Modern methods of ultrasound in obstetrics. Ultrasound obstetric (II-III trimesters of pregnancy)

Ultrasound scanning is a rather young method of medical imaging. The first ultrasound (ultrasound examination) was carried out only in 1956, and in obstetrics and gynecology this method has been used since the mid-60s of the last century.

The importance of ultrasound in obstetrics cannot be overestimated. Before the introduction of ultrasound imaging, it was impossible to accurately determine the size of the fetus, specify the gestational age, examine the structure of the placenta, and diagnose congenital malformations. Sometimes X-rays were used to diagnose deformities, but exposing all pregnant women to it was out of the question due to the adverse effects of radiation on the fetus. Therefore, it can be said without exaggeration that the revolutionary improvement in perinatal outcomes that has taken place in recent years is due to ultrasound diagnostics in obstetrics.

No one doubts the great importance of ultrasound in obstetric practice. The possibility of detecting many diseases and disorders in the development of pregnancy, harmlessness, ease of implementation in various situations led to the widespread use of this method.

Now ultrasound scanning is the leading research method in obstetrics and gynecology. And that's why:

1. Ultrasound provides reliable information about the position, shape and size of the pelvic organs, as well as the fetus;
2. the study is convenient and does not require any preparation;
3. ultrasound is publicly available;
4. ultrasound is harmless to living tissues;
5. the study is painless and not associated with discomfort;
6. Ultrasound is performed in real time. This circumstance provides several advantages at once:
   • no time is needed to process the material, develop and print any images, the result of the study becomes obvious at the end of the study;
   • the researcher sees his "picture"; in real time and has the ability to manipulate the image to achieve the best.

Modern medical ultrasound devices make it possible to obtain high-resolution three-dimensional images of objects (up to 0.1 mm), to examine small vessels and tissue textures, and to observe blood flow in vessels.

Is medical ultrasound safe for the human body, and even more so for the fetus?

It is not news to scientists that ultrasound can damage and even destroy living cells. But we are talking about prolonged and intense exposure to ultrasound, usually technical. And the dose and frequency of medical, and even more so obstetric ultrasound, are hundreds and thousands of times less than the damaging dose and frequency. And then, in the more than 50-year history of ultrasound scanning, no serious harmful effects on children have been noticed behind it.

Theoretically and practically, during ultrasound examination, the body is exposed to a high frequency sound wave, from 2 to 10 (usually 3.5-5) MHz. This wave is in no way related to radiation, but is an ordinary sound, but its frequency spectrum lies outside the audible region, such as, for example, the cry of a bat or a dolphin. By the way, the dolphin is taken as a symbol of the ultrasonic trend in medicine. In the aquatic environment, the dolphin's ultrasonic impulses help it, just as in ultrasound diagnostics, to determine the size, position and speed of an object.

So, the sent ultrasonic pulse is reflected from different structures of the body and perceived by the receiving sensor, the whole process resembles an echo in the mountains, which is why it is called echolocation. Further conversion of the signal using a computer allows you to get a picture on the monitor screen, according to which this or that conclusion is made. The diagnostic doses of ultrasound are, of course, very small to cause harm to the fetus.

Sometimes you can hear the statement: healthy people do not go for ultrasound. Is it necessary for a normal pregnancy? There can be only one answer: of course, it is necessary. Firstly, because a preventive approach is always preferable, especially in obstetrics. After all, the fetus itself will not go to the ultrasound room and say: "I've been feeling bad lately."

Here are some arguments in favor of the need for ultrasound monitoring of the course of pregnancy:

• malformations of the fetus in 90% of cases develop in perfectly healthy people, without any risk factors. Those. such defects are detected in a timely manner only with ultrasound performed for preventive purposes;
• there may be significant fetal malformations with an external successful pregnancy;
• clinical examination (i.e. palpation by external methods) is not reliable in establishing a multiple pregnancy, not to mention the control of normal (associated) intrauterine development of twins;
• pregnant women with a low location and placenta previa, as a rule, do not know about it until they start bleeding;
• up to 50% of women who claim to know exactly the gestational age (including "at conception") are mistaken for more than 2 weeks, and these 2 weeks can be very important, especially in a situation of premature birth for premature babies .

