Absolutely all pregnant women periodically have to undergo ultrasound examinations. During this examination, the doctor draws attention to the size of the baby's body parts and necessarily compares them with the norm for this period of pregnancy.
What is fetal photometry and what is it for?
Fetometry is the determination of fetal size using ultrasound. It allows you to determine how the growth and development of the baby proceeds, diagnose disorders and identify most of the threats in time.
All measurements are usually done in millimeters according to a universal plan for all clinics.
The results obtained are compared with the standards that are already defined for each week. This allows to draw conclusions about the compliance of the development of the fetus to the stated duration of pregnancy.
During each ultrasound examination, the doctor must give a conclusion in which all parameters of the fetometry are indicated:
- The coccyx-parietal size (CTR) is the growth of the baby from crown to tip of the coccyx, especially informative on early terms pregnancy;
- The biparietal size (BDP) is the width of the head of the fruit, measured along the smallest axis between the temples, it is especially important to determine it in the second trimester;
- The length of the femur (dB), more precisely, is measured by the femur;
- Abdominal circumference (coolant);
- The chest volume (FG) is the same as the diameter (DG).
These indicators allow you to specify the duration of pregnancy and different terms They have informative content, therefore the simultaneous comparison of all gives the best results. Most often, up to 36 weeks, doctors pay more attention to OJ, BP and DB, and after that - OJ, OG and DB.
Allowable rates
When interpreting the results of their measurements, the doctor uses a ready-made plate with acceptable standards. They differ for each week of pregnancy, for example, BDP in the 20th obstetric week is 47 mm, and OG is 34 mm. At the 32nd these values are already 82 mm and 63 mm, respectively.
Severe deviations from the norm can be a sign of internal fetal disease. Knowing the measurement results, the future mother can independently interpret them using a special table.
A mismatch in fetal sizes may indicate:
- The delay intrauterine development (if there is a delay of 2 weeks, less is not a reason for suspicion);
- The presence of congenital abnormalities;
- Mutations of the fetus.
If certain indicators of the fetus do not coincide with the norm, do not panic. Sometimes the reason is a banal error in measurements made by a doctor.
Often it happens that all real indicators of the fetus do not coincide with the table, in this case we can not exclude errors in determining the duration of pregnancy. Therefore, in such situations, additional studies are always prescribed, most often dopplerometry.
Fetometry of the fetus by week (table)
To simplify the interpretation of the results of photometry, a special table has been created with average results. It indicates the fetal fetal rates by week, starting from the 11th, before measurements are not carried out.
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Obstetric week of pregnancy |
Fruit weight, g |
OG (GDK), mm |
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But it is necessary to take into account that the average values are fixed in the plate, and the sizes of each baby can differ. It depends on many factors, including heredity. Therefore, if the child is a little less than the norm - this is no reason to worry, you need to follow its growth in dynamics. If it is positive - it can be an individual feature of the baby.
Rules of the procedure
Fetometry is a mandatory part of the standard. The doctor may also prescribe additional examinations if he has doubts about the development of the fetus. Measurement of the fetus can be made during ultrasound through the anterior abdominal wall, as well as during transvaginal examination.
Only a doctor has the right to decipher the results of fetomet'i, taking into account certain individual moments, for example, height, weight, and additions of parents, as well as their age.
Features of preparation for fetometriya depend on what method it will be carried out:
- During transabdominal examination (through the front wall of the abdomen) in the early stages, the patient should drink about half a liter of water an hour before the procedure. In 2-3 trimesters there is no such need.
- Transvaginal examination does not require prior preparation.
Sometimes a doctor can use both methods simultaneously to clarify the results. For the future mom, it is important to advance, even while making an appointment, clarify how the research will be conducted.
During pregnancy, the fetus continuously grows and develops, and the future mom regularly undergoes all necessary examinations to monitor this process. One of the methods is ultrasound, and it can be used not only to determine the position of the fetus, but also to carry out various measurements of the unborn child. It is very important to determine the fetal abdominal circumference by week of pregnancy, since this indicator reports physical and mental development the unborn baby, the presence of pathologies and potential abnormalities in the children's body.
It is impossible to determine this mandatory assessment criterion by eye, therefore, the screening procedure is used, which tells a lot about the health status of the future child in the prenatal period. Up to 14 weeks is such an important indicator, which is also like the coolant, is part of.
As a rule, the indications of fetal abdominal circumference are compared weekly with a special table, and these values differ somewhat in different terms and in different trimesters. Be sure that this measurement is performed at 2 and 3 of the planned screening (approximately at the twentieth and weeks), and the differences obtained allow us to judge the development of a new organism.
Indicators of fetal coolant, obtained using ultrasound, are compared with a table of normal values.First of all, it is important to understand how the physician-Uzist performs the measurement. It's simple: fetal coolant is a conditional segment, conducted along the line of the liver, stomach and umbilical vein. Measurement can only be done on a special ultrasound machine, and it is important to obtain an extremely accurate value, so as not to doubt the systematic development of the embryo in the prenatal period. When the doctor gets a real value, then immediately compares with the established indicators of the norm.
