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Obstetrics and Gynecology (1)-Anatomy and Pregnancy
Includes anatomy, female reproductive system physiology, pregnancy physiology, pregnancy diagnosis, prenatal examination and pregnancy care, fetal appendage abnormalities, etc.
Modifié à 2024-01-12 09:24:16
Obstetrics and Gynecology (1)-Anatomy and Pregnancy
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Obstetrics and Gynecology
Anatomy
external genitalia
internal genitalia
vaginal
Uterus
form
organizational structure
uterine body
endometrium
Dense layer
sponge layer
Functional layer
basal layer
Muscle layer
Serosal layer (visceral peritoneum)
cervix
alkaline mucus
Mucosa: single layer tall columnar epithelium
Vagina: stratified squamous epithelium
Location
uterine ligaments
broad ligament
The uterine arteries, veins and ureters pass through the base
round ligament
cardinal ligament
uterosacral ligament
oviduct
Serosal layer
smooth muscle layer
Mucosal layer (single layer of high-rise columnar epithelium)
ovary
No peritoneum on the surface
Covered by a single layer of cuboidal epithelium (germinal epithelium)
ovarian tunica albuginea
ovarian parenchyma
cortex
medulla
Blood vessels, lymph and nerves
artery
abdominal aorta
ovarian artery
internal iliac artery
uterine artery
Superior branch (corporeal branch of uterus)
fundal branch of uterus
fallopian tube branch
ovarian branch
Lower branch (cervical-vaginal branch) (upper 1/3 of vagina)
Vaginal arteries (mid-section of vagina)
internal pudendal artery
Infrahaemorrhoidal artery
perineal artery
labial artery
clitoral artery
vein
Right ➡️Inferior vena cava
Left ➡️Left renal vein
lymph
external genital lymph
superficial inguinal lymph nodes
Upper group
Lower group
inguinal lymph nodes
pelvic lymph
iliac lymph node group
sacral lymph node group
Lumbar lymph node group (para-aortic lymph node group)
nerve
external genitalia
pudendal nerve
internal genitalia
Sympathetic and parasympathetic nerves
pelvis
pelvic floor
Outer layer
superficial perineal fascia
bulbocavernosus muscle
ischiocavernosus muscle
Superficial transverse perineal muscle
external anal sphincter
Middle layer (urogenital diaphragm)
deep transverse perineal muscle
urethral sphincter
Inner layer (pelvic diaphragm)
levator ani muscle
pubococcygeus muscle
iliococcygeus muscle
ischiococcygeus
female reproductive system physiology
Characteristics of women at each stage of their life
childhood
Before 8 years old: early childhood
After 8 years old: late childhood
puberty
Breast development: a sign of puberty
menarche
sexual maturity
perimenopause
Menstruation and clinical manifestations of menstruation
Ovarian function and cyclic changes
Synthesis and secretion of ovarian sex hormones
androgens
Main: Adrenal gland
Times: Ovary
follicle intima
androstenedione
interstitial cells and gate cells
Testosterone
Cyclic changes in the endometrium and other parts of the genitals
endometrium
proliferation phase
Early stage of proliferation (5-7 days)
Cuboid or low columnar
Middle stage of proliferation (8-10 days)
columnar
Late stage of proliferation (11th to 14th day)
tall columnar
secretory phase
Early secretion (days 15-19)
subnuclear vacuoles
Mid-secretory phase (20-23 days)
apical secretion
Late secretory period (24-28 days)
glycogen secretion
menstrual period
Other parts of the genitals
breast
Estrogen: Breast Duct
progesterone: acinar
Regulation of menstrual cycle
hypothalamic gonadotropin-releasing hormone GnRH
Adenopituitary reproductive hormone
Gonadotropins (glycoprotein hormones)
follicle stimulating hormone FSH
