Pregnancy examination should be combined with the specific situation of both husband and wife. If it is the first child, both families have no history of genetic diseases, and they can be routinely screened for liver and kidney function, routine hematuria and infectious diseases. If you are pregnant with a second child, it depends on the specific situation, such as contraception with a ring or abortion. In this case, in order to avoid bad pregnancy, in addition to routine examination, we should also check whether there are problems with uterine cavity, fallopian tube and sex hormones.
Pregnancy and childbirth is a great event for any family, especially with the cancellation of compulsory premarital examination and the improvement of everyone's awareness of prenatal and postnatal care, more and more people realize the importance of pregnancy preparation and pre-pregnancy examination, and couples of childbearing age will take the initiative to go to the hospital for physical examination.
Because there are many medical institutions that carry out pre-pregnancy examination now, the level is mixed, and everyone is at a loss when choosing the examination items. For most couples who have no bad birth history, it is enough to develop a healthy lifestyle, abandon bad habits and go to the hospital for routine pre-pregnancy examination. However, for those friends who have a history of poor fertility or family hereditary diseases, it is very important to choose the pre-pregnancy examination items reasonably.
How to prepare for pregnancy and conduct reasonable pre-pregnancy examination? 1. Develop a healthy lifestyle and maintain a peaceful pregnancy mentality.
A healthy lifestyle mainly includes no smoking, no drinking, no staying up late, proper exercise and reasonable nutrition.
Pregnancy takes time and patience. Under normal circumstances, there is no need to "count the days and hold the time". Excessive tension is not conducive to pregnancy, but counterproductive. For women with normal menstrual cycle (28-30 days), the ovulation period is about 14 days, which is the time when the pregnancy probability is the highest. Just adjust your mind and let nature take its course.
Avoid contact with toxic and harmful chemical and physical environment before pregnancy and early pregnancy. Women of childbearing age should try to stay away from pets and avoid eating raw meat.
2. eugenics, starting from quitting smoking.
It is generally believed that female friends need to quit smoking. We know that if women smoke, it is easy to cause menstrual disorder and reduce the chance of pregnancy.
After pregnancy, if you still don't quit smoking, harmful substances in tobacco can harm the developing embryo through the placenta, especially in the early stage of embryonic development. Smoking by pregnant mothers is closely related to fetal chromosome aberration, abortion, stillbirth, multiple malformations and intrauterine growth retardation. In addition, pregnant women who smoke are more prone to anemia, and postpartum breast milk deficiency is more common.
So does this man need to give up smoking? In my outpatient consultation, I often meet couples arguing about whether the man needs to quit smoking, which is very helpless. Smoking by men is also harmful. Smoking has a bad effect on male fertility. The sperm density, sperm activity rate and normal sperm rate of smokers are significantly lower than those of non-smokers, which will increase the risk of male infertility.
In addition, harmful substances in tobacco will affect sperm DNA and cause changes in male sperm genetic material, thus increasing the risk of embryo abnormality. If the man must find 10 thousand reasons to smoke, please don't smoke in front of his wife, and don't let "second-hand smoke" become a hidden danger to the fetus.
3. What do you need to make up during pregnancy?
In addition to a healthy diet, couples are generally advised to take 0.4-0.8mg folic acid preparation in the third month before pregnancy, and take multivitamins containing folic acid if economic conditions permit to prevent fetal neural tube defects and other birth defects.
4. How do healthy couples choose the examination items?
If healthy couples have no bad birth history or family hereditary diseases, they can choose the following items for general examination. The woman includes gynecological examination (preferably including cervical cancer screening and human papillomavirus detection), gynecological ultrasound examination, sex hormone detection, thyroid function examination, leucorrhea routine, urine routine, blood routine, blood type, liver function and hepatitis virus index examination.
In addition to the general routine examination, if the man has the habit of smoking, drinking and staying up late, it is recommended to have a semen examination. If both husband and wife are negative for hepatitis B surface antibody, it is recommended to inject hepatitis B vaccine six months before pregnancy.
Special examination items generally include couples' chromosomes, thalassemia screening, folic acid level determination and prenatal five-item (TORCH) examination. TORCH test refers to the antibody test of a group of pathogenic microorganisms (Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus). The initial infection of this group of pathogens in early pregnancy may cause perinatal infection, leading to adverse reproductive consequences such as abortion, stillbirth, premature delivery, congenital malformation and mental retardation.
The purpose of pre-pregnancy examination is to understand the infection and immune status of women and give corresponding guidance. If rubella virus antibody IgG (-), we suggest that rubella vaccine be injected before pregnancy and strict contraception for 3 months.
