Booklet Instructions

For the reason to build a pregnancy-friendly environment, the number of prenatal tests will be increased from 10 to 14 (one each at the week 8, 24, 30, and 37), two ultrasound examinations (week 8-16 and after week 32) and screening for gestational diabetes mellitus and maternal anemia (week 24-28) in mid and late pregnancy since July 1, 2021. Please sign the record sheet for each examination and record the results in the booklet. If you have any questions, you can also record them in the booklet to ask the medical staff during the prenatal tests.

As of July 1, 2021, pregnant women whose gestational ages are listed above are eligible for the prenatal tests and examinations corresponding to those gestational ages. If you are still in doubt, you can ask the medical staff at the time of prenatal tests. In addition, the medical staff will provide further explanation and guidance according to your needs after assessing your condition.

- Booklet Instructions -

Don't forget to bring your maternity booklet(this booklet and the Maternity Health Booklet)

and NHI card while having a prenatal test!

Issuer: Health Promotion Administration, Ministry of Health and Welfare

Publishing Date: 2021.06

Prenatal test additional booklet

4

5 "Dos" and "Don'ts" during pregnancy

The Health Book for Expectant Mothers

◉ Do receive prenatal tests according to schedule

◉ Do know the signs of premature birth

◉ Do take good care during pregnancy

◉ Do recognize pregnancy complications

◉ Do know the signs of labor

◉ Do not smoke or drink

◉ Do not be exposed to second hand smoke

◉ Do not take medication without doctor's orders

◉ Do not use drugs

◉ Do not choose a C-section in order to pick the time of birth

Prenatal self check-up record and prenatal test record of Week 8




................................... 16.................................. 20.................................. 22.................................. 24

Prenatal test record

Ultrasound test

Prenatal test: ultrasound screening records

Overview on prenatal test: ultrasound screening

.............................................................. 12........................................................ 15

Other information

Understanding Gestational Diabetes Mellitus (GDM)

Understanding Maternal Anemia

.................................................... 26............................................................................ 28

............................................ 02.......................................................................................... 05

................................................................................... 08

General table of prenatal test

Payment schedule for prenatal test and services provided

Prenatal test records

Prenatal check-up records

Table of contents

Payment schedule Recommended weeks Services provided

1st prenatal test

First trimester(Less than 13 weeks)

Week 8

1. Routine prenatal test. (Note 1)

2. First ultrasound examination.(Recommended for 8-16 weeks: assessment of fetal count, fetal heartbeat, fetal size measurement, implantation position, and due date)

2nd prenatal test

Prior to 12

1. After confirming that there is a fetal heartbeat, thefollowing inspections must be included:

(1) Questions: Family history, expectant mother's pastmedical history, pregnancy history and any discomfort with the fetus, addicted habits.

(2) Physical: Weight, height, blood pressure, thyroid, breast exam, pelvis exam, chest and abdomen exams.

(3) Lab testing: Blood routine (WBC, RBC, Pit, Hct, Hb, MCV), blood type, Rh factor, HBsAg and HBeAg(Those who cannot go through these exams thistime due tospecial circumstances can do so in the 5th prenataltest instead), VDRL (syphilis test), RPR(Rapid plasma reagin), Rubella IgG (rubellantibody), AIDS (EIAorPA) and urine routine.(Note 2)

2. Routine prenatal test. (Note 1)Note: Pregnant who tested negative for the Rubella antibody should be vaccinated after giving birth, this vaccine women is government-funded. (Note 4)

3rd prenatal

test

Second trimester(over 13 weeks but less than 29

weeks)

Week 161. Routine prenatal test. (Note 1)

2. Premature birth prevention guide.

2

Payment schedule for prenatal test and services provided

3Payment schedule for prenatal test and services provided


4th prenatal test

Second trimester

(over 13 weeks but less than 29

weeks)

Week 20


2. Second ultrasound examination.(Recommended around 20 weeks: assessment of fetal count, fetal heartbeat, fetal size measurement, the position of the placenta, and the amount of amniotic fluid)

