The modern pregnancy monitoring program provides for a three-time mandatory screening of a woman in the perinatal period. The main task of a comprehensive examination is to control the quality of women's and children's health, as well as to identify possible congenital malformations and developmental anomalies.
Genomic pathologies such as Edwards syndrome, Turner syndrome, Down syndrome on ultrasound are diagnosed with an accuracy of 91%. This allows the woman to decide whether to terminate or keep the pregnancy. Signs of severe genetic damage to the fetus are determined at the first or second screening, when the possibility of abortion is still possible (up to 22 weeks). In the future, if a woman refuses to give birth to a known sick child, the gynecologist can only offer artificial childbirth. Such a procedure is unsafe, painful and can seriously injure the psyche.
Downism has no gender or ethnicity and does not respond to treatment. In the process of growing up a child with Down syndrome, it is possible to correct his behavior with the help of special developmental programs, but it is impossible to get rid of the genomic syndrome. The occurrence of Downism is due to intrauterine chromosomal failure. The complete set of chromosomes of a healthy organism is 46 pieces.
In Down syndrome, an additional copy of the twenty-first chromosome is formed, as a result of which there are 47 of them. The causes of the disease are not determined, but it has been established that they are not derived from the negative influence of environmental factors, psychosomatic health or the asocial lifestyle of the parents. The disease is called a "mistake of nature" that cannot be predicted and prevented.
Factors that determine the risk of having a baby with a mutated chromosome:
In the case of multiple pregnancies, the disease affects both identical twins and only one if the children are fraternal. With a chromosomal mutation, the threat of spontaneous abortion and the birth of a still child increases several times.
Ultrasound in the perinatal period
Examination of a pregnant woman by means of ultrasound is one of the mandatory moments of perinatal screening. If the process of carrying a child is unremarkable, an ultrasound scan is performed once in each trimester. In case of complicated pregnancy, the doctor prescribes additional ultrasound procedures. Ultrasound waves are safe for the baby and mother, therefore, the study has no restrictions on the frequency of sessions.
Scanning can be done in several ways:
- 2-D ultrasound - black and white image, only a medical specialist (ultrasound doctor) can decode a flat image;
- 3-D ultrasound - the data received from the sensor is processed by a computer program, a three-dimensional image of the embryo is projected onto the monitor;
- 4-D-method - the child is displayed on the screen in three-dimensional projection, while it is possible to observe his movements in the womb.
- TVP (size of the collar space in thickness). The standard indicator for the amount of fluid under the skin of the embryo in the neck area should not exceed 2.7 mm. In Down syndrome, TVP is markedly increased;
- the size of the upper jaw. On ultrasound, the shortened upper jaw of the baby is clearly visible, which is a characteristic sign of Downism;
- anatomical structure of the outer part of the ears. Underdeveloped auricles are grounds for suspicion of a genomic abnormality;
- Heart rate (rhythm or heart rate);
- absence of the main nasal bone. Downs, as a rule, have a flattened face shape. This sign indicates the presence of pathology.
- Heart defects
- Insufficient length of the humerus and femur
- Increased thickness of the collar space
- No nasal bone
- Detection of a cyst in the choroid plexus.
In the last two options, the procedure takes a longer period of time. At the request of the parents, the doctor can print a photo of the baby. In order to prevent serious health problems for the mother and child, it is strictly forbidden to ignore ultrasound in the perinatal period.
First trimester diagnosis
At the first ultrasound, carried out from 10 to 14 weeks, the doctor assesses the fetometry (total size of the child), its position in the womb and the nature of the pregnancy. To identify Downism, certain markers (normative indicators) are used, with which the real picture of the study is compared.
The main defining markers are:
For a child in the first trimester, the following indicators are considered normal:
Ultrasound to determine fetal malformations
Unfortunately, not all pregnancies end with the birth of a healthy baby. In about 6% of cases, the child shows signs of a syndrome even at the initial stage of development. Not all deviations are considered incompatible with life. For example, signs of Down syndrome on ultrasound indicate that the baby will be special, but will live a long enough life if other malformations are not found in the fetus with this syndrome.
The diagnosis of Down syndrome is quite common. This is a congenital pathology of a genetic nature. Due to the fact that the fetus has an extra chromosome in 21 feathers. Down syndrome because of this feature is also called trisomy.
Down syndrome in the fetus is rarely limited only by the features of the external difference between the child and other children. Often this syndrome manifests itself as a combination of several congenital malformations characteristic of this pathology. Often on ultrasound, in addition to the characteristic features, you can see the abnormal structure of the heart, which will also be a developmental defect. Duodenal atresia and incomplete bowel rotation can also be associated with Down syndrome. Children with this deviation are at high risk of developing leukemia (acute leukemia).
Almost half of all children with Down syndrome have heart defects in the form of a ventricular septal defect. The intestine often affects a severe defect: the aganglionic area, or completely, of the large intestine, which is called Hirschsprung's syndrome. This condition often leads to intestinal obstruction and serious problems with digestion and bowel movements.
The Importance of Ultrasound in the Risk of Down Syndrome
Ultrasound diagnostics is able to accurately diagnose abnormalities in the development of the fetus with severe congenital malformations at a fairly early stage of pregnancy. This is necessary so that the parents have enough information and an accurate forecast for the life and health of the child. In especially difficult cases with a combination of several severe malformations, parents will be offered an abortion.
Down's syndrome itself is not so terrible, the combined vices are terrible, which will not be able to allow the child to live a life with a satisfactory quality. There is a risk of developing other diseases that have joined after the birth of a baby. The child will not be able to withstand the numerous surgeries to correct the anomalies and will die anyway.
For these purposes, a screening study is carried out along with an ultrasound scan. In the early stages of pregnancy, when termination of pregnancy with a positive decision of the council is still possible, a number of non-invasive and invasive procedures are performed.
Non-invasive tests include a biochemical blood test for hCG and ultrasound of the fetus. I resort to invasive measures when the first type of research gives more doubts than accurate information.
Invasive procedures include amniocentesis, chorionic villus sampling, and chordocentesis. All these procedures are carried out under the control of ultrasound and only in a certified hospital, where there are highly qualified specialists. Subject to all the rules and carried out by competent doctors, these methods of invasive diagnostics do no harm to either the mother or the fetus. These methods allow you to determine the presence of any syndrome or other malformations.
