Diagnosis of pregnancy and routine prenatal care
Ai-Xia LiuWomen’s Hospital School of Medicine
Zhejiang University
Part I Pregnancy: defined as the maternal
condition of having a developing embryo or fetus in the body.
Lennart Nilsson (born 1922) is a Swedish photographer and scientist. He is noted for his photographs of in vivo human embryos in 1965.
Oocyte and sperms
Implantation
fertilization
Only one sperm can penetrate through the zona pellucida of oocyte
20w old fetal issucking his thumb
11w fetal
Embryo: 0-8weeks Fetus: 9-40weeks
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
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
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
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
Signs Increased basal body temperature Breast tenderness Chadwick's sign (darkening of the cervix, v
agina, and vulva), Goodell's sign (softening of the vaginal po
rtion of the cervix), Hegar's sign (softening of the uterus isthm
us),
chloasma linea nigra
Skin change: increased pigmentation including chloasma, linea nigra, stretch marks
stretch marks
First trimester pregnancy
Bleeding (25%) Spontaneous abortion (25-50%) Uterine cramping with bleeding in
the first trimester is suggestive of impending abortion
Pregnancy test
Human chorionic gonadotropin (HCG) is produced by trophoblasts from 8 days after fertilization
Urine pregnancy test Serum pregnancy test: more sensiti
ve HCG may be detected in maternal seru
m in 9 days
Positive manifestations
Fetal heart tone (120-160 BPM)
Doppler device can detect at 10 weeks
• Ultrasound examination of fetus is one of the most useful technical way
Positive manifestations
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)
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
Positive manifestations
Palpation of fetus (22 weeks)
Leopold Maneuver to determine the fetal presentation
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.
Transverse lie
Longitudinal lie
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
Routine Prenatal care
Part II
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
The first prenatal visit
Usually at the first trimester, most thorough History Physical examination Laboratory tests
History
Obstetrical history Medical history Family history Social history
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
Medical history
Previous and current medical disease Diabetes, chronic hypertension Medication Previous surgeries Blood transfusion history
General history
Family history Diabetes Mental retardation Genetic disorders
Social history and education
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
Physical examination
Pelvic examination Evaluation for abnormal vaginal discharge Performance of cervical culture Assessment of pelvic soft tissue: cervix and u
terine Bony pelvis
Clinical pelvimetry : pelvic inlet, midpelvis and pelvic outlet
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)
Laboratory tests
Urinalysis: bacteria, sugar, and protein Pap smear :detection abnormal cells Infectious disease: gonorrhea, chlamyd
ia, group B streptococcus, et al Stool test when indicated Tuberculin skin test for high risk patien
ts
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
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
Subsequent Visit Weight gain Blood pressure Fundal height Abdominal examination Fetal heart tones Edema Urine test
fetal size and position
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