Iinzuzo kunye Neengozi ze-Amniotomy (Ukukhutshwa kweMbundu)
Usenokuva ukuba kukho iindlela ezininzi zokunyusa abasebenzi (okanye ukukhawuleza). Enye yeendlela abantu abahlala bethetha ngayo ngoku kuphula amanzi esikhwameni, inqubo ebizwa ngokuthi "amniotomy" okanye "ukuphuka kweembrane" (AROM). Enyanisweni, ukuphula i-ngxowa yamanzi kukungenelela kwabasebenzi abaye basebenzisa izithinteli nababelethisi iminyaka engaphezu kwekhulu.
Ukusetyenziswa okusemthethweni kwe-amniotomy kuyahluka kwihlabathi, kunye nenkqubo isetyenziswe rhoqo kwiindawo ezithile kwaye ingabikho kwabanye.
Unokuphulaphula isikhwama samanzi kunokunceda ukuqala okanye ukukhawulezisa abasebenzi, kwaye ukuba kunjalo, yintoni indima edlala ngayo? Ziziphi iingozi ezenzekayo kwenkqubo? Kwaye ungalindela ntoni ukuba ukhetha ukuba uphuke amanzi akho?
Ukuqonda i-Amniotomy / Ukuphula i-Bag yamanzi
Iimniotic sac imigqa yesisu kunye nezindlu ze- amniotic fluid , umntwana kunye ne-placenta. Inika umqobo kwintsholongwane yengane yakho ngexesha lokukhulelwa kunye nokunyanzela umntwana xa uhamba. Yenziwe i-amnion kunye nekhetho. Ngoko ukuphuka kwamanzi kusebenza njani ukunyusa abasebenzi?
I-amniotomy inokuboleka ekusebenzeni kuzo zombini iikhemikhali nezindlela zomzimba. I-Amniotic fluid iqulethe iikhemikhali kunye nama-hormone, xa ekukhululwa, kucatshangelwa ukukhuthaza abasebenzi. Ngokwenyama, isikhwama samanzi sinokubonelela intambo phakathi kwentloko yomntwana kunye nomlomo wesibeleko.
Xa isikhwama samanzi siphukile (ukucinga ukuba intloko yomntwana isetyenziswe kakuhle kwisibeleko somntwana) intloko yengane inokunika uxinzelelo oluthe ngqo kwi-cervix ukunceda ngokuphucula. Xa i-amniotomy isenziwa, ithemba ukuba le nkqubo iya kubomeleza ukuchasana nokusebenza kwekhawulezi, kunye nenjongo yonke yokunciphisa abasebenzi.
Kwimizuzu engama-10 yabasetyhini, isikhwama samanzi siphula ngokukhawuleza ngaphambi kokuqala komsebenzi. Ukuba i-AROM ingenziwanga, isikhwama sivame ukuphula ngokukhawuleza ngexesha lomsebenzi osebenzayo, naliphi na ixesha phakathi kokuqala komsebenzi kunye nokuhanjiswa kwengane.
Ukuphula i-Bag yeManzi ukuThuthukisa abasebenzi
Esikhundleni sokuphuka ngokukhawuleza, isikhwama samanzi singaphulwa ngumsebenzi wezobugqirha ukuqala okanye ukunyusa abasebenzi. Makhe sijonge ezi zinto ngokwahlukileyo.
- Ukuchithwa: I-amniotomy ingenziwa ngaphambi kokuqala komsebenzi ukuqala okanye ukunyusa abasebenzi . Kwezinye iimeko, i-amniotomy ingasetyenziselwa yodwa, nangona kaninzi idibene ne-IV Pitocin . Izindlela ezifanelekileyo zokuqala abasebenzi (nayiphi na inkcazo) kuxhomekeke kulungelo lomlomo wesibeleko (jonga ngezantsi). I-Wih i-cervix efanelekileyo, indlela efanelekileyo kakhulu isebenzisa inhlanganisela ye-amniotomy ne-Pitocin.
