Pre-pregnancy health care (3 months before pregnancy) Pre-pregnancy health care is the forward movement of pregnancy health care through the assessment and improvement of the health status of couples planning to become pregnant, reducing or eliminating risk factors leading to birth defects and other adverse pregnancy outcomes, preventing the occurrence of birth defects, and improving the quality of the birth population. I. Health education and guidance Following the principle of combining universal guidance and personalized guidance, couples planning pregnancy are given pre-pregnancy health education and guidance. The main contents include: (1) Prepared and planned pregnancy, avoiding high-age pregnancy. (2) Reasonable nutrition, control body mass (weight) gain. (3) Supplementation with folic acid 0.4 to 0.8 mg/d, or a multivitamin containing folic acid validated by evidence-based medicine. Pregnant women with previous neural tube defects (NTDs) require folic acid supplementation of 4mg/day. (4) Women with genetic, chronic and infectious diseases who are preparing for pregnancy should be evaluated and instructed. (5) Reasonable use of medication and avoidance of drugs that may affect the normal development of the fetus. (6) Avoid contact with toxic and harmful substances in the living and occupational environments (e.g. radiation, high temperature, lead, mercury, benzene, arsenic, pesticides, etc.) and avoid close contact with pets. (7) Change bad habits (e.g. smoking, alcoholism, drug abuse, etc.) and lifestyles; avoid high-intensity work, high-noise environments and domestic violence. (8) Maintaining mental health, relieving mental stress, and preventing the occurrence of psychological problems during pregnancy and after childbirth. (9) Reasonable choice of exercise. II. Routine health care 1. Assessment of pre-pregnancy high-risk factors: (1) Inquire about the health status of the couple preparing for pregnancy. (2) Evaluate the history of previous chronic diseases, family and genetic history, those who are not suitable for pregnancy should be informed in time. (3) Detailed knowledge of adverse pregnancy and childbirth history. (4) Lifestyle, diet and nutrition, occupational status and work environment, exercise (labor), domestic violence, interpersonal relationships. 2. Physical examination: (1) Including measurement of blood pressure, body mass, and calculation of body mass index (BMI), BMI = body mass (kg)/height (m)2. (2) Routine gynecological examination. Third, auxiliary examination 1, mandatory items: (1) routine blood; (2) routine urine; (3) blood type (ABO and Rh); (4) liver function; (5) renal function; (6 fasting blood glucose; (7) HBsAg; (8) syphilis spirochetes; (9) HIV screening; (10) cervical cytology (1 year without examination). 2. Preparatory tests: (1) Screening for toxoplasmosis, rubella virus, cytomegalovirus and herpes simplex virus (TORCH). (2) Cervicovaginal discharge test (routine vaginal discharge, gonococcus, chlamydia trachomatis). (3) Thyroid function test. (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan and Chongqing). (5) 75g oral glucose tolerance test (OGTT; for high-risk women). (6) Lipid test. (7) Gynecological ultrasonography. (8) Electrocardiogram. (9) Chest X-ray. Pregnancy care The main feature of pregnancy care is the requirement for a systematic provision of evidence-based prenatal screening programs at specific times. The schedule of prenatal examinations is determined by the purpose of the prenatal examination. First, the number of prenatal checkups and gestational weeks Reasonable number of prenatal checkups and gestational weeks can not only ensure the quality of pregnancy health care, but also save medical and health resources. According to the current situation of pregnancy health care in China and the needs of prenatal checkup programs, the recommended gestational weeks for prenatal checkups in this guideline are: 6-13 weeks +6, 14-19 weeks +6, 20-24 weeks, 24-28 weeks, 30-32 weeks, 33-36 weeks, 37-41 weeks. For those with high risk factors, increase the number of times as appropriate. II. Contents of prenatal examination (I) First prenatal examination (6-13 weeks of pregnancy+6) 1. Health education and guidance: (1) Awareness and prevention of miscarriage. (2) Nutrition and lifestyle guidance (hygiene, sex life, sports exercise, travel, work). (3) Continue to supplement folic acid 0.4-0.8mg/d until the 3rd month of pregnancy, and continue to take multivitamins containing folic acid if available. (4) Avoid contact with toxic and harmful substances (such as radiation, high temperature, lead, mercury, benzene, arsenic, pesticides, etc.), and avoid close contact with pets. (5) Use drugs with caution and avoid drugs that may affect the normal development of the fetus. (6) If necessary, vaccinate against tetanus or influenza during pregnancy. (7) Change bad habits (e.g. smoking, alcoholism, drug abuse, etc.) and lifestyles; avoid high-intensity work, high-noise environments and domestic violence. (8) Maintaining mental health, relieving mental stress, and preventing the occurrence of psychological problems during pregnancy and after delivery. 