Kubazali besikhathi esizayo, ukulinganisa isisindo se-fetus ku-ultrasound kukuvumela ukuba ucabange lo mntwana osekunesikhathi eside elindelwe kangcono kancane. Ethimbeni lezokwelapha, le datha ibalulekile ukuze kulungiswe ukulandelana kokukhulelwa, indlela yokubeletha kanye nokunakekelwa kwengane lapho izalwa.

Akunakwenzeka ukukala umbungu esibelethweni. Ngakho-ke kungenxa ye-biometrics, okusho ukuthi ukukalwa kombungu ku-ultrasound, lapho singaba nesilinganiso sesisindo sombungu. Lokhu kwenziwa ngesikhathi se-ultrasound yesibili (cishe ama-22 WA) kanye ne-ultrasound yesithathu (cishe ama-32 WA).

Udokotela uzokala izingxenye ezihlukene zomzimba wombungu:

• i-cephalic perimeter (i-PC noma i-HC ngesiNgisi);
• ububanzi be-bi-parietal (BIP);
• i-perimeter yesisu (i-PA noma i-AC ngesiNgisi);
• ubude be-femur (LF noma FL ngesiNgisi).

Le datha yebhayomethrikhi, evezwa ngamamilimitha, ibe isifakwa kufomula yezibalo ukuze kutholwe isilinganiso sesisindo sengane ngamagremu. Umshini we-fetus ultrasound wenza lesi sibalo.

Kukhona cishe amafomula wokubala angamashumi amabili kodwa e-France, lawo e-Hadlock yiwona asetshenziswa kakhulu. Kunezinhlobonhlobo eziningana, ezinamapharamitha angu-3 noma angu-4 we-biometric:

• I-Log10 EPF = 1.326 - 0.00326 (AC) (FL) + 0.0107 (HC) + 0.0438 (AC) + 0.158 (FL)
• I-Log10 EPF = 1.3596 + 0.0064 PC + 0.0424 PA + 0.174 LF + 0.00061 BIP PA - 0.00386 PA LF

Umphumela ukhonjiswe embikweni we-ultrasound ngenkulumo ethi “EPF”, ethi “Ukulinganisa isisindo sengane”.

Nokho, umphumela otholiwe uhlala uyisilinganiso. Amafomula amaningi aqinisekisiwe ngesisindo sokuzalwa sika-2 kuya ku-500 g, ne-margin yephutha uma kuqhathaniswa nesisindo sokuzalwa sangempela esisuka ku-4 kuya ku-000% (6,4), ngenxa yengxenye yekhwalithi nokunemba kokusika. izinhlelo. Ucwaningo oluningana luphinde lwabonisa ukuthi ezinganeni ezinesisindo esiphansi (ngaphansi kuka-10,7 g) noma izingane ezinkulu (ngaphezu kwe-1 g), umkhawulo wephutha wawungaphezu kuka-2%, nokuthambekela kokucabangela ngokweqile izingane. yesisindo esincane futhi ngokuphambene nokubukela phansi izingane ezinkulu.

Umphumela uqhathaniswa namajika okulinganisa isisindo sengane asungulwe yi-French College of Fetal Ultrasound (3). Umgomo uwukuhlola ama-fetus ngaphandle kwejwayelekile, atholakala phakathi kuka-10 ° no-90 ° percentile.. Isilinganiso sesisindo se-fetus senza sikwazi ukubona lezi zimo ezimbili ezeqisayo:

• i-hypotrophy, noma isisindo esiphansi seminyaka yokukhulelwa (PAG), okusho ukuthi isisindo sengane esingaphansi kwephesenti le-10 ngokweminyaka yokukhulelwa enikeziwe noma isisindo esingaphansi kuka-2 g ngesikhathi. Le PAT ingaba umphumela we-pathology kamama noma ye-fetus noma i-uteroplacental anomaly;
• i-macrosomia, noma “ingane enkulu”, okusho ukuthi ingane enesisindo sombungu esikhulu kunamaphesenti angama-90 enkathini yokukhulelwa enikeziwe noma enesisindo sokuzalwa esingaphezu kuka-4 g. Lokhu kuqapha kubalulekile esimweni sesifo sikashukela sokukhulelwa noma isifo sikashukela esivele sikhona.

Lezi zimo ezimbili ezeqisayo ziyizimo eziyingozi enganeni engakazalwa, kodwa nakumama uma kwenzeka i-macrosomia (ukwanda kwengozi yokuhlinzwa, ukopha ngesikhathi sokubeletha ikakhulukazi).

