When is the first ultrasound done during pregnancy? Screening of the first trimester of pregnancy - what you need to know about the rates and results What is CTE during pregnancy on ultrasound.

The first perinatal screening is a comprehensive diagnosis of the expectant mother, which is carried out even before the birth of the baby from 10 to 13-14 weeks of intrauterine development. A classic study of this kind combines only 2 main types of medical manipulations - biochemical analysis of maternal serum and ultrasound of the fetus.

At the end of the tests, the data obtained will be monitored, based on a comparison of the result with the indications of the screening rate by ultrasound of the 1st trimester. The main task of an individual examination is the early detection of genetic abnormalities in the fetus.

Indications for

Despite the fact that the primary diagnosis is carried out for many pregnant women, there are special categories of patients who are primarily required to undergo an ultrasound scan and take a blood test in order to eliminate the danger to the life of the unborn child and their own health. This group of people includes future mothers who:

previously gave birth to children with any developmental disabilities;
already have a child with fixed genetic pathologies;
crossed the threshold of the 35-40th anniversary;
were exposed during the period of gestation to infectious diseases;
have ever suffered from excessive use of alcohol or drugs;
have a history on their hands with notes about the threat of spontaneous miscarriage;
are with the potential father of the baby in a closely related union;
for any reason, took medications prohibited for use during gestation;
know about the presence of hereditary anomalies in the family lineage;
have experienced a stillbirth in the past;
received a diagnosis indicating the termination of the child's development;
show an independent desire to analyze the risk of having an infant with special forms of the disease.

Smoking during pregnancy is the basis for mandatory screening in the first trimester

How are the results of a fetal screening ultrasound deciphered?

Ultrasound diagnostics is prescribed, as a rule, from 10-11 weeks to 13-14 weeks, since this interval of the obstetric period provides the first real opportunity to study the basic structures of the developing baby. 11-12 weeks is a special period characterized by the transformation of an embryo into a fetus.

There is a list of the most important indicators of fetal development, which formed the basis for decoding the ultrasound conclusion. These include: CTE, PAPP-A, heart rate, BPR, TVP, hCG, NK, etc. In order to establish an accurate prognosis of the course of pregnancy, the specialist needs to compare the personal data of his patient, obtained at the first screening, with the approved standards that are prescribed in the corresponding tables.

Coccyx-parietal size

CTE is one of the most important indicators of 1 screening during pregnancy. This parameter indicates the length of the embryo / fetus, which is measured from the crown (top of the head) to the coccygeal bone. If the CTE deviates from its normal range, it can be assumed that the intrauterine development of the unborn child is at risk.

According to medical observations, the numerical designation of the coccygeal-parietal size increases as the gestation period increases. Sometimes a decrease in the index under consideration indicates an incorrectly established age of the fetus. In this case, we can talk about one of the varieties of the norm. In order to make sure of the diagnosis, the patient should make an appointment for the 2nd ultrasound scan.

CTE is one of the main indicators of fetal health

Heart rate

The state of the heart rate requires regular medical monitoring, since if there are pathological processes in the baby's body, they will be detected on time. If the anomaly is revealed at an extremely early stage of its development, the likelihood of a favorable outcome will increase.

Up to 3-4 weeks, the child's SS rhythm coincides with the indicators of his mother's pulse. The average value is in the range from 76 to 84 beats per minute with the normal functioning of the woman's body.

Further, when the heart structure of the fetus enters a new stage of natural improvement, the number of its contractions will begin to increase evenly. Every 24 hours, the value will exceed the previous "record" by approximately 2.5-3 units. So, by 8-9 weeks, the heart rate of a child developing according to the approved rate will reach 172-176 beats / min.

If, before 83-85 days of gestation, using ultrasound diagnostics, such dangerous phenomena as fetal deformity or complete absence of heartbeat were not recorded, then a frozen pregnancy can be excluded from the list of possible pathologies. The subsequent phases of body formation are less difficult than the 12-week "Spartan marathon".

Provided that improved and high-quality models of medical devices were used for screening, potential parents will be able to get a more informative characteristic of the current state of the child. It is not worth resorting to 3D / 4D ultrasound without special need. Such modern devices, although they can register the intrauterine activity and appearance of the baby, but their dose of radiation in case of abuse of ultrasound can negatively affect the health of the child.

Nasal bone length

Changes in the structure of the oblong nasal bone also indicate the presence of deviations. Examining the condition of fetuses that have been diagnosed with congenital ailments, scientists have come to the conclusion that genetic failure is often expressed in the underdevelopment of the bone structures of the nose. The first screening during pregnancy to establish the length of the nasal bone (NK) is performed no earlier than 12-13 weeks. If the doctor has scheduled an ultrasound session at 10-11 weeks of pregnancy, this means that he will only need to make sure that the nasal bone is present.

In medical practice, there are often significant deviations from the norm of ultrasound, which in fact turned out to be a manifestation of the individuality of the unborn child. In this case, the indicators of other tests will comply with the standard.

Collar space thickness

The main task of the study of TVP is to measure the thickness of the fold located on the back of the neck. When the main organ systems are formed in the fetus, the area of the collar space begins to fill with a special liquid, the amount of which is carefully analyzed.

If the indicator at the first screening has exceeded the thickness of 3 millimeters, then it is possible with a high degree of probability to suspect damage to the chromosomal segments.

Study of the structure of the yolk sac

In simple terms, the yolk sac is a temporary organ that helps maintain the life of the embryo at the initial stage of its formation. From the moment of conception, this important neoplasm is several times larger in size than the size of the unborn baby.

It should be noted that the detection of yolk bladder deformity or an overestimated / lowered indicator during screening, in most cases, indicates the development of a dangerous disease, for example, Down's syndrome. Sometimes, under similar circumstances, a frozen pregnancy is diagnosed - premature death of the embryo.

It is not worth neglecting the 1st screening, because with its help the sonologist will be able to examine the unique structure more carefully, making appropriate conclusions about its condition. If the yolk bladder is at risk of collapse, immediate medical attention is needed. This is due to the fact that the bubble formed only for 3–3.5 months controls many processes in the child's body.

Its most indicative functions include:

isolation of extremely important protein structures involved in the construction of protective membranes for embryonic cells;
the formation of a capillary network and erythrocytes, which will become the "foundation for laying" the circulatory system of the fetus;
temporary liver replacement;
determining the sex of the child by delivering to him the gametes developed in the cavity of the yolk sac.

Also, this organ is responsible for protecting the small organism from the mother's antibodies. As ambiguous as it may sound, the cells of a woman's immune system, like soldiers guarding human health, attack the fetus, seeing in it a potential threat - a foreign element. In order to provide the embryo with a safe environment, the yolk sac actively secretes hormones that begin to participate in the process of lowering blood pressure, "pacifying" immune resistance and preparing the mammary glands for breastfeeding.

After 12-14 weeks, the bladder stops its activity, gradually transforming into a cyst-like inclusion, localized near the umbilical cord

Placenta location

The localization of the placenta affects the course of the forthcoming pregnancy, therefore, during a comprehensive examination, a lot of time is devoted to it. According to the medical standard, this organ should not be located in the lower region of the uterus, since its abnormal structure provokes an obstruction of the birth canal. Such a common gynecological deviation is called presentation.

Detection of an ailment at the first screening in early pregnancy does not always become a cause for concern. At an early stage, there is still a chance for a change in an extremely precarious position - in the subsequent period of gestation, the uterus can rise, while taking its proper place. If a favorable outcome is not observed, doctors begin to develop a detailed action plan, which implies individual indicators for a particular patient.

Biparietal fetal head size

BPD is an extremely important index that is also prescribed in the results of the first screening. Without going into the details of medical terminology, we can say that this indicator implies the measurement of the head along the minor axis - the distance from one temporal bone to another. The biparietal size of the fetus is of particular value, primarily due to its direct relationship to the brain, which is located in the cranium.

