancyNauseamorning sickness of pregnancy (4-12W)results from rapidly rising serum levels of HCGFatigue: one of the earliest symptoms of pregnancyFrequent urinationMost pregnant women experience a number of symptoms which can signify pregnancy. The symptoms can include missed menstruation, nausea and vomiting, excessive tiredness and fatigue, cravings for certain foods that are not normally sought out, and frequent urination particularly during the night.
13Signs 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),A number of early medical signs are associated with pregnancy. These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy.increased basal body temperature sustained for over 2 weeks after ovulation, Breast tenderness is common during the first trimester
14Skin change: increased pigmentation including chloasma, linea nigra, stretch marks chloasma or the mask of pregnancy when present in pregnant women is a tan or dark skin discoloration .pigmentation of linea alba – Linea nigra, (darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually appearing around the middle of pregnancy). Stretch marks are the result of the rapid stretching of the skin associated with rapid fetal growth (common in puberty) or weight gain during pregnancy, and they also are influenced by hormonal changes associated with pregnancychloasmalinea nigrastretch marks
15First trimester pregnancy Bleeding (25%)Spontaneous abortion (25-50%)Uterine cramping with bleeding in the first trimester is suggestive of impending abortion
16Pregnancy test Urine pregnancy test Human chorionic gonadotropin (HCG) is produced by trophoblasts from 8 days after fertilizationUrine pregnancy testSerum pregnancy test: more sensitiveHCG may be detected in maternal serum in 9 daysPregnancy detection can be accomplished using one or more various pregnancy tests, which detect hormones generated by the newly formed placenta. Clinical blood and urine tests can detect pregnancy 12 days after implantation.Home pregnancy tests are urine tests, and normally cannot detect a pregnancy until at least 12 to 15 days after fertilization. Blood pregnancy tests are more accurate than urine tests. A quantitative blood test can determine approximately the date the embryo was conceived.
17Positive manifestations Fetal heart tone( BPM)Doppler device can detect at 10 weeks
18Positive manifestations Ultrasound examination of fetus is one of the most useful technical way
23Second trimester pregnancy SymptomsGeneral well-being: the most comfortable time for a pregnant womanPain: stretching of pelvic structuresUterine contraction (Braxton hicks contractions)Braxton Hicks contractions also known as false labor or practice contractions, are sporadic uterine contractions that sometimes start around 6 weeks. However, they are not usually felt until the second trimester or third trimester of pregnancy. They are a tightening of the uterine muscles for one to two minutes and are thought to be an aid to the body in its preparation for birth. Not all expectant mothers feel these contractions. They are not thought to be part of the process of effacement [i‘feismənt] 子宫颈展平of the cervix.
24Second trimester pregnancy Abdominal enlargement:quickening: primigravida wmultigravidas wFetus: attains a size of almost 1000g by 28wMotion: begin at 16-20wViabilityQuickening: means the day that the pregnant woman recognized fetal movement for the first time. Sensation of fetal movement occurs at weeks in primigravida and at weeks in multigravidas.
25Positive manifestations Palpation of fetus (22 weeks)Leopold Maneuver to determine the fetal presentation
26In 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.
27Longitudinal lie Transverse lie A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput [‘ɔksipʌt 】枕后is the leading part (the part that first enters the birth canal). All other presentations are abnormal (malpresentations) which are either more difficult to deliver or not deliverable by natural means.Cephalic presentation means head first. This is the normal presentation.Breech presentation means the fetal butt is coming out first.means the fetus is oriented from one side of the mother to the other and neither the head nor the butt is coming out first.Compound presentation means that a fetal hand is coming out with the fetal head.Shoulder presentation means that the fetal shoulder is trying to come out first.
28Third trimester pregnancy SymptomsContraction: more apparentPain in the lower back and legs: pressure on muscles and nerves by the uterus and fetal headLightening: descent of the fetal headweight gain: fetal grows rapidlyFetal movement: regularly, strongThis period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and backache.which is the most weight gain throughout the pregnancy. The fetus will be growing the most rapidly during this stage, gaining up to 28 g per day . The fetus begins to move regularly, and is felt by the woman. Fetal movement can become quite strong and be disruptive to the woman
30Part II Routine Prenatal care Pregnancy is a normal physiologic event that is sometimes complicated by pathologic processes dangerous to the health of the mother and fetus. The abnormalities during pregnancy should be recognized so that their effects can be minimized. The principle aim of prenatal care is identification and special treatment of high-risk pregnancy, and to ensure as much as possible an uncomplicated pregnancy and the delivery of healthy baby.Prior to modern medicine, many mothers and their babies did not survive pregnancy and the birth process. Today, good prenatal care can significantly improve the quality of the pregnancy and the outcome for the infant and mother.Prenatal care (also known as antenatal care) refers to the medical and nursing care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc.), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. The availability of routine prenatal care has played a part in reducing maternal death rates and miscarriages as well as birth defects, low birth weight, and other preventable infant problems.
