Uma kunokuntuleka kwe-insulin emzimbeni, kuvela isifo sikashukela.
Phambilini, lapho le mahomoni yayingasetshenziswa njengomuthi, abesifazane abanale ndlela yokuzivocavoca babengenalo ithuba lokuzala. Yi-5% kuphela yazo ekhulelwa, kanti ukushona kwe-fetus bekucishe kube ngama-60%!
Kulezi zinsuku, isifo sikashukela kwabesifazane abakhulelwe sesiphelile ukusongela, ngoba ukwelashwa kwe-insulin kuvumela abesifazane abaningi ukuba bazale futhi bazale ngaphandle kwezinkinga.
Izibalo
Inkinga yokukhulelwa eyinkimbinkimbi yesifo sikashukela i-mellitus (DM) ihlala igxilwe kakhulu ekunakekelweni kwama-endocrinologists kanye nabezokubelethisa, ngoba ihlotshaniswa nezinkinga ezivame kakhulu esikhathini se-perinatal futhi isongela impilo kamama nengane ezayo.
Ngokwezibalo, ezweni lethu uhlobo 1 no-2 sikashukela kutholakala ku-1-2% abesifazane abakhulelwe. Ngaphezu kwalokho, i-pregestational (1% yamacala) kanye nesifo sikashukela sokukhulelwa (noma i-GDM) ihlukile.
Isimo esiyingqayizivele sesifo sokugcina ukuthi sikhula kuphela esikhathini se-perinatal. I-GDM ihlanganisa kuze kube ngu-14% wokukhulelwa (umkhuba wezwe). E-Russia, lokhu kudalwa kwezifo kutholakala ku-1-5% yeziguli.
Isifo sikashukela sabesifazane abakhulelwe, njengoba kuvame ukubizwa ngokuthi i-GDM, sitholakala kwabesifazane abakhuluphele abanezakhi zofuzo ezingezinhle (izihlobo ezinesifo sikashukela esivamile). Ngokuqondene nesifo sikashukela kwabesifazane lapho bezalwa, le ndlela yokuxilonga imvelo ayivelakancane futhi ibalwa ngaphansi kwamacala ayi-1%.
Izizathu zokubukeka
Isizathu esiyinhloko inzuzo yesisindo kanye nokuqala koshintsho lwe-hormonal emzimbeni.
Amaseli wethishu kancane kancane alahlekelwa amandla abo okubamba i-insulin (iba lukhuni).
Ngenxa yalokhu, i-hormone etholakalayo ayisanele ngokwanele ukugcina inani leshukela elifanele egazini: yize i-insulin iqhubeka ukukhiqizwa, ayikwazi ukufeza imisebenzi yayo.
Ukukhulelwa ngesifo sikashukela esikhona
Abesifazane kufanele bazi ukuthi ngesikhathi sokukhulelwa bancishiswa ngokuphuza izidakamizwa ezinciphisa ushukela. Zonke iziguli zibekelwa i-insulin therapy.
Njengomthetho, ku-trimester yokuqala, isidingo saso sincishisiwe. Kwesibili - inyuka ngezikhathi ezi-2, kuthi kwesesithathu - yehle futhi. Ngalesi sikhathi, udinga ukulandela ngokuqinile ekudleni. Kuyinto engathandeki ukusebenzisa zonke izinhlobo ze-sweeteners.
Ngokwesifo sikashukela sokukhulelwa, kunconywa ukudla okunamafutha ngamaprotheni. Kubalulekile ukuthi ungadli ukudla okunamafutha amaningi: amasoseji kanye nesinqe, ubisi lwekhalori ephezulu. Ukwehlisa ukudla okune-carbohydrate ekudleni okukhulelwe kuzonciphisa ingozi yokuthola umntwana osanda kuzalwa.
Ukunciphisa amanani we-glycemic esikhathini se-perinatal ekuseni, kunconyelwa ukudla okungenani ama-carbohydrate. Kuyadingeka ukubheka njalo ukubalwa kwegazi. Yize i-hyperglycemia emnene ngesikhathi sokukhulelwa ibhekwa njengengozi, igwenywa kangcono.
Kwabesifazane abakhulelwe abanesifo sikashukela sohlobo 1, i-hypoglycemia nayo ingavela. Kulokhu, kuyadingeka ukuthi kuqashelwe njalo yi-endocrinologist kanye ne-gynecologist.
Lesi sifo sikuthinta kanjani ukuzalwa kwengane?
