Nginesiqiniseko sokuthi uzwile lawa magama kaningi kunalokho okukhumbulayo njengamanje, kodwa mhlawumbe awukaze wazi ngokuqinisekile. umehluko okhona phakathi kwegama elilodwa nelinye, ungakhathazeki ngoba kuyinto ejwayelekile kakhulu. Namuhla ngifuna ukukusiza ukuthi ukhombe lezi zifo ezimbili ukuze kusukela namhlanje uzokwazi ukukhomba ukuthi yisiphi isifo ngasinye.
Ongakwazi ukuthi womabili la magama ayenzeka noma angenzeka ngesikhathi sokukhulelwa futhi kuya ngezinga, kungabeka bobabili umama nengane engcupheni yokufa. Ngakho-ke akukho kulezi zifo ezimbili okufanele zithathwe njengehlaya, yizifo ezimbili ezimbi kakhulu.
Yini i-pre-eclampsia?
I-Preeclampsia yiyona ukutholakala komfutho wegazi ophakeme kanye namaprotheni emchameni angaqala ukukhula ngemuva kweviki lama-20 lokukhulelwa. Ukuphela kwendlela yokwelapha nokunqoba lesi sifo ngukubeletha ingane, kodwa uma lokhu kuzokwenzeka ngokushesha okukhulu, ingane kuzodingeka ibe se-incubator ngokuphumula okuphelele kanye nokulawulwa okuphelele kwezokwelapha. Umsebenzi uzokwenziwa ngangokunokwenzeka. Kusuka ku-preeclampsia kungathuthuka kuye e-eclampsia, Ngokuba ne-pre ngaphambi kwethemu, sekuvele kwaqondakala ukuthi kungahamba ngaphambili.
Ngaphezu kwalokho, i-preeclampsia ingakwazi zivela ekuqaleni kwenkathi yangemva kokubeletha (ngokuvamile phakathi nesonto lokuqala) futhi ngezinye izikhathi kube nezimpawu ezimbalwa ekuqaleni. Imibandela yezokwelapha ihlanganisa amazinga umfutho wegazi ≥ 140/90 mmHg okungenani amashothi amabili ahlukene kanye nokuba khona kwe i-proteinuria ephawulekayo (isb., ≥300 mg kumchamo wamahora angu-24 noma isilinganiso seprotheni/creatinine ≥0,3). Kunamafomu “anezici ezinzima” lapho izimpawu ezinjengomfutho wegazi ≥160/110 mmHg, amaplatelet aphansi, ama-enzyme esibindi aphezulu, ukwehluleka kwezinso, i-pulmonary edema, noma izimpawu zemizwa (ikhanda elibuhlungu elibuhlungu, ukuphazamiseka okubukwayo).
Yini i-eclampsia?
I-Eclampsia yiyona isenzakalo sokuquleka ngowesifazane okhulelwe, into engenzeka futhi ngemuva kweviki lama-20 lokukhulelwa. Njengaku-pre-eclampsia, ukubeletha kufanele kwenziwe ngoba bobabili umama nengane basengozini yokufa.
Empeleni, i-eclampsia iyinkimbinkimbi yezinzwa ye-preeclampsia lapho zenzeka ukuquleka noma i-coma ngaphandle kwanoma iyiphi enye imbangela. Ingase ibonakale ngesikhathi sokukhulelwa, ukubeletha, noma esikhathini sokuqala kwangemva kokubeletha. Ngokuvamile kwandulelwa ikhanda elibuhlungu kakhulu, ukubona okuhlanekezelwe, ukudideka noma i-hyperreflexia. Ukuphatha okuphuthumayo kubandakanya ukuzinza komama, ukuphathwa kwe i-magnesium sulphate ukuvimbela ukuquleka okwengeziwe, ukulawula umfutho wegazi kanye ukunqanyulwa kokukhulelwa lapho kuphephile.
Ayikho indlela yokuvikela lezi zifo, kodwa kubaluleke kakhulu ukuthi bonke abantu besifazane babhekane nakho konke ukulawula ngaphambi kokubeletha, okuzovumela ukuxilongwa nokwelashwa ngesikhathi esifanele ukuzama ukuvimbela (noma ngabe kufanele kubonakale kuzokwenza okufanayo) i-pre-eclampsia, ukugwema i-eclampsia ukuthi ingenzeki.
