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Doppler, for pregnant women, what is it? Indicators, norm, transcript

The system "mother-placenta-fetus" is the most important link in the process of gestation and childbirth. The worse it will function, the greater difficulties in prenatal development the child will experience.

Useful substances and oxygen are delivered to the fetus with the help of blood vessels located in the placenta and umbilical cord. If some of these blood vessels are not working properly, the baby is not receiving enough food.

Dopplerometry in pregnancy is a procedure that helps to assess the condition of the blood streams and the degree of their deterioration. It is not prescribed to all pregnant women, but only to those who have good reasons for passing this survey.

Doppler measurement for pregnant women

Indications for the appointment of dopplerometry in pregnancy:

  • Dystrophic changes in chorionic villi - can be seen by a doctor on a planned ultrasound at 20 weeks. The basis of these villi are capillaries. If the circulation of the placenta is disturbed, then partial or complete blockage of the vessels becomes apparent on ultrasound examination.

In such cases, the pregnant woman is diagnosed as "a threat of fetoplacental insufficiency," and she can be sent for examination with the help of a doppler.

Absolute indication for the diagnosis is the presence of several ultrasound results, in which dystrophic changes in the chorionic villi are noted.

  • Insufficient number of blood vessels in the umbilical cord - can be diagnosed first with the help of conventional ultrasound. Normally, the umbilical cord should have 3 blood vessels: two arteries and one vein. But in some cases, the specialist diagnoses only 2 vessels (arteries are not two, but only one). The doctor diagnoses "the only artery of the umbilical cord" (EAP) and prescribes conducting dopplerometry.
  • Intrauterine fetal hypoxia - can be detected by blood analysis and by cardiotocography (CTG). If during repeated studies the parameters remain unchanged, the pregnant woman is assigned a Doppler scan whose purpose is to detect problems in the functioning of the utero-placental blood flow system.

Content

Dates and frequency of Doppler

Dopplerometry in pregnancy can be prescribed no earlier than 20 weeks, despite the fact that the placenta itself ripens completely by 15-16 weeks.

The procedure should be performed no more often than once in 3-4 weeks, but, as a rule, if after the treatment course the placental blood flow state improved significantly, then the Doppler try not to prescribe any more.

The only exception is when the body of a pregnant woman constantly provokes a worsening of blood supply, and all measures for treatment are only temporary.

In particular, these are women who have thrombophilia and other diseases associated with bleeding disorders. Such patients are prescribed Doppler examination at 20, 24, 28, 32 and 36 weeks.

After the eighth month of pregnancy, the examination usually loses its relevance, since women with thrombophilia rarely wear a child up to 40 weeks.

Dopplerometry - interpretation of indicators, norm

Dopplerometry - interpretation of indicators, norm

In order to interpret the Doppler indices it is necessary to familiarize with such concepts as systolic and diastolic blood flow velocity.

  • Systolic velocity is the rate of blood flow during systole (the state of the heart muscle when contracted). Diastolic velocity is the speed of blood flow during relaxation of the heart muscle. The following concepts are used to evaluate the results of the study:
  • The pulsation index (PI) is the ratio of the difference between the systolic velocity and the diastolic velocity to the mean velocity of the blood flow.
  • Resistive index (RI) is the difference between systolic blood flow velocity and diastolic velocity.
  • Systolic-diastolic ratio (SBO) is the ratio of the blood flow velocity to the compression phase and the relaxation phase of the heart muscle.

Normally, with Doppler measurement for pregnant women, starting from week 20, starts to decrease from 2.0 to 0.40. Pathologic indices of blood flow in the uterine artery in the third trimester are BSR values ​​exceeding the level of 2.6.

The resistive index as the delivery approaching should also decrease from 3.8 to 2.22. Too dramatic decrease or, conversely, an increase in RI is considered a pathology and requires medical intervention.

Degrees of circulatory disorders

When deciphering dopplerometry in pregnant women, three degrees of vascular fetal and placental abnormalities can be identified, which will indicate the severity of the processes that occurred in the direction of deterioration.

  • Violation of grade I A means that in the uteroplacental blood flow there are pathological changes, the fetus-placental blood flow is not affected. Violations can be detected either in the right, or in the left artery, or in both at once. At this stage, there is no threat to the life of the fetus, but if you do not start treatment in time, the first degree will be transformed into the third in 3 weeks, and the therapy may already be powerless.
  • Violation of I B degree means that pathological changes have occurred in the fetus-placental blood flow, and utero-placental continues to function normally. The violation is considered harmless to the life of the child, but requires medical treatment.
  • Violation of the II degree means that pathological changes have affected both uteroplacental and placental-placental blood flow. Such a diagnosis involves placing the patient on inpatient treatment and frequent ultrasound monitoring of the fetus and placenta.
  • Violation of the third degree means that the system of blood supply of the fetus and the placenta is in critical condition, the child experiences severe hypoxia, and pregnancy is close to interruption. This condition suggests immediate hospitalization and intravenous infusion of drugs to improve blood circulation, as well as bed rest.

Any pathology revealed on the Doppler study should alert the doctor, because if there is no timely reaction of the child's life, a mortal danger can be threatened.

Therefore, if the gynecologist sends to hospital for treatment, it is necessary to follow these prescriptions and go to the hospital.

Types of doppler examination of pregnant women

Doppler ultrasound for pregnant women can be carried out in two forms: duplex scanning and triplex scanning. The method is chosen depending on the tasks that the doctor faces. The more complex the situation and the more alarming the symptoms, the more detailed diagnosis the doctor chooses.

  • Duplex scanning - is assigned to check the blood flow velocity. It can be used in two modes: pulsed and constant. Such a study allows to identify the cause of violation of patency of blood vessels, as well as a specific artery, the functioning of which is broken.
  • Triplex scanning - performs all the same functions as duplex. Its difference is that it becomes possible to examine the blood flow in a color variant - this makes the study more accurate. Triplex scanning is a complement to duplex scanning.

How is doppler

The procedure is similar to ultrasound. Actually, this is the apparatus of ultrasound, only with the Doppler study a special sensor is connected to it.

The doctor lubricates the abdominal wall of the pregnant with a special gel, and then the image is displayed on the screen. However, with Doppler, the central object of investigation is not the child, but the placenta and umbilical cord.

Therefore, the image of the baby on the screen is miniature, and the histograms, which indicate the movement of the blood flow on the contrary, occupy most of the monitor.

During the research, the doctor turns on the sound sensors and listens to the rhythm of the pulsation in the blood vessels. The study itself lasts longer than usual ultrasound (on average, about 30 minutes).

Doppler control can provide indispensable help in managing complex pregnancies with chronic fetal hypoxia and maternal blood clotting disorders. Thanks to him, many pregnancies are successfully saved and nurtured before the due dates.

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