ULTRASOUND STUDY Ultrasonography (ultrasound, scan) - the only highly informative, safe noninvasive method to conduct dynamic monitoring

of the fetus at the earliest stages of its development. RATIONALE The basis of ultrasound is the reverse piezoelectric effect. Ultrasonic waves, reflected differently from the organs and tissue structures, captured a receiver located inside the sensor, and converted into electrical impulses. These pulses are displayed on the screen is proportional to distance from the sensor to the corresponding structure. In obstetrics the most widely used two main methods: transabdominal and transvaginal scanning. When used transabdominal scanning sensors (linear, convex) with a frequency of 3.5 and 5.0 MHz, with transvaginal - sectoral sensors with a frequency of 6.5 MHz and above. Use transvaginal probe allows for earlier periods to establish the fact of pregnancy, with greater accuracy study the development of the ovum (embryo and extraembryonic structures), since I trimester diagnosis most of the gross malformations of the embryo / fetus. GOAL The main objectives of ultrasound in obstetrics: The establishment of pregnancy, watching over her; Determination of fetal eggs; Embriometriya and fetometriya; Diagnosis of fetal anomalies; Assessment of functional status of the fetus; Platsentografiya; Monitoring during invasive studies [chorionic villus sampling, amniocentesis, cordocentesis, fetal surgery (fetohirurgii)]. Tasks ultrasound in I trimester of pregnancy: The establishment of uterine pregnancy on the basis of visualization of fetal eggs in the uterus; Exclusion of ectopic pregnancy; Diagnosis of multiple pregnancy, type of placentation (bihorialnaya, MC); Assessment of the growth of the ovum (average internal diameter of the ovum, CTE of the embryo / fetus); Assessment of fetal life (heart activity, motor activity); Study the anatomy of the embryo / fetus, detection of chromosomal abnormalities ehomarkerov; Study of extraembryonic structures (yolk sac, amnion, chorion, umbilical cord); Diagnosis of pregnancy complications (threatened abortion, which began an abortion, complete abortion, hydatidiform mole); Diagnosis of genital pathology (uterine fibroids, uterine anomalies in the structure, intra-uterine pathology, entities ovaries). Tasks ultrasound in the II trimester of pregnancy: Assessment of fetal growth;

 Diagnosis of malformations; Investigation of markers of chromosomal abnormalities; Diagnosis of early forms of ZRP; Assessment of localization, the thickness and structure of the placenta; Identify the number of agents. Tasks ultrasound in the III trimester of pregnancy: Diagnosis of malformations with late manifestation; Identify ZRP; Assessment of functional status of the fetus (evaluation of motor and respiratory activity, Doppler blood flow in the "mother-placenta-fetus"). INDICATIONS Ultrasound screening of pregnant women in our country is carried out in terms of 10-14, 20-24 and 30-34 weeks. RESEARCH METHODS AND INTERPRETATION OF RESULTS Diagnosis of uterine pregnancy by ultrasound at the earliest possible time. On the third week of pregnancy in the cavity the uterus begins to render fertilized egg in the form of education ehonegativnogo round or ovoid shape diameter of 5-6 mm. In 4-5 weeks, can render the embryo - ehopozitivnoy strips 6-7 mm in size. Head embryo is identified with 8-9 weeks in a separate anatomical education round average diameter of 10-11 mm. The most accurate indicator of gestational age in the I trimester - CTE (Figure 11-1). In Table. 111 are shown gestational CTE standards for uncomplicated pregnancies. In Fig. 11-1. The crown-rump length embryo. The average error in determining gestational age in the measurement of gestational sac is 5 days, CTE - 2 days. Rated life of the embryo in early pregnancy is based on the registration of his heart activity and motor activity. If you register the ultrasound fetal heart activity can be 4 5 weeks. Heart rate gradually increased with the 150-160 ppm in 5-6 weeks to 175-185 ppm in 78 weeks, followed by reduced to 150-160 per minute to 12 weeks. Locomotor activity assessed from 7-8 weeks. Table 11-1. The crown-rump length of the embryo / fetus in the I trimester of pregnancy Gestational age, weeks The value of CTE, mm 5 3 6 6 7 10 8 16 9

