Izinzuzo nezingozi ze-Amniotomy (Ukukhishwa Kwezimfucu Zokufakelwa)
Kungenzeka ukuthi wezwa ukuthi kunezindlela eziningi zokwenza umsebenzi (noma ukusheshisa). Enye yezindlela abantu abavame ukukhuluma ngazo ukuphula amanzi esikhwameni, inqubo ebizwa ngokuthi "amniotomy" noma "ukubhuka kwamakhemikhali" (AROM). Eqinisweni, ukwephula isikhwama samanzi kungukungenelela kwabasebenzi okuye kwasetshenziselwa izidakamizwa nababelethisi iminyaka engaphezu kwekhulu.
Ukusetshenziswa kwangempela kwe-amniotomy kuyahlukahluka emhlabeni jikelele, ngenqubo isetshenziswa njalo ezindaweni ezithile futhi njalo kwezinye.
Kungaphula isikhwama samanzi kusiza ukuqala noma ukusheshisa umsebenzi, futhi uma kunjalo, idlala indima ngayiphi indlela? Yiziphi izingozi ezingase zibe khona kule nqubo? Futhi yini ongayilindela uma ukhetha ukuphuza amanzi akho?
Ukuqonda Amniotomy / Breaking the Bag of Water
I-sac amniotic igxila esibelethweni futhi igcina amniotic fluid , baby, kanye placenta. Ihlinzeka isithiyo ekutheleleni isifo somntwana wakho ngesikhathi sokukhulelwa kanye nokunyakaza ingane lapho uhamba. Yakhiwa i-amnion ne-chorion. Ngakho ukuphuza amanzi kusebenza kanjani ekubambiseni umsebenzi?
I-amniotomy ingakhokhela ukuthi isebenze kokubili amakhemikhali nezindlela zomzimba. I-Amniotic fluid iqukethe amakhemikhali namahomoni okuthi, lapho ekhishwe, kucatshangwa ukuthi akhuthaze abasebenzi. Ngokwemvelo, isikhwama samanzi singanikeza umkhumbi phakathi kwekhanda lomntwana kanye nomlomo wesibeletho.
Uma isikhwama samanzi siphukile (ucabanga ukuthi ikhanda lomntwana lisetshenziselwa kahle umlomo wesibeletho) ikhanda lomntwana linganikeza ingcindezi eqondile emgodini wesibeletho ukusiza ngokuhlanza. Uma i-amniotomy isenziwa, kulindeleke ukuthi le nqubo izoqinisa izingqinamba kanye nomsebenzi wejubane, nomgomo jikelele wokunciphisa abasebenzi.
Ngamaphesenti angama-10 abesifazane, isikhwama samanzi siphumula ngokuzenzekelayo ngaphambi kokuqala komsebenzi. Uma i-AROM ingenziwanga, isikhwama ngokuvamile siphumula ngesikhathi sokusebenza okusebenzayo, nganoma isiphi isikhathi phakathi kokuqala komsebenzi nokubeletha kwengane.
Ukuphula i-Bag of Water ukuze kukhuthazwe umsebenzi
Esikhundleni sokuphula ngokweqile, isikhwama samanzi singahle siphulwe ngumchwepheshe wezokwelapha ukuqala noma ukunyusa abasebenzi. Ake sibuke lokhu ngokwehlukana.
- Ukwenyuka: I-amniotomy ingenziwa ngaphambi kokuqala komsebenzi ukuqala noma ukwenza umsebenzi . Kwezinye izimo, i-amniotomy ingasetshenziswa yedwa, nakuba kaningi ihlangene ne-IV Pitocin . Izindlela ezinhle zokuqala zomsebenzi (kunoma yikuphi ukubonisa) kuxhomeke ekuthandeni komlomo wesibeletho (bheka ngezansi). I-Wih isifo sofuba esifanele, indlela ephumelela kakhulu isebenzisa inhlanganisela ye-amniotomy ne-Pitocin.
- Ukungathandwa kwabathelisi esikubona: I-amniotomy ingenziwa futhi ngemuva kokuba owesifazane esevele esebenza, enethemba lokusheshisa noma ukukhuphula abasebenzi . (Funda kabanzi mayelana nobude bomsebenzi obanzi ). Nakuba kungasheshe kuphuthumise inqubo, kungase kuhlinzeke, kwezinye izimo, ukunciphisa kancane isidingo sokuzalwa kwe-laarean (nakuba ngezinye zezohwebo).
Ezinye Izinzuzo Zokuqeda I-Bag Yamanzi
Ngaphezu kokungeniswa noma ukukhushulwa kwemisebenzi, ukuphuka isikhwama samanzi kungaba nezinye izinzuzo.
