A lokacin daukar ciki, tayin na tasowa a cikin rami kuma yayi wanka a cikin ruwan amniotic. Ya ƙunshi ruwa na 96%, wannan ruwa mai canzawa koyaushe yana ƙunshe da kayan lantarki, abubuwan ma'adinai (sodium, potassium, calcium, trace elements, da sauransu), amino acid, amma har da ƙwayoyin tayi.

Alamar farko na ruwan amniotic ya bayyana jim kadan bayan hadi tare da samuwar ramin mahaifa a rana ta 7. A cikin makonni na farko na juna biyu, amfrayo shine ainihin abin da amfrayo ke ɓoyewa ta hanyar wani sabon yanayi na faɗaɗawar sel (wanda ake kira extravasation). Hakanan mahaifiyar ta ɓoye wani ɗan ƙaramin ɓangaren ruwan ta hanyar motsi na ruwa daga villi na chorionic da ke cikin mahaifa. Koyaya, tsakanin makonni 20 zuwa 25, fatar tayi zata zama mara lalacewa (tsarin keratinization). Sabili da haka, ana tabbatar da ƙimar ruwan amniotic ta hanyar daidaitawa tsakanin abin da tayi (samarwa) da abin da ya haɗiye a cikin utero.

• Rawar ruwa ana yin shi ta hanyoyi biyu:

  -Saikumburin fitsari na tayi kuma musamman diuresis wanda aka kafa da misalin 12-13 WA. Bayan makonni 20, ya zama babban tushen samar da ruwan amniotic wanda ya kai 800 zuwa 1200 ml / 24 hours a ƙarshen ciki (a kan 110 ml / kg / d zuwa 190 ml / kg / d a makonni 25).

  - da ruwan huhu, wanda aka ɓoye daga makonni 18, ya kai 200 zuwa 300 ml / 24h a ƙarshen ciki.

• Abun reabsorption Ruwan amniotic yana yiwuwa godiya ga hadiye jariri mai zuwa. Lallai, tayin yana haɗiye babban ɓangaren ruwan amniotic, wanda hakan ke wucewa ta tsarin narkewar abinci da tsarin numfashi, kafin a watsa shi zuwa ga mahaifiyar uwa da kasancewa, a ƙarshen tseren, kodan uwar gaba .

Godiya ga wannan “sarkar” na samar da ilimin lissafi, ruwan amniotic yana biye da wani sake zagayowar cikin makonni na ciki don dacewa da nauyi da haɓaka jariri mai zuwa:

• Kafin 20 WA, adadin ruwan amniotic a cikin rami a hankali yana ƙaruwa (daga 20 ml a 7 WA zuwa 200 ml a 16 WA),
• Tsakanin makonni 20 da makonni 33-34, ƙarar ta tsaya kusan 980 ml,
• Bayan makonni 34, ƙarar ruwan amniotic yana raguwa, tare da hanzarin abin da ke faruwa zuwa makonni 39, ƙarar ruwan ya kai kusan 800 ml a lokaci.

  Mai canzawa bisa ga matan, ƙarar ruwan amniotic yana tsakanin 250 ml (ƙarancin iyaka) da lita 2 (babban iyaka), don a ce ɗaukar ciki al'ada ce.

Ruwan ruwan amniotic yana taka rawa iri -iri da ke canzawa yayin daukar ciki. Na farko kuma mafi sanannun ayyukansa: kare ɗan da ba a haifa ba daga girgiza da amo.

Amma ruwan amniotic shima yana taimakawa:

• tabbatar da zaman lafiyar yanayin tayin, kula da zazzabi mai ɗorewa da daidaita ƙarar sa ga ci gaban jariri,
• kama bambance -bambancen dandano, haske, ƙamshi ko ji, don haka yana haɓaka yaron a ci gaban azzakarin utero.
• sauƙaƙe motsi na tayin kuma shiga cikin ingantaccen ƙwayar tsoka da ilimin halittar jiki,
• samar da gishirin ruwa da ma'adinai waɗanda jariri na gaba ke buƙata.
• man shafawa, lokacin da membranes ke fashewa, yankin al'aura kuma ta haka suke shirya jiki don wucewar yaro.

