Hnub no, nyob rau hauv kev kuaj mob ntawm fetal malformations thiab txawv txav thaum lub sijhawm cev xeeb tub, cov cuab yeej siv niaj hnub tau nce zuj zus, uas tso cai rau koj saib qhov teeb meem ntawm sab hauv. Cov cuab yeej ultrasonic yog dav siv hauv kev kuaj mob thiab kev tsom xam ntawm cov kab mob thiab cov xwm txheej ntawm tib neeg lub cev. Cov kev tshawb fawb zoo li no tau nkag mus rau hauv kev kho mob kev coj noj coj ua thiab yog qhov tseem ceeb hauv kev soj ntsuam thiab kev kho mob. Rau cov poj niam cev xeeb tub, ntxiv rau txoj kev tshawb fawb niaj hnub, ib qho ultrasound ntawm tus menyuam hauv plab nrog dopplerometry tau sau tseg. Nov yog ib qho kev coj ua rau txhua qhov chaw kho mob.
Dopplerometry
Thoob plaws tag nrho lub sijhawm yug menyuam, tus poj niam raug tshuaj xyuas nrog lub tshuab ultrasound. Nyob rau theem sib txawv ntawm cev xeeb tub, fetal dopplerometry tau raug sau tseg los ua kev tshawb fawb thiab tiv thaiv kev loj hlob tsis zoo. Dopplerometry yog ib hom ultrasound uas feem ntau ua nyob rau lub hli dhau los ntawm cev xeeb tub, feem ntau nyob rau hauv peb lub hlis twg.
Kev kawm txog ntshav ntws hauvcov hlab ntsha hauv nruab nrab ntawm tus menyuam hauv plab, tsev menyuam, placenta tso cai rau koj los ntsuas cov ntshav ntws thiab lub xeev ntawm cov hlab ntsha tseem ceeb, nrog rau cov hlab ntsha ntawm cov hlab ntsha, uas ua kom lub neej thiab kev noj haus ntawm tus menyuam hauv plab. Yuav kom ua tiav qhov kev tshawb fawb no, xav tau ib lub nozzle tshwj xeeb. Raws li txoj cai, Doppler ultrasound tau ua nrog rau qhov tseem ceeb lossis tuaj yeem muab cais tawm, kev kawm ntxiv los ntawm tus kws kho mob.
Doppler ultrasound teem caij
Dopplerometry tso cai rau koj los txiav txim qhov loj me, txoj kab uas hla thiab qhov chaw ntawm cov hlab ntsha tseem ceeb tsis yog ntawm tus menyuam hauv plab xwb, tab sis kuj ntawm cov placenta, umbilical cord, uterus ntawm poj niam, qhov ceev ntawm cov ntshav ntws los ntawm cov hlab ntsha, thiab tseem ua rau nws tuaj yeem tshawb xyuas lub sijhawm muaj kev ua txhaum cai lossis kev tuag ntawm kev ua haujlwm ntawm cov placenta, uas tuaj yeem ua rau muaj kev cuam tshuam ntau yam teeb meem thaum cev xeeb tub thiab thaum yug menyuam. Yog li ntawd, qhov tseem ceeb ntawm txoj kev tshawb fawb no yuav tsum tsis txhob kwv yees. Yog li, raws sij hawm fetal dopplerometry, deciphering nws cov ntsuas tso cai rau kev tiv thaiv raws sij hawm, txo tus mob thiab tiv thaiv kev pheej hmoo.
Indications rau dopplerometry
Dopplerometry raws li kev tshawb fawb ntxiv yuav tsum tau muab tshuaj yog tias pom muaj kab mob hauv qab no hauv tus poj niam cev xeeb tub:
- Preeclampsia.
- Hypertension.
- Kidney disease.
Thiab tseem tuaj yeem muab tshuaj Doppler fetal rau kev tshawb pom ntxov ntawm kev loj hlob tsis zoo, congenital malformations, kev loj hlob qeeb,oligohydramnios, qhov ua tau ntawm kev loj hlob ntxov ntxov ntawm cov placenta, anomalies nyob rau hauv cov qauv ntawm txoj hlab ntaws los yog congenital chromosomal pathologies, mob plawv tsis xws luag, thiab lwm yam.
