Njira matenda akalandire chithandizo: chibadwa, olanda, si olanda. Zikuonetsa ntchito, zotsatira

matenda akalandire chithandizo ndi kufufuza zovuta mimba. Cholinga - ndi kupeza pathologies zosiyanasiyana za khanda pa magawo chitukuko yoopsa.

The njira yofala akalandire chithandizo matenda: atagwira ultrasound, nkhani za zolembera osiyanasiyana mu mwazi wa pakati, chorionic villus zitsanzo zosankhidwazi, kutenga khungu la magazi umbilical chingwe, amniocentesis.

ndi matenda akalandire chithandizo Kodi

Mwa kugwiritsa ntchito njira zosiyanasiyana matenda akalandire chithandizo kwenikweni wapezeka matenda chitukuko yoopsa monga syndrome Edwards, syndrome Down a matenda a mtima ndi mapangidwe kuvutika ena. Kuti zotsatira za matenda akalandire chithandizo angasankhe tsogolo la mwanayo. Atalandira deta matenda mogwirizana ndi Dr. mayi wasankha mwana wabadwa kapena mimba ndi linasokonekera. Yabwino Zoneneratu angalole ndi konzanso mwana wosabadwayo. Pakuti matenda akalandire chithandizo zikugwirizana ndi kukhazikitsidwa kwa bambo ndi Kupenda chibadwa, yomwe ikuchitika mu magawo oyambirira mimba, komanso mtima wa kugonana yoopsa. ntchito zonsezi kudzera Center likulu la matenda akalandire chithandizo Prospekt Mira, yemwe walunjika ndi Professor MV Medvedev. Pano mukhoza pochitika bwino kuti akalandire chithandizo bwinobwino kuphatikizapo ultrasound. Ntchito pa Center kwa luso lamakono 3D, 4D.

Njira matenda akalandire chithandizo

Current diagnostics akalandire chithandizo amagwiritsa ntchito njira zosiyanasiyana ndiponso sayansi. Mmene ndi mlingo wa mphamvu iwo zosiyanasiyana. Ambiri, matenda akalandire chithandizo ali m'magulu awiri akuluakulu: olanda ndipo sanali olanda akalandire chithandizo matenda.

Non-olanda, kapena ngati iwo ali kutchedwa, njira zochepa olanda Musapereke opaleshoni ndi zoopsa wa mwana wosabadwayo ndi mayi. njira zimenezi analimbikitsa kwa amayi onse oyembekezera, amangokhala oopsa. mayeso chizolowezi ultrasound ayenera kutenga malo. njira olanda kumafuna kulowerera (kusokonezedwa) mu thupi la mimba, uterine patsekeke. Njira simuli otetezeka kotheratu, kotero anapatsa iwo kwa dokotala monga yomalizira, pamene pali funso yosungira thanzi la mwana osabadwa.

Non-olanda matenda akalandire chithandizo

Njira si olanda monga ultrasound ndi kuyezetsa magazi kuti akalandire chithandizo, amene amalola kuona kuti mphamvu ya chitukuko cha mwana wosabadwayo. Non-olanda ndipo ankaona kuti akalandire chithandizo matenda a zinthu yoopsa seramu kwa magazi a mayi.

Ultrasound ndi ndondomeko ambiri, alibe zovuta zilizonse zoipa pa mkazi ndi zipatso payokha. Kodi amayi onse oyembekezera ayenera kulandira ino? Mfundo moot, mwina si chofunika mu nkhani iliyonse. Ndagwira ultrasound chimaika Dr. zifukwa zambiri. Mu trimester, mukhoza kudziwa chiwerengero cha mimba, moyo ngati chipatso payokha, ndi yeniyeni yaitali. Mu chachinayi mwezi ultrasound akhoza kale kusonyeza aakulu malformations kobadwa nako wa mwana wosabadwayo, malo latuluka, amniotic madzimadzi. Patatha milungu 20 angaone kugonana tsogolo la mwanayo. Ultrasound amalola kudziwa anomalies zosiyanasiyana, ngati kuwunika anasonyeza pakati mkulu alpha-fetoprotein, ndipo ngati mbiri banja pali ena zopindika. Dziwani kuti palibe zotsatira ultrasound kungapangitse kuti zana pa zana a mwana wosabadwa wathanzi.

