I-diabetes mellitus ibizwa ngokuthi i-endocrine pathology, enezimbangela eziningana zokuthuthuka futhi ibonakala ngokukhiqizwa okunganele kwe-insulin, ukwephulwa komphumela wayo kumaseli we-peripheral izicubu nezicubu, noma inhlanganisela efanayo yalezi zinto zombili. Kunezindlela eziningana zalesi sifo, kodwa zonke zinophawu olufanayo lomtholampilo - i-hyperglycemia (ushukela wegazi ophakeme).
Uma lesi sifo senzeka phakathi nesikhathi sokukhulelwa, sihambisana nokumelana ne-insulin futhi kwakheka engxenyeni yesibili yokukhulelwa, sikhuluma nge-gestationalabetes mellitus (GDM). Kodwa-ke, izinketho zokuthola i-pathology ezinsizeni zokuqala zokukhulelwa kungenzeka, khona-ke ochwepheshe bacabanga ngendlela yangaphambi kokutholwa kwalesi sifo, enzima kakhulu futhi inemiphumela emibi kakhulu kumama nengane.
Imiphumela yesifo sikashukela ngesikhathi sokukhulelwa, ukuphathwa kwabesifazane abane-endocrine pathology, kanye nomphumela we-hyperglycemia kwi-fetus kubhekwa esihlokweni.
Izinhlobo ze-pathology kwabesifazane abakhulelwe
Isifo sikashukela sokuthambekela, okungukuthi, esivele ngisho nangaphambi kokukhulelwa kwengane, sinokuhlukaniswa okulandelayo:
- ifomu lesifo elithobekile luhlobo oluzimele lwe-insulin (uhlobo 2), olwesekelwa ekudleni okune-carb ephansi futhi olungahambelani nama-pathologies emithambo yegazi;
- ukwehla okulinganiselayo - uhlobo lwesifo esincike ku-insulini noma olungatheni i-insulin (uhlobo 1, 2), olungiswa ngokwelashwa kwezidakamizwa, noma ngaphandle kwezinkinga zokuqala;
- uhlobo olunzima lwalesi sifo - i-pathology, ehambisana nokuphuma njalo koshukela wegazi ohlangothini olukhulu noluncane, ukuhlaselwa njalo kwesimo se-ketoacidotic;
- i-pathology yanoma yiluphi uhlobo, ehambisana nezinkinga ezinzima ezivela kwizixhobo ze-renal, ukuhlaziywa kwezibuko, ubuchopho, uhlelo lwezinzwa oluzungezile, imithambo yegazi nemithambo yegazi yabalingisi abahlukahlukene.
Isimo sezinhlobo ezahlukahlukene zesifo "esimnandi"
Isifo sikashukela i-mellitus nayo yabiwa:
- ukunxeshezelwa (ukuphathwa kangcono);
- okuncishisiwe (isithombe esicacile somtholampilo);
- ukubola (i-pathologies enzima, ukuhamba kaningi kwe-hypo- ne-hyperglycemia).
Isifo sikashukela sokutholwa komzimba sivame ukukhula kusukela ngeviki lama-20 lokukhulelwa, sivame ukutholakala nesifo sokuxilongwa elabhorethri. Abesifazane bahlobanisa ukuqala kwezimpawu zesifo (ukoma, ukuchama ngokweqile) nesikhundla sabo "esithandekayo", ngaphandle kokubanika ukubaluleka okukhulu.
Ushukela omningi uthinta kanjani umzimba womama
Kuwo wonke umuntu, kungaba ngowesifazane, owesilisa noma wengane, i-hyperglycemia engapheli ibhekwa njengesimo se-pathological. Ngenxa yokuthi inani elikhulu le-glucose lihlala ligazi, amaseli nezicubu zomzimba kuhlushwa ukuntuleka kwamandla. Kwethulwa izindlela zokunciphisana, kepha, ngokuhamba kwesikhathi, zandisa isimo.
Ushukela omningi uthinta kabi izindawo ezithile zomzimba wowesifazane (uma sikhuluma ngesikhathi sokukhulelwa). Izinqubo zokujikeleza kwegazi ziyashintsha, ngoba amangqamuzana egazi abomvu ayaqina, ukuqina kuyalimala. Imikhumbi ye-Peripheral kanye ne-coronary iba kancane, i-lumen yayo incishisiwe ngenxa yokuvalwa kwama-plaque atherosselotic.
