What is doppler ultrasound during pregnancy
During the entire period of pregnancy, a woman must undergo a series of studies, including ultrasound. With the help of ultrasound, you can determine the condition of the fetus, the usefulness of its development and, if necessary, promptly prescribe treatment or make a crucial decision regarding further pregnancy.
What is dopplerography?
Many women who are carrying a child for the first time are interested in the question: "Doppler ultrasound during pregnancy - what is it?". At its core, doppler sonography is a type of ultrasound. The main objective of the study is to assess the state of blood circulation in the arteries of the uterus, placenta and umbilical cord and determine the functionality of the fetal place. Dopplerometry makes it possible to detect circulatory disorders, which has a very high prognostic value. This type of study allows to determine the presence of placental insufficiency or to identify delays in the development of the fetus.
Diagnosis is carried out in the format of "mother-placenta-baby." This type of examination is required for every pregnant woman.
There is a huge difference between conventional ultrasound and doppler imaging. The latter technique has such distinctive features:
- allows you to determine how healthy the heart muscle in a child is,
- determines the patency of umbilical cord vessels,
- evaluates the functioning of the placenta,
- allows you to detect the entanglement of the fetus by the umbilical cord,
- allows you to determine how well the blood vessels of the fetus are supplied,
- reveals the presence of fetal hypoxia.
The device allows you to set the speed of blood flow, and in different vessels and arteries of the brain, umbilical cord, aorta, and in the uterus of the mother.
How is the diagnosis carried out and is it harmful?
Frequently asked question: "How do doppler ultrasound during pregnancy?". Diagnostic measures for the patient are no different from conventional ultrasound. A woman lies on a couch, a special gel is applied on her stomach, and a study is being conducted. But then the doctor’s actions are somewhat different. To begin with, an ordinary examination is carried out and when a “suspicious” vessel is detected, the Doppler function is activated on the ultrasound machine. After that, a close-up vessel and blood flow will be visible on the monitor. The device is able to independently detect deviations from the norm and provide information.
There is no harm in the diagnosis on the ultrasound machine, so no need to worry. More harm to yourself and the fetus can be done if you worry. On the contrary, the diagnosis allows you to prevent possible complications.
Over the past 50 years, many studies have been conducted that have not revealed any negative effect on the human body of ultrasound devices.
Types of research
The survey can be conducted in two modes:
Duplex mode - what is it? Doppler ultrasound during pregnancy in this mode allows you to get almost complete information about the vessel, assess its patency and in the presence of violations to identify them in a timely manner.
The triplex mode is just a color image that gives a complete picture of what is happening in the vessel under study. The results obtained in this mode are considered more reliable.
Norm indicators in the diagnosis
For most women, little knowledge of what it is - Doppler ultrasound during pregnancy. They want to know which indicators are the norm, and in which cases deviations may indicate problems with the fetus.
The diagnosis takes into account three main indicators:
- LMS or C / D, that is, systolic-diastolic ratio. The indicator is calculated by dividing the maximum blood velocity in the systole (that is, recorded at the time of cardiac muscle contraction) by the speed that was recorded at the time of heart relaxation (that is, the diastolic index). For each vessel, the indicators are completely different.
- Resistance Index (IR). It is determined by dividing the difference between the maximum and minimum blood flow rates.
- The pulsation index (PI) is also determined by dividing, but the difference between the maximum and minimum speeds is divided by the average blood flow over the entire cardiac cycle.
All these indicators are combined into one group - ASC, that is, indices of vascular resistance.
Indicators of the norm for Doppler ultrasound during pregnancy
The tables show the boundary indicators, that is, a parameter is considered normal, which does not exceed the one shown in the table.
If you find deviations from the norm, then you should not immediately panic. On the contrary, the doctor has the opportunity to begin therapy as quickly as possible and prevent an adverse outcome of pregnancy.
If irregularities are found in the bloodstream
Detected abnormalities in decoding Doppler ultrasound during pregnancy can confirm the presence and extent of violations in the uteroplacental and fetal-placental system.
