Screening during pregnancy

A popular screening method during pregnancy causes many contradictions among doctors and expectant mothers. A prenatal or pre -ration complex of research allows you to identify threats of pregnancy and the risks of the presence of defects in the fetus.

Families during pregnancy are several types of laboratory and ultrasound diagnostics at different periods, and also determine the risk of defects as a percentage. After such a comprehensive diagnosis, the results may be indications for detailed invasiic type examinations and consultations with a geneticist. However, invasive methods are associated with high risk to pregnancy and fetus, therefore, they are rarely prescribed.

A high percentage of risk does not mean the guarantee presence of defects, but requires deeper and more detailed examinations. Referring to reviews about screening during pregnancy, we can say that this procedure helps to prevent danger to mother and child at any time and childbirth. In the presence of dubious indicators, do not despair, it is necessary to conduct repeated and deeper tests at the request of specialists.

How is screening during pregnancy?

The word "screening" in translation from English means selection, weeding, sorting. Such a literal definition can clearly understand that the tests and tests for screening during pregnancy determine various pathologies. Specific analyzes included in the mandatory complex can be divided into periods of pregnancy.

Terms of screening during pregnancy:

1. The first trimester (from 11 to 13 weeks).
2. The second trimester (from 16 to 24 weeks).
3. The third trimester (based on the complex of the previous ones).

Types of screening tests:

• dopplerometry;
• cardiotocography;
• blood for biochemistry;
• ultrasound study.

Screening during pregnancy by terms

Let us consider in more detail all periods of analyzes and the need for each of them to identify pathologies by screening, as well as their normative meanings and dangerous deviations. Since the analyzes are not justified reasons for the stress of expectant mothers, they should be correctly interpreted and if you need to pass it again.

The first screening during pregnancy

The most important analysis is the first screening in early pregnancy and, even if you feel good, this is not a reason to assume that you do not need diagnostics. The first screening at the 12th week of pregnancy is carried out by a study by ultrasound and a biochemical detailed blood test. The latter needs accurate indicators of hCG and RARR-A.

During an ultrasound screening during pregnancy at the 12th week, the gynecologist will not only be able to determine the presence of all vital organs and limbs, but also calculate the thickness of the collar space (TVP). This special zone between the skin of the neck and tissues accumulates a kind of liquid, and the threat of pathology depends on its thickness. Often serious violations indicate pathology or developmental features.

The reliability of the result is ensured by the following conditions:

• the size of the embryo from the core to the crown is usually 44-85 mm;
• saggital scanning is carried out along the body of the mother, dividing it into two visually equal parts;
• the time for diagnosis should be as close as possible to 12 weeks.

Also, factors such as the quality of equipment and the qualification of a specialist are important in diagnosis of this kind. The image should be complete and, if the fetal head is turned or bent, then this may complicate the measurement of the TVP. The norm of the first screening during pregnancy is 0.11-0.16 cm at a maximum value of 0.25 cm.

An increased TVP indicates the presence of chromosomal disorders, for example, Down syndrome or Edwards and others that will be detected on subsequent screening. However, the measurement of the TVP does not give complete confidence in the presence of defects, so a blood test is also carried out. Also, in rare cases, an amniocentesis (analysis of amnetic fluid) and cordocentesis (blood test of the umbilical cord) can be prescribed.

When examining blood on the first screening, two indicators are taken into account:

1. HCG. The level of this hormone, distinguished by the germin shell, is an indicator of pregnancy and usually should not exceed the norm (from 200 thousand to 95 thousand honey/ml).
   • The increase speaks of such factors:

• multiple;
• the wrong diagnostic period;
• diabetes in pregnant women;
• toxicosis;
• chromosomal disorders or Down syndrome.
  • Reduced hCG can mean:
• placental failure;
• the risk of ectopic pregnancy;
• the risk of miscarriage;
• edwards syndrome.

2. RARR-A. The immunomodulating protein of the placenta should be within normal (from 0.33 to 8.55). Its high deviations indicate developmental disabilities:

• the risk of miscarriage;
• downs, Langa, Edwards syndromes;
• chromosomal disorders.

