Kuyezetsa magazi, masabata 12 a mimba: ulamuliro mawu olembedwa

Kodi kudziwa ngati mwana wosabadwayo osauka, kaya kupatuka iliyonse monga ziwalo mkati anapanga nyenyeswa? Mayankho angapereke (tsiku ndi amene anadza mimba pako - masabata 12) ultrasound. Kuphimba kupenda chitukuko cha mwana wosabadwayo, likupereka bwinobwino za majini ndi chromosomal maonekedwe a mwana m'tsogolo. Izi zimathandiza kudziwa kupezeka kapena kusapezeka kwa anomalies.

US akugwira nthawi 12-sabata

Kwenikweni ndondomeko ikuchitika m'njira ziwiri: transvaginally (kudzera nyini mothandizidwa masensa wapadera) ndi transabdominal (kudzera pakhungu la pamimba). Yotsirizira ndi ambiri, ndi oyamba zoika akazi onse boma, koma ena a iwo, mu milandu zotsatirazi:

- ngati latuluka (chorion kapena) otsika Ufumuyo;

- ngati pali kulephera khomo lachiberekero, ndipo m'pofunika kuti aone mlingo;

- Ngati pali zizindikiro za cysts yotupa ndi zokhudzana (matenda zolondola), kapena mfundo ya fibroids uterine achita kwambiri ili, koma njira №2 anaulula mudziwe pang'ono;

- pamene akuona mwana khosi dera kapena kuyeza kukula bwino, zimakhala zovuta kuti apange chifukwa chakuti zipatso si zolakwika, kapena subcutaneous m'mimba minofu kwambiri wandiweyani.

Kafukufuku ali mkati mochita: mkazi atagona, kupinda mawondo anu; dokotala amaika mu nyini akupanga kafukufuku umene disposable amavala kuteteza kondomu. Kawirikawiri, onse anachita mosamala kwambiri, choncho pakati Kodi Simumva kuwawa.

phunziro Transabdominal anachita zomwezo. mpweya onse pakati pa kachipangizo ndi khungu osati galimoto, koteronso kukhale zotsatira pachithunzichi. Kuti ngati kuli kotheka kuchepetsa Mwina wa kulakwitsa, ntchito gel osakaniza wapadera kuti umagwiritsidwa ntchito pamimba. Pang'onopang'ono kusuntha sensa mmimba, kotero kuti inu mukhoza kuwona matupi a nyenyeswa, komanso monga chiberekero ndi latuluka mayi. Ultrasound ndi otetezeka kwathunthu kwa mwana wosabadwayo ndipo sayambitsa iye kuwonongeka.

Kodi pokonzekera US

Kukonzekera zimadalira njira. Ngati mumamwa transvaginal, Ndi bwino kugwiritsa ntchito mpaka tsiku 1 asanachite phunziro anthu mankhwala, yomwe INGATHE kuyambitsa nayonso mphamvu: mikate yoyera, nyemba, kabichi, nandolo. Matumbo ayenera anadzikhuthula, mwinamwake pali mpweya kuteteza mosamala chiberekero ndi mwana wosabadwayo. Ngati inu mufika kuganiza kuti m'mimba ndi mpweya, mukhoza kumwa mankhwala "Espumizan" imene palibe vuto lililonse kwa mwana wosabadwayo.

Pamaso kuphunzira transabdominal kumwa lita theka la madzi kwa mphindi 30 pamaso pa chiyambi. M'pofunika kuti panali chikhodzodzo full, omwe zifotokoza mwana wosabadwayo ndi kuonanso chikhalidwe chake.

kakulidwe ka mwana mu nyengo 12-sabata

Ambiri a ziwalo zikuluzikulu apanga nyenyeswa ndi ena nyumba yaing'ono kupitiriza mapangidwe ake. Kukula pafupifupi wa mwanayo ndi 80 mm, ndi kulemera - pafupifupi 20 magalamu. Komanso, madokotala kuti kudya zipatso ziwalo:

- kugunda kwa mtima ucaschenne kuposa mu trimester lachitatu, pafupifupi 170 kumenyedwa pa yokha;

- nkhope ya mwana sunalinso zikuwoneka ngati namchidwe, ndipo amapeza makhalidwe a anthu;

- mukhoza kuona zikope, makutu, pang'ono vellus tsitsi (pa malo nsidze ndi nsidze wa Education);

