Encyclopedia of Family Medicine

Chapter 36 Sexual knowledge and eugenics (8)
Sugar, protein and fat are the main sources of heat energy produced by the human body and the main components of human organs.Among the minerals, the most important ones for pregnant women are calcium and iron.The growth of fetal bones needs a lot of calcium. If the food of pregnant women is deficient in calcium, the calcium needed by the fetus can only be taken from the mother, which will cause low back pain, leg pain, tetany and tooth loss in pregnant women, and even serious bone loss. Malacia, pelvic deformation, and dystocia can occur during childbirth.If the mother is deficient in calcium, the fetus will also suffer from rickets, which is congenital rickets.Iron is one of the main raw materials for hematopoiesis.Iron deficiency in food can cause anemia in pregnant women.

Vitamins are also indispensable for human growth and development.Vitamin A has the effect of promoting human growth and development.Pregnant women need 20% to 60% more than non-pregnant women.Vitamin B1 participates in the body's sugar metabolism process, maintains the normal function of the nerve, heart and digestive system, and vitamin C can prevent scurvy and increase resistance to disease.Such as pregnant women lack of vitamin C, prone to bleeding gums, osteoporosis and fractures.

Nutrients that pregnant women need are provided by a variety of foods.For the health of pregnant women and fetuses, choose easy-to-digest and nutrient-rich foods, do not overeating, do not eat partial eclipses, avoid spicy foods, and avoid alcohol and smoking.

6. Sex life during pregnancy

Once identified as pregnancy, sexual life to moderation.Especially during the first and last 3 months of pregnancy.Because in early pregnancy, frequent sex life can easily lead to miscarriage.In the third trimester of pregnancy, vaginal and vulvar tissue congestion, edema, varicose veins, etc., can cause vaginal wall tearing or varicose vein nodules rupture due to sexual life, causing massive bleeding, or premature rupture of membranes, or even premature delivery.In addition, sexual life at the end of pregnancy reduces the cleanliness of the vagina, which is easy to cause serious infections before, during and after delivery.Not good for mother and fetus.

In the sexual life during pregnancy, the man should pay attention to care and be considerate of the woman, and choose a sexual position that reduces the pressure of the woman, such as lateral position, female upper position, etc.

7.Prenatal care

In order to protect the health of pregnant women and fetuses, women with signs of pregnancy should go to the hospital for examination immediately.It is convenient for doctors to understand the overall situation of pregnant women early and discover potential unfavorable factors for pregnant women and fetuses.If the pregnant woman suffers from serious heart, liver, kidney and other important organ diseases and is not suitable for continuing pregnancy; or suffers from viral influenza or rubella in the first trimester of pregnancy, or has hereditary diseases in both immediate family members, Or if it is determined that the fetus has a genetic disease, the method of induced abortion can be used to terminate the pregnancy as soon as possible.If everything is normal for pregnant women, they should start regular prenatal checkups from now on.

The degree of prenatal examination is formulated according to the characteristics of fetal development and maternal physiological changes, the purpose is to check fetal development and maternal health, early detection of problems, early correction and treatment.Prenatal visits throughout the pregnancy require 9 to 13 times.The initial inspection should be within 3 months after menopause, then once a month within 28 weeks of pregnancy, once every two weeks within 1 to 28 weeks of pregnancy, and once a week within 36 to 1 weeks of pregnancy.If any abnormality is found, the doctor must follow the appointment time for follow-up.

