Intrauterine development of the umbilical-portal venous system: two- and three-dimensional ultrasound examination. Blood circulation of the fetus and newborn child Reliability of screenings and the need for them

20.11.2023 Gynecology

Screening 1st (first) trimester. Screening timing. Screening results. Ultrasound screening.

Your baby has overcome all the difficulties and dangers associated with the embryonic period. It safely reached the uterine cavity through the fallopian tubes, trophoblast invasion into the endometrium occurred, and chorion formation occurred. The embryo grew and changed in an incredible way every week, the rudiments of all the most important organs and systems were formed, the torso, head, and limbs were formed.
Finally, it grew to 10 weeks, acquiring all those necessary features, a child-like configuration, which made it possible to call it a fetus from that moment on.
The time has come for screening of the 1st (first) trimester.
Today we will talk about the timing of first trimester screening and the results of ultrasound screening.

This topic is vast and of course you can’t get rid of it with just one article. We have to look at many anomalies and malformations that may already be suspected or even diagnosed at this time. But let's start from the beginning.

What is screening?

Screening- this is a set of necessary measures and medical research, tests and other procedures aimed at the preliminary identification of individuals among whom the likelihood of having a certain disease is higher than that of the rest of the population being examined. Screening is only the initial, preliminary stage of population examination, and individuals with positive screening results require subsequent diagnostic examination to establish or exclude the presence of a pathological process. The inability to carry out diagnostic tests that allow one to establish or exclude the presence of a pathological process with a positive screening result makes the screening itself pointless. For example, biochemical screening for fetal chromosomal diseases is not justified if subsequent prenatal karyotyping is not possible in a given region.

Any screening program must be accompanied by clear planning and assessment of the quality of screening, since any screening test conducted in the general population may cause more harm than good for the individuals being examined. The concept of “screening” has fundamental ethical differences from the concept of “diagnosis”, since screening tests are carried out among potentially healthy people, so it is very important that they have realistic ideas about the information that this screening program provides. For example, when conducting ultrasound screening for chromosomal pathology of the fetus in the first trimester of pregnancy, women should not have the idea that detecting an increase in the thickness of the nuchal space (NT) in the fetus necessarily indicates the presence of Down syndrome and requires termination of pregnancy. Any screening has certain limitations, in particular, a negative result of a screening test does not guarantee the absence of the disease, just as a positive test result does not indicate its presence.

When and why was first trimester screening invented?

Every woman has a certain risk that her child may have a chromosomal abnormality. It is for everyone, and no matter what lifestyle she leads and social status she occupies.
In systematic (non-selective) screening, a specific screening test is offered to all individuals in a specific population. An example of such screening is ultrasound screening for fetal chromosomal abnormalities in the first trimester of pregnancy, which is offered to all pregnant women without exception at 11-13(+6) weeks.

So, first trimester screening- this is a set of medical studies conducted at a period of 11-13(+6) weeks, and aimed at the preliminary identification of pregnant women, among whom the likelihood of having a child with chromosomal abnormalities (CA) is higher than in other pregnant women.

The main place among detected CAs is occupied by Down syndrome (trisomy of 21 pairs of chromosomes).
The English physician John Langdon Down was the first to describe and characterize the syndrome, later named after him, in 1862, as a form of mental disorder.
Down syndrome is not a rare pathology - on average there is one case in 700 births. Until the mid-20th century, the causes of Down syndrome remained unknown, but the relationship between the likelihood of having a child with Down syndrome and the age of the mother was known, and it was also known that all races were susceptible to the syndrome. In 1959, Jerome Lejeune discovered that Down syndrome occurs due to trisomy of the 21st pair of chromosomes, i.e. the karyotype is represented by 47 chromosomes instead of the normal 46, since the chromosomes of the 21st pair, instead of the normal two, are represented by three copies.

In 1970, the first method of screening for trisomy 21 in the fetus was proposed, based on the increasing likelihood of this pathology with increasing age of the pregnant woman.
When screening based on maternal age, only 5% of women would be classified as “high risk,” and this group would include only 30% of fetuses with trisomy 21 in the population.
In the late 1980s, screening methods appeared that took into account not only age, but also the results of studying the concentration of such biochemical products of fetal and placental origin in the blood of a pregnant woman, such as alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotropin (hCG ) and inhibin A. This screening method is more effective than screening based only on the age of the pregnant woman, and with the same frequency of invasive interventions (about 5%) it can identify 50–70% of fetuses with trisomy 21.
In the 1990s, a screening method was proposed based on maternal age and fetal nuchal translucency thickness (nuchal translucency thickness) at 11–13(+6) weeks of pregnancy. This screening method can identify up to 75% of fetuses with chromosomal abnormalities with a false-positive rate of 5%. Subsequently, the screening method, based on the age of the mother and the value of fetal TVL at 11–13 (+6) weeks of pregnancy, was supplemented by determining the concentrations of biochemical markers (free fraction of β-hCG and PAPP-A) in the mother’s blood serum in the first trimester of pregnancy, which made it possible to identify 85–90% of fetuses with trisomy 21.
In 2001, it was found that ultrasound examinations at 11–13 weeks did not show nasal bones in 60–70% of fetuses with trisomy 21 and 2% of fetuses with a normal karyotype. The inclusion of this marker in a screening method based on ultrasound and determination of biochemical markers in the first trimester of pregnancy can increase the detection rate of trisomy 21 up to 95%.

What ultrasound markers that increase the risk of CA do we evaluate?

Primarily, these are widening of the nuchal translucency thickness (NTT), lack of visualization of the nasal bones, reverse blood flow in the ductus venosus, and tricuspid regurgitation.

Collar space- is an ultrasound manifestation of fluid accumulation under the skin in the dorsum of the fetal neck in the first trimester of pregnancy.

The term "space" is used regardless of whether the space is septated or not, whether the space is localized in the neck or extends throughout the fetal body.
The incidence of chromosomal diseases and malformations in the fetus depends on the size of the TVP, and not on its ultrasound characteristics.
During the second trimester of pregnancy, the nuchal translucency usually disappears or, in rare cases, transforms into either cervical edema or cystic hygroma, with or without generalized fetal edema.

The thickness of the fetal nuchal translucency can be measured using a transabdominal ultrasound examination in 95% of cases; in other cases, a transvaginal examination is necessary. However, the results obtained during transabdominal or transvaginal examination do not differ.
1 Measurements are taken at 11–13(+6) weeks of pregnancy when the coccygeal-parietal size of the fetus is from 45 mm to 84 mm. This is an important point, because It is not uncommon that at exactly 11 weeks or 11 weeks and 1-2 days the fetus is a couple of millimeters less than 45 mm. This is a normal option, but in this case the study will have to be postponed for a week.
2 The measurement should be carried out strictly in the sagittal section of the fetus, with the fetal head in a neutral position.
3 The image should be enlarged so that only the head and upper chest of the fetus are visible on the screen.
4 The image size must be enlarged so that the minimum cursor movement results in a 0.1 mm change in size.
5 The thickness of the collar space should be measured at its widest point. It is necessary to differentiate the echostructures of the fetal skin and the amniotic membrane.
6 Cursors should be placed on the internal boundaries of the echo-positive lines delimiting the collar space, without entering it.
7 During the study, it is necessary to measure TVP several times and select the maximum of the obtained measurements.
In 5–10% of cases, the umbilical cord is entangled around the neck; this can lead to a false increase in TVP. In such cases, the TVP measurement should be taken on both sides of the umbilical cord, and the average of these two measurements is used to assess the risk of fetal chromosomal abnormality.

Visualization of fetal nasal bones

Should be performed at gestational age of 11–13(+6) weeks and with a fetal CTE of 45–84 mm.
It is necessary to enlarge the image of the fetus so that only the head and upper body of the fetus are represented on the screen.
A strictly sagittal section of the fetus should be obtained, and the plane of insonation should be parallel to the plane of the nasal bone.
When visualizing the nasal bone, three distinct lines should be present. The upper line represents the fetal nasal skin, the lower, more echogenic and thick, represents the nasal bone. The third line is a continuation of the first, but is located slightly higher than it and represents the tip of the fetal nose.
At 11–13(+6) weeks, a fetal profile can be obtained and assessed in more than 95% of fetuses.
With a normal karyotype, the absence of visualization of the nasal bones is typical for 1% of fetuses in women of the European population and for 10% of fetuses in women of the Afro-Caribbean population.
The nasal bones are not visible in 60–70% of trisomy 21 fetuses, 50% of trisomy 18 fetuses, and 30% of trisomy 13 fetuses.
With a false-positive rate of 5%, a combination screening including measurement of TVP, imaging of the fetal nasal bones, and measurement of maternal serum concentrations of PAPP-A and β-hCG has the potential to detect more than 95% of fetuses with trisomy 21.

This fetus is one of a dichorionic twin. TVP and ductus venosus flow are normal, but there is no visualization of the nasal bones. The result of karyotyping is Down syndrome, the karyotype of the 2nd fetus of twins is normal.

Doppler ductus venosus and tricuspid regurgitation

With chromosomal abnormalities, malformations of various organs and systems often form, including congenital malformations of the cardiovascular system.

The ductus venosus is a unique shunt that delivers oxygenated blood from the umbilical vein, which is directed primarily through the oval window into the left atrium, to the coronary and cerebral arteries. The blood flow in the ductus venosus has a characteristic shape with high speed in the phase of ventricular systole (S-wave) and diastole (D-wave) and orthograde blood flow in the phase of atrial contraction (a-wave).
At 11–13(+6) weeks of pregnancy, impaired blood flow in the ductus venosus is combined with the presence of chromosomal pathology or heart defects in the fetus and is a sign of a possible unfavorable pregnancy outcome. At this stage of pregnancy, a pathological form of blood flow velocity curves is observed in 80% of fetuses with trisomy 21 and in 5% of fetuses with a normal karyotype.
Tricuspid regurgitation is a wave of blood flowing back through the valve between the right ventricle and the atrium of the heart. In 95% of cases, tricuspid regurgitation, as well as reverse blood flow in the ductus venosus, disappears over the next few weeks, usually by 16 weeks; however, in 5% of cases it may indicate the presence of congenital heart disease. Therefore, it is recommended to undergo extended fetal echocardiography at 18-20 weeks.

It is extremely important and necessary that specialists involved in calculating the risk of chromosomal pathology of the fetus based on an assessment of its profile undergo appropriate training and certification confirming the level of quality of performing this type of ultrasound examination.

Of course, first trimester screening is not limited to identifying ultrasound markers that increase the risk of having a child with chromosomal abnormalities such as Down, Edwards, Patau, Turner and Triploidy syndromes. During this period, developmental anomalies such as exencephaly and acrania, malformations of the limbs and sirenomelia, omphalocele and gastroschisis, megacystis and sm prune belly, anomaly of the body stem can also be diagnosed, suspect sm Dandy-Walker and Spina bifida when changing size of the IV ventricle, anorectal atresia when pelvic translucency is detected. And that's not all. I will try to talk about the listed anomalies and malformations in the future.

In conclusion, a few words about the first trimester screening procedure in our center

All specialists of our center work according to the recommendations of the international organization The Fetal Medicine Foundation (https://www.fetalmedicine.org/) and have certificates from this organization. The Fetal Medicine Foundation (FMF), led by Professor Kypros Nicolaides, is engaged in research in the field of fetal medicine, diagnosis of fetal anomalies, diagnosis and treatment of various pregnancy complications. Certified specialists and centers receive software developed by FMF to calculate the risk of fetal chromosomal pathology based on ultrasound and biochemical screening data. To obtain a certificate in ultrasound examination in 11-13(+6) weeks it is necessary to undergo theoretical training in a course supported by FMF; undergo practical training at an FMF-accredited center; provide FMF with ultrasound photographs demonstrating the measurement of fetal TVP, visualization of the nasal bones, Doppler measurements of blood flow in the venous duct and tricuspid valve according to the criteria developed by FMF.

After filling out and signing numerous documents and consents at the reception, you will be invited to the ultrasound room, where I or my colleagues will assess the development of the fetus, all the necessary ultrasound markers of CA, as well as other possible changes in the chorion, uterine walls and ovaries.
After the study, you will be given a conclusion in two copies and photographs of your baby (or babies). You keep one copy of the report, and the second will need to be given in the treatment room, where blood will be taken from a vein for the biochemical part of the screening. Based on ultrasound and biochemistry data, special software will calculate the individual risk of fetal chromosomal pathology and in 1-2 days you will receive a result indicating the individual risks for the main CAs. If you wish, you can receive the result by email.
If you receive results with a low risk of major CA, you will be recommended to repeat the ultrasound at 19-21 weeks of pregnancy. If the risk turns out to be high, then remember that this is the result of a screening study, and not a diagnosis. To make an accurate diagnosis, you will need to consult a geneticist and conduct diagnostic methods such as chorionic villus biopsy or amniocentesis for the purpose of prenatal karyotyping.
In 2012, another high-precision method of prenatal DNA diagnostics appeared, the uniqueness of which is that it does not require invasive procedures (unless taking blood from a vein of a pregnant woman is considered invasive) - Non-invasive prenatal test.

I bring to your attention a table of pregnancy outcomes with increasing TVP:

As you can see, even with a very large TVP, approximately 15% of children can be born healthy, but there is a much greater chance that the fetus will have CA or major developmental anomalies.

Preparing for the study

Biochemical screening is carried out on an empty stomach (4-6 hours of fasting). More often, ultrasound and biochemistry are performed on the same day, in my opinion, this is very convenient, but if you have recently eaten, you can only undergo an ultrasound and donate blood on another day, most importantly no later than the full 13 weeks of pregnancy. You don't need any special preparation for an ultrasound, but a full bladder can cause discomfort for you and the examiner.
In most cases, ultrasound is performed transabdominally (no need to undress), but sometimes it is necessary to switch to transvaginal examination. It is not uncommon that at the beginning of the study, the position of the fetus does not allow the necessary measurements to be taken. In this case, you need to cough, turn over from side to side, and sometimes even postpone the study for 15-30 minutes. Please be understanding.

That's all, see you in 2 weeks!

Using Doppler sonography, quantitative indicators of blood flow velocity in the fetal venous duct in various phases of the cardiac cycle were studied in healthy women from 11 to 14 weeks of pregnancy. At the same time, the concentration in the blood of the pregnant woman of pregnancy-associated plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (beta-CG) was taken into account. It was found that in healthy pregnant women, linear blood flow velocities in the fetal venous duct have a significant (almost twofold) variation range, which excludes the dependence of these indicators on the gestational age in weeks and on the thickness of the chorion. A weak negative correlation has been established between the content of specific proteins and pregnancy hormones (PAPP-A and beta-CG) in a woman’s blood and the relative angle-independent parameters of blood flow in the fetal venous duct - the ratio of blood flow velocities in systole and early diastole, as well as the venous velocity index and index vein resistance. The identified dependence gives grounds to use angle-independent parameters of blood flow velocity curves in the fetal venous duct, determined at the turn of the first and second trimesters of pregnancy, as an additional criterion for predicting prenatal risk.

pregnancy

dopplerography

fetal ductus venosus

blood flow velocity curves

1. Altynnik N.A. The value of Doppler assessment of blood flow in the fetal venous duct in early pregnancy for the formation of a high-risk group for the birth of children with chromosomal abnormalities. Bulletin of Volgograd Medical Sciences. university. – 2012. – No. 4. – P. 66–68.

2. Lisyutkina E.V. Diagnostic value of Dopplerography of blood flow in the venous duct of the fetus at different stages of pregnancy: abstract of thesis. dis. ...cand. honey. Sci. – M., 2013. – 18 p.

3. The procedure for providing medical care in the field of “obstetrics and gynecology (except for the use of assisted reproductive technologies).” Order of the Ministry of Health of the Russian Federation dated November 1, 2012 No. 572n.

4. Radzinsky V.E. Obstetric aggression. – M.: Publishing house of the magazine Status Praesens, 2011. – 618 p.

5. ISUOG Practice Recommendations: Use of Doppler Ultrasound Technologies in Obstetrics. International Society of Ultrasound Diagnostics in Obstetrics and Gynecology (ISUOG) / A. Bride, G. Acharya, C. M. Bilardo, etc. // Ultrasound and functional diagnostics. – 2014. – No. 5. – P. 87–98.

6. Maiz N. Ductus venosus Doppler at 11 to 13 weeks of gestation in the prediction of outcome in twin pregnancies / N. Maiz, I. Staboulidou, A.M. Leal et al. // Obstet. Gynecol. – 2009. – Vol. 113. – R. 860–865.

The relevance of the problem of early prediction and prevention of the development of obstetric complications in order to reduce perinatal and infant morbidity and mortality determines the search for new predictors of problematic outcomes of pregnancy and childbirth. Over the past decade, medical institutions have been widely equipped with ultrasound scanners equipped with color Doppler mapping and reducing the total radiation exposure to the fetus to a safe threshold. This makes it possible to expand the scope of standard screening ultrasound examination of pregnant women for the early formation of high-risk groups. Among the Doppler parameters determined in the first trimester of pregnancy, the study of blood flow velocity curves (BVR) in the fetal venous duct has attracted the greatest attention of researchers. The high prognostic value of studying the spectrum of CSC in this vessel at the end of the first - beginning of the second trimester of pregnancy has been proven in relation to the presence of chromosomal abnormalities, congenital heart defects in the fetus and the outcome of multiple pregnancies. But these studies concerned only the qualitative study of CSC (registration of retrograde or unidirectional blood flow). Quantitative normative parameters of blood flow velocity in the fetal venous duct at the turn of the first and second trimesters of pregnancy in various phases of the cardiac cycle still remain unknown. This limits the possibility of using this method to predict other types of obstetric pathology. The existing problem indicated the direction of the research.

The purpose of the work is to determine the normative parameters of fetal blood flow rates in 11-14 weeks of pregnancy.

Material and research methods

The subject of the study consisted of 72 somatically healthy women with a physiological course of singleton pregnancy, having from 11 weeks. + 0/7 days up to 13 weeks. + 6/7 days of gestation. Criteria for inclusion in the study:

a) age from 18 to 35 years;

b) pregnancy from 11 to 14 weeks;

c) bearing one fetus;

d) location of the chorion in the fundus or along the side walls of the uterus;

e) absence of extragenital pathology in the stage of sub- and decompensation;

f) spontaneous conception;

g) the absence of an episode of threatening termination of the observed pregnancy both at the time of the study and at its earlier stages.

The study of blood circulation in the fetal venous duct was carried out using a Voluson E8 ultrasound device (USA), in compliance with the ALARA (As Low As Reasonably Achievable) principle - “As Low As Reasonably Achievable”, i.e. using the most prudently low output power possible. Registration of blood flow in the fetal venous duct was carried out by specialists who have the appropriate Certificate from the Fetal Medicine Foundation. The velocity of blood flow was measured in systole (S), diastole (E) of the ventricles of the heart, as well as during contraction of the vestibules of the heart, i.e. in late diastole (A).

The ratios of phase blood flow velocities (S/E and S/A), as well as angle-independent indices - the venous resistance index (VRI) and the venous velocity index (VVI) were calculated. The study was conducted as an addition to the standard examination in the first trimester of pregnancy, determined by the “Basic spectrum of examination of pregnant women” of the federal Procedure for the provision of medical care in the field of “obstetrics and gynecology (except for the use of assisted reproductive technologies)”. In addition to the data from the clinical examination of patients, the work took into account the content of pregnancy-related plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (beta-hCG) in the blood of women on the day of examination, both in quantitative values and in the form of “multiple” of median" (MoM).

The recorded data were processed using the method of correlation and variation analysis and are presented as “mean ± standard deviation” (M ± SD) and 95% confidence interval (95% CI).