Fetal ultrasound and Down syndrome. An important picture from the first weeks of pregnancy
The first stage at which congenital malformations of the fetus are confirmed or refuted is ultrasound. Many genetic disorder syndromes can be seen after 10 weeks of pregnancy. A fetus with Down syndrome is no exception.
Ultrasound diagnostics is supported by biochemical studies of the mother's blood. This is called combination screening. Given the necessary or selective criteria, the probability of diagnosing a fetus with Down syndrome is approximately 75%. The use of doppleroscopy allows you to determine the malformations of the heart of the fetus. The combination of both methods increases the degree of correctness of the result.
Down syndrome markers
Ultrasound markers are called visible changes in the fetus, which are associated with a particular syndrome or malformations. Down syndrome has a specific set of symptoms.
Today, in the field of ultrasound research, a large information base has been accumulated in the form of photo and video materials, in which all obvious and indirect signs are displayed. Thanks to her, you can differentiate the general signs of a certain disease. When comparing photos, you can confirm or deny the diagnosis, which reduces the risk of having an unviable baby.
If there are signs that indicate a high degree of likelihood of the fetus having Down syndrome, doctors call a consultation. There is no one definite sign that would confirm this diagnosis with one hundred percent probability. Only the signs, of which there are several, in the aggregate, make it possible to make this diagnosis.
The most important marker that can prompt a doctor to suspect signs of the syndrome is the thickness of the collar space (approximately 75% sensitivity). In second place is the absence of a nasal bone (58%). Signs such as heart disease, rather short thighs and humerus tubular bones, increased intestinal echogenicity, extensive cysts of the choroid plexus, foci with hyperechoicity in the heart, signs of duodenal atresia are all signs confirming Down syndrome in the fetus.
Collar space. Measuring change
The collar zone in the fetus is an area transparent on ultrasound between the folds of tissues on the body of the embryo. It is also called the cervical fold. It is located in the area of formation of the future neck and below the back of the head. Its changes are clear signs associated with the syndrome.
The optimal time for measurement is from 11 to 14 weeks. This is a prerequisite for the first pregnancy screening. The data obtained during the study for this period are the most informative. They determine the risk of chromosomal abnormalities in the fetus. Signs of developmental deviation at this time are already evident enough.
The thickness of the cervical fold more than 3 mm is an indicator of the likelihood of having a fetus with Down syndrome, or the unborn child has other malformations.
However, an increase in the collar zone is not always a clear indicator of developmental deviation. Only taking into account all additional studies (biochemical blood test, gestational age of the fetus, mother's age) can we assume any malformations. And even despite this, the probability of a correct diagnosis is no more than 80%.
However, in ultrasound there are concepts of data error. Even considering that this is the main method of research for the presence of chromosomal abnormalities, there is a possibility of error. This is possible if the measurement technique is violated. The human factor can also cause errors not only in the measurement of the collar space, but also in the study of the nasal bone. Only the correct technique and the doctor's experience will help to accurately identify malformations.
Measurements of the pelvis and fetal brain structures
The presence of the syndrome can be confirmed by abnormalities in the structure of the cerebellum. In particular, his hyperplasia shows the presence of a clear deviation from the norm of development. A decrease in the frontal lobe indicates a high risk of Down syndrome in the unborn baby.
A serious deviation from the norm of development is the smaller tubular bones of the embryo. A clear decrease in the ilium and an increase in the angle between them is visualized.
If diagnosed with a malformation
Parents have the right to decide for themselves what kind of child they have. Even if a serious developmental defect has been found in the fetus, and the parents will be immensely happy to have such a child, no one has the right to oblige them to terminate the pregnancy. Doctors will do their best to make life for such a special baby acceptable to his condition.
However, if the parents are not ready for such responsibility, then they have the right to submit an application with a request for a consultation to decide on the termination of pregnancy. This is only possible up to 21 weeks. At a later date, termination of pregnancy is not possible according to the law of the Russian Federation.
Down syndrome on ultrasound: is it possible to determine the signs, what does the result look like?
Is it possible to determine Down syndrome by ultrasound
Down syndrome in the fetus is diagnosed by ultrasound in 60-90% of cases. High accuracy of the examination is achieved by comparing the development of the fetus with the norm. In addition to Down's syndrome, ultrasound can detect signs of a number of other genetic malformations. Pathologies in the structure of the heart, incomplete bowel rotation, duodenal atresia can also serve as signs of Down syndrome in the fetus, all these malformations are recorded by ultrasound.
Tests before marriage
Down syndrome is observed in one case per 700-800 pregnancies and is characterized by the presence of an extra 21st chromosome. The syndrome itself is not dangerous to health, although it affects the later life of the child. Unfortunately, along with Down's syndrome, a number of other pathologies develop, which are also detected on ultrasound. These pathologies can cause significant harm to the health of the baby.
The possibility of having a baby with Down syndrome increases with the age of the parents. In addition, the risk of a chromosomal abnormality increases significantly if one of the parents already has Down syndrome. In some cases, the pathology is mosaic in nature and may be invisible even for very close people.
Down syndrome is reliably diagnosed in the perinatal period using ultrasound and a number of other techniques.
How does Down syndrome manifest after birth?
Children with Down syndrome have a number of external differences. Their faces are flatter, with a poorly defined bridge of the nose and a fold of the epicanthus at the inner corners of the eyes. The child's skull is shortened, with a flat nape.
After birth, children with Down syndrome are somewhat lagging behind in physical and mental development, but in most cases they are capable of learning. Over time, the mental retardation, in comparison with other children, will become more and more noticeable.
In addition, people with Down syndrome are more likely to suffer from congenital heart defects (observed in almost 40% of cases). The presence of an extra chromosome significantly increases the risk of developing some other diseases: cataracts, Alzheimer's, myeloid leukemia, and disturbances in the functioning of the digestive system are often encountered. Weakened immunity makes people with the syndrome more vulnerable to viruses and colds.
Methods for diagnosing a chromosomal abnormality
Chromosomal abnormalities can be diagnosed by non-invasive and invasive methods. The former make it possible to establish a number of pathologies characteristic of chromosomal abnormalities. Invasive methods are used to make an accurate diagnosis.
