浙大医学院附属妇产科医院产科 Company LOGO Normal pregnancy and birth defects HuWenSheng Women’s Hospital School of Medicine Zhejiang University
浙大医学院附属妇产科医院产科 Company LOG Normal Pregnancy-- Terminology Pregnancy The course that the embryo and the fetus grow in the maternal body Stages of pregnancy 1. Early pregnancy: ≤12 weeks 2. Mid pregnancy: ≥13 weeks,≤27 weeks 3. Late pregnancy:≥28 weeks 4. Term pregnancy:≥37 weeks,<42 weeks
浙大医学院附属妇产科医院产科 Company LOG Part I Physiology of Pregnancy
浙大医学院附属妇产科医院产科 Company LOG Formation of Embryo Fertilization 1. Place: oviduct (ampulla) 2. Process capacitation → acrosome reaction→ penetrate the zona pellucida→ second meiosis →zygote
浙大医学院附属妇产科医院产科 Company LOG Formation of Embryo Implantation 1. requirement 1) Disappear of zona pellucida 2) Formation of syncytiotrophoblast 3) Synchronized development of blastocyst and endometrium 4) Adequate progesterone
浙大医学院附属妇产科医院产科 Company LOG Formation of Embryo 2. Process 1) morula (day 3) → enter uterine cavity (day 4) → early blastocyst→ late blastocyst (day 6-7) → implantation 2) location→ adherence→ penetration
浙大医学院附属妇产科医院产科 Company LOG Development of embryo and fetus Definition 1. embryo: ≤ 8 weeks 2. Fetus: ≥ 9 weeks, human shape
浙大医学院附属妇产科医院产科 Company LOG Development of embryo and fetus Physiology of fetus 1. Circulation 1) fetus ←→placenta←→ mater 2) 1 umbilical vein (full of oxygen), 2 umbilical artery (lack of oxygen) 3) Mixed blood (vein and artery)
浙大医学院附属妇产科医院产科 Company LOG Development of embryo and fetus 2. Hematology 1) Erythropoiesis From yolk sac: 3 weeks From liver: 10 weeks From bone marrow and spleen: term (90%) EPO production: 32 nd week
浙大医学院附属妇产科医院产科 Company LOG Development of embryo and fetus 2) Fetal hemoglobin Fetal hemoglobin: early pregnancy Adult hemoglobin: 32 nd week Term: fetal type Hb 25% 3) White cells Leukocytes: 8 week Lymphocytes (antibody production): 12 week, thymus and spleen
浙大医学院附属妇产科医院产科 Company LOG Development of embryo and fetus 3. Gastrointestinal tract 1) drink amniotic fluid: 4 th month 2) no proteolytic activity 3) enzymatic deficiencies in liver: bilirubin is not easy to be clear.
浙大医学院附属妇产科医院产科 Company LOG Development of embryo and fetus 4. Kidney Its function begins at th week 5) Endocrinology 1) Fetal thyroid: the first endocrine gland (6 th week), synthesize thyroxine at 12 th week 2) Fetal adrenal cortex: widen (20 th week), a fetal zone. synthesize steroid hormones (E3, liver placenta mater)
浙大医学院附属妇产科医院产科 Company LOG Placenta Structure 1. Primary villus syncytiotrophoblast cytotrophoblast 2. Secondary villus 3. third class vilus fetal capillary enter the stroma
浙大医学院附属妇产科医院产科 Company LOG Placenta Function 1. metabolism 1) Exchange of O 2 and CO 2 2) Exchange of nutritive factors and waste 2. Defensive Limited. IgG, virus, drug
浙大医学院附属妇产科医院产科 Company LOG Placenta 3. Endocrine 1) HCG 2) HPL 3) E 4) P 5) Oxytocinase 6) Cytokines and Growth Factors 4. Immunity tolerance
浙大医学院附属妇产科医院产科 Company LOG Fetal membranes Structure chorion and amnion Amnion A double-layered translucent membrane Become distended with fluid
浙大医学院附属妇产科医院产科 Company LOG Umbilical Cord Structure amnion, yolk sac, one vein, two artery and Wharton jelly Length 30-70cm
浙大医学院附属妇产科医院产科 Company LOG Amniotic fliud Source 1. exudation of fetal membranes (early pregnancy) 2. Fetal urine 3. Fetal lung 4. Exudation of amnion and fetal skin
浙大医学院附属妇产科医院产科 Company LOG Amniotic fliud Absord 1. Fetal membrane 2. Umbilical cord 3. Fetal skin 4. Fetal drinking Feature ml at 36 th -38 th week (peak), transparent → slightly turbid
浙大医学院附属妇产科医院产科 Company LOG Amniotic Fliud Function 1. Protect fetal move freely, warm 2. Protect mater prevent infection