Isilinganiso sesisindo sengane siyidatha ebalulekile yokujwayela ukulandelwa kokuphela kokukhulelwa, inqubekelaphambili yokubeletha kodwa nokunakekelwa kwengane esanda kuzalwa.

Uma ku-ultrasound yesithathu isilinganiso sesisindo somntwana siphansi kunejwayelekile, i-ultrasound yokulandelela izokwenziwa phakathi nenyanga yesi-8 ukuqapha ukukhula kwengane. Esimeni sokuzalwa ngaphambi kwesikhathi okusongelwa (i-PAD), ubungozi bokuzalwa ngaphambi kwesikhathi okungase kube khona buzolinganiselwa ngokuya ngegama kodwa nangesisindo sengane. Uma isisindo sokuzalwa esilinganisiwe siphansi kakhulu, ithimba lezinsana lizobeka yonke into ukuze linakekele umntwana ozalwa ngaphambi kwesikhathi kusukela ekuzalweni.

Ukuxilongwa kwe-macrosomia kuzoshintsha nokuphathwa kokukhulelwa sekwephuzile nokubeletha. I-ultrasound yokulandelela izokwenziwa phakathi nenyanga yesi-8 yokukhulelwa ukuze kwenziwe isilinganiso esisha sesisindo sengane. Ukunciphisa ubungozi be-shoulder dystocia, ukulimala kwe-brachial plexus kanye ne-neonatal asphyxia, ekhuphuke kakhulu ku-macrosomia - ngo-5% enganeni enesisindo esiphakathi kuka-4 no-000 nama-4% enganeni engaphezu kuka-500 g (30) - ukuzalwa noma ukuhlinzwa okuhleliwe. inganikelwa. Ngakho, ngokwezincomo ze-Haute Autorité de Santé (4):

• uma kungekho isifo sikashukela, i-macrosomia ngokwayo ayiyona inkomba ehlelekile yesigaba sokubeletha esihleliwe;
• isigaba sokubeletha esihleliwe sinconywa uma kwenzeka isisindo se-fetus esilinganiselwe esikhulu noma esilingana no-5 g;
• ngenxa yokungaqiniseki kwesilinganiso sesisindo se-fetus, ngenxa yokusola kwe-macrosomia phakathi kuka-4 g no-500 g, isigaba sokubeletha esihleliwe kufanele sixoxwe ngecala ngalinye;
• lapho kukhona isifo sikashukela, isigaba sokubeletha esihleliwe sinconywa uma isisindo se-fetus silinganiselwa ukuthi sikhulu noma silingana no-4 g;
• ngenxa yokungaqiniseki kwesilinganiso sesisindo se-fetus, ngezinsolo ze-macrosomia phakathi kuka-4 g kuya ku-250 g, isigaba sokuhlinzwa esihleliwe kufanele kuxoxwe ngaso sonke isikhathi, kucatshangelwa ezinye izindlela ezihlobene nesifo kanye ne-pathology. umongo wokubelethisa;
• ukusola kwe-macrosomia akuyona inkomba ehlelekile yesigaba sokuhlinzwa esihleliwe uma kwenzeka isibeletho esinezibazi;
• Uma kusolwa i-macrosomia kanye nomlando we-shoulder dystocia oyinkimbinkimbi ngenxa yokwelulwa kwe-brachial plexus, kunconywa isigaba sokuhlinzwa esihleliwe.

Uma kuzanywa indlela ephansi, ithimba lokubelethisa kufanele liphelele (umbelethisi, udokotela wezibeletho, udokotela obulala izinzwa kanye nodokotela wezingane) ngesikhathi sokubeletha kubhekwe engozini uma kwenzeka i-macrosomia.

Esimeni sokwethulwa kwe-breche, isilinganiso sesisindo se-fetus siyacatshangelwa futhi lapho kukhethwa phakathi kokuzama umzila wesitho sangasese sowesifazane noma ingxenye ehleliwe yokuhlinzwa. Isisindo sombungu esilinganiselwa phakathi kwamagremu angu-2 no-500 siyingxenye yenqubo yokwamukeleka yomzila wesitho sangasese sowesifazane osungulwe yi-CNGOF (3). Ngaphezu kwalokho, kungase kunconywe ukuhlinzwa ngokuhlinzwa.