Naluphi na ukubonakaliswa kwentlungu kunye nokukhupha ngexesha lokukhulelwa kufuna ukunakekelwa kwangoko kunyango. Oku kungaba ngumqondiso wokuqala kokusweleka kwesisu. Umbuzo wokuqala wowesifazane osukele ngongqingili ngexesha lokukhulelwa nguye omele akwenze? Impendulo - musa ukukwesaba ngaphambi kwexesha! Ukuba konke kwenziwe ngokuchanekileyo, ukukhulelwa kwesisu kungaphephelwa, emva koko kubelethe umntwana onempilo.
Ukutshatyalaliswa komtshato kuyinkxalabo yokukhulelwa kunye nokwenqatshwa kwe-fetus ngexesha lokungaphaya komntwana ngaphandle kwesibeleko. Ukwahlukana phakathi kokutshatyalaliswa kwesisu nokuzalwa kwangaphambi kokulula kunokulula: emva kokubeleka umntwana angasindiswa, njengoko amalungu akhe ayasebenza kwaye aphuhliswe, emva kokuphuphuma kwesisu - ukusinda komntwana akunakwenzeka. Ndiyabulela kwimpumelelo yamachiza anamhlanje, ukukwazi ukugcina ubomi ngaphandle kwesibeleko sikamama, nangona kubantwana abancinci kakhulu, kuye kwandiswa ngokukodwa. Emazweni athuthukileyo, iintsana ezizalwe kwiveki yama-25 yokukhulelwa sele zikhuliswe ngononophelo. Kule meko, iintsana ezingasemva kwexesha aziyi kulahlekelwa amandla okukhula kwaye ziqhelekile ukuphuhlisa.
Iingcali zihlula ukuhlukana okungafaniyo, kubangelwa zizizathu zendalo, kunye nokuvelisa (ukukhipha isisu okanye ukukhupha isisu). Ezi zilandelayo ziyakucasula, umzekelo, ngezizathu zonyango. Emva koko siza kuthetha malunga nokulahleka kwamathambo.
Izizathu zokulahlekelwa ngamathambo
Ziyakwazi ukuhluka, kuxhomekeke kwimpilo yowesifazane, imbali yakhe yokukhulelwa kwangaphambili, ukuvela kwezisisu nokunye. Ngaphezu kwe-60% yokulahleka kwezinto eziphathekayo kubangelwa yi-blastocyst pathology, kwaye ngamanye amaxesha izinto zokubeletha kunye nezinye izizathu zidlala indima ebalulekileyo. Kwi-10-15% yokukhulelwa, ukulahlekelwa ngamathambo kungozi ngengozi, kungekho zihlandlo ezibonakalayo.
I-Blastotcystosis yiyona nto ibangela kakhulu isongelo lokukhulelwa kwesisu ekukhulelweni. Iqulethe iimpazamo ekubunjweni komntwana, ezingabonakali ukuba kungenzeka ukukhula kwawo. I-Blastocystosis idla ngokuphindaphindiweyo ngokuhlanganiswa "kweengxaki zesini" ezibi zesinina noyise. Kule meko, ukukhulelwa kwesisu kubakho ekuqaleni kweeveki ezi-6-7 zokukhulelwa. Ukwenza oku, akukho nto inokuyenza. Kwaye akufanelekanga, kuba umntwana ngenxa ye-blastocystosis ayiqhelekanga. Ngenxa yoko, ukuba unina uphilile kwaye akukho zichaso, unokukhawuleza ukucwangcisa ukukhulelwa okulandelayo. Ubungakanani bokuphindaphinda kokusweleka kwesisu ngenxa yesizathu esifanayo.
Iimbangela zokuphuphuma kwesisu ekuphuhlisweni komntwana:
- pathology yeeseli zegciwane (ii-oocytes kunye ne-spermatozoa) - ngokuphindaphindiweyo kunye nokulahleka kwamathambo okuphindaphindiweyo;
- mpikiswano ye-serological;
iiphene ze-chromosomal ze-fetus;
- iziphene zentuthuko (iimpembelelo zesistim seentsholongwane, isifo senhliziyo, ukukhubazeka kwezinto eziphilayo, njl.)
