High-risk pregnancy

　　The uterus of high-risk pregnancy often cannot communicate with the other side of the well-developed uterine cavity, so the残角子宫can be fertilized in the following two possible ways: one is that the sperm wanders from the contralateral fallopian tube to the affected fallopian tube to combine with the egg and enter the残角; the other is that the fertilized egg wanders from the contralateral fallopian tube to the affected fallopian tube and enters the残角for implantation and development. The muscular wall of the cornual uterus in high-risk pregnancy is often underdeveloped and cannot withstand the growth and development of the fetus. Most of them have a complete or incomplete muscular layer rupture between 14-20 weeks of pregnancy, causing severe internal hemorrhage, symptoms similar to those of fallopian tube interstitial pregnancy rupture. Occasionally, some reach full term, and uterine contractions may occur during delivery, but since it is impossible to deliver vaginally, the fetus often dies during labor. High-risk pregnancy should be diagnosed and operated on as soon as possible. Under the supervision of electronic laparoscopy, the cornual uterus should be resected by combined hysteroscopy and laparoscopy. If it is a viable fetus, cesarean section should be performed first, followed by the resection of the cornual uterus. Normally, the embryo is implanted in the uterine cavity after a woman becomes pregnant, which is called intrauterine pregnancy. If it is implanted in some place outside the uterine cavity, it is called extrauterine pregnancy, which is also known as ectopic pregnancy in medicine. The site of high-risk pregnancy (ectopic pregnancy) is most often seen in the fallopian tube, and it can also be seen in the ovary, cervix, and other places. If the surviving embryo in the fallopian tube pregnancy falls into the abdominal cavity, it may occasionally continue to grow on the omentum and other visceral organs in the abdominal cavity, forming abdominal pregnancy. If the implanted embryo in the fallopian tube separates from the tubal wall and flows into the abdominal cavity, it forms a tubal pregnancy abortion; if the villi of the embryo penetrate the tubal wall and rupture, it forms a tubal pregnancy rupture; both can cause intra-abdominal hemorrhage, but the latter is more serious, often leading to shock due to a large amount of internal hemorrhage, even threatening life.

　　Patients with high-risk pregnancy (ectopic pregnancy) often report severe abdominal pain around the 12th week of pregnancy, which may be accompanied by or without vaginal bleeding, and the uterus shows asymmetrical enlargement. If there is no miscarriage in the early pregnancy, these symptoms will disappear by the second trimester of pregnancy. In fact, there is no absolute boundary between cornual pregnancy and normal pregnancy in terms of anatomy. Therefore, the incidence of cornual pregnancy will depend on the extremely mild symptoms at the early pregnancy of the patient, and further examination is required to be discovered.

　　Pregnancy-induced hypertension syndrome, pregnancy-related hemorrhage, abnormal placenta, prolonged pregnancy, polyhydramnios, macrosomia or microsomia of the fetus, intrauterine distress of the fetus, intrauterine growth restriction of the fetus, abnormal placental position, and incompatibility of maternal and fetal blood types are common complications of high-risk pregnancy.

　　1. Difficulties in estimating delivery during pregnancy:such as pelvic narrowness, malpresentation of the fetus, abnormal umbilical cord, cephalopelvic disproportion, and possible postpartum hemorrhage, postpartum infection, or postpartum shock.

　　2. Complications of pregnancy with internal medical diseases:Such as heart disease, hypertension, kidney disease, diabetes, viral hepatitis, and others.

　　3. Viral infections:Such as cytomegalovirus, herpes virus, rubeola virus, and others, which can lead to fetal abortion, preterm birth, stillbirth, and others.

　　The clinical manifestations of high-risk pregnancy are divided into pre-pregnancy high-risk and post-pregnancy high-risk.

　　First, pre-pregnancy high-risk

　　Prepregnancy examination:

　　History of abnormal pregnancy and childbirth: such as multiple miscarriages; had preterm birth, prolonged pregnancy, stillbirth, and various difficult deliveries; delivered macrosomia and low birth weight infants, congenital malformation infants; had cesarean section or had symptoms or history of preeclampsia.

　　Physical quality:

　　1. Obesity, as obese women have more complications during pregnancy, such as preeclampsia.

　　2. Suffered from diseases affecting skeletal development, such as rickets, tuberculosis, and others.

　　3. Reproductive tract malformations, which are prone to pelvic narrowness, abnormal birth canal, and affect the normal progress of labor, leading to adverse conditions such as prolonged labor and fetal asphyxia.

