Ultrasound 32 week pregnant transcript. Ultrasound interpretation

To determine the anatomical and functional state of the fetus during pregnancy, there are a number of methods, the most common of which is. It is quite informative, allows you to reach a large number of women and, very importantly, is safe.

In order to identify malformations and diseases, they carry out ultrasonic(universal rapid screening covering more than 85% of pregnant women). It allows you to make decisions about further tactics for managing each pregnancy, as well as to identify pregnant women at risk for developing various complications for the fetus and mother.

Ultrasonography ( it is most advisable to carry out in the following screening deadlines pregnancy:

Chorion- the outer embryonic membrane covered with villi, which, together with the wall of the uterus, subsequently forms, thanks to which the fetus is nourished during pregnancy. Its localization gives an idea of ​​the further localization of the placenta (which is necessary to know to determine pregnancy management tactics), and a change in thickness may indicate the presence of intrauterine infection of the embryo/fetus, as well as malnutrition of the fetus, although this indicator is also more informative in late pregnancy.

In addition, during the first one, the structural features of the uterus (for example, duplication of the uterus, saddle-shaped uterus) and its appendages (primarily the presence of ovarian cysts) are noted. These indicators are also important for determining further pregnancy management tactics.

If necessary, the ultrasound diagnostician notes in the protocol the date of repeated ultrasound control.

Decoding the indicators of the second ultrasound at 20-24 weeks

Gestation period 20-24 weeks optimal for studying the anatomical structures of the fetus. Detection at this stage determines further tactics for pregnancy management, and in case of a gross defect that is incompatible with life, it allows to terminate the pregnancy. A typical ultrasound protocol at 20-24 weeks is presented in Table 5.

The structure of the ultrasound protocol can be divided into the following main groups:

1. Information about the patient (full name, age, beginning of last menstruation)
2. Fetometry(measurement of the main dimensions of the fetus)
3. Fetal anatomy (organs and systems)
4. Provisional organs (those that exist temporarily, such as the placenta, umbilical cord, and amniotic fluid)
5. Conclusion and recommendations

In this protocol, as with ultrasound at 10-14 weeks, the first day of the last menstruation is indicated, against which the gestational age is calculated. The number of fruits and the fact that the fruit is alive(this is determined by the presence of and ). If there are two or more fruits, each is studied and described separately. Must be indicated (the ratio of the large part of the fetus to the entrance to the pelvis). It may be head(the fetus is presented with the head) and (the buttocks and/or legs are presented). The fruit may be located transversely, which should be reflected in the protocol.

Next is carried out fetometry– measurement of the main dimensions of the fetus, among which are determined: biparietal size of the head, its circumference and fronto-occipital size, abdominal circumference, lengths of tubular bones on the left and right (femur, humerus, shin bones and forearm). The combination of these parameters makes it possible to judge the rate of fetal growth and compliance with the expected gestational age according to menstruation.

Biparietal fetal head size (BSD) measured from the outer surface of the superior contour to the inner surface of the inferior contour of the parietal bones (Figure 1, line bd).

Fronto-occipital size (FOR)– the distance between the outer contours of the frontal and occipital bones (Figure 1, line ac).

Cephalic index– BPR / LZR * 100% - allows you to draw a conclusion about the shape of the fetal head.

Head circumference (HC)– circumference along the outer contour.

The size of the head is measured using a strictly transverse ultrasound scan at the level of certain anatomical structures of the brain (the cavity of the transparent septum, the cerebral peduncles and the visual thalamus), as shown on the right side of Figure 1.

Figure 1 – Scheme for measuring the size of the fetal head

1 – cavity of the transparent septum, 2 – visual thalamus and cerebral peduncles,bd– biparietal size,ac– fronto-occipital size

The size of the abdomen is measured by scanning in a plane perpendicular to the spinal column. In this case, two sizes are determined - abdominal diameter and circumference, measured along the outer contour. The second parameter is used more often in practice.

Next are measured length of tubular bones of limbs: femur, shoulder, lower leg and forearm. It is also necessary to study their structure to exclude the diagnosis skeletal dysplasia(genetically determined pathology of bone and cartilage tissue, leading to serious disturbances in the growth and maturation of the skeleton and affecting the functioning of internal organs). The examination of the limb bones is carried out on both sides so as not to miss reduction malformations(that is, underdevelopment or absence of parts of the limbs on one or both sides). Percentile values ​​of fetometric indicators are given in Table 6.

