Izimbangela Zomsebenzi Wangaphambi Kokusebenza: Ukwelashwa Komlomo Wesibeletho Ongenamandla

-Delile

• Kwenziwa Kanjani I-Cerclage?
• Kwenziwa Nini I-Cerclage?
• Yiziphi izingqinamba ezingaba khona?
• Kwenzekani Kamuva?
• Kwenzekani Kamuva?
• Iphumelela Kangakanani ICerclage?

Uthi bewazi?

I-cerclage yokuqala ephumelelayo yomlomo wesibeletho yabikwa nguShirodkar ngo-1955. Kodwa-ke, ngoba le nqubo yayivame ukuholela ekulahlekelweni kwegazi okukhulu futhi ama-suture kwakunzima ukuwasusa, odokotela bafuna ezinye izindlela.

I-cerclage kaMcDonald, eyethulwa ngo-1957, yaba namazinga empumelelo aqhathaniswa nenqubo yaseShirodkar-futhi yanciphisa nenani lokusika nokulahleka kwegazi, ubude bokuhlinzwa, nobunzima ekususeni imisipha. Ngalezi zizathu, odokotela abaningi bakhetha indlela kaMcDonald. Abanye basebenzisa indlela eguquliwe yeShirodkar, elula futhi ephephile kunendlela yasekuqaleni.

Uma umhlinzeki wakho wokunakekela esola ukuthi unomlomo wesibeletho onganele, angancoma ukuqiniswa komlomo wesibeletho ngokusebenzisa inqubo ebizwa ngokuthi i-cerclage yomlomo wesibeletho. Ngaphambi kokuba umlomo wesibeletho uqiniswe ngokuhlinzwa udokotela uzohlola ukungahleleki kombungu ngokwenza i-ultrasound.

Kwenziwa Kanjani I-Cerclage?

I-cerclage yenziwa egumbini lokuhlinzela, lapho isiguli singaphansi kwe-anesthesia. Udokotela usondela emlonyeni wesibeletho ngesitho sangasese sowesifazane. Kuthungwa ibhande lezinsipho (umthungo, intambo noma okokufana) ozungeze umlomo wesibeletho ukuze uhlale uvaliwe. I-suture ibekwe eduze ne-os yangaphakathi (ukuphela komlomo wesibeletho ovuleka esibelethweni).

I-cerclage ye-transabdominal wuhlobo olukhethekile lwe-cerclage elidinga ukusikwa odongeni lwesisu. Le ndlela ingasetshenziswa lapho kungekho izicubu zomlomo wesibeletho ezanele zokubamba umthungo noma lapho i-cerclage ebibekwe ngaphambilini ingaphumelelanga. Owesifazane onomlando wokulahlekelwa kokukhulelwa okuningi, udokotela angabeka i-cerclage yesisu ngaphambi kokukhulelwa.

Kwenziwa Nini I-Cerclage?

Ama-cerclages amaningi enziwa phakathi ne-trimester yesibili yokukhulelwa (phakathi kwamasonto ayi-13 kuya kwangama-26 okukhulelwa), kepha angabekwa nangezinye izikhathi, kuya ngesizathu se-cerclage. Ngokwesibonelo:

• Ama-cerclages akhethiwe imvamisa ibekwa cishe ngesonto le-15 lokukhulelwa, imvamisa ngenxa yezinkinga ngesikhathi sokukhulelwa esedlule.
• Ama-cerclages aphuthumayo zibekwa lapho ukuhlolwa kwe-ultrasound kukhombisa umlomo wesibeletho omfushane, onwetshiwe.
• Eziphuthumayo noma? Ubuqhawe? ama-cerclages imvamisa ibekwa phakathi kweviki le-16 kanye nelama-24 lokukhulelwa uma umlomo wesibeletho uvuleke ngaphezu kuka-2 cm futhi usuvele ukhishiwe, noma uma ulwelwesi (isikhwama samanzi) lungabonakala esithweni sangasese ku-os wangaphandle (ukuvuleka komlomo wesibeletho esithweni sangasese ).

Yiziphi izingqinamba ezingaba khona?

Ama-cerclages akhethiwe aphephile uma kuqhathaniswa. Ama-cerclages aphuthumayo noma aphuthumayo anengozi enkulu yezinkinga, kufaka phakathi ukuqhekeka kolwelwesi oluzungeze ingane, ukuphambana kwesibeletho, kanye nokutheleleka ngaphakathi kwesibeletho. Uma kwenzeka ukutheleleka, umthungo uyasuswa bese kwenziwa ukubeletha ukuletha ingane ngokushesha. Komama abathola i-cerclage ephuthumayo, kunengozi yokuthi le nqubo izokwandisa ukukhulelwa kuphela kube ngamaviki angama-23 noma angama-24. Kule minyaka, izingane zinengozi enkulu kakhulu yezinkinga zesikhathi eside.

Ucwaningo luye lwabonisa ukuthi abesifazane abadinga i-cerclage yomlomo wesibeletho basengozini enkulu yokusebenza ngaphambi kwesikhathi futhi ngokuvamile badinga ukwelashwa okuningi ngesikhathi sokukhulelwa kwabo.

Kwenzekani Kamuva?

