Kunezinhlobo ezahlukahlukene zokukhulelwa okungamawele ngokuya ngendlela yokukhulelwa kanye nokufakwa kombungu. Ngakho-ke siyahlukanisa:

- amawele e-monozygotic (cishe ama-20% amawele akhulelwe) avela ekukhulisweni kweqanda elilodwa ngesidoda. Ngesonto lokuqala lokukhulelwa, iqanda lihlukana libe izingxenye ezimbili ezizokhula ngokwehlukana. Izinto zofuzo zemibungu emibili ngakho-ke ziyefana: zingamawele obulili obufanayo azobukeka efana ncamashi, yingakho igama elithi “amawele afanayo”. Phakathi kwalokhu kukhulelwa okune-monozygous, kunezinhlobo ezahlukahlukene zokumiliswa ngokuya ngesikhathi sokuhlukaniswa kweqanda, ngokwazi ukuthi ngokuhamba kwesikhathi lihlukanisa, imibungu ihlala isondele futhi yabelana ngezithasiselo zokukhulelwa.

• uma ukwehlukaniswa kwenzeka ezinsukwini ezingaphansi kwezinsuku ezimbili ngemuva kokukhulelwa, iqanda ngalinye lizoba ne-placenta yalo nesikhwama se-amniotic. Sibe sesikhuluma ngokukhulelwa okungamawele okubili (ama-placenta amabili) ne-biamniotic (amaphakethe amabili e-amniotic).
• uma ukwahlukana kwenzeka phakathi kosuku lwesithathu nolwesikhombisa, ukufakwa kuzoba yi-monochorial (i-placenta eyodwa) ne-biamniotic (izikhwama ezimbili ze-amniotic). Amawele abelana ngendawo efanayo lapho kufakwa khona izintambo zombili zombili.
• uma ukuhlukaniswa kwenzeka ngemuva kosuku lwesishiyagalombili, ukufakwa kungu-monochorial (i-placenta), i-monoamniotic (i-amniotic pocket).

- amawele e-dizygotic (80% amawele akhulelwe) avela ekukhulelweni kwamaqanda amabili, ngalinye ngesidoda esihlukile. Abanazo izakhi zofuzo ezifanayo ngakho-ke bangaba ngabobulili obufanayo noma obuhlukile. Babukeka ngokufana njengoba abafowethu noma odade ababili bebebukeka befana. Ngamunye une-placenta yakhe nesikhwama sakhe se-amniotic, ngakho-ke ukukhulelwa kwe-bichorium kanye ne-biamniotic. I-trimester ultrasound yokuqala ingathola ukukhulelwa okubili ngokukhombisa izikhwama ezimbili zokukhulelwa. Wenza futhi ukuxilongwa kwe-chorionicity (i-placenta eyodwa noma amabili), ukuxilongwa okubaluleke kakhulu ngoba kuholela ekuhlukaneni okuphawulekayo ngokuya kwezinkinga ngakho-ke izindlela zokuqapha ukukhulelwa.

Ukukhulelwa amawele kubhekwa njengokukhulelwa okuyingozi. Sibona ikakhulukazi:

• ubungozi obukhulayo bokukhubazeka kokukhula kwe-intrauterine (IUGR), ikakhulu ngenxa yokwabelana kombungu ngemithombo yamaplasenti elinganiselwe noma ukuphazamiseka kokujikeleza kwegazi ngesikhathi sokukhulelwa sekwedlule isikhathi. Le IUGR ibhekele i-neonatal hypotrophy (isisindo esiphansi sokuzalwa), esivame kakhulu emawele.
• ingozi eyengeziwe yokuzalwa kwangaphambi kokubeletha. Ama-20% ezingane ezizalwe ngaphambi kwesikhathi zivela ekukhulelweni okuningi futhi ama-7% amawele ayizingane ezizalwe ngaphambi kwesikhathi (2), nazo zonke izifo zokuphefumula, zokugaya ukudla kanye nezinzwa zemizwa ezibangelwa lokhu kuqala.
• ingozi eyandayo yokufa komuntu ngokuzalwa, izikhathi eziphindwe ka-5 kuye kwezingu-10 ukukhulelwa okungamawele kunokukhulelwa okukodwa.
• ingozi eyengeziwe ye-toxemia yokukhulelwa. Ekukhulelweni okungamawele, umfutho wegazi ophakeme uvame kakhulu izikhathi ezine, futhi ungadala ukubambezeleka kokukhula embundwini owodwa noma womabili.

Ukuvimbela nokubona lezi zinkinga ngokushesha okukhulu, ukukhulelwa amawele kungaphansi kokubhekwa okwandayo ngudokotela onolwazi oluhle ngalolu hlobo lokukhulelwa. Ama-Ultrasound kanye ne-dopplers kuvame kakhulu, ngemvamisa yanyanga zonke, noma nangaphezulu uma kukhona umehluko omkhulu ekukhuleni phakathi kwemibungu. Umama wesikhathi esizayo ubuye alaliswe ngaphambi kwekhefu lokugula kusuka emasontweni angama-20.

