Recognized as the most informative and absolutely safe method control over the course of pregnancy. This procedure also allows for a period of 5 weeks - doctors see a formed fetal egg, and at 6 weeks - a full-fledged embryo.

Timing

Throughout the entire period of bearing a child, a woman is prescribed an ultrasound examination three times at exactly the agreed time:

• 10-14 weeks;
• 20-24 weeks;
• 30-34 weeks.

Despite the fact that the safety of ultrasound has been confirmed, gynecologists do not recommend "getting carried away" with this procedure - it is advisable for pregnant women to undergo it no more than 4 times during the entire period of pregnancy, although additional visits to an ultrasound diagnostician may be prescribed.

What does ultrasound show during early pregnancy?

Women can have two types of ultrasound:

1. transabdominal. In this case, the patient must prepare for the procedure - 30 minutes before it starts, you need to drink about half a liter of water (non-carbonated) and not go to the toilet. That is, the ultrasound examination procedure is carried out with a filled bladder.
2. . This type of examination is carried out without any preliminary preparation, the bladder must be empty. The sensor from the ultrasound machine is inserted into the vagina, after which a special cover or condom with a gel is put on it.

The ultrasound examination procedure in the 1st trimester of pregnancy lasts a maximum of 30 minutes, the doctor takes all the necessary measurements, records the data obtained in the protocol - this document will help the gynecologist determine how normal the pregnancy is and whether the fetus is developing correctly.

The considered diagnostic procedure in the first trimester of pregnancy is carried out for:

• determining the location of the fetal egg - may develop normal pregnancy, and maybe the formation / fixation of the fetal egg in the fallopian tubes;
• diagnosing multiple pregnancy, if the doctor sees only the bottom of the fetal egg, then a singleton pregnancy is diagnosed;
• assessment of the structure of the embryo, the size of the fetal egg;
• identification of pregnancy problems - for example, a specialist will pay attention to, can diagnose reversible or irreversible spontaneous abortion or.

In addition, ultrasound early dates pregnancy allows not only to fix the fact of conception, but also to identify various diseases internal genital organs - for example, it is with the help of ultrasound that tumor formations in the ovaries are most often diagnosed, a septum inside the uterus or the bicornuity of this hollow organ is detected.

Deciphering ultrasound of the 1st trimester: norms and deviations

Ultrasound diagnosis of uterine pregnancy

If a specialist conducts an ultrasound examination in the early stages of pregnancy, then he will be able to see the fetal egg in the upper part of the uterus, and it looks like an oval (in some cases rounded) dark spot. If the pregnancy is multiple, then the doctor, respectively, will see two / three and so on such dark spots.

The transabdominal type of the study under consideration makes it possible to establish the onset of uterine pregnancy at the earliest possible date - 5 weeks, when the absence of menstruation from the estimated start date lasts about 14 days. At this time, the size of the fetal egg will be at least 5 mm in diameter.

Transvaginal ultrasound examination of the uterus is more informative - the doctor can confirm the fact of pregnancy for a period of 4 weeks, that is, after 6 days of delayed menstruation. The diameter of the fetal egg in this case will be 3 mm in diameter, which is normal.

As for the visualization of the embryo, with transabdominal ultrasound this can be done for a period of 6 weeks, with transvaginal ultrasound - 5 weeks, moreover, the embryo will look like white spot in the cavity of the dark formation. You can listen to clear contractions of the heart (beat) of the embryo for a period of 6 weeks.

If a woman has a normal menstrual cycle, that is, there are no habitual delays or early onsets, then transvaginal ultrasound can be performed at 6 weeks of pregnancy. Such an examination does not belong to the “mandatory program” and is carried out only at the request of the patient. If the menstrual cycle is unstable and the delay in menstruation cannot be accurately determined, then the estimated gestational age is set by the uzist.

How to estimate the size and growth of the fetal egg / embryo

This data is based on two indicators:

• coccygeal-parietal size;
• mean internal diameter of the ovum.

For a specific gestational age, there are established indicators (conditional, of course) of the average internal diameter of the fetal egg, which are included in the program of ultrasound machines. These data automatically establish a practically exact gestational age, but an error of 6 days in the direction of increase and decrease is allowed.

The term "coccygeal-parietal size" means the length of the embryo's body from head to tailbone, and this indicator is measured very first. It is by this size that you can more accurately determine the gestational age - the error is only 3 days.

Note:if the average internal diameter of the fetal egg is 14 mm, but the doctor cannot visualize the embryo, then experts will talk about a pregnancy that has stopped its development.

The principle of assessing the vital activity of the fetus and embryo

Heartbeat and motor activity are the main indicators that allow a specialist to assess the vital activity of the embryo.

If a transvaginal ultrasound is performed, then already at a period of 6 weeks, the doctor sees the heartbeat of the embryo. If it is within the normal range, then there will be a clear rhythm of contractions, but for each period of pregnancy they have their own frequency:

• 6-8 weeks - 130-140 beats per minute;
• 9-10 weeks - 190 beats per minute;
• the entire period before childbirth - 140-160 beats per minute.

Heart rate should be measured without fail, since it is this indicator that allows specialists to determine problems with bearing a child. For example, if the heart rate is sharply increased or reduced, then doctors will place the woman at risk for miscarriage.

Note:if the ultrasound confirmed that the length of the embryo in the coccygeal-parietal size is 8 mm, but heartbeats are not detected, then the specialist may suspect an undeveloped pregnancy. In this case, a re-examination is carried out after 7 days and only after that a final diagnosis is made.

As for the motor activity of the embryo, it can be seen already at 7-9 weeks of pregnancy. At first, the embryo simply moves the whole body (chaotically), a little later already types of flexion and extension of the body. Doctors are well aware that the embryo rests very often and therefore the indicator of motor activity cannot be the main criterion in assessing its vital activity.

Assessment of the structure of the embryo

The doctor should pay special attention to the structure (anatomy) of the fetus during the ultrasound examination in the 1st trimester of pregnancy. For example, already at a period of 12 weeks, a specialist can diagnose fetal pathologies that will not be compatible with life - for example, a hernia of the spinal cord, absence of a brain, and abnormal development of the skeleton.

The specialist will definitely evaluate the collar space and determine its thickness - according to this indicator, it will be possible to identify diseases of the fetus of a chromosomal nature. An increase in the collar space by 3 mm is allowed, but large indicators will indicate the presence of chromosomal pathology in 80% of cases.

Modern medicine has the latest generation of ultrasound equipment, which makes it possible to diagnose abnormalities in the structure of all systems and organs of the unborn child as early as 12 weeks of pregnancy. Such an accurate diagnosis allows parents to make a choice - to leave the pregnancy or terminate it for medical reasons.

Study of extraembryonic structures

When conducting an ultrasound examination in the 1st trimester, a specialist will examine the yolk sac, amnion and chorion, and their assessment is mandatory.

Yolk sac- a structure that performs important functions - hematopoietic and nutritional, moreover, throughout the entire period of pregnancy. It is possible to determine this sac as early as 5 weeks of pregnancy, by the 10th week of pregnancy its dimensions reach 7 mm, but after 12 weeks of pregnancy it is not possible to determine / identify / assess the state of the yolk sac even with the help of ultrasound - this is the norm.

Doctors have long noted a direct relationship between the size of the yolk sac and the outcome of pregnancy. The fact is that the wrong size of the sac, changes in its shape and walls in most cases are accompanied by a delay in the growth of the embryo.

Chorion- this is the shell of the fetal egg, which consists of villi. Its size (thickness) is equal to the gestational age in weeks, but this rule "works" only in the first trimester. If there is underdevelopment or changes in the structure of the chorion, then the death of the fetus can be accurately predicted. The fact is that the villi of the chorion are very tightly attached to the uterine cavity, and if its structure is changed, then it is simply impossible for the villi to “catch on” - a miscarriage begins.