Ukuqapha kwe-Fetal: Uma ingane yakho idinga ukuqapha okusheshayo, isazi sakho sezinambuzane noma umbelethisi singadinga ukuphula isikhwama sakho samanzi ukwenza lokhu kwenzeke. I-amniotomy iyadingeka ukuze kwenziwe ukuqapha kwangaphakathi kwe-fetal , njengoba kuqapha kufanele kufakwe esikhwameni somntwana. Ukuphuza isikhwama samanzi kuyadingeka ukuze ufake i- intrauterine catheter pressure . Kule nqubo, i-catheter ifakwa esibelethweni ukuze kunqume kangcono amandla wezinkinga zakho.
Ukubona ukutholakala kwe-meconium: Ukuphula isikhwama samanzi kungabonisa ukuba khona kwe- meconium -stained amniotic fluid.
Uma i-meconium itholakala nge-amniotomy, lokhu kunikeza isikhathi sethimba lakho lokunakekelwa kwezempilo ukuhlela izinyathelo ezifanele, kuye ngobukhulu be-meconium.
Inqubo
Ngemuva kokuqinisekisa ukuthi uyazi inqubo futhi uqinisekise ukuthi umlomo wesibeletho usuvuthiwe (bheka ngezansi), udokotela wakho wezibeletha noma umbelethisi uzokubeka esimisweni.
Njengoba isikhwama sakho samanzi sizokhishwa, umhlengikazi wakho uzoqinisekisa ukuthi unamathawula amaningi ahlanzekile ngaphansi kwakho.
Udokotela wakho noma umbelethisi uzobe esehlola ngokucophelela kwesisu ukuze uqinisekise ukuthi ikhanda lomntwana lisetshenziswa ngokuqinile embelethweni wakho wesibeletho. Ukusebenzisa i-amnihook (i-hook enkulu ye-crochet hook ye-hook enomphetho omncane ocijile), noma i-amnicot (iglavu ene-hook encane ebukhali ekugcineni komunye weminwe), izokhipha izingqimba zakho. Ngokudala izinyembezi esikhwameni, i-amniotic fluid izoqala ukugeleza.
Ukwephulwa kwangempela kwesikhwama samanzi akufanele kube yinto ebuhlungu kakhulu kunokuhlola okujwayelekile kwamanzi ukuze uhlole umlomo wakho wesibeletho. Kungase kungabikho uketshezi oluningi, noma kunalokho, kungase kuqale njengento encane nje. Ngokuvamile uzoqhubeka nokuvuza amanzi ngamanani amancane okwehla komsebenzi wakho.
Ngemuva kokuthi isikhwama sakho siphukile, ithimba lakho lomsebenzi lizoqapha ingane yakho futhi liqiniseke ukuthi konke kuhle. Uma uzobe usukuma ukuhamba, umhlengikazi wakho uzokunika idethi enkulu yokumisa ukuze ubambe amanzi lapho eqhubeka.
Ngemva kokuphuka kwamanzi ungase uqaphele ukuthi uqala ukuba nezinkinga noma ungase uzizwe sengathi ingane yakho ihlehlile ekukhuleni kwakho. Uma ngabe unemivimbo ngaphambi kokuphuka kwamanzi wakho, ungase uzizwe ukwanda kwamandla okwephula noma ungase ungaboni umehluko nhlobo.
Ngaphambi kokuqeda ibhulogi lakho lamanzi
Ngaphambi kokuthola i-amniotomy ukukhuthaza noma ukwandisa umsebenzi, udokotela wakho wezifo uzokhuluma nawe ngenqubo futhi axoxe ngezingozi nezinzuzo. Uzobala futhi ukuthi kungenzeka ukuthi le nqubo izophumelela (amaphuzu akho kaBhishobhi) futhi uqiniseke ukuthi awunazo izizathu zokuthi kungani inqubo ingenzeki (izinkomba).
Ukunquma uma I-Cervix Yakho "Yenhle" -AmaBishop Score
Ngaphambi kokuba isikhwama sakho samanzi sidilizwe ukuze senze umsebenzi, udokotela wakho wezifo uzobala inombolo eyaziwa ngokuthi amaphuzu kaBishop. Amaphuzu kaMbhishobhi anika ukulinganisa "kokunakekelwa" komlomo wakho wesibeletho, okungathi ungalinganisa uma ukwephula isikhwama sakho samanzi kungenzeka ukuthi uqale umsebenzi noma cha.