The content of the prenatal examination is as follows:

推算预产期。即预测孩子将要分娩的大概日期。从末次月经第一天算起，月份加9或减3、日期加7（农历加15）即为预产期。如末次月经的第一天是3月1日，预产期则为12月8日。

Uterine fundus height, abdominal circumference.Measuring the height of the uterine fundus and abdominal circumference, and drawing a pregnancy map, can roughly estimate the growth and development of the fetus at each stage, and judge whether the growth of the fetus in the uterus is normal.If the uterine height and abdominal circumference on the pregnancy chart are below the standard, it indicates that the fetus has intrauterine growth retardation, and the cause of fetal intrauterine growth retardation should be found out first, and symptomatic treatment should be given.

fetal position.The normal fetal position during labor should be head down and buttocks up.In the second trimester of pregnancy, the fetus is still suspended in the amniotic fluid, and the position can be rotated. If it is found that the fetal position is not correct, it can be corrected.Without regular prenatal checkups.It is not until the third trimester of pregnancy that the fetal position is found to be incorrect. Since the fetal body has partially entered the pelvis, the opportunity for correction is missed, and dystocia is prone to occur.

Fetal heart sounds.Normal fetal heart sounds are 120-160 beats per minute, like the ticking of a clock, and can be heard in the abdomen of pregnant women after 18-20 weeks of pregnancy. Too fast or too slow fetal heart sounds indicate abnormal growth and development of the fetus.

blood pressure.This should be documented at the initial antenatal visit.If it is found that the blood pressure of pregnant women has an upward trend during pregnancy, attention should be paid.If the systolic blood pressure exceeds 30mmHg (4kPa) of the initial blood pressure, the diastolic blood pressure exceeds 15mmHg (2kPa).If there are no other signs and symptoms, it is called gestational hypertension.If it is accompanied by symptoms such as edema, proteinuria, and dizziness at the same time, it is called pregnancy-induced hypertension syndrome.See page 97 for its diagnosis and management.

weight.Pregnant women did not gain more than 12 kilograms of weight throughout pregnancy, and the rate of weight gain in late pregnancy exceeded that of other stages of pregnancy.If the edema is not obvious, and the weight increases more than 5 kg per week, it may be hidden edema and should be treated in time to avoid other complications.

pelvis.In primipara or multiparous women with a history of dystocia, the pelvis should be measured after 28 weeks of gestation.The pelvis is the most important part of the birth canal.The speed and success of childbirth are closely related to the size and shape of the pelvis.If the fetus is significantly larger than the pelvis, or the pelvis is deformed, labor may be difficult.Cesarean section is optional for these women.

Laboratory check.Mainly blood routine, platelet count, bleeding time.Coagulation time, blood type identification.Liver function, etc.In particular, urine routine examination should be a must-check item for each prenatal examination.If there are pregnancy complications, various laboratory tests related to the complications are also required.

Ultrasonography.At the discretion of the doctor.Ultrasound is safe for both mother and baby, so don't worry.

Pregnant women with serious diseases such as heart disease, hepatitis, chronic nephritis, essential hypertension, diabetes, hyperthyroidism or hypothyroidism should be followed up and checked in the high-risk pregnancy clinic.It is also necessary to carry out systematic monitoring and treatment with the assistance of specialists to make it safe through pregnancy.Obstetric complications such as pregnancy-induced hypertension, maternal-fetal incompatibility, multiple pregnancy, severe anemia, placenta previa, early placental abruption, intrahepatic cholestasis should be performed under the guidance of an obstetrician if obstetric complications occur during pregnancy treat.

Common symptoms and diseases during pregnancy

1.poor appetite, vomiting

Anorexia and vomiting often appear as early pregnancy reactions, most common in about 40 days after menopause, the symptoms are obvious when waking up in the morning, some vomiting is acid water, and severe cases may spit out green bile.Some vomit infrequently.Vomiting only after brushing teeth or eating fatty foods.Some vomit frequently and cannot eat.Even vomiting after drinking water, pregnant women have severe dehydration or even exhaustion such as fatigue, dry skin, pink lips, sunken eye sockets, etc.

For those with mild symptoms, no special treatment is required. Avoid oily and meaty foods, eat more bland food, eat less frequently, pay attention to rest, maintain a stable mental and emotional environment, and maintain a relaxed and happy living environment, which will help reduce the symptoms of pregnancy reactions. It can be used when necessary. Vitamin B620 mg/time, 3 times/day, vitamin B120 mg/time, 3 times/day.

