‫ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﻌﺎﻟﻤﻴﯿﺔ ﻟﻠﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﺘﻮﻟﻴﯿﺪ ﻭوﺃأﻣﺮﺍاﺽض ﺍاﻟﻨﺴﺎء‬

‫ﺍاﻟﺪﻟﻴﯿﻞ ﺍاﻟﻌﻤﻠﻲ ﻟﻠﺠﻤﻌﻴﯿﺔ ﻓﻲ ﺇإﺟﺮﺍاء ﺍاﻟﺪﺭرﺍاﺳﺔ ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻟﻠﺠﻨﻴﯿﻦ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ‬

‫ﻟﺠﻨﺔ ﺍاﻟﻤﻌﺎﻳﯾﻴﯿﺮ ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ‬

‫ﺇإﻥن ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﻌﺎﻟﻤﻴﯿﺔ ﻟﻠﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﺘﻮﻟﻴﯿﺪ ﻭوﺃأﻣﺮﺍاﺽض ﺍاﻟﻨﺴﺎء ‪ ISUOG‬ﻫﮬﮪھﻲ ﻣﻨﻈﻤﺔ ﻋﻠﻤﻴﯿﺔ‬ ‫ّ‬
‫ﺗﺸﺠﻊ ﺍاﻟﻤﻤﺎﺭرﺳﺎﺕت ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ ﺍاﻟﺴﻠﻴﯿﻤﺔ‪ ،٬‬ﻭوﺍاﻟﺘﻌﻠﻴﯿﻢ ﻭوﺍاﻟﺒﺤﺚ ﻓﻲ ﻣﺠﺎﻝل ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ ﻭوﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ‬
‫ﺼﺺ ﻟﺠﻨﺔ ﺍاﻟﻤﻌﺎﻳﯾﻴﯿﺮ ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ ﺍاﻟﻤﻨﺒﺜﻘﺔ ﻋﻦ ﻫﮬﮪھﺬﻩه ﺟﻤﻌﻴﯿﺔ ﻓﻲ ﺗﻄﻮﻳﯾﺮ ﺇإﺭرﺷﺎﺩدﺍاﺕت ﺗﻄﺒﻴﯿﻘﻴﯿﺔ ﻭوﺑﻴﯿﺎﻧﺎﺕت‬ ‫ﻟﻠﻨﺴﺎء‪ .‬ﻭوﺗﺘﺨ ّ‬
‫ﺗﻮﺍاﻓﻘﻴﯿﺔ ﺗﺸ ّﻜ ُﻞ ﺗﻮﺻﻴﯿﺎﺕت ﺗﻌﻠﻴﯿﻤﻴﯿﺔ ﺗﺰ ّﻭو ُﺩد ﻣﻘ ّﺪﻣﻲ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ﺑﻤﻘﺎﺭرﺑﺔ ﺗﻮﺍاﻓﻘﻴﯿﺔ ﻟﻠﺘﺼﻮﻳﯾﺮ ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ‪ .‬ﻭوﺗﻌﻜﺲ‬
‫ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﻣﺎ ﺗﺼﻨّﻔﻪﮫ ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺑﺄﻧﻪﮫ ﺃأﻓﻀﻞ ﻁطﺮﻕق ﺍاﻟﻤﻤﺎﺭرﺳﺔ ﻓﻲ ﺧﻼﻝل ﻓﺘﺮﺓة ﺇإﺻﺪﺍاﺭر ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت‪ .‬ﻭوﺑﺎﻟﺮﻏﻢ ﻣﻦ‬
‫ﺃأﻥن ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺑﺬﻟﺖ ﺟﻬﮭﺪﺍاً ﻛﺒﻴﯿﺮﺍاً ﻟﻠﺤﺮﺹص ﻋﻠﻰ ﺃأﻥن ﺗﻜﻮﻥن ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺩدﻗﻴﯿﻘﺔ ﻟﺪﻯى ﺻﺪﻭوﺭرﻫﮬﮪھﺎ‪ ،٬‬ﺇإﻻ ﺃأﻧّﻬﮭﺎ ﻻ ﺗﺘﺤ ّﻤﻞ ﻻ‬
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‫ﻱي ﻣﻦ ﻣﻮﻅظﻔﻴﯿﻬﮭﺎ ﺃأﻭو ﺃأﻋﻀﺎﺋﻬﮭﺎ ﻣﺴﺆﻭوﻟﻴﯿﺔ ﺑﻴﯿﺎﻧﺎﺕت ﺃأﻭو ﺁآﺭرﺍاء ﺃأﻭو ﺗﺼﺮﻳﯾﺤﺎ ﺕت ﻏﻴﯿﺮ ﺩدﻗﻴﯿﻘﺔ ﺃأﻭو ﻣﻀﻠﻠﺔ ﺗﺼﺪﺭر ﻋﻦ‬ ‫ﻫﮬﮪھﻲ ﻭوﻻ ﺃأ ّ‬
‫ﺃأﻥن ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﻤﺬﻛﻮﺭرﺓة ﻏﻴﯿﺮ ﻣﻌﺪﺓة ﻟﺘﺸ ّﻜﻞ ﻣﻌﻴﯿﺎﺭرﺍاً ﻗﺎﻧﻮﻧﻴﯿﺎ ً ﻟﻠﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ ّ‬
‫ﻷﻥن ﺍاﻟﺘﻔﺴﻴﯿﺮﺍاﺕت‬ ‫ﺍاﻟﻠﺠﻨﺔ ﺍاﻟﻤﻌﻨﻴﯿّﺔ‪ .‬ﺫذﻟﻚ ّ‬
‫ﻭوﺍاﻟﺘﺄﻭوﻳﯾﻼﺕت ﺍاﻟﻜﺎﻣﻨﺔ ﻓﻴﯿﻬﮭﺎ ﻗﺪ ﺗﺘﺄﺛﺮ ﺑﻈﺮﻭوﻑف ﺍاﻟﻔﺮﺩد ﻭوﺍاﻟﻤﻮﺍاﺭرﺩد ﺍاﻟﻤﺘﻮﺍاﻓﺮﺓة‪ .‬ﺇإ ّﻥن ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﻤﻌﺘﻤﺪﺓة ﺗُﻮ ّﺯزﻉع ﻣﺠﺎﻧﺎ ً‬
‫ﺑﻤﻮﺍاﻓﻘﺔ ﻣﻦ ﺍاﻟﺠﻤﻌﻴﯿﺔ )‪.(info@isuog.org‬‬

‫ﺍاﻟﻤﻘﺪﻣﺔ‬

‫ﻳﯾﺴﺘﺨﺪﻡم ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي )ﺍاﻷﻣﻮﺍاﺝج ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ( ﻛﺠﺰء ﺭرﻭوﺗﻴﯿﻨﻲ ﻣﻦ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﻄﺒﻴﯿﺔ ﺍاﺛﻨﺎء ﺍاﻟﺤﻤﻞ ﻓﻲ ﺣﺎﻝل‬
‫ﺗﻮﻓﺮ ﺍاﻹﻣﻜﺎﻧﻴﯿﺎﺕت ﻟﺬﻟﻚ ﻭو ﻣﻦ ﺍاﻟﺸﺎﺋﻊ ﺗﻘﺪﻳﯾﻤﻬﮭﺎ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﺜﺎﻧﻲ ﻣﻦ ﺍاﻟﺤﻤﻞ )‪ (1‬ﺍاﻥن ﺯزﻳﯾﺎﺩدﺓة ﺍاﺳﺘﺨﺪﺍاﻡم ﺍاﻟﺘﺼﻮﻳﯾﺮ‬
‫ﺍاﻟﺼﺪﻭوﻱي ﺃأﺛﻨﺎء ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻭو ﺧﺎﺻﺔ ﻓﻲ ﺍاﻷﻣﺎﻛﻦ ﺍاﻟﺘﻲ ﺗﺘﻮﻓﺮ ﻓﻴﯿﻬﮭﺎ ﺍاﻹﻣﻜﺎﻧﻴﯿﺎﺕت ﻟﺬﻟﻚ ﻭو ﺍاﻟﺘﻘﺪﻡم ﺍاﻟﺘﻘﻨﻲ‬
‫ﺍاﻟﺴﺮﻳﯾﻊ ﻭو ﻣﻦ ﺿﻤﻨﻬﮭﺎ ﺍاﻟﻤﺴﺎﺑﺮ ﻋﺎﻟﻴﯿﺔ ﺍاﻟﺬﺑﺬﺑﺎﺕت ﻋﺒﺮ ﺍاﻟﻤﻬﮭﺒﻞ ﺳﻤﺤﺖ ﺑﺎﻟﺤﺼﻮﻝل ﻋﻠﻰ ﺻﻮﺭر ﺻﺪﻭوﻳﯾﻪﮫ ﻋﺎﻟﻴﯿﺔ ﺍاﻟﺪﻗﺔ‬
‫ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻭو ﺗﻄﻮﺭرﺕت ﻟﺪﺭرﺟﺔ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﺗﻘﻴﯿﻢ ﻭو ﻣﺮﺍاﻗﺒﺔ ﺍاﻟﺘﻄﻮﺭرﺍاﺕت ﺍاﻟﺒﺎﻛﺮﺓة ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ‬
‫ﺑﺪﻗﺔ‪ .‬ﺍاﻟﻬﮭﺪﻑف ﻣﻦ ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﻫﮬﮪھﻮ ﺗﻘﺪﻳﯾﻢ ﺍاﻟﻤﻌﺎﻳﯾﻴﯿﺮ ﺍاﻟﺘﻲ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺘﺒﻌﻬﮭﺎ ﻣﻘﺪﻡم ﺍاﻟﺨﺪﻣﺔ ﺍاﻟﺼﺤﻴﯿﺔ‪ .‬ﺇإﻥن ﺍاﻟﺪﺭرﺍاﺳﺔ‬
‫ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﺗﺸﻴﯿﺮ ﺇإﻟﻰ ﺍاﻟﻤﺮﺣﻠﺔ ﻣﻦ ﺍاﻟﺤﻤﻞ ﺍاﻟﺘﻲ ﺗﺄﺗﻲ ﺑﻌﺪ ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺍاﻟﻌﻴﯿﻮﺷﻴﯿﺔ )ﻭوﺟﻮﺩد‬
‫ﻛﻴﯿﺴﺔ ﺣﻤﻞ ﺿﻤﻦ ﺍاﻟﺮﺣﻢ ﻣﻊ ﻭوﺟﻮﺩد ﻓﻌﺎﻟﻴﯿﺔ ﻗﻠﺒﻴﯿﺔ ﻟﻠﺠﻨﻴﯿﻦ( ﻭو ﺣﺘﻰ ﺍاﻷﺳﺒﻮﻉع ‪ 13+6‬ﺃأﺳﺒﻮﻉع ﺣﻤﻠﻲ ‪ .‬ﺍاﻟﺪﺭرﺍاﺳﺔ‬
‫ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﺍاﻟﺘﻲ ﺗﺠﺮﻯى ﺑﻌﺪ ﻫﮬﮪھﺬﻩه ﺍاﻟﻤﺮﺣﻠﺔ ﻻ ﺗﺪﺧﻞ ﺿﻤﻦ ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ‪ .‬ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﻨﺸﺮﺓة ﻧﺤﻦ ﻧﺴﺘﺨﺪﻡم ﻣﺼﻠﺢ‬
‫ﺍاﻟﻤﻀﻐﺔ )‪ (Embryo‬ﻟﻠﻤﺮﺣﻠﺔ ﻣﺎ ﻗﺒﻞ ﺍاﻷﺳﺒﻮﻉع ‪ 10‬ﻣﻦ ﺍاﻟﺤﻤﻞ ﻭو ﻣﺼﻠﺢ ﺟﻨﻴﯿﻦ )‪ (Fetus‬ﻣﻦ ﺑﻌﺪ ﺫذﻟﻚ‪ ,‬ﻟﻴﯿﻌﻜﺲ‬
‫ﺣﻘﻴﯿﻘﺔ ﺃأﻧﻪﮫ ﺑﻌﺪ ﺍاﻷﺳﺒﻮﻉع ﺍاﻟﻌﺎﺷﺮ ﻣﻦ ﺍاﻟﺤﻤﻞ ﻳﯾﻜﻮﻥن ﺗﻜﻮﻥن ﺍاﻷﻋﻀﺎء ﺍاﻷﺳﺎﺳﻲ ﻗﺪ ﺍاﻛﺘﻤﻞ ﻭو ﺍاﻟﺘﻄﻮﺭرﺍاﺕت ﺍاﻟﻼﺣﻘﺔ ﺗﻜﻮﻥن‬
‫ﻓﻲ ﺍاﻟﺠﻨﻴﯿﻦ ﺑﺸﻜﻞ ﺍاﺳﺎﺳﻲ ﻧﻤﻮ ﺍاﻟﺠﻨﻴﯿﻦ ﻭو ﻧﻀﺞ ﺍاﻷﻋﻀﺎء )‪.(2,3‬‬
 ‫ﺍاﻋﺘﺒﺎﺭرﺍاﺕت ﻋﺎﻣﺔ‬

‫ﻣﺎ ﻫﮬﮪھﻲ ﺍاﻟﻐﺎﻳﯾﺔ ﻣﻥن ﺍاﺟﺭرﺍاء ﺍاﻟﺩدﺭرﺍاﺳﺔ ﺍاﻟﺻﺩدﻭوﻳﯾﺔ ﻓﻲ ﺍاﻟﺛﻠﺙث ﺍاﻷﻭوﻝل ﻣﻥن ﺍاﻟﺣﻣﻝل؟‬

‫ﻋﻤﻮﻣﺎ ﺍاﻟﻬﮭﺪﻑف ﻣﻦ ﺇإﺟﺮﺍاء ﺍاﻟﺪﺭرﺍاﺳﺔ ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻫﮬﮪھﻮ ﺗﻘﺪﻳﯾﻢ ﻣﻌﻠﻮﻣﺎﺕت ﺩدﻗﻴﯿﻘﺔ ﺗﺴﻬﮭﻞ ﻣﻦ‬
‫ﺍاﻟﻮﻻﺩدﺓة ﻭو ﺗﺤﺴﻦ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﻄﺒﻴﯿﺔ ﺃأﺛﻨﺎء ﺍاﻟﺤﻤﻞ ﻭو ﺗﻘﺪﻳﯾﻢ ﺃأﻓﻀﻞ ﺍاﻟﻨﺘﺎﺋﺞ ﺍاﻟﻤﻤﻜﻨﺔ ﻟﻜﻞ ﻣﻦ ﺍاﻷﻡم ﻭو ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻓﻲ ﺍاﻟﻤﺮﺣﻠﺔ‬
‫ﺍاﻷﻭوﻟﻰ ﻟﻠﺤﻤﻞ ﻣﻦ ﺍاﻟﻬﮭﺎﻡم ﺗﺄﻛﻴﯿﺪ ﺍاﻟﻌﻴﯿﻮﺷﻴﯿﺔ‪ ,‬ﺗﺤﺪﻳﯾﺪ ﺳﻦ ﺍاﻟﺤﻤﻞ ﺑﺪﻗﺔ‪ ,‬ﻭو ﺗﺤﺪﻳﯾﺪ ﻋﺪ ﺍاﻷﺟﻨﺔ ﻓﻲ ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺘﻌﺪﺩد ﻣﻊ ﺗﻘﻴﯿﻢ‬
‫ﻧﻤﻂ ﺍاﻟﻜﻮﺭرﻳﯾﻮﻧﻴﯿﺔ ﻭو ﺍاﻷﻣﻨﻴﯿﻮﺳﻴﯿﺔ )ﺗﺤﺪﻳﯾﺪ ﻣﺎ ﺇإﺫذﺍا ﻛﺎﻥن ﺣﻤﻞ ﺛﻨﺎﺋﻲ ﺍاﻟﻜﻮﺭرﻳﯾﻮﻥن‪ ,‬ﺍاﺣﺎﺩدﻱي ﺍاﻟﻜﻮﺭرﻳﯾﻮﻥن ﺛﻨﺎﺋﻲ ﺍاﻷﻣﻨﻴﯿﻮﻥن‪,‬‬
‫ﺃأﺣﺎﺩدﻱي ﺍاﻷﻣﻨﻴﯿﻮﻥن(‪ .‬ﺣﺘﻰ ﻧﻬﮭﺎﻳﯾﺔ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻓﺈﻥن ﺍاﻟﺪﺭرﺍاﺳﺔ ﺗﻘﺪﻡم ﻓﺮﺻﺔ ﻟﻜﺸﻒ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻜﺒﺮﻯى ﻟﺪﻯى‬
‫ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻛﻤﺎ ﻳﯾﺘﻢ ﻗﻴﯿﺎﺱس ﺳﻤﺎﻛﺔ ﺍاﻟﻨﻘﺮﺓة )‪ (NT‬ﻓﻲ ﺍاﻷﻧﻈﻤﺔ ﺍاﻟﺼﺤﻴﯿﺔ ﺍاﻟﺘﻲ ﺗﻘﻮﻡم ﺑﺘﻘﺪﻳﯾﻢ ﺍاﻹﻣﻜﺎﻧﻴﯿﺎﺕت ﻟﻜﺸﻒ‬
‫ﺍاﻻﺿﻄﺮﺍاﺑﺎﺕت ﺍاﻟﺼﺒﻐﻴﯿﺔ )‪ .(Aneuploidy screening‬ﻣﻦ ﺍاﻟﻤﻌﺮﻑف ﺃأﻳﯾﻀﺎ ﺑﺄﻥن ﻋﺪﺩد ﻣﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻜﺒﺮﻯى‬
‫ﻳﯾﻤﻜﻦ ﺃأﻥن ﺗﺘﻄﻮﺭر ﻓﻲ ﻣﺮﺣﻞ ﻣﺘﺄﺧﺮﺓة ﻣﻦ ﺍاﻟﺤﻤﻞ ﺃأﻭو ﺍاﻧﻬﮭﺎ ﻻ ﺗﻜﺸﻒ ﺣﺘﻰ ﺑﺎﺳﺘﺨﺪﺍاﻡم ﺃأﺣﺪﺙث ﺍاﻷﺟﻬﮭﺰﺓة ﻭو ﻣﻦ ﻗﺒﻞ ﺃأﻛﺜﺮ‬
‫ﺍاﻷﺧﺼﺎﺋﻴﯿﻴﯿﻦ ﺧﺒﺮﺓة ﺑﺬﻟﻚ‪.‬‬

‫ﻣﺗﻰ ﻳﯾﺗﻡم ﺇإﺟﺭرﺍاء ﺍاﻟﺩدﺭرﺍاﺳﺔ ﺍاﻟﺻﺩدﻭوﻳﯾﺔ ﻓﻲ ﺍاﻟﺛﻠﺙث ﺍاﻷﻭوﻝل ﻣﻥن ﺍاﻟﺣﻣﻝل ؟‬

‫ﻟﻴﯿﺲ ﻫﮬﮪھﻨﺎﻙك ﺃأﻱي ﺩدﺍاﻉع ﻹﺟﺮﺍاء ﺃأﻱي ﺩدﺭرﺍاﺳﺔ ﺻﺪﻭوﻳﯾﺔ ﻓﻘﻂ ﻣﻦ ﺃأﺟﻞ ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺻﺤﺔ ﺍاﻟﺤﻤﻞ ﺑﺪﻭوﻥن ﻭوﺟﻮﺩد ﺃأﻱي ﺃأﺳﺒﺎﺏب‬
‫ﻁطﺒﻴﯿﺔ ﺃأﻭو ﻋﻼﻣﺎﺕت ﻣﺮﺿﻴﯿﺔ ﺃأﻭو ﺍاﺳﺘﻄﺒﺎﺑﺎ ﺧﺎﺹص ﻳﯾﺴﺘﺪﻋﻲ ﺇإﺟﺮﺍاء ﺫذﻟﻚ‪ .‬ﻭو ﻣﻦ ﺍاﻷﻓﻀﻞ ﺃأﻥن ﻧﻨﺼﺢ ﺑﺈﺟﺮﺍاء ﺍاﻟﺪﺭرﺍاﺳﺔ‬
‫ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻟﻠﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﻣﺎ ﺑﻴﯿﻦ ﺍاﻷﺳﺒﻮﻉع ‪ 11‬ﻭو ‪ 13+6‬ﺃأﺳﺒﻮﻉع ﺣﻤﻠﻲ ‪ ,‬ﻓﻔﻲ ﻫﮬﮪھﺬﻩه‬
‫ﺍاﻟﻤﺮﺣﻠﺔ ﻳﯾﺼﺒﺢ ﻣﻦ ﺍاﻟﻤﻤﻜﻦ ﺗﺤﻘﻴﯿﻖ ﺍاﻷﻫﮬﮪھﺪﺍاﻑف ﺍاﻟﺘﻲ ﺫذﻛﺮﻧﺎﻫﮬﮪھﺎ ﺳﺎﺑﻘﺎ ) ﺗﺄﻛﻴﯿﺪ ﺍاﻟﻌﻴﯿﻮﺷﻴﯿﺔ‪ ,‬ﺗﺤﺪﻳﯾﺪ ﺳﻦ ﺍاﻟﺤﻤﻞ ﺑﺪﻗﺔ‪ ,‬ﻋﺪﺩد‬
‫ﺍاﻷﺟﻨﺔ ﻭو ﻧﻤﻂ ﺍاﻟﻜﻮﺭرﻳﯾﻮﻧﻴﯿﺔ ﻭو ﺍاﻷﻣﻨﻴﯿﻮﺳﻴﯿﺔ ﻭو ﺗﻘﻴﯿﻢ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻜﺒﺮﻯى( )‪ .(4-20‬ﻗﺒﻞ ﺍاﻟﺒﺪء ﺑﺎﻟﺪﺭرﺍاﺳﺔ ﻳﯾﺠﺐ ﻋﻠﻰ‬
‫ﺍاﻟﻤﻘﺪﻡم ﺍاﻟﺼﺤﻲ ﺃأﻥن ﻳﯾﻘﺪﻡم ﻟﻠﺤﺎﻣﻞ‪/‬ﺍاﻟﺰﻭوﺟﻴﯿﻦ ﻭو ﻳﯾﺸﺮﺡح ﻛﻼ" ﻣﻦ ﺍاﻟﻔﻮﺍاﺋﺪ ﻭو ﺍاﻹﻣﻜﺎﻧﻴﯿﺎﺕت ﺍاﻟﻤﺤﺪﻭوﺩدﺓة ﻟﻠﺪﺭرﺍاﺳﺔ ﺍاﻟﺼﺪﻭوﻳﯾﺔ‬
‫ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫ﻣﻥن ﻳﯾﺟﺏب ﺃأﻥن ﻳﯾﻘﻭوﻡم ﺑﺈﺟﺭرﺍاء ﺍاﻟﺩدﺍاﺭرﺳﺔ ﺍاﻟﺻﺩدﻭوﻳﯾﺔ ﻓﻲ ﺍاﻟﺛﻠﺙث ﺍاﻷﻭوﻝل ﻣﻥن ﺍاﻟﺣﻣﻝل؟‬

‫ﺇإﻥن ﺍاﻷﺷﺨﺎﺹص ﺍاﻟﺬﻳﯾﻦ ﻳﯾﻘﻮﻣﻮﻥن ﺑﺘﻘﺪﻳﯾﻢ ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﻄﺒﻴﯿﺔ ﻟﻠﺤﻮﺍاﻣﻞ ﻳﯾﺠﺐ ﻭو ﺑﺸﻜﻞ ﺭرﻭوﺗﻴﯿﻨﻲ ﺃأﻥن ﻳﯾﻜﻮﻥن ﻟﺪﻳﯾﻬﮭﻢ ﺍاﻟﺘﺪﺭرﻳﯾﺐ‬
‫ﺍاﻟﻤﻬﮭﻨﻲ ﺍاﻟﻤﻨﺎﺳﺐ ﻹﺟﺮﺍاء ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ ﻟﻠﺴﻴﯿﺪﺍاﺕت ﺍاﻟﺤﻮﺍاﻣﻞ‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫ﻟﺘﺤﻘﻴﯿﻖ ﺃأﻓﻀﻞ ﺍاﻟﻨﺘﺎﺋﺞ ﻣﻦ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻧﺤﻦ ﻧﻘﺘﺮﺡح ﺃأﻥن ﻳﯾﻘﻮﻡم ﺑﻬﮭﺬﺍا ﺍاﻷﺟﺮﺍاء ﺍاﻷﺷﺨﺎﺹص ﺍاﻟﺬﻳﯾﻦ ﻟﺪﻳﯾﻬﮭﻢ ﺍاﻟﻤﻌﺎﻳﯾﺮ‬
‫ﺍاﻟﺘﺎﻟﻴﯿﺔ ‪:‬‬

