Isifo Sikashukela Ekhulelwe

Lo mbhalo udingida ngokuningiliza ukuthi kufanele wenze njani uma owesimame etholakele enesifo sikashukela ngaphambi kokukhulelwa. Uma izinga le-glucose ephakeme selitholakele kakade ngesikhathi sokukhulelwa, khona-ke lokhu kubizwa ngokuthi isifo sikashukela sokukhulelwa. Uhlobo 1 noma 2 sikashukela, njengomthetho, akuyona into ephula umthetho wokuba ngumama, kepha ikhulisa kakhulu ubungozi kwabesifazane nakowesifazane.

Indlela enhle yokuvimbela izinkinga kwisifo sikashukela kwabesifazane abakhulelwe ukubheka ushukela wakho wegazi kakhulu

Isifo sikashukela esikhulelwe sidinga ukunakwa okuseduze kodokotela. Owesifazane okhulelwe onesifo sikashukela ungaphansi kokuqashwa kwe-grenecologist. Uma kunesidingo, baphendukela kochwepheshe abancane: i-ophthalmologist (amehlo), i-nephrologist (izinso), isazi sezinhliziyo (inhliziyo) nabanye. Noma kunjalo, izinyathelo eziyinhloko ukusekela amazinga kashukela wegazi asondele kokujwayelekile, okwenziwa yisiguli uqobo.

Kuhle ukunxephezela isifo sikashukela, okungukuthi, ukufezekisa ukuthi ushukela wegazi ucishe ufane nowabantu abaphilile - lokhu kuyinto esemqoka edinga ukwenziwa ukuze kuzalwe ingane ejwayelekile futhi kugcinwe impilo yowesifazane. Amanani kashukela egazi asondele kakhudlwana kokuphakeme, anciphisa amathuba ezinkinga kuzo zonke izigaba zokukhulelwa, kusukela ekukhulelweni kuya ekubelekeni.

Ukuhlolwa kwengozi kanye ne-contraindication yokukhulelwa okunesifo sikashukela

Owesifazane ophethwe isifo sikashukela sohlobo 1 noma uhlobo 2 kufanele ahlolwe udokotela ovimbela inzalo-gynecologist, endocrinologist nodokotela ojwayelekile esigabeni sokuhlela ukukhulelwa. Ngasikhathi sinye, isimo sesiguli, amathuba okuba nomphumela omuhle wokukhulelwa, kanye nezingozi zokutholwa kwesisu zizosheshisa ukukhula kwezinkinga zesifo sikashukela kuyahlolwa.

Yiziphi izivivinyo owesifazane onesifo sikashukela okudingeka azenze esiteji sokuhlola ukuthi kungenzeka yini ukuthi umphumela wokukhulelwa uphumelele:

1. Thatha ukuhlolwa kwegazi kwe-glycated hemoglobin.
2. Ngokuzimela ulinganise ushukela wegazi nge-glucometer izikhathi ezingama-5-7 ngosuku.
3. Linganisa umfutho wegazi ekhaya nge-tracking yengcindezi yegazi, futhi futhi ubone ukuthi ngabe kukhona i-postural hypotension. Lokhu kwehla okukhulu komfutho wegazi, obonakaliswa ngesiyezi ekukhuphukeni okubukhali kusuka endaweni yokuhlala noma yokulala.
4. Thatha izivivinyo ukuze uhlole izinso zakho. Qoqa umchamo wansuku zonke ukuthola ukunqunyelwa kwe-creatinine nokuqukethwe kwamaprotheni. Thatha ukuhlolwa kwegazi nge-plasma creatinine ne-urea nitrogen.
5. Uma amaprotheni etholakala umchamo, hlola izifo ezithinta umchamo.
6. Bheka nodokotela wamehlo ukuze uhlole isimo semikhumbi ye-retinal. Kuyinto efiselekayo ukuthi incazelo yombhalo ye-fundus ihambisana nezithombe zemibala. Bazosiza ekuqhathaniseni ngokomqondo ukuqhathanisa nokuhlola izinguquko ngesikhathi sokuhlolwa okwengeziwe.
7. Uma owesifazane onesifo sikashukela esefinyelele eminyakeni engama-35, unesifo sokuqina kwegazi kwamathambo, i-nephropathy, ukukhuluphala, i-cholesterol ephezulu, unezinkinga ngemithambo yegazi.
8. Uma i-ECG itshengise i-pathology noma kunezimpawu zesifo senhliziyo, kungakuhle ukuthi wenze izifundo ngomthwalo.
9. Kuhlolwa izimpawu ze-peripheral neuropathy. Hlola ukuthinteka, izinhlungu, izinga lokushisa kanye nokuzwela kokudlidliza kokuphela kwezinzwa, ikakhulukazi emilenzeni nasezinyaweni
10. Bheka ukuthi ngabe i-autonomic neuropathy isithuthukile yini: inhliziyo, i-gastrointestinal, i-urogenital nezinye izindlela zayo.
11. Hlola ukuthambekela kwakho kwe-hypoglycemia. Ingabe izimo ze-hypoglycemia zivame ukuvela? Kusinda kangakanani? Yiziphi izimpawu ezejwayelekile?
12. Kuhlolwa izilonda zesifo sikashukela ezinshukela
13. Thatha ukuhlolwa kwegazi lamahomoni e-thyroid: i-hormone egqugquzela i-thyroid (TSH) ne-thyroxine mahhala (i-T4 mahhala).

