Mayi Rhesus-nkhondo ndi mwana wosabadwayo pa mimba: tebulo. Timakumana mkangano wa mayi ndi mwana wosabadwayo

Pa mimba anakhudzidwa ndi zifukwa zambiri. Mkulu mavuto amanyamula mayi RH-nkhondo ndi mwana wosabadwayo. Komabe, si aliyense akumvetsa zifukwa zodabwitsazi, zomwe zimabweretsa mantha. Choncho, kudziwa momwe owopsa RH Chinthu ndi pamene pali RH-nkhondo "mayi wosabadwa" ayenera iliyonse mayi woyembekezera.

Rhesus nkhondo - ndichiyani?

Kuti timvetsetsetse chikhalidwe cha vutoli, m'pofunika woyamba kumvetsa kufunika kwa RH china. Ndi mapuloteni yeniyeni, yomwe ili pamwamba erythrocyte. mapuloteni ichi chili mwa mwazi wa 85% ya anthu onse, ndi ena akusowa. Choncho, zofukizira oyamba amaonedwa zabwino Rhesus Chinthu ndi zoipa chachiwiri.

Choncho, amasankha makhalidwe immunological wa chamoyo ndi mwamtheradi zopanda phindu pa thanzi la munthu. RH chinthu akhoza anasankha RH + ndipo Rh-. Kwa nthawi yoyamba mawu anayamba mu 1940 asayansi ndi Aleksandrom Vinerom Karlom Landshteynerom. RH nkhondo mayi ndi mwana wosabadwayo ndi immunological zosagwirizana magazi RH mu ngati ndi mayi zoipa ndi mwana wosabadwayo positive. Kuopsa Rhesus-nkhondo kwagona kuti zingayambitse yoopsa imfa padera, padera. zodabwitsazi angaoneke m'tsogolo mayi RH alibe m'kati gestation ndi pa ntchito. Timakumana mayi ndi nkhondo wosabadwa kumaonekera ngati mwana wosabadwayo anatengera RH + bambo ake.

Zimayambitsa mayi RH-nkhondo ndi mwana wosabadwayo

Mtembo wa m'tsogolo mayi mwana magazi ndi RH + ndi loopsa kwambiri, choncho umabala chitetezo kuti adzatani maselo yoopsa ofiira mbaavunga. Rhesus-nkhondo mayi ndi mwana wosabadwayo anafotokoza transplantsentarnym malowedwe a maselo yoopsa ofiira ndi zabwino RH imayambitsa mwazi wa amayi ndi chizindikiro negative.

nkhondo Immunological kukuchitika chifukwa choti zotsatira za mimba woyamba. Pa gestation Rhesus-nkhondo mwina chifukwa magazi imene chinthu RH si n'komwe, mimba yapita, padera. Komanso RH atakwatirana mwazi sizingathe kulowa mwanayo m'magazi a mayi pobereka, kotero thupi la mayi amakhala atengeke ndi RH chinthu oipa, ndi mosavuta RH-nkhondo pa mimba wachiwiri kuchuluka. Iwo kumaonjezera ngozi ya isoimmunization pa gawo la Kaisara. magazi zosagwirizana akhoza chikwiyire magazi pa mimba ndi kubereka chifukwa cha kuwonongeka kwa latuluka lapansi.

Mwina nkhondo RH gulu magazi

RH Chinthu ndi chibadwa anatsimikiza ndi lalikulu anatengera khalidwe. Ngati mayi ali ndi RH oipa, ndi atate wake pamene homozygosity ndi zabwino, mwana nthawi zonse afika RH +. Pankhaniyi, ngozi za nkhondo ya gulu magazi kwambiri. Tikanena za bambo wa heterozygosity imabwera kufala kwa mwana wosabadwayo RH zoipa kapena zabwino Isometric.