Namuhla siyazi ukuthi ayikho indlela eqinisekisa ukuvimbela okungu-100%, kodwa kunezinyathelo ezingakwazi ukunciphisa ingozi kwabesifazane abakhethiwe, njengokusetshenziswa kwe i-aspirin yedosi ephansi ebekwe udokotela kwabesifazane abakhulelwe abasengozini enkulu, nokuqapha eduze ngokuhlolwa komfutho wegazi kanye nokuhlolwa komchamo. Ukulandelela ngaphambi kokubeletha kuyisihluthulelo sokubona izimpawu eziyisixwayiso kusenesikhathi futhi uthathe isinyathelo ngesikhathi.
Kodwa ngokulandelayo ngifuna ukukunikeza imininingwane eyengeziwe mayelana nokuthi ngasinye salezi zifo simayelana nani ngoba ziyinto okufanele abesifazane sizithathe ngokungathi sína.
Izimpawu Nezimpawu zePreeclampsia
Odokotela bayaligcizelela iqiniso lokuthi abesifazane abakhulelwe kufanele bahlale beqaphile futhi bashayele ucingo ngokushesha kunoma yisiphi isimo esiphuthumayo noma ezinye izimpawu eziyinqaba abazibonayo. Okuthile okubonakala kungajwayelekile kithi akufanele neze kujwayelekile kuzofanele ushayele udokotela ngokushesha ukuthola lezi zimpawu ezilandelayo ze-pre-eclampsia:
- Ukuvuvukala okungazelelwe wezandla, ubuso nezinyawo
- Ubuhlungu obukhulu esifundeni esingaphezulu esiswini
- Ubuhlungu bekhanda obunzima obungapheli noma ngabe udokotela wakho ukunikeze imishanguzo yezinhlungu ephephile ekukhulelweni kwakho.
- Umbono ofiphele noma ukuvela kwamabala amnyama ngombono
- Ukuqhafaza
Uma uthola ukuthi ungase ube ne-preeclampsia ezigabeni zokuqala, uzodinga ukubonana nodokotela wakho ngokushesha ukuze unikezwe ukwelashwa. phatha ngempumelelo ngangokunokwenzeka nje kutholwa ngesikhathi Kungavinjelwa ekubeni kubi kakhulu.
Ngaphezu kwalokho, kubalulekile ukwazi ukuthi abanye besifazane abane-preeclampsia ungavezi izimpawu ezisobala ekuqaleni. Kwezinye, kuyaphawulwa edema ezibukisayo ezandleni, eminweni nasebusweni, nezindandatho eziyeka ukungena, futhi ukuzuza ngokushesha kwesisindo (isb., ngaphezu kuka-2 kg ngeviki elilodwa) ngenxa yokunqwabelana koketshezi. Uma i-preeclampsia iqhubeka, izimpawu ezinzima zingase zibe khona: ubuhlungu bekhanda obukhulu ukuphikelela, ukubona okuphambene, ukudideka, i-hyperactive reflexes, ubuhlungu ku-quadrant engenhla kwesokudla sesisu, ukucindezeleka kokuphefumula, umthamo ophansi womchamo kanye nomfutho wegazi ophakeme kakhulu. Akuvamile, kungase kubangele isifo sohlangothi.
Imiphumela enganeni ihlanganisa umkhawulo wokukhula ngenxa yokwehla komsebenzi we-placenta, ukulethwa ngaphambi kwesikhathi uma ukunqanyulwa kokukhulelwa kusenesikhathi kuyadingeka futhi, ezimweni ezimbi kakhulu, ukuqhuma kweplacenta. Ngakho-ke, uma uhlangabezana nanoma yiziphi izimpawu ezingavamile, kunconywa ukuthi ufune iseluleko sezokwelapha ngokushesha.
Izimpawu nezimpawu ze-eclampsia
Izimpawu zesici se-eclampsia yilezi isithuthwane. Ezinye izimpawu nezimpawu zifana noma zincane kune-pre-eclampsia, yize ingahluka ngokuya ngezinga lokubandakanyeka. Nalu uhlu lwezimpawu ezingakhula kubantu besifazane abakhulelwe abane-pre-eclampsia futhi ababa ne-eclampsia:
- Ukwenyuka komfutho wegazi ophakeme
- Inani elinyukile lamaprotheni emchameni
- Ubuhlungu besisu
- Ubumpumputhe be-Cortical
- Isicanucanu nokuhlanza
- Ukulimala kwemisipha
- Ukulahlekelwa ukwazi
I-Eclampsia ingenzeka ngokuzumayo ngisho nakwabesifazane abanezimpawu zangaphambili ezithambile. Ngezinye izikhathi, ukuqunjelwa kwenzeka ngaphambi kokuqala kwezimpawu. aura nekhanda elibuhlungu elibuhlungu, izinguquko ezibukwayo kanye ne-malaise evamile. Okuhamba phambili yilokhu ukuzinza komama, vikela indlela yomoya, lawula i-magnesium sulphate ukuvimbela ukuphindaphinda, ukulawula umfutho wegazi ophakeme, nokuhlola isidingo sokunqamula ukukhulelwa ngokuphepha kumama nengane.
