Uzdg during pregnancy deciphering the results. Does the procedure harm the baby. What are the types of dopplerography

Ultrasound during pregnancy is a method ultrasound diagnostics, which allows to evaluate the characteristics of blood flow in the "fetus-placenta-mother" system. This is highly informative diagnostic procedure, the name stands for Doppler Ultrasound.

It is the method of choice throughout pregnancy, and especially from 18 to 26 weeks, when CTG and other studies are not informative, while there is an urgent need to obtain data on the fetal blood supply.

What is the basis of ultrasound diagnostics during pregnancy

During the ultrasound of pregnant women, the Doppler effect is used. That is, the same ultrasonic wave that is used in conventional ultrasound, only it, reflected from erythrocytes floating through the vessel, gives an idea of the characteristics of blood flow in the vessels.

During the procedure, the doctor may visualize and evaluate the following:

is there an entanglement of the fetus with the umbilical cord, how much does it suffer from this
measure blood flow velocity, diameter and patency of umbilical cord vessels, uterine arteries, large vessels of the fetus
assess the child's heart rate

Types of ultrasound performed during pregnancy

There are 2 types of ultrasound for pregnant women:

duplex scanning. This is a combination of conventional ultrasound and spectral Doppler analysis. With the help of such a study, it is possible to assess the anatomy of the vessel, the speed of blood flow in it.
Triplex ultrasound scanning. In this case, the previous 2 modes are combined with color flow mapping. This allows you to evaluate not only the anatomy of the vessel, but also its patency.

Who needs an ultrasound

when the umbilical cord is wrapped around the fetal neck on ultrasound
with pathology of the placenta
when it is found on ultrasound that the size of the fetus does not correspond to the gestational age
if the pregnancy is multiple
with rhesus conflict
with preeclampsia
If previous pregnancy was complicated, ended in miscarriage or stillbirth
if the mother has such diseases that cause vascular pathology: diabetes, hypertension, kidney disease, pathology of the coagulation system.

Preparing for an ultrasound scan for a pregnant woman

The study does not require preparation. It can be performed after the pregnant woman eats, you can - on an empty stomach. You do not need to follow a diet for the study, fill bladder also not needed.

How is the procedure

How is ultrasound of pregnant women performed:

The woman comes to the office, lies down on the couch, lifting her clothes so that the stomach is free for examination.
A special gel is applied to it. It is needed in order to avoid image errors associated with air that gets between the skin and the sensor.
The procedure takes about half an hour. It is absolutely painless, does not deliver discomfort mother and harmless to the fetus.

How to understand ultrasound data

Decoding of ultrasound is carried out only by an obstetrician-gynecologist. Below are the numbers that will indicate the norm, depending on the duration of pregnancy.

Systolic-diastolic ratio (SDR) in vessels

This is the ratio between the maximum velocity in the vessel in systole and the residual velocity in diastole. The indicator is determined in the large vessels of the uterus, fetus, umbilical cord. Each vessel has its own time limit.

1. So, in the umbilical cord artery, the LMS should be like this:

at 16-19 weeks: 4.45-4.67
20-22 weeks: 3.75-3.95
23-25 weeks: 3.41-3.6
26-28 weeks: 3.1-3.27
29-31 weeks: 2.82-2.94
32-35 weeks: on average - 2.48-2.52
35-37 weeks: 2.4-2.45
38 weeks or more: 2.19-2.22.

2. In the arteries of the uterus in the III trimester: LMS: 1.3-3.7.

IR (resistance index)

This is the ratio of the LMS to the maximum blood velocity in the vessel in systole. In this case, the higher the number, the greater the resistance in the vessel, that is, somewhere its patency is impaired. Norm UZDG during pregnancy, according to the resistance index, it depends on the gestational age and the diameter and type of the vessel.

how blood vessels develop in twins, whether one of them can develop at the expense of the other.

To be sure of the health of the unborn baby, a pregnant woman undergoes many examinations from the moment she is registered with the antenatal clinic until delivery. It is recommended that in each trimester it is mandatory to take a general blood test, a general urinalysis, biochemical analysis blood. Once at a period of 10-14 weeks, blood is taken from a pregnant woman to determine the likelihood of Down syndrome in a baby, and about 20 weeks - to determine the level of antibodies to infections (herpes, cytomegalovirus, chlamydia, toxoplasma). If any abnormalities are found, the tests will have to be repeated after the course of treatment.

