What does the big tank of the fetus mean. Questions about Ventriaculegaly. Efficiency of ultrasound of the central nervous system of the fetus

Prenatal screening - This is a combined biochemical and ultrasound study, consisting of blood test to determine the level of the main hormones of pregnancy and the usual ultrasound of the fetus with a measurement of several quantities.

A standard examination during pregnancy is considered only a planned ultrasound, screening is usually carried out either if you wish a pregnant woman in more detail in order to make sure all 100% in the right development of the baby, or is appointed by a doctor at the risk of the occurrence of chromosomal pathologies of the fetus.

The risk group includes pregnant women:

• older than 35 years and / or the age of the biological father of the child over 40 years;
• having in the family hereditary abnormalities of the fetus;
• with a frozen pregnancy in the past, the birth of a deadly child and / or with repeated spontaneous miscarriages;
• chasing in the first trimester with viral or infectious diseases;
• taking drugs dangerous drugs.

• First screening I trimester (in 11-14 weeks)
  • Screening ultrasound and its norm + photo protocol 1st ultrasound
  • Biochemical screening ("Double test") and its decoding
• • Screening ultrasound: norms and deviations + photo protocol 2nd ultrasound
  • Biochemical Screening (Triple Test): Decryption and Risks
• Third screening (for 30-34 weeks)
• Preparation for screening ultrasound
• Preparation for biochemical screening (blood test)
• The cost of complex screening

First screening or "double test" (in 11-14 weeks)

Screening includes two stages: the passage of ultrasound and blood taking for analysis.

In the course of ultrasound research, the diagnostic determines the amount of fruits, the term of pregnancy and removes the size of the embryo: CTR, BPR, the size of the cervical fold, the nasal bone and so on.

According to this data, we can say how correctly the baby is developing in the womb.

Screening ultrasound and its norms

Evaluation of the size of the embryo and its structure. Copchiko-Dread Size (CRT) - This is one of the definitions of the embryo, the value of which corresponds to the period of pregnancy.

The CTR is the size of the cochetic to the Temkin, without taking into account the length of the legs.

There is a table of regulatory values \u200b\u200bof the CTR according to pregnancy week (see Table 1).

Table 1 - CR stand according to the term of pregnancy

The deviation of the fetus of the fetus from the norm in the most part speaks of the rapid development of the baby, which is the harbinger of the nipping and the birth of a major fetus.

Too small fetal body size, testifies to:

• initially, the incorrect time of pregnancy by a plot gynecologist, even before a visit to the diagnostic;
• lag in development as a result of hormonal insufficiency, infectious disease or other ailments of the mother of the child;
• genetic pathologies for the development of the fetus;
• the intrauterine death of the fetus (but only provided that heart abbreviations do not listen).

Biparity size (BPD) of the fetal head - This is an indicator of the development of the toddler's brain, measured from the temple to the temple. This value also increases in proportion to the gestation period.

Table 2 - the norm of the fetus head of the fetus under a certain period of pregnancy

Exceeding the fetal head of the fetus head can talk about:

• large fruit if the remaining sizes are also higher than the norm for a week or two;
• the hopping growth of the embryo if the remaining sizes are normal (after a week or two, all parameters should be aligned);
• the presence of a brain tumor or brain herniege (pathologies are incompatible with life);
• hydrocephalius (Water Tank) of the brain due to an infectious disease in the future mother (antibiotics are prescribed and under success, pregnancy is pregnant).

Biparity size is less than the norm in the case of underdevelopment of the brain or the lack of some of its sections.

The thickness of the collar space (TVP) or the size of the "necklace" - This is the main indicator, which, with a deviation from the norm, indicates a chromosomal disease (Down syndrome, Edwards Syndrome or the other).

A healthy baby TVP with the first screening should not be more than 3 mm (for ultrasound conducted through the belly) and more than 2.5 mm (for vaginal ultrasound).

The magnitude of the TVP itself does not mean anything, it is not a sentence, just there is a risk. It is possible to talk about the high probability of the development of chromosomal pathology in the fetus only in the case of poor blood test results for hormones and with a cervical fold of more than 3 mm. Then, to clarify the diagnosis, the chorion biopsy is prescribed to confirm or refute the presence of chromosomal pathology of the fetus.

Table 3 - TWP standards for weeks of pregnancy

Nose bone length. The fetus with the chromosomal anomaly is wagged in the chromosomal anomaly than in a healthy fetus, therefore, with deviations in the development of the nasal bone at the first screening, either absent (at 11 weeks), or its value is too small (from 12 weeks).

The length of the nasal bone is compared with the regulatory value from 12 weeks of pregnancy, on July 10-11, the doctor can only specify its presence or absence.

In the inconsistency of the nose bone length of the pregnancy, but the remaining indicators are normal, there is no reason for anxiety.
Most likely, this is an individual feature of the fetus, for example, the nose of such a baby will be small and smoky, like parents or someone from close relatives, for example, at grandmother or great-grandfathers.

Table 4 - nasal length rate

Also on the first screening ultrasound, the diagnostics notes, visualize the bones of the skull, butterfly, spine, bones of the limbs, the front abdominal wall, stomach, bladder. On this period, these organs and parts of the body are already well visible.

Evaluation of the fetal life. In the first trimester of pregnancy, the behavior of the embryo is characterized by cardiac and motor activity.

Since the movements of the fetus are usually periodic and hardly distinguishable, then the diagnostic value has only Embryrous CCS, and motor activity is simply noted as "determined".

Heart Frequency (CSS) Fetal, regardless of gender, in 9-10 weeks should be in the range of 170-190 beats per minute, from 11 weeks and until the end of pregnancy - 140-160 beats per minute.

CSS Fetal below the norm (85-100 Ud / min) or above the norm (more than 200 ice / min) - an alarming attribute in which is appointed additional examination And if necessary treatment.

Study of extra-immabrional structures: the yolk bag, chorion and amnion. Uz-diagnostic in the protocol of the screening ultrasound examination (in other words, in the ultrasound results form) notes the data on the yolk bag and chorion, about the appendages and the walls of the uterus.

The yolk bag is an embryo organ that until the 6th week is responsible for the production of vital proteins, plays the role of primary liver, a blood system, primary genital cells.

In general, the gusty bag performs various important functions up to 12-13 weeks of pregnancy, then the need for it disappears, because the fetal has separate bodies: liver, spleen, etc., which will take all the responsibilities for ensuring life .

By the end of the first trimester, the gusty bag is reduced in size and turns into a cystic education (a yoyful stalk), which is located near the base of the umbilical. Therefore, in 6-10 weeks, the gusty bag should be no more than 6 mm in diameter, and after 11-13 weeks - in the normal place it is not visualized at all.

But everything is purely individually, the main thing is that he does not finish its functions before canceledTherefore, for 8-10 weeks, it must be at least 2 mm (but not more than 6.0-7.0 mm) in diameter.

If up to 10 weeks the gusty bag is less than 2 mm, then this may indicate the undeveloped pregnancy or the lack of progesterone (then duphaston or urozhastan are prescribed), and if on any time in the first trimester, the diameter of the yolk bag is more than 6-7 mm, then it says risk of development of pathologies of the fetus.

Chorion is an outer sheath of the embryo, covered with many veins, which are growing into the inner wall of the uterus. In the first trimester of pregnancy, Chorion provides:

• foot nutrition with necessary substances and oxygen;
• aid of carbon dioxide and other products of life;
• protection against penetration of viruses and infections (at least this function is not durable, but with timely treatment, the fruit is not infected).

Within the norm, the localization of the chorion "at the bottom" of the uterine cavity (on the upper wall), on the front, rear or one of the side walls (left or right), and the chorion structure should not be modified.

The arrangement of chorion in the field of the inner zoom (the transition of the uterus in the neck), on the bottom wall (at a distance of 2-3 cm from the sewage) is called the preservation of chorion.

But not always such a diagnosis indicates the prelationship of the placenta in the future, usually chorion "moves" and is thoroughly enshrined.

The prevention of chorion increases the risk of spontaneous miscarriage, so in such a diagnosis, observe the bed mode, move less and do not overhead. Treatment One thing: Lying in bed days (rising only in the toilet), at times raising the legs and remaining in this position of 10-15 minutes.

By the end of the first trimester, the Chorion will become a placenta, which until the end of pregnancy will gradually "mature" or how else they say "aging."

Up to 30 weeks of pregnancy - the degree of maturity 0.

So the ability of the placenta is estimated to provide a child with everything necessary at each stage of pregnancy. There is also the concept of "premature aging of the placenta," which speaks about the complication of the course of pregnancy.

Amnion is an inner water shell of the embryo, in which amniotic fluid accumulates (spindle water).

number spindle water At 10 weeks - about 30 ml, in 12 weeks - 60 ml, and then it is an increase of 20-25 ml per week, and at 13-14 weeks already contains about 100 ml of water.

When inspecting the uterus, an increased tone of the uterine mineometry (or hypertonus of the uterus) can be detected. Normally, the uterus should not be in good shape.

Often, in the results of the ultrasound, you can see the recording "Local thickening of myometrium on the back / front wall", under which it implies both a short-term change in the muscle layer of the uterus because of the feeling of emotion in a pregnant woman when conducting an ultrasound and an increased tone of the uterus, which is the threat of spontaneous miscarriage.

The neck of the uterus is also examined, its zev should be closed. The length of the cervix for 10-14 weeks of pregnancy should be about 35-40 mm (but not less than 30 mm for primary and 25 mm for repeated). If she is shorter, then it talks about the risk of premature births in the future. Approaching the day of the alleged childbirth, the neck of the uterus will be crushed (but there must be at least 30 mm by the end of the pregnancy period), and in front of the births of her Zev - to reveal.

The deviation from the norm of some parameters at the first screening does not give a reason for unrest, just a pregnancy in the future should be observed more closely, and only after the second screening you can talk about the risk of developing defects from the fetus.

Standard ultrasound protocol in the first trimester

Biochemical screening ("Double test") and its decoding

The biochemical screening I trimester implies the definition of two elements contained in the blood of a woman: the level of free B-hCG and protein-a blood plasma - PAPP-A. These are two pregnancy hormones and in the normal development of the baby they must correspond to the norm.

Horionic gonadotropin of man (hCG) Consists of two subunits - alpha and beta. Free beta-hCG - in its own kind, is unique, so its value is taken for the main biochemical marker used to assess the risk of the presence of chromosomal pathology in the fetus.

Table 5 - Norma B-hgch during pregnancy for weeks

Improving the value of free B-hCG says about:

• risk of the presence of Down syndrome (in case of exceeding the norm by two times);
• multiple pregnancy ( hCG level increases in proportion to the number of fruits);
• presence in pregnant diabetes;
• guestRose (i.e., with an increase in blood pressure + edema + protein detection in the urine);
• fetal developmental deposits;
• bubble drift, choriocarcinoma (rare type of tumor)

Down the value of beta-hCG indicates:

• the risk of the presence of Edwards syndrome (trisomy 18) or Patau syndrome (trisomy 13);
• threat of abortion;
• delayed fetus in development;
• chronic placental insufficiency.

Papp-A. - associated with pregnancy protein-a plasma.

Table 6 - PAPP-A norm for pregnancy for weeks

The reduced content of PAPP-A in the blood of a pregnant woman gives a good reason to assume about the risk available:

• development of chromosomal pathology: Down syndrome (Trisomy 21), Edwards Syndrome (Trisomy 18), Patay's Syndrome (Trisomy 13) or Cornelia de Lange syndrome;
• spontaneous miscarriage or intrauterine fetal death;
• fetoplacentage insufficiency or hypotrophy of the fetus (that is, the insufficient body weight due to the nutritional disorders);
• the development of preeclampsia (is evaluated in conjunction with the level of placental growth factor (PLGF). The high risk of development of preeclampsia speaks a decrease in Rarr-A together with a decrease in the placental growth factor.

Increased PAPP-A may be observed if:

• woman puts twins / triples;
• the fruit is large and the mass of the placenta is increased;
• the placenta is low.

Both indicators are important for diagnostic purposes, so they are usually considered in the complex. So if the papp-A is reduced and raised beta-hCG - there is a risk of the presence of Down syndrome, and with a decrease in both indicators - Edwards Syndrome or Pataau syndrome (Trisomia 13).

After 14 weeks of pregnancy, the analysis on Pap-A is considered non-informative.

Second Screening II Trimester (in 16-20 weeks)

II screening, as a rule, is prescribed with deviations in screening, less often in the threat of pregnancy interrupt. In the absence of deviations, the second comprehensive screening can not be carried out, and only the ultrasound of the fetus can be passed.

Screening Ultrasound: norms and deviations

Screening ultrasound on this period is aimed at determining the "skeletal" structure of the fetus and developing it internal organs.
Fetometry. The diagnostics notes the presence of the fetus (pelvic or head) and removes other fetal development indicators (see Table 7 and 8).

Table 7 - Regulatory Dimensions of the Fetal Ultrasound

As at first screening, the length of the nasal bone is measured in the second. With normal remaining indicators, the deviation of the length of the nasal bone from the norm is not considered a sign of chromosomal pathologies in the fetus.

Table 8 - nasal length rate

According to the measurements, you can judge the true term of pregnancy.

Anatomy of the fetus. The inspection of the internal bodies of the baby is underway.

Table 9 - Regulatory values \u200b\u200bof the cerebellum fetus for weeks

The dimensions of both the side ventricles of the brain and the large fetal tank should not exceed 10-11 mm.

Usually the remaining indicators, type: nasolabial triangle, soccer, spine, 4-chamber cutting heart, cut through 3 vessels, stomach, intestines, kidneys, bladder, lungs - in the absence of visible pathologies are noted as "norm".

The place of attachment of cords to the front abdominal wall and to the center of the placenta is considered the norm.

