Pre-conception health care (3 months before conception) I. Main contents of health education and guidance: 1. Take 0.4~0.8mg/d of folic acid supplementation; pregnant women with previous neural tube defects (NTD) should take 4mg of folic acid supplementation daily. 2. Use medication reasonably and avoid using drugs that may affect the normal development of the fetus. 3.Avoid contact with toxic and harmful substances in the living and occupational environment (such as radiation, high temperature, lead, mercury, benzene, arsenic, pesticides, etc.) and avoid close contact with pets. Deng Jie, Department of Obstetrics and Gynecology, Xiangyang First People’s Hospital 4. Change bad habits (such as smoking, alcoholism, drug abuse, etc.) and lifestyle; avoid high-intensity work, high-noise environment and domestic violence. II. Routine health care 1. Assessment of pre-pregnancy high-risk factors: (1) Ask about the health status of the couple preparing for pregnancy. (2) Assess previous history of chronic diseases, family and genetic history, those who are not suitable for pregnancy should be promptly informed. (3) Detailed information on history of adverse pregnancy and delivery. (4) Lifestyle, diet and nutrition, occupational status and work environment, exercise (labor) situation, domestic violence, interpersonal relationships, etc. 2. Physical examination: (1) Including measurement of blood pressure and weight, calculation of body mass index (BMI), BMI = weight (kg)/height (m)2. (2) Routine gynecological examination. Auxiliary examination 1. Compulsory items: including the following items: (1) routine blood; (2) routine urine; (3) blood group (ABO and Rh); (4) liver function; (5) kidney function; (6) fasting blood sugar; (7) HBsAg; (8) syphilis spirochete; (9) HIV screening; (10) cervical cytology (for those who have not been examined within 1 year). 2. Preparation items: including the following items: (1) Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus (TORCH) screening. (2) Cervicovaginal discharge test (routine vaginal discharge, gonococcus, Chlamydia trachomatis). (3) Thyroid function test. (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan, Chongqing, etc.). (5) 75g oral glucose tolerance test (OGTT; for high-risk women). (6) Blood lipid examination. (7) Gynecologic ultrasound examination. (8) Electrocardiogram. (9) Chest x-ray. Pregnancy care I. Number of prenatal checkups and gestational weeks: 6-13 weeks +6, 14-19 weeks +6, 20-24 weeks, 24-28 weeks, 30-32 weeks, 33-36 weeks, 37-41 weeks of gestation. For those with high-risk factors, increase the number of times as appropriate. 2. Contents of prenatal checkup (a) First prenatal checkup (6-13 weeks +6) 1. Health education and guidance: (1) Awareness level guidance on miscarriage; (2) Guidance on nutrition and lifestyle; (3) Continue folic acid supplementation until the third trimester; avoid contact with toxic substances, use drugs with caution, and get tetanus and influenza vaccination if necessary. 2. Routine health care: (1) establish a pregnancy health care manual; (2) carefully inquire about menstruation, determine the week of pregnancy and project the expected date of delivery; (3) assess the risk factors during pregnancy; (4) physical examination: blood pressure and weight measurement, routine gynecological examination (for those who have not done so in the first 3 months of pregnancy); fetal heart rate determination (by Doppler auscultation, around 12 weeks of pregnancy). 3. Mandatory tests: (1) blood and urine routine; (2) blood type (ABO and Rh); (3) liver and kidney function; (4) fasting blood sugar; (5) HbsAg, syphilis spirochete, HIV screening. (Note: items already checked in the first 6 months of pregnancy may not be checked, and hepatitis B virus may be checked for those with hepatitis B major triplet). 4. Preparation items: (1) Hepatitis C virus (HCV) screening; (2) Anti-D titer test (Rh negative); (3) 75g OGTT (for high-risk pregnant women or those with symptoms); (4) Thalassemia screening; (5) Thyroid function test. (6) Serum ferritin (for those with hemoglobin <105g/L); (7) Tuberculin (PPD) test (for high-risk pregnant women); (8) Cervical cytology (for those who have not been tested in the first 12 months of pregnancy); (9) Cervical discharge test for gonococcus and Chlamydia trachomatis (for high-risk pregnant women or those with symptoms); (10) Bacterial vaginosis (BV) test (for those with a history of preterm delivery); (11) Ultrasound. (12) electrocardiogram. (II) Prenatal examination at 14-19+6 weeks of gestation 1. Health education and guidance: awareness and prevention of miscarriage; guidance on nutrition and lifestyle; start calcium supplementation 600mg/d; hemoglobin below 105g/l, iron supplementation 60-100mg/d. 2. Routine health care: (1) Analyze the results of the first prenatal examination. (2) Ask about vaginal bleeding, diet and exercise. (3) Physical examination, including blood pressure and weight, to assess whether the maternal weight gain is reasonable; fundal height and abdominal circumference, to assess whether the fetal weight gain is reasonable; fetal heart rate measurement. 