Research results and discussion

The data obtained indicate that the speed of blood flow in the ductus venosus in the fetus at the turn of the first and second trimesters of gestation during a physiological pregnancy varies widely (table).

In various phases of the fetal cardiac cycle, individual characteristics in the group of subjects determined a more than twofold discrepancy in the recorded parameters. At the same time, the linear parameters of blood circulation did not depend on either the gestational age in weeks or the thickness of the chorion measured by ultrasound scanning. There were no cases of retrograde blood flow in the ductus venosus in the fetus (a marker of intrauterine hypoxia or hereditary pathology) in the examined women.

Indicators of blood flow velocity curves in the fetal ductus venosus in various phases of the cardiac cycle in the early stages of physiological pregnancy

The ratios of blood flow velocities in systole and early diastole (S/E) in healthy pregnant women were less variable - the discrepancies in the indicators were no more than 11%. This made it possible to identify a weak inverse correlation between this indicator and the concentration of human chorionic gonadotropin in the blood of a pregnant woman (r = -0.3; p< 0,05). Соотношение скоростей кровотока в венозном протоке плода в систолу и позднюю диастолу (S/А) также имело большую вариабельность (почти двухкратное превышение максимального значения над минимальным), что не позволило определить взаимосвязь этого показателя с другими результатами стандартного обследования беременных. Размах вариации индексов скоростей вен и резистентности вен был намного меньше - в пределах 46 и 37 % соответственно. Это определило наличие отрицательной корреляционной связи между сравниваемыми параметрами кровотока в венозном протоке плода и продукцией специфических гормонов и белков беременности - бета-ХГ и РАРР-а (коэффициенты корреляции соответственно равны - 0,41 (р < 0,05) и - 0,34 (р < 0,05). При этом не имел преимуществ вид представления бета-ХГ и РАРР-а (количественные значения или МоМ); связь указанных параметров была слабой, но доказанной посредством проверки нулевой гипотезы. Так как определение продукции бета-ХГ и РАРР-а в МоМ используется в качестве одного из критериев прогноза пренатального риска с ранних сроков беременности , выявленная взаимосвязь открывает перспективы использования для этих целей и числовых значений исследования кровотока в венозном протоке плода. Но оценка эффективности нового прогностического критерия становится возможной только при условии четкого представления о нормативных значениях КСК в указанном кровеносном сосуде.

Conclusion

The data obtained are preliminary, however, they show that the curves of blood flow velocities in the fetal ductus venosus in early pregnancy can be subjected not only to qualitative analysis (identification of retrograde and zero blood flow), but can also be presented in the form of numerical values for early prediction gestational complications.

Reviewers:

Agarkova L.A., Doctor of Medical Sciences, Professor, Director, Research Institute of Obstetrics, Gynecology and Perinatology, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk;

Sotnikova L.S., Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology, Faculty of Education and Training, State Budgetary Educational Institution of Higher Professional Education "Siberian State Medical University" of the Ministry of Health of the Russian Federation, Tomsk.

The work was received by the editor on February 12, 2015.

Bibliographic link

Mikheenko G.A., Yuryev S.Yu., Korotkova Yu.Yu. PHASE PARAMETERS OF BLOOD FLOW VELOCITY IN THE DUCTUUS VENOUS OF THE FETAL IN HEALTHY WOMEN AT 11–14 WEEKS OF PREGNANCY // Fundamental Research. – 2015. – No. 1-1. – P. 107-109;
URL: http://fundamental-research.ru/ru/article/view?id=36777 (access date: 12/13/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

Over the past decade, medical institutions have been widely equipped with ultrasound scanners equipped with color Doppler mapping and reducing the total radiation exposure to the fetus to a safe threshold. This makes it possible to expand the scope of standard screening ultrasound examination of pregnant women for the early formation of high-risk groups. Among the Doppler parameters determined in the first trimester of pregnancy, the study of blood flow velocity curves (BVR) in the fetal venous duct has attracted the greatest attention of researchers. The high prognostic value of studying the spectrum of CSCs in this vessel at the end of the first – beginning of the second trimester of pregnancy has been proven in relation to the presence of chromosomal abnormalities, congenital heart defects in the fetus and the outcome of multiple pregnancies. But these studies concerned only the qualitative study of CSC (registration of retrograde or unidirectional blood flow). Quantitative normative parameters of blood flow velocity in the fetal venous duct at the turn of the first and second trimesters of pregnancy in various phases of the cardiac cycle still remain unknown. This limits the possibility of using this method to predict other types of obstetric pathology. The existing problem indicated the direction of the research.

The purpose of the work is to determine the normative parameters of fetal blood flow rates in 11–14 weeks of pregnancy.

Material and research methods

a) age from 18 to 35 years;

b) pregnancy from 11 to 14 weeks;

c) bearing one fetus;

d) location of the chorion in the fundus or along the side walls of the uterus;

e) absence of extragenital pathology in the stage of sub- and decompensation;

f) spontaneous conception;

g) the absence of an episode of threatening termination of the observed pregnancy both at the time of the study and at its earlier stages.

The ratios of phase blood flow velocities (S/E and S/A), as well as angle-independent indices - venous resistance index (VRI) and venous velocity index (VVI) were calculated. The study was conducted as an addition to the standard examination in the first trimester of pregnancy, determined by the “Basic spectrum of examination of pregnant women” of the federal Procedure for the provision of medical care in the field of “obstetrics and gynecology (except for the use of assisted reproductive technologies)”. In addition to the data from the clinical examination of patients, the work took into account the content of pregnancy-related plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (beta-hCG) in the blood of women on the day of examination, both in quantitative values and in the form of “multiple” of median" (MoM).

The recorded data were processed using the method of correlation and variation analysis and are presented as “mean ± standard deviation” (M ± SD) and 95% confidence interval (95% CI).

Research results and discussion

Indicators of blood flow velocity curves in the fetal ductus venosus in various phases of the cardiac cycle in the early stages of physiological pregnancy

Blood flow in the ductus venosus

During the entire period of intrauterine development, the embryo, and later the fetus, is affected by various harmful factors. In such conditions, the young mother has a serious responsibility: on the one hand, to protect the baby from external threats:

And on the other hand, to ensure the internal constancy of the body. The healthcare system provides a gentle daily regimen (including physical activity) for a pregnant woman. The relevance of the issue is due to the fact that the slightest provoking factors can affect the baby’s health. Already today, according to WHO, there is an increase in the number of newborns with developmental anomalies in urbanized cities.

In this case, it is recommended to carry out timely screening. An innovator in this area is the Minimax company, which is engaged in research in all areas of medicine. Back in 1994, the company conducted Doppler studies, and now these technologies make it possible to detect intrauterine anomalies in the early stages.

Venous blood flow: research methods

Of greatest interest from the point of view of identifying anomalies is the blood flow in the ductus venosus, as well as the umbilical artery. The ductus venosus (Ductus of Arantius) is a narrow canal connecting the umbilical and inferior vena cava. This is essentially an anastomosis that bypasses the hepatic bloodstream. The feasibility of studying the speed of blood flow, as well as its direction, arises already in the early stages of fetal development.

Already at 11 weeks, the first ultrasound examinations are performed: normally, blood flow in the ductus venosus in the fetus should move towards the right atrium. Often, genetic characteristics, as well as teratogenic factors, lead to the fact that the fetus has critical (sometimes incompatible with life) developmental anomalies.

One of the most popular problems is reverse venous blood flow. In this case, peaks are recorded on ultrasound, which indicate that blood is being discharged in the opposite direction (to the umbilical vein). This may indicate tricuspid valve insufficiency or other cardiovascular abnormalities.

If the venous blood flow of the fetus is disrupted and intrauterine development is not threatened, then surgical interventions are performed after birth.

Reverse blood flow in the ductus venosus in the fetus. How should we treat him?

At the first ultrasound screening a week ago, the sonologist discovered something incomprehensible, which he called “reverse blood flow in the ductus venosus in the fetus.” These words make your hair stand on end, and the worst thoughts take root in your head. It seems that life has stopped, and what you hear is nothing more than a sentence. But in order to take a thoughtful and balanced step, let's figure it out without emotions.

What is ductus venosus reversal in the fetus?

The ductus venosus is a vessel that connects the umbilical vein (which carries oxygenated arterial blood) with the inferior vena cava. It has a very small diameter - only 2-3 mm, so only an experienced sonologist is able to examine it, and then only with expert-class equipment. Through the venous duct, arterial blood immediately enters the heart and partially into the brain, because It is these organs that need large amounts of oxygen.

The blood flow in this vessel is normally directed only in one direction (towards the heart). Reverse flow is not possible due to the powerful smooth muscle sphincter present in the venous duct. However, under certain conditions, the pressure in the vessel increases so much that a reversal of the ductus venosus appears in the fetus, i.e. movement of blood in the opposite direction (away from the heart).

What does reverse blood flow look like in the ductus venosus in the fetus?

Normally, the Dopplerographic picture of the venous duct is three-phase (see Figure 1):

Contraction of the ventricles. At this time, the atria are maximally relaxed, so blood flows to them at a very high speed. This is the highest peak on the graph (labeled “A” in the figure).
Passive filling of the ventricles from the atria (early diastole). The blood flow speed is also high, but somewhat less than in systole. Therefore, on the graph this is a peak of lower height (indicated by the letter “B”).
Atrial contraction and active filling of the ventricles. The movement of blood slows down sharply, so a notch appears (indicated by the letter “C”), but normally it never reaches the zero line because the blood in the ductus venosus does not move back.

Figure 1. Normal blood flow in the ductus venosus

If a reverse of the ductus venosus appears in the fetus, this indicates that the pressure in the vessel is very high, and the blood rushes in the opposite direction at the moment of atrial contraction. In the ultrasound picture it looks like this (see Figure 2). Below the isoline, a wave is determined (indicated by a circle).

Figure 2. Reversal of blood flow in the ductus venosus in the fetus.

What does reverse in the ductus venosus in the fetus indicate?

Reversal in the ductus venosus is considered a marker of chromosomal pathology or heart disease in the fetus, reflecting hemodynamic insufficiency. However, this feature cannot be absolutized either. In a study of high-risk patients, it was found that reverse blood flow in the fetal ductus venosus was associated with chromosomal pathology or cardiac ducts in 90% of cases. But in 5% of cases, false positive results are also possible, when a reversal is detected, but everything is fine with the child.

Let us repeat once again that the study did not include all pregnant women, but only those with high genetic risks. This is age over 35 years, a history of the birth of children with hereditary pathologies, stillbirths, increased thickness of the nuchal translucency, etc.

Diagnostic errors

In addition to the fact that the venous duct has a small diameter, the image from it also changes from the movements of the fetus and from the movements of the woman’s anterior abdominal wall. Therefore, research should be trusted only to professionals!

In addition, the hepatic vein passing nearby may also be superimposed on the Dopplerogram of the ductus venosus. Even normally, the presence of reverse is allowed in it, and when layered, it is transferred to the vessel under study, which can be mistakenly taken for reverse in the fetal venous duct.

What to do if reverse blood flow is detected in the ductus venosus in the fetus?

Provided that ultrasound with Doppler sonography is done correctly and there are no artifacts, reverse blood flow in the venous duct should be treated as follows:

if a woman is not included in a high-risk group, then within a week a detailed ultrasound examination of the fetal heart is performed and a genetic consultation is indicated;
If, simultaneously with the reverse, a decrease in the nasal bones and a thickening of the nuchal space are revealed, then karyotyping is indispensable. To do this, either amniocentesis or chorionic villus biopsy is performed.

It turns out that reverse blood flow in the ductus venosus in the fetus is just an argument for more detailed and targeted diagnostics during pregnancy.

Ksk in the ductus venosus

The ductus venosus (DV) is a narrow tube-shaped vein with an isthmic entrance, which is a direct communication between the umbilical vein and the central venous system, through which a flow of well-oxygenated blood is formed, bypassing the hepatic circulation. The diameter of the VP is 3 times smaller than the diameter of the intra-abdominal part of the umbilical vein, and its length is only 2-3 mm outside of pregnancy. Due to the presence of a smooth muscle sphincter innervated by fibers of the solar plexus, the phrenic nerve and the vagus nerve, the VP plays an active role in regulating the volume of arterial blood flowing through it. In a normally developing pregnancy, throughout all phases of the fetal cardiac cycle, blood flow in the VP remains unidirectional, representing a three-phase curve. In one cardiac cycle, ventricular systole, early diastole, reflecting passive filling of the ventricles, and late diastole, active contraction of the atria, are distinguished.

Despite the small size of the ductus venosus, the assessment of CSC in this vessel is possible in most fetuses outside of pregnancy. Such high results were obtained primarily by experts, since when obtaining the spectrum of blood flow in the VP, its “contamination” from neighboring vessels often occurs. In addition, “contamination” with signals from the middle hepatic vein can cause false reverse values of blood flow in the VP during the phase of atrial contraction. The movement of the mother's abdominal wall and the behavioral reactions of the fetus itself cause a displacement of the VP during the recording of the SSC. Therefore, optimal registration and interpretation of CSCs in EP obtained in the first trimester of pregnancy is only possible for a very experienced and conscientious specialist working with high-quality ultrasound equipment.

However, it should be noted that in the hands of an expert, the study of blood flow in the venous duct at the end of the first trimester of pregnancy is possible using middle-class devices even without the color flow mode.

Considering the insufficiently high reproducibility of assessing blood flow indices in the VP, most specialists use zero and reverse values of blood flow during the phase of atrial contraction as diagnostic criteria for pathological CSCs. According to most researchers, assessment of blood flow in the VP in early pregnancy should be carried out in patients at high risk of having a child with SCA and congenital defects.

For the first time, these changes in the blood flow in the fetal venous duct with a chromosomal defect were described by T. Huisman and S. Bilardo in 1997. Reverse blood flow in the VP during the phase of atrial contraction and an expanded nuchal space of up to 8 mm were found in one fetus with trisomy 18 from twins in 13 weeks of pregnancy.

In our country, for the first time, the reverse values of blood flow during the phase of atrial contraction in fetuses with CA were reported by M.V. Medvedev et al. and I.Yu. Kogan et al. in 1999. In the observation of I.Yu. Kogan et al., reverse values of blood flow in the VP during the phase of atrial contraction were found at 12 weeks of pregnancy in a fetus with trisomy 21. In the case we described, similar changes in blood flow in the VP were detected in a fetus with trisomy 18 outside pregnancy. The table presents summary literature data on the frequency of occurrence of zero and reverse values of blood flow in the VP during the phase of atrial contraction during fetal CA. The data presented indicate a fairly large scatter in the frequency of pathological CSCs in the venous duct in CA - from 58 to 100%. These results can apparently be explained by the following reasons.

Firstly, zero and reverse values of blood flow in the VP during the phase of atrial contraction are a marker of fetal CAU only at certain stages of pregnancy. Thus, according to E. Antolin et al., the pathological spectrum of blood flow in the EP in CA is significantly more common at gestational age (76.9%) compared to the first week of pregnancy, when abnormal blood flow velocity curves were recorded only in 42.2% of all chromosomal defects. The transient nature of pathological CSCs in the venous duct with an abnormal karyotype of the fetus in early pregnancy is also indicated by A.A. Morozova and E.A. Shevchenko. Considering that the studies were conducted at different times, this fact may have influenced the different frequency of detection of pathological SSCs in the VP of fetuses with CA.

Secondly, it is known that CA is often accompanied by congenital heart defects (CHD), which in early pregnancy can lead to changes in blood flow in the VC. Summary data from different research groups on the incidence of pathological blood flow in the VP during early stages of congenital heart disease are shown in the table.

Thirdly, zero and reverse values of blood flow in the VP during the phase of atrial contraction can also be recorded in fetuses with a normal karyotype. It should be emphasized that in many studies the frequency of false positive results did not exceed the level of 5%, which is accepted as the “gold standard” in prenatal diagnosis. However, with the expansion of the nuchal space in the fetus, both with CA and with a normal karyotype, the frequency of pathological SSCs in the VP increases significantly. In this case, changes in blood flow in the VP are often transient.

In conclusion of this chapter, it should be emphasized that currently the main echographic marker of CA in early pregnancy is the expansion of the fetal nuchal space. In cases where this marker is detected, prenatal karyotyping is a necessary component of prenatal examination in early pregnancy. At the same time, Doppler technologies and assessment of the fetal nasal bones should be considered important additional signs that can improve the efficiency of early prenatal diagnosis of CA, especially in cases of borderline or “controversial” expansion of the nuchal space. It should also be remembered that in some cases, assessment of the fetal nasal bones and detection of pathological SSCs in the VP makes it possible to diagnose CA with normal values of the nuchal space. And in cases where the nuchal translucency is expanded, the additional detection of pathological SSCs in the VP and the absence/hypoplasia of the fetal nasal bones makes it possible to more convincingly explain to patients the need for prenatal karyotyping.

Standards for first screening during pregnancy: what to do if everything is bad?

For some reason, the procedure called “screening” (from English - screening - sifting) causes anxiety in most expectant mothers, some of whom refuse the procedure only because they are afraid to hear unpleasant news about its results.

But screening, especially with the use of modern computer systems and high-precision instruments, is not fortune-telling, but an opportunity to look into the future and find out what the probability is that in due time a baby will be born with an incurable disease.

For parents, this is an opportunity to decide in advance whether they are ready to take care of a child who will require enormous attention and care.

Norms for first screening during pregnancy

First trimester screening essentially consists of two procedures already familiar to women: ultrasound and blood sampling.

When preparing for procedures, it is important to follow your doctor's recommendations and try to remain calm.

Ultrasound standards

During an ultrasound examination, a specialist examines in detail the structure of the embryo, and specifies the gestational age based on indicators such as the coccygeal-parietal size of the embryo (CTE) and the biparietal size of the fetal head (BF).

And, most importantly, it takes the necessary measurements that are informative for assessing the condition of the fetus.

This is, first of all:

Nuchal translucency thickness (NTT) is the most important indicator during ultrasound to identify the risk of chromosomal pathologies.

Norms for TVP depending on the age of the embryo

If TVP exceeds the normal value, then this is a reason to suspect the presence of a chromosomal abnormality in the fetus.

Determination of the nasal bone - it is visualized already at 10 - 11 weeks of pregnancy, and at the 12th week it should be at least 3 mm. This is true for 98% of healthy embryos.
Fetal heart rate (HR) - depending on the week of pregnancy, the following are considered normal indicators:

An increased heart rate in the fetus is also one of the signs of Down syndrome.

Spectrum of blood flow in the ductus arantius (venous) in the fetus. A reverse blood flow waveform occurs in only 5% of embryos without chromosomal abnormalities.
The size of the maxillary bone of the fetus - its lag in size is typical for embryos with trisomy.
Bladder volume – at the age of 12 weeks, the bladder is determined in most healthy embryos only from the 11th week. An enlarged bladder is an additional possible sign of Down syndrome in the fetus.

Biochemical blood test standards

If possible, you should donate blood for a screening examination on the day of the genetic ultrasound or, if this is not possible, the very next day.

Ideally, blood for a screening test is taken in the morning on an empty stomach, or, in extreme cases, no less than 4 hours after a meal.

In the first trimester, screening to identify the degree of risk for the presence of embryonic malformations consists of assessing two indicators: the free β-subunit of hCG and PAPP-A.

The “range” of the values of these blood markers acceptable at each stage of pregnancy (by week) is quite wide and may vary in screening loci depending on the ethnic composition of the region.

However, in relation to the median of a given region - the average normal value for a specific stage of pregnancy - the level of the analyzed indicators should be from 0.5 to 2 MoM.

Moreover, when calculating the risks in each individual case, it is not the pure MoM that is taken, but the one calculated adjusted for the anamnesis of the expectant mother, the so-called. adjusted MoM.