The abnormal attachment of the umbilical attachment includes edible, shell and cleaving, which leads to difficulties in the generic process, hypoxia of the fetus and even his death during childbirth, if the planned COP is not appointed or during preterm birth.

Therefore, in order to avoid the death of the fetus and blood loss, a planned caesarean section (COP) is appointed at childbirth.

There is also a risk of delay in development, but with normal indicators of the development of the baby and the careful observation of the woman in labor, everything will pass safely for both.

Placenta, umbilical umbilical waters. The placenta is most often on the rear wall of the uterus (in the form it can be clarified to the right or left), which is considered the most successful attachment, since this part of the uterus is best supplied with blood.

Zone closer to the bottom also has a good blood supply.

But it happens that the placenta is localized on the front wall of the uterus, which is not considered something pathological, but this area is exposed to stretching with the growth of the baby inside the womb "Plus" the active movements of the crumbs - all this can lead to the placenta detachment. In addition, the prelationship of the placenta is more common in women with the front layout of the placenta.

This is not critical, simply this information is important for making a decision on the method of delivery (whether the cesarean secession needs and what difficulties may occur during childbirth).

Normally, the edge of the placenta should be 6-7 cm (or more) above the inner domestic language. Anomalous is considered to be its location in the lower part of the uterus in the field of the inner sewage, partially or completely overlapping it. Such a phenomenon is called the "placenta prelationship" (or low placenta).

The thickness of the placenta is more informative to measure after 20 weeks of pregnancy. Prior to this period, only its structure is noted: homogeneous or inhomogeneous.

From 16 and to 27-30 week of pregnancy, the structure of the placenta should be unchanged, uniform.

The structure with the expansion of intervalistic space (MVP), echonegative formations and other deviations negatively affects the nutrition of the fetus, causing hypoxia and lagging in development. Therefore, curantyl treatment is assigned (normalizes blood circulation in the placenta), actovegin (improves the supply of fetus by oxygen). With timely treatment, kids are born healthy and on time.

After 30 weeks there is a change in the placenta, its aging, and as a result of heterogeneity. At the later date, this is a normal phenomenon that does not require additional surveys and treatment.

Normally up to 30 weeks, the maturity of the placenta "zero".

The number of accumulating waters. To determine their number, the diagnostics makes the calculation of the amniotic fluid index (exercise) according to the measurements made during the ultrasound.

Table 10 - norms of the index of amniotic fluid on weeks

Find your week of pregnancy in the first column. The second column shows the range of the norm for this period. If the exercise specified by the uzisser in screening results is included in this range, the amount of accumulating water corresponds to the norm, less than the norm means early lowers, and more - multi-way.

There are two severity: moderate (insignificant) and pronounced (critical) lowland.

The pronounced lowroad threatens the anomalous development of the fetus limbs, the nervous system of the kid suffers, suffer. As a rule, kids who have moved in the womb of Malovodie, lagging behind in development and weight.

With pronounced lowland, drug treatment must be appointed.

Mild lowland usually does not require treatment, it is only necessary to establish food, minimize physical exertion, take a vitamin complex (must be included in it vitamin E).

In the absence of infections, gestosis and diabetes, the mother of the child, and when developing a baby within the normal range - there is no reason for excitement, most likely, this is a feature of the course of this pregnancy.

Norma Pupovina has 3 vessels: 2nd artery and 1-A Vienna. The absence of one artery can lead to various pathologies in the development of the fetus (to the pork of the heart, the atresia of the esophagus and the fake, hypoxia of the fetus, violation of the work of the urogenital or central nervous system).

But O. normally Pregnancy, when the work of the missing artery compensates for the existing, can be said when:

• normal results of blood tests on the maintenance of hgch, free estriol and AFP, i.e. in the absence of chromosomal pathologies;
• good fetal development indicators (according to ultrasound);
• the absence of defects of the structure of the fetal heart (when the fetal of the open functional oval window is detected, it is not necessary to worry about, it is usually closed up to a year, but it is necessary to observe the cardiologist once every 3-4 months);
• not disturbed bloodstain in the placenta.

Baby with such anomaly, as the "single artery of the umbilical arteries" (abbreviated EAP), usually appear on light weight, can often root.

Until a year, it is important to monitor changes in the body of the child, after the year of the life of the crumbs, it is recommended to thoroughly engage in his health: organize proper balanced nutrition, reception of vitamins and minerals, to carry out the strengthening immunity procedures - all this is capable of leading the condition of the small organism in order.

Cervical and walls of the uterus. In the absence of deviations, the Ultrasound Protocol will notice the "neck and wall of the uterus without features" (or abbreviated b / o).

The length of the cervix in this trimester should be 40-45 mm, permissible 35-40 mm, but not less than 30 mm. If it observes its discovery and / or shortening compared with the previous measurement with an ultrasound or softening of its tissues, which is generalizable called "Eastic-cervical insufficiency" (ICN), then the installation of pessary obstetric unloading or overlapping seams is appointed to keep the pregnancy and reach term.

Visualization. Normally, it must be "satisfactory." Visualization is difficult at:

• uncomfortable for studying the position of the fetus (just the baby is located so that it is not all possible to see and measure or he constantly spinned during the ultrasound);
• overweight (in the graph of visualization, the reason is due to the subcutaneous fatty fiber (PJC));
• estiqules at the future mommy
• hypertonus uterus when conducting an ultrasound.

Standard Ultrasound Protocol in the second trimester

Biochemical Screening or Triple Test

The biochemical screening of the blood of the second trimester is aimed at determining the three indicators - the level of free B-hgch, free estriol and AFP.

Norma free beta-hgch Look at the table below, and find the decoding here, it is similar to every period of pregnancy.

Table 11 - the rate of free B-HCG in the second trimester

Free estriol. - This is one of the pregnancy hormones, which reflects the functioning and development of the placenta. With the normal course of pregnancy, it grows progressively from the first days of the beginning of the formation of the placenta.

Table 12 - free estriol norm for weeks

Increasing the amount of free estriol in the blood of a pregnant woman is observed with multiple pregnancy or a large weight of the fetus.

The decrease in the level of estriol is observed in fetoplasative insufficiency, the threat of abortion, bubble drift, intrauterine infection, adrenal hypoplasics or anensphaly (defect development of the nervous tube) of the fetus, Down syndrome.

Critical is considered to reduce free estriol by 40% or more of the normative value.

Acceptance of antibiotics during the analysis period may also affect the decrease in the blood estriol in the blood of a woman.

Alpha Fetoprotein (AFP) - It is a protein produced in the liver and gastrointestinal Baby, starting with 5 weeks of pregnancy from conception.

In the blood of the mother, this protein enters the placenta and from the oil-free water, and begins to grow in it from 10 weeks of pregnancy.

Table 13 - Norm Afp For weeks pregnancy

If during pregnancy a woman sick viral infectionAnd the kid had necrosis of the liver, it also observes an increase in AFP in blood serum pregnant.

Third screening (for 30-34 weeks)

Total conduct two screenings during pregnancy: in the first and second trimesters. In the third trimester of pregnancy, it is a final control over the state of health of the fetus, they are watching its position, the functionality of the placenta is evaluated, the decision on the method of the root separation is made.

For this, an ultrasound of the fetus is appointed for 30-36 weeks, and from 30-32 weeks cardiotokography (abbreviated CTG - registration of changes in the heart activities of the fetus depending on its motor activity or uterus cuts).

Dopplerography may also be assigned, which allows us to evaluate the strength of blood flow in the uterine, placental and main vessels of the fetus. With this study, the doctor learns whether the baby has enough nutrients and oxygen, because it is better to prevent the appearance of fetal hypoxia than to solve the problems with the health of the crumbs after delivery.

It is the thickness of the placenta along with the degree of maturity shows its ability to supply the fruit with everything necessary.

Table 14 - placenta thickness (norm)

With a decrease in thickness, they are diagnosed with "placenta hypoplasia". Usually this phenomenon causes late toxicosis, hypertension, atherosclerosis or infectious diseases transferred to the woman during pregnancy. In any case, treatment or supporting therapy is assigned.

Most often, the placenta hypoplasia is observed in fragile miniature women, because one of the factors for reducing the thickness of the placenta is the weight and physique of pregnant. It is not scary, more is more dangerous to increase the thickness of the placenta and as a result of its aging, which speaks of pathology, which can lead to the interruption of pregnancy.

The thickness of the placenta increases with iron deficiency anemia, Pestosis, diabetes mellitus, rhesv conflict and with viral or infectious diseases (transferred or existing) in pregnant women.

Normally, the gradual thickening of the placenta occurs in the third trimester, which is called its aging or maturity.

The degree of maturity placenta (norm):

• 0 degree - up to 27-30 weeks;
• 1 degree - 30-35 weeks;
• 2 degree - 35-39 weeks;
• 3 degree - after 39 weeks.

Early forming of the placenta is fraught with a deficiency of nutrients and oxygen, which threatens the hypoxy of the fetus and the lag in development.

An important role in the third trimester also plays the number of accumulating waters. Below is a regulatory table for an amniotic fluid index - a parameter characterizing the amount of water.

Below is the table of the regulatory size of the fetus for weeks of pregnancy. The kid can not match the specified parameters a bit, because all the kids are individual: someone will be large, someone is small and fragile.

Table 16 - the regulatory sizes of the fetus on ultrasound for the entire period of pregnancy

Preparation for screening ultrasound

Transabdominal ultrasound - the sensor is etched by the abdominal wall of a woman, a transvaginal ultrasound - the sensor is introduced into the vagina.

With a transabdominal ultrasound, a woman, with a period of up to 12 weeks of pregnancy, should come to the diagnosis with a complete urinary bubble, drinking 1-1.5 liters of water for half an hour to visit to the ultrasound doctor. It is necessary that the full bladder "squeezed" the umbrella from the pelvis cavity is that it will be possible to consider it better.

From the second trimester, the uterus increases in size and is well visualized without any preparation, so the need for a complete urinary bubble disappears.

Take a handkerchief with you to wipe the residual gel from the belly.

With a transvaginal ultrasound, it is preliminarily necessary to carry out hygiene of external genital organs (without douching).

A doctor can say in advance to purchase a condom in a pharmacy, which is put on the sensor for hygiene, and go to the toilet to press if the last urination was more than an hour ago. To maintain intimate hygiene, take with you special wet wipes, which will also purchase in advance in the pharmacy or in the store on the relevant department.

Transvaginal ultrasound is usually carried out only in the first trimester of pregnancy. With the help of it, you can still up to 5 weeks of pregnancy to detect a fetal egg in the uterus cavity, abdominal ultrasound is not always under this early term.

The advantage of vaginal ultrasound is that it can determine ectopic pregnancy, threat of miscarriage in the pathology of the location of the placenta, diseases of the ovaries, phallopy pipes, uterus and her necks. Also, a vaginal study makes it possible to more accurately appreciate how the fruit develops, which is difficult to do in women with overweight (in the presence of fat folds on the stomach).

For ultrasound examination, it is important that the gases do not interfere with the survey, so in case of meteorism (bloating) it is necessary to take a day before the ultrasound take 2 tablets of Espumizan after each food reception, and in the morning of the survey, drink 2 Espeamizan tablets or schuket bag, explore it in the floor Water cup.

Preparation for biochemical screening

Blood take from veins, preferably in the morning and necessarily an empty stomach. The last meal must be 8-12 hours before sampling. On the morning of the blood fence day, you can drink only mineral water without gas. Remember that tea, juice and other such liquid is also food.

The cost of complex screening

If a planned ultrasound study in urban women's consultations most often spend for a small fee, either at all for free, then to hold a prenatal screening - the rated range of procedures.

Only biochemical screening costs from 800 to 1600 rubles. (from 200 to 400 UAH) depending on the city and the laboratory "Plus" for the usual ultrasound of the fetus, it is necessary to pay somewhere 880-1060 rubles. (220-265 UAH.). In total, the complex screening will cost a minimum of 1,600 - 2,660 rubles. (420-665 UAH).

It makes no sense to carry out prenatal screening on any gestation period, if the abortion is not ready, in the case of confirmation by doctors, the presence of mental retardation (Down syndrome, Edwards, etc.) or vices of any organs.

Comprehensive screening is intended for early diagnosis of pathologies in the intrauterine development of the fetus in order to be able to produce only healthy offspring.

Norma

Important! The table is not the reason for premature conclusions, only the attending physician is able to properly decipher the ultrasound.

Preparation and conduct of ultrasound

At 20 weeks, ultrasound can be carried out without special training. A pregnant woman does not need to stick to the diet and wait for the urinary bubble filling.

Conducting ultrasound based on the transabdominal method (the sensor is located on the front wall of the abdomen). If you spend 20 weeks to ultrasound a vaginal sensor, there is a possibility of premature miscarriage.

Pregnant can lie on the left side or on the back. In order for the ultrasonic wave to penetrate the uterus, a special gel is applied on the stomach on a water-soluble basis. It is easily eliminated by the usual paper napkin And does not bring inconvenience.

Protocol for ultrasound

Filling data on the fruit, the state of the octoperwater and the placenta is performed by a clear protocol:

1. Indicates the number of fruits.
2. The prelationship of the fetus is estimated, it is indicated which part of the body is in close proximity to the outlet of the uterus. The optimal option is the head preview, it is also possible to predict the fetus of the pelvic region. Ultrasound (20 weeks) allows any location of the fetus, but by 30 week it should stabilize so that the child can be born freely and without complications.
3. It is indicated by the presence or absence of a cordial cord.
4. The state of the inner membrane of the uterus (myometrium) is described, which can affect the possibility of miscarriage.
5. The quantity and condition of the amphibian water is estimated, the presence of low or multi-way, suspension (on this period, any suspension in the oily water is pathology).
6. Specifies the length of the cervix. On the ultrasound (20 weeks), the norm of this indicator is at least 3 cm.
7. The state of the internal and external oz is described. On this time it must be closed.
8. The state of the placenta is also rated. It should be located approximately in seven centimeters from the inner mouth. The presence of any damage requires urgent hospitalization of pregnant.