- kwambiri minofu pafupifupi anayamba, kotero chipatso ikuyenda nthawi zonse, ndipo gululi ndi achipembedzo padera ndi m'malo wachisokonezo;

- crumb grimaces ndi akakufinyani manja ake pa nkhonya, zala Tingaone pa misomaliyo;

- mwanayo zachitika impso ndi pafupifupi anapanga matumbo, magazi anati maselo ofiira ndi oyera;

- athanzi, onse hemispheres ubongo, koma "malamulo" pamene dorsal;

- inu mukhoza kuona amene ali mnyamata kapena msungwana, koma chifukwa wosabadwa si nthawi zonse momwe mukufuna amayi ndi madokotala, n'zotheka amalakwitsa Choncho, kukhala yeniyeni kwambiri pa munda pa 16 TH sabata.

Kodi kuwerenga zotsatira?

Paper ndi zotsatira za kafukufuku udzapeza manja anu pambuyo mosamala (masabata 12) wapangidwa. Analysis Kufotokoza adzapatsidwa hereinafter.

Kuyambira mwezi wachitatu kale bwino anawona mwana kapena ayi. Chotero ngati "nambala ya zipatso" ndime zalembedwa awiri kapena kuposa zikutanthauza kuti mudzakhala ndi mapasa (atatu ndi zina zotero. D.) Kodi kale zotheka komanso kupeza ngati zipatso odnoyaytsovye (mapasa), kapena ndi mapasa (heterozygous).

ulaliki

Ili ndi dzina la chipatso, yomwe ili pafupi ndi ngalande kubadwa. Pa masabata 12, zingakhale chilichonse: miyendo, mutu, kapena mwana konse udzakhazikitsidwe pa opendekera. ulaliki yomaliza ayesedwa ndi sabata 32 mimba. Ngati mutu si ili kunja kwa chiberekero, akuwatenga miyezo zotheka kuti vutoli.

Kuyeza kukula kwa mwana wosabadwayo (kapena fetometry)

Chinawathandiza kumvetsa n'chakuti pa US ndi kufunika kusankha, koma ayenera kuchita dokotala amene oyendetsa osati manambala kokha, komanso pa zinthu chachikulu ndi pakati. mfundo zonse oboznalsya zilembo ndi manambala. Nawa akuluakulu:

• Maganizo matenda (BPD, BRGP) - chidule izi kutanthauza otchedwa biparietal kukula ie, mtunda kuchokera mutu umodzi .. Parietal fupa. Kwa nthawi ya masabata 12 ultrasound ayenera kusonyeza 21 mamilimita BDP.
• Kukula kwa mwana - za 8.2 cm, kulemera ayenera kukhala osachepera 17-19 ga
• FML, DlB - ndi kutalika kwa ntchafu. Normal - 7 mpaka 9 mm.
• Nuchal sayenera upambana 2,7 mm. Malinga ndi kukula kwake anatsimikiza ngati pali matenda aliwonse aakulu. Nthawi zambiri, pafupifupi 1.6 mm.
• Mawu akuti CTE (CRL) potanthauza kukula coccyx-parietal, mwachitsanzo kutalika pazipita mutu kwa coccyx, ponseponse - .. 43-73 mm.

Palinso achidule ena:

• Phokoso (AP) - phewa kutalika.
• AC (OJ) - m'mimba circumference.
• ABD (J) - pamimba awiri.
• PC - kukula kwa mtima.
• Ogi - mutu circumference.

Pakuti onse a magawo awa 1 mosamala mimba akulola dokotala-sonologu kudziwa kukula ndi kukhala dongosolo mwana. Ngati inu anapanga miyezo ndi zosakwana ponseponse kwa anthu ambiri Akuti monga iwo anagwa: mogwirizana ndi nthawi yomweyo kapena ayi. Ngati simukugwirizana pang'ono chabe, ndiye palibe chifukwa mantha. Mwina molakwa kumatanthauza nthawi ndi kwenikweni tsopano sabata 11. Kapena mwina mwanayo ngati kukula chifukwa cha makolo undersized.

Komanso fufuzani ngati pali zopindika mu chitukuko cha ziwalo mkati, pali ngati umbilical chingwe kukodwa, zimene kugunda kwa mtima (mlingo - kuchokera kumenyedwa 150 kapena 174 pa mphindi imodzi), ngati pali kupatuka pa makhalidwe a madzimadzi amniotic.

