Ukuchonga i-pathology kwizigaba zokuqala zokuphuhliswa kwe-intrauterine kuncedwa ngokuhlola i- trimester yokuqala . Olu bunzima beendlela zokuxilonga lujoliswe ekuhloleni izinga lokuphuhliswa kwe-intrauterine lomntwana ngokuthelekisa izikhombisi zexesha lokukhulelwa. Le nkqubo inyanzelekile kwaye iqhutyelwa kuwo wonke oomama.
Kutheni uhlolo lokukhulelwa?
Ukuhlolwa ngexesha lokukhulelwa kuyinkqubo enyanzelekileyo, ngexesha apho ingozi yokuphuhla okungaqhelekanga kumntwana isungulwe. Iinkqubo zokuxilonga zikunceda ukuchonga ukuxhomekeka kokuveliswa kwezinto ezingafaniyo ze-fetus, ukuseka ukungafani phakathi kokuphuhliswa kwezitho zangaphakathi zentsana ngexesha lokukhulelwa.
Inkqubo isiluleko, kodwa abafazi abanqabe ukwenza njalo, bekwazi ukubaluleka kwezi zifundo. Kwakhona kukho izibonakaliso, ubukho bokuba kubangela ukuziphatha okufunekayo kweso sifundo:
- ubudala bomfazi ngaphezu kweminyaka engama-35;
- isongelo sokukhupha isisu ;
- ukukhipha isisu kwi-anamnesis;
- ubukho be-chromosomal engafanelekanga kumntwana ekukhulelwe kwangaphambili;
- ukutshatyalaliswa kwezifo ezincinci;
- Ukunyanzeliswa kokusetyenziswa kweziyobisi ezichasene ngeendlela ezimfutshane;
- ubukho bemikhwa emibi (utywala, utywala);
- ubudlelwane obusondeleyo noyise nomama wengane.
Ukuhlolwa kwe-trimester yokuqala-yintoni na?
Ukuhlolwa kokuqala kokukhulelwa kukuhlolwa ngokubanzi komzimba womama. Ngokuphunyezwa kwayo, oogqirha baphishekela injongo yokuxilongwa kwangaphambili kunye nokulungiswa kokuphuhliswa kokukhula komntwana. Ngelo xesha, bavavanya isimo sempilo kamama ozayo. Ukuhlolwa kwe-trimester yokuqala kuqukethe i-ultrasound kunye nokuhlolwa kwegazi nge-biochemical for a woman pregnant. Uvavanyo lweempawu zegazi lwenziwa kwinqanaba lesibini, phambi kobugqwetha kunye nokusola kwezilwanyana ngenxa yesiphumo se-ultrasound. Amanyathelo ayenziwa ngokuqhubekayo, iinkqubo ezimbini zivunyelwe ngolunye usuku.
Ukuhlolwa kwe-ultrasound ye-1 trimester
I-Ultrasound ekukhuleleni ibalulekile. Ngoncedo lwe-ultrasound, oogqirha bakwazi ukujonga esibelethweni sikamama, ukuvavanya imeko yenyama encinci, izitho zayo zangaphakathi. Ekuhambeni yesi sifundo kwisithuba omnye ezintathu yokuhluza, oogqirha sinikele ingqalelo nezalathisi anthropometric, ezo sisalathisi uphuhliso olufanelekileyo ndingekazalwa, umzimba ingqamana ubungakanani ubudala bayo sokukhulelwa. Xa i-trimester ihlolwa, ugqirha ugxininisa kule parameters elandelayo:
- I-KTP (ubukhulu beparietal size);
- ubungakanani bentloko yentloko;
- ukulingana kwe-hemispheres yecerebral;
- ubukhulu beethambo elide;
- ubukhulu beentliziyo kunye nobubanzi beempahla ezishiya;
- ukuhlaliswa kwesisu nezinye izitho zangaphakathi.
I-Biochemical Screening Trimester
Iimvavanyo ezifanayo ngexesha lokukhulelwa ogqirha bamisela emva kokufumana umphumo omubi we-ultrasound. Ukuxhomekeka kwe-pathology kwisikrini sogqirha, oogqirha bafuna ukuqinisekisa ukuba iinjongo ezicetywayo ziqikelelwa. Kufuneka kuqatshelwe ukuba lolu phofu lwenziwa kuphela ngexesha elithile lokukhulelwa, njengoko imigangatho yesalathisi ixhomekeke ngqo kwisiteji sokuthoba. Xa uvavanyo lwegazi lwe-biochemical liqwalasele ezi zilandelayo:
- HCG ;
- PAPP-A .
Uboniso lokuqala lubonisa ntoni?