Such a detailed analysis allows you to see the whole picture of the state of the fetus and prevent premature miscarriage.

Features of the second prenatal screening

Most often, the ultrasound of the child at 20 weeks is carried out in conjunction with a dopplerometric study. This allows you to detect the presence of chromosomal or genetic deviations of the fetus or confirm that the child is completely healthy.

Dopplerometry determines the presence of certain substances in the blood and their content. Analyze the full picture and draw conclusions about the state of the fetus can only the attending physician and a genetic doctor.

In 20 weeks, ultrasound is the safest and informative study that shows the general state of the fetus and the degree of development of all vital organs.

Paul definition

At 20 weeks, the ultrasound can mostly show the floor of the future child. Determine it is easy. The boys have sexually visible immediately, and girls have any bulges.

Difficulties with floor definition may occur due to the location of the fetus. In this case, you can re-study after 15 minutes. Pregnant women advise to eat a little chocolate so that the baby becomes active.

When a child is located on the stomach, it is also difficult to determine its floor. Some kids during the ultrasound turn away or hide, because the sex of the child for parents remains a mystery to the birth.

Even when using modern ultrasound equipment, errors with the definition of the floor are possible, each should be ready for this.

Pregnant state

On this period, toxicosis is already passed, but pregnant can often feel the feeling of gravity in the abdomen or heartburn. Frequent side effects Are convulsions of the icy muscles and headaches. To minimize these sensations, you need to rest fully rest, eat and use a sufficient amount of vitamins.

It is important to monitor the swelling and the state of discharge. If the swelling gives discomfort, you will need to turn to your doctor. When changing the number or state of secretions, it is also urgent to consult with a gynecologist to prevent the fetus infection.

A study of 20 weeks is the most important analysis of the state of the fetus, so you should not pull and neglect them. Otherwise, any defects of development or deviation may not be detected on the desired period.

It would seem that only recently test showed 2 bright strips, and has already come 20 weeks of pregnancy. This is the equator of your interesting position, and most importantly, the most difficult period of toxicosis has long been behind. You have already become accustomed to your new condition and sensations and, of course, managed to love the younger little tiny. The weight of the kid is already about 250-300 g. The tummy becomes noticeable, and familiar are already starting to be interested, do not expect replenishment. It is time for an ultrasound for 20 weeks of pregnancy.

Fruit at 20 pregnancy week

With the beginning of the second trimester, the baby begins to grow more actively. Its organs are almost completely formed. From 20 weeks your child opens eyes, he already has cilia.

21 weeks of pregnancy. Uzi showed that we are waiting for the boy !!

Approximately 20-22 hours a day, the baby sleeps, but wakes up every hour to play. The child can already distinguish between the voices, so it is time to start talking to him, read fairy tales.

If you have been appointed ultrasound at 20 weeks of pregnancy, you can learn half a child and how much it is right now. If the kid sits on the pope or across the abdomen, it is not a reason for anxiety. He still has a lot of time to lie down down.

Feelings of the future mother

If it has not yet happened, then, most likely, at week 20 you can feel the chapels of the baby. From now on, you fully start feeling my mother. The child reacts to the touch of the hand and already actively moves the handles and legs.

Some moms may notice that in the daytime, the kid is less active. For the most part, this is due to the fact that the day you are quite mobile and thereby can give the baby. All his activity falls on the morning and mostly for a while before bedtime. Ask Pope to hand on the stomach and you will notice how the baby gradually calms down and also goes to bed.

But if the child stopped pushing or, on the contrary, it became too active - this is a reason to consult a doctor so that he appoints you an ultrasound at 20 weeks of pregnancy to clarify the causes of this behavior.

Pain: the norm or the need to urgently consult a doctor

As already mentioned, the child begins to gain weight, and, accordingly, the stomach is becoming more and more. The uterus continues to grow up and is already beginning to put pressure on the internal organs. Many of the future mothers are first faced with heartburn, constipation and hemorrhoids. But with such symptoms, the doctor can easily help you, wringing the necessary drugs. A small pain may appear in the urinary bubble area and the uterus, which occurs only when turning in the position of the lying. It testifies to tensile ligaments and is not dangerous for the infant.

But if you have the beginning of pulling the abdomen, like when menstruation, there was pain in the lower back or increased the tone of the uterus, the doctor will urgently appoint you an ultrasound of the fetus for 20 weeks. Since all this alarming interruption signs of pregnancy.

Selection at 20 pregnancy week

If you have noticed sharp or pulling pain at the bottom of the abdomen, which are accompanied by bloody discharges, is the first sign of peeling the placenta. We immediately consult a doctor so that he appointed an ultrasound for a period of 20 weeks and discharged you the necessary medicines or sent you to inpatient treatment.

If the bleeding appeared after sexual intercourse or inspection by the doctor on the chair - this may indicate the erosion of the cervix.

Curl, green or yellow discharge are always considered an indicator of the presence of infection in the vagina. Most often, such diseases will be accompanied by itching, burning or pain at the bottom of the abdomen. Ultrasound in this case, most likely, you will not need. The doctor will give you the direction for analyzes, on the basis of which you can assign treatment to you.

Normal allocations for a period of 20 weeks - white or light gray, which do not have an unpleasant smell.

Weight for 20 weeks

Since the toxicosis is already behind, and the pregnant woman begins to eat normally, now it is worth taking care of its weight. For the fifth month of an interesting position, it is normal to dial from 3 to 6 kg. But it will be better if the weekly weight gain will be not more than 500 g.

The baby in the tummy already weighs about 300 g and has a height of about 15 cm. All of its vital organs are practically formed, so shelling becomes more tangible. It can already distinguish between votes, light and darkness, turn the head. If nothing bothers you, then the doctor is most likely not to appoint an ultrasound at 20 weeks of pregnancy.

Naturally, as throughout the entire pregnancy, at 20 week, the food should also be useful. Since toxicosis has already completely retreated, the appetite at this time can play very much. Try not too much and big portions. Divide your feed by four, five, and then there may be six food receptions, which will be small and varied. Turn into your diet various cereals, low-fat meat, all kinds of dairy products. Do not forget about fruits with vegetables, they can be left for a snack between your main eating.

If at 20 weeks began to torment the heartburn, then it is from the diet to exclude everything roasted, salty and very sweet. To reduce the symptoms of heartburn, you can drink a glass of milk before bedtime.

Sex life at the 20th week of pregnancy

If there is no threat to abortion and your doctor has nothing against your sex life, then the second trimester will be the safest period for sex. Only now they will now have to choose optimally convenient postures for both partners, because the child in his stomach begins to actively grow, and not to harm him, you will have to choose such a position in which the pressure on the stomach is completely excluded. Also do not "act" during pregnancy.

If, during sexual intercourse, the partner experienced at least the slightest discomfort, sex must be interrupted and after consulting a doctor. He will inspect the belly and may appoint an ultrasound of the fetus for 20 weeks to be sure that everything is fine with him and there is no reason for concern.

In the first trimester, attend the doctor was only once 1 time per month. With the beginning of the next three-month period, go to women's consultation will have 2 times a month. To properly diagnose and be confident in the right development of the fetus, you will have to pass blood from the finger, urine and ultrasound. The first analysis will show whether the blood sugar is not elevated, but the second will indicate whether everything is in order with the kidneys and there are no inflammatory processes in the urinary organs.

There are few reasons in order to get to know ultrasound testimony at 20 weeks. Most likely, the doctor will appoint you to spend it only in the case of certain complaints or if the first ultrasound was made for a very long time. If the testimony is not for the ultrasound, but you still can't wait to learn the floor of the future baby, you can go to any paid clinic where pregnant surveys are carried out.

It is possible that on this time you will be prescribed a triple test analysis test: HCG + Estriol + AFP. This study is carried out to exclude the bottom of the child from the child.

The main danger of a period of 20 weeks is that if pregnancy is flooded, the signs of this may not appear at all. Therefore, the doctor for reinsurance can appoint you an ultrasound kid for 20 weeks.

No less dangerous now is the prolonged tone of the uterus and pulling the pain at the bottom of the abdomen. If you notice such symptoms, immediately consult a doctor or call it to the house. This is necessary to do this, since the fruit born on this period will not be able to survive.

The tone of the uterus may occur and disappear is adorable. This happens when you climb the stairs, take an inconvenient position or just go a lot.

Anxious sign can also be dizziness, nausea, drowsiness. But most often such symptoms can only be caused by overworking at work. Notify the authorities about your interesting position so that you are transferred to light work.

Abdominal pain can also be provoked by constipation or hemorrhoids. They do not make up much danger, but about such symptoms also need to notify your doctor.

Ultrasound for 20 weeks of pregnancy

Ultrasound of 20 weeks is carried out as a compulsory screening in the second trimester. On this time, you can already find out the gender of your baby, whether its development corresponds to the gestation period, whether the state of the placenta and spindle water is normal, is there a chance of congenital defects or deviations.

Uzi rules for 20 weeks: if the pregnancy proceeds without any complications, the weight of the baby will not exceed 250 g and the growth of 16 cm. But these are characteristic parameters only for those women who are not inclined to dry multiple pregnancy and large fetus. If the sex of the baby is male, then, most likely, the indicators will be slightly overestimated and the PDR according to biometrics will be put on the week, or even two before.

For a period of 20 weeks, the doctor can already explore:

1. Biometric indicators: fetal size, logo-occipital size, abdominal circle and head, length of tubular bones. These indicators will tell you how much the fruit corresponds to development for a term. It is not necessary to prematurely raise if the baby is less than laid. Perhaps in your case it will be the norm, if not, the doctor will appoint you vitamins for better infant growth.

2. Development vices: This is the best time to find out if there is any deviations from the baby. On the first ultrasound, nothing can be seen, and the third will not show all the fruit, especially if the placenta is located on the front wall of the uterus.

3. Structure, thickness, location and degree of maturity of the placenta. This is a very important body, thanks to which the child gets all the nutrients from the mother. Normally, it must be from 16.7 to 28.6 mm. Up to 30 weeks is considered the optimal indicator 0 degree of maturity. From 30 to 34 - 1 degree, from 35 to 39 - 2 degree, and all weeks after - 3 degree.

4. The quantity and quality of the accumulation waters: the norm at the 20th week of pregnancy is 86-230 mm. If the indicators are higher or lower, it speaks of many or low. In the first case, this indicator indicates some infectious disease, diabetes mellitus or rhesv conflict. In the second - the reasons for such anomaly, medicine is still not known, and all treatment is directed only to maintain a healthy state of the fetus.

Ultrasound errors at 20 weeks when determining sex

Ultrasound at 20 weeks is an excellent chance to find out who you are waiting for. The chapels of the baby are becoming more clear and frequent, so with a qualified inspection of problems with the definition of sex should not occur. But still, there are cases when the floor on the ultrasound is put wrong. There are several significant reasons for it:

1. The ultrasound can not give a clear definition of the floor not because the bad apparatus, but because the doctor is able to make a mistake. It may incorrectly interpret seen on the screen.

2. The baby is very mobile, and the device cannot catch the floor of the baby. To avoid such trouble, you should not eat a lot of sweet, especially chocolate.

3. At the reception in the ultrasonic office, the baby fell asleep in an unsuitable position.

4. The ultrasound device may be too old and show also the presence of urinary infections (MPI). This is not a reason for concern, especially if most recently you had a runny nose or you experienced stress. Otherwise, your gynecologist will send you to analyzes to make sure that everything is fine with your health and child. In some cases, doctors can advise to leave a piece of chocolate to wake the baby. In this case, ultrasound will be able to repeat after 15 minutes.

Boy or girl

On the ultrasound of 20 weeks of pregnancy, the doctor with confidence in 80% will be able to say the floor of the future kid. Difficulty can only be the location of the baby in the stomach, and therefore the characteristic signs of one or another can be absolutely not to see.

Ultrasound Girls 20 week shows the lack of convexities in the crotch area. If the child does not put the legs, only one strip will be visible.

Ultrasound of the boy for 20 week will definitely show the presence of male genital organs, which are difficult not to notice on this period.

The doctor, of course, may be mistaken by telling you that you are waiting for the girl. With the boys, everything is much easier.

Multiple pregnancy

If you have multiple pregnancy - it will immediately show the first ultrasound for a period of 10-11 weeks. It is very important that the doctor defines one or bilay embryos as early as possible. When the doctor sees that you have twins, on ultrasound 20 weeks, he will already determine this with complete confidence.

It is very important that the doctor turns out to be experienced and qualified, because if he puts the wrong diagnosis of both fruits, it can carry very bad consequences.

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What shows ultrasound at 20 weeks of pregnancy?

During pregnancy, the woman is extremely important to follow their health and the condition of the baby in the womb. For example, on average, 3 times over the entire period of toaling will need to undergo an ultrasound study. And what shows ultrasound at 20 weeks?

Why should ultrasound?

So, the ultrasound at 20 weeks of pregnancy will show whether the fruit is growing, whether everything is in order with his health. This study helps to determine the size of the future kid and assess the harmony of its development. So, if the results of the ultrasound 20 weeks do not correspond to the main generally accepted standards in medical practice, the gynecologist assigns additional surveys and analyzes to find out the cause of deviations. In addition, the ultrasound 20 weeks of pregnancy, the decoding of which should be carried out only by an experienced specialist, will help identify some pathologies.

