产前保健指南解读课件

产前保健指南解读产前保健存在的问题产前保健存在的问题n n缺乏产前检查的规范化方案缺乏产前检查的规范化方案n n盲目开出一些无关紧要的检查项目盲目开出一些无关紧要的检查项目 又常漏掉重要的检查项目又常漏掉重要的检查项目n n 不合理补充营养素不合理补充营养素n n不重视孕期健康教育及指导不重视孕期健康教育及指导 2020/11/32本指南制订的意义本指南制订的意义n n传统产前检查模式缺乏循证医学证据的支持传统产前检查模式缺乏循证医学证据的支持 n n全国各地产前检查的方案差异较大全国各地产前检查的方案差异较大n n许多国家早已发布了自己的产前保健指南并不断更新许多国家早已发布了自己的产前保健指南并不断更新n n孕期保健指南将规范产前检查的时间和内容孕期保健指南将规范产前检查的时间和内容 2020/11/33指南说明指南说明n n 强化循证医学的理念强化循证医学的理念n n本指南包括：孕前保健和孕期保健本指南包括：孕前保健和孕期保健n n每次检查的内容均包含：每次检查的内容均包含：1.1.健康教育及指导健康教育及指导 2.2.常规保健常规保健 3.3.辅助检查（必查项目和备查项目）辅助检查（必查项目和备查项目）n n本次发布：文字版本次发布：文字版+表格版表格版2020/11/34 孕前保健（孕前3月）n n参照国家计生委国家免费孕前优生健康检查项目参照国家计生委国家免费孕前优生健康检查项目试点工作技术服务规范试点工作技术服务规范(2010)(2010)，卫生部孕前保，卫生部孕前保健服务工作规范（健服务工作规范（20072007年）年）n n将辅助检查分为必查项目和备查项目，减少必查项将辅助检查分为必查项目和备查项目，减少必查项目，增加备查项目。目，增加备查项目。2020/11/35健康教育及指导1.1.有计划的妊娠有计划的妊娠2.2.合理营养合理营养,控制体重控制体重3.3.遗传病、慢性病、传染病的评估遗传病、慢性病、传染病的评估4.4.合理用药合理用药5.5.避免接触有毒有害物质和宠物避免接触有毒有害物质和宠物6.6.改变不良生活方式改变不良生活方式;避免高强度的工作、高噪音环境和家庭避免高强度的工作、高噪音环境和家庭暴力暴力7.7.保持心理健康保持心理健康8.8.合理运动方式合理运动方式9.9.补充叶酸补充叶酸2020/11/36特别说明 叶酸补充叶酸补充 ：0.4mg0.8mg/d0.4mg0.8mg/d，或含叶酸的复合维生素，或含叶酸的复合维生素 The U.S.Preventive Services Task Force(USPSTF)and Centers for Disease Prevention and Control(CDC)The U.S.Preventive Services Task Force(USPSTF)and Centers for Disease Prevention and Control(CDC)recommend that all women of childbearing age take a daily vitamin supplement containing 400 to 800 recommend that all women of childbearing age take a daily vitamin supplement containing 400 to 800 micrograms of folic acid.micrograms of folic acid.Ann Intern Med 2009;150:632-39.Ann Intern Med 2009;150:632-39.既往发生过既往发生过NTDNTD的孕妇，则需每天补充叶酸的孕妇，则需每天补充叶酸4mg4mg Vincenzo Berghella.Obstetric Evidence Based Guidelines.London:Informa;2007Vincenzo Berghella.Obstetric Evidence Based Guidelines.London:Informa;2007 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Management Working Group;20092020/11/37必查项目（1 1）血常规）血常规（2 2）尿常规）尿常规（3 3）血型（）血型（ABOABO和和RhRh）（4 4）肝功能）肝功能（5 5）肾功能）肾功能（6 6）空腹血糖）空腹血糖 （7 7）HBsAgHBsAg（8 8）梅毒筛查）梅毒筛查（9 9）HIVHIV筛查筛查 （1010）宫颈细胞学检查）宫颈细胞学检查(1(1年内未查者）年内未查者）2020/11/38备查项目(1)TORCH(1)TORCH筛查筛查(2)(2)宫颈阴道分泌物检查宫颈阴道分泌物检查(白带常规、淋球菌、沙眼衣原体白带常规、淋球菌、沙眼衣原体)(3)(3)甲状腺功能检测甲状腺功能检测(4)(4)地中海贫血筛查（广东、广西、海南、湖南、湖北、四川、重庆等地）地中海贫血筛查（广东、广西、海南、湖南、湖北、四川、重庆等地）(5)75g OGTT(5)75g OGTT(高危妇女高危妇女)(6)(6)血脂检查血脂检查(7)(7)妇科超声妇科超声(8)(8)心电图心电图(9)(9)胸部线胸部线2020/11/39孕期保健n n孕期保健的日程安排要根据产前检查的目的来孕期保健的日程安排要根据产前检查的目的来决定决定 n n本指南推荐的产前检查的孕周分别是：本指南推荐的产前检查的孕周分别是：Health Care Guideline:Routine Prenatal Care.14th Edition.Minnesota:ICSI;2010Health Care Guideline:Routine Prenatal Care.14th Edition.Minnesota:ICSI;20102020/11/310n首次（妊娠 6-13+6 周）产前检查2020/11/311健康教育及指导1.1.