Why is fetal fetometry performed? Ultrasound and Doppler in the second trimester
In the second trimester, ultrasound is performed at 20-24 weeks.
Tasks:
1. Confirm the development of pregnancy;
2. Assess the correspondence of the size of the fetus to the expected period of pregnancy and identify delayed fetal development, malformations and diseases;
3. Identify fetal malformations and, if necessary, carry out invasive diagnostics (amniocentesis, placental villous aspiration, cordocentesis);
4. Determine quantity amniotic fluid;
5. Exclude the diagnosis of umbilical cord entanglement;
6. Determine the placenta attachment site, abnormalities in the development of the placenta (for example, cysts);
7. You can determine the sex of the child.
According to the ultrasound protocol in the second trimester, the number of fetuses, their position and presentation are determined. The frequency and rhythm of fetal heart contractions are assessed. Fetometric indicators are measured and their compliance with the gestational age is assessed.
The minimum mandatory volume of fetometry includes measurement of the biparietal diameter (BPD) of the head, abdominal circumference (AC) and the length of both femurs (DF or femur length - FL).
If a discrepancy between one or more basic fetometric indicators and the gestational age is detected, as well as when pathology is detected in the fetus, it is necessary to conduct extended fetometry, which includes measuring the head circumference (HC), the frontal-occipital size of the head (LZR or occipito- frontalis diameter - OFD) and calculation of ratios as a percentage: BPD to LZR or cephalic index (CI or CI=BPD/OFD), OG to coolant (NS/AC), and after 22 weeks of gestation - DB of bone to coolant (FL/AC ).
Cross-sections visualize the fetal skull and brain structures at various levels. The M-echo, the cavity of the transparent septum, the thalamus (visual thalamus), choroid plexuses. To be measured: width posterior sections the bodies of the lateral ventricles (triangle), the anteroposterior size of the cistern magna and the interhemispheric size of the cerebellum.
The fetal facial structures are examined. The profile of the face, nasal bone and nasolabial triangle are visualized. Special attention is paid to the assessment of the orbits, upper and lower jaw. The fetal spine is assessed using longitudinal and transverse scanning. It is mandatory to obtain a longitudinal section of the spine with clear visualization of the spinous processes. Survey chest The fetus is performed in a longitudinal section of the fetal torso to assess the contours of the diaphragm and lungs.
The heart is examined in a four-chamber section. Are being studied great vessels(aorta, pulmonary trunk, superior vena cava).
The anterior abdominal wall of the fetus is examined. At the same time, the state of attachment of the umbilical cord vessels to the fetus is determined. An echoscopy of organs is performed abdominal cavity fetus Imaging of the stomach and intestines is mandatory. The kidneys are assessed and bladder fetus It is necessary to study the longitudinal and cross sections of the kidneys, evaluate their shape, size, location, condition of the parenchyma and collecting system. The study of fetal anatomy ends with a study of the structure of the bones of the limbs on both sides (femur and humerus, as well as shins and forearms).
The placenta, umbilical cord and amniotic fluid are assessed and the amniotic fluid index is measured.
Give an assessment anatomical features body, cervix and appendages.
Parameters recorded during ultrasound examination in the second trimester of pregnancy:
Number of fruits;
Presentation (cephalic, pelvic);
Fetal heart rate (bpm);
Simple fetometry:
BPR - biparietal size heads, mm;
OB - abdominal circumference, mm;
DB - length of the femur: right/left, mm;
Fruit weight, grams;
Advanced fetometry:
OG - head circumference, mm;
LZR - fronto-occipital size, mm;
Cephalic index (N = 71-87%);
Exhaust gas/coolant ratio (N = 114-131%);
DB/CO ratio (N = 22 ± 2%);
Placenta, umbilical cord, amniotic fluid:
Localization of the placenta (anterior, posterior, fundus, right, left);
Thickness of the placenta, mm;
Umbilical cord vessels (N = 2 arteries, 1 vein);
The amount of amniotic fluid (normal, high, low water); in case of pathology - amniotic index;
Uterus, ovaries: structural features:
Uterus/ovaries;
Cervix.
Image of a fetus at 24 weeks gestation
Heartbeat. The normal heart rate at this stage is 140-160 beats per minute, the nature of the contractions is rhythmic, depending on the movement of the fetus, physical activity mothers, effects on mother various factors: heat, cold, various diseases. With a lack of oxygen, heart rate compensatory increases (more than 160 beats per minute) and then decreases (less than 120 beats per minute).