Luteinizing hormone LH
prolactinPRL
amenorrhea lactation syndrome
Effects of other endocrine gland functions on the menstrual cycle
pregnancy physiology
Fertilization and fertilized egg development, transport and implantation
Implantation
6 to 7 days after ovulation
process
Capacitation ➡️Acrosome reaction ➡️Zona pellucida reaction ➡️Fertilization
Implantation conditions
The zona pellucida disappears
syncytiotrophoblast
Synchronous development of blastocyst and endometrium
Adequate amounts of estrogen and progesterone
(Immunity) Endometrial receptivity
Embryos, fetal development characteristics and fetal physiological characteristics
Formation and function of fetal appendages
placenta
structure
amniotic membrane
leafy chorion
Endo: extraembryonic mesoderm
External: trophoblast
Inner: Cytotrophoblast
External: syncytiotrophoblast
decidua basalis
Function
material exchange
gas exchange
simple diffusion
Nutrient supply
glucose
facilitated diffusion
Amino acids, calcium, phosphorus, iodine, iron
active transport
Eliminate fetal metabolites
defense function
The virus can pass
Synthetic function
Human chorionic gonadotropin hCG (glycoprotein)
mechanism
Maintain menstrual corpus luteum and form gestational corpus luteum
Promote the formation of estrogen and progesterone
suppress immunity
Stimulates fetal testicles to secrete testosterone and promotes sexual differentiation of male fetuses
Stimulate thyroid activity
Human placental prolactin hPL (single chain polypeptide)
mechanism
mammary acinar development
Insulinogenic
lipolysis
Inhibit glucose uptake
Inhibit maternal rejection
Estrogen (steroid hormone)
Progesterone (steroid hormone)
Oxytocinase (glycoprotein)
Inactivate oxytocin to maintain pregnancy
Thermostable alkaline phosphatase HSAP
Evaluate the placenta
Cytokines and growth factors
Immune Function
fetal membrane
Inner: amniotic membrane
External: Smooth chorion
umbilical cord
One vein and two arteries
amniotic fluid
Main source: mid-term and later - urine
Absorption: fetal swallowing
Maximum 1000ml at 38 weeks, 800ml at 40 weeks
Changes in maternal body during pregnancy
reproductive system
Uterus
Braxton Hicks contractions (12-14w physiological painless contractions)
vaginal
Chadwick's sign
breast
Montessori nodules
circulatory system
36~38, prone to heart failure
Second stage of labor, prone to heart failure
blood pressure
Early and mid-stage low (lower diastolic blood pressure)
Late stage, decline
Increased pulse pressure
blood system
blood volume
Plasma 1000ml, red blood cells 450ml
Plasma increases more than RBC, physiological dilution
blood components
WBC, slightly increased, mainly neutrophils
There is no obvious change in the number of platelets, which may decrease (pregnancy thrombocytopenia)
coagulation related
increased blood clotting
Decreased fibrinolytic function
Increased erythrocyte sedimentation rate
Decreased plasma albumin
urinary system
Increased renal plasma flow RPF
Increased glomerular filtration rate GFR
More nocturnal urination than daily urination
respiratory system
Lung capacity is not affected
The number of times does not change much
Breathe deeply➡️Increase ventilation
Mucous membrane thickening, prone to upper respiratory tract infection
urinary system
Increase in RPF and GFR
Physiological diabetes
The right side is susceptible to pyelonephritis
pregnancy diagnosis
early pregnancy diagnosis
Symptoms and signs
Menopause
Early pregnancy reaction
Frequent urination
breast changes
Montessori nodules
Gynecological examination
6~8w, black plus levy
other
Auxiliary inspection
pregnancy test
