Some pregnant women have been on tenterhooks all day from the first day of pregnancy, worrying about whether the baby in their stomachs is developing normally. In fact, if you master some conditions of fetal development, you don't have to worry too much.
The growth and development of the fetus is regular. Generally, it grows fastest in the first trimester, relatively stable in the second trimester, slow in the third trimester, and basically stops growing about a week before birth. Therefore, we can infer the growth of the fetus through the physiological indicators of pregnant women.
First of all, we can judge the development of fetal length by measuring the height of uterine fundus (that is, the distance from uterine fundus to pubic symphysis). In general, the fundus is about the center of pubic bone and navel at 16 weeks of pregnancy; After 20 ~ 22 weeks of pregnancy, the fundus basically reaches the navel; At 32 weeks of pregnancy, the fundus of uterus reached 2 ~ 4 cm below xiphoid process. When it exceeds or obviously lags behind the corresponding indicators, it indicates that the fetus is abnormal, and the reasons should be found under the guidance of a doctor.
Secondly, we can monitor whether the fetal weight gain is normal by checking the weight gain of pregnant women. During pregnancy, the average weight gain of pregnant women should be 10 ~ 12 kg. The fetus is about 3 kg, the placenta is about 0.6 g, the amniotic fluid is about 0.8 kg, and * * * is about 4.5 kg. Others such as uterus, breast, blood and water increased by about 5.5 kg, accounting for about 10 kg. From 34 to 38 weeks of pregnancy, pregnant women gain an average of 0.5 kg per week. In the third trimester, the average weekly increase is 0.3 ~ 0.35 kg. If you gain weight too fast, edema may occur.
At the same time, we can also judge whether the fetal development is normal by monitoring the fetal movement. Generally, normal fetus has no less than 3 ~ 5 fetal movements per hour/kloc-0, and about 30 ~ 40 fetal movements per hour/kloc-0. You can measure the morning, middle and evening 1 hour, and then multiply the sum of these three hours by 4 to get the fetal movement number 12 hour. If it is less than 10 times, it means that there is something wrong with the fetus and you should go to the hospital immediately.
2. The fetal monitor is the savior of the fetus.
The fertilized egg formed by the combination of sperm and egg has unlimited vitality and develops into a new life individual. After 4 months of pregnancy, fetal activity is enhanced, and most pregnant women can perceive fetal activity in the uterus-a kind of "conscious fetal movement". The fetus is like a fish playing in the water. Sometimes it raises its hand, sometimes it kicks its leg, and sometimes it pouts its hips. When it is happy, it comes to play "free fist". If you are tired, take a rest or sleep for a while. When the pregnancy is overdue, the placenta is aging, and the ability to transport oxygen and nutrients is low, fetal hypoxia occurs, or the umbilical cord is wrapped around the neck, knotted and twisted, causing fetal hypoxia and suffocation. In the early stage of hypoxia, the fetus struggled desperately, and pregnant women felt abnormal fetal movement, even unbearable. When hypoxia lasts, it enters the decompensation stage, and the fetus changes from excitement to inhibition, and the fetal movement weakens until it disappears. Usually, the fetus dies 12 ~ 24 hours after the fetal movement disappears. Therefore, fetal movement is one of the reliable indicators of fetal safety. If pregnant women can carefully record the daily activities of the fetus, it is possible to find the potential danger of intrauterine hypoxia in time. You should seek medical treatment at the early stage of abnormal fetal movement. Doctors can take appropriate and effective measures to terminate pregnancy in time, such as cesarean section, which may save the child.
How to count fetal movements? The method is simple. Pregnant women take the left lateral position and experience the number of fetal movements. Every time the fetus moves, draw a line on the paper, or put a bean or match stick in the box to count, and record it every morning, noon and evening 1 time. Multiply the sum of 3 hours of fetal movements by 4, and then calculate the number of fetal movements of 12 hours. If 1 hour fetal movement is less than 3 hours, or 12 hours fetal movement is less than 10 times, especially when fetal movement disappears, it is a danger signal, and you should see a doctor immediately without delay, so as to avoid fetal death in the uterus.
In the past, for women in labor, doctors could only listen to the changes of fetal heart sounds with stethoscope, and understand the intensity and duration of uterine contraction through touch and palpation. This method is simple, but not accurate enough. Due to human resources, energy, time and other factors, it is difficult for medical staff to continuously observe the changes of uterine contraction and fetal heart rate for a long time, and because touching uterine contraction and listening to fetal heart rate can not be carried out at the same time, it is impossible to understand the relationship between them, which often leads to some potential dangers of the fetus being ignored and delaying diagnosis and treatment. Therefore, people have developed an electronic instrument-fetal monitor.
