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

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