It is impossible to imagine a field of medicine where additional examination methods would not be used. Due to its safety and information content, ultrasound is used especially actively for many diseases. Doppler is an opportunity not only to assess the size and structure of organs, but also to record the features of moving objects, in particular, blood flow.

Ultrasound examination in obstetrics provides a huge amount of information regarding the development of the fetus, with its help it became possible to determine not only the number of embryos, their sex and structural features, but also observe the nature of blood circulation in the placenta, fetal vessels and heart.

There is an opinion that the examination of expectant mothers using the ultrasound method can harm the unborn baby, and with Doppler imaging, the radiation intensity is even higher, so some pregnant women are afraid and even refuse the procedure. but many years of experience in the use of ultrasound allows us to reliably judge that it is absolutely safe, and so much information about the condition of the fetus cannot be obtained in any other non-invasive way.

Doppler ultrasound should be performed by all pregnant women in the third trimester, according to indications it can be prescribed earlier. Based on this study, the doctor excludes or confirms the pathology, the early diagnosis of which makes it possible to start treatment in a timely manner and prevent many dangerous complications for the growing fetus and mom.

Features of the method

Doppler is one of the ultrasound methods, therefore it is carried out using a conventional apparatus, but equipped with special software. It is based on the ability of an ultrasound wave to reflect from moving objects, while changing its physical parameters. The reflected ultrasound data is presented in the form of curves that characterize the speed of blood movement through the vessels and chambers of the heart.

The active use of dopplerometry has become a real breakthrough in the diagnosis of almost all types of obstetric pathology, which is usually associated with. Through clinical observations, the indicators of the norm and deviations for various vessels were determined, by which one or another pathology is judged.

Doppler measurement during pregnancy makes it possible to establish the size and location of blood vessels, the speed and characteristics of blood flow through them at the time of heart contraction and relaxation. The doctor can not only objectively judge the pathology, but also indicate the exact place of its occurrence, which is very important when choosing treatment methods, since hypoxia can be caused by pathology of both uterine arteries and umbilical cord vessels, and impaired development of fetal blood flow.

Doppler ultrasound is duplex and triplex... The latter option is very convenient in that not only the blood flow velocity is visible, but also its direction. With duplex dopplerometry, the doctor receives a black and white two-dimensional image, from which the machine can calculate the speed of blood movement.

an example of a frame of a triplex Doppler examination

Triplex study is more modern and provides more information about blood flow. The resulting color image shows the blood flow and its direction. The doctor sees red and blue streams on the monitor, and it may seem to the layman that it is arterial and venous blood moving. In fact, the color in this case does not indicate the composition of the blood, but about its direction - towards or away from the sensor.

No special training is required before Doppler sonography, but a woman may be advised not to eat or drink for a couple of hours before the procedure. The study does not cause pain or discomfort, the patient lies on her back, and the abdominal skin is treated with a special gel that improves the conduct of ultrasound.

Indications for dopplerometry

Doppler ultrasound as a screening is indicated for all pregnant women in the third trimester. It means that even in the absence of pathology, it should be carried out in a planned manner, and the obstetrician-gynecologist will definitely send the expectant mother for examination.

The optimal interval is between 30 and 34 weeks of pregnancy. During this period, the placenta is already well developed, and the fetus is formed and is gradually gaining mass, preparing for the upcoming birth. Any deviation from the norm in this period is clearly noticeable, and at the same time, doctors will still have time to correct the violations.

Unfortunately, not every pregnancy goes so well that the expectant mother undergoes an ultrasound scan with Doppler measurements on time and, rather, for prevention. There is a whole list of indications for which the study is carried out outside the established framework for screening and even repeatedly.

If there is reason to assume a delay in its development, which is noticeable with a conventional ultrasound scan, then the Doppler study will be recommended as early as 20-24 weeks. Before this period, it is inappropriate to carry out the procedure due to insufficient development of the placenta and fetal vessels, which can cause erroneous conclusions.

Indications for unscheduled Doppler measurements are:

  • Diseases of the mother and pathology of pregnancy - kidney disease, high blood pressure, vasculitis;
  • Fetal disorders - developmental delay, lack of water, congenital malformations of organs, asynchronous development of fetuses in multiple pregnancies, when one of them lags significantly behind the others, aging of the placenta.

Additional dopplerometry of the fetus can be shown if its size does not correspond to the proper one for a given period of pregnancy, because growth retardation is a sign of possible hypoxia or defects.