Patients with severe vomiting and obvious dehydration should be hospitalized for rehydration and antiemetic treatment, and diseases related to nausea and vomiting should be ruled out if necessary.

2. Frequent urination
In early pregnancy, due to the enlarged uterus, the pressure on the bladder increases, and the expansion of the bladder is also restricted, which can lead to an increase in the number of bladder emptying and frequent urination, especially nocturia.Generally, no special treatment is required. After 3 months of pregnancy, the symptoms disappear naturally after the enlarged uterus rises into the abdominal cavity.However, women with low resistance during pregnancy are prone to urinary tract infections, which should be excluded from routine urine tests.

3.constipate

During pregnancy, gastrointestinal motility slows down, and the enlarged uterus also compresses the intestines and causes constipation.This is not a disease and generally does not require treatment.However, the following measures can help to reduce or avoid constipation: (1) adjust the diet, eat more green leafy vegetables and fruits rich in fiber; (2) do some light physical activities in moderation, but do not stand for too long; (3) keep Form a good defecation habit and defecate on time; (4) Take honey in moderation to help defecation, and take laxative drugs under the guidance of a doctor when necessary, such as Chinese medicine Maren pills, Western medicine fruit guide tablets, etc.

4.itching

It can occur as early as the 6th week of pregnancy, usually after the 28th week of pregnancy, mainly on the skin of the limbs and abdomen, and sometimes itching and insomnia.The itching can disappear automatically in a short period of time, and it can also last until one week after delivery. Some pregnant women are accompanied by jaundice and increased serum bilirubin.However, most patients do not have hepatosplenomegaly, and serum transaminases are normal or slightly elevated.Jaundice can gradually disappear after delivery.Mild transient itching requires no special treatment.Those with severe itching can take 60 mg of luminal orally every night, so that pregnant women can have a good rest.But to strengthen follow-up, observe the development of the disease.If itching is accompanied by jaundice, serum bilirubin, and transaminase increase, a doctor should be asked to rule out infectious hepatitis.If it is indeed caused by pregnancy, the traditional Chinese medicine Yinchen Decoction can be given to relieve itching and jaundice, and cholestyramine can be taken orally.Severe jaundice affects fetal development, should be checked by a doctor, and hospitalized if necessary.

5. Swelling of lower extremities
In late pregnancy, due to the mechanical compression of the inferior vena cava by the enlarged uterus, the venous return of the lower extremities is blocked, causing edema of the lower extremities.This kind of edema is mostly pitted, that is, the skin is pressed with fingers, and depressions appear in the pressed area.Sometimes patients do not have obvious pitting edema, but their weekly weight gain exceeds 0 kg, which is called recessive edema.Mild edema generally does not require medical treatment.Pregnant women should lie on their sides, raise their feet slightly, and pay more attention to rest, which can relieve symptoms.If the swelling is obvious, you should go to the hospital for examination and take medicine under the guidance of a doctor.

6.Calf twitching

After the 20th week of pregnancy, the calcium requirement of pregnant women increases significantly, and the normal diet can no longer meet their needs, which can cause calf convulsions at this time.Taking calcium in time, 2 grams per day, can play a preventive and therapeutic role.When taking it, you can also take cod liver oil pills, vitamin B, etc.

7. Vascular filling of the lower extremities

Vascular engorgement of the lower extremities, also known as varicose veins of the lower extremities, usually occurs in the third trimester of pregnancy.The causes are: (1) the increased blood volume of the uterus and ovary during pregnancy, and the increased blood flow in the iliac vein, which affects the venous return of the lower extremities; (2) the enlarged uterus compresses the pelvic cavity and blocks the return of the inferior vena cava; (3) Vasodilation affected by hormones; (4) congenital factors, such as hypoplasia of veins or venous muscularis; (5) long-term standing or walking can aggravate lower extremity vascular filling, which is mainly manifested as subcutaneous venous engorgement, like earthworms It twists and turns, showing a cyan-blue vascular network.