Kusukela ngo-1965, ukwahlukaniswa ngezigaba okwakhiqizwa yi-American obstetrician-gynecologist R. White kuye kwasetshenziswa ukuhlola ubungozi bokungalungi kwengqondo e-fetus. Ingozi incike ku:

• isikhathi sikashukela kowesifazane;
• Lesi sifo saqala eminyakeni emingaki;
• yiziphi izinkinga zesifo sikashukela esivele sikhona.

Izinga lobungozi besifo sikashukela kowesifazane okhulelwe ngokusho kukaP. White

Amanothi:

• DR - retinopathy yesifo sikashukela; I-DN - isifo sikashukela se-nephropathy; I-CHD - isifo senhliziyo; I-CRF - ukuhluleka kwe-renal okungamahlalakhona.
• Ikilasi A - ingozi ephansi kakhulu yezinkinga, ikilasi i-RF - isiphetho esingesihle kakhulu somphumela wokukhulelwa.

Lokhu kuhlukaniswa kuhle kwabodokotela nabesifazane abanesifo sikashukela sohlobo 1 noma uhlobo 2 abahlela ukukhulelwa.

Iyini ingozi yesifo sikashukela ekhulelwe umama nengane

Ingozi yokuthola isifo sikashukela sohlobo loku-1 ngesikhathi sokuphila kwengane yile:

• cishe i-1-1,5% - enesifo sikashukela sohlobo 1 kumama ;;
• cishe ama-5-6% - onesifo sikashukela sohlobo 1 kubaba;
• ngaphezu kwama-30% - uma uthayipha ushukela ongu-1 kubo bobabili abazali.

Owesifazane nodokotela abambonisana naye lapho ehlela ukukhulelwa kufanele banikezwe izimpendulo ezilinganayo zemibuzo:

• Isifo sikashukela siyokuthinta kanjani ukukhulelwa nempilo yengane? Yimaphi amathuba okukhulelwa nokukhulelwa okunempilo?
• Ukukhulelwa kuzosithinta kanjani isifo sikashukela? Ngabe ivusa ukuthuthuka okusheshayo kwezinkinga zayo eziyingozi?

Contraindication yokukhulelwa kwabesifazane abanesifo sikashukela:

• i-nephropathy ebukhali (i-serum creatinine> i-120 μmol / L, isilinganiso sokuhlunga kwe-glomerular 2 g / ngosuku);
• umfutho wegazi ophakeme ongenakudonswa ngaphansi kolawulo, isb., umfutho wegazi ngaphezulu kwe-130-80 mm RT. Ubuciko., Yize iqiniso lokuthi owesifazane uthatha imishanguzo ye-hypertension;
• i-retinopathy ekhulayo ne-maculopathy, ngaphambi kokuvela kwe-laser retinal;
• izifo zenhliziyo ezi-coronary, angina pectoris ezingazinzi;
• izifo ezithathelwanayo noma ezingamahlalakhona ezingapheliyo (isifo sofuba, i-pyelonephritis, njll);
• Isifo sikashukela - ku-trimester yokuqala yokukhulelwa iyinkomba yokuqedwa kwaso.

