Evaluation of the fetus will be at the hour of pregnancy and at the hour of the fall. Assessment of the fetus
Mriya kozhnoї probable mami - to give birth to a healthy full-fledged child. І methods of diagnostics I will become a fetus by calling already on the early terms of vaginess z'yasuvat, whether the little ones will be healthy or able to breathe. But it's not all that simple. Pre-diagnosis of the fetus is not the most reliable and far from accurate.
Nasampered, significant in terms. Prenatal diagnosis - ce dopological diagnosis of fetal pathology at the stage of intrauterine development. Before such a diagnosis, the fatherhood should be identified in the early terms of vacancy and the status of a child. Prenatal diagnosis allows revealing Down's syndrome and other chromosomal ailments, damage to the development of the heart, coarse calculus of the brain and spinal cord, spinal hernia. And also indicate the stage of maturity of the leg of the fetus, the stage of acid starvation of the fetus and other illnesses.
risiku group
Persh nizh vyrishuvatisya on the pre-diagnosis diagnosis without special evidence, the father is guilty of memory - it’s not safe for a child. Zvichayne zapokoennya, domineering to all future fathers, I’m not yet ready to go to the diagnosis of the fetus. Prote won't be needed by the vagits:
Older than 35 years;
Women, who were already young children with birth injuries and recent vaginess.
For women, who already had ailments of recessive ailments, and for women - potential carriers of such ailments;
Women, yakі were obstezhenі z an hour conceived schodo di ї nevіdomih speeches. Why is it related to this, that stench can be for a child who is developing, more shkidlivimi;
Women, yakі suffered from infectious diseases (toxoplasmosis, rubella and others);
In 95% of cases, the methods of pre-surgical diagnostics do not show any obvious defects. And even though the development of the fetus is still revealed, the post is about the health of the development of pregnancy. Tse decisions are taken less than the father, and we can only think about it and take care of it! Vіdomi vipadki, if women took care of pregnancy, regardless of the results of diagnostics and when they gave birth to healthy children. Finding confirmation by modern technical methods of prenatal diagnosis may be incomplete. As a rule, to interrupt the vaginess of the father, they are vilified, only if they show a vice, which can cause important complications, or it can be fatal. Anyone need a consultation with a geneticist who can confirm or confirm the diagnosis. Varto nagolosity, that the number of fathers is more important until the rest, saving the life of a newly-finished child.
Main methodsrenal diagnostics
One of the main methods of obstezhennia is the analysis of the ancestor of the fathers. Doctors tsіkavlyat usі vіdomі vipadki grievous ailments, yaki repeat from generation to generation. For example, the people of the children with vadas, wikidni, bezpіddya. As soon as sіm'ї vyyavlyayutsya spadkovі zahvoryuvannya, then fahivtsі signify, what a risk of yogo transmission to offspring. This analysis can be carried out for an hour and up to pregnancy.
Genetic analysis - follow-up of the chromosome set of both fathers.
Okrema group - invasive methods of fetal diagnostics. The stench is carried out under ultrasound control, under general anesthesia, at the hospital. After the procedure, it takes 4-5 years to change under the supervision of doctors. Invasive methods- tse:
Biopsy of the chorion - diagnosis of clitin from the possible placenta. It will be carried out on 8-12 days of pregnancy. The advantages of this method are the term of completion (up to 12 days) and the speed of completion of the survey (3-4 days). The method of carrying out: a small amount of chorional tissue through a syringe, through a catheter, which is inserted into the cervical canal; 2) then zamoktuyut a piece of tissue with a syringe for the help of a long neck, introduced through the fetal wall at the empty uterus. Like any other method, a biopsy is connected with a rhysic. Risk of bleeding in a woman (1-2%), risk of fetal infection (1-2%), risk of malnutrition (2-6%), risk of fluctuating disease of fruit michur and other complications.
Placentocentesis (a biopsy of the chorion) - occurs in the II trimester. To be carried out so by itself, like a biopsy;
Amniocentesis - analysis of navcoloplid midline at 15-16 pregnancy. For help, the head is drawn into a syringe, inserted through the cherevnu wall into the empty uterus. The most secure method for diagnosing a fetus is that it does not exceed 1%. Shortcomings of this diagnostic method: 3-hour analysis (2-6 days) results in an average of 20-22 days. Also, there is a risk of developing small children and maly (less than 1%) risk of developing diseases among new people.
Cordocentesis - analysis of the umbilical cord blood of the fetus. Tse highly informative method of diagnostics. Optimal term vikonannya -22-25 tyzhniv. A sample of blood is taken for help from the vein of the umbilical cord, introduced through a puncture of the anterior cervical wall near the empty uterus. Cordocentesis has minimal complication.
So non-invasive methods fetal diagnostics:
Screening for maternal oroval factors - vykonuetsya between 15 and 20 days of vagity. Material - blood vein of the vagina. There is practically no risk for the fetus. Tsey analysis of testimony usim vagіtnim.
Ultrasound screening of the fetus, membranes and placenta (US). Carry out on terms of 11-13 and 22-25 days of pregnancy. Testimony usіm vagіtnim.
Sorting of fetal cells is carried out between 8 and 20 days of pregnancy. The material of the study is the woman's blood. In the blood, fetuses (fetal) cells are seen, which are analyzed. Possibility of this method is the same as in biopsy, placentocentesis and cordocentesis. There are no proteo riziki in mayzhe. But it’s also an expensive analysis and insufficiently reliable. Tsya technique today vikoristovuєtsya not too often.
Using different methods of diagnostics, the fetus can be further diagnosed with unsafe illness and living in. Abo, I’m sure that there are no serious illnesses. May we have a good mood, I wish you health and wellness to you and your children!
At the stage of development of science and technology, impersonal methods of assessment will become a fruit. They include the ultrasound method of diagnostics with dopplerometry, electrocardiography, cardiotography, assessment of the biophysical profile of the fetus, the acid-base state of the blood of the fetus, the examination of the navcoloplidnye waters, biopsy of the chorion, endoscopic and hormonal methods.
I. Ultrasound scanning, using a highly informative, non-shedding method of follow-up, allows dynamic monitoring of the fetal body.
Caution for the development of pregnancy is possible from early terms. Already 3 days of pregnancy in an empty uterus, a fetus egg with a diameter of 5-6 mm is visualized. In 4-5 years, the embryo may be revealed in an apparently echo-positive female with a size of 6-7 mm. The head of the embryo is identified at 8-9 tyzhniv, having a round anatomical appearance and a rounded shape with a diameter of 10-11 mm. The growth of the embryo is uneven. The highest rates of growth are indicated for the first trimester. The most accurate indicator of the term vagity in the first trimester is the size of the coccygeal-thyme growth.
