Q1 What is the purpose of prenatal checkups?
A Prenatal checkups have four main purposes: to provide advice, comfort, education and support to pregnant women; to treat minor symptoms that come with pregnancy, to screen for high-risk factors, and to prevent detection and management of high-risk factors.
Q2 Are prenatal checkups really beneficial for mothers and children?
A The answer is yes. Studies over the past 50 years have confirmed that prenatal screening improves pregnancy outcomes; reduces perinatal and maternal mortality; and that pregnancy outcomes are poor in unscreened pregnancies.
Q3 How many times do I need to be examined throughout my pregnancy?
A For low-risk pregnancies, the routine practice in China is to have 9 antenatal checkups starting from the confirmation of early pregnancy; for high-risk pregnancies, the number of checkups should be increased according to the condition. For pregnant women without comorbidities in developing countries, WHO (2006) recommends at least 4 antenatal checkups at <16 weeks, 24-28 weeks, 30-32 weeks and 36-38 weeks of gestation. According to the current situation of pregnancy care and the need for prenatal checkups in China, the 1st edition of the Guidelines for Preconception and Pregnancy Care developed by our Chinese Medical Association in 2011 still recommends 9 prenatal checkups, with the following gestational weeks: 6~14 weeks, 14~20 weeks, 20~24 weeks, 24~28 weeks, 30~32 weeks, 33~36 weeks, and 37~41 weeks of pregnancy.
Q4 How much do I know about the first prenatal checkup?
A Many mothers-to-be know from the Internet that the first prenatal checkup (also known as the first visit) has a lot of items and requires some “money”. But it’s hard to figure out how to do it, what to do and how much money is needed. Now I’m going to give you an inventory of the approximate examination items and costs. The initial examination begins with a complete medical history, asking the pregnant woman about her past medical and surgical history, family and genetic history, reproductive history, the presence of abnormalities in the current pregnancy, allergy history, etc., to initially screen for any high-risk factors. Then, a physical examination, including a general and gynecologic examination, is performed to rule out any disease.
In addition, we still routinely perform extra-pelvic measurements, but it has been well documented that extra-pelvic measurements do not predict cephalopelvic asymmetry at delivery. Therefore, in the 1st edition of the guidelines, the Chinese Medical Association does not recommend routine external pelvic measurements. The main recommendation is to measure the pelvic outlet diameter in late pregnancy. There are also some laboratory tests, including blood tests, ultrasound, electrocardiogram, cervical smear and gonococcus, and some special tests, such as early tumor, mid tumor or TORCH, which cost about 1000 RMB and fluctuate depending on the test.
Q5 What blood tests are required during pregnancy?
A There is a slight difference in the number of tests required by level II hospitals and level III hospitals, with level II hospitals requiring fewer tests and level III hospitals requiring more tests, but the difference is not significant. The tests required by tertiary hospitals include blood analysis, liver and kidney function, blood type and antibody screening, syphilis, HIV, and hepatitis virus serology (hepatitis B, C, and E), which are usually done during the initial consultation. A glucose tolerance test is also performed at 24-28 weeks. There are no established screening tests for these three pathogens, and none of the maternal serologic specific antibody tests can confirm when a pregnant woman is infected, whether the fetus is involved, or whether there are any long-term sequelae, nor can the results of maternal serologic screening be used to determine whether a pregnancy should be terminated. It is recommended that preconception screening or targeted screening during pregnancy should not be performed routinely on all pregnant women to avoid psychological fear and unnecessary interventions.
Q6 Why is urinalysis routinely tested?
A Routine urinalysis is done at every prenatal visit. It tests your urine sugar and urine protein levels. Although it is common to have positive urine sugar in pregnancy. However, high levels of urine sugar may indicate diabetes. Urine protein may indicate a urinary tract infection or kidney disease. In late pregnancy, it may be a sign of pre-eclampsia. If these problems occur, they need to be addressed. Of course, there is now evidence that urine testing is not necessary every time, but only for those pregnant women with comorbidities or complications, such as hypertensive disorders in pregnancy, combined kidney disease or diabetes, who need to detect changes in their condition.
Q7 Why should I have ultrasound during pregnancy and does it affect the fetus?
A:In clinical practice, ultrasound has become a universally accepted and valuable diagnostic tool. Most ultrasound devices used in obstetrical applications use real-time imaging technology with B-shape display. Although ultrasound may have some possible biophysical effects, such as tissue thermal effects and cavitation effects, which are recognized, diagnostic ultrasound in the medical field is considered safe. As for the use of diagnostic ultrasound in pregnancy, no potential hazards in the offspring have been reported. Only a few studies have found an association between ultrasound and left-handedness among male offspring, with statistically significant differences. This is unlikely to be the result of brain injury, as ultrasound exposure during pregnancy is not associated with other indicators of brain injury (e.g., motor and language developmental deficits, poor school performance, visual impairment, or hearing loss).