Free β-subunit of hCG

When assessing the risk of developing chromosomal diseases of the fetus, the analysis of free β-hCG is more informative than the level of the hCG hormone itself.

Because The cause of changes in hCG in a woman may be conditions not related to bearing a baby (hormonal diseases, taking certain medications, etc.).

Whereas the predictable change in the level of the β-subunit of hCG is specific to the state of pregnancy.

With a normally developing embryo, the levels of free β-hCG in a woman’s blood will be approximately as follows:

Provided that the gestational age is established correctly and, neglecting the possibility of a false result, the reasons for the discrepancy between the level of β-hCG in a woman’s blood and the gestational age may be completely different reasons not related to abnormalities in the development of the fetus.

RAPP-A standards

A pregnancy-specific protein is produced by the outer layer of the placenta and is observed in the woman’s blood throughout pregnancy.

Its level increases according to the duration of pregnancy.

Limits of PAPP-A indicators in the blood of a patient during a normally developing pregnancy

The value of PAPP-A, as a marker of chromosomal pathologies of the fetus, is alarming when the value is lower than the average in the region (MoM below 0.5). In the first trimester, this may mean a risk of developing Down and Edwards syndromes.

It must be borne in mind that after the 14th week of pregnancy, to determine the risk of developing Down syndrome in the fetus, the PAPP-A level is not informative, because compared with those of a healthy pregnancy, even in the presence of trisomy 21.

Decoding the results of the first screening

To evaluate the results of prenatal screening tests, certified computer programs are used, developed specifically for these purposes and configured to work in the home laboratory.

Therefore, all studies must be completed at one institution.

Only combined screening - assessment of ultrasound data in conjunction with the analysis of biochemical blood markers - becomes the key to obtaining a highly accurate prognosis.

The indicators of a double biochemical test performed in the first trimester of pregnancy are considered in combination with each other.

Thus, a low level of PAPP-A in combination with an increased level of β-hCG in a woman’s blood, all other things being equal, gives serious grounds to suspect the development of Down syndrome in the fetus, and in combination with a reduced level of β-hCG - the risk of developing Edwards syndrome.

In this case, the data from the ultrasound protocol become decisive for making a decision about sending a woman for invasive diagnostics.

If the ultrasound does not reveal any pathological abnormalities in the fetus, then, as a rule, the expectant mother is recommended to undergo repeated biochemical screening, if the duration of pregnancy allows, or to wait for the opportunity to undergo screening in the second trimester.

Unfavorable results of the first screening

Screening data is processed by a “smart” computer program, which issues a verdict on the level of risk for the development of chromosomal pathologies in the fetus: low, threshold or high.

In our country, a risk value of less than 1:100 is considered high. This means that one in a hundred women with similar results of the first screening will give birth to a child with developmental defects.

And such a risk is a clear indication for an invasive examination method in order to diagnose chromosomal diseases of the embryo with 99.9% confidence.

Threshold risk means that the risk of having a child with incurable developmental disabilities ranges from 1:350 to 1:100 cases.

In this situation, the woman requires consultation with a geneticist, whose task, after an individual appointment, is to determine whether the expectant mother is in a high or low risk group for carrying a fetus with developmental defects.

As a rule, the geneticist suggests that the woman calm down, wait and undergo additional non-invasive examinations in the second trimester (second screening), after which she invites her to a second appointment to review the results of the second screening and determine the need for invasive procedures.

Fortunately, the lucky women whose first trimester screening shows a low risk of carrying a sick child: more than 1:350, the vast majority among expectant mothers. They do not require additional examinations.

What to do if you have unfavorable results

If, based on the results of prenatal screening, the expectant mother is found to have a high risk of having a child with congenital malformations, then her first priority is to maintain peace of mind and plan her further actions.

Future parents should determine how important it is for them to have accurate information about the presence of pathologies in the development of the unborn child, and in this regard, decide whether to continue examinations to make an accurate diagnosis.

What to do if you receive poor results after the first screening?

The first screening should not be repeated in another laboratory.

This way you will only waste precious time. And even more so, you shouldn’t wait for the second screening.

If you receive poor results (if the risk is 1:100 or lower), you should immediately seek advice from a geneticist.

You should not wait for a scheduled appointment at the LC and seek a referral or appointment with a geneticist.

You need to immediately find a qualified specialist and attend a paid appointment. The fact is that the geneticist will most likely prescribe an invasive procedure for you. If the period is still short (up to 13 weeks), then this will be a chorionic villus biopsy.

All women with a high risk of having a child with genetic abnormalities are better off undergoing a chorionic villus biopsy, since other procedures to identify the genotype of the fetus, amniocentesis and cordocentesis, are carried out at a later date.

Results from any invasive procedure should take approximately 3 weeks. If you do the analysis for a fee, then a little less.

If fetal developmental anomalies are confirmed, then, depending on the family’s decision, the doctor may issue a referral to terminate the pregnancy.

In this case, termination of pregnancy will be carried out within a week.

Now imagine if you do amniocentesis in a week. Wait another 3 weeks for results. And at 20 weeks you are offered to terminate the pregnancy, when the fetus is already actively moving, when there is full awareness that a new life is living in your body.

After 20 weeks, a viable baby can be born in a good clinic. For periods over 20 weeks, abortions are not performed, but artificial births are performed for medical reasons.

Such interventions break the psyche of the woman and the father of the child. It's very hard. Therefore, it is at 12 weeks that a difficult decision should be made - to find out the truth and have an abortion as early as possible. Or accept the birth of a special child as a given.

Reliability of screenings and the need for them

From expectant mothers in queues to see a doctor in antenatal clinics, on thematic forums, and sometimes from doctors themselves, you can hear very different opinions about the advisability of screening during pregnancy.

And indeed. Screenings are not very informative. They do not provide a definitive answer to the question of whether your child has a genetic disorder. Screening provides only a probability and also creates a risk group.

The first screening gives parents the opportunity to conduct a more accurate diagnosis and terminate a short pregnancy or prepare as much as possible for the birth of a special child.

The absence of risks for the development of abnormalities in the development of the fetus, due to chromosomal pathologies, according to screening will allow a young mother to calmly carry her pregnancy to term, being 99% sure that her baby is out of trouble (since the likelihood of false positive results from screening is negligible).

Disputes about the need to undergo screenings and their moral side, apparently, will not subside soon. However, when answering the question of whether it is worth accepting a doctor’s referral for screening, future parents should mentally move forward a few months and imagine a situation where the risks were justified.

And only after realizing their readiness to accept a special baby can mom and dad confidently write a waiver or agree to examinations.

117 COMMENTS

Help me figure out the fetal heart rate is 154 beats/min. KTR 75.0mm. TVP 2.10mm. Free beta subunit of hCG 21.70 IU/l /0.673 MoM. PAPP-A 13.190 IU/l / 2.648 MoM. Trisomy 21 base risk 1: 126. Individual risk 1: 2524. Trisomy 18. basic risk 1:324 individual risk 1:6483. Trisomy 13 base risk 1:1012.<1:20000

Based on the data you provided, we can draw the following conclusions.

An ultrasound examination in the 1st trimester of pregnancy is carried out to determine the risk of Down syndrome in the fetus. It is carried out from 10 weeks 6 days to 13 weeks 6 days of gestation. Earlier or later research is ineffective.
The fetal heart rate depends on the stage of pregnancy and is 161–179 beats per minute in the 10th week of pregnancy, 150–174 beats per minute in the 12th week of pregnancy.
The CTE of the fetus for effective ultrasound should be more than 45 mm.
TVP is normally in the range of 1.5–2.2 mm at the 10th week of gestation, 1.6–2.5 at the 12th week.
The results of biochemical screening indicate an increased risk of having a child with Down syndrome and Edwards syndrome.
Normally, the free beta subunit of hCG is from 0.5 to 2.0 MoM, and PAPP-A is from 0.5 to 2.5 MoM. IU/l data depends on the laboratory and its interpretation is given separately.
Risks for deviations from the norm must be more than 1:380. You are at increased risk for trisomy 21, or Down syndrome, and trisomy 18, or Edwards syndrome.

To obtain reliable information, you need to contact a antenatal clinic with the results of the research. Based on all the data obtained, you will be offered appropriate pregnancy monitoring.

If necessary, you will be asked to undergo an invasive diagnostic method in the form of amniocentesis to determine possible pathologies in the fetus.

Please help me understand the results of an ultrasound examination in the 1st trimester (13-14 weeks) heart rate 158 per minute. KTR 76.0 mm. TVP 1.37mm. BPR 26.8 mm. Exhaust gas 95.0 mm. Coolant 77.0 mm. DlB 14.0 mm. Risk with Down syndrome is low 1:1501

You do not indicate the exact gestational age based on ultrasound. Does it coincide with the date of the last menstruation?

Another important indicator during an ultrasound examination in the 1st trimester of gestation is the visualization and thickness of the nasal bone. This indicator is one of the markers for the risk of a fetus having Down syndrome.

Ultrasound screening in the 1st trimester of pregnancy is performed from 10 weeks 6 days to 13 weeks 6 days. An earlier or later study is not informative.

With an ultrasound examination in the 1st trimester, the doctor determines the size of the fetus, gestational age, location and condition of the placenta, and the risk of Down syndrome in the child.

Based on the data you provided, we can draw the following conclusions.

The fetal heart rate at the 13th week of gestation is in the range of 147–171 beats per minute.
The average CTE is 63–74 mm at the 13th week, and 63–89 mm at the 14th week.
The normal TVP is 0.7–2.7 mm. An increase in the thickness of the nuchal translucency is evidence of an increased risk of having a child with Down syndrome.
BPR at the 13th week is in the range of 20–28 mm, at the 14th week – 23–31 mm.
OG at the 13th week is 73–96 mm, at the 14th week – 84–110 mm.
Coolant at the 13th week varies between 58–80 mm, at the 14th week – 66–90 mm.
Dlb at the 13th week is normally 7.0–11.8 mm, at the 14th week – 9.0–15.8 mm.

The risk for Down syndrome is calculated by a special computer program that takes into account the data obtained during an ultrasound examination, the woman’s age, a burdened medical history with the presence of children with Down syndrome in the woman or her close relatives, including her husband’s side. Normally, this figure should be 1:380 or less.

According to the data you provided, you are not in the risk group for having a child with Down syndrome.

To obtain reliable information, you need to contact an obstetrician-gynecologist with the results of the 1st screening ultrasound.

Thanks a lot! At least a little, but they calmed me down) they’ll look more accurately at the second ultrasound)

Good afternoon, help me understand the adjusted Mom and calculated risks

fb-hCG 92.6 ng/ml 3.50 Accor MoM,

PAPP-A 10.5 mlU/ml 2.37 Accor MoM,

Corrected MoM and calculated risks when conducting biochemical screening during pregnancy are necessary to obtain the risks of having a child with a congenital pathology.

MoM is the coefficient of the degree of deviation from the average normal values. Is universal for all laboratories.

The MoM may deviate depending on a number of factors:

The race of the woman;

Bad habits, including smoking;

Number of fetuses in the uterus;

Concomitant diseases, including diabetes, hypertension;

Pregnancy through IVF.

Adjusted values of indicators are calculated adjusted for risk factors. As a result, the absolute and adjusted MoM values may differ significantly.

The normal values for fb-hCG in ng/ml and PAPP-A in mlU/ml are different for each laboratory. When issuing test results, there is a column with standards for a given laboratory.

The norm for MoM ranges from 0.5 to 2.0 MoM.

In your case, there is not enough data to decrypt.

If we take into account only the MoM provided by you, we can note an increase in both indicators relative to the norm. This may be due not only to an increased risk of having a child with a congenital anomaly, but also to the characteristics of pregnancy or the development of two or more fetuses.

To receive a full transcript, you need to provide the research findings to your obstetrician-gynecologist. If necessary, you will be referred for an invasive test, or amniocentesis, to obtain reliable information.

Hello, help me understand the results of the 1st ultrasound screening. Pregnancy period: 12 weeks, 6 days body length - 63, femur length - 8.6, nasal bones - two 2.2 mm each, without any features.

For your conclusion, you did not indicate the main indicator - the risk of developing Down syndrome, which is determined based on the results of an ultrasound study, the woman’s age and the presence of risk factors for the development of the pathology.

Your data indicates the following:

CTE at 12 weeks 6 days of gestation is 51–73 mm.

Heart rate at 12–13 weeks is in the range of 150–174 beats per minute.

TVP from the 12th week to 12 weeks 6 days is in the range of 0.7–2.5 mm. The average value is 1.6 mm. An increased risk is established when the TVP increases above 2.5 mm.

BDP from the 12th to 13th week of gestation is 18–24 mm.

Normal exhaust gas is 58–84 mm.

Coolant normally varies from 50 to 72 mm.

Dlb at the 12th week of pregnancy is 4.0–10.8 mm.

The nasal bones should be visualized and range from 1.8 to 2.3 mm.

Blood flow in the ductus venosus should not normally be zero or reverse.

The ultrasound screening data you provided for the 1st trimester of pregnancy is within normal limits.

To confirm the normal course of pregnancy and the absence of risk of having a child with Down syndrome, you need to consult a gynecologist at the antenatal clinic at your place of residence. You must have an ultrasound doctor's report with you.

Good afternoon, I need your help. The Uzist almost gave me a heart attack. She was very rude. And as soon as she began to move it over her stomach, she rudely shouted: You have an anomaly. You need to see a geneticist. She didn’t explain anything, she just was rude and tried to understand that this screening was a death sentence! Here's the conclusion:

The thickness of the collar space is 4.3 mm; the nasal bones are visualized to be 1.0 mm long; pulsation index in the ductus venosus 1.07/reverse. The coccygeal-parietal size of the embryo is 54 mm. The purity of the heartbeat is 159 beats per minute. Pregnancy 12.1 weeks.

The conclusion you described lacks data. To complete the picture, you need to know your age and the presence of risk factors for having a child with Down syndrome, as well as the full conclusion of the ultrasound screening.

In ultrasound screening, which is performed from 10 weeks 6 days to 13 weeks 6 days of pregnancy, the main thing is the conclusion about the risk of Down syndrome. This parameter is calculated automatically by a computer program.

In addition, ultrasound examination should indicate the dimensions of the head in the form of biparietal size and circumference, abdominal circumference and thigh length. Another important indicator is the location and condition of the placenta, through which the child receives the necessary nutrients for normal growth and development.

Based on the data you provide, the following conclusions can be drawn.

KTP, or coccygeal-parietal size at 12–13 weeks of gestation is 51–59 mm.
The fetal heart rate should be between 150 and 174 beats per minute.

The thickness of the collar space, or TVP, should be 1.6–2.5 mm.

The nasal bones at 12 weeks of pregnancy should be clearly visible and be more than 3 mm.

The pulsation index in the venous duct normally does not have negative indicators or reverse.

An increase in TVP, a decrease in the thickness of the nasal bones and the presence of reversal in the venous duct indicate an increased risk of having a child with Down syndrome.

However, you should not rely only on ultrasound data. In order to confirm or refute pathology in the fetus, you need to immediately contact a gynecologist at the antenatal clinic.

Based on all the data received from you, the specialist will prescribe further examination, which includes non-invasive and invasive procedures.

Non-invasive interventions include biochemical screening with determination of beta-hCG and PAPPA-A levels. The study allows you to calculate the risk of a chromosomal abnormality in the fetus.

Based on the results of studies, if there is an increased risk of having a child with a congenital pathology, you will be offered to undergo invasive intervention in the form of amniocentesis, cordocentesis or chorionic villus biopsy.

And remember that stress and anxiety in your position are unacceptable.

Hello! I had a screening done at 12 weeks and 6 days, KTR 64, TVP 1.7 mm, elevated hCG 2.578, other indicators were normal. Risk 1:687. Please tell me something is wrong? What is the likelihood of developing pathologies in a child?

There is not enough data to reliably assess the result. To complete the picture you need to know:

Your age.
Do you or your immediate relatives have children with Down syndrome or other genetic pathologies?
A complete picture of the ultrasound screening, indicating the dimensions of the head, abdomen, femur length, visualization and thickness of the nasal bone. The nasal bone becomes accessible from 11 weeks of gestation.
Risks due to a genetic abnormality after a biochemical study.
You indicate the risk of 1:687, but do not specify what kind of screening it is: ultrasound or biochemical.

The risk of a chromosomal abnormality should normally be more than 1:380 based on the results of ultrasound and biochemical screening.

The CTE of the fetus at 12 weeks of gestation ranges from 51 to 59 mm, at 13 weeks - from 62 to 73 mm.

TVP at 12 weeks is in the range of 1.6–2.5 mm. An increased risk of having a child with Down syndrome is established when this indicator exceeds 3 mm.

The data you indicated from the ultrasound screening are within normal limits.

Normally, the free beta subunit of hCG is in the range of 0.5–2.0 MoM. In your case the indicator has been increased.

Elevated hCG levels may be associated with:

Down syndrome in the fetus;
multiple pregnancy with two or more fetuses;
toxicosis of the first half of pregnancy;
the presence of concomitant diseases in the mother, including diabetes mellitus, arterial hypertension.

In order to obtain reliable information, you should contact your attending obstetrician-gynecologist, who, based on all the data, will make a conclusion and develop tactics for further pregnancy management, adjusted for concomitant diseases. If indicated, you will be offered to undergo a second biochemical screening or invasive intervention in the form of amniocentesis.

Based on the risk you indicated, I can say that 1 woman out of 687 can give birth to a child with a congenital pathology. This indicator belongs to the low-risk group.

I am 25 years old, I have no relatives with any pathologies either on my husband’s side or on mine. Ultrasound at 12.3 weeks ktr 64 mm, heart rate 160, tvp 1.7 mm, nasal bone 1.5 mm. Chorionic presentation. They did an ultrasound and immediately took blood from a vein.

Hello, please help me figure it out. They suggest doing a puncture because there are risks. Screening 12 days and 4 days.

Weight: 56.1 Height: 153 Age: 33.

Intracranial space 2.2mm

Ductus venosus 0.90

Nasal bones 2.4 mm

Free hCG beta subunit 6.70 IU/l equivalent to 0.184 MoM

PAPP-A 0.628 IU/l is equivalent to 0.187 MoM

Trisomy 21: basic (1:407) individual (1:8144)

Trisomy 18: basic (1:995) individual (1:335)

Trisomy 13: basic (1:3121) individual (1:22)

Have you or your close relatives had pregnancies with an established genetic pathology?

Let's look at the results of your screening. Let's start with ultrasound research.

You do not indicate what the risk for Down syndrome was according to the ultrasound. In addition, for correct interpretation of the data, it is necessary to indicate all fetal dimensions: BPD, head circumference and femur length. The condition of the placenta is of no small importance.

The fetal heart rate at 12–13 weeks of pregnancy should be 150–174 beats per minute.
CTE at 12–13 weeks of gestation is in the range of 51–73 mm. At 12 weeks 4 days, CTE can be from 49 to 69 mm.
TVP normally varies from 1.6 to 2.5 mm.
The intracranial space should be between 1.5 and 2.5 mm.
The ductus venosus should not have negative values and not have reverse.
The nasal bones begin to be visualized from the 11th week of pregnancy. Their normal thickness is 1.8–2.3 mm.

Based on the data you provided, we can conclude:

The fetus experiences a slight increase in heart rate, which may indicate hypoxia. It is necessary to know the condition of the placenta.
If tachycardia is associated with insufficient functioning of the placenta, hospitalization in the gynecological department is necessary.
Lack of oxygen for the fetus may be associated with bad habits of the mother, among which smoking is the most harmful.

Let's look at biochemical screening.