Amma ruwan amniotic shima alama ce mai mahimmanci ga lafiyar tayi. Don haka, gwajin don tantance adadin ruwan amniotic shine duban dan tayi. Ana iya ba da shawarar wannan idan mai aikin ya tuhumi rashin daidaituwa a tsayin mahaifa, raguwar motsi na tayi ko ɓarkewar membranes da wuri. Mai sonographer na iya yin amfani da dabaru daban -daban don tantance yiwuwar oligoamnios (raguwa a cikin adadin ruwan amniotic) ko hydramnios (yawan ruwan amniotic, duba ƙasa), wato:

Auna mafi girman tanki a tsaye (CGV)

Har ila yau ana kiranta hanyar Chamberlain, jarrabawar ta ƙunshi binciken duban dan tayi na duk ramin ruwan mahaifa domin gano babban tafkin ruwa (wurin da babu tsangwama tare da memba na tayi ko igiyar ciki). Auna zurfinsa sannan yana jagorantar ganewar asali:

• idan bai wuce 3 cm ba, binciken yana nuna oligoamnios,
• idan ta auna tsakanin 3 zuwa 8 cm, al'ada ce,
• idan ya fi 8 cm girma, yana iya nuna hydramnios.

Ƙididdigar mahaifa (ILA)

Wannan jarrabawar ta ƙunshi raba cibiya zuwa kashi huɗu, sannan aunawa da ƙara zurfin tankokin da aka gano.

• idan bai wuce mm 50 ba, haɗarin oligoamnios yayi yawa,
• idan ta auna tsakanin 50 mm zuwa 180 mm; adadin ruwan amniotic al'ada ne,
• idan ya fi 180 mm, ya kamata a yi la'akari da hydramnios.

Bayan ƙarar ruwan amniotic, mai aikin na iya yin nazarin abubuwan da suka haɗa shi, kamar yadda lamarin yake yayin yin amniocentesis. Manufa: don neman wakili mai kamuwa da cuta idan mahallin yana son kamuwa da cutar tayi ko yin nazarin chromosomes na tayin don gano yuwuwar cututtukan cututtukan asali (farawa da trisomy 21). A zahiri, ruwan amniotic yana ɗauke da ƙwayoyin sel da yawa a cikin dakatarwa, wanda yawansu ya kai kololuwa tsakanin makonni 16 zuwa 20. Noman waɗannan sel yana ba da damar samar da karyotype don haka don tantance daidai haɗarin wasu haɗarin chromosomal.

A lokacin bin bayan haihuwa, mai yin aikin yana ba da kulawa ta musamman ga ƙarar ruwan amniotic ta hanyar auna tsayin mahaifa. Manufa: don warewa ko kula da isasshen (oligoamnios) ko wuce kima (hydramnios) yawan ruwan amniotic, cututtukan guda biyu waɗanda zasu iya haifar da mummunan sakamako akan sakamakon ciki.

L'oligoamnios

L'oligoamnios shine mafi yawan rashin lafiyar ruwan amniotic (tsakanin 0,4 zuwa 4% na ciki). Wannan rashin isasshen ruwan amniotic (kasa da 250 ml) na iya bayyana a lokuta daban -daban yayin daukar ciki kuma yana haifar da matsaloli masu yawa ko seriousasa dangane da matakin ci gaban tayin. Mafi yawan haɗari:

• Pulmonary hypoplasia (dakatar da ci gaban huhu) yana haifar, lokacin haihuwa, gazawar numfashi,
• Anomalies na tsarin musculoskeletal (Tsarin maginin tukwane), jaririn da ba a haifa ba yana iya motsawa cikin utero.
• ɓarkewar ɓarkewar membranes da ke rikitarwa ta hanyar kamuwa da cutar mahaifa-sabili da haka yana ƙara haɗarin haihuwa, shigar da haihuwa ko haihuwa ta sashin tiyata.

