Life beating. Control of heartbeat of a fruit of
Heartbeat of a fruit is the main indicator of viability of future child which reflects his state and changes at once as soon as there is any adverse situation. For this reason doctors control work of heart of the kid throughout all pregnancy and especially - at the time of delivery.
One of important indicators of normally developing pregnancy is heartbeat of a fruit. Throughout all pregnancy and especially at the time of delivery doctors carefully monitor reductions of heart of the child as the frequency and nature of heartbeat reflect its general state.
Development of heart - very difficult process. The heart rudiment at a fruit is put on 4 - y to week of pregnancy and represents a hollow tube. Approximately on 5 - y to week there are first pulsing reductions, and by 8 - 9 weeks heart becomes four-chamber (two auricles and two ventricles), i.e. as at the adult. Because the fruit does not breathe independently, and receives oxygen from mother, his heart has the features - existence of an oval window (an opening between the right and left auricles) and an arterial (botallov) channel (the vessel connecting an aorta and a pulmonary artery). It distinguishes fruit heart from the adult`s heart. These features of a structure of heart promote that oxygen comes to all bodies and systems of a fruit. After the child`s birth the oval window is closed and the arterial channel is fallen down.
For an assessment of warm activity of a fruit are used by ultrasonography (ultrasonic research), EhoKG (echocardiography). auskultation (listening) of a fruit, KTG (kardiotokografiya).heartbeat of a fruit can determine
of ultrasonography of heart of a fruit by
at the beginning of pregnancy by ultrasonic research (ultrasonography). Normal at transvaginal ultrasonography (the sensor is entered into a vagina) reductions of heart of an embryo are found in 5 - 6 weeks of pregnancy, and at transabdominal ultrasonography (the sensor settles down on a stomach) - in 6 - 7 weeks. In the first trimester of pregnancy (till 13 weeks) the heart rate (HR) of an embryo changes depending on pregnancy term. In 6 - 8 weeks of ChSS makes 110 - 130 beats per minute, in 9 - 10 weeks - 170 - 190 beats per minute, with 11 - y weeks of pregnancy and before childbirth - 140 - 160 beats per minute. Such changes of ChSS are connected with development and formation of function of vegetative nervous system (that part of nervous system which is responsible for work of internals of a fruit). Heart rate - an important indicator of viability of an embryo. So, adverse predictive signs are urezheny ChSS to 85 - 100 beats per minute and increase over 200 blows. In this case it is necessary to carry out the treatment directed to elimination of the reason of change of ChSS. Lack of warm reductions with a length of embryo over 8 mm is a sign of not developing pregnancy. For the purpose of confirmation of not developing pregnancy repeated ultrasonography in 5 - 7 days by results of which the final diagnosis is made is carried out. >
In the II-III trimesters of pregnancy when carrying out ultrasonography it are investigated by p a heart arrangement in a thorax (heart is located at the left and borrows about 1/3 thorax at cross scanning), heart rate (norm - 140 - 160 beats per minute), nature of reductions (rhythmical or spasmodic). ChSS on late terms depends on many factors (movements of a fruit, physical activity of mother, impact on mother of various factors: heat, cold, various diseases). At a lack of ChSS oxygen at first over 160 beats per minute (this state is called tachycardia) kompensatorno increase, and then, at deterioration in a condition of a fruit, there are lower than 120 beats per minute (bradycardia).by
For detection of malformations of heart investigates a so-called “four-chamber cut“. This such ultrasonic image of heart at which it is possible to see at the same time all four chambers of heart - two auricles and two ventricles. At usual ultrasonography of a four-chamber cut of heart it is possible to reveal about 75% of heart diseases. According to indications additional research - an echo - a fruit cardiography is conducted.
a fruit Echocardiography
the Echocardiography / EhoKG is a special ultrasonic research at which all attention is paid to heart. EKHOKG - a complex method at which besides two-dimensional (usual) ultrasonography other operating modes of BONDS - the scanner are used: M - the mode (one-dimensional ultrasonography, is used only for inspection warmly - vascular system) and Doppler`s regime (it is applied to research of a blood-groove in various departments of heart). This research allows to investigate a structure and function of heart and large vessels and is carried out only according to indications.
Indications for carrying out an echocardiography of a fruit are:
- the age of the pregnant woman is more senior than 38 years;
- about diabetes at the pregnant woman;
- the infectious diseases transferred to pregnancy time;
- the congenital heart diseases (CHD) at the pregnant woman;
- the birth before children with VPS;
- pre-natal growth inhibition of a fruit;
- identification of changes in heart at ultrasonography of a fruit (violation of a rhythm, increase in heart, etc.) ;
- detection of other congenital defects or genetic diseases which are often combined with heart diseases.
the Most optimum terms of carrying out EhoKG of a fruit are 18 - 28 weeks of pregnancy. In later terms visualization of heart is complicated as the amount of amniotic waters decreases and the fruit sizes increase.
by One more method of an assessment of heartbeat of a fruit is the auskultation (listening) of heart of a fruit. Auskultation of heartbeat of a fruit is the simplest method. Its performance requires only an obstetric stethoscope - a small tubule. The obstetric stethoscope differs from usual in a wide funnel which is put to a naked stomach of the pregnant woman, the obstetrician puts the ear to other end.by
For many years the stethoscope form practically did not change. The classical obstetric stethoscope is made of a tree, but also stethoscopes from plastic and aluminum meet now.
