3. 4
PRENATAL CARE
• the primary method for pregnancy
monitoring
• identification and special treatment
• to ensure an normal pregnancy and the
delivery
• lower risk of complication
4. 5
high-risk pregnancy
Age<16y or ≥35y
Obesity or <50kg
Body height< 145cm
Pregnancy compliations
Chronic diseases
Infection
Bleeding
…
5. 6
Initial Office Visit
• Identify all risk factors
• Medical history, general examination,
obstetric examination
• High-risk pregnancies - individualized
specialized care
6. 7
1.History
First interview :
Age, Occupation, menstrual, etc
LMP normal cycle (28d)
EDC 40w or 280d
Naegele’s rule:Naegele’s rule:
EDC = LMP-3 months + 7daysEDC = LMP-3 months + 7days
e.g. LMP:2012-04-01
EDC:2013-01-08
LMP (last menstrual period)
EDC (expected date of confinement)
7. 8
1.History
A. Maternal Age
• <16y – dystocia (Macrosomia, position of the
fetus, pelvis immaturity… )
• ≧35y -pregnancy-induced hypertension,
diabetes, obesity, chromosomal abnormalities
B. Modality of Conception
• ART (test-tube baby)- multiple gestation,
pregnancy-induced hypertension, preterm birthART (assisted reproductive technologies )
8. 9
C. Pastmedical History
• DM ， hypertension, seizure disorder, cardiac
conditions
• Previous blood transfusion (blood group
antibody, infection virus )
• Drug sensitivities
D. Family History
• Inherited diseases, retardation, birth defects,
perinatal deaths
1.History
DM (Diabetes mellitus)
10. 11
1.History
E. Past Obstetric History
a. Habitual abortion
b. Previous stillbirth or fetal death
c. Previous preterm delivery
d. isoimmunization （ Rh or ABO ）
e. Previous preeclampsia-eclampsia
f. Previous infant with genetic disorder or
congenital anomaly
g. artificial abortion operation
13. 14
Leopold maneuvers
• First: What fetal part occupies the fundus?
• Second: On what side is the fetal back?
• Third: What fetal part lies over the pelvic
inlet?
• Fourth: On which side is the cephalic
prominence?
Leopold maneuvers can describe : fetal lie,
presentation, position, attitude
22. 23
Pelvic outlet
Subpubic angle>90°
IT (intertuberal
diameter)>8.5cm
PS (Posterior sagittal
diameter)
• PS + IT > 15cm
• outlet is adequate
Measurement of the BI
23. 24
internal pelvimetry
item Pelvic inlet midpelvis Pelvic outlet
transverse
diameter
13cm 10cm
(ischial spine
diameter )
8.5-9.5cm
IT or TO
anteroposterior
diameter
11.5cm
(DC-1.5)
11.5cm 11.5cm
24. 25
Laboratory Tests
A. Blood screening
hematocrit/ hemoglobin/ WBC/blood type/
serologic test for syphilis/ rubella/
hepatitis B/HIV
HCG/ unconjugated estriol/AFP--
trisomy 21 and 18
early 1-hour post glucose
Glucose level is checked after ingestion of 50g
of glu (GDM)
24-28w
15-20w
the first
visit
25. 26
3.Laboratory Tests
B. Genetics Testing: age >35/ abnormal
pedigrees
at 10-12w: CVS (chorionic villus sampling)
at 16-18w: standard amniocentesis
C. Urine Testing: urinary protein, glucose, and
ketones
26. 27
Subsequent Visits
the standard schedule :
• 0-32w: Once every 4 weeks
• 32-36w: Once every 2 weeks
• 36w-delivery: Once each week
0 32w 36w delivery
4w 1w2w
32. 33
Assessment Of Prenatal
Diagnosis
Amniocentesis (15-20w)
• cytology for detection of infection
• AFP (alpha-fetoprotein) evaluation for neural
tube defect assessment
• Karyotype or DNA assays
Risks: Pain/Cramping
Vaginal spotting
Fetal loss(≤0.5%)
33. 34
Assessment Of Prenatal
Diagnosis
Fetal Blood Sampling (2-3trimester)
chromosomal or metabolic analysis of the fetus
assessment and treatment of certain fetal conditions
(Rh sensitization and alloimmune thrombocytopenia)
Risk: fetal death
34. 35
Assessment Of Prenatal
Diagnosis
Chorionic Villus Sampling (10-12w)
• transcervically or transabdominally
• availability earlier in pregnancy
• allows for chromosomal status, fetal karyotype,
and DNA assays
Risks: 0.5% rate of complication
Preterm delivery
PROM (premature rupture of membranes)
Fetal injury
35. 36
Assessment Of Fetal Well-being
1. Fetal Monitoring Techniques
A. External Fetal Monitoring
a continuous beam of ultrasound waves
B. Internal Fetal Monitoring
an electrode attached to the fetal scalp
36. 37
Assessment Of Fetal Well-being
C. Sonographic Fetal Monitoring
Biophysical profile
• fetal breathing movements
• fine motor movement
• gross fetal tone
• amniotic fluid volume
39. 40
Fetal Heart Rate
• Periodic FHR changes :
accelerations
decelerations
• Decelerations: different meaning depending
on when then occur in relation to contractions
41. 42
late Decelerations
• late Decelerations: abnormal
uteroplacental insufficiency
intervention:
Change maternal position
Give oxygen by face mask
Stop oxytocin infusion, etc
46. 47
AFI :the vertical depths of the largest pocket
in each of four eaual uterine quadrants
DISORDERS OF AMNIONIC FLUID
VOLUME
•AFI (amnionic fluid index)
•Maximum amniotic fluid is at 28w – 800ml
•After 28w, amniotic fluid decreases
•At 40w, amniotic fluid is at 500ml
50. 51
Question&Answer
1. What is prenatal period Ⅰ
2. If an LMP =Nov 1st,2009; LMP=Feb,27th,2010,
When is the EDC?
3.What is high risk pregnancy?
4. What is the function of Leopold maneuvers?
5. How to measure the DC and TC?
6. What is the FHR deceleration?
7. What kinds of FHR deceleration is divided into?
8. What are the indicators of lung maturity?
9. How much is a normal amniotic fluid volume?