Ultrasound occupies a special place in obstetrics. It was he who made it possible for obstetricians-gynecologists to observe the intrauterine development of the fetus and take emergency measures at the slightest deviation from the norm. Usually, in the normal course of pregnancy, three planned ultrasound examinations are performed (one in each trimester: at terms of 10-14, 20-24 and 32-34 weeks) the so-called "ultrasound screening", i.e. a massive three-time study of all pregnant women in order to identify various abnormalities during pregnancy at different stages, as well as anomalies and malformations of the fetus and signs of intrauterine suffering. But if there are clinical indications, ultrasound can be performed at any time during pregnancy with the frequency prescribed by the doctor observing the expectant mother.

In the first trimester Ultrasound is necessary to set the gestational age, if a threatened miscarriage or ectopic pregnancy is suspected. For a period of 10-12 weeks it is possible to determine the correctness of the formation of the bone skeleton of the hearth, to reveal a gross pathology of the brain and other organs. Diagnosis of pregnancy by ultrasound using a transvaginal sensor is possible already with a delay of menstruation of 3-5 days (a period of 4.5 weeks, counting from the first day of the last menstruation, as is customary in obstetrics). At this time, a fetal egg is visualized in the uterine cavity, the diameter of which in millimeters is approximately equal to the number of days of delay. Within 5-6 weeks the embryo becomes visible.

A heartbeat can be detected already in an embryo 4-5 mm long. The head is distinguishable at 7-8 weeks, limbs at 9 weeks. Such a high information content of ultrasound makes it possible to detect many fetal malformations already in the first trimester of pregnancy, when it can be interrupted by medical abortion.

Diagnosis of the sex of the fetus on ultrasound is often possible already in the period of 13-16 weeks. The most accurate gestational age can be set in the 1st trimester, when the coccygeal-parietal size of the embryo is measured (i.e., its length). In this case, the error, as a rule, does not exceed 3 days. Over time, the error increases.

Therefore, it is recommended that all pregnant women undergo ultrasound for the first time in the early stages (up to 12 weeks). This is also important in terms of identifying complications such as non-developing pregnancy, while there is an empty fetal egg (anembryony) or the absence of a heartbeat in the embryo. It is important to identify the tone of the uterus and other signs of a threatened abortion.

With ultrasound, such a serious disease as hydatidiform mole is also well detected. Multiple pregnancy is diagnosed starting from the earliest dates, which allows you to determine the further tactics of its management.

At 18-20 weeks it is possible to reliably determine the sex of the fetus.

Term 20-24 weeks is very important for assessing all the internal organs of the fetus and identifying most of the existing congenital malformations. It is possible to identify and signs of various genetic abnormalities and syndromes, for example, there are a number of well-defined ultrasound markers of Down syndrome. In the last, third trimester, the placenta, the position of the fetus, its functional state, weight, height, and compliance with the size of the gestational age are assessed.

In big time during ultrasound, the main dimensions of the fetus are necessarily measured: biparietal size or head circumference, average diameter or circumference of the abdomen and thigh length, and many other equally important biometric indicators of the fetus. In some cases, other dimensions are also specified.

There are tables of standards for these sizes and different periods of pregnancy, a comparison with which allows you to identify conditions such as fetal malnutrition. Some vices and determine its weight. On ultrasound, many congenital malformations of the fetus can be detected, but the frequency of their detection significantly depends on the qualifications of the specialist and on the quality of the ultrasound machine.

During the examination, the location, size, thickness and degree of "maturity" of the placenta are also determined, which is of great practical importance in terms of identifying placenta previa, placental abruption, signs of fetal hemolytic disease, placental insufficiency and other serious complications of pregnancy, including especially relevant in the last time of intrauterine infection.

Meshcheryakov R.Yu. obstetrician-gynecologist of the highest category, ultrasound doctor

The cycle is conducted by Doctor of Medical Sciences, Professor
Ozerskaya Irina Arkadievna.

Additional information and registration e-mail:
[email protected] mail.ru

As a result of the lesson, the doctor should gain knowledge on the following issues:

Signs of an unchanged ultrasound picture of the uterus, ovaries and fallopian tubes;
- ultrasound signs of anomalies and malformations of the uterus and ovaries;
- ultrasound signs of pathological changes in the most common diseases of the uterus, ovaries and fallopian tubes;
- the main ultrasound signs of concomitant pathological processes in adjacent organs and areas (including the organs of the large and small pelvis, retroperitoneal space);
- ultrasonic signs of pathological changes in complications of the most common diseases of the uterus and appendages;
- the possibilities and features of the use of modern techniques used in ultrasound diagnostics of the pelvic organs in women, including pulsed and color Doppler, ultrasound-guided puncture biopsy, contrast echohysterosalpingoscopy, etc.