Assessment of the vitality of the embryo in early termsґruntuєtsya on registration of yogo heart activity and rukhovoї activity. Vykoristannya intrauterine mode allows zdiisnyuvat registration of heart activity from 4-5 tyzhnіv vagity. Heart rate rapidly decreases from 150-160 per 1 minute for 5-6 days to 175-185 per 1 minute for 7-8 days with a further decrease to 150 per 1 minute for 12 days.
The motor activity is observed from 7-8 days of pregnancy. Vidsutnіst sіrkovoї dіyalnostі and ruhovoї aktivnosti vozduє on the death of the embryo.
The most important place is occupied by ultrasonic obstezhennja at the aggravated excess of vaginess, to that іnshі adjuncts methods of further workomistkі and do not always allow otrimati sufficient information about the development of the embryo.
Diagnosis of vagity, which does not develop, is possible with an empty stomach. fruiting egg(anembrionia). With this fetus, the egg does not exceed 2-3 cm in diameter, there may be fuzzy, sweating walls due to degenerative changes.
Ultrasound diagnostics of varicose veins is based on the visualization in the empty uterus of both fetuses or fetuses.
When the development of the fetus in the 2nd and 3rd trimesters of pregnancy, the main attention is paid to the reduction of the biparental head size, the middle size. chest and abdomen, as well as dozhina stegnova cysts. Fetometry allows you to carry out a divination of the weight of the body of the fetus.
Due to the stagnation of modern ultrasound equipment, it became possible to assess the activity of various organs and systems of the fetus, as well as antenatally diagnose more vrodzhenikh vad development.
In the middle of the congenital veins, the development of the fetus is most clearly seen in the CNS: anencephaly, hydrocephalus, and craniocerebral hernia. It is also possible to diagnose diaphragmatic hernias, defects of the ridge, anomalies in the development of the heart and other waterways, atresia of the intestine, hydronephrosis and polycystosis of the nirok.
From the middle of the II trimester of pregnancy, it is possible to designate a fetus. Ultrasound scanning allows you to accurately establish the localization of the placenta, its age and stage of maturation.
AT stay rocky Ultrasound devices have appeared that allow to evaluate indications of blood flow in the mother-placenta-plaid system. Dosledzhennya svidnosti blood flow in the uterine arteries and vessels of the fetus allows 100% to diagnose the pathology of blood circulation.
Under ultrasound control, it is possible to perform intrauterine puncture of the umbilical cord (cordocentesis). Indications before cordocentesis are various and include the diagnosis of congenital and recessive pathology, intrauterine infection, fetal hypoxia, fetal anemia in immunocompetitive vaginess. Crimium diagnostics for the additional method of cordocentesis, it is possible to carry out intrauterine therapy for hemolytic fetal ailments.
Fetal karyotyping for additional cordocentesis may be significant before amniocentesis and biopsy of the chorion, so the results of the follow-up of the blood of the fetus can be removed after 24-48 years, at that time, when analyzing the nascoloplasty waters, the biopsy of the chorion is only 2-3 years
2. Electrocardiography of the fetus.
The most widely used methods for assessing the heart rate of the fetus are electrocardiographic (ECG) and phonocardiographic (FCG) studies, so for additional auscultation of fetal heart failure, it is not possible to take complete information about the yogo state.
When analyzing the antenatal ECG, the heart rate, the nature of the rhythm, the magnitude and severity of the thoracic complex, and also its shape are indicated. Normally, the fetal rhythm is correct. The heart rate rapidly fluctuates from 120 to 160 per 1 min., the P wave of aggravation, the trivalence of the shunt complex becomes 0.03-0.07 s., as the voltage fluctuates from 9 to 65 μV. For the zbіlshennyam termіn vаgіtnostі vіznaєєєєєєєєєєєєєєєєєє povysov podvishchennya voltazh shlunochkovogo complex.
FKG characterizes the sound phenomena that accompany the heart's speed. The sound is represented by two groups of oscillations, which evoke the 1st and 2nd tones of the heart. Inodes are registered III and IY tone. Tone I is formed when the atrioventricular and occluded valves of the heart are closed. Most of the wines are made up of 4-6 colivans, the trivalence of yoga is close to 0.1 s. Tone II settles down when the heart valves are closed and is composed of 2-4 drops. The average trivality is close to 0.04 s.
Parallel registration and recording of ECG and FCG of the fetus give a warning about the phase of the cardiac cycle, allow antenatally to diagnose congenital heart rhythm disturbances, and also give an important role in the diagnosis of fetal hypoxia and umbilical cord pathology.
3. Fetal cardiotography.
Cardiotocographic examination of the fetus is one of the leading methods for assessing the fetus. Modern cardiomonitors are based on the principle of Doppler, which allows recording changes in the intervals between the same cycles of the fetal heart rate, as if they are converted to a change in the frequency of the heart rate, which is reflected in the light, sound, digital and graphic. Attached are also equipped with sensors that allow you to register the short-term activity of the uterus and fetal growth at the same time.
The cardiac activity of the fetus is assessed at the balls. The sum of the points indicates the presence or the presence of a sign of damage to the heart of the fetus: 8-10 points are considered as the norm, 5-7 points are the pre-pathological state, which indicate the need for a further relativistic guarding of the fetus; 4 balls and less - as pathological.
4. Biophysical profile of the fetus (FFP).
Assessment of the biophysical profile includes 6 parameters:
a) non-stress test (NST)
b) fetal dychalnye (DDP)
c) rukhova activity (SO)
d) fetal tone (T)
e) obsyag navkoloplіdnyh waters
f) stage of placental maturity (FFP)
The maximum score is 10-12 points. The non-stress test is evaluated at the cardiomonitoring follow-up. The essence of yoga is related to the development of the reaction of the fetal heart-vascular system in the case of rupture. In the norm, the fetal circulation is accompanied by an accelerated rhythm of the heart rates. Due to the nature of the reaction of the cardiac activity of the fetus in the presence of an ovulation test, the test is considered negative, which indicates the tension and compensatory reactions of the fetus.
Other parameters of SFD are determined during ultrasonic scanning.
The fetal dyhals become regular at 32-33 days of pregnancy and occur at a frequency of 40-70 per whilin. With the fifty, I will overdue the VagiTi resisted zbilhennya Kilkol, the rukhvs up to 100-150 for Khvvin, the subsidence of the ї ї ї ї ї ї ї ї ї ї ї ї ї ї ї ок є є є є є є є є є
I will become an indicator of the fetus, yogo rukhova activity and tone. In healthy pregnant women, fetal growth reaches a maximum of up to the 32nd week of pregnancy, after which the number of women changes to the 40th day. Tonks of the fetus are characterized by lateral-ginal ruhi kintsivok and vertebral stupa from turning to the outward ginal position. As a result, the fetal movements will not end in turning to the final position, which indicates progressing hypoxia. An indicator of a good fetus will be no less than 3 active ruhiv of the fetus for 30 whilins.
