Maererano nedudziro yeWHO, kuberekwa kwakafa “kufa kwechigadzirwa chepamuviri apo rufu urwu rwakaitika pamberi pekudzingwa kana kubviswa kwakakwana kwemuviri waamai, zvisinei nehurefu hwenhumbu. Rufu runoratidzwa ?? nenyaya yekuti mushure mekuparadzaniswa uku, "fetus" haifeme kana kuratidza chero chimwe chiratidzo chehupenyu senge kurova kwemoyo, kupuruzira tambo yembilical kana kubata kunoshanda kwetsandanyama kunoitwa nekuda kwechido ". IWHO yakatsanangurawo chikumbaridzo chekuita: masvondo makumi maviri nemaviri e amenorrhea (WA) akapedzwa kana huremu hwe22 g. Isu tinotaura nezvekufa kwechibereko muchibereko (MFIU) apo rufu rwunoonekwaÌ ?? kusati kwatanga kwebasa, zvinopesana nerufu rweparpartum, rwunoitika semhedzisiro yerufu panguva yebasa.

Iine kuberekwa kwe9,2 kwevana vasina hupenyu pakuberekwa 1000, France ndiyo ine mwero wepamusoro wekubereka muEurope, inoratidza chirevo cheEuropean nezvehutano hwepamoyo EURO-PERISTAT ya2013 (1). Mukuburitswa kwepepanhau (2) zvine chekuita nemhedzisiro iyi, Inserm inotsanangura, zvisinei, kuti uyu murume akakwirira anogona kutsanangurwa nenyaya yekuti makumi mana kusvika makumi mashanu muzana ekuberekwa kwakafa muFrance kunokonzerwa nekumiswa kwekubata nhumbu (IMG), izvi nekuda kwe a "inoshingairira mutemo wekutarisa kweakaberekwa anomalies uye neinononoka tsika yeIMG". Kubva pamasvondo makumi maviri nemaviri, feticide iri kuitiswa pamberi peIMG kuitira kudzivirira kutambudzika kwechibereko. Saka IMG inotungamira mukuzvarwa kwemwana "akafa".

Iyo RHEOP (Rejista Yevakaremara kweVana uye Perinatal Observatory) (3), iyo inoronga kuberekwa kwevakafa muIsère, Savoie neHaute-Savoie, yegore ra2011 inoshuma chiyero chekuzvarwa kwe7,3, 3,4 ‰, kusanganisira 3,9 ‰ Yekuzvarwa patsva (MFIU) uye XNUMX ‰ yekukonzera kuberekwa (IMG).

Kuti uyedze kutsanangura chinokonzera kufa kwechibereko muchibereko, kuongororwa kunoitwa nenzira. Inosanganisira zvirinani (4):

• histological kuongororwa kwepascenta;
• chitunha che "fetus" (mushure mekubvumirwa nemurwere);
• Kleihauer bvunzo (kuongororwa kweropa kuyera huwandu hwesero redumbu remucheche rinowanikwa pakati pemasero matsvuku eropa amai);
• kutsvaga kwemaqugutinins asina kujairika;
• serologies yaamai (parvovirus B19, toxoplasmosis);
• cervico-kusangana nekutsi kwemukadzi uye placental hutachiona swabs;
• kutsvaga antiphospholipid antibody syndrome, systemic lupus, mhando 1 kana 2 chirwere cheshuga, dysthyroidism.

Zvinonyanya kukonzera MFIU ndezvi:

• vasculo-placental anomaly: retro-placental hematoma, toxemia, pre-eclampsia, eclampsia, HELLP syndrome, foeto-maternal hemorrhage, placenta previa uye zvimwe zvakashata zvekuiswa kweplacenta;
• chirwere chemaappendage: tambo (tambo yekutsvagisa, tambo yakakomberedza mutsipa, banga, kuiswa kwakanaka, ndiko kuti tambo yakaiswa pane membreni uye kwete iyo placenta), amniotic fluid (oligoamnios, hydramnios, kuputika kwembambo);
• bumbiro remitemo fetal anomaly: kuberekwa kusakwana, autoimmune hydrops edema (generalized edema), kuwedzerwa-kuwedzerwa chirwere chirwere, zvadarika;
• intrauterine kukura kunonoka;
• chikonzero chinotapukira: chorioamniotic, cytomegalovirus, toxoplasmosis;
• chirwere chemadzimai: pre-iripo isina kugadzikana chirwere cheshuga, chirwere chetachiona, chakakosha arterial hypertension, lupus, cholestasis yekuzvitakura, kushandiswa kwezvinodhaka, hutachiona hutachiona (nhoroondo yekubvaruka kwechibereko, kusagadzikana, septum uterine), antiphospholipid syndrome;
• kushungurudzika kwekunze panguva yekuzvitakura;
• kushaya mweya kana kushungurudzika panguva yekusununguka.