Establishing the risk of Down syndrome in a fetus on an ultrasound scan is called ultrasound screening. The method is often used in combination with a biochemical analysis of the mother's blood. Accuracy of Down's Syndrome Diagnosis on Ultrasound in the second trimester of pregnancy can reach 91%. The examination is carried out at 11-13 and 16-18 weeks of pregnancy.
Invasive techniques
Invasive prenatal diagnosis can lead to a number of complications. The risk to the fetus and mother is small. However, the procedure is only prescribed if necessary if the fetus's Down syndrome is confirmed by ultrasound and maternal blood tests.
Biochemical screening
The main task of screening is to identify risk groups from the point of view of giving birth to a child with severe diseases, including those with chromosomal abnormalities. Biochemical screening is recommended for all women in the first and second trimesters of pregnancy.
Diagnostics in the first trimester of pregnancy
In the first trimester of pregnancy, Down syndrome can be diagnosed by ultrasound, due to the presence of a number of pathologies. These include the increased thickness of the collar space in the fetus, the smaller, in comparison with the norm, the size of the cerebellum and frontal lobe, impaired bone formation, heart defects, the absence of the nasal bone, etc.
It is important to remember that no single marker will be considered sufficient for a reliable diagnosis of Down syndrome - only ultrasound data are not enough for this. Therefore, having received the results of the examination, you do not need to be upset ahead of time - you need to consult a specialist.
What if the diagnosis was confirmed?
Examination can show pathology in the fetus. It is up to the parents to decide what to do next. If they are ready for responsibility, then even if Down's syndrome was confirmed by ultrasound and invasive research methods, the parents can leave the child. Despite the peculiarities of development, he can live a long and happy life. In cases where there are too many pathologies, doctors may recommend terminating the pregnancy. However, even in this case, the decision will be made by the parents.
Let's not look for Down syndrome in embryos! ©
What kind of children does society need?
The quote stated in the title of this post is the essence of the claims of the international organizations involved in supporting people diagnosed with Down syndrome. I'll tell you more.
Everyone knows that Down syndrome is the most common chromosomal mutation compatible with life. With her, the embryo, instead of a pair of twenty-first chromosomes, is found three such "X". Sometimes the cause of the disease is the wrong "fusion" of chromosomes - the so-called Robertsonian translocation. The result is one - a child is born with a certain set of characteristic features, which in some cases are incompatible with life (we are talking about gross malformations of internal organs), under a different set of circumstances, they complicate the development and socialization of a sick baby.
The most common developmental disorders in Down syndrome are muscle weakness, cataracts, congenital heart disease, strabismus, intestinal disorders and a number of structural features of the skull and limbs, as a result of which the child's body acquires characteristic features. This is the so-called Mongoloid eye section, and the big tongue, and short fingers, and the keeled chest. It is not at all necessary that a toddler with Down's Syndrome necessarily exhibits all of these signs. Much depends on the specific type of mutation that led to the development of the syndrome. And the quality of the future life is largely determined by the participation of parents in the fate of the child - all kinds of medical and rehabilitation measures.
History already knows many cases when people with Down syndrome successfully graduated from universities, became artists and started their own families. But, unfortunately, the life of most children with such a diagnosis is short and difficult - both due to poor organization of care for patients, and due to the persisting prejudice against this disease in society (in most cases, mothers abandon children with Down syndrome while still in the hospital).
Of course, the diagnosis of Down syndrome today is carried out during pregnancy in all civilized countries. According to the legislation of many states (including ours), a woman whose fetus has signs of this disease has the right to a medical abortion until late pregnancy. So every woman undergoes an ultrasound scan in each trimester. With a high risk of Down syndrome in the fetus, one of the invasive diagnostic procedures (for a period of 17 to 22 weeks) is possible: examination of amniotic fluid taken with a thin needle (amniocentesis) or analysis of a chorionic villus sample, samples of which are also obtained using a needle or a plastic tube. Both procedures lead to a miscarriage in one percent of cases, but with about a 95 percent probability they can detect Down syndrome in the fetus.
And recently, the German company LifeCodexx has developed a non-invasive test that allows in 95% of cases to detect Down syndrome in a fetus in the first trimester of pregnancy. It consists of two procedures - an ultrasound scan of the embryo and taking a blood sample from the mother, which is applied to a special test strip. Ultrasound examination evaluates the indices of the permeability of the cervical fold, as well as the presence or absence of the nasal bone in the embryo (typical signs of Down syndrome at this stage of pregnancy). The test, called the PrenaTest, evaluates the fetus's genome from its DNA circulating in the mother's blood. Thus, the new study avoids amniocentesis or chorionic biopsy, as well as late abortions (if, upon receiving a positive result, the woman decides to terminate the pregnancy).
In Switzerland, Germany and Austria, physicians have received this innovation with optimism. Some insurance companies have even suggested including it in the mandatory package of procedures for pregnant women. but an unexpected opponent of the procedure was the community of international organizations supporting people with Down syndrome. It has filed a lawsuit with the European Court of Human Rights against the manufacturing company PrenaTest. Thus, 30 associations from 16 countries declared that the Strasbourg court should “protect the right of people with Down syndrome to exist”.
No words, as they say. It is not yet clear how this story will end, but its very existence makes us think about our global prospects. Mutations are undoubtedly the engine of evolutionary progress, when they endow a biological species with qualities that help it better adapt to life in a changing ecological environment. Those mutations that randomly reduce the viability of an individual are eliminated by nature - hence both spontaneous abortions and early mortality in the absence of medical care (the laws are the same for both animals and humans). Of course, the social essence of the human race allows you to interfere with the laws of nature - it is thanks to this that the life of all "non-standard" and initially unadapted children continues - to the delight of themselves and their parents (it's good when everything goes like this). But! With what moral, ethical, biological. Yes, any position can be considered the desire to preserve the life of absolutely all embryos, regardless of their viability? Opponents of any type of artificial termination of pregnancy scream about "abortion eugenics" - it is impossible, they say, to interfere with the natural course of things! But what do we get in the end? What a society.
The question is complex. You can debate endlessly. I have already expressed my position, and over the past months it has not changed at all. But in the story with this claim to the European Court, I am outraged by something else. The new technique makes it possible to avoid dangerous - in terms of complications - diagnostic techniques at a later date. That is, even closing her eyes to Down syndrome, she simply saves the life of a certain percentage of children (including healthy ones). Could such an important invention be the reason for litigation? Strange, strange life.
