Kuyini lokhu?
Kuwo wonke omama abazoba khona abahloliwe, iqembu labesifazane liyabonakala, okuba nemiphumela ehluke kakhulu kunomkhuba. Lokhu kusikisela ukuthi emntwaneni wabo amathuba okuba ne-pathologies noma amaphutha aphakeme kunamanye. Ukuhlolwa kwangaphambi kokubeletha kuyinkimbinkimbi yezifundo ezihloswe ekutholeni ukukhubazeka okuthuthukayo noma ukukhubazeka okungathí sina kwengane. Le nkimbinkimbi ihlanganisa:
Ukuhlolwa kwesimo semvelo - ukuhlolwa kwegazi okukuvumela ukuba unqume ukuthi kukhona izinto ezithile ("izimpawu") egazini elishintsha kwezinye izifo ezinjenge-Down's syndrome, i-Edwards syndrome, ne-neural tube defects. Ukuhlolwa kwamakhemikhali yedwa kuphela ukuqinisekiswa kwamathuba, kodwa hhayi ukuxilongwa Ngakho-ke, naye ucwaningo olwengeziwe lwenziwe;
♦ Ukuhlolwa kwe-Ultrasound (i-ultrasound) - kwenziwa ku-trimester ngayinye yokukhulelwa futhi kuvumela ukubona inqwaba yeziphambeko ze-anatomical nokungajwayelekile kokuthuthukiswa kwengane. Ukuhlolwa kwangaphambi kokubeletha kunezinyathelo eziningana, okubalulekile kuzo zonke, njengoba inikeza ulwazi mayelana nokuthuthukiswa kwengane nezinkinga ezingenzeka.
Izingozi zokuthuthukisa ukwelashwa kwengane engakazalwa:
♦ iminyaka yobudala yowesifazane ingaphezu kweminyaka engama-35:
♦ okungenani kube nokukhipha isisu okungenani kokubili kokuqala kokukhulelwa;
♦ sebenzisa ngaphambi kokukhulelwa noma ekuqaleni kwezinyathelo zokukhulelwa kwamalungiselelo amaningi emithi;
♦ iphathwe yi-bacterial mother's future, infections viral;
♦ Ukuba khona emndenini wengane ene-genetically confirmed Down syndrome, ezinye izifo ze-chromosomal, izinkinga zokuzalwa ezingenayo;
♦ Ukuthuthwa komndeni kwezinto ezingavamile;
♦ izifo ezithinta izifo emndenini oseduze;
♦ ukuvezwa kwemisebe noma ezinye izinto ezilimaza komunye wabashade ngaphambi kokukhulelwa.
Yini ehlola ukuhlolwa kwezinto eziphilayo?
• I-subunit yamahhala ye-hormone ye-chorionic yabantu (hCG)
• I-RARP A yiprotheni ehlobene ne-plasma A.
HGH hormone ikhiqiza amaseli egobolondo le-embryo (i-chorion). Kungenxa yokuhlaziywa kwe-hCG ukuthi ukukhulelwa kungathathwa kakade ngosuku lwesibili-3 emva kokukhulelwa. Izinga le-hormone liyakhula ngo-1 trimester futhi lifinyelela ekuphakameni kwalo ngamasonto 10-12. Ngaphezu kwalokho, iyanciphisa kancane kancane futhi ihlale ihlala njalo phakathi nengxenye yesibili yokukhulelwa. I hormone yeHCG inamayunithi amabili (i-alpha ne-beta). Enye yazo i-beta ehlukile, esetshenziselwa ukuxilongwa.
Uma izinga le-hCG liphakanyisiwe, lingakhuluma nge:
• Amaphutha amaningi (okujwayelekile kweHCG ukwanda ngokulingana nenani lezithelo);
• I-Down's syndrome nezinye izifo;
♦ i-Toxicosis;
♦ isifo sikashukela kumama ozayo;
♦ isikhathi esingakalungi sokukhulelwa.
Uma izinga le-hCG liyancipha, likwazi ukukhuluma ngalokhu:
♦ ukuba khona kwe-ectopic pregnancy;
♦ Ukukhulelwa okungathuthuki noma ukusongelwa kokukhipha isisu;
♦ ukuthuthukiswa okuphuthumayo kwengane ezayo;
♦ ukungabi khona kwamapayipi;
♦ Ukufa komntwana (ku-III-III trimester yokukhulelwa).
Kubalwa ngefomula elandelayo:
I-MoM - ukubaluleka kwenkomba ku-serum ehlukaniswe nenani eliphakathi lenkomba yalesi sikhathi sokukhulelwa. Ukujwayelekile kuyigugu lenkomba eduze komunye.