Ultrasound
Second and third trimester pregnancy diagnosis
Physical signs and examination
enlargement of uterus
Fetal Movement FM
Conscious fetal movement around 20w
32~34 peak
carcass
Fetal heart sounds (fetal heart rate FHR)
12w can be explored
Listen with 18~20w stethoscope (normal 110~160)
Auxiliary inspection
Ultrasound
Doppler ultrasound
Fetal posture, fetal delivery, fetal presentation, fetal orientation
fetal position
fetal position in utero
fetal position
The relationship between the longitudinal axis of the carcass and the longitudinal axis of the maternal body
Horizontal production, vertical production
fetal presentation
The fetal part enters the pelvic entrance first
Head first, buttocks first, shoulders first, face first
Tire position
The relationship between the fetal presentation indicator point and the maternal pelvic bone
Prenatal care and pregnancy care
Perinatology
Pregnancy monitoring
Prenatal check-up time
Palace calculation 9 to 11 times
20 to 36 weeks, once every 4 weeks
From 36 weeks onwards, once a week
Calculate pregnancy period and gestational age
Month ➕9 or ➖3, day number ➕7
Abdominal examination
Pelvis measurement
entrance plane
Diagonal diameter<11.5
Iliopectineal outer diameter<18
mid pelvic plane
Ichial interspinous diameter <10
The width of the sciatic notch is less than two horizontal fingers
Exit plane
Intertubercular diameter of ischium <7.5 or pubic arch <90 degrees
may be narrow
Intertubercular diameter ➕ Posterior sagittal diameter <=15
narrow
fetal monitoring
Early pregnancy monitoring
Second trimester monitoring
Third trimester monitoring
Fetal movement
electronic fetal monitoring
Predicting fetal hypoxic reserve
NST (non-stress test)
reactive
suspicious type
unresponsive
OCT (oxytocin challenge test)
Type I
Type II
Type III
hypoxia
fetal biophysical score
Placenta function test
Fetal maturity check
Nutrition, medication, and management during pregnancy
Medication
Genetic counseling, prenatal screening, prenatal diagnosis and fetal surgery
prenatal screening
Aneuploidy chromosomal abnormalities
First trimester joint screening
Ultrasound measurement of fetal nuchal translucency NT thickness
Serology test for pregnant women
Pregnancy-associated plasma protein-A (PAPP-A)
Free beta-human chorionic gonadotropin
Second trimester screening
Serological marker testing
Alpha-fetoprotein AFP
human chorionic gonadotropin hCG
Free beta-human chorionic gonadotropin
free estriol
neural tube malformation
serology test
Elevated alpha-fetoprotein AFP (15 to 20 weeks of pregnancy)
prenatal diagnosis
Related diseases
sex link
X chain
X hidden
red-green color blindness
hemophilia
progressive malnutrition
Y chain
Hirsutism of external auditory canal
autosomal
often hidden
phenylketonuria
Hepatolenticular deformation
Albinism
Structural deformity
Ultrasound prenatal diagnosis
early pregnancy
Spina bifida, holoprosencephaly, dextrocardia, conjoined twins
late pregnancy
Hydrocephalus, hydronephrosis, polycystic kidney disease
pregnancy complications
Miscarriage (less than 28w)
Cause
Embryonic chromosomal abnormalities are most common
clinical manifestations
Postmenopausal abdominal pain and vaginal bleeding
early miscarriage
Bleeding first and then abdominal pain
late miscarriage
Abdominal pain first and then bleeding
Common types
threatened abortion
The cervix is not opened
Miscarriage is inevitable
The cervix is opened
incomplete abortion
Part of the pregnancy product or placenta remains in the uterine cavity or is incarcerated in the cervix, affecting uterine contractions and causing bleeding.
