1. The purpose of maternity checkup is to detect abnormal manifestations of mother and fetus as early as possible and to intervene in time. Due to the current inadequate and imperfect understanding of human diseases, the limitations of medical science and the existence of a process of disease development, the absence of abnormalities in this maternity examination (for example, some infectious diseases in the incubation period or window period, there may be no clinical manifestations, and the laboratory can not detect) does not indicate that the mother and fetus are completely healthy in the next stage, does not indicate that you and the fetus are all normal, but only indicates “no abnormality detected for the time being”. Moreover, it is still common to see fetal cardiac arrest, heart malformations found only after birth, or even newborns dying at birth despite no abnormalities on the maternity exam. Please avoid having sex and being impulsive during pregnancy, exercise and eat properly, and take the initiative to learn and write down your problems. If the fetal movement is more than or less than half of the usual rate, you should seek medical attention promptly. It is advisable to go to bed early and get up early, exercise appropriately and adjust your diet. If the fetal movement is too active or half as much or less than usual, you should consult a doctor as soon as possible. If you have abdominal cramps, abdominal pain, vaginal bleeding or fluid flow, you should consult a doctor as soon as possible.
Remember, after pregnancy, pregnant women are not queens, not too much withdrawal of temper to make sex, most men have their own work and life pressure, should understand the husband’s early morning and late night; as a husband, also can not grant people to the real, more considerate wife, more walks with his wife, buy pregnant baby items. There are always some pregnant women because of the couple quarrel, angry stomach pain, come to the hospital, and even in the hospital to quarrel with you and me, call people funny.
Late pregnancy self-counting fetal movement, if the fetal movement is more or less than half of the plain, you should promptly consult a doctor, including fetal heart monitoring and ultrasound monitoring of umbilical blood flow, etc. If you see redness (small amount of bloody vaginal discharge) and regular abdominal pain when you are close to the expected date of delivery, you should be admitted to hospital for delivery. Please exercise properly and control your diet (restrict rice, noodles and fruits). If the fetal head is not in the pelvis and there is a lot of vaginal fluid, please lie down with a pillow on the buttocks and call 120 for the physician to handle the case.
2.Pubic symphysis separation = non septic pubic osteitis, pubic symphysis arthritis: causes ① fetal enlargement during pregnancy presses on maternal pelvis; hormones such as P during pregnancy cause ligament loosening; ② difficult or emergency delivery, difficult forceps delivery; ③ cephalopelvic disproportion (such as huge baby with difficult shoulder delivery), fetal previa abnormalities (such as fetal head overpronation or supination, or fetal over lateral flexion); ④ congenital developmental abnormalities, chondromalacia.
Manifestations ① pubic symphysis pain at the pubic mound is the most obvious (there is radiating pain in front of and behind the pelvis and at the root of the thighs), aggravated by weight bearing and long distance walking; ② slow movement of the center of gravity when walking and duck gait; ③ some patients have pain in the low back and groin area. Normal pubic gap 4-6mm, if >10mm may have symptoms.
Diagnosis: ①limited fixed pressure pain; ②widened gap at the joint by hand; ③positive pelvic compression-separation test; ④ultrasound >10mm or misalignment difference (the upper edge of one side of the pubic joint is higher than the other side) >5mm; ⑤flat supine X-ray, the patient’s lower limbs on one side of the stirrups forcefully to understand the misalignment of the pubic joint (average 3mm), mostly accompanied by pubic chondritis, the X-ray sign is gross irregularity of the edge of the pubic joint, also It is often accompanied by chondromalacia of the pubic symphysis.
Treatment: Prenatal: control fetal weight, moderate exercise, not long-term bed rest without exercise. Terminate the pregnancy when appropriate; for those with severe pain, consider cesarean delivery if the bilateral thighs cannot be fully opened and flexed out in supine position to form a good delivery position; however, the symptoms may still persist for a period of time after cesarean delivery.
Postpartum: ① hard bed rest, lateral lying, 2-10 weeks; ② apron, non-elastic straps pelvic fixation; ③ difficulty in urination, leave urinary catheter; ④ hot compress, spectrum irradiation, Chinese medicine to activate blood circulation and remove blood stasis; ⑤ both sides of sacroiliac joint and pubic union separation and pain, prenatal symptoms are not obvious, try to postpartum can not move and complaints. CS is recommended, ⑥ analgesics, calcium supplementation for 6 months; most of them will be relieved 2 weeks-2 months after delivery, walking backwards for 90min/d.