On recent weeks expectations special procedures allow you to assess the condition of the baby - whether he receives enough oxygen, whether he is stunted in growth, whether there is an entanglement of the umbilical cord around the child's neck. For this purpose, ultrasound, fetal dopplerography and cardiotocography are used.

Doppler ultrasound during pregnancy

Doppler ultrasound (USDG) is an ultrasound that allows you to assess the level of blood flow in the mother-placenta-fetus system. According to the results, pregnancy complications are established or predicted - fetoplacental insufficiency, preeclampsia, preeclampsia, and others.

How does dopplerography work?

In the middle of the 19th century, the physicist Doppler discovered that a sound wave is reflected from moving objects differently than from stationary ones. More than 100 years later, such an important discovery was applied in medicine, when the ability to perform Doppler sonography was added to the first ultrasound machines. Blood is a heterogeneous liquid, but a mixture of plasma and cells. These cells are constantly moving at high speed through the vessels, which means that the Doppler effect is applicable to them. The examination shows the presence of blood flow in a particular vessel, its direction and intensity, determines the diameter of an artery or vein.

The use of ultrasound in obstetrics allows you to judge the uteroplacental blood flow and the work of the umbilical cord, namely:

right and left uterine arteries,
vessels of the umbilical cord of the fetus - two arteries and a vein,
middle cerebral artery fetus.

What parameters are determined by ultrasound?

To reliably assess the state of uteroplacental blood flow, the following digital parameters are used:

resistance index - an indicator that allows you to judge the diameter of blood vessels,
systolic-diastolic ratio - a coefficient that reflects the uteroplacental blood supply and the state of the umbilical artery in various phases of the heartbeat (contraction and relaxation),
pulsation index is a special parameter for assessing the elasticity of the vascular wall of the umbilical arteries.

The norms of these indicators are presented in special diagnostic tables in accordance with the weeks of gestation.

Thus, ultrasound allows for early stages detect deviations in the blood supply of the child and choose the optimal treatment for the pregnant woman so that the baby is born healthy.

The interpretation of the results is performed by the doctor of ultrasound diagnostics - his opinion is reflected in the conclusion of the examination protocol. More detailed comments about the condition of the baby will be given by the observing gynecologist.

What Can Be Detected With Doppler Ultrasound?

In a state of nutritional deficiency, the study shows the centralization of blood flow - the redistribution of circulating blood to vital important bodies. In this case, the issue of conservative treatment or delivery, depending on the duration of pregnancy and the significance of violations.

Normal blood flow (left); violation of blood flow in the placenta (right)

Allocate violations of the utero-placental-fetal blood flow III degrees:

IA: decrease in uteroplacental circulation with normal placental-fetal,
IB: decrease in placental-fetal blood flow with a sufficient level of uteroplacental blood flow.
II: moderate violation of the uteroplacental and placental-fetal blood supply.
III: a pronounced decrease in fetal blood flow, regardless of the level of the uteroplacental.

Royal- placental blood flow assessed by the state of the arteries of the uterus, and placental-fetal - by the vessels of the umbilical cord.

The degree of deviation from the norm directly affects the presence of such pathologies in the baby as delay syndrome prenatal development, chronic hypoxia, and after birth - perinatal lesion of the central nervous system. Often there is such an anomaly as the only artery of the umbilical cord. The diagnostic accuracy is 70-80%.

These deviations are very severe and may require treatment of a newborn child in the intensive care unit, and then a long rehabilitation due to the vulnerability of the brain to a lack of oxygen.

At what stage of pregnancy do ultrasound?

It is possible to evaluate the effectiveness of uteroplacental blood flow from 16-20 weeks of gestation, when the placenta is normally already fully formed. The examination is included in the screening program in the third trimester of pregnancy - at 30-34 weeks. Sometimes the attending obstetrician-gynecologist recommends that you undergo the procedure earlier - simultaneously with the second screening ultrasound at 20-24 weeks.

fetal ultrasound

As you know, the first ultrasound is done at 10-14 weeks. At this time, the placenta has not yet fully formed, which means that it is impossible to adequately assess the blood supply. For so early term study how many embryos are fixed in the uterine cavity, sizes gestational sac, the presence of gross malformations and indirect signs chromosomal abnormalities. For the first time, the expectant mother will be able to hear the heartbeat of her future son or daughter, it appears from about 6 weeks.