3.Compulsory items: None. 4.Preparation items: (1) Down's syndrome screening (15-20 weeks of gestation, the best testing gestational week is 16-18 weeks). (2) Amniocentesis to check fetal karyotype (16-21 weeks of gestation; for pregnant women aged 35 years and above at the due date or for those at high risk). (3) Prenatal examination at 20-24 weeks of gestation 1. Health education and guidance: awareness and prevention of miscarriage; guidance on nutrition and lifestyle; significance of fetal system ultrasound screening. 2. Routine health care: (1) Ask about fetal movement, vaginal bleeding, diet and exercise. (2) Physical examination, same as 14-19 weeks of pregnancy +6 prenatal examination. 3.Mandatory checkups: (1) Fetal system ultrasound screening (18-24 weeks of gestation) to screen for serious malformations of the fetus. (2) Routine blood and urine tests. 4. Preparation items: cervical assessment (ultrasound measurement of cervical length). (4) Antenatal checkups at 24-28 weeks of gestation 1. Health education and guidance: awareness and prevention of miscarriage; significance of gestational diabetes mellitus (GDM) screening. 2. Routine health care: (1) Ask about fetal movement, vaginal bleeding, contractions, diet and exercise. (2) Physical examination, same as 14-19 weeks of pregnancy +6 prenatal examination. 3, mandatory items: (1) GDM screening: it is recommended to perform 75g OGTT directly, and its normal upper limit is 5.1 mmol/L for fasting glucose, 10.0 mmol/L for 1h glucose and 8.5 mmol/L for 2h glucose. (2) urine routine. 4. Preparation items: (1) Anti-D titer test (for Rh negative). (2) Cervicovaginal discharge to detect fetal fibronectin (fFN) level (for those at high risk of preterm delivery). (E) Prenatal checkups at 30-32 weeks of gestation 1. Health education and guidance: guidance on mode of delivery; start to pay attention to fetal movement; guidance on breastfeeding; guidance on newborn care. 2. Routine health care: (1) Ask about fetal movement, vaginal bleeding, contractions, diet and exercise. (2) Physical examination, same as 14-19 weeks of pregnancy +6 prenatal examination, fetal position examination. 3.Must check items: (1) Blood and urine routine. (2) Ultrasound. 4. Preparation items: ultrasound to measure sensory length or cervicovaginal secretion to detect fetal fibronectin (fFN) level for those at high risk of preterm delivery. (6) Antenatal checkups at 33-36 weeks of gestation 1. Health education and guidance: guidance on lifestyle before delivery; guidance on knowledge related to delivery (symptoms of labor, mode of delivery, labor analgesia); prevention of depression. 2. Routine health care: (1) Ask about fetal movement, vaginal bleeding, contractions, skin itching, diet, exercise, and preparation before delivery. (2) Physical examination, same as prenatal examination of pregnancy 30-32. 3. Compulsory check-ups: urinary routine. 4.Ready items: (1) Screening for Group B Streptococcus (GBS) at 35-37 weeks of gestation. (2) Liver function and serum bile acid test at 32-34 weeks of gestation. (3) Electronic fetal heart monitoring (NST) examination from 34 weeks of gestation (for high-risk pregnant women). (4) Electrocardiogram review (high-risk pregnant women). (7) Antenatal checkups at 37-41 weeks of gestation 1. Health education and guidance: guidance on knowledge related to childbirth (symptoms of labor, mode of delivery, labor analgesia); guidance on neonatal immunization; guidance on puerperium; monitoring of intrauterine condition of the fetus; hospitalization to induce labor if gestation is >41 weeks. 2. Routine health care: (1) Ask about fetal movement, contractions, redness, etc. (2) Physical examination, same as prenatal examination of 30-32 weeks of pregnancy; cervical examination and Bishop score. 3.Must check items: (1) Ultrasound examination: assess fetal size, amniotic fluid volume, placental maturity, fetal position and the ratio of peak systolic and end-diastolic flow rate of umbilical artery (S/D value), etc. (2) NST examination (once a week). 4. Preparation items: None.