Izindlela zokuthola isifo sokubeletha ngaphambi kokubeletha: izakhi zofuzo, ezingenayo, ezingenasidingo. Izinkomba zokuqokwa, imiphumela

Ukuxilongwa kwangaphambi kokubeletha kuyinkimbinkimbi yokuhlolwa kokuthuthukiswa kokukhulelwa. Umgomo oyinhloko ukutholakala kwamathambo ahlukahlukene ebusweni ezinyathelweni zokuthuthukiswa kwe-intrauterine.

Izindlela ezivame kakhulu zokuxilongwa ngaphambi kokubeletha: ukwenza i-ultrasound, okuqukethwe kwamakaki ahlukahlukene egazini owesifazane okhulelwe, i-biopsy ye-chorion, ethatha intambo yegazi, i-amniocentesis.

Kuyini ukuhlolwa kokubeletha?

Ukusebenzisa izindlela ezihlukahlukene zokuxilongwa ngaphambi kokubeletha, kungenzeka ngempela ukuthola ukukhushulwa kwesisu ngendlela efana ne-Edwards syndrome, i-Down's syndrome, ukuphazamiseka kwenhliziyo nokunye okungajwayelekile. Ngokuqinisekile imiphumela yokuthola isifo sokubeletha ngaphambi kokubeletha inganquma isiphetho somntwana. Emva kokuthola idatha yokuhlonza ngokubambisana nodokotela, unina unquma ukuthi umntwana uzozalwa noma ukukhulelwa kuzophazanyiswa. Ukubikezela okuthakazelisayo kungavumela ukuvuselelwa kwe-fetus. Ukuxilongwa kwangaphambi kokubeletha kuhlanganisa ukusungulwa kobunikazi ngendlela yokuhlolwa kwezinto zokuzalwa, okwenziwa ekuqaleni kwezigaba zokukhulelwa, kanye nokuzimisela kobulili bomntwana. Zonke lezi zinsizakalo enhlokodolobha zihlinzekwa yisikhungo sokuHlola ngaphambi kokubeletha eMas Avenue, esiholwa nguProfesa M.V. Medvedev. Lapha ungakwazi ukuhlolwa okuphelele ngaphambi kokubeletha, kuhlanganise ne-ultrasound. Isetshenziswe kusikhungo sobuchwepheshe besimanje se-3D, 4D.

Izindlela zokuxilongwa ngaphambi kokubeletha

Ukuhlolwa kwangaphambi kwesikhathi kokubeletha kusetshenziswa izindlela eziningi nobuchwepheshe. I-Degree, kanye nezinga lamathuba abaye bahluka. Ngokuvamile, ukuxilongwa kwangaphambi kokubeletha kuhlukaniswe ngamaqembu amakhulu amabili: ukuxilongwa kwangaphambi kokubeletha ngaphambi kokubeletha nokungahambi kahle.

Okungenasidingo, noma njengoba kubizwa nangokuthi, ukungena okuncane, izindlela azihlinzeki ngokungenelela okuhlinzekwayo nokuhlukunyezwa kumntwana nomntwana. Izinqubo ezinjalo zinconywa kubo bonke abesifazane abakhulelwe, akuzona neze eziyingozi. Ukuhlolwa okuhleliwe kwe-ultrasound kumele kudlule ngempela. Izindlela ezivame ukubandakanya ukungena (ukuphazamiseka) emzimbeni wesifazane okhulelwe, emgodini wesibindi. Izindlela aziphephile ngokuphelele, ngakho udokotela uzibeka ezimweni ezimbi kakhulu, lapho umbuzo wokulondoloza impilo yengane engakazalwa.

Ukuxilongwa kwangaphambi kokubeletha ngaphambi kokubeletha

Izindlela ezingekho emangalisweni zifaka ukuhlolwa kwe-ultrasound noma kokubeletha kokubeletha, okukuvumela ukuthi ugcine izinyathelo ezivela ekuthuthukiseni i-fetus. Ukungahlosiwe nakho kubhekwa ukuxilongwa kokubeletha kokubeletha kwe-fetus ngokusho kwezinto ze-serum zegazi lomama.