‫ﻟﺪﻳﯾﻪﮫ ﺍاﻟﺘﺪﺭرﻳﯾﺐ ﺍاﻟﻜﺎﻣﻞ ﻓﻲ ﺍاﺟﺮﺍاء ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي ﺍاﻟﺘﺸﺨﻴﯿﺼﻲ ﻭو ﻣﻌﺎﻳﯾﺮ ﺍاﻟﺴﻼﻣﺔ ﺍاﻟﺨﺎﺻﺔ ﺑﺬﻟﻚ;‬ ‫‪.1‬‬
‫ﻳﯾﺸﺎﺭرﻙك ﻓﻲ ﺍاﻟﺒﺮﺍاﻣﺞ ﺍاﻟﻄﺒﻴﯿﺔ ﺍاﻟﺘﺪﺭرﻳﯾﺒﻴﯿﺔ ﻟﻠﺘﻌﻠﻴﯿﻢ ﺍاﻟﻤﺴﺘﻤﺮ;‬ ‫‪.2‬‬
‫ﺃأﺛﺒﺖ ﺃأﻥن ﻟﺪﻳﯾﻪﮫ ﺍاﻟﻤﻌﺮﻓﺔ ﻓﻲ ﺗﺪﺑﻴﯿﺮ ﻭو ﻣﺘﺎﺑﻌﺔ ﺍاﻟﺤﺎﻻﺕت ﺍاﻟﻤﺸﺘﺒﻪﮫ ﺑﻬﮭﺎ ﻭو ﻏﻴﯿﺮ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ;‬ ‫‪.3‬‬
‫ﺍاﻟﻤﺸﺎﺭرﻛﺔ ﻓﻲ ﺍاﻟﺒﺮﺍاﻣﺞ ﺍاﻟﺨﺎﺻﺔ ﺑﻀﺒﻂ ﻭو ﺗﺄﻣﻴﯿﻦ ﺍاﻟﺠﻮﺩدﺓة )‪.(21‬‬ ‫‪.4‬‬
 ‫ﻣﺎ ﻫﮬﮪھﻲ ﺍاﻷﺟﻬﮭﺯزﺓة ﺍاﻟﺻﺩدﻭوﻳﯾﺔ ﺍاﻟﺗﻲ ﻳﯾﺟﺏب ﺃأﻥن ﺗﺳﺗﺧﺩدﻡم ﻓﻲ ﺍاﻟﺩدﺭرﺍاﺳﺔ ﺍاﻟﺻﺩدﻭوﻳﯾﺔ ﻟﻠﺛﻠﺙث ﺍاﻷﻭوﻝل ﻣﻥن ﺍاﻟﺣﻣﻝل؟‬

‫ﻧﻨﺼﺢ ﺑﺎﺳﺘﺨﺪﺍاﻡم ﺍاﻷﺟﻬﮭﺰﺓة ﺍاﻟﺘﻲ ﺗﻤﻠﻚ ﺍاﻹﻣﻜﺎﻧﻴﯿﺎﺕت ﺍاﻟﺘﺎﻟﻴﯿﺔ‪:‬‬

‫ﺟﻬﮭﺎﺯز ﺗﺼﻮﻳﯾﺮ ﺑﺎﻷﻣﻮﺍاﺝج ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺛﻨﺎﺋﻲ ﺍاﻷﺑﻌﺎﺩد ﺑﺎﻟﺰﻣﻦ ﺍاﻟﺤﻘﻴﯿﻘﻲ ﻟﺴﻠﻢ ﺍاﻟﺘﺪﺭرﺝج ﺍاﻟﺮﻣﺎﺩدﻱي;‬ ‫•‬
‫ﻣﺠﺲ )‪ (Transducer‬ﻋﺒﺮ ﺍاﻟﺒﻄﻦ ﻭو ﻣﺠﺲ ﻋﺒﺮ ﺍاﻟﻤﻬﮭﺒﻞ;‬ ‫•‬
‫ﺇإﻣﻜﺎﻧﻴﯿﺎﺕت ﺍاﻟﺘﺤﻜﻢ ﺑﻤﻘﺪﺍاﺭر ﺍاﻟﻄﺎﻗﺔ ﺍاﻟﺨﺎﺭرﺟﺔ ﻭو ﺇإﻣﻜﺎﻧﻴﯿﺔ ﻋﺮﺽض ﺫذﻟﻚ;‬ ‫•‬
‫ﺇإﻣﻜﺎﻧﻴﯿﺔ ﺗﺠﻤﻴﯿﺪ ﺍاﻟﺼﻮﺓة ﻭو ﺍاﻟﺘﻜﺒﻴﯿﺮ;‬ ‫•‬
‫ﻓﺮﺟﺎﺭرﺍاﻥن ﺍاﻟﻜﺘﺮﻭوﻧﻴﯿﺎﻥن;‬ ‫•‬
‫ﺇإﻣﻜﺎﻧﻴﯿﺔ ﻁطﺒﺎﻋﺔ ﻭو ﺗﺨﺰﻳﯾﻦ ﺍاﻟﺼﻮﺭر;‬ ‫•‬
‫ﺍاﻟﺼﻴﯿﺎﻧﺔ ﻭوﺍاﻟﻤﻌﺎﻳﯾﻨﺔ ﺍاﻟﻤﻨﺘﻈﻤﺘﺎﻥن ﻷﻧﻬﮭﻤﺎ ﺿﺮﻭوﺭرﻳﯾﺘﺎﻥن ﻷﺩدﺍاء ﺍاﻟﺘﺠﻬﮭﻴﯿﺰﺍاﺕت ﺍاﻷﻓﻀﻞ‪.‬‬ ‫•‬

‫ﻛﻴﯿﻒ ﻳﯾﻤﻜﻦ ﺗﻮﺛﻴﯿﻖ ﺍاﻟﺘﺼﻮﻳﯾﺮ؟‬

‫ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻜﻮﻥن ﺍاﻟﺘﻘﺮﻳﯾﺮ ﻋﻠﻰ ﻧﺴﺨﺔ ﺍاﻟﻜﺘﺮﻭوﻧﻴﯿﺔ ﻭو ﺃأﻭو ﻭوﺭرﻗﻴﯿﺔ )‪ .(Appendix‬ﻳﯾﺠﺐ ﺍاﻥن ﺗﺤﻔﻆ ﺍاﻟﻮﺛﺎﺋﻖ ﺑﺸﻜﻞ ﻣﺤﻠﻲ‬
‫ﺿﻤﻦ ﺍاﻟﻘﻮﺍاﻧﻴﯿﻦ ﺍاﻟﻤﺤﻠﻴﯿﺔ ﻋﻠﻰ ﺃأﻥن ﺗﻜﻮﻥن ﻣﺘﻮﻓﺮﺓة ﻟﻠﺴﻴﯿﺪﺓة ﻭو ﺍاﻟﻄﺒﻴﯿﺐ ﺍاﻟﻤﺮﺳﻞ‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫ﻫﮬﮪھﻞ ﻳﯾﻌﺘﺒﺮ ﺍاﻟﺘﺼﻮﻳﯾﺮﺍاﻟﺼﺪﻭوﻱي )ﺍاﻹﻳﯾﻜﻮ( ﺃأﻣﻦ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ؟‬

‫ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻜﻮﻥن ﺗﻌﺮﺽض ﺍاﻟﺠﻨﻴﯿﻦ ﻓﻲ ﺍاﻟﺤﺪ ﺍاﻷﺩدﻧﻰ ﻣﻦ ﺣﻴﯿﺚ ﺍاﻟﻮﻗﺖ ﻭو ﺍاﻟﻄﺎﻗﺔ ﺍاﻟﺼﺎﺩدﺭرﺓة ﻋﻦ ﺍاﻟﻤﺴﺒﺎﺭر ﺑﺎﺳﺘﺨﺪﺍاﻡم ﻣﺒﺪﺃأ‬
‫‪) .(As Low As Reasonably Achievable) ALARA‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫ﺍاﻟﻌﺪﻳﯾﺪ ﻣﻦ ﺍاﻷﺧﺼﺎﺋﻴﯿﻴﯿﻦ ﺍاﻟﻌﺎﻟﻤﻴﯿﻦ ﻭوﻣﻨﻬﮭﻢ ‪ ISUOG‬ﻭوﺻﻠﻮﺍا ﺇإﻟﻰ ﺍاﻟﻘﻨﺎﻋﺔ ﺑﺄﻥن ﺍاﺳﺘﺨﺪﺍاﻡم ﺍاﻷﻣﻮﺍاﺝج ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬
‫ﺑﻄﺮﻳﯾﻘﺔ ‪ B-mode‬ﻭو‪ M-mode‬ﺃأﻣﻦ ﺑﺴﺒﺐ ﻣﺤﺪﻭوﺩدﻳﯾﺔ ﺍاﻟﻄﺎﻗﺔ ﺍاﻟﻨﺎﺗﺠﺔ ﻋﻨﻬﮭﺎ ﻓﻲ ﻛﻞ ﻣﺮﺍاﺣﻞ ﺍاﻟﺤﻤﻞ )‪ .(22,23‬ﻭو‬
‫ﻟﻜﻦ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﺳﺘﺨﺪﺍاﻡم ﺍاﻟﺪﻭوﺑﻠﺮ ﻳﯾﺘﺮﺍاﻓﻖ ﻣﻊ ﺍاﺳﺘﺨﺪﺍاﻡم ﻁطﺎﻗﺔ ﺻﺎﺩدﺭرﺓة ﻋﺎﻟﻴﯿﺔ ﻭو ﺑﺎﻟﺘﺎﻟﻲ ﻣﻊ ﻣﺨﺎﻁطﺮﺓة ﺣﻴﯿﻮﻳﯾﺔ ﻭو ﺧﺎﺻﺔ‬
‫ﻟﺪﻯى ﺗﻄﺒﻴﯿﻘﻬﮭﺎ ﻋﻠﻰ ﺃأﻣﺎﻛﻦ ﺻﻐﻴﯿﺮﺓة ﻣﺤﺪﺩدﺓة ﻣﻬﮭﻤﺔ ﻟﻠﺪﺭرﺍاﺳﺔ )‪ .(24,25‬ﻳﯾﺠﺐ ﺍاﺳﺘﺨﺪﺍاﻡم ﺍاﻟﺪﻭوﺑﻠﺮ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ‬
‫ﺍاﻟﺤﻤﻞ ﻟﺪﻯى ﻭو ﺟﻮﺩد ﺍاﻻﺳﺘﻄﺒﺎﺏب ﺍاﻟﺴﺮﻳﯾﺮﻱي ﻟﺬﻟﻚ‪ .‬ﺍاﻟﻤﺰﻳﯾﺪ ﻣﻦ ﺍاﻟﻤﻌﻠﻮﻣﺎﺕت ﻣﻮﺟﻮﺩدﺓة ﻓﻲ ﻧﺸﺮﺓة ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﺨﺎﺻﺔ‬
‫ﺑﺎﻟﺴﻼﻣﺔ )‪.(22‬‬

‫ﻣﺎﺫذﺍا ﻟﻮ ﻛﺎﻥن ﻣﻦ ﺍاﻟﻤﺘﻌﺬﺭر ﺍاﻟﻘﻴﯿﺎﻡم ﺑﻬﮭﺬﺍا ﺍاﻟﻔﺤﺺ ﺿﻤﻦ ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت؟‬

‫ﻫﮬﮪھﺬﻩه ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺗﻤﺜﻞ ﺍاﻷﺳﺎﺳﻴﯿﺎﺕت ﺍاﻟﻌﺎﻟﻤﻴﯿﺔ ﻷﺟﺮﺍاء ﺍاﻟﺪﺭرﺍاﺳﺔ ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻭو ﻟﻜﻦ ﻳﯾﺠﺐ‬
‫ﺍاﻷﺧﺬ ﺑﻌﻴﯿﻦ ﺍاﻻﻋﺘﺒﺎﺭرﺍاﻟﻈﺮﻭوﻑف ﺍاﻟﻤﺤﻠﻴﯿﺔ ﻭو ﺍاﻟﻄﺒﻴﯿﺔ ﻓﻲ ﺍاﻟﻤﻨﻄﻘﺔ‪ .‬ﻓﻲ ﺣﺎﻝل ﻛﺎﻥن ﻣﻦ ﻏﻴﯿﺮ ﺍاﻟﻤﻤﻜﻦ ﺍاﻟﻘﻴﯿﺎﻡم ﺑﺎﻟﺪﺭرﺍاﺳﺔ‬
‫ﺿﻤﻦ ﻫﮬﮪھﺬﻩه ﺍاﻟﺸﺮﻭوﻁط ﻧﻨﺼﺢ ﺑﺘﻮﺛﻴﯿﻖ ﺍاﻷﺳﺒﺎﺏب ﻟﻌﺪﻡم ﺍاﻟﻘﻴﯿﺎﻡم ﺑﺬﻟﻚ‪ .‬ﻓﻲ ﻣﻌﻈﻢ ﺍاﻟﺤﺎﻻﺕت ﻣﻦ ﺍاﻟﻤﻨﺎﺳﺐ ﺇإﻋﺎﺩدﺓة ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺃأﻭو‬
‫ﺍاﺭرﺳﺎﻝل ﺍاﻟﺤﺎﻣﻞ ﻟﻤﻘﺪﻡم ﺻﺤﻲ ﺃأﺧﺮ ﻭو ﻳﯾﺠﻴﯿﺐ ﺃأﻥن ﻳﯾﺘﻢ ﺫذﻟﻚ ﻓﻲ ﺃأﺳﺮﻉع ﻭوﻗﺖ ﻣﻤﻜﻦ ﻟﺘﺠﻴﯿﺐ ﺍاﻟﻤﺮﻳﯾﻀﺔ ﺍاﻟﺘﻮﺗﺮ ﺍاﻟﻤﺮﺍاﻓﻖ‬
‫ﺍاﻟﺬﻱي ﻗﺪ ﻳﯾﺤﺪﺙث ﻧﺘﻴﯿﺠﺔ ﻋﺪﻡم ﺍاﻟﻮﺻﻮﻝل ﻟﻠﻬﮭﺪﻑف ﺍاﻟﻤﻨﺸﻮﺩد ﻣﻦ ﺍاﻟﻔﺤﺺ ﺍاﻷﻭوﻟﻲ‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬
 ‫ﻣﺎ ﺍاﻟﺬﻱي ﻳﯾﺠﺐ ﺍاﻟﻘﻴﯿﺎﻡم ﺑﻪﮫ ﻓﻲ ﺣﺎﻟﺔ ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺘﻌﺪﺩد؟‬

‫ﺗﺤﺪﻳﯾﺪ ﺍاﻟﻜﻮﺭرﻳﯾﻮﻧﻴﯿﺔ ﻭو ﺍاﻷﻣﻨﻴﯿﻮﺳﻴﯿﺔ ﻳﯾﻌﺘﺒﺮ ﻣﻦ ﺍاﻷﺳﺎﺳﻴﯿﺎﺕت ﻣﻦ ﺃأﺟﻞ ﺍاﻟﻔﺤﺺ ﻭو ﺍاﻟﺘﺪﺑﻴﯿﺮ ﻓﻲ ﺍاﻟﺤﻤﻮﻝل ﺍاﻟﻤﺘﻌﺪﺩدﺓة‪ .‬ﻳﯾﺠﺐ ﺃأﻥن‬
‫ﺗﺤﺪﺩد ﺍاﻟﻜﻮﺭرﻳﯾﻮﻧﻴﯿﺔ ﻓﻲ ﻣﺮﺣﻠﺔ ﻣﺒﻜﺮﺓة ﺣﻴﯿﺚ ﻳﯾﻜﻮﻥن ﺗﺤﺪﻳﯾﺪﻫﮬﮪھﺎ ﺃأﻛﺜﺮ ﻣﺼﺪﺍاﻗﻴﯿﺔ )‪ .(26-28‬ﻣﺎ ﺃأﻥن ﻳﯾﺘﻢ ﺗﺤﺪﻳﯾﺪ ﺫذﻟﻚ ﻳﯾﺤﺪﺩد‬
‫ﺑﻌﺪﻫﮬﮪھﺎ ﻛﻴﯿﻔﻴﯿﺔ ﺍاﻟﻤﺘﺎﺑﻌﺔ ﻭو ﻋﺪﺩد ﻣﺮﺍاﺕت ﺍاﻟﻔﺤﻮﺹص ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﺍاﻟﻼﺯزﻣﺔ ﻭو ﺫذﻟﻚ ﺣﺴﺐ ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﺍاﻟﻤﺤﻠﻴﯿﺔ ﻭو ﺍاﻹﻣﻜﺎﻧﻴﯿﺎﺕت‬
‫ﺍاﻟﻤﺘﻮﻓﺮﺓة‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫ﺍاﻹﺭرﺷﺎﺩدﺍاﺕت ﻹﺟﺭرﺍاء ﺍاﻟﺗﺻﻭوﻳﯾﺭر ﺍاﻟﺻﺩدﻭوﻱي‬

‫‪ .1‬ﺗﻘﻴﯿﻢ ﺍاﻟﻌﻴﯿﻮﺷﻴﯿﺔ ﻓﻲ ﻣﺮﺣﻠﺔ ﻣﺒﻜﺮﺓة ﻣﻦ ﺍاﻟﺤﻤﻞ‬

‫ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻷﺭرﺷﺎﺩدﺍاﺕت ﻳﯾﻜﻮﻥن ﺳﻦ ﺍاﻟﺤﻤﻞ ﺣﺴﺐ ﺳﻦ ﺍاﻟﺤﻤﻞ ﺍاﻟﻄﻤﺜﻲ ﺃأﻭو ﺍاﻟﺤﻤﻠﻲ ﻭو ﻫﮬﮪھﻮ ‪ 14‬ﻳﯾﻮﻡم ﺃأﻛﺒﺮ ﻣﻦ ﺳﻦ ﺍاﻟﺤﻤﻞ‬
‫ﺍاﻟﺘﻠﻘﻴﯿﺤﻲ‪ .‬ﻳﯾﻤﻜﻦ ﻣﺸﺎﻫﮬﮪھﺪﺓة ﺗﻄﻮﺭر ﺍاﻟﺠﻨﻴﯿﻦ ﻋﺒﺮ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي ﻭو ﻳﯾﺘﺸﺎﺑﻪﮫ ﻣﻊ ﻧﻈﺎﻡم ﺗﺼﻨﻴﯿﻒ ﻛﺎﺭرﻳﯾﻨﺠﻲ ﺍاﻟﺨﺎﺹص‬
‫ﺑﺎﻟﻤﻀﻐﺔ ﻟﺪﻯى ﺍاﻹﻧﺴﺎﻥن )‪ .(3‬ﻳﯾﺸﺎﻫﮬﮪھﺪ ﺟﻨﻴﯿﻦ ﺍاﻹﻧﺴﺎﻥن ﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺑﻄﻮﻝل‪ to 1 2‬ﻣﻢ ﺑﺎﻟـﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي ﻭو ﻳﯾﺰﺩدﺍاﺩد‬
‫ﻁطﻮﻟﺔ ﺑﻤﻌﺪﻝل ‪ 1‬ﻣﻠﻢ ﻓﻲ ﺍاﻟﻴﯿﻮﻡم‪ .‬ﻭو ﻻ ﻳﯾﻤﻜﻦ ﺗﻤﻴﯿﺰ ﻗﻄﺒﻲ ﺍاﻟﺠﻨﻴﯿﻦ ﻗﺐ ﻣﺮﻭوﺭر ‪ 53‬ﻳﯾﻮﻡم ﺃأﻱي ﺑﻄﻮﻝل ﺟﻨﻴﯿﻦ ‪ 12‬ﻣﻢ ﺗﻘﺮﻳﯾﺒﺎ ﻭو‬
‫ﺫذﻟﻚ ﻋﻨﺪﻣﺎ ﻳﯾﻈﻬﮭﺮ ﺍاﻟﺘﺠﻮﻳﯾﻒ ﺍاﻟﻤﻌﻴﯿﻨﻲ ﺍاﻟﺸﻜﻞ ﻟﻠﺪﻣﺎﻍغ ﺍاﻟﺒﺪﺋﻲ ) ‪ (Rhombencephal cavity‬ﻭو ﺍاﻟﺬﻱي ﺳﻮﻑف‬
‫ﻳﯾﺘﻄﻮﺭر ﺇإﻟﻰ ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻟﺮﺍاﺑﻊ )‪.(18‬‬

‫ﺗﺤﺪﻳﯾﺪ ﺍاﻟﻌﻴﯿﻮﺷﻴﯿﺔ‬

‫ﺇإﻥن ﻣﺼﻄﻠﺢ ﺍاﻟﻌﻴﯿﻮﺷﻴﯿﺔ ﻳﯾﺸﻴﯿﺮ ﺣﺮﻓﻴﯿﺎ ﺇإﻟﻰ ﺍاﻟﻘﺪﺭرﺓة ﻋﻠﻰ ﺍاﻟﺤﻴﯿﺎﺓة ﺑﺸﻜﻞ ﻣﻨﻔﺼﻞ ﻋﻦ ﺍاﻟﺮﺣﻢ ﻭو ﻫﮬﮪھﺬﺍا ﻻ ﻳﯾﻨﻄﺒﻖ ﻋﻠﻰ‬
‫ﺍاﻟﻤﻀﻐﺔ ﺃأﻭو ﺍاﻟﻤﺮﺍاﺣﻞ ﺍاﻷﻭوﻝل ﻟﺤﻴﯿﺎﺓة ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻟﻜﻦ ﻫﮬﮪھﺬﺍا ﺍاﻟﻤﺼﻄﻠﺢ ﻣﻘﺒﻮﻝل ﻓﻲ ﺻﻒ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﻷﻣﻮﺍاﺝج ﺍاﻟﺼﺪﻭوﻳﯾﺔ ﻭو‬
‫ﻳﯾﺸﻴﯿﺮ ﻟﻤﺸﺎﻫﮬﮪھﺪﺓة ﺍاﻟﻔﻌﺎﻟﻴﯿﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﻭو ﻳﯾﺸﻴﯿﺮ ﺑﺄﻥن ﺍاﻟﺤﻤﻞ ﺣﻲ‪ .‬ﻋﻴﯿﻮﺷﻴﯿﺔ ﺍاﻟﺠﻨﻴﯿﻦ ﻣﻦ ﻭوﺟﻬﮭﺔ ﻧﻈﺮ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي ﺗﻌﻨﻲ‬
‫ﺃأﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﻟﺪﻳﯾﻪﮫ ﻓﻌﺎﻟﻴﯿﺔ ﻗﻠﺒﻴﯿﺔ ﻓﻲ ﻓﺘﺮﺓة ﺇإﺣﺮﺍاء ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي‪ .‬ﺗﺘﻢ ﻣﺸﺎﻫﮬﮪھﺪﺓة ﺍاﻟﻔﻌﺎﻟﻴﯿﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﻟﺪﻯى ﺍاﻟﺠﻨﻴﯿﻦ ﺍاﻟﻄﺒﻴﯿﻌﻲ‬
‫ﺑﺴﻦ ﺣﻤﻞ ‪ 37‬ﻳﯾﻮﻡم ﺣﻤﻠﻲ )‪ ,(29‬ﻭو ﻫﮬﮪھﻲ ﺍاﻟﻔﺘﺮﺓة ﺍاﻟﺘﻲ ﻳﯾﺒﺪﺃأ ﺑﻬﮭﺎ ﺍاﻷﻧﺒﻮﺏب ﺍاﻟﻘﻠﺒﻲ ﻟﻠﻤﻀﻐﺔ ﺑﺎﻟﻨﺒﻀﺎﻥن )‪ . (30‬ﻳﯾﻤﻜﻦ‬
‫ﻣﺸﺎﻫﮬﮪھﺪﺓة ﺍاﻟﻔﻌﺎﻟﻴﯿﺔ ﺍاﻟﻘﻠﺒﻴﯿﺔ ﻟﺪﻯى ﻣﻌﻈﻢ ﺍاﻟﺤﻤﻮﻝل ﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﻁطﻮﻝل ﻣﻀﻐﺔ ‪ 2‬ﻣﻢ ﺃأﻭو ﺃأﻛﺜﺮ )‪ (31‬ﻭو ﻟﻜﻦ ﻫﮬﮪھﻨﺎﻙك ‪10%‬‬
‫‪ 5% to‬ﻣﻦ ﺍاﻷﺟﻨﺔ ﻣﻤﻦ ﻻ ﻳﯾﻨﻄﺒﻖ ﻋﻠﻴﯿﻬﮭﺎ ﺫذﻟﻚ ﻣﺎ ﺑﻴﯿﻦ ﻁطﻮﻝل ‪ 2 - 4‬ﻣﻢ )‪.(32,33‬‬