3. Premature birth prevention guide.

5thprenatal test

Week 24


2. Lab testing: Blood routine (WBC, RBC, Plt, HCT, Hb, MCV) and screening for gestational diabetes mellitus. (Note 2)

6th prenatal

test Week 28 Routine prenatal test. (Note 1)

7th prenatal

test

Third trimester(over 29 weeks)

Week 30 Routine prenatal test. (Note 1)

8th prenatal testWeek 32


2. The following tests are provided around week 32: VDRL or RPR.

3. For pregnant women who are at risk of HIV infection, it is recommended to have an additional HIV test (ElAor PA).

4. Third ultrasound examination.(Recommended after 32 weeks: assessment of fetal heartbeat, fetal size measurement, fetal position, the position of the placenta, and the amount of amniotic fluid)

9th prenatal


10th prenatal test

Week 36


2. Subsidy for maternal Group B Streptococcus screening. (Note 3)

11th prenatal


4

Note1: Routine prenatal test includes

(1) Questions: Prenatal discomfort such as bleeding, abdominal pain, headache and spasm, etc.

(2) Physical: Weight, blood pressure, fetal heartbeat, fetal position and edema.

(3) Lab tests: Protein and glucose in urine.

Note 2: Regular blood check includes:White blood cells (WBC), Red blood cells (RBC), Blood platelet (Pit), Hematocrit (Hct), Hemoglobin (Hb) and Mean corpuscular volume (MCV).

Note 3: Maternal Group B Streptococcus (GBS) screening should be provided once betweenweeks 35 and 37. If there are signs of premature birth, this should be dealt with by amedical doctor and this limit may not apply.

Note 4: For information related to vaccination sites, please call preventive vaccination hotlinesin each city and county to consult.

※ Pregnant women who have had more than 14 prenatal tests and more than 3 ultrasound tests can pay for their expenses. If diagnosed by a doctor as medically necessary, they will be covered by health insurance.

※ Suppose you are more than 40 weeks pregnant and still need a prenatal test and do not meet health insurance coverage. In that case, the medical service provider will apply to the Health Promotion Administration, Ministry of Health and Welfare for an ad hoc prenatal test subsidy by filling out a reason in advance.

12th prenatal

test


Week 38 Routine prenatal test. (Note 1)

13th prenatal


14th prenatal



5

1st time

Payment schedule


Recommended weeks Week 8

3rd prenatal test

Payment schedule

Second trimester(over 13 weeks but less

than 29 weeks)


5th prenatal test

Payment schedule


than 29 weeks)


2nd prenatal test

Payment schedule



4th prenatal test

Payment schedule


than 29 weeks)


6th prenatal test

Payment schedule


than 29 weeks)




Hospital

Physician's signature

Test date (yyyy)　　　　(mm)　　　(dd)

Hospital



Hospital



Hospital



Hospital



Hospital



6

9th prenatal test

Payment schedule



11th prenatal test

Payment schedule



10th prenatal test

Payment schedule



12th prenatal test

Payment schedule



Hospital



Hospital



7th prenatal test

Payment schedule



8th prenatal test

Payment schedule



Hospital



Hospital



Hospital



Hospital



7Prenatal test record

13th prenatal test

Payment schedule



14th prenatal test

Payment schedule



Note: If you want to know the relevant medical instructions of each prenatal test, please scan the QRcode of the prenatal test with a mobile device.

Hospital



Hospital



8

Basic information

Number of past pregenancies Height cm

Due date (yyyy / mm / dd) Weight before pregnancy kg

The last men strual cycle started on (yyyy / mm / dd) BMI before pregnancy

kg/m^2

Routine prenatal test records

Routine prenatal test Result Routine prenatal test Result

Rh factor HBsAg

Blood type HBsAg

White Blood Cell (WBC)

1st time 2nd time

The first VDRL(VDRL or RPR)

x103/uL x103/uL

Red Blood Bell (RBC)x106/uL x106/uL

The second VDRL(VDRL or RPR)

Blood Platelet (Plt)x103/uL x103/uL

Rubella antibody response

Hematocrit (Hct)% %

Group B Streptococcus test (GBS)

Mean Cell Volume (MCV)fl fl

Pelvis test

Hemoglobin (Hb) g/dL

Normal

Abnormal

g/dL

Normal

Abnormal

Others

Gestational Diabetes Mellitus

GLU AC : mg/dL

GLU 1 hr : mg/dL

GLU 2 hr : mg/dLOthers

Normal Abnormal

※ The information on this form will be used for health unit policy evaluation or case tracking health management.