Normally, the free beta-hCG subunit and PAPP-A range from 0.5 to 2.0 MoM.
Your biochemical screening data is within normal limits. The exception is the individual risk of trisomy 13, or Patau syndrome.

The risk of having a child with trisomy 13 is 1 in 22 women. This indicator belongs to the high-risk group. Perhaps you or your close relatives previously had children with developmental anomalies, which led to such indicators.

To make sure that the baby is healthy, you should undergo an invasive procedure in the form of amniocentesis followed by genetic counseling.

Irina Vyacheslavovna thank you very much.

Age 43

Among the relatives there is no one with pathologies; there is a 15-year-old child who is healthy.

Two STs in 2014 and 2015.

Term 12n6d according to m, 12n3d according to ultrasound

Fetal CTE 59.7, BPR 21.1, TG 75.8, OB 65.7, DB 8.2, HR 162, no defects in the calvarial bones, TVP 2.5, nasal bones 1.8, normal blood flow, anterior chorion localization, fetal weight 65+/-9

Risks due to a genetic abnormality after a biochemical blood test:

PAPP-A 0.422, fb-hCG 2.39

age risk 1:30

Biochemical risk T21 1:50

Combined risk for Trisomy 21 1:50

Trisomy 13/18 +TE 1:50

MoM of the neck fold 1.61

Currently the term is 13.5 according to ultrasound

The age-related risk of having a child with Down syndrome increases after a woman reaches 40 years of age.

Due to the fact that you are 43 years old and have a history of 2 missed pregnancies, you will be asked to undergo an invasive procedure in the form of amniocentesis. In addition, you have increased risks based on the results of the first screenings.

Let's analyze all the data.

The gestational age according to ultrasound and menstruation can vary within 7 days, which depends on the time of ovulation and fertilization of the egg.

The normal CTE of the fetus at 12–13 weeks of pregnancy is 51–73 mm.
The fetal BPD is 18–24 mm.
Exhaust gas - 58–84 mm.
Coolant - 50–72 mm.
DB - 4.0–10.8 mm.
The fetal heart rate should vary between 150–174 beats per minute.
TVP should normally be 1.6–2.5 mm.
The nasal bones should be visualized and their thickness should be between 1.8 and 2.3 mm.

You do not indicate what the risk for Down syndrome is based on the results of ultrasound screening. This indicator is calculated automatically by a special program.

All the data you provided is within normal limits. However, the thickness of the nasal bones and TVP are at the lower limits of normal, which, together with age, will make the risk result higher.

According to the results of a biochemical study, PAPP-A and fb-hCG should be from 0.5 to 2.0 MoM.

You have an increase in the free beta-hCG subunit, which may be associated with the presence of Down syndrome in the fetus or result from concomitant pathology.

Risks after studies should be more than 1:380. Your risks are increased. This means that with tests like yours, 1 woman in 50 has a chance of giving birth to a child with a genetic pathology.

To clarify the diagnosis, you need to immediately contact your treating gynecologist, who, based on all the data, will be able to develop tactics for further pregnancy management.

You will be asked to undergo amniocentesis to make a correct diagnosis.

Pregnancy period: 12 weeks 3 days, ktr 57mm, hCG 41.5 ng’ml, rrr-a 1365.6ml, tvp 0.1mm

Down syndrome.v.risk.1:1417 estimated risk. 1:5712

Sind.Edwards. age.risk.1:1274 calculated risk. 1:1000

Hello, I'm Lisa. Help me find out. Thank you. Can not wait.

To obtain accurate information, you need to contact the gynecologist at your place of residence with the results of the study.

You are providing insufficient information. For an accurate conclusion, it is necessary to know all the parameters based on the results of ultrasound and biochemical screening. For reliability it is necessary:

Anamnestic data indicating whether you or close relatives have a genetic pathology.
Fetal dimensions: head size, abdominal circumference, thigh length.
Fetal heart rate.
Visualization of the nasal bone and its thickness.
Condition of the placenta.
Biochemical test data in MoM, or international units, which are the same for all laboratories.
If you indicate data in ng/ml, then you must indicate the standards of the laboratory where you donated blood for testing, since the data may differ.

Normal CTE at 12–13 weeks of pregnancy is in the range of 51–73 mm.
The normal TVP is 0.7–2.5 mm.
After biochemical screening, the risks should be more than 1:380.

Based on the risks you indicated, you do not fall into a group at high risk of having a child with a genetic abnormality. But only your obstetrician-gynecologist can make a conclusion about a normal pregnancy.

Good afternoon, please tell me. Ultrasound: Term 13.3. KTR -68mm, HR-164, TVP 1.5mm, nose 2.5mm, PI0.25.

Blood: PAPP-A 8.075 IU/l-1.705 Mohm b-hCG 80.86 IU/l - 2.123 Mohm

Help me decipher, the doctor didn’t say anything

Unfortunately, there is not enough data. The full list can be found on the page http://in-waiting.ru/ask-qa (Category “Pregnancy Development”)

Irina Vyacheslavovna, thank you very much for the detailed information, I live in Italy, and it was very difficult to understand the results, there is still a week before my appointment with the doctor, I would be very grateful if you give a brief explanation, Here are my results (I donated blood a week before the ultrasound - the doctor said so):

Date of the first day of the last menstruation 02/28/17

My age is 28; Height 167, weight 53

Duration 12 weeks and 2 days

Baby's heart rate: 156bpm

Top cross length (CRL): 62.0 mm

Diameter biparietal (DVP): 19.0 mm

hcg:57.8 UI equivalent to 1.135 MoM

PaPP-A: 0.904 UI equivalent to 0.355 MoM

Risks of trisomy 21:

basic 1:771 correct 1:630

Risks of trisomy 18:

Base 1:866 correct 1:13014

Risks of trisomy 13:

Basic 1:5858 correct< 1:20000

Does the pregnancy period match according to menstruation and ultrasound?

At this point, if the dates match, you should be 13-14 weeks pregnant. If they do not match, you need to rely on ultrasound screening.

Based on the research results provided by you, the following conclusions can be drawn.

The fetal heart rate at 12–13 weeks of gestation is in the range of 150–174 beats per minute. Your baby's heart rate is within the normal range of 156 beats per minute.

CRL, or CTR, or coccygeal-parietal size at 12–13 weeks varies from 42 to 73 mm. The CTE of your fetus is 62 mm, which is normal.

NT, or TVP, or nuchal translucency thickness is normally in the range of 0.7–2.5 mm and should not exceed 3 mm.

In order to make a conclusion about the result of ultrasound screening, you need to know all the fetal measurements and the risk for Down syndrome, which is calculated automatically.

Biochemical screening results: free beta-hCG subunit and PAPPA-A should be in the range of 0.5–2.0 MoM, and the risks for chromosomal abnormalities should be higher than 1:380.

In your case, neither the baseline nor the adjusted risk values place you at risk for a chromosomal abnormality.

In order to find out accurate information, contact your local gynecologist.

Irina Vyacheslavovna, thank you very much, I am sincerely grateful.

Please help me understand the analyses.

Second pregnancy. Mother's age is 22 years. Weight 52.0kg

Pregnancy 12 weeks + 3 days according to KTR

Fetal heart rate 152 beats/min

Nasal bone: determined; Tricuspid valve Doppler: normal; Doppler ductus venosus: normal;

Free hCG beta subunit: 23.80 IU/l equivalent to 0.580 MoM

RARRA-A: 4.014 IU/L equivalent to 1.378 MoM

Baseline risk: trisomy 21; 1:1035; trisomy 18; 1: 2470; trisomy 13; 1:7763

Individual risk: trisomy 21; 1:20709; trisomy 18; 1:49391; trisomy 13: 1:155262.

The data is not complete enough:

When was your last period?
Do gestational dates match according to menstruation and ultrasound?
How was your previous pregnancy?
What is the meaning of TVP, or NT, or collar space thickness?
Dimensions of the fetal head, abdominal circumference and length of the femur?
What is the risk for Down syndrome based on screening results?

Based on the data provided, the following conclusions can be drawn.

CTE in pregnancy 12–13 weeks is in the range of 51–59 mm.

The fetal heart rate should vary from 150 to 174 beats per minute.

The nasal bone after 11 weeks of pregnancy should be clearly visible and be more than 3 mm.

The ductus venosus normally does not have negative values or reverse.

According to the results of biochemical screening, the free beta-hCG subunit and PAPAA-A should be in the range from 0.5 to 2.0 MoM.

The risks for a chromosomal abnormality, both according to ultrasound screening and biochemical testing, should be greater than 1:380.

The research data you provide is within normal limits. However, there is insufficient data to draw a conclusion.

You need to contact a gynecologist at your place of residence and provide him with all the findings. By comparing anamnestic data, ultrasound and biochemical screening, the doctor will be able to answer what risks you have for having a child with a chromosomal abnormality.

Hello. Please tell me the results of screening for a period of 11 weeks and 4 days.

PAPP-A 0.28 (according to the Life Cyclt program)

Down syndrome 1:475

Edwards Syndrome-(T18)- 1:5862.

I’ll be donating blood to geneticists in a week. Well, now I can’t find a place for myself. Help me understand these indicators.

Please help me understand the analysis

Age 38 years. Weight 110kg

Pregnancy 11 weeks + 3 days

TVP - 1.80 mm (1.40 MoM)

Fetal heart rate 134 beats/min

Nasal bone: determined, 2.3mm;

hCG: 39.2 ng/ml; 0.94 MoM

RARRA-A: 1.04 mlU/ml; 0.95 MoM

Biochemical risk+NT 1:873 (below cut-off), Double test 1:800 (below cut-off), Age risk 1:126, trisomy 13/18<1:10000;

There is not enough data to answer the question of how your child is developing. It is not possible to judge the condition of the fetus only by the results of the study indicated by you.

For a complete picture, you need to contact a gynecologist at your place of residence for tests.

To give an opinion about the child’s condition and the risk of developing a chromosomal abnormality, you need to know:

History of a woman.
Full description of ultrasound screening results.
Conclusion of an ultrasound study indicating the risk of having a child with Down syndrome.

Normally, the risk of a chromosomal abnormality should be higher than 1:380, both according to the results of ultrasound and after a biochemical study.

Every woman over 35 years of age is at increased risk of having a child with Down syndrome. You need to consult a geneticist and, if necessary, conduct additional tests in the form of invasive intervention: amniocentesis, cordocentesis or chorionic villus biopsy.

Free beta-hCG subunit and PAPPA-A should be between 0.5 and 2.0 MoM.
At 11 weeks, 3 days of pregnancy, the fetal calf size is 37–54 mm.
TVP is in the range of 0.8–2.2 mm.
The nasal bones begin to be visualized from the 11th week of gestation, and their thickness should not exceed 3 mm.
The fetal heart rate is 153–177 beats per minute.

In your case, it is necessary to know the condition of the placenta, since according to the results of an ultrasound examination, the child has bradycardia, or a decrease in heart rate. To improve the condition of the fetus, you need to undergo a course of treatment.

In addition, bradycardia may be one of the signs of impending spontaneous miscarriage.

To maintain and prolong your pregnancy, you need to urgently consult a doctor.

Tell me, is everything okay?

13 weeks pregnant exactly at the time of screening

Ductus venosus PI 1.040

Choriton/Placenta - low on the anterior wall

Umbilical cord - 3 vessels

hCG - 53.7 IU/l equiv. 1,460 Mohm

PPAP-A - 2.271 IU/l equiv. 0.623 MoM

Trisomy 21 1:10326

Trisomy 18<1:20000

Trisomy 13<1:20000

Preeclampsia before 34 weeks of pregnancy 1:640

Preeclampsia before 37 weeks of pregnancy 1:168

Let's look at all the data you provided. Let's start with being within the normal range.

The fetal heart rate at 13 weeks of gestation can range from 147 to 171 beats per minute.
The fetal CTE, or coccygeal-parietal size, at 13 weeks of pregnancy is 51–75 mm, the average value is 63 mm.
TVP, or nuchal translucency thickness, or NT, is one of the main indicators during the first ultrasound screening, since based on this indicator the risk of having a child with Down syndrome is calculated. Normally, TVP is 0.7–2.7 mm.
The BPD, or biparietal size of the fetal head should be in the range of 20–28 mm, the average value is 24 mm.

The ductus venosus should have positive values. If the indicator is negative or there is a reversal, this increases the risk of a child developing a chromosomal abnormality.

The fetal umbilical cord normally consists of three vessels: 2 arteries and 1 vein, through which oxygen and nutrients necessary for the development of the fetus are supplied.

To make a conclusion about the condition of the fetus, the following data is not enough:

Fetal dimensions: head circumference, abdominal circumference, thigh length.
Visualization and thickness of the baby's nasal bones, which are measured after 11 weeks of pregnancy.
Visualization of the internal organs of the fetus.
Conclusion of ultrasound screening for Down syndrome, which is normally more than 1:380.

According to the results of the ultrasound, the placenta in your case is located along the anterior wall. The location of the baby's seat may vary depending on the implantation site. Moreover, for a normal pregnancy, the placenta should be located 7 cm or more above the internal os.

According to the ultrasound, your placenta is located low, which means its location is below 7 cm from the internal os. This indicator is monitored at the second ultrasound. Most often, as pregnancy progresses, the placenta rises and takes a normal position. In the case when its elevation is not carried out, we can talk about the low location of the placenta, which requires the close attention of the woman and the doctor.

According to the results of biochemical screening, the normal levels of free beta-hCG subunit and PAPPA-A are 0.5–2.0 MoM.

Risks are normally higher than 1:380.

In your case, the risk of developing late gestosis is increased. This may be due to the course of this pregnancy and previous ones. The risk increases if a woman had gestosis in a previous pregnancy. To do this, you need to know your obstetric-gynecological and somatic history.

To get reliable information, contact your local obstetrician-gynecologist.

Hello! Help with sorting out the tests: 3rd pregnancy. 30 years

ultrasound 1st trimester 05/16/2017 (estimated pregnancy period 10 weeks 4 days)

fetometry: CTE 48 mm. embryo size = 11 weeks. 5 days

nasal bone 2.2 mm.

general screening: from 05/17/2017 (calculated by ultrasound 11 weeks 5 days)

rrr- A=0.53 MOM. HCG-3.12 MOM

Disease Down Syndrome

Age risk 1:810………..Calculated risk 1:184 -High risk

Disease Down Syndrome only in biochemistry

Age risk 1:810………..Calculated risk 1:28 -High risk

The rest of the indicators were low. I had a geneticist and amniocentesis was recommended.

Question...what week is the calculation based on? At 10 and 12 weeks then the tests will be normal, if at 11 weeks then yes there are risks of increased hCG...

Converted MOM to another unit (ng/ml)…using medians

Which week should I take for calculation? if 1 day of last menstruation. 03/03/2017

The gestational age is calculated based on the results of the 1st ultrasound screening. This is due to the fact that the fetus in the period from 10 weeks 6 days to 13 weeks 6 days has the same size, which is calculated using special tables. After the 14th week of gestation, fetal development varies and depends on genetic characteristics.

Calculation of gestational age by ultrasound is calculated on the basis of data on all sizes of the fetus.

The gestational age according to ultrasound and the date of the last menstruation may differ, depending on ovulation. Ovulation may be early, then the gestational age is longer according to ultrasound. With late ovulation, the gestational age will be shorter according to ultrasound. If ovulation occurred in the middle of the menstrual cycle, the gestational age according to ultrasound and the date of the last menstrual period will coincide.

In order to answer your question correctly, the following information is required:

Fetal dimensions indicated in mm: BDP, abdominal circumference, thigh length.
Size, location and condition of the placenta.
Fetal heart rate.
Conclusion on the risk of having a child with Down syndrome based on ultrasound screening results.
Your medical history: have you or your close relatives had children with a chromosomal abnormality?
How did previous pregnancies end?
The nature of the menstrual cycle: its regularity, how long after the next menstruation begins, how many days menstruation lasts.

Based on the date of your last menstrual period, your pregnancy should be 17–18 weeks. According to ultrasound screening - 18–19 weeks. A difference within 7 days is not a deviation. The gestational age is calculated using ultrasound screening.

The CTE of the fetus at 11 weeks 5 days of pregnancy is in the range of 39–57 mm, the average value is 48 mm.
The normal TVP is 0.8–2.2 mm.
The nasal bone is clearly visualized after 11 weeks, its average thickness is 1.4 mm. After the 12th week of pregnancy, its thickness should be more than 3 mm.

Based on biochemical screening, free beta-hCG subunit and PAPPA-A should be between 0.5 and 2.0 MoM. The calculation in ng/ml is individual for each laboratory, and the standards are indicated separately.

Risks should normally be more than 1:380.

In your case, the level of hCG and the risks of a chromosomal abnormality are increased.

In order to make sure that the fetus does not have a chromosomal pathology, you need to undergo additional examination in the form of amniocentesis followed by consultation with a geneticist.

Tell me if everything is okay, the doctor said there are abnormalities in the tests. What does this mean? I am 29 years old, 9 months ago I gave birth to my first child. I have no relatives with pathology. At the time of the ultrasound, it was 12.5 days per month, according to the ultrasound 12.2 days .KTR - 56mm.HR-160 beats/min.TVP-1.4 mm.Nasal bone-2.1mm.PI-1.1.PAPP-00.861 MOM.v-hCG - 0.291 MOM.

Hello, I was referred to a geneticist for screening tests. Please tell me if I should worry. I’m 28 years old. Ultrasound: 11 weeks, 4 days, ktr-48mm, bg-16.6mm, heart rate-171 beats, tvp-1.5mm ., ksk in the venous duct - 1.00., length of the nasal bones - 1.5 mm., yolk sac - 3.1 mm., screening: hCG - 91.70 me/l/2.131 mm., PAPP-A-0.373 me/ l/0.255mom., trisomy 21-ind: 1:706, base: 1:58., trisomy 18-ind: 1: 1588, base: 1: 4326., trisomy 13-ind: 1: 5017, base: 1 :3055. Thanks in advance!

Based on the results of screening in the first trimester of pregnancy, you are at high risk of having a child with Down syndrome.

To make sure that the fetus does not have a chromosomal abnormality, you need to consult a geneticist. If necessary, the doctor will refer you for additional research in the form of invasive diagnostics. Depending on the stage of pregnancy, you may be offered a chorionic villus sampling, cordocentesis or amniocentesis.

We will analyze the provided data from your research.

At 11–12 weeks of pregnancy, the norms for the first ultrasound screening are:

CTE - 38–56 mm, the average value for 11 weeks 4 days is 47 mm;
BRG - 13–21 mm;
TVP - 0.8–2.4 mm;
blood flow in the venous duct is positive, has no reverse values;
nasal bones are clearly visualized, their thickness is on average 1.5 mm;
yolk sac - more than 2 mm from 6 to 12 weeks of gestation.

The ultrasound values you indicated are within normal limits. To determine the risk of Down syndrome in a child, you need to know:

all sizes of the fetus;
condition of the placenta;
ultrasound conclusion, in which a special program calculates the risk of a chromosomal abnormality.

According to the results of biochemical screening, the free beta-hCG subunit and PAPPA-A should be in the range from 0.5 to 2.0 MoM, and the risks of chromosomal pathologies are higher than 1:380.

With an increase in beta-hCG, the risk of Down syndrome in the fetus increases. This indicator may also increase as a result of other reasons, such as gestosis, diabetes mellitus or other concomitant diseases.

According to your indicators, a child with trisomy 21 pairs of chromosomes, or Down syndrome, can be born to 1 in 58 women, which is a high risk.

Only your doctor can give you more detailed information.

