Pathology of the fetus on ultrasound: large head, nose, stomach
- Diagnosis of hypoxia
- What are the dangers of suffocation by an umbilical cord?
ULTRASOUND diagnosis of pregnant women is carried out three times. But if the need arises, your doctor may order additional investigation to confirm or exclude the diagnosis.
At each routine ultrasound the doctor looks looks like a fetus. Whether the head, legs, arms, belly, nose the stage of development of the baby. At a later date, the doctor reveals what organs are developed correctly: heart, stomach, liver, etc.
Sometimes doing an ultrasound until 12 weeks. This is shown in the following cases:
- Burdened obstetric and gynecological anamnesis. That is, if in the past there have been cases of miscarriage, pregnancy loss, suspected a stalled pregnancy, etc.
- Complications during the current pregnancy (bleeding, acute abdominal pain)
- Pregnancy, which occurred after IVF
- If a previous pregnancy was identified fetal abnormalities (down syndrome or other trisomy, hydrocephalus, etc.)
Also to 12 weeks the ultrasound can give women with suspected hematoma. A hematoma under the influence of harmful factors on the pregnant uterus (infection, preeclampsia). Hematoma is:
These hematomas differ only by the time of their formation. If the hematoma is still no placenta is formed, it is called a retrochorial.
In the early stages of pregnancy a small hematoma usually does not cause pain in the abdomen and the ultrasound revealed. But it happens that in the early stages haematoma of large size, it’s dangerous abortion. In the later stages hematoma negative effect on the fetus – leads to hypoxia, reduction of the fetus in size. Early detection and not the large size of the hematoma will help heal and give birth to healthy full-term baby. Treatment of a hematoma, basically, requires space in the hospital.
What can you identify in the first trimester?
During the first ultrasound can determine the risk of down syndrome and some other chromosomal abnormalities. Most importantly, the fruit was of a certain size. Measured CTE (coccyx-parietal size), it needs to be at least 45 mm but no more than 84 mm. If the fetus is too small or too large on the contrary, it will be impossible to interpret this indicator as the nuchal translucency thickness or area (VIP).
The thickness of the neck area is the thickness of all the tissues in the neck. Normally, this rate does not exceed 2.7 mm, and the average is 1.6 mm. If the size of the neck area more than 3 mm, the probability of the presence of down syndrome in the fetus is very big. Definitely one indicator does not give right to put such a serious diagnosis. A pregnant woman is shown to pass a number of examinations, including biochemical blood test, amniocentesis. The importance in confirming the presence of fetal down syndrome has an age pregnant. If a woman is older than 35 years, the risk of having a child with down syndrome increases markedly.
In case of suspected down syndrome in the fetus to conduct additional measurement of brain structures (the thickness of the neck area is normal, these measurements can not be made). The cerebellum in down’s syndrome reduced in size, as well as the frontal lobe. Also, if this syndrome ultrasound revealed the shortening of the fronto-thalamic distance.
The nose of down syndrome flattened and shortened, also the bone above the nose has a saddle shape. This is due to the development of the nasal bones. In this condition the nose becomes ossified with some slowing in this regard, the first ultrasound analog may simply not see the nose. Of course, with further development of the nose appears but it is reduced in size and somewhat deformed.
In fetometry at 12 weeks included measurements of individual organs and body parts. Head size (biparietal size) is equal to 21 mm, femur length of about 8 mm. in addition, estimate the circumference of the abdomen and the head, the shoulder length.
Suspected defects, which are found on the ultrasound at 12 weeks, not in all cases is confirmed by further survey. But if at this period was the suspicion of the presence of down syndrome, then subsequent ultrasound the doctor more detail and will examine the parameters of the fetus.
The second routine ultrasound
It is carried out in the period 20-22 weeks of pregnancy. By that time, the structure of the child developed and can be seen much better. We can evaluate the structure of individual organs and to identify their pathology. The heart of the fetus by that time fully formed, and renal pelvis. The presence of heart defects with simultaneous expansion of the renal pelvis must push on the idea of the presence of down syndrome. In this period the experienced doctor notices changes of the nose, characteristic of down syndrome. The extended nose along with the nose.
The gastrointestinal tract on ultrasound
The stomach of the baby is also more formed by that time and must have a cavity. Sometimes it happens that the cavity is not visualized or the opposite is extension. Sometimes it can be just a coincidence – the fruit took a particular position, the bad and the ULTRASONIC sensor, and sometimes the lack of, or an extension of the cavity in the stomach may indicate serious pathologies of the fetus.
For starters the specialist to ensure that the stomach has. Because sometimes perhaps the development of such a blemish as diaphragmatic hernia, where the stomach is moved from the abdominal cavity into the chest. If the stomach is in the right place, it is necessary to trace its connection with the esophagus and the intestine.
With atresia of the esophagus the gastric cavity is not detected. If a problem occurs in the pyloric (section of the stomach before the small intestine), the cavity may contain hyperechoic on and even be extended. A different kind of inclusion into the stomach of the fetus should be differentiated from tumor. Sometimes the fetus in utero can swallow the blood that ultrasound will also be noticeable. But such situations rarely lead to an increase in the stomach cavity, it still remains relatively small.