流产的认识和预防流产的认识和预防2.2.生活方式的指导生活方式的指导3.3.避免接触有毒有害物质和宠物避免接触有毒有害物质和宠物4.4.慎用药物慎用药物5.5.孕期疫苗的接种孕期疫苗的接种6.6.改变不良生活方式改变不良生活方式;避免高强度的工作、高噪音环境和家庭暴力避免高强度的工作、高噪音环境和家庭暴力7.7.保持心理健康保持心理健康8.8.继续补充叶酸继续补充叶酸0.4mg0.8mg/d0.4mg0.8mg/d至至3 3个月个月,有条件继续服用含叶酸的复合有条件继续服用含叶酸的复合维生素维生素 2020/11/312必查项目 1.1.血常规血常规2.2.尿常规尿常规3.3.血型（血型（ABOABO和和RhRh）4.4.肝功和肾功肝功和肾功5.5.空腹血糖空腹血糖6.6.HBsAgHBsAg 7.7.梅毒筛查梅毒筛查8.HIV8.HIV筛查筛查2020/11/313备查项目1.HCV1.HCV筛查筛查 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.20082.2.抗抗D D滴度滴度(Rh(Rh阴性者阴性者)Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007 3.75g OGTT(3.75g OGTT(高危孕妇高危孕妇)Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;20094.4.地中海贫血筛查地中海贫血筛查5.5.甲状腺功能筛查甲状腺功能筛查Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;20095.5.甲状腺功能筛查甲状腺功能筛查Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;20092020/11/314备查项目6.6.血清铁蛋白血清铁蛋白(Hb(Hb105g/L105g/L者）者）Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Management Working Group;20097.7.结核菌素结核菌素(PPD)(PPD)试验（高危孕妇）试验（高危孕妇）Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Management Working Group;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007 8.8.宫颈细胞学检查（孕前宫颈细胞学检查（孕前1212月未查者）月未查者）Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Management Working Group;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007 裘佳敏裘佳敏,刘铭刘铭,段涛段涛.产前检查产前检查.中华全科医师杂志中华全科医师杂志,2007,6(6):334-336,2007,6(6):334-336 2020/11/315备查项目9.9.宫颈分泌物检测淋球菌和沙眼衣原体宫颈分泌物检测淋球菌和沙眼衣原体(高危孕妇或有症状者高危孕妇或有症状者)Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Group;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007 董悦董悦.对围产期对围产期TORCHTORCH感染筛查的重新评价感染筛查的重新评价.中华妇产科杂志，中华妇产科杂志，2004,392004,39（1111）:725-728:725-72810.10.细菌性阴道病的检测（早产史者）细菌性阴道病的检测（早产史者）Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Group;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;200711.11.心电图检查心电图检查2020/11/316备查项目12.12.超声检查超声检查n n早孕期：确定宫内妊娠、孕周、双胎绒毛膜性早孕期：确定宫内妊娠、孕周、双胎绒毛膜性n n 妊娠妊娠11-1311-13+6+6周：周：测量胎儿测量胎儿NTNT厚度并核定孕周厚度并核定孕周 NT NT测量按照英国胎儿医学基金会标准进行测量按照英国胎儿医学基金会标准进行（）（）2020/11/317支持文献1.Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;20091.Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;20092.Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:2.Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Pregnancy Management Working Group;20093.Obstetric Evidence Based Guidelines.London:Informa;20073.Obstetric Evidence Based Guidelines.London:Informa;20074.4.