Ama-Hydrops fetalis

I-Hydrops fetalis yisimo esibi. Kwenzeka lapho amanani angavamile oketshezi akha ezindaweni ezimbili noma ngaphezulu zomzimba wombungu noma usana olusanda kuzalwa. Kuyisibonakaliso sezinkinga eziyisisekelo.

Kunezinhlobo ezimbili zama-hydrops fetalis, immune kanye ne-nonimmune. Uhlobo luxhomeke embangela yoketshezi olungavamile.

• Ama-immune hydrops fetalis imvamisa kuyinkinga yenkinga enkulu yokungahambelani kwe-Rh, engavinjelwa. Lesi yisimo lapho umama onezinhlobo zegazi ezingezinhle ze-Rh enza izivikeli mzimba emangqamuzaneni egazi ane-Rh yengane yakhe, futhi amasosha omzimba awela i-placenta. Ukungahambelani kwe-Rh kubangela ukuthi kubhujiswe inani elikhulu lamaseli abomvu egazini embungwini (Lokhu kwaziwa nangokuthi isifo se-hemolytic sosana olusanda kuzalwa.) Lokhu kuholela ezinkingeni kubandakanya ukuvuvukala okuphelele komzimba. Ukuvuvukala okukhulu kungaphazamisa indlela izitho zomzimba ezisebenza ngayo.
• Ama-hydrops angasebenzi omzimba kuvame kakhulu. Ibalelwa kuma-90% wamacala ama-hydrops. Isimo senzeka lapho isifo noma isimo sezokwelapha sithinta amandla omzimba okuphatha uketshezi. Kunezimbangela ezintathu ezinkulu zalolu hlobo, izinkinga zenhliziyo noma zamaphaphu, i-anemia enamandla (efana ne-thalassemia noma izifo), nezinkinga zofuzo noma zokukhula, kufaka phakathi i-Turner syndrome.

Inani lezingane ezakha ama-immune hydrops fetalis lehlile ngenxa yomuthi obizwa nge-RhoGAM. Lesi sidakamizwa sinikezwa njengomjovo komama abakhulelwe abasengozini yokungahambelani kwe-Rh. Isidakamizwa sibavimbela ekwenzeni ama-antibody ngokumelene namaseli abomvu ezingane zabo. (Kunokunye ukungalingani kwamazinga weqembu legazi okungadala ne-immune hydrops fetalis, kepha iRhoGAM ayisizi ngalokhu.)

Izimpawu zincike ebucayi besimo. Amafomu amancane angadala:

• Ukuvuvukala kwesibindi
• Shintsha umbala wesikhumba (i-pallor)

Izinhlobo ezinzima kakhulu zingadala:

• Izinkinga zokuphefumula
• Amabala okulimaza noma oku-purlish esikhumbeni
• Ukwehluleka kwenhliziyo
• I-anemia enamandla
• I-jaundice enamandla
• Ukuvuvukala okuphelele komzimba

I-ultrasound eyenziwe ngesikhathi sokukhulelwa ingakhombisa:

• Izinga eliphakeme le-amniotic fluid
• I-placenta enkulu ngokungajwayelekile
• Uketshezi olubangela ukuvuvukala ngaphakathi nangaseduze kwezitho zomntwana ezingakazalwa, kufaka phakathi isibindi, ubende, inhliziyo, noma indawo yamaphaphu

Kuzokwenziwa i-amniocentesis kanye ne-ultrasounds ejwayelekile ukunquma ubunzima besimo.

Ukwelashwa kuya ngesizathu. Ngesikhathi sokukhulelwa, ukwelashwa kungafaka:

• Umuthi wokubangela ukubeletha ngaphambi kwesikhathi kanye nokulethwa kwengane
• Ukulethwa ngaphambi kwesikhathi kokuhlinzwa uma isimo siba sibi kakhulu
• Ukunikeza ingane ingane igazi ngenkathi isisesibelethweni (ukumpontshelwa igazi ngaphakathi kwe-intrauterine)

Ukwelashwa kwengane esanda kuzalwa kungabandakanya:

• Kuma-immune hydrops, ukumpontshelwa okuqondile kwamangqamuzana abomvu egazi afana nohlobo lwegazi losana. Ukumpontshelwa kokushintshwa ukuze kususwe umzimba wengane yezinto ezibhubhisa amangqamuzana abomvu egazi nakho kuyenziwa.
• Ukususa uketshezi olungeziwe emaphashini nasezilungwini zesisu ngenaliti.
• Imithi yokulawula ukwehluleka kwenhliziyo nokusiza izinso ukukhipha uketshezi oluthe xaxa.
• Izindlela zokusiza ingane ukuthi iphefumule, njengomshini wokuphefumula (i-ventilator).

I-Hydrops fetalis ivame ukuholela ekufeni kosana ngaphambi nje noma ngemuva kokubeletha. Ingozi iphezulu kakhulu ezinganeni ezizalwa kusenesikhathi noma ezigulayo lapho zizalwa. Izingane ezinokukhubazeka kwesakhiwo, futhi lezo ezingenasizathu esikhonjwayo sama-hydrops nazo zisengozini enkulu.

Ukulimala kobuchopho okuthiwa i-kernicterus kungenzeka esimweni sokungahambelani kwe-Rh. Ukubambezeleka kwentuthuko kubonakale ezinganeni ezithola ukumpontshelwa i-intrauterine.

Ukungahambelani kwe-Rh kungavinjelwa uma umama enikezwa i-RhoGAM ngesikhathi sokukhulelwa nangemva kokukhulelwa.

• Ama-Hydrops fetalis

UDahlke JD, uMagann EF. Ama-hydrops ama-immune kanye nama-nonimmune. Ku: Martin RJ, Fanaroff AA, Walsh MC, ama-eds. UFanaroff kanye neMithi kaMartin's Neonatal-Perinatal Medicine. Umhlaka 10. IPhiladelphia, PA: Elsevier Saunders; 2015: isahluko 24.

ULanglois S, Wilson RD. Ama-hydrops we-Fetal. Ku: Pandya PP, Oepkes D, Sebire NJ, Wapner RJ, ama-eds. Imithi ye-Fetal: Isayensi Eyisisekelo kanye Nokuzijwayeza Komtholampilo. 3rd ed. IPhiladelphia, PA: Elsevier; 2020: isahluko 36.

ISuhrie KR, iThabbah SM. Ukukhulelwa okuyingozi kakhulu. 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 114.