Ukucoca, iiveki ezi-12 zokukhulelwa: eziqhelekileyo, ukuchonga

Indlela ukwazi ukuba le mveku, nokuba na kokushenxa izibilini akhiwa imvuthuluka? Iimpendulo anganika (xa umhla ngawo weza ukhulelwe - iiveki ezili-12) ultrasound. Ukuhlolelwa ukuba bahlole uphuhliso ndingekazalwa, kube unika umfanekiso ocacileyo weempawu yemfuza chromosomal wosana elizayo. Oku kwenza kube lula ukufumanisa ubukho okanye ukungabikho mgaqweni.

US ebambe kwisithuba seeveki-12

Ngokomthetho le nkqubo yenziwa ngeendlela ezimbini: transvaginally (ngokusebenzisa lobufazi ngoncedo boluvo ezizodwa) kunye transabdominal (kusetyenziswa ulusu esisu). Le yokugqibela kuxhaphake kakhulu, kwaye bokuqala ukuba ukuqesha abafazi bonke kurhulumente, kodwa kuphela abanye babo, kwezi meko zilandelayo:

- ukuba ngumkhaya (chorion okanye) ephantsi apha;

- Ukuba kukho lingabi wesibeleko, kwaye oko kuyimfuneko ukuhlola isidanga;

- Ukuba kukho iimpawu cysts ukudumba kunye waso (ukuba ukuxilongwa), okanye yindawo fibroids zesibeleko ibekwe ngqo kakhulu, kodwa indlela №2 kutyhilwa ulwazi encinane;

- xa kuhlolwa indawo entanyeni umntwana okanye yokulinganisa ubungakanani ekunene, kunzima ukuvelisa ngenxa yokuba isiqhamo nto imbi, nokuba inyama ongama esiswini eshinyene kakhulu.

A phando phantsi ndlela: umfazi elele, eguqa ngamadolo zenu; Ugqirha ifaka kungena kwilungu lobufazi uphenyo cuke apho ezilahlwayo unxiba ukukhusela ikhondom. Ngokuqhelekileyo, bonke kwenziwa ngononophelo olukhulu, ngoko ukhulelwe akuthethi zintlungu.

isifundo Transabdominal kwenziwa kwindawo enye. Zonke emoyeni phakathi woluvo kwaye isikhumba ukuqhuba, kwangokunjalo kubekho iziphumo ezingachanekanga. Ukuze kangangoko kunokwenzeka ukunciphisa amathuba yemposiso, sebenzisa ijeli ekhethekileyo oluthi lusetyenziswe esiswini. Ngcembe yisa woluvo esiswini, ukuze ukwazi ukubona kwezidumbu iimvuthuluka, kwakunye wesibeleko kunye ngumkhaya nonina. Ultrasound kukhuselekile ngokupheleleyo kwimveku kwaye akubangeli kuye nawuphi na umonakalo.

Indlela ukulungiselela US

Ukulungiselela kuxhomekeke indlela. Ukuba usebenzisa transvaginal, kucetyiswa ukuba usebenzise ukuya usuku olu-1 ngaphambi kokuba isifundo ezo mveliso, nto leyo olubangela ukubila: isonka esimhlophe, iimbotyi, ikhaphetshu, iertyisi. Amathumbu kufuneka kuqongqothwa, kungenjalo kukho iigesi ukuthintela zoviwo wesibeleko kunye olungekazalwa. Ukuba ufumana imvakalelo ukuba nesisu olunyuswe, uyakwazi usele ichiza "Espumizan", nto leyo engenabungozi olungekazalwa.

Phambi ukufunda transabdominal basela kwisiqingatha ilitha yamanzi imizuzu engama-30 phambi kokuqala. Kuyimfuneko ukuba kukho isinye epheleleyo, nto leyo iya kuvavanya ezi mbungu nokuba ingaphononongwa imeko yakhe.