With the confirmation of the first degree of impaired blood flow there is a big chance that the pregnancy will still be full-term, and the birth will take place naturally. But this is possible if there are no complications and deterioration of blood flow before the birth.
In principle, the first degree of deviations from the norm does not lead to the death of the fetus. A survey is usually carried out at intervals of 2 weeks and CTG is monitored. Blood pressure of the expectant mother is subject to mandatory monitoring.
In the second stage, blood flow problems are observed in the vessels of the uterus and umbilical cord. In such a situation, a woman and a child require constant monitoring in a medical facility. It is possible to conduct therapeutic measures that will eliminate the oxygen starvation of the fetus.
The third stage of impaired blood flow is characterized by the fact that speed quantitative indicators tend to zero. There may be reverse blood flow at the moment when the heart muscle is relaxed. In such a situation, the following measures can be taken:
- if the gestation period is 22 weeks or more, surgery may be recommended,
- if the term is still too short, then intensive therapy is prescribed so that the woman can carry the fetus at least until 22 weeks.
Medicine and technology are not standing still. To date, even a device has been developed that allows monitoring the development of the fetus at home. In this case, there will be no question at what period of pregnancy the ultrasound doppler is performed. Although you should not skip a routine diagnosis, especially if there are factors in the history that predispose to poor blood flow or chronic diseases.
Portable doppler allows you to clearly hear the baby's heartbeat, and this is the calmness of the mother. If you have any suspicions about the health of the fetus, you can immediately consult a doctor.
Gynecologists recommend using such a device not earlier than the 16th week. For the procedures you need to purchase only the highest quality gel from reliable suppliers.
What do pregnant women say?
To date, there is only a small percentage of women who in every way avoid examinations after the conception of a child, including ultrasound. In most cases, the expectant mother is ready to take care of the health of her baby. However, the reality is that for free, even a blood test will not work.
The average price of Doppler ultrasound during pregnancy - 1.5-2 thousand rubles. If we talk about a full screening and three-dimensional study, which can be supplemented by video recording, then such a “pleasure” will cost 4-5 thousand rubles. As a rule, the price varies depending on the status of the clinic and the location.
At the same time in the state clinic, where the expectant mother is serviced, there should be an ultrasound machine with a Doppler function. If a doctor sends a woman for examination in the direction, it should be free of charge.
When a child is desired and a woman worries about his health, the question of how much Doppler ultrasound during pregnancy does not arise. There will always be money to prevent potential disastrous consequences. Expectant mother should not neglect the recommendations of the doctor in order to communicate the pregnancy and give birth to the baby in due time.
How does the ultrasound doppler work?
Doppler intervention, as this study is called in medical circles, works like a normal ultrasound machine. Doppler during pregnancy is designed to determine the placental blood flow in the "mother - placenta - fetus" system.
The difference between Doppler ultrasound during pregnancy and conventional ultrasound is that the Doppler is able to:
- determine the state of health of the baby's heart,
- listen to the heartbeat, establish the patency and the lumen of the fetal umbilical cord vessels,
- determine how well the blood vessels of the fetus are supplied,
- detect insufficient functioning of the placenta and hypoxia in the early stages.
These studies are possible, since the Doppler ultrasound scanner works by responding to the speed of blood flow in various vessels of the umbilical cord, fetal aorta, brain arteries and arteries of the uterus of a woman.
On the screen, the blood flow is indicated by the movement of the red bodies in a two-dimensional image.
Types of dopler during pregnancy
This study can be carried out in 2 modes: duplex and triplex.
The duplex mode is able to give an idea of the vessel itself, which is being studied, its patency and the causes of the impaired blood flow, if they are present, are evaluated.
The triplex mode adds a color image to the duplex study, which gives a vivid picture of the movement of red blood cells. A study conducted with triplex scanning is considered the most accurate.
How is the ultrasound with a doppler during pregnancy?
