妊娠診斷醫(yī)學(xué)課件

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chapter3

diagnosisofpregnancy1

chapter3

diagnosisofp2023/9/162◆firsttrimester<13week◆secondtrimester14w～27+6w◆thirdtrimester≥28wPregnacystages14-1819-2324-2828-3232-3637-402023/8/82◆firsttrimester<132023/9/163diagonosisofearlypregnancySection12023/8/83diagonosisofearlypDiagnosisofEarlyPregnancyHistoryandsymptomsAmenorrheaThefirstandthemostimportantsymptomNote1:emotionaltension,chronicdiseaseandcertainmedications→delayedmensesNote2:lactation,IUDanddysfunctionofendocrine→pregnancyDiagnosisofEarlyPregnancyHiDiagnosisofEarlyPregnancyMorningsicknessFatigue,swirling,nauseaandvomiting(the6thweek↑

→the12thweek↓).Hyperemesisgravidarum:protractedvomitingnecessitatinghospitalization.Causes:HCG,delayedgastricemptying(P↑)DiagnosisofEarlyPregnancyMoDiagnosisofEarlyPregnancyUrinarysymptomsBladderirritability,frequencyandnocturiaCauses:increasedcirculationinpelvis(EandP↑),enlargementoftheuterus.Note:urinaryinfectionmustberuledoutDiagnosisofEarlyPregnancyUrDiagnosisofEarlyPregnancyMastodyniathedevelopmentofmammaryducts(E↑)andalveolarsystem(P↑)circulation↑→engorgementofthebreastsConstipationsmoothmusclerelaxant(P↑)WeightgainDiagnosisofEarlyPregnancyMaDiagnosisofEarlyPregnancySignsThechangesofgenitalorgansVagina:bluishorpurplediscoloration(congestedpelvicvasculature).Increasedvaginaldischarge(EandP↑)Cevix:JACKQUEMIER’SORCHADWICK'SSIGNsofteningandbluishdiscoloration.Thecervicalmucus→agranularpatternDiagnosisofEarlyPregnancySiDiagnosisofEarlyPregnancy9UterocervicaljunctionHegar’ssign:awidenedzoneofsoftnesscoupledwithcompressibility,resultinginadoughnut-shaped,slightlyspongyconfiguration.DiagnosisofEarlyPregnancy9UDiagnosisofEarlyPregnancyAbdominalenlargementEnlargementofuterus(noticedatthe12thweek)6w8w12wDiagnosisofEarlyPregnancyAbDiagnosisofEarlyPregnancy11BreastchangesEnlargementandvascularengorgement(6th–8thweek)2.Montgomery’stubercles:6th–8thweek,EandP↑3.Colostrumsecretion(16thweek)orsecondarybreastsDiagnosisofEarlyPregnancy11DiagnosisofEarlyPregnancyLaboratorytestsPregnancytestUrineHCGtest(onestep):+or–β-HCG:>25mIU/LUltrasonographyEnlargementofuterusGestationalsacEmbryoorfetalpulseDiagnosisofEarlyPregnancyLaDiagnosisofEarlyPregnancyOthertestsCervicalmucusexaminationBasalbodytemperature(BBT)DiagnosisofEarlyPregnancyOtDiagnosisof2rdand3ndpregnancySymptomsandsignsEDC:+9or–3(month),+7(day)EnlargementofuterusDiagnosisof2rdand3ndpregnaDiagnosisofmidorlatepregnancyFetalmovement(FM)Thefirstperception:inthe18th–20thweeksDiagnosisofpregnancy,durationofpregnancy,thesafetyoffetusCount:3timesperday,1hourpertime.sum×4=FM/12hours.Normal:≥30/12hoursDiagnosisofmidorlatepregnDiagnosisofmidorlatepregnancyFetalhearttonesHeared:the18th–20thweeksNormalrate:120-160bpmDifferentiation:umbilicalsouffle(臍帶雜音)FetalbodyPalpated:outlinesofthefetus(the20thweek).DiagnosisofmidorlatepregnDiagnosisofmidorlatepregnancyLaboratorytestsUltrasonographyThenumberoffetusFetallieFetalpresentationFetalpositionFetaldeadornotPlacentaandcord(velocityofflow)SizeoffetusDiagnosisofmidorlatepregnDiagnosisofmidorlatepregnancyFetalelectrocardiography,FECG12thweekDiagnosisofmidorlatepregnFetalAttitudeFetallieReferstotherelationshipofthelongaxisofthefetustothelongaxisofthemotherLongitudinallieThelongaxisofthefetusisparallelwiththatofthemotherTransverselieThelongaxisofthefetuscrossesthatofthemotherverticallyFetalAttitudeFetallieFetallieFetallieFetalAttitudeFetalpresentationheadpresentationOcciputpresentation(95%),browpresentationandfacepresentation.BreechpresentationCompletebreechpresentationFrankbreechpresentationIncompletebreechpresentation:footlingpresentationFetalAttitudeFetalpresentatiHeadpresentationorbreechHeadpresentationorbreechFetalAttitudeFetalpositionReferstotherelationshipofthepointofdirectionofthepresentingparttooneofthe4quadrantsofthepelvisortothetransversediameterofthematernal