Ukukhulelwa okuphindaphindiwe kuyinkqubo yokuzikhandla lapho izingane ezimbili noma ngaphezulu zikhula khona ngesikhathi esisodwa esibelethweni. Kwenzeka ku-1-1.6% yazo zonke ukukhulelwa. Manje kukhona ukwanda kwezigameko zokukhulelwa okuhlukahlukene, okuhlobene nokusebenza okusebenzayo kobuchwepheshe bokuzala bokusiza.
Izimbangela zokukhulelwa okuningi
Ngokucabangela izici zokukhulelwa okuphindaphindiwe, odokotela bavame ukulalela izimbangela zenzeke. Ngokwezifundo zabo nokubona, lokhu kungase kungenzeki kuwo wonke umama ongase abe khona. Phakathi kwezimbangela ezibangela ukukhulelwa okuningi, odokotela babone lokhu okulandelayo:
- I-Genetic predisposition. Ngokusho kocwaningo lwezakhi zofuzo, abesifazane abaye baba nokukhulelwa okuningi emgqeni wesifazane (kusukela kunogogo, ugogo-ugogo) banamathuba angaphezu kuka-8-8 kunokuba abanye babe ngamama amawele.
- Ubudala. Ngaphansi kwethonya lokulungiswa kwe-hormone premenopausal emva kweminyaka engama-35 kwabesifazane, amaqanda amaningana angavuthwa ngesikhathi sokuya esikhathini, okwandisa amathuba okukhulelwa amawele.
- Ukwamukelwa kwemithi. Ngokuvamile, ngokumelene nesimo sokuthatha izidakamizwa ezibizwa ngokuthi i-hormone (ukwelapha ukungabi nabantwana, ukugqugquzelwa kwe-ovulation), kukhona ukuvuthwa okwenziwa ngesikhathi esisodwa kwamaqanda amaningana angakhulelwa.
- Ubukhona bokuzalwa eziningana ku-anamnesis. Ukukhulelwa okuphindaphindiwe kuvame ukuqoshwa odokotela kwabesifazane abakhulelwe.
- I-IVF. Enkambweni yokukhulelwa kwe- extracorporal , amangqamuzana amaningana ocansi ahlelwa sampuli ngesikhathi esisodwa, okuyinto, emva kokukhulelwa, efakwa esibelethweni. Ithuba lemibungu eminingana elilenga ngesikhathi esisodwa liphakeme.
Ukubeletha amawele
Ekukhulelweni kwamawele angama-dizygotic, amawele avela ekukhanyeni. Ngokuvamile izakhi zofuzo zibhekisela kuzo njenge-raznoyaytsevye. Ukuthuthukiswa kwezithelo ezinjalo kwenzeka ngokufaka umanyolo ngesikhathi esisodwa wama-oocyte amabili ahlukene. Kulesi simo, ukuvuthwa kwala ma-cell cells kungenzeka ku-ovary eyodwa nakuma-ovarie ahlukene. Ukuhlelwa phansi kokuthuthukiswa kwamawele angama-dizygotic kungathola ifa lomthamo womama. Izingane ezizalwa ngenxa yokukhulelwa okunjalo zingabesifazane abangashadile noma bobulili obuhlukile.
Echaza ukukhulelwa kwamawele, okukhethekile kule nqubo, odokotela bayaqaphela ukuthi uma i-raznoyaytseva kabili esibelethweni sikamama, ama-placentas amabili akhiwa njalo. Ngokuvamile baseduze komunye nomunye, baze basithinte, kodwa bangahlala bahlukaniswa. I-embryo ngayinye ifakwe ebusweni elihlukile (fetus), ehlukaniswa i-septum. Kulesi sakhiwo se-anatomiki kunezinhlobo ezimbili ze-chorionic ne-2 amniotic membranes.
Ukukhulelwa ngamawele
Kulesi simo, ukuthuthukiswa kokukhulelwa okuhlukahlukene kubangelwa ukuhlukaniswa kweqanda elilodwa lokubeletha ngezigaba ezahlukene zokuthuthukiswa kwalo. Ukuvama kokuzalwa kwezingane ezinjalo akudluli amacala ama-3-5 ngokuzalwa kwabantu abangu-1000. Ukuhlukaniswa kweqanda elifakwe umquba kuya ezingxenyeni ezimbili ezilinganayo kwesinye sezigaba kungahle kubangelwe ukulibaziseka kokufakelwa, ukwephulwa kwe-acidity nokubunjwa kwe-ionic kwemvelo, kanye nomthelela wezinto zangaphandle emzimbeni.
Ukuthuthukiswa kwamawele angama-monozygotic kungase kube ngenxa yokukhulelwa kwe-ovum, eyayinama-nuclei amabili ngesikhathi esisodwa. Uma ukwehlukaniswa kweqanda elikhulelwe kwenzeka esikhathini esingakapheli izinsuku ezintathu emva kokukhulelwa - izithelo zine-placenta kanye ne-amniotic cavity. Uma uhlukanisa phakathi kwezinsuku ezingu-4-8 kusukela ocansini wesondo, imibungu emibili yakhiwa, ngayinye ibe ne-sac amniotic yayo, kodwa i-placenta ejwayelekile ngamabili.
