Ngenxa yezinguquko ze-hormonal, ukukhulelwa kungukuhlasela okuvame kakhulu kokungalingani ekusebenzeni kwe-glucose kwabesifazane. Ukudala ukumelana ne-insulin, kuholela ekuthuthukisweni kwesifo sikashukela sokukhulelwa (GDM) kubantu besifazane abangama-12.
Ukuthuthuka ngemuva kwamasonto ayi-16, isifo sikashukela sokukhulelwa, okuthi imiphumela yaso empilweni yezingane noma ebukweni ibe yingozi kakhulu, kubangela imiphumela emibi nokufa.
Yini isifo sikashukela esiyingozi esiyingozi ngesikhathi sokukhulelwa?
Ukungalingani ohlelweni lokunxephezela lwe-carbohydrate metabolism kuholela ekuthuthukisweni kwe-GDM. Le pathology iqala ngesikhathi sokukhulelwa futhi ekuqaleni i-asymptomatic, izibonakalise ezimweni eziningi esevele ikwesithathu trimester.
Cishe isigamu sabesifazane abakhulelwe, i-GDM kamuva iba nesifo sikashukela sohlobo II lwangempela. Ngokuya ngezinga lesinxephezelo se-GDM, imiphumela ibonakaliswa ngezindlela ezihlukile.
Usongo olukhulu kakhulu uhlobo olungafakwanga lwalesi sifo. Uyaziveza:
- ukuthuthukiswa kokukhubazeka ku-fetus okubangelwa ukushoda kwe-glucose. Ukungalingani kokudla kwe-carbohydrate metabolism kumama ngesikhathi sokukhulelwa kokuqala, lapho i-pancreas ingakaqali ukwakheka ku-fetus, kubangela ukuntuleka kwamangqamuzana, okuholela ekwakhekeni kwezimpawu nesisindo esiphansi. I-Polyhydramnios iyisibonakaliso esiyingqayizivele sokudla okunganele kwe-glucose, okuvumela ukuthi le pathology isolwe;
- isifo sikashukela sikashukela - indlela ekhula ngenxa yesifo sikashukela esibelethweni futhi ibonakala ngokungalingani kwe-metabolic ne-endocrine, izilonda ze-polysystemic;
- ukuntuleka kokukhiqizwa kwe-survilant, okubangela ukuphazamiseka kohlelo lokuphefumula;
- ukuthuthukiswa kwe-hypoglycemia yangemva kokubeletha, ukuvusa ukuphazamiseka kwemizwa nengqondo.
I-Fetal Diabetesic Fetopathy
I-pathology ebizwa ngokuthi yi-diabetesic fetopathy (DF) iba ngumthelela wethonya likashukela womama ekukhuleni kwengane.
Kubonakala ngokungasebenzi kwezitho zangaphakathi zengane - imithambo yegazi, amanyikwe, izinso, uhlelo lokuphefumula, okubangela i-neonatal hypoxia, hypoglycemia, ukwehluleka kwenhliziyo okuqhamile, ukukhula kwesifo sikashukela sohlobo II nokunye ubunzima obukhulu enganeni, kufaka phakathi nokufa.
I-Macrosomy
I-Intrauterine hypertrophy (macrosomia) yisibonakaliso esivame kakhulu se-DF. I-Macrosomia iba ngumphumela wokuqalwa koshukela ovela kumama ngokusebenzisa i-placenta ungene esibelethweni.
Ushukela owedlulele ngaphansi kwesenzo se-insulin ekhiqizwa ama-pancreas we-fetus aguqulwa abe ngamafutha, okwenza ukuthi afakwe ezithweni futhi isisindo somzimba wengane sizokhula ngesivinini esikhulu - ngaphezu kwama-4 kg.
Ukungalingani komzimba kuwuphawu lwangaphandle lwezingane ezine-macrosomia. Banomzimba omkhulu ngokungahlukani nenhloko nezinyawo, isisu esikhulu namahlombe, isikhumba esibomvu, esiluhlaza, simbozwe umqubuko we-petechial, i-lubricant efana noshizi noboya ezindlebeni.