The doctor must acquire or consolidate skills in the following areas:

Determine the indications and expediency for ultrasound;
- to choose adequate methods of ultrasound examination;
- take into account deontological problems when making a decision;
- on the basis of ultrasonic semiotics to identify changes in organs and systems;
- identify ultrasound signs of changes in the pelvic organs in women, determine their localization, prevalence and severity;

Conduct a differential diagnosis with ultrasound and identify signs:

a. - anomalies in the development of the uterus and ovaries; b. - inflammatory diseases and their complications; in. - tumor lesions; d. - secondary changes caused by pathological processes in adjacent organs and tissues and in generalized processes; e. - changes after the most common surgical interventions and some of their complications (abscesses, infiltrates, etc.);
- compare the signs identified during the study with the data of clinical laboratory and instrumental research methods;
- determine the need for additional ultrasound examination;
- to determine the sufficiency of the available diagnostic information for drawing up a conclusion according to the ultrasound data;
- attribute the data obtained to a particular class of diseases;
- to form a conclusion (or, in some cases, a differential diagnostic series), to determine, if necessary, the timing and nature of repeated ultrasound and the feasibility of additional other diagnostic methods.

At present, the examination of a person with the help of ultrasonic waves has become so widely applicable that we no longer imagine how we managed without it before. Most often, this is the primary method of examination and the establishment of a final or primary diagnosis. Sometimes this is the only method of examination. To date, ultrasound devices are at such a high stage of development that they can not only detect diseases and their localization, but also influence the pathology, that is, treat.

Ultrasound devices are used only by highly qualified doctors - diagnosticians. And the ultrasound machine itself is as harmless as possible for the person being examined. Especially the issue of safety worries young mothers, because we are talking not about one, but about two people at once. Therefore, medicine in this case offers high-precision safe ultrasound diagnostic devices in obstetrics and gynecology. The new equipment has a number of additional functions and significantly expands the possibilities of extensive diagnostics. During the leak control program or completely independent of it, you can undergo a qualitative ultrasound examination. You can undergo this detailed examination with or without a doctor's referral.

Thanks to such a high-precision ultrasound device - diagnostics in obstetrics, an obstetrician - gynecologist has the opportunity to examine in detail all the organs of a developing fetus. This aims to identify various pathologies in time, which, thanks to the level of modern medicine, can be influenced, or to reassure parents that no pathologies have been identified. Also, ultrasound in obstetrics allows you to conduct a successful pregnancy, set the timing of pregnancy, childbirth, the number of fetuses, the location of the fetus, and much more.

Ultrasound diagnostics in obstetrics and gynecology is permissible from the moment of the first signals that pregnancy has occurred, that is, from 5 to 6 weeks from the first day of the start of the last menstruation.

At the level of legislation, ultrasound diagnostics in obstetrics during pregnancy should be performed three times. The first - the first trimester, that is, the eleventh - thirteenth week, the second - the second trimester, that is, from the twentieth to the twenty-second week, and the third time - the last, third trimester, which falls on 32-34 weeks of pregnancy. The number of ultrasound examinations in obstetrics may increase when pathologies are visible or suspected that they may develop.

According to the World Health Organization, ultrasound diagnostics in obstetrics is the most important method for monitoring the developing fetus and does not affect it, so this method should not be feared and avoided.

What determines ultrasound in obstetrics in each trimester of pregnancy

First trimester

Confirmation of a real pregnancy, as well as the establishment of its term. One of the main tasks of early diagnosis is to determine the location of the released fertilized egg: in the cavity or outside the uterus, then we are talking about a pathological pregnancy that must be terminated to save the woman's life.

An interesting function of an ultrasound examination of a pregnant woman is to determine the number of developing fetuses, as well as their gender.

At the embryonic stage, an ultrasound specialist can also confirm the viability of the embryo.

Starting from the first day of the end of the previous menstrual cycle, it is possible to determine the gestational age. The earliest terms are determined by determining the size of the fetal sac, and later by establishing the length from the coccyx to the crown of the head.

