Echocardiography Winner of delivery!
#SaberEsPoder and the 3 essential ultrasounds of pregnancy are: screening at week 12, morphological study at week 20 and fetal echocardiography starting at week 28.
With great joy we share with you the echocardio of our patient who won the raffle for the fees of a birth, I hope it allows us to continue sharing more of her pregnancy.
Introduction
In this ultrasound what we are going to check is your baby’s little heart. OK? To make sure you don’t have heart disease, okay? Let’s see first how he is… Look over here he’s in a ball. This is the head, the body up here, here comes the neck and the back, the spine, the spine, the spine, then over here the buttocks. Everything black in the ultrasound is water. It has a good amount of liquid. This is a little leg.
We already know sex, right? She’s still a girl. Booty and leg here, booty and leg here and here the lips of the vulva But look how she is here… All contortionist, I remember that she was sitting down. Yes and so it goes. Now look, if I come down here, this is the exit, this is the cervix, this is where you saw… There is nothing, it’s something, your baby is up here. She is like this crossed, she is sitting crossed. Now they change positions, right? Yes, right now it has a lot of space. Because last time she had her head on and now she is… Right now she already sat down.
This is the heart that we are going to listen to. She is going at a good pace, she is going fast and she has a heart rate of 141, which is normal, between 120 and 160. We are going to start by measuring your baby’s bones to see how she is growing. This is the little head seen from above, the crown. From one temple to the other. BPD 73.3 and this is the head circumference: Head circumference 257.3 very good. The little face that is hidden here looks at the forehead, one eye, the other eye, the nose, the little mouth over here. This is a slice of the abdominal circumference, this black circle is the stomach that is full, which tells us that it is swallowing the liquid well. Here we are going to measure… her tummy. Abdominal circumference 242.1 and here the legs, this little white line is the leg bone, the femur and here you can see the knee, here is the face, everything together there. She is balled up, exactly, she is very comfortable. And this is the bone of the other leg, which is the femur. Femur 52.1 Millimeters, 5 centimeters, 5.2 centimeters. Here is your baby’s face. I’m going to move you a little to see if he changes position. So that you can see the heart better, because you can see that it is made into a ball and takes more work. Have a good view of the little heart. Right now your baby weighs 200 kilos. Yes, she is chubby, she is 28 weeks old, she is perfect. According to the time of pregnancy, 28 weeks is the best time to study the baby’s heart. It’s the little hand, have you seen the hand yet? These are the little fingers of the hand, the placenta that is here at the bottom of the uterus, which is very good, that is where it has to be.
The blackness of water is seen with a very good amount of liquid, all of this is water. Maximum lagoon 71 which is perfect. This is like, the droplets that you are going to see here with 2 colors is the umbilical cord. Here I see how the blood passes through the umbilical cord. And this tells us how the placenta is oxygenating your baby and is doing very well. Okay? How it feeds, how it oxygenates. IP 1.03, IR 0.66 This placenta is working well. If the liquid runs out, doctor, are you feeling? The baby is starting to run out of fluid. Isn’t there a symptom? No, only with the check-ups can you know or unless the membranes have ruptured and you feel that it is getting you wet. Because you see that there are cases where the liquid runs out. That is why it is important to check to see that it is not liquid. And what could be the reason for that? Many times when a baby does not feed well, the blood does not reach them well, they stop producing amniotic fluid, they produce 90% of it. If they are no longer growing much, they also urinate less and produce less fluid. So it has to do with food, too, yes.
Fetal echocardiography, the baby's heart
Here we are seeing the little heart, nothing more than the fact that it has the column in front of it makes us all this shadow. The heart. His ribs, his spine, his heart. That which moves is the heart, these are the two ventricles, the two atria, it is a small slice at the level of the thorax. Left is this side, right is this side. The tip of the heart towards the left side, if I make an imaginary line of the spine starting in the middle of the heart, it makes an angle of 45 degrees, that is the cardiac axis that tells us that it is not deviated either to the left or to the right. right, it is in a normal position. The left atrium is more elongated, the right one is rounder and the ventricles are the same size. Between the two atria there is this little door that opens and closes, it is the foramen ovale that is going to close, but until the moment of birth, now it is normal for it to be open. These are the valves of the heart; mitral and tricuspid are at the same level, opening and closing at the same time.
Here I put colors to see how the blood passes, there are no sudden changes in color, which tells us that these valves open and close correctly. Between the two ventricles you will see this little white line, this here is the interventricular septum. This is the interventricular septum that prevents the passage of blood from one side to the other, I paint it in colors and there I see that the blood does not mix, it is not seen that it is passing from one side to the other, well separated, well. Exit of the pulmonary artery, the right ventricle, that leaves this black line that is the exit of the pulmonary artery and from the left ventricle it goes up and comes this other artery, the aorta. When they are not crossed is when there is a problem and it is seen that it is crossing the aorta very well. Well, the exit of the great vessels is good, the pulmonary artery is made like a Greek “y”, the bifurcation of the pulmonary artery is good. To the left atrium, these little black stripes that reach are the pulmonary veins, pulmonary veins well.
If my baby had a heart problem, would she see herself now? This is what she would detect, a large percentage of heart diseases are detected with this study. But the patient doesn’t feel? No, the mother doesn’t feel anything. But with this we could know if there is any heart disease, be ready until the moment of birth, have the cardiologist for a more in-depth examination of the baby. Here is the pulmonary, the aorta and here they join, it is the ductus arteriosus which is also a little door that will close but until the baby is born. This is the transverse plane that is the pulmonary, aorta and cava, it looks good.
Here we are going to make… A handle of a cane, so that it can be seen, that it is marked, there I see that there are no narrowings, that there are no blockages and that the blood passes freely. And this is the aorta that supplies our entire body. Right now can you tell how tall he is from head to toe? Yes, well, an approximate. Here come the vena cavae that reach the right atrium, perfect, cava drainage well. His little heart is perfect, he has no heart disease, it is a normal sized heart, well located and well formed.
Let’s see if he leaves it in 4D by uncovering his face a little. Let’s see if he removes his hand, he already stretched a little, see. Here is the little head, the eyes, the nose but she has her hand in front… She is in profile, exactly. It’s the profile. It looks good but the little hand is in front of it. Many times here we have to do the 4D, but the baby has to cooperate, when they cooperate is when you can see, otherwise look with the little hand he is covering the face and right now with the little hand… From week 26 onwards it is the best time to do the 4D You just have to cooperate, then maybe the next visit you can see it, remove your little hand and let it be seen. OK? All very well! Congratulations!
Conclusions
Well, as you may have seen in the study and everything we explained, this little heart is a healthy heart, it is a baby that grows according to the time of pregnancy, which is 28 weeks. Remember fetal echocardiography, the ideal time is from week 26, the normal recommendation is between 26 and 31, this is when you can best see the baby’s heart. Of course, from week 20 we begin to see that heart very well, but we like the fine details around week 28.
This is our patient who met us on YouTube and who came to do the first trimester screening study in week 12, who came to do the structural and morphological study and is now with us in the study of the little heart, the echocardiography fetal. Well, remember we are here at Creafam to serve and help you, if at any time you have any questions about how your baby is doing, come to us, we can help and advise you.
Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.