Izimpawu nokwelashwa kwe-fetopathy yesifo sikashukela kosanda kuzalwa

Njengoba kukhuphuka izinga likashukela kowesifazane ngesikhathi sokukhulelwa, ubungozi bokuthola i-fetus diabetesic fetopathy (DF) luyanda. Lesi sifo sibonakaliswa yi-endocrine and dysfunctions metabolic, lesion polysystemic.

Kuyini isifo sikashukela?

I-DF iyinkimbinkimbi yezimpawu ezikhula esibelethweni ngokubekezelelwa kwe-glucose engasebenzi kahle kumama. Umuthi uya ngokuqhubekayo ungena ngomgoqo we-placental, wedlula isidingo sakho entweni ekhulayo.

I-DF iyinkimbinkimbi yezimpawu ezikhula esibelethweni ngokubekezelelwa kwe-glucose engasebenzi kahle kumama.

Ama-ketones nama-amino acid angena kanye noshukela. I-insulin ne-glucagon, okungama-pancreatic hormone, awedluliswa kusuka kumama. Baqala ukuthuthukiswa ngokuzimela kuphela emavikini angama-9 ukuya kwele-12. Ngokuphikisana nalesi sizinda, ku-trimester yokuqala, kuvela ushukela wamaprotheni, ukwakheka kwezicubu kuphazamiseka ngama-radicals wamahhala. Imizimba ye-ketone eyeqile ifaka ubuthi emzimbeni okhulayo.

Lezi zinqubo ziholela kokungalungi kwenhliziyo, imithambo yegazi, izinso nezinye izitho. I-fetopathy yesifo sikashukela ivezwa ushintsho olusebenzayo ku-fetus, ukuphazamiseka kwezinhlelo ezahlukene. Izinkimbinkimbi zemitholampilo kanye nelabhorethri zibhekwa njengezemithi ngekhodi le-ICD-10.

Lapho ukukhiqizwa kwabo kwe-insulin kuqala, amanyikwe yingane i-hypertrophied, okuholela ekungeneni kwe-insulin ngokweqile. Ukukhulupha ngokweqile kanye nokukhubazeka kwe-lecithin metabolism.

Ngemuva kokubeletha, i-embryofetopathy ibuye ibuye futhi noma ibe yisinye isifo - isifo sikashukela sengane esanda kuzalwa.

Izimbangela eziphambili

Lezi zimo ezilandelayo kumama zingaba imbangela ze-DF:

• i-hyperglycemia;
• ukwephulwa kokuhlanganiswa kwe-lipid;
• ama-radical wamahhala ngokweqile;
• ketoacidosis;
• i-hyperinsulinemia (umthamo omkhulu weglue);
• ukwehla okubucayi kwamazinga kashukela ngenxa yokusebenzisa ngokweqile izidakamizwa;
• angiopathy.

I-fetal fetopathy yenzeka kwabesifazane abakhulelwe abanesifo sikashukela esatholakala ngaphambi kokukhulelwa, kanye nesimo sangaphambi kwesifo sikashukela. Ngemuva kwamasonto angama-20 wokukhulelwa, kwesinye isikhathi isifo sikashukela sokuqubuka kwesinye isikhathi senzeka, ngenxa yalokho i-DF nayo ingakhula. Ngezinga elikhulayo likashukela kumama, inkomba ku-fetus nayo izokwanda.

Imbangela ye-DF ingaba ukwephulwa kokuhlanganiswa kwama-lipids kumama.

Imbangela ye-DF ingaba ketoacidosis kumama.

Imbangela ye-DF ingaba yi-angiopathy kumama.

Imbangela ye-DF ingaba yi-hyperglycemia kamama.

Imbangela ye-DF ingaba khona kwe-ketoacidosis kumama.

