Ngokwencazelo ye-WHO, ukuzalwa komntwana oshonile “ukufa komkhiqizo wokukhulelwa lapho lokhu kufa kwenzeka ngaphambi kokuxoshwa noma ukukhishwa okuphelele komzimba kamama, kungakhathaliseki ukuthi ubude besikhathi sokukhulelwa bungakanani. Ukufa kubonisiwe ?? ngokuthi ngemva kwalokhu kuhlukana, umbungu awuphefumuli futhi awubonisi noma yiziphi ezinye izimpawu zokuphila ezinjengokushaya kwenhliziyo, ukushayeka kwenkaba noma ukufinyela okusebenzayo komsipha ongaphansi kwesenzo sentando ” . I-WHO iphinde yachaza umkhawulo wokuphila: amasonto angama-22 e-amenorrhea (WA) aqediwe noma isisindo esingu-500 g. Sikhuluma ngokufa kwe-fetus esibelethweni (MFIU) lapho ukufa kubonakalaÌ ?? ngaphambi kokuqala kokubeletha, ngokuphambene nokufa kwe-perpartum, okwenzeka ngenxa yokufa ngesikhathi sokubeletha.

Ngokuzalwa okungu-9,2 kwezingane ezingaphili ngakunye kwezingu-1000 ezizalwayo, iFrance inezinga eliphezulu kakhulu lokuzala izingane ezishonile eYurophu, kubonisa umbiko waseYurophu mayelana nempilo yokubeletha i-EURO-PERISTAT ka-2013 (1). Enkulumweni yabezindaba (2) ephathelene nale miphumela, i-Inserm icacisa, nokho, ukuthi lesi sibalo esiphezulu singachazwa ngokuthi u-40 kuya ku-50% wezinsana ezizalwa zishonile eFrance zibangelwa ukunqanyulwa kokukhulelwa kwezokwelapha (IMG), lokhu ngenxa yokukhulelwa. "inqubomgomo esebenza kakhulu yokuhlolwa kwezinkinga zokuzalwa kanye nokwenza sekwephuzile kwe-IMG". Kusukela emavikini angama-22, umuthi wokugomela uyenziwa ngaphambi kwe-IMG ukuze kugwenywe ukuhlupheka kwengane. Ngakho-ke i-IMG iholela eqinisweni ekuzalweni kwengane "ezelwe isagcwele".

I-RHEOP (Register of Child Disabilities and Perinatal Observatory) (3), ebala izingane ezizalwa zishonile e-Isère, eSavoie naseHaute-Savoie, ngonyaka ka-2011 ibika izinga lokuzalwa lika-7,3, 3,4 ‰, kuhlanganise no-3,9 ‰ ngokuzala umntwana oshonile ngokuzenzekelayo (MFIU) kanye no-XNUMX ‰ ngokuzala umntwana oshonile (IMG).

Ukuze uzame ukuchaza imbangela yokufa komntwana esibelethweni, ukuhlolwa kwenziwa ngendlela ehlelekile. Kubandakanya okungenani (4):

• ukuhlolwa kwe-histological ye-placenta;
• i-autopsy ye-fetus (ngemuva kwemvume yesiguli);
• ukuhlolwa kwe-Kleihauer (ukuhlolwa kwegazi ukuze kukale inani lamangqamuzana egazi abomvu engane ekhona phakathi kwamangqamuzana abomvu egazi likamama);
• ukucinga ama-agglutinins angajwayelekile;
• serologies komama (parvovirus B19, toxoplasmosis);
• i-cervico-vaginal kanye ne-placental swabs ezithathelwanayo;
• ngifuna i-antiphospholipid antibody syndrome, i-systemic lupus, uhlobo 1 noma isifo sikashukela se-2, i-dysthyroidism.

Izimbangela ezivame kakhulu ze-MFIU yizi:

• i-vasculo-placental anomaly: i-retro-placental hematoma, i-toxemia, i-pre-eclampsia, i-eclampsia, i-HELLP syndrome, ukopha kwe-foeto-mamaternal, i-placenta previa nokunye ukuphazamiseka kokufakwa kwe-placenta;
• i-pathology yama-appendages: intambo (intambo ye-procidence, intambo entanyeni, ifindo, ukufakwa kwe-velamentous, okusho ukuthi intambo efakwe kuma-membrane hhayi i-placenta), i-amniotic fluid (i-oligoamnios, i-hydramnios, ukuphuka kwe-membrane);
• ukuphazamiseka kwe-fetus ngokomthethosisekelo: i-congenital anomaly, i-autoimmune hydrops edema (i-edema evamile), i-transfusion-transfused syndrome, ukwephuza isikhathi;
• ukukhubazeka kokukhula kwe-intrauterine;
• Isizathu esithathelwanayo: i-chorioamniotic, i-cytomegalovirus, i-toxoplasmosis;
• i-pathology kamama: isifo sikashukela esingazinzile ngaphambili, isifo se-thyroid, i-arterial hypertension ebalulekile, i-lupus, i-cholestasis yokukhulelwa, ukusetshenziswa kwezidakamizwa, i-pathology yesibeletho (umlando wokuphuka kwesibeletho, ukukhubazeka, i-uterine septum), i-antiphospholipid syndrome;
• ukuhlukumezeka kwangaphandle ngesikhathi sokukhulelwa;
• ukuphelelwa umoya noma ukuhlukumezeka ngesikhathi sokubeletha.

