Screening, amasonto angu-12 bekhulelwe: kokubusa okulotshiweyo

Indlela ukwazi uma ingane ekhulayo esibelethweni, kungakhathaliseki noma iyiphi ukuphambuka njengoba izibilini akhiwa imvuthu? Izimpendulo anganika (uma usuku elafika ukhulelwe - amasonto 12) ultrasound. Screening ukuhlola ukuthuthukiswa kwe-fetus, ke unika isithombe esicacile sokuthi izici zofuzo chromosomal umntwana esikhathini esizayo. Lokhu kwenza kube nokwenzeka ukucacisa khona noma ukungabi khona anomalies.

US ubambe isonto 12 isikhathi

Ngokuyinhloko inqubo eyenziwa ngezindlela ezimbili: transvaginally (nge sangasese ngosizo nemishini ekhethekile yokuthungatha) kanye transabdominal (ngesikhumba esiswini). Lesi sakamuva landile, futhi owokuqala ukuba aqoke bonke abesifazane isimo, kodwa ezinye zazo, kulezi zimo ezilandelayo:

- uma placenta (chorion noma) ongaphakeme enamathiselwe;

- uma kukhona ukuhluleka wesibeletho, futhi kuyadingeka ukuhlola degree;

- Uma kukhona izimpawu izinhlumba ukuvuvukala futhi ezihlobene (ukuze ukusazi ngokunembile isifo esikuphethe), noma ISIZINDA of lesizalo fibroids ngokukhethekile kakhulu elise, kodwa ngendlela №2 wembula imininingwane kancane;

- lapho ekuhloleni entanyeni endaweni kwengane noma ekulinganiseni usayizi olungile, kunzima ukukhiqiza ngenxa yokuthi ukuthi izithelo akukubi, noma izicubu ongama besisu emaningi kakhulu.

Ucwaningo ingaphansi indlela: kwakukhona owesifazane olele, eguqa ngamadolo akho; udokotela ifaka esithweni sowesifazane uphenyo ultrasonic lapho alahlwayo othwala ukuvikela ikhondomu. Ngokuvamile, bonke kwenziwe ngokucophelela okukhulu, ngakho abakhulelwe engazizwa ubuhlungu.

cwaningo Transabdominal kwenziwa endaweni efanayo. Zonke emoyeni phakathi inzwa kanye isikhumba hhayi ukushayela, ngakho kungase kube nemiphumela ayilungile. Ukuze ngangokunokwenzeka ukunciphisa amathuba nephutha, sebenzisa gel ekhethekile esetshenziswa esiswini. Kancane kancane ukuhambisa inzwa esiswini, ukuze ungakwazi ukubona imizimba imvuthuluka, kanye kwesibeletho futhi placenta umama. Ultrasound iphephile ngokuphelele i-fetus futhi akabubangeli kuye yikuphi ukulimala.

Indlela sokulungiselela US

Ukulungiselela incike indlela. Uma usebenzisa transvaginal, kutuswa ukuba usebenzise usuku olu-1 ngaphambi kwesifundo mikhiqizo, okungase kubangele ukuvutshelwa: isinkwa esimhlophe, ubhontshisi, iklabishi, uphizi. Amathumbu kumele akhishwe, kungenjalo kukhona amagesi ukuvimbela luhlolo kwesibeletho futhi ingane. Uma unomuzwa wokuthi esiswini is Ayihaba, ungakwazi uphuze izidakamizwa "Espumizan", okuyinto ingozi embungwini.

