1.When to start prenatal checkup? What is the significance of prenatal checkups? All checkups during pregnancy are prenatal checkups, so the checkups have started since your first visit to the doctor. The so-called maternity checkups are only to collect the data of pregnant women for unified management, so as to facilitate tracking and follow-up. You should know that a doctor’s daily outpatient workload is about 60 to 80 people, and the average consultation time of a mother-to-be is only 5-10 minutes, so it is quite difficult to complete the medical history taking and proper diagnosis and treatment in the shortest possible time without such preliminary preparation as file building and filing. On the other hand, obstetrics-related examinations are not like other specialties, and our examinations often need to be booked in advance (6-8 weeks or even more in advance in our hospital). For mothers-to-be who come in and say they want to have such and such examinations, I can only tell you with regret that in the vast majority of cases it is impossible for me to meet your requests. In addition, we usually place the check-ups around 16 weeks. When it comes to prenatal checkups, it is impossible not to talk about the significance of prenatal checkups. The most common question that many parents-to-be ask when they come for a maternity visit is, “Is this baby normal and okay?” I think this is the question that every obstetrician is most afraid of and has the most headaches. In fact, we can’t give you a general answer about normal or abnormal. Prenatal checkup is a phase by phase checkup, and each week of pregnancy has its own focus, we are more interested in “detecting” problems that have already occurred and “avoiding” more serious problems, rather than “predicting” problems that have not yet occurred. “Of course, sometimes we will focus more on possible problems based on the results of the preliminary examinations, and sometimes we will adjust the examinations and treatment according to the situation of each pregnant woman. For example, for gestational diabetes, we usually put it at 24-28 weeks, but for a pregnant woman with polycystic ovary syndrome, obesity, or abnormal fasting glucose, we may do the screening and intervention earlier. Prenatal checkups are probably just a pleasant chat in most cases, because after all, only a few babies have abnormalities. The questions like “can I eat ice cream” and “do I need to detoxify the fetus” are not strictly medical questions, but it is always worthwhile to have a doctor tell you the answers. Li Da, Department of Obstetrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University 2. I often encounter this question: “Doctor, I just had my period, why do you say I am already one month pregnant?” . In fact, for a pregnant woman who ovulates regularly, we calculate the gestational week from the day of the last menstruation. In fact, the gestational age is 2 weeks younger than what we call the gestational age, so we often tell a pregnant woman who knows the exact time of ovulation or the time of intercourse to start counting her weeks 2 weeks ahead. For pregnant women with irregular menstruation and ovulation disorders, it is not reasonable to calculate from the last menstruation, so you also need the time of ovulation, the time of pregnancy test, HCG within 6 weeks and early pregnancy ultrasound to correct the gestational week. 3. Do I need to test HCG and progesterone during early pregnancy? I do not advocate HCG and progesterone testing in early pregnancy to guide early pregnancy preservation. In fact, checking HCG and progesterone is a very fashionable thing in China, and many doctors will tell you that HCG and progesterone are low and you need to take some injections. I do not agree with this practice. HCG is secreted by the cells of the syncytial trophoblast. What is the syncytial trophoblast is simply the part of the fertilized egg that will form the placenta in the future after division, it is not part of the fetus. Therefore, the HCG level reflects the development of the cells of the syncytial trophectoderm, and we often see that the HCG is more than 100,000, but still the pregnancy sac is empty. The HCG is not always rising, it starts to drop around 8 weeks, so it’s not that the fetus is bad if it drops. Some people may say that monitoring the doubling of HCG can tell whether the embryo is developing well or not, but in fact, as already mentioned, HCG is not secreted by the embryo itself, so how can it reflect the good or bad fetus. By doubling, we mean that every 2-3 days, the HCG value doubles. Of course, if the HCG doubling is very poor and the peak is below 20,000, we think that the embryo may be bad indeed. But a new question has arisen, is it that the doubling is very poor and the peak is low and we have ways to improve this situation, unfortunately, none of the therapeutic measures we can think of, whether it is low molecular heparin, progesterone, HCG or immunotherapy such as immunoglobulin, fat milk, LIT, etc., can improve the quality and survival of the embryos. In one of the trials, low molecular heparin treatment improved the development of trophoblast cells and increased peak HCG levels, but unfortunately, the syncytial trophoblast is not the fetus and low molecular heparin treatment did not improve fetal survival. What about the other test “progesterone”? Here I’ll borrow a quote directly from Professor Duan Tao (because I’m too tired to code myself, bad). The reason for testing progesterone is that one of the major causes of miscarriage is luteal insufficiency (a small percentage), which leads to low progesterone levels and further leads to miscarriage. If detected in time, progesterone can be supplemented to prevent miscarriage from occurring. In fact, the gold standard for the diagnosis of luteal insufficiency indicates that two endometrial biopsies are performed in the mid-luteal phase, so it is almost impossible to use such a gold standard for diagnosis in clinical practice. This is why some people propose to check progesterone levels to determine luteal function, but this method is not reliable: ① normal pregnancy progesterone levels fluctuate widely (in fact, two tests on the same day in the same person can be very different); ② low progesterone levels are more a result of embryonic dysplasia than a cause of miscarriage; ③ half of the patients diagnosed with luteal insufficiency have normal progesterone levels; ④ during early pregnancy, the There are 2 sources of progesterone, one is secreted by the corpus luteum and the other is secreted by the trophoblast, so it is impossible to determine which cause of low levels is responsible. For these reasons, I do not advocate routine testing of HCG and progesterone, because such tests may look wonderful, but they seem very weak in terms of interpretation, prediction or intervention. Since the predictive value is limited and interventions are ineffective, sometimes such tests just flatly increase the anxiety of the parents-to-be, so I would not routinely check them, and even if I do, it is never for the purpose of guiding the use of medications for fetal preservation. What are the circumstances in which I would check? If a pregnant woman has ovulation disorder, does not know the exact time of ovulation and ultrasound does not reveal clinical evidence of pregnancy, I would choose to check HCG to help determine the time of conception and progesterone to help determine the possibility of ectopic pregnancy and miscarriage. 4. What tests and treatments are needed during early pregnancy? Finally, it comes back to the question of which tests are needed. In principle, I do not recommend any tests that do not provide appropriate interventions but only increase maternal anxiety. The tests I recommend during early pregnancy are: ① transvaginal ultrasound at 7 weeks of pregnancy (if you have a past history of pelvic inflammatory disease, abortion or ectopic pregnancy, or if you have symptoms of suspected ectopic pregnancy, you can advance the test to rule out ectopic pregnancy) and an NT test (ultrasound to measure the thickness of the nuchal translucency) at 13 weeks of pregnancy; ② thyroid function test at 7 weeks of pregnancy; ③ fasting glucose test if you have not done so before pregnancy, and glucose tolerance test for high-risk groups. The only treatment recommended in early pregnancy is supplementation. The only treatment recommended during early pregnancy is folic acid supplementation. I do not advocate additional nutritional intake, and weight loss during early pregnancy will not affect embryonic development.