Obstetric ultrasonography

Fine ultrasound is the sonographic examination in the context of prenatal diagnosis, so an investigation of the unborn child, particularly by means of a high-resolution ultrasound machine. Synonymous with the terms sonographic fine diagnosis, organ malformation screening and ultrasound are used.

This ultrasound can be performed only by specially qualified doctors for this purpose, to which the pregnant woman is optionally identified by their gynecologist if it can not perform even the investigation.

The fine ultrasound examination is only in some states (eg, Mecklenburg- Vorpommern) paid in Germany as regular performance by health insurance, in most a separate regulation by the competent gynecologist is needed to achieve this, which is made ​​on the basis of the presence of risk factors or malformation notes.

Statement options

By means of the fine ultrasound, which can be carried out in the period from about the 19th to the 22nd week of pregnancy, it is theoretically possible to determine or rule out some developmental disorders and some physical features in the child. So-called sonographic soft markers are often detected during ultrasound or fine can be assessed in more detail or largely excluded.

Chromosomal peculiarities (eg, Down syndrome, Edwards syndrome, Patau syndrome ) can not be diagnosed. Only the combination of different physical problems ( see also: soft markers ) to communicate specific chromosome features, so an amniocentesis to nearly 100 percent secure diagnosis can be considered.

Investigated organ systems

By ultrasound specific organs or organ structures of the unborn child will be assessed. Particular attention is paid to the possible lack of organ systems, malformations of organs and the timely development of the organs.

It examines in particular:

• The face: features would be, for example, cleft lip and cleft palate, an unusually small or large eye relief or an unusual facial profile, eg by an underdeveloped ( hypoplastic = ) nasal bone,

• The head: Features would be, for example, hydrocephaly ( = a collection of cerebrospinal fluid due to a derivation disorder), microcephaly ( = too small head), anencephaly ( = a Neuralrohrfehlbildung, characterized by the absence of parts of the bony skull roof, the meninges, the scalp and parts of the brain ), holoprosencephaly ( = a developmental disorder of the forebrain and the face), encephalocele ( = brain break), enlarged ventricles (ventricles ) or choroid plexus cysts in the brain

• The spine: a feature would, for example, a form of spina bifida aperta ( = closure disorder of the spinal canal )

• The extremities: Features would be, for example, a shortened femur ( = femur) or a shortened humerus ( = humerus), an under-developed ( = hypoplastic ) or absent ( = aplastic ) middle phalanx of the fifth finger, a special position of the fingers (for as bends or superpositions ), a form of congenital hand or Fußfehlbildungen ( = dysmelia ) or Vielfingrigkeit ( = polydactyly )

• The stomach: a special feature would be, for example, an omphalocele ( = umbilical cord breaks or the umbilical cord to the baby is bloated baggy and abdominal organs emerge through the navel ), a gastroschisis ( = abdominal wall column ), a gastroschisis ( = mostly right of the umbilicus located malformation the abdominal wall with prolapse of bowel loops ) or a diaphragmatic hernia

• The gastrointestinal tract: Features would, for example, transfers or blockages, such as a bowel obstruction ( duodenal stenosis, double-bubble phenomenon )

• The kidneys and urinary disorders: special features would be, for example, cysts, a Potter 's Syndrome (will depending on the extent in the types Potter I, II, III, IV distinction ), or abnormalities in the kidney area (eg, horseshoe kidney, water bag kidney hydronephrosis, renal pelvic extension)

• The heart: Features would be, for example, heart failure, or white spots ( = golf ball phenomenon )

Evaluation of images

As the ultrasound images of the fine ultrasound can be assessed and what and how much can be seen it depends also on the quality of the study area, the experience of the examining physician, amniotic fluid volume ( little amniotic fluid = worse sound conduction ), the fetal position, gestational age, the strength the abdominal wall of the mother, scars, etc from.

It may be helpful to consider a study with 3D ultrasound or 4D ultrasound into consideration so that any detected a peculiarity assessed more accurately and which can be optimally planned pre-and postnatal treatment of the child.

Chromosomal features can not be diagnosed by ultrasound. Nevertheless, physical markings and other sonographic soft markers can sometimes be detected and thereby " the ultrasound examination [ ... ] the rail for pränataldiagnostisch - invasive measures such as amniocentesis, chorionic villus sampling and Chordozentese ". ( Maier, 2000, p 128).

The Center for Technology Assessment in Switzerland examined in one study ( ZfTA, 2001, p 124) the proportion of suspected diagnoses during pregnancy and actual facts after birth. It was found that seen at statistically 75 out of 100 children have become conspicuous with different ultrasound in developmental disorders, this ultimately did not confirm and the children are born without abnormalities. So it can be said that there is a sometimes strong concern, uncertainty and psychological stress of the pregnant women in the majority of cases of prenatally expressed tentative diagnoses, which turns out in the end as unfounded.