Hello! Now I am one week pregnant, I only just now found out that I have abnormal blood results from the first screening at 12 weeks, papp -0.41 mom, hCG - 0.42 mom! He didn’t tell me anything about this earlier, although they should have referred me to a gyneticist, as I understand it, but alas, the train has already left! Calculated risk T-21 1:6657, T-18 1:2512, T-13 2:, and according to the program astaria T-13 1:1422, help me decipher I’m going crazy for the second day.

According to the ultrasound and the first and second, everything is fine without pathologies! My doctor on vacation will find out why it happened that they didn’t inform me about the low blood levels. The midwife couldn’t tell me if my results were scary.

Normal values for biochemical screening in the first trimester of pregnancy are free beta-hCG subunit and PAPPA-A from 0.5 to 2.0 MoM.

Deviations from normal values can be caused by a number of factors, including fetal development anomalies and unfavorable pregnancy.

A simultaneous decrease in beta-hCG and PAPPA-A levels may occur with an increased risk of developing Edwards syndrome in the fetus. In addition, indicators may be reduced if spontaneous miscarriage threatens.

The estimated risk for a chromosomal abnormality in the fetus should be higher than 1:380 for all indicators.

Your calculated risks are within normal limits.

When detecting reduced levels of beta-hCG and PAPPA-A, the doctor is guided by ultrasound screening data. If the study reveals deviations from the norm, it is necessary to undergo a consultation with a geneticist and, if indicated, conduct additional research in the form of an invasive intervention.

If the ultrasound screening results do not reveal any abnormalities, it is recommended to undergo a second screening test at 16–20 weeks of pregnancy.

To resolve any questions you may have, you need to contact the antenatal clinic at your place of residence.

Good afternoon, please help me decipher this, I am 28 years old, the screening was at 11 weeks. Blood results -PAPP-A-4.33, -cor.mom 1.96, free beta hCG-134, corr.mom 2.63.biochemical risk + NT on the date of sample collection 1:7076 below the cutoff, age-related risk at date of sample collection 1:726, trisomy 13/18+NT<1:10000 ниже пор. Отсечки.помогите расшифровать пожалуйста!

You have undergone biochemical screening in the first trimester of pregnancy, which is carried out from 10 weeks 6 days to 13 weeks 6 days. At the same time, the first ultrasound examination is scheduled.

The assessment of the fetal condition is carried out based on the totality of studies performed: biochemical and ultrasound screenings. If there are deviations, the woman is referred to a geneticist for consultation. If indicated, additional invasive research is performed in the form of cordocentesis, chorionic villus biopsy or amniocentesis, depending on the gestational age.

Normally, the results of biochemical screening indicators for free beta-hCG subunit and PAPPA-A are in the range of 0.5–2.0 MoM.

The estimated risks for the development of a chromosomal abnormality in the fetus should be higher than 1:380 for all indicators.

The corrected MoM value normally varies from 0.5 to 2.0 MoM. This indicator is calculated by a special computer program individually for each pregnant woman. In this case, adjustments are made for age, anamnestic features and a number of other factors.

Based on the biochemical screening indicators provided by you, we can conclude that the child is not at risk for developing a chromosomal abnormality if an error was made in the writing and instead of 134 MoM there should be 1.34 MoM of the free beta-hCG subunit. If this indicator is elevated, this may indicate fetal pathology.

To obtain correct information, I recommend that you contact an obstetrician-gynecologist at your place of residence. After studying the results of biochemical and ultrasound screenings together, the doctor will choose further tactics for managing your pregnancy.

Good afternoon, I’m now in Bulgaria, I had an ultrasound and biochemical screening at 12 weeks and 3 days, the first day of my last period was April 8, before that my cycle was disrupted, the date of conception was April 23, I donated blood on July 14, 2017. I’m 33 years old and weigh 85 kg. , according to the ultrasound, the doctor said that everything was fine, but she didn’t give any conclusions with measurements, only a photo of the baby, I’m very worried about the results of the analysis, I can’t decipher it, please help

Risk of Down syndrome 1 in 12,000

Edwards syndrome 1 in 29,000

Patau syndrome 1 k

Turner syndrome 1 k

Biochemical risk of Down 1 in 4300

Age risk 1:54

Free bCG 0.33 MoM

In order to give an opinion about the condition of the fetus, it is necessary to know the results of ultrasound and biochemical screenings of the first trimester together. These studies allow us to get a complete picture.

Ultrasound allows you to take measurements of the fetus in order to identify pathologies of the child’s organ systems. In the gestation period from 10 weeks 6 days to 13 weeks 6 days, all fetuses have similar parameters; after the 14th week of gestation, the child begins to develop individually, which is genetically determined. In addition, the thickness of the collar space and nasal bones is measured. Based on the data obtained, the risk of Down syndrome in the fetus is determined. The condition of the placenta is important.

Normal free beta-hCG subunit and PAPPA-A range from 0.5 to 2.0 MoM. Risks for chromosomal abnormalities should be above 1:380 for all indicators.

In your case, 2 indicators do not fit into the norm: the free beta-hCG subunit is reduced and the risk of Down syndrome is high due to age.

Risks for Down syndrome are determined automatically by a special computer program, taking into account a number of factors.

A decrease in beta-hCG may indicate the presence of a chromosomal abnormality in the fetus in the form of Edwards syndrome, placental insufficiency, or threatening spontaneous miscarriage.

Any of the reasons requires immediate consultation with an obstetrician-gynecologist. If necessary, you will be prescribed the necessary therapy. In addition, genetic counseling is indicated for you, since you are at high risk for Down syndrome. According to indications, the geneticist will prescribe an additional study in the form of amniocentesis.

Hello! Help please, I didn’t donate blood, because the doctor said that it was too late, the last period was 16.05, according to the ultrasound they said no, they asked when the previous ultrasound was on 18.04 and they did it, all the data that is in the ultrasound: period 13, 5 weeks, ktr 75 mm, IVP 22 mm, heart rate 172 (she cried during the ultrasound, maybe that’s why) TVP 1.7, nasal bone +, blood flow in the venous duct pi 0.96, no tricuspid regurgitation, no CA markers, anatomy all +, limbs +, uterus and all without any features, cervix length Tvuzi 43 mm pharynx closed, DPM a uter dexpi- 2.56, a uter sinpi 1.95, this is all the data that is available, I want to take the genetic test, but the doctor said to wait for 2 screenings and then We’ll understand everything for him since they can’t set a deadline, can I pass the C grade relying on the deadline for this ultrasound and could it be that the deadline of May 16 is correct, and not from April 18, or should I listen to the doctor and wait for the second screening? The concern is that I took Reduxin 10 in the first weeks of pregnancy, as it turned out later, I’m afraid it might affect the baby, I drank it for a week, the doctor refrained from commenting on this matter, thanks in advance for your answer!

I am 25, weight 90, my first child is healthy.

Assuming your last period was 5/16, you should currently be 11-12 weeks gestational. If the last period is April 18, then the pregnancy period is 15–16 weeks.

To answer your question about the duration of pregnancy, you need to know:

Have you had any problems with your menstrual cycle before?
Have you had intermenstrual bleeding before?
Do you have any underlying medical conditions such as hypertension, diabetes or thyroid disease?
Do you have gynecological diseases, including cervical erosion and hormonal diseases?
Did you take sex hormones before pregnancy?
At what stage of pregnancy did you register for pregnancy? What happened during the gynecological examination?
How was your last period? Have there been any changes to them?
Did you take Reduxin 10 as prescribed and under the supervision of a doctor?
Why didn't you protect yourself from pregnancy when taking Reduxin?
How long did you take the drug?
Your height?

The gestational age is determined based on the results of the first ultrasound screening. This is due to the fact that all fetuses at a gestation period of 10 weeks 6 days - 13 weeks 6 days are of a similar size.

Ultrasound and biochemical studies are carried out at gestational ages of 10 weeks 6 days - 13 weeks 6 days. In this case, blood is donated strictly after an ultrasound, which is associated with obtaining a result for a specific stage of pregnancy.

If you donate blood for chromosomal markers yourself, the data obtained may be incorrectly interpreted.

If we assume that normal menstruation was on April 18, then the following data is obtained.

The CTE of the fetus at 13 weeks 5 days varies from 59–85 mm.
The normal fetal heart rate at the 13th week of pregnancy is 147–171 beats per minute.

An increase in the indicator may be associated with your emotional state or indicate oxygen starvation of the fetus. It is necessary to know the condition of the placenta. If there are pathological changes in it, it is necessary to undergo appropriate therapy. The second option is to do a repeat ultrasound.

TVP at 13–14 weeks of gestation should be 0.7–2.7 mm, the average value is 1.7 mm.
The nasal bone should be clearly visible and be greater than 3 mm.
Blood flow in the ductus venosus normally does not have a negative value or regurgitation.
The cervix is 35–45 mm long, the internal and external os are closed.

Reduxin 10 is a drug for the treatment of obesity with central action. Has strict indications for use. During pregnancy, its use is prohibited, as there is no data on its safety for the fetus. Its use must be accompanied by strict contraception.

Hello! Thank you for your answer, the menstrual cycle is without delay, always on time, without discharge outside of menstruation, it so happened that I took hormones and everything was normal, the doctor prescribed reduxin to cause a positive trend towards weight loss, I took it for 7 days from 10.05 to 16.05, 16.05 menstruation went and lasted about 12 hours almost as usual, but less so, then they ended, I took a test on May 16 and it turned out to be positive, before taking reduxin I also took a test, that is, on May 6 and May 8 they were negative, I took hormones on April 6, everything was within the normal range, I wanted to take a C, but at the reception center they said that I myself could not take the test even for a fee and also advised a second ultrasound (that the data could be false positive or false negative) the doctor did not say anything about contraception (endocrinologist) I warned that there was an attempt to get pregnant just in March and the tests were negative, I specifically waited for my period on April 18 to understand whether there would be a delay or not, I did more than one test, I can’t even understand how this happened, after March they took contraception, most likely if there was a conception, it was on April 18 than on May 16, I think so, I’ll go for an ultrasound on August 15 to confirm or refute the date, so that all the parameters are accurately described for the nose, arms, legs, everything in general, then with this ultrasound I’ll go to a geneticist, since my local gynecologist can’t explain or say anything! Thank you!

Good afternoon Please help me decipher the tests of 1 screening. I am 31 years old, 3rd pregnancy, ultrasound term (CTR) is 12 weeks + 5 days, obstetric term is 12 weeks. Heart rate 155 st/m, CTE 64.0 mm, TVP 1.8 mm, nasal bone is determined. Free beta unit hHF 179.0 IU/l/4.171 MoM, PAPP-A 5.270 IU/l/1.722 MoM. Trisomy 21 basic risk 1:556 individual risk (basic + ultrasound + HD) 1:5616. trisomy 18 basic risk - 1:1359, ind. Risk 1:27185. Trisomy 13 base risk 1: 4264, index risk 1: 85276.

Among the screening data of the first trimester of pregnancy, you have normal indicators and deviations from the norm. Let's look at everything in detail.

An ultrasound examination includes not only the determination of CTE, TVP, fetal heart rate and visualization of the nasal bones, but also gives a general idea of the development of the fetus by indicating all its sizes and the condition of the placenta. In addition, after the study, a conclusion is given about the possibility of developing Down syndrome in the fetus. This indicator is calculated by an automatic program.

Let us analyze the ultrasonic indicators presented by you.

The gestational age according to menstruation and ultrasound is the same and is 12–13 weeks.
The fetal heart rate at 12–13 weeks of gestation varies from 150 to 174 beats per minute.
The CTE of the fetus is 50–72 mm at 12 weeks 5 days.
TVP normally ranges from 0.7–2.5 mm.
The nasal bones are clearly visible and their thickness is more than 3 mm.

These indicators are within normal limits.

Let's analyze the results of biochemical screening.

Normally, the free beta-hCG subunit and PAPPA-A are in the range of 0.5–2.0 MoM.

The risks for all chromosomal abnormalities must be higher than 1:380. All indicators below this level fall into the high-risk group.

In your case, the risks of a chromosomal abnormality in the fetus do not fall into the high-risk group. However, beta-hCG and PAPPA-A levels are overestimated.

An isolated increase in PAPPA-A has no diagnostic value.

Increased concentrations of beta-hCG may occur:

In order to make sure that the child does not have a pathology, you need to immediately contact a gynecologist. After comparing all the data, the doctor will decide on further tactics for managing your pregnancy. You may need genetic counseling.

Hello, please tell me, I really need help deciphering the 1st screening.

I am 27 years old, my second pregnancy is planned, my first child is healthy. Last day of menstruation 08.05.

Ultrasound results (ultrasound period 11 weeks 3 days): CTR 46, BPR 18, heart rate 174, TVP 6.2. Biochemistry result: PAPP-A 0.907, hCG 0.717, risk tr.18 1:293, tr.21 1:1581, tr. 13 1:1153

The result of the second ultrasound on a different device after 6 days: CTR 59 (corresponding to 12 weeks 3d), BPR 19 (corresponding to 13 weeks), heart rate 165, TVP 4.6, nasal bone 1.7, Pi 0.90, VI ventricle 2.8, fetal features - preaxial polydantia of both hands cannot be excluded, umbilical cord 3 vessels. Conclusion: expansion of the TVP and the sixth ventricle as markers of CA.

Based on these data, is it possible to talk about any incurable diseases and what is my risk that the child will be born sick?!

The geneticist says that for such indications the pregnancy cannot be terminated and recommends undergoing a chorionic villus biopsy and a control ultrasound within a week.

Let's decipher the first screening study. The norms for the 11th–12th weeks of pregnancy are:

In your case, the marker of a chromosomal abnormality in the fetus is TVP.

According to the results of biochemical screening, the free beta-hCG subunit and PAPPA-A should be in the range of 0.5–2.0 MoM, and the risk values should be higher than 1:380.

According to the results of the study, you have an increased risk of having a child with trisomy 18, or Edwards syndrome.

Let's look at the second screening study. The growth of the child is noted according to the gestational age. The norms for the 12–13th week of pregnancy are:

KTR - 51–59 mm;
BPR - 18–24 mm;
Heart rate - 150–174 beats per minute;
TVP - 1.6–2.5 mm;
nasal bone - clearly visualized, average value is 1.8 mm;
VI ventricle - 10–15 mm.

Pathological indicators are expansion of the sixth ventricle and excess of the TVP value.

Another pathology according to ultrasound is preaxial polydactyly of both hands in the fetus. The pathological condition is manifested by doubling of fingers. This defect can be isolated, or it can occur as part of a chromosomal pathology in the fetus.

Gestational age 12w 6d according to KTR

Fetal heart rate 167 beats/min.

Ductus venosus PI 0.890

Chorion/placenta low on the posterior wall

Umbilical cord 3 vessels

Markers of fetal chromosomal pathology:

Nasal bone: determined; Tricuspid valve Doppler: normal

HCG 61.4 IU/L is equivalent to 1.805 MoM

PAPP-A 1.569 IU/l is equivalent to 0.528 MoM

Uterine artery PI 1.49 equivalent to 0.930 MoM

Trisomy 21 - basic risk 1:452/ind. risk 1:498

Trisomy 18 - basic risk 1:1110/ind. risk< 1:20000

Trisomy 13 - basic risk 1:3480/ind. risk< 1:20000

Preeclampsia before 34 weeks. pregnancy 1:4142

Fetal growth retardation up to 37 weeks of pregnancy 1:482

Spontaneous birth before 34 weeks of pregnancy 1:197

The gynecologist, as I understand it, drew attention to the risk of trisomy 21, in particular the too “close” index of ind. risk to the baseline. She also spoke about the research method by taking blood from a vein for DNA analysis (the procedure is not cheap). Please tell me whether there is any point in this study, which the doctor described, given such indications. Thank you very much in advance!

You have undergone the first fetal screening test in the form of an ultrasound and biochemical blood test.

I would like to clarify a few questions:

Have you had any pregnancies before and how did they end?
Are there any children in your family with Down syndrome or other chromosomal pathologies?
Ultrasound conclusion on the risk of having a child with Down syndrome.
Concomitant pathology.
Gynecological diseases.

We will analyze the data you provided.

The norms for 12–13 weeks of pregnancy are:

KTR -mm;
TVP - 1.6–2.5 mm;
BPR -mm;
ductus venosus - has no negative or reverse meaning;
umbilical cord - 3 vessels;
the nasal bone is clearly defined.

These indicators are within normal limits.

The location of the placenta can be any, however, it should be located high above the level of the cervix. At this stage of pregnancy, a low location of the placenta is allowed. As a rule, as pregnancy progresses, it rises upward. In order to avoid the threat of spontaneous miscarriage and bleeding, I recommend that you abstain from sexual activity until the next ultrasound.

Biochemical screening allows you to conduct a blood test for markers of chromosomal abnormalities in the fetus: trisomy 13, 18 and 21 pairs of chromosomes.

Normally, the levels of free beta-hCG subunit and PAPPA-A should be from 0.5 to 2.0 MoM.

The risks for a chromosomal abnormality must be higher than 1:380 for all indicators.

According to the results of the study, you are in a high-risk group for premature birth before 34 weeks of pregnancy, which requires increased attention from a doctor.

The indicator for trisomy 21 pairs of chromosomes, or Down syndrome, is close to the basic and individual risk, but does not fall into the high-risk group.

Perhaps your doctor had a different research method in mind, since you underwent non-invasive prenatal diagnostics for congenital chromosomal pathologies. Most likely, the gynecologist suggested that you undergo biochemical screening in the second trimester of pregnancy to exclude pathology in the fetus.

You should check the details with your treating gynecologist, who, if indicated, will prescribe additional research methods for you.

I found the name of the procedure:

Non-invasive prenatal diagnostics for congenital chromosomal pathologies

Help me figure out the fetal heart rate is 153 beats/min. KTR 73.0mm. TVP 1.90 mm. Free beta subunit of hCG - 101.20 IU/l/2.715 MoM PAPP - 3.208 IU/l/0.513 MoM. Trisomy 21 base risk 1:699. Individual risk 1:361 Trisomy 18. basic risk 1:1780 individual risk 1:35604. Trisomy 13 base risk 1:5564 individual risk 1:111279

I would like to communicate with you via email, if it’s not difficult, please write

On July 11, 2017, blood was drawn for 1 screening and an ultrasound examination of the fetus was performed. The ultrasound specialist set a deadline of weeks. KTR - 52mm, HR-160, TVP - 0.7mm, the nasal bone is determined (I can even see it from the photo). On August 18 (more than a month later!) the blood results finally arrived - hCG - 76.9 IU/l, PAPPA - 0.373 IU/l. They write the risks of Trisomy 21 - 1: 222 (area of attention), Trisomy 1: 706 (area of attention), trisomy 13 1: 1722. Send to a geneticist. This is the first child, there are no hereditary diseases, no abnormalities in the family either. I am a healthy person in all respects. BUT: I know exactly the day when my husband and I actually tried. Because, due to family circumstances (illness of the husband’s mother), this could not happen on any other day. And in principle, the child is conscious. This is May 1, 2017. Accordingly, the period cannot be more than 10 weeks, it can be 9 weeks and 5-6 days, for example (conception does not always occur on the day of PA). Among other things, if the term is set according to the coccygeal-parietal size, then we have a peculiarity in our family - my own father was born with a weight of 5.2 kg (and they have all 3 children with the same weight), my mother is 4.2 kg. I'm 3.3kg - normal weight. But still, everyone in the family was born large. I am very worried about possible deviations. But, as far as I understand, with a shorter actual period, hormone levels should be lower. And our TVP is small.

In order to answer your question correctly, the following information is required:

First day of last menstruation.
Do you have a regular menstrual cycle? Its duration.
Have you done ovulation tests? If yes, which ones?
A complete picture of ultrasound screening with a conclusion on the risk of developing a child with Down syndrome.
Free beta-hCG and PAPPA-A subunit results in MoM study units. Other indicators are individual for each laboratory and may differ significantly.