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman Genital organs 1. Uterus 1) capacity: 5ml-5000ml.weight: 50g-1000g 2) Hypertrophy of muscle cells 3) Endometrium→decidua: basal decidua, capsular decidua, true decidua 4) Contraction: Braxton Hicks 5) Isthmus uteri: 1cm→ 7-10cm
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman 6) Cervix: colored 7) Ovary: placenta replaces ovary (10 th week) 8) Vagina: dilated and soft, pH↓(anti-bacteri bacteria) 9) Ligaments: relaxed
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman Cardiovascular system 1. Heart: move upward, hypertrophy of cardiac muscle 2. Cardiac Output increase by 30%, reach to peak at 32 nd –34 th week 3. Blood pressure early or mid pregnancy Bp↓.late pregnancy Bp↑.Supine hypotensive syndrome
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman Hematology 1. Blood volume 1) Increase by 30%-45% at 32 nd –34 th (peak) 2) Relatively diluted 2. Composition 1) Red cells Hb:130→110g/L, HCT:38%→ 31%. 2) White cells: slightly increase 3) Coagulating power of blood: ↑ 4) Albumin: ↓,35 g/L
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman The Respiratory system 1. R rate: slightly ↑ 2. vital capacity: no change 3. Tidal volume: ↑ 40% 4. Functional residual capacity:↓ 5. O 2 consumption: ↑ 20%
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman The urinary system 1. Kidney 1) Renal plasma flow (RFP):↑35% 2) Glomerular filtration rate (GFR):↑ 50% 2. Ureter Dilated (P↑) 3. Bladder Frequent micturation
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman Gastrointestinal system 1) Gastric emptying time is prolonged→ nausea. 2) The motility of large bowel is diminished → constipation 3) Liver function: unchanged
浙大医学院附属妇产科医院产科 Company LOG Physiologic changes in pregnant woman Endocrine 1. Pituitary (hypertrophy) 1) LH/FSH: ↓ 2) PRL:↑ 3) TSH and ACTH:↑ 2. Thyroid 1) enlarged (TSH and HCG↑) 2) thyroxine↑ and TBG↑ → free T 3 T 4 unchanged
浙大医学院附属妇产科医院产科 Company LOG Part Ⅱ Diagnoses of Pregnancy
浙大医学院附属妇产科医院产科 Company LOG Presumptive Symptoms Amenorrhea: strongly suggestive of pregnancy Nausea and vomiting Morning sickness of pregnancy Results from rapidly rising serum levels of HCG (human chorionic gonadotropin) Begin at 4 weeks and finish at 12 weeks
浙大医学院附属妇产科医院产科 Company LOG Probable Signs Pelvic organs Chadwick’s sign: vaginal mucosa has bluish color (6-8w) Goodell’s sign: cyanosis and softening of cervix(6w) Hegar’s sign: softening between cervix and uterine fundus causes a sensation of separateness between these two structures
浙大医学院附属妇产科医院产科 Company LOG Presumptive Symptoms Breast changes Tenderness and tingling Enlargement (second month ) Nodularity (sebaceous glands) Colostrums secretion (begin after 16 w gestation) Secondary breasts (Axillary breast tissue often cause a symptomatic lump in the axilla)
浙大医学院附属妇产科医院产科 Company LOG Secondary breast Breast Enlargement
浙大医学院附属妇产科医院产科 Company LOG Presumptive Symptoms Urinary tract Frequent urination and nocturia Infection Quickening 16-20weeks in primigravidas weeks in multigravidas Fatigue one of the earliest symptoms of pregnancy returns to normal by the 16 th to 18 th week
浙大医学院附属妇产科医院产科 Company LOG Presumptive signs Skin changes Chloasma:darkening of the skin over forehead, bridge of the nose and cheekbones Linea nigra: darkening of the nipples and lower midline of abdomen Stretch marks: separation of the underling collagen tissue and appear as irregular scars Spider telangiectases
浙大医学院附属妇产科医院产科 Company LOG Pregnancy test Urine pregnancy test Positive around the first missed cycle Serum pregnancy test: more sensitive HCG may be detected in maternal serum in 7 days
浙大医学院附属妇产科医院产科 Company LOG Presumptive signs Increased basal body temperature (>18 days)
浙大医学院附属妇产科医院产科 Company LOG Ultrasound examination of fetus is one of the most useful technical way Cervical mucus examination Progestational challenge Positive manifestations