5. How should couples with poor birth history choose the examination items?
There are many types of bad birth history, and the common problems in genetic counseling include: recurrent abortion, stillbirth, abnormal fetal pregnancy history (congenital heart disease, polydactyly, polydactyly, cleft lip and palate, hydrocephalus, clubfoot, neural tube defect, short limb deformity, abnormal development of external genitalia, etc. ) and the birth history of mentally retarded children.
Due to the limited space, it is impossible to introduce all the problems. This paper focuses on two common outpatient types-recurrent abortion and the birth history of mentally retarded children, and how these couples should choose the examination items.
Repeated abortion
The medical definition of habitual abortion refers to three abortions with same-sex partners before 24 weeks of pregnancy, whether continuous or intermittent, also known as habitual abortion. In practical work, we regard women's two spontaneous abortions as recurrent abortions. When two or more spontaneous abortions occur, relevant examinations should be carried out, and the cause of abortion has been made clear.
Generally, about 50% of recurrent abortion can be found through examination. These reasons include chromosome abnormality of one spouse, uterine malformation, uterine vascular abnormality and local circulation disorder, luteal insufficiency, prolactin increase, polycystic ovary syndrome, thyroid disease, immune factors and reproductive tract infection factors.
Therefore, couples with a history of recurrent abortion should have the above-mentioned examination before pregnancy, make clear the cause, and then carry out targeted prevention and treatment. It should be noted that the most common cause of spontaneous abortion is chromosome abnormality of embryo itself, accounting for 60% of spontaneous abortion. We suggest that after spontaneous abortion, it is best to preserve the embryo tissue and conduct chromosome analysis to determine whether spontaneous abortion is caused by chromosome abnormality of the embryo itself.
Birth history of children with mental retardation
The birth history of mentally retarded children is also a common situation in genetic counseling. Mental retardation refers to the obvious obstacle of intellectual function and social adaptability in the development process (before 18 years old) caused by various reasons, and the incidence rate in the population is 1% 3%.
Many couples have a misunderstanding. They think that since the first child has been sick, they can directly check the fetus after pregnancy again. Actually, this is a very wrong understanding. Because the causes of mental retardation are very complicated, external environmental factors account for about 1/3, including malnutrition during pregnancy, perinatal infection, hypoxia, trauma, premature delivery, exposure to neurotoxic drugs and so on. Congenital genetic factors account for about 2/3, including chromosome abnormalities, monogenic diseases, polygenic diseases, genetic metabolic diseases and so on.
We can only guide couples to have children with mental retardation as much as possible after making a clear diagnosis of the children who already have the disease, and also avoid the risk of them having children with mental retardation again to the greatest extent.
6. Do couples with a family history of genetic diseases have a pre-pregnancy examination?
This kind of couple is also one of the more common situations in our genetic counseling clinic. There are many kinds of genetic diseases, and the diagnosis of each genetic disease is different. If this happens, it is suggested that both husband and wife must consult a professional genetic counseling clinic or prenatal diagnosis institution before pregnancy, and must not blindly get pregnant, leading to the risk of giving birth to a child with genetic diseases again.
Common hereditary diseases include congenital deafness's disease, thalassemia, phenylketonuria, leguminous diseases, Duchenne muscular dystrophy, spinal muscular dystrophy, albinism, hemophilia, Marfan syndrome, achondroplasia, polycystic kidney disease and congenital adrenal hyperplasia.
First of all, it is necessary to carry out genetic diagnosis on the sick patient (called proband in genetic counseling), make clear the pathogenic genes of the proband and analyze the family, then we can assess the reproductive risk of other family members, and use prenatal diagnosis technology when necessary to avoid the birth of sick fetus during pregnancy.
Pre-pregnancy examination needs to be done carefully. Before pregnancy, both men and women need to go to the hospital to do a series of related tests, such as the semen of boys, the six hormones of girls, prenatal and postnatal care, thyroid, antibodies, ovarian function, liver function and kidney function. If you are pregnant, it is best to check the follicular condition and endometrial thickness once a month.
Pre-pregnancy examination: routine blood examination, routine urine examination, routine leucorrhea examination, gynecological endocrine and immune system examination, cervical smear examination, chromosome examination, etc.
Pregnant mothers with dental diseases also need to have an oral examination, and expectant mothers without dental diseases do not need an examination. Because of the toothache during pregnancy, considering the influence of therapeutic drugs on the fetus.
The pre-pregnancy tests mentioned above are very simple and can be done in almost all hospitals, which is suitable for every expectant mother. Others have some special tests, such as ABO hemolysis, measles antibody, AIDS test and hepatitis B test.