The volume of fluid waters, on the basis of other parameters, does not reflect the functional state of the central nervous system of the intrauterine fetus, however, it is an indication of indirect interference with the result of pregnancy. Change in the amount of navcoloplidnyh waters to report about the pathological result of vaginess.
Ultrasound placentografiya allows you to determine the degree of maturity of the placenta for the term vaginosti. In case of uncomplicated excess of vaccinity, 0 stages of placental maturity are indicated at the term of 27-30 tizhniv, stage 1 - 30-32 tizhniv, II stage - 34-36 tizhniv, III stage - 38 tizhniv. In case of aggravated vaginess or extragenital pathology of the mother, the old placenta is pre-mature.
5. Amnioskopiya.
For the purpose of cultivating, I will become navkoloplіdnyh waters of the fetus at the hour of vagity, I will stop amnioskopіy - a transcervical survey of the lower pole of the fruit mіkhur. With an uncomplicated excess of vaginess, one can see a sufficient amount of light, clear, opalescent, cloudy waters with a presence of white syr-like oil. Insufficient amount of water, revealed by meconium and greenery, indicates fetal hypoxia and postnatal vaginess.
6. Amniocentesis.
With the method of removing the navcoloplidnyh waters for follow-up, carry out a puncture of the amniotic emptying - amniocentesis. For which vicory, there are a few ways to take in large-scale waters: transabdominal, transvaginal, transcervical. Amniocentesis can be performed from the 16th day of pregnancy. It should be used to assess the maturity of the fetus, latent intrauterine infection in cases of suspected congenital anomalies in the development of the fetus, hemolytic ailment, postnatal pregnancy, chronic fetal hypoxia.
For additional amniocentesis, they develop a biochemical and bacteriological warehouse, an acid-base camp in the cold waters, and also diagnose genetic diseases.
When ill, linked to the X chromosome, they become a fetus. For this, a cytological study of native clitins (designation of X- and Y-chromatin) is carried out, or a karyotype is determined for the culture of clitin of amniotic rhinitis. When the human fetal status is restored, the transfusion of vaginess through a high risk of the birth of a sick boy (50%) is shown.
Prenatal diagnosis in the course of the development of the central nervous system is carried out with the help of the determination of alpha-fetoprotein in the blood of the mother and amniotic fluid and by the radioimmunoassay method. An increase in alpha-fetoprotein over 200 ng/ml in blood syrometry and 10,000 ng/ml in the amniotic fluid indicates the development of the fetus in the fetus.
For the diagnosis of recessive pathology in the first trimester of pregnancy, the method of transcervical biopsy of the chorion should be used.
7. Fetoscopy - a non-intermediate examination of the fetus with a special fiber-optic endoscope, introduced into the amniotic emptying through the fetal wall and uterus. The method allows you to look at the surrounding parts of the fetus, the placenta, the umbilical cord, identify the development of the fetus, biopsy the fetal skin or take a blood sample from the umbilical cord vessels for the diagnosis of hemophilia or hemoglobinopathy.
8. The acid-base balance of the blood of the fetus improves the level of manifestation of metabolic disorders in hypoxia. At the norm, pH is 724 and higher. Zsuv pH vіd 7.24 to 7.2 is rated as subcompensated acidosis. pH lower than 7.2 indicates the presence of decompensated acidosis. The remaining criterion for the viability of the fetus is blood pH = 6.7.
9. Hormonal methods of follow-up.
In the assessment of the hormonal status of the woman, there is a trace of damage, that in the early term of vaginess, the function of all internal secretions is promoted. Already in the pre-implantation period, at the stage of blastocyst germ cells secrete progesterone, extradiol and chorionic gonadotropin, which may be of great importance for the implantation of the fruiting egg. In the process of organogenesis of the fetus, the hormonal function of the placenta grows and, through the course of pregnancy, it secretes a large amount of hormones.
In addition to placental hormones (placental lactogen and progesterone), one can judge the function of the placenta, as well as changing fetal hormones (estradiol, estriol) to a greater world invigorate the fetus.
The rest of the day before the curtains of estrogen excretion in the section should be 23-24 mg per doba. Due to the presence of fetal hypoxia, the estrogen rhubarb from the dobou section changes to 10 mg per doba, and a decrease to 5 mg per doba should be noted about the need for a term birth.
Rizke decrease in estrogen (less than 2 mg per doba) is associated with anencephaly, pathology of supracutaneous fetal insufficiency, Down syndrome, intrauterine infection.
About the camp of the fetus can be judged by the presence in the blood of the vaginal enzymes, which are produced by the placental tissue. Particularly respect among them is attached to thermostable pool phosphatase, as it increases with fetal hypoxia.
Widely used in clinical practice of various methods of assessing the development of the fetus, it is associated with a significant decrease in perinatal mortality, as one of the main indications of the development of medical assistance. Diagnosis is valid in two directions: 1 - assessment of the features of the anatomical development of the fetus; 2 - the attainment of the yogo functional state.
For the assessment of the fetus, I will become a fetus during the first hour of vagity and the first hour of the gradual vicoration of clinical, biochemical and biological methods of follow-up.
Before clinical methods of diagnostics be seen:
auscultation,
Determining the frequency of the ruhu of the fetus,
Determining the rate of growth of the uterus,
· Depending on the nature of the preparation of the amniotic fluid (with amnioscopic examination, amniocentesis, vilitia of navcolous waters).
In everyday practice, the obstetrician is widely victorious auscultation method for assisted stethoscope , the rhythm and frequency of the heart rate is assessed, the clarity of the heart tones In the norm of the fetal heart rate, it should be 120 to 160 beats per whilina. Prote auscultation of the fetal heartbeat, which may be the most important assessment of the future of the fetus and the diagnosis of yogo hypoxia. It allows to reveal only rough changes in the frequency of heart rates (HR) - tachycardia, bradycardia and pronounced arrhythmia, which are most often blamed for acute hypoxia. In case of chronic hypoxia, there is no auscultatory change in cardiac activity. Auscultation of the fetal heartbeat can be of great value for the purpose of the fetus, as it is victorious as a test for assessing its reactivity. With the help of the method of the heartbeat of the fetus, listen to it until that next day. The frequent heartbeat of the fetus in the case of a thief is a clear indicator of a good future for the fetus. Vidsutnist reaction of heart rate or the appearance of more than an insignificant increase in heartbeat may be indicative of fetal hypoxia and will require additional methods of follow-up.
