Unyango lwexinzelelo lwengcinezelo luya kulandela isethi ehlukeneyo yezikhokelo kunonyango lwengcinezelo ephezulu yegazi ngaphandle kokukhulelwa. Injongo ephambili yonyango kwabasetyhini abakhulelweyo kukuthintela ukuphuhliswa kweemeko ezinzulu ezifana nokunciphisa ukukhula komntwana okanye ukuphazamiseka kwamapayipi. Ukukhulelwa kwakhona kuzisa ezinye iinkxalabo kwiiplani zonyango zonyango, ekubeni inzala yomntwana kufuneka ithathelwe ingqalelo kunye nomama.
Iindlela eziqhelekileyo ezisetyenziswayo unyango kubasetyhini abakhulelweyo abanexinzelelo lwegazi:
- Ukulala ikhefu
- I-short-term (acute) yeyeza
- Ixesha elide (elingapheliyo) unyango lweziyobisi
Xa ukhetha isicwangciso esithile sonyango, iinkcukacha ezinjengeba igazi eliphezulu likhona ngaphambi kokukhulelwa, ukude kangakanani ukukhulelwa, kunye nendlela umntwana ayenze ngayo kufuneka ukuba kuqwalaselwe.
Uphulo lweZibhulo
Ukuphumla kwesibhedlele, okanye umsebenzi onqandekileyo, kuye kwabekwa ixesha elide kwiimeko zamagxininiso omzimba, kungakhathaliseki ukuba yiyiphi imbangela. Nangona le nkqubo isetyenziswe ixesha elide kwaye iyaqhubeka iyindlela ekhethwa yonyango, kukho ubungqina obuncinane obuxhasa ukuphumelela kwale nyango. Kuye kwaqhutyelwa uphando oluthile lweeklinikhi ezincinane, kunye nolunye uhlaziyo olunzulu lweencwadi, kodwa akukho zifundo ezinkulu ezenziwe. Ngokubanzi, iziphumo zixutywe. Ezinye iziphumo zibonise ukuba ukuphumla komabhedlele akunikezeli ngeenzuzo zokukhusela, ngelixa ezinye iincwadi zibonise encinci, kodwa zilinganiselwe, zinciphisa umngcipheko wokuphucula ukunyuka kwengcinezelo yegazi okanye ukukhutshwa kwangaphambili.
Ngenxa yokungabikho kobungqina obuqinileyo, ukuphumla kombhede akufanele kubonwa njengeqhinga elichanekileyo lokunyanga. Sekunjalo, umsebenzi ovalwe ngokunyanisekileyo awunayo nayiphi na ingozi yempilo kwaye ungasetyenziswa ukuba awuphazamisi kwishedyuli yakho eqhelekileyo. Kwiimeko apho zikhona iingxaki eziyaziwayo ngegazi elijikelezayo kwi-placenta - "ukungakwazi ukuphelelwa yintsholongwane" - ukuphumla kwesibhedlele kunokubonelela ngezibonelelo ezongezelelweyo.
Iipilisi zexesha elifutshane kunye nexesha elide
Ukusetyenziswa kweziyobisi yindlela ephumelelayo, ebonakalisiweyo yokumodareyitha uxinzelelo lwegazi ngexesha lokukhulelwa, nangona kufuneka unakekelwe ekukhetheni nasekulawuleni iziyobisi. Ngenxa yokuba unyango lwezonyango ngexesha lokukhulelwa lunokuthi lithwale ingozi kumama kunye nosana, ngokuqhelekileyo lugcinwe kuphela kwiimeko apho uxinzelelo lwegazi luphezulu kakhulu, ngokuqhelekileyo> 150/100 mmHg.
Ukufumana unyango lwexesha elifutshane, amayeza amaninzi atyunjwa yiyo:
- I-Labetalol - i-bloc blocker
- Hydralazine
- I-nifedipine ekhuselekile-ekhuselweyo ye-calcium channel blocker
- Ukukhululwa ngokukhawuleza kwe-nicardipine - i-blocker ye-calcium
Ngethuba elifutshane, ukuba ezi ziyobisi azikwazi ukulawula uxinzelelo lwegazi, ngezinye izilwanyana kuthiwa yi-diazoxide kusetyenziswa ukuba ukulawulwa kwegazi ngokukhawuleza kuyadingeka.
