pregnancy

Original source / Raw SKILL.md

---
name: pregnancy
description: Track pregnancy health, prenatal checkups, symptoms, weight, blood pressure, and fetal development with support for multiple pregnancies
argument-hint: <operation_type+description, e.g.: start 2025-01-01, checkup week 12 NT normal, weight 62.5>
allowed-tools: Read, Write
schema: pregnancy/schema.json
---

# Pregnancy Management Skill

Full-cycle pregnancy tracking and management, from preconception to delivery, providing comprehensive pregnancy health monitoring and management.

## Core Flow

```
User Input → Parse Operation Type → Execute Operation → Generate/Update Data → Save → Output Result
```

## Supported Operations

| Operation | Description | Example |
|-----------|-------------|---------|
| start | Start pregnancy record | /pregnancy start 2025-01-01 |
| checkup | Log prenatal checkup | /pregnancy checkup week 12 NT normal |
| symptom | Log symptoms | /pregnancy symptom nausea moderate |
| weight | Log weight | /pregnancy weight 62.5 |
| vital | Log vital signs | /pregnancy vital bp 115/75 |
| status | View status | /pregnancy status |
| next-checkup | Next checkup | /pregnancy next-checkup |
| type | Multiple pregnancy setting | /pregnancy type twins |
| fetal | Fetal information | /pregnancy fetal A weight 1200g |

## Step 1: Parse User Input

### Operation Type Recognition

| Input Keywords | Operation |
|----------------|-----------|
| start | start |
| checkup | checkup |
| symptom | symptom |
| weight | weight |
| vital | vital |
| status | status |
| next, next-checkup | next-checkup |
| type, twins | type |
| fetal | fetal |

### Date Recognition

| Input | Standard Format |
|------|-----------------|
| YYYY-MM-DD | YYYY-MM-DD |
| this month X day | YYYY-MM-DD |
| last month | Calculate date |
| X weeks ago | Calculate date |

### Gestational Age Recognition

| User Input | Extracted Result |
|------------|------------------|
| week 12 | 12 weeks |
| 12w | 12 weeks |

### Checkup Type Recognition

| User Input | Standard Type |
|------------|---------------|
| NT | NT scan |
| Triple test, 唐筛 | Triple test |
| Anomaly scan | Anomaly scan |
| OGTT, 糖耐 | Glucose tolerance test |
| Routine | Routine checkup |

### Result Recognition

| Normal | Abnormal |
|--------|----------|
| normal | abnormal |
| low risk | high risk |
| negative | positive |

### Symptom Type Recognition

| Keywords | Symptom Type | English |
|----------|--------------|---------|
| nausea | nausea | nausea |
| fatigue | fatigue | fatigue |
| edema | edema | edema |
| back pain | back_pain | back pain |
| contractions | contractions | contractions |

### Severity Recognition

| Mild | Moderate | Severe |
|------|----------|--------|
| mild | moderate | severe |

### Blood Pressure Format Recognition

| User Input | Systolic | Diastolic |
|------------|----------|-----------|
| 120/80 | 120 | 80 |
| 120 over 80 | 120 | 80 |

## Step 2: Check Information Completeness

### start Operation Required:
- lmp_date: Last menstrual period date

### start Operation Validation:
- LMP cannot be future date
- LMP should be within past 10 months
- If active pregnancy exists, prompt to complete first

### checkup Operation Required:
- week: Gestational age
- check_type: Checkup type
- results: Results

### weight Operation Recommended:
- Weight value (number + unit)
- If no pre-pregnancy weight, prompt to set

### vital Operation Required:
- Blood pressure value or vital sign type

## Step 3: Interactive Prompts (If Needed)

### Scenario A: Missing LMP Date
```
Please provide your last menstrual period date:
(Format: YYYY-MM-DD)
```

### Scenario B: Active Pregnancy Exists
```
Active pregnancy record exists

Current pregnancy: LMP 2025-01-01, Due date 2025-10-08
Tip: Please complete current pregnancy before starting new record
```

### Scenario C: Missing Pre-Pregnancy Weight
```
Pre-pregnancy weight missing

Please set pre-pregnancy weight first:
/profile weight 60

Or:
/pregnancy weight 62.5 --pre-pregnancy 60
```

