Preeclampsia

IPreeclampsia umfutho wegazi ophakeme nezimpawu zokulimala kwesibindi noma izinso ezenzeka kubantu besifazane ngemuva kweviki lama-20 lokukhulelwa. Yize kuyivelakancane, i-preeclampsia nayo ingenzeka kowesifazane ngemuva kokubeletha ingane yakhe, imvamisa kungakapheli amahora angama-48. Lokhu kubizwa nge-postpartum preeclampsia.

Imbangela ngqo ye preeclampsia ayikaziwa. Kwenzeka cishe ku-3% kuya ku-7% wakho konke ukukhulelwa. Isimo kucatshangwa ukuthi siqala ku-placenta. Izici ezingaholela ekukhuleni kwe- preeclampsia zifaka:

• Ukuphazamiseka okuzenzakalelayo
• Izinkinga zomthambo wegazi
• Ukudla kwakho
• Izakhi zofuzo zakho

Izici ezinobungozi zalesi simo zifaka:

• Ukukhulelwa kokuqala
• Umlando owedlule we-preeclampsia
• Ukukhulelwa okuningi (amawele noma ngaphezulu)
• Umlando womndeni we-preeclampsia
• Ukukhuluphala ngokweqile
• Ukuba mdala kuneminyaka yobudala engama-35
• Ukuba yi-African American
  
• Umlando wesifo sikashukela, umfutho wegazi ophakeme, noma isifo sezinso
• Umlando wesifo se-thyroid

Imvamisa, abesifazane abane-preeclampsia abazizwa begula.

Izimpawu ze-preeclampsia zingafaka:

• Ukuvuvukala kwezandla nobuso noma amehlo (i-edema)
• Ukuzuza kwesisindo ngokungazelelwe ngaphezulu kwezinsuku ezi-1 kuye kwezi-2 noma ngaphezulu kwamakhilogremu ama-2 (0.9 kg) ngesonto

Qaphela: Okunye ukuvuvukala kwezinyawo namaqakala kubhekwa njengokujwayelekile ngesikhathi sokukhulelwa.

Izimpawu ze-preeclampsia ezinzima zifaka:

• Ikhanda elingapheli noma liba libi kakhulu.
• Ukuphefumula kanzima.
• Ubuhlungu besisu ohlangothini lwesokunene, ngaphansi kwezimbambo. Ubuhlungu bungazwakala ehlombe langakwesokudla, futhi bungadideka nesilungulela, ubuhlungu benyongo, igciwane lesisu, noma ukukhahlela ingane.
• Ukungachami kaningi.
• Ukucanuzela kwenhliziyo nokuhlanza (uphawu olukhathazayo).
• Izinguquko zombono, kufaka phakathi ubumpumputhe besikhashana, ukubona amalambu akhanyayo noma amabala, ukuzwela ekukhanyeni, nokungaboni kahle.
• Ukuzizwa unekhanda elincane noma uqulekile.

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa komzimba. Lokhu kungakhombisa:

• Umfutho wegazi ophezulu, uvame ukuba ngaphezu kuka-140/90 mm Hg
• Ukuvuvukala ezandleni nasebusweni
• Ukuzuza kwesisindo

Kuzokwenziwa ukuhlolwa kwegazi nomchamo. Lokhu kungakhombisa:

• Amaprotheni emchameni (proteinuria)
• Ama-enzyme wesibindi aphakeme kunokujwayelekile
• Ukubalwa kweplatelet okuphansi
• Amazinga we-creatinine aphakeme kunokujwayelekile egazini lakho
• Amazinga aphezulu e-uric acid

Izivivinyo zizokwenziwa futhi ukuze:

• Bona ukuthi igazi lakho liqina kanjani
• Qapha impilo yengane

Imiphumela yokukhulelwa kwe-ultrasound, ukuhlolwa okungekho ukucindezeleka, nezinye izivivinyo kuzosiza umhlinzeki wakho anqume ukuthi ngabe ingane yakho idinga ukulethwa khona manjalo.