iimpembelelo ekuphuhlisweni kwentambo yomlomo;
- Inkohlakalo ebangelwa ukufa kwe-chorionic fetal death
Izizathu zokuphuphuma kwesisu kwiimeko zomama:
- utshintsho lwengingqi kwizitho zokuzala, ezinjengeengxaki ze-uterine, ukulibala kwayo, izilonda, i-uterine fibroids, izilonda zomlomo wesibeleko. Kwakhona, ukuphuphuma kwesisu kuchatshazelwa ukukhulelwa (okubangela ukuba ukhulelwe i-ectopic pregnancy), iipolps, umdlavuza womlomo wesibeleko, ukuxhamla emva kwezilonda ezivuthayo. Isongelo sokukhulelwa kwesisu ngexesha lokukhulelwa singabangelwa yizinto ezingaqhelekanga ekuphuhliseni iplascenta. Abasetyhini abaneempazamo ezifanayo kufuneka babe phantsi kolawulo oluchanekileyo lwezonyango kunyaka. Ukukhulelwa ngeli xesha kuchanekile.
- ubude bomama. Ukufika kokufika kokuqala kokukhulelwa emva kweminyaka engama-38 kuthathwa njengexesha elide.
- ugula kumama. Ezi ziquka: izifo eziqhelekileyo eziqhelekileyo, izifo ezibangelwa yi-viral disease ezibangelwa ngumkhuhlane ophezulu, izifo ezingapheliyo (njenge-syphilis okanye i-toxoplasmosis), i-endocrine function pathology (umzekelo, isifo sikashukela), ukuphazamiseka kwengqondo, ukuphazamiseka, ukukhathazeka kwengqondo kunye ne-hormonal, e.
ukuphuka kweembrane kunye nokusuleleka kwintsholongwane.
- iingxaki ngenxa yeenkqubo zokuxilonga (zenzeke kwiimeko ezinqabileyo): xa uhlola i-fetus ene-endoscope ekhethekileyo, kunye novavanyo lwe-amniocentesis, kunye ne-biopsy yobustile (esolula umgca ongaphandle lwama-fetal membryo - ukutshitshiswa kwe-veillical veinlical vein).
- ukutya kokuphazamiseka.
izinto ezinengqondo nangokomzwelo, njengokwesaba ukukhulelwa, ukukhathazeka kwengqondo.
Umngcipheko ophezulu wokukhulelwa komzimba kwabasetyhini uvela emva kokunyangwa kwabantwana, ukukhulelwa okubanzi kunye nabasetyhini abaphuza utywala kunye nabomsi ngexesha lokukhulelwa. Ngokuqhelekileyo, isisongelo sokuphuphuma kwesisu siphumela emva kokukhipha isisu - sikhula ukukhulelwa kwesisu (ukulahleka kwe-3 okanye ukukhulelwa okungaphezulu).
Kufanelekile ukucacisa ukuba i-myoma ayisoloko iquka ukungaphambuki. Ngokuqhelekileyo ayibonakali ngokuqhelekileyo kubasetyhini abaselula (abaqhelekileyo kwiminyaka engama-40 ubudala). Abaninzi abasetyhini abane-uterine ye-uoma abangenazo iingxaki bekhulelwe, kodwa kwi-trimester yesibini okanye yesithathu yokukhulelwa banokuba neengxaki. Ngokuqwalasela oogqirha, ithuba lokuzala umntwana onempilo lukhulu ngokwaneleyo. Ukongezelela, i-myoma ayidla ngokukhawuleza ibangela ukulahleka kwamathambo okuphindaphindiweyo.
Iimpawu zokuphuphuma kwesisu
Izibonakaliso zokuphuphuma kwesisu ezingenangqondo ziphuma kwi-trimester yokuqala yokukhulelwa (de kube sekupheleni kweveki le-16). Iimpawu zokutshatyalaliswa kwesisu zivame ukuwela ngexesha lokuya esikhathini ngokuqhelekileyo kwiimviwo ze-4, 8 neye-12 zokukhulelwa. Kwakhona, ukulahlekelwa ngamathambo kubakho rhoqo ngeenxa yesonto le-14 lokukhulelwa, ngelixa i-placenta yenziwa, kwaye ukuveliswa kwamahomoni emzimbeni ophuzi kuncitshiswa kakhulu.