### Scenario D: Abnormal Checkup Results
```
Abnormal checkup results

Checkup item: Triple test (16 weeks)
Result: High risk (T21 risk 1:50)

Recommendations:
• Consult obstetrician immediately
• Consider NIPT or amniocentesis
• Do not panic, high risk does not equal diagnosis
```

## Step 4: Generate JSON

### Pregnancy Data Structure

```json
{
  "pregnancy_id": "pregnancy_20250101",
  "lmp_date": "2025-01-01",
  "due_date": "2025-10-08",
  "due_date_confidence": "medium",
  "corrected_by_ultrasound": false,

  "current_week": 0,
  "current_day": 0,
  "current_trimester": "first",
  "days_passed": 0,
  "days_remaining": 280,
  "progress_percentage": 0,

  "multi_pregnancy": {
    "pregnancy_type": "singleton",
    "fetal_count": 1,
    "fetal_profiles": [
      {
        "baby_id": "A",
        "estimated_weight": null,
        "position": null,
        "heart_rate": null,
        "amniotic_fluid_index": null,
        "growth_percentile": null
      }
    ]
  },

  "prenatal_checks": [
    {
      "check_id": "check_001",
      "week": 12,
      "check_type": "NT scan",
      "scheduled_date": "2025-03-25",
      "completed": false,
      "results": {},
      "preparation": "Full bladder required"
    }
  ],

  "symptoms": {
    "nausea": {"present": false, "severity": null},
    "fatigue": {"present": false, "severity": null},
    "edema": {"present": false, "severity": null}
  },

  "weight_tracking": [],
  "blood_pressure": [],
  "fetal_movement": {"tracking_started": false},

  "nutrition_plan": {
    "folic_acid": {"dose": "400μg", "frequency": "daily"},
    "iron": {"dose": null},
    "calcium": {"dose": null},
    "dha": {"dose": null}
  },

  "notes": "",
  "completed": false,
  "delivery_date": null,
  "delivery_outcome": null,

  "metadata": {
    "created_at": "2025-01-01T00:00:00.000Z",
    "last_updated": "2025-01-01T00:00:00.000Z"
  }
}
```

Complete schema definition: see [schema.json](schema.json).

## Step 5: Save Data

1. Read `data/pregnancy-tracker.json`
2. Update corresponding data
3. Write back to file
4. If detailed records exist, save to `data/pregnancy-records/YYYY-MM/YYYY-MM-DD_pregnancy-record.json`

## Execution Instructions

```
1. Parse user input and determine operation type
2. Execute corresponding logic based on operation type
3. Validate input data and state
4. Generate JSON compliant with schema.json
5. Save to data/pregnancy-tracker.json
6. Output operation result and summary to user
```

## Example Interactions

### Example 1: Start Pregnancy Record
```
User: /pregnancy start 2025-01-01

System:
Pregnancy record created

Pregnancy Information:
LMP: January 1, 2025
Due Date: October 8, 2025
Current gestational age: 0 weeks
Trimester: First trimester

Due date confidence: Medium (calculated from LMP)

Next Checkup:
12-week NT scan - March 25, 2025 (84 days away)
Preparation: Full bladder required

Checkup Schedule Overview:
12 weeks: NT scan
16 weeks: Triple test/NIPT
20 weeks: Anomaly scan
24 weeks: Glucose tolerance test
28 weeks: Routine checkup
32-36 weeks: Every 2 weeks
37-40 weeks: Weekly

Nutrition Recommendations:
• Folic acid: 400-800μg/day
• Iron: Supplement in 2nd/3rd trimester
• Calcium: 1000-1200mg/day
• DHA: 200-300mg/day

Data saved to: data/pregnancy-records/2025-01/2025-01-01_pregnancy-record.json
```

### Example 2: Log Checkup
```
User: /pregnancy checkup week 12 NT normal

System:
Checkup record updated

Checkup Information:
Gestational age: 12 weeks
Checkup item: NT scan
Date: March 25, 2025
Result: Normal (NT value 1.8mm)

This checkup completed

Next Checkup:
16-week Triple test - April 22, 2025 (28 days away)
Preparation: Fasting blood draw
```

