Decoding of ultrasound screenings of pregnancy. Ultrasound during pregnancy: decoding Decoding ultrasound at the 14th week of pregnancy

26.06.2020

MODERN OPPORTUNITIES OF ULTRASOUND EXAMINATION IN PRENATAL DIAGNOSTICS OF CONGENITAL AND HEREDITARY DISEASES IN THE EARLY PERIOD OF PREGNANCY (Literature review).

1.1. The thickness of the collar space and the length of the fetal nasal bones as prenatal echographic markers of fetal chromosomal abnormalities in early pregnancy.

1.2. Possibilities of prenatal echography in the early diagnosis of spinal hernia in the fetus.

1.3. Prenatal aspects of a single umbilical artery as a marker of congenital and hereditary diseases.

CLINICAL CHARACTERISTICS OF THE EXAMINED PREGNANT WOMEN AND METHODS OF THE STUDY.

2.1. Clinical characteristics of the examined pregnant women.

2.2. Research methods.

DEVELOPMENT OF REGIONAL REGIONAL INDICATORS OF THE THICKNESS OF THE COLLAR SPACE AND THE LENGTH OF THE NASAL BONES OF THE FRUIT AT 11-14 WEEKS OF PREGNANCY.

3.1. Collar space.

3.2. The length of the nasal bones.

DEVELOPMENT OF REGULATORY INDICATORS AND DIAGNOSTIC VALUE OF EVALUATION OF THE IV FETAL VENTRICLE FOR DETECTING SPINAL HERNIA IN EARLY PERIOD OF PREGNANCY.

4.1. Development of normative indicators of the IV ventricle of the fetal brain at 11-14 weeks of gestation.

4.2. Diagnostic value of assessment of the IV fetal ventricle for prenatal ultrasound detection of spinal hernias in early pregnancy.

POSSIBILITIES OF PRENATAL ECHOGRAPHY IN EARLY DIAGNOSTICS OF THE SINGLE CABIN ARTERY.

Recommended list of dissertations

Ultrasound prenatal markers of congenital and hereditary diseases in early pregnancy 2012, Doctor of Medical Sciences Altynnik, Natalya Anatolyevna
The value of ultrasound assessment of the thickness of the collar space of the fetus in early pregnancy for prenatal diagnosis of chromosomal abnormalities 2002, Candidate of Medical Sciences Altynnik, Natalya Anatolyevna
Expanded collar space of the fetus as a prenatal echographic marker of congenital and hereditary diseases 0 years old, Candidate of Medical Sciences Kopytova, Elena Ivanovna
Ultrasound diagnostics of congenital malformations of the fetus in early pregnancy 2007, Doctor of Medical Sciences Esetov, Murad Asedinovich
Prenatal ultrasound diagnostics of congenital heart defects in early pregnancy 2009, Doctor of Medical Sciences Shevchenko, Elena Anatolyevna

Dissertation introduction (part of the abstract) on the topic "Improvement of the screening ultrasound examination protocol at 11-14 weeks of pregnancy"

Reducing perinatal morbidity and mortality is one of the main tasks in the system of maternal and child health care, in the structure of which congenital and hereditary diseases occupy a leading place. Up to 2.5% of newborns are born with hereditary defects, which are usually severe. Gross chromosomal defects, which have an absolutely unfavorable prognosis for life and health, are recorded in 2-3 cases per 1000 newborns. In this regard, a program for the prevention of congenital and hereditary pathology in children is of particular importance, one of the main components of which is the prenatal detection of both congenital malformations and chromosomal defects.

In the Russian Federation, 3 screening ultrasound examinations are regulated at 11-14, 20-22 and 32-34 weeks of pregnancy (Order of the Ministry of Health and the Russian Federation No. 808n of October 2, 2009 “On approval of the procedure for the provision of obstetric and gynecological care.” However, if In the II and III trimesters of pregnancy, prenatal ultrasound diagnostics of congenital malformations are already in many ways not difficult, the use of echography in the early stages of pregnancy still requires a solution to many methodological issues.

So, unresolved and in recent years comprehensively discussed are the issues of the expediency of developing regional standards for the most informative echographic markers of chromosomal abnormalities in the early stages of pregnancy - the thickness of the collar space and the length of the nasal bones of the fetus (Kozlova O.I., 2007; Kopytova E.I., 2007 ; Sopek I. et al., 2006). In addition, domestic and foreign researchers have so far gained experience in the use of echography in the diagnosis of only pronounced malformations (Medvedev M.V. et al., 2005; Kosovtsova N.V., 2007; Shevchenko E.A., 2007; Esetov M.A. 2007; McFeede K., 2008). Most of the defects in the fetus are still diagnosed only in the second half: pregnancy. Improvement is of particular interest; prenatal ultrasound diagnostics of spina bifida, as well as the only one ;, the artery of the umbilical cord in the early stages of pregnancy, which is: one of the leading markers ^ of congenital and hereditary diseases;

Therefore, an urgent task! is: development of:, new: prenatal echographic markers that could be effectively used for; screening ultrasound studies in early pregnancy.

PURPOSE AND OBJECTIVES OF THE RESEARCH

The purpose of this work was to improve the protocol of screening: ultrasound examination; to improve the efficiency of srenatal diagnosis of congenital and hereditary diseases in 11-14 weeks of pregnancy. To achieve the set: goals in the course of the study: the following tasks were solved:,

1. To develop regional normative percentile indices of the thickness of the collar space: and the length of the nasal, fetal bones at 11-14 weeks of gestation.

2. Conduct a comparative analysis of the developed normative indicators of the thickness of the collar space; and the length of the nasal bones. fetus with similar indicators in other regions.

3. Develop normative percentile: values of the IV cerebral ventricle? fetus at, 11-14 weeks of gestation and evaluate the effectiveness of use: this parameter for the early diagnosis of spina bifida.

4. To develop a research technique for umbilical cord vessels during screening-ultrasound examination at the end of the first trimester of pregnancy to ensure early prenatal diagnosis of the only umbilical artery.

SCIENTIFIC NOVELTY OF RESEARCH

In this work, for the first time, using sufficient clinical material, regional standards have been developed for the most informative prenatal echographic markers of chromosomal abnormalities in early pregnancy - the thickness of the collar space and the length of the nasal bones of the fetus. For the first time, the high information content of the echo-graphic assessment of the size of the IV ventricle of the fetal brain for early prenatal diagnosis of spinal hernia has been shown. Developed regional percentile values of the IV ventricle of the fetal brain at 11-14 weeks of gestation. For the first time, a technique was developed for assessing the vessels of the umbilical cord in the early stages of pregnancy, and its high information content in the early prenatal diagnosis of a single umbilical cord artery was shown.

PRACTICAL IMPORTANCE OF THE WORK

The practical significance of the work lies in the implementation of a standardized improved approach to assessing the ultrasound anatomy of the fetus during screening ultrasound examinations at 11-14 weeks of pregnancy to identify a high-risk group for congenital and hereditary diseases, which will increase the efficiency of early prenatal diagnosis of both chromosomal abnormalities and various congenital vices. The normative indicators of the most informative echographic markers of chromosomal abnormalities in the early stages of pregnancy have been developed. Based on the results obtained, a new protocol for screening ultrasound examination of the fetus at the end of the first trimester of pregnancy was developed.

PROVISIONS FOR PROTECTION

1. To use the length of the nasal bones of the fetus as an echographic marker of chromosomal abnormalities in the early stages of pregnancy, regional standards are required.

2. Evaluation of the size of the IV ventricle of the fetal brain is a highly informative prenatal echographic criterion in establishing a spinal hernia at the end of the first trimester of pregnancy.

3. Study of the umbilical arteries at the level of the urinary bladder of the fetus using the color Doppler mapping mode is a highly informative method for prenatal diagnosis of a single umbilical artery at 11-14 weeks of gestation.

