Frozen cev xeeb tub

Frozen cev xeeb tub yog ib qho teeb meem tseem ceeb hauv obstetrics thiab gynecology. Hmoov tsis zoo, txhua tus poj niam tuaj yeem ntsib xws li pathology. Yuav ua li cas rau qhov no thiab thaum twg koj tuaj yeem npaj cev xeeb tub dua, peb nrog Obstetrician-gynecologist Marina Eremina.

Lub cev xeeb tub yog dab tsi

Muaj ob peb nqe lus uas piav txog tib yam mob: nchuav menyuam, tsis tsim cev xeeb tub thiab nchuav menyuam. Lawv txhua tus txhais tau ib yam - tus me nyuam hauv plab mam li nco dheev loj hlob (1). Yog tias qhov no tshwm sim txog li 9 lub lis piam, lawv tham txog kev tuag ntawm embryo, txog li 22 lub lis piam - tus me nyuam hauv plab. Nyob rau hauv cov ntaub ntawv no, ib tug nchuav menyuam tsis tshwm sim, lub fetus tseem nyob rau hauv lub uterine kab noj hniav.

Cov kws kho mob feem ntau pom zoo tias 10-20 feem pua ​​​​ntawm tag nrho cov cev xeeb tub tuag hauv thawj lub lis piam. Nyob rau tib lub sijhawm, cov poj niam uas tau pom qhov tsis muaj kev xeeb tub feem ntau nqa tus menyuam yam tsis muaj teeb meem yav tom ntej. Txawm li cas los xij, muaj cov xwm txheej thaum ob lossis ntau lub cev xeeb tub nyob rau hauv kab khov. Tom qab ntawd cov kws kho mob tham txog ib txwm nchuav menyuam, thiab qhov kev kuaj mob no twb xav tau kev soj ntsuam thiab kho.

Cov cim qhia ntawm cev xeeb tub khov

Ib tug poj niam tsis tshua muaj peev xwm paub nws tus kheej seb nws cev xeeb tub tau nres los yog tsis. Muaj ntshav tawm ntau, zoo li thaum nchuav menyuam, tsis nyob ntawm no, tsis muaj qhov mob. Feem ntau tus neeg mob hnov ​​​​zoo, thiab qhov mob hnyav dua rau nws hnov ​​​​tus kws kho mob qhov kev kuaj mob.

Qee zaum koj tseem tuaj yeem xav tias muaj teeb meem. Cov tsos mob hauv qab no yuav tsum ceeb toom:

• cessation ntawm xeev siab;
• cessation ntawm lub mis engorgement;
• kev txhim kho ntawm tus mob dav dav; qee zaum cov tsos ntawm ntshav daub.

- Hmoov tsis zoo, tsis muaj cov cim qhia ntawm kev xeeb tub, thiab tsuas yog ultrasound tuaj yeem ua qhov kev kuaj mob kom raug. Cov tsos mob no yog cov ntsiab lus heev. Obstetrician-gynecologist Marina Eremina.

Nrog rau cov cim qhia no, cov kws kho mob qhia kom ua ultrasound, tsuas yog thaum lub sij hawm ultrasound koj tuaj yeem txiav txim siab seb lub embryo yog khov los yog tsis. Qee zaum cov cuab yeej siv tsis tu ncua lossis tus kws tshaj lij tsis muaj peev xwm tuaj yeem ua yuam kev, yog li cov kws kho mob qhia kom kuaj xyuas ultrasound hauv ob qhov chaw zoo dua nrog qhov sib txawv ntawm 3-5-7 hnub), lossis tam sim ntawd xaiv lub tsev kho mob nrog cov cuab yeej niaj hnub thiab tsim nyog. kws kho mob.