BPR- norm 5.1-6.8 cm. Coolant - 5-7.1 cm. Exhaust gas - 6-7.8 cm. Fronto-occipital size- 6.9-9 cm.
If the fetal head is fixed at the pelvic inlet, optimal imaging for determining biparietal size is usually not possible. In such cases, the study protocol indicates that it is impossible to determine the biparietal size. An attempt to measure the biparietal size in such a situation can lead to a diagnostic error and incorrect labor management tactics.
The biparietal size of the fetal head is measured from outer surface upper contour to inner surface the lower contour of the parietal bones. The fetal head usually has a slightly elliptical shape. Less commonly, the size of the head is increased in the transverse (brachycephaly) or longitudinal (dolichocephaly) direction. The shape of the head is assessed using the cranial index (the ratio of the biparietal size of the head to the fronto-occipital size). Normally it is 0.74-0.83.
Brachycephaly and dolichocephaly are considered normal variants, but may cause errors in determining gestational age and estimated fetal weight. With brachycephaly, the fetal head is wider and the biparietal size is larger than normal.
If we do not take into account its correspondence to other fetometric indicators, then the estimated fetal weight and gestational age for brachycephaly will be overestimated, and for dolichocephaly, on the contrary, underestimated. To avoid diagnostic errors in brachycephaly and dolichocephaly, the length of the femur, circumference of the head and abdomen of the fetus are measured to determine the gestational age and estimated weight of the fetus.
If the fetal head is delayed by 2 weeks or more relative to the gestational age, the disproportion between the sizes of the head and abdomen can indicate malnutrition (insufficient weight) of the fetus. A lag in the weight and growth of the fetus during ultrasound can be suspected by a proportional decrease in the size of the head and abdomen of the fetus, while the BPR/OB indicator does not differ from the norm and does not exceed 1.
Fetal abdominal circumference- one of diagnostic criteria intrauterine developmental delay. During mass examinations for intrauterine growth retardation, in addition to absolute fetometric indicators, relative indicators are used: the ratio of the length of the thigh to the circumference of the abdomen and the circumference of the head to the circumference of the fetal abdomen.
DB- 3.3-5 cm. Only the ossified part of the femur is measured. Despite the fact that femur slightly curved, the length of the femur is measured as the shortest distance from the proximal to the distal points of the diaphysis.
Fruit weight - 700-730 grams.
The fetal weight is greater than normal due to:
1. poor nutrition.
2. heredity - if you or your husband were born large, then the child may also be large.
3. diabetes mellitus in pregnancy - glucose levels in the fetus increase, which stimulates excess secretion of insulin, which is a growth factor.
4. post-term pregnancy, because the fetus continues to grow.
Most common cause low fetal weight is feto-placental insufficiency: blood is discharged into the cerebral arteries to maintain normal blood supply to the brain and a compensatory decrease in blood flow in the internal organs.
At the same time, the increase in abdominal circumference slows down in the absence of changes in other fetometric indicators (asymmetrical intrauterine growth retardation). With prolonged placental insufficiency, the increase in all fetometric indicators slows down, the expected weight of the fetus decreases, and the relative fetometric indicators return to normal limits.
Asymmetrical intrauterine developmental delay turns into symmetrical. Misdiagnosis of symmetrical intrauterine growth restriction may occur when the fetus is developing normally, but due to individual body characteristics, its weight remains below the 10th percentile for gestational age.
The normal thickness of the placenta at this stage is 25.37 mm (19.6-32.9). Sometimes the placenta may be larger than normal, but its structure and blood flow (during Doppler) in the umbilical cord are not changed, and the fetus does not lag behind in development. Normally, the thickness of the placenta in millimeters is approximately equal to the gestational age in weeks.
Thickening of the placenta is possible with:
Development of Rhesus conflict;
Diabetes mellitus;
Constant smoking of women during pregnancy.
If present in the mother's body chronic infections(virus herpes simplex, cytomegalovirus, chlamydia, ureaplasmosis) inflammation of the placenta (placentitis) may develop. On ultrasound, the placenta looks thickened, with a changed structure. But the diagnosis is established taking into account the diseases suffered by the woman during pregnancy, blood and urine tests, and a vaginal smear.
A decrease in the thickness of the placenta is observed in women suffering from hypertension and arterial hypertension pregnant women, and is often combined with intrauterine retention fetal development.