严英榴严英榴.胎儿结构异常的早孕期超声筛查胎儿结构异常的早孕期超声筛查.中国实用妇科与产科杂志中国实用妇科与产科杂志,2008,24,2008,24（2 2）：）：102-106102-1065.Nicolaides KH5.Nicolaides KHIncreased nuchal translucency with normal karyotype/Nicolaides KH Increased nuchal translucency with normal karyotype/Nicolaides KH.The 11-13+6 weeks scan.The 11-13+6 weeks scanLondon:Fetal Medicine FoundationLondon:Fetal Medicine Foundation，20042004，71-9471-946.American Institute of Ultrasound in Medicine6.American Institute of Ultrasound in MedicineAIUM Practice Guideline for the AIUM Practice Guideline for the Performance of an Antepartum Obstetric Ultrasound ExaminationEB/OLPerformance of an Antepartum Obstetric Ultrasound ExaminationEB/OL 2020/11/318备查项目 13.13.早孕期母体血清学筛查早孕期母体血清学筛查(PAPP-A(PAPP-A 和游离和游离-hCG)-hCG)(妊娠妊娠10131013+6+6周周)注意事项：空腹；超声确定孕周；确定抽血当天的注意事项：空腹；超声确定孕周；确定抽血当天的体重。体重。高危者，可考虑绒毛活检或联合中孕期血清学筛查高危者，可考虑绒毛活检或联合中孕期血清学筛查结果再决定羊膜腔穿刺检查结果再决定羊膜腔穿刺检查1.1.李之朋李之朋,杨春艳杨春艳,陈敏陈敏.唐氏综合征的早期筛查唐氏综合征的早期筛查.中国实用妇科与产科杂志中国实用妇科与产科杂志,2008,24,2008,24（2 2）：）：87-9087-902.ACOG Practice Bulletin No.77:Screening for fetal chromosomal abnormalities.American College of Obstetricians and Gynecologists.2.ACOG Practice Bulletin No.77:Screening for fetal chromosomal abnormalities.American College of Obstetricians and Gynecologists.Obstet GynecolObstet Gynecol,2007,109(1):217-227.,2007,109(1):217-227.3.Wald NJ,Rodeck C,Hackshaw AK,et al.First and second trimester antenatal screening for Down syndrome:the results of the serum,3.Wald NJ,Rodeck C,Hackshaw AK,et al.First and second trimester antenatal screening for Down syndrome:the results of the serum,urine and ultrasound screening study(SURUSS).urine and ultrasound screening study(SURUSS).Health Technol Assess,Health Technol Assess,2003,7:1-77.2003,7:1-77.4.Malone FD,Canick JA,Ball RH,et al.First trimester or second trimester screening,or both,for Downs syndrome4.Malone FD,Canick JA,Ball RH,et al.First trimester or second trimester screening,or both,for Downs syndrome（FASTERFASTER）.N N Engl J Med Engl J Med 2005;353:2001-2011.2005;353:2001-2011.5.Wald NJ,Nuttly WJ,Hackshaw AK.Antenatal screening for Down syndrome with the quadruple test.5.Wald NJ,Nuttly WJ,Hackshaw AK.Antenatal screening for Down syndrome with the quadruple test.Lancet,Lancet,2003,361:835-8362003,361:835-836 2020/11/319备查项目 14.14.