Studying fetal anatomy- one of the most important components of ultrasound examination at 20-24 weeks. It is at this time manifest(manifest themselves) many. The study of the anatomical structures of the fetus is carried out in the following order: head, face, spine, lungs, heart, abdominal organs, kidneys and bladder, limbs.

Studying brain structures begins when measuring the size of the head, because upon careful examination the doctor can determine the integrity of the bone structure, the presence extracranial(outside the skull) and intracranial(intracranial) formations. A study is carried out of the cerebral hemispheres, lateral ventricles, cerebellum, cistern magna, visual thalamus and cavity of the septum pellucidum. The width of the lateral ventricles and the anteroposterior size of the cistern magna normally does not exceed 10 mm. An increase in this indicator indicates a disturbance in the outflow or production of fluid and the appearance of dropsy of the brain.

The next step is studying face– the profile, orbits, and nasolabial triangle are assessed, which makes it possible to identify anatomical defects (for example, “protrusion” of the upper jaw with a bilateral or median facial cleft), as well as the presence of markers of chromosomal abnormalities (reduced length of the nasal bones, smoothed profile). When studying the eye sockets, a number of gross defects can be identified, for example, cyclopia(the eyeballs are completely or partially fused and are located in the middle of the face in one orbit), neoplasms, anophthalmia(underdevelopment of the eyeball). The study of the nasolabial triangle primarily reveals the presence of the palate.

Study spine along the entire length in longitudinal and transverse scanning - allows you to identify hernial protrusions, including spinabifida– spina bifida, often combined with spinal cord malformations.

When researching lungs their structure is studied (the presence of cystic formations can be determined), size, the presence of free fluid in the pleural (chest) cavity, and neoplasms.

Next we study heart for the presence of four chambers (normally the heart consists of 2 atria and 2 ventricles), the integrity of the interventricular and interatrial septa, valves between the ventricles and atria, as well as the presence and correct origin/entry of large vessels (aorta, pulmonary trunk, superior vena cava) . The location of the heart, its size, and changes in the cardiac sac (pericardium) are also assessed.

When scanning organs abdominal cavity– stomach and intestines – their presence, location, size is determined, which makes it possible to indirectly judge other organs of the abdominal cavity. In addition, an increase or decrease in the size of the abdomen during fetometry indicates the presence of pathology (for example, dropsy, hernias, hepato- and splenomegaly - enlargement of the liver and spleen). Next we explore kidneys and bladder for their presence, shape, size, location, structure.

Studying provisional authorities allows you to indirectly judge the condition of the fetus, intrauterine infections and other conditions that require correction.

It is studied according to the following parameters:

1. Localization. The ultrasound diagnostician necessarily reflects the localization of the placenta, especially its position relative to the internal os of the cervix. Since when the placenta is not attached correctly, for example, when it completely covers the internal os ( complete), this is accompanied by bleeding during pregnancy, and vaginal delivery is impossible. If the lower edge of the placenta is located lower than 7 cm from the internal os, ultrasound control is required at 27-28 weeks.
2. Thickness. The placenta is a dynamically developing provisional organ of the fetus, therefore during pregnancy its thickness increases on average from 10 to 36 mm, although these values ​​​​vary in a fairly wide range, which is presented in table 7.

After 36 weeks, the thickness of the placenta usually decreases. The discrepancy of this parameter with standard values ​​should alert, first of all, to the presence of an intrauterine infectious process, as well as a discrepancy between the nutrients supplied to the fetus and its needs.

1. Structure. Normally, it is homogeneous and should not contain inclusions. Inclusions may indicate premature aging of the placenta (which can cause fetal growth retardation); heterogeneity indicates the possible presence of infection.
2. Degree (stage) of maturity. The placenta changes its structure unevenly, most often this process occurs from the periphery to the center. In an uncomplicated pregnancy, changes pass through stages from 0 to III sequentially (0 - before 30 weeks, I - 27-36, II - 34-39, III - after 36 weeks). This indicator allows us to predict the complicated course of pregnancy, the presence syndrome (FGR). Currently, premature placental maturation is considered to be stage II before 32 weeks and degree III before 36 weeks. Ultrasound assessment of the placental structure is shown in Table 8.

* chorionic membrane – layer with villi facing the fruit

** parenchyma- placental tissue itself

*** basal layer– the outer surface where the placenta adheres to the wall of the uterus

Used for evaluation amniotic fluid index. When determining it, the uterine cavity is conventionally divided into 4 quadrants by two planes drawn through the linea alba (the connective tissue structure of the anterior abdominal wall located along the midline) vertically and horizontally at the level of the navel. Next, in each quadrant, the depth (vertical size) of the largest pocket of amniotic fluid (amniotic fluid) free from fetal parts is determined, all 4 values ​​are summed up and displayed in centimeters. If the index is less than 2 cm - this is, if more than 8 cm - . This is a diagnostically significant sign of the presence of infection and developmental defects. Indicators of the amniotic fluid index at different stages of pregnancy are presented in Table 9.