Abesifazane ababenengcindezi yegazi ephansi ekuqaleni kokukhulelwa kwabo, kulandelwa ukukhuphuka okukhulu kwengcindezi yegazi badinga ukubhekelwa eduze kwezinye izimpawu ze-preeclampsia.

I-Preeclampsia ivame ukuxazulula ngemuva kokuzalwa kwengane kanye ne-placenta ilethwayo. Noma kunjalo, ingaqhubeka noma iqale ngemuva kokubeletha.

Imvamisa, emasontweni angama-37, ingane yakho ikhula ngokwanele ukuba ibe nempilo ngaphandle kwesibeletho.

Ngenxa yalokhu, umhlinzeki wakho uzofuna ukuthi ingane yakho ilethwe ukuze i-preeclampsia ingabi kubi kakhulu. Ungathola imithi yokusiza ukuqala umsebenzi, noma ungadinga isigaba se-C.

Uma ingane yakho ingakakhuli ngokuphelele futhi une-preeclampsia emnene, lesi sifo singaphathwa ekhaya kuze kube yilapho ingane yakho isikhulile. Umhlinzeki uzoncoma:

• Ukuvakasha njalo kodokotela ukuqinisekisa ukuthi wena nengane yakho nisebenza kahle.
• Imithi yokwehlisa umfutho wegazi (kwesinye isikhathi).
• Ubukhulu be-preeclampsia bungashintsha ngokushesha, ngakho-ke uzodinga ukulandelelwa ngokucophelela okukhulu.

Ukuphumula kombhede ngokuphelele akusanconywa.

Kwesinye isikhathi, owesifazane okhulelwe one-preeclampsia ungeniswa esibhedlela. Lokhu kuvumela ithimba lezokunakekelwa kwezempilo ukuthi libheke kakhulu ingane nomama.

Ukwelashwa esibhedlela kungafaka:

• Vala ukuqapha komama nengane
• Imithi yokulawula umfutho wegazi nokuvikela ukuqubuka nezinye izinkinga
• Imijovo ye-steroid yokukhulelwa ngaphansi kwamasonto angama-34 ukukhulelwa ukusiza ukusheshisa ukukhula kwamaphaphu engane

Wena nomhlinzeki wakho nizoqhubeka nokuxoxa ngesikhathi esiphephe kunazo zonke sokubeletha ingane yakho, ucabangela lokhu:

• Usondele kangakanani osukwini lwakho olubekiwe.
• Ubukhulu be-preeclampsia. IPreeclampsia inezinkinga eziningi ezinzima ezingalimaza umama.
• Iqhuba kahle kanjani ingane esibelethweni.

Ingane kufanele ibelethwe uma kunezimpawu ze-preeclampsia ebucayi. Lokhu kufaka phakathi:

• Ukuhlolwa okukhombisa ukuthi ingane yakho ayikhuli kahle noma ayitholi igazi nomoya-mpilo owenele.
• Inombolo engezansi yengcindezi yakho yegazi ingaphezu kuka-110 mm Hg noma ingaphezu kuka-100 mm Hg ngokungaguquguquki esikhathini esingamahora angama-24.
• Imiphumela yokuhlolwa kwesibindi engajwayelekile.
• Izinhlungu zekhanda ezinzima.
• Ubuhlungu endaweni yesisu (isisu).
• Ukuquleka noma izinguquko ekusebenzeni kwengqondo (eclampsia).
• Ukwanda ketshezi emaphashini kamama.
• I-HELLP syndrome (ayivamile).
• Ukubalwa kweplatelet okuphansi noma ukopha.
• Ukukhishwa komchamo ophansi, amaprotheni amaningi emchameni, nezinye izimpawu zokuthi izinso zakho azisebenzi kahle.