妊娠妊娠 10-12 10-12周周行绒毛活检（高危孕妇行绒毛活检（高危孕妇）Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Antenal screening and diagnostic testing for singleton pregnancies.Obstetric guideline17.Vancouver:Antenal screening and diagnostic testing for singleton pregnancies.Obstetric guideline17.Vancouver:BCRCPBCRCP;2003;2003 2020/11/320n妊娠 14-19+6周 产前检查2020/11/321健康教育及指导1.1.流产的认识和预防流产的认识和预防2.2.妊娠生理知识妊娠生理知识3.3.孕期营养和生活方式的指导孕期营养和生活方式的指导4.4.中孕期胎儿非整倍体筛查的意义中孕期胎儿非整倍体筛查的意义5.Hb105g/L,5.Hb105g/L,补充元素铁补充元素铁60-100mg/d60-100mg/d6.6.开始补充钙剂开始补充钙剂,600mg/d,600mg/d 2020/11/322特别说明n nHb105g/L,Hb105g/L,补充元素铁补充元素铁60-100mg/d60-100mg/d Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008.Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008.Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009n n补充钙剂补充钙剂,600mg/d,600mg/d Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;20072020/11/323必查项目必查项目 无2020/11/324备查项目n n胎儿非整倍体中孕期血清学筛查（胎儿非整倍体中孕期血清学筛查（AFP,hCG and AFP,hCG and uE3uE3）(妊娠妊娠15201520+0+0周，最佳孕周周，最佳孕周16-1816-18周周)2020/11/325支持文献1.Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;20091.Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;20092.Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy 2.Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Management Working Group;20093.Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008.3.Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008.4.Antenal screening and diagnostic testing for singleton pregnancies.Obstetric 4.Antenal screening and diagnostic testing for singleton pregnancies.Obstetric guideline17.Vancouver:guideline17.Vancouver:BCRCPBCRCP;2003;20035.ACOG Practice Bulletin No.77:Screening for fetal chromosomal abnormalities.American College 5.ACOG Practice Bulletin No.77:Screening for fetal chromosomal abnormalities.American College of Obstetricians and Gynecologists.of Obstetricians and Gynecologists.Obstet GynecolObstet Gynecol,2007,109(1):217-227.,2007,109(1):217-227.6.Wald NJ,Rodeck C,Hackshaw AK,et al.First and second trimester antenatal screening for Down 6.Wald NJ,Rodeck C,Hackshaw AK,et al.First and second trimester antenatal screening for Down syndrome:the results of the serum,urine and ultrasound screening study(SURUSS).syndrome:the results of the serum,urine and ultrasound screening study(SURUSS).Health Health Technol Assess,Technol Assess,2003,7:1-77.2003,7:1-77.7.Malone FD,Canick JA,Ball RH,et al.First trimester or second trimester screening,or both,for 7.Malone FD,Canick JA,Ball RH,et al.First trimester or second trimester screening,or both,for Downs syndromeDowns syndrome（FASTERFASTER）.N Engl J Med N Engl J Med 2005;353:2001-2011.2005;353:2001-2011.8.Wald NJ,Nuttly WJ,Hackshaw AK.Antenatal screening for Down syndrome with the quadruple 8.Wald NJ,Nuttly WJ,Hackshaw AK.Antenatal screening for Down syndrome with the quadruple test.test.Lancet,Lancet,361:835-36,2003.361:835-36,2003.9.9.