Izimpawu nezimpawu ze-fetopathy

Nge-fetopathy, fetus ine-insulin cell hyperplasia, ngenxa yokuthi i-hypertrophic yendawo yeziqhingi zeLangerhans ikhula kumanyikwe. Ezinye izimpawu zesifo:

• ukuthuthukiswa kwesifo esinamafutha esinamafutha;
• ukumiswa ngokweqile kwamafutha angaphansi;
• ukukhuphuka kwezinso, isibindi nezindlala ze-adrenal ngokuthuthukiswa okungekuhle kwalezi zitho;
• ukwakheka kwama-glycogen granules kwezicubu ze-epithelial ze-renal tubules;
• shintsha ezindongeni zemikhumbi emincane njengohlobo lwe-Microangiopathy yesifo sikashukela.

Ezinganeni ezisanda kuzalwa ezine-DF, i-hypertrophy ejwayelekile ibonwa, isilinganiso somzimba sephulwe (umthamo wesisu ungamaviki ama-2 ngaphambi kosayizi wekhanda, imvamisa yekhanda lincane kakhulu kunebhande lamahlombe). Izimpawu zesici se-pathology:

• isisindo sidlula ama-4 kg;
• ithoni yesikhumba ebomvu-cyanotic;
• ukuba khona kwe-petechiae;
• inani elikhulu loshizi olunjenge-ushizi;
• ukuthakazelelwa kwesikhumba nama-eyeball;
• izinga le-hemoglobin ephakeme;
• ubunzima noma ukuyeka ukuphefumula ngemuva kokubeletha;
• ukulethwa okungafanele;
• Izicubu ezithambile nesikhumba ziyavuvukala, ngenxa yalokho ubuso bubukeka budlabha.

Usana olusanda kuzalwa lunephethini lokulala eliphazamisekile, likhuphuka ngokuthokozela, alincelisi kahle.

Isibonakaliso esibonakalayo se-pathology ukuba khona kwe-petechiae.

Isibonakaliso esibonakalayo se-pathology sisisindo esingaphezu kwama-4 kg.

Isibonakaliso esibonakalayo se-pathology yithoni yesikhumba ebomvu-cyanotic.

Isibonakaliso esibonakalayo se-pathology yellowness yesikhumba nama-eyeball.

Izindlela zokuxilonga ezidingekayo

Indlela eyinhloko yokuthola i-fetopathy ku-fetus is scan scanning, esenziwa ngo-trimesters wokuqala nowesibili kanye, amahlandla ama-2 noma ama-3 ezinyangeni ezi-3 zokugcina. Uma kwenzeka isifo sikashukela singena kumama, lesi sifo senziwa masonto onke ngemuva kwamasonto angama-30 noma angama-32.

Ngesikhathi sokufunda, udokotela wembula i-macrosomia, ukwephulwa kwezilinganiso zomzimba. Kwi-DF, izinkomba ezilandelayo zimpawu:

• ukuphindeka kabili kwekhanda;
• endaweni yengozi, kutholakala indawo ye-echo-negative;
• i-contour yomzimba ombaxambili (imbangela ingaba ukukhula kwe-puffness noma izicubu ezinamafutha ngokweqile);
• polyhydramnios.

Kusetshenziswa ezinye izifundo eziningi ukuqinisekisa ukutholakala kwale nkinga:

1. Ukuhlolwa kwesimo se-biophysical sengane. Isikhathi esingaphezu kwehora nesigamu, umsebenzi we-locomotor, ukuphefumula, kanye nenhliziyo yenhliziyo yengane iyaqoshwa. Ukuthuthukiswa kwengqondo kwe-morphofunctional kuyahlolwa.
2. I-Cardiotocography enezivivinyo ezisebenzayo. Izinga lenhliziyo lihlolwa ngaphansi kwezimo ezahlukahlukene.
3. I-Dopplerometry ukuhlola ukusebenza kohlelo lwezinzwa. Inani lezilinganiso zemisipha yenhliziyo, umthamo nesikhathi sokuphuma kwegazi okuvela endaweni engakwesobunxele, isilinganiso sokuhamba kwegazi okuphuma ku-umbilical cord, ratio ye-systolic-diastolic.

Izimpawu ze-biochemical zokuhlola igazi nomchamo ziyahlolwa ukuthola ukuthikamezeka kwe-metabolic ne-endocrine ye-placenta.

