Myelomeningocele

IMyelomeningocele ukukhubazeka kokuzalwa lapho umgogodla nomsele womgogodla ungavali ngaphambi kokuzalwa.

Isimo uhlobo lwe-spina bifida.

Imvamisa, phakathi nenyanga yokuqala yokukhulelwa, izinhlangothi zombili zomgogodla womntwana (noma umgogodla) ziyahlangana ukumboza umgogodla, izinzwa zomgogodla, nama-meninges (izicubu ezihlanganisa umgogodla). Ubuchopho obukhulayo nomgogodla kuleli phuzu babizwa ngokuthi i-neural tube. I-Spina bifida isho noma yikuphi ukukhubazeka kokuzalwa lapho i-neural tube endaweni yomgogodla ihluleka ukuvalwa ngokuphelele.

I-Myelomeningocele yisici se-neural tube lapho amathambo omgogodla engakheki ngokuphelele. Lokhu kubangela umsele womgogodla ongaphelele. Intambo yomgogodla nama-meninges kuphuma emhlane wengane.

Lesi simo singathinta ingane eyodwa kwezingu-4,000.

Amanye amacala we-spina bifida ajwayelekile kakhulu:

• ISpina bifida occulta, isimo lapho amathambo omgogodla angavali khona. Intambo yomgogodla nama-meninges kuhlala endaweni futhi isikhumba imboza ukukhubazeka.
• I-Meningoceles, isimo lapho ama-meninges aphuma khona ekukhubazekeni komgogodla. Intambo yomgogodla ihlala isendaweni.

Okunye ukuphazamiseka kokuzalwa noma ukukhubazeka kokuzalwa nakho kungaba khona enganeni ene-myelomeningocele. Izingane eziyisishiyagalombili kweziyishumi ezinalesi sifo zine-hydrocephalus.

Ezinye izinkinga zomgogodla noma uhlelo lwe-musculoskeletal zingabonakala, kufaka phakathi:

• I-Syringomyelia (i-cyst egcwele uketshezi ngaphakathi kwentambo yomgogodla)
• Ukuhlukaniswa kwe-Hip

Isizathu se-myelomeningocele asikaziwa. Kodwa-ke, amazinga aphansi e-folic acid emzimbeni wowesifazane ngaphambi nangesikhathi sokukhulelwa kwasekuqaleni abonakala edlala indima kulolu hlobo lokukhubazeka kokuzalwa. I-Folic acid (noma i-folate) ibalulekile ekuthuthukiseni ubuchopho nomgogodla.

Uma ingane izalwa ine-myelomeningocele, izingane zesikhathi esizayo kulowo mndeni zinengozi enkulu kunabantu abaningi. Kodwa-ke, ezimweni eziningi, akukho ukuxhumana komndeni. Izici ezinjengesifo sikashukela, ukukhuluphala ngokweqile, nokusetshenziswa kwemithi elwa nokuquleka kunina kungandisa ubungozi balesi sifo.

Usana olusanda kuzalwa olunalesi sifo luyoba nendawo evulekile noma isikhwama esigcwele uketshezi maphakathi nendawo ukwehla emuva.

Izimpawu zingafaka:

• Ukulahlekelwa yisinye noma ukulawulwa kwamathumbu
• Ukuntuleka okuncane noma okuphelele kwemizwa
• Ukukhubazeka okuyingxenye noma okuphelele kwemilenze
• Ubuthakathaka bezinqulu, imilenze, noma izinyawo zosana olusanda kuzalwa

Ezinye izimpawu kanye / noma izimpawu zingafaka:

• Izinyawo noma imilenze engajwayelekile, efana ne-clubfoot
• Ukwakhiwa koketshezi ngaphakathi kogebhezi (i-hydrocephalus)

Ukuhlolwa ngaphambi kokubeletha kungasiza ukuthola lesi simo. Ngesikhathi se-trimester yesibili, abesifazane abakhulelwe bangahlolwa igazi elibizwa nge-quadruple screen. Lesi sivivinyo sihlola i-myelomeningocele, i-Down syndrome, nezinye izifo zokuzalwa kwengane. Iningi labesifazane abaphethe umntwana one-spina bifida bazoba nezinga eliphakeme leprotheyini elibizwa nge-maternal alpha fetoprotein (AFP).