周建军周建军,胡娅莉胡娅莉.唐氏综合征的中孕期筛查唐氏综合征的中孕期筛查.中国实用妇科与产科杂志中国实用妇科与产科杂志,2008,24:90-93,2008,24:90-932020/11/326备查项目 n n羊膜腔穿刺检查胎儿染色体羊膜腔穿刺检查胎儿染色体（妊娠（妊娠16-2116-21周）周）(预产期时孕妇年龄预产期时孕妇年龄3535岁或高危人群）岁或高危人群）卫生部卫生部.产前诊断技术管理办法产前诊断技术管理办法(2002(2002年年)2020/11/327n妊娠 20-24周 产前检查 2020/11/328健康教育及指导1.1.早产的认识和预防早产的认识和预防2.2.营养和生活方式的指导营养和生活方式的指导 3.3.胎儿系统超声筛查的意义胎儿系统超声筛查的意义 2020/11/329必查项目1.1.胎儿系统超声筛查胎儿系统超声筛查（妊娠（妊娠18-2418-24周）周）：筛查胎儿的：筛查胎儿的严重畸形严重畸形2.2.血常规血常规3.3.尿常规尿常规 2020/11/330支持文献n n18-2218-22周周 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007 n n18-2118-21周周 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008.Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008.n n18-2018-20周周 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007n n18-2318-23周周 陈敏陈敏.胎儿结构异常的中孕期超声筛查胎儿结构异常的中孕期超声筛查.中国实用妇科与产科杂志中国实用妇科与产科杂志,2008,24(2):106-110,2008,24(2):106-110 严英榴严英榴.先天性心脏病的产前筛查及诊断先天性心脏病的产前筛查及诊断.中华临床医师杂志中华临床医师杂志,2010,4(6):706-710,2010,4(6):706-710 Stansard views for examination of the fetus/Pilu G Nicolaides KH,Ximenes R,et al.The 18-23 weeks scan.London:ISUOG Stansard views for examination of the fetus/Pilu G Nicolaides KH,Ximenes R,et al.The 18-23 weeks scan.London:ISUOGFetal Fetal Medicine Foundation Medicine Foundation，2002.2002.n n18-2418-24周周 段涛段涛.产前检查产前检查.中华全科医师杂志中华全科医师杂志,2007,6(6):334-336,2007,6(6):334-336 n n16-2416-24周周 卫生部卫生部.产前诊断技术管理办法产前诊断技术管理办法(2003(2003年年)2020/11/331备查项目n n宫颈评估（超声测量宫颈长度和内口宽度）宫颈评估（超声测量宫颈长度和内口宽度）中华医学会妇产科分会产科学组中华医学会妇产科分会产科学组.早产的临床诊断与治疗推荐指南早产的临床诊断与治疗推荐指南(草案草案).).中华妇产科杂志中华妇产科杂志,2007,42(7):498-500,2007,42(7):498-500 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Group;2009 2020/11/332n妊娠 24-28周 产前检查2020/11/333健康教育及指导1.1.早产的认识和预防早产的认识和预防2.GDM2.GDM筛查的意义筛查的意义 2020/11/334必查项目1.GDM1.GDM筛查筛查 50g GCT 50g GCT：7.2mmol/L,11.1 mmol/L,7.2mmol/L,11.1 mmol/L,则进行则进行75g OGTT 75g OGTT 11.1mmol/L,11.1mmol/L,即测空腹血糖即测空腹血糖 直接行直接行75g OGTT(75g OGTT(空腹空腹5.1mmol/L,15.1mmol/L,1小时小时10.0mmol/L,210.0mmol/L,2小时小时8.5mmol/L)8.5mmol/L)International association of diabetes and pregnancy study groups recommendations on the diagnosis and International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy classification of hyperglycemia in pregnancy Diabetes Care,2010,33:676-682.Diabetes Care,2010,33:676-682.2.2.