Broad ligament: maintains the central position of the uterus in the pelvic cavity.

Round ligament: maintains the anteverted position of the uterus.

Cardinal ligament: prevents uterine prolapse and fixes the normal position of the cervix.

Uterine fundal ligament: indirectly keeps the uterus in the forward position.

interstitium

Isthmus (ligation site)

Ampulla (the site where the fertilized egg binds)

umbrella part

Endometrium: proliferative phase

Breast: mammary duct hyperplasia

Uterine contractility: enhanced

Cervical mucus: increased, thin, stringy, fern leaf-like crystals.

Vaginal epithelium: hyperplasia/keratosis

Fallopian tube peristalsis: enhanced

Water and sodium metabolism: water and sodium retention

Feedback function: positive/negative feedback

basal body temperature

Endometrium: secretory phase

Breast: Breast alveolar hyperplasia

Uterine contractility: decreased

Cervical mucus: less, thick, stringy, oval-shaped

Vaginal epithelium: accelerated shedding

Fallopian tube peristalsis: inhibited

Water and sodium metabolism: water and sodium excretion

Feedback: negative feedback

Basal body temperature: rises by 0.3~0.5℃

placental function

Uterus: It is the organ that changes the most during pregnancy and after delivery. The uterus is significantly enlarged and soft, and the uterus in early pregnancy is spherical and asymmetrical. At 12 weeks of pregnancy, the uterus is uniformly enlarged and can be palpated above the pubic symphysis. The mild dextral rotation in late pregnancy is related to the sigmoid colon occupying the left side of the pelvis. The vaginal mucosa is edematous, thickened, and has increased folds. Vulva: Local congestion, skin thickening, and pigmentation during pregnancy. Some pregnant women may have varicose veins in the vulva or lower limbs.

Uterus: It is the organ that changes the most during pregnancy and after delivery. The uterus is significantly enlarged and soft, and the uterus in early pregnancy is spherical and asymmetrical. At 12 weeks of pregnancy, the uterus is uniformly enlarged and can be palpated above the pubic symphysis. The mild dextral rotation in late pregnancy is related to the sigmoid colon occupying the left side of the pelvis. The vaginal mucosa is edematous, thickened, and has increased folds. Vulva: Local congestion, skin thickening, and pigmentation during pregnancy. Some pregnant women may have varicose veins in the vulva or lower limbs.

The nipples are enlarged, darkened, easily erected, the areola is colored, and the peripheral sebaceous glands are enlarged to form scattered small bulges called hooded nodules.

The increase in plasma is greater than the increase in red blood cells. Plasma increases by 1000ml and red blood cells increase by 450ml, which dilutes the blood and causes physiological anemia. There was a slight increase in white blood cells and an increase in neutrophils. Thrombocytopenia. The coagulation factors increase, causing the blood to be in a hypercoagulable state. Thrombosis forms rapidly in the blood vessels on the surface of the placenta after delivery, which is beneficial to preventing postpartum hemorrhage.

Cardiac output reaches its peak between 32 and 34 weeks of pregnancy. If a pregnant woman has heart disease, special attention should be paid to closely observing the condition during the 32-34 weeks of pregnancy, delivery and the first 3 days of the puerperium to prevent heart failure. If a pregnant woman lies in the supine position for a long time, the uterus compresses the inferior vena cava, which can cause a decrease in blood return to the heart, a decrease in cardiac output, and a drop in blood pressure, which is called supine hypotension syndrome.

Frequent urination occurs in early and late pregnancy. The right ureter is compressed by the right-handed uterus, and pregnant women are prone to pyelonephritis, which is more common on the right side. It can be prevented by lying on the left side.

Pregnant women experience hyperventilation.

In the early stages of pregnancy (about 6 weeks after menopause), about half of women experience varying degrees of nausea or vomiting, which is more severe in the morning and is called early pregnancy reaction. Usually disappears on its own around 12 weeks of pregnancy.

If postpartum hemorrhagic shock occurs, it can cause ischemia and necrosis of the pituitary gland, leading to Sheehan syndrome.

Butterfly-shaped brown spots on cheeks. Stretch marks appear.

Weight: There is no significant change before 12 weeks of pregnancy. After that, the weight increases by an average of 350g per week. By the time the pregnancy is full term, the weight increases by an average of 12.5g.

Sugar: The characteristics and changes of sugar metabolism during pregnancy can lead to the occurrence of gestational diabetes.

Menopause: Once menstruation is more than 10 days past due, pregnancy should be considered first. Menopause is the earliest and most important symptom of pregnancy.

Early pregnancy reaction: It occurs around 6 weeks after menopause and usually disappears naturally around 12 weeks into pregnancy.

