Aia kekahi mau ʻano like ʻole o ka hāpai ʻana o ka māhoe ma muli o ke ʻano o ka momona a me ka hoʻokomo o ka hānau. Hoʻomaopopo mākou:

- mau māhoe monozygotic (ma kahi o 20% o nā hānau māhoe) i hopena ʻia mai ka momona o kahi hua hoʻokahi e kahi sperm. I loko o ka pule mua o ka hāpai ʻana, hoʻokaʻawale ka hua manu i ʻelua hapa a laila e hoʻomohala ʻokoʻa. ʻO nā mea genetical o nā fetus ʻelua no laila ʻano like: he māhoe lāua o ka wahine like e nānā like, no laila ke ʻano o nā māhoe like. Ma waena o kēia hāpai ʻōhua monozygous, aia kekahi mau ʻano implantation like ʻole i ka manawa o ka mahele o ka hua manu, e ʻike nei i ka mahele hope ʻana, ʻo ka pili loa o nā embryo e kaʻana like ana i nā annexes hāpai.

• inā kū ka hoʻokaʻawale ma lalo o ʻelua mau lā ma hope o ka hoʻouluulu ʻana, e loaʻa i kēlā me kēia hua manu kāna placenta a me ka ʻeke amniotic. A laila ʻōlelo mākou e pili ana i ka hāpai ʻana o ka māhoe bichorial (ʻelua placentas) a me biamniotic (ʻelua ʻeke amniotic).
• inā kū ka hoʻokaʻawale ma waena o ka lā 3 a me 7, ʻo ka implantation he monochorial (hoʻokahi placenta) a me biamniotic (ʻeke ʻeke amniotic) ʻelua. Mahele like nā māhoe i ka placenta like i hoʻokomo ʻia ai nā kaula ʻelua.
• inā hana ka hoʻokaʻawale ma hope o ka lā 8th, ʻo ka implantation he monochorial (kahi placenta), monoamniotic (kahi ʻeke amniotic).

- nā māhoe dizygotic (80% o nā hānau māhoe) nā hopena mai ka momona o nā hua ʻelua, kēlā me kēia e kahi sperm ʻokoʻa. ʻAʻohe o lākou ʻano no ka nohona like a no laila hiki ke like a like ʻole ka moekolohe. Nānā like lākou e like me ke ʻano like o nā kaikaina a i ʻole nā ​​kaikuahine. Loaʻa iā lākou i kā lākou placenta a me kā lākou ʻeke amniotic, no laila he bichorium a me kahi hāpai hāpai biamniotic. Hiki i ka ultrasound trimester mua ke huai i ka hapai māhoe ma o ka hōʻike ʻana i ʻeke ʻeke hānau ʻelua. Hana ʻo ia i ke kuhi o ka chorionicity (hoʻokahi a ʻelua paha placentas), kahi hōʻailona koʻikoʻi nui no ka mea ke alakaʻi ia i nā ʻokoʻa kaulana e pili ana i nā pilikia a no laila o ka mālama ʻana i nā hāpai.

Manaʻo ʻia ʻo ka māhoe ʻana he hāpai hāpai. Hoʻomaopopo mākou i:

• hoʻonui i ka makaʻu o ka ulu ulu intrauterine (IUGR), ma muli o ke kaʻanalike ʻana o ka pēpē i nā kumuwaiwai placental palena ʻole a i ʻole nā ​​maʻi o ke kahe i ka wā o ka hāpai hope. ʻO kēia IUGR ke kuleana no ka neonatal hypotrophy (hoʻohaʻahaʻa hānau hānau), ʻoi aku ka nui o nā māhoe.
• hoʻonui i ka makaʻu o ka hānau mua. 20% o nā pēpē ma mua i hele mai mai nā hāpai wahine he nui a me 7% o nā māhoe he pēpē premature loa (2), me nā hanu āpau o ka hanu, digestive a me nā neurological pathologies i hoʻokumu ʻia e kēia prematurity.
• ua hoʻonui ʻia ka makaʻu o ka make ma ka perinatal, 5 a 10 mau manawa ke kiʻekiʻe aʻe i ka hāpai hāpai māhoe ma mua o ka hāpai hoʻokahi (3).
• ka hoʻonui i ka makaʻu o ka toxemia o ka hāpai keiki. I ka hāpai male māhoe, ʻo ka hypertension he 4 mau manawa pinepine, a hiki ke hoʻoulu i ka ulu ʻana i hoʻokahi a i ʻole nā ​​fetus ʻelua.

I mea e pale aku ai a ʻike i kēia mau pilikia i ka wā hiki loa, hiki i nā hāpai māhoe ʻana ke hoʻonui i ka nānā ʻana e kahi mea hana me ka ʻike maikaʻi o kēia ʻano hāpai. ʻOi aku ka pinepine o nā ultrasounds a me nā dopplers, me ka awelika o ka manawa pinepine, a ʻoi aku paha inā he ʻokoʻa nui i ka ulu ʻana ma waena o nā fetus. Hoʻomaha ʻia ka makuahine e hiki mai ana me ka hoʻomaha maʻi mai 20 mau pule.