Tus kws kho mob tshwj xeeb hauv ultrasound kuaj pom qhov tsis muaj cev xeeb tub los ntawm cov cim hauv qab no:

• tsis muaj kev loj hlob ntawm lub fetus qe nyob rau hauv 1-2 lub lis piam;
• qhov tsis muaj embryo nrog lub qe me me ntawm tsawg kawg 25 mm;
• Yog hais tias lub coccyx-parietal loj ntawm lub embryo yog 7 hli los yog ntau tshaj, thiab tsis muaj lub plawv dhia.

Qee lub sij hawm koj yuav tsum tau kuaj ntshav ntau rau hCG los xyuas seb qib ntawm cov tshuaj hormone no hloov pauv. Nrog rau ib txwm cev xeeb tub, nws yuav tsum tau nce.

Frozen thaum ntxov cev xeeb tub

Qhov kev pheej hmoo ntawm cev xeeb tub yog qhov tshwj xeeb tshaj yog nyob rau thawj peb lub hlis twg.

"Feem ntau, tsis nco qab cev xeeb tub tshwm sim nyob rau theem pib, ntawm 6-8 lub lis piam, muaj tsawg zaus tom qab 12 lub lis piam ntawm cev xeeb tub," hais tias obstetrician-gynecologist.

Lub sijhawm txaus ntshai tom ntej tom qab thawj peb lub hlis twg yog 16-18 lub lis piam ntawm cev xeeb tub. Tsis tshua muaj, kev loj hlob ntawm lub embryo nres nyob rau tom qab hnub.

Ua rau lub cev xeeb tub

Ib tug poj niam uas hnov ​​qhov kev kuaj mob no tej zaum yuav xav tias ib yam dab tsi tsis ncaj ncees lawm rau nws. Txawm li cas los xij, cov kws kho mob paub tseeb tias 80-90 feem pua ​​​​ntawm cov poj niam cev xeeb tub yog vim lub embryo nws tus kheej, los yog, vim nws cov caj ces txawv txav. Raws li nws tau muab tawm, lub embryo tig mus ua tsis tau. Lub grosser lub pathology, sai dua lub cev xeeb tub yuav tuag. Raws li txoj cai, qhov txawv txav embryo tuag txog li 6-7 lub lis piam.

Lwm yam ua rau kev nchuav menyuam tsuas yog 20 feem pua ​​​​ntawm cov neeg mob (2). Cov laj thawj no twb txuas nrog leej niam, thiab tsis nrog tus menyuam.

Dab tsi tuaj yeem yog qhov ua rau nchuav menyuam.

1. Kev ua txhaum ntawm cov ntshav coagulation system, ntau yam thromboses, raws li zoo raws li antiphospholipid syndrome, uas cov ntshav coagulates heev nquag. Vim li no, tus placenta yuav tsis tuaj yeem tiv nrog nws txoj haujlwm ntawm kev txhawb nqa tus menyuam hauv plab, thiab yav tom ntej tus menyuam yuav tuag.

2. Hormonal tsis ua haujlwm. Txhua yam kev tsis txaus ntseeg, txawm tias nws tsis muaj progesterone lossis ntau dhau ntawm cov txiv neej cov tshuaj hormones, tuaj yeem cuam tshuam rau kev loj hlob ntawm lub embryo.

3. Cov kab mob sib kis, feem ntau yog kis kab mob sib deev, cytomegalovirus, rubella, mob khaub thuas thiab lwm yam. Nws yog tshwj xeeb tshaj yog txaus ntshai mus ntes lawv nyob rau hauv thawj peb lub hlis twg, thaum tag nrho cov plab hnyuv siab raum thiab lub cev ntawm tus me nyuam hauv plab yog pw.

4. Sib npaug chromosomal translocations nyob rau hauv niam txiv. Nws suab nyuaj, tab sis qhov tseem ceeb yog qhov no - cov kab mob ntawm cov niam txiv muaj cov kab mob ntawm cov chromosomes.