‫ﺗﺤﺪﻳﯾﺪ ﺍاﻟﺤﻤﻞ ﺩدﺍاﺧﻞ ﺍاﻟﺮﺣﻢ‬

‫ﺇإﻥن ﻭوﺟﻮﺩد ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ ﺩدﺍاﺧﻞ ﺍاﻟﺮﺣﻢ ﻳﯾﻘﻄﻊ ﺍاﻟﺸﻚ ﺑﺎﻟﻴﯿﻘﻴﯿﻦ ﺑﺄﻥن ﺍاﻟﺤﻤﻞ ﺩدﺍاﺧﻞ ﺍاﻟﺮﺣﻢ‪ ,‬ﻟﻜﻦ ﺍاﻟﻤﻌﺎﻳﯾﺮ ﺍاﻟﺘﻲ ﺗﺤﺪﺩد ﻣﺎﻫﮬﮪھﻴﯿﺔ‬
‫ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ ﻏﻴﯿﺮ ﻭوﺍاﺿﺤﺔ ‪ .‬ﺇإﻥن ﺍاﺳﺘﺨﺪﺍاﻡم ﻣﺼﻠﺤﺎﺕت ﻣﺜﻞ ﻛﻴﯿﺲ ﺣﻤﻞ ﻳﯾﺒﺪﻭو ﻓﺎﺭرﻏﺎ ﺃأﻭو ﺣﺘﻰ ﺍاﻟﺤﻠﻘﺔ ﺍاﻟﺴﺎﻗﻄﻴﯿﺔ‬
‫ﺍاﻟﻤﻀﺎﻋﻔﺔ )‪ (Double decidual ring‬ﺃأﻭو ﺣﺘﻰ ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ ﺍاﻟﻜﺎﺫذﺏب ﻟﻴﯿﺲ ﺑﺎﻟﻤﺼﻄﻠﺤﺎﺕت ﺍاﻟﺪﻗﻴﯿﻘﺔ ﺍاﻟﺘﻲ ﺗﺆﻛﺪ ﺃأﻭو‬
‫ﺗﻌﻜﺲ ﻭوﺟﻮﺩد ﺣﻤﻞ ﺩدﺍاﺧﻞ ﺍاﻟﺮﺣﻢ‪ .‬ﻓﻲ ﺍاﻟﻨﻬﮭﺎﻳﯾﺔ ﻳﯾﻜﻮﻥن ﺍاﻟﻘﺮﺍاﺭر ﺑﻮﺟﻮﺩد ﺍاﻟﺤﻤﻞ ﺷﺨﺼﻲ ﻭو ﺑﺎﻟﺘﺎﻟﻲ ﻳﯾﻜﻮﻥن ﺗﺎﺑﻌﺎ ﻟﺨﺒﺮﺓة‬
‫ﺍاﻹﻧﺴﺎﻥن ﺍاﻟﺬﻱي ﻳﯾﻘﻮﻡم ﺑﺎﻟﻔﺤﺺ ﺍاﻟﺼﺪﻭوﻱي‪ .‬ﻓﻲ ﺍاﻟﺤﺎﻻﺕت ﻏﻴﯿﺮ ﺍاﻟﻌﺮﺿﻴﯿﺔ ﻳﯾﺴﺘﺤﺴﻦ ﺍاﻷﻧﺘﻈﺎﺭر ﺣﺘﻰ ﻳﯾﺼﺒﺢ ﺍاﻟﺠﻨﻴﯿﻦ‬
‫ﻣﺸﺎﻫﮬﮪھﺪﺍا ﺩدﺍاﺧﻞ ﺍاﻟﻜﻴﯿﺲ ﺍاﻟﺤﻤﻠﻲ ﺣﻴﯿﺚ ﻳﯾﺆﻛﺪ ﻫﮬﮪھﺬﺍا ﺑﺄﻥن ﺍاﻟﻜﻴﯿﺲ ﺍاﻟﻤﺸﺎﻫﮬﮪھﺪ ﻫﮬﮪھﻮ ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬
 ‫‪ .2‬ﺍاﻟﻘﻴﯿﺎﺳﺎﺕت ﺍاﻟﺒﺎﻛﺮﺓة ﻓﻲ ﺍاﻟﺤﻤﻞ‬

‫ﺗﻢ ﻭوﺻﻒ ﻗﻴﯿﺎﺱس ﻣﺘﻮﺳﻂ ﻗﻄﺮ ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ )‪ (MSD‬ﺑﺪﺃأ ﻣﻦ ﺍاﻟﻴﯿﻮﻡم ‪ 35‬ﻣﻦ ﺃأﺧﺮ ﺩدﻭوﺭرﺓة ﻁطﻤﺜﻴﯿﺔ‪ .‬ﻭو ﻣﺘﻮﺳﻂ ﻗﻄﺮ‬
‫ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ ‪ MSD‬ﻫﮬﮪھﻮ ﻭوﺳﻄﻲ ‪ 3‬ﺃأﻗﻄﺎﺭر ﻣﺘﻌﺎﻣﺪﺓة ﻟﻠﻜﻴﯿﺲ ﺍاﻟﻤﻤﺘﻠﺊ ﺑﺎﻟﺴﺎﺋﻞ ﺩدﺍاﺧﻞ ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ )‪ .(34‬ﺇإﻥن‬
‫ﺍاﻟﻤﺨﻄﻄﺎﺕت ﺍاﻟﺨﺎﺻﺔ ﺑﻜﻞ ﻣﻦ ﻗﻴﯿﺎﺱس ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ ﻭو ﻁطﻮﻝل ﺍاﻟﺠﻨﻴﯿﻦ ‪ CRL‬ﻣﺘﻮﻓﺮﺓة ﻭو ﻟﻜﻦ ﺑﻮﺟﻮﺩد ﺍاﻟﺠﻨﻴﯿﻦ ﻳﯾﻜﻮﻥن‬
‫ﻗﻴﯿﺎﺱس ‪ CRL‬ﺍاﻟﺬﻱي ﻳﯾﻌﻜﺲ ﺩدﻗﺔ ﺃأﻛﺒﺮ ﻓﻲ ﺗﻘﺪﻳﯾﺮ ﺳﻦ ﺍاﻟﺤﻤﻞ ﻣﻘﺎﺭرﻧﺔ ﻣﻊ ﻗﻴﯿﺎﺱس ﻛﻴﯿﺲ ﺍاﻟﺤﻤﻞ ﺍاﻟﺬﻱي ﻳﯾﺘﻔﺎﻭوﺕت ﺑﺸﻜﻞ ﻛﺒﻴﯿﺮ‬
‫ﻓﻲ ﺗﺤﺪﻳﯾﺪ ﺳﻦ ﺍاﻟﺤﻤﻞ )‪.(35,36‬‬

‫‪ .3‬ﻗﻴﯿﺎﺳﺎﺕت ﺍاﻟﺠﻨﻴﯿﻦ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ‬

‫ﻣﺎ ﻫﮬﮪھﻲ ﺍاﻟﻘﻴﯿﺎﺳﺎﺕت ﺍاﻟﺘﻲ ﻳﯾﺠﺐ ﺇإﺟﺮﺍاﺅؤﻫﮬﮪھﺎ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ؟‬

‫ﻗﻴﯿﺎﺱس ﻁطﻮﻝل ﺍاﻟﺠﻨﻴﯿﻦ ‪ CRL‬ﻳﯾﻤﻜﻦ ﺃأﻥن ﻳﯾﺘﻢ ﻣﻦ ﺧﻼﻝل ﺍاﻟﺘﺼﻮﻳﯾﺮ ﻋﺒﺮ ﺍاﻟﺒﻄﻦ ﺃأﻭو ﻋﺒﺮ ﺍاﻟﻤﻬﮭﺒﻞ‪ .‬ﻳﯾﺘﻢ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ‬
‫ﻣﻘﻄﻊ ﺳﻬﮭﻤﻲ ﻋﻠﻰ ﻛﺎﻣﻞ ﻁطﻮﻝل ﺍاﻟﺠﻨﻴﯿﻦ ﻭوﺍاﻷﻣﺜﻞ ﺃأﻥن ﻳﯾﻜﻮﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﺑﻮﺿﻊ ﺃأﻓﻘﻲ ﻋﻠﻰ ﺍاﻟﺸﺎﺷﺔ‪ ,‬ﺗﻜﺒﺮ ﺍاﻟﺼﻮﺭرﺓة ﺑﻌﺪﻫﮬﮪھﺎ‬
‫ﺑﺸﻜﻞ ﻛﺎﻓﻲ ﺣﻴﯿﺚ ﺗﻤﻠﺊ ﻣﻌﻈﻢ ﻋﺮﺽض ﺍاﻟﺸﺎﺷﺔ ﻭو ﻳﯾﺸﻜﻞ ﺧﻂ ﺍاﻟﻘﻴﯿﺎﺱس ﺍاﻟﻘﻤﻲ ﺍاﻟﺬﻳﯾﻠﻲ ‪ CRL‬ﺯزﺍاﻭوﻳﯾﺔ ‪ 90‬ﺩدﺭرﺟﺔ ﻣﻊ‬
‫ﺷﻌﺎﻉع ﺍاﻷﻣﻮﺍاﺝج ﺍاﻟﺼﻮﺗﻴﯿﺔ )‪ .(37,38‬ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺘﻢ ﺍاﻟﻘﻴﯿﺎﺱس ﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﺑﻮﺿﻊ ﻣﺤﺎﻳﯾﺪ )ﺃأﻱي ﺃأﻧﻪﮫ ﻟﻴﯿﺲ ﻣﻨﻌﻄﻔﺎ‬
‫ﻋﻠﻰ ﻧﻔﺴﻪﮫ ﺃأﻭو ﻣﻔﺮﻁط ﺍاﻟﺒﺴﻂ(‪ .‬ﻭو ﻳﯾﺠﺐ ﺃأﻥن ﺗﻜﻮﻥن ﻧﻬﮭﺎﻳﯾﺘﻲ ﺍاﻟﺮﺃأﺱس ﻭو ﺍاﻟﺬﻳﯾﻞ ﻟﻠﺠﻨﻴﯿﻦ ﻭوﺍاﺿﺤﺘﻴﯿﻦ‪ .‬ﻳﯾﺠﻴﯿﺐ ﺗﺠﻨﺐ ﻭوﺟﻮﺩد‬
‫ﻋﻨﺎﺻﺮ ﺃأﺧﺮﻯى ﻓﻲ ﺍاﻟﺼﻮﺭرﺓة ﻣﺜﻞ ﺍاﻟﻜﻴﯿﺲ ﺍاﻟﻤﺤﻲ‪ .‬ﻭو ﻣﻦ ﺃأﺟﻞ ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺃأﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﻟﻴﯿﺲ ﺑﻮﺿﻌﻴﯿﺔ ﻓﺮﻁط ﻋﻄﻒ‬
‫ﻳﯾﺠﻴﯿﺐ ﺃأﻥن ﺗﺘﻢ ﻣﺸﺎﻫﮬﮪھﺪﺓة ﺍاﻟﺴﺎﺋﻞ ﻣﺎ ﺑﻴﯿﻦ ﺩدﻗﻦ ﺍاﻟﺠﻨﻴﯿﻦ ﻭو ﺻﺪﺭرﻩه )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(1‬ﻳﯾﻜﻮﻥن ﺫذﻝل ﺻﻌﺒﺎ ﻓﻲ‬
‫ﺍاﻟﻤﺮﺣﻠﺔ ﻣﺎ ﺑﻴﯿﻦ ﺍاﻷﺳﺒﻮﻉع ‪ 6-9‬ﻣﻦ ﺍاﻟﺤﻤﻞ ﺣﻴﯿﺚ ﻳﯾﻜﻮﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﻣﻨﻌﻄﻔﺎ ﻋﻠﻰ ﻧﻔﺴﻪﮫ ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﺤﺎﻟﺔ ﻓﺈﻥن ﺍاﻟﻘﻴﯿﺎﺳﺎﺕت‬
‫ﺗﻤﺜﻞ ﺍاﻟﻄﻮﻝل ﺍاﻟﺮﻗﺒﻲ ﺍاﻟﺬﻳﯾﻠﻲ ﻭو ﻟﻜﻦ ﻧﺒﻘﻲ ﻋﻠﻰ ﺍاﻟﻤﺼﻄﻠﺢ ﺍاﻟﻘﻤﻲ ﺍاﻟﺬﻳﯾﻠﻲ ‪ . CRL‬ﻓﻲ ﺍاﻟﻤﺮﺍاﺣﻞ ﺍاﻟﺒﺎﻛﺮﺓة ﻣﻦ ﺍاﻟﺤﻤﻞ ﻻ‬
‫ﻳﯾﻤﻜﻦ ﻋﺎﺩدﺓة ﺗﻤﻴﯿﻴﯿﺰ ﺍاﻟﻘﻄﺐ ﺍاﻟﻘﻤﻲ ﻣﻦ ﺍاﻟﻘﻄﺐ ﺍاﻟﺬﻳﯾﻠﻲ ﻟﺬﻟﻚ ﻧﻠﺠﺄ ﻋﺎﺩدﺓة ﺇإﻟﻰ ﺃأﻁطﻮﻝل ﻗﻴﯿﺎﺱس ﻧﺤﺼﻞ ﻋﻠﻴﯿﻪﮫ‪.‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪: 1 :1‬ﺟﻧﻳﯾﻥن ﺑﻁطﻭوﻝل ﻗﻣﻲ ﺫذﻳﯾﻠﻲ ‪ 60 CRL‬ﻣﻠﻡم‪ 12 +3 ,‬ﺍاﺳﺑﻭوﻉع ﺣﻣﻠﻲ‪ .‬ﻻﺣﻅظ ﺍاﻟﻭوﺿﻌﻳﯾﺔ ﺍاﻟﻣﻌﺗﺩدﻟﺔ ﺃأﻭو ﺍاﻟﺣﻳﯾﺎﺩدﻳﯾﺔ ﻟﺭرﻗﺑﺔ ﺍاﻟﺟﻧﻳﯾﻥن‪.‬‬
‫ﻗﻴﯿﺎﺱس ﺍاﻟﻘﻄﺮ ﻣﺎ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ ‪ BPD‬ﻭو ﻣﺤﻴﯿﻂ ﺍاﻟﺮﺃأﺱس ‪ HC‬ﻭو ﻳﯾﻜﻮﻥن ﻓﻲ ﺃأﻛﺒﺮ ﻣﻘﻄﻊ ﻣﺤﻮﺭرﻱي ﻣﺘﻨﺎﻅظﺮ ﺣﻘﻴﯿﻘﻲ‬
‫ﻳﯾﻤﻜﻦ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻴﯿﻪﮫ ﻟﺮﺍاﺱس ﺍاﻟﺠﻨﻴﯿﻦ ﻭو ﻻ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻜﻮﻥن ﻣﺸﻮﺷﺎ ﺑﻮﺟﻮﺩد ﺃأﻋﻀﺎء ﻗﺮﻳﯾﺒﺔ ﺃأﻭو ﺑﺴﺒﺐ ﺿﻐﻂ ﺍاﻟﻤﺴﺒﺎﺭر‬
‫ﻋﻠﻰ ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻓﻲ ﺍاﻷﺳﺒﻮﻉع ﺍاﻟﻌﺎﺷﺮ ﻣﻦ ﺍاﻟﺤﻤﻞ ﻳﯾﻤﻜﻦ ﻣﺸﺎﻫﮬﮪھﺪﺓة ﺍاﻟﻌﻨﺎﺻﺮ ﺍاﻟﺘﺎﻟﻴﯿﺔ ﻋﻠﻰ ﺍاﻟﺨﻂ ﺍاﻟﻤﺘﻮﺳﻂ ﻟﻠﺮﺃأﺱس‪ :‬ﺍاﻟﺒﻄﻴﯿﻦ‬
‫ﺍاﻟﺜﺎﻟﺚ‪ ,‬ﺍاﻟﺜﻠﻢ ﺃأﻭو ﺍاﻟﺸﻖ ﻣﺎ ﺑﻴﯿﻦ ﻧﺼﻒ ﻛﺮﺗﻴﯿﻦ ﺍاﻟﺪﻣﺎﻍغ‪ ,‬ﺍاﻟﻀﻔﺎﺋﺮ ﺍاﻟﻤﺸﻴﯿﻤﻴﯿﺔ ﻳﯾﺠﺐ ﺃأﻥن ﺗﻜﻮﻥن ﻭوﺍاﺿﺤﺔ‪ .‬ﻣﻦ ﺍاﻷﺳﺒﻮﻉع ‪13‬‬
‫ﻳﯾﺸﻜﻞ ﻛﻞ ﻣﻦ ﺍاﻟﻮﻁطﺎء ﻭو ﺍاﻟﺒﻄﻴﯿﻦ ﺍاﻟﺜﺎﻟﺚ ﻋﻼﻣﺔ ﻭوﺍاﺿﺤﺔ‪ .‬ﻳﯾﺘﻢ ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺍاﻟﻤﺤﻮﺭر ﻭو ﺍاﻻﺗﺠﺎﻩه ﺑﺄﻥن ﻳﯾﺸﻜﻞ ﻓﻲ ﺍاﻟﺼﻮﺭر‬
‫ﻛﻞ ﻣﻦ ﺍاﻟﻘﺮﻳﯾﻨﺎﺕت ﺍاﻷﻣﺎﻣﻴﯿﺔ ﻟﻠﺒﻄﻴﯿﻨﺎﺕت ﺍاﻟﺠﺎﻧﺒﻴﯿﺔ ﻭوﺍاﻟﻔﺼﺎﻥن ﺍاﻟﻘﺬﺍاﻟﻴﯿﺎﻥن ﻟﻠﺪﻣﺎﻍغ ﺍاﻻﻋﻠﻰ ﻣﻦ ﺍاﻟﻤﻘﻄﻊ ﺍاﻟﺨﺎﺹص‬
‫ﺑﺎﻟﻤﺨﻴﯿﺦ )‪. (1,38-41‬‬

‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻘﻴﯿﺎﺱس ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻦ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻮﺿﻊ ﺍاﻟﻔﺮﺟﺎﺭرﺍاﻥن ﺍاﻹﻟﻜﺘﺮﻭوﻧﻴﯿﺎﻥن ﺃأﻭو ﺍاﻟﻤﺆﺷﺮﺍاﻥن ﺑﺤﺴﺐ ﺍاﻟﻤﺨﻄﻄﺎﺕت‬
‫ﺍاﻟﻤﺨﺘﺎﺭرﺓة ﻭو ﻳﯾﻜﻦ ﺍاﺳﺘﺨﺪﺍاﻡم ﺃأﻱي ﻣﻦ ﺍاﻟﻄﺮﻳﯾﻘﺘﻴﯿﻦ‪ :‬ﻣﻦ ﺍاﻟﺨﺎﺭرﺝج ﻟﻠﺪﺍاﺧﻞ ﺃأﻭو ﺍاﻟﺨﺎﺭرﺝج ﻟﻠﺨﺎﺭرﺝج )‪) (1,39,42,43‬ﺍاﻟﺮﺳﻢ‬
‫ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪.(2‬‬

‫ﻗﻴﯿﺎﺳﺎﺕت ﺃأﺧﺮﻯى‬

‫ﻫﮬﮪھﻨﺎﻟﻚ ﺍاﻟﻌﺪﻳﯾﺪ ﻣﻦ ﺍاﻟﻤﺨﻄﻄﺎﺕت ﺍاﻟﺨﺎﺻﺔ ﺑﻘﻴﯿﺎﺱس ﻣﺤﻴﯿﻂ ﺍاﻟﺒﻄﻦ ‪ AC‬ﻭو ﻁطﻮﻝل ﺍاﻟﻔﺨﺬ ﻭو ﻣﻌﻈﻢ ﺃأﻋﻀﺎء ﺍاﺍاﻟﺠﻨﻴﯿﻦ ﻭوﻟﻜﻦ ﻻ‬
‫ﻳﯾﻮﺟﺪ ﺳﺒﺐ ﻟﻘﻴﯿﺎﺱس ﻛﻞ ﺗﻠﻚ ﺍاﻷﻋﻀﺎء ﺃأﺛﻨﺎء ﺍاﻟﺪﺭرﺍاﺳﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ‪.‬‬

‫‪ .4‬ﺗﻘﻴﯿﻢ ﺳﻦ ﺍاﻟﺤﻤﻞ‬

‫ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻌﺮﺽض ﻋﻠﻰ ﺍاﻟﺴﻴﯿﺪﺓة ﺍاﻟﺤﺎﻣﻞ ﺇإﺟﺮﺍاء ﺍاﻟﺘﺼﻮﻳﯾﺮ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻣﺎ ﺑﻴﯿﻦ ﺍاﻷﺳﺒﻮﻉع ‪ 10‬ﻭو ‪13+6‬‬
‫ﻭو ﺫذﻟﻚ ﻣﻦ ﺃأﺟﻞ ﺗﺤﺪﻳﯾﺪ ﺳﻦ ﺍاﻟﺤﻤﻞ ﺑﺪﻗﺔ ﻋﺎﻟﻴﯿﺔ )ﺗﻮﺻﻴﯿﺎﺕت ﺩدﺭرﺟﺔ ﺃأ(‪.‬‬

‫ﻳﯾﺤﺪﺩد ﺳﻦ ﺍاﻟﺤﻤﻞ ﺑﺎﺳﺘﺨﺪﺍاﻡم ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺍاﻟﺼﺪﻭوﻱي ﺿﻤﻦ ﺍاﻟﻤﻌﻄﻴﯿﺎﺕت ﺍاﻟﺘﺎﻟﻴﯿﺔ‪:‬‬

‫ﺳﻦ ﺍاﻟﺤﻤﻞ ﺍاﻟﻄﻤﺜﻲ ﺃأﻭو ﺍاﻟﺤﻤﻠﻲ ﻭو ﻳﯾﻤﺜﻞ ﺍاﻟﺘﺎﺭرﻳﯾﺦ ﺑﻌﺪ ﺍاﻟﺤﻤﻞ ‪ 14 +‬ﻳﯾﻮﻡم‬ ‫•‬
‫ﺣﺠﻢ ﺍاﻟﺠﻨﻴﯿﻦ ﻭو ﺍاﻟﻤﻀﻐﺔ ﻧﺴﺒﺔ ﻟﺴﻦ ﺍاﻟﺤﻤﻞ ﺍاﻟﺘﻠﻘﻴﯿﺤﻲ‬ ‫•‬
‫ﻗﻴﯿﺎﺱس ﺍاﻷﻋﻀﺎء ﺍاﻟﻄﺒﻴﯿﻌﻲ‬ ‫•‬
‫ﺗﻘﻨﻴﯿﺔ ﺍاﻟﻘﻴﯿﺎﺱس ﺍاﻟﻤﺴﺘﺨﺪﻣﺔ ﺗﻜﻮﻥن ﺗﺒﻌﺎ ﻟﻤﺨﻄﻄﺎﺕت ﺍاﻟﻨﻤﻮ ﺍاﻟﻤﺨﺘﺎﺭرﺓة‬ ‫•‬
‫ﺍاﻟﻘﻴﯿﺎﺳﺎﺕت ﻣﻮﺛﻮﻗﺔ ﻭو ﻳﯾﻌﺘﻤﺪ ﻋﻠﻴﯿﻬﮭﺎ ﻣﻦ ﻗﺒﻞ ﺍاﻟﻤﺮﺍاﻗﺒﻴﯿﻦ ﻭو ﺑﻴﯿﻦ ﺑﻌﻀﻬﮭﻢ‬ ‫•‬
‫ﺟﻬﮭﺎﺯز ﺍاﻟﺘﺼﻮﻳﯾﺮﺍاﻟﻤﺴﺘﺨﺪﻡم ﺣﻴﯿﺚ ﺗﻜﻮﻥن ﻣﻌﺎﻳﯾﻴﯿﺮﻩه ﻣﺒﺮﻣﺠﻪﮫ ﺑﺸﻜﻞ ﺩدﻗﻴﯿﻖ‬ ‫•‬

‫ﺇإﻥن ﺗﺤﺪﻳﯾﺪ ﺳﻦ ﺍاﻟﺤﻤﻞ ﺍاﻟﺪﻗﻴﯿﻖ ﻟﻪﮫ ﺃأﻫﮬﮪھﻤﻴﯿﺔ ﻛﺒﻴﯿﺮﻩه ﻓﻲ ﺍاﻟﻤﺘﺎﺑﻌﺔ ﺍاﻟﻼﺣﻘﺔ ﻟﻠﺤﻤﻞ ﻭو ﺗﺤﺪﻳﯾﺪ ﺳﻦ ﺍاﻟﺤﻤﻞ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻣﻦ‬
‫ﺍاﻟﺤﻤﻞ ﻣﻦ ﺃأﻭوﻟﻰ ﺍاﻻﺳﺘﻄﺒﺎﺑﺎﺕت ﻹﺟﺮﺍاﺋﻪﮫ‪ .‬ﻭوﻫﮬﮪھﻮ ﻳﯾﻘﺪﻡم ﻣﻌﻠﻮﻣﺎﺕت ﻫﮬﮪھﺎﻣﺔ ﻣﻦ ﺃأﺟﻞ ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﻤﺜﺎﻟﻲ ﻟﻨﻤﻮ ﺍاﻟﺠﻨﻴﯿﻦ ﻓﻲ ﻣﺮﺣﻠﺔ‬
‫ﻣﺘﻘﺪﻣﺔ ﻣﻦ ﺍاﻟﺤﻤﻞ‪ ،٬‬ﻭوﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﻨﺴﺎﺋﻴﯿﺔ ﺑﻮﺟﻪﮫ ﻋﺎﻡم ﻭوﺇإﺩدﺍاﺭرﺓة ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺒﻜﺮ ﻭوﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺘﺄﺧﺮ ﺗﺤﺪﻳﯾﺪﺍاً )‪ .(44,45‬ﻻ‬
‫ﻳﯾﻤﻜﻦ ﺗﺤﺪﻳﯾﺪ ﺗﺎﺭرﻳﯾﺦ ﻳﯾﻮﻡم ﺗﻜﻮﻳﯾﻦ ﺍاﻟﺠﻨﻴﯿﻦ ﺑﺪﻗﺔ ﺗﺎﻣﺔ ﺇإﻻ ﻓﻲ ﺣﺎﻻﺕت ﺍاﻟﺤﻤﻞ ﺍاﻟﻨﺎﺷﺌﺔ ﻋﻦ ﺗﻜﻨﻮﻟﻮﺟﻴﯿﺔ ﺍاﻟﻤﺴﺎﻋﺪﺓة ﻋﻠﻰ‬
‫ﺍاﻻﻧﺠﺎﺏب ﻟﺬﺍا ﻳﯾﺒﻘﻰ ﺗﺤﺪﻳﯾﺪ ﺗﺎﺭرﻳﯾﺦ ﺍاﻟﺤﻤﻞ ﻣﻦ ﺧﻼﻝل ﺍاﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻟﻮﺳﻴﯿﻠﺔ ﺍاﻷﺩدﻕق ﻭوﺍاﻷﻛﺜﺮ‬
‫ﻣﻮﺛﻮﻗﻴﯿﺔ ﻟﺘﺤﺪﻳﯾﺪ ﻋﻤﺮ ﺍاﻟﺤﻤﻞ )‪ .(39,46‬ﻣﻦ ﻫﮬﮪھﻨﺎ‪ ،٬‬ﻳﯾُﻨﺼﺢ ﺑﺄﻥن ﺗﺨﻀﻊ ﻛﺎﻓﺔ ﺍاﻟﻨﺴﺎء ﺍاﻟﺤﻮﺍاﻣﻞ ﺇإﻟﻰ ﻣﺴﺢ ﺑﺎﻟﻤﻮﺟﺎﺕت‬
‫ﺍاﻟﻔﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻣﺒﻜﺮ ﺑﻴﯿﻦ ﺍاﻷﺳﺎﺑﻴﯿﻊ ﺍاﻟﻌﺸﺮ ﻣﻦ ﺍاﻟﺤﻤﻞ ﻭو ﺍاﻷﺳﺎﺑﻴﯿﻊ ﺍاﻟﺜﻼﺙث ﻋﺸﺮ)‪ 10+0‬ﺇإﻟﻰ ‪ (13+6‬ﻟﺘﺤﺪﻳﯾﺪ ﻋﻤﺮ‬
‫ﺍاﻟﺤﻤﻞ ﻭوﻛﺸﻒ ﺣﺎﻻﺕت ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺘﻌﺪﺩدﺓة )‪ .(47‬ﻓﻔﻲ ﺍاﻟﻔﺼﻞ ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﺗﺮﺗﺒﻂ ﻣﻌﺎﻳﯾﻴﯿﺮ ﻋﺪﺓة ﺑﻌﻤﺮ ﺍاﻟﺤﻤﻞ ﺇإﻻ‬
‫ﺃأﻥن ‪ CRL‬ﻳﯾﻜﻮﻥن ﺍاﻷﻛﺜﺮ ﺩدﻗﺔ ﺇإﺫذ ﻳﯾﺴﻤﺢ ﺑﺘﺤﺪﻳﯾﺪ ﺯزﻣﻦ ﺣﺪﻭوﺙث ﺍاﻟﺤﻤﻞ ﺧﻼﻝل ﻓﺘﺮﺓة ‪ 5‬ﺃأﻳﯾﺎﻡم ﺑﺪﻗﺔ ‪ %95‬ﻣﻦ ﺍاﻟﺤﺎﻻﺕت‬
‫)‪.(48-52‬‬