Definition of Down syndrome by ultrasound
An ultrasound examination can be used to assess the likelihood of having a baby diagnosed with Down syndrome. Doing an ultrasound, they try to determine the presence of abnormalities indicating chromosomal mutations, expressed in the abnormal formation of the fetus. The technique is called ultrasound screening and can detect Down syndrome in 60 - 91% of cases.
Varieties of measurements
The probability of finding deviations depends on the type of measurements, called markers. There is no specific relationship inherent in a particular pathology, which forces us to take into account several indicators:
Even if these markers are found on ultrasound, this is not a confirmation of a chromosomal abnormality.
Screening requirements
The effectiveness of an ultrasound scan depends on the correctness of its implementation, namely, compliance with certain conditions. The study in the first trimester of pregnancy should be carried out from the 11th week and no later than the 13th week.
When a child is located in the uterus in such a way that it is difficult to make an adequate assessment of his condition, the woman is asked to perform certain actions: tapping on the stomach; coughing; minor movements. This is necessary for the fetus to change the position in the womb. Also, the method of performing ultrasound, which is available to do through the vagina or the skin on the abdomen, depends on the location.
Signs indicating the presence of an anomaly
The specialist is able to diagnose Down syndrome during the study if the gestational age is 11 - 13 weeks. The most significant indicator in determining this pathology is the thickness of the collar zone. If the collar space in the photo is thinner than 3 mm, then the risk of a chromosomal abnormality is extremely high.
In addition to determining the thickness of the cervical fold, the diagnosis of the syndrome is possible using other parameters. Particular attention is paid to the structure of the fetal brain and pelvis. If a chromosomal abnormality is noted, then one can see in the photo hypoplasia of the cerebellum, its significant decrease in size along with the frontal lobe. When it is possible on ultrasound to simultaneously detect a decrease in the size of the thalamic frontal distance and the cross-section of the cerebellum, then with a high probability, one can assert the presence of a syndrome.
An increase in the angle between the ilia with a simultaneous decrease in their length will serve as evidence of the anomaly. The indicator is measured in the cross-sectional area of the middle of the sacrum.
Percentage of risk
Regardless of the identification of certain symptoms, it is difficult to talk about the presence of the syndrome. We are talking only about the risk, which increases as a percentage for certain signs. For example, the absence of a new bone in 70% of cases is evidence of pathology, but 2% of children, despite this, are born healthy. The detection of a violation of blood flow in the venous ducts in 80% of cases confirms the anomaly, but 5% of newborns who had such deviations by the 11th week are normal.
Down syndrome is also confirmed by the following deviations:
- Enlarged bladder
- Tachycardia
- Absence of one of the umbilical arteries.
These signs in themselves are never confirmation of anomalous phenomena and require additional research.
Step-by-step ultrasound examination during pregnancy
The Ministry of Health of the Russian Federation issued Order No. 457, according to which women are required to undergo an ultrasound scan three times during pregnancy. The first study is carried out no later than the 13th week, the second at the 24th, and the third time at the 34th week. This is due to the need to control the dynamics of growth, the older the fetus, the more likely it is to determine an obvious symptom of an anomaly.
First screening
During each screening, certain tasks are set, in particular, at the 13th week, they seek to detect the presence of chromosomal pathology. The anatomical structure is assessed in order to identify characteristic malformations in development. The detection of a chromosomal abnormality with a high degree of certainty will allow taking preventive measures, for example, if it is decided to have an abortion, it will take place with minimal consequences for the health of the mother.
However, at this stage it is impossible to find all the defects characteristic of Down's syndrome, that is, it is probably premature to assert its absence at this time, even taking into account biochemical screening.
Second screening
Conducting a study at the 24th week will be more informative and will allow you to study in detail the structure of the fetus. Three types of defects can be identified here:
Ultrasound examination does not give a complete picture even in this case, that is, there is no guarantee that there is no anomaly. Only visualization of large defects of the heart muscle is available, but an insignificant degree of pulmonary stem stenosis cannot be diagnosed. The syndrome at this stage of screening is determined by the location and thickness of the placenta, as well as the volume of the available amniotic fluid.
Modern ultrasound technologies guarantee a two-chamber planar and three-chamber volumetric image. Each of the techniques is effective in its segment, for example, superficial defects: facial defects; spinal hernia - detected by a three-chamber method. Defects characteristic of internal organs are determined by a two-chamber study. The second anatomical ultrasound is performed within 45 minutes.
Stage Three
The third stage, carried out at the 34th week, is also important, because there is a small group of defects that appear after a second examination. There are several reasons for this:
You can do without the third stage, for example, in the United States, local doctors consider only the first two studies mandatory. They are allowed to be neglected by pregnant women in whom the second screening fully reveals the picture and there is a guarantee that the child is not threatened with Down syndrome.
Risk system
How high the likelihood of a fetus having a syndrome is determined by a special scale. There is a system of risks, if they exceed an indicator of 1: 380, then the woman is sent for additional examination. There are the following types of risks: high; short; average. If the data on the scale exceeds 1: 200, then there is a high probability that the syndrome will be diagnosed.
A satisfactory result is 1: 3001, in which additional tests are not required. An unscheduled ultrasound scan is recommended with an average risk, when the result is in the range between 1: 201 - 1: 3000. Signs indicating the presence of Down syndrome, in this case, are found, but they should be confirmed, for which an ultrasound examination is prescribed at the 16th week.
Conclusion
According to medical statistics, a woman who has reached the age of 35 - 40 years old can give birth to a child who will be diagnosed with Down syndrome with a probability of 1: 214, but women who have crossed the 45-year-old line are at much greater risk. The syndrome occurs in one infant out of nineteen newborns.
It can be stated that as they grow older, this likelihood increases, and doctors recommend an additional examination with ultrasound. However, even the revealed signs of anomaly are not a verdict, if there is only one pathology, then the probability is 2%.
When the number of echo markers is maximum, that is, all available signs are identified, chromosomal abnormalities appear in 92% of children. We can safely say only one thing, each expectant mother should be regularly examined and is under the supervision of a doctor who will monitor the condition at all stages of gestation.
