Precise fetal protection: Precise interpretation of ultrasound examination during early pregnancy

Clinical practical early pregnancy ultrasound reference value

The following is a comprehensive report of domestic and foreign literature and the summary of my many years of clinical practice data, which has high practical value.

1. Domestic literature reference standards

1. Pregnancy sac: β-HCG > 1000IU Yin Chao visible pregnancy sac, β-HCG> 1800IU belly super can show the gestational sac, the fetal heart can be seen after 2 weeks;The diameter of the sac is about 14-18mm. Before 9 weeks of pregnancy, the diameter of the gestational sac increased by about 1mm per day.

2. ElpClasty: The average diameter of the gestational sac is> 8mm, and the yin is super visible to the yolk; the average diameter of the gestational sac is> 18mm, the abdomen is super visible to the yolt;The diameter of the yolk sac is 3-6mm, and the size of the yolk sac changes with the gestational weeks. In 10 weeks of pregnancy, the maximum diameter of the yolk sac is 5-6mm.The yolk bag> 6.1mm indicates that the development is abnormal, and the possibility of the breds of> 7mm embryo is more likely to stop.Big yolk cylinder is related to abnormal embryo chromosomes.

3. Embryo: The average diameter of the gestational sac is> 16mm. The germ (CRL) should be seen through Yin Chao, and the diameter of the gestational sac is ≥18mm. There is no CRL, and the possibility of embryo is incubation.great.The diameter of the gestational sac is> 25mm.CRL’s growth rate is 1mm per day.

The number of days of pregnancy age is equal to the average pregnancy capsule diameter mm + 30;

The number of days of pregnancy is equal to the CRL length mm + 42;

The number of weeks of pregnancy is equal to CRL length CM + 6.5 (± 4 days);

6-12 weeks of pregnancy, the most accurate prediction of fetal age with CRL.

4. Filtering of the fetal heart tube: You should show the fetal heart beating any size of the normal CRL after the yin super examination;

Second, the American ultrasound radiologist learns 4 diagnostic criteria for pregnancy failure:

① CRL ≥ 7mm and no heartbeat;

② The average diameter of the gestational sac is ≥25mm and there is no embryo;

③ Check out the embryo of heartbeat after 2 weeks of the yolk sac.

④ Check out the embryo with a heartbeat of the yolk sac pregnancy sac 11D.

There are also eight situations "suspicious but cannot be determined to fail in pregnancy"

① CRL length is <7mm and has no heartbeat;

② The average diameter of the gestational sac is 16-24mm and there is no embryo;

③ Check out the gestational sac without a yolk sac 7-13D. There is no heartbeat embryo in 7-13D;

④ Check out the gestational sac with a yolk sac after 7-10d, and there is no heartbeat embryo;

⑤ No embryos are seen after the last menstrual period of ≥6 weeks;

⑥ Empty shenal film (you can see that the amniotic fluid is adjacent to the yolk sac but no embryo);

The diameter of the yolk cycles> 7mm;

⑧ Small pregnancy sac, that is, the average diameter of the gestational sac and the length of the head and hip length is <5mm.

The expert group pointed out that if the above or more situations are found, further evaluation should be further evaluated.

3. Summary of clinical experience of ultrasound examination results

Compared with the four diagnostic standards for pregnancy failure during pregnancy, ultrasound reference value during early pregnancy is different.Domestic ultrasound reference values are strict and sensitive; ultrasound data can accurately predict embryonic development, but it may be prematurely concluded and some cases are misjudged to stop fetal protection.

U.S. ultrasound standards are relatively loose, lagging reaction, and it is not easy to conclude early, causing less chances of misjudgment, but it may lead to unnecessary tire protection time.

For example, domestic standards: The average diameter of the gestational sac is> 16mm to see CRL and fetal heart through Yin Chao, and the diameter of the gestational sac is ≥16mm without CRL and fetal heart, indicating that embryos are stopped.In clinical practice, those who have found that the diameter of the gestational capsule in the yin -sharing sac is ≥16mm. There are no CRLs and fetal hearts. Some cases will be tire or observed for several days. The embryo will stop developing after a few days.Clinical experience has confirmed that domestic standards are too strict. If doctors easily abandon the fetal protection and the embryo continues to develop to normal, it may cause doctors and patients.