Since this organ is the main element of the central nervous system, as well as the central processor of the body system, its condition is monitored with special attention by the specialist conducting the ultrasound examination.

If there are no suspicious indications in the final screening data, then the brain develops normally. A decreased index signals a lack of any parts of the brain or a delay in its development.

Blood chemistry

After the results of ultrasound diagnostics are received, on the basis of which the actual gestational age is determined, the pregnant woman will have to undergo the final stage of the perinatal examination - blood biochemistry. Screening involves carrying out 2 tests, each of which helps to identify elements of protein origin - PAPP-A and hCG.

2-3 days before the blood biochemistry of the expectant mother, it is recommended to reduce the amount of fast food, spices, nuts, fatty foods, chocolate and confectionery

PAPP-A is a special hormone (plasma protein A) that is responsible for the gradual and safe development of the baby in the womb. Usually, the indicators about its content are found out only from 12-13 weeks, however, as an exception, the procedure for taking blood is carried out a little earlier.

Human chorionic gonadotropin is also a hormone that, unlike protein A, is released immediately after conception. It is noteworthy that its amount actively reaches its maximum value at 11-12 weeks, then the level of hCG content gradually decreases, fixing itself at a stable indicator.

As soon as the patient undergoes perinatal screening in full, doctors will begin to compare the identified indices with the norm, making a full-fledged final conclusion.

What pathologies can be detected at the 1st screening?

With the help of a comprehensive study in the first trimester, you can find a fairly impressive list of pathologies that cause complications of various severity, starting with the deformation of an organ and ending with the death of the baby. The most commonly diagnosed ailments include:

hydrocephalus;
glioma;
Down syndrome;
cerebral hernia;
astrocytoma;
Shershevsky-Turner syndrome;
omphalocele;
aneurysm;
Patau syndrome;
bradycardia;
meningocele;
intrauterine infection;
Edwarts syndrome;
hypoxia;
tachycardia;
Smith-Opitz syndrome;
developmental delay;
anemia;
hemimelia (underdevelopment of the limbs);
Cornelia de Lange syndrome;
heart disease.

Only a doctor has the right to diagnose the above-mentioned congenital diseases, since the interpretation of an ultrasound scan carried out by the patient on his own may be performed incorrectly. Formation of a diagnosis based on the indicators of the first screening implies a comprehensive qualitative analysis of all the data obtained, taking into account each aspect and "pitfall". That is why expectant mothers are advised to trust their health and the life of the baby only to a professional in their field. The constructive unity of the patient with the attending physician increases the likelihood of a healthy child being born.

An ultrasound scan at a period of 13 - 15 weeks of pregnancy is quite informative and in theory it even becomes possible to determine the sex of the child. However, it is worth noting that screening for determining the sex of the baby during this period of pregnancy is often inaccurate.

In this article, we will talk in detail about why ultrasound screening is performed at 13-15 weeks of pregnancy and what it shows. We will also discuss the issues of determining the sex of the child at this stage of pregnancy.

At this time, the development of the placenta ends. She now performs her main functions and begins to produce progesterone and estrogens in large doses. At the same time, normally, the thickness of the placenta during this period should be 16 millimeters according to ultrasound data.

The placenta not only participates in the development of the baby, but also protects him from the influence of the outside world. It traps most toxic substances, filters the blood from infectious agents and suppresses the inadequate response of the mother's immune response to the fetus.

Meanwhile, the development of the baby is proceeding at an accelerated pace. Among the most important changes in his body at this time, the following should be noted:

The baby's brain is actively developing, the first reflexes are already beginning to form.
Despite the fact that the child's activity is increasing, he is still in a dream most of the time.
The formation of the baby's skeleton is picking up speed. The formation of the thyroid gland is coming to an end, and it begins to participate in the deposition of calcium in the bones of the child.
The baby's skin looks very thin and wrinkled, due to the fact that there is still too little subcutaneous fatty tissue.
The baby's chest contracts cyclically. However, this is not breathing, but only training of the muscle corset of the sternum.
The kid acquires the rudiments of twenty milk teeth.

Ultrasound at 13 weeks

An ultrasound screening at 13 weeks of gestation, in theory, can even show the sex of the child. However, it is very inaccurate, since at this time the screening is not very informative in terms of determining the sex of the child.

It should be noted that ultrasound screening at this time will demonstrate the maximum accuracy of determining the sex of the child if the boy is growing. And this is not surprising, since the boy is easier to identify because of the specific structure of the genitals.

This week, targeted ultrasound diagnostics of the placenta is being conducted. Including its exact position is determined. If the placenta is too low, then to determine its position, measure the length from the internal os of the uterus.

However, this is not a final value, since over time, the walls of the uterus will only stretch, which means that the final placenta attachment will be much higher.

It is very important to do a fetal heart rate analysis (cardiotocography) this week. Along with this, the baby's motor activity is monitored.

The main purpose of ultrasound examination at 13 weeks is to analyze the collar zone. Such a diagnosis allows one to suspect the presence of genetic developmental anomalies in the infant.

Changes at week 14

By this time, the urinary system of the fetus begins to work fully, which significantly increases the load on the mother's kidneys. In the event that a woman has chronic pyelonephritis, due to such a distribution of the load, she may experience a progression of the disease.

At this time, many of the baby's organs begin to work almost fully, although they distribute half of the load on the mother's body.

Significant changes in the child's body during this period include the following:

the thyroid and pancreas are gradually included in the work process and even begin to produce a small amount of biologically active substances;
the child develops individual facial features, while the face itself takes on a rounded shape;
the first hairs appear on the head of the fetus;

sweat glands are formed and gradually included in the work;
the bone marrow begins to produce blood cells;
in boys, the prostate completes its formation, while in girls the ovaries descend into the pelvic cavity;
the baby at this time already hears quite well and even sees, and he reacts to music and light with active movements.

Ultrasound at 14 weeks

Ultrasound screening at 14 weeks of gestation relative to 13 weeks of gestation is still not very informative in terms of determining the sex of the child. At this time, the situation is the same as the week before: the boy will be best seen.

However, even if ultrasound screening to determine the sex of the child shows that there is a boy in the womb, these data should not be taken on faith immediately. At this stage of pregnancy, such conclusions require additional verification (including the use of biochemical screening).

In general, at 14 weeks, ultrasound diagnostics makes it possible to measure the coccygeal-parietal size of the baby (CTE) with high accuracy. In this case, the length of the child's thighs is also determined, in order to exclude malformations of the skeletal system of the lower extremities.

In addition, at this time, the development of the child's internal organs is assessed. "Targeted" diagnostics of the heart, gastrointestinal tract, bladder and brain are being conducted.

On an ultrasound scan, it is mandatory to look at the location of the placenta. Normally, it should be located directly at the bottom of the uterus, but sometimes the lateral (on the walls) location is also considered the norm. However, more often lateral location threatens with placental abruption.

Changes at week 15

At this time, the uterus is actively increasing in size and stretching, although in general its shape is still rounded. At the same time, the volume of circulating blood in the mother's body increases by about 20-25%.

And it does not go unnoticed. So the load on a woman's heart increases enormously, although in the overwhelming majority of cases this does not threaten anything.

By this time, the total level of hCG decreases, which ultimately leads to normal indicators of the woman's emotional background. The following changes are observed in the child's body:

the cells of the pituitary gland begin to actively participate in the work, which increases the rate of development of the child's body;
the cerebral cortex accelerates the rate of its development and growth, the central nervous system begins to work actively;
the gallbladder begins to secrete a small amount of bile, which is eventually thrown into the baby's intestines;
the sebaceous and sweat glands are already formed and are included in the work;
all the digestive work is undertaken only by the formed liver.