Kodi US

Akalandire chithandizo akalandire chithandizo matenda mu mawonekedwe a ultrasound akulimbikitsidwa amayi apakati pa mawu otsatirawa:

• masabata 11-13 mimba;
• masabata 25-35 mimba.

Unafotokoza kuti matenda a boma la mayi ndi mwana wosabadwayo. Transducer kapena kachipangizo dokotala waika padziko pamimba wa pakati, pali kulowerera mafunde phokoso. mafunde awa azunguliridwa sensa, ndipo iye amawaika iwo pa nsalu yotchinga polojekiti. Pa gawo oyambirira mimba nthawi zina amagwiritsidwa ntchito transvaginal njira. Pankhaniyi, kafukufuku ndi anaikapo mu nyini. Amene zolakwika limatchula mosamala ultrasound?
• Kubadwa zopindika a chiwindi, impso, mtima, matumbo ndi ena.
• Mpaka masabata 12 a zizindikiro za matenda Down a.
Kukula kwa mimba:
• Ectopic kapena masterbatch.
• Chiwerengero cha fetuses m'mimba.
• Gestational.
• Kholo kapena breech mwana wosabadwayo.
• The kwanthawi mawu a chitukuko.
• Chikhalidwe cha kugunda kwa mtima.
• mwana Gender.
• Malo ndi chikhalidwe cha latuluka lapansi.
• The otaya magazi mu ziwiya.
• Nyimboyi wa chiberekero.

Choncho, ultrasound amalola kudziwa kuvutika kulikonse. Mwachitsanzo, hypertonicity la chiberekero kungachititse kuti kuopseza padera. Popeza anapeza anomaly ichi, n'zotheka njira yake kusunga mimbayo.

Kuyezetsa magazi

Seramu otengedwa akazi anafufuza zili ake zinthu zosiyanasiyana:
• AFP (alpha-fetoprotein).
• NE (unconjugated estriol).
• HCG (anthu chorionic gonadotropin).
The njira panopa mosamala kuti akalandire chithandizo ali ndi digiri mokwanira mkulu molondola. Koma pali nthawi mayeso chimasonyeza kapena zonama zabwino kapena zonama alibe chifukwa. Kenako dokotalayu chimaika njira zina za kuyezetsa magazi kuti akalandire chithandizo, monga ultrasound kapena njira yodziwira ndi olanda.

Center matenda akalandire chithandizo Prospekt Mira mu Moscow amathera maola 1.5 chabe amuzolengedwa mosamala, ultrasound, ndipo amapereka akalandire chithandizo azichiona. Kuwonjezera kuphimba ndi trimester, n'zotheka pochitika wachiwiri trimester amuzolengedwa mosamala ndi uphungu ndi ultrasound.

The alpha-fetoprotein

Akalandire chithandizo matenda a matenda majini ntchito njira kudziwa mlingo wa alpha-fetoprotein magazi. Mayeso mosamala limasonyeza Mwina za kubadwa kwa mwana ndi kudwala ichi monga anencephaly, wolumala msana, ndi ena. Komanso, mtengo mkulu wa AFP zingasonyeze chitukuko cha zipatso zambiri, osayika nthawi, n'zotheka padera ndi ngakhale anaphonya mimba. Yolondola kwambiri zotsatira kusanthula amapereka, ngati anaika pa 16-18 sabata TH mimba. Zotsatira pamaso 14 kapena pambuyo 21 TH mlungu zambiri olakwika. Nthawi zina reappointed chopereka magazi. Pa mlingo mkulu chimaika Dr. ultrasound, zikhoza molondola kulandira chitsimikizo cha matenda yoopsa. Ngati US alibe kudziwa chifukwa cha okhutira mkulu wa alpha-fetoprotein, amniocentesis akapatsidwa. Phunziro ili ndi molondola kwambiri amasankha kusintha AFP. Ngati magazi wodwalayo kuchuluka misinkhu ya alpha-fetoprotein, angayambitse mavuto woyembekezera, monga kakulidwe yomweyo, mwina yoopsa imfa, kapena placental abruption. Low AFP ophatikizana hCG mkulu ndi estriol otsika zikusonyeza kuthekera syndrome Down. dokotala amaganizira magawo onse: m'badwo mkazi, timadzi ta m'thupi. Ngati chofunika, kusankha zina njira akalandire chithandizo.

