Routine Ultrasonography in Pregnancy
The miracle of ultrasonography, which is one of the greatest innovations in contemporary medicine, is our biggest assistant in the clinic with its models whose resolution is increasing in recent years. It is widely used in clinical applications as a diagnostic method with a high diagnostic capacity and no risk in use in good hands with the principle of working with radiation and sound waves.
Every woman who applies with a suspicion of pregnancy is actually referring to a doctor, dreaming that she has a healthy pregnancy. Indeed, mostly pregnancies are healthy. However, in cases where there may be a problem, the main purpose of ultrasonography is to detect possible problems at the earliest period and provide the earliest health support to the woman.
Its Use in Early Pregnancy Application
The first aim in the use of ultrasonography in the woman who applied with a menstrual delay or pregnancy test positivity is to determine a gestational sac in the uterus. The primary goal should be to protect women’s health, at which point the diagnosis of ‘ectopic pregnancy’, which refers to the gestational sac located in the tubes, should be excluded. In this concept, which you can read in detail in the link of ectopic pregnancy, drug treatment can be applied without the need for surgery in early diagnosis, or if there is an indication for surgery, an ectopic operation can be performed laparoscopically without allowing bleeding for the abdomen.
Apart from this, the location of ultrasonography is very important for the diagnosis of mole pregnancies and impaired pregnancy. In cases where mole pregnancies and impaired pregnancies called ‘missed abortus’ occur but the fetus is formed after a while, the heartbeat disappears and the baby is lost, the possibility of termination of pregnancy is offered to the woman early.
In empty pregnancies (anembrionic pregnancy) in which gestational sac is formed but yolk sac and embryo cannot be seen, ultrasonography is diagnostic and pregnancy should be terminated.
The early diagnosis of multiple pregnancies and the determination of single-double egg twins and triplets early are also important contributions of ultrasonography.
Even if the gestational sac has been followed and even a heartbeat has been detected, the fact that the gestational sac has been completely discarded or remained fragment after a bleeding will enable the selection of medical aid and intervention options.
In addition, gynecological details such as presence of fibroids or fibroids in the womb of the woman, determination of congenital differences in the uterus and ovarian cysts can also be illuminated by ultrasonography. In the presence of these situations, risk planning can be made in pregnancy and the problems that may occur in the long run are tried to be reduced.
One of the biggest benefits of ultrasonography in early pregnancy is that the gestational week can be determined correctly. It will give the most accurate information with the least margin of error in terms of accurate determination of the gestational week obtained with the head butt distance that can be measured from the 6th week to the 14th week. If there is a difference in the measurement of head butt distance with the last menstrual period, the pregnancy week determination determined by the head butt distance is taken as reference and pregnancy is monitored accordingly. This week, the margin of error in the gestational week is only 3 days.
The heart rate and rhythm of the fetus may indicate the development and low risk of fetus during pregnancy, as well as heart diseases in rhythm disturbances and high-speed beats.
Ultrasonography in Pregnancy Follow-up
During pregnancy, ultrasonography determination is performed by increasing the frequency, taking into account the features of pregnancy, usually once a month and towards the end of pregnancy follow-up.
Whether the development of the fetus continues within normal limits or not can be determined by ultrasonographic measurements. In cases where the development is slow, the diagnosis of ‘intrauterine development restriction’ can be made, and if necessary, Doppler currents can be monitored and the baby’s development can be monitored by serial follow-up and the woman’s life improvement plans can be made (such as aspirin use, increasing bed rest, reviewing nutrition …). The use of ultrasonography is of great benefit for the possibility of reduction of amniotic fluid called oligohydramnios in the intrauterine growth restriction. On the contrary, in cases where the baby grows fast, the diagnosis of fetal macrosomia (large baby) and polyhydramnios, which expresses the increase in amniotic fluid, can be determined and diabetes research can be repeated meticulously.
During the pregnancy; In complicated situations such as pregnancy-related diabetes, preeclampsia, early membrane rupture (early water intake), passing term (pregnancies longer than 40 weeks), it will be life-saving for the fetus to follow the fetus and amniotic fluid amount at the right time.
In the last weeks of pregnancy, determining the amount of amniotic fluid in the biophysical profile scoring we use to determine the well-being of the fetus and monitoring the movements and breathing of the fetus are also performed by ultrasonography.
The location of the placenta by ultrasonography allows the determination of the cause of the woman’s existing bleeding in determining the placenta located below. Vaginal delivery is not possible in the sub-located placenta called placenta previa and it is possible to provide planned cesarean and pre-blood and blood products against the possibility of surgical bleeding especially in women who have previously been administered cesarean and diagnosed with placenta previa in their current pregnancy.
The diagnosis of ablatio placenta, which expresses the early separation of the placenta, can be made by ultrasonography.
Determining with which part the baby enters the pelvis in the pregnancies or multiple pregnancies before birth (head arrival, breech arrival, side posture, etc.) will be useful in determining the type and risks of delivery and taking necessary precautions.
In the periods of more than 14 weeks of pregnancy, the determination of pregnancy week by ultrasonography cannot maintain its accuracy until the early period and the potential growth differences and error rate of infants can be up to 3 weeks. However, it still maintains an important place in the determination of pregnancy patients.
Ultrasonography is important in determining large babies at the end of pregnancy in terms of estimated weight determination and can be a guide for determining the risks such as difficult birth and shoulder attachment. However, 10% error in weight determination should be taken into consideration in ultrasonography.