IMPLEMENTATION OF RESEARCH RESULTS

The results of the study were introduced into the practice of the Center for Prenatal Diagnostics at the Maternity Hospital No. 27 in Moscow, the Department of Ultrasound Diagnostics No. 2 of the MUZ "Maternity Hospital No. 4" in Krasnoyarsk and the Department of Prenatal Diagnostics of the State Institution "Ulyanovsk Regional Clinical Hospital". The results of the work are used in training cadets at the Department of Ultrasound and Prenatal Diagnostics of the FGOU PDO "Institute for Advanced Studies of the Federal Medical and Biological Agency".

STRUCTURE AND SCOPE OF THE DISSERTATION

The thesis is presented on 105 pages of typewritten text, consists of a title page, a table of contents, an introduction, four chapters of our own research, a discussion of the results, conclusions and practical recommendations. The list of references consists of 30 domestic and 78 foreign sources. Illustrative material is presented by 9 tables and 31 figures.

The work was carried out on the basis of the Department of Ultrasound and Prenatal Diagnostics (Head of the Department - Doctor of Medical Sciences, Professor MV Medvedev) FGOU PDO “Institute for Advanced Studies of the Federal Medical and Biological Agency”.

Clinical observations and material collection were carried out in maternity hospital №1 in Astana and in the center of prenatal diagnostics at maternity hospital №27 in Moscow.

Similar dissertations in the specialty "Radiation diagnostics, radiation therapy", 01/14/13 code VAK

The value of transvaginal echography in early pregnancy for prenatal diagnosis of congenital and hereditary diseases 2004, Candidate of Medical Sciences Shevchenko, Elena Anatolyevna
The length of the nasal bones of the fetus as a prenatal echographic marker of chromosomal abnormalities 2007, Candidate of Medical Sciences Kozlova, Olesya Ivanovna
Combined ultrasound and biochemical screening of fetal chromosomal pathology in the first trimester of pregnancy in pregnant women in the North-West region of Russia 2005, candidate of medical sciences Nekrasova, Ekaterina Sergeevna
DIAGNOSTIC SIGNIFICANCE OF BLOOD FLOW DOPPLEROGRAPHY IN THE FETAL VENOUS DUCT IN THE EARLY PERIOD OF PREGNANCY 2013, Candidate of Medical Sciences Lisyutkina, Evgeniya Valerievna
Comprehensive ultrasound assessment of fetal facial structures in order to identify fetuses with Down syndrome in the second trimester of pregnancy 2013, candidate of medical sciences Strupeneva, Ulyana Anatolyevna

Conclusion of the thesis on the topic "Radiation diagnostics, radiation therapy", Badigova, Elena Aleksandrovna

G. In the course of the research, it was found that the top; the border of the normative values of the thickness of the collar space of the fetus (95th percentile) in< казахской популяции в сроки от 11 недель/О дней до 11 недель/б; дней» беременности; является^ 2,1; мм, 12 недель/О дней - 12 недель/6 дней - 2,4 мм, 13 нсдель/Одней - 13 иедель/6 дней -2,5 мм, что достоверно не отличается от российских популяционных значений.

2. Byazhney; border; the standard values of the length of the nasal bones of the fetus (5th percentile) in the Kazakh population in the period from 11 weeks / O days to 11 weeks / 6 days of pregnancy is 0.7 mm, 12 weeks / 0 days - 12 nsd / 6 days - 0 ^ 9 mm, 13 weeks / 0 days - 13 weeks / 6 days - 1.2 mm, which; significantly lower than the Russian population values.

3. Echographic assessment of the size of the IV ventricle of the fetal brain is a highly informative diagnostic criterion for spinal hernias during ultrasound screening at 11-14 weeks of gestation. When used as a diagnostic criterion, the absence of an image of the IV ventricle can increase the accuracy of prenatal diagnosis of ^ spina bifida: from 50% (with a standard assessment of the fetal spine) to 80%.

4. According to the results of our research; the most accurate method, prenatal ultrasound diagnosis ^ of the only umbilical artery at 11-14 weeks of pregnancy is! study of the umbilical arteries at the level of the urinary bladder of the fetus using the color Doppler mapping mode. This method allows to provide a single umbilical artery at * the first screening ultrasound in 100% of cases.

1. When echographic assessment of the length of the nasal bones of the fetus during screening ultrasound examination at 11-14 weeks of pregnancy, it is necessary to take into account the population characteristics of the normative indicators.

2. The protocol of ultrasound screening examination of the anatomical structures of the fetus at the end of the first trimester of pregnancy must be supplemented with an assessment of the fourth ventricle of the fetal brain to ensure an earlier diagnosis of spinal hernias.

3. To achieve the most accurate prenatal ultrasound diagnosis of a single umbilical artery at 11-14 weeks of gestation, it is necessary to study the umbilical arteries at the level of the fetal bladder using the color Doppler mapping mode.

List of dissertation research literature Candidate of Medical Sciences Badigova, Elena Aleksandrovna, 2011

1. Altynnik H.A. The value of ultrasound assessment of the thickness of the collar space of the fetus in early pregnancy for prenatal diagnosis of chromosomal abnormalities: Diss. ... Cand. honey. sciences. M., 2002.

2. Altynnik H.A., Medvedev M.V. Standard values of the coccygeal-parietal size and thickness of the collar space of the fetus in early pregnancy // Ultrasound. Diagn. Akush. Gin. Pediatrician. 2001. T. 9. No. 1.S. 35-37.

3. Altynnik H.A., Yudina E.V., Medvedev M.V. et al. Perinatal outcomes with echographic markers of congenital and hereditary pathology. IV. Expanded collar space // Prenat. Diagn. 2003. T. 2. No. 3. S. 174-179.

4. Voskresenskaya S.B., Vaytsekhovich I.A. The effectiveness of an ultrasound marker of the first trimester of pregnancy of an enlarged collar space in prenatal diagnosis of chromosomal pathology // Prenat. Diagn. 2003. T. 2. No. 4. S. 266-269.

5. Girling J. On the significance of the results of laboratory research // Russian medical journal. 1995. T. 1.No. 5.P. 5.

6. Glantz S. Medical and biological statistics. Per. from English M., Praktika, 1998.459 s:

7. Klipa M.V., Pankova E.E., Golikhina T.A. et al. Prenatal diagnosis of Down syndrome in the Krasnodar Territory: successes and problems //

8. Prenatus. Diagn. 2004. T. 3. No. 4. S. 261-264.

9. Kozlova OI The length of the fetal nasal bones as a prenatal echographic marker of chromosomal abnormalities: Diss. ... Cand. honey. sciences. M., 2007.

10. Kosovtsova N.V., Shamanskaya E.F., Kopytova E.I. Realities of prenatal ultrasound diagnostics of congenital malformations in early pregnancy in Yekaterinburg // Prenat. Diagn. 2004. T. 3. No. 4. S. 319-320.

11. Kosovtsova N.V., Shamanskaya E.F., Kopytova E.I. Expanded collar space in the fetus: a combination with chromosomal abnormalities and congenital malformations // Prenat. Diagn. 2004. T. 3. No. 3. S. 234-235.

12. Kuznetsova T.V., Baranov A.N., Kiseleva N.V. and others. Prenatal diagnosis of chromosomal diseases in the fetus: ten years of experience // Bulletin of the Russian Association of obstetricians and gynecologists. 1997. No. 3. S. 95-99.

13. Medvedev M.V., Altynnik H.A. Collar space in fetuses in early pregnancy: new aspects of prenatal diagnosis // Ultrasound. Diagn. Akush. Gin. Pediatrician. 1999. T. 7.No. 1.S. 1926.