Among other reasons for an ultrasound scan with Doppler ultrasound, there may be an unfavorable obstetric history (miscarriages, stillbirths), the age of the expectant mother over 35 years old or under 20, post-term pregnancy, an umbilical cord entanglement around the fetal neck with the risk of hypoxia, changes in, damage or injury to the abdomen.

Doppler parameters

When conducting an ultrasound scan with Doppler, the doctor assesses the condition of the uterine arteries and. They are the most accessible to the apparatus and characterize well the state of blood circulation. If indicated, it is possible to assess the blood flow in the baby's vessels - the aorta, middle cerebral artery, kidney vessels, heart chambers. Usually, such a need arises when certain defects are suspected, with intrauterine hydrocephalus, developmental delay.

The most important organ that unites the body of the mother and the unborn baby is the placenta. It brings nutrients and oxygen, while simultaneously removing unnecessary metabolic products, realizing its protective function. In addition, the placenta secretes hormones, without which the correct development of pregnancy does not occur, therefore, without this organ, the maturation and birth of a baby is impossible.

The formation of the placenta begins actually from the moment of implantation. Already at this moment, active changes in the vessels take place, aimed at providing sufficient supply of the contents of the uterus with blood.

The main vessels supplying blood to the growing fetus and the enlarging uterus are the uterine and ovarian arteries located in the pelvic cavity and in contact with each other in the thickness of the myometrium. Branching into smaller vessels in the direction of the inner layer of the uterus, they turn into spiral arteries that carry blood to the intervillous space - the place where the blood exchange between mother and baby takes place.

The blood enters the fetus through the vessels of the umbilical cord, the diameter, direction and speed of blood flow in which is also very important, primarily for a growing organism. Possible slowing of blood flow, reverse flow, abnormalities in the number of vessels.

Video: Fetal Circulation Lecture Series

As the gestation period increases, the spiral vessels gradually expand, specific changes occur in their walls, allowing a large volume of blood to be delivered to the constantly growing uterus and baby. Loss of muscle fibers leads to the transformation of arteries into large vascular cavities with low wall resistance, thereby facilitating blood exchange. When the placenta is fully formed, the uteroplacental circulation increases by about 10 times.

With pathology, the correct transformation of the vessels does not occur, the introduction of trophoblast elements into the wall of the uterus is disrupted, which certainly entails the pathology of the development of the placenta. In such cases, there is a high risk of hypoxia due to lack of blood flow.

Hypoxia is one of the most powerful pathogenic conditions in which both growth and differentiation of cells are disturbed, therefore, during hypoxia, certain violations of the fetus are always detected. To exclude or confirm the fact of a lack of oxygen, dopplerometry is shown, which evaluates blood flow in the uterine, umbilical vessels, and intervillous space.

example of hypoxia due to impaired placental blood flow

The ultrasound machine records the so-called blood flow velocity curves. For each vessel, they have their own limits and normal values. Assessment of blood circulation occurs throughout the entire cardiac cycle, that is, the rate of movement of blood in systole (heart contraction) and diastole (relaxation). For the interpretation of the data, it is not the absolute indicators of blood flow that are important, but their ratio in different phases of the heart.

At the moment of contraction of the heart muscle, the blood flow rate will be highest - maximum systolic velocity (Mcc)... When the myocardium relaxes, the movement of blood slows down - the ultimate diastolic velocity (KDS)... These values ​​are displayed as curves.

When decoding Doppler data, several indices are taken into account:

  1. Systolic-diastolic ratio (SDR) - the ratio between the end-diastolic and maximum blood flow at the time of systole, calculated by dividing the MSS indicator by the CDP;
  2. Pulsation index (PI) - we subtract the value of CDP from the MSS indicator, and divide the result by the figure of the average speed (CC) of blood movement in this vessel ((MSS-KDS) / SS);
  3. Resistance index (IR) - the difference between systolic and diastolic blood flow is divided by the MSS indicator ((MSS-KDS) / MSS).

The results obtained can either exceed the average normal values, which indicates a high peripheral resistance on the part of the vascular walls, or decrease. In both cases, we will be talking about pathology, because both narrowed vessels and dilated, but with low pressure, equally poorly cope with the task of delivering the required volume of blood to the uterus, placenta and fetal tissues.