Ngaphambi cwaningo transabdominal baphuza isigamu ilitha lamanzi imizuzu 30 ngaphambi kokuqala. Kuyadingeka ukuthi kwakukhona esinyeni egcwele, okuyinto zizodingida fetus ukuhlola isimo sakhe.

ukuthuthukiswa Child esikhathini isonto 12

Abaningi kwezitho ezinkulu ziye zasungula imvuthu kanye ezinye izakhiwo ezincane uqhubeke lasungulwa. Ukwanda isilinganiso ingane 80 mm, futhi isisindo - 20 amagremu. Futhi, odokotela bathi ukudla izithelo izici ezifana:

- kwenhliziyo ucaschenne ezingaphezu kuka e yokuthathu yesithathu, futhi kungase kube mayelana 170 ngomzuzu;

- ubuso wengane ayisekho libukeka unoshobishobi, futhi ethola izici zobuntu;

- ungabona amajwabu amehlo, izindlebe, kancane vellus izinwele (esizeni amashiya kanye eyelashes semfundo);

- iningi imisipha cishe athuthukile, ngakho izithelo ihamba ngaso sonke isikhathi, futhi inhlangano lingama okuvele kunalokho kunezinxushunxushu;

- Crumb grimaces futhi ekucindezela izandla zakhe ezandleni, iminwe kungabonwa izinzipho;

- ingane uye wazakhela izinso futhi cishe kwakhiwa amathumbu, igazi waphawula amaseli abomvu namhlophe;

- bakheké ngokuphelele, zombili ama- zobuchopho, kodwa "imiyalo" ngenkathi amaphiko;

- ungabona ngubani ungumfana noma intombazane, kodwa ngoba ingane engakazalwa akuyona indlela ofuna umama futhi odokotela njalo, kungenzeka ukuba wenze iphutha, ngakho-ke, uma sikubeka ngokuqondile enkundleni 16 th ngesonto.

Kanjani ukufunda imiphumela?

Paper ne imiphumela yocwaningo uzothola izandla zakho phezu emva Ukuhlolwa (amasonto 12) yenziwa. Ukuhlaziywa Incazelo uzonikezwa ngemuva kwalokhu.

Kusukela ngenyanga yesithathu isivele Uboné kahle, ingane noma cha. Ngakho-ke, uma "inani izithelo" ikholomu kulotshiwe ezimbili noma ngaphezulu, lokho kubonisa ukuthi kuzodingeka twins (ezintathu nokunye. D.) Ingabe kakade kungenzeka futhi uthole ukuthi uma izithelo odnoyaytsovye (amawele), noma-ke amawele (heterozygous).

isethulo

Lona igama izithelo, elise esiseduzane emgudwini wokuzala. Eemvekeni ezi-12, kungaba yini: imilenze, ikhanda, noma ingane nhlobo esisogwini idayagonali. isethulo Final is esikalini ngesonto 32nd yokukhulelwa. Uma inhloko ingekho aphume kwesibeletho, kuthatha bonke izinyathelo kunokwenzeka ukuze balungise lesi simo.

Ukulinganisa ubukhulu fetus (noma fetometry)

Sokuqonda US kanye nesidingo ukuhlola okukhethwa, kodwa kufanele benze udokotela ngubani Orient hhayi izinombolo kuphela, kodwa futhi ku isimo jikelele abakhulelwe. Zonke amazinga oboznalsya izincwadi ezithile kanye nezinombolo. Nazi ayinhloko:

• ukucindezeleka okuguquguqukayo (BPD, BRGP) - lokhu isifinyezo selisho okuthiwa usayizi biparietal ie, ibanga kusuka ekhanda omunye .. parietal ithambo. Ukuze isikhathi esingamasonto 12 ultrasound kumele sibonise 21 mm BDP.
• Kukhula umntwana - mayelana 8.2 cm, isisindo akumele ibe ngaphansi kuka 17-19 g
• FML, DlB - ubude senyonga. Okuvamile - 7 kuya 9 mm.
• Nuchal kumele singeqi 2.7 mm. Ngokusho lingakanani kunqunywa ukuthi kukhona izifo ezingathi sína. Ngokwesilinganiso, kuba cishe 1.6 mm.
• Igama elithi CTE (CRL) isho ubukhulu coccyx-parietal, okusho umkhawulo wobude kusukela ekhanda kuya coccyx, kuyinsakavukela - .. 43-73 mm.