Ultrasound of the peritoneum is one of the most popular types of examinations. What does an ultrasound of the abdomen give and what does the doctor reveal on the study?
The procedure is performed on an empty stomach in the morning. For several days before the examination, the patient will have to limit himself to food: due to the fact that gases accumulate in the intestines, through which ultrasound does not pass, the result of the examination may be either invisible or incorrect. Alcohol and carbonated drinks, beans, fatty, spicy, salty foods and black bread must be excluded from the diet for 3 days.
For a complete cleansing of the intestines, doctors recommend taking a laxative the day before the examination. In addition, pharmaceutical preparations, for example, activated carbon, will help get rid of gases. In the morning before the examination, you should not eat breakfast, smoke, drink water and suck lollipops, so as not to cause stomach cramps and not get a distorted result. It is better to suffer hunger for a few hours than to get a wrong diagnosis or a second referral for an ultrasound of the abdomen.
The liver is responsible for breaking down fats and ridding the body of accumulating harmful substances. Therefore, for example, when taking potent drugs, doctors recommend drinking hepatoprotectors, that is, drugs that protect the organ, improve its work and remove poison.
Normal liver readings should be approximately as follows:
- The sizes of the right lobe - up to 12 cm, left - up to 7 cm;
- The diameter of the portal vein is up to 13 mm, the vena cava is up to 15 mm;
- The diameter of the bile duct is up to 8 mm;
- The angle of the right lobe should be no more than 75 degrees, the angle of the left - no more than 45.
The edges should be straight and crisp. The liver should be equally dense in structure, without seals and neoplasms. On the ultrasound, the vessels and ligaments should be visible.
As a rule, the state of the gallbladder is described along with data on the liver, since these organs are not only located nearby in the abdominal cavity, but also perform the same function: bile, which is necessary for the breakdown of fats, which occurs in the liver, is produced and stored in gallbladder. Diseases such as cholecystitis and the formation of gallstones are associated with malfunctioning of the gallbladder.
Normally, this organ should have the following parameters:
- Length - from 6 to 9 cm;
- Width - from 3 to 5 cm;
- Organ wall thickness - up to 4 mm;
- The lower edge of the bladder can protrude 1 cm from the lower edge of the liver.
Ultrasound also shows the size of the gallbladder ducts through which fluid enters the duodenum and liver. The diameter of the bile duct should be no more than 6 mm, the diameter of the hepatic duct should be no more than 5.
The pancreas produces digestive enzymes, as well as insulin and glucagon. Incorrect work of this organ is fraught not only with pancreatitis and stomach problems, but also with the appearance of diabetes.
A normal test result for the pancreas should be something like this:
- Head - no more than 32 mm;
- Body - no more than 21 mm;
- Tail - no more than 35 mm;
- Pancreatic duct - no more than 2 mm.
The structure of the pancreas should be homogeneous, and the density should correspond to the density of the liver or be slightly higher. The contours of the organ should be clear. As in other cases, blurred contours and increased size indicate tissue inflammation and edema. Cysts, tumors and stones in the ducts will also be visible during ultrasound examination.
Ultrasound of the intestine and stomach is rarely done, since these are hollow organs through which ultrasound passes poorly, which makes it impossible to detect mucosal lesions. But the study shows the presence of fluid or foreign bodies in the cavities, which can be helpful in making a diagnosis.
Spleen and lymph nodes
The spleen, along with the kidneys and liver, is involved in blood purification. In this organ, antibodies are produced, the blood is filtered from bacteria and protozoa, and its spent blood cells are destroyed.
Violations of the work of this organ are less common and do not lead to such fatal consequences as violations of the liver or pancreas. Normally, the organ will be approximately 12 cm long and 8 cm wide. With inflammation and the appearance of neoplasms, the dimensions of the organ will increase, and the echo structure will be heterogeneous. If the interpretation of the ultrasound results indicates that the spleen is enlarged, you should come to grips with your health: often the inflammation of this organ speaks of an infectious disease or problems with blood circulation. If ultrasound shows a heterogeneous echo structure, then this may indicate the death of the spleen tissues.
In the conclusion, the number of examined and pathologically altered lymph nodes, their location, shape, size and internal structure are described. As in the case of the spleen, pathologies in the lymph nodes often indicate diseases of other organs.
Kidneys and ureters
Ultrasound of the kidneys is often prescribed separately from ultrasounds of other organs. This study helps to identify abnormalities in the functioning of the organ, tumors, the presence of stones and other unpleasant diseases. Normal kidney parameters should be something like this:
- The size is 5 * 6 * 12 cm, the thickness of the parenchyma, that is, the outer shell, is up to 25 mm. One kidney may be slightly larger than the other, but not more than 2 cm;
- The structure is even, the contours are clear, echogenicity is at the level of the liver or slightly below;
- Breathing mobility - no more than 3 cm.
Together with the kidneys, the doctor may examine the ureters and adrenal glands. They should be free of neoplasms, stones and sand.
Ultrasound of the vessels of the abdominal cavity
Vascular ultrasound is often performed in conjunction with Doppler diagnostics, which allows you to assess not only the state of the vessels, but also the blood flow in them. Ultrasound is carried out in parallel with the examination of the abdominal organs, that is, together with the state of the tissue, the state of the adjacent vessels and the level of blood supply to the organ are assessed. Separately evaluated:
- Portal venous system;
- Iliac arteries;
- Hollow vein;
- Arteries and veins of the liver, spleen and other organs.
The study of the vessels of the abdominal cavity helps to most accurately diagnose, find out the cause of the disease and assess the general condition of the patient's abdominal organs.
Deciphering an ultrasound scan is a complex process, and a doctor should deal with it. Often, patients who do not have the necessary knowledge try to interpret the examination results themselves, and when the results do not fit into the norm, they panic. Only a qualified doctor can correctly interpret the results, distinguish the disease from the characteristics of the organism, and make an accurate diagnosis.
Ultrasound of internal organs is a stage of diagnostics, which is carried out if a pathological process is suspected, as well as an obligatory part of the annual medical examination. The method is quite simple to carry out, painless, does not require intervention in the human body. The advantages of ultrasound of the abdominal organs include the fact that the procedure is able to show the presence of pathology in the early stages of development.