hCG

Chorionic gonadotropin anthu kapena (hCG) mimba mu magawo oyambirira kupenda zizindikiro zofunika kwambiri. Plus kusanthula izi - magawo oyambirira tanthauzo, ngakhale pamene ultrasound si nkhani. Pambuyo umuna, dzira lili tsiku 6-8 amayamba kutulutsa hCG.
HCG monga glycoprotein wapangidwa ndi Alpha ndi beta subunits. Alpha zofanana ndi mahomoni pituitary (FSH, TSH, LH); ndipo beta - wapadera kwambiri. N'chifukwa chake mayeso kwa kagawo kakang'ono beta (beta-hCG) amagwiritsidwa ntchito molondola kupeza zotsatira. Mofulumira matenda mayeso n'kupanga ntchito, zomwe si ntchito yeniyeni HCG mayeso (mu mkodzo). Magazi beta hCG molondola oterewa mimba kale pa masabata 2 umuna. Anthu ambiri hCG mu mkodzo matenda kukula masiku 1-2 pasanafike m'magazi. The mkodzo milingo hCG mu nthawi 2 zochepa.

Zinthu okhudza HCG

KUFOTOKOZERA hCG mimba magawo oyambirira, m'pofunika kuganizira zina kulimbikitsa chifukwa cha kuwunika.
Kuenjezera hCG pa mimba:
• Non-ikupanga ananena ndi moyo weniweni.
• mimba zingapo (kuwonjezera zotsatira zake mogwirizana ndi chiwerengero cha zipatso).
• Early toxicosis.
• Preeclampsia.
• Major malformations.
• Kuvomereza progestogens.
• shuga.
Kutsitsa mlingo wa HCG - kusagwirizana nthawi, wodekha kwambiri kumanga-hCG woipa kuposa 50% ya mwakale:
• Non-ikupanga ananena ndi moyo weniweniwo (zambiri chifukwa cha mkombero osasamba).
• anaopseza mimba (mlingo yafupika ndi oposa 50%).
• anaphonya mimba.
• perenashivanie.
• mimba Ectopic.
• Matenda placental insufficiency.
• Imfa ya mwana wosabadwa mu trimester 2-3.

njira olanda

Ngati dokotala mukuganiza kuti kudziwika matenda otengera, matenda a chitukuko cha olanda matenda akalandire chithandizo iyenera kugwiritsidwa ntchito, zikhoza kugwiritsidwa ntchito njira imodzi mwa zotsatirazi:
• cordocentesis.
• Chorionic villus zitsanzo zosankhidwazi (kuphunzira zikuchokera maselo imagwiritsidwa latuluka).
• Amniocentesis (amniocentesis).
• Platsentotsentez (kuzindikiridwa kukumana ndi mavuto pambuyo matenda).

Ubwino olanda njira - kudya ndi changwiro chifukwa chitsimikizo. Ntchito mimba msanga. Choncho, ngati pali kukayikirana aliyense wa kuvutika mu chitukuko yoopsa, kuti akalandire chithandizo matenda a matenda otengera kumabweretsa zolondola. Makolo ndi madokotala mwina mu nthawi kusankha kusiya zipatso kapena kutsirizitsa mimba. Ngati makolo, ngakhale kudwala, komabe kusankha kusunga mwana, madokotala nthawi kuchita bwino ndi kusintha mimba ndipo ngakhale kuchitira mwana wosabadwayo m'mimba. Ngati chigamulo pa mimba lavomerezedwa, ndiye mu magawo oyambirira, pamene kupatuka wapezeka, mwakuthupi ndiponso mwamaganizo, njirayi ndi zosavuta analekerera.

