The topics of publications under the heading “Echography in Obstetrics” are echographic markers of the course of pregnancy, ultrasound biometry of the fetus, diagnosis of fetal malformations, the Mansoura nomogram for determining the size of the cervix during pregnancy, etc.
Currently, to assess the patency of the fallopian tubes, echoHSG using three-dimensional reconstruction and the use of contrast agents (hysterosalpingo contrast sonography - HyCoSy) is becoming increasingly common. The phase boundary between sulfur hexafluoride bubbles and aquatic environment acts as a “mirror” for ultrasonic waves; Thus, the echogenicity of the solution introduced into the uterine cavity, which then enters the lumen of the fallopian tubes, increases, and the contrast between the organs, structures, and tissues visualized on the monitor screen increases. This makes it possible to obtain reliable contrasting of the uterine cavity, its boundaries and contours, to visualize the lumen of the fallopian tubes from the standpoint of “evidence-based” medicine, and to increase the reproducibility of the method.
Skeletal dysplasias represent a large group of fetal developmental abnormalities that vary in severity and clinical manifestations. The introduction of prenatal echography has expanded the possibilities for diagnosing fetal skeletal dysplasia, which is especially important in the presence of lethal pathology. One of the most common lethal fetal skeletal dysplasias is thanatophoric dysplasia, with an incidence of 0.21 to 0.80 per 10,000 newborns. This paper presents 4 cases of prenatal ultrasound diagnostics Fetal TD.
Microdeletion syndromes are a special type of chromosomal diseases in which a section of chromosomal material is lost, which cannot be detected by routine standard cytogenetic diagnostic methods. Microdeletion can be a consequence of a chromosome break or the result of unequal crossing over. Formally, microdeletions are classified as chromosomal abnormalities because they change the number of genes, not their structure, but from a practical point of view they are inherited as autosomal dominant monogenic diseases.
Placental mesenchymal dysplasia or placental mesenchymal hyperplasia is a rare anomaly of the placental stem villi, characterized by placentomegaly, cystic dilatation and vesicle formation, and vascular abnormalities. For the first time, MDP was described as hyperplasia of the stem villi of the placenta in pregnant women with high levelα-fetoprotein in combination with a large placenta and echographic signs of partial hydatidiform mole.
Frontonasal dysplasia (FND) is a developmental defect of the middle part of the face, consisting in a violation of the movement of the eyes towards the nose during embryogenesis. Despite the fact that changes in the phenotype in FND syndrome seem to be obvious: facial cleft, agenesis of the corpus callosum, pathology of the soft tissues of the nose, hypertelorism, etc. and should not cause difficulties for a doctor of ultrasound prenatal diagnostics, in the literature there is a limited number of publications devoted to prenatal diagnosis of FND syndrome.
Hemolytic disease of the fetus is hemolytic anemia that develops as a result of the production of antibodies by the mother's immunocompetent system that destroy the red blood cells of the fetus. Most often, antibodies of a Rh-negative mother are directed against fetal Rh antigens; less often, antibodies are produced in the body of a mother with blood group 0 and are directed against group antigens. The purpose of this study was to study the capabilities of echographic and Doppler antenatal monitoring in the non-invasive diagnosis of hemolytic disease of the fetus. 128 women (130 fetuses) with Rh-sensitized pregnancies who had anti-Rh antibodies were examined sonographically.
Among the umbilical cord anomalies, true and false nodes are distinguished. If the latter are limited thickenings on the umbilical cord due to varicose dilation of the umbilical vein, accumulation of Wharton's jelly or bending of the vessels inside the umbilical cord and do not have clinical significance, then the formation of true nodes can pose a certain danger to the fetus. This article presents a description of a case of a true umbilical cord node, diagnosed in the fetus using ultrasound, and also confirmed after the birth of the child during examination of the placenta.
According to the Fetal Medicine Foundation, the normal length of the cervical canal during transvaginal examination at 22-24 weeks of pregnancy has an average value of 36 mm. The risk of spontaneous miscarriage is inversely proportional to cervical length and increases exponentially when the cervical canal length is less than 15 mm. Dilatation of the internal pharynx, manifested on ultrasound by the appearance of a funnel in this area, is nothing more than an echographic criterion reflecting the process of shortening of the cervix, which subsequently leads to premature birth.
Despite the undeniable progress of prenatal diagnostics, in our daily practice we continue to encounter situations where it is necessary not only to establish the fact of the presence of congenital malformations of the musculoskeletal system in the fetus, but, more importantly, the need to identify the nosological affiliation of a specifically detected skeletal anomaly. Describing such a situation was the purpose of this work.
Congenital obstructive upper airway disease (COLD) is a rare life-threatening condition that results from a variety of fetal anomalies, including laryngeal and/or tracheal atresia, laryngeal cysts, and oropharyngeal or neck tumors. The most common cause of OPVDP is laryngeal atresia, but the frequency of detection of this defect is unknown.
this work is devoted to ultrasound identification of natural midline cystic structures of the fetal brain: Verge's cavity (1) and the cavity of the intermediate velum (2). In the first case, the patient was referred for research with a diagnosis of “interhemispheric cyst of the fetal brain”, in the second - with ventriculomegaly. Ultrasound was performed using transabdominal and, if necessary, transvaginal approaches. Methods of three-dimensional image reconstruction, volumetric contrast imaging, multiplanar analysis and color Doppler mapping (CDC) were used.
Urinoma is an encapsulated collection of fluid caused by extravasation of urine through the perirenal spaces or rupture of the kidney and its fascia. The most common cause of urinomas is obstruction at the level of the ureteropelvic anastomosis or posterior urethral valves. Additional causes include megaureter or (rarely) vesicoureteral reflux. An ultrasound sign of urinoma is an ellipsoidal or crescent-shaped cystic formation adjacent to the kidney or spine. Urinomas large sizes can take on various forms, stretching and displacing the kidney.
Ring-shaped placenta (lat. placenta membranacea, or placenta diffusa) is a very rare anomaly of placental development, in which all or almost all fetal membranes remain covered with chorion villi, since there is no differentiation of the chorion into chorion leave and chorion frondosum. The frequency of this pathology is 1: 20,000-40,000 births. We present two cases of diagnosis of annular placenta and one case of annular chorion.
At certain historical stages in the development of obstetric and perinatal diagnostic ultrasound, the introduction of a fetal biophysical profile test was of revolutionary significance. Long-term and numerous studies of its effectiveness were accompanied by controversy, debate and criticism. Nevertheless, the vast majority of guidelines on echography in perinatology today still consider BPP as a current technique, giving preference to a modified version of the test.