Kev kawm ntawm cov hlab ntsha hauv tsev menyuam los ntawm txoj kev Doppler
Dopplerometry ntawm cov hlab ntsha hauv lub tsev menyuam tso cai rau koj los ntsuas lub xeev ntawm lub vascular system ntawm lub tsev menyuam, placenta, interciliary chaw. Qhov tsim ntawm qhov chaw interciliary tshwm sim txawm tias thaum lub sij hawm implantation ntawm embryo, kwv yees li ib lub lis piam tom qab conception. Cov ntshav ncig hauv tsev menyuam ntawm tus poj niam yog ua nrog kev koom tes ntawm ob txoj hlab ntsha: zes qe menyuam thiab uterine. Txawm tias thaum lub sij hawm tsim cov placenta, qee qhov kev hloov pauv tshwm sim hauv cov phab ntsa ntawm cov hlab ntsha, uas tom qab ntawd ua rau lawv txoj kev loj hlob thiab kev nthuav dav nyob rau tib lub sijhawm nrog kev loj hlob ntawm cov placenta. Ua tsaug rau cov txheej txheem no, cov ntshav ntws hauv uteroplacental yog tsim los rau tag nrho kev tsim cov placenta thiab nce 10 zaug.
Uterine hlab ntsha Doppler tso cai rau koj los ntsuas kev ua haujlwm ntawm cov hlab ntsha ntawm cov hlab ntsha, qhov tsim ntawm qhov kawg ntawm qhov pib ntawm 3rd trimester. Thaum muaj teeb meem tshwm sim thaum cev xeeb tub, tsis yog tag nrho cov hlab ntsha tau hloov pauv lub cev, yog li, lawv tsis nthuav thiab tsis loj hlob thaum lub sij hawm placental loj hlob. Yog li, cov hlab ntsha tsis tuaj yeem muab cov ntshav txaus thiab cov ntshav txaus rau lub cev, uas tuaj yeem ua rau nws tuag lossis tsis muaj cov as-ham thiab oxygen. Qhov no, dhau los, tuaj yeem ua rau placental abruption, nchuav menyuam thiab nchuav menyuam.
Doppler: txiav txim siab
Thaum uaDoppler txoj kev tshawb fawb ntawm lub vijtsam ntawm lub tshuab ultrasound qhia cov duab nraaj ntawm kev ceev ntawm cov ntshav ntws los ntawm cov hlab ntsha thaum lub sij hawm txhua lub voj voog, uas txawv hauv systolic thiab diastolic. Txhawm rau nkag siab yav tom ntej yog dab tsi ntawm ceg txheem ntseeg, peb yuav txiav txim siab:
- Systol yog lub siab uas tshwm sim thaum lub plawv cov leeg cog lus.
- Diastole yog lub siab uas tshwm sim thaum lub plawv cov leeg so.
Yog li, rau ib lub plawv dhia, muaj cov cim qhia ntawm systolic thiab diastolic siab hauv cov hlab ntsha. Txhua qhov ntawm cov hlab ntsha uas tau kawm muaj nws tus kheej cov qauv thiab cov yam ntxwv ntawm qhov nkhaus ntawm cov ntshav khiav nrawm.
Cov ntsuas hauv qab no yog siv los ntsuas cov qauv thiab ntsuas ntawm cov ntshav ntws:
- Systole-diastolic ratio.
- Pulse index.
- Resistance index.
Qhov sib piv systolic-diastolic, pulse Performance index thiab qhov ntsuas tsis kam cuam tshuam txog lub xeev ntawm cov hlab ntsha loj thiab aortas thiab cov ntshav ntws hauv lawv, uas yog lub hom phiaj ntawm kev tshawb fawb xws li Doppler. Cov qauv thiab kev sib txawv ntawm lawv cuam tshuam ntau hom kev loj hlob ntawm tus menyuam hauv plab, txiav txim siab cov kab mob cuam tshuam nrog kev cuam tshuam ntawm cov ntshav ntws ntawm cev xeeb tub. Yog li, tus kws kho mob tuaj yeem ntsuas qhov kev ua haujlwm ntawm cov placenta, nws txoj kev muaj peev xwm, muab cov fetus nrog oxygen reserves los ntawm txoj hlab ntaws, nrog rau kev ua tsis zoo hauv kev loj hlob ntawm tus me nyuam hauv plab cuam tshuam nrog kev mob plawv thiab kab mob ntawm cov leeg nqaij.
