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11УДК: 618.291-07
FETOMETRY AS A MODERN METHOD OF ASSESSING FETAL
DEVELOPMENT
TESHAEV SHUKHRA T JUMAEVICH
Professor, department of anatomy and clinical anatomy of the Bukhara medical Institute. City of Bukhara. Republic of Uzbekistan.
ORCID ID 0000-0002-2089-5492 KHAMDAMOVA MUHKHAYOHON TUKHTASINOVNA DSc, docent of department of obstetrics and gynecology 2 of the Bukhara medical Institute. City of Bukhara. Republic of Uzbekistan.
ORCID ID 0000-0003-3128-6120 RABIEV SANJAR NASRITDINOVICH Independent doctoral student of department of obstetrics and gynecology 2 of the Bukhara medical Institute. City of Bukhara. Republic
of Uzbekistan. ORCID ID 0000-0001-8618-0791 ABSTRACT
Modern visualization techniques allow us to obtain a sufficient amount of information about the anatomometric features of the fetus. However, systematic studies on the relationship between the mother's somatotype and fetometric parameters of the fetus at the stages of its development in women with different somatotypes have not been conducted.
Key words: fetometry, ultrasound, biparietal size, head circumference, frontal-occipital size.
ФЕТОМЕТРИЯ, КАК СОВРЕМЕННЫЙ МЕТОД ОЦЕНКИ РАЗВИТИЯ
ПЛОДА
ТЕШАЕВ ШУХРАТЖУМАЕВИЧ
доктор медицинских наук, профессор кафедры анатомии и клинической анатомии. Бухарский Государственный медицинский
институт имени Абу Али Ибн Сино, город Бухара Республика
Узбекистан. ОЯСЮ Ю 0000-0002-2089-5492 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА ОБо, доцент кафедры акушерство и гинекологии, Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, город Бухара Республика Узбекистан.
ОИСЮ 1О 0000-0003-3128-6120 РАБИЕВ САНЖАР НАСРИДДИНОВИЧ Докторант кафедры акушерство и гинекологии, Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, город Бухара Республика Узбекистан.
ОИСЮ 1О 0000-0001-8618-0791 АННОТАЦИЯ
Современные визуализационные методики позволяют получать достаточное количество информации о анатомомет-рических особенностях плода. Тем не менее, систематические исследования по взаимосвязи соматотипа матери и фетомет-рических показателей плода на этапах его развития у женщин с разными соматотипами практически не проводились.
Ключевые слова: фетометрия, ультразвук, бипариеталь-ный размер, окружность головки, лобно-затылочный размер.
ФЕТОМЕТРИЯ ХОМИЛА РИВОЖЛАНИШИНИНГ ЗАМОНАВИЙ БАХОЛАШ УСУЛИ СИФАТИДА
ТЕШАЕВ ШУХРАТЖУМАЕВИЧ
Т.ф.д., анатомия ва клиник анатомия кафедраси профессори, Бухоро давлат тиббиёт институти, Бухоро шацри, Узбекистон
Республикаси. ОРСЮ 1О 0000-0002-2089-5492 ХАМДАМОВА МУХАЙЁХОН ТУХТАСИНОВНА ОБо, акушерлик ва гинекология кафедраси доценти, Бухоро
давлат тиббиёт институти, Бухоро шацри, Узбекистон Республикаси. ORCID ID 0000-0003-3128-6120 РАБИЕВ САНЖАР НАСРИДДИНОВИЧ Акушерлик ва гинекология кафедраси докторанти, Бухоро давлат тиббиёт институти, Бухоро шацри, Узбекистон Республикаси. ORCID ID 0000-0001-8618-0791 АННОТАЦИЯ
Замонавий визиализацион усуллар цомиланинг анатомо-метрик хусусиятлари цацида жуда куп маълумот олиш имконини беради. Шунга царамай, турли соматиплар билан аёлларда ривож-ланиш цомила ривожланиш босцичларида она соматотипи ва цомила фетометрик курсаткичлар уртасидаги муносабатлар буйича тизимли тадцицотлар утказилмаган.
Калит сузлар: фетометрия, ультратовуш, бипариетал улчам, бош айланаси, пешона-чакка улчами.
The current stage of development of perinatology is characterized by the widespread introduction of various additional research methods to assess the condition and features of fetal development - [1, 3]. Of the variety of modern methods of studying the fetoplacental system, echography, cardiotocography and dopplerography are the most widespread. They solve different tasks, but in a complex they give the maximum information about the condition of the fetus.