Within the framework of the National Priority Project "Health" in the period 2010-2014. regions of the Russian Federation have switched to a new modern methodology for the country of mass combined early prenatal screening for common chromosomal aneuploidies and congenital malformations. In total, about 2 million pregnant women were examined in expert offices in 63 regions of Russia, and more than 10 thousand fetuses with various developmental disorders were identified. In 2015, on the initiative of the Ministry of Health of the Russian Federation, the prenatal diagnostics course of the Department of Medical Genetics of the Russian Medical Academy of Postgraduate Education conducted an Audit-2015 to evaluate the work of the country's regions using a new algorithm.
Endocervical polyp is a focal hyperplastic process, the recurrence rate of which reaches 19%. It can occur at any age, but more often at 40-45 years old. Among the reasons contributing to its occurrence are violations hormonal status and chronic inflammatory processes. The optimal period for simultaneous visualization of endometrial and cervical canal polyps in patients of reproductive age during routine transvaginal echography is the end of the proliferative phase of the menstrual cycle.
Rombencephalosynapsis is a pathology of the rhombencephalon, which includes the cerebellum, pons and medulla, surrounding the rhomboid fossa, which is the bottom of the 4th ventricle. An anomaly of cerebellar development is characterized by the absence (or severe hypoplasia) of the vermis and a different spectrum of non-separation of cerebellar structures (hemispheres, dentate nuclei, cerebellar peduncles - usually superior and middle). Rhombencephalosynapsis is an uncorrectable disorder with a very poor prognosis, so early diagnosis is necessary. Descriptions of cases of this pathology during pregnancy are rare; we present our experience in ultrasound diagnosis of various forms of rhombencephalosynapsis.
EEC syndrome (ectrodactyly-ectodermal dysplasia-clefting syndrome) is a rare genetic syndrome, a hereditary pathology with an autosomal dominant pattern of inheritance, usually manifested by a triad of signs: facial cleft, ectodactyly of the limbs and signs of ectodermal dysplasia. Due to the small number of publications devoted to the prenatal diagnosis of this genetic syndrome, we present a number of our own observations of the diagnosis of EEC syndrome at different stages of pregnancy. Patient N., 24 years old, applied to the medical genetics department of MONIIAG at 21.4 weeks of pregnancy due to a suspected malformation of the limbs in the fetus.
This publication presents clinical cases of ultrasound diagnosis of tumors in the fetus - lymphangioma and sacrococcygeal teratoma. These tumors belong to different morphological groups, but the unifying point in these ideas is the large volume of formations. Lymphangiomas are mature, benign tumors arising from lymphatic vessels. Lymphangiomas are quite rare and account for approximately 10-12% of all benign tumors in children. Sacrococcygeal teratoma is the most common congenital tumor of newborns, occurring in approximately one in 35,000 to 40,000 live newborns.
Chorioangiomas or hemangiomas of the placenta are the most common benign tumors of the placenta, the frequency of which is 0.2-139 cases per 10 thousand births. Chorioangiomas are nontrophoblastic tumors and develop from primitive chorionic mesenchyme at approximately 2-3 weeks of pregnancy and are represented by a large number of newly formed capillary-type vessels. To illustrate the possibilities of ultrasound diagnosis of large placental chorioangioma, we present our clinical observation, as well as an algorithm for managing the patient’s pregnancy.
Pregnancy in a cesarean section scar is considered a type of ectopic pregnancy and is associated with high maternal and pediatric morbidity and mortality. This condition is associated with a high risk of uterine rupture as pregnancy progresses and massive bleeding. Frequency of this disease, according to various authors, is 1/1800-1/2200 pregnancies. During 2012-2014 In MONIIAG clinics, 10 clinical cases of pregnancy in the uterine scar were observed. The main role in diagnosing pregnancy in the scar belongs to the ultrasound method.
In the presented observation, the patient had an almost asymptomatic course of ectopic pregnancy. Erased clinical picture and the rather rare localization of the ovum in combination with a non-developing pregnancy led to a number of diagnostic errors. At first, ectopic pregnancy was regarded as a non-developing uterine pregnancy, and then as a formation of the left uterine angle, a myomatous node with degeneration. The use of Dopplerography and three-dimensional echography during the examination allowed us to make the correct diagnosis.
Experts from the district offices of the Moscow region assessed the presence/absence of the nasal bone and measured it in all pregnant women (about 150 thousand examined over 3.5 years of screening). The analysis of the detection of pathology (aplasia/hypoplasia) of the nasal bone in fetuses with chromosomal pathology showed that out of 266 prenatally identified cases of Down syndrome in the fetus in the first trimester, the nasal bone was pathological in 248 cases, which is 93.2%. With Edwards syndrome, the nasal bone is pathological in 78 fetuses, which is 71%, with Patau syndrome - in 24 (59%) fetuses, with monosomy X - in 24 (42%) cases, with triploidy - in 22 (49%) fetuses.
An antenatal echographic examination of 27 fetuses with various types of fetal heart rhythm disturbances was carried out: transient episodes of bradycardia - asystole in the second trimester of pregnancy, isolated premature atrial contractions, sinus bradycardia, AV block of the second degree, ventricular tachycardia, etc. Echographic and Doppler studies were carried out using modern ultrasound scanners. After birth, clinical monitoring of the children's condition and a comparative analysis of perinatal results were carried out.
Hemorrhage is the leading cause of maternal mortality in the world: 127,000 women die from it every year, accounting for 25% of all maternal deaths, and there is no downward trend in the incidence of this complication. The purpose of this work was to study the characteristics of uterine hemodynamics and the course of the postpartum period after ligation of the internal iliac arteries and ovarian arteries during obstetric hemorrhage.
The study included 156 patients of reproductive age from 25 to 38 years (average 33.7±3.4 years), who underwent conservative myomectomy in different gynecological hospitals in Yerevan and were interested in pregnancy. All women in the preoperative period and 3 months after surgery twice (in the proliferative and secretory phase of the cycle) underwent sonography in 2D and 3D modes with reconstruction of the uterine cavity in a coronal section.
Ultrasound diagnostics open forms spina bifida is not a difficult problem in the second trimester of pregnancy. The detection of changes such as Arnold-Chiari II syndrome and a spinal defect with the formation of a hernial protrusion leaves no doubt about the diagnosis. The only exceptions are those cases when the ultrasound manifestation of the defect is represented only by spinal deformation. Currently, the greatest interest is in identifying this defect in the first trimester of pregnancy. Ultrasound criteria such as the absence of intracranial translucency, smoothness of the brainstem angle, a decrease in biparietal size below the 5th percentile, etc. are studied.