Ukukhulelwa Ukulungiselela Abesifazane Abanesifo Sikashukela

Ngakho-ke, usifundile isigaba esedlule, kepha noma kunjalo, uzimisele ukukhulelwa futhi ube nengane. Uma kunjalo, khona-ke kowesifazane onesifo sikashukela, isigaba sokulungiselela ukukhulelwa siqala. Kudinga umzamo obonakalayo futhi ungaba mude kakhulu, kepha kuyadingeka impela ukuwudlulisa ukuze inzalo ibe nempilo.

Umthetho oyinhloko: ungaqala ukukhulelwa kuphela uma isilinganiso sakho se-glycated hemoglobin HbA1C sehla saya ku-6.0% noma ngaphansi. Futhi izilinganiso eziningi zikashukela wegazi ozithatha ngemitha kashukela egazini nazo kufanele zibe ezijwayelekile. Idayari yokuzihlola yeglucose egazini kufanele igcinwe futhi ihlaziywe nodokotela njalo emavikini angu-1-2.

Futhi, umfutho wegazi kufanele uhlale ngaphansi kwe-130/80, noma ngabe ungaphuzi umuthi. Khumbula ukuthi amaphilisi wengcindezi "amakhemikhali" awakuthinti kabi ukukhula kwesibeletho. Ngakho-ke, ngesikhathi sokukhulelwa kuzodingeka ukuthi sikhanseliwe. Uma ungakwazi ukulawula umfutho wegazi ophakeme ngaphandle kwemithi noma ungakhulelwe, kungcono ukuyeka ukuba ngumama. Ngoba ubungozi bomphumela wokukhulelwa ongemuhle uphezulu kakhulu.

Ukuthola isinxephezelo sikashukela esihle, ngesikhathi sokulungiselela ukukhulelwa, owesifazane kufanele enze okulandelayo:

• zonke izinsuku ukukala ushukela wegazi nge-glucometer ngaphandle kobuhlungu esiswini esingenalutho kanye nehora elilodwa emva kokudla;
• kwesinye isikhathi kuyathandeka ukukala ushukela wakho futhi ngo-2 noma 3 ekuseni - qiniseka ukuthi akukho-hypoglycemia yasebusuku;
• ukuphatha nokusebenzisa irekhodi lesisekelo sokwelashwa kwe-insulin;
• uma uthatha amaphilisi anciphisa ushukela wesifo sikashukela sohlobo 2, alahle bese ushintshela ku-insulin;
• ukuzivocavoca ngesifo sikashukela - ngaphandle kokusebenza ngokweqile, ngentokozo, njalo;
• landela ukudla okulinganiselwe kuma-carbohydrate, adonswa ngokushesha, udla izikhathi ezingama-5-6 ngosuku ngezingxenye ezincane

Imisebenzi eyengeziwe yokulungiselela ukukhulelwa unesifo sikashukela:

• ukukala njalo komfutho wegazi;
• uma kukhona umfutho wegazi ophakeme, kufanele uphathwe ngokulawulwa, futhi “nangomendo”, ngoba ngesikhathi sokukhulelwa umuthi we-hypertension uzodinga ukukhanselwa;
• ihlolwe kusengathi ngudokotela wezifo zamehlo futhi welaphe i-retinopathy;
• thatha i-folic acid ku-500 mcg / ngosuku ne-potassium iodide ku-150 mcg / ngosuku, uma kungekho okuphikisana;
• yekela ukubhema.

Ukukhulelwa Sikashukela: Ungaba Kanjani Nomntwana Onempilo

Ngesikhathi sokukhulelwa unesifo sikashukela, owesifazane kufanele enze imizamo ebalulekile yokugcina ushukela wegazi lakhe eduze kwamanani ajwayelekile. Ngaphezu kwalokho, unake kakhulu ama-index we-glucose we-1 namahora ama-2 ngemuva kokudla. Ngoba yizo ezingakhula, futhi ushukela wegazi osheshayo kungenzeka uhlale uvamile noma uphansi kakhulu.

Ekuseni, udinga ukuvivinya i-ketonuria ngemichilo yokuhlola, isb. Uma ama-ketones avele emchameni. Ngoba abesifazane abakhulelwe abanesifo sikashukela banamathuba amaningi okuvela kweziqephu zasebusuku ze-hypoglycemia. Lezi ziqephu zibonakaliswa ngokubonakala kwama-ketones kumchamo wasekuseni. Ngokusho kwezifundo, i-ketonuria ihlotshaniswa nokwehla kokuqina kwengqondo kwinzalo yesikhathi esizayo.