In most cases, and especially if you are being monitored at a paid clinic, then an ultrasound Doppler is no different from your planned ultrasound examination. The fact is that modern ultrasound machines are already equipped with a dopplerograph function. If your usual device is a bit older than the modern one, then you will be sent for examination to another place where such a device is available.
Conducting an ultrasound study using a doppler during pregnancy is similar to the procedure of an ordinary ultrasound:
- You come to the office at the appointed time (no special preparation for such an ultrasound is required),
- You are put on a couch and asked to lower the skirt or pants,
- A special gel is applied on the tummy and, by running a special ultrasound with the “mouse,” the doctor examines the life inside you.
This is what you will be forced to do when you are sent to the Doppler. The doctor acts a little differently. First, he examines the general picture of the state of the uterus and fetus on a routine ultrasound. Then determines the location of the vessel, which he wants to consider more closely (vessels in the umbilical cord, arteries of the brain and others).
Then turns on the Doppler function. After that, on the screen you can see a picture that shows the state of blood flow in the vessel in question. Next, the device itself analyzes the information received and reports abnormalities, if any. In general, the examination takes a few minutes.
Who and when doppler ultrasound is prescribed during pregnancy?
During the carrying of the baby, a gynecologist who observes a pregnant woman, a specific plan of action is developed. The development of this plan depends on the general condition of the woman, the presence of chronic diseases and bad habits, the development of the fetus according to the terms. But there are mandatory procedures that are the same for every pregnant woman. One of these procedures is a Doppler ultrasound examination. This examination must be performed 2 times within 9 months, if there are no additional indications for its conduct:
- On 22 - 24 week,
- At 30 - 34 weeks.
But, if the doctor at the next scheduled examination notices any deviations from the norm, then he has every right to send you to doplerometry and several times. Additional indicators for carrying out an Doppler ultrasound during pregnancy are:
- high maternal blood pressure
- kidney problems
- the presence of a bad habit - smoking - at the expectant mother,
- the presence of pre-eclampsia,
- multiple pregnancy,
- rhesus conflict of mother and fetus
- pathologies during previous pregnancies,
- discrepancies in fetal size and gestational age,
- the presence of chronic and hereditary diseases (diabetes, etc.),
- bad cardiotocography results.
Is doppler harmful during pregnancy?
A study using Doppler ultrasound is absolutely harmless and does not affect the development of the fetus. Most likely, this study is even useful. Why? Doppler is a very accurate study of the condition of the fetus and the degree of its development. It happened that only Doppler ultrasound was able to determine fetal hypoxia, and the treatment was prescribed in time, which prevented the accident. Sometimes only Doppler ultrasound can consider entwining the baby's umbilical cord and its degree (double, triple, single, taut, not tight).
That's what doppler is during pregnancy. No examination during pregnancy should cause excitement in a woman. The excitement is harmful to your health and the health of your future baby. Watch your behavior, nutrition, habits, and each new study will delight you with the sounds of the baby's heartbeat.
Dopplerometry during pregnancy
What is doppler ultrasound during pregnancy? A standard ultrasound scan visualizes soft tissue without evaluating blood movement (static). To diagnose any pathology of such a survey, as a rule, enough. However, in cases where it is necessary to establish the diameter of blood vessels, blood flow and the level of blood pressure, Doppler ultrasound is indispensable. The effectiveness of Doppler is achieved due to the ability to assess the dynamic environments of the body.
What is doppler for pregnant triplex scanning method? During this procedure, three modes of operation are used - spectral, normal and color. Triplex ultrasound Doppler during pregnancy provides an opportunity to assess the vascular bed, not only its anatomy or blood flow, but also the permeability, which is ensured by the exact color image of the device. So the doctor gets the most reliable picture of the development and current state of the child.