Ngexesha lokuhlola, oogqirha bazama ukukhenkcela okungaqhelekanga kwechromosomal. Ezi mpazamo azibonakali naluphi na uhlobo, ubukho babo abuchaphazeli imeko yowesifazane okhulelweyo. Nangona kunjalo, banokuthi bachongwe ngumbonakalo obonakalayo ekubonakaleni komntwana kunye nokuba khona kwamakishi athile kwigazi lomama ozayo. Phakathi kwezilwanyana ezinokuthi zinceda ukuchonga ukuhlolwa kwe-trimester yokuqala:
- I-Down syndrome - i- trisomy 21 i- chromosomes, ivela kwiimeko ezili-1 ze-700.
- I-pathology ye-neural development development (encephalocele).
- I-Omphalocele - ngenxa yale nxalenye yokukhubazeka yezitho zangaphakathi ibeka phantsi kwesikhumba sodonga lwangasemva lwesisu, kwisigxobo se-hernial.
- I-Patau syndrome yi-trisomy kwi-chromosome 13. Inqabile, i-case ye-10 000 yokukhulelwa. Ihambelana nomonakalo omkhulu kumalungu angaphakathi. I-90% yabantwana abazalwe ngolu hlobo lwezilwanyana ziyafa ngonyaka wokuqala wokuphila.
- I-Edwards syndrome - trisomy kwi-chromosome 18. Lwenzeka kwi-1 yee-7000. Ngokuqhelekileyo kwenzeka kumama asebekhulile (ukhulelwe emva kweminyaka engama-35).
- I-Triploidy - umntwana ufumaneka ukuba unesithathu se-chromosomes, ehamba kunye neentlobo ezimbi.
- I-Cornelia de Lange syndrome - ebonakaliswa kukuphuhliswa komntwana wesisu ngokugqithiseka kwengqondo kwixesha elizayo.
Ukuhlolwa kokuqala kwee-trimester kwenziwa njani?
Ukuhlola ukukhulelwa kwisigama sokuqala kuqhutyelwa kwixesha elifanelekileyo. Ibhinqa ikwaziswa kwangaphambili kweso siganeko. Ngexesha elimisiweyo ufika ekuboniswaneni kwaye kuqala uhamba nge-ultrasound. Olu pho nonongo lunokuthi lube lugqithiso lwangaphakathi (ngokusebenzisa isondo) okanye isisigxina (ngokusebenzisa udonga lwesisu sangaphakathi). Ngokuqhelekileyo, inkqubo yesigulane ayifani ngokungafani ne-ultrasound evamile. Emva kokufumana iziphumo, ukuba kukhankanywa i-pathology, uvavanyo lwegazi luyalawulwa. Izinto eziphathekayo zithathwa kwi-vein, kwisisu esingenalutho ekuseni.
Ukuhlolwa kokuqala kokukhulelwa - ixesha
Ukuzilungisa ngokwabo, ukulungiselela kwangaphambili kweso sifundo, abafazi bahlala bebanomdla oogqirha xa besenza i-screening ye-trimester yokuqala. Ixesha lolu vavanyo lucacile kakhulu - ukwenzela ukufumana iziphumo eziphambili, kufuneka lenziwe ngokuthe ngqo kwixesha elithile lokukhulelwa. I-optimal ye-screening yithuba ukususela ngosuku lokuqala lweveki ye-10 yokukhulelwa ukuya kwi-6 yesonto le-13. Kwiimeko ezininzi, ukuhlolwa kokuqala kokukhulelwa, imihla leyo ekhankanywe ngasentla, yenziwa kwiiveki ezi-11 ukuya ku-12. Ngeli xesha, impazamo ekubalweni ayifanele.
Ukulungiselela ukuhlolwa kwexesha eli-1
Ukukhusela i-trimester yokuqala yayiyinjongo, oogqirha bafuna ukuthobela imithetho yokulungiselela isifundo. Kwimeko ye-ultrasound, yonke into iyilula: ukuba yenziwa ngumenzi wecala, akukho mfuneko ekhethekileyo yokulungiselela; ukuba ngaba udonga lwangaphakathi lomzimba - luyafuneka ukuba luzalise i-bladder phambi kwenkqubo ye-ultrasound.
Ukulungiselela ukuhlolwa kwegazi nge-biochemical kuyinkimbinkimbi kwaye iquka:
- Ukuthotyelwa kokutya: ukukhutshwa ekudleni kweelitrus, ukutya kwezilwanyana zasemanzini, ushokolethi.
- Ukukhanyela izitya ezicandiweyo nezityebileyo.
- Igazi linikezela ngeeyure zasekuseni, kwisisu esingenalutho. Isidlo sokugqibela kufuneka senzeke ngaphaya kweeyure eziyi-12 phambi kwexesha eliqikelelwayo lokuhlalutya.
Iziphumo zokuphonononga i-trimester eyi-1 - ukucacisa, ukuqheleka
Emva kokuvavanywa kwekota yokuqala, ukuchazwa kweziphumo kwenziwa kuphela ngugqirha. Umntu okhulelwe akanakukwazi ukuvavanya ixabiso elithe lafunyanwa, nangona xa kuthelekiswa namazinga omgangatho. Ukukhulelwa ngalunye kunempawu zayo, ngoko ke, ukuhlolwa kwesiphumo kufuneka kwenziwe ngokuqwalasela inkqubo yesigxina, ixesha layo, umzi womzimba wesetyhini, inani lezityalo ezivelisa.