Ngokuya ngendawo yabo, amanye amawele akhulelwe angabonisa nezingozi ezithile. Endabeni yokukhulelwa kwe-monochorial (i-placenta eyodwa yazo zombili izingane), inkinga esatshwayo yi-transfusion-transfusion syndrome (TTS), ethinta i-15 kuye ku-30% yalokhu kukhulelwa (4). Lesi sifo sibhekene nokusatshalaliswa kahle kwegazi phakathi kwale mibungu emibili: enye ithola ngokweqile, enye ayenele. Ukuhlolwa kwe-ultrasound okwavela njalo ngenyanga noma kwamasonto onke kuyadingeka ukuze kutholakale le nkinga ngokushesha okukhulu.

Endabeni yokukhulelwa kwe-monoamniotic monochorial, enye ingozi yengezwa kuleyo ye-TTS: leyo yokubanjwa kwezintambo. Njengoba kungekho ukwahlukana phakathi kwemibungu ehlanganyela esikhwameni esifanayo se-amniotic, intambo yayo yenkaba ingaphambuka phakathi kwayo. Ukuqapha okwengeziwe kuyadingeka kusuka ku-22-30 WA.

Uma enye yezingozi zokukhulelwa amawele kungukubeletha ngaphambi kwesikhathi, noma kunjalo, umuntu akufanele aye kude kakhulu ekuqhubekeni kokukhulelwa ukuze kukhule kahle amawele amabili azibeka engozini, ekupheleni kokukhulelwa, yokungabi nokwanele. igumbi noma uketshezi lwe-amniotic. Ukukhulelwa amawele empeleni kufushane kunokukhulelwa okukodwa. Ezingeni lokuphefumula, amawele avuthwa emasontweni amabili ngaphambi kwezingane ezivela ekukhulelweni okukodwa.

Ezincomweni zayo zokuphathwa kokukhulelwa amawele, i-CNGOF ikhumbula ngaleyo ndlela izikhathi zokugcina:

- uma kwenzeka ukukhulelwa kwe-bichorium okulula, ukubeletha, uma kungenzekanga ngaphambili, kuvame ukuhlelwa phakathi kwamasonto angama-38 namaviki angama-40

- uma kwenzeka ukukhulelwa okungafani nalutho kwe-biamniotic monochorial, ukulethwa kuhlelelwe phakathi kuka-36 WA no-38 WA + izinsuku ezingu-6

- uma kwenzeka ukukhulelwa kwe-monoamniotic monochorial, kunconywa ukuzala la mawele ngisho nangaphambi kwalokho, phakathi kwamasonto angama-32 kuya kwangu-36 ubudala.

Ngokuphathelene nendlela yokubeletha, isigaba sangasese noma sokuhlinzwa, "asikho isizathu sokuncoma umzila owodwa wokulethwa ngaphezu komunye uma kwenzeka ukukhulelwa amawele noma ngabe yisiphi isikhathi saso", kusho i-CNGOF. Ngakho-ke, ukukhulelwa amawele akuyona inkomba eqinile yesigaba sokuhlinzwa, noma ngabe kwenzeka lapho kwethulwa ku-breech yewele lokuqala noma uma kwenzeka isibeletho sinesibazi.

Imodi yokulethwa izokhethwa ngokwesikhathi sokukhulelwa, isisindo sezinsana, izikhundla zazo (ezibonakala ku-ultrasound), isimo sempilo yazo, i-chorionicity, ububanzi bekhaba lomama wesikhathi esizayo. Uma kwenzeka ukungakhuli kakhulu, ukukhubazeka okukhulu kokukhula, ukukhathazeka okungapheli kwengane, ukukhulelwa kwe-monochorial monoamniotic, isigaba se-cearean ngokuvamile senziwa ngokushesha.

Ukuzalwa kwamawele kuhlala, njengokukhulelwa okungamawele, kusengozini. Isilinganiso sokukhishwa kwensimbi kanye nesigaba sokuhlinzwa siphezulu kunokukhulelwa okukodwa. Ingozi yokopha ngesikhathi sokubeletha nayo iyanda ngoba i-placenta inkulu futhi isibeletho, sisuswe kakhudlwana, sisebenza kancane, sivimbela isimo se-ligation yemvelo yemikhumbi emincane yesibeletho.

Uma kuzanywa indlela esezingeni eliphansi, yenziwa esigabeni sokubeletha nge-gynaecologist yokubelethisa enomkhuba wokubeletha amawele kanye nowesazi sokubulala izinzwa.

Ngaphezu kwalokho, konke kufanele kwenziwe ukunciphisa isikhathi esiphakathi kokuzalwa kwalezi zingane ezimbili, ngoba iwele lesibili lichayeka kakhulu ezinkingeni ezahlukahlukene zokubeletha: ukwethula okungalungile, ukusikwa okungasebenzi kahle, ukuhlupheka kwengane kulandela ukuhlangana okuyingxenye ye-placenta ngemuva kokuzalwa ukuzalwa kwengane yokuqala, ukuzalwa kwentambo, njll.