Bleeding the most
Susceptible to infection
complete miscarriage
special type
missed abortion
coagulopathy
recurrent miscarriage
early recurrent miscarriage
late recurrent miscarriage
reason
Cervical anatomic abnormalities
autoimmune abnormalities
prothrombotic state
Miscarriage combined with infection
Auxiliary inspection
B-ultrasound
Look at the heartbeat
blood hcG
6 to 8 weeks, normal growth rate is 66%
treat
aura
miscarriage
other
Qing Palace
missed abortion
Check blood coagulation first, give estrogen, and then curettage
Miscarriage combined with infection
Principle: Control infection first and then curettage
ectopic pregnancy
fallopian tube pregnancy
site of occurrence
Ampulla > Isthmus, interstitium rarely (but very dangerous)
Cause
Main: fallopian tube inflammation
pathology
fallopian tube changes
fallopian tube rupture
Isthmus 6 weeks
Interstitial part 12~16 weeks
fallopian tube miscarriage
Ampulla 8 to 12 weeks
uterine changes
Same as pregnancy, but smaller and with decidualization
Triangular decidual canal
A-S reaction
clinical manifestations
symptom
triad of ectopic pregnancy
Menopause
stomach ache
Not broken, dull pain on one side
Rupture, severe tearing pain on one side
vaginal bleeding
physical signs
Cervical lifting pain/swaying pain (increasing peritoneal irritation)
Profuse bleeding and floating feeling
Auxiliary inspection
Ultrasound
ikB
Location of pregnancy PUL, hCG>3500 alert to ectopic pregnancy
Serum progesterone measurement
Laparoscopy (not the gold standard)
Posterior vaginal fornix puncture (simple and reliable)
Diagnostic curettage
Differential diagnosis
Other acute abdomen (hcG-)
abortion
acute salpingitis
acute appendicitis
Rupture of corpus luteum
Ovarian cyst pedicle torsion
Replenish
intrauterine embryonic arrest
acute pelvic inflammatory disease
ovarian endometrioma cyst rupture
trophoblastic tumor
treat
Mainly surgery
Indications for surgery (5)
Surgical approach
conservative surgery
radical surgery
drug
hyperemesis gravidarum
Bleeding, dehydration, ketosis, acidosis and other symptoms
Cause
endocrine factors
hcG high
Changes in thyroid function
clinical manifestations
Starting from the 6th week of pregnancy, persistent vomiting and inability to eat around 8 weeks
diagnosis
B-ultrasound➕hematuria test
complication
Hyperthyroidism
No need to take antithyroid drugs
Wernicke's encephalopathy
Supplement VitB1
Nystagmus, visual impairment, gait and stance affected
treat
Correct dehydration and electrolytes
Supplement Vit B1 first, then polarizing solution
Daily urine output＞1000ml
Supplement potassium 1g per 500ml urine
Antiemetic
Hypertension during pregnancy (occurring after 20 weeks of pregnancy)
Classification
Isolated gestational hypertension
Preeclampsia
high blood pressure, protein in urine
severe preeclampsia
Blood pressure >160/110, or combined with other organ damage
Eclampsia
Smoking it, you will wake up after smoking it
Chronic hypertension complicated by preeclampsia
It's high blood pressure
Pregnancy complicated by chronic hypertension
Pathophysiology
Inadequate recasting of uterine spiral arterioles
Placenta implantation is too shallow
Inflammation immune system activation
immune overload
Damage to the vascular endothelium
Vasospasm
genetic factors
nutritional deficiencies
pathophysiological effects
to mother
brain
Cerebral edema, intracranial hypertension, transient discharge
Cerebral infarction
kidney
Proteinuria (proportional to prognosis)
liver
Heart
Increased cardiac load can lead to heart failure
blood pressure
Hypercoagulability ➕ Concentration (cell endothelial damage, dehydration)
Infant (uterine placental blood perfusion)
Lack of nutrition
children
hypoxia
stillbirth
Placental bed blood vessel rupture
placental abruption
examine
Routine inspection
Blood and urine routine
Liver and kidney function
coagulation
electrocardiogram
Electronic fetal heart rate monitoring
B-ultrasound check of fetus and amniotic fluid
Preeclampsia and Eclampsia
Urine protein, fundus
B-ultrasound
blood gas, electrolytes
Cardiac color ultrasound and cardiac function, umbilical artery blood flow
Head CT, MRI
Differential diagnosis
chronic nephritis
Pregnancy complicated by chronic hypertension
Chronic hypertension complicated by preeclampsia
Hypertension during pregnancy
treat
in principle
Antihypertensive, antispasmodic, sedative, etc. Monitor mother and child closely Terminate pregnancy at the right time
Preeclampsia
Assessment and monitoring
General processing
step down
Indications
