Ụzọ nke prenatal nchoputa: mkpụrụ ndụ ihe nketa, invasive, na-abụghị invasive. Egosi maka ojiji, na-arụpụta

Prenatal nchoputa bụ a mgbagwoju nnyocha nke afọ ime. The isi nzube - bụ ịchọpụta dị iche iche pathologies nke nwa ọhụrụ na nkebi nke nwa ebu n'afọ na mmepe.

The kasị ụzọ nke prenatal nchoputa: ejide ultrasound, na ọdịnaya nke dị iche iche na nrịbama n'ime ọbara nke a ime, chorionic villus nlele, na-ewere anụ ahụ nke eriri nwa ọbara, amniocentesis.

Gịnị bụ prenatal nchoputa

Site n'itinye ụzọ dị iche iche nke prenatal nchoputa n'ezie ahụrụ na nwa ebu n'afọ na mmepe ọrịa dị ka Edwards syndrome, Down si syndrome, ọrịa obi na na guzobere ọzọ abnormalities. Na-arụpụta nke prenatal nchoputa pụrụ ikpebi akara aka nke nwa ahụ. Mgbe na-anata na-achọpụta ọrịa data na mmekota na Dr. nne kpebie na nwa a mụrụ ma ọ bụ na ime bụ etre. Mma amụma nwere ike ikwe ka a nwa ebu n'afọ ghara ịgbanwe. N'ihi prenatal nchoputa emetụta oruru nke ibu nna site mkpụrụ ndụ ihe nketa nnyocha, nke a rụrụ ná mmalite nkebi nke afọ ime, nakwa dị ka mkpebi siri ike nke nwa ebu n'afọ na mmekọahụ. All ọrụ ndị a na-awa na isi obodo Center nke prenatal nchoputa na Prospekt Mira, nke na-gawa site Prọfesọ MV Medvedev. Ebe i nwere ike rue a mbara prenatal nnyocha, tinyere ultrasound. Eji na Center maka ọhụrụ 3D technology, 4D.

Ụzọ nke prenatal nchoputa

Ugbu prenatal nchọpụta nsogbu na-eji a dịgasị iche iche ụzọ na teknụzụ. N'ókè na larịị nke ikike ha dị iche iche. Ke ofụri ofụri, prenatal nchoputa na-kewara abụọ nnukwu iche iche: invasive na-abụghị invasive prenatal nchoputa.

Non-invasive, ma ọ bụ ka ha na-akpọ, na-erughị invasive ụzọ adịghị inye ịwa ahụ na trauma nke nwa ebu n'afọ na nne. Ndị dị otú ahụ na usoro na-atụ aro maka ihe niile ụmụ nwaanyị dị ime, ha bụ ndị dị nnọọ ka ize ndụ. Eme ultrasound ule ga-abụrụ-ebe. Ịwakasị usoro abuana intrusion (nnyonye anya) na aru nke a ime, ahụ eriri akpa nwa oghere. Ụzọ bụ kpam kpam nchebe, ka nyere ha ka ha na dọkịta dị ka a ikpeazụ resotu, mgbe e nwere ajụjụ nke na-echebekwa ndị ahụ ike nke nwa e bu n'afọ.

Non-invasive prenatal nchoputa

N'ihi na ndị na-abụghị invasive ụzọ gụnyere ultrasound na prenatal screening, nke na-enye ohere anyị na-edebe Ọnọdụ nke mmepe nke nwa ebu n'afọ. Non-invasive na a na-ewere a prenatal nchoputa nke nwa ebu n'afọ na ọbara ihe n'ihi na ọbara nne nwa.

Ultrasound bụ ihe kasị nkịtị usoro, ọ na-adịghị ihe ọ bụla na-emerụ mmetụta na nwaanyị ahụ na mkpụrụ n'onwe ya. Niile bụ abụ nne ga-enweta ihe a na-amụ? A moot uche, ma eleghị anya, ọ bụ chọrọ ọ bụla ikpe. Holding ultrasound ahọpụta Dr. n'ihi ọtụtụ ihe. Ke akpa trimester, i nwere ike ikpebi na-ọnụ ọgụgụ nke ime, na-ebi ndụ ma mkpụrụ n'onwe ya, a kpọmkwem okwu. N'ọnwa nke anọ ultrasound nwere ike ugbua na-egosi oké congenital malformations nke nwa ebu n'afọ, Plasenta ebe, mmiri ọmụmụ. Mgbe 20 izu pụrụ ikpebi n'ọdịnihu mmekọahụ nke nwa. Ultrasound na-enye ohere ime ka a mata ihe dị iche iche anomalies, ma ọ bụrụ na analysis gosiri a ime elu Alfa-fetoprotein, na ọ bụrụ na ndị ezinụlọ akụkọ ihe mere eme e nwere ụfọdụ ntụpọ. Ọ bụ uru na-arịba ama na ọ dịghị nke ultrasound pụta pụrụ ekwe nkwa na otu narị percent nke a ike nwa ebu n'afọ.