It is known that the diagnosis of this heart defect is based on a direct sign - visualization of the site of narrowing of the aorta, and, possibly, expansion of the proximal aorta. However, it is quite difficult to clearly visualize the area of narrowing of the aorta in the fetus and is possible only in isolated observations. The defect can be seen only when there is a decrease in the diameter of the aortic isthmus by more than 1/3 compared to the norm for each stage of pregnancy. The key to the prenatal diagnosis of aortic coarctation is a comprehensive accounting of data obtained both from the study of a four-chamber section of the heart (dilatation of the right ventricle, hypoplasia of the left ventricle) and from the assessment of the main arteries themselves.
The most important marker of genetic syndromes of both chromosomal and non-chromosomal origin is micrognathia. Micrognathia (lower micrognathia, microgenia) is an anomaly of the development of the lower jaw, characterized by its hypoplasia. Diagnosis of this condition with trisomy 18 and triploidy reaches 80%. When you enter the term “micrognatia” into the OMIM search engine, you can find 447 different syndromes and associations, the syndromic core of which includes this important genetic marker.
The purpose of this study was to analyze the coincidence of the results of routine two-dimensional transvaginal ultrasound in postmenopausal patients with the final pathomorphological conclusion of the study of endometrial biopsy, to determine the possibility of using three-dimensional power Doppler ultrasound in patients with obliteration of the cervical canal in postmenopause.
In recent years, with the development and reduction in cost of ultrasound technologies in the world, there has been a rapid introduction of diagnostic ultrasound in childbirth. Just as ultrasound once revolutionized antenatal care, so it is now happening in the management of childbirth. Ultrasound in the second stage of labor is of primary importance to assess the progress of the fetal head along the birth canal.
Clinical case invasive trophoblastic tumor that developed after curettage of the uterus for a non-developing pregnancy, not accompanied by an increase in β-hCG levels and diagnosed using 3D/4D reconstruction of the uterine cavity. Histological examination confirmed the presence of a destructive trophoblast tumor, and the patient was prescribed chemotherapy.
Feto-fetal transfusion syndrome, also known as feto-fetal transfusion syndrome, is a serious complication of monochorionic multiple pregnancies in which disproportionate blood flow occurs in the fetuses. The absence of any intervention leads to death (about 80%) or severe morbidity of the fetuses.
In the prenatal period, the lungs are in a compressed state and do not perform their main function (breathing), so it is impossible to carry out an objective assessment of their functional state before birth. Even in the case of normal fetal development and the absence of any anatomical changes in the lungs, it is impossible to confidently predict their absolute functional usefulness in the neonatal period. The purpose of this work is to study the possibilities of using three-dimensional ultrasound in assessing the condition of the lungs with diaphragmatic hernia and predicting postnatal outcomes during prenatal diagnosis of this malformation.
Back in 1980, a study was published in the British Journal of Obstetrics and Gynecology confirming that with open spina bifida, the value of the fetal head for a given gestational age is less than that of healthy fetuses. More than 30 years have passed, and now not a single international congress can go by without reports that this pattern can also be observed in fetuses at 11-14 weeks. In other words, only by adding the measurement of the fetal head BPD to early fetometry, it is possible, if not to diagnose the pathology, then to identify a risk group for this often disabling and sometimes fatal malformation already during early screening.
Feto-fetal transfusion syndrome is a severe complication of multiple monochorionic pregnancy associated with the presence of transplacental vascular communications. The syndrome develops in 10-15% of cases during monozygotic pregnancy. The etiopathogenesis of the syndrome is based on a circulatory imbalance between intraplacental vascular beds twin fruits. Ultrasound and Doppler fetoplacental monitoring of 5 pairs of twins with an uncorrected complicated course of monochorionic twin pregnancy was carried out.
Fetal neuroblastoma is a tumor arising from undifferentiated neural tissue of the adrenal glands in the retroperitoneum or from the sympathetic ganglia in abdominal cavity, chest, pelvis, head and neck area. More than 90% of neuroblastomas in fetuses arise in the adrenal glands. Patient T., 40 years old, applied for a routine screening ultrasound at 32 weeks. An ultrasound examination revealed a tumor of the fetal right adrenal gland with metastases to the liver.
Heart defects are the most common congenital disease of the fetus and account for more than 50% of the structure of child mortality associated with congenital and hereditary pathologies. Despite the high resolution of modern ultrasound equipment and the presence of color Doppler mapping in all modern devices, the frequency of detection of fetal heart defects does not exceed 40-45%. This article describes the most common errors that occur during routine examination of the fetal heart and presents methods for optimizing ultrasound images when assessing the main sections of the heart.
Cervical pregnancy is a rare variant of ectopic pregnancy and a life-threatening condition due to the possible development of massive bleeding. Ectopic pregnancy continues to be a serious gynecological problem to this day. Numerous publications indicate an increase in the number of ectopic pregnancies, the frequency of which in Russia in 1991-1996. was 11.3-12 per 1000 pregnancies, and has now increased to 19.7 per 1000 pregnancies. To illustrate the possibility of successful ultrasound diagnosis of cervical pregnancy using 3D echography, we present one of our observations.
Ellis-van Creveld syndrome (chondroectodermal dysplasia, mesodermal dysplasia, mesodermal dwarfism with six fingers) is a rare autosomal recessive condition with variable phenotypic features, its incidence is 1 case in 60,000 live births. In domestic journals devoted to the problems of prenatal ultrasound diagnostics, we have not found a single report on the prenatal detection of this syndrome. In this regard, we present our own experience of prenatal diagnosis of Ellis - van Creveld syndrome.
Congenital heart defects rarely affect fetal development. This was first noted in the studies of B. Mac Mahon et al. However, there are defects that are incompatible with life, and after birth the child immediately dies. Some congenital heart defects, even simple forms, develop a malignant course in the early neonatal period, causing the development of circulatory decompensation and respiratory failure. The main reason for this is the imperfection of compensatory mechanisms.
We present a clinical observation of the anatomical variant of the location of the left innominate vein with its horizontal course. This feature is one of the rare anatomical variants of the normal structure of the human venous system. Echography of the fetal heart was performed at 22 and 32 weeks of pregnancy. The patient gave birth to a healthy boy; no developmental defects or abnormalities in the functioning of the heart were detected; the child’s growth and development corresponded to the age norm.
From 2006 to 2011, 125 congenital heart defects (CHD) were detected prenatally in the first trimester of pregnancy. Of these, 68 (55%) CHDs were combined with various chromosomal anomalies (CA) of the fetus, 30 (24%) were part of various multiple congenital malformations (MCDM), 27 (21%) CHDs were isolated. Echocardiography examined a four-chamber section of the fetal heart and a section through three vessels. Ultrasound was performed with a transabdominal sensor; only when necessary (difficult visualization) was an intracavitary sensor used.