Uma ukuhlolwa kwesikrini se-quadruple kulungile, ukuhlolwa okuqhubekayo kuyadingeka ukuqinisekisa ukuxilongwa.

Ukuhlolwa okunjalo kungafaka:

• I-ultrasound yokukhulelwa
• I-Amniocentesis

IMyelomeningocele ingabonakala ngemuva kokuzalwa kwengane. Ukuhlolwa kwe-neurologic kungakhombisa ukuthi ingane ilahlekelwe yimisebenzi ehlobene nezinzwa ngaphansi kwesici. Isibonelo, ukubuka ukuthi usana luphendula kanjani lapho kunqatshelwa izingcwecwe ezindaweni ezahlukahlukene kungatshela lapho ingane ingayizwa khona imizwa.

Ukuhlolwa okwenziwe enganeni ngemuva kokuzalwa kungafaka ama-x-ray, i-ultrasound, i-CT, noma i-MRI yendawo yomgogodla.

Umhlinzeki wezokunakekelwa kwempilo angaphakamisa ukwelulekwa ngezakhi zofuzo. Ukuhlinzwa kwe-intrauterine ukuvala isici (ngaphambi kokuba umntwana azalwe) kunganciphisa ubungozi bezinkinga ezithile zakamuva.

Ngemuva kokuzalwa kwengane yakho, kuvame ukuphakanyiswa ukuhlinzekela ukulungisa isici ezinsukwini ezimbalwa zokuqala zokuphila. Ngaphambi kokuhlinzwa, usana kufanele luphathwe ngokucophelela ukunciphisa ukulimala komgogodla oveziwe. Lokhu kungafaka:

• Ukunakekelwa okukhethekile nokuma
• Imishini yokuvikela
• Izinguquko ezindleleni zokuphatha, ukondla nokugeza

Izingane ezine-hydrocephalus zingadinga ukufakwa kwe-ventriculoperitoneal shunt. Lokhu kuzosiza ukukhipha uketshezi oluthe xaxa kusuka kuma-ventricles (ebuchosheni) kuya emgodini we-peritoneal (esiswini).

Ama-antibiotic angasetshenziswa ukwelapha noma ukuvimbela izifo ezifana ne-meningitis noma izifo zomgudu womchamo.

Iningi lezingane lizodinga ukwelashwa impilo yonke ezinkingeni ezibangelwa ukulimala komgogodla nezinzwa zomgogodla.

Lokhu kufaka:

• Izinkinga zesinye namathumbu - Ukucindezela okuncane okuya phansi kwesinye kungasiza ukukhipha isinye. Amashubhu okuhambisa amanzi, abizwa ngokuthi ama-catheters, nawo angadingeka. Izinhlelo zokuqeqesha amathumbu kanye nokudla okuphezulu kwe-fiber kungathuthukisa ukusebenza kwamathumbu.
• Izinkinga zemisipha namalunga - I-Orthopedic noma ukwelashwa ngokomzimba kungadingeka ukwelapha izimpawu zemisipha. Ama-brace angadingeka. Abantu abaningi abane-myelomeningocele ikakhulukazi basebenzisa isihlalo sabakhubazekile.

Izivivinyo zokulandelela ngokuvamile ziyaqhubeka kuyo yonke impilo yengane. Lokhu kwenziwa ku:

• Bheka inqubekela phambili yentuthuko
• Phatha noma yiziphi izinkinga zengqondo, zezinzwa noma zomzimba

Abahlengikazi abavakashelayo, izinsizakalo zezenhlalakahle, amaqembu okusekela, kanye nama-ejensi endawo anganikeza ukusekelwa ngokomzwelo futhi asize ngokunakekelwa kwengane ene-myelomeningocele enezinkinga noma ukulinganiselwa okukhulu.

Ukubamba iqhaza eqenjini lokusekela le-spina bifida kungasiza.

I-myelomeningocele ivame ukulungiswa ngokuhlinzwa, kepha izinzwa ezithintekile kungenzeka zingasebenzi ngokujwayelekile. Ukuphakama kwendawo lapho kukhubazeka khona emhlane wengane, izinzwa eziningi zizothinteka.