Duplex scanning during pregnancy
What is doppler ultrasound during pregnancy duplex scanning techniques? This type combines the work of two complementary modes - spectral and normal. The image obtained on the screen after Doppler research is black and white. Thanks to the nuances, the doctor can evaluate the anatomical features of the vessels and find out if the normal movement speed of the blood in them. So with the help of duplex scanning, vascular permeability is evaluated.
What is a doplerometric study during pregnancy
One of the specific methods of ultrasound is dopplerometry for pregnant women. The basic principle of the procedure is the Doppler effect, which consists in measuring the rate of ultrasound reflection from blood particles in motion. It is important to do an ultrasound scan with a doppler during pregnancy in order to determine in time the presence of irregularities in the placenta, since it will determine whether the fetus will receive all the necessary substances for its development. This type of diagnosis can detect the early stage of hypoxia and prevent placental insufficiency (FPN).
During pregnancy, the woman gynecologist develops a plan for monitoring the fetus. Diagnostic procedures are prescribed on the basis of the general health of the expectant mother, the presence of her bad habits and chronic diseases. Nevertheless, there are mandatory procedures for every pregnant girl, one of which is Doppler ultrasound. In addition, the doctor, conducting a routine examination, may notice any abnormalities. Then an additional Doppler ultrasound is appointed. Indications for the procedure will be:
- kidney problems
- increase in blood pressure,
- having bad habits
- multiple pregnancy,
- the rhesus conflict of the parents' blood,
- if the size of the fetus does not match the gestation period,
- negative results of cardiotocography,
- the presence of diabetes and other chronic or hereditary pathologies.
How long doppler do during pregnancy
Doppler sonography during pregnancy can be prescribed in two cases - for prophylaxis (no more than two times, as a rule, it is performed at about 23 and 30 weeks) or if there are indications. In the latter case, the procedure is done at any stage of pregnancy. Since Doppler ultrasound is not on the list of mandatory (not included in the screening), it may not be assigned to some women at all. Preventive Doppler ultrasound is done in order to identify violations of blood flow in the placenta or umbilical cord.
Is DoS ultrasound harmful?
В течение трех десятков лет применения доплер УЗИ при беременности не выявлено негативных последствий. Ультразвуковое излучение длится потоками длительностью в тысячные доли секунды, а не беспрерывно. Около половины лучей поглощается тканями тела мамы. The real impact on the child is minimal and does not reach the values specified in the characteristics of the device. So, Doppler ultrasound - harmless procedure for the baby and his mother. Another confirmation of this is the low heating capacity of the device and the strict observance of radiation dosing during the examination process.
When prescribing a study by a doctor, it is worth asking if this is a necessary measure. If, in response, the specialist specifies the specific reasons, the procedure should be done, since it will help to detect many pathologies in a timely manner and save the life of the baby. If the pregnancy is proceeding normally, but there is no reason for concern, the parents independently decide whether to do a Doppler ultrasound. Despite the fact that the harm of this diagnostic method has not been proven, as a prevention, pregnant women should limit themselves to two standard studies.
In contrast to the use of ultrasound in classical ultrasound, where ultrasound waves with varying degrees of intensity are reflected from stationary objects, making it possible to assess the uniformity of their internal structure, density and structure, Doppler sonography allows you to "see" the moving medium. The basis of this property of ultrasound is the effect discovered by Doppler as early as the 50s, the essence of which is to assess changes in the reflected ultrasonic vibrations from moving and stationary structures.
Taking into account that all organic structures have a different degree of acoustic resistance, that is, they reflect ultrasound received by an ultrasound sensor with a different degree of intensity, the vessel filled with moving blood divides the same ultrasonic pulses into two types:
- equal to the original frequency of ultrasonic waves generated and perceived by the sensor. Such waves allow you to mark the contour of the vessel, since the vessel is a fixed object,
- reduced or increased frequencies of ultrasonic waves relative to the initially emitted ones. The frequency change occurs in a mobile environment, that is, in the blood that fills the vessel.