I will become an indicator of the fruit of yoga Rukhova activity , Yaka in healthy vagits reaches a maximum of up to 32 tizh. The appearance of ruhіv fetus (DP) to witness about the yogo good camp. If mother observes DP without ushkodzhennya or a decrease in activity, then health and no threat to my life. First of all, like a mother bald at the song change in the DP, then you can be restless in trouble. At the cob stages of intrauterine hypoxia of the fetus, restless behavior of the fetus is observed, which is manifested in more frequent and more intense yogo activity. With progressive hypoxia, there is a weakening of the pinion of the hands.
To assess the rukhovoї activity of the fetus, special forms are used, in which estimating skin DP starting from 900 to 2100, then for 12 years . Number of DP over 10 to speak about the final stage of the fetus. What a woman knows less than 10 rubles, especially two days of sleep, this camp becomes threatening to the fetus. Later, the obstetrician takes away information about the intrauterine state of the fetus in the vagina. The method of registration does not allow for the daily normal activity of women. In case of negative results, the doctor should send the patient for obstezhennia to the hospital.
In stationary minds, krim dodatkovykh methods dosledzhennya, it is possible to win another method of registering DP for assessing the yogo intrauterine state. Vagina register DP lying on the boots with a stretch of 30 min. chotiri razi for the day (900, 1200, 1600 and 2000) and enter it with a special card. When evaluating the results, it is important to pay respect not only for the number of ruins at least 4 in 2 years), and change their number of days by stretching for a few days. On the suffering of the fetus, it is indicated: an increase in rukhovoї activity, or a change in DP by 50% per day. As the coming days of DP turn to a colossal level, then there are no problems for the fetus at the moment.
Of particular value in the diagnosis of fetal hypoxia is the onset of registration of cardiac activity and rukhovo activity.
Significant obsyag information about the camp of the fetus can be taken vimiryuvannya height standing of the fundus of the uterus. Dani vimiryuvannya ring out vikoristovuyutsya between 20 and 36 days vagity. To determine the rate of growth and development of the fetus, it is necessary at dynamics (skin 2 tyzh.) vimiryuvaty height of standing of the bottom of the uterus above the pubic articulation and near the abdomen. The introduction of the omission of rozmіrіv from the term vagity allows to reveal the appearance of the growth of the fetus. Vіdstavannya standing height of the fundus of the uterus on the 2 cm and more in line with the norm otherwise, її increase in the stretch of 2-3 days . with dynamic watchfulness for vaginal indicate the growth of the fetus , which will require a further assessment. Іnuє unknown factors that make it easier to assess the growth of the fetus (damage to the method of vimiryuvannya, damage to fat metabolism in the mother, supra-world, or the number of amniotic rіdina is reduced, rich in vagity, the position of the fetus is incorrect). However, data on the height of the standing of the fundus of the uterus are left as a good clinical indicator of a normal, accelerated or reduced fetal growth.
Contamination of amniotic fluid at the hour of vagity can be detected by a path amnioskopії or amniocentesis, as well as in case of early opening of the fetal membranes.
amnioskopiya– transcervical view of the lower pole of the fruit michur. Presentation houses for meconium pointing to chronic hypoxia of the fetus, or to a large number of short-lived gostra, and due to the presence of new lesions in post-acne fetal infections, it can be born without asphyxia. The presence of a small house meconium in the amniotic cavity (yellow or greenish color) with prematurity is not an absolute sign of fetal hypoxia. How much meconium near the rainy waters is found in great number(dark green or black color) especially in women with high risk (piznіy preeclampsia, rhesus-isoimmunization, chorioamnionitis and іn), then it appears as an intimidating frame of the fetus. Mutne farbuvannya navkoloplіdnіh vіdі vіdtіt about the postponement vаgіtnіst, zhovte - about GSHP or Rhesus-sum_snist.
Biochemical methods of diagnostics of the fetus:
· Follow-up hormonal profile: chorionic gonadotropin, placental lactogen, estrogen (estriol), progesterone, prolactin, thyroid hormones, corticosteroids;
· Determining the stage of fetal maturity on the basis of cytological data of the navcoloplid waters and the concentration of phospholipids (lycetin and sphingomyelin) in the navcoloplide waters taken away by amniocentesis;
· Follow-up of the blood of the fetus, taken by way of intrauterine puncture - cordocentesis;
· Biopsy of chorionic villi for fetal karyotyping and identification of chromosomal and genetic abnormalities.
For the assessment of the fetus, the hour of the vacancy should be the same hormonal activity of the fetoplacental system , Scho sing world to lie in the physiological activity of the fetus and significant world in the functional activity of the placenta. Among biochemical methods The most widely known in practice is the concentration of estriol and placental lactogen in the mother's organism.
For the ignorant estriol є the main metabolite of the head estrogen - estradiol. Under the hour of vagity for the greater part of the destruction of estriol in the same placenta. Serednyodobova kіlkіst svidіlennogo іz sekeyu hormone to become 30-40mg. Vision less than 12 mg/dobu note about the decrease in the activity of the fetoplacental complex. Change in place of estriol up to 5 mg per doba speak about the suffering of the fetus. Falling excretion of estriola below 5 mg/dobu threaten the life of the fetus. So yak on the vene of the Esproil in organism of the mother, the nonsense of the factor (the mill of the pepper, the folding of the sbor of the Dobovo Sich, the Likarsky Rechovin, the Wide DIAPASE OF DOSLIIDZHENNE, then the ilon format, the ilmari, zbіgaєtsya with other clinical and biophysical indications. It is taken into account that equal estriol should be administered to the fetus in cases of vagity, aggravated by preeclampsia, fetal growth in the mother of the fetus, maternal maternal diabetes, which in the group of high risk women is caused by fetal hypoxia.
Placental lactogen (PL) synthesized by the placenta and can be assigned to maternal blood. The concentration of the submerged blood in the blood of the mother is directly related to the mass of the functional placenta. Also, with a normal excess of vaginess, the magnitude of the sub-water body in the syrovattsi increases in the world of placental growth. Due to the presence of a pathologically small placenta, the level of PL in maternal blood is low. The function of the sub-water organ may play a significant role in the evaluation of the fetus in women, in those with fibrosis and infarctions of small placenta, especially in case of aggravated vagity with gestosis, or due to the presence of intrauterine stuttering of fetal growth. With physiologically passing vagity in the water of the mother's blood in the mother's blood, gradually increase and become vіd 6 to 15 mcg/ml, then the decrease in PL for women after 30 tizhniv. vagity to equal less than 4 mcg/mlє threatening to the fetus. For a sprat of tizhnіv before the death of the fetus, the rіven of the underwater chovn falls sharply. With insufficient function of the placenta, a decrease in the level of PL in the blood is expected. The results of the appointment instead of an underwater chin, obviously, cannot be victorious as a single criterion for diagnosing fetal hypoxia.
