Ukubeletha kwezingane sikashukela kuyinqubo ehlangabezana kakhulu nayo kwezokwelapha. Emhlabeni, kunabesifazane abangu-2-3 kwabesifazane abangu-100 abakhulelwe abane-carbohydrate metabolism disorder. Njengoba lokhu kudalwa kwengqondo kudala izinkinga eziningi zokubelethisa futhi kungathinta kabi impilo kamama nengane yesikhathi esizayo, futhi kuholele ekufeni kwabo, owesifazane okhulelwe phakathi naso sonke isikhathi sokukhulelwa (isenzo sokukhulelwa) ulawulwa ngokuqinile yi-gynecologist kanye ne-endocrinologist.
Izinhlobo zesifo sikashukela ngesikhathi sokukhulelwa
Ku-mellitus (DM) yesifo sikashukela, okuqukethwe kukashukela wegazi kuyakhuphuka. Le nto ibizwa ngokuthi yi-hyperglycemia, kwenzeka ngenxa yokungasebenzi kahle kwamanyikwe, lapho kukhiqizwa khona i-insulin ye-hormone. I-Hyperglycemia ithinta kabi izitho nezicubu, kuphakamisa umzimba. Isifo sikashukela singenzeka kwabesifazane esikhathini eside ngaphambi kokukhulelwa kwabo. Kulokhu, izinhlobo ezilandelayo zeshukela zikhula komama abakhulelwe:
- Thayipha isifo sikashukela sokuqala esingu-1 (sincike ku-insulin). Kwenzeka entombazaneni ebuntwaneni. Amaseli we-pancreas akhe akakwazi ukukhiqiza inani elifanelekile le-insulin, futhi ukuze liphile, kubalulekile ukuphindisela ukuntuleka kwaleli hormone nsuku zonke ngokulijova esiswini, isikhafu, umlenze noma ingalo.
- Thayipha isifo sikashukela sohlobo lwe-2 (okungeyona insulin). Izici ezibangela ukuvezwa kofuzo nokukhuluphala. Isifo sikashukela esinjalo senzeka kubantu besifazane ngemuva kweminyaka engama-30 yobudala, ngakho-ke abantu abazinqunyelwe kusengaphambili futhi bahlehlise ukukhulelwa babe neminyaka engama-32 38, vele banalesi sifo uma bephethe ingane yabo yokuqala. Ngalesi sifo, kukhiqizwa inani elanele le-insulin, kodwa ukusebenzisana kwalo nezicubu kuyaphazamiseka, okuholela ekungeneni kweglucose egazini.
Ukubeletha kwezingane sikashukela kuyinqubo ehlangabezana kakhulu nayo kwezokwelapha.
Ku-3-5% wabesifazane, lesi sifo sikhula ngesikhathi sokukhulelwa. Lolu hlobo lwe-pathology lubizwa ngokuthi i-gestationalabetes mellitus noma i-GDM.
Isifo sikashukela sokutholwa kwesisu
Le ndlela yalesi sifo iqondakala kuphela kwabesifazane abakhulelwe. Kwenzeka emavikini angama-23 kuya kwengxenye yalesi sikhathi futhi kuhlotshaniswa nokukhiqizwa kwe-placenta yama-hormone adingekayo yi-fetus. Uma la ma-hormone evimba umsebenzi we-insulin, khona-ke inani likashukela egazini likamama olindele likhuphuka, bese kuba nesifo sikashukela.
Ngemuva kokubeletha, amanani eglucose egazi abuyele kwesejwayelekile futhi lesi sifo sihamba, kepha kuvame ukuvela ngesikhathi sokukhulelwa okulandelayo. I-GDM ikhulisa ubungozi bokukhula besikhathi esizayo kowesifazane noma enganeni yakhe yesifo sikashukela sohlobo 2.
Isifo sikashukela sokutholwa kwesisu senzeka ngeviki lama-23 kuya kweligama futhi sihambisana nokukhiqizwa kwe-placenta yama-hormone adingekayo yi-fetus.
Ngabe isimo salesi sifo siyawuthinta amandla okuzala?
Ukukhulelwa ngakunye kuqhubeka ngokuhlukile, ngoba kuthonywa yizici ezinjengobudala kanye nesimo sempilo kamama, izici zakhe zomzimba, isimo se-fetus, zombili i-pathologies enazo.
Impilo enesifo sikashukela kowesifazane okhulelwe inzima, futhi imvamisa ayikwazi ukwazisa ingane ngaphambi kokuphela kwethemu yayo. Ngohlobo lwesifo esincike ku-insulin noma olungatheni i-insulin, abesifazane abangama-20-30% bangathola ukungahambi kahle emavikini angama-20-27 wokukhulelwa. Kwabanye besifazane abakhulelwe, kufaka phakathi futhi labo abahlushwa i-gestational pathology bangathola ukuzalwa ngaphambi kwesikhathi. Uma umama okhulelwe ebhekwa njalo ochwepheshe futhi elandela zonke izincomo zabo, angonga ingane.