Uphuhliso umntwana kwisithuba seeveki-12

Uninzi amalungu ezinkulu ziye kwiimvuthuluka kunye nezinye izakhiwo amancinci kuqhubeka lasungulwa. Ukukhula avareji umntwana 80 mm, kwaye ubunzima - malunga 20 grams. Kwakhona, oogqirha bathi ukutya iziqhamo ezinjalo iimpawu:

- izinga intliziyo ucaschenne ngaphezu kwithuba leenyanga ezintathu lesithathu, kwaye malunga ne-170 uqumba ngomzuzu;

- ubuso somntwana akusekho ikhangeleka ngathi tadpole, kwaye uzuza zobuntu;

- ungabona iinkophe, earlobes, iinwele vellus omncinane (kwisayithi amashiya kunye amashiya of Education);

- uninzi izihlunu phambili ngokuyenza, ngoko iziqhamo ihamba lonke ixesha, kunye nentshukumo ubukhulu becala ezizenzekelayo kunokuba ingalawuleki;

- mixture grimaces kwaye licudisa izandla zakhe ezandleni, iminwe kubonakala phezu nezikhonkwane;

- umntwana liqulunqe wezintso kwaye phantse Obumbe amathumbu, igazi waphawula iiseli ezibomvu namhlophe igazi;

- bakha ngokupheleleyo, zombini zifaka yobuchopho, kodwa "imiyalelo 'ngoxa amaphiko;

- ungabona ngubani na inkwenkwe okanye intombazana, kodwa kuba umbungu akusoloko indlela ofuna umama kunye noogqirha, kuyenzeka ukuba wenze impazamo, ke ngoko, ukuba ngqo ngakumbi entsimini, xa kwiveki 16 th.

Indlela ukufunda iziphumo?

Bephepha iziphumo zophononongo uya ukufumana izandla zakho emva kokuba ukuhlolwa (iiveki ezili-12) yenziwe. Uhlalutyo Inkcaza ziya kunikwa emva koku.

Ukususela ngenyanga yesithathu sele kubonakala kakuhle, umntwana okanye hayi. Ngoko ke, ukuba "inani leziqhamo" umhlathi ibhalwe ezimbini okanye ngaphezulu, loo nto ibonisa ukuba kuza kufuneka amawele (ezintathu njalo njalo. D.) Ngaba sele kunokwenzeka ukuba nako ukufumanisa ukuba odnoyaytsovye iziqhamo (amawele), okanye amawele (heterozygous).

intshumayelo

Eli ligama le iziqhamo, zibekwe kufutshane emjelweni wokuzalwa. Xa beneeveki ezili-12, kunokuba nto: imilenze, intloko, okanye umntwana kwaphela kwi idiagonal. intshumayelo lokugqibela ziphononongwa kwiveki 32 yokukhulelwa. Ukuba intloko ayikho ngaphandle isibeleko, kuthatha onke amanyathelo lula ukulungisa le meko.

Ukulinganisa ubungakanani olungekazalwa (okanye fetometry)

Ziqonde i US kunye nemfuneko ukuvavanya iinketho, kodwa kufuneka enze ugqirha lowo hlengisa hayi amanani kuphela, kodwa kwakhona kwi imeko esibanzi abakhulelweyo. Yonke imigangatho oboznalsya oonobumba ethile kunye namanani. Nazi ezona ziphambili:

• eguquguqukayo (BPD, BRGP) - le shunqulelo isho ekuthiwa-biparietal ubungakanani oko kukuthi, umgama ukusuka entloko enye .. Parietal ithambo. Isithuba seeveki 12 ultrasound kufuneka sibonise 21 mm BDP.
• Ukukhula umntwana - malunga 8.2 cm, ubunzima kufuneka bungabi ngaphantsi kwe-17-19 g
• FML, DlB - ubude kasikrobana. Normal - 7 ukuya ku-9 mm.
• Nuchal mayingagqithi 2.7 mm. Ngokutsho kubungakanani bayo kuxhomekeke ingaba kukho naziphi na izigulo ezinzulu. Kwi-avareji, kuba nama-1,6 mm.
• Igama elithi CTE (CRL) ukuchaza ubukhulu coccyx-Parietal, okt ubude ukusuka entloko ukuya coccyx, norm - .. 43-73 mm.