Second screening during pregnancy

Ultrasound of screening during pregnancy of the second trimester allows you to determine the presence of deviations in the fetus and a possible risk of termination of pregnancy. The level and possible slowdown in development in connection with the inconsistency of indicators are clarified. The size and location of the embryo relative to the pelvis is clarified, on the basis of which the childbirth method is accepted.

An important stage of ultrasound is fetometry, which allows you to measure the body and identify the risk of dysplasia (skeleton development). Each limb and their correspondence on the absence of their parts and pathologies are also evaluated. At the stage of fetometry, such vices are diagnosed in more detail:

1. Amniotic fluid. The depth of the filling indicates a little or multi-lead for deviations, which leads to defects.
2. Face. The nasal part and jaw are carefully studied to detect cleft, smoothed and shortened parts of the face with Down syndrome, cyclophy or underdevelopment of the eyes (anophthalmia).
3. Brain. Both ventricles, their external and internal formations are measured. With an increase in the norm of 10 mm, you can fear hydrocephalus (water formations).
4. Organs. Diagnosed with the absence of defects and painful formations.
5. Placenta. Its location allows you to determine the delivery, and the thickness indicates the possible infection of the fetus or Rh conflict and developmental delays.
6. Spine. Measurement and appearance allow you to determine diseases and hernias.
7. Umbilical cord. The amount of veins and blood vessels is estimated, which may indicate hypoxia.

Biochemical screening during pregnancy up to 20 weeks is usually carried out on the basis of hormone estriol, hCG and AFP hormone. High deviations from the norm of these indicators may indicate the presence of vices or complications in which there is:

1. Intrauterine death:

• increased AFP;
• HCG, Estriol.

2. Nervous tube condition defects:

• increased AFP;
• HCG, estriol is normal.

3. Multiple:

• increased AFP, hCG, estriol.

4. The backwardness of development:

• increased AFP;
• HCG, Estriol.

5. Early birth:

• increased AFP;
• HCG, Estriol.

6. Down syndrome:

• reduced AFP, estriol;
• increased hCG.

7. Patau syndrome:

• AFP is normal;
• estriol of any;
• reduced hCG.

8. Edwards syndrome:

• reduced AFP, hCG, estriol.

9. Trisomy:

21 pair chromosomes:

• reduced AFP, estriol;
• increased hCG.

13 pairs of chromosomes:

• AFP is normal;
• estriol of any;
• reduced hCG.

18 pairs of chromosomes:

• reduced AFP, hCG, estriol.

The hormone alpha-phytoprotein is produced by the liver and gastrointestinal tract of the fetus, which protects it from the effects of the immunity of the mother. His deviations from the norm may indicate:

1. Reducing the level of AFP:

• the wrong period of pregnancy, established earlier, can be the cause of differences from the norm;
• down syndrome is confirmed by the presence of 21 pairs of chromosomes and fully confirms preliminary studies;
• edwards syndrome is confirmed by 18 in pairs of chromosomes and is not amenable to treatment, therefore, a further decision is made to preserve the fetus;
• the death of the child should be confirmed by ultrasound diagnostics, then the surgical removal of the fetus is carried out.

2. AFP increase:

• viral infection can cause fruit liver;
• a hernia or fusion of abdominal walls is confirmed on an ultrasound;
• the underdevelopment of the nervous tube leads to the crevice of the spine and anencephalus;
• esophageal atresia means the absence of channels that ensure the receipt of the necessary food to the fetus;
• meckel syndrome is confirmed by a hernia of the skull or brain on the back of the head with ultrasound.

The hormone of Estriol is released by the placenta and liver of the child and its level should gradually increase, since it takes part in the generic readiness of the uterus and mammary glands during lactation:

1. With an increase in estriol:

• disease of the liver and urinary tract in the mother;
• multiple;
• the size of the fetus is greater than the norm.

2. With a decrease:

• anencephalus;
• hypoplasia;
• infectious diseases of the child;
• early birth;
• down syndrome;
• fetoneda -resistance of the placenta.