Umbilical cord(the provisional organ that connects the embryo/fetus with the maternal body) normally contains 3 large vessels: one vein and two arteries. In many hereditary pathologies, only one umbilical cord artery is found, which requires more careful management of pregnancy.

Also subject to mandatory examination (for its length, which is important if there is a threat of miscarriage), appendages(for the presence of ovarian cysts), uterine wall(if there was a history of cesarean section, the condition of the scar is assessed).

Based on the ultrasound examination performed during pregnancy, a conclusion is made about the presence (VLOOKUP) fetus or some other pathology and recommendations are given.

Ultrasound indicators in the third trimester

Third ultrasound at 32-34 weeks necessary to identify malformations that appear only in late pregnancy (for example , aneurysm of the vein of Galen– disruption of the structure of the vascular wall of a large cerebral vessel). It allows you to assess the functional state of the fetus and make a diagnosis syndrome (FGR), which makes it possible to carry out a set of necessary therapeutic measures and identify indications for timely and careful delivery. The presence of FGR requires mandatory monitoring after 7-10 days during active therapy.

An important point is (head or), which significantly affects the method of delivery. It is also necessary to define estimated fetal weight, which should be taken into account in the tactics of further management of pregnancy and especially childbirth.

To assess the condition of the fetus in the third trimester, the definition can be used biophysical profile of the fetus during ultrasound (Table 10).

When assessing the tabular parameters, the sum of points is determined, on the basis of which a conclusion is made about the condition of the fetus:

• 12-8 – norm;
• 7-6 – questionable condition of the fetus, possible development of complications;
• less than 5– pronounced intrauterine hypoxia(insufficient oxygen supply to the fetus, leading to varying degrees of disruption of its vital functions) with a high risk perinatal losses(fetal loss during the period from pregnancy to 168 hours after birth).

Ultrasound examination during screening periods makes it possible to identify a large number of pathologies and take preventive measures to eliminate them as much as possible in the prenatal period, and if elimination is impossible, to reduce the consequences.

Regardless of the course of pregnancy, an ultrasound examination at this stage is prescribed to all pregnant women.

The purpose of this procedure is to diagnose anomalies and malformations of the child, as well as to evaluate the organs and systems that ensure the vital activity and development of the fetus (including the placenta).

Studying the condition of the placenta is especially important, since by this period it becomes possible to visually recognize signs of placental insufficiency. This state of the organ, designed to nourish and protect the baby, is a direct threat to the life, health and development of the child in the womb.

Condition of the fetus at 32 weeks of gestation

By this time, the condition of the fetal skin reaches a state close to that of a newborn. A layer of subcutaneous fat accumulates - this makes the skin smooth and light. Lanugo (fluff) practically disappears, leaving thicker hairs in very small quantities on the head and body. In addition to the respiratory system, internal organs and systems operate almost at the level of a newborn. There is an active process of strengthening interneuron connections.

The position (presentation) of the fetus, which is determined at 32 weeks, is considered final. In the case of breech presentation, over the next 2 weeks it is possible to perform an external rotation of the baby. When the baby is positioned transversely or at an angle, this possibility is absent. This position of the baby is a sign of insufficient oxygen supply. In this regard, pregnant women are prescribed a Doppler study.

At this stage, normally, the amount of amniotic fluid has the largest volume. The volume is maintained until week 37, then the amount of water decreases. Therefore, during the period from 32 to 37 weeks, the kidneys of the expectant mother work under overload, in addition, the pregnant uterus mechanically compresses the surrounding tissues, causing stagnation in them. That is why the pathology of the mother’s kidneys manifests itself most often during this period. If there are signs of differences from the norm in the functioning of the urinary system, the woman may be prescribed an additional ultrasound procedure for diagnosing the condition of the kidneys.

Features of the ultrasound procedure during final screening

During an ultrasound examination at 32 weeks, the doctor evaluates the fetometric data of the fetus, confirms the fertility and timing of pregnancy, and determines the position of the baby in the womb. If the child’s size differs significantly from the norm, ultrasound diagnostics can determine this. If the baby’s size is 2 weeks behind the lower limit of normal, this is a cause for concern and additional examination. In this case, it is clear that for some reason, for example, due to placental insufficiency, the child does not receive enough nutrition and oxygen.