Functional disorders pelvic organs among women in the modern world are very widespread. To compare the state of the pelvic floor and the course of reparative processes, 100 women were sonographically examined at different times in the postpartum period with in various ways delivery through the natural birth canal.
Congenital kidney tumors are very rare disease, which has an ambiguous prognosis for life. The frequency of this pathology among newborns is very low and cases of prenatal diagnosis are extremely rare, so we decided to publish our own clinical observation of prenatal detection of mesoblastic nephroma in the fetus in the third trimester of pregnancy.
Meckel-Gruber syndrome (splanchnocystic dysencephaly) is a complex of multiple lethal congenital malformations with an autosomal recessive type of inheritance. Due to the great rarity of this syndrome and isolated publications in the domestic literature devoted to its diagnosis, we present our own experience of prenatal diagnosis of 3 cases of Meckel-Gruber syndrome.
For a comprehensive assessment of the hemodynamics of the uterus in healthy women of the reproductive, peri- and postmenopausal periods, 339 patients were examined. All subjects had no history of surgical interventions on the internal genital organs or gynecological complaints. Ultrasound examination was carried out using modern ultrasound machines in a set of multi-frequency transabdominal and transvaginal sensors according to generally accepted methodology examination of the pelvic organs in women.
Schizencephaly is a rare brain anomaly associated with the formation of a cleft in the brain, as a result of which the lateral ventricles communicate with the subarchnoid space. The main ultrasound criterion for the defect is a cleft in the brain substance, emanating from the lateral ventricle and reaching the cerebral cortex. The defect can be either unilateral or bilateral. When using the CDC mode for schizencephaly, an open circle of Willis is revealed.
The common atrioventricular canal is a defect in which defects of the interatrial and interventricular septa are combined with splitting of the atrioventricular valves. The frequency of the defect is 3-7% among all heart defects in newborns. The defect is often (up to 60%) combined with aneuploidies, among which the most common is trisomy 21 and other syndromes (up to 50%), mainly heterotaxy syndrome. We provide a description of observations of prenatal diagnosis of the common atrioventricular canal and interruption of the aortic arch.
Vasa previa is one of the variants of membrane attachment, in which the umbilical cord vessels cross the amniofetal membranes at a lower level than the presenting part of the fetus. These vessels, unprotected by Wharton's jelly, can rupture at any time during pregnancy, leading to profuse bleeding and antenatal fetal death. In addition, their damage is possible during amniotomy and during vaginal delivery, therefore prenatal diagnosis of vasa previa is of great practical importance.
Congenital malformations of the central nervous system(CNS) are quite often diagnosed by ultrasound examination of the fetus. The exact frequency of Arnold-Chiari syndrome is unknown, but meningomyelocele occurs in 1-4 cases per 1000 births, occupying one of the first places in the structure of central nervous system anomalies. Three main types of this anomaly are known: I - penetration of the cerebellar tonsils into the cervical spinal canal; II - herniation of the dysplastic cerebellum into the foramen magnum in combination with elongation of the brain stem; III - isolated total displacement of the hindbrain structures into the enlarged foramen magnum, accompanied by the formation of a hernia. We present our own clinical observation of a combination of Arnold-Chiari malformation with diaphragmatic hernia, microgenia and hypotelorism.
One of the main problems of the postpartum period in modern obstetrics is infectious and inflammatory diseases, which include inflammatory processes of the birth canal: infected perineal wound, endometritis, parametritis. The purpose of this publication is to develop an algorithm for a comprehensive ultrasound examination, including, in addition to two-dimensional echography, three-dimensional visualization of the uterus and three-dimensional Dopplerography of the uterine vasculature in postpartum women after spontaneous labor and cesarean section, which will allow us to determine new approaches to the prediction and early diagnosis of postpartum complications, to provide the opportunity earlier drug correction of pathological conditions.
From 2002 to 2007, 45,114 screening obstetric ultrasound examinations were carried out at the Medical Genetic Consultation (Vitebsk). During this period, 321 congenital malformations of the fetus were identified during pregnancy up to 22 weeks, which served as an indication for termination of pregnancy at the request of the family, 96 (29.9%) of them were diagnosed in the first trimester. The detection rate of congenital pathology in the first trimester of pregnancy increased from 25% in 2002 to 38% in 2007, and the range of congenital malformations also changed.
We present to your attention a protocol for a three-dimensional ultrasound examination of the fetal heart in multiplanar imaging mode, an algorithm for step-by-step construction of diagnostic cardiac sections included in an extended echocardiographic examination of the fetus. A three-dimensional echocardiographic examination of the fetal heart, like any three-dimensional study, begins with a scan of the heart in the mode of a standard two-dimensional ultrasound image, necessary for optimizing the ultrasound image of the fetal heart, searching for the optimal echo access at the level of which the volume will be “taken”.
Amniotic band syndrome (Simonart syndrome) is a rare malformation of the amnion, consisting in the presence of tissue cords. Passing through the amniotic cavity, amniotic cords can connect individual sections of the placenta, umbilical cord and/or fetal body. The frequency of detection of amniotic bands ranges from 1 in 1200 to 1 in 15,000 births. Amniotic bands can lead to a variety of fetal developmental abnormalities. Most often, newborns have ring constrictions on one or more limbs. In 12% of cases of amniotic bands in the fetus, craniofascial anomalies are observed: cleft lip and palate, nasal deformities, anophthalmia, microphthalmia, hypertelorism, strabismus (strabismus), iris coloboma, ptosis, obstruction of the lacrimal gland. An extremely rare complication of amniotic bands is fetal decapitation.
Congenital malformations of the musculoskeletal system are a large group of defects that differ in etiology, pathogenesis and clinical manifestations. Prenatal diagnosis of congenital malformations of the musculoskeletal system is of great practical importance, since many of these defects have an unfavorable prognosis for life and health. Ultrasound assessment of the fetal musculoskeletal system becomes possible from the end of the first trimester of pregnancy. Individual elements of the skeleton begin to be visualized from the earliest stages of pregnancy, and by 12-14 weeks all its main structures become available for assessment.
One cannot but agree that two-dimensional ultrasound is the basis of modern echography and, thanks to it, doctors have achieved great success in solving many clinical problems in obstetrics, diagnosing diseases and malformations in the fetus. At the same time, it would be naive to believe that all diagnostic problems have been solved and new techniques should not be developed in practice, introducing them to solve routine problems or to improve the accuracy of detection and detailing of anomalies. The material for the article was the experience of 3D/4D ultrasound of 7554 pregnant women (from 6 to 41 weeks), while various developmental anomalies were found in 209 fetuses.