The placenta attachment site is determined by which wall of the uterus the chorion or placenta is located on, how far the placenta is from internal pharynx The cervix is the site of exit from the uterine cavity. Low attachment The placenta may be present during ultrasound examinations performed in the first and second trimesters, but until the third trimester the placenta can migrate, that is, rise up the wall of the uterus.
Amniotic fluid. During an ultrasound examination, the amniotic index is determined, which indicates the amount of water: the uterus is divided into quadrants by two perpendicular lines (transverse - at the level of the pregnant woman’s navel, and longitudinal - along the midline of the abdomen), then the indicators obtained by measuring the largest vertical column of amniotic fluid are summed up in each quadrant. The result is assessed using centile tables. An increase in the amniotic index indicates polyhydramnios, a decrease indicates oligohydramnios.
Low water. Usually explained by a decrease in the excretory capacity of cells amniotic sac.
Reasons:
1. gestosis;
2. hypertension mothers;
3. infectious inflammatory diseases mothers (40% of cases);
4. inflammatory diseases of the female genital area (34%);
5. insufficient production of amniotic fluid due to malformations excretory system fetus and fetal renal dysfunction;
6. violation metabolic processes in a woman's body (obesity III degree);
7. fetoplacental insufficiency.
Symptoms: abdominal pain, especially when the fetus moves.
With oligohydramnios, complications of pregnancy and childbirth often occur: primary weakness develops labor activity, the frequency of bleeding increases. Frequency breech presentation fetus increases to 13%.
Oligohydramnios is a decrease in the volume of amniotic fluid to 500 ml or less as a result of an imbalance between their absorption and production. Most often observed in younger pregnant women with increased blood pressure in the third trimester of pregnancy and in women with increased risk development of fetal malnutrition (lag in fetal size from normal for a given period).
If oligohydramnios is suspected, exclude birth defects fetal development, especially if it is detected in the second trimester (up to 28 weeks) of pregnancy, because sometimes severe oligohydramnios can be combined with defects such as polycystic kidney disease or the absence of kidney disease.
Oligohydramnios can also be a sign of intrauterine infection of the fetus; it can occur against the background of a decrease in fetal urine excretion into the amniotic cavity when chronic hypoxia, which is observed with intrauterine growth retardation.
In 40% of women with oligohydramnios, the size of the fetus lags behind the norm. Due to a sharp decrease in the volume of amniotic fluid, compression of the umbilical cord may occur between the fetus and the walls of the uterus, which can lead to acute oxygen deficiency and fetal death; It is extremely rare that adhesions (adhesions) form between the walls of the uterus and the skin of the fetus.
With oligohydramnios, the amniotic sac is “flat”, does not function as a hydraulic wedge, and does not contribute to the dilatation of the cervix, which creates the risk of weak labor. Oligohydramnios can be primary (with intact membranes) and secondary, or traumatic (as a result of damage to the membranes with a gradual leakage of water, which sometimes goes unnoticed by the woman: amniotic fluid is mistaken for leucorrhoea).
Diagnosis of oligohydramnios is mainly based on an ultrasound examination, but during the examination the doctor may notice that the height of the uterine fundus and abdominal circumference lag behind normal for a given stage of pregnancy and are reduced motor activity fetus, the uterus is dense on palpation, parts of the fetus and heartbeat are clearly visible. At vaginal examination during childbirth, a “flat” amniotic sac is detected, stretched over the fetal head.
If oligohydramnios is detected before 28 weeks of pregnancy, comprehensive examination to determine possible reason and assessing the condition of the fetus. If fetal malformations are detected, pregnancy is terminated according to medical indications. When oligohydramnios is combined with intrauterine hypoxia and fetal growth retardation, treatment is carried out until 33-34 weeks of pregnancy, and if treatment is ineffective and the condition of the fetus worsens, early delivery is carried out. During childbirth, the “flat” amniotic sac is opened to prevent labor weakness.
Therapeutic measures are aimed at preventing and eliminating fetal pathology. The condition and amount of amniotic fluid is determined using ultrasound.
Polyhydramnios
Polyhydramnios (polyhydramnios) occurs in 0.5-1.5% of all pregnancies.
Reasons:
1. excessive primary formation of amniotic fluid by the membranes of the fetus;
2. some malformations of the fetus, in which it is difficult for the amniotic fluid swallowed by the fetus to enter the intestine;
3. diabetes mellitus mothers;
4. multiple pregnancy.