The main methods of treatment and treatment are: (1) Proper rest to ensure enough sleep time every day; (2) Avoid standing or walking for a long time, and adjust work if necessary; (3) Don’t wear tight shoes and socks, when resting Lower extremities should be raised slightly.

8. Headaches and high blood pressure

This symptom is one of the clinical manifestations of severe pregnancy-induced hypertension syndrome, which is a serious complication during pregnancy.It affects the health of pregnant women and fetuses and even endangers the lives of pregnant women and fetuses.Once this symptom occurs, it is necessary to arouse a high degree of vigilance and go to the hospital immediately.

The disease is more common in young pregnant women younger than 20 years old and multiparous women older than 40 years old, as well as multiple pregnancy, polyhydramnios, and pregnant women with a history of chronic nephritis and hypertension.

The basic pathological change of pregnancy-induced hypertension syndrome is systemic arteriole spasm, which leads to tension of vessel wall, stenosis of lumen, slow blood flow, elevated blood pressure and insufficient blood supply to organs.Clinically, it can be manifested as edema, high blood pressure, proteinuria, headache, dizziness, blurred vision, vomiting and even convulsions, and heart failure.Routine urine and liver and kidney function tests are helpful for diagnosis.

Pregnancy-induced hypertension also causes hypoxia in the uterus, growth retardation, suffocation and even death.

Treatment and treatment methods mainly include: (1) regular prenatal examinations, weighing, blood pressure, and urine protein at each examination.Especially in the second half of pregnancy, these checks are more important; (2) pay attention to proper rest and nutrition.Pregnant women need more rest during pregnancy.Try to rest in bed for more than 10 hours a day, preferably in the left lateral position, so that the blood flow of the lower extremities and abdomen can be fully returned to the heart, and the blood flow of the kidneys and the uterus and placenta can be guaranteed.The diet should be rich in protein and vitamins, supplemented with an appropriate amount of calcium, and do not have a partial eclipse; (3) Appropriately use antihypertensive, diuretic and sedative drugs under the guidance of a doctor; (4) Strengthen monitoring and hospitalization if necessary.If the pregnancy is close to term, the pregnancy can be terminated in time, and the mode of delivery can be determined according to the condition of the cervix of the pregnant woman.

9. Vaginal bleeding during pregnancy
The diseases of vaginal bleeding in early pregnancy include miscarriage, ectopic pregnancy, hydatidiform mole and so on.The diseases of vaginal bleeding in the second and third trimesters of pregnancy include placenta previa, rupture of placenta marginal sinuses, early placental abruption, and premature birth.There are pregnancy complicated with cervical submucosal fibroids, cervical polyps, cervical cancer, vaginal trauma, etc., but it is very rare.

(1) Miscarriage

Occurs more often in early pregnancy.If a woman is diagnosed with pregnancy, vaginal bleeding is a common manifestation of miscarriage.At the same time of vaginal bleeding, accompanied by mild lower abdominal pain, check the size of the uterus in line with the menopause month, which is a threatened abortion.When vaginal bleeding increases, or abdominal pain intensifies, check for dilation of the cervix, which is an inevitable miscarriage.When part of the embryonic tissue is discharged from the vaginal opening and there is still a lot of bleeding in the vagina, it is an incomplete or complete miscarriage.

Threatened abortion generally requires bed rest, appropriate use of sedatives, the most important thing is to prohibit sexual life, do not abuse miscarriage drugs.In case of vaginal bleeding due to inevitable miscarriage or incomplete miscarriage, dilatation and curettage or intravenous oxytocin should be given immediately to terminate the pregnancy.If it is a complete miscarriage, no treatment is generally required.

