Ultrasound during pregnancy: transcript. Identification of pregnancy complications
Usually, either the study of the uterus and its appendages, or the uterine cervix separately is carried out. However, there are situations where research is carried out jointly.
Ultrasound of the uterus during pregnancy: what information is obtained with its help?
The purpose of the appointment of such a study is to control the condition of the fetus and exclude possible anomalies that can develop in the uterus. Also, with the help of diagnostics, the state of the organs in the small pelvis is studied.
What is checked and examined during an ultrasound of the uterus?
- The size and shape of the uterus, its localization;
- The presence or absence of its abnormal structure (bicorn, saddle, double uterus);
- The state of the inner uterine layer (endometrium). Early diagnosis allows you to identify such uterine pathologies as a polyp, and find out its location and other characteristics.
How necessary is this research? Ultrasound of the uterus during pregnancy helps in the detection of uterine fibroids and adenomyosis (a condition in which the endometrium grows outside the organ).
In what case does the doctor prescribe the procedure? Almost always, the passage of an ultrasound of the uterus is strictly necessary for those women who have had stitches in order to eliminate the threat of early termination of pregnancy (early opening of the cervix). In this situation, a transvaginal uterine ultrasound is indicated to take place every three weeks.
Uterus on ultrasound: pregnancy at 5 weeks
Diagnosis during this period aims to confirm or refute the pregnancy that originated in the female body. Thus, an ultrasound of the uterus shows pregnancy at the fifth week, and in some cases it is possible even earlier - at the third or fourth week. In addition, it allows you to find out the following information:
- Localization of pregnancy (uterine or ectopic);
- To identify pathological neoplasms in the organ;
- Set the estimated date of conception;
- Assess the condition of the fetal egg (determine whether there is a threat of termination of pregnancy, and whether the pregnancy is dead).
Often, during an ultrasound of the uterus during pregnancy, various kinds of gynecological diseases are diagnosed. It is desirable that they be cured at the stage of pregnancy planning, but not in all cases, the conception of a baby can be considered planned and expected. In addition, sometimes a woman does not suspect that she has any pathologies, because she does not feel any symptoms. That is why you need to visit a gynecologist at least once a year and undergo appropriate diagnostics in the form of an ultrasound examination.
Tone of the uterus during pregnancy (ultrasound)
The tone of the uterus is its contractions that occur prematurely. Uterine tone is especially dangerous in the second trimester, as it can lead to a miscarriage or provoke a fetal stop in development. What can a woman do to relieve uterine tension?
- Sleep at least eight hours a day;
- Reduce sexual activity;
- Do not be subjected to severe stress;
- Eat right and balanced;
- Not subjected to heavy physical exertion;
- Eliminate bad habits from your lifestyle.
In addition, the doctor also makes a decision on how to reduce uterine tone. Often, progesterone-containing drugs are prescribed for this.
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The introduction of the ultrasound method has significantly expanded the diagnostic capabilities in modern gynecology. With the spread, the requirements for its implementation have also increased, in particular, ultrasound of the uterus. In the course of numerous studies and observations, the indications and possibilities of this method have been significantly expanded.
Existing research methods are quite simple and have no contraindications.
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Ways
Pregnancy period, weeks Length, mm Width, mm The height of the fundus of the uterus, cm 8 71-82 42-53 8 10 92-103 55-64 9 12 111-123 65-74 11 16 135-145 76-85 14 18 171-182 92-102 17 20 191-203 113-121 19 22 208-215 122-141 22-23 24 220-231 139-158 23-25 26 245-252 159-172 25-27 28 271-279 179-182 27-30 30 302-312 180-193 27-31 32 318-324 192-201 30-32 34 331-342 198-207 31-35 36 338-345 211-224 32-36 38 351-363 228-241 35-38 40 372-381 247-261 33-37 ovarian ultrasound
The study of the appendages, as a rule, is carried out in a complex examination of the female reproductive system. Preliminary preparation for ovarian ultrasound is not specific and is described in the section “How to prepare for uterine ultrasound”.
When choosing a research method, preference should be given, since visualization of the ovaries is not always possible with a transabdominal examination.
With regards to the timing of the diagnosis, ultrasound of the uterus and ovaries differs slightly.
The first phase of the cycle is considered the optimal period; it is also possible to make a diagnosis in the middle of the cycle (, control of the ovulatory process). If the study is carried out in the second phase of the cycle, the possibility of visualization of follicular cysts, which can be falsely mistaken for true cysts, should be considered.
Therefore, so that the decoding of the ultrasound is not erroneous, it should be repeated in the first half of the cycle.
