La ukuhlinzwa komntwana e-INPer Sekuyithuluzi elibalulekile lokushintsha ukubikezela kwezingane ezinezinkinga noma izifo ezinkulu zokuzalwa ngaphambi kokuzalwa. Emakamelweni okuhlinzwa alesi sikhungo sikahulumeni saseMexico, kwenziwa izinqubo eziyinkimbinkimbi ngaphakathi kwesibeletho sikamama kusetshenziswa amasu angangenisi kakhulu, aklanyelwe ukunciphisa izingozi nokuthuthukisa ikhwalithi yempilo yesikhathi esizayo yezinsana ezisanda kuzalwa.
Lo modeli, ohlanganisa ukuxilongwa kwangaphambi kokubeletha, ukungenelela kwangaphakathi kwesibeletho kanye nokulandelela okuqhubekayo, ibeke iNational Institute of Perinatology “Isidro Espinosa de los Reyes” njengesikhungo sikazwelonke sokubhekisela endleleni yokukhulelwa okuyingozi kakhulu, ikakhulukazi ukukhulelwa kwamawele okubangela ukukhulelwa. Babelana nge-placenta futhi kuveze izinkinga ezinkulu.
Kuyini ukuhlinzwa kombungu e-INPer futhi kuziphi izimo lapho kubhekwa khona?
Ukuhlinzwa kombungu okwenziwe e-INPer kuhlanganisa izinqubo zokuhlinzwa ezithuthukisiwe ngesikhathi sokukhulelwa Lezi zinqubo zihloselwe ukwelapha izimo ezisongela ukuphila embungwini noma izimo ezingaholela ezinkingeni ezinkulu zempilo zesikhathi eside ngemva kokuzalwa. Umgomo awukona nje kuphela ukuthi ingane izalwe iphila, kodwa futhi nokunciphisa ukukhubazeka kwesikhathi eside.
Ngokusho kochwepheshe bezokwelapha komama nomntwana kulesi sikhungo, lokhu kungenelela kukhonjiswa ikakhulukazi ku- ukukhubazeka kokuzalwa, izifo ezinkulu ze-fetus, kanye nezinkinga ezithile zokukhulelwa okuningiKulesi simo, ukukhulelwa kwamawele abelana nge-placenta eyodwa kuthatha indawo ebalulekile ohlelweni ngenxa yezinga eliphezulu lezinkinga zawo.
EMexico, idatha ephethwe yi-INPer ikhombisa ukuthi Ukukhulelwa okukodwa kwabangu-90 kuwukukhulelwa kwamaweleKulezi, cishe ama-30% ahilela imibungu ehlanganyela i-placenta. Lesi sici, esaziwa ngokuthi i-shared chorionicity, sandisa kakhulu ingozi yezifo eziyinkimbinkimbi ezisongela ukusinda komntwana oyedwa noma bobabili.
Phakathi kwezifo eziphathwa ngokuhlinzwa kwengane, okulandelayo kuyaphawuleka: I-Twin-to-twin transfusion syndrome (TTTS)Ukuvinjelwa kokukhula okukhethayo kanye nalokho okubizwa ngokuthi amawele e-acardiac, izimo lapho ukushintshana kwegazi noma ukukhula okungalingani phakathi kwezinsana kungabangela ukuvela okusheshayo kakhulu futhi okungaba yingozi uma kungekho sinyathelo esithathwayo ngesikhathi.
Ukuxilongwa kusenesikhathi ngaphambi kokukhulelwa kanye nokuqapha ngokucophelela ukukhulelwa
Isisekelo sohlelo Ukuhlinzwa kombungu e-INPer kuyindlela yokuxilonga ehlelekile kakhulu kusenesikhathiIsikhathi esibalulekile siphakathi kwamasonto angu-11 no-13.6 okukhulelwa, isikhathi lapho kwenziwa khona ukuhlolwa kwekota yokuqala, okwaziwa emhlabeni wonke ngokuthi ukuhlolwa kwamasonto angu-12.
Lolu cwaningo luhlanganisa i-ultrasound eningiliziwe kanye nokuhlaziywa kwengozi ye- thola ukukhubazeka kwesakhiwo, izimpawu zofuzo kanye nezici eziyingozi kumamaLokhu kuhlola kuvumela ukuhlonza kusenesikhathi ukukhubazeka kombungu, kanye ne-preeclampsia, isifo sikashukela sokukhulelwa, noma ezinye izinkinga ezingase zithinte inkambo yokukhulelwa.
Endabeni ukukhulelwa kwamawele nge-placenta ehlanganyelweI-INPer iqinisa ukuqapha ngokuhlolwa njalo emavikini amabili, ukuhlolwa njalo kwe-ultrasound yesakhiwo, izifundo ze-Doppler kanye nokuhlolwa okuhlose ukuqapha ingozi yokuzalwa ngaphambi kwesikhathi kanye nezinguquko ezisheshayo ekukhuleni noma ekujikelezeni kwegazi phakathi kwabantwana bobabili.