Amnion- this is a water shell, a sac in which the embryo is located surrounded amniotic fluid. Conducting this type of study in the early stages of pregnancy allows the specialist to identify the small diameter of the amniotic cavity, and this will indicate its underdevelopment, which always leads to problems with the development of pregnancy. But an increase in size will indicate the presence of intrauterine infection.

Identification of pregnancy complications

In the 1st trimester of pregnancy, most often, of all possible pathologies, the threat of abortion is diagnosed. Moreover, it is with the help of the study in question that the doctor can diagnose this pathological condition at the very beginning of its development - the walls of the uterus will be thickened. Women very often feel themselves, as this condition is accompanied by. If the diagnosis has taken place, then doctors carry out therapeutic treatment, which is designed to preserve the pregnancy. But if there was a detachment of the fetal egg, the woman has from the vagina, then the diagnosis will be made "started spontaneous abortion."

Important! If the miscarriage has already taken place, then the patient must undergo an ultrasound examination to determine whether the remnants of the fetal egg remain in the uterine cavity. And if such remnants are revealed, then the woman is sent for the scraping procedure..

With the help of this study in the early stages of pregnancy, the doctor can diagnose:

1. Yellow body cyst. This is a fairly common formation, which will be characterized by the presence of thick walls, and its structure will be assessed as heterogeneous - in principle, this is considered the norm. The corpus luteum cyst is prone to self-resorption and completely disappears by the end of the first trimester.
2. bubble skid. This complication is extremely rare - 1 case per 2,000 - 3,000 pregnant women. Highly dangerous state, which is characterized by a pathological lesion of the chorion. Bubble skid always leads to the death of the fetus, since the chorion turns into vine-like formations that destroy the fetal egg.

An ultrasound examination in the first trimester of pregnancy allows you to identify any pathological changes in the fetal egg and embryo - for example, at a gestational age of 12 weeks, the doctor can diagnose a cleft lip and other facial defects in an unborn child. The problem is that the type of research under consideration in early pregnancy is carried out exclusively at the request of the woman, and therefore early identification of problems with the fetus, when it is still possible to make a decision about the advisability of carrying it, is not always possible.

Content

Proper diagnosis of the disease is already halfway to its cure, which is why it is so important to use modern and fast methods in this process. So, if the organs in the abdominal cavity are disturbed, an ultrasound examination is a procedure that cannot be dispensed with. Find out what signs of possible diseases the analysis can show.

What is included in an abdominal ultrasound

This type of diagnostics is used very widely today, because the abdominal cavity contains the internal organs of a person responsible for various functions of the body. With ultrasound of the OBP, they examine:

• gastrointestinal tract, which includes the stomach, intestines;
• pancreas;
• lymphatic organs: spleen, abdominal lymph nodes;
• gallbladder;
• liver;
• retroperitoneal space: kidneys and adrenal glands, abdominal aorta, inferior vena cava;
• urinary organs: ureters and bladder, prostate gland in men, uterus and appendages in women.

With the help of ultrasound, a doctor can quickly obtain detailed information about the state of the organ in question, and for the patient, such manipulations are painless and harmless. Deciphering the data of this study helps to timely identify various pathologies that have begun to develop in the body, for example:

• organ cyst;
• single or multiple abscesses;
• swelling in the abdomen;
• fluid in the abdominal cavity;
• malformations of the fetus during pregnancy.

The size of the spleen is normal

The main reason when a doctor examines this organ in detail is its enlargement. Ultrasound of the spleen should also be done if the patient had an abdominal injury and there is a suspicion of its rupture and internal bleeding. The doctor needs to evaluate:

• Do the contour and dimensions of the organ differ from the norm, which for adults are:
  • thickness - 4-5 cm;
  • width - 6-8 cm;
  • length - 11-12 cm.
• Calculate the area of ​​the spleen; for this characteristic, indicators from 15.5 to 23.5 square meters are considered normal. cm.
• Are there neoplasms and tissue damage.
• How is it located relative to adjacent organs.

What does an ultrasound of the stomach show?

Such a study is often prescribed not only if the patient complains of pain in the organ, but also as preventive measures for the timely detection of an incipient disease or to evaluate the results of the treatment. When deciphering the ultrasound of the abdominal cavity, close attention is paid to data on the state of the stomach, because with such a diagnosis it is possible to identify:

• hiatal hernia;
• esophagitis - an inflammatory disease of the esophageal mucosa;
• gastroesophageal reflux disease;
• tumors;
• if necessary, detect foreign bodies.

Although this type of diagnosis in certain cases will not replace an endoscopic or x-ray examination, a doctor cannot do without it when monitoring the chronic course of certain diseases, for example, gastritis or peptic ulcer. When decoding ultrasound of the gastrointestinal tract in a quick and painless way, determine:

• swelling of the walls of the organ and the lack of delimitation of the wall;
• stomach ulcer;
• enlarged due to varicose veins;
• diffuse neoplastic wall thickening;
• pyloric stenosis - congenital or acquired;
• gastric carcinoma ;
• lymphoma and other dangerous diseases.

Normal size of the liver on ultrasound in adults

This organ consists of two unequal lobes, and normally it should have a homogeneous echostructure and be interrupted only by the portal vein and branches of this blood vessel.
An important criterion that is paid attention to in the diagnosis is the compliance of the liver with such parameters defined for adult patients:

• length:
  • glands - 14-18 cm;
  • right lobe - 11-15 cm;
• size in diameter - 20-22.5 cm;
• right lobe, oblique vertical size - up to 15 cm;
• the height of the left lobe - up to 10 cm;
• sagittal size - from 9 to 12 cm;
• share thickness:
  • right - up to 12.5 cm;
  • left - up to 7 cm.

What does a liver ultrasound show? If, when deciphering the results, an increase is indicated, this clearly indicates the development of pathological processes in it, for example, cirrhosis or hepatitis. Also an important indicator is that the shape of the lower angle of the organ should be pointed: in the region of the left lobe - no more than 45 degrees, in the right - no more than 75 degrees. When diagnosing, you need to pay attention to the visualization of the vessels passing through the liver, because one of the main functions of the gland is blood filtration.

An ultrasound examination looks at the structure of the liver and how clear and even the contours of the organ are, whether the sound conductivity of the gland is good. Deviations in the values ​​of these parameters always indicate the presence of problems in the work of the body. So, if during the diagnosis an increased density is visible, we can talk about diffuse changes and dysfunction of this natural filter. With ultrasound diagnostics, it is possible to consider calcifications in the liver - deposits of calcium salts that have arisen after the patient has suffered serious diseases.

What does an ultrasound of the kidneys show?

These paired bean-shaped organs perform the function of cleansing the body of harmful substances by removing them together with a human waste product - urine. Deciphering the ultrasound of the abdominal cavity always includes their parameters such as structure, shape, location. The right kidney should be placed slightly lower than the left, and the difference in their sizes should not exceed 2 cm. Normal for an adult are such figures characterizing the parameters of these urinary organs:

• length - 10-12 cm;
• kidney thickness - 4-5 cm;
• width - 5-6 cm;
• parenchyma thickness - up to 2.3 cm.

With ultrasound of the kidneys, such violations in their functioning can be detected:

• anomalies of blood vessels: narrowing of the renal artery, the appearance of additional veins;
• the formation of kidney stones;
• chronic pyelonephritis - the process of inflammation of the tissues of the organ, which leads to a violation of the normal outflow of urine;
• expansion of the renal pelvis - pyelectasis;
• cyst;
• tumors: benign or malignant.