Examination of the ovaries is done either for preventive purposes during the passage of a gynecological examination, or if any pathology is suspected
Ovarian sizes
It has already been mentioned that ultrasound of the ovaries in women can be performed by any of the methods presented, regardless of the day of the menstrual cycle. The size of the appendages is in a wide range and depends on the patient's age, history, day of the menstrual cycle, oral contraceptives.
Outwardly, the ovaries have an ovoid shape, smooth clear contours, the internal structure is significantly variable depending on the phase of the cycle. Follicles can be determined as early as 2-4 years of age in girls, their number also changes with age.
The volume of the ovaries is calculated by the formula:
V= a*b*c*0.5, where
a, b, c - length, width, thickness in centimeters, 0.5 - coefficient.Girls
The sizes of the ovaries at a young age are as follows:
During the reproductive period
Postmenopausal
It should be borne in mind that the ovaries should be equal in size before the onset of menarche and during menopause, and an increase in the volume of one of the ovaries by more than twice compared to the second indicates malignancy and requires a more detailed examination.
Interpretation of ultrasound results
The ultrasound method has expanded non-invasive diagnostic capabilities for most diseases of the female reproductive system.
A properly conducted study and a correctly executed conclusion carry comprehensive information about the reproductive system.
The volume of detected pathology is extremely large, so let's consider the main ultrasound diagnostic criteria.
The causes of such a disease may be inflammatory diseases of the genital organs, adenomyosis, uterine fibroids, abortions or a genetic predisposition
Enlargement of the uterus
In addition to the previously discussed physiological causes of an increase in the size of the uterus, there are a number of reasons for its pathological increase:
- In this case, there is a slight increase in the uterus, an ectopically located fetal egg is visualized.
This method of examination is the only method for determining an ectopic pregnancy.- Almost always accompanied by an increase in the size of the uterus due to rounded heteroechoic formations of the myometrium.
- On ultrasound, it has a similar picture with myoma, however, the nodes often have reduced echogenicity and cystic components in the structure of the node.
- Internal endometriosis is characterized by an increase in the anteroposterior size, uneven wall thickness, and the presence of a hyperechoic formation in the myometrium.
- Hyperplasia of the myometrium only in advanced cases leads to an increase in the linear dimensions of the uterus.
Reduction in the size of the uterus or its absence
- Condition after surgical removal of the uterus
- Aplasia or hypoplasia of an organ
- Volumetric formations of the small pelvis, which lead to displacement of the uterus or atrophic processes in it.
Enlargement of appendages
The ovaries can increase while maintaining the internal structure, as well as with its violation:
- Multifollicular ovaries. Bilateral increase due to numerous follicles (against the background of hormonal dysfunction).
- Polycystic. More often a bilateral pathological process, ultrasound does not show a change in the structure of the appendages throughout the entire cycle.
- Endometriosis. This disease is difficult to diagnose by ultrasound, the process is often bilateral.
gynecological disease. It can cause ovarian cysts, menstrual irregularities, and even infertility.- Oophoritis. The inflammatory process more often covers both appendages, echogenicity decreases, and the shape approaches spherical.
- Ovarian pregnancy is a rare pathology, is unilateral.
- Adnexal torsion is an acute unilateral process, the ultrasound picture is nonspecific. Requires laparoscopic follow-up examination followed by surgical treatment.
- Tumors. All volumetric processes, both benign and malignant, lead to a unilateral significant increase in the volume of the appendage. The ultrasound picture is heterogeneous.
Lack of visualization of the ovaries can be observed after surgical removal of the organ from one or both sides, with agenesis or aplasia. In a transabdominal examination, visualization difficulties are often associated with insufficient filling of the bladder.
A large number of gynecological pathologies require the active use of modern diagnostic methods, including the ultrasound method, at all stages of diagnosis and treatment.
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In general, preparation for the study is not difficult. As a rule, the doctor or nurse tells the patient about all its features.
During a transabdominal examination, a woman should clear the intestines from accumulated gases. To do this, three days before the procedure, you need to switch to light nutritious food. Legumes, black bread, fresh vegetables and fruits, cow's and goat's milk should be excluded from the diet. If necessary, the doctor will select carminative and enzyme preparations. On the evening before the examination, it is advisable to go to the toilet.
About an hour before the procedure, the patient should drink several glasses of water or compote. The filled bladder will serve as a kind of acoustic window, facilitating the penetration of ultrasonic waves deep into the patient's body.
With transvaginal, transrectal or hysteroscopic ultrasound, no special preparation is required. Immediately before the procedure, you need to empty your bladder.