+ －

+ －

+ －

+ －

+ －

+ －

Prenatal test summary record

9

※ For babies born by mothers who tested positive (+) for both HBsAg and HBeAg, newborns should be injected with HBIG and hepatitis B vaccination as soon as possible within 24 hours of birth. After the third in ection of hepatitis B vaccination, 12-month old babies should receive HBsAg and anti-HBs tests. If the test results of HBsAg and anti-HBs are negative, and hepatitis B vaccine can be taken for free.

※ (formerly in Maternal Health Booklet, page 53) Mothers with positive HBsAg should record the prenatal test results with the doctors help in the hepatitis B follow-up records (page 53). For expectant mothers with hepatitis B virus concentration above 106 lU/mL who are at high risk of vertical transmission from mother to child, please refer them to a gastroenterologist for evaluation and antiviral treatment, in order to reduce the risk of hepatitis B infection in newborns. Besides, pregnant women should also be educated to follow their doctors recommendations for postpartum treatment.

※ Expectant mothers who tested negative (-) for the rubella antigen should be careful of protecting themselves from an infection of rubella during pregnancy. After delivery, they should receive MMR mixed vaccination with the proof of negative rubella antigen test in a clinic or a vaccination contracted hospital as soon as possible (pregnancy should be avoided within 4 months of inoculation, but pregnancy found within 4 weeks after vaccination should not be regarded as an indication forabortion of pregnancy).

※ Expectant mothers who tested positive for syphilis, please ask doctor to assist in a confirmation examination. If the infection is confirmed, expectant mothers should receive treatment as soon as possible to prevent newborns from contracting congenital syphilis.

※ Expectant mothers who tested positive for HIV are requested to receive treatment as soon as possible and receive preventive measures and supporting medical care during the birth process to prevent newborns from contracting HIV.

※ If anemia is found in the routine blood test of the expectant mother, the cause of the anemia should be further investigated and corrected to reduce the risk of preterm delivery and low fetal weight. If the expectant mother has microcytic anemia (MCV<80fl), the husband should also be screened for microcytic anemia to assess the risk and severity of fetal thalassemia.

※ Most of the cases of low platelets (Plt <150x103/uL) found in routine blood tests of expectant mothers are temporary low platelets caused by pregnancy, while a few are related to preeclampsia, medications, viral infections, and immune reactions. Mild hypoplasticity (Plt100-149x103/uL) with no symptoms does not require treatment, but regular follow-up is recommended. Expectant mothers should be aware of vaginal bleeding, recurrent gum bleeding, and purple bruising of the skin (and) should seek medical attention as soon as possible.

※ If a mother-to-be is diagnosed with gestational diabetes, she is at an increased risk of mega-baby, obstructed labor, fetal death, preeclampsia, and chronic diabetes. Glucose control can be assisted by diet, exercise, or medication. Blood glucose should be less than 95mg/dL before meals and less than 120mg/dL two hours after meals to reduce complications caused by gestational diabetes mellitus.

Note: there are blanks for prenatal tests in following pages where records could be kept.

Prenatal test summary record

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Prenataltest test schedule 1st time 2nd time 3rd time 4th time 5th time 6th time

Recommended weeks Week 8 Week 16 Week 20 Week 24 Week 26 Week 28

Prenatal test date

Gestational age

Weight (kg)

Blood pressure (mmHg)

Fetal heart rate(times/minute)

Glucosuria

Urine protein

Edema

Varicose veins

Note:

If there are unfamiliar scars or suspected domestic violence, please report such incidence in accordance with the regulations and fill out the Taiwan close relations violence risk evaluation chart.

