It is already visible? Ultrasonography in the first trimester of pregnancy
Supervision in a maternity welfare unit over the pregnant woman is carried out according to a certain scheme. What enters it and why all these numerous surveys, analyses and inspections are necessary?
the Ultrasound is used by
in obstetrics not so long ago - from the middle of 1960 - x years. And, despite it, today it is already impossible to imagine inspection of the pregnant woman without ultrasonography. During this time doctors saved up extensive practical experience in application of this method of research, were repeatedly improved OUSE - scanners, appeared three - and four-dimensional ultrasonography, and the most important, grew not one generation of healthy children.with
As the ultrasound works?
Ultrasound are called by the sound waves extending in space with high frequency (it is higher than 20 kHz). Sensors of BONDS - scanners are at the same time both a source and the receiver of ultrasonic waves. Ultrasonic wave, passing through various fabrics in an organism, changes the speed and it is reflected, all these changes are fixed and will be transformed to the image on the monitor of BONDS - the scanner. Now at inspection of pregnant women two types of sensors are used: transabdominal - THAT (by means of them research is conducted through a forward belly wall) and transvaginal - TV (research is conducted through a vagina). In the first trimester both types of sensors can be used, but more informatively transvaginal ultrasonography because TV - the sensor is brought closer to a uterus and has the big frequency of radiation of BONDS - waves that gives more accurate image on the monitor of BONDS - the scanner. From the second trimester generally transabdominal ultrasonography is used.by
of ultrasonography of pregnant women it is carried out three times - in 10 - 14 weeks, 20 - 24 and 30 - 34 weeks. If necessary the doctor the obstetrician - the gynecologist can appoint additional ultrasonography, and even not one.
Ultrasonic research of a fruit (ultrasonography, an ekhografiya) is the only rather informative and safe method of research allowing to estimate development of pregnancy from the very beginning of and before childbirth. The first visit to an office of ultrasonography is necessary to future mother already at the beginning of pregnancy.
For transabdominal ultrasonography - to fill a bladder. For this purpose it is necessary to drink about 300 - 500 ml of liquid without gas in 30 minutes prior to research. With itself on research it is necessary to take a pure diaper or a towel. During research special transparent gel without color and a smell is applied on a stomach and on the sensor. To transvaginal ultrasonography of special preparation it is not required. It is only necessary to empty a bladder before research. During research the special protective cover or a condom is put on the sensor and gel is applied.
Research lasts on average 10 - 30 minutes. After that the doctor fills in the special protocol in which in detail writes down all results of ultrasonography.by
In the first trimester of pregnancy of ultrasonography it is carried out on purpose:
- of establishment of localization (arrangement) of fetal egg (in a cavity of a uterus or out of it);
- of diagnostics one - or polycarpous pregnancy;
- of an assessment of the sizes and growth, structure of fetal egg and embryo;
- of an assessment of activity of an embryo or fruit;
- of research of a structure of an embryo or fruit;
- of research of ekstraembrionalny structures (zheltochny bag, horion, amnion);
- of diagnostics of complications of pregnancy (menacing or the begun abortion, etc.);
- of diagnosis of diseases and malformations of internal genitals (uterus myoma - a benign tumor of a uterus, cysts and tumors of ovaries, a two-horned uterus, an intrauterine partition, etc.) . > >
Establishment of uterine pregnancy
At early diagnostics of pregnancy fetal egg at ultrasonic research will be defined ul by li as roundish or oval education is dark - gray (almost black) color, located, as a rule, in the top half of a cavity of a uterus. At polycarpous pregnancy on the earliest terms it is possible to see separately located two and more fetal eggs. Diagnostics of uterine pregnancy at THAT is scanning is possible at the obstetric term of 5 - 6 weeks i.e. when the periods delay at a regular menstrual cycle makes 1 week and more. Average diameter of fetal egg in these terms is equal to about 5 - 7 mm. At transvaginal ultrasonography visualization of fetal egg in a uterus is possible slightly earlier - at a periods delay for 3 - 6 days that it corresponds to 4 - 5 weeks of pregnancy. At the same time the sizes of fetal egg make 2 - 4 mm. The embryo is defined from 5 weeks of pregnancy at TV - research and with 6 - at THAT in the form of linear education in a cavity of fetal egg of white color. In the same terms or a bit later it is possible to define warm reductions.It is normal of
in the presence of a regular menstrual cycle surely definition of existence of an embryo in fetal egg in 6 weeks of pregnancy at TV scanning. In this term it is not obligatory to do ultrasonography, but if to carry out it (at the request of the woman, at habitual not incubation of pregnancy), then in 6 weeks the embryo has to be defined. And if a cycle irregular, then term precisely it is impossible to determine by periods. Then term is determined by ultrasonography and if there is no embryo, looked repeatedly.to
At identification of any aberration recommends carrying out control ultrasonography in a week.