Kukhona nezinye izindawo izifinyezo:

• Hum (AP) - ubude ehlombe.
• AC (OJ) - selilonke kwamathumbu.
• ABD (J) - esiswini ubukhulu.
• PC - usayizi inhliziyo.
• OG - ikhanda selilonke.

Ngoba bonke laba nemingcele 1 Ukuhlolwa ekukhulelweni ivumela udokotela-sonologu ukuthola indlela akhule isakhiwo kwengane. Uma wenze izilinganiso lingaphansi kuka sivamile wonkana Kulinganiselwa njengoba bawa: ngokulingana futhi ngesikhathi esifanayo noma cha. Uma ungavumelani kancane kuphela, bese asikho isizathu ukwethuka. Mhlawumbe ngokungalungile enqunyelwe isikhathi futhi empeleni manje kuphela ngesonto 11. Noma mhlawumbe ingane kukhula ngenxa abazali undersized.

Futhi, thola ukuthi zikhona yini izinkinga zokwakheka ukuthuthukiswa izibilini, kukhona ngabe enkabeni intambo singabanjwa, yini ukushaya kwenhliziyo (izinga - kusukela ngomzuzu 150 kuya 174), uma kukhona ukuphambuka ku izici amniotic fluid.

Ukufunda isiphetho ultrasound okhulelwe angase nobuso amazwi anjengokuthi "polyhydramnios" futhi "oligohydramnios". Lokho kuyinto nokuthi kuyadingeka okuthile wesabe? Akukho okungalungile ngala mazwi lapho. Kuyinto kuphela ekutholweni nenani amanzi lapho umbungu sintanta: uma kukhona ngaphezu kudingekile, polyhydramnios fixed, uma engaphansi - oligohydramnios. Ngokuvamile, lokhu kuwubufakazi bokuthi ezinye ukuhlukumeza: Ukutheleleka intrauterine (IUI), iziyaluyalu izinso, isimiso sezinzwa esiyinhloko. Bheka futhi ukuthi amanzi Murky. Uma yebo, khona-ke pointer kuze kufike ekungenweni izifo.

I oyisisekelo uma ithola ngeziphambeko kusukela kuyinsakavukela - ukungaxhamazeli, kodwa ukuya kudokotela onguchwepheshe.

Kungakhathaliseki kungaba khona ngeziphambeko kusukela placenta?

Ultrasound sikubonise enamathiselwe "ingane esihlalweni" njengoba zikhula, uma kukhona isifo, nokuningi. Inketho engcono kakhulu ukunamathisela kususwa udonga lwangemuva kwesibeletho. Kodwa yi-placenta kungaba ngokuthi 'namathela' futhi ngaphambili, ngisho kuze kufike phansi. Ngesikhathi esifanayo akufanele abaphila umlomo kwangaphakathi kwesibeletho. Lesi simo kuthiwa i chorionic noma maphakathi placenta previa. Kulokhu, kungakhathaliseki isimo zizoshintsha, kepha uma kungenjalo, afeze Ukubeletha ukuthunyelwa. Uma nemihlathi akuzona avaliwe ngokugcwele, ubizwa ngokuthi previa akuphelele; lokuzalwa ngesikhathi esifanayo kwenziwe ngendlela evamile.

Uma placenta "Wanamathela" eduze ophumayo (esingaphansi 70 mm), isethulo uphansi. Njengoba kungase kube usongo ukopha, kunconywa abakhulelwe imodi kancane esebenzayo. Khona-ke sebenzisa ukuthi placenta phezulu bavuke. Uma kumaviki awu 32-36 lokhu kwenzeka, ngeke kube usongo, futhi owesifazane abelethe ngendlela evamile.

