I-ultrasound yesibili yokukhulelwa, ebizwa ngokuthi i-morphological ultrasound, iyisinyathelo esibalulekile ekuqaphelweni kokukhulelwa ngoba ikwazi ukubona ukukhubazeka okungenzeka kwengane. Kubazali, kuphinde kube okugqamile: lokho kokuthola ubulili bomntwana.

I-ultrasound yesibili yenzeka ngomhla wesi-5 wokukhulelwa, phakathi kwamasonto angama-21 kuya kwangu-24 ubudala, kahle kahle emasontweni angama-22 ubudala.

Akuphoqelekile kodwa kuyingxenye yokuhlolwa okunqunywe ngokuhlelekile ngesikhathi sokulandelela ukukhulelwa futhi kunconywa kakhulu.

Kulokhu kuhlolwa, akudingekile ukuzila ukudla noma ukuba nesinye esigcwele. Ngakolunye uhlangothi, akunconywa ukubeka ukhilimu noma amafutha esiswini ngesikhathi samahora angu-48 ngaphambi kwe-ultrasound ukuze ungathinti ikhwalithi yesithombe.

Udokotela ugcoba isisu sikamama ozoba ngumama ngamanzi aphuzi ukuze kube lula ukudlula kwe-ultrasound. Khona-ke, uzohambisa uphenyo esiswini ukuze athole izithombe ezihlukene, noma izingxenye, zomntwana. Le ultrasound yesibili ihlala isikhathi eside kuneyokuqala ngoba ifunda ngendlela ehlelekile i-anatomy egcwele yengane.

Inhloso eyinhloko yale ultrasound iwukubheka ukungahambi kahle kwe-morphological. Udokotela uzofunda isitho ngasinye ngendlela efanele ngokwenza izigaba eziphambanayo ezivumela, “ezingeni” ngalinye, ukulawula ubukhona nokuma kwezitho ezihlukene: inhliziyo, ubuchopho, izitho ezihlukene zesisu (isisu, esinyeni, amathumbu) , zonke izitho ezine.

Kuphakathi nalokhu kuhlolwa lapho ukukhubazeka kombungu kutholakala kalula. Kodwa-ke, nakuba isebenza kahle futhi iyinkimbinkimbi, i-morphological ultrasound ayithembeki ngo-100%. Ngezinye izikhathi kwenzeka ukuthi i-anomaly ye-fetus, ngisho ekhona kulesi sigaba sokukhulelwa, ayitholakali phakathi nale ultrasound. Lokhu kwenzeka lapho ukukhubazeka kungatholakali noma kungenakufinyeleleka esithombeni, isikhundla se-fetus sifihla ukukhubazeka, noma lapho umama wesikhathi esizayo ekhuluphele ngokweqile. Izicubu ze-subcutaneous adipose empeleni zingaphazamisa ukudlula kwe-ultrasound futhi ziguqule ikhwalithi yesithombe.

Phakathi nale ultrasound yesibili, udokotela uphinde ahlole:

• ukukhula kwengane kusetshenziswa i-biometrics (isilinganiso sobubanzi be-biparietal, i-cranial perimeter, i-perimeter yesisu, ubude be-femoral, ububanzi besisu obuphambene) imiphumela yakho izoqhathaniswa nejika lokukhula;
• i-placenta (ubukhulu, isakhiwo, izinga lokufaka);
• inani le-amniotic fluid;
• ukuvuleka kwangaphakathi komlomo wesibeletho ikakhulukazi uma kwenzeka ukufinyela.

Kungalesi sikhathi sesibili se-ultrasound lapho kumenyezelwa khona ubulili bomntwana - uma abazali befisa ukwazi vele - futhi uma ingane ihlezi kahle. Kulesi sigaba sokukhulelwa, izitho zangasese zangaphandle zakhiwe futhi ziyabonakala esithombeni, kodwa kuhlale kukhona umkhawulo omncane wephutha, kuye ngokuthi isikhundla somntwana ikakhulukazi.

Ngezinye izikhathi i-Doppler yenziwa phakathi nalokhu ultrasound. Ngemisindo ebhalwe kugrafu, isiza ukulawula ukugeleza kwegazi emithanjeni ehlukene kanye nasemithanjeni (imithambo yesibeletho, i-umbilical arteries, i-cerebral arteries). Kuyithuluzi elihambisanayo lokulawula ukukhula kombungu ezimeni ezithile eziyingozi noma izinkinga zokubelethisa (1):

• isifo sikashukela sokukhulelwa;
• umfutho wegazi ophakeme;
• ukucindezeleka kwe-fetus;
• ukukhubazeka kokukhula esibelethweni (IUGR);
• ukungahambi kahle kwe-amniotic fluid (oligoamnios, hydramnios);
• ukukhubazeka kwe-fetus;
• ukukhulelwa kwe-monochorial (ukukhulelwa kwamawele nge-placenta eyodwa);
• isifo sikamama esivele sikhona (i-hypertension, lupus, nephropathy);
• umlando we-obstetric vascular pathologies (IUGR, pre-eclampsia, abruption placental);
• umlando wokufa esibelethweni.