### Example 3: Log Weight
```
User: /pregnancy weight 62.5

System:
Weight recorded

Weight Information:
Record date: March 20, 2025
Current gestational age: 12 weeks

Current weight: 62.5 kg
Pre-pregnancy weight: 60.0 kg
Weight gained: 2.5 kg
Current BMI: 23.1 (normal)

Weight Gain Assessment:
Recommended pregnancy weight gain: 11.5-16 kg
Current progress: Normal

Late pregnancy recommendations:
Weekly weight gain: 0.35-0.50 kg
```

### Example 4: Set Twins
```
User: /pregnancy type twins

System:
Multiple pregnancy type set

Pregnancy Type Information:
Type: Twin pregnancy
Fetal count: 2

Due Date Adjustment:
Original due date: October 8, 2025 (40 weeks)
Adjusted due date: September 17, 2025 (37 weeks)
Earlier by: 3 weeks

Checkup Frequency Adjustment:
• From 28 weeks: Every 2 weeks
• From 32 weeks: Weekly
• Add cervical length monitoring
• Add fetal growth monitoring

Weight Gain Recommendations:
Total recommended gain: 16-24 kg
Late pregnancy weekly gain: 0.5-0.7 kg

Recommendations:
• Consult Maternal-Fetal Medicine specialist (MFM)
• Consider referral to tertiary hospital
• Create delivery plan (discuss at 32-34 weeks)
```

For more examples, see [examples.md](examples.md).


---

## Referenced Files

> The following files are referenced in this skill and included for context.

### schema.json

```json
{
  "$schema": "http://json-schema.org/draft-07/schema#",
  "$id": "https://wellallyhealth.com/schemas/pregnancy-tracker.json",
  "title": "PregnancyTracker",
  "description": "Pregnancy management data structure",
  "type": "object",
  "properties": {
    "created_at": {
      "type": "string",
      "format": "date-time",
      "description": "Creation time"
    },
    "last_updated": {
      "type": "string",
      "format": "date-time",
      "description": "Last update time"
    },
    "current_pregnancy": {
      "type": ["object", "null"],
      "description": "Current pregnancy record"
    },
    "pregnancy_history": {
      "type": "array",
      "items": {"type": "object"},
      "description": "Pregnancy history records"
    },
    "statistics": {
      "type": "object",
      "properties": {
        "total_pregnancies": {"type": "integer"},
        "current_pregnancy_week": {"type": ["integer", "null"]},
        "total_weight_gain": {"type": "number"},
        "average_weekly_gain": {"type": "number"},
        "checkups_completed": {"type": "integer"},
        "checkups_scheduled": {"type": "integer"}
      }
    },
    "settings": {
      "type": "object",
      "properties": {
        "reminder_days_before": {"type": "integer", "default": 7},
        "weight_unit": {
          "type": "string",
          "enum": ["kg", "lbs"],
          "default": "kg"
        },
        "preferred_checkup_time": {"type": "string", "default": "morning"}
      }
    }
  },
  "required": ["created_at", "last_updated"]
}

```

### examples.md

```markdown
# Pregnancy Skill Examples

## I. Start Pregnancy Record (start)

### Example 1: Basic Start
```
User: /pregnancy start 2025-01-01

System:
Pregnancy record created

Pregnancy Information:
Last Menstrual Period: January 1, 2025
Due Date: October 8, 2025
Current Week: 0 weeks
Trimester: First Trimester

Due Date Confidence: Medium (calculated based on LMP)

Next Prenatal Checkup:
12 weeks NT scan - March 25, 2025 (84 days remaining)
Preparation: Full bladder required

Prenatal Checkup Plan Overview:
12 weeks: NT scan
16 weeks: Triple Screen/NIPT
20 weeks: Anatomy Scan
24 weeks: Glucose Tolerance Test
28 weeks: Routine Checkup
32-36 weeks: Every 2 weeks
37-40 weeks: Every week

Nutrition Recommendations:
• Folic acid: 400-800 mcg/day (3 months before pregnancy to first trimester)
• Iron: Supplement in second and third trimesters
• Calcium: 1000-1200 mg/day
• DHA: 200-300 mg/day
```

### Example 2: Ultrasound Correction
```
User: /pregnancy start 2025-01-01 ultrasound May 15