Lapho kutholwa i-macrosomia, ukwenza ukuzalwa kwemvelo akunconywa ngenxa yezinga eliphakeme lowehlakalo. Ngaphezu kwalokho, ukuba khona kwayo kukhulisa ubungozi be-encephalopathy, okuholela ekuthuthukisweni kokubuyiselwa kwengqondo noma ukufa.
Jaundice
Izimpawu ezisetshenziswayo ze-DF ezinganeni ezisanda kuzalwa zifaka ne-jaundice, ekhonjiswa ngokuphuzi kwesikhumba, iso sclera, nokungasebenzi kwesibindi.
Ngokungafani ne-jaundice yokuzivocavoca kwezingane ezisanda kuzalwa, enezimpawu ezifanayo futhi ezedlula ngokwayo ngemuva kwesonto, ukubonakala kwe-jaundice ezinganeni ezine-diopicathy yesifo sikashukela kudinga ukwelashwa okuyinkimbinkimbi, ngoba kubonisa ukukhula kwe-pathologies yesibindi.
I-Hypoglycemia
Ukuqedwa kwe-glucose kusuka kumama kuye kumntwana ngemuva kokuzalwa kwakhe ngemuva kokukhushulwa kwe-insulin okwenziwa yi-pancreas yakhe kuholela ekukhuleni kwe-neonatal hypoglycemia kosanda kuzalwa - olunye uphawu lwe-DF.I-Hypoglycemia ikhulisa ukuthuthukiswa kokulimazeka kwezinzwa ezinganeni, kuthinta ukukhula kwabo kwengqondo.
Ukugwema i-hypoglycemia kanye nemiphumela yako - ukweqiwa, ukukhohlisa, ukulimala komqondo - kusukela ngesikhathi sokuzalwa kwezinsana ezisanda kuzalwa, isimo sezinga likashukela sithathwa ngaphansi kokulawulwa, uma siwa, ingane ihlaselwa ngeglucose.
Izinga eliphansi le-calcium ne-magnesium esegazini
Ukwehla okuphezulu kweshukela ngesikhathi sokukhulelwa kubangela ukungalingani kumetabolism yamaminerali, okubangela i-hypocalcemia ne-hypomagnesemia kosanda kuzalwa.
Ukwehla kwesilinganiso samazinga e-calcium egazi kuye ku-1.7 mmol / L noma ngaphansi enganeni kubonwa ezinsukwini ezingama-2-3 ngemuva kokuzalwa.
Lesi simo sizibonakalisa nge-hyper-excitability - ingane esanda kuzalwa ihlikihla izingalo zayo, ikhala ngokubabaza, ine-tachycardia ne-tonic decrease. Izimpawu ezinjalo zenzeka osanda kuzalwa kanye ne-hypomagnesemia. Kukhula lapho ukuhlangana kwe-magnesium kufinyelela ezingeni elingaphansi kuka-0.6 mmol / L.
Ukuba khona kwesimo esinjalo kutholakala kusetshenziswa i-ECG kanye nokuhlolwa kwegazi. Ku-1/5 yezingane ezisanda kuzalwa eziye zaquleka ngenxa ye-neonatal hypomagnesemia noma i-hypocalcemia, ukuphazamiseka kwemizwa kuyabonakala. Ngokukhululeka kwabo, izingane zinqunyelwe i-IM, ukuphathwa kwezixazululo ze-magnesium-calcium.
Izinkinga zokuphefumula
Izingane ezine-DF kungenzeka kakhulu kunezinye ukuzwa i-intrauterine hypoxia engapheli.
Ngenxa yokwakheka okunganele kwe-pulmonary survilant, eqinisekisa ukwanda kwamaphaphu ezinganeni ezisanda kuzalwa ngokuphefumula kokuqala, zingaba nezinkinga zokuphefumula.
Ukubukeka kokuphefumula komoya, ukuboshwa kokuphefumula kushiwo.
Ukulethwa kwangaphambi kwesikhathi
I-GDM ingenye yezimbangela ezijwayelekile zezinsana ezibandayo, ukukhipha isisu ngokuzimela, noma ukuzalwa ngaphambi kwesikhathi.