‫ﻓﻲ ﺍاﻟﻤﺮﺍاﺣﻞ ﺍاﻟﺒﺎﻛﺮﺓة ﻣﻦ ﺍاﻟﺤﻤﻞ ﺣﻴﯿﺚ ﻳﯾﻜﻮﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﺻﻐﻴﯿﺮ ﻧﺴﺒﻴﯿﺎ ﻓﺈﻥن ﺍاﻷﺧﻄﺎء ﻓﻲ ﺍاﻟﻘﻴﯿﺎﺳﺎﺕت ﺳﻮﻑف ﺗﺆﺛﺮ ﺑﺸﻜﻞ‬
‫ﻛﺒﻴﯿﺮ ﻋﻠﻰ ﺗﻘﻴﯿﻢ ﺳﻦ ﺍاﻟﺤﻤﻞ ﻭو ﺍاﻟﺘﻮﻗﻴﯿﺖ ﺍاﻟﻤﺜﺎﻟﻲ ﻟﺘﺤﺪﻱي ﺳﻦ ﺍاﻟﺤﻤﻞ ﻳﯾﻜﻮﻥن ﻣﺎ ﺑﻴﯿﻦ ﺍاﻷﺳﺒﻮﻉع ﺍاﻟﺜﺎﻣﻴﯿﻦ ﻭو ﺍاﻷﺳﺒﻮﻉع‬
‫‪ 13+6‬ﺍاﺳﺒﻮﻉع ﺣﻤﻠﻲ )‪) . (48‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :2‬ﺭرﺃأﺱس ﺍاﻟﺟﻧﻳﯾﻥن‪ :‬ﺻﻭوﺭرﺓة )ﺃأ( ﺍاﻟﻘﻁطﺭر ﻣﺎ ﺑﻳﯾﻥن ﺍاﻟﺟﺩدﺍاﺭرﻳﯾﻳﯾﻥن ‪ . BPD‬ﺍاﻧﺗﺑﻪﮫ ﻟﻠﻣﺣﻭوﺭر ﺍاﻟﺣﻘﻳﯾﻘﻲ ﻋﺑﺭر ﺍاﻟﺧﻁط ﺍاﻟﻣﺗﻭوﺳﻁط ﻟﺭرﺃأﺱس ﺍاﻟﺟﻧﻳﯾﻥن ﻭو ﺍاﻟﺗﻭوﺿﻊ‬
‫ﺍاﻟﻣﺭرﻛﺯزﻱي ﻟﻠﺑﻁطﻳﯾﻥن ﺍاﻟﺛﺎﻟﺙث ﻋﻠﻰ ﺍاﻟﺧﻁط ﺍاﻟﻣﺗﻭوﺳﻁط ﻭو ﺍاﻟﻌﻧﺎﺻﺭر ﺍاﻷﺧﺭرﻯى ﻋﻠﻰ ﺍاﻟﺧﻁط ﺍاﻟﻣﺗﻭوﺳﻁط ) ‪ T‬ﺗﺷﻳﯾﺭر ﻟﻠﺑﻁطﻳﯾﻥن ﺍاﻟﺛﺎﻟﺙث ﻭو ﺍاﻟﻭوﻁطﺎء ‪ .(Thalamus‬ﻭو ﻓﻲ ﻫﮬﮪھﺫذﺍا‬
‫ﺍاﻟﻣﻘﻁطﻊ ﻳﯾﻣﻛﻥن ﻗﻳﯾﺎﺱس ﻣﺣﻳﯾﻁط ﺍاﻟﺭرﺃأﺱس )‪ .(HC‬ﺻﻭوﺭرﺓة )ﺏب( ﺍاﻟﺿﻔﺎﺋﺭر ﺍاﻟﻣﺷﻳﯾﻣﻳﯾﺔ ﺍاﻟﻁطﺑﻳﯾﻌﻳﯾﺔ )ﺙث( ﻭوﻣﺷﻭوﻝل ﺍاﻟﻣﺦ ﻣﺎﺑﻳﯾﻥن ﻧﺻﻔﻲ ﺍاﻟﻛﺭرﺗﻳﯾﻥن ﺍاﻟﺩدﻣﺎﻏﻳﯾﺗﻳﯾﻥن )ﺍاﻷﺳﻬﮭﻡم(‪ .‬ﻻﺣﻅظ‬
‫ﺃأﻥن ﺍاﻟﺿﻔﺎﺋﺭر ﺍاﻟﻣﺷﻳﯾﻣﻳﯾﺔ ﺗﻣﺗﺩد ﻣﺎ ﺑﻳﯾﻥن ﺍاﻟﺣﺩدﻭوﺩد ﺍاﻷﻧﺳﻳﯾﺔ ﻭو ﺍاﻟﺣﺩدﻭوﺩد ﺍاﻟﻭوﺣﺷﻳﯾﺔ ﻟﻠﻘﺭرﻳﯾﻥن ﺍاﻟﺧﻠﻔﻲ ﻟﻠﺑﻁطﻳﯾﻥن ﺍاﻟﺟﺎﻧﺑﻲ‪ .‬ﺍاﻟﻘﺭرﻳﯾﻧﺎﺕت ﺍاﻷﻣﺎﻣﻳﯾﺔ ﻳﯾﺷﺎﺭر ﺇإﻟﻳﯾﻬﮭﺎ ﺑﺭرﺅؤﻭوﺱس ﺍاﻷﺳﻬﮭﻡم‪.‬‬
 ‫‪ .5‬ﺗﻘﻴﯿﻢ ﺍاﻟﺠﻨﻴﯿﻦ ﻣﻦ ﺍاﻟﻨﺎﺣﻴﯿﺔ ﺍاﻟﺘﺸﺮﻳﯾﺤﻴﯿﺔ‬

‫ﻣﺎ ﺗﺰﺍاﻝل ﺍاﻟﺪﺭرﺍاﺳﺔ ﺍاﻟﺘﺸﺮﻳﯾﺤﻴﯿﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﺜﺎﻧﻲ ﻣﻦ ﺍاﻟﺤﻤﻞ ‪ 18-22‬ﺃأﺳﺒﻮﻉع ﺣﻤﻞ ﺍاﻟﻤﻌﻴﯿﺎﺭر ﺍاﻟﺮﺋﻴﯿﺴﻲ ﻓﻲ ﺗﻘﻴﯿﻢ ﺍاﻟﺠﻨﻴﯿﻦ‬
‫ﻣﻦ ﺍاﻟﻨﺎﺣﻴﯿﺔ ﺍاﻟﺘﺸﺮﺣﻴﯿﺔ ﻓﻲ ﻛﻞ ﻣﻦ ﺍاﻟﺤﻤﻮﻝل ﺍاﻟﻌﺎﻟﻴﯿﺔ ﻭو ﺍاﻟﻤﻨﺨﻔﻀﺔ ﺍاﻟﺨﻄﻮﺭرﺓة )‪ .(54-57‬ﺗﻘﻴﯿﻢ ﺍاﻷﺟﻨﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل‬
‫ﻣﻦ ﺍاﻟﺤﻤﻞ ﻣﻦ ﺍاﻟﻨﺎﺣﻴﯿﺔ ﺍاﻟﺘﺸﺮﻳﯾﺤﻴﯿﺔ ﺑﺪء ﺍاﻋﺘﺒﺎﺭر ﻣﻦ ﺃأﻭوﺍاﺧﺮ ﺍاﻟﺜﻤﺎﻧﻴﯿﻨﺎﺕت ﺃأﻭو ﺍاﻟﺘﺴﻌﻴﯿﻨﺎﺕت ﻣﻦ ﺍاﻟﻘﺮﻥن ﺍاﻟﻤﺎﺿﻲ ﻭو ﺫذﻟﻚ ﺑﻌﺪ‬
‫ﻅظﻬﮭﻮﺭر ﻣﺴﺎﺑﺮ ﻓﻌﺎﻟﺔ ﻋﺒﺮ ﺍاﻟﻤﻬﮭﺒﻞ )‪ .(58,59‬ﺍاﻟﺒﺪء ﺑﺎﺳﺘﺨﺪﺍاﻡم ﻗﻴﯿﺎﺱس ﺳﻤﺎﻛﺔ ﺍاﻟﻨﻘﺮﺓة ‪ NT‬ﻓﻲ ﻣﺴﺢ ﺍاﻻﺿﻄﺮﺍاﺑﺎﺕت‬
‫ﺍاﻟﺼﺒﻐﻴﯿﺔ ﻓﻲ ﺍاﻷﺳﺎﺑﻴﯿﻊ ‪ 11‬ﺇإﻟﻰ ‪ 13+6‬ﺃأﺩدﻯى ﺇإﻟﻰ ﺇإﻋﺎﺩدﺓة ﺍاﻻﻫﮬﮪھﺘﻤﺎﻡم ﺑﻜﺸﻒ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﺘﺸﺮﻳﯾﺤﻴﯿﺔ ﺑﺸﻜﻞ ﺑﺎﻙك )ﺍاﻟﺠﺪﻭوﻝل‬
‫‪ .(2‬ﻭوﺃأﻫﮬﮪھﻢ ﺍاﻟﻔﻮﺍاﺋﺪ ﻣﻦ ﺍاﻟﻤﻘﺪﻣﺔ ﺗﻀﻢ‪ :‬ﻛﺸﻒ ﺍاﻟﻜﺜﻴﯿﺮ ﻣﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻜﺒﺮﻯى‪ ,‬ﺍاﻹﻁطﻤﺌﻨﺎﻥن ﺍاﻟﺒﺎﻛﺮ ﻟﺪﻯى ﺍاﻟﺴﻴﯿﺪﺍاﺕت ﻋﺎﻟﻴﯿﺎﺕت‬
‫ﺍاﻟﺨﻄﻮﺭرﺓة‪ ,‬ﺗﺸﺨﻴﯿﺺ ﻣﻮﺭرﺛﻲ ﺑﺎﻛﺮ ﻭو ﺍاﻧﻬﮭﺎء ﺍاﻟﺤﻤﻞ ﺍاﻟﺒﺎﻛﺮ ﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺫذﻟﻚ ﺿﺮﻭوﺭرﻳﯾﺎ‪ .‬ﻣﺤﺪﻭوﺩدﻳﯾﺔ ﺍاﻟﺪﺭرﺍاﺳﺔ ﻓﻲ ﺍاﻟﺜﻠﺚ‬
‫ﺍاﻷﻭوﻝل ﻣﻦ ﺍاﻟﺤﻤﻞ ﻫﮬﮪھﻮ ﺍاﻟﺤﺎﺟﺔ ﺇإﻟﻰ ﺃأﺧﺼﺎﺋﻴﯿﻦ ﻣﺪﺭرﺑﻴﯿﻦ ﻭو ﻣﺤﺘﺮﻓﻴﯿﻦ‪ ,‬ﻋﺪﻡم ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﻧﺴﺒﺔ ﺍاﻟﻜﻠﻔﺔ\ﺍاﻟﻔﻮﺍاﺋﺪ ﻭو ﻅظﻬﮭﻮﺭر‬
‫ﺗﺸﻮﻫﮬﮪھﺎﺕت ﺗﺸﺮﻳﯾﺤﻴﯿﺔ ﻭو ﻣﺮﺿﻴﯿﺔ ﻓﻲ ﻣﺮﺍاﺣﻞ ﻣﺘﺄﺧﺮﺓة ﻣﻦ ﺍاﻟﺤﻤﻞ )ﻣﺜﻞ‪ :‬ﺍاﻟﺠﺴﻢ ﺍاﻟﺜﻔﻨﻲ ‪ -‬ﻧﻘﺺ ﺗﺼﻨﻊ ﺍاﻟﻘﻠﺐ ﺍاﻷﻳﯾﺴﺮ(‬
‫ﻭوﺍاﻟﺘﻲ ﺗﺠﻌﻞ ﻣﻦ ﺍاﻟﻜﺸﻒ ﺍاﻟﻤﺒﻜﺮ ﻣﺴﺘﺤﻴﯿﻼ ﻭو ﺻﻌﻮﺑﺔ ﻓﻲ ﺗﻘﺪﻳﯾﻢ ﺍاﻹﺳﺘﺸﺎﺭرﺓة ﺑﺴﺒﺐ ﻋﺪﻡم ﺍاﻟﺘﺄﻛﺪ ﻣﻦ ﺃأﻫﮬﮪھﻤﻴﯿﺔ ﺑﻌﺾ‬
‫ﺍاﻟﻌﻼﻣﺎﺕت )‪.(54-56, 60-62‬‬

‫ﺍاﻟﺮﺃأﺱس‬

‫ﻳﯾﺠﺐ ﺍاﻥن ﻳﯾﻈﻬﮭﺮ ﺗﺼﻠﺐ ﺍاﻟﻌﻈﻢ ﺍاﻟﺠﻤﺠﻤﻲ ﻓﻲ ﺧﻼﻝل ﻧﻬﮭﺎﻳﯾﺔ ﺍاﺳﺒﻮﻉع ‪ 11‬ﻛﺎﻣﻼً )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(2a‬ﻭوﻣﻦ‬
‫ﺍاﻟﻤﻔﻴﯿﺪ ﺍاﻟﺒﺤﺚ ﺗﺤﺪﻳﯾﺪﺍاً ﻋﻦ ﺗﺼﻠّﺐ ﺍاﻟﻌﻈﻢ ﻓﻲ ﺍاﻷﺳﻄﺢ ﺍاﻟﻤﺤﻮﺭرﻳﯾﺔ ﻭوﺍاﻹﻛﻠﻴﯿﻠﻴﯿﺔ‪ .‬ﻛﻤﺎ ﻻ ﻳﯾﻨﺒﻐﻲ ﻭوﺟﻮﺩد ﺃأ ّ‬
‫ﻱي ﻋﻴﯿﺐ ﻋﻈﻤ ّﻲ‬
‫)ﺗﺸﻮﻳﯾﻪﮫ ﺃأﻭو ﺗﻌﻄﻴﯿﻞ( ﻓﻲ ﺍاﻟﺠﻤﺠﻤﺔ‪.‬‬

‫ﻭوﻣﻦ ﺍاﻟﻔﺘﺮﺓة ﺍاﻟﻤﻤﺘﺪﺓة ﺑﻴﯿﻦ ‪ 11‬ﺍاﻟﻰ ‪ 13+6‬ﺃأﺳﺎﺑﻴﯿﻊ ﺗﺴﻴﯿﻄﺮ ﺍاﻟﺒﻄﻴﯿﻨﺎﺕت ﺍاﻟﺠﺎﻧﺒﻴﯿﺔ ﻋﻠﻰ ﺍاﻟﻤﻨﻄﻘﺔ ﺍاﻟﺪﻣﺎﻏﻴﯿﺔ ﺣﻴﯿﺚ ﺗﻈﻬﮭﺮ‬
‫ﻛﺒﻴﯿﺮﺓة ﻭوﻣﻤﺘﻠﺌﺔ ﺑﺎﻟﻀﻔﺎﺋﺮ ﺍاﻟﻤﺸﻴﯿﻤﻴﯿّﺔ ﺍاﻟﻤﻮﻟّﺪﺓة ﻟﻠﺼﺪﻯى ﻓﻲ ﺍاﻟﺨﻠﻔﻴﯿﺔ ﺍاﻟﺘﻲ ﺗﻤﺜﻞ ﺍاﻟﺜﻠﺜﻴﯿﻦ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪.(2b‬‬
‫ﻭوﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻈﻬﮭﺮ ﻧﺼﻔﺎ ﺍاﻟﻜﺮﺓة ﻣﺘﻤﺎﺛﻠﻴﯿﻦ ﻭوﻣﻨﻔﺼﻠﻴﯿﻦ ﺑﺸﻜﻞ ﻭوﺍاﺿﺢ ﻟﻠﻌﻴﯿﺎﻥن ﺑﺸﻖ ﻭوﻣﻨﺠﻞ ﺑﻴﯿﻦ ﻧﺼﻔﻲ ﺍاﻟﻤﺦ‪ّ .‬‬
‫ﺇإﻥن ﻗﺸﺮﺓة‬
‫ﺍاﻟﺪﻣﺎﻍغ ﺭرﻗﻴﯿﻘﺔ ﻟﻠﻐﺎﻳﯾﺔ ﻭوﺗﻈﻬﮭﺮ ﺟﻠﻴﯿﺔ ﻓﻲ ﺍاﻟﻠﻘﻄﺔ ﺍاﻷﻣﺎﻣﻴﯿﺔ ﻋﻠﻰ ﺷﻜﻞ ﺑﻄﺎﻧﺔ ﻟﻠﺒﻄﻴﯿﻨﻴﯿﻦ ﻣﻤﻠﺆﺓة ﺑﺴﺎﺋﻞ ﻣﻦ ﻫﮬﮪھﻨﺎ ﻳﯾﻔﺘﺮﺽض‬
‫ﻋﺪﻡم ﺍاﻋﺘﺒﺎﺭرﻫﮬﮪھﺎ ﺍاﺳﺘﻘﺴﺎء ﺩدﻣﺎﻏﻲ‪ .‬ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﺴﻦ ﺍاﻟﻤﺒﻜﺮﺓة‪ ،٬‬ﺑﻌﺾ ﺍاﻟﻬﮭﻴﯿﺎﻛﻞ ﺍاﻟﺪﻣﺎﻏﻴﯿﺔ )ﻣﺜﻞ ﺍاﻟﺠﺴﻢ ﺍاﻟﺜﻔﻨﻲ‪ ،٬‬ﺍاﻟﻤﺨﻴﯿﺦ( ﻟﻢ‬
‫ﺗﻜﺒﺮ ﺑﻤﺎ ﻓﻴﯿﻪﮫ ﺍاﻟﻜﻔﺎﻳﯾﺔ ﻟﺘﺴﻤﺢ ﺑﺈﺟﺮﺍاء ﻓﺤﺺ ﺩدﻗﻴﯿﻖ‪ .‬ﻭوﻗﺪ ﺗ ّﻢ ﺗﻘﺪﻳﯾﻢ ﺍاﻗﺘﺮﺍاﺡح ﺑﺄﻧﻪﮫ ﻳﯾﻤﻜﻦ ﺗﻘﻴﯿﻴﯿﻢ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﻟﻠﺤﻔﺮﺓة‬
‫ﺍاﻟﺨﻠﻔﻴﯿﺔ ﻣﺎ ﺑﻴﯿﻦ ﺍاﻷﺳﺒﻮﻉع ‪ 11‬ﺍاﻟﻰ ‪ ،٬13+6‬ﻣﺜﻞ ﺍاﺟﺮﺍاء ﻓﺤﺺ ﻟﻔﺘﺢ ﻋﻴﯿﺐ ﺍاﻷﻧﺒﻮﺏب ﺍاﻟﻌﺼﺒﻲ‪ ،٬‬ﻭوﻟﻜﻦ ﻻ ﻳﯾﻤﻜﻦ‬
‫ﺍاﻋﺘﺒﺎﺭرﻩه ﻣﻌﻴﯿﺎﺭرﺍاً )‪ .(63‬ﻭوﻓﻲ ﺍاﻟﻔﺘﺮﺓة ﻣﺎ ﺑﻴﯿﻦ ‪ 11‬ﺍاﻟﻰ ‪ 13+6‬ﺃأﺳﺒﻮﻋﺎً‪ ،٬‬ﻳﯾﻤﻜﻦ ﺍاﺟﺮﺍاء ﻣﺤﺎﻭوﻟﺔ ﻟﺘﺨﻴﯿﻞ ﺍاﻟﻌﻴﯿﻨﻴﯿﻦ‬
‫ﻭوﻋﺪﺳﺎﺗﻬﮭﻤﺎ‪ ،٬‬ﻭوﺍاﻟﻤﺴﺎﻓﺔ ﺑﻴﯿﻦ ﺍاﻟﺤﺠﺎﺟﻴﯿﻦ ﻭوﺍاﻟﺼﻮﺭرﺓة ﺍاﻟﺠﺎﻧﺒﻴﯿﺔ ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﺍاﻻﻧﻒ ﻭوﻋﻈﺎﻣﻪﮫ ﻭوﺍاﻟﻔﻚ ﺍاﻟﺴﻔﻠﻲ ﻭوﻛﺬﻟﻚ ﺍاﺳﺘﻘﺎﻣﺔ‬
‫ﺍاﻟﻔﻢ ﻭوﺍاﻟﺸﻔﺘﻴﯿﻦ)‪) (28,64,65‬ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(3‬ﻭوﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺫذﻟﻚ‪ ،٬‬ﻭوﻣﻊ ﻏﻴﯿﺎﺏب ﺍاﻟﺸﺬﻭوﺫذ ﺍاﻟﻮﺍاﺿﺢ‪ ،٬‬ﻳﯾﺠﺐ‬
‫ﺃأﻥن ﻻ ﻳﯾﺆﺩدﻱي ﺍاﻟﻔﺸﻞ ﻓﻲ ﻓﺤﺺ ﻭوﺟﻪﮫ ﺍاﻟﺠﻨﻴﯿﻦ ﺇإﻟﻰ ﺍاﻟﻤﺰﻳﯾﺪ ﻣﻦ ﺍاﻟﻔﺤﻮﺻﺎﺕت ﻗﺒﻞ ﺍاﻟﻔﺤﺺ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﻤﺘﻮﺳﻂ ﻣﻦ ﻓﺘﺮﺓة‬
‫ﺍاﻟﺤﻤﻞ‪.‬‬
 ‫ﺍاﻟﺠﺪﻭوﻝل ﺭرﻗﻢ ‪ 1‬ﻣﺨﻄﻄﺎﺕت ﻣﻌﺎﺩدﻟﺔ ﻋﻠﻢ ﺍاﻹﺣﺼﺎء ﺍاﻟﺤﻴﯿﻮﻱي ﻟﻠﻨﻈﺮ ﻓﻲ ﺍاﻷﺷﻬﮭﺮ ﺍاﻟﺜﻼﺛﺔ ﺍاﻷﻭوﻟﻰ ﻟﻔﺘﺮﺓة ﺣﻮﺍاﻟﻲ ‪ 13+6‬ﺃأﺳﺎﺑﻴﯿﻊ‬
‫ﻣﻼﺣﻈﺎﺕت‬ ‫ﺍاﻟﻔﺌﺔ ﺍاﻟﻌﻤﺮﻳﯾﺔ )ﺑﺎﻷﺳﺒﻮﻉع(‬ ‫ﻣﻘﻴﯿﺎﺱس ﺍاﻟﺘﺮﻛﻴﯿﺒﺔ‬ ‫ﺍاﻟﻤﺮﺟﻊ‬
‫ﺗﻢ ﺍاﺧﺘﻴﯿﺎﺭرﻫﮬﮪھﺎ ﻻﺳﺘﺨﺪﺍاﻣﻬﮭﺎ ﻣﻦ ﻗﺒﻞ‬
‫‪Robinson  &  Fleming  (52)  (1975);  quoted  ‬‬
‫ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﻄﺒﻴﯿﺔ ﺍاﻟﺒﺮﻳﯾﻄﺎﻧﻴﯿﺔ ﻟﻠﻤﻮﺟﺎﺕت‬ ‫ﻣﻦ ‪ 9‬ﺍاﻟﻰ ‪6+13‬‬ ‫ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي‬
‫)‪by  Loughna  et  al  (41)  (2009‬‬
‫ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ )‪(41‬‬
‫ﻣﻦ ‪ 5.0‬ﺍاﻟﻰ ‪18.0‬‬ ‫ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي‬ ‫)‪Hadlock  et  al  (83)  (1992‬‬
‫‪  ‬‬
‫ﻣﻦ ‪ 6.1‬ﺍاﻟﻰ ‪13.3‬‬ ‫ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي‬ ‫)‪Daya  (84)  (1993‬‬
‫‪  ‬‬
‫ﻳﯾﺘﻀﻤﻦ ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ‬
‫)‪ (BDP‬ﻭوﻣﺤﻴﯿﻂ ﺍاﻟﺮﺃأﺱس )‪(HC‬‬
‫ﻣﻦ ‪ 6+2‬ﺍاﻟﻰ ‪15+0‬‬ ‫ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي‬ ‫)‪Verburg  et  al  (43)  (2008‬‬
‫ﻭوﻣﺤﻴﯿﻂ ﺍاﻟﺒﻄﻦ )‪ (AC‬ﻭوﻋﻈﻢ ﺍاﻟﻔﺨﺬ‬
‫ﻭوﺍاﻟﻤﺨﻴﯿﺦ‬
‫ﻳﯾﺘﻀﻤﻦ ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ‬
‫ﻣﻦ ‪ 5‬ﺍاﻟﻰ ‪14‬‬ ‫ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي‬ ‫)‪McLennan  &  Schluter  (85)  (2008‬‬
‫)‪ (BDP‬ﺍاﻟﻰ ‪ 14‬ﺃأﺳﺒﻮﻉع‬
‫ﻓﻲ ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺒﻜﺮ ﺭرﺳﻢ ﺍاﻟﺒﻴﯿﺎﻧﻲ ﻟﺴﻨﺔ‬
‫‪ 1982‬ﻫﮬﮪھﻮ ﺃأﻛﺜﺮ ﺩدﻗﺔ ﻣﻦ ﺍاﻟﺮﺳﻢ‬ ‫ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ‬ ‫)‪Hadlock  et  al  (86)  (1982‬‬
‫ﺍاﻟﺒﻴﯿﺎﻧﻲ ﻟﺴﻨﺔ ‪1984‬‬
‫ﺗﻢ ﺍاﺧﺘﻴﯿﺎﺭرﻫﮬﮪھﺎ ﻻﺳﺘﺨﺪﺍاﻣﻬﮭﺎ ﻣﻦ ﻗﺒﻞ‬
‫‪Altman  &  Chitty  (39)  (1997);  quoted  by  ‬‬
‫ﺍاﻟﺠﻤﻌﻴﯿﺔ ﺍاﻟﻄﺒﻴﯿﺔ ﺍاﻟﺒﺮﻳﯾﻄﺎﻧﻴﯿﺔ ﻟﻠﻤﻮﺟﺎﺕت‬ ‫ﻣﻦ ‪ 12+6‬ﺍاﻟﻰ ‪35+4‬‬ ‫ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ‬
‫)‪Loughna  et  al  (41)  (2009‬‬
‫ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ )‪(41‬‬
‫ﻳﯾﺘﻀﻤﻦ ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي‬
‫)‪ (CRL‬ﻭوﻣﺤﻴﯿﻂ ﺍاﻟﺮﺃأﺱس )‪(HC‬‬
‫ﻣﻦ ‪ 10‬ﺍاﻟﻰ ‪43‬‬ ‫ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ‬ ‫)‪Verburg  et  al  (43)  (2008‬‬
‫ﻭوﻣﺤﻴﯿﻂ ﺍاﻟﺒﻄﻦ )‪ (AC‬ﻭوﻋﻈﻢ ﺍاﻟﻔﺨﺬ‬
‫ﻭوﺍاﻟﻤﺨﻴﯿﺦ‬
‫ﻳﯾﺠﺐ ﺃأﻥن ﺗﺆﺧﺬ ﻫﮬﮪھﺬﻩه ﺍاﻟﻘﻴﯿﺎﺳﺎﺕت ﻭوﻓﻘﺎ ً ﻟﻠﺘﻘﻨﻴﯿﺎﺕت ﺍاﻟﺘﻲ ﺗﻢ ﻭوﺻﻔﻬﮭﺎ ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﻤﻘﺎﻻﺕت ﻭوﺍاﺧﺘﺒﺎﺭرﻫﮬﮪھﺎ ﻋﻠﻰ ﺍاﻟﺴﻜﺎﻥن ﺍاﻟﻤﺤﻠﻴﯿﻴﯿﻦ ﻗﺒﻞ ﺃأﻥن ﻳﯾﺘﻢ ﺍاﻋﺘﻤﺎﺩد ﺗﻨﻔﻴﯿﺬﻫﮬﮪھﺎ؛ ﺍاﻟﻘﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻴﯿﻦ‬
‫)‪ ،٬(BDP‬ﺍاﻟﻄﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي )‪(CRL‬‬