浙大医学院附属妇产科医院产科 Company LOG Probable Signs Abdominal enlargement (the uterus rises out of the pelvis and into the abdomen) Uterine contractions (Braxton hicks contractions)
浙大医学院附属妇产科医院产科 Company LOG Ballottement (16-20w) Uterine souffle It may be more easily accomplished by a vaginal examination
浙大医学院附属妇产科医院产科 Company LOG Positive manifestations Fetal heart tone ( BPM) Doppler device can detect at 10 weeks
浙大医学院附属妇产科医院产科 Company LOG Lie of fetus Longitudinal lie Transverse lie
浙大医学院附属妇产科医院产科 Company LOG Fetal presentation Determined by the portion of the fetus that can be felt through the cervix Cephalic presentations Classified according to the position of the fetal head in relation to the body of the fetus Breech presentations Classified according to the position the legs and buttocks which present first
浙大医学院附属妇产科医院产科 Company LOG Fetal presentation Cephalic presentation Vertex Face Brow
浙大医学院附属妇产科医院产科 Company LOG Fetal presentation Breech presentation Complete Incomplete frank
浙大医学院附属妇产科医院产科 Company LOG 胎先露:最先进入骨盆入口的胎儿部分
浙大医学院附属妇产科医院产科 Company LOG Fetal position
浙大医学院附属妇产科医院产科 Company LOG 胎方位:胎儿先露部的指示点与母体骨盆的关系 枕左后( LOP) 枕右后( ROP)
浙大医学院附属妇产科医院产科 Company LOG 胎方位:胎儿先露部的指示点与母体骨盆的关系 骶右后( RSP) 肩右前( RScA)
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG Part Ⅲ Antenatal care
浙大医学院附属妇产科医院产科 Company LOG Prenatal care Routine prenatal care Every 4 weeks during the first 28 weeks of gestation Every 2 weeks from 28 to 36 weeks Weekly from 36 weeks to delivery
浙大医学院附属妇产科医院产科 Company LOG Initial Visit History health history childbearing history Estimated date of confinement (EDC ) Physical examination General examination obstetric examination Accessory examination Laboratory Tests US Examination of cytogenetics
Initial Visit History health history childbearing history Estimated date of confinement (EDC) Physical examination Accessory examination General history Previous and current medical disease Diabetes, chronic hypertension Medication Previous surgeries Blood transfusion history Family history
Initial Visit History health history childbearing history Estimated date of confinement (EDC) Physical examination Accessory examination Past pregnancies EGA at the time of delivery or abortion Fetal outcome Mode of delivery: vaginal or cesarean section Complications: GDM, preeclampsia Present pregnancy
History health history childbearing history Estimated date of confinement (EDC) Physical examination Accessory examination the last normal menstrual period Subtract 3 from (or add 9 to) the month of the last normal menstrual period, and add 7 to the first day of the last normal menstrual period 减 3 加 7 (农历加 15 ) US may be used if the LMP is uncertain Initial Visit
History Physical examination General examination obstetric examination Accessory examination Height, weight and blood pressure should be recorded Systolic flow murmur at the left sternal border
Initial Visit History Physical examination General examination obstetric examination Accessory examination 病史 Fundal height Abdominal examination Fetal heart tones Edema 一般情况 检查
浙大医学院附属妇产科医院产科 Company LOG Leopold maneuvers Palpation of fetus (22 weeks) Leopold Maneuver to determine the fetal presentation
Pelvic examination Pelvic examination ) Assessment of pelvic soft tissue: cervix and uterine Bony pelvis external pelvimetry internal pelvimetry
浙大医学院附属妇产科医院产科 Company LOG External pelvimetry 孕妇取伸腿仰卧位,两 髂前上棘外缘的距离, 正 常值为 23-26cm 髂棘间径 髂棘间径 Interspinal diameter (IS)
浙大医学院附属妇产科医院产科 Company LOG External pelvimetry 孕妇取伸腿仰卧位,测 量两髂嵴外缘最宽的距 离,正常值为 25-28cm 髂嵴间径 Intercristal diameter (IC)
浙大医学院附属妇产科医院产科 Company LOG External pelvimetry 第 5 腰椎棘突 下至耻骨联合上 缘中点的距离, 正常值为 18- 2Ocm 骶耻外径 External conjugate (EC)
浙大医学院附属妇产科医院产科 Company LOG External pelvimetry 两坐骨结节内侧 缘的距离,正常值 为 cm 坐骨结节间径或称出口横 径 Transverse outlet