However, in current clinical practice, the appointment of estriol in the blood and excretion of yoga has not known a wide stagnation, moreover, the appointment of estriol gives close to 80% of false results. Also, the value of placental lactogen level may be low. In this hour, methods of ultrasonic follow-up and electronic monitoring of the fetus have come to change.
Most informative respect biophysical methods for assessing the fetus . Before them one can see: electrocardiography, echography and cardiotocography, which are widely known in the everyday robotic obstetrician.
Methods for assessing the heart rate of the fetus are also indirect (From the cranial wall of the uterus) electrocardiography and fetal phonography. When analyzing antenatal ECG appoint Heart rate, character of the rhythm, size, shape and trivality of the tunic complex. With fetal hypoxia, damage to the conductivity of the heart, a change in the amplitude and an increase in the trivality of the heart tones, splitting of them are revealed. Blame noise, especially systolic, with chronic fetal hypoxia, to speak about a severe yoga camp.
FKG represented oscillations that reflect I and II heart tones. Pathology of the umbilical cord is characterized by the appearance of a systole murmur on FCG and an uneven amplitude of heart tones.
Ultrasound follow-upє the most reliable and accurate method of antenatal diagnosis of the fetus.
The method allows:
Carry out dynamic fetometry,
· to estimate the global and dychalny ruhi of the fetus,
Heart activity of the fetus,
Tovshchina and area of the placenta,
Volume of amniotic fluid,
· Vimiryuvati shvidkіst fetal and uterine krovoobіgu.
Nasamfored, signify biparietal diameter of the fetal head (BDP), mean diameter of the chest (DG) and abdomen (DZh). Reliable sign of stuttering of the growth of the fetus - inconsistency on the 2nd day. and more BPR of the fetal head to the actual term of vaginess, and navitt disruption of mutual relations between the dimensions of the fetal head and the fetal sheath. A comprehensive ultrasound assessment of the rate of fetal growth allows for early diagnosis and an objective assessment of the fetal status.
Great value may vyvchennya dyhalnyh ruhiv fetus. For the analysis of the dyhal activity of the fetus, the following indicators are used: - the index of the dyhal rupture of the fetus (the number of hours of the dyhal rupture to the total equivalence of the fetus); the frequency of dyhal ruptures of the fetus (number of dichal ruptures per quill); the average trivality of episodes of dyhal rukhivs; average number of dyhal rukhivs per episode. Trivalіst doslіdzhennya may become no less than 30 min. For the presence of dyhalic ruptures of the fetus, the next day is repeated. Vidsutnіst dikhalnyh ruhіv protyag 2-3 doslіdzhen roztsіnyuёtsya like a rotten prognostic sign. Signs of fetal suffering are changes in the nature of dihal activity as a sharp decrease in movement. With the manifestation of fetal hypoxia, the nature of fetal collapse changes. There are dychalnye ruhi in viglyadі haeka or urivuschastny dyhannya with trivial episodes of apnea.
The most accessible, most accurate and most accurate method of evaluating the fetus for the rest of the pregnancy trimester cardiotocography (CTG) of the fetus. The cardiotocograph is designed in such a way that it simultaneously registers the heart rate of the fetus, the contraction of the uterus and the fetus. The current cardiotocography is indicative of the most common symptoms, which are observed to guard against the fetal heartbeat and short-lived uterine activity as early as the hour of vagity, so the process is gentle. In this hour, it is essential to carry out screening control over the fetal state, both in outpatient minds and in hospitals. In risky groups for perinatal losses, screening control is carried out dynamically. Call the registration of the fetal heart rate to stop at 30 tyzh. viscosities on the lines, which are collapsing due to the speed of 10 to 30 mm / min / min, with a stretch of 30 min.
To characterize the fetus for the help of CTG, there are such indicators: basal heart rate rate, basal rhythm variability, frequency and amplitude of oscillations, amplitude and frequency of accelerations and decelerations, fetal heart rate in fetal heart rate, fetal movements and functional tests.
Pid basal rhythm (BR) to understand the dovgostrokovu change of heart rate. A decrease in yoga below 120 beats / min is classified as bradycardia, and an increase over 160 beats / min is classified as tachycardia. Also, the heart rate was not more than 120-160 beats / min, as the normal area. Tachycardia is divided into degrees of severity: mild (160-170 bpm) and severe (more than 170 bpm). Bradycardia is also subdivided into mild (120-100 bpm) and hard (less than 100 bpm) degrees of severity. As a rule, bradycardia manifests itself at an hour of troch more than 3 hours, that letter turns to the exit BR, and is called deceleration.
In case of a physiological excess of vaginess, the fetal body is assessed on the basis of:
The results of the development of the uterus and fetus with the term of gestation;
Auscultation of fetal heart tones during cutaneous examination of the vagal woman's consultation:
fetal motor activity;
The results of ultrasound, which should be carried out in terms of pregnancy 18-22 days, 32-33 years before the canopy (to reveal the biological profile of the fetus and stage of placental maturity in terms of gestation).
With an aggravated excess of pregnancy, the assessment of the fetus will enter the complex of stationary obstezhennia of the vagina, directed to the diagnosis of pathology in her, hypoxia of the fetus and the indicated degree of severity.
For the diagnosis of fetal hypoxia, you need:
Fetal heart rate assessment:
Evaluation of the rukhovoї activity of the fetus;
amnioskopiya;
Ultrasound of the fetus and placenta.
Heart activity of the fetus is assessed on the basis of the results of auscultation of fetal heart tones and cardiotocography (CTG). Auscultation of the fetal heart tones is carried out with a skin examination of the vagina, in the first period of the fall - skin 15-30 minutes and posture, in the other period of the fall - after the skin battle. Assess the frequency, rhythm and sonority of the heart tones of the fetus. Tachy-abo bradycardia, arrhythmia, muffled or muffled fetal heartbeat - clinical signs of hypoxia.
Antheta intranatal cardiotography allows you to evaluate the frequency of fetal heart rates on aphids, short uterine activity and fetal rukhovy activity. Changes in basal rate, heart rate variability, acceleration and deceleration reflect the body of the fetus and may be signs of hypoxia.
The movement activity of the fetus is assessed by the results of the birth of the number of fetal failures for the 30th month of the month and in the evening. At the norm, for 30 minutes, 5 and more fetal ruptures are recorded. Overnight in healthy women, the developmental activity of the fetus grows. In case of hypoxia of the fetus, which is due, there are more frequent and stronger thieves, in case of progressive hypoxia - weakening and aggravation, with further signs of damage to the fetus. In case of chronic fetal hypoxia, there is an increase in the supra-world or a sharp change in the difference between the number of children and the number of children in the evening.
The reaction of the fetal heart rate to cardiac activity may be objectively recorded with CTG (myocardial reflex).
