ʻO ka "hui" mua me ka pēpē, ke kali ʻia nei ka ultrasound trimester mua e nā mākua e hiki mai ana. Kāhea ʻia hoʻi ka ultrasound dating, he mea nui hoʻi ia ma ka obstetrically.

Hana ʻia ka ultrasound hāpai mua ma waena o 11 WA a me 13 WA + 6 lā. ʻAʻole koi ʻia akā ʻo ia kekahi o nā 3 ultrasounds systematically i hāʻawi ʻia i nā makuahine e manaʻo nei a mahalo nui ʻia (HAS manaʻo) (1).

Hana ʻia ka ultrasound mua trimester ma ke ala ʻōpū. Hoʻopili ka mea hoʻomaʻamaʻa i ka ʻōpū o ka makuahine me ka wai gelled i mea e hoʻomaikaʻi ai i ka maikaʻi o ke kiʻi, a laila hoʻoneʻe i ka ʻimi ma ka ʻōpū. Kakaʻikahi a inā pono no ka loaʻa ʻana o kahi ʻimi maikaʻi, hiki ke hoʻohana ʻia ke ala vaginal.

ʻAʻole koi ʻo Ultrasound iā ʻoe e loaʻa i ka ʻōpū piha. ʻAʻole ʻeha ka nānā ʻana a palekana ka hoʻohana ʻana i ka ultrasound no ka pēpē. ʻAʻole pono e kau i ka ʻaila ma ka ʻōpū i ka lā o ka ultrasound no ka mea hiki ke hoʻopilikia i ka lawe ʻana o ka ultrasound.

ʻO kekahi o nā pahuhopu o kēia ultrasound mua, ʻo ia ka loiloi ʻana i ka makahiki hānau a no laila ʻoi aku ka pololei o ka lā o ka hāpai ʻana ma mua o ka helu ʻana ma muli o ka lā o ka hoʻomaka ʻana o ka manawa hope. No kēia, hana ke kauka i kahi biometry. Ana i ka cranio-caudial lōʻihi (CRL), ʻo ia hoʻi ka lōʻihi ma waena o ke poʻo a me nā ʻāʻī o ka ʻōpū, a laila hoʻohālikelike i ka hopena me kahi pihi kuhikuhi i hoʻokumu ʻia e like me ka formula Robinson (gestational age = 8,052 √ × (LCC). ) +23,73).

Hiki i kēia ana ke koho i ka lā o ka hoʻomaka ʻana o ka hāpai ʻana (DDG) me ka pololei o ka hoʻohui a i ʻole ʻelima mau lā ma 95% o nā hihia (2). E kōkua ana kēia DDG i ka hōʻoia a hoʻoponopono ʻana i ka lā kau (APD).

I kēia wā o ka hāpai ʻana, ʻaʻole nui loa ka ʻōpū, akā i loko, ua ulu maikaʻi ka embryo. Aia ma waena o 5 a 6 knm mai ke po'o a hiki i ka piko, a i 'ole ma kahi o 12 knm ke ku ana, a 'o kona po'o he 2 knm ke anawaena (3).

Ke manaʻo nei kēia ultrasound mua e nānā i nā ʻāpana ʻē aʻe:

• ka helu o na keiki. Inā he ʻōpū māhoe, e hoʻoholo ke kauka inā he hapai māhoe monochorial (kahi placenta no nā keiki ʻelua) a i ʻole he bichorial (hoʻokahi placenta no kēlā me kēia pēpē). He mea koʻikoʻi kēia hōʻailona o ka chorionicity no ka mea e alakaʻi i nā ʻokoʻa kaulana i nā ʻano o nā pilikia a no laila ke ʻano o ka hahai ʻana i ka hāpai ʻana;
• ke ola o ka ʻōpū: i kēia wā o ka hāpai ʻana, ke neʻe nei ka pēpē akā ʻaʻole i manaʻo ka makuahine. Nalu ʻo ia, me ka manaʻo ʻole, ka lima a me ka wāwae, kikoo, curls i loko o ka pōpō, hoʻomaha koke, lele. Hiki ke lohe ʻia kona puʻuwai puʻuwai, wikiwiki loa (160 a 170 beats / minute), ma kahi ultrasound doppler.
• morphology: e hōʻoia ke kauka i ka hele ʻana o nā lālā ʻehā a pau, ka ʻōpū, ka ʻōpū, a nānā i nā contours cephalic a me nā mea o ka paia o ka ʻōpū. Ma ka ʻaoʻao ʻē aʻe, ʻoi aku ka nui o ka ʻike ʻana i kahi hemahema morphological. ʻO ia ka lua o ka ultrasound, i kapa ʻia ʻo morphological, e hana ia;
• ka nui o ka wai amniotic a me ke alo o ka trophoblast;
• ana nuchal translucency (CN): ma ke ʻano he ʻāpana o ka nānā ʻana i ka maʻi o Down (ʻaʻole i koi ʻia akā hāʻawi ʻia ma ka ʻōnaehana), e ana ke kauka i ka translucency nuchal, kahi snore maikaʻi i hoʻopiha ʻia me ka wai ma hope o ka ʻāʻī o ka pēpē. Hoʻohui ʻia me nā hopena o ka serum marker assay (PAPP-A a me ka beta-hCG manuahi) a me ka makahiki makuahine, hiki i kēia ana ke helu i kahi "pilikia hui" (a ʻaʻole e hana i kahi hōʻailona) o nā abnormalities chromosomal.