Kukho nezinye izifinyezo:

• Hum (AP) - ubude egxalabeni.
• AC (OJ) - wedini esiswini.
• Abd (J) - esisu ubukhulu.
• PC - ubukhulu kwentliziyo.
• OG - intloko wedini.

Kuba zonke ezi parameters 1 yovavanyo ngexesha lokukhulelwa ivumela ugqirha-sonologu agqibe ukuba akhule kwaye aphuhle ubume yosana ngayo. Ukuba wenze imilinganiselo lingaphantsi kwe norm kuba abantu ngokubanzi kuqikelelwa njengoko bawa: ngokomlinganiselo kwaye ngexesha elinye okanye hayi. Ukuba awuvumi kancinane kuphela, ngoko akukho sizathu sokuba ukothuka. Mhlawumbi phosakeleyo echazwe ixesha yaye okunene ngoku kuphela kwiveki ye-11. Okanye mhlawumbi usana olo ukukhula ngenxa yokuba abazali undersized.

Kwakhona, ufumanise ukuba ingaba kukho naziphi na iziphene kuphuhliso enyama yangaphakathi, na ukuba enkabeni intambo okanye azibophelele, yintoni umlinganiselo intliziyo (izinga - ukusuka ibetha 150 ukuya 174 ngomzuzu), ukuba kukho umahluko iimpawu fluid.

Ukufunda isiphelo ultrasound okhulelweyo nazo kunye amagama afana "polyhydramnios" kunye "oligohydramnios". Ntoni na nokuba ingaba kuyimfuneko ukuba yinto ukuba woyike? Ayikho into engalunganga ngala mazwi apho. Ku va isigqibo kobungakanani amanzi apho umbungu ndiyihlanganise ndiyidadise kuphela: ukuba kukho ngaphezu kuyimfuneko, polyhydramnios ezisisigxina, ukuba ngaphantsi - oligohydramnios. Amaxesha amaninzi, oku bubungqina ezinye kakubi: usuleleko intrauterine (IUI), ukuphazamiseka ezintso, inkqubo luvo. Bona kwakhona ingaba amanzi sobumnyama. Ukuba ewe, ngoko ke kukho isalathisi ukuya kufikelela usulelo.

Umthetho basic xa sibona ukutenxa kule norm - nokungoyiki, kodwa ukuba uye yincutshe.

akukho nokuba ingaba ukutenxa ngumkhaya?

Ultrasound ibonisa apho eqhotyoshelweyo "isihlalo umntwana" njengoko ekhula, ukuba kukho izifo, kwaye ngaphezulu. Eyona ndlela ilungileyo kukwayamanisa nodonga elingasemva wesibeleko. Kodwa ngumkhaya unako 'banamathele' kwaye ngaphambili, kude kuse emazantsi. Ngelo xesha ke kufuneka ukuba zilala phezu umlomo engaphakathi wesibeleko. Le meko kuthiwa chorionic okanye central beendawo previa. Kulo mzekelo, nokuba le meko izakutshintsha, yaye ke ukuba akunjalo, a endla ntirho ngoqhaqho lonikezelo. Ukuba imihlathi azikho lavalwa ngokupheleleyo, ubizwa ngokuthi previa ezingaphelelanga; ukuzalwa ngexesha elifanayo kwenziwa ngendlela eqhelekileyo.

Ukuba ngumkhaya "ziyaxinga" kufuphi uphumo (ngaphantsi kwe-70 mm), le ntetho lisephantsi. Ekubeni kusenokuba intsongelo ukopha, kucetyiswa imo ngaphantsi esebenzayo abakhulelweyo. Emva koko ukubona ukuba beendawo phezulu kuvuka. Ukuba ngu kwiiveki 32-36 oku kuyenzeka, akuyi kuba isoyikiso, yaye umfazi uya kuzala ngendlela eqhelekileyo.