Symptoms: feeling of heaviness and pain in the abdomen, malaise, swelling of the legs. Due to excessive accumulation of amniotic fluid, the enlarged uterus puts pressure on neighboring organs and lifts the diaphragm, which complicates the blood circulation and breathing of the pregnant woman, and the functions of some organs are disrupted.
As a result of great mobility, the fetus can take incorrect positions. The volume of the abdomen at the level of the navel with polyhydramnios reaches 100-120 cm or more. When palpating the abdomen, a distinct gurgling sound (fluctuation) is often heard.
Childbirth with polyhydramnios is most often premature, accompanied by early rupture of amniotic fluid. Due to overstretching of the uterus, labor weakness may occur, postpartum hemorrhage and other complications.
Polyhydramnios - an increase in the volume of amniotic fluid more than 1500 ml.
In case of anomalies (malformations) of fetal development, the process of ingestion of water by the fetus is disrupted, as a result of which the balance between their production and excretion changes. Upon examination, the height of the uterine fundus and abdominal circumference exceed normal values for this stage of pregnancy.
The fetus actively floats in the amniotic fluid, which can cause the umbilical cord to become entwined around the neck and torso. If polyhydramnios is suspected, the doctor clarifies the diagnosis using ultrasound, while excluding intrauterine infection, fetal malformations.
Two forms of polyhydramnios: acute and chronic.
For chronic polyhydramnios the amount of water increases gradually. If the condition of the pregnant woman remains satisfactory, then the doctor carries out outpatient treatment: limits use table salt, prescribes diuretics.
Acute polyhydramnios is less common than chronic polyhydramnios. In this case, the amount of amniotic fluid increases sharply within several hours or days, a sharp increase in the size of the uterus is observed, in some cases the woman experiences abdominal pain, shortness of breath, and severe swelling. Ultrasound and methods for identifying defects are used to confirm the diagnosis. intrauterine development fetus (determine the content of alpha-fetoprotein in the amniotic fluid).
For acute polyhydramnios the woman is hospitalized and prescribed bed rest. In case of severe shortness of breath and abdominal pain, abdominal amniocentesis is performed (piercing the amniotic sac through the anterior abdominal wall). The fluid is released slowly, at a rate of 500 ml/hour, because rapid removal of even a small amount of amniotic fluid can be complicated by placental abruption and premature birth.
Doppler
Doppler– safe and informative method, which allows you to monitor blood circulation in the mother-placenta-fetus system, determine the condition of the fetus and identify intrauterine development disorders. Using this study, it is possible to detect umbilical cord entanglement, placental abruption or dysfunction of its vessels, fetal heart defects, etc.
Indications:
1.diseases of the pregnant woman(diseases cordially- vascular system, kidney; diabetes, Rh sensitization, gestosis);
2.Fetal diseases and malformations(intrauterine growth retardation, oligohydramnios, premature ripening of the placenta, multiple pregnancies, heart defects, umbilical cord abnormalities, chromosomal pathologies);
3.burdened obstetric history.
The examination is carried out at 23-24 weeks.
At normal course pregnancy this study allows you to monitor blood circulation in unified system mother - placenta - fetus, predict the growth and development of the fetus. Blood flow is determined mainly in uterine arteries(right and left), as well as in the arteries of the umbilical cord.
The severity of disturbances in the mother-placenta-fetus system:
First degree(compensated violation) is the most common. The condition of the fetus is not disturbed; pathogenetic therapy and monitored over time (once every 7-10 days), treatment can be carried out on an outpatient basis.
Second degree(compensated or subcompensated violation). Changes in blood circulation in the umbilical cord arteries are recorded. The fetus suffers from mild hypoxia.
Patients with a compensated form can be treated on an outpatient basis, but if possible dynamic observation and provided that the treatment started gives positive effect. Research is carried out weekly. In other cases, urgent hospitalization is indicated. If the indicators are normalized, the prognosis is satisfactory.
Third degree(decompensated fetal circulatory disorder). Rarely seen.
When performing Doppler measurements, a graphic image of the blood flow velocity appears on the screen during cardiac cycle in the form of a two-three-phase curve with a maximum level in systole (contraction of the heart muscle) - the maximum systolic speed or pulse component - and a minimum in diastole (relaxation of the heart muscle) - the end diastolic speed. For each vessel there are characteristic typical blood flow velocity curves.