In accordance with the obtained indices, three degrees of disorders of the uteroplacental circulation are distinguished:

  • When 1A degree an increase in IR is detected in the arteries of the uterus, while the blood flow in the placental-fetal part is maintained at a normal level;
  • the opposite situation, when blood circulation in the vessels of the umbilical cord and placenta is impaired, but preserved in the uterine arteries characterizes 1B power(IR is increased in the umbilical vessels and normal in the uterine vessels);
  • When 2 degrees there is a disturbance of blood flow both from the uterine arteries and placenta, and in the vessels of the umbilical cord, while the values ​​have not yet reached critical figures, the CDS is within normal limits;
  • Grade 3 accompanied by severe, sometimes critical, values ​​of blood flow in the placental-fetal system, and blood flow in the uterine arteries can be both altered and normal.

If the dopplerometry is installed the initial degree of circulatory disorders in the mother-placenta-fetus system, then treatment is prescribed on an outpatient basis, and after 1-2 weeks the pregnant woman needs a repeated ultrasound scan with a Doppler to monitor the effectiveness of therapy. After 32 weeks of gestation, multiple CTGs are shown to exclude fetal hypoxia.

Violation of blood flow of 2-3 degrees requires treatment in a hospital with constant monitoring of the condition of both the woman and the fetus. With critical values ​​of Doppler measurements, the risk of placental abruption, intrauterine fetal death, and premature birth is significantly increased. Once every 3-4 days, such patients undergo dopplerometry, and cardiotocography - daily.

Severe disturbance of blood flow, corresponding to grade 3, threatens the life of the fetus, therefore, in the absence of the possibility of its normalization, the question of the need for delivery is raised, even if it has to be done ahead of time.

Premature artificial childbirth in some cases of pathologically proceeding pregnancy aims to save the life of the mother, because intrauterine fetal death due to inadequate blood flow can cause a fatal one. Of course, such serious issues are not solved alone by the attending physician. To determine the tactics, a consultation of specialists is created, taking into account all possible risks and possible complications.

Norm and pathology

Since the state of the vessels of both the uterus, and the placenta, and the fetus is constantly changing throughout pregnancy, it is important to assess blood circulation precisely by correlating it with a specific gestational age. For this, the average norms for weeks have been established, the compliance with which means the norm, and the deviation means pathology.

Sometimes, with a satisfactory condition of the mother and the fetus, some deviations are found in the Doppler process. You should not panic at the same time, because timely diagnosis will allow you to correct the blood flow at the stage when its changes have not yet caused irreversible consequences.

The norms for weeks imply the determination of the diameter of the uterine, spiral arteries, and the fetal middle cerebral artery. Indicators are calculated from 20 weeks to 41. For the uterine artery IR in the period of 20-23 weeks is normally no more than 0.53. gradually decreasing by the end of gestation, at 36-41 weeks it is no more than 0.51. In the spiral arteries, this indicator, on the contrary, increases: at 20-23 weeks it is no more than 0.39, by 36 weeks and before delivery - up to 0.40.

Fetal blood flow is characterized by the arteries of the umbilical cord, the IR for which does not exceed 0.79 up to 23 weeks, and by 36 weeks it decreases to a maximum value of 0.62. The middle cerebral artery of the baby has similar normal resistance index values.

FROM TO during pregnancy, it gradually decreases for all vessels. In the uterine artery, the indicator at 20-23 weeks can reach 2.2 (this is the maximum normal value), by 36 weeks and until the end of pregnancy it is no more than 2.06. In the spiral arteries of the LMS at 20-23 weeks no more than 1.73, by 36 - 1.67 and below. The vessels of the umbilical cord have a LMS of up to 3.9 by 23 weeks of gestation and no more than 2.55 at 36-41 weeks. In the middle cerebral artery of the baby, the numbers are the same as in the arteries of the umbilical cord.

Table: SDO norms for dopplerometry by week of pregnancy

Table: summary values ​​of the norms of planned Doppler

We have given only some normal values ​​for individual arteries, and the doctor during the examination assesses the entire complex of vessels, correlating the indicators with the condition of the mother and fetus, CTG data and other examination methods.

Every expectant mother should know that an ultrasound scan with Doppler is an integral part of the entire pregnancy observation period, because not only development and health, but also the life of a growing organism depends on the state of the vessels. Careful control of blood flow is the task of a specialist, therefore it is better to entrust the interpretation of the results and their interpretation in each specific case to a professional.

