Ngisho nowesifazane ophile kahle akaqiniseki ukuthi ukukhulelwa kwakhe kuzoqhubeka ngaphandle kwenkinga eyodwa. Ngakho-ke, iziguli ezinesifo sikashukela i-mellitus futhi ezifuna ukuba nengane zisengozini enkulu kakhulu, ngoba ukungasebenzi kahle ohlelweni lwe-endocrine kuholela ku-fetopathy ye-fetus.
Isifo sikashukela sokugula kwesifo sikashukela yisifo esenzeka phambi kwesifo sikashukela kowesifazane osesimweni. Emzimbeni wakhe, kukhuphuka ngendlela ehlelekile ushukela wegazi.
Nge-fetopathy, isimo sezinguquko ze-fetus kanye nokungasebenzi kahle emsebenzini wezitho nezinhlelo zakhe kwenzeka. Lokhu kuthinta ukusebenza kwemikhumbi, izinso namanyikwe yingane.
Kwabesifazane abanesifo sikashukela, inkambo yokukhulelwa izoncika kuningi lezinto:
- uhlobo lwesifo;
- izici zokwelashwa;
- ukuba khona kwezinkinga.
Kepha ukuvama ukuthwala ingane ngezinga eliphakeme loshukela egazini kunzima kakhulu ukukubekezelela futhi lokhu kwenzeka ngaso sonke isikhathi. Ngakho-ke, imvamisa ukusindisa impilo yengane nonina, odokotela benza isigaba secesare.
Ngabe ukukhula kwesibeletho kukhula kanjani futhi iziphi izingozi ezinganeni ezisanda kuzalwa?
Isizathu esiyinhloko sokubonakala kwe-pathology yi-hyperglycemia, ngoba kwabesifazane abakhulelwe inkambo yesifo sikashukela ayingazinzi, okwenza kube nzima ukulawula isimo se-fetus kanye nonina.
Imvamisa lokhu kuholela ezinkingeni ngemithambo yegazi. Ngaphezu kwalokho, isifo sikashukela, njenge-fetopathy yesibeletho sesimo esithathelwanayo, singabonakala uma isiguli sanda ngokwanda ushukela wegazi ngaphambi kokukhulelwa, noma lapho i-hyperglycemia yathuthuka ngesikhathi sokukhulelwa.
I-embryofetopathy yesifo sikashukela inale ndlela elandelayo yokuvela: ushukela omningi ungena esibelethweni nge-placenta, ngenxa yokuthi amanyikwe aqala ukukhiqiza i-insulin ngobuningi. Ukweqisa ushukela ngaphansi kwethonya le-hormone iba ngamafutha, ngakho-ke umbungu ukhula ngemodi eshesha ngesibonakaliso samafutha angaphansi.
Ku-gestationalabetes mellitus, lapho ipancreas ingakhiqizi isamba esidingekayo se-insulin, ukuwohloka kwenzeka cishe amasonto angama-20 wokukhulelwa. Kulesi sigaba, i-placenta isebenza ngokuzikhandla, ekhulisa ukukhiqizwa kwe-chorionic gonadotropin. I-Contrinsular hormone yehlisa ukuzwela kwezicubu ukungena ku-insulin futhi yenza izinguquko ze-glycemic zisebenze.
Izici ezikhulisa amathuba okukhula kwe-fetopathy zibandakanya:
- isifo sikashukela sokukhulelwa, esedlule;
- iminyaka engaphezu kwengu-25;
- isisindo se-fetus (kusuka ku-4 kg);
- isisindo ngokweqile;
- ukuthola isisindo ngokushesha ngesikhathi sokukhulelwa (kusuka kuma-20 kg).
Konke lokhu kunomthelela ongemuhle emzimbeni wengane. Ngemuva kwakho konke, i-glucose ingena egazini le-fetus, futhi ngaphambi kwesonto le-12 lokukhulelwa, i-pancreas yayo ayikwazi ukukhiqiza i-insulin yayo.
Ngemuva kwalokho i-hyperplasia yokubuyiselwa kwamaseli we-organ ingaqhamuka, okuholela ku-hyperinsulinemia. Lokhu kudala ukwehla okukhulu kokuxinwa ushukela, ukukhula okungajwayelekile kwesibeletho nezinye izinkinga.
Izingozi ezingaba khona ezinganeni ezisanda kuzalwa:
- ukuqhubeka kwe-polyneuro-, retino-, nephro- ne-angiopathy.