Olee otú bụ US

Prenatal prenatal nchoputa n'ụdị ultrasound na-atụ aro maka ihe niile ụmụ nwaanyị dị ime na ndị na-esonụ okwu:

• 11-13 izu nke dị ime;
• 25-35 izu nke afọ ime.

Ọ nyere maka nchoputa nke ala nke nne na nwa ebu n'afọ. Transducer ma ọ bụ mmetụta dọkịta tent n'elu afo nke a ime, e nwere onye na intrusion nke ụda ebili mmiri. Ndị a mmiri na ebili mmiri na-tọrọ atọ mmetụta, na ọ na-adọba ha na ileba anya ihuenyo. Na mmalite ogbo nke afọ ime a na-mgbe ụfọdụ transvaginal usoro. Na nke a, na nyocha na-etinyere n'ime ikpu. Nke deviations achọpụta echetakwa ultrasound?
• Birth ntụpọ nke imeju, akụrụ, obi, eriri afọ na ndị ọzọ.
• Up 12 izu nke mgbaàmà nke Down si syndrome.
Mmepe nke ime:
• Ectopic ma ọ bụ masterbatch.
• The ọnụ ọgụgụ nke ụmụaka ebu n'afọ nọ n'afọ.
• Gestational.
• The nne na nna ma ọ bụ breech nwa ebu n'afọ.
• The lag na okwu nke development.
• The ọdịdị nke obi otiti.
• Gender nwa.
• Location na ọnọdụ nke Plasenta.
• The ọbara arịa.
• The ụda olu nke akpanwa.

N'ihi ya, ultrasound na-enye ohere ka ịchọpụta ọ bụla abnormalities. Ka ihe atụ, hypertonicity nke akpanwa pụrụ iduga iyi egwu nke ime ọpụpụ. Ebe chọpụtara nke a anomaly, o kwere omume na-adọ jikoro iji chebe ime.

Echetakwa ọbara

Ọbara-e si inyom na-enyocha n'ihi na ya ọdịnaya nke dị iche iche bekee:
• AFP (Alfa-fetoprotein).
• ne (unconjugated estriol).
• HCG (mmadụ chorionic gonadotropin).
The ugbu usoro prenatal echetakwa nwere a zuru ezu elu ogo ziri ezi. Ma e nwere mgbe a ule na-egosi ma ọ bụ ụgha mma ma ọ bụ ụgha na-ebughị N'ihi. Ekem-ahọpụta ọzọ ụzọ nke prenatal screening, dị ka ultrasound ma ọ bụ a na-achọpụta ọrịa usoro bụ invasive.

Center nke prenatal nchoputa na Prospekt Mira na Moscow na-emefu dị nnọọ 1.5 awa Biochemical screening, ultrasound, ma na-enye prenatal oge. Ke adianade screening mbụ trimester, ọ bụ omume na-agabiga nke abụọ trimester Biochemical echetakwa na ndụmọdụ na ultrasound.

The Alfa-fetoprotein

Prenatal nchoputa nke mkpụrụ ndụ ihe nketa ọrịa eji usoro nke na-ekpebi na ọkwa nke Alfa-fetoprotein na ọbara. Nke a echetakwa ule ekpughe puru nke ọmụmụ a na nwa na a daa ọrịa dị ka anencephaly, spina n'ọkpụkpụ azụ m, na ndị ọzọ. Ọzọkwa, a elu nke AFP nwere ike na-egosi na mmepe nke ọtụtụ mkpụrụ osisi, na-ekwesịghị ekwesị arụnyere oge, ohere nke ime ọpụpụ na ọbụna Agbaghara ite ime. The kasị ezi pụta analysis na-enye, ma ọ bụrụ na-etinye na 16-18 nke izu nke afọ ime. Results tupu nke 14 ma ọ bụ mgbe 21 nke izu nke na-ezighị ezi. Mgbe ụfọdụ reappointed ọbara onyinye. Na a elu na-ahọpụta Dr. ultrasound, ọ nwere ike reliably enweta nkwenye nke nwa ebu n'afọ na ọrịa. Ọ bụrụ na ndị US adịghị chọpụta ihe na-akpata nke elu ọdịnaya nke Alfa-fetoprotein, amniocentesis e kenyere. Nke a na-amụ bụ ihe ziri ezi na-ekpebi mgbanwe ke AFP. Ọ bụrụ na onye ọrịa ahụ ọbara ụba etoju nke Alfa-fetoprotein, nwere ike ime ka nsogbu n'oge ime, dị ka otito na-egbu oge, ma eleghị anya nwa ebu n'afọ na ọnwụ, ma ọ bụ placental abruption. Low AFP jikọtara elu HCG na a ala estriol egosi na o na-Down syndrome. The dọkịta na-elebara niile parameters: nwaanyị ahụ afọ, hormone etoju. Ọ bụrụ na achọrọ, inye ọzọ prenatal ụzọ.

HCG

Chorionic gonadotropin mmadụ ma ọ bụ (HCG) na ime ná mmalite nkebi iji chọpụta ihe ndị kasị mkpa na-egosi. Plus a analysis - mmalite nkebi nke definition, ọbụna mgbe ultrasound abụghị ihe ọmụma. Mgbe njiko spam nwoke na akwa nwere a 6-8 ụbọchị na-amalite na-emepụta HCG.
HCG ka a glycoprotein esịnede Alfa na beta subunits. Alpha yiri na pituitary homonụ (FSH, TSH, LH); na beta - pụrụ iche. Ọ bụ ya mere ule maka beta subunit (beta-HCG) a na-eji ihe n'ụzọ ziri ezi na-enweta n'ihi. Ndị ngwangwa-achọpụta ọrịa ule ibe na-eji, nke na-adịghị emetụta a kpọmkwem HCG ule (na mmamịrị). The ọbara beta HCG n'ụzọ ziri ezi ịchọpụta ime ugbua na 2 izu nke Fertilization. Ịta nke HCG na mmamịrị na-achọpụta ọrịa matures 1-2 ụbọchị mgbe e mesịrị ka na ọbara. The mmamịrị HCG etoju na 2 ugboro obere.

Ihe na-emetụta ndị HCG

Akọwapụta HCG ime ná mmalite nkebi, ọ dị mkpa iji gaa na akaụntụ ụfọdụ n'ime ihe na-akpali n'ihi nke analysis.
Mmụba nke HCG n'oge ime:
• Non-nnabata ọkọdọhọ na ndụ n'ezie.
• Multiple ime (ntọt ke n'ihi hà ka ọnụ ọgụgụ nke mkpụrụ).
• Early toxicosis.
• Preeclampsia.
• Isi malformations.
• Ịnakwere progestogens.
• Diabetes mellitus.
Ẹsụhọde larịị nke HCG - nonconformity oge, nnọọ ngwa ngwa Mee-HCG kasịnụ ukwuu karịa 50% nke norm:
• Non-nnabata ọkọdọhọ na ndụ n'ezie (ọzọ mgbe n'ihi na nke oge ufodu okirikiri).
• egwu ite ime (larịị na-belata karịa 50%).
• Agbaghara ite ime.
• perenashivanie.
• Ectopic ime.
• Ala ala placental insufficiency.
• The ọnwụ nke a nwa ebu n'afọ na 2-3 trimester.

invasive ụzọ

Ọ bụrụ na dọkịta kpebie na maka nchọpụta nke butere n'aka ọrịa, ọrịa na mmepe nke invasive prenatal nchoputa ga-na etinyere, ọ ga-eji otu n'ime ndị na-esonụ usoro:
• cordocentesis.
• Chorionic villus nlele (ọmụmụ nke ndị mejupụtara mkpụrụ ndụ na Nleta Plasenta).
• Amniocentesis (amniocentesis).
• Platsentotsentez (mata-ezighị ezi pụta mgbe otu ọrịa).

The uru invasive ụzọ - ngwa ngwa na-ekwe nkwa na a zuru okè N'ihi. Ji n'oge ime. Ya mere, ọ bụrụ na e ọ bụla enyo nke abnormalities na nwa ebu n'afọ na mmepe, prenatal nchoputa nke butere n'aka ọrịa na-eduga ná ezi nkwubi okwu. Nne na nna na ndị dọkịta nwere ike na oge ka a mkpebi na-ahapụ ndị mkpụrụ osisi ma ọ chupu a ime. Ọ bụrụ na nne na nna, n'agbanyeghị nke daa ọrịa, ka na-ekpebi na-na nwa, ndị dọkịta nwere oge kwesịrị ekwesị na-eduzi na ịgbanwe na ime ma na-emeso nwa ebu n'afọ nọ n'afọ. Ọ bụrụ na mkpebi na-ete ime na-anabata, mgbe ahụ, ná mmalite nkebi, mgbe ahụrụ ndiiche, ma n'ụzọ anụ ahụ na uche, a na usoro a na-nnọọ mfe anabata.

