Ukukhulelwa kwabesifazane abane-metabolism ye-glucose engasebenzi kahle kudinga ukubhekwa njalo kwezokwelapha, ngoba ngenxa kashukela wegazi omkhulu enganeni, ama-pathologies amaningi kungenzeka, kwesinye isikhathi angahambelani nokuphila. I-fetopathy ye-fetus ifaka ukungahambi kahle ekwenziweni kwezitho zomzimba, izifo ezenziwa yisibeleko, ukunyuka kwesibeletho esibelethweni futhi ngokushesha nje emva kokuzalwa, ukuzalwa ngaphambi kwesikhathi kanye nokuhlukumezeka phakathi kwabo, ngenxa yesisindo ngokweqile kwengane.
Imbangela ye-fetopathy ingaba uhlobo lwe-1 sikashukela, isifo sikashukela sokuthambisa, ushintsho lokuqala kumetabolism - ukubekezelela glucose okhubazekile, futhi kucatshangelwa umkhuba wokuvuselelwa kabusha kwalesi sifo kanye nohlobo 2 sikashukela. Eminyakeni eyikhulu edlule, amantombazane anesifo sikashukela awazange nje aphile iminyaka evundile. Futhi yize kuqale amalungiselelo e-insulin, munye kuphela kwabesifazane abangamashumi amabili ongakhulelwa futhi aphumelele ukuba nomntwana, ngenxa yengozi enkulu, odokotela baphikelela ekuhushuleni isisu. Isifo sikashukela mellitus empeleni saphuca owesifazane ithuba lokuba ngumama. Manje, sibonga umuthi wanamuhla, amathuba okuba nengane enempilo enxeshezelwe ngokwanele ngalesi sifo cishe angama-97%.
Kuyini isifo sikashukela?
I-fetopathy yesifo sikashukela ifaka phakathi i-pathologies eyenzeka esibelethweni ngenxa ye-hyperglycemia ehlala njalo noma ngezikhathi ezithile kumama. Lapho ukwelashwa kwesifo sikashukela kunganele, kungajwayelekile noma kungabikho, ukuphazamiseka kwengqondo kokukhula kwengane kuqala kusukela ku-1st trimester. Umphumela wokukhulelwa uncike kancane esikhathini sesifo sikashukela. Izinga lesinxephezelo salo, ukulungiswa okufika ngesikhathi kokwelashwa, kucatshangelwa izinguquko ze-hormonal kanye ne-metabolic ngesikhathi sokukhulelwa, kubalulekile.
Amaqhinga okulashwa afanele ngesikhathi sokukhulelwa, akhiqizwa ngudokotela onekhono, akuvumela ukuthi uzuze ushukela wegazi ojwayelekile ojwayelekile - okujwayelekile ushukela wegazi. I-fetopathy yesifo sikashukela enganeni kuleli cala ayikho ngokuphelele noma ibhekwa ngesilinganiso esincane. Uma kungekho ukungalungi okukhulu kwe-intrauterine, ukwelashwa okufika ngesikhathi ngokushesha nje ngemuva kokuzalwa kungalungisa ukuthuthukiswa kwamaphaphu okunganele, kuqede i-hypoglycemia. Imvamisa, ukuphazamiseka ezinganeni ezinamazinga aphansi wesifo sikashukela kususwa ukuphela kwesikhathi se-neonatal (inyanga yokuqala yokuphila).
Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule
- Ukwehlela ushukela -95%
- Ukuqedwa kwe-vein thrombosis - 70%
- Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
- Ukuqeda umfutho wegazi ophakeme - 92%
- Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%
Uma i-hyperglycemia ivame ukwenzeka ngesikhathi sokukhulelwa, izikhathi zokwenza ushukela omncane nge-ketoacidosis, osanda kuzalwa angathola:
- isisindo esandisiwe
- izinkinga zokuphefumula
- ukwanda kwezitho zangaphakathi,
- Izinkinga zamathambo
- ukuphazamiseka kwe-metabolism yamafutha,
- ukungabikho noma ukukhula okungaphansi komhubhe we-vertebrae, ithambo lomsila, amathambo amathanga, izinso,
- inhliziyo nezinhlelo zokuchama
- ukwephula ukwakheka kohlelo lwezinzwa, ama-cerebral hemispheres.
Kwabesifazane abane-mellitus yesifo sikashukela engakhokhwanga ngesikhathi sokuthinta komzimba, i-gestosis ebukhali iyabonakala, ukuqubuka okubukhali kwezinkinga, ikakhulukazi i-nephropathy ne-retinopathy, ukutheleleka kwezinso okuvame kakhulu kanye nomsele wokubeletha, ukushayisana kwe-hypertensive kanye nemivimbo kungenzeka kakhulu.