In case of a complicated pregnancy and suspected fetal developmental delay, additional examination and urgent measures are required to stop the baby’s suffering. Ultrasound is one of the most accurate and safe methods for diagnosing the fetus at any stage of pregnancy.

Ultrasound at 32 weeks: determining the condition of the placenta

At 32 weeks, the placenta is examined with special attention, its condition, its ability to perform functions in full, its structure, and location are studied. During this period, the diagnostic procedure for studying the placenta is most accurate.

The placenta is an organ without which it is impossible for the baby to feed and breathe in the womb. Any functional disorder or structural defect of this organ entails suffering for the baby, a slowdown in its growth and development caused by malnutrition and hypoxia. When interpreting ultrasound data, the following indicators are taken into account:

• location of the placenta;
• thickness;
• degree of maturity (from 0 to III);
• presence/absence of foreign inclusions (calcification), heart attacks.

The placenta insertion is of great importance for the normal process of delivery. Normally, the placenta is attached to the anterior or posterior wall of the reproductive organ (uterus). When the placenta is located close to the internal os of the uterus, there is a risk of bleeding during labor. In some cases, the placenta completely blocks the birth canal, making natural delivery impossible. In this case, surgical resolution of labor is carried out by cesarean section. After determining the position of the placenta, its thickness is assessed, measurements are taken at the site of attachment of the umbilical cord.

With an uncomplicated gestational process, the thickness of the placenta is within normal limits. In a complicated course, placental insufficiency (insufficient thickness of the placenta), an inflammatory process or edema (excessive thickness) can be diagnosed.

It is not worthwhile to independently interpret these indicators and compare them with the norm. It's better to wait for a specialist's comments. For reference, you can use the following information: the placenta matures from stage 0 to stage III. The last stage is III. The placenta should reach this stage at 36 weeks of gestation. Aging of the placenta that is too rapid requires observation and therapeutic intervention to improve blood flow in the placenta.

Fetometric data at 32 weeks with ultrasound diagnostics

When deciphering, the data obtained by ultrasonic scanning are compared with the normative ones. Normal fetometry indicators at 36 weeks are as follows:

• sizes: biparietal (from 75 mm to 89 mm) and fronto-occipital (from 95 mm to 113 mm);
• head circumference from 283 mm to 325 mm;
• abdominal circumference from 258 mm to 314 mm;
• lengths of tubular bones: femur - from 56 mm to 66 mm, tibia - from 52 mm to 60 mm, shoulder - from 52 mm to 62 mm, forearm - from 45 mm to 53 mm.

Using the Doppler method at 32 weeks

Dopplerography (Doppler ultrasound) is one of the most informative, simple and safe ways to diagnose the condition of the blood supply tract in the uterus-placenta-fetus system. In ultrasound diagnostics, the Doppler method involves a thorough study of the blood flow in the vascular system of the uterus, the vessels of the placenta and the great vessels of the fetus. Thanks to the data obtained and comparing them with standards, the doctor can draw a conclusion about the condition of the child in the womb, its oxygen supply and the functioning of the myocardium and the vessels that supply it. The main Doppler indices are shown in the table:

Additional diagnostic procedures

By week 32, the accuracy of information obtained by ultrasound increases. This is especially true for determining the amount of amniotic fluid. In the event of a slowdown in fetal development, it is at this time that a diagnostic procedure such as amnioscopy(study of amniotic fluid).

Excessive or insufficient amount of water may be evidence of a malfunction of the placenta. Thanks to this procedure, you can timely and accurately diagnose:

• hydramnios;
• hypoamnion.

One of the frequently used procedures for direct diagnosis of a baby’s heart rate and indirect diagnosis of its condition is CTG. CTG or cardiotocography is an ultrasound examination method that allows you to record and even “voice” the work of the baby’s myocardium, in order to then compare it with standards.

Ultrasound scanning methods used in obstetric and gynecological practice have a high degree of safety, reliability, and information content. They require virtually no preparation and do not cause any inconvenience to the expectant mother. They allow a comprehensive assessment of the body condition of the expectant mother and her baby in a non-invasive way.

An ultrasound at 32 weeks of pregnancy is the third routine screening that a woman needs to undergo.

This ultrasound is considered very important, because it is on it that doctors look at the presentation of the fetus and determine the tactics of the upcoming birth.