E pili ana i ke kāne o ka pēpē, i kēia wā ʻo ka tubercle genital, ʻo ia hoʻi ke ʻano e lilo ai i ka penis e hiki mai ana a i ʻole ka clitoris e hiki mai ana, ʻaʻole i hoʻokaʻawale ʻia a he 1 a 2 mm wale nō. Hiki nō naʻe, inā maikaʻi ke kūlana o ka pēpē, inā e hana ʻia ka ultrasound ma hope o 12 pule a inā loaʻa ka ʻike o ke kauka, e hoʻoholo i ke ʻano o ka pēpē e like me ke ʻano o ka tubercle genital. Inā kū pololei i ke koʻi o ke kino, he keikikāne; ina ua like, he kaikamahine. Akā e makaʻala: loaʻa i kēia wanana kahi kuhi hewa. Ma lalo o nā kūlana maikaʻi loa, ʻo 80% wale nō ka hilinaʻi (4). No laila makemake nui nā kauka e kali no ka ultrasound ʻelua i mea e hoʻolaha ai i ke kāne o ka pēpē i nā mākua e hiki mai ana, inā makemake lākou e ʻike.

• he hāpai keiki ʻana : aia ka ʻeke embryo akā ʻaʻohe hana puʻuwai a ʻoi aku ka haʻahaʻa o nā ana o ka embryo ma mua o ka maʻamau. I kekahi manawa he "hua moa": aia i loko o ka ʻeke hānai nā membrane a me ka placenta e hiki mai ana, akā ʻaʻohe embryo. Ua pau ka hāpai ʻana a ʻaʻole i ulu ka embryo. I ka wā o ka hāʻule ʻole ʻana, hiki i ka ʻeke hāpai ke haʻalele wale, akā i kekahi manawa ʻaʻole a piha ʻole paha. A laila kauoha ʻia nā lāʻau lapaʻau e hoʻoulu i ka hoʻopaʻa ʻana a hoʻoikaika i ka wehe piha ʻana o ka embryo. Inā hāʻule, e hoʻokō ʻia ka lāʻau lapaʻau e ka aspiration (curettage). I nā hihia a pau, pono ka nānā pono ʻana e hōʻoia i ka haʻalele piha ʻana o ka huahana o ka hāpai ʻana;
• kahi hāpai hāpai ectopic (GEU) a i ʻole ectopic: ʻaʻole i hoʻokomo ʻia ka hua manu i loko o ka ʻōpū akā i loko o ka proboscis ma muli o ka neʻe ʻana a i ʻole ka maʻi implantation. Hōʻike maʻamau ʻo GEU i ka wā mua me ka ʻeha o ka ʻōpū haʻahaʻa a me ke koko, akā i kekahi manawa ʻike ʻia i ka wā o ka ultrasound mua. Hiki i ka GEU ke holomua a hiki i ka hoʻokuke ʻana, stagnation a i ʻole ka ulu ʻana, me ka pilikia o ka naha ʻana o ka ʻeke hānai e hiki ke hōʻino i ka paipu. ʻO ka nānā ʻana me nā hoʻāʻo koko e hoʻāʻo i ka hormone beta-hcg, nā hoʻokolohua lapaʻau a me nā ultrasounds hiki ke nānā i ka ulu ʻana o GEU. Inā ʻaʻole ma kahi pae kiʻekiʻe, lawa ka mālama ʻana me ka methotrexate i mea e hoʻokuke ʻia ai ka ʻeke hānai. Inā ʻoi aku ka lōʻihi, hana ʻia ka lapaʻau ʻokiʻoki no ka wehe ʻana i ka ʻeke hānai, a i kekahi manawa ka paipu inā ua poino;
• ʻoi aku ka maikaʻi ma mua o ka translucency nuchal maʻamau ʻIke pinepine ʻia i nā pēpē me ka trisomy 21, akā pono e hoʻokomo ʻia kēia ana i ka nānā ʻana i hui pū ʻia no ka trisomy 21 e noʻonoʻo ana i ka makahiki makuahine a me nā hōʻailona serum. I ka hopena o ka hopena hopena i hui pū ʻia ma mua o 1/250, e manaʻo ʻia e hoʻokumu i kahi karyotype, e ka biopsy trophoblast a i ʻole amniocentesis.