Fetal Doppler: Indications for the procedure, interpretation of indicators

Waiting for the appearance of the baby immerses the future mother in a series of endless experiences: thoughts of motherhood, the anticipation of the first meeting and anxiety for the safe development of the fetus accompany the woman throughout pregnancy. Often, she thinks about the adequacy of medical management of pregnancy and the need for certain studies to identify pathologies in the body of a developing baby.

Anxiety and fears associated with the ongoing process - the natural state of a pregnant woman. However, very often in an effort to learn as much as possible, the expectant mother is forced to collect information from various sources, where reliable data are not always given. To eliminate the impact of negative information, we will try to understand some aspects and consider what is dopplerometry of the fetus.fetal dopplerometry

Modern ultrasound examinations

With the help of modern equipment, you can identify the characteristics of many serious pathologies and prevent their further development. Such procedures are painless and safe for the health of both the expectant mother and the developing body. Ultrasound examinations are necessary to monitor the development of the fetus in every pregnant woman. Ultrasound examinations for women with susceptibility to various pathologies are especially important. These are patients over 35 years old or those with serious hereditary or acquired diseases.

Diagnosis with the help of special equipment makes it possible to obtain more complete and reliable information about the state of the fetus. Such studies allow us to identify signs of severe fetal diseases, possible deviations and complications in the management of pregnancy. Timely assessment of the state of the developing fetus helps to identify the mental retardation of the child, congenital malformations and disorders of the internal organs.

Using ultrasound equipment identifies abnormalities in the maternal organism.Based on the results of the analysis, the doctor can judge the condition of the uterus and placenta. Modern devices make it possible to find out if the child has enough oxygen or, conversely, the baby suffers because of its insufficient amount. Timely identification of threatening factors makes it possible to eliminate them safely.what is doplerometry

Dopplerography during pregnancy

One of the ultrasound techniques is doppler sonography. This diagnostics is based on the use of the Doppler effect, the essence of which is reduced to capturing the reflected changes in the frequency and length of the radiation due to reflection from the object. In the human body, blood cells are considered as moving objects. The Doppler method allows you to set the characteristics of blood flow in the arteries and blood vessels of the fetus, maternal uterus, umbilical cord and placenta. With its help, determine the nature and location of the pathology.

What does a woman experience during the study?

Dopplerography during pregnancy is an absolutely painless and harmless procedure for both the mother and the fetus. If the ultrasound device is equipped with special technical and software, it is often carried out simultaneously with ultrasound diagnostics.Doppler sonography does not differ in any way from the standard ultrasound examination. However, it allows you to find out the vital characteristics of the fetus that cannot be detected with a conventional ultrasound scan.

How is the procedure?

Dopplerometry of uterine and fetal vessels does not require special training. The future mother simply comes to the ultrasound specialist, preferably an hour and a half after eating. It does not require a full bladder or special diets.

A pregnant woman needs to sit on a couch, freeing the belly for the study as much as possible. An ultrasound diagnostics specialist will apply a drop of special gel so that the sensor slides freely. In principle, the description of the procedure is the same as in a conventional ultrasound examination.

The monitor will display color images, in which the movement of the blood flow directed to the sensor is highlighted with shades of red flowers, and the blue blood flow directed from the sensor is highlighted in blue colors. The intensity of the color tone means a higher speed of blood flow in the artery.dopplerometry of the fetus transcript

Planned ultrasound using the Doppler method

One of the important conditions for the adequate management of pregnancy is the timeliness of fetal Doppler. At what time to do, exactly determine the observing doctor. The first examination is usually prescribed for terms from 20 to 24 weeks. At this time, it is already possible to determine the likelihood of impaired blood flow in both the placental layer and in the umbilical cord or in the fetus.

In the case of pathology, appropriate therapy is prescribed and careful monitoring of the condition of the fetus right up to the birth of the baby. Dopplerometry is especially important for pregnant women at risk. If there is no evidence, then at 30-34 weeks of pregnancy the next examination is carried out using the Doppler diagnostics.

Fetal heartbeat

The heart rate of the developing in the womb is considered an indicator of most of the processes occurring in the developing fetus. According to its structure, the heart rhythm is a carrier of a huge amount of information. It characterizes the protective and adaptive reactions of the fetus to negative effects and any changes.

Despite the large number of techniques and the development of complex, invasive means of studying cardiac activity, the method of ultrasound diagnostics is by far one of the most accurate, affordable and safe.That is why all women's clinics and maternity hospitals have special ultrasound machines.

