In the center of Immunology and Reproductions has been successfully working successfully Program of prenatal screening . Our specialists are invited to lecture on specialized conferences, in other clinics. Our laboratory receives consistently good assessments in the quality control system. Specially trained specialists are calculated by risks.
What is prenatal diagnostics?
The word "prenatal" means "prenatal". Therefore, the term "prenatal diagnosis" means any studies to clarify the state of the intrauterine fetus. Since the human life begins from the moment of conception, various health problems can be not only after birth, but also before birth. Problems can be different:
- Pretty harmless, with which the fruit can cope with himself,
- more serious when timely medical care will retain the health and life of the intrauterine patient,
- Fully enough with which modern medicine can not cope.
To find out the health status of the intrauterine fetus, the methods of prenatal diagnosis are used, which include ultrasound examination, cardiotocography, various biochemical studies, etc. All these methods have different capabilities and limitations. Some methods are quite safe, such as an ultrasound study. Some are associated with a certain risk for intrauterine fetus, for example, amniocentesis (sample of arrogant water) or biopsy of chorion villion.
It is clear that the methods of prenatal diagnostics associated with the risk of pregnancy complications should be applied only when there are good testimony to use them. In order to maximize the circle of patients in need of invasive (i.e., associated with interference in the body) methods of prenatal diagnostics, the selection is used Risk groups Development of certain problems at the intrauterine fetus.
What is risk groups?
Risk groups are such groups of patients, among which the likelihood of detecting one or another pregnancy pathology is higher than in the entire population (among all women of this region). There are risk groups for the development of pregnancy, pregnancy, gestosis (late toxicosis), various complications in childbirth, etc. If a woman as a result of the examination turns out to be in a risk group for one or another pathology, this does not mean that this pathology will definitely develop. This means only the fact that this patient has one or another type of pathology may arise more likely than the rest of the women. Thus, the risk group is not identical to the diagnosis. A woman can be in the risk group, but no problems during pregnancy may not be. And the odd, the woman may not be in the risk group, but it may arise. The diagnosis means that this patient has already discovered this or that pathological state.
Why do we need risk groups?
Knowing that the patient is included in a particular risk group, helps a doctor to properly plan the tactics of pregnancy and childbirth. The allocation of risk groups allows you to protect patients who are not included in risk groups, from unnecessary medical interventions, and vice versa, allows us to substantiate the appointment of certain procedures or research by patients in risk groups.
What is screening?
The word screening means "sieving". In medicine under screening, they understand the implementation of simple and secure research to large groups of the population in order to allocate groups of risk of developing one or another pathology. Prenatal screening is called studies conducted by pregnant women in order to identify risk groups of pregnancy complications. A special occasion of prenatal screening is screening to identify risk risk groups of congenital defects in the fetus. Screening does not allow to identify all women who may have a one or another problem, but makes it possible to allocate a relatively small group of patients, inside which most of those with this type of pathology will be focused.
Why do you need screening malformations of the fetus?
Some types of congenital defects in the fetus are quite common, for example, Down syndrome (trisomy on the 21st pair of chromosomes or trisomy 21) - in one case by 600 - 800 newborns. This disease, as well as some other congenital diseases, occurs at the moment of conception or in the earliest stages of the development of the embryo and with the help of invasive methods of prenatal diagnostics (biopsy of chorion and amniocense biopsy) can be diagnosed on fairly early pregnancy. However, such methods are associated with a risk of a number of complications of pregnancy: the miscarriage, the development of the conflict on the Rh Factor and the Blood Group, the fetal infection, the development of hearing loss in the child, etc. In particular, the risk of miscarriage after such studies is 1: 200. Therefore, these studies should be prescribed only to women of high risk groups. Risk groups include women older than 35 and especially over 40 years old, as well as patients with the birth of children with defects in the past. However, children with Down syndrome can be born in very young women. Screening methods are completely safe studies conducted within a certain period of pregnancy, it allows a very large degree of probability to identify groups of women with the risk of Down syndrome, which can be shown to conduct a biopsy of the chorion or amniocente biopsy. Women who do not fall into groups of risk do not need additional invasive research. Detection of increased risk of developing fetal developmental defects using screening methods is not a diagnosis. The diagnosis can be delivered or rejected using additional tests.
What types of congenital defects are screened?
Currently, screening is recommended for the following types of congenital defects in the fetus:
- Down syndrome (trisomy on twenty-first pair chromosomes)
- Edwards Syndrome (trisomy in the eighteenth pair)
- Defects of the nervous tube (Spina Bifida and Anedsephalia)
- Tricomy risk of 13 chromosome (Pataau syndrome)
- Triploidy of maternal origin
- Sherosezhevsky-Turner without water
- Syndrome Smith Lemlit
- Cornel de Lange syndrome
What types of research are held within the framework of screening of the risk of malformations from the fetus?
By Research types Allocate:
- Biochemical Screening : Blood test for various indicators
- Ultrasonic Screening : Detection of signs of development anomalies using ultrasound.
- Combined Screening : The combination of biochemical and ultrasound screenings.
A common trend in the development of prenatal screening is the desire to obtain reliable information about the risk of development of certain violations on as early as possible pregnancy. It turned out that the combined screening at the end of the first trimester of pregnancy (timing of 10-13 weeks) makes it possible to get closer to the effectiveness of the classic biochemical screening of the second trimester of pregnancy.
Ultrasonic screening used for mathematical risk treatment of the fetal anomalies is carried out only 1 time: at the end of the first trimester of pregnancy.
Concerning biochemical screening The set of indicators will be different in different times of pregnancy. In terms of pregnancy 10-13 weeks The following indicators are checked:
- Free β-subunit of human chorionic hormone (sv. β-hgch)
- PAPP-A (Pregnancy Associated Plasma Protein A), associated with pregnancy Plasma protein A
Calculation of the risk of measuring the fruit anomalies carried out on the basis of measuring these indicators is called Dual biochemical test of the first trimester of pregnancy .
Using the dual test in the first trimester, the risk of detecting from the fetus Down syndrome (T21) и Edwards Syndrome (T18) , Trisomy on 13 chromosome (Pataau syndrome), triploydia of maternal origin, Sherezhevsky-Turner syndrome without water. The risk of nervous tube defects with a double test cannot be considered because the key indicator for determining this risk is α-fetoprotein, which is started to determine only from the second trimester of pregnancy.
Special computer programs allow you to calculate the combined risk of fetal development anomalies, taking into account the biochemical indicators defined in the dual test of the first trimester and the results of the ultrasound made in the deadlines of 10-13 weeks of pregnancy. Such a test is called Combined with twey dual test of the first trimester of pregnancy or Triple test of the first trimester of pregnancy . The results of the risk calculation obtained using a combined double test is much more accurate than risk calculations only on the basis of biochemical indicators or only on the basis of ultrasound.
If the test results in the first trimester indicate a group of risk of chromosomal fetal anomalies, to exclude the diagnosis of chromosomal anomalies to the patient can be carried out. Biopsy Vorsin Chorione .
In terms of pregnancy 14 - 20 weeks According to the last menstruation ( Recommended deadlines: 16-18 weeks ) The following biochemical indicators are determined:
- General hCG or free β-subunit hCG
- α-fetoprotein (AFP)
- Free (unconjugated) estrilla
- Inhibin A.
For these indicators, the following risks are calculated:
- Down syndrome (trisomy 21)
- Edwards Syndrome (Trisomy 18)
- Defects of the nervous tube (the absence of the spina bifida) and Anediephalia).
- Tricomy risk of 13 chromosome (Pataau syndrome)
- Triploidy of maternal origin
- Sherosezhevsky-Turner without water
- Syndrome Smith Lemlit
- Cornel de Lange syndrome
Such a test is called Four Test of the Second Trimeter of Pregnancy or Four biochemical screening in the second trimester of pregnancy . The truncated version of the test is the so-called triple or dual test of the second trimester, including 2 or indicator: HCG or free β-subunit HCG, AFP, free estriol. It is clear that the accuracy of the dual or double trimester tests II is lower than the accuracy of the four trimester test II.
Another variant of the biochemical prenatal screening is Biochemical screering risk of only nervous tube defects in the second trimester of pregnancy . At the same time, only one biochemical marker is determined: α-fetoprotein
What time of pregnancy is the screening of the second trimester?
At 14 - 20 weeks of pregnancy. The optimal period is 16 - 18 weeks of pregnancy.
What is a fourth test of the second trimester of pregnancy?
The main variant of the biochemical screening of the second trimester in the CIR is the so-called quadrup or quadrup test, when the definition of the three indicators is added Definition of Inhibin A.
Ultrasonic screening in the first trimester of pregnancy.
In the first trimester of pregnancy, the main size used in the calculation of risks is the width of the neck transparency (English "Nuchal Translude" (NT) ", Franz." Clarté Nuchale "). In Russian medical use, this term is often translated as "collar space" (TVP) or "cervical fold". The cervicacy, collar space and cervical fold - complete synonyms that can be found in different medical texts and denoting the same thing.
Cervicacy - definition
- The neck transparency is how the cluster of subcutaneous fluid on the rear surface of the fetal neck in the first trimension of pregnancy looks like in an ultrasound study.
- The term "neck transparency" is used regardless of whether it has partitions or whether it is limited to the cervical area or surrounds the fetus
- The frequency of chromosomal and other anomalies is primarily associated with the width of transparency, and not with how it looks in general
- During the second trimester, transparency is usually absorbed, but in some cases it can turn into either cervical edema or in cystic hygromas in combination or without a combination with generalized edema.