(2) Molar
The clinical characteristics are: ①The pregnancy reaction after menopause is severe, and the symptoms of pregnancy-induced hypertension syndrome can appear very early; ②Vaginal bleeding occurs early, sometimes it is a small amount of dripping, sometimes shock occurs in vaginal bleeding, and sometimes blood clots are mixed with Blister-like tissue; ③During the examination, it was found that the uterus was significantly larger than the menopausal month, and the pregnant woman felt that the mass in the lower abdomen grew rapidly.Accompanied by lower abdominal pain; ④ enlarged uterus without fetal movement, and no fetal heart sounds; ⑤ blood and urine human chorionic gonadotropin (HCG) increased significantly; ⑥ B-ultrasound can assist in diagnosis.

Once the hydatidiform mole is diagnosed, dilatation and curettage are required.The scraped tissue should be sent for pathological examination, and according to the doctor's opinion, decide whether to perform preventive chemotherapy.

(3) Ectopic pregnancy
After pregnancy, the embryo does not implant in the uterine cavity, but in a place outside the uterine cavity, such as the fallopian tube, ovary, intraperitoneal cavity, or outside the cervix, which is called ectopic pregnancy (commonly known as ectopic pregnancy).Part of ectopic pregnancy, of which the most common tubal pregnancy.Its clinical characteristics are: ①After a short period of menopause, there will be a small amount of vaginal bleeding, sometimes dripping and not clean, accompanied by dull pain and discomfort in the lower abdomen; ②When there is severe pain in the lower abdomen, it is often accompanied by nausea, vomiting, palpitation, and cold sweat , anal swelling feeling, and even fainting.During the examination, the patient was in shock, with abdominal tenderness and rebound tenderness, but not much vaginal bleeding; ③ urine pregnancy tests were mostly negative, and blood HCG increased; ④ B-ultrasound and gestational sacs could be diagnosed outside the uterine cavity.

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If a ruptured ectopic pregnancy occurs, surgery should be performed immediately.If it is an unruptured type, conservative surgery or Chinese and Western medicine treatment is feasible.Conservative surgery includes abdominal salpingotomy or scratching, and laparoscopic surgery.Drug treatment can be systemic methotrexate, or methotrexate or hypertonic saline can be directly injected into the embryo sac.Traditional Chinese medicine prescriptions also have a therapeutic effect on ectopic pregnancy.While conservative treatment with drugs, observation should be strengthened.If internal bleeding or shock occurs, surgery is still required.

(4) Placenta previa

Vaginal bleeding occurs in the second and third trimesters of pregnancy.If it is not accompanied by lower abdominal pain, it is called painless vaginal bleeding.This is the main symptom of placenta previa.

Its clinical features are: pregnant women often have sudden vaginal bleeding without any reason.The morning and evening of the bleeding time and the amount of bleeding are related to the position of the placenta and the cervix.When the placenta completely covers the cervix, the bleeding time is earlier, and the vaginal bleeding starts repeatedly at about 7 months of pregnancy. Later, shock occurs, even endangering the lives of mother and baby.When the placenta partially covers the cervix, the bleeding time is later and the amount of bleeding is less.

Treatment options for placenta previa should be based on gestational age, gestational age, and vaginal bleeding.When the gestational age is less than 37 weeks, the fetal heart rate is good, it is estimated that the baby is not easy to survive at birth, the vaginal bleeding is not much, and the pregnant woman's general condition is good, sedatives such as diazepam 5-10 mg/time, 2-3 times/day, can be given to suppress the uterus Constricting agents such as salbutamol 2~4 mg/time, 3 times/day, for a total of 3 days, and hemostatic agents such as vitamin K110 mg intramuscularly, 2 times a day.Also consider using magnesium sulfate, hemostatic aromatic acid, etc. for intravenous drip.When necessary, small and multiple blood transfusions are used to correct anemia.The purpose of the above treatment is to prolong the time as much as possible to make the fetus mature. If the pregnant woman has heavy vaginal bleeding or shock symptoms, regardless of the size of the fetus and whether it is alive or not, cesarean section should be performed immediately with the principle of saving the life of the pregnant woman.

(End of this chapter)