　

Need follow up Need referral

　

Areas of attention or abnormality

　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

Next prenatal test date

10

※ Those in the 2months

11

7th time 8th time 9th time 10th time 11th time 12th time 13th time 14th time

Week 30 Week 32 Week 34 Week 36 Week 37 Week 38 Week 39 Week 40

　 Need follow

up Need referral　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

Prenataltest test schedule 1st time 2nd time 3rd time 4th time 5th time 6th time

Recommended weeks Week 8 Week 16 Week 20 Week 24 Week 26 Week 28

Prenatal test date

Gestational age

Weight (kg)

Blood pressure (mmHg)

Fetal heart rate(times/minute)

Glucosuria

Urine protein

Edema

Varicose veins

Note:

If there are unfamiliar scars or suspected domestic violence, please report such incidence in accordance with the regulations and fill out the Taiwan close relations violence risk evaluation chart.

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

　


　


　

No special findings

Next prenatal test date

11

12

Examination Report

Photo paste here

Reporter Examination Date / / (yyyy/mm/dd)

Due date

Examination result □ Routine prenatal test □ Need to follow up

(recommended from Week 8 to 16)

AC cm, FTA Week

FL cm, FTA Week

Basic information

Name Age Medical history number Gestational age

Due date / / (yyyy/mm/dd)

The last menstrual cycle started on / / (yyyy/mm/dd)

Number of fetus □ Singleton □ Twins □ Multiple

With or without heartbeat □ Yes □ No

Implantation position □ Normal □ Abnormal

Ultrasound record of the first prenatal examination

13

Examination Report

Photo paste here


Number of fetus □ Normal □ Excessive □ Low

Examination result □ Routine prenatal test □ Need to follow up

(recommended around Week 20)

BPD cm, FTA Week

AC cm, FTA Week

FL cm, FTA Week

EFW g, FTA Week

Basic information






Placental position □ Anterior Placenta □ Placenta previa□ Posterior Placenta □ Low-lying Placenta

Prenatal test: ultrasound screening records


14

Examination Report

Photo paste here


Number of fetus □ Normal □ Excessive □ LowExamination result □ Routine prenatal test □ Need to follow up

(recommended after Week 32)

BPD cm, FTA Week

AC cm, FTA Week

FL cm, FTA Week

EFW g, FTA Week

Basic information






Fetal position □ Vertex position □ Abnormal fetal position

Placental position □ Anterior Placenta □ Placenta previa□ Posterior Placenta □ Low-lying Placenta


15

Purpose

Limits

Result

Prenatal examination ultrasound screening is a non-intrusive exam. It can be used to check the diameter of the baby's parietal, abdomen circumference and thigh length, in order to understand the fetal development and make growth assessment. It also shows the position of theplacenta and the amount of amniotic fluid. At least three ultrasound exams are recommended throughout the entire labor and delivery process, the first at 8-16 weeks, the second around 20 weeks, and the third at 32 weeks until delivery. Those with special conditions can be observed or followed up after the doctor's assessment.

There are limits to the accuracy of an ultrasound exam. For example, ultrasound cannot get through bones, the fat tissues in the mother’s abdomen are too thick, the baby is lying on its belly. Also, polyhydeamnio (too much amniotic fluid) will move the baby’s head too far away from the detector and cause a blurry image. When oligohydramnio (not enough amniotic fluid)occurs, the baby's limbs overlap each other and prevent the sound wave from entering, so the accuracy of ultrasound screening will be limited due to the scanning conditions.

Prenatal test ultrasound only serve as a screening tool and it is not the final diagnosis. Not all fetalproblems can be detected by ultrasound. The ultrasound report the following:

1. Crown-rump length (CRL): To measure the length of the fetus from the top of the head to the buttocks, it is usually necessary to find the horizontal lying surface of the fetus and measure the longest distance from the top of the head to the buttocks of the fetus. This is the most important indicator for measuring fetal weeks in the first trimester and can also be used to determine whether the due date needs to be revised.

2. Biparietal diameter (BPD): It is a measurement of the diameter of a developing baby's skull, from one parietal bone to the other. BPD is used to estimate fetal weight and gestational age. If BPD does not match the gestational age, a further diagnosis is required, including the assessment of the gestational age or other abnormal conditions.