14. Medvedev M.V., Altynnik H.A. The length of the nasal bones of the fetus at 12-14 weeks of gestation as a prenatal echographic marker of chromosomal abnormalities // Prenat. Diagn. 2003. T. 2. No. 1. S. 66-70.

15. Medvedev M.V., Altynnik H.A. On the issue of ultrasound assessment of fetal anatomy in early pregnancy // Prenat. Diagn. 2002. T. 1.No. 2.P. 158-159.

16. Medvedev M.V., Yudina E.V. Ultrasound Screening // Fundamentals of Prenatal Diagnostics / Ed. Yudina E.V., Medvedeva M.V. M .: Realnoe Vremya, 2002.S. 41-88.

17. Medvedev M.V., Altynnik H.A. Fundamentals of ultrasound screening at 11-14 weeks of gestation. M .: Real Time, 2009.108 p.

18. Nekrasova E.S., Talantova O.E., Koroteev A.L., Baranov B.C. Cases of "prenatal diagnosis of multiple malformations at the end of the first trimester of pregnancy // Prenat. Diagn. 2004. T. 3. No. 2. P. 31-34.

19. Nekrasova E.S., Koroteev A.L., Kuznetsova T.V., Baranov B.C. A new approach to calculating the risk * during screening * ultrasound examination in the first trimester of pregnancy // Prenat. Diagn. 2005. T. 4. No. 1. P. 22-281

20. Novikova I.V., Lazyuk G.I., Pribushenya O.V. et al. Morphological examination of the heart in fetuses with chromosomal diseases, aborted after prenatal diagnosis in the first trimester of pregnancy // Prenat. Diagn. 2004. T. 3. No. 3. S. 197-202.

21. Fundamentals of prenatal diagnosis / Ed. Yudina E.V., Medvedeva M.V. M .: RAVUZDPG, Realnoe Vremya, 2002.184 p.

22. Prenatal echography / Ed. Medvedeva M.B. Moscow: Realnoe Vremya, 2005.560 p.

23. Snyders R.J.M., Nicolaides K.H. Ultrasound markers of fetal chromosomal defects. M .: Vidar, 1997.175 p.

24. Ultrasound fetometry: reference tables and nomograms / Ed. Medvedeva M.B. M .: Realnoe Vremya, 2002.S. 80.

25. Shevchenko E.A. The value of transvaginal echography in early pregnancy for prenatal diagnosis of congenital and hereditary diseases: Diss. ... Cand. honey. sciences. M., 2004.

26. Esetov M.A. Prenatal * ultrasound diagnostics of congenital defects in the first trimester of pregnancy. II. Spina bifida // Prenat. Diagn. 2003. T. 2. No. 4. S. 274-278.

27. Yudina E.V. Trisomy 18: analysis of 28 cases of prenatal diagnosis // Prenat. Diagn. 2002. T. 1.No. 1.S. 35-42.

28. Yudina E.V. Echographic markers of chromosomal fetal anomalies: the only artery of the umbilical cord // Prenat. Diagn. 2002. T. 1.No. 3, p. 240.

29. Yudina E.V. Ultrasound prenatal markers of chromosomal abnormalities in the second trimester of pregnancy: Diss. ... doct. honey. sciences. M., 2003.

30. Yudina E.V., Medvedev- M.V. Multicenter study "Prenatal diagnosis of Down syndrome in Russia in 2005, or Perinatal drama in three parts with a prologue and epilogue" // Prenat. Diagn. 2007. T. 6. No. 4. G. 252-257.

31. Belosovicova H., Svyatkina O., Manasova S., Valtrova H., Calda P. Presence of intracranial translucency (IT) in a case of large open spina bifida // Ultrasound Obstet. Gynec. 2010. V. 36 (Suppl. 1). P. 184.

32. Bernard J.P., Senat M.V., Ville Y. Intra and inter observer variability in nasal bones assessment at 11-14 weeks // Ultrasound Obstet. Gynecol. 2003. V. 22. Suppl. 1.P. 82.

33. Bilardo C. M., Miiller M. A., Pajkrt E. et al. Increased nuchal translucency thickness and normal karyotype: time for parental reassurance // Ultrasound Obstet. Gynecol. 2007. V. 30. No. 1. P. 11-18.

34. Borobio V., Borrell A., Penalva V. et al. Nasal bone assessment in firsttrimester detection of trisomy 21 // Ultrasound Obstet. Gynecol. 2005. V. 26. P. 377.

35. Borrel! A., Borobio V., Gonce A. et al. Fetal? Nasal bone and "ductus veno-sus blood- flow; assessed transvaginally at the 11-14 week scan - new data; including unselected and; high: risk pregnancies // Ultrasound Obstet: Gynecol. 2006. V. 28. P. 362.

36. Bower S., Ghitty L., Bewley Si et all First trimester nuchal translucency screening of the general population: data from three centers // 27th British Congress of Obstetrics and "Gynaecology. Dublin; 1995.

37. Bromley B; Lieberman E-., Shipp T., Benacerraf B. Fetal: nasal bone length: a marker for Down syndrome in the second trimester // J. Ultrasound Med. 2002. V. 21. P. 1387-1394.

38. Bronshtein M :, Zimmer E.Z. There is an absence of the nasal bone in every normal fetus in the early pregnancy // Ultrasound Obstet. Gynecol. 2003. V. 22. Suppl. l.P. 81.

39. Calda P., Koucky Mi, Viskova H. et al. Nasal bone length as a marker of Down syndrome // Ultrasound Obstet. Gynecol. 2003; V. 22. Suppl. l. P: 81,

40. Centini G., Rosignoli L., Kenanidis A., Petraglia F., Nasal; bone visualization: a comparison between 3D and 2D ultrasound1 in the5 first-early "second trimester // Ultrasound Obstet. Gynecol; 2003. V. 22. Suppl. L.P. 81.

41. Chaoui R., Benoit B ;, Mitkowska-Wozniak H., Heling K.S., Nicolaides K.H. Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11-13-week scan // Ultrasound Obstet. Gynecol. 2009: V. 34. P. 249-252.

42. Ghasen S. T., Sharma G., Kalish R.B., Chervenak F; A. First-trimester screening for aneuploidy with fetal nuchal translucency in a United States-population // Ultrasound Obstet. Gynecol. 2004. P. 318.

43. Chen M., Lee C. P., Tang R. et al. First-trimester examination of fetal nasal bone in the Chinese population // Prenat. Diagn. 2006. V. 26. P. 703-706.

44. Cheng C.C., Bahado-Singh R.O., Chen S.C., Tsai M.S. Pregnancy outcomes with increased nuchal translucency after routine Down syndrome screening // Int. J. Gynaecol. Obstet. 2004. V. 84. P. 5-9.

45. Cicero S., Bindra R., Rembouskos G. et al. Integrated ultrasound and biochemical screening for trisomy 21 using fetal nuchal translucency, absent fetal nasal bone, free ß-hCG and PAPP-A at 11 to 14 weeks II Prenat. Diagn. 2003. V. 23. P. 306-310.

46. Cicero S., Curcio P., Papageorghiou A. et al. Absence of nasal bone in fetuses with trisomy 21 at 11-14 weeks of gestation: an observational study // Lancet. 2001. V. 356. P. 1665-1667.

47. Cicero S., Dezerega V., Andrade E. et al. Learning curve for sonographic examination of the fetal nasal bone at 11-14 weeks // Ultrasound Obstet. Gynecol. 2003. V. 22. No. 2. P. 135-137.

48. Cicero S., Longo D., Rembouskos G. et al. Absent nasal bone at 11-14 weeks of pregnancy and chromosomal defects // Ultrasound Obstet. Gynecol. 2003. V. 22. No. 1. P. 31-35.