Ngokwelashwa kokuqala, ubude bempilo abuthinteki kakhulu. Izinkinga zezinso ngenxa yokungasebenzi kahle komchamo yizimbangela ezivame kakhulu zokufa.

Iningi lezingane lizoba nobuhlakani obujwayelekile. Kodwa-ke, ngenxa yengozi ye-hydrocephalus ne-meningitis, eziningi zalezi zingane zizoba nezinkinga zokufunda nokuphazamiseka kokuquleka.

Izinkinga ezintsha ngaphakathi komgogodla zingakhula kamuva empilweni, ikakhulukazi ngemuva kokuthi ingane iqale ukukhula ngokushesha ngesikhathi sokuthomba. Lokhu kungaholela ekulahlekelweni okuningi kokusebenza kanye nezinkinga zamathambo ezifana ne-scoliosis, ukukhubazeka kwezinyawo noma kweqakala, okhalweni olususukile, nokuqina okuhlangene noma izinkontileka.

Abantu abaningi abane-myelomeningocele ikakhulukazi basebenzisa isihlalo sabakhubazekile.

Izinkinga ze-spina bifida zingafaka:

• Ukuzalwa okubuhlungu nokulethwa kanzima komntwana
• Ukutheleleka kaningi komchamo
• Ukwakhela uketshezi ebuchosheni (i-hydrocephalus)
• Ukulahlekelwa wukulawulwa kwamathumbu noma kwesinye
• Ukutheleleka kobuchopho (meningitis)
• Ubuthakathaka obungapheli noma ukukhubazeka kwemilenze

Lolu hlu kungenzeka lungabandakanyi konke.

Shayela umhlinzeki wakho uma:

• Isaka noma indawo evulekile iyabonakala emgogodleni wosana olusanda kuzalwa
• Ingane yakho yephuze ukuhamba noma ukukhasa
• Izimpawu ze-hydrocephalus ziyakhula, kufaka phakathi indawo ethambile, ukucasula, ukulala ngokweqile nobunzima bokudla
• Izimpawu ze-meningitis ziyakhula, kufaka phakathi umkhuhlane, intamo eqinile, ukucasuka, kanye nokukhala okuphezulu

Izengezo ze-Folic acid zingasiza ekwehliseni ubungozi bokukhubazeka kwamathambo we-neural njenge-myelomeningocele. Kunconywa ukuthi noma yimuphi owesifazane ocabanga ukukhulelwa athathe u-0,4 mg we-folic acid ngosuku. Abesifazane abakhulelwe abanengozi enkulu badinga umthamo ophakeme.

Kubalulekile ukukhumbula ukuthi ukushoda kwe-folic acid kufanele kulungiswe ngaphambi kokukhulelwa, ngoba amaphutha akhula ngokushesha kakhulu.

Abesifazane abahlela ukukhulelwa bangahlolwa ukuze kutholakale inani le-folic acid egazini labo.

UMeningomyelocele; I-Spina bifida; Umgogodla ocacile; Isici se-Neural tube (NTD); Isici sokuzalwa - myelomeningocele

• I-Ventriculoperitoneal shunt - ukukhipha

• I-Spina bifida
• I-Spina bifida (amadigri obukhali)

IKomidi Lokuzivocavoca Ngokubeletha, Inhlangano Yezokwelapha Komama Abakhulelwe. I-American College of Obstetricians kanye neGynecologists. Umbono weKomidi le-ACOG cha. I-720: ukuhlinzekwa komama-fetus kwe-myelomeningocele. Isikhubekiso seGynecol. 2017; 130 (3): e164-e167. I-PMID: 28832491 pubmed.ncbi.nlm.nih.gov/28832491/.

UKinsman SL, uJohnston MV. Okuzenzakalelayo kokuzalwa kwesistimu yezinzwa emaphakathi. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 609.

U-Licci M, Guzman R, Soleman J. Izinkinga zomama nezokubelethisa ekuhlinzweni kwengane ngokulungiswa kokubeletha kwe-myelomeningocele: ukubuyekeza okuhlelekile.Ukugxila kweNeurosurg. 2019; 47 (4): E11. I-PMID: 31574465 pubmed.ncbi.nlm.nih.gov/31574465/.

UWilson P, uStewart J. Meningomyelocele (spina bifida). Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 732.