Lapho ukuxilonga ngaphambi kokubeletha (i-ultrasound, amniocentesis) kwembula ukuthi umntwana unesimo esibi kakhulu noma ukuthi ukuqhubeka kokukhulelwa kubeka ukuphila kowesifazane engozini, abezokwelapha banikeza umbhangqwana ukunqanyulwa kokukhulelwa kwezokwelapha (noma ukunqanyulwa kokukhulelwa ngendlela yokwelapha) . I-IMG igadwe ngokuqinile futhi ilawulwa yi-athikili L2213-1 yeKhodi Yezempilo Yomphakathi (1). Ngakho, ngokomthetho, “Ukunqanyulwa kokukhulelwa ngokuzithandela kungenziwa, nganoma isiphi isikhathi, uma odokotela ababili beqembu lezinhlaka eziningi beqinisekisa, ngemva kokuba leli qembu selinikeze umbono walo wokweluleka, noma ukuthi ukuqhubeka kokukhulelwa kuyingozi kakhulu. impilo yowesifazane, okusho ukuthi kunethuba elinamandla lokuthi ingane engakazalwa izohlushwa isimo sokudonsela phansi okuthile okuqashelwa njengokungelapheki ngesikhathi sokuxilongwa. “

Ngakho-ke umthetho awubeki uhlu lwezifo noma ukukhubazeka okugunyazwe i-IMG, kodwa imibandela yokubonisana nethimba lezinhlaka eziningi elizolethwa ukuze lihlole isicelo se-IMG futhi linikeze isivumelwano salo.

Uma ngabe i-IMG icelelwa impilo kamama ozozala, ithimba kufanele lihlanganise okungenani abantu aba-4 okuhlanganisa:

• ilungu le-gynecologist-obstetrician lesikhungo sokuxilonga ngaphambi kokubeletha esihlukahlukene
• udokotela okhethwe owesifazane okhulelwe
• usonhlalakahle noma isazi sokusebenza kwengqondo
• uchwepheshe esimweni owesifazane anaso

Uma i-IMG icelelwa impilo yengane, isicelo sihlolwa ithimba lesikhungo sokuxilonga ngaphambi kokubeletha okuhlukahlukene (CPDPN). Owesifazane okhulelwe angacela ukuthi udokotela azikhethele abambe iqhaza ekubonisaneni.

Kuzo zonke izimo, ukukhetha ukunqamula ukukhulelwa noma cha kulele kowesifazane okhulelwe, okumele ngabe wazisiwe ngaphambilini ngayo yonke imininingwane.

Namuhla, akuvamile ukuthi i-IMG yenziwe ngenxa yesimo sempilo yowesifazane okhulelwe. Ngokombiko we-Multidisciplinary Centers for Prenatal Diagnosis 2012 (2), ama-IMG angama-272 enziwe ngezizathu zomama ngokumelene ne-7134 ngezizathu zengane. Izisusa ze-fetus zihlanganisa izifo zofuzo, ukungahambi kahle kwe-chromosomal, i-malformation syndromes kanye nezifo ezingase zivimbele ukuphila kwengane noma zibangele ukufa lapho izalwa noma eminyakeni yayo yokuqala. Kwesinye isikhathi ukusinda kwengane akukho engcupheni kodwa iyoba nenkinga yokukhubazeka ngokomzimba noma ngokwengqondo. Lokhu kunjalo ikakhulukazi esimweni se-trisomy 21. Ngokombiko we-CNDPN, ukukhubazeka noma ama-syndromes angalungile kanye nezinkomba ze-chromosomal zisuka kumvelaphi engaphezu kuka-80% wama-IMG. Sekukonke, cishe u-2/3 wezitifiketi ze-IMG ngezizathu ze-fetus zenziwa ngaphambi kuka-22 WA, okusho ukuthi ngesikhathi lapho umbungu ungasebenzi khona, kubonisa lo mbiko ofanayo.

Ngokuya ngesikhathi sokukhulelwa kanye nempilo kamama ozoba ngumama, i-IMG yenziwa ngendlela yezokwelapha noma yokuhlinzwa.

Indlela yezokwelapha yenzeka ezigabeni ezimbili:

• ukuthatha i-anti-progestogen kuzovimbela isenzo se-progesterone, ihomoni ebalulekile ekugcineni ukukhulelwa
• Ngemva kwamahora angu-48, ukuphathwa kwe-prostaglandin kuzokwenza kube nokwenzeka ukuyenga ukubeletha ngokudala ukufinyela kwesibeletho kanye nokunwetshwa komlomo wesibeletho. Ukwelashwa okudambisa izinhlungu ngokufakwa noma i-epidural analgesia kwenziwa ngokuhlelekile. Umbungu ube usukhishwa ngokwemvelo.

Indlela yezinsimbi iqukethe isigaba sakudala sokuhlinzwa. Igcinelwe izimo eziphuthumayo noma iphikisana nokusetshenziswa kwendlela yokwelapha. Ukubeletha ngokwemvelo kuhlale kunelungelo ukuze kulondolozwe ukukhulelwa okungenzeka okulandelayo, ngokugwema isibazi sokuhlinzwa esenza buthaka isibeletho.

Kuzo zombili izimo, umkhiqizo we-feticide ujovwa ngaphambi kwe-IMG ukuze wenze inhliziyo yengane ime futhi kugwenywe ukucindezeleka kwengane.

Ukuhlolwa kwe-placenta kanye ne-fetus kunikezwa ngemva kwe-IMG ukuze kutholwe noma kuqinisekiswe izimbangela zokungajwayelekile kombungu, kodwa isinqumo sokuthi akwenzeki noma cha sihlala sikubazali.

Ukulandelela okungokwengqondo kunikezwa ngokuhlelekile kumama kanye nombhangqwana ukuze badlule kulobu bunzima obunzima bokushonelwa lapho ebeletha.

Uma kuhambisana kahle, ukuzalwa kwesitho sangasese sowesifazane kuyisinyathelo esibalulekile ekuhlangenwe nakho kwalokhu kushonelwa. Ngokuya ngokuya beqaphela ukunakekelwa ngokwengqondo kwale mibhangqwana eshonelwe, amanye amaqembu okubeletha aze enze isiko ngesikhathi sokuzalwa. Abazali futhi, uma bethanda, bangakwazi ukusungula uhlelo lokuzalwa noma bahlele umngcwabo womntwana. Izinhlangano ngokuvamile ziba ukusekela okubalulekile phakathi nalezi zikhathi ezinzima.