Ultrasonography during pregnancy of
Every year only in one Russia (who is not “world champion“ in birth rate at all) about one million pregnant women in the appointed days come to female consultations and, having waited for the turn (in this plan our medicine for the present changed a little since “the developed socialism“), is quiet or with some nervousness keep within on the couches close to the intricate design from light plastic encouragingly winking future mother all the light-emitting diodes and the cursor on the accurate monitor. On stomachs to women doctors apply a thin film of transparent gel, establish something, bearing a faint resemblance to the microphone, - and the action widely known as “obstetric ultrasonic research“ begins. Or, in other words, - ultrasonography.
Looking at the fancy scatterings dancing on all width of the monitor it is gray - black grains and is red - blue rings, not one and even not hundred future mothers for certain reflected - and whether this next invasion scientifically - technical progress in secret of pre-natal life so is necessary? For many thousands of years the mystery of the life arising in a maternal womb was the most strict taboo for public eyes - and it did not prevent to be born safely to hundreds of generations of our ancestors. So can, it would be worth keeping this taboo and from now on? What will lose mankind with ultrasonography cancellation, except an opportunity more or less precisely to define a fruit sex during pregnancy? Let`s try to understand together.
Get acquainted: Ultrasonography
As says the popular medical encyclopedia, ultrasonic research represents no other than “the method of research of internals and fabrics based on the analysis of distinctions of reflection of ultrasonic fluctuations from structures of different density“. In general, shortly and clear... that who has the diploma about the successful termination of the higher education institution training to some knowledge from the field of great science - physics. And it is not especially clear to most of potential mothers, in due time avoided these higher education institutions. To such mothers, probably, it makes sense to talk about ultrasonography slightly in more detail.
the Device similar to the microphone, - what is established during ultrasonography on a stomach of the pregnant woman - is called a transdyuser, or, in other words, the sensor.
the Sensor really makes fluctuations. And with so big frequency that though these fluctuations also represent sound waves, it is impossible to hear them. Therefore they also received the name “ultrasonic“ (i.e. supersonic). Getting deep into bodies of future mother, the ultrasound proceeding from a transdyuser faces her internals, and also a body and internals of the kid who accommodated in a female uterus. Also it is reflected from them with a different speed - because all of them have different density. The tennis ball which is approximately also started up by blow of a racket with a different speed jumps aside from dense soil and softer grass covering. Mothers reflected from internals and a fruit ultrasonic waves come back on a transdyuser who catches them and sends to the analyzing part of the device. This most analyzing part (as a part of which, of course, there is quite powerful computer), very quickly transforms a difference to speeds of reflection of ultrasound in the video image. It is that, actually, and the doctor who is carrying out ultrasonography studies on the monitor - and future mother sees (if the doctor turns the monitor to her, certainly).All this
is not followed pain how many - nibud significant discomfort for the pregnant woman and for the doctor. And practically does not involve negative consequences for health of yet not been born child. But provides the mass of information - sometimes vital for future mother and her kid. For this reason ultrasonography gained such wide circulation in modern scientific obstetrics.history has some
. It is not enough
of ultrasonography - rather young kind of medical visualization: the first conscious interest in ultrasound as to means of diagnostics arose in a scientific world about sixty years ago. The first experience of practical application of ultrasonography in obstetrics was gained still later - in 1958 the British doctor D. Donald for the first time in the world carried out measurement of the sizes of a head of the fruit which is in a uterus by means of ultrasound.60 - x years of the 20th century the method of ultrasonic scanning began with
large-scale victorious procession along hospitals and policlinics of the developed countries With the middle. On the one hand, it was promoted by technical improvements of the diagnostic ultrasonic equipment - now with its help it was possible to make out not only contours of a head of a fruit, but also more fine details of its anatomy. On the other hand, advance of ultrasonography was helped by the results of numerous researches testifying to almost full safety of this method of visualization for mother and a fruit. At least, during experiments it became clear that those doses and intensity of ultrasonic radiation which take place at standard obstetric ultrasonography were not reflected in embryos of laboratory animals and chromosomes of living cells in any way.
80 - e and 90 - e years of the last century were marked by the most real technical and methodological revolution of ultrasonography - to replace former, having very modest diagnostic potential, to devices more and more powerful and difficult arranged ultrasonic scanners allowing to observe a fruit in a womb practically in real time and even capable to generate the three-dimensional image came. Resolution of modern ultrasonic cars gives to the expert the chance to see not only the movements of fingers of hands of the kid, but even a blinking its century - and only it was only possible to dream of it thirty years ago! Whether, as they say, still will be...