I-Ultrasound iyindlela ejwayelekile kunazo zonke, ayinayo imiphumela eyingozi kumuntu wesifazane nomntwana ngokwakhe. Ingabe bonke omama abazayo kufanele bafunde lolu cwaningo? Lo mbuzo uphikisana, mhlawumbe akudingeki ngaso sonke isikhathi. I-Ultrasound inqunywe udokotela ngezizathu eziningi. Esikhathini sesithathu sokuqala, unganquma inani lokukhulelwa, kungakhathaliseki ukuthi ingane iphilile, iyini isikhathi esiqondile. Ngenyanga yesine, i-ultrasound ingabonisa kakade ukungalungi okuncane kokuzalwa komntwana, indawo ye-placenta, kanye nenani lama-amniotic fluid. Ngemuva kwamaviki angu-20, kungenzeka ukuthi unqume ubulili bomntwana ongakazalwa. Ivumela i-ultrasound ukubona izinkinga ezihlukahlukene uma ukuhlaziywa kubonisa owesifazane okhulelwe ophezulu we-alpha-fetoprotein, futhi futhi uma kunezinkinga zokuthuthukiswa emlandweni womndeni. Kufanele kuqaphele ukuthi akukho mphumela we-ultrasound ongaqinisekisa ukuzalwa okungu-100% kwe-fetus enempilo.

I-ultrasound yenziwa kanjani?

Ukuxilongwa ngaphambi kokubeletha ngaphambi kokubeletha ngesimo se-ultrasound kunconywa kubo bonke abesifazane abakhulelwe ngemigomo elandelayo:

• Isonto eli-11-13 lokukhulelwa;
• 25-35 ngesonto lokukhulelwa.

Ukuxilongwa komzimba womzimba womama, kanye nokuthuthukiswa kwe-fetus, kunikezwa. I-transducer noma inzwa udokotela ubeka esiswini sowesifazane okhulelwe, ukuhlasela kwamagagasi omsindo kwenzeka. Lawa mafutha athathwa yi-sensor, futhi iwadlulisela esikrinini sokuqapha. Ngesikhathi sokuqala sokukhulelwa, ngezinye izikhathi umzila we-transvaginal usetshenzisiwe. Kulesi simo, inzwa ifakwa ngaphakathi kwesifazane. Yiziphi izinto ezingavamile ezingabonisa ukuhlolwa kwe-ultrasound?
• Ukungahambi kahle kwesibindi, izinso, inhliziyo, amathumbu nabanye.
• Kuze kube amasonto angu-12 okuthuthukiswa kwe-Down syndrome.
Ukuthuthukiswa kokukhulelwa ngokwayo:
• Ectopic noma uterine.
• Inomboro yamabele ekubelethweni.
• Isikhathi sokukhulelwa.
• Inhloko noma isethulo se-pelvic ye-fetus.
• Ukugxila ekuthuthukiseni ngokuvuthwa.
• Imvelo yenhliziyo.
• Ubulili bomntwana.
• Indawo kanye nesimo se-placenta.
• Ukugeleza kwegazi ezitsheni.
• I-Tonus yesibeletho.

Ngakho, ukuhlolwa kwe-ultrasound kwenza kube lula ukubona noma yikuphi ukuphutha. Isibonelo, umfutho wegazi ophezulu wesibeletho ungabangela usongo lokukhulelwa kwesisu. Uma uthola lokhu okungahambi kahle, kungenzeka ukuthi uthathe izinyathelo ngesikhathi sokulondolozwa kokukhulelwa.

Ukuhlolwa ngegazi

I-serum yegazi ethathwe owesifazane ihlolwe ngokuqukethwe kwezinto ezihlukahlukene kuye:
• I-AFP (i-alpha-fetoprotein).
• NE (i-estriol engaziwa).
• I-HC (i-chorionic gonadotropin).
Le ndlela yokuhlola ngaphambi kokubeletha inezinga eliphakeme kakhulu lokunemba. Kodwa kunezimo lapho ukuhlolwa kubonisa ukuthi kukhona umphumela omubi noma wamanga omubi. Khona-ke udokotela ukhethe izindlela ezengeziwe zokwehlola ngaphambi kokubeletha, isibonelo, i-ultrasound noma enye indlela yokuxilongwa okuphazamisayo.