Bokudlala ngumkhaya kule kota ilingana no 0. "lobular" ngumkhaya - le ngokuzalana ukuqola, yaye kwimeko enjalo ke kuyimfuneko ukuba udibane nogqirha. Le iidipozithi of iityuwa calcium zibizwa ngokuba calcifications. Ummiselo na, ukuba zikhona ngumkhaya weqondo yokuqala uqolile.

Ukuba kukho ukufa inxalenye ethile "isihlalo mntwana," oku kuthiwa beendawo engabalulekanga. Kulo mzekelo, kukho imfuno engxamisekileyo udibane nogqirha ukufumanisa unobangela ukumisela unyango, kuba ukuba oko kuya kwenzeka, yaye emva koko, umntwana akayi kuba ioksijini ngokwaneleyo kwaye kuyimfuneko ukuba izinto zalo zophuhliso.

Wesibeleko: isakhiwo kukarhulumente

Ngomhla wama-12 we-veki umlinganiselo ubungakanani wesibeleko, apho kufuneka bungabi ngaphantsi kwe-30 mm. Okukhona ke, ngcono. Ukuba ine elifutshane kakhulu, ngaphantsi kwe-20 mm, ukukhulelwa esibhedlela, kwaye zingasetyenziswa tyando unyango. emlonyeni wesizalo zivaliwe, ngaphandle kunye nezo ziphuma ngaphakathi.

Myometrium (imisipha okanye imeko) lubonisa ukuba kukho ingozi kwesisu. Ukuba isifo ibonisa ukuba kweli xesha kukho hypertonicity le isibeleko, lo mfazi liphathwa. izinto ngakumbi okungaka njenge "ukuxubana" ngesisu, "atyhale-kume" kule ngingqi empontshwa.

Indlela ukujonga ixesha ultrasound

Ukusebenzisa iitafile ezikhethekileyo ze CTE zibalwa yobudala sokukhulelwa. Kusenokwenzeka ukuba enjalo elakhelwe kwiprogram kumatshini ultrasound. Thelekisa amagama - a ebalwa ukusuka kwixesha sexesheni lokugqibela ultrasound ezikhutshiweyo. Ukuba umahluko incinane (iiveki omnye okanye emibini), uya kufumana ithuba ngqo elichazwe obstetrician. Kwimeko mismatches ngakumbi (iiveki ezingaphezu kwe-2), thatha lula ultrasound elithi echazwe.

siswini: yintoni nokuba njani

Qaphela ngakumbi xa ukhulelwe - iiveki ezili-12. Ultrasound nokuxilongwa - zonke ezi zifundo zenzelwe ukuba ukuvavanya uphuhliso olungekazalwa. Kule ultrasound kuqala kwenziwe, uze amisele zikhusela (ngokuxhomekeke yokusebenza). Sisisebenzise xa:

- abasetyhini abakhulelweyo engama-35 nangaphezulu.

- Ngaphambi koko, abantwana abazalwa ufile.

- Ukuhlolisisa usulelo iziqhamo intrauterine yangaphambili kubonakele.

- umntwana ezelwe, siye safumanisa ukuba angahlangani chromosomal.

- Ku tilulamisela ukuba mgaqweni ezifana unezihlobo zabazali bobabini.

Kuphela kumaziko ezizodwa bathela ukuhluza (iiveki ezili-12). Indlela ukukwenza oko? Qokelela zonke iimvavanyo: ultrasound, igazi, iingcombolo zangaphandle. isifundo Uvavanyo lwenza i zofuzo, yaye kujoliswe ikakhulu ukuba nithathele ingqalelo sobosobo amanani: ezamahala beta-hCG kunye PAPP-A. Ngokubanzi, aba abamakishi kuzo ifundwa zidityaniswe esekwe kakuhle. Ukuba ubuncinane omnye wabo etshintshile, oko akuthethi ukuba ingane ethile ngezifo.