49. Comas C., Martinez J. M., Ojuel J. et al. First-trimester nuchal edema as a marker of aneuploidy // Ultrasound Obstet. Gynecol. 1995. V. 5. P. 26-29.

50. Cossi P.S., Murta C.G.V., Bussamra L.C.S. et al. Ethnic variation of fetal nasal bone length between 11-14 weeks "gestation in Brazilian population // Ultrasound Obstet. Gynecol. 2006. V. 28. P. 519-520.

51. Csapo B., Husslein P., Krampl E. Multiplanar imaging of the nasal bone at 11-14 weeks 11 Ultrasound Obstet. Gynecol. 2003. V. 22. Suppl. 1.P. 8182.

52. De Keersmaecker B., Buisson O., Bernard J.P., Ville Y. Ultrasonographic diagnosis of spina bifida at 12 weeks: heading towards new indirect signs // Ultrasound Obstet. Gynecol. 2000. V. 16. Suppl. 1.P. 60.

53. Geipel A., Germer U., Welp T. et al. Prenatal diagnosis of single umbilical artery: determination; of the absent side, associated * anomalies, Doppler findings and perinataroutcome // Ultrasound Obstet. Gynecol. 2000. V. 15. P: 114-117. ".

54. Goncalves L. F., Espinoza J., Lee W. et al. Hypoplastic rather than absent nasal? bones: a; novel phenotypic characteristic of trisomy 21. Description-by 3D ultrasound and clinical significance // Ultasound Obstct. Gynccol. 2004. V. 24. No. 3. P. 326-327.

55. Has R., Kalelioglu I., Ermis H. et al. First trimester screening of trisomy 21 by nuchal translucency measurement // Ultrasound Obstet. Gynecol; 2004. V. 24. No. 3. P. 321.

56. Henrich W., Minderer S., Gloning K. P.H., Stöger H. The nasal bone in fetuses with trisomy 21: sonographic versus pathomorphological findings // Ultrasound Obstet. Gynecoll 2003. V. 22. Suppl. 1.P. 81>.

57. Hernadi L., Torocsik M. Screening for fetal anomalies in the 12th week of pregnancy by transvaginal-sonography in< an unselected population // Pre-nat. Diagn. 1997. V. 17. № 8. P. 753-759.

58. Hsiao G. Normal intracranial translucency at 11-13 + 6 weeks in Chinese population // Ultrasound Obstet. Gynec. 2010. V. 36 (Suppl. 1). P. 227.

59. Hui P.W., Lee C.P., Tang M.H.Y. Interobserver variability in ultrasound examination of fetal nasal bone at 10-14 weeks of gestation // Ultrasound Obstet. Gynecol. 2002. V. 20: Suppl; 1. P. 1-2.

60. Kanellopoulos V., Katsetos C., Economides D. E. Examination of fetal nasal bone and repeatability of measurement in early pregnancy // Ultrasound Obstet: Gynecol: 2003. V. 22; No. 2. P., 131-134.,

61. Krantz D.A., Hallahan T.W., Macri V.J. The effect of ethnicity on firsttrimester nasal bone assessment // Ultrasound Obstet. Gynecol. 2006. V. 28. P. 530.

62. Larose C., Massoc P., Hillion Y. et al. Comparison of fetal nasal bone assessment by ultrasound at 11-14 weeks and postmortem X-ray in trisomy 21: a prospective observational study // Ultrasound Obstet. Gynecol. 20031 V. 22. No. 1. P. 27-30.

63. Malone F.D., Ball R. II., Nyberg D.A. et al. First trimester nasal bone evaluation for aneuploidy in an unselected general population: results from the FASTER trial // Am. J: Obstet. Gynecol. 2003. V. 189. S79.

64. Massoc P.H., Bernard J.P., Ville Y. Fetal nasal bones assessment in the general population at 11-14 weeks // Ultrasound Obstet. Gynecol. 2002. V. 20. Suppl. 1.P. 65.

65. McAuliffe F., Fong K., Toi A. et al. Ultrasound detection of fetal anomalies in the first trimester in conjunction with nuchal translucency screening: a feasibility study // Ultrasound Obstet. Gynecol. 2004. V. 24. No. 3. P. 349.

66. McLeod N.L., Young D.C., Van den Hof M.C. Interobserver variability of the subjective evaluation of the nasal bone and nasal bridge for the risk of Down syndrome after 18 wks "gestation // Ultrasound Obstet. Gynecol. 2006. V. 28. P. 414.

67. Monni G., Zoppi M. A., Ibba R. M. et al. Absence of fetal nasal bone and aneuploidies at 11-14 weeks in an unselected population // Ultrasound Obstet. Gynecol. 2002. V. 20. Suppl. 1.P. 89.

68. Monni G., Zoppi M. A., Ibba R. M. et al. First-trimester nuchal translucency and nasal bone assessment for Down syndrome screening at a single center // Ultrasound Obstet. Gynecol. 2006. V. 28. P. 362.

69. Moon M.H., Cho J.Y., Lee Y.M. et al. Nasal bone length at 11-14 weeks of pregnancy in the Korean population // Prenat. Diagn. 2006. V. 26. P. 524-527.

70. Morgan B.L.G., Ross M.G. Umbilical Cord Complications // www.emedicine.com, 2003

71. Munoz H., Dezerega V., Schnapp C. et al. Nuchal translucency screening program result in a Chilean center // Ultrasound Obstet. Gynecol. 2003. V. 22. Suppl. 1.P. 78-79.

72. Munoz H., Rencoret G., Leiva J., Diaz C., Barrera C., Rodriguez M., Toledo V., Germain A. Intracranial translucency (IT) reference range for Chilean population at the 11-13 + 6 weeks scan // Ultrasound Obstet. Gynec. 2010. V. 36 (Suppl. 1). P. 268-269.

73. Nizard J., Couderc S., Senat M.V. et al. Prospective follow-up of children with nuchal translucency above the 99th percentile at 11-14 weeks with normal karyotype. Results at 3 years // Ultrasound Obstet. Gynecol. 2004. V. 24. No. 3. P. 251-252.

74. Orlandi F., Bilardo C. M., Campogrande M. et al. Measurement of nasal bone length at 11-14 weeks of pregnancy and its potential role in Down syndrome risk assessment // Ultrasound Obstet. Gynecol. 2003. V. 22. No. 1. P. 36-39.

75. Orlandi F., Rossi C., Orlandi E. et al. Incorporation of nasal bone assessment into first-trimester Down syndrome screening with free beta hCG, PAPP-A and nuchal translucency // Ultrasound Obstet. Gynecol. 2006. V. 28. P. 42 (M21.

76. Otano L., Aiello H., Igarzabal L. et al. Association between first trimester absence of fetal nasal bone on ultrasound and Down syndrome // Prenat. Diagn. 2002. V. 22. No. 10. P. 930-932.

77. Pajkrt E., Mol B. W. J., Boer K. et al. Intra- and interoperator repeatability of the nuchal translucency measurement // Ultrasound Obstet. Gynecol. 2000. V. 15. No. 4. P. 297-301.

78. Peralta C. F. A., Falcon O., Wegrzyn P. et al. Assessment of the gap between the fetal nasal bones at 11 to 13 + 6 weeks of gestation by three-dimensional ultrasound // Ultrasound Obstet. Gynecol. 2005. V. 25. P. 464-467.

79. Pigni A., Ghisoni L., Castagna C. et al. Nuchal translucency measurements in 18,000 patients: FMF certified and non certified sonologists compared // Ultrasound Obstet. Gynecol. 2004. V. 24. No. 3. P. 324-325.