Uhlu lwemisebenzi yesifo sikashukela ekhulelwe:

1. Ukudla kowesifazane okhulelwe akufanele kube okuqinile kakhulu, okunama-carbohydrate “acothayo” anele ukuvikela i-ketosis yendlala. Ukudla okunama-carbohydrate aphansi sikashukela okhulelwe akulungile.
2. Ukulinganisa ushukela wegazi nge-glucometer - okungenani izikhathi eziyisikhombisa ngosuku. Esiswini esingenalutho, ngaphambi nangemva kokudla ngakunye, ebusuku, futhi kwesinye isikhathi ebusuku. Umthamo we-insulin kufanele uguqulwe ushukela wegazi hhayi esiswini esingenalutho, kodwa ngemuva kokudla.
3. Ukwelashwa kwesifo sikashukela esikhulelwe kuchaziwe ku-athikili engezansi.
4. Lawula ukuvela kwama-ketones (i-acetone) kumchamo, ikakhulukazi nge-gestosis yakuqala nangemva kwamasonto angama-28-30 ekhulelwe. Ngalesi sikhathi, isidingo se-insulin siyakhuphuka.
5. Ukuhlolwa kwegazi kwe-hemoglobin ye-glycated kufanele kuthathwe okungenani isikhathi esisodwa nge-trimester.
6. Thatha i-folic acid ku-500 mcg / ngosuku kuze kufike isonto le-12 lokukhulelwa. I-potassium iodide ku-250 mcg / ngosuku - lapho kungekho khona ukungqubuzana.
7. Ukuhlolwa kwe-Ophthalmologist ngokuhlolwa kwe-fundus - isikhathi esingu-1 nge-trimester. Uma ukukhula kwe-retinopathy yesifo sikashukela kukhula noma ukubhebhetheka kwe-retinopathy kukhula ngokushesha, ukwanda kwe-laser retinal kwenziwa ngokushesha, ngaphandle kwalokho ubumpofu obugcwele busongelwa.
8. Ukuhambela njalo kudokotela we-obstetrician-gynecologist, endocrinologist noma isifo sikashukela. Kufika kumaviki ama-34 okukhulelwa - njalo emavikini ama-2, ngemuva kwamasonto angama-34 - nsuku zonke. Kulokhu, isilinganiso sesisindo somzimba, umfutho wegazi, kuthathwa ukuhlolwa komchamo okujwayelekile.
9. Uma kutholakala ukuthi kunegciwane lesifo somchamo kwisifo sikashukela, abesifazane abakhulelwe kuzodingeka bathathe imishanguzo echazwe ngudokotela (!). Kuzobe kuyi-I trimester - ama-penicillin, kuma-II noma ama-trimesters e-II - ama-penicillin noma ama-cephalosporins.
10. Odokotela nowesifazane abakhulelwe uqobo baqapha ukukhula nesimo sesibeletho. I-Ultrasound yenziwa njengokuyalelwa yi-obstetrician-gynecologist.

Yimaphi amaphilisi okucindezela abekwe odokotela ngesikhathi sokukhulelwa:

• Xoxa nodokotela wakho ukuthi kufanele unikezwe i-magnesium-B6 ne-taurine ekwelashweni kwe-hypertension ngaphandle kwezidakamizwa.
• Ezidakamizweni "zamakhemikhali", i-methyldopa isidakamizwa yokuzikhethela.
• Uma i-methyldopa ingasizi ngokwanele, kungenzeka kuvinjelwe ama-calcium blockers noma β1-khetha adrenergic blockers.
• Izidakamizwa ze-diuretic - kuphela izinkomba ezimbi kakhulu (ukugcinwa kwe-fluid, i-edema ye-pulmonary, ukwehluleka kwenhliziyo).

Ngesikhathi sokukhulelwa, wonke amaphilisi ahlobene nalawo makilasi alandelayo afakwa emthethweni:

• izidakamizwa ezinciphisa ushukela;
• kusuka ku-hypertension - ACE inhibitors nama-angiotensin-II receptor blockers;
• izigebengu ezivimba izigebengu;
• ama-antibiotic (aminoglycosides, tetracyclines, macrolides, njll);
• ama-statin ukwenza ngcono ukubalwa kwegazi cholesterol.