To understand what are the ideal values, you should give a few examples from the table:
- Week 14 - the coolant is 85 mm;
- Week 20 - coolant reaches 144 mm;
- 26 obstetric week - Coolant exceeds 217 mm;
- 30 obstetric week - coolant rate varies within 365 mm;
- 40 obstetric week - characteristic measurement can reach 350 mm.
Important! It is necessary to understand that these are average indicators of the norm, since in practice the values may differ somewhat both upwards and downwards, and a variety of factors may influence this. But, nevertheless, it is also impossible to disregard them.
Features abnormalities
Having found out what fetal coolant is, it remains only to deal with the norms and real deviations, on which they depend and what they are talking about.
If in a particular case there is a deviation from the norm of the circumference of the abdomen of the fetus, then this is not a reason for panic. It is not excluded that there are genetic features of the structure of the body, and small parents, in most cases, especially tiny babies are born - this is the first argument in favor of physiological abnormalities. By the way, girls are also smaller than boys, so the sex of the fetus can also be of great importance.
The development of abnormalities of the fetus can be affected by various reasons, including the lifestyle of the expectant mother. In order to immediately eliminate the risk of pathology, the doctor conducts a qualitative examination of all internal organs and systems, directs the pregnant patient to an appointment with genetics. Much worse, when the pathology is obvious on the monitor screen, which not only affects the fetal development of the embryo, but also provides a number of congenital diseases.
If the abdominal circumference of the fetus is visibly impaired by ultrasound, the doctor makes a preliminary conclusion - IUGR, that is, intrauterine growth retardation. In terms of when the internal organs and abdomen are of normal size, the disease has received the definition of an asymmetric form; when their size is clearly reduced on the background of a small abdomen, the illness acquires a symmetrical shape. One way or another, a complete diagnosis of the pregnant body is required and, in addition, the doctor may question the successful delivery.
Such deviations may be due to smoking and alcoholism, hypoplasia of the placenta or impaired blood flow, or diagnoses such as catarrhal diseases, chronic lesions of the kidneys, liver, heart.
Whatever the cause of the deviations of the development of the fetus from the normal values, such a problem must be solved immediately. But in order to detect pathology in a timely manner, you need to contact a gynecologist as early as possible for registration and strictly follow all the doctor’s recommendations, do not skip routine examinations and tests, and even undergo unscheduled examinations if physicians consider them necessary.
Intrauterine growth retardation
Prevention, diagnosis, treatment
It happens that future mothers hear at the reception at the attending physician or in the ultrasound room a frighteningly incomprehensible abbreviation - IURD. Its decoding is even more frightening - "intrauterine growth retardation". A pregnant woman faced with a similar diagnosis is plagued by many questions. How dangerous is this condition? How will it affect the health of the baby? Will he be able to catch up?
What is FPN and ZVUR?
Nutrition and respiration of the fetus is provided by a temporary ("provisional") organ - the placenta, which supplies the fetus with the necessary substances for life, obtaining them from the mother's circulating blood. The condition in which the placenta does not adequately cope with its responsibilities is called placental insufficiency (FPN). The placental insufficiency over time leads to the fact that the fetus, not receiving the required amount of nutrients, weighs less than the norm. This condition is called intrauterine growth retardation (IUGR), or intrauterine growth retardation (VZRP), or fetal hypotrophy.
The causes of FPN are diverse. These include: late gestosis (nephropathy) - increased blood pressure, protein in the urine, edema, prolonged elevation of the uterus with the threat of premature birth, uterine abnormalities, abnormal development of the placenta and umbilical cord (for example, short umbilical cord), general maternal diseases ( heart defects, hypertension), common infections (from rubella to flu), rhesus-conflict. Factors predisposing to the development of FPN are rightly considered to be bad habits - smoking, addiction to alcohol and any drugs. Very often, one or both fetuses are susceptible to developmental delay in twins.
Sick or just small?
Of course, not always a child is born small due to FPN. There is the concept of "constitutional-low-weight fetus". It makes sense when parents of short stature are born small child. In this case, the child is born with low body weight, but completely healthy, not experiencing additional difficulties in the period of adaptation to extrauterine life, as children exposed to the true IUGR. Hypotrophic children differ from lightweight ones by the insufficient functioning of organs. It is important to understand that IUGR is not just a shortage of body weight, but an important symptom of a far advanced FPN. And most importantly, FPN can cause fetal fetal death, since if blood circulation is disturbed in the mother-placenta-fetus system, as a last resort, the delivery of oxygen and nutrients to the fetus may stop.