IN clinical practice To quantify the state of blood flow, the following main indicators are used (vascular resistance indices - ISS):
Systole-diastolic ratio(SDO) - the ratio of maximum systolic to end-diastolic blood flow velocity.
Pulsation index(PI, PI) - the ratio of the difference between the maximum systolic and end-diastolic velocities to the average blood flow velocity.
Resistance index(RI, IR) - the ratio of the difference between the maximum sitolic and end-diastolic velocity to the maximum systolic speed blood flow RI = (S-D)/S.
Aorta
At 16-19 weeks it can be registered in 50% of cases, at 20-22 weeks - in 96%; at 23 weeks - 100%, at 36-41 weeks - 86%.
In the first half of pregnancy, ASC does not change significantly.
The average blood flow speed increases from 20 cm/sec at 20 weeks to 30 cm/sec at 40 weeks.
The study of blood flow velocity curves (BVR) is of practical interest after 22-24 weeks, because early disorders, as a rule, are not detected due to the large compensatory capabilities of the fetal blood circulation.
Fetal cerebral vessels
The most informative study is the average cerebral artery. The study is possible using color Doppler mapping (CDC), which allows you to clearly visualize the vessels of the circle of Willis ( arterial circle brain, located at the base of the brain and providing compensation for insufficient blood supply due to inflow from other vascular areas). SSCs in the cerebral arteries have the appearance characteristic of a vascular system of average resistance - without negative values of diastolic blood flow.
With CDK, the middle cerebral artery is recorded in 95% of cases.
Blood flow speed increases from an average of 6 cm/sec at 20 weeks to 25 cm/sec at 40 weeks.
ASCs in the middle cerebral artery increase from 20 to 28-30 weeks, and then decrease.
SDO less than 2.3 is a pathology.
Internal carotid artery registered at 19-41 weeks. Before 25 weeks there is no diastolic component in most cases.
Ultrasound and Doppler measurements during II trimester:
Subsoil, cmWeight, gBPR, mmDB, mmDGK, mmOJ, mmAI13103124122424-1412,35228162626-1514,27732192830-1616,41183522343473 - 2017181603924384077 - 2111 820.32174228414480 - 221922,12704431445083 - 2252024,13454734485286 - 2302125,94165037505588 - 2332227,85065340535989 - 2352329, 76075643566390 - 2372431,27336046596890 - 238
Ned- weeks
R- height
BPR- biparietal size
DB- thigh length
DHA- chest diameter
coolant- abdominal circumference
AI- amniotic index
Week VSAAorta Umbilical cord arteries IRSDOIRSDOIRSDO16-20.22 ± 1.040.78 ± 0.005 6.41 ± 0.354.56 ± 0.1117-20.22 ± 1.040.78 ± 0.005 6.41 ± 0.354.56 ± 0.1118-2 0.22 ± 1.040.78 ± 0.005 6.41 ± 0.354.56 ± 0.1119-20.22 ± 1.040.78 ± 0.005 6.41 ± 0.354.56 ± 0.1120-23.21 ± 0.690.74 ± 0.005 5.70 ± 0.323.86 ± 0.0921-23.21 ± 0.690.74 ± 0.005 5.70 ± 0.323.86 ± 0.0922-23.21 ± 0.690.74 ± 0.005 5.70 ± 0.323.86 ± 0.09230 .94 ± 0.0126.67 ± 1.040.71 ± 0.008 > 2.35.05 ± 0.193.51 ± 0.10240.94 ± 0.0126.67 ± 1.040.71 ± 0.008 > 2.35.05 ± 0.193 .51 ± 0.1025--0.71 ± 0.008 3.51 ± 0.10
BSA- internal carotid artery
IR- resistance index
SDO- systolic-diastolic ratio
Fetal fetometry by week, the table of which is given below, is carried out in order to establish the dimensions of the fetus and compare the obtained numbers with standard indicators embryo growth by week from special tables. Fetometry is carried out in conjunction with ultrasound - this makes it possible to monitor the health and development of the child and monitor the condition of his mother.
Fetometry norm developing embryo needed to quantify its development and timely detection various deviations. During this examination, doctors determine exact date the onset of pregnancy, the weight of the embryo and its dimensions. During research, the volume of water in the amniotic area is determined. This technique makes it possible to quickly detect developmental delays in the unborn child and take the necessary measures.
