I-Rhesus-impikiswano phakathi komama ne-fetus ngesikhathi sokukhulelwa: itafula. Ukungqubuzana kwamasosha omama nomntwana

Izinto eziningi zithinta inkathi yokukhulelwa. Izingozi eziphakeme zithwala impi ye-rhesus phakathi komama ne-fetus. Kodwa-ke, akubona wonke umuntu oqonda izimbangela zalesi senzakalo, okubangela ukwesaba ukumiswa. Ngakho-ke, ukwazi ukuthi kuyingozi yini i-Rh factor nokuthi uma kukhona i-Rh-conflict "umama-fetus", wonke umama ozayo uzophoqeleka.

I-Rhesus-impikiswano - iyini?

Ukuze uqonde ukuthi ingqinamba yenkinga, kubalulekile kuqala ukuthi uqonde ukubaluleka kwe-Rh factor. Kuyiprotheni ekhethekile ekhona emangqamuzaneni abomvu egazi. Le phrotheni ikhona egazini lika-85% kubo bonke abantu, kanti abanye abakho. Ngakho-ke, owokuqala kubo bacatshangwa ukuthi banesimo esihle se-Rh factor, kanti lesibili sibi.

Ngakho-ke, inquma izici zokuzivikela komzimba futhi ayithinti impilo yabantu. I-Rhesus factor ngokuvamile ikhethwe i-Rh + ne-Rh-. Ngokokuqala ngqa leli gama laqala ngo-1940 ngabososayensi u-Alexander Wiener noKarl Landsteiner. Ukuphikisana kwe-Rhesus emkhatsini wamama ne-fetus kungavumelani ne-immunological ku-Rh isici segazi uma kwenzeka ukuthi kunomama kumama kanye ne-fetus. Ingozi ye-Rhesus ingxabano ukuthi ingabangela ukufa komntwana, ukubeletha nokukhulelwa kwesisu. Lesi simo singabonakala kumama wesikhathi esizayo one Rh enhle kokubili inqubo yokwelapha isisu, futhi ngesikhathi sokubeletha. Ukungqubuzana kwamagciwane phakathi komama nomntwana kubonakala uma i-fetus izuza iHr + kusuka kubaba.

Izimbangela ze-rhesus-impikiswano phakathi komama ne-fetus

Ngomzimba womama wesikhathi esizayo, igazi lomntwana onamaRh + liyisongelo elibi, ngakho liveza izifo ezithinta amagciwane abomvu we-fetus futhi azibhubhise. I-Rhesus-impikiswano yomama ne-fetus ichazwa ngokufakelwa okufakelwayo kwamaseli abomvu we-fetus nge-Rh factor enhle egazini lika-mama elinenkomba engalungile.

Ukungqubuzana kwempi ngokuyinhloko kubangelwa umphumela wokukhulelwa kokuqala kowesifazane. Ngesikhathi sokubeletha kwe-fetus, ukungqubuzana kwe-Rh kungabangelwa ukumpontshelwa igazi, lapho i-Rh factor engacatshangelwa khona, ukukhipha isisu, ukukhipha isisu. Futhi, i-Rh-engahambisani negazi yengane ingafaka igazi lomama ngesikhathi sokubeletha, ngakho-ke umzimba womama usuke unomthelela omubi we-Rh factor, futhi kungenzeka ukuthi ukwanda kwengxabano ye-rhesus ngesikhathi sokukhulelwa kwesibili kuyanda. Ingozi yokulawulwa kwezimpahla iyanda ngesigaba sokudla. Ukungahambisani negazi kungabangela ukuphuma kwegazi ngesikhathi sokukhulelwa nokubeletha ngenxa yomonakalo obala.

Amathuba okuphikisana kweRhesus ngeGlue Group

I-Rhesus factor iwuphawu oluzuzwa ngokwezakhi zofuzo. Uma unina unama-Rh ombi, futhi ubaba une-homozygousity enhle, umntwana uthola iRh + ngaso sonke isikhathi. Kulesi simo, ingozi yokulwa phakathi kweqembu legazi liphezulu kakhulu. Futhi esimweni se-heterozygosity kababa, amathuba okudluliswa okungalungile noma okwakhiwa ama-Rh emntwaneni uyalingana.