Ultrasound at 15 weeks of gestation (video)

Ultrasound at 15 weeks

Ultrasound screening at 15 weeks of pregnancy can already quite accurately determine the sex of the child. The reason for this is that this week of pregnancy, the differentiation of the baby's genitals ends.

However, ultrasound screening can accurately determine the sex of the child at 15 weeks only if the baby is "the right" side turned to the wall of the abdomen. And, as in the previous 13 and 14 weeks, it is the boy who will be best identified.

Despite the fact that in terms of determining the sex, ultrasound at week 15 is quite effective, it is usually not performed at this time. An ultrasound examination is done only for certain indications, among which there is a serious threat of the development of congenital diseases of the baby.

According to the ultrasound, at this stage of pregnancy, the height of the so-called "standing of the bottom of the uterus" should be from 14 to 16 centimeters. Due to an increase in the volume of circulating blood in the mother, an exacerbation of chronic cardiac pathologies is possible.

To control and stop them (stop progression), ECG and ultrasound of the heart are used. In case of exacerbation or the appearance of serious cardiac abnormalities, doctors terminate the pregnancy.

Prenatal screening - This is a combined biochemical and ultrasound examination, consisting of a blood test to determine the level of the main hormones of pregnancy and a conventional ultrasound of the fetus with the measurement of several values.

First screening or "double test" (at 11-14 weeks)

Screening includes two stages: an ultrasound scan and taking blood for analysis.

During the ultrasound examination, the diagnostician determines the number of fetuses, gestational age and takes the size of the embryo: CTE, BPD, the size of the cervical fold, nasal bone, etc.

According to these data, we can say how well the baby develops in the womb.

Ultrasound screening and its norms

Estimation of the size of the embryo and its structure. Coccyx-parietal size (CTE)- This is one of the indicators of the development of the embryo, the value of which corresponds to the gestational age.

CTE is the size from the coccyx to the crown of the head, excluding the length of the legs.

There is a table of standard KTP values according to the week of pregnancy (see table 1).

Table 1 - The rate of CTE according to the gestational age

The deviation of the size of the fetus from the norm upwards indicates the rapid development of the baby, which is a harbinger of bearing and giving birth to a large fetus.

Too small size of the fetal body indicates:

the initially incorrectly set period of pregnancy by the district gynecologist, even before the visit to the diagnostician;
developmental delay as a result of hormonal deficiency, infectious disease or other ailments in the mother of the child;
genetic pathologies of fetal development;
intrauterine fetal death (but only on condition that fetal heartbeats are not heard).

Biparietal size (BPD) of the fetal head Is a measure of the development of a baby's brain, measured from temple to temple. This value also increases in proportion to the gestational age.

Table 2 - The rate of BPD of the fetal head at a certain gestational age

An excess of the norm for BPD of the fetal head may indicate:

large fruit, if the other sizes are also higher than the norm by a week or two;
spasmodic growth of the embryo, if the other sizes are normal (after a week or two, all parameters should equalize);
the presence of a brain tumor or cerebral hernia (pathologies incompatible with life);
hydrocephalus (dropsy) of the brain due to an infectious disease in the expectant mother (antibiotics are prescribed and, with successful treatment, the pregnancy remains).

The biparietal size is less than normal in the case of underdevelopment of the brain or the absence of some of its parts.

The thickness of the collar space (TVP) or the size of the "neck fold"- this is the main indicator that, if abnormal, indicates a chromosomal disease (Down syndrome, Edwards syndrome, or another).

In a healthy child, TBP at the first screening should not be more than 3 mm (for ultrasound performed through the abdomen) and more than 2.5 mm (for vaginal ultrasound).

The value of TVP in itself does not mean anything, it is not a sentence, there is simply a risk. It is possible to speak of a high probability of the development of chromosomal pathology in the fetus only in the case of poor results of a blood test for hormones and when the size of the cervical fold is more than 3 mm. Then, to clarify the diagnosis, a chorionic biopsy is prescribed to confirm or deny the presence of chromosomal abnormalities of the fetus.

Table 3 - Norms of TVP by week of pregnancy

The length of the nose bone. In a fetus with a chromosomal abnormality, ossification occurs later than in a healthy fetus, therefore, with deviations in development, the nasal bone is either absent at the first screening (at 11 weeks), or its value is too small (from 12 weeks).

The length of the nasal bone is compared with the standard value from the 12th week of pregnancy, at 10-11 weeks the doctor can only indicate its presence or absence.

If the length of the nasal bone does not match the gestational age, but the rest of the indicators are normal, there is no cause for concern.
Most likely, this is an individual feature of the fetus, for example, the nose of such a baby will be small and snub-nosed, like that of a parent or one of close relatives, for example, a grandmother or great-grandfather.

Table 4 - The norm of the length of the nasal bone

Also, at the first ultrasound screening, the diagnostician notes whether the bones of the cranial vault, butterfly, spine, limb bones, anterior abdominal wall, stomach, bladder are visualized. At this time, the indicated organs and parts of the body are already clearly visible.

Assessment of the vital functions of the fetus. In the first trimester of pregnancy, the vital activity of the embryo is characterized by cardiac and motor activity.

Since fetal movements are usually periodic and barely distinguishable at this time, only the heart rate of the embryo has diagnostic value, and motor activity is simply noted as “determined”.

Heart rate (HR) fetus, regardless of gender, at 9-10 weeks should be in the range of 170-190 beats per minute, from 11 weeks to the end of pregnancy - 140-160 beats per minute.

Fetal heart rate below normal (85-100 beats / min) or above normal (more than 200 beats / min) is an alarming sign in which additional examination and, if necessary, treatment is prescribed.

Examination of extraembryonic structures: yolk sac, chorion and amnion. Also, the ultrasound diagnostician in the screening ultrasound examination protocol (in other words, in the ultrasound results form) notes data on the yolk sac and chorion, on the appendages and walls of the uterus.

Yolk sac- This is an organ of the embryo, which until the 6th week is responsible for the production of vital proteins, plays the role of the primary liver, circulatory system, primary germ cells.

In general, the yolk sac performs various important functions up to 12-13 weeks of pregnancy, then the need for it disappears, because the fetus is already forming separate organs: the liver, spleen, etc., which will take on all the responsibilities for ensuring life. ...

By the end of the first trimester, the yolk sac shrinks in size and turns into a cystic formation (yolk stalk), which is located near the base of the umbilical cord. Therefore, at 6-10 weeks, the yolk sac should be no more than 6 mm in diameter, and after 11-13 weeks, it is normally not visualized at all.

But everything is purely individual, the main thing is that it does not finish its functions ahead of schedule, so for 8-10 weeks it should be at least 2 mm (but not more than 6.0-7.0 mm) in diameter.

If up to 10 weeks the yolk sac is less than 2 mm, then this may indicate an undeveloped pregnancy or a lack of progesterone (then Dufaston or Utrozhestan is prescribed), and if at any time in the first trimester the diameter of the yolk sac is more than 6-7 mm, then this indicates the risk of developing pathologies in the fetus.

Chorion- This is the outer shell of the embryo, covered with many villi that grow into the inner wall of the uterus. In the first trimester of pregnancy, the chorion provides:

nutrition of the fetus with the necessary substances and oxygen;
removal of carbon dioxide and other waste products;
protection against the penetration of viruses and infections (although this function is not durable, but with timely treatment, the fetus does not become infected).

Within normal limits, the localization of the chorion "at the bottom" of the uterine cavity (on the upper wall), on the front, back or one of the side walls (left or right), and the structure of the chorion should not be changed.

The location of the chorion in the area of the internal pharynx (transition of the uterus to the cervix), on the lower wall (at a distance of 2-3 cm from the pharynx) is called chorionic presentation.

But such a diagnosis does not always indicate a placenta previa in the future, usually the chorion "moves" and is thoroughly fixed higher.