Isibeletho esikhulu esithuthukile ngenxa ye-macrosomia singaphezu kwama-4 kg, ezimeni ezingama-24% sibangela ukuzalwa ngaphambi kwesikhathi, okuvame ukuholela ekwandeni kokuphefumula kokuphazamiseka kwengqondo ezinsaneni ezisanda kuzalwa ngokumelene nesizinda sokulibaziseka kokufika kwesikhathi emaphashini ohlelo olunethiwekhi.
Yini esongela ushukela okhulelwe?
I-GDM engakhokhisiwe ibanga i-toxosis enzima kwabesifazane abakhulelwe ku-trimester yesithathu. Izinkinga eziyingozi kakhulu kowesifazane ziyi-preeclampsia ne-eclampsia. Lapho besongelwa, owesifazane okhulelwe ungeniswa esibhedlela ukuze aqale kabusha futhi azalwe ngaphambi kwesikhathi.
Ukuqina kwesihlungu
Izinguquko emithanjeni yegazi ngenxa yokwephulwa kwe-carbohydrate metabolism ziyimbangela ye-gestosis.
Umfutho wegazi okhuphukile kanye ne-edema ukuvezwa kwayo okujwayelekile kuma-30-79% abesifazane. Kuhlanganiswe namanye ama-pathologies, kungadala imiphumela emibi. Isibonelo, ukuhlanganiswa kwe-gestosis ne-DF kuholela ekubukekeni kwe-uremia.
Ngaphezu kwalokho, ukuthuthukiswa kwe-gestosis kubangela ukulahleka kwamaprotheni emchameni, ukubukeka kwe-dropsy kokukhulelwa, i-nephropathy, i-eclampsia, kudala ingozi empilweni kamama.
Ukuthuthukiswa kwe-gestosis enzima kunomthelela ku:
- isifo sikashukela iminyaka engaphezu kwe-10;
- isifo sikashukela ngaphambi kokukhulelwa;
- ukutheleleka ngethamo lomchamo ngesikhathi sokukhulelwa.
Umfutho wegazi ophakeme
Abesifazane abahlushwa umfutho wegazi ophezulu bafakwa esigabeni abasengozini yokuthola i-GDM ngesikhathi sokukhulelwa.
Kwabesifazane abakhulelwe, izinhlobo ezi-2 zehypertension ziyahlukaniswa:
- ezingamahlalakhona - Kubonwa kowesifazane ngaphambi kokukhulelwa kwengane noma kuze kufike isonto lama-20 lokukhulelwa futhi kuyimbangela yezinkinga ezi-1-5% ngesikhathi sokukhulelwa;
- kwezokuxhumanaivele kuma-5-10% abesifazane abakhulelwe ngemuva kweviki lama-20 futhi ihlala ezinye izinyanga eziyi-1.5. ngemuva kokubeletha. I-Hypertension yenzeka kaningi ngokukhulelwa okuningi.
I-Preeclampsia
Ingxabano eyenzeka kuma-7% abesifazane abakhulelwe ngemuva kweviki lama-20, ikota yabo - esikhathini sokubeletha ngezinsuku ezi-4 zokuqala.
Ukuxilongwa ngokomtholampilo kumchamo. Uma ingalashwa, inyukela kwi-eclampsia (icala eli-1 kwabesifazane abangama-200), okuholela ekufeni.
Into esemqoka eku / ekwazisweni kwe-magnesium sulfate kanye nokulethwa kokuqala.
Ukuphuphuma kwesisu
Ubungozi bokungaziphathi kahle kwesifo sikashukela kuyanda ngezikhathi ezithile. Ukwanda kokuxinana kwegazi ngenxa yokushoda kwe-insulin kuholela ekuthuthukisweni kokungapheleli kwe-placental, ukubonakala kwe-thrombotic pathologies kanye nokuqedwa kokukhulelwa.
Ngabe i-GDM ikuthinta kanjani ukuzalwa kwengane?