Since it is not known when the first day of your last period was, it can be assumed that you ovulated early. This also explains the difference of 7 days between your estimated gestational age and the ultrasound screening data.

An ultrasound examination is taken for the gestational age. Up to 12 weeks of gestation, fetal growth is the same. Individual growth begins after the 12th week.

For 11–12 weeks of pregnancy, ultrasound standards are as follows:

KTR - 34–59 mm;
Fetal heart rate - 150–174 beats per minute;
TVP - 0.8–2.2 mm, but not more than 3 mm;
The nasal bones at the 11th week of pregnancy are clearly visualized, but not measured.

According to the risks after a biochemical study, all indicators should be more than 1:380. The data below fall into the high-risk group.

In your case, genetic counseling is necessary. If indicated, you will be asked to undergo an invasive fetal examination to determine chromosomal pathology.

Please help me decipher the results! I am 27 years old. according to the monthly period, 12 allotments and 4 days at the time of delivery of hair 1, and according to the ultrasound on the same day, 13 weeks. and 2 days. KTR 67 neck fold 2.6 mm nasal bone 2.1 mm. result RAPP-A 6, 13 speed MoM 1.79, fb-hCG 42, 7 speed MoM 1.33. Biochemical risk 1:5252, double test 1:8589 Age risk 1:872. Trisomy 13/18 + NT 1:10000

There is not enough data to fully decipher the condition of the fetus. Need to know:

a complete picture of ultrasound screening indicating all dimensions of the fetus: BPD, abdominal circumference, thigh length;
conclusion based on the results of ultrasound screening indicating the risks of developing Down syndrome in the fetus;
Fetal heart rate;
condition of internal organs;
number of umbilical cord vessels;
size, condition and location of the placenta;
your medical history data.

The normal difference in the timing of pregnancy according to ultrasound screening and menstruation is considered to be within 7 days. The gestation period depends on the moment of ovulation, which can be not only in the middle of the cycle, but also early or late.

The following indicators are considered normal values for the first ultrasound screening at 13–14 weeks of pregnancy:

KTR - 54–78 mm;
The TVP, or cervical fold, ranges from 1.7–2.7 mm;
The nasal bone is clearly visible on ultrasound, and its thickness ranges from 2 to 4.2 mm.

According to the results of biochemical screening, the free beta-hCG subunit and PAPPA-A should be in the range from 0.5 to 2.0 MoM, other units of measurement are individual for each laboratory. Risks for all indicators of chromosomal abnormalities are normally higher than 1:380.

To obtain accurate information about the condition of the fetus, you need to contact an obstetrician-gynecologist at your place of residence. Based on the totality of all data: medical history, ultrasound and biochemical screening, the doctor will answer all your questions.

Good afternoon. Help me understand the screening results. Ultrasound and blood tests 12 weeks 5 days Ultrasound data: CTE 69mm BPR 21mm Fetal heartbeat: determined, heart rate 166 beats/min. PI: 0.91 Thickness of the nuchal space: 1.6 mm Nasal bone visualized: 2.1 mm Fetal anatomy: Bones of the cranial vault: b/o Brain structures: M-echo: b/o Spine: b/o Stomach: b/o Anterior abdominal wall: b/o Choroid plexuses: b/o IV ventricle: Four-chamber section of the heart: b/o Bladder: b/o Upper and lower extremities: b/o Yolk sac: not visualized Amnion: features: b/o Predominant localization of the villous chorion: posterior wall of the uterus, thickness 13 mm Structure of the orion: b/o Condition of the uterine walls: b/o Ovaries: in the right corpus luteum 23 mm Conclusion: Ultrasound signs of progressive pregnancy, 13 weeks Blood test data: PRISCA I trimester test Associated with pregnancy protein A (PAPP-A): 0.95 mIU/ml Free b-subunit 26.40 ng/ml

For a gestational age of 12–13 weeks, the following are considered to be the norms:

KTR - 50–72 mm;
BPR - 18–24 mm, average value is 21 mm;
Fetal heart rate - 150–174 beats per minute;
PI - the indicator should have a positive value with the absence of regurgitation;
TVP - 0.7–2.5 mm, the average is 1.6 mm;
nasal bone - clearly visualized, its thickness varies from 2 to 4.2 mm;
fetal anatomy - without features;
chorion thickness - 10.9–19.8 mm;
the structure of the chorion is without features, located high above the internal os;
amnion - without features;
corpus luteum - 10–30 mm.

The data you provided is within normal limits.

To make a conclusion, it is necessary to know the risk of Down syndrome in the fetus based on the results of ultrasound screening, which is calculated automatically by a special computer program based on all the data obtained and the woman’s medical history.

There is very little data to decipher the results of biochemical screening. Need to know:

indicators of the free subunit of beta-hCG and PAPPA-A in the MoM unit of measurement, which is universal for all laboratories and normally ranges from 0.5 to 2.0;
when indicating other units of measurement, such as mIU/ml or ng/ml, it is necessary to give the values of normal values, which are different for each laboratory and are indicated when issuing results;
risks due to the presence of chromosomal abnormalities in the fetus: trisomy 13, 18 and 21 pairs of chromosomes, which are normally higher than 1:380.

Good afternoon First pregnancy

26 years. Pregnancy 12 weeks. 6 days. Ultrasound screening: CTE 83mm, BPR 25mm, heart rate 155 beats/min, TVP 2.1mm, nasal bones 2.5mm. Biochemistry results: hCG 44.78 IU/l/ 1.430 MoM, PAPP-P 4.456 IU/l- 0.646 MoM. What is the likelihood of Down syndrome

Hello, I’m 31 years old, I had genetic screening done in the 1st trimester, these are the results, help me figure it out:

2nd pregnancy, 62.5 kg, at the time of screening 30 years 11 months, concomitant disease chronic autoimmune thyroiditis.

Last menstruation 17.05. Ovulation 05.06. (Late ovulation, the period is a little less than what is written)

Ultrasound: CTE 43.5. Nose bones 2.3mm. Heart rate 172 beats/min. The thickness of the collar space is 1.5 mm.

Gestation period 11.1 weeks

free beta-hCG 200. 4.01 MoM;

PAPP-A 1.19. 0.69MOM

Biochemical + NT 1:86

Double test >1:50

Age risk 1:565

Trisomy 18+NT<1:10000

Now I'm 16 weeks pregnant, an ultrasound scan was done, everything was normal, no abnormalities. We took an AFP test and 2nd trimester screening, we are waiting for the result.

Thanks for the answer.

There are a few important questions left for you:

How was ovulation checked? What tests were used?
How did your first pregnancy end?
Are you taking Levothyroxine, Euthyrox or others tablets for chronic autoimmune thyroiditis?
Are you seeing an endocrinologist?
What are the TSH levels?
Do you have hypothyroidism?
Fruit sizes: BPR, OJ, DB.
Conclusion on the risk of Down syndrome based on ultrasound screening results.
Have you been referred to genetic counseling?
Have you or your close relatives had children with chromosomal abnormalities?

For a gestational age of 11–12 weeks, the norm is in the range of:

KTR - 42–50 mm;
nasal bones are clearly visualized;
TVP - 0.8–2.2 mm.

The biochemical parameters of the first screening, free beta-hCG subunit and PAPPA-A, normally vary from 0.5 to 2.0 MoM.

Your beta-hCG level is 2 times higher than normal. This may be due to:

Risks for chromosomal abnormalities are normally above 1:380 for all indicators.

According to a biochemical study, you are in a high-risk group for having a child with a chromosomal pathology.

I recommend waiting for the results of the second screening, contacting your obstetrician-gynecologist and, if indicated, a geneticist. The question of whether it is advisable to visit a geneticist is decided individually for each woman.

Good afternoon I ask for your advice. 2nd pregnancy, 13 weeks. and 3 days. 40 years. Weight 70.4. According to ultrasound and blood: CTR 72 mm, BPR 22 mm, LZ 29 mm, OG 82 mm, coolant 71 mm, femur length 11 mm. Heart rate 158. TVP 2.1 mm. The nasal bones are visualized, 2.6 mm. The thickness of the chorion is 19 mm, along the posterior wall of the uterus. An interstitial-subserous myomatous node with a diameter of 47 mm is located along the posterior wall of the uterus. Hypertonicity of the myometrium along the anterior wall of the uterus. Free beta subunit of hCG 23.30 IU/l/0.658 MoM. PAPP-A 2.170 IU/l/ 0.616 MoM. Baseline risk: trisomy 21 - 1:69. Trisomy 18 - 1: 174. Trisomy 13 - 1: 545. Individual. risk of trisomy 21 - 1:827. Trisomy 18 - 1: 3486. Trisomy 13 - 1: 2476. I understand that there is always a risk, no one is immune. But I would not like to do amniocentesis and similar tests. Thank you in advance.

Hello, I need your advice

According to monthly period 12 weeks, according to ultrasound 14 weeks.

Beta subunit hCG: 13.68 IU/l/ 0.455 MoM

PAPP-A: 1.574 IU/l/ 0.426 MoM

Trimosomy 21: baseline: 1:504

Trimosomy 18: baseline: 1:1328

Trimosomy 13: baseline: 1:4139

Risk of hyperthesia disorders

Risk of developing preeclampsia before 34 weeks 1:2017

Fetal growth restriction up to 37 weeks 1:282

Doppler ultrasound of the uterine arteries:

Mean arterial pressure 83.4 mm Hg. equivalent to 0.960 MoM

Mother's age 32 years

There are a few questions left for you:

Do you have regular periods?
If the menstrual cycle is irregular, the minimum and maximum dates for the onset of menstruation.
According to the results of the ultrasound, the gestational age is exactly 14 weeks or, for example, 13 weeks 6 days.
Have you ever had a pregnancy and how did it progress? Were there any complications during pregnancy and childbirth?

If the gestational age is 14 weeks or more, ultrasound screening is not informative for identifying the risk of Down syndrome in the fetus.

According to the results of the first ultrasound screening at 14 weeks of pregnancy, the indicators should be within the following limits:

Heart rate - 146–168 beats per minute;
KTR - 63–89 mm;
TVP - 0.7–2.7 mm;
thigh length - 9.0–15.8 mm;
blood flow in the venous duct - has a positive value in the absence of reverse.

Based on the results of biochemical screening, the indicators should be within the following limits:

Free beta-hCG subunit - 0.5–2.0 MoM;
PAPPA-A - 0.5–2.0 MoM;
the risks of developing abnormalities in the fetus are higher than 1:380.

You are at increased risk of fetal growth restriction before 37 weeks of pregnancy. This means that with the same indicators, this risk to the fetus is in one in 282 women.

Hello! Please consult.

Based on the results of the first screening at 12 weeks and 4 days

hCG was 0.45 mOhm

HCG free b-subunit 18

Trisomy 21: basic

Trisomy 18: basic

Trisomy 13: basic

I was not satisfied with the hCG level and a few days later I took it again..

Term 13 weeks and 1 day

Free b-subunit 15

HCG 59026.47 mIU/ml

PAPP-A plasma protein 6.56 IU/ml

Please tell me, is it normal that hCG decreases? Or does this mean something?

I will be very grateful for the answer..

Have you had a consultation with your doctor about the research results?
What were the indicators of ultrasound and biochemical screening?
The risk value for trisomy 18 pairs of chromosomes according to the results of a biochemical blood test.
Condition of the placenta.
Your general condition: pain in the lower abdomen, presence or absence of bloody discharge from the genital tract, toxicosis.

According to ultrasound screening at 12–13 weeks of pregnancy, the normal indicators are:

You do not indicate the values of the first biochemical screening indicators, except for beta-hCG. Without data, it is impossible to give a conclusion.

The indicators should be as follows:

A reduced beta-hCG level can be observed with:

I recommend that you immediately contact a gynecologist at your place of residence to obtain reliable information on the research results. If indicated, you will be recommended to consult a geneticist with additional research methods.

Good afternoon. Help me figure it out, I’m really worried. I am 33 years old. Pregnancy 2. Weight 46 kg. 1 - pregnancy ended in childbirth (baby is healthy). An ultrasound was done by a geneticist at 12 weeks 4 days; according to the results, all indicators were normal, no abnormalities were found in the fetus. BUT: there is a marginal placenta previa. At 12 weeks 6 days I did a biochemical screening: according to the results, PAPP-A (mom) was 1.78, and free hCG (mom) was 2.21. How to understand this? (very worried)

How does a real pregnancy proceed?
Is there toxicosis?
Is there pain in the lower abdomen or bloody discharge from the genital tract?
Why did you have your first ultrasound done by a geneticist? Was there evidence for this?
How was your previous pregnancy and childbirth?
Do you have any concomitant diseases such as diabetes or other pathologies?

Based on the results of biochemical screening, the following data should be normal:

indicators of free beta-hCG subunit and PAPPA-A - 0.5–2.0 MoM;
risks for all indicators are higher than 1:380.

In your case, there is a slight increase in beta-hCG. This indicator may increase if:

Marginal placenta previa is the location of the placenta in the area of the internal os, but does not extend beyond it.

Diagnosed marginal placenta previa in the first 16 weeks of pregnancy requires increased attention from a gynecologist. If there are no complaints, bloody discharge from the genital tract, and the patient’s general condition is satisfactory, management is carried out on an outpatient basis.

If complaints arise, hospitalization is carried out in a hospital.

visiting a bathhouse, sauna;
performing any physical activity;
sexual acts.

As a rule, with the growth of the uterus, the placenta rises upward, which is determined by the second ultrasound. If the placenta does not rise, the patient is managed according to treatment protocols.

Good night. Help me decipher the results, please! Gestational age at the time of screening was 12 weeks 2 days (32 years):

T 21 B 1:473 I 1:179

T 18 B 1:1129 I 1:17730

T 13 B 1:3550 I 1:14695

free beta hCG 90.90

Uterine arteries PI 1.740

Cervical canal length 33

At 12–13 weeks of pregnancy, ultrasound examination indicators are:

Heart rate - 150–174 beats per minute;
KTR - 51–59 mm;
TVP - 0.7–2.5 mm;
BPR - 18–24 mm;
exhaust gas - 58–84 mm, average value - 71 mm;
Coolant - 50–72 mm.

The data you provided is within normal limits.

You indicate biochemical screening data in the data, the interpretation of which is indicated individually for each laboratory. The international unit of measurement for free beta-hCG subunit and PAPPA-A is MoM, which is common to all laboratories. Indicators from 0.5 to 2.0 MoM are considered normal.

Risks based on the study results for all indicators should be higher than 1:380. Indicators less than 1:380 are considered high risk.

In your case, you are in a high-risk group for having a child with trisomy 21 pairs of chromosomes, or Down syndrome according to an individual calculation. It can be assumed that you or your close relatives had children with Down syndrome.

In order to determine whether your child is sick, it is necessary to undergo genetic counseling. If indicated, you will be offered amniocentesis or other invasive testing. Based on the results of a fetal DNA test, the presence or absence of genetic abnormalities will be determined.

Good afternoon. I would like to get a little advice. I am 33 years old. Gestation period: weeks. Screening results: PAPP-A - 0.473 mΩ, BHG - 1.494 mΩ. Risk for trisomy 21 1:189. Ultrasound examination revealed no signs of congenital malformation or markers of chromosomal abnormalities.

According to ultrasound at 12.6 weeks, TVP was 2.2 mm, nasal bone was 2.0 mm, heart rate was 158 beats per minute. The geneticist said that there is a risk, and an ultrasound should be done before 20 weeks. To be honest, I don’t quite understand, there is no risk based on the ultrasound, but there is a risk based on the blood test. I did everything in one day. They were completely confused and terrified. I'm worried that the puncture will lead to a miscarriage.

There is not enough data to reliably answer your question. It is necessary to indicate:

What kind of pregnancy is it?
How the previous pregnancies ended, if any.
In the case of childbirth, how the pregnancy proceeded, whether there were any abnormalities in the fetus according to the results of the study, whether there was any pathology in the child.
If there were abortions, were any of them abortions for medical reasons?
Are there any children with Down syndrome among your relatives?
A complete ultrasound picture indicating all the data: the size of the fetus, the condition of the placenta, a conclusion on the risk of Down syndrome.

Based on the data you provided, we can draw the following conclusions.

The norm for the first ultrasound screening at 12–13 weeks of gestation is the following data:

The biochemical screening standards are:

free beta-hCG subunit and PAPPA-A - 0.5–2.0 MoM;
risks for all indicators are above 1:380.

In your case, based on all the data, the fetus is at high risk for Down syndrome. This means that a child with a chromosomal pathology can be born to one woman out of 189 with the same data as you.

If a geneticist believes that you have indications for amniocentesis, you should listen and undergo the procedure.

Amniocentesis is performed under ultrasound guidance. Complications occur in very rare cases.

Help me please. I took tests at 11 weeks and 6 days. Ultrasound results:

KTR-52, BPR-17, ChSS-164, TVP - 1.6 (MoM 1.15), Spout - 1.6

BetaHCG-71.5 ng/ml (cor. MoM = 1.54)

PAPP-A - 1.29 mIU/ml (cor. MoM = 0.48)

I am 29 years old, first pregnancy, fetus 1

Biochemical risk+NT 1:760

Double test 1:265

Age risk 1:681

Trisomy 13/18+ NT<1:10000

You have undergone a double screening test for the first trimester of pregnancy, which includes:

ultrasound examination of the fetus;
biochemical blood test.

There is very little data to give a conclusion about the development of your pregnancy. Need to know:

Regularity of the menstrual cycle.
Do pregnancy dates match according to menstruation and ultrasound.
Were there any children in the family with developmental anomalies, including Down syndrome?
Full description of ultrasound screening:

head circumference;
abdominal circumference;
thigh length;
Are the cerebral hemispheres symmetrical?
brain structure;
condition of internal organs;
number of vessels in the umbilical cord;
venous blood flow;
condition of the placenta;
conclusion about the risk of Down syndrome in the fetus.

According to the results of biochemical screening:

risks due to chromosomal abnormalities.

At 11–12 weeks of pregnancy, the norms during the first ultrasound screening should vary within the following limits:

KTR - 40–58 mm;
BPR - 13–21 mm;
Heart rate - 153–177 beats per minute;
TVP - 0.8–2.2 mm, the average value at 11 weeks and 6 days is 1.6 mm;
the bones of the nose are clearly visualized, their thickness begins to be determined from the 12th week of gestation.

Based on the results of biochemical screening, the indicators should be:

free beta-hCG subunit and PAPPA-A - 0.5–2.0 MoM;

In your case, there is an increased risk of having a child with a chromosomal abnormality. This means that with the same indicators as yours, it is possible for 1 out of 265 women to have a child with the pathology.

I recommend that you consult a gynecologist to choose further tactics for managing your pregnancy. You may need genetic counseling, the indications for which can only be determined by your attending physician.

Good afternoon I kindly ask you to help me understand the ultrasound examination. I am 34 years old. Second pregnancy and second birth. Term 12 weeks 3 days. How do I understand that I have deviations in the nasal bone and TVP? Somewhere there are still indicators written, not the norm. Could these also be developmental deviations? What can be the consequences of these fetal abnormalities? Very worried.

The cranial vault is normal;

TVP 2.4 (Normal up to 2.37)

Anterior breast wall - normal

Bladder is normal

Extremities N-norm, B-norm

ChSSud. 1 min.

SVD of the yolk sac is normal

Section through 3 vessels - unclear

I would like to receive more information in order to give a correct conclusion about the development of your child:

Features of the first pregnancy.
What were the indications for caesarean section? The operation was performed either planned or emergency.
What is the conclusion regarding the risk of Down syndrome based on the results of ultrasound screening?
Have you undergone biochemical screening in the first trimester of pregnancy?
Have you been prescribed genetic counseling?
Were there chromosomal pathologies in the family?
Do you have any complaints of pain in the lower abdomen?