Doppler analysis allows not only to timely diagnose severe hypoxia, gestosis of the second half of pregnancy, fetal growth retardation, but also largely helps to prevent their appearance and progression. Thanks to this method, the percentage of intrauterine deaths and the frequency of severe complications in childbirth in the form of asphyxia and distress syndrome of newborns have decreased. The result of timely diagnosis is adequate therapy for pathology and the birth of a healthy baby.

Disorders of blood flow can occur in the human body, which can lead to serious diseases. Difficulties and difficult situations often arise during. It is important to constantly monitor the development and condition of the child and mother.

For these purposes, special research and monitoring methods are used with the help of modern equipment. Doppler is a study that makes it possible to find out that the blood supply in human vessels is abnormal.

Doppler is a type of ultrasound examination

How the blood vessels of a person work depends on how efficiently they transfer blood to all organs. Throughout the entire period of pregnancy, a woman is prescribed an ultrasound scan several times.

With its help, the development of the internal organs of the fetus, the increase in the size of the child is assessed and various pathologies are identified. For additional research of the fetus, dopplerometry is used.

Doppler is a type of study. It is performed on a standard ultrasound machine, but with a special sensor. This sensor sends out ultrasonic waves, which have the ability to be displayed from objects in motion and change their data about physical values.

The screen displays information in the form of a graph characterizing the speed at which blood moves through the heart chambers and arteries.

Using this method, the nature of blood circulation in the vessels that provide nutrition to the human body, as well as the placenta, uterus and child is assessed. During the Doppler study, the size and location of the vessels is established, with what speed the blood moves through them during the complete cardiac cycle.

Based on its results, the doctor identifies possible pathologies in the human blood supply system, as well as between the mother and the child. It also determines where the pathology develops and prescribes the correct treatment.

There are two types of Doppler measurements:

  1. Duplex - in this case, the device displays a black and white image with a two-dimensional picture and calculates the speed at which blood is moving.
  2. Triplex is a modern and informative research option. The device displays a color picture with blood flow on the screen. The two colors on the screen show in which direction the blood is moving.

Doppler analysis is based on the study of the movement of blood in the blood vessels of a person. Modern equipment makes it possible to identify violations in this process.

Indications for dopplerometry

The indication for a Doppler study is the different development of the fetus in multiple pregnancies.

Typically, Doppler is done at the start of the third trimester of pregnancy for all women. That is, the doctor sends the expectant mother for research on a mandatory basis, even without special suspicions of the threat of pregnancy.

A suitable period is between 30 and 34 weeks. At this time, the development of the placenta is completed, the child is formed, preparing for birth, and all changes in the indicators will be clearly noticeable. And the doctor will have time for treatment in case of pathology.

But very often pregnancy proceeds with complications. There are cases when pathology is detected on a conventional ultrasound and Doppler is required at an earlier date. Doppler studies can be performed from 20-24 weeks. Shorter procedures give erroneous results.

Additional dopplerometry is prescribed in the following cases:

  • the presence of maternal diseases (, kidney disease, diabetes mellitus, etc.)
  • delayed child development
  • lack of water or polyhydramnios
  • disorders in the development of children's organs
  • differences in fetal development in multiple pregnancies
  • aging placenta
  • Rh-conflict between mother and child

This study can also be prescribed in the case of a post-term pregnancy, cord entanglement, abdominal trauma, poor fetal CTG readings, when the mother is younger than 20 and older than 35 years. For the above cases, one of the causes of pregnancy complications is a lack of oxygen to the baby. This is what is revealed in the first place by this study.

Also, Doppler ultrasonography is prescribed for people with problems in the circulatory system. The scope of its application is quite wide. It is often used to study the brain. It allows you to find out where the vessel is clogged, why it happened or prevent these consequences of a violation of the movement of blood.

When examining the vessels of the extremities, dopplerometry is also used. During its course, problems with veins and arteries are identified, the likelihood of blood clots.

Doppler is a very important study. This procedure is done to check for circulatory problems in the brain or limbs. It is a must for all pregnant women. In cases of complications of pregnancy, this procedure is prescribed for re-examination.

In the next video, see when Doppler is still used in addition to pregnancy:

Preparation for research

Doppler examination procedure does not require special training

Many people worry about Doppler. Those who are heading to this procedure for the first time often ask questions about how to prepare for it.