I-Dopplerometry isetshenziselwa ukuqinisekisa ukutholwa kwezifo ukuhlola ukusebenza kohlelo lwezinzwa.

Ukuqinisekisa ukutholwa, kusetshenziswa i-cardiotocography enezivivinyo ezisebenzayo.

Ukuqinisekisa ukutholwa, kusetshenziswa ukuhlolwa kwesimo se-biophysical sengane.

Ungayelapha kanjani i-fetopathy yesifo sikashukela?

Ukwelashwa kwe-fetopathy kuhloswe ukuqeda ukubonakaliswa kwesifo sikashukela kumama. Ukuze ukwelashwa kube ngempumelelo, owesifazane kufanele abheke njalo ushukela wegazi lakhe nomfutho wegazi.

Ukwelashwa kwabantu abakhulelwe

Kukho konke ukukhulelwa, ukulawulwa kwe-glycemic kumama kuyenziwa, ukwelashwa kwe-insulin kuyenziwa (kulungiswe uma kunesidingo). Njalo emahoreni ama-3 noma ama-4, ukuhlolwa koshukela egazini kwenziwa nsuku zonke.

Kuyadingeka ukulandela ukudla okuvinjelwe ikhalori, kuphoqelekile ukuthatha amavithamini ukwenza ngokwejwayelekile imetabolism.

Ukuzalwa kwengane

Udokotela unquma isikhathi esifanele sokubeletha. Uma ukukhulelwa kudlula ngaphandle kwezinkinga, lesi sikhathi singamaviki angama-37. Uma kwenzeka kusongelwa impilo kamama noma yengane, kwenziwa isinqumo ngesidingo sokulethwa ngaphambi kwamasonto angama-36.

Ngesikhathi sokubeletha, izinga le-glycemia lilawulwa. Uma izinga likashukela lowesifazane liphansi kakhulu, amandla alahlekile (inani elikhulu lezinto liyadingeka ukunciphisa izindonga zesibeletho), ukuzala kwengane kuba nzima ngenxa yokuntuleka kwamandla kukamama. Kukhona ubungozi bokuqhamuka ne-hypoglycemic coma ngemuva kokubeletha.

Izinyathelo ezilandelayo zithathwa:

• ukwethulwa kwekhambi le-soda ukuvikela i-ketoacidosis;
• Izimpawu ze-hypoglycemia zimiswa ama-carbohydrate asheshayo (ukuthatha amanzi amnandi noma i-dropper enesixazululo se-glucose);
• ngemizwelo, kusetshenziswa i-hydrocortisone;
• Ukwenza ngcono izinqubo ze-metabolic, kusetshenziswa izixazululo zamavithamini.

Lapho kukhona i-fetopathy, isinqumo kwesinye isikhathi senziwa ngokulethwa kokuhlinzwa.

Lapho kukhona i-fetopathy, isinqumo kwesinye isikhathi senziwa ngokulethwa kokuhlinzwa. Amathuba okuzalwa kwemvelo kuncike esikhathini sabo. Uma zihlala isikhathi esingaphezu kwamahora ayi-8, phendukela esigabeni secesarea.

Ukukhwabanisa kwe-Postpartum

Ngenxa yokuqothuka okwenzeka ngokushesha kweglucose kumthamo owedlule ngemuva kokuzalwa kwengane kanye ne-insulin ethe xaxa, i-hypoglycemia ingahle ibe khona kosanda kuzalwa. Ukuthambisa kwemisipha kuyehla, ukucindezela kanye nokushisa komzimba kuyehla, futhi nengozi yokuboshwa kokuphefumula iyanda. Ukuvimbela ubunzima, ikhambi le-glucose liphathwa engxenyeni yehora ngemuva kokubeletha. Uma kungekho ukuphefumula, kusetshenziswa umoya omncane we-hardware. Ukuze amaphaphu aqonde, umuntu osebenzisa i-survil anganikezwa ingane. Lokhu yinto ekhethekile esiza ingane yakho ukuba iphefumule okokuqala.