Asalinsa: dalilai daban-daban na tayi (lalacewar tsarin koda ko tsarin urinary, anomaly chromosomal), mahaifa (ciwon suga na ciki, kamuwa da cuta ta CMV, da sauransu) ko rashin lafiyar mahaifa (rashin jini-rashin lafiya, rashin isasshen jijiyoyin jijiyoyin jiki, da sauransu). Gudanar da oligoamnios sannan ya dogara da manyan dalilan sa.

L'hydramnios

Thehydramnios yana bayyana yawan ruwan amniotic da ya wuce lita 1 zuwa 2. Wannan anomaly na iya ɗaukar nau'i biyu:

• hydramnios mai saurin jinkiri yawanci yana bayyana a kusan watanni uku na uku na ciki kuma an yarda da shi sosai.
• m hydramnios, mai sauri don shigarwa galibi ana gani a cikin watanni uku na biyu na ciki. Yana tare da alamun asibiti waɗanda galibi ba a jure su ba: ciwon mahaifa, wahalar numfashi, ƙanƙancewa, da sauransu.

 Wannan rashin daidaituwa a cikin adadin ruwan amniotic na iya sake haifar da dalilai daban -daban. Lokacin da asalin asalin mahaifa, hydramnios na iya zama saboda ciwon sukari na haihuwa, pre-eclampsia, kamuwa da cuta (CMV, parvovirus B19, toxoplasmosis) ko rashin jituwa tsakanin Rh tsakanin uwa da yaro. Amma hydramnios kuma za a iya bayyana shi ta rashin isasshen jini ko wasu naƙasasshe na tsarin juyayi na tsakiya ko tsarin narkewar tayin.

Kuma kamar oligoamnios, hydramnios yana gabatar da wani adadin haɗarin rikitarwa: isar da wuri, ɓarkewar membranes da wuri, gabatar da jariri a cikin iska, haihuwar igiya, gefen mahaifa; wasu nakasu a cikin yara, waɗanda suka bambanta gwargwadon tsananin cutar.

Dangane da bambancin abubuwan da ke haddasawa da kuma haɗarin da ke tattare da mahaifa da ɗanta, ana tantance kulawar gwargwadon hali.

• Lokacin da ya fito daga yanayin warkarwa a cikin utero ko bayan haihuwa (anemia, da sauransu), hydramnios shine batun takamaiman magani don ilimin cutar.
• Hakanan ana iya ba da shawarar gudanar da alamomin a wasu lokuta. Daga nan sai mai aikin likitanci ya zaɓi neman magani dangane da anti-prostaglandins don rage diuresis na tayi ko fitar da huhu don takaita haɗarin haihuwa.
• A cikin mawuyacin hali (anamnios), za a iya la'akari da ƙarshen likitanci na ciki bayan tattaunawa da iyaye.

Ruwan amniotic yana kunshe da membranes biyu, amnion da mawaƙa, wanda ke zama ramin mahaifa. Lokacin da suka fashe, suna iya sa ruwa ya kwarara. Sannan muna magana ne game da ruɓewar membranes ko kuma galibi na tsinke jakar ruwa.

• Rushewar membranes a lokaci shine alamar haihuwar haihuwa. Magungunan rigakafin ƙwayoyin cuta kawai don kare yaron daga kamuwa da cutar za a iya ba da shawarar idan ba a fara aiki a cikin awanni 12 da fashewa ba, kuma an tsara shigar da cikin cikin awanni 24 zuwa 48 idan babu ƙanƙarar aiki.
• Rushewar membranes da ke faruwa kafin ajali an ce bai kai ba. Makasudin gudanarwar yana da sauƙi: jinkiri gwargwadon lokacin isar da wuri don isa 37 WA daidai. Biyewa ya haɗa da asibiti har zuwa haihuwa don sauƙaƙe kimantawa na yau da kullun (ƙididdigar kamuwa da cuta, duban dan tayi, sa ido na zuciya), maganin rigakafi don hana yiwuwar kamuwa da tayi, da kuma tushen tushen corticosteroid don hanzarta haɓaka huhu (kafin 30 WA ) na jaririn da ba a haifa ba. Lura, duk da haka: fashewar membranes kafin makonni 22 galibi yana sanya mahimmancin hasashen tayin.