The monitor can be used for both external monitoring and internal monitoring. During external monitoring, a probe with a pressure measuring device is placed on the uterine body to measure uterine contractility; Another probe connected with the sounding device is placed on the back of the fetus to record the fetal heart sound; At the same time, the lying-in woman holds a button, and when she senses fetal movement, she presses the switch. Finally, the contraction, fetal heart rate and fetal movement are recorded simultaneously on the marking chart through the sensor. During internal monitoring, one end of the manometric catheter is inserted into the uterine cavity, the electrode is installed on the fetal scalp, and the other end is connected with a recorder to measure uterine contraction and fetal heart rate. This method is accurate and can find slight deviation, but it is rarely used in clinic because it may cause injury and intrauterine infection.
Through the monitoring of fetal monitor, we can know the intensity of labor (uterine contractility), the tolerance of fetus to uterine contraction-hypoxia load and the function of fetus-placenta, so as to guide clinical treatment.
Normal fetal heart rate is between 120 ~ 160 beats/min, with a certain range of variation. When the fetus is active, the fetal heart rate increases moderately. If the fetal heart rate exceeds 160 beats per minute, or is lower than 120 beats, or there is no variability, or the fetal heart rate remains unchanged during fetal movement, it indicates that the intrauterine fetus is hypoxic. If the fetal heart slows down in the early stage of uterine contraction and returns to its original level in the late stage of uterine contraction, it is called "early slowdown" in medicine, suggesting that the fetal head is compressed and the parasympathetic nerve tension is enhanced; If the fetal heart rate begins to slow down at the peak of uterine contraction, it has not recovered to its original level at the end of uterine contraction, which is "late deceleration", indicating that the placenta function is not good; If there is no correlation between uterine contraction and fetal heart rate deceleration, it is called "variation deceleration", suggesting that there may be fetal umbilical cord compression. If the above abnormal changes persist in clinic, in order to save the dangerous fetus, cesarean section is often needed to end the delivery.
3. Fetal blood type examination and calculation
Blood type is a complicated problem. ABO blood group system is commonly used, that is, people's blood groups are divided into four types: A, B, AB and Type. Type A human red blood cells have antigen A, type B people have antigen B, type AB people have antigens A and B, and type O people have no antigen. According to the genetic law of blood type, knowing the blood type of parents can calculate the possibility of children's blood type.
Blood group genetic relationship between parents and children
The possible blood types of parents and children are A, B, ABA A, OB, ABA A, B, AB, OA BAB, A, BOB B, OA, ABB B, OA, ABB A.
When the mother was pregnant for 2 months, the embryo of fetal deciduous teeth began to develop, and at 5 months, deciduous teeth began to calcify, while the embryo of permanent teeth began to develop. If the fetus does not get enough nutrition during the embryonic period, or the mother takes tetracycline drugs, it can directly affect the growth and development of fetal teeth, and it is easy to have dental diseases and "tetracycline teeth" after birth. Therefore, during pregnancy, mothers should avoid taking tetracycline drugs and eat foods rich in calcium, such as milk and eggs. Do more outdoor activities, bask in the sun, promote the development of embryonic teeth and bones, and prevent children from suffering from congenital dental diseases.
5. Health care methods for obese pregnant women's fetuses
Pregnancy is an unforgettable experience for first-time mothers, especially for obese women.
Obese pregnant women, especially those with hyperglycemia, are prone to give birth to macrosomia, that is, newborns with a fetal weight of more than 4 kg at birth. Most babies who are obese within 6 months after birth are not obese when they are young. But if he is still overweight after six months, his father or mother is obese, and the child may still be obese when he grows up. It can be seen that birth weight is not the only reason for obesity in the future. Heredity, family, environment, overnutrition, improper diet, etc. It has a more important influence on whether the body is obese. If we can attach great importance to this and try our best to overcome the unfavorable factors in some links, we can avoid obesity.
At present, obesity in pregnant women has been regarded as one of the high-risk factors in perinatal period (that is, from the 28th week of pregnancy to postnatal 1 week). Because obese pregnant women will have many complications during pregnancy, such as hypertension, obvious proteinuria, gestational diabetes, overdue pregnancy, macrosomia delivery and so on. Obese pregnant women also need surgical delivery and postpartum hemorrhage more than normal-weight pregnant women. This is because the fat in the pelvic cavity of obese pregnant women affects the fixation of fetal head, and the huge fetus often causes head-pelvic asymmetry, uterine contraction weakness, poor productivity, slow progress of labor, meconium inhalation, intrauterine asphyxia, dystocia, neonatal asphyxia, neonatal intracranial hemorrhage and other adverse conditions, so it is often necessary to use oxytocin to induce labor or perform cesarean section.