Measuring cervical transparency
Dates of pregnancy and kerchiko-parmer
The optimal period of pregnancy for measuring the SP is the term of 11 weeks to 13 weeks 6 days. The minimum size of the CTR is 45 mm, the maximum is 84 mm.
There are two reasons for the selection of the term of 11 weeks as the earliest period for measuring SPP:
- Screening requires the ability to perform a biopsy of the chorion violence before the time when this study may complicate the clipping of the fetus limbs.
- On the other hand, many rough fetal defects can only be detected after 11 weeks of pregnancy.
- The diagnosis of the ommophalcela is possible only after 12 weeks.
- The diagnosis of Ancentsephaly is possible only after 11 weeks of pregnancy, since only from this period the ultrasound signs of the fetus skull ossification appear.
- Evaluation of the four-chamber heart and large vessels is possible only after 10 weeks of pregnancy.
- The bladder is visualized in 50% of healthy fruits in 10 weeks, in 80% - at 11 weeks and in all fruits - in 12 weeks.
Image and measurement
To measure the SP, the ultrasonic apparatus must have a high resolution with the function of the video loop and calibrators that can measure the size with an accuracy of the tenths of the millimeter. The SP can be measured using an abdominal sensor in 95% of cases, in cases where it is impossible to perform, a vaginal sensor should be used.
When measuring the SPP, only the head and the upper part of the fruit of the fetus should fall into the picture. The increase should be maximum, so that a small displacement of the markers gives a change in the dimension of no more than 0.1 mm. With an increase in the picture, before or after fixing the image, it is important to reduce the hein. This avoids the measurement error when the marker falls into the blurred area and thus the size of the SP will be underestimated.
A good sanggital section should be obtained, the same quality as when measuring the CTR. The measurement should be carried out in the neutral position of the fetus head: the extension of the head can increase the value of the TWP by 0.6 mm, the bending of the head is to reduce the indicator by 0.4 mm.
It is important not to confuse the skin of the fetus and amnion, because during these periods of pregnancy both education look like thin membranes. If doubt, it is necessary to wait for the moment when the fruit will make movement and depart from Amnion. An alternative way is to ask for a pregnant poking or lightly knock on the abdominal wall of pregnant.
The greatest perpendicular distance between the internal contours of the neck transparency is measured (see figure below). Measurements are carried out three times, the greatest size value is used to calculate. In 5-10% of cases, a campus of umbilical cords around the cervix, which can significantly make it difficult to measure. In such cases, 2 measurements are used: higher and below the place of cordial cord, to calculate risks, use the average value of these two dimensions.
Ultrasound scanning standards at the end of the first trimester of pregnancy are developed by the Fetal Medicine Foundation (FMF) based in England. The Uzi CIR group includes the FMF protocol.
Additional ultrasound signs of the risk of Down syndrome
Recently, in addition to measuring the SP for the diagnosis of Down syndrome at the end of the first trimester of pregnancy, the following ultrasound features will be used:
- Definition of the nasal bone . At the end of the first trimester, the nasal bone Not determined With the help of ultrasound in 60-70% of fruit with Down syndrome and only 2% of healthy fruits.
- Evaluation of blood flow in arancium (venous) duct . Violations of the blood flow waveform in the arancium duct are found in 80% of fruits with Down syndrome and only 5% chromosomally normal fruits
- Reducing the size of the maxillary bone
- Increase the size of the bladder ("Megationist")
- Moderate tachycardia in the fetus
Form of blood flow in the Arancium duct with dopplerometry. At the top: norm; Below: with trisomy 21.
Not only Down syndrome!
During the ultrasound, at the end of the first trimester, the assessment of the fetal contour supplies to identify the following fetal anomalies:
- Exnezafalia - Anedsephalia
- Cystic hygroma (swelling at the level of the neck and back of the fetus), more than half of the cases due to chromosomal anomalies
- Ommopalcela and Gastroshizis. The diagnosis of ommopalcela can only be delivered after 12 weeks of pregnancy, since the physiological umbilical hernia is pretty often detected, has no clinical value.
- The only umbilical artery (in a large percentage of cases is combined with chromosomal anomalies in the fetus)
How are risks calculated?
Special software is used to calculate risks. A simple determination of the level of indicators in the blood is not enough to decide, increased the risk of development anomalies, or not. Software must be certified for use in order to prenatal screening. At the first stage of the computer account, the figures obtained in the laboratory diagnostics are translated into the so-called MOM (Multiple of Median, multiple medians), characterizing the degree of deviation of a particular indicator from the median. At the next stage of the calculation, MOM is amended for various factors (the mass of the body of a woman, the racial affiliation, the presence of some diseases, smoking, multiple pregnancy, etc.). As a result, the so-called corrected MOM are obtained. At the third stage of the calculation, the adjusted MOM is used to calculate risks. Software is specially adjusted to the methods of determining indicators and reagents used in the laboratory. It is unacceptable to calculate risks using tests made in another laboratory. The most accurate calculation of the risks of the fetal anomalies occurs when using a ultrasound data, made in 10-13 weeks of pregnancy.
What is MOM?
MOM is the English abbreviation of the term "Multiple of Median", which means "multiple median". This is a coefficient showing the degree of deviation of the value of one or another indicator of prenatal screening from the average value for the period of pregnancy (medians). MOM is calculated by the following formula:
Mom = [Value for the test of the patient's serum] / [Value of median indicator for the term of pregnancy]
Since the value of the indicator and the median have the same measurement units, the MOM value does not have units of measurement. If the MOM value in the patient is close to one, then the value of the indicator is close to the average in the population, if the unit is above the average in the population, if the unit is below the average in the population. With congenital fetal vices, there may be statistically significant deviations of MOM markers. However, the MOM is almost never used in the calculation of the risks of the fetal anomalies. The fact is that with a number of factors, the MOM values are deviated from the average in the population. Such factors include the patient's body, smoking, racial affiliation, the occurrence of pregnancy as a result of Eco and others. Therefore, after receiving the MOM values, the risk calculation program makes amendment to all these factors, resulting in the so-called "proterrigated MOM value", which and Used in risk calculation formulas. Therefore, in the conclusion form, according to the results of the analysis, the proorplified MOM values are specified next to the absolute values of the indicators for each indicator.
Typical MOM profiles in pregnancy pathology
With different fetal anomalies, MOM values are combined with normal. Such combinations of MOM deviations are called MOM profiles with one or another pathology. The tables below are the typical MOM profiles at different times of pregnancy.
|TP.21 (Down syndrome)||0.41||1,98|
|TP.18 (Edwards Syndrome)||0.16.||0.34.|
|I / II triploidide||0.75 / 0.06.|
Typical MOM profiles - first trimester
|Anomaly||Afp||Society. Hgch.||St. Estor.||Inhibibin A.|
|TP.21 (Down syndrome)||0.75||2,32.||0.82.||1,79.|
|TP.18 (Edwards Syndrome)||0.65||0.36.||0.43||0.88.|
|I / II triploidide||6,97||thirteen||0.69|
Typical MOM profiles - second trimester
Indications for prenatal screening I and II trimester on the risk of fetal anomalies
Currently, prenatal screening is recommended to carry out all pregnant women. The order of the Ministry of Health of the Russian Federation of 2000 obliges women's advice to conduct a biochemical prenatal screening to all pregnant patients in the second trimester of pregnancy in two indicators (AFP and HCG).
Order No. 457 of 28.12.2000 "On the improvement of prenatal diagnosis in the prevention of hereditary and congenital diseases in children":
The importance of monitoring congenital diseases on a permanent basis in Moscow is also considered in the decision of the Government of Moscow on the establishment of the city program "Health of Children" for 2003-2005.
Resolution of the Government of Moscow dated July 23, 2002 No. 572-PP
On the other hand, prenatal screening should be purely voluntary affairs. In most Western countries, the duty of the doctor is to inform the patient about the possibility of conducting such research and the objectives, opportunities and limitations of prenatal screening. The patient itself decides, to make it tests, or not. The same point of view also adheres to the CIR Group. The main problem is that there is no treatment of discovered anomalies. In case of confirmation of the presence of anomalies, the married couple becomes before choosing: interrupt pregnancy or save it. This is a difficult choice.
What is Edwards Syndrome?
This condition due to the presence in the karyotype of the extra 18th chromosome (trisomy 18). The syndrome is characterized by rude physical anomalies and mental retardation. This is a fatal condition: 50% of sick children die in the first 2 months of life, 95% - during the first year of life. Girls are amazed 3-4 times more often than boys. The frequency in the population ranges from 1 case by 6000 genera to 1 case per 10,000 genera (approximately 10 times less than Down syndrome).
What is a free β-subunit hCG?
Molecules of a series of pituitary hormones and placenta (thyrotropic hormone (TG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and human chorionic hormone (HCG)) have a similar structure and consist of α and β-subunits. Alpha subunits of these hormones are very similar and the main differences between hormones consist in the structure of β-subunits. LG and HCG are very similar not only on the structure of α-subunits, but also in the structure of β-subunits. That is why they are hormones with the same action. During pregnancy, the production of LH, the pituitary gland drops almost to zero, and the concentration of hCG is very high. The placenta produces very large amounts of hCG, and although it is mainly this hormone enters the blood in the assembled form (a dimeric molecule consisting of both subunits), in a small amount in the blood, the free (not associated with the α-subunit) of the β-subunit of HCG is also coming into the blood. Its concentration in the blood is many times less than the concentration of common hCG, but this indicator may significantly indicate the risk of problems at the intrauterine fetus in the early pregnancy. The definition of a free β-subunit HCG in the blood is also important for the diagnosis of trophoblastic disease (bubbling and chorionepitheliomes), some egg tumors in men, monitoring the success of extracorporeal fertilization procedures.