Ukuxilongwa kanye nezigaba
Ukuxilongwa kusekelwe ekuhlanganiseni high blood pressure kanye nokungajwayelekile noma izimpawu zaselabhorethri. I-proteinuria ngokuvamile iqinisekiswa nge Ukuhlaziywa kwamahora angama-24 (≥ 300 mg) noma ngesilinganiso esihle samaprotheni/i-creatinine yomchamo. I-Preeclampsia ingahlukaniswa ngokuthi Leve noma nge izici ezibucayi ngokusekelwe emazingeni omfutho wegazi kanye nezimpawu ezihambisanayo (i-thrombocytopenia, ukuphazamiseka kwesibindi noma izinso, i-pulmonary edema, ukuphazamiseka kwemizwa). Ngisho nangaphandle kwe-proteinuria, ukuba khona kwalezi zimpawu ezine-hypertension eqhubekayo kuwumhlahlandlela wokuxilongwa.
Ngokubonisana, ochwepheshe bazohlola izilinganiso ze-voltage ngokuphindaphindiwe ukuze bakhiphe inani elingalodwa. isimo esicindezelayoIzimpawu, i-reflexes, isisindo, i-diuresis nayo iyahlolwa futhi kwenziwa ukuhlolwa. ukuhlolwa kwegazi (ama-platelet, ama-enzyme esibindi, i-creatinine) nomchamo wezikhathi ezithile. Ebakhulelweni abane-hypertension yangaphambilini noma yokukhulelwa, ubufakazi bokuthi i-preeclampsia eyengeziwe ngokusebenzisa lezi zindlela zokunquma ezifanayo.
Ukuqapha ingane kuhlanganisa ukubala kwengane. ukunyakaza kwe-fetus, ultrasound nge i-biometry kanye ne-Doppler, ukuhlolwa kokukhula kanye nevolumu ye-amniotic fluid. Ezimweni ezimaphakathi noma ezinzima, amaphrofayili e-biophysical nokuqapha okuvamile kwengezwa ukuze kulindelwe noma yiziphi izimpawu zokucindezeleka.
Izimbangela ze-preeclampsia
Izimbangela eziqondile ze-preeclampsia ne-eclampsia ziyi akwaziwa Kodwa kunezici ezithile ezingaba izimbangela noma izibangeli, okuhlanganisa:
- La ukusakazeka kwegazi okungalungile maqondana nesibeletho
- Imithambo yegazi elimele
- Ukudla okungenamsoco
- Izinkinga zesistimu yomzimba
Namuhla kubhekwa ukuthi ukhiye uku ukufakelwa kwe-placenta okungavamile ngokungasebenzi kahle kwe-endothelial. I-Genetic, i-vascular, kanye ne-immunological mechanisms ithunyelwa ukuthi iguqule izinga lemithanjeni yesibeletho kanye ne-placenta perfusion. Umphumela uba a ukunciphisa umoya-mpilo kanye nokutholakala kwezakhi ku-fetus kanye nokwehla kwezinguquko zesistimu kumama ezikhuphula umfutho wegazi futhi zilimaze ezinye izitho.
Izimbangela ze-eclampsia
I-Eclampsia iphawulwa ukuqala kokuquleka, futhi ine izici ezifanayo ku-preeclampsia, nakuba ezinye izici zihlanganisa:
- Ukukhuluphala
- Omama abane-preeclampsia
- Ifa
- Ukudla okungalungile
- Isistimu yezinzwa emaphakathi enezinkinga
- Izinkinga ze-Neurological
Ngomqondo ongokoqobo, i-eclampsia yi- ukuziphendukela kwemvelo kwemizwa ye-preeclampsia lapho ukulimala kwe-endothelial kanye nomfutho wegazi ophakeme kuthinta ubuchopho, kubangele i-edema, ukucasuka kwe-cortical, nokuwa. Nakuba kungase kwenzeke ngaphandle kwe-proteinuria enzima, ngokuvamile kune-a ukuwohloka okuqhubekayo okudinga ukuqapha kanye nokuthatha isinyathelo kusenesikhathi.