What ultrasonography can?Obstetric ultrasonic scanning helps to find
the answer to a set of the questions very important for the family expecting the birth of the kid. You judge:
In the first trimester pregnancies of ultrasonography is the most sensitive tool for identification of such problems as extra-uterine pregnancy, threat of an abortion or so-called “puzyrny drift“ (a rough deviation in development of fetal egg, fraught terrible for health and the woman`s life complications). The executed at the first suspicion on this pathology, ultrasonic scanning gives to the woman and doctors a necessary reserve of time for adequate treatment. And it is already a lot of.
Besides, the ultrasonic research conducted at the end of the first trimester of pregnancy allows to diagnose for a germ a number of rough uglinesses - incompatible with life or guaranteeing a heavy invalidization of the child after the birth. As well as to suspect a number of hereditary diseases - such as a Down syndrome, for example. Confirmation or exception of this diagnosis is carried out by means of invasive prenatal diagnostics (a biopsy of a horion the) of 1 which is carried out again - by means of ultrasonography. Early detection of serious illnesses at an embryo and a fruit gives to parents the chance to resolve a difficult issue of destiny of pregnancy. According to passionless statistics, interruption of such pregnancies in the first trimester gives the smaller number of complications in comparison with interruption on later terms and puts much a smaller psychological trauma to parents - in comparison with that that happens when the problem is found after the birth of the kid.
At last, ultrasonography in the first trimester can already please parents with news about mass replenishment of family, that is establish the fact of polycarpous pregnancy. And happy future father of twins or triplets will receive a necessary reserve of time for creation appropriate to such number of kids financially - technical, speaking to officialese, bases.
In the second trimester pregnancies of ultrasonography it is irreplaceable for an assessment of development of a fruit - ultrasonic scanning allows to define compliance of the kid to term of pregnancy, to study a condition of a placenta (its sizes, in particular). It is very important information because serious aberrations can demand the emergency medical intervention at this time.
In cases when laboratory inspection of future mother reveals at it certain deviations (changes of a koagulogramma, for example), before doctors sharply the question of development of late toxicosis of pregnancy - a gestoz rises. Ultrasonic research of a blood-groove in placenta vessels (a so-called dopplerometriya) helps to answer this question. And, respectively, allows to appoint competent treatment in time.
ultrasonography on this piece of pregnancy and for diagnostics of a so-called anti-phospholipidic syndrome - quite common cause of not incubation of pregnancy and premature birth is Useful.
At last, the ultrasonography executed in the second trimester quite can accurately specify to future parents what toys and what kidswear can be got in shops already now - a small hockey stick with small baseball caps or nice dolls and elegant hats. However, if the family wishes to leave a fruit floor in secret till the moment of the birth, it is necessary to warn the doctor only in advance - and he will delicately keep silent even if he will see strong indications of a sex of the kid.
But the main objective of ultrasonography in the second trimester, perhaps, is prenatal diagnostics of congenital uglinesses at a fruit. Its sizes and extent of development of bodies allow the skilled expert to examine attentively a lot of things - beginning from fingers on hands and legs and finishing with details of a structure of vertebras. By means of the ultrasonic scanner of high resolution on these terms of pregnancy it is possible to find tens of kinds of congenital malformations of a fruit. And it allows doctors and future parents to develop rational tactics of further conducting pregnancy.the main mission of ultrasonography can consider by
In the third trimester an assessment of a fetoplatsentarny complex. This term difficult to pronounce is understood as a working condition of a placenta and indicators of development of a fruit - its sizes, degree of a maturity of bodies and systems. At an essential deviation of these indicators from norm it is possible to suspect so-called fetoplatsentarny insufficiency and a syndrome of a delay of pre-natal development. These states often demand competent medical intervention - otherwise very probably the birth of the malovesny, unripe and weakened kid.
also the problem of prenatal diagnosis of congenital malformations of a fruit assigned to ultrasonography does not lose the relevance. On this piece of pregnancy the so-called late revealed uglinesses - those which are not always visualized at ultrasonography on earlier terms are diagnosed. Such, for example, as gidronefroz and megaureter (expansion of a kidney lokhanka and increase in a mochetochnik, respectively). Sometimes ultrasonography not only helps to find congenital defects in a fruit, but also allows to carry out their treatment directly in a uterus cavity. For example, at the difficulty of an otkhozhdeniye of urine caused by an urethra malformation in a fruit, the puncture of a bladder of the kid which is carried out under ultrasonography control helps to prevent destruction of his kidneys. It gives real hope for successful surgical treatment after the birth.can answer
In the third trimester of ultrasonography also a set of other questions - what prelying of a fruit, for example. In other words, how exactly the kid intends to leave patrimonial ways - forward a head or buttocks. Or what arrangement of a placenta in relation to a uterine pharynx... However it in most cases has rather small value, by the time of childbirth can still change.
of ultrasonography: to whom, where, when and how many?