Phakathi nesonto lesishiyagalombili lokuthuthukiswa kwe-fetal, i-hematogenesis ivela, lapho amangqamuzana egazi abomvu atholakala khona ukungena egazini likaMama. Lokhu kuvikela isimiso somzimba sokuvikela omama, ngoba i-antigen fetal ibhekwa njengangaphandle. Ngakho-ke, umzimba wesifazane okhulelwe ukhiqiza ama-antibodies anti -usive, okubangela ukuxabana kwe-rhesus phakathi komama nomntwana. Ingozi yokuphikisana kwama-immunological ngesikhathi sokubeletha incane ngokwanele futhi i-0.8% kuphela, kodwa yingozi kakhulu, ngakho-ke idinga ukutadisha okukhethekile nokunakwa. Ukwembulela cishe iR Rh yengane ezayo ngokuhlaziywa kweqembu legazi labazali kuzovumela ukubikezela ku-Rh rhesus-impikiswano ngesikhathi sokukhulelwa. Itafula libonisa ngokucacile amathuba okungahambisani negazi.

Imiphumela kanye nezinsongo ku-Rh rhesus impikiswano ngesikhathi sokukhulelwa

Ukungqubuzana komzimba phakathi komama nomntwana kubhekene nemiphumela emibi yengane. Ama-antigens akhiqizwa umzimba womama, ethola umzimba wesinye isizwe nge-Rh factor engavumelani, angena emgodleni wegazi wesisu e-barrier hematoplacental futhi abulale inqubo ye-hematopoiesis yengane, evimbela ukwakheka kwamangqamuzana egazi abomvu.

Lokhu ukuziphatha kwama-antibodies kungabangela isimo esiyingozi kakhulu kumntwana obusongela ukuphila kwengane ezayo, ebonakala nge-acidosis, hypoxia, i-anemia. Emzimbeni wengane iqoqa inani eliluhlaza ngokweqile futhi kukhona ukuphazanyiswa ekuthuthukiseni cishe zonke izinhlelo nezinhlaka. Uma izinyathelo zingathathwa ngesikhathi esifanele, kunesisindo esibi sokukhulelwa kwesisu, ukufa komntwana wesisu, ukubeletha kwengane, ukuzalwa kwengane ene-hemolytic disease ezoqhubeka ithuthuka ngokuphathelene nokuqoqwa komzimba wamantombazane omzimba we-antiresusive, ukuthuthukiswa okubangelwa ukungqubuzana phakathi komama nengane ngesikhathi sokukhulelwa . Kungabangela nokudalwa kwamathambo okuthuthukiswa, okuvezwa ngokunyuka ngokweqile kwezitho zangaphakathi, ubuchopho, inhliziyo, umonakalo we-CNS onobuthi.

Izimpawu

U-Rhesus-impikiswano phakathi komama ne-fetus ngesikhathi ukhulelwe ayinayo imiboniso yemitholampilo nezimpawu ezithile. Thola ukuthi inkinga kungenzeka kuphela ngokusebenzisa i-laboratory test blood, ekhombisa ukuthi kukhona ama-antibodies e-Rh factor negative.

Embusweni, ukungahambisani kwegazi kubonakala ekuthuthukiseni isifo se- hemolytic sezitho zangaphakathi kanye nezinhlelo zomzimba, okungaholela ekufeni kwayo kusukela emavikini angu-20-30 okukhulelwa, kanye nokukhulelwa kwesisu, ukubeletha, ukubeletha ngaphambi kwesikhathi.

Ngaphezu kwalokho, ingane egcwele isikhathi sonke ingabonisa uhlobo oluhle lwe-hemolytic pathology, i-icteric ne-anemic. I-Rhesus-impikiswano ebusweni ibonakala ekubukeni egazini lamaseli egazi abomvu abomvu, pathologies yentuthuko yezitho zangaphakathi. I-symptomatology inqunywa inani lama-antibodies akhiqizwa umzimba womama. Esimweni esinzima, lesi sifo senziwa ngokubonakala kokuvuvukala komntwana - kukhona ukwanda ngobukhulu bezitho zangaphakathi, ukubukeka kwe-ascites, ukwanda kwe-placenta nomthamo we-amniotic fluid. Isisindo somntwana singakhula kuze kube izikhathi ezimbili, lesi sifo sivame ukuhambisana ne-dropsy.

Ucwaningo lwelabhu

I-Rhesus-conflict "mama-fetus" ngesikhathi sokukhulelwa ingavimbela ukuxilongwa ngokushesha, ngokuyinhloko ngendlela yokwethula i-Rh factor yebaba nomama ngaphambi kokuqala kokukhulelwa esikhathini esizayo noma ngokwemibandela yayo yokuqala.