Okokuqala ukuphuma kwegazi kubuthakathaka, ke igazi liba mnyama, liba mnyama. Ngamanye amaxesha udibanisa ne-mucus. Ukuhlamba kungenziwa ixesha elifutshane kwaye kungabalulekanga. Kwakhona kwenzeka ukuba ifana nomjikelezo oqhelekileyo wokuya esikhathini. Ukuphuma kwintsholongwane ekukhulelweni kokuqala kuyinto eqhelekileyo kwaye ngokuqhelekileyo kubakho kanye emva kokukhulelwa okuqinisekileyo. Lihlala ligazi likaMama, kungekhona isiqhamo. Kwenzeka ukuba ukuphuma kwegazi akubalulekanga kwaye kusombululwe ngokukhawuleza ngexesha elifutshane. Nangona kunjalo, ukuba ukuphuma kwegazi kuhamba kwaye kuhamba neentlungu ezibuhlungu kwisisu esisezantsi-oku ngokuqinisekileyo kukuqala kokusweleka komzimba. Ukuba kukho ukunyuka oku ngakumbi kwezi mpawu, ukulahla i-blastocysts okanye iinxalenye ze-uteri wesibeleko-ukuphazamiseka kwesisu sekusekho.
Ukungahambi kakuhle komzimba
Xa ukuphuphuma kwesisu sele kusekhona kwaye izicubu ze-placenta okanye i-fetal sac (mhlawumbi nge-embryo) ziwela kwisini-sibhekene nokuphelelwa kwesisu okungaphelelanga. Kule meko, ukukhulelwa komzimba kusongela imeko yesisu, ubungakanani balo obuhambelana nokuphuhliswa kokukhulelwa kunye nomsele wentsholongwane. Ngaphandle kokuphelelwa kwesisu okungaphelelanga, inxalenye yamathambo ayikhutshwe, kwaye inxalenye ye-blastocyst neengxenyana ezincinci ze-chorion biopsy zihlala kwisisu. Iindawo ezihlala zibangelwa ukugafa, ezinokuqhubeka ixesha elide. Kule meko, ukucocwa kwesibeleko kuyadingeka, kuba kungenjalo umfazi usongelwa ukuphuma kwintsholongwane okanye unyango. Ukucocwa kwenziwa phantsi kwe-anesthesia.
Ukuba zonke iinxalenye zomntwana ogqityiweyo kunye ne-placenta zaxoshwa kwi-uterus - ukukhulelwa kwesisu kuphelile. Ngokuqhelekileyo kwenzeka kakhulu ekuqaleni - ngeveki yesixhenxe. Isibeleko asinalutho kwaye ayifuni ukucocwa okongeziweyo.
Ukutshatyalaliswa komtshato kukukhulelwa okhatywayo. Kule meko, i-embryo ifile, kodwa ukukhulelwa kuyaqhubeka. Umntwana ofayo angahlala kwisibeleko ngeeveki ezimbalwa, kwangeenyanga. Umbele uyayeka ukukhula, kodwa intamo yayo ivalwe ngokuqinile. Iziphumo zovavanyo lokukhulelwa zingenakuqinisekiswa kwiiveki ezimbalwa emva kokufa komntwana. Eyona ndlela efanelekileyo yokufumana ukuba imbungu iyaphila yi-ultrasound. Ngeveki yesihlanu yokukhulelwa, usenokwazi ukubona intliziyo yesisu. Ukuba ugqirha ugqiba ukuba ukukhulelwa kushushu, umntwana kufuneka asuswe ngokukhawuleza.
Isizathu sokuphuma kwamanzi singabahlula ngokwengxenye ye-placenta okanye iimbumba ezivela eludongeni lwe-uterine. Ngamanye amaxesha ukufa kwesibindi kwaye, ngenxa yoko, ukuphuphuma kwesisu kuyenzeka nangona kunqongophala kwaye kuphelelwa ixesha elifutshane. Abafazi abakhulelweyo abaye baqala ukuphuma igazi kufuneka bahlale begcina iisampula zegazi kwisiqwenga seesicu ukuze udokotela afunde.
Unyango kunye nokuthintela ukulahlekelwa ngamathambo
Kwezinye iimeko, ukukhulelwa kwesisu kunokuthintelwa ngempumelelo. Kule meko, unyango luxhomekeke kwisizathu kunye nemvelo yeengxaki zokukhulelwa. Ngokungafaniyo nemiphumo yengozi yokukhulelwa kwexesha lokukhulelwa ngexesha lokukhulelwa, ukuba izigqibo asikwazi ukuzenza ngaphambili. Ngamanye amaxesha unako ukubeletha umntwana ophilileyo kwaye ngekamva akunazo iingxaki zokukhulelwa.