Kwabesifazane abakhulelwe abane-diagnostic ye-GDM, isikhathi sokusebenza sinqunywa ngokuya ngobunzima besifo, izinga lesinxephezelo, nezinkinga zokubelethisa.
Imvamisa, ukubeletha kuthathwa emavikini angama-37- 38 uma umbungu unesisindo esingaphezu kuka-3.9 kg. Uma isisindo se-fetus singaphansi kwama-3.8 kg, ukukhulelwa kudluliselwa kumaviki angama-39- 40.
I-Ultrasound isetshenziswa ukuthola isisindo se-fetus kanye nokuhambisana kwayo nosayizi we-pelvis yowesifazane, amathuba okuzalwa kwemvelo.
Uma isimo sikamama nengane sivunyelwe, ukulethwa kwenziwa ngokwemvelo nge-anesthesia eyenziwe ngezigaba, isilinganiso sehora ngehora le-glycemic, ukwelashwa kwe-insulin, ukwelashwa kokungalingani kwe-placental, control ye-cardiotocographic.
Imiphumela yokugqugquzela kwabasebenzi ku-GDM
Ukuxilongwa kwe-GDM kumama kukhulisa amathuba ezinkinga ngesikhathi sokubeletha kwakhe kanye nengane.Ubungozi babo buba buncane kakhulu uma isigaba se-cesarean noma ukulethwa kwezitho zangasese sowesifazane senziwa emavikini angama-39.
Ukugqugquzelwa kwabasebenzi ngaphambi kwamasonto angama-39 kufanelekile kuphela lapho kukhona uphawu oluthile olukhombisa ukubonakala kwengozi yokuzalwa.
Kubo bobabili, ubungozi bezinkinga bukhulu kakhulu uma ukubeletha kuqale ngokungazenzisi emavikini angama-38- 39.
Ukwelashwa nokuvimbela izinkinga ngesikhathi sokukhulelwa
Ukuthi ukukhulelwa kuzokwenzeka kanjani kubantu besifazane abanesifo sikashukela kuya ngezinga labo lokuziqapha kanye nokulungiswa okuqhubekayo kwe-hyperglycemia. Uhlobo lokwelashwa luhambisana nezinkomba zomama ngamunye futhi ukhethwa ngokuhambisana nazo.
Ukulaliswa esibhedlela ngenhloso yokuhlolwa kunconywa ukuba kwenziwe izikhathi ezi-3 ngesikhathi sokukhulelwa:
- ku-trimester yokuqala uma kutholakala ukuthi kutholakala isifo;
- ngesonto lama-20 - ukulungisa uhlelo lokwelashwa ngokuya ngesimo sikamama kanye nesibeletho;
- ngomhla wama-36 ukulungiselela inqubo yokuzalwa bese ukhetha indlela enhle kakhulu yokulethwa kwabo.
Ngaphezu kokulawula amazinga kashukela kanye nokuncishiswa kokunxephezela, abesifazane abakhulelwe abane-GDM banqunyelwe nokudla okukhethekile nesethi yokuzivocavoca.
Ukuvimbela izinkinga ze-GDM kubandakanya:
- ukutholwa okufika ngesikhathi kwesifo sikashukela kanye nesimo se-prediabetes kanye nokulaliswa esibhedlela, okuvumela ukuthi kwenziwe ukuhlolwa futhi kulungiswe ukwelashwa;
- ukutholwa kusenesikhathi kwe-DF kusetshenziswa i-ultrasound;
- ukuqapha ngokucophelela nokulungiswa kwe-glucose kusuka ngosuku lokuqala lokutholwa kwesifo sikashukela;
- ukunamathela esimisweni sokuvakasha ku-gynecologist.
Amavidiyo ahlobene
Izici zobungozi kanye nengozi yesifo sikashukela sokukhulelwa kule vidiyo:
Phambilini, ukukhonjwa kwe-GDM kanye nokuziphatha okunekhono kokwelashwa okuphoqelekile phakathi nesikhathi sonke sokukhulelwa kuzoba yisisekelo sezinkinga kanye nemiphumela emincane kubo bobabili umama yena nengane yakhe.