The article discusses what the ultrasound of the abdominal cavity shows, how it goes and what are the features of decoding the data obtained in adults and children.
The method belongs to simple, but at the same time informative procedures. The attending specialist will prescribe an ultrasound examination of the abdominal cavity if the patient has the following complaints:
- pain syndrome in any area of the abdomen (short-term or long-term, pulling, cutting, stabbing, aching pain);
- a feeling of bitterness in the mouth;
- heaviness in the projection of the stomach;
- excessive gassing;
- hiccups;
- attacks of nausea and vomiting;
- weight loss for no apparent reason;
- yellowness of the sclera, skin.
Ultrasound results may show the following changes:
- Biliary system - inflammation, presence of calculi, deformation of the gallbladder, tumor.
- Liver - inflammation, the formation of connective tissue elements, the appearance of steatosis (accumulation of fat on the surface of the gland), a tumor, a cavity with pus.
- Kidneys - urolithiasis, nephrosclerosis, inflammation.
- Spleen - organ infarction, neoplasm, cavity with pus, inflammation, accumulation of helminths.
- Pancreas - neoplasm, abscess, inflammation.
- Ascites is a pathological accumulation of fluid in the abdominal cavity in women, men, children.
- Changes in the structure of blood and lymphatic vessels, aneurysms.
After the procedure, the specialist issues a conclusion. Deciphering the ultrasound of the abdominal cavity is the task of the doctor who gave the direction for the study.
How to Prepare for Diagnosis?
The result of the procedure will be correct only if the subject is properly prepared. The last meal should be on the evening before the ultrasound. It is especially important to comply with the condition when examining the gallbladder, stomach.
For the last two days, it is better not to use medications, especially those that promote muscle relaxation or stop painful manifestations. Refusal of medicines is discussed with the attending physician.
If the patient will be examined by the bladder, you need to drink up to 1.5 liters of fluid within an hour before diagnosis.
Examination of the abdominal cavity (ultrasound) is carried out not only for adult patients, but also for children. Babies also need to be prepared for diagnosis. The infant should not eat or drink for the last hour before the procedure. Children 1-3 years old are not given food and water 3-4 hours before the ultrasound.
Procedure technique
The device for ultrasound diagnostics is located in a separate office. The examinee exposes the upper part of the body, lies on the couch near the apparatus in the position determined by the doctor. A special gel is applied to the patient's skin in the study area and to the device sensor, which ensures the penetration of waves into the tissues.
The sensor is installed in a certain position, which changes from time to time. The examinee can receive a command from the doctor about the need to change breathing during the examination procedure. Manipulation is not painful. In the case of diagnostics against the background of traumatic injury, discomfort is possible.
The duration of the procedure is determined by the volume of the investigated area. As a rule, it does not exceed 15-20 minutes. At the end of the examination, the gel is wiped off with napkins. The form with the results of ultrasound diagnostics is given to the patient in his hands or pasted into the outpatient card.
results
Let's look at the data on the transcript of the ultrasound of the abdominal cavity (norm and possible deviations).
Liver
The doctor assesses the size of the gland, how clearly its contours are visible, the presence of neoplasms. Normal indicators (cm):
- the length of the right lobe is 12-14;
- oblique measurements - up to 13;
- in the anteroposterior direction - up to 4;
- caudate - 1.5-2 x 6-7.
Normally, there should be no seals, the organ should be of a homogeneous structure, without deformation, neoplasms. Separately, the indicators of blood supply to the study area are assessed (the diameter of the central hepatic vein is up to 0.1 cm, the blood flow velocity of the hepatic artery is 0.95 m / s).
Spleen
The study will show an increase in the size of the organ, the presence of a tumor, structure and state of echogenicity. A healthy gland has dimensions of 12 cm x 5 cm x 7 cm. Oscillation up or down by 1 cm may be a physiological norm.
The spleen has a homogeneous structure, smooth contours, weak echogenicity. Doppler, which is an obligatory part of the ultrasound machine, assesses the blood flow in the organ. The blood flow velocity in the spleen artery is within 0.8-0.91 m / s, in the vein - 0.2 m / s.
Biliary system
The doctor examines the condition of the common bile duct and gallbladder. It should be noted that in men, the pathology of the biliary system occurs more often than in females.
Norms of ultrasound of the biliary system:
- the bubble is pear-shaped or rounded;
- echogenicity is absent;
- walls are smooth and uniform;
- bubble size - 0.8 cm x 0.03 cm x 0.35 cm;
- the diameter of the common bile duct is 0.1 cm.
What the device can show during research:
- calculi;
- indirect signs of the presence of helminthiasis (violation of patency and expansion of the common bile duct, pathology of the contractility of the bladder);
- neoplasms;
- accumulation of abnormal fluid around the gallbladder.
Pancreas
In a healthy subject, the organ has a coarse-grained structure, characterized by high echogenicity and uniformity. Changes in anatomical features give rise to thinking about the inflammatory process, pancreatic necrosis, the presence of a tumor.
The doctor estimates the size of the pancreas and the diameter of its excretory duct:
- head (anteroposterior direction) - 0.11-0.29 cm;
- body (anteroposterior direction) - 0.04-0.21 cm;
- tail (anteroposterior direction) - 0.07-0.28 cm;
- the diameter of the excretory duct is no more than 0.02 cm.
Kidney
The condition of the kidneys is assessed outside the abdominal cavity, however, the diagnosis of their condition is included in the standard ultrasound examination protocol. What does ultrasound of the kidneys give? The doctor gets the opportunity to examine the shape, location, size of the paired organ, the state of blood flow.
In a healthy patient, the left kidney is localized at the level of the XII rib, and the right one is a few centimeters lower. Normal sizes are 11 cm x 4.5 cm x 5.5 cm. Each measurement is allowed to fluctuate up and down by 0.5-1 cm. The kidney capsule should be smooth, homogeneous and continuous.
The border between the cortex and medulla is clearly visible. The thickness of the parenchyma is 1.3-2 cm, in elderly patients it is 1-1.2 cm. The blood flow velocity is assessed by a Doppler instrument and is about 100 cm / s.
Intestines
Estimated:
- Wall thickness;
- uniformity of liquid filling;
- availability of patency;
- the presence of cysts, tumors.