Ultrasound of the second trimester is more informative. The fetus has reached sufficient size - you can examine it internal organs, make the necessary measurements, assess the blood supply and condition of the placenta, the amount amniotic fluid. Some parents already at this ultrasound are told the gender of the unborn baby. The arteries of the umbilical cord are clearly visible - not only their width and blood circulation, but also the location of the loops (the presence of entanglement). The doctor will also approximately determine how much the baby weighs.

The examination is completely painless and looks exactly like a regular ultrasound. The doctor will only change the sensor to a Doppler, apply a special gel to the skin and examine the vessels. In this case, the mother will hear the sound of the baby's heartbeat. Deciphering the results by a specialist will take a few minutes. If deviations from the norm are found, the doctor recommends necessary treatment at home, in a day hospital or in the pregnancy pathology department.

Indications for dopplerography in complicated pregnancy:

pronounced preeclampsia - increased blood pressure, edema, excess protein in general analysis urine;

The doctor measures the blood pressure of a pregnant woman

diabetes;
kidney disease;
deviations in the blood coagulation system;
intrauterine growth retardation;
prolongation of pregnancy;
lack or excess of amniotic fluid;
pregnancy with twins or triplets;
Rhesus conflict between mother and fetus;
diseases of the cardiovascular system in the mother;
any placental pathology;
complicated course of previous pregnancies;
the only artery of the umbilical cord;
unsatisfactory results of cardiotocography (low heart rate or insufficient fetal motor activity).

Is the study safe?

Gynecologist explaining to a pregnant woman the need for Doppler ultrasound

For a long time, ultrasound was considered absolutely safe for mother and child - it does not cause an increase in any diseases or changes in condition, it does not even require a skin puncture, there is no risk of infection. However, in last years publications appeared that the use of ultrasound causes local heating of tissues, and the use of technology began to be treated with restraint. However, there is no evidence that Doppler ultrasound is harmful. The need for any intervention, including ultrasound, is always evaluated in terms of the balance of benefits and possible harm.

Therefore, you should not go through the procedure only “for the sake of interest” - if necessary, the specialist will definitely prescribe it.

Dopplerography during pregnancy is a highly informative study, the results of which make it possible to assess the condition of the baby in the womb, predict probable problems during childbearing and childbirth, and also start treatment in a timely manner if necessary.

Most women do not know about such a study as Doppler until the onset of the third trimester, and from that moment on, Doppler for pregnant women becomes quite a familiar procedure.

Doppler- this is one of the ultrasound diagnostic methods that allows you to assess the intensity of blood flow in various vessels, for example, in the vessels of the uterus and umbilical cord. It is most informative after 30 weeks, but in case of deviations during pregnancy (for example, if the fetus is lagging behind in development), Doppler ultrasound can be prescribed earlier - starting from 20 weeks.

Doppler indications

Adequate placental blood flow provides normal flow pregnancy. Violation of blood flow can lead to intrauterine growth retardation (IUGR), so the main reason for prescribing dopplerometry during pregnancy is precisely the discrepancy between the size of the body and / or organs of the baby.

Not necessarily with impaired blood flow, the child will lag behind in development, just the risk of an unfavorable course of pregnancy increases significantly. And vice versa, if there is a suspicion of a fetal lag in development, but the blood flow is not disturbed, then in most cases this indicates that the woman is carrying a small but healthy child.

Dopplerometry is also prescribed for:

premature maturation of the placenta;
severe oligohydramnios or polyhydramnios;
umbilical cord anomalies;
Rhesus conflict;
gestosis (late toxicosis, complicated by vomiting, severe swelling and increased pressure in a pregnant woman);
the future mother has kidney disease, hypertension, diabetes mellitus;
suspected chromosomal pathology;
non-immune dropsy of the fetus;
uneven development of children multiple pregnancy(when there is a difference in their body weights of more than 10%).

If the fetus has heart problems, Doppler is performed together with CTG, the so-called Doppler echocardiography.

With fetoplacental insufficiency, dopplerometry is carried out systematically every 2-3 weeks.

Also, with the development of complications during the previous gestation of the fetus, a Doppler ultrasound may be prescribed during a subsequent pregnancy.

Preparation for the study and how it is carried out

Dopplerometry in pregnant women is carried out according to indications, and a mandatory examination in case of normal flow pregnancy is not. But more and more often in women's consultations all women, without exception, at 30-34 weeks, doppler ultrasound is performed as an assessment of the condition of the fetus.

This procedure is painless and harmless to both mother and fetus. The principle of Doppler ultrasound is the same as conventional ultrasound during pregnancy: a special Doppler sensor is driven across the abdomen, which is equipped with every modern ultrasound diagnostic device. Therefore, this type of research does not require special preparation.