Kunezici eziningana ezingathonya ukubaluleka kwezinkomba ezitholakalayo:
♦ isisindo sowesifazane okhulelwe;
♦ ukubhema;
♦ ukuthatha imithi;
• umlando wesifo sikashukela okhulelwe kumama ozayo;
• ukukhulelwa ngenxa ye-IVF.
Ngakho-ke, lapho ubala izingozi, odokotela basebenzisa i-MoM value elungisiwe. Ukucabangela zonke izici nezici. Izinga lama-MoM kusuka ku-0.5 kuya ku-2.5. Futhi uma kwenzeka ukukhulelwa okuningi, kufika ku-3.5 MoM. Kuye ngemiphumela etholakalayo, kuzocaca ukuthi umama wesikhathi esizayo usesengozini ye-chromosomal pathologies noma cha. Uma kunjalo, udokotela uzokwazisa ucwaningo oluqhubekayo. Akudingekile ukukhathazeka kusengaphambili uma unikezwe ukuhlolwa kwesigamu sesibili - kunconywa ukuthi bonke abesifazane abakhulelwe bahlolwe, kungakhathaliseki ukuthi yini imiphumela yesigaba sokuqala sohlolo. UNkulunkulu uvikela ephephile!
II Imibuzo Yokuhlola
"Ukuhlolwa kathathu"
Kuqhutshwa isonto eli-16 kuya kweleshumi lama-20 lokukhulelwa (isikhathi esifanele kusukela ngesonto lama-16 ukuya ku-18).
Ukuhlola okuhlanganisiwe
• Ukuhlolwa kwe-ultrasound (ukusebenzisa idatha etholakala ku-trimester yokuqala);
• Ukuhlolwa kwezinto eziphilayo;
• Ukuhlolwa kwegazi nge-AFP;
I-estriol yamahhala;
• i-gonadotropin ye-chorionic (hCG). Ukuhlolwa kwesibili kuhlose ukukhomba ingozi yokuba nengane ene-Down's syndrome, i-Edwards, i-neural tube defect kanye nezinye izimo ezimbi. Ngesikhathi sokuhlolwa kwesibili, ukuhlolwa kwehomoni ye-placenta nesibindi sesisu se-fetus, esithwala ulwazi oludingekayo mayelana nokuthuthukiswa kwengane. I-hormone ye-HCG isivele ikhankanywe ngenhla, kodwa enye enye idinga izincazelo.I-Alfa-fetolrothein (AFP) yiprotheni ekhona egazini lomntwana izigaba zakuqala zokuthuthukiswa kwamabrionic. Ukwenziwa kwesibindi nesisu somntwana we-fetus.Isenzo se-alpha-fetaprotein sihlose ukuvikela isisu kusuka ohlelweni lomzimba lwamasosha omama.
Ukwanda kwezinga le-AFP kubonisa ukuthi kungenzeka ukuthi kukhona khona:
♦ ukungalungi kwe-neural tube ye-fetus (i-anencephaly, i-spina bifida);
♦ I-Meckel syndrome (isibonakaliso - i-occipital craniocebrbral hernia;
♦ i-athera atresia (i-pathology of development fetal, lapho i-fetus ebusweni iphela ngokungafihli, ingafinyeleli esiswini (ingane ayinakudla ngomlomo) 1 ";
♦ i-hernia embilical;
♦ okungenalo uthando emdongeni wangaphakathi lwesisu lomntwana;
♦ I-fetal fover necrosis ngenxa yokutheleleka ngegciwane.
Ukunciphisa izinga le-AFP kusikisela:
♦ I-Down's syndrome - i-trisomy 21 (isikhathi emva kwamasonto ayishumi okukhulelwa);
♦ U-Edwards syndrome - i-trisomy 18;
♦ isikhathi sokukhulelwa okungalungile (okukhulu kunesidingo sokucwaninga);
♦ ukufa kwe-fetus.
- Amazinga we-AFP ku-serum
I-estriol yamahhala - le hormone ikhiqiza kuqala i-placenta, futhi kamuva isibindi se-fetus. Esikhathini esijwayelekile sokukhulelwa, izinga le-hormone likhula njalo.
Ukwanda kwezinga le-estriol kungakhuluma nge:
♦ Ukukhulelwa okuningi;
♦ isithelo esikhulu;
♦ Izifo zesibindi, isifo sezinso kumama ozayo.