When blood cells (erythrocytes) move in the direction of the source of ultrasonic waves, their surface often reflects ultrasonic pulses, which causes an increase in the reflected frequency relative to the original, the movement of blood flow from the radiation source, on the contrary, reduces the frequency of reflected pulses. This phenomenon is called the Doppler shift, in the first case it will have a positive value, and in the second - a negative one.
The placenta is a temporary organ providing interconnection between the mother’s body and the developing fetus. The main functions of the placenta are:
- delivery of nutrients to the fetus,
- oxygen supply
- removal of end products of metabolism and carbon dioxide,
- protection from the ingestion of the child's toxic substances and drugs,
- synthesis of hormones that support the normal development of pregnancy.
The main criterion for the full functioning of the placenta is the corresponding state of blood flow in the uteroplacental system. Any changes in blood flow in the uteroplacental system, detected using Doppler ultrasound (USDG) can be considered the beginning of the development of pathological disorders in fetal development.
In order to understand what is uteroplacental blood flow (IPC) and what is its value in ensuring the full development of the child, it is necessary to track the relationship between the timely formation of placental vessels formed from small arterioles and the growing needs of the embryo that requires blood volume delivery in 10 times their initial needs.
The final restructuring of small arterioles ends by the beginning of the third trimester (20-24 weeks). At this point, the vessels are sufficiently thick so that, due to their low resistance, they can circulate a large volume of blood. Delayed or impaired formation of high-grade arteries causes an increase in resistance, which leads to impaired blood flow.
How long to conduct a USDG depends on the risk of complications in a woman or a child. The first doppler ultrasound during pregnancy should be carried out after the final formation of the circulatory system, that is, at 20-24 weeks of pregnancy.
The study on these terms should be carried out in patients who are at risk of developing the following complications:
- chronic kidney disease,
- endocrine disorders
- vascular disorders
- burdened history (repeated early termination of pregnancy),
- abnormal placentation in the presence of fibroids or scar in the area of the formation of the placenta,
- delayed fetal development,
- rhesus conflict of mother and fetus
- oxygen starvation of the fetus,
- multiple pregnancy.
USDG of the fetus at 20-24 weeks of gestation not only allows you to identify circulatory disorders in the circle “mother → placenta → fetus”, but also, to the extent possible, correct the disturbances with the help of timely therapy.
Dopplerography during pregnancy includes not only the study of blood circulation in the “mother → placenta → fetus” circle, that is, the movement of blood in the uterus and umbilical cord vessels, but also the blood flow in the main arteries of the fetus:
- cerebral blood supply,
- renal arteries,
- venous vessels.
When conducting an USDG monitor, the monitor shows a schematic representation of changes in the speed of blood movement throughout the entire cardiac cycle. The graph is a curve with two or three phases, where the highest level reflects the speed of blood flow at the time of contraction of the heart (systolic velocity), and the lowest level - the speed at the time of rest of the heart muscle (diastolic velocity). On this graph you can see typical curves for each individual vessel.
For a full assessment of the state of the blood flow, it is not the speed indicators that are decisive, but the coefficients (indices) reflecting the relationship between systolic and diastolic velocities. In practice, the following factors are used:
SDI (LMS) is a systolic-diastolic ratio calculated by the formula: SDI = MaxS / MinD, where MaxS is the maximum systolic velocity of blood, and MinD is the minimal diastolic velocity of blood.
Table: Standards for changes in the SDI score in accordance with the gestational age
When and how do doppler ultrasound during pregnancy
Doppler ultrasound during pregnancy - this is a survey that captures the data of blood flow in the vessels, which are communicated between a woman and a child.
Modern ultrasound diagnostic devices are already equipped with additional functionality in order to simultaneously conduct an ultrasound scan with a Doppler. Thus, during the study, the ultrasound machine on the monitor shows the blood circulation graph in color. The technique is similar to the standard examination, when the waves are reflected from the tissue structure of the body, but with the Doppler effect, the reflection comes from the red blood cells, which provides a complete description of the blood flow in the arteries of the uterine cavity and fetal brain, as well as in the venous duct.
