Isifo sikashukela nokukhulelwa - indlela yokuzala ingane enempilo

I-diabetes mellitus ukuphazamiseka kwe-metabolic emzimbeni womuntu okuhambisana nokungapheleli kwe-pancreatic, sensitivity ye-insulin, noma umphumela ohlanganisiwe walezi zinto. Umbuzo wokuthi ngabe isifo sikashukela nokukhulelwa kungahlanganiswa yini kuxoxwa ngaso ngabaningi abadumile be-endocrinologists emhlabeni. Iningi labo liqinisekile ukuthi le miqondo emibili akufanele ihlanganiswe, kepha ukunqatshelwa akunakuthwala inkinga yokuzala ingane. Inketho enhle kakhulu yaqashelwa ukuqeqeshwa kwamantombazane agulayo kusukela ebusheni. Kukhona "nezikole zikashukela ezikude" ezikude.

Ukuhlukaniswa okujwayelekile

Lesi sifo singenzeka kubantu besifazane ngaphambi kokukhulelwa kwengane, futhi lolu hlobo lwe-pathology luzobizwa ngokuthi yi-pregestational. Uma "isifo sikashukela" savela ngesikhathi sokukhulelwa, khona-ke isifo sikashukela siyindlela yokuthambisa (ikhodi ye-ICD-10 - O24.4).

Ukwehlukahlukana kokuqala kwe-pathology ayilungele kahle udaba lwengane, ngoba umzimba wengane uthathwa ngokungenakulawulwa kakhulu kwe-glucose ngokweqile kusukela ngesikhathi sokukhulelwa. Lokhu kubangela ukukhula kwengcindezi ye-metabolic futhi kungavusa ukubukeka kokungafani kwemvelo nokulimala.

Inketho yesibili ithembeke ngokwengeziwe. Njengomthetho, isifo sikashukela i-mellitus ngesikhathi sokukhulelwa senzeka engxenyeni yayo yesibili, okusho ukuthi ngesikhathi sokubekwa kwezitho nezitho zesibeletho, kwakungekho miphumela emibi yamazinga kashukela aphezulu.

Indlela yokugula yesifo

Ngokuyahlukaniswa kwe-Dedov kusuka ngonyaka we-2006, isifo sikashukela esingajwayelekile kubantu besifazane abakhulelwe singaba ngalezi zindlela ezilandelayo.

Uhlobo oluncane lwesifo sikashukela sohlobo 2, esilungiswa ekudleni futhi olungahambisani nokuphazamiseka kwemithambo yegazi.

Ithebula lezinhlobo ze-insulin

Ifomu elijwayelekile yisifo sanoma yiluphi uhlobo, esidinga ukusetshenziswa kwezidakamizwa ezinciphisa ushukela, ngaphandle kwezinkinga noma ezihambisana nezigaba zazo zokuqala:

• i-retinopathy esigabeni esandayo (ukuphazamiseka kwe-trophism ye-retinal ye-analyzer ebonakalayo);
• i-nephropathy ngesimo se-microalbuminuria (i-pathology yemikhumbi yezinso ngenani elincane lamaprotheni emchameni);
• i-neuropathy (ukulimala kwama-nerve node namaseli).

Ifomu elinzima elinamaconsi esivamile kushukela nokubukeka kwe-ketoacidosis.

1 noma 2 uhlobo lwesifo olunezinkinga ezinzima:

• i-retinal trophic pathology;
• umsebenzi wemithambo ye-renal engasebenzi kahle, ebonakaliswa ukwehluleka kwezinso;
• unyawo lwesifo sikashukela;
• i-sclerosis of the coronary artery;
• i-neuropathy;
• ingozi ye-cerebrovascular;
• ukuvezwa kwemithambo yemilenze.

Kuya ngokuthi izindlela zokubuyisana zomzimba zibhekana kanjani nomsebenzi wokwehliswa ushukela wegazi, kunezigaba eziningana zesifo sikashukela se-pre-gestationalabetes mellitus. Ngayinye yazo inezinkomba zayo zelebhu ekhonjiswe etafuleni (ku-mmol / l).

Ifomu lokuphaka

Isifo sikashukela i-mellitus, esenzeka ngesikhathi sokukhulelwa, sihlukane futhi. Ngokuya ngokwendlela ongakwazi ngayo ukugcina izinkomba zobungako begluku egazini ngaphakathi kwemikhawulo ejwayelekile, isifo singakwazi ukwahlukanisa esincishiswa ngokudla futhi esilungiswa ngokwelashwa kokudla kanye nokusetshenziswa kwe-insulin.

Ngokwezinga lomsebenzi wezinqubo zokuncindezela, kunesigaba sokunxeshezelwa kanye nokubuyiswa kwemali.

Indlela yokuthuthukiswa kwesifo sikashukela kwabesifazane abakhulelwe

Uhlobo lwesifo "Esimnandi" luqhamuka ngemuva kwesizinda sezinguquko ezibhubhisayo kumaseli we-pancreas, abhekene nokuqalwa kwe-insulin. Leli fomu livela njengemiphumela emibi yezinto zangaphandle ngokubhekisele emuva esimweni sokuphangwa kwefa.

I-Hyperglycemia iyisisekelo sanoma yiluphi uhlobo lwesifo sikashukela, kufaka phakathi ukuthinta umzimba

Isifo sohlobo 2, esihambisana nokuphulwa kokuzwela kwamangqamuzana nezicubu zomzimba ukuya ku-insulin, siqala ngenxa yokungondleki kahle, impilo yokuhlala. Isifo sikashukela sokukhulelwa sabesifazane abakhulelwe sifana kakhulu nokwehluka kwesibili kwe-pathology ngendlela yayo yokukhula.

I-placenta, edingekayo ekusetshenzisweni kobudlelwano obuhlala njalo phakathi kukamama nengane ngesikhathi sokukhulelwa, ikhiqiza inani elikhulu lama-hormone. Iqiniso lokuthi i-adrenal glands yabesifazane iqala ukuhlanganisa inani elikhulu le-cortisol kanye nokukhishwa okusheshayo kwe-insulin okuvela emzimbeni ngomchamo (kusebenze i-insulinase kuyacasulwa) kuholela ekutheni amaseli nezicubu zomzimba ziba buthaka kakhulu ku-insulin. Amangqamuzana e-pancreatic awakwazi ukukhulisa inani elifanele lezinto ezisebenza ngama-hormone, okuholela ekukhuleni kweglucose yegazi nokukhula kwendlela yokutholwa kwalesi sifo.

Izimpawu ze-pathology

Umtholampilo wesifo sikashukela kowesifazane okhulelwe kuncike kulezi zinto ezilandelayo:

• uhlobo lwesifo;
• isigaba sesinxephezelo;
• ukuhluleka sekukhona isikhathi eside kangakanani;
• ukuthuthukiswa kwezinkinga;
• umlando wezokwelapha osetshenzisiwe

Izimpawu zesifo sikashukela sokukhulelwa ziyafana nesithombe somtholampilo sefomu lokuhlwaya

Esikhathini esiningi, ifomu lokuthinta alinakho ukubonakaliswa (isifo sikashukela esisetshenzisiwe) noma baswele. Izimpawu ezithile ze-Hyperglycemia kwesinye isikhathi ziyavela:

• ukoma okungapheli;
• ukukhipha ukuphuma komchamo;
• isifiso sokudla esikhulu phakathi kokudla okwanele emzimbeni;
• isikhumba esikhanyayo;
• imishayo efana furunculosis.

Izinkinga ezingaba khona

Ukukhulelwa ngesifo sikashukela sohlobo lwangaphambi kokumiswa kokubeletha kunikeza inani elikhulu lezinkinga ezivela kumama nengane, futhi ifomu lesifo eliya nge-insulin lihambisana nemibandela enjalo kaningi kunezinye izinhlobo zesifo. Imiphumela elandelayo ye-pathological ingahle ibe khona:

• isidingo sesigaba se-caesarean;
• izithelo ezinkulu ezingafinyeleli amazinga entuthuko;
• isisindo ngesikhathi sokuzalwa ngaphezu kwama-4.5-5 kg;
• Ukukhubazeka kwe-Erb - ukwephulwa kokungabikho kwamahlombe;
• ukuthuthukiswa kwe-preeclampia yobunzima obuhlukahlukene;
• Izinkinga nokungalungiseki kokuzalwa kwengane enganeni;
• ukuzalwa ngaphambi kwesikhathi;
• isifo sokuxineka kwengane;
• ukuqothuka kokukhulelwa;
• ukufa kwengane ngesikhathi sokuphila kwengane noma ngenyanga yokuqala emva kokuzalwa.