3. Femur length (FL): Measures the longest bone in the body and reflects the limbs.

4. Abdominal circumference (AC): It is a measurement taken during a pregnancy ultrasound in order to gauge the circumference of the fetal abdomen. The AC gives an indication of whether the fetus is normally grown inside the uterus in relation to size and development. The AC can be calculated with other measurements to estimate the weight of fetus.

5. Placenta position: If the placenta is too close to or directly covers the cervix, it would be a low-lying placenta or placenta previa, which prevents the fetus from entering the birth canal during delivery; it is one of the causes of prenatal and postpartum hemorrhage and caesarean section.

6. Confirmation of multiple births: Women who are pregnant with multiples may have more possibility of pregnancy complications, ultrasound exams may be done to track how the fetuses are growing, in order to arrange appropriate checkups and treatment.

7. Assessment of amniotic fluid volume: Amniotic fluid volume is one of the important indicators of fetal abnormalities or dysplasia, polyhydeamnio (too much amniotic fluid) or oligohydramnio (not enough amniotic fluid) is related to the prognosis of the fetus.



(Source of materials: Taiwan Society of Ultrasound in Medicine,Taiwan Association of Obstetrics and Gynecology)

16

Your medical history serves as an important reference for the doctors. Please fill out the following in detail. If you have/had any of the following symptoms, please check the relevant box.

Medical History

□　1. Chronic hypertension

□　2. Diabetes

□　3. Heart disease

□　4. Surgical Diseases

□　5. Idney disease

□　6. Thyroid disease

□　7. Coagulation disorders

□　8. Notifiable disease

□　9. Gynecologic tumor and cancer

□ 10. Central nervous system disease

□ 11. Urinary system diseases

□ 12. Gastrointestinal and liver disease

□ 13. Anemia

□ 14. Systemic lupus erythematosus (SLE) andautoimmune disorders

□ 15. Bronchial asthma and lung diseases

□ 16. Epilepsy

□ 17. Are there any other hereditary diseases or disorders in the family history?

□ 18. Dangerous exposure(smoking, smoking in the same residence, drinking alcohol)

□ 19. Do drugs

□ 20. Others

Medical history during pregnancy

□ 1. Hysteromyomectomy or uterusrepair surgery

□ 2. Heart surgery

□ 3. Hypertension

□ 4. Gestational Diabetes

□ 5. Premature birth(delivery at less than 37 weeks of pregnancy)

□ 6. Congenital abnormalities

□ 7. Neonatal death

□ 8. Vaginal delivery birth difficulty

□ 9. Postnatal bleeding

□ 10. Previous fetus infection of B streptococcus

□ 11. Amniotic fluid embolism

□ 12. Intra-amniotic inflammation

□ 13. Ecessive or low amniotic fluid

□ 14. Premature rupture of membranes

□ 15. Placenta previa and placental abruption

□ 16. Placenta accrete

□ 17. Fetal abnormalities or intra-uterine fetal death;stillbirths

□ 18. Fetal abnormality need the surgical treatment

□ 19. Abnormal results for prenatal hereditary screening(chromosome orgenetic testing)

□ 20. Fetal distress

□ 21. Pre-eclampsia

□ 22. Eclampsia

□ 23. Others

The last menstrual cycle started on : / / (yyyy/mm/dd)

Self checklist :　□ Bleeding　　　□ Abdominal Pain　　　□ Headache　　　□ Spasm

　　　　　　　 □ Other symptoms :

The following is recorded on / / (yyyy/mm/dd) (week )

First trimester: less than 17 weeks

※ Table for self-assessment, medical staffs should help expectant mothers to check the boxes before the medical instructions.

week 8Prenatal self check-up record

17

Please check the boxes of the health information that I have read.