For example, US standards: CRL ≥ 7mm and no heartbeat, or the average diameter of the gestational sac ≥25mm and no embryo, indicating that embryos are stopped.Too loose standards have led to the continued fetal protection of pregnant women. Most pregnant women’s ending is embryos to stop, and only a few tire preservation is successful.Doctor and patient dispute.

4. Early pregnancy Practical Yin Chao Diagnosis Standard

If the vaginal ultrasound reference value of the domestic early pregnancy is relaxed, it may be more suitable for clinical reality, such as:

The average diameter of the gestational sac is 8-10mm, the yin super can see the yolk cylinder, and the diameter of the gestational sac is> 10mm yin and the yin super without seeing the yolk cylinder.

Normal yolk diameter is <6mm, the diameter of the yolk cycle is> 6.1mm, indicating that the embryo development is abnormal, the diameter of the yolk cysts> 7mm indicates the possibility of the embryo stopping, and the yolk diameter is> 8mm.

The average diameter of the normal pregnancy sac is 14-18mm. The CRL should be seen through Yin Chao, and the gestational sac diameter is 19-20mm without the germ. It indicates that the embryo is dysplasia. The diameter of the gestational sac is ≥21mm.

CRL has no fetal heart 3-4mm in length, indicating that suspicious embryos are stopped, and the CRL length is ≥5mm.

The average diameter of the gestational sac and the length of the CRL is about 14-18mm. Before 9 weeks of pregnancy, this range indicates that embryonic dysplasia, including large gestational sacs and small gestational sacs; the reference value after 9 weeks of pregnancy is significantly smaller.

Small gestational sac: The difference between the average diameter of the gestational sac and the CRL is <14mm is a small gestational sac, the 10-13mm is a mild small gestational sac, the 6-9mm is a moderate small gestational sac, and ≤5mm is a severe gestational sac.

The difference between the average diameter of the gestational sac and the CRL is <10mm. The possibility of embryo is stopped.

Most of the small gestational capsules appear in the uterine effusion or vaginal hemorrhage in about 1-2 weeks after examination; the success rate of the small gestational sac fetus is significantly reduced significantly.

Large gestational sac: The average diameter of the pregnancy sac is greater than 18mm in length and CRL. The 19-21mm is a mild large gestational sac, 22-24mm is a moderate large gestational sac, and ≥25mm is severe gestational sac.

The uterine cavity effusion appears 1-2 weeks after examination; most of the large gestational capsules are good after treatment after tire protection.

The diameter of the pregnancy sac: [(long + wide) ÷ 2]

The diameter of the pregnancy sac: [(long + wide + thick) ÷ 3]

The difference between normal pregnancy sac and germ: the average diameter of the gestational sac-germ length = 14-18mm

HCG > 7500IU/L visible yolk cylinder.

When the CRL diameter has seen the fetal heart 1-4mm, the HCG level is about 30000-50000IU/L.If HCG at this time

<30000IU/L, prompt HCG to rise slowly.HCG > 50000IU/L has not seen germ and/or fetal hearts, and embryos may be large.

Precision diagnosis and precision fetal protection theory during early pregnancy are based on the comprehensive analysis of various test results. It cannot be easily concluded with an ultrasonic report form or a hormone test form.Determining embryo development generally requires a horizontal and vertical comprehensive assessment of serotics testing indicators and vaginal ultrasound results in order to obtain a relatively accurate diagnosis. It is difficult to accurately judge the vaginal ultrasound or serum testing indicators alone.Clinically, the yin super examination during early pregnancy meets the expectations, but the serotics testing indicators are abnormal, and vice versa, so the interpretation of serotics indicators and ultrasound test results generally choose longitudinal comparison and horizontal comparison.

Vertical comparison is the results of this serum test results compared with the results of the previous serum test. This ultrasound is compared with the last ultrasound result;

The horizontal comparison is that the serum test is compared with the ultrasound results, especially the first inspection cannot be compared vertically, and only horizontal comparison can be selected.

Through vertical comparison and horizontal comparison, you can analyze and evaluate embryonic development.

A single indicator during the early pregnancy test such as Yin Chao is in line with the gestational week, but the serum science indicators are poor, or the yin super indicators are abnormal, but the serotics indicators are normal, and the probability of pregnancy failure increases. Effective fetal preservation measures must be taken.