Gallbladder size, normal in adults

This pear-shaped organ is located at the bottom of the liver in a separate recess and is closed by the peritoneum from the side of the abdominal cavity. It collects bile produced by the liver, and then regulates its supply to the digestive tract. Deciphering the ultrasound of the gallbladder gives an idea of ​​its shape, size, condition of the walls, volume and internal contents. For adult patients, the following indicators are considered normal, identified during the examination:

• the distance from the bottom of the bubble to the narrowest lobe is 6-10 cm;
• organ width - up to 5 cm;
• wall thickness - does not exceed 4 mm;
• the volume varies from 30 to 50 ml.

common bile duct

When deciphering the ultrasound of the abdominal cavity, attention should be paid to the data on this tubular formation, which doctors also call choledoch. The length of the bile duct can vary from 2 to 12 cm. The inner diameter of the common bile duct in different parts of this formation can be from 2 to 8 mm. The doctor needs to consider whether this value does not exceed 8 mm in the widest part of the formation. By deciphering the ultrasound diagnosis of the common bile duct, a specialist can see the stones formed in it and establish a diagnosis of choledocholithiasis.

Ultrasound of the pancreas

The importance of examining this organ is explained by the fact that insulin is synthesized in it, and timely noticed deviations in its work make it possible to take measures to prevent serious pathological changes in the body. When deciphering the research data, attention should be paid not only to the size of the pancreas, but also to its echogenicity (image brightness) and the clarity of the contours. All parts of the gland should be well visualized on the screen:

• head - normally its thickness does not exceed 3.2 cm;
• organ body - up to 2.5 cm;
• tail - up to 3.0 cm.

The uzist should carefully examine the diameter of the Wirsung duct. This indicator should normally be 1.5-2 mm, and in response to the introduction of intravenous secretin, expand to 2.5-5 mm. The expansion of the Wirsung duct or the lack of response to the intake of this hormone indicates the development of an inflammatory process - pancreatitis. Often, deformations in this zone occur during the development of a tumor of the head of the pancreas. An experienced doctor will be able to see abscesses, areas of necrosis and the presence of stones that clog the ducts with an ultrasound examination of the organ.

How to decipher the results of an ultrasound

An independent analysis of ultrasound data for a person without special medical education in the vast majority of cases will not reveal a clear picture of his state of health. A complete and accurate interpretation of the abdominal ultrasound should be carried out either by the ultrasound doctor or by the attending doctor who referred the patient for such an analysis.

Only the specialist conducting the study sees in real time the work of the organs, how mobile they are, how blood circulates through them. For a complete and correct interpretation of the data in order to make a diagnosis, a doctor must take into account a whole range of factors in total:

• the exact location and size of all organs;
• the structure of their tissues;
• possible presence of deformations;
• signs indicating chronic diseases;
• the presence of tumor benign or malignant neoplasms.

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To determine the anatomical and functional state of the fetus during pregnancy, there are a number of methods, the most common of which is. It is informative enough to cover a large number of women and, most importantly, safe.

In order to detect malformations and diseases, ultrasonic(universal rapid survey, covering more than 85% of pregnant women). It allows you to make decisions about the further management of each pregnancy, as well as identify pregnant women at risk for the development of various complications for the fetus and mother.

Ultrasound procedure ( most appropriate to carry out in the following screening terms pregnancy:

Chorion- the outer villous embryonic membrane, which, together with the wall of the uterus, later forms, thanks to which the fetus is nourished during pregnancy. Its localization gives an idea of ​​the further localization of the placenta (what you need to know to determine the management of pregnancy), and a change in thickness may indicate the presence intrauterine infection embryo/fetus, as well as fetal malnutrition, although this indicator is also more informative in late pregnancy.

In addition, during the first, structural features of the uterus (for example, doubling of the uterus, saddle uterus) and its appendages (primarily the presence of ovarian cysts) are noted. These indicators are also important for determining further tactics of pregnancy management.

If necessary, the doctor of ultrasound diagnostics notes in the protocol the date of the repeated ultrasound control.

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

Pregnancy 20-24 weeks optimal for studying the anatomical structures of the fetus. Identification at this time determines the further tactics of pregnancy management, and in case of a gross defect that is incompatible with life, it allows you to terminate the pregnancy. A typical ultrasound protocol at 20-24 weeks is presented in Table 5.

The structure of the ultrasound protocol can be divided into the following main groups:

1. Information about the patient (name, age, the beginning of the last menstruation)
2. Fetometry(measurement of the main dimensions of the fetus)
3. Anatomy of the fetus (organs and systems)
4. Provisional organs (temporarily existing, such as the placenta, umbilical cord, and amniotic fluid)
5. Conclusion and recommendations

In this protocol, as with ultrasound at 10-14 weeks, the first day of the last menstruation is indicated, relative to which the gestational age is calculated. It also notes the number of fruits and that the fruit is alive(this is determined by the presence of and ). In the presence of two or more fruits, each is studied and described separately. Be sure to indicate (the ratio of the large part of the fetus to the entrance to the pelvis). It may be head(fetus presented with head) and (buttocks and/or legs presented). The fruit may be located transversely which should be reflected in the protocol.

Next is carried out fetometry- measurement of the main dimensions of the fetus, among which are determined: the biparietal size of the head, its circumference and fronto-occipital size, abdominal circumference, the length of the tubular bones on the left and right (femur, humerus, bones of the lower leg and forearm). The combination of these parameters makes it possible to judge the rate of fetal growth and compliance with the estimated gestational age for menstruation.

Biparietal fetal head size (BDP) measured from the outer surface of the upper contour to the inner surface of the lower contour of the parietal bones (Figure 1, line bd).

Fronto-occipital size (LZR)– distance between the outer contours of the frontal and occipital bones (Figure 1, line ac).

Cephalic index- BPR / LZR * 100% - allows you to draw a conclusion about the shape of the fetal head.

Head circumference (OH)- the circumference along the outer contour.

Measurement of head dimensions is carried out with strictly transverse ultrasound scanning at the level of certain anatomical structures of the brain (cavity of the transparent septum, cerebral peduncles and visual tubercles), as shown in the right side of Figure 1.

Figure 1 - Scheme for measuring the size of the fetal head

1 - cavity of the transparent septum, 2 - visual tubercles and legs of the brain,bd- biparietal size,ac- fronto-occipital size

The dimensions of the abdomen are measured by scanning in a plane perpendicular to the spinal column. This defines two sizes - diameter and circumference of the abdomen, measured along the outer contour. The second parameter is used more often in practice.

Further measured length of the tubular bones of the limbs: femoral, shoulder, lower leg and forearm. It is also necessary to study their structure to rule out the diagnosis. skeletal dysplasia(genetically determined pathology of bone and cartilage tissue, leading to serious disorders in the growth and maturation of the skeleton and affecting the functioning internal organs). The study of the bones of the limbs is carried out on both sides, so as not to miss reductional malformations(that is, underdevelopment or absence of parts of the limbs on one or both sides). Percentile values ​​of fetometric indicators are shown in Table 6.

Study of fetal anatomy- one of the most important components of ultrasound at 20-24 weeks. It is in this period manifest(manifest themselves) many. The study of the anatomical structures of the fetus is carried out in the following order: head, face, spine, lungs, heart, abdominal organs, kidneys and bladder, limbs.

Study of brain structures begins even when measuring the size of the head, because upon careful examination, the doctor can determine the integrity of the bone structure, the presence extracranial(outside the skull) and intracranial(intracranial) formations. The study of the cerebral hemispheres, the lateral ventricles, the cerebellum, the large cisterna, visual tubercles and the cavity of the transparent septum is carried out. The width of the lateral ventricles and the anteroposterior size of the large cistern do not normally exceed 10 mm. An increase in this indicator indicates a violation of the outflow or production of fluid and the appearance of dropsy of the brain.