What is the indicator: General hgch or free β-subunit hCG - preferably used in the triple test of the second trimester?
The use of the definition of a free β-subunit of the HCG compared with the definition of the total hCG gives a more accurate calculation of the risk of Down syndrome, however, in classical statistical calculations of the risk of EDVARDS syndrome in the population, the level of general hCG in the blood of the mother was used. For the β-subunit of HGG such calculations was not carried out. Therefore, it is necessary to make a choice between a more accurate calculation of the risk of Down syndrome (in the case of a β-subunit) and the ability to calculate the risk of Edwards syndrome (in the case of a common hCG). Recall that in the first trimester to calculate the risk of EDVARDS syndrome, it is used intently free β-subunit HCG, but not a common hCG. Edwards syndrome is characterized by low numbers of all 3 trigger test indicators, so in such cases both variants of the triple test can be made (with a common hCG and with a free β-subunit).
What is PAPP-A?
Associated with pregnancy Plasma protein A (PregnanCy-Associated Plasma Protein-A, Papp-A) was first described in 1974 in the form of a high molecular weight protein fraction in the serum of women in late pregnancy. It turned out that this is a large zinc-containing metalcoprotein with a molecular weight of about 800 kDa. During pregnancy, PAPP-A is generated by a syncytotrophoblast (tissue that is the outer layer of placenta) and an extragraxin cytotrofublast (islands of fetal cells in the thickness of the uterus mucous membrane) and enters the blood flow of the mother
The biological significance of this protein is not fully studied. It was shown that he binds heparin and is an inhibitor of granulocyte elastase (enzyme induced during inflammation), therefore it is assumed that PAPP-A modulates the immune response of the parent organism and is one of the factors that ensures the development and survival of the placenta. In addition, it was found that it is a protease, splitting protein 4, binding an insulin-like growth factor. There are serious reason to believe that PAPP-A is one of the factors of Paraconne Regulation not only in the placenta, but also in some other tissues, in particular in atherosclerotic plaques. It is proposed to use this marker as one of the risk factors of ischemic heart disease.
The concentrations of PAPP-A in the blood of the mother are constantly increasing with an increase in the period of pregnancy. The greatest growth of this indicator is noted at the end of pregnancy.
During the last 15 years, PAPP-A was studied as one of the three risk markers of trisomy 21 (Down syndrome) (together with a free β-subunit of hCG and the thickness of the collar space). It turned out that the level of this marker at the end of the first trimester of pregnancy (8-14 weeks) is significantly reduced in the presence of trisomy 21 or trisomy 18 (Edwards syndrome). The uniqueness of this indicator is that its significance as a dowon syndrome marker disappears after 14 weeks of pregnancy. In the second trimester, it levels in maternal blood in the presence of trisomy 21 do not differ from those in pregnant women with a healthy fruit. If you consider PAPP-A as an isolated Daun syndrome risk marker in the first trimester of pregnancy, it would be the most significant of its definition on the timing of 8-9 weeks. However, the free β-subunit of the hCG is a stable risk marker of Down syndrome in the deadlines of 10-18 weeks, that is, later PAPP-a. Therefore, the optimal amount of blood delivery for the dual test of the first trimester of pregnancy is 10-12 weeks.
The PAPP-A Measurement Combination with the definition of the concentration of the free β-subunit HCG in the blood and the definition of a TVP with the help of an ultrasound at the end of the first trimester of pregnancy allows you to identify up to 90% of women with the risk of developing Down syndrome in the older age group (after 35 years). The probability of false positive results is about 5%.
In addition to the prenatal screening of the risk of Down syndrome and Edwards Syndrome, in obstetrics, the definition of PAPP-a is also used in the following types of pathology:
- Threat of miscarriage and stopping the development of pregnancy at small times
- Cornelia de Lange syndrome.
Risk diagnostics Stop development of fruit At small pregnancy rates, he was historically the first clinical application for the definition of PAPP-A in the blood serum proposed in the early 1980s. It was shown that women with low PAPP-A levels in early pregnancy fall into the risk group of the subsequent stop of the development of pregnancy and severe forms of late toxicosis . Therefore, it is recommended to define this indicator in terms of 7-8 weeks to women with severe pregnancy complications in history.
Cornelia de Lange syndrome - This is a rare form of congenital malformations of the fetus, detected in 1 case by 40,000 genera. The syndrome is characterized by the lag of mental and physical development, heart and limb defects and characteristic features of the person. It was shown that with this state, PAPP-A levels in the blood in the period of 20-35 weeks are significantly lower than the norm. The study of the Eitken Group in 1999 showed that this marker can be used for screening on Cornelia de Lange syndrome and in the second trimester of pregnancy, since the levels of the indicator in such pregnant women were on average 5 times lower than the norm.
The reagents used to determine the PAPP-A and the free β-subunit HCG are an order of magnitude more expensive than the reagents used for most hormonal indicators, which makes this test more expensive study compared with the definition of most hormones of the reproductive system.
What is α-fetoprotein?
This is the glycoprotein of the fetus produced first in the yolk bag, and then in the liver and the gastrointestinal tract of the fetus. This is a transport protein in the blood of a fetus, connecting a number of different factors (bilirubin, fatty acids, steroid hormones). This is a double height regulator of the intrauterine fetus. In an adult, no known Functions of AFP does not perform, although it may increase in blood for diseases of the liver (cirrhosis, hepatitis) and at some tumors (hepatocolet carcinoma and germinative carcinoma). In the blood of the mother, the level of AFP gradually increases with an increase in the period of pregnancy and reaches a maximum of 30 weeks. The level of AFP in the blood of the mother rises during the defects of the nervous tube in the fetus and with multiple pregnancy, it decreases - with Down syndrome and when Edwards syndrome.
What is free estriol?
Estor is synthesized in a placenta from 16α-hydroxy-dehydroepintroscheon-sulfate coming from the fetus. The main source of estriol predecessors is the adrenal glands of the fetus. Estor is the main estrogenic hormone of pregnancy and provides the growth of the uterus and the preparation of the mammary glands to lactation.
90% of the estriot after 20 weeks of pregnancy are formed from the DEA-from the fetus. A large yield of the DEA-C from the adrenal gland of the fetus is associated with the low activity of 3β-hydroxycenoid dehydrogenase in the fetus. Protective mechanism protecting the fetus from excess androgenic activity is the rapid conjugation of steroids with sulfate. For a day, the fruit produces more than 200 mg of Dae-C per day, 10 times more mother. In the liver of the mother, the estriol is rapidly conjugated with acids, mainly with hyaluronic acid, and is thus inactivated. The most accurate method for determining the activity of the fetal adrenal glands is to determine the level of free (non-conjugated) estriol.
The level of free estriol gradually rises as pregnancy develops and in the third trimester of pregnancy can be used to diagnose the well-being of the fetus. With the deterioration of the state of the fetus in the third trimester of pregnancy, a sharp drop in the level of free estriol may be observed. The free estriol level is often reduced in Down syndrome and with Edwards syndrome. The reception of dexamethasone, prednisolone or methipred during pregnancy, suppresses the function of the fetus adrenal glands, therefore the level of free estriol in such patients is often reduced (reducing the flow of estron from the fetus). When taking antibiotics, the rate of estriol conjugation in the liver and the inverse absorption of conjugates from the intestines is reduced, so the level of estriol is also reduced, but already due to the acceleration of its inactivation in the body of the mother. To accurate interpretation of the triple test data, it is very important that the patient indicates a complete list of drugs that have been accepted or taken during pregnancy with doses and deadlines.
Algorithm for prenatal screening I and II trimester of pregnancy.
1. Calculate the term of pregnancy, better after consulting a doctor or with the help of a consultant.
Screening I trimester has its own characteristics. It is held on time 10 - 13 weeks of pregnancy and is quite rigidly limited in terms. If you pass the blood too early or too late, if you make mistakes in the calculation of the time of pregnancy at the time of blood delivery, the accuracy of the calculation will decrease sharply. The deadlines for pregnancy in obstetrics are usually calculated on the first day of the last menstruation, although conception occurs on the day of ovulation, i.e., at a 28-day cycle - 2 weeks after the first day of menstruation. Therefore, dates 10 - 13 weeks for the day of menstruation correspond to 8 to 11 weeks on conception.
To calculate the term of pregnancy, we recommend using an obstetric calendar posted on our website. Difficulties in the calculation of pregnancy time can be with an irregular menstrual cycle, during pregnancy, coming soon after delivery, with a cycle, more than a week deviating from 28 days. Therefore, it is best to trust professionals, and to calculate the deadlines of pregnancy, the ultrasound and blood delivery to consult a doctor.
2. Make Uzi.
The next stage should be an ultrasound 10 - 13 weeks of pregnancy. The data of this study will be used by the risk calculation program both in the first and in the second trimester. It is necessary to start a survey with an ultrasound, since problems with the development of pregnancy can be found in the process of study (for example, a stop or development in development), a multiple pregnancy, the timing of conception will be quite accurately calculated. The doctor who conducts an ultrasound will help the patient to calculate the delivery time for biochemical screening. If ultrasound is done too early by pregnancy, then, perhaps, the doctor recommends repeating the study after a while.
To calculate the risks, the following data from the conclusion of ultrasound will be used: Date Ultrasound, Copchiko-Dark Size (CTR) and the thickness of the collar space (TVP) (English reductions, respectively, CRL and NT), as well as visualization of nasal bones.
