What does a Doppler ultrasound show? Doppler ultrasound during pregnancy: the essence and purpose of the method. Middle cerebral artery

During 9 months of gestation, a woman must undergo several routine ultrasound diagnostics. This is mandatory and safe procedure, with the help of which doctors find out how the pregnancy is progressing, what position the fetus is in and whether its development corresponds to the term. Ultrasound with Doppler (Dopplerography, Doppler ultrasound) is a safe and informative research method that evaluates the quality of blood flow in the “uterus-placenta-fetus” system.

What is Doppler in pregnant women and how is it done? What are the indications for Doppler sonography? What do Doppler ultrasound results show during pregnancy and how to interpret them?

What is Doppler ultrasound during pregnancy and why is it needed?

Dopplerography is one of the methods of prenatal research that works like a regular ultrasound machine. This diagnostic method allows you to identify disorders in the development of the fetus. After Doplerometry, the doctor will identify the cause of the failure, determine treatment tactics, or decide on early delivery. This important research helps preserve the health of the expectant mother and the life of the fetus.

During the procedure, the frequency of the sound is assessed, which changes when reflected from a moving object (bloodstream). As mentioned earlier, it is used to assess the state of blood flow in the “uterus-placenta-fetus” system.

Doppler ultrasound differs from conventional ultrasound in the following ways:

During pregnancy, Doppler reacts to the speed of blood movement in different vessels (umbilical cord vessels, fetal aorta, cerebral arteries, uterine vessels).

During the scan, the doctor observes the movement of red blood cells (red blood cells) on a screen in a two-dimensional image.

There are 2 types of Doppler: duplex and triplex. Duplex mode allows you to assess the patency of blood vessels and identify the causes of circulatory disorders. Triplex mode presents a color picture with the movement of red blood cells. Ultrasound specialists prefer triplex scanning, which shows the most accurate results.

Indications for Dopplerography

After confirmation of pregnancy, a woman must register with a gynecologist. The doctor will monitor the course of pregnancy and develop an action plan for each patient individually. This takes into account the condition of the pregnant woman, the development of the fetus, chronic diseases And bad habits mother.

During pregnancy, every woman must carry out other mandatory procedures. Dopplerography is an important study that is prescribed twice during the entire period if there are no additional indications.

As a rule, scanning is carried out during the following periods:

From 22 to 24 weeks;
From 30 to 34 weeks.

If during the next scheduled examination the doctor suspects various abnormalities, then an ultrasound with Doppler is prescribed several more times.

Dopplerometry is used in the presence of diseases in the expectant mother:

Arterial hypertension;
High degree of anemia (significant decrease in the number of red blood cells or hemoglobin in the bloodstream);
Large fibroids in the uterus;

Sexual infections;
Insufficiency of the respiratory organs (lack of complete gas exchange);
Functional failure of the heart.

In case of pathological development of pregnancy or abnormalities of the placenta, Doppler ultrasound is performed in the following cases:

Dopplerography is not contraindicated for expectant mothers.

How is Doppler ultrasound performed?

Dopplerometry does not require preparation from a pregnant woman. This procedure is almost no different from a regular ultrasound. The only difference from the standard ultrasound examination the fact that a woman has the opportunity to listen to the heartbeat of the unborn child and the sound of blood flowing through the vessels.

Interpretation of ultrasound results with Doppler during pregnancy

Using Doppler ultrasound, the doctor determines the condition of the fetus and the expectant mother.

To assess the movement of blood through the vessels, specially developed indices are used - the ratio of blood flow speed during contraction and relaxation of the heart muscles.

Using a graph, the specialist identifies the maximum blood velocity during systole(contraction of the heart), the final speed in diastole (relaxation of the heart muscles), as well as the average speed during systole and diastole. Then the device calculates one or more markers by which blood flow parameters are assessed: PI - pulsation index, IR - resistance index, SDO - systole-diastolic ratio.

After receiving the results, the doctor compares them with the norm and determines the condition of the unborn child. The norms for the results obtained during Doppler ultrasound during pregnancy for different indicators are presented in the tables below.