Placental insufficiency is expressed in a violation of transport, trophic, endocrine, metabolic and other essential functions placenta, which leads to a decrease in its ability to maintain adequate exchange between the organisms of the mother and fetus. The basic sign of fetoplacental dysfunction is the predominant disturbances of blood flow in the arteries of the umbilical cord, chorionic plate and supporting villi, confirmed by the results of Doppler measurements.
Modern echography makes it possible to monitor the development of the fetus from the earliest stages of intrauterine development. Thanks to three-dimensional ultrasound, in the early stages of pregnancy it is possible to more accurately determine the embryonic age and identify gross malformations earlier. Visualization of the embryo is possible for the first time with a three-dimensional examination of the ovum for at least 3-4 weeks (length about 1.5 mm). At this stage, you can see the amniotic cavity, the embryo in the form of a “grain of rice” and the attaching stalk. At 5 weeks, the neural tube begins to form (the length of the embryo reaches 3 mm), somites are formed, and the rudiments of the heart, lungs, thyroid gland, and umbilical vessels develop.
Multicystic kidney is congenital anomaly, with which renal parenchyma replaced by cysts of various sizes. A multicystic kidney is formed when embryogenesis is disrupted in the 4-6th week of pregnancy. The pathogenesis of multicystic kidney is based on atresia of the ureteropelvic anastomosis during embryonic development. In case of bilateral multicystic disease, termination of pregnancy is indicated, and in case of unilateral multicystic disease, removal of the affected kidney is indicated in the near future after the birth of the child.
Cholelithiasis- a disease characterized by the formation of stones in the lumen of the biliary system. This article describes a case of complete filling of the lumen of the gallbladder with stones, which rarely occurs in children under one year of age.
Considering the lack of normal biometric parameters of the fetal lungs in the available literature, the authors of this article conducted a study, the purpose of which was to develop a technique for measuring fetal lungs, studying the nature of their growth and the characteristics of intrauterine breathing movements at different stages of pregnancy.
Intrauterine premature closure of the oval window is a rare pathology. There are a few publications that describe isolated cases of this pathology. With antenatal closure of the foramen ovale, right ventricular heart failure develops, and the child is usually born dead or dies soon after birth.
The frequency of spontaneous miscarriages in the first trimester remains stable for many years and accounts for 15-20% of all wanted pregnancies. In structure obstetric complications This pathology ranks second. The purpose of this work is to determine the most informative echographic markers of miscarriage in the first trimester to predict pregnancy outcome.
Cardiotocography and Doppler ultrasound are currently the leading methods for assessing the condition of the fetus during pregnancy. The purpose of this study is to clarify the value of automated cardiotocography and Doppler ultrasound in diagnosing the condition of the fetus during pregnancy.
Children with trisomy 18 are born with severe prenatal hypoplasia. In 40% of cases, pregnancy is complicated by polyhydramnios. The phenotypic manifestations of the syndrome are diverse, and disturbances in the structure of the face and the musculoskeletal system are almost constant. There is a strawberry-shaped head (81%), choroid plexus cysts (50%), absence of the corpus callosum, expansion of the cistern magna, the lower jaw and the opening of the mouth are small, ears deformed and low located.
An important task Intrauterine echocardiography is the diagnosis of complex conotruncal malformations in the fetus. The purpose of our study is to analyze the main points of intrauterine echocardiographic diagnosis of conotruncal defects. Using comprehensive echocardiography, 430 pregnant women at risk for congenital heart defects were examined from 1995 to 1999.
Accurate knowledge of the gestational age has important to assess the nature of fetal development, diagnose some congenital defects, select optimal time termination of pregnancy and setting the date for issuing prenatal leave (especially for women with irregular menstrual cycles), as well as for scientific research. The purpose of this work is to assess the possibility of the standards we have established for individual parameters of fetometry and the computer program created on their basis for calculating the gestational age, weight and growth of the fetus in the first, second and third trimesters during a physiologically developing pregnancy.
Ultrasound fetometry. An attempt to create an algorithm for predicting fetal weight and growth during the third trimester during a physiologically developing pregnancy. The program is designed in such a way that when using it, even an inexperienced specialist cannot make too many mistakes. big mistakes when determining fetal weight.
Thanatoform dysplasia is one of the most common forms of skeletal dysplasia, characterized by pronounced micromelia, a narrow chest and a protruding forehead. Along with achondroplasia and hypochondroplasia, it belongs to related skeletal dysplasias in the group of achondroplasias.
Antenatal damaging factors, in particular acute respiratory viral infections, suffered by a pregnant woman in the early stages, have a certain impact on the development of the fetal egg, which is manifested in the disproportionality of the growth of extraembryonic formations - the amnion and chorion cavities (exocoelom). We divided pregnant women (200) aged 17 to 40 years, among whom the research was conducted, into 2 groups: 1 - included women who had suffered from ARVI and (or) had signs of a threat of miscarriage; in 2 - with an apparently successful pregnancy.
Three-dimensional ultrasound in obstetrics provides improved visualization of the following fetal structures: face, limbs, skeleton, heart, brain. The article reflects the use of three-dimensional ultrasound in the first trimester of pregnancy to diagnose chromosomal aneuploidy and fetal malformations in early gestation.
The cervix during pregnancy is an extremely important anatomical and functional structure. Disorders that occur in the cervix can seriously affect the outcome of pregnancy. The cervical size nomogram is based on the results of a study of 204 normal pregnancies using TVUS from 10 to 38 weeks, and 100 pregnant women at high risk of cervical incompetence who underwent TVUS before and after the cerclage procedure.
The World Health Organization and many national scientific associations have developed the recommendations presented below for examining women at various stages of pregnancy, without introducing restrictions on the qualifications of the personnel conducting the study or on the capabilities of the equipment used. The guidelines consist of a list of items that, at a minimum, should be included in each completed ultrasound report.
An anomaly of brain development - Arnold-Chiari malformation (syndrome) was first described in 1986. Modern pathomorphology distinguishes three main types of this anomaly: I - penetration of the cerebellar tonsils into the cervical spinal canal; II - herniation of the dysplastic cerebellum into the foramen magnum in combination with elongation of the brain stem; III - isolated total displacement of the hindbrain structures into the enlarged foramen magnum, accompanied by the formation of a hernia. Type I is usually not accompanied by damage to the spinal cord and is detected more often in adults using CT and NMR. Types II and III of the defect are characterized by high mortality in the perinatal period or early childhood. According to autopsy data, in children with meningomyelocele, Arnold-Chiari malformation type II is detected in 95-100% of cases.