3. Rent blood.
Having ultrasound results and knowing the accurate period of pregnancy can come for blood. Blood taking to analyze the prenatal screening in the CIR Group of Companies is held daily, including weekends. On weekdays, blood takes from 7:45 to 21:00, on weekends and holidays: from 8:45 to 17:00. Blood takes 3-4 hours after the last meal.
In terms of pregnancy 14-20 weeks for the last menstruation (recommended time: 16-18 weeks), the following biochemical indicators are determined:
- General hCG or free β-subunit hCG
- α-fetoprotein (AFP)
- Free (unconjugated) estrilla
- Inhibin A.
4. We get the result.
Now you need to get the results of the analysis. The readiness time of the results of the analysis of prenatal screening in the CIR Group of Companies is one working day (except for a quadru-test). This means that the analyzes donated from Monday to Friday will be ready on the same day, and those withdrawn from Saturday on Sunday - on Monday.
Conclusions according to the results of the study are issued to the patient in Russian.
Tibil. Explanations of terms and abbreviations
|Report date||Computer processing date|
|Gestational age||Weeks + days|
|Date ultrasound||Date of ultrasound. It usually does not coincide with the date of delivery of blood.|
|Fruit||The number of fruits. 1 - single-lodge pregnancy; 2 - twins; 3 - Trino|
|ECO||Pregnancy occurred as a result of eco|
|Ktr||Copchiko-parmer size defined during ultrasound|
|MOM.||Multiple medians (Multiple of Median), degree of deviation of the result from average for a given period of pregnancy|
|Sorrow MOM.||Argued MOM. MOM value after correction by weight of the body, age, race, the amount of fruits, the presence of diabetes, smoking, the treatment of infertility by the ECO method.|
|Nt.||The thickness of the collar space (Nuchal Translude). Synonym: cervical fold. In various options, reports can be given or absolute values in mm, or the degree of deviation from median (MOM)|
|Age risk||The average risk for this age group. No factors are not taken into account except age.|
|Tr. 21.||Trisomy 21, Down syndrome|
|Tr. eighteen||Trisomy 18, Edwards Syndrome|
|Biochemical risk||The risk of fetal anomalies after computer processing of blood analysis data excluding ultrasound data|
|Combined risk||The risk of fruit anomalies after computer processing of blood analysis data taking into account the ultrasound data. The most accurate rate of risk.|
|FB-HCG.||Free β-subunit hgch|
|DPM.||Date of last menstruation|
|HCG.||General HCG (Human Chorionic Gonadotropin)|
|UE3.||Free Estriol (Unconjugated Estriol)|
|+ NT.||The calculation was carried out taking into account the data of the ultrasound|
|MIU / ML.||MME / ml|
|NG / ML||ng / ml|
|IU / ML.||Me / ml|
Patient Information: Please note that if you plan to undergo a prenatal screening in the CIR group of companies, then the ultrasound data made in other institutions will be taken into account only if there is a special agreement of the CIR Group of Companies with these institutions.
Information for doctors
Dear colleagues! In accordance with the order of the Ministry of Health No. 457 and the Resolution of the Government of Moscow No. 572, the CIR Group of Companies provides services to other medical institutions to conduct prenatal screening on the risk of chromosomal anomalies. You can invite our employees to come to you with a lecture on this program. To send a patient to screening, the attending physician must fill in a special direction. The patient can come to handle blood independently, but it is possible to take blood in other institutions with subsequent delivery to our laboratory, including our courier. If you want to get the results of double, triple and quadrup tests of the first and second trimesters of pregnancy, combined with ultrasound data, the patient must come to us for an ultrasound, or we must sign a special agreement with your institution and include in the program of your Ultrasound Specialists, but only after Check out our expert on functional diagnostics to your institution and familiarization with the quality of equipment and the qualifications of specialists.
Screening ultrasound is very important during pregnancy. With this method, doctors receive information on how the fruit is developing in the maternal womb. This article will help future mothers to figure out why this study is being conducted.
What it is?
Currently, it is impossible to imagine the diagnosis of various pathologies of pregnancy without ultrasound surveys. Essence of the method - The principle of penetration and reflection of ultrasound waves from the inner media of the body. With the help of the ultrasound of a small pelvis, you can identify various deviations of the course of pregnancy in a variety of intrauterine fetal development periods.
The first trimester is a very important period when the embryo forms all the main internal organs. Timely diagnosis in this period allows you to identify development anomalies and emerging anatomical defects.
It should be noted that the abuse of the ultrasound in the first weeks of pregnancy is not worth it.
The essence of ultrasonic prenatal screening, which is carried out in 2 trimester, is already Determination of hazardous genetic and chromosomal pathologies. Also at this time, it is possible to estimate the functioning of all vital fetal organism systems. In this period, the development of the future child can determine the work of the heart and heartbeat. Uzi also allows you to establish various orthopedic disorders.
Dates of carrying
In each period of pregnancy, 1 screening is carried out. In this case, ultrasound examination cannot be considered harmful. More frequent Uzi can lead to the fact that after birth, a child will have various neurological or mental disorders.
1 trimester - a mandatory period for performing ultrasound screening. Doctors prescribe such a diagnostic course for the 10-14 week of pregnancy. The 2nd screening is carried out already in the next trimester of pregnancy. In this case, the diagnostic complex is held on 16-20 weeks.
Screening 3 trimester is carried out by women with various violations or anomalies for the development of the fetus. If the first ultrasound screening tests have not shown any violations, then in this case the third screening may not be required. The need to carry out a complex of research in this period of pregnancy determines the observing pregnant woman an obstetrician gynecologist.
Screening 3 trimester usually on 30-34 weeks. The term of it can be shifted to 7-10 days for medical reasons. In the third period, the identified indicators are necessary for doctors to select the optimal boring tactics.
A ultrasound study on this period of pregnancy establishes the prevention of the fetus, as well as the presence or absence of signs of placental insufficiency.
The third screening allows the doctors to finally deal with whether the cesarean cross section should be carried out.
What is done?
Doctors recommend to take the screening to all pregnant women. It is especially important to make such research to those women in which the course of pregnancy flows with various violations. It is also better not to avoid passing ultrasound research by future mommies who conceived a child after 35 years. Availability in close relatives or parents of a pregnant woman of various genetic diseases - an important reason for the ultrasound.
Ultrasound examination, conducted on 11-12 weeks, allows you to identify a rather dangerous clinical condition - anencephalius. It is characterized by a complete or partial absence of a brain in the fetus. The presence of this feature is an indication for the interruption of pregnancy. This pathology is revealed, as a rule, by the end of 1 trimester.
Hydrocephalus - Another severe clinical condition of the fetus. In this case, an ultrasound specialist discovers a large amount of spinal fluid in a kid. Quite often, this feature is combined with other developmental anomalies. Progression of this state can also be a significant indication for interrupting pregnancy.
Encephalomeningocele - pathological condition, perfectly detected during screening. This is usually transient pathology. In order to evaluate and monitor the course of this state, the doctors are prescribed several re-ultrasound studies. The diagnosis is completely removed if there are no such violations during the next screening.
It is important to note that the conclusion of the ultrasound is not a diagnosis. To establish an accurate pathology requires a mandatory re-consultation of the obstetrician-gynecologist, who observes a pregnant woman.
During pregnancy, several screenings are held. They allow you to track the dynamics of growth and development of the fetus.
Vices of the heart - Very important pathology that can be easily installed with ultrasound. To assess the level of blood flow in this case, doppler mapping is used. With the help of such a test, pathological blood flows (regurgitation) can be determined due to the existing violations in the operation of heart valves. The identification of this pathology is a very important conclusion that necessarily requires further recheccakes.
Accumulation in the abdomen of the fruit of pathological fluid (ascites) - An unfavorable sign. The appearance of this symptom requires the obligatory diagnosis of diseases of the internal organs in the baby developing in the maternal womb. In some cases, abnormalities for the development of the cardiovascular system can also lead to the development of this state. The rhesus conflict also contributes to the accumulation of pathological fluid in the abdominal cavity of the fetus.
If the baby has identified any genetic or chromosomal pathologies, then in this case, consultation of genetics is required. To clarify the diagnosis, the doctor may appoint an additional range of blood tests.
To obtain reliable results it is very important to properly prepare for the study. Doctors pay quite great importance.
- On the eve of ultrasound screening, a pregnant woman must observe a hypolypidemic diet. Dinner before the study should be as easy as possible. All fat and fried products are completely excluded. A week before the study it is better to eat the most easy, but calorie food. Pregnant woman should not limit the protein. However, you should choose the easiest types of protein food. Such products include chicken, turkey, white fish and lean beef.
- 2-3 days before ultrasonic screening of the future mommy follows the maximum limit the use of any vegetables and fruits. They contain quite a lot of coarse fiber, which contributes to gas formation. Spanging the intestines from gases will not give opportunities to a specialist ultrasound to fully conduct a study. In this case, the doctor will give conclusion about strong echonegativity.
- To obtain reliable results is very important restrict intense physical exertion . This should be done in both the first and second screen. Visits to yoga for pregnant women can lead to the fact that the results of the ultrasound will be unreliable.
- Pregnant women It is impossible nervous . Long or protracted psycho-emotional stress has a negative effect on the royal and placental blood flow. If the future mommy is constantly nervous and worries, then ultimately it contributes to the formation of placental insufficiency.
Research can be carried out in several ways - transabdominal and transvaginal. In the early periods of pregnancy, doctors prefer to prescribe ultrasound transvaginal. Such a study is carried out only if there is no contraindication to its conduct on the future motley.