Kaukaʻi ʻia i ko lākou wahi, hiki i kekahi mau māhoe hāpai keiki ke hōʻike i kahi pilikia ʻino. I ka hāpai hāpai monochorial (kahi hoʻokahi placenta no nā pēpē ʻelua), ʻo ka pōpilikia makaʻu ka transfusion-transfused syndrome (TTS), e pili ana iā 15 a 30% o kēia mau hāpai (4). Kuhi ʻia kēia maʻi e ka maikaʻi ʻole o ka hoʻokaʻawale ʻana o ke koko ma waena o nā fetus ʻelua: loaʻa ka nui i kekahi, ʻaʻole lawa ka lua. Pono ka mālama ʻana i kēlā me kēia mahina a ʻoi paha i kēlā me kēia pule ultrasound i mea e ʻike ai i kēia pilikia ma ka hiki wawe.

I ka hāpai ʻana i ka monoamniotic monochorial hāpai, ua hoʻohui ʻia kekahi mea ʻē aʻe i ko TTS: ʻo ka paʻa ʻana o nā kaula. ʻOiai ʻaʻohe pā ma waena o nā fetus i kaʻana like i ka ʻeke amniotic like, e wili paha kā lākou kaula umbilical ma waena o lākou. Pono ka hoʻonui i ka nānā ʻana mai 22-30 WA.

Inā hānau ʻia kahi o nā pilikia o ka hāpai hāpai māhoe, akā naʻe, ʻaʻole pono e hele lōʻihi kekahi i ka hoʻomau ʻana o ka hāpai ʻana no ka hoʻomohala maikaʻi ʻana o nā māhoe ʻelua i makaʻu, i ka hopena o ka hāpai ʻana, no ka lawa ʻole. ʻAʻole lumi a i ʻole wai amniotic. ʻO ka hānau male māhoe, ʻo ka ʻoiaʻiʻo, ʻoi aku ka pōkole ma mua o ka hāpai hoʻokahi ʻana. Ma ka pae hanu, ua oʻo nā māhoe ʻelua mau pule ma mua o nā pēpē mai kahi hāpai hoʻokahi (5).

I loko o kāna mau ʻōlelo aʻoaʻo no ka mālama ʻana i nā hāpai hāpai māhoe, hoʻomanaʻo ʻo CNGOF i kēia mau lā palena pau:

- i ka hanana o ka hāpai ʻana o ka bichorium paʻakikī, hānau keiki, inā ʻaʻole i hana ʻia ma mua, hoʻonohonoho pinepine ʻia ma waena o 38 mau pule a 40 mau pule.

- i ka hanana o ka hāpai ʻole ʻana o ka biamniotic monochorial, ua hoʻonohonoho ʻia ma waena o 36 WA a 38 WA + 6 mau lā.

- i ka hanana o ka monamniotic monochorial hāpai, ua pono e hānau i kēia mau māhoe ma mua, ma waena o 32 a 36 mau pule.

No ke ʻano o ka lawe ʻana, ʻāpala a i ʻole ʻāpana cesarean, "ʻaʻohe kumu e paipai ai i kahi ala hānau ma mua o kahi ala ʻē aʻe i ka hāpai ʻana o ka māhoe me ka nānā ʻole i kāna huaʻōlelo", e hōʻike ana i ka CNGOF. No laila, ʻo ka hāpai ʻana o ka māhoe ʻaʻole ia he hōʻailona paʻa no ka ʻāpana cesarean, ʻoiai i ka hanana o ka hōʻike i ka breech o ka māhoe mua a i ʻole i ka hanana o kahi kōpū ʻehaʻeha.

E koho ʻia ke ʻano o ka hānau ʻana e like me ka manawa o ka hāpai ʻana, ke kaupaona o nā pēpē, ko lākou kūlana (ʻike ʻia ma ultrasound), ko lākou kūlana olakino, chorionicity, ka laulā o ka pelvis o ka makuahine e hiki mai ana. I ka hanana o ka prematurity loa, retardation o ka ulu nui ʻana, ka pilikia o ka fetal kūpilikiʻi, ka hāpai ʻana monochni monokorial, hana ʻia kahi ʻāpana cesarean koke.

Noho ka hānau ʻana o nā māhoe, e like me ka hāpai ʻana o ka māhoe, i ka makaʻu. ʻOi ke kiʻekiʻe o ka unuhi instrumental a me ka ʻāpana cesarean ma mua o kahi hāpai hoʻokahi. Hoʻonui pū ʻia ka makaʻu o ke kahe ʻana i ka wā o ka lawe ʻana no ka mea ʻoi aku ka nui o ka placenta a ʻo ka uterus, ʻoi aku ka mamao, nā kirimana liʻiliʻi liʻiliʻi, keakea i ka hanana o ka ligation maoli o nā moku liʻiliʻi o ka uterus.

Inā hoʻāʻo ʻia kahi ala haʻahaʻa, hana ʻia ia ma kahi ʻāpana caesarean me kahi gynecologist kauka hānau i loaʻa ka ʻike i nā hānau māhoe ʻelua a me kahi anesthesiologist.

Hoʻohui ʻia, pono e hana i nā mea āpau e hoʻopōkole i ka manawa ma waena o ka hānau ʻana o nā pēpē ʻelua, no ka mea ʻoi aku ka maka o ka māhoe ʻelua i nā pilikia like ʻole o ka hānau hānau ʻana: hōʻike maikaʻi ʻole, hana maikaʻi ʻole ʻana i ka hopena, ka ʻehaʻeha ʻana o ka fetal ma hope o ka ʻāpana o ka placenta ma hope o ka hānau ʻana. . hānau o ka pēpē mua, hānau o ke kaula, a pēlā aku.