The next step is studying face– the profile, eye sockets, nasolabial triangle are assessed, which makes it possible to identify anatomical defects (for example, “protrusion” of the upper jaw with bilateral or median facial cleft), as well as the presence of markers of chromosomal abnormalities (reduction in the length of the nasal bones, smoothed profile). When studying the eye sockets, a number of gross defects can be determined, for example, cyclopia(eyeballs are completely or partially fused and are located in the middle of the face in one eye socket), neoplasms, anophthalmia(underdevelopment of the eyeball). The study of the nasolabial triangle primarily reveals the presence of the palate.

Study spine throughout in longitudinal and transverse scanning - allows you to identify hernial protrusions, including spinabifida- spina bifida, often combined with malformations of the spinal cord.

When researching lungs their structure is studied (the presence of cystic formations can be determined), sizes, the presence of free fluid in the pleural (thoracic) cavity, neoplasms.

Further study a heart for the presence of four chambers (normally, the heart consists of 2 atria and 2 ventricles), the integrity of the interventricular and interatrial septa, valves between the ventricles and the atria, as well as the presence and correct discharge / confluence of large vessels (aorta, pulmonary trunk, superior vena cava) . The very location of the heart, its size, changes in the heart bag (pericardium) are also evaluated.

When scanning organs abdominal cavity- stomach and intestines - their presence, location, size is determined, which makes it possible to indirectly judge other organs of the abdominal cavity. In addition, an increase or decrease in the size of the abdomen during fetometry indicates the presence of pathology (for example, dropsy, hernia, hepato- and splenomegaly - an increase in the liver and spleen). Further research kidneys and bladder for their presence, shape, size, localization, structure.

Study of provisional authorities allows you to indirectly judge the condition of the fetus, intrauterine infections and other conditions that require correction.

It is studied according to the following parameters:

1. Localization. The doctor of ultrasound diagnostics necessarily reflects the localization of the placenta, especially its position relative to the internal pharynx of the cervix. Since with improper attachment of the placenta, for example, when it completely covers the internal os ( complete), this is accompanied by bleeding during pregnancy, and vaginal delivery is not possible. If the lower edge of the placenta is located lower than 7 cm from the internal os, ultrasound control is required at 27-28 weeks.
2. Thickness. The placenta is a dynamically developing provisional organ of the fetus, therefore, during pregnancy, its thickness increases on average from 10 to 36 mm, although these values ​​vary in a fairly wide range, which is presented in table 7.

Pregnancy period, weeks	Placenta thickness, mm
	21,96 (16,7-28,6) 22,81 (17,4-29,7) 23,66 (18,1-30,7) 24,52 (18,8-31,8) 25,37 (19,6-32,9) 26,22 (20,3-34,0) 27,07 (21,0-35,1) 27,92 (21,7-36,2) 28,78 (22,4-37,3) 29,63 (23,2-38,4) 30,48 (23,9-39,5) 31,33 (24,6-40,6) 32,18 (25,3-41,6) 33,04 (26,0-42,7) 33,89 (26,8-43,8) 34,74 (27,5-44,9) 35,59 (28,2-46,0) 34,35 (27,8-45,8) 34,07 (27,5-45,5) 33,78 (27,1-45,3) 33,50 (26,7-45,0)

After 36 weeks, the thickness of the placenta usually decreases. The discrepancy between this parameter and the normative values ​​should alert, first of all, regarding the presence of an intrauterine infectious process, as well as the discrepancy between the nutrients supplied to the fetus and its needs.

1. Structure. Normally, it is homogeneous, it should not have inclusions. Inclusions may indicate premature aging of the placenta (which can cause fetal growth retardation), heterogeneity indicates the possible presence of infection.
2. The degree (stage) of maturity. The placenta changes its structure unevenly, most often this process occurs from the periphery to the center. In an uncomplicated course of pregnancy, changes go through stages from 0 to III sequentially (0 - up to 30 weeks, I - 27-36, II - 34-39, III - after 36 weeks). This indicator allows predicting the complicated course of pregnancy, the presence of syndrome (SZRP). Currently, the presence of II degree up to 32 and III degree up to 36 weeks is considered to be premature maturation of the placenta. An ultrasound assessment of the structure of the placenta is shown in Table 8.

* chorionic membrane - layer with villi facing the fetus

** parenchyma- tissue of the placenta

*** basal layer- the outer surface that the placenta adjoins the wall of the uterus

Used for evaluation amniotic fluid index. When it is determined, the uterine cavity is conditionally divided into 4 quadrants by two planes drawn through the white line of the abdomen (the connective tissue structure of the anterior abdominal wall located along the midline) vertically and horizontally at the level of the navel. Further, in each quadrant, the depth (vertical size) of the largest pocket of amniotic fluid (amniotic fluid) free from parts of the fetus is determined, all 4 values ​​are summed up and displayed in centimeters. If the index is less than 2 cm - this is, if more than 8 cm -. This is a diagnostically significant sign of the presence of infection, malformations. Indicators of the amniotic fluid index in different dates pregnancies are presented in Table 9.

Umbilical cord(a provisional organ that connects the embryo / fetus with the mother's body) normally contains 3 large vessels: one vein and two arteries. In many hereditary pathologies, only one umbilical artery occurs, which requires more careful management of pregnancy.

Also subject to mandatory research (for its length, which is important in the presence of a threat of termination of pregnancy), appendages(for ovarian cysts) uterine wall(if there was a history cesarean section, the condition of the scar is assessed).

Based on the ultrasound examination performed during pregnancy, a conclusion is made about the presence of (VLOOKUP) fetus or some other pathology and recommendations are given.

Ultrasound indicators in the third trimester

Third ultrasound at 32-34 weeks necessary to detect malformations that appear only in late pregnancy (for example, , aneurysm of the vein of Galen- violation of the structure of the vascular wall of a large cerebral vessel). It allows you to assess the functional state of the fetus, make a diagnosis syndrome (SZRP), which makes it possible to carry out a complex of necessary therapeutic measures, to identify indications for timely and careful delivery. The presence of sdfd requires mandatory monitoring after 7-10 days against the background of active therapy.

An important point is (head or), which significantly affects the method of delivery. It is also necessary to define estimated fetal weight, which should be taken into account in the tactics of further management of pregnancy and especially childbirth.

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

When evaluating the tabular parameters, the sum of the points is determined, on the basis of which a conclusion is made about the condition of the fetus:

• 12-8 – norm;
• 7-6 - the doubtful condition of the fetus, the possible development of complications;
• less than 5- pronounced intrauterine hypoxia(lack of oxygen supply to the fetus, leading to varying degrees of impairment of its vital functions) with a high risk perinatal losses(fetal loss between pregnancy and 168 hours after birth).

Ultrasound examination during screening periods allows to detect a large number of pathologies and take preventive measures to eliminate them as much as possible in the prenatal period, and if it is impossible to eliminate them, to reduce the consequences.

There is no such woman who would not worry about the condition of the fetus inside. The embryo goes through a long way of development from several cells to a full-fledged organism. To track all changes and exclude fetal abnormalities, its development is monitored using ultrasound.

With the help of ultrasound, photometry is done, that is, some important indicators are measured. But in this article, we will pay more attention to the biparietal head size of a growing man (BDP). The interpretation of ultrasound - all the data obtained with the help of ultrasound, is given by the doctor. The results on paper are mostly just numbers. It is difficult to understand them without special medical knowledge. You need to have an idea of ​​what screening is. Then it will be clear what information is provided by the doctor of ultrasound diagnostics.

What is BDP on ultrasound during pregnancy

When a woman bears a child, she must undergo an ultrasound scan 3 times during pregnancy. Each time it is necessary to check such basic measurements as BPR, LZR and KTR. What is BDP on ultrasound during pregnancy? Biparietal size is the main indicator that displays the width of the fetal head. According to this indicator, doctors can judge whether or not there is a developmental pathology in the prenatal period. Already in the early stages, doctors are able to detect genetic mutations and malformations due to such parameters as the coccygeal-parietal size of the fetus (KTR), biparietal size (BPR) and fronto-occipital size (LZR).

