Rau cov niam txiv yav tom ntej, kwv yees qhov hnyav ntawm tus menyuam hauv plab ntawm ultrasound tso cai rau koj los xav txog tus me nyuam tos ntev me ntsis zoo dua. Rau pab neeg kho mob, cov ntaub ntawv no yog qhov tseem ceeb rau kev hloov kho kev xeeb tub tom qab, txoj kev xa menyuam thiab kev saib xyuas tus menyuam thaum yug los.

Nws tsis tuaj yeem ntsuas tus menyuam hauv plab hauv utero. Nws yog vim li no los ntawm biometrics, uas yog hais txog kev ntsuas ntawm tus menyuam hauv plab ntawm ultrasound, uas peb tuaj yeem muaj qhov kwv yees ntawm tus menyuam hauv plab. Qhov no yog ua tiav thaum lub sij hawm ultrasound thib ob (ib ncig 22 WA) thiab qhov thib peb ultrasound (nyob ib ncig ntawm 32 WA).

Tus kws kho mob yuav ntsuas qhov sib txawv ntawm tus menyuam hauv plab lub cev:

• lub cephalic perimeter (PC lossis HC hauv lus Askiv);
• ob-parietal txoj kab uas hla (BIP);
• lub plab perimeter (PA lossis AC hauv lus Askiv);
• qhov ntev ntawm tus femur (LF lossis FL hauv lus Askiv).

Cov ntaub ntawv biometric no, qhia hauv millimeters, ces nkag mus rau hauv cov qauv lej kom tau txais kev kwv yees ntawm tus menyuam hauv plab hauv grams. Lub tshuab fetal ultrasound ua qhov kev suav no.

Muaj txog nees nkaum tus qauv kev suav tab sis hauv Fabkis, cov ntawm Hadlock yog siv ntau tshaj. Muaj ntau ntau yam sib txawv, nrog 3 lossis 4 biometric tsis:

• Log10 EPF = 1.326 - 0.00326 (AC) (FL) + 0.0107 (HC) + 0.0438 (AC) + 0.158 (FL)
• Log10 EPF = 1.3596 + 0.0064 PC + 0.0424 PA + 0.174 LF + 0.00061 BIP PA - 0.00386 PA LF

Qhov tshwm sim yog qhia nyob rau hauv daim ntawv qhia ultrasound nrog hais txog "EPF", rau "Kev kwv yees ntawm tus menyuam hauv plab".

Txawm li cas los xij, cov txiaj ntsig tau txais tseem yog kwv yees. Feem ntau ntawm cov qauv tau raug lees paub rau qhov hnyav ntawm qhov yug ntawm 2 txog 500 g, nrog cov npoo ntawm qhov yuam kev piv rau qhov tseeb qhov hnyav ntawm 4 mus rau 000% (6,4), vim yog ib feem ntawm qhov zoo thiab qhov tseeb ntawm kev txiav. kev npaj. Ntau qhov kev tshawb fawb kuj tau qhia tias rau cov menyuam mos uas tsis muaj qhov hnyav (tsawg dua 10,7 g) lossis cov menyuam mos loj (ntau dua 1 g), qhov kev ua yuam kev yog ntau dua 2%, nrog rau kev nyiam rau cov menyuam mos. ntawm qhov hnyav me me thiab ntawm qhov tsis sib xws rau underestimate cov me nyuam loj.

Cov txiaj ntsig tau muab piv rau qhov ntsuas qhov hnyav ntawm tus menyuam hauv plab tau tsim los ntawm Fab Kis Tsev Kawm Qib Siab ntawm Fetal Ultrasound (3). Lub hom phiaj yog los tshuaj xyuas cov fetuses tawm ntawm tus qauv, nyob nruab nrab ntawm 10 ° thiab 90 ° feem pua.. Kev kwv yees ntawm qhov hnyav ntawm tus menyuam hauv plab yog li ua rau nws tuaj yeem txheeb xyuas ob qhov kev xav no:

• hypotrophy, los yog qhov hnyav rau lub hnub nyoog gestational (PAG), uas yog hais tias tus menyuam mos qhov hnyav qis dua 10 feem pua ​​​​raws li lub hnub nyoog gestational muab lossis qhov hnyav dua 2 g ntawm lub sijhawm. Qhov PAT no tuaj yeem yog qhov tshwm sim ntawm leej niam lossis tus menyuam hauv plab pathology lossis ntawm uteroplacental anomaly;
• macrosomia, los yog "tus me nyuam loj", uas yog hais tias tus me nyuam hauv plab hnyav dua li 90 feem pua ​​​​ntawm cov hnub nyoog gestational los yog txawm tias muaj qhov hnyav dua 4 g. Qhov kev soj ntsuam no yog qhov tseem ceeb hauv cov kab mob gestational diabetes lossis ntshav qab zib uas twb muaj lawm.

Ob qhov kev kub ntxhov no yog qhov xwm txheej txaus ntshai rau tus menyuam hauv plab, tab sis kuj rau leej niam hauv qhov xwm txheej ntawm macrosomia (muaj kev pheej hmoo ntau dua ntawm kev phais mob, los ntshav thaum yug me nyuam tshwj xeeb).