In the last few years, there has been a trend to use new diagnostic ultrasound techniques, such as color flow imaging, energy Doppler, and pulsed Doppler. These techniques require more acoustic exposure than B- and M-mode ultrasound, with the highest levels of pulsed Doppler. In pulsed Doppler ultrasound, the sound waves are clustered above a very small volume, so the same tissue is exposed to the sound waves all the time during the examination. Thus, making the thermal effect maximum. Results from animal studies show that pulsed Doppler ultrasound produces significant thermal effects, especially on the ear bone.
In order to ensure the continued safe use of diagnostic ultrasound in the medical field, the output power of modern obstetric ultrasound equipment is controlled only in the United States. Ultrasound equipment displays a “thermal index” and a “mechanical index” on the display screen to encourage the sonographer to try to protect the fetus or embryo from the potential hazards of acoustic exposure. However, the thermal and mechanical indices do not take into account external factors such as sampling time, examination time, and patient temperature. Therefore, thermal and mechanical indices are not the best indicators of the risk of fetal biological effects, but should be considered as the most practical and understandable way to assess such risks.
Q8 In Shanghai, how many ultrasounds are usually required during pregnancy?
For low-risk pregnancies, at least 4 ultrasounds are usually performed during pregnancy.
Early pregnancy – to confirm early pregnancy and rule out ectopic pregnancy
20-24 weeks of gestation — Mid-pregnancy fetal ultrasound (screening for large malformations)
36-37 weeks of gestation – assessment of risk factors and mode of delivery
Around 40 weeks of gestation Re-evaluation including fetal size, amniotic fluid, placenta, etc.
For high-risk pregnancies, increase the number of tests depending on the circumstances. In addition, ultrasound is also required in the following cases.
11 weeks-14 weeks of pregnancy – measurement of NT, nasal bone
28-30 weeks of gestation – growth monitoring
Q9 What is the purpose of fetal ultrasound in mid-trimester?
A The main purpose of routine fetal ultrasound in midtrimester, which we often refer to as ultrasound screening for macrosomia, is to provide accurate diagnostic information to medical personnel to bring about the best possible prenatal management and the best possible pregnancy outcome for both mother and fetus. The test allows determination of the gestational week as well as performing fetal size measurements for timely detection of growth abnormalities later in the pregnancy. Other purposes include detection of congenital anomalies and multiple pregnancies.
Routine prenatal screening includes evaluation of the following.
Cardiac activity ;
Number of fetuses (chorionicity should be checked in case of multiple pregnancies);
gestational age/fetal size;
Basic fetal anatomy;
appearance and position of the placenta.
Although many congenital anomalies can be detected, it is important to emphasize that even the most experienced operator using the best ultrasound equipment may miss them, especially those that manifest only in the second trimester. Prior to the start of the examination, the health care provider should counsel and inform the pregnant woman/couple about the potential benefits and limitations of routine ultrasound in midtrimester and provide full informed consent.
Q10 Who should receive a midtrimester fetal ultrasound?
A Many countries usually offer at least one routine midtrimester fetal ultrasound. For example, a working group on prenatal ultrasound organized by the Eunice Kennedy Shriver National Center for Child Health and Human Development in the United States agreed that all women should receive an ultrasound examination during pregnancy to detect fetal anomalies and pregnancy complications.9 A series of ultrasound examinations for pregnant women at high risk for adverse pregnancy outcomes (e.g., hypertension or diabetes mellitus) and a series of ultrasound examinations for some pregnant women at high risk for adverse pregnancy outcomes are available. Series of ultrasound examinations and more detailed targeted ultrasound examinations for some patients’ specific conditions, although helpful for these patients, are not part of the routine screening.
Q11 When should midtrimester fetal ultrasound be performed?
A Routine fetal ultrasound in midtrimester is usually performed at 18 to 22 weeks of gestation. This period balances the need to determine the week of gestation (the earlier the week of gestation is determined the more accurate it is) with the need to detect major congenital anomalies in the fetus in a timely manner. In countries where there is a time limit for termination of pregnancy, a balance should be struck between the timing of the test and the detection rate in order to allow sufficient time for counseling and further testing. Some centers perform fetal anatomy at 13 to 16 weeks of gestation by transvaginal ultrasound. This early examination provides useful information about fetal gestational age as a baseline for assessing fetal growth and development, as well as clarifying the chorionicity of twin pregnancies, but the provider performing this procedure requires special training to interpret these early anatomical structures.