The presence of a fertilized egg in the uterine cavity does not exclude the presence of an ectopic pregnancy. In very rare cases, in the presence of a normal uterine pregnancy, an ectopic one is also present, in which the fetal sac is in the tube. With the help of ultrasound, such a pathology should be excluded or detected in time. The presence of more than one fetus is detected as early as the fifth week of pregnancy. Moreover, it is this week that the probability of spontaneous miscarriage of the second or third embryo arises. It is not necessary for the mother to know such information, but such a miscarriage can lead to curettage of a viable fetus, so a gynecologist should know about this threat.

With the help of ultrasound, the fact of the heartbeat is fixed, which is the first registration of a new life, the viability of the fetus.

Second trimester

Clarification of the gestational age for several factors. Determination of the number of babies. Diagnosis of pathological abnormalities. Determination of the localization of the placenta.

Ultrasound examination will also help to identify volumetric neoplasms in the cavity of the small pelvis of the mother, which can adversely affect the course of pregnancy and childbirth.

At this stage, the main parameters by which the gestational age is determined are the size of the head, the circumference of the abdomen and the length of the femur bone. At the same time, in the presence of multiple pregnancies, detailed diagnostics are carried out for each fetus, and individually, regardless of the indicators of one baby, including the determination of the gestational age, the number of fetal sacs, and placentas.

In the presence of a floating placenta, regular monitoring is necessary to determine its location just before the birth.

third trimester

With the help of ultrasound, a delay in the growth and development of the fetus is detected, and previously unidentified anomalies of the child are confirmed. The exact position of the fetus or presentation, the location of the placenta is determined. The amount of amniotic fluid is estimated. Determination of developmental anomalies at this stage plays a decisive role in determining the tactics of labor management. For example, the detection of such pathologies as hernias of various localization, hydrocephalus are one hundred percent indications for a caesarean section.

The definition of fetal pathology is also important for the psychological preparation of the family for the birth of a child with defects.

Involvement of a medical team at the time of delivery for urgent assistance and possible resuscitation of a newborn with such congenital defects as a hernia of the diaphragm, pathology of the interventricular septum

Determination of the position of the fetus and presentation before childbirth will allow you to choose the right tactics for conducting labor

Determination of the amount of amniotic fluid. A small and large amount of water is closely related to abnormalities in the development of the fetus.

Use in a 3D format ultrasound system

The use of real-time ultrasound allows you to see the baby in motion. Modern ultrasound systems in obstetrics, operating on the Doppler principle, assess the state of blood circulation in the entire utero-placental system of the fetus and mother

Types of ultrasound in obstetrics

There are two types of this study:

Transabdominal (sensors are located outside the abdominal wall)

Transvaginal (a special probe is inserted into the vagina)

Preparation for ultrasound in obstetrics and gynecology is not required. Remember that in the presence of serious pathologies, an ultrasound examination is not the only method for diagnosing and determining treatment tactics. Be sure to visit a specialist - a gynecologist.

In modern medicine, there is one instrumental method of examination, without which no independent branch of this general science can do today - this is the method of ultrasound. In short, it is called - ultrasound. Today it is the most common and safe method of abdominal, organ and tissue research. It is carried out under the influence of ultrasonic waves on the organ or tissue under study.

Scientists drew attention to the fact that ultrasonic waves have the ability to freely penetrate tissues, and special equipment captures on monitors a clear image of everything that is in the zone of action of the waves. It is this feature that allows specialists to identify various deviations of tissues and organs of the body from the norm. And the fact that such a method of research does not pose absolutely any additional threat to the health of the subject has made the ultrasound method the most popular and in demand today.

Another advantage and a feature of ultrasound is its painlessness and the quality of the information received on the status of the survey. Ultrasound studies occupy a special place in obstetrics. This method allows us to accurately identify many gynecological and obstetric problems at the earliest stages. Among them are:

In addition, with the help of ultrasonic waves, pregnancy and its terms, ectopic pregnancy are easily determined. In obstetrics, there is one immutable rule for conducting this type of study - the bladder, at the time of the examination, must be full.

Benefits of ultrasound in obstetrics

This method makes it possible to examine in detail all the female organs hidden inside the small pelvis, without causing any inconvenience to the patient. On the monitor screen, you can easily view the uterine cavity, determine the natural size and volume of the ovaries, and their anatomical position. In an ultrasound examination of the cavities inside the small pelvis, tumor neoplasms of oncological and non-oncological etiology are quite easily detected, you can find out what condition the bladder and genitals are in after surgical interventions. Such studies should be carried out within 5 to 6 days from the onset of periodic discharge. During this period, the mucous membranes of the uterus (endometrium) become the thinnest, and this allows you to more accurately determine the presence of polyps, fibroids, myomas.