I-Pathology ithinta imishini yokusebenza kwe-renal, ivuse ukuthuthukiswa kokungalingani, kanye nombono, ukunciphisa izinga layo lobukhulu. I-Hyperglycemia ibangela ukuvela kwesihenqo ngaphambi kwamehlo, ama-hemorrhages kanye nokwakheka kwama-micaneurysms e-retina. Ukuqhubekela phambili kwe-pathology kungaholela ngisho nasekungaboni. Ngokuphikisana nesizinda sesifo sikashukela sokuthinta umzimba, ushintsho olunjalo alwenzeki, kodwa uma owesifazane ehlupheka kwifomu lokuphamba, ukulungiswa kwesimo esiphuthumayo kuyadingeka.
Izibalo ezinoshukela ophakeme nazo zithinta inhliziyo yowesifazane. Ingozi yokuthola isifo senhliziyo i-coronary iyanda, ngoba imikhumbi ye-coronary nayo ingena ezilondeni ze-atherosulinotic. Uhlelo lwezinzwa oluphakathi nolubamba iqhaza lubandakanyeka kwinqubo ye-pathological. Ukuzwela kwesikhumba semikhawulo engezansi kuyashintsha:
- usizi ekuphumuleni;
- ukuntuleka kokuzwela kobuhlungu;
- umuzwa wokuhlwaya;
- ukwephulwa komqondo wokushisa;
- ukuntuleka kokuzwa kombono wokudlidliza noma, ngakolunye uhlangothi, ukweqisa kwaso.
Izinkinga ze- "sifo esiphundu" ziyizimo ezibucayi kakhulu, iningi lazo ezithathwa njengezingalungiseki
Ngaphezu kwalokho, isimo se-ketoacidotic kungenzeka kubantu besifazane abakhulelwe ngasikhathi esithile. Lokhu kuyinkimbinkimbi enkulu yesifo “esimnandi”, ebonakala ngamanani aphezulu kashukela egazini kanye nokuqongelela imizimba ye-ketone (acetone) egazini nomchamo.
Izinkinga zokukhulelwa ezinokwenzeka ngenxa yesifo sikashukela sokukhulelwa
Abesifazane abanesimo sokuthokomala salesi sifo bahlushwa yizinkinga eziningi ngesikhathi sokuzala kwengane kaningi kuneziguli ezinempilo. Imvamisa ye-preeclampsia, i-eclampsia, ukuvuvukala, kanye nomonakalo wezinto zokusebenza wezinso. Iphawuleka kakhulu ingozi yokutheleleka kohlelo lwe-urinal, ukuzalwa ngaphambi kwesikhathi.
Ukuvuvukala komzimba kungenye yezimpawu ezikhanyayo ze-gestosis sekwephuzile. I-Pathology iqala ngeqiniso lokuthi imilenze iyavuvukala, bese kuba khona ukuvuvukala kodonga lwesisu, imilenze engenhla, ubuso nezinye izitho zomzimba. Owesifazane kungenzeka angabi nezikhalazo, kepha uchwepheshe onolwazi uzobona ukwanda kwe-pathological kwesisindo somzimba esigulini.
Izimpawu ezingeziwe:
Izimbangela zeGlocose Ephezulu Yegazi Ngesikhathi Sokukhulelwa- uphawu olubalulekile luhlala kwiminwe yezindandatho;
- kunomuzwa wokuthi izicathulo ziye zaba zincane;
- ebusuku owesifazane uvuka kakhulu ukuya endlini encane;
- Ukucindezela ngomunwe endaweni engezansi yomlenze kushiya ukujula okujulile.
Ukulimala kwezinso kubonakaliswa ngokulandelayo:
- umfutho wegazi uyenyuka;
- ukudumba kwenzeka;
- amaprotheni ne-albhamuin avela ekuhlaziyeni komchamo.
Isimo somtholampilo singaba esikhanyayo noma singenamkhawulo, kanye nezinga lamaprotheni adalulwa emchanjeni. Ukuqhubeka kwesimo se-pathological kubonakaliswa ukwanda kobukhulu bezimpawu. Uma kuvela isimo esifanayo, ochwepheshe banquma ukulethwa okuphuthumayo. Lokhu kukuvumela ukuthi usindise impilo yengane nonina.