>160/110, must be reduced
>150/100, it is recommended to reduce
140~150/90~100, not recommended
Target
No concurrent organ function damage
Systolic blood pressure: 130~155
Diastolic blood pressure: 80~105
concurrent organ damage
Systolic blood pressure: 130~139
Diastolic blood pressure: 80~89
Commonly used medicines
labelore
nifedipine
Nitroglycerin (first choice in hyperbaric crisis)
Nitroprusside (hyperbaric crisis, other drugs are useless)
antispasmodic
Magnesium sulfate
Application conditions
Knee jerk reflex exists
Urine output (≥17ml/h or ≥400ml/24h)
The first manifestation of poisoning: disappearance or decrease of tendon reflexes
Poisoning rescue: intravenous injection of 10% calcium gluconate
calm
diuretic
Brain edema
Mannitol (contraindicated in heart failure or potential heart failure)
Promote fetal lung maturation
Glucocorticoids
Terminate pregnancy
generally
Can wait until 37 weeks
severe preeclampsia
<24 weeks, terminate
24 to 28 weeks, depending on the situation
28~34 weeks
Unstable, promotes lung ripening, terminated
stable, expectant
>=34 weeks, terminate
Eclampsia (common cause of death: cerebrovascular accident)
Antispasmodic: magnesium sulfate
Continue to use for 24~48 hours after delivery
Reduce intracranial pressure
Mannitol
Termination of pregnancy after controlling convulsions
Timing of pregnancy termination
generally
Can wait until 37 weeks
Severe
<34 weeks
The condition is controllable, active treatment is required, and the pregnancy can continue
The condition is uncontrollable (severe), promotes fetal lung maturity, and terminates pregnancy
>34 weeks
Terminate pregnancy
prevention
sports
Eat properly
Calcium supplement
Take 1.5~2.0g orally daily
aspirin
Stop taking it 5 to 10 days before terminating pregnancy
HELLP syndrome
Features
Hemolysis, elevated creatinine, thrombocytopenia
Main causes of death
Multifunctional organ failure and DIC
diagnosis
intravascular hemolysis
elevated liver enzymes
Thrombocytopenia
Intrahepatocholestasis of pregnancy ICP
Cause
hyperestrogen state
Bile acid metabolism disorder
Changes in the liver cell membrane and obstruction of bile outflow
increased bile reflux
Influence
To the pregnant mother
postpartum hemorrhage
to the fetus
Increased perinatal morbidity and mortality
Fetal distress, premature birth, amniotic fluid meconium contamination
clinical manifestations
First appearance: itchy skin
jaundice
skin scratches
diagnosis
clinical manifestations
laboratory tests
Serum bile acid determination TBA (≥10μmol/L)
Graduation
Mild
TBA10~39.9μmol/L
No other obvious symptoms except itching
Severe
TBA≥40μmol/L
With other serious conditions
treat
Cholic acid-lowering treatment
Ursodeoxycholic acid
Obstetric management
Timing of pregnancy termination
Mild: 38~39 weeks
Severe: 34~37 weeks
Acute fatty liver disease of pregnancy (AFLP)
Most common cause of acute liver failure
clinical manifestations
persistent gastrointestinal symptoms
examine
laboratory tests
Bile enzyme isolation
Videography
Ultrasound
Diffuse liver parenchymal echogenicity (bright liver)
Liver biopsy (gold standard)
treat
Terminate pregnancy as soon as possible
Premature birth (delivery at 28w but less than 37w)
Classification
premature birth with intact fetal membranes
Cause
overdistension of the uterus
maternal-fetal stress response
placenta previa
intrauterine infection
Intrauterine infection (most common)
Premature rupture of membranesPPROM
therapeutic preterm birth
predict
Transvaginal ultrasonography of cervical length
Biochemical examination of cervical secretions
clinical manifestations
Irregular contractions at first, then regular contractions
treat
<34 weeks
Expectant treatment
Suppress uterine contractions
calcium channel blockers
nifedipine
prostaglandin synthase inhibitor
Indomethacin (short-term use before 32 weeks, to monitor amniotic fluid volume and fetal ductus arteriosus blood flow)
beta adrenergic receptor agonists
Litojun
Atosiban
Magnesium sulfate
Promote lung ripening
Dexamethasone
betamethasone
control infection
>34 weeks, terminate pregnancy
expired pregnancy
pathology
amniotic fluid
placenta
fetus
Normal growth and macrosomia
premature fetal syndrome
fetal growth restriction
diagnosis
Verify pregnancy weeks
Determine the safety of the fetus (key)
deal with
Promote cervical ripening (Bishop score)
≥7, direct labor induction
<7, promote maturation first and then induce labor
PGE2 vaginal preparation
cervical dilation balloon
induction of labor