The use of ultrasound in obstetrics is justified by the following reasons. At least 50% of women who confidently say they know their pregnancy dates are off by at least two weeks, and the timing of delivery can be critical to the baby's survival. 90% of fetal anomalies occur without family history. Even with a clinically normal pregnancy, gross fetal anomalies can occur. Neither clinical trial, nor heredity do not provide reliable information about multiple pregnancies. In a significant number of cases with low-lying placenta, there are no symptoms until bleeding begins.
The purpose of this work is to study the anatomical changes of the cervix during pregnancy, using transfundal pressure when performing transvaginal ultrasound in patients with a history of isthmicocervical insufficiency or its threat, as well as to study pregnancy outcomes after suturing the cervix in cases of a positive response to transfundal pressure.
The most impressive images that can be obtained in obstetric practice are portraits of the fetus before the onset of labor. The best results are achieved if the fetal profile is in a central position during volume scanning. A viewing angle of 60 degrees is optimal at which a complete image of the fetal face can be obtained. Choosing an angle that is too small can cause parts of the face to be "lost", and motion-induced artifacts can occur at high line densities, which are chosen to achieve good resolution.
Surface-mode 3D ultrasonography is used when abnormalities are suspected on 2D examination. This makes it possible, especially in cases of developmental defects of the face and limbs, to confirm and clarify the diagnosis. For successful use of the method, it is important to have a good knowledge of the normal three-dimensional anatomy of the fetus in a superficial mode.
The purpose of this review is to summarize the advantages and disadvantages of the new techniques transvaginal color Doppler and three-dimensional ultrasound in the field of gynecology and obstetrics.
In most cases, using the two-dimensional echography method, it is possible to obtain and document individual scanning planes that are most interesting for prenatal diagnosis. An experienced researcher, by comparing two-dimensional images, can mentally construct a three-dimensional model. However, problems arise when individual 2D scans cannot be obtained. This situation is typical when the fetus is in an unusual position or when examining fetuses with complex malformations that must be examined in several planes.
The cycle is conducted by Doctor of Medical Sciences, Professor
Ozerskaya Irina Arkadievna.
Additional Information and recording by e-mail:
ozerskaya_usd@ mail.ru
As a result of the lesson, the doctor should gain knowledge on the following issues:
Signs of an unchanged ultrasound picture of the uterus, ovaries and fallopian tubes;
- ultrasound signs of anomalies and malformations of the uterus and ovaries;
- ultrasound signs of pathological changes in the most common diseases of the uterus, ovaries and fallopian tubes;
- main ultrasound signs of concomitant pathological processes in adjacent organs and areas (including pelvic organs, retroperitoneal space);
- ultrasound signs of pathological changes in complications of the most common diseases of the uterus and appendages;
- possibilities and features of the use of modern techniques used in ultrasound diagnostics of the pelvic organs in women, including pulsed and color Dopplerography, ultrasound-guided puncture biopsy, contrast echohysterosalpingoscopy, etc.
The doctor must acquire or strengthen skills in the following areas:
Determine the indications and feasibility of performing ultrasound;
- choose adequate ultrasound examination techniques;
- take into account deontological problems when making decisions;
- based on ultrasound semiotics, identify changes in organs and systems;
- identify ultrasound signs of changes in the pelvic organs in women, determine their localization, prevalence and severity;
Conduct differential diagnostics using ultrasound and identify signs:
A. - developmental anomalies of the uterus and ovaries; b. - inflammatory diseases and their complications; V. - tumor lesion; d. - secondary changes caused pathological processes in adjacent organs and tissues and in generalized processes; d. - changes after the most common surgical interventions and some of their complications (abscesses, infiltrates, etc.);
- compare the signs identified during the study with data from clinical laboratory and instrumental research methods;
- determine the need for additional ultrasound examination;
- determine the sufficiency of the available diagnostic information to draw a conclusion based on ultrasound data;
- assign the data obtained to one or another class of diseases;
- formulate a conclusion (or in some cases a differential diagnostic series), determine, if necessary, the timing and nature of a repeat ultrasound and the advisability of additionally performing other diagnostic methods.
Year of issue: 2005
Genre: Diagnostics, obstetrics
Format: DjVu
Quality: Scanned pages
Description: Nevertheless, the rapid progress of medical science dictates the need to make attempts to solve this problem. The sixth edition of “Echography in Obstetrics and Gynecology (Theory and Practice)”, published in Russian in two volumes, is the fruit of efforts undertaken in this direction by a large team of leading foreign specialists. Despite the ever-increasing accessibility of the Internet, each ultrasound diagnostic doctor has his own library of necessary reference literature in the form of reference books, which he has to turn to again and again in everyday practice. We hope that this Guide will be one of them.
When preparing the book “Echography in Obstetrics and Gynecology,” in each section the authors considered basic concepts only to the minimum extent that was required to move on to presenting the features of the modern understanding of a particular pathology. But even taking this approach into account, the volume of the book turned out to be quite significant. Readers may rest assured that if well-known characteristics were worthy of further mention, it was only because they, having undergone "natural selection" from the point of view of practical value, still retained their value for diagnosis and became to a certain extent "pathognomonic".
Some sections of echography in obstetrics have undergone fundamental changes, and in some cases, studying the presented material may require some effort from the reader. First of all, this concerns issues affecting the genetic basis of the modern classification of skeletal dysplasia, since it has now begun to be based on data obtained from the study of gene mutations.
The peculiarity of ultrasound diagnostics in obstetrics and gynecology is that the specialist who examines the fetus as a patient must have multidisciplinary theoretical training. He must not only be well oriented in the anatomy of any region of the body (from the brain and heart to the structure of the foot), but also be familiar with the manifestations of variability in anatomical structures associated with variations in their normal or abnormal development. He is required to be fluent in assessing the various functional processes observed during pregnancy and have sufficiently deep knowledge in highly specialized areas (for example, hematology and immunology). We hope that the book “Echography in Obstetrics and Gynecology” will contribute to the implementation of these difficult tasks and help you expand your capabilities in the important matter of protecting the health of the mother and her unborn child.
We thank everyone who assisted us in preparing the translation of this publication with advice, consultations and reviewing.
The book “Echography in Obstetrics and Gynecology” is intended for ultrasound diagnostic specialists, obstetricians-gynecologists, perinatologists and doctors of related specialties.
