I ka wā hāpai, ulu ka pēpē i loko o ka lua a ʻauʻau i ka wai amniotic. Hoʻokumu ʻia me 96% wai, ʻo kēia wai e hoʻololi mau nei i loko o nā electrolytes, nā mea mineral (sodium, potassium, calcium, trace elements, etc.), amino acids, akā pū kekahi me nā pūnae fetal.

Hōʻike koke ʻia nā ʻāpana mua o ka wai amniotic ma hope o ka hoʻoulu ʻana me ka hoʻokumu ʻana o ka lua amniotic i ka lā 7. I loko o nā pule mua o ka hāpai ʻana, ua hūnā ʻia ka wai e ka embryo ponoʻī e kahi hanana o ka hoʻonui extracellular (i kapa ʻia ʻo extravasation). ʻO kahi hapa liʻiliʻi o ka wai i hūnā ʻia e ka makuahine ma o ka neʻe ʻana o ka wai mai ka chorionic villi e kū nei i ka placenta e hiki mai ana. Eia nō naʻe, ma waena o 20 a 25 mau pule, lilo ka ʻili o ka pēpē i impermeable (keratinization process). No laila, ʻo ka nui o ka wai amniotic e hōʻoiaʻiʻo ʻia e ke kaulike ma waena o ka mea i hoʻokuʻu ʻia e ka fetus (hana) a me ka mea e ʻai ai i loko o ka ʻōpū.

• Hoʻokuʻu wai hana nui ʻia ma o ʻelua mau ala:

  - Le systema mimi fetal a ʻoi aku ka nui o ka diuresis i hoʻonohonoho ʻia ma kahi o 12-13 WA. Ma hope o 20 mau pule, lilo ia i kumu nui o ka hana ʻana o ka wai amniotic a hiki i 800 a 1200 ml / 24 mau hola i ka hopena o ka hāpai ʻana (kūʻē i ka 110 ml / kg / d a hiki i 190 ml / kg / d ma 25 mau pule).

  - ka wai māmā, huna ʻia mai 18 mau pule, hiki i ka 200 a 300 ml / 24h ma ka hopena o ka hāpai ʻana.

• ʻO ka hanana reabsorption Hiki i ka wai amniotic ma muli o ka ʻai ʻana o ka pēpē e hiki mai ana. ʻOiaʻiʻo, ʻai ka fetus i kahi hapa nui o ka wai amniotic, a pēlā e hele ai i loko o kāna ʻōnaehana digestive a me kāna ʻōnaehana hanu, ma mua o ka lawe ʻia ʻana i ke kino makuahine a i ka hopena o ka heihei, kānana ʻia e nā puʻupaʻa o ka makuahine e hiki mai ana. .

Mahalo i kēia "chain" o ka hana physiological, hahai ka wai amniotic i kahi pōʻai kūikawā i nā pule o ka hāpai ʻana e hoʻololi i ke kaumaha a me ka ulu ʻana o ka pēpē e hiki mai ana:

• Ma mua o 20 WA, piʻi mālie ka nui o ka wai amniotic i loko o ka lua (mai 20 ml ma 7 WA a 200 ml ma 16 WA),
• Ma waena o 20 mau pule a me 33-34 mau pule, ua stagnates ka nui ma kahi o 980 ml,
• Ma hope o 34 mau pule, emi ka nui o ka wai amniotic, me ka wikiwiki o ka hanana i 39 mau pule, hiki i ka nui o ka wai ma kahi o 800 ml i ka manawa.

  E like me nā wahine, ʻo ka nui o ka wai amniotic ma waena o 250 ml (palena haʻahaʻa) a me 2 lita (palena kiʻekiʻe), no laila ua ʻōlelo ʻia he maʻamau ka hāpai ʻana.

Hiki i ka wai amniotic ke hoʻololi i ka wā hāpai. ʻO ka mea mua a kaulana loa o kāna mau hana: pale i ke keiki hānau ʻole mai ka haʻalulu a me ka walaʻau.

Akā, kōkua pū ka wai amniotic i:

• e hōʻoiaʻiʻo i ka paʻa o ke kaiapuni o ka pēpē, mālama i ka mahana mau a hoʻololi i kona leo i ka ulu ʻana o ka pēpē,
• hopu i nā ʻokoʻa o ka ʻono, ka māmā, ka ʻala a i ʻole ka lohe ʻana, pēlā e paipai ai i ka ulu ʻana o ke keiki i loko o ka ʻōpū.
• hoʻomaʻamaʻa i ka neʻe ʻana o ka fetus a komo i kāna hoʻomohala maikaʻi ʻana i ka muscular a me ka morphological,
• hāʻawi i ka wai a me ka paʻakai mineral e pono ai ka pēpē e hiki mai ana.
• lubricate, i ka wā e haki ai nā membrane, ka ʻāpana genital a pēlā e hoʻomākaukau ai i ke kino no ka hele ʻana o ke keiki.