Frequent urination

skin

Breast: Montessori nodules visible

Gynecological examination: The uterus gradually enlarges and becomes soft with the menopausal month. The isthmus of the uterus is extremely soft, and the uterine body and the cervix seem to be disconnected, which is called the black plus sign.

Pregnancy test:hCG

Ultrasound: It is the gold standard for detecting intrauterine pregnancy.

Uterine enlargement: uterine fundus height and uterine length at different weeks of gestation (2-3 fingers above the pubic symphysis at the end of 12 weeks, between the umbilicus and pubis at the end of 16 weeks, one finger below the umbilicus at the end of 20 weeks, one finger above the umbilicus at the end of 24 weeks). Three fingers above the umbilicus at the end of 28th week, between the umbilicus and the xiphoid process at the end of 32nd week, two fingers below the xiphoid process at the end of 36th week, or slightly between the umbilicus and the xiphoid process at the end of 40th week)

Fetal movement: Pregnant women begin to feel fetal movement at 18-20 weeks of gestation, and multiparous women begin to feel fetal movement earlier than primiparous women. Fetal movements are more active at night and in the afternoon, and disappear during the fetal sleep cycle (lasting 20-40 minutes). After 28 weeks of pregnancy, the number of fetal movements is greater than or equal to 10 times every two hours.

Fetal heartbeat: normal 110-160 beats per minute.

Fetal body: At 24 weeks of pregnancy, the four-part palpation method can be used to distinguish the fetal head, fetal buttocks, fetal back and fetal limbs, and initially determine the fetal pattern, fetal presentation and fetal position.

cephalic presentation

breech presentation

shoulder first

Frequency of examinations: Once a week from 6 to 13 weeks of pregnancy, 14 to 19 weeks from 20 to 24 weeks, 25 to 28 weeks from 29 to 32 weeks, 33 to 36 weeks, and once a week from 37 to 41 weeks of pregnancy.

Estimation of expected date of delivery (EDC): From the first day of the last menstrual period, the month is subtracted by 3 or added by 9, and the date is added by 7

Palpation: Four-part palpation method: When doing the first three steps of inspection, the examiner faces the head of the pregnant woman, and when doing the fourth step of inspection, the examiner faces the toes of the pregnant woman.

Auscultation: The clearest place to auscultate fetal heart sounds is on the upper side of the pregnant woman's abdominal wall near the back of the fetus. In occipital presentation, the fetal heart sound is to the right or left below the umbilicus; in breech presentation, the fetal heart sound is to the right or left above the umbilicus; When the shoulder is presented, the fetal heart sound is clearest below the umbilicus.

Pelvis measurement

Do not increase extra energy and protein in the first trimester, and start increasing protein in the second trimester. Carbohydrates are the main source of energy. Excessive fat intake can easily cause pregnancy complications. Vitamins are essential substances for fetal growth and development. Lack of inorganic salts and trace elements in early pregnancy can easily cause fetal malformations and poor development.

I started to feel fetal movement around 20 weeks. Count fetal movements at the same time every day, count 10 fetal movements each time and record the time spent. If it takes more than two hours, it is recommended to see a doctor. Pregnant women may feel that the fetal movements are slightly reduced. If the fetal movements are less than ten in two hours, they can change their position, such as lying on the left side, and count for another two hours. If the fetal movements are still less than ten, they should seek medical treatment in time.

Recognize signs of labor: irregular uterine contractions, feeling of fetal descent, redness

Characteristics of uterine contractions include

Pelvic entrance plane:

The midpelvic plane is the smallest plane of the pelvis.

pelvic outlet plane

Pelvic axis and pelvic tilt

formation of lower uterine segment

cervical changes

Changes to the vagina, pelvic floor tissues, and perineum

Fetal head and skull: However, if the fetus is overly mature and the skull is hard, the fetal head will not easily deform, which can easily lead to dystocia.

Fetal head diameter lines: There are four main diameter lines in the fetal head.

The sagittal suture and fontanel are important landmarks in determining fetal orientation. Among them, the occipital-anterior position is more conducive to completing the birth mechanism.

Nursing assessment: Fetal heartbeat - auscultate every hour during the latent period and every 30 minutes during the active period. Cervical dilatation is an important indicator for observation of labor. Primiparas should be checked every 4 hours during the incubation period and every 1-2 hours after entering the active phase. Rupture of fetal membranes: The amniotic fluid located in front of the occipital presentation is called anterior amniotic fluid, about 100ml. When the intra-amniotic pressure increases to a certain level, the fetal membranes naturally rupture. It can be tested with pH test paper. When pH ≥ 7, the membrane is likely to break.

Labor pain is associated with gradually increasing contractions. Reduced comfort is related to uterine contraction, bladder filling, rupture of fetal membranes, etc. Anxiety is related to concerns about the safety of oneself and the fetus.

