Ngesikhathi sokukhulelwa, i-fetus ikhula emgodini futhi igeze ngoketshezi lwe-amniotic. Yakhiwe ngamanzi angama-96%, lolu ketshezi olushintsha njalo luqukethe ama-electrolyte, izakhi zamaminerali (i-sodium, i-potassium, i-calcium, izakhi zokulandelela, njll.), ama-amino acid, kodwa namaseli e-fetus.

Izimpawu zokuqala ze-amniotic fluid zivela ngokushesha ngemva kokuvundiswa ngokwakhiwa kwe-amniotic cavity ngosuku lwe-7. Emasontweni okuqala okukhulelwa, uketshezi lube selukhishelwa umbungu ngokwawo ngesenzo sokwanda kwe-extracellular (okubizwa ngokuthi i-extravasation). Ingxenye encane yoketshezi iphinde ikhishwe ngumama ngokuhamba kwamanzi ku-chorionic villi ekhona ku-placenta yesikhathi esizayo. Kodwa-ke, phakathi kwamaviki angama-20 kuya kwangu-25, isikhumba sombungu asikwazi ukungena (inqubo ye-keratinization). Ngakho-ke, umthamo we-amniotic fluid uqinisekiswa ukulingana phakathi kwalokho okukhishwe yi-fetus (ukukhiqizwa) nalokho ekugwinya esibelethweni.

• Ukukhipha uketshezi kwenziwa ikakhulukazi ngezindlela ezimbili:

  - Le syi-fetus urinary stem futhi ikakhulukazi i-diuresis ehlelwe cishe ngo-12-13 WA. Ngemuva kwamasonto angama-20, iba umthombo oyinhloko wokukhiqizwa kwe-amniotic fluid efinyelela ku-800 kuya ku-1200 ml / amahora angu-24 ekupheleni kokukhulelwa (ngokumelene no-110 ml / kg / d kuya ku-190 ml / kg / d emavikini angu-25).

  - the uketshezi lwamaphaphu, efihliwe kusukela emavikini angu-18, ifinyelela ku-200 kuya ku-300 ml / 24h ekupheleni kokukhulelwa.

• Isenzo se-reabsorption i-amniotic fluid ingenzeka ngenxa yokugwinya kwengane ezayo. Ngempela, i-fetus igwinya ingxenye enkulu ye-amniotic fluid, ngaleyo ndlela idlula ohlelweni lwayo lokugaya kanye nesistimu yayo yokuphefumula, ngaphambi kokuba idluliselwe emzimbeni womama kanye nokuba, ekupheleni komncintiswano, ihlungwe yizinso zomama ozayo. .

Ngenxa yaleli "ketango" lokukhiqizwa komzimba, uketshezi lwe-amniotic lulandela umjikelezo othize phakathi namasonto okukhulelwa ukuze livumelane nesisindo nokukhula komntwana ozayo:

• Ngaphambi kuka-20 WA, inani le-amniotic fluid emgodini liyakhula kancane kancane (kusuka ku-20 ml ku-7 WA kuya ku-200 ml ku-16 WA),
• Phakathi kwamaviki angama-20 namaviki angama-33-34, umthamo uyanda cishe u-980 ml,
• Ngemuva kwamaviki angama-34, umthamo we-amniotic fluid uyehla, ngokusheshisa kwento efinyelela emavikini angama-39, umthamo woketshezi ufinyelela cishe ku-800 ml ngesikhathi.

  Okuguquguqukayo ngokwabesifazane, umthamo we-amniotic fluid uphakathi kuka-250 ml (umkhawulo ophansi) no-2 wamalitha (umkhawulo ophezulu), ukuze ukukhulelwa kuthiwa kujwayelekile.

I-amniotic fluid idlala izindima ezihlukahlukene ezishintshayo ngesikhathi sokukhulelwa. Eyokuqala futhi eyaziwa kakhulu ngemisebenzi yayo: vikela ingane engakazalwa ekushaqekeni nomsindo.

Kodwa i-amniotic fluid nayo iyasiza:

• iqinisekisa ukuzinza kwemvelo ye-fetus, igcina izinga lokushisa elihlala njalo futhi ivumelanisa nevolumu yayo ekukhuleni kwengane,
• bamba umehluko ekunambithekeni, ekukhanyeni, ephunga noma ekuzweni, ngaleyo ndlela kukhuthaze ukukhula kwezinzwa zengane esibelethweni.
• lula ukunyakaza kombungu futhi ubambe iqhaza ekuthuthukisweni kwayo okuhle kwemisipha kanye ne-morphological,
• hlinzeka ngamanzi kanye nosawoti wamaminerali adingwa ingane yesikhathi esizayo.
• gcoba, lapho ulwelwesi luphuka, i-genital tract futhi ngaleyo ndlela ulungiselele umzimba ukuhamba kwengane.