System:
Pregnancy record created

Pregnancy Information:
Last Menstrual Period: January 1, 2025
Due Date: October 8, 2025
Ultrasound Correction: May 15, 2025
Adjusted Due Date: October 10, 2025

Due Date Confidence: High (based on ultrasound correction)
```

## II. Record Prenatal Checkup (checkup)

### Example 3: Normal NT Scan
```
User: /pregnancy checkup week 12 NT normal

System:
Prenatal checkup record updated

Checkup Information:
Gestational Week: 12 weeks
Check Type: NT scan
Date: March 25, 2025
Result: Normal (NT value 1.8mm)

This checkup completed

Next Prenatal Checkup:
16 weeks Triple Screen - April 22, 2025 (28 days remaining)
Preparation: Fasting blood draw
```

### Example 4: High-Risk Triple Screen
```
User: /pregnancy checkup 16weeks triple-screen high-risk

System:
Abnormal prenatal checkup result

Check Type: Triple Screen (16 weeks)
Result: High risk (Trisomy 21 risk 1:50)

Recommendations:
• Consult your prenatal care physician immediately
• Consider NIPT or amniocentesis
• Don't panic, high risk does not mean diagnosis

Next Prenatal Checkup:
Please confirm next checkup time with your doctor
```

### Example 5: Glucose Tolerance Test
```
User: /pregnancy checkup week 24 glucose-tolerance 7.5 8.2 6.8

System:
Prenatal checkup record updated

Glucose Tolerance Test Results:
Fasting Glucose: 5.3 mmol/L (normal <5.1)
1-Hour Glucose: 7.5 mmol/L (normal <10.0)
2-Hour Glucose: 6.8 mmol/L (normal <8.5)

Diagnosis: Gestational Diabetes

Recommendations:
• Consult a nutritionist immediately
• Control diet, monitor blood glucose
• Moderate exercise
• Record blood glucose values daily
```

### Example 6: Routine Checkup
```
User: /pregnancy checkup week 28 routine bp120/70 weight65kg

System:
Prenatal checkup record updated

Checkup Information:
Gestational Week: 28 weeks
Check Type: Routine Checkup
Blood Pressure: 120/70 mmHg (normal)
Weight: 65kg
Fundal Height: 26cm
Abdominal Circumference: 90cm
Fetal Heart Rate: 145 bpm (normal)

Next Prenatal Checkup:
30 weeks - 2 weeks later
```

## III. Record Symptoms (symptom)

### Example 7: Morning Sickness
```
User: /pregnancy symptom nausea moderate

System:
Symptom recorded

Symptom Information:
Type: Nausea
Severity: Moderate
Frequency: Daily

Current Gestational Week: 12 weeks (First Trimester)

Assessment:
Morning sickness is common in the first trimester, typically improves by 14-16 weeks.

Management Recommendations:
• Small, frequent meals (6-8 small meals per day)
• Eat soda crackers before getting out of bed
• Avoid empty stomach
• Stay hydrated

Important Note:
If vomiting is severe causing dehydration (reduced urination, dizziness), seek medical attention immediately.

Data synced to symptom records
```

### Example 8: Edema
```
User: /pregnancy symptom edema feet mild

System:
Symptom recorded

Symptom Information:
Type: Edema
Severity: Mild
Location: Ankles

Current Gestational Week: 32 weeks (Third Trimester)

Assessment:
Mild edema is common in late pregnancy.

