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During pregnancy, there are certain deadlines for performing tests – both laboratory and imaging – including ultrasound. Therefore, it does not make sense to perform the latter test during monthly follow-up visits to the doctor – unless the pregnancy is complicated (e.g. with a semi-prominent placenta).
The first ultrasound examination is performed as standard between 11 and 13 weeks of pregnancy. They are referred to as prenatal testing because it assesses the parameters that may indicate the presence of genetic syndromes in the fetus. Second ultrasound is moving between 18 and 22 weeks of pregnancy – then a detailed assessment of the anatomy of the fetus is made. Third ultrasound takes place around 32 weeks of pregnancy. Its purpose is to assess the pace and regularity of fetal development. It is important for choosing the place of delivery in the event of significant deviations from the norm.
Ultrasound examination performed between the 18th and 22nd week of pregnancy makes it possible to identify the presence of congenital abnormalities in the fetus (up to 90% of cases), to identify high-risk pregnancies (up to 90% of cases) and to assess the condition of the fetus. It is worth remembering that in accordance with the law in force in Poland, the diagnosis of severe malformations in the fetus before the 22nd week of pregnancy allows for premature termination.
The study begins with evaluation of the skull. Its bipolar dimension and circumference are measured, and the correctness of the structure of the brain is assessed. Then the facial skeleton and the fetal profile, eye sockets, nose, jaw, mandible and palate are visible. The so-called neck fold (not to be confused with the nuchal translucency – assessed between the 11th and 13th week of pregnancy). Then he evaluates himself spineand especially its continuity. It continues to investigate heart – its location, size, presence of cavities (there should be four of them), routes of blood outflow, action. Assesses itself chest: its shape, the presence of the lungs and the diaphragm. When assessing the abdominal cavity, the presence of the stomach, liver and kidneys as well as the continuity of the walls are taken into account; abdominal circumference is also measured. Finally, it evaluates itself upper and lower limbs: the presence of all bones is checked, the length of the femur is measured. The final stage of the study is placenta evaluation – its location, thickness and structure, and an estimate of the amount of amniotic fluid.
In physiological pregnancy, all the above-mentioned structures of the fetus will be normal, and the amount of amniotic fluid will be normal. The location of the placenta will not raise any objections as well, and its structure will correspond to the age of pregnancy. The umbilical cord, the number of vessels running in it and the blood flow in the umbilical artery will also be correctly assessed.
However, during the second ultrasound examination, various types can also be found fetal pathologies: from spinal and / or cerebral hernias, hydrocephalus, glandular cystic lung degeneration, diaphragmatic or umbilical hernia, gastroschisis, duodenal atresia to changes in the position of the placenta – centrally or partially prominent placenta, or abnormal amount of amniotic fluid – oligohydramnios or polyhydramnios. In addition, there is a whole range of possible heart defects, in case of suspicion of which an in-depth diagnosis is necessary.
It is impossible to discuss here all the possible disorders that can be detected by ultrasound. Either way, if any fetal abnormality is suspected, further extended diagnosis is required in centers specializing in fetal medicine. After the diagnosis is made, it is often possible to start treatment intrauterine, and certainly – right after the birth of the newborn. It is important to know early on with what defect the baby will be born with and what care it will require right after birth. Having this information sometimes determines the choice of the route of delivery. For example, a child with a large spinal hernia will not be able to be born through nature. This may result in significant complications – both during childbirth and in the course of further development. The solution of choice is then a caesarean section.
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