# Medical voice medical vision #
What should be examined in the prenatal visit?
How many times should I check?
When to check?
Is preconception testing that important?
What do I need to pay special attention to?
In today's class, Professor Ma Liangkun of Peking Union Medical College Hospital will introduce the importance of preconception examination and the focus of examination in the first, second and third trimesters of pregnancy!
Obstetrics and Gynecology Network video number
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Obstetric examination of a woman during pregnancy
Pregnancy examination
We particularly emphasize the importance of regular obstetric examinations! In some cities, moms don't have regular maternity checkups, and we recommend that moms do obstetric check-ups in a hospital very regularly. If conditions permit, it is very important to find the same doctor to do the obstetric examination from start to finish.
Whether it is urban or rural, our country advocates that everyone do regular prenatal examination, for prenatal examination, our country has laws and regulations, the current main items of prenatal examination are based on the former Ministry of Health and the Chinese Medical Association Obstetrics and Gynecology Branch issued the "Maternal Health Care Work Specifications" and "Pre-pregnancy and Pregnancy and Maternity Health Care Guidelines (1st Edition)" determined.
The importance of regular obstetric check-ups
How important are prenatal visits? Prenatal examination can make us have a baby without life danger, can make our baby healthier, understand the health status of TA, can have a better health care plan; in addition, the high risk factors can be screened and intervened, so a good prenatal examination and regular pregnancy health management is an important tool and weapon for us to get a good baby.
When it comes to obstetric examinations, some people will say: Where should I go for a maternity examination? Where should my hospital be? It is recommended that you determine your own maternity examination hospital through the following 3 points according to your physical condition.
1. If there are various comorbidities, it is recommended to go to the general hospital for obstetric examination, which is safer and can be consulted in time;
2. If the body is very healthy, there is no underlying disease, and there is no bad habit, we recommend that you go to the nearby maternal and child health hospital for obstetric examination and delivery;
3, if the economic conditions are very good, you want to have better services, thoughtful and humane methods to help through the special stage of childbirth and pregnancy, you can go to a private hospital to do obstetric examinations.
Number of check-ups
Obstetric check-ups are at least once during early pregnancy, every 4 weeks before 28 weeks, every 2 weeks after 28 weeks, and weekly after 36 weeks. This is the interval between obstetric examinations.
A mother will have about 16 obstetric check-ups from the first pregnancy to the later pregnancy. If it is a certain hospital and doctor to give you a maternity examination, the doctor will be particularly aware of your habits, personality, things to pay attention to, and dangerous situations to pay attention to.
Contents of the obstetric examination
The obstetrician will ask about your medical history, for example, what was your condition? What kind of diseases have you had before? What happened to fertility in the past? What kind of family history do you have in your family?
Then we have to do some basic physical examinations, every time we do a maternity test, we have to measure our weight and blood pressure at the door, which are the things we pay attention to, pay attention to the growth of weight during pregnancy, whether there is high blood pressure during pregnancy, these common problems. We also do some ancillary tests, including ultrasounds, blood tests, bacterial infections, etc., all of which are tools to escort pregnant women.
Many people have never been to the hospital before having a baby and don't know what the hospital doctor will ask about. In fact, during the obstetric examination, the doctor will usually ask: How is your general situation? Are you sick? Do parents have high blood pressure or diabetes? In addition, the history of previous fertility and the situation of contraception, is the usual menstruation regular? Was there nausea, vomiting, bleeding, or stomach pain during this pregnancy? Are there any other teratogenic factors? There are no abnormalities such as headache, dizziness, or edema.
In addition to the basic tests of cardiopulmonary function, blood pressure, and weight, gynecological examinations, obstetric Doppler fetal heart examinations, uterine abdominal circumference measurements, and pelvic measurements are also done.
Auxiliary examinations include mandatory items and items for reference, mandatory items include blood tests, pregnancy to know your blood type, RH vagina, whether there are hepatitis B, hepatitis C, AIDS and other infectious diseases, liver and kidney function, coagulation function, thyroid function, whether there is anemia, etc. These tests need to fully understand your physical condition. At the same time, do the urine routine test, the urine test is to help us determine whether there is an infection, whether there is kidney disease, whether there are some blood sugar problems, these tests can provide us with an answer.
Next ultrasound is also particularly critical, ultrasound is the eye of our obstetrician and gynecologist, it can determine whether the baby has a fetal heartbeat, whether there is NT thickening, whether there is an abnormality of the anatomy, and finally help determine the fetal position, the size of the baby. This is followed by routine ECG tests and fetal heart rate monitoring that will be done in the later trimester of pregnancy.
First trimester test highlights:
Ultrasound examination is very important, in about 7-8 weeks, we recommend that you do an ultrasound to see if it is a baby, or two babies, whether the baby has fetal heartbusts, to rule out the possibility of ectopic pregnancy.
The next month is a month later, about 11-13 + 6, we will do another ultrasound, this ultrasound is a very important test called NT, people who have done mothers who have been pregnant know that NT is very important. NT is called the thickness of the transparent layer behind the baby's neck, and if the thickness of the pellucida behind the neck exceeds normal, we should specifically prompt that the baby may have staining abnormalities, may have heart diseases, and will proceed to the next step of chromosomal screening.