Based on the data you provided, the following conclusions can be drawn.

During pregnancy 12–13 weeks, indicators based on ultrasound screening results should be within the following limits:

KTR - 50–72 mm;
TVP - 0.7–2.5 mm;
nasal bones - 2–4.2 mm;
Heart rate - 150–174 beats per minute;
blood flow in the ductus venosus is positive, has no reverse;
scar thickness - more than 5 mm;

Differences in ultrasound standards may be due to the class of ultrasound diagnostic device. In this case, it is necessary to focus on the values of normal indicators for a specific laboratory.

If indicated, you will be asked to undergo a consultation with a geneticist with an invasive research method.

In addition, you need to undergo biochemical screening, which will allow you to identify risks for a number of chromosomal pathologies.

Good afternoon! Help me understand the screening results. period 12 weeks.3 days.

chorion: high on the anterior wall

umbilical cord 3 vessels

Biochemistry of maternal serum:

PAPP-A 1.258 IU/l/0.378 MoM

Expected risk of Trisomy 21,18,13:

trisomy 21: base risk 1:996; individual risk 1:19913

trisomy 18: base risk 1:2398; individual risk 1:3064

trisomy 13: base risk 1:7533; individual risk 1:21322

Please clarify a few important questions:

Your age.
What kind of pregnancy is this?
Full picture of ultrasound with a conclusion on the risk of Down syndrome in the fetus.
Thickness of the nasal bone according to ultrasound.
Your general condition, complaints of pain in the lower abdomen, bleeding from the genital tract or others.

For a gestational age of 12–13 weeks, ultrasound screening indicators should be as follows:

Heart rate - 150–174 beats per minute;
KTR - 47–67 mm;
TVP - 0.7–2.5 mm;
BPR - 18–24 mm;
nasal bone - clearly visualized, more than 3 mm.

The nasal bone begins to be visualized from the 11th week of pregnancy, and its thickness begins to be assessed from the 12th week of gestation.

The ultrasound examination data you indicated are within normal limits.

The results of a biochemical study should normally be as follows:

free beta-hCG subunit and PAPPA-A - 0.5–2.0 MoM;
risks for chromosomal abnormalities - more than 1:380.

In your case, according to the results of a biochemical blood test, a decrease in beta-hCG and PAPPA-A is noted.

A decrease in beta-hCG may occur with:

Edwards syndrome;
ectopic pregnancy;
placental insufficiency;

A decrease in PAPPA-A may occur with:

Cornelia de Lange syndrome;
Down syndrome;
Edwards syndrome;
high risk of spontaneous miscarriage.

Hello, Irina Vyacheslavovna! Please help me identify the risks. I am 35 years old, this is my fifth pregnancy (two children, two miscarriages). At the first screening of 12 weeks 6 days, an ultrasound revealed a golf ball, heart rate 160, TVP 1.8, nasal bone 2.2, biochemistry-hCG 0.306. PPAR 2.002Mohm. The base risk for Down Syndrome is 1:225. individual 1:4498. I got to see a geneticist only after the second ultrasound screening (22 weeks). On ECHO-CG of the fetus there is only a 2mm MCA ball, everything else is without pathologies. The geneticist immediately told me that I was at high risk for diabetes. And in my case she considers the risk to be basic! Wrote -0.5 percent. I’m very worried, but do you think it’s worth it?

P.S. During the first screening, I took Utrozhestan (400 mg per day), had breakfast at 6 am, and took the test at 12.00. Could there be an error?

In order to talk about your child's condition, you need to know:

Timing of spontaneous miscarriages.
Has the cause of the miscarriages been determined?
What kind of examination, treatment and planning of subsequent pregnancy was there after miscarriages?
Age of the child's father.
Did you have any signs of threatening spontaneous miscarriage at the time of the screening test in the form of pain in the lower abdomen or bloody discharge from the genital tract?
The reason for the late appearance to the geneticist.
What were the geneticist’s recommendations after the consultation?
Full picture of ultrasound in the first and second trimesters.
Have you done a second biochemical screening?
Have you been adjusted according to the results of a biochemical analysis for taking Utrozhestan?

Golf ball syndrome is an ultrasound marker of a hyperechoic intracardiac focus. The average size of the formation is 1–6 mm. Most often found in the papillary muscle of the left ventricle. Golf balls are microcalcifications in muscle tissue.

A golf ball is often one of the markers of Down syndrome. However, microcalcifications can also occur during normal fetal development.

By the time of birth, in most cases, the golf ball disappears on its own.

At 12–13 weeks of pregnancy, the norms for ultrasound screening are as follows:

Heart rate - 150–174 beats per minute;
TVP - 1.6–2.5 mm;
nasal bones - clearly visualized, 2–4.2 mm.

Blood is donated for biochemical screening strictly on an empty stomach. It is not advisable to even not drink water. When taking a hormonal drug, you had to clarify this when taking the test. The results of the study had to be adjusted.

According to the results of a biochemical study, the norms are as follows:

In your case, there is a decrease in beta-hCG, which may be due to:

Edwards syndrome;
ectopic pregnancy;
placental insufficiency;
high risk of spontaneous miscarriage.

Taking Utrozhestan may suggest that you were at risk of pregnancy loss.

I cannot rule out pathology in the fetus. Only invasive research in the form of cordocentesis, chorionic villus biopsy or amniocentesis, depending on the gestational age, can be reliable.

You missed the deadline when you could have done an additional examination.

With the same results as yours, the risk of having a child with Down syndrome is 1 in 225 births.

Hello, help me understand the results! I am 35 years old, 6 pregnancies, 2 children, 3 abortions. Ultrasound 12.4 weeks. Heart rate 154, CTR 59, TVP 1.63, ductus venosus 1.21, nasal bone 1.94. Free beta subunit hCG 30.9 IU/l equivalent to 0.836 MoM, PAPP-A 0.096 IU/l equivalent to 0.167 MoM. Trisomy 21 base risk 1:233 individual 1:616, trisomy base risk 1:557 individual 1:356, trisomy 13 basic rtsk1:1751 individual 1:1706

I would like to receive answers to the following questions:

Have you or your close relatives had children with chromosomal abnormalities?
There were abortions for medical reasons.
Age of the child's father.
Complaints characteristic of a threatened spontaneous miscarriage: pain in the lower abdomen, spotting.

For a gestation period of 12–13 weeks, ultrasound screening standards are as follows:

Heart rate - 150–174 beats per minute;
KTR - 49–69 mm;
TVP - 0.7–2.5 mm;
ductus venosus - positive value with no reverse values;
nasal bone - 2–4.2 mm.

Normal data for biochemical screening are:

beta-hCG - from 0.5 to 2.0 MoM;
PAPPA-A - from 0.5 to 2.0 MoM;
risks for all indicators are more than 1:380.

A decrease in PAPPA-A levels can occur with:

Cornelia de Lange syndrome;
Down syndrome;
Edwards syndrome;
threat of premature termination of pregnancy.

In your case, you are at high risk of having a child with trisomy 21, or Down syndrome, and 18, or Edwards syndrome, chromosome pairs.

Hello! The indicators are as follows:

free beta hCG 4.83 IU/l 0.123 MoM

PAPP-A 1.010 IU/l /0.355 MoM

Trixomy 21 basic 1:962 individual 1:19247

Trixomy 18 basic 1:2307 individual 1:201

Trixomy 13 basic 1:7248 individual 1:6131

Pregnancy 12 weeks 6 days

All other ultrasound parameters are normal

Hello, I'm 35 years old. I did genetic screening and the result was (high risk of diabetes based on biochemistry only). according to the ultrasound result as of October 05, 2017. -11 weeks 5 days, CTE 50.7 mm, heart rate 162, nuchal translucency thickness 1.5 mm, fetal nasal bone length 2.1 mm, yolk sac SVD 4 mm, age-related risk 1/336, risk limit 1/250, calculated risk 1/236. At the time of the test, I was and still am taking Duphaston, 1 tab twice a day, there was a risk of spotting from August 11 to September 3, 2017, and no one warned me that the test was being taken on an empty stomach. FB_DBS (Conc. 129.0) (PTO corr. 2.32). But at the same time, the doctor says that perhaps due to duphaston the hormone is increased..... I didn’t understand her, I couldn’t even really explain. Don't know. maybe not exactly. etc. I had a terotoxic goiter and was tested for hormones on October 21, 2017. TSH showed 6.18 when the norm is 0.27-4.20. Could this analysis also have an impact? Please help me, explain to me what and how. In advance, thank you very much for any answer.

Have you had any pregnancies and how did they end?
Were there any children in the family with Down syndrome or other chromosomal abnormalities?
Full picture of ultrasound screening.
Complete picture of biochemical screening.

The norms for indicators for 11–12 weeks of pregnancy are:

KTR - 39–57 mm;
Fetal heart rate - 153–177 beats per minute;
TVP - 0.8–2.2 mm;
the average length of the nasal bones is 1.4 mm, while the bones are clearly visualized, and their size begins to be assessed from the 12th week of gestation;
SVD of the yolk sac - 4.2–5.9 mm;
risks - more than 1:380.

Based on the results of biochemical screening, the norms are:

free beta-hCG subunit and PAPPA-A - 0.5–2.0 MoM;
risks for chromosomal abnormalities - more than 1:380.

Elevated beta-hCG levels may result from:

high risk of Down syndrome in the fetus;
severe toxicosis;
endocrinological pathology, including diabetes mellitus in the mother.

Indicators may change if the analysis is performed incorrectly, if it was not taken on an empty stomach.

If you took the test on an empty stomach, but took Duphaston, it was necessary to notify the laboratory assistant so that the results of the biochemical study could be adjusted.

visit an endocrinologist to adjust and prescribe the necessary treatment for thyrotoxic goiter, followed by re-testing;
be observed during pregnancy not only by a gynecologist, but also by an endocrinologist;
undergo genetic counseling;
undergo a second biochemical and ultrasound screening;
if indicated, undergo invasive diagnostics in the form of amniocentesis to accurately identify the condition of the fetus.

1. The first pregnancy was IVF / currently natural.

2. Indications for caesarean section were due to the fact that the pregnancy was IVF, but labor began

unexpectedly at 37 weeks, everything was as expected and the waters broke and contractions began. As a result, I had an emergency operation; the doctor didn’t like the discharge (dark brown, + the cervix did not open). There was 1 artery in the umbilical cord (there was no fetal hypoxia during pregnancy).

3. There were no chromosomal pathologies in the family.

4. On the days of screening, there was short-term pain in the lower abdomen.

I am 34 years old. Second pregnancy. 1st child is healthy 4 years old.

The cranial vault is normal;

Nasolabial triangle is normal

TVP 2.4 (Normal up to 2.37)

Anterior breast wall - normal

Bladder is normal

Extremities N-norm, B-norm

Heart rate - 160 beats. 1 min.

Blood flow in the ductus venosus PI - 1.14

4-chamber section of the heart - normal

SVD of the yolk sac is normal

Section through 3 vessels - unclear

Predominant localization of the chorion: anterior wall

The structure of the chorion is not changed

Number of vessels in the umbilical cord -3

The place of attachment of the umbilical cord to the placenta from the edge is 3.3 mm, normal.

Features: hypertonicity along the anterior wall. mimometer thickness. in the area of the scar 6.7 mm.

Conclusion: the fetus corresponds to 12.5 weeks.

The next day, I went to another laboratory and another specialist to do an ultrasound. October 18 12 weeks 4 days. Results:

Cranial vault without features

Butterfly without features

Stomach without features

Anterior breast wall without features

Bladder/kidneys without features

Facial angle without features

Spine without features

Limbs without features

Ductus venosus without features

Conclusion: The fetus corresponds to 12.6 weeks of pregnancy. Risk of CA.

Same day tests:

Biochemical risk +NT on the date of sample collection 1>50 above the cut-off threshold

Age risk at sample collection date 1:284

Triosomy 13/18+NT 1:5396 below the cutoff.

PAPP-A 3.45 mlU/ml 0.76 Speed

fb-hCG 72.8 ng/ml 1.80 Speed

At 3-4 obstetric weeks, I took an X-ray of my nose due to a severe runny nose, not knowing about the pregnancy. The gynecologist was informed about this from the 5th week of pregnancy. At the moment I somehow managed to get a referral to a geneticist. But for some reason she thinks that my indicators are low, although as I understand it, the biochemical risk +NT on the date of sample collection is 1>50 above the cut-off threshold - this is a high risk of having a child with Down syndrome? And is the age-related risk also high? Or am I missing something? Thanks for the answer.

For the week of gestational age, the norms are as follows:

KTR - 50–72 mm;
BPR – 18–24 mm;
TVP - 0.7–2.5 mm;
nasal bones - 2–4.2 mm;
Heart rate - 150–174 beats per minute;
blood flow in the venous duct is positive and has no reverse.

According to the results of the second ultrasound, there are deviations in the form of increased TVP and a decreased value of the nasal bones. This may be evidence of a chromosomal abnormality in the fetus.

Let's look at the results of biochemical screening:

free beta-hCG subunit and PAPPA-A – 0.5–2.0 MoM;
the risks of a chromosomal abnormality are higher than 1:380.

Beta-hCG and PAPPA-A are within normal limits in your case.

According to research results, you are at risk for having a child with a chromosomal abnormality.

In your case, a consultation with a geneticist is required, who can make the following recommendations:

undergo an additional second screening: biochemical and ultrasound;
undergo invasive diagnostics of the fetal condition:
amniocentesis - at 16–20 weeks of pregnancy;
cordocentesis - at 22–25 weeks of pregnancy.

Based on all the data, the geneticist will be able to give an opinion about the development of your child.

Ultrasound at the 12th week of pregnancy: heart rate 165; ktr 54; TVP 1.6 mm, nasal bones are visible

Free hCG 26.49/0.490 MoM; PAPP-A 4.162/1.091 MoM

Trisomy 21 - basic risk 1:734, individual risk 1:14683

Trisomy I18 - basic risk 1: 1707, individual risk<1:20000

Trisomy 13-basic risk 1:5376, individual risk<1:20000

Hello. Please help me decipher the results of biochemical screening of the 1st trimester. They said that I was in a risk group, I’m very worried. Age 33 years, height 166, weight 51 kg

According to ultrasound, the period is 12 weeks.5 days.

KTR 63.1, TVP 1.6, PI- 1.23, BPR - 18.4, OG- 70, coolant - 55, DB -7.8, DNA-2.3 mm, BZ-2.0 mm, ultrasonic markers No chromosomal diseases were identified.

Biochemical screening: heart rate - 156, CTE - 63.1, TVP - 1.60, nasal bone is determined by PIVP 1.23

HCG 265.00 IU/l /6.953 MoM

PAPP-A 4.140 IU/l / 1.164 MoM

Trisomy 21 base risk 1:389, ind. risk 1:154

Trisomy 18 base risk 1:946, ind. risk 1:18928

Trisomy 13 base risk 1:2970, ind. risk 1:59399

Hello. Please help me understand the first screening. I am 34 years old, weight 93. Neither I nor my husband had any abnormalities in our family. The first day of the last menstruation was 08/06/17. When registering, type 2 diabetes was detected. In the first days I also take Duphaston and Utrozhestan, because the threat of miscarriage remains. Here is the result of the ultrasound. Pregnancy week. KTR - 49 mm, heartbeat is determined, heart rate - 176 beats / min. The yolk sac is visualized - 5 mm. TVP - 1.1 .nasal bone 2.2.bpr-16 mm.lzr-20 mm.olzh-52 mm.hip-4.8 mm.shoulder-4.3 mm.fetal anatomy: butterfly+.spine +.stomach+.anterior abdominal wall+.bones cranial vault +. bladder +. limbs +. predominant localization of the chorion: posterior wall of the uterus. thickness - 12 mm. chorion structure: unchanged. dshm 58 mm. vmz closed. blood test. holy beta subunit hCG - 14.02 IU/l/ 0.231 MoM.papp_a-0.651IU/l/ 0.142 MoM..

Trisomy 21 basic 1:271, individual 1:1261.

Trisomy 18 1:612, individual 1:33.

Trisomy. 13 1:1933, individual 1:174. Thanks in advance for your answer.

Help me understand the screening conclusion: according to biopsy, Down syndrome is 1:155, hcgb -ng/ml 105.0 normal MOM 2.20, Papp-a -mm -3981.80 - normal MOM 1.17, pigf- 21.9 MOM 0.53 , nc - 1.7 mm, tvp - 1.2 mm, ktr - 60 mm, bpr - 20.7, og - 73 mm, cool - 63 cm, vpr normal, sb rhythm correct, down syndrome: low risk, 1 :10207 not biopsy

Screening was carried out a week ago, I am 31 years old

Good afternoon Help me understand the conclusion of 1 screening. Screening was carried out at 12 weeks 1 day.

Ultrasound - period 12 weeks + 1 days according to KTR

Fetal heart rate bpm

hCG - 68.70 IU/n/1.661 MoM

PAPP-A - 5.118 IU/n/1.638 MoM

For GI doctors: an individual risk of 1:101 and above (1:102, 1:103...) is considered low

trisomy 21 - base risk - 1:595, ind. risk 1:11895

trisomy 18 - base risk - 1:1397, ind. risk 1:20000

trisomy 13 - base risk - 1:4397, ind. risk 1:20000

I forgot to indicate the age - 30 years old, the anemnesis shows 2 frozen pregnancies at 7 weeks.

Good afternoon Today I had my first screening. Help me to understand. Duration 12 weeks. I am 32 years old, this is my second pregnancy, the first went well, I gave birth to a healthy baby 2 years ago. There are no children with disabilities or syndromes in my family. The ultrasound said that everything was normal, but the blood results were not very good and the doctor called them scissors. Indicators:

Chorion high on the anterior wall

Umbilical cord 3 vessels

The nasal bone is determined; Doppler measurements of the tricuspid valve are normal.

There are no sizes of the fruit, only a description:

Head/brain looks normal

The spine looks normal

Heart 4-chamber section normal

The belly looks normal

Bladder/kidneys identified

Arms, legs: identified, both visible

Trisomy 21: baseline 1:447; individual (basic+ultrasound+BC) 1:1770

Trisomy 18: baseline 1:1033; individual (basic+ultrasound+BC) 1:20652

Trisomy 13: baseline 1:3255; individual (basic+ultrasound+BC) 1:65092

It seems that all the indicators are normal, but I am concerned about the blood results (biochemistry of maternal serum):

hCG: 120.65 IU/l/2.807 MoM

PAPP-A: 0.584 IU/l/0.496 MoM

Tell me how great the risk of pathology is and should I worry, otherwise I’ve already exhausted myself.

You still have the following questions:

Your weight.
Your height.
Do you have any concomitant diseases: diabetes mellitus, thyroid pathology, hypertension and others.
Are you taking any medications?
How is the pregnancy progressing: is there any toxicosis or signs of miscarriage, including pain in the lower abdomen or discharge from the genital tract.

At 12 weeks of pregnancy, the following indicators are considered the norms for ultrasound screening:

Fetal heart rate - 150–174 beats per minute;
KTR - 51–59 mm;
TVP - 1.6–2.5 mm;
BPR - 20 mm;
chorion - located high above the internal os along the anterior or posterior wall or in the fundus of the uterus;
umbilical cord - has 3 vessels;
nasal bones - clearly visualized, more than 3 mm;
internal organs - without features.

Based on the results of biochemical screening, the following indicators are considered normal:

free beta-hCG subunit and PAPPA-A - from 0.5 to 2.0 MoM;
risks for all indicators are more than 1:380.