- i-gestosis enzima;
- ukubola okukhulu kwesifo esiholayo, lapho i-hyperglycemia ingena khona kwi-hypoglycemia;
- i-polyhydramnios eqapheleke ku-75% yamacala;
- ukuvela kokubeletha kanye nokulimala kwengane (10-12%);
- ukukhipha isisu ngokungacabangi ekuqaleni kokukhulelwa (20-30%).
Ngokunganeleki kwe-placental nezinkinga ngemikhumbi, kwakheka i-intrauterine hypoxia. Uma isifo sikashukela sanda ukwanda okungalawulwa kahle kwengcindezi yegazi, khona-ke amathuba okuba ne-eclampsia ne-preeclampsia ayanda.
Ngenxa yokukhuluphala kwengane, ukuzalwa ngaphambi kwesikhathi kungaqala, okuphawulwe ngamacala angama-24%.
Isithombe somtholampilo se-fetopathy kushukela
Uphawu oluphambili lwalesi simo ukubukeka kwengane: isikhumba sakhe sivuvukile, sinephunga elibomvu eliluhlaza okwesibhakabhaka, libukeka njengomphunga we-petechial (subcutaneous pinpoint hemorrhage) futhi kunesisindo esimanzi. Ngaphezu kwalokho, isisindo somzimba wosanda kuzalwa cishe singamakhilogremu amane kuya kwayisithupha, izimbotshana zaso ziyafushane, ibhande lamahlombe libanzi, futhi ngenxa yamafutha angaphezulu ngokweqile, isibungu esikhulu siyaphuma.
Ngenxa yokungafani kahle kwe-surgonant emaphashini, ukuphefumula kwengane kuyaphazamiseka. Ngakho-ke, ukufushane komoya noma ngisho nokuboshwa kokuphefumula kuphawulwa emahoreni ambalwa okuqala ngemuva kokuzalwa.
Futhi, izimpawu ze-fetopathy yesifo sikashukela ukuphazamiseka kwemizwa, okubandakanya:
- ukweqisa, ukushintshana nge-hyper-excitability (ukuzamazama komhlaba, ukulala okuphezulu, ukukhathazeka);
- i-Reflex yokuncela abampofu;
- buthaka ithoni yemisipha.
Olunye uphawu olukhona lokuvezwa kwezingane ngukuqothuka kwamehlo kwe-sclera yamehlo nesikhumba. Kodwa-ke, lesi simo singadidaniswa ne-physical jaundice, eyenzeka lapho kuthathelwa indawo amaprotheni amaseli egazi aqukethe i-iron ne-hemoglobin kubantu abadala.
Ngama-jaundice omzimba ezinganeni eziphilile, i-sclera yeso nesikhumba nazo ziphenduka ziphuzi, kepha ngemuva kwesonto izimpawu uqobo lwazo ziyanyamalala.
Futhi ezinganeni ezisanda kuzalwa ezinesifo sokusha kwesifo sikashukela, i-jaundice ikhombisa ukwenzeka kwezinqubo ze-pathological esibindini, esidinga ukwelashwa okukhethekile.
Ukuxilonga
Ngokuvamile, ukuthola ama-pathologies esibelethweni, i-ultrasound isetshenziselwa ukubona ngeso lengqondo inqubo yokukhula kwe-intrauterine. Kwi-trimester yokuqala, ucwaningo lwenziwa kanye, okwesibili emavikini angama-24- 28. Ngalesi sikhathi, ungathola ukuthi ngabe kukhona yini amaphutha ekwakhekeni kwezinhlelo zenhliziyo, zezemizwa, zokugaya ukudla, zamasosha omzimba kanye nezokuzala.
Kwi-trimester yesithathu, indlela yokuxilongwa kwe-ultrasound yenziwa izikhathi ezi-2-3. Uma isiguli sinendlela yokuthola isifo sikashukela esincike ku-insulin, khona-ke isifundo senziwa emavikini angama-30 ukuya kwele-30, bese kuthi kube njalo njalo ezinsukwini eziyi-7.
Nge-embryofetopathy, iskena se-ultrasound singakhombisa:
- ukushintshwa kwendawo echonegative kugebhezi, okubonisa ukuvuvukala;
- ukungalingani komzimba;
- ukuphindeka kabili kwekhanda;
- i-polyhydramnios;
- i-contour engabili yomntwana;
- macrosomia.
Ukuhlolwa kwesimo se-biophysical sengane esibelethweni kuyenziwa futhi. Lokhu kukuvumela ukuba ubone ukwehluleka ekukhuleni kwengqondo kwe-morphofunctional, okuthathwa njengophawu oluyingozi kakhulu lwe-embryopathy. Ukubona ubunzima, ukunyakaza, ukushaya kwenhliziyo nokuphefumula kwengane kuqoshwa amahora angama-1.5.
