Wahi a ka manaʻo WHO, he hānau make ka "make o kahi huahana o ka hapai ʻana i ka wā o kēia make ma mua o ka kipaku ʻia ʻana a i ʻole ka unuhi piha ʻana o ke kino o ka makuahine, me ka nānā ʻole i ka lōʻihi o ka hānau. Hōʻike ʻia ka make ?? e ka ʻoiaʻiʻo ma hope o kēia kaʻawale ʻana, ʻaʻole hanu ka fetus a hōʻike i kekahi hōʻailona o ke ola e like me ka puʻuwai puʻuwai, ka pā ʻana o ka umbilical cord a i ʻole ka hōʻemi maikaʻi ʻana o kahi mākala i kau ʻia i ka hana o ka makemake. Ua wehewehe pū ka WHO i kahi paepae ola: 22 mau pule o ka amenorrhea (WA) i pau a i ʻole ke kaupaona o 500 g. ʻLelo mākou no ka make fetal i utero (MFIU) ke mālama ʻia ka makeÌ ?? ma mua o ka hoʻomaka ʻana o ka hana, i kūʻē i ka make mau loa, i hopena ma muli o ka make i ka wā hana.

Me nā hānau hānau he 9,2 o nā keiki ola ʻole no kēlā me kēia 1000 mau hānau, ʻo France ka helu hānau hānau kiʻekiʻe ma ʻEulopa, e hōʻike ana i ka hōʻike ʻEulopa e pili ana i ke olakino perinatal EURO-PERISTAT o 2013 (1). I loko o kahi paʻi paʻi (2) e pili ana i kēia mau hopena, ua wehewehe ʻo Inserm, akā naʻe, hiki ke wehewehe ʻia kēia kiʻekiʻe e ka ʻoiaʻiʻo 40 a 50% o nā hānau hānau ma Palani i pili i nā hoʻopau olakino o ka hāpai ʻana (IMG), no kēia "kahi kulekele hana nui o ka kānana ʻana no nā anomalies congenital a me kahi hana lohi a IMG". Mai nā 22 mau hebedoma, lawe maoli ʻia kahi pēpē i mua o ka IMG i mea e hōʻalo ai i ka ʻeha ʻana o ka fetal. No laila alakaʻi ka IMG i ka ʻoiaʻiʻo i ka hānau ʻana o kahi keiki "hānau hānau".

ʻO ka RHEOP (Kakau inoa o nā pilikia kīnā keiki a me ka Observatory Perinatal) (3), e helu ana i nā hānau hānau ma Isère, Savoie a me Haute-Savoie, no ka makahiki 2011 e hōʻike nei i ka nui o ka hānau hānau o 7,3, 3,4 ‰, me 3,9 ‰ no ka hānau hānau kūlohelohe (MFIU) a me XNUMX ‰ no ka hānau hānau make (IMG).

I mea e hoʻāʻo ai e wehewehe i ke kumu o ka make ʻana o ka fetal ma utero, lawe ʻōnaehana ʻia kahi loiloi. Loaʻa iā ia ma ka liʻiliʻi (4):

• ninaninau histological o ka placenta;
• kahi autopsy o ke fetus (ma hope o kaʻae ʻana o ka mea maʻi);
• kahi hōʻike Kleihauer (hōʻike i ke koko e ana i ka nui o nā hunaola ʻulaʻula fetal i waena o nā hunaola ʻulaʻula makuahine);
• kahi hulina no nā aglutinins kūpono ʻole;
• nā mākua makuahine (parvovirus B19, toxoplasmosis);
• nā swab infectious cervico-vaginal a me nā placental;
• e ʻimi nei i ka maʻi maʻi antibody antiphospholipid, lupus ʻōnaehana, ʻano 1 a i ʻole 2 diabetes, dysthyroidism.

ʻO nā kumu maʻamau o MFIU ka:

• kahi anomaly vaskulo-placental: hematoma retro-placental, toxemia, pre-eclampsia, eclampsia, HELLP syndrome, foeto-maternal hemorrhage, placenta previa a me nā anomalies o placental insertion;
• kahi maʻi pilikino o nā pākuʻi: kaula (cord procidence, kaula a puni ka ʻāʻī, nā piko, hoʻokomo komo velamentous, ʻo ia hoʻi kahi kaula i hoʻokomo ʻia ma nā membrane a ʻaʻole ka placenta), ka wai amniotic (oligoamnios, hydramnios, rupture o nā membrane);
• kahi anomaly fetal kumukānāwai: anomaly congenital, autoimmune hydrops edema (generalized edema), transfusion-transfused syndrome, overdue;
• intarduterine ulu retardation;
• ke kumu infectious: chorioamniotic, cytomegalovirus, toxoplasmosis;
• pathology makuahine: ka maʻi kōpaʻa paʻa ʻole ma mua, ka maʻi thyroid, hypertension arterial pono, lupus, cholestasis o ka hāpai ʻana, hoʻohana lāʻau lāʻau, pathology uterine (moʻolelo o ka haki uterine, malformations, uterine septum), antiphospholipid syndrome;
• trauma kūwaho i ka wā hāpai;
• asphyxiation a i ʻole trauma i ka wā hānau.

Ma 46% o nā hihia, ʻaʻole wehewehe ʻia ka make o ka fetal, eia naʻe, kikoʻī ka RHEOP (5).