Amaqembu asengozini enkulu afaka iziguli ezinesifo sikashukela isikhathi esingaphezu kweminyaka eyi-10-12, ezinekufa ngaphambi kwesikhathi, kanye nalabo abanenkinga eyodwa noma ngaphezulu, kanye neziguli ezinokutheleleka kwe-urinary tract.

Izinkinga ngakwengane

Ngokuya ngasikhathi sokuthi ukukhula kwesifo sikashukela kwenzeka ngasikhathi esingakanani nokuthi imiphumela yeshukela ephezulu emzimbeni wengane iba nini, kunezindlela ezintathu eziyinhloko, ukuthuthukiswa kwesimo sengane.

Ukungasebenzi kahle

Ukuthuthukiswa kokulimala, ukungasebenzi kahle kokubeletha kanye nokuhlukunyezwa kuyinto ebonwa ezinganeni ezinomama abanesimo sikashukela sangaphambi kokubeletha. Ukuboniswa nezimpawu ze-pathology empeleni akuhlukile kunalezo ezingabonakala ezinganeni ziphuma komama ngaphandle kokuthi "isifo esimnandi":

• ukungabikho kwezinso noma zombili izinso;
• ukushiyeka kwenhliziyo;
• ukonakala kokuthuthukiswa kwentambo yomgogodla;
• ukushiyeka kwe-neural tube;
• ukuhlelwa okungafanele kwezitho zomzimba;
• i-pathology ye-septum yamakhala;
• ukuhlukaniswa kwezindebe nolwanga;
• ukungafani kusuka ohlelweni oluphambili lwezinzwa.

Ukungabikho kwezinso eyodwa kuhlukahluka kwe-pathology yomzimba wengane ngokumelene nesizinda sikashukela we-pregestive sikamama

Ukukhipha isisu okuzenzakalelayo

Kwabesifazane abanesifo sikashukela sangaphambi kokutholwa kokubeletha, amathuba okukhishwa kwezisu okuzenzakalelayo aphakeme kaningana. Lokhu akuhlotshaniswa nokuhlukumezeka kwezakhi zofuzo zesibeletho, okuvela kuzo ukuphuphuma kwesisu komama abanempilo, kepha ukungabinayo indawo kanye nokukhula kokungalungi kwengane okuvela kuyo, akuhambelani nempilo.

I-Macrosomy

Lesi yisimo se-pathological, esihambisana nokukhuphuka ngokweqile kwesisindo sengane ngesikhathi sokuzalwa (ngenhla kwe-4,5 kg kg). Ukuthuthukiswa kwe-macrosomia kuhambisana nesidingo sesigaba se-caesarean ngenxa yengozi enkulu yokuhlukumezeka kwengane nengane yokuzalwa kukamama.

Ukuhlelwa kokukhulelwa kwesifo sikashukela

Abesifazane abanesifo sokuxilongwa kwesifo sikashukela ngaphambi kokukhulelwa kwengane kufanele bazi ukuthi kubaluleke kangakanani ukuhlela ukukhulelwa kulesi simo futhi kubhekwe njalo uchwepheshe ofanelekayo.

Ukuhlela kufaka ukuhlolwa kanye nomlando wezokwelapha, kubandakanya amaphuzu alandelayo:

• ukuba khona kwezinkinga zesifo;
• ukucolisiswa kwesimo sikashukela;
• imininingwane yokuziqapha erekhodwe kudayari yomuntu siqu;
• ukuba khona kwezifo ezihlangene;
• umlando womndeni;
• ukuba khona kwe-pathologies yamafa.

Lezi zivivinyo ezilandelayo nazo zenziwa:

• isilinganiso somfutho wegazi, ukubonisana nodokotela wezinhliziyo;
• ukuhlolwa ngudokotela wezifo zamehlo, ukwelashwa kwezigaba zokuqala ze-retinopathy;
• ukuhlolwa kwesifo senhliziyo (i-ECG, i-echocardiography);
• i-biochemistry yegazi;
• ukucaciswa kwezinkomba zama-hormone egilo;
• ukuhlolwa kwempilo kwengqondo yesiguli.

Igazi inguluzi yemvelo esetshenziselwa izindlela eziningana zokuxilonga ngokumelene nesifo sikashukela

Ngaphezu kwalokho, kuyadingeka ukulahla imikhuba emibi uma ikhona, ukuhlolisiswa okuningilizayo kwaleyo mishanguzo ethathwa ngowesifazane ukuze kugwemeke umthelela omubi enganeni ezayo.