A case of closed foramen N injury after pubic symphysis plate fixation and medial femoral area sensory impairment and decreased muscle strength of the internal retractor; closed foramen N entered the lesser pelvis along the medial edge of the psoas major muscle, adhered to the fascial surface of the internal muscle of the closed foramen anteriorly, went through the closed canal to the femur, and could project to the superior pubic branch (four transverse fingers lateral to the pubic symphysis). Orthopedics considers screw + repositioning forceps set when separating more than 3cm, arc shaped plate + screw.
3.scarred uterus Risk of re-pregnancy in scarred uterus: prone to pregnancy at the uterine scar, aggressive placenta praevia, placental implantation and invasion of adjacent organs; need to deliver by cesarean section again, difficult surgery, prone to haemorrhage, a few need to cut the uterus to stop bleeding. If abdominal pain should be treated urgently to prevent uterine rupture; avoid abdominal violence, regular labor and delivery, and require admission around 39 weeks.
As there are quite a lot of risks in the scar uterus trial of labor, most of them are delivered by cesarean section, re-operation, prone to incision diverticulum formation, making long-term irregular vaginal bleeding (or bloody material) after delivery, medical experts, at present, can not completely prevent and control the disease, so it is required to strictly control the rate of initial cesarean section (i.e. the first delivery, try to give birth by yourself, do not do cesarean section, the consequences are endless ah).
4, intestinal echo enhancement: not a disease but a sonographic manifestation, refers to the fetal intestinal echo enhancement, its intensity is close to or higher than the similarity of the femoral echo, common in the small intestine of mid-pregnancy fetuses or the colon of late-pregnancy fetuses, the incidence of 1% in the middle and late stages, the majority of fetuses with normal follow-up results, but also a significant proportion of fetuses confirmed the existence of abnormalities, such as digestive tract anomalies, chromosomes, intestinal obstruction, fetal fecal peritonitis, cystic fibrosis, intra-amniotic hemorrhage, intrauterine infection, etc.
5, fixed painful points at the hip: due to fetal compression, pregnancy-related hormone influence, maternal pelvic floor muscle hypertrophy edema and compression injury during pregnancy, resulting in obvious pain at the hip joint, which affects walking. It is recommended that the husband massage the painful point at night, using the point pressure method, learn the massage technique, massage with appropriate strength (there is a certain pain when pressing) for 15-20 minutes, and the pain at the place will be relieved the next day, but it needs to be adhered to day by day.
Single umbilical artery: Single umbilical artery can occur alone, combined with chromosomal anomalies and other malformations are not uncommon. About 50% of children with trisomy 18 and 10%-50% of children with trisomy 13 are associated with a significantly increased risk of heart malformation, kidney malformation and FGR. Further fetal echocardiography is required.
Femoral length less than 2 standard deviations Fetal ultrasound showing femoral length less than 2 standard deviations may be related to parental height characteristics, but fetal growth restriction (FGR), developmental anomalies (including malformations), and long bone dysplasia cannot be ruled out. Establish prenatal diagnosis and regular obstetric examinations with continuous observation.
Cholestasis syndrome ICP presence of bile salt stasis causes capillary duplex within the placental villi placental dysfunction, prone to fetal distress or even fetal cardiac arrest without obvious signs. Itching of the skin and extremities, which interferes with sleep and fetal development.
History of multiple miscarriages Susceptible to placental residue during labor, heavy bleeding during and after delivery with uterine cavity infection, fetal malformation; such as placental adhesion or even implantation, induction of uterine bleeding, possible hysterectomy during delivery.
Reduced G-6-PD quantification G-6-PD (erythrocyte glucose 6-phosphate dehydrogenase) deficiency “nibblenaemia”, a hereditary hemolytic disease, seen in about 90% of males and more common in those <3 years old, prone to neonatal jaundice. Please avoid oxidants Antimalarials (quinoline, quinine), analgesics and antipyretics (antipyrine, finasteride), sulfonamides (Benadryl, etc.), nitrofurans (furacilin, furazolidone), fava beans, gentian violet, mothballs, etc.
Advanced pregnancy Risks of advanced pregnancy: hypertension, diabetes mellitus, abnormal fetal growth and development, abnormal labor, etc. Pregnant women are advised to undergo prenatal diagnosis as early as possible, and pregnant women are aware of the risks and agree to regular maternity checkups.
Hypertensive disorders Risk of hypertensive disorders in pregnancy: multiple organ damage (heart, liver, kidney, eye, intracranial hemorrhage, etc.), edema, convulsions, placental abruption, fetal growth abnormalities, abortion, preterm delivery, stillbirth; most of them require cesarean section and are prone to bleeding during delivery. Pregnant women are aware of the risks and agree to regular obstetric examinations. The pregnant woman is advised to follow a low-salt diet and to consume high-protein and low-fat foods.