‫ﺍاﻟﺮﻗﺒﺔ‬

‫ﺗﻘﻴﯿﻴﯿﻢ ﺍاﻟﺘﺨﻄﻴﯿﻂ ﺍاﻟﺼﺪﻭوﻱي ﻟﻠﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ‪ NT‬ﻫﮬﮪھﻮ ﺟﺰء ﻣﻦ ﺍاﻟﻜﺸﻒ ﻋﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﻜﺮﻭوﻣﻮﺳﻮﻣﻴﯿﺔ ﻭوﻗﺪ ﺗﻤﺖ‬
‫ﻣﻨﺎﻗﺸﺘﻬﮭﺎ ﺃأﺩدﻧﺎﻩه‪ .‬ﻳﯾﺠﺐ ﺍاﻻﻧﺘﺒﺎﻩه ﺟﻴﯿﺪﺍاً ﻻﺻﻄﻔﺎﻑف ﺍاﻟﺮﻗﺒﺔ ﻣﻊ ﺍاﻟﺠﺴﻢ ﻭوﺗﺤﺪﻳﯾﺪ ﻣﺠﻤﻮﻋﺔ ﺍاﻟﺴﻮﺍاﺋﻞ ﺍاﻻﺧﺮﻯى ﻣﺜﻞ ﺍاﻟﻮﺭرﻡم‬
‫ﺍاﻟﻜﻴﯿﺴﻲ ﺍاﻟﺮﻁطﺐ ﻭوﺃأﻛﻴﯿﺎﺱس ﺍاﻟﻮﺭرﻳﯾﺪ ﺍاﻟﻮﺩدﺍاﺟﻲ ﺍاﻟﻠﻤﻔﺎﻭوﻳﯾﺔ )‪.(28,65‬‬

‫ﺍاﻟﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي‬

‫ﻳﯾﺠﺐ ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻟﻘﻄﺎﺕت ﻁطﻮﻟﻴﯿﺔ ﻭوﻣﺤﻮﺭرﻳﯾﺔ ﻹﻅظﻬﮭﺎﺭر ﺍاﺻﻄﻔﺎﻑف ﺍاﻟﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻭوﺍاﻟﻤﺴﺘﻘﻴﯿﻢ‪ ،٬‬ﻭوﺑﺬﻝل‬
‫ﺍاﻟﺠﻬﮭﺪ ﻭوﺍاﻟﻤﺤﺎﻭوﻟﺔ ﻹﻅظﻬﮭﺎﺭر ﺍاﻟﺠﻠﺪ ﺍاﻟﺴﻠﻴﯿﻢ ﺍاﻟﻤﻮﺟﻮﺩد ﻓﻮﻗﻪﮫ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(4‬ﻭوﺑﺎﻟﺮﻏﻢ ﺫذﻟﻚ‪ ،٬‬ﻭوﻓﻲ ﺣﺎﻝل ﻋﺪﻡم‬
‫ﻭوﺟﻮﺩد ﺗﺸﻮﻩه ﻭوﺍاﺿﺢ‪ ،٬‬ﻓﺈﻥن ﻋﺪﻡم ﻧﺠﺎﺡح ﻓﺤﺺ ﺍاﻟﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي ﻓﻲ ﻫﮬﮪھﺬﺍا ﺍاﻟﻮﻗﺖ ﻻ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺆﺩدﻱي ﺍاﻟﻰ ﺇإﺟﺮﺍاء ﺍاﻟﻤﺰﻳﯾﺪ‬
‫ﻣﻦ ﺍاﻟﻔﺤﻮﺻﺎﺕت ﻗﺒﻞ ﺍاﻟﻔﺤﺺ ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻟﻤﺘﻮﺳﻂ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺍاﻻﻧﺘﺒﺎﻩه ﺗﺤﺪﻳﯾﺪﺍاً ﺍاﻟﻰ ﺍاﻟﺸﻜﻞ ﻋﻨﺪﻣﺎ ﻳﯾﻜﻮﻥن ﺍاﻝل‪ BPD‬ﺃأﻗﻞ‬
‫ﻣﻦ ‪ %5‬ﻣﻦ ﺍاﻟﻄﺒﻴﯿﻌﻲ )‪.(66‬‬
 ‫ﺍاﻟﺠﺪﻭوﻝل ﺭرﻗﻢ ‪2‬‬
‫ﻓﺤﺺ ﺗﺸﺮﻳﯾﺤﻲ ﻓﻲ ﺍاﻟﻔﺘﺮﺓة ﻣﺎ ﺑﻴﯿﻦ ‪ 11‬ﺍاﻟﻰ ‪ 13+6‬ﺃأﺳﺎﺑﻴﯿﻊ‬

‫ﻣﻮﺟﻮﺩدﺓة ﺍاﻭو‪ /‬ﻭوﻁطﺒﻴﯿﻌﻴﯿﺔ؟‬ ‫ﺍاﻟﺠﻬﮭﺎﺯز‪ /‬ﺍاﻟﻤﻨﻄﻘﺔ ﺍاﻟﺘﺸﺮﻳﯾﺤﻴﯿﺔ‬

‫ﻣﻮﺟﻮﺩدﺓة‬ ‫ﺍاﻟﺮﺃأﺱس‬
‫ﻋﻈﺎﻡم ﺍاﻟﺠﻤﺠﻤﺔ‬
‫ﻣﻨﺘﺼﻒ ﺍاﻟﻤﻨﺠﻞ‬
‫ﻣﺸﻴﯿﻤﺔ ﺍاﻟﻌﻴﯿﻦ ﺷﺒﻜﺔ ﻣﻦ ﺍاﻷﻭوﻋﻴﯿﺔ ﺃأﻭو ﺿﻔﻴﯿﺮﺓة ﺑﻄﻴﯿﻨﺎﺕت ﻣﻤﺘﻠﺌﺔ‬
‫ﻅظﻬﮭﻮﺭر ﺑﺸﻜﻞ ﻁطﺒﻴﯿﻌﻲ‬ ‫ﺍاﻟﺮﻗﺒﺔ‬

‫ﺳﻤﺎﻛﺔ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ‪) NT‬ﺇإﺫذﺍا ﺗﻤﺖ ﺍاﻟﻤﻮﺍاﻓﻘﺔ ﻋﻠﻴﯿﻬﮭﺎ ﺑﻌﺪ ﺍاﻟﻤﻮﺍاﻓﻘﺔ‬

‫ﻭوﺍاﻟﺘﺪﺭرﻳﯾﺐ‪ /‬ﻭوﺍاﻋﺘﻤﺎﺩد ﻋﺎﻣﻞ ﺍاﻟﺘﺸﻐﻴﯿﻞ ﺍاﻟﻤﺘﻮﻓﺮ(‬

‫ﺍاﻟﻌﻴﯿﻨﺎﻥن ﻣﻊ ﺍاﻟﻌﺪﺳﺎﺕت*‬ ‫ﺍاﻟﻮﺟﻪﮫ‬

‫ﻋﻈﺎﻡم ﺍاﻷﻧﻒ*‬
‫ﺍاﻟﺼﻮﺭرﺓة ﺍاﻟﺠﺎﻧﺒﻴﯿﺔ ﻁطﺒﻴﯿﻌﻴﯿﺔ‪ /‬ﺍاﻟﻔﻚ*‬
‫ﺍاﻟﺸﻔﺎﻩه ﺳﻠﻴﯿﻤﺔ*‬
‫ﺍاﻟﻔﻘﺮﺍاﺕت )ﻁطﻮﻟﻴﯿﺔ ﻭوﻣﺤﻮﺭرﻳﯾﺔ(*‬ ‫ﺍاﻟﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي‬
‫ﺍاﻟﺠﻠﺪ ﻳﯾﻐﻄﻲ ﺑﻄﺮﻳﯾﻘﺔ ﺳﻠﻴﯿﻤﺔ*‬
‫ﻣﺠﺎﻻﺕت ﺍاﻟﺮﺋﺔ ﻣﺘﺴﺎﻭوﻳﯾﺔ‬ ‫ﺍاﻟﺼﺪﺭر‬
‫ﻻ ﺍاﻧﺼﺒﺎﺏب ﻭوﻻ ﻛﺘﻞ‬
‫ﻧﺸﺎﻁط ﻗﻠﺐ ﻣﻨﺘﻈﻢ‬ ‫ﺍاﻟﻘﻠﺐ‬
‫ﺣﺠﻴﯿﺮﺍاﺕت ﺍاﻟﻘﻠﺐ ﺍاﻷﺭرﺑﻊ ﻣﺘﺴﺎﻭوﻳﯾﺔ*‬
‫ﺍاﻟﻤﻌﺪﺓة ﻣﻮﺟﻮﺩدﺓة ﻓﻲ ﺍاﻟﺒﺮﻉع ﺍاﻟﻌﻠﻮﻱي ﺍاﻻﻳﯾﺴﺮ‬ ‫ﺍاﻟﺒﻄﻦ‬
‫ﺍاﻟﻤﺜﺎﻧﺔ*‬
‫ﺍاﻟﻜﻠﻴﯿﺘﺎﻥن*‬
‫ﺍاﺩدﺧﺎﻝل ﻁطﺒﻴﯿﻌﻲ ﻟﻠﺤﺒﻞ ﺍاﻟﺴﺮﻱي‪/‬ﺟﺪﺍاﺭرﺍاﻟﺒﻄﻦ‬ ‫ﺟﺪﺍاﺭر ﺍاﻟﺒﻄﻦ‬
‫ﻻ ﻋﻴﯿﻮﺏب ﻓﻲ ﺍاﻟﺤﺒﻞ ﺍاﻟﺴﺮﻱي‬
‫ﺍاﺭرﺑﻌﺔ ﺍاﻁطﺮﺍاﻑف ﻛﻞ ﻣﻨﻬﮭﺎ ﺛﻼﺛﺔ ﺃأﺟﺰﺍاء‬ ‫ﺃأﻁطﺮﺍاﻑف ﺍاﻟﺠﺴﻢ‬
‫ﺍاﻟﻴﯿﺪﺍاﻥن ﻭوﺍاﻟﻘﺪﻣﺎﻥن ﻣﻊ ﺗﻮﺟﻪﮫ ﻁطﺒﻴﯿﻌﻲ*‬
‫ﺍاﻟﺤﺠﻢ ﻭوﺍاﻟﻨﺴﻴﯿﺞ‬ ‫ﺍاﻟﻤﺸﻴﯿﻤﺔ‬
‫ﺣﺒﻞ ﺑﺜﻼﺛﺔ ﺃأﻭوﻋﻴﯿﺔ*‬ ‫ﺍاﻟﺤﺒﻞ ﺍاﻟﺴﺮﻱي‬

‫*ﻫﮬﮪھﻳﯾﻛﻠﻳﯾﺎﺕت ﺧﻳﯾﺎﺭرﻳﯾﺔ ﻣﻌﺩدّﻟﺔ ﻭوﻣﻧﻘﻭوﻟﺔ ﻋﻥن ‪ Fong et al‬ﻓﻭوﻧﻎ ﻭوﺁآﺧﺭرﻭوﻥن )‪ ،٬(58‬ﻭوﻣﺎﻙك ﺃأﻭوﻟﻳﯾﻑف ﻭوﺁآﺧﺭرﻭوﻥن ‪،٬(87) McAuliffe et al‬‬
‫ﺗﺎﻳﯾﺑﺎﻝل ﻭوﺁآﺧﺭرﻭوﻥن ‪ ،٬(60) Taipale et al‬ﻭوﻓﻭوﻥن ﻛﺎﻳﯾﺳﻧﺑﺭرﻍغ ﻭوﺁآﺧﺭرﻭوﻥن ‪.(88) VonKaisenberg et al‬‬
 ‫ﺍاﻟﻘﻔﺺ ﺍاﻟﺼﺪﺭرﻱي‬

‫ﻳﯾﺤﺘﻮﻱي ﺍاﻟﺼﺪﺭر ﻋﺎﺩدﺓةً ﻋﻠﻰ ﺭرﺋﺘﻴﯿﻦ ﻣﺘﺠﺎﻧﺴﺘﻴﯿﻦ ﺻﺪﻭوﻳﯾﺎ ً ﻭوﻓﻖ ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‪ ،٬‬ﻣﻦ ﺩدﻭوﻥن ﺃأﻱي ﺩدﻟﻴﯿﻞ ﻋﻠﻰ‬
‫ﺍاﻻﻧﺼﺒﺎﺏب ﺍاﻟﺠﻨﺒﻲ ﺃأﻭو ﺍاﻟﻜﻴﯿﺴﻲ ﺃأﻭو ﺍاﻟﻜﺘﻞ ﺍاﻟﺼﻠﺒﺔ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺗﻘﻴﯿﻴﯿﻢ ﺍاﺳﺘﻤﺮﺍاﺭرﻳﯾﺔ ﺍاﻟﺘﻨﻔﺲ ﺍاﻟﺒﻄﻨﻲ‪ ،٬‬ﻣﺸﻴﯿﺮﺍاً ﺍاﻟﻰ ﻁطﺒﻴﯿﻌﺔ‬
‫ﻣﻮﻗﻊ ﺍاﻟﻤﻌﺪﺓة ﻭوﺍاﻟﻜﺒﺪ ﺩدﺍاﺧﻞ ﺍاﻟﺒﻄﻦ‪.‬‬

‫ﺍاﻟﻘﻠﺐ‬

‫ﺍاﻟﻤﻮﻗﻊ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﻘﻠﺐ ﻫﮬﮪھﻮ ﺍاﻟﺠﺎﻧﺐ ﺍاﻻﻳﯾﺴﺮ ﻣﻦ ﺍاﻟﺼﺪﺭر )ﺃأﻳﯾﺴﺮﻳﯾﺔ ﺍاﻟﻘﻠﺐ( ﻭوﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻮﺛﻖ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ‬
‫‪ .(5‬ﻭوﻗﺪ ﺗﺒﻴﯿﻦ ﺃأﻧﻪﮫ ﻣﻦ ﺍاﻟﻤﻤﻜﻦ ﺍاﻟﻘﻴﯿﺎﻡم ﺑﺎﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻷﻛﺜﺮ ﺗﻔﺼﻴﯿﻼً ﻟﻠﻘﻠﺐ ﻓﻲ ﺧﻼﻝل ‪ 11‬ﺍاﻟﻰ‬
‫‪ 13+6‬ﺃأﺳﺎﺑﻴﯿﻊ )‪ ,(67,68‬ﻭوﻟﻜﻨﻪﮫ ﻟﻴﯿﺲ ﺟﺰءﺍاً ﻣﻦ ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪ .‬ﻭوﻷﺳﺒﺎﺏب ﻭوﻗﺎﺋﻴﯿﺔ‪ ،٬‬ﻟﻢ ﻳﯾﺸﺮ ﺍاﻟﻰ ﺍاﺳﺘﺨﺪﺍاﻡم ﺍاﻟﺪﻭوﺑﻠﺮ‬
‫ﻓﻲ ﺧﻼﻝل ﺍاﻟﻔﺤﺺ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪.‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :3‬ﻭوﺟﻪﮫ ﺍاﻟﺠﻨﻴﯿﻦ )ﺃأ( ﺻﻮﺭرﺓة ﻭوﺟﻪﮫ ﺍاﻟﺠﻨﻴﯿﻦ ﺍاﻟﺠﺎﻧﺒﻴﯿﺔ ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﺗﻈﻬﮭﺮﻋﻈﺎﻡم ﺍاﻷﻧﻒ ) ‪ .(NB‬ﻳﯾﻤﻜﻦ ﻣﻼﺣﻈﺔ ﺍاﻟﻄﻮﻝل ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﻔﻚ ﺍاﻟﻌﻠﻮﻱي ﻭوﺍاﻟﻔﻚ‬
‫ﺍاﻟﺴﻔﻠﻲ‪) .‬ﺏب( ﺍاﻟﻌﻴﯿﻨﺎﻥن ﻁطﺒﻴﯿﻌﻴﯿﺘﺎﻥن ﻣﻊ ﺍاﻟﻜﺮﻳﯾﺎﺕت ﻭوﺍاﻟﻌﺪﺳﺎﺕت )ﺍاﻟﺴﻬﮭﺎﻡم( ﻣﺮﺋﻴﯿﺔ‪) .‬ﺕت( ﺷﻔﺎﻩه ﺍاﻟﺠﻨﻴﯿﻦ ﻓﻲ ﺍاﻻﺳﺒﻮﻉع ‪ .13‬ﻳﯾﻤﻜﻦ ﻣﻼﺣﻈﺔ ﺳﻼﻣﺔ ﺍاﻟﺸﻔﺔ ﺍاﻟﻌﻠﻮﻳﯾﺔ ﻭوﺍاﻟﺨﻂ‬
‫ﺍاﻟﻔﺎﺻﻞ ﺑﻴﯿﻦ ﺍاﻟﺸﻔﺘﻴﯿﻦ )ﺍاﻟﺴﻬﮭﻢ(‪ .‬ﺗﻔﺎﺻﻴﯿﻞ ﺍاﻷﻧﻒ ) ‪ (N‬ﻣﺤﺪﻭوﺩدﺓة‪.‬‬
 ‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :4‬ﺍاﻟﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي ﻟﻠﺠﻨﻴﯿﻦ‪ .‬ﻣﻦ ﺍاﻟﻤﻤﻜﻦ ﺭرﺅؤﻳﯾﺔ ﺍاﻟﺠﻠﺪ ﺍاﻟﺴﻠﻴﯿﻢ )ﺍاﻟﺴﻬﮭﻢ ﺍاﻟﻘﺼﻴﯿﺮ ﺍاﻟﺴﻤﻴﯿﻚ( ﻭو ﻫﮬﮪھﻮ ﺍاﻟﺨﻠﻔﻴﯿﺔ ﺍاﻟﻤﺮﺋﻴﯿﺔ ﻟﻠﻔﻘﺮﺍاﺕت ﻣﻦ ﺍاﻟﺮﻗﺒﺔ ﺍاﻟﻰ ﺍاﻟﻌﺠﺰ‬
‫ﻓﻲ ﻋﺮﺽض ﻣﺘﻮﺳﻄﻲ ﺻﺤﻴﯿﺢ‪ .‬ﻣﻦ ﺍاﻟﻤﻤﻜﻦ ﻣﻼﺣﻈﺔ ﻅظﻬﮭﻮﺭر ﺍاﻟﺘﺤﺠﺮ ﻓﻲ ﻓﻘﺮﺍاﺕت ﺍاﻟﻌﻤﻮﺩد‪ ،٬‬ﻭوﺍاﻷﻗﻮﺍاﺱس ﺍاﻟﻌﺼﺒﻴﯿﺔ‪ ،٬‬ﺍاﻟﺘﻲ ﻻ ﺗﺰﺍاﻝل ﻏﻀﺮﻭوﻓﻴﯿﺔ‪ ،٬‬ﻣﺘﻤﺎﺛﻠﺔ ﺍاﻟﺼﺪﻯى ﺃأﻭو‬
‫ﻣﺘﺪﻧﻴﯿﺔ ﺍاﻟﺼﺪﻯى‪ .‬ﻋﻨﺪ ﺍاﻟﻌﻨﻖ )ﺍاﻟﺴﻬﮭﻢ ﺍاﻟﻄﻮﻳﯾﻞ( ﻟﻢ ﺗﺘﺤﺠﺮ ﻓﻘﺮﺍاﺕت ﺍاﻟﻌﻤﻮﺩد ﺑﻌﺪ ﻭوﺍاﻟﺒُ ْﺪ ْﺃأﺓة ﺍاﻟﻐﻀﺮﻭوﻓﻴﯿﺔ ﻣﺘﺪﻧﻴﯿﺔ ﺍاﻟﺼﺪﻯى؛ ﻭوﻫﮬﮪھﺬﺍا ﻁطﺒﻴﯿﻌﻲ‪.‬‬

‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :5‬ﺍاﻟﻘﺴﻢ ﺍاﻟﻤﺤﻮﺭرﻱي ﻟﺼﺪﺭر ﺍاﻟﺠﻨﻴﯿﻦ ﻋﻠﻰ ﻣﺴﺘﻮﻯى ﻟﻘﻄﺔ ﺍاﻟﺤﺠﻴﯿﺮﺍاﺕت ﺍاﻷﺭرﺑﻌﺔ ﻟﻠﻘﻠﺐ‪ ،٬‬ﺣﻴﯿﺚ ﺗﺸﻴﯿﺮ ﻗﻤﺔ ﺍاﻟﻘﻠﺐ ﺍاﻟﻰ ﺍاﻟﻴﯿﺴﺎﺭر )‪ .(L‬ﻳﯾﻤﻜﻦ ﻣﻼﺣﻈﺔ‬
‫ﺃأﻥن ﺍاﻷﺫذﻳﯾﻨﻴﯿﻦ ﻭوﺍاﻟﺒﻄﻴﯿﻨﻴﯿﻦ ﻣﺘﺴﺎﻭوﻳﯾﺎﻥن ﻋﻠﻰ ﺟﺎﻧﺒﻲ ﺍاﻟﺤﺎﺟﺰ )ﺍاﻟﺴﻬﮭﻢ(‪ .‬ﻣﺠﺎﻻﺕت ﺍاﻟﺮﺋﺔ ﻫﮬﮪھﻲ ﻣﺘﺠﺎﻧﺴﺔ ﻭوﻣﺘﻨﺎﻅظﺮﺓة‪ .‬ﻳﯾﻘﻊ ﺍاﻟﺸﺮﻳﯾﺎﻥن ﺍاﻷﻭوﺭرﻁطﻲ )‪ (Aorta‬ﻓﻲ ﺍاﻟﺠﺎﻧﺐ ﺍاﻷﻳﯾﺴﺮ‬
‫ﻟﻠﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي ) ‪.(S‬‬
 ‫ﻣﺤﺘﻮﻯى ﺍاﻟﺒﻄﻦ‬