Ochwepheshe kulesi sikhungo bagcizelela ukuthi Izinkinga eziningi zikhula ngokusheshaNgakho-ke, ithuba lokungenelela lilinganiselwe. Ngakho-ke, ukudluliselwa kusenesikhathi ezikhungweni ezinolwazi kwezokwelapha umbungu kanye nokuhlinzwa okungangenisi kakhulu kuyisici esibalulekile sokuphatha lokhu kukhulelwa.
Le ndlela ihambisana nezincomo zemiphakathi yesayensi efana ne- I-International Society of Ultrasound ku-Obstetrics and Gynecology, okugqamisa umthelela wokuhlolwa kwekota yokuqala yokukhulelwa ekunciphiseni ukufa nokukhubazeka okuhambisana nokukhubazeka kokuzalwa kanye nezinkinga ze-placenta.
Amazinga empumelelo: kusukela engozini enkulu kuya ekusindeni
Idatha ephethwe amaqembu e-INPer ikhombisa ukuthi, lapho ukungenelela kombungu kungenziwa ezimweni ezinzima kakhuluAmathuba okufa komntwana oyedwa noma bobabili angadlula u-90%. Lesi simo sibonakala kakhulu ezinkingeni ezinkulu zokukhulelwa kwamawele nge-placenta ehlanganyelwe.
Njengoba kunikezwe lesi simo, ukuhlinzwa kombungu kubhekwa njengenqubo yokuhlinzwa. ithuluzi lokwelapha elinembile kakhuluEnye yezinqubo ezivelele kakhulu i-placental laser photocoagulation, inqubo esetshenziswa ekwelapheni i-Twin-to-Twin Transfusion Syndrome eye yashintsha kakhulu isimo sokukhulelwa okuningi.
Ngale ndlela, ochwepheshe be-INPer babonisa ukuthi cishe cishe Ezimweni ezingama-85%, okungenani eyodwa yezingane ezisanda kuzalwa iyasinda.Futhi ukuthi phakathi kuka-65% no-70% wokukhulelwa kuholela ekuzalweni kwezingane zombili. Lezi zibalo zihambisana nemiphumela yezikhungo zokubhekisela zamazwe ngamazwe futhi zinikeza umbono womthelela wangempela walezi zindlela zokungenelela.
Emhlabeni jikelele, kulinganiselwa ukuthi phakathi kuka-10% no-15% wokukhulelwa kwamawele nge-placenta ehlanganyelwe Bangathuthukisa i-TTTS. Ngaphandle kokwelashwa okufanele, ukufa kwangaphambi kokubeletha kungasukela ku-80% kuya ku-100%. Yingakho-ke intshisekelo yokwandisa lezi zinhlobo zamasu ezinhlelweni zezempilo zomphakathi ukuze kuncishiswe kokubili ukufa kanye nokukhubazeka okukhulu ebuntwaneni.
Emtholampilo wansuku zonke we-INPer, le miphumela iqinise ukuzibophezela ku- ukutholwa kusenesikhathi, ukuqapha okuhlelekile, kanye nokuhlinzwa okungadingi ukungenelela okuningi njengezinsika zokunikeza ithuba langempela lokusinda ekukhulelweni, eminyakeni embalwa edlule, okwakunezinketho ezimbalwa kakhulu.
Uhlelo olunemikhakha eminingi lokuhlinzwa kombungu okungangenisi kakhulu
Uhlelo lwe Ukuhlinzwa Kwengane Engenasibeletho e-INPer kwaqala ukusebenza ngo-2022 Kusukela ngaleso sikhathi, selaphe iziguli ezingaphezu kuka-120. Akukhona nje ukuba namagumbi okuhlinzwa nemishini yobuchwepheshe, kodwa mayelana nokuhlanganisa ithimba elikhethekile kakhulu elihlanganisa icala ngalinye kusukela ekuxilongweni kuya ekulandeleni kosana olusanda kuzalwa.
Lolu hlelo luhilela ochwepheshe bezokwelapha komama nosana, odokotela bezinzwa bezingane, odokotela benhliziyo bezingane ezisanda kuzalwa, kanye nochwepheshe bezokubelethisa kanye nezifo zabesifazane ngokuqeqeshwa ekuhlinzeni okuthuthukisiwe kwe-laparoscopic. Ukubambisana okuseduze phakathi kwalezi zindawo kuvumela ukuhlela ukungenelela okuyinkimbinkimbi kanye nokusabela ezinkingeni ezingaba khona ngesikhathi senqubo.
Ikhathalogi yamasu enziwe e-INPer ifaka phakathi ukumpontshelwa igazi ngaphakathi kwesibeletho, ukufakwa kwama-catheter e-fetus, ukwelashwa kwama-hernias e-diaphragmatic kanye nokungenelela okuhlukahlukene ku-placenta noma ku- intambo yombilical ukuqinisa ukujikeleza kwegazi lomntwana osanda kuzalwa.
Esinye isici esiphawulekayo salolu hlelo ukuthi i-Institute isizisungule njenge Isikhungo kuphela eMexico esilungisa amaphutha e-neural tube sisebenzisa i-fetoscopy engangenisi kakhuluLolu khetho lumelela ushintsho olukhulu ekuhlinzeni okuvulekile kwengane okujwayelekile, okudinga ukusikwa okukhulu esibelethweni.
Nge-fetoscopy, ukungenelela kwenziwa ngokusebenzisa izimbobo ezincane odongeni lwesisu kanye ne-uterineYilapho kufakwa khona amakhamera nezinsimbi zokuhlinzwa ezincane. Le ndlela ihlose ukunciphisa ukulimala komama nosana, ukunciphisa ingozi yokubeletha ngaphambi kwesikhathi, kanye nokulondoloza kangcono isibeletho ukuze silungele ukukhulelwa kwesikhathi esizayo.
Ukulungiswa kwezinkinga ze-neural tube: inqubo ehlukile
Phakathi kokukhubazeka okuxazululwe ukuhlinzwa kombungu e-INPer, okulandelayo kuvelele: izinkinga ze-neural tube, njenge-myelomeningocele noma i-spina bifida, izifo ezingabangela ukukhubazeka kwamalungu, izinkinga zokulawula i-sphincter kanye nezinye izinkinga ezibalulekile zezinzwa.
Besebenzisa inqubo ye-fetoscopic esetshenziswa esikhungweni, odokotela abahlinzayo Zivala ukulimala emhlane wombungu ngaphakathi kwesibelethongaphandle kwesidingo sokukhishwa kwengxenye noma ukususwa kwesisu okubanzi. Le ndlela ihlose ukuvikela izakhiwo zemizwa ngaphambi kokuzalwa nokunciphisa umonakalo oqhubekayo owenzeka ngenkathi ingane isesemanzini e-amniotic.
Ochwepheshe bamazwe ngamazwe kwezokwelapha umbungu bayavuma ukuthi Ukwelapha i-myelomeningocele ngesikhathi sokukhulelwa kungathuthukisa ukuhamba futhi kunciphisa amathuba okukhubazeka okukhulu. Nakuba kungaqedi ngokuphelele yonke imiphumela engemihle, kunikeza ingane ithuba elikhulu lokuhamba noma ukuzimela kakhudlwana esikhathini esizayo.
Ukwamukelwa kwalezi zindlela ezingangenisi kakhulu ezikhungweni zomphakathi njenge-INPer kuyingxenye yomkhuba womhlaba wonke, ikakhulukazi oqhutshwa yi- eYurophu nase-United States, lapho kubhalwe khona ukwehla kwezinkinga zikamama uma kuqhathaniswa nokuhlinzwa okuvulekile kanye nokulondolozwa okungcono kobuqotho besibeletho.
Ngokugwema izibazi ezinkulu esibelethweni, ingozi Ukuqhekeka kwesibeletho kuyingozi ekukhulelweni kwesikhathi esizayo, futhi ezimweni eziningi, amathuba okubeletha kwesitho sangasese sowesifazane ahlala ekhona.Le nkinga, engase ibonakale ingeyasemuva, ihlobene nokuhlela ukuzala kwabesifazane abahlinzwa umbungu.
Umthelela wamazwe ngamazwe kanye nokufana neYurophu
Nakuba uhlelo lwe-INPer Fetal Surgery luse-Mexico, Indlela kanye nemiphumela kuhambisana nokuhlangenwe nakho kwezikhungo eziphambili zaseYurophu. kwezokwelapha komama nosana. Emazweni anjengeSpain, iBelgium, iFrance noma i-United Kingdom, amayunithi akhethekile abonise ukubaluleka kokuhlinzwa ngaphakathi kwesibeletho ekunciphiseni ukufa nokukhubazeka okuhambisana nokukhubazeka kokuzalwa.
Intuthuko ku i-microfetoscopy, enezinsimbi ezingaphansi kwamamilimitha amabili ububanziLokhu kuthuthuka kuye kwavumela ukwelashwa okunembe kakhulu ngaphandle kokulimala okuncane kumama. Lokhu kuye kwasiza ekuthuthukisweni kokuhlinzwa kombungu kusuka kokukhetha okulinganiselwe kakhulu kuya ethuluzini elihlanganiswe nezinqubo ezithile zokuphatha ukukhulelwa ezinobungozi obukhulu.