23 10 31 11 41 12 53 13 66 From 4-5 weeks of gestation the yolk sac is defined, the value of which varies from 6 to 8 mm. By 12 weeks is a physiological reduction of the yolk sac. The absence of yolk sac and its premature reduction - a poor prognostic sign. With the help of transvaginal sonography in the I trimester of pregnancy is diagnosed gross birth defects - anencephaly, herniated spinal cord, skeletal abnormalities, and others megatsistis 11-14 weeks, it is essential to identify ehomarkerov chromosomal abnormalities - edema collar, hypoplasia / absence of nasal bone, nonimmune fetal hydrops, CTE mismatch fetal gestational age. In the study of fetal growth and development in the II and III trimester of pregnancy is carried out fetometriyu (measuring the size of fetus). The required amount of fetometrii includes measurement of the size and biparietal head circumference, diameter or circumference of the abdomen, and femur length (the length of the bones was measured from both sides) (Figure 11-2). Normative gestational parameters are given in Table fetometrii. 11-2. Based on these possible to determine the parameters estimated fetal weight when carrying out echography in II and III trimester of investigating the structure of the brain, skeleton, skull face, fetal organs: heart, lungs, liver, stomach, intestines, kidneys, and adrenal glands, urinary bladder. Through ultrasound can diagnose the majority of fetal anomalies. For a detailed assessment of the anatomy additionally use a three-dimensional fetal ultrasound, which allows to obtain three-dimensional image study structures. The spectrum of fetal chromosomal abnormalities ehomarkerov, detected in the II trimester of pregnancy, involves changes in the various organs and systems: ventriculomegaly, choroid plexus cysts side ventricles, abnormal shape of the skull and the cerebellum ("strawberry", "lemon", "banana"), hyperechoic bowel, pyeloectasia, the only umbilical artery, symmetrical shape of ZRP. With the help of ultrasound can examine in detail the placenta and get the necessary information about its location, thickness, the structure. Localization of the placenta in various stages of pregnancy varies because of "migration" from

the lower segment to the bottom the uterus. Upon detection of placenta previa before 20 weeks of pregnancy ultrasound should be repeated every 4 weeks. The final conclusion about the location of the placenta should be done at the end of pregnancy. An important indicator of the placenta - its thickness. For the thickness of the placenta is characterized by a typical growth curve for As the pregnancy. By 36-37 weeks the placenta stops growing. Later in physiological pregnancy, its thickness decreases, or remains at the same level, accounting for 3,3-3,6 cm Ultrasonic signs of change in the placenta at different stages of pregnancy to determine the degree of maturity of P. Grannum (Table 11-3). Table 11-3. Ultrasonic signs of maturity of the placenta Degree maturity placenta Chorionic membrane Parenchyma The basal layer 0 Straight, smooth Homogeneous Not identified I Slightly wavy Little echogenic areas Not identified II From the recesses Linear echogenic Seal The linear arrangement of small echogenic areas (basal dotted line) III From the recesses, reaching the basal layer Round Seal with depression in the center of Large and partly fused echogenic zone, giving an acoustic shadow Changes in the structure of the placenta can be in the form of cysts, which are visualized as ehonegativnye Education different shapes and sizes. Ultrasound diagnosis is based on identifying PONRP ehonegativnogo space between the wall of the uterus and

placenta. Ultrasound is also used for the diagnosis of postoperative viability of the uterine scar. On the consistency of scar tissue showed a homogeneous structure and smooth contours of the lower uterine segment thickness was not less than 3-4 mm. The failure of the uterine scar is diagnosed based on detection of a defect in the form of a deep niches, thinning of the alleged scar, the presence of a large number of hyperechoic inclusions (Connective tissue). With the help of ultrasound receive valuable information about the state of the cervix during pregnancy and the risk of preterm birth. With transvaginal ultrasound, which has significant advantages over digital examination of cervical and transabdominal sonography may determine the length of the cervix uterus throughout, state of the internal os, the cervical canal