Prenatal Care

Revision Diagnosis of Early Pregnancy Manifestations A.Symputoms: Amenorrhea ; Nausea with or without vomiting(morning sickness) Urinary frequency and urgency; Pain slightly in the breast, 0ther symputoms :Uterine bleeding B.Signs: Montgomery; Hegar’s sign;

Helpful Examinations A.Clinical test B.Pelvic ultrasonography C. Basal body temperature （ BBT ） D. Pregestin test E. Cervical mucus examination

Differential diagnosis A. Myomas B. Ovarian tumor C. Ectopic pregnancy

Diagnosis of the second and third Trimester of pregnancy Manifestations A.Symputoms: Amenorrhea ; Disturbance in urination; Perception of fetal movement B.Presumptive Signs: Breast changes ; Discoloration of the vaginal mucosa ; Increased skin pigmentation and appearance of abdominal striae C.Probable evidence of pregnancy: Enlargement of the abdomen; Chan ges in size,shape ,and consistency of the uterus; Braxton Hicks Contraction ; Ballotement D.Positive signs of pregnancy:Fetal heart action Fetal movement by sonography Recongnition of the fetal in the uterus cavity by sonography

Revision Helpful Examinations: Clinical test; Ultrasonography

Differential diagnosis of pregnancy: Myomas; Ovarian tumor

Other examinations: fetal lie ; fetal presentation ; fetal position

Lecturer:

Liu Wenhui Sophie liu The Department of Gynecology & Obstetrics in Zhongnan Hospital

Early pregnancy

The second trimester and the third trimester

Introduction

Contents  History  Physical

examination  Laboratory tests  Advice to paients  Tests & precedures  Nutrition in pregnancy

History  

   

Age ,ethnic background,occupation Onset of LMP and its normality,possible conception dates,bleeding after LMP,medical history,all prior pregnancies(duration,outcome,and complications),symptoms of present pregnancy Use of drugs, alcohol,tobacco,caffeine,nutritional habits Family history of congenital anomalies and heritable disease History of childhood varicella Prior STDs or risks for HIV infection

 How

to describe a woman’s gravidity para x+y x is the number of babies delivered (include live birth, stillbirth) y is the number of pregnancies the woman has had(include ectopic pregnancies and abortions prior to 24 weeks gestation) 孕 2 产 0 孕 38W 待产 (Chinese)

Physical examination  Height,weight,blood

pressure,general physical

examination  Abdominal and pelvic examination: 1.estimate uterine size or measure fundal height 2.evaluate bony pelvis for symmetry and adequancy 3.evaluate cervix for structural anatomy,infection,effacement,dilation 4.detect fetal heart sounds by Doppler device after 10 weeks

Laboratory tests ■ Urinalysis,complete blood count(RBC HGB,WBC,PLT),blood group,RH type,atypical antibody screening,HbsAg evaluation,ALT,AST,etc. ■ HIV screening,cervical Pap smear

Advice to patients ■

prenatal visits

maintain a schedule of regular prenatal visits: 0-28weeks every 4 weeks 28-36weeks every 2 weeks 36weeks on weekly

■

Diet

1.eat a balanced diet containing the major food groups 2.take prenatal vatamins with iron and folic acid 3. expect to gain 10-15Kg. Do not diet to lose weight during pregnancy 4.decrease caffeine intake to 0-1 cup of coffe ,tea, or cola daily 5.avoid eat raw or rare meat 6.eat fresh fruits and vegetables and wash them before eating

medication Do not take medications unless prescribed or authorized by physician  Abstain from alcohol,tabacoo,and all recreational drugs 

Common drugs that are teratogenic or fetotoxic Alcohol androgen Estrogen misoprostol ribavirin Tobacco smoking progestins

X –Rays and noxious exposures

■

1.Avoid x-rays 2.inform physicians 3. Avoid chemical or radiation hazards 4. Avoid handling cat and dog

■

Rest and activity

1.obtain adequate rest each day 2.abstain from strenous physical work or activity 3. exercise regularly 4. Avoid exhausting or hazardous exercise

■ Birth

classes

enroll in a childbirth preparation class well before due date

Tests & procedures Each vist: weight,blood pressure, fundal height,fetal heart rate, urine specimen for protein and glucose, health ,and nutrition

6-12weeks Confirm uterine size and grouth;document fetal heart tones;chorionic villus sampling