Ukuchazwa kwe-Rh-impikiswano isekelwe emininingwaneni yokumpontshelwa igazi ngaphambili, inkambo kanye nomphumela wokukhulelwa kokuqala, ukutholakala kokukhipha isisu, ukukhubazeka, ukufa komntwana ngaphakathi kwesibeletho sikamama, izifo ze-hemolytic yengane, okuvumela ukucacisa ngokunembile amathuba okuba yingozi.

Ukuhlolwa kwegazi le-laboratory ekunqumeni imizimba ephikisanayo kanye nenhloko yenzelwa bonke abesifazane abanezinsolo zokuphikisana ezibhekene ne-rhesus ngesikhathi sokukhulelwa. Ukuhlaziya kufanele kuhanjiswe kubaba wengane. Uma kungenzeka ukuthi kwenzeke i-Rh-impikiswano enkulu, owesifazane okhulelwe kufanele ahlolwe njalo ngenyanga. Kusukela ngesonto lama-32, ukuhlolwa kwelabhutrikhi kwenziwa kabili ngenyanga, futhi kusukela ngeviki lama-36, njalo ngesonto kuze kube sekulethwa. Uma kune-rhesus-impikiswano ekukhulelweni, izifundo zizonquma okuqukethwe kwama-antibodies emzimbeni womama. Ekuqaleni ukutholakala kwegazi kutholakala, kunciphise ingozi yezinkinga, ngoba umphumela we-Rh-izingxabano uqongelela ngokuhamba kwesikhathi.

Izindlela ze-Ultrasound nezingahlaselayo zokuhlolisisa ingozi kumntwana

Ukuze uhlolisise ngokugcwele ukuphikisana kwe-immunological phakathi kwe-fetus nomama, i-ultrasound yenziwa okungenani izikhathi ezine kusukela nge-20 kuya ku-36 ngesonto lokukhulelwa, nangaphambi kokubeletha. I-Ultrasound ingalandelela ukuthuthukiswa kwe-fetus, futhi ihlonze ukuthi kukhona khona i-pathologies.

Esikhathini sesifundo, isimo nesilinganiso se-placenta, ivolumu yesisu lesisu, amniotic fluid, kanye nemithanjeni ehlanjululwayo yentambo yomzimba ihlolwe.

Izindlela ezengeziwe zokuphenya yi-ECG, i-cardiotocography, i-phonocardiography, evumela ukuthi kunqunywe izinga le-fetus le-hypoxia ekuxabaneni kwe-Rh. Ulwazi olubalulekile luhlinzekwa ngezindlela ezingavamile zokuhlola - amniocentesis kanye negazi lomthambo wegazi ngokusebenzisa i-cordocentesis. Ukuxilongwa kwe-amniotic fluid kuvumela ukucacisa isihloko semithi ephikisayo, ubulili bomntwana, ukuvuthwa kwamaphaphu emfusus. Izinga eliqondile lokugula litholakala nge-cardocenosis eqenjini legazi kanye ne-Rh factor emzimbeni wegazi. Ngaphezu kwalokho, ucwaningo lubonisa ukuba khona kwamaprotheni, okuqukethwe kwe-hemoglobin, i-bilirubin, i-reticulocytes, ama-antibodies agxile kumaseli abomvu egazi.

Ukwelapha

Uma kukhona ukungqubuzana phakathi komama ne-fetus eqoqweni legazi, indlela ephumelelayo yokwelapha kuphela ukumpompela ingane nge-veilical vein ngaphakathi kwesibeletho sikamama. Inqubo ilawulwa yi-ultrasound. Isilinganiso esinjalo senza sikwazi ukunciphisa isimo se-fetus, sikhulise isikhathi sokukhulelwa, sinciphise ukubonakaliswa kwe-anemia, hypoxia.

Ukunciphisa umthelela we-Rh-impikiswano, ukwelashwa kwe-oksijeni nakho kwenziwa, ukwelashwa okungekho okuqondile, okufaka amavithamini, amalungiselelo ensimbi, i-calcium, i-antihistamines. Uma ingane isifo esibi kakhulu, isigaba sokudla sikhulelwe amaviki angu 37-38 wokukhulelwa. Futhi, owesifazane okhulelwe unqunywe i-plasmapheresis, evumela ukunciphisa okuqukethwe kwama-antibodies egazini kumaseli abomvu e-fetus.