The biparietal size of the fetus is measured exactly after the 20th week of pregnancy, when the first screening is performed. BDP on ultrasound is the size between the two temples. The information received is compared with the data corresponding to your term. All norms are listed in the table. With its data, which reflect the normal development, we will get acquainted later.

BPR norms by week

Since the baby in the womb develops very quickly, the rates increase every week. All pregnant women want to know how fast the fetus is developing inside them, if there are any abnormalities.

The size of the fetal head is measured using ultrasound. The other two indicators (BPR and LZR) correlate with those average values ​​that are considered the norm today.

We look at the BDP indicator on ultrasound during pregnancy. The standard is given in millimeters.

The table below shows the measurement norms from 14 to 24 weeks.

Gestational age (weeks)		Head circumference
14	22	103
15	27	112
16	32	124
17	36	135
18	40	146
19	44	158
20	47	170
21	50	183
22	54	195
23	57	207
24	59	219

These data are averaged. That is, a deviation of 2 mm in one direction or the other is considered acceptable.

Screening of pregnant women at 12 weeks

We examined what BDP means on ultrasound during pregnancy. This is the distance between the parietal bones of a small head.

An important ultrasound screening is performed between 12 and 14 weeks. This study allows you to determine how the baby feels in the womb, how it develops. Ultrasound is done through the skin of the abdomen (transabdominally). By week 12, BDP should be within 21 mm. Also at this time, the diameter of the chest (DHA) is measured. It should be 24 mm, CTE is approximately 51 mm at this time. Another important indicator is the thickness of the collar zone. Its value is a marker of the presence (absence) of Down syndrome. Normally, TVZ should be 0.71 - 2.5 mm.

The doctor also looks at the condition of the uterus, the amount of amniotic fluid, their purity or turbidity.

What are the deviations

We repeat what BDP is on ultrasound during pregnancy. This is a study of the development of the brain. After all, the brain and heart are the most important organs of a child. If they do not develop properly, the child may be born disabled.

When the BDP index does not correspond to normal values, the doctor may establish one of the following diagnoses:

• Delayed fetal development. Such a diagnosis is made if all other indicators do not go beyond allowable limits, and the biparietal size is reduced. This can be observed for two reasons: the size of the brain is less than normal due to its underdevelopment or due to the absence of part of the brain tissue.
• Indicators of LZR and BPR are exceeded, while others correspond to the norm. These are indications of hydrocephalus in the fetus. In the people, this disease is called dropsy.
• The diagnosis of Down syndrome is made if the collar space is enlarged, heart defects are present and a decrease in the fronto-thalamic distance is diagnosed, and the size of the cerebellum is also less than normal. This is all measured at 23 weeks. In addition to these measurements, it is also necessary to analyze the genome and take the mother's blood for analysis.
• Tumors or cysts in the brain. If BDP has increased due to a tumor, then the mother is recommended to artificially terminate the pregnancy.

If the data obtained from the study is not too optimistic, the doctor prescribes an additional ultrasound. Perhaps there was an error. This often occurs if the period is rather short or the study was carried out by an inexperienced doctor.

Measurements at 23 weeks pregnant

The next ultrasound is usually performed at 22-23 weeks. At the 6th month, the baby is already fully formed. At this time, the brain and the entire central nervous system of the fetus are actively developing. Therefore, an ultrasound scan must be completed in order to find out what biparietal and fronto-occipital size of the skull is at this stage of development in the baby.

What does BPD mean on ultrasound during pregnancy? This information directly speaks about the development of the unborn baby.

At this time, the indicators should be as follows:

• BPR - 52 - 64 mm.
• LZ - 67 - 81 mm.
• Growth at this time is approximately 20-26 cm.

At this time also measured:

• Femur. Its length is 38 -42 mm.
• Fetal tibia - 36-42 mm.
• Fibular - 35-42 mm.

Brain activity at 23-24 weeks already corresponds to the newborn. They say that the baby is already beginning to dream at this time, smile, and remind his mother of himself with light jerks.

If a child is born at this time, then such a birth is already classified as a premature birth, and not a miscarriage. With the help of medical equipment in the maternity hospital, it is possible to leave it.

The state of health of a woman in the 2nd and 3rd semesters

In addition to the parameters of the child, with the help of ultrasound, the state of the amniotic fluid, as well as the blood flow in the umbilical cord in the second semester, are also studied. Mom's health is just as important. As you know, both organisms at this time are completely interconnected. The state of the cardiovascular and nervous system of a woman also needs to be examined during pregnancy. In order for the birth to be successful, a woman needs to go to pregnancy courses and gradually engage in physical and breathing exercises. At the 3rd semester, be sure to check the condition of the heart.

intrauterine growth retardation

For the most part, gold reserves are not obtained by chance. Often, the expectant mother herself is to blame for intrauterine growth retardation. The reasons for the SVR can be:

1. Infection. When it occurs, the pathogen is established and treatment is prescribed for the mother. If the infection has already damaged the child's brain, there will be little point in treating it.
2. Oxygen starvation. This is a very dangerous condition for a child. A pregnant woman should walk for 2 hours a day for fresh air.
3. Fetoplacental insufficiency.

We already know what BDP is on ultrasound during pregnancy. This indicator with developmental delay will be very small - below 18 mm at 14 weeks. In order to prevent such serious deviations, it is advisable to find out about pregnancy in the first weeks in order to follow all the doctor's advice from the very beginning.

hydrocephalus and microcephaly

With hydrocephalus, the volume of the head is larger than that of the average fetus. And with microcephaly in the unborn child, the size of the head is smaller than it should be for a given gestational age.

It is not always associated with mutations or disease. Often the child's parents are short and have relatively small skull bones (compared to the majority of the world's population). Then their child will also be smaller than the average newborn.

BDP at the end of pregnancy

Why are measurements taken in the 3rd trimester, if the BPD on ultrasound is fully consistent with the norm? The fact is that at the end of pregnancy, doctors need to know how much the size of the fetal head corresponds to the mother's genitals. If it is clear that it will be difficult for a woman to give birth on her own due to the large head of the child, then she is advised to do a planned caesarean section.

If everything is foreseen in advance, then the woman will not have any complications during childbirth. However, a caesarean section is an operation that has its own risks, which must also be considered.

Prevention

We explained in detail what BDP means on ultrasound. How to prevent the occurrence of deviations in the development of the embryo? In order for the fetus to develop normally, it needs certain conditions: daily walks in the fresh air and good nutrition of the mother, the measured rhythm of her life, the exclusion of heavy physical exertion and situations that cause nervous tension. A woman also needs a good sleep. If a lady is going to raise a baby alone, it will be very difficult for her. Therefore, doctors insist that the child must be planned. When planning, parents agree in advance on whether the woman will work during gestation, how long she will work labor activity.

Before conception, it is important for the expectant mother to undergo an examination. The presence in the blood of infections such as rubella, the herpes virus and toxoplasmosis can lead to the loss of a child. Also, some couples are better off undergoing genetic testing. This is especially important for those parents in whose families there were diseases of a hereditary nature.

findings

We explained what BPR is on ultrasound during pregnancy, what LZR and KTP are. Doctors use these parameters to judge whether the fetal brain is developing correctly.

It is very important for physicians to know the rate of BDP. Ultrasound determines all the necessary indicators. Therefore, even in the womb, it is possible to determine deviations in the development of the fetus and prevent the birth of a terminally ill child.

In some cases, according to the indications of ultrasound, a woman is prescribed treatment, after which repeated measurements of the fetus are made.

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

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

Screening includes two stages: an ultrasound scan and blood sampling for analysis.