Ezimweni ezingu-46%, ukufa komntwana kuhlala kungachazwanga, nokho, kucacisa i-RHEOP (5).

Ngemva kokuxilongwa kokushona kombungu esibelethweni, ukwelashwa ngezidakamizwa kunikezwa umama ozoba khona ukuze alethe. Ukuxoshwa kwengane ngomzila wesitho sangasese sowesifazane kuhlala kukhethwa kunesigaba sokuhlinzwa.

Ukwesekwa ngokwengqondo nakho kuyasebenza ukuze kusize umbhangqwana ukuba udlule ekuhlukumezekeni kokushonelwa ngesikhathi sokubeletha. Lokhu kusekelwa kuqala uma nje kumenyezelwa ukushona komntwana, okuhlanganisa nokukhethwa kwamagama. Abazali banikezwa ukuxoxisana nombelethisi onguchwepheshe bokushonelwa obelethwayo noma isazi sokusebenza kwengqondo. Ingabe bafuna ukubona ingane, ukuyithwala, ukuyigqokisa, noma ukungayiqambi igama? Kukubazali ukwenza lezi zinqumo eziyingxenye ebalulekile yosizi lwabo. Laba bashadikazi futhi banezinsuku ezingu-10 ngemuva kokuzalwa zokukhetha ukunikeza ingane yabo umngcwabo futhi ingcwatshwe, noma ukuhambisa isidumbu esibhedlela ukuze sishiswe.

Ukulila kwePerinatal kuwukuzila okukodwa: okomuntu ongaphilanga, ngaphandle kwasesiswini sikanina. Ngokocwaningo lwaseMelika (6), ingozi yokucindezeleka ngemva kokuzalwa kwengane ingaqhubeka iminyaka emi-3 ngemva kokubeletha. Ngakho-ke kuyatuswa ukulandelelwa kwengqondo, kanye nosizo oluvela emaqenjini okusekelana nezinhlangano.

Umbono "womntwana ozelwe ngaphandle kokuphila" wavela okokuqala emthethweni waseFrance ngo-1993. Kusukela ngaleso sikhathi, umthetho uye washintsha izikhathi eziningana. Ngaphambi kwesimemezelo n ° 2008-800 ka-Agasti 20, 2008, umbungu owodwa kuphela ongaphezu kwamasonto angu-22 ubudala owawukhona mayelana nesimo somphakathi. Kusukela manje kuqhubeke, isitifiketi sokuzalwa singalethwa. ngaphambi kuka-22 SA (kodwa ngokuvamile ngemva kuka-15 SA) ngesicelo sabazali. Ngemuva kwalesi sikhathi, ikhishwa ngokuzenzakalelayo.

Lesi sitifiketi senza kube nokwenzeka ukusungula “isenzo sengane neÌ ?? ngaphandle kokuphila ”okunikeza abazali ithuba lokuthi, uma befisa, banikeze igama lokuqala elilodwa noma amabili enganeni yabo futhi balifake ebhukwini lerekhodi lomndeni wabo, noma ukusungula elinye uma bengenalo. hhayi okwamanje. Ngakolunye uhlangothi, alikho igama lomndeni noma isixhumanisi esinganikezwa le ngane ezalwe isishonile; ngakho-ke akuyena umuntu osemthethweni. Nokho, ngokomfanekiso, lo myalo uphawula igxathu eliya phambili lokuqashelwa kwezingane ezizalwa sezifile njengomuntu, kanjalo nokulila nokuhlupheka okubazungezile. Kuwukuba futhi kwabashadile ukuqashelwa isimo sabo "somzali".

Uma kwenzeka ukubeletha ngaphambi kwamasonto angu-22, owesifazane akakwazi ukuzuza ngekhefu lokubeletha. Udokotela, nokho, angammisa umsebenzi amnikeze ilungelo lesinxephezelo esivela kuMshwalense Wezempilo.

Uma kwenzeka ebeletha ngemva kwamasonto angu-22, owesifazane uyazuza ngekhefu eligcwele lokuyoteta. Lokhu kukhulelwa kuzophinde kucatshangelwe abezenhlalakahle lapho kubalwa ilivu yokuyoteta elandelayo.

Ubaba uzokwazi ukuhlomula ngezibonelelo zekhefu lokubeletha zansuku zonke, lapho ethula ikhophi yesenzo somntwana ongaphili kanye nesitifiketi sikadokotela sokulethwa kwengane ezelwe ifile futhi iphila.

Abazali bangazuza ngebhonasi yokuzalwa (kuncike ezinsizeni) kuphela uma ukuphela kokukhulelwa kwenzeka kusukela osukwini loku-1 lwenyanga elandela inyanga yesi-5 yokukhulelwa. Khona-ke kuyadingeka ukukhiqiza ubufakazi bokukhulelwa ngalolu suku.

Ngokwezintela, kuyamukelwa ukuthi izingane ezisazalwa phakathi nonyaka wentela futhi ezazala indawo aÌ € ukusungulwa kwesenzo sengane ?? ezingaphili zisetshenziselwa ukunquma inani lamayunithi.