Panguva yekuzvitakura, fetus inokura mugomba uye inogeza muamniotic fluid. Inoumbwa ne96% yemvura, iyi inogara ichichinja mvura ine electrolytes, mineral elements (sodium, potassium, calcium, trace elements, etc.), amino acids, asiwo masero e fetus.

Matangiro ekutanga eamniotic fluid anoonekwa nguva pfupi mushure mekusangana nekugadzirwa kweamniotic cavity pazuva rechinomwe. Mumasvondo ekutanga enhumbu, mvura inobva yabuda ne "embryo pachayo" nechiitiko che extracellular expansion (chinonzi extravasation). Chikamu chidiki chemvura chinovanzwa zvakare naamai kuburikidza nekufamba kwemvura kubva kune chorionic villi iripo mune ramangwana placenta. Zvisinei, pakati pemavhiki makumi maviri nemakumi maviri nemashanu, ganda re "fetus" rinova risingapindiki (keratinization process). Nokudaro, huwandu hweamniotic fluid hunovimbiswa nekuenzanisa pakati pezvinobudiswa ne fetus (kugadzirwa) uye izvo zvinomedza muchibereko.

• Fluid excretion inonyanya kuitwa nenzira mbiri:

  - Le syfetal urinary stema uye kunyanya iyo diuresis iyo inomisikidzwa yakatenderedza 12-13 WA. Mushure memavhiki makumi maviri, inova iyo huru yekugadzirwa kweamniotic fluid inosvika 20 kusvika 800 ml / maawa makumi maviri nemana pakupera kwepamuviri (kupikisa 1200 ml / kg / d kusvika 24 ml / kg / d pamavhiki makumi maviri nemashanu).

  - the mvura yemapapu, yakavanzwa kubva kumasvondo gumi nemasere, inosvika 18 kusvika 200 ml / 300h pakupera kwekuita pamuviri.

• Iyo reabsorption phenomenon amniotic fluid inogoneka nekuda kwekumedza kweramangwana mwana. Zvechokwadi, fetus inomedza chikamu chikuru cheamniotic fluid, iyo nokudaro inopfuura nepakati pekudya kwayo uye hurongwa hwekufema kwayo, isati yaendeswa kumuviri waamai uye kuva, pakupera kwenhangemutange, yakasvibiswa neitsvo dzemangwana amai. .

Nekuda kwe "ketani" iyi yekugadzirwa kwemuviri, iyo amniotic fluid inotevera kutenderera kwakanyanya mumavhiki ekuzvitakura kuti ienderane nehuremu uye kukura kwemwana anotevera:

• Pamberi pe20 WA, huwandu hweamniotic fluid mugomba hunowedzera zvishoma nezvishoma (kubva pa20 ml pa7 WA kusvika 200 ml pa16 WA),
• Pakati pemavhiki makumi maviri nemavhiki makumi matatu nematatu kusvika makumi matatu nemana, vhoriyamu inomira yakatenderedza 20 ml,
• Mushure memavhiki makumi matatu nemana, huwandu hweamniotic fluid hunodzikira, nekukasira kwechiitiko kusvika kumasvondo makumi matatu nemapfumbamwe, huwandu hwemvura hunosvika 34 ml panguva.

  Kusiyana maererano nevakadzi, kuwanda kweamniotic fluid iri pakati pe250 ml (yakaderera muganho) uye 2 malita (yakakwirira muganho), kuitira kuti pamuviri unzi wakajairika.

Amniotic fluid inobata mabasa akasiyana-siyana anoshanduka panguva yekuzvitakura. Yokutanga uye inonyanya kuzivikanwa yemabasa ayo: chengetedza mwana asati aberekwa kubva kune zvinotyisa uye ruzha.

Asi amniotic fluid inobatsirawo:

• inovimbisa kugadzikana kwezvakatipoteredza mucheche, kuchengetedza tembiricha isingaperi uye kugadzirisa huwandu hwayo mukukura kwemwana,
• kutora misiyano mukuravira, chiedza, kunhuwa kana kunzwa, nokudaro kusimudzira kwemwana muchibereko chekunzwa.
• fambisa mafambiro e "fetus" uye kutora chikamu mukukura kwayo kwemhasuru uye morphological,
• kupa mvura uye mineral salts izvo mwana anouya anoda.
• lubricate, apo membrane inoputika, chidimbu chepabonde uye nokudaro kugadzirira muviri wekufamba kwemwana.