尿常规尿常规2020/11/335备查项目1.1.抗抗 D D 滴度复查滴度复查(Rh(Rh 阴性者阴性者)2.2.宫颈阴道分泌物宫颈阴道分泌物 fFN fFN 检测检测(早产高危者早产高危者)Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009中华医学会妇产科分会产科学组中华医学会妇产科分会产科学组.早产的临床诊断与治疗推荐指南早产的临床诊断与治疗推荐指南(草案草案).).中华妇产科杂志中华妇产科杂志,2007,42(7):498-500,2007,42(7):498-500时春艳时春艳.胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值中华围产医学杂志胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值中华围产医学杂志,2006,9(1):2-5,2006,9(1):2-5 2020/11/336n妊娠 30-32周 产前检查2020/11/337健康教育及指导1.1.分娩方式指导分娩方式指导2.2.注意胎动注意胎动 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.20082008 不主张胎动计数不主张胎动计数3.3.母乳喂养指导母乳喂养指导4.4.新生儿护理指导新生儿护理指导2020/11/338必查项目1.1.血常规血常规2.2.尿常规尿常规 3.3.超声检查：胎儿生长、羊水量、胎位、胎盘超声检查：胎儿生长、羊水量、胎位、胎盘 Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.20082020/11/339备查项目1.1.超声测量宫颈长度超声测量宫颈长度 （早产高危者）（早产高危者）2.2.宫颈阴道分泌物检测宫颈阴道分泌物检测 fFN fFN （早产高危者）（早产高危者）2020/11/340n妊娠 32-36周 产前检查 2020/11/341健康教育及指导1.分娩前生活方式的指导2.分娩相关知识 3.新生儿疾病筛查 4.抑郁症的预防 2020/11/342必查项目 尿常规尿常规2020/11/343备查项目1.1.妊娠妊娠35-3735-37周周 GBS GBS筛查：具有高危因素的孕妇（如合并糖尿病、前次新生筛查：具有高危因素的孕妇（如合并糖尿病、前次新生儿有儿有GBSGBS感染等），取肛周与阴道下感染等），取肛周与阴道下1/31/3分泌物培养分泌物培养 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 Health Care Guideline:Routine Prenatal Care.13th Edition.Minnesota:ICSI;2009 （常规筛查）（常规筛查）Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009（常规筛查）（常规筛查）Obstetric Evidence Based Guidelines.London:Informa;2007 Obstetric Evidence Based Guidelines.London:Informa;2007（常规筛查）（常规筛查）Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008（不主张常规筛查）（不主张常规筛查）2.2.妊娠妊娠32343234周周肝功、血清胆汁酸检测（高发病率地区疑似肝功、血清胆汁酸检测（高发病率地区疑似ICPICP的孕妇）的孕妇）3.NST3.NST检查检查(妊娠妊娠3434周开始，高危孕妇周开始，高危孕妇)Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.20084.4.心电图复查（高危孕妇心电图复查（高危孕妇）2020/11/344n妊娠37-41周产前检查（7-11次）2020/11/345健康教育及指导1.1.分娩相关知识（临产的症状、分娩方式、分娩镇痛）分娩相关知识（临产的症状、分娩方式、分娩镇痛）2.2.新生儿免疫接种指导新生儿免疫接种指导3.3.产褥期指导产褥期指导4.4.胎儿宫内情况的监护胎儿宫内情况的监护5.5.4141周周,住院并引产住院并引产 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Clinical Practice Guideline for Pregnancy Management.Version 2.0.Washington,DC:Pregnancy Management Working Group;2009 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008 Antenatal care routine care for the healthy pregnant woman.NICE clinical guideline 62.2008 中华医学会妇产科学分会产科学组中华医学会妇产科学分会产科学组.妊娠晚期促宫颈成熟与引产指南妊娠晚期促宫颈成熟与引产指南(草案草案).).中华妇产科杂志中华妇产科杂志,2008,43(1):75-76,2008,43(1):75-76 2020/11/3