Management Recommendations:
• Elevate legs while resting
• Avoid prolonged standing or sitting
• Sleep on left side
• Moderate walking
• Reduce salt intake

Warning:
If sudden swelling occurs in face or hands, seek medical attention immediately to rule out preeclampsia.
```

## IV. Record Weight (weight)

### Example 9: Normal Weight Gain
```
User: /pregnancy weight 62.5

System:
Weight recorded

Weight Information:
Record Date: March 20, 2025
Current Gestational Week: 12 weeks

Current Weight: 62.5 kg
Pre-pregnancy Weight: 60.0 kg
Weight Gained: 2.5 kg
Current BMI: 23.1 (normal)

Weight Gain Assessment:
Recommended Total Pregnancy Weight Gain: 11.5-16 kg
Current Progress: Normal

Expected First Trimester Weight Gain: 1-2 kg
Current Weight Gain: 2.5 kg (slightly above)

Second and Third Trimester Recommendations:
Weekly Weight Gain: 0.35-0.50 kg

Nutrition Recommendations:
• Balanced diet, avoid "eating for two"
• Quality protein: Fish, poultry, eggs, dairy, legumes
• Complex carbs: Whole grains, tubers
• Fruits and vegetables: 500g or more daily
```

### Example 10: Excessive Weight Gain
```
User: /pregnancy weight 68

System:
Weight recorded

Weight Information:
Current Weight: 68.0 kg
Pre-pregnancy Weight: 60.0 kg
Weight Gained: 8.0 kg
Current Gestational Week: 20 weeks

Weight Gain Assessment:
Pregnancy Weight Gained: 8.0 kg
Recommended Weight Gain: About 5-6kg (at this stage)
Status: Excessive weight gain

Recommendations:
• Control high-sugar, high-fat foods
• Increase vegetable proportion
• Moderate exercise
• Reduce refined carbohydrates
```

## V. Record Vital Signs (vital)

### Example 11: Normal Blood Pressure
```
User: /pregnancy vital bp 115/75

System:
Blood pressure recorded

Blood Pressure Information:
Record Date: March 20, 2025
Current Gestational Week: 12 weeks

Blood Pressure: 115/75 mmHg
Classification: Normal

Mean Arterial Pressure: 88.3 mmHg

Recommendations:
Blood pressure is normal, keep it up!

Recommendations:
• Monitor blood pressure regularly
• Watch for headache, vision changes
• Seek medical attention if blood pressure rises
```

### Example 12: High Blood Pressure Warning
```
User: /pregnancy vital bp 145/95

System:
High blood pressure warning

Blood Pressure Information:
Blood Pressure: 145/95 mmHg
Classification: Stage 2 Hypertension

Risk Assessment:
Blood pressure is elevated, close monitoring needed.

Seek Medical Care Immediately:
• Check urine protein
• Assess liver and kidney function
• Check platelets
• Assess fetal status

Warning Symptoms (seek immediate care if present):
• Severe headache
• Blurred vision, flashing lights
• Upper abdominal pain (right upper quadrant)
• Nausea and vomiting
• Shortness of breath

Please contact your prenatal care physician or go to the emergency room immediately!
```

## VI. Multiple Pregnancy Setup (type)

### Example 13: Twin Pregnancy
```
User: /pregnancy type twins

System:
Multiple pregnancy type set

Pregnancy Type Information:
Type: Twin Pregnancy
Fetal Count: 2

Due Date Adjustment:
Original Due Date: October 8, 2025 (40 weeks)
Adjusted Due Date: September 17, 2025 (37 weeks)
Advance: 3 weeks

Important Notes:
Multiple pregnancy is high-risk, recommendations:

Prenatal Checkup Frequency Adjustment:
• From 28 weeks: Every 2 weeks
• From 32 weeks: Every week
• Add cervical length monitoring (starting at 16-18 weeks)
• Add fetal growth monitoring (every 4-6 weeks)

Special Monitoring:
• Fetal growth discordance
• Signs of Twin-Twin Transfusion Syndrome (TTTS)
• Cervical shortening

Recommended Weight Gain:
Total Recommended Gain: 16-24 kg
Second and Third Trimester Weekly Gain: 0.5-0.7 kg

Recommendations:
• Consult Maternal-Fetal Medicine (MFM) specialist
• Consider referral to tertiary hospital
• Create delivery plan (discuss at 32-34 weeks)

Fetal Profiles Created:
• Fetus A - Information to be completed
• Fetus B - Information to be completed
```

### Example 14: Triplet Pregnancy
```
User: /pregnancy type triplets

System:
Multiple pregnancy type set

Pregnancy Type Information:
Type: Triplet Pregnancy
Fetal Count: 3

Due Date Adjustment:
Original Due Date: 40 weeks
Adjusted Due Date: 35 weeks
Advance: 5 weeks