Kev kwv yees ntawm qhov hnyav ntawm tus menyuam hauv plab yog cov ntaub ntawv tseem ceeb los hloov kho qhov kev ua raws li qhov kawg ntawm cev xeeb tub, kev loj hlob ntawm kev yug menyuam tab sis kuj tseem muaj peev xwm saib xyuas menyuam mos.

Yog hais tias nyob rau hauv lub thib peb ultrasound qhov kwv yees ntawm lub fetus qhov ceeb thawj ntawm tus me nyuam mos yog qis dua tus qauv, ib tug soj ntsuam ultrasound yuav tsum tau ua nyob rau hauv lub 8th lub hlis los saib xyuas kev loj hlob ntawm tus me nyuam. Nyob rau hauv qhov xwm txheej ntawm kev hem thawj yug ntxov ntxov (PAD), qhov hnyav ntawm kev yug ntxov ntxov yuav raug kwv yees raws li lub sijhawm tab sis kuj yog qhov hnyav ntawm fetal. Yog tias qhov kwv yees qhov hnyav ntawm qhov yug me nyuam qis heev, pab pawg neonatal yuav muab txhua yam los saib xyuas tus menyuam ntxov ntxov thaum yug los.

Kev kuaj mob ntawm macrosomia kuj tseem yuav hloov kev tswj kev xeeb tub lig thiab kev yug menyuam. Kev soj ntsuam xyuas ultrasound yuav tau ua thaum lub hli 8 ntawm cev xeeb tub txhawm rau ua qhov kwv yees tshiab ntawm tus menyuam hauv plab. Txhawm rau txo qhov kev pheej hmoo ntawm lub xub pwg dystocia, brachial plexus raug mob thiab neonatal asphyxia, nce siab heev hauv macrosomia - los ntawm 5% rau tus menyuam hnyav ntawm 4 thiab 000 g thiab 4% rau tus menyuam mos dua 500 g (30) - induction lossis teem sijhawm phais. tej zaum yuav muaj. Yog li, raws li cov lus pom zoo ntawm Haute Autorité de Santé (4):

• Thaum tsis muaj ntshav qab zib, macrosomia nyob rau hauv nws tus kheej tsis yog ib qho kev qhia rau kev teem caij phais;
• qhov teem caij phais phais raug pom zoo nyob rau hauv qhov xwm txheej ntawm kwv yees qhov hnyav ntawm tus menyuam hauv plab ntau dua lossis sib npaug li 5 g;
• vim qhov tsis paub meej ntawm qhov kwv yees ntawm qhov hnyav ntawm tus menyuam hauv plab, rau qhov tsis txaus ntseeg ntawm macrosomia ntawm 4 g thiab 500 g, qhov teem caij phais yuav tsum tau sib tham nyob rau hauv rooj plaub ntawm rooj plaub;
• nyob rau hauv lub xub ntiag ntawm ntshav qab zib mellitus, kev teem caij phais phais raug pom zoo yog tias qhov hnyav ntawm fetus kwv yees ntau dua lossis sib npaug li 4 g;
• vim qhov tsis paub meej ntawm qhov kwv yees ntawm qhov hnyav ntawm tus menyuam hauv plab, rau qhov kev xav ntawm macrosomia ntawm 4 g txog 250 g, qhov teem caij phais yuav tsum tau sib tham nyob rau hauv rooj plaub ntawm cov xwm txheej, suav nrog lwm cov txheej txheem ntsig txog pathology thiab obstetrical ntsiab lus;
• qhov tsis txaus ntseeg ntawm macrosomia tsis yog nyob rau hauv nws tus kheej ib qho kev qhia rau ib qho kev npaj phais mob nyob rau hauv cov kev tshwm sim ntawm ib tug caws pliav uterus;
• Yog tias xav tias macrosomia thiab keeb kwm ntawm lub xub pwg dystocia nyuaj los ntawm elongation ntawm lub brachial plexus, ib qho kev teem caij phais yuav raug pom zoo.

Yog tias kev sim ua kom tsawg, pab pawg kws kho mob yuav tsum ua kom tiav (tus kws yug menyuam, kws kho menyuam yaus, kws tshuaj loog thiab kws kho menyuam yaus) thaum yug menyuam suav tias muaj kev pheej hmoo hauv qhov xwm txheej ntawm macrosomia.

Nyob rau hauv cov ntaub ntawv ntawm kev nthuav qhia breech, qhov kwv yees ntawm qhov hnyav ntawm fetus kuj tseem raug coj mus rau hauv tus account thaum xaiv ntawm kev sim ntawm qhov chaw mos los yog qhov teem caij phais. Qhov hnyav ntawm tus menyuam hauv plab kwv yees li ntawm 2 txog 500 grams yog ib feem ntawm qhov kev lees paub ntawm qhov chaw mos txoj hauv kev tsim los ntawm CNGOF (3). Nyob rau hauv tas li ntawd, ib tug caesarean tej zaum yuav pom zoo.