Yokuvuthwa umzanyana kule eside ilingana 0. "lobular" placenta - lena besigaba sesibili ukuvuthwa, futhi isimo esinjalo kubalulekile kudokotela. Imali-calcium nosawoti zibizwa ngokuthi calcifications. Kuyinsakavukela, uma zikhona e-placenta bezinga lokuqala ukuvuthwa.

Uma kukhona ukufa ingxenye ezinye "ingane esihlalweni," lokhu kubizwa ngokuthi yi-placenta esivimba amanzi. Kulokhu, kunesidingo esiphuthumayo kudokotela ukuze kutholakale imbangela futhi zibeka ukwelashwa, ngoba uma zizofezeka, bese, leyo ngane ngeke babe-mpilo ngokwanele futhi kudingekile ekuthuthukiseni izinto zalo.

Wesibeletho: isakhiwo esimweni

On the 12 th ngesonto ngesilinganiso usayizi wesibeletho, okuyinto akufanele kube ngaphansi kuka-30 mm. The eside kangakanani, ngcono. Uma enendawo esifushane kakhulu, ngaphansi kuka-20 mm, ukukhulelwa esibhedlela, futhi ingase isetshenziselwe nokuhlinzwa ukwelashwa. lesizalo imilomo zivaliwe, zangaphakathi nezangaphandle.

Myometrium (umsipha noma isimo) uveza ukuthi kukhona ingozi yisisu. Uma uphethwe ubonisa ukuthi kule nkathi kukhona hypertonicity kwesibeletho, owesifazane belashwa. amaqiniso okwethusayo Ikakhulukazi ezifana "fossilization 'esizalweni," push-silingo "esifundeni lumbar.

Indlela ukunquma inkathi ultrasound

Ukusebenzisa amathebula esikhethekile CTE ibalwa yobudala sokukhulelwa. Kungenzeka ukuthi isici okufana eyakhelwe ohlelweni umshini ultrasound. Qhathanisa imigomo - a ibalwa kulezi zinyanga esikhathini kanye ultrasound ikhishwe. Uma umehluko mncane (isonto elilodwa noma amabili), uthola isikhathi ngqo eshiwo obelethisayo. Endabeni mismatches ngaphezulu (ngaphezu kuka-2 amaviki), bazithatha kalula izinto ultrasound eside echaziwe.

Ukuhlolwa kumuntu okhulelwe: kuyini futhi kanjani

Qaphela ikakhulu lapho umuntu ekhulelwe - amasonto 12. Ultrasound Ukuhlolwa - zonke lezi izifundo zenzelwe ukuhlola ukuthuthukiswa umbungu. Kulesi ultrasound wokuqala kwenziwa, bese linqume futhi ukuhlolwa (kuye ngokuthi ukusebenza). Chitha uma:

- kwabesifazane abakhulelwe engu-35 nangaphezulu.

- Ngaphambi kwalokho, izingane azalelwa efile.

- Ukuhlolwa odlule izithelo intrauterine ukutheleleka itholiwe.

- ingane ibelethwe, siye wathola angahlangani chromosomal.

- Sekutholakele ukuthi anomalies enjalo izihlobo zabo bobabili abazali.

Kuphela izikhungo ekhethekile iveza ukuhlolwa (amasonto 12). Indlela ukukwenza? Ukuqoqa konke ukuvivinywa: ultrasound, igazi, idatha yangaphandle. cwaningo Ukuhlola kwenza isazi sezakhi zofuzo futhi focus ikakhulu badonsekela collar kanye izibalo: khulula beta-hCG futhi PAPP-A. Ngokuvamile, lezi nakomaka kufundvwe ekuhlanganisweni ezimisiwe. Uma okungenani omunye wabo ishintshile, akusho ukuthi i-fetus iyakwazi ezinye egunjini lokuhlolwa kwezifo.