Mune 46% yematambudziko, kufa kwe fetus kunoramba kusingatsanangurike, zvisinei, inotsanangura iyo RHEOP (5).

Mushure mekuongororwa kwekufa kwemucheche muchibereko, kurapwa kwemishonga kunoendeswa kuna amai-vanozove kuitira kukurudzira basa. Kudzingwa kwemucheche nenzira yemadzimai kunogara kuchisarudzirwa kuchikamu chekusiyiwa.

Tsigiro yepfungwa iripowo yekubatsira vaviri vacho kuti vapfuure nekushungurudzika kwekufirwa kweparinatal. Rutsigiro urwu rwunotanga nekukurumidza kana rufu rwemwana rwaziviswa, kusanganisira nesarudzo yemazwi. Vabereki vanopihwa kubvunzurudzwa nanyamukuta anoongorora kufirwa nemwana wepamoyo kana chiremba wepfungwa. Vanoda here kuona mwana, kumutakura, kumupfekedza, kana kusamupa zita? Zviri kuvabereki kuti vatore sarudzo idzi dzinova chikamu chakakosha chehurongwa hwavo hwekuchema. Vaviri ava vanewo mazuva gumi mushure mekuzvarwa kusarudza kupa mwana wavo mariro nekuviga, kana kuendesa mutumbi kuchipatara kuti vapise.

Kuchema kwePerinatal kuchema kwevamwe: kweiye munhu asina kurarama, kunze kwedumbu raamai vake. Zvinoenderana neongororo yeAmerica (6), njodzi yekushungurudzika mushure memwana akazvarwa akafa inogona kuramba ichisvika kumakore matatu mushure mekuzvara. Psychological yekutevera saka inokurudzirwa, sekutora rutsigiro kubva kumapoka ekutsigira nemasangano.

Pfungwa ye "mwana akazvarwa asina hupenyu" yakaonekwa kekutanga mumutemo weFrance muna 1993. Kubva ipapo, mutemo wakashanduka kakawanda. Pamberi pechirevo n ° 2008-800 yaAugust 20, 2008, chete fetus anopfuura masvondo makumi maviri nemaviri aivapo maererano nehukama hwevanhu. Kubva ikozvino zvichienda mberi, gwaro rekuzvarwa rinogona kuendeswa. pamberi pe22 SA (asi kazhinji mushure me22 SA) pachikumbiro chevabereki. Mushure medu izwi, rinobva raburitswa.

Chitupa ichi chinoita kuti zvigone kumisikidza "chiito chemwana neÌ ?? vasina hupenyu ”izvo zvinopa vabereki mukana, kana vachida, kupa mumwe kana maviri mazita ekutanga kumwana wavo uye kuti aiswe mubhuku rekodhi remhuri, kana kumisikidza rimwe kana vasina rimwe. kwete izvozvi. Kune rimwe divi, hapana zita remhuri kana chinongedzo chekubatanidza chinogona kupihwa kune uyu mwana akazvarwa akafa; saka haisi munhu wepamutemo. Nechiratidzo, zvakadaro, chirevo ichi chinoratidza nhanho kumberi yekucherechedzwa kwevana vakazvarwa semunhu, uye nekudaro kwekuchema nekutambura kwakavakomberedza. Izvo zvakare kune vaviri vacho kuziva chimiro chavo che "mubereki".

Muchiitiko chekuzvara pamberi pemasvondo makumi maviri nemaviri, mukadzi haakwanise kubatsirwa nezororo rekubereka. Chiremba anokwanisa, zvisinei, kumupa basa rekumira kumupa kodzero yekuripwa kubva kuInishuwarenzi yehutano.

Mune chiitiko chekubereka mushure memasvondo makumi maviri nemaviri, mukadzi anobatsirwa nezororo rakazara rekubereka. Iyi nhumbu inozotarisirwawo nechengetedzo yemagariro kana uchiverenga nguva inotevera yekuzorora.

Ivo baba vanozokwanisa kubatsirwa kubva kuzuva rega rega paternity zororo, pakuratidzira kopi yechiito chemwana asina hupenyu uye chezvechiremba chitupa chekusununguka kwemwana akazvarwa akafa uye anogona.

Vabereki vanogona kubatsirwa kubva kubhonasi yekuzvarwa (zvichienderana nezviwanikwa) chete kana kupera kwemimba kuchiitika kubva pazuva rekutanga remwedzi unotevera mwedzi wechi1 wepamuviri. Izvo zvino zvinodikanwa kuburitsa humbowo hwepamuviri pazuva iri.

Panyaya yemitero, zvinogamuchirwa kuti vana vaive vachiri vakazvarwa mukati megore remutero uye ndiani akabereka nzvimbo aÌ € kugadzwa kwechiito chemwana mudiki ?? isina hupenyu anoshandiswa kuona huwandu hweyuniti.