80. Prefumo F., Bhide A., Sairam S. et al. First-trimester absence of fetal nasal bone: effect of ethnicity // Ultrasound Gbstet. Gynecol. 2002. V. 20. Suppl. 1. P. 3. /

81. Schiott K. MV Christiansen M :, Petersen OB., Uldbjerg N. First trimester screening for, Down syndrome by "Consecutive Combined Test" in a high-risk population // Ultrasound! Obstet Gynecol. 2004 ". V. 24. No. 3. P. 246247.

82. Senat MV, Bernard JP, Boulvain M., Ville Y. Intra- and interoperator variability in fetal nasal bone assessment: at 11-14 weeks of gestation // Ultrasound "Obstet. Gynecol; 2003. V. 22. No. 2. P. 138-141.

83. Shah A.A., Lewis D., Vohra N. Absence of intracranial translucency on first trimester screen as a predictor of open-neural? tube defects // Ultrasound Obstet. Gyncc. 2010. V. 36 (Suppl. 1). P. 24.

84. Shalmi A. C., Woidemann K., Sundberg K. et al. Outcome of fetuses with, enlarged nuchal translucency in the first trimester. Results from the "Copenhagen first trimester study" // Ultrasound Obstet. Gynecol. 2003. V. 22. Suppl. l.P. 12.

85. Shin J.S., Yang J.H., Chung J.H. et al. The relation between fetal nasal bone length and biparietal diameter in the Korean population // Prenat.

86. Diagn. 2006. V. 26. P. 321-323.

87. Sonek J., McKenna D., Webb D. et al. Nasal bone length throughout gestation: normal ranges based on 3537 fetal ultrasound measurements // Ultrasound Obstet. Gynecol. 2003. V. 21. No. 2. P. 152-155.

88. Sonek J.D., Cicero S., Neiger R., Nicolaides K.H. Nasal bone evaluation in prenatal screening for trisomy 21: a review // Ultrasound Obstet. Gynecol. 2006. V. 28. P. 414. "

89. Spencer K., Bindra R., Nicolaides K. Five years experience of screening for chromosomal anomalies in a 1st trimester OSCAR clinic // Ultrasound Obstet. Gynecol. 2003. V. 22. Suppl. 1.P. 12.

90. Sperber G. Facial skeleton // Craniofacial development. Gamilton, Ontario, Canada: B. Decker Inc., 2001. P. 104.

91. Thilaganathan B., Khare M., Williams B., Wathen N.C. Influence of ethnic origin on nuchal translucency screening for Down "s syndrome // Ultrasound Obstet. Gynecol. 1998. V. 12. No. 2. P. 112-114.

92. Van den Hof M.C., McLeod N.L., Young D.C. Subjective appraisal of fetal nasal bridge and / or bone for the risk of Down syndrome (DS) after 18 weeks "gestation // Ultrasound Obstet Gynecol. 2006. V. 28. P. 413414.

93. Vijayalakshmi B., Lees C., Goodburn S. et al. Two-stage combined nuchal plus triple test screening: the "pragmatic" test // Ultrasound Obstet. Gynecol. 2004. V. 24. No. 3. P. 247-248.

94. Viora E., Masturzo B., Errante G. et al. Ultrasound evaluation of fetal nasal bone at 11 to 14 weeks in a consecutive series of 1906 fetuses //

95. Prenat. Diagn. 2003. V. 23. No. 10. P. 784-787.

96. Wong S.F., Ng W.F., Ho L.C. Histopathological findings of the nose of Down syndrome abortuses // Prenat. Diagn. 2003. V. 23. No. 7. P. 561-563.

97. Zoppi M. A., Ibba R. M., Axiana C. et al. Absence of fetal nasal bone and aneuploides at first-trimester nuchal translucency screening in unse-lected pregnancies // Prenat. Diagn. 2003. V. 23. No. 6. P. 496-500.

Please note that the above scientific texts are posted for information and obtained by means of recognition of the original texts of dissertations (OCR). In this connection, they may contain errors associated with the imperfection of recognition algorithms. There are no such errors in PDF files of dissertations and abstracts that we deliver.

Screening examinations of a pregnant woman is a necessary method for diagnosing intrauterine diseases of a child. Ultrasound is the gold standard among research methods because it is safe and has good imaging capabilities. From the 10th week, signs of fetal genetic defects can be detected. In order to standardize the study, certain protocols for ultrasound diagnostics have been adopted in Russia. They reflect most of the nuances that need to be paid attention to during the research.

There are 2 main protocols for ultrasound diagnostics in a pregnant woman: at 10-14 weeks (first screening) and 20-24 (second screening). To correctly decipher their results, it is necessary to know the normal characteristics of the fetus, at various stages of gestation, and correlate them with screening data. The third study is of an overview nature and does not have a special form.

Transcript of the protocol of the first screening

This document indicates the main indicators of the growth and vital activity of the embryo, the state of the structures that ensure the development of the fetus. These include:

the uterus itself (its wall and appendages);
The yolk sac is an important component of the embryo's organism, which is the first source of germ cells, the “first liver” and the first hematopoietic organ. It only functions in the first trimester;
chorion - a modified endometrium of the uterus, which subsequently participates in the formation of the placenta.

Consider the normal characteristics of these formations and possible pathologies that ultrasound can reveal at 10-14 weeks of pregnancy.

Uterus

Since all pathological changes in the uterus are clearly visualized in the first trimester, its structure must be carefully studied. This will help you choose the appropriate tactics for managing your pregnancy and prevent complications during delivery. You should also pay attention to the state of the cervix in dynamics, which will help to timely determine isthmic-cervical insufficiency and prescribe the correct therapy.

Ultrasound examination of the appendages (ovaries and fallopian tubes) allows you to diagnose the following pathological changes:

ectopic pregnancy;
the presence of neoplasms;
the presence of fluid in the small pelvis;
cystic deformity of organs.

In a normal ultrasound scan, it is indicated that the wall of the uterus and its appendages are unchanged.

Yolk sac

The yolk sac is a temporary organ that, by the second trimester of pregnancy, becomes sclerosed (degenerates into connective tissue) and loses its function. At the first screening, in the period from the 10th to the 12th week, it can be visualized as an echogenic formation of an oval or spherical shape. Its diameter (in the protocol it is designated "average inner") is 7-10 mm.

After the 12th week of pregnancy, this formation may normally be absent. Such a change is physiological, therefore, when decoding an ultrasound scan, you should not be afraid of the absence of a yolk sac.

Chorion

The pathological changes in the chorion, which are detected on ultrasound screening, include 3 groups:

unwanted localization (presentation) is a condition when the chorion and, as a result, the placenta, will be located in the area of the pharynx of the uterus. When decoding an ultrasound scan, you should pay attention to this nuance, as it will determine the tactics of the subsequent management of pregnancy;
chorionic detachment (partial or complete) is an extremely negative sign that threatens to be interrupted;
neoplasms (chorionepithelioma).

Normally, the diagnostician will note the location of the chorion and the absence of changes in its structure.

Assessment of the condition of the fetus

At the first ultrasound screening, three main indicators are assessed, which make it possible to objectively judge the development of the embryo.

The coccyx-parietal size (CTE) is the length of the fetus, which is measured at the most prominent points of the coccyx (if possible to determine) and the parietal bones. It is important to evaluate the CTE in accordance with the gestational age, which will lead to a conclusion about the course of the development of the embryo. Normal indicators of the coccygeal-parietal size, according to the clinical recommendations of Professor O.V. Makarov, are:

A slight mismatch between the CTE and the menstrual period may be a variant of normal development. A difference of more than 7 mm from the average, in 76% is a sign of pathology.

The collar space is the distance between the inner surface of the embryo's skin and the outer surface of the soft tissues of the fetus, which is assessed in the neck area. The main pathological sign that you should pay attention to when decoding is the expansion of the collar space by more than 5 mm. In this case, the risk of intrauterine pathologies increases significantly.