It should be noted that medicine does not stand still, and today many health problems kid can be solved even before his birth. And the sooner it will be done, the more chances that the baby will be born absolutely healthy. In addition, the ultrasound of 20 weeks, whose norm is known to all experienced gynecologists, allows you to calculate the approximate age of crumbs from the moment of conception, and also assume when childbirth will begin. And this is especially important if the planned operation of the cesarean section is necessary, as well as in the case of urgent hospitalization of the baby after birth (for example, if necessary).

Also, the ultrasound of 20 weeks, whose indicators can tell about many ways will allow the doctor to draw conclusions about the state of the uterus and the cervix, which will help find out what will be the way of the root separation ( natural childbirth Or cesarean section), and whether stimulation will also need. Therefore, it is simply irresponsible to ignore this study. Each woman should pass an ultrasound 20 weeks. Its norm is presented below.

Norms of ultrasound 20 weeks and deciphering the main indicators of the fetus

So what are the norms of ultrasound 20 weeks? Below are the main indicators that will be determined with this study.

The bipartive fetus size (the distance from one toddler's temple to another) on this period is 45-53 millimeters.

Another rule of ultrasound 20 weeks of pregnancy is a frontal-occipital size (length of the cut from forehead to the nape). It is approximately 56-68 millimeters.

SHOCK! Effect of ultrasound on DNA

Circa Circle is about 154-186 millimeters.

The girth of the abdomen is 137-166 millimeters.

The next indicator of the ultrasound 20 weeks is the length of the hip, which should be in between 26 to 38 millimeters.

The length of the leg is approximately 27-33 millimeters.

Another result of the ultrasound 20 weeks is the length of the shoulder, equal to about 26-36 millimeters.

The length of the forearm is 23-29 millimeters.

The nasal bone has a length equal to 5.8-8.2 millimeters.

Also on the ultrasound, spent on the 20th week of pregnancy, the thickness of the collar zone (cervical fold) is determined, which should be approximately 2.8-3 millimeters on this period.

Copchiko-temporal size (distance from the tailbone to the pattern). It should normally be approximately 15-16 millimeters.

Another indicator of the ultrasound 20 weeks is the weight of the future kid on this period. It is 280-350 grams.

The growth of crumbs is approximately 24-26 millimeters.

These are the main norms and decryptions of the ultrasound 20 weeks of pregnancy for the fetus. But in addition to these measurements, the doctor will also examine all the internal organs of the fetus, for example, kidneys, liver, lung, intestines, heart, stomach, bladder, gall-bubble. This will allow early to identify possible anomalies and deviations.

Other indicators defined on the ultrasound

Not only the fruit is inspected on the ultrasound, which is held at the 20th week of pregnancy. The doctor also will evaluate the condition of umbilical cord, placenta, uterus and cervix to draw conclusions about the current course of pregnancy and childbirth. For example, ferrous water is being studied. Uzisser will rate their number and in case of deviation in one direction or another will give a diagnosis of multi-way or low. In addition, the doctor will find out whether there is no suspension in the amniotic fluid that can talk about intrauterine infection.

Also in decoding an ultrasound 20 weeks of pregnancy will have data on the state of the placenta. In particular, the place of attachment of the child's place to the uterus will be appreciated (in the case of low attachment there are risks of detachment and premature genera). In case of thinning or seals, the doctor will have to carry out additional surveys to find out whether the baby placenta provides all necessary (oxygen, nutrients).

Also, the norms of ultrasound 20 weeks include data on the state of the umbilical cord. It is measured its length, and the number of vessels is calculated. In general, there should be 3, but some women have 2, which means that over the course of such pregnancy you need to monitor especially carefully and intently. Also, perhaps the ultrasound will want to get another result of an ultrasound 20 weeks. Using a transvaginal sensor, the doctor will appreciate the state of the cervix to identify the main cause of premature births in the late launches - Eastic-cervical insufficiency.

In addition, on an ultrasound study, you can see the uterus tone, and it is dangerous, firstly, due to the threat of miscarriage, and, secondly, because of it, the fruit does not have the ability to obtain a sufficient amount of nutrients and oxygen. That is why it is so important to know the norms of ultrasound 20 weeks of pregnancy. But it is not all. This study should conduct an experienced doctor. Also for such diagnostics it is necessary to use modern and accurate equipment that will allow reliable results.

It remains only to add that an ultrasound is a mandatory planned study that every future mother should take place three times for pregnancy. After all, it allows you to assess the state of the fetus and the uterus and identify possible problems, eliminating which as early as possible, you can ensure the health of the baby.

Deciphering the indicators of the second ultrasound in 20-24 weeks

1. Fetometry
2. Piercing
3. Conclusion and recommendations

alive head cross. What should be reflected in the protocol.

Next is carried out fetometry

Cefalic index - BPD / LZR * 100% - allows you to conclude about the form of the fetus head.

Head Circle (OG)

bD.- biparity size,aC- Lobno-occipital size

diameter and abdominal circle. measured by outdoor contour. The second parameter in practice is used more often.

Next are measured. femoral, shoulder, shin and forearm. It is also necessary to study their structure to exclude a diagnosis. skeletal dysplasium reducing defects of development

Study anatomy of Futal manifest

Study brain structures extracranial (outside the skull) and intracranial hydrocephaliya - Water brain.

The next step is studied face cyclope anofthalmia

Study spine spina.bifida.

In the study lungs

Next is studied a heart

When scanning organs abdominal cavity kidneyand bladder

Study provisorial organs

Placenta

1. Localizationcomplete placenta prediction
2. Thickness table 7. .

1. Structure
2. The degree (stage) of maturity.

* chorial membrane -

** parenchyma - actually fabric placenta

*** basal layer

For rate spindle water Used. When it is determined, the uterine cavity is conditionally divided into 4 quadrant with two planes, carried out through a white lines of the abdomen (the connective tissue structure of the front abdominal wall, located on the middle line) vertically and horizontally at the navel level. Next, in each quadrant, the depth (vertical size) of the greatest pocket of amniotic fluid (oil-free waters) is determined, free from the parts of the fetus, all 4 values \u200b\u200bare summed up and output in centimeters. If the index is less than 2 cm is low, if more than 8 cm - multi-way. This is a diagnostically significant sign of the presence of infection, SZRP, malformations.

Umbilical cord

cervix podcatt (for the presence of ovarian cysts) the walls of the uterus

congenital malformations(UPR)

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Ultrasound for 20 weeks of pregnancy

20 weeks of pregnancy occurred - half of the term. This is the easiest and most prosperous period. In the second trimester, a woman ceases to torment toxicosis, dizziness and headaches pass. The tummy begins to grow noticeably, while the future mother does not feel awkward. She moves freely, can walk a lot and engage exercise For pregnant women.

At the same time, the formation of internal organs and kid systems is ends. He can already hear, to see, suck his finger and actively move. Future mommy managed to love her baby and listens to each of his movement.

In the second trimester, the placenta has already been fully formed and can fully fulfill its protective functions, supplying oxygen and nutrition to the child.

To determine the course of pregnancy in the current trimester, the doctor prescribes the surrender of mandatory analyzes, including the second planned ultrasound study.

Pregnancy 20 weeks: ultrasound

Thanks to modern equipment, an ultrasound specialist at the 20th week of pregnancy can already be considered in the smallest detail multidimensional image of the fetus, his heart, kidney, evaluate the development of the brain, spine, and even the structures of the person, and also determine the sex of the child.

In addition, the doctor makes frozen the growth of the baby, the circle of the head and the tummy, the length of the femoral bone. According to the results of the data obtained, the weight of the child is calculated.

During the study, the doctor maximally establishes the term of pregnancy and the estimated date of delivery.

It should be noted that the second planned ultrasound makes it possible to see many chromosomal markers characteristic of Down syndrome. If only a few markers of chromosomal deviations are available in the first trimester, then in the second, their number reaches 22.

It is impossible to ignore this examination. During pregnancy, 20 weeks of ultrasound is the most informative in the diagnosis of the child's development, the state of the cervix, placenta, spindlewater waters and the tone of the uterus.

A specialist thoroughly explores the placenta and evaluates its condition. According to the results of the research, it is a forecast for whether it can protect against infections from infections until the fetus and to ensure the fruit of nutrients and oxygen. When the placenta is sealing or thinning, as well as during its premature aging, blood flow can be broken. In such cases, an additional examination and maintenance of the fetal life is appointed in stationary conditions.

The doctor also draws attention to the placenta attachments, measures the cervix and explore the umbilical cord.

If the ultrasound of the 19th week of pregnancy has normal indicators, then the next scheduled survey is appointed at 32 weeks.

Ultrasound at 20 weeks of pregnancy: decoding

For any examination, a scale determining the norm is characterized. What are the normal fetal performance at the 20th week of development? We give the main parameters of the normal development of the baby:

• Distance from one temple to another (bipartive size) - 45-53 mm;
• Lobno-occipital size - 56-68 mm;
• Head Circle - 154-186 mm;
• Abdominal circle - 137-167 mm;
• The thigh length is 26-38 mm;
• Shin length - 23-33 mm;
• Shoulder length - 26-36 mm;
• Forearm length - 23-29 mm;
• Copchiko-dark size - 15-16 mm;
• The growth of crumbs is 24-26 mm;
• The weight of the fetus - 280-350 gr.

The specialist is also very closely studying ultrasound indicators at the 20th week of pregnancy relating to the state of the placenta. The boundaries of the norm:

• The optimal thickness is 22 mm, but it can have normal deviations from 16.7 to 28.6 mm;
• Structure - 0 degrees of maturity;
• The accompaniment of accumulating waters is 86-230 mm. Multiple pregnancy It assumes a larger amount of fluid.

The doctor measures the length of the umbilical. It usually reaches 50-70 cm, which allows the crumb to move freely in the uterine cavity. Pupil thickness - about 2 cm. The volume of circulating blood is 35 ml / min. Pupovina in this period should have three blood vessels, but some women have only two. In this case, the doctor is particularly accurately monitored for the state of the fetus and the future mother.

The specialist necessarily explores the tone of the uterus - it is dangerous. If the uterus is in a tone, then there is a threat of miscarriage. In addition, for this reason, the infant does not receive a sufficient amount of oxygen and nutrients.

As can be seen from the foregoing, it is impossible to overestimate the need for an ultrasound. Each woman, responsibly, and with love relating to his position, should undergo all necessary surveys on time.

The diagnostic procedure, including ultrasound research, should conduct and decipher only an experienced specialist. To obtain reliable results, it is necessary to use modern and accurate equipment.

It remains only to add that the ultrasound will help to identify the slightest pathologies, which, with timely elimination, will not harm the future mom and her child.

Text: Natalia Novgorodtseva

Sources:

• the main
• Surveys
• Decoding

To determine the anatomical and functional state of the fetus during pregnancy, there are a number of methods, the most common of which is ultrasonic. It is informative enough, allows you to cover a large number of Women and, which is very important, is safe.

In order to identify malformations and diseases are carried out ultrasonic Screening Study (Universal express examination, covering more than 85% of pregnant women). It allows you to make decisions about the further tactics of making each pregnancy, as well as to allocate pregnant women relating to the risk group on the development of various complications for the fetus and mother.

Ultrasound procedure (Ultrasound ) most appropriate to carry out in the following screening timing Pregnancy:

1. 10-14 weeks
2. 20-24 weeks
3. 32-34 weeks

Decryption of the first ultrasound of 10-14 weeks

Ultrasound on 10-14 weeks allows you to identify some rough fetal patterns (for example, anencephaliya - a complete or partial absence of large hemispheres of the brain, bones of the skull and soft tissue bones), as well as form a risk group on chromosomal fruit pathology based on measuring the thickness of the collar space, which can be correctly evaluated on this period of pregnancy.

InformationIf you are classified a pregnant woman in the risk group, it is further proposed to pass a more detailed study, for example, such as prenatal karyotyping, that is, the study of the chromosomal set of the fetus.

Typical Ultrasound Protocol in 10-14 weeks of pregnancy is presented in Table 1.

From first day of the last menstruation The term of pregnancy for each specific point in time is calculated, its satisfaction is determined by the deadline based on ultrasound data. This indicator is used due to the fact that we do not know the exact moment of fertilization of the egg cell sperm and the beginning of the development of the embryo.

Based on the period of pregnancy established by the combination of the above data, the estimated date of delivery is necessarily exhibited, which corresponds to 40 weeks of pregnancy. If there are two and more fruits, each is studied separately.

When conducting an ultrasound, 2 methods are used: transabdomomominal(research through the front abdominal wall) and transvaginal (Study through the vagina), which is also necessarily noted in the protocol.

To determine the term of pregnancy and conformity to the deadline for the first day of the last menstruation, this indicator is used as copchiko-rash fetus size (Ktr ) - Maximum distance from the head to the tailbone. The measurement is carried out in the sagittal embryo scanning (the sagittal axis from the Latin "Sagitta" - an arrow, that is, it is directed in front of the back, and the plane passing through the sagittal axis divides the body of the person into two symmetrical halves). When the fetus moves, the CTR measurement is carried out at the time of the maximum extension. Regulatory indicators of the smoke-darkness of the embryo / fetus depending on the period of pregnancy are shown in Table 2.

*Percentile - This is the concept of medical statistics. To determine it takes a large sample from the population, which is examined on a specific basis. Next, the averages are selected from all values, which are 50th percentiles, and all that lies between the 5th to the 95th, it is assumed for the norm. Accordingly, the values \u200b\u200bbelow 5th and above the 95th percentile require further upwards.

Another one of the indicators under study under the ultrasound is frequency Frequency Frequency (CSS). The change in the heart rate can indirectly indicate a chromosomal pathology, but on an early period there is usually a large diagnostic value. This indicator is more important in the late period of pregnancy, when the intrauterine suffering of the fetus can be determined on the basis of CCC changes. The regulatory indicators of the Fetal CCS depending on the period of pregnancy are shown in Table 3.