Mandatory Doppler in pregnancy is used twice. Often, studies combine - ultrasound plus Doppler, so the dates are the same, which allows assessing the condition of the mother and baby in the complex at the following stages of development:
- 21 - 24 weeks
- 30 - 33 weeks.
Doppler ultrasound during pregnancy is prescribed more times if the doctor has serious concerns that a pathological process is developing inside the womb. Mostly among these testimonies distinguish:
- smoking women
- renal failure
- the presence of high blood pressure
- multiple gestation,
- diagnosis of rhesus conflict.
Doppler rates by week of pregnancy: table
Usually, an Doppler ultrasound is started by examining the blood flow between the two uterine arteries and the placental organ, since in more than 70% of cases, the circulatory disorder is observed solely on one side of the preeclampsia. During the study, indicators of systole (contraction of the ventricles of the heart) and diastole (interval relaxation of the heart in the interval of contractions) are measured.
Standards for gestation weeks contain the following indicators:
- The resistance index, or abbreviated IR, is calculated using the formula (C - D) / C, and the difference between the systolic and diastolic velocities, which are divided by the final diastolic, is studied.
- Distal Systolic Ratio (LMS) implies an index between the maximum contraction rate and the highest relaxation rate (C / D),
- The pulsation index (PI) is used to estimate the rate of pulsation, the difference between the velocities divided by the mean blood flow data (C - D) / M) is calculated.
What can be learned with the help of Doppler?
Dopplerometry is one of the methods for studying blood flow in the body vessels of the future mother. Through this study, it is possible to determine the direction as well as the speed of blood flow in the arteries and veins, determine the width of the lumen of the vessels and, in addition, calculate the pressure inside the vessel. In addition, this method helps to determine the health status of the baby’s heart, listen to his heartbeat, establish the degree of patency and lumen of the umbilical cord of the fetus, and how well his organs are supplied with blood. It is thanks to the Doppler that it is possible to diagnose in time the insufficiency of the functioning of the placenta or hypoxia. And sometimes only a doppler is able to show the entanglement with the umbilical cord and clearly indicate what it is: one-, two- or threefold.
Principles of the method
In a homogeneous medium, ultrasound propagates at a stable speed. If you send it to an object with a lot of moving particles, the waves will be reflected from each and carry their information. The recording of reflected waves and their interpretation using computer technology is called doppler sonography. In medicine, arterial and venous blood is taken as the medium with actively moving particles. Dopplerometry is used not only in obstetrics. This is a common method of research vessels of the lower and upper extremities, the human heart.
Dopplerometry (Doppler ultrasound) during pregnancy is one of the most significant ways to diagnose the condition of the fetus. As a result of the study, it is possible to obtain the speed of movement of blood through the vessels of the mother and child. Knowing the normal values and comparing them with the obtained result, we can conclude about the functional state of the tissues and whether the baby suffers intrauterinely from a small amount of incoming blood and oxygen (hypoxia).
Doppler can be carried out in two versions.
- Duplex scanning. A two-dimensional image is constructed, the rate of blood flow, the direction, the structure of the vascular wall are estimated.
- Triplex mapping. The picture turns out to be three-dimensional; one can clearly trace the anatomical structures, the vessels and their relation to the adjacent tissues. This is an advanced duplex scan option.
What parameters are determined
Dopplerography can be performed for pregnant women for various purposes, for example, to study the blood flow in the cavities of the heart to detect malformations. More often, the following vessels are measured and only after 20 weeks:
- uterine arteries right and left
- umbilical artery,
- middle cerebral artery in the fetus.
It is in them that the first violations appear. By the speed of blood flow, you can judge whether the fetus suffers in utero or not.
In the analysis, indicators are calculated, then the data obtained in the study are compared by special tables with the values laid down for a similar period.
- IR. This is the resistance index, calculated by the formula (C-D) / C, where C is the blood flow velocity at the time of heart contraction, D is at the time of relaxation.