Asi amniotic fluid zvakare chiratidzo chakakosha chehutano hwe fetus. Saka nekudaro, bvunzo yekuongorora huwandu hweamniotic fluid ndeye ultrasound. Izvi zvinogona kukurudzirwa kana murapi achifungidzira kusaenzana mukukwirira kwechibereko, kuderera kwekufamba kwe "fetus" kana kuputika nguva isati yakwana ye membranes. Iye sonographer anogona kuzoshandisa nzira dzakasiyana kuongorora inogona kuitika oligoamnios (kuderera kwehuwandu hweamniotic fluid) kana hydramnios (yakawandisa amniotic fluid, ona pazasi), zvinoti:

Chiyero chetangi rakakura kwazvo (CGV)

Iyo inonziwo nzira yaChamberlain, kuongororwa kunosanganisira kuongororwa kweultrasound kweamniotic cavity yose kuitira kuti pawane dura guru remvura (panzvimbo pasina kukanganiswa nenhengo ye fetus kana guvhu). Kuyera kudzika kwayo kunotungamira kuongororwa:

• kana iri pasi pe3 cm, kuongororwa kunoratidza oligoamnios,
• kana akayera pakati pe3 ne8 cm, zvakajairika,
• kana yakakura kupfuura 8 cm, inogona kuratidza hydramnios.

Iyo amniotic index (ILA) kuyerwa

Kuongorora uku kunosanganisira kupatsanura rukuvhute mu 4 quadrants, zvino kuyera nekuwedzera kudzika kwematangi akaonekwa.

• kana iri pasi pe50 mm, njodzi ye oligoamnios yakakwirira,
• kana ichiyera pakati pe50 mm ne180 mm; huwandu hweamniotic fluid hwakakwana,
• kana yakakura kupfuura 180 mm, hydramnios inofanira kufungwa.

Pamusoro pehuwandu hweamniotic fluid, murapi angangofanira kuongorora zvinhu zvinoiumba, sezvazvinoita kana uchiita amniocentesis. Chinangwa: kutsvaga mushonga unotapukira kana mamiriro ezvinhu achifarira kutapukirwa kwe "fetus" kana kudzidza machromosomes e "fetus" kuti aone zvikonzero zvinogona kuitika zvemajini (kutanga ne trisomy 21). Kutaura zvazviri, amniotic fluid ine masero e "fetus" akawanda mukurembera, uwandu hwayo hunosvika pakakwirira pakati pemasvondo gumi nematanhatu kusvika makumi maviri. Kurimwa kwemasero aya kunoita kuti zvikwanise kugadzira karyotype uye nekudaro kunyatsoongorora dzimwe njodzi dzechromosomal abnormalities.

Panguva yekutevera mushure mekuberekwa, murapi anotarisisa huwandu hweamniotic fluid nekuyera kureba kwechibereko. Chinangwa: kusabvisa kana kutarisira isina kukwana (oligoamnios) kana yakawandisa (hydramnios) huwandu hweamniotic fluid, iyo 2 pathologies inogona kuve nemhedzisiro yakakomba pamhedzisiro yekuzvitakura.

L'oligoamnios

L'oligoamnios ndiyo inonyanya kuzivikanwa amniotic fluid abnormality (pakati pe0,4 ne4% yenhumbu). Uku kusakwana kweamniotic fluid (isingasviki 250 ml) kunogona kuonekwa panguva dzakasiyana panguva yekuzvitakura uye kukonzera matambudziko akanyanya kana mashoma zvichienderana nedanho rekukura kwe fetus. Njodzi dzinowanzoitika:

• Pulmonary hypoplasia (kumisa kukura kwemapapu) kugadzira, pakuzvarwa, kutadza kufema,
• anomalies of the musculoskeletal system (Potter sequence), mwana asati azvarwa asingakwanisi kufamba muchibereko.
• Kutsemuka nguva isati yakwana yemembrane yakaomeswa nehutachiona hweamai-fetal uye nokudaro njodzi yakawedzera yekusununguka nguva isati yakwana, kuiswa kwebara kana kuberekwa nechikamu chekuvhiya.

Mabviro ayo: zvakasiyana-siyana fetal zvinokonzera (renal kana weti hurongwa malformation, chromosomal anomaly), amai (gestational chirwere cheshuga, CMV utachiona, etc.) kana placental chirwere (kuwedzerwa-kuisira chirwere, murombo vascularization pamusoro appendages, etc.). Kutungamirirwa kwe oligoamnios kunobva kwaenderana nezvikonzero zvayo zvikuru.