1. General care and support: Provide a good environment, encourage pregnant women to actively participate in delivery, and replenish fluids and calories: (There is no dietary restriction in the first stage of labor, and you are willing to take in easily digestible food and water.) Activities and rest: (There are no restrictions on activities or positions after delivery. It is not recommended to lie on the bed for a long time. Pregnant women can be encouraged to move out of bed to facilitate the progress of labor. However, those with one of the following conditions should rest in bed: First child The membrane has been broken The second pregnancy was complicated by severe preeclampsia, the third pregnancy was abnormal bleeding, and the fourth pregnancy was complicated by heart disease. ) Urination and defecation: (Pregnant women are encouraged to urinate every 2-4 hours to prevent bladder filling from affecting uterine contractions and fetal presentation. Those with difficulty urinating should be given catheterization.) Keep it clean (: Give perineal irrigation to prevent infection.) 2 Specialist care: Promote uterine contractions: (You can change the position and stimulate the nipples. Intravenous infusion of small doses of oxytocin, pay attention to excessive uterine contractions.) Artificial rupture of membranes: (Not recommended for those who have a smooth labor process. Once the fetal membranes rupture , the fetal heart rate should be listened to immediately, the characteristics of the amniotic fluid should be observed, and the time of membrane rupture should be recorded. If the membranes rupture for more than 12 hours without delivery, antibiotics should be given as directed by the doctor. ) Labor Pain Care.

Uterine contractions and fetal heart rate - should be monitored and recorded every 5-10 minutes, with fetal heart auscultation for 30-60 seconds between contractions. Rupture of membranes and feeling of defecation - If the fetal membranes are still not ruptured after the cervix is ​​fully dilated, it will affect the descent of the fetal head, and artificial rupture of membranes should be performed. Fetal descent and delivery - As labor progresses, the fetal head is exposed to the vaginal opening during uterine contractions, and the exposed part continues to increase. During the interval between contractions, the fetal head retracts into the vagina, which is called fetal head exposure. When the biparietal diameter of the fetal head crosses the pelvic outlet and the fetal head no longer retracts during uterine contractions, it is called crowning of the fetal head.

Anxiety is related to worry about whether the fetus will be successfully delivered Lack of knowledge: Lack of knowledge on the correct use of abdominal pressure in conjunction with uterine contractions. The risk of injury is related to precipitous labor, maternal uncooperation, perineal protection and improper delivery techniques.

1. General care and support: During the second stage of labor, midwives should accompany you to relieve your tension and fear. There are no dietary restrictions, and liquid and semi-liquid foods and fluids are encouraged between contractions. 2 Specialist care: Guidance on delivery positions: (Generally, there are no restrictions on delivery positions to improve comfort. Among them, the semi-recumbent position with knees bent is the most common delivery position. This position is convenient for observing the progress of labor and can fully expose the perineum during delivery. However, this position will also compress the pelvic blood vessels, affect the blood supply to the placenta, and is not conducive to the mother's use of abdominal pressure, which may lead to prolonged labor. ) Guide mothers to hold their breath and exert force: (The key to shortening the second stage of labor when using abdominal pressure correctly. It is recommended that mothers should be guided to exert force after they feel the feeling of holding their breath downwards. Within 5 to 30 minutes of full dilatation of the cervix of a primipara, if there is no voluntary breath-holding sensation, there is no need to encourage the mother to hold her breath and exert force. During each uterine contraction, first inhale and then hold your breath, then close your lips tightly and push the upper glottis downward, lasting 5 to 7 seconds, repeat 3-4 times. The mother can breathe freely between contractions and relax her whole body. ) Preparation for delivery: (When the fetal head of a primiparous woman is exposed by 3~4cm, the caliber of the uterus of a multiparous woman is fully opened, and the perineum is bulging and tense, preparations for delivery should be made.) Delivery: Assess whether episiotomy is needed (routine episiotomy is not recommended. Perineal tearing is unavoidable or the mother and fetus are sick and it is urgent to end the delivery. Episiotomy is performed and the incision is made when the fetal head is crowned. Reduce bleeding.) Protect the perineum and assist in the delivery of the fetal head: (Premature and excessive intervention in normal delivery is currently not recommended.) Treatment of the umbilical cord around the neck to assist in the delivery of the fetal body: (After the delivery of the fetal head, do not rush to deliver the fetal shoulder and wait patiently for the next time During uterine contractions, do not use external pressure on the abdomen. At this time, use your left hand to squeeze from the base of the newborn's nose down to the chin to squeeze out the mucus and amniotic fluid in the mouth and nose.

Signs of placenta detachment: 1. The fundus of the uterus becomes hard and spherical. After the placenta is detached, it drops to the lower segment of the uterus. The lower segment passively expands. The uterine body is pushed upward in a long and narrow shape, and the fundus of the uterus rises above the umbilicus. 2. The stripped placenta descends to the lower segment of the uterus, and the exposed section of the umbilical cord at the vaginal opening extends on its own. 4. There is a small amount of vaginal bleeding. 4. When the ulnar side of the palm of the hand is used to gently press the lower uterine segment above the maternal pubic symphysis, the uterine body rises and the exposed umbilical cord no longer retracts. Apgar score: Based on five physical signs: heart rate, respiration, muscle tone, laryngeal reflex and skin color within one minute after birth, each item is scored from 0 to 2 points, with a full score of 10 points. If the score is 8-10, it is a normal newborn; if the score is 4-7, it is mild asphyxia, and if it is 0-3, it is severe asphyxia.

There is a risk of invalid parent-child bonding: associated with fatigue, perineal incision pain or undesirable sex of the newborn Potential complications: postpartum hemorrhage, neonatal asphyxia

1. Newborn care: Dry and keep warm, clear the respiratory tract, and handle the umbilical cord: (The umbilical cord can be ligated 30 to 60 seconds after the newborn is born or after the umbilical cord blood vessels stop pulsing.) Newborn examination and records: (Conduct a physical examination, wipe off the fetal fat on the soles of the newborn's feet and make footprints and thumb prints on the newborn's medical record.) 2. Assist the delivery of the placenta: (The delivery person must not massage, press down on the fundus of the uterus or pull the umbilical cord with hands when the placenta has not been completely detached, so as not to cause partial detachment of the placenta and cause bleeding or break the umbilical cord. When it is confirmed that the placenta has been completely detached, hold the fundus of the uterus with your left hand during uterine contractions and press it. At the same time, gently pull the umbilical cord with your hand to assist in the delivery of the placenta. After the placenta and fetal membranes are delivered, massage the uterus to stimulate uterine contraction and reduce bleeding. At the same time, pay attention to observe and measure the amount of bleeding. If the placenta is not completely separated and there is heavy bleeding, or the placenta has not been discharged 30 minutes after the fetus was delivered, manual placenta removal should be performed. ) 3 Check the placenta and fetal membranes 4 Check the soft birth canal 5. 2-hour postpartum care (general care: measure blood pressure and pulse after delivery.) (Assess the amount of vaginal bleeding and prevent postpartum hemorrhage: observe uterine contractions every 30 minutes. When the bleeding exceeds 300ml, it should be treated as postpartum hemorrhage.) (Promote parent-child interaction: maintain skin-to-skin contact between mother and baby for at least 90 minutes, and assist in completing the first breastfeeding.)

Non-pharmacological labor analgesia: including breathing techniques, music therapy, hydrotherapy, accompanying labor, aromatherapy, hypnosis Acupoint massage, hot compress and other methods.

Medicinal labor analgesia: including epidural anesthesia and spinal anesthesia. Combined epidural anesthesia is currently the most effective method of labor analgesia with less impact on mother and baby. Commonly used drugs include bupivacaine, ropivacaine, etc.

changes in the reproductive system

breast

blood circulation

digestive system

urinary system

Endocrine System

abdominal wall changes

It can be slightly higher within 24 hours after delivery, generally not exceeding 38°C. 3-4 days after delivery, breast enlargement occurs due to extreme engorgement of blood vessels and lymphatic vessels in the breast, accompanied by an increase in body temperature, which is called lactation fever.

Uterine involution: 1 day after delivery, it slightly rises to the level of the navel, and 10 days after delivery, it descends into the pelvic cavity. Postpartum uterine contraction pain usually occurs 1-2 days after delivery and lasts for 2-3 days and resolves on its own.

Lochia: Postpartum uterine decidua is shed, and blood, necrotic decidua tissue, etc. are discharged through the vagina called lochia. Lochia has a fishy smell but no odor, lasts for 4-6 weeks, and the total amount is 250-500ml. Normal lochia is divided into bloody lochia, nocturnal lochia and white lochia according to color, composition, appearance and duration.

Rest and food: A comfortable and quiet resting environment, and keep the sheets clean. One hour after delivery, mothers are encouraged to eat a liquid diet or a light semi-liquid diet, or a normal diet. Food should be rich in nutrients, sufficient calories and water. Breastfeeding mothers should eat more protein and soup foods, and also take appropriate vitamin and iron supplements. Iron supplements are recommended for three months.

Urination and defecation: Encourage and assist mothers to urinate 4 hours after delivery. If there is concern about pain caused by urination, help them urinate. The methods are as follows: 1. Wash the vulva with hot water or rinse the area around the external opening of the urethra with warm water to induce urination; apply hot compress to the lower abdomen and massage the bladder to stimulate bladder muscle contraction. 2. Acupuncture acupuncture points such as Guanyuan, Qihai, Sanyinjiao, and Yinlingquan to promote urination. 3. Intramuscular injection of neostigmine methyl sulfate to promote urination. 4. Catheterize and leave the urinary catheter in place for 1-2 days. Defecation; intestinal motility is weakened. Pregnant women are encouraged to drink more water, eat more vegetables, and get out of bed early to prevent constipation.

Health care exercise: Get out of bed for light activities 6-12 hours after delivery, and do casual activities indoors on the second day after delivery.

Adjust mentally

Advantages of breastfeeding

Breastfeeding tips: Breastfeed on demand. Breastfeeding precautions: Each time you breastfeed, you should empty one breast and then suck on the other. After breastfeeding, pick up the baby and pat the baby's back for 1-2 minutes to expel air from the stomach to prevent vomiting.

The standard for judging whether the amount of milk secretion is sufficient: the milk can be sucked out and stored in a milk storage bag. Storage time: no more than 4 hours at 20~30℃, no more than 48 hours at 4℃, 6 months at -15~-5.

Perineal wound: Observe the surrounding area daily for bleeding, hematoma, redness, swelling and secretions, and the mother should be in the healthy side lying position. For those with severe perineal edema, you can use 50% copper sulfate moist heat compress twice a day for 20 minutes each time or irradiate the vulva with infrared rays 24 hours after delivery. Those with perineal hematoma will cooperate with the physician for incisional treatment.

Women are prohibited from sexual intercourse within 42 days after delivery and can resume normal life based on postpartum examination results. Breastfeeding women are recommended to use contraceptive methods instead of medications. Inform the mother to go to the hospital with the baby in 42 days for a comprehensive examination.

Embryonic factors: Chromosomal abnormalities are the most common cause of spontaneous abortion.

Maternal factors: systemic diseases, immune factors, reproductive organ abnormalities (relaxation of the internal cervical os can easily cause late miscarriage due to premature rupture of membranes.) Others (incompatible blood types, frequent sexual intercourse, excessive smoking, alcoholism, and drug abuse)

Placental factors: placenta previa, placental abruption

Environmental factors: Excessive exposure to harmful chemicals and physical factors.

For miscarriages that occur within 8 weeks of pregnancy, most of the products of pregnancy can be completely separated from the uterine wall and excreted, with little bleeding. At 8 to 12 weeks of pregnancy, the placental villi are well developed and have a strong connection with the decidua basalis. If a miscarriage occurs at this time, the products of pregnancy are often not easily separated and excreted completely. After 12 weeks of pregnancy, the placenta has been completely formed. During miscarriage, there is often abdominal pain first, and then the fetus and placenta are expelled.

① Threatened abortion: It is characterized by a small amount of vaginal bleeding after menopause, which is less than the menstrual flow, sometimes accompanied by slight lower abdominal pain, low back pain, and waist drop. Gynecological examination: The size of the uterus is consistent with the number of weeks after menopause, and the cervix is ​​not dilated. After rest and treatment, if the bleeding stops or the abdominal pain disappears, the pregnancy can continue; if the bleeding increases or the abdominal pain worsens, it may develop into inevitable miscarriage.

② Inevitable miscarriage: Developed from threatened abortion, miscarriage is inevitable. The symptoms include increased vaginal bleeding and worsening abdominal pain. Gynecological examination: The size of the uterus is consistent with or slightly smaller than the number of weeks after menopause, and the cervix has been dilated.

③Incomplete abortion: It develops from unavoidable miscarriage. Part of the pregnancy products is excreted from the body, and some remains in the uterus, thus affecting the contraction of the uterus, causing vaginal bleeding to continue. In severe cases, it can cause hemorrhagic shock and reduce lower abdominal pain. Gynecological examination: Generally, the uterus is smaller than the number of weeks after menopause and the cervix has been dilated. There is constant blood flowing out of the cervix. Sometimes it can be seen that the placental tissue is blocked in the cervix or some of the products of pregnancy have been discharged from the vagina, while some are still in the uterine cavity. Sometimes the cervix has been closed.

④ Complete miscarriage: The products of pregnancy have been completely discharged, vaginal bleeding gradually stops, and abdominal pain disappears. Gynecological examination: The uterus is close to normal size or slightly smaller, and the cervical opening has been closed.

⑤ Missed abortion: Also known as expired abortion, it refers to the case where the embryo or fetus has died and remains in the uterine cavity and has not yet been discharged naturally. After the death of the embryo or fetus, the uterus no longer increases but shrinks, and the early pregnancy reaction disappears. If it has reached the second trimester, the pregnant woman will not feel the abdominal enlargement and the fetal movement will disappear. Gynecological examination: the uterus is smaller than the gestational age and the cervix is ​​closed. The fetal heartbeat cannot be heard during auscultation.

Recurrent miscarriage: refers to three or more spontaneous miscarriages occurring in a row with the same sex partner.

Miscarriage combined with infection: may cause intrauterine infection.

Key points of treatment - The principle of treatment for threatened abortion is to rest in bed and prohibit sexual life; reduce stimulation; if necessary, give sedatives that are less harmful to the fetus; for pregnant women with insufficient luteal function, intramuscular injection of 20 mg of progesterone per day as directed by the doctor to facilitate preservation. Pregnancy; and pay attention to timely ultrasound examination to understand the development of the embryo and avoid blind preservation of the fetus. Once miscarriage is inevitable, the embryo and placental tissue should be completely discharged as soon as possible to prevent bleeding and infection. The principle of treatment of incomplete abortion is that once the diagnosis is confirmed, uterine aspiration or forceps curettage should be performed to remove residual tissue in the uterine cavity. The principle of treatment for complete abortion is that if there are no signs of infection, no special treatment is generally required. The principle of treatment of missed abortion is to promptly expel the fetus and placenta to prevent the dead fetus and placental tissue from remaining in the uterine cavity for a long time and causing severe coagulation dysfunction and DIC.

The risk of infection is related to factors such as prolonged vaginal bleeding and residual tissue in the uterine cavity. Anxiety is related to factors such as concerns about the health of the fetus.

Care of pregnant women with threatened abortion: Pregnant women with threatened abortion need to rest in bed, and their emotional state will also affect their fetal preservation effect. Nursing care for those whose pregnancy cannot continue: Nurses should actively take measures to prepare for the termination of pregnancy in a timely manner. Prevention of infection: Nurses should check the patient's temperature, blood count and vaginal bleeding. Instruct pregnant women to use sterile perineal pads. Health education: For those with insufficient luteal corpus function, use progesterone treatment correctly according to doctor's instructions to prevent miscarriage. For example, if the cervix is ​​loose, the lax internal cervix should be repaired before pregnancy. If pregnant, intrauterine cerclage can be performed at 12 to 16 weeks of pregnancy.

Fallopian tube inflammation: This is the main cause of fallopian tube pregnancy.

Fallopian tube dysplasia or dysfunction: dysplasia such as lack of mucociliation can be the cause of fallopian tube pregnancy.

Fertilized egg swims

Assisted reproductive technology: Due to the application of assisted reproductive technology in recent years.

Others: endometriosis, insertion of intrauterine devices, etc.

Fallopian tube pregnancy miscarriage: It is more common in fallopian tube ampullary pregnancy, and the onset is usually between 8 and 12 weeks of pregnancy.

Fallopian tube pregnancy rupture: It is more common in the fallopian tube isthmus, and the onset is usually around 6 weeks of pregnancy.

Old ectopic pregnancy: Sometimes after miscarriage or rupture of fallopian tube pregnancy, if it is not treated in time or the internal bleeding has gradually stopped, the condition has been stable for too long, and the embryo dies or is absorbed. However, pelvic hematoma formed by long-term repeated internal bleeding can become organized, harden, and adhere to surrounding tissues, which is clinically called old ectopic pregnancy.

Secondary abdominal pregnancy: But occasionally there are survivors, if the chorionic tissue of the surviving embryo is still attached and in situ, it is discharged into the abdominal cavity and replanted with nutrients.

Persistent ectopic pregnancy: The pregnancy products are not completely removed during the operation or surviving trophoblast cells continue to grow.

Menopause: Most patients experience irregular vaginal bleeding 6 to 8 weeks after menopause.

Abdominal pain: It is the main symptom for patients with fallopian tube pregnancy. When the fallopian tube pregnancy is miscarried or ruptured, the patient suddenly feels tearing pain in the lower abdomen on one side. .

Vaginal bleeding: After the death of the embryo, hCG in the blood decreases, and there is often irregular vaginal bleeding, dark red or dark brown in color, small in amount and in the form of drops.

Fainting and shock

Abdominal mass: It can be formed due to blood coagulation, gradual hardening, and adhesion to surrounding organs.

Diagnostic points: ① Posterior vaginal fornix puncture: It is a simple and reliable diagnostic method. Drawing out dark red blood without coagulation is positive. If the drawn blood is red and coagulates within ten minutes, it indicates that it has entered the blood vessel by mistake. ②Pregnancy test: Measure hCG in blood ③Ultrasound examination: Diagnosis of early ectopia

Key points of treatment: ① Surgical treatment: According to the situation, perform a salpingectomy on the affected side or a conservative surgery to preserve the patient's fallopian tube and its function. ②Drug treatment: Chemical drug treatment is mainly suitable for early-stage odor-prone pregnancy. Systemic medication is commonly methotrexate.

Risk of shock associated with bleeding Fear related to fear of surgical failure

Care for patients undergoing surgical treatment: ① Actively prepare for surgery ② Provide psychological support Care for patients receiving non-surgical treatment: ① Closely observe the condition: such as increased bleeding, worsening abdominal pain, obvious anal swelling, etc. ② Strengthen care for chemical drug treatment: Chemotherapy generally uses systemic drugs, but also local drugs. ③ Instruct the patient to rest and eat: The patient should rest in bed, and instruct the patient to take in sufficient nutrients, especially foods rich in ferritin, to promote the increase of hemoglobin and enhance the patient's resistance. health education

maternal factors

Fetal and placental factors: premature rupture of membranes and choriojonitis are the most common.

Threatened prematurity: When the pregnancy is between 28 weeks and less than 37 weeks, regular uterine contractions occur, accompanied by progressive shortening of the cervical canal, but the cervix has not yet expanded.

Premature labor: When the pregnancy is 28 weeks and less than 37 weeks, there are regular uterine contractions, accompanied by progressive changes in the cervix, the cervix is ​​shortened by more than or equal to 80%, and the cervix is ​​dilated. The situation is similar to that of full-term pregnancy.

There is a risk of suffocation related to the immaturity of premature infants. Anxiety is associated with concerns about the prognosis of premature infants.

① Preventing premature birth: Pregnant women should be in good physical and mental condition and should be guided to strengthen their nutrition to avoid activities that induce uterine contractions. High-risk pregnant women must rest in bed more often, preferably on the left side. Those with loose cervical os should undergo uterine underwear cerclage at 12 to 16 weeks of pregnancy. ② Nursing care of drug therapy: Commonly used drugs that inhibit work include: albuterol, magnesium sulfate, channel blockers, and prostate synthase inhibitors. ③Prevent the occurrence of neonatal complications: Give pregnant women glucocorticoids such as dexamethasone and betamethasone as directed by the doctor before delivery, which can promote fetal lung maturity. ④Prepare for childbirth ⑤Provide psychological support to pregnant women

The basic pathophysiological change of this disease is systemic arteriolar spasm. Due to arteriolar spasm, the lumen is narrowed, peripheral resistance is increased, endothelial cells are damaged, permeability is increased, and body fluid and protein leakage, manifesting as increased blood pressure, proteinuria, edema, hemoconcentration, etc.

Hypertension during pregnancy: Hypertension for the first time after 20 weeks of pregnancy, with systolic blood pressure greater than or equal to 140mmHg and diastolic blood pressure greater than or equal to 90mmHg. It returned to normal within 12 weeks after delivery, with proteinuria (-), and the patient was accompanied by epigastric discomfort or thrombocytopenia. Diagnosis can be made after delivery.

Preeclampsia: ① Mild: Appears after 20 weeks of pregnancy, blood pressure is greater than or equal to 140/90mmHg, and urine protein is greater than or equal to 0.3g/24h ②Severe: blood pressure is greater than or equal to 160/110mmHg, urine protein is greater than or equal to 2.0g/24h

Eclampsia: The occurrence of convulsions on the basis of pre-eclampsia and subsequent semi-coma is called eclampsia. The typical attack process of eclampsia: firstly, the eyes are fixed, the pupils are dilated, the head is turned to one side, the teeth are locked, and then the corners of the mouth and facial muscles tremble. After a few seconds, the muscles of the whole body and limbs become rigid, the hands are clenched, and the arms are straightened. Strong twitching. The twitching lasts for about a minute, the intensity weakens, and then the muscles all over the body relax, and then the breathing is resumed by taking a deep breath.

Chronic hypertension complicated by preeclampsia: Pregnant women with high blood pressure have no proteinuria before 20 weeks of gestation. If urinary protein is greater than or equal to 0.3g/24h or random urinary protein after 20 weeks of gestation ( ), or urinary protein suddenly appears after 20 weeks of gestation. Increase, further increase in blood pressure or decrease in platelets.

Pregnancy complicated by chronic hypertension: blood pressure greater than or equal to 140/90mmHg before pregnancy or before 20 weeks of pregnancy, but not significantly aggravated during pregnancy, or hypertension is first diagnosed after 20 weeks of pregnancy and continues beyond 12 weeks postpartum.

Physical condition: Typical patient symptoms include hypertension, edema, and proteinuria after 20 weeks of pregnancy. Focus on assessing the patient's urine protein, edema, subjective symptoms, convulsions, coma, etc. ① Collect 24-hour urine for urine protein examination: any 24-hour urine protein amount greater than or equal to 0.3g is abnormal.

Treatment points: The basic treatment principles are sedation, antispasmodic, antihypertensive, diuretic, and timely termination of pregnancy. Diazepam is commonly used for sedation, magnesium sulfate is the first antispasmodic drug, and captopril is commonly used as an antihypertensive drug.

1 Medication and care Magnesium sulfate is currently the preferred antispasmodic drug for the treatment of preeclampsia and eclampsia. Medication method ① Intramuscular injection: 20ml of 25% magnesium sulfate and 2ml of 2% lidocaine for deep intramuscular injection. ② Intravenous administration: The intravenous loading dose is 4 to 6 g, dissolved in 20 ml of 25% glucose solution for intravenous infusion, or dissolved in 100 ml of 5% glucose (15 to 20 minutes) for rapid intravenous infusion, followed by intravenous infusion of 1 to 2 g/h of magnesium sulfate. maintain. 2 Toxic reactions: The therapeutic concentration of magnesium sulfate is similar to the poisoning concentration. Therefore, when treating magnesium sulfate, its toxic effects should be closely observed and the dosage of magnesium sulfate should be carefully controlled. It is generally recommended that the infusion rate of magnesium sulfate is 1g/h and not exceed 2g/h. The daily dosage is 25~30g. Excessive magnesium sulfate can inhibit respiratory and myocardial contractile functions and even endanger life. The first symptom of poisoning is the weakening or disappearance of the knee reflex. As the blood enzyme concentration increases, systemic hypotonia and respiratory depression may occur. In severe cases, the heartbeat may suddenly stop. 3 Precautions: Nurses should monitor the blood pressure of pregnant women before and during medication, and check the indicators at the same time. ① Knee reflex must exist ② Breathing no less than 16 times per minute ③ Urine output no less than 400ml every 24 hours or no less than 17ml every hour. 4. Detoxification: When injecting 10% calcium gluconate 10ml intravenously, it should be completed in more than three minutes. If necessary, it can be repeated once an hour until breathing, urination and nerve suppression return to normal, but no more than eight times in 24 hours.

The mechanism is not yet clear and is related to elevated estrogen and genetic and environmental factors.

Itchy skin is the first symptom. Jaundice: The patient's urine becomes darker and the stool becomes lighter.

Fetal diseases, multiple pregnancy, pregnancy complications, placental and umbilical cord lesions, idiopathic oligohydramnios

Acute oligohydramnios: less common. It usually occurs between 20 and 24 weeks of pregnancy. Due to the sharp increase in amniotic fluid, pregnant women's uterus will increase significantly within a few days, their diaphragm will be elevated, they will have difficulty breathing, they will not be able to lie down, and they will even become cyanotic. Chronic polyhydramnios: more common. It usually occurs in the third trimester of pregnancy, and the amniotic fluid slowly increases within a few weeks. Most pregnant women can adapt to it, and it is often discovered during prenatal check-ups.

Diagnostic points: Ultrasound examination is the most important auxiliary examination method. Treatment points: For those with polyhydramnios combined with severe fetal structural abnormalities, the pregnancy should be terminated as soon as possible after diagnosis. Those with polyhydramnios and normal fetuses should find the cause and actively treat the primary disease.

General care, condition observation, increasing comfort Cooperation with treatment: The speed of amniotic fluid release should not be too fast, about 500ml per hour, and the amount of amniotic fluid released at one time should not exceed 1500ml.

Fetal structural abnormalities, placental dysfunction, maternal factors, amniotic membrane lesions

Pregnant women feel abdominal discomfort during fetal movement, which may be accompanied by decreased fetal movement. During the examination, it was found that the uterus was high and the abdominal circumference was smaller than that of the same period of gestation. The uterus was sensitive and slight stimulation could easily trigger uterine contractions. Postpartum labor pains are severe and uterine contractions are often uncoordinated, and the cervix expands slowly, resulting in prolongation. The membrane sac was not obvious before vaginal examination, and the amniotic fluid outflow was small after artificial rupture of membranes.

Diagnostic points: Ultrasound examination is the most important auxiliary examination method. Amniotic fluid volume measurement: Amniotic fluid volume can be measured when membranes are ruptured, but oligohydramnios cannot be detected early.

Treatment points: If oligohydramnios is combined with severe fatal structural abnormalities of the fetus, the pregnancy should be terminated as soon as possible. For oligohydramnios combined with normal fetuses, the cause should be actively searched for and removed, the gestational age should be extended as early as possible, and the pregnancy should be terminated in a timely manner.