Kuwerenga mapeto ultrasound pakati akhoza kukumana ndi mawu monga "polyhydramnios" ndi "oligohydramnios". Chiyani komanso ngati kuli koyenera kuti chinachake kuopa? Palibe cholakwika ndi mawu awa. Ndi chabe mtima wa kuchuluka kwa madzi amene wosabadwa amayandama: ngati pali kuposa zofunika, polyhydramnios mapulani ngati zochepa - oligohydramnios. Nthawi zambiri imeneyi ndi umboni wa ena amazunza: intrauterine matenda (IUI), matenda a impso, chapakati mantha dongosolo. Onaninso ngati madzi kale loipa. Ngati inde, ndiye ndi Cholozera bwino kwa matenda.

Ulamuliro zofunika pamene detects zolakwika mwakale - osati mantha, koma kupita katswiri.

Kaya pakhoza kukhala zolakwika ku latuluka chiyani?

Ultrasound zikusonyeza kumene Ufumuyo "mpando mwana" monga okhwima, ngati pali matenda, ndi zina zambiri. Njira ndi angagwirizanitse kumbuyo khoma la chiberekero. Koma latuluka akhoza "kum'mamatira" ndi kutsogolo, ndipo ngakhale pansi. Pa nthawi yomweyo sitiyenera alipo pakamwa lamkati la chiberekero. Matenda amatchedwa chorionic kapena chapakati latuluka previa. Pankhaniyi, kaya zinthu idzasintha, ndipo ngati ndi ayi, achite gawo la Kaisara yobereka. Ngati nsagwada ndi mokwanira chatsekedwa, iwo akutchedwa previa chosakwanira; kubadwa nthawi yomweyo ikuchitika monga zina zonse.

Ngati latuluka "Anapitirizabe" pafupi kuchoka (zosakwana 70 mm), ulaliki ndi otsika. Popeza akhoza kusokoneza magazi, izo tikulimbikitsidwa pakati mode layamba. Ndiye kusunga ngati latuluka m'mwamba adzauka. Ngati ndi masabata 32-36 izi zitachitika, sadzakhala kuopseza, ndipo mkazi adzabereka kudacita.

Kukhwima kwa latuluka pa mawu amenewa ndi wofanana 0. "lobular" latuluka - ichi ndi digiri yachiwiri kukhwima, ndi zinthu ngati m'pofunika dokotala. The miyala ya salt kashiamu amatchedwa calcifications. Ponseponse, ngati iwo alipo mu nsengwa wa digiri choyamba cha kukhwima.

Ngati pali imfa ya enaake "mpando mwana," uyu akutchedwa m'mnyewa wamtima latuluka. Pankhaniyi, Akufunika kukaonana ndi dokotala kudziwa chifukwa ndi mankhwala mankhwala, chifukwa ngati chidzachitike, ndipo mwana mulibe mpweya okwanira ndi kofunika chitukuko zinthu zake.

Chiberekero: kapangidwe boma

Pa 12 TH sabata muyeso khomo lachiberekero kukula, amene ayenera kukhala osachepera 30 mm. Motalikira ndi bwino. Ngati iye ali aafupi kwambiri, zosakwana 20 mm, mimba ali m'chipatala ndipo angagwiritsidwe ntchito kwa opaleshoni chithandizo. pakamwa uterine atsekedwa, onse kunja ndi mkati.

Myometrium (minofu kapena chikhalidwe) imasonyeza ngati pali chiopsezo cha padera. Ngati matenda limasonyeza kuti nthawi iyi pali hypertonicity la chiberekero, mkazi kuchitiridwa. mfundo makamaka zoopsazi monga "fossilization" mimba, "Kankhani-Chikoka" m'chigawo lumbar.

Kodi kudziwa nthawi ya ultrasound

Ntchito matebulo wapadera kwa zaka CTE masamu gestational. N'kutheka kuti mbali amenewa anamanga mu pulogalamu ultrasound makina. Yerekezani mawu - ndi masamu nthawi yomalizira kusamba ndi ultrasound chikalata. Ngati kusiyana ndi yaing'ono (mlungu umodzi kapena iwiri), mudzaona enieni nthawi mwachindunji ndi azamba a. Pankhani ya mismatches zambiri (kuposa 2 masabata), mopepuka akuti kumatanthauza ultrasound.