Isikhungo sokuthola isifo sokubeletha eMas Avenue eMoscow sichitha amahora angu-1.5 kuphela ukuhlolwa kwesimo semvelo , i- ultrasound, futhi sinikeza ukubonisana ngaphambi kokubeletha. Ngaphezu kokuhlolwa kwe-trimester yokuqala, kungenzeka ukuba uhlole ukuhlolwa kwezinto eziphilayo nge-trimester yesibili, kanye nokweluleka kanye ne-ultrasound.

Okuqukethwe kwe-alpha-fetoprotein

Ukuxilongwa kwesifo sangasese ngaphambi kokubeletha kusetshenziswa indlela yokuthola izinga le-alpha-fetoprotein egazini. Lokhu kuhlolwa kokuhlola kungabonisa ukuthi kungenzeka ukuzalwa kwengane ene-pathology njenge-anencephaly, spina bifida nezinye. Futhi, i-index ephakeme ye-alpha-fetoprotein ingabonisa ukuthuthukiswa kwezinsana eziningana, ngezikhathi ezingalungile, ukuze kube nokukhulelwa kwesisu noma ngisho nokukhulelwa okubandayo. Imiphumela enembile kunayo yonke itholakala uma isenziwa ngeviki le-16-18 lokukhulelwa. Imiphumela ngaphambi kwe-14 noma ngemuva kweviki lama-21 ivame ukungahambi kahle. Ngezinye izikhathi ukunikezelwa kwegazi kabusha kunqunywe. Ngezinga eliphezulu, udokotela ubeka i-ultrasound, lokhu kuvumela ukuqinisekiswa okuthembekile okwengeziwe kwesifo se-fetus. Uma i-ultrasound ingaboni imbangela yokuqukethwe okuphezulu kwe-alpha-fetoprotein, i-amniocentesis inqunywe. Lolu cwaningo luqondisa ngokunembile ushintsho ku-alpha-fetoprotein. Uma izinga le-alpha-fetoprotein landa egazini likagulane, izinkinga zingase zenzeke ngesikhathi sokukhulelwa, isibonelo, ukubambezeleka ekuthuthukiseni, mhlawumbe ukufa kokufelwa, noma ukuphazamiseka okuphazamisayo. I-alpha-fetoprotein ephansi ehlanganiswe ne-CG ephakeme ne-estriol ephansi ibonisa ukuthi kungenzeka ukuthuthukiswa kwe-Down syndrome. Udokotela ucabangela zonke izinkomba: yobudala besifazane, okuqukethwe kwama-hormone. Uma kunesidingo, izindlela zokuhlola ngaphambi kokubeletha zibekiwe.

I-HCG

I-gonadotropin ye-chorionic noma (hCG) ekukhulelweni kokuqala ikuvumela ukuba uhlole izinkomba ezibaluleke kakhulu. Ngaphezu kwalokhu kuhlaziywa - imigomo yokuqala yencazelo, nalapho ngisho ne-ultrasound engaziwa. Emva kokufaka umanyolo we-ovum, i-HCG isivele ikhiqizwa ngosuku 6-8.
I-HCG njenge-glycoprotein iqukethe ama-subunits e-alpha ne-beta. I-Alpha ifana nama-hormone we-pituitary (FSH, TTG, LH); Kodwa i-beta ihlukile. Yingakho ukuhlolwa kwe-beta-subunit (beta-hCG) isetshenziselwa ukuthola umphumela onembile. Ekuxilongweni okucacile, kusetshenziswe amathrekhi wokuhlola, lapho ukuhlola okuqondile kweHCG (yomchamo) kungasetshenzisiwe. Egazini, i-beta-hCG ihlolisisa ngokunembile ukukhulelwa kungakapheli amasonto amabili kusuka ekukhuliseni. Ukugxila kokuxilongwa kwe-hCG emvuthweni we-urine 1-2 kwezinsuku kamuva emuva kwegazi. Emcinini izinga le hCG liphindwe izikhathi ezimbili.