Ultrasound examination of the fetus is today one of the most informative methods of research in obstetrics. This method is used for fetometry (determining the size of the fetus or its individual parts by ultrasound, specifying the gestational age and weight of the fetus), diagnosing malformations of the gastrointestinal tract, musculoskeletal system, urinary tract, genitals, heart, brain and spinal cord. Ultrasound is also used to determine the location of the placenta and to diagnose
multiple pregnancies. It is also possible to study the biophysical profile of the fetus, the volume of amniotic fluid, the function of the cardiovascular system and placental circulation. The method provides significant assistance in cordo-and amniocentesis, chorionic biopsy, and diagnosis of ectopic pregnancy - [2, 4]. High-frequency sound waves are used to obtain the image. The study is carried out in M-modal and two-dimensional, three-or four-dimensional modes. The sensor sends and receives high-frequency ultrasonic signals (2-8 MHz), recording the time of the wave passage to a certain structure and back. This time is proportional to the distance from this structure to the ultrasound source. Knowing the speed of propagation of ultrasound in human tissues (1540 m / s), the recorded time of the wave passage can be converted into electrical signals and reproduced on the screen as the distance to the structure. Even more realistic images are obtained when scanning in 3D and 4D modes - [5, 6]. At the same time, the farther away from the sensor the fruit is located, the lower the signal frequency should be. The boundaries between media with different densities are most clearly visible during ultrasound, for example, between liquid and soft tissues, between soft tissues and bones. If the difference in the density of fetal tissues and surrounding structures is small, the image of the fetus will be fuzzy, and the study will be uninformative (for example, with low water content, it is not possible to determine the circumference of the fetal abdomen, and with the underdevelopment of the calyx-pelvis system, to distinguish the kidney parenchyma from the surrounding fiber) - [10].
Despite the fact that the negative effect of ultrasound on the fetus is not proven, this study is carried out only according to indications. According to the recommendations of the American Society of Obstetricians and Gynecologists, as well as the US National Institutes of Health, ultrasound is not one of the mandatory methods of examination
during pregnancy. Nevertheless, the indications for the procedure are reflected in a sufficient number of domestic and foreign publications - [7, 9].
Evaluation of fetal development is the most important task of obstetricians at the stages of pregnancy and childbirth. According to the order of the Ministry of Health of the UZR of May 18, 2012 No. 137 " On approval of the Procedure for providing medical care in the profile "Obstetrics and Gynecology (except for the use of assisted reproductive technologies)", the examination of pregnant women includes a mandatory three-time screening ultrasound examination: during 11-14 weeks of pregnancy, when a comprehensive prenatal diagnosis of fetal development disorders is carried out, including ultrasound examination and determination of maternal serum markers (pregnancy-related plasma protein A and the free beta-subunit of chorionic gonadotropin), followed by complex calculation of the individual risk of having a child with a chromosomal pathology. In the early stages of uncomplicated pregnancy, the measurement of the average internal diameter of the fetal egg and the coccygeal-parietal size (CTD) of the embryo is limited. It should be noted that the CT of the embryo is less subject to individual fluctuations than the average internal diameter of the fetal egg, and therefore, its use for determining the gestational age gives better results. The error in this case usually does not exceed ± 3 days - [8]. To determine the duration of pregnancy based on the obtained measurement results, use the formulas included in the software of ultrasound devices, or regional standards Demidova V. N. (2014). At 18-21 weeks, ultrasound examination is performed to detect late-manifesting congenital anomalies of fetal development; ultrasound examination at 30-34 weeks is performed for the purpose of functional assessment of the fetal condition.
According to the Bulletin of the American Society of Obstetricians and Gynecologists, depending on the goals of ultrasound during pregnancy, there are two types of it —standard and targeted. With a
standard ultrasound, the contents of the uterus are described (the number and position of the fetus, the location of the placenta, the approximate volume of amniotic fluid is estimated). Fetometry is performed: the biparietal size of the head, its circumference, the circumference of the abdomen, and the length of the femur are measured.
Examine the anatomy of the brain, heart, kidneys, bladder, stomach, spinal cord, and determine the attachment and number of vessels of the umbilical cord. An important point is to determine the frequency and rhythm of the fetal heart rate. Targeted ultrasound is used for a more thorough examination of the fetus in case of suspected malformations or severe intrauterine developmental delay. At the same time, special attention is paid to certain organs and systems.
For targeted ultrasound, the study is used in volumetric modes. The areas of interest are photographed or videotaped - [8, 9]. To determine the biparietal size of the fetal head, the sensor is placed perpendicular to the sagittal suture in the place of the best visualization of the M-echo. At the same time, the sickle of the large brain, the cavity of the transparent septum and the thalamus, the cerebellum, are visible, located at the same distance from the inner surface of the parietal bones. The anterior and posterior horns of the lateral ventricles (lateral to the sickle of the large brain) can be visualized) and the third ventricle (along the midline), the water supply of the brain, the subcortical nuclei, as well as various malformations and anomalies, tumors, dysplasia and hypoplasia of the brain. Modern devices allow you to visualize even the middle cerebral artery in the area of the lateral sulcus. If the cerebellum, eye sockets, temporal bone, and sphenoid wings are visible, the sensor is positioned incorrectly. When performing this measurement, technical difficulties may occur if the fetal head is fixed at the entrance to the small pelvis - [10].
