I-Cerclage, i-Bedrest kunye nezinye iziNyango
Ukungazi kakuhle komlomo, owaziwa nangokuthi ingakwazi ukuphelelwa yintsholongwane, isisifo somlomo wesibeleko esinamandla okanye sonakaliswe ukuhlala sivalwe ngexesha lokukhulelwa. Ngenxa yoko kubangelwa ukuzalwa kwangaphambi kwexesha kwaye mhlawumbi ukulahlekelwa ngumntwana, ngenxa yobude bexesha elifutshane. Kukholelwa ukuba ukungaqiniseki komlomo yimbangela ye-20 ukuya kwi-25% yazo zonke ilahleko zentsimbi yesibini.
Oku kungapheliyo ngokubanzi kubonisa ekuqaleni kwekota yesibini, kodwa mhlawumbi ekupheleni kwexesha lesithathu kwekota.
Ngokuqhelekileyo ikwahlula njengesivulo sangaphambi kwesibeleko ngaphandle komsebenzi okanye ukuchasana. Ukuxilongwa kungenziwa ngokomntu okanye nge-ultrasonography. Ukusetyenziswa kwe-ultrasonography kuye kwaba luncedo kakhulu ekuxilongeni kwaye kwenziwa xa i- os yomlomo (ukuvulwa) inkulu kune-2.5 cm, okanye ubude bufinyeze ngaphantsi kwama-20 mm. Ngamanye amaxesha i-funneling ibonakala; Le yilapho inxalenye yangaphakathi yomlomo wesibeleko, i-os yangaphakathi (isabelo somlomo wesibeleko esondele kwintsana) isiqalile ukutshabalalisa. I-os yangaphandle ayiyi kuba nefuthe xa ifunyanwe ngexesha. Izinto ezandisa ukwanda kokubandezeleka kwintsholongwane engenazo zi:
- Ukuchazwa
- Ingxaki yomlomo wesibeleko
- Iimpembelelo zeHormon
- Umlomo wesibeleko esifutshane
- I-D & C icetywe
- Izifo ezingasebenzi
Ukuba ufumaniswe emva kokulahlekelwa kweyesibini okanye ngaphambi kokuba ukhulelwe ukuba ukhulelwe ukuba uya kuba neengxaki ngamandla akho omlomo wesibeleko, i-cerclage (ukubethela umlomo wesivalo uvaliwe) inokwenziwa ngeprolactically malunga neveki ezi-14 ukuya kwe-16.
Kuthiwa ukuba ngaphambili unayo i-cerclage eyenzeka ngokuthe xaxa ukukhulelwa kukuqhubeka.
Ukuxilongwa okwenziwe ngexesha lokukhulelwa, kufuneka uhlangabezane neemfuno ezithile phambi kokuba i-cerclage inokwenziwa. Awufanelekanga kwi-cerclage ukuba unayo:
- Ukunyanzeliswa komzimba wesibeleko
- Usana lwakho selufile
- Ungaphezulu kwe-4 cm
- Amanzi akho aphukile
Kukho iindlela ezinhlanu ezahlukeneyo zokwenza i-cerclage. Ezi zibini eziqhelekileyo yiMcdonald neShirodkar.
Inkqubo yeMcDonald yenziwa nge-5 mm yeqela le-suture elihlala phantsi eliphakamileyo kwisibeleko somlomo. Oku kuboniswe xa kukho ukuchithwa okuphawulekayo kwinqanaba eliphantsi lomlomo wesibeleko. Ngokuqhelekileyo isuswe kwiiveki ezingama-37, ngaphandle kokuba kukho isizathu sokususa ngaphambili, njengokusuleleka kwintsholongwane, ukuqeshwa kwabasebenzi, ukukhulelwa kwangaphambili kweembrane, njl njl. Kuboniswa ukuba oku kunempembelelo encinci kwithuba lokuhanjiswa kwesisu.
I-Shirodkar nayo isetyenziswa ngokusetyenziswa rhoqo. Nangona kunjalo, oku bekukade kusisigxina sekhredithi yesigxina esihlala sisigxina ebomini, ngoku sele sisuswe malunga neiveki ezingama-37. Xa lolu hlobo lwe-cerclage lwenziwa, icandelo le- carea liya kuhlala lenziwa. Kukho oogqirha abasebenzisa iindlela zokuguqulwa, apho ukuhanjiswa akudingeki ukuba kube ngu-calarean, kwaye i-suture ayishiywe. Buza udokotela wakho ukuba yintoni inkqubo eyenzayo.