Amnioskopiya (transcervical examination of the lower pole of the fruit michur) is carried out with the help of an amnioskop for the daily indications (placental previa, colpitis, endocervicitis) and the hour of pregnancy (after 37 days) and in the first period of the fall. At the norm, there is a sufficient amount of light, clear, navcolous waters, with fetal hypoxia - a small amount of waters of green color and breasts of meconium.
Ultrasound follow-up allows to reveal the syndrome of fetal growth obstruction, fetoplacental insufficiency, in which case chronic intrauterine fetal hypoxia can be established.
To clarify the degree of severity of fetal hypoxia, follow the following:
CTG from functional (prevailing) tests;
Ultrasound with dopplerography;
designation of the biophysical profile of the fetus, ultrasound placentography;
Amniocentesis;
Biochemical studies of enzymes in the placenta and indications of the acid-puddle condition of the fetus;
Follow-up of hormone levels.
CTG from the conducted functional (navantazhuvalny) tests should be considered as a method of spontaneous manifestation of the compensatory capacities of the fetus. It is possible to carry out samples from the breath for breath and vision, for physical examinations (step-test), thermal test and the manifestation of the reaction of the fetus on ultrasonic follow-up. Changes in the CTG curve against the background of functional (non-stress) tests allow diagnosing fetal hypoxia and degree of severity. The stress oxytocin test is rarely associated with possible complications for the fetal mother.
Ultrasound with dopplerography gives the possibility to assess the blood flow in the aorta and umbilical cord of the fetus and in the uterine arteries from the monitor screen of the blood flow curves. In the norm of the III trimester of vaginess, there is an incremental increase in volumetric blood flow with an additional decrease in the peripheral vascular support. With impaired fetoplacental blood flow, diastolic blood flow in the umbilical artery and aorta of the fetus decreases. Decompensated fetoplacental insufficiency may have zero and negative indicators of diastolic blood flow.
The biophysical profile of the fetus is a total assessment in points of five parameters: the results of a non-stress test for CTG data and some of the results of ultrasound of the fetus. Assess the fetal dysrhythmias, fetal dysrhythmia and fetal tone, assess the navcoloplidnyh waters with the improvement of the placental "maturity" stage. Balna ots_nka svіdchit about the severity of fetal hypoxia.
Ultrasound placentografiya transfers the designation of localization, rozmіrіv that structure of the placenta. With a normal excess of vacancy, "maturation" of the placenta and a progressive increase in the size of the body and the area to the term are observed. In case of placental insufficiency, there may be a thinning or thickening of the placenta, an increase or a change in its area, as well as an early ripening of that pathological change in its structure (brushes, calcification, infarction and hemorrhage).
Amniocentesis - doslіzhennya of amniotic, the fraud of Transabdominal (rydshe - transserovykalo). ).
The term vagity has more than 34 terms:
РН, рСО2, рО2, together with electrolytes, sechovin, protein in the amniotic cavity (for diagnosing the degree of severity of fetal hypoxia;
Rivne hormones (placental lactogen, estriol), enzymes (pool phosphatase, ?-glucuronidase, hyaluronidase and in) (to exclude placental insufficiency and fetal hypotrophy);
Optical thickness of bilirubin, fetal blood type, titer of Rhesus or group antibodies (for diagnosing the degree of manifestation of fetal hemolytic disease);
Cytological and biochemical (creatinine, phospholipid) indicators (for assessing the stage of fetal maturity).
Biochemical studies of the level of specific enzymes (oxytocinase and thermostable pool phosphatase) of the placenta in the dynamics of the II and III trimesters of pregnancy give the opportunity to reveal the functional state of the placenta.
Follow-up indications of the acid-base balance (ACS) of the fetus (pH, pCO2 and pO2) should be carried out with a cordocentesis (puncture of the umbilical cord of the fetus during amniocentesis) with vaccination or puncture of a part of the fetus, which is forwarded, in the canopies (Zaling test). For follow-up, you can vicorate and navcoloplіdnі water. Indicators of CBS in relation to the results of clinical and instrumental examinations (CTG, ultrasound) make it possible to objectively set the degree of severity of hypoxia.
The appointment of the level of hormones (progesterone, placental lactogen, estrogen), which are dissolved in the placenta and organs of the fetus, is carried out in the 2nd and 3rd trimesters of pregnancy. At the norm, the total amount of hormones gradually rises to the end of vagity. With placental insufficiency, there may be a decrease in the level of progesterone and placental lactogen. An indicator of fetal suffering is a decrease in the amount of estriol (it is most important in the body of the fetus). In chronic placental insufficiency due to impaired fetal trophism, a change in the concentration of all hormones is observed.
More on the topic of ASSESSMENT METHODS I WILL BECOME A FRUIT:
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- PHYSICAL AND NERVOUS PSYCHIC DEVELOPMENT OF CHILDREN. COMPREHENSIVE ASSESSMENT I WILL BECOME A HEALTH CHILD. EVALUATION OF THE FUNCTIONAL STATE OF THE CARDIOVASCULAR SYSTEM IN CHILDREN AND PIDLITS
1. Clinical:
A) auscultation with the help of an obstetric stethoscope- the rhythm and frequency of the heart are assessed quickly, the clarity of the heart tones. Acuscultation allows to reveal only gross changes in heart rate - tachycardia, bradycardia and pronounced arrhythmia, which is often blamed on acute hypoxia. In case of chronic hypoxia, there is no auscultatory change in cardiac activity. Auscultation of the fetal heartbeat can be of great value for the purpose of the fetus, as it won out Yak test forEstimates of yoga reactivity. With the help of the method of the heartbeat of the fetus, listen to it until that next day. The frequent heartbeat of the fetus in the case of a thief is a clear indicator of a good future for the fetus. Vidsutnist reaction of heart rate or the appearance of more than an insignificant increase in heartbeat may be indicative of fetal hypoxia and will require additional methods of follow-up.
B) the development of rukhovoї activity of the fetus- Healthy vagits reach a maximum of 32 days, after which the number of fetal ruptures changes. The appearance of ruhіv fetus (DP) to witness about the yogo good camp. If mother observes DP without ushkodzhennya or a decrease in activity, then health and no threat to my life. First of all, like a mother bald at the song change in the DP, then you can be restless in trouble. At the cob stages of intrauterine hypoxia of the fetus, restless behavior of the fetus is observed, which is manifested in more frequent and more intense yogo activity. With progressive hypoxia, there is a weakening of the pinion of the hands. To assess the rukhovoї activity of the fetus, special forms are used, in which Appoints skin DP, starting from 9 to 21 years, then for 12 years. Kіlkіst DP ponad 10 svіdchit about the last camp of the fetus. If a woman pays less than 10 rubles, especially two days of sleep, this camp will be regarded as a threat to the fetus. Later, the obstetrician takes away information about the intrauterine state of the fetus in the vagina. The method of registration does not allow for the daily normal activity of women. In case of negative results, the doctor should send the patient for obstezhennia to the hospital.