Normal performance
The normal shape of the uterus is pear-shaped. The approximate length of the body in adult women is -5 cm, thickness - 3.5 cm, width - 5.5 cm. After menopause, the size of the organ decreases. 20 years after the end of menstruation, all parameters decrease by 1 cm. Particular attention is paid to the thickness of the endometrium. This is the lining of the uterus. The probability of implantation of the fetal egg depends on its properties. The egg is not implanted in a shell that is too thick or too thin.
Normally, the thickness of the endometrium on the 3rd - 4th day of the menstrual cycle is up to 4 mm. Then the indicator gradually increases, reaching 10 - 17 mm by day 28. On ultrasound examination, the membrane is anechoic. This means that the endometrium contains a lot of fluid that absorbs ultrasonic waves. Hyperechoic inclusions should be absent.
Consider each pathology visible on ultrasound of the uterus.
Myoma
This is a neoplasia of the uterus of a benign nature, which is diagnosed most often. According to statistics, the disease is found in every fourth woman after 40 years. The main problem provoked by fibroids in women of reproductive age is infertility, in postmenopausal women - cancer of the uterine body.
On ultrasound, a fibroid is defined as a hypoechoic neoplasm, with smooth, but sometimes not quite clear contours and a layered structure. The closer to the surface the layer lies, the higher its echogenicity. Sometimes perpendicular bands of increased or decreased echogenicity are visible on the monitor.
If the node is located directly under the mucous membrane, the neoplasm is defined as a deformation of the endometrium. In addition, the node can swell, grow into adipose tissue, and become saturated with calcium salts. Nine out of 10 submucosal fibroids have their own blood vessels.
Lipoma
Lipoma is a benign neoplasm of the myometrium. It is rare, mainly in women over 50. Specific features are roundness, uniformity. On ultrasound, the uterus is very similar to fibroids, especially with fatty infiltration. A lipoma never has its own blood flow.
Sarcoma of the uterus
Uterine sarcoma is a malignant neoplastic disease characterized by diffuse and nodular growth. Always has its own blood flow, very often - cystic changes. It occurs relatively rarely.
chorioncarcinoma
Chorionic carcinoma is a malignant tumor associated with pregnancy. In every second patient, it is a consequence of hydatidiform mole, in 30% it develops after an abortion, and only in 20% after childbirth. As a rule, the doctor notices a small neoplasm of a homogeneous structure on the monitor. If the tumor is larger, accumulations of fluid are found in it. A biopsy is necessary for an accurate diagnosis.
endometriosis
Endometriosis is a pathological condition in which the endometrium is localized outside the uterine cavity. Depending on the location of pathological foci, there are internal and external endometriosis.
On ultrasound of the uterus, only the internal variety can be diagnosed, which has three stages:
- 1 - the foci are located directly close to the uterine cavity, penetrate into the mucous membrane by no more than 5 mm. The basal layer is thickened, serrated, deformed. In some areas, the endometrium is not defined. In the myometrium - single hyperechoic zones.
- 2 - the wall of the uterus is affected by pathology at ½ depth. Myometrium and endometrium are thickened. Thickening is non-uniform. In the muscular membrane - hyperechoic and anechoic foci with a diameter of up to 5 mm.
- 3 - the uterus is affected more than half the depth. Often, serosa, the outer shell, is drawn into the process. Ultrasound examination reveals large pathological foci. The wall of the uterus is significantly thickened, in the affected area hypoechoic stripes alternate with hyperechoic ones.
Special attention should be paid to the retrocervical form of the disease, which is characterized by damage to the cervix. Ultrasound of the uterus reveals an accumulation of foci with a different echostructure. The contour is fuzzy, when pressed with a sensor, pain is noted.
endometritis
An acute or chronic disease characterized by an inflammatory process that affects the inner lining of the uterus. The approximate incidence rate is 7% among women of reproductive age. To obtain more reliable information, ultrasound should be performed two days before menstruation or in the first week of a new cycle.
During the examination, the following signs of pathology are observed:
- dilated uterine cavity;
- heterogeneous structure of the mucosa;
- different thickness of the endometrium in different areas;
- thinning of the inner shell, inconsistency of thickness with the phase of the cycle;
- fibrous change in the basal layer of the endometrium.
The more criteria the doctor observes, the higher the likelihood of making a correct diagnosis.