Akalandire chithandizo mosamala: ndichiyani nanga

Samalani kwambiri pamene mimba - 12 masabata. Ultrasound mosamala - maphunziro onse awa yadaikidwa kuti asa- chitukuko cha mwana wosabadwayo. Mu ultrasound ichi choyamba kuchitika, ndipo ndiye mankhwala ndi kuphimba (malingana ndi ntchito). Chumacho ngati:

- amayi apakati zaka 35 ndi kuposerapo.

- zisanachitike, ana anabadwa akufa.

- Kukambirana za matenda yapita zipatso intrauterine anali wapezeka.

- mwana wabadwa, ife anapeza chromosomal chosayenerera.

- Iwo anakhazikitsa kuti anomalies amenewa ndi achibale a makolo onse.

Only mu malo apadera zokolola kuphimba (masabata 12). Kodi kuchita izo? Sungani mayesero onse: ultrasound, magazi, deta kunja. phunziro ziyenera akupanga zachibadwa, ndi cholinga ndi ambiri amakopeka ndi kolala ndi manambalawo: ufulu beta-hCG ndi PAPP-A. Ambiri, zolembera awa anaphunzira okhazikika bwino kuphatikiza. Ngati mmodzi wa iwo, zasintha sizitanthauza kuti mwana wosabadwayo ali kudwala.

Choncho pamene ndisanabadwe pa masabata 12 a mimba, ntchito ndi makhalidwe a zolembera izi. Iwo syvorochnye mapuloteni. Ngati ali ndi kupatuka, ndiye mwana ndi kuvutika chibadwa. Free β-hCG - ndi kagawo kakang'ono wa chorionic (chorion - nyongolosi izi) anthu gonadotrophin ndi PAPP-A - ndi mimba-kugwirizana mapuloteni A. kuphunzira zolozerazi ntchito Elisa zofufuza (enzyme zogwirizana immunosorbent zofufuza).

HCG kumapangitsa kaphatikizidwe mahomoni steroid (mu nsengwa ndi thupi chikasu). Madokotala aona kuti hCG kumateteza mwana wosabadwayo ku kukanidwa. Kufufuza msinkhu, mukhoza zolosera pa njira zina za mimba. Malinga ndi zomwe zachipatala, hCG kumawonjezera pang'onopang'ono mpaka sabata 10 ndiyeno amakhalabe pafupifupi mlingo yemweyo (kuchokera 5000 kuti 50000 IU / L) kwa masabata 33, ndipo kenako adzauka pang'ono.

1 mosamala mimba ndi TH 10 mu sabata 13 akuti. Kuwerengetsa mavuto onse, kutenga kwambiri deta: US tsiku CTE ndi TPV (nuchal translucency).

nkhani izi nzofunikira kwambiri ndi kudziwa kuvutika alipo mu DNA lapansi. Komabe, ngati umboni anakweza pang'ono, osadandaula ndi kuchita pozindikira mopupuluma. Inu muyenera kutsatira zachibadwa, amene ndikuuzani chochita lotsatira. Palinso kuthekera kuti pachithunzichi Werengani ultrasound. Kuyezetsa magazi a mimba 12-sabata Mungathe kubwereza - kulongosolerana, kapena dokotala mankhwala olanda matenda, zomwe molondola kwambiri kudziwa akonzedwa majini a mwanayo. Malinga nthawi, chikusonyeza chorionic villus zitsanzo zosankhidwazi kapena amniocentesis.

Ngakhala 1 mosamala wasonyeza chiopsezo otsika kwambiri a kuvutika chromosomal mu mwana wosabadwayo, si koyenera kuti amusiyitse kafukufuku, zomwe zikuchitika pa mwezi 4-5 mimba. Komanso hCG ndi AFP, kudziwa mlingo wa ufulu estriol (patatu mayeso).

Pofuna kudziwa magawo β-hCG ndi PAPP-A, kupereka mosamala magazi. masabata 12 - ali nthawi yokwanira kuti athe kudziwa pamaso pa kusanthula amuzolengedwa (kapena kusowa) kuvutika mu DNA.

Mapeto a kuwunika

Malinga ndi zotsatira za MAGAZI kuwulula chifukwa kanjedza kusiyana mwakale. Choncho, kuyezetsa magazi a mimba 12-sabata angasonyeze zotsatirazi:

- Down Syndrome.