Ukudla sikashukela okhulelwe

Kulesi siza, sikholisa zonke iziguli ukwelashwa okusebenzayo kwesifo sikashukela sohlobo 2 futhi sithayiphe nohlobo loku-1 ukuze siguqukele ekudleni okune-carbohydrate ephansi. Lokhu kudla akulungile kuphela:

• ngesikhathi sokukhulelwa;
• ngokwehluleka okunzima kwezinso.

Ukudla okune-carbohydrate ephansi kwabesifazane abakhulelwe abanesifo sikashukela kuyenqatshelwa, ngoba kungalimaza ukukhula kwesibeletho.

Ukuvinjelwa kwama-carbohydrate ekudleni kuvame ukuholela eqinisweni lokuthi umzimba ushintshela ekudleni onawo namafutha awugcinayo. Lokhu kuqala ketosis. Kwakhiwa izidumbu zeKetone, kufaka phakathi i-acetone, etholakala umchamo kanye nephunga lomoya osetshenzisiwe. Ngohlobo 2 sikashukela, lokhu kungazuzisa isiguli, kepha hhayi ngesikhathi sokukhulelwa.

Njengoba ufunda esihlokweni esithi “I-Insulin ne-Carbohydrate: Iqiniso Okufanele Ukwazi”, ama-carbohydrate amancane owadlayo, kuba lula kakhulu ukugcina ushukela wegazi ojwayelekile. Kodwa ngesikhathi sokukhulelwa - ukuvimbela ukuthuthukiswa kwe-ketosis kubaluleke kakhulu. Ukhuphuka kwegazi glucose kungaholela ezinkingeni zokukhulelwa nokuzalwa kwengane. Kodwa i-ketonuria iyingozi ngisho nangokwengeziwe. Yini okufanele uyenze?

Ama-carbohydrate, adonswa ngokushesha, awakufanele ukudliwa ushukela. Kepha ngesikhathi sokukhulelwa, ungazivumela ukuthi udle imifino emnandi (izaqathe, ama-beet kanye nezithelo), empilweni ejwayelekile kuyalulekwa ukuthi ungafaki ekudleni. Futhi ubheke ngokucophelela ukuvela kwama-ketones emchosheni ngemichilo yokuhlola.

Umuthi osemthethweni wake wancoma phambilini ukudla kwesifo sikashukela kwabesifazane abakhulelwe abane-carbohydrate engama-60%. Eminyakeni yamuva, baye babona izinzuzo zokwehlisa amaphesenti ama-carbohydrate futhi manje batusa indlela yokudla lapho ama-40 465% ama-carbohydrate, amafutha angama-35- 40% namaprotheni angama-20-25%.

Abesifazane abakhulelwe abanesifo sikashukela bayalwa ukuba badle ukudla okuncane amahlandla ama-6 ngosuku. Lokhu ukudla okuyi-3 okuyinhloko kanye nemililo emi-3 eyengeziwe, kufaka phakathi ebusuku ukuvikela i-hypoglycemia yasemini. Iningi labaphenyi likholelwa ukuthi ukudla kwekhalori kwesifo sikashukela esikhulelwe kufanele kube okujwayelekile, noma ngabe umuntu wesifazane ekhuluphele ngokweqile.

Umjovo we-insulin

Ngesikhathi sokukhulelwa, ukuzwela kwezicubu esenzweni se-insulin kwehla emzimbeni wowesifazane ngaphansi kwethonya lamahhala e-placental, isb., Ukumelana kwe-insulin kukhula. Ukunxenxa lokhu, ama-pancreas aqala ukukhiqiza i-insulin eningi. Ukushesha ushukela wegazi kuhlala kuyinto evamile noma iyancipha, kuthi ngemuva kokudla kukhuphuke kakhulu.

Konke lokhu kufana kakhulu nentuthuko yesifo sikashukela sohlobo 2. Kepha lezi yizinguquko ezijwayelekile zemvelo ze-metabolic ukuqinisekisa ukukhula kwesibeletho. Uma ngaphambi kokuthi i-pancreas ivele isebenza ngamkhawulo wamakhono ayo, khona-ke ngesikhathi sokukhulelwa owesifazane angaba nesifo sikashukela sokukhulelwa, ngoba manje akasakwazi ukubekezelela umthwalo owandayo.

Abesifazane abakhulelwe banikezwa i-insulin ngenkuthalo hhayi kuphela isifo sikashukela sohlobo 1, kodwa futhi nesifo sikashukela sohlobo 2 nesifo sikashukela sokukhulelwa, uma kungenzeki ukulondolozela ushukela ojwayelekile wegazi ngokudla nangokuzivocavoca.