I-hyperglycemia ivame ukwenzeka kaningi, iba yingozi enkulu yokukhipha isisu - amahlandla ama-4 uma iqhathaniswa nesilinganiso ezigabeni zokuqala. Imvamisa, umsebenzi wokubeletha uqala, 10% ingozi enkulu yokuba nengane efile.
Izimbangela eziphambili
Uma kunoshukela omningi egazini likamama, kuzobuye kubonwe ku-fetus, ngoba ushukela ungena kwi-placenta. Ungena ngokuqhubekayo enganeni ngenani elingaphezu kwezidingo zakhe zamandla. Kanye noshukela, ama-amino acid kanye nemizimba ye-ketone ingena ngaphakathi. Ama-pancreatic mahormone (insulin neglucagon) egazini le-fetus alidluliswanga. Baqala ukukhiqizwa emzimbeni wengane kusuka emavikini angama-9 kuya ku-12 abakhulelwe. Ngakho-ke, izinyanga zokuqala ezintathu ukubekwa kwezitho nokukhula kwazo kwenzeka ezimeni ezinzima: Amaprotheni kashukela we-glucose, ama-radicals mahhala aphazamisa ukwakheka kwawo, ama-ketones anobuthi okwakha umzimba. Kungalesi sikhathi lapho kwakhiwa khona amaphutha enhliziyo, amathambo nobuchopho.
Lapho fetus iqala ukukhiqiza i-insulin yayo, i-pancreas yayo iba yi-hypertrophied, ukukhuluphala kuyavela ngenxa ye-insulin ngokweqile, kanti ne-lecithin synthesis iyalimala.
| Imbangela ye-fetopathy kushukela | Umphumela ongemuhle kosanda kuzalwa |
| I-Hyperglycemia | Ama-molecule we-glucose akwazi ukubopha amaprotheni, aphazamisa ukusebenza kwawo. Amazinga kashukela aphezulu emithanjeni yegazi aphazamisa ukukhula kwawo okujwayelekile nezinqubo zokuvimbela ukuvimba. |
| Ama-radicals wamahhala okweqile | Kuyingozi ikakhulukazi lapho ubeka izitho nezinhlelo ze-fetus - ngamanani amakhulu ama-radicals mahhala angashintsha ukwakheka okujwayelekile kwezicubu. |
| I-Hyperinsulinemia ihambisana nokudla okuthe xaxa kwe-glucose | Ukwanda kwesisindo somntwana osanda kuzalwa, ukukhula okuthe xaxa ngenxa yamahomoni ngokweqile, ukukhuphuka kwevolumu yezitho zomzimba, naphezu kokungasebenzi kwawo kokuqina. |
| Izinguquko ku-lipid synthesis | I-Neonatal stress syndrome - ukwehluleka kokuphefumula ngenxa yokunamathela kwe-alveoli yamaphaphu. Kwenzeka ngenxa yokuntuleka kwe-surgonant - into elawula amaphaphu kusuka ngaphakathi. |
| I-ketoacidosis | Imiphumela ebuhlungu kwezicubu, i-hypertrophy yesibindi nezinso. |
| I-Hypoglycemia ngenxa yokusebenzisa izidakamizwa ngokweqile | Ukudla okwanele kwezakhamzimba ku-fetus. |
| I-Angiopathy kaMama | I-Fetal hypoxia, ushintsho ekwakhekeni kwegazi - ukwanda kwenani lamangqamuzana abomvu egazi. Ibambezele ukuthuthuka ngenxa yokuntuleka kwenhliziyo. |
Izimpawu nezimpawu ze-fetopathy
I-fetopathy yesifo sikashukela ezinganeni ezisanda kuzalwa ibonakala kahle ngokubona, izingane ezinjalo zihluke kakhulu ezinsaneni ezinempilo. Mikhulu: i-4,5-5 kg noma ngaphezulu, inamafutha akhiqizwayo angaphansi, isisu esikhulu, esivame ukuvuvukala, enobuso obunjengobuso benyanga obukhethekile, intamo emfushane. I-placenta nayo i-hypertrophied. Amahlombe wengane abanzi kakhulu kunekhanda, izinyawo zibonakala zimfushane ngokuqhathaniswa nomzimba. Isikhumba sibomvu, sinephunga eliluhlaza okotshani, izikhwehlela ezincane ezinjengomunyu zivame ukubonwa. Okusanda kuzalwa kuvame ukuba nokukhula ngokweqile kwezinwele, kuhlanganiswa kakhulu ngamafutha.