Ngakho lapho bahlolwe kwamasonto angu-12 bekhulelwe, ukusetshenziswa izici zalezi iziphambano. It syvorochnye amaprotheni. Uma babe ukuphambuka ke umntwana uyoba kwezinso zofuzo. Mahhala β-hCG - a subunit ka chorionic (chorion - lokhu igciwane) womuntu gonadotrophin futhi PAPP-A - kuyinto nokukhulelwa ezihambisana amaprotheni A. Ukuze ukufunda ngalezi zinkomba esetshenziswa ELISA Assay (enzyme exhumene Assay immunosorbent).

HCG kuvusa zamagama hormone steroid (e-placenta nomzimba ophuzi). Odokotela baye bathola ukuthi hCG ivikela umbungu kusuka ukwenqatshwa. Ukuhlaziya ezingeni, ungenza izibikezelo ngenkambo okwengeziwe yokukhulelwa. Ngokwezibalo yezokwelapha, hCG kwandisa kancane kancane kwaze kwaba ngesonto 10 bese uhlala cishe ezingeni elifanayo (kusuka 5000 kuya 50000 IU / L) amasonto 33, bese ongama kancane.

1 Ukuhlolwa ekukhulelweni 10 th kuleli viki 13 kwethemu. Ukuze abale zonke izingozi, thatha idatha eningi: US usuku CTE futhi TPV (Translations nuchal).

Lezi cwaningo abaluleke kakhulu kangakanani ukubona kwezinso ekhona kuma-chromosome. Nokho, uma ubufakazi ephakanyiswe kancane, ungakhathazeki wenze iziphetho ngokuphamazela. Udinga nje zisebenza isazi sezakhi zofuzo, abazokutshela ukuthi sizokwenzenjani. Kukhona kungenzeka ukuthi ayilungile wokufundwayo ultrasound. Screening okukhulelwa isonto 12 kungaba liphindwe - ukucacisa, noma udokotela imithi uphethwe koda, enquma ngokunembe kakhudlwana isethi genetic ingane. Kuye ngalokho isikhathi, wenze noma chorionic villus izibonelo zalokho noma amniocentesis.

Uma ngisho 1 Ukuhlolwa luveza a obuncane kakhulu chromosomal kwezinso ku-fetus, akudingekile ukuba ayiyeke le inhlolovo, ebanjwa ku 4-5 ngenyanga yokukhulelwa. Ngaphezu kwalokho hCG futhi izindaba ze-AFP, kutholakale izinga estriol khulula (test kathathu).

Ukuze ukwazi ukubona nemingcele β-hCG futhi PAPP-A, ukunikeza igazi. Kumaviki awu 12 - has isikhathi esanele ukuze akwazi ukuthola ubukhona ukuhlaziywa kwamakhemikhali (nobe kungazuzi) kwezinso e-chromosome.

Isiphetho yokuhlaziya

Kuye imiphumela ukuhlolwa kwegazi kwembula ukuthi kungani izibalo zehluke kuyinsakavukela. Ngakho, ukuhlolwa kokukhulelwa ngesonto-12 kungase kwembule okulandelayo:

- Down Syndrome.

- Akekho noyedwa isithelo, futhi 2 (3, njll ...). izithelo okuningi - amazinga ngaphezulu kule hormone.

- toxicosis.

- engalungile isethi inkathi sokukhulelwa. Isonto we kwengane ngayinye uhambelana ipharamitha ukuthi inquma yobudala ngqo umbungu.

- eBukhoneni sikashukela unina.

- ukhulela ethunjini.

- ingozi Ephakeme yisisu.

Ingabe ikhona imithetho ukusebenza?

Yiqiniso kukhona! Funda kubo unga ngokwenza izifundo ezifana ultrasound, ukuhlolwa (amasonto 12). kuyinsakavukela It empeleni iyokwaziwa ngisho ngemva kokutadisha udokotela idatha. Nokho, kukhona srednemeditsinskie izinkomba icaciswe iviki yokukhulelwa ngamunye. Ngokwesibonelo, β-hCG ku 11-12 ngesonto kufanele kube kusuka 200,000 ukuze 90,000 IU / ml.