In addition, the third screening is an opportunity to confirm the previously determined gender of the child, as well as make sure that the fetus is developing normally.

At this stage of pregnancy, the anatomy and biometric parameters of the child, the condition of the placenta in which he resides, as well as the maturity of the internal organs of the fetus are examined.

An ultrasound examination performed at the 32nd week of fetal development does not require special preparatory measures.

There is no need to go on a diet, not eat food for several hours, drink a lot of water or not drink it at all.

Before lying on the doctor’s couch, a woman is supposed to undress to the waist, exposing her stomach.

Ultrasound diagnostics of the fetus in the third trimester of its development should be carried out exclusively by the abdominal method, scanning the abdominal cavity through the abdominal walls.

In order for the doctor to gain full access to the entire surface of the fair sex’s abdomen, the woman must lie on a special couch on her back and take a relaxed position.

For the convenience of performing an ultrasound, the patient’s right side is supported with a small auxiliary bolster.

After the lady is settled on the couch, the doctor will lubricate her stomach with ultrasound gel and place a transducer sensor on it, which reads information about pregnancy using ultrasound waves.

By manually moving the device's sensor, the sonologist will check all the parameters of the developing pregnancy that interest him.

An ultrasound performed at this stage should not cause pain in either the mother or the child. From slight pressure on the walls of the abdomen, the child can increase his activity and begin to move his limbs.

The timing of an ultrasound at 32 weeks of pregnancy depends on which type of procedure you choose.

If you want to limit yourself to a regular, two-dimensional screening, you will spend about twenty minutes in the doctor's office. Three-dimensional and four-dimensional screenings will take longer - from forty minutes to an hour.

Many gynecologists who supervise pregnancies often advise their patients who are in the third trimester of pregnancy to undergo not a two-dimensional, but a three-dimensional or four-dimensional ultrasound.

Modern ultrasound machines have better diagnostic capabilities.

3D and 4D ultrasound procedures have another advantage that is valuable for parents of unborn children.

After undergoing these types of ultrasound, you can get high-quality photo and video files that will show your baby.

Many clinics provide the 3D screening recording service. As a rule, it is paid, but its cost is low.

If you plan to invite your husband or partner for screening, choose 3D ultrasound.

During the procedure, the future father will be able to examine his child in detail, see how he moves his arms and legs, and also hear his heartbeat.

Doctors note that joint visits to a sonologist’s office strengthen psycho-emotional ties between future parents and prepare women’s husbands or partners for the upcoming responsibility of fatherhood.

Fetal biometry and developmental features

In the period since the second planned ultrasound, screening carried out at 32 weeks should show significant changes in the size and level of development of the fetus.

Thirty-two weeks of pregnancy is a good time to analyze the developing baby's brain. The doctor should conduct a thorough examination of his hemispheres, cerebellum and lateral ventricles.

The width of the latter should fluctuate within ten millimeters - this is the norm for the vast majority of children whose gestational age is 32 weeks.

Indicators of the width of the ventricles of the brain, which differ from the norm in a larger direction, may indicate possible hydrocephalus of the child, caused by excessive pressure of amniotic fluid on his head.

After examining the brain, the doctor moves on to examining the face. The baby's eye sockets, nose and lips should be proportional and fully formed.

Many doctors agree that the third screening procedure is best carried out using modern 3D or 4D equipment.

It will help check all indicators of child development that doctors are interested in, as well as identify various pathologies that may simply be invisible on a simple, two-dimensional ultrasound.

3D ultrasound allows you to check your child’s spine for hernias and clefts. Visual examination of the fetus should confirm that it is developing proportionately.

Despite the fact that since the second ultrasound the baby has grown significantly and can no longer spin freely in the mother’s belly, he must maintain acceptable mobility, moving his arms or legs, opening his mouth.

Interpretation of data obtained on ultrasound (otherwise known as “fetal development indicators”) should be carried out by an experienced specialist.

Most often, interpretation of ultrasound becomes the responsibility of sonologists performing the procedure; less often, gynecologists supervising pregnancy do this.

At this stage, the baby's skin, which was once thin, transparent and wrinkled, becomes denser, acquires a flesh-colored tint and is completely smoothed out due to the accumulation of subcutaneous retina.

The vellus hair that covers the baby's body in the first trimesters of pregnancy completely disappears by the third trimester, and the hair remains only on the baby's head.

Bipariental size (between the temporal bones) – BPR or BRGP; Thigh length – DlB; Chest diameter - DGrK

The child's brain continues to actively develop. The sensory systems of his body are improved, new neural connections are created and strengthened.