Speaking of Features performing ultrasound examinations in obstetrics , the first thing I want to say is that there are two types of ultrasound examinations:

These are completely different research methods, so we will consider each of them in detail and separately.

Methods for conducting obstetric ultrasound

There are such methods performing an obstetric ultrasound :

• 1. Transabdominal examination. It is carried out lying on the couch. Such a study is intended mainly to identify pathologies of intrauterine development of the fetus and determine the overall course of pregnancy. In this case, the examination is carried out through the abdominal wall. To do this, a special gel is applied to the woman's stomach. During the study, a special transmitter is used, the signals from which are sent to a computer for processing and then displayed on the monitor screen. Thus, the doctor has the opportunity to make an accurate opinion about the condition of the fetus or about pathologies that prevent pregnancy. It is during a transabdominal examination that a woman's bladder should be full.
• 2. Transvaginal examination. It is carried out in contrast to the first research method with an empty bladder. This is an indispensable circumstance, otherwise the specialist will not be able to guarantee that the monitor screen will have a clear picture necessary to establish an obvious or possible pathology of the internal organs of the small pelvis. With this method of ultrasound, a special probe is inserted into the vagina. True, a latex tip is necessarily put on the sensor before insertion, but most often they use a simple condom.

During a transvaginal examination, the doctor makes an opinion:

Besides Ultrasound in obstetrics helps to determine with almost one hundred percent accuracy the gender of the unborn child.

Reasons for an ultrasound during pregnancy

The main reason for conducting an ultrasound examination of pregnant women is the need to determine a more accurate picture of the course of pregnancy and its timing. What is the need for this?

• 1. The family may not be aware of any congenital or genetic abnormalities that may cause abnormal development of the fetus. Ultrasound makes it possible to detect the development of pathology in the early stages.
• 2. When there is a need to determine the exact timing of pregnancy.
• 3. With the detection of multiple pregnancy.
• 4. With the determination of the anatomical location of the placenta.
• 5. With the detection of pathologies that prevent the proper course of pregnancy.
• 6. With the identification of some deviations in the development of the fetus from the norm.

The latter circumstance has many rather serious grounds. So, for example, an ultrasound scan at the fourteenth week reveals the presence of Down syndrome in the fetus. At this time there is a possibility of termination of pregnancy. Therefore, it is so important to conduct such a study at this particular time. An ectopic pregnancy can also be identified. If you do not pay due attention to this problem, there may be a specific threat to the life of a woman.

The detection of multiple pregnancies allows young parents to mentally and financially prepare for such a significant event. And most importantly when ultrasound in obstetrics for a doctor, it is an opportunity to conduct research in real time and the possibility of prescribing a timely and only correct treatment.

Ultrasound is considered one of the most informative research methods in obstetrics.

J. Fields of application of ultrasound.

A. Fetometry is the determination of the size of the fetus or its individual parts by means of ultrasound. The method allows you to specify the gestational age and weight of the fetus. An assessment of fetometric indicators, taking into account the data of the anamnesis and physical examination (date of the last menstruation and the height of the uterine fundus), is used to diagnose intrauterine development disorders.

B. Diagnosis of malformations. Modern ultrasound equipment allows diagnosing even minor malformations of the gastrointestinal tract, skeleton, urinary tract, genital organs, heart and central nervous system. Ultrasound is also used to determine the location of the placenta and diagnose multiple pregnancies.

B. Assessment of the condition of the fetus. With the help of ultrasound, the biophysical profile of the fetus and the volume of amniotic fluid are assessed. The use of ultrasound for prenatal diagnosis has led to a reduction in perinatal mortality. Doppler study makes it possible to assess the function of the fetal cardiovascular system and placental circulation.

D. Control in invasive studies. Ultrasound is used for amniocentesis, chorionic biopsy, and cordocentesis. In addition, ultrasound is used to diagnose ectopic pregnancy with bloody discharge from the genital tract and pain in the lower abdomen in early pregnancy.

YY. General characteristics of ultrasound

Purpose of ultrasound. According to the Bulletin of the American Society of Obstetricians and Gynecologists, depending on the purpose of ultrasound during pregnancy, there are two types of ultrasound - standard and targeted.

