Скачать или смотреть Multiple Miracles: Ultrasound Guidance for High-Risk Pregnancies by Dr. Robinson Alice

Multiple gestation, or multiple pregnancy, refers to the presence of two or more fetuses in the womb. Ultrasound plays a vital role in managing multiple gestations, ensuring optimal maternal and fetal outcomes.

Diagnostic Role:

1. Detection: Ultrasound confirms multiple gestation and determines the number of fetuses.
2. Chorionicity: Ultrasound identifies the placental structure, essential for diagnosing monochorionic (shared placenta) or dichorionic (separate placentas) pregnancies.
3. Amnionicity: Ultrasound determines the number of amniotic sacs, crucial for diagnosing monoamniotic (shared sac) or diamniotic (separate sacs) pregnancies.

Monitoring Role:

1. Fetal Growth: Regular ultrasound assessments track fetal growth, detecting potential growth restriction or discordance.
2. Fetal Well-being: Ultrasound monitors fetal movement, tone, and heart activity.
3. Placental Function: Ultrasound evaluates placental health, identifying potential complications.

Interventional Role:

1. Selective Reduction: Ultrasound-guided procedures reduce the number of fetuses in high-order multiple gestations.
2. Cord Occlusion: Ultrasound-guided cord occlusion treats complications like twin-to-twin transfusion syndrome.
3. Intrauterine Transfusions: Ultrasound-guided transfusions manage fetal anemia.

Predictive Role:

1. Preterm Birth Risk: Ultrasound assesses cervical length and fetal fibronectin to predict preterm birth risk.
2. Fetal Complications: Ultrasound detects potential complications like twin-to-twin transfusion syndrome or fetal anomalies.

Current Advances:

1. 3D/4D Ultrasound: Enhances fetal anatomy evaluation and guides interventions.
2. Doppler Ultrasound: Evaluates fetal blood flow and detects potential complications.
3. Fetal Echocardiography: Assesses fetal heart structure and function.

Best Practices:

1. Regular ultrasound examinations (every 2-4 weeks)
2. Standardized ultrasound protocols
3. Multidisciplinary care teams
4. Patient education and counseling

Conclusion:

Ultrasound plays a critical role in managing multiple gestations, ensuring timely diagnosis, monitoring, and intervention. Advancements in ultrasound technology continue to improve fetal and maternal outcomes.

Recommendations:

1. American College of Obstetricians and Gynecologists (ACOG)
2. Society for Maternal-Fetal Medicine (SMFM)
3. International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)
4. Fetal Diagnostics and Ultrasound Centre Benin (FDUC)