"Umhlangano" wokuqala nengane, i-trimester ultrasound yokuqala ilindelwe ngabomvu ngabazali besikhathi esizayo. Ebizwa nangokuthi i-ultrasound yokuphola, kubalulekile futhi ngokubeletha.

I-ultrasound yokuqala yokukhulelwa yenzeka phakathi kwezinsuku eziyi-11 no-13 WA + 6 izinsuku. Akuyona impoqo kepha ingenye yama-ultrasound amathathu ahlinzekwa ngokuhlelekile komama abakhulelwe futhi kunconywe kakhulu (izincomo ze-HAS) (3).

I-ultrasound yokuqala ye-trimester ivame ukwenziwa ngomzila wesisu. Udokotela ugqoka isisu sikamama ozayo ngamanzi agcwele ijeli ukuze athuthukise ikhwalithi yesithombe, bese ehambisa uphenyo esiswini. Kuyaqabukela futhi uma kudingeka ukuze kutholakale ukuhlolwa kwekhwalithi, umzila wesitho sangasese ungasetshenziswa.

I-Ultrasound ayidingi ukuthi ube nesinye esigcwele. Ukuhlolwa akunabuhlungu futhi ukusetshenziswa kwe-ultrasound kuphephile enganeni. Kunconywa ukuthi ungabeki ukhilimu esiswini ngosuku lwe-ultrasound ngoba lokhu kungaphazamisa ukudluliswa kwe-ultrasound.

Enye yezinhloso zale-ultrasound yokuqala ukuhlola iminyaka yokukhulelwa futhi ngaleyo ndlela ibeke usuku lokukhulelwa ngokunembile kunokubala okusekelwe osukwini lokuqala kwesikhathi sokugcina. Ngenxa yalokhu, udokotela wenza i-biometry. Ilinganisa ubude be-cranio-caudial (CRL), okusho ukuthi ubude obuphakathi kwekhanda nezinqe zombungu, bese buqhathanisa umphumela nejika lesethenjwa elisungulwe ngokwendlela yeRobinson (iminyaka yokukhulelwa = 8,052 √ × (LCC) ) +23,73).

Lesi silinganiso senza sikwazi ukulinganisa usuku lokuqala kokukhulelwa (DDG) ngokunemba kokuhlanganisa noma ukukhipha izinsuku ezinhlanu kumacala angama-95% (2). Le DDG nayo izosiza ukuqinisekisa noma ukulungisa usuku olubekiwe (APD).

Kulesi sigaba sokukhulelwa, isibeletho asikabi sikhulu kakhulu, kepha ngaphakathi, umbungu usuvele ukhule kahle. Inobukhulu obuphakathi kuka-5 no-6 cm ukusuka ekhanda kuye ezinqeni, noma ukuma okungu-12 cm, kanti ikhanda lalo lingaba ngu-2 cm ububanzi (3).

Le ultrasound yokuqala ihlose ukuhlola eminye imingcele ethile:

• inani lemibungu. Uma kungukukhulelwa okungamawele, udokotela uzonquma ukuthi ngabe ukukhulelwa okubili kwama-monochorial (i-placenta eyodwa yazo zombili izingane) noma i-bichorial (i-placenta eyodwa yombungu ngamunye). Lokhu kutholakala kwe-chorionicity kubaluleke kakhulu ngoba kuholela kokwehluka okuphawulekayo ngokuya ngezinkinga ngakho-ke ngezindlela zokulandelwa kokukhulelwa;
• ubungako bombungu: kulesi sigaba sokukhulelwa, ingane iyahamba kodwa umama ozayo akakayizwa namanje. Uhambisa amagagasi, ngokungazikhetheli, ingalo nomlenze, welule, agobe ibhola, ngokuzumayo ayakhululeka, agxume. Ukushaya kwenhliziyo yakhe, ngokushesha okukhulu (160 to 170 beats / minute), kuzwakala kwi-doppler ultrasound.
• i-morphology: udokotela uzoqinisekisa ukutholakala kwazo zonke izitho ezine, isisu, isinye, futhi uzohlola ukubukeka kwe-cephalic kanye nodonga lwesisu. Ngakolunye uhlangothi, kusenzima kakhulu ukuthola okungalungile okwenzeka morphological. Kuzoba yi-ultrasound yesibili, ebizwa nge-morphological, ukuyenza;
• inani le-amniotic fluid nokuba khona kwe-trophoblast;
• isilinganiso se-nuchal translucency (CN): njengengxenye yokuhlolwa okuhlanganisiwe kwe-Down's syndrome (akuphoqelekile kepha kuhlinzekwa ngokuhlelekile), udokotela ulinganisa ukuguquguquka kwe-nuchal, i-snore enhle egcwele uketshezi ngemuva kwentamo yombungu. Kuhlanganiswe nemiphumela ye-serum marker assay (i-PAPP-A ne-beta-hCG yamahhala) nobudala bomama, lesi silinganiso senza kube lula ukubala “ubungozi obuhlanganisiwe” (hhayi ukwenza ukuxilongwa) kokungajwayelekile kwe-chromosomal.