Doppler: cov cai
rau kev ntsuasCov txiaj ntsig ntawm kev tshawb fawb Doppler siv cov lus tshwj xeeb ntawm cov txiaj ntsig. Lawv qhia tag nrho cov kev cai tso cai ntawm fetal Doppler rau peb qhov ntsuas:
- Systole-diastolic ratio.
- Resistance index.
- Pulse index.
Cov kev tshawb fawb no yuav tsum tau ua rau txhua tus poj niam cev xeeb tub, tab sis qhov no yog qhov tseem ceeb tshwj xeeb tshaj yog rau cov neeg muaj kev pheej hmoo thiab muaj teeb meem ntawm cov ntshav ncig lossis kev tsis zoo ntawm caj ces.
Dopplerometry ntawm cov hlab ntsha hauv plab thiab kev kuaj ultrasound yog muab rau lub sijhawm 23 lub lis piam ntawm cev xeeb tub. Nyob rau lub sijhawm no, cov txheej txheem no tseem ceeb heev rau kev ntsuas qhov kev pheej hmoo ntawm cov teeb meem thiab malformations ntawm cov placenta, uas tuaj yeem ua rau kev xeeb tub. Tab sis cov kev tshawb fawb no tuaj yeem ua tiav los ntawm 13 lub lis piam mus txog thaum kawg ntawm cev xeeb tub. Txhua lub lim tiam muaj nws tus kheej Doppler ntsuas. Tag nrho cov kev tshawb fawb no yog ua los kawm txog peb txoj hlab ntsha loj: umbilical artery, uterine artery, fetal aorta.
Qhov sib piv systolic-diastolic yuav tsum yog 2, 4 lossis tsawg dua los ntawm 20 lub lis piam ntawm cev xeeb tub.
Qhov ntsuas qhov tsis kam yog xam rau txoj hlab ntaws, lub tsev menyuam, thiab cov hlab ntsha hauv nruab nrab. Tus qauv yog:
- rau uterine - tsawg dua lossis sib npaug rau 0.58;
- rau umbilical hlab ntsha - tsawg dua lossis sib npaug rau 0.62;
- rau cov menyuam hauv plab nruab nrab ntawm lub paj hlwb, qhov ntsuas yuav tsum tsawg dua lossis sib npaug rau 0.77.
Tam sim no ib nrab ntawm cev xeeb tub, cov duab no tau xyaumtsis hloov. Thiab thaum kawg ntawm lub sijhawm cev xeeb tub, qhov sib piv systolic-diastolic yuav tsum tsis pub tshaj ob units.
Display values
Fetal Doppler hauv 3rd peb lub hlis twg kawm txog cov ntshav ntws thiab pab txhawb kev ua haujlwm ntawm kev kuaj mob ntxov, kev teem sijhawm ntawm kev tiv thaiv ntawm placental insufficiency, kev kho mob ntawm preeclampsia nrog cov yam ntxwv ntawm cov ntshav ntws hauv cov hlab ntsha hauv lub tsev menyuam. Thaum kuaj pom qhov txo qis hauv qhov nruab nrab diastolic tus nqi, qhov sib piv systolic-diastolic nce ntau, thiab, raws li, lwm qhov ntsuas suav ntawm nws lub hauv paus kuj nce.
Thaum dopplerometry hauv lub semester thib ob thiab thib peb ntawm cev xeeb tub, cov kws kho mob tshwj xeeb tshwj xeeb rau cov hlab ntsha hauv plab. Kev kawm txog cov ntshav ntws nkhaus ntawm cov hlab ntsha hauv nruab nrab ntawm lub plab yog qhov tseem ceeb tom qab lub lim tiam thib kaum ntawm cev xeeb tub. Hauv qhov no, qhov diastolic nam ntawm cov ntshav ntws tsis tuaj yeem kuaj pom txog 14 lub lis piam. Nyob rau hauv ib tug me nyuam mos uas muaj chromosomal anomalies, rov qab diastolic ntshav ntws feem ntau yog kaw rau lub sij hawm ntawm 10-13 lub lis piam.
Nyob rau hauv lub cev xeeb tub tsis yooj yim, qhov sib piv systolic-diastolic tsis tshaj peb units ntawm cov ntshav ntws nkhaus. Lub pathology ntawm kev loj hlob ntawm fetal yog tus cwj pwm los ntawm qhov txo qis hauv qhov kawg-diastolic tshaj tawm mus txog qhov ploj mus.
Los ntawm lub hlis thib tsib thiab ntxiv ntawm cev xeeb tub, qhov ntsuas tseem ceeb tshaj plaws yog cov kev tshawb fawb ntawm cov ntshav hauv plab. Ua ntej ntawm tag nrho cov, lub aorta yog kuaj, thiabnruab nrab cerebral hlab ntsha. Cov txiaj ntsig ntawm cov ntshav ntws no yog tus cwj pwm los ntawm kev kub siab systolic nyob rau hauv lub aorta, feem ntau nrog los ntawm kev txo qis hauv cov txiaj ntsig diastolic. Lawv me me, qhov kev pheej hmoo ntawm pathologies ntau dua. Qhov xwm txheej tsis zoo tshaj plaws yog xoom tus nqi ntawm diastolic tivthaiv.
Rau cov hlab ntsha hauv nruab nrab, kev kho mob hauv cov ntshav tuaj yeem nrog, ntawm qhov tsis sib xws, los ntawm kev nce hauv diastolic tivthaiv, uas, dhau los, yog qhov tshwm sim ntawm cerebral hyperperfusion lossis qhia txog kev loj hlob ntawm fetal hypoxia..
Thaum kuaj ntshav ntws nrawm nrawm hauv cov hlab ntsha hauv cov hlab ntsha, cov systolic peaks nyob feem ntau ntawm feem pua ntawm qhov nkhaus thiab nyob rau tib theem yam tsis muaj qhov tob tob, poob rau diastolic feem ntawm lub sijhawm luv luv tshwm sim. Yog li, tag nrho cov nkhaus yuav luag tsis sib xws nrog tsis muaj qhov ntse ntse peaks. Yog tias qhov siab siab ntawm cov systolic tivthaiv lossis qhov ploj ntawm diastolic siab tau qhia, qhov no yuav qhia tau tias muaj chromosomal pathology ntawm tus menyuam hauv plab, nrog rau qhov pib ntawm fetal hypoxia.
Doppler ultrasound yog li 70% tseeb. Qhov zoo tshaj plaws yog txoj kev tshawb fawb ntawm uteroplacental thiab fetal-placental cov ntshav ntws, uas tuaj yeem yuav luag ib puas feem pua pom ntau yam mob.
Kev Tshawb Fawb Kev Tshawb Fawb
Raws li kev ntsuas ntawm cov ntsuas sib txawv, cov ntsuas ntawm cov ntshav ntws tsis zoo tau muab faib ua qhov sib txawvqib:
- 1 degree yog kev ua txhaum ntawm cov ntshav uteroplacental uas tsis hloov pauv ntawm fetal-placental ntshav ntws los yog ua txhaum ntawm fetal-placental nrog tsis hloov uteroplacental.
- 2 degree - qhov no yog qhov hloov pauv ib zaug thiab ua txhaum ntawm ob hom ntshav ntws, qhov ntsuas uas tsis ncav cuag qhov tseem ceeb, tab sis coj qhov chaw.
- 3 degree yog qhov muaj kev cuam tshuam tseem ceeb hauv cov ntsiab lus ntawm fetal-placental ntshav ntws, tsis hais qhov muaj kev hloov pauv lossis txawm tias ua txhaum me ntsis ntawm cov ntshav ntws hauv uteroplacental.
Kev taw qhia rau kev teem caij Doppler
Fetal Doppler tuaj yeem muab tshuaj ib zaug lossis ob zaug thaum cev xeeb tub tag nrho raws li cov txheej txheem niaj hnub. Qee lub sij hawm nws raug sau ntau zaus. Qhov no tshwm sim yog tias muaj kev pheej hmoo lossis pathologies rau kev loj hlob ntawm tus menyuam hauv plab, lossis yog tias qhov mob ntawm lub tsev menyuam thiab cov placenta xav tau. Muaj cov npe ntawm cov lus qhia uas nws tsuas yog tsim nyog thiab yuav tsum tau mus kawm Doppler:
- Yog leej niam muaj hnub nyoog tshaj 35 los yog qis dua 20 (thaum ntxov los yog lig cev xeeb tub).
- Polyhydramnios thiab oligohydramnios.
- Ib qho kev cuam tshuam ntawm txoj hlab ntaws tau tshwm sim ntawm txoj kev tshawb fawb yav dhau los nrog lub tshuab ultrasound.
- Kev loj hlob Fetal lags qab cov qauv tsim.
- Niam muaj mob hnyav.
- Thaum cev xeeb tub dhau los xaus rau kev nchuav menyuam lossis cov menyuam yug los muaj qhov tsis xws luag lossis tseem yug menyuam.
- Yog tias muaj qhov tsis txaus ntseeg.
- Thaum ntaucev xeeb tub.
- Yog leej niam muaj qhov tsis zoo Rh yam, uas tuaj yeem ua rau fetal rejection yog tias cov hlab ntsha tawg.
- Thaum CTG parameters tsis txaus siab.
- Yog tias muaj mob rau lub plab ntawm tus poj niam cev xeeb tub.
Yog tias muaj kev hem thawj ntawm kev xeeb tub tam sim ntawd, txoj kev tshawb fawb Doppler yuav tsum tau txiav txim siab vim li cas rau qhov kev ntshai ntawd. Nyob rau hauv cov ntaub ntawv no, tus poj niam mus rau lub hnub lub tsev kho mob, qhov twg thawj qhov uas nws ua yog mus kuaj Doppler ultrasound thiab noj cov tshuaj hormonal nyob rau hauv thiaj li yuav tswj lub cev xeeb tub mus txog rau thaum cov nqe lus ntawm uas nws muaj peev xwm mus nqa tawm ib tug nyab xeeb tus me nyuam nrog tsawg heev. txaus ntshai.
Npaj rau kev kawm
Txhawm rau npaj rau kev kawm Doppler, nws raug nquahu kom tus poj niam cev xeeb tub noj zaub mov ob peb teev ua ntej mus ntsib chav ultrasound thiab tom qab ntawd txwv nws tus kheej tsuas yog dej xwb. Txhawm rau pib txoj kev kawm, koj yuav tsum tau pw ntawm lub rooj zaum ze ntawm lub cuab yeej ntawm koj nraub qaum, thaum qhib koj lub plab los ntawm lub hauv siab mus rau puab tais. Ib los yog ntau tshaj ib tee ntawm ib tug tshwj xeeb conductive gel yog siv rau saum npoo ntawm tus poj niam cev xeeb tub lub plab mog, uas yuav pab tau nkag mus rau lub ultrasound teeb liab, thiab ib tug tshwj xeeb sensor yog thov, uas yog smoothly tsav nyob rau hauv lub plab mog.
Fetal Dopplerometry tuaj yeem ua tau ob qho tib si ntawm cov khoom siv dub thiab dawb, thiab ntawm cov khoom siv xim niaj hnub, uas tus kws tshaj lij ultrasound yuav pom cov nkhaus nrog lub ncov qhia qhov kev siv thiab cov qauv lossis kev sib txawv ntawm cov ntshav ntws hauv cov hlab ntsha. Tom qab kev kawm, tus kws kho mob yuav nkag mus rau cov ntaub ntawv tau txais thaum lub sij hawmkev ntsuam xyuas, thiab sau ntawv rau lawv, tom qab ntawd nws yuav muab qhov xaus ntawm Doppler ultrasound rau tes ntawm tus poj niam cev xeeb tub.
Fetal Doppler, ntsuas thiab lawv txhais lus yuav yog ib qho kev pabcuam zoo rau tus kws kho menyuam yaus-gynecologist hauv kev tswj tus poj niam cev xeeb tub, npaj kom muaj kev nyab xeeb thiab saib xyuas cov teeb meem. Kev soj ntsuam ntawm lub xeev ntawm cov kab mob hauv nruab nrog cev thiab tus me nyuam hauv plab nrog kev pab ntawm Doppler kev tshawb fawb tau yooj yim heev thiab tau ua pov thawj nws cov txiaj ntsig thiab kev ntseeg tau ntau xyoo. Ntau thiab ntau cov kev tshawb fawb nyob rau hauv xyoo tas los no tau lees paub qhov kev nyab xeeb ntawm kev tshuaj xyuas siv tshuab ultrasound, tshem tawm qhov muaj feem cuam tshuam rau kev noj qab haus huv ntawm leej niam thiab tus menyuam hauv plab.