- FROM TO. This systole-diastolic ratio is calculated using the C / D formula.
- PI. This pulsation index is calculated by the formula (C-D) / M, in this case, M is the average blood flow velocity in the vessel under investigation.
The tables below present the norms of Doppler ultrasound during pregnancy at different periods.
Table - Normal values of blood flow in the umbilical arteries
Table - Normal ultrasound Doppler indices in the uterine arteries during pregnancy
Table - Rate of blood flow in the middle cerebral artery of the fetus
How do Doppler ultrasound during pregnancy, is no different from doing the usual research. The pregnant woman lies, while the doctor performs an examination of the fetus and uterus with an ordinary sensor. If necessary, the specialist performs mode switching on the device and after that performs Doppler sonography. The picture on the monitor at the same time is supplemented with graphs of the speed of blood in the vessels, and a blue-red staining of the black-and-white image appears.
Usually dopplerometry is performed by an abdominal sensor. If it is necessary to differentiate the vessels, for example, with placenta previa, such a study can be performed by a vaginal sensor.
Special training for performing Doppler ultrasound is not necessary. You should have two diapers with you - one should be put on the couch and lie down on it, the other subsequently remove the remnants of the gel from the surface of the abdomen.
When can and should be done
Dopplerometry can be carried out in the early stages from the time when the heartbeat is recorded in the embryo, from about the sixth to the seventh week of pregnancy. However, in 1 trimester, you can only fix the blood flow. Usually, such a study is conducted when a missed pregnancy is suspected, when the heartbeat is not clearly defined.
Until the 20th week, the determination of blood flow in the uterine arteries, umbilical cord vessels and fetal brain does not have such a fundamental value, therefore it is performed extremely rarely.
Indications for additional Doppler ultrasound during pregnancy
Dopplerometry of the fetus and maternal vessels is carried out in women at risk for the development of pregnancy complications. Namely:
- with the risk of preeclampsia - with a similar complication of a previous pregnancy, with overweight, with increased pressure in a woman, with edema, with problems with the kidneys, diabetes,
- in case of multiple pregnancies - to identify additional fistula between vessels and prevent the robbery syndrome,
- with different mother and fetus rhesus - even in the absence of rhesus antibody titers in the blood of a woman, disturbances in the blood flow can be stated as the first sign of hemolytic disease.
Dopplerometry must also be performed in the following cases:
- fetal growth retardation by ultrasound,
- identification of polyhydramnios or low water,
- CTG changes (fetal heartbeat recordings),
- with premature discharge of water up to 34 weeks,
- in identifying congenital malformations in the fetus,
- with a single umbilical artery,
- with placenta previa,
- if there are signs of aging of the placenta by ultrasound,
- if a woman had previously had fetal death in utero.
With the help of the Doppler study, one can reliably indicate whether the fetus has an entanglement of the umbilical cord and how many times.
The degree of blood flow disorders
After registration of the velocity of blood flow between the systems of the woman-placenta and the placenta-fetus, changes are evaluated by degrees. This helps to more clearly assess the picture of what is happening. Further, the decoding of the data obtained in Doppler.
- Grade 1A. Changes are recorded only in the uterine vessels resistance index, the blood flow in the umbilical artery and brain of the fetus is maintained at a normal level.
- Degree 1B. Irregularities in the vessels of the umbilical cord, the head and neck of the fetus, while in the uterine vessels - the norm.
- Degree 2. There are changes in the blood flow in the vessels of the mother and fetus, but the numbers are not critical.
- Degree 3. Detectable indicators indicate a severe, often critical, fetal condition that requires immediate treatment or delivery.
Is the procedure always necessary?
Today, almost all women do Doppler ultrasound during third trimester pregnancy at least once, and when violations are detected - at least one more control. There are no contraindications for this procedure.
If pregnancy proceeds without complications, there are no violations according to the fetal CTG recording and conventional ultrasound, the woman feels the movement of the baby well, there is no urgency to complete the study.
