Aia nā ʻano like ʻole e hōʻoia ai i ka hāpai ʻana: ʻo ka hoʻāʻo ʻana i ka hāpai ʻana o ka mimi, i loaʻa ma ke kūʻai aku ma nā hale kūʻai lāʻau lapaʻau, nā hale kūʻai lāʻau lapaʻau a me nā hale kūʻai kūʻai, a me ka hoʻāʻo ʻana i ke koko hāpai ʻana i hana ʻia ma ka hale hana. Ke alo nei me kahi hoʻokolohua lapaʻau e hoʻāla ana i kahi kānalua e pili ana i ka hāpai ʻana a i ʻole ka hōʻike ʻana i kahi hōʻailona hōʻailona, ​​​​hiki i ke kauka ke kuhikuhi i kahi serum dosage o hCG, a laila e uku hou ʻia.

Hoʻokumu ʻia kēia hōʻike hilinaʻi ma ka ʻike ʻana i ka hormone hCG i loko o ke koko. Hoʻopiliʻia kēia "hormone hāpai" e ka hua i ka wā i hoʻokomoʻia ai, i ka wā e pili ai i ka paia o ka'ōpū. No nā mahina 3, mālama ka hCG i ka corpus luteum e hoʻoikaika, kahi ʻili liʻiliʻi e hūnā i ka estrogen a me ka progesterone, pono no ka hoʻomohala kūpono o ka hāpai ʻana. Hoʻopālua ka pae o ka hCG i kēlā me kēia 48 hola i nā pule mua o ka hāpai ʻana a hiki i kona kiʻekiʻe ma kahi o ka ʻumi pule o ka amenorrhea (10 WA a i ʻole 12 pule o ka hāpai ʻana). A laila e emi koke a hiki i kahi pāpū ma waena o 16 a me 32 AWS.

Hāʻawi ka serum hCG assay i ʻelua mau hōʻailona: ke ola o ka hāpai ʻana a me kona holomua maikaʻi e like me ka quantitative evolution o ka pae. Ma ke ano o ka manao:

• ʻelua mau laʻana a € i kekahi mau lā kaʻawale e hōʻike ana i ka piʻi ʻana o nā pae hCG e hōʻike ana i kahi hāpai holomua holomua.
• ʻO ka hāʻule ʻana o nā pae hCG hiki ke hōʻike i ka hopena o ka hāpai ʻana (ka hāʻule ʻole).
• ʻO ka piʻi ʻole ʻana o nā pae hCG (pālua, hāʻule, piʻi aʻe) he hōʻailona paha ia o kahi hāpai ectopic (GEU). ʻO ka plasma hCG assay ka hōʻike kumu no GEU. Ma ka waiwai ʻoki ʻia o 1 mIU / ml, ʻo ka ʻike ʻole ʻana o kahi ʻeke intrauterine ma ka ultrasound e hōʻike ikaika ana iā GEU. Ma lalo o kēia paepae, ʻaʻole ʻike nui ka ultrasound, ʻo ka hana hou ʻana o nā assays ma hope o ka lohi o 500 mau hola i loko o ka hale hana like e hiki ai ke hoʻohālikelike i nā uku. ʻO ka stagnation a i ʻole ka nawaliwali o ka piʻi ʻana e hoʻāla i ka GEU me ka ʻole o ka hōʻoia ʻana. Eia nō naʻe, ʻaʻole hoʻopau kona holomua maʻamau (pālua o ka helu i nā hola 48) i ka GEU (48).

Ma ka ʻaoʻao ʻē aʻe, ʻaʻole ʻae ka pae o ka hCG i ka pili pono ʻana o ka hāpai ʻana. ʻO ka mea i kapa ʻia ʻo ultrasound dating (ke ultrasound mua ma 12 pule) hiki ke hana i kēia. Pēlā nō, ʻoiai ʻoi aku ka kiʻekiʻe o ka hCG i nā hāpai he nui, ʻaʻole kahi kiʻekiʻe kiʻekiʻe o ka hCG he hōʻailona hilinaʻi o ka hiki ʻana o kahi hāpai māhoe (2).

