Kumuntu wesifazane, ukuzala ingane akuyona isivivinyo esilula, ngoba ngalesi sikhathi umzimba wakhe usebenza ngemodi ethuthukisiwe. Ngakho-ke, esikhathini esinjalo, izimo ezihlukahlukene ze-pathological zivame ukuvela, ngokwesibonelo, isifo sikashukela sabesifazane abakhulelwe. Kepha siyini isifo sikashukela sokukhulelwa futhi singayithinta kanjani impilo yowesifazane nowesibeletho.
Lesi sifo senzeka lapho amazinga kashukela egazini ephezulu kakhulu ngesikhathi sokukhulelwa. Imvamisa lesi sifo sinyamalala ngokushesha ngemuva kokuzalwa kwengane. Kodwa-ke, lolu hlobo lwesifo sikashukela luyingozi kubantu besifazane, ngoba inkambo yalo ingabhekwa njengengozi yokwanda kwesifo sohlobo 2 ngokuzayo.
I-mestitus yesifo sikashukela sokutholwa komzimba kwenzeka ku-1-14% yabesifazane. Lesi sifo sinokuvela ezigabeni ezahlukahlukene zokukhulelwa. Kwi-trimester yokuqala, isifo sikashukela senzeka ku-2.1% yeziguli, kwesibili - ku-5.6%, kuthi kwesesithathu - ku-3.1%
Izimbangela nezimpawu
Ngokuvamile, noma yiluphi uhlobo lwesifo sikashukela luyisifo se-endocrine lapho ukwehluleka khona emzimbeni we-carbohydrate metabolism. Ngokuphikisana nalesi sizinda, kukhona isihlobo noma ukungapheleli ngokuphelele kwe-insulin, okumele kukhiqizwe ama-pancreas.
Isizathu sokuntuleka kwale-hormone singase sehluke. Isibonelo, ukungasebenzi kahle ezinhlelweni zokuguqula i-proinsulin ibe yi-hormone esebenzayo, ukwehla kwenani lamaseli we-beta kumanyikwe, ukuntuleka komqondo wokuqonda kwe-insulin ngamaseli, nokunye okuningi.
Umphumela we-insulin kuma-carbohydrate metabolism unqunywa ngokuba khona kwama-receptors akhethekile we-glycoprotein kwezicubu ezincike kuma-hormone. Lapho zivuselelwa, ukuthuthwa koshukela emangqamuzaneni kuyenyuka futhi amazinga kashukela egazini ayancipha.
Ngaphezu kwalokho, i-insulin ilingisa ukusetshenziswa koshukela nokuqongelela kwayo njenge-glycogen kwezicubu, ikakhulukazi emsipha wamathambo nesibindi. Kuyaphawuleka ukuthi ukukhishwa kwe-glucose ku-glycogen nakho kwenziwa ngaphansi kwethonya le-insulin.
Enye i-hormone ithinta umsoco wamaprotheni kanye namafutha. Inomphumela we-anabolic, ivimbela i-lipolysis, isebenze i-biosynthesis ye-DNA ne-RNA kumaseli ancike ku-insulin.
Lapho kuvela isifo sikashukela sokukhulelwa, izimbangela zaso zifaka izici ezimbalwa. Okubaluleke kakhulu kuleli cala ukungasebenzi kahle kokusebenza phakathi komphumela wokunciphisa ushukela we-insulin nomphumela we-hyperglycemic ovela ngamanye ama-hormone.