Pa sabata chitatu chitukuko yoopsa pali magazi, imene maselo ofiira ndi digiri yapamwamba ya Mwina akhoza kukodwa mu m'magazi a mayiyo. Chitetezo izi maulendo m'thupi amayi monga yoopsa Antigen imatengedwa mlendo. Choncho, thupi limapanga wapakati RH chitetezo, amene amachititsa RH nkhondo mayi ndi mwana wosabadwayo. Chiopsezo nkhondo immunological ndi laling'ono mokwanira pa gestation ndi 0,8 yekha%, koma ndi oopsa kwambiri, choncho amafuna kuphunzira mwapadera ndiponso kuwaganizira. Kuwulula za mwana RH MAGAZI pa gulu la makolo choti yotani mimba RH-nkhondo. Tebulo bwino chikusonyeza Mwina zosagwirizana magazi.

Zotsatira ndi kumuopseza ndi rhesus nkhondo pa mimba

Timakumana mayi ndi nkhondo wosabadwa ana amakumana ndi mavuto aakulu chifukwa cha mwanayo. The antigens opangidwa ndi thupi mayi, kupeza thupi yachilendo atakwatirana ndi RH chinthu umalowa mu yoopsa magazi kudzera chotchinga ndi gematoplatsentarny kusokoneza hematopoiesis ndondomeko mwana, inhibiting mapangidwe maselo a magazi.

chitetezo Izi khalidwe zingachititse chikhalidwe loopsa kwambiri kwa mwana wosabadwayo, kusokoneza moyo wa mwana, amene amakhala ndi acidosis, hypoxia, magazi m'thupi. Mu thupi la mwanayo amasonkhana yambiri madzimadzi ndi kuphwanya pafupifupi onse ziwalo ndi kachitidwe. Zikatero, ngati miyeso si kutengeramo yake, pali lalikulu chiopsezo padera, imfa yoopsa padera, kubadwa kwa mwana ndi matenda hemolytic kuti adzapitiriza patsogolo chifukwa kudzikundikira mu thupi la kupanga mwana antirhesus oteteza zomwe zinkachititsa kuti mayi ndi mwana wosabadwayo pa mimba . Komanso zingachititse chitukuko cha matenda, amene afotokozedwa mu kuwonjezeka kwambiri mu ziwalo, ubongo, mtima, poizoni chotupa wa chapakati mantha dongosolo.

zizindikiro

RH nkhondo mayi ndi mwana wosabadwayo pa mimba alibe zizindikiro matenda ndi zizindikiro zenizeni. N'zotheka kudziwa vuto kudzera mwa kusanthula zasayansi magazi, zimene zikusonyeza kukhalapo kwa chitetezo ku RH-negative.

Mu yoopsa zosagwirizana magazi kumaonekera chitukuko cha matenda hemolytic za ziwalo ndi machitidwe a thupi, amene kungachititse kuti uwonongedwe panthawi milungu 20-30 mimba, komanso kuti zikamera wa padera padera, yobereka isanakwane.

Komanso, zonse yaitali mwana angaoneke edematous, icteric ndi magazi ochepa mawonekedwe a matenda hemolytic. Rhesus-nkhondo akupezeka mwana wosabadwayo mu maonekedwe magazi a mwana pathologies maselo ofiira magazi a ziwalo. Symptomatology chifukwa cha kuchuluka kwa chitetezo opangidwa ndi mayi thupi. Mu mawonekedwe choopsa cha matenda kumachitika pamene kutupa kwa mwana wosabadwayo - pali kuwonjezeka mu kukula kwa ziwalo zimenezi, a ascites kuwonjezeka nsengwa ndi amniotic madzimadzi buku. kulemera mwanayo akhoza ziwonjezeke kwa kawiri, nthendayo zambiri limodzi ndi edema.

kafukufuku zasayansi

Rhesus-nkhondo "mayi wosabadwa" pa mimba chingalepheretse matenda oyambirira, makamaka mu mawonekedwe a kudziwa bambo RH Chinthu ndi mayi pamaso pa mimba lotsatira kapena kale mawu ake.