In your case, there is an increase in beta-hCG, which may indicate:

Down syndrome;
multiple pregnancy;
severe toxicosis;
diabetes mellitus in the mother.

An increase in beta-hCG levels can be caused by:

undergo a second biochemical screening at 16–20 weeks of pregnancy;
If indicated, consult a geneticist.

1. Miscarriages occurred at 7 and 9 weeks.

2. The reasons were not established.

3. There was no examination, but before the real pregnancy (immediately after the miscarriage I took Regulon for 3 months, after the withdrawal I immediately became pregnant unplanned)

4.Spouse’s age is 45 years.

5. There were no allocations, but for screening I traveled 100 km by bus, then walked about 1 km, since I had never been to the regional center before, I was looking for a residential complex. Maybe something was overextended there.

6. My gynecologist didn’t refer me to a geneticist right away; she said that she would send me after the second screening.

7. The geneticist explained the risks, I refused cordocentesis, and as a result, analysis after the birth of the child for CA is all that remains.

8. Ultrasound 1 screening CTE 62, HR 160, TVP 1.8 nasal bridge length 2.2 Echofocus in the left ventricle MHA-golf ball. Duration 12 weeks 6 days.

Ultrasound 2 screening BDP 53, fronto-occipital size 69, left femur 34, tibia 30, humerus 32, forearm 29, head circumference 190 mm, abdominal diameter 50, right femur 34, right tibia 30, right humerus 32, forearm 29. The anatomy of the fetus is completely unremarkable. Features: echofocus in the left ventricle.

9. On the second biochemical. screening at 17 weeks (done in our laboratory, I was then in the hospital with increased tone, tested 2 days before discharge right in the hospital) AFP 73.7 IU per ml, hCGmme per ml. Utrozhestan was 200 mg per day.

10. No correction was made for Utrozhestan.

If an ultrasound does not detect a golf ball at 32 weeks, does this mean that there is no diabetes or is it just an analysis after birth?

Thanks for the additions to your question.

Based on all the data you provided, I can draw the following conclusions.

You needed to schedule a genetic consultation no later than 18–20 weeks of pregnancy, taking into account:

the presence of two spontaneous miscarriages in the early stages;
lack of examination after miscarriages;
your age - 35 years old;
your husband’s age is 45 years;
the presence of risks of having a child with a chromosomal abnormality based on the results of ultrasound and biochemical studies;
the presence of an ultrasound marker of a chromosomal abnormality in the fetus.

If you were to see a geneticist, additional invasive testing might be possible.

To determine your child's condition, you needed to undergo cordocentesis suggested by a geneticist. There are risks of miscarriage after the procedure, however, only an invasive study would give you the answer to all your questions.

The condition of the child and the presence of a chromosomal abnormality can be judged only after the results of the examination. In your case, it is necessary to check the child after birth for CA.

An ultrasound examination allows one to identify the risks of developing a particular pathology in the fetus, without making a diagnosis. Additional more precise research is needed.

Hello Irina, explain my screening. I am 42 years old, third pregnancy, third birth, type 2 diabetes mellitus, 12 weeks and five days. Heart rate 169; CTE 63; TVP 2.00 mm; nasal bone determined; Doppler ductus venosus 1.00; hCG 28.87IU/l /1.100MoM;PPAP-2.281IU/l /1.116MoM

Trisomy 21 basic 1:43 ind1:864

Trisomy 18. basic 1:105 ind1:2101

Trisomy 13 basic 1:330 ind1:6594

Hello Irina Vyacheslavovna. Help me decipher my first screening.

I am 38 years old. Term 12 weeks + 5 days according to KTR.

Fetal heart rate 158 beats/min

The nasal bone is identified.

Free beta subunit of hCG -17.47 IU/l/0.528 MoM

PAPP-A 2.129 IU/l/ 0.719 MoM

Trisomy 21 Basic 1:109 Individual 1:2177

Trisomy 18 Basic 1:265 Individual 1:5295

Trisomy 13 Basic 1:831 Individual 1:16618

Please help me, I can’t find a place for myself, I’m very worried.

Irina, good afternoon!

I am 28 years old, period 12.1 (due at the time of ultrasound)

Fetal heart rate 164 beats/min

Life Cycle program PTO PAPP-A - 0.89; Free hCGB - 2.78

Astraia program PTO PAPP-A - 0.98; Free hCGB - 3.38

Down syndrome 1:1718 (Life Cycle program), 1:10667 (Astraia program)

Edwards syndrome 1:(Life Cycle program), 1:35817 (Astraia program)

Patau syndrome 1:(Life Cycle program), 1:(Astraia program)

Turner Syndrome 1:(Life Cycle Program)

Triploily 1:(Life Cycle program)

Thank you very much in advance.

Irina, good afternoon!

Please help me decipher the results of the first screening.

I am 30 years old, period 12.1 (due at the time of ultrasound)

weight - 63kg, height 162cm

First pregnancy, there were no anomalies on my side or my husband’s side

Fetal heart rate 162 beats/min

Interparietal (BPR) - 20.0mm

Chorion/placenta - low on the anterior wall

amniotic fluid - normal amount

umbilical cord - 3 vessels

head/brain - looks normal, spine looks normal, anterior abdominal wall looks normal, stomach is visible, bladder/kidneys are visible, arms/legs - both visible.

free hCG beta subunit 21.9 IU/l equivalent to 0.595 MoM

PAPP-A - 6.182 IU/L equivalent to 2.544 MoM

Trisomy 21 basic risk 1:573 /individual 1:11451

Trisomy 18 base risk 1:1366< 1:20000

Trisomy 13 base risk 1:4293< 1:20000

Thank you very much in advance.

Hello! please help me understand the test results.

pregnancy at the time of testing 12+5 days

there was no one on the family line with deviations or defects.

second pregnancy (first without pathologies) child 10 years old

hCG 17.32 IU/l /0.571 MoM

PAPP-A 2.283IU/L /1.141MoM

trisomy 21 individual 1:777, basic 1:15536

trisomy 18 individual 1:898 basic 1:37967

trisomy 13 individual 1: 5955 basic 1: 119098

Please tell me if there is a risk of having a child with a pathology based on the results of these tests.

Hello, please help me figure this out.

Screening 12 days and 4 days

Weight: 62.45 Height: 165 Age: 35. First day of menstruation: 09.25.2017

Nasal bone: determined; Tricupsidal valve Doppler: normal; Tricupsidal valve Doppler: normal; Dopplerometry of the venous duct: 0.80;

Free hCG beta subunit: 104.00 IU/l / 2.003 MoM

PAPP-A 0.696IU/l / 0.313MoM

Trisomy 21: basic (1:245) individual (1:1265)

Trisomy 18: basic (1:587) individual (1:11743)

Trisomy 13: basic (1:1845) individual (1:18268)

The doctor referred me to a geneticist. What's wrong?

Hello, please help me figure it out!

Screening 1st trimester

term under DPM -12 weeks + 0 days.

term according to KTR - 12 weeks + 3 days.

age - 42, height 160 cm, weight 77.2, pregnancy -1 (natural)

Smoking, diabetes, heredity - no

visualization - fetal position limited

The nasal bone is determined

B - hCG - 33.68 IU/l - equivalent 0.898 MoM

PPAP-A - 2.341 IU/l equivalent to 1.101 MoM

Risks Basic Individual

Trisomy 21 1:44 1:890

Trisomy18 1:107 1:2139

Trisomy 13 1:336 1:6721

The ultrasound specialist said everything was fine, the doctor didn’t say anything...

Did I read your article and was worried about something? I'm completely confused about the risks!

Thank you for your reply

Hello, I'm 24. Ultrasound 12 over. 6 to.

VN+, NK+, hands+, feet+, butterfly+, urinary+, stomach+ on+, HF+, LF+

Komircevy space 1.6 mm, nasal bone 3.4 mm

Heart rate 156 bpm

Motor activity is normal

Corresponds to 12 over. 6 days Low placentation

Free b-hCG 0.380 mOhm

Rarr-a 1.330 mOhm

Initial risk 21 1:988, 18 1:2446, 13 1:7665

Revised risk 21 1:7048, 18 1:17451, 13 1:54678

The geneticist said there are abnormalities, you need to donate blood within a week

Hello, help me figure it out! 25 years old, ultrasound 13 weeks + 2 days according to Ktr. HR 154, CTE 71.0; TVP 1.70; pl 1.01; hCG 13.60;\ 0.362 mom. papp-a 0.998; \0.644 mom

trisomy 21 base 1:964(individual 1:19274) trisomy 18 base 1:2432(individual<1:20000) трисомия 13 базовый 1:7607 (индивид <1:20000)

Hello! Help me figure out the free beta subunit of hCG 1.379 MoM, PAPP-A 0.695; trisomy 21 basic 1:887, individual. 1:9064, 18 base trisomy. 1:2137 individual<1:20000, трисомия 13 баз. 1:6712 индивид. <1:20000

Hello! Tell me the risk of developing Down syndrome. Screening 1 indicators are as follows

the nasal bone is visualized

no tricuspid regurgitation was detected

orthrograde blood flow PI 0.91

hCGb 177.3 mom 3.55

papp-a 3430.2 mom 1.14

Hello. Today we did screening for 12 weeks, according to the protocol the indicators are: ktr - 51.7 heart rate - 159, tvp - 1.2 nasal bone - 1.5 bpr - 13.8 - 11.6. I'm worried about TVP and BPR.

Good afternoon, according to the results of the first screening, the ultrasound conclusion was that there were no suspicions of congenital birth defects, but the serum indicators were as follows (gestational age 12 weeks)

free hCG beta subunit: 12.9 IU/l / 0.298 MoM

APP-A: 1.180IU/l / 0.389 MoM

Trisomy 21 basic risk 1:936 individual 1:18727

Trisomy 18 bases. risk 1:2244 individual 1:1550

Trisomy 13 base risk 1:7052 individual 1:20000

The doctor did not give any explanations; they sent me for the 2nd screening at 20 weeks.

After the second screening, the doctor’s conclusion is as follows: “The abdominal section of the umbilical vein has a right-sided course, the gallbladder is located to the left of the umbilical vein, the right umbilical vein is persistent.”

We scheduled a consultation with geneticists, but in our city they are by appointment only. I made an appointment, but the wait is still long. Already all exhausted. I don't know what to think. The doctor again did not give any explanation. Help me figure it out, please

The blood circulation of a fetus is significantly different from that of an adult.

The fetus is in the womb, which means it does not breathe with its lungs - the ICC does not function in the fetus, only the BCC works.

The fetus has communications, they are also called fetal jesters, these include:

foramen ovale (which drains blood from the RA into the LA)
arterial (Batalov) duct (duct connecting the aorta and pulmonary trunk)
ductus venosus (this duct connects the umbilical vein to the inferior vena cava)

These communications close over time after birth, and when they are not closed, congenital malformations are formed.

Now we will analyze in detail how blood circulation occurs in a child.

The baby and mother are separated from each other by the placenta; the umbilical cord, which contains the umbilical vein and umbilical artery, goes from it to the baby.

Oxygen-enriched blood travels through the umbilical vein as part of the umbilical cord to the fetal liver; in the fetal liver, the umbilical vein is connected to the inferior vena cava through the DUCT VENOUS. We remember that the inferior vena cava flows into the RA, in which there is an OVAL WINDOW, and through this window blood flows from the RA into the LA, where the blood mixes with a small amount of venous blood from the lungs. Then from the LA through the left interventricular septum into the LV, and then enters the ascending aorta, then through the vessels to the upper part of the body. Collecting in the SVC, the blood of the upper half of the body enters the RA, then into the RV, then into the pulmonary trunk. Let us remember that the ATRERIAL DUCT connects the aorta and the pulmonary trunk, which means that the blood that entered the pulmonary table, for the most part, due to the high resistance in the vessels of the ICC, will not go into the lungs as in an adult, but through the ductus arteriosus into the descending part of the aortic arch. About 10% is thrown into the lungs.

The umbilical arteries carry blood from the fetal tissues to the placenta.

After ligation of the umbilical cord, the ICC begins to function as a result of the expansion of the lungs, which occurs with the child’s first breath.

Closing communications:

First, the ductus venosus closes by the 4th week, and in its place the round ligament of the liver is formed.
The ductus arteriosus then closes as a result of vasospasm due to hypoxia for 8 weeks.
The very last window to close is the oval window, during the first half of life.

This article is the first part of a series about the heart and blood circulation. Today’s material is useful not only for general development, but also for understanding what heart defects there are. For a better presentation, there are many drawings, half of them with animation.

Diagram of blood flow in the heart AFTER birth

Deoxygenated blood from the whole body is collected in the right atrium through the superior and inferior vena cava (upper - from the upper half of the body, along the lower - from the lower). From the right atrium, venous blood enters the right ventricle through the tricuspid valve, from where it enters the lungs through the pulmonary trunk (= pulmonary artery).

Scheme: vena cava? right atrium? ? right ventricle? [pulmonary valve] ? pulmonary artery.

Structure of the adult heart(picture from www.ebio.ru).

Arterial blood from the lungs through 4 pulmonary veins (2 from each lung) it is collected in the left atrium, from where through the bicuspid ( mitral) the valve enters the left ventricle and is then released through the aortic valve into the aorta.

Scheme: pulmonary veins? left atrium? [mitral valve] ? left ventricle? [aortic valve] ? aorta.

Pattern of blood flow in the heart after birth(animation).
Superior vena cava - superior vena cava.
Right atrium - right atrium.
Inferior vena cava - inferior vena cava.
Right ventricle - right ventricle.
Left ventricle - left ventricle.
Left atrium - left atrium.
Pulmonary artery - pulmonary artery.
Ductus arteriosus - ductus arteriosus.
Pulmonary vein - pulmonary vein.

Diagram of blood flow in the heart BEFORE birth

For adults, everything is simple - after birth, the blood flows are separated from each other and do not mix. In the fetus, blood circulation is much more complicated, which is due to the presence of the placenta, non-functioning lungs and gastrointestinal tract. The fruit has 3 features:

open foramen ovale(foramen ovale, “forAmen ovale”),
open ductus arteriosus(ductus arteriosus, ductus arteriosus)
and open ductus venosus(ductus venosus, “ductus venosus”).

The foramen ovale connects the right and left atria, the ductus arteriosus connects the pulmonary artery and aorta, and the ductus venosus connects the umbilical vein and the inferior vena cava.

Consider the blood flow in the fetus.

Fetal circulation diagram
(explanations in the text).

Oxygen-enriched arterial blood from the placenta flows through the umbilical vein, which runs in the umbilical cord, to the liver. Before entering the liver, the blood flow is divided, and a significant part of it bypasses the liver along ductus venosus, present only in the fetus, and goes into the inferior vena cava directly to the heart. Blood from the liver itself through the hepatic veins also enters the inferior vena cava. Thus, before flowing into the right atrium, the inferior vena cava receives mixed (venous-arterial) blood from the lower half of the body and the placenta.

Through the inferior vena cava, mixed blood enters the right atrium, from where 2/3 of the blood passes through the open foramen ovale enter the left atrium, left ventricle, aorta and systemic circulation.

Oval hole And ductus arteriosus in the fetus.

Movement of blood through the foramen ovale(animation).

Movement of blood through the ductus arteriosus(animation).

1/3 of the mixed blood entering the inferior vena cava is mixed with all purely venous blood from the superior vena cava, which collects blood from the upper half of the fetal body. Next, from the right atrium, this flow is directed to the right ventricle and then to the pulmonary artery. But the lungs of the fetus do not work, so only 10% of this blood enters the lungs, and the remaining 90% through ductus arteriosus are discharged (shunted) into the aorta, worsening its oxygen saturation. 2 umbilical arteries depart from the abdominal aorta, which in the umbilical cord go to the placenta for gas exchange, and a new circle of blood circulation begins.

Liver The fetus is the only organ of all that receives pure arterial blood from the umbilical vein. Thanks to the “preferential” blood supply and nutrition, by the time of birth the liver has time to grow to such an extent that it takes up 2/3 of the abdominal cavity and in relative terms weighs 1.5-2 times more than an adult.

Arteries to the head and upper body extend from the aorta above the level of the confluence of the ductus arteriosus, so the blood flowing to the head is better oxygenated than, for example, the blood flowing to the legs. Like the liver, the newborn's head is also unusually large and takes up 1/4 of the entire body length(in an adult - 1/7). Brain newborn is 12 - 13% body weight(in adults 2.5%). Probably, young children should be unusually smart, but we cannot guess this due to a 5-fold decrease in brain mass. 😉

Changes in blood circulation after birth

When a newborn takes his first breath, he the lungs expand, vascular resistance in them drops sharply, and blood begins to flow into the lungs instead of the arterial duct, which first becomes empty and then becomes overgrown (scientifically speaking, it becomes obliterated).

After the first inspiration, the pressure in the left atrium increases due to increased blood flow, and the foramen ovale stops functioning and overgrown. The ductus venosus, umbilical vein and terminal sections of the umbilical arteries also become overgrown. Blood circulation becomes the same as in adults.

Heart defects

Congenital

Because heart development is quite complex, this process can be disrupted during pregnancy by smoking, drinking alcohol or taking certain medications. Congenital heart defects are in 1% of newborns. Most often registered:

defect(non-closure) of the interatrial or interventricular septum: 15-20%,
incorrect location ( transposition) aorta and pulmonary trunk - 10-15%,
tetralogy of Fallot- 8-13% (narrowing of the pulmonary artery + malposition of the aorta + ventricular septal defect + enlargement of the right ventricle),
coarctation(narrowing) of the aorta - 7.5%
patent ductus arteriosus - 7 %.

Purchased

Acquired heart defects occur in 80% of cases due to rheumatism(as they now say, acute rheumatic fever). Acute rheumatic fever occurs 2-5 weeks after a streptococcal throat infection ( sore throat, pharyngitis). Since streptococci are similar in antigenic composition to the body's own cells, the resulting antibodies trigger damage and inflammation in the circulatory system, which ultimately leads to the formation of heart defects. In 50% of cases the mitral valve is affected(if you remember, it is also called bicuspid and is located between the left atrium and the ventricle).

Acquired heart defects are:

isolated (2 main types):
- valve stenosis(narrowing of the lumen)
- valve insufficiency(incomplete closure, resulting in reverse blood flow during contraction)
combined (stenosis and insufficiency of one valve),
combined (any damage to different valves).

It is worth noting that sometimes combined defects are called combined, and vice versa, because There are no clear definitions here.

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Intrauterine development of the umbilical-portal venous system: two- and three-dimensional ultrasound examination. Blood circulation of the fetus and newborn child Reliability of screenings and the need for them

Screening 1st (first) trimester. Screening timing. Screening results. Ultrasound screening.

Bibliographic link

Blood flow in the ductus venosus

Venous blood flow: research methods

Reverse blood flow in the ductus venosus in the fetus. How should we treat him?

What is ductus venosus reversal in the fetus?

What does reverse blood flow look like in the ductus venosus in the fetus?

What does reverse in the ductus venosus in the fetus indicate?

Diagnostic errors

What to do if reverse blood flow is detected in the ductus venosus in the fetus?

Ksk in the ductus venosus

Standards for first screening during pregnancy: what to do if everything is bad?

Norms for first screening during pregnancy

Ultrasound standards

Biochemical blood test standards

Free β-subunit of hCG

RAPP-A standards

Decoding the results of the first screening

Unfavorable results of the first screening

What to do if you have unfavorable results

Reliability of screenings and the need for them

117 COMMENTS

Now we will analyze in detail how blood circulation occurs in a child.

Diagram of blood flow in the heart AFTER birth

Diagram of blood flow in the heart BEFORE birth

Changes in blood circulation after birth

Heart defects

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