Ukhuphuka ushukela wegazi kungaholela ezinkingeni zokukhulelwa, eziyingozi kuzalo nakowesifazane. I-fetopathy yesifo sikashukela - ibonakaliswa esibelethweni nge-edema yamafutha angapheli, umsebenzi okhubazekile wezitho eziningi. Kungadala izinkinga ezinkulu esikhathini sokuqala kwangaphambi kokubeletha.

I-Macrosomy iyinzuzo eyeqile yesisindo esenziwa ingane, ngaphansi kwethonya lezinga likashukela egazini likamama. Kubangela ubunzima lapho kudlula emgodini wokubeletha, ukuzalwa ngaphambi kwesikhathi, kuholela ekulimaleni enganeni noma kowesifazane ngesikhathi sokuzalwa kwengane.

Ngakho-ke, unganqikazi ukuqala imijovo ye-insulin nesifo sikashukela kwabesifazane abakhulelwe, uma kunesidingo. Uhlobo lonyango lwe-insulin lubekwe ngudokotela. Owesifazane kufanele acabangele ukusebenzisa iphampu ye-insulin esikhundleni semijovo yendabuko ngama-syringes noma amapeni wesirinji.

Uyacelwa uqaphele ukuthi engxenyeni yesibili yokukhulelwa, isidingo se-insulin singakhula kakhulu. Imithamo yemijovo ye-insulin ingadinga ukukhushulwa ngesici esingu-2- 2 uma siqhathanisa nokuthi mangaki ama-injake ngaphambi kokukhulelwa. Kuya ngezinkomba zikashukela wegazi ngemuva kokudla, umuntu wesifazane ngaso sonke isikhathi olinganisa kabuhlungu nge-glucometer.

Isifo sikashukela esikhulelwe kanye nephropathy (izinkinga zezinso)

I-Diabetes nephropathy igama eliyinkimbinkimbi yezilonda ezahlukahlukene zezinso nemithambo yegazi yabo eyenzeka kushukela. Lokhu kuyinkinga eyingozi ethinta iziguli ezingama-30- 40% ezinesifo sikashukela futhi okuvame ukuholela ekwehlulekeni kwezinso.

Njengoba kukhonjisiwe ekuqaleni kwalesi sihloko, i-nephropathy enzima ingukuphikisana nokukhulelwa. Kepha abesifazane abaningi abanesifo sikashukela se-nephropathy “sobumnene” noma “esilinganiselwe” sokukhula bathande ukukhulelwa babe omama.

Ezimweni eziningi ezine-nephropathy yesifo sikashukela, ukuzalwa kwengane esebenzayo kungalindeleka. Kepha, kungenzeka kakhulu, inkambo yokukhulelwa izoba yinkimbinkimbi, ukuqashwa kongoti kanye nokwelashwa okunamandla kuzodingeka. Amathuba amabi kakhulu ngabesifazane abenze umsebenzi wezinso ongabonakali kahle, ngokunciphiswa kwemvume ye-creatinine kanye nenani elandayo le-creatinine ku-plasma yegazi (hlola izivivinyo - hlola!).

I-nephropathy yesifo sikashukela yandisa ingozi yokuthola imiphumela emibi yokukhulelwa kulezi zizathu ezilandelayo:

• Izikhathi eziningana kaningi, ukukhulelwa kuyinkimbinkimbi nge-preeclampsia. Ikakhulu kulabo besifazane abanesifo sikashukela se-nephropathy ababenomfutho wegazi ophakeme ngisho nangaphambi kokukhulelwa. Kodwa noma ngabe owesifazane ekuqaleni wayenomfutho wegazi ojwayelekile, i-preeclampsia isenokwenzeka kakhulu.
• Ukuzalwa ngaphambi kwesikhathi nge-nephropathy yesifo sikashukela kwenzeka kaningi. Ngoba isimo sowesifazane singase sibe sibi kakhulu, noma kungaba khona usongo enganeni. Ezimweni ezingama-25-30%, ukuzalwa kwengane kwenzeka ngaphambi kwesonto lama-34 lokukhulelwa, ngamaphesenti angama-50 amacala - kuze kube yisonto lama-37.
• Ngesikhathi sokukhulelwa, ngokubhekene nesizinda se-nephropathy, kumaphesenti angama-20 wamacala, ukuwohloka kwengane noma ukuthuthukiswa komzimba kuyabonakala.