For example, both serum testing indicators and Yin Chao of Early pregnancy indicate normal, have no clinical discomfort, and pregnant women with simple and unnatural abortion history of medical history without fetal treatment, and can only be observed during pregnancy;Pregnant women, active babies can significantly increase pregnancy success rates.

Fifth, embryonic dysplasia examination

1. Yin Chao indicates that embryonic dysplasia such as large gestational sac or small gestational sac, mostly related to genetic factors, endocrine abnormalities, abnormal immune, pre -thrombosis, metabolic abnormalities. According to the history of miscarriage and abortion, selectively check the following after pregnancy.project:

① Endocrine factors: HCG, P, E2, TSH;

② Immune factors: 3 ACA, β2-GP1-AB, LA), anti-nuclear antibodies (ANA), anti-extraction antigen antibodies, thyroid oxidase antibodies (TPOAB);

③ Coagulation function: D-cluster (DD), protein S (PS), platelet aggregation (PAGT);

④ Metabolic function: same -type cysteine (HCY), naphnia -based tetrahydrogen folic acid reduction enzyme (MTHFR), fasting blood glucose;

⑤ Others: blood routine, liver and kidney function, urine routine.

Reproductive abortion or complex pregnant women’s candidate projects: 5 items of rheumatism, anti -dual -chain DNA antibody (DSDNA), anti -nuclear bodies (ANUA), anti -group protein antibody (AHA), anti -mitochondrunctia (AMA), Ama Ya Ya Ya Ya Ya Ya Ya Ya Ya YaType division (2/4/9), corner antibroteine antibody (AKA), tumor necrosis factor (TNF-α), thyroid globulin antibody (TGAB), NK cells, B cells, protein C (PC), anticoagulant)Bloodase III (AT III), thrombosis elastic diagram (TEG).

Sixth, embryonic dysplasia treatment

1. Insufficient hormone level during early pregnancy:

① Within HCG8000IU, the increase of less than 66%the next day, 1-2 in the daily injection of low molecular heparin (HCG growth is slightly slower in injection per day, HCG growth is significantly slowly injected daily per day).Stop medicine for 1 week.

② When Yin Chao shows the germ 2-4mm, when you see the fetal heart, such as HCG <30000IU, the HCG is rising slowly, 1-2 branches of low molecular heparin are injected daily; HCG growth is slightly slower per day, and HCG growth is significantly slowly injected 2 daily injection daily injections per day.; Check HCG in a week, and then inject the medicine for 1 week after the HCG recovers.

③ HCG > 50000IU does not see the heart of the germ, indicating that the embryo grows slowly, 2 daily injection of low molecular heparin, 5 days in injection to check the yin super, if you see the heart of the germ, then the low molecular heparin is injected as appropriate; if the germ is not seen,Heart, it is prompted to stop embryo.

2. Early pregnancy embryo dysplasia

Small gestational sac: Mild small gestational sac inject 1 low-molecular heparin per day; moderate small gestational sac inject 1-2 daily injections, severe small gestational sac injection of 2-3 daily injection daily, and then injection of the medicine for 1 week after returning to normal.

If hormones and DD examinations are normal during early pregnancy, the probability of failure of small pregnancy sac pregnancy failure is low, and the probability of failed to fail in pregnancy in moderate small gestational sac is slightly increased; most of the hormone levels of severe small gestational sac hormones are abnormal, and pregnancy failure rate is higher.

3. Poor embryonic development is related to immunity and abnormal coagulation, and immunosuppressive agents and anticoagulants are usually used, such as nylon nylon, hydroxyl chlorine, cyclopanin, mulcurine, mulctilizine, other Kimo Mosh, Immunoglobulin, low molecular heparin, sodium sodium sodium sodium, aspirin, clopidogret, etc.See the follow -up chapter for specific usage and treatment: treatment of anti -phospholipid syndrome during pregnancy, diagnosis and treatment of unlimized connective tissue disease during pregnancy, principles of lupin treatment during pregnancy, recurring abortion before thrombosis, low -molecular heparin application in recurrent abortion,Prevention and control of venous thromboembolism in obstetrics and gynecology.

Pregnancy Test Midstream 5-Tests