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 high-risk factors during pregnancy. Maternal history, especially adverse maternal history such as miscarriage, preterm labor, stillbirth, history of stillbirth, history of reproductive tract surgery, any malformation of the fetus or mental retardation of the young child, pre-pregnancy preparations, family history of the person and his/her spouse and history of hereditary diseases. Pay attention to the presence of pregnancy comorbidities, such as: chronic hypertension, heart disease, diabetes, liver and kidney disease, systemic lupus erythematosus, blood diseases, neurological and psychiatric disorders, etc., and promptly ask for consultation with relevant disciplines, those who are not suitable to continue the pregnancy should be informed and terminate the pregnancy in a timely manner; those who continue the pregnancy in high-risk pregnancies are evaluated to see if they should be referred to the hospital. There is no vaginal bleeding in this pregnancy, and there are no possible teratogenic factors. (4) Physical examination. Including measurement of blood pressure, body mass, calculation of BMI; routine gynecological examination (not done in the first 3 months of pregnancy); fetal heart rate measurement (using Doppler auscultation, about 12 weeks of pregnancy). 3, mandatory items: (1) routine blood; (2) urine routine; (3) blood type (ABO and Rh); (4) liver function; (5) kidney function; (6) fasting blood glucose; (7) HBsAg; (8 syphilis spirochetes; (9) HIV screening. (Note: Items that have been checked in the first 6 months of pregnancy can be checked without repeating) 4. Preparatory items: (1) Hepatitis C virus (HCV) screening. (2) Anti-D titer test (Rh negative). (3) 75g OGTT (high-risk pregnant women or those with symptoms). (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan and Chongqing). (5) Thyroid function test. (6) Serum ferritin (those with hemoglobin <105g/L). (7) Tuberculin (PPD) test (high-risk pregnant women). (8) Cervical cytology (those who have not been examined in the first 12 months of pregnancy). (9) Cervical secretion test for gonococcus and chlamydia trachomatis (high-risk pregnant women or those with symptoms). (10) Testing for bacterial vaginosis (BV) (for those with a history of preterm labor). (11) Maternal serologic screening in early pregnancy for fetal chromosomal aneuploidy abnormalities [pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG, 10-13 weeks of gestation]. Precautions: fasting; ultrasound to determine gestational week; determine body mass on day of blood draw. In high-risk individuals, consider chorionic villus biopsy or combined midgestation serologic screening results before deciding on amniocentesis. (12) Ultrasonography. Ultrasonography is performed during early pregnancy: to determine intrauterine pregnancy and gestational week, fetal viability, number of fetuses or nature of twin chorionic villi, and uterine adnexa. Ultrasound of fetal nuchal translucency thickness (NT) at 11-13 weeks of gestation; approved gestational week.NT measurements are performed according to the British Fetal Medicine Foundation standards. (13) Chorionic villus biopsy (10-12 weeks of gestation, mainly for high-risk pregnancies). (14) Electrocardiogram. (II) 14-19 weeks of gestation + 6 prenatal checkups 1. Health education and guidance: (1) Awareness and prevention of miscarriage. (2) Knowledge of pregnancy physiology. (3) Guidance on nutrition and lifestyle. (4) Meaning of screening for fetal chromosomal aneuploidy anomalies in the middle trimester. (5) Hemoglobin <105g/L, serum ferritin <12ug/L, supplementation of elemental iron 60-100mg/d. (6) Beginning of calcium supplementation, 600mg/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 body mass, to assess whether the growth of pregnant women's body mass is reasonable; uterine fundal height and abdominal circumference, to assess whether the growth of fetal body mass is reasonable; fetal heart rate measurement. 3.Required items: None. 4.Preparatory items: (1) Maternal serologic screening for fetal chromosome aneuploidy anomalies in the middle trimester (15-20 weeks of gestation, with the optimal gestational week of detection being 16-18 weeks). Precautions: Same as early pregnancy serologic screening. (2) Amniocentesis screening for fetal karyotyping (16-21 weeks of gestation; for pregnant women aged 35 years and above at the time of expected delivery or for high-risk groups). (C) Prenatal examination at 20-24 weeks of pregnancy 1. Health education and guidance: (1) Awareness and prevention of preterm labor. (2) Nutrition and lifestyle guidance. (3) The significance of fetal systematic ultrasound screening. 2, Routine health care: (1) Inquiries about fetal movement, vaginal bleeding, diet and exercise. (2) Physical examination, same as 14-19 weeks gestation + 6 prenatal examination. 3.Required items: (1) Fetal systematic ultrasound screening (18-24 weeks of gestation), screening for serious malformations of the fetus. (2) Blood routine, urine routine. (4) Preparatory items: cervical assessment (ultrasound measurement of cervical length). (D) Prenatal examination at 24-28 weeks of pregnancy 1. Health education and guidance: (1) Recognition and prevention of preterm labor. (2) Significance of screening for gestational diabetes mellitus (GDM). 2. Routine health care: (1) Inquire about fetal movement, vaginal bleeding, contractions, diet and exercise. (2) Physical examination, same as 14-19 weeks of pregnancy +6 prenatal examination. 3.Required items: (1) GDM screening. First, 50g glucose screening (GCT), if blood glucose ≥7.2mmol/L, ≤11.1mmol/L, then 75gOG ≥11.1mmol/L, then fasting blood glucose is measured. The international recently recommended method is not necessary to first 50gGCT, if possible, can be directly performed 75gOGTT, the upper limit of normal for fasting blood glucose 5.1mmol / L, 1h blood glucose 10.0 mmol / L, 2h blood glucose 8.5mmol / L. Or through the detection of fasting blood glucose seat screening criteria. (2) Urine routine. 4.Preparatory items: (1) Anti-D titer test (Rh-negative people). (2) Cervicovaginal secretion test for fetal fibronectin (fFN) level (for those at high risk of preterm labor). (E) Prenatal examination at 33-36 weeks of pregnancy 1. Health education and guidance: (1) Guidance on lifestyle before delivery. (2) Knowledge related to labor and delivery (symptoms of approaching labor, guidance on delivery methods, labor analgesia). (3) Newborn disease screening. (4) Prevention of depression. 2. Routine health care: (1) Inquiries about fetal movement, vaginal bleeding, contractions, skin itching, diet, exercise, and preparation for delivery. (2) Physical examination, same as pregnancy 30-32 prenatal examination. 3.Required items: urine routine. 4.Preparatory items: (1) 35-37 weeks of pregnancy Group B Streptococcus (GBS) screening: pregnant women with high-risk factors (such as combined diabetes mellitus, newborns born from previous pregnancies with GBS infections, etc.), take the perianal and lower 1/3 of the vagina for culture of the secretions. (2) Liver function and serum bile acid test at 32-34 weeks of gestation (pregnant women in areas with high incidence of ICP). (3) Electronic fetal heart monitoring (no-load test, NST) examination starting at 34 weeks of gestation (high-risk pregnant women). (4) Electrocardiogram review (high-risk pregnant women). (F) Prenatal examination at 37-41 weeks of pregnancy 1. Health education and guidance: (1) Knowledge related to labor (symptoms of labor, guidance on delivery methods, labor analgesia). (2) Guidance on newborn immunization. (3) Instruction on the puerperium. (4) Monitoring of intrauterine conditions of the fetus. (5) Gestation ≥ 41 weeks, hospitalization and induction of labor. 2. Routine health care: (1) Inquire about fetal movement, contractions, and redness. (2) Physical examination, same as pregnancy 30-32 prenatal examination; perform cervical examination and Bishop score. 3.Required items: (1) ultrasonography: assess fetal size, amniotic fluid volume, placental maturity, fetal position and the ratio of peak systolic to end-diastolic flow rate of the umbilical artery (S/D value). (2) NST examination (once a week). 4.Remarked items: None. Third, the content of pregnancy is not recommended for routine examination 1, extra-pelvic measurements: there is sufficient evidence to show that extra-pelvic measurements do not predict cephalopelvic disproportion at delivery. Therefore, there is no need to routinely check extra-pelvic measurements during pregnancy. For vaginal delivery, the pelvic outlet diameter can be measured in late pregnancy. Toxoplasma gondii, cytomegalovirus and herpes simplex virus serologic screening: there is no mature screening method for these three pathogens, and serologic specific antibody testing of pregnant women cannot confirm when a pregnant woman is infected, whether the fetus is involved, and whether there are any long-term sequelae, and it cannot be based on the results of the serologic screening of pregnant women to decide whether or not termination of pregnancy is necessary. It is recommended that pre-pregnancy screening or targeted screening during pregnancy should not be performed on all pregnant women to avoid psychological fear and unnecessary intervention. 3, BV screening: the incidence of BV in pregnancy is 10-20%, which is related to the occurrence of preterm labor, high-risk pregnant women with preterm labor can be screened for BV, but it is not suitable for all pregnant women to carry out routine BV screening. 4, cervicovaginal secretion test fFN and ultrasonography to assess the cervix: pregnant women at high risk of preterm labor, the value of these two screenings is that a negative result suggests that there is no likelihood of preterm labor in the near future, thus minimizing unnecessary interventions. However, there is insufficient evidence to support cervicovaginal secretion fFN testing and ultrasound cervical evaluation in all pregnant women. 5. Urine protein and blood tests at each prenatal visit: Urine protein and blood tests are not required at each prenatal visit, but may be repeated in pregnant women with hypertensive disorders of pregnancy and anemia of pregnancy. 6. Thyroid function screening: hypothyroidism in pregnant women affects the development of children's neurointelligence. Some experts suggest screening thyroid function (FT3, FT4, TSH) in all pregnant women, but there is not enough evidence to support screening thyroid function in all pregnant women, and adequate iodine intake should be ensured during pregnancy. 7. Tuberculosis screening: At present, there is not enough evidence to support screening for tuberculosis (including PPD test and chest X-ray) for all pregnant women. High-risk pregnant women (high TB prevalence areas, poor living conditions, HIV infection, drug addicts) can be screened for TB at any point in their pregnancy.