妇科第一次见习Diagnosisofpregnancyantenatalcare详解.ppt

Part one Diagnosis of pregnancy Purpose: to confirm pregnancy, embryo number, and gestational age to exclude ectopic pregnancy or other pathologic condition Head presentation Breech presentation Fetal position Definition: relative position between the indication point of fetal presentation and maternal pelvis. Indication point include: Occipital presentation→occipital bone Face presentation→chin Breech presentation→sacrum Shoulder presentation→scapula Fetal position of Occipital presentation Fetal position of Occipital presentation Assistant examination Blood routine, blood type, urine routine Liver function, renal function, fasting?blood-glucose HBsAg, TP, TRUST, HIV Ultrasound examination: uterine or ectopic, fetus alive or not, NT, fetal number, etc. health education Oral folic acid 0.4-0.8mg/d*3m Avoid flu and medicine Quit smoking and alcohol Avoid pressure Initial office visit Antenatal care during second- and third-trimester History General examinaiton Obstetric examination abdominal?perimeter Fundus height Four maneuvers of Leopold pelvimetry External pelvimetry Interspinal diameter, IS 23~26cm Intercristal diameter, IC 25~28cm External conjugate, EC 18~20cm Intertuberous diameter, IT=transverse outlet, TO 8.5~9.5cm IT8cm, posterior sagittal diameter of outlet 8~9cm, +IT15cm Angle of pubic arch, 90°should not80° Internal pelvimetry Diagonal conjugate, DC 12.5~13cm, 24 weeks DC-2.5cm=obstetrical conjugate 10cm Bi-ischial diameter, 10cm Incisura ischiadica, 5.5~6cm Assessment of fetal well-being Fetal monitoring techniques Fetal maturity tests Criteria for the NST Baseline between 110 and 160 bpm The presence of periodic accelerations of fetal heart rate of 15 bpm over baseline for 15 seconds after FM Absence of decelerations of variability of the fetal heart rate In the case of nonreassuring NST, further evaluation or delivery depend on the clinical context Oxytocin challenge test (OCT) Performed by intravenous infusion of dilute oxytocin until thre