The norm of SDO and IR of the uterine arteries on different terms pregnancy is presented in the table:

Week of pregnancy	FROM TO	IR
12 — 13	2 – 3.5	0.52 – 0.7
14 — 16	1.9 – 2.5	0.48 – 0.68
17 — 19	1.7 – 2.5	0.44 – 0.62
20 — 24	1.6 – 2.5	0.4 – 0.6
25 — 31	1.7 – 2.4	0.4 – 0.58
32 — 37	1.6 – 2.3	0.35 – 0.58
38 — 40	1.4 – 2	0.32 – 0.55

Norm of SDO and IR of umbilical cord vessels:

Week of pregnancy	FROM TO	IR
14 — 15	5 – 8.4	0.8 – 0.88
16 — 17	4 – 6.8	0.74– 0.85
18 — 19	3 – 0.53	0.67 – 0.8
20 — 22	2.9 – 4.4	0.66 – 0.78
21 — 24	2.5 – 3.8	0.61 – 0.76
25 — 27	2.5 – 3.8	0.6 – 0.75
28 — 31	2.3 — 3	0.54 – 0.7
32 — 36	2 – 2.8	0.5 – 0.65
37 — 40	1.8 – 2.8	0.45 – 0.64

Normal indicators of SDO and IR of the middle cerebral artery:

Week of pregnancy	FROM TO	IR
20 — 25	4.3 – 6.8	0.77 – 0.85
26 — 27	4.2 – 7.8	0.76 – 0.87
28 — 29	4 – 8.7	0.75 – 0.88
30 — 33	3.7 – 8.6	0.74 – 0.88
34 — 37	3.3 – 7.9	0.69 – 0.87
38 — 40	2.8 – 7.5	0.64 – 0.86

Most often, disturbances in blood flow in the placenta occur as a result of late toxicosis or hypertension in the expectant mother.

Insufficiency of blood circulation in the uterus-placenta system can be identified using the following parameters:

A decrease in the rate of diastolic relaxation below normal;
Increased resistance index in the arteries of the uterus;
Early diastolic notch on the uterine artery blood velocity graph.

Impaired blood circulation in the placenta-fetus system can be judged by a decrease in velocity in the umbilical cord arteries and an increase in resistance indices for a certain period of pregnancy.

Classification that describes the degree of placental circulatory disorder:

IA Art. – pathological blood flow in the uterine arteries;
IB Art. – impaired circulation in the blood vessels of the umbilical cord, which does not reach critical numbers;
II Art. – pathological blood flow in the arteries of the uterus and umbilical cord, not reaching critical values;
III Art. – absence of blood flow or negative indicators at the moment of relaxation in the vessels of the umbilical cord.

Pathologies of blood flow in the middle cerebral artery of a child are identified by the following ultrasound signs:

Deviation from the norm IR and a high difference between systolic and diastolic pressure (below normal);
Absence or negative blood flow at the time of relaxation of the heart muscles;
Centralization of fetal circulation.

Signs of a disorder of intracardiac blood flow with functional heart failure in a child:

Reduced blood flow through all valves;
Tricuspid valve insufficiency;
Diastolic blood flow through the tricuspid valve is “adult-type” in the fetus.

Pathological pulsations and synchronous heart rhythm in mother and fetus indicate a violation of blood circulation in the venous vessel of the umbilical cord.

To identify the degree of blood flow disorder in a child, it is necessary to take into account the disturbance of blood flow in different vessels:

In addition, at 11–14 weeks of pregnancy, venous blood flow is disrupted due to hereditary diseases or congenital pathologies of the fetal heart, which increases the likelihood of an unfavorable pregnancy outcome.

If there are two or more fetuses, an ultrasound with Doppler is also prescribed. At the same time, the arteries of the umbilical cord and brain of both children are examined. This is necessary to prevent feto-fetal transfusion syndrome (a complication of multiple pregnancy, in which the blood flow of different fetuses differs).

If the indices in the arterial vessels of the umbilical cord in one fetus are greater than in the other, this indicates that the first child has a lack of blood.

Based on the above, ultrasound with Doppler is an absolutely safe diagnostic method for a pregnant woman and fetus from the 13th week. With the help of the study, the gynecologist monitors the course of pregnancy and quickly responds to any pathologies.

Ultrasound diagnostics occupies not the last place among diagnostic procedures accepted in obstetric and gynecological practice. Its use makes it possible to promptly identify and prevent the lion's share of pathological abnormalities in the condition of the mother and child in her womb.

