New pregnant mothers, do you know these things about prenatal check-ups? Do you know how to count fetal movements?

Author: Chen Qian, Chief Physician, Peking University First Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

When a woman finds out she is pregnant, she begins a journey of life. There are many stops on this journey, and at each stop we must check on time to see if the baby and the pregnant mother are safe and healthy. This is what we call prenatal check-ups.

1. How many prenatal checkups should I have during the entire pregnancy?

From conception to birth, you will generally need to have 10 or more prenatal checkups during the entire pregnancy. Generally, you will go to the hospital to create a record at 12 weeks of pregnancy. From 13 weeks of pregnancy, you will have a prenatal checkup every 4 weeks. From 24 to 36 weeks of pregnancy, you will have a prenatal checkup every 2 weeks. When you are about 36 weeks pregnant, you will have a prenatal checkup every week, because from 36 weeks on, you are getting closer to the date of delivery.

Prenatal examinations are currently mainly aimed at screening for fetal diseases, while also taking the mother into consideration to reduce their adverse effects. Providing correct examination methods and medical advice during this period is the key to reducing maternal and perinatal mortality rates.

2. What problems can prenatal examinations screen for in the fetus?

The main aspects of fetal screening are as follows:

When a fertilized egg develops from a cell into a baby, the most important thing is to understand whether the fetal structure development is normal. For example, polydactyly, syndactyly, cleft lip, limb development abnormalities, abnormal heart structure, etc. are mainly screened through ultrasound examinations. Dynamic assessment of the main organs of the fetus at different weeks of gestation is a major content of prenatal examinations.

Generally, you may have 4-5 ultrasound examinations throughout your pregnancy.

The first time is in the early pregnancy, about 6-7 weeks, to determine whether the fetus is in the uterine cavity and whether there is a fetal heartbeat or fetal bud.

The second ultrasound is around 11 weeks to 13+6 weeks, which is the NT screening. It determines whether the head-to-rump length is consistent with the gestational age, measures the thickness of the fetal nuchal translucency, and infers the risk of Down syndrome.

The third ultrasound examination is around 20-24 weeks, and is a full-body physical examination of the fetus, also known as major fetal malformation screening. However, ultrasound examinations have certain limitations and cannot screen out all fetal malformations. It is a screening of the gross structure of the whole body.

The fourth ultrasound examination is around 30 weeks of pregnancy. It dynamically observes the growth and development of the fetus to see if it matches the number of weeks of amenorrhea. It can also further check for structural abnormalities in the fetus, which is the so-called minor malformation.

In the later stages of pregnancy, when the due date is approaching, another ultrasound examination will generally be done to check the condition of the amniotic fluid, placenta, umbilical cord blood flow, etc.

Figure 1 Original copyright image, no permission to reprint

When ultrasound examination reveals abnormalities in the fetus, such as heart abnormalities, further fetal echocardiography can be performed. Other abnormalities can be detected by fetal magnetic resonance imaging. However, not all malformations can be screened out.

In addition, prenatal examinations will screen for some common chromosomal abnormalities. In our country, the screening is more focused on Down syndrome. Severe chromosomal abnormalities may cause structural abnormalities in the fetus, which can be easily discovered during the series of examinations.

Chromosomal abnormalities are mainly screened through serology, which infers the risk of the fetus developing Down syndrome through some indicators in the mother's body. It is usually completed between 12-26 weeks of pregnancy.

Down syndrome screening only estimates the probability of the fetus developing Down syndrome, indicating a high risk. The baby may have a high chance of developing Down syndrome, and further invasive tests are required, including cord blood puncture, amniocentesis, chorionic villus sampling, etc. If there are high-risk factors, such as the mother's delivery age is over 35 years old, or she has given birth to a child with chromosomal abnormalities, invasive prenatal diagnosis should be done directly.

Figure 2 Original copyright image, no permission to reprint

In the late pregnancy, fetal heart rate monitoring should be performed to monitor the amount of amniotic fluid and the condition of the placenta, to see if the fetus is in distress or hypoxia in the uterus, and to further ensure the health and safety of the fetus.

3. What are the examinations for pregnant mothers during pregnancy?

During pregnancy, a woman's body will undergo some changes. Whether she can withstand these changes requires further examination and determination by a doctor.

In the early stages of pregnancy, doctors are more concerned about whether the pregnant mother had any chronic diseases before pregnancy. Therefore, in the early stages of pregnancy, doctors will recommend that pregnant mothers undergo examinations for pregnancy complications. By asking about medical history, doctors will find out whether there are high blood pressure, diabetes, kidney disease, thyroid disease, infectious diseases, etc. If there are certain chronic diseases, doctors will assess whether the pregnant mother is suitable to continue the pregnancy under the current conditions. To determine whether the disease is suitable for pregnancy, doctors will further assess whether it needs treatment. If treatment is required, a treatment method will be selected for the pregnant mother to avoid any impact on the fetus and the pregnant mother during pregnancy.

In the second and third trimesters, around 24-28 weeks of pregnancy, a sugar screening test is done to determine whether the mother has gestational diabetes. Blood pressure is measured regularly to see if there is gestational hypertension. In addition, urine protein and body weight should be measured regularly.

In addition to regular prenatal checkups to detect any abnormalities in the fetus and the mother, the mother herself should also monitor the baby's condition in the late pregnancy. Counting fetal movements is a simple and effective way to do this.

4. How to count fetal movements in the late pregnancy?

As the fetus grows, around the eighth month of pregnancy, the fetal nervous system matures and the fetal movements become more regular. Fetal movement is a very sensitive indicator and is an indicator of whether the fetus is safe in the womb, so it is very important to count fetal movements in the late pregnancy.

Start counting fetal movements at a relatively fixed time every day, such as after meals, at the same time in the morning, noon and evening, and for the same length of time. There is a simple way to count fetal movements. Take two small bowls or two small plates, put a handful of beans in one, soy beans, mung beans, or red beans are all fine, and put a bean in the other bowl every time it moves. After an hour, count the number of beans in this bowl, which is the number of fetal movements.

Figure 3 Original copyright image, no permission to reprint

Counting fetal movements is to evaluate the regularity of the baby's fetal movements. It does not mean that the baby must move a certain number of times per minute or hour. Some people say that more than 3-5 fetal movements per hour are normal. Some pregnant mothers have more fetal movements, while others have fewer. Regardless of whether it is more or less, the increase or decrease in the number of fetal movements should not exceed 50%. Exceeding 50% may indicate that the fetus is abnormal. If the baby usually moves 20 times per hour, a 50% reduction is 10 times, so if the baby moves more than 3-5 times per hour, it may not be normal for the baby. If the fetal movement is abnormal, seek medical attention in time.

Finally, I hope every pregnant mother can complete this pregnancy journey smoothly. There will inevitably be hardships during the journey, but in the end she will have a healthy baby.