During an ultrasound examination, the diagnostician determines the number of fetuses, the gestational age and takes the size of the embryo: KTP, BDP, the size of the neck fold, nasal bone, and so on.

According to these data, we can say how well the baby develops in the womb.

Ultrasound screening and its norms

Assessment of the size of the embryo and its structure. Coccyx-parietal size (KTP)- this is one of the indicators of embryo development, the value of which corresponds to the gestational age.

KTP is the size from the tailbone to the crown, excluding the length of the legs.

There is a table of standard CTE values ​​​​according to the week of pregnancy (see table 1).

Table 1 - KTR norm according to gestational age

The deviation of the size of the fetus from the norm upwards indicates the rapid development of the baby, which is a harbinger of the bearing and birth of a large fetus.

Too small size of the fetal body indicates:

• initially incorrectly set gestational age by the district gynecologist, even before the visit to the diagnostician;
• developmental delay as a result of hormonal deficiency, infectious disease or other ailments in the mother of the child;
• genetic pathologies of fetal development;
• intrauterine death of the fetus (but only on condition that the fetal heartbeats are not heard).

Biparietal size (BDP) of the fetal head- This is an indicator of the development of the baby's brain, measured from temple to temple. This value also increases in proportion to the duration of pregnancy.

Table 2 - Norm of BPR of the fetal head at a certain gestational age

Exceeding the norm of BPR of the fetal head may indicate:

• a large fetus, if the other sizes are also above the norm for a week or two;
• spasmodic growth of the embryo, if the other dimensions are normal (in a week or two, all parameters should even out);
• the presence of a brain tumor or cerebral hernia (pathologies incompatible with life);
• hydrocephalus (dropsy) of the brain due to an infectious disease in a future mother (antibiotics are prescribed and, with successful treatment, the pregnancy persists).

The biparietal size is less than normal in case of underdevelopment of the brain or the absence of some of its sections.

The thickness of the collar space (TVP) or the size of the "neck crease"- this is the main indicator that, in case of deviation from the norm, indicates a chromosomal disease (Down syndrome, Edwards syndrome or another).

In a healthy child, TVP at the first screening should not be more than 3 mm (for ultrasound performed through the abdomen) and more than 2.5 mm (for vaginal ultrasound).

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

Table 3 - Norms of TVP by weeks of pregnancy

The length of the nose bone. In a fetus with a chromosomal abnormality, ossification occurs later than in a healthy fetus, therefore, with deviations in development, the nasal bone at the first screening is either absent (at 11 weeks) or its value is too small (from 12 weeks).

The length of the nasal bone is compared with the standard value from the 12th week of pregnancy, at 10-11 weeks the doctor can only indicate its presence or absence.

If the length of the nasal bone does not correspond to the gestational age, but the rest of the indicators are normal, there is no reason for concern.
Most likely, this is an individual feature of the fetus, for example, the nose of such a baby will be small and snub-nosed, like that of parents or one of close relatives, for example, a grandmother or great-grandfather.

Table 4 - The norm of the length of the nasal bone

Also, at the first ultrasound screening, the diagnostician notes whether the bones of the cranial vault, butterfly, spine, limb bones, anterior abdominal wall, stomach, and bladder are visualized. At this time, these organs and parts of the body are already clearly visible.

Assessment of the vital activity of the fetus. In the first trimester of pregnancy, the vital activity of the embryo is characterized by cardiac and motor activity.

Since fetal movements are usually periodic and barely distinguishable at this time, only the embryonic heart rate has diagnostic value, and motor activity is simply noted as “determined”.

Heart rate (HR) fetus, regardless of gender, at 9-10 weeks should be in the range of 170-190 beats per minute, from 11 weeks until the end of pregnancy - 140-160 beats per minute.

Fetal heart rate below the norm (85-100 beats / min) or above the norm (more than 200 beats / min) is an alarming sign, in which an additional examination and, if necessary, treatment are prescribed.

Study of extraembryonic structures: yolk sac, chorion and amnion. Also, the ultrasound diagnostician in the protocol of screening ultrasound (in other words, in the form of ultrasound results) notes data on the yolk sac and chorion, on the appendages and walls of the uterus.

Yolk sac- this is the organ of the embryo, which until the 6th week is responsible for the production of vital proteins, plays the role of the primary liver, circulatory system, primary germ cells.

In general, the yolk sac performs various important functions up to the 12-13th week of pregnancy, then there is no need for it, because the fetus is already forming separate organs: the liver, spleen, etc., which will take on all the responsibilities for life support .

By the end of the first trimester, the yolk sac shrinks and turns into a cystic formation (yolk stalk), which is located near the base of the umbilical cord. Therefore, at 6-10 weeks, the yolk sac should be no more than 6 mm in diameter, and after 11-13 weeks, normally it is not visualized at all.

But everything is purely individual, the main thing is that he does not finish his functions earlier due date, therefore, at 8-10 weeks it should be at least 2 mm (but not more than 6.0-7.0 mm) in diameter.

If up to 10 weeks the yolk sac is less than 2 mm, then this may indicate a non-developing pregnancy or a lack of progesterone (then Dufaston or Utrozhestan is prescribed), and if at any time in the first trimester the diameter of the yolk sac is more than 6-7 mm, then this indicates the risk of developing pathologies in the fetus.

Chorion- this is the outer shell of the embryo, covered with many villi that grow into the inner wall of the uterus. In the first trimester of pregnancy, the chorion provides:

• nutrition of the fetus with essential substances and oxygen;
• removal of carbon dioxide and other waste products;
• protection against the penetration of viruses and infections (although this function is not durable, but with timely treatment, the fetus does not become infected).

Within the normal range, the localization of the chorion is “at the bottom” of the uterine cavity (on the upper wall), on the anterior, posterior, or one of the side walls (left or right), and the structure of the chorion should not be changed.

The location of the chorion in the area of ​​\u200b\u200bthe internal pharynx (the transition of the uterus to the cervix), on the lower wall (at a distance of 2-3 cm from the pharynx) is called chorion presentation.

But such a diagnosis does not always indicate placenta previa in the future, usually the chorion “moves” and is thoroughly fixed higher.

Chorionic presentation increases the risk of spontaneous miscarriage, so with this diagnosis, stay in bed, move less and do not overwork. There is only one treatment: lie in bed for days (getting up only to use the toilet), sometimes raising your legs up and remaining in this position for 10-15 minutes.

By the end of the first trimester, the chorion will become the placenta, which will gradually "ripen" or, as they say, "age" until the end of pregnancy.

Until the 30th week of pregnancy - the degree of maturity is 0.

This evaluates the ability of the placenta to provide the child with everything necessary at each stage of pregnancy. There is also the concept premature aging placenta", which indicates a complication of the course of pregnancy.

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

The amount of amniotic fluid at 10 weeks is about 30 ml, at 12 weeks - 60 ml, and then it increases by 20-25 ml per week, and at 13-14 weeks there are already about 100 ml of water.

When examining the uterus with an uzist, an increased tone of the uterine myometrium (or uterine hypertonicity) can be detected. Normally, the uterus should not be in good shape.

Often in the results of ultrasound you can see the record "local thickening of the myometrium along the posterior / anterior wall", which means both a short-term change in the muscular layer of the uterus due to a feeling of excitement in a pregnant woman during an ultrasound scan, and an increased tone of the uterus, which is a threat of spontaneous miscarriage.

The cervix is ​​also examined, its pharynx should be closed. The length of the cervix at 10-14 weeks of pregnancy should be about 35-40 mm (but not less than 30 mm for nulliparous and 25 mm for multiparous). If it is shorter, then this indicates the risk of premature birth in the future. Approaching the day of the expected birth, the cervix will shorten (but should be at least 30 mm by the end of the pregnancy), and before the birth itself, her pharynx will open.