Ultrasonic research becomes practically to all pregnant women, and repeatedly. Usually ultrasonography is carried out in a maternity welfare unit where future mother is observed, is a so-called first level of ultrasonic obstetric screening (“siftings“, in Russian speaking). In cases when ultrasonography of the first level found certain problems, more detailed and qualified ultrasonic scanning - research of the second level obstetric OUSE - screening can be necessary. That usually becomes in the interregional medikogenetichesky consultations, the centers of prenatal diagnostics and other establishments equipped with scanners of high resolution and completed with personnel of expert qualification.
As for pregnancy terms on which it is necessary to pass ultrasonography, should recognize: they can strongly vary depending on features of a course of concrete pregnancy. If it is about “problem“ pregnancy, then the number of ultrasonic researches can easily exceed ten. However at any pregnancy the number passed by the woman of ultrasonography has to be not less than three. And terms for these researches are recorded in normative documents of the Russian Ministry of Health - it is useful for any future mother to know it, at least to estimate professional qualification and conscientiousness of the doctor observing her.the First ultrasonography is usually carried out by
in an interval between 10 and 14 weeks of pregnancy, the second - between the 20 and 24, third - between 32 and 34 weeks. The tasks assigned to these three standard researches were in details considered above so to repeat there is no sense. But for certain it makes sense to discuss other very important problem: whetherultrasonography absolutely safely for a fruit Is valid
It is known that absolutely safe in the world is present nothing. This common truth fully belongs also to ultrasonography. The ultrasound, unfortunately, is not absolutely harmless factor of external environment - at high intensity and high total doses of radiation ultrasonic waves are capable to damage the genetic device of living cells and even physically to destroy them. In relation to a germ it is fraught with emergence of rough uglinesses and even death - as was repeatedly proved in experiments on embryos of animals still in 70 - e years of last century. Certainly, such doses and intensity were never used in the course of standard ultrasonic scanning of a human fruit. Epidemiologists, “the incidences having the finger on the pulse“ within decades, demonstrate that usual ultrasonic scanning how many - nibud has no the significant damaging effect concerning a human germ and a fruit. For this reason the special-purpose committee of experts of World Health Organization officially approves quadruple ultrasonography during pregnancy. Stipulating at the same time that before the 10th week of pregnancy this research, whenever possible, should not be conducted.
of the Smoke without fire, as they say, does not happen, and in medical literature the next unpleasant news concerning ultrasonography is not present and will fly. For example, in June, 1999 the group of researchers from Dublin published the results of research forcing to doubt in perfect security even the ultrasonography that parameters which is rutinno used in obstetrics. In particular, this research found the increased percent of precancer mutations in embryos of the laboratory mice who were exposed to not intensive influence of ultrasound - just to it what is at usual ultrasonography in a maternity welfare unit. It means that the probability of development of cancer in the mice who vnutriutrobno were affected by ultrasound is slightly higher in comparison with animals, ultrasonography in a maternal uterus not “passing“. And though researchers are far from doing how many - nibud categorical conclusions from the work, “written by a feather“ it is impossible to ignore at all desire.
generally, without symbolical “scales“, usual for any medical technology, to the family planning to get posterity, not to manage also in a case with obstetric ultrasonography. However think: on one bowl of these scales is quite notable (2 - 4 - percentage) risk of the birth of the child with invalidiziruyushchy uglinessm, and on another... preliminary results of the only research conducted on laboratory mice. Millions of children for last decades underwent pre-natal influence of ultrasound, at the same time any epidemiological researches as it was already told, did not find the disturbing changes in a condition of children`s health connected with this influence.
Yes, ultrasound - rather serious physical phenomenon, would also be unreasonable to concern to him simply and serenly: 8 - 10 times to try “to make out“ a floor of a fruit or repeatedly and without special need to specify its prelying and nature of warm activity. But two-stage obstetric OUSE - screening remains completely justified now, that work of scientists from Dublin gave to world medicine a reason for the most serious reflections.