Chorionic presentation increases the risk of spontaneous miscarriage, therefore, with this diagnosis, observe bed rest, move less and do not overwork. There is only one treatment: to lie in bed for days (getting up only to use the toilet), sometimes raising your legs up and staying in this position for 10-15 minutes.

By the end of the first trimester, the chorion will become the placenta, which until the end of pregnancy will gradually “mature” or, as they say, “grow old”.

Up to 30 weeks gestation - maturity 0.

This is how the ability of the placenta to provide the baby with everything necessary at every stage of pregnancy is assessed. There is also the concept of "premature aging of the placenta", which indicates a complication of the course of pregnancy.

Amnion- This is the inner aqueous membrane of the embryo, in which the amniotic fluid (amniotic fluid) accumulates.

The amount of amniotic fluid at 10 weeks is about 30 ml, at 12 weeks - 60 ml, and then it increases by 20-25 ml per week, and at 13-14 weeks it already contains about 100 ml of water.

When examining the uterus with an uterus, an increased tone of the myometrium of the uterus (or hypertonicity of the uterus) can be detected. Normally, the uterus should be out of tone.

Often in the ultrasound results, you can see the entry "local thickening of the myometrium along the posterior / anterior wall", which means both a short-term change in the muscular layer of the uterus due to a feeling of excitement in a pregnant woman during ultrasound, and an increased tone of the uterus, which is a threat of spontaneous miscarriage.

The cervix is also examined, its pharynx must be closed. The length of the cervix for 10-14 weeks of pregnancy should be about 35-40 mm (but not less than 30 mm for primiparous and 25 mm for multiparous). If it is shorter, it indicates the risk of premature birth in the future. Approaching the day of the expected birth, the cervix will shorten (but should be at least 30 mm by the end of the pregnancy), and before the birth itself, its pharynx will open.

The deviation from the norm of some parameters at the first screening does not give rise to worries, just pregnancy in the future should be observed more closely, and only after the second screening can we talk about the risk of developing fetal malformations.

Standard first trimester ultrasound protocol

Biochemical screening ("double test") and its decoding

Biochemical screening of the first trimester involves the determination of two elements contained in a woman's blood: the level of free b-hCG and plasma protein-A - PAPP-A. These are two hormones of pregnancy and with the normal development of the baby, they should correspond to the norm.

Human chorionic gonadotropin (hCG) consists of two subunits - alpha and beta. Free beta-hCG is unique in its way, therefore its value is taken as the main biochemical marker used to assess the risk of chromosomal abnormalities in the fetus.

Table 5 - The norm of b-hCG during pregnancy by week

An increase in the value of free b-hCG indicates:

the risk of the fetus having Down syndrome (if the norm is doubled);
multiple pregnancies (hCG levels increase in proportion to the number of fetuses);
the presence of diabetes mellitus in a pregnant woman;
preeclampsia (i.e., with an increase in blood pressure + edema + detection of protein in the urine);
fetal malformations;
cystic drift, choriocarcinoma (a rare type of tumor)

A decrease in the beta-hCG value indicates:

the risk of the fetus having Edwards syndrome (trisomy 18) or Patau syndrome (trisomy 13);
the threat of termination of pregnancy;
fetal growth retardation;
chronic placental insufficiency.

PAPP-A- pregnancy-associated plasma protein-A.

Table 6 - The norm of PAPP-A during pregnancy by weeks

A low level of PAPP-A in a pregnant woman's blood gives a strong reason to assume that there is a risk:

the development of chromosomal pathology: Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Patai syndrome (trisomy 13) or Cornelia de Lange syndrome;
spontaneous miscarriage or intrauterine fetal death;
placental insufficiency or fetal malnutrition (i.e., underweight due to malnutrition of the baby);
development of preeclampsia (assessed in conjunction with the level of placental growth factor (PLGF). A high risk of developing preeclampsia is indicated by a decrease in PAPP-A together with a decrease in placental growth factor.

An increase in PAPP-A can be observed if:

a woman is carrying twins / triplets;
the fetus is large and the mass of the placenta is increased;
the placenta is low.

For diagnostic purposes, both indicators are important, therefore they are usually considered in combination. So if PAPP-A is reduced and beta-hCG is increased, there is a risk of the fetus having Down syndrome, and with a decrease in both indicators, Edwards syndrome or Patau syndrome (trisomy 13).

After 14 weeks of pregnancy, the PAPP-A test is considered uninformative.

Second trimester screening (at 16-20 weeks)

II screening, as a rule, is prescribed in case of deviations in the I screening, less often with the threat of termination of pregnancy. In the absence of deviations, the second comprehensive screening can not be carried out, but only an ultrasound of the fetus can be performed.

Ultrasound screening: norms and deviations

Screening ultrasound at this time is aimed at determining the "skeletal" structure of the fetus and the development of its internal organs.
Fetometry. The diagnostician notes the presentation of the fetus (pelvic or cephalic) and removes other indicators of fetal development (see table 7 and 8).

Table 7 - Standard sizes of the fetus by ultrasound

As in the first screening, the length of the nasal bone is measured in the second. With normal other indicators, the deviation of the length of the nasal bone from the norm is not considered a sign of chromosomal abnormalities in the fetus.

Table 8 - The norm of the length of the nasal bone

According to the measurements taken, one can judge the true duration of pregnancy.

Fetal anatomy. The Uzist is examining the baby's internal organs.

Table 9 - Standard values of the fetal cerebellum by week

The dimensions of both the lateral ventricles of the brain and the cisterna magna should not exceed 10-11 mm.

Usually, other indicators, such as: Nasolabial triangle, Eye sockets, Spine, 4-chamber cut of the heart, Cut through 3 vessels, Stomach, Intestine, Kidneys, Bladder, Lungs - in the absence of visible pathologies are marked as "normal".

The place of attachment of the umbilical cord to the anterior abdominal wall and to the center of the placenta is considered the norm.

The abnormal attachment of the umbilical cord includes the marginal, membranous and split, which leads to difficulties in the birth process, fetal hypoxia and even its death during childbirth, if a planned CS is not prescribed or during premature birth.

Therefore, in order to avoid fetal death and blood loss in a woman during childbirth, a planned cesarean section (CS) is prescribed.

There is also a risk of developmental delays, but with normal developmental indicators of the baby and careful observation of the woman in labor, everything will go well for both.

Placenta, umbilical cord, amniotic fluid. The placenta is located most often on the back wall of the uterus (more on the right or left can be specified in the form), which is considered the most successful attachment, since this part of the uterus is best supplied with blood.

The zone closer to the bottom also has a good blood supply.

But it happens that the placenta is localized on the front wall of the uterus, which is not considered something pathological, but this area is prone to stretching during the growth of the baby inside the mother's womb, plus the active movements of the baby - all this can lead to placental abruption. In addition, placenta previa is more common in women with an anterior placenta.

This is not critical, just this information is important for deciding on the method of delivery (whether a caesarean section is necessary and what difficulties may arise during childbirth).

Normally, the edge of the placenta should be 6-7 cm (or more) above the internal pharynx. Abnormal is considered to be its location in the lower part of the uterus in the area of the internal pharynx, partially or completely overlapping it. This phenomenon is called "placenta previa" (or low placenta).

It is more informative to measure the thickness of the placenta after the 20th week of pregnancy. Until this time, only its structure is noted: homogeneous or heterogeneous.

From 16 to 27-30 weeks of pregnancy, the structure of the placenta should be unchanged, homogeneous.

A structure with an expansion of the intervillous space (MVP), echo-negative formations and other kinds of abnormalities negatively affects the nutrition of the fetus, causing hypoxia and developmental delay. Therefore, treatment is prescribed Curantil (normalizes blood circulation in the placenta), Actovegin (improves the supply of oxygen to the fetus). With timely treatment, babies are born healthy and on time.