There is no need to make any preparatory steps before the Doppler study. There is no need for a full bladder or a specific diet the day before.

How dopplerometry is performed

In primiparous women, questions often arise about how the Doppler procedure itself is performed. Doppler examination is no different from conventional ultrasound. It is absolutely painless and does not give any unpleasant sensations. The duration of the procedure is slightly longer than a standard ultrasound and lasts about 30 minutes.

The patient is placed on a special couch, maximally exposing the place where the vessels will be examined. The ultrasound specialist lubricates the area with a gel that makes it easier to slide the transducer and conducts ultrasound waves.

The doctor guides the sensor and records the indicators of blood flow in the main vessels. A color picture appears on the computer screen depicting the direction and speed of blood flow in the vessel at which the sensor is aimed. All indicators are recorded on the card and given to the doctor for verification.

Doppler parameters

If necessary, with dopplerometry, you can check the state of the child's blood vessels, chambers of his heart, kidney

In the process of dopplerometry, mainly the arteries of the uterus and umbilical cord vessels are studied. Through them, food flows from the mother to the fetus. Moreover, they are more accessible for the apparatus and perfectly represent the parameters of blood circulation.

But in special cases, it is possible to check the main vessels of the child, him, the chambers of the heart, kidneys. This is required in case of suspicion of abnormal development of internal organs or developmental problems.

The most important organ connecting a pregnant woman and her fetus is the placenta. It is formed from the very beginning of pregnancy and performs the following functions:

  • transfer of nutrients from mom to baby
  • oxygen supply to the fetus
  • removal of decay products
  • release of the necessary hormones for the course of pregnancy
  • protection of the fetus from external influences

Without the placenta, pregnancy itself and the birth of a child are impossible.

The second most important vessels are the arteries of the uterus and ovaries. Through them, blood flows to the developing body of the child and to the uterus, which increases in size during pregnancy. These arteries branch out into small vessels leading to the cavity of the uterus, and grow into spiral arteries that provide blood circulation in the mother-baby system.

The umbilical cord vessels provide the baby with blood. Its size is very important for the normal course of pregnancy. The nutrition of the fetus depends on the size of the umbilical cord, in which direction and at what speed the blood moves along it.

With an increase in the duration of pregnancy, the vessels increase in size. This is because the growing body and the enlarging uterus require more and more blood and oxygen to develop. At the end of pregnancy, blood flow between mom and baby increases by almost 10 times.

When a pathology occurs, the vessels are not able to expand enough and provide the required amount of blood. There is a pathology in the development of the placenta, and fetal hypoxia occurs.

Hypoxia is a child's condition resulting from a lack of oxygen, which leads to serious disturbances in the child's mental and physical development. It is for the detection of hypoxia that the Doppler study is intended.

In the Doppler process, the machine notes the speed at which the blood flow is moving in each important vessel. All vessels have their own values ​​in certain ranges. The blood flow rate is assessed during the entire cycle of the heart, from contraction to relaxation.

The ratio of indicators at different moments of the cycle is required to calculate special indices. By the value of these indices, various pathologies in the blood supply are detected.

Main indices:

  1. Systolic-diastolic ratio (SDR). This index is calculated by dividing the maximum speed at which blood is expelled from the heart by the maximum final speed at rest.
  2. Resistance index (RI). It is obtained by dividing the difference between the minimum and maximum speeds by the value of the maximum speed.
  3. Ripple Index (PI). It is calculated by dividing the difference between the minimum and maximum velocities by the average blood flow velocity.

Important parameters for studying blood flow by Doppler are the velocities during contraction of the heart and during its rest, as well as the ratio of these velocities. Based on these data, indices are calculated and the probability of pathology is determined.

Norm and pathology

If no abnormalities in the bloodstream are found during the study, then the pregnancy proceeds without complications.

During the development of pregnancy, vascular changes and their increase occur. Therefore, for a correct assessment of the state of blood flow, the value of blood movement obtained during the study should be correlated with a certain period of pregnancy.

Often, when the mother is feeling well, disturbances in the blood supply of the child are revealed. You should not be afraid of this. This means that changes are only at the initial stage and with proper treatment, it is possible to avoid serious consequences.

All main indicators are calculated from 20 to 41 weeks of pregnancy. Each artery and vessel has its own allowable values ​​for each week.