Normal indicators for biometric examination of the fetus:

• biparietal size - eighty-five millimeters;
• fronto-occipital size - one hundred and two millimeters;
• head circumference - three hundred eleven millimeters;
• abdominal girth – two hundred and seventy millimeters;
• thigh length – sixty-two millimeters;
• height - four hundred thirty millimeters;
• weight - about two kilograms.

What do they look for on an ultrasound at 32 weeks?

The doctor performing the ultrasound is required to assess the condition of the provisional organs: the placenta and umbilical cord, despite the fact that they have already been thoroughly examined during earlier screenings.

In addition, the condition of the uterus, appendages and other internal organs of a woman should not escape the doctor’s attention.

If the doctor reveals that the body of the mother or child is not functioning properly, the woman will have to go to the hospital for preservation.

The presentation of the fetus, which is visualized by doctors at this stage of pregnancy, is considered final.

If it falls within normal limits, doctors enter this data into a medical record, with which the woman will go to the maternity hospital.

If the ultrasound results indicate that your fetus is in pelvic position, your doctor may suggest manual external adjustment of the baby's position inside the abdomen.

Cases when babies are located across the bellies of their mothers or diagonally are also not the norm. External adjustment of the fetus during diligence of these types is prohibited!

Oblique or transverse position of the fetus is one of the signs of oxygen deficiency. To exclude the presence of this symptom, you should undergo a Doppler procedure.

An ultrasound performed at 32 weeks of pregnancy can reveal placental insufficiency, which often leads to premature birth.

This deficiency is characterized by functional disorders in the placenta, which can complicate the functioning of the respiratory and digestive systems of the child’s body, weaken its protective functions, and also provide a colossal lack of hormones necessary for the fetus to develop adequately.

The normal location of the placenta is diagnosed if the edge of its bottom does not block the internal outlet of the cervix.

The degree of maturity of this organ, which for many months was zero, at this time is equal to one. The placenta can reach the second degree of maturity only after 34 weeks of pregnancy.

The average thickness of this organ, detected by ultrasound at 32 weeks, is thirty-three millimeters.

The amniotic index of amniotic fluid should range from one hundred and fifty to two hundred and fifty millimeters.

Possible entanglement of the baby's neck with the umbilical cord can only be detected by examining the fetus using a three-dimensional or four-dimensional ultrasound.

Classic ultrasound in 2D format cannot cope with this task.

If an ultrasound shows the umbilical cord entwined around the baby’s neck or the doctor diagnosing the integrity of this organ finds out that there are not three, but two arteries inside it, then the pregnant woman will have to undergo another study - Doppler.

During this procedure, sonologists will rule out or confirm the presence of hypoxia in the child, which could affect its development.

The length of the cervix during the 32nd week of gestation should fluctuate within thirty millimeters.

During an ultrasound, the sonologist must carefully examine this organ and find out whether the woman has uterine hypertonicity and whether her pregnancy is complicated by the appearance of cysts.

An ultrasound at 32 weeks is a mandatory procedure that allows you to track the development of the child and determine the tactics for the upcoming birth.

Do not forget to take a special diaper to the ultrasound room, which you will lay on the couch.

A towel or paper napkins will not be superfluous, with the help of which you can quickly and effectively remove the remnants of a special ultrasound gel used by a sonologist to enhance contact of the sensor with the skin.

Modern medicine has stepped far forward and today has a number of hardware techniques for early diagnosis of pathologies of fetal development and monitoring the state of a woman’s health during pregnancy. While carrying a child, a woman who is registered with an antenatal clinic or is being observed at a perinatal center undergoes an ultrasound examination three times.

The last such examination is carried out during the period 32-34 weeks of pregnancy in order to determine the condition of the fetus and the presence or absence of placental insufficiency.

What are they watching?

At 32 weeks of fetal development with ultrasound examination (ultrasound) pay attention to a number of key factors.

• The type of presentation of the fetus relative to the birth canal is determined - it can be transverse, cephalic or pelvic. At the same time, a plan for managing the birth process is formed - whether labor will take place naturally, or whether surgical delivery will be required.
• A more precise date of expected birth is determined.
• It is observed how the final formation of the child proceeds, in what condition the placenta is and how it is located, whether the fetus has an umbilical cord entwined.
• It is predicted whether or not the born child will need surgical or resuscitation care.

The timing of the third examination using ultrasound can be performed less strictly than the first two, which are done in the early stages of pregnancy. If the first two ultrasound results were without pathology, then the timing of the third examination, in agreement with the doctor, can be expanded and carried out in the period 30-31 or 34-37 weeks.

