Uphulo
Ngokwezibalo, ukulimala okuhlukeneyo komsele wokuzalwa kufumaneka kumfazi wesibini owazala. Ifom yezona ziqhelekileyo ziphuma ngokukhawuleza kwe-perineum. Iyenzeka kwi-7-15% yabasetyhini abadlulayo.
Izinto zobungozi
Enoba izihlunu zomzimba ziyakwazi ukujamelana noxinzelelo lwe-fetal ngexesha lokubeletha kwaye ulula ngokwaneleyo ukuba uphephe intloko yesana, kuxhomekeke ekubeni ziguquguquke kangakanani. Ukunciphisa ukunyaniseka kwezi zinto ezilandelayo: i-crotch ephakamileyo kunye ne-musculature ephucukileyo-umgama phakathi kwe-anus kunye nomnyango wesini ungaphezulu kwama-7-8 cm; ubudala beminyaka engama-30 ubudala; i-pelvis encinci; isiqhamo esikhulu; inkqubo yokuvuvukala kwisisu ngexesha lokubeleka; ukuhanjiswa ngokukhawuleza nangokukhawuleza; ukuvuvukala kwe-perineum (ubunqongophala bezabasebenzi kunye nemizamo eqhubekayo).
Yintoni ongayilindela ekuzalweni kwesibili?
Izinto ezibangela umngcipheko wokuqhekeka kwe-perineum ziquka izikrakra emva kokulimala okuqhubekayo ngexesha lokuzalwa kwangaphambili. Iisisombululo ezixhamlayo apho ezi zibazi zihlanganiswa khona akunakukwazi ukululaza kwaye, ngenxa yokungahambi kakuhle, iinyembezi ekuzalweni kwesibeleko, ngokuqhelekileyo kwiseva elidala. Kodwa awukwazi ukuthetha ngawo njengombuso wesinyithi. Abagqithisi, abaziyo malunga neengxaki ezinjalo ekuzalweni kwangaphambili, baya kuba nexhala elilodwa lokukhusela i-perineum. Ukuba izikrepha kwiziko lokuphulukana kwangaphambili zazincinci kwaye zaphiliswa ngexesha, zingenakuphazamisana nomsebenzi oqhelekileyo ngokuphindaphindiweyo ngaphandle kwekhefu, ingakumbi ukuba umntwana akayena mkhulu. Ukuba kwakungabikho ukuphuka ngohlobo lokuqala, ngoko umfazi okhulayo umngcipheko wokuwafumana uncinci, kuba iintlungu zomzimba emva kokuziswa kokuqala ziba nzima kakhulu.
Thintelo
Njengoko kuchaziwe ngasentla, esinye sezimbangela zokuphuka ngumntwana omkhulu. Kungenzeka ukuba ukuba umntwana wakho ozelwe kuqala ulinganise ngaphezu kwe-4000 g, ngoko ke okwesibini ayiyi kuba enkulu, ngoko ke ukuzalwa kuya kuba nzima kakhulu. Ukuze ungagqithisi omnye umntwana kwisibeleko, hlawula ngakumbi ingondlo efanelekileyo. Ukutya okulungileyo kumama ozayo kukudibanisa iiprotheni kunye namavithamini. Kodwa ukusetyenziswa kokutya okunotye kwi-carbohydrates, i-glucose, kufuneka kupheliswe. Ngethuba elifanayo kwiinyanga zokugqibela zokukhulelwa, inyama ingcono ukuba ingadli - iyabakhombisa izicubu kwaye inqande ukunyaniseka kwazo. Yibeke endaweni yentlanzi okanye inkukhu. Uthintelo olufanelekileyo lokuphuka ngexesha lomsebenzi luyi-massage ye-perineum kunye neoli ekhethekileyo. Kucetyiswa ukuba ukwenze kwiveki yama-33 yokukhulelwa. Phalaza ioli encinane yezilwanyana kwiminwe kunye nokwelula ukuhamba kuholele kwesikhumba se-perineum, njengokungathi ukulinganisa ukwelulwa kwesini: ngokuqhelekileyo, ngcono. I-gymnastics efanelekileyo neyongqinileyo inceda - isethi yemisebenzi eqinisa imisipha ye-perineum. Xa kungabikho usongelo lokubeleka kwangaphambi kokuzalwa, ubomi obusondelene rhoqo bucetyiswa kwiiveki zokugqibela zokukhulelwa. Kubalulekile ukuba uqaphele ukuba le prophylaxis ifanelekile ngakumbi ukulungiselela ukuzalwa kokuqala, kodwa nayo isebenza kakuhle kumama omama.
Amacandelo
Ukunqunyulwa kwe-perineum ngexesha lomsebenzi kungabizwa ngokuba yintlupheko. Le ngxubusho yokugqitywa kwezicubu ezungeze isiqalo sesisu. Iveliswa kwinqanaba xa intloko yentsana iboniswe ngokukodwa kwinqanaba lokuzala. Izigqibo ezithintekayo zenziwa rhoqo, kwaye inxalenye enkulu - ekuzalweni kokuqala: ukususela kuma-50 ukuya kuma-70%. I-perineum idibaniswa kunye nomgca we-median okanye emva kwayo, kuxhomekeke kwiimpawu ze-anatomiki. Ukukhangela kumgca ophakathi, okanye ngenye indlela - i-perineotomy, iphilisa ngokukhawuleza kwaye ingabonakali kangako emva kokubeleka. Yingakho ababeleki bavame ukukukhetha.
Xa kuyimfuneko?
Ukuba kukho isisongelo sokuphuka okanye ukuba ukuphuka kuqalile, iindawo ezihamba phambili zelonda elinqunyiwe, xa kuthelekiswa nemiphetho eqhekekileyo yokuphuka, kulula ukulungisa nokuphulukisa ngokukhawuleza. Ukuba ukugqitywa kokuqala komsebenzi kuyimfuneko kwi-hypoalia yobusana okanye kwiimeko ezingavumelekanga zophuhliso (i-hydrocephalus). Ukuzalwa ngaphambi kokuzalwa. Ukwandisa ukuvulwa kwesisu, xa umntwana unzima ukunqoba isalathiso sokuzalwa (umzekelo, ngexesha lokuzalwa kwi-pelvic presentation okanye nge-fetus enkulu).
Yintoni ongayilindela ekuzalweni kwesibili?
Ubunokwenzeka ukuba ukuphuka okutsha kuya kwenzeka kwisiza sobomvu, okwakhiwa ngexesha lokuzalwa komzimba ekuzalweni kokuqala, lukhulu. Kodwa ayiyi 100%. Ngokuxhomekeke kwiimeko, ugqirha ugqiba ukuba ngaba umfazi angazala ixesha lesi-2 ngaphandle kokunqunyulwa. Ukuba ithuba lokuphuka kwi-rumen liphezulu, kucatshangelwa ukuba kungcono ukwenza ukusika kunokuba ufumane ikhefu. Okwangoku, abanye oogqirha bazama ukuphepha ukukhawuleza kwe-perineum ngexesha lokubeletha ngokuphindaphindiweyo, nokuba bahlala beqhuba okokuqala.
Thintelo
Ekubeni iziganeko, eqinisweni, ziyahlukana ngokufanayo, zenzeke ngokugqithiseleyo, yonke into eyenziwa ngumama wesikhathi esizayo ukwenzela ukuba 'angabhidli' iyakufanelekela ukuthintela ukusika. Khumbula ukutya kunye nokuzivocavoca kwezilwanyana ezincinci! Ungabaqeqesha naphi na: ekuhambeni, phambi kweTV, elele embhedeni.
Kegel Gymnastics
1. Ukunyanzela okuphantsi. Qinisekisa izihlunu ze-perineum, zibambe kule ngingqi ngemizuzwana emithathu, uze ukhulule. Unokuyichukumisa umsebenzo ukuba udibanisa imisipha yakho imizuzwana emi-5-20.
2. I-gymnastics. Gcobhoza izihlunu iintsuku ezingama-3-5, uze ukhulule. Ngoku, qinisa izihlunu ngokuncinci, zibambe, kwaye-ukuya kwii-4-7 izigaba. Hlaziya ngokuthe ngcembe, uhlalise imizuzwana 2-3 kwinqanaba ngalinye.
3. Ukunciphisa. Gxininisa kwaye ukhululeke imisipha yakho ngokukhawuleza. Phinda amaxesha amaninzi.
4. Ukuphuma ngaphandle. Gweba njengesihlalo okanye ukubeletha. Lo msebenzi, ngaphandle kwemisipha ye-perineum, ibangele uxinzelelo kunye nesisu esiswini. Uqeqesho lunokuqala ngeendlela ezili-10 eziphambanisayo, izicucu ezili-10 kunye nama-pops ama-10 amahlanu ngosuku. Phinda usebenze ubuncinane amaxesha angama-25 ngosuku olunye. Oku kulula, kuba imisebenzi enjalo ayibonakali ngokupheleleyo kwabanye.
Ukuzalwa kwangaphambili
Ezi ziquka iimeko apho umsebenzi wezentsebenzo uqala phakathi kweeveki ezingama-28 neye-37 zokukhulelwa kwaye xa umlomo wesibeleko uvulwa ngaphambi kwexesha elifanelekileyo. Ubuninzi bebasebenzi be-preterm ngu-6-8% wabo bonke abazalwa.
Imiba engozi:
- Umfazi okhulelweyo uneminyaka engama-16 kunye nangaphezulu kweminyaka engama-30 ubudala
- Ubukho bentsholongwane emzimbeni womama ozayo
- ukuhluleka komlomo wesibeleko, xa kuvula ngaphandle kokulwa ngaphezu kwe 3-4 cm
- zangaphambili zangaphambili okanye ukukhipha izisu
- imisebenzi yokuhlinzwa kwizitho zesisu esiswini ngokukhulelwa
- ezinye iinguqulelo ze-fetus ezihamba kunye ne-polyhydramnios
- ukukhulelwa okubanzi
- umsebenzi ofuna umsebenzi owenziwe ngumzimba okanye uhamba noxinzelelo lwengqondo
- Ukubhema, ukusetyenziswa kweziyobisi kunye nokusetyenziswa kotywala
Abafazi abakhulelweyo abaye bazalela ngaphambi kwekota, umngcipheko wokuphindaphinda kwimeko - 3-4 amaxesha aphezulu kunabo bonke. Kuyaziwa ukuba kule meko amathuba okuba ukhuphe ukukhulelwa kwesibili malunga ne-80%. Yaye kunye namava amabini abelethwe ngaphambi kokuzalwa, umngcipheko wokuphindaphinda umcimbi ukwanda ngamaxesha angama-6. Ubunzima bokuqhelana nomsebenzi wentsholongwane rhoqo kwandisiwe xa ukukhulelwa kwesisu kusemngciphekweni ngexesha lokukhulelwa. Ubuthathaka bentsebenziswano kwabasetyhini abangaphezu kweminyaka engama-30 ubudala buqhelekileyo ngokuphindwe kabini kuneminyaka engama-20-25. Phantse ama-60% amawele, ngaphezu kwe-90% yeethathu, kwaye phantse onke amawele angama-4-5 okanye ngaphezulu avela phambi kwekota
Thintelo
1. Ukuphepha ukuzalwa kwangaphambi kokuzalwa, kuyimfuneko ukufumana isizathu esabangela ukuba kubekho inkathazo. Ukungaphakanyiswa kokukhulelwa kubangelwa rhoqo ngenxa yokusuleleka kwintsholongwane. Kule meko kuyimfuneko ukudlulisa uvavanyo malunga nobukho bebhaktheriya phambi kokuqala kokukhulelwa kwesibili. Ukuba zifunyanwe kumfazi okhulelweyo sele sele, ugqirha uya kumisela unyango ukususela kwi-trimester yesibini.
2. Oogqirha banokwenza nokunciphisa ukukhutshwa kwamanye amacaka.
3. Umama ozayo owake wafumana ukukhulelwa kwangaphambi kokuncinci angancoma ukuba angamsebenzi umsebenzi kunye nokunciphisa umsebenzi ukuya ekuphumleni kokulala ngexesha lesibini kunye neyesithathu zokukhulelwa.
4. Ukuqala kokubeleka kwangaphambi kwexesha kunokurhoxisa ngesondo. Ngoko ke, kwiinyanga ezintathu zokugqibela zokukhulelwa, umama okhuselekileyo kufuneka agweme ukulala ngesondo, ukwenzela ukuba angabangeli ukuchithwa okusebenzayo kwesibeletho.
Ubuthathaka bomsebenzi
Le nkcenkceshe ekuzalweni kubonakaliswa yimincinci ebuthakathaka, emfutshane, ephosa ukuvulwa komlomo wesibeleko kunye nomtshato wesisu ekuzalweni komsele.
Imiba engozi:
- iingxaki ze-endocrine kunye neengxaki zokuxhamla komzimba kumama ozayo (ukukhuluphala, ukusilela komsebenzi we-thyroid)
- ukugqithisa kwesibeletho, uphawu lwe-fetus emininzi, umntwana omdala kunye ne-polyhydramnios
- ukungahambi kakuhle kwesibeleko
Ubudala bomfazi bungaphezulu kweminyaka engama-30
ukonwaba kakhulu, ukwesaba, iimvakalelo ezibi ngaphambi kokubeleka
Yintoni ongayilindela ekuzalweni kwesibili?
Ubuthathaka bezabasebenzi buqheleke kakhulu kubafazi abasemagqabini. Kodwa umngcipheko wokuphindaphinda ukhulule ngokwaneleyo, ngakumbi ngokudala. Ugqirha ugqiba ukulungeleka komsele wokuzalwa kwiveki yama-38-39 yokukhulelwa. Ukuba kuyimfuneko, le ndlela yokuqulunqwa imiselweyo, njenge-amniotomy (okanye i-autopsy ye-bladder). Le nqubo yenziwa kwiwadi yokubeleka kwaye ayizintlungu ngokupheleleyo kumama, kuba akukho ziphelo zentlungu kwiimbrane. Emva kwe-amniotomy, ukuveliswa kwe-prostaglandins - izinto eziphilayo ezibhekiselele ekusebenziseni umsebenzi wezabasebenzi - kufuneka ziqaliswe. Kwakhona, ukucaphukiswa kweengxube zengxowankulu yokuzalwa kuqinisa, okukhokelela ekunciphiseni ukucutha, kwaye ngoko ke ukuqinisa ukuphulwa. Ukuba, iiyure ezingama-3 emva kwe-amniotomy, izichaso aziqali, oogqirha bayalungisa i-prostaglandin.
Izixhobo zokuzimela
Ukugqithiswa kwabo kukusebenza ngokunikezelwa kwemisebenzi, apho umntwana osisigxina esithatha ixesha elipheleleyo uchithwa ngedolophu yokuzala ngokuncediswa kwe-forcepress. Ugqirha uyabasibeka ngentloko yomntwana, ethatha amandla okugxotha kwesibeleko kunye nesisu esiswini somfazi obelethayo. Ukusebenza kokusebenzisa i-forceps kunqunywe ngumgqirha kwiimeko xa ukuqhubeka kwendalo kungasebenzi ngenxa yengozi yeengxaki ezinzima. Ngokusoloko ihamba kunye nokusebenza ukucima i-perineum ukwandisa umsele wokuzala ukukhusela ukuveliswa kweempazamo ezinkulu kumfazi.
Xa uqeshwe?
Isibonakaliso sokusebenza kwamagqabhagqabha anesithintelo sinokwahlukana ngamaqela amabini: izibonakaliso zomama kunye nomntwana wesibalo ezinxulumene nokukhulelwa nokuzala, kunye nezibonakaliso zengqungquthela ezinxulumene nezifo zowesifazane ezingavumeli iinzame.
Thintelo
Nangona ukuba ubuthathaka bentsebenzo yinkxalabo, ibonakaliswe ngqo kwinkqubo yokuzalwa, unokuzama ukukhusela ukuba kwenzeke ngexesha lokukhulelwa. Oku kuyinyani ngakumbi kubafazi abasele bejongene nale ngxaki. Ukulungiselela u-Physiopsychic yokubeletha kubamba indima ebalulekileyo apha. Kulungile ngaphambi kokuba kuqalwe kwakhona ukuphelisa izifo ze-endocrine, ukuba zikhona, ukulungelelanisa ubunzima nokuyeka imikhwa emibi. Kususela kwiiveki ezingama-36 kuyacetyiswa ukuba kuthathe amavithamini, okwandisa amandla okwenziwa kwesibeletho: zibandakanya i-vitamin B6, folic kunye ne-ascorbic acid. Ukuba ekuzalweni kokuqala imbangela yobuthathaka kwabasebenzi kwakuyiyolo lokuzala, kuyacetyiswa ukuqonda ubunzima bokuzilolonga kunye nokuzivocavoca umzimba okwenziwa ngabafundisi bezikolo zabazali bexesha elizayo.
Ubungqina obungqina:
- iifom ezinzima ze-preeclampsia, ezifuna ukungabikho kunye nokuxhatshazwa kwowesifazane ohamba phambili
- Ubuthathaka obuqhubekayo ekuzameni (ukungabikho kwentloko yengane ngaphezu kweeyure ezingama-2)
- ukuphazamiseka kwangaphambili kweplacental ekupheleni komsebenzi
- i-hypoxia yobunzima be-fetus (i-oksijini yindlala), xa ukukhawuleza kunokukhokelela ekufeni komntwana
Iimpawu zeSomatic:
- isifo senhliziyo, ukungaphumeleli kwentliziyo
- uxinzelelo lokuphefumula ngenxa yesifo sesifo
- usongelo lomsebenzi we-retina
- iintlobo ezinzima zeengxaki ze-neuropsychic
- usebenze kwizitho zesisu esiswini esenziwa ngomhla wokusebenza
- ukunyanzeliswa kosulelo, ukushisa okuphezulu kumama
Ukuba okokuqala kwakukho ukuthetha malunga nokucwangciswa kwesicelo se-forceps kwiimpawu zengqungquthela, ngoko ke ukuhanjiswa ngokuphindaphindiweyo kwangoko kunokwenzeka kuphela ngemvume yabogqirha. Ngokomzekelo, mhlawumbi phakathi kokukhulelwa komfazi uye wenza umsebenzi wokulungisa amehlo, kunye ne-ophthalmologist, owayesenqabela ukubeletha kwangokwemvelo ngenxa yendlela enokwenzeka ngayo yokubuyisela imitha ngexesha lokuzama, ngoku uya kunika imvume. Kodwa ubungqina obunqamlekileyo buyimfuneko kwaye abukwazi ukuvela kubantwana abazalwayo.