One of the most important moments that are defined in the ultrasound of 10-14 weeks, is the thickness of the collar space. (TVP) - The amount of fluid on the rear surface of the neck neck. To determine it, there are strictly defined criteria:

1. The term of pregnancy from 10 weeks to 13 weeks is 6 days, since in an earlier period, this indicator is technically difficult. After 14 weeks, the lymphatic system of the child copes with excess fluid, so the definition of a TVP ceases to be informative.
2. The fetus CRT must lie in the range from 45 to 84 mm.
3. The study is carried out in the sagittal scanning of the fetus.

An increase in this indicator indirectly indicates the possibility of presence of Down syndrome (trisomy of 21 chromosome - that is, instead of 46 chromosomes normally, the child has 47 chromosomes), which requires a more serious examination (prenatal karyotyping) to confirm or exclude a diagnosis. Regulatory indicators of the thickness of the collar space of the embryo / fetus depending on the period of pregnancy are presented in Table 4.

With an ultrasound of 10-14 weeks, such anatomical structures of the embryo / fetus are investigated: the bones of the skull of the skull, the "butterfly" (ultrasonic picture of the brain structure), spine, stomach, front abdominal wall (for the presence of intrauterine hernia), urinary bubble, bones of the limbs. But on this period, it is not always possible to exclude malformations, so when detecting deviations, they are recorded in the graph of special marks, and then, together with an obstetrician-gynecologist, and, if necessary, the decision makes the need for a more in-depth examination.

When carrying out ultrasound research, such extragracial organs as a gusty bag and chorion are also investigated. Yellow bag - this is provisory (existing temporary) authority that exists up to 12 weeks of pregnancy is necessary for early Development Embryos, after 12 weeks ceases to exist, decreases in size and remains at the base of the umbilical cord. Its size (internal diameter) is important when making a diagnosis of undivided pregnancy.

Chorion. - The outer-coated germinal shell, which, together with the wall of the uterus, further forms a placenta, thanks to which the fruit is powered during pregnancy. Its localization gives an idea of \u200b\u200bthe further localization of the placenta (which you need to know to determine the tactics of pregnancy), and the change in thickness may indicate the presence of intrauterine infection of the embryo / fetus, reserves-conflict, as well as the fetal disorders, although this indicator is also more informative in Late time of pregnancy.

In addition, when conducting the first screening ultrasound, the peculiarities of the uterus structure are noted (for example, a counya uterus, doubling the uterus, a saddot uterus) and its appendages (first of all, the presence of ovarian cysts). These indicators are also important for determining the further tactics of pregnancy.

If there is a need, the ultrasound diagnostician notes the date of re-ultrasound control in the protocol.

Deciphering the indicators of the second ultrasound in 20-24 weeks

Term of pregnancy 20-24 weeks optimal to study the anatomical structures of the fetus. Detection on this period of malformations determines the further tactics of pregnancy, and with rough vice, incompatible with life, allows you to interrupt pregnancy. The standard ultrasonic study protocol in 20-24 weeks is presented in Table 5.

The structure of the Ultrasound Protocol can be divided into the following main groups:

1. Information about the patient (name, age, beginning of the last menstruation)
2. Fetometry (measuring the main size of the fetus)
3. Anatomy of the fetus (organs and systems)
4. Piercing organs (existing temporary, such as placenta, umbilical umbilical water)
5. Conclusion and recommendations

In this protocol, as with an ultrasound of 10-14 weeks, the first day of the last menstruation is indicated, relative to which the term of pregnancy is calculated. Also marked the amount of fruits and the fact that the fruit is alive (This is determined by the presence of heartbeat and movement of the fetus). If there are two and more fruits, each is studied and described separately. It is necessarily indicated by the prevention of the fetus (the ratio of the large part of the fetus to the entrance to the pelvis). It can be head (Fruit will take off his head) and pelvis (the buttocks and / or legs will be preserved). The fruit can be located crossWhat should be reflected in the protocol.

Next is carried out fetometry - measurement of the basic dimensions of the fetus, among which are determined by: the biparic size of the head, its circle and the frontal-occipital size, the circumference of the abdomen, the length of the tubular bones on the left and right (femoral, shoulder, leg bones and forearm). The set of these parameters allows you to judge the growth rates of the fetus and the compliance of the pregnancy period allegedly for menstruation.

Biparity Fruit Head Size (BPD) Measured OT. outdoor surface Upper contour to the inner surface of the lower contour of the dark bones (Figure 1, BD line).

Lobno-occipital size (LZR)- the distance between the outer contours of the frontal and occipient bones (Figure 1, line AC).

Cefalic index - BPD / LZR * 100% - allows you to conclude about the form of the fetus head.

Head Circle (OG) - The length of the circle along the outer contour.

The measurement of the sizes of the head is carried out with strictly transverse ultrasonic scanning at the level of certain anatomical structures of the brain (cavity of the transparent partition, brain legs and visual bugs), as shown in the right side of Figure 1.

Figure 1 - Size measurement of the fetus head sizes

1 - the cavity of the transparent partition, 2 - visual bumps and legs of the brain,bD. - biparity size,aC - Lobno-occipital size

The dimensions of the abdomen are measured when scanning in a plane perpendicular to the spinal column. This determines two sizes - Diameter and abdominal circle, measured by outdoor contour. The second parameter in practice is used more often.

Next are measured length tubular bones of limbs: femoral, shoulder, shin and forearm. It is also necessary to study their structure to exclude a diagnosis. skeletal dysplasium (due to genetically, the pathology of bone and cartilage tissue, leading to serious impairment of growth and ripening of the skeleton and affecting the functioning of internal organs). Study of the bones of the limbs is carried out on both sides to not miss reducing defects of development (That is, underdevelopment or absence of parts of the limbs with one or both of both sides). The percentage values \u200b\u200bof fetometric indicators are shown in Table 6.

Study anatomy of Futal - One of the most important components of an ultrasound study in 20-24 weeks. This time manifest (Show yourself) Many malformations of development. The study of the anatomical structures of the fetus is carried out in the following order: head, face, spine, lungs, heart, abdominal organs, kidney and bladder, limbs.

Study brain structures Began even when measuring the sizes of the head, because with attentive consideration, the doctor can determine the integrity of the bone structure, the presence extracranial (outside the skull) and intracranial (intracranial) formations. A study of large hemispheres of the brain, side ventricles, cerebellum, a large tank, visual bugs and cavities of a transparent partition. The width of the side ventricles and the front seat size of a large tank - normally does not exceed 10 mm. An increase in this indicator indicates a violation of outflow or fluid production and appearance hydrocephaliya - Water brain.

The next step is studied face- The profile, society, the nasolabic triangle is estimated, which allows you to identify anatomical defects (for example, the "protrusion" of the upper jaw with a bilateral or median cleft of the face), as well as the presence of markers of chromosomal anomalies (reducing the length of the nose bones, smoothed profile). When studying the eyewit, you can define a number of rough defects, for example, cyclope (Eyeballs are completely or partially fascinated and are in the middle of the face in one eyeball), neoplasms, anofthalmia (underdevelopment of the eyeball). The study of the nasolabial triangle primarily reveals the presence of cleft lips and sky.

Study spine All through the longitudinal and transverse scanning - allows you to identify hernias, including spina.bifida. - Spinal splitting, often combined with spinal cord definitions.

In the study lungs Their structure is studied (it is possible to determine the presence of cystic formations), the size, the presence of free fluid in the pleural (thoracic) cavity, the neoplasm.

Next is studied a heart For the presence of four chambers (in the normal, the heart consists of 2 atrial and 2 ventricles), integrity of interventricular and interpresenting partitions, valves between ventricular and atriality, as well as the presence and correct removal / lifting of large vessels (aorta, pulmonary trunk, upper vein) . Another heart is still evaluated, its sizes, changes in the heart bag (pericardium).

When scanning organs abdominal cavity - Stomach and intestines - their presence, location, dimensions, which makes it indirectly to judge and other abdominal organs. In addition, the increase or decrease in the size of the abdomen during fetometry indicates the presence of pathology (for example, watering, hernia, hepato and splenomegaly - an increase in liver and spleen). The following are investigated kidney and bladder For their presence, shape, size, localization, structure.

Study provisorial organs Allows indirectly to judge the state of the fetus, defects, intrauterine infections and other states requiring correction.

Placenta It is studied in the following parameters:

1. Localization. The ultrasound diagnosis doctor necessarily reflects the localization of the placenta, especially its position relative to the inner zea of \u200b\u200bthe cervix. Since with the wrong attachment of the placenta, for example, when it completely overlaps the inner zev ( complete placenta prediction), it is accompanied by bleeding during pregnancy, and childbirth through natural generic paths impossible. At the location of the lower edge of the placenta is lower than 7 cm from the inner state, the ultrasound control of 27-28 weeks is required.
2. Thickness. The placenta is a dynamically developing fetal provisional organ, so during pregnancy its thickness increases on average from 10 to 36 mm, although these values \u200b\u200bvary in a sufficiently large range, which is presented in table 7..

After 36 weeks, the placenta thickness usually decreases. The inconsistency of this parameter to the regulatory values \u200b\u200bshould be alerted primarily relative to the presence of an intrauterine infectious process, the conflict in the rhesus factor, as well as non-compliance with the fetus of nutrients and its needs.

1. Structure. Normally, it is homogeneous, it should not be inclusions. Inclusion may indicate the premature aging of the placenta (which can cause a delay in the development of the fetus), heterogeneity indicates the possible availability of infection.
2. The degree (stage) of maturity. The placenta changes its structure unevenly, most often this process comes from the periphery to the center. With the uncomplicated course of pregnancy, the changes pass from 0 to III sequentially (0 - to 30 weeks, I - 27-36, II - 34-39, III - after 36 weeks). This indicator allows you to predict a complicated course of pregnancy, availability fetal Development Syndrome (SZRP). Currently, premature maturation of the placenta is considered the presence of II degree up to 32 and III degree up to 36 weeks. Ultrasonic assessment of the structure of the placenta is shown in Table 8.

* chorial membrane - layer with vile fapels

** parenchyma - actually fabric placenta

*** basal layer - outer surface, which placenta is adjacent to the wall of the uterus

For rate spindle water Used amniotic fluid index. When it is determined, the uterine cavity is conditionally divided into 4 quadrant with two planes, carried out through a white lines of the abdomen (the connective tissue structure of the front abdominal wall, located on the middle line) vertically and horizontally at the navel level. Next, in each quadrant, the depth (vertical size) of the greatest pocket of amniotic fluid (oil-free waters) is determined, free from the parts of the fetus, all 4 values \u200b\u200bare summed up and output in centimeters. If the index is less than 2 cm is malovodieif more than 8 cm - multi-way. This is a diagnostically significant sign of the presence of infection, SZRP, malformations. Indicators of the index of amniotic fluid in different times of pregnancy are presented in Table 9.

Umbilical cord (A provisional body that connects the embryo / fruit with their motherhood) in the norm contains 3 major vessels: one vein and two artery. With many hereditary pathologies, there is only one umbilical artery, which requires more careful pregnancy.

Also mandatory research cervix (on the subject of its length, which is important in the presence of a threat of pregnancy interruption), podcatt (for the presence of ovarian cysts) the walls of the uterus (If a caesarean section was in history, the state of the scar) is estimated).

Based on the Uz-research conducted in the second trimester of pregnancy, it is concluded that congenital malformations (UPR) Fetal or some other pathology and recommendations are given.

Ultrasound indicators in the third trimester

Third ultrasound in 32-34 weeks It is necessary to identify the defects of the development, which are manifested only in the later periods of pregnancy (for example , aneurysm Vienna Galen - violation of the structure of the vascular wall of a large brain vessel). It allows you to evaluate the functional speech, to diagnose Development Delay Syndrome (SZRP)What makes it possible to carry out a complex of necessary medical events, identify readings for timely and careful delivery. The presence of SZRP requires compulsory control after 7-10 days amid active therapy.

An important point is pREFERENCE OF PERVA (Head or pelvic), which significantly affects the method of delivery. Also mandatory definition estimated mass of the fruitWhat should be taken into account in the tactics of further pregnancy and especially childbirth.

To assess the state of the fetus in the 3th trimester, the definition can be used biophysical profile of the fetus during the ultrasound (Table 10).

When evaluating tabular parameters, the amount of points is determined, on the basis of which the conclusion is made on the state of the fetus:

• 12-8 - norm;
• 7-6 - doubtful state of the fetus, the possible development of complications;
• less than 5. - pronounced intrauterine hypoxia (insufficiency of oxygen admission to the fruit, leading to different degrees of violations of its livelihood) with high risk perinatal losses (Loss of the fetus in the period from 22 weeks of pregnancy up to 168 hours after birth).

Ultrasound examination in screening time allows you to identify a large number of pathologies and make preventive measures to maximize them eliminate in the intrauterine period, and if it is impossible to eliminate the effects.

• Varieties
• The reasons
• Diagnosis and timing
• At-risk groups
• Forecasts

Pregnancy - joyful and at the same time anxious waiting for the sacrament of nature, which is about to happen. On the entire path of intrauterine development of the baby, the mother listens to each of its movement, with trepidation waiting for the results of all the analyzes and the results of any studies. Everyone wants to hear from doctors the same phrase: "Your child is healthy." But it happens not always.

There are various pathology of the fetus that are diagnosed on different timing Pregnancy and make parents make a serious decision - a crumb to light will appear or not. Painful deviations from the normal development process may be congenital and acquired.

Varieties

Since the causes of pathologies in the fetus may be due to genetics or external factors, congenital and acquired deviations differ. The first are present from the very moment of conception and are diagnosed most often on early timingWhile the second may appear at the child and be detected by doctors at any stage of pregnancy.