Diagnosis of FPN
The simplest method of monitoring fetal growth is to measure the height of the uterus floor above the womb and compare the results with standards for this period. Along with this, newer methods are used - determination of the content of placental hormones in the mother’s blood - placental lactogen, alkaline phosphatase, and some others. Obviously, a healthy placenta produces hormones in sufficient quantities, and the diseased pathological process - on the contrary. These parameters are determined by the mother’s blood test. Cardiotocography (CTG) also plays an important role in the diagnosis of FPI, during which the fetal heart activity is recorded on a special tape and on the screen. During this belly exam future mom attach a special sensor, through which the vibrations created by the baby's heartbeat, are transmitted to the device, where the signal is transformed into a certain curve, which reflects the number of fetal heartbeats. The purpose of this study is to make sure that the fetus is not lacking in oxygen. If the normal number of fetal heartbeats is 120-160 beats per minute, then with a lack of oxygen, it decreases or increases. Other indicators are also changing - a reaction to perturbations, etc.
The most common and accurate method for diagnosing intrauterine growth retardation is ultrasound. Using ultrasound, you can accurately determine not only the discrepancy between the mass of the fetus normal for a given period of pregnancy, but also to find out how much the development of the fetus is proportional and harmonious, how the internal organs of the fetus function, whether the umbilical cord or the umbilical cord has a normal structure. Using a variety of ultrasound - Doppler studies - you can get information about the speed and direction of blood flow through the umbilical cord vessels and the large arteries of the fetus.
Treat or feed?
The delayed development of the fetus detected with the help of ultrasound should be treated. The goal of treatment in this case is not to “fatten the baby”, but to normalize the metabolic processes and support the vital functions of the fetus.
For the treatment of fetal hypotrophy used a large arsenal of medicines. Treatment should be individualized, taking into account the reasons that caused the FPI in this particular case. The success of treatment largely depends on how timely it is started.
In therapy of NEF, tocolytic (i.e., relaxing uterus) and vasodilators are widely used. Their use allows the small vessels to expand and increase the volume of uteroplacental blood flow. A similar goal is pursued by the appointment of infusion therapy - intravenous drip injection of blood substitutes, which reduce blood viscosity and facilitate its passage through the capillaries. Of great importance in the treatment of placental insufficiency is also the use of vitamins (especially vitamin C and E) and amino acids, which allows you to normalize the composition of circulating blood and enrich it with substances necessary for the construction of organs and tissues of the fetus, as well as the synthesis of its enzymes and hormones.
Currently, many non-pharmacological agents, such as medical ozone, hyperbaric oxygenation (medical procedure — breathing oxygen-enriched air under conditions of high barometric pressure) and some others, are also used to treat intrauterine growth retardation. It is highly desirable to comply with the regime, which in English-speaking countries is called "bed rest" - during the day you should spend in bed in a side position for at least 6 hours. Well, the age-old Russian "quiet hour" - daytime sleep in the afternoon.
For future mothers who are carrying a small child, it is very important to have a nutritious diet rich in vitamins and animal proteins, as well as a regime with limited physical activity. Although you should not overeat, remembering that the excess in the diet does not lead to a proportional increase in the amount of nutrients taken by the placenta for the fetus. It is a historical fact that, even during the siege, Leningrad women were born mostly full-bodied children.
The effect of therapeutic measures should be constantly monitored using ultrasound and CTG, which are usually prescribed at intervals of 2 weeks (CTG - if necessary, and more often). Treatment of IUGR almost always gives good results, although only in 10-20% of cases the weight of the fetus can be brought back to normal. In most cases, it is possible to observe adequate growth of the fetus, for example, in 7–10 days, the size of the fetus increases accordingly, but does not lag even further, which is considered to be quite a satisfactory result of treatment. In rare cases, when the efforts of doctors are in vain, the absence of growth of the fetus is recorded on ultrasound, the joining of water deficiency, the Doppler measurements worsen, and CTG shows signs of oxygen deficiency. In this case, you need to think about emergency delivery. The choice of method of delivery (childbirth or cesarean section) depends on the readiness of the body and cervix for childbirth and the severity of the fetus. If there is no certainty that a weakened child will suffer birth stress, a cesarean section is preferred.
Prevention of FPI
It is necessary to think about the welfare of the unborn baby before pregnancy. It must be remembered that abortion, injuring the uterus, can later lead to impaired uteroplacental circulation. During pregnancy, it is better to resolutely stop smoking and drinking alcohol, contact with toxic substances and sources of radiation - especially in early pregnancy, when the placenta is formed. It is necessary to treat infectious diseases and possible foci of infection, such as carious teeth or chronic tonsillitis, in a timely manner (or better in advance). All future mothers, without exception, are recommended to take multivitamin preparations for pregnant women.
Sometimes pregnant women from high-risk groups (too young; women over 30 years old, expecting their first child; suffering from chronic diseases; having low-weight babies who have given birth in the past; with long breaks between pregnancies) are recommended for courses of drug prevention of FPI for periods up to 12 weeks, 20-23 weeks and 30-32 weeks, which include vasodilators and vitamins.
Separated effects
As a rule, children undergoing IUGR in intrauterine life require more thorough care after birth. In growth and weight, such children usually catch up with their peers by the age of one and a half to two years, although due to reduced immunity indicators they get sick more often than other children. In addition, these children sometimes have problems with concentration and perseverance. However, medical rehabilitation helps young children to overcome all difficulties and to have full health in adult life.