Uma umbelevuza wakho ungathandeki (uma unamaphuzu ka-Bishop ngaphansi kuka-6), ukukhishwa nge-amniotomy ne-Pitocin ngokuvamile akunconywa kanti nezinye izinqubo, njengokusebenzisa i-prostaglandin gel noma i-Cytotec (misoprostol) ukuze uvuthwe umlomo wakho wesibeletho kungase kunconywa esikhundleni. Noma ungase umane ukhethe ukulinda kuze umlomo wakho wesibeletho uhle kakhulu.
Isibalo sakho seBhishobhi sibalwa ngokunika amaphuzu ngokususelwa ekubelethweni komlomo wakho wesibeletho, ukususwa kwakho (ukuthi mncane kangakanani umlomo wesibeletho sakho), isiteshi sakho se-fetal (ukuthi ingane iphansi kangakanani esithombeni sakho), nokuvumelana nokuma. Amaphesenti ayisishiyagalolunye noma ngaphezulu ukuthi umlomo wesibeletho wakho "uyathandeka" futhi kunethuba elihle lokuba nokulethwa kwesisu. Isikhwama sakho samanzi akufanele siphulwe ngaphandle kokuthi isiteshini sakho se-fetal singu-0, noma sihle.
Amaphuzu kaBhishobhi
| Ukuhlolwa kwesibeletho | Amaphuzu angu-0 | 1 iphuzu | Amaphoyinti amabili | Amaphuzu amathathu |
| I-Dilation (cm) | Kuvaliwe | 1-2 cm | 3-4 cm | 5-6 cm |
| Ukuqeda (amaphesenti) | Amaphesenti angu-0-30 | Amaphesenti angama-40-50 | Amaphesenti angama-60-70 | Amaphesenti angu-80 |
| Isiteshi se-Fetal | -3 | -2 | -1, 0 | +1, +2 |
| Ukuvumelana | Qinisekile | Phakathi | I-soft | |
| Isikhundla | I-posterior | I-Med | Anterior |
Izizathu Zokungenzi Amniotomy (Izincomo)
Kunezimo ezimbalwa lapho isikhwama samanzi akufanele siphulwe. Lezi zivame ukucaca futhi zinganqunywa ngokubukeza isimiso se-ultrasound (ngesikhatsi sesi-trimester yesibili noma kamuva) futhi senza ukuhlolwa kwesisu. Lokhu kufaka:
- Isethulo esingavamile: Uma ingane ibhekwa noma iminye imibono efana nesethulo sokubukwa noma isethulo se-brow isikhwama akufanele siphulwe.
- Uma ikhanda lomntwana lingenele noma "lingene" ekuhlolweni. ( Isiteshi sokukhulelwa esingu-0 sisho ukuthi ikhanda lomntwana ligcwele ngokugcwele).
- I-Vasa previa: I- Vasa previa yisimo esingavamile lapho izitsha zegazi zomntwana ezisuka ku-placenta noma intambo ye-umbilical idlula phezu komlomo wesibeletho ngaphansi kwengane (lokhu kungatholakala ku-ultrasound yenqubo ngesikhathi se-trimester yesibili).
Izingozi Nezinkinga Ezihlanganiswa Nokuqeda I-Bag of Water (Amniotomy)
Kunezinkinga ezimbalwa ezihambisana ne-amniotomy, uma nje unesifo sofuba esifanelekile futhi umntwana usuke ehlanganyela. Izinkinga zingabandakanya:
- Ukwehluleka kwemisebenzi ukuqala: Umsebenzi angeke uqale ngokuphula isikhwama samanzi bese usebenzisa i-Pitocin, kodwa ngalesi sikhathi, "uzinikezele" ukuletha njengoba kunengozi encane yokutheleleka isikhathi eside isikhwama siphukile. (Uma amanzi ephuka ngaphambi kokuba kuqala ukubeletha, iningi labantu liya emsebenzini phakathi namahora angu-24).
- Ukwandisa umfutho wesisu: Uma ikhanda lomntwana lingasetshenziswa kahle emgodini wesibeletho, ukwephula isikhwama samanzi kungandisa ingozi yokulimaza, ngakho-ke kuholela ezinkingeni ngokulethwa.
- I-cord prolapse (I-probability of cord prolapse, noma intambo ye-umbilical ewela ngaphakathi kwesiswini phambi kwengane, iphansi uma isiteshi sesisu singu-0).
- Ukucindezeleka kwesisu: Ngokungajwayelekile, ukwephula isikhwama samanzi kungaholela ekucindezelekeni komntwana .
- Ukwandisa ubuhlungu (Ukwanda kwezibuhlungu empeleni akuyona inkinga, kodwa kulindeleke ukuthi "kuzuze" uma kusebenza kahle, njengoba ukuqala nokuqhubeka komsebenzi kuyaziwa ukuholela ebuhlungu obukhulu).