Ezinsukwini zokuqala ngemuva kokuzalwa, udokotela obelethayo uqapha ukuphefumula kwengane ngokucophelela ngezimpawu ze-DF. Ukuhlolwa kwegazi kwe-biochemical kwe-calcium ne-magnesium, glycemia, urinalysis, ne-electrocardiography kuyadingeka.

Njalo emahoreni amabili, ubisi lwebele luyaphuzwa. Ukudla okuvame ukubuyisa inani le-glucose ne-insulin.

Ukuqeda ukuphazamiseka kwemizwa, kusetshenziswa izixazululo eziqukethe i-calcium ne-magnesium. Uma kwenzeka ukungasebenzi kahle kwesibindi, kufakwa i-iradiation nge-UV.

Uma kwenzeka ukungasebenzi kahle kwesibindi kokusha, kufakwe i-irradiation ekhanyayo ngokukhanya kwe-ultraviolet.

Ezinsukwini zokuqala ngemuva kokuzalwa, udokotela ohlinzayo wenza ukuhlolwa kwegazi okune-calcium ne-magnesium, i-glycemia, nokuhlolwa komchamo kosanda kuzalwa.

Uma kungekho ukuphefumula osanda kuzalwa, kusetshenziswa umoya omncane we-hardware.

Iba yini imiphumela?

Izingane ezizalwe omama abanesifo sikashukela basengozini enkulu yokuba nalesi sifo ngokuzayo. Izazi ze-Endocrinologists ziphawula ukuthi amathuba we-pathology ancike kakhulu ezicini zofuzo, kunokuba abe ngumlando we-fetopathy. Izingane ezinjalo zithambekele ekulimazeni i-lipid metabolism kanye nokukhuluphala, kwezinye izimo kukhona ukuphazamiseka kwezinzwa zamaseli wezinzwa nezinzwa, ukungasebenzi kwengqondo. Lezi zinguquko zincane ngezindlela zokwelapha ezifika ngesikhathi.

Izimpawu ze-fetopathy ezinganeni ezisanda kuzalwa ziya ngokuya zinyamalala ngokungabikho kokungahambi kahle nezinkinga. Ngemuva kwezinyanga ezingama-2-3, kunzima ukuhlukanisa ingane enjalo neyinempilo.

Imiphumela nemiphumela yokwelashwa kwe-pathology engaziwa

Uma kungekho zindlela ezidingekayo zokwelapha nokubheka ngokucophelela isimo sowesifazane ngesikhathi sokukhulelwa, lesi sifo singasiholela ezinkingeni eziyingozi:

• i-neonatalabetes mellitus (ingakhula ibe yisifo sikashukela sohlobo II);
• izicubu hypoxia;
• hypocalcemia;
• isifo sokucindezeleka;
• i-hypoglycemia;
• ukuphazamiseka kwengqondo nokwengqondo (ngenxa ye-hypomagnesemia);
• i-cardiomyopathy;
• hyperbilirubinemia
• i-perinatal asphyxia;
• polycythemia;
• i-renal vein thrombosis;
• iTachypnea yesikhashana.

I-pathology engatholakali ingadala ukufa kwengane esanda kuzalwa.

Ngokuya ngemiyalo kadokotela oholayo, i-prognosis ezimweni eziningi ilungele ingane nonina. Izimpawu ze-pathology zibonakala emavikini okuqala empilo yengane, kancane kancane icindezela.

Ukuvimbela

Lapho uhlela ukukhulelwa, kuyadingeka ukuhlola ukuphazamiseka kwe-glucose metabolism. Ku-mellitus yesifo sikashukela, kunconywa ukufeza isinxephezelo esizinzile izinyanga ezimbalwa ngaphambi kokukhulelwa, kanye nokugcina amanani ajwayelekile ngesikhathi sokukhulelwa kwengane. Kuyadingeka ukulandela ngokuqinile umthamo obekiwe we-insulin, ovumelaniswe nokudla.

Ukuze ugweme izinkinga, kubalulekile ukulandela izincomo zikadokotela oqondayo bese uthola ukuxilongwa okuhleliwe ngesikhathi.