Maternal health tips and medical advice during the epidemic prevention and control period

In view of the current severe and complex epidemic prevention and control situation, the Henan Provincial Health Commission organized experts from the Henan Provincial Maternal and Child Health Hospital to put forward the following suggestions to the majority of pregnant women during the epidemic prevention and control period in view of the health characteristics and medical needs of pregnant women:

First, the key time node of prenatal examination

Prenatal maternal examinations vary from person to person, and whether obstetric examinations can be postponed can be judged based on the gestational age, the content of the obstetric examination, the grading of the pregnancy risk assessment, and the pregnant woman's self-management ability. There are 7-11 routine obstetric examinations during pregnancy, and pregnant women with a "green" and "yellow" pregnancy risk assessment can reasonably arrange obstetric examinations according to the guidance of doctors and according to the gestational week, if there is no special situation, they can appropriately postpone the time of obstetric examinations and monitor the fetal intrauterine situation at home, but at several key checkpoints, pregnant women are still checked according to the requirements of time nodes. Pregnancy risk assessment is "orange", "red" and "purple", all prenatal examinations must be checked on time and protected. The following are the key points that require medical attention:

(1) First trimester (6-13+6 weeks)

1. The previous menstrual regularity, clear menopause for more than 6 weeks, if there is abdominal pain or vaginal bleeding and other symptoms in time to go to the hospital for examination.

2. Ultrasonography of "fetal cervical transparent layer" (NT) at 11-13+ 6 weeks of intrauterine pregnancy, and the thickness of the transparent layer of the fetal neck is measured by ultrasound.

(2) Second trimester (14-27+6 weeks)

1. Intrauterine pregnancy 15-20 + 6 weeks pregnant second trimester aneuploidy maternal serological screening (Tang sieve). Prenatal diagnosis at 18 to 24 weeks is recommended for people with high-risk factors, such as the age of due birth at or above 35 years, abnormal serological screening, fetal development abnormalities or suspected structural malformations on imaging during pregnancy, congenital or genetic diseases in one of the spouses, family genetic history, having given birth to a child with a severe congenital defect, and people who have been identified by other specialists as requiring antenatal diagnosis.

2. Intrauterine pregnancy 18-24 weeks of fetal system B ultrasound screening (macrodistesis), screening for fetal appearance development of larger malformations.

3. 75 grams of oral glucose tolerance test (OGTT) test at 24-28 weeks of intrauterine pregnancy, commonly known as "sugar screen", preliminarily check whether pregnant women have gestational diabetes. Fasting blood should be drawn before 9 a.m. for OGTT, as late may affect the results. Fasting for 8-10 hours before preparing for the OGTT examination, a normal diet for 3 consecutive days before the examination, that is, eating no less than 150 grams of carbohydrates per day, the night before the OGTT examination should avoid early morning reactive hyperglycemia caused by too long fasting, thus affecting the diagnosis.

(3) Third trimester (28 weeks of pregnancy and beyond)

1. Fetal motility changes should be closely observed, and fetal motility abnormalities should be treated immediately.

2. Ultrasound examination of the third trimester at 28-32 weeks of intrauterine pregnancy further excludes fetal malformations.

3. After 32 weeks of intrauterine pregnancy, electronic fetal heart rate monitoring (NST) is generally performed once every 2 weeks, and the intrauterine state of the fetus is assessed through electronic fetal heart rate monitoring, and the intrauterine distress of the fetus is found, so that further measures can be taken in time.

4. Check-up once a week after 37 weeks of intrauterine pregnancy. At 37 weeks, it is necessary to evaluate the intrauterine condition of the fetus and discuss the mode of delivery, and it is recommended that after 37 weeks of pregnancy, it is best not to postpone the time of obstetric examination.

5. Pregnant women who are close to the due date, such as vaginal redness, regular contractions or premature rupture of membranes (a large amount of vaginal fluid), should seek medical attention as soon as possible.

(4) Puerperium period (within 42 days after childbirth)

If there is fever, obvious lower abdominal pain or breast pain, increased vaginal bleeding, etc., see a doctor promptly.

Second, pregnant women at home self-monitoring tips

1. Regular work and rest time, pay attention to daily monitoring of body temperature, whether there are suspicious symptoms of the new coronavirus, such as fever, cough, sore throat, chest tightness, dyspnea, fatigue, diarrhea, conjunctivitis, muscle soreness, etc., and seek medical treatment in time if there is an abnormality.

2. Measured weekly weight, excessive weight gain in pregnant women increased the risk of children greater than gestational age, dystocia, birth injuries, gestational diabetes, etc.; insufficient weight gain in pregnant women was related to adverse pregnancy outcomes such as fetal growth restriction, premature babies, and low birth weight. Therefore, it is necessary to pay attention to weight management and manage weight according to the BMI (weight kg/height m2) before pregnancy:

(1) BMI < 18.5, weight gain rate in the second and third trimesters of pregnancy 0.44-0.58 kg/week;

(2) The BMI is 18.5-24.9, and the weight gain rate in the second and third trimesters of pregnancy is 0.35-0.50 kg/week;

(3) The BMI is 25.0-29.9, and the weight gain rate in the second and third trimesters of pregnancy is 0.23-0.33 kg/week;

(4) BMI ≥ 30, weight gain rate in the second and third trimesters of pregnancy is 0.17-0.27 kg/ week.