Ngokuntuleka kwe-insulin emzimbeni wowesifazane, isibeletho singafa ngemuva kwamasonto angama-38- 39 ekhulelwe, uma-ke, uma ukulethwa kwemvelo kungakaze kwenzeke ngaphambi kwalesosikhathi, kubangelwe ngumsebenzi emavikini angama-38 kuya kokukhulelwa.
I-contraindication eyinhloko yokukhulelwa nokubeletha
Uma owesifazane onesifo sikashukela ehlela ukuba nengane, kufanele abonane nodokotela kusengaphambili futhi axhumane naye ngalolu daba. Kunokuphambana okuningana kokuqanjwa kwemicabango:
- Uhlobo olunzima lwalesi sifo oluyinkimbinkimbi i-retinopathy (ukulimala kwemithambo ezinhlamvini zamehlo) noma i-nephropathy yesifo sikashukela (ukulimala kwemithambo yezinso, ama-tubules kanye ne-glomeruli).
- Inhlanganisela yesifo sikashukela kanye nesifo sofuba.
- I-pathology engahambisani ne-insulin (ukwelashwa nge-insulin ayisebenzi, i.e. ayiholeli ekuphuculeni).
- Ukuba khona kowesifazane wengane onenkinga yokuzala.
Akunconyelwe ukuba nezingane ngenxa yabalingani bomshado uma bobabili benesifo sohlobo 1 noma 2, ngoba ingazuzelwa yingane. Ukuxabanisa kungamacala lapho ukuzalwa kwangaphambilini kwagcina khona ngokuzalwa kwengane efile.
Njengoba abesifazane abakhulelwe bengaba ne-GDM, bonke omama abakhulelwe kufanele bahlolwe ushukela wegazi ngemuva kwamasonto angama-24 wokukhulelwa.
Uma kungekho mkhawulo emqondweni, owesifazane ngemuva kokuqala kwakhe kufanele avakashele ochwepheshe njalo futhi alandele izincomo zabo.
Njengoba abesifazane abakhulelwe bengaba ne-GDM, bonke omama abakhulelwe badinga ukuthi bahlolwe igazi ngoshukela ngemuva kwamasonto angama-24 wokukhulelwa ukuze baqinisekise noma baphikise iqiniso lalesi sifo.
Ezimweni zokwelashwa, kunezimo lapho kufanele unqamule ukukhulelwa ngaphambi kwamasonto ayi-12. Lokhu kwesinye isikhathi kwenziwa nge-Rhesus sensitization (ukungqubuzana kwesimo esingesihle se-Rhesus sikamama nengane enhle, lapho umama ethuthukisa amasosha omzimba elwa esibelethweni). Ngenxa yokuzwa izinzwa, ingane izalwa inokulimazeka nezifo zenhliziyo nezesibindi ezinzima noma ifele esibelethweni. Isinqumo sokuqeda ukukhulelwa senziwa ngokubonisana ochwepheshe abaningana.
Yini ingozi yesifo sikashukela sokukhula kwengane?
Ekuqaleni kokukhulelwa, i-hyperglycemia ithinta kabi ukwakheka nokuthuthukiswa kwezitho zomntwana. Lokhu kuholela ekukhubazekeni kwenhliziyo yokuzalwa, ukukhubazeka kwamathumbu, ukulimala kakhulu ebuchosheni nasezinso. Ezimweni ezingama-20%, ukungondleki kwe-fetus kukhula (okulele ekukhuleni kwengqondo nangokomzimba).
Abesifazane abaningi abanesifo sikashukela bazala izingane ezinesisindo esikhulu somzimba (kusuka ku-4500 g), ngoba Ezinganeni, umzimba uqukethe izicubu eziningi ze-adipose. Ezinganeni ezisanda kuzalwa, ngenxa yama-deposits angamafutha, kukhona ubuso obuyindilinga, ukuvuvukala kwezicubu, nesikhumba sinombala ogqamile. Izinsana zikhula kancane ezinyangeni zokuqala zokuphila, zinganciphisa umzimba. Ezimweni ezingama-3-6%, izingane ziba nesifo sikashukela uma omunye wabazali enaso, ezimweni ezingama-20% ingane ifa lesi sifo, uma bobabili ubaba nomama behlushwa yi-pathology.