Ngoko xa bahlolwe kwiiveki ezili-12 zokukhulelwa, ukusetyenziswa iimpawu zezi amakishayo. Oko syvorochnye neeproteni. Ukuba unayo unxaxho, ngoko lo mntwana uya ukungaqheleki yemfuza. Free β-hCG - enganeno of chorionic (chorion - le intsholongwane) gonadotrophin zabantu kunye PAPP-A - yinto ukukhulelwa enxulumene protein A. Ukuze ukufunda ezi mpawu kusetyenziswa ELISA kulingwa (enzyme enxulumene kulingwa immunosorbent).

HCG lukwakhuthaza Yindibanisela hormone steroid (kwi ngumkhaya umzimba etyheli). Oogqirha bafumanisa ukuba hCG sikhusela olungekazalwa evela ukwaliwa. Ukuphonononga inqanaba, ungenza uqikelelo kwikhosi ngakumbi yokukhulelwa. Ngokutsho manani zonyango, hCG yandisa ngokuthe ngcembe de kwiveki 10 yaye emva koko ihlala malunga kwinqanaba elifanayo (ukususela 5000 ukuya 50000 IU / L) ukuya kwiiveki 33, uze emva koko nivuke kancinane.

1 ukuhlolwa ekukhulelweni yi yesi-10 kwiveki ye-13 kwikota. Ukuze kubalwe zonke iingozi, thatha elininzi data: US umhla CTE kunye TPV (Translations nuchal).

ibaluleke kakhulu ngayo ukuchonga ukungaqheleki ezikhoyo zofuzo La cazululo. Noko ke, ukuba ubungqina wakhulisa kancinane, ungakhathazeki kwaye wenze izigqibo ngokungxama. Kufuneka nje ukuba isicelo zofuzo, ngubani na oya kukuxelela ntoni elandelayo. Kukho kwakhona Kungenzeka ukuba ayilunganga read ultrasound. Ukuhlolwa ukukhulelwa ngeveki-12 kungaba waphinda - ukucacisa, okanye ugqirha uyakukumisela isigulo yeli lizwe, nto leyo ngokucokisekileyo ngakumbi ukumisela iseti genetic bomntwana. Kuxhomekeke ngaliphi ixesha, wenze nokuba chorionic villus zeesampulu okanye amniocentesis.

Ukuba nokuba 1 zokusikrinwa libonakalise ingozi ephantsi kakhulu ezingaqhelekanga chromosomal kwi ndingekazalwa, akukho mfuneko ungamshiyi phando, lwenzeka kwinyanga 4-5 zokukhulelwa. Ngaphezu koko hCG and AFP, ukuqinisekisa inqanaba estriol mahala (uvavanyo ezintathu).

Ukuze kumiselwe parameters β-hCG kunye PAPP-A, ukunika zokuhlola igazi. kwiiveki 12 - ixesha elaneleyo ukuze akwazi ukubona ubukho uhlalutyo zengqo- (okanye ukunqongophala) ukungaqheleki xa zofuzo.

Isiphelo yokuhlaziya

Kuxhomekeka kwiziphumo zeemvavanyo kwegazi abonisa isizathu sokuba amanani zahluka kwisiqhelo. Ngenxa yoko, ukuhlolwa ukukhulelwa ngeveki-12 ukuze asombulule kulandelayo:

- Down Syndrome.

- Akukho namnye iziqhamo, 2 (3, njl ...). isiqhamo ngakumbi - amanqanaba ngaphezulu hormone.

- toxicosis.

- iseti elingalunganga ngexesha lokukhulelwa. Ngeveki nganye ekukhuleni komntwana lihambisana parameter egqiba iminyaka ngqo olungekazalwa.

- Ubukho isifo seswekile unina.

- pregnancy.

- umngcipheko eliphezulu kwesisu.

Ingaba kukho nayiphi na imithetho yokusebenza?

Kakade kukho! Funda ukuba ungakwazi ngokwenza izifundo ezifana ultrasound, ukuvavanyela (iiveki ezili-12). yinto yamihla le Kuya kwaziwa emva kokufunda ugqirha data. Noko ke, kukho srednemeditsinskie izalathi ichazwe ngokucacileyo ngeveki nganye lokukhulelwa. Umzekelo, β-hCG weveki 11-12 kufuneka ibe ukusuka 200,000 ukuya 90.000 IU / ml.