Contraindication

Kunemibandela yokuphikisana okuphelele noma okuhlobene nokuzala kwengane. Okuphelele kufaka phakathi:

• ukulimala kwezinso okunzima;
• Isifo senhliziyo se-Ischemic;
• I-pathology eqhubekayo yohlaziyo olubukwayo.

Isifo sikashukela nokukhulelwa - le nhlanganisela ayifaneleki (icatshangelwa) kulezi zimo ezilandelayo:

• iminyaka yowesifazane engaphezulu kweminyaka engama-40;
• ukuba khona kwesifo sikashukela kuyo yomibili imibhangqwana;
• isifo sikashukela i-mellitus kanye nokuzwela kukaRhesus;
• isifo sikashukela kanye nesifo sofuba esisebenzayo;
• ukuzalwa kwezingane ezinomlando wokungasebenzi kahle ngemuva kwesifo;
• i-ketoacidosis ku-trimester yokuqala yokukhulelwa;
• isifo sezinso esingamahlalakhona;
• izimo zokuphila ze-asocial.

Ukuxilongwa kwesifo sikashukela ngesikhathi sokukhulelwa

Udokotela we-gynecologist-endocrinologist uhlola umzimba womuntu wesifazane okhulelwe, ulinganisa ukujikeleza kwesisu, ukuphakama kwesikhwama se-uterine, ukuphakama nesisindo sowesifazane, nosayizi we-pelvis. Ukuhlolwa kwesisindo sesineke kuyinkomba ebalulekile yokuxilonga. Ngokusekelwe kwimiphumela owesifazane okhulelwe ayibonisa ekuhlolweni kokuqala, benza isheduli yokuthola isisindo esivumelekile ngezinyanga nangeviki.

Ukuxilongwa kwelabhorethri kuqukethe lezi zivivinyo ezilandelayo:

• ukuhlolwa okujwayelekile komtholampilo (igazi, umchamo, i-biochemistry);
• i-lipids yegazi ne-cholesterol;
• izinkomba zokubumbana;
• isiko lomchamo;
• umchamo ngokusho kweZimnitsky, ngokusho kukaNechiporenko;
• ukuzimisela kwezinga lamahomoni abesifazane;
• ukuzimisela kwe-acetone kumchamo;
• umchamo wansuku zonke we-albhamuinuria.

Enye yezindlela ezithile ezivumela ukunquma ukuba khona kwe-pathology kwabesifazane abakhulelwe kubhekwa njengokuhlolwa kokubekezelela kwe-glucose yomlomo. Kuqukethe igazi elisheshayo, ukuphuza i-hyperosmolar glucose egxiliwe kanye nesampula yegazi (ngemuva kwamahora 1, 2). Umphumela ukhombisa ukuzwela kwamangqamuzana nezicubu zomzimba.

Ukuhlolwa kokubekezelela i-glucose - esinye sezigaba zokuhlolwa okuphoqelekile kowesifazane okhulelwe

Ukuphathwa nokwelashwa kwesifo sikashukela ngesikhathi sokukhulelwa

Isidingo sokuqala yikhono lowesifazane lokuzihlola ngokwalo amazinga kashukela wegazi ngokuqoshwa kwedatha okulandelayo kwidayari yomuntu siqu. Ngesikhathi sokukhulelwa, izincomo zomtholampilo zibonisa isidingo sokubheka izinkomba izikhathi ezi-7 ngosuku. Kukhona nemichilo yokuhlola ukukala izinga lemizimba ye-ketone kumchamo. Lokhu kungenziwa ekhaya.

Imodi yamandla

Ukulungiswa kokudla nokuvuselelwa kwemenyu yomuntu siqu kukuvumela ukuthi ugcine amazinga kashukela engaphansi kwemingcele eyamukelekayo, ukuvimbela ukukhula kwe-ketoacidosis kanye nokuthola isisindo ngokweqile komuntu wesifazane. Ochwepheshe batusa ukunciphisa inani lama-carbohydrate asetshenziselwa ku-35% wokudla okuphelele kwansuku zonke. Cishe ama-25% kufanele adliwe ekudleni kwamaprotheni, ama-40% asele kufanele abe ngamafutha angenawo amandla.

Umsoco okhulelwe ungokulandelayo:

• ibhulakufesi - I-10% lemali yansuku zonke yamakhalori;
• isidlo sasemini - kuze kufike ku-30%;
• isidlo sakusihlwa - kuze kufike ku-30%;
• ukudla okulula phakathi kokudla okuyinhloko - kufinyelela kuma-30%.