- Ukongezwa: I-amniotomy inokuthi yenziwe emva kokuba ibhinqa isele ibesebenza, nethemba lokukhawuleza okanye ukunyusa abasebenzi . (Funda kabanzi malunga nobude bemisebenzi ). Ngelixa lisoloko likhawuleza le nkqubo, linokubangela ukuba, ngamanye amaxesha, kuncitshiswe kancinci kwidingo lokuzalwa kwe-laarean (nangona kukho i-tradeoffs).
Ezinye iiNzuzo zokuPhula iNgxowa yamanzi
Ukongeza kokungeniswa okanye ukunyuka kwezabasebenzi, ukuphula i-ngxowa yamanzi kunokufumana ezinye iintlawulo.
Ukubeka iliso lomntwana : Ukuba umntwana wakho ufuna ukuvavanywa okufutshane, umgqirha wakho okanye umbelethisi unokufuna ukuphula i-bag yakho yamanzi ukuze kwenzeke oku. I-amniotomy iyadingeka ukwenzela ukuba kwenziwe iliso lwangaphakathi lomntwana , njengoko iliso kufuneka lifakwe kwi-scalp yomntwana. Ukuqhekeka isikhwama samanzi kuyadingeka ukuze kufakwe i- catheter ye- intrauterine . Kule nkqubo, i-catheter ifakwa kwi-uterus ukuze kulungiswe kangcono amandla olwaphulo lwakho.
Ukuqwalasela ubukho be-meconium: Ukuqhawula isikhwama samanzi kungabonisa ukuba khona kwe- meconium -stained amniotic fluid.
Ukuba i-meconium ifumaneka nge-amniotomy, oku kunika ixesha lakho lexesha lokunakekelwa kwezempilo ukucwangcisa amanyathelo afanelekileyo, kuxhomekeke kubukhulu be-meconium.
Inkqubo
Emva kokuqinisekisa ukuba ujwayelene nenkqubo kwaye uqinisekisa ukuba umlomo wakho wesibeleko "uvuthiwe" (jonga ngezantsi), umgqirha wakho okanye umbelethisi uyakukubeka kule nkqubo.
Ekubeni isikhwama sakho samanzi siya kukhutshwa, umongikazi wakho uya kuqinisekisa ukuba unamathoyilethi ahlanzekileyo ngaphantsi kwakho.
Ugqirha okanye umbelethisi uya kwenza uvavanyo olusisigxina lomzimba ukuze uqinisekise ukuba intloko yomntwana isetyenziswe ngokuqinisekileyo kwi-cervix yakho. Ukusebenzisa i-amnihook (uhlobo oluthile lwenkohlakalo enokwindawo encinci), okanye i-amnicot (iglavu elinesibinci esincinci esiphezulu komnye weminwe), iya kugubha iimbumba zakho. Ngokudala inyembezi kwingxowa, i-amniotic fluid iya kuqala ukukhupha.
Ukuphulwa kwangempela kwesikhwama samanzi akufanele kube yinto ebuhlungu kunokuba uvavanyo lwama-vaginal rhoqo uhlolisise umlomo wakho wesibeleko. Inokuthi ikhulule i-fluid, okanye endaweni yoko, ingaqala njengento encinane nje. Ngokuqhelekileyo uya kuqhubeka ukuvuza umbane ngamanani amancinci kwintsali yakho yomsebenzi.
Emva kokuba ibhegi yakho iphukile, iqela lakho labasebenzi liya kubeka iliso umntwana wakho kwaye uqinisekise ukuba konke kulungile. Ukuba uya kuvuka uhamba, umongikazi wakho uyakukunika ipasiti enkulu yokubamba ukuhambisa amanzi njengokuba iqhubeka.
Emva kokuba amanzi akho aphulwe ungabona ukuba uqala ukuba neengxaki okanye uvakalelwa kukuba umntwana wakho uye wawayeka ngakumbi kwi-pelvis yakho. Ukuba unokuphulwa kwamanzi ngaphambi kokuphulwa kwamanzi, unokuvakalelwa ukwanda kwezinto ezichaseneyo okanye ungaziveki umahluko.
Ngaphambi kokuba Uphule Umtya Wakho Wamanzi
Ngaphambi kokuba ube ne-amniotomy okanye ukunyusa abasebenzi, umgqirha wakho uza kuthetha nawe malunