What Are the Most Common Risks Associated with Late Pregnancy?

Late pregnancy means that from the 28th week to the 40th week of pregnancy, it is said that when entering the third trimester, attention should be paid to the safety of the mother and the fetus. Pregnant women must undergo regular prenatal check-ups. They must have regular lives and emotional stability. In addition to continuing to ensure rich nutrition and appropriate activities during this period, you should also pay more attention to communicating with your baby, and try to maintain a calm, calm and impatient mood. In addition, it is necessary to prepare mentally and materially for childbirth.

Late pregnancy

Late pregnancy means that from the 28th week to the 40th week of pregnancy, it is said that when entering the third trimester, attention should be paid to the safety of the mother and the fetus. Pregnant women must undergo regular prenatal check-ups. They must have regular lives and emotional stability. This

After entering late pregnancy, some uncomfortable symptoms will appear due to endocrine changes and oppression of the enlarged uterus. If it is not serious, it is a late pregnancy reaction, and some measures can be taken to alleviate it without having to worry about it. These discomforts subside naturally after giving birth.

In the third trimester, the fetus develops rapidly and prone to obstetric complications. The main points of self-care are: strengthen self-monitoring and measure fetal heart rate, count fetal movements, and if you encounter vaginal fluid, bleeding, abdominal pain, reduced fetal movement, you should go to the hospital in time to prevent premature birth.

Eighth month: Fetal bone development is basically complete. The muscles are more developed. Fetal movements are also more frequent, sometimes kicking the mother's abdomen with force.

Month 9: Fetal development has reached the completion stage, and the skin becomes soft and smooth. Its position moved down to the lower abdomen, and turned, ready to be born.

The 10th month: The fetus has matured, the diameter of the fetal head is> 9.0 cm, the skin is pink, there is much subcutaneous fat, and the appearance is full.

Nutrition, pain, expectancy

1. Food intake for pregnant women at the end of pregnancy

Fetal nutrition comes from the mother's body. Although pregnant women should take balanced nutrition during pregnancy, each stage of the fetal organ system varies. In view of the nutrition that is particularly needed for the development of the fetal organ system at this time, expectant mothers should eat more foods such as fish, meat, eggs, milk, green vegetables, rice, noodles, liver, etc., so as to cultivate a healthy and healthy baby!

In the second half of pregnancy, due to rapid fetal development, maternal placenta, uterus, breast enlargement, amniotic fluid, and blood volume increase, pregnant women need to increase protein intake, preferably more than half from high physiological value of animal protein. In addition, edema and swelling of the lower limbs may occur at this stage. It is advisable to eat low-salt food and rice porridge, red bean soup and mung bean soup to improve symptoms.

Want to give birth to a beautiful baby with fair skin and pink powder? Here's a little tip: you can eat some tofu, soy milk, pineapple juice, it works well!

2, pain warnings at the end of pregnancy

During pregnancy, the uterus often shrinks, especially when it is close to the expected date of birth. We call it "false pain" or "false pain", because it can easily cause discomfort and anxiety in pregnant women, so some people mistakenly believe that It is about to be born, but it happens more irregularly and is less painful.

If the contraction occurs about every ten minutes, you should promptly notify your doctor and be ready to go to the hospital for delivery. If the contraction occurs every five minutes, it means that the labor has begun and the uterus will contract regularly. At this time, the contraction is called labor pain, and then there will be severe pain. The expectant mother must go to the hospital quickly.

In addition, he should be reminded that sometimes the amniotic membrane breaks open before there is any pain. This is "early breaking water". You should immediately ask your doctor to check whether the cervix is open and whether there is umbilical cord prolapse. Breaking the water for too long is more likely to cause bacterial infections, leading to some complications. Care should be taken.

3. Prepare hospital supplies at the end of pregnancy

It is usually 36 weeks of pregnancy, and it is possible at any time. Therefore, it is recommended that expectant mothers at the end of pregnancy put the supplies and documents needed for hospitalization in the same bag together, so that they can be at any time and take it away at any time. Leaked because of panic. Generally, the necessary documents for admission include: registered card, health insurance card, pregnant woman's health handbook, and identity cards of both spouses.

As for the items that may be used in hospital, the mothers can prepare according to their needs.

1) .Fashing utensils: towel, soap, facial cleanser, toothbrush, toothpaste, tooth cup, comb, washbasin (for warmth bath with hemorrhoids).

2) Clothing: front button-down pajamas, slippers, cotton socks (for cold protection), clothes and shoes worn by mother and baby when discharged.

3). Tableware: cup, spoon.

4). Hygiene and cleaning supplies: postpartum tampons and disposable trousers (some hospitals will provide one set).

5). Breastfeeding equipment: breastfeeding (front open) corset, breastfeeding pad, breast milk bag, breast pump.

6). Others: skin care products, skin lotion, toilet paper.

Pregnant women should self-monitor fetal movement in the third trimester

Monitoring fetal movement can detect chronic hypoxia in the fetus early and treat it in time to ensure the normal development of the fetus. Therefore, from the 7th month of pregnancy, until pregnancy, pregnant women are best to monitor their fetal movements.

So how do you monitor fetal movement? Huang Xiaolin, Chief Physician of Chaoyang District Maternal and Child Health Hospital, said: The number of fetal movements is 3 times each morning, middle and evening. The counts are added up and multiplied by 4 for 12-hour fetal movements. If there are more than 30 fetal movements in 12 hours, it is good for the fetus; in 20-30 fetal movements, you should pay more attention and increase the number of counts. If the fetal movement is less than or equal to 20, there may be hypoxia in the fetus, and you need to go to the hospital in time. If time is not convenient, you can count for an hour between 8-10 pm. More than 3 times is normal; less than or equal to 3 times need attention. If the fetal movement disappears for 12 hours, it is a fetal movement alarm. The fetus is in danger of death. You must go to the hospital in time.

Entering the third stage of pregnancy, usually called the perinatal period. At this time, attention should be paid to the safety of the mother and the fetus. Therefore, pregnant women must undergo prenatal checkups regularly, and their lives must be regular and their emotions stable.

1. You need to add enough calcium. The requirement of calcium for pregnant women in the third trimester is significantly increased, because fetal teeth and bone calcification require a lot of calcium, pregnant women should drink more bone soup, shrimp skin soup, eat more sesame, kelp, animal liver, eggs.

2. Add enough vitamin B1. Inadequate vitamin B1 in the third trimester of pregnancy will cause symptoms similar to the early pregnancy reaction, and even affect the contraction of the uterus of the pregnant woman during labor, resulting in difficult labor, so pregnant women should eat coarse grains rich in vitamin B1.

3. In addition to regular meals in late pregnancy, snacks and dinners should be added, such as milk, biscuits, walnuts, fruits and other foods. Dinners should choose foods that are easy to digest.

In the diet during the third trimester, the following can be noted:

1. Increase legume protein, such as tofu and soy milk;

2. Eat more seafood, such as kelp and laver; animal offal and nut foods;

3 Pay attention to control the intake of salt and water to avoid edema,

4 Choose foods with small volume and high nutritional value, such as animal food; reduce foods with low nutritional value and large volume, such as potatoes and sweet potatoes

5. Eat high-energy foods, such as sugar and honey

6. For pregnant women with edema, the daily amount of salt should be limited to less than 5 grams.

After entering the third trimester, due to endocrine changes and oppression of the enlarged uterus, some uncomfortable symptoms will appear. If it is not serious, it is a late pregnancy reaction, and some measures can be taken to alleviate it without having to worry about it. These discomforts subside naturally after giving birth. However, if you have any of the acute symptoms listed below, you should go to the hospital immediately.

Bleeding gums

Gingival bleeding, especially after brushing. Clean teeth thoroughly with a toothbrush after eating. Taking vitamins.

asthma

You can't breathe when you are doing things hard or even speaking. Get as much rest as possible. If you feel breathless and there are no chairs nearby, try crouching. Add an extra pillow at night and go to the doctor if you have asthma

Heartburn

There is intense burning pain in the center of the chest. Avoid eating lots of cereals, beans, foods with a lot of seasonings, or fried foods. Drink a cup of warm milk at night, and use a soft pad to raise your head. Take medicine to treat hyperacidity under the guidance of a doctor.

constipation

Drain hard, dry stools less often than usual. Eat foods high in fiber and drink plenty of water. Go to the toilet whenever you want. Exercise regularly. When taking any iron medication prescribed by your doctor, you should take it after meals and drink plenty of water. Seek medical attention if you have persistent constipation, and do not take laxatives indiscriminately.

Painful cramps

It often happens at night. Painful contractions in the calf and foot muscles are common. Seizures are usually triggered by leg extensions with toes down. Massage cramps or feet. In order to improve blood circulation, you can take a walk and move, if the pain is reduced, you can walk for a while. Take calcium and vitamin D.

Frequent urination

Pee often. If you find yourself going to the toilet at night, drink less water in the evening. If you experience painful urination, you may have an infection and seek medical attention.

Leaking urine

Whenever you run, cough, sneeze, or laugh, urine leaks out. Frequent urination. Exercise your pelvic floor muscles regularly. Prevent constipation and avoid lifting heavy objects.

Hemorrhoids

Itching, pain, and bleeding during bowel movements. Prevent constipation. Try not to stand for long. Apply hot or cold topically.

rash

Red rashes often occur in sweaty skin folds under the breast or in the groin. Wash the affected area with unscented soap and let it dry. Reduce skin discomfort with gardenia water. Wear wide cotton clothes.

insomnia

It's troublesome to fall asleep, and it's hard to sleep after waking up. Some pregnant women have terrible dreams around childbirth or the fetus. Reading a book, exercising for a while or taking a warm bath before going to bed can help you sleep. Try adding an extra pillow. When you sleep on your side, put the pillow between your thighs.

Vaginal discharge

There are more clear or yellow discharge than usual, without itching, pain or odor. Avoid using vaginal deodorants and perfumed soaps. Use a light colored sanitary pad. Seek medical attention if you feel itchy, sore, or have secretions or smells.

Varicose veins

Pain in the legs, pain and swelling in the veins of the calves and thighs. Raise your feet often to rest. Don't stand for too long.

Sweating

Sweating after a little effort, or waking up at night feeling hot and sweating. Wear loose cotton clothes. Drink plenty of water. Windows open at night.

After entering the third trimester, the uterus of the pregnant woman has become extremely swollen, and the burdens of various organs and systems are nearing the peak. Therefore, the psychological pressure on pregnant women is also relatively heavy. Due to changes in body shape and inconvenience of movement, some psychological changes have occurred in pregnant women. Many pregnant women will have an ambivalence of excitement and tension, which will lead to psychological problems such as emotional instability, mental depression, and even the whole body due to psychological effects. Weakness, unwilling to move even if everything is normal.

Due to the approaching due date, pregnant women's fear, anxiety or anxiety about childbirth will be aggravated, and the childbirth will change. Some pregnant women are too worried about how to cope when they are expecting labor. If there is a threat of labor, they will not be too late to go to the hospital. Therefore, they will rush to the hospital with a little turmoil. Require early hospitalization. Therefore, mental health care in the third trimester should pay attention to the following issues:

1.Understand the principles of childbirth and related scientific knowledge

The best way to overcome the fear of childbirth is to let pregnant women know the whole process of childbirth and the possible situations, and to train pregnant women before childbirth. Many local hospitals or relevant institutions have organized "pregnant women's schools". Education for pregnant women and their husbands in the early, middle and late stages, specializing in explaining relevant medical knowledge and cooperation of pregnant women in childbirth. This is of great help to effectively alleviate the psychological pressure, relieve the ideological burden, and do good health care during pregnancy, and timely find and diagnose various abnormal conditions.

2. Prepare for childbirth

Preparations for childbirth include medical examinations, psychological preparations and material preparations during the third trimester. The purpose of all preparation is to hope that the mother and baby are safe, so the preparation process is also a comfort to the pregnant woman. If a pregnant woman learns that her family and doctors have done a lot of work for herself, and that she also considers unexpected situations, then she should have the bottom of her heart.

After the third trimester, especially near the due date, the husband of the pregnant woman should stay at home, so that his wife can rely on her.

3. It is not advisable to enter the hospital early when there is no accident in the body.

There is no doubt that being in the hospital during labor is the safest way. However, waiting too long for early admission is not necessarily good. First of all, the medical equipment is limited. If every pregnant woman is admitted in advance, the hospital cannot be as comfortable, quiet and convenient as at home. Secondly, there is a sense of urgency when pregnant women are not expectant to labor for a long time after admission. The post-admission patient has already given birth, which is also a stimulus to her. In addition, everything in the maternity ward can affect the mood of the inpatient, and this effect is sometimes not very beneficial.

Therefore, pregnant women should stabilize their emotions, maintain a peaceful mood, and wait for the arrival of childbirth with peace of mind. Pregnant women who are not recommended by the doctor should not wait in advance.

After 28 weeks of pregnancy, due to maternal factors or fetal reasons, artificially initiated uterine contraction to terminate pregnancy is called late pregnancy induction of labor.

[Indications] (1) Maternal aspect

Late pregnancy indication

1. Certain pregnancy complications, heart disease, chronic hypertension, kidney disease, diabetes, etc. The condition cannot be controlled, and continued pregnancy will endanger the life of the mother and child.

2. Severe pregnancy-induced hypertension syndrome, mild placental abruption, low placenta previa, etc., the fetus is mature.

3. Full-term pregnancy with ruptured membranes for 12 to 24 hours without labor.

4. Expired pregnancy.

5. Acute hyperhydramnios with symptoms of compression.

(B) the fetus

Stillbirth

2. Fetal malformations (hydrocephalus, anencephaly).

3. Intrauterine growth retardation and maternal and child blood type incompatibility.

[Contraindications] 1. Obvious pelvic pelvis, obstruction of birth canal (uterine fibroids, ovarian tumors), horizontal position, hip position, etc. It is estimated that those who have difficulty in vaginal delivery.

Contraindications for late pregnancy

2. Scar the uterus. (Such as the history of cesarean section, uterine fibroid enucleation).

3. Malformed uterus. (Such as double uterine malformations, etc.)

4. Complete placenta previa, heavy placental abruption.

5. Township-level health centers, no cesarean section, lack of technical conditions to rescue mothers and children, any application of uterine contractions is strictly prohibited.

[Methods and precautions] (1) Induction of labor by medicine

Late pregnancy considerations

1. Oxytocin Induced labor Oxytocin has a selective contraction effect on uterine smooth muscle. It is the most commonly used and effective induction drug, but the individual differences are obvious. The more sensitive the uterus of full-term pregnancy is to the effect of oxytocin, the higher the rate of successful labor induction is for those with mature cervix.

(1) Method: Start with a low concentration, first administer 5% glucose solution intravenously, adjust the drip rate to 8 drops / min, and then add 2.5U oxytocin to 5% glucose solution to make a 0.5% concentration infusion. Adjust according to contraction strength. Usually does not exceed 10mu / min (30 drops / min). Maintain the intrauterine pressure up to 50-60mmHg. The contraction interval is 2 to 3 minutes, which lasts 40 to 60 seconds. For those who are not sensitive, the dose of oxytocin can be increased appropriately.

The indications and contraindications should be strictly controlled, and the medical education network should be fully consulted before the medication, and the medical history, physical examination, and cervical examination scores should be sorted out to rule out pelvis disproportion.

During instillation, someone should closely observe the changes in contractions, blood pressure, pulse and fetal heart rate. Recorded every 15 minutes. Those with conditions can use electronic fetal monitors. During the infusion, if you find that the contractions are too strong for more than 1 minute, or the fetal heart sound changes, you should stop the infusion immediately. The half-life of oxytocin in the mother's blood is 2 to 3 minutes. It can improve quickly after stopping the drug. If necessary, sedatives can be added to inhibit its effect to prevent uterine rupture or intrauterine distress.

Due to the anti-diuretic effect of oxytocin, it can increase the reabsorption of water and cause oliguria. You should be alert to the occurrence of water poisoning. Therefore, the amount of infusion for one induction labor should not exceed 1000ml. Too fast.

If pregnant women have chest tightness, shortness of breath, chills, rash or even shock, stop taking the medicine immediately and rescue them immediately.

If the labor induction is unsuccessful on the same day, it can be repeated, but other labor induction methods should be considered after three days.

2. Prostaglandins induced by prostaglandins (PGF2a, PGE2) can promote cervical maturation. It has a contractive effect on the uterus in all stages of pregnancy.

(1) Method: The route of administration is oral, intravenous and topical (placed in the posterior vaginal fornix). Among them, vaginal medication is the safest. The following describes vaginal medication.

DGE2 suppository: PGE2 suppository containing 3ml can be inserted into the posterior vaginal fornix, if it is not effective, put another one the next day.

Carbosuppository: domestically produced PG05, with the same usage as PGEa.

Misoprostol: Abbreviated as "Miso", low-dose application: 25ug placed in the vaginal vault, replay after 4 hours without contractions. The total amount does not exceed 200ug.

(2) Matters needing attention:

Pregnant women suffer from severe comorbidities, such as heart disease, acute liver, kidney disease, glaucoma, asthma, epilepsy, and severe anemia.

Pay attention to side reactions and their treatment. Such as nausea, vomiting, diarrhea, vitamin B6, metronidazole, atropine can be given; medical education network finishing release such as tachycardia, headache, can be given sedatives; such as blood pressure can generally recover in a short time; such as skin bleeding Intravenous infusion of hydrocortisone; if the contraction is too strong, the drug should be discontinued immediately, and a contraction inhibitor such as Shuchuanling sulfate orally, or the prostaglandin inhibitor indomethacin should be given to combat the prostaglandin-induced Tonic uterine contraction.

B) Surgical induction of labor

1. Artificial stripping of the membrane is an older type of induction of labor, currently not commonly used clinically. This method can mechanically expand the cervix, stimulate the cervix with fingers to cause oxytocin release, and achieve induction of labor.

(1) Operation steps: warm soapy enema before operation, empty the bladder, and listen to the fetal heart. Take the bladder lithotomy position, routine disinfection, and spread towels. The surgeon wears sterile gloves, stretches the fingers into the cervical canal, slightly dilates the cervix, and then peels around the cervix, between the uterine wall and the fetal membrane, 1 to 2 circles, and a depth of 3 to 5 cm.

(2) Matters needing attention:

Contractions can be initiated within 24 hours after peeling.

The operation should be strictly aseptic to prevent infection. During the operation, the movement should be gentle to prevent the cervical movement or rupture of the fetal membrane caused by rough movement.

Pay attention to observe fetal heart changes and contractions.

This technique is forbidden for those who have placenta previa; this technique is not suitable for those with immature cervix, buttocks and floating fetal head.

2. Artificial rupture membrane technique uses artificial methods to rupture the fetal membranes and allow amniotic fluid to flow out. Medical Education Network organizes and releases them to induce or strengthen contractions, shorten the labor process, and accelerate labor. This technique is currently the main method of oxytocin or induction of labor in late pregnancy. It is simple, effective and widely used in clinical practice.

(1) Mechanism of action:

Increase in prostaglandin synthesis: Prostaglandin synthesis increases after rupture of the membrane, so that the contraction of the uterine muscle fibers is coordinated and powerful, thereby forming an effective delivery force.

Promote cervical maturation: The increase of prostaglandin after rupture of membranes softens and matures the cervix, dilates the cervix, and accelerates the labor process.

Increase in oxytocin release: With the disappearance of the amniotic fluid sac, the fetal head directly presses the cervix, stimulating the nerve plexus next to the cervix, which increases the release of oxytocin and further strengthens the strength of the contractions.

(2) Indications:

Induction of labor: mature cervix, fixed fetal head, unbroken fetal membranes, pregnancy-induced hypertension, expired pregnancy, mild placental abruption or partial placenta previa, stillbirth, oligohydramnios, etc.

Induced labor: When the birth process enters the active period, the membrane is broken, and the acceleration of the birth process is significant. It can understand the fetal intrauterine condition according to the amount of amniotic fluid, characteristics and color, and timely detect and deal with intrauterine distress. During the labor process, the relative pelvic pelvis is not called, the incubation period or the prolonged period is prolonged, or the labor process progresses slowly.

(3) Operation steps: empty the bladder before the operation, listen to the fetal heart, and there is no fetal distress. Take the bladder lithotomy position, and routinely disinfect and spread towels. The surgeon first touched the anterior amniotic sac with his finger and guided it with his finger. The other hand held a forceps or puncture needle. In the absence of contractions, the fetal membrane was pinched or punctured (Figure 17-2) to allow the amniotic fluid to slowly flow out. If the filling of the anterior amniotic sac is obvious, the medical education network will release too much amniotic fluid. The membrane should be broken at a higher position, and the puncture hole should be small to facilitate the slow outflow of amniotic fluid to prevent sudden drop in abdominal pressure and cause placental abruption. No filling, focus on expanding the membrane opening when the membrane is broken to understand the amount of amniotic fluid and the degree of pollution. If necessary, push up the fetal head to facilitate the outflow of amniotic fluid. Record the membrane rupture time and amniotic fluid.

(4) Matters needing attention:

Listen to fetal heart sound immediately after rupture.

Observe for one hour after membrane rupture, and drip oxytocin as appropriate to end labor as soon as possible and reduce infection.

After 12 hours of rupture, antibiotics should be applied to prevent infection.

(3) Comprehensive labor induction methods

Promote cervical maturity, initiate contractions, accelerate labor progression, and end labor as soon as possible in various ways. In the past, castor oil was commonly used orally (reduced now, occasionally causing excessive contractions), hot soapy enema, nipple stimulation, prostaglandin suppositories, artificial peeling, etc., and then induced by labor with oxytocin intravenous drip. it is good. In recent years, "safety of mothers" has been advocated. The method of induction of labor is more cautious. It should be comprehensively analyzed and should not be excessively interfered with the labor process. It is all based on safety and the safest and most effective method of induction of labor should be selected.