the Heartbeat of a fruit listened through a belly wall is one of the most important vital signs of a fruit as on its character it is possible to estimate a fruit condition.Warm tones of a fruit are listened by
approximately from the middle of pregnancy, i.e. with 20 - y weeks, and less often - with 18 - y weeks. In process of pregnancy progressing warm tones are listened more and more distinctly. The doctor the obstetrician - the gynecologist surely listens to fruit heart at each survey of the pregnant woman and at the time of delivery. Auskultation of warm tones of a fruit is carried out in position of the pregnant woman lying on a couch.At an auskultation of a stomach of the pregnant woman except heartbeat of a fruit other sounds are defined by
: intestinal noise (irregular gurgling and poured), reductions of an aorta and uterine vessels (the blowing noise coinciding with pulse of the woman). At an auskultation of heartbeat of a fruit the doctor the obstetrician - the gynecologist defines a point of the best listening of tones, ChSS, rhythm and nature of warm reductions. Warm tones of a fruit are listened in the form of rhythmical double blows with a frequency about 140 beats per minute, i.e. twice more often than at mother. The point in which warm tones are listened best of all depends on the provision of a fruit in a uterus cavity. At head prelying (when the child is located the head down) heartbeat is distinctly listened below a navel on the right or at the left, in dependence because in what party the fruit back is turned. At the cross provision of a fruit heartbeat is well listened at the level of a navel, on the right or at the left in dependence because into what party the child`s head is turned. And if the child is in pelvic situation, then his heart is better listened above a navel. At polycarpous pregnancy after 24 weeks heartbeat distinctly is defined in different departments of a uterus.
Listening to warm tones of a fruit, the obstetrician defines their rhythm: tones can be rhythmical, that is arise at regular intervals, and arrhythmic (spasmodic) - through unequal periods. Arrhythmic tones are characteristic of congenital heart diseases and a pre-natal hypoxia (oxygen insufficiency) of a fruit. Also aurally nature of tones is defined: distinguish clear and deaf tones of heart. Clear tones are heard accurately and are norm. Dullness of tones testifies to a pre-natal hypoxia.Heartbeat of a fruit can badly be listened by
in a case:
- of an arrangement of a placenta on a forward wall of a uterus;
- of abundance of water or lack of water;
- of excess thickness of a forward belly wall at obesity;
- of the increased physical activity of a fruit.
At the time of delivery (fights) the doctor - the obstetrician determines heartbeat of a fruit approximately each 15 - 20 minutes. At the same time the doctor estimates heartbeat of a fruit before fight to find out how the fruit reacts to it. During attempts the obstetrician listens to heartbeat after each attempt as he attempts is very responsible period for a fruit: during attempts muscles of a uterus, a belly wall and a pelvic bottom at mother are reduced that leads to compression of vessels of a uterus and reduction of intake of oxygen to a fruit.
C 32 - y weeks of pregnancy perhaps objective research of heartbeat of a fruit by means of a kardiotokografiya (KTG). Kardiotokografiya is a simultaneous registration of serdtsetsebiyeniye of a fruit and reductions of a uterus. Modern cardiomonitors are equipped also with the sensor allowing to write down physical activity of a fruit.warm tones of a fruit are listened by
in position of the pregnant woman on a back, on one side or sitting. Kardiotokografiya is carried out before childbirth and during them. The sensor is fixed on the pregnant woman`s stomach in the place of the best listening of warm tones of a fruit. Record is kept within 1 hour then the heart rate of a fruit and its change in response to fights and the movements of a fruit is estimated.
in a number of the female consultations equipped with the equipment for carrying out KTG, this research is conducted everything pregnant, but it is obligatory in the following cases.
- gestoz heavy degree - pregnancy complication at which arterial pressure increases there are hypostases, protein in urine as at this state blood circulation on small vessels of internals of mother is broken and, therefore, are broken plodovo - a placentary blood-groove and intake of oxygen to a fruit;
- existence of a hem on a uterus;
- fever at mother over 38 ° With;
- existence of chronic diseases (diabetes, arterial hypertension);
- induction (calling) of childbirth or a rodostimulyation at weakness of patrimonial activity;
- childbirth at perenoshenny or premature pregnancy.
from a fruit:
- abundance of water or lack of water;
- presenilation of a placenta;
- pre-natal arrest of development of a fruit;
- of violation of an arterial blood-groove, revealed by means of a dopplerometriya;
- change of character and heart rate at an auskultation.
After registration of KTG the main (average) frequency of heartbeat of a fruit (normal - 120 - 160 beats per minute), variability of a warm rhythm (normal ChSS can change on 5 - 25 beats per minute), change of ChSS in response to fight or the movement of a fruit, existence of uchashcheniye of a warm rhythm (so-called aktseleration) and urezheny (detseleration). Existence of increase of warm reductions in response to reduction of a uterus and the movement of a fruit is considered a good predictive sign. Urezheniye of ChSS can be a consequence plodovo - placentary insufficiency and a pre-natal hypoxia of a fruit, and also normal meets at pelvic prelying of a fruit. A bad predictive sign urezheny ChSS less than 70 beats per minute lasting more than 1 minute are considered.If necessary (at violation of a condition of a fruit) KTG is carried out by
repeatedly to pregnancy time.
Thus, research of heartbeat of a fruit by means of various methods is necessary throughout all pregnancy and at the time of delivery as allows to estimate a condition of a fruit and in due time to carry out necessary treatment and to resolve an issue of a method and terms of a rodorazresheniye.