The study is usually carried out on a special couch. Future mommy is lying on his back. At later pregnancy, more thorough view is required. To this end, an ultrasound specialist can ask the future mammy to roll over to the left side.
The study conducted with a bladder filled with a bladder is also Helps to get more reliable results. If such a filling is required, then the future mommy is necessarily warned in the women's clinic in advance. The transabdominal method is usually performed on the background of a complete bladder. Transvaginal ultrasound should be better done after its emptying.
After the ultrasound study, it is necessary to decipher the results. Makes this watching pregnant woman obstetrician gynecologist. Doctors ultrasound diagnosis do not put diagnoses. In some cases, additional biochemical blood tests are required to eliminate pathology.
For better visualization, a specialist handles the belly of a pregnant special gel. This transparent substance is applied to the front abdominal wall, and after the study is completely removed. It should be noted that the application of this fund is not able to cause any allergic manifestations.
In the first trimester, a number of clinical indicators are determined:
- One of them is Cocchiko-parmer (CRT). It also requires the estimated weight of the fetus. With this indicator you can install the estimated period of pregnancy. CRT is rated in millimeters.
- Length of nasal bone - Another clinical figure used to estimate the initial period of intrauterine development of the embryo. The absence of this element in the future kid is an unfavorable symptom. If the nasal bone is absent from the fetus by the 14th week of its development, then in 75% cases this indicates the presence of serious anomalies.
- Biparic fetal size (BPD) Allows you to estimate a very important indicator - the development of the fetal brain. Also, this clinical sign can be an indirect manifestation of neurological violations that are emerging in a child. This indicator is also defined in mm. At the 10th week of pregnancy, the values of this criterion are 14 mm.
- Thickness of collar space - This is an important clinical sign that allows you to identify Down Syndrome in the earliest stages of its formation. At the 11th week of pregnancy, this indicator is 0.8-2.4 mm. It is very important to carry out the dynamics of changes in this ultrasound criterion for several weeks. This will make it possible to indirectly confirm or eliminate Down syndrome at the kid.
- For Cardiovascular System Estimates The heartbeat is necessarily calculated. At the 11th week of pregnancy, this indicator is 153-177 shots per minute. A strong decline in this criterion is an unfavorable symptom that requires compulsory additional diagnostics.
Ultrasonic screening is necessary to establish coarse pathologies of intrauterine development. This research complex is not carried out only at the request of the future mother, and must be carried out in strictly regulated for this time.
About why do ultrasound screering during pregnancy, you can learn from the following video.
Many women are afraid and worried about the results of this test, thinking that he will definitely say, whether everything is in order with the child or not. I will help you understand complex numbers and signs.
Why do I need the first screening
First of all, screening is not just an ultrasound or blood delivery, this is a comprehensive study of the condition of the body.
The first screening is carried out on a period of 11-13 weeks to identify the likelihood of the birth of a child with chromosomal pathologies, which are often incompatible with life and may be indications in the interruption of pregnancy. Therefore, it is important to identify as early as possible.
It is important to understand that a shrinking survey does not give 100% guarantees of the absence of pathologies in the fetus, but shows only their probability.
For example, screening has shown that relative to your risks are low, but are not excluded. Or, on the contrary, the risks are high, but everything is in order with the child. Unfortunately, this also happens, since the results can be false positive.
What studies will need to go
Let's focus in detail on all indicators and possible procedures for detecting chromosomal pathologies.
Perinatal screening is carried out to identify the likelihood of a child's birth with such pathologies as, Down syndrome (extra chromosome in 21 pairs), Edwards syndrome (extra chromosome in 18 pairs) and Pataau syndrome (extra chromosome in 13 pairs).
As I said, it is held on a period of 11-13 weeks and consists of 2 stages: ultrasound and blood tests on B-hCG and PAPP-A.
During the ultrasound, the thickness of the folding space of the fetus, the presence and size of the nasal bone is carried out.
Blood from Vienna
B-hCG and the PAPP-A Plasma-A - Papp-A (Pregnancy-Associated Plasma Protein-a) is estimated in the blood.
By values of B-HCG, one can judge the course of pregnancy and the appearance of deviations. The maximum concentration of the hormone is celebrated on July 10-11, then it gradually decreases and remains constant until the end of pregnancy.
Rarr-A is responsible for the formation and growth of the placenta. Its concentration increases during pregnancy and depends on the mass of the fetus and its gender. The presence of chromosomal pathology in the future child is manifested by a decrease in its concentration. After 14 weeks, the study is not informative, since its concentration may remain normal even with severe chromosomal pathology.
Important additional factors
It is important to note that it is necessarily taken into account
- ✓ Age of pregnant
- ✓ Weight
- ✓ Smoking
- ✓ Pregnancy term
- ✓ Number of fruits
- ✓ Romatic affiliation
- ✓ Whether eco was held and if so, then the transfer date
- ✓ Related diseases
- ✓ Pregnancy features (threat of interrupt, for example)
- ✓ Reception of drugs
- ✓ Women had children with chromosomal pathologies and the presence of such relatives
From the accuracy of the data provided by you will depend on the test result.
The following data is entered into a special program. In Russia there are 2: PRISCA (Prenatal Risk Calculatio) and Astraia.
Screening results in PrisCA program are represented as graphics and numbers. Astraia is different from PRISCA the opportunity not only to receive data on the likelihood of the birth of a child with pathology, but also to calculate the risk of preeclampsia, a serious complication of pregnancy. This program was developed by the Fetal Medicine Foundation (Fetal Medicine Foundation, FMF). The doctor should have an appropriate certificate and license to carry out this kind of screenings.
Summing up on screening I trimester I want to say that if you have an age of 35+, eco, concomitant pathology and let you smoke, then we naturally expect high risks for the birth of a child with pathology. It is like a probability of falling in winter when it is slippery, higher than the likelihood of falling in the summer. But the same, does not mean that you will definitely fall in winter. This is exactly what screensing.
Uzi - Screening
Pregnancy is at the same time joyful, and an exciting period in the life of a woman. Currently, in obstetrics, great importance is paid to ultrasound screening during certain time of pregnancy. But how important is it? Why exactly during these terms? All this will be discussed in this article.
What is the usual ultrasound study differs from screening?
It is important to know that screening is carried out by absolutely all pregnant women on the same deadlines. The purpose of this study is to identify serious anomalies for the development of the fetus. In other words, the diagnosis is carried out on the best apparatus and the most qualified specialists, because they are of great responsibility - to identify certain violations in development during intrauterine development.
What time of pregnancy should UZ-screening should be carried out?
According to the order of the Ministry of Health (No. 572 N of 01.11.2012) in this issue there are strictly defined deadlines, to deviate from which it follows only in extreme situations. The first screening is carried out from 11 to 14 week of pregnancy, the second - from 18 to 21 week of pregnancy, and the third - on the period of 30-34 weeks of pregnancy.
First Uz-Screening: What are the indicators normally?
On the period of 11-14 weeks, all pregnant women must pass one of the most important studies - an ultrasound diagnosis of the expert class. The doctor defines such indicators as:
- The heartbeat of the embryo (on screening time it is important to determine not just the presence or absence of heartbeat, but also the heart rate. So for example, the palbit of 140-160 beats per minute). Signs of bradycardia (when CSS 100 shots per minute and less) and severe tachycardia (heart rate above 160) are an unfavorable sign.
- Measurement of Copchiko-Dread Size (abbreviated - CTR).
- Measurement of the thickness of the collar space (abbreviated - TVP)
- The length of the nasal bone (the lower limit of the norm is 2 mm).
- The location of Chorione, the place of the future placenta. Normally, the chorion is located on any wall of the uterus, but the situation in which the chorion is located in the field of the inner sewage, or extremely close to it is considered. This embodiment of the attachment of chorion can cause the placenta or low placenta.
- The presence or absence of a chorion detachment. Chorion is essentially a place from which it is formed later than the placenta. It is for this reason that it is important to determine if there are no sites that peelled from the wall of the uterus.
- Compliance with the size of the embryo term of pregnancy. When carrying out an ultrasound, the doctor always asks the woman the first day of the last menstruation. And this question is asked not for idle curiosity. Thanks to this information, it is possible to understand whether the size of the embryo corresponds to the term of pregnancy. That's why a woman is very important to know this information and tell her doctor.
What are the normal values of the thickness of the collar space (TVP)?
|Lower border of norm||Upper limit||Mean|
What does the increase in TVP?
An increase in the thickness of the collar space is one of the signs of chromosomal anomalies, most often this marker is characteristic of Down syndrome, due to the accumulation of fluid in this area. However, it should be aware that the measurement of the TVP should be carried out at a certain position of the embryo (it should not be excessively bending or blending the head).
What can indicate a reduction in the length of the nasal bone?
Reducing the length of the nasal bone can be a marker of chromosomal anomalies. However, the diagnosis cannot be delivered in an ally one sign. In the event of identifying certain deviations on the results of the ultrasound, the extended examination is carried out.
What anomalies of development can be revealed during the first Uz-screening?
On the first screening, you can usually identify the most severe defects of development. These include both serious chromosomal anomalies, certain genetic diseases, severe malformations.
- Down syndrome
- Syndrome Pataau.
- Anediephalia (no brain)
- Hydrocephalus (excess accumulation of spinal fluid in the brain, expansion of likvarny spaces)
- Complex heart defects (Tetrad, Pentada Fallo, partition defects)
- Vices of the development of the musculoskeletal system (no limbs, fingers)
Is it possible only on the basis of the first Uz-screening to make a diagnosis of severe pathology of the embryo?