During the decoding of the results of the first screening, attention should be paid to a decrease in fetal heart rate. Normal values after the 10th week are 150 beats / min. An unfavorable prognostic sign during pregnancy is fetal bradycardia - when the heart rate is less than 100 beats / min.

Transcript of the second screening protocol

In the study protocol of a pregnant woman at 20-24 weeks, 4 groups of results are distinguished, which require decoding and interpretation:

fetometry - implies an assessment of the size of the body parts of the embryo and their compliance with the gestational age;
fetal anatomy - this group of data that allow us to conclude about the state of the internal organs of the fetus;
condition of temporary organs (placenta, umbilical cord, amniotic fluid);
the condition of the uterus and its appendages (ovaries and fallopian tubes).

Changes in these structures suggest the presence of pathology in the intrauterine development of the child. It is important to note that during the second screening, the fetus is already visualized very clearly, therefore, in addition to signs of genetic abnormalities, the doctor may see gross defects. They are listed in a separate line in the protocol.

During the second screening, the PMF (estimated fetal weight) is also calculated. To do this, use several formulas (Zhordania, Yakubova, and so on) and calculate the arithmetic mean. However, PMP can deviate significantly from real indicators. Therefore, you should not attach decisive importance to it.

Fetometry

The main task of these measurements is to determine the proportionality of the fetal body and the correspondence of the lengths of body parts to the child's age. The asymmetry of these structures may indicate the presence of genetic diseases. For example, unilateral shortening of the femur is a manifestation of Down's syndrome. Fetometry helps determine the need for further research, including invasive ones.

Here are the normal characteristics of fetal body parts, which are necessary when decoding fetometric indicators:

Index	Gestation period (week)	Average values (mm)	Rate options (mm)
BPR (biparietal size)	20	4.7	4,3-5,1
	21	5	4,5-5,3
	22	5.3	5,0-5,7
	23	5.6	5,3-6,0
	24	5.9	5,6-6,4
LZR (frontal-occipital size)	20	60	57-64
	21	64	61-67
	22	67	63-70
	23	70	66-73
	24	74	70-77
Abdominal circumference	20	4.7	4,3-5,1
	21	5.1	4,7-5,5
	22	5.4	5,0-5,9
	23	5.7	5,4-6,2
	24	6.1	5,7-6,5
Head circumference	20	177	174-180
	21	188	184-192
	22	196	193-200
	23	209	205-212
	24	221	218-224
Humerus length	20	33	30-37
	21	36	32-39
	22	39	35-42
	23	42	39-46
	24	45	42-49
Forearm bone length	20	29	26-32
	21	32	29-35
	22	35	31-38
	23	38	34-42
	24	41	38-44
Femur length	20	3.3	2,9-3,6
	21	3.6	3,2-4,0
	22	3.9	3,5-4,2
	23	4.1	3,7-4,6
	24	4.4	4,0-4,7

The table shows the actual data from the monograph of Professor Strizhakov, however, it is important to note that they are constantly changing (within 2-3 mm). The final decision on fetometry data should be made by a doctor.

The average PMF is 400-650 g.

Fetal anatomy

The main purpose of studying the internal organs of the fetus is to detect defects. Most of them are easy to diagnose. In this case, the ultrasound doctor will determine the presence of pathology, the type of developmental disorder and mark these data in the protocol. This is true for:

organs of the central nervous system (the most common defect is anencephaly);
kidney (polycystic, hydronephrosis);
bladder (megacystic);
lungs;

Attention should be paid when decoding fetal anatomy data on a four-chambered heart section. Normal measurement results:

left ventricle - 4
right ventricle - 4
left atrium - 4
right atrium - 6

The condition of the temporary organs, the uterus and its appendages, as a rule, is not described in detail. The localization of the placenta and its compliance with the gestational period, the number of vessels in the umbilical cord (normally 3) and the abundance of amniotic fluid (normal values: volume 500-1500 ml; amniotic fluid index 10-20) are noted.

Deciphering the protocols of screening research is a rather complicated process that requires knowledge of the normal parameters of the fetus and their adequate interpretation. Based on these data, we can conclude about the course of pregnancy. However, in order to avoid mistakes in your conclusions, you should seek the help of your doctor.

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 taking blood for analysis.

During the ultrasound examination, the diagnostician determines the number of fetuses, gestational age and takes the size of the embryo: CTE, BPD, the size of the cervical fold, nasal bone, etc.

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

Ultrasound screening and its norms

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

CTE is the size from the coccyx to the crown of the head, excluding the length of the legs.

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

Table 1 - The rate of CTE according to the 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 bearing and giving birth to a large fetus.

Too small size of the fetal body indicates:

the initially incorrectly set period of pregnancy 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 fetal death (but only on condition that fetal heartbeats are not heard).

Biparietal size (BPD) of the fetal head Is a measure of the development of a baby's brain, measured from temple to temple. This value also increases in proportion to the gestational age.

Table 2 - The rate of BPD of the fetal head at a certain gestational age

An excess of the norm for BPD of the fetal head may indicate:

large fruit, if the other sizes are also higher than the norm by a week or two;
spasmodic growth of the embryo, if the other sizes are normal (after a week or two, all parameters should equalize);
the presence of a brain tumor or cerebral hernia (pathologies incompatible with life);
hydrocephalus (dropsy) of the brain due to an infectious disease in the expectant mother (antibiotics are prescribed and, with successful treatment, the pregnancy remains).

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

The thickness of the collar space (TVP) or the size of the "neck fold"- this is the main indicator that, if abnormal, indicates a chromosomal disease (Down syndrome, Edwards syndrome, or another).

In a healthy child, TBP 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, it is not a sentence, there is simply a risk. It is possible to speak of a high probability of the development of chromosomal pathology in the fetus only in the case of poor results of a blood test for hormones and when the size of the cervical fold is more than 3 mm. Then, to clarify the diagnosis, a chorionic biopsy is prescribed to confirm or deny the presence of chromosomal abnormalities of the fetus.

Table 3 - Norms of TVP by week 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 is either absent at the first screening (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 match the gestational age, but the rest of the indicators are normal, there is no cause 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 a parent 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, bladder are visualized. At this time, the indicated organs and parts of the body are already clearly visible.

Assessment of the vital functions 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 heart rate of the embryo 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 to the end of pregnancy - 140-160 beats per minute.

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

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

Yolk sac- This is an 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 12-13 weeks of pregnancy, then the need for it disappears, because the fetus is already forming separate organs: the liver, spleen, etc., which will take all the responsibilities of ensuring life. ...

By the end of the first trimester, the yolk sac shrinks in size 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, it is normally not visualized at all.

But everything is purely individual, the main thing is that it does not finish its functions ahead of schedule, so for 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 an undeveloped 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 the necessary 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 normal limits, the localization of the chorion "at the bottom" of the uterine cavity (on the upper wall), on the front, back 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 the internal pharynx (transition of the uterus to the cervix), on the lower wall (at a distance of 2-3 cm from the pharynx) is called chorionic presentation.

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

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

By the end of the first trimester, the chorion will become the placenta, which until the end of pregnancy will gradually “mature” or, as they say, “grow old”.

Up to 30 weeks gestation - maturity 0.

This is how the ability of the placenta to provide the baby with everything necessary at every stage of pregnancy is assessed. There is also the concept of "premature aging of the placenta", which indicates a complication of the course of pregnancy.

Amnion- This is the inner aqueous membrane 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 it already contains about 100 ml of water.

When examining the uterus with an uterus, an increased tone of the myometrium of the uterus (or hypertonicity of the uterus) can be detected. Normally, the uterus should be out of tone.

Often in the ultrasound results, you can see the entry "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 ultrasound, and an increased tone of the uterus, which is a threat of spontaneous miscarriage.