Akā ʻo ka wai amniotic kekahi mea hōʻailona koʻikoʻi o ke olakino fetal. No laila, ʻo ka hoʻāʻo e loiloi i ka nui o ka wai amniotic he ultrasound. Hiki ke ʻōlelo ʻia kēia inā manaʻo ke kauka he mea ʻino i ke kiʻekiʻe o ka ʻōpū, ka emi ʻana o ka neʻe ʻana o ka fetal a i ʻole ka haki ʻana o nā membrane. Pono paha ka mea kākau sonographer e hoʻohana i nā ʻano hana like ʻole e loiloi i kahi oligoamnios hiki ke hoʻemi ʻia (e emi ana ka nui o ka wai amniotic) a i ʻole hydramnios (ke wai amniotic nui, e ʻike i lalo), ʻo ia hoʻi:

ʻO ke ana ʻana o ka pahu pahu kūwaho nui loa (CGV)

Ua kapa ʻia ʻo Chamberlain's method, ʻo ka hoʻokolokolo ʻana e pili ana i ka ʻimi ultrasound o ka lua amniotic holoʻokoʻa i mea e ʻimi ai i ka waihona wai nui loa (kahi i hoʻopilikia ʻole ʻia me kahi lālā o ka pēpē a i ʻole ke kaula umbilical). ʻO ke ana o kona hohonu e alakaʻi i ka ʻike:

• inā ʻoi aku ka liʻiliʻi ma mua o 3 knm, hōʻike ka hōʻike i ka oligoamnios,
• ina he 3 a 8 knm ke ana, he mea ma'amau,
• inā ʻoi aku ma mua o 8 knm, hiki ke hōʻike i ka hydramnios.

ʻO ke ana amniotic index (ILA).

ʻO kēia hoʻokolohua ʻo ka māhele ʻana i ka umbilicus i 4 quadrants, a laila e ana a hoʻohui i ka hohonu o nā pahu i ʻike ʻia.

• inā ʻoi aku ka liʻiliʻi o 50 mm, ʻoi aku ka nui o ka oligoamnios,
• inā ana ʻo ia ma waena o 50 mm a me 180 mm; ʻO ka nui o ka wai amniotic he mea maʻamau,
• inā ʻoi aku ma mua o 180 mm, pono e noʻonoʻo ʻia kahi hydramnios.

Ma waho aʻe o ka nui o ka wai amniotic, pono paha i ke kauka ke kālailai i nā mea e haku ai, e like me ke ʻano o ka hana ʻana amniocentesis. ʻO ka pahuhopu: e ʻimi i kahi lāʻau infectious inā makemake ʻia ka pōʻaiapili i kahi maʻi fetal a i ʻole ke aʻo ʻana i nā chromosomes o ka pēpē e ʻike ai i nā pathologies o ke kumu genetic (hoʻomaka me ka trisomy 21). ʻO ka ʻoiaʻiʻo, ʻo ka wai amniotic ka nui o nā pūpū fetal i hoʻokuʻu ʻia, ʻo ke ʻano o ka mea i hiki i kona kiʻekiʻe ma waena o 16 a 20 mau pule. ʻO ka mahi ʻana i kēia mau pūnaewele e hiki ai ke hana i kahi karyotype a no laila e loiloi pololei i kekahi mau pilikia o nā mea ʻino chromosomal.

I ka wā o ka hoʻokō prenatal, e nānā pono ke kauka i ka nui o ka wai amniotic ma ke ana ʻana i ke kiʻekiʻe o ka ʻōpū. ʻO ka pahuhopu: e kāpae a mālama paha i ka nui (oligoamnios) a i ʻole ka nui (hydramnios) nui o ka wai amniotic, nā maʻi ʻelua e hiki ke loaʻa i nā hopena koʻikoʻi i nā hopena o ka hāpai ʻana.

L'oligoamnios

L'oligoamnios ʻO ka maʻamau o ka wai amniotic maʻamau (ma waena o 0,4 a me 4% o ka hāpai ʻana). Hiki ke ʻike ʻia kēia hemahema o ka wai amniotic (ma lalo o 250 ml) i nā manawa like ʻole i ka wā o ka hāpai ʻana a hoʻoulu i nā hoʻopiʻi koʻikoʻi a i ʻole ka liʻiliʻi ma muli o ke ʻano o ka ulu ʻana o ka fetus. ʻO nā pilikia pinepine loa:

• ʻO ka pulmonary hypoplasia (hoʻopau i ka ulu ʻana o nā māmā) e hoʻohua ai, i ka hānau ʻana, hāʻule ʻole ka hanu,
• nā anomalies o ka ʻōnaehana musculoskeletal (Potter sequence), hiki ʻole i ke keiki hānau ʻole ke neʻe i loko o ka ʻōpū.
• ʻO ka haki ʻana o nā membrane i paʻakikī e ka maʻi maternal-fetal a no laila ua hoʻonui ʻia ka pilikia o ka hānau mua ʻana, ka hoʻokomo ʻana i ka hana a i ʻole ka hānau ʻana ma ka ʻāpana cesarean.

ʻO kona kumu: nā kumu fetal like ʻole (ka maʻi a i ʻole ka urinary system malformation, chromosomal anomaly), makuahine (gestational diabetes, CMV infection, etc.) a i ʻole kahi placental disorder (transfusion-transfusion syndrome, poor vascularization o nā appendages, etc.). ʻO ka mālama ʻana i ka oligoamnios e pili ana i kāna kumu nui.