Doppler- this is a visual assessment of blood flow (when a color and graphic image of curves of blood flow velocities is observed from the monitor screen).

dopplerography- this is the same dopplerometry, only the indications are additionally recorded on the tape in order to track the change (improvement / deterioration) in blood flow after the treatment.

Interpretation of dopplerometry indicators

Uterine arteries (a. uterina dextra - right and a. uterina sinistra - left uterine arteries, respectively). The uzist must determine the nature of the blood flow both in the left and in the right uterine artery, because with gestosis it can be disturbed in only one artery. Thus, assessing the blood flow in only one artery, you can give a false conclusion, which will negatively affect the health of the baby and the expectant mother.

There is such a scientific theory that if blood flow is disturbed in only one (mainly in the right) uterine artery, a woman has high risk appearance late toxicosis(gestosis) with all the negative consequences.

With gestosis, the blood flow in the uterine artery is first disturbed, and when the situation worsens, the blood flow in the umbilical cord arteries worsens. Therefore, in case of violation of blood flow in the uterine arteries, it is necessary to periodically re-doppler to control the situation.

To assess blood flow in the uterine arteries, the resistance index (IR or RI) is calculated.

Often, pregnancy-induced hypertension develops due to a violation uterine blood flow. The body of the expectant mother independently increases blood pressure to increase blood flow to the intervillous space. So mom, without realizing it, helps the baby. Thus, it is necessary to improve blood flow and hypertension will disappear on its own.

Violation of blood flow in the uterine arteries is when the value of IR, PI or LMS is greater than normal.

The pulsation index (PI) of the uterine arteries should be within the following limits.

Indicators in the right and left uterine artery may differ slightly from each other. If both indicators are within the normal range, then such a picture is not considered a negative phenomenon.

Deviation of blood flow parameters from the norm in two uterine arteries at once indicates a violation of the uteroplacental circulation. This situation requires specific treatment - move more (regularly go for swimming or gymnastics for pregnant women).

Violation of blood flow in only one uterine artery indicates asymmetry of the uteroplacental blood flow. If the pregnancy proceeds normally, and the baby develops in accordance with the term, then the placenta is performing its functions.

You should be aware that at 18-21 weeks there may be a temporary violation of blood flow in the uterine arteries. This phenomenon is explained by the fact that the adaptive physiological process of cytotrophoblast invasion has not yet been finally completed. Therefore, if abnormalities in the uterine arteries are detected, a second Doppler ultrasound should be performed after 2-3 weeks, i.e. observe blood flow in dynamics.

The systolic-diastolic ratio (SDO) in the uterine arteries should be:

Umbilical cord arteries (a. umbilicalis). To obtain true results, the study should be carried out only at a time when the baby is at rest, and only when his heart rate is in the range of 120-160 beats per minute. Indeed, physiologically it is so laid down that with an increase in heart rate, there is a decrease in IR in the umbilical artery, and vice versa, with a decrease in heart rate, an increase in IR occurs.

Measurement of blood flow in the umbilical arteries should be carried out when the pregnant woman is lying on her back! Assessment of the severity of umbilical cord blood flow disorders cannot be objective at the location future mother"on the left side".

The umbilical cord must have two arteries and one vein. If there is an anomaly (a single umbilical artery), then the fetus may suffer from a lack of oxygen and nutrients, due to which there is a lag in its mass and growth. But it happens that the fetus adapts to such an existence and does not experience a deficiency of the necessary substances. Such children are born with low weight, but absolutely viable. Therefore, if there is one umbilical artery and the blood flow in it is not disturbed, then there is no cause for concern. But if the blood flow in a single artery is disturbed, inpatient treatment should be carried out to improve blood flow and, if necessary, early delivery (if the fetus is far behind in development).

The most widely used in assessing the nature of blood flow in the arteries of the umbilical cord was the resistance index. The readings in both umbilical cord arteries should be almost the same.

A blood flow disorder in the umbilical cord is when the value of IR, PI or LMS in the umbilical cord arteries is higher than normal.

The pulsation index (PI or PI) of the umbilical arteries must comply with the following standards:

Pathological is the registration of zero and reverse values of diastolic blood flow. This means that the fetus is in critical condition.

Only 2-3 days remain from the moment the permanent reverse values appear until the death of the fetus, therefore, it is necessary to carry out C-section to save the baby's life. This is possible only from the 28th week, when the baby is viable.

