Izimpawu zokuzalwa ngaphambi kwesikhathi, izimbangela kanye nezinkinga ezingaba khona

-Delile

• Izimbangela eziyinhloko
• Izimpawu nezimpawu zokuzalwa ngaphambi kwesikhathi
• Izinkinga ezingenzeka
• Ungakuvimbela kanjani ukuzalwa ngaphambi kwesikhathi

Ukuzalwa ngaphambi kwesikhathi kuhambelana nokuzalwa kwengane ngaphambi kwamasonto angama-37 okukhulelwa, okungenzeka ngenxa yokutheleleka kwesibeletho, ukuqhekeka ngaphambi kwesikhathi kwesikhwama se-amniotic, ibhande le-placenta noma izifo ezihlobene nowesifazane, njenge-anemia noma i-pre-eclampsia, isibonelo.

Lesi simo singabonakala ngezimpawu ezithile njengokufinywa kwesibeletho okuvamile nokujwayelekile, ukukhuphuka kwesitho sangasese sowesifazane kanye nengcindezi noma ubuhlungu esifundeni se-pelvic, ngokwesibonelo. Kubalulekile ukuthi owesifazane aye esibhedlela ngokushesha lapho ezwa lezi zimpawu, ngoba ukubeletha ngaphambi kwesikhathi kungadala ubungozi enganeni, ngoba kuye ngobudala bokukhulelwa izitho zisengakhula kahle, futhi kungaba nezinkinga inhliziyo nobunzima bokuphefumula, isibonelo.

Ngakho-ke, esimweni sokusebenza ngaphambi kwesikhathi, udokotela angazama ukuhlehlisa ukubeletha esebenzisa imishanguzo namasu okuvikela ukuvinjelwa kwesibeletho nokunwebeka, noma kunjalo, kunzima ukukwazi ukuhlehlisa ukulethwa isikhathi esingaphezu kwamahora angama-48 kuye kwangama-72. Endabeni yokuzalwa kwengane engakazalwa, kujwayelekile ukuthi uhlale kwi-ICU esanda kuzalwa ukuze ukubhekwa kwayo kubhekwe futhi kuvinjelwe izinkinga.

Izimbangela eziyinhloko

Ukuzalwa ngaphambi kwesikhathi kungenzeka kakhulu kubantu besifazane abangaphezu kweminyaka engama-35 noma engaphansi kwengu-16, ukhulelwe amawele, uphinde wazalwa ngaphambi kwesikhathi noma lapho elahlekelwa yigazi esithweni sangasese sesithathu sesithathu sokukhulelwa. Ngaphezu kwalokho, ezinye izimo ezingadala umsebenzi ngaphambi kwesikhathi yilezi:

• Ukuqhekeka ngaphambi kwesikhathi kwesikhwama se-amniotic;
• Ukwenza buthakathaka komlomo wesibeletho;
• Ukutheleleka kwamagciwane I-Streptococcus agalactiae (iqembu B streptococcus);
• Ibutho le-Placental;
• Pre eclampsia;
• Ukushoda kwegazi;
• Izifo ezifana nesifo sofuba, ugcunsula, ukutheleleka kwezinso;
• Ukukhulelwa amawele;
• In vitro fertilization;
• Ukukhubazeka kwengane;
• Umzamo omkhulu womzimba;
• Ukusetshenziswa kwezidakamizwa ezingekho emthethweni neziphuzo ezidakayo;
• Ubukhona be-fibroids esibelethweni.

Ngaphezu kwalokho, abesifazane abanomlando we-vaginosis nabo basengozini enkulu yokuzalwa ngaphambi kwesikhathi, ngoba amanye amabhaktheriya angakhipha ubuthi futhi akhuthaze ukukhishwa kwama-cytokines nama-prostaglandin athanda ukubeletha. Okunye ukudla nezitshalo zokwelapha nakho kungakhuthaza ukusikwa kwesibeletho futhi kukhuthaze ukusebenza ngaphambi kwesikhathi futhi, ngakho-ke, kuyaphikiswa ngesikhathi sokukhulelwa. Bheka uhlu lwetiye okungafanele ukuthi owesifazane okhulelwe azidle.

Izimpawu nezimpawu zokuzalwa ngaphambi kwesikhathi

Owesifazane angasola ukuthi uya emsebenzini ngaphambi kwesikhathi lapho enezimpawu nezimpawu ezifana ne:

• Ukuphambana kwesibeletho;
• Ingcindezi ngaphansi kwesisu;
• Isifiso esengeziwe sokuchama;
• Ukwanda kokukhishwa kwesitho sangasese sowesifazane, okuba yi-gelatinous futhi kungahle kungaqukathi imikhondo yegazi;
• Ubuhlungu phansi emuva;
• Uhudo kwezinye izimo;
• I-colic enkulu.