Doppler ultrasound during pregnancy allows you to assess the quality of blood flow through the main arteries of the “uterus-placenta-fetus” system and timely diagnose existing disorders and failures.

Dopplerography during pregnancy as the main diagnostic procedure

The most complete and reliable information on a Dopplerogram can be obtained during the period from the 30th to the 34th week of pregnancy

Analysis of Doppler data

The Dopplerogram (blood flow graph) is deciphered by a qualified specialist who, highlighting certain areas, calculates relative indices showing vascular resistance and describing the nature of blood supply in the uteroplacental and placental-fetal vascular bed. It also compares the obtained data with the established norm.

The most comprehensive data are obtained from a cumulative study of all utero-fetal blood circulation: utero-placental blood flow, placental-fetal blood supply, blood movement through the main vessels of the fetal brain and the arteries of the uterus. Diagnostic criteria for circulatory disorders in the “uterus-placenta-fetus” system are:

slowing down blood flow in the uterine arteries during diastole;
slowing/cessation/reverse flow in the umbilical cord arteries during diastole.

In severe conditions, such changes are detected in the systolic period. The following relative indices are assessed: systolic-diastolic ratio (the ratio of blood flow rates during systole and diastole), resistance index (IR - vascular wall resistance), PI (pulsation index).

Decoding Dopplerographic indices, standards

As a result of the research, average standards for relative indices calculated based on blood flow velocity indicators were derived. They depend on the stage of pregnancy.

The standards for SDO are shown in the table:

The average IR of the aorta of a child in the womb is 0.75. For the middle cerebral artery from 22 weeks to delivery, the IR is 0.773.

Based on the above standards, decoding determines the degree of circulatory pathology in the “uterus-placenta-fetus” system. It is also established what type of blood flow (uteroplacental/MPC, placental-fetal/PPC) blood flow is disturbed. Three degrees of circulatory disturbance between the uterus and the child in its cavity have been established:

one of the types of blood flow of the MPC or ACC is disrupted while the other is preserved;
both types of blood flow are impaired, but disturbances in this moment not critical and require immediate intervention for correction;
Both types of blood flow (MPC or PPK) are impaired; the level of impairment is critical.

Based on the received transcript of the Dopplerogram, the obstetrician-gynecologist leading the pregnancy judges the degree of suffering of the child in the womb for a number of pathological processes: impending Rh conflict, the degree of vascular pathology of the mother and child in her womb as it progresses diabetes mellitus, hypertension or myocardial disease. The doctor also has the opportunity to assess the condition of the blood vessels of the fetuses during multiple pregnancies, and determine whether the development of one fetus is at the expense of the other.

H what is Doppler ultrasoundduring pregnancy?Doppler The fetus is one of the specific options for conducting ultrasound examination, the main principle of which is the use of the “Doppler effect”. Doppler testing is especially important for pregnant women.

It does not provide such a complete and detailed picture regarding the condition of the fetus, placenta and the mother’s body, which only increases the diagnostic value of Doppler ultrasound. It is for this reason that Doppler sonography is an integral part of prenatal diagnosis of pathology of the fetus and placenta, although not at all stages of pregnancy.

The essence of the above “Doppler effect” is that ultrasonic waves, reaching moving objects, are reflected from them and produce a highly informative picture on the screen of a special device. Blood has the fastest dynamic current in the human body.

On-screen 2D image carries information in the form of red corpuscles(i.e. red blood cells in reality), which indicates the presence of blood flow in this area of soft tissue.

What can you find out with Doppler ultrasound?

Using this diagnostic method, it is possible to assess the speed of blood flow through the maternal vessels, their diameter, and the pressure in their lumen. Doppler ultrasound allows you to identify and analyze the state of the baby’s cardiovascular system in the womb, the placenta, as well as the absence or presence of pathology of the umbilical cord vessels.

Particular importance is attached to the possibility of excluding the presence of intrauterine infection of the fetus and, in particular, due to the wrapping of the umbilical cord around the child’s neck. The cells of the body's nervous system are the first to respond to insufficient oxygen supply, therefore detection of hypoxia at its early stage very important in the practice of any diagnostician.

Ultrasound examination without the use of the “Doppler effect” provides visualization of soft tissues without dynamic assessment of blood movement through the vessels, i.e. absolutely static.

