Table of contents:
- Why are the first and second screenings needed?
- How does the third screening differ from the first two?
- Will the third screening be paid only?
- So do you need a third screening or not?
Since the beginning of 2021, the procedure for providing medical care in the field of "obstetrics and gynecology" has been changed in Russia. The most discussed innovation was the abolition of the third mandatory screening. We will tell you what doctors think about it, and why many of them believe that ultrasound in late pregnancy is vital for expectant mothers.
On January 1, 2021, a new order of the Ministry of Health began to operate "On the approval of the procedure for the provision of medical care in the profile of" obstetrics and gynecology "(with the exception of the use of assisted reproductive technologies)".
The document turned out to be twice the size of the previous one, which was adopted in 2012, and changed many of the rules for examining pregnant women. For example, the number of visits to an obstetrician-gynecologist was reduced from seven to five, to a dentist - from two to one, and the obligatory visit to an otolaryngologist was completely canceled.
The women reacted calmly to some innovations: some are even glad that there is no need to waste time visiting the lore. But the cancellation of ultrasound in late pregnancy is very worrisome for expectant mothers.
Why are the first and second screenings needed?
The first compulsory ultrasound scan in Russia is performed at 11-13 weeks. The doctor determines the exact duration of pregnancy, assesses the physique of the child and the symmetry of the brain, looks at how the heart of the embryo works, characterizes the volume of amniotic fluid, the structure and size of the placenta, the state and tone of the uterus.
Obstetrician-gynecologist Irina Gordeeva on the Novosibirsk Online portal explains that the first screening is necessary to identify chromosomal pathologies, which are often incompatible with life: they are direct indications for termination of pregnancy. In this case, 15 parameters are evaluated, but ultrasound does not give 100% guarantees: anomalies can go unnoticed.
During the second screening at 18-21 weeks, they look at the position of the child, the place of attachment of the umbilical cord, the volume of amniotic fluid, the bone structure and the state of the internal organs of the fetus. About 20 parameters are already being evaluated, and you can see pathologies that were not recorded by the first ultrasound: the heart, blood flow, brain structures, organs of the abdominal and thoracic cavities are already visualized.
How does the third screening differ from the first two?
The logic behind the screening sequence is simple: the embryo changes, and each transformation requires observation - after all, different problems become noticeable at different stages of fetal development. And therefore, Gordeeva believes, the third ultrasound is just as necessary as the first two: after all, it allows you to identify abnormalities that were not diagnosed during previous studies.
The monograph by MV Medvedev and NA Altynik "Screening ultrasound examination at 30-34 weeks of gestation" lists pathologies that become apparent in the third trimester. These are the majority of congenital tumors of the brain and heart, anomalies in the development of the testicles, penis and urethra, as well as various neoplasms. There will be no third ultrasound - and they may go unnoticed.
Also, it is according to the results of the third screening that the physician decides whether a woman needs a cesarean section. For example, a girl will be sent to him, whose baby is lying incorrectly or the umbilical cord has wrapped around his throat. Sometimes it is an ultrasound scan at a later date that shows that a woman needs to give birth not in an ordinary maternity hospital, but in a specialized one, where the problem child can immediately be helped.
Concerned women share their experiences on forums, and there are enough of those whose children the third screening saved their lives.
Will the third screening be paid only?
Officials explain that women need not worry: the third screening will remain free. It will only cease to be mandatory: pregnant women will be referred to it if indicated.
An additional ultrasound scan in the third trimester will be prescribed if there is a suspicion of an incorrect position or presentation of the child, in the absence or violation of the fetal heart rate and other disorders. They also promise a third screening for women at risk: for example, those with significant excess weight or carrying twins - in this case, the usual methods of obstetricians are not enough to determine the position of the fetus.
The gynecologist draws up perinatal risk scales in each trimester, explains Ekaterina Voropaeva, deputy chief physician for obstetrics and gynecology of the Chelyabinsk OKB No. 2, and if the scores are high, the woman will definitely be sent for the third ultrasound - this is in the doctor's interests. She adds that she sees no point in assigning such a study to a young healthy woman with her first pregnancy.
So do you need a third screening or not?
Disputes about this do not stop. Some doctors consider the procedure unnecessary, and draw attention to the fact that in most European countries there is no third compulsory screening. Others answer: so we are not in Europe! There, and the equipment is different, and insurance may include other tests: for example, NIPT - a genetic test, which already in the fourth week allows you to detect many pathologies.
Women themselves debate. Some say that in any case they will go to a paid clinic, because the "horsemen" in ordinary hospitals do not really know how to do anything. Others consider the procedure unnecessary, because other tests are sufficient. Still others blame the coronavirus: they say, colossal money is being spent on the pandemic, and now officials are trying to "bite off" the budget intended for pregnant women.
But for what reasons the third screening was canceled, in essence, it does not matter. Simple logic dictates: pregnancy is a complex and dynamic process, and the more supervision and control over it, the more a woman has a chance to safely give birth to a child. A visit to the dentist may indeed be superfluous, but an ultrasound scan of the fetus is not at all a check of fillings.
Not all women have the means to pay for an ultrasound scan on their own: for many, the amount of one and a half to two thousand rubles is significant. And the very fact of canceling the third screening affects the attitude towards him: probably, since the doctors deleted him from the list of mandatory procedures, then it is not so important, the girls will think. There is no guarantee that even the healthiest woman will not have problems after the first two "clean" screenings. So one can understand the uzists who are protesting against the new rules and demanding their abolition.
If you are on their side, pay attention to the petition of the obstetrician-gynecologist Nikolai Vladimirovich Pipenko, who believes: the third ultrasound should be free and compulsory. The petition has already collected 50+ thousand signatures, but the more there are, the higher the likelihood that officials will think: is it worth saving on young mothers?
If you have already signed the petition, read our other articles: what nine signs of pregnancy few people know about, how a pregnancy test works and what you will need during the nine months that you will be carrying a baby.