Hormone HCG and its normative deviations in conjunction with indicators of other blood biochemistry tests and ultrasound diagnostics may indicate possible syndromes of Down, Patau or Edwards. It is also worth considering the normative deviations of chromosomes and previous blood screening during pregnancy. Based on a complete detailed diagnosis, the gynecologist can make a diagnosis for the presence or absence of pathologies for the development of the fetus, impaired pregnancy and threat of childbirth.

Third screening during pregnancy

Ultrasound diagnosis at 33 weeks determines:

1. General assessment of the health of the fetus.
2. The possibility of vices.
3. The amniotic fluid and their excess speak of multi -guide, which leads to the incorrect arrangement of the fetus, the loss of the umbilical cord, the bleeding, vices and death of the child.
4. Assessment of behavior.
5. The placental state implies the possibility of cesarean section if it is located below the norm, which can cause bleeding and injury during natural delivery or hypoxia of the fetus.
6. The approximate weight should be about 2.5 kg, since if the weight at 40 weeks exceeds 4 kg, then the gynecologist and obstetrician will decide on the surgical acceptance of childbirth.
7. The dimensions of the body parts.

Dopplerometry determines the normal work of blood supply between the woman, her placenta and the child, the strangulation of the umbilical cord and defects of the heart. Such screening during pregnancy is not prescribed for the norm of indicators of the first trimesters, since the diagnostic radiation power is higher than with ultrasound. There are several indicators for this study:

• maternal diseases of the heart and circulatory system, kidneys and liver, diabetes;
• fetal development pathologies and infectious intra -placental diseases;
• heavy pathologies of the anamnesis.

The degree of defects that the Dopplerometry reveals:

1. Violation of a compensated type is often found and does not cause serious pathologies of development. Farms can be adjusted with medication and under outpatient observation. With normalization of the state of childbirth, they are resolved naturally, and with a deterioration, a decision is made on a cesarean section ahead of schedule.
2. Violation of the subcompensated type is determined by insufficient blood flow and a reduced amount of oxygen. With outpatient treatment, a course of medication is prescribed and the pregnant woman is under constant medical supervision. With a deterioration in the condition, there is the possibility of early childbirth.
3. Violation of a decompensated type is quite rare, which requires immediate hospitalization in a hospital and enhanced medical control. A worsened state provides for an interruption or early birth.

Dopplerchocardiography allows you to examine the heart blood flow of the child and detects severe heart pathologies, and also determines the risk of death of the child and allows you to prescribe timely drug treatment. Indications for such a study are:

• growing placenta in the uterus of a pregnant woman;
• slow development and pathology of the fetus;
• violation of the heart of the heart in ultrasonic diagnosis;
• disturbances in the fetus and arrangement of the umbilical cord;
• disruptions in the operation of the circulatory system;
• heartbeat disorders;
• the need to determine the defects and prescribes treatment;
• deviations from the norm of blood vessels and arteries;
• suspicions of pathology of the heart;
• frequent vices of internal organs.

Cardiocography is performed for all pregnant women and determines the general condition and frequency of the pulse in the fetus, which is carried out only after 32 weeks. In the study, it calculates the fetal condition that shows:

• about 1 - lack of vices;
• about 1.5 - the probability of violations;
• about 2.5 - the risk of developing vice;
• more than 3 - the presence of vice.

Controversial facts about pregnant women screening

There are several common opinions that may affect the solution of such a study:

1. A blood test does not allow to determine the result with high accuracy, but in conjunction with other methods gives a more complete picture about the state of health of the baby and the course of pregnancy.
2. The impossibility of correcting defects really exists, but diagnostic indicators allow us to make an important decision on artificial termination of pregnancy or on the necessary measures during childbirth.
3. Poor well -being of the mother is an important aspect for the cancellation of diagnostics, since general indicators can significantly distort the actual data.
4. Fear of a negative diagnosis must be overpower and understand that the diagnosis can only assume the assumption of pathologies.
5. Ultrasound does not harm when examining with high -quality equipment.
6. Good heredity and the absence of diseases in the family do not guarantee protection against fetal pathologies.
7. The price of screening during pregnancy is about 1,500 rubles, which can only be partially paid for the health care center or additional medical insurance.

Video about screening during pregnancy

Find out how screening goes and what it shows can be shown by the next video: