I-Cerclage, i-Bedrest kanye Nezinye Ukwelapha
Ukungaqondakali komlomo wesibeletho, owaziwa nangokuthi awukwazi ukuphelelwa yisibeletho, kungumlomo wesibeletho obuthakathaka noma owonakele ukuhlala uvaliwe ngesikhathi sokukhulelwa. Ngakho-ke kubangelwa ukubeletha ngaphambi kwesikhathi futhi mhlawumbe ukulahlekelwa umntwana, ngenxa yobude obuncane bokuzikhandla. Kukholelwa ukuthi ukungaqiniseki kwesibeletho kungumphumela we-20 kuya ku-25% wabo bonke abalahlekelwa yi-second-trimester.
Lokhu ukungakwazi kahle kuboniswa ekuqaleni kwe-trimester yesibili, kodwa kungenzeka ukuthi sekupheleni kwesikhathi sokuqala kwe-trimester.
Ijwayele ukuhlukaniswa njengesivalo sangaphambi kwesikhathi somlomo wesibeletho ngaphandle kokusebenza noma ukuphikisana. Ukuxilongwa kungenziwa ngesandla noma nge-ultrasonography. Ukusetshenziswa kwe-ultrasonography kuye kwaba usizo kakhulu ekuxilongweni futhi kwenziwa uma i- os yomlomo wesibeletho ingaphezulu kuka-2.5 cm, noma ubude bufinyelele phansi ngaphansi kwama-20 mm. Ngezinye izikhathi ukubhoboza kubuye kubonakale; yilapho ingxenye yangaphakathi yomlomo wesibeletho, i-os yangaphakathi (ingxenye yomlomo wesibeletho osondelene nengane) isiqalile ukuqeda. I-os yangaphandle ngeke ichitheke uma ixilongwe ngesikhathi. Izingosi ezandisa amathuba okuhlukunyezwa komlomo wesibeletho ezingenakukwazi yizona:
- DES exposure
- I-Traumatic Cervical
- Amathonya ama-hormonal
- Umlomo wesibeletho esifushane
- I-D & C eqinelayo
- Izimo eziphuthumayo zozalo
Uma utholakala ukuthi ngemuva kokulahlekelwa kwesibili noma kathathu ngaphambi kokukhulelwa kuyasolakala ukuthi uzoba nezinkinga ngamandla omlomo wesibeletho sakho, i-cerclage (ukufaka umlomo wesibeletho uvaliwe) ingenziwa nge-prophylactically cishe emavikini angu-14 kuya ku-16.
Kuthiwa ukuthi ekuqaleni unayo i-cerclage eyenzeka kakhulu ukuthi ukukhulelwa kuqhubeke.
Ukuze uthole ukuxilongwa okwenziwe ngesikhathi sokukhulelwa, kufanele uhlangabezane nemigomo ethile ngaphambi kokuba i-cerclage ingenziwa. Awunelungelo le-cerclage uma unayo:
- Ukuphefumula komlomo wesibeletho
- Umntanakho usefile kakade
- Uneminyaka engaphezulu kuka-4 cm enwetshiwe
- Amanzi akho aphukile
Kunezindlela eziyisihlanu ezahlukene zokwenza i-cerclage. Lezi ezimbili ezivame kakhulu yiMcDonald neShirodkar.
Inqubo kaMcDonald yenziwa nge-5 mm band ye-suture engunaphakade ebeka phezulu esibelethweni. Lokhu kuboniswa uma kukhona ukuchithwa okuphawulekayo kwengxenye ephansi yomlomo wesibeletho. Ngokuvamile isuswe emavikini angu-37, ngaphandle uma kunesizathu sokukususa ekuqaleni, njengokutheleleka, ukuqala komsebenzi, ukubhubha ngaphambi kwesikhathi ngaphambi kwalokho, kubonakala sengathi lokhu kunomthelela omncane kakhulu ekwenzeni ukubeletha kwesisu.
I-Shirodkar iphinde isetshenziswe njalo. Kodwa-ke, lokhu kwakungu-souture yesikhwama esingapheliyo esikhwameni sezinkampani ezizohlala zingaguquki ngokuphila, manje zisuswe cishe amasonto angu-37. Uma lolu hlobo lwe-cerclage lwenziwa, isigaba se-cearean sizohlale senziwa. Kukhona odokotela abenza amasu okuguqulwa, lapho ukulethwa akudingeki ukuba kube yi-cearean, noma i-suture ayishiywe kahle. Buza udokotela wakho ukuthi iyiphi inqubo abayenza.
I-cerclage ye-Hefner, eyazi nokuthi inqubo ye-Wurm, isetshenziselwa ukuxilongwa kamuva kwesikhumba somlomo esingenakulungele. Ngokuvame ukwenziwa nge-U noma i-mattress suture futhi inenzuzo uma kunesilinganiso esincane se-cervix esisele.
I-corticular ligament cerclage ye-uterosacral ivame ukwenza ngemuva kokuba izinqubo zikaMcDonald ne-Shirodkar zihlulekile, noma lapho kukhona isandulela ngculaza esincane esifushane noma i-subacute cervicitis. Kungenziwa okwesifazane kodwa kuqhutshwa njalo ngesisu. Futhi, ukulethwa kwe-cearean kunesibopho sokuzalwa.
Inqubo yokugcina, i-Lash, yenziwa esimweni esingakhulelwe. Ngokuvamile kwenziwa ngemuva kokuhlukunyezwa komlomo wesibeletho okubangele ukukhubazeka kwe-anatomical. Kukhona okungenzeka, nakuba kungavamile, umphumela wecala lokungasebenzi.
Yize lezi zinqubo zisindisa impilo, nazo zinezingozi ezingase zibe khona:
- I-Chorioamnionitis (Ukwelashwa kwesikhwama se-amniotic, 1-7%) (Le nengozi iyanda njengoba ukukhulelwa kuqhubeka futhi kunama-30% womlomo wesibeletho ohlanjululwa ngaphezu kwama-3 ama-cms.)
- Umsebenzi wokuqala
- Ukuchotshozwa komlomo wesibeletho noma ukuxoshwa (Lokhu kungenziwa enkambisweni noma ekulethwa kwezidingo, kusuka emathisheni amasha okwenza umlomo wesibeletho.)
- Ukulimala kwesisu (okungavamile)
- Ukwehla kwesisu somama
- Dystocia yomlomo wesibeletho
- Ukuphuka komzimba
I-prophylactic inqubo ngokuvamile ukugcina isiguli amahora angu-24 ngaphambi kokwenza i-cerclage. Ngalesi sikhathi uzobe esebhekwe umsebenzi wokuqala futhi ahlolwe ukutheleleka. Ngokuvamile, lokhu kwenziwa ngesiguli esiteshini se-Trendelenburg, izinyawo ngaphezu kwekhanda lakho. I-anesthesia yomgogodla isetshenziselwa ukuvimbela ubuhlungu kanye nokuhlukunyezwa komama ngesikhathi se-cerclage. Isibilini sakho sizogcwala ukuzama futhi ukuhambisa izinambuzane zakho kude ne-os. Uzonikezwa ama-antibiotics ukuze usize ukuvimbela ukutheleleka, no-Indocin ukusiza umzimba wakho ukuba ungazinaki i-prostaglandins ekhishwe ngesikhathi senqubo.
Emva kokusebenza uzobe ulala embhedeni wamahora angu-24 alandelayo, mhlawumbe ku-Trendelenburg isikhundla. Futhi kuqashwe umsebenzi we-uterine.
Uma usukhishwe esibhedlela uzobe uhlala ekuphuleni kwepilvic (akukho ocansini) ngenxa yokusala kokukhulelwa. Kuzodingeka ube nezikhathi zokuphumula usuku ngalunye futhi wehla umsebenzi wokuzivocavoca. Uzobonakala ehhovisi okungenani kanye ngesonto kuze kube sekuzalweni. Uzobe uhlolwe futhi ngomsebenzi wokuqala. Uma unezinhlangothi ezithile kufanele uxhumane nodokotela wakho ngokushesha.
I-clerlage ibonakala iyindlela yokwelapha ephumelelayo kakhulu yesandulela ngculaza engakwazi. Amanani okuphumelela angaba phezulu kakhulu (80-90%), ikakhulukazi uma kwenziwa esikhathini esidlule ekukhulelwe. Uma unenkinga ngomlando wakho wokubeletha noma umsolwa onomlomo wesibeletho angenakukwazi ukucela udokotela wakho ukuba akuhlole.
Imithombo:
Ikomidi lase-American College of Obstetricians kanye neGynecologists (ACOG) eKomitjhini ye-Practice Bulletins - I-Obstetrics. I-ACOG Yokuzivocavoca Bulletin No. 142: Ukukhukhumeza ukuphathwa kokuntuleka komlomo wesibeletho. I-Obstetrics & Gynecology. 2014; 123: 372.
Berghella V, et al. Ukungakwazi ukusebenza komlomo wesibeletho. http://www.uptodate.com/home. Ifinyelele ngomhla kaDisemba 24, 2015.
I-Obstetrics: Ukulungiswa Okuvamile Nezinkinga. IGabbe, S, Niebyl, J, Simpson, JL. Edition Sixth.