‫ﻓﻲ ﺧﻼﻝل ﺍاﻟﻔﺘﺮﺓة ﻣﺎ ﺑﻴﯿﻦ ‪ 11‬ﺍاﻟﻰ ‪ 13+6‬ﺃأﺳﺒﻮﻉع ﻣﻦ ﺍاﻟﺤﻤﻞ‪ ،٬‬ﻳﯾﺠﺐ ﺃأﻥن ﺗﻜﻮﻥن ﺍاﻟﻤﻌﺪﺓة ﻭوﺍاﻟﻤﺜﺎﻧﺔ ﺍاﻟﺘﺮﻛﻴﯿﺒﺘﻴﯿﻦ ﺍاﻟﻮﺣﻴﯿﺪﺗﻴﯿﻦ‬
‫ﻟﺴﺎﺋﻞ ﻧﻘﺺ ﺍاﻟﺼﺪﻯى ﻓﻲ ﺍاﻟﺒﻄﻦ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(6a,b‬ﻓﻤﻮﻗﻊ ﺍاﻟﻤﻌﺪﺓة ﻓﻲ ﺍاﻟﺠﻬﮭﺔ ﺍاﻟﻴﯿﺴﺮﻯى ﻟﻠﺒﻄﻦ ﻣﻊ‬
‫ﺃأﻳﯾﺴﺮﻳﯾﺔ ﺍاﻟﻘﻠﺐ ﻳﯾﺴﺎﻋﺪ ﻋﻠﻰ ﺗﺄﻛﻴﯿﺪ ﻣﻮﺿﻊ ﺍاﻷﺣﺸﺎء ﺍاﻟﻄﺒﻴﯿﻌﻲ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺍاﻻﺷﺎﺭرﺓة ﺍاﻟﻰ ﻣﻮﻗﻊ ﻛﻠﻴﯿﺘﻲ ﺍاﻟﺠﻨﻴﯿﻦ ﺍاﻟﻤﺘﻮﻗﻌﺔ‬
‫ﺍاﻟﻤﺤﺎﻁطﺔ ﺑﺎﻟﻨﺨﺎﻉع ﻣﺜﻞ ﺣﺒﺔ ﻓﻮﻝل ﺗﺸﻜﻞ ﺑﺸﻜﻞ ﻁطﻔﻴﯿﻒ ﺗﺮﻛﻴﯿﺒﺎﺕت ﻣﻮﻟﺪ ﺍاﻟﺼﺪﻯى ﻣﻊ ﺍاﻟﺤﻮﺽض ﺍاﻟﻜﻠﻮﻱي ﺍاﻟﻤﺮﻛﺰﻱي‬
‫ﺍاﻟﻨﻤﻮﺫذﺟﻲ ﺍاﻟﻨﺎﻗﺺ ﺍاﻟﺼﺪﻯى )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(6b‬ﻭوﻓﻲ ﺍاﻷﺳﺒﻮﻉع ‪ 12‬ﻟﻠﺤﻤﻞ‪ ،٬‬ﻳﯾﺠﺐ ﺃأﻥن ﺗﻜﻮﻥن ﻣﺜﺎﻧﺔ‬
‫ﺍاﻟﺠﻨﻴﯿﻦ ﻋﻠﻰ ﺷﻜﻞ ﺗﺮﻛﻴﯿﺒﺔ ﻣﺴﺘﺪﻳﯾﺮﺓة ﻣﺘﻮﺳﻄﺔ ﻧﺎﻗﺼﺔ ﺍاﻟﺼﺪﻯى ﻓﻲ ﺃأﺳﻔﻞ ﺍاﻟﺒﻄﻦ‪.‬‬

‫ﺟﺪﺍاﺭر ﺍاﻟﺒﻄﻦ‬

‫ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻮﺛﻖ ﺍاﻻﺭرﺗﻜﺎﺯز ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﺤﺒﻞ ﺍاﻟﺴﺮﻱي ﺑﻌﺪ ‪ 12‬ﺃأﺳﺒﻮﻋﺎ ً ﻣﻦ ﺍاﻟﺤﻤﻞ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪.(6c‬‬
‫ﻭوﻳﯾﻜﻮﻥن ﺍاﻟﻔﺘﻖ ﺍاﻟﺴﺮﻱي ﺍاﻟﻔﻴﯿﺰﻳﯾﻮﻟﻮﺟﻲ ﻣﻮﺟﻮﺩد ﻟﻐﺎﻳﯾﺔ ‪ 11‬ﺃأﺳﺒﻮﻋﺎ ً ﻛﻤﺎ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺘﻢ ﺗﻤﻴﯿﺰﻩه ﻋﻦ ﺍاﻟﻘﻴﯿﻠﺔ ﺍاﻟﺴﺮﻳﯾﺔ ﻭوﺍاﻧﺸﻘﺎﻕق‬
‫ﺍاﻟﺒﻄﻦ ﺍاﻟﺨﻠﻘﻲ )‪.(28,65,69‬‬

‫ﺍاﻷﻁطﺮﺍاﻑف‬

‫ﻳﯾﻨﺒﻐﻲ ﻣﻼﺣﻈﺔ ﻭوﺟﻮﺩد ﺍاﻟﺠﺰء ﺍاﻟﻌﻈﻤﻲ ﻟﻸﻁطﺮﺍاﻑف ﺍاﻟﻌﻠﻮﻳﯾﺔ ﻭوﺍاﻟﺴﻔﻠﻴﯿﺔ ﻭوﻭوﺟﻮﺩد ﺍاﻟﺘﻮﺟﻪﮫ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﻴﯿﺪﻳﯾﻦ ﻭوﺍاﻟﺮﺟﻠﻴﯿﻦ ﻓﻲ‬
‫ﺧﻼﻝل ‪ 11‬ﺍاﻟﻰ ‪ 13+6‬ﺃأﺳﺎﺑﻴﯿﻊ ﻓﻲ ﻓﺤﺺ ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‪ .‬ﻭوﻗﺪ ﺗﻈﻬﮭﺮ ﻋﻈﺎﻡم ﺍاﻷﺻﺎﺑﻊ ﺍاﻟﻨﻬﮭﺎﺋﻴﯿﺔ ﻟﻠﻴﯿﺪ ﻓﻲ‬
‫ﺍاﻷﺳﺒﻮﻉع ‪ ,11‬ﺧﺼﻮﺻﺎ ً ﻋﻨﺪ ﺍاﻟﻔﺤﺺ ﺍاﻟﻤﻬﮭﺒﻠﻲ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪.(7a‬‬

‫ﺍاﻷﻋﻀﺎء ﺍاﻟﺘﻨﺎﺳﻠﻴﯿﺔ‬

‫ﻭوﻳﯾﺴﺘﻨﺪ ﺗﻘﺪﻳﯾﺮ ﺍاﻷﻋﻀﺎء ﺍاﻟﺘﻨﺎﺳﻠﻴﯿﺔ ﻭوﺟﻨﺲ ﺍاﻟﺠﻨﻴﯿﻦ ﻋﻠﻰ ﺗﻮﺟﻪﮫ ﺍاﻟﺤﺪﻳﯾﺒﺔ ﺍاﻟﺘﻨﺎﺳﻠﻴﯿﺔ ﻓﻲ ﺍاﻟﻤﺴﺘﻮﻯى ﺍاﻟﺴﻬﮭﻤﻲ ﺍاﻟﻨﺼﻔﻲ‪،٬‬‬
‫ﻭوﻟﻜﻨﻬﮭﺎ ﻟﻴﯿﺴﺖ ﺩدﻗﻴﯿﻘﺔ ﺑﻤﺎ ﻓﻴﯿﻪﮫ ﺍاﻟﻜﻔﺎﻳﯾﺔ ﻻﺳﺘﺨﺪﺍاﻣﻬﮭﺎ ﻷﻏﺮﺍاﺽض ﺳﺮﻳﯾﺮﻳﯾﺔ‪.‬‬

‫ﺍاﻟﺤﺒﻞ ﺍاﻟﺴﺮﻱي‬

‫ﻳﯾﻨﺒﻐﻲ ﻣﻼﺣﻈﺔ ﻋﺪﺩد ﺃأﻭوﻋﻴﯿﺔ ﺍاﻟﺤﺒﻞ ﺍاﻟﺴﺮﻱي ﻭوﺩدﺧﻮﻟﻪﮫ ﻓﻲ ﺍاﻟﺴﺮﺓة ﻭوﻭوﺟﻮﺩد ﺍاﻷﻛﻴﯿﺎﺱس ﺍاﻟﺨﺎﺻﺔ ﺑﻪﮫ‪ .‬ﻳﯾﻤﻜﻦ ﺗﻘﻴﯿﻴﯿﻢ ﺍاﻟﻤﺨﺘﺼﺮ‬
‫ﻟﻠﻤﻨﻄﻘﺔ ﺍاﻟﻤﺠﺎﻭوﺭرﺓة ﻟﻠﻤﺜﺎﻧﺔ‪ ,‬ﻣﻦ ﺧﻼﻝل ﺍاﺳﺘﺨﺪﺍاﻡم ﻟﻮﻥن ﺃأﻭو ﻁطﺎﻗﺔ ﺍاﻟﺪﻭوﺑﻠﺮ‪ ,‬ﺃأﻥن ﻳﯾﺴﺎﻋﺪ ﻋﻠﻰ ﺗﺄﻛﻴﯿﺪ ﻭوﺟﻮﺩد ﺍاﺛﻨﻴﯿﻦ ﻣﻦ ﺃأﻭوﻋﻴﯿﺔ‬
‫ﺍاﻟﺤﺒﻞ ﺍاﻟﺴﺮﻱي ﺍاﻟﺪﻣﻮﻳﯾﺔ‪ ،٬‬ﻭوﻟﻜﻨﻪﮫ ﻻ ﻳﯾﺸﻜﻞ ﺟﺰءﺍاً ﻣﻦ ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‪.‬‬

‫ﺩدﻭوﺭر ﺍاﻟﻔﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻟﺜﻼﺛﻲ ﻭوﺍاﻟﺮﺑﺎﻋﻲ ﺍاﻷﺑﻌﺎﺩد‬

‫ﺣﺎﻟﻴﯿﺎ ً ﻻ ﻳﯾﺘﻢ ﺍاﺳﺘﺨﺪﺍاﻡم ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻟﺜﻼﺛﻴﯿﺔ ﻭوﺍاﻟﺮﺑﺎﻋﻴﯿﺔ ﺍاﻷﺑﻌﺎﺩد ﻓﻲ ﺗﻘﻴﯿﻴﯿﻢ ﻣﺮﺣﻠﺔ ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ‬
‫ﺍاﻟﺘﺸﺮﻳﯾﺤﻲ ﻟﻠﺠﻨﻴﯿﻦ‪ ،٬‬ﻭوﺫذﻟﻚ ﻷﻥن ﺍاﻟﺤﻠﻮﻝل ﻟﻴﯿﺴﺖ ﺟﻴﯿﺪﺓة ﻛﺤﻠﻮﻝل ﻓﺤﺺ ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺍاﻟﺜﻨﺎﺋﻴﯿﺔ ﺍاﻷﺑﻌﺎﺩد‪.‬‬
‫ﻭوﺑﺤﺴﺐ ﺍاﻟﺨﺒﺮﺍاء‪ ،٬‬ﻗﺪ ﺗﻜﻮﻥن ﻫﮬﮪھﺬﻩه ﺍاﻟﻮﺳﺎﺋﻞ ﻣﻔﻴﯿﺪﺓة ﻓﻲ ﺗﻘﻴﯿﻴﯿﻢ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت‪ ،٬‬ﺧﺼﻮﺻﺎ ً ﺗﻠﻚ ﺍاﻟﺘﻲ ﺗﻈﻬﮭﺮ ﻓﻲ ﺍاﻟﺘﺸﺮﻳﯾﺢ‬
‫ﺍاﻟﺴﻄﺤﻲ )‪.(70‬‬
‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :6‬ﺑﻁطﻥن ﺍاﻟﺟﻧﻳﯾﻥن‪) .‬ﺃأ( ﺍاﻟﻠﻘﻁطﺔ ﺍاﻟﻣﺣﻭوﺭرﻳﯾﺔ ﻟﻠﺑﻁطﻥن ﻓﻲ ﺍاﻟﻣﺳﺗﻭوﻯى ﺣﻳﯾﺙث ﻳﯾﻘﺎﺱس ﻣﺣﻳﯾﻁط ﺍاﻟﺑﻁطﻥن )ﺧﻁط ﻣﺗﻘﻁطﻊ( ﻭوﺗﻅظﻬﮭﺭر ﺍاﻟﻣﻌﺩدﺓة ) ‪ (S‬ﻭوﺍاﻟﻭوﺭرﻳﯾﺩد ﺍاﻟﺳﺭرﻱي‬
‫) ‪) .(UV‬ﺏب( ﺍاﻟﻠﻘﻁطﺔ ﺍاﻹﻛﻠﻳﯾﻠﻳﯾﺔ ﻟﻠﺑﻁطﻥن ﺗﻅظﻬﮭﺭر ﺍاﻟﻛﻠﻳﯾﺗﺎﻥن ﻣﻊ ﺍاﻟﺣﻭوﺽض ﺍاﻟﻛﻠﻭوﻱي ﺍاﻟﻣﺭرﻛﺯزﻱي ﺍاﻟﻧﺎﻗﺹص ﺍاﻟﺻﺩدﻯى )‪ ،٬K‬ﺃأﺳﻬﮭﻡم(‪ ،٬‬ﺍاﻟﻣﻌﺩدﺓة ) ‪ (S‬ﺍاﻟﻐﺷﺎء ) ‪.(Diaph, lines‬‬
‫)ﺕت( ﺇإﺩدﺧﺎﻝل ﺍاﻟﺣﺑﻝل ﺍاﻟﺳﺭرﻱي )ﺍاﻟﺳﻬﮭﻡم(‪ .‬ﻣﻼﺣﻅظﺔ ﺃأﻥن ﺷﺭرﻳﯾﺎﻧﻳﯾﻥن ﻣﻥن ﺍاﻟﺷﺭرﺍاﻳﯾﻳﯾﻥن ﺍاﻟﺳﺭرﻳﯾﺔ ﻣﺭرﺋﻳﯾﺎﻥن‪.‬‬
‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :7‬ﺃأﻁطﺮﺍاﻑف ﺍاﻟﺠﻨﻴﯿﻦ‪) .‬ﺃأ( ﺍاﻟﺬﺭرﺍاﻉع ﻁطﺒﻴﯿﻌﻴﯿﺔ ﺗﻈﻬﮭﺮ ﺍاﻻﺻﻄﻔﺎﻑف ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﺬﺭرﺍاﻉع ﻭوﺍاﻟﻤﻌﺼﻢ‪) .‬ﺏب( ﺍاﻟﺴﺎﻕق ﺍاﻟﻄﺒﻴﯿﻌﻴﯿﺔ ﺗﻈﻬﮭﺮ ﺍاﻟﺘﻮﺟﻪﮫ ﺍاﻟﻄﺒﻴﯿﻌﻲ ﻟﻠﺴﺎﻕق‬
‫ﺑﺎﻟﻨﺴﺒﺔ ﺍاﻟﻰ ﺃأﺳﻔﻞ ﺍاﻟﺴﺎﻕق‪ .‬ﻭوﺃأﻳﯾﻀﺎ ً ﻣﻦ ﺍاﻟﻤﻤﻜﻦ ﺭرﺅؤﻳﯾﺔ ﺍاﻟﻜﻠﻰ ) ‪ (K‬ﻭوﺍاﻟﻤﻌﺪﺓة ) ‪.(S‬‬

‫‪ .6‬ﺗﻘﻴﯿﻴﯿﻢ ﺍاﻟﻜﺮﻭوﻣﻮﺳﻮﻣﺎﺕت ﺍاﻟﺸﺎﺫذﺓة‬

‫ﻗﺪ ﻳﯾُﻄﻠﺐ ﻓﺤﺺ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﻟﻠﻜﺮﻭوﻣﻮﺳﻮﻣﺎﺕت ﺍاﻟﺸﺎﺫذﺓة ﻓﻲ ﺍاﻟﺜﻠﺚ ﺍاﻻﻭوﻝل ﻣﻦ ﻣﺮﺣﻠﺔ ﺍاﻟﺤﻤﻞ‪ ،٬‬ﻣﻌﺘﻤﺪﺍاً‬
‫ﻋﻠﻰ ﺳﻴﯿﺎﺳﺎﺕت ﺍاﻟﺼﺤﺔ ﺍاﻟﻌﺎﻣﺔ ﻭوﺍاﻟﻤﻮﻅظﻔﻴﯿﻦ ﺍاﻟﻤﺪﺭرﺑﻴﯿﻦ ﻭوﺗﻮﻓﺮ ﻣﻮﺍاﺭرﺩد ﺍاﻟﺮﻋﺎﻳﯾﺔ ﺍاﻟﺼﺤﻴﯿﺔ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺘﻀﻤﻦ ﻓﺤﺺ‬
‫ﺍاﻟﺜﻠﺚ ﺍاﻷﻭوﻝل ﻗﻴﯿﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﻟﻠﺠﻨﻴﯿﻦ )‪ .(71,72‬ﻭوﻗﺪ ﺗﻤﺖ ﺇإﺿﺎﻓﺔ ﺍاﻟﻤﺰﻳﯾﺪ ﻣﻦ ﺗﺤﺴﻴﯿﻦ ﺃأﺩدﺍاء ﺍاﻟﻔﺤﺺ ﻭوﺫذﻟﻚ ﻣﻦ‬
‫ﺧﻼﻝل ﺇإﺿﺎﻓﺔ ﻋﻼﻣﺎﺕت ﺃأﺧﺮﻯى‪ ،٬‬ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﻗﻴﯿﺎﺱس ﺍاﻟﻜﻴﯿﻤﻴﯿﺎء ﺍاﻟﺤﻴﯿﻮﻳﯾﺔ ﻟﻠﺒﻴﯿﺘﺎ ﺍاﻟﻤﺠﺎﻧﻴﯿﺔ ﺃأﻭو ﺍاﺟﻤﺎﻟﻲ ﻣﻮﺟﻬﮭﺔ ﺍاﻟﻐﺪﺩد ﺍاﻟﺘﻨﺎﺳﻠﻴﯿﺔ‬
‫ﺍاﻟﻤﺸﻴﯿﻤﻴﯿﺔ ﺍاﻟﺒﺸﺮﻳﯾﺔ )ﻫﮬﮪھﺮﻣﻮﻥن ‪ (hCG‬ﺍاﻭو ﺇإﺟﻤﺎﻟﻲ ﺑﺮﻭوﺗﻴﯿﻦ ﺍاﻟﺒﻼﺯزﻣﺎ ‪ A‬ﺍاﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﺤﻤﻞ )‪.(73) (PAPP-A‬ﻭوﻓﻲ‬
‫ﺍاﻟﻈﺮﻭوﻑف ﺍاﻟﻤﻨﺎﺳﺒﺔ‪ ،٬‬ﻳﯾﺴﻌﻰ ﻁطﺎﻗﻢ ﺍاﻟﻌﻤﻞ ﺻﺎﺣﺐ ﺍاﻟﺨﺒﺮﺓة ﺍاﻟﻤﻨﺎﺳﺒﺔ ﻭوﺣﺎﻣﻞ ﺍاﻟﺸﻬﮭﺎﺩدﺍاﺕت ﺍاﻟﻤﻨﺎﺳﺒﺔ ﺇإﻟﻰ ﺍاﻟﺒﺤﺚ ﻋﻦ‬
‫ﻋﻼﻣﺎﺕت ﺍاﺧﺘﻼﻝل ﺍاﻟﺼﻴﯿﻐﺔ ﺍاﻟﺼﺒﻐﻴﯿﺔ‪ ،٬‬ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﻋﻈﺎﻡم ﺍاﻷﻧﻒ‪ ،٬‬ﻭوﻗﻠﺲ ﺛﻼﺛﻲ ﺍاﻟﺸﺮﻓﺎﺕت ﻭوﻗﻠﺲ ﺍاﻷﻗﻨﻴﯿﺔ ﻭوﻏﻴﯿﺮﻫﮬﮪھﺎ‬
‫)‪ .(74-76‬ﻛﻤﺎ ﻳﯾﻨﺼﺢ ﺍاﻟﻜﺜﻴﯿﺮ ﻣﻦ ﺍاﻟﺨﺒﺮﺍاء ﺃأﻥن ﺗﻘﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻔﻮﻗﻴﯿﺔ ﻣﺎ ﺑﻴﯿﻦ ﺍاﻷﺳﺒﻮﻉع ﺍاﻟﺤﺎﺩدﻱي ﻋﺸﺮ ﻭوﺍاﻷﺳﺒﻮﻉع‬
‫ﺍاﻟﺜﺎﻟﺚ ﻋﺸﺮ ‪ ،٬6+‬ﺍاﻟﻤﻮﺍاﻓﻖ ﻟﻘﻴﯿﺎﺱس ﻁطﻮﻝل ﺍاﻟﺘﺎﺟﻲ ﺍاﻟﻤﻘﻌﺪﻱي )‪ (CRL‬ﻣﺎ ﺑﻴﯿﻦ ‪ 45‬ﻭو‪ 84‬ﻣﻠﻢ‪ .‬ﺗﻢ ﺍاﺧﺘﻴﯿﺎﺭر ﻫﮬﮪھﺬﺍا ﺍاﻹﻁطﺎﺭر‬
‫ﻷﻥن ﺍاﻟﻔﺤﺺ ﻳﯾﺘ ّﻢ ﺑﺸﻜﻞ ﻣﺜﺎﻟﻲ ﻛﻤﺎ ﻳﯾﺴﻤﺢ ﺣﺠﻢ ﺍاﻟﺠﻨﻴﯿﻦ ﺑﺘﺸﺨﻴﯿﺺ ﺗﺸﻮﻫﮬﮪھﺎﺗﻪﮫ‬ ‫ﻟﻌﻤﺮ ﺍاﻟﺤﻤﻞ ﺑﺴﺒﺐ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ‪ّ ،٬‬‬
‫ً‬
‫ﺍاﻟﺮﺋﻴﯿﺴﻴﯿﺔ‪ ،٬‬ﻭوﻫﮬﮪھﺬﺍا ﻣﺎ ﻳﯾﻌﻄﻲ ﻟﻠﻤﺮﺃأﺓة ﺍاﻟﺘﻲ ﺗﺤﻤﻞ ﻁطﻔﻼً ﻣﺼﺎﺑﺎ ﺧﻴﯿﺎﺭر ﺍاﻟﻘﻴﯿﺎﻡم ﺑﺈﺟﻬﮭﺎﺽض ﻣﺒﻜﺮ )‪ .(77‬ﻛﻤﺎ ﻳﯾﺘﻄﻠﺐ ﺗﻨﻔﻴﯿﺬ‬
‫ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﻋﺪﺓة ﻋﻨﺎﺻﺮ ﻟﻴﯿﺄﺧﺬ ﻣﻜﺎﻥن ﻣﻨﺎﺳﺐ‪ ،٬‬ﺑﻤﺎ ﻓﻲ ﺫذﻟﻚ ﺍاﻟﻤﻌﺪﺍاﺕت ﺍاﻟﻤﻨﺎﺳﺒﺔ ﻭوﺗﻘﺪﻳﯾﻢ ﺍاﻻﺳﺘﺸﺎﺭرﺓة ﻭوﺍاﻟﻤﻌﺎﻟﺠﺔ‬
‫ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ ﻭوﻛﺬﻟﻚ ﻋﻤﺎﻝل ﺍاﻟﺘﺸﻐﻴﯿﻞ ﻣﻊ ﺍاﻟﺘﺪﺭرﻳﯾﺐ ﺍاﻟﻤﺘﺨﺼﺺ ﻭوﺍاﻻﺳﺘﻤﺮﺍاﺭر ﻓﻲ ﺍاﻋﻄﺎء ﺍاﻟﺸﻬﮭﺎﺩدﺍاﺕت‪ .‬ﻭوﻳﯾﻤﻜﻦ ﺍاﻟﺤﺼﻮﻝل‬
‫ﻋﻠﻰ ﺍاﻟﻤﺰﻳﯾﺪ ﻣﻦ ﺍاﻟﺘﻔﺎﺻﻴﯿﻞ ﻣﻦ ﺍاﻟﻬﮭﻴﯿﺌﺎﺕت ﺍاﻟﻮﻁطﻨﻴﯿﺔ ﺫذﺍاﺕت ﺍاﻟﺼﻠﺔ ﻭوﺍاﻟﺠﻤﻌﻴﯿﺎﺕت ﺍاﻟﺨﻴﯿﺮﻳﯾﺔ ﻣﺜﻞ ﻣﺆﺳﺴﺔ ﻁطﺐ ﺍاﻟﺠﻨﻴﯿﻦ‬
‫)‪ .(www.fetalmedicine.com‬ﻭوﻣﻊ ﺫذﻟﻚ‪ ،٬‬ﻭوﺣﺘﻰ ﻓﻲ ﺣﺎﻝل ﻋﺪﻡم ﻭوﺟﻮﺩد ﺑﺮﻧﺎﻣﺞ ﻓﺤﺺ ﻳﯾﻌﺘﻤﺪ ﻋﻠﻰ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ‬
‫ﺍاﻟﻘﻔﻮﻳﯾﺔ‪ ،٬‬ﻳﯾﻨﺼﺢ ﺑﺈﺟﺮﺍاء ﺗﻘﻴﯿﻴﯿﻢ ﻧﻮﻋﻲ ﻟﻠﻤﻨﻄﻘﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﻷﻱي ﺟﻨﻴﯿﻦ ﻭوﺇإﺫذﺍا ﻛﺎﻥن ﻳﯾﺒﺪﻭو ﺳﻤﻴﯿﻜﺎً‪ ،٬‬ﻳﯾﺠﺐ ﺍاﻟﻨﻈﺮ ﻓﻲ ﺇإﺣﺎﻟﺘﻪﮫ ﺍاﻟﻰ‬
‫ﺧﺒﻴﯿﺮ‪.‬‬

