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Medical science
Kamalidinova Shakhnoza Mahmudkhanovna, Tashkent Institute for Advanced Medical Education Fazylov Akram Akmalovich, Tashkent Institute for Advanced Medical Education,
Tashkent, Uzbekistan E-mail: [email protected]
PRENATAL ULTRASOUND DIAGNOSIS OF HEART DISEASE
Abstract: Our study shows that early fetal echocardiography, performed in the period from 12 to 16 weeks of gestational age, is technically possible using the ultrasound protocol of the heart and can identify a wide range of significant cardiac abnormalities. Such an assessment may be an important part of early perinatal counseling, especially in fetuses with known genetic abnormalities or with other extracardiac defects. In addition, it allows to evaluate the progression of the disease and, given the beginning of the widespread use of intrauterine interventions, can provide an earlier and effective fetoscopy.
Keywords: pregnancy, ultrasound screening, malformations, cardiac abnormalities.
The study of the heart of the fetus is one of the most im- grams were made abdominal and transvaginal, if necessary.
The complete echocardiography protocol of the fetus included a section through four chambers, a section through the left and right output tracts, noting "vascular crossing", the aortic arch, measured the right and left ventricles, atria, aortic diameter, pulmonary artery. Two-dimensional images of the structures of the heart were obtained. Heart rate, heart rate, and PR interval were also assessed, and the output of the aorta, pulmonary artery, and right and left ventricle were measured (Figure 1-8). The gestational age of the fetus was calculated on the last menstruation or using ultrasound measurements of fetal biometry.
Results of the study. During the study period, 142 fetal studies were performed. The average gestational age of the fetus for echocardiography was 19 weeks (range 12-22 weeks). A transabdominal study was sufficient to produce high-quality echograms in 104 of 142 fruits; in 26 cases, to clarify the diagnosis, additional images were obtained using a transvaginal study. All cases of transvaginal studies conducted as a result of restriction of transabdominal examination were carried out on a gestation period of less than 15 weeks, an average of 13.1 weeks (range 12.4-14.7 weeks). A complete study was conducted on 130 of 142 fruits.
Of course, the indication for early echocardiography is the determination of structural changes in the heart, where there is a suspicion of heart abnormality (91.7%) and fetal extracardiac abnormalities (50%). An increase in the collar space (>3 mm) is becoming an increasingly common indication for early fetal echocardiography, in 13.8% of such cases the pathology of the heart of the fetus was confirmed. Control echography at 22 weeks.
Routine echocardiography of the fetus was performed in 128 of 142 fetuses at a gestation period of more than 20 weeks
portant stages of ultrasound in the second half of pregnancy. The assessment of this organ causes the greatest difficulties for the doctors of ultrasound diagnostics, conducting screening ultrasound diagnostics, conducting screening studies [1].
According to practical guidelines developed by the American Institute of Ultrasound in Medicine (AIUM) in 1998 [2] and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) in 2006 [3], the 4-chamber section, the left and right output paths should be included in a screening ultrasound of the fetal heart, albeit with the proviso "if it is technically feasible". Visualization of the main vessels of the heart in real time requires certain skills in the "manipulation" of the sensor and may be difficult due to insufficient experience of the doctor in scanning the heart in the antenatal period [4], and therefore the search and development of an available method for ultrasound examination of the fetal heart, less dependent on motor activity of the fetus and the experience of the researcher, remain the task of current research in prenatal diagnosis.
We offer you a protocol for ultrasound examination of the fetal heart, an algorithm for the step-by-step construction of diagnostic cardiac sections included in the extended echocardiography examination of the fetus. This protocol can be applied at work, which allows visualizing and assessing the anatomy of the fetal heart and allowing timely diagnosis of heart defects.
Materials and research methods. A retrospective analysis of fetal echocardiograms, performed from July 2016 to December 2018 in the "fetal heart" program at the Republican Center "Mother and Child Scrining", was conducted.
Echocardiography of the fetus was determined at 12-22 weeks of gestation. In this study, all embryonic echocardio-
PRENATAL ULTRASOUND DIAGNOSIS OF HEART DISEASE
of gestation. Ten pregnancies were terminated, and over four were lost observation. In all aborted pregnancies, significant heart diseases were diagnosed and/or extracardiac or genetic abnormalities were observed.
Cardiac abnormalities were found in 32 of 142 fruits (22.5%). Of the 128 fruits examined in the early stages, 19 were diagnosed with cardiac pathology, they were re-examined at 20 weeks of gestation. Upon further evaluation, only 3 out of19 fetuses were first diagnosed with a cardiac anomaly, but upon further examination revealed a normal heart. However, no pathology is missed with early echocardiography. These studies showed a sensitivity of 100%, a specificity of
97.3%, a positive prognostic value of 84.2%, and a negative prognostic value of 100% for major heart diseases.
Our study shows that early fetal echocardiography, performed in the period from 12 to 16 weeks of gestational age, is technically possible using the ultrasound protocol of the heart and can identify a wide range of significant cardiac abnormalities. Such an assessment may be an important part of early perinatal counseling, especially in fetuses with known genetic abnormalities or with other extracardiac defects. In addition, it allows to evaluate the progression of the disease and, given the beginning of the widespread use of intrauterine interventions, can provide an earlier and effective fetoscopy.
References:
1. Fundamentals of fetal echocardiography Medvedev M. V., Zhanti F. 2013.- 128 p.
2. AIUM Practice Guidelince for the Anterpartum Obstetric Ultrasound Examination. J. Ultrasound Med, 2003; 22: 1161125.
3. International Society of Ultrasound in Obstetric and Gynecology (ISUOG): guidelince for performing the "basic" and "extended basic" cardiac scan. Ultrasound Obstetric Gynecol, 2006; 27: 107-113.
4. Yoo S.-J., Lee Y.-H. Kim E. S. et al. There are three ways to detect the abnormalities during the obstetrics screening. Ultrasound Obstet Gynecol 9 (1997): 173-182.