chorionic villus zochepa chabe pamalangizo

Chorionic villus zitsanzo zosankhidwazi kumafuna kusanthula particles tosaoneka villi chorionic - tsogolo placental maselo. tinthu Ichi ndi zofanana majini wa mwana wosabadwayo, amene amalola kuti mufotokozere ndi chromosomal zikuchokera, kudziwa thanzi majini a mwanayo. kuwunika imagwiridwa matenda amaganiziridwa kugwirizana ndi zolakwa chromosomal pa lingaliro (Edwards matenda, matenda Down a, Patau neri Al.), Kapena pa chiopsezo kukhala ndi matenda osachiritsika a enaake fibrosis, zenga magazi m'thupi selo, chorea Gentigtona. Zotsatira chorionic villus zitsanzo zosankhidwazi limasonyeza 3.800 matenda mwana. Koma ngati chilema, ndi chilema cha chubu ubongo, njira zimenezi sizingatheke wapezeka. kudwala Izi wapezeka zokha amniocentesis kapena cordocentesis njira.
Pa nthawi ya kusanthula chorion makulidwe ayenera kukhala osachepera 1 cm, logwirizana ndi masabata 7-8 mimba. Posachedwapa, ndondomeko amachitidwa pa masabata 10-12, ndi wabwino kwa mwana wosabadwayo. Koma pasanafike sabata 13.

kuchita njira

Njira puncture (transcervically kapena transabdominally) anasankha madokotala. Mukhoza kumene isanafalikire ndi chorion uterine makoma. Mulimonsemo, ndi biopsy imagwiridwa m'manja mwa ultrasound.

mkazi atagona pa nsana wake. Malo wasankhidwa kuti puncture zofunika kwenikweni m'dera mankhwala ochititsa. Puncture khoma m'mimba, myometrial khoma amapangidwa kuti singano m'chimake m'gulu kufanana chorion. Pa US ankalamulira gulu la singano. Syringe opangidwa nsalu chorionic villus zitsanzo zosankhidwazi, muvi chikutha. Pamene transcervical njira, mkazi pa bedi ngati kufufuza bwinobwino. Express ululu si anamva. The khomo pachibelekeropo ndi ukazi makoma atathana ndi pliers wapadera. Access amaperekedwa ndi catheter monga akafika minofu chorionic akulowa syringe ndi chuma anatengedwa kusanthula.

amniocentesis

njira akalandire chithandizo matenda monga ambiri - pathological njira kudziŵa yoopsa - amniocentesis. Ndi bwino 15-17 sabata. Kuchititsa boma ulamuliro wa ultrasound mwana wosabadwayo. Doctor khoma m'mimba amaika singano mu madzimadzi amniotic, imayamwa wina kuchuluka kwa kusanthula ndi singano kuchotsedwa. Kukonzekera kwa masabata 1-3. Amniocentesis ndi pang'ono zoopsa chitukuko cha mimba. Mu 1-2% ya akazi angakhale nayo kutayikira madzi, izo zimaleka popanda mankhwala. Mowiriza mimba zitha kumachitika mu 0.5% ya milandu. Singano mwana wosabadwayo chawonongeka, mukhoza kuchita ndondomeko ngakhale milandu mimba angapo.

njira majini

Dontho mayeso - ndi zatsopano otetezeka majini njira kafukufuku yoopsa limasonyeza Patau syndrome, Edwards, Down, Turner, Klinefelter. mayeso imachitika pa maziko a deta analandira kwa magazi a mayi. mfundo ndi yakuti imfa yachibadwa angapo a maselo placental mu mtsempha wa magazi a mayi 5% DNA yoopsa. Izi zimathandiza matenda trisomies lalikulu (dontho mayeso).

Kodi ndondomeko? Zimatengera magazi mtsempha wa mkazi wapakati, DNA yoopsa adzamasulidwa. chifukwa amaperekedwa pasanathe masiku khumi. mayeso ikuchitika pa siteji iliyonse ya mimba kwa masabata 10. Ndi lolondola mudziwe 99,7%.