Kune nzira dzakasiyana dzekusimbisa pamuviri: iyo weti pamuviri bvunzo, inowanikwa pamusoro pakaunda muma pharmacy, zvitoro zvemishonga uye masupamaketi, uye bvunzo yemimba yeropa inoitwa murabhoritari. Kutarisana nekuongororwa kwekliniki kunokonzera kusava nechokwadi pamusoro pepamuviri kana kupa chiratidzo chenyevero, chiremba anogona kupa serum dosage yehCG, iyo inobva yadzorerwa.

Uyu muedzo wakavimbika unobva pakuonekwa kwehomoni hCG muropa. Iyi "hormone yepamuviri" inovanzwa nezai pakarepo painosimwa, painonamatira kumadziro echibereko. Kwemwedzi mitatu, hCG ichaita kuti corpus luteum irambe ichishanda, gland duku iyo inozobudisa estrogen uye progesterone, inokosha pakukura kwakakodzera kwepamuviri. Chiyero chehCG chinopeta kaviri maawa makumi mana nemasere ega ega mumavhiki ekutanga ekuzvitakura kuti asvike pakukwirira kwayo kutenderedza vhiki yegumi yeamenorrhea (3 WA kana mavhiki gumi nemaviri ekuzvitakura). Inobva yadzikira nekukurumidza kusvika pabani pakati pe48 ne10 AWS.

Serum hCG assay inopa zviratidzo zviviri: kuvapo kwepamuviri uye kufambira mberi kwayo kwakanaka maererano nehuwandu hwekuchinja kwehuwandu. Schematically:

• masampuli maviri aÌ € mazuva mashoma akaparadzana anoratidza kuwedzera hCG mazinga anopupurira kune inonzi nhumbu inofambira mberi.
• kudonha kwemazinga ehCG kunogona kuratidza kupera kwepamuviri (kubvisa pamuviri).
• kufambira mberi kusingadzorwi kwemazinga eHCG (kupeta kaviri, kudonha, kusimuka) kunogona kuva chiratidzo che ectopic pregnancy (GEU). Iyo plasma hCG assay ndiyo yekutanga bvunzo yeGEU. Pakuchekwa-chekwa kukosha kwe1 mIU/ml, kusaonekwa kwe intrauterine sac paultrasound kunoratidza zvakasimba GEU. Pazasi pechikumbaridzo ichi, iyo ultrasound isinganyatso kudzidzisa, kudzokorora kweassays mushure mekunonoka kwemaawa 500 murabhoritari imwechete inobvumira kuenzaniswa kwemitengo. Kumira kana kusasimba kufambira mberi kwechiyero kunomutsa GEU pasina zvakadaro kuisimbisa. Nekudaro, kufambira mberi kwayo kwakaringana (kupeta kaviri kweyero pamaawa e48) hakubvisi GEU (48).

Kune rumwe rutivi, chiyero cheHCG hachibvumiri kufambidzana kwakavimbika kwepamuviri. Izvo chete izvo zvinonzi kufambidzana ultrasound (yekutanga ultrasound pamasvondo gumi nemaviri) inobvumira izvi kuti zviitwe. Saizvozvowo, nepo chiyero cheHCG chinowanzokwirira mumimba yakawanda, chiyero chepamusoro chehCG hachisi chiratidzo chakavimbika chekuvapo kwepamuviri mapatya (12).

Panguva yekutanga kubvunzana kwepamuviri (masvondo gumi asati asvika), kuongororwa ropa kunosungirwa 10 zvakatemwa:

• kutsunga kweboka reropa uye Rhesus (ABO; Rhesus naKell phenotypes). Kana pasina kadhi reboka reropa, sampuli mbiri dzinofanira kutorwa.
• kutsvaga kweIrregular Agglutinins (RAI) kuitira kuona kusawirirana kunobvira pakati peamai vemangwana uye fetus. Kana tsvagiridzo iri yakanaka, kuzivikanwa uye kupihwa mazita emasoja ekudzivirira chirwere anosungirwa.
• kuongorora syphilis kana TPHA-VDLR. Kana bvunzo iri yakanaka, mushonga wepenicillin unodzivirira mhedzisiro pafetus.
• kuongororwa kwerubella uye toxoplasmosis mukushayikwa kwemagwaro akanyorwa achibvumira kudzivirirwa kutorwa pasina (5). Muchiitiko cheyakaipa serology, toxoplasmosis serology ichaitwa mwedzi wega wega wekuzvitakura. Kana iri negative rubella serology, serology ichaitwa mwedzi wega wega kusvika mavhiki gumi nemasere.

Kumwe kuongorora ropa kunopihwa zvakarongeka; hazvisi zvekumanikidzwa asi zvinokurudzirwa zvakasimba:

• Kuongororwa HIV 1 uye 2
• kuongororwa kwemaserum markers (level yePAPP-A protein uye hCG hormone) pakati pemasvondo masere negumi nemana. Yakabatana nezera remurwere uye kuyerwa kwehuchal translucency ye "fetus" pamimba yekutanga ultrasound (pakati pe8 ne14 WA + mazuva matanhatu), iyi dosi inoita kuti zvikwanise kuongorora njodzi yeDown's syndrome. yakakura kudarika kana yakaenzana ne 11/13, amniocentesis kana choriocentesis ichataurwa kuitira kuongorora fetal karyotype. MuFrance, kuongororwa kweDown's syndrome hakusungirwe. Ziva kuti bvunzo nyowani yetrisomy 6 iripo: inoongorora DNA yefetus iri kutenderera muropa raamai. Kuita kwebvunzo iyi parizvino kuri kusimbiswa netarisiro yekugadziridzwa kweiyo yekuongorora nzira yetrisomy 21 (1).

Mune zvimwe zviitiko, kumwe kuongorora ropa kunogona kurongerwa:

• kuongororwa kweanemia kana paine zvinhu zvine njodzi (kusakwana kwekudya kudya, miriwo kana vegan kudya)

Kumwe kuongororwa ropa kucharairwa panguva yekuzvitakura:

• kuongororwa kweBHs antigen, uchapupu hwehepatitis B, mumwedzi wechitanhatu wemimba
• kuverengwa kweropa kutarisa anemia mumwedzi wechitanhatu wenhumbu

Zvingave kana kuti kwete mai-ku-va-anoronga kuzvara pasi pe epidural, kubvunza kwe-pre-anesthesia kunosungirwa. Kunyanya, anesthesiologist anonyora kuongororwa ropa kuti aone zvinogona kuitika coagulation matambudziko.