Ukwelashwa kwesifo somfutho wegazi kulandela iqoqo lemihlahlandlela ehlukile kunokwelashwa kwengcindezi ephakeme yegazi ngaphandle kokukhulelwa. Umgomo oyinhloko wokwelashwa kwabesifazane abakhulelwe ukuvimbela ukuthuthukiswa kwezimo ezinzima kakhulu ezifana nokunciphisa ukukhula komntwana noma ukuphazamiseka okuphazamisayo. Ukukhulelwa futhi kufaka ezinye izikhathazo ezinhlelweni zokwelashwa zendabuko, ngoba inhlalakahle yomntwana kufanele ibhekwe njengeyomama.
Izindlela zokwelashwa ezivame ukusetshenziswa kakhulu kwabesifazane abakhulelwe abanezifo eziphakeme zegazi yizi:
- Ukuphumula kombhede
- Ukwelashwa kwezidakamizwa ezincane (okwesikhashana)
- Ukwelashwa kwezidakamizwa zesikhathi eside (okungapheli)
Ekukhetheni uhlelo oluthile lwezokwelapha, imininingwane efana nokuthi ngabe igazi eliphakeme likhona ngaphambi kokukhulelwa, ukuthi ukukhulelwa ukude kangakanani, nokuthi ingane yenza kanjani kufanele konke kucatshangelwe.
Ukwelapha Ukuphumula Kwesibhedlele
Ukuphumula kombhede, noma umsebenzi ovinjiwe, sekuyisikhathi eside kunqunyelwe amacala okugonywa ngokweqile, kungakhathaliseki ukuthi iyini imbangela yalo. Nakuba lo mkhuba usetshenzisiwe isikhathi eside futhi uqhubeka ukhetha ukwelashwa okuthandwayo, kuncane kakhulu ubufakazi obunamandla obusekela ukuphumelela kwalolu cwaningo. Ucwaningo oluthile oluncane olwenziwe emtholampilo luye lwaqhutshwa, kanye nokubuyekezwa kwezincwadi eziphelele, kepha akukho zifundo ezinkulu ezenziwe. Ngokuvamile, imiphumela ixutshwe. Ucwaningo oluthile lubonise ukuthi ukuphumula kombhede akunikezi izinzuzo zokuzivikela, kanti ezinye izifundo zibonise ezincane, kodwa zilinganiselwe, zinciphisa ingozi yokukhula kanzima komfutho wegazi ophezulu noma ukuletha ngaphambi kwesikhathi.
Ngenxa yokungabi nobufakazi obunamandla, ukuphumula kombhede akufanele kubhekwe njengendlela eqondile yokwelashwa. Noma kunjalo, umsebenzi ovinjelwe ngomusa awufaki izingozi zezempilo ezingathí sina futhi ungasetshenziswa uma ungaphazamisi isimiso sakho esivamile. Ezimweni lapho kunezinkinga ezaziwayo ngegazi eligeleza ngaphakathi kwe-placenta - "ukungakwazi ukusebenza kwe-uteroplacental" - ukuphumula kombhede kunganikeza izinzuzo ezengeziwe.
Ukwelashwa Kwemithi Yesikhathi Esifishane Nesikhathi Eside
Ukwelashwa kwezidakamizwa kuyindlela ephumelelayo, efakazelwe yokunciphisa ukucindezelwa kwegazi ngesikhathi sokukhulelwa, nakuba ukunakekelwa kufanele kusetshenziswe ekukhetheni nasekuphatheni izidakamizwa. Ngenxa yokuthi ukwelashwa kwezidakamizwa ngesikhathi sokukhulelwa kungathwala ingozi kokubili umama nengane, ngokuvamile kuvunyelwe ukusetshenziswa kuphela ezimweni lapho ukucindezelwa kwegazi kuphakeme khona, ngokuvamile> 150/100 mmHg.
Ukuze uthole ukwelashwa kwesikhashana esifushane, izidakamizwa ngokuvamile ezikhethwe yizo:
- I-Labetalol - i-block blocker
- Hydralazine
- I-nifedipine-ukukhululwa okuqinisekisiwe - isiphequluli sesiteshi se-calcium
- Ukukhululwa ngokushesha kwe-nicardipine - i-blocker yesiteshi se-calcium
Esikhathini esifushane, uma lezi zidakamizwa zingakwazi ukulawula ukucindezelwa kwegazi, ngezinye izikhathi izidakamizwa ezibizwa ngokuthi i-diazoxide zisetshenziswe uma kudingeka ukulawulwa kwegazi ngokushesha.