Enye inkinga evame ukwenzeka ngesifo sikashukela i-preeclampsia. Odokotela bacabanga ngokukhula kwayo lapho kuvela izimpawu ezilandelayo:
- i-cephalgia enzima;
- ukwehla okukhulu kwe-acuity ebonakalayo;
- izimpukane phambi kwamehlo;
- ubuhlungu emcabangweni wesisu;
- izikhathi zokuhlanza;
- ukungazi kahle.
Abesifazane bangahlupheka:
- kusuka emanzini aphezulu;
- ukuhlukunyezwa kwangaphambi kwesikhashana;
- i-atom yesibeletho;
- ukukhipha isisu okuzenzakalelayo;
- ukuzala.
Ukuqaphela izimpawu ezibalulekile kuyimfuneko yowesifazane okhulelwe
Umphumela we-hyperglycemia ku-fetus
Hhayi umzimba wowesifazane kuphela, kodwa nengane ine-hyperglycemia engapheli. Izingane ezizalwa omama abagulayo kungenzeka kaningi ukuthi zithinteke yizimo zempilo kunawo wonke umuntu. Uma owesifazane okhulelwe enesimo sangaphambi kokumiswa kwalesi sifo, ingane ingazalwa ine-kuzaliwa ngokuzalwa noma ukungahambi kahle. Ngokuphikisana nesizinda sohlobo lokugula lokuthinta, izingane zizalwa zinesisindo somzimba, okungezinye zezimpawu ze-fetusathy ye-fetus.
I-hyperglycemia engapheli yomama nayo iyingozi enganeni ngoba amancanyana ayo ngesikhathi sokukhula kwengane isetshenziselwa ukukhiqiza inani elikhulu le-insulin. Ngemuva kokuzalwa, umzimba wakhe uyaqhubeka nokusebenza ngendlela efanayo, okuholela ezimweni ezivame kakhulu ze-hypoglycemic. Izingane zibonakaliswa inani elikhulu le-bilirubin emzimbeni, elivezwa yi-jaundice ezinganeni ezisanda kuzalwa, kanye nokwehla kwenani lawo wonke amaseli egazi.
Enye inkinga engenzeka emzimbeni womntwana yi-syndrome yokuphefumula yokuphefumula. Amaphaphu engane awanayo i-surgonant eyanele - into ephazamisa inqubo yokunamathela kwe-alveoli ngesikhathi sokwenza imisebenzi yokuphefumula.
Ukuphathwa kowesifazane okhulelwe onesifo sikashukela
Uma isiguli sinesifo sikashukela sokukhulelwa ngaphambi kwesikhathi sokukhulelwa, umthetho olandelwayo wokuqapha lezi ziguli ugcizelela isidingo sokulaliswa esibhedlela abathathu.
- Isikhathi sokuqala ukuthi owesifazane angeniswe esibhedlela ngokushesha ngemuva kokuxhumana nodokotela wezifo zabesifazane mayelana nokubhalisa ukukhulelwa. Isiguli siyahlolwa, isimo sezinqubo ze-metabolic siyalungiswa, kukhethwe irejimeni yokwelashwa kwe-insulin.
- Ngokwesibili - emavikini angama-20. Inhloso yokungena esibhedlela ukulungiswa kwesimo, ukuqapha umama nengane ngamandla akhe, ukwenziwa kwezinyathelo ezizovimba ukwanda kwezinkinga ezahlukahlukene.
- Isikhathi sesithathu singamaviki angama-35- 36. Owesifazane okhulelwe ulungiswa ngokuzalwa kwengane.
Isimo sowesifazane kufanele sibhekwe njalo uchwepheshe ofanelekayo
Kunezinkomba eziphuthumayo zokuthi owesifazane angaya esibhedlela. Lokhu kufaka ukubonakala kwesithombe somtholampilo ocacile walesi sifo, isimo se-ketoacidotic, izinombolo ezibucayi ze-glycemic (phezulu naphansi), kanye nokukhula kwezinkinga ezingamahlalakhona.