"Echography in obstetrics and gynecology"
PART 1
- Devices for ultrasound examinations
- Ultrasound in obstetrics: standards for displaying power output information and biological effects of ultrasound
- Normal anatomy of the pelvic organs with transvaginal echography
- Transvaginal echography in the first trimester of pregnancy
- Assessment of nuchal translucency thickness in the first trimester of pregnancy to screen for chromosomal abnormalities
- Transvaginal echography in the diagnosis of ectopic pregnancy
- Fetometry
- Prenatal diagnosis of heart defects
- Functional fetal echocardiography
- Ultrasound examination of the placenta
- Ultrasound examination of the umbilical cord and membranes
- Use of Doppler ultrasound to assess the condition of the fetus
- Doppler study of uteroplacental circulation
- Color Dopplerography in obstetrics
- Introduction to prenatal diagnosis of malformations
- Prenatal diagnosis of brain development abnormalities
- Anomalies of the development of the organs of the neck and chest cavity
- Ultrasound examination of the fetal gastrointestinal system
- Ultrasound examination genitourinary system fetus
- Anomalies in the development of the fetal skeletal system
- Fetal syndromes
- Ultrasound diagnosis of chromosomal abnormalities
- Intrauterine growth restriction
- Diagnosis, management and prognosis based on ultrasound data
- Ultrasound examination in multiple pregnancies
PART 2
- The role of echography in the management of pregnant women with immunopathology
- Assessment of the biophysical profile of the fetus: theoretical background and practical application
- Chorionic villus biopsy
- Amniocentesis
- Fetal blood test
- Invasive methods of treating the fetus under ultrasound control
- Ultrasound examination of the cervix during pregnancy
- Ultrasound examination for trophoblastic disease
- Ultrasound examination in the postpartum period
- Ultrasound diagnostics of women's diseases during pregnancy
- Transabdominal and transvaginal echography in the diagnosis of pelvic tumors
- Color Doppler mapping in the diagnosis of pelvic tumors
- Ultrasound diagnosis of uterine diseases
- Transvaginal echography in the diagnosis of endometrial pathology
- The use of transvaginal echography and color Dopplerography for early diagnosis of ovarian and endometrial cancer
- MPT of the female pelvis as a solution to the problem with indeterminate ultrasound results
- Color Doppler sonography for pelvic pain syndrome
- Transvaginal echography in the diagnosis of female infertility
- Transvaginal color Dopplerography in the diagnosis of female infertility
- Echohysterography and echohysterosalpingography. Examination of the uterine cavity and tubal patency using echography
- Invasive interventions under the control of transvaginal, transrectal and transperineal echography
- Transvaginal echography in patients with urinary incontinence
- Ultrasound examination of the pelvic floor after childbirth
- Ultrasound of the mammary glands
- Three-dimensional echography in obstetrics
- Application of three-dimensional power Dopplerography in gynecology
- Three-dimensional power Doppler ultrasound in the assessment of angiogenesis of tumors of the female genital organs
- Construction of histograms with three-dimensional color Dopplerography: new method blood flow quantification
- The use of three-dimensional color Doppler ultrasound to assess the condition of the uterus before and after uterine artery embolization
IN modern medicine There is one hardware method of examination, without which not a single independent branch of this general science can do today - this is the ultrasound method. In short, it is called ultrasound. Today this is the most common and safe method of cavity, organ and tissue research. It is carried out by exposing the organ or tissue being examined to ultrasonic waves.
Scientists drew attention to the fact that ultrasonic waves have the ability to freely penetrate tissue, and special equipment records on monitors a clear image of everything that is in the zone of action of the waves. It is this feature that allows specialists to identify various deviations of tissues and organs of the body from the norm. And the fact that this method of research poses absolutely no additional threat to the health of the subject has made the ultrasound method the most popular and in demand today.
Another advantage and The peculiarity of ultrasound is its painlessness and the quality of information received about the status of the survey. Ultrasound examinations occupy a special place in obstetrics. This method makes it possible to accurately identify many gynecological and obstetric problems at the earliest stages. Among them are:
In addition, using ultrasound waves, pregnancy and its timing, as well as ectopic pregnancy can be easily determined. In obstetrics, there is one immutable rule for conducting this type of examination - the bladder must be full at the time of the examination.
Advantages of ultrasound in obstetrics
This method makes it possible to consider everything in detail female organs, hidden inside the pelvis, without causing any inconvenience to the patient. On the monitor screen you can easily examine the uterine cavity, determine the natural size and volume of the ovaries, and their anatomical position. Ultrasound examination of the cavities inside the small pelvis quite easily reveals tumor neoplasms of oncological and non-oncological etiology; you can find out what condition the bladder and genitals are in after surgical interventions. Such studies should be carried out within 5–6 days from the start of periodic discharge. During this period, the lining of the uterus (endometrium) becomes thinner, and this makes it possible to more accurately determine the presence of polyps, fibroids, and fibroids.
Speaking of features conducting ultrasound examinations in obstetrics , first of all, I would like to say that there are two types of ultrasound examinations:
These are completely different research methods, so we will consider each of them in detail and separately.
Methods for performing obstetric ultrasound
There are such methods performing an obstetric ultrasound :
- 1. Transabdominal examination. It is performed while lying on a couch. This study is intended mainly to identify pathologies of intrauterine development of the fetus and determine the general course of pregnancy. In this case, the examination is carried out through the abdominal wall. To do this, a special gel is applied to the woman’s stomach. During the study, a special transmitter is used, the signals from which are sent to a computer for processing and then displayed on the monitor screen. Thus, the doctor has the opportunity to form an accurate opinion about the condition of the fetus or about pathologies that prevent pregnancy. It is during a transabdominal examination that a woman’s bladder should be full.
- 2. Transvaginal examination. It is carried out in contrast to the first research method with an empty bladder. This is an immutable circumstance, otherwise the specialist will not be able to guarantee that the monitor screen will have a clear picture necessary to establish obvious or possible pathology of the internal organs of the small pelvis. With this method of ultrasound examination, a special sensor is inserted into the vagina. True, before insertion, a latex tip must be put on the sensor, but most often a simple condom is used.
During a transvaginal examination, the doctor makes an opinion:
Besides Ultrasound in obstetrics helps determine the sex of the unborn child with almost one hundred percent accuracy.
Reasons for performing an ultrasound during pregnancy
The main reason for carrying out ultrasound examination pregnant women is the need to determine a more accurate picture of the course of pregnancy and its timing. What is the reason for this need?
- 1. The family may not be aware of any congenital or genetic abnormalities that can cause pathology in fetal development. Ultrasound makes it possible to detect the development of pathology in the early stages.
- 2. When there is a need to determine the exact timing of pregnancy.
- 3. With the detection of multiple pregnancy.
- 4. With definition anatomical location placenta.
- 5. With the detection of pathologies that impede the proper course of pregnancy.