Already connected, first artificially rupture membranes, then instill oxytocin
labor management
cesarean section
fetal appendage abnormalities
placenta previa
definition
After 28w
Cause
Endometrial damage
assisted reproduction
Trophoblast cells develop later
Classification
completeness
Partiality
marginality
low lying placenta
clinical manifestations
symptom
Unprovoked, painless vaginal bleeding
Complete, early bleeding (28w)
Borderline, late bleeding (perinatal period)
examine
Fetal heart rate monitoring
Blood routine, CRP
Film degree exam
B-ultrasound
MRI (suspected placenta accreta)
Postpartum examination of placenta and fetal membranes
diagnosis
Cause➕clinical manifestations➕auxiliary examination
Differential diagnosis
placental abruption
Placental margin sinus rupture
umbilical cord velamentous attachment
rupture of vasa previa
Cervical lesions
Antepartum hemorrhage
premature birth
Influence
Intrapartum and postpartum hemorrhage
placenta accreta
puerperal hemorrhage
Poor perinatal prognosis
treat
in principle
Suppress uterine contractions, stop bleeding, correct anemia, prevent infection and terminate pregnancy in a timely manner Comprehensive judgment based on vaginal bleeding volume, gestational age, parity, fetal position, presence of shock, fetus survival and placenta previa type
Expectant therapy (suppression, resistance, promotion)
generally
correct anemia
Stop bleeding
Glucocorticoids
Prevent infection
B-ultrasound test
Terminate pregnancy
vaginal delivery
cesarean section
prevention
Use contraception
avoid damage
pregnancy management
placental abruption
definition
After 28 weeks, the placenta is in normal position
Cause
Pregnancy-induced hypertension
Sudden drop in uterine pressure
Premature rupture of membranes after delivery of the first twin twins
Blunt trauma
Pathology and pathophysiology
Uteroplacental apoplexy (Coufleur uterus)
clinical manifestations
Vaginal bleeding, abdominal pain
installment
Issue 0
Postpartum retrospective findings
Phase I
Soft uterus, no fetal distress
Phase II
Phase III
Shock, with or without DIC
complication
intrauterine death
DIC
hemorrhagic shock
acute renal failure
amniotic fluid embolism
Auxiliary inspection
B-ultrasound
Negative cannot be ruled out (retrograde placenta)
Blood routine
Coagulation routine DIC
Urine routine
Liver and kidney function
electrocardiogram
diagnosis
Cause➕clinical manifestations➕auxiliary examination
Differential diagnosis
placenta previa
threatened uterine rupture
Influence
mother
blood loss
Son
acute hypoxia
treat
in principle
Early identification, active treatment of shock, timely termination of pregnancy, control of DIC, and reduction of complications
correct shock
Monitor the fetus
Terminate pregnancy
vaginal delivery
cesarean section
II, III degree, induced labor (dead or alive)
Dealing with complications
postpartum hemorrhage
coagulopathy
kidney failure
premature rupture of membranes
definition
Before giving birth
Classification
At 37 weeks, term premature rupture of membranes PROM
Less than 37 weeks, premature rupture of membranes (PPROM)
Cause
Infection (main)
High stress
Uneven force
trauma
Nutritional factors, poor fetal membranes
clinical manifestations
vaginal discharge
Auxiliary inspection
speculum
Ultrasound
p H
vaginal fluid smear
Cervicovaginal fluid biochemical testing
diagnosis
Differential diagnosis
Vaginitis
stress urinary incontinence
Influence
mother
Infect
placental abruption
Son
premature birth
treat
Full term
Hospitalized for delivery
Preterm
Inducing labor
Terminate pregnancy
Expectant treatment
generally
Promote lung ripening
Prevent infection
Suppress uterine contractions
Protect fetal nervous system
Abnormal amniotic fluid volume
polyhydramnios
More than 2000ml
Cause
fetus
Nervous system (anencephaly, spina bifida, neural tube defects)
digestive tract abnormalities
multiple pregnancy
placenta umbilical cord disease
placental villous hemangioma
Pregnancy complications
diabetes
Auxiliary inspection
Ultrasound
Check for fetal diseases
other
diagnosis
AFV (maximum vertical depth of dark area of amniotic fluid) >=8cm
AFI (Amniotic Fluid Index)>=25cm
>45, too heavy
treat
Combined fetal structural abnormalities
termination
combined with normal fetus
Find the cause and treat the underlying disease
Seriously, put amniotic fluid
Repeated growth, >34 weeks, termination of pregnancy
Oligohydramnios
Less than 300ml
Cause
Fetal structural abnormalities (urinary system)
Placental hypofunction
maternal body
Pregnancy-induced hypertension
diagnosis