The doctor writes a conclusion, which is a preliminary diagnosis. After evaluating the results, the attending specialist confirms that the patient is "Healthy" or the necessary therapy regimen is selected.
After conception for several weeks, the size of the fetus is so small that even specialized equipment is not able to determine whether the fertilization of the egg has taken place or not. How long does an ultrasound scan show pregnancy?
Ultrasound examination during pregnancy is an important procedure that can be used to determine whether conception has taken place, the exact date, and whether there are any abnormalities in the development of the embryo.
There are several types of ultrasound monitoring that are used by doctors depending on the purposes and functions required of the procedure. In the early stages of pregnancy, the study is carried out in two ways:
- Transvaginal. The most accurate examination technique used in the early stages of bearing a child. Using this technique, pregnancy can be determined after 3 weeks from the day of the intended conception. Along with the examination, it is necessary to take a blood test to determine the level of hCG. And if the dynamics of growth of the hormone is observed, but during the ultrasound, the ovum was not found, then we can talk about an ectopic pregnancy.
- Transabdominal study. The procedure is performed by placing probes on the anterior abdominal wall. At the same time, the accuracy of the examination is an order of magnitude lower than in the case of transvaginal diagnostics. In this case, pregnancy can be recorded only 4-5 weeks after fertilization of the egg and successful implantation of the embryo to the uterine wall.
Is it possible to do an ultrasound so early?
Almost every woman who is in an "interesting position" is aware that during the entire period of bearing a child, she needs to go through 3 planned procedures. The goal is to determine the dynamics of fetal development and eliminate the risks of pathological abnormalities in the unborn child.
The first screening ultrasound, after which a blood sample is taken to analyze the dynamics of hCG growth, is prescribed for 10-12 weeks of pregnancy. But, as a rule, most women want to know about the presence of a developing fetus as early as possible. And then the question becomes relevant, will this procedure negatively affect the development of the baby?
In fact, the ultrasound used during the examination is a normal and harmless high frequency sound waves that are not perceived by our hearing organs. The only thing that ultrasound monitoring has an effect on is the uterus, which, after the procedure, can become toned. Therefore, if the uterus is in hypertonicity or there is a risk of miscarriage, then it is better to postpone the transvaginal ultrasound.
Advice! The question of when you can do the first ultrasound is best dealt with with your consulting doctor. Doctors do not recommend unscheduled transvaginal ultrasounds if there is aching pain in the lower abdomen, cramps and spotting.
It should also be said that conducting an ultrasound study in early pregnancy has a number of advantages:
- confirmation of the pregnancy test result;
- determination of an ectopic pregnancy at an early stage, which avoids a threat to the woman's reproductive health;
- the ability to determine a single or multiple pregnancy;
- assessment of the risk of miscarriage due to increased uterine tone;
- determination of the most accurate time of conception.
When is ultrasound prescribed?
When to go for the first ultrasound scan? If, after a delay, a woman made a pregnancy test, and he showed 2 strips, then you need to go to a gynecologist, who will tell you exactly when to conduct the first ultrasound study. Such a procedure is prescribed purely on an individual basis, taking into account all the risks and the need for a survey.
If, after a visual examination, it turned out that the pregnancy is proceeding without complications, then the first ultrasound scan is prescribed at 10-12 weeks. True, sometimes testing is prescribed much earlier - at 4-6 weeks it is already clear whether pregnancy has come or not.
Indications for early research
An ultrasound study already 10 days after the delay is able to show whether a pregnancy has occurred or not. But this does not mean that such an early diagnosis is shown to absolutely all women. There are a number of indications that a doctor may recommend early research:
- A delay in menstruation is accompanied by pain in the lower abdomen and bloody discharge, which is not typical for menstruation.
- If a woman has a history of early miscarriages.
- When menstruation is delayed, the test is positive, but at the same time, neither visual inspection nor palpation confirms the fact of conception.
- With previous surgeries on the uterus, including cesarean section.
- When there is no accurate data on the last menstruation.
Ultrasound diagnostics in this case will allow not only to determine the gestational age, but also the correct attachment of the fetus, whether there is a risk of IB, as well as possible pathologies in the development of the embryo.
If an operation was previously performed on the uterus, then with the help of a diagnostic ultrasound examination it will be possible to determine the state of the postoperative scar and whether the embryo is fixed in this area.
How is the procedure carried out?
As mentioned earlier, there are two methods of research: transvaginal and transabdominal. Most often, doctors turn to the first method for early diagnosis, since it is more accurate.
The essence of the technique is as follows: a special device is inserted into the woman's vagina, on which a condom is preliminarily put on, which excludes the possibility of infection entering the genital organ.
At the end of this device there is a camera-sensor that records the state of the internal cavity of the uterus and transmits the data to the equipment. As a result, on the screen we can observe everything that happens inside the uterus.
If, nevertheless, a transabdominal examination was prescribed, then you should know that it is carried out with a full bladder.
If pregnancy is not confirmed
So, from what time the ultrasound shows pregnancy, we have already found out. Now let's try to figure it out, is it possible that during the examination no embryo was found inside the uterus?
There are several explanations for this:
- Very short gestation period.
- Outdated hardware
- Low qualifications of an uzist.
- Implantation took place elsewhere: fallopian tubes, appendages, peritoneum.
- There is no pregnancy and the test result is false positive.
- Doctor's mistake. We are all human and everyone has the right to make mistakes.
If during the study the pregnancy is not confirmed, then, first of all, it is necessary to show the results of the examination to your consulting physician.
When the fact of the presence of WB is excluded, after a while you can repeat the test and visit the gynecologist.
Important! An ectopic pregnancy that develops in the tube is rather false to see in the early stages, so you should also pay attention to indirect signs.
Outcome
At the end of this publication, I would like to add: in the overwhelming majority of cases, an early ultrasound scan is carried out solely out of idle interest. If there are no alarming symptoms, then this is quite possible, but in the case when there is a pulling pain in the lower abdomen and uncharacteristic discharge, it is better to consult a gynecologist before an ultrasound examination.
Did you or your friends undergo ultrasound diagnostics only as prescribed 3 times during the entire pregnancy, or were additional examinations prescribed?
Probably now it is very difficult to find a person who has never undergone a procedure in his life. ultrasound examination (ultrasound) of the abdominal cavity... Surely many have done it more than once.