Q12 What tests are available to screen for neonatal defects during early pregnancy?
A Early pregnancy screening tests are hematological tests and ultrasounds performed from 11-14 weeks of pregnancy to check for defects in the baby. These screenings are used to assess the risk of Down syndrome and trisomy 18. These screenings can be used as a stand-alone combined test or as part of the next step-by-step screening.
Ultrasound, also known as nuchal translucency thickness (NT) screening, is used to measure the thickness of the skin at the back of the neck. A thickened nuchal translucency is a characteristic of Down syndrome, trisomy 18 or other problems
It is a characteristic of Down syndrome, trisomy 18 or other problems. The blood test checks the mother’s blood for levels of two substances, pregnancy-related protein A and human chorionic gonadotropin, which are required during pregnancy. Elevated levels of these two proteins may be characteristic of Down syndrome.
Q13 What tests are available to screen for newborn defects during midtrimester?
A In the mid-trimester, a test called the “combined multi-marker screen” is used to screen for Down syndrome, trisomy 18 and neural tube defects. This test is used to monitor your blood levels for three or four of the following substances.
Alpha-fetoprotein (AFP) DD is produced by the growing embryo. It is usually found in the amniotic fluid, fetal blood. It is also found in small amounts in the mother’s blood.
Estriol: Hormone produced by the placenta and the liver of the fetus.
Human chorionic gonadotropin.
A hormone that inhibits the production of the protein ADD placenta.
Testing for the first three substances is called triple screening. If all four substances are tested, it is called quadruple screening (see FAQ: Birth Defects Screening)
Q14 What tests can I offer if I am at risk of carrying a fetus with defects? What is an invasive fetal test?
A If the results of the screening test indicate a high risk of delivering a baby with a birth defect, an invasive fetal test is required.
Invasive fetal testing refers to any procedure that requires the insertion of medical instruments such as syringes into the uterus to examine the fetus. Invasive testing can be dangerous to the fetus because of the need to put medical instruments into the uterus, which may stimulate uterine contractions, lead to amniotic fluid breakage or bacterial infection, for example, chorionic villus biopsy and amniocentesis increase the chance of miscarriage by about 1%. Therefore, it is important to evaluate the need and risk of invasive testing before deciding to perform it.
Chorionic villus biopsy
The chorionic villi are the basic tissue that makes up the placenta. A chorionic villus biopsy is a medical test in which cells and tissues are extracted from the placenta through the abdomen and uterus of the pregnant woman. The doctor will first determine the location of the placenta with the help of an ultrasound, then inject a local anesthetic into the abdomen of the pregnant woman, and once she is sufficiently anesthetized, the doctor will place a suction needle into the placenta to extract the sample. The procedure takes about one minute. The sample can be used to test for chromosomal or other transmission factors, such as Down’s syndrome or thalassemia.
Like amniocentesis, chorionic villus biopsy is an invasive test that carries some risk to the fetus, increasing the chance of fetal miscarriage by 1%. Chorionic villus biopsy can be performed at 11-13 weeks of pregnancy, while amniocentesis should not be performed until after 16 weeks.
Amniocentesis
Amniocentesis is a procedure that involves passing through the mother’s abdomen and uterus to access the fetal amniotic membrane to extract amniotic fluid for medical testing. The doctor will first determine the location of the fetus and the amniotic fluid with the help of ultrasound and then place a suction needle to the placenta to extract a sample. The sample can be used to test for chromosomal or other transmission factors, such as Down’s syndrome or thalassemia.
Amniocentesis is not performed until 16 weeks because the amniotic fluid is low and the amnion is not fully united with the chorionic villi, whereas chorionic villus biopsy can be performed from 11-14 weeks of pregnancy. Amniocentesis, like chorionic villus biopsy, is an invasive test and carries some risk to the fetus, increasing the chance of miscarriage by 1%.
Q15Why do you count fetal movements? How can pregnant women count their own fetal movements?
A Fetal movement refers to the activity of the fetus in the uterus, which can be fetal limb movement, swinging, fetal and fetal body rotation, turning and rolling, etc. The fetal movement is related to the blood and oxygen supply of the fetus in the uterus.
The fetal movement is related to the supply of blood and oxygen to the fetus in the uterus, which is an important indicator of the fetal well-being. When the placenta is not functioning well, fetal movement can be reduced or even disappear. In normal pregnancy, pregnant women start to feel fetal movement at 18-20 weeks, and it increases with the increase of pregnancy weeks.
The number of fetal movements increases with the increase of gestational weeks and reaches a peak at 29 to 32 weeks of pregnancy. After 38 weeks of gestation, fetal movement decreases due to the decline of the fetal previa. In late pregnancy, the fetal physiological sleep cycle is more obvious, and the cycle of fetal movement is also more obvious than before.
The periodicity of fetal movement is also more obvious than before, generally at 8-12 am evenly, decreasing to the least at 2-3 pm, and increasing to the most at 8-11 pm. The fetal movement is about 30-40 times a day, but individual differences
The fetal movements are different from each other, and each pregnant woman has her own pattern of fetal movements. All pregnant women should be aware of the significance of counting fetal movements in late pregnancy and must start counting fetal movements from 28 weeks of pregnancy. The appropriate time is to pay attention to fetal movement at a fixed time every morning, noon and night, and count fetal movement for one hour at a fixed time. If there is no fetal movement for 1 hour or less than 6 fetal movements in 2 hours, you should go to the hospital as soon as possible.
Q16 What should I do if a breech position is found during the labor and delivery?
A What should I do if I find a breech position during labor and delivery?
Before 32 weeks of pregnancy, breech presentation can be changed to cephalic presentation by itself and no special treatment is needed. If breech previa is still present after 32 weeks of gestation, fetal position correction should be considered, including chest-knee position and external rotation.
For breech position, with the patient’s consent, the doctor’s first choice is chest-knee position transfer. If the thoracic-knee position is unsuccessful, external inversion may be considered. The external inversion is performed under B-mode ultrasound and electronic monitoring of the fetal heart, and must be performed under conditions that allow for an emergency cesarean section. External reversal is rarely performed routinely in breech positions in China.
With regard to the choice of breech delivery method, currently worldwide, for almost 25 years, even in better equipped hospitals, most still prefer to terminate the pregnancy by cesarean section. Many Nordic and North American countries have adopted cesarean delivery as the routine mode of delivery for breech presentation; domestic statistics in this area are incomplete, and although the chance of performing a cesarean delivery in full-term breech position has been reported to be 50-60%, it is believed that the reported rate is much lower than the actual data. The reason for this is that cesarean delivery can reduce the rate of perinatal disease due to vaginal delivery in breech position, which is also supported by the weed cellar.
Q17 Can I try to deliver vaginally in the breech position?
A In breech delivery, planned cesarean delivery before delivery has the lowest perinatal outcome compared to cesarean and vaginal delivery at the time of delivery. The same conclusion has been reached by data from Asia, where a study of multicenter data from nine Asian countries, including China, Japan, Vietnam, and Nepal, showed that delivery by breech cesarean improved perinatal outcomes. It is noteworthy that 2 months after the publication of the Lancet study in 2000, the cesarean rate for breech delivery in the Netherlands increased from 50% to 80%, the morbidity rate for perinatal infants weighing ≤4000 g decreased from 0.35% to 0.18%, and the incidence of neonatal birth injuries decreased from 0.29% to 0.08%.
Thus, the benefits of a full-term breech cesarean delivery are better supported by evidence and have been accepted by most obstetricians, and the art of breech assisted delivery is gradually being lost. However, it is still safe to choose the right patient for a vaginal delivery in a place where delivery is possible. Therefore, when consulting with obstetricians about the breech delivery method, they should first consider the hospital’s delivery conditions and the proficiency of the breech delivery technique, take into account the overall situation of the pregnancy, and fully communicate with the patient about the advantages and disadvantages of vaginal delivery, and then make a final decision based on the wishes of the pregnant woman.
Q18 What is TORCH syndrome?
A: TORCH is a combination of the initials of several pathogenic microorganisms that cause disease in pregnant women and can cause fetal infections and even birth defects in newborns. T is for toxoplasma, R is for rubella virus, C is for cytomegalovirus (CMV), H is for herpe simplex virus (HSV), and O is for others, mainly syphilis spirochetes (treponema pallidum). treponema pallidum), etc.
Serologic screening for Toxoplasma gondii, cytomegalovirus, and herpes simplex virus: Currently, there are no established screening tools 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, or whether there are any long-term complications, nor can the serologic screening results of pregnant women be used to determine whether a pregnancy should be terminated. It is recommended that preconception screening or targeted screening during pregnancy should not be performed routinely on all pregnant women to avoid psychological fear and unnecessary interventions for pregnant women.