复旦大学上海医学院妇产科学系2009级六年制妇产科学课件 Pregnancy diagnosis, Prenatal care Genetic counseling.ppt

Pregnancy diagnosis, Prenatal care Genetic counseling Wei Jiang, M.D. Attending of Ob Gyn Ob Gyn Hospital, Fudan University 419 Fangxie Road, Shanghai jw52317@ Overview Key points Case discussion Pregnancy diagnosis Pregnancy diagnosis Amenorrhea Other symptoms Pregnancy tests Fetal heart tones Fetal movements Ultrasound Estimated date of confinement Add 7 days to the 1st day of the LMP subtract 3 months. Pregnancy diagnosis History Basic information Age Gravidity Parity Abortuses LMP EDC Case 1 A 28-year-old women, whose LMP was Aug 10, 2012, was refer to our out-patient department. Her menses is 14 5-6/30d. Clinical thinking What is the most likely diagnosis? What should be your next steps? How would you confirm the diagnosis? History married 0-0-0-0 Menstrual: regular, 5-6/30 d Lab test Urine HCG: + Ultrasound Prenatal care Prenatal care Purpose Ensure an uncomplicated pregnancy for mother and baby Identify and treat high risk pregnancy early Prenatal care When and what? In our hospital: 11-14W: NT (nuchal translucency) 14-20W: serum screening for genetic disease 18-22W: ultrasound screening for fetal anomaly 14-20W: amniocentesis 22-26W: Screening for GDM 30-34W: Fetal growth measurements From 35W: NS Loepold’s maneuver First maneuver: Perform the first loepold’s maneuver to identify the fetal lie, which maybe longitudinal or transverse and fetal presentation, which may be cephalic or vertex or maybe breech. To do this,lightly palpate the woman’s upper abdomen to identify the fetal part in the fundus. Loepold’s maneuver First maneuver: If the part is relatively soft and irregular, you’re palpating the buttocks, if the part feels round and firm, freely moveable, you’re palpating the fetal head. If you feel head or buttocks in the fundus, the lie is longitudinal. Otherwise, the lie is transverse. Loepold’s maneuver Second maneuver: Next, perform the second