□　1. Prenatal test list (Page 2 of this booklet)

□　2. Overview on prenatal test: UltrasoundScreending (Page 51 of this booklet)

□　3. Information on quitting smoking(Maternal Health Booklet page 51)

□　4. Free prenatal AIDS screening

□　5. Prenatal hereditary disease screening and subsidy

□　6. Notes during pregnancy

□　7. How to deal with discomforts during pregnancy

□　8. Weight control and diet during pregnancy

□　9. Prenatal infections and complications

□ 10. Warning signs for immediate doctors visit

Maternal care hotline : 0800-870-870

For smoking situations, please check the relevant box.

1. Do I currently smoke? 　 Yes (Please refer to page 51 of the Maternal Health Booklet and quit smoking) 　　 No

2. Over the past week, is there anyone smoking in front of me when I am at home? 　 Yes (Please refer to page 51 of the Maternal Health Booklet and ask your family to quit smoking) 　　 No

(Please refer to the Maternal Medical instructions Booklet)

You can write down the questions that you would like to ask the doctor / midwife / nurse (such as diet, exercise, lifestyle, smoking, drinking and nutrition):

Prenatal self check-up record of Week 8

Expectant mothers signature 　 Parents signature

18

Special instructions from medical staffs

If you have vaginal bleeding in the early stages of pregnancy, seek immediate medical attention.

First ultrasound examination. (please paste the examination report on page 12 of this booklet)

Development of fetus

Week 6 to week 8 Fetus heart beat could be detected by ultrasound.

Medical instructions

Information on quitting smoking (Maternal Health Booklet page 51)

Ultrasound screening instructions of prenatal examination (Page 15 of this booklet)

Congenital diseases

Prenatal hereditary disease screening and subsidy

Prevention from smoking and drinking

Girls and boys are equally precious

Prevention of premature births

How to deal with discomforts during pregnancy

Weight control and diet during pregnancy

Infections and complications during pregnancy

Warning signs for immediate doctor's visit

Please fasten your seat belt when riding in a car ※ Please scan the QR code on the rightfor medical instructions.

Hospital : Physician's signature : Expectant mothers signature :

Maternal care hotline : 0800-870-870 Next prenatal test date / / (yyyy/mm/dd)


week 8Prenatal test record


19

MEMO

8th Prenatal test record

20




Second trimester: over 13 weeks but less than 29 weeks



□　1. Overview on prenatal test: UltrasoundScreending (Page 15 of this booklet)

□　2. Information on quitting smoking(Page 51 of this booklet)

□　3. Prevention of premature births, high riskpregnancy

□　4. Notes during pregnancy

□　5. How to deal with discomforts during pregnancy


□　7. Infections and complications during pregnancy

□　8. Warning signs for immediate doctor's visit

□　9. Prenatal exercise

□ 10. Breastfeeding

□ 11. Understanding Maternal Anemia (Page 26 of this booklet)

□ 12. Understanding Gestational Diabetes Mellitus (Page 28 of this booklet)




Mode Thermometer

1. In the past month, have you been disturbed with depression, an iety or hopelessness? 　　　Yes　　　No

2. In the past month, have you lost interests or sense of pleasure of things?　　　　　　　　 Yes　　　No

(Note: If you answer yes to both following questions, it is strongly suggested that you tell your family about it or seek doctors assistance.)





21



□ Ultrasound screening instructions of prenatal examination(Page 15 of this booklet)

□ Information on quitting smoking(Maternal Health Booklet page 51)

□ Prevention of premature births, high risk pregnancy

□ Notes during pregnancy

□ How to deal with discomforts during pregnancy

□ Weight control and diet during pregnancy

□ Prenatal infections and complications

□ Warning signs for immediate doctors visit

□ Prenatal exercise

□ Breastfeeding

□ Please fasten your seat belt in the car

□ Understanding Maternal Anemia(Page 26 of this booklet)

□ Understanding Gestational Diabetes Mellitus(Page 28 of this booklet)

Prenatal test findings

No special findings


1. □ need follow □ need referral




Special medical advice

Whether you were screened for gestational diabetes mellitus from Week 24 to Week 28.(The results are recorded on page 8 of this booklet)

Whether maternal anemia test was done from Week 24 to Week 28.(The results are recorded on page 8 of this booklet)

Prenatal education course.