In order to avoid accidents during delivery, obese pregnant women should have regular prenatal examination to find and treat pregnancy complications in time. Strengthen prenatal monitoring, pregnant women after 28 weeks of pregnancy and fathers of future children should learn to do fetal movement monitoring, and provide information for prenatal and perinatal monitoring of medical staff in time. In order to avoid underestimating the weight of the fetus, we can do B-ultrasound to help predict whether it is a macrosomia, so as to make prenatal preparations.
Some obese pregnant women are malnourished and take in too many calories, but protein's intake is insufficient, which leads to the decrease of colloid osmotic pressure in intravascular plasma and the retention of extracellular fluid in the body, leading to overweight. Some obese pregnant women do not gain weight or actually lose weight during pregnancy, but they can still ensure the normal growth of fetal weight, indicating that the "calories" stored in obese pregnant women are enough to meet their own and fetal heat needs. Obese pregnant women should have reasonable daily nutrition, neither excessively restricting diet nor overeating. Protein and bean products should be the main products. Only in this way can we ensure the normal development of the fetal body, especially the normal development of the fetal brain.
The average weight gain of pregnant women with normal weight during pregnancy is 1.2kg, and that of obese pregnant women is 8-9 kg. Women who may give birth to a huge baby should be vigilant. When they need to end the delivery by cesarean section, they should make psychological preparations in advance and cooperate with doctors during and after the operation. Newborns of obese women need to monitor blood sugar changes within 6 hours after birth. When asymptomatic hypoglycemia occurs, sugar water and breast milk should be fed as soon as possible, and glucose should be injected intravenously if necessary. After delivery, mothers and babies generally need to be hospitalized for 7 days to ensure their safety.
6. Type and measurement of fetal position
The position of the fetus in the uterus is called fetal position. Fetal position is named according to the relationship between the maternal pelvis and the exposed part of the fetus (the part exposed to the mother first). For example, the occipital bone at the back of fetal head is located in the left front of maternal pelvis, and its fetal position is called occipital left front position; Fetal occipital bone is located in the right front of maternal pelvis, fetal position is the right front of occipital bone, and so on. The left anterior occipital position and the right anterior occipital position in front of the pelvis are normal fetal positions, which occupy the least volume after entering the pelvis and are easy to give birth smoothly. Occipital transverse position is normal in the early stage of labor. If it is persistent occipital transverse position, it is abnormal fetal position. Other fetal positions are abnormal.
The fetus grows and matures day by day in the mother. It takes about 6 weeks to touch the fetus in a pregnant woman's belly.
Before 26 weeks of pregnancy, there was relatively more amniotic fluid, so the fetal position was not fixed. After the 26th week, it can be measured manually. There are four steps:
When checking the fetal position, the examiner stands on the right side of the pregnant woman and adopts the following methods:
The purpose is to check the fetal position at the bottom of the uterus, and the examiner moves his hands alternately at the bottom of the uterus to understand the fetal position. The characteristics of fetal head are round, hard and floating ball feeling; The breech position is characterized by softness, no floating feeling and roundness; Sometimes you stretch your legs.
The purpose is to check the position of the fetus on the left and right sides of the uterus. Push the pregnant woman's abdomen to the opposite side with one hand, and touch the fetal part with the other hand, taking the fetal back as a plane; Then push it to the opposite abdomen, and touch the uneven parts such as the limbs, hands and feet of the fetus with the other hand.
The purpose is to find out whether the fetal part on the pubic symphysis is the head or the hip.
The purpose is to know whether the fetal presentation has entered the pelvis. Examiners face pregnant women's feet and find out and present them alternately with their hands.
7. Correction method of fetal breech position
The fetal position with the fetal head up and the fetal hip down is called breech position. It belongs to pathological fetal position.
The lower limbs of breech infants can assume various postures: those whose legs bend in front of the buttocks are called "full breech position" or "full breech position"; When the lower limb extends straight to the head, it is called "leg extension hip" or "single hip"; One or both feet of the fetus extend in the direction of the mother's vagina, which is called "foot position".