Lub luag haujlwm tseem ceeb yog ua los ntawm txoj kev ua neej ntawm tus poj niam, nrog rau nws lub hnub nyoog. Qhov kev pheej hmoo ntawm kev xeeb tub uas tsis tsim kev loj hlob nce ntxiv thaum lub hnub nyoog qis dua. Yog tias thaum muaj hnub nyoog 20-30 xyoo nws nyob nruab nrab 10%, ces thaum muaj hnub nyoog 35 xyoo nws twb 20%, thaum 40 xyoo nws yog 40%, thiab tshaj 40 nws mus txog 80%.

Lwm cov laj thawj uas ua rau tsis muaj cev xeeb tub:

• haus kas fes (4-5 khob ib hnub);
• haus luam yeeb;
• noj tej yam tshuaj;
• tsis muaj folic acid;
• systematic kev nyuaj siab;
• cawv.

Muaj ntau ntau yam uas tsis raug suav tias yog ua rau lub cev tsis muaj menyuam. Tab sis tsis yog! Tsis tuaj yeem ua rau:

• huab cua mus ncig;
• kev siv cov tshuaj tiv thaiv kab mob ua ntej cev xeeb tub (hormonal contraceptives, spirals);
• kev tawm dag zog lub cev (muab tias tus poj niam mus rau hauv kev ua si hauv tib hom ua ntej cev xeeb tub);
• sib deev;
• rho menyuam.

Yuav ua li cas nrog lub cev xeeb tub

Yog tias koj muaj hnub nyoog qis dua 35 xyoos thiab qhov no yog koj qhov kev nchuav menyuam thawj zaug, cov kws kho mob qhia kom tsis txhob ntxhov siab lossis ntshai. Feem ntau qhov no yog kev huam yuaj, thiab koj qhov kev sim tom ntej los ua leej niam yuav xaus thaum yug tus menyuam noj qab nyob zoo. Tam sim no thawj qhov uas yuav tsum tau ua yog tshem tawm lub qe fetal phais los yog kho mob.

Lub sijhawm no, tus poj niam xav tau kev txhawb nqa ntawm cov neeg hlub. Yog li tsis txhob khaws koj txoj kev xav hauv koj tus kheej, tham txog kev xav nrog koj tus txiv, niam, hluas nkauj.

Rau koj tus kheej kev thaj yeeb ntawm lub siab, nws yuav tsis yog superfluous mus kuaj rau tus qauv kis kab mob - ob qho tib si ntawm kev sib deev, thiab mob khaub thuas thiab lwm yam kab mob. Yog tias tsis pom dab tsi, koj tuaj yeem xeeb tub dua.

Ib qho ntxiv yog tias qhov no yog qhov thib ob lossis ntau dua tsis tau cev xeeb tub, ces koj yuav tsum paub qhov ua rau ntawm qhov teeb meem thiab tshem tawm lawv.

Cev xeeb tub tom qab cev xeeb tub

Lub cev xeeb tub khov ib txwm ua rau muaj kev tu siab. Tab sis, qee lub sij hawm tom qab, tus poj niam rov qab los thiab pib npaj kev sim tshiab los yug tus menyuam. Koj tuaj yeem xeeb tub dua tom qab 4-6 lub hlis (3). Thaum lub sij hawm no, nws yog ib qhov tsim nyog yuav tau rov qab tsis tau tsuas yog lub cev, tab sis kuj lub hlwb. Tom qab tag nrho, tus poj niam cev xeeb tub, thiab nws keeb kwm hormonal hloov. 

pom zoo:

• tso kev haus luam yeeb thiab cawv;
• tsis txhob tsim txom cov khoom uas muaj caffeine;
• tsis txhob noj cov rog thiab ntsim;
• ua kis las;
• taug kev ntau zaus.

Nws tseem yuav siv sij hawm rau lub endometrium kom npaj tau txais lub qe tshiab hauv plab. 