AFV (maximum vertical depth of dark area of amniotic fluid) <=2cm
AFI (amniotic fluid index) <=5cm
Umbilical cord abnormalities
Umbilical cord presentation (unruptured) and umbilical cord prolapse (ruptured)
Cause
Not in the pot, not connected
“The blocking is not tight”
Influence
Increase cesarean section rate
treat
Umbilical cord presentation
Head low buttocks high
umbilical cord prolapse
Full cervix dilation, assisted delivery
The cervix is not fully dilated and the cervix is opened
Fetal abnormalities and multiple pregnancies
fetal growth restriction
Related definitions
small for gestational age
fetal growth restriction
low birth weight infant
Cause
Mainly maternal factors
Classification
Internally balanced FGR
Externally symmetrical FGR
Externally caused asymmetrical FGR
examine
treat
Find the cause
treat
Obstetric management
continue pregnancy
Terminate pregnancy
giant fetus
high risk factors
Influence
mother
shoulder dystocia
Son
intracranial hemorrhage
diagnosis
Abdominal examination
Palace height>35cm
Palace height➕Abdominal circumference>=140cm
stillbirth
definition
>20 weeks
treat
Once confirmed, induce labor immediately
method
Intraamniotic injection of ethacridine and oxytocin
4 weeks after fetal death, blood coagulation test
fetal distress
Cause
acute fetal hypoxia
chronic fetal hypoxia
clinical manifestations
acute fetal distress
Abnormal fetal heart rate (first increased and then decreased)
Meconium contamination of amniotic fluid (need to be combined with fetal heart rate monitoring)
Abnormal fetal movements (frequent at first and then decreased)
acidosis
chronic fetal distress
Fetal movement decreases or disappears
Abnormal prenatal fetal heart rate monitoring
treat
acute
Terminate pregnancy as soon as possible
Full dilatation of the cervix
Midwifery
The cervix is not fully dilated
cesarean section
Chronic
Small gestational age, expectant therapy
Termination of pregnancy (caesarean section in both cases)
multiple pregnancy
type
dizygotic twins
monozygotic twins
Dichorionic diamniotic monozygotic twins
Monochorionic diamniotic monozygotic twins
Monochorionic monoamniotic sac monozygotic twins
Conjoined twins
Pregnancy combined with internal medicine and surgery
Pregnancy complicated by heart disease
Cardiovascular changes during pregnancy and childbirth
32 to 34 weeks of pregnancy, second stage of labor, 3 days postpartum [risk]
late pregnancy
supine hypotensive syndrome
Types of heart disease complicated by pregnancy and its impact on pregnancy
Structural abnormality
Congenital heart disease (most common)
left to right shunt
Right-to-left shunt (tetralogy of Fallot/Eisenmenger syndrome)
No shunt type
rheumatic heart
myocarditis
Abnormal function
specific to pregnancy
Hypertensive heart disease of pregnancy
peripartum cardiomyopathy
Cause unknown
dilated cardiomyopathy
Occurs in late pregnancy, puerperium and 3 months postpartum
Pregnancy may recur
Effect on fetus
Preterm birth, miscarriage, stillbirth, fetal growth restriction, fetal distress and neonatal asphyxia
Common complications
heart failure
early heart failure
Chest tightness, palpitations, shortness of breath after slight activity
Resting, heart rate >110, breathing >20
Sitting up to breathe at night due to chest tightness
A small amount of persistent crackles at the base of the lungs that does not disappear after coughing
infective endocarditis
hypoxic cyanosis
Pulmonary embolism and venous embolism
malignant arrhythmias
treat
Heart disease with cardiac function class I to II and left-to-right shunting
Can get pregnant
Prevent heart failure
Close supervision
Treat heart failure with “three non-stop measures”
Prophylactic use of cardiotonic drugs is not advocated
Unsaturated dosage
No long-lasting effect
Improvement and discontinuation of medication
Obstetric pregnancy methods (after controlling heart failure)
vaginal delivery
first stage of labor
calm
semi-recumbent position
oxygen
Antibiotics to prevent infection (infection-induced heart failure)
second stage of labor
avoid holding back breath
Midwifery
third stage of labor
Place sandbag on abdomen
Oxytocin injection (without ergometrine)
Cardiac function class III to IV
<12 weeks
induced abortion, termination of pregnancy
>12 weeks
Considering
Pregnancy complicated by diabetes
Classification
Diabetes combined with pregnancy
gestational diabetes
Cause
Increased glucose uptake by the fetus
Renal plasma flow and glomerular filtration rate increase during pregnancy, but reabsorption remains unchanged.
