Prenatal Care
Ⅰ.The Purpose of Prenatal Care
? Pregnancy is a normal physiological
course that is only occasionally
complicated by pathological processes
threatening to the mother and fetus.
However even a normal pregnancy may alter
the pregnant woman’s physiological function,
so that danger to the mother or fetus may
occur.
? Therefore the purpose of prenatal
care is to ensure an uncomplicated
pregnancy for mother and baby.
? In addition,the early identification
and treatment of the high-risk
pregnancy is also very important.
Ⅱ,Definition of Perinatology
? In recent years perinatology has been
established and there are 4 possible
definition described by world health
organization(WHO).
? 1,from the 28th week of pregnancy to the first
week of postpartum
? 2,from the 20th week of pregnancy to the 4th
week of postpartum
? 3,from the 28th week of pregnancy to the 4th
week of postpartum
? 4,from the formation of embryo to the first
week of postpartum
? At the present,the first definition has been
used widely in clinic practice
Ⅲ,Date of the Prenatal
Examination
? Prenatal examination begins on the early
stage of pregnancy.
? At the 20-36th week of gestation
performed once every 4 weeks.
? After the 36th week of gestation once a
week.
? That is,at 20,24,28,32,36,37,38,39,40
week respectively,and the total number is
9.
Ⅳ,First Prenatal Visit
? 1,History
* age
* job
* EDC(expected date of confinement)
* menstrual and post obstetric history
* history of present pregnancy
* family history and husband health status
? The EDC is arrived at by counting back 3 months or
adding 9 months from the first day of the LMP (Last
Menstrual Period) and then adding 7 days.
? 2,Physical Examination
– General examination
? Development,nutrient,height,spine,
complicated with other disease,breast
(nipple),weight,edema……
? 3,Obstetric Examination
? 1) Abdominal Examination
? *inspection:
? *palpation,four maneuvers of leopold
? *auscultation:
? 2) Pelvimetry
? *external pelvimetry
? **interspinal diameter 髂棘间径 ( 髂前上
棘外缘 )23-26cm
? **intercristal diameter 髂嵴间径 (髂嵴 外缘 )
25-28cm
? **intertrochanteric diameter 粗隆间径
28-31cm
? **extermal conjugate 骶耻外径 (第 5腰椎
棘突下至耻骨联合上缘中点 ) 18-20cm
? **Intertuberal diameter (坐骨结节间径 )
-- transverse outlet 出口横径 8.5-9.5cm
? **posterior sagittal diameter of outlet 出
口
后矢状径 8-9cm
? 出口后矢状径 +坐骨结节间径 >15cm
? **angle of subpubic arch 耻骨弓角度 >90
.
? *Internal pelvimetry
? **diagonal conjugate 对角径 (耻骨联合下
缘至骶岬上缘中点 ) 12.5-13cm
? 对角径 -（ 1.5-2.0cm)=真结合径 11cm
? **bi-ischial diameter 坐骨棘间径 10cm
? **diameter of sacrospinal ligament 坐骨切
迹（骶棘韧带）宽度 5.5-6.0cm (3横指 )
? 3) Vaginal Examination
? 4) Rectal Examination
? 5) Pregnogram (BP,weight,length of uterus,
AC,BPD,urine protein,fetal position,FHR,
edema)
? 4,Assistant Examination
? 1) laboratory determination (blood rutine,
liver function,virus……
? 2) ultrasonic examination
? 3) amniotic fluid analysis
? 4) examination of the fetal genetic disease
? 5) examination of the functional capacity
of the placenta
Ⅴ,Repeat Prenatal Visits
? Ⅵ, Monitoring for fetus and maturity
? 1,The high risk infant (GW <37w or >42w; BW
<2500g; BW> GA; 1’Apgar < 3; intrapartum infection; high
risk pregnancy; operation; perinatal death of neonatal’s
brother or sister)
? 2,Fetal monitoring in uterus
胎儿宫内监测
? 1) first trimester (uterus size = GW? Pregnant sac?