Systolic-diastolic ratio (SDO) in the umbilical arteries:

If the blood flow in the umbilical cord is disturbed, then, as a rule, there is a delay in the development of the fetus. If now there is no developmental delay, and the blood flow in the umbilical cord is disturbed, then later, without treatment, a fetal developmental lag may be observed.

Middle cerebral artery of the fetus (a. cerebri media). When the fetus suffers, there is increase in the values of PI, SDO and speed in SMA.

Maximum speed (aka V max) in the fetal middle cerebral artery:

Systolic-diastolic ratio (SDO) for the middle cerebral artery:

fetal aorta. It leaves the left ventricle of the heart, goes along the spine and ends in the lower abdomen, where the aorta divides into two iliac arteries, which provide blood supply to the human legs.

Deviations in the blood flow of the aorta can be detected only after 22-24 weeks of pregnancy.

The disruption of blood flow is increasing the values of IR, PI and SDO. Critical (talking about the death of the fetus) is considered registration of extremely low values up to their complete disappearance.

Changes in the aorta characterize the severity intrauterine hypoxia fetus.

Systolic-diastolic ratio (SDR) for the fetal aorta:

Venous duct (VP). It is studied in the extended Doppler assessment of blood flow.

During the study, it is necessary not to take into account episodes of hiccup-like respiratory movements of the child and active movement.

Indexes are not used to assess the venous duct.

Diagnostic criterion pathological condition fetus is considered to be negative or zero blood flow values in the phase of atrial contraction. Zero or reverse values are recorded with fetal malnutrition, congenital malformations of the right heart, non-immune dropsy of the fetus.

Even with critical blood flow in the arteries of the umbilical cord, but with preserved blood flow in the venous duct in the phase of atrial contraction, it is possible to extend the gestation to the optimal time for childbirth.

Description of blood flow disorders and their treatment

1 degree

1 A degree- violation of blood flow in the uterine arteries, while in the umbilical cord the blood flow remains normal.

This degree of blood flow disturbance is not dangerous for the fetus.

Medical treatment of this condition is ineffective. Doctors still prescribe therapy with Actovegin and Curantil. Do not see on occasion!
In fact, if there is a violation of blood flow in the uterine arteries, it is more expedient to simply walk more often. fresh air(breathing full chest) + eat right + move more (hiking, special exercises for pregnant women, exercises in the morning, yoga, swimming). And do not sit for hours at the computer! That's all treatment.

1 B degree- violation of blood flow in the arteries of the umbilical cord, and in the uterine arteries hemodynamics is normal.

This degree of blood flow disturbance requires the use of blood-thinning drugs to avoid developmental delay and fetal hypoxia.

In this case, a treatment is prescribed aimed at improving blood circulation (Placenta compositum, Curantil or Trental). Actovegin is prescribed as an antihypoxant, which improves the supply of oxygen to the fetus.
A blood test for coagulation ability (coagulogram) is also prescribed. With increased blood clotting, it is necessary to take stronger blood-thinning drugs than Curantil (for example, heparin or an agent that includes acetylsalicylic acid).

I degree of violation does not lead to the death of the fetus. There is a systematic monitoring of the nature of the blood flow (every 2 weeks) "plus" the control of fetal CTG (after 28 weeks of pregnancy). In addition, be sure to follow blood pressure in a pregnant woman.

2 degree- simultaneous violation of blood flow in the uterine arteries and in the umbilical cord, which does not reach critical values (when the blood flow is preserved in the venous duct).

In such a state of without fail appointed drug treatment in a hospital where round-the-clock monitoring of the fetus is provided. It is also necessary to monitor the state of blood flow by conducting Doppler + CTG every 2 days.

In degree II hemodynamic disturbances are rare, but there may be cases of intrauterine death.

3 degree- critical disorders of blood flow in the umbilical cord with intact or impaired blood flow in the uterine arteries. A critical violation is understood as the registration of reverse diastolic blood flow or its absence at all.

III degree of violation poses a danger to the health of the child, because in half of the cases, intrauterine death of the baby occurs. Therefore, when a 3rd degree of blood flow disturbance is detected, it is necessary to urgently perform a caesarean section in order to save the life of the baby, because at this stage of the disorder, treatment is not effective.

Conservative (natural) childbirth at grade 3 can lead to perinatal death of the child.

The cost of a doppler ultrasound in a private clinic is about 1,200 rubles.