These measurements are carried out to clarify the following parameters by the gynecologist:
- The length of the embryo between the coccyx and the crown (KTR) is determined at the very first examination, when the embryo is no more than 6 centimeters.
- In the second trimester, the gynecologist measures the so-called biparental size (BPR), which allows you to find out the date of conception with an accuracy of plus or minus 10 days.
- The doctor can determine the fetal hip length (HF), which can also help determine the date of conception, but with less accuracy - the error ranges within 14 days.
- Chest volume (CV) is determined approximately at the 20th week of pregnancy.
- The child's abdominal circumference (AB) can tell us whether the baby is developing correctly or not. Using an ultrasound, his stomach, gall bladder, part of the vein in the navel, duct, and venous ducts are examined. The measurement is canceled if the fetal weight exceeds 4 kilograms.
- The embryonic head circumference (EC) is determined.
After receiving the data, the doctor compares the results with the control figures in the table.
Standard data on baby development
The developmental norm at which the baby is considered healthy was identified by large quantity examinations of pregnant women using ultrasound. The usual rate of fetal fetometry by week, the table of which will help the expectant mother herself understand the examination results, is given below.
Duration by week BPR DB OG Time period by week BPR DB OG
11 17 7,2 19 26 65 50 64,1
12 20 8,9 23 27 68 52,8 68,5
13 23,8 11,9 23,8 28 72 54,9 72,8
14 27,7 15,5 25,8 29 75,9 56,5 75,9
15 31,7 18,5 27,6 30 77,8 58,9 78,8
16 34,7 21,9 24,1 31 79,8 60,5 80,9
17 38,9 24,1 27,9 32 81,7 62,8 82,7
18 41,8 27,9 40,6 33 83,7 64,9 84,8
19 43,9 30, 6 43,8 34 85,9 65,9 87,9
20 46,7 33.8 47,9 35 87,8 66,9 90,7
21 49,9 36,8 49,7 36 89,6 68,8 93,7
22 52,8 39,9 52,7 37 90,9 70,8 96,7
23 55,9 42,9 55,9 38 91,8 72,8 98,9
24 59,7 45,9 58,7 39 92,9 74,8 100,7
25 62,9 47,9 61,9 40 94,6 76,9 102,9
The numbers shown in the table are not absolute values. Therefore, doctors often use rounded values of the obtained indicators. Each baby develops according to a genetically determined individual schedule, so small deviations The given figures should not particularly worry expectant mothers.
How are fetometric measurements carried out?
The examination is prescribed to a pregnant woman at the 12th, 22nd and 32nd weeks, and if there are any problems, the procedure may be unscheduled.
Research is carried out at ultrasound examination pregnant woman. The sensor can be used vaginally (for this purpose it is packaged in a condom) or installed on the belly of the expectant mother after lubricating this area with a special gel.
The first fetometric examination is carried out from the 10th to the 14th week, and the data obtained is compared with the average figures from the table. The procedure makes it possible to find out the date of birth of the baby. At this time, the possibility of various chromosomal abnormalities and other abnormalities can be checked. During this period, the most important figures are KTE and coolant.
The second fetometric check is done at the 20th week. With its help, the absence of various abnormalities in the development of the embryo is confirmed, and doctors are convinced of its proper development. Then parents can find out from the gynecologist the sex of the unborn child.
If a pregnant woman wants to compare instrument readings with data from the average table, she will need to check the baby’s real DB, BPR, and EG for compliance with the above figures. It must be taken into account that the baby will grow in leaps and bounds, so gynecologists study progress in growth.
The third and final check is carried out at 33 weeks, when the baby is already formed. The gynecologist checks his health and chooses the necessary tactics for childbirth. At this time, doctors are more interested in OH and coolant, the symmetry of the development of the upper and lower limbs, the expected weight of the child.
In some cases, fetometry can be performed at 32 weeks. If no pathology or abnormality is found, ultrasound is no longer performed.
The results obtained from these procedures help detect fetal developmental delays in the womb.
The child will have serious problems, if its indicators differ from the normative ones for up to 14 days.
Before this, gynecologists must assess the condition of the expectant mother, the correct functioning of the placental structures, and find out what condition the uterine fundus is in. Deviations from standards may occur due to infections, genetic abnormalities, the mother’s propensity for such bad habits as alcoholism and smoking, the presence of parents of a child genetic characteristics. In a fragile woman, the indicators of the unborn baby will be slightly less than the normative numbers, and in the child of a large, tall woman, these figures will be overestimated.