Ukuphikisana nokuqina kwe-insulin, ukuthuthuka kancane kancane, kwenza ukuntuleka kwe-insulin kudalulwe nangaphezulu. Izici ezishukumisayo nazo zinomthelela kulokhu:
- isisindo ngokweqile esidlula esivamile ngo-20% noma ngaphezulu, esitholakala ngaphambi kokukhulelwa;
- ushukela wegazi ophakeme, oqinisekiswa yimiphumela yokuhlaziywa komchamo;
- ukuzalwa kwangaphambilini kwengane enesisindo kusuka kumakhilogremu amane;
- ubuzwe (isifo sikashukela esivame kakhulu ukubonakala kuma-Asia, Hispanics, Blacks and Native Americanans);
- ukuzalwa kwengane efile phambilini;
- ukuntuleka kokubekezelela ushukela;
- ukuba khona kwesifo se-ovarian;
- i-polyhydramnios ebonakala ngokuwedlula kwamanzi e-amniotic;
- ifa;
- ukuphazamiseka kwe-endocrine okwenzeka ngesikhathi sokukhulelwa kwangaphambilini.
Ngesikhathi sokukhulelwa, ukuphazamiseka kwe-endocrine kwenzeka ngenxa yezinguquko zomzimba, ngoba kakade esiteji sokuqala sokukhulelwa, i-metabolism iyakhiwa kabusha. Ngenxa yalokho, ngokushoda okuncane kwe-glucose ku-fetus, umzimba uqala ukusebenzisa izinqolobane zokubhuka, uthola amandla kuma-lipids.
Esikhathini sokuqala sokukhulelwa, ukuhlelwa kabusha okunamandla kwe-metabolic kwanelisa zonke izidingo zamandla we-fetus. Kepha ngokuzayo, ukunqoba ukumelana ne-insulin, i-hypertrophy yamaseli e-pancreatic beta avela, nawo abe matasa kakhulu.
Ukukhiqizwa okwandayo kwehomoni kunxephezelwa ukubhujiswa kwalo okushesha. Kodwa-ke, kakade ku-2nd trimester yokukhulelwa, i-placenta yenza umsebenzi we-endocrine, ovame ukuthinta i-carbohydrate metabolism.
Ama-estrogens akhiqizwa yi-placenta, ama-steroid afana nama-steroid ama-hormone kanye ne-cortisol aba ngabaphikisi be-insulin. Ngenxa yalokhu, kakade esontweni lama-20, kuvela izimpawu zokuqala zesifo sikashukela sokukhulelwa.
Kodwa-ke, kwezinye izikhathi, owesifazana wembula izinguquko ezincane kuphela ekuxakekeni kwe-glucose, lesi simo sibizwa ngokuthi i-pre-gestationalabetes mellitus. Kulesi simo, ukushoda kwe-insulin kuqashelwa kuphela ngokuhlukunyezwa kokudla kwe-carbohydrate kanye nokuba khona kwezinye izinto ezisolisayo.
Kuyaphawuleka ukuthi isifo sikashukela ngesikhathi sokukhulelwa asihambisani nokufa kwamangqamuzana e-beta noma ukuguquguquka kwe-molecule ye-hormone. Ngakho-ke, lolu hlobo lokuphazamiseka kwe-endocrine lubhekwa njengelubuyisekayo, okusho ukuthi lapho ukulethwa kwenzeka, kunxephezelwa wedwa.
Izimpawu zesifo sikashukela sokuthambisa asemncane, ngakho-ke abesifazane bavame ukuzisho izici zomzimba zokukhulelwa. Ukubonakaliswa okuyinhloko okwenzeka ngalesi sikhathi kuyizimpawu ezijwayelekile zanoma yiluphi uhlobo lokuphazamiseka ku-carbohydrate metabolism:
- ukoma
- dysuria;
- isikhumba esikhanyayo;
- ukukhuluphala kwesisindo kanye nezinto.
Njengoba izimpawu zesifo sikashukela sokukhulelwa zingafani nhlobo, ukuhlolwa kwelabhoratri kuyisisekelo sokuthola lesi sifo. Futhi, owesimame uvame ukunikezwa ukuskena kwe-ultrasound, lapho unganquma khona izinga lokuntuleka kwe-placental futhi uthole i-pathology ye-fetus.