Ukuqala, xa ukukhulelwa kwesisu kusemngciphekweni, kusetyenziswe unyango olulondolozayo, ngelixesha apho lona wesifazane kufuneka enze ngokukhawuleza uviwo lwezonyango kwaye athathe unyango njengoko kuchazwe ngugqirha. Ngokuqhelekileyo, ezi zidakamizwa ze-diastolic, i-sedatives, i-painkillers, ngamanye ama-hormonal (kuquka iziyobisi ezivimba ukuveliswa kweprotaglandins). Ngamanye amaxesha ibhinqa lifuna nje ukubonelela ngomoya onobubele kule xesha elinzima ukuba aphephe ukuthabatha. Isigulane kufuneka sihlale silala embhedeni.
Kuba nayiphi na, nokuba yinto encinane kakhulu xa ukhulelwe, kufuneka udibane nodokotela wakho kusasa. Unokwenza i-ultrasound scan ukwenzela ukuba uqikelele ukuba ngaba umbungu usaphila. Ukuba kunjalo, umfazi udla ngokuya kwisebe lokukhulelwa kwezilwanyana ukuze aqhubeke nokukhulelwa. Kwi-90% yamatyala adlula ngempumelelo, kwaye ukukhulelwa kuphelela ngokuzalwa komntwana onempilo, ngokuqhelekileyo ngexesha. Nangona kunjalo, ekubeni kukho umngcipheko wokuzalwa ngaphambi kokuzalwa, ukukhulelwa kufuneka kuhlolwe ngenyameko. Kwenzeka ukuba ibhinqa "lihlala" ewadi kwiiveki eziliqela, ngezinye iinyanga eziliqela.
Ngeentsilelo zomlomo wesibeleko kwi-trimester yesibini yokukhulelwa, ukugqithwa kwee-circumferential seams kwi-cervix kwenziwa. Oku kunciphisa izinga lokungaphumeleli kwalo. Intamo kufuneka ivaliwe ngexesha lokukhulelwa, ngaphandle koko iqanda lingawela ngaphandle kwesibeletho. Unyango olunjalo lusebenza kakuhle kuma-80% amacala. Kubaluleke kakhulu ukuba xa umama okhulelweyo avunyelwa ekuzalweni udokotela wachaza ukuba wayedalwe loo mgca!
Ukuba ngexesha lokukhulelwa kukhona ukuphuma ngokukhawuleza kwe-amniotic fluid okanye ibhinqa liqaphele ukuqhuba okuqhubekayo-oku kungakhokelela ekugqibeleni kwimbumba. Kwimeko enjalo, ibhinqa kufuneka lifakwe esibhedlele kwangoko. Ukuqala ngokusemthethweni kokusebenza kunzima kakhulu ukuyeka. Kwiintsholongwane zokubeletha, ukutyalwa kwezabasebenzi kuyimfuneko. Maxa wambi i-membrane iphilisa ngokuzimela kwaye ukukhulelwa kuqhubeka ngokuchanekileyo.
Ukuthintela ukulahleka kokukhulelwa ngenxa yongquzulwano ye-serological (ngoku ayisoloko iyimbangela yokukhulelwa kwesisu), ngamanye amaxesha ukutshintshiselwa kwamanye amazwe kwenziwa ngexesha lokukhulelwa. Yenzelwe ukususa iiseli ezonakalisiweyo, iintsholongwane kunye ne-bilirubin engaphezulu. Kwi-exchange exchange transfusion, i-75% yegazi lomntwana iguquka. Oku akutshintshi igazi lakhe ngokwenene, kuba umntwana uya kuqhubeka nokuvelisa iiseli zegazi kunye nama-antigens akhe. Izigulane zifumana unyango oluxhasayo olubandakanya ukulawulwa kwe-albin e-intanvenous yokunciphisa ingozi ye-bilirubin engena kwi-brain.
Izigulane zokuthintelwa kokungahambelani zilawulwa i-immunoglobulin ii-Rh D iiyure ezingama-72 emva kokubeleka, ukukhulelwa kwamathambo nokukhupha isisu. Imveliso iqulethe inani elikhulu le-anti-Rh. Isebenza ngokususa ii-Rh ezithintekayo zeeseli zegazi ezithintela igazi likaMama. Ukusetyenziswa kwesi siza kukhusela izifo, kwaye ukhusela umntwana ngexesha lokukhulelwa okulandelayo. Le nkqubo kufuneka iphindwe emva kokuzalwa kunye nokukhulelwa kwesisu.