Imiphumela ye-hypoglycemia
Ezimweni ezingama-85%, izingane zabesifazane ezinesifo sikashukela emahoreni okuqala empilo ziba ne-hypoglycemia (ukwehla kweglucose yegazi). Ukujuluka kwezingane ezisanda kuzalwa, kubhekana nengcindezi yokwazi, ama-cramps, i-tachycardia nokuboshwa kwesikhashana kokuphefumula. Ngokutholwa okufika ngesikhathi kwe-pathology kanye nokufakwa kokufakwa kweglucose ezinsaneni, i-hypoglycemia inyamalala ngemuva kwezinsuku ezintathu ngaphandle kwemiphumela. Ezimweni ezingavamile, lesi sifo siholela ekuphazamisweni kwemizwa nasekufeni kwezinsana.
Ungadla kanjani ukhulelwe ushukela?
Ngisho nangaphambi kokukhulelwa, owesifazane ukunciphisa ubungozi bezinkinga zakuqala nakwephuzile udinga ukuthola isinxephezelo esiqhubekayo sesifo sikashukela (ukufinyelela amazinga kashukela egazini asondele kokujwayelekile) futhi alondoloze sonke isikhathi sokukhulelwa kwakhe. Lokhu kuzosiza ukudla okuqinile okunqunywe yi-endocrinologist.
I-chocolate, ushukela, i-confectionery, ilayisi ne-semolina, ubhanana kanye namagilebhisi, iziphuzo ezimnandi azikhishwa ekudleni. Umhluzi onamafutha, inhlanzi, inyama kanye ne-cottage shizi awela ngaphansi kokuvinjelwa. Ukudla okuqukethe i-carbohydrate njenge-pasta, isinkwa se-rye, i-buckwheat ne-oatmeal, amazambane kanye nama-legumes kuvunyelwe.
Kufanele udle ngasikhathi sinye izikhathi eziyi-6 ngosuku. Ekuseni, kungcono ukudla inyama nezithelo, kusihlwa - kefir nemifino.
Ngesikhathi sokudla, udinga ukubheka ushukela wegazi nsuku zonke, futhi ngokwanda kwezinga lawo, thatha imishanguzo yesifo sikashukela, kufaka phakathi nezidakamizwa ezinciphisa ushukela we-herbal kanye ne-injulin insulin.
Ngesikhathi sokudla, udinga ukubheka ushukela wegazi nsuku zonke.
Ngabe ukulaliswa esibhedlela kuyadingeka nini?
Abanesifo sikashukela abakhulelwe bakhonjiswa esibhedlela okwesikhashana. Ngokokuqala ngqa, kwenzeka ezigabeni zokuqala futhi kuyadingeka ukuthi umuntu ahlolwe ngokucophelela owesifazane, ekhomba ubungozi nokuxazulula inkinga yokulondolozwa kwengane. Ukulaliswa kwesibili kwenziwa engxenyeni yesibili yokukhulelwa (emavikini angama-24), ngoba isifo sikashukela siyaqhubeka ngalesi sikhathi. Ukulaliswa esibhedlela kwesithathu kuyadingeka ukulungiselela umama okhulelwe ngokuzalwa kwengane.
Ukuzalwa kwengane kushukela
Ukulethwa kwenzeka emavikini angama-38 kuya kwayi-38 ngemuva kokuhlolwa okuningiliziwe kowesifazane nowesibeletho.
Ukulethwa kokuhlela
Isikhathi sezisebenzi nohlobo lwazo kunqunywa ngawodwana. Ngokuthola indawo evamile yengane (ikhanda kuqala), i-pelvis ethuthukisiwe kamama okhulelwe nokungabikho kwezinkinga, ukuzalwa okuzenzakalelayo kuhlelwa ngomsele wemvelo wokuzalwa. Kwezinye izimo, kushiwo isigaba se-cesarean.
Ngosuku lokuzalwa, isiguli akufanele sidle. Njalo emahoreni angama-4-6, ujova nge-insulin, bese kuthi glucose ibhekwe kaningi. Ukuzalwa kwengane kulawulwa yi-compact tomography. Uma kunengozi ye-asphyxiation (i-asphyxiation ye-fetus), ama-forceps asetshenzisiwe asetshenziswa.
Ukuvuselelwa kwezingane ezisanda kuzalwa
Izingane eziningi zizalwa zinezimpawu zesifo sikashukela (i-endocrine kanye ne-metabolic dysfunction). Ukulungisa isimo sezingane ngokwejwayelekile, vimbela i-hypoglycemia futhi zenze ukwelashwa kwe-syndromic, zithola umoya omncane wokufakelwa emahoreni okuqala empilo, imijovo ye-hydrocortisone iphathwa izikhathi eziyi-1-2 ngosuku izinsuku ezingama-5, nokuphazamiseka kwemithambo yegazi - iplasma, kanye ne-hypoglycemia - imithamo emincane yeglucose.