Ultrasound diagnostics in obstetrics is practically the only most reliable and safe method research that helps the doctor evaluate the development and condition of the fetus in the womb. With the development of technology in medicine come more and more new methods. Dopplerography can be considered one of them, although its use began about 25-30 years ago, but it has become actively used by doctors in obstetrics relatively recently.

Which is used during usually ultrasound in order to assess the state of blood flow in the vessels of various organs and tissues. It is based on the Doppler effect. It can identify the displacement of blood particles, measure the speed of blood flow in the vessels and evaluate various specially designed blood flow indices.

Kinds

There are two main types of doppler sonography. The first is color mapping., when moving blood particles in the vessels on the screen of the device are painted in different colors depending on the direction and speed of blood flow. When the particles are directed towards the sensor, the vessel is painted in shades of red, when the blood moves in the direction opposite to the sensor - in various shades blue. The higher the speed, the brighter color. With the help of color doppler, the vascularization of organs, pathological formations is assessed, small vessels are searched, and arteries and veins are differentiated.

The second type is spectral or impulse dopplerography.. With the help of it, the blood flow is recorded in the form of a curve graph, and then various mathematical calculations are carried out with it.
In addition, depending on the number of simultaneously applied modes, duplex and triplex Doppler ultrasonic scanning are distinguished.

Dopplerography. Spectral Doppler of the common carotid artery

Duplex scanning combines two modes: conventional gray scale ultrasound and one of the Doppler modes, which simultaneously show the image in real time. Thus, visualization of organs and vessels is obtained with simultaneous receipt of information from color or spectral Dopplerography.

When triplex scanning, in addition to the gray-scale image, two Doppler modes (color and pulse) are simultaneously enabled.

In obstetrics, when assessing the condition of the fetus, as a rule, duplex scanning is used.

When is it prescribed for pregnant women?

In the III trimester of pregnancy, dopplerography is performed for all pregnant women during screening 3 in addition to. For some women, dopplerography is indicated already in the second trimester of pregnancy, since during this period it is still impossible to assess the well-being of the fetus by any other methods.

Indications for ultrasound for the fetus may be accompanying illnesses or certain conditions of the mother: arterial hypertension, threatened miscarriage, or premature birth, anemia of a high degree, large uterine fibroids, infection of the genital area, respiratory and heart failure.

Indications for Doppler sonography can still be changes detected in the placenta: changes in the structure of the placenta detected by ultrasound, discrepancy between the thickness or degree of maturity of the placenta and the gestational age, placental presentation.

In addition, dopplerography is indicated if there are signs of any abnormalities in the development of the fetus itself: IUGR or vice versa large fruit, Rhesus conflict, ultrasonic signs infections in the fetus, signs of hypoxia or heart failure, birth defects heart, great vessels, kidneys, 2 or more loops of the umbilical cord around the neck.

There are no contraindications to Doppler ultrasound in pregnant women.

Why conduct such a survey?

Dopplerography (USDG) is used to significantly improve the quality of diagnosis and assess the severity of disorders functional state at the fetus. With the help of ultrasound, you can quickly and safely assess the condition of the fetus. After Doppler ultrasound, the doctor can more reasonably determine the further tactics of pregnancy, as well as resolve questions about best timing and method of delivery, if there are any abnormalities in the development of the fetus.

Preparation

Dopplerography of the fetus does not require any special preparation of a pregnant woman.

It is only worth noting that the examination of fetal blood flow should be carried out during the period of fetal rest, with a rhythmic and normal heart rate corresponding to its gestational age. Respiratory movements, movements of the body and limbs of the child are the reason for the registration of an unstable blood flow schedule in the vessel under study, according to which it is impossible to correctly calculate the speed parameters.

After the mother eats, the fetus, as a rule, becomes more active, so it is recommended that Doppler ultrasound be performed a couple of hours after eating.

How does it go

The study of fetal blood flow is carried out in the same way as a conventional gray scale ultrasound. Most often, these two types of research are performed simultaneously.

The woman should free her stomach from clothes and lie down on the couch. It is advisable to lie straight on your back, but if it is difficult for a pregnant woman to stay in this position for a long time or the fetus is in some kind of atypical position, it is allowed to lie on its side. The doctor applies the gel to the area of the uterus and applies an ultrasound probe to the pregnant woman's abdomen at various points in search of the main vessels needed to study.