• 1) With a standard ultrasound, the following parameters and indicators are evaluated.
• *Description of the contents of the uterus. The number and position of the fetuses, the localization of the placenta are determined, an approximate assessment of the volume of amniotic fluid is carried out (in case of multiple pregnancy, for each fetus separately).
• *Fetometry.
• 1) Biparietal head size.
• 2) Head circumference.
• 3) The circumference of the abdomen.
• 4) Thigh length.
• *After the 22nd week of pregnancy, using formulas or nomograms, it is imperative to calculate the estimated fetal weight and the percentile to which this indicator corresponds (for example, the estimated weight determined from the table based on the biparietal size of the head and abdominal circumference of the fetus is 1720 g, which corresponds to 25 th percentile for a given gestational age).
• *Anatomy of the fetus. The brain, heart, kidneys, bladder, stomach, spinal cord are visualized, and the attachment and number of umbilical cord vessels are determined.
• *Frequency and rhythm of fetal heart rate.
• *Other pathological changes. You can find an increase (edema) of the placenta, overdistension of the fetal bladder, marked expansion of the pelvicalyceal system and ascites. The mother can detect pathology of the pelvic organs, such as uterine fibroids.
• 2) Targeted ultrasound is used for a more thorough examination of the fetus in cases of suspected malformations or severe IUGR. At the same time, special attention is paid to certain organs and systems. For targeted ultrasound, a two-dimensional study is used. The areas of interest are photographed. Recently, video recording has been increasingly used with ultrasound.
• 3) Biophysical profile of the fetus. It was proposed to evaluate individual indicators of the state of the fetus according to a point system. The advantages of this method are high sensitivity (allows diagnosing intrauterine hypoxia even at an early stage) and high specificity.
• 4) Selective ultrasound. In some cases, after a standard or targeted ultrasound, when there are no indications for repeating these studies, selective ultrasound is allowed. It includes regular assessment of a certain indicator, such as the location of the placenta, amniotic fluid volume, biophysical profile, fetal head size, heart rate, fetal presentation, as well as ultrasound-guided amniocentesis.

YYY. Indications for ultrasound

Clarification of the gestational age before caesarean section, labor induction and artificial abortion.

Assessment of fetal development in the presence of risk factors for VUZR and macrosomia: severe preeclampsia, long-term arterial hypertension, CRF and severe diabetes mellitus.

Bleeding from the genital tract during pregnancy.

Determination of fetal presentation with an unstable position of the fetus at the end of pregnancy and if it is impossible to determine the presentation of the fetus by other methods during childbirth.

Suspicion of multiple pregnancy: if the heartbeat of at least two fetuses is heard, if the height of the uterine fundus exceeds the gestational age, and if the pregnancy occurred after the induction of ovulation.

Inconsistency of the size of the uterus with the gestational age. Ultrasound allows you to clarify the gestational age, as well as to exclude poly- and oligohydramnios.

Volumetric formation of the small pelvis, revealed during vaginal examination.

Suspicion of hydatidiform mole. With cystic drift, arterial hypertension, proteinuria, ovarian cysts, and the absence of a fetal heartbeat (with a Doppler study at a gestational age of more than 12 weeks) can be observed.

Isthmic-cervical insufficiency. (With the help of ultrasound, the state of the cervix is ​​​​monitored, the optimal time is chosen for applying a circular suture.

Suspicion of an ectopic pregnancy or a high risk of this pathology.

Suspicion of fetal death.

Invasive research methods: fetoscopy, intrauterine blood transfusion, cordocentosis, chorionic biopsy, amniocentesis.

Suspicion of uterine pathology: uterine fibroids, bifurcated uterus, bicornuate uterus.

Control of the position of the VMC.

Monitoring the growth of the ovarian follicle.

Assessment of the biophysical profile of the fetus after the 28th week of pregnancy (if intrauterine hypoxia is suspected).

Various manipulations during childbirth, such as turning and extracting the second fetus with twins.

Suspicion on a lot - and an oligohydramnios.

Suspicion of premature detachment of the placenta.

External rotation of the fetus on the head in breech presentation.

Determination of fetal weight in premature rupture of amniotic fluid and premature birth.

High level of a-FP in the serum of a pregnant woman. Ultrasound is performed to clarify the gestational age and exclude multiple pregnancies, anencephaly and the death of one of the fetuses.

Evaluation of previously diagnosed fetal malformations.

Family history of birth defects.

Evaluation of fetal development in multiple pregnancies.

Determining the duration of pregnancy in case of late treatment of a pregnant woman to a doctor. ultrasound diagnostics obstetrics echographic