Ukuze ukwelashwa kwesikhashana eside okumele kuqhubeke amasonto noma izinyanga, ukukhetha kwezidakamizwa kuyafana. I-Labetalol ingenye yezidakamizwa ezisetshenziswa kakhulu kubesifazane abakhulelwe. Nakuba zonke izidakamizwa zithwala izingozi eziyingqayizivele iziguli ezikhulelwe, i-labetalol iye yaboniswa ukuthi iphephile ngokujwayelekile ngesikhathi sokukhulelwa. Kanye ne-labetalol, ezinye izidakamizwa ezingasetshenziswa zihlanganisa:
- I-Methyldopa
- Abavimbela isiteshi se-calcium eside (i-Nifedipine)
Ukuhlolwa kwe-Fetal
Ukuhlola kwe-Fetal - ukuhlola impilo kanye nesimo somntwana - kuyisici esithile sokuphikisana sokuphatha umfutho wegazi ophezulu.
Ngenkathi i-ultrasound kufanele yenziwe emavikini angu-16-20 ukuze inikeze ukufundwa okuyisisekelo okusemthethweni okuzohlola ukuthi izinga lokukhula lomntwana liphi, asikho isivumelwano esicacile mayelana nendima yezinye izivivinyo. Odokotela abaningi bazokwenza "ukuhlolwa kwe-nonstress" kanye ne-"amniotic fluid index" noma "iphrofayli yezinto eziphilayo" ngesonto onke ekupheleni kokukhulelwa, njengendlela yokuqinisekisa ukuthi ukukhula kuqhubeka ngokujwayelekile. Ngokuvamile, ukuqapha okusheshayo kuyadingeka kuphela uma izimo ziphakamisa ukuthi ingane ingase ibe engozini. Lezi zimo zihlukile kwabesifazane abahlukene kodwa zingabandakanya izimpawu zokuthi igazi ligeleza kumntwana liye laphazamiseka.
Ukusebenza Nokuhlinzeka Ngokucindezeleka Kwesisindo
Cishe bonke abesifazane abanesifo somfutho wegazi ocindezelekile ngeke baqhubeke nokudiliva okujwayelekile ngesikhathi esiphelele. Laba besifazane ngokuvamile baphumelela ekuhambiseni izidakamizwa futhi azikho ezinye izinkinga ezinkulu. Ezimweni lapho ukucindezelwa kwegazi kuphakanyiswa kakhulu, noma uma kwenzeka ku-preeclampsia, ukuhanjiswa ekuqaleni kuvame ukucatshangelwa. Uma kwenzeka izinkinga ezinkulu, njenge-eclampsia, ukulethwa kokuqala ngokuvamile kuzama ukugwema ukuthuthukiswa kwezinkinga ezingase zisongele ukuphila. Kodwa-ke, ngokuvamile, khumbula ukuthi iningi labesifazane abane-hypertension elikhulelwe likhulelwe liba nempumelelo, likhulelwe isikhathi eside futhi banezinsana ezinempilo.
Imithombo:
> I-Meher, i-S, i-Abalos, i-E, i-Carroli, i-G, i-Meher, i-S. Bed ihlala ngaphandle noma engaphandle > esibhedlela > yomshuwalense ngesikhathi sokukhulelwa. I-Cochrane Database Syst Rev 2005; : CD003514.
> Remuzzi, G, Ruggenenti, P. Ukuvimbela kanye nokwelashwa kokucindezeleka okuhlobene nokukhulelwa: Yini esiyifunde eminyakeni eyishumi edlule? Am J Kidney Dis 1991; 18: 285.
> Duley, L, Henderson-Smart, DJ, Meher, S. Izidakamizwa zokwelashwa kakhulu kwegazi ngesikhathi sokukhulelwa. I-Cochrane Database Syst Rev 2006; 3: CD001449.
> Abalos, E, Duley, L, Steyn, DW, Henderson-Smart, DJ. Ukwelashwa kwezidakamizwa ezingenakuqeda amandla okunciphisa ukucindezeleka komzimba ngokweqile ngesikhathi sokukhulelwa (Ukubuyekezwa kwe-Cochrane). I-Cochrane Database Syst Rev 2007; : CD002252.
> Podymow, T, Agasti, P. Postpartum inkambo yokucindezeleka komzimba kanye ne-preeclampsia. Ukushisa ngokweqile ekukhulelwe 20006; 25: 210.