With each Doppler study, the state of both uterine arteries, the umbilical artery, and the middle cerebral artery of the fetus are necessarily studied. According to the indications, a study of the venous duct, thoracic aorta, renal arteries, umbilical cord vein, inferior vena cava, intracardiac blood flow of the fetus can be performed.

The doctor displays the necessary vessel on the screen first in gray color, then turns on one of the Doppler modes, registers and studies the necessary blood flow parameters, and then enters them into the study protocol.

The holding time is slightly longer than holding without it and depends on the position and motor activity fetus. The calmer the child behaves, the faster and easier it is for the doctor to register his blood flow.

What can show?

Oxygen deficiency of the fetus can occur as a result of deviations in the transport of oxygen to the tissues of the fetus at its various stages:

with maternal hypoxia;
with placental insufficiency;
with changes in the umbilical cord;
with fetal diseases.

Ultrasound, as a research method, can give the doctor great and valuable information about how the baby feels in the womb. The doctor compares the indicators obtained during the study with normative tables and draws a conclusion about the condition of the fetus, about the level at which violations occur and what they can lead to.

At 11-14 weeks of gestation, a change in blood flow in the venous duct often serves as a marker of chromosomal diseases or fetal heart defects, which can lead to adverse pregnancy outcomes.

In the II and III trimesters, an increase in the values of peripheral resistance indices (IR, PI) or the ratio of blood flow velocity in systole to diastole (SDO) in the arteries of the woman's uterus indicates a violation of the uteroplacental blood supply.

The values of LMS or IR of the umbilical arteries are higher than normal, as well as the detection of a blood flow spectrum with zero or negative values speeds indicate a violation of the fetal-placental blood flow.
Evaluation of blood flow in the middle cerebral artery of the fetus allows you to identify violations cerebral circulation at the fetus.

Where to go with the results?

Having received a doctor's opinion, you should contact an obstetrician-gynecologist, in whom she is observed about this pregnancy. He, in conjunction with other studies, will conduct a general assessment of the condition of the fetus, and, if necessary, prescribe the necessary treatment or further observation.

Conclusion

Dopplerography is a valuable and non-invasive method for examining pregnant women. It allows you to receive important diagnostic information in the complicated course of pregnancy and thus prevent or start treatment of the developing pathological condition of the fetus in time.

Depending on the course of pregnancy, as well as the history of the woman "in position", in addition to routine examinations, additional procedures may be prescribed for the expectant mother. Their main goal, as before, is to take care of the health of the woman and the little one in her womb. In addition to the traditional ultrasound diagnostics of pregnant women, which allows to assess the development of the crumbs and the condition of the organs reproductive system women, in some cases, ultrasound may be indicated. What is this study? What parameters of the health of a woman and her crumbs is it intended to evaluate?

Behind the abbreviation "USDG" lies such an important study as Doppler ultrasound. The examination is aimed at checking the blood flow between the pregnant woman and the fetus. The intermediate link is the placenta. It is no secret that this is how the baby receives the oxygen and nutrients necessary for life. During the examination, the length of ultrasonic waves reflected from moving objects is recorded. Their frequency depends on the direction and rate of movement of the object. Popularity this method diagnostics is due to several factors - safety for a woman and her baby, non-invasiveness, painlessness and high accuracy. The data obtained as a result of this kind of ultrasound are considered reliable and objective. On this moment dopplerography is the only method that allows you to accurately assess the vessels of a pregnant woman and a baby in her womb. If violations are found, action must be taken immediately.

Ultrasound ultrasound during pregnancy - what is it and what is the purpose of this scan? During the examination, the following are checked:

Status and development (degree of maturity) " children's place"- placenta.
The quality of blood circulation in the placenta.
Blood flow in the uterine vessels.

Violation of blood flow almost inevitably leads to insufficient supply of nutrients, as well as oxygen to the child - his hypoxia. The consequence of this is damage to the nervous structures of the baby, as well as other gross malformations. Severe hypoxia can cause the death of a peanut. That is why the first Doppler is recommended for a period of 12-14 gestational weeks. In evaluation genetic pathologies baby important role play data obtained as a result of the Doppler sonography of his middle cerebral artery.

Ultrasound during pregnancy - what does a doppler scan show

The result obtained depends on the type of study conducted by the pregnant woman. There are 2 types of Doppler examination:

The first is a duplex scan - a combination of conventional ultrasound and Doppler analysis. As a result, an image of vessels with blood moving through them is presented for evaluation. As a result, a specialist can evaluate the anatomical structure of the vessels, as well as the speed of blood movement in them.
The second is triplex ultrasound scanning. Ultrasound with CDC during pregnancy provides color duplex scanning data, and also allows you to assess the lumen of the vessels (i.e., their patency).