Ngakho-ke, uma owesifazane eletha lezi zimpawu ngaphambi kwamasonto angama-37 ekhulelwe, kubalulekile ukuthi abize udokotela wababelethisi bese eya esibhedlela ayohlolwa bese kuthathwa izinyathelo ezidingekayo.

Ukuqinisekisa ukuthi kunengozi yokuzalwa ngaphambi kwesikhathi futhi unqume ukuthi uzokwenzenjani kuleli cala, udokotela uzokwazi ukuhlola ukulinganiswa kwesibeletho sesibeletho nge-ultrasound engaphandle kanye nokuba khona kwe-fibronectin ye-fetal ekusithekeni kwesitho sangasese sowesifazane.

Isilinganiso esingaphezu kwama-30 mm emlomo wesibeletho sikhombisa ubungozi obukhulu bokulethwa zingakapheli izinsuku eziyi-7 futhi abesifazane abanalo leli nani kufanele bahlolwe i-fibronectin. Uma owesifazane enezilinganiso eziphakathi kuka-16 no-30 mm kodwa i-fibronectin engalungile yomntwana unobungozi obuphansi bokulethwa, noma kunjalo, lapho i-fibronectin ye-fetal inempilo, kunengozi yokulethwa kungakapheli amahora angama-48.

Izinkinga ezingenzeka

Izinkinga zokuzalwa ngaphambi kwesikhathi zihlobene nesikhathi sokukhulelwa kwengane lapho izalwa, futhi kungahle kube khona:

• Ukulethwa ngaphambi kwesikhathi emasontweni angama-23 kuya kwangu-25:izimo eziningi zingakhula ukukhubazeka okukhulu, njengokukhubazeka kobuchopho, ukungaboni noma ukungezwa;
• Ukulethwa ngaphambi kwesikhathi emasontweni angama-26 nama-27: ezinye izimo zingakhula nokukhubazeka okulingene, njengokukhubazeka kokubona, ukungabi namandla okulawula izimoto, i-asthma engapheli nobunzima ekufundeni;
• Ukulethwa ngaphambi kwesikhathi emasontweni angama-29 kuya kwangama-31: iningi lezingane likhula ngaphandle kwezinkinga, kepha ezinye zingaba nezinhlobo eziphansi zokukhubazeka kobuchopho nezinkinga zokubuka;
• Ukuzalwa ngaphambi kwesikhathi emasontweni angama-34 kuya kwangu-36: izingane ezizalwe ngaphambi kwesikhathi zikhula ngendlela efanayo nalabo abazalwa ngesikhathi, kepha maningi amathuba okuthi babe nezinkinga zokukhula nezokufunda.

Ngokuvamile, izingane ezizalwe ngaphambi kwesikhathi zifakwa ku-incubator, ngoba azikwazi ukugcina ukushisa komzimba. Ngakho-ke, le divayisi igcina izinga lokushisa nomswakama kufana nesibeletho, ivumela ukukhula kwayo.

Izingane ezingaphansi kwamasonto angama-34 ezikhulelwe zingase zixhunywe kuzinto zokuphefumula, njengoba ngaphambi kwamasonto angama-34 okukhulelwa zintula i-surfactant, into eyenza ukufakwa komoya emaphashini futhi, ngenxa yalesi sizathu, izimpawu ezinjengombala oluhlaza okwesibhakabhaka zingavela. nezipikili zeminwe, izindebe namakhala ekhaleni.

Ngaphezu kwalokho, izingane ezizalwe ngaphambi kwesikhathi zisengozini enkulu yokuphindaphindeka komzimba, okunciphisa ikhono lokubona, ngakho-ke zonke izingane ezingakazalwa zidinga ukugqoka isichibi samehlo ngenkathi zise-ICU yokuzalwa. Ingane idedelwa ekhaya kuphela lapho ifinyelela ku-2 kg nalapho izitho zayo sezivele zikhule ngokwengeziwe, ukuze ikwazi ukugwinya ngaphandle kweshubhu futhi iphefumule ngaphandle kosizo lwamadivayisi.

Ungakuvimbela kanjani ukuzalwa ngaphambi kwesikhathi

Ukugwema ukuzalwa ngaphambi kwesikhathi, lokho owesifazane okhulelwe angakwenza ngesikhathi sonke sokukhulelwa ukugwema ukuzivocavoca umzimba ngokweqile nokulandela yonke imihlahlandlela yababelethisi ngesikhathi sokubonisana ngaphambi kokubeletha.

Kodwa-ke, uma ukulethwa kuqala ngaphambi kwesikhathi esilindelekile, udokotela wokubelethisa angancoma ukusetshenziswa kwemithi efana ne-corticosteroids noma i-oxytocin antagonists, engasetshenziswa phakathi kwamasonto angama-25 nama-37 okukhulelwa. Lezi zindlela zokuvimbela ukubeletha ngaphambi kwesikhathi kufanele zenziwe ngenkathi usesibhedlela futhi zisetshenziswe ngokuya ngezinzuzo zomama nengane.