? 2) second trimester
? 3) third trimester
? Fetal electronic monitoring 胎心电子监测
? A,胎心率的监测
? a,胎心率基线 (bpm; FHR variability)
? b,一过性胎心率变化
? acceleration
? deceleration
? early deceleration (fetal head
compressed)
variable deceleration (umbilical cord
compressed)
? late deceleration (fetal hypoxia)
? B,Assessment of intrauterine fetal reserve ability
预测胎儿储备能力
? a,NST(Non-stress test),Reaction pattern (> 3 FM
with FHR increase > 15bpm,duration > 15s
within 20min) and Non-reaction pattern
? b,CST(contraction stress test)
? OCT(oxytocin challenge test) OCT(+) [late
deceleration occurs reapeatly; FHR baseline
variability decreased; no FHR increase after FM)--
- placenta function decreased and OCT (-) (fetus
is safe within one week)
Fetal bio-physiological score
? Manning score
? NST
? Fetal breath movement
? Fetal movement
? Muscle tension
? Amniotic fluid
? 10 is normal; <8 is acute or chronic
hypoxia
? 3,Placental function examination
? 1) 胎动,fetal movement of counting
? 12h>10次 正常
? 2) 孕妇尿雌三醇值,estriol in maternal
24h urine
? >15mg/24h 正常
? 10-15mg/24h 警戒值
? <10mg/24h 危险值
? E/C 比值 (estriol/creatine)
? >15 正常值
? 10-15 警戒值
? <10 危险值
? 3） HPL (human placental lactogen in
maternal serum) 孕妇血清胎盘生乳素
? 妊娠足月 <4mg/L 胎盘功能低下
? 突然下降 50% 胎盘功能低下
? 4） others OCT; FBPS
? 4,Fetal maturity 胎儿成熟度检查
? 1）正确推算预产期
? 2）宫高、腹围预测胎儿大小 (FW = length of
uterus X AC + 200)
? 3） B超 BPD>8.5
? 4） 羊水 L/S 比值 (lecithin/sphingomyelin)>2 =
Fetal lung maturity)
? 5） 其他 ( Cr – renal; ΔOD450 – liver ……)
Intrauterine diagnosis
? 1,Amniocentesis – chromosome,enzyme,
virus
? 2,B-ultrasound – fetal malformation
Ⅰ.The Purpose of Prenatal Care
? Pregnancy is a normal physiological
course that is only occasionally
complicated by pathological processes
threatening to the mother and fetus.
However even a normal pregnancy may alter
the pregnant woman’s physiological function,
so that danger to the mother or fetus may
occur.
? Therefore the purpose of prenatal
care is to ensure an uncomplicated
pregnancy for mother and baby.
? In addition,the early identification
and treatment of the high-risk
pregnancy is also very important.
Ⅱ,Definition of Perinatology
? In recent years perinatology has been
established and there are 4 possible
definition described by world health
organization(WHO).
? 1,from the 28th week of pregnancy to the first
week of postpartum
? 2,from the 20th week of pregnancy to the 4th
week of postpartum
? 3,from the 28th week of pregnancy to the 4th
week of postpartum
? 4,from the formation of embryo to the first
week of postpartum
? At the present,the first definition has been
used widely in clinic practice
Ⅲ,Date of the Prenatal
Examination
? Prenatal examination begins on the early
stage of pregnancy.
? At the 20-36th week of gestation
performed once every 4 weeks.
? After the 36th week of gestation once a
week.
? That is,at 20,24,28,32,36,37,38,39,40
week respectively,and the total number is
9.
Ⅳ,First Prenatal Visit
? 1,History
* age
* job
* EDC(expected date of confinement)
* menstrual and post obstetric history
* history of present pregnancy
* family history and husband health status
? The EDC is arrived at by counting back 3 months or
adding 9 months from the first day of the LMP (Last
Menstrual Period) and then adding 7 days.