Of course, ideally it is better to stick to the traditional 32 weeks.

In addition to the parameters described above, the child is subjected to Doppler measurements (DPM) during the study. This method is one of the types of ultrasound diagnostics, which is used to determine the speed of blood flow in the vessels of the fetus, in the umbilical cord and in the uterus of a pregnant woman. The greatest information content from Doppler measurements can be obtained only after the 30th week of fetal development, however, if the presence of any pathologies is suspected, the procedure can be prescribed and carried out much earlier.

Doppler ultrasound helps determine the following conditions:

• early overripening of the placenta;
• excessive or insufficient amount of amniotic fluid;
• pathologies of umbilical cord formation;
• uneven development of one of the fetuses during multiple pregnancy;
• hydrops fetalis;
• Rh conflict or chromosomal pathology.

DPM is not a mandatory procedure, but it is performed by everyone, since it is used to determine the presence of disturbances in blood flow between the fetus and the placenta, and also to evaluate the functioning of the child’s heart.

If there are any deviations from the norm, this will mean that the further development of the fetus is at risk. Depending on the intensity of the disturbance in blood flow dynamics, both developmental delays and fetal death are possible.

Indicators and their interpretation

By the eighth month of pregnancy, when the fetus has formed, an ultrasound shows that it already has quite well developed cardiovascular and central nervous systems, the gastrointestinal tract and urinary system, and has all the appropriate signs of gender. The baby's appearance also undergoes some changes - a fuzz of hair appears on the head, arms and legs become plumper, and pronounced cheeks appear.

It happens that during ultrasound screening the child turns away from the sensor, then confirmation of the determination of his gender will be difficult and sometimes impossible. The interpretation of ultrasound screening indicators is divided into subsections, which imply a description of the development of the fetus and the condition of the uterus of a pregnant woman.

Anatomical development of the fetus

This includes the following indicators:

• Head part– examine the correctness and integrity of the formed skull and facial part of the head.
• Brain area– the formation of both hemispheres, the cerebellum, the visual thalamus, as well as other important parts of the brain is assessed. Particular attention is paid to measuring the width of the ventricles of the brain for the presence of hydrocephalus - normally this size should not exceed 10 millimeters.
• Facial department examine for the presence of developmental defects of the orbit, evaluate the area of ​​the nasolabial triangle.
• Vertebral department– look for the presence of a hernia or other pathologies.
• Bronchopulmonary department– determine the parameters of the bronchi and lungs, their level of maturity, the presence of neoplasms in the form of cysts, and also determine the presence of fluid in the pleural area.
• Heart area– check the presence of all four chambers in the organ, the presence of fluid in the area of ​​the pericardial sac, determine the condition of the partitions between the cardiac ventricles and atria, and also look at the position of the aorta and pulmonary artery.
• Organs of the gastrointestinal tract– determine the parameters and position of the stomach, liver, and intestines.
• Organs of the urinary system– determine the parameters and location of the kidneys, look at the renal pelvis, ureters, and bladder.

Condition of the baby's place (placenta)

• Place of its attachment in the uterus relative to the cervix. In a normal state of development, the placenta is attached in such a way that its lower part does not reach the level of the internal os by 7 centimeters or more.
• Determined degree of maturity of the placenta– at 32 weeks it is conventionally designated as “first” degree, but by 34 weeks this indicator changes to “second” degree.
• The thickness of the placenta is measured. Typically, these parameters can normally range from 25 to 41.5 millimeters.

Condition of amniotic fluid

The amount of amniotic (amniotic) fluid is determined in order to identify its excess or deficiency. There is a so-called amniotic index - a special table that, depending on the duration of pregnancy, determines the norm or deviation from it. So, at 32 weeks, oligohydramnios will be indicated by an index of 76 millimeters or less, moderate oligohydramnios - from 77 to 86 millimeters, the normal amount of amniotic fluid will be indicated by the index 144-242 millimeters.

An index parameter of less than 50 millimeters is considered dangerous to the life of a child.

Umbilical cord condition

Define:

• the composition of the umbilical cord, which normally should have two arteries and one vein;
• the presence of intrauterine umbilical cord entanglement in the fetus, for which 3D volumetric scanning and image transmission sensors are used;
• analyze whether the fetus has intrauterine hypoxia, for which the Doppler method is used.