Izici zobungozi kuzo zombili izifo
I-Preeclampsia ne-eclampsia ingahlasela abesifazane abakhulelwa besebancane noma ngaphezulu kwe iminyaka 40. Nakuba kungase kube nezinye izici zobungozi ezifana nalezi:
- Izakhi zofuzo
- Ukukhulelwa kokuqala
- Ozakwethu abasha kukho konke ukukhulelwa
- Ukukhulelwa okuningi
- Ukukhuluphala
- Isifo sikashukela kanye nesifo sikashukela sokukhulelwa
- Isikhathi eside phakathi kokukhulelwa kokunye
- Ingozi yokuthola i-eclampsia iphezulu kubantu besifazane abangenalutho (ngaphandle kokukhulelwa kwangaphambilini) kunalabo asebenazo izingane.
- Ukhuluphele
Lezi zici zengezwa kwamanye aziwa kahle: umfutho wegazi ophezulu ongapheli, isifo sezinsoi-thrombophilia, lupus kanye nokunye ukuphazamiseka kwe-autoimmune, umlando womndeni noma womuntu siqu we-preeclampsia, kanye nobuchwepheshe bokusiza bokuzala. Ukuba ne-preeclampsia ekukhulelweni okudlule kwandisa amathuba okuphinda, ikakhulukazi uma kwenzeka kusenesikhathi. Labo abahlushwa umfutho wegazi ophakeme ongelashiwe noma ababa ne-preeclampsia enzima nabo basengozini enkulu. ingozi yenhliziyo yesikhathi eside, ngakho-ke ukulandela ngemuva kokubeletha kanye nemikhuba yokuphila enempilo kubalulekile.
I-HELLP syndrome
El I-HELLP syndrome Kuyifomu elinzima elihlobene ne-preeclampsia, echazwa ngokuthi hemolysis, ama-enzyme esibindi aphezulu kanye amaplatelets aphansi. Ingavela ngesikhathi sokukhulelwa noma emahoreni angu-48 okuqala ngemva kokubeletha futhi ibonakale ngokucanuzela kwenhliziyo, ukuhlanza, ikhanda elibuhlungu, izinhlungu ezingenhla zesisu, kanye nokugula okuvamile. Kudinga ukulaliswa esibhedlela, ukwelashwa okufana nalokho kwe-preeclampsia/eclampsia enzima, ukumpontshelwa okungase kube khona futhi ngokuvamile, ukunqanyulwa kokukhulelwa kuye ngesimo somtholampilo kanye neminyaka yokukhulelwa.
Ingabe i-preeclampsia ne-eclampsia ingelashwa?
Njengazo zonke izifo, ikhambi noma ukwelashwa kwesifo okungcono kakhulu ukuvimbela. Kungakho ukwelashwa kwe-pre-eclampsia kuhloswe ikakhulu ekuvimbeleni ukukhula kwe-eclampsia. Ngakho-ke kuyadingeka ukuthi ingane izalwe ngokushesha okukhulu ukusindisa impilo yayo noma ngabe kufanele ibe se-incubator isikhathi eside ngangokunokwenzeka. Kodwa-ke, uma owesifazane okhulelwe ethola isifo esisodwa noma esinye ezinyathelweni zokuqala zokukhulelwa, ukubeletha ingane kusenesikhathi kungenzeka kungabi yindlela engcono kakhulu.
Uma i-preeclampsia ithambile, udokotela angase anikeze imithi yokwehlisa umfutho wegazi kanye a ukuphumula okuhlobeneOkhulelwe angase asale esesibhedlela ukuze kuqashwe umfutho wegazi lakhe eduze futhi kuhlolwe yena nosana lwakhe ukuqinisekisa ukuthi baphumile engozini.
Uma i-pre-eclampsia inzima kakhulu futhi nengane ingakwazi ukulethwa, khona-ke nquma i-corticosteroids kowesifazane okhulelwe ukuze ukusheshisa ukuvuthwa kwamaphaphu e-fetus futhi, kwezinye izimo, ukusiza ukuzinzisa ama-platelet kumongo we-HELLP, okusiza ukukhulelwa ukuxazulula ngokuphepha ngangokunokwenzeka.
Ekulawuleni ukungezwani, izidakamizwa eziphephile zibekwe phambili ekukhulelweni njenge i-labetalol, methyldopa o i-hydralazineImithi ephikisanayo iyagwenywa, njenge I-ACE inhibitors o ama-angiotensin receptor blockersKu-preeclampsia emnene, ama-antihypertensives awahlali esetshenziswa uma amazinga engeqi imingcele ethile; inhloso ukugcina amaleveli ngaphakathi kobubanzi obuphephile ngaphandle kokuphazamisa uketshezi lwe-placenta. Akunconywa ukuqeda ngokuphelele usawoti ekudleni ezimweni eziningi; kunconywa ukugcina a i-hydration eyanele futhi unciphise ukucindezeleka ngokomzimba, njengoba kuqondiswa udokotela.