The cervix is also examined, its pharynx must be closed. The length of the cervix for 10-14 weeks of pregnancy should be about 35-40 mm (but not less than 30 mm for primiparous and 25 mm for multiparous). If it is shorter, it 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, its pharynx will open.

The deviation from the norm of some parameters at the first screening does not give cause for concern, just pregnancy in the future should be observed more closely, and only after the second screening can we talk about the risk of developing fetal malformations.

Standard first trimester ultrasound protocol

Biochemical screening ("double test") and its decoding

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 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 way, therefore its value is taken as the main biochemical marker used to assess the risk of chromosomal abnormalities 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 (if the norm is doubled);
multiple pregnancies (hCG levels increase in proportion to the number of fetuses);
the presence of diabetes mellitus in a pregnant woman;
preeclampsia (i.e., with an increase in blood pressure + edema + detection of protein in the urine);
fetal malformations;
cystic drift, choriocarcinoma (a rare type of tumor)

A decrease in the beta-hCG value indicates:

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

PAPP-A- pregnancy-associated plasma protein-A.

Table 6 - The norm of PAPP-A during pregnancy by weeks

A low level of PAPP-A in a pregnant woman's blood gives a strong reason to assume that there is a risk:

the 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 fetal death;
placental insufficiency or fetal malnutrition (i.e., underweight due to malnutrition of the baby);
development of preeclampsia (assessed in conjunction 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, therefore they are usually considered in combination. So if PAPP-A is reduced and beta-hCG is increased, there is a risk of the fetus having Down syndrome, and with a decrease in both indicators, Edwards syndrome or Patau syndrome (trisomy 13).

After 14 weeks of pregnancy, the PAPP-A test is considered uninformative.

Second trimester screening (at 16-20 weeks)

II screening, as a rule, is prescribed in case of deviations in the I screening, less often with the threat of termination of pregnancy. In the absence of deviations, the second comprehensive screening can not be carried out, but only an ultrasound of the fetus 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 (pelvic or cephalic) and removes other indicators of fetal development (see table 7 and 8).

Table 7 - Standard sizes of the fetus by ultrasound

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

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

According to the measurements taken, one can judge the true duration of pregnancy.

Fetal anatomy. The Uzist is examining the baby's internal organs.

Table 9 - Standard values of the fetal cerebellum by week

The dimensions of both the lateral ventricles of the brain and the cisterna magna should not exceed 10-11 mm.

Usually, other indicators, such as: Nasolabial triangle, Eye sockets, Spine, 4-chamber cut of the heart, Cut 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 the norm.

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

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

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

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

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

But it happens that the placenta is localized on the front wall of the uterus, which is not considered something pathological, but this area is prone to stretching during the growth of the baby inside the mother's womb, plus the active movements of the baby - 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 pharynx. Abnormal is considered to be its location in the lower part of the uterus in the area of the internal pharynx, partially or completely overlapping it. This phenomenon is called "placenta previa" (or low placenta).

It is more informative to measure the thickness of the placenta after the 20th week of pregnancy. Until this time, 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.

A structure with an 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 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. At a later date, 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".

Amniotic fluid. To determine their number, the diagnostician calculates the amniotic fluid index (AFI) according to measurements made during ultrasound.

Table 10 - Norms of the amniotic fluid index by week

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

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

Severe oligohydramnios threatens with abnormal development of fetal limbs, deformity of the spine, and the baby's nervous system also suffers. As a rule, babies who have suffered from oligohydramnios in the womb lag behind in development and weight.

With severe lack of water, drug treatment must be prescribed.

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

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

Normally, the umbilical cord has 3 vessels: 2nd artery and 1st 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 blood test results for 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 for up to a year, but it is necessary to be observed by a cardiologist every 3-4 months);
not disturbed blood flow in the placenta.

Babies with such an anomaly as the "single artery of the umbilical cord" (abbreviated as EAP) are usually born with a small weight and can often get sick.

Up to a year, it is important to monitor the 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 body in order.

The cervix and walls of the uterus. In the absence of abnormalities, the ultrasound protocol will indicate “Cervix and uterine walls without features” (or abbreviated as 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 in comparison with the previous measurement with ultrasound or softening of its tissues, which is collectively called "isthmic-cervical insufficiency" (ICI), then the installation of an obstetric unloading pessary or suture is prescribed in order to preserve the pregnancy and reach the prescribed term.

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

the position of the fetus is inconvenient for the study (the baby is just positioned so that not everything can be seen and measured, or he was constantly spinning during the ultrasound);
overweight (the reason is indicated in the visualization column - due to subcutaneous fatty tissue (SFA));
swelling in the expectant mother
hypertonicity of the uterus during ultrasound.

Standard second trimester ultrasound protocol

Biochemical screening or "triple test"

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

Free beta-hCG rate look at the table below, and you will find the decryption, it is the same at each stage of pregnancy.

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

Free estriol Is one of the pregnancy hormones that 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 - 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 high fetal weight.

A decrease in the level of estriol is observed in fetoplacental insufficiency, the threat of termination of pregnancy, cystic drift, intrauterine infection, adrenal hypoplasia or anencephaly (neural tube defect) of the fetus, Down syndrome.

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

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

Alpha-fetoprotein (AFP) 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 build up in it from the 10th week of pregnancy.

Table 13 - Norm of AFP by weeks of pregnancy

If during pregnancy a woman was sick with a viral infection, and the baby had liver necrosis, then an increase in AFP in the 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 in the second trimesters. In the third trimester of pregnancy, a kind of final control over the state of the fetus's health is carried out, its position is monitored, the functionality of the placenta is assessed, and a decision is made on the method of delivery.

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

Doppler sonography can also be prescribed, which allows you to assess the strength of blood flow in the uterine, placental and great 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 appearance of fetal hypoxia than to solve the health problems of the baby 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 it needs.

Table 14 - Placenta thickness (norm)

With a decrease in thickness, the 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 supportive 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 consequence, its aging, which indicates a pathology that can lead to abortion.

The thickness of the placenta increases with iron deficiency anemia, gestosis, diabetes mellitus, Rh-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 aging or maturity.

Placenta maturity (normal):

0 degree - up to 27-30 weeks;
1st degree - 30-35 weeks;
2nd 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 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 that characterizes the amount of water.

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

Table 16 - Standard size of the fetus by ultrasound for the entire period of pregnancy

Preparation for screening ultrasound

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

With transabdominal ultrasound, a woman with a period of up to 12 weeks of pregnancy should come for diagnosis with a full bladder, having drunk 1-1.5 liters of water half an hour or an hour before visiting an ultrasound doctor. This is necessary so that a full bladder "squeezes" the uterus out of the pelvic cavity, which will give a better view of 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 the rest of the special gel from your abdomen.

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

The doctor can tell in advance to purchase a condom from the pharmacy, 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. To maintain intimate hygiene, take with you special wet wipes, which you can also purchase in advance at the pharmacy or in the store at the appropriate department.

Transvaginal ultrasound is usually performed only in the first trimester of pregnancy. With the help of it, it is possible to detect a fertilized 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 an ectopic pregnancy, the threat of miscarriage in case of pathology of the location of the placenta, diseases of the ovaries, fallopian tubes, uterus and its cervix. Also, vaginal examination makes it possible to more accurately assess how the fetus is developing, which can be difficult to do in overweight women (if there is a fold of fat on the abdomen).

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

Preparing 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 drink only mineral water without gas. Remember that tea, juice and similar liquid are also food.

Comprehensive screening cost

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 laboratory "plus", for a regular ultrasound of the fetus, you need to pay somewhere around 880-1060 rubles. (220-265 UAH). In total, a 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's syndrome, Edwards syndrome, etc.) or malformations of any organs.