- 6. With the identification of some deviations in fetal development from the norm.
The latter circumstance has many quite serious reasons. For example, an ultrasound at the fourteenth week can reveal the presence of Down syndrome in the fetus. At this time, it is possible to terminate the pregnancy. Therefore, it is so important to conduct such a study at this particular time. It is also possible to define ectopic pregnancy. If you do not pay proper attention to this problem, a specific threat to a woman’s life may arise.
Detecting a multiple pregnancy allows young parents to prepare mentally and financially for such a significant event. And most importantly when performing ultrasound in obstetrics For a doctor, this is the opportunity to conduct research in real time and the ability to prescribe timely and the only correct treatment.
Ultrasound is considered one of the most informative research methods in obstetrics.
J. Areas of application of ultrasound.
A. Fetometry is the determination of the size of the fetus or its individual parts using ultrasound. The method allows you to clarify the gestational age and weight of the fetus. Assessment of fetometric parameters taking into account data from anamnesis and physical examination (date of last menstruation and height of the uterine fundus) is used to diagnose intrauterine development disorders.
B. Diagnosis of developmental defects. Modern ultrasound equipment makes it possible to diagnose even minor malformations of the gastrointestinal tract, skeleton, urinary tract, genital organs, heart and central nervous system. Ultrasound is also used to determine the location of the placenta and diagnose multiple pregnancies.
B. Fetal assessment. Using ultrasound, the biophysical profile of the fetus and the volume of amniotic fluid are assessed. The use of ultrasound for prenatal diagnosis has led to a decrease in perinatal mortality. Doppler examination makes it possible to assess the function of the fetal cardiovascular system and placental circulation.
D. Control during invasive studies. Ultrasound is used for amniocentesis, chorionic villus sampling and cordocentesis. In addition, ultrasound is used to diagnose ectopic pregnancy with bloody discharge from the genital tract and pain in the lower abdomen in early pregnancy.
YY. general characteristics Ultrasound
Purposes of ultrasound. According to the bulletin of the American Society of Obstetricians and Gynecologists, depending on the purposes of ultrasound during pregnancy, there are two types - standard and targeted.
- 1) With standard ultrasound, the following parameters and indicators are assessed.
- *Description of the contents of the uterus. The number and position of fetuses, the location of the placenta are determined, and an approximate estimate of the volume of amniotic fluid is carried out (in case of multiple pregnancy - for each fetus separately).
- *Fotometry.
- 1) Biparietal size of the head.
- 2) Head circumference.
- 3) Abdominal circumference.
- 4) Thigh length.
- *After the 22nd week of pregnancy, using formulas or nomograms, it is necessary to calculate the expected weight of the fetus and the percentile to which this indicator corresponds (for example, the expected weight, determined from a table based on the biparietal size of the head and abdominal circumference of the fetus, is 1720 g, which corresponds to 25 th percentile for a given gestational age).
- *Anatomy of the fetus. The brain, heart, kidneys, bladder, stomach, spinal cord are visualized, and the attachment and number of umbilical cord vessels are determined.
- *Fetal heart rate and rhythm.
- *Other pathological changes. You can detect enlargement (swelling) of the placenta, overdistension of the fetal bladder, pronounced expansion of the pyelocaliceal system and ascites. Pathology of the pelvic organs, such as uterine fibroids, can be detected in the mother.
- 2) Targeted ultrasound is used for a more thorough examination of the fetus if developmental defects or severe VUZR are suspected. In this case, special attention is paid to certain organs and systems. For targeted ultrasound, a two-dimensional study is used. Areas of interest are photographed. IN Lately During ultrasound, video recording is increasingly being used.
- 3) Biophysical profile of the fetus. It was proposed to evaluate individual indicators of the fetal condition using a point system. The advantages of this method are high sensitivity (allows you to diagnose intrauterine hypoxia even at early stage) and high specificity.
- 4) Selective ultrasound. In some cases, after a standard or targeted ultrasound, when there are no indications for repeating these studies, selective ultrasound is allowed. It includes regular assessment of a certain indicator, for example, the location of the placenta, the volume of amniotic fluid, the biophysical profile, the size of the fetal head, heartbeat, fetal presentation, as well as ultrasound-guided amniocentesis.
YYYY. Indications for ultrasound
Clarifying the gestational age before caesarean section, labor induction and induced abortion.
Assessment of fetal development in the presence of risk factors for VUGR and macrosomia: severe preeclampsia, long-term arterial hypertension, chronic renal failure and severe diabetes mellitus.
Bleeding from the genital tract during pregnancy.
Determination of fetal presentation in case of unstable fetal position at the end of pregnancy and if it is impossible to determine fetal presentation by other methods during childbirth.
Suspicion of multiple pregnancy: if the heartbeat of at least two fetuses is heard, if the height of the uterine fundus exceeds gestational age and if pregnancy occurs after ovulation induction.
Discrepancy between the size of the uterus and the duration of pregnancy. Ultrasound allows you to clarify gestational age, as well as exclude polyhydramnios and oligohydramnios.
A pelvic mass detected during vaginal examination.
Suspicion of hydatidiform mole. With hydatidiform mole, arterial hypertension, proteinuria, ovarian cysts, and absence of fetal heartbeat may be observed (with Doppler examination at a gestational age of more than 12 weeks).
Isthmic-cervical insufficiency. (Using ultrasound, the condition of the cervix is monitored and the optimal time for applying a circular suture is selected.
Suspicion of ectopic pregnancy or high risk of this pathology.
Suspicion of fetal death.
Invasive research methods: fetoscopy, intrauterine blood transfusion, cordocentosis, chorionic villus biopsy, amniocentesis.
Suspicion of uterine pathology: uterine fibroids, bifurcated uterus, bicornuate uterus.
Monitoring the position of the VMC.
Monitoring the growth of the ovarian follicle.
Assessment of the biophysical profile of the fetus after the 28th week of pregnancy (if intrauterine hypoxia is suspected).
Various manipulations during childbirth, for example, turning and extracting the second fetus in case of twins.
Suspicion of polyhydramnios and oligohydramnios.
Suspicion of premature placental abruption.
External rotation of the fetus onto its head during breech presentation.
Determination of fetal weight in cases of premature rupture of amniotic fluid and premature birth.
High level of a-FP in the serum of a pregnant woman. Ultrasound is performed to clarify gestational age and exclude multiple pregnancies, anencephaly and death of one of the fetuses.
Assessment of previously diagnosed fetal malformations.
Family history of birth defects.
Assessment of fetal development in multiple pregnancies.
Determination of gestational age late application pregnant woman to the doctor. ultrasound diagnostics obstetrics echographic