Kuneneratu nkhondo Rhesus zachokera deta kuikidwa yapita magazi, otaya ndi zotsatira za mimba woyamba, kupezeka kwa mimba padera, yoopsa imfa m'mimba mwa mayi ake, matenda hemolytic mwana, kupanga izo odalirika mwatsatanetsatane kudziwa Mwina wa chiopsezo isoimmunization.

mayesero Laboratory magazi kudziwa matupi antirhesus ndi maudindo umachitika kwa amayi onse ndi amaganiziridwa mimba RH-nkhondo. Nkhani ayenera kutenga ndi bambo a mwanayo. Ngati imabwera RH-nkhondo ndi mkulu, amayi apakati ziyenera kuyesedwa mwezi uliwonse. Pa 32 TH sabata mayesero zasayansi akutsatiridwa kawiri pa mwezi, pa 36 - mlungu uliwonse mpaka yobereka. Ngati wapezeka mimba RH-nkhondo, kuphunzira adzaona zili chitetezo m'thupi la mayi. The kudwala kale matenda, m'munsi chiopsezo cha matenda oyamba, monga zotsatira za uchembere-nkhondo amasonkhana pa nthawi.

Ultrasound ndi njira olanda za kuwerengetsa zowopseza kwa mwana wosabadwayo

Matenda immunological mkangano wa mayi ndi mwana wosabadwayo mwatsatanetsatane, yotengekatengeka ultrasound nthaŵi zinayi kwa masabata 20 mpaka 36 ya mimba ndi pamaso yobereka. Ultrasound amalola kuti younikira makhalidwe a mwana wosabadwayo, komanso kudziwa kupezeka kwa kuvutika.

phunziro amaweruza chikhalidwe ndi kukula kwa latuluka, ndi yoopsa m'mimba buku, amniotic madzimadzi, umbilical chingwe mitsempha.

njira kafukufuku zina ndinu electrocardiogram, cardiotocography, phonocardiography kuti kulola mwana wosabadwayo kudziwa mlingo wa hypoxia zosemphana rhesus. Kupereka uthenga wofunika olanda ziyenera - kuphunzira madzimadzi amniotic ndi amniocentesis ndi magazi umbilical chingwe ndi cordocentesis. Matenda a madzimadzi amniotic kudziwa matupi titer antirhesus, kugonana kwa mwana, yoopsa ya m'mapapo kukhwima. Mlingo chenicheni cha matenda anapezeka ndi kardotsentoza gulu magazi ndi RH imayambitsa yoopsa magazi chingwe. Komanso kafukufuku akusonyeza pamaso pa mapuloteni whey, hemoglobin, bilirubin, reticulocytes, chitetezo, pa erythrocytes lapansi.

chithandizo

Ngati nkhondo ndi wapezeka mayi ndi yoopsa gulu magazi, pafupifupi yodalirika mankhwala magazi ndi mwana wosabadwayo kudzera m'mitsempha umbilical mkati m'mimba. Ndondomeko anachita m'manja mwa ultrasound. muyeso Zimenezi zimathandiza kuchepetsa matenda a mwana wosabadwayo, kutalikitsa mimba, kuchepetsa zizindikiro za kuchepa magazi, hypoxia.

Pochepetsa zotsatira za uchembere nkhondo mpweya mankhwala ndi ankachititsanso anatumizidwa mlingo nonspecific mankhwala, womwenso mavitamini, kukonzekera ndi okhutira ndi chitsulo, calcium, mankhwala. Ngati mwana wosabadwayo zimawonedwa chikhalidwe aakulu, gawo la Kaisara amachitidwa pa masabata 37-38 mimba. Komanso, amayi apakati kutumikiridwa plasmapheresis, zimene zimachititsa zili chitetezo mu magazi kuti maselo ofiira a mwana wosabadwayo.