Ua ntej npaj cev xeeb tub tshiab, nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas ntau yam:

1. Txheeb xyuas qhov muaj feem cuam tshuam rau qhov teeb meem: tshuaj, ib puag ncig, kab mob, thiab lwm yam.
2. Kawm txog keeb kwm ntawm cov txheeb ze. Txawm hais tias muaj xwm txheej ntawm cev xeeb tub, thrombosis, mob plawv lossis mob stroke thaum tseem hluas.
3. Tau kuaj kab mob STDs, cov tshuaj hormones thiab ntshav txhaws.
4. Tham nrog tus kws kho caj ces.
5. Ua ib qho ultrasound ntawm lub plab hnyuv siab raum.
6. Ntsuam xyuas kev sib raug zoo ntawm cov neeg koom tes.

Feem ntau, kev kho mob tsis tas yuav tsum tau ua, vim tias kev nchuav menyuam feem ntau yog tshwm sim los ntawm kev ua txhaum ntawm caj ces. Txawm li cas los xij, yog tias qhov no tsis tshwm sim thawj zaug, yuav tsum tau ntsib kws kho mob kev sab laj thiab kev teem caij kho tshwj xeeb. 

Kev xeeb tub ntxov tshaj li 4 lub hlis tom qab tsis cev xeeb tub yog qhov poob siab heev, txawm hais tias nws muaj peev xwm ua tau. Lub cev yuav tsum tau rov zoo tag nrho thiaj li tsis suav nrog qhov rov qab ua dua. Yog li ntawd, yuav tsum tau siv txoj kev tiv thaiv kab mob txhim khu kev qha. Yog tias cev xeeb tub tshwm sim, koj yuav tsum tau mus ntsib kws kho mob thiab ua raws li tag nrho nws cov lus pom zoo. 

Yuav tsum tau xeem

Yog tias koj tau poob ob lossis ntau tus menyuam mos, koj yuav tsum tau ua tib zoo tshuaj xyuas. Feem ntau, cov kws kho mob pom zoo cov npe hauv qab no ntawm kev sim thiab cov txheej txheem:

• karyotyping ntawm niam txiv yog qhov kev ntsuam xyuas tseem ceeb uas yuav qhia tau tias cov txij nkawm lawv tus kheej muaj kev txawv txav ntawm caj ces; - tsom xam ntawm cov ntshav coagulation system: coagulogram (APTT, PTT, fibrinogen, prothrombin lub sij hawm, antithrombin lll), D-dimer, platelet aggregation los yog thrombodynamics, homocysteine ​​​​ntaus pom kev hloov pauv hauv cov noob ntawm coagulation system;
• HLA-typing - kuaj ntshav rau histocompatibility, uas yog coj los ntawm ob niam txiv; - TORCH-complex, uas kuaj pom cov tshuaj tiv thaiv kab mob rau herpes, cytomegalovirus, rubella thiab toxoplasma;
• kev kuaj mob rau kev sib deev; - kuaj ntshav rau cov tshuaj hormones: androstenediol, SHBG (kev sib deev hormone binding globulin), DHEA sulfate, prolactin, tag nrho thiab dawb testosterone, FSH (follicle-stimulating hormone), estradiol, thiab thyroid hormones: TSH (thyroid stimulating hormone), T4 (thyroxine). T3 (triiodothyronine), thyroglobulin.

Yog tias qhov kev ntsuam xyuas pom tias muaj teeb meem nrog coagulation, koj yuav tsum tau sab laj nrog tus kws kho mob hemostasiologist, yog tias muaj cov noob caj noob ces - tus kws kho caj ces, yog tias muaj cov tshuaj hormones - gynecologist thiab endocrinologist.

Tej zaum tus khub yuav tau mus ntsib tus kws kho mob andrologist thiab dhau ib qho kev xeem.