Ukubeka i-cerclage kungokokuqala ochungechungeni lwezinyathelo ezingadingeka ukuze kuqinisekiswe impumelelo yenqubo nokukhulelwa kwakho. Ngemuva kokuhlinzwa, udokotela wakho angakunikeza umuthi ovimba ukuthi isibeletho sakho singangeni. Ungathatha lo muthi usuku olulodwa noma ezimbili. Ngemuva kokuphuma esibhedlela, udokotela wakho uzofuna ukukubona njalo ukuze ahlole ukusebenza ngaphambi kwesikhathi.

Ukutheleleka kuyinto ekhathazayo ngemuva kwanoma iyiphi inqubo yokuhlinzwa. Uma ngabe une-cerclage ephuthumayo noma eyiqhawe, ubungozi bokutheleleka buyanda. Lokhu kungenxa yokuthi isitho sowesifazane sangasese sinamagciwane angatholakali ngaphakathi kwesibeletho. Lapho isikhwama samanzi silenga phansi esithweni sangasese, kunengozi eyengeziwe yokutheleleka ngamagciwane ngaphakathi kwesibeletho nangaphakathi kwesikhwama se-amniotic esiphethe ingane. Udokotela wakho angakunikeza ama-antibiotics ukunciphisa ubungozi bokutheleleka. Uma kutholakala ukutheleleka ngaphakathi kwesikhwama samanzi, ukukhulelwa kufanele kuqedwe ukuze kuvinjelwe imiphumela emibi yezempilo kumama.

Umthungo uvame ukususwa cishe ngeviki lama-35 kuye kwangama-37 lokukhulelwa, lapho ingane ifinyelele esigabeni esigcwele. I-cerclage yesisu ayinakususwa, futhi abesifazane abane-cerclages besisu bazodinga izingxenye ze-C ukuletha.

Kwenzekani Kamuva?

Ukubeka i-cerclage kungokokuqala ochungechungeni lwezinyathelo ezingadingeka ukuze kuqinisekiswe impumelelo yenqubo nokukhulelwa kwakho. Ngemuva kokuhlinzwa, udokotela wakho angakunikeza umuthi ovimba ukuthi isibeletho sakho singangeni. Ungathatha lo muthi usuku olulodwa noma ezimbili. Ngemuva kokuphuma esibhedlela, udokotela wakho uzofuna ukukubona njalo ukuze ahlole ukusebenza ngaphambi kwesikhathi.

Ukutheleleka kuyinto ekhathazayo ngemuva kwanoma iyiphi inqubo yokuhlinzwa. Uma ngabe une-cerclage ephuthumayo noma eyiqhawe, ubungozi bokutheleleka buyanda. Lokhu kungenxa yokuthi isitho sangasese sowesifazane sinamagciwane angatholakali ngaphakathi kwesibeletho. Lapho isikhwama samanzi silenga phansi esithweni sangasese, kunengozi eyengeziwe yokutheleleka ngamagciwane ngaphakathi kwesibeletho nangaphakathi kwesikhwama se-amniotic esiphethe ingane. Udokotela wakho angakunikeza ama-antibiotics ukunciphisa ubungozi bokutheleleka. Uma kutholakala ukutheleleka ngaphakathi kwesikhwama samanzi, ukukhulelwa kufanele kuqedwe ukuze kuvinjelwe imiphumela emibi yezempilo kumama.

Umthungo uvame ukususwa cishe ngeviki lama-35 kuye kwangama-37 lokukhulelwa, lapho ingane ifinyelele esigabeni esigcwele. I-cerclage yesisu ayinakususwa, futhi abesifazane abane-cerclages besisu bazodinga izingxenye ze-C ukuletha.

Iphumelela Kangakanani ICerclage?

Akukho ukwelashwa okukodwa noma inhlanganisela yenqubo yomlomo wesibeletho enganele engaqinisekisa ukukhulelwa okuphumelelayo. Okungenziwa kakhulu odokotela ukunciphisa ingozi kuwe nasenganeni yakho. Njengomthetho ojwayelekile, ama-cerclages asebenza kahle lapho efakwa ekuqaleni kokukhulelwa nalapho umlomo wesibeletho mude futhi ujiyile.

Amanani okuphatha ukukhulelwa isikhathi eside ngemuva kwe-cerclage ayahluka kusuka kumaphesenti angama-85 kuye kwangama-90, kuya ngohlobo lwe-cerclage olusetshenzisiwe. (Izinga lempumelelo libalwa ngokuqhathanisa inani lokukhulelwa elethwe ngesikhathi noma esiseduze nesikhathi nenani eliphelele lezinqubo ezenziwe.) Ngokuvamile, i-cerclage ekhethiwe inezinga lokuphumelela eliphakeme kakhulu, i-cerclage yezimo eziphuthumayo inenani eliphansi kunawo wonke, futhi i-cerclage ephuthumayo iwela ndawana thize phakathi . I-cerclage ye-transabdominal ayivamile ukwenziwa futhi izinga lokuphumelela lilonke alibaliwe.

Ngenkathi ucwaningo oluningi lukhombisile imiphumela emihle ngemuva kwe-cerclage, alukho ucwaningo lwekhwalithi ephezulu olukhombisile ukuthi abesifazane abathola i-cerclage banemiphumela engcono kakhulu yokuthi labo abalala embhedeni bayaphumula.