Deviation from the norm of some parameters during the first screening does not give cause for concern, just pregnancy in the future should be monitored more closely, and only after the second screening can we talk about the risk of developing malformations in the fetus.

Standard ultrasound protocol in the first trimester

Biochemical screening ("double test") and its interpretation

Biochemical screening of the first trimester involves the determination of two elements contained in a woman's blood: the level of free b-hCG and plasma protein-A - PAPP-A. These are the two hormones of pregnancy, and with the normal development of the baby, they should correspond to the norm.

Human chorionic gonadotropin (hCG) consists of two subunits - alpha and beta. Free beta-hCG is unique in its kind, therefore its value is taken as the main biochemical marker used to assess the risk of chromosomal pathology in the fetus.

Table 5 - The norm of b-hCG during pregnancy by week

An increase in the value of free b-hCG indicates:

• the risk of the fetus having Down syndrome (in case of exceeding the norm twice);
• multiple pregnancy ( hCG level increases in proportion to the number of fruits);
• the presence of diabetes in a pregnant woman;
• gestosis (i.e. with an increase blood pressure+ edema + detection of protein in the urine);
• malformations of the fetus;
• hydatidiform mole, choriocarcinoma (a rare type of tumor)

A decrease in the value of beta-hCG indicates:

• the risk of the fetus having Edwards syndrome (trisomy 18) or Patau syndrome (trisomy 13);
• threat of abortion;
• fetal growth retardation;
• chronic placental insufficiency.

PAPP-A Plasma pregnancy-associated protein A.

Table 6 - Norm of PAPP-A during pregnancy by week

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

• development of chromosomal pathology: Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Patai syndrome (trisomy 13) or Cornelia de Lange syndrome;
• spontaneous miscarriage or intrauterine death of the fetus;
• placental insufficiency or fetal malnutrition (ie, insufficient body weight due to malnutrition of the baby);
• the development of preeclampsia (estimated together with the level of placental growth factor (PLGF). A high risk of developing preeclampsia is indicated by a decrease in PAPP-A together with a decrease in placental growth factor.

An increase in PAPP-A can be observed if:

• a woman is carrying twins/triplets;
• the fetus is large and the mass of the placenta is increased;
• the placenta is low.

For diagnostic purposes, both indicators are important, so they are usually considered in combination. So if PAPP-A is lowered and beta-hCG is increased, there is a risk of Down syndrome in the fetus, and if both indicators are reduced, Edwards syndrome or Patau syndrome (trisomy 13).

After 14 weeks of gestation, a PAPP-A test is considered non-informative.

Second screening of the II trimester (at 16-20 weeks)

II screening, as a rule, is prescribed for deviations in I screening, less often for the threat of abortion. In the absence of deviations, the second comprehensive screening can be omitted, and only a fetal ultrasound can be performed.

Ultrasound screening: norms and deviations

Screening ultrasound at this time is aimed at determining the "skeletal" structure of the fetus and the development of its internal organs.
Fetometry. The diagnostician notes the presentation of the fetus (breech or head) and takes other indicators of fetal development (see tables 7 and 8).

Table 7 - Normative dimensions of the fetus according to ultrasound

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

Table 8 - The norm of the length of the nasal bone

According to the measurements taken, it is possible to judge the true gestational age.

Fetal anatomy. An uzist examines the internal organs of the baby.

Table 9 - Normative values ​​of the fetal cerebellum by week

The dimensions of both the lateral ventricles of the brain and the large cistern of the fetus should not exceed 10-11 mm.

Usually, other indicators, such as: Nasolabial triangle, Eye sockets, Spine, 4-chamber section of the heart, Section through 3 vessels, Stomach, Intestine, Kidneys, Bladder, Lungs - in the absence of visible pathologies are marked as "normal".

The place of attachment of the umbilical cord to the anterior abdominal wall and to the center of the placenta is considered normal.

Abnormal attachment of the umbilical cord includes marginal, sheath and split, which leads to difficulties in the birth process, fetal hypoxia and even death during childbirth, if a planned CS is not prescribed or in case of premature birth.

Therefore, in order to avoid fetal death and blood loss in a woman during childbirth, a planned caesarean section (CS) is prescribed.

There is also a risk of developmental delay, but with normal baby development and careful monitoring of the woman in labor, everything will go well for both.

Placenta, umbilical cord, amniotic fluid. The placenta is most often located on the back wall of the uterus (in the form it can be specified more on the right or left), which is considered the most successful attachment, since this part of the uterus is best supplied with blood.

The area closer to the bottom also has a good blood supply.

But it happens that the placenta is localized on the anterior wall of the uterus, which is not considered something pathological, but this area is prone to stretching when the baby grows inside the mother's womb "plus" active movements of the crumbs - all this can lead to placental abruption. In addition, placenta previa is more common in women with an anterior placenta.

This is not critical, just this information is important for deciding on the method of delivery (whether a caesarean section is necessary and what difficulties may arise during childbirth).

Normally, the edge of the placenta should be 6-7 cm (or more) above the internal os. Its location in the lower part of the uterus in the region of the internal os is considered abnormal, partially or completely blocking it. This phenomenon is called "placenta previa" (or low placentation).

The thickness of the placenta is more informative to measure after the 20th week of pregnancy. Until this period, only its structure is noted: homogeneous or heterogeneous.

From 16 to 27-30 weeks of pregnancy, the structure of the placenta should be unchanged, homogeneous.

The structure with the expansion of the intervillous space (MVP), echo-negative formations and other kinds of abnormalities negatively affects the nutrition of the fetus, causing hypoxia and developmental delay. Therefore, treatment is prescribed with Curantil (normalizes blood circulation in the placenta), Actovegin (improves the supply of oxygen to the fetus). With timely treatment, babies are born healthy and on time.

After 30 weeks, there is a change in the placenta, its aging, and as a result, heterogeneity. On the late term this is already a normal phenomenon that does not require additional examinations and treatment.

Normally, up to 30 weeks, the degree of maturity of the placenta is “zero”.

The amount of amniotic fluid. To determine their number, the diagnostician calculates the amniotic fluid index (AFI) according to measurements taken during ultrasound.

Table 10 - Norms of the amniotic fluid index by week

Find your week of pregnancy in the first column. The second column shows the normal range for a given period. If the IAI indicated by the uzist in the screening results is within this range, then the amount of amniotic fluid is normal, less than the norm means early oligohydramnios, and more means polyhydramnios.

There are two degrees of severity: moderate (minor) and severe (critical) oligohydramnios.

Severe oligohydramnios threatens with abnormal development of the fetal limbs, spinal deformity, and the baby's nervous system also suffers. As a rule, children who have suffered oligohydramnios in the womb are lagging behind in development and weight.

With severe oligohydramnios, drug treatment must be prescribed.

Moderate oligohydramnios usually does not require treatment, it is only necessary to establish nutrition, minimize physical activity, take vitamin complex(must include vitamin E).

In the absence of infections, preeclampsia and diabetes in the mother of the child, and with the development of the baby within the normal range, there is no reason for concern, most likely, this is a feature of the course of this pregnancy.

Normally, the umbilical cord has 3 vessels: 2 arteries and 1 vein. The absence of one artery can lead to various pathologies in the development of the fetus (heart disease, esophageal atresia and fistula, fetal hypoxia, disruption of the genitourinary or central nervous system).

But about the normal course of pregnancy, when the work of the missing artery is compensated by the existing one, we can talk about:

• normal results of blood tests for the content of hCG, free estriol and AFP, i.e. in the absence of chromosomal pathologies;
• good indicators of fetal development (according to ultrasound);
• the absence of defects in the structure of the fetal heart (if an open functional oval window is found in the fetus, you should not worry, it usually closes up to a year, but it is necessary to be observed by a cardiologist every 3-4 months);
• unimpaired blood flow in the placenta.