Izimpawu ezilandelayo zingavela ngqo ngemuva kokuzalwa:
- Ukuphazamiseka kokuphefumula ngenxa yokuthi amaphaphu awakwazi ukuqondisa. Ngemuva kwalokho, ukuboshwa ngokuphefumula, ukufupheka, ukuphefumula kaningi kungenzeka.
- I-jaundice entsha, njengophawu lwesifo sesibindi. Ngokungafani ne-jaundice yomzimba, ayidlulisi ngokwayo, kepha idinga ukwelashwa.
- Ezimweni ezibucayi, ukwakhiwa ngaphansi kwemilenze, ukusakazeka okhalweni nasezinyaweni, ukufakwa kwamaphethelo aphansi, ukwakheka okungajwayelekile kwezitho zangasese, ukuncipha kwevolumu yenhloko ngenxa yokwakhiwa kwengqondo kungabonakali.
Ngenxa yokuqothuka okusheshayo kokudla ushukela kanye ne-insulin ethe xaxa, umntwana osanda kuzalwa uba ne-hypoglycemia. Ingane iyashintsha ibe mnyama, ithoni yakhe yemisipha inciphe, bese kuqala ukukhuphuka, izinga lokushisa nokucindezela kwehle, ukuboshwa kwenhliziyo okungenzeka.
Izindlela zokuxilonga ezidingekayo
Ukuxilongwa kwe-fetopathy yesifo sikashukela kwenziwa ngesikhathi sokukhulelwa ngesisekelo sedatha kuma-hyperglycemia womama kanye nokuba khona kwesifo sikashukela mellitus. Izinguquko ze-pathological ku-fetus ziqinisekiswa yi-ultrasound.
Kwi-trimester yokuqala, i-ultrasound iveze i-macrosomia (ukuphakama okwandisiwe kanye nesisindo sengane), ukulinganiselwa komzimba, usayizi omkhulu wesibindi, uketshezi olwedlulele lwe-amniotic. Kwi-trimester yesi-2, i-ultrasound ingadalula iziphambeko ohlelweni lwezinzwa, izicubu zamathambo, izitho zokugaya kanye nomchamo, inhliziyo nemithambo yegazi. Ngemuva kwamasonto angama-30 ekhulelwe, i-ultrasound ikwazi ukubona izicubu ezinamafutha kanye namafutha ngokweqile enganeni.
Owesifazane okhulelwe onesifo sikashukela unqunyelwa nenombolo yezifundo ezengeziwe:
- Iphrofayli ye-Biophysical ye-fetus Kungumsebenzi womntwana, ukuhamba kwakhe kokuphefumula kanye nenhliziyo. Nge-fetopathy, ingane isebenza kakhulu, izikhathi zokulala zimfushane kunokujwayelekile, akukho ngaphezu kwemizuzu engama-50. Ukuwohloka okuhlala njalo nokuqhubeka isikhathi eside kokushaya kwenhliziyo kungenzeka.
- I-Dopplerometry oqokwe emavikini angama-30 ukuhlola ukusebenza kwenhliziyo, isimo semithambo ye-fetus, ukwanele kokuphuma kwegazi entambo ye-umbilical.
- I-CTG yesibeletho ukuhlola ubukhona nokushaya kwenhliziyo isikhathi eside, thola i-hypoxia.
- Ukuhlolwa kwegazi ukuqala ngamathathu ama-trimesters njalo emavikini ama-2 ukuthola iprofayili ye-hormonal yowesifazane okhulelwe.
Ukuxilongwa kwe-diopleitis yesifo sikashukela kosanda kuzalwa kwenziwa ngesisekelo sokuhlolwa kokubukeka kwengane nedatha evela ekuhlolweni kwegazi: inani elikhulayo kanye nenani lamangqamuzana abomvu egazi, izinga elikhulayo le-hemoglobin, ukwehla koshukela kuya ku-2.2 mmol / L kanye namahora angama-2-6 ngemuva kokuzalwa.
Ungayelapha kanjani i-fetopathy yesifo sikashukela
Ukuzalwa kwengane ene-fetopathy kowesifazane onesifo sikashukela kudinga ukunakekelwa okukhethekile. Kuqala ngesikhathi sokubeletha. Ngenxa yesibeletho esikhulu nengozi enkulu ye-preeclampia, ukuzala okujwayelekile kuvame ukunqunywa emavikini angama-37. Izikhathi zangaphambilini zingenzeka kuphela ezimweni lapho ukukhulelwa okuthe xaxa kusongela impilo kamama, ngoba izinga lokusinda kwengane engaphambi kokubeletha ine-diabetic fetopathy liphansi kakhulu.