L'hydramnios

L 'hydramnios inotsanangura kuwandisa kweamniotic fluid inodarika 1 kusvika ku2 litres. Iyi inomaly inogona kutora nzira mbiri:

• chisingaperi chinononoka kutanga hydramnios inowanzoitika mukati mechikamu chechitatu chekuzvitakura uye inobvumirwa zvakanaka.
• iyo acute hydramnios, inokurumidza kuisa inonyanya kuonekwa muchikamu chechipiri chekudzivirira. Inoperekedzwa nezviratidzo zvechipatara zvinowanzove zvisingabvumirwi: kurwadziwa kwechibereko, kuoma kwekufema, kuputika, nezvimwewo. Kashoma, zvaizoitika mu1 / 1500 kusvika ku1 / 6000 pamuviri.

 Uku kusajairika muhuwandu hweamniotic fluid kunogona zvakare kuve nezvikonzero zvakasiyana. Kana iri yekuzvarwa kwaamai, hydramnios inogona kunge yakakonzerwa negestational chirwere cheshuga, pre-eclampsia, utachiona (CMV, parvovirus B19, toxoplasmosis) kana Rh kusawirirana pakati paamai nemwana. Asi hydramnios inogonawo kutsanangurwa neanemia kana kumwe kukanganisa kwepakati tsinga kana digestive system yefetus.

Uye kufanana neoligoamnios, hydramnios inopa imwe nhamba yengozi yezvinetso: kusununguka nguva isati yasvika, kuputika kusati kwapera kwe membrane, kuratidzwa kwemwana ari mubeche, cord procidence, rutivi rwaamai; kumwe kukanganisa muvana, izvo zvinosiyana zvichienderana nekuoma kweiyo pathology.

Tichifunga nezvekusiyana-siyana kwezvikonzero uye njodzi kune amai nemwana, kutarisira kunoongororwa pane imwe nyaya-ne-nyaya.

• Kana ichibva kuchirwere chinorapika muchibereko kana mushure mekuzvarwa (anemia, nezvimwewo), hydramnios inyaya yekurapa kwakananga kweiyo pathology yakataurwa.
• Symptomatic management inogona zvakare kukurudzirwa mune zvimwe zviitiko. Chiremba anobva asarudza kurapwa kwakavakirwa pa anti-prostaglandin kuderedza kuyerera kwe "fetus diuresis" kana kubudisa mapunctures kuderedza njodzi dzekuzvarwa nguva isati yakwana.
• Muzviitiko zvakakomba zvikuru (anamnios), kubviswa kwechiremba kwepamuviri kunogona kufungwa mushure mekukurukurirana nevabereki.

Amniotic fluid inoumbwa nema membranes maviri, amnion nechoriyoni, izvo zvinoumba uterine cavity. Padzinoputika, dzinogona kukonzera mvura kuyerera. Tinobva tataura nezvekutsemuka kwemembrane kana kuti kazhinji kacho kuputika kwehomwe yemvura.

• Kutsemuka kwemembrane panguva yenguva chiratidzo chekuzvara kwemwana. Kurapa chete nemishonga inorwisa mabhakitiriya kudzivirira mwana kubva kune utachiona hunogona kukurudzirwa kana marwadzo asina kutanga mukati memaawa gumi nemaviri ekuputika, uye kupinza kunorongwa mukati memaawa makumi maviri nemana kusvika ku12 pasina kusununguka kwekusununguka.
• Kutsemuka kwemembranes kunoitika nguva isati yakwana inonzi nguva isati yakwana. Chinangwa che manejimendi chiri nyore: kunonoka zvakanyanya sezvinobvira kuendesa nguva isati yakwana kuti isvike zvinokwana 37 WA. Kutevera kunosanganisira kuiswa muchipatara kusvika pakuzvara kwemwana kuitira kuti zviitwe nguva nenguva kuongororwa (infectious assessment, ultrasound, cardiac monitoring), kurapa kwemishonga inorwisa mabhakitiriya kudzivirira utachiona hunogona kuitika hwe fetus, pamwe nekurapa kwecorticosteroid-based kukurumidza kukura kwemapapu (asati 30 WA. ) yemwana asati azvarwa. Cherechedza, zvisinei: kuputika kwemembrane pamberi pemavhiki makumi maviri nemaviri kunowanzoisa chirevo chakakosha che fetus panjodzi.