　　4. Family history of genetic diseases.

　　5. Poor nutritional status.

　　Second, high-risk after pregnancy

　　Abnormal conditions during pregnancy: pregnancy-induced hypertension syndrome, pregnancy hemorrhage, placental abnormalities, prolonged pregnancy, polyhydramnios, macrosomia or microsomia of the fetus, intrauterine distress of the fetus, intrauterine growth retardation of the fetus, abnormal placental position, incompatibility of maternal and fetal blood types. Difficulties in estimated delivery during pregnancy: such as pelvic narrowing, malpresentation, umbilical cord abnormalities, cephalopelvic disproportion, and possible postpartum hemorrhage, postpartum infection, or postpartum shock.

　　Comorbidities during pregnancy: such as heart disease, hypertension, kidney disease, diabetes, viral hepatitis, and others.

　　Viral infections: such as cytomegalovirus, herpes virus, rubella virus, and others.

　　Early pregnancy exposure to harmful substances: such as radiation, pesticides, chemical toxins, and taking drugs harmful to the fetus.

　　Other conditions: macrosomia, multiple pregnancy, and other situations.

　　High-risk pregnancy should be prevented from multiple aspects, including careful prevention from prenatal examination to prenatal care.

　　First, nursing skills

　　1. Side sleeping

　　Have the mother sleep on her side, avoid long periods of standing or sitting, to reduce pain in the area. Placing a cushion under the buttocks while sitting can also be helpful.

　　2. Massage

　　Within 10 days after childbirth, family members can use their palms to gently massage the pregnant woman in a circular motion until the area feels firm, and should stop massaging temporarily if there is uterine contraction and severe pain. Lie on the stomach to relieve pain.

　　3. Analgesics

　　If you still feel pain and discomfort, which affects rest and sleep, you should inform the medical staff, and mild sedatives can be used for pain relief if necessary. Prevention and health care in perinatal health care

　　Prenatal examination, also known as perinatal health care, can timely understand the physical condition of pregnant women and the growth and development of the fetus, ensuring the health and safety of both mother and fetus. The first thing to consider is the timing of prenatal examination, which divides the entire pregnancy process into three stages based on the different characteristics of each stage of pregnancy: early pregnancy (within 12 weeks), middle pregnancy (13-27 weeks), and late pregnancy (28-40 weeks). The content of prenatal examination varies according to different periods:

　　Early pregnancy:

　　After confirming pregnancy, within 12 weeks of amenorrhea, establish a 'Maternal and Child Health Handbook' at a related obstetrics and gynecology institution, and conduct the first prenatal examination. In the early pregnancy period, it is mainly to record past medical history, drug sensitivity history, family history, menstrual history, pregnancy history, etc.; understand whether there are diseases or abnormal conditions that affect pregnancy; general examination: blood pressure, weight, height, heart, lungs, liver, spleen, thyroid, breasts, etc., to understand the development and nutritional status of pregnant women; gynecological examination: uterine position and size, determine whether it is consistent with the gestational age, and pay attention to whether there is inflammation, malformation, and tumor of the reproductive organs; blood routine, urine routine, hepatitis B surface antigen, liver function, kidney function, syphilis screening, and electrocardiogram examination.

　　Middle pregnancy:

　　Perform prenatal checks once every four weeks (16, 20, 24, 28 weeks). The middle pregnancy period is mainly to measure blood pressure, weight, fundal height, abdominal circumference, and fetal heart rate during each physical examination, and pay attention to whether there is edema of the lower limbs; re-examine blood routine to detect anemia in pregnancy in a timely manner, re-examine urine routine to screen for pregnancy-induced hypertension and gestational diabetes; it is recommended to do a serological screening for Down syndrome and neural tube defects between 15-20 weeks of pregnancy; it is recommended to do an ultrasound screening for fetal surface malformations between 20-24 weeks of pregnancy; it is recommended to do a screening for gestational diabetes between 24-28 weeks (50g glucose screening test).

