"Musangano" wekutanga nemwana, yekutanga trimester ultrasound inomirira nemwoyo wose nevabereki venguva yemberi. Iyo inonziwo kufambidzana ultrasound, yakakoshawo kudzivirira.

Yekutanga pamuviri ultrasound inoitika pakati pe11 WA uye 13 WA + 6 mazuva. Hazvisi zvekumanikidzira asi ndeimwe ye3 ultrasounds yakarongeka yakapiwa kuna amai vane pamuviri uye inokurudzirwa zvikuru (HAS mazano) (1).

Yekutanga trimester ultrasound inowanzoitwa kuburikidza nemudumbu nzira. Murapi anopfekedza dumbu raamai-ava-ave nemvura ine gelled kuitira kuti avandudze kunaka kwemufananidzo, ozofambisa probe padumbu. Zvizhinji kashoma uye kana zvichidikanwa kuti uwane kuongororwa kwemhando, nzira yevaginal inogona kushandiswa.

Ultrasound haidi kuti uve nedundira rakazara. Kuongororwa hakuna marwadzo uye kushandiswa kwe ultrasound kwakachengeteka kune fetus. Zvinokurudzirwa kuti usaisa kirimu padumbu pazuva re ultrasound sezvo izvi zvinogona kukanganisa kutapurirwa kwe ultrasound.

Chimwe chezvinangwa zveiyi yekutanga ultrasound ndeyekuongorora nguva yekuzvitakura uye nekudaro zuva rekubata pamuviri zvakanyatsonaka kupfuura kuverenga kunoenderana nezuva rekutanga kwekupedzisira nguva. Nokuda kweizvi, mushandi anoita biometry. Inoyera cranio-caudial kureba (CRL), kureva kureba pakati pemusoro nemagadziko eembryo, yobva yaenzanisa mhedzisiro nereferensi curve yakagadzwa zvinoenderana neRobinson formula (gestational age = 8,052 √ × (LCC) ) +23,73).

Chiyero ichi chinoita kuti zvikwanise kufungidzira zuva rekutanga kubata pamuviri (DDG) nekururama kwekuwedzera kana kubvisa mazuva mashanu mu95% yezviitiko (2). Iyi DDG inozobatsirawo kusimbisa kana kugadzirisa zuva rakakodzera (APD).

Panguva ino yekuzvitakura, chibereko hachina kunyanya kukura, asi mukati, embryo yakatogadzirwa zvakanaka. Inoyera pakati pemasendimita mashanu kusvika matanhatu kubva kumusoro kusvika kumagaro, kana kuti inosvika masendimita gumi nemaviri yakamira, uye musoro wayo unokwana masendimita maviri pakufara (5).

Iyi yekutanga ultrasound ine chinangwa chekutarisa akati wandei ma paramita:

• nhamba yemafetus. Kana iri pamuviri pemapatya, murapi anozoona kuti imimba yemapatya ari monochorial (placenta imwe yemafetus) kana bichorial (placenta imwe pafetus imwe neimwe). Kuongororwa kwechorionicity kunokosha zvikuru nokuti kunotungamirira kune zvakasiyana-siyana maererano nezvinetso uye naizvozvo nzira dzekudzivirira pamuviri;
• simba re "fetus": panguva ino yenhumbu, mwana ari kufamba asi amai vanozoberekwa havasati vazvinzwa. Anozunungusa, asingadi, ruoko negumbo, anotambanudza, anomonerera kuita bhora, kamwe kamwe anozorora, anosvetuka. Kurova kwemoyo wake, nekukurumidza (160 kusvika 170 kurova / miniti), inogona kunzwika pane doppler ultrasound.
• morphology: murapi achaita kuti kuvepo kwemakumbo mana ese, dumbu, dundira, uye achatarisa cephalic contours uye ayo emadziro emimba. Nekune rimwe divi, zvichiri zvakawandisa kuti utarise zvingangoita morphological malformation. Ichava yechipiri ultrasound, inonzi morphological, kuzviita;
• kuwanda kweamniotic fluid uye kuvapo kwetrophoblast;
• nuchal translucency (CN) kuyerwa: sechikamu chekuongorora kwakabatanidzwa kweDown's syndrome (kwete zvekumanikidzira asi zvakarongwa), murapi anoyera nuchal translucency, ngonono inozadzwa nemvura kuseri kwegoro rechibereko. Yakasanganiswa nemigumisiro ye serum marker assay (PAPP-A uye yemahara beta-hCG) uye zera reamai, chiyero ichi chinoita kuti zvikwanise kuverenga "ngozi yakasanganiswa" (uye kwete kuita kuongororwa) kwechromosomal abnormalities.

