Iindlela kokuxilongwa siswini: yemfuza, ezihlaselayo, non-invasive test. Iimpawu zibonisa ukuba ukusetyenziswa, iziphumo

uphethwe siswini i uviwo entsonkothileyo yokukhulelwa. Eyona njongo ephambili - kukuchonga ezimbi ezahlukeneyo usana kwi amanqanaba Palsy.

Eyona ndlela iqhelekileyo siswini ukugula: ebambe ultrasound, okubhalwe yabamakishi ezahlukeneyo egazini umntu okhulelweyo, chorionic villus kwesampulu, ukuthatha kwakho eluswini igazi imfesane yosana, amniocentesis.

Yintoni ukuhlaziya kwangaphambi

Ngokusebenzisa iindlela ezahlukeneyo kokuxilongwa siswini ngokwenene labonwa nengxaki Palsy ezifana Edwards syndrome, Down engqondweni, ukuphazamiseka zentliziyo kwaye ukuyilwa nokunye ukukhubazeka. Ukuba iziphumo loxilongo siswini ingenza isigqibo bayahlelwa mntwana. Emva kokufumana idata diagnostic ngentsebenziswano ne uGqirha nonina egqiba umntwana uzelwe okanye ukukhulelwa uphazamiseka. Ingxelo Elilungileyo ukuze avumele kwimo olungekazalwa. Moshilongo siswini isebenza ukusekwa lukatata ngokuyincina yemfuza, oluqhutywa kwi zigaba zokuqala zokukhulelwa, kwakunye nokumiselwa ngesondo Palsy. Zonke ezi nkonzo zinikelwe kwiZiko eyinkunzi loxilongo siswini kwi Prospekt Mira, nto leyo ephethwe uProfesa MV Medvedev. Apha ungenza kuwisa uviwo olubanzi siswini, kuquka ultrasound. Isetyenziswa e-Centre for the iteknoloji entsha 3D, 4D.

Iindlela isifo siswini

uxilongo zangoku siswini usebenzisa iintlobo iindlela ezahlukeneyo kunye nobuchwephesha. Ubungakanani kunye neqondo amandla baye kuhluka. Ngokubanzi, uxilongo siswini yahlulwe ngamaqela amabini amakhulu: ezonakalisayo kunye non-invasive diagnosis siswini.

Non-invasive, okanye njengoko ibizwa, iindlela ngaphantsi ezihlaselayo musa ukunika zoqhaqho nongcungcutheko olungekazalwa kunye nonina. iinkqubo ezinjalo Kucetyiswa ukuba bonke abasetyhini abakhulelweyo, ukuba nje iyingozi. Iimviwo ultrasound lwarhoqo kufuneka ukuba zenzeke. ubuchule ezingeyonzalelwane zibandakanya intrusion (uphazamiseko) emzimbeni umntu okhulelweyo, lweHo- zesibeleko. Iindlela abakhuselekanga ngokupheleleyo, ngoko esabela ukuba kwagqirha njengelinge lokugqibela, xa kukho umbuzo wokulondoloza impilo yomntwana olungekazalwa.

Non-invasive diagnosis siswini

Kuba iindlela non-invasive ziquka ultrasound kunye siswini, esivumela ukuba sigcine Dynamics kuphuhliso olungekazalwa. Non-invasive kwaye kuthathwa uxilongo siswini kwemiba serum ezingekazalwa kuba ligazi sikanina.

Ultrasound inkqubo eqhelekileyo, oko akuthethi ukuba naziphi na iziphumo eziyingozi kwi umfazi kunye isiqhamo ngokwalo. Ingaba bonke oomama abakhulelweyo kufuneka ufumane kwesi sifundo? Ingongoma moot, mhlawumbi akuyomfuneko kuzo zonke iimeko. Holding ultrasound umisa uGqirha ngenxa yezizathu ezininzi. Kwithuba leenyanga ezintathu yokuqala, uyakwazi ukubona inani ukukhulelwa, nihlala isiqhamo ngokwalo, igama ngqo. Xa ngenyanga ultrasound yesine kakade ukubonisa malformations ezinzulu iziphene yosana olungekazalwa, indawo ngumkhaya, fluid. Emva kweeveki 20 basenokuphawula besini elizayo bomntwana. Ultrasound ivumela ukuba ukuchonga mgaqweni ezahlukeneyo, ukuba uhlalutyo wabonisa okhulelweyo eliphezulu alpha-fetoprotein, kwaye ukuba imbali yosapho kukho ezinye iziphene. Kubalulekile ukuqaphela ukuba akukho namnye iziphumo ultrasound akakwazi akuqinisekisi ikhulu ekhulwini umbungu esempilweni.

