Pre-conception health care (3 months before pregnancy)
I. Health education and guidance
(1) Prepare and plan for pregnancy, and avoid pregnancy at advanced age (35 years or older).
(2) Reasonable nutrition and control of weight gain.
(3) Folic acid supplementation 0.4-0.8mg/d. Pregnant women with previous neural tube defects (NTD) should take 4mg of folic acid daily.
II. Routine health care
1. Assessment of preconception risk factors: health status. Previous medical history, family and genetic history, and those who are not suitable for pregnancy should be promptly informed.
2. Physical examination.
(1) including measurement of blood pressure, weight and height.
(2) Routine gynecological examination.
Auxiliary examinations
1. Compulsory items.
(1)Blood routine;
(2)Urine routine;
(3) Blood group (ABO and RH);
(4) Liver function;
(5)Kidney function;
(6)Fasting blood glucose;
(7) HBsAg;
(8) Syphilis spirochetes;
(9)HIV screening;
(10) Cervical cytology (if not checked within 1 year).
2. Preparation items.
(1) Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus (TORCH) screening.
(2) Cervicovaginal discharge examination (routine vaginal discharge, gonococcus, Chlamydia trachomatis).
(3) Thyroid function test.
(4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Chongqing, etc.).
(5) 75g oral glucose tolerance test (high-risk women).
(6) Blood lipid screening.
(7)Gynecologic ultrasound examination.
(8)Electrocardiogram.
Pregnancy care
I. Number of prenatal checkups and gestational weeks
At present, we recommend: 6-13+6 weeks, 14-19+6 weeks, 20-24 weeks, 24-28 weeks, 30-32 weeks, 33-36 weeks and 37-41 weeks of gestation. For those with high-risk factors, increase the number of times as appropriate.
Second, the content of prenatal examination
(A) First prenatal checkup (6-13+6 weeks of gestation)
1. Health education and guidance: continue to supplement folic acid 0.4-0.8mg/d until 3 months of pregnancy, and continue to take multivitamins containing folic acid if available. Avoid contact with toxic and harmful substances, avoid close contact with pets. Use drugs with caution. Get tetanus or influenza vaccination during pregnancy. Change bad living habits. Maintain mental health and relieve mental stress.
2. Routine health care.
(1) Establish a pregnancy health care manual.
(2)Ask carefully about menstruation. Determine the week of pregnancy and project the expected date of delivery.
3.Must check items.
(1)Blood routine;
(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.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 (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan, Chongqing, etc.)
(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 examined 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) Testing for bacterial vaginosis (BV) (for those with a history of preterm delivery).
(11) Early maternal serologic screening for fetal chromosomal aneuploidy abnormalities [pregnancy-associated plasma protein A (PAPP-A) and free beta-hCC, lO-13 weeks gestation].
Precautions: fasting; ultrasound to determine gestational week; determine weight on the day of blood draw. In high-risk individuals, consider chorionic villus biopsy or combine with midtrimester serologic screening results before deciding on amniocentesis.
(12) Ultrasonography. Ultrasonography is performed in early pregnancy to determine intrauterine pregnancy and gestational week, fetal viability, fetal number, and uterine adnexa. Ultrasonography is performed at ll-13 weeks of gestation to measure the thickness of the posterior nuchal translucency; the gestational week is approved.
(13) Chorionic villus biopsy (lO-12 weeks of gestation, mainly for high-risk pregnancies).
(14) Electrocardiogram.
(II) Prenatal checkups at 14-19+6 weeks of gestation
1. Health education and guidance: nutrition and lifestyle guidance. Hemoglobin <105g/L, supplementation of elemental iron 60 a 100mg/d. Start calcium supplementation, 600mg/d.
2.Regular health care: physical examination, including blood pressure, weight, uterine height and abdominal circumference; fetal heart rate measurement.
3.Compulsory check-up items: none.
4.Prepared items.
(1) Midtrimester maternal serological screening for fetal chromosomal aneuploidy abnormalities (15-20 weeks of gestation, the best testing gestational week is 16-18 weeks). Caution: Same as early pregnancy serological screening.
(2) Amniocentesis for fetal karyotype (16-21 weeks of gestation; for maternal age ≥35 years at the due date or for high-risk groups).
(3) Prenatal checkups at 20-24 weeks of gestation
1. Health education and guidance: nutrition and lifestyle guidance. The significance of fetal system ultrasound screening.
2.Routine health care.
(1)Ask about fetal movement, vaginal bleeding, diet and exercise.
(2)Physical examination as before.
3.Must check items.
(1)Fetal system ultrasound screening (18-24 weeks of gestation) to screen the fetus for serious malformations.
(2)Routine blood and urine tests.
(4) Preparation: cervical assessment (ultrasound measurement of cervical length).
(D) Prenatal checkups at 24-28 weeks of pregnancy
1.Health education and instruction on.