L'hydramnios

kahydramnios wehewehe i ka nui o ka wai amniotic ma mua o 1 a 2 lita. Hiki i kēia anomali ke lawe i ʻelua ʻano:

• hydramnios hoʻomaka mālie mau ʻike pinepine ʻia ma kahi o ke kolu o ka trimester o ka hāpai ʻana a ua ʻae maikaʻi ʻia.
• ʻo ka hydramnios acute, wikiwiki e hoʻokomo ʻike nui ʻia i ka lua o ka trimester o ka hāpai ʻana. Hoʻopili pū ʻia me nā hōʻailona maʻi i hoʻomanawanui pinepine ʻia: ʻeha ʻōpū, pilikia hanu, contractions, etc. ʻAʻole hiki ke loaʻa i ka 1/1500 a 1/6000 hāpai.

 Hiki ke loaʻa hou nā kumu like ʻole o kēia abnormality i ka nui o ka wai amniotic. Inā no ka makuahine, ʻo ka hydramnios paha ma muli o ka maʻi diabetes gestational, pre-eclampsia, maʻi (CMV, parvovirus B19, toxoplasmosis) a i ʻole Rh incompatibility ma waena o ka makuahine a me ke keiki. Akā hiki ke wehewehe ʻia nā hydramnios e ka anemia a i ʻole kekahi mau hemahema o ke kikowaena o ka ʻōpū a i ʻole nā ​​​​pūnaewele digestive o ka fetus.

A e like me ka oligoamnios, hāʻawi ka hydramnios i kekahi helu o ka pilikia o nā pilikia: ka hānau mua ʻana, ka haki ʻana o nā membranes, ka hōʻike ʻana o ka pēpē i ka breech, ke kau ʻana o ke kaula, ka ʻaoʻao makuahine; kekahi mau malformations i nā keiki, e like me ke koʻikoʻi o ka pathology.

Ma muli o ka ʻokoʻa o nā kumu a me nā pilikia no ka makuahine a me ke keiki, loiloi ʻia ka mālama ʻana i kēlā me kēia hihia.

• Ke hele mai ia mai kahi maʻi hiki ke hoʻōla ʻia i loko o ka ʻōpū a i ʻole ma hope o ka hānau ʻana (anemia, a me nā mea ʻē aʻe), ʻo ka hydramnios ke kumuhana o kahi lapaʻau kūikawā no ka maʻi maʻi.
• Hiki ke ʻōlelo ʻia ka hoʻokele symptomatic i kekahi mau hihia. A laila koho ke kauka i ka lāʻau lapaʻau e pili ana i nā anti-prostaglandins e hōʻemi i ka diuresis o ka fetal a i ʻole ka haʻalele ʻana i nā puncture e kaupalena i nā pilikia o ka hānau mua ʻana.
• Ma nā hihia koʻikoʻi (anamnios), hiki ke noʻonoʻo ʻia kahi hoʻopau lāʻau o ka hāpai ʻana ma hope o ke kūkākūkā ʻana me nā mākua.

Aia ka wai amniotic i ʻelua mau membrane, ka amnion a me ka chorion, ka mea e hana ai i ka lua opu. Ke naha lākou, hiki ke hoʻokahe ka wai. A laila, kamaʻilio mākou no ka naha ʻana o nā membrane a ʻoi aku ka maʻamau o ka naha ʻana o ka ʻeke wai.

• ʻO ka haki ʻana o nā membrane i ka wā ʻōpiopio he hōʻailona ia o ka hānau ʻana. ʻO ka lāʻau antibiotic wale nō e pale aku i ke keiki mai ka maʻi hiki ke hāʻawi ʻia inā ʻaʻole hoʻomaka ka hana ma loko o 12 mau hola ma hope o ka haki ʻana, a hoʻolālā ʻia ka induction i loko o 24 a 48 mau hola me ka ʻole o nā contractions hana.
• ʻO ka haki ʻana o nā membrane i hana ʻia ma mua o ke kau ʻana i ʻōlelo ʻia he mua. A laila maʻalahi ka pahuhopu o ka hoʻokele: hoʻopaneʻe i ka hiki ke hiki i ka hoʻopuka mua ʻana a hiki i ka 37 WA. ʻO ka hahai ʻana e pili ana i ka hale maʻi a hiki i ka hānau ʻana i mea e hoʻomaʻamaʻa ai i nā loiloi maʻamau (ka loiloi infectious, ultrasound, ka nānā ʻana i ka naʻau), ka lāʻau antibiotic e pale ai i kahi maʻi fetal, a me ka lāʻau corticosteroid-based e hoʻolalelale i ka ulu ʻana o ka māmā (ma mua o 30 WA. ) o ke keiki i hanau ole ia. E hoʻomanaʻo naʻe: ʻo ka haki ʻana o nā membrane ma mua o 22 mau pule e hoʻokau pinepine ai i ka prognosis koʻikoʻi o ka ʻōpū.