3. Regular exercise: All pregnant women without contraindications to exercise during pregnancy are recommended to perform regular exercise during pregnancy, that is, moderate-intensity exercise for 5 days a week for 30 minutes each time. Depending on your preference, you can choose from general forms of housework, walking, slow dancing, walking to work, gymnastics for pregnant women, swimming, cycling, yoga and Kegel sports. Pregnant women with contraindications to exercise during pregnancy are not recommended to exercise regularly except for daily activities. Contraindications to exercise during pregnancy include severe cardiac or respiratory disease, severe preeclampsia/eclampsia, uncontrolled hypertension, cervical insufficiency, persistent vaginal bleeding, preterm birth, placenta previa, premature rupture of membranes, multiple pregnancies (three and more).

4. Fetal movement monitoring: Generally, the fetus begins to consciously move at 20 weeks of pregnancy, and fetal movement is more active at night or in the afternoon. After 28 weeks' gestation, fetal motility count < 10 times per 2 hours or decreased by 50% suggests a possibility of fetal hypoxia.

Precautions for counting fetal movements: when counting fetal movements, it is best to lie on the left side or feel comfortable position; the environment is quiet and the mood is relaxed; the fetus is counted once in a row, and the interval between them is more than 5 minutes; if there is a significant change in fetal movement, especially if there is a significant reduction or disappearance, go to the hospital in time.

5. Monitor blood pressure and blood sugar: Pregnant women with hypertensive diseases during pregnancy should monitor blood pressure in time, such as blood pressure ≥ 140/90 mm Hg, or dizziness, dizziness, palpitation, breath holding, lower limb edema, etc., should go to the hospital in time. Pregnant women with gestational diabetes should eat according to the diabetic diet recipe, pay attention to monitoring blood sugar, and ensure exercise; those who use insulin should self-regulate their blood sugar monitoring, taking the form of self-monitoring and regular gestational diabetes outpatient follow-up guidance adjustment.

6. Diet: To eat a balanced diet, the diet is light and diverse.

Third, the need to seek medical attention in time to remind the situation

1. Any form of vaginal bleeding that occurs at any time during pregnancy, regardless of whether it is accompanied by pain or not, should be treated as soon as possible.

2. Delayed treatment of hyperemesis gravidarum will cause water-electrolyte abnormalities and even serious complications of Wernicke's encephalopathy.

3. Digestive tract symptoms at any time of pregnancy, such as nausea and vomiting, diarrhea, abdominal pain can not be taken lightly, often related to various acute abdomen in pregnancy, acute fatty liver during pregnancy.

4. There are many causes of abdominal pain during pregnancy, the condition is complex, abdominal pain in early pregnancy should pay attention to abortion, ectopic pregnancy; it may also occur in pregnancy appendicitis, pancreatitis, cholecystitis, intestinal obstruction and other acute abdomen, can not delay treatment.

5. Abnormal fetal movement: decreased, weakened or disappeared fetal movement, or too frequently often marks the lack of oxygen in the fetus in the womb, and timely medical treatment may save the life of the fetus.

6. Increased blood pressure, edema, excessive weight gain, there is a possibility of gestational hypertension diseases, gestational diabetes.

7. Vaginal fluid: Vaginal fluid occurs in the late pregnancy period, which may be premature rupture of membranes.

8. Paroxysmal abdominal tightening and stiffness: may be a contraction initiation of threatened miscarriage, premature birth or imminent labor. Persistent lower abdominal pain, be wary of placental abruption.

9. Skin itching and jaundice during pregnancy may be related to intrahepatic cholestasis and liver disease during pregnancy.

10. Other: if there is panic during pregnancy, you can't lie flat at night, you need to raise the pillow or sit up to relieve it, it may be early heart failure; headache and dizziness during pregnancy may be related to cerebrovascular lesions.

4. Precautions for medical treatment

1. During the epidemic prevention and control period, confirmed cases of new crown pneumonia and asymptomatic pregnant women with asymptomatic infection are treated in the designated hospital for treatment of new crown pneumonia; pregnant women involved in the epidemic (pregnant women who are not diagnosed in the centralized isolation point, sealing and control areas, control areas, home isolation, and pregnant women with health codes of yellow codes and red codes) go to the epidemic-related diagnosis and treatment areas of designated special medical institutions in various places Ordinary pregnant women (other pregnant women other than confirmed pregnant women and epidemic-related pregnant women) go to medical institutions other than the designated treatment hospitals for new crown pneumonia and the epidemic-related diagnosis and treatment areas of specialized medical institutions (preferentially selected medical institutions with registers), and fever pregnant women go to medical institutions that set up fever clinics.

2. Where high-risk factors are found in the process of obstetric examination and need further examination, please check according to the doctor's requirements.

3. Take the initiative to cooperate with the guidance of the staff, efficiently and safely do a good job in obstetric examination, adopt the correct way and wear the correct type of mask throughout the process, take the initiative to accept body temperature detection, and cooperate with epidemiological inquiries. If a pregnant woman is hospitalized, she will be accompanied by hospital regulations during her hospital stay and will not be allowed to visit her.

4. On the way to the hospital and in the hospital, avoid taking public transportation, pay attention to cold and warmth, and avoid colds; pregnant women and accompanying family members should wear medical surgical masks or N95 masks throughout the whole process; you can carry hand sanitizer or disinfectant wipes with you to maintain hand hygiene; and keep a distance between people as much as possible (at least 1 meter).

5. After contacting hospital door handles, curtains and other hospital items, try to use hand disinfectant, if you can not disinfect your hands in time, do not touch the mouth, eyes, nose.

6. After going out to go home, you should properly dispose of the mask, change clothes, wash your hands, and wash your face, facial features and other exposed parts. Clothes should be washed and disinfected as soon as possible, and coats should be placed in the air circulation.

Coordinator: Liu Yang

Editor-in-charge: Zhang Chi