Njani na i US

diagnosis siswini siswini ngohlobo ultrasound Kucetyiswa ukuba bonke abasetyhini abakhulelweyo kwiikota zilandelayo:

• kwiiveki 11-13 zokukhulelwa;
• kwiiveki 25-35 zokukhulelwa.

Ilungiselelwe ukuba une imeko unina kunye olungekazalwa. Transducer okanye sensor iisethi ugqirha phezu komhlaba esisu umntu okhulelweyo, kukho kwenkolo ngamaza yesandi. Ezi amaza rivaleleke sensor, yaye ubeka phezu esweni screen. Ngelo kumabakala okuqala lokukhulelwa wambi kusetyenziswa indlela transvaginal. Kulo mzekelo, i-probe lifakwa lobufazi. Zeziphi izinto ezinxaxhileyo chonga zokuhlola ultrasound?
• Birth iintsilelo kwesibindi, izintso, intliziyo, amathumbu kunye nabanye.
• Ukuya kwiiveki 12 iimpawu Down engqondweni.
Uphuhliso ukukhulelwa:
• ethunjini okanye masterbatch.
• Inani kumitha esibelekweni.
• sokukhulelwa.
• Umzali okanye breech umbungu.
• I-lag ngokwemigaqo yophuhliso.
• Uhlobo nokubetha kwentliziyo.
• umntwana Gender.
• Indawo kunye nemeko ngumkhaya.
• Igazi flow nasezimpahleni.
• I-ithoni isibeleko.

Ngenxa yoko, ultrasound ivumela ukufumanisa nantoni na engaqhelekanga. Umzekelo, hypertonicity le isibeleko kungakhokelela isisongelo kwesisu. Akuba akubona anomaly, kunokwenzeka ukuba ukuthatha amanyathelo ngexesha alondoloze ukukhulelwa.

Ukufakwa igazi

Serum athathwa abafazi kuvavanywa nokuqulethileyo kwezinto ezahlukeneyo:
• AFP (alpha-fetoprotein).
• NE (estriol unconjugated).
• HCG (chorionic human gonadotropin).
Indlela lukhoyo siswini unezinga sezingeni eliphezulu okuchaneka. Kodwa kukho amaxesha xa uvavanyo ebonisa okanye japan okungamanga okanye lobuxoki-negative. Ke ugqirha wonyula iindlela ezongezelelweyo siswini, ezifana ultrasound okanye indlela diagnostic yi wesibeleko esigqibeleleyo.

IZiko loxilongo siswini kwi Prospekt Mira e Moscow ichitha iiyure nje 1.5 zengqo- screening, ultrasound, kwaye ubonelela thethwano sikanina. Ukongezelela ukuhluza senyanga yokuqala, kunokwenzeka ukuba lidlule ezintathu lomkhusane yesibini kwemichiza yeengcebiso ultrasound.

Enamagama-fetoprotein

uxilongo siswini kwezifo genetic usebenzise indlela yokufumanisa inqanaba alpha-fetoprotein ngegazi. Olu lokuhlolwa utyhila okuba kokuzalwa kosana ngale ngezifo njengokuba anencephaly, yomqolo bifida, kunye nabanye. Kwakhona, kukho izinga eliphezulu AFP zinokubonisa uphuhliso iziqhamo ezininzi, engafanelekanga ixesha efakiweyo, ithuba kwesisu kunye isisu nokuba aphoswe. Uhlalutyo ziphumo echanekileyo inikeza, ukuba ibekwe phezu 16-18 ngeveki th yokukhulelwa. Iziphumo phambi 14 okanye emva kwiveki yama-21 ka kaninzi eziphosakeleyo. Ngamanye amaxesha waqashwa ukunikela ngegazi. Ngeqondo eliphezulu imisela uGqirha ultrasound, kusenokuba ngokuthembekileyo ukufumana isiqinisekiso kwezifo Palsy. Ukuba US akafuni ukufumana unobangela isiqulatho ophezulu kumagama-fetoprotein, amniocentesis wabelwa. Olu phando ngokucokisekileyo ngakumbi kugqiba utshintsho kwi-AFP. Ukuba igazi yomguli kumanqanaba kumagama-fetoprotein, kungabangela iingxaki ngethuba lokukhulelwa, ezifana kokulibazisa yophuhliso, mhlawumbi ukufa ezingekazalwa, okanye abruption placental. Low hCG eliphezulu AFP ezidibeneyo kunye estriol ephantsi lubonisa ithuba Down syndrome. Ugqirha kuthathela ingqalelo zonke iparameters: iminyaka eli bhinqa, hormone. Ukuba kuyimfuneko, amisele iindlela ezongezelelweyo siswini.