Congenital

Congenital, genetic pathologies of the fetus in medicine are called trisomes. This is a deviation from the normal chromosome of a child, which appears in the earlieges of its intrauterine formation.

Pathologies caused by the wrong number of chromosomes:

• down syndrome - problems with the 21st chromosome; Signs - dementia, specific appearance, growth delay;
• patau syndrome - disorders with the 13th chromosome; manifestations - multiple defects, idiots, multiply, problems with genital organs, deafness; Sick children rarely live up to 1 year;
• edwards Syndrome - the pathology of the 18th chromosome; Symptoms - small lower jaw and mouth, narrow and short eye slots, deformed ear sinks; 60% of children do not live up to 3 months, only 10% reach up to 1 year.

Diseases dictated by the wrong genital chromosome:

• sherezhevsky-Turnner syndrome - the lack of a girl X-chromosome; Signs - lowerness, infertility, sexual infantilism, somatic violations;
• polisomy in the X chromosome manifests itself a minor reduction in intelligence, psychosis and schizophrenia;
• polisomy on Y-chromosome, symptoms are similar to the previous pathology;
• syndrome Klinfelter is striking boys, signs - on the body weakened hair growth, infertility, sexual infantilism; In most cases, mental retardation.

Pathology, the cause of which is polyploidy (the same number of chromosomes in the nucleus):

• triploidy;
• tetraploidy;
• the reason is the genes of the fetus;
• fucking before birth.

If the reasons for the pathology of the fetus during pregnancy are genetic nature, they can already be corrected, such diseases are incurable. The child will have to live with them all his life, and parents will have to sacrifice many to grow it. Of course, among patients with Down syndrome, for example, talented, even gifted people, famous for the whole world, should be understood that these are units, happy exceptions from the rules.

Acquired

It also happens that the embryo can be absolutely healthy genetically, but acquires deviations in the process of its uterine development under the influence of various disadvantaged factors. These may be the disease of the mother, which it transferred during pregnancy, a bad environmental situation, the wrong lifestyle, etc.

The acquired pathology of the fetus during pregnancy can affect the most different organs and systems. Among the most common can be noted as follows:

• deformation or absence (full, partial) internal organs (most often suffers from the brain) or parts of the body (limbs, for example);
• anatomical defects of the facial skeleton;
• heart defects;
• the incoming of the spinal channel;
• brain hypovozbudility (perinatal) manifests itself after the birth of a baby in the form of a low tone of muscles, lethargy, drowsiness, unwillingness to suck the chest, lack of crying, but such pathology is amenable to treatment;
• brain hyperoportability (perinatal) is also successfully treated, symptoms - strong tensions, chin trembling, long crying, cry;
• hypertensional hydrocephalic syndrome is characterized by an increased head volume, drinking spring, imbalances between the facial and brain shares of the skull, delays in development.

In a special group, deviations from normal intrauterine development can also be distinguished, the reasons for which it is very difficult to determine. So the nature ordered, and nothing can be done about it. These include:

• the pathology of the fetus of the fetus at different stages of pregnancy: it can be too long or very short, the loss of its loops, knots, anomalous attachment, thrombosis and cysts - all this can lead to hypoxia and the death of a child;
• multipleness (including Siamese twins);
• much and lowland;
• placenta pathology: hyperplasia (its too big weight) and hypoplasia (if its mass is less than 400 gr), heart attack, chorioangoma, trophoblastic disease, placental insufficiency;
• improper presence of the fetus Some doctors are also called pathology.

Each of these deviations requires a special relationship from doctors and parents to the tonted child, marginal care, and most importantly - conservation of calm. In order not to hear a disappointing diagnosis from the doctor, you need to try to exclude all the factors from your life that can cause acquired the pathologies of the fetus. This is in the forces of every woman waiting for a child.

Stars with Down syndrome. People with Down syndrome can be gifted. Among celebrities with such a congenital pathology - artist Raymond Hu, Maria Langovaya swimming champion, lawyer Paula Sazh, actors Pascal Düken and Max Lewis, musician and composer Ronald Jenkins.

The reasons

Prevention of fruit pathologies implies an exception to the young mother of those factors that can provoke the development of intrauterine deviations. The most common reasons for such diseases include the following.

Heredity

If you know about the presence of genetic abnormalities in you, before conception, you must pass a number of surveys and analyzes.

Unfavorable environmental conditions

Mom's work at a chemical plant, in a laboratory with toxic substances, accommodation near large industrial enterprises or radiation zone can lead to irreversible consequences.

Wrong lifestyle

The external deformities of newborns are very often due to smoking, alcoholism, drug addict, insufficiency or poor mother's nutrition during pregnancy.

Diseases

Viral and bacterial diseases can turn into a kid with the most dangerous pathologies:

• the flu is up to 12 weeks either by miscarriage, or the child will be completely healthy;
• flu after 12 weeks can lead to hydrocephalus and placenta pathologies;
• rubella is fraught with deafness, blindness, glaucoma and damage to the bone fetus system;
• toxoplasmosis transmitted through cats provokes the development of microcephaly, meningoencephalitis, brain water, eye damage and CNS;
• hepatitis B: It is dangerous in intrauterine infection of the fetus by this virus, as a result, 40% of children can be cured, but 40% die under the age of 2 years;
• cytomegaly can pass the baby in the womb, and it risks born blind, deaf, with cirrhosis of the liver, intestinal lesion and kidney, encephalopathy.

Venestic diseases are no less dangerous for the fetal intrauterine development:

• herpes can pass the child and cause such pathologies as microcephalus, hypotrophy, blindness;
• at the infected syphilis of the fetus there is a specific rash, the defeat of the bone system, liver, kidneys, CNS;
• gonorrhea leads to eye diseases, conjunctivitis, generalized infection (sepsis), amnionit or chorioamnionitis.

To avoid such hazardous consequences for the life and health of not yet born baby, parents must do everything possible to eliminate the above reasons. Get away from the harmful work, move away from the industrial zone, quit smoking and drinking, full-fed, avoid disease and heal them at the very first symptoms. You can learn about the pathology of the fetus already in 12 weeks when the first examination is made for its presence.

Multi-speaking statistics. With alcoholism of mothers, toxicosis is found in 26%, intrauterine death The child is 12%, miscarriages - in 22%, heavy labor - in 10%, premature children - at 34%, generic injuries - 8%, asphyxia - 12%, weakened newborns - in 19%.

Diagnosis and timing

Prenatal diagnosis of deviations in the development of the fetus is a complex and capacious process. One of the most important stages is the screening of the fruit pathology, which is a complex of surveys appointed by pregnant women at 12, 20 and 30 weeks. As a rule, it is a study of blood for the presence of biochemical serum markers of chromosomal disorders. Usually, the fetal check on pathology includes the following activities.

Blood tests

I Trimester (Double Test):

• free β-subunit (its concentration) hgch;
• PAPP-A: Plasma protein A.

II trimester (triple test on the pathology of the fetus):

• it is detected or a common hCG, or, as in the first trimester, a free β-subunit of hCG;
• α-fetoprotein (AFP protein);
• free estrill (unconjugated).

A mandatory addition to blood tests is an ultrasound. The results of the results are always comprehensive. However, the blood test on the pathology of the fetus is associated with an ultrasound, even with an ultrasound, cannot give 100% guarantees, therefore invasive diagnostic methods are carried out: chorion abion and cordocentsis.

HorionBiopsy

This is obtaining chorion tissue to identify and prevent chromosomal diseases, the carriage of chromosomal anomalies and monogenic diseases. It is performed in the form of puncture of the uterus, which can be carried out through the abdominal wall, vagina or neck of the uterus with special tongs or aspiration catheter.

Those parents who want to know how to determine the pathology of the fetus in the early periods can take advantage of this analysis, since its main advantage is to perform diagnostics already on 9-12 weeks, as well as the rapid obtaining results (2-3 days). Indications for conducting:

• age older than 35 years;
• the presence of a child with angrin (congenital malformation), monogenic, chromosomal diseases;
• heredity of chromosomal anomaly, gene mutation;
• in 10-14 weeks of pregnancy, according to the echography, the thickness of the collar space is more than 3 mm.

This analysis on the pathology of the fetus is quite painful and can provoke bleeding, but with experienced medical personnel everything passes without complications.

Cordocentsis

This is a method for producing a cord (cord) blood child for research. It is usually carried out parallel to the amniocentsis (the analysis of spindle water). It is possible not earlier than 18 weeks.

Under infiltration anesthesia through the abdominal front wall, they make a puncture with a needle and pump out the required amount of blood from the vessel. Such a fruit survey on pathology can identify chromosomal and hereditary diseases, reserves-conflict, hemolytic disease.

Read more about the method here.

Ultrasound

One of the most faithful and reliable diagnostics is an ultrasound study. Many parents worries which pathology of the fetus can be revealed during pregnancy on the ultrasound, and which they can remain, as they say, "behind the scenes".

Uzi for 12 week reveals:

• vices of the CNS (anencephaliya);
• the absence of a peritoneal front wall (gastrossisis);
• the pathology of the spine in the fetus;
• umbilical hernia (ommopalcela);
• lack of limbs;
• down syndrome.

At 20 week, almost all visible fruit pathology on ultrasound can be diagnosed. This is explained by the fact that most of the internal organs and the kid systems are already well formed.

At 30, the ultrasound study can only confirm or disprove the data obtained by other methods (using blood, cordo-beacter, chorion abion).

Now - about what kind of fruit pathology does not reveal ultrasound:

• blindness;
• mental retardation;
• deafness;
• small malformations of the organs of the fetus - obstruction of liver ducts, defects of cardiac partitions;
• genetic diseases: Myopathy Duceda, fibrosis, phenylketonuria;
• chromosomal fruit pathology - Edwards Syndrome, Patau, Turner.

However, the last group of these deviations does not elude nevertheless from doctors, as they helps to identify blood test for the pathology of the fetus and other methods of diagnosis.

A young mother can not feel any symptoms that something is wrong with her baby. Only a complex of diagnostic events at different stages of pregnancy can identify deviations. Thus, the signs of the pathology of the fetus in the early periods detected by the ultrasound should be visually noticeable. These are external deviations in its development: the shape of the skull, the size ratio, the features of the skin folds, etc.

Unfortunately, there are cases when a child is born with pathologies, not detected prenatal. This happens either due to the inexperience and non-professionalism of medical personnel, or due to malfunction or ultra-solidity of ultrasound equipment.

Facts. Thanks to the ultrasound, up to 80% of congenital pathologies in the fetus are revealed, of which in 40% of cases of pregnancy are interrupted due to heavy, resulting in disabilities or incompatible vices.

At-risk groups

There is a group of women who fall under the closest attention of genetics, as the risk of developing deviations is very large. They necessarily take the blood to the pathology of the fetus and the remaining diagnostic events at different stages of pregnancy are held. These are the following cases:

• age older than 35 years;
• if the family already has a child with pathology;
• previous miscarriages, stillbirth, frozen pregnancy;
• heredity (if one of the parents - Down syndrome);
• prolonged reception of strong medicines during pregnancy;
• the impact of radiation on the mother's body.

If a woman falls into a risk group, she has a detailed consultation, how to find out whether there are pathology from the fetus, and appoint all the necessary activities for this. The main goal of such screenings is to find out whether it is possible to help the child and leave such a pregnancy before the delivery.

ATTENTION: RADIATION! If a young mother was irradiated with radiation, she needs to be informed about this to the doctor, since it is for this reason that children are most often born with irreversible and non-external deformities.

Forecasts

Further development of events depends largely on what time the pathology of the fetus is detected (the better the better) and which deviation was diagnosed. The doctor can only advise, but the decision is made by the parents themselves.

If the genetic mutation is strong and attracts the inevitable death of the child (intrauterine or in the first year of life), the abortion is proposed. If external deformities are small, modern plastic surgery It works wonders, and the child in the future can look just like the rest of the kids. Each case is too individual and unique, so requires a special approach.

If the pathology of the fetus development pathologies have been identified, parents need to be primarily listening to the opinion of doctors. If the deviations are too serious and make the life of the baby in the future unbearable and at the same time the young couple has every chance to conceive a healthy child next time, doctors offer interruption of pregnancy. Each case is unique and requires an individual approach.

The correct decision can be taken by weighing everything "for" and "against". It is impossible to panic or despair: it will only aggravate the situation. Modern medicine creates miracles, and it is necessary to fully rely on this case on the professional opinion of an experienced, who knows the doctor's sense. New articles We are in social networks

source: www.vse-pro-detey.ru.

Uz-diagnosis for pregnant women spend three times. But if there is a need, the doctor may assign an additional study to confirm or exclude a diagnosis.

On each of planned ultrasound Doctor looks like a fruit. Does the head, legs, hands, belly, the nose of this development stage, on which the baby is located. At the later dates, the doctor reveals what bodies are developed correctly: the heart, stomach, liver, etc.

Ultrasound up to 12 weeks

Ultrasound of pregnancy on early term

Sometimes they do ultrasound up to 12 weeks. This is shown in the following cases:

• Haded obstetric and gynecological history. That is, if in the past there were cases of miscarriage, mischief of pregnancy, suspected of "frossable" pregnancy, etc.
• Complications during the current pregnancy (bleeding, acute abdominal pain)
• Pregnancy that came after Eco
• If during the previous pregnancy, the pathologies of the fetus were identified (Down syndrome or other trisomy, hydrocephalus, etc.).

Also up to 12 weeks of ultrasound can make women with suspicion of hematoma. The hematoma occurs when exposed to harmful factors for a pregnant uterus (infections, prestal). Hematoma happens:

• Retrochorial.
• Retroplated.

These hematomas differ only by the moment of their formation. If the hematoma was formed still without an formed placenta, then it is called retrohorial.