Uma kukhona i-fetopathy yesifo sikashukela, khona-ke ingane isebenza kakhulu, futhi ubuthongo bayo bufushane (kufika imizuzu engama-50). Ngaphezu kwalokho, ngesikhathi sokuphumula, ukuqoshwa okuvela njalo nokuhlala isikhathi eside kuyaqoshwa.
Noma nge-GDM, i-dopplerometry iyenziwa, lapho izinkomba ezinjengalezi zihlolwa:
- inani lokukhishwa kwenhliziyo;
- isilinganiso sokuqothuka kwe-myocardial;
- ukuzimisela kwenkomba yokumelana nokugeleza kwegazi ku-artery ye-umbilical kanye nobudlelwano bayo be-diastolic ne-systolic;
- ukusungulwa kwesikhathi sokuxoshwa kwe-ventricle yesinxele yenhliziyo.
I-Dopplerometry yenziwa ngesonto 30, ngenxa yokuthi isimo senqubo yezinzwa esemaphakathi sinqunywa. Ngakho-ke, inqubo ingafaniswa nokuhlolwa okugxile okuncane kwe-ultrasound.
I-Cardiotocography ngokuhlolwa kokuhlolwa kokusebenza okukuvumela ukulandela izinga lokushaya kwenhliziyo kunoma yiziphi izimo. Ngesikhathi sokuhlolwa kwe-KGT kwenziwa lapho udokotela athatha amasampula amaningana.
Njengoba unesifo sikashukela kwabesifazane abakhulelwe, kuyadingeka ukubona ukuthi ngabe zikhona yini izimpawu ze-FPN (ukungenelela kokubeletha). Lokhu kwenziwa ngokusebenzisa umchamo nokuhlolwa kwegazi. Izinkomba zamamaki we-biochemical wohlelo lwe-fetoplacental angaba ngale ndlela elandelayo: α-fetoprotein, oxytocin, progesterone ne-lactogen ye-placental.
Ubunzima be-fetopathy bunqunywa izinga le-AFP. Kulesi simo, ukuqina kwamaprotheni kungaphezu kokujwayelekile, okubonakalayo ku-trimester yesithathu yokukhulelwa.
Ngokufanelekile, nge-hyperglycemia, iphrofayili ye-hormonal iyanconywa ukuthi ihlolwe njalo ezinsukwini eziyi-14, kusukela enyangeni yesithathu yokukhulelwa.
Ukwelashwa nokuvimbela
Ukuvimbela ukwenzeka kwe-hypoglycemia nokukhula kwezinkinga ezalandela, isisombululo se-glucose (5%) sithunyelwa enganeni ngemuva kokuzalwa. Ngasikhathi sinye, njalo emahoreni ama-2 udinga ukunikezwa ubisi lukamama, okungeke kuvume ukuthi isimo sithuthuke.
Isikhathi sobuntu sihambisana nokubhekwa kwezokwelashwa, lapho udokotela eqapha ukuphefumula kosana olusanda kuzalwa. Uma kuphakama izinkinga, khona-ke isiguli sixhunywe kwi-ventilator.
Uma kukhona ukuphazamiseka kwemizwa, khona-ke amakhambi e-magnesium ne-calcium ayalawulwa. Ngokuhlukumezeka kwesibindi, okubonakaliswa yellowness yesikhumba, amaseshini emisebe ye-ultraviolet ayenziwa.
Ngemuva kokubeletha owesifazane, inani le-insulin lincishiswa ngento ka-2-3. Lokhu kungenxa yokuthi izinga leshukela egazini ngalesi sikhathi lehla kakhulu. Kepha ngokuqhubeka kwesikhathi, izinkomba ze-glycemic zibuyela kokujwayelekile.
Ukuvimbela isifo sikashukela sohlobo 2 kanye nokuthathwa kwesibeletho kwabesifazane abakhulelwe kubandakanya ukutholwa okufika ngesikhathi nokwelashwa okulandelayo kweshukela. Kubalulekile futhi ukuqapha njalo futhi, uma kunesidingo, ukwenza ushintsho ekugxilisweni kweglucose.
Ukuhlolwa kwe-ultrasound kufanele futhi kwenziwe ngesikhathi, okuzokuvumela ukuthi ubone noma yikuphi ukuphazamiseka kokuthuthuka ekuqaleni kwesigaba. Enye imfuneko yokuvimbela izinkinga ukuvakasha ngokuhlelekile ku-gynecologist.
Le vidiyo ekulesi sihloko izokhuluma ngokuzalwa ngempumelelo lapho kunesifo sikashukela.