I-cerflage yeHefner, nayo iyazi njengendlela ye-Wurm, isetyenziselwa ukuxilongwa kwexesha lomlomo wesibeleko. Ngokuqhelekileyo kwenziwa nge-U okanye umthamo we-mattress kwaye unenzuzo xa kukho inani elincinci lomlomo wesibeleko.
I-posteracal cardinal ligament cerclage iyenziwa ngokubanzi emva kokuba iinkqubo zikaMcDonald kunye neShirodkar ziphumelele, okanye apho kukho umlomo wesibeletho esifutshane okanye unesifo somlomo wesibeletho. Kungenziwa kwindlovu kodwa isenziwa rhoqo ngesisu. Kwakhona, ukuhanjiswa kwe-calasan ukugunyazwa ukuzalwa.
Inkqubo yokugqibela, iLash, iyenziwa kwimeko engekhoyo. Ngokuqhelekileyo kwenziwa emva kokuxhatshazwa komlomo okubangele ukukhubazeka kwe-anatomical. Kukho okunokwenzeka, nangona kunqabile, umphumo wecala lokungapheli.
Nangona le nkqubo iyakusindisa ubomi, nayo inokubakho ingozi:
- I-Chorioamnionitis (Ukukhulelwa kwesikhwama se-amniotic, 1-7%) (Lo mngcipheko ukhuphuka xa ukhulelwe kwaye ku-30% yomlomo wesibeleko oxoxwa ngaphezu kwe-3 cms.)
- Umsebenzi wokuqala
- Ukutyunjwa kwentsholongwane yesibeleko okanye ukuchithwa (oku kungenziwa kwinkqubo okanye ekuhanjisweni, ukusuka kwimizimba ebomvu eyenza emntwaneni wesibeleko.)
- Injury (inqabile)
- Ukukhulelwa komama
- Dystocia wesibeleko
- Uterine rupture
Inkqubo yokuprophylactic ngokuqhelekileyo ukugcina isigulane kwiiyure ezingama-24 ngaphambi kokuba wenze i-cerclage. Ngeli xesha, uya kugcinwa ngenxa yomsebenzi wabantu bokuqala kunye nokuhlolwa kwesifo. Ngokuqhelekileyo, oku kwenziwa ngegulane kwi-Trendelenburg isikhundla, inyawo ngaphezu kwentloko yakho. I-anesthesia yomgulane isetyenziselwa ukuthintela intlungu kunye nokutshatyalaliswa kwabantwana ngexesha le-cerclage. Isibilini sakho siya kugcwaliswa ukuzama ukuhambisa iimbumba zakho kude ne-os. Uya kunikwa iziza-antibiotics ukukunceda ukukhusela isifo, kunye ne-Indocin ukukunceda umzimba wakho ukuba ungawunaki i-prostaglandins ekhutshwe ngexesha le nkqubo.
Emva kokusebenza uya kuba sekhefu lokuphumla kwiiyure ezingama-24 ezilandelayo, mhlawumbi kwi-Trendelenburg. Ubekwa esweni malunga nomsebenzi wesisu.
Xa usukhululiwe esibhedlele uya kuba sekhefu lokulala (akukho ngesondo) kwintsali yokukhulelwa. Uya kufuneka ube nexesha lokuphumla imihla ngemihla kunye nokunciphisa umzimba. Uya kubonakala eofisini ubuncinci kanye ngeveki ukuya kuzalwa. Uya kujongwa kwakhona ngomsebenzi wokuqala. Ukuba unayo nayiphi na inqatshana kufuneka uqhagamshelane nodokotela wakho ngokukhawuleza.
I-cerclage ibonakala yinkqubo enemiphumo enomlomo wesibeleko. Imilinganiselo yokuphumelela ingaba phezulu (80-90%), ingakumbi xa yenziwe ngaphambili ekukhulelweni. Ukuba unenkxalabo malunga nembali yakho yokubeletha okanye ummangali wesibeleko esingenakukwazi ukucela ukuba ugqirha yakho ikuhlolisise.
Imithombo:
Ikholeji yase-American College of Obstetricians kunye neGynecologists (ACOG) IKomidi yeeNkqubo zoBudletins - I-Obstetrics. I-ACOG Yenza i-Bulletin Nombolo 142: I-coerclage yokulawula ukungaqiniseki komlomo wesibeleko. I-Obstetrics & Gynecology. 2014; 123: 372.
Berghella V, et al. Ukungakwazi ukuzala. http://www.uptodate.com/home. Ufikelele kwiDisemba 24, 2015.
I-Obstetrics: Iziqhelo eziqhelekileyo kunye neengxaki. Gabbe, S, Niebyl, J, Simpson, JL. I sixhenxe.