In stationary minds, krim dodatkovykh methods dosledzhennya, it is possible to win another method of registering DP for assessing the yogo intrauterine state. Vagina Register DP lying on the boots Break 30 min, chotiri for a day (9.00, 12.00, 16.00 and 20.00) І enter at the special card. When evaluating the results, it is important to pay attention not only to the number of ruptures (if the fetus is full, it may not be less than 4 for 2 years), but to change them for a few days. Indicate the suffering of the fetus; no increase in rukhovoї activity, or a change in DP by 50% per day. As the coming days of DP turn to a colossal level, then there are no problems for the fetus at the moment.
Of particular value in the diagnosis of fetal hypoxia is the onset of registration of cardiac activity and rukhovo activity.
B) the rate of growth of the uterus- to determine the rate of growth and development of the fetus, it is necessary in dynamics (skin 2 tyzh.) to control the height of the standing of the fundus of the uterus above the pubic articulation and near the abdomen. The increase in the height of the standing of the fundus of the uterus is 2 div and more against the norm chi in the daytime and the increase in the stretch of 2-3 tizhniv. with dynamic caution for the vaginal indication for fetal growth, which will require a further assessment. Іnuє unknown factors that make it easier to assess the growth of the fetus (damage to the method of vimiryuvannya, damage to fat metabolism in the mother, supra-world, or the number of amniotic rіdina is reduced, rich in vagity, the position of the fetus is incorrect). However, data on the height of the standing of the fundus of the uterus are left as a good clinical indicator of a normal, accelerated or reduced fetal growth.
D) farbuvannya amniotic rindine- under the hour of vagity, it can be detected by means of amnoscopy or amniocentesis, as well as during early rupture of the fetal membranes. Amnioskopiya - transcervical examination of the lower pole of the fruit michur. The presence of a house of meconium indicates a chronic hypoxia of the fetus, or a large number of gostra is short-lived, and due to the presence of new damage in post-acne sour, it can be born without asphyxia. The presence of a small house meconium in the amniotic cavity (yellow or greenish color) with prematurity is not an absolute sign of fetal hypoxia. If the meconium in the most abundant waters is found in the great number (dark green or black color), especially in the higher rhizomes (healthy gestosis, Rhesus-isoimmunization, chorioamniomitis, etc.), then it is considered as a threat to the fetus. Muddy farbuvannya navkoloplіdnih waters to tell about the postponement of vagіtnіst, Zhovte - about. GSHP or Rh insanity.
2. Biochemical - follow-up Hormonal activity of the fetoplacental system , How to lie in the physiological activity of the fetus and the significant world in the functional activity of the placenta.
A) the appointment of estriol in the blood and in the section- In non-vagic estriols, the main metabolite of the head estrogen is estradiol. Under the hour of vagity for the greater part of the destruction of estriol in the same placenta. Serednyodobova kіlkіst svidіlennogo іz sekeyu hormone to become 30-40 mg. Vision Mensch 12 mg per doba Indication of a decrease in the activity of the fetoplacental complex. Change in place of estriol Up to 5 mg per doba speak about the suffering of the fetus. Falling excretion of estriola Below 5mg per doba threaten the life of the fetus. So yak on the vene of the Esproil in organism of the mother, the nonsense of the factor (the mill of the pepper, the folding of the sbor of the Dobovo Sich, the Likarsky Rechovin, the Wide DIAPASE OF DOSLIIDZHENNE, then the ilon format, the ilmari, zbіgaєtsya with other clinical and biophysical indications. It is important to note that equal estriol can improve the fetal state in cases of vagity, aggravated by preeclampsia, hindered fetal growth, mother's gestational diabetes, so that fetal hypoxia is caused in the group of high risik women.
B) determination of placental lactogen (PL) in the blood– PL is synthesized by the placenta, and its concentration in the blood of the mother is changed in direct deposition in the form of a functional placenta. With a normal excess of vacancy, the magnitude of the sub-water ovary in the syrovattsi increases with the growth of the placenta. Due to the presence of a pathologically small placenta, the level of PL in maternal blood is low. The function of the sub-water organ may play a significant role in the evaluation of the fetus in women, in those with fibrosis and infarctions of small placenta, especially in case of aggravated vagity with gestosis, or due to the presence of intrauterine stuttering of fetal growth. With physiologically passing vagity in the water of the mother's blood in the mother's blood, gradually increase and become Vid 6 to 15 mcg/ml, decrease in PL in women after 30 tizh. vagity to equal Mensch 4 mcg/mlє threatening to the fetus. For a sprat of tizhnіv before the death of the fetus, the rіven of the underwater chovn falls sharply. With insufficient function of the placenta, a decrease in the level of PL in the blood is expected.
3. Biophysical- Most informative:
A) echography (ultrasound)- The most reliable and accurate method of antenatal diagnosis of the fetus. Allows you to conduct dynamic photometry, evaluate fetal and dycal fetal circulation, fetal cardiac activity, placental tissue and placental area, amniotic rіdinia, control fetal and uterine blood flow. b Іparієtalny rozmir fetal sister-in-law (BPR),The average diameter of the chest (DG) and the abdomen (DZ). Reliable sign of stuttering of the growth of the fetus - inconsistency on the 2nd day. and more BPR of the fetal head to the actual term of vaginess, and navitt disruption of mutual relations between the dimensions of the fetal head and the fetal sheath. A comprehensive ultrasound assessment of the rate of fetal growth allows for early diagnosis and an objective assessment of the fetal status. Great value may Vyvchennya of dyhal ruhіv fetus . For the analysis of the dyhal activity of the fetus, the following indicators are used: 1) the index of the dyhal rupture of the fetus (the number of hours of the dyhal rupture to the total period of the fetus); 2) the frequency of dychal ruptures of the fetus (number of dichal ruptures per quill); 3) average trivality of episodes of dyhal ruptures; 4) the average number of dyhal rukhivs per episode. Trivality dosledzhennya may become Not less than 30 min. For the presence of dyhalic ruptures of the fetus, the next day is repeated. Vidsutnіst dikhalnyhRuhіv protyazh 2-3 doslіdzhen roznіuєtsya like a bad prognostic sign. Signs of fetal suffering are changes in the nature of dihal activity as a sharp decrease in movement. With the manifestation of fetal hypoxia, the nature of fetal collapse changes. There are dychalnye ruhi in viglyadі haeka or urivuschastny dyhannya with trivial episodes of apnea.