Ukugula ushukela kukhulisa ukukhulelwa. Ingozi yayo ukuthi i-glycemia ingavusa amandla: kusenesikhathi - ukungasebenzi kahle kwesibeletho kanye nokukhipha isisu okuzenzakalelayo, futhi ngokuhamba kwesikhathi - i-polyhydramnios, okuyingozi ngokubuyela ekubelethweni ngaphambi kwesikhathi.
Owesifazane unqunyelwa isifo sikashukela uma kuvela lezi zingozi ezilandelayo:
- amandla ezixakaxaka zezinso zezinso ne-retina;
- inhliziyo ischemia;
- ukuthuthukiswa kwe-gestosis (toxicosis) nezinye izinkinga zokukhulelwa.
Izinsana ezizalwa omama abanjalo zivame ukuba nesisindo esiningi: 4.5 kg. Lokhu kungenxa yokudla okuningana kwe-glucose kamama ku-placenta bese kungena egazini lengane.
Ngasikhathi sinye, amanyikwe ekhanda lengqondo ihlanganisa i-insulin futhi ikhuthaza ukukhula kwengane.
Ngesikhathi sokukhulelwa, ushukela uzibonakalisa ngezindlela ezihlukile:
- i-pathology attenuation iyingxenye ye-1st trimester: amanani eglucose wegazi ancishisiwe. Ukuvimbela i-hypoglycemia ngalesi sigaba, umthamo we-insulin uncishiswa okwesithathu;
- kusukela ngesonto le-13 lokukhulelwa, isifo sikashukela siyaqhubeka futhi. I-Hypoglycemia kungenzeka, ngakho-ke, umthamo we-insulin uyanda;
- emavikini angama-32 kuya phezulu kokuzalwa kwengane, kunokuthuthuka enkingeni yesifo sikashukela, i-glycemia kungenzeka, futhi umthamo we-insulin uphinde ukhuphuke okwesithathu;
- ngokushesha ngemuva kokubeletha, ushukela wegazi uyancipha kuqala, bese uyanda, ufinyelela izinkomba zawo zokubeletha ngosuku lwe-10.
Mayelana nezindlela ezinzima kangaka zesifo sikashukela, owesifazane ulaliswa esibhedlela.
Ukuxilonga
Isifo sikashukela sibhekwa njengasungulwa uma, ngokwemiphumela yokuhlolwa kwelebhu, amanani eglucose egazini (esiswini esingenalutho) ingu-7 mmol / l (kusuka emthanjeni) noma ngaphezulu kuka-6.1 mmol / l (kusuka ngomunwe).
Uma kusolwa isifo sikashukela, kuyahlolwa isivivinyo sokubekezelela ushukela.
Olunye uphawu olubalulekile lwesifo sikashukela ushukela umchamo, kodwa kuphela kuhlangene ne-hypoglycemia. Isifo sikashukela siphazamisa umzimba nama-carbohydrate metabolism emzimbeni, sivusa i-ketonemia. Uma izinga likashukela lizinzile futhi livamile, kubhekwa ukuthi ushukela unxephezelwe.
Izinkinga ezingaba khona
Isikhathi sokuphikisana nesizinda sikashukela sihambisana nezinkinga eziningi.
Okuvame kakhulu - ukukhipha isisu ngokuzenzakalelayo (15-30% yamacala) emavikini angama-20-27.
Ama-toxoses abambezelayo nawo ayenzeka, ahlotshaniswa ne-pathologies yezinso yesiguli (6%), ukutheleleka kwe-urinary tract (16%), i-polyhydramnios (22-30%) nezinye izinto. Imvamisa i-gestosis iba (35-70% yabesifazane).
Uma ukwehluleka kwezinso kufakwa kule ndlela, amathuba okuzala futhi anda kakhulu (20-45% wamacala). Engxenyeni yabesifazane ngokuzala polyhydramnios kungenzeka.
Ukukhulelwa kuphambene uma:
- kukhona i-microangiopathy;
- ukwelashwa kwe-insulin akuniki umphumela;
- bobabili abashadikazi banesifo sikashukela;
- inhlanganisela yesifo sikashukela nesifo sofuba;
- Esikhathini esedlule, abesifazane bebephindaphinda inzalo;
- isifo sikashukela sihlanganiswa nengxabano kaRhesus kumama nengane.
Njengoba kunesifo sikashukela esikhokhelwayo, ukukhulelwa nokuzala kuzalwa ngokuphepha. Uma i-pathology ingashabalali, umbuzo uphakama ngokulethwa ngaphambi kwesikhathi noma ngesigaba se-cesarean.