For diagnostic purposes, conventional ultrasound is sufficient, however, in cases where there is a need to determine blood flow, vessel diameter and blood pressure, Doppler ultrasound is much more effective. This efficiency is achieved, first of all, by the fact that Doppler examination evaluates the dynamic environment of the body.

Types of Doppler testing during pregnancy

Duplex. This type of Doppler ultrasound is based on a combination of conventional and spectral complementary modes. The image appears in black and white. The specialist has the opportunity to assess the anatomical features of the vessels being studied and the speed of blood flow in them. Thus, the patency of blood vessels is assessed.

Triplex. The operating principle of this type is still based on a combination of two modes, but a color mode is added to them. With this addition, vascular assessment has more accurate diagnostic results. Not only the anatomy of the vessel and its blood flow is assessed, but also the state of patency through a color image, which is more accurate and visual for the diagnostician.

How long does it take to do Doppler? Doppler examination is prescribed for pregnant women on later gestation(30-35 weeks of development), but it is also possible to prescribe it earlier (20-24 weeks).

Indications for Doppler ultrasound in early pregnancy there are, for example, suspicion of a delay in the intrauterine formation of the child’s systems and organs, phytoplacental insufficiency. Early dates in a Doppler study are unscheduled, therefore the risk of detecting certain types of pathological changes increases significantly.

TO additional indications Mandatory Doppler ultrasound for pregnant women includes:

kidney pathology;
carrying multiple pregnancies;
high or low water pregnancy;
presence of gestosis;
pathological pregnancies in life history;
bad habits of the expectant mother (smoking, alcoholism);
the expectant mother's tendency to increased level blood pressure;
genetically and hereditarily determined pathology (and other hereditary hormonal disorders);
deviations from the norm of the result.

In order to facilitate preparation for childbirth, a Doppler study is performed in the prenatal period along with a standard ultrasound. The procedure helps the doctor think through the entire birth order and assess the need for a cesarean section.

Doppler ultrasound differs little from the conventional ultrasound procedure. The manipulation is performed by a specialized device equipped with a sensor and a special program for processing the data received from each pregnant woman.

The information read by the sensor is processed and visualized on a special screen in duplex or triplex mode (depending on the type of device and the funding of the medical institution conducting Doppler ultrasound).

referral for research;
extracts from the previous ultrasound;
results of cardiotocoraphy;
ECG results;
personal documentation (passport, policy);
napkins (paper, wet) or towel;
diaper.

A pregnant woman is warned that her clothing during the Doppler ultrasound procedure should not be difficult to remove. A woman should freely expose the abdominal area and, if necessary, the perineum. The patient is placed on the couch face up, then with a special transparent gel draw a line on the area under study and, applying the device to the site, begin diagnostic manipulations. Gel serves an excellent remedy to ensure continuous contact of the device with the skin of the pregnant woman.

The duration of Doppler ultrasound is variable. In some cases, a diagnostician will only need a few minutes, while in others, the study can take up to half an hour. In particularly difficult cases, the diagnostic procedure may last even longer, due to the difficulty of identifying pathological changes.

At the end of the study, the gel is removed with previously prepared napkins or a towel. The ultrasound procedure ends, and now all that remains is to wait for the results.

Normal indicators and interpretation of Dopplerometry for pregnant women

Only good specialist can give high-quality transcript seen results of Doppler ultrasound during pregnancy.

Produced assessment of a number of vascular formations th, which includes:

uterine arteries;
arterial and venous vessels of the umbilical cord;
middle artery of the child's brain;
child's aorta;
fetal heartbeat.

Each vessel receives assessment based on three main parameters: systolic-diastolic ratio, pulsation index, resistance index.

The diagnostician must additionally evaluate the condition of the vascular wall, the filling of the vessels, the speed and activity of blood flow in them, and the state of oxygen saturation of the soft tissues.

There are many meanings of the norm the three main Doppler parameters listed above, depending on the week and month of pregnancy, which are listed in specialized tables.

In general, starting from gestation, systolic-diastolic ratio should not exceed 2.4.

Resistance index normally should be: for the uterine artery - less than 0.58, for the umbilical artery - less than 0.62, for the middle cerebral artery - less than 0.77.