Only a specialist can identify abnormalities and delays in fetal growth. He will prescribe appropriate therapy for the pregnant woman and her unborn baby.
Fetal growth restriction is an intrauterine delay physical development fetus
Such babies are often called “low birth weight”. In 30% of cases they are born as a result premature birth(up to 37 weeks of gestation) and only in 5% of cases during full-term pregnancy (at 38-41 weeks).
There are two main forms of intrauterine growth retardation (IUGR for short): symmetrical and asymmetrical. How are they different from each other?
If the fetus has a deficiency of body weight, it lags behind in terms of growth length and head circumference. normal indicators for a given gestational age, then a symmetrical form of IUGR is diagnosed.
The asymmetric form of IUGR is observed in cases where the fetus, despite the lack of body weight, does not lag behind the normal indicators of height length and head circumference. The asymmetric form of IUGR is more common than the symmetric one.
There are also three degrees of severity of IUGR:
I degree - fetal delay by 2 weeks;
II degree - delay by 2-4 weeks;
III degree - delay in fetal development for more than 4 weeks.
What reasons can lead to the development of IUGR?
If we talk about symmetrical IUGR, then, as a rule, it arises due to chromosomal abnormalities fruit, genetic disorders metabolism, hypofunction thyroid gland and pituitary dwarfism. Also play an important role viral infections(rubella, herpes, toxoplasmosis, cytomegalovirus).
The asymmetric form of IUGR is caused by pathologies of the placenta in the third trimester of pregnancy, or more precisely, fetoplacental insufficiency (abbreviated as FPI). FPN is a pathology in which the placenta cannot fully supply the fetus nutrients, which circulate in the mother's blood. As a result, FPN can cause fetal hypoxia, that is, oxygen starvation.
FPN can occur due to: late gestosis, abnormal development of the umbilical cord, multiple pregnancy, placenta previa, placental vascular lesions.
Unfavorable factors can provoke IUGR of any form. external factors- reception medicines, exposure to ionizing radiation, smoking, alcohol and drug consumption. Also, the risk of developing IUGR increases with a history of abortion.
In many cases the real reason ZVRP cannot be established.
Symptoms of retarded fetal growth and development
Unfortunately, the symptoms of IUGR are quite erased. A pregnant woman is unlikely to be able to suspect such a diagnosis on her own. Only regular observation by an obstetrician-gynecologist throughout pregnancy helps to timely diagnose and treat IUGR.
It is widely believed that if a pregnant woman gains little weight during pregnancy, then most likely the fetus is small. This is partly true. However, this is not always true. Of course, if a woman limits her food intake to 1500 calories per day and is addicted to diets, this can lead to IUGR. But IUGR also occurs among pregnant women who, on the contrary, experience too much weight gain. That's why this sign not reliable.
With pronounced IUGR expectant mother Fetal movements that are more infrequent and sluggish than usual may alert you. This is a reason for emergency treatment to the gynecologist.
Examination for fetal growth restriction
When examining a pregnant woman with IUGR, a doctor may be alerted by the discrepancy between the height of the uterine fundus and the standards for a given period of pregnancy, that is, the size of the uterus will be slightly smaller than the normal size.
The most reliable method for diagnosing FGR is ultrasound examination fetus, during which the ultrasound specialist measures the fetal head circumference, abdominal circumference, hip circumference, and estimated fetal weight. In addition, with the help of ultrasound, you can determine how they function internal organs fetus
If IUGR is suspected, a Doppler study (a type of ultrasound) must be performed to assess blood flow in the vessels of the fetus and placenta.
An important research method is fetal cardiotocography (CTG), which also allows one to suspect IUGR. Using CTG, the baby's heartbeat is recorded. Normally, the fetal heart rate ranges from 120 to 160 beats per minute. If the fetus lacks oxygen, the heartbeat becomes faster or slower.
Regardless of the stage of pregnancy and the severity of the disease, IUGR must be treated in any case to maintain the vital functions of the fetus. In some cases, if there is a slight lag of the fetus from the norm (approximately 1-2 weeks according to ultrasound), then this should be considered as a variant of the norm or as a “tendency to FGR”. In this case, dynamic observation is carried out.