Atabadwa mwana anagwira kuikidwa mmalo mwa m'malo erythrocytes wosweka ndi mankhwala matenda hemolytic - dropper yotuluka poizoni m'thupi ndipo kumachepetsa erythrocyte kuwola, walitsa ndi kunyezimira ultraviolet. Chithandizo amafuna tima njira ya mankhwala kuyan'anila neonatologists, nthawi zina mwana aikidwa mu odwala mwakayakaya. Kudyetsa mwana mkaka wam'mawere ali osavomerezeka pa masabata oyambirira 2 atabadwa mu nkhani ya matenda hemolytic.

Genera ndi nkhondo Rhesus

Nthawi zambiri zotsatira za mimba pamaso pa RH-nkhondo - kubadwa msanga. Choncho, ntchito ya madokotala ndi mbali ya kubala ana, mabuku kuwunika ndondomeko zake chitukuko. Kwa matenda pa nyengo yonse ya mimba anagwira ultrasound, Doppler, CTG. Ngati zina kukhala pa ngozi kuti mwana wosabadwayo, chosankha pa kubadwa asanakalambe.

Nthawi zambiri, pamene wobereka nkhondo Rhesus itha gawo la Kaisara. Kubereka mwachibadwa n'zochepa kwambiri ndi pokhapokha ngati chikhalidwe yoopsa ndi zogwira mtima ndi moyo wa mwanayo si pangozi. gawo la Kaisara imatengedwa kwambiri otetezeka ndi aulere kwa mwana wosabadwayo. Pobereka amafuna pamaso pa neonatologists kuchita kuwatsitsimula ngati n'koyenera. Kubereka ayenera kuchitika okonzeka ndi zipangizo zonse zofunikira zachipatala ndi malo kuyang'aniridwa ndi madokotala kwambiri oyenerera.

zodzitetezera

Nkhondo "mayi wosabadwa" pa mimba zingachititse mavuto aakulu chifukwa cha mwanayo. Choncho, kufunika njira zoyezera kwambiri umalimbana kupewa RH-nkhondo ndi isoimmunization chitukuko. Pamene magazi n'kofunika kuganizira ngakhale ndi mwiniwake, m'pofunika kupulumutsa mimba loyamba, komanso kuteteza mimba. Mofanana kwambiri ndi kukonzekera bwino mimbayo. Kuphunzira magulu magazi, RH chinthu chingamulepheretse mimba RH-nkhondo. Table gulu magazi ngakhale kupewa mavuto m'tsogolo. Kuyenera khutu ku njira ya mimba. Monga prophylaxis ntchito mu mnofu jekeseni wa RH immunoglobulin kwa magazi mwiniwake akazi ndi RH alibe ndi kuchuluka chiwopsezo kuti Antigen positive. Zinthu zimenezi wawononga maselo ofiira amene anali abwino kwa chonyamulira RH chinthu, potero kuchepetsa chiopsezo isoimmunization ndi RH nkhondo.

jakisoni The akutsatiridwa pambuyo kuchotsa mimbayo, padera, intrauterine opaleshoni popewa mimba. Komanso, RH m'thupi globulin chikuyendetsedwera kuti amayi apakati a gulu chiopsezo pa masabata 28 ndipo kachiwiri pa 34 kuchepetsa mosavuta chitukuko cha matenda hemolytic wa mwana wosabadwayo. Komanso jakisoni ndi kutumikiridwa mu masiku 2-3 atabadwa, potero kuchepetsa chiopsezo Rhesus-nkhondo mu mimba wotsatira. Immunoglobulin chikuyendetsedwera ndi aliyense mimba, ngati Mwina kubereka mwana ndi zabwino RH china.

Choncho, mayi RH-nkhondo ndi mwana wosabadwayo si chifukwa kuchotsa mimbayo. Mosavuta osauka Rhesus nkhondo ndi yaing'ono kwambiri, choncho palibe chifukwa mtima. Ndiyamika zamakono za immunology pali nthawi amatha kuchita wamphamvu ndi wathanzi mwana.