Ukuncipha ezingeni lika-estriol kungabonisa:
♦ ukungakwazi ukusebenza ngokwe-fetoplacental;
♦ I-Down's syndrome;
♦ Anencephaly of the fetus;
♦ usongo lokubeletha ngaphambi kwesikhathi;
♦ i-Adrenal hypoplasia ye-fetus;
♦ ukutheleleka kwe-intrauterine. Izindlela ze-estriol ku-serum.
Ukuhlolwa kwe-Ultrasound III Trimester
Iqhutshwa kusukela nge-30 ukuya kweyama-34 ngesonto lokukhulelwa (isikhathi esiphezulu sisuka ku-32 kuya kwesonto lama-33). I-ultrasound ihlola isimo kanye nendawo ye-placenta, inquma inani le-amniotic fluid kanye nendawo ye-fetus esibelethweni. Ngokwezibonakaliso, udokotela angakwazi ukunikeza izifundo ezengeziwe - i-dopplerometry ne-cardiotocography. I-Doppler - lolu cwaningo lwenziwe kusukela ngesonto lama-24 lokukhulelwa, kodwa ngokuvamile odokotela bayalibeka ngemuva kweviki lama-30.
Izinkomba zokwenza:
♦ ukungakwazi ukusebenza ngokwe-fetoplacental;
♦ ukwanda okwanele ekuphakameni kokuma kwe-uterine fundus;
♦ Ukungaxhunyiwe kwendwangu yomzimba;
♦ gestosis, njll
I-Doppler yindlela ye-ultrasound enikeza ulwazi mayelana nokunikezwa kwegazi lesisu. Ijubane lokugeleza kwegazi emithonjeni yesibeletho, intambo yomzimba, umthambo we-cerebral middle kanye ne-aorta ye-fetus uphenywa futhi kuqhathaniswa namanani okwamanje. Ngokusho kwemiphumela, iziphetho zithathwa ngokuthi ngabe i-fetus blood supply iyinto evamile, kungakhathaliseki ukuthi kukhona ukuntuleka kwe-oxygen nezakhi. Uma kunesidingo, izidakamizwa zibekiwe ukuba zithuthukise ukunikezwa kwegazi kwe-placenta. I-Cardiotocography (CTG) iyindlela yokurekhoda izinga lokushaya kwenhliziyo lesisu kanye nezinguquko zalo ekuphenduleni izinqamulelo ze-uterine. Kunconywa ukuba uchithe kusukela ngesonto lama-32 lokukhulelwa. Le ndlela ayikho ukuphikiswa. I-CTG yenziwa ngosizo lwenzwa ye-ultrasonic, ekhonjiswe esiswini sowesifazane okhulelwe (ngokuvamile esetshenziswa ngaphandle, okuthiwa yi-CTG engaqondile). Ubude be-CTG (kusukela emaminithini angu-40 ukuya kwangu-60) kuxhomeke ezigabeni zomsebenzi nokunye kwe-fetus. I-CTG ingasetshenziswa ukuqapha isimo somntwana nangesikhathi sokukhulelwa, nangesikhathi sokuzalwa ngokwaso.
Izinkomba ze-CTG:
♦ isifo sikashukela kumama ozayo;
♦ ukukhulelwa nge-Rh factor engalungile;
♦ ukutholakala kwama-antiphospholipid antibodies ngesikhathi sokukhulelwa;
♦ ukuphuza ekukhuleni komntwana.
Udokotela uqondisa ekuhlolweni futhi (uma kunesidingo) uncoma ukuhlolwa okunye, kodwa akumelwe athinte isinqumo sowesifazane. Omama abaningi abasaqala baqale ukwenqaba ukuhlola ukuhlola, bephikisana ngokuthi bazobeletha kunoma yikuphi, kungakhathaliseki ukuthi yini imiphumela yocwaningo. Uma ungena kwinombolo yabo futhi ungafuni ukwenza ukuhlolwa, khona-ke lokhu kuyakwesokudla, futhi akekho ongakuphoqa. Indima kadokotela ukuchaza ukuthi kungani ukuhlolwa kokubeletha kuqhutshwa, yiziphi izifo ezingase zenziwe ngenxa yocwaningo oluqhubekayo, futhi uma kwenzeka izindlela zokuxilonga ezingavamile (chorionic biopsy, amniocentesis, cordocentesis), tshela ngezingozi ezingenzeka. Phela, ingozi yokukhipha isisu emva kokuhlolwa okunjalo i-2%. Udokotela kumele futhi akuxwayise ngalokhu. Ngeshwa, odokotela abanaso isikhathi sokuchaza ngokuningiliziwe imiphumela yokuhlola. Sithemba ukuthi kulesi sihloko sikwazi ukucacisa ezinye izici zalolu cwaningo olubalulekile.