四、妊娠各期保健要求及监护内容
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|时|                            | 一 般 监 护                    |               |
|  | 保 健 要 求                |--------------------------------| 卫生宣传      |
|期|                            | 临 床                          | 实 验 室      | |
|--|----------------------------|--------------|----------------|----------------|
|  |                            |早孕检查，测基|                |                |
|孕|尽早发现孕妇，检查内科合    |础血压，及早发|尿常规、血色素、|早孕生理特点，  |
|早|并症，进行孕期保健指导。    |现妊娠禁忌症及|肝功能（必要    |优生优育、预防  |
|期|                            |合并症。      |时）。           |先天畸形。      |
|--|----------------------------|--------------|----------------|----------------|
|  |                            |              |母血甲胎蛋白测  |                |
|孕|                            |测宫底高度及听|定（必要时）超声|孕期卫生及孕妇  |
|中|注意胎儿宫内发育情况及孕    |胎心、绘制妊娠|波检查（必要    |饮食指导。      |
|期|妇营养。                    |图。          |时）。           |                |
|期|                            |              |                 |                |
|--|----------------------------|--------------------------------|----------------|
|  |                            |按产前检查项目详细记录（血压、水|                |
|孕|定期产前检查，测量骨盆，预 |肿、宫高、胎位、胎心先露情况，纠 |临产知识及产前  |
|晚|测分娩方式，发现及处理妊   |正胎位）进行高危孕妇评分、随访、 |准备，预防早产、|
|期|高征及其他孕期合并症。     |管理，进行产前自我监护——胎动   |过期妊娠，介绍  |
|  |                            |计数。                          |分娩生理。      |
|--|----------------------------|--------------------------------|----------------|
|分|                            |                                |指导临产中如何  |
|娩|提高接产质量，抓好“五防”、|正确观察及处理产程，科学接生、新|配合，解除紧    |
|期|“一加强”。                |生儿处理。                      |张。            |
|--|----------------------------|--------------------------------|----------------|
|产|                            |                                |                |
|褥|                            |                                |                |
|期|                            |产褥期护理、新生儿护理，认真执行|                |
|及|产母及新生儿护理。          |产后访视（母、婴）制度，对早产儿|产褥期生理卫    |
|新|                            |及低体重儿加强管理，产后42天母 |生，婴儿护理及  |
|生|                            |婴检查。                        |喂养。          |
|儿|                            |                                |                |
|期|                            |                                |                |
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五、高危妊娠产前评分标准
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| 异 常 情 况                |评分| 异 常 情 况                            |评分|
|----------------------------|----|----------------------------------------|----|
|一| 年龄≥35                |5   | | 骨盆狭小或畸形                       |10   |
|  |------------------------|----|    |------------------------------------|----|
|般| ≥40                    |10  | | 臀位、横位                          |10   |
|   |------------------------|----|  |------------------------------------|----|
|情| 身高＜1．5＞1．4米      |5 |    | 先兆早产＜34Ｗ                     |15   |
|  |------------------------|----| |------------------------------------|----|
|况| ≤1．4米 |10| | 34—37Ｗ |10|
|--|------------------------|----| |------------------------------------|----|
| | 自然流产史≥2次 |5 |本| 过期妊娠41—42Ｗ |5 |
| |------------------------|----| |------------------------------------|----|
| | 早产史≥2次 |5 | | ＞42Ｗ |10|
| |------------------------|----|次|------------------------------------|----|
|异| 新生儿死亡史1次 |5 | | 羊水过多 |10|
| |------------------------|----| |------------------------------------|----|
|常| 死胎、死产史≥2次 |10|妊| 妊高征轻、中 |5 |
| |------------------------|----| |------------------------------------|----|
|产| 先天异常儿史1次 |5 | | 重 |10|
| |------------------------|----| |------------------------------------|----|
|史| ≥2次 |10|娠| 子痫 |20|
| |------------------------|----| |------------------------------------|----|
| | 难产史 |10| | 阴道流血 |10|
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| | 贫血5—7克 |5 | | | |
| |------------------------|----| | 胎儿宫内窘迫 | |
| | ≤5克 |10|常| 胎心＜100次／分＞160次／分 |15|
|严|------------------------|----| | 胎动＜1次／时 | |
| | 活动性肺结核 |10| | | |
|重|------------------------|----|情|------------------------------------|----|
| |心脏病或心功能Ⅰ—Ⅱ级 |5 | | | |
|内|------------------------|----| | 胎心＜120次／分，＞160次／分|10|
| | Ⅲ级 |10|况| 胎动＜3次／时 | |
|科|------------------------|----| |------------------------------------|----|
| | 心衰史或心功能Ⅳ级 |20| | 胎动＜5次／时 |5 |
|合|------------------------|----| |------------------------------------|----|
| | 糖尿病，能饮食控制 |5 | | 多胎（双胎、三胎） |10|
|并|------------------------|----| |------------------------------------|----|
| | 不能饮食控制 |10| |早破水（破水后12小时以上才临产） |10|
|症|------------------------|----| |------------------------------------|----|
| | 活动性传染性肝炎 |10| | 估计胎儿过大（≥4000克） |10|
| |------------------------|----|--|------------------------------------|----|
| | | |致| 孕妇本人及一级亲属有遗传病史 |5 |
| | | |畸|------------------------------------|----|
| | | |因| 接触可疑致畸药物、物理化学因素 |5 |
| | | |素| | |
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注：5分为高危。