Xa uvavanya izikhombisi zokuphuhliswa komntwana ngamnye, ezifunyenwe yi-ultrasound, oogqirha baqwalasela le iiparitha ezilandelayo:
- I-KTR - ubukhulu bomntwana obusuka kwisithsaba ukuya kumsila;
- ubude bomzimba - ubungakanani bomzimba wengane ukusuka phezulu ukuya kwiintendele;
- intloko;
- I-BDP (ubukhulu biparietal) - umgama phakathi kwe-hillocks emnyama;
- I-TVP - ubukhulu bekhola yendawo;
- Intlawulo yenhliziyo - izinga lentliziyo lomntwana.
Xa uqhuba ukuhlolwa kwezinto eziphilayo ngexesha lokukhulelwa, thobela iingqalelo ezimbini ezibalulekileyo:
- β-hCG-chorionic gonadotropin;
- I-PAPP-A iprotheni-A, ehambelana nokukhulelwa.
Imigangatho yokuhlola i-trimester eyi-1 - ukuchongwa kwe-ultrasound, itafile
Kwimeko nganye, oogqirha, xa bavavanya iziphumo ze-ultrasound ukuhlola i-trimester yokuqala, yenza ulungiso lweempawu ezizimeleyo zokukhula komntwana. Ngenxa yoko, amayeza avuma ukuphambukiswa okukodwa kwezibonakaliso kwiimimiselo ezisetyenzisiweyo. Ukongeza, iziphumo zezifundo zinokuchaphazeleka ngenye into - iphutha ekubaleni ixesha elichithwe ngumgqirha. Ukuthabatha uvavanyo lokuqala lokukhulelwa, imimiselo yazo enikezelwa kwitheyibhile elingezantsi, oogqirha baqala ukugqiba ixesha elichanekileyo lokuthwala.
Ukuhlolwa kwe-trimester yokuqala-ukucacisa iziphumo zegazi
Njengoko kuphawuliwe ngasentla, ukufundwa kwegazi lomfazi okhulelwe kuthatyathwa xa i-pathology ifumaneka okanye ukuba kukho ukusola nge ultrasound. Kule meko, oogqirha baqwalasela ezi zilandelayo:
- I-β-hCG- griadotropin, i-hormonal substance eyenziwe ngekhetho. Ngokuncedwa kwakhe ukufumanisa ukukhulelwa kwiindawo zokuqala. Nangona kunjalo, uyisalathisi esibalulekileyo kwi-1 trimester kuphela. Nsuku zonke ukuxinwa kwe-hCG kwanda, kufinyelela kwi-weeks 12 ukuya kwe-12.
- I-PAPP-A iprotheni-A, ehambelana nokukhulelwa. Le nxalenye yeprotheni iveliswa yi-placenta, inoxanduva lokuphuhlisa nokusebenza kwayo. Emva kokuhlolwa kwezinto ezinokwenziwa kwezinto eziphilayo kwimizi yokuqala yesithathu, iziphumo zigqitywa ngugqirha obona umfazi okhulelweyo. Ixabiso lalezi zikhombisi ngexesha lokukhulelwa linikezelwa kwiithebhile ezingezantsi.
Ubundlobongela bomntwana ekuqalekisweni kokuqala
Ukuhlolwa kokubeleka kwe-1 trimester akuvumeli ukuba kuqinisekiswe ngokuchanekileyo isondo sekusasa lomntwana. Ngenxa yoko, oogqirha abathinteli ngokubaluleka kwesi sikhombisi. Nangona kunjalo, ngesicelo somama ngokwakhe, ingcali kwindawo efanelekileyo yomntwana ingenza iingcamango zakhe malunga nesondo lomntwana. Ngokwenza oko, abahlali bahambelane neyinyani kwaye bahlala bephosakele, ngoko ke xa ukuhlolwa kokuqala kwenziwe le parameter ayiqwalaselwe.
Iziphumo ezingalunganga zokujonga i-trimester yokuqala
Isiphumo esiphumeleyo sokujonga i-trimester yokuqala sizathu sokuhlaziywa kwakhona. Nangona kunjalo, kuqhutywa emva kwexesha, kwi-2 kwaye, ukuba kuyimfuneko, kwi-3 trimesters. Kwiimeko ezinqabileyo, ngeziphumo ezimbi ezivela kwizifundo eziliqela, oogqirha banokubambelela ekuqhubeni ukuxilonga. Kakade ngeziphumo zale ziphando isigqibo sokwandiswa kokukhulelwa okanye ukuphazamiseka kwayo kwenziwa. Phakathi kwezi ndlela zokuxilonga:
- chorionic villus biopsy;
- cordocentesis (uhlalutyo lwegazi lwentambo);
- i-amniocentesis (i-amniotic fluid).