chorionic villus nlele

Chorionic villus nlele agụnye analysis of microscopic ahụ nke chorionic villi - n'ọdịnihu placental mkpụrụ ndụ. Nke a urughuru bụ yiri mkpụrụ ndụ ihe nketa nke nwa ebu n'afọ, nke na-enye ohere ka mara na chromosomal mejupụtara, iji chọpụta mkpụrụ ndụ ihe nketa ahụ ike nke nwa. The analysis a rụrụ n'ime-enyo enyo na ọrịa metụtara na chromosomal njehie mgbe a tụụrụ ime (Edwards syndrome, Down si syndrome, Patau et al.), Ma ọ bụ n'ihe ize ndụ nke na-emepe emepe ihe na-enweghị ngwọta ọrịa cystic fibrosis, sickle cell anaemia, chorea Gentigtona. N'ihi chorionic villus nlele ekpughe 3,800 nwa e bu n'afọ ọrịa. Ma ndị dị otú a ntụpọ, a ntụpọ nke nural tube, usoro a na-apụghị ahụrụ. Nke a daa ọrịa achọpụtara naanị mgbe amniocentesis ma ọ bụ cordocentesis usoro.
Mgbe oge nke analysis chorion ọkpụrụkpụ kwesịrị erughị 1 cm, nke kwekọrọ 7-8 izu nke afọ ime. Na nso nso, usoro a na-rụrụ 10-12 izu, ọ bụ odi mfe maka nwa ebu n'afọ. Ma, ọ bụghị mgbe e mesịrị ka nke 13 izu.

n'ịrụ usoro

Method mgbapu (transcervically ma ọ bụ transabdominally) họrọ dọkịta na-awa. Ọ na-adabere na ebe metụtara nanị akụkụ ụfọdụ dịtụ chorion eriri akpa nwa mgbidi. Na nke ọ bụla, a biopsy a rụrụ n'okpuru akara nke ultrasound.

The nwanyị bụ ụgha na ya azụ. The họọrọ ebe mgbapu mkpa anestetiiki mmetụta. Ịmapusị abdominal mgbidi, myometrial mgbidi e mere ka agịga n'ọbọ gụnyere ukem chorion. On US achịkwa ije nke agịga. Ntụtụ emepụta akwa chorionic villus nlele, agịga na-ewepụ. Mgbe transcervical usoro, a nwaanyị na n'ihe ndina dị ka a nkịtị nyochaa. Express mgbu na-adịghị chere. The cervix na mmamiri mgbidi na ofu na pụrụ iche ngwa mkpaji. Access na-nyere a catheter dị ka ọ na-eru chorionic anụ ahụ enyekwara ntụtụ na ihe a na-e maka analysis.

amniocentesis

prenatal achọpụta ọrịa usoro na-agụnye ihe ndị kasị - enweghị nchịkwa usoro nke na-ekpebi nwa ebu n'afọ na - amniocentesis. Ọ na-atụ aro 15-17 izu. Na-eduzi na steeti akara nke nwa ebu n'afọ ultrasound. Doctor site abdominal mgbidi inserts a agịga n'ime mmiri ọmụmụ, na eme nzuzu a ụfọdụ ego nke analysis na agịga wepụrụ. Ịkwadebe nke 1-3 izu. Amniocentesis bụ obere ize ndụ maka mmepe nke ime. Na 1-2% nke ndị inyom pụrụ inwe leakage nke ọmụmụ, ọ na-akwụsị na-enweghị ọgwụgwọ. Spontaneous ite ime nwere ike na-erukwa na 0,5% nke ikpe. Agịga nwa ebu n'afọ na-mebiri emebi, i nwere ike igosi usoro ọbụna nke multiple ime.

mkpụrụ ndụ ihe nketa usoro

Ntụpọ ule - bụ Kacha ọhụrụ mma mkpụrụ ndụ ihe nketa usoro nwa ebu n'afọ na a chọpụtala Patau syndrome, Edwards, Down, Turner, Klinefelter. Ule na-mụụrụ na ndabere nke data nwetara site na ọbara nne nwa. The ụkpụrụ bụ na eke ọnwụ nke a ọnụ ọgụgụ nke placental mkpụrụ ndụ n'ime ọbara iyi nke nne 5% nwa ebu n'afọ na DNA. Nke a na-eme ka o kwe omume ịchọpụta isi trisomies (ntụpọ ule).

Olee otú usoro? Ewe ọbara a akwara nke a nwaanyị dị ime, nwa ebu n'afọ na DNA na-tọhapụrụ. N'ihi na e nyere n'ime ụbọchị iri. The ule a rụrụ mgbe ọ bụla na ogbo nke ime site 10 izu. Izi ezi nke ọmụma 99.7%.