Kuqikelelwa ukuba isiqingatha seamawele sizalwa ekuqaleni, ngaphambi kweeyonto ezingama-36, okuyi-inyanga ngaphambi kokuba iiveki ezingama-40 zitshintshwe umntwana ongenamntwana. Iintlanu kunye nezinye iiplani ze-oda eziphezulu zinethuba elikhulu lokuzalwa kwangethuba. Kwezinye iimeko, ukuqala komsebenzi wabasebenzi kungenqunyulwa, ngelixa kwezinye iimeko, ingozi kumama okanye kwiintsana ifuna isigqibo sokuqala sokukhulelwa. Nazi ezinye zezizathu eziqhelekileyo ukuba kutheni amawele azalwa ngokukhawuleza.
Umsebenzi wokuqala
Ukuqala kokuqala komsebenzi akuqhelekanga ekukhulelweni ezininzi. Ukuthatha nje iintsana ezininzi kunyusela kakhulu umngcipheko womsebenzi wokuqala, ngoko kubalulekile ukuba oomama abalindelekileyo bamawele okanye ngaphezulu bazi iziganeko baze bafune unyango olufanelekileyo. Ezinye zeengxaki kunye neemeko ezichazwe ngezantsi zingenza ukuba kuqalwe abasebenzi, kodwa ngezinye izizathu isizathu esicacileyo. Kodwa kungakhathaliseki isizathu, xa isibeleko siqala ukukhontrakthi kunye / okanye umlomo wesibeleko uqala ukuvula ukulungiselela ukuzalwa, umphumo ungumsebenzi wokuqala. Kwezinye iimeko, inokumiswa, kodwa xa ingenako, iintsana ziya kunikelwa ngaphambi kokuzalwa kwaye zizalwe kusasa.
Kaninzi
Preeclampsia
Amaninzi amaninzi ephindaphindiweyo aya kuhlangana nomfutho wexinzelelo (uxinzelelo oluphezulu lwegazi) ngexesha lokukhulelwa, enye yeengxaki eziqhelekileyo zokukhulelwa. I-Preeclampsia yisifo esichazwe ngophango oluphezulu lwegazi kunye nezinga eliphezulu leprotheni kumchamo. Ingakhange ihlolwe, ingabangela ingxaki enzulu yonyango kumama, kubandakanywa ukuxhatshazwa, ukushaywa kwesibindi, kunye nomonakalo wesibindi. I-Preeclampsia ilawulwa, kodwa akukho nonyango ngaphandle kokuba ivelise iintsana. Xa iimeko zangaphambili ze-preeclampsia zixakekile, ukuhanjiswa kweewele kwangaphambili kunokucetyiswa.
Iingxaki zePlacenta
Ngamawele, kukho enye okanye iplascenta enye , leyo yilungu elixhasa abantwana ngexesha labo kwisibeleko. Iqhotyoshelwe kumbindi wesisu somama kwaye ixhunywe kwiintsana 'ngeembilicaI zazo. Ngama-placenta (s) ekukhulelweni okubanzi okubandakanya umlinganiselo omkhulu wodonga lwe-uterine, kukho umngcipheko ophezulu weengxaki ezinokuba yingozi kumama okanye kwiintsana. Ukuphazamiseka kwePlacental , apho i-placenta ichitheka, okanye i- placenta previa, apho i-placenta ifakwe ngaphantsi kwesibeleko, ekhusele ukuvulwa komlomo, ezinye iimeko ezinokubangela ukuhanjiswa kwangethuba.
Nangona iingxaki ze-placental ezifana nalezi zinokuchaphazela ama-singleton, i-Twin-to-Twin Transfusion Syndrome (i-TTTS) isifo esiyingqayizivele kumawele. Iyenzeka xa imilambo yegazi engavamile ikhula kwi-placenta enye, eyabangela ukutshintshiselana kokungalingani kokuhamba kwegazi. Kwiimeko ezibuhlungu eziye zonakalise iintsana, ukuhanjiswa kungabonwa.
Imbundu ye-Ruptured Amniotic
Ngexesha lokukhulelwa, umntwana - okanye kwimeko yeamawele, umntwana - ufihliwe kwipokethi ye-fluid, kwi-sac amniotic. Njengengxenye yenkqubo yomsebenzi, isigxobo siza kuvulwa (esaziwa ngokuthi "ukuphulwa kwamanzi"). Kodwa ngamanye amaxesha i-sac ruptures ekuqaleni, eyaziwa ngokuthi yi-PROM (Ukukhutshwa kweMimbranes ngaphambi kokuqala) okanye i-PPROM (UkuPhambi kweMimbranes ngaphambi kokuqala) xa kwenzeka phambi kweeveki ezingama-37. Emva kokuba isikhwama samanzi siphule, sinika ithuba lokusuleleka xa ukuhanjiswa kungekudala, kwaye kunokususa ukuhanjiswa kwamawele kwangethuba.