Ushukela wegazi kwabesifazane abakhulelwe kanye nokuxilongwa kwalesi sifo
Yiliphi izinga likashukela wegazi elamukelekayo ngesikhathi sokukhulelwa? Ijubane le-glucose akufanele lidlule ku-5.1 mmol / L, ngemuva kokudla kwasekuseni inkomba ingafinyelela ku-6.7 mmol / L.
Futhi kufanele abe ngamaphesenti amangaki i-hemoglobin? Imvamisa yale nkomba ingafika ku-5.8%.
Kepha uzithola kanjani lezi zinkomba? Ukuthola ukuthi ngabe ushukela awudluli yini ngesikhathi sokukhulelwa, kwenziwa ama-diagnostic akhethekile, kufaka phakathi ukudlula okujwayelekile komchamo nokuhlolwa kwegazi ushukela, i-acetone, isivivinyo sokubekezelela ushukela kanye nokuthola izinga le-hemoglobin ye-glycated.
Futhi, ukutholakala kwesifo sikashukela sokukhulelwa kwenziwa ngemuva kokuhlolwa okujwayelekile, okufana negazi biochemistry ne-OAC. Ngokwezinkomba, usiko lomchamo we-bacteriological, ukuhlolwa komchamo ngokusho kweNechiporenko kungabekwa. Futhi qhubeka ngokubonisana nodokotela, i-endocrinologist, udokotela wamehlo kanye nodokotela wamehlo.
Isibonakaliso sokuqala sikashukela ngesikhathi sokukhulelwa yi-glycemia ephezulu (kusuka ku-5.1 mmol / l). Uma amazinga kashukela wegazi edlulwa, khona-ke izindlela ezisezingeni lokucwaninga zisetshenziswa ukusiza ukuthola isifo sikashukela ngesikhathi sokukhulelwa.
Kuyaphawuleka ukuthi uma i-hemoglobin ye-glycated inyuswa, khona-ke lokhu kusho ukuthi ukwanda kokuhlushwa kwe-glucose kwakungekhona kanyekanye. Ngakho-ke, i-hyperglycemia ivezwa ngezikhathi ezithile ezinsukwini ezingama-90 ezedlule.
Kepha ushukela ovele umchamo ungatholakala kuphela lapho ukufundwa koshukela okuvela ku-8 mmol / l. Le nkomba ibizwa ngokuthi umbundu we-renal.
Kodwa-ke, izidumbu ze-ketone ezinomchamo zingatholakala ngaphandle kweglucose yegazi. Yize kukhona ukuba khona kwe-acetone kumchamo akuyona inkomba eqondile yokuthi owesifazane utholakala enesifo sikashukela esikude. Ngemuva kwakho konke, ama-ketones angatholakala nge:
- i-toxicosis;
- isifiso sokudla;
- ukungondleki;
- AbakwaSARS nezinye izifo ezihambisana nokushisa;
- i-preeclampsia ene-edema.
Ngokuphathelene nephrofayili ye-glycemic, umnyombo walolu cwaningo ukukala ushukela wegazi emandleni ngaphezu kwamahora angama-24 ngezikhathi ezahlukahlukene, ngaphambi nangemva kokudla. Umgomo ukuthola iziqongo ze-glycemia, ezizosiza ekwelapheni i-hyperglycemia engapheli.
Luyini uvivinyo lokubekezelela ushukela? Le ndlela ikuvumela ukuthi uthole ukungasebenzi kahle okufihliwe emzimbeni we-carbohydrate metabolism. Kuhle ukukhumbula ukuthi ukulungiselela okungafanele kwesifundo kungathinta imiphumela yako. Ngakho-ke, ngakusasa kufanele udle kahle, ngaphandle kokucindezela okungokomzwelo nangokomzimba.
Ukuze uthole isifo sikashukela sokukhulelwa, uzodinga ukubonana nodokotela wamehlo ozohlola i-fundus.