浙大医学院附属妇产科医院产科 Company LOG External pelvimetry 出口后矢状径 Posterior sagital diameter of outlet 坐骨结节间径中点至骶 骨尖端的长度,正常值 为 8-9cm
浙大医学院附属妇产科医院产科 Company LOG External pelvimetry 正常值为 90 度,小于 80 度为不正常,此 角度反映骨盆出口横径的宽度 Angle of pubic arch 耻骨弓角度 Angle of pubic arch
浙大医学院附属妇产科医院产科 Company LOG Internal pelvimetry Diagonal conjugate 对 角 径 Diagonal conjugate 为耻骨联合下缘至骶岬上缘中点的距离,正常值为 cm ,此值减去 1.5-2m 为骨盆入口前后径长度,又称真结合径。
浙大医学院附属妇产科医院产科 Company LOG Internal pelvimetry 两坐骨棘间的距离, 正常值约为 l0cm 坐骨棘间径 Interspinous diameter
浙大医学院附属妇产科医院产科 Company LOG Internal pelvimetry 坐骨切迹宽度 坐骨棘与骶骨下部间的距离, 即骶棘韧带宽度,将阴道内的 食指置于韧带上移动,若能容 纳 3 横指 ( 约 5.5-6cm) 为正常, 否则属中骨盆狭窄
Initial Visit History Physical examination Accessory examination Laboratory Tests Ultrasound examinations Examination of cytogenetics Blood screening Blood routine test Blood type (ABO and RH) Detect diseases: rubella, syphilis, hepatitis B, HIV Screening test for certain diseases according family history Diabetes screen Urinalysis Infectious disease: gonorrhea, chlamydia, group B streptococcus, et al
浙大医学院附属妇产科医院产科 Company LOG Subsequent visit History Pregmant women examinations height, abdominal parameter, weight, et Fetal examinations Estimation of fetal weight Monitoring fetal well Prenatal diagnosis
浙大医学院附属妇产科医院产科 Company LOG Methods of assessment for fetal at risk Fetal movement After 28 weeks, patients should be instructed to do fetal kick counts Normal: 30 fetal movements in 12 hours
浙大医学院附属妇产科医院产科 Company LOG Methods of assessment for fetal at risk Ultrasound (fetal number, presentation, viability, placental location, gestational age and fetal anatomy, multiple sonographic markers for aneuploidy screening) Biophysical profile and Doppler velocimetry
浙大医学院附属妇产科医院产科 Company LOG Methods of assessment for fetal at risk External fetal monitoring Internal fetal monitoring
浙大医学院附属妇产科医院产科 Company LOG Fetal heart rate interpretation Baseline Rate Normal: 120~160 bpm Affected by following factors: Gestational age Fetal status Maternal fever \ position \ drugs
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG Periodic changes Accelerations Decelerations Early Late Variable Sinusoidal patterns
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG
浙大医学院附属妇产科医院产科 Company LOG Contraction Stress Test Adequate contraction pattern at least 3 contractions of 40 seconds’ duration in a 10-minute period Negative: no late or significant VD Positive: LD following 50% or more of contractions Equivocal-suspicious: intermittent LD or significant VD
浙大医学院附属妇产科医院产科 Company LOG Methods of assessment for fetal at risk NST Fetal breathing movements Fetal movement Fetal tone Determination of the amniotic fluid volume ----Biophysical profile
浙大医学院附属妇产科医院产科 Company LOG Manning 评分
浙大医学院附属妇产科医院产科 Company LOG Fetal maturity tests Lung maturity is essential for normal respiration immediately after birth Assessment by measuring surface-active lipid components of surfactant (lecithin, phosphatidyl glycerol)
浙大医学院附属妇产科医院产科 Company LOG Fetal maturity tests Methods (measuring surface-active lipid components of surfactant ) Lecithin: Sphingomyelin (L: S) Ratio Phosphatidylglycerol (PG) Foam stability index (FSI)
浙大医学院附属妇产科医院产科 Company LOG Part Ⅳ Prenatal Screening, Diagnosis and Genetic counseling
浙大医学院附属妇产科医院产科 Company LOG What is genetic counselling The process by which patients or relatives at risk of a disorder that may be hereditary are advised of the consequences of the disorder, the probability of developing or transmitting it, and of the ways in which this may be prevented, avoided or ameliorated
浙大医学院附属妇产科医院产科 Company LOG Genetic Counseling Is a communication process which deals with the human problems associated with the occurrence, or the risk of occurrence, of a genetic disorder in a family.