At localization of fetal egg out of a uterus cavity, i.e. at extra-uterine pregnancy, visualization of fetal egg is complicated and is not always possible. Reliable sign of extra-uterine pregnancy definition of heartbeat of an embryo out of a uterus cavity is considered.the Assessment of the sizes and growth of fetal egg and an embryo
For an assessment of the sizes and growth of fetal egg and an embryo / fruit are used by
such indicators as average internal diameter of fetal egg (SVD) and a tailbone - the parietal size of an embryo / fruit (KTR). by
For definition of SVD of fetal egg measure length, width and the pereena - back the sizes of fetal egg on an internal contour, then the received measurements are summarized, and the sum shares on 3. For each term of pregnancy in the first trimester the SVD sizes of fetal egg are determined. These data are entered in special tables and in the BONDS program - scanners that allows to determine by this indicator pregnancy term approximately. The average mistake in determination of term of pregnancy on SVD of fetal egg makes ± 6 days.
the First size which is measured at visualization of an embryo is a tailbone - the parietal size (KTR). In fact, it is embryo length from the head to a tailbone. It is necessary to pay attention that KTR of an embryo is less subject to individual fluctuations, than the average internal diameter of fetal egg therefore use of this size for determination of term of pregnancy yields more exact results. The mistake at the same time makes ± 3 days. Lack of the ekhografichesky image of an embryo at SVD of fetal egg more than 14 mm is a reliable sign of not developing pregnancy at which there is no embryo.the Assessment of activity of an embryo and a fruit
Activity of an embryo (fruit) in the first trimester is estimated by
on warm and physical activity. of
Is normal at transvaginal ultrasonography warm activity at an embryo is registered from 5 - 6 weeks of pregnancy. At the same time the correct rhythm of warm reductions is observed. The Heart Rate (HR) of an embryo at the uncomplicated course of pregnancy gradually increases from 110 - 130 beats per minute in 6 - 8 weeks up to 190 beats per minute in 9 - 10 weeks then decreases to 140 - 160 and remains at this level before childbirth. Size ChSS at an embryo in the first trimester is important for forecasting of a course of pregnancy. So, reduction of ChSS to 85 - 100 beats per minute and increase over 200 are adverse predictive signs and indicate high probability of interruption of pregnancy. Lack of visualization of warm reductions at embryo KTR more than 8 mm is a sign of not developing pregnancy. For final confirmation of not developing pregnancy carrying out control ultrasonography in a week following the results of which the final diagnosis is made is obligatory.Physical activity of an embryo is defined by
from 7 - 8 weeks of pregnancy. At the beginning it is weak, single, hardly distinguishable movements. Then - bendings and extensions of a trunk. After that, in process of growth and development of an embryo, there are movements of extremities. But it is necessary to pay attention that episodes of physical activity can be replaced by long intervals of rest therefore registration of warm reductions is more important criterion for evaluation of activity of an embryo.