Kune vabereki remangwana, kufungidzira fetus uremu pane ultrasound inokutendera iwe kufungidzira uyu akamirirwa kwenguva refu mwana zvishoma zvirinani. Kune timu yekurapa, iyi data yakakosha mukugadzirisa nhumbu yekutevera, nzira yekusununguka uye kuchengetwa kwemwana pakuzvarwa.

Izvo hazvigoneke kuyera iyo fetus mu utero. Saka zviri kuburikidza ne biometric, ndiko kuti kuyerwa kwe "fetus" pa ultrasound Izvi zvinoitwa panguva yechipiri ultrasound (inenge 22 WA) uye yechitatu ultrasound (inenge 32 WA).

Murapi achayera zvikamu zvakasiyana zvemuviri wechi "fetus":

• iyo cephalic perimeter (PC kana HC muChirungu);
• iyo bi-parietal dhayamita (BIP);
• mudumbu mudenderedzwa (PA kana AC muchiRungu);
• kureba kwemukadzi (LF kana FL muChirungu).

Iyi biometric data, inoratidzwa mumamirimita, inozopinzwa muchimiro chemasvomhu kuti itore fungidziro yehuremu hwe "fetus" mumagiramu. Iyo fetal ultrasound muchina inoita iyi kuverenga.

Kune angangoita makumi maviri ekuverenga mafomula asi muFrance, iwo eHadlock ndiwo anonyanya kushandiswa. Pane misiyano yakati wandei, iine matatu kana mana ebiometric parameter:

• Log10 EPF = 1.326 - 0.00326 (AC) (FL) + 0.0107 (HC) + 0.0438 (AC) + 0.158 (FL)
• Log10 EPF = 1.3596 + 0.0064 PC + 0.0424 PA + 0.174 LF + 0.00061 BIP PA - 0.00386 PA LF

Mhedzisiro yacho inoratidzirwa pane iyo ultrasound mushumo ine zvakataurwa "EPF", ye "Kufungidzira kwehuremu hwe" fetus ".

Nekudaro, mhedzisiro yakawanikwa inoramba iri fungidziro. Mazhinji mafomula akagoneswa ezviremera zvekuzvarwa zve2 kusvika 500 g, nemuganho wekukanganisa uchienzaniswa nehuremu chaihwo hwekuzvarwa kubva pa4 kusvika ku000% (6,4), nekuda kwechikamu kune kunaka uye kunyatsoita kwekucheka zvirongwa. Ongororo dzinoverengeka dzakaratidzawo kuti kune huremu hwevacheche vacheche (isingasviki 10,7 g) kana vana vahombe (vanopfuura 1 g), muganho wekukanganisa waive wakakura kupfuura 2%, uine tsika yekufungisisa vana. yehuremu hushoma uye pane zvinopesana kushora vashoma vacheche.

Mhedzisiro yacho inofananidzwa ne "fetal" weight ratings curves yakagadzwa neFrench College yeFetal Ultrasound (3). Chinangwa ndechekuongorora fetus kubva pane zvakajairwa, iri pakati pe10 ° uye 90 ° percentile. Iko kufungidzira kwehuremu hwe "fetus" zvinoita kuti zvikwanise kuona izvi zviviri zvakanyanyisa:

• hypotrophy, kana huremu hwakaderera hwezera rekubata (PAG), ndiko kuti uremu hwe "fetus" pazasi pegumi muzana maererano nezera rekubata rakapihwa kana huremu huri pasi pe10 g panguva. Iyi PAT inogona kuve mhedzisiro yehunamai kana hwehutachiona hutachiona kana hwehutachiona hwepamuviri;
• macrosomia, kana "mwana muhombe", ndokuti mwana anehuremu hunorema kupfuura 90th percentile yeiyo nguva yakapihwa yekubata kana kunyange aine huremu hwekuzvarwa hunopfuura 4 g. Uku kuongorora kwakakosha mune yechiitiko cheshuga cheshuga kana chirwere cheshuga chisati chavepo.

Iyi miviri miviri yakanyanyisa mamiriro ezvinhu ane njodzi kumwana asati aberekwa, asiwo kuna amai mune chiitiko chemacrosomia (yakawedzera njodzi yechikamu chekusiya, kubuda ropa panguva yekusununguka kunyanya).