　　Late pregnancy:

　　In the late pregnancy period (28-36 weeks), check once every two weeks; after 36 weeks, check once a week. In the late pregnancy period, it is necessary to continue the physical examination in the middle pregnancy period, pay attention to check the fetal position, correct it in time if there is an abnormality; count the fetal movements and record them; it is recommended to do regular fetal heart monitoring; timely re-examine the B-ultrasound to observe the growth and development of the fetus, the position and maturity of the placenta, and the condition of amniotic fluid. Dietary therapy, nutrient absorption, high-risk pregnancy should be supplemented with vitamins appropriately. Vitamin A can increase the resistance of pregnant women and help the growth and development of the fetus. Vitamin B can promote appetite, stimulate milk secretion, and promote the growth of the fetus; Vitamin C can promote the development of fetal bones and teeth and enhance resistance. All these vitamins can be supplemented appropriately. Vitamin D can help the absorption of calcium and phosphorus, making the development of bones and teeth normal. In areas with sunlight, it may not be necessary to supplement vitamin D.

　　II. Dietary characteristics

　　During pregnancy, due to physiological changes, there are different dietary requirements, which can be roughly divided into three stages:

　　In the early stages of pregnancy, the first three months are the period when the fetus's organs are forming. At this time, the expectant mother should avoid malnutrition and increase the intake of protein appropriately. At the same time, attention should be paid to the combination of coarse and fine. At this stage, normal diet may be affected due to morning sickness and other early pregnancy reactions. At this time, the expectant mother should eat small meals mixed with carbohydrates and protein, but should not eat stimulating foods and refined sugar cubes. The period from 4 to 6 months of pregnancy is the key nutritional stage for pregnant women. During this period, the fetus grows rapidly and requires a large amount of nutrition.

　　In the late stage of pregnancy, as the time of delivery and breastfeeding approaches, one should pay special attention to eating less or no indigestible foods or foods that may cause constipation. One should try to eat a balanced diet that is high in calories, nutrition, and fiber, which is helpful for sleeping at night and can also provide energy for delivery and breastfeeding.

　　Nutrient intake:

　　1. Fresh milk: 250-500 grams per day.

　　2. Staple food: One should consume 450-500 grams per day. One should eat more coarse grains rich in vitamin B and trace elements and eat less refined rice and flour.

　　3. Fresh fruits and vegetables: One should consume about 400 grams of vegetables and 200 grams of fruits per day, which can basically meet the body's needs for vitamin A, C, calcium, and iron.

　　4. Eggs: One should add 1-2 eggs per day, as eggs are rich in protein, calcium, phosphorus, and various vitamins. Beans contain a large amount of easily digestible protein, vitamin B, C, iron, and calcium. Soybean sprouts and mung bean sprouts are also rich in vitamin E. This type of food should be consumed about 80 grams per day.

　　5. Meat: Fish and various meats can provide a large amount of the required protein. About 100 grams can be provided in daily meals. To ensure an adequate intake of iodine, one should eat more seaweed, nori, sea fish, and shrimp.

　　Vitamin supplementation:

　　The diet of pregnant women should not only maintain the metabolic balance of the mother's body but also provide various nutrients for the healthy development of the embryo. Pregnant women should try various foods, have a moderate amount of chicken, duck, fish, and meat, eat more vegetables and fruits, and also add some coarse grains. Proteins and inorganic salts are particularly important. Sufficient protein can promote the development of the fetus's brain and improve the intellectual level of the fetus. In addition, calcium and phosphorus are essential elements for the fetus's bones and teeth, while iron is an important element for the production of blood and tissue cells. Therefore, pregnant women should eat more eggs rich in calcium, such as egg yolks, shrimp shells, and beans, and lean meats rich in iron. Pregnant women should not eat animal livers. Deficiency of zinc in the early stage of pregnancy is prone to congenital malformations, so pregnant women must pay attention to obtaining zinc from dietary sources. Animal foods such as meat and fish, and seafood are the main sources of zinc. Plant foods such as buckwheat, rye, wheat, corn, peanut kernels, and walnuts also contain a high amount of zinc.

　　It is important to pay attention to the intake of folic acid, which mainly exists in various green leafy vegetables. The amount of folic acid in the body is small, and it is a water-soluble vitamin that can dissolve in water. Pregnant women must eat a certain amount of fresh green vegetables to obtain enough folic acid. According to surveys, most pregnant women with a history of miscarriage or signs of miscarriage during pregnancy have insufficient folic acid intake. When eating various stir-fried vegetables, one should also eat the vegetable soup. Pregnant women can also supplement folic acid by eating some raw and washed vegetables such as rapeseed and Chinese cabbage. In addition, green vegetables contain many kinds of nutrients needed by humans, and pregnant women should eat more green vegetables.