Ukubeletha kwenzeka kanjani ebusweni besifo
Isikhathi sokulethwa sinqunywa ngawodwana. Odokotela bahlola ubulukhuni be-pathology, izinga likashukela egazini, ukuba khona kwezinkinga ezivela emzimbeni womama nengane. Qiniseka ukuthi ubheka izinkomba ezibalulekile, uhlola ukuvuthwa kwezakhi zomzimba wengane. Uma ukuqhubekela phambili kokulimala kwezinsizakusebenza kwezinso noma umbono kwenzeka, izithiyo ezibambelekayo zinquma ngokubeletha emavikini angama-37.
Ngokukhulelwa okujwayelekile, isisindo sengane esingama-3.9 kg siyisibonakaliso sokuzalwa kwayo ekuqaleni kwesigaba se-cesarean. Uma owesimame nengane bengakakulungeli ukuzalwa kwengane, futhi isisindo se-fetus singeqi ku-3.8 kg, ukukhulelwa kungalulwa kancane.
Iwadi yokubeletha
Inketho enhle ukubukeka kwengane ngokusebenzisa umsele wokuzalwa wemvelo, noma ngabe umama unesifo "esimnandi". Ukubeletha kwengane enesifo sikashukela sokukhulelwa kwenzeka ngokubheka njalo ushukela wegazi nemijovo ye-insulin yesikhathi esithile.
Uma umsele wokubeletha womuntu wesifazane okhulelwe ulungiselelwe, ukuzala kwengane kuqala ngesikhwebu sesinye i-amniotic. Ukusebenza ngempumelelo kuthathwa njengesibonakaliso ukuze inqubo yokubonakala kwengane yenzeke ngendlela yemvelo. Uma kunesidingo, ihhashi le-oxytocin liyabhalwa. Ikuvumela ukuvuselela izivumelwano zesibeletho.
Kubalulekile! Isifo sikashukela sisodwa asiyona inkomba yesigaba se-Caesarean.
Lapho kudingeka ngokushesha ukulethwa:
- isethulo esingalungile se-fetus;
- i-macrosomy;
- ukwephulwa kokuphefumula kwengane nokushaya kwenhliziyo;
- ukubulawa kwesifo esiyisisekelo.
Ingane esindayo iyisibonelo esibonakalayo esibonakalayo se-macrosomia ye-fetusUmzila KaKesareya Wesifo Sikashukela
Kusukela ngo-12 ekuseni, owesifazane akufanele adle amanzi nokudla. Ngemuva kwamahora angama-24 ngaphambi kokuhlinzwa, owesifazane okhulelwe ukhansele umjovo we-insulin isikhathi eside. Ekuseni kakhulu, i-glycemia ilinganiswa kusetshenziswa imichilo eqondile. Inqubo efanayo iphindwa njalo ngemizuzu engama-60.
Uma i-glucose esegazini idlula umkhawulo ka-6.1 mmol / l, owesifazana okhulelwe udluliselwa kudropi eqhubekayo we-insulin solution. Ukuqapha i-glycemia kwenziwa ngamandla amakhulu. Inqubo uqobo lokulethwa kokuhlinzwa ihlongozwa ukuthi yenziwe ekuseni.
Isikhathi se-postpartum
Ngemuva kokubeletha, udokotela ukhansela imijovo ye-insulin yowesifazane. Ngesikhathi sezinsuku ezimbalwa zokuqala, izinkomba zoshukela wegazi zigadiwe, ukuze kuthi, uma kunesidingo, kulungiswe ukuphazamiseka kwe-metabolic. Uma isiguli sine-gestationalabetes mellitus, ngokuzenzekelayo iba yisixhumanisi seqembu elisengozini sokuqalwa kohlobo lwesifo esizimele se-insulin, okusho ukuthi kufanele ibhaliswe kudokotela oqeqeshiwe we-endocrinologist.
Ngemuva kwezinyanga eziyi-1.5 nezingu-3 ngemuva kokubeletha, owesifazane kufanele abuye anikele ngegazi ukuhlola izibalo ze-glycemic. Uma umphumela wenza udokotela angabaze, kuvunyelwe ukuhlolwa okunomthwalo ushukela. Isiguli sinconywa ukulandela ukudla, ukuhola impilo esebenzayo, futhi uma ufisa ukukhulelwa futhi, yenza ukuhlolwa okugcwele komzimba futhi ulungiselele ngokucophelela ukukhulelwa nokuzala umntwana.