Ukuba, nangona kunjalo, ingqubuzana ye-serological yenzeka kwi-trimester yesibili yokukhulelwa, ngoko, njengommiselo, inkqubo iya kuqala kokufa kwe-fetal, kwaye emva kokusweleka komzimba. Ukukhulelwa okulandelayo kwiimeko ezinjalo, njengomthetho, kuhlolwe ngokunyamekileyo kwaye ngokuqhelekileyo kuphelela ngokuzalwa ngokuphumelelayo komntwana onempilo.
Emva kokuphuma kwesisu
Okokuqala, kufuneka ulinde ngokuqaliswa kwesondo ngesithuba seentsuku ezi-2 (musa ukusebenzisa iitamponi ngeli xesha). Abanye besetyhini baphinde baqale umsebenzi wesondo kuphela emva kokuhamba kwesisu emva kokuphuma kwesisu, okuqhelekileyo kubonakala kwiiveki ezi-4-6 emva kokukhulelwa.
Ukuvuthwa ngokuqhelekileyo kuthatha kuqala ukuya esikhathini, ukuze emva kokukhulelwa kwesisu, kukho umngcipheko wokukhulelwa okukhawulezayo emva koko. Iingcali zincoma ukusebenzisa iindlela zokukhusela ubuncinane ubuncinane ezintathu, ezine inyanga emva kokusweleka. Kufuneka kuqaphele ukuba kukho izingozi eziyaziwayo ezibandakanyeka ngokukhawuleza kokukhulelwa okulandelayo emva kokuphuma kwesisu. Kodwa ukulinda akukhethi ngenxa yezizathu zonyango, kodwa ngenxa yezizathu zengqondo. Ibhinqa emva kokulahleka kokukhulelwa lixhala malunga noko kuya kwenzeka emva koko. Uvakalelwa ukwesaba kwaye uyazibuza rhoqo ukuba uya kukwazi ukukhulelwa kwakhona aze abele umntwana. Isi simo sengqondo esingaqhelekanga esingenzi negalelo ekuphuculweni kokuhleleka kokukhulelwa.
Iziqhelo eziqhelekileyo azibangeli. Ukutshatyalaliswa kokuqala akuthethi ukuba ukukhulelwa okulandelayo kuya kuba okufanayo. Emva kwezinto ezintathu ezilandelelanayo, amathuba okuba umntwana ayingama-70%, amane-50%. Ukuba ulahlekelwe ukukhulelwa kwakho kokuqala kwiinyanga ezintathu zokuqala, umngcipheko wokulahlekelwa ukukhulelwa komnye kuphezulu nje kuphela kweyonke. Ngaloo ndlela, nangona kungekho siqinisekiso sokuthi ukukhulelwa komnye kuza kwenzeka ngaphandle kokuphazamiseka, ukukhulelwa kwesisu akuyikukhansela ithuba lokuba ngumama onoyolo.
Zingaphi iimeko zokulahlekelwa ngamathambo?
Kukholelwa ukuba enye yee sixhenxe ziqinisekisile ukukhulelwa kubangela ukukhulelwa komzimba. Ngokomzekelo, e-UK, ukukhulelwa kulahlekelwa ngabafazi abangama-100 000 ngonyaka. Oku kuthetha ngamakhulu amabheji ngamathambo ngosuku. Esi sikali sanda kakhulu xa sicinga ukukhulelwa okungaqinisekanga. Oko kukuthi, kwiimeko apho owesifazane ekhulelwe isisu, ngaphambi kokubona ukuba ukhulelwe. Ezi zintathu kwikota yazo zonke ilahleko ezilahlekileyo.
Kwi-20% yabasetyhini abakhulelweyo ekuqaleni kokukhulelwa kukhona ukuphuma kwegazi, isiqingatha saso bubungqina bokuphuphuma komzimba. I-10 kwi-10 yokukhulelwa iphela ngokukhulelwa komzimba. I-75% yokulahleka kwezinto ezilahlekileyo zenzeka kwi-trimester yokuqala yokukhulelwa, ukuya kwiiveki ezili-12 ukususela ekuqaleni. Iziganeko zokulahleka komzimba ziphezulu kubafazi abaselula (ngaphantsi kweminyaka engama-25) kwaye kuphela ngaphambi kokuqala kokuphuma kwesisu.