Ukwelashwa kwe-insulin

Uma sikhuluma ngesimo sangaphambi kokumiswa kwalesi sifo, isigamu sokuqala sokukhulelwa esinohlobo 1 nohlobo 2 sikashukela siyefana ngesilinganiso esidingekayo se-insulin, kepha ngemuva kwesonto lama-24 isidingo sanda ngefomu lesifo elizimele le-insulin. Ngesikhathi sokukhulelwa, ukukhetha kunikezwa ku-Actrapid, Humulin R, Novorapid, Humalog.

Ukwelashwa kwe-insulin kanye nekhono lokulungisa ukudla - amandla okuvikela ingane nonina ezingxenyeni ezinkulu zezitho nezinhlelo zomzimba

Isidingo esikhulu sokwelashwa kwe-insulin sici sesikhathi kusuka esontweni lama-24 kuye kwele-30, ngemuva kokuncishiswa kakhulu. Abanye ochwepheshe bakhuluma ngamathuba okusebenzisa uhlelo lwamaphampu ekuphatheni izidakamizwa. Lokhu kusebenza kulabo besifazane abasebenzisa amaphampu ngaphambi kokukhulelwa kwengane.

Umsebenzi womzimba

Uhlobo lwesifo sikashukela esingancikileli kwe-insulin siyazwela kakhulu uma sivivinya umzimba. Kunezimo lapho umsebenzi owanele wowesifazane okhulelwe uvumela ukubuyisela ukuphathwa kwe-insulin. Isifo sohlobo 1 asizweli kangako ekucindezelekeni, futhi ukusebenza ngokweqile, kunalokho, kungadala ukuhlaselwa kwe-hypoglycemia.

Isidingo sokulaliswa esibhedlela

Lapho kunendlela yesifo sikashukela sangaphambi kokumiswa komzimba, owesifazane okhulelwe ungeniswa esibhedlela amahlandla amathathu:

1. Emavikini ama-8-10 - ukunquma umsebenzi weendlela zokubuyisana, ukucacisa ubukhona bezinkinga, ukuqeqesha owesifazana, ukuqhuba ukulungiswa kokudla nokwelashwa.
2. Emavikini angama-18-20 - ukunqunywa kwe-pathologies evela enganeni nakunina, ukuvimbela izinkinga, ukulungiswa kwezinqubo ze-metabolic.
3. Emavikini angama-35-36 - ukulethwa noma ukulungiselela ukuzalwa kwengane.

Ithemu nendlela yokulethwa

Isikhathi esifanele kunazo zonke sokuzalwa kwengane enanoma iluphi uhlobo lwalesi sifo ngamaviki angama-37. Kusukela ngesonto lama-36, izinkomba ezilandelayo zibhekwa nsuku zonke:

• ukuvusa ingane;
• ukulalela ukushaya kwenhliziyo;
• ukuhlolwa kokugeleza kwegazi.

Owesifazane angazizalela yena ngokwakhe uma kungenzeka wethule ikhanda le-fetus, ngosayizi ojwayelekile we-pelvis, uma kungekho zinkinga zesifo sikashukela. Ukuzalwa ngaphambi kwesikhathi kubalulekile kulezi zimo ezilandelayo:

• ukonakala kwenhlala-kahle yengane;
• ukonakala kwezinkomba zaselebhu kamama;
• ukuthuthukiswa kokuhluleka kwezinso;
• Ukwehla okukhulu kwe-visual acuity.

Isisu

Uhlobo loku-1 lwalesi sifo alunaziphikiso zokuncelisa ingane ibele, uma ingane uqobo ingenakho ukulimala kokubeletha noma izinkinga. Okuwukuphela kwendlela engathandeki ukwanda kokwehluleka kokwehluleka kwezinso komama.

Ukuncelisa ibele yisinyathelo esivunyelwe ekwakheni ubudlelwano obusondelene phakathi kukamama nengane ngemuva ngemuva kwesifo "esimnandi"

Uhlobo 2 lufuna ukwelashwa kwe-insulin kwangemva kokubeletha, ngoba izidakamizwa ezinamazinga kashukela aphansi zingathinta umzimba womntwana ngokufanayo. Ngemuva kokuqedwa kokondla kwemvelo, udinga ukuxhumana ne-endocrinologist ukuze ubuyekeze amaqhinga wokunye ukwelashwa.

Ukubuyekezwa Okukhulelwe