Nezvebonde remucheche, panguva iyi tubercle yesikarudzi, kureva chimiro chinozova nhengo yeramangwana kana kuti clitoris yeramangwana, haisati yasarudzwa uye inongoyera 1 kusvika 2 mm. Izvo zvinogoneka, kana mucheche akamira zvakanaka, kana iyo ultrasound ikaitika mushure memavhiki gumi nemaviri uye kana murapi aine ruzivo, kuti aone bonde remucheche zvinoenderana nekutarisa kweiyo genital tubercle. Kana iri perpendicular kune axis yemuviri, mukomana; kana zvakafanana, musikana. Asi chenjera: kufanotaura uku kune muganho wekukanganisa. Pasi pemamiriro ezvinhu akanaka, inongova 12% yakavimbika (80). Vanachiremba saka kazhinji vanosarudza kumirira yechipiri ultrasound kuitira kuti vazivise bonde remwana kuvabereki venguva yemberi, kana vachida kuzviziva.

• kubuda pamuviri : "embryo sac" iripo asi hapana kushanda kwemoyo uye zviyero zve "embryo" zvakaderera pane zvakajairika. Dzimwe nguva i "zai rakajeka": gestational sac ine membrane uye ramangwana placenta, asi hapana embryo. Nhumbu yakabva yapera uye embryo haina kukura. Muchiitiko chekubvisa pamuviri, gestational sac inogona kubuda pakarepo, asi dzimwe nguva haisi kana kuti isina kukwana. Mishonga inobva yatemerwa kuti ikonzerese macontractions uye kukurudzira kuzara kwe "embryo". Muchiitiko chekukundikana, kurapwa kwekuvhiya nechishuwo (curettage) kuchaitwa. Muzviitiko zvese, kutarisisa kwepedyo kunofanirwa kuve nechokwadi chekubuda kwakazara kwechigadzirwa chekuzvitakura;
• ectopic nhumbu (GEU) kana ectopic: zai harina kuisa muchibereko asi muproboscis nekuda kwekutama kana kuisirwa kusagadzikana. GEU inowanzo ratidza kukurumidza kufambira mberi nekurwadziwa kwepazasi mudumbu uye kubuda ropa, asi dzimwe nguva zvinoonekwa sezvinei panguva yekutanga ultrasound. GEU inogona kufambira mberi kusvika pakudzingwa, kumira kana kukura, ine ngozi yekuputika kwegestational sac iyo inogona kukuvadza chubhu. Kuongorora nekuongororwa kweropa kuyedza iyo beta-hcg mahormone, kuongororwa kwekiriniki uye ultrasound kunoita kuti zvikwanise kutarisa kushanduka kweGEU. Kana isiri padanho repamusoro, kurapwa ne methotrexate kunowanzo kukwana kukonzera kudzingwa kwegestational sac. Kana yakakwira, chirwere chekuvhiya ne laparoscopy chinoitwa kuti chibvise gestational sac, uye dzimwe nguva tube kana yakakuvadzwa;
• zviri nani pane zvakajairika nuchal translucency inowanzoonekwa muvacheche vane trisomy 21, asi chiyero ichi chinofanira kuiswa mukuongororwa kwakasanganiswa kwetrisomy 21 tichitarisa zera raamai uye serum markers. Muchiitiko chekupedzisira chakabatanidzwa chikuru kupfuura 1/250, zvinozokurudzirwa kumisa karyotype, netrophoblast biopsy kana amniocentesis.