The value of the SDO of the umbilical cord should decrease by 40 weeks from 4.0 to 2.0. Pathology is noticeable when, after 32 weeks, this figure is higher than 2.6.

The RI of the umbilical cord also decreases with the approach of labor from 0.65 to 0.41. A sharp decrease or increase may indicate disturbances in the blood flow.

IR of the uterine arteries changes very little during pregnancy - from 0.34-0.6 to 0.32-0.57.

A small part of the values ​​of the indicators is given. For each vessel in the human body, there are maximum permissible values ​​of the indices. The attending physician compares the state of health in all parameters of important vessels.

If the study revealed the characteristics of blood flow within normal values, then the pregnancy proceeds without complications and the child receives the necessary nutrition. At the slightest deviation, clarification of the cause and immediate treatment is required.

Doppler-Detected Disorders

To monitor the condition of the fetus with impaired blood flow, it is necessary to periodically undergo the CTG procedure

Doppler is a very important study. According to its results, it is possible to identify in the early stages some pathologies in the nutrition of the fetus and to prescribe treatment in a timely manner.

There are three degrees of pathology:

  • Grade 1 A - small changes in the arteries of the uterus, with normal blood flow between the placenta and the fetus. The opposite situation is 1 degree B - there are changes in the blood flow of the umbilical cord, but everything is normal in the uterine arteries.
  • 2 degree - pathologies in the bloodstream of the umbilical cord and uterus are noticeable, but their values ​​do not exceed the permissible norms.
  • Grade 3 - disastrous changes in the movement of blood along the umbilical cord, but in the arteries of the uterus, this movement may be normal.

Each stage has its own characteristics of pregnancy management.

If 1 degree of pathology is detected in the bloodstream between the mother and the child, it is enough to undergo a 1-2-week course of treatment that improves blood flow. Therapy is mostly done at home. After that, you need to do a second study.

To monitor the condition of the fetus, CTG (cardiotocography of the baby's heart) is periodically performed. With the improvement of the results of repeated Dopplerometry, the pregnancy is prolonged until natural childbirth.

For stage 2 blood flow disorders, therapy is prescribed to stimulate blood flow, and CTG and Doppler measurements are performed every 2 days. When the condition worsens, the issue of preterm birth is considered.

At stage 3, urgent inpatient treatment is required under close supervision. With such violations, the risk of death of the child is likely and almost always in this case, pregnancy is terminated by early birth. The decision is made by a council of doctors, all possible risks and complications are taken into account.

If violations of blood supply in or limbs of a person are detected, it is also necessary to immediately undergo treatment, selected for each specific case. After improving the patient's condition, periodic monitoring is required to exclude new pathologies.

Violations detected during the Doppler study always require close attention. Hypoxia is very detrimental to the fetus, its development and life. Each stage of the pathology requires immediate treatment and constant monitoring.

Is Doppler ultrasound harmful?

Doppler sonography is absolutely safe for both mom and baby

Most people fear how harmful Doppler imaging is for them. Such questions arise due to the fact that the device, like many similar devices, operates on powerful radiation.

Each transducer is issued with accompanying documentation, which contains technical data for each examination mode.

In addition, health care institutions maintain regulations that indicate the permissible exposure for each type of work. All ultrasound specialists know about the capabilities of their devices, and use them only when the benefits of the study are much greater than the harm to the patient's body.

Doppler examination is absolutely safe for all people. The ultrasound machine for such a diagnosis has a low heating capacity and is strictly dosed at each session. Such research is safe for both mother and baby. On the contrary, it is an important procedure that requires their peace of mind.

Doppler ultrasound is an important study to identify pathologies in the blood supply to the body. This is a safe procedure and does not require any special training.

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

It does not give such a complete and detailed picture of the condition of the fetus, placenta and the mother's body itself, which only increases the diagnostic value of Doppler ultrasound. It is for this reason that Doppler ultrasonography 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 give a highly informative picture on the screen of a special apparatus. Blood has the fastest dynamic current in the human body.

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

What you can learn with Doppler ultrasound

With the help of 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, 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 baby's neck. The cells of the nervous system of the body are the first to react to insufficient oxygen supply, therefore detection of hypoxia at an 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 flow through the vessels, i.e. absolutely static.

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

Types of dopplerometry during pregnancy

Duplex. This type of Doppler ultrasound is based on a combination of normal and spectral complementary modes. The image is black and white. The specialist has the opportunity to assess the anatomical features of the investigated vessels and the rate of blood flow in them. Thus, there is an assessment of the patency of the vessels.