B) indirect (from the cervical wall of the uterus) electrocardiography and phonography of the fetus — When analyzing the antenatal ECG, the heart rate, the nature of the rhythm, the magnitude, the shape and the trivality of the tunic complex are determined. With fetal hypoxia, damage to the conductivity of the heart, a change in the amplitude and an increase in the trivality of the heart tones, splitting of them are revealed. Blame noise, especially systolic, with chronic fetal hypoxia, to speak about a severe yoga camp. PCG is represented by oscillations that reflect I and II heart tones. Pathology of the umbilical cord is characterized by the appearance of a systole murmur on FCG and an uneven amplitude of heart tones.
C) cardiotography (CTG)- the most accessible, most accurate method of assessing the fetal growth during the remaining trimester of pregnancy . Cardiotocograph registers fetal heart rate, uterine contractions and fetal contractions at the same time. In this hour, it is essential to carry out screening control over the fetal state, both in outpatient minds and in hospitals. In risky groups for perinatal losses, screening control is carried out dynamically. Call the registration of the fetal heart rate to stop at 30 tyzh. viscosities on lines that collapse due to fastness of 10 to 30 mm/hv, draw length 30 hv, yak minimum.
To characterize the fetus for the help of KTG vikoristovuyutNext indicators: basal heart rate rate, basal rhythm variability, frequency and amplitude of oscillations, amplitude and frequency of accelerations and decelerations, fetal heart rate in fetal heart rate, fetal movements and functional tests.
Criteria Normal LTT:
■ Basal rhythm at the borders 120-160 bpm;
■ Amplitude of basal rhythm variability - 5-25 beats/min;
■ Deceleration during the day or sometimes sporadic, shallow and even short decelerations;
■ 2 accelerations and more are registered for 10 minutes of recording.
Irrespective of those that CTG is a sufficiently informative method that allows you to determine the size of the intrauterine fetus, the information content of the follow-up is significantly increasing, as the stench will increase Functional tests:
1) non-stress test for fetal reactivity- Recording of CTG is carried out with a pull of 20 minutes. During this hour, at least 2 accelerations were observed by 15 and more beats / hv with trivality 15 and more at a time from fetal failures, indicating a favorable (reactive) fetal state. At this hour, a lot of NTs are pinned already after 10 minutes, so that two accelerations are guarded. Even though 20 minutes of fetal rupture is not detected, it is necessary to stimulate fetal rupture by palpation of the uterus and continue an hour of guarding until 40 min. The appearance of the next fetal movement and the subsequent acceleration signifies reactivity to the test. Even if spontaneously, or after positive effusions in the fetal circulation, it does not appear, or there is no acceleration of heart rate in the fetal circulation, the test is considered non-reactive or reactive. Areactivity of the fetus, as a rule, is conditioned by yogo intrauterine suffering. It is recommended to carry out a non-stress test after the 30th term of pregnancy 1 time for 2-4 days
2) contractile stress test (oxytocinovium)- a single form of the fetoplacental system development in clinical practice is the contraction of the uterus. Normal health plaid shows uterine contractions without any difficulties, which should be observed during the day of periodic changes in heart rate. In case of hypoxia, it is often not possible to endure a lack of acidity, as it is possible to wait for the hour of the uterine contraction, which is necessary for the yogo heart activity. To overcome the contractile stress test, stimulate the contraction of the uterus with intravenous injections of oxytocin. . Attachments for CTG are placed on the hip wall and stretched for 15-20 minutes for the activity of the uterus and heart rate. In rich women, in some VIDs, they are associated with an unreactive non-stress test, during which period normal fetal disorders may appear and they do not need stimulation with oxytocin. In other women, spontaneous contractions of the uterus of sufficient frequency and valority are observed, which also does not require oxytocin infusion. In case of rich vaginal contractions of the uterus, you can call for the help of protective massage with a warm towel. The damage to the essence of the mechanical tearing of the nipples is the simplest form of the contractile stress test. Vaughn vdaєtsya zdebіshogo. Only in times of negative effect in the form of stimulation of the nipples, as the rest of the steps become stagnant in the form of tension. Sensitivity of myometrium to oxytocin difference and before the cob test is not shown. To this end, intravenous administration of oxytocin should be initiated from small doses - 0.05 OD (1 ml of synthetic oxytocin - 5 OD - in 100 ml of 5% glucose) or 0.01 OD. The speed of injection is at least 1 ml/min, the skin is treated for 5-10 mins until the appearance of three early uterus trivality 40-60 with a 10-minute period. As soon as the signs of deceleration are reached, the frequency of oxytocin administration is soon reached. The introduction of oxytocin is also pinned down, if the uterine contractions begin to be milked in parts (3 per 10 minutes), and the recording of the CHG is continued, the docking intervals between the rates will not become larger after 10 minutes. The test is considered negative for normal heart rate variability without deceleration. Sustained test is accompanied by an increase in the basal rhythm of more than 150 per 1 min, or a decrease in yoga below 110 per 1 min; change in variability to monotonous rhythm; due to deceleration in half of the fluctuations of the uterus. With a positive test, the skin contraction of the uterus is accompanied by the appearance of decelerations. When the activity of the uterus rises, beta-mimetics (alupent, partusisten) are administered intravenously as soon as possible for galvanization. Clinical zastosuvannya VІD obmezhene, shards of wine will require great hours and may cause low negligence.
D) ultrasound placentography- determine the degree of maturity of the placenta, the term of gestation and the days of pathological changes.
E) Doppler monitoring of blood flow in the mother-placenta-plaid system- For the skin judge, there are characteristic curves of the blood flow. Follow the blood flow in the uterine artery, umbilical artery, fetal aorta.
Biophysical profile of the fetus- include the results of a non-stress test performed during a cardiac monitor follow-up, and echoscopy indications that are indicated by ultrasound scanning in real time (fetal dyspnea, fetal dysmotility, fetal tone, fetal fluid volume, stage of placental maturity). Skin from the parameters is estimated as 0 to 2 points.
Invasive diagnostic methods become the fetus zastosovitsya only at the vapadka, as if the roughness in the face of otrimanoї іnformatsії outweighs the possibility of risky complications, caused by these methods:
BUT) Amtniocentesis-transabdominal, transvaginal, transcervical - with analysis of navcoloplidnyh waters.
B) cordocentesis- collection of blood from the umbilical cord by way of intrauterine puncture under ultrasound control,
AT) Fetoscopy- An uninterrupted examination of the fetus through a thin endoscope, introductions into the amniotic rіdina, with the use of blood sampling and epidermis for genetic follow-up in case of suspected congenital anomaly of the fetus,
G) Biopsy of chorion villi- transcervical or transabdominal parkan at line 8-12 tyzhniv. under ultrasound control - for fetal karyotyping and identification of chromosomal and genetic abnormalities.