Ngempela, ngokuphazamiseka kwe-endocrine, izinkinga ezinjenge-retinopathy yesifo sikashukela zivame ukuvela.
Iyini ingozi yesifo enganeni?
Bonke abesifazane abakhulelwe abanoshukela omningi bayazibuza: yini ubungozi besifo sikashukela sokukhulelwa kwengane? Imvamisa lesi sifo asisiyongo empilweni kamama, futhi inkambo yaso ayiyithinti ikakhulukazi impilo yakhe. Kepha ukubuyekezwa kodokotela bathi uma kungekho makhambi, ukwelashwa kwabasebenzi kuvame ukwenzeka ngezinkinga zokubelethisa nezokubeletha.
Kumfazi okhulelwe ophethwe yisifo sikashukela sokukhulelwa, kuvela i-microcirculation kwezicubu. Nge-spasm yemikhumbi emincane, i-endothelium ilimele, i-lipid peroxidation icushiwe, futhi i-DIC iyathuthuka. Lokhu kubangela izingqinamba njengokukhula kokungakwazi kahle kwe-placental nge-hypoxia elandelayo ye-fetus.
Umphumela ongemuhle wesifo sikashukela enganeni futhi ulele ekukhuleni kokudla kwe-glucose kusibeletho. Ngemuva kwakho konke, i-pancreas yakhe okwamanje ayikakwazi ukukhiqiza i-insulin ngesilinganiso esifanele, futhi i-hormone eyenziwe emzimbeni womama ayinakungena emvimbelweni wokubeletha.
I-glucose yegazi engalawulwa ifaka isandla ekusebenzeni kabi kwe-metabolic kanye ne-discirculatory. Futhi i-hyperglycemia yesibili ibangela ushintsho olusebenzayo nolwakhekile kuma-membranes weseli, iphinde ithuthukise i-hypoxia yezicubu zezingane.
Futhi, izinga eliphezulu likashukela ezinganeni lubangela i-hypertrophy yamaseli we-beta wamanyikwe. Ngenxa yalokhu, ngemuva kokuzalwa, ingane ingahle ibone ukungasebenzi kahle kakhulu kwe-carbohydrate metabolism kanye nokungasebenzi kahle okusongela impilo yosana olusanda kuzalwa.
Uma i-mestitus yesifo sikashukela esingelashwa ingaphathwa ku-trimester yesithathu yokukhulelwa, ingane iye yakhula nge-macrosomia ene-hepato- ne-splenomegaly. Ngisho nangemva kokuzalwa, ezinye izingane zinokungazinzi kwezitho nezinqubo ezahlukahlukene.
Imiphumela emqoka yesifo sikashukela sokukhulelwa yilezi:
- ukuncipha kwengane;
- i-hypoxia ye-fetus enokubuyiselwa emuva kokukhula kwe-intrauterine;
- ingozi enkulu yokufa ebuntwaneni;
- ukuzalwa ngaphambi kwesikhathi;
- ukutheleleka njalo kwamapheshana okuchama ngesikhathi sokukhulelwa;
- i-preeclampsia, i-eclampsia, ne-preeclampsia kwabesifazane;
- i-macrosomia kanye nomonakalo kumsele wokubeletha;
- izilonda fungal ze-mucosa zangasese.
Futhi, izinkinga ezinzima zesifo sikashukela ngesikhathi sokukhulelwa zifaka phakathi ukukhipha isisu okwenzeka ezigabeni zokuqala. Kodwa-ke, kaningi izimbangela zokuphuphuma kwesisu zilele ekuwohlokeni kwesifo sikashukela, esingatholakalanga ngesikhathi.
Ngisho noma kungekho ukwelashwa kokuphazamiseka kwe-endocrine ngesikhathi sokukhulelwa, isifo sikashukela sokukhulelwa ngemuva kokubeletha singaphenduka ushukela ojwayelekile.
Le ndlela yesifo idinga ukwelashwa okude, futhi mhlawumbe okuhlala isikhathi eside.