　　Water and rough fiber are essential during pregnancy. Pregnant women should also pay attention to the intake of water and rough fiber. They should drink water in moderation and eat more fresh vegetables and fruits rich in fiber to promote peristalsis and prevent constipation.

　　The diagnosis of high-risk pregnancy mainly depends on the medical history and family history of the pregnant woman, supplemented by the detection and confirmation of the fetus.

　　First, those who are 35 years old.

　　Second, there are the following conditions in the history of childbirth.

　　1. Two or more miscarriages.

　　2. Previous stillbirth or neonatal death.

　　3. Previous premature delivery or low birth weight infant.

　　4. Previous large fetus.

　　5. Have a history of stillbirth or neonatal death.

　　6. Have family diseases or malformations.

　　7. Have a history of cesarean section.

　　8. Have a history of birth injury.

　　9. Premature delivery caused by congenital malformations of the reproductive tract (uterine septum, bicornuate uterus, incomplete cervix closure).

　　10. Pregnant after years of infertility and treatment.

　　11. Have uterine fibroids or ovarian cysts.

　　Third, ask for detailed medical history for the following diseases.

　　1. Essential hypertension or chronic hypertension;

　　2. Heart disease, especially with a history of heart failure or cyanotic heart disease;

　　3. Chronic nephritis;

　　4. Diabetes;

　　5. Thyroid disease;

　　6. Hepatitis;

　　7. Anemia;

　　8. Other endocrine diseases.

　　Fourth, used drugs or received radioactive examinations during early pregnancy.

　　Fifth, diseases in childhood that affect bone and iliac development, such as tuberculosis and rickets.

　　Sixth, special examinations.

　　1. Estimation of gestational age and fetal development.

　　2. Examination of placental function.

　　3. Fetal maturity.

　　4. Fetal monitoring.

　　Early pregnancy reactions in the early stage of pregnancy are severe, appetite is poor, during this period the growth of the fetus is slow, diet should be balanced, avoid malnutrition, the amount does not need to be too much; in the middle and late stages of pregnancy, the growth of the fetus accelerates, and the amount of food gradually increases. A reasonable diet does not mean that eating more is better, too much heat can also lead to the fetus being overweight and causing difficult labor.

　　For the supplementation of vitamins and trace elements, it is not advisable to supplement them alone when unsure of a particular deficiency, in order to avoid imbalance. If there is still a problem, it is still advisable to consult a doctor and not to supplement arbitrarily.

　　If the pregnant women with high-risk pregnancy are over 35 years old, have a history of Down syndrome children or family history, have a family history of congenital metabolic disorders (such as enzyme system defects) or chromosomal abnormalities, have given birth to an anencephalic child or a child with spina bifida, they should go to the genetic counseling clinic for relevant examinations (such as chorionic villus sampling, amniocentesis, etc.). For pregnant women with high-risk pregnancy, different treatments should be given according to different causes. For pregnancy complications (such as pregnancy-induced hypertension) and pregnancy-related diseases (such as heart disease, kidney disease, etc.), special treatment should be given according to various characteristics. In the field of obstetrics, attention should be paid to the following aspects:

　　1. Increase nutrition The nutritional status of pregnant women is extremely important for the growth and development of the fetus, so enough nutrition should be provided to pregnant women. Actively correct anemia and supplement sufficient vitamins, iron, calcium, and various trace elements, various amino acids. Pregnant women should not be picky or biased in their diet and should pay attention to the reasonable allocation of various nutrients.

　　2. Pay attention to rest Bed rest can improve the blood circulation of the uterine placenta, and it is better to lie on the left side. During pregnancy, it is necessary to ensure that there is a nap in the afternoon.

　　3. Intermittent oxygen therapy is important for pregnant women with reduced placental function, which can be 2 times a day, each for 30 minutes.

　　4. Injection of glucose and vitamin C can improve the fetus's tolerance to hypoxia, especially for pregnant women with intrauterine growth restriction. Specific usage: 500 milliliters of 10% glucose plus 2 grams of vitamin C, intravenous slow infusion, once a day, for 5 to 7 days as a course. This helps to increase the fetal liver glycogen reserve or compensate for its consumption, and enhance its compensatory ability to hypoxia.