Treatment for growth retardation and intrauterine development
A large arsenal is used for the treatment of IUGR in obstetrics. medical supplies, which improve uteroplacental blood flow.
These include:
Tocolytic drugs that help relax the uterus: beta-agonists (Ginipral, Salbutamol), antispasmodics (Papaverine, No-shpa);
- infusion therapy with the prescription of glucose, blood substitute solutions to reduce blood viscosity;
- drugs to improve microcirculation and metabolism in tissues (Actovegin, Curantil);
- vitamin therapy (magne B6, vitamins C and E).
Drugs are prescribed for long period with careful CTG monitoring of the condition of the fetus.
The diet of a pregnant woman with IUGR should be balanced. Food should contain proteins, fats and carbohydrates. No need to “lean” on certain products. You can and should eat everything. You should especially not neglect meat and dairy products, since they contain greatest number proteins of animal origin, the need for which increases by 50% by the end of pregnancy.
However, we should not forget that the main goal of treatment for IUGR is not to “fatten” the child, but to provide him with normal height and development. Therefore, there is no need to overeat.
Pregnant women are recommended to take daily hiking on fresh air, emotional peace. It is traditionally believed that an afternoon nap (if desired, of course) has a beneficial effect on physical condition fetus and mother.
From non-drug methods IUGR treatment is used hyperbaric oxygen therapy(inhalation of air enriched with oxygen) and medical ozone.
The issue of delivery in the presence of IUGR is relevant. In each case, it must be decided individually, based on the condition of the fetus according to ultrasound and CTG, as well as the state of health of the mother. If there is no certainty that a weakened child will be able to be born independently, then preference is given caesarean section. In severe cases, surgery is performed as an emergency.
Complications of IUGR:
Intrauterine fetal death;
- hypoxia (oxygen starvation) of the fetus;
- abnormalities of fetal development.
Prevention of IUGR:
Healthy lifestyle, refusal bad habits before planned pregnancy;
- refusal of abortion;
- timely examination and treatment infectious diseases see a gynecologist before your planned pregnancy.
Consultation with an obstetrician-gynecologist on the topic of fetal growth restriction:
1. According to ultrasound, the placenta is too small, but the height, weight of the fetus and head circumference are normal. The doctor said that I have FPN. Is this true?
No. Such a diagnosis is not made based solely on the size of the placenta.
2. Is it possible to cure FGR if you eat a lot?
Unless IUGR is associated with chronic malnutrition. In other cases balanced diet should be in combination with the main treatment.
3. Does the weight of the fetus depend on the weight of the mother?
In part, the weight of the fetus depends on many factors, including the weight of the mother.
4. If parents short and weight, then the child should be small?
Most likely, and this is the norm. The diagnosis of IUGR is not made in such cases.
5. I was diagnosed with fetal hypotrophy by ultrasound. What does it mean?
Fetal hypotrophy and IUGR mean the same thing - a delay in fetal development.
6. Is it necessary to go to hospital if you have IUGR?
This should be decided by your obstetrician-gynecologist, based on ultrasound and CTG data over time. In case of stage I IUGR, if there are no signs of fetal hypoxia, there is no need for hospitalization. For grade II or III IUGR, hospitalization is required.
7. I am 35 weeks pregnant, but upon examination, the height of the uterine fundus corresponds to 32 weeks. What is this? ZVRP?
There may be slight errors when the doctor measures the height of the uterine fundus. If ultrasound and CTG reveal no abnormalities, then everything is in order.
8. At the last ultrasound I was told that the fetal abdominal circumference was 3 weeks behind the due date, but all other indicators were normal. Is this ZVRP? Need treatment?
Most likely this is individual feature fetus, if other parameters are within normal limits. If Doppler and CTG also do not reveal any deviations, then there is no IUGR and there is no need for treatment.
9. What is the “count to 10” test, which is recommended for IUGR?
The “count to 10” test is a test to evaluate fetal movements. It is recommended for all pregnant women from 28-30 weeks, and for IUGR it is especially relevant. A woman needs to count fetal movements every day between 9:00 am and 9:00 pm. Normally there should be 10 or more. If there are fewer of them, this indicates oxygen starvation baby.
10. According to ultrasound data, the child is 2 weeks behind in parameters. CTG and Doppler are normal. Do I need treatment?
A slight lag in fetal parameters by 1-2 weeks is possible and normal. You need to look at the dynamics.
Obstetrician-gynecologist, Ph.D. Christina Frambos.