Xa unyango olude kufuneka luqhubeke iiveki okanye iinyanga, ukhetho lweziyobisi lufana. I-Labetalol yenye yezilwanyana ezisetyenziswa ngokuqhelekileyo kwabasetyhini abakhulelweyo. Nangona zonke iziyobisi ziphethe ingozi ekhethekileyo kwizigulana ezikhulelwe, i-labetalol iboniswe ukuba ikhuselekile ukusetyenziswa ngexesha lokukhulelwa. Kanye ne-labetalol, ezinye iziyobisi ezingasetyenziswa ziquka:
- Methyldopa
- I-block-activator block blockers (Nifedipine)
Uhlolo lokuThola
Ukuvavanya kwe-Fetal - ukujonga impilo kunye nesimo sengane - yinto ephikisanayo yokuphatha uxinzelelo lwengqondo.
Nangona i-ultrasound kufuneka yenziwe ngeeveki eziyi-16 ukuya ku-20 ukubonelela ngokuchanekileyo ukufunda okusemgangathweni apho kuhlola ukukhula komntwana, akukho mvumelwano ecacileyo malunga nendima yeminye imvavanyo. Uninzi oogqirha baya kwenza "uvavanyo lokungaqiniseki" kunye ne "index" ye "amniotic fluid" okanye "iphrofayili ye-biophysical" ngeveki ukuya ekupheleni kokukhulelwa, njengendlela yokuqinisekisa ukuba ukukhula kuqhubeka ngokuqhelekileyo. Ngokuqhelekileyo, ukubeka esweni ngokukhawuleza kuyadingeka xa iziganeko zibonisa ukuba umntwana usengozini. Ezi meko zihluke kwabesetyhini abahlukeneyo kodwa zingabandakanya iimpawu zokuphuma kwegazi kwintsana.
Izabasebenzi kunye nokuThutyiswa nge-Hypertension
Phantse bonke abesifazana abanengcinezelo yongcinezelo yongcinezelo baya kuqhuba ukuhanjiswa okuqhelekileyo kwixesha elipheleleyo. La mabhinqa aphumelele ukuhanjiswa kwesisu kwaye akukho nezinye iingxaki ezinzulu. Kwiimeko apho uxinzelelo lwegazi luphakanyisiwe kakhulu, okanye kwiimeko ze-preeclampsia, ukuhanjiswa kwangethuba kufuthi kuqwalaselwe. Kwiimeko zeengxaki ezinzulu, njenge-eclampsia, ukuhanjiswa kwangethuba kudla ukuzama ukukhusela ukuphuhliswa kweengxaki ezisongela ubomi. Ngokubanzi ke, khumbula ukuba ininzi yabasetyhini ngokukhulelwa-kubangela ukuba ingcinezelo yenyongweni ibe nempumelelo, ukukhulelwa kwexesha elipheleleyo kunye neentsana ezinempilo.
Imithombo:
> Meher, S, Abalos, E, Carroli, G, Meher, S. Bed uhlala kunye okanye ngaphandle > ukubhedlelelwa esibhedlele > ngenxa yengozi yempembelelo ngexesha lokukhulelwa. Cochrane Database Syst Rev 2005; : CD003514.
> Remuzzi, G, Ruggenenti, P. Ukuthintela kunye nokunyanga kokuxinzeleleka kwegazi: Yintoni esiyifunde kwiminyaka eyi-10 edluleyo? Ngaba iJ Kidney Dis 1991; 18: 285.
> Duley, L, Henderson-Smart, DJ, Meher, S. Iziyobisi ukwenzela unyango lwexinzelelo eliphezulu lwegazi ngexesha lokukhulelwa. I-Cochrane Database Syst Rev 2006; 3: CD001449.
> Abalos, E, Duley, L, Steyn, DW, Henderson-Smart, DJ. Ulwaphulo lwezonyango olusisiseko samanyathelo omzimba wokunyuka kwengqondo ekumanyeni (Ukuhlaziywa kweCochrane). I-Cochrane Database Syst Rev 2007; : CD002252.
> Podymow, T, Agasti, P. Postpartum inkqubo yokuxinzeleleka kwengqondo kunye ne-preeclampsia. Uxinzelelo lwexinzelelo kwi-20006; 25: 210.