Kunezindlela ezahlukene zokuqinisekisa ukukhulelwa: ukuhlolwa kokukhulelwa komchamo, okutholakala ekhawuntareni emakhemisi, ezitolo zezidakamizwa nasezitolo ezinkulu, kanye nokuhlolwa kokukhulelwa kwegazi okwenziwa elabhorethri. Ebhekene nokuhlolwa komtholampilo okuvusa ukungabaza ngokukhulelwa noma ukwethula uphawu oluyisixwayiso, udokotela angase anikeze isilinganiso se-serum se-hCG, esiyobe sesibuyiselwa.

Lokhu kuhlolwa okuthembekile kusekelwe ekutholeni i-hCG yehomoni egazini. Le "hormone yokukhulelwa" ifihliwe yiqanda ngokushesha nje lapho lifakwe, lapho linamathela odongeni lwesibeletho. Izinyanga ezi-3, i-hCG izogcina i-corpus luteum isebenza, indlala encane ezophinde ikhiphe i-estrogen ne-progesterone, ebalulekile ekukhuleni okufanele kokukhulelwa. Izinga le-hCG liphindeka kabili njalo emahoreni angama-48 phakathi namasonto okuqala okukhulelwa ukuze lifinyelele inani eliphakeme cishe ngeviki leshumi le-amenorrhea (10 WA noma amasonto ayi-12 okukhulelwa). Bese yehla ngokushesha ukuze ifinyelele ithafa eliphakathi kuka-16 no-32 AWS.

Ukuhlolwa kwe-serum hCG kunikeza izinkomba ezimbili: ukuba khona kokukhulelwa nokuqhubeka kahle kwayo ngokusho kokuguquguquka kobuningi bezinga. Ngokohlelo:

• amasampula amabili aÌ € izinsuku ezimbalwa ngokuhlukana abonisa amazinga e-hCG akhuphukayo afakazela lokho okubizwa ngokuthi ukukhulelwa okuqhubekayo.
• ukwehla kwamazinga e-hCG kungase kubonise ukuphela kokukhulelwa (ukuphuphuma kwesisu).
• ukuqhubekela phambili okungalawuleki kwamazinga e-hCG (ukuphinda kabili, ukuwa, ukukhuphuka) kungase kube uphawu lokukhulelwa kwe-ectopic (GEU). Ukuhlolwa kwe-hCG ye-plasma kuwukuhlola okuyisisekelo kwe-GEU. Ngenani elinqunyiwe elingu-1 mIU / ml, ukungabonwa kwesikhwama se-intrauterine ku-ultrasound kuphakamisa kakhulu i-GEU. Ngaphansi kwalo mngcele, i-ultrasound ayinalo ulwazi kakhulu, ukuphindaphinda kokuhlolwa ngemva kokulibaziseka kwamahora angu-500 endaweni yokucwaninga efanayo kuvumela ukuqhathaniswa kwamazinga. Ukuma noma ukuqhubeka okubuthakathaka kwezinga kuvusa i-GEU ngaphandle kokuqinisekisa. Kodwa-ke, ukuqhubeka kwayo okuvamile (ukuphinda kabili kwesilinganiso emahoreni angu-48) akuqedi i-GEU (48).

Ngakolunye uhlangothi, izinga le-hCG alikuvumeli ukuphola okuthembekile kokukhulelwa. Kuphela okuthiwa i-ultrasound yokuqomisana (i-ultrasound yokuqala emavikini angu-12) ivumela lokhu ukuba kwenziwe. Ngokufanayo, nakuba izinga le-hCG ngokuvamile liphakeme ekukhulelweni okuningi, izinga eliphezulu le-hCG aliyona inkomba ethembekile yokuba khona kokukhulelwa okungamawele (2).

Ngesikhathi sokubonisana kokuqala kokukhulelwa (ngaphambi kwamaviki ayi-10), ukuhlolwa kwegazi kunqunywe ngesibopho4:

• ukunqunywa kweqembu legazi kanye ne-Rhesus (ABO; i-Rhesus ne-Kell phenotypes). Uma lingekho ikhadi leqembu legazi, kufanele kuthathwe amasampula amabili.
• usesho lwe-Irregular Agglutinins (RAI) ukuze kutholwe ukungezwani okungenzeka phakathi komama wesikhathi esizayo kanye nombungu. Uma ucwaningo luluhle, ukuhlonzwa kanye nokuhlelwa kwezakhi zamasosha omzimba kuyisibopho.
• ukuhlolwa kwe-syphilis noma i-TPHA-VDLR. Uma ukuhlolwa ku-positive, ukwelashwa okusekelwe ku-penicillin kuzovimbela imiphumela ku-fetus.
• ukuhlolwa kwe-rubella kanye ne-toxoplasmosis ngokungabikho kwemibhalo ebhaliwe evumela ukungatheleleki ukuthi kuthathwe kalula (5). Uma kwenzeka i-serology engalungile, i-toxoplasmosis serology izokwenziwa inyanga ngayinye yokukhulelwa. Esimeni se-rubella serology engalungile, i-serology izokwenziwa njalo ngenyanga kuze kube amasonto angu-18.

Okunye ukuhlolwa kwegazi kunikezwa ngokuhlelekile; aziphoqelekile kodwa zituswa ngokuqinile:

• Ukuhlolwa kwe-HIV 1 no-2
• ukuhlolwa kwezimpawu ze-serum (izinga le-PAPP-A protein ne-hCG hormone) phakathi kwamaviki angu-8 no-14. Kuhlotshaniswa neminyaka yesiguli kanye nesilinganiso sokuguquguquka kwe-nuchal kwe-fetus ngesikhathi sokukhulelwa kokuqala (phakathi kuka-11 no-13 WA + izinsuku ezingu-6), lesi silinganiso senza kube nokwenzeka ukuhlola ingozi ye-Down's syndrome. inkulu noma ilingana no-21/1, kuzophakanyiswa i-amniocentesis noma i-choriocentesis ukuze kuhlaziywe i-karyotype yengane. EFrance, ukuhlolelwa i-Down's syndrome akuphoqelekile. Qaphela ukuthi ukuhlolwa okusha kokuhlolwa kwe-trisomy 250 kukhona: kuhlaziya i-DNA yombungu ojikeleza egazini likamama. Ukusebenza kwalokhu kuhlolwa okwamanje kuqinisekiswa ngombono wokuguqulwa okungenzeka kwesu lokuhlola le-trisomy 21 (21).

Kwezinye izimo, okunye ukuhlolwa kwegazi kungase kunqunywe:

• ukuhlolwa kwe-anemia uma kwenzeka kuba sengozini (ukudla okunganele, ukudla kwemifino noma i-vegan)

Okunye ukuhlolwa kwegazi kuzoyalwa ngesikhathi sokukhulelwa:

• ukuhlola i-antigen ye-BHs, ufakazi wesifo sokusha kwesibindi kohlobo B, ngenyanga yesi-6 yokukhulelwa
• isibalo segazi ukuhlola i-anemia enyangeni yesi-6 yokukhulelwa

Ukuthi ozoba umama uhlela ukubeletha ngaphansi kwe-epidural noma cha, ukubonisana kwangaphambi kokubulala izinzwa kuyisibopho. Ikakhulukazi, udokotela obulala izinzwa uzonquma ukuhlolwa kwegazi ukuze kutholakale izinkinga ezingaba khona zokuqunjelwa.