‫ﻛﻴﯿﻒ ﺗﻘﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ‬

‫ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﺘﻢ ﺇإﺟﺮﺍاء ﻗﻴﯿﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﺍاﻟﻤﺴﺘﺨﺪﻡم ﻟﻠﻔﺤﺺ ﻓﻘﻂ ﻣﻦ ﻗﺒﻞ ﻋﺎﻣﻠﻲ ﺗﺸﻐﻴﯿﻞ ﻣﺪﺭرﺑﻴﯿﻦ ﻭوﻣﻌﺘﻤﺪﻳﯾﻦ‪.‬‬
‫ﻭوﻳﯾﻤﻜﻦ ﻗﻴﯿﺎﺳﻬﮭﺎ ﻋﻦ ﻁطﺮﻳﯾﻖ ﺟﺪﺍاﺭر ﺍاﻟﺒﻄﻦ ﺃأﻭو ﻋﻦ ﻁطﺮﻳﯾﻖ ﺍاﻟﻤﻬﮭﺒﻞ‪ .‬ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻜﻮﻥن ﺍاﻟﺠﻨﻴﯿﻦ ﻓﻲ ﻭوﺿﻊ ﻣﺤﺎﻳﯾﺪ‪ ،٬‬ﻛﻤﺎ ﻳﯾﺠﺐ‬
‫ﺍاﻟﺤﺼﻮﻝل ﻋﻠﻰ ﻣﻘﻄﻊ ﺳﻬﮭﻤﻲ ﻭوﺗﻜﺒﻴﯿﺮ ﺍاﻟﺼﻮﺭرﺓة ﻟﺘﺘﻀﻤﻦ ﺭرﺃأﺱس ﺍاﻟﺠﻨﻴﯿﻦ ﻭوﺍاﻟﺠﺰء ﺍاﻟﻌﻠﻮﻱي ﻣﻦ ﺍاﻟﺼﺪﺭر‪ .‬ﺇإﺿﺎﻓﺔً ﺍاﻟﻰ‬
‫ﺫذﻟﻚ‪ ،٬‬ﻳﯾﺠﺐ ﺗﺤﺪﻳﯾﺪ ﺍاﻟﻐﺸﺎء ﺍاﻟﻤﺤﻴﯿﻂ ﺑﺎﻟﺠﻨﻴﯿﻦ ﺑﺸﻜﻞ ﻣﻨﻔﺼﻞ ﻋﻦ ﺍاﻟﺠﻨﻴﯿﻦ‪ .‬ﻳﯾﺘﻢ ﺗﻌﺮﻳﯾﻒ ﺍاﻟﻠﻘﻄﺔ ﺍاﻟﻤﺘﻮﺳﻄﺔ ﻟﻮﺟﻪﮫ ﺍاﻟﺠﻨﻴﯿﻦ‬
‫ﻣﻦ ﺧﻼﻝل ﻭوﺟﻮﺩد ﻁطﺮﻑف ﻣﻮﻟﺪ ﺍاﻟﺼﺪﻯى ﻟﻸﻧﻒ ﻭوﺷﻜﻞ ﺍاﻟﺤﻨﻚ ﺍاﻷﻣﺎﻣﻲ ﺍاﻟﻤﺴﺘﻄﻴﯿﻞ‪ ،٬‬ﻭوﺍاﻟﺪﱢﻣﺎ ُ‬
‫ﻍغ ﺍاﻟﺒَﻴﯿﻨِ ّﻲ ﺍاﻟﺸﻔﺎﻑف ﻓﻲ‬
‫ﺍاﻟﻮﺳﻂ ﻭوﺍاﻟﻐﺸﺎء ﺍاﻟﻘﻔﻮﻱي ﺍاﻟﺨﻠﻔﻲ‪ .‬ﻭوﺍاﺫذ ﻟﻢ ﻳﯾﻜﻦ ﺍاﻟﻘﺴﻢ ﺗﻤﺎﻣﺎ ً ﻓﻲ ﺍاﻟﻮﺳﻂ‪ ،٬‬ﻟﻦ ﻳﯾﻜﻮﻥن ﻁطﺮﻑف ﺍاﻷﻧﻒ ﻣﺮﺋﻴﯿﺎ ً ﻭوﺳﻴﯿﻈﻬﮭﺮ‬
‫ﺍاﻻﻣﺘﺪﺍاﺩد ﺍاﻟﻌﻈﻤﻲ ﺍاﻟﻤﺘﻌﺎﻣﺪ ﻟﻠﻮﺍاﺟﻬﮭﺔ ﺍاﻷﻣﺎﻣﻴﯿﺔ ﻟﻠﻔﻚ ﺍاﻟﻌﻠﻮﻱي‪ .‬ﻳﯾﺠﺐ ﻋﻠﻰ ﺟﻬﮭﺎﺯز ﺍاﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ ﺃأﻥن ﻳﯾﺴﻤﺢ‬
‫ﺑﺪﻗﺔ ﻗﻴﯿﺎﺱس ‪ 0.1‬ﻣﻢ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺃأﻥن ﻳﯾﻮﺿﻊ ﺍاﻟﻔِﺮْ ﺟﺎﺭر ﺑﻄﺮﻳﯾﻘﺔ ﺻﺤﻴﯿﺤﺔ )‪ (on-on‬ﻟﻘﻴﯿﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﻛﺎﻟﻤﺴﺎﻓﺔ‬
‫ﺍاﻟﻘﺼﻮﻯى ﺑﻴﯿﻦ ﺍاﻟﻐﺸﺎء ﺍاﻟﻘﻔﻮﻱي ﻭوﺣﺎﻓﺔ ﺍاﻷﻧﺴﺠﺔ ﺍاﻟﻠﻴﯿﻨﺔ ﺍاﻟﺘﻲ ﺗﻐﻄﻲ ﺍاﻟﻔﻘﺮﺍاﺕت ﺍاﻟﻌﻨﻘﻴﯿﺔ )ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ﺭرﻗﻢ ‪ .(8‬ﺇإﺫذﺍا‬
‫ﺗﻢ ﺍاﻟﺘﺄﻛﺪ ﺃأﻥن ﺃأﻛﺜﺮ ﻣﻦ ﻗﻴﯿﺎﺱس ﻭوﺍاﺣﺪ ﻳﯾﻤﺘﻠﻚ ﻛﻞ ﺍاﻟﻤﻌﺎﻳﯾﻴﯿﺮ‪ ،٬‬ﻳﯾﺠﺐ ﺗﺴﺠﻴﯿﻞ ﺍاﻟﻘﻴﯿﺎﺱس ﺍاﻟﺬﻱي ﻳﯾﻤﺘﻠﻚ ﺍاﻟﺤﺪ ﺍاﻻﻗﺼﻰ ﻭوﺍاﺳﺘﺨﺪﺍاﻣﻪﮫ‬
‫ﻓﻲ ﺗﻘﻴﯿﻴﯿﻢ ﺍاﻟﻤﺨﺎﻁطﺮ‪ .‬ﻭوﻳﯾﺘﻄﻠﺐ ﺍاﻟﺤﻤﻞ ﺍاﻟﻤﺘﻌﺪﺩد ﺍاﻋﺘﺒﺎﺭرﺍاﺕت ﺧﺎﺻﺔ‪ ،٬‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺃأﺧﺬ ﺍاﻟﺘﺸﺎﺭرﻙك ﺑﻌﻴﯿﻦ ﺍاﻻﻋﺘﺒﺎﺭر‪.‬‬
 ‫ﺍاﻟﺮﺳﻢ ﺍاﻟﺘﻮﺿﻴﯿﺤﻲ ‪ :8‬ﻗﻴﯿﺎﺱس ﺍاﻟﺴﻤﺎﻛﺔ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬

‫ﻛﻴﯿﻒ ﻳﯾﺘﻢ ﺍاﻟﺘﺪﺭرﻳﯾﺐ ﻭوﺍاﻟﺘﺤﻜﻢ ﺑﻨﻮﻋﻴﯿﺔ ﻗﻴﯿﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ‬

‫ﻳﯾﺘﻄﻠﺐ ﻗﻴﯿﺎﺱس ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ ﺍاﻟﻤﻮّﺛﻖ ﻭوﺍاﻟﻘﺎﺑﻞ ﻟﻠﺘﻜﺮﺍاﺭر ﺍاﻟﺘﺪﺭرﻳﯾﺐ ﺍاﻟﻤﻨﺎﺳﺐ‪ .‬ﻭوﻗﺪ ﺗﻢ ﺇإﻧﺸﺎء ﺗﺪﻗﻴﯿﻖ ﺷﺎﻣﻞ ﻋﻦ ﺃأﺩدﺍاء‬
‫ﻋﺎﻣﻞ ﺍاﻟﺘﺸﻐﻴﯿﻞ ﻭوﺿﻊ ﻣﻼﺣﻈﺎﺕت ﺍاﻳﯾﺠﺎﺑﻴﯿﺔ ﻓﻲ ﺍاﻟﻌﺪﻳﯾﺪ ﻣﻦ ﺍاﻟﺪﻭوﻝل‪ ,‬ﻭو ﺑﺎﻟﺘﺎﻟﻲ ﻳﯾﺠﺐ ﺃأﻥن ﺗﺆﺧﺬ ﺑﻌﻴﯿﻦ ﺍاﻻﻋﺘﺒﺎﺭر ﺑﺎﻟﻨﺴﺒﺔ‬
‫ﺍاﻟﻰ ﺟﻤﻴﯿﻊ ﺍاﻟﻤﻤﺎﺭرﺳﻴﯿﻦ ﺍاﻟﺬﻳﯾﻦ ﻳﯾﺸﺎﺭرﻛﻮﻥن ﻓﻲ ﺑﺮﻧﺎﻣﺞ ﻓﺤﺺ ﻳﯾﻌﺘﻤﺪ ﻋﻠﻰ ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻘﻔﻮﻳﯾﺔ‪) .‬ﻧﻘﻄﺔ ﻣﻤﺎﺭرﺳﺔ ﺟﻴﯿﺪﺓة(‬

‫‪ .7‬ﺍاﻟﺒﻨﻴﯿﺎﻥن ﺃأﻭو ﺍاﻟﻬﮭﻴﯿﺎﻛﻞ ﺍاﻻﺧﺮﻯى ﺩدﺍاﺧﻞ ﻭوﺧﺎﺭرﺝج ﺍاﻟﺮﺣﻢ‬

‫ﻳﯾﺠﺐ ﺗﻘﻴﯿﻴﯿﻢ ﺻﺪﻯى ﺍاﻟﺒﻨﻴﯿﺔ ﻟﻠﻤﺸﻴﯿﻤﺔ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﺍاﻹﺷﺎﺭرﺓة ﻭوﻣﺘﺎﺑﻌﺔ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﺍاﻟﺘﻲ ﺗﻈﻬﮭﺮ ﺑﺸﻜﻞ ﻭوﺍاﺿﺢ‪ ،٬‬ﻣﺜﻞ ﺍاﻟﻜﺘﻞ ﺃأﻭو‬
‫ﺍاﻟﻤﺴﺎﺣﺎﺕت ﺍاﻟﻜﻴﯿﺴﻴﯿﺔ ﺍاﻟﻮﺍاﺣﺪﺓة ﺃأﻭو ﺍاﻟﻤﺘﻌﺪﺩدﺓة ﺃأﻭو ﻣﺠﻤﻮﻋﺔ ﺍاﻟﺴﻮﺍاﺋﻞ ﺗﺤﺖ ﺍاﻟﻤﺸﻴﯿﻤﺔ )<‪5‬ﺳﻢ(‪ .‬ﻛﻤﺎ ﻳﯾﻌﺘﺒﺮ ﻣﻮﻗﻊ ﺍاﻟﻤﺸﻴﯿﻤﺔ‬
‫ﺑﺎﻟﻨﺴﺒﺔ ﺍاﻟﻰ ﻋﻨﻖ ﺍاﻟﺮﺣﻢ ﺃأﻗﻞ ﺃأﻫﮬﮪھﻤﻴﯿﺔ ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﻤﺮﺣﻠﺔ ﻣﻦ ﺍاﻟﺤﻤﻞ ﻷﻥن ﺍاﻟﻤﻌﻈﻢ "ﻳﯾﻬﮭﺎﺟﺮ ﺃأﻭو ﻳﯾﺮﺗﺤﻞ" ﺑﻌﻴﯿﺪﺍاً ﻋﻦ ﻋﻨﻖ‬
‫ﺍاﻟﺮﺣﻢ ﺍاﻟﺪﺍاﺧﻠﻲ )‪ .(78‬ﻭوﻻ ﻳﯾﺠﺐ ﺇإﻳﯾﺠﺎﺩد ﻣﺸﻴﯿﻤﺔ ﻣﻨﺰﺍاﺣﺔ ﻓﻲ ﻫﮬﮪھﺬﻩه ﺍاﻟﻤﺮﺣﻠﺔ‪.‬‬

‫ﻭوﻛﻦ ﻋﺮﺿﺔً ﻟﻨﺪﻭوﺏب ﺍاﻟﺤﻤﻞ‬ ‫ﻛﻤﺎ ﻳﯾﺠﺐ ﺇإﻋﻄﺎء ﺍاﻧﺘﺒﺎﻩه ﺧﺎﺹص ﻟﻠﻤﺮﻳﯾﻀﺎﺕت ﺍاﻟﻠﻮﺍاﺗﻲ ﺧﻀﻌﻦ ﻟﻌﻤﻠﻴﯿﺎﺕت ﻗﻴﯿﺼﺮﻳﯾﺔ ﺳﺎﺑﻘﺎً‪ّ ،٬‬‬
‫ﺃأﻭو ﺍاﻟﻤﺸﻴﯿﻤﺔ ﺍاﻟﻤﻠﺘﺼﻘﺔ ﻣﻊ ﻣﻀﺎﻋﻔﺎﺕت ﺧﻄﻴﯿﺮﺓة‪ .‬ﻭوﻟﺪﻯى ﻫﮬﮪھﺆﻻء ﺍاﻟﻤﺮﻳﯾﻀﺎﺕت‪ ،٬‬ﻳﯾﺠﺐ ﺍاﻟﺘﺪﻗﻴﯿﻖ ﻓﻲ ﺍاﻟﻤﻨﻄﻘﺔ ﺍاﻟﻤﻮﺟﻮﺩدﺓة ﺑﻴﯿﻦ‬
‫ﺍاﻟﻤﺜﺎﻧﺔ ﻭوﺑﺮﺯزﺥخ ﻋﻨﻖ ﺍاﻟﺮﺣﻢ ﻋﻨﺪ ﻣﻮﻗﻊ ﺍاﻟﻨﺪﺑﺔ ﺍاﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺍاﻟﻌﻤﻠﻴﯿﺔ ﺍاﻟﻘﻴﯿﺼﺮﻳﯾﺔ‪ .‬ﻓﻲ ﺍاﻟﺤﺎﻻﺕت ﺍاﻟﺘﻲ ﻳﯾﺸﺘﺒﻪﮫ ﺑﻬﮭﺎ‪ ،٬‬ﻳﯾﺠﺐ‬
‫ﺍاﻻﺧﺬ ﺑﻌﻴﯿﻦ ﺍاﻻﻋﺘﺒﺎﺭر ﺿﺮﻭوﺭرﺓة ﺍاﻟﺘﺤﻮﻳﯾﻞ ﺍاﻟﻰ ﺃأﺧﺼﺎﺋﻲ ﻹﺟﺮﺍاء ﺍاﻟﻤﺰﻳﯾﺪ ﻣﻦ ﺍاﻟﺘﻘﻴﯿﻴﯿﻢ ﻭوﺍاﻟﻤﻌﺎﻟﺠﺔ ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ )‪.(79,80‬‬
‫ﻭوﻋﻠﻰ ﺭرﻏﻢ ﻣﻦ ﺍاﻧﻪﮫ ﺳﻮﻑف ﺗﺜﺎﺭر ﻓﻲ ﺍاﻟﻤﺴﺘﻘﺒﻞ ﻣﺴﺄﻟﺔ ﺍاﻟﻔﺤﺺ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻲ ﻟﺪﻯى ﺍاﻟﻨﺴﺎء ﺍاﻟﻠﻮﺍاﺗﻲ ﺧﻀﻌﻦ ﻟﻌﻤﻠﻴﯿﺎﺕت‬
‫ﻗﻴﯿﺼﺮﻳﯾﺔ ﺳﺎﺑﻘﺎ ً )‪ ،٬ (81,82‬ﻓﺤﺎﻟﻴﯿﺎ ً ﻫﮬﮪھﻨﺎﻙك ﺃأﺩدﻟﺔ ﻏﻴﯿﺮ ﻛﺎﻓﻴﯿﺔ ﻟﺪﻋﻢ ﺍاﺩدﺭرﺍاﺝج ﻫﮬﮪھﺬﻩه ﺍاﻟﺴﻴﯿﺎﺳﺔ ﻓﻲ ﺍاﻟﻤﻤﺎﺭرﺳﺔ ﺍاﻟﺮﻭوﺗﻴﯿﻨﻴﯿﺔ‪.‬‬

‫ﻓﻲ ﻋﻠﻢ ﺍاﻻﻣﺮﺍاﺽض ﺍاﻟﻨﺴﺎﺋﻴﯿﺔ‪ ،٬‬ﻗﺪ ﻳﯾﺘﻢ ﺍاﻛﺘﺸﺎﻑف ﻛﻼ ﺍاﻻﻣﺮﺍاﺽض ﺍاﻟﺨﺒﻴﯿﺜﺔ ﻭوﺍاﻟﺤﻤﻴﯿﺪﺓة ﻓﻲ ﺍاﻟﻔﺤﺺ ﺧﻼﻝل ﺍاﻟﺜﻠﺚ ﺍاﻻﻭوﻝل‪.‬‬
‫ﻭوﻳﯾﺠﺐ ﻭوﺻﻒ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﻓﻲ ﺷﻜﻞ ﺍاﻟﺮﺣﻢ ﻣﺜﻞ ﺣﺎﺟﺰ ﺍاﻟﺮﺣﻢ ﻭوﺍاﻟﺮﺣﻢ ﺫذﻱي ﺍاﻟﻘﺮﻧﻴﯿﻴﯿﻦ‪ .‬ﻛﻤﺎ ﻳﯾﺠﺐ ﻣﻌﺎﻳﯾﻨﺔ ﺍاﻟﻤﺒﺎﻳﯾﺾ‬
‫ﻟﻠﻜﺸﻒ ﻋﻦ ﺍاﻟﺘﺸﻮﻫﮬﮪھﺎﺕت ﻭوﺍاﻟﻜﺘﻞ‪ .‬ﻭوﺍاﻫﮬﮪھﻤﻴﯿﺔ ﻫﮬﮪھﺬﻩه ﺍاﻟﻨﺘﺎﺋﺞ ﻭوﺍاﺩدﺍاﺭرﺗﻬﮭﺎ ﻫﮬﮪھﻲ ﺧﺎﺭرﺝج ﻧﻄﺎﻕق ﺍاﻟﻤﺒﺎﺩدﺉئ ﺍاﻟﺘﻮﺟﻴﯿﻬﮭﻴﯿﺔ‪.‬‬
 Guideline Authors
L.   J. Salomon*, Department of Obstetrics and Fetal Medicine and SFAPE (Societe Francaise d’Ameliorationdes Pratiques
Echographique), Paris Descartes University, Assistance Publique-Hopitaux de Paris, Hopital Necker Enfants, Paris,
France
Z. Alfirevic*, Department for Women’s and Children’s Health, University of Liverpool, Liverpool, UK
C. M. Bilardo, Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Centre Groningen,
Groningen, The Netherlands
G. E. Chalouhi, Department of Obstetrics and Fetal Medicine and SFAPE (Societe Francaise d’Amelioration
Des Pratiques Echographique), Paris Descartes University, Assistance Publique-Hopitaux de Paris, Hopital Necker
Enfants, Paris, France
T. Ghi, Department of Obstetrics and Gynaecology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
K. O. Kagan, Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
T. K. Lau, Fetal Medicine Centre, Paramount Clinic, Central, Hong Kong
A. T. Papageorghiou, Fetal Medicine Unit, St George’s, University of London, London, UK
N. J. Raine-Fenning, Division of Obstetrics & Gynaecology, School of Clinical Sciences, University of Nottingham,
Nottingham, UK
J. Stirnemann, Obstetrics and Fetal Medicine, GHU Necker-Enfants Malades, University Paris Descartes, Paris, France
S. Suresh, Mediscan Systems & Fetal Care Research Foundation, Mylapore, Chennai, India
A. Tabor, Fetal Medicine Unit, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
I. E. Timor-Tritsch, Department of Obstetrics and Gynecology, New York University School of Medicine, NewYork,
NY, USA
A. Toi,Medical Imaging and Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto,ON,
Canada
G. Yeo, Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal DiagnosticUnit, KK Women’s and
Children’s Hospital, Singapore

*L. J. S. and Z.A. contributed equally to this article.

Citation
  Guidelines should be cited as: ‘Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK,
These
Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG
Practice Guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41: 102–113.’