Mo-Mo Amawele
Amaphesenti amancinci amawele e-monozygotic (afanayo) afunyaniswa njengamawele e-monochorionic-monoamniotic (Mo-Mo) . Abagcini nje babelane ngeplacenta enye kodwa badibene kwi-sac amniotic eyodwa. Kukho ingozi yentambo okanye ukunyanzeliswa kwentambo kule meko, imeko ebonakalayo eyonakalisa intsapho yokuphila. Kwezinye iimeko apho oku kwenzeka khona, inketho eyona nto ingcono kwiintsana kukubonelelwa kwangaphambili.
Uthintelo loKhula
IUGR - okanye i- restriction-growth restriction - liqela elikhulu leeetekisi ezisetyenziselwa ukuchaza ingxaki encinci nemiphumo emibi. Lo ngumntwana okanye zombini iintsana ezincinci kwaye zingakhuli ngokwaneleyo. Ngezinye iindleko zokukhulelwa, elinye iwele lichaphazeleka yi-IUGR ngelixa elinye alikho (elaziwa njengeCandelo lokuThutyelwa kweCandelo lokuThuthukiswa kweTraithine Growth or SIUGR). Nangona amawele ahlala ezalwa amancinci kunama-singleton, i-IUGR enzima ingabangela iingxaki ezinzulu zintsana. Ukufikelela kwikota enye yokukhulelwa kwama-twin IUGR. Kukho izizathu ezibalulekileyo zokukhutshwa komda; ezinye zibandakanya ezinye iimeko ezikhankanywe apha, ezifana nokungaqiniseki kwamaplanga, umbane ophantsi okanye u-Twin-to-Twin Transfusion Syndrome (TTTS). Ukuba kunqunywe ukuba iwele liye layeka ukukhula okanye lixinzelelekile, ukuhanjiswa kwangethuba kunokuba yinto ekhethekileyo.
Kuthatyathwa ixesha kwi-37 okanye kwiiveki ezingama-38
Iimbono ziyahluka ngexesha elifanelekileyo lokuhambisa amawele okanye ngaphezulu. Xa umsebenzi wabasebenzi okanye ezinye iingxaki ezibekwe kuyo, iinjongo zidla ngokuba "kamva ngcono." Kodwa kwiiveki ezimbalwa zokugqibela zokukhulelwa, oogqirha abahlukeneyo banokuba neendlela ezahlukeneyo. Kwabanye, ukuzalwa okukhethiweyo kwiiveki ezingama-37 okanye ezingama-38 kulungele ukukhulelwa kwamanye amawele, ngoko ke ugqirha wakho unokumisela ukuhanjiswa kweveki ezimbalwa. Abanye bathanda ukulinda baze babone.
Imithombo:
Dodd, JM, et al., "Ukuzalwa okhethwayo kwiiveki ezingama-37 zesisu ngokubambisana nokunyamekela okuqhelekileyo kwabasetyhini abanokukhulelwa okungahambi kakuhle kwixesha: i-Twins Time of Birth Randomzed Trial." IBritish Journal of Obstetrics and Gynecology, ngoJuni 2012. iphe. 964.
Habli, M., et al. "Ukuhlaziywa kwama -twwin-to-twin syndrome: ukuhlaziywa okubanzi." Iiklinikhi kwiPerinatology , ngoJuni 2009. iphe. 391.
ULeeman, uL. kunye no-Fontaine, uP., "Ukuxhatshazwa koxinzelelo lwe-Hypertensive of Pregnancy." I- American Family Physician , ngoJulayi 2008, iphe. 93.
Moh, W., et al., "Izinto ezingaphezulu kweeNtsholongwane ezithintela ukuguqulwa kwezilwanyana kunye ne-Intrauterine Growth Restriction: Umxholo wokukhulelwa , ngoJuni 2012.
"Ukukhulelwa Kwamaxesha amaninzi." Ikholeji yaseMerika yase-Amerika kunye neGynecologists , ifumaneka ngoFebruwari 27, 2016. http://www.acog.org/Patients/FAQs/Multiple-Pregnancy
Saliva, HM, et al., "Ukufa kwe-Perinatal ehambelana ne-abruptio placenta kuma-singleton kunye nokuphindaphinda." I- American Journal ye-Obstetrics ne-Gynecology , ngoJulayi 2005, iphe. 198.
"Iingxaki zokukhulelwa kwesiTwin." Uziko lweZonyango lwe-UCSF lwe-Fetal Treatment. Kufikeleleka ngoFebhuwari 27, 2016. https://web.archive.org/web/20111221205053/http://fetus.ucsfmedicalcenter.org/twin/