Kodwa i-amniotic fluid nayo iyinkomba ebalulekile yempilo yengane. Ngakho-ke, ukuhlolwa kokuhlola inani le-amniotic fluid yi-ultrasound. Lokhu kunganconywa uma udokotela esola ukungavamile kokuphakama kwesibeletho, ukuncipha kokunyakaza kwe-fetus noma ukuphuka ngaphambi kwesikhathi kolwelwesi. I-sonographer kungase kudingeke ukuthi isebenzise amasu ahlukene ukuhlola i-oligoamnios okungenzeka (ukuncipha kwenani le-amniotic fluid) noma i-hydramnios (i-amniotic fluid eyeqile, bheka ngezansi), okungukuthi:

Isilinganiso sethangi elikhulu elime mpo (CGV)

Okubizwa nangokuthi indlela ka-Chamberlain, ukuhlola kuhilela ukuhlolwa kwe-ultrasound kwayo yonke imbobo ye-amniotic ukuze kutholwe indawo yokugcina amanzi (indawo lapho kungekho khona ukuphazamiseka kwelungu lombungu noma inkaba). Ukukalwa kokujula kwayo bese kuqondisa ukuxilongwa:

• uma ingaphansi kuka-3 cm, ukuhlolwa kuphakamisa i-oligoamnios,
• uma ilinganisa phakathi kuka-3 no-8 cm, kujwayelekile,
• uma ingaphezu kuka-8 cm, ingase ibonise ama-hydramnios.

Isilinganiso se-amniotic index (ILA).

Lokhu kuhlola kuhlanganisa ukuhlukanisa inkaba ibe amaquadrants angu-4, bese kulinganiswa futhi kwengezwe ukujula kwamathangi ahlonziwe.

• uma ingaphansi kuka-50 mm, ingozi ye-oligoamnios iphezulu,
• uma ukala phakathi kuka-50 mm no-180 mm; inani le-amniotic fluid lijwayelekile,
• uma ingaphezu kuka-180 mm, i-hydramnios kufanele icatshangelwe.

Ngale kwevolumu yoketshezi lwe-amniotic, udokotela kungase kudingeke ahlaziye izakhi eziluqambayo, njengoba kwenzeka lapho enza i-amniocentesis. Inhloso: ukubheka i-ejenti ethelelanayo uma umongo uvuna ukutheleleka kombungu noma ukufunda ama-chromosome osana ukuze kutholwe izifo ezingenzeka zemvelaphi yofuzo (kusukela nge-trisomy 21). Eqinisweni, uketshezi lwe-amniotic luqukethe amaseli amaningi e-fetus amisiwe, ukugcwala kwawo kufinyelela phezulu phakathi kwamaviki ayi-16 nangama-20. Ukutshalwa kwalawa maseli kwenza kube nokwenzeka ukukhiqiza i-karyotype futhi ngaleyo ndlela kuhlolwe ngokunembile izingozi ezithile zokungajwayelekile kwe-chromosomal.

Ngesikhathi sokulandelela ngaphambi kokubeletha, udokotela unaka ngokukhethekile umthamo we-amniotic fluid ngokukala ubude besibeletho. Inhloso: ukukhipha noma ukunakekela inani elinganele (i-oligoamnios) noma (i-hydramnios) eleqile le-amniotic fluid, izifo ezi-2 ezingaba nemiphumela emibi kakhulu emiphumeleni yokukhulelwa.

Oligoamnios

Oligoamnios kuwukungajwayelekile kwe-amniotic fluid (phakathi kuka-0,4 no-4% wokukhulelwa). Lokhu kuntuleka kwe-amniotic fluid (ngaphansi kuka-250 ml) kungavela ngezikhathi ezahlukene ngesikhathi sokukhulelwa futhi kubangele izinkinga ezinkulu kakhulu noma ezincane kuye ngesigaba sokukhula kombungu. Izingozi ezivame kakhulu:

• I-hypoplasia yamaphaphu (evimbela ukukhula kwamaphaphu) ukukhiqiza, ukuzalwa, ukwehluleka ukuphefumula,
• i-anomalies yesistimu ye-musculoskeletal (ukulandelana kwe-Potter), ingane engakazalwa engakwazi ukuhamba esibelethweni.
• ukuphuka ngaphambi kwesikhathi kolwelwesi olwenziwa nzima ngenxa yokutheleleka komama nengane futhi ngenxa yalokho anda engozini yokubeletha ngaphambi kwesikhathi, ukwethukwa noma ukuzalwa ngokuhlinzwa.

Imvelaphi yayo: izimbangela ezihlukahlukene ze-fetus (ukungasebenzi kahle kwezinso noma umchamo, i-chromosomal anomaly), umama (isifo sikashukela sokukhulelwa, ukutheleleka kwe-CMV, njll.) noma ukuphazamiseka kwe-placental (i-transfusion-transfusion syndrome, i-vascularization empofu yama-appendages, njll.). Ukuphathwa kwe-oligoamnios ke kuncike ezimbangela zayo eziyinhloko.