The undoubted advantage of ultrasound is the ability to control the work of the heart. Already in the earliest periods, when other methods cannot yet be applied, ultrasound examinations can reveal defects and pathologies. Doppler echocardiography is the leader in studies of hemodynamic processes in the fetal heart.dopplerography during pregnancy

This is a modern method of studying the work of the developing fetal heart in utero, it allows you to identify and evaluate three basic characteristics - the speed, direction and nature of blood flow. With it, you can select the most complex congenital defects. Doppler echocardiography carried out on the following indicators:

  • Sdfd, or pathological conditions, where the study of intracardiac blood flow is a decisive predictive factor.
  • With conventional ultrasound, anomalies of the heart are visible.
  • To clarify congenital heart disease.
  • Identify the nature and nature of hemodynamic disorders.
  • When violations and failures of heart rhythms.

Analysis of the work of the heart is carried out in tandem with other equally important studies, however, using ultrasound diagnostic methods, it is possible to find out the frequency of contractions of the heart muscle. With the likelihood of fetal hypoxia or impaired placental circulation, such non-stress tests can be carried out in the right quantities. This will allow you to compare the results with previous ones and track the status of the future baby in dynamics. Ultrasound examinations are especially needed after the treatment has been carried out.pregnancy management

When do they do such a study?

Diagnostics by the Doppler method is carried out after the complete formation of the placenta, usually this period of more than 18 weeks. Indications for dopplerometry - the presence of diseases such as preeclampsia, hypertension, kidney disease, diabetes and other serious diseases, as well as age up to 20 or over 35 years. With a negative Rh factor of blood rejection of the fetus due to circulatory disorders, therefore, the doctor prescribes an ultrasound examination according to this method. Multiple pregnancy is also the basis for Doppler sonography.

This study is carried out if the doctor suspected violations in the development of the fetus and the presence of congenital malformations, to detect low water or premature maturation of the placenta. Dopplerography is used to exclude chromosomal changes in the fetus and to determine abnormalities in the structures of the placenta and umbilical cord.

It is recommended if the previous ultrasound examination revealed umbilical cord embryo, with injuries of the abdomen of a pregnant woman, with poor results of cardiotocography (CTG) or the likelihood of development of the future baby from the generally accepted norms, as well as in cases where previous pregnancies ended in miscarriage.

Mandatory examination

According to the state prenatal screening program, every pregnant woman who is observed in any Russian medical institution must undergo an ultrasound examination at least three times. These studies include dopplerometry of the fetus.

In 3 trimester, the fetus occupies a position in which it will remain until the birth. Therefore, with the help of ultrasound on these terms is determined previa - head, pelvic or transverse.In addition, ultrasound diagnostics allows to determine the general condition of the unborn child, its mass, as well as the degree of maturity of the placenta, the transparency of the amniotic fluid and their quantity. The health of the fetus depends on the state of the placental layer. Detection of abnormalities in its maturation will indicate abnormalities in the development of the baby.fetal doplerometry norm

Doppler index values ​​and analysis

The results of the research are evaluated by a doctor observing the course of pregnancy. According to the indicators of fetal dopplerometry, the following are determined:

  • Resistive index (IR) is the difference between the systolic indices (with a contraction of the heart muscle) and the diastolic (with the relaxation of the cardiac muscle) blood flow rates.
  • The pulsation index (PI) is the difference between the systolic and diastolic blood flow velocities relative to the mean blood flow velocity in the vessel being diagnosed.
  • LMS - the relationship between systolic and diastolic blood flow velocity in the vessel.

For each type of arteries, these indicators may be different. Using dopplerometry, specialists calculate the blood circulation in the umbilical cord and uterine arteries, as well as in the carotid arteries and arteries of the future baby’s brain and its aorta.Based on the obtained digital data, the doctor can conclude whether the fetus suffers from a lack of oxygen or not.

Interpretation of dopplerometry of the fetus changes throughout pregnancy. DLS, IL and PI rates slowly decline in the second half of pregnancy. However, the obtained indicators depend on many factors of pregnancy and can be assessed only by a specialist.

IR rates by week of pregnancy:

Deadline in weeks

Minimum IR value

Maximum value of IR

From 20 to 23

0,601

0,801

24 to 29

0,561

0,771

From 30 to 33

0,519

0,741

From 34 to 37

0,481

0,701

From 38 to 41

0,401

0,681

LMS indicators also change as the term increases:

Deadline in weeks

LMS in the umbilical arteries

LMS in the uterine arteries

From 20 to 22

3,860±0,900

1,951±0,030

23 to 25

3,510±0,100

1,910±0,030

From 26 to 28

3,190±0,800

1,830±0,020

29 to 31

2,880±0,600

1,780±0,020

32 to 34

2,520±0,400

1,730±0,030

35 to 37

2,400±0,500

1,680±0,020

From 38 to 41

2,190±0,300

1,690±0,020

The interpretation of the results is based on an assessment of the indices, which reflect the degree of blood flow disorders. An increase in indices indicates an increased resistance to blood flow, and their low rates indicate a decrease in resistance to blood flow. This takes into account the indicator LMS.