The biparietal size of the fetal head is measured from the outer surface of the upper contour to the inner surface of the lower contour of
the parietal bones. The head of the fruit is usually slightly elliptical in shape. Less often, the size of the head is increased in the transverse (brachycephaly) or longitudinal (dolichocephaly) direction - [1, 5, 7].
The shape of the head is evaluated using the cranial index (the ratio of the biparietal size of the head to the frontal-occipital size). Normally, it is 0.74-0.83. Brachycephaly and dolichocephaly are considered variants of the norm, but may cause errors in determining the gestational age and the estimated weight of the fetus. In brachycephaly, the fetal head is wider and the biparietal size is larger than normal. If you do not take into account its compliance with other fetometric indicators, then the estimated fetal weight and gestational age in brachycephaly will be overestimated, and in dolichocephaly — on the contrary, underestimated. In order to avoid diagnostic errors in brachycephaly and dolichocephaly, the length of the femur, the circumference of the head and abdomen of the fetus are measured to determine the gestational age and the estimated weight of the fetus - [8, 9].
The circumference of the fetal head is measured at the same level as the biparietal size of the fetal head. The circumference is measured either by computer planimetry, or by a formula, having previously determined the frontal-occipital and biparietal dimensions of the head. Below is the formula for determining the circumference of the fetal head: OG = 1/2 f (LZR + BPR) f 3.1416, where OG is the circumference of the fetal head, LZR is the frontal — occipital size, and BPR is the biparietal size of the fetal head. Although the circumference of the fetal head is almost independent of its shape, this indicator varies significantly and, unlike the biparietal size, is less often used to calculate the estimated weight of the fetus. In cases where a computer or calculator is used to calculate the estimated weight, the values of the circumference of the fetal head are substituted into the regression equations - [1, 3]. The circumference of the fetal abdomen is determined in a plane that is
perpendicular to the longitudinal axis of the fetal trunk. The sensor is positioned so that the gas bubble of the stomach and the middle part of the hepatic vein are visible on the screen (without capturing the area where the hepatic vein flows into the umbilical). The upper poles of the kidneys are usually located slightly caudal to the study plane. The sensor is positioned parallel to the fetal spine, caudal to the heart. Then the sensor is rotated 90°, trying to keep it strictly perpendicular to the abdominal wall of the fetus. The circumference of the abdomen is measured several times until two or three approximately identical results are obtained. In the absence of a computer planimeter, two diameters of the fetal trunk are determined in the study plane, and then the abdominal circumference is calculated using the following formula: OJ = 1/2 f (D1 + D2) f 3.1416, where OJ is the circumference of the fetal abdomen, D1 and D2 are the trunk diameters. Fetal abdominal circumference is one of the diagnostic criteria for intrauterine developmental delay.
In mass examinations for intrauterine developmental delay, in addition to absolute fetometric indicators, relative ones are used: the ratio of the length of the hip to the circumference of the abdomen and the circumference of the head to the circumference of the abdomen of the fetus - [6, 8]. When measuring the length of the fetal femur, only the ossified part of the femur is measured. The epiphyses of the femur in the fetus are poorly ossified and poorly visualized. Although the femur is somewhat curved, the length of the femur is measured as the shortest distance from the proximal to distal points of the diaphysis. Ossification of the distal epiphysis of the femur usually occurs at 28-35 weeks of pregnancy. This trait is often used to determine the gestational age - [9]. At the same time, in the relevant literature there is a significant number of indicators of fetometry developed by both domestic and foreign researchers, which necessarily gives rise to the problem of choosing a particular nomogram. It is quite obvious that there is no single norm of
fetometric indicators, since the latter directly depend on the model of the ultrasound scanner used, ethnic, constitutional characteristics of the mother and fetus, geographical, environmental and other factors. This is confirmed by significant differences in fetometry indicators, which were carried out in a large number of foreign studies - [5, 6]. According to the majority of researchers, there are inter-population, racial and regional features of the main fetometric parameters - [4, 6]. The differences are explained not only by the ethnic characteristics of the population, but also by the socio - economic conditions of life.
Significant importance is given to ultrasound placentography, which allows you to determine its localization, structure and size, as well as pathological changes. Placental localization can affect the growth and development of the fetus. Violation of fetal growth is more often noted when the placenta is located in the lower segment of the uterus, which, apparently, is due to the peculiarities of the uterine blood circulation.
Along with such data, there is information in the literature about the absence of the influence of placental localization on growth - [4, 6]. Thus, in the studies of G. M. Savelyeva et al. (2012) demonstrated that in SORP, the placenta location on the anterior and posterior walls of the uterus is detected with the same frequency.
Modern visualization techniques allow us to obtain a sufficient amount of information about the anatomometric features of the fetus. However, systematic studies on the relationship between the mother's somatotype and fetometric parameters of the fetus at the stages of its development in women with different somatotypes have not been conducted.
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