After the parturient's abdominal wall is slack or amniotic fluid is excessive, the fetus can move freely in the uterine cavity, which is prone to breech position; The abdominal wall of primipara is too tight, amniotic fluid is less, uterus is deformed, and double uterus can affect the natural rotation of fetus and form breech position; Hydrocephalus, anencephaly, placenta previa, pelvic stenosis and pelvic tumor affect the fetal head into the basin, and it is also easy to form breech position.
In breech delivery, the lower limbs and buttocks are delivered first, and the largest and most important head in the carcass is delivered last. Different from breech delivery, the fetal head changes its length (deformation) by squeezing the birth canal, and the skull overlap reduces the volume of the fetal head to facilitate the passage of the birth canal, but breech delivery has no such adaptive change. Therefore, the head position with the same pelvic weight can also give birth smoothly. If it is breech position, it is very likely that the fetal head will be dystocia, especially those with pelvic stenosis. Even after the delivery of the fetal buttock and shoulder, the fetal head, especially the mandible, is easily stuck in the pelvic cavity, and in severe cases, the fetus will be suffocated alive.
The probability of spontaneous delivery of breech babies is small, and most of them need to be removed by midwives. Fetal limb fracture, skull fracture, cervical dislocation, spinal cord injury, asphyxia, intracranial hemorrhage and aspiration pneumonia may occur during midwifery.
Therefore, prenatal examination should be done regularly during pregnancy, and breech position should be corrected in time if it is found at 30 weeks (7 and a half months).
Generally, the method of chest and knee supine position is used for correction. When pregnant women lie flat on their chests and knees, their breasts should be close to the bed surface, their hips should be raised as much as possible, and their knees should be connected to the bed at a 90-degree angle. Do it on an empty stomach in the morning and before going to bed 15 ~ 20 minutes.
After treatment in prone position of chest and knees 1 ~ 2 weeks, when the fetal position is not positive, you can use acupuncture at Yin point (dichotomy outside the edge of little toe nail) to transfer the fetus. If it is still ineffective, under the guidance of a doctor, the fetus can be artificially transferred-"eversion", and the fetal head can be pushed to the pelvis through the abdominal wall. After correcting the fetal position, wrap the abdomen with a binding cloth to prevent the fetus from being transposed again. After eversion, pregnant women should carefully count the fetal movements. If abnormal fetal movement is found to be active or decreased or weakened, you should seek medical attention immediately. Because when the fetus is transposed, it is possible to wrap the umbilical cord around a part of the carcass, or even strangle the neck, resulting in fetal hypoxia and abnormal fetal movement.
The incidence and mortality of breech delivery assisted by vaginal traction are very high. Cesarean section should be considered if there are the following indications.
Pelvic stenosis, larger fetus; Premature delivery is high, and the fetus is precious; Soft birth canal and uterine malformation; Premature water breakthrough or slow progress in labor; During labor, it is found that the fetal heart rate is accelerated, slowed down, weakened or irregular, or the fetus is still alive due to umbilical cord prolapse; Extreme extension of fetal head in breech position-"staring at the stars", such as forced vaginal delivery, can cause serious spinal cord injury, so cesarean section is also suitable.
Pregnant women in breech position should ensure adequate rest after delivery, and don't get out of bed at will, especially after rupture of membrane, so as to avoid umbilical cord prolapse.
8. The danger and treatment of fetal transverse position
If the longitudinal axis of the carcass is at right angles to the longitudinal axis of the mother, it is medically called transverse position. Transverse position also belongs to a pathological fetal position.
Transverse position is caused by pelvic stenosis, placenta previa preventing fetal head from entering the basin, or abdominal wall relaxation of parturient, or saddle uterus and twins.
The risk of delivery in transverse position is greater than that in breech position. Only small live or dead fetuses that have been soaked and folded can be delivered through vagina. Otherwise, it is impossible to be born through the birth canal. It's like walking through the door with a stick. Although the door is wide and the stick is thin, you can only take it with you. If you hold it sideways, the stick will get stuck on the door frame. Forcing through, either break the stick, or break the door frame, or "both lose." The outcome of transverse vaginal delivery is similar, with more maternal uterine rupture and fetal death. Therefore, cesarean section is the safest for full-term live fetuses without transverse deformity.
If pregnant women and their families insist on not agreeing to cesarean section after transverse delivery, they can perform "inversion" under deep general anesthesia with ether-the operator reaches into the uterine cavity, pulls out the fetal foot, and turns the fetus into breech-assisted delivery.
If the fetus has died when the parturient comes to the hospital, the feasible method is to "behead", first pull out the fetal body, and then take out the sawed fetal head.