When identifying serious deviations in the development of the embryo, it is pleasant to expand the diagnostic search, this is necessary to eliminate false-positive results. Such diagnostic procedures include: delivery of analyzes for genetic two and three. If necessary, you can carry out amniocentsis and chorion biopsy. These analyzes make it possible to conduct an extended genetic analysis of charin water and chorion tissues in order to identify coarse and serious pathologies). However, it should be remembered that these diagnostic procedures can lead to serious complications, up to spontaneous interruption of pregnancy).
Some defects detected during the study do not require additional research, due to their evidence. For example, the absence of limb or pronounced disorders of the nervous tube (anencephalia, hydrocephalus).
What if the first Uz-screening was detected by heavy defects of development?
If, during the examination, the doctor determined the presence of signs that indicate the embryo of serious developmental defects, in this case a clarification conversation is held with a woman, a consultation is gathering as part of doctors: an obstetrician-gynecologist, genetics, neonatologist, sometimes a children's surgeon is sometimes invited. When identifying malformations that are incompatible with life, a woman is invited to interrupt pregnancy for medical testimony. If the identified violations concern only external defects without risk for life, the woman itself makes a decision: to continue to continue to enter pregnancy or not.
Second Uz-screening: Dates and goals of holding?
In the period of 18-21 weeks, a second screening is carried out, which allows you to study the fruit much more in more detail. On the second screening you can determine:
- Heart patterns (no heart partitions, valve patterns)
- Lack of or pathology of the internal organs of the fetus or anomalous location (single kidney, its incorrect form, kidney omission, no gallbladder, spleen, mirror arrangement of organs, vascular anomalies - extension of vessels (aneurysms)
- Tumors in fruit
- The number of accumulating waters.
- The location of the placenta (whether there is no prelation, the placenta detachment, is there any hematoma in the uterine cavity, in space between the placenta and the uterus)
- Anomalies of the facial skull structure (the incomplement of the upper lip - the hunger of the lip, the incoming of the solid sky - the wolf fall)
- The speed of blood flow in the system "mother-placenta-fruit". The bloodstream is estimated both in the uterine arteries and according to the vessels of the umbilical arteries, and even in the middle brain artery of the fetus for the detection of blood flow violations and signs of oxygen starvation (hypoxia) of the fetus.
- Mandatory is the study of the cervical (its length, width of the cervical canal).
Third Uz-screening: When is it carried out and what allows you to reveal?
This study is carried out in the third trimester, namely, on the period of 30-32 weeks of pregnancy. Allows you to identify the most difficult, difficult diagnostic defects of the development and pathology of the development of pregnancy. These include:
- Multi-sized fetus tumors
- Complex defects of the development of the vascular brain system
- Difficult to visualize the vices of the internal organs of the fetus.
- The rotation of the placenta into the muscular wall of the uterus
- Fliques of head and spinal cord
- Different diagnosed heart and vessel defects
The necessary research in the third trimester includes the study of blood flow, calculation of the number of arrogant water, the study of the fetal heartbeat, the definition of all fruit sizes (the so-called fetometry at which the size of all skeleton bones is measured), as well as to carry out cervicometry (determining the length of the uterine cervical).
What to do if the screening is missing?
A similar situation is usually more common in women, who, because of certain reasons, later learned about their pregnancy, as well as young primaries, and women who mistakenly believed that they had a climax (but in fact, menstruation has ceased to Power of pregnancy). In such situations, the ultrasound of the expert class is needed as soon as possible, because the likelihood of detecting developmental defects in late dates is large, which can create certain risks for the fetus and mother.
Does it be necessary to determine the field of fetus when conducting an ultrasound research?
The doctor performing ultrasound screening should be implemented in a mandatory manner of the urinary fetal system. But in front of the doctor in this case, it is not just a goal - to determine the floor, it should not miss any defects of the development of genital organs (watering of eggs, cryptorchism, Kustener-Rokitansky syndrome and other developmental abnormalities)
Is it necessary to prepare for this study?
No special preparation is required before researching. However, the first screening is usually carried out with a bladder filled with a bladder (in this case, visualization is better). Therefore, this time has to come on an ultrasound with a filled bladder). Before the study, there should be a slight feeling of urge to urination (but no need to overdo).
Do I need to do an ultrasound between screenings?
With normally proceeding pregnancy, there is no need for ultrasound studies outside screening. However, there are certain pathologies that require constant monitoring and state dynamics. For example, with impairment of blood flow in uterine arteries, or in vessels of umbilical umbilical systems, it is necessary to carry out frequent ultrasound studies with a mandatory measurement of blood flow velocity (Dopplerometry).
What ultrasound device is used when conducting screening?
Typically, this study is carried out on the very good devices of the expert class, allowing to build and simulate a 3-d image. But it is worth noting not only the high resolution of these devices, but also people performing this study. Screening holds the best specialists who have extensive experience and knowledge.
How important is the screening?
Uz-screening in obstetrics is of great importance. It is due to such an extended diagnostics that it was possible to significantly increase the detection of malformations, complex anomalies, chromosomal diseases. At the above reasons, the contribution of ultrasonic diagnostics to obstetrics is very difficult to overestimate. Most of the vices are detected already during the first screening, which significantly reduced the birth of children with complex developmental disorders and chromosomal anomalies.
Pregnancy screening is a complex of medical research, tests and other diagnostic procedures for preliminary calculation of women with a high risk of developing certain diseases from her or fetus for the period of its tooling or the appearance of complications during pregnancy / in childbirth. I do not need to screen This is a dubious result of research, this reflects only the likelihood of pathologies, and not their presence.
Screening during pregnancy is a complex of medical research, tests and other diagnostic procedures for preliminary calculation of women with high risk of developing certain diseases from her or fetus for the period of its toaling or the appearance of complications during pregnancy / in childbirth.
It should not be afraid of screening, since even with a doubtful result of the studies, this reflects only the likelihood of pathologies, and not their presence.
Why do you need screening?
More prenatal (prenatal) diagnostics are necessary for two purposes: to predict the risks of the occurrence of complications during pregnancy and identify the prerequisites for the development of malformations of the fetus.
Possible pregnancy complications detected on screenings:
- Preeclampsia is a pathological condition, characterized by an increase in blood pressure, proteinuria (protein presence in the urine), potential edema and kidney damage and other organs. More often develops in the second half of pregnancy.
- Eclampsia - the life-threatening life of the mother and fetus, which is characterized by an increase in blood pressure, convulsions, coma and death (mother and / or fetus)
- Fetoplacentage insufficiency (FPN) is the pathological condition of the mother (placenta in particular), leading to hypoxia (lack of oxygen) and delay in the development of the fetus with a high risk of intrauterine fetal death.
- The latency of the intrauterine development (ZORO) of the fetus is a pathological condition in which the fetus for the growth and mass of the body lags behind its gestational (alleged) age.
- A frozen pregnancy is a pathological consideration, in which the fruit stops in the development and driving us to rock up to 28 weeks.
Congenital malformations of the fetus, registered during screenings:
- Anediephalia is a complete or partial absence of large hemispheres of the brain, soft tissues and bones of the skull.
- Microcephaly is a pronounced decrease in the dimensions of the skull and the brain while maintaining the normal size of other parts of the body.
- The cleft of the sky ("Hare Guba") - the gap / cleft in the middle part of the sky of the fetus, which is formed due to the incompleteness of half the sky.
- Hydrocephalus - excess accumulation of the spinal fluid in the ventricles of the brain.
- Congenital heart defects are defects in the structure of the heart and / or main vessels in the fetus.
- Many syndromes: Down, Patau, Shereshvsky-Turner, etc.).
After screening, pregnant women are divided into groups of risk of possible development of complications from the women themselves and their fruits. Further conduct of the bench (diagnosis, treatment and objects) in each group differ. Thanks to the screening system, the fertility of healthy children has increased and the mortality rate of fruits has decreased during begging.
What are screenings
There are 5 types of screening during pregnancy:
- Immunological (testing of pregnant women with a number of infections that potentially violating the development of the fetus. These include rubella, herpes, chickenpox, cytomegalovirus, toxoplasmosis, etc. is appointed to all when registering about pregnancy);
- Cytogenetic (not required, is carried out according to indications);
- Molecular (identification of rare mutations found with a frequency of not more than 1%. Assigns in unique cases)
Separately, the invasive diagnosis is isolated: the biopsy of the chorion (fence a piece of fabrics of the outer shell around the embryo), amniocentesis (puncture for the intake of octopling water), placentocentsis (placenta biopsy) and cordocentsis (fence of the fetal cord blood). These are complex manipulations, they are necessary for cytogenetic research when searching for chromosomal diseases. It is highly rare and only after the cascade of other surveys with disappointing results to confirm or eliminate the diagnosis.
In addition to 5 types of screening every 2-4 weeks, pregnant women give blood and urine for generally clinical analysis.
Consider more, why should each examination need.
Clinical blood test
Common blood test (UAC) is a mandatory study appointed with each treatment to the therapist (and practically all other medical professionals). The data of this survey allow us to obtain a general idea of the state of the body of patients.
In the first half of pregnancy, the analysis is held 1 time per month, in the second half - every 2 weeks.
The main indicators of the UAC:
- Hemoglobin. The main component of the erythrocytes (red blood cells). Hemoglobin function - transfer of oxygen from the lungs to organs and tissues and removing carbon dioxide. At the concentration of hemoglobin, the presence of anemia is determined.
- Hematokritis is the ratio of cell elements and a liquid blood environment. This indicator reflects the severity of anemia, shows how thick blood (the risk of thrombosis increases).