Comprehensive screening is designed for early diagnosis of pathologies in the intrauterine development of the fetus, so that only healthy offspring can be produced.

Deciphering of ultrasound during pregnancy is carried out by two doctors - a specialist in ultrasound diagnostics and an attending obstetrician-gynecologist. The first one issues a conclusion about the gestational age and the discovered features and pathology, the second one compares them with the family history, the peculiarities of the course of pregnancy in this particular woman.

Based on all this, it is concluded whether everything is in order, whether it is necessary to take measures to correct the condition of the fetus, uterus or other organs. The study is carried out according to a specific protocol, which changes slightly depending on the duration of pregnancy. The doctor examines the fetus, placenta, umbilical cord, amniotic fluid, cervix and body of the uterus, makes certain measurements and enters them into the ultrasound form for pregnancy.

How to decode the results of ultrasound of pregnant women

At the end of the study, a conclusion is made on all the indicated data, as well as recommendations are given. Here the sonologist writes when, in his opinion, it is worth undergoing the next study, how soon after the ultrasound scan it is necessary to visit the antenatal clinic.

Ultrasound data that are important for evaluation during pregnancy differ in the first trimester from those that will be evaluated later in the second and third trimesters. This is due to the fact that the child does not immediately turn out the way he is born.

It develops from a "disc" (as it is seen by ultrasound up to 10 weeks), passing through the embryo stage (visible on a monitor, similar to a fish), and only then full arms, legs, torso and head appear, which are measured using ultrasound ...

First trimester study

The first ultrasound examination protocol during pregnancy includes the following data:

Passport data of a woman
Obstetric gestational age (calculated from the last menstrual period)
The number of fetuses in the uterus
Parietal coccygeal (CTE) fetal size (this indicator is the "predecessor" of the "height" or "body length" indicator): indicated in millimeters
Heartbeats (here they write - are they (s / b +) or not (s / b -)), their frequency
Collar thickness (mm)
The presence or absence of a yolk sac, if any - its average diameter
The location of the chorion (future placenta): it can be located on any wall of the uterus, as well as in the area of its bottom or internal os. The latter option is called the word "chorionic presentation or placenta presentation"
Chorionic structure: normally should not be "changed"
Appendages of the uterus: their size, the presence of cysts, developmental anomalies are assessed
Features of the structure of the uterus: tumors, fibroids, developmental anomalies.

After the doctor wrote down the specific measurement numbers, he needs to compare them with the ultrasound standards during pregnancy. They are graded based on gestational age. Moreover, it should be noted that a study carried out earlier than 8 weeks gives the most accurate results about the timing of pregnancy, since at this time the embryos do not yet have individual characteristics .

Parameter table

So, the normal parameters of fetal ultrasound by weeks of pregnancy can be presented in the form of a table, where all parameters, except for the term, are presented in millimeters:

Term in weeks	CTE	Yolk sac, inner diameter	Ovum diameter	Biparietal diameter
5	1-2	Not measured	5-18	Not measured
6	4-5	3,01	13-22	Not measured
7	5-17	4,0	21-24	Not measured
8	10-25	4,5	29-30	6-7,0
9	16-36	5,0	33-36	8,5-10
10	24-49	5,10	39-44	11-14
11	34-58	5,50	47-51	13-21
12	42-73	6,0	56-57	18-24
13	51-87	5,85	63-65	20-28

This is an average table for decoding ultrasound during pregnancy. Ultrasound doctors use the full version, where each parameter has its own norms, depending not only on the week, but also on the day of pregnancy (for example, 6 weeks 5 days differ from 6 weeks exactly).

In addition, according to their tables, it is determined whether a given indicator lies in the average value, or there are some deviations upward or downward ("centile grid").

After the examination, the result of an ultrasound scan is issued during pregnancy. For example: “The fetus is one, the gestational age corresponds to… weeks,… days. No developmental anomalies were found. Uterus, appendages - no features. Recommended: re-examination at 20 weeks. "

If you ask, the doctor can give you an ultrasound certificate of pregnancy of such a sample (so that you can show it at work if it is associated with difficult or harmful conditions):

“The patient (full name), according to the transvaginal (transabdominal) examination, has (uncomplicated, complicated) pregnancy… weeks,… days. Recommended: dynamic observation in a antenatal clinic (hospital). "

Features of the study in the first trimester, questions of pregnant women

Developmental anomaly detection issues

The first ultrasound is mainly aimed at confirming the developing pregnancy, determining the timing of ultrasound during pregnancy, and detecting malformations.
In this period, they look very carefully to see if chromosomal abnormalities have manifested themselves. It is they who can lead to the death of the fetus or newborn, because of them, the child can be born as a deeply disabled person.

Non-pathological features of the first trimester

About hormonal regulation of pregnancy

Corpus luteum on ultrasound during pregnancy. Until 12-16 weeks, this formation produces progesterone, which is necessary to maintain pregnancy, then the placenta takes over this function.

After a delay in menstruation has appeared, the presence of a corpus luteum means that, most likely, you are pregnant, although the embryo is not yet visible.
The size of 2-3 cm of the corpus luteum in the presence of a confirmed pregnancy indicates its normal course. The same dimensions without pregnancy - corpus luteum cyst.
If there is a pregnancy, and the corpus luteum is less than 20 mm, this indicates that there is a danger for bearing a fetus, since there is little progesterone.

The ultrasound showed pregnancy and the test was negative. This should not be the case. But if you bought tests from different manufacturers, and they all show 1 strip, there may be pathologies (for example, a polyp, tumor or cystic drift) mistaken for pregnancy. It is necessary to conduct an ultrasound examination in dynamics, as well as the determination of hCG in the blood.

Other features in ultrasound diagnostics

Sometimes an ultrasound scan shows multiple pregnancies. This, of course, is a surprise for the parents, but there is nothing wrong with that. The appearance of twins and triplets is especially likely in those parents in whose family there have already been such cases.

Signs of multiple pregnancy before ultrasound

early and severe toxicosis - vomiting, nausea, salivation, asthma, cramps in the limbs
the test becomes positive, with the second bar visible as a thick line
gaining weight quickly
belly grows fast
a lot of active movements are felt after 16 weeks, and it is not clear where there are more movements - to the right, left, bottom or top.

Ultrasound diagnostics in the second and third trimesters

Decoding of ultrasound during pregnancy is also carried out according to the protocol. Only in this case, there are much more ultrasound indicators during pregnancy.

Fetal presentation

Presentation - what part of the fetus lies to the exit from the uterus. This is especially important in the third trimester, when it is already not long before childbirth.

For example, if an ultrasound scan shows a breech presentation of the fetus, and the photo of the study confirms this, then the tactics of obstetricians are as follows:

try to make an external turn (at 33-34 weeks, under ultrasound control)
if this fails, or breech presentation was discovered later, delivery is usually performed by caesarean section.

Number of fruits

At these times, ultrasound can already accurately determine how many children you will become parents. The fact that you have a multiple pregnancy will be confirmed by an ultrasound photo: there you will see two heads, two torsos, and so on. A 4d pregnancy ultrasound will show a three-dimensional image of each of the babies in real time.

Fetometry of the fetus

In the second and third trimester, knowledge of the norms for a much larger number of indicators helps to decipher an ultrasound scan for pregnancy. So, in order to assess how the size of the fetus corresponds to the calculated obstetric period, such a concept as biometrics is used, and the interpretation of ultrasound during pregnancy is carried out precisely according to its norms. There are norms for such indicators of fetometry of the fetus:

parietal bone distance (BPD),
chest diameter (CHD)
head circumference (OG)
abdominal circumference (coolant)
sagittal (SJ) and transverse (RV) size of the abdomen
thigh length (DB)
the length of each of the shin bones
longitudinal shoulder (DP)
the length of the radius and ulna
height.