Late pregnancy Late pregnancy is prone to fetal cardiac arrest due to placental hypoplasia or obstructed labor due to oversized fetus.
Isolated lung: A non-functioning embryonic, cystic lung tissue isolated from the normal lung; ILS is common, with the isolated lung within the lung lobe, surrounded by the same visceral pleura, with the cystic lesion communicating or not communicating with the normal bronchus, mostly in the lower lobe of the left lung, especially in the posterior basal segment, with abnormal arteries mostly from the thoracic aorta, followed by the abdominal aorta, draining to the pulmonary veins, inferior vena cava and the odd vein. ELS can also be considered as a parapneumonic lobe, which is rare and refers to a septated lung outside of the lobe with a cystic cavity that does not communicate with the normal bronchus and is often combined with other congenital anomalies such as diaphragmatic hernia, pulmonary dysplasia, ectopic pancreas, pericardium and colon. Respiratory and cardiovascular symptoms are common in PS. In pediatric patients, feeding difficulties, shortness of breath, and cyanosis may be present. In older pediatric patients and adults, some cases of PS may occur on physical examination without obvious symptoms. If the isolated lung is connected to the bronchus with secondary infection, it may present with symptoms of respiratory infection such as cough, sputum, hemoptysis, fever and recurrent lung infections. Since the blood supply to the isolated lung is mainly from the body circulation, and the blood supply from the body arteries can
The blood supply to the isolated lung is mainly from the body circulation, and the blood supply from the body arteries can be large enough to cause severe left-to-right shunts and even congestive heart failure. The diagnosis is confirmed by clinical manifestations, CT imaging or MRA. 10% to 15% of patients do not have clinical symptoms; it is recommended that surgery be performed as soon as possible once the diagnosis is confirmed, and if there is an infection, it should be performed 1 to 2 years after the inflammation is controlled.
The surgery should be performed 1 to 2 weeks after the inflammation is controlled. In order to avoid recurrent infection, hemoptysis and even severe left-to-right shunt, resulting in the occurrence of congestive heart failure. Isolated pneumonectomy is feasible for EL S, and lobectomy is usually performed for IL S. In addition, it is beneficial to improve the rate of complete resection of isolated lungs. The surgical procedure should also pay attention to the presence of other congenital malformations. The principle of surgery is to remove the lesion and to ligate the blood supply artery and regurgitant vein exactly.
If the two fetuses are too close to each other, abortion and preterm delivery are likely to occur. The prognosis for preterm infants is poor.
The choroidal plexus produces cerebrospinal fluid and choroidal cysts are located in the choroidal plexus, which are round or oval cystic structures with anechoic areas, 4-5 mm in diameter, usually less than 10 mm. most of them are unilateral, bilateral cysts are more common in male fetuses, and unilateral cysts are similar in male and female fetuses[1 ]. Choroidal cysts are most often found in late early or midterm pregnancies and shrink significantly or disappear after 24 to 26 weeks.Chudleigh was first identified in midterm fetuses in 1984. The incidence has been reported in the literature to range from 0.18% to 2.5%, with an average of 1%. The incidence in our study was significantly lower than that reported in the literature, probably because: (1) many of the pregnant women who came to our obstetrics department for initial examination were already in advanced stages of pregnancy. (2) The observation was not careful enough, and the diagnosis may be missed. The level of knowledge and experience of the ultrasonographer, the quality of the ultrasound equipment and the gestational age at the time of the examination all affect the results of the examination. Because amniocentesis for chromosomal examination is still unacceptable to most pregnant women in China, none of the 10 pregnant women with fetal choroidal cysts in this study underwent amniocentesis for chromosomal examination. Many scholars believe that fetal choroidal cysts are associated with chromosomal abnormalities
Cysts Risk of combined pelvic tumors (cysts) in pregnancy: the possibility of cyst rupture, peritonitis, miscarriage, preterm delivery, obstruction of the birth canal causing obstructed labor, tumor degeneration or even malignant transformation during pregnancy, and maternal knowledge of the risk. If the pelvic mass is >125px in diameter in mid-pregnancy, surgery is recommended.
Coughing Intense and frequent coughing can lead to preterm labor, miscarriage, placental abruption, premature abruption of membranes, intrauterine infection, etc. In severe cases, please consult the respiratory medicine department.