Ma hope o ka hōʻoia o ka make o ka fetal ma utero, lawelawe ʻia ka lāʻau lapaʻau i ka makuahine i mea e hoʻohua ai i ka hana. ʻO ka kipaku ʻia ʻana o ke pēpē e ke ala hele a ʻoi aku ka maikaʻi ma mua o ka ʻāpana cesarean.

ʻO ke kākoʻo psychological kahi i kōkua i nā kāne e hele i loko o ka ʻeha o ka kanikau perinatal. Hoʻomaka kēia kākoʻo ke hoʻolaha koke ʻia ka make o ka pēpē, me ke koho ʻana i nā huaʻōlelo. Hāʻawi ʻia nā mākua i kahi kūkākūkā me kahi palekeiki e loea ana i ka perinatal bereavement a i ʻole ka psychologist. Makemake paha lākou e ʻike i ka pēpē, halihali iā ia, ʻaʻahu iā ia, a i ʻole hāʻawi ʻia i inoa? Aia i nā mākua ke hoʻoholo i kēia mau koho a he ʻāpana nui ia o kā lākou hana kaumaha. Loaʻa iā lāua he 10 mau lā ma hope o ka hānau ʻana e koho e hāʻawi i kā lāua pēpē i kahi kanu kupapaʻu a me ke kanu ʻana, a i ʻole e lawe i ke kino i ka haukapila no ke kanu ʻana i ke ahi.

He kanikau kū hoʻokahi ke kanikau Perinatal: ʻo ke kanaka i ola ʻole, koe wale nō i ka ʻōpū o kona makuahine. Wahi a kahi noiʻi ʻAmelika (6), hiki ke hoʻomau i ka makaʻu o ke kaumaha ma hope o ke keiki hānau make a hiki i 3 mau makahiki ma hope o ka hānau ʻana. No laila e paipai ʻia ka psychological follow-up, e like me ke kōkua e kākoʻo ai i nā hui kākoʻo a me nā hui.

Ua ʻike ʻia ka manaʻo o kahi "keiki hānau ʻole ke ola" no ka manawa mua ma ke kānāwai Farani ma 1993. Mai ia manawa, ua ulu ke kānāwai i nā manawa he nui. Ma mua o ke kānāwai n ° 2008-800 o ʻAukake 20, 2008, hoʻokahi wale nō fetus ma ʻō aku o 22 mau pule i pili e pili ana i ke kūlana civila. Mai kēia manawa, hiki ke hāʻawi i kahi palapala hānau. ma mua o 22 SA (akā ma hope o 15 SA) ma ke noi a nā mākua. Ma hope o kēia kau, hoʻopuka ʻia ia.

Mālama kēia palapala hōʻoia i ka hiki ke hoʻokumu i kahi “hana a ke keiki neÌ ?? me ke ola ʻole ”e hāʻawi ai i nā mākua i ka hiki, inā makemake lākou, e hāʻawi i hoʻokahi a i ʻole ʻelua inoa mua i kā lākou keiki a hoʻokomo ʻia i loko o kā lākou puke moʻolelo ʻohana, a i ʻole hoʻokumu i hoʻokahi inā ʻaʻohe o lākou. aole naʻe. Ma ka ʻaoʻao ʻē aʻe, ʻaʻole hiki ke hāʻawi ʻia i ka inoa ʻohana a i ʻole ka pilina ʻoihana i kēia keiki hānau hānau ʻole; no laila ʻaʻole ia he kanaka kū kānāwai. Eia nō naʻe, he hōʻailona kēia kānāwai i kahi piʻi i mua no ka ʻike ʻana i nā keiki hānau hou ma ke ʻano he kanaka, a no laila no ke kūmākena a me nā ʻeha e hoʻopuni iā ​​lākou. ʻO ia kekahi no ka ʻelua mau mea e hoʻomaopopo ai i ko lāua kūlana "makua".

I ka hanana o ka hānau hānau ma mua o 22 mau hebedoma, ʻaʻole hiki i ka wahine ke pōmaikaʻi i ka haʻalele makuahine. Hiki i ke kauka ke hoʻopuka iā ia i kahi hana hana e hāʻawi ana iā ia i ke kuleana e uku ai mai ka ʻInikua Ola.

I ka hanana o ka hānau hānau ma hope o 22 mau pule, pōmaikaʻi ka wahine i ka haʻalele hānau piha. Lawe pū ʻia kēia hāpai ʻana e ka palekana kaiaulu ke helu ʻana i ka haʻalele hānau hope.

E hiki i ka makuakāne ke keu pono mai nā haʻawina o ka haʻalele paternity i kēlā me kēia lā, ma ka hōʻike ʻana i kahi kope o ka hana a ke keiki ola ʻole a me ka palapala hōʻike lapaʻau no ka hānau ʻana o kahi keiki i hānau make a ola.

Hiki i nā mākua ke keu pono mai ka bonus hānau (ma muli o nā kumuwaiwai) inā loaʻa ka hopena o ka hāpai ʻana mai ka lā 1st o ka mahina ma hope o ka 5th o ka mahina o ka hāpai ʻana. A laila pono e hana i ka hōʻoia o ka hāpai keiki ma kēia lā.

E pili ana i ka ʻauhau, ʻae ʻia i kēlā mau keiki i hānau ʻia i ka makahiki ʻauhau a nāna i hānau kahi wahi a ka € hoʻokumu ʻana i kahi hana a ne keiki ?? Hoʻohana ʻia nā ola ʻole e hoʻoholo i ka helu o nā anakahi.