Doppler ultrasound is done frequently and at different stages of pregnancy. Как и обычное ультразвуковое исследование оно не несет опасности для мамы и малыша. Существуют предположения, что при этом происходит некоторое нагревание тканей, а также механическое воздействие на них вследствие кавитации. Допплерометрия отличается от обычного УЗИ тем, что интенсивность ультразвуковых волн выше, чем и создается большее воздействие на ткани.
If violations are revealed
Depending on the violations revealed, the tactics of management of the pregnant woman. Often have to deal with the following.
- Malformations. Detection of defects incompatible with life (for example, transposition of cardiac vessels) in the 2nd trimester is an indication for abortion. If the prognosis of the defect is more favorable, the degree of severity of violations of the fetus in utero is specified, on the basis of which the time and mode of delivery can be adjusted.
- First degree blood flow disorder. In 95% of cases after treatment, even on an outpatient basis, on control Doppler, all indicators are within the normal range. About 5% of women in the detection of impaired blood flow of the first degree in the later stages retain these changes until the birth, while the condition of the baby does not suffer.
- Disturbance of blood flow of the second degree. In this case, inpatient treatment and control of Doppler every three to five days is necessary. Depending on the original cause of the impaired blood flow, the dynamics can be positive or negative.
- Violation of blood flow of the third degree. Detection of similar changes in pregnant women in 2 and 3 trimesters ends with delivery in the next few weeks. In the opposite case, the probability of fetal death is high.
For the treatment of disorders of MPPC drugs are used to improve uteroplacental and fetal blood flow, anabolic drugs. The following means are allowed during gestation:
It is important to know and understand what Doppler ultrasound is during pregnancy and to perform it prophylactically at least once from 30 to 34 weeks. If violations are detected, dynamic observation of women is possible not only by week but also by day. The important effect of Doppler on ultrasound: shows whether there is hypoxia during pregnancy and the likelihood of preeclampsia. The study is not dangerous for women and children. On the contrary, it has a high diagnostic value.
Reviews: "Excess check does not hurt"
And I was given dopplerography twice (25 weeks and there were edemas at a late term, about 36 weeks) on the same apparatus as the ultrasound, they simply switched the mode, it was visible not the baby, but the small vessels. In my opinion, there is no particularly terrible in this procedure.
I was given a doppler, showed a blood flow disorder ... the doctor was very frightened, sent me to the hospital to go to bed, they looked at me in rd and said that it was okay, there are several stages of blood flow disturbance: 1A. 1B and 2A .2B I have 1A- insignificant ... with such a diagnosis, they are not placed in the hospital ... if 2B and the like are more serious. They registered them in rd chimes and Actovegin was intravenously dripped. a month later, the Doppler once again got rid of the same bloodstream, and again G was waiting for it, and out of three RDs they sent back with the words “panikyorshy” .. it was all at 36 weeks ... there is nothing terrible in the dopler, an extra check will never hurt — especially concerns nutrition lyalika.
In general, doppler is prescribed to everyone, I have now 32 weeks and have already reappointed ... but for the first time they did the placenta for 24 weeks ... they also wanted to put the hospital right away ... but they went to the doppler .. it turned out that everything was fine ... everything came to the baby ... soon go again ... look like what happened.
When you are in the hospital, they can drive a Doppler every day. As far as I know, this is an ordinary ultrasound, they are watching the blood flow there. On an ordinary ultrasound you look at the size of the head, tummy, etc., and here they only look at the blood flow (so that there is no hypoxia).
We were at the doctor again yesterday and we were once again doppler. and the doctor said, it is necessary to repeat every 2-3 weeks! to my question, is it dangerous, he said, the usual ultrasound is also not useful, but if there are indications, you need to do it, and that it is better to do a doppler and see a problem for its timely elimination, than to blame yourself ... ps We lost the first B at 25 weeks and the cause was never found, perhaps the blood flow was disturbed ...