Ngesikhathi esifanayo, izinhlangano zomhlaba wonke kanye nemiphakathi yesayensi zigcizelela ukuthi ukunikeza lawa masu ngaphakathi kwezinhlelo zezempilo zomphakathi Kuyisihluthulelo sokunciphisa ukungalingani ekufinyeleleni ekwelashweni okuyinkimbinkimbi kakhulu. Akukhona nje ukuvimbela ukufa, kodwa nokunciphisa umthwalo wokukhubazeka kwabantwana okuhambisana nezimo ezingavamile, okuthi uma kwelashwa ngesikhathi, kungaba nomphumela ohlukile.
Okuhlangenwe nakho kwe-INPer kuyahambisana nalesi simo somhlaba wonke, ukuhlanganisa ukuhlinzwa kombungu okungangenisi kakhulu emodeli yokunakekelwa okuphelele kokubelethaNakuba uhlelo ngalunye lwezempilo lunezici zalo, izifundo ezitholiwe ziyathakazelisa amaqembu aseYurophu afuna ukuqinisa ukubambisana phakathi kokuxilongwa kokukhulelwa, ukungenelela ngaphakathi kwesibeletho kanye nokunakekelwa kwezinsana.
Esimeni lapho Ingane eyodwa kwezingu-33 izalwa ine-anomaly yokuzalwa nayo.Ngokusho kwezilinganiso zomhlaba wonke, amathuba okungenelela esibelethweni anezela ungqimba olwengeziwe lwezinketho zokwelapha, lapho zihlelwe kahle, ezinganciphisa kakhulu imiphumela yesikhathi eside. Funda kabanzi mayelana isifo senhliziyo sokuzalwa kanye nomthelela wayo.
Ukunakekelwa okuphelele nokukhululekile: kusukela ekuxilongweni kuya ekuthuthukisweni kwezinzwa
Enye yezinsika zemodeli ye-INPer ukuthi ukuhlinzwa komntwana akucatshangwa njengesenzo esizimelekodwa njengengxenye yendlela yokunakekelwa eqala ngokuhlolwa kwenyanga yokuqala bese iqhubeka ngemva kokuzalwa komntwana.
Lo mzila uhlanganisa ukuxilongwa ngaphambi kokubeletha, ukungenelela kombungu uma kuboniswe, ukunakekelwa okukhethekile kwezingane ezisanda kuzalwa kanye nokuqapha ukuthuthukiswa kwezinzwa zezingane ezihlinzwe. Lokhu kulandelela isikhathi eside kuvumela ukuhlolwa kwentuthuko yezokwelapha, ukuhlonza izidingo zokuvuselelwa, kanye nokulungiswa kohlelo lokunakekelwa esimweni ngasinye.
Lesi sikhungo siphinde sagcizelela ukuthi Ukunakekelwa okunikezwayo kule ndawo kumahhala.Lokhu kwandisa ukufinyelela emindenini ebingakuthola kunzima kakhulu ukukhokhela izinqubo eziyinkimbinkimbi kakhulu kanye nokulandelela okulandelayo.
Empeleni, le ndlela ebanzi ibeka i-INPer njenge- isikhungo sokubhekisela sokukhulelwa okuyingozi kakhulu kanye nokukhubazeka kokuzalwa, kokubili kochwepheshe bezempilo abadlulisela amacala kanye neziguli ezifuna ukuhlolwa okukhethekile ngesikhathi sokukhulelwa.
Kumaqembu ezokwelapha aqeqeshwayo, uhlelo luphinde lunikeze indawo yokufunda kwezokwelapha umbungu, ukuhlinzwa okungangenisi kakhulu kanye nokuxhumana kwemikhakha eminingi, izindawo ezintathu ezibumba ukuthuthuka kokunakekelwa okuthuthukisiwe kwangaphambi kokubeletha emazweni amaningi.
Okuhlangenwe nakho okuqoqwe nge Ukuhlinzwa kombungu e-INPer kukhombisa ukuthi inhlanganisela yokuxilongwa kwasekuqaleni, ubuchwepheshe obungenazo izithiyo eziningi kanye nokusebenza ngokubambisana Kungaguqula ukubikezela kokukhulelwa okuyinkimbinkimbi kakhulu. Esimweni samazwe ngamazwe lapho imithi yokubeletha iqhubekela phambili kumamodeli ahlanganisiwe, lolu hlobo lohlelo lomphakathi luqinisa umqondo wokuthi ukusindisa impilo yengane ngaphambi kokuzalwa nokunciphisa izinkinga zesikhathi esizayo kuwumgomo ofinyelelekayo lapho kuhlanganiswa ubuchwepheshe, ukuqapha okuqhubekayo, kanye nokufinyelela ngokulinganayo ekwelashweni.