Synechia
Intrauterine adhesions (synechia). Synechia - connective tissue structures that grow in the uterine cavity. Interfering with the implantation of a fertilized egg, synechia often causes infertility. As a rule, changes occur as a result of a long-term and improperly treated endometritis, less often - after curettage, childbirth, abdominal operations on the uterus. On ultrasound, the doctor sees hyperechoic structures that sprout the uterine cavity, connecting the anterior and posterior walls. As a rule, neoplasms are straight, directed from back to front.
endometrial hyperplasia
Most often, glandular cystic hyperplasia is diagnosed. On ultrasound, the pathology has a structure similar to a sponge. Every third case has its own arteries, every tenth also has veins. The focus may occupy the entire uterine cavity or only part of it. It often occurs in combination with polyps.
polyps
Polyps are benign neoplasms of a round or oval shape that have a characteristic stalk. Rarely, cysts form inside the polyp.
endometrial cancer
Pathology ranks first in the structure of oncological diseases of the reproductive system among women over 60 years of age. On the monitor of the ultrasound machine, a heterogeneous tumor is seen, without clear edges, with uneven contours. Echogenicity, compared with the myometrium, is higher. The depth of penetration into the wall of the uterus is determined by the stage at which the disease is diagnosed. As a rule, this is half the thickness of the myometrium or more. With untimely or incorrect treatment, the tumor spreads deeper, passes to neighboring organs and structures, and gives distant metastases.
birth defects
Of the congenital malformations of the uterus, ultrasound diagnoses:
- hypoplasia;
- aplasia;
- unicornuate uterus;
- bicornuate uterus;
- saddle uterus;
- infantile uterus;
- rudimentary uterus;
- intrauterine septum;
- bifurcation of the genitals.
Each of the diseases is characterized by its own characteristics. Evaluating the image on the screen, an experienced doctor will easily make the correct diagnosis.
It is important to understand that the ultrasound result itself is not a diagnosis. The final conclusion about the state of health of the patient can only be made by the attending physician, taking into account the data of the clinical picture and the results of other additional research methods, including laboratory ones.
Ultrasound of the cervix during pregnancy
Ultrasound examination of the cervix during pregnancy is an important diagnostic procedure in obstetrics. To date, the survey is recommended to be carried out three times, in each of the trimesters. In the first half, the length of the neck is stable, after the twentieth week it begins to decrease. The reduction rate is approximately 5 mm in 4 weeks of pregnancy. If the indicators exceed the norm, the woman is recommended measures to preserve the pregnancy.
The private medical clinic "Altravita" is equipped with the most modern equipment for ultrasound. Doctors of the clinic conduct daily examinations, thanks to which they have a very extensive experience. As a rule, a qualitative examination is enough to make a final diagnosis. To make an appointment, call the phone number listed on the website or fill out an electronic form.
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 quite informative, allows you to reach a large number of women and, most importantly, is 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.
Ultrasonography ( 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 of intrauterine infection of the embryo/fetus, as well as malnutrition of the fetus, 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:
- Information about the patient (name, age, the beginning of the last menstruation)
- Fetometry(measurement of the main dimensions of the fetus)
- Anatomy of the fetus (organs and systems)
- Provisional organs (temporarily existing, such as the placenta, umbilical cord, and amniotic fluid)
- 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 of 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 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:
- 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.
- 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.
- 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.
- 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 at different stages of pregnancy 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 caesarean section in the anamnesis, 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.
Medical Center "Doctor 2000" is famous for its department of obstetrics and gynecology. Competent doctors with vast practical experience behind them work here. You can completely entrust them with your health and the health of your unborn baby!
When is an ultrasound of the uterus and fetus performed?
As a rule, the following periods are distinguished: 5-8 weeks of pregnancy, 10-12 weeks, 20-24 weeks, 30-32 weeks, ultrasound of the fetus before childbirth. In no case should women neglect such an important diagnostic technique.
Ultrasound of the uterus and appendages, as well as the fetus during pregnancy, is screening in nature. At the beginning of pregnancy, an ultrasound examination is performed to determine the presence of a fetal egg, determine the gestational age and control other parameters. Particular attention is paid to monitoring possible pathologies: the presence of an ectopic pregnancy, a violation of the development of the fetus, detachment of the chorion, etc. In the later stages of pregnancy, the examination of the uterus evaluates more serious anomalies. Thus, ultrasound of the uterus and fetus is a strictly necessary measure that allows, if necessary, to quickly correct the course of pregnancy, avoiding serious complications.
The decision on the number of required ultrasound procedures is made by the obstetrician-gynecologist in whom the patient is observed. Deciphering the results of examinations of the fetus or cervix during pregnancy is carried out by the same specialist. Remember that only a competent doctor can correctly assess the state of affairs, and most importantly, make the right decision in case of problematic situations.