Kukhona ingozi ekhulayo yokulethwa kwezidakamizwa lapho kuphulwa isikhwama samanzi kwenziwa ukufakwa (isilinganiso se-C-sigaba sincane kakhulu uma senziwa ukukhuphula abasebenzi). Kucatshangwa ukuthi ezinye zalezi zimo zingenxa yokubona ukutholakala kwe-meconium ngemuva kokuphula isikhwama, futhi ngale ndlela, izinga lokunyuka kwesigaba se-C ngeke libhekwe njengengcindezi. (Nge-meconium esindayo, ingxenye ye-C ingenziwa ukuze ugweme ukuthi ingane ifune i-meconium ngesikhathi sokubeletha).
Imibuzo Yokubuza Ngaphambi Kokuqeda Amanzi
Ezinye zezinto ozozifuna ngaphambi kokuvuma ukuthi amanzi akho aphukile zihlanganisa:
- Ngizovunyelwa ukuhamba ngemva kwamanzi ami ephukile?
- Ngidinga ukuqapha okungaphezulu?
- Iziphi izibonakaliso zezinkinga ozozifuna futhi kanjani?
- Ungacabange kanjani ukuthi i-amniotomy izoshintsha umsebenzi wami othize?
- Zikhona yini ukungenelela okungadingeka ngenxa yalokhu?
- Yiziphi ezinye izindlela zami?
- Nginayo isikhathi sokwenza lesi sinqumo?
Ngezansi Ekuqedeni Ibhulogi Lakho Lamanzi Ukuqeda Umsebenzi
Abaqanjiwe baye basebenzisa i-amniotomy noma bephule isikhwama samanzi ukuze bakhuthaze abasebenzi ukuze baqale noma bathuthuke ngokushesha kwekhulu, nakuba singaqiniseki indima ngqo le nqubo edlala ngayo. Ngokuvamile, ingozi incane kulabo abaye benza isimiso se-ultrasound (ukulawula i-vasa previa), uma umntwana eboshiwe kahle, futhi uma ukulethwa kubonakala kungakapheli amahora angu-24 noma ngaphezulu. Uma isetshenziselwa ukukhishwa kwemisebenzi, ukwephula isikhwama samanzi kuvame ukusetshenziselwa ukuhlanganiswa ne-pitocin kwabesifazane abanomlomo wesibeletho omuhle.
Uma ubheka izinzuzo noma ukungalungi kokungenelela komsebenzi, kubalulekile ukukala ubunzima obungabhekana nezinzuzo ezikhona. Siyazi ukuthi ukukhulelwa okwandisa isonto noma ngaphezulu kunsuku efanele kungabangela izinkinga, futhi ukufakelwa kuyindlela eyodwa yokunciphisa lezi zingozi.
Ukuphuza isikhwama samanzi kuyadingeka lapho kuqapha ukubhekwa komzimba obuseduze nokuqapha kwangaphakathi kwe-fetal kanye / noma ukuhlolwa kwengcindezi ye-intrauterine.
Njalo ukukhulelwa kuhlukile futhi kubalulekile ukuthi owesifazane usebenze nesigqila sakhe ukuze anqume ukuthi yini engcono kuye njengomuntu ngamunye. Kubalulekile ukucabangela wonke umlando wakho wezokwelapha, isimo somlomo wesibeletho sakho, kanye nezintandokazi zakho.
> Imithombo:
> I-American College yezidakamizwa namaGynecologists. Indlela Yokunciphisa Ukungenelela Ngesikhathi Sokusebenza Nokuzalwa. 2017. https://www.acog.org/Clinical-Guidance-and-Publications/Ikomidi-Opinions/Ikomidi-on-Obstetric-I-Practice /Approaches-to-Limit-Intervention-During-Labor-and-Birth
> Cunningham, F. Gary, noJohn Whitridge Williams. Williams Obstetrics. ENew York: McGraw-Hill Medical Medical, 2014. Phrinta.
> Smyth, R., Markham, C., noT. Dowswell. I-Amniotomy yokunciphisa umsebenzi osebenzayo. I-Cochrane Database yezibuyekezo ezihleliwe . 2013. (6): i-CD006167.
> Wei, S., Wo, B., Qi, H. et al. Amniotomy Early and Oxytocin Ekuqaleni Yokuvimbela, noma Ukwelapha, Ukuyeka Isigaba Sokuqala Ukusebenza Ngokungafani Ngokuqhathaniswa Nokunakekelwa Kwamanje. I-Cochrane Database yezibuyekezo ezihleliwe . 2013. (8): CD006794.