Babies with an anomaly such as the “single umbilical artery” (abbreviated as EAP) are usually born with a small weight, they can often get sick.

Up to a year, it is important to monitor changes in the child's body, after a year of life, the crumbs are recommended to thoroughly take care of his health: organize a proper balanced diet, take vitamins and minerals, perform immunity-strengthening procedures - all this can bring the state of a small organism in order.

Cervix and walls of the uterus. In the absence of deviations, the ultrasound protocol will indicate “The cervix and walls of the uterus without features” (or abbreviated b / o).

The length of the cervix in this trimester should be 40-45 mm, 35-40 mm is acceptable, but not less than 30 mm. If its opening and / or shortening is observed compared to the previous measurement during ultrasound or softening of its tissues, which is collectively called "isthmic-cervical insufficiency" (ICI), then the installation of an obstetric unloading pessary or suturing is prescribed to save the pregnancy and reach the prescribed term.

Visualization. Normally, it should be "satisfactory". Visualization is difficult when:

• the position of the fetus inconvenient for research (it’s just that the baby is positioned so that not everything can be seen and measured, or he was constantly spinning during the ultrasound);
• overweight (in the visualization column, the reason is indicated - due to subcutaneous adipose tissue (SAT));
• edema in the expectant mother
• hypertonicity of the uterus during ultrasound.

Standard ultrasound protocol in the second trimester

Biochemical screening or "triple test"

Biochemical blood screening of the second trimester is aimed at determining three indicators - the level of free b-hCG, free estriol and AFP.

The rate of free beta hCG look at the table below, and you will find the transcript, it is similar at each stage of pregnancy.

Table 11 - The rate of free b-hCG in the second trimester

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

Table 12 - The rate of free estriol by week

An increase in the amount of free estriol in the blood of a pregnant woman is observed with multiple pregnancies or a large fetal weight.

A decrease in the level of estriol is noted with fetoplacental insufficiency, threatened miscarriage, cystic mole, intrauterine infection, adrenal hypoplasia or anencephaly (defect in the development of the neural tube) of the fetus, Down syndrome.

A decrease in free estriol by 40% or more of the standard value is considered critical.

Taking antibiotics during the test period can also affect the decrease in estriol in the woman's blood.

Alpha fetoprotein (AFP)- This is a protein produced in the liver and gastrointestinal tract of the baby, starting from the 5th week of pregnancy from conception.

This protein enters the mother's blood through the placenta and from the amniotic fluid, and begins to grow in it from the 10th week of pregnancy.

Table 13 - AFP norm by week of pregnancy

If during pregnancy a woman had a viral infection, and the baby had liver necrosis, then an increase in AFP in the blood serum of the pregnant woman is also observed.

Third screening (at 30-34 weeks)

In total, two screenings are carried out during pregnancy: in the first and second trimesters. In the third trimester of pregnancy, a kind of final monitoring of the health of the fetus is carried out, its position is monitored, the functionality of the placenta is assessed, and a decision is made on the method of delivery.

To do this, somewhere at 30-36 weeks, an ultrasound of the fetus is prescribed, and from 30-32 weeks, cardiotocography (abbreviated CTG - registration of changes in the fetal heart activity depending on its motor activity or uterine contractions).

Dopplerography can also be prescribed, which allows you to assess the strength of blood flow in the uterine, placental and main vessels of the fetus. With the help of this study, the doctor will find out if the baby has enough nutrients and oxygen, because it is better to prevent the occurrence of fetal hypoxia than to solve the health problems of the crumbs after childbirth.

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

Table 14 - Thickness of the placenta (normal)

With a decrease in thickness, a diagnosis of placental hypoplasia is made. Usually this phenomenon causes late toxicosis, hypertension, atherosclerosis or infectious diseases suffered by a woman during pregnancy. In any case, treatment or maintenance therapy is prescribed.

Most often, placental hypoplasia is observed in fragile miniature women, because one of the factors in reducing the thickness of the placenta is the weight and physique of the pregnant woman. This is not scary, more dangerous is an increase in the thickness of the placenta and, as a result, its aging, which indicates a pathology that can lead to termination of pregnancy.

The thickness of the placenta increases with iron deficiency anemia, preeclampsia, diabetes mellitus, Rhesus conflict and with viral or infectious diseases(transferred or present) in a pregnant woman.

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

The degree of maturity of the placenta (normal):

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

Early aging of the placenta is fraught with a deficiency of nutrients and oxygen, which threatens with fetal hypoxia and developmental delay.

An important role in the third trimester is played by the amount of amniotic fluid. Below is a normative table for the amniotic fluid index - a parameter characterizing the amount of water.

Below is a table of standard fetal sizes by week of pregnancy. The baby may not meet the specified parameters a little, because all children are individual: someone will be large, someone will be small and fragile.

Table 16 - Normative dimensions of the fetus by ultrasound for the entire period of pregnancy

Preparing for a Screening Ultrasound

Transabdominal ultrasound - the sensor is driven along the abdominal wall of a woman, transvaginal ultrasound - the sensor is inserted into the vagina.

With a transabdominal ultrasound, a woman with a period of up to 12 weeks of pregnancy should come to the diagnosis with a full bladder, having drunk 1-1.5 liters of water half an hour or an hour before the visit to the ultrasound doctor. This is necessary so that the full bladder “squeezes out” the uterus from the pelvic cavity, which will make it possible to better examine it.

From the second trimester, the uterus increases in size and is well visualized without any preparation, so there is no need for a full bladder.

Take a handkerchief with you to wipe off the remaining special gel from your stomach.

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

The doctor can tell you to buy a condom from the pharmacy in advance, which is put on the sensor for hygiene purposes, and go to the toilet to urinate if the last urination was more than an hour ago. For supporting intimate hygiene bring special wet wipes, which are also purchased in advance at a pharmacy or in a store in the appropriate department.

Transvaginal ultrasound is usually performed only in the first trimester of pregnancy. With it, it is possible to detect a fetal egg in the uterine cavity even before the 5th week of pregnancy, abdominal ultrasound is not always possible at such an early stage.

The advantage of vaginal ultrasound is that it is able to determine ectopic pregnancy, the threat of miscarriage in the pathology of the location of the placenta, diseases of the ovaries, fallopian tubes, uterus and cervix. Also, a vaginal examination makes it possible to more accurately assess how the fetus develops, which can be difficult to do in overweight women (if there is a fold of fat on the abdomen).

For ultrasound examination, it is important that gases do not interfere with the examination, therefore, in case of flatulence (bloating), it is necessary to take 2 tablets of Espumizan after each meal the day before the ultrasound, and in the morning on the day of the examination, drink 2 tablets of Espumizan or a bag of Smecta, spreading it to the floor a glass of water.

Preparation for biochemical screening

Blood is taken from a vein, preferably in the morning and always on an empty stomach. The last meal should be 8-12 hours before sampling. In the morning on the day of blood sampling, you can only drink mineral water without gas. Remember that tea, juice and other similar liquids are also food.

The cost of comprehensive screening

If a planned ultrasound examination in city antenatal clinics is most often carried out for a small fee or completely free of charge, then prenatal screening is an expensive set of procedures.

Biochemical screening alone costs from 800 to 1600 rubles. (from 200 to 400 UAH) depending on the city and the “plus” laboratory, you also need to pay about 880-1060 rubles for a regular ultrasound of the fetus. (220-265 UAH). In total, comprehensive screening will cost at least 1,600 - 2,660 rubles. (420-665 UAH).

It makes no sense to conduct prenatal screening at any stage of pregnancy if you are not ready to have an abortion if doctors confirm that the fetus has mental retardation (Down syndrome, Edwards, etc.) or defects in any organs.

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