In the early period of pregnancy, the little hematoma, as a rule, does not cause abdominal pain and is detected on the ultrasound. But it happens that in the early periods of the hematoma of large sizes, it is dangerous interruption of pregnancy. In the late period of hematoma, negatively affects the fruit - leads to hypoxia, reducing the fetus in size. Early detection and not large hematoma sizes will help cure and give birth to a healthy duddy child. Treatment of hematoma, basically, requires room facilities.

What can be revealed in the first trimester?

During the first ultrasound, it is possible to determine the risk of Dauna syndrome and some other chromosomal pathologies. The most important thing is that the fruit is a definite size. It is measured by the CTR (Copshuxy-Dark Size), it must be at least 45 mm, but not more than 84 mm. If the fruit is too small or vice versa large, it will be impossible to interpret such an indicator as the thickness of the collar space or zone (TVP). On screening of the first trimester, you can identify some chromosomal diseases of the fetus

The thickness of the collar zone is the thickness of all tissues in the neck area. Normally, this indicator does not exceed 2.7 mm, and the average value is 1.6 mm. If the size of the collar zone is greater than 3 mm, then the likelihood of the presence of Down syndrome in the fetus is very large. Of course, one indicator does not give the right to expose such a serious diagnosis. A pregnant woman shows a number of surveys, including a biochemical study of blood, amniocentesis. Important in confirmation of the presence of Dauna's disease in the fetus has a pregnant age. If a woman over 35 years old, then the risk of the child's birth with Down syndrome significantly increases.

When suspicion of Down syndrome, the fetus is carried out an additional measurement of the brain structures (if the thickness of the collar zone is normal, then these measurements may not be produced). The cerebellum during the Daun disease is reduced in size, as well as the frontal share. Also, with this ultrasound syndrome, it reveals shortening the front and thalamic distance.

The nose in the Down syndrome is compiled and shortened, also the bone above the nose has a saddream shape. This is due to the development of nose bones. With this pathology, the nose is shown with some slowdown, in connection with this, at first ultrasound, the Sonolog may simply not see the nose. Of course, with further development, the nose appears, but it decreases in size and is somewhat deformed.

In fetometry on the period of 12 weeks, the dimension of the sizes of individual organs and parts of the body is included. Head size (biparity size) is 21 mm, the thigh length is approximately 8 mm. In addition, the circumference of the abdomen and the head, the length of the shoulder.

Suspections for the vices, which found on ultrasound in 12 weeks, not in all cases confirmed with further examination. But if on this period there were suspicions for the presence of Down syndrome, then at the following ultrasound, the doctor will be more detailed and intently examine the parameters of the fetus.

Second planned ultrasound

Screening of the second trimester of pregnancy

It is carried out on the period of 20-22 weeks of pregnancy. By this period of the structure of the child are developed and visible is much better. You can already assess the structure of individual organs and identify their pathology. The heart of the fetus for this period is fully formed, like kidneys with lochs. The presence of heart defects with the simultaneous expansion of kidney pelvis should push the idea of \u200b\u200bthe presence of Down syndrome. At this time, an experienced doctor will notice a nasal change characteristic of Daun's disease. The nose is expanded with the bridge.

Tools for ultrasound

The toddler stomach is also more formed by this deadline and must have a cavity. Sometimes it happens that the cavity is not visualized or on the contrary, its expansion is observed. Sometimes it can only be an accident - the fruit took a certain position, a bad ultrasonic sensor, and sometimes the absence or expansion of the cavity in the stomach can talk about serious pathologies of the fetus.

To begin with, the specialist needs to make sure that there is a stomach. Because Sometimes it is possible to develop such a vice as a diaphragmal hernia, in which the stomach moves from the abdominal cavity to the chest. If the stomach is in the right place, then you need to trace his connection with the esophagus and the intestine.

With the atresia of the esophagus, the cavity of the stomach is not detected. If the problem arises in the pyloric department (the stomach department in front of the small intestine), the cavity may contain hyperheogenic inclusions and even extended. A different kind of inclusion in the stomach of the fetus should be differentiated with a tumor. Sometimes the fruit can inlet can deeply block the blood that will also be noticeably on the ultrasound. But such situations rarely lead to an increase in the cavity of the stomach, it still remains relatively small.

It is worth noting that the normal dimensions of the stomach are enough variable. As a result, the expansion of the cavity is noted, or the increase in the entire stomach is problematic. It is necessary to evaluate the abdomen's circumference and relate it to other parameters.

The small intestine in the second trimester at the fetus is also well formed. It must be approximately the same diameter and do not contain hyperheogenic inclusions. If the ultrasound is revealed to turn on high density - it may be a sign of some pathologies that will later be confirmed by the newborn. The Mekonian Ileus syndrome (hyperheogenic inclusions in the intestine) may be a sign of genetic pathology (cyanoiscidosis, Down syndrome, trisomy in 18 and 13 chromosome).

Study of the brain

Ultrasonic research of the fetal brain

With the second screening ultrasound, it is possible to evaluate the structures of the brain in more detail. By 22 weeks, the ventricles of the brain are well formed. An increase in their size is called ventriculose. Many experts initially call it hydrocephalus. But the concept of hydrocephalus includes an increase in intracranial pressure and an enlarged head size. Normally, in the transverse measurement of the side ventricles, the size must be up to 10 mm. But in different sources, the size varies somewhat.

Hydrocephalus can be suspected if the fetus revealed genetic pathologies (for example, Down syndrome). The likelihood of hydrocephalus in the fetus is also great if the mother moved some infections during pregnancy. For example, toxoplasmosis, herpes virus, rubella cause multiple fruit pathologies, including hydrocephalus

If a specialist put Ventrikomegaly on the second planned ultrasound, then 30 weeks can talk about hydrocephalus.

Also on the second ultrasound, the doctor can see the face of the fetus. In this period, it is fully formed - nose and lips resemble those in newborns. In the presence of clefts between the nose and the lip, the doctor also looks like it. Clevers can be on one side of the nose or on both. Sometimes such a vice is combined with the elbow of the upper heaven. Other nose pathologies for ultrasound are not visible in this period.

Ultrasound at 30 weeks

On the third planned ultrasound, it is possible to confirm or eliminating previously issued diagnoses. So, for example, you can trace the entire travelers to the rectum. Sometimes, the contents of the colon contains hyperheogenic inclusions - this is a variant of the norm. The lumen of the small intestine is small in relation to the colon.

The head should not be greater than the norm, otherwise it will be evidence of hydrocephalus. Of course, one size of the head for the diagnosis of hydrocephalus is not enough, ventricles should still be increased. And if the outer hydrocephalus developed, the subarachnoid space increases.

Diagnosis of hypoxia

With the normal course of pregnancy, the ultrasound of 30 weeks is the last before childbirth. The third ultrasound is often carried out using Doppler. It is necessary to assess the blood flow in the placenta and reveal hypoxia.

In addition to the Dopplerometry in the detection of hypoxia, the general picture will help on the ultrasound - the fruit is small and actively moving. The CTG analysis is also important for diagnosing hypoxia. With oxygen starvation, the heart of the child beats too slowly (in motion up to 130 shots, alone until 110).

In hypoxia, the child is trying to find a place and moves too intensively, which can lead to a cord.

What is dangerous crucible cord?

Quite often on this ultrasound, the doctor reveals a cordial cord around the head, or rather the neck of the fetus. In some cases, by the time of birth, the kid moves and several times turns the intrauterine and "unraveling". If the cordress is missing, and there are no knots on it, then the accused does not cause the fetus of discomfort, it develops and grows well. And if there were no problems in childbirth (the doctor freed his head from the umbilical in time), the hooking is also not a reason for concern. Matching umbilical

It is worth worrying only if an umbilical curtain arose. In this case, blood flow between mom and child is disturbed. The tight campus of the umbilical cord can be isolated, and can be combined with another taking (one around the neck, the second around the head, abdomen or other part of the body). At the same time, the Pupovna itself is shortened and limits the fetus mobility.

There are cases of multiple cordial cordhouse around the neck of the child. This option is not very favorable, but if it does not cause hypoxia, it can end the birth of a healthy kid.

The most unfavorable outcome when losing the umbilical cord and caused by this hypoxia is a cerebral palsy and other neurological violations of the newborn.

Causes of palsy

• Hypoxia before or during childbirth.
• Weight of the premature child less than 2000
• Intrauterine infections and other teratogens (medicines).

Family couple plans pregnancy

It is possible to prevent the development of a cerebral platter only preventive - pregnancy planning, refusal to receive harmful drugs, the absence of stressful situations. In new scientific research, more and more reveal a genetic predisposition to cerebral palsy.

It should be noted that such a diagnosis as cerebral palsy is exposed only after 1 year. And before that, the baby lives with a newborn encephalopathy. Pickup pose after a year, because For this diagnosis, some clinical manifestations need to be traced during the first 12 months of life are needed.

To confirm the cerebral palsy, a number of surveys are carried out: EEG, CT of the head, etc. The child's parents should carefully monitor the development of the baby to see signs of the development of cerebrals or its absence. What time after childbirth will be held to develop the clinic is not known for certain.

Most fruit pathologies are diagnosed on ultrasound. That is why ultrasound diagnosis is included in screening.

To work normally and maintain the life of the body, the brain must be protected from external negative factors that can damage it. In the role of protection, not only the bones of the skull, but also the shell of the brain, which are the so-called protective case with numerous layers and structure. The layers of brain shells form that they contribute to the normal activity of the vascular weeliness, as well as the circulation of the spinal fluid. What are tanks, what role they perform, we will consider below.

Sheath brain

The shells have several layers: solid, which is located near the bones of the skull, arachnoidal or web, as well as a vascular shell, referred to as a soft leaf, which covers the brain tissue and splits with it. Consider in more detail each of them:

1. The solid shell has a close connection with the bones of the skull. On the inner surface there is a process that is included in the brain slots to share departments. The largest process is between two hemispheres and forms a sickle, the rear part of which is connected to the cerebellum, limiting it from the occipital parts. At the top of the solid shell there is another process that forms a diaphragm. All this helps to ensure good protection against the pressure of the brain mass on the pituitary. In some parts of the brain there are so-called sinuses, according to which venous blood leaves.
2. Inside the solid placed arachnoid sheath, which is quite thin, transparent, but strong and durable. It shaves the brain substance. Under this shell there is a subarachnoid space, which separates it from a soft leaf. It placed cerebrospinal fluid. Above deep furrows, the subarachnoid space is wide enough, resulting in formed.

Brain shells are structured tissue structures that cover the spinal cord. Without tanks, the brain and nervous system will not function.

Tsister varieties and their location

The main volume of liquor (cerebrospinal fluid) is placed in tanks that are in the field of the stem department of the brain. Under the cerebellum in the rear cranial fossa is located a large occipital or cerebelchikovo-brain. Next comes a pretense or tank of the bridge. It is located ahead of the bridge, the border with the tank interchange, it is bordered with the tank cerebellar and cerebral and the subpautical spinal brain space. Then are located. They are pentagonal shape and contains such tanks as an intercom and intersection. The first is located between the legs of the brain, and the second is between the frontal shares and the crossroads of the visual nerves. The bypass or distribution tank has the type of channel distorted form, which is located on both sides of the brain legs, borders in the front with such tanks as the inter-interest and bridge, and the back - with quadruple. Further consider quirky or retrocerebellar brain tank where. It is placed between the cerebeller and the corn body. In its areas, the presence of arachnoidal (retrocelebellar) cysts often note. If the cyst increases in the amount, then a person may have an increased pressure inside the skull, hearing impairment and vision, equilibrium and orientation in space. The sideways tank is in the big brain, in the lateral of his furrows.

Brain tanks located mainly in the front of the brain. They support communication through the holes of the punk and Majandi and filled with the spinal fluid (liquor).

Liquor movement

Circulation of the liquor occurs continuously. It should be. It fills not only the subhashidal space, but also the central cerebral cavities that are located deeply in the tissue and are referred to as brain ventricles (there are four of them). In this case, the fourth ventricle is associated with the liquor channel of the spine. Likvor himself performs several roles:

Surrounds the outer layer of the cortical substance;

Moves in the ventricles;

Penetrates the brain tissue along the vessels;

So, represent a part of the line of the spinal fluid cycle, are its external storage, and the ventricles are an internal reservoir.

Education of lycvore

The synthesis of the liquor begins in the joints of the vessels of brain ventricles. They are growing with a velvety surface, which are located on the walls of the ventricles. Tanks and their cavities are interconnected. B. large brain tankinteracts with the fourth ventricle with special slots. The synthesized liquor enters through these holes in the subarachnoid space.

Features

The cycle of the spinal fluid has different directions of movement, it takes place slowly, depends on the pulsation of the brain, the frequency of respiration, the development of the spine as a whole. The main part of the lycvore is absorbed by the venous system, the rest is the lymphatic system. Likvore is closely connected with cerebral shells and cloth, ensures normalization of the exchange processes between them. The liquor provides an additional outer layer that protects the brain from injuries and disorders, and also reimburses the distortion of its size, moving, depending on the speaker, maintains the energy of neurons and the osmosis balance in tissues. Through the cerebrospinal fluid into the venous system, slags and toxins are emitted, which appear in cerebral tissue when metabolism. The lycvore serves as a barrier at the turn with the bloodstream, it delays some substances that come out of the blood, and skips others. In a healthy person, this barrier contributes to the prevention of from the blood of different toxins into the brain fabric.

Features in children

Subarachnoid shell in children is very thin. The newborn child has the volume of subarachnoid space is very large. As it increases, the space increases. It reaches such a volume as an adult, already to adolescence.