I ka wā o ke kūkākūkā hāpai mua (ma mua o 10 mau pule), pono e kuhikuhi ʻia nā hoʻokolohua koko:

• ka hoʻoholo ʻana o ka hui koko a me Rhesus (ABO; Rhesus a me Kell phenotypes). I ka loaʻa ʻole o kahi kāleka hui koko, pono e lawe ʻia ʻelua mau laʻana.
• ka ʻimi ʻana no Irregular Agglutinins (RAI) i mea e ʻike ai i kahi kūpono ʻole ma waena o ka makuahine e hiki mai ana a me ka pēpē. Inā maikaʻi ka noiʻi, pono ka ʻike a me ka titration o nā antibodies.
• ka nānā ʻana no ka syphilis a i ʻole TPHA-VDLR. Inā maikaʻi ka hoʻāʻo ʻana, ʻo ka lāʻau lapaʻau i hoʻokumu ʻia i ka penicillin e pale i nā hopena i ka pēpē.
• ka nānā ʻana no ka rubella a me ka toxoplasmosis me ka loaʻa ʻole o nā palapala i kākau ʻia e ʻae ʻia ka pale ʻana e lawe ʻia (5). I ka hopena o ka serology maikaʻi ʻole, e hana ʻia ka serology toxoplasmosis i kēlā me kēia mahina o ka hāpai ʻana. I ka hihia o ka rubella serology, e hana ʻia ka serology i kēlā me kēia mahina a hiki i 18 mau pule.

Hāʻawi ʻia nā hoʻokolohua koko ʻē aʻe; ʻAʻole koi ʻia lākou akā paipai ikaika ʻia:

• ʻO ka hoʻāʻo HIV 1 a me 2
• ka ho'āʻoʻana o nā hōʻailona serum (ka pae o ka protein PAPP-A a me ka hormone hCG) ma waena o 8 a me 14 mau pule. Hoʻopili ʻia me ka makahiki o ka mea maʻi a me ke ana ʻana o ka nuchal translucency o ka pēpē i ka ultrasound hapai mua (ma waena o 11 a me 13 WA + 6 mau lā), hiki i kēia dosage ke loiloi i ka hopena o Down's syndrome. ʻoi aku ka nui a i ʻole like me 21/1, e noi ʻia kahi amniocentesis a i ʻole choriocentesis i mea e loiloi ai i ka karyotype fetal. I Farani, ʻaʻole koi ʻia ka nānā ʻana i ka maʻi maʻi Down. E hoʻomanaʻo, aia kahi hōʻike hoʻāʻo hou no ka trisomy 250: ʻike ia i ka DNA o ka pēpē e holo ana i loko o ke koko makuahine. Ke hōʻoia ʻia nei ka hana o kēia hoʻokolohua me ka manaʻo i ka hoʻololi ʻana o ka hoʻolālā screening no trisomy 21 (21).

I kekahi mau hihia, hiki ke kuhikuhi ʻia nā hoʻokolohua koko ʻē aʻe:

• ka nānā ʻana no ka anemia inā loaʻa nā kumu pilikia (ka ʻai ʻole i ka meaʻai, ka meaʻai meaʻai a i ʻole ka meaʻai vegan)

E kauoha ʻia nā hoʻāʻo koko ʻē aʻe i ka wā hāpai:

• ka hoʻāʻo ʻana no ka antigen BHs, hōʻike i ka maʻi hepatitis B, i ka mahina 6 o ka hāpai ʻana
• he helu koko e nānā ai i ka anemia i ka mahina 6 o ka hāpai ʻana

Inā hoʻolālā ka makuahine e hānau ma lalo o kahi epidural a ʻaʻole paha, pono ke kūkākūkā pre-anesthesia. ʻO ka mea nui, e kuhikuhi ka anesthesiologist i kahi hoʻāʻo koko e ʻike ai i nā pilikia coagulation.