The prenatal examination manual that every expectant mother should read.

Pregnancy check-up is also called prenatal check-up, It refers to the whole period from the diagnosis of pregnancy to the delivery. Health examination of pregnant women and fetuses and psychological guidance for pregnant women, including early pregnancy diagnosis, first prenatal examination and subsequent prenatal examination, and screening and diagnosis of fetal birth defects. Birth examination is an important means to ensure maternal and infant health, and every expectant mother should carry out it on time.

Menstruation regularity, women with sex life should go to the hospital to check whether they are pregnant or not (menopause > 5 weeks). After the diagnosis of pregnancy and the fetus has heartbeat, you can go to the community hospital to establish a pregnancy health care card (small card) and embark on the journey of pregnancy examination from now on.

The total number of routine prenatal examinations is 9 ~ 11:

    The first examination took place during 6 ~ 8 weeks of menopause. Pregnancy 20 ~ 36 weeks, check once every 4 weeks; After 37 weeks of pregnancy, the examination shall be conducted once a week. High-risk pregnant women need to increase the number of prenatal examinations according to specific conditions.

Examination items include mandatory examination and future examination. Mandatory examination items are items that every pregnant woman needs to examine. According to the specific conditions of pregnant women, the medical conditions vary slightly from place to place.

First pregnancy test: 6 ~ 13 +6 weeks

Routine health care

  • Blood pressure, weight, gynecological examination.

Required Check Items

    Blood routine and urine routine: do not need to be rechecked every prenatal examination, but pregnant women with hypertensive disorder complicating pregnancy or anemia need to be rechecked regularly. Blood type (ABO and Rh typing), liver and kidney function, fasting blood glucose, hepatitis B surface antigen (HBsAg), treponema pallidum, HIV) screening. Cervical cytology examination: suitable for those not checked within one year before pregnancy. Electrocardiogram examination. B-mode ultrasound.

Items for future reference

    Hepatitis C virus screening. Anti-D titer test: For patients with Rh negative blood type, 75 g glucose tolerance screening (OGTT): For high-risk pregnant women or people with suspected diabetic symptoms. Thalassemia screening: Hereditary diseases, It is popular in southern China such as Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan, Chongqing and other places. Therefore, pregnant women in these areas need to be screened during early pregnancy. Thyroid function test: Thyroid dysfunction during pregnancy not only affects the development of fetal nervous system, It also increases the risk of miscarriage and stillbirth, For example, pregnant women who have had unknown abortion history, have given birth to children with mental dysplasia, have had thyroid disease history, anemia and type 1 diabetes, It should be tested before or during the first trimester of pregnancy. Serum ferritin: This test should be carried out in patients with mild anemia. Tuberculin test: For high-risk pregnant women, Such as tuberculosis high incidence areas, poor living conditions, HIV infection, drug addicts. Cervical secretion testing: Neisseria gonorrhoeae and Chlamydia It is suitable for high-risk pregnant women or symptomatic patients. Bacterial vaginosis, , BV) Detection: For those who have a history of premature delivery. Maternal Serological Screening of Fetal Chromosome Abnormalities in Early Pregnancy: Serological indicators include human chorionic gonadotropin (hCG) and pregnancy-associated protein A (PAPP-A). Chorionic villus biopsy at 10-12 weeks of pregnancy is suitable for pregnant women with abnormalities detected in the previous test, which can detect fetal chromosome abnormalities as early as possible and terminate pregnancy in time. Ultrasound detection of fetal cervical posterior translucency (NT) at the end of 11-13 weeks of pregnancy is used for screening Down’s syndrome.

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Second examination: 14 ~ 19 +6 weeks

Routine health care

  • Blood pressure, body weight, abdominal circumference, uterine floor height, fetal heart.

Required Check Items

    Maternal serological screening of fetal chromosome abnormalities in the second trimester of pregnancy: triple method is adopted, i.e. Alpha-fetoprotein (AFP), hCG and free estriol (E3) are detected, and the risk degree is calculated in combination with the age and gestational age of the pregnant woman. If it is high risk, amniocentesis is required.

Items for future reference

    Amniocentesis Examination of Fetal Chromosome; 16 to 23 week, Through collecting fetal cells in amniotic fluid, the fetal chromosome is directly checked for abnormality. It is a diagnostic examination for chromosomal abnormalities. This examination is an invasive examination. Not a regular check, Only for pregnant women over 35 years old, who are at high risk of Down’s screening or who have given birth to chromosomal abnormalities in the past, Experienced physicians are required to perform puncture with the assistance of B-ultrasound. The risk rate of abortion is less than 1%. Non-invasive DNA prenatal detection technology: It is to collect maternal peripheral blood to detect fetal DNA, Compared with invasive examination such as villus biopsy and amniocentesis, Trisomy 21, trisomy 18, trisomy 13 and sex chromosome abnormalities can be detected, and the examination time is 12 ~ 24 weeks of pregnancy. The examination is relatively safe, but the screening disease spectrum is narrow and cannot replace amniocentesis. Amniocentesis is recommended for people over 35 years old, high risk of Tang screen and children who have given birth to trisomy.

