Modern Abilities of Ultrasound Diagnostics in Obstetrics and Gynecology in a Private Medical Centre

The goal: to analysis of ultrasound diagnostics to identify hereditary and congenital abnormalities of the fetus, as well as gynecological diseases in the private clinic Medical Centre Lotos. Material and methods. A retrospective analysis of surveys 11645 female-patients aged 18 to 45 years divided into 3 groups. The first group (n = 3046) consisted of patients who underwent screening ultrasound examinations on the 11-14 weeks of pregnancy, 18-21 weeks and 32-34 which let reveal congenital malformations of the fetus. On the terms of gestation of 11-14 and 18-21 markers of chromosomal fetal malfunctions were estimated, that gave the second group of patients (n = 3840). The third group (n = 3772) - patients who had ultrasound to reveal pathologies of small pelvis organs. Examinations were carried out with Ultrasound Scanners Voluson 6 Expert (General Electric The UK), convex transducer 2-5 MHz and transvaginal transducer 4-9 MHz with 3D scanning technologies. The obtained data were compared with the ultrasound department results of inter district centre of prenatal diagnostics Chelyabinsk city. Comparison of the efficiency of research was carried on the basis of one-factor dispersive analysis. Results. 85 fetuses with congenital malformations were revealed in the first group (2.8% from the amount of patients), that suits common data. In the second group the carrying out of ultrasound and biochemical screening revealed 18 patients with the high risks of fetal malformations. To prove fetal chromosomal anomalies in this group prenatal karyotyping was performed. Some gene mutations were revealed: autosomal in the form of trisomy (2 cases of Down's syndrome) and X-Chromosome monosomy (1 case of Turner's syndrome). In the third group in 71.1% examinations gynecological pathology with the biggest unit weight of womb mioma, endometriosis, ovarian cysts and tumors were revealed. Conclusions. MC “Lotos” doesn't yield a 2nd level medical organization - inter district centre of prenatal diagnostics in Chelyabinsk city according to the structure of revealed pathology in obstetrical and gynecological and can be included in territorial programme of state guarantees of free medical service on the basis of private - state partnership.

пренатальная диагностика, пороки развития плода, хромосомные аномалии, частная медицинская клиника, prenatal diagnosis, fetal malformations, сhromosomal anomalies, private medical centre

1. Стародубов В.И., Суханова Л.П., Сыченков Л.Г. Репродуктивные потери как медико-социальная проблема демографического развития России. Социальные аспекты здоровья населения. Эл. журнал. 2011; 6 (22): http://vestnik.mednet.ru (дата обращения 8.12.2014).

2. Snijders R.J., Johnson S., Nicolaides K.H. et al. First-trimester ultrasound screening for chromosomal defects. Ultrasound Obstet.Gynecol.1996; 7: 216-226.

3. Bhaduri M., Fong K., Toi A. et al. Fetal anatomic survey using three-dimensional ultrasound in conjunction with first-trimester nuchal translucency screening. Prenat. Diagn. 2010; 30: 267-273.

4. Гаврикова О.А., Блинов А.Ю., Брюхина Е.В. и др. Пренатальная ультразвуковая диагностика врожденных пороков развития в ранние сроки беременности. Материалы IV Регионального форума “Мать и дитя”. М., 2010. 64.

5. Syngelaki A., Chelemen T., Nicolaides K.H. et al.Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks. Prenat.Diagn. 2011; 31: 90-102.

6. Wax J., Minkoff H., Johnson A. et al. Consensus report on the detailed fetal anatomic ultrasound examination: indications, components, and qualifications. J. Ultrasound Med. 2014; 33: 189.

7. Kagan K.O., Wright D., Nicolaides K.H. et al. Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet. Gynecol. 2008; 31: 618-624.

8. Benacerraf B.R., Shipp T.D., Bromley B. Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet. Gynecol. 2009; 34: 110-115.

9. Bagratee J.S., Regan L., Khullar V. et al. Reference intervals of gestational sac, yolk sac and embryo volumes using three-dimensional ultrasound. Ultrasound Obstet. Gynecol. 2009; 34: 503-509.

10. Bermejo C., Martfnez Ten P., Cantarero R. et al. Threedimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet. Gynecol. 2010; 35: 593-601.

11. Votino C., Cos T., Abu-Rustum R.S. et al. Use of spatio-temporal image correlation at 11-14 weeks' gestation. Ultrasound Obstet. Gynecol. 2013; 42 (6): 669-678.

12. Crane J.P, Le Fevre M.L., Winborn R.C. et al. A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. Am. J. Obstet. Gynecol. 1994; 171: 392-399.

13. Ghi T., Huggon I.C., Nicolaides K.H. et al. Incidence of major structural cardiac defects associated with increased nuchal translucency but normal karyotype. Ultrasound Obstet. Gynecol. 2001; 18: 610-614. 20. 21. 22.

14. Chaoui R., Nicolaides K.H. From nuchal translucency to intracranial translucency: towards the early detection of spina bifida. Ultrasound Obstet. Gynecol. 2010; 35: 133-138.

15. Geipel A., Gembruch U. Screening performance of first trimester nuchal translucency, ductus venosus blood flow and tricuspid regurgitation for cardiac defects. Z. Geburtshilfe Neonatol. 2012; 216 (4): 157-161.

16. Salvesen K., Lees C., Abramowicz J. et al. ISUOG statement on the safe use of Doppler in the 11 to 13 + 6-week fetal ultrasound examination. Ultrasound Obstet.Gynecol. 2011; 37: 628.

17. Salomon L.J., Alfirevic Z., Berghella V. et al. ISUOG Clinical Standards Committee. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet. Gynecol. 2011; 37: 116-126.

18. Simpson L.L. Screening for congenital heart disease. Obstet. Gynecol. Clin. N. Am. 2004; 31: 51-59.

19. Веропотвелян Н.П., Студникова В.С., Кодунов Л.А. и др. Спонтанная эволюция врожденных изолированных дефектов межжелудочковой перегородки сердца у детей первого года жизни. Ультразвуковая и функциональная диагностика. 2009; 4: 11-23.

20. Slimani S., Kehila M., Hammami A. et al. Role of early ultrasound in prenatal screening for morphological abnormalities in the first trimester. 13th World Congress in Fetal Medicine. https:// fetalmedicine.org/abstracts/2014. (дата обращения 24.11.2014).

21. Sonek J. First trimester ultrasonography in screening and detection of fetal anomalies Am. J. Med. Genet.2007; 145: 45-61.

22. Abu-Rustum R.S., Daou L., Abu-Rustum S. Role of first-trimester sonography in the diagnosis of aneuploidy and structural fetal anomalies. J. Ultrasound Med. 2010; 29: 1445-1452.