Nokho, kufanele sikhumbule ukuthi ukuhlolwa okukhulelwa ngesonto-12 sinika Yiqiniso, eliphezulu kakhulu, kodwa noma kunjalo hhayi yalokho ephelele, ngoba wonke owesifazane imizimba yabo ikakhulukazi, i-akhawunti kumele kuthathwe ngudokotela wakho. Uma umbungu kungesilo kuphela, khona-ke nzima ukuhlonza. Bheka izibalo. Uma kunjalo ezingaphezu kweyodwa nengxenye noma ezimbili izikhathi, lokho kungase kube baphetha ngokuthi imibungu 2 noma ngaphezulu. Ngamunye izithelo chorion ayo futhi ukukhiqizwa ezahlukene hormone. Ngakho-ke, ezifana ukusebenza high, futhi umama esizayo wathumela i-ultrasound ukuqinisekisa nokukhulelwa izingane eziningi ngasikhathi.

Uma bahlolwe (amasonto 12), amagugu ejwayelekile ke sayihlolisisa ne idatha etholwe ukuze ukubala ngabe zokugula kuyinto. Odokotela asetshenziselwe le nhloso isici esikhethekile, ngokuthi umama. Kulinganiselwa by ifomula: Inani hormone okuthiwa imisiwe esekelwe imiphumela ukuboniswa, ihlukaniswe hCG (lokhu kulingana sokukhulelwa evamile). Kufanele uthole eyodwa (kungcono kuhle). Awu kakade imiphumela zonke izifundo yahlulelwe noma ukufaka iqembu kumama ingozi nge chromosomal kwezinso noma cha. Kuyaphawuleka ukuthi ngisho noma konke kusenjalo kwenzeka, akusiyo sinqumo sokugcina, kodwa omunye kwenzeke. Ngakho-ke, ezinye izinkomba kuqhathaniswa bese kuphela wenze noma yiziphi iziphetho. Ukubukeza wonke ukuhlolwa kokukhulelwa ngesonto-12: ultrasound, amahomoni, RTA kungathatha isifundo sesibili e senyanga yesibili.

PAPP-A amaprotheni obhekene izivikeli mzimba we ukhulelwe, futhi kuyasiza placenta ukusebenza. Njengoba imibundu ngokucacile imingcele kuchazwa, ukuphambuka yayo kakhulu engathandeki. .. Lonke Iphuzu liwukuthi ezinjalo "kuzuba" izibalo ukukhuluma hhayi kuphela nokwahlulelwa kungenzeka, kodwa yayihlanganisa nokuthi kwezinso esabekayo like-Down syndrome, de Lange syndrome, njll kubhekwa evamile elandelayo izibalo: kusuka 11 th-12 th ngesonto - 0.7 kuya 4,76; kusukela th 12 neviki 13 - 1,03- 6,01.

Uphenyo izifundo

Abesifazane abenza Ukuhlolwa (amasonto 12), ezahlukene ukusho ngakho. Othile ngokungalungile ezikhonjwe wobulili ingane. Kukhona incazelo - igama elithi sincane kakhulu, sizokwazi ekugcineni ukusho ozozalwa: uyintombazane noma umfana, kuphela 16 th ngesonto. Futhi ukukhuluma mayelana amanani ahlukene. Abanye abantu iphumelele ekuhlolweni mahhala, abanye ukhokhe kusuka 1000 kuya ruble 3000.

Nokho, omama abaningi bathi Ukuhlolwa ultrasound, futhi akusize uqonde ukuthi kuyinto ingane yakho. Njengoba lezi izinqubo kudingeka, kungashiwo ukuhlolelwa lesi sifo futhi welashwe kusenethuba ukuqala kokuba isifo ingane yazalwa enempilo.