Nangona kunjalo, kufuneka kukhunjulwe ukuba ukuhlolwa kwendawo ukukhulelwa ngeveki-12 inika, Kakade ke, phezulu kakhulu, kodwa hayi yoko ogqibeleleyo, kuba wonke umfazi mzimbeni zabo ezithile,-akhawunti kufuneka kuthathwe ngugqirha wakho. Ukuba umbungu nje kuphela, ngoko ke kunzima ukubona. Jonga le mifanekiso. Ukuba ngaphezu kwesinye enesiqingatha okanye amabini amaxesha, kunokwenziwa isigqibo sokuba ngeembumba-2 okanye ngaphezulu. Ngalinye iziqhamo chorion yayo nemveliso hormone ezahlukeneyo. Ngoko ke, ukusebenza loo aphezulu, nonina elizayo wathumela ukuba ultrasound ukuqinisekisa ukuba ukhulelwe.

Xa zahlolwa (iiveki ezili-12), iinqobo ezisemgangathweni ngoko cross-zihlolwe ne lwazi ezithathwe ukuze ubale ukuba ngezifo na. Oogqirha zisetyenziselwa le njongo yinto ekhethekileyo, ebizwa umama. Oku ibalwa ifomula: inani incindi yedlala, obekiweyo esekelwe kwiziphumo yokubahluza, yahlulelwe kwii hCG (oku ingqamana lokukhulelwa eziqhelekileyo). Kufuneka ukufumana enye (ukuba isendaweni). Well sele kwiziphumo zonke izifundo bagwetywe nokuba ziquka iqela unina-umngcipheko abanala makhwiniba chromosomal okanye hayi. Kubalulekile ukuphawula ukuba kwanokuba zonke ngequbuliso Kwathi, kuba akukho sigwebo lokugqibela, kodwa ke mnye kuphela kwenzeke. Ngoko ke, ezinye izikhombisi zithelekiswa kwaye kuphela koko wenze naziphi izigqibo. Impinda yonke ukuvavanyela i ukukhulelwa ngeveki-12: ultrasound, iihomoni, RTA ingathatha isifundo sesibini senyanga yesibini.

Iprotheni i-RARP-A inoxanduva lokukhusela umfazi okhulelweyo, kwaye inceda kwakhona umsebenzi we-placenta. Ekubeni imingcele yemingcele icaciswe ngokucacileyo, ukuphambuka kwayo kuyinto engathandekiyo. Into enjalo kukuba "ukunyuka" kwezi zibonakaliso akuthethi nje ukukhulelwa komzimba, kodwa kunye neendlela ezimbi ezinjalo njenge-Down's syndrome, i-Lange syndrome, njl. Amanani aqhelekileyo: ukusuka ngomhla we-11 ukuya ku-12 Iiveki - 0,7 - 4,76; Ukususela kwi-12 ukuya kweveki ye-13-1.03-6.01.

Iingqinisiso malunga nophando

Abasetyhini abaye bahlola (iiveki ezili-12), baphendule ngokungafaniyo ngalo. Omnye ulungelelanisa ngesini ngesondo somntwana. Kukho inkcazo yale nto - ixesha lifutshane kakhulu, ekugqibeleni liya kuthiwa ngubani oza kuzalwa: intombazana okanye inkwenkwe, kuphela ngeveki le-16. Bathetha ngamanani ahlukeneyo. Abanye abantu bavavanya ukukhululeka, abanye bahlawula i-ruble eyi-1,000 ne-3,000.

Nangona kunjalo, uninzi unina uqaphele ukuba i-ultrasound kunye nokuncedisa ukunceda ukuqonda indlela ukuphuhliswa kwengane kuqhubeka ngayo. Ukususela ngoku ezi nkqubo ziyimfuneko, kunokwenzeka ukuxilonga nokuqala ngexesha lokuphatha izifo ezikhoyo ukuze umntwana azalwe enempilo.