浙大医学院附属妇产科医院产科 Company LOG WHAT DO GENETIC COUNSELORS DO? Provide information and support to families who have members with birth defects or genetic disorders and to families who may be at risk for a variety of inherited conditions. Identify families at risk, investigate the problem present, interpret information about the disorder, analyze inheritance patterns and risks of recurrence and review available options with the family.
浙大医学院附属妇产科医院产科 Company LOG Referral of Clients 1. Those couples who have had a child with a birth defect or known genetic disorder 2. Those who are known to be heterozygous carriers of a specific genetic disease 3. Those who have known or suspected inherited disorder in the family and are either contemplating marriage or starting a family
浙大医学院附属妇产科医院产科 Company LOG 4. Those who are experiencing reproductive problems such as infertility, multiple miscarriage, or stillbirths 5. Those who are contemplating marriage to relative or an interracial marriage 6. Those with possible exposure to toxic agents, illness, or mutagens during peregancy 7. Women 35 years of age, and older, who are considering prenatal diagnosis Genetic counseling is also offered in conjunction with screening programs
浙大医学院附属妇产科医院产科 Company LOG Components of genetic counseling (1) Initial interview (2) Obtaining a history and preparing a pedigree (3) Establishing diagnosis (4) Determining and communicating recurrence risks and discussing the disorder (5) Follow-up (6) Evaluation
浙大医学院附属妇产科医院产科 Company LOG This process involves an attempt by one or more appropriately trained persons to help the individual or family. ( 1 ) comprehended the medical facts: diagnosis, probable course of the disorder, & available management. ( 2 ) appreciate the way heredity contributes to the disorder, and the risk of recurrence in specified relatives.
浙大医学院附属妇产科医院产科 Company LOG (3) understand the options for dealing with the risk of recurrence. (4) choose the course of action which seems appropriate to them in view of their risk and their family goals and act in accordance with that decision. (5) make the best possible adjustment to the disorder in an affected family and/or to the risk of recurrence of that disorder.
浙大医学院附属妇产科医院产科 Company LOG Prenatal Screening, Diagnosis and Treatment A relatively new field within obstetrics Related to the advent and advancement of realtime US Screening: select high-risk individuals at risk for a given diagnosis or complication Diagnosis: diagnostic and usually far more specific than screening, but bear a greater risk of complications
浙大医学院附属妇产科医院产科 Company LOG Screening for genetic diseases The diseases are passed genetically from parents to their offsping Autosomal dominant or recessive disease X-linked disorder The first step in determining fetal risk is to screen the mother for the diease Which is ususally done in higher risk groups
浙大医学院附属妇产科医院产科 Company LOG Common genetic diseases Autosomal dominant or recessive disease Cystic fibrosis 囊性纤维变性 Sickle-cell disease 镰状细胞 ( 贫血 ) 病 Tay-Sachs disease Thalassemia [θælə'si:miə ] 地中海贫血 X-linked disorders Hemophilia [hi:mə'filiə] 血友病
浙大医学院附属妇产科医院产科 Company LOG Chromosomal abnormalities Aneuploidy (extra or missing chromosomes) Generally the cause of these syndromes Obvious phenotypic differences and congenital anomalies, not always be detected by prenatal US Fetal karyotype is the only way to achieve a definitive diagnosis of aneuploidy Screening test are exist for some syndromes
浙大医学院附属妇产科医院产科 Company LOG Chromosomal abnormalities Trisomy usually results in early abortion An infant is occasionally born with trisomy or triploidy and survive Down syndrome(Trisomy 21) Trisomy 18 Trisomy 13