hCG

Chorionic gonadotropin kwabantu okanye (hCG) ekukhulelweni kwi zigaba okuqala ukuvavanya izalathi ibalulekileyo. Plus le Uhlalutyo - nisaqala kwenkcazelo, naxa ultrasound nje ulwazi. Emva kokukhulelwa, iqanda unomhla 6-8 aqalise ukuvelisa hCG.
HCG njenge glycoprotein ubunjwe alpha beta subunits. Alpha twatse ne hormone yebhinqa (FSH, TSH, LH); beta - wahlukile. Kungenxa yoko le nto uvavanyo ukuze enganeno beta (beta-hCG) isetyenziselwa ukufumana ngokuchanekileyo isiphumo. zisetyenziswa koonotsheluza ngokukhawuleza diagnostic test, nto leyo awusebenzi uvavanyo oluthile HCG (Umchamo). Le hCG beta igazi ngokuchanileyo nokuxilonga ukukhulelwa sele kwiiveki 2 isichumiso. Uyondelelwano lwee- hCG Umchamo diagnostic ekhulisa kweentsuku 1-2 emva kwe egazini. Umchamo Amanqanaba hCG ngamaxesha-2 ngaphantsi.

Imiba echaphazela HCG

Ukuchaza hCG ukukhulelwa xa usaqala, kuyimfuneko ukuba bakuthathele ingqalelo ezinye izinto eziphembelela result uhlalutyo.
Ukwandisa of hCG ngexesha lokukhulelwa:
• Ukungathobeli ekuthiwa ubomi benene.
• ukukhulelwa Multiple (ukwanda isiphumo ngokomlinganiselo inani iziqhamo).
• toxicosis Early.
• yokukhulelwa.
• malformations Major.
• Ukwamkelwa progestogens.
• Diabetes osegazini.
Ukwehlisa umgangatho HCG - xesha nonconformity, kakhulu kade boxinzelelo ukwakha-hCG mkhulu kwe-50% ye-lebakala elithile:
• Ukungathobeli ekuthiwa ubomi benene (amaxesha amaninzi ngenxa umjikelezo).
• isisu isongelwe (kwinqanaba kuncitshiswa ngaphezu kwe-50%).
• ephosiweyo isisu.
• perenashivanie.
• ukukhulelwa ethunjini.
• Chronic insufficiency placental.
• Ukufa osadaleka 2-3 ezintathu.

iindlela invasive

Ukuba ugqirha ugqiba ukuba ekufumanekeni kwezifo ilifa, ukuphazamiseka kuphuhliso loxilongo invasive siswini kufuneka isicelo, oko ingasetyenziswa enye kwezi nkqubo zilandelayo:
• cordocentesis.
• Chorionic villus kwesampulu (ukufunda ukwakhiwa iiseli esakha ngumkhaya).
• Amniocentesis (amniocentesis).
• Platsentotsentez (ezichongiweyo emibi emva unosulelo).

Uncedo iindlela ezonakalisayo - fast kwaye eqinisekisa yoko ogqibeleleyo. Used in ekukhulelweni ekuqaleni. Ngoko ke, ukuba kukho urhano na ukungaqheleki kuphuhliso ezingekazalwa, uxilongo siswini kwezifo ilifa ikhokelela izigqibo ezichanekileyo. Abazali kunye noogqirha ekuhambeni kwexesha kwenza isigqibo sokushiya isiqhamo okanye ukuphelisa ukukhulelwa. Ukuba abazali, nangona ngezifo, kodwa isigqibo ukugcina umntwana, oogqirha kufuneka ixesha ukuqhuba kakuhle kwaye ulungise ukukhulelwa yaye baphathe umbungu esibelekweni. Ukuba isigqibo ngokuqhomfa yamkelwe, ngoko xa usaqala, xa ecaleni elibhaqiweyo, ngokomzimba nasengqondweni, le nkqubo kulula kakhulu kunyanyezelwa.