After 30 weeks, there is a change in the placenta, its aging, and as a result, heterogeneity. At a later date, this is already a normal phenomenon that does not require additional examinations and treatment.

Normally, up to 30 weeks, the degree of maturity of the placenta is "zero".

Amniotic fluid. To determine their number, the diagnostician calculates the amniotic fluid index (AFI) according to measurements made during ultrasound.

Table 10 - Norms of the amniotic fluid index by week

Find your week of pregnancy in the first column. The second column indicates the range of the norm for this period. If the AFI, indicated by the uzist in the screening results, is included in this range, then the amount of amniotic fluid is normal, less than the norm means early oligohydramnios, and more - polyhydramnios.

There are two degrees of severity: moderate (insignificant) and severe (critical) oligohydramnios.

Severe oligohydramnios threatens with abnormal development of fetal limbs, deformity of the spine, and the baby's nervous system also suffers. As a rule, babies who have suffered from oligohydramnios in the womb lag behind in development and weight.

With severe lack of water, drug treatment must be prescribed.

Moderate oligohydramnios usually does not require treatment, it is only necessary to establish nutrition, minimize physical activity, take a vitamin complex (it must include vitamin E).

In the absence of infections, preeclampsia and diabetes mellitus in the mother of the child, and with the development of the baby within the normal range, there is no reason for worry, most likely, this is a feature of the course of this pregnancy.

Normally, the umbilical cord has 3 vessels: 2nd artery and 1st vein. The absence of one artery can lead to various pathologies in the development of the fetus (heart disease, esophageal atresia and fistula, fetal hypoxia, disruption of the genitourinary or central nervous system).

But about the normal course of pregnancy, when the work of the missing artery is compensated by the existing one, we can talk about:

normal blood test results for hCG, free estriol and AFP, i.e. in the absence of chromosomal pathologies;
good indicators of fetal development (according to ultrasound);
the absence of defects in the structure of the fetal heart (if an open functional oval window is found in the fetus, you should not worry, it usually closes for up to a year, but it is necessary to be observed by a cardiologist every 3-4 months);
not disturbed blood flow in the placenta.

Babies with such an anomaly as the "single artery of the umbilical cord" (abbreviated as EAP) are usually born with a small weight and can often get sick.

Up to a year, it is important to monitor the changes in the child's body, after a year of life, the crumbs are recommended to thoroughly take care of his health: organize a proper balanced diet, take vitamins and minerals, perform immunity-strengthening procedures - all this can bring the state of a small body in order.

The cervix and walls of the uterus. In the absence of abnormalities, the ultrasound protocol will indicate “Cervix and uterine walls without features” (or abbreviated as b / o).

The length of the cervix in this trimester should be 40-45 mm, 35-40 mm is acceptable, but not less than 30 mm. If its opening and / or shortening is observed in comparison with the previous measurement with ultrasound or softening of its tissues, which is collectively called "isthmic-cervical insufficiency" (ICI), then the installation of an obstetric unloading pessary or suture is prescribed in order to preserve the pregnancy and reach the prescribed term.

Visualization. Normally, it should be "satisfactory". Visualization is difficult when:

the position of the fetus is inconvenient for the study (the baby is just positioned so that not everything can be seen and measured, or he was constantly spinning during the ultrasound);
overweight (the reason is indicated in the visualization column - due to subcutaneous fatty tissue (SFA));
swelling in the expectant mother
hypertonicity of the uterus during ultrasound.

Standard second trimester ultrasound protocol

Biochemical screening or "triple test"

Biochemical screening of blood in the second trimester is aimed at determining three indicators - the level of free b-hCG, free estriol and AFP.

Free beta-hCG rate look at the table below, and you will find the decryption, it is the same at each stage of pregnancy.

Table 11 - The rate of free b-hCG in the second trimester

Free estriol Is one of the pregnancy hormones that reflects the functioning and development of the placenta. In the normal course of pregnancy, it progressively grows from the first days of the beginning of the formation of the placenta.

Table 12 - Rate of free estriol by week

An increase in the amount of free estriol in the blood of a pregnant woman is observed with multiple pregnancies or high fetal weight.

A decrease in the level of estriol is observed in fetoplacental insufficiency, the threat of termination of pregnancy, cystic drift, intrauterine infection, adrenal hypoplasia or anencephaly (neural tube defect) of the fetus, Down syndrome.

A decrease in free estriol by 40% or more from the standard value is considered critical.

Taking antibiotics during the test period can also affect a decrease in estriol in a woman's blood.

Alpha-fetoprotein (AFP) Is a protein produced in the liver and gastrointestinal tract of the baby, starting from the 5th week of pregnancy from conception.

This protein enters the mother's blood through the placenta and from the amniotic fluid, and begins to build up in it from the 10th week of pregnancy.

Table 13 - Norm of AFP by weeks of pregnancy

If during pregnancy a woman was sick with a viral infection, and the baby had liver necrosis, then an increase in AFP in the serum of the pregnant woman is also observed.

Third screening (at 30-34 weeks)

In total, two screenings are carried out during pregnancy: in the first and in the second trimesters. In the third trimester of pregnancy, a kind of final control over the state of the fetus's health is carried out, its position is monitored, the functionality of the placenta is assessed, and a decision is made on the method of delivery.

For this, somewhere at 30-36 weeks, an ultrasound scan of the fetus is prescribed, and from 30-32 weeks cardiotocography (abbreviated CTG - registration of changes in the fetal cardiac activity, depending on its motor activity or uterine contractions).

Doppler sonography can also be prescribed, which allows you to assess the strength of blood flow in the uterine, placental and great vessels of the fetus. With the help of this study, the doctor will find out if the baby has enough nutrients and oxygen, because it is better to prevent the appearance of fetal hypoxia than to solve the health problems of the baby after childbirth.

It is the thickness of the placenta, along with the degree of maturity, that shows its ability to supply the fetus with everything it needs.

Table 14 - Placenta thickness (norm)

With a decrease in thickness, the diagnosis of "placental hypoplasia" is made. Usually this phenomenon causes late toxicosis, hypertension, atherosclerosis or infectious diseases suffered by a woman during pregnancy. In any case, treatment or supportive therapy is prescribed.

Most often, placental hypoplasia is observed in fragile miniature women, because one of the factors in reducing the thickness of the placenta is the weight and physique of the pregnant woman. This is not scary, more dangerous is an increase in the thickness of the placenta and, as a consequence, its aging, which indicates a pathology that can lead to abortion.

The thickness of the placenta increases with iron deficiency anemia, gestosis, diabetes mellitus, Rh-conflict and with viral or infectious diseases (transferred or present) in a pregnant woman.

Normally, a gradual thickening of the placenta occurs in the third trimester, which is called aging or maturity.

Placenta maturity (normal):

0 degree - up to 27-30 weeks;
1st degree - 30-35 weeks;
2nd degree - 35-39 weeks;
Grade 3 - after 39 weeks.

Early aging of the placenta is fraught with a deficiency of nutrients and oxygen, which threatens fetal hypoxia and developmental delay.

An important role in the third trimester is played by the amount of amniotic fluid. Below is a normative table for the amniotic fluid index - a parameter that characterizes the amount of water.

Below is a table of the standard sizes of the fetus by week of pregnancy. The kid may not correspond a little to the specified parameters, because all children are individual: someone will be large, someone will be small and fragile.

Table 16 - Standard size of the fetus by ultrasound for the entire period of pregnancy

Preparation for screening ultrasound

Transabdominal ultrasound - the sensor is guided along the abdominal wall of a woman, transvaginal ultrasound - the sensor is inserted into the vagina.

With transabdominal ultrasound, a woman with a period of up to 12 weeks of pregnancy should come for diagnosis with a full bladder, having drunk 1-1.5 liters of water half an hour or an hour before visiting an ultrasound doctor. This is necessary so that a full bladder "squeezes" the uterus out of the pelvic cavity, which will give a better view of it.