- Osati wina zipatso, ndi 2 (3, etc ...). More zipatso - milingo ina ya timadzi lapansi.

- toxicosis.

- Pachithunzichi akonzedwa nthawi ya mimba. Kwa mlungu uliwonse chitukuko mwana limafanana ndi chizindikiro kumene kumatsimikizira zaka chenicheni cha mwana wosabadwayo.

- Kukhalapo kwa shuga mu mayi.

- mimba Ectopic.

- High chiopsezo padera.

Kodi pali malamulo alionse a ntchito?

Kumene kuli! Phunzirani iwo mungathe ndi kupanga maphunziro monga ultrasound, kuphimba (masabata 12). wakudziko Izo kudziwika Nditaphunzira dokotala deta. Komabe, pali srednemeditsinskie zizindikiro zodziwika bwino kwa mlungu uliwonse mimba. Mwachitsanzo, β-hCG pa sabata 11-12 ayenera kukhala ku 200,000 okwana 90,000 IU / ml.

Komabe, tiyenera adzanyamula kukumbukira kuti mosamala wa mimba 12-sabata amapereka, ndithudi, kwambiri, komabe chifukwa wangwiro, chifukwa mkazi aliyense ali makamaka zawo thupi, chifukwa ayenera kumwedwa ndi dokotala. Ngati mwana wosabadwayo si iye yekha, ndiye n'zovuta oterewa. Tayang'anani pa manambalawo. Ngati iwo ali oposa theka kapena awiri zina Ndizachidziwikire kuti mazira 2 kapena zambiri. Aliyense wa zipatso za chorion yake ndi osiyana kupanga timadzi. Choncho, ngati mkulu ntchito, ndipo mayi tsogolo anatumiza ultrasound wosonyeza kuti ndi mimba angapo.

Kamodzi ndisanabadwe (masabata 12), mfundo muyezo ndiye mtanda kaye deta analandira kuti kuwerengetsa ngati kudwala ndi. Madokotala ntchito Mwaichi chinthu chapadera, wotchedwa amayi. Iwo masamu mfundo ndi: chiwerengero cha timadzi, lomwe lakhazikitsidwa zochokera pa zotsatira za kuyezetsa magazi, lagawidwa hCG (ichi limafanana ndi mimba zachilendo). Iwo ayenera kupeza munthu (ziri Choncho). Chabwino kale pa zotsatira za maphunziro onse adzaweruzidwa kaya monga gulu mayi matenda ndi kuvutika chromosomal kapena ayi. Dziwani kuti ngakhale zonse mwadzidzidzi izo zinachitika, si chigamulo chomaliza, koma mmodzi yekha wa ziyerekezo lapansi. Choncho, zizindikiro zina akuyerekezedwa ndi ndiye yekha kupanga mfundo iliyonse. Yofotokoza lonse kuphimba 12 sabata mimba: ultrasound, mahomoni, RTA zingatenge kuphunzira wachiwiri trimester chachiwiri.

PAPP-A mapuloteni udindo chitetezo cha m'thupi ya mimba ndipo kumathandiza latuluka ntchito. Popeza pamakomo ali bwino malire n'chiyani, zopatuka zake kwambiri osafunika. .. Mfundo lonse kuti "kudumpha" kanjedza kulankhula osati za padera zotheka, komanso za kuvutika zoipazi ngati ozerezeka, de Lange matenda, etc. imatengedwa yachibadwa zotsatirazi kanjedza: kuchokera TH 11 TH 12 sabata - 0,7 kuti 4,76; kuchokera TH 12 sabata 13 - 1,03- 6,01.

Reviews a maphunziro

Akazi amene anachita mosamala (masabata 12), osiyana kunena za izo. Wina molakwa anazindikira kugonana mwanayo. Kuli kufotokozera - liwu ndi chochepa, kudzakhala kotheka potsiriza kunena amene adzabadweyo: mtsikana kapena mnyamata, kokha pa 16 TH sabata. Komanso kambiranani za mitengo yosiyanasiyana. Anthu ena mayeso kwaulere, ena kulipira kuchokera 1000 kuti rubles 3000.

Komabe, amayi ambiri amanena kuti mosamala ultrasound, ndi kukuthandizani kumvetsa bwanji mwana wanu. Popeza njira izi tsopano chofunika, tingathe anapezeka ndi kutengedwera mu nthawi amayamba ndi matenda amene kunabadwa mwana wathanzi.