chorionic villus isampula

Chorionic villus yesampulu ibandakanya uhlalutyo amasuntswana ezincinane of villi chorionic - iiseli elizayo placental. Le yamasuntswana yi zemfuza efanayo ndingekazalwa, nto leyo evumela ukuba ukuchaza ukwakhiwa chromosomal, ukufumanisa impilo genetic wosana. Uhlalutyo lwenziwa izifo ekwakurhanelwa ezinxulumene iimpazamo chromosomal ekukhulelweni (Edwards syndrome, Down engqondweni, Patau et al.), Okanye emngciphekweni wokuhlaselwa sisifo esinganyangekiyo of abanesigulo esinganyangekiyo, irhengqe cell anemia, chorea Gentigtona. Isiphumo chorionic villus isampulu utyhila 3,800 izifo umntwana ongekazalwa. Kodwa isiphako onjalo, kukho isiphene uvaleke, le ndlela ngeke andibhaqwa. Le ngezifo ibanjiwe kuphela xa amniocentesis okanye cordocentesis iinkqubo.
Ngexesha uhlalutyo chorion ubukhulu kufuneka ungabi ngaphantsi kwe-1 cm, elivumelana kwiiveki 7-8 zokukhulelwa. Kutshanje, lenquba yenzelwa kwi kwiiveki 10-12, kuba ikhuseleke kakhulu olungekazalwa. Kodwa kungadlulanga kwiveki ye-13.

kwenqubo

Indlela okuhlatywa (transcervically okanye transabdominally) ekhethiweyo oogqirha. Kuxhomekeke phezu apho localized kweendonga zesibeleko chorion kakhulu. Xa kunjalo, a biopsy lwenziwa phantsi kolawulo ultrasound.

Eli bhinqa engqengqe ngomqolo. Le ndawo akhethelwe le okuhlatywa oluyimfuneko nefuthe intlungu. Zokuhlatywa udonga esiswini, kwenziwa udonga myometrial ukuze esingxotyeni inaliti yayiquka chorion ngaxeshanye. On US intshukumo ezilawulwa yenaliti. Ngesirinji amalaphu eziveliswe chorionic villus kwesampulu, inaliti isusiwe. Xa indlela transcervical, umfazi esofeni ngathi uviwo eqhelekileyo. iintlungu Express akukho ngayo. Iindonga kumlomo wesizalo yaye kusisi ayinakutshintshwa kunye iplayasi ezikhethekileyo. Access inikwa a catheter njengoko ifikelela izihlunu chorionic uzibandakanya isirinji nezinto ithathwa ukwenzela uhlalutyo.

amniocentesis

ubuchule siswini zokuxilonga ziquka ixhaphakileyo - indlela zophendlo lwezifo ze yokufumanisa thole - amniocentesis. Kucetyiswa kwiveki 15-17. Ekuqhubeni ulawulo karhulumente ukuba le ultrasound olungekazalwa. Doctor eludongeni esiswini ufaka ngenaliti fluid, yadika isixa esithile zohlalutyo kunye inaliti isusiwe. Ukulungiselela le kwiiveki 1-3. Amniocentesis kuyinto encinane eyingozi ukuba uphuhliso yokukhulelwa. Ngowe-1-2% yabasetyhini zinokuba ukuvuza kolwelo, ime ngaphandle unyango. Ukuqhomfa okuzenzekelayo inokwenzeka kuphela ngo-0.5% yamatyala. engekazalwa inaliti yonakele, uyakwazi ukwenza le nkqubo nakumatyala lokukhulelwa ezininzi.

ubuchule genetic

DOT test - yindlela entsha ekhuselekileyo yemfuza kuphando ezingekazalwa lubonisa Patau syndrome, Edwards, Ezantsi, Turner, Klinefelter. Uvavanyo lwenziwa ngokusekelwe data efunyenwe egazini sikanina. Umgaqo kukuba ukufa yendalo yenani leeseli placental ibe ligazi kumsinga umama 5% DNA Palsy. Oku kwenza kube lula ukufumanisa trisomies ezinkulu (DOT test).

Njani na indlela? Kuthatha igazi ukusuka apho iphuma khona yomfazi okhulelweyo, uyakhululwa DNA Palsy. Isiphumo unikwa kwisithuba seentsuku ezilishumi. Uvavanyo lwenziwa ngalo naliphi na inqanaba lokukhulelwa ukusuka kwiiveki ezili-10. Ukuchaneka kweenkcukacha 99,7%.