Izinto ezithinta i-hCG

Ukuchaza i-hCG ngesikhathi sokukhulelwa ngezigaba zakuqala, kubalulekile ukucabangela ezinye izici ezithinta umphumela wokuhlaziywa.
Ukwandisa ku-hCG ngesikhathi sokukhulelwa:
• Ukungahambisani phakathi kwesikhathi esilinganiselwe nesikhathi sangempela.
• Ukukhulelwa okuphindaphindiwe (ukwanda komphumela kufana nenani lezithelo).
• I-toxicosis yokuqala.
• Gestosis.
• Amaphutha amakhulu.
• Ukuphathwa kweGestagen.
• Isifo sikashukela sabantu.
Ukunciphisa izinga lokungahambisani kwe-hCG, ukukhushulwa okwedlulele ngokweqile ku-HCG ukuhlushwa okungaphezu kuka-50% wendabuko:
• Ukungahambisani phakathi kwesikhathi esilinganiselwe nesikhathi sangempela (ngokuvamile ngenxa yomjikelezo ongavamile).
• Ingozi yokukhulelwa kwesisu (izinga liyehla ngo-50%).
Ukukhulelwa okukhukhulayo.
• Ukukhokhisa imali.
• Ukukhulelwa kwe-Ectopic.
• Ukungasebenzi kahle okungekho emthethweni.
• Ukufa kwe-Fetal ku-3 trimester.

Izindlela ezimangalisa

Uma udokotela enquma ukuthi ukuxilongwa kwangaphambi kokubeletha kufanele kusetshenziselwe ukuhlonza izifo ezithintekayo, ukukhathazeka okuthuthukiswayo, enye yezinqubo ezilandelayo zingasetshenziswa:
• Cordocentesis.
• I-chorion biopsy (ukucubungula ukwakheka kwamaseli okuvela kuwo i-placenta).
• Amniocentesis (isifundo se-amniotic fluid).
• I-Placentocentesis (imiphumela emibi ngemuva kokutheleleka kwezifo ezithintekayo).

Inzuzo yezindlela ezihlaselayo yijubane nokuqinisekiswa okuphelele komphumela. Isetshenziswa ekukhulelwe kokuqala. Ngakho-ke, uma kukhona ukusola okungajwayelekile ekuthuthukiseni i-fetus, ukuxilongwa kokubeletha ngaphambi kokubeletha kwenza kube lula ukuthola iziphetho eziqondile. Abazali nodokotela banganquma ngokuhamba kwesikhathi: ukushiya ingane noma ukuqeda ukukhulelwa. Uma abazali, naphezu kwe-pathology, besenquma ukushiya ingane, odokotela banesikhathi sokuphatha kahle nokulungisa ukukhulelwa baze baphathe ngisho nesisu esiswini. Uma isinqumo sokuqeda ukukhulelwa samukelwa, ngakho-ke lapho kuqala, lapho kutholakala ukwehlukana, ngokomzimba nangokwenqubo le nqubo kulula ukudlulisela.

