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مجله زناشویی - دیگر نگران تولد فرزند عقب‌مانده نباشید !
مجله عشق و زناشویی

دیگر نگران تولد فرزند عقب‌مانده نباشید !

نویسنده :سودا امیری
تاریخ:شنبه 12 اردیبهشت 1394-10:54 ق.ظ


نوزاد,بیماریهای ژنتیکی,عقب‌ ماندگی در کودکان

تولد هر نوزاد عقب‌افتاده یا بیمار هزینه‌ها، زحمات و مشکلات بسیاری را برای جامعه و خانواده‌ها رقم می‌زند. علاوه بر این چنین کودکانی اکثرا زندگی دردناک و مشکلات روحی و روانی بسیاری پیدا می‌کنند. شاید حتی بسیاری از آنها به سن بلوغ نرسند و از دنیا بروند بنابراین سلامت جنین همیشه یکی از بزرگ‌ترین دغدغه‌های ذهنی مادرها و پدرها بوده است اما این روزها با پیشرفت علم ژنتیک می‌توان در بسیاری از موارد از جمله ازدواج‌های فامیلی و... حتی با احتمال صد درصد از تولد نوزاد بیمار جلوگیری كرد! دکتر ابوطالب صارمی، متخصص زنان، زایمان و نازایی در این مورد به شما توضیح می‌دهد.

در 3ماهه اول این اقدام را انجام دهید
سیاست و هدف رشته تخصصی زنان، تولد و تحویل یک نوزاد سالم به مادری سالم است. اگر یک زایمان موفق انجام شود اما نوزاد عقب‌افتادگی ذهنی یا یک اشکال مادرزادی مثل فتق دیافراگم داشته باشد این سیاست به درستی اجرا نشده است. پس باید چه کار کنیم؟ اینجاست که علم ژنتیک و غربالگری به کمک ما می‌آید. اکنون امکانات زیادی در این زمینه در کشور ایران وجود دارد که بیمارستان صارم کامل‌ترین آنها را داراست. این غربالگری به خصوص در 3 ماهه اول بارداری اهمیت بسیاری دارد. در این زمان سونوگرافی سه‌بعدی انجام می‌دهیم و جنین را از لحاظ خطر بیماری‌های مادرزادی مثل عقب‌افتادگی ذهنی بررسی می‌کنیم. آزمایش خون نیز انجام می‌دهیم تا ببینیم اختلالات کروموزومی دیگری مطرح است یا خیر. بخش ژنتیک می‌تواند در این موارد تشخیص قطعی بدهد.

امکان سقط جنین بیمار تا قبل از 18 هفتگی
در بخش ژنتیک با 2 روش می‌توان از جنین سلول‌هایی استخراج کرد و بررسی کروموزومی انجام داد. یکی از روش‌ها آمنیوسنتز است که در آن با استفاده از سوزن مخصوص با کمک سونوگرافی از آب درون کیسه دور جنین نمونه‌برداری می‌شود. سپس آزمایشگاه سلول‌هایی را که از جنین داخل این آب دفع شده بررسی می‌کند و به ما می‌گوید آیا از لحاظ کروموزومی اختلال دارد یا خیر. این روش بعد از 3 ماهه اول بارداری کاربرد دارد. با روش نمونه‌برداری از جفت یا CVS نیز می‌توان قبل از 3 ماهه اول به اختلالات جنین پی برد و او را هم از لحاظ کروموزومی و هم بیماری‌های متابولیک، تالاسمی‌ها، اختلالات مولکولی ژن و اختلالات میتوکندری بررسی كرد. در حال حاضر پزشکی قانونی در مورد چندین بیماری اجازه سقط می‌دهد بنابراین با تشخیص این اختلالات می‌توان قبل از 18هفتگی جنین  دارای مشکل را سقط کرد.

حتی اگر سابقه بیماری دارید می‌توانید فرزندی سالم به دنیا بیاورید!
ممکن است بپرسید آیا راهی هم وجود دارد که قبل از بارداری بتوان احتمال ایجاد اختلالات جنین را تعیین كرد تا اینکه فرد باردار شود و بعد بگوییم برود سقط کند؟ پاسخ مثبت است. با استفاده از روش PGD اگر زوجی سوابق بیماری‌های فامیلی یا بیماری‌های متابولیک، ژنتیک یا تالاسمی داشته باشند می‌توان جنین سالم به آنها تحویل داد. به این صورت که ابتدا با استفاده از IVF چندین جنین تشکیل می‌شود و وقتی جنین‌ها 8 سلولی شدند توسط لیزر و سیستم میکرواینجکشن از هرکدام یک سلول بیرون آورده شده (این کار به جنین آسیبی نمی‌زند) و به بخش ژنتیک فرستاده می‌شود. ظرف 8 ساعت مشخص می‌شود که کدام جنین معیوب است و جنین‌های سالم انتخاب می‌شوند. البته با استفاده از این روش تعیین جنسیت هم می‌توان انجام داد.

اگر مبتلا به تالاسمی مینور هستید ...
گاهی اوقات زن و شوهر هر دو مبتلا به تالاسمی مینور هستند بنابراین هر دو می‌توانند با احتمال 25 درصد فرزند تالاسمی ماژور به دنیا بیاورند. این بیماران نگهداری‌شان بسیار دشوار است و هر هفته باید خون تزریق کنند، حتی ممکن است به سن بلوغ هم نرسند و از دنیا بروند. این یک تراژدی برای جامعه است! اولا اینکه هزینه سنگینی برای جامعه دارد و ثانیا برای خانواده‌ها دردسرهای فراوانی ایجاد می‌کند، در حالی که ما می‌توانیم از این وضعیت پیشگیری کنیم. اول از همه اینکه بهتر است این دو نفر با هم ازدواج نکنند. در اینجا اهمیت مشاوره قبل از ازدواج و بارداری مشخص می‌شود. حال ممکن است زن و مرد به هر دلیلی عاشق هم باشند یا معتقد باشند كه دختر عمو و پسر عمو عقدشان در آسمان‌ها بسته شده و با هم ازدواج کرده باشند. در این صورت توصیه می‌شود حتما قبل از بارداری مشاوره ژنتیک انجام دهند. در حالت سوم نیز ممکن است خانم باردار شده باشد و بعد به ما مراجعه کند. در این حالت نیز می‌توان غربالگری انجام داد و عده‌ای از آنها که مشکوک نیستند را می‌شود کنار گذاشت. درصدی از آنها می‌مانند که نمی‌توانیم تصمیم بگیریم آیا جنین‌شان عیب دارد یا خیر. آن زمان است که از روش CVS و آمنیوسنتز استفاده می‌کنیم.




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