- Erythrocytes - red blood cells. When screening, pregnant women define only the number of erythrocytes, without evaluating their characteristics.
- Color indicator. Reflects the hemoglobin content in red blood cell. It is evaluated by the character of anemia and the presence of iron deficiency in the body.
- Platelets are a shaped element of blood, participating in its coagulation and fibrinolysis (thrombus resorption).
- Leukocytes are white blood cells, participate in immune reactions. Their function is the protection of the body from viruses, bacteria and other alien particles. Leukocytosis (leukocyte increases) indicates inflammation or other pathologies. However, pregnant women have moderate leukocytosis - norm.
- Leukocyte formula. This is the percentage of different types of leukocytes in the blood: neutrophils, eosinophils, basophils, lymphocytes and monocytes). According to this formula, you can approximately assume the cause of the pathological process (viruses, bacteria, parasites, allergies, etc.).
- Erythrocyte sedimentation rate (SE). An increase in this indicator indicates the presence of inflammation or disease. Pregnant women normally are up to 2 times higher than that of non-remote women.
Clinical analysis of urine
The survey is carried out to assess the state of the kidneys, the load on which in women during the toasting of the fetus increases several times. It is appointed monthly to the first half of pregnancy, then 1 time in 2 weeks.
Main indicators of general urine analysis:
- Density (specific weight);
- PH is the concentration of free hydrogen ions in urine. It depends on the number of acids and acidic salts in it;
- Protein. In the urine of a healthy person, protein is practically no;
- Glucose. Glucosuria (improving glucose in the urine) indicates diabetes in a patient. In pregnant women, he is gestational, that is, it appears during pregnancy and passes after childbirth;
- Bilirubin. Normally, it is not in the urine, it appears during jaundice;
- Urobilinogen. This is a substance formed in the intestine from bilirubin. In the urine there may be his traces, its complete absence means that the bile does not enter the intestine, it means that there are problems with the liver or a bubble;
- Ketone bodies. It is formed when fatty acids splitting in the liver. Normally in the urine;
- Erythrocytes (red blood cells). Normally, there are no single in the urine;
- Leukocytes (White Blood Cells). Can be detected single;
- Epithelium. In a healthy woman in OAM, epithelial cells are absent;
- Cylinders - protein and cell particles. Appear in renal pathology;
- Bacteria. Normally they are not in the urine;
- Salt. Should not be detected.
Online consultation doctor-gynecologist
Cost consultation: from 500 rubles
As part of the consultation, you will be able to voice your problem, the doctor will clarify the situation, decrypts the tests, will answer your questions and give the necessary recommendations.
Blood analysis on biochemical markers includes several indicators:
- Protein and its fractions;
- Alkaline phosphatase;
- AST, Alt;
- Uric acid;
- Electrolytes (calcium, potassium, sodium, magnesium), etc.
Additionally, other markers (indicators) are revealed during biochemical screening:
- Special serum proteins.
- Horionic gonadotropin of man (HCG) - hormone synthesized by the embryo. This hormone germin produces 24-48 hours after fertilizing the egg. Its concentration gradually increases and reaches a peak at 8 week of pregnancy, after which it decreases to a constant value (5000-50000 IU \ L), which is preserved before delivery. High concentration of hCG at the first screening may indicate pathology.
Ultrasound (ultrasound) is a highly informative and harmless method, with the help of which doctors are watching the development and state of the fetus from the earliest stages. Pregnant woman does not require special training before the procedure.
A total of three screening ultrasound are held:
- The first screening - on the 10-13 week of pregnancy;
- The second screening is on the 18-20 week of pregnancy;
- Third screening - on the 30-34 week of pregnancy;
At ultrasound examination, a fruit egg in the uterus is seen from the 3rd week. Fetal heartbeat under ultrasound is determined from 4-5 weeks, and motor activity - from 7-8 weeks.
Now consider what is determined in each mandatory screening, spent once in trimester.
In the first trimester for the 10-13 week of pregnancy, a combined test is conducted. It includes:
- General blood analysis;
- General urine analysis;
- Biochemical blood test (search for biomarkers - signs or indicators of pregnancy complications or congenital malformations of the fetus);
- Determination of human chorionic gonadotropin (hCG);
- Ultrasound uterus to assess the state of the fetus.
- Screening for preeclampsia.
Preeclampsia is a complication of pregnancy, manifested by attacks of hypertension (an increase in blood pressure above 140/90 mm Hg. Art.) And the appearance of proteinuria (protein in the urine). After 20 weeks of pregnancy occur more often, but the prerequisites for further development can be determined before.
Screening for preeclampsia includes:
- Determination of proteinuria (the amount of protein in the urine, on the preeclampsia indicates the result ≥ 300 mg per day)
- The measurement of blood pressure (the blood pressure ≥ 140/90 mm Hg indicates the preeclampsia. Art.).
The earlier preeclampsia manifests itself, the hardest it is.
The first shricking is the most important. It allows you to estimate the risks of the development of the complication of pregnancy and the malformations of the fetus or delay in its development. Most intrauterine pathologies (80%) can already be detected in the first trimester of pregnancy. Ultrasound of the uterus and fetus plays a major role in this diagnosis.
Tasks ultrasound in the first trimester:
- Confirmation of uterine pregnancy (finding a fetal egg in the uterus cavity);
- Elimination of ectopic pregnancy;
- Determining the amount of fruit;
- Evaluation of the growth of the fetus, its viability, study of the anatomy;
- Diagnosis of pregnancy complications;
- Detection of pathologies of the genital organs of a woman.
The first semester is the most important. Most pathologies arise exactly on the early period of pregnancy. Therefore, it is so important in time to account for women's advice on time, and ideally it is worth planning pregnancy in advance, passing diagnosis and treatment at the gynecologist, endocrinologist and other specialists.
For a period of 12 weeks, the doctor may assume the sex of the child with a 50% probability.
If after these manipulations, the high risk of birth of a child with pathology is re-conducted. In confirmation of pathology, prenatal (prenatal) karyotyping (study by chromosomes - the structures of the cell nuclei, where DNA is located).
Such a two-stage approach allows you to identify more than 90% of cases of chromosomal pathologies by the fetus.
It is carried out on the period of 18-20 weeks of pregnancy.
- General blood analysis;
- General urine analysis;
- Blood chemistry;
- Definition of hgch;
- Hormonal profile (first of all estriol - female sex hormone, produced by the placenta during pregnancy);
- Ultrasound uterus;
- Screening for preeclampsia (measurement of blood pressure, detection of proteinuria).
Tasks ultrasound in the II Trimester:
- Evaluation of the growth of the fetus (elimination of the delay of its development);
- Identification of malformations of development and chromosomal pathologies;
- Evaluation of the placenta;
- Determination of the number of accumulating waters.
In addition, on the second screening, the doctor has already confirmed the sex of the child, which is also important for women.
It is held on the 30-34 week of pregnancy.
The diagnostic complex usually includes:
- General blood testing and urine;
- Blood chemistry;
- Ultrasound uterus and fetus;
- Doppler - study of the vessels of the fetus using an ultrasonic technique;
- CTG - cardiotokography. This is a study of the cardiac activity of the fetus. It is prescribed at risks of intrauterine hypoxia (oxygen starvation), and from 33 weeks 1 time 2 weeks before genera to all pregnant women.
- Prechangelampsia screening (measurement of blood pressure, detection of proteinuria).
Tasks for ultrasound in the third trimester:
- Checking the presence of malformations and delay in the development of the fetus;
- Assessment of the state of the fetus (motor activity, breathing and blood flow);
- Determination of localization, thickness and placenta structures.
By 36-37 weeks of the placenta ceases to grow, after which it remains at the same level or decreases. The state of the placenta is directly reflected on the health of the fetus.
Do not be afraid or nervous before screening. Even if the result is positive, it only confirms that pathology is possible. That is, it can hypothetically be, but not already there! Further diagnosis is aimed at confirmation or elimination of possible pathology, and the second version of the development of events is once more likely.
Screening 1 trimester of pregnancy
For nine months, a lot of useful and important research is appointed to the patient. Ultrasonic Screening during pregnancy It is one of the most informative and valuable. Screening first trimester It comes to the number of mandatory diagnostic procedures recommended by each waiting for a baby to a woman. Thanks First Integrated examination (ultrasound + prenatal screening), the doctor may eliminate the risks of chromosomal anomalies.
When they make the first screening
Screening has a diagnostic value in determining a number of pathologies. Full ultrasound with measurements of the fetal parameters is performed from 11 to 14 week of pregnancy. In this time interval, the embryo turns into a fruit. On this time, the body and internal organs of the future child are well formed, and one can eliminate the presence of gross defects. As a rule, the study consists of two stages: ultrasound and biochemical blood test. The combination of scan results with laboratory blood indicators gives an Akuster-gynecologist a more unfolded picture of the first screening.
How is it Screening OE examinationScreening is absolutely safe for the fetus and the future mother procedure, no matter how it is necessary for it. In 1 trimester of pregnancy, ultrasound is carried out both transvaginal and transabdominal method. With a transvaginal scanning, it is necessary to remove the lower part of the clothing, including underwear. When examining an external sensor through the abdominal wall - it is enough to raise a blouse or shirt. The patient falls on his back, and the doctor begins to perform ultrasound screening. On this period of pregnancy, this provision will not cause discomfort. For convenience, you can bend legs in the knees. When using an intrafitalized sensor, a condom is used.
How to prepare for first screening
As we have already indicated above, in this trimester, ultrasound scanning can be carried out by two methods. On the eve of the ultrasound of pregnancy, some special preparation is required.