- Oddly txaus, qhov ua rau lub cev xeeb tub tsis yog feem ntau yog txiv neej. Qhov no yog vim tsis yog tus cwj pwm phem, xws li cawv thiab haus luam yeeb, tab sis kuj yog kev tsis txaus noj haus, piv txwv li, kev siv cov khoom tsis zoo, kev ua neej nyob tsis muaj zog, thiab ntau lwm yam, qhia meej. Obstetrician-gynecologist Marina Eremina.

Ib tug txiv neej feem ntau yuav raug qhia kom ua ib qho spermogram txuas ntxiv thiab, yog tias teratozoospermia muaj nyob rau hauv kev tshuaj ntsuam, tom qab ntawd raug kuaj ntxiv rau DNA fragmentation hauv spermatozoa lossis electron microscopic kuaj spermatozoa - EMIS.

Yuav luag tag nrho cov txheej txheem no tau them. Txhawm rau kom tsis txhob tawg, muab lawv tag nrho, mloog tus kws kho mob cov lus pom zoo. Raws li koj cov keeb kwm kho mob, tus kws kho mob tshwj xeeb yuav txiav txim siab seb qhov kev xeem twg yog qhov tseem ceeb.

Hmoov tsis zoo, tseem muaj cov xwm txheej uas cov kws kho mob tsis tuaj yeem nrhiav qhov laj thawj ntawm qhov teeb meem.

Cov txheej txheem ntxuav yog dab tsi?

Yog tias cev xeeb tub tsis tsim thiab tsis muaj qhov nchuav menyuam, tus kws kho mob yuav tsum xa tus neeg mob mus ntxuav. Lub xub ntiag ntawm tus menyuam hauv plab rau ntau tshaj 3-4 lub lis piam hauv tsev menyuam yog qhov txaus ntshai heev, nws tuaj yeem ua rau hnyav los ntshav, o thiab lwm yam teeb meem. Cov kws kho mob pom zoo tias koj yuav tsum tsis txhob tos kom rho menyuam tawm sai li sai tau, nws yog qhov zoo dua los ua qhov kev tshem tawm sai li sai tau.

Qhov no tuaj yeem yog nqus aspiration lossis rho menyuam nrog cov tshuaj uas yuav cia lub embryo raug tshem tawm yam tsis muaj kev phais.

"Kev xaiv ntawm txoj kev yog tus kheej, nyob ntawm lub sijhawm thaum cev xeeb tub nres, ntawm qhov muaj contraindications rau ib lossis lwm txoj kev, muaj kev xeeb tub thiab yug menyuam hauv keeb kwm, thiab, ntawm chav kawm, qhov xav tau ntawm tus poj niam nws tus kheej. raug coj mus rau hauv tus account, ”piav qhia Obstetrician-gynecologist Marina Eremina.

Yog li, kev rho menyuam tawm kho mob, piv txwv li, tsis haum rau cov poj niam uas muaj adrenal tsis txaus, mob raum lossis mob raum tsis ua haujlwm, uterine fibroids, anemia, inflammatory kab mob ntawm cov poj niam cev xeeb tub.

Txoj kev phais pom zoo rau kev txiav cev xeeb tub mus txog 12 lub lis piam hauv Peb Lub Tebchaws yog lub tshuab nqus tsev nqus, thaum lub qe fetal raug tshem tawm siv nqus thiab catheter. Cov txheej txheem yuav siv sij hawm 2-5 feeb thiab ua raws li hauv zos los yog tag nrho cov tshuaj loog.

Curettage yog ib txoj kev uas tsis nyiam thiab yuav tsum tau siv rau hauv cov xwm txheej tshwj xeeb, piv txwv li, yog tias muaj cov ntaub so ntswg nyob hauv lub tsev menyuam tom qab lub tshuab nqus tsev.

Tom qab ntxuav, cov ntsiab lus ntawm lub tsev menyuam raug xa mus rau kev kuaj histological. Qhov kev tshuaj ntsuam no yuav tso cai rau koj nkag siab txog qhov ua rau lub cev xeeb tub tsis zoo thiab zam kev rov tshwm sim ntawm qhov xwm txheej yav tom ntej.