浙大医学院附属妇产科医院产科 Company LOG Sex chromosomal abnormalities Most common sex chromosome aneuploides 45XO: turner syndrome, monosomy X 47XXY: klinefelter syndrome The most common aneuploidies are those of sex chromosomes. They are less severely affected than the autosomal aneuploidies No screening test for these two syndormes Diagnosed by prenatal diangosis
浙大医学院附属妇产科医院产科 Company LOG Fetal congenital anomalies Primarily arise during embryogenesis, but also can progress as development continues Occur in any organ system Neural tube Defects: spina bifida and anencephaly Associated with folate deficency and can be screened Cardiac Defects Potter Syndrome
浙大医学院附属妇产科医院产科 Company LOG Indications for prenatal diagnosis: advanced maternal age previous child with a chromosome abnormality family history of a chromosome abnormality family history of single gene disorder family history of a neural tube defect family history of other congenital structural abnormalities abnormalities identified in pregnancy other high risk factors (consanguinity, poor obst., history, maternal illnesses
浙大医学院附属妇产科医院产科 Company LOG Methods of prenatal diagnosis Invasive: Amniocentesis Chorionic villus sampling Cordocentesis Preimplatation genetic diagnosis Fetoscopy Non-invasive testing: Maternal serum AFP Maternal serum screen Ultrasonography Isolation of fetal cells from maternal circulation
浙大医学院附属妇产科医院产科 Company LOG Prenatal screening First trimester US: Nuchal translucency (NT) Serum screen: HCG+PAPP-A Second trimester Triple screen: MSAFP, estriol andβ-hCG Quad screen: MSAFP, estriol, β-hCG and inhibinA US
浙大医学院附属妇产科医院产科 Company LOG First Trimester NT (Nuchal translucency) PAPP-A (pregnancy associated plasma protein-A) hCG (human chorionic gonadotropin)
浙大医学院附属妇产科医院产科 Company LOG Ultrasonography The mid-trimester anomaly scan: for structural abnormality at wks. Cardiac defect. NTD: 95% of all spina bifida( lemon sign) ( banana sign) Gastrointestinal abnormalities: anterior abdominal wall defect( omphalocele and gastroschisis) /obstruction and atresia. Thoracic abnormalities: congenital diaphragmatic hernia
浙大医学院附属妇产科医院产科 Company LOG Prenatal diagnosis Amniocentesis Aspiration of ml of amniotic fluid through the abdominal wall under ultrasound guidance around the 16 weeks of gestation. Risk (1/200): rupture of membranes, preterm labor and rarely fetal injury
浙大医学院附属妇产科医院产科 Company LOG Prenatal diagnosis Amniocentesis. 1. Chromosomal analysis: most commonly Down syndrome testing for maternal age, high risk serum tests and ultrasound markers. 2. DNA analysis for genetic disease. 3. Enzyme assays for inborn errors of metabolism. 4. Investigation of fetal lung maturity 5. Bilirubin ( for rhesus iso-immunization)
浙大医学院附属妇产科医院产科 Company LOG Prenatal diagnosis Chorionic villus sampling It enables diagnosis in first trimester (10-11 week of gest.) under ultrasound guidance by transcervical or transabdominal aspiration of chorionic villi These are fetal cells drived from the outer layer of trophoblast. Risk is higher: preterm labor, premature rupture of membrane, previable labor, fetal injury
浙大医学院附属妇产科医院产科 Company LOG Prenatal diagnosis Cordocentesis Visualisation of the umbilical vessels by transabdominal ultrasound and enabling fetal blood sampling.
浙大医学院附属妇产科医院产科 Company LOG Prenatal diagnosis Fetoscopy Visualisation of foetus by means of endoscope It can be undertaken to diagnose a subtle structural abnormalities pointing to a serious diagnosis Can also be used to obtain fetal samples for some diagnosis as inherited skin disorders
浙大医学院附属妇产科医院产科 Company LOG Preimplantation genetic diagnosis
浙大医学院附属妇产科医院产科 Company LOG