Week 21 to week 24 The fetus' nostrils will open, and he/she will start to practice breathing.He/she can also hear sounds, and you can talk to him/her.




※ If there are unfamiliar scars or suspected domestic violence, please report such i n c i d e n c e i n a c c o r d a n c e w i t h t h e regulations and fill out the Taiwan close relations violence risk evaluation chart (TIPVDA scale).

※ Please scan the QR code on the rightfor medical instructions.



22


Third trimester: over 29 weeks






□　4. Infections and complications during pregnancy


□　6. Getting to know postpartum depression


□　8. Breastfeeding

□　9. Preparing for prenatal




Mode Thermometer


2. In the past month, have you lost interests or sense of pleasure of things?　　　　　　　　 Yes　　　No








23




□ Prevention of premature births, high risk pregnancy

□ How to deal with discomforts during pregnancy


□ Infections and complications during pregnancy

□ Warning signs for immediate doctor's visit

□ Getting to know postpartum depression


□ Breastfeeding

□ Preparing for prenatal


□ Purchasing the child safety seat


No special findings






Special medical advice

Please make sure that the fetus is facing downward at this time.

Have you had free HIV screening for pregnant women?If not, you can contact your health care provider for a free screening.

A third ultrasound is recommended after the 32nd week. (Records are attached to page 14 of this booklet)


Week 29 to week 32The fetus' arms and legs have become more powerful, often punching and kicking in the mother's womb.In addition, the fetus is generally in a head-down position.








24


Third trimester: over 29 weeks




□　2. Overview on Group B Streptococcus screening



□　5. Infection during pregnancy and pregnancycomplications


□　7. Oral understanding of postpartum depression


□　9. Newborn screening

□ 10. Breastfeeding

□ 11. Preparing for prenatal

□ 12. Getting to know the delivery methods




Mode Thermometer


2. In the past month, have you lost interests or sense of pleasure of things? 　　　　　　　　 Yes　　　No








25




□ Overview on Group B Streptococcus screening


□ Infection during pregnancy and pregnancy complications

□ Warning signs for immediate doctor's visit

□ Oral understanding of postpartum depression


□ Newborn screening

□ Breastfeeding

□ Preparing for prenatal

□ Getting to know the delivery methods

□ Prepare for contractions

□ Medical facilities for maternal and child care



No special findings






Special instructions from medical staffs

You may conduct Group B Streptococcus (GBS) screening during Week 35 to 37.(The test results are recorded on page 8 of this booklet)

Do you know the harm of enterovirus to newborns and how to prevent it ?

Are you ready to give birth ?


Week 37 to week 40 The fetus' is smoother. The skull hardens, and the finger and toenails are fully grown.








Understanding Gestational Diabetes Mellitus

In pregnant women with gestational diabetes mellitus, high blood glucose levels during pregnancy can pass through the placenta and affect the fetus, resulting in fetal overweight, neonatal hypoglycemia, neonatal jaundice, and the risk of obstructed labor. In addition, it increases the rate of cesarean section for the mother, and half of the women may develop chronic diabetes after 20 years. Pregnant women with family history, old age, obesity, previous stillbirths, fetal malformations, fetal overgrowth, and excessive amniotic fluid found on delivery are at high risk for gestational diabetes mellitus.

The government includes the 75-mg oral glucose tolerance test as a general maternity subsidy in July 2021, following the recommendation made by the International Association of Diabetes and Pregnancy Study Group (IADPSG) in 2010 to use the 75-mg oral glucose tolerance test to diagnose gestational diabetes mellitus. The 75g oral glucose tolerance test is performed at Week 24 to 28 of gestation on an 8-hour fasting basis. It is based on a fasting blood glucose level above 92mg/dL, a first-hour blood glucose level above 180mg/dL. A second-hour blood glucose level above 153mg/dL and the diagnosis of gestational diabetes mellitus is made when one or more of the above three criteria is met.

26

Pregnant women diagnosed with gestational diabetes mellitus can usually maintain average blood glucose through dietary control and exercise. The recommendations for dietary management are:

1. You should plan your overall caloric intake according to your pre-pregnancy BMI and adjust your caloric intake according to your weight gain and daily blood glucose level during pregnancy. It is recommended that you develop a diet plan in consultation with a dietitian and develop a regular and quantitative diet.