Rotundum is a placental variant, which refers to a thickened grayish-white ring around the concave center of the placental surface. The ring is formed by the bifold amniotic membrane and chorionic membrane, and the amniotic membrane on the amniotic surface of the placenta does not cover the edge of the placenta, but forms a folded ring at the nearby placental edge.
Maternal and child blood group incompatibility: Pregnant women are informed of the risks of maternal and child blood group incompatibility during pregnancy: abnormal fetal growth and development, fetal edema, hemolysis, loss, etc., miscarriage, preterm delivery, etc. occur, and pregnant women are informed of the risks and agree to regular maternal checkups.
UTI: UTI has a long treatment cycle and is prone to become chronic. Treatment with medication may affect the fetus, but the pathogenic bacteria of UTI itself are more likely to cause fetal abnormalities, miscarriage, preterm delivery, and intrauterine infection.
Ventricular dilatation Lateral ventricles ≥15 mm in width are considered hydrocephalus, with causes such as chromosomal abnormalities, inflammation, and mass compression. After 20 weeks of gestation, lateral ventricles or cerebellar medullary pools with a width of more than 10 mm should be alerted to ventricular dilatation hydrocephalus and should be followed up closely. A width >10 mm and <15 mm is called mild ventricular dilatation. The incidence is 1.5‰-22‰, mostly not due to obstruction of the ventricular system, and should be further examined for extracranial lesions, such as agenesis of the corpus callosum and cardiac malformations.
Placenta praevia: the placenta is low and some of them can be moved up to normal with the increase of gestational weeks, but most of them are prone to recurrent bleeding or massive bleeding at one time, and then uterine cavity infection and adhesion, placenta implantation, etc.; if the bleeding is heavy, it will endanger the life of mother and fetus, and some pregnant women may be hospitalized for a long time. Take care to avoid increased abdominal pressure (e.g. laughing, coughing, constipation), ask to sit on the toilet with the chair at least as high as the knee, and a cesarean section should be performed for a limited period of time.
Anemia causes limited fetal development, easy miscarriage and preterm delivery due to poor body condition, dizziness and weakness, placenta abruptio with increased blood pressure, etc. If the effect of iron supplementation is poor, blood transfusion is needed if necessary.
Pregnancy combined with hyperthyroidism The risks of pregnancy combined with hyperthyroidism include abnormal fetal growth and development, miscarriage, preterm delivery and fetal loss, hyperthyroidism crisis during pregnancy and perinatal period, etc. Pregnant women should be aware of the risks and agree to regular maternity checkups. After the birth of the fetus, blood should be collected as soon as possible to check its nail function.
The risk is hypertension, pre-eclampsia, eclampsia and placental abruption. Hypothyroidism affects the neurological development of the fetus, and if not well controlled, the IQ of the child is lower than normal. Blood should be collected as soon as possible after the birth of the fetus to check its nail function.
Dilated or separated renal pelvis (fetus): Urinary tract obstruction leads to retention of urine in the renal pelvis and calyces. Severe hydronephrosis can result in atrophy of the renal parenchyma and an increase in kidney size. 2-2.8% of normal fetuses and 17%-25% of trisomy 21 infants can have pelvic fluid detected. Fetal anomalies may occur with anterior-posterior diameter values of the separated renal pelvis ≥4 mm at 15-20 weeks, ≥5 mm at 20-30 weeks, and ≥7 mm at 30-40 weeks and should be followed until after birth.
Twin pregnancy Risks of twin pregnancy in pregnant women: hypertension, diabetes, abnormal fetal development, fetal loss, twin transfusion syndrome, postpartum hemorrhage during labor and delivery, etc. Pay attention to nutritional follow-up during pregnancy. Pregnant women are aware of the risks and agree to regular maternity checkups. To avoid premature rupture of membranes and umbilical cord prolapse causing fetal cardiac arrest outside the hospital, admission to the hospital at 35-36 weeks is usually required. Currently, we do not screen for risk of trisomy 21 in twin pregnancies.
Placental hematosinus An echogenic area on the maternal surface of the placenta, as indicated by ultrasound in pregnancy, is considered a possible hematosinus. Most of the blood sinuses are naturally formed pools of blood behind the placenta, but if the placenta is located in a thin wall, it is prone to rupture under conditions such as external impact or violent fetal movement, leading to placental abruption or prenatal hemorrhage, etc. Pregnant women are advised to avoid violent activities or collisions. They should be aware of the risks and agree to regular review.