Tsis tas li ntawd, tus poj niam raug pom zoo kom mus rau qhov kev rov qab los. Nws suav nrog kev siv tshuaj tua kab mob, noj tshuaj tua kab mob, cov vitamins, tsis suav nrog kev ua lub cev thiab so kom zoo.

Yog tias koj thawj zaug hnov ​​​​qhov kev kuaj mob ntawm "tsis cev xeeb tub" los ntawm kws kho mob, nws zoo li tias qhov kev sim ua kom muaj menyuam tom ntej yuav ua tiav. Feem ntau nws yog kev huam yuaj ib zaug, ib qho kev ua txhaum ntawm caj ces. Tab sis txawm tias cov poj niam, uas qhov no yog qhov thib ob lossis thib peb tsis tau xeeb tub, muaj txhua txoj hauv kev los ua leej niam.

Qhov tseem ceeb tshaj plaws yog nrhiav qhov laj thawj ntawm qhov teeb meem, thiab tom qab ntawd - kev kuaj mob, kev kho mob, so thiab kho kom rov zoo. Thaum txoj kev no tau dhau mus lawm, koj yuav tsum ua ultrasound ntawm lub plab hnyuv siab raum thiab xyuas kom meej tias endometrium loj hlob raws li lub voj voog, tsis muaj polyps, fibroids lossis o ntawm lub tsev menyuam kab noj hniav, mus ntsib tus kws kho mob thiab kho cov kab mob uas twb muaj lawm. . Nyob rau tib lub sijhawm, koj yuav tsum ua lub neej noj qab haus huv, noj folic acid thiab noj zaub mov kom zoo, tag nrho cov no yuav ua rau koj muaj feem yuav xeeb tub yav tom ntej thiab yug menyuam noj qab nyob zoo.

Cov yam ntxwv ntawm kev coj khaub ncaws thaum lub sijhawm no

Tom qab qhov kawg ntawm cev xeeb tub, kev coj khaub ncaws yuav rov qab mus rau tus poj niam. Feem ntau, nws tuaj 2-6 lub lis piam tom qab qhov txheej txheem. Nws yog ib qho yooj yim los xam lub sij hawm tuaj txog ntawm cov hnub tseem ceeb. Hnub rho menyuam yog thawj hnub, thiab lub sij hawm raug suav los ntawm nws. Piv txwv li, yog tias tus poj niam muaj lub tshuab nqus tsev rau lub Kaum Ib Hlis 1, thiab nws lub voj voog yog 28 hnub, nws lub sijhawm yuav tsum tuaj rau lub Kaum Ib Hlis 29. Qhov kev ncua sij hawm tuaj yeem tshwm sim los ntawm hormonal tsis ua haujlwm. Kev coj khaub ncaws tom qab lub tshuab nqus tsev yuav tsis zoo dua li niaj zaus, txij li cov mucous daim nyias nyias yuav tsis muaj sijhawm kom rov zoo tag nrho.

Yog hais tias tus poj niam yog "curettage", ces lub tsev menyuam yuav raug mob ntau dua, yog li kev coj khaub ncaws yuav tsis tuaj rau ob lossis ntau lub hlis.

Lub sijhawm no, tus poj niam yuav tsum tau ceev faj tshwj xeeb thiab tiv thaiv nws tus kheej, vim tias lub cev tseem tsis tau npaj rau kev xeeb tub thib ob.

Yog tias koj pom tias koj lub sijhawm tom qab ntxuav tau ntev dua li qhov xav tau thiab zoo li los ntshav, nco ntsoov sab laj nrog kws kho mob, qhov no yuav yog ib qho kev mob tshwm sim.

Nrov lus nug thiab lus teb

Qhov chaw ntawm

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3. Agarkova IA Tsis-tsim cev xeeb tub: kev ntsuam xyuas ntawm cov kev pheej hmoo thiab prognosis // 2010