Kulesi sigaba sokukhulelwa, umntwana cishe u-25 cm ukusuka ekhanda kuye ozwaneni, ingxenye yobukhulu bayo bokuzalwa. Inesisindo esingu-500 gr. Izinyawo zayo zilinganiselwa ku-4 cm (2).

Usenendawo enkulu yokunyakaza, noma ngabe umama ozalayo akazizwa njalo. Akaboni kodwa uzwela kakhulu uma ethintwa. Ulala cishe amahora angu-20 ngosuku.

Imilenze yakhe, izingalo zakhe zibonakala ngokucacile, ngisho nezandla zakhe zineminwe eyakhiwe kahle. Ephrofayilini, isimo sekhala lakhe siyavela. Inhliziyo yayo ilingana nomnqumo, futhi ngaphakathi kuyo zonke izingxenye ezine zikhona njengoba kukhona umthambo wamaphaphu kanye ne-aorta.

Sibona cishe wonke ama-vertebrae esithombeni, enza uhlobo lokuma. Akanazo izinwele okwamanje, kodwa phansi elula.

Kubazali, le ultrasound yesibili ivame ukuba mnandi kakhulu: umntwana mkhulu ngokwanele ukuze sikwazi ukubona kahle ubuso bakhe, izandla zakhe, imilenze yakhe, kodwa isencane ngokwanele ukuba ivele ngokugcwele esikrinini futhi ivumele ukubuka konke kwalokhu okuncane. eseyakheke kahle.

Uma kusolakala ukuthi kukhona okungahambi kahle kwe-morphological, umama ozozala udluliselwa esikhungweni sokuxilonga ngaphambi kokubeletha kanye / noma ku-sonographer eyinkomba. Okunye ukuhlolwa kuyenziwa ukuze kuqinisekiswe ukungahambi kahle futhi kucwengisiswe ukuxilongwa: i-amniocentesis, i-MRI, i-cardiac ultrasound, i-MRI noma i-fetus scan, ukubhoboza igazi lengane, ukuhlolwa kwegazi lombhangqwana, njll.

Ngezinye izikhathi izivivinyo azikuqinisekisi i-anomaly. Ukuqapha ukukhulelwa bese kuqala kabusha ngokujwayelekile.

Uma ukuphambana okutholiwe kungembi kangako, kuzolandelwa umkhondo othize wesikhathi esisele sokukhulelwa. Uma i-anomaly ingelashwa, ikakhulukazi ngokuhlinzwa, kusukela ekuzalweni noma phakathi nezinyanga zokuqala zokuphila, konke kuzohlelwa ukuze kusetshenziswe lokhu kunakekelwa.

Lapho ukuxilongwa kwangaphambi kokubeletha kuqinisekisa ukuthi umntwana uhlushwa “isimo sokudonsela phansi okuthile esiqashelwa njengokungalapheki ngesikhathi sokuxilongwa” ngokwemibhalo, umthetho (3) ugunyaza iziguli ukuthi zicele ukunqanyulwa kokukhulelwa ngokwezokwelapha (IMG) noma “ ukukhipha isisu okwelaphayo” nganoma yisiphi isikhathi sokukhulelwa. Izakhiwo ezithile ezigunyazwe i-Biomedicine Agency, i-Multidisciplinary Centers for Prenatal Diagnosis (CPDPN), zinesibopho sokuqinisekisa ukuqina nokungalapheki kwezifo ezithile ze-fetus futhi ngaleyo ndlela zigunyaze i-IMG. Lezi yizifo zofuzo, ukukhubazeka kwe-chromosomal, i-malformation syndromes noma ukuphazamiseka okukhulu kakhulu (kobuchopho, inhliziyo, ukungabikho kwezinso) okungasebenzi ngesikhathi sokuzalwa futhi okungaholela ekufeni kwengane lapho izalwa noma eminyakeni yayo yokuqala. , ukutheleleka okungase kuvimbele ukuphila komntwana noma kubangele ukufa kwayo lapho izalwa noma eminyakeni yayo yokuqala, isifo esiholela ekukhubazekeni okukhulu ngokomzimba noma kwengqondo.

Phakathi nale ultrasound yesibili, ezinye izinkinga zokukhulelwa zingatholwa:

• i-intrauterine growth retardation (IUGR). Ukuqapha ukukhula njalo kanye ne-Doppler ultrasound kuzobe sekwenziwa;
• i-placenta engavamile, njenge-placenta praevia. I-ultrasound izoqapha ukuvela kwe-placenta.