I-hydramnios

Theama-hydramnios ichaza ukweqisa kwe-amniotic fluid engaphezu kwamalitha angu-1 kuya kwangu-2. Lokhu okudidayo kungase kwenzeke ngezindlela ezimbili:

• ama-hydramnios aqala kancane angapheli ngokuvamile ivela ku-trimester yesithathu yokukhulelwa futhi ibekezelelwa kahle.
• ama-hydramnios ashubile, ayashesha ukuwafaka ibonakala kakhulu ku-trimester yesibili yokukhulelwa. Ihambisana nezimpawu zomtholampilo ezivame ukubekezelelwa kabi: ubuhlungu besibeletho, ubunzima bokuphefumula, ukufinyela, njll. Okungavamile, kwakuzokwenzeka ku-1 / 1500 kuya ku-1 / 6000 yokukhulelwa.

 Lokhu kungavamile kumthamo we-amniotic fluid kungase futhi kube nezimbangela ezahlukene. Uma isuka komama, i-hydramnios ingase ibe ngenxa yesifo sikashukela sokukhulelwa, i-pre-eclampsia, ukutheleleka (CMV, i-parvovirus B19, i-toxoplasmosis) noma ukungahambisani kwe-Rh phakathi kukamama nengane. Kodwa i-hydramnios ingabuye ichazwe nge-anemia noma ukukhubazeka okuthile kwesimiso sezinzwa esimaphakathi noma sokugaya ukudla kwengane.

Futhi njenge-oligoamnios, i-hydramnios iveza inani elithile lengozi yezinkinga: ukubeletha ngaphambi kwesikhathi, ukuphuka ngaphambi kwesikhathi kolwelwesi, ukwethulwa komntwana e-breech, i-cord procidence, uhlangothi lukamama; ukukhubazeka okuthile ezinganeni, okuhluka ngokuya ngobunzima be-pathology.

Uma kubhekwa ukwehlukahlukana kwezimbangela kanye nezingozi kumama nengane, ukunakekelwa kuhlolwa icala ngalinye.

• Uma ivela esimweni esilaphekayo esibelethweni noma ngemva kokuzalwa (i-anemia, njll.), i-hydramnios iyisihloko sokwelashwa okuqondile kwalesi sifo esishiwo.
• Ukuphathwa kwe-Symptomatic kungase futhi kunconywe ezimweni ezithile. Udokotela ube esekhetha ukwelashwa okusekelwe kuma-anti-prostaglandin ukuze kuncishiswe i-fetus diuresis noma ukukhipha ama-puncture ukuze kukhawulwe izingozi zokubeletha ngaphambi kwesikhathi.
• Ezimweni ezimbi kakhulu (ama-anamnios), ukunqanyulwa kokukhulelwa kwezokwelapha kungacatshangelwa ngemva kokuxoxisana nabazali.

I-amniotic fluid iqukethe ama-membrane amabili, i-amnion ne-chorion, ezakha umgodi wesibeletho. Lapho ziqhuma, zingabangela ukugeleza koketshezi. Sibe sesikhuluma ngokuqhekeka kolwelwesi noma okuvame kakhulu ukugqashuka kwesikhwama samanzi.

• Ukuqhekeka kolwelwesi ngesikhathi sokuzala kuwuphawu lokubeletha okuseduze. Ukwelashwa ngama-antibiotic kuphela ukuze kuvikelwe ingane ekungenweni izifo okungase kunconywe uma isibeletho singaqali phakathi namahora angu-12 okuqhuma, futhi ukufakwa kuhlelwe phakathi kwamahora angu-24 kuya kwangu-48 ngaphandle kokusinyazwa kwesibeletho.
• Ukugqabuka kwe-membrane okwenzeka ngaphambi kwesikhathi kuthiwa kungaphambi kwesikhathi. Inhloso yabaphathi-ke ilula: bambezeleka ngangokunokwenzeka ukulethwa ngaphambi kwesikhathi ukuze kufinyelele ku-37 WA. Ukulandelela-ke kuhilela ukulaliswa esibhedlela kuze kube ukubeletha ukuze kube lula ukuhlolwa okujwayelekile (ukuhlolwa okuthelelanayo, i-ultrasound, ukuqapha inhliziyo), ukwelashwa ngama-antibiotic ukuvimbela ukutheleleka okungenzeka kwengane, kanye nokwelashwa okusekelwe ku-corticosteroid ukusheshisa ukukhula kwamaphaphu (ngaphambi kwama-30 WA. ) wengane engakazalwa. Nokho, qaphela: ukugqashuka kolwelwesi ngaphambi kwamasonto angama-22 ngokuvamile kubeka engcupheni ukubikezelwa okubalulekile kombungu.