What pathology can be detected with Doppler ultrasound: insufficient functioning of the placenta, fetal hypoxia, decreased blood flow speed, decreased blood pressure in the vessels.

Is Doppler testing harmful?

The important fact is that Doppler ultrasound completely safe for health future child. The safety of ultrasound is evidenced by its low heating capacity and strict adherence to its dosage at each diagnostic session.

In addition, ultrasound is not dangerous to the health of the expectant mother. On the contrary, Doppler ultrasound is necessary procedure, which is not only painless, but also does not require the woman to worry before undergoing it. Doppler will only help in diagnosis possible pathologies absolutely harmless to health.

Video Doppler ultrasound

For a better understanding of what visualization of fetal blood flow looks like using Doppler ultrasound, we suggest watching this video.

Even more detailed information can be obtained through an active discussion on the issue of Doppler in pregnancy. Therefore, do not hesitate to ask each other questions that interest you and give equally complete and useful answers. Share your own experiences, if you have already undergone a Doppler ultrasound procedure. Remember that the discussion helps not only you, but also those women who are just planning their first pregnancy.

Throughout pregnancy, a woman must undergo a number of studies, including ultrasound. Using ultrasound, you can determine the condition of the fetus, the fullness of its development and, if necessary, prescribe treatment in a timely manner or make a fundamental decision regarding further pregnancy.

What is Dopplerography?

Many women who are bearing a child for the first time are interested in the question: “Doppler ultrasound during pregnancy - what is it?” At its core, Dopplerography is a type of ultrasound. The main purpose of the study is to assess the state of blood circulation in the arteries of the uterus, placenta and umbilical cord and determine the functionality of the fetal place. Doppler measurements make it possible to detect circulatory disorders, which has a very high prognostic value. This type of research allows us to determine the presence placental insufficiency or identify delays in fetal development.

Diagnosis is carried out in the “mother-placenta-baby” format. This type examinations are mandatory for every pregnant woman.

Distinctive features

Types of research

The examination can be carried out in two modes:

duplex;
triplex.

Duplex mode - what is it? Doppler ultrasound during pregnancy in this mode allows you to obtain almost complete information about the vessel, assess its patency and, if there are any violations, identify them in a timely manner.

Triplex mode is just a color image that gives a complete picture of what is happening in the vessel under study. The results obtained in this mode are considered more reliable.

Normal indicators for diagnosis

For most women, there is little knowledge about what it is - Doppler ultrasound during pregnancy. They want to know what indicators are normal, and in what cases deviations may indicate problems with the fetus.

When diagnosing, three main indicators are taken into account:

SDO or S/D, that is, the systole-diastolic ratio. The indicator is calculated by dividing the maximum blood speed in systole (that is, recorded at the time of contraction of the heart muscle) by the speed that is recorded at the time of relaxation of the heart (that is, the diastolic indicator). For each vessel, the indicators are completely different.
Resistance index (RI). Determined by dividing the difference between the maximum and minimum blood flow velocity.
The pulsatility index (PI) is also determined by division, but the difference between the maximum and minimum speed is divided by the average blood flow for the entire cardiac cycle.

All these indicators are combined into one group - ISS, that is, vascular resistance indices.

Normal indicators for Doppler ultrasound during pregnancy

Uterine arteries:

Gestation period, weeks

Spiral arteries:

Gestation period, weeks

Umbilical cord arteries:

Gestation period, weeks

The tables indicate limit values, that is, a parameter that does not exceed that given in the table is considered normal.

If you find deviations from the norm, then you should not immediately panic. On the contrary, the doctor has the opportunity to start therapy as quickly as possible and prevent an unfavorable pregnancy outcome.

If abnormalities in the blood flow are detected

Detected deviations in Doppler ultrasound interpretation during pregnancy can confirm the presence and degree of disorders in the uteroplacental and fetoplacental system.

If the first degree of blood flow disturbance is confirmed, there is a high chance that the pregnancy will still be full-term and the birth will take place naturally. But this is possible if complications and deterioration of blood flow do not arise before birth.

In principle, the first degree of deviation from the norm does not lead to fetal death. Typically, examinations are carried out every 2 weeks and CTG monitoring is done. Blood pressure of the expectant mother is subject to mandatory monitoring.