The uterus and its muscular layer

The following indicators are assessed:

• determine the length of the uterus, which normally is no more than 29-30 millimeters, and also look at the external and internal os of the cervix, which should be closed until labor occurs;
• the muscular layer of the uterus is examined for the homogeneity of the myometrium - whether there were scars after surgical interventions, whether there is any development of neoplasms;
• The tone of the uterine muscles is assessed.

Appendages

The ovaries and fallopian tubes are also subject to examination for the presence of cystic formations in them. The usefulness of the data obtained is undeniable, since most pathological conditions in the fetus develop without pronounced symptoms, and they can only be identified by resorting to diagnostic studies, which include ultrasound.

All research data is recorded in a special medical protocol, which is certified by the diagnostician conducting the examination. This protocol is a mandatory document that a woman takes with her to the maternity hospital. Based on the protocol data, the doctor plans the delivery tactics, taking into account all the nuances that may arise during labor.

Fruit size

In addition to assessing the internal organs, their condition and development, at 32 weeks of pregnancy it is already possible to determine the sex, size and weight of the baby. Indicators of fetal development are assessed using developed tables containing parameters and norms taken as a standard.

• Hand sizes– measure the length of the forearm (44-56 millimeters) and shoulder (51-61 millimeters).
• Foot sizes– measure the length of the lower leg (49-60 millimeters) and thigh (54-65 millimeters).
• Biparietal parameters of the head– the length of a conventional line passing between the parietal bones of the skull from the upper edge to the inner surface of the lower edge. Normally, indicators vary between 74-90 millimeters.
• Fronto-occipital parameter of the head– the distance from the frontal to the occipital bone, normally it is 94-110 millimeters.
• Head circumference– measured for data reliability in three projections; normally this parameter is 279-330 millimeters.
• Abdominal circumference- Normally it is 254-315 millimeters.

If all indicators during the examination are normal, the doctor concludes that the pregnancy is developing normally and the fetus corresponds to the 32nd week of development. These indicators are not a dogma; it is necessary to take into account some family characteristics of certain parameters. However, if the studied parameters tend to hypertrophy, this may indicate a high maturity of the placenta and the danger of its destruction, which in turn disrupts the life support of the fetus.

If such a pathology is noticed in time, it will help to take timely measures to avoid unpleasant consequences for the mother and child.

Fetal weight

Using an ultrasound at 32 weeks of pregnancy, you can determine the baby’s height and find out how much he weighs. Of course, these results may differ slightly in one direction or another from the real ones, but this error is small. Normally, the baby’s height at this stage of development is 430-445 millimeters, and his average weight is in the range of 1950-2150 grams. These standards are relevant if there is only one fetus in the uterus, but when the pregnancy is multiple, each fetus will have its own parameters.

Normally, both fetuses should develop equally, but it happens that one of the children develops a little faster and more intensely than the other or others. So, for example, when twins develop in the uterus, the weight of each baby at 32 weeks will be 1600-1750 grams.

The parameters of the weight and height of the fetus are also necessary data in order to plan tactics for managing the birth process. There are cases when the anatomical structure of a woman’s pelvis does not correspond to normal delivery of a large fetus.

If you do not know the parameters of the fetus in advance, the death of the child or mother may occur during childbirth, since in this particular case delivery is indicated through an operation called “caesarean section”.

Currently, performing an ultrasound scan of a pregnant woman in the last stages of pregnancy is a mandatory diagnostic procedure for all. It is carried out quickly and painlessly, but its results are invaluable. The woman will not need any special preparation before the examination.

Doctors recommend that women listen especially carefully to their feelings during this period, and if there are changes in their health, immediately seek medical help. At this stage of pregnancy, there is a risk of premature cervical dilatation, therefore a woman must wear a special support bandage.

If you neglect this advice, the child, under the influence of its own gravity, begins to descend towards the entrance to the pelvis ahead of schedule, which leads to increased pressure on the cervix, and it regards this as a signal for the start of labor and begins to open. Thus, it is possible to provoke premature birth.

In addition to the risks associated with the uterus, in the third trimester of pregnancy the likelihood of developing late gestosis (toxicosis) in pregnant women increases. This condition is accompanied by an increase in arterial blood pressure, impaired kidney function with the appearance of edema and protein in the urine. These symptoms cannot be ignored, since at any moment a terrible complication, called eclampsia of pregnant women, can begin against their background, when a woman can be in mortal danger.

Doctors advise you to control your diet, monitor the amount of fluid you drink, and lead as active a lifestyle as possible, avoiding venous stagnation and swelling of the lower extremities. In addition, it is necessary to regularly measure blood pressure and monitor the urine output for cloudiness.