Endabeni ye-eclampsia, ngokuvamile iphathwa ngayo i-magnesium sulphate okubonakala kusebenza ngempumelelo, futhi futhi kuphephile kubo bobabili umama nengane. Uma imithi yehluleka ukulawula umfutho wegazi futhi ingane isesimeni esibucayi sengane, sheshisa abasebenzi ngokuphepha. Uma izimo zingafaneleki noma amaphaphu omntwana engavuthiwe ngokwanele, anikezwa corticosteroids kumama. Umzila wokulethwa uncike esimweni: ngokuvamile umzila okhethwayo ukungeniswa uma kungenzeka, futhi uyaligodla ilungelo isigaba se-Caesarean Uma indlela yesitho sangasese sowesifazane ingasebenzi noma ukuzinza kukamama/kwengane kuyayiphoqa. Ngemva kokungeniswa, izimpawu ngokuvamile ziyadamba phakathi namahora; ngemva kokuhlinzwa, zingase ziqhubeke izinsuku ezimbalwa.
Isikhathi sokuqeda ukukhulelwa sinqunywa ngokusho kwe iminyaka yokukhulelwa, ukuvela komtholampilo, kanye nemiphumela yokuqapha komama nengane. Ngemva kwephuzu elithile, ingozi yokuqhubeka nokukhulelwa idlula leyo yokuzalwa ngaphambi kwesikhathi. Ngaphambi kwamasonto ayisihluthulelo, ukwandisa isikhathi sokukhulelwa kubhekwa ngaphansi kokuqondisa okuqinile esibhedlela, nge amasheke nsuku zonke umfutho wegazi, ukuphuma komchamo, isisindo, amaplatelet, ama-enzyme esibindi kanye ne-creatinine, kanye nama-serial ultrasounds, amaphrofayili e-biophysical kanye ne-Doppler.
Ngemva kokubeletha, umama kufanele ahlale endlini ukubonwa njengoba i-preeclampsia ingakwazi kubi okwesikhashana noma i-debut esikhathini sangemva kokubeletha. Ukulandelela kubalulekile ngoba laba besifazane bethula a ingozi yenhliziyo ephakeme kukho konke ukuphila; ngakho-ke, kuyatuseka ukuthi uhlole njalo umfutho wegazi, i-cholesterol, namazinga kashukela futhi ugcine impilo enempilo yenhliziyo.
Nini ukubonisana ngokuphuthumayo
Owesifazane okhulelwe kufanele athinte uchwepheshe wakhe wokudlulisela phambili uma ethula ikhanda elisha engaphenduli kumaphilisi ezinhlungu avumelekile njengeparacetamol, ukuvuvukala okungazelelwe izandla noma ubuso, ukuphazamiseka okubukwayo, ubuhlungu obukhulu engxenyeni engenhla kwesokudla sesisu, ukuphefumula, umchamo omncane noma a ukuzuza kwesisindo kungazelelweIzimpawu ezingavamile ngesikhathi sokukhulelwa akufanele zifane; ukunakekelwa kusenesikhathi kungavimbela izinkinga.
Lezi zifo ziyingxenye ye- izifo ze-hypertensive zokukhulelwa, okuhlanganisa umfutho wegazi ophakeme ongamahlalakhona, umfutho wegazi ophakeme ngesikhathi sokukhulelwa, kanye ne-preeclampsia enesifo esingamahlalakhona noma esingenaso ngaphambili. Ukuqonda umehluko phakathi kwabo kusiza ukwenza kube ngokwakho ukulandela: umfutho wegazi ophakeme wokukhulelwa awuveli nge-proteinuria noma ukulimala kwesitho futhi ngokuvamile uyanyamalala ngemva kokubeletha; I-preeclampsia, ngakolunye uhlangothi, ihlotshaniswa ne i-proteinuria noma ukubandakanyeka kwezitho zomzimba, futhi idinga isu lokulawula eliqinile.
Yazi izimpawu, uhambisane nemithetho ukuhlolwa kokubeletha futhi ukulandela imiyalelo yethimba lezokwelapha kuyindlela engcono kakhulu yokuvikela wena nosana lwakho. Nakuba ukuqala kwayo kungenakugwenywa ngaso sonke isikhathi, ukuxilongwa kusenesikhathi nokuphathwa ngendlela efanele kunciphisa kakhulu ingozi yezinkinga ezifana ne-eclampsia, ukuqhuma kweplacenta noma ukukhula kombungu okukhawulelwe. Uma uzizwa uxakile noma unezimpawu ezingajwayelekile, unganqikazi ngomzuzwana ukuya kudokotela.