Kukosheswa kwehuremu hwe "fetus" data rakakosha kuchinjisa kuteedzerwa kwekuguma kwemimba, kufambira mberi kwekusununguka asiwo kutarisirwa kwechecheche.

Kana pane yechitatu ultrasound fungidziro yehuremu hwe fetus iri pasi pane zvakajairwa, inotevera-up ultrasound ichaitwa mukati memwedzi wechi8 kutarisa kukura kwemwana. Kana zvikaitika kutyisidzirwa kwekuzvarwa nguva isati yakwana (PAD), kuomarara kwekuzvarwa kusati kwasvika kunofungidzirwa maererano neshoko asiwo kuhuremu hwemucheche. Kana huremu hwekufungidzirwa hwekuzvarwa hwakanyanya kuderera, timu yekuzvarwa inoisa zvese munzvimbo yekutarisira mwana asati azvarwa kubva pakuzvarwa.

Kuongororwa kwemacrosomia kuchachinja zvakare manejimendi yekunonoka kubata pamuviri uye kubereka. Yekutevera-up ultrasound ichaitwa mukati memwedzi wechi8 wepamuviri kuitira kuti uwane fungidziro itsva yehuremu hwe "fetus". Kuti kuderedze njodzi yepafudzi dystocia, brachial plexus kukuvara uye neonatal asphyxia, yakawedzera zvakanyanya mu macrosomia - ne5% yemwana anorema pakati pe4 kusvika 000 g uye 4% yemucheche anopfuura 500 g (30) - induction kana yakatarwa chikamu chesaarean inogona kupihwa. Nekudaro, zvinoenderana nezvakakurudzirwa neHaute Autorité de Santé (4):

• mukushayikwa kwechirwere cheshuga, macrosomia pachayo haisi chiratidzo chehurongwa hwechikamu chakarongwa chekusiya;
• chikamu chakarongwa chekuregedza chinokurudzirwa kana paine huwandu hunofungidzirwa hwe "fetus" hwakakura kana kuti hwakaenzana ne5 g;
• nekuda kwekusava nechokwadi kwekufungidzira kwehuremu hwe "fetus", pakufungira macrosomia pakati pe4 g uye 500 g, chikamu chakarongwa chekusiya chinofanira kukurukurwa pane kesi-ne-kesi hwaro;
• muhupo hwechirwere cheshuga, chikamu chakarongwa chekuregedza chinokurudzirwa kana huremu hwe "fetus" hunofungidzirwa kunge hukuru kana kuti hwakaenzana ne4 g;
• nekuda kwekusava nechokwadi kwekufungidzira kwehuremu hwe "fetus", pamusoro pekufungidzirwa kwemacrosomia pakati pe4 g kusvika 250 g, chikamu chakarongwa chekuregedza chinofanira kukurukurwa pane imwe nyaya-ne-kesi hwaro, uchifunga nezvezvimwe zvinodiwa zvine chekuita nehurwere uye mamiriro ekuvhiringidza;
• fungidziro ye macrosomia haisi pachayo chiratidzo chakarongeka chechikamu chakarongwa chekuregedza muchiitiko chechibereko chakazvimba;
• Kana macrosomia inofungidzirwa uye nhoroondo yepafudzi dystocia yakaoma nekukwirisa kweiyo brachial plexus, chikamu chakarongwa chekusiya chinokurudzirwa.

Kana nzira yakaderera ikaedzwa, timu yekusununguka inofanirwa kunge izere (nyamukuta, chiremba wekubereka, anesthesiologist uye chiremba wevana) panguva yekusununguka inofungidzirwa panjodzi mune macrosomia.

Muchiitiko chekuburitswa kwemhepo, fungidziro yehuremu hwe "fetus" inoonekwawo pakusarudza pakati pekuyedza nzira yemunhukadzi kana chikamu chakarongwa chekuregedza. Kurema kwe "fetus" kunofungidzirwa pakati pe 2 kusvika 500 gramu chikamu chemitemo inogamuchirwa yemunzira yemukadzi yakagadzwa neCNGOF (3). Kupfuura izvozvo, cesarean anogona saka kukurudzirwa.