At the second stage of blood flow disturbances, problems are observed in the vessels of the uterus and umbilical cord. In such a situation, the woman and child require constant monitoring in a medical facility. It is possible to carry out therapeutic measures that will eliminate oxygen starvation fetus

The third stage of blood flow disturbance is characterized by the fact that speed quantitative indicators tend to zero. Reverse blood flow may occur when the heart muscle is relaxed. In such a situation, the following measures can be taken:

Examination at home

Medicine and technology do not stand still. Today, even a device has been developed that allows you to monitor the development of the fetus at home. In this case, the question will not arise at what stage of pregnancy Doppler ultrasound is performed. Although you should not skip routine diagnostics, especially if you have a history of factors predisposing to worsening blood flow or chronic diseases.

A portable Doppler allows you to clearly hear the baby's heartbeat, and this means peace of mind for the mother. If you have any suspicions about the health of the fetus, you can immediately consult a doctor.

What do pregnant women say?

Today, there is only a small percentage of women who avoid examinations in every possible way after conceiving a child, including ultrasound. In most cases, the expectant mother is ready to take care of the health of her baby. However, the reality is that even a blood test cannot be done for free.

The average price of Doppler ultrasound during pregnancy is 1.5-2 thousand rubles. If we talk about a full screening and extensive study, which can be supplemented by video recording, then such a “pleasure” will cost 4-5 thousand rubles. As a rule, the price fluctuates depending on the status of the clinic and location.

At the same time, the state clinic where the expectant mother is served must have an ultrasound machine with Doppler function. If a doctor sends a woman for examination based on a referral, it should be carried out free of charge.

Finally

When a child is desired and a woman is worried about his health, the question of how much a Doppler ultrasound during pregnancy costs does not arise. There will always be money to prevent possible disastrous consequences. Future mom should not neglect the doctor’s recommendations in order to carry the pregnancy to term and give birth to the baby on time.

Pregnancy is a wonderful time. But all nine months of waiting for a baby are accompanied by mixed feelings: sometimes joyful, sometimes anxious. Many expectant mothers, having heard enough stories about allegedly harmful effects as a result of ultrasound, they are terrified of such examinations. Others, on the contrary, cannot wait to go through to see their baby and make sure that he is healthy.

A routine ultrasound is performed to assess the baby's intrauterine development, as well as its position. But, besides this, at certain times they do Doppler ultrasound - one of the types of ultrasound.

What can you find out using Doppler?

Doppler ultrasound is one of the methods for studying blood flow in the vessels of the expectant mother’s body. Thanks to this study, it is possible to determine the direction and speed of blood flow in the arteries and veins, determine the width of the lumen of the vessels and, in addition, calculate the pressure inside the vessel. In addition, this method helps to determine the health of the baby’s heart, listen to his heartbeat, determine the degree of patency and lumen of the fetal umbilical cord vessels, as well as how well his organs are supplied with blood. It is thanks to Doppler that it is possible to diagnose insufficient functioning of the placenta or. And sometimes only a Doppler is able to show and clearly indicate what it is: one, two or three times.

What types of Doppler testing are there?

Doppler testing during pregnancy can be performed in two modes. These are duplex and triplex scanning. With duplex scanning, the vessel is visible, and its patency can be assessed, and if it is broken, then the reasons.

With duplex scanning, the anatomy of blood vessels is examined and the speed of blood flow is assessed. Triplex differs from the previous one in that a color image is added to it. This type of research is more accurate.

Doppler ultrasound does not require special preparation.

Is this study safe for a baby?

Doppler ultrasound during pregnancy is an absolutely harmless and painless procedure. On the contrary, it is necessary, since obstetric practice proves: there are numerous cases where, thanks to Doppler, it was possible to identify problems in time and prevent an accident, since doctors were able to select the appropriate treatment for the pregnant woman and determine the appropriate tactics for childbirth.

Who is prescribed Doppler during pregnancy?

As a rule, Doppler testing is prescribed to all expectant mothers in the third trimester. In most consultations, the examination is scheduled for 23-24 weeks of pregnancy, and then at 30-34 weeks. However, if necessary, Doppler ultrasound can be prescribed at any time, regardless of the period. This is often true for preeclampsia, high blood pressure, diabetes, kidney problems, and poor heredity. In addition, a Doppler may be necessary if the woman carrying the baby smokes and cannot give up this addiction.

Especially for- Olga Pavlova