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The third examination: 20 ~ 23 +6 weeks

Routine health care

  • Blood pressure, body weight, abdominal circumference, uterine floor height, fetal heart.

Required Check Items

  • Blood routine, urine routine.

    B-ultrasound screening of fetal system: 18 to 24 week, Preferably not more than 28 weeks. Systematic screening of fetal organs by B-ultrasound, Found a severe fatal developmental malformation of the fetus, Such as anencephaly, severe encephalocele, severe open spina bifida, severe visceral eversion, fatal chondroplasia, transposition of great arteries and other serious congenital heart diseases. The prenatal ultrasound detection rate of fetal malformation is about 50-70%, Due to various factors such as gestational age, amniotic fluid, fetal position, maternal abdominal wall thickness and so on, many organs may not be able to be displayed or not clearly displayed. At present, many malformations such as atrial septal defect, ventricular septal defect, ear malformation, finger/toe abnormality, anal atresia, external genital malformation, congenital megacolon and so on cannot be completely diagnosed by ultrasound.

Items for future reference

    Measurement of Cervical Length by B-mode Ultrasound: Persons at Risk of Premature Delivery.

The 4th examination: 24 ~ 28 weeks:

Routine health care

  • Blood pressure, body weight, abdominal circumference, uterine floor height, fetal heart.

Required Check Items

  • 75 g glucose tolerance screening (OGTT).

Items for future reference

    Anti-D titer test: For people with Rh negative blood type. Cervical vaginal secretion fetal fibronectin (fFN) test: This test is combined with ultrasonic examination to evaluate cervix, which can estimate the risk and timing of premature delivery in pregnant women. Pregnant women who have a history of premature delivery or are likely to have premature delivery are high-risk groups.

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The 5th examination: 30 ~ 32 weeks

Routine health care

  • Blood pressure, body weight, abdominal circumference, uterine floor height, fetal heart, fetal orientation.

Required Check Items

    Blood routine, urine routine. Obstetric B-ultrasound examination.

Items for future reference

    B-ultrasound measurement of cervical length or fFN detection: those at risk of premature delivery.

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Pay attention to fetal movement:

Counting fetal movements is a very useful self-monitoring method for pregnant women, which can discover abnormal conditions such as fetal intrauterine hypoxia in time and is very important to the health of the baby.

Generally, starting from the 28th week of pregnancy, choose a relatively fixed hour in the morning, middle and evening, and count when the baby has more activities. Each continuous activity is counted as one from the beginning to the rest. The number of fetal movements in three hours is multiplied by 4, which is 12 hours of fetal movements.

If the fetal movement count ‚Č• 30 times/12 hours is normal; Fetal movements are less than 10 times/12 hours, or more than 50% less than the normal value, or fetal movements are too frequent, indicating that the fetus may lack oxygen and needs to go to the hospital in time.

The 6th examination: 32 ~ 36 weeks

Routine health care

  • Blood pressure, body weight, abdominal circumference, uterine floor height, fetal heart, fetal orientation.

Required Check Items

  • Urine routine.

Items for future reference

    Screening of Group B Streptococcus (GBS): Foreign data show that the rate of premature delivery induced by GBS can be as high as 60%, It is suggested that all pregnant women should be screened for GBS at 35 ~ 37 weeks of pregnancy. At present, no general test has been carried out in China. However, for pregnant women at high risk of premature delivery, it is recommended to have tests. Liver function and serum bile acid tests: 34 weeks ago, for those suspected of intrahepatic cholestasis of pregnancy. Non-Stress Test (NST): Fetal heart changes after 34 weeks can be observed through fetal heart monitor without uterine contraction and other external stimuli. Electrocardiogram reexamination: for those at high risk.

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The 7th to 11th examination: 37 weeks to delivery

Routine health care

  • Blood pressure, body weight, abdominal circumference, uterine floor height, fetal heart, fetal orientation, cervical examination and Bishop score (examination of cervical maturity).

Required Check Items

  • Obstetric B-ultrasound, blood routine, urine routine and no stress test.

Health related knowledge

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Small Reminder

    1. During the prenatal examination, clothes should be as loose as possible and shoes should be easy to wear and take off.

    2. Fasting is required before liver and kidney function, Down’s screening, blood sugar and OGTT examination.

    3. Down’s screening, sheep wear, fetal abnormality B-ultrasound examination, etc. have strict gestational age requirements, and must be checked according to the appointment time.

    4. Fetal abnormality B ultrasound commonly known as three-dimensional, is actually based on two-dimensional ultrasound, three-dimensional reconstruction imaging. The so-called [four-dimensional] mostly for the purpose of commercial interests, it is suggested that all expectant mothers should go to a professional and standardized hospital for fetal abnormality examination.

    5. In some areas, small cards built in community hospitals can be converted into health care cards (large cards) used for prenatal examination in later delivery hospitals around 20 weeks of pregnancy. Since mutual recognition of all auxiliary examination items has not been reached in community hospitals and general hospitals or maternal and child health care hospitals, some examination items need to be re-examined.

    6. Serological screening of Toxoplasma gondii, cytomegalovirus and herpes simplex virus is recommended before pregnancy because the current detection cannot confirm the infection time and impact degree.