　　5. Preventing preterm labor Once the signs of preterm labor appear, such as uterine contractions and slight vaginal bleeding, immediate bed rest should be taken, and drugs to suppress uterine contractions should be administered.

      Hospital nursing early screening

　　Early screening of high-risk pregnant women, key management and monitoring, and timely and correct treatment are important measures to reduce maternal and perinatal mortality. It also has great significance for eugenic breeding. Key monitoring includes two aspects: the pregnant woman and the fetus.

      Understand the fetus's condition

　　1. Pregnancy chart: Make a certain standard curve with the weight, blood pressure, abdominal circumference, fundal height, fetal position, fetal heart rate, edema, proteinuria, and biparietal diameter from ultrasound examination of pregnant women. Record the findings and results of each prenatal examination on the curve chart at any time, and observe and compare continuously to understand the growth and development of the fetus.

　　2. Measurement of fundal height: The data obtained from measuring the fundal height is related to the birth weight of the fetus. Therefore, measuring the fundal height can predict the growth and development of the fetus. From 20 to 34 weeks of pregnancy, the fundal height increases by an average of about 1cm per week, and after 34 weeks, the rate of increase of the fundal height slows down. A fundal height of more than 30cm indicates that the fetus is mature. Japanese scholars such as Ichiro Sugiyama proposed a formula for calculating the fetal development index: Fetal development index = fundal height (cm) - (months + 1) × 3. A result of 5 may indicate twins, polyhydramnios, or macrosomia.

　　3. Ultrasound examination: Measure the size of a certain part of the fetus, such as biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), etc., to judge the growth and development of the fetus, among which BPD is most commonly used. Ultrasound examination shows BPD > 8.5cm indicates that the fetus weighs > 2500g, the fetus is mature, and > 10cm, which may be a macrosomic fetus.

      Fetal Maturity Measurement

　　1. Estimate whether the fetus is mature based on gestational age and fetal size; gestational age of 42 weeks is considered post-term. 4000g is considered a macrosomic fetus. 2. Amniotic fluid analysis of lecithin/sphingomyelin ratio (L/S) indicates lung maturity. If the ratio is ≥2, it indicates fetal lung maturity; the content is usually above 2mg/L at 3000g.

　　Fetal fat cell count indicates the maturity of the skin. After staining with 0.1% Congo red, fetal fat cells appear orange, and cells without fat particles are stained blue. Orange cells >20% indicate maturity, and 50% indicate post-term pregnancy.

       Placental Function Measurement

　　1. Determination of hCG in Blood and Urine: About 7 days after the embryo implants, hCG can be detected in blood and urine, which gradually increases with the development of the embryo, reaching a peak around 80 days, and then gradually decreasing, maintaining a certain level and gradually disappearing after delivery. The determination of hCG in the early pregnancy reflects the condition of placental villous function and is of significance for monitoring threatened abortion and hydatidiform mole. It is of little value in late pregnancy.

　　2. Determination of hPL in Blood: Human placental lactogen (hPL) is a protein hormone secreted by placental trophoblast cells, which gradually increases with pregnancy, reaching a peak at 34-36 weeks, then slightly flattening, and gradually disappearing after delivery. hPL can only be measured in the blood of pregnant women. The critical value for late normal pregnancy is 4ug/ml, and a value below this indicates poor placental function and fetal emergency. The level of hPL can better reflect the secretory function of the placenta and is internationally recognized as a method to measure placental function. Continuous dynamic monitoring is more meaningful. It is combined with E3 and B-ultrasound placental function grading for higher accuracy.

　　3. Determination of Estrone (E3) in Urine: Collecting the pregnant woman's 24-hour urine and measuring E3 by RIA is a commonly used method to understand the condition of placental function. The 24-hour urine E3 in the late pregnancy is 100 times. The fetal movement is more at night than during the day. A decrease in fetal movement may indicate fetal intrauterine hypoxia. For high-risk pregnant women, fetal movement counting should be performed, with three counts per day in the morning, afternoon, and evening, each for one hour, and the sum of the three times multiplied by 4 is the number of fetal movements in 12 hours. >30 times/12h indicates normal.