31Prenatal care Preconception care Routine prenatal care Women who contemplate pregnancy should be evaluated for the conditions that could affect a future pregnancyRoutine prenatal careEvery 4 weeks during the first 28 weeks of gestationEvery 2 weeks from 28 to 36 weeksWeekly from 36 weeks to deliveryContemplate. [‘kɔntem.pleit] 打算
32The first prenatal visit Usually at the first trimester, most thoroughHistoryPhysical examinationLaboratory testsA healthy first trimester is crucial to the normal development of the fetus. The mother-to-be may not be showing much on the outside, but inside her body all the major body organs and systems of the fetus are forming. It is during this first trimester that the fetus is most susceptible to damage from substances such as alcohol, drugs, certain medications, and illnesses such as rubella (German measles).
33History Obstetrical history Medical history Family history Social history
34Complete obstetric history Present pregnancy and menstrual historyEstimated gestational age(EGA), EDCThe length and duration of menstruationPast pregnanciesEGA at the time of delivery or abortionFetal outcomeMode of delivery: vaginal or cesarean sectionComplications: GDM, preeclampsia
35Medical history Previous and current medical disease Diabetes, chronic hypertensionMedicationPrevious surgeriesBlood transfusion history
36General history Family history Social history and education Diabetes Mental retardationGenetic disordersSocial history and education
37Physical examination Physical examinations generally consist of: Checking (mother's) blood pressure(Mother's) height and weightPelvic examDoppler fetal heartrate monitoring(Mother's) blood and urine tests
38Physical examination Pelvic examination Clinical pelvimetry： Evaluation for abnormal vaginal dischargePerformance of cervical cultureAssessment of pelvic soft tissue: cervix and uterineBony pelvisClinical pelvimetry：pelvic inlet, midpelvis and pelvic outletPelvic soft tissue: to note any pelvic mass, evaluation of the uterus (the size and position of the uterus, cervical length) and to determine the age of the fetus.Bony pelvis: pelvic inlet, midpelvis and pelvic outlet.Pelvimetry [pel'vimitri
39Laboratory Tests Blood screening Blood routine test Blood type (ABO and RH)Detect diseases: rubella, syphilis, hepatitis B, HIVScreening test for certain diseases according family historyDiabetes screen: glucose challenge test (GCT)All pregnant women are tested for the Rh factor during the early weeks of pregnancy. A mother and fetus may have incompatible blood types. The most common is Rh incompatibility. Rh incompatibility occurs when the mother's blood is Rh-negative and the father's blood is Rh-positive and the fetus' blood is Rh-positive. The mother may produce antibodies against the Rh-positive fetus, which may lead to anemia in the fetus. Incompatibility problems are monitored and appropriate medical treatment is available to prevent the formation of Rh antibodies during pregnancy.
40Laboratory tests Urinalysis: bacteria, sugar, and protein Pap smear :detection abnormal cellsInfectious disease: gonorrhea, chlamydia, group B streptococcus, et alStool test when indicatedTuberculin skin test for high risk patientsUrine testing - to screen for bacteria, sugar, ketones and protein.Pap smear - to detect the presence of abnormal cellsTo detect infectious diseases – gonorrhea[.gɔnə'ri:ə ], chlamydia[klə'midiə] , Group B streptococcus[.streptəu'kɔkəs ], et al.
41Laboratory tests Neural tube defects screening testing First trimester screening (10w3d-13w6d)Nuchal translucency(NT) measurement+serum analytesSecond trimester screening(15-20w)Serum analyses: AFP+HCG+estriol (uE3)Diagnostic genetic testingChorionic villus sampling (CVS) (10-12w )Amniocentesis ( 16-18w )Age>35 or abnormal pedigreesfirst trimester screening (combination of maternal serum analytes [PAPPA+βhCG] and fetal nuchal translucency measurement)screening for neural tube defects and chromosomal abnormalities (blood test for hCG + estriol +AFP, 15-20w),Genetic testing –including chorionic villus sampling (CVS) at 10-12w and amniocentesis at 16-18w. It is indicated for women over age 35 and those with abnormal pedigrees家系 to detect inherited diseases (i.e., sickle-cell anemia, Tay-Sachs disease).
42Subsequent Visit Every 4w until 28(32)w Every 2w until 36w After 36 weeks, every 1 w until deliveryComplicated pregnancies require closer surveillance
43Subsequent Visit fetal size and position Weight gain Blood pressure Fundal heightAbdominal examinationFetal heart tonesEdemaUrine testfetal size and positionEach visit including weight gain, blood pressure, fundal height, abdominal examination, fetal heart tones, urine test, edema and fetal size and position.