From the second trimester, the uterus increases in size and is well visualized without any preparation, so there is no need for a full bladder.

Take a handkerchief with you to wipe the rest of the special gel from your abdomen.

With transvaginal ultrasound, it is first necessary to carry out hygiene of the external genital organs (without douching).

The doctor can tell in advance to purchase a condom from the pharmacy, which is put on the sensor for hygiene purposes, and go to the toilet to urinate if the last urination was more than an hour ago. To maintain intimate hygiene, take with you special wet wipes, which you can also purchase in advance at the pharmacy or in the store at the appropriate department.

Transvaginal ultrasound is usually performed only in the first trimester of pregnancy. With the help of it, it is possible to detect a fertilized egg in the uterine cavity even before the 5th week of pregnancy, abdominal ultrasound is not always possible at such an early stage.

The advantage of vaginal ultrasound is that it is able to determine an ectopic pregnancy, the threat of miscarriage in case of pathology of the location of the placenta, diseases of the ovaries, fallopian tubes, uterus and its cervix. Also, vaginal examination makes it possible to more accurately assess how the fetus is developing, which can be difficult to do in overweight women (if there is a fold of fat on the abdomen).

For ultrasound, it is important that gases do not interfere with the examination, therefore, in case of flatulence (bloating), it is necessary to take 2 Espumisan tablets after each meal the day before the ultrasound scan, and in the morning on the day of the examination, drink 2 Espumisan tablets or a Smecta bag, spreading it to the floor a glass of water.

Preparing for biochemical screening

Blood is taken from a vein, preferably in the morning and always on an empty stomach. The last meal should be 8-12 hours before sampling. In the morning on the day of blood sampling, you can drink only mineral water without gas. Remember that tea, juice and similar liquid are also food.

Comprehensive screening cost

If a planned ultrasound examination in city antenatal clinics is most often carried out for a small fee or completely free of charge, then prenatal screening is an expensive set of procedures.

Biochemical screening alone costs from 800 to 1600 rubles. (from 200 to 400 UAH.), depending on the city and laboratory "plus", for a regular ultrasound of the fetus, you need to pay somewhere around 880-1060 rubles. (220-265 UAH). In total, a comprehensive screening will cost at least 1,600 - 2,660 rubles. (420-665 UAH).

It makes no sense to conduct prenatal screening at any stage of pregnancy if you are not ready to have an abortion if doctors confirm that the fetus has mental retardation (Down's syndrome, Edwards syndrome, etc.) or malformations of any organs.

Comprehensive screening is designed for early diagnosis of pathologies in the intrauterine development of the fetus, so that only healthy offspring can be produced.

In Russia, it is customary to conduct screening ultrasound studies three times during pregnancy: at 10-14, 20-24 and 30-34 weeks of gestation. In addition, additional ultrasound of the fetus is permissible for medical reasons. Often, an early ultrasound scan (up to 8 weeks) is prescribed to confirm the onset of uterine pregnancy and an ultrasound scan before childbirth to determine the tactics of obstetrics.

14 weeks is the optimal time for perhaps the most important study of an entire pregnancy: the first perinatal screening. If by the 14th week the expectant mother has not yet undergone such a screening, it is strongly recommended to do this before the expiration of fourteen weeks from the first day of the last menstruation.

First screening, 14 weeks pregnant

The fact is that after this period, the results of a biochemical blood test (it includes the first screening) will not be informative. And the increased size of the fetus in the womb after 14 weeks can make it difficult to assess the risk of developmental abnormalities! In addition, in case of detection of serious pathologies, the woman and the doctors have little time to decide whether to prolong the pregnancy further.

The approximate growth of the unborn child in the uterus by this time is from 8 to 11 cm, and the weight is approximately 40 grams. To some, such sizes will seem insignificant, but, in reality, almost all organs are formed in the fetus at a period of 14 weeks! In the future, only their growth, development and complication of functions will take place. This means that for a period of 12-14 weeks, the doctor will be able to diagnose malformations of the child in the womb with high reliability, clarify the individual structural features and make a diagnosis.

By the time of the study, the first trimester, which is considered the most crucial time of pregnancy, has already been completed. For a woman, this brings good news: the period of toxicosis is over or will end soon; the second trimester of pregnancy is usually associated with improved well-being, emotional recovery and the onset of the long-awaited maternity leave!

But at the same time, it is necessary to find out whether an important stage in the formation of all organ systems of the unborn child has been completed correctly. Therefore, up to 14 weeks is the time for the expectant mother to find out how her pregnancy is developing.

Preparation for ultrasound

Preparing for an ultrasound scan during pregnancy is not much different from a standard ultrasound scan. On the eve, it is recommended to exclude from the diet foods that increase gas formation in the intestine (legumes, flour, carbonated drinks, reduce the consumption of vegetables and fruits). An hour before the ultrasound scan, you should drink 200 ml of liquid. The fact is that the study is carried out transabdominally (with an external sensor) and the bladder must be filled to improve visualization. If the doctor decides that a vaginal probe is needed, the bladder will be asked to empty.

After the issuance of an ultrasound report, the pregnant woman is given a referral for a biochemical blood test. Such a comprehensive study to determine the risk of intrauterine fetal abnormalities is called pregnancy screening. It is carried out for all women, even absolutely healthy ones. It is not recommended to give up the study.

In addition, for a period of 14 weeks, you can not be afraid to harm the child. at. Since the time of the most active cell division is behind, all possible risks of ultrasound exposure decrease many times from about 12 weeks of pregnancy.

Why is ultrasound performed at this time?

In addition to confirming the very fact of the onset of uterine pregnancy and establishing its exact timing, according to the results of an ultrasound scan at 10-14 weeks, the doctor can assume serious congenital anomalies of the unborn child, and also make sure that there is no obstetric-gynecological pathology in the mother. After the study, an ultrasound specialist evaluates the fetometry data (fetal size) and makes a conclusion about the expected date of birth. It is also possible to determine the sex of the unborn child, but not always.

Some mothers do not want to go to the ultrasound room for various reasons. Someone worries about the effects of ultrasound on the fetus. Others motivate their decision by the “naturalness” of pregnancy and the fact that this condition is “not a disease”.

But it has been proven that the timely passage of the necessary studies greatly reduces the risk of pathology of pregnancy and childbirth, both for the mother and the child. It must be remembered that before the appearance of ultrasound in the diagnosis of perinatal pathology, the number of complications of pregnancy and childbirth, including fatal ones, was ten times higher! And the negative effect of radiation on the fetus is much lower than the risks of refusing ultrasound.

Will the doctor tell the baby's sex at 14 weeks?

Many parents are interested to know if it is possible to determine the sex of their baby at 14 weeks of gestation by ultrasound. Yes, because gender at the genetic level is formed from the moment of conception. But until a certain time, it could only be clarified by an invasive way (with a biopsy and a blood test). It is for a period of 12-14 weeks that a competent specialist with good diagnostic equipment will be able to inform the parents of the sex of the unborn child based on the results of an ultrasound scan.

But, unfortunately, it is not always possible to establish the sex of the child at the first screening at 14 weeks: during this period, the fetus is very mobile, and it is not easy for the doctor to "catch" the position on the screen where you can clearly see its sexual characteristics. If your little one "hides" the floor from you by crossing legs or covering with arms, don't worry. At the second screening ultrasound, performed from 20 weeks of pregnancy, the gender of the unborn child will be informed!

Interestingly, the sexual characteristics of boys are often "disguised" as girls. Descent of the testicles into the scrotum normally occurs closer to 30 weeks of pregnancy. For some, this process is completed after birth. This means that the doctor may be mistaken and name the wrong gender: assume the birth of a girl, especially in the early stages of pregnancy. This is partly why doctors prefer not to inform in advance the gender and not to reassure future parents. Already from 20 weeks of pregnancy, which corresponds to the time of the second screening, establishing the sex of the unborn child will not be a problem.