The rate of dopplerometry of the fetus is the exclusion of any pathology of the blood flow.However, even with their identification, a woman should not despair. After all, studies are conducted in order to adjust the management of pregnancy and prevent the deterioration of the baby. If necessary, the doctor will select the necessary effective and safe treatment.

If blood flow disorders are detected, their degree is established, of which there are three:

The degree of blood flow disorders

Testimony characteristics

1 degree

A

Disruption of blood flow in the placenta is limited to one of the uterine arteries, the remaining hemodynamic parameters are stable and consistent with normal

B

The blood flow has a violation at the level of messages due to umbilical cord vessels, uterine arteries function normally

2 degree

Changed blood flow in the arteries of the uterus and umbilical cord

3 degree

Indicators are critical, possible occurrence of reverse blood flow in the arteries.

Summary values ​​of normal indices of planned doplerometry:

Vessel

Index

28 week

32 week

36 week

40 week

Umbilical artery

FROM TO

3,10-3,70

2,80-3,40

2,40-3,00

2,20-2,50

IR

0,650-0,730

0,600-,670

0,550-0,630

0,510-0,590

PI

1,080-1,090

0,950-0,960

0,830-0,840

0,730-0,740

Aorta fetus

FROM TO

6,00-7,60

5,70-7,30

5,40-7,10

5,20-6,80

IR

0,820-0,880

0,800-0,860

0,770-0,830

0,750-0,810

PI

1,790-2,240

1,760-2,200

1,740-2,170

1,720-2,130

Internal carotid artery

FROM TO

5,60-6,50

4,70-5,60

4,00-4,80

3,30-4,10

IR

0,780-0,880

0,740-0,840

0,710-0,810

0,690-0,780

PI

1,980-2,390

1,700-2,060

1,440-1,770

1,220-1,510

Uterine artery

FROM TO

1,70-1,90

1,70-1,90

1,70-1,90

1,70-1,90

IR

0,460-0,550

0,690-0,860

0,690-0,860

0,690-0,860

PI

0,690-0,860

0,690-0,890

0,690-0,860

0,690-0,860

Here, only some indices are within the normal range for individual arteries.The doctor, conducting a study, evaluates the whole complex of blood movement, correlating the obtained values ​​with the general state of the mother and fetus, the results of CTG and other examinations.

The future mother should understand that dopplerometry is a prerequisite for the adequate management of pregnancy. The development of the future baby depends on the normal blood flow. Careful monitoring of blood circulation is the task of a knowledgeable specialist, therefore, it is better to entrust the decoding of data to a professional.

Doppler ultrasound provides an effective diagnosis of fetal hypoxia, gestosis and developmental delay. This method largely allows you to prevent their occurrence and progression. As a result of such a diagnosis, effective therapy is possible.dopplerometry of uterus and fetus vessels

Pathology detected. What to do?

If in the process of research the result of Doppler is such that it requires the immediate adoption of certain medical effects, then the doctor will undoubtedly do everything possible to preserve the health of the mother and the future baby.

At the initial degree of impaired blood flow, outpatient treatment is usually prescribed with a mandatory control ultrasound examination.The results of Doppler will confirm the effectiveness of the therapy. For longer periods (from 32 weeks), multiple cardiotocography (CTG) is recommended to prevent the oxygen starvation of the fetus.

In cases of violations of 2 or 3 degrees, hospital treatment is required, where the expectant mother will be under the constant supervision of doctors. Critical indexes of dopplerometry indicate undesirable consequences: a placental abruption, intrauterine death of the baby or the likelihood of premature birth may occur. In the hospital, such patients are given daily cardiotocography and Doppler - once every 3 days.

When severe violations of blood circulation, corresponding to the third degree, there is a threat to the life of the fetus, so if it is not possible to bring it to the optimal state, then the question of the need for premature delivery is solved. Artificial birth is often carried out in order to, first of all, save the life of the mother. Fetal loss of the fetus due to improper blood flow can cause deadly bleeding, blood poisoning or embolism.Nevertheless, such a serious issue is not solved only by one attending physician. To select the appropriate tactics, consultations of narrow specialists are created, where all possible risks and complications for both the fetus and the mother are taken into account.

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