Mayelana nobulili bengane, kulesi sigaba i-tubercle yesitho sangasese, okusho ukuthi isakhiwo esizoba yipipi elizayo noma i-clitoris yesikhathi esizayo, namanje asinandaba futhi silinganisa u-1 kuye ku-2 mm kuphela. Kodwa-ke kungenzeka, uma ingane imi kahle, uma i-ultrasound yenzeka ngemuva kwamasonto ayi-12 futhi uma udokotela enolwazi, ukunquma ubulili bengane ngokuya ngesimo sesifuba sangasese. Uma kuqondana ne-eksisi yomzimba, kungumfana; uma iyafana, intombazane. Kepha qaphela: lesi sibikezelo sinomkhawulo wephutha. Ngaphansi kwezimo ezinhle kakhulu, kungokwethenjelwa okungu-80% kuphela (4). Odokotela ngakho-ke ngokuvamile bakhetha ukulinda i-ultrasound yesibili ukuze bamemezele ubulili bengane kubazali besikhathi esizayo, uma befuna ukuyazi.

• ukuphuphuma kwesisu : umbungu wesikhwama ukhona kepha awukho umsebenzi wenhliziyo futhi izilinganiso zombungu zingaphansi kunokujwayelekile. Kwesinye isikhathi kuba "iqanda elicacile": isaka lokukhulelwa liqukethe ulwelwesi kanye ne-placenta yesikhathi esizayo, kepha akunambungu. Ukukhulelwa kwaphela futhi umbungu awuzange ukhule. Uma kwenzeka ukuphuphuma kwesisu, isaka lokukhulelwa lingaphuma ngokuzenzekelayo, kepha kwesinye isikhathi alikho noma aliphelele. Imithi iyabhalwa-ke ukuthi idale ukuphambana futhi ikhuthaze ukuhlukaniswa okuphelele kombungu. Uma kwenzeka ukwehluleka, ukwelashwa ngokuhlinzwa nge-aspiration (curettage) kuzokwenziwa. Kuzo zonke izimo, ukuqapha okusondele kuyadingeka ukuqinisekisa ukukhishwa okuphelele komkhiqizo wokukhulelwa;
• ukukhulelwa kwe-ectopic (GEU) noma i-ectopic: iqanda alizange lifakwe esibelethweni kepha ku-proboscis ngenxa yesifo sokufuduka noma sokufakwa. I-GEU ivame ukukhombisa kusenesikhathi ukuqhubekela phambili ngezinhlungu ezisezingeni eliphansi esiswini kanye nokopha, kepha kwesinye isikhathi kutholakala ngengozi ngesikhathi se-ultrasound yokuqala. I-GEU ingaqhubekela phambili ekuxoshweni okuzenzakalelayo, ukuma noma ukukhula, ngengozi yokuqhekeka kwesikhwama sokukhulelwa esingalimaza ithubhu. Ukuqapha ukuhlolwa kwegazi ukucwaninga i-beta-hcg hormone, ukuhlolwa kwemitholampilo kanye ne-ultrasound kwenza kube lula ukuqapha ukuvela kwe-GEU. Uma ingekho esigabeni esithuthukile, ukwelashwa nge-methotrexate kuvame ukwanele ukudala ukuxoshwa kwesikhwama sokukhulelwa. Uma ithuthukile, kwenziwa ukwelashwa nge-laparoscopy ukuze kususwe isikhwama sokukhulelwa, futhi kwesinye isikhathi kube neshubhu uma konakele;
• okungcono kunokuguquguquka okujwayelekile kwe-nuchal kuvame ukubonwa ezinganeni ezine-trisomy 21, kepha lesi silinganiso kufanele sifakwe ekuhlolweni okuhlanganisiwe kwe-trisomy 21 kucatshangelwa ubudala bomama kanye nezimpawu ze-serum. Uma kwenzeka umphumela wokugcina ohlanganisiwe omkhulu kuno-1/250, kuzophakanyiswa ukusungula i-karyotype, nge-trophoblast biopsy noma i-amniocentesis.