Conclusion

Ultrasound is the method of choice when monitoring the course of pregnancy in our time. It is a modern, inexpensive and highly informative method that prevents most complications of pregnancy and childbirth. Ultrasound as part of the first screening performed for up to 14 weeks is a mandatory study. It is included in the required minimum in the diagnosis of obstetric and gynecological pathology and the observation of normal pregnancy. In addition to establishing and clarifying the diagnosis, expectant parents will be shown their baby for a period of 14 weeks and will even be able to determine the sex of the unborn child.

It is interesting that it is during this period that parents can see their child "in all its glory": now he is fully formed and is already a little man. In the future, the sensor of the ultrasound machine will not "capture" the baby's body completely, and it will be impossible to see the entire fetus on the screen, but only its individual fragments.

The 14th week of pregnancy can be called a kind of "turning point" - at this time the second trimester of pregnancy begins. This means that from that moment on, most pathologies and abnormalities for the fetus are no longer as terrible as in the early stages of pregnancy. An actively growing and developing baby will make itself felt more and more - even now he has grown to 8-10 cm and weighs about 30-40 g.

The fetus at the 14th week of pregnancy becomes even more similar to a person, only "in miniature". Small, he actively moves, frowns, clenches his fists and, in contact with the abdominal wall, pushes off from it. True, the woman does not yet feel this, although many pregnant women argue that even at such an early stage as 14 weeks, they felt the "movement" of the crumbs.

The fetus at the 14th week of pregnancy continues to "build up" the skeleton, and the first ribs begin to appear. Surprisingly, already now the baby is preparing for birth - making movements with the diaphragm that resemble breathing. A 14-week-old fetus already knows how to distinguish tastes: swallowing amniotic fluid, the baby reacts to sweet with frequent swallowing reflexes, to sour or bitter ones - on the contrary, weak.

The body of the fetus is now still covered with a dense protective lubricant, but under it, on the thin skin of the baby, a fluff has already appeared, the name of which is lanugo. The first and thin hairs that cover the body of the fetus (by the way, the same fluff is already on the baby's head) are designed to hold a special protective lubricant: thanks to it, in the future, the baby will easily slide along the birth canal. In addition to the fact that the soft and light lanugo covers the entire body of the fetus, the baby already boasts the presence of eyebrows and eyelashes.

All systems and organs of the baby are already laid down and functioning, their work is becoming more perfect and harmonious. In addition, the genitals are already formed, although it is still difficult to distinguish on ultrasound who "lives" in the mother's stomach. But it is already possible to determine the blood group and the Rh factor inherent in the baby - despite the fact that the blood composition has not yet been completely formed.

Ultrasound at 14 weeks of gestation

But after all, ultrasound is not only and not so much carried out to determine the sex of the baby and its size. Ultrasound at 14 weeks of gestation is one of the very informative methods to assess the degree of fetal development and the compliance of this development with the norm. Moreover, it is already quite simple to establish such a correspondence: the fetus at this time has a size sufficient for a clear visualization of all its structures.

The main parameters that are assessed using ultrasound at the 14th week of pregnancy are the coccygeal-parietal size of the baby (length, growth of the fetus from the crown of the head to the coccyx); biparietal size (transverse size of the fetal head); head circumference and abdominal circumference. Also, ultrasound at 14 weeks of gestation allows you to measure the length of the baby's thigh, and at the same time - the ratio of the two femurs to exclude malformations.

Additionally, the specialist evaluates the development of the long bones of the fetus (ulnar, radial, humeral, peroneal and tibial), feet and hands. And with them - and an assessment of the development of internal organs: heart, stomach, kidneys, intestines, bladder, brain.

Screening

Screening today is considered one of the most modern and reliable methods of examination, allowing timely identification and detection of chromosomal abnormalities and abnormalities of the fetus. And the first screening examination, which is often also called a double test (due to the study of two markers in a biochemical blood test) is usually shown at a period of 11-14 weeks. Here are just the most optimal time - 12-13 weeks: screening also involves, in addition to a biochemical blood test, and an ultrasound examination of the collar zone of the fetus. Such a study makes it possible, with a high degree of probability, to exclude the possibility of developing any congenital abnormalities in the baby. But, since the collar zone refers to unstable markers and constantly changes as the fetus develops, its study is possible within clearly defined periods. And usually at the full 14 weeks of pregnancy, her examination within the framework of screening does not provide reliable results. Why, it is advisable to carry out screening either earlier than this period, or already wait for the right moment for the second screening examination, which occurs at 15-20 weeks of pregnancy (optimally at 16-18).

Tests at the 14th week of pregnancy

If by this time the expectant mother has not yet passed all the tests shown by this time, she may be assigned tests at the 14th week of pregnancy - in the form of a general and gynecological examination, urinalysis, consultation with a therapist, dentist and otolaryngologist. As mentioned above, tests at the 14th week of pregnancy may also suggest a planned ultrasound scan. A blood test, among other things, may also include determining the levels of the hormone chorionic gonadotropin (hCG) in the body of a pregnant woman. If during the first few weeks of pregnancy the level of hCG in the body of the expectant mother constantly increases, then, starting from 8-9 weeks, reaching its peak, the level of hCG decreases slightly and remains so throughout the second trimester. If the level of hCG at this stage does not correspond to the norm, this may indicate the possibility of developing some chromosomal abnormalities in the fetus. However, such an analysis is not the final diagnosis and becomes a reason for additional research.

In some cases, a puncture of the amniotic fluid may be required as an analysis. This analysis is carried out solely according to indications, and a woman can refuse it: the doctor must necessarily notify the expectant mother, albeit a meager, but still existing, possibility of miscarriage (the risk of miscarriage is 1: 200). The process of taking a sample for analysis consists in inserting a needle into the uterus (at the same time as an ultrasound scan to see where the baby is), through which a certain amount of amniotic fluid is taken for examination. In the future, the analysis of the amniotic fluid will make it possible to assume or exclude the presence of possible chromosomal abnormalities in the fetus.

Pain

Toxicosis at 14 weeks gestation is usually a thing of the past. However, it is often replaced by pains of a completely different nature, most often back pain and headaches.

Painful sensations in the back are often the consequences of a woman's love for high heels. Therefore, if already from the beginning of pregnancy the expectant mother has not given up this "luxury", then now is the time to do it. Lower back pain during this period also occurs due to a gradual increase in the weight of the expectant mother and a shift in the center of gravity.

Headaches at week 14, like migraines, can occur spontaneously and unexpectedly, and it is better, of course, to prevent them than to fight the painful sensations later. To do this, you need to get enough rest, not overwork, avoid hunger and avoid noisy, smoky rooms. If the headache still made itself felt, the main thing is to prevent the use of medications. To relieve pain symptoms, you need to lie down in a dark and cool, well-ventilated room, and massage of the temporal part will not interfere.

It is possible that the expectant mother will also visit the pain at the 14th week of pregnancy, concentrated in the lower abdomen and having a weak and dull character. This is a consequence of the stretching of the ligaments that anchor the uterus. However, you should be wary if the pains in the 14th week of pregnancy in the abdomen are constant or occur abruptly and unexpectedly, cramping or aching pains are a clear sign of uterine hypertonicity. You should also call a doctor immediately if abdominal pain is accompanied by pain in the lumbar region, profuse watery vaginal discharge or bleeding. It is very likely that such symptoms indicate a high risk of pregnancy failure and even intrauterine fetal death.

Feel

If the pregnancy proceeds according to the norm, then the sensations at the 14th week of pregnancy, characteristic of the early stages, recede. The expectant mother has already “exhausted herself” with toxicosis, her emotional state has also stabilized, the baby is practically not threatened by all the dangers that could harm him in the first weeks of pregnancy ... preparation with your child.