Izimpawu nezimpawu ze-preeclampsia zivame ukuphela kungakapheli amasonto ayisithupha ngemuva kokubeletha. Kodwa-ke, umfutho wegazi ophezulu kwesinye isikhathi uba kubi ezinsukwini ezimbalwa zokuqala ngemuva kokubeletha. Usesengozini ye-preeclampsia kuze kube amasonto ayisithupha ngemuva kokubeletha. Le postrartum preeclampsia inengozi enkulu yokufa. Uma ubona noma yiziphi izimpawu ze-preeclampsia, thintana nomhlinzeki wakho wokunakekelwa kwezempilo ngokushesha.

Uma uke waba ne-preeclampsia, kungenzeka ukuthi uyiphinde uyithuthukise futhi ngesikhathi sokukhulelwa. Ezimweni eziningi, ayinzima njengasekuqaleni.

Uma unengcindezi ephezulu yegazi ngesikhathi sokukhulelwa okungaphezu kokukodwa, maningi amathuba okuthi ube nomfutho wegazi ophezulu lapho ukhula.

Izinkinga ezijwayelekile kodwa ezinzima zomama zingabandakanya:

• Izinkinga zokopha
• Ukuquleka (eclampsia)
• Ukubambezeleka kokukhula kwengane
• Ukuhlukaniswa ngaphambi kwesikhathi kwe-placenta esibelethweni ngaphambi kokuzalwa kwengane
• Ukudabuka kwesibindi
• Unhlangothi
• Ukufa (kuyaqabukela)

Ukuba nomlando we-preeclampsia kwenza owesifazane abe sengozini enkulu yezinkinga zesikhathi esizayo ezifana nalezi:

• Isifo senhliziyo
• Isifo sikashukela
• Isifo sezinso
• Umfutho wegazi ophakeme ongapheli

Shayela umhlinzeki wakho uma unezimpawu ze-preeclampsia ngesikhathi ukhulelwe noma ngemuva kokubeletha.

Ayikho indlela eqinisekile yokuvimbela i-preeclampsia.

• Uma udokotela wakho ecabanga ukuthi usengozini enkulu yokuthola i-preeclampsia, bangaphakamisa ukuthi uqale i-aspirin yengane (81 mg) nsuku zonke ngasekupheleni kwe-trimester yokuqala noma ekuqaleni kwe-trimester yesibili yokukhulelwa kwakho. Kodwa-ke, UNGAQALI i-aspirin yengane ngaphandle kokuthi ubonane nodokotela wakho kuqala.
• Uma udokotela wakho ecabanga ukuthi ukudla kwakho kwe-calcium kuphansi, bangaphakamisa ukuthi uthathe isithasiselo se-calcium nsuku zonke.
• Azikho ezinye izindlela ezithile zokuvimbela i-preeclampsia.

Kubalulekile ukuthi bonke abesifazane abakhulelwe baqale ukunakekelwa ngaphambi kokubeletha futhi baqhubeke nokukhulelwa nangemva kokubeletha.

I-toxemia; Umfutho wegazi ophezulu okhulelwe (PIH); Umfutho wegazi ophezulu wokukhulelwa; Umfutho wegazi ophezulu - i-preeclampsia

• Preeclampsia

I-American College of Obstetricians kanye neGynecologists; Task Force on Hypertension in Pregnancy. Umfutho wegazi ophakeme lapho ukhulelwe. Umbiko we-American College of Obstetricians and Gynecologists ’Task Force on Hypertension in Pregnancy. Isikhubekiso seGynecol. 2013; 122 (5): 1122-1131. I-PMID: 24150027 pubmed.ncbi.nlm.nih.gov/24150027/.

UHarper LM, uTita A, Karumanchi SA. Umfutho wegazi ophathelene nokukhulelwa. Ku: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, abahleli. ICreasy neResnik's Maternal-Fetal Medicine: Izimiso kanye Nokuzijwayeza. Umhlaka 8. IPhiladelphia, PA: Elsevier; 2019: isahluko 48.

Sibai BM. I-Preeclampsia nokuphazamiseka kwe-hypertensive. I-Landon MB, i-Galan HL, i-Jauniaux ERM, et al, ama-eds. Ama-Obstetrics kaGabbe: Ukukhulelwa Okujwayelekile Nenkinga. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2021: isahluko 38.