At this time, Down's screening will also be done, what is Down's screening? Tang refers to the meaning of Tang's 21 three-body. Down screening is based on NT, serology, and other indicators to see if the baby in the stomach is at risk of developing a Down child.
Second trimester examination focus:
Next do a fetal system ultrasound in about 22 weeks, what is fetal system ultrasound? It is from head to toe to check whether the baby has a large anatomical structure. 24-28 weeks, give everyone to drink glucose water, do a glucose tolerance test, is to see if you have gestational diabetes. Of course, there are special circumstances to be appropriate in advance, such as you have given birth to a huge child in the last child, you have gestational diabetes before, or we find other problems, especially suspect that you have gestational diabetes, we will also do such a test in advance.
Regarding Down screening, we suggest here that the results of Down screening are divided into low-risk and high-risk risk, which does not mean normal or abnormal, so this concept is different from ordinary testing. We also want to tell you that ultrasound is not 100%, for a variety of abnormalities, the detection rate of ultrasound screening is about 50% to 70%, what is its impact? Factors influencing gestational age, amniotic fluid, fetal position, and maternal fat thickness. So we need to know that not all deformities can be screened. Our country has regulations, such as for anencephaly, large spina bifida, large heart malformations, large gastrointestinal malformations, it is required to be able to screen out, but some small deformities, such as six fingers, are not in the middle pregnancy routine screening must be able to screen out the malformations, so ultrasound screening is only to screen for those fatal, teratogenic malformations.
Prenatal diagnosis:
Prenatal diagnosis is involved in the second trimester, which is not just screening to tell the risks, but to make a diagnosis. So, who needs a prenatal diagnosis? The following 10 populations are those that require prenatal diagnosis of numbered seating. Or at least to know what kind of prenatal diagnosis I should do.
1. Pregnant women over 35 years old (including 35 years old).
2. High-risk pregnant women found in prenatal screening
3. Pregnant women who have given birth to children with abnormal chromosomal abnormalities
4. One of the spouses is a pregnant woman with abnormal chromosomal carriers
5. Pregnant women who may be carriers of some X-linked genetic disease gene
6. Pregnant women who suspect that the fetus has chromosomal diseases in prenatal examination
7. Pregnant women with unexplained recurrent miscarriages, stillbirths, stillbirths, etc
8. Pregnant women who have given birth to children with unexplained mental retardation or multiple deformities
9. Pregnant women with a clear family history of genetic diseases
10. Other pregnant women who need prenatal diagnosis
So these are all things that need to be communicated with the maternity hospital and doctors to know what kind of prenatal diagnosis you are going to make.
What are the commonly used prenatal diagnostic methods?
Methods of prenatal diagnosis include ultrasonography, villus biopsy in early pregnancy, amniocentesis in the middle trimester, and umbilical cord blood puncture in the third trimester. These are different methods at different times, the most common of which are ultrasonography and amniocentesis.
tests for glucose tolerance:
Glucose tolerance test is usually 8 hours without eating or drinking, it is best to go to the hospital before 9 a.m. to start the examination, pay attention to the normal diet and activity of the first 3 days before the examination, during the examination should sit quietly, do not run around, in order to achieve a normal blood glucose result.
The indicators of blood glucose are very strict, < 5.1 on an empty stomach, 10.0 < 1 hour after taking sugar, and 8.5 < 2 hours after taking sugar. Any time the blood glucose meets or exceeds the standard, gestational diabetes can be diagnosed.
If gestational diabetes is not well controlled, the harm is huge, which will increase the risk of hypertension, preterm birth, infection, ketoacidosis in the mother's pregnancy, and also increase a series of risks in the baby's huge baby, dystocia, and even fetal stillbirth. Therefore, if you have gestational diabetes, you must do a good job in the management and control of blood sugar.
Highlights of the third trimester examination:
In the third trimester, we will do an ultrasound at about 30-32 weeks to assess the size, fetal position, placenta and amniotic fluid of the baby. After term, we will also do another ultrasound to see if the baby is suitable for natural childbirth, whether there is too little amniotic fluid or other problems. Next, if there are various comorbidities, probably every time we do fetal heart monitoring, this is also an important way to assess the intrauterine safety of the fetus.
How do pregnant mothers assess themselves? Counting fetal movements is the most effective way to prevent many pregnant women and babies from dangerous conditions. We are advocating that you have 3 times a day, 1 hour each time to feel at ease and carefully experience your baby, how many times he has moved. Generally speaking, 1 hour and 3 times is enough, there are many mothers who say, we are very busy, I don't have so much time to count the tires! Then we ask mothers to pay attention to a change in your baby, because some babies are lively and active, some babies may be relatively quiet, some babies may love to move in the morning, and some babies may love to move at night. As long as it is perceiving your baby and knowing that the TA's activity is in a normal range during this time period, it is OK.
Therefore, counting fetal movements can be very formal to count, or it can be a normal perception, which is very critical.
Prenatal examinations have different subsidies in various regions and countries, such as blood tests, overall cost packaging, and local policies. You may wish to ask your friends what their reimbursement and preferential policies are, and then do a variety of checks.
Editor-in-Charge: Ma Ye