12-18weeks  Genetic

counseling for women 35 years or older at EDC  Those with a family history of congenital anomalies, a previous child with chromosomal abnormality,and so on  Perform aminocentesis

12-24weeks  Fetal

ultrasound examination to show fetal anatomy in greater detail

16-20weeks  Maternal

serum AFP testing and HCG to screen fetal teratogenic

20-24 weeks  Instruct

patient in signs of preterm labor and rupture of membranes

24-28 weeks Screening for GDM(gestational diabete mellitus)by a 50g glucose load or OGTT

28-36 weeks  Repeat

the complete blood count to evaluate for anemia of pregnancy  Determination of fetal position and presention(LOA or LOP)  Antepartum fetal testing (NST,OCT)

36 weeks to delivery  Repeat

HIV testing ,cervical culture N gonorrhoeae and chlamydia in at-risk patient  Elective delivery piror to 37 weeks of gestation should confirmation of fetal lung maturity

Nutrition in pregnancy balanced nutrient weight normal the healthy mum give birth to a healthy baby

Combining Forms Combining Form  amni/o

   

meaning amnion

Terminology Meaning amniocentesis amniotic fluid Produced by fetal membranes and the fetus. cervic/o cervix,neck endocervicitis chori/o chorion choriogenesis chorion/o chorionic colp/o vagina colporrhaphy colposcopy culd/o cul-de-sac culdocentesis Placement of a needle through the posterior wall of the vagina with withdrawal of fluid for diagnostic purposes.

Combining Form

meaning

 men/o

menses,

Terminology

Meaning

amenorrhea

menstruation Absence of menses for 6 months or for longer than 3 of the patient’s normal menstrual cycles. dysmenorrhea oligomenorrhea Infrequent or scanty menstrual periods. menorrhagia Abnormally heavy or long menstrual periods. Fibroids are a leading causes of menorrhagia.

Combining Form metr/o metri/o menstruation.

meaning Terminology Meaning uterus metrorrhagia Uterine bleeding other than caused by menometrorrhagia

periods.  my/o  myom/o

 nat/i  obstetr/o

Excessive uterine bleeding at and between menstrual

muscle muscle tumor

endometriosis myometrium myomectomy

Removal of fibroids from the uterus. birth neonatal The first 4 weeks of life after birth. midwife obstetric

Combining Form meaning Terminology  ov/o egg ovum  ovari/o

Meaning

 salping/o

ovary ovarian fallopian tubes salpingectomy

 uter/o

uterus

uterine prolapse

 vagin/o

vagina

vaginal orifice

Orifice means opening. Vaginitis Bacteria and yeast (Candida) commonly cause this infection.  vulv/o

vulva

vulvovaginitis

Suffixes Suffix  -arche

Meaning Terminology Meaning beginning menarche

 -gravida

pregnancy

primigravida

A woman during her first pregnancy (primi-means first). Gravida is also used as a noun to describe a pregnancy woman, and it may be followed by numbers to indicate the number of pregnancies(gravida 1,2,3)

Suffix 

-parous

Meaning

to bear,bring

Terminology

Meaning

primiparous

forth An adjective describing a woman who has borne (delivered )at least one child. Para is also used as a noun and may be followed by numbers to indicate the number of deliveries after the 20th week of gestation (para 1,2,3). 

-rrhea discharge leucorrhea This nonbloody vaginal discharge may be mucoid or purulent (containing pus) and a sign of infection or cervicitis. menorrhea



-tocia

labor,birth

dystocia oxytocia Oxy-means rapid.

Case 1  Name

: Mary Sex:Female  Age :30 Occupation:Teacher  She has married for one year,now She has following problems:cessation of menstruation about 2 months, Her appitite has declined for three weeks,she goes to toilet every 2 hours in recent 3 weeks . Question: List her probably symptoms and signs . Make a clinical diagnosis. Make a clinical differential diagnosis for the enlargrment of uterus.

Case 2  Lili’s

menstruation has stopped for 38 weeeks . She has a girl of 3 years old.this is her second gestation.Now she feels the normal fetal movement every day .Through examination , her weight is 70 Kg, Bp 110/70 mmHg,FHR is 142 bpm,the height of the uterus is 34 cm,the fetal’s occiput is in the left anterior side of maternal. Question: Give the correct diagnosis

wish

you :

Learn to learn ； Learn to do ； Learn to together ； Learn to be. —— 原香港中文大学校长金耀基