Transverse position, especially the neglected transverse position during pregnancy, has a high incidence of uterine rupture, massive hemorrhage, infection, fetal limb delivery from vagina, umbilical cord prolapse and death. Regular pregnancy check-ups should be conducted to avoid the above accidents.
9. Treatment of fetal overweight
The abnormal growth rate of pregnant women's uterus, that is, the pregnant abdomen exceeds the pregnant month, may be pathological development. Such as obesity, macrosomia, twins, polyhydramnios and diabetes.
Some people think that having a big baby is good, healthy, not sick and easy to feed. In fact, this view is not correct.
Although macrosomia can give birth smoothly, there are still fetal injuries, residual sequelae, and even cerebral palsy and mental retardation caused by head-basin imbalance and induced labor.
Twin pregnancy, pregnant women have a heavy burden, and are prone to anemia, pregnancy-induced hypertension syndrome, premature delivery, postpartum hemorrhage, abnormal fetal position and so on.
Hyperhydramnios can be complicated with fetal malformation, often with symptoms of oppression, which makes pregnant women overburdened, and the pregnancy needs to be terminated because of severe malformation.
Children born to pregnant women with diabetes are usually huge children. Whether it is recessive or dominant diabetes, it is difficult to give birth smoothly if pregnant women do not get good treatment and care during pregnancy.
10. Treatment of fetal hydrocephalus
From the third week of embryogenesis, the ectodermal cells on the back of the embryo proliferate and thicken, forming neural plates, then developing into neural sulcus, and then closing into neural tubes. The front and rear ends of the tube are closed at the latest, which are called front and rear holes. There are three enlarged brain vesicles on the head side of neural tube, and then the brain vesicles differentiate into two cerebral hemispheres and diencephalon, cerebellum, pons and medulla oblongata. The end of neural tube differentiates into spinal cord. Subsequently, the neural lumen differentiates into ventricular system in the brain: two lateral ventricles, the third ventricle, the aqueduct and the fourth ventricle, in which cerebrospinal fluid flows in the central canal of the spinal cord.
Hydrocephalus refers to hydrocephalus caused by abnormal development or virus infection during the embryonic development of the ventricular system, in which the orifices or holes connecting various parts of the ventricular system are deformed or blocked, which hinders the circulation of cerebrospinal fluid and makes cerebrospinal fluid gather in the whole ventricle or a certain part, which is called obstructive hydrocephalus, and the brain tissue is compressed around the skull. If the development of arachnoid granules is abnormal, cerebrospinal fluid can not be discharged into the dural sinus, so that a large amount of cerebrospinal fluid accumulates in the subarachnoid space and causes non-obstructive hydrocephalus, which presses the brain tissue to the center and away from the skull.
Children with hydrocephalus are characterized by large head, wide cranial suture, patent halogen door, relatively small face, white eyeball under pressure, and mostly sunset eyes. Due to the different degrees of brain tissue compression, there are different degrees of brain development retardation and mental retardation. Because of high intracranial pressure, sick children are prone to vomiting and headache, which affects appetite and development. Severe hydrocephalus often dies during childbirth because of the large skull. Mild hydrocephalus can be treated with cerebrospinal fluid to reduce intracranial pressure, but it is not easy to be completely treated, leaving sequelae and mental retardation. Many people died young.
For hydrocephalus, prevention is very important, and pregnant women should strengthen the prevention and treatment of viral infection in the early pregnancy.
1 1.
Under normal circumstances, the abdominal growth of pregnant women is regular, which is consistent with the month of pregnancy. When the pregnancy is full, the height of the uterus is about 32 ~ 35 cm and the abdominal circumference is about 90 ~ 100 cm. The size of the pregnant woman's belly mainly depends on the weight and volume of the fetus in the uterus, and it is also related to the pregnant woman's weight and thinness, amniotic fluid volume, singleton or twin.
If the pregnant woman's stomach is smaller than the pregnant month, if the uterus is pregnant for 5 ~ 6 months at 7 months, the most likely reason is intrauterine growth retardation.
In addition, such as oligohydramnios, thin and tight abdominal wall, fetal malformation or intrauterine death. , can make the uterus grow slowly, or even stop growing, so that the pregnant woman's stomach is smaller than the pregnant month. Some pregnant women dare not eat enough for fear that their children will have dystocia in the future.
In fact, low birth weight infants have many shortcomings, such as easy hypoxia, low resistance and poor stress. In the process of delivery, fetal distress or neonatal asphyxia, hypoglycemia, fetal neonatal death and other accidents are prone to occur. Perinatal mortality is also higher than that of normal-weight newborns.