Some physiological changes that arise more and more due to a deficiency of nutrients in the body of the expectant mother can somewhat darken the joy of a woman. A lack of vitamin C, for example, can be accompanied by bleeding gums and a decrease in the defenses of the pregnant woman's body. Deficiency of vitamin A affects dry and brittle hair and nails, peeling of the skin. However, all these negative manifestations can be avoided by eating well and constantly replenishing the increased need for mineral and nutrients.

Stomach

But how much joy a woman experiences, admiring an already clearly rounded tummy! The belly at the 14th week of pregnancy, albeit still quite small, but already quite noticeable. From the navel downward, dividing the tummy in two, a dark stripe can clearly appear. There is no reason to worry in this regard - this pigmentation is temporary, it is associated with the accumulation of melanin in the skin cells, and over time it will pass on its own.

But it's time to think about clothes for pregnant women, as well as about the choice of cosmetics in order to avoid the appearance of stretch marks. Today, such cosmetics are freely sold both in pharmacies and in specialized stores, the choice of gels, creams, balms for stretch marks for pregnant women is unusually large. If the "factory" remedies do not suit a woman, you can always resort to effective and well-proven remedies for stretch marks in the form of olive or almond oil.

Uterus

The belly grows all for the same reason - due to the gradual increase in the uterus as the baby grows. The uterus at the 14th week of pregnancy relative to the pubic bone is already beginning to rise to the navel. Its bottom is located between the pubic joint and the navel, while the upper edge rises about 10-13 cm above the pubis. Significantly increased in size, the uterus is already felt through the anterior abdominal wall, and a woman can feel it by putting her hand to her stomach.

Discharge at 14 weeks of gestation

Normally, pregnancy at this stage is accompanied by secretions, which are characteristic in the early stages. So, moderate and uniform discharge at the 14th week of pregnancy, having a light color and a slightly sour smell, indicates a normal course of pregnancy. Any changes in color and consistency - the appearance of pus or mucus, cheesy discharge, which are also accompanied by itching and burning in the vaginal area, indicates the appearance of an infection.

Candidiasis (thrush), caused by the multiplication of fungi of the genus Candida, often becomes characteristic of pregnancy. Colpitis and vulvitis can be other troubles that a mother-to-be can experience while carrying a baby. Each of these diseases requires mandatory treatment - not only to eliminate unpleasant symptoms, but also to avoid infection of the fetus.

The appearance of bloody discharge, which is also accompanied by abdominal pain, becomes an alarming sign. This situation indicates a high probability of premature termination of pregnancy, and a visit to a doctor when such symptoms appear is necessary immediately: delay is now impermissible. You will also need an additional examination if spotting spotting appears at the 14th week of pregnancy, appearing more and more after intercourse or gynecological examination, and is not accompanied by abdominal pain. The presence of such symptoms indicates the possibility of cervical erosion.

Bleeding

Bleeding at the 14th week of pregnancy becomes a very frightening symptom. Bleeding is nothing more than an incipient miscarriage. It is usually accompanied by cramping pain in the abdomen: the uterus, contracting, pushes the fetus out. In this case, it will not be possible to deal with the situation on its own, and the intervention of specialists in order to preserve the pregnancy becomes a necessity. Only minor bleeding that appears should already be a sufficient reason for urgent medical attention, and even more so, bleeding that occurs at the 14th week of pregnancy. A timely response may well stop a miscarriage that has begun and prevent premature termination of pregnancy. But for this it is necessary to act very quickly.

Cold

Although the main dangers for a baby at 14 weeks of gestation remain for the most part in the past, however, a cold at 14 weeks of gestation can still become a catalyst for rather serious complications. Colds are especially dangerous, accompanied by a prolonged increase in temperature to 38 degrees and above. Already at the first symptoms of a cold, it is imperative to seek the advice of a doctor - treating the disease is imperative.

As in the early stages of pregnancy, first of all, a cold at the 14th week of pregnancy requires a woman to observe rest and bed rest, to eliminate symptoms - the use of mainly traditional methods of treatment. However, it is also possible to use some drugs: at the 14th week of pregnancy, some drugs prohibited in early pregnancy are already approved for use. But only - with the consent of the doctor and strictly according to indications, self-medication during pregnancy is not permissible and can cause a lot of trouble.

Temperature

The temperature at the 14th week of pregnancy can accompany a fairly large number of various diseases. Although the most important reason for the rise in temperature, of course, are various colds and viral diseases. They cause fever and infectious diseases (flu, rotavirus infection, toxoplasmosis), and inflammatory diseases of the urinary tract (pyelonephritis, cystitis), and inflammatory diseases of the respiratory tract (pneumonia, bronchitis).

When the temperature rises, one cannot do without consulting a doctor: initially it is necessary to establish the causative agent of the disease, from which the main threat emanates, and, if necessary, prescribe competent treatment. Long-term fever is quite dangerous for the normal course of pregnancy: from the second trimester, high temperature can cause pathology of the placenta and the development of placental insufficiency, and in infectious diseases it also poses a threat of intrauterine infection of the fetus.

Then, a consultation with a doctor in the presence of a temperature is necessary. If, for some reason, an immediate visit to a doctor is impossible, it is possible and necessary to bring down the temperature with “improvised” means. Shown are bed rest, plentiful and warm drinks, at high temperatures - rubdowns and lotions, and in extreme cases, the use of drugs based on paracetamol. If the high temperature persists for several hours, hospitalization of the expectant mother and further observation in the hospital are required.

Alcohol

Alcohol at the 14th week of pregnancy, as well as before and after this period, is best left on the list of "unused" foods. If in the early stages of pregnancy alcohol can cause a pathology in the development of forming organs, now alcoholic beverages, although they do not have a damaging effect, are no less dangerous. After all, the baby continues to develop very quickly, all its main organs and systems are already working, and alcohol at the 14th week of pregnancy already causes a violation of their function. In addition, the negative effect of alcohol at 14 weeks of gestation can have a negative effect on the still-forming bone tissue.

Nutrition at 14 weeks of gestation

The nutritional recommendations remain the same: nutrition at 14 weeks of gestation should be balanced, healthy and complete. It is also advisable from now on to limit the consumption of foods that can cause allergic reactions and increase the risk of developing allergies in the baby in the future.

You need to be careful with citrus fruits, honey, eggs, caviar, cow's milk, chocolate, vegetables and fruits of bright orange or red color. It is advisable to remove strong rich broths, all kinds of barbecue steaks, smoked meats and canned food from the table. Cooking is shown with the steam method, by baking, boiling or stewing.

Although meat must be present in the diet of a pregnant woman, as a source of the necessary protein, it is better to replace its fatty varieties with dietary ones - rabbit, chicken, lean veal or beef. At the same time, fish should be included in the diet on a regular basis - to provide the body with phosphorus and useful unsaturated fatty acids.

You should not get carried away with foods that increase gas formation and "fix" that can cause constipation - pears, legumes, cabbage. Instead, it will be helpful to enrich the diet with fermented milk products, fiber-rich vegetables and fruits to avoid constipation.

Sex

At the 14th week of pregnancy, a woman, as a rule, said goodbye to unpleasant pregnancy companions, characteristic of the early stages - toxicosis, drowsiness, irritability. The "golden time" is coming, the time of realizing one's future motherhood and new relationships with the future dad - intimate as well. Sex at the 14th week of pregnancy is not only not contraindicated, but is capable of reopening spouses to each other. Therefore, in the absence of any contraindications, it is not worth giving up physical intimacy, especially since sex now can bring much richer sensations and colors. A woman, preparing to become a mother, is already becoming more and more soft and pliable. The man, in turn, realizing the full degree of responsibility, treats his spouse with greater tenderness and caution. And therefore, sex at the 14th week of pregnancy even turns into a kind of sacrament, a way to get to know each other even better and get closer.