Estrogen and progesterone increase maternal glucose utilization
Characteristics of glucose metabolism during pregnancy
Increase in anti-insulin substances in the body, insulin resistance
Increased blood volume, thinning of blood, decreased insulin
Effects of diabetes on pregnancy
for pregnant women
Abnormal embryonic development or even death
Infect
polyhydramnios
giant fetus
to the fetus
giant fetus
Growth restricted
maturation disorder
diagnosis
gestational diabetes
Fasting blood sugar >=5.1mmlo/L, confirmed
4.4-5.1mmol/L, perform OGTT
<4.4mmol/L, normal, OGTT is not possible at the moment
Differential diagnosis
clinical manifestations
Sanduo: excessive drinking, eating, and urinating
Heavy weight (>90kg)
treat
in principle
Actively control the blood sugar of pregnant women to prevent the occurrence of maternal and fetal complications
Control objectives
Before meals, 2h, night
Nutrition
sports
drug
insulin
Managing ketoacidosis
Principle: Fast first then slow, salt first then sugar
>16.6mmol/L, 0.9%NaCl insulin
Drop to 13.9mmol/L, 5% glucose insulin (add 1U insulin for every 2-4g glucose), until 11.1mmol/L
Terminate pregnancy at the right time
Control is up to standard, waiting until the expected delivery date
Insulin treatment is required and close monitoring is required until 39w.
TORCH syndrome
treat
Toxoplasmosis
acetylspiramycin
RV and CMV infections
Antivirus not recommended
sexually transmitted diseases
gonorrhea
Earliest manifestation: Cervicitis
G-diplococci
purulent inflammation
Affinity for columnar epithelium and transitional epithelium
The highest incidence rate
syphilis
Pathogen
Treponema pallidum
genital warts
deal with
Small lesions on vulva
Trichloroacetic acid application
The lesions are large and pedunculated
Physical therapy (laser, microwave, freezing, electrocautery)
Chlamydia trachomatis infection
treat
Aki is the first choice (erythromycin is the first choice if she is not pregnant)
blood system diseases
anemia
Influence
Effects on pregnant women
anemic cardiomyopathy
hemorrhagic shock
Complicated puerperal infection
Effects on the fetus
fetal growth restriction
fetal distress
premature birth or stillbirth
Classification
Iron deficiency anemia (most common)
examine
serum iron deficiency
Serum iron <6.5umol/L
megaloblastic anemia
examine
folate deficiency
Serum folic acid <6.8nmol/L, red blood cell folic acid <227nmol/L
diagnosis
Hb<110g/L, specific volume<0.33
Graduation
Mild
Hb, 100～109
Moderate
70～99
Severe
40～69
Extremely severe
<40
Idiopathic thrombocytopenic purpura
treat
Glucocorticoids (preferred)
gamma globulin
Splenectomy (performed from 3 to 6 months)
Platelet transfusion (not necessary unless critical)
acute appendicitis
Influence
to mother
Perforated appendicitis complicated by diffuse peritonitis