I-chorionic biopsy

I-chorion biopsy ihilela ukuhlaziywa kwezinhlayiyana ezincane ze-chorion eziyingozi, amaseli we-placenta ezayo. Lezi zinhlayiyana zifana nezakhi zofuzo, okwenza kube lula ukubunjwa kwe-chromosome, ukucacisa impilo yomzimba wengane. Ukuhlaziywa kwenziwa ngokusola kwezifo ezihambisana namaphutha e-chromosomal ekukhulelweni (i-Edwards syndrome, i-Down's syndrome, i-Patau, njll) noma engozini yokuhlaselwa izifo ezingelapheki ze-cystic fibrosis, i-sickle cell anemia, i-chorea kaGentygton. Umphumela we-chorion biopsy uvumela ukukhomba izifo ezingu-3800 zezingane ezizayo. Kodwa isici esinjalo njengesici ekuthuthukiseni ithubhu ye-neural ayitholakali ngale ndlela. Lesi sifo sitholakale kuphela enkambisweni ye-amniocentesis noma i-cordocentesis.
Ngesikhathi sokuhlaziywa, ubukhulu be-chorion kufanele okungenani kube ngu-1 cm, okuhambisana namasonto angu-7-8 wokubeletha. Muva nje, inqubo yenziwa ngesonto lama-10-12, iphephile kakhulu kulomntwana. Kodwa hhayi ngaphambi kweviki le-13.

Inqubo

Indlela yokugcoba (i-transcervical noma i-transabdominal) ikhethwa ngabahlinzayo. Kuxhomeke lapho i-chorion itholakala khona ngezindonga zesibeletho. Noma kunjalo, i-biopsy yenziwa nge-ultrasound.

Owesifazane ulele emhlane wakhe. Indawo ekhethiwe yokwenza i-puncture isuke isetshenzisiwe ngethonya lendawo. Ukugqama kwodonga lwesisu, udonga lwe-myometrium, lwenziwa ngendlela yokuthi inaliti ihambelane nekhanda lesikhumba. Ukuhamba kwenaliti kulawulwa yi-ultrasound. I-syringe isampula izicubu ze-chorion villi, inaliti isusiwe. Emoyeni ye-transcervical, lo wesifazane ubeka esihlalweni njengokungathi wayehlolwe ngendlela evamile. Izinzwa ezizwakalayo ezibuhlungu azizwakala. Umlomo wesibeletho kanye nezindonga zesisindo zihlelwe nge-forceps ekhethekile. Ukutholakala kunikezwa umcengezi, lapho izicubu ze-chorionic zifinyelela kuso, i-syringe ifakwe futhi izinto zithathwa ukuze zihlaziywe.

Amniocentesis

Izindlela zokuxilongwa ngaphambi kokubeletha zibandakanya indlela ejwayelekile kakhulu yokuthola ukuphathwa kwe-fetal development - amniocentesis. Kunconywa ukuthi uyibambe ngamasonto angu-15-17. Phakathi nenqubo, isimo se-fetus silawulwa yi-ultrasound. Udokotela ngokusebenzisa udonga lwesisu esisondeza inaliti emanzini amniotic fluid, uthola inqwaba yokuhlaziywa futhi inaliti isusiwe. Imiphumela elungiselelwe amaviki amathathu. I-Amniocentesis ayiyingozi ekuthuthukiseni ukukhulelwa. I-1-2% yabesifazane ingaba nokuvuza okuketshezi, lokhu kuphela ngaphandle kokwelashwa. Ukukhipha isisu okungajwayelekile kungavela kuphela ku-0.5% wamacala. I-fetus ayilimazi inaliti, inqubo ingenziwa ngisho nokukhulelwa okuningi.

Izindlela zofuzo

Isivivinyo se-DOT yisindlela esisha esiphephile sokuphefumula se-fetus, sivumela ukukhomba isifo se-Patau, Edwards, Down, Shereshevsky-Turner, uKlinefelter. Ukuhlolwa kusekelwe kumininingwane etholakala egazini likaMama. Umgomo wukuthi ukufa kwezemvelo kwamangqamuzana amaningi e-placenta kuwela egazini likaMama 5% we-DNA ye-fetal. Lokhu kwenza kube lula ukuhlolisisa i-trisomy enkulu (ukuhlolwa kwe-DOT).

Inqubo yenziwa kanjani? Igazi elisuka emthanjeni wesifazane okhulelwe liyathathwa, i-DNA yesisu isabelwe. Umphumela unikezwa ezinsukwini eziyishumi. Uhlolo luqhutshwa nganoma yisiphi isikhathi sokukhulelwa, kusukela ekuqaleni kwamasonto ayishumi. Ukuthembeka kolwazi kungu-99.7%.