2. Eat a balanced diet and consume appropriate amounts of staple foods, fruits, fats, dairy and meat, fish, eggs, and beans according to your diet plan.

3. Eat less fried food.

4. Eat more fiber-rich foods, more vegetables, and whole grains.

5. Eat as mild as possible and avoid processed or preserved foods; steamed, boiled, and cold foods are recommended.

Exercise is recommended at least five days a week, 30 minutes a day, or at least 150 minutes a week of moderate-intensity aerobic activity (e.g., walking, swimming, etc.), interspersed with rest intervals. The principle is to maintain slight panting, no thirst, and no heat during exercise.

During pregnancy, daily blood glucose should be controlled at 60-95 mg/dl fasting, 60-140 mg/dl one hour after meals, and 60-120 mg/dl two hours after meals.

27

Understanding Maternal Anemia

In Taiwan, nearly 10% to 20% of pregnant women have anemia at the time of their initial prenatal test and up to 30% to 40% at delivery. Maternal anemia may result in small fetuses, premature births, increased perinatal mortality, developmental delays, attention deficit, and mental retardation. It may also increase the burden on the heart and lungs of pregnant women, cause dizziness, fainting, poor wound healing, poor uterine contraction, difficult labor, postpartum depression, and make pregnant women with postpartum hemorrhage more dangerous, so pregnant women and health care providers need to pay special attention.

Iron requirements increase during pregnancy, with 15 mg/day recommended for the first and second trimesters and up to 45 mg/day for the third trimester and nursing mothers. In addition to supplying the needs of the pregnant woman and the fetus, iron is stored in large quantities in the fetus for use during the first six months of life. Inadequate iron intake during pregnancy may have adverse effects on the brain and mental symptoms of the fetus. It is recommended to consume more iron-rich foods such as seaweeds (clams, octopus, oysters, etc.), liver, red meat, and dark vegetables (amaranth, sweet peas, red cabbage, etc.).

If the hemoglobin result is less than 10.5 g/dL, it means anemia. In cases of mild anemia, iron supplements are usually given first, and the treatment's effectiveness is evaluated. If there is no good response after treatment, further treatment or examination is needed to improve the cause of the adverse reaction or to find out the cause of the disease, such as intestinal absorption problems (inadequate absorption of oral medication or poor absorption due to taking the medication with antacids), inability to take the medication regularly, or chronic bleeding in other areas. For pregnant women who are unable to take oral iron supplements, intravenous iron supplements may be considered. In cases of severe anemia (hemoglobin <6g/dL), which can lead to inadequate oxygen delivery to the fetus, resulting in fetal distress, decreased amniotic fluid volume, or even fetal death, an emergency blood transfusion may be recommended. The anemia should be followed up during pregnancy and after delivery, and the treatment should be continued until 6-12 weeks after delivery.

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Name: Maternal Health Booklet

Author (Editor, Translator): Health Promotion Administration, Ministry of Health and

Welfare (Ad)

Issuer: Health Promotion Administration, Ministry of Health and Welfare

Address: No.36,Tacheng St ” DatongDist” Taipei City,(Taipei office)

Website: http://www.hpa.gov.tw

Phone: (02)2522-0888

Publishing Date: 2021.06

Edition: 1st Edition

Other formats:

This publication is also published on the website of Health Promotion Adminstration,

Ministry of Health and Welfare Website: (http://www.hpa.gov.tw/) and

(http://health99.hpa.gov.tw/)

Copyright holder: Health Promotion Administration, Ministry of Health and Welfare

All rights reserved. Any forms of using or quotation, part or all should be authorized by copyright holder Health Promotion Administration, Ministry of Health and Welfare, ROC.. Please contact with Health Promotion Administration, Ministry of Health and Welfare, ROC.. (TEL:886-2-2522-0888)

This publication is funded by the Tobacco Hazards Prevention and Health Protection Funds of Health Promotion Administration.

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