Ngenxa yamathuba aphezulu we-hypoglycemia kamama ngesikhathi sokubeletha, amazinga eglucose egazini aqashwa njalo. Ushukela ophansi ulungiswa ngesikhathi ngokuphathwa kwe-intravenous kwekhambi le-glucose.
Esikhathini sokuqala ngemuva kokuzalwa kwengane, ukwelashwa nge-fetopathy kuqukethe ukulungiswa kweziphazamiso okungenzeka:
- Ukugcina amazinga evamile eglucose. Ukondliwa okuvama ukubekwa njalo emahoreni ama-2, mhlawumbe ngobisi lwebele. Uma lokhu akwanele ukuqeda i-hypoglycemia, isisombululo se-glucose esingu-10% siphathwa kahle izingxenye ezincane. Izinga lakhe legazi eliqondisiwe licishe libe ngu-3 mmol / L. Akudingeki ukwanda okukhulu, ngoba kuyadingeka ukuthi ama-pancreas we-hypertrophied ayeke ukukhiqiza i-insulin ngokweqile.
- Ukuphefumula ukwesekwa. Ukusekela ukuphefumula, kusetshenziswa izindlela ezahlukahlukene zokwelapha i-oksijini, kungenzeka ukuphatha amalungiselelo okulungiselela.
- Ukulandelela izinga lokushisa. Ukushisa komzimba kwengane ene-diabetesicopopathy kugcinwa njalo emazingeni angama-36,5 -37,5 degrees.
- Ukulungiswa kwemali esele ye-electrolyte. Ukuntuleka kwe-magnesium kunxephezelwa yisisombululo se-25% se-magnesium sulfate, ukuntuleka kwe-calcium - 10% solution ye-calcium gluconate.
- Isibani se-Ultraviolet. Ukwelashwa kwe-jaundice kuqukethe izikhathi zemisebe ye-ultraviolet.
Yimiphi imiphumela
Ezinganeni ezisanda kuzalwa ezinesifo sikashukela sikashukela esikwazile ukugwema ukungasebenzi kahle, izimpawu zesifo ziwohloka kancane kancane. Ngezinyanga ezingama-2-3, ingane enjalo kunzima ukuyihlukanisa kusuka enempilo. Akunakwenzeka ukuthi athuthukise enye i-mellitus yesifo sikashukela futhi kungenxa izici zofuzokunokuba khona kwe-fetopathy ebuntwaneni.
Izingane ezizalwe omama abanesifo sikashukela zivame ukuba nomkhuba wokukhuluphala kanye ne-lipid metabolism. Lapho befika eminyakeni engu-8, isisindo somzimba wabo sivame ukuba ngaphezulu kwesilinganiso, amazinga abo egazi e-triglycerides ne-cholesterol ayaphakanyiswa.
Ukungasebenzi kobuchopho kubonwa kumaphesenti ama-30 wezingane, izinguquko ezinhlizweni nasemithanjeni yegazi - ngesigamu, ukulimala ohlelweni lwezinzwa - ku-25%.
Imvamisa lezi zinguquko azincane, kepha ngesinxephezelo esibi sesifo sikashukela ngesikhathi sokukhulelwa, kutholakala iziphambeko ezinkulu ezidinga ukungenelela okuphindaphindekile kokuhlinzwa kanye nokwelashwa okujwayelekile.
Ukuvimbela
Udinga ukulungiselela ukukhulelwa unesifo sikashukela izinyanga eziyisithupha ngaphambi kokukhulelwa. Ngalesi sikhathi, kuyadingeka ukuthola isinxephezelo esizinzile sesi sifo, ukwelapha yonke i-foci engapheli yesifo. Umaki wokulungela ukuzala ingane izinga elijwayelekile le-hemoglobin ye-glycated. I-Normoglycemia ngaphambi kokukhulelwa, ngesikhathi sokukhulelwa nangesikhathi sokubeletha iyimfuneko yokuzalwa kwengane enempilo kumama onesifo sikashukela.
Ushukela wegazi ulinganiswa njalo emahoreni ama-3-4, i-hyper- ne-hypoglycemia imiswa ngokuphuthumayo. Ukutholwa okufika ngesikhathi kwe-fetopathy yesifo sikashukela enganeni, kuyadingeka ukubhalisa emtholampilo wezinyanga ezinsukwini zokuqala, kwenziwe zonke izifundo ezibekiwe.
Ngesikhathi sokukhulelwa, owesifazane kufanele avakashele njalo hhayi kuphela i-gynecologist, kodwa futhi ne-endocrinologist ukulungisa umthamo wezidakamizwa.