Diabetes mellitus Risk of gestational diabetes mellitus: miscarriage, preterm delivery, hypertension, fetus too big, too small or malformation, easy fetal cardiac arrest, excessive amniotic fluid ketoacidosis, etc., newborn baby easy to hypoglycemia, low blood calcium, easy to jaundice, etc. Pregnant women are aware of the risk and agree to regular maternity checkups. Pay attention to diet control (dietitian guidance, less frequent meals, less porridge), exercise, monitor blood sugar, and hospitalization if necessary.
Breech position A serious high-risk type. The fetal membranes are prone to premature rupture and cord prolapse (especially if one foot is underneath), if this happens outside the hospital, elevate the breech position and call 120. some of them can be corrected by chest and knee manipulation, but the cord may be entangled, too tightly entangled may occur fetal cardiac arrest, it is appropriate to manipulate the situation of fetal movement and self-listening fetal heart after manipulation; some of them may occur preterm delivery, etc. The fetus in breech position mostly needs to be admitted to hospital at 39 weeks and delivered by cesarean section, and the fetus is prone to congenital x-joint dislocation and other malformations.
Pregnancy vomiting: ketone body ++++, hospitalization is recommended to avoid adverse effects of high ketone body on the fetus.
The incidence of amniotic band syndrome is relatively rare, and the ratio of its incidence to birth rate is 7. 8:10000, which refers to the rupture of part of the amniotic membrane to produce fibrous bundles or fibrous sheaths, causing the embryo or fetus to adhere to the amniotic band, binding, compressing and entangling the fetus, causing the fetus to suffer from splitting or developmental malformations of the affected organs.
Excessive amniotic fluid can be caused by diabetes mellitus, maternal and fetal blood type incompatibility, infection and fetal malformation, some of which are of unknown origin; it can easily lead to premature rupture of membranes, placental abruption, cord prolapse, abnormal fetal position and cord entanglement, preterm delivery, compression of the heart and lungs and respiratory distress. If the cause of excessive amniotic fluid is unknown, consider cord blood test (Prenatal Diagnostic Center of Southern Hospital), the collection of cord blood may lead to premature delivery and stillbirth. Pay attention to avoid constipation, laughing, coughing, etc. If water breaks, call 120 to be handled by physician on site. Low salt and less soup diet is recommended.
Low amniotic fluid Low amniotic fluid may risk; low amniotic fluid occurs in FGR, chronic placental insufficiency due to hypertensive disorders in pregnancy; high incidence of fetal birth defects, high rate of perinatal morbidity and mortality, and poor prognosis. Postnatal neonates mostly have neurological brain development disorders with pediatric mental retardation.
Risk of red and white blood cells or hematuria in urine Possible urinary tract infection, urinary stones, diabetes mellitus and other gestational diseases, and compression of the kidneys, ureters and bladder by an enlarged uterus may also lead to these conditions. Ultrasound is needed to check for stones in the kidney, renal pelvis and ureter, and antibiotics if necessary. Renal colic caused by kidney stones is very painful, difficult to treat and prone to recurrence, and may lead to miscarriage, premature birth, and increased infection.
Intraventricular strong echogenic spot: gradually decreases with increasing gestation and disappears by 1 year of age at the latest. It may be associated with inflammation, thickening and calcification of the papillary tendon cords, which in itself does not impair health or cardiac function, is a normal variant and is common in Asians. 2-5% incidence of EIF at 18-22 weeks, 16-30% in trisomy 21 and 39% in trisomy 13. EIF is at increased risk if accompanied by other ultrasound abnormalities; alone, there is less chance of fetal abnormalities; at maternal age ≥31 years, there is The incidence of chromosomal abnormalities in EIF fetuses is about 1/600, and fetal echocardiography is feasible.
Pruritus during pregnancy, partly of unknown cause, partly associated with abnormal liver metabolism, in severe cases causing fetal cardiac arrest without aura, and pregnant women may develop significant impairment of liver function. It requires a high degree of concern.
Vaginitis: including Candida, trichomonas, and cellular vaginitis, may cause miscarriage, premature rupture of membranes, preterm delivery, and some fetuses are born with infections and manifestations of eye and throat infections.
If you want to induce labor, you need a certificate of consent from the family planning department of your household or place of residence. Before inducing labor, you need to complete the relevant blood test, ECG, chest X-ray and ultrasound for scarred uterus. In a very small number of cases, if one type of induction fails, other methods or cesarean section will be required.
Uterine fibroids Pregnancy combined with uterine fibroids is prone to abnormal fetal position and miscarriage, preterm labor, abnormal labor and high bleeding at delivery, but not the cause of cesarean delivery. In case of cesarean delivery, the decision to remove them will be made intraoperatively according to the situation.
Take care to consciously learn the general knowledge about pregnancy and postpartum, especially about newborn and jaundice.