Pathologies that can be identified on Ultrasound
The data of the first screening Allow the risk of the following pathologies:
Edwards syndrome or trisomy in 18 chromosome;
Patau syndrome or trisomy on 13 chromosome;
Scharevsky-Turner syndrome or trisomy in the X chromosome;
Down syndrome or trisomy of 21 chromosome;
Stop in the development of pregnancy;
Slow fetal development;
Coarse malformations of heart development;
Pathology of the nervous tube;
Other pregnancy pathology incompatible.
The preliminary diagnosis after the first screening is placed on the basis of compliance or inconsistency of the parameters of the fetus of the norm. There is a table in which all the sizes of the fetus are indicated throughout the pregnancy. In the first trimester, such parameters such as the heart rate (heart rate), the length of the nasal bone (NK), TVP (thickness of the collar space), BPR (biparity size), OG (head circle), coolant (abdominal circle), dB (length Hips), CTR (Copchiko-Dark Size), Cervical Length. Assess the place of attachment of chorion / placenta, markers of chromosomal anomalies, the number of vessels in umbilical cord, blood flow in the uterine arteries and in the venous duct, neoplasms of ovary and uterus. In addition to these indicators, the specialist estimates at the first ultrasound and other data.
Including screenings 1 and 2 trimesters show:
The structure of the heart and other internal organs of the fetus
The length of the bones of the shoulders, forearm and thighs of the fetus
Head circle size, fruit abdomen
The thickness of the placenta and its location
The number of amniotic waters (norm, lowland, multi-way)
State of umbilical umbilical vessels in it
State of the uterus and cervix
Other features and pregnancy pathology
Indications and contraindications for screening
The ultrasound of the first trimester is carried out on a voluntary basis. However, the gynecological obstetricists and the Ministry of Health recommends it to make all pregnant women, without exception. Take care of the health of the future child and your own is the primary task of the patient. Ultrasound screenings are among the most common surveys around the world. There are no contraindications to the conduct of ultrasound, since the study is non-invasive and does not represent hazards for mom and fetus.
There are several categories of pregnant women who have the risks of chromosomal anomalies high:
Future moms from 35 years and older
Patients who have undergone infectious diseases in early terms
Patients hosting in early antibiotics and other drugs incompatible with position
Patients with a diagnosis of "unbearable pregnancy" in history
Women already having a child in the family with defective development
Pregnant women with diagnosed risk of spontaneous abortion
- Patients consisting in close relationship with the father of the child
Decoding research results
Interpretate results First Ultrasound May only obstetrician gynecologist. The attending physician can perform both functions at once. In most profile clinics, gynecologists conduct an ultrasound study Pregnancy Alone. It is very convenient for patients: they get detailed comments from their doctor immediately after Screening . Do not require detailed detail of the survey from an ultrasound specialist. On any deviations from the norm, the doctor will specify directly in the process. Ultrasound . All other questions can be asked at the reception at the gynecologist.
TVP or thickness of collar space
A TVP is one of the parameters on which an obstetrician gynecologist is focused when assessing the risk of chromosomal anomaly from the fetus. Under this name, the space is hidden, located between the inner surface of the skin and soft tissues covering the cervical spine. Along with other indicators, it is the most important risk marker of chromosomal anomalies from the future child. TVP data is advisable to measure on Ultrasound only in First trimester , up to 13 weeks. Next after 14 weeks Pregnancy The liquid in the cervical fold is solved.
The doctor on a special table of standard TPP values will determine the norm or deviation of this indicator.
CRT or Copchiko-parmer
The measurement of the CTR allows the doctor to determine the term of pregnancy in 1 trimester, with an accuracy of + \ - 4-5 days. Like a TVP is measured only until 14 weeks 1 trimester and is estimated on special regulatory tables. After this period, the sensor Ultrasound It can no longer cover the length of the fetus. On the following scans, the doctor assesses the growth of the child along the length of the body parts.
BPR or Biparity Size
Biparity size is fixed by a specialist at each of the planned Ultrasound Surveys Pregnancy . There is a table for which the doctor joins the BPR indicators on Screening . When measuring all the growth rates of the fetus are calculated by the estimated mass of the fetus, and these indicators determine the choice of the method of root separation (through natural generics or operational delivery).
Heart rate or cardiac frequency
The CSS parameter gives a doctor the opportunity to estimate the function of the cardiovascular system of the fetus. This indicator needs special control as on First survey and throughout Pregnancy . It indicates whether the fetus has a reduction activity of the heart. On Ultrasound Two its criteria are taken into account: the frequency and rhythm of abbreviations.
Чit may affect the results Screening
What is essentially Ultrasound screening ?
This is a study Pregnancy based on reflection of ultrasound waves from the tissues of the human body. The sensor transmits a signal that in turn is reflected from the fetus organs and the future mother. The specialist decrypts the image by noting all the necessary data along the diagnostics.
Despite the high informativeness of the scanning of pregnancy, some factors may affect its results. The first factor is the number of accumulating (or amniotic) waters. When small, the volume of fluid may limit the ability to research. This very limits the ability of a doctor. The second reason can be the position of the fetus at the time of screening. In some cases, the first time cannot be determined not only the parameters, but also the sex of the child. Since this is a safe procedure, no restrictions for re-scanning pregnancy. Therefore, in such a development of events, the doctor may appoint an additional study.
(1 estimates, average 5 out of 5)
Thursday, August 15, 2019
During pregnancy, the woman informs that it should be screened. And they send an ultrasound to the familiar procedure. Of course, the question arises: what differs screening from ultrasound? Why, when having tooling a child, an unfamiliar medical term is used and what does it mean?
What is Screening
In fact, everything is quite simple. This term is called a control comprehensive examination of a pregnant woman on a certain period. The concept includes ultrasound diagnostics, at which the doctor makes conclusions about the state of the future mother, its childbearing bodies, and in addition, assesses how much the baby is growing and developing.
Also, the mentioned complex includes a biochemical blood test for very specific hormones, the level of which is of great importance in the diagnosis of probable genetic disorders from the fetus.
Screening is appointed by a doctor with normal, physiological pregnancy three times over the entire period - every three months.
What is ultrasound
Ultrasound during pregnancy is an indispensable method of visual observation of what happens inside the uterus. It is carried out using sensors, one of which is an elongated, small diameter - in the first trimester, the doctor introduces a woman into the vagina. Thanks to the ultrasonic waves, the emitted apparatus, the doctor sees the image of the uterus on the monitor, the embryo in it. The proximity of the sensor to the studied organs allows to analyze as accurately as possible, as the very beginning of pregnancy occurs.
Subsequently, on any time after 12 weeks, the other is wide - the sensor is installed on the belly of a woman. However, the same method is the same: the doctor evaluates the picture, measures and compares the parameters, tracking the course of pregnancy.
What is common between screening and ultrasound procedure
What to do - ultrasound or screening - there is no such question. During pregnancy, the ultrasound, appointed for the general inspection of the fetus and the future mother, will also be called screening.
In the first trimester, the biochemical blood test in the screening will be mandatory. It is impossible to miss it not to miss the development of possible congenital diseases. The remaining two trimesters, with repeated complex surveys, the study of blood for hormones will be assigned if the doctor alerted for the first time.
Ultrasound examination of the initial pregnancy period is no less compulsory research. The doctor will determine whether the embryo is located correctly in the uterus, whether he began to grow. In addition, in this phase of toaling the fetus begins to beat the heart. This is an important moment for a doctor and undoubtedly for a future mother.
Difference ultrasound from screening
Once ultrasound enters the concept of screening during pregnancy, to say that it is better impossible. How to identify differences between these procedures.
The only thing that should be noted is a different content of a comprehensive survey in different trimesters. As already mentioned, blood for analysis in the second and third trimesters is not necessary if there is absolutely no deviations in the very first different.
However, the ultrasound study should certainly need in every trimester - three times. If blood indicators determine the presence of disorders in genetics, the anatomical deviations, disorders of the formation of various organs and fetal systems reveal on ultrasound. They look, whether the baby is enough oxygen coming from the mother in the arteries of the umbilical arteries. And with the final inspection, the doctor also checks the readiness of the child to leave the maternal womb: the location (legs to the generic paths or head), the absence of a cordial cord, the proportion of the heart and lungs.
As a result, it is possible to answer the question of what the difference can be answered as follows: Ultrasound diagnostics can be carried out by a pregnant woman outside screening, if necessary. For example, to clarify the floor of the future infant. But screening always includes a mandatory ultrasound for general control over the course of pregnancy.
Also, screening differs from a simple ultrasound that any ultrasound study of the internal organs of the future mother is not part of screening. It includes only ultrasound of the uterus and fetus, vessels, their blood supply, in concrete weeks of observed pregnancy.
And, finally, if any violations were discovered during the complex, or the doctor suspected that something goes wrong, as a woman could send to the re-ultrasound, and again take blood for analysis. In this situation, the additional examination will not be considered screenshots.
Who spends screening
A complex of research during pregnancy, its composition and timeline determines the doctor an obstetrician-gynecologist. It sends to ultrasound and necessary biochemical analyzes. Deciphering results also deals. After collecting full information, all the results, the doctor makes the final conclusions that screening shown.
Recommendations of specialists
The most important thing for the doctor is to preserve the health of the future mother, help her make pregnancy to the end without complications, avoid any risks for the baby. Therefore, assigning a complex of surveys, the doctor, first of all, takes care of his patients. Not a single study during pregnancy cannot be neglected, because you can miss a disorder that is easily eliminated at the very beginning of its appearance, but with which it is very difficult to fight later.