This study is extremely informative and absolutely safe for humans, however, it requires a well-trained specialist in this field, as well as high-precision equipment. It is as a result of the absence of one or another item from the latter that errors in diagnosis occur, after which many argue that ultrasound is a fortune-telling on coffee grounds.
Many people believe that ultrasound can harm human health, but in fact this is absolutely not the case.
What is an ultrasound scan?
Ultrasound examination is a study of the state of organs and tissues using ultrasonic waves. Ultrasound is reflected as it passes through tissues, or rather through the boundaries between different tissues. A special sensor captures these changes, which are the basis of the image. The ultrasound used in the device does not cause tissue damage. There are several types of ultrasound examination, among which the most commonly used are scanning (what is traditionally called ultrasound), as well as Doppler ultrasound. Doppler is based on the Doppler effect, which means a change in the wavelength reflected from moving objects. This effect makes it possible to study the blood flow and the state of the patency of the blood vessels.
Ultrasound examination has found a very wide application in medicine and is used to diagnose diseases of a large number of organs: in surgery and therapy, in ophthalmology and neurology, in cardiology and vascular surgery, in urology, obstetrics and gynecology(at present, almost no child is born without a preliminary ultrasound examination in the womb).
For each specific ultrasound, currently there are programs for processing information parameters installed on modern devices, which significantly increases the quality of diagnosis of diseases in a particular area, special techniques are used, such as 3D and 4D ultrasound.
In this review, I will tell you exactly about Abdominal ultrasound so as not to interfere with all areas of the human body in one pile.
WHAT CAN BE DETECTED WITH ABDOMINAL CAVITY USAGE?
- the size of the organs, their location in the abdominal cavity and in relation to each other;
- the presence of pathological masses in the abdominal cavity, their relationship with organs;
- the presence of congenital anomalies in the development of internal organs, deformation, doubling, absence or underdevelopment of the organ;
- changes in the structure of organ tissues: cirrhosis, fatty degeneration, stone deposition, thickening of the walls of organs;
- the presence or absence of normal functioning of organs: peristaltic waves, contractions, atony;
- the presence of a pathological accumulation of fluid in the abdominal cavity - ascites.
Modern equipment and good specialist training allow detecting even small formations and suggesting their origin, after which the patient will be sent for a more in-depth examination.
INDICATIONS FOR STUDY:
The main indications are:
- nausea;
- painful sensations in the abdomen;
- belching;
- increased gas formation;
- changes in the shape and size of the abdominal organs based on the results of palpation;
- suspicion of the presence of pathological formations in the abdominal cavity.
However, the list of indications can be significantly expanded by the attending physician, but this is an individual approach to the patient.
A referral for research can be issued by the attending physician, then there is a possibility that it will be performed free of charge, and so does a person, if he has any symptoms, can contact any medical center and carry out research on a paid basis. Research prices are very different in different cities and in different centers, not always expensive means high quality. It is best to look for a doctor based on the reviews of your friends and relatives.
PREPARATION FOR RESEARCH.
First, you need to prepare mentally. If a person is sent for any kind of research, then he probably has some kind of complaints. Few people go to the clinic simply because they "want to get checked", and not every doctor will issue a referral without evidence. Otherwise, the diagnostic service will simply drown. It is better not to be nervous, if you cannot cope with emotions on your own, then you should take a sedative. The procedure is painless, the result will be handed to you immediately and you can quickly take any further action if something is found.
Secondly for the research to be successful, requires a little preparation in terms of diet within a few days. This is necessary so that there is no increased gas formation in the intestines and the accumulated air does not shield the waves and does not interfere with the study. It takes a few days exclude fresh fruits and vegetables, black bread, legumes, whole milk, juices and carbonated drinks from the diet... Last meal no later than 8-10 hours before the proposed study, that is, it should be carried out on an empty stomach, before the study, in a few hours, you can take the so-called defoamers (espumisan, bobotik, disflatil or banal activated carbon)... If there is a tendency to constipation, then it is advisable to use laxative suppositories the day before. BUT NOT CLISM!
Thirdly, before the ultrasound examination, the patient should not have such studies of the gastrointestinal tract, such as endoscopic or X-ray contrast. Doctors sometimes just give directions and the patient himself makes an appointment in the corresponding offices. In the ultrasound office they cannot know that an hour before the ultrasound of the abdominal cavity you have a gastroscopy. However, if you come for an ultrasound scan after examining the stomach, it will not be informative, because the air in the stomach and intestinal loops will not allow you to fully examine other organs.
HOW IS THE STUDY PERFORMED?
Going to research, you need to bring a sheet and a towel to wipe off the gel used during the procedure (in case there are no napkins in the office).
The patient is placed on a couch, a special echo gel is applied to the area under study, which will ensure the conduction of waves through the skin. This moment is not the most pleasant, since the gel is sticky and cool, but for the sake of research, you can tolerate a little, at the end of the procedure, the gel is easily removed with a napkin.
The study itself is not particularly difficult for the patient, his task is simply to lie down and fulfill the doctor's simple requests: turn on any side, take a deep breath or hold his breath. The procedure lasts on average from 15 to 30 minutes, after which the doctor will issue a completed protocol form and possibly a snapshot of the area that interests him most, if necessary.
I personally went through this procedure more than once. Having a not quite healthy gallbladder and chronic gastritis, periodically reminding of myself with exacerbations, I sometimes experience so much pain that I have to seek medical help in order to exclude a serious pathology.
The last time I did an ultrasound in connection with the stem. that I often began to appear bitterness in the mouth, periodically nausea bothered, problems with stool began and the right hypochondrium ached... In general, the symptoms of course fit into the clinical picture of biliary dyskinesia, but after I had acute cholecystitis during pregnancy, I decided to check it out.
As it should be, I excluded from the diet all prohibited foods, before the study I took a drug containing simethicone (
To exclude the pathology of the organs of the upper gastrointestinal tract, I still had to do gastroscopy, but there, fortunately, nothing criminal was revealed.
So this study quite often finds structural confirmation of symptoms that bother a person, but is not a method for 100% diagnosis of diseases. This study is still quite subjective and often the opinions of different doctors may differ. So, if any serious pathology is detected, it is worth undergoing a more in-depth examination in order to finally determine the diagnosis.
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