Ngemuva kokuzalwa, umntwana unikezwa ukumpontshelwa kwegazi endaweni esikhundleni sokuthatha i-erythrocyte ebolile futhi anikeze ukwelashwa kwe-hemolytic pathology - i-droppers esusa izinto ezinobuthi emzimbeni futhi unciphise izinga lokubola kwe-erythrocyte, i-irradiation ne-ultraviolet imisebe. Ukwelashwa kudinga inkambo yokwelashwa eqinisiwe, ukubonwa odokotela be-neonatology, ngezinye izikhathi ingane ibekwa ku-unit unit yokunakekela kakhulu. Ukuncelisa ingane akunconywa phakathi kwamasonto amabili okuqala ngemuva kokuzalwa uma kwenzeka isifo se-hemolytic.

Ukubeletha ne-Rh-impikiswano

Ngokuvamile umphumela wokukhulelwa phambi kwe-Rh-impi - ukuzalwa ngaphambi kwesikhathi. Ngakho-ke, umsebenzi odokotela ukwandisa isikhathi sokubeletha ingane, ukuqapha ngokugcwele ukuthuthukiswa kwengane. Ukuxilongwa kulo lonke isikhathi sokukhulelwa, i-ultrasound, i-dopplerometry, i-CTG. Uma ukubhekwa okunye kubonisa ingozi enkulu emntwaneni, isinqumo senziwa mayelana nokuzalwa ngaphambi kwesikhathi.

Ezimweni eziningi, ukubhekwa kwe-fetus uma kwenzeka ingxabano ye-Rhesus iholela esigabeni sokugcina. Ukuzalwa ngokwemvelo kudlulela ngokweqile kakhulu futhi kuphela uma isimo se-fetus sihlolwa njengokunethezeka futhi impilo yomntwana ingengozini. Isigaba saseKesariya kubhekwa njengesiphephelo kunazo zonke futhi singenalo isisu. Ngesikhathi sokubeletha, ukutholakala kwe-neonatologist kuyadingeka ukufeza ukuvuselelwa uma kunesidingo. Izithiyo kufanele ziqhutshwe ekamelweni elihlomele kahle futhi ngaphansi kokuqondiswa odokotela abaqeqeshiwe kakhulu.

Izinyathelo zokuvimbela

Ukungqubuzana komama nomntwana ngesikhathi sokukhulelwa kungabangela imiphumela embi kwengane. Ngakho-ke, izinyathelo zokuzivikela ezihloswe ekuvimbeleni i-Rhesus-ukungqubuzana kanye nokuthuthukiswa kokuqokwa kwamatshe kubaluleke kakhulu. Ngokumpompela igazi kubalulekile ukucabangela ukuhambisana nomnikeli, kubalulekile ukugcina ukukhulelwa kokuqala, nokuvimbela isisu. Ukuhlela ngokucophelela ukukhulelwa akubalulekile kakhulu. Ukutadisha uhlobo lwegazi, i-Rh factor izovimbela ukulwa kwe-rhesus ngesikhathi sokukhulelwa. Ishadi elihambisana neqembu legazi lisiza ukugwema izinkinga esikhathini esizayo. Ukunakekela kufanele kuthathwe ngenkathi yokukhulelwa. Njengesilinganiso se-prophylactic, umjovo we-antiretuscular immunoglobulin ovela egazini legazi kwabesifazane abane-Rh factor engalungile futhi kusetshenziselwa ukwanda okukhulu kwe-antigen. Lesi sidakamizwa sibhubhisa i-erythrocytes, esivela kumthwali we-Rh factor, ngaleyo ndlela kuncishiswe ukwehliswa kwezimoto kanye nengozi yokuvela kwe-Rh-impikiswano.

Ama-injection ayenziwa ngemva kokukhipha isisu, ukukhubazeka, ukuvimbela ukukhulelwa kwe-intrauterine. I-Antirezus immunoglobulin nayo ihlinzekwa kwabesifazane abakhulelwe engozini ngesonto 28 futhi futhi ukunciphisa amathuba okuthola isifo sofuba lwe-hemolytic. Futhi futhi ukujola kunqunywe phakathi kwezinsuku ezingu-2-3 emva kokubeletha, okuvumela ukunciphisa ingozi ye-Rh-impikiswano ekukhulelweni okulandelayo. I-Immunoglobulin inikezwa njalo ukukhulelwa, uma kungenzeka ukuthi umntwana abe ne-Rh factor ephezulu.

Ngakho-ke, impikiswano ye-Rh phakathi komama nomntwana akuyona ithuba lokukhipha isisu. Amathuba okuthuthukisa i-Rh-impikiswano isincane kakhulu, ngakho-ke asikho isizathu sokuphelelwa ithemba. Ngenxa yokuphumelela kwanamuhla kwe-immunology, kukhona ithuba lokukhuthazelela umntwana oqinile futhi onempilo.