? 2,Physical Examination
– General examination
? Development,nutrient,height,spine,
complicated with other disease,breast
(nipple),weight,edema……
? 3,Obstetric Examination
? 1) Abdominal Examination
? *inspection:
? *palpation,four maneuvers of leopold
? *auscultation:
? 2) Pelvimetry
? *external pelvimetry
? **interspinal diameter 髂棘间径 ( 髂前上
棘外缘 )23-26cm
? **intercristal diameter 髂嵴间径 (髂嵴 外缘 )
25-28cm
? **intertrochanteric diameter 粗隆间径
28-31cm
? **extermal conjugate 骶耻外径 (第 5腰椎
棘突下至耻骨联合上缘中点 ) 18-20cm
? **Intertuberal diameter (坐骨结节间径 )
-- transverse outlet 出口横径 8.5-9.5cm
? **posterior sagittal diameter of outlet 出
口
后矢状径 8-9cm
? 出口后矢状径 +坐骨结节间径 >15cm
? **angle of subpubic arch 耻骨弓角度 >90
.
? *Internal pelvimetry
? **diagonal conjugate 对角径 (耻骨联合下
缘至骶岬上缘中点 ) 12.5-13cm
? 对角径 -（ 1.5-2.0cm)=真结合径 11cm
? **bi-ischial diameter 坐骨棘间径 10cm
? **diameter of sacrospinal ligament 坐骨切
迹（骶棘韧带）宽度 5.5-6.0cm (3横指 )
? 3) Vaginal Examination
? 4) Rectal Examination
? 5) Pregnogram (BP,weight,length of uterus,
AC,BPD,urine protein,fetal position,FHR,
edema)
? 4,Assistant Examination
? 1) laboratory determination (blood rutine,
liver function,virus……
? 2) ultrasonic examination
? 3) amniotic fluid analysis
? 4) examination of the fetal genetic disease
? 5) examination of the functional capacity
of the placenta
Ⅴ,Repeat Prenatal Visits
? Ⅵ, Monitoring for fetus and maturity
? 1,The high risk infant (GW <37w or >42w; BW
<2500g; BW> GA; 1’Apgar < 3; intrapartum infection; high
risk pregnancy; operation; perinatal death of neonatal’s
brother or sister)
? 2,Fetal monitoring in uterus
胎儿宫内监测
? 1) first trimester (uterus size = GW? Pregnant sac?
? 2) second trimester
? 3) third trimester
? Fetal electronic monitoring 胎心电子监测
? A,胎心率的监测
? a,胎心率基线 (bpm; FHR variability)
? b,一过性胎心率变化
? acceleration
? deceleration
? early deceleration (fetal head
compressed)
variable deceleration (umbilical cord
compressed)
? late deceleration (fetal hypoxia)
? B,Assessment of intrauterine fetal reserve ability
预测胎儿储备能力
? a,NST(Non-stress test),Reaction pattern (> 3 FM
with FHR increase > 15bpm,duration > 15s
within 20min) and Non-reaction pattern
? b,CST(contraction stress test)
? OCT(oxytocin challenge test) OCT(+) [late
deceleration occurs reapeatly; FHR baseline
variability decreased; no FHR increase after FM)--
- placenta function decreased and OCT (-) (fetus
is safe within one week)
Fetal bio-physiological score
? Manning score
? NST
? Fetal breath movement
? Fetal movement
? Muscle tension
? Amniotic fluid
? 10 is normal; <8 is acute or chronic
hypoxia
? 3,Placental function examination
? 1) 胎动,fetal movement of counting
? 12h>10次 正常
? 2) 孕妇尿雌三醇值,estriol in maternal
24h urine
? >15mg/24h 正常
? 10-15mg/24h 警戒值
? <10mg/24h 危险值
? E/C 比值 (estriol/creatine)
? >15 正常值
? 10-15 警戒值
? <10 危险值
? 3） HPL (human placental lactogen in
maternal serum) 孕妇血清胎盘生乳素
? 妊娠足月 <4mg/L 胎盘功能低下
? 突然下降 50% 胎盘功能低下
? 4） others OCT; FBPS
? 4,Fetal maturity 胎儿成熟度检查
? 1）正确推算预产期
? 2）宫高、腹围预测胎儿大小 (FW = length of
uterus X AC + 200)
? 3） B超 BPD>8.5
? 4） 羊水 L/S 比值 (lecithin/sphingomyelin)>2 =
Fetal lung maturity)
? 5） 其他 ( Cr – renal; ΔOD450 – liver ……)
Intrauterine diagnosis
? 1,Amniocentesis – chromosome,enzyme,
virus
? 2,B-ultrasound – fetal malformation