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

How long does Doppler take? Doppler examination is prescribed for pregnant women late gestation(30-35 weeks of development), however, its earlier appointment is possible (20-24 weeks).

Indications for Doppler ultrasound in the early stages of pregnancy, for example, there is a suspicion of a delay in the intrauterine formation of the systems and organs of the child, phytoplacental insufficiency. The early dates in the Doppler study are unscheduled, so the risk of detecting a certain kind of pathological changes is significantly increased.

Additional indications compulsory Doppler ultrasound for pregnant women include:

  • kidney pathology;
  • carrying multiple pregnancies;
  • high water or low water pregnancy;
  • the presence of gestosis;
  • history of abnormal pregnancies;
  • bad habits of the expectant mother (smoking, alcoholism);
  • the tendency of the expectant mother to high 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, Doppler examination is performed in the prenatal period along with a standard ultrasound scan. The procedure helps the doctor to think over the entire order of childbirth and assess the need for a cesarean section.

Doppler ultrasound differs little from the procedure of conventional ultrasound examination. The manipulation is carried out with a specialized apparatus equipped with a sensor and a special program for processing the data obtained 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 financing of the medical institution conducting Doppler ultrasound).

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

A pregnant woman is warned that her clothes during the Doppler ultrasound procedure should not be difficult to remove. The woman should freely expose the abdomen and, if necessary, the perineum. The patient is placed on the couch face up, then a line is applied to the area under study with a special transparent gel and, by applying the apparatus to the site, diagnostic manipulations are started. The gel is an excellent tool for ensuring uninterrupted contact of the apparatus with the skin of a pregnant woman.

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

At the end of the study, the gel is removed with pre-prepared napkins or a towel. The ultrasound procedure ends, and now the main thing is to wait for the results.

Indicators of the norm and decoding of dopplerometry for pregnant women

Only a good specialist can give high-quality decryption Doppler results seen during pregnancy.

Produced evaluation of a number of vascular lesions th, which includes:

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

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

The diagnostician is obliged to additionally assess the state of the vascular wall, the filling of the vessels, the speed and activity of blood flow in them, the state of oxygenation of the soft tissues.

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


In general, starting from the gestation period, systolic-diastolic relationship should not exceed 2.4.

Resistance index Normally, it should be: for the uterine artery - less than 0.58, for the umbilical artery - less than 0.62, for the middle artery of the brain - less than 0.77.

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

Is Doppler Study Harmful?

What is important is the fact that Doppler ultrasound completely safe for health unborn 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 harmful to the health of the expectant mother. On the contrary, Doppler ultrasound is a necessary procedure that is not only painless, but also does not require a woman's anxiety before undergoing it. Doppler will only help in diagnosing possible pathologies, which is absolutely harmless to health.

Video Doppler ultrasound

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

Even more detailed information can be obtained through the active discussion of Doppler in pregnancy. Therefore, do not hesitate to ask each other the questions you are interested in and give no less complete and useful answers. Share your own experiences, if you have already undergone the Doppler ultrasound procedure. Remember that discussion helps not only you, but also those women who are just planning their first pregnancy in their life.

During the period of bearing a child, it is very important for women to undergo regular examinations in order to be able to monitor the condition of the fetus, as well as to timely identify abnormalities in intrauterine development.

Diagnosis is mandatory in the third trimester of pregnancy. At this time, experts recommend passing dopplerometry- ultrasound examination, with the help of which it is possible to assess the blood flow in the vessels of the uterus and umbilical cord. This technique is used to exclude the presence of anomalies and pathological conditions. If the fetal-placental blood flow is not disturbed, then there is no threat to the normal course of pregnancy. If various deviations are detected, patients are prescribed Doppler measurements already starting from the second trimester of bearing a child.

The indications for the procedure are:

  • signs of fetal developmental delay;
  • symptoms of impaired blood flow;
  • pronounced high water or, conversely, low water;
  • early maturation of the placenta;
  • severe late toxicosis;
  • anomalies of the umbilical cord;
  • a history of a pregnant woman with kidney pathologies, diabetes mellitus or hypertension;
  • dropsy of a non-immune nature, found in the fetus;
  • signs of the presence of chromosomal pathology;
  • rhesus conflict.