(1) Awareness and prevention of preterm labor.
(2) The significance of gestational diabetes screening.
2. Routine health care: same as before.
3.Compulsory checkups.
(1) Gestational diabetes screening. Oral 50g glucose screening. The most recent international recommendation is to perform 75g glucose screening directly if available, or by testing fasting glucose as a screening standard.
(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) Antenatal checkups at 30-32 weeks of gestation
1. Health education and guidance.
(1)Guidance on mode of delivery.
(2) Start to pay attention to fetal movement.
(3) Breastfeeding instruction.
(4)Instruction on newborn care.
2.Routine health care: same as before; fetal position check.
3.Must check items.
(1)Blood routine, urine routine.
(2)Ultrasound examination: fetal growth and development, amniotic fluid volume, fetal position, placenta position.
(4) Preparation items: ultrasound measurement of cervical length or cervicovaginal secretion to detect fFN level for those at high risk of preterm delivery.
(F) Prenatal checkups at 33-36 weeks of gestation
1.Health education and guidance.
(1)Guidance on lifestyle before delivery.
(2) Knowledge related to childbirth (symptoms of labour, guidance on mode of delivery, labour analgesia).
(3) Newborn disease screening.
2.Routine health care.
(1)Ask about fetal movement, vaginal bleeding, contractions, skin pruritus, diet, exercise, and preparation for delivery.
(2)Physical examination is the same as the previous one.
3.Must check items: urine routine.
4.Preparatory items.
(1)Screening for group B streptococcus at 35-37 weeks of gestation: pregnant women with high-risk factors (such as combined diabetes, infection in newborns born in previous pregnancy, etc.), culture of perianal and lower 1/3 of vaginal secretions will be taken.
(2) Liver function and serum bile acid test at 32-34 weeks of gestation [pregnant women in areas with high incidence of intrahepatic cholestasis during pregnancy].
(3) Electronic fetal heart monitoring (no-load test, NST) examination starting at 34 weeks of gestation (high-risk pregnant women).
(4) ECG review (high-risk pregnant women).
(7) Antenatal checkups at 37-41 weeks of gestation
1. Health education and guidance.
(1) Knowledge related to childbirth (symptoms of labor, guidance on delivery methods, labor analgesia).
(2) Guidance on immunization of newborns.
(3) Instruction on puerperium.
(4) Intrauterine monitoring of the fetus.
(5) Hospitalization and induction of labor if the pregnancy is >41 weeks.
2.Routine health care.
(1)Ask about fetal movement, contractions, redness, etc.
(2)Physical examination as before; perform cervical examination and Bishop score.
3.Must check items.
(1)Ultrasonography: assess fetal size, amniotic fluid volume, placental maturity, fetal position and the ratio of peak systolic and end diastolic flow velocity of umbilical artery (S/D ratio), etc.
(2) NST examination (1 time per week).
4. Preparation items: None.
3.The contents of routine examination are not recommended during pregnancy
1. External pelvic measurements: There is sufficient evidence that external pelvic measurements do not predict cephalopelvic disproportion at delivery. Therefore, it is not necessary to routinely check external pelvic measurements during pregnancy. For pregnant women with vaginal delivery, the pelvic outlet diameter can be measured in late pregnancy.
Serologic screening for Toxoplasma gondii, cytomegalovirus and herpes simplex virus: Currently, there are no established screening methods 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 long-term sequelae, 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 on all pregnant women to avoid psychological fear and unnecessary interventions.
3.BV screening: the incidence of BV during pregnancy is 10% to 20%, which is related to the occurrence of preterm birth. Pregnant women at high risk of preterm birth can be screened for BV, but routine BV screening should not be performed for all pregnant women.
4, cervicovaginal secretion test fFN and ultrasonography to assess the cervix: Pregnant women at high risk of preterm delivery, the value of these two screening tests is that negative results suggest that there is no possibility of preterm delivery in the near future. Thus, unnecessary interventions are minimized. However, there is insufficient evidence to support cervicovaginal discharge fFN testing and ultrasound cervical assessment in all pregnant women.
5.Checking urine protein and blood routine at each antenatal visit: urine protein and blood routine tests are not required at each antenatal visit, but repeated urine protein and blood routine tests may be performed in pregnant women with gestational hypertensive disease and gestational anemia.
6. Thyroid function screening: Hypothyroidism in pregnant women affects the development of neurointelligence in children, and some experts recommend screening the thyroid function of all pregnant women, but there is not enough evidence to support the screening of thyroid function in all pregnant women, and adequate iodine intake should be ensured during pregnancy.
Screening for tuberculosis: There is insufficient evidence to support screening for tuberculosis (including PPD tests and chest x-ray) in all pregnant women. High-risk pregnant women (those in areas with high TB prevalence, poor living conditions, HIV infection, and drug addiction) can be screened for TB at any time of pregnancy.