课件：社区孕产妇保健.ppt

询问产后休养情况，测量血压、体重、体温，进行全面的体检，重点进行乳房和妇科检查，了解乳房泌乳情况、子宫复旧、外阴伤口愈合及盆底肌肉恢复情况，必要时化验血红蛋白、尿蛋白、血糖等，进行产后避孕等方面的咨询和指导。 了解婴儿生长发育是否良好，测量体重、身长、头围，检查心、肺、肝、脾、听力、视觉反应、大小便等情况，指导婴儿喂养和护理。 * 计划生育保健指导 一、产后6～8周（产褥期）后无阴道出血及感染者可恢复性生活。 二、避孕指导 哺乳期避孕方法推荐：男用避孕套、 女用阴道隔膜、宫内节育器（产后3个月）、单纯孕激素避孕药 。 哺乳期内不能采用复方避孕药物，因为避孕药中雌激素抑制促乳素的分泌，使乳汁减少，并可通过母乳影响婴儿。 三、坚持纯母乳喂养6个月 * 尚未恢复正常者 （一）生殖系统尚未恢复正常或发现有异常情况者，则需转原分娩医院继续治疗，并随访结果转归。 （二）有合并症的产妇，有关脏器的功能如心、肝、肾等功能尚未恢复正常或还有有关症状者，则需转至相关专科继续治疗。 * 产后42天检查记录表 * * * * * 但是非常遗憾的是，我国育龄妇女普遍缺乏叶酸。1991-1992年对30个项目县的育龄妇女的调查结果：育龄妇女体内的叶酸缺乏率为30%，而且，这种缺乏的分布有地域性：北方高于南方、农村高于城市、山区高于平原。中国神经管畸形的最高峰，也被称为世界神经管畸形的珠穆朗玛峰就在山西省（山西省政府曾经有过一个削峰工程）。当然孕妇更易缺乏叶酸，因为需要量增加了。 * * * Goal-directed care: In many countries, the antenatal exam is divided into stations - history, blood pressure, height and weight, urine testing, abdominal palpation and fetal heart tones, etc. - with the woman moving from station to station until her antenatal exam card is filled in for the visit. When information is gathered in this way, there is a risk that the information gathered is analyzed in isolation rather than integrated. Goal-directed care, on the other hand, involves gathering information in such a way that certain complications are either detected or ruled out. The table shows how information can be gathered in a goal-directed way. Collecting information in this way forces the provider to look critically at all of the parameters that are being checked, and deciding if they mean that the woman’s pregnancy is evolving normally or that she is experiencing a complication that needs to be managed. The quality of antenatal care can be improved by having goal-directed care, not only because providers are processing the information they gather, but also because this way of gathering information facilitates clinical decision making. * 孕10周Doppler可听到胎心音 对轻度子痫前期孕妇的指导 必须及时转院处理，转出后一定要随访落实； 定期做产前检查，严密随访病情； 左侧卧位休息，每天要左侧卧位休息10-12小时； 高蛋白、低盐饮食，但不严格限盐； 如果血压进一步升高，水肿和蛋白尿加重，则需及早住院治疗。 一旦出现头痛、眼花、胸闷、视物不清，无原因的恶心，右上腹疼痛，夜间不能平卧，甚至抽搐和昏迷等危