Ukwelashwa kanye nokuzalwa kwengane
Uma owesifazane okhulelwe enesifo sikashukela, ukwelashwa kwenziwa kanye ne-endocrinologist kanye ne-gynecologist. Kulokhu, isiguli kufanele sikwazi ukuzimela ngokuzimela ukulawula i-glycemia nangemva kokudla.
Ukuze ukuzalwa kwengane nesifo sikashukela sokukhulelwa siphumelele, isiguli sinqunyelwe ukudla okukhethekile. Lapho ibhekwa, kubalulekile ukuthi udle ukudla ngezingxenyana ezincane, ungadli ukudla okunamafutha futhi okuthosiwe, futhi ungadli ukudla okungenamsoco okubandakanya nokudla okusheshayo. Lapho uthwala ingane, imikhiqizo ekhulisa ukungatheleleki futhi igcwala umzimba ngamavithamini, amaminerali kanye ne-fiber (izithelo, okusanhlamvu okugcwele, okusanhlamvu okuhlukahlukene, imifino) kuzoba wusizo.
Kepha uma imiphumela ngemuva kokudla ibingabalulekile ekulweni ne-hyperglycemia, khona-ke isiguli sinqunyelwe i-insulin therapy. I-insulin ye-GDM isetshenziswa kwe-Ultra-iDemo kanye nokuthatha isikhathi esifushane.
Kuyadingeka ukujova i-insulin kaninginingi, unikezwe ukudla kwe-caloric kokudla kanye ne-glycemia. Imithamo nemiyalo yokuthi ungawujova kanjani umuthi kufanele icaciswe yi-endocrinologist.
Kuhle ukukhumbula ukuthi abesifazane abakhulelwe abanesifo sikashukela abavunyelwe ukuthatha amaphilisi anciphisa ushukela. Ngezinye izikhathi ukwelashwa okulekelelayo kungenziwa, lapho:
- amavithamini;
- Izithuthukisi ze-microcirculation;
- I-Chophytol;
- izidakamizwa ezivimbela ukuthuthukiswa kokungatholakali kwe-placental.
Ngokwezibalo, isifo sikashukela sokukhulelwa ngemuva kokuzalwa kwengane emaphesheni angama-80% siya sodwa futhi lapho owesifazana ephuma esibhedlela sokubelethisa, isimo sakhe siba mathupha kuye. Kepha inqubo yokubukeka kwengane ingaba yinkimbinkimbi.
Ngakho-ke, imvamisa ingane esanda kuzalwa inesisindo esiningi. Ngakho-ke, ezimweni eziningi, le nkinga ixazululwa yisigaba se-cesarean, ngoba uma owesifazane ebeletha ingane yedwa, amahlombe akhe angalimala.
Ukubeletha kwengane ngesikhathi sikashukela i-mellitus ecaleni lokwelashwa kwalesi sifo ngesikhathi sokukhulelwa nokuhlolwa njalo kwezokwelapha kuyaphumelela. Kepha imvamisa izinga likashukela wegazi ezinganeni ezisanda kuzalwa akuyona into ejwayelekile. Ukuze lesi simo sidlule, kwanele ukusincelisa noma ukuxuba okukhethekile.
Ukuvimbela i-mellitus yesifo sikashukela sokuthambisa umzimba ukuthobela imigomo yokudla okunempilo, ukuvivinya umzimba njalo nge-octopus kanye nokujwayelekile kokulala nokuphumula. Futhi, labo asebevele benesifo sikashukela sokukhulelwa ngesikhathi sokukhulelwa kwangaphambilini badinga isikhathi esithe xaxa sokuqapha ukugcwala kwe-glucose egazini, balandele ukudla okune-carb ephansi futhi bahlele konke ukukhulelwa okulandelayo.
Imininingwane yesifo sikashukela sokukhulelwa inikezwe kuvidiyo ekulesi sihloko.