References
1.  Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G,Munoz H, Prefumo
F, Toi A, Lee W; ISUOG Clinical Standards Committee. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan.
Ultrasound Obstet Gynecol 2011; 37: 116–126.
2. Deter RL, Buster JE, Casson PR, Carson SA. Individual growth patterns in the first trimester: evidence for difference in embryonic and fetal
growth rates. Ultrasound Obstet Gynecol1999; 13: 90–98.
3. Blaas HG. The examination of the embryo and early fetus: how and by whom? Ultrasound Obstet Gynecol1999; 14: 153–158.
4. Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2010; 4:
CD007058.
5. Bennett KA, Crane JMG, O’Shea P, Lacelle J, Hutchens D, Copel JA. First trimester ultrasound screening is effective in reducing post term
labor induction rates: a randomized controlled trial. Am J Obstet Gynecol 2004; 190: 1077–1081.
6. Hoffman CS, Messer LC, Mendola P, Savitz DA, Herring AH, Hartmann KE. Comparison of gestational age at birth based on last menstrual
period and ultrasound during the first trimester.PaediatrPerinat Epidemiol 2008; 22: 587–596.
7. Taipale P, Hiilesmaa V. Predicting delivery date by ultrasound and last menstrual period in early gestation. Obstet Gynecol 2001; 97: 189–194.
8. Skalkidou A, Kieler H, Stephansson O, Roos N, Cnattingius S,Haglund B. Ultrasound pregnancy dating leads to biased perinatal morbidity
and neonatal mortality among post-term-borngirls. Epidemiology 2010; 21: 791–796.
9. Harrington DJ, MacKenzie IZ, Thompson K, Fleminger M, Greenwood C. Does a first trimester dating scan using crown rump length
measurement reduce the rate of induction of labour for prolonged pregnancy? An uncompleted randomised controlled trial of 463 women. BJOG
2006; 113: 171–176.
10. Ott WJ. Accurate gestational dating: revisited. Am J Perinatol 1994; 11: 404–408.
11. Wisser J, Dirschedl P, Krone S. Estimation of gestational age by transvaginal sonographic measurement of greatest embryonic length in dated
human embryos. Ultrasound Obstet Gynecol1994; 4: 457–462.
12. Tunon K, Eik-Nes SH, Grøttum P, Von During V, Kahn JA. Gestational age in pregnancies conceived after in vitro fertilization: a comparison
between age assessed from oocyte retrieval,crown–rump length and biparietal diameter. Ultrasound ObstetGynecol 2000; 15: 41–46.
13. Grange G, Pannier E, Goffinet F, Cabrol D, Zorn JR. Dating biometry during the first trimester: accuracy of an every-day practice. Eur J
Obstet Gynecol Reprod Biol 2000; 88: 61–64.
14. Chalouhi GE, Bernard JP, Benoist G, Nasr B, Ville Y, Salomon LJ. A comparison of first trimester measurements for prediction of delivery
date. J Matern Fetal Neonatal Med 2011; 24: 51–57.
15. Salomon LJ, Pizzi C, Gasparrini A, Bernard J-P, Ville Y. Predictionof the date of delivery based on first trimester ultrasound measurements:
an independent method from estimated date of conception. J Matern Fetal Neonatal Med 2010; 23: 1–9.
16. Caughey AB, Nicholson JM, Washington AE. First- vs second trimester ultrasound: the effect on pregnancy dating and perinatal outcomes.
Am J Obstet Gynecol 2008; 198: 703.e1–6.
17. Thorsell M, Kaijser M, Almstrom H, Andolf E. Expected day of delivery from ultrasound dating versus last menstrual period-obstetric
outcome when dates mismatch. BJOG 2008; 115:585–589.
18. Bottomley C, Bourne T. Dating and growth in the first trimester. Best Pract Res ClinObstetGynaecol 2009; 4: 439–452.
19. Sonek J. First trimester ultrasonography in screening and detection of fetal anomalies.Am J Med Genet C Semin Med Genet 2007; 145: 45–61.
20. Snijders RJ, Johnson S, Sebire NJ, Noble PL, Nicolaides KH. First-trimester ultrasound screening for chromosomal defects. Ultrasound
ObstetGynecol 1996; 7: 216–226.
21. Ville Y. ‘Cecin’est pas une ´echographie’: a plea for quality assessment in prenatal ultrasound. Ultrasound Obstet Gynecol 2008; 31: 1–5.
22. Abramowicz JS, Kossoff G, Marsal K, TerHaar G. Safety Statement, 2000 (reconfirmed 2003). International Society of Ultrasound in
Obstetrics and Gynecology (ISUOG).Ultrasound Obstet Gynecol 2003; 21: 100.
23. Torloni MR, Vedmedovska N, Merialdi M, Betran AP, AllenT, Gonzalez R, Platt LD; ISUOG-WHO Fetal Growth Study Group. Safety of
ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis. Ultrasound Obstet Gynecol 2009; 33: 599–608.
24. Hershkovitz R, Sheiner E, Mazor M. Ultrasound in obstetrics: a review of safety. Eur J Obstet Gynecol Reprod Biol 2002; 101: 15–18.
25. Salvesen K, Lees C, Abramowicz J, Brezinka C, TerHaar G, Marsal K. ISUOG statement on the safe use of Doppler in the 11 to 13+6-week
fetal ultrasound examination. Ultrasound Obstet Gynecol 2011; 37: 628.
26. Lewi L, Jani J, Blickstein I, HuberA, Gucciardo L, Van Mieghem T, Done´ E, Boes AS, Hecher K, Gratac s E, Lewi P, Deprest J. The
outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol 2008;
199: 493.e1–7.
27. Dias T, Arcangeli T, Bhide A, Napolitano R, Mahsud-DornanS, Thilaganathan B. First-trimester ultrasound determination of chorionicity in
twin pregnancy. Ultrasound Obstet Gyneco l2011; 38: 530–532.
28. Fong KW, Toi A, Salem S, Hornberger LK, Chitayat D, Keating SJ, McAuliffe F, Johnson JA. Detection of fetal structural abnormalities with
US during early pregnancy. Radiographics 2004; 24: 157–174.
29. Jurkovic D, Gruboeck K, Campbell S. Ultrasound featuresof normal early pregnancy development. Curr Opin Obstet Gynecol 1995; 7:
493–504.
30. Tezuka N, Sato S, Kanasugi H, Hiroi M. Embryonic heart rates:development in early first trimester and clinical evaluation. Gynecol Obstet
Invest 1991; 32: 210–212.
31. Levi CS, Lyons EA, Zheng XH, Lindsay DJ, Holt SC. Endovaginal US: demonstration of cardiac activity in embryos of less than 5.0 mm in
crown-rump length. Radiology 1990; 176: 71–74.
32. Goldstein SR. Significance of cardiac activity on endovaginal ultrasound in very early embryos. Obstet Gynecol 1992; 80: 670–672.
33. Brown DL, Emerson DS, Felker RE, Cartier MS, Smith WC. Diagnosis of early embryonic demise by endovaginal sonography. J Ultrasound
Med 1990; 9: 631–636.
34. Oh JS, Wright G, Coulam CB. Gestational sac diameter in very early pregnancy as a predictor of fetal outcome. Ultrasound Obstet Gynecol
2002; 20: 267–269.
35. Robinson HP, Sweet EM, Adam AH. The accuracy of radiological estimates of gestational age using early fetal crown-rump length
measurements by ultrasound as a basis for comparison.Br J Obstet Gynaecol 1979; 86: 525–528.
36. Robinson HP. ‘‘Gestation sac’’ volumes as determined by sonar in the first trimester of pregnancy. Br J Obstet Gynaecol 1975; 82: 100–107.
37. Salomon LJ, Bernard M, Amarsy R, Bernard JP, Ville Y. The impact of crown–rump length measurement error on combined Down syndrome
screening: a simulation study. Ultrasound Obstet Gynecol 2009; 33: 506–511.
38. Sladkevicius P, Saltvedt S, Almstrom H, Kublickas M, Grunewald C, Valentin L. Ultrasound dating at 12–14 weeks of gestation. A
prospective cross-validation of established dating formulae in in-vitro fertilized pregnancies. Ultrasound Obstet Gynecol 2005; 26: 504–511.
39. Altman DG, Chitty LS. New charts for ultrasound dating of pregnancy.Ultrasound Obstet Gynecol 1997; 10: 174–191.
40. Salomon LJ, Bernard JP, Duyme M, Dorion A, Ville Y. Revisiting first-trimester fetal biometry. Ultrasound Obstet Gynecol2003; 22: 63–66.
41. Loughna P, Chitty L, Evans T, Chudleigh T. Fetal size and dating: charts recommended for clinical obstetric practice.Ultrasound 2009; 17:
161–167.
42. Hadlock FP, Deter RL, Carpenter RJ, Park SK. Estimating fetal age: effect of head shape on BPD. AJR Am J Roentgenol 1981; 137: 83–85.
43. Verburg BO, Steegers EAP, De Ridder M, Snijders RJM, Smith E, Hofman A, Moll HA, Jaddoe VW, Witteman JC. New charts for
ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohortstudy. Ultrasound Obstet
Gynecol 2008; 31: 388–396.
44. Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term. Cochrane Database Syst Rev 2000; (2):
CD000170.
45. Mongelli M, Wong YC, Venkat A, Chua TM. Induction policy and missed post-term pregnancies: a mathematical model. Aust
N Z J Obstet Gynaecol 2001; 41: 38–40.
46. Hoffman CS, Messer LC, Mendola P, Savitz DA, Herring AH, Hartmann KE. Comparison of gestational age at birth based on
last menstrual period and ultrasound during the first trimester. Paediatr Perinat Epidemiol 2008; 22: 587–596.
47. NICE. Antenatal care: Routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence:
London, 2010.
48. Savitz DA, Terry JW, Dole N, Thorp JM, Siega-Riz AM, Herring AH. Comparison of pregnancy dating by last menstrual period, ultrasound
scanning, and their combination. Am J Obste tGynecol 2002; 187: 1660–1666.
49. Bagratee JS, Regan L, Khullar V, Connolly C, Moodley J. Reference intervals of gestational sac, yolk sac and embryo volumes using three
dimensional ultrasound. Ultrasound Obstet Gynecol 2009; 34: 503–509.
50. Grisolia G, Milano K, Pilu G,Banzi C, David C, Gabrielli S, Rizzo N, Morandi R, Bovicelli L. Biometry of early pregnancy with transvaginal
sonography. Ultrasound Obstet Gynecol 1993; 3: 403–411.
51. Robinson HP. Sonar measurement of fetal crown-rump length as means of assessing maturity in first trimester of pregnancy. Br Med J 1973;
4: 28–31.
52. Robinson HP, Fleming JE. A critical evaluation of sonar ‘‘crown-rump length’’ measurements. Br J Obstet Gynaecol 1975; 82: 702–710.
53. Dias T, Mahsud-Dornan S, Thilaganathan B, Papageorghiou A, Bhide A. First-trimester ultrasound dating of twin pregnancy: are singleton
charts reliable? BJOG 2010; 117: 979–984.
54. Saltvedt S, Almstrom H, Kublickas M, Valentin L, Grunewald C. Detection of malformations in chromosomally normal fetuses by routine
ultrasound at 12 or 18 weeks of gestation-a randomized controlled trial in 39,572 pregnancies. BJOG 2006; 113: 664–674.
55. Chen M, Lee CP, Lam YH, Tang RYK, Chan BCP, Wong SF, Tse LH, Tang MH. Comparison of nuchal and detailed morphology
ultrasound examinations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol
2008; 31: 136–146; discussion 146.
56. Timor-Tritsch IE, Fuchs KM, Monteagudo A, D’Alton ME. Performing a fetal anatomy scan at the time of first-trimester screening. Obstet
Gynecol 2009; 113: 402–407.
57. Abu-Rustum RS, Daou L, Abu-Rustum SE. Role of first trimester sonography in the diagnosis of aneuploidy and structural fetal anomalies. J
Ultrasound Med 2010; 29: 1445–1452.
58. Timor-Tritsch IE, Bashiri A, Monteagudo A, Arslan AA. Qualified and trained sonographers in the US can perform early fetal anatomy scans
between 11 and 14 weeks. Am J Obstet Gynecol 2004; 191: 1247–1252.
59. Bronshtein M, Zimmer EZ. Transvaginal ultrasound diagnosis of fetal club feet at 13 weeks, menstrual age. J Clin Ultrasound, 1989; 17:
518–520.
60. Taipale P, Ammala M, Salonen R, Hiilesmaa V. Learning curve in ultrasonographic screening for selected fetal structural anomalies in early
pregnancy. Obstet Gynecol 2003; 101: 273–278.
61. Cedergren M, Selbing A. Detection of fetal structural abnormalities by an 11–14-week ultrasound dating scan in an unselected
Swedish population. Acta Obstet Gynecol Scand 2006; 85: 912–915.
62. Fisher J. First-trimester screening: dealing with the fall-out. Prenat Diagn2011; 31: 46–49.
63. Chaoui R, Nicolaides KH. From nuchal translucency to intracranial translucency: towards the early detection of spina bifida. Ultrasound
Obstet Gynecol 2010; 35: 133–138.
64. Sepulveda W, Wong AE, Martinez-Ten P, Perez-Pedregosa J. Retronasal triangle: a sonographic landmark for the screening
of cleft palate in the first trimester. Ultrasound Obstet Gynecol 2010; 35: 7–13.
65. Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities
at 11–13 weeks. Prenat Diagn 2011; 31: 90–102.
66. Bernard J-P, Cuckle HS, Stirnemann JJ, Salomon LJ, Ville Y. Screening for fetal spina bifida by ultrasound examination in the first trimester
of pregnancy using fetal biparietal diameter. Am J Obstet Gynecol 2012; 207: 306.e1–5.
67. DeVore GR. First-trimester fetal echocardiography: is the future now? Ultrasound Obstet Gynecol 2002; 20: 6–8.
68. Yagel S, Cohen SM, Messing B. First and early second trimester fetal heart screening. Curr Opin Obstet Gynecol 2007; 19:
183–190.
69. van Zalen-Sprock RM, Vugt JM, van Geijn HP. First-trimester sonography of physiological midgut herniation and early diagnosis
Of omphalocele. Prenat Diagn 1997; 17: 511–518.
70. Bhaduri M, Fong K, Toi A, Tomlinson G, Okun N. Fetal anatomic survey using three-dimensional ultrasound in conjunction
with first-trimester nuchal translucency screening. Prenat Diagn 2010; 30: 267–273.
71. Nicolaides KH, Azar G, Byrne D, Mansur C, Marks K. Fetal nuchal translucency: ultrasound screening for chromosomal defects in first
trimester of pregnancy. BMJ; 1992; 304: 867–869.
72. Nicolaides KH, Snijders RJ, Gosden CM, Berry C, Campbell S. Ultrasonographically detectable markers of fetal chromosomal abnormalities.
Lancet 1992; 340: 704–707.
73. Kagan KO, Wright D, Baker A, Sahota D, Nicolaides KH. Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free
beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 2008; 31: 618–624.
74. Kagan KO, Cicero S, Staboulidou I, Wright D, Nicolaides KH. Fetal nasal bone in screening for trisomies 21, 18 and 13 and Turner syndrome
at 11–13 weeks of gestation.Ultrasound Obstet Gynecol 2009; 33: 259–264.
75. Kagan KO, Valencia C, Livanos P, Wright D, Nicolaides KH. Tricuspid regurgitation in screening for trisomies 21, 18 and 13 and Turner
syndrome at 11+0 to 13+6 weeks of gestation. Ultrasound Obstet Gynecol 2009; 33: 18–22.
76. Maiz N, Valencia C, Kagan KO,Wright D,Nicolaides KH. Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner
syndrome at 11–13 weeks of gestation.Ultrasound Obstet Gynecol 2009; 33: 512–517.
77. Nicolaides KH. Screening for fetal aneuploidies at 11 to 13 weeks. Prenat Diagn 2011; 31: 7–15.
78. Mustafa SA, Brizot ML, Carvalho MHB, Watanabe L, Kahhale S, Zugaib M. Transvaginal ultrasonography in predicting placenta previa at
delivery: a longitudinal study. Ultrasound Obstet Gynecol 2002; 20: 356–359.
79. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar
pregnancy. Am J Obstet Gynecol 2012; 207: 44.e1–13.
80. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accrete and cesarean
scar pregnancy. A review.Am J Obstet Gynecol 2012; 207: 14–29.
81. Stirnemann JJ, Chalouhi GE, Forner S, Saidji Y, Salomon LJ, Bernard J-P, Ville Y. First-trimester uterine scar assessment by transvaginal
ultrasound. Am J ObstetGynecol 2011; 205: 551.e1–6.
82. Stirnemann JJ, Mousty E, Chalouhi G, Salomon LJ, Bernard J-P, Ville Y. Screening for placenta accreta at 11–14 weeks of gestation. Am J
Obstet Gynecol2011; 205: 547.e1–6.
83. Hadlock FP, Shah YP, Kanon DJ, Lindsey JV. Fetal crown rump length: reevaluation of relation to menstrual age (5–18 weeks) with high-
resolution real-time US. Radiology 1992; 182:501–505.
84. Daya S. Accuracy of gestational age estimation by means of fetal crown-rump length measurement. Am J ObstetGynecol 1993; 168: 903–908.
85. McLennan AC, Schluter PJ. Construction of modern Australian first trimester ultrasound dating and growth charts. J Med Imaging Radiat
Oncol 2008; 52: 471–479.
86. Hadlock FP, Deter RL, Harrist RB, Park SK. Fetal biparietal diameter: a critical re-evaluation of the relation to menstrual age by means of
real-time ultrasound. J Ultrasound Med 1982; 1: 97–104.
87. McAuliffe FM, Fong KW, Toi A, Chitayat D, Keating S, Johnson J-A. Ultrasound detection of fetal anomalies in conjunction with first-
trimester nuchal translucency screening: a feasibility study. Am J Obstet Gynecol2005; 193: 1260–1265.
88. von Kaisenberg CS, Kuhling-von Kaisenberg H, Fritzer E, Schemm S, Meinhold-Heerlein I, Jonat W. Fetal transabdominal anatomy scanning
using standard views at 11 to 14 weeks’ gestation. Am J ObstetGynecol2005; 192: 535–542.

(Guideline review date: December 2015)

This document was translated and reviewed on behalf of SANA Medical NGO
(www.sanango.org) by: Reem S. Abu-Rustum, MD; Hassan Aji, MD; Alyda El Hage Nehme
(Technical Translator) and Mazen Hatem, MD.
 ‫ﻣﻠﺤﻖ ‪ :‬ﻭوﺭرﻗﺔ ﻋﻤﻞ ﺧﺎﺻﺔ ﺑﺎﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﺍاﻟﻔﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ )ﻣﺜﺎﻝل(‬

‫ﺍاﻟﻤﺮﻳﯾﻀﺔ‬
‫ﺭرﻗﻢ ﺍاﻟﻬﮭﻮﻳﯾﺔ‬
‫ﺍاﻟﻤﺤﻮﻝل‬
‫ﺗﺎﺭرﻳﯾﺦ ﺍاﻟﻮﻻﺩدﺓة )ﺍاﻟﻴﯿﻮﻡم‪ /‬ﺍاﻟﺸﻬﮭﺮ‪ /‬ﺍاﻟﺴﻨﺔ(‬
‫ﺗﺎﺭرﻳﯾﺦ ﺍاﻟﻤﻌﺎﻳﯾﻨﺔ )ﺍاﻟﻴﯿﻮﻡم‪ /‬ﺍاﻟﺸﻬﮭﺮ‪ /‬ﺍاﻟﺴﻨﺔ(‬
‫ﺍاﻟﻤﺼ ّﻮﺭر ﺑﺎﻟﻤﻮﺟﺎﺕت ﺍاﻟﻔﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‪ /‬ﺍاﻟﻤﺮﺍاﻗﺐ‬
‫ﺩدﻭوﺍاﻋﻲ ﺍاﻟﺘﺼﻮﻳﯾﺮ ﻭوﺍاﻟﻤﻌﻠﻮﻣﺎﺕت ﺍاﻟﺴﺮﻳﯾﺮﻳﯾﺔ ﺍاﻟﻀﺮﻭوﺭرﻳﯾﺔ‬

‫ﺗﺎﺭرﻳﯾﺦ ﺍاﻟﻄﻤﺚ ﺍاﻷﺧﻴﯿﺮ‬

‫ﺍاﻟﻈﺮﻭوﻑف ﺍاﻟﺘﻘﻨﻴﯿﺔ‪ :‬ﺟﻴﯿﺪﺓة‪ /‬ﻣﺤﺪﺩدﺓة ﺑـ‬

‫ﻣﻔﺮﺩد‪ /‬ﻣﺘﻌﺪﺩد )ﻭوﺭرﻗﺔ ﻟﻜﻞ ﺟﻨﻴﯿﻦ( ﻓﻲ ﺣﺎﻟﺔ ﺗﻌﺪﺩد ﺍاﻷﺟﻨﺔ‬

‫ﺍاﻟﻤﺒﺎﻳﯾﺾ‬
‫ﺍاﻟﻤﻈﻬﮭﺮ‪ :‬ﻁطﺒﻴﯿﻌﻲ؛ ﻏﻴﯿﺮ ﻁطﺒﻴﯿﻌﻲ*‬
‫ﺍاﻟﺸﺬﻭوﺫذ‬

‫ﻣﺌﻮﻳﯾﺔ )ﻧﻄﺎﻕق ﻣﺮﺟﻌﻲ(‬ ‫ﻣﻠﻠﻴﯿﻤﺘﺮ‬ ‫ﺍاﻟﻤﻘﺎﻳﯾﻴﯿﺲ‬

‫ﻁطﻮﻝل ﺗﺎﺝج ﺍاﻟﺮﺩدﻑف‬
‫ﺍاﻟﺸﻔﺎﻓﻴﯿﺔ ﺍاﻟﻔﻘﻮﻳﯾﺔ‬
‫ﻗﻄﺮ ﺑﻴﯿﻦ ﺍاﻟﺠﺪﺍاﺭرﻳﯾﻦ‬
‫ﻣﺤﻴﯿﻂ ﺍاﻟﺮﺃأﺱس‬
‫ﻣﺤﻴﯿﻂ ﺍاﻟﺒﻄﻦ‬
‫ﺟﺪﻝل ﻁطﻮﻝل ﺍاﻟﻔﺨﺬ‬

‫*ﻧﺘﺎﺋﺞ ﻏﻴﯿﺮ ﻁطﺒﻴﯿﻌﻴﯿﺔ )ﺃأﺫذﻛﺮ ﺍاﻟﺘﻔﺎﺻﻴﯿﻞ ﺭرﺟﺎء(‬

‫ﺗﺤﺪﻳﯾﺪ ﻋﻤﺮ ﺍاﻟﺤﻤﻞ ﺍاﺳﺘﻨﺎﺩدﺍاً ﺇإﻟﻰ ﺍاﻟﺼﻮﺭرﺓة ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬

‫)ﺃأﺳﺒﻮﻉع‪ +‬ﻳﯾﻮﻡم(‬

‫ﺍاﺳﺘﻨﺘﺎﺝج‬
‫‪ o‬ﻣﻌﺎﻳﯾﻨﺔ ﻁطﺒﻴﯿﻌﻴﯿﺔ ﻭوﻛﺎﻣﻠﺔ‬
‫‪ o‬ﻣﻌﺎﻳﯾﻨﺔ ﻁطﺒﻴﯿﻌﻴﯿﺔ ﺇإﻧﻤﺎ ﻏﻴﯿﺮ ﻛﺎﻣﻠﺔ‬
‫‪ o‬ﻣﻌﺎﻳﯾﻨﺔ ﻏﻴﯿﺮ ﻁطﺒﻴﯿﻌﻴﯿﺔ‬
‫‪ o‬ﺧﻄﻂ‬
‫‪ §‬ﻻ ﺩدﺍاﻋﻲ ﻟﻠﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﺍاﻟﻔﻮﻕق ﺍاﻟﺼﻮﺗﻴﯿﺔ‬
‫‪ §‬ﻣﺮﺍاﺟﻌﺔ ﻣﺨﻄﻂ ﻟﻬﮭﺎ ﺑﻌﺪ ‪ ....‬ﺃأﺳﺎﺑﻴﯿﻊ‬
‫‪ §‬ﺗُﺤﺎﻝل ﺇإﻟﻰ ‪...‬‬
‫‪ §‬ﻣﻌﻠﻮﻣﺎﺕت ﺃأﺧﺮﻯى‬
‫ﻏﻴﯿﺮ ﻣﺮﺋﻲ‬ ‫ﻏﻴﯿﺮ ﻁطﺒﻴﯿﻌﻲ*‬ ‫ﻁطﺒﻴﯿﻌﻲ‬ ‫ﻣﻈﻬﮭﺮ ﺍاﻟﺠﻨﻴﯿﻦ ﺑﺎﻟﺘﺼﻮﻳﯾﺮ ﺑﺎﻟﻤﻮﺟﺎﺕت ﻓﻮﻕق‬
‫ﺍاﻟﺼﻮﺗﻴﯿﺔ )ﺍاﻟﺮﻣﺎﺩدﻱي = ﺍاﺧﺘﻴﯿﺎﺭرﻱي(‬
‫ﺍاﻟﺮﺃأﺱس‬
‫ﺍاﻟﺸﻜﻞ‬
‫ﺟﻮﻑف ﺍاﻟﺤﺎﺟﺰ ﺍاﻟﺸﻔﺎﻑف‬
‫ﺧﻂ ﺍاﻟﻮﺳﻂ ﺍاﻟﻤﻨﺠﻞ‬
‫ﻣﻬﮭﺎﺩد‬
‫ﺍاﻟﻮﺟﻪﮫ‬
‫ﺍاﻟﻤﺤﺠﺮﺍاﻥن‬
‫ﺍاﻟﺼﻮﺭرﺓة ﺍاﻟﺠﺎﻧﺒﻴﯿﺔ‬
‫ﺍاﻟﻌﻨﻖ‬
‫ﺍاﻟﺼﺪﺭر‬
‫ﺍاﻟﻤﻨﻄﻘﺔ ﺍاﻟﺮﺋﻮﻳﯾﺔ‬
‫ﺍاﻟﺤﺠﺎﺏب‬
‫ﺍاﻟﻘﻠﺐ‬
‫ﻧﺸﺎﻁط ﺍاﻟﻘﻠﺐ‬
‫ﺍاﻟﺤﺠﻢ‬
‫ﻣﺤﻮﺭر ﺍاﻟﻘﻠﺐ‬
‫ﺭرﺅؤﻳﯾﺔ ﺍاﻟﻐﺮﻑف ﺍاﻷﺭرﺑﻊ‬
‫ﺍاﻟﺒﻄﻦ‬
‫ﺍاﻟﻤﻌﺪﺓة‬
‫ﺍاﻷﻣﻌﺎء‬
‫ﺍاﻟﻜﻠﻴﯿﺘﺎﻥن‬
‫ﺍاﻟﻤﺜﺎﻧﺔ ﺍاﻟﺒﻮﻟﻴﯿﺔ‬
‫ﺩدﺧﻮﻝل ﺍاﻟﺤﺒﻞ ﻓﻲ ﺍاﻟﺒﻄﻦ‬
‫ﺷﺮﺍاﻳﯾﻴﯿﻦ ﺍاﻟﺤﺒﻞ ﺍاﻟﺴﺮﻱي‬
‫ﺍاﻟﻌﻤﻮﺩد ﺍاﻟﻔﻘﺮﻱي‬
‫ﺍاﻟﻤﻔﺎﺻﻞ‬
‫ﺍاﻟﺬﺭرﺍاﻉع ﺍاﻟﻴﯿﻤﻨﻰ )ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﺍاﻟﻴﯿﺪ(‬
‫ﺍاﻟﺴﺎﻕق ﺍاﻟﻴﯿﻤﻨﻰ )ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﺍاﻟﺮﺟﻞ(‬
‫ﺍاﻟﺬﺭرﺍاﻉع ﺍاﻟﻴﯿﻤﻨﻰ )ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﺍاﻟﻴﯿﺪ(‬
‫ﺍاﻟﺴﺎﻕق ﺍاﻟﻴﯿﺴﺮﻯى )ﺑﻤﺎ ﻓﻴﯿﻬﮭﺎ ﺍاﻟﺮﺟﻞ(‬
‫ﺍاﻟﺠﻨﺲ )ﺍاﺧﺘﻴﯿﺎﺭرﻱي(‪ :‬ﺫذﻛﺮ ﺃأﻧﺜﻰ‬
‫ﻣﻌﻠﻮﻣﺎﺕت ﺃأﺧﺮﻯى‪:‬‬

‫ُﺧ ّﺰﻧﺖ‬ ‫ﻁطُﺒﻌﺖ‬ ‫ﺃأﺻﺪﺭرﺕت‬

‫ﻋﺪﺩد ﺍاﻟﺼﻮﺭر‬