Who is shown an unscheduled vascular ultrasound during pregnancy

Ultrasound is not a mandatory routine examination. However, dopplerography allows you to assess the blood supply of the little one even at a time when CTG and other methods will be uninformative. The first conduction of vascular Doppler is recommended at the end of the first-beginning of the second trimester. For the next examination future mom can be sent in the period from 18 to 26 weeks of waiting for the little one and at 31-33 weeks. At the same time, many women do not undergo Doppler scanning even once during pregnancy. In some cases, women "in position" are shown regular Doppler control.

The additional observation group includes women who:

A decrease in the rate of blood flow in the placenta due to pathological processes in it (lack of "children's place").
The umbilical cord has less than three vessels.
There was a discrepancy between the actual parameters of the crumbs and the data of the corresponding gestational age (developmental delay). The wording "developmental delay" is used in cases of a delay of 2 or more weeks.
Severe toxicosis of the first trimester.
Late toxicosis - gestosis.
If a woman and her baby have a conflict over the Rh factor. In this case, the mother's body produces antibodies to the erythrocytes of the blood of the little one.
During diagnostic ultrasound entanglement of the umbilical cord in the neck of the baby was found.
The presence in the uterine cavity of more than one baby. The increased load on the woman's circulatory system increases the likelihood of impaired blood flow in the placenta.
Negative history - failure of pregnancy or the birth of a dead baby due to abnormalities in the placenta.
Concomitant diseases such as diabetes mellitus, hypertension, pathologies of the kidneys and the hematopoietic system.

ultrasound during pregnancy

As we found out earlier, Doppler ultrasound is performed in the presence of certain indications. How is the research done? How to decipher the data obtained during the ultrasound?

Ultrasound scan during pregnancy - how is the scan performed

The total duration of the examination does not exceed half an hour, does not require preliminary preparation and does not cause discomfort - the procedure differs little from a standard abdominal ultrasound.

How is ultrasound done during pregnancy:

The pregnant woman lies on a trestle bed (on her back or on her side) and exposes her stomach.
A special gel is applied to the anterior wall of the peritoneum - this remedy improves adhesion between the transducer and the abdominal surface, minimizing image errors.
Next, the specialist drives the sensor over the abdomen and evaluates the information displayed on the monitor - blood flow in the vessels of the uterus, umbilical arteries, aorta and cerebral artery of the baby. Special attention is given to the blood supply to the placenta, as well as the condition of the umbilical cord.

Ultrasound during pregnancy - decoding of ultrasound data

It’s worth mentioning right away that only an obstetrician-gynecologist who observes this pregnancy. Self-interpretation of information is unacceptable.

The results of ultrasound during pregnancy are evaluated in terms of the following indices:

FROM TO. The systolic-diastolic ratio reflects the ratio between the maximum and residual velocities in the vessels (systole and diastole). This indicator is installed for large uterine vessels, umbilical cord arteries and vessels of the baby. For each gestational age, the LMS indicators are different.
The average velocity of blood flow in the uterine vessels.
Pulsation index (PI). This indicator is calculated as the quotient between the difference in speeds (maximum and residual) and the average blood flow velocity.
Resistance index (IR). The difference between the systole and diastole values is divided by the systole value.

Depending on the degree of deviation of the obtained values from the reference norms, the doctor draws conclusions:

Whether the child in the womb of a woman suffers from a lack of oxygen or nutrition. The doctor makes conclusions about the child's condition.
If we are talking about two babies, it is monitored whether one child develops at the expense of the other.
If there is a violation of the blood flow, the localization of the pathology is established - the placental-fetal and utero-placental blood flow does not work properly.

If violations nevertheless take place, the degree of their severity is established - violations were detected only in one type of blood flow, deviations in both types of blood flow (PPK and BMD), but they are not critical, or critical violations were found in the AUC and BMD.

6. The average rate of uterine blood flow is 60-71 cm/sec (3rd gestational trimester).

7. This PI for the 3rd gestational trimester is 0.4-0.64.

A decrease in the rate of blood movement certainly leads to an increase in the LMS and IR. This picture indicates fetoplacental insufficiency.

After receiving the Doppler data, you should carefully listen to the recommendations of the doctor. This type research is different a high degree reliability, so it should not be ignored in any case.