I-Preeclampsia iyinkinga enkulu yokukhulelwa okuholela ekunikezelweni kwegazi okungekuhle kwi-placenta, ukuntuleka kwezakhi zomzimba nomoya-mpilo we-fetus. Izimpawu zayo yilezi:

• umfutho wegazi ophakeme;
• ukuvuvukala
• ukukhuphuka kwenani lamaprotheni kumchamo;
• umuntu wesifazane uthola isisindo ngokushesha ngenxa yokugcinwa kukamanzi emzimbeni.

Kunzima ukubikezela kusengaphambili ukuthi ukukhulelwa kuzosheshisa yini ukuthuthukiswa kokulimala kwezinso likashukela. Kukhona okungenani izinto ezi-4 ezingathinta lokhu:

1. Imvamisa, ngesikhathi sokukhulelwa, izinga lokuhlunga kwe-glomerular lenyuka ngo-40-60%. Njengoba uyazi, i-nephropathy yesifo sikashukela ivela ngenxa yokufayiliswa okwandisiwe. Ngakho-ke, ukukhulelwa kungaba kubi kakhulu kule nkinga yesifo sikashukela.
2. Umfutho wegazi ophakeme uyimbangela ebalulekile yomonakalo wezinso. Ngakho-ke, i-hypertension kanye ne-preeclampia, okuvame ukwenzeka kwabesifazane abakhulelwe abanesifo sikashukela, kungaba nomthelela omubi ekusebenzeni kwezinso.
3. Ngesikhathi sokukhulelwa, ukudla komuntu wesifazane kufanele kube nephesenti elikhulu lamaprotheni, ngoba ingane iyayidinga kakhulu. Kepha inani elikhulu lamaprotheni ekudleni liholela ekwandeni kokuhlunga kwe-glomerular. Lokhu kungasheshisa inkambo yemvelo ye-nephropathy yesifo sikashukela.
4. Ku-nephropathy yesifo sikashukela, iziguli zivame ukubekwa izidakamizwa - ama-inhibitors e-ACE - anciphisa ukukhula komonakalo wezinso. Kepha le mithi ithinta kabi ukukhula kwesibeletho, ngakho-ke iyakhanselwa ngesikhathi sokukhulelwa.

Ngakolunye uhlangothi, ngesikhathi sokukhulelwa, abesifazane abanesifo sikashukela bayelulekwa ukuba bahlole ngokucophelela amazinga abo kashukela egazini. Futhi lokhu kungaba nomthelela omuhle kakhulu ekusebenzeni kwezinso.

Izimpawu zezinkinga zezinso zivame ukuvela sezigabeni zokugcina ze-nephropathy yesifo sikashukela. Ngaphambi kwalokhu, lesi sifo sitholakala ngokuhlaziywa kwamaprotheni omchamo. Okokuqala, i-albhamuin ivela kumchamo, futhi lokhu kubizwa ngokuthi yi-microalbuminuria. Kamuva, kufakwa amanye amaprotheni, amakhulu kunawo.

I-Proteinuria yi-excretion yamaprotheni omchamo. Ngesikhathi sokukhulelwa, abesifazane abane-nephropathy yesifo sikashukela bavame ukukhulisa kakhulu i-proteinuria. Kepha ngemuva kokuzalwa kwengane, kungenzeka ukuthi yehle iye kwizinga elidlule. Ngaso leso sikhathi, umthelela omubi ukukhulelwa onawo ekusebenzeni kwezinso kungenzeka ngemuva kwesikhathi.

Ukuzalwa kwengane ebusweni besifo sikashukela kowesifazane okhulelwe

Kwabesifazane abakhulelwe abanesifo sikashukela, umbuzo wokuthi isikhathi esingakanani sokubeletha sinqunywa ngamunye. Kulokhu, odokotela banaka lezi zinto ezilandelayo:

• isimo se-fetus;
• izinga lokuvuthwa kwamaphaphu akhe;
• ukuba khona kwezinkinga zokukhulelwa;
• uhlobo lwenkambo yesifo sikashukela.

Uma owesifazane ngesikhathi sokukhulelwa eba nesifo sikashukela sokukhulelwa, futhi ngasikhathi sinye ushukela wegazi ojwayelekile, khona-ke cishe uyodlulisela ingane ethengweni lemvelo lokubeletha.