Njengoba sinesifo sikashukela komunye wabazali, ubungozi bokukhulisa le nkinga enzalweni yi-2-6%, kubo bobabili - kufinyelela kuma-20%. Zonke lezi zinkinga zenza kube nzima ukwanda kokuzala kwengane okujwayelekile. Isikhathi sangemva kokubeletha sivame ukuhlotshaniswa nezifo ezithathelanayo.
Izimiso zokwelashwa
Kubalulekile ukukhumbula ukuthi owesifazane onesifo sikashukela kufanele abonwe udokotela ngaphambi kokukhulelwa. Lesi sifo kufanele sinxephezelwe ngokuphelele ngenxa yokwelashwa okuhle kwe-insulin nokudla.
Ukudla kwesiguli kuhambisana ngqo ne-endocrinologist futhi kuqukethe okungenani imikhiqizo ye-carbohydrate, amafutha.
Inani lokudla kwamaprotheni kufanele longezwe kancane. Qinisekisa ukuthatha amavithamini A, C, D, B, amalungiselelo e-iodine ne-folic acid.
Kubalulekile ukuqapha inani lama-carbohydrate futhi uhlanganise kahle izidlo namalungiselelo e-insulin. Amaswidi ahlukahlukene, i-semolina ne-porridge yerayisi, ujusi wamagilebhisi kufanele ungafakwa ekudleni. Bukela isisindo sakho! Kuyo yonke inkathi yokukhulelwa, owesifazane akufanele athole ngaphezu kwama-10-11 kilogalamu.
Imikhiqizo Yesifo Sikashukela evunyelwe futhi Evinjelwe
Uma ukudla kwehluleka, isiguli sidluliselwa ekwelashweni kwe-insulin. Umthamo wemijovo nenombolo yazo kunqunywa futhi kulawulwa ngudokotela. Esikhathini sikashukela, ukwelashwa okuthobekile kukhonjiswa ngendlela yamakhambi. Abesifazane abakhulelwe banconyelwa imisebenzi emincane ngokomzimba ngendlela yokuhamba ngezinyawo.
Zonke lezi zinyathelo zisebenza kwabesifazane abanesifo sikashukela sohlobo 1. Isifo sikashukela sohlobo 2 nesifo sikashukela sokuthambisa asivamile kubantu besifazane abasebenza ngokuzalwa.
Ukulawulwa kokukhulelwa
Ukuze ulondoloze ukukhulelwa, kuyadingeka ukunxephezela ngokuphelele ushukela.
Njengoba isidingo se-insulin ngezikhathi ezihlukile zokuphefumula sehlukile, owesifazane okhulelwe udinga ukulaliswa esibhedlela okungenani kathathu:
- ngemuva kwesicelo sokuqala sokuthola usizo lodokotela;
- okwesibili ngesonto 20- 24. Ngalesi sikhathi, isidingo se-insulin sishintsha njalo;
- futhi emavikini angama-32-36, lapho i-toxicosis sekwephuzile ijoyina, okuyingozi enkulu ukukhula kwesibeletho. Ukulaliswa esibhedlela kuleli cala kungaxazululwa yisigaba se-Caesarean.
Ukukhulelwa kungenzeka uma ingane ikhula ngendlela evamile nangaphandle kwezinkinga.
Iningi lodokotela libheka ukulethwa kumaviki angama-35- 38 ngokufanele. Indlela yokulethwa iqondene nomuntu ngamunye. Isigaba seKhesariya ezigulini ezinesifo sikashukela senzeka ngamaphesenti angama-50 amacala. Ngaso leso sikhathi, ukwelashwa kwe-insulin akuyeki.
Izinsana ezizalwa omama abanjalo zibhekwa ngaphambi kwesikhathi. Badinga ukunakekelwa okukhethekile. Emahoreni okuqala empilo yengane, konke ukunakwa kodokotela kugxile ekuvinjelweni nasekulawulweni kwe-glycemia, acidosis, kanye nokutheleleka ngegciwane.
Amavidiyo ahlobene
Mayelana nokuthi ukukhulelwa nokubeletha kuhamba kanjani nesifo sikashukela, kuvidiyo:
Ukukhulelwa kungukuhlolwa okubaluleke kakhulu kowesifazane onesifo sikashukela. Ungathembela kumphumela ophumelelayo ngokubheka ngokucophelela zonke izincomo nemiyalo ye-endocrinologist.