Uma ukuhlukaniswa kubonakala ngosuku lwesishiyagalolunye nesishiyagalolunye emva kokukhulelwa, imibungu ithola isikhwama esivamile samamniotic kanye ne-placenta eyodwa. Ukuhlukaniswa kweqanda ngosuku 13-15 kungabangela ukukhubazeka okuphelele-okuholela ekuthuthukiseni amawele e-Siamese. Kukhona okungajwayelekile kakhulu - 1:50 000-100 000 amacala okukhulelwa.
Amathuba okukhulelwa okuningi
Ngomqondo wemvelo, amathuba okuba nezingane eziningana ngesikhathi esisodwa sincane - 1.5-2%. Amacala angu-99% lawa mawele, kanti kathathu nezithelo ezingaphezulu azivami kakhulu - ngaphansi kwe-1% yazo zonke izigameko. Ngesikhathi esifanayo, odokotela bathola ukuhlala njalo - kaningi kukhona ukukhulelwa okuningi ne-IVF. Lokhu kusiza ubuchwepheshe bokuzala kuhilela ukufakelwa emkhunjini wesibeletho semibungu eminingi ngesikhathi esisodwa, okungafakwa ngempumelelo. Endabeni yokukhulelwa kwemvelo, ithuba lokuzalwa kwamawele amabili landa emva kweminyaka engama-35.
Izimpawu zokukhulelwa okuningi
Uma ukukhulelwa okuphindwe kabili kukhula, izimpawu ezibonwe ezinyangeni zokuqala azifani nalokho okuqoshwe yowesifazane lapho ethwele ingane eyodwa. Leli qiniso liphinde lenze umbuzo ovame ukwenziwa ngabomama abalindayo abanesithakazelo odokotela, ngesikhathi esingakanani ukukhulelwa okuningi kungenziwa. Ukusebenza kulolu cwaningo yi-ultrasound, okunikeza umphumela wokufundisa futhi kungenziwa masonto onke ama-4-5.
I-ultrasound yokukhulelwa okuningi
Ngaphambi kokuthola ukukhulelwa okuningi ngosizo lwe-ultrasound, udokotela wenza ucwaningo lowesifazane okhulelwe. Ukucabanga ukuthi owesifazane uthwele amawele, ababelethi abanokuhlangenwe nakho bangenza usayizi okhulayo wesibeletho, okungaphezu kwesimiso salesi sikhathi. Ezinye izimpawu zokukhulelwa okuningi azikho. Kuphela lapho kuqhutshwa i-ultrasound emgodini we-uterine, imibungu eminingana ibonakala ngokubonakalayo. Ngokwenza kanjalo, qaphela izici ezibalulekile ezingase zithinte nakakhulu amaqhinga wokudiliva:
- inani le-placenta (ukukhetha);
- inani lama-blister fetal (amniotic).
I-HCG ekukhulelweni okuningi
Izinga le- hCG ekuxilongweni kokukhulelwa okunezinkambu zinezinzuzo ezimbalwa zokufundisa. Ukwanda kwalesi sibonakaliso kungabhekwa njengesibonakaliso se-pathology, ukwephula inqubo yokuthuthukiswa komntwana. Le ndlela ayiqondi ngokugcwele izici ezithile zokukhulelwa okuthile - akunakwenzeka ukucacisa ukuthi owesifazane ukhulelwe kangakanani. Indlela i-hCG ishintsha ngayo cishe ekukhulelweni okuningi ngesonto, ungabona etafuleni elingezansi.
Ukukhulelwa okuningi - izingozi
Ukukhulelwa okuningi kuthinta umzimba okuningi. Ngenxa yalokho, ithuba lokuthuthukisa izidakamizwa ezihlobene nempilo yowesifazane noma ngenqubo yokukhulelwa liphakeme. Ngokuvame ukwenza njalo, izinkinga ezilandelayo zokukhulelwa okuningi zenzeka:
- ukukhulelwa kwesisu esemncane;
- ukulethwa ngaphambi kwesikhathi ;
- ukufa kwe-intrauterine kwesinye sezidakamizwa;
- gestosis sekwephuzile;
- ukuphelelwa kwesifo sangemva kwesisu;
- hypoxia weyodwa noma kokubili izinsana;
- ukubambezeleka ekuthuthukisweni;
- ukuhlanganiswa nokubunjwa kwamawele e-Siamese.
Ukubeletha ngokukhulelwa okuningi
Uma ukukhulelwa okuningi kwenzeka ngokuvamile, izinsana zikhona isikhathi eside, ukulethwa kungenzeka ngendlela engokwemvelo. Uma sicabanga ngezici ezibalulekile zokuqhuba umsebenzi ngesikhathi sokukhulelwa okuningi, odokotela bathi ukwanda kwamathuba okuthuthukisa isidingo sokulethwa kwezimo eziphuthumayo. 3-4 amasonto ngaphambi kosuku olulindelekile lokubeletha, owesifazane ulaliswe esibhedlela, ahlolisise futhi ahlole isimo se-obstetric. Ukuthuthukiswa kungenzeka ngokusho kwesinye sezimo ezilandelayo:
- Uma kwakukhona izinkinga ngesikhathi sokukhulelwa, enye yezingane ezifakiwe zitholakala ngapha nangapha, zombili zinezethulo zomzimba noma kunesifo esibelethweni kusukela ekukhulelwe kwangaphambili - baqhuba isigaba sokuqeda ukuhlela.
- Isimo sokukhulelwa sinelisekile, izinsana zisesimweni eside - zenza ukubeletha kwemvelo.