Special Considerations:
Triplet pregnancy is very high risk
Recommendations:
• Immediate referral to tertiary hospital MFM specialist
• Close monitoring (every 2 weeks)
• Early delivery planning (28-30 weeks)
```

## VII. Fetal Information (fetal)

### Example 15: Fetal Weight
```
User: /pregnancy fetal A weight 1200g

System:
Fetal information updated

Fetus A Information:
Weight: 1200g (45th percentile)
Gestational Week: 28 weeks

Assessment:
Fetal development is normal, weight within normal range.
```

### Example 16: Fetal Position
```
User: /pregnancy fetal A position cephalic

System:
Fetal information updated

Fetus A Information:
Position: Cephalic (head down)
Confirmed: June 20, 2025
Notes: Cephalic, fixed

Assessment:
Cephalic presentation is the most favorable position for delivery.
```

### Example 17: Fetal Heart Rate
```
User: /pregnancy fetal A heart 145

System:
Fetal information updated

Fetus A Information:
Heart Rate: 145 bpm (normal)
Variability: Normal

Assessment:
Heart rate within normal range (110-160 bpm).
```

## VIII. View Status (status)

### Example 18: Complete Status
```
User: /pregnancy status

System:
Current Pregnancy Status

Basic Information:
Last Menstrual Period: January 1, 2025
Due Date: October 8, 2025
Current Date: March 31, 2025

Pregnancy Progress:
Current Week: 12 weeks + 6 days
Trimester: First Trimester (1-13 weeks)
Days Passed: 89 days
Days Remaining: 191 days
Progress: 32%

Fetal Development:
Size: Plum size (about 5-6cm)
Weight: About 14g
Important Milestones:
✅ Organ development mostly complete
✅ Fingers and toes differentiated
✅ External genitalia beginning to form

Weight Tracking:
Pre-pregnancy Weight: 60.0 kg
Current Weight: 62.5 kg
Weight Gained: 2.5 kg
Recommended Weight Gain: 11.5-16 kg
Status: Normal

Recent Symptoms:
• Nausea (moderate) - Daily
• Fatigue (mild) - Frequent

Recent Blood Pressure:
March 20: 115/75 mmHg (normal)

Completed Checkups:
✅ 12 weeks NT scan - March 25 (normal)

Next Checkup:
16 weeks Triple Screen - April 22, 2025
22 days remaining

Preparation: Fasting blood draw

Focus This Week:
• Continue folic acid supplementation 400 mcg/day
• Seek immediate care if vaginal bleeding or abdominal pain
• Rest well, avoid strenuous exercise
```

## IX. Next Checkup Reminder (next-checkup)

### Example 19: Next Checkup
```
User: /pregnancy next-checkup

System:
Next prenatal checkup reminder

Next Checkup Information:
Check Type: Triple Screen (16 weeks)
Scheduled Date: April 22, 2025 (Tuesday)
22 days remaining (3 weeks)

Checkup Description:
Triple Screen (Down Syndrome Screening) uses blood tests to detect
certain markers in maternal serum, assessing the risk of chromosomal
abnormalities such as Down syndrome.

Preparation:
• Fast for 8+ hours
• Bring ID and insurance card
• Bring previous checkup records
• Schedule appointment in advance
```

## Trimester Divisions

| Trimester | Weeks | Duration |
|-----------|-------|----------|
| First Trimester | 1-13 weeks | About 3 months |
| Second Trimester | 14-27 weeks | About 3.5 months |
| Third Trimester | 28-42 weeks | About 3.5 months |

## Recommended Weight Gain (Based on IOM)

| Pre-pregnancy BMI | BMI Range | Total Gain | Second/Third Trimester Weekly Gain |
|-------------------|-----------|------------|------------------------------------|
| Underweight | <18.5 | 12.5-18 kg | 0.51 kg |
| Normal | 18.5-24.9 | 11.5-16 kg | 0.42 kg |
| Overweight | 25.0-29.9 | 7-11.5 kg | 0.28 kg |
| Obese | >=30.0 | 5-9 kg | 0.22 kg |

```