It should be noted that the normal size of the stomach is quite variable. As a consequence, notice the extension of the cavity, or increase the entire stomach to determine problematic. You need to evaluate the circumference of the abdomen and to correlate it with other parameters.
The small intestine is in the second trimester the fetus is well-formed. It should be about the same diameter and do not contain hyperechoic inclusions. If ultrasound revealed the inclusion of high density – it can be a symptom of some of the pathologies that later are confirmed in the newborn. Syndrome machiavelo ileus (hyperechogenic inclusions in the gut) can be a symptom of a genetic disease (cystic fibrosis, down syndrome, trisomy 18, and chromosome 13).
The study of the brain
The second screening ultrasound can assess the structures of the brain in more detail. To 22 weeks of well-formed ventricles of the brain. Increase their size is called ventriculomegaly. Many experts initially call it hydrocephalus. But the concept of hydrocephalus includes increased intracranial pressure and increased head size. Normally, when the transverse dimension of the lateral ventricles size should be up to 10 mm. But in different sources vary a few dimensions.
Hydrocephalus may be suspected if the fetus has the genetic disease (e.g. down syndrome). Also, the probability of hydrocephalus in the fetus if the mother suffered some infection during pregnancy. For example, toxoplasmosis, herpes virus, rubella cause multiple fetal abnormalities, including hydrocephalus
If the specialist put ventriculomegaly at the second routine ultrasound, at 30 weeks we can talk about hydrocephalus.
Also on the second ultrasound the doctor can see the face of the fetus. In this period it is fully formed nose, and lips resemble those of newborns. In the presence of a cleft between nose and lip and the doctor make out it. The cleft can be on one side of nose or both. Sometimes this defect is combined with a cleft palate. Other diseases of the nose on the ultrasound in this period are not visible.
Ultrasound at 30 weeks
The third routine ultrasound may confirm or exclude previously assigned diagnoses. For example, you can track the calving of the gastrointestinal tract to the rectum. Sometimes, the contents of the colon contain hyperechoic inclusion is a normal variant. The lumen of the small intestine is small in relation to the colon.
The head should not be more than the norm, otherwise it will be an indication of hydrocephalus. Of course, one head size for the diagnosis of hydrocephalus is not enough, more needs to be enlarged ventricles. But if developed external hydrocephalus, the subarachnoid space increases.
Diagnosis of hypoxia
During normal pregnancy ultrasound at 30 weeks is the last before the birth. The third ultrasound is often carried out with the use of Doppler. It is necessary to assess blood flow in the placenta and identify hypoxia.
In addition doplerometriya to identify hypoxia will help the overall picture on the ultrasound – the fruit are small and actively moving. CTG analysis is also important for the diagnosis of hypoxia. During oxygen starvation of the child’s heart beats too slowly (in motion to 130 beats alone to 110).
During hypoxia the child tries to find a place and move excessively, which can lead to obvity umbilical cord.
What are the dangers of suffocation by an umbilical cord?
Quite often, this ultrasound the doctor detects the entanglement umbilical cord around the head, or rather the neck of the fetus. In some cases, at the time of birth the baby was kicking and several times turns in utero and «unraveling». If the clamping of the umbilical cord is missing and there are no nodes, the entanglement does not cause discomfort to the fetus, it develops and grows well. And if you birth no problems (physician time freed the head from the umbilical cord), entanglement is also not a cause for concern.
Should we be worried only if there is a tight entanglement of the umbilical cord. In this case, disrupted blood flow between mother and child. The tight entanglement of the umbilical cord can be isolated, and can be combined with another entanglement (one around the neck, the second around his head, belly or other body part). However, the umbilical cord shortens and limits the mobility of the fetus.
There are cases of multiple entanglement umbilical cord around the baby’s neck. This option is not very favorable but if does not cause hypoxia, it may end with the birth of a healthy baby.
The same unfavorable outcome in obvity umbilical cord and the resulting hypoxia is cerebral palsy and other neurological disorders of the newborn.
Causes of cerebral palsy
- Hypoxia before or during birth.
- The weight of a premature baby is less than 2000
- Intrauterine infections and other teratogens (drugs).
To prevent the development of cerebral palsy can only oseltamivir – pregnancy planning, refusal of harmful drugs, no stress. In new research, more and more reveal a genetic predisposition to cerebral palsy.
It should be noted that a diagnosis like cerebral palsy exhibit only after 1 year. And before that, the kid lives with encephalopathy of the newborn. Cerebral palsy put after a year because of this diagnosis need some clinical manifestations that must be tracked during the first 12 months of life.
To confirm cerebral palsy conducted a number of tests: EEG, head CT, etc. the child’s Parents should closely monitor the baby’s development, to see the signs of development of cerebral palsy or lack thereof. How long after delivery will be held to develop the clinic is not known for certain.
Most of the pathologies of the fetus are diagnosed on ultrasound. That is why ULTRASOUND diagnosis is included in the screening.