Deformation of tanks

Tanks play a special role in the movement of the liquor. Expansion of brain tank Signals about the disorder of the activity of the liquor system. An increase in the size of a large tank, which is placed in the rear cranial fossa of a small size, leads to deformation of the brain structure quickly. Usually people do not have discomfort with a slight increase in tanks. It can disturb small headaches, weak nausea, violation of vision. If the disease continues to develop, it can lead to serious health hazard. Therefore, the synthesis and the absorption of the liquor should maintain a balance.

If it is assembled in it a large amount of spinal fluid, they say about such a disease as hydrocephalus. Consider this question in more detail.

Hydrocephalus

This disease is formed in violation of the liquor cycle. The reason for this may be increased synthesis of the spinal fluid, the difficulties in its movement between the ventricles and the subarachnoid space, the liquor's absorption failure through the walls of the veins. The hydrocephalus is internal (the liquid is formed in the ventricles), and the outer (the liquid accumulates in the subpautory space). The disease occurs with inflammation or impaired metabolic processes, congenital ways of ways, which is carried out by a liquor, as well as as a result of injuries of the brain. The presence of a cyst also leads to the appearance of pathology symptoms. Man complains of headaches in the morning, nausea, vomiting. It may be stagnant on the bottom of the eye or swelling nerve. In this case, the tomography of the brain is carried out for the setting of the correct diagnosis.

Fetal brain tank

With the eighteenth to the twentieth week of pregnancy, women according to the results of the ultrasound can be considered about the state of the fetal system. The data make it possible to judge the presence or absence of brain pathology. A large tank is easily identified when applying an axial scanning plane. It gradually increases in parallel with the growth of the fetus. So, at the beginning of the sixteenth tank week is about 2.8 mm, and at the twenty-sixth week its size increases to 6.4 mm. If larger tanks, talk about pathological processes.

Pathology

The reasons pathological changes There may be congenital or acquired in the brain. The first refers:

AVM ARNOLDA KIARI, which flows with a disturbed outflow of the spinal fluid;

Abm Dandy Walker;

The narrowing of the brain water supply, as a result, an obstacle arises for the movement of the liquor;

Chromosome disorders at the genetic level;

Card-brain hernia;

The agent of the corn body;

Cysts leading to hydrocephalus.

For acquired reasons belongs:

Intrauterine hypoxia;

Head or spinal cord injury;

Cysts or neoplasms that violate the liquor current;

Infections affecting the CNS;

Thrombosis of the vessels in which the liquor comes.

Diagnostics

In case of violations in the liquor system, the following diagnosis is carried out: MRI, CT, study of the eye dNA, the study of the brain tanks using radionuclide cycling, as well as neurosonography.

It is very important to know how the likvorn system works, as its pathology occurs and manifests itself. To pass full-fledged treatment in case of pathologies, you need to contact a specialist in time. In addition, the results of the ultrasound at different times of pregnancy make it possible to explore the development of the brain of the fetus to make the right forecast and in the future planning treatment.

Keywords

annotation scientific article on other medical sciences, author of scientific work - Kozlova Olesya Ivanovna

An analysis of 385 volumes of the brain of healthy fruits in terms of 16 to 27 weeks of pregnancy was carried out. To assess depth large tank The brain used the multiplaner reconstruction of the fetal brain to obtain an axial cut passing through the cerebellum. Measured front-facing size large tank The brain from the rear surface of the worm of the cerebeller to the inner surface of the occipital bone. In the course of the studies, the depth was found large tank Brain (GBC) gradually increases throughout second trimester pregnancy, MAKING on average in 16/0-16 / 6 weeks 2.8 (2.1-4.3) mm and 6.4 (4,48.4) mm in 26 / 0-26 / 6 weeks. Developed standard percental depth values large tank The brain (average, 5th and 95th percentile) can be used to assess the development of the brain of the fetus when conducting ultrasonic research in the second trimester of pregnancy.

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Fetal Brain Was Retrospectively Evaluated in 385 Normal Fetuses AT 16-27 Weeks of Gestation. A Multiplanar Brain Reconstruction Mode Wassed to Obtain The Axial Cerebral Plane Which Passes Through The Cerebellum. All Measurements Were Performed from The Posterior Aspect of the Cerebellum to the Inner Surface of the Occipital Bone. The Key Research Findings SHOWED THAT THE DEPTH OF THE CISTERNA MAGNA TENDS TO INCREASE DURING THE SECOND TRIMESTER AND MAKES UP 2.8 (RANGE 2,1-4,3) MM AT 16 / 0-16 / 6 WEEKS TO 6.4 (RANGE 4,4 -8.4) MM AT 26 / 0-26 / 6 Weeks. The Established Percentile Depth Values for the Fetal Cisterna Magna (Mean, 5 Th and 95 Th Percentile) CAN BE Used to Assess Normal Fetal Brain Development While Performing Ultrasound In The Second Trimester Of Pregnancy

Text of scientific work on the topic "Regulatory indicators of the size of a large brain tank in fruit in the second trimester of pregnancy"

UDC 618.33

Regulatory indicators of the size of a large brain tank in fruit in the second trimester of pregnancy

O. I. Kozlova

Institute for advanced training of the Federal Medical and Biological Agency of Russia, Moscow

An analysis of 385 volumes of the brain of healthy fruits in terms of 16 to 27 weeks of pregnancy was carried out. To estimate the depth of a large brain tank, a multiplaner reconstruction of the fetal brain was used to obtain an axial cut passing through the cerebellum. The front-facing size of a large brain tank was measured from the rear surface of the cerebellum worm to the inner surface of the occipital bone. During the studies, the study found that the depth of the large brain tank (GBC) gradually increases throughout the second trimester of pregnancy, constituting on average at 16 / 0-16 / 6 weeks 2.8 (2.1-4.3) mm and 6 , 4 (4.4- 8.4) mm - at 26 / 0-26 / 6 weeks. The developed regulatory percental values \u200b\u200bof the depth of a large brain tank (average, 5th and 95th percentile) can be used to assess the development of the fetal brain during ultrasound research in the second trimester of pregnancy.

Keywords: fruit, second trimester of pregnancy, large tank, ultrasound examination.

Normal Size Values \u200b\u200bfor Fetal Cisterna Magna in Second Trimester Of Pregnancy

Fetal Brain Was Retrospectively Evaluated in 385 Normal Fetuses AT 16-27 Weeks of Gestation. A Multiplanar Brain Reconstruction Mode Wassed to Obtain The Axial Cerebral Plane Which Passes Through The Cerebellum. All Measurements Were Performed from The Posterior Aspect of the Cerebellum to the Inner Surface of the Occipital Bone. The Key Research Findings SHOWED THAT THE DEPTH OF THE CISTERNA MAGNA TENDS TO INCREASE DURING THE SECOND TRIMESTER AND MAKES UP 2.8 (RANGE 2,1-4,3) MM AT 16 / 0-16 / 6 WEEKS TO 6.4 (RANGE 4,4 -8.4) MM AT 26 / 0-26 / 6 Weeks. The established percentile depth values \u200b\u200bfor the fetal cisterna magna (mean, 5th and 95th percentile) can be used to assess normal fetal brain development while performing ultrasound in the second trimester of pregnancy Key words: fetus, second trimester, cisterna magna, ultrasound examination.

According to the order of the Ministry of Health of the Russian Federation of 12.11.2012 No. 572n "On approval of the procedure for providing medical care According to the "Obstetrics and Gynecology" profile (with the exception of the use of auxiliary reproductive technologies), a screening ultrasound study of the fetus in the second trimester of pregnancy in Russia should be carried out in the deadlines of 18-21 weeks of pregnancy. The study of the anatomy of the fetal brain in screening mode in the second trimester of pregnancy should be carried out using a series of axial sections. One of the sections passes through the rear cranial fossa and the cerebellum. Also, in this slice, a large brain tank is based on a list of the protocol of the anatomical structures of the fetus subject to mandatory assessment during the screening ultrasound research in the second half of pregnancy.

A large tank (cerebellar-brain) belongs to the tanks of the subpasy space. It is located in the deepening between the rejoiced brain of the ventral and cerebellum doorsally, the back is limited to a spider shell. This is the largest of all subparent tanks.

The depth of the large tank in the second half of pregnancy should normally be in the range of 2-10 mm. Thus, the upper boundary of the rate of depth of a large tank in the second half of pregnancy is considered to be 10 mm, but its size depend on the period of pregnancy and the size of the fetus. By-

it is necessary to assess the size of a large tank, taking into account the term of pregnancy.

An increase in the depth of a large tank is characteristic of such anomalies of brain development, as a malformation of Dandy Walker, arachnoid cyst rear cranial fossa. Also, the increase in the large tank is characteristic of both non-chromosomal syndromes (system syndrome) and for chromosomal syndromes (trisomy 18, trisomy 21).

Therefore, the development of percentile standards of the depth of a large brain tank is necessary for its objective assessment during the second screening ultrasound of the fetus.

PURPOSE OF THE WORK

Develop the echographic regulatory values \u200b\u200bof the depth of a large fetal tower in 16-27 weeks of pregnancy.

Research methodology

To develop regulatory percentile values \u200b\u200bof the depth of a large tank (GBC) in the fetus, the results of a survey of 385 pregnant women were selected with end-to-end echographic observation from 16 to 27 weeks. For final analysis, only the data obtained during the examination of patients who have completed pregnancy ended with urgent childbirth and the birth of normal healthy children are selected. The age of the surveyed patients on average was 28 years.

Issue 4 (52). 2014.

The selection criteria for patients appeared:

1) the well-known date of the last menstruation at 26-30 day cycles;

2) an uncomplicated course of pregnancy;

3) the presence of one-lodge pregnancy without signs of any pathology in the fetus;

4) the lack of a fact of receiving oral contraceptives within 3 months before the conception cycle;

5) Urgent childbirth with a normal fruit with mass at birth within the regulatory values \u200b\u200b(more than 10th and less than the 90th percentile by weight and length of the body depending on the gestational age).

To estimate the GBC, the multiplanar reconstruction of the fetal brain was used in order to obtain an axial slice using bulk echography. The assessment of the GBC was carried out in an axial plane passing through the rear cranial fossa and the cerebellum, measurements - from the rear surface of the cerebellum worm to the inner surface of the occipital bone.

GBC measurements were carried out retrospectively after the scope of the image of the fetal brain on the VOLUSON E8 Ultrasonic Apparatus (GE) using a special volume scanning transducer. Analysis of volume reconstructions was carried out on a personal computer when using a special 4D View program (GE). Statistical analysis was carried out using Excel 2011 spreadsheets.

Results of research

And their discussion

In the course of the studies we spent, it was found that a large fetal brain tank is an easily identifiable structure when using an axial scanning plane in the second trimester of pregnancy. In our studies, the definition of the GBC was achieved in 100% of successfully renovated surround reconstructions.

When studying the PC fetus, it was established a gradual increase in terms of 16 to 27 weeks of pregnancy. According to our results, the numerical values \u200b\u200bof the fetal cylinder fetal values \u200b\u200bwere 2.8 (2.1-4.3) mm in 16 / 0-1 / 6 weeks and 6.4 (4.4-8.4) mm - at 26 / 0-26 / 6 weeks of pregnancy (Table).

Regulatory percentile indicators (5th, 50th, 95th) GBC fetal in the second trimester of pregnancy

Percentile

5th 50th 95th

16/0-16/6 2,1 2,8 4,3

17/0-17/6 2,8 3,6 4,3

18/0-18/6 2,8 4,4 6,0

19/0-19/6 3,0 4,6 6,2

20/0-20/6 3,2 4,8 6,4

21/0-21/6 3,4 5,1 6,8

22/0-22/6 3,6 5,4 7,2

23/0-23/6 3,9 5,7 7,5

24/0-24/6 4,1 6,0 7,9

Ending table

Pregnancy term, GBC week, mm

Percentile

5th 50th 95th

25/0-25/6 4,2 6,2 8,2

26/0-26/6 4,4 6,4 8,4

Comparative analysis The data we received with the results of foreign researchers showed that the first domestic regulatory indicators of the CCC differ from foreign, but these differences did not wear a significant nature.

Conclusion

Thus, the studies we spent convincingly demonstrated the real possibility of assessing the GBC of the Fetal under screening ultrasound examination in the second trimester of pregnancy. The procentle values \u200b\u200bdeveloped by us can be used to assess the development of the brain of the fetus in the second trimester of pregnancy.

LITERATURE

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4. Lai T. H, CHENG Y. M, CHANG F M. PRENATAL DIAGNOSIS OF TRISOMY 21 IN A FETUS WITH AN ENLARGED CISTERNA MAGNA // ULTRASOUND OBSTET. Gynecol. - 2002. - Vol. 20. - P 413-416.

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6. Quarello E., Molho M., Garel C., et al. PreNatal Abnormal Features of the Fourth Ventrile in Jouubert Syndrome and Related Disorders // Ultrasound Obstet. Gynecol. - 2014. - Vol. 43. - P 227-232.

7. Salomon L. J., Stirnemann J., Bernard J., et al. Cisterna Magna Measurements in Normal Fetuses in Relation to Gestational Age and Other CovariaBles // Ultrasound Obstet. Gynecol. - 2010. - Vol. 36 (Suppl. 1). - P 52-167.

8. Sonographic Examination of the Fetal Central Nervous System: Guidelines for Performing The "Basic Examination" and The "Fetal Neurosonogram" // Ultrasound Obstet. Gynecol. - 2007. - Vol. 29. - P 109-116.

9. Steiger R. M., Porto M., Lagrew D. C., Randall R. Biocomery of the Fetal Cisterna Magna: Estimates of the Ability to Detect Trisomy 18 // Ultrasound Obstet. Gynecol. - 1995. - Vol. 5. - P 384-390.

Contact Information

Kozlova Olesya Ivanovna - Assistant Department of Ultrasonic and Prenatal Diagnostics Institute for Advanced Training of the Federal Medical Agency, E-Mail: [Email Protected]