Ukuba nengxenye yecesarean noma ukuzalwa komzimba nakho kungukuzikhethela okuhle. Ukuzilungiselela owesifazane onesifo sikashukela kungenzeka uma kuhlangabezana nale mibandela elandelayo:

• isifo sikashukela silawulwa kahle;
• azikho izinkinga zokuvimbela;
• isisindo se-fetus singaphansi kwama-4 kg futhi sisesimweni esijwayelekile;
• odokotela banamandla okubheka isimo se-fetus futhi babheke nezinga le-glucose esegazini likamama ngesikhathi sokubeletha.

Nakanjani bazoba nesigaba sokukhamba uma:

• Owesifazane okhulelwe une-pelvis noma isikhumba esincane esibelethweni;
• owesifazane unesifo sikashukela se-nephropathy.

Manje emhlabeni, iphesenti lesigaba se-caesarean liyi-15.2% phakathi kwabesifazane abanempilo kanye ne-20% ezigulini ezinesifo sikashukela i-mellitus, kufaka phakathi ukuthinta umzimba. Phakathi kwabesifazane abaye batholakala benesifo sikashukela ngaphambi kokukhulelwa, isigaba se-Caesarean sanda saya ku-36%.

Ngesikhathi sokubeletha, odokotela baqapha izinga le-glucose egazini le-capillary 1 ngehora. Kubalulekile kakhulu ukugcina ushukela wegazi likamama ezingeni elijwayelekile nge-glucose ye-intravenous kanye nemithamo ephansi ye-insulin. Ukusetshenziswa kwephampu ye-insulin nakho kunikeza imiphumela emihle.

Uma isiguli, kanye nodokotela, bekhethe isigaba secesare, khona-ke basihlela ekuseni kakhulu. Ngoba phakathi kwalawa amahora umthamo we "medium" noma i-insulin enwetshiwe, owawuphethwe ebusuku, uzoqhubeka. Ngakho-ke kuzokwenzeka ukuthi ungafaki i-glucose noma i-insulin lapho kukhishwa i-fetus.

Isikhathi se-postpartum

Lapha sibheka isimo lapho owesifazane eba nesifo sikashukela esincike ku-insulin ngaphambi kokukhulelwa. Uma isifo sikashukela saqala ukutholwa ngesikhathi sokukhulelwa, funda lesi sihloko ngesifo sikashukela sokukhulelwa kowesifazane osesithombeni.

Ngemuva kokuzalwa, i-placenta iyayeka ukuthinta imetabolism emzimbeni wowesifazane onama-hormone ayo. Ngokuvumelana nalokho, ukuzwela kwezicubu kukhuphuka nge-insulin. Ngakho-ke, imithamo ye-insulin yemijovo kufanele incishiswe kakhulu ukuze ugweme i-hypoglycemia enzima.

Cishe umthamo we-insulin ungancishiswa ngamaphesenti angama-50 ngemuva kokuzalwa ngendlela yemvelo nangama-33% esimweni sesigaba se-cesarean. Kepha ngokwelashwa kwe-insulin, ungagxila izinkomba eziqondile zesiguli, hhayi idatha yabantu “evamile”. Ukukhetha umthamo ofanele we-insulin kungenziwa kuphela ngokulinganisa ushukela wegazi njalo.

Eminyakeni embalwa edlule, ukuncelisa abesifazane abanesifo sikashukela bekuyinkinga. Lokhu kuvinjelwe:

• amaphesenti aphezulu okuzalwa ngaphambi kokubeletha;
• izinkinga ngesikhathi sokuzalwa kwengane;
• ukuphazamiseka okunamandla kwe-metabolic kwabesifazane.

Lesi simo manje sesishintshile. Uma isifo sikashukela sinxephezelwa kahle futhi ukulethwa kuqedwe ngesikhathi, ukuncelisa kungenzeka futhi kunconywe. Kulokhu, khumbula ukuthi iziqephu ze-hypoglycemia zinciphisa ukuhamba kwegazi ukuya egazini le-mammary kanye nokukhiqizwa kobisi lwebele. Ngakho-ke, kufanele uzame ukungabavumeli.

Uma isiguli silawula ushukela wakhe, ukwakheka kobisi lwayo kuzofanela nakwabesifazane abaphilile. Ngaphandle kokuthi okuqukethwe kweglucose kungangezelelwa. Kusakholelwa ukuthi izinzuzo zokuncelisa ibele zidlula le nkinga.