Ultrasound diagnostics of blood flow in the uterine vessels and the umbilical cord is also indicated for women carrying two or three children with different body weights. A difference in weight exceeding 10% is considered significant.

In the process of performing dopplerometry, a specialist studies indicators of several criteria, in particular, it is investigated LMS in the umbilical artery... This value plays an important role, since the intrauterine development of the fetus largely depends on it.

If the blood flow in the vessels of the umbilical cord is disturbed, then the fetal-placental blood circulation also deteriorates, which can cause various abnormalities in the child.

Acceptable indicators

  1. In the period from 20 to 24 weeks, the standard value of the systolic-diastolic ratio of the vessels of the umbilical cord should not exceed 4.4.
  2. From 25 to 27 weeks, the LMS indicator decreases to 3.8.
  3. From 28 to 33 weeks, the norm of LMS in the arteries of the umbilical cord is no more than 3.2.
  4. Starting from 34 weeks and before delivery (39-41 weeks), the systolic-diastolic ratio of the vessels should not be higher than 2.9.

A decrease in the intensity of blood flow in the umbilical arteries disrupts the normal fetal-placental blood circulation, which negatively affects the development of the fetus and can provoke the occurrence of anomalies and pathologies.

Registration of zero or reverse values ​​of diastolic blood flow indicates the critical condition of the baby. It is important to urgently carry out a pregnant cesarean section in order to save the life of the child. The operation should be performed within 2-3 days after the examination and detection of abnormalities. However, such a surgical intervention is permissible no earlier than 28 weeks of gestation, when the fetus is already able to survive outside the womb, supported by special devices.

Treatment

If the LMS norm in the umbilical cord artery is violated, but at the same time normal hemodynamics in the uterine vessels remains, then pregnant women are prescribed drugs to improve blood circulation - Trental, Placenta Composition or Curantil... Women in a position with increased blood clotting are credited with more powerful means to thin it, such as Thrombo-Ass and so on. Additionally, you should take Actovegin, providing a full supply of oxygen to the fetus.

If the LMS norm in the umbilical cord artery and uterine vessels is violated, but the values ​​are not critical, then the pregnant women are treated with medication in the hospital, providing round-the-clock monitoring of the conditions of the mother and the fetus. Doppler and CTG are performed regularly.

In case of a critical disturbance of blood flow in the umbilical arteries, an urgent cesarean section is necessary.

Doppler ultrasound for pregnant women, this is a type of ultrasound, this procedure helps to assess the state of blood flow. Doppler ultrasound for pregnant women reveals fetal hypoxia.

Indications for

The examination is carried out after the eighteenth week, twice, if the following indications are not present:
  1. age, pregnant less than twenty years old and more than thirty-five;
  2. unsatisfactory CTG;
  3. more than the norm of amniotic fluid;
  4. less than the norm of amniotic fluid;
  5. negative rhesus factor;
  6. suspicions of the child's pathology;
  7. trauma to the abdomen;
  8. chronic diseases in the expectant mother;
  9. multiple pregnancy;
  10. delay in the development of the child.

This procedure does not require special preparation.

How is Dopplerometry performed?

Dopplerometry is performed as an ultrasound procedure:
  1. The patient lies down on the couch. Position on the back or on the left side.
  2. The specialist applies the gel, it helps the ultrasonic sensor to move.
  3. Red outlines on the screen show blood flow to the sensor, blue from the sensor.
  4. The brighter the color, the more active the blood flow.

Deciphering the indicators of dopplerometry for pregnant women and the norm

It is rather difficult to assess blood flow, therefore, the norms are often relative. These indicators are:
  1. pulsation index (PI);
  2. resistance index (IR);
  3. systolic-diastolic ratio (LMS).
The higher the indices, the stronger the resistance to blood flow. The lower the index, the less resistance.
With IR indications - above 0.773, SDS - above 4.4 at 22 weeks of gestation, there may be problems with the fetus.

Dopplerometry norm for pregnant women


  • LMS, IR of the uterine arteries are enlarged, this indicates oxygen starvation of the fetus, which leads to a delay in development.
  • LMS, IR of the umbilical cord arteries are enlarged, indicating gestosis.
  • LMS, IR in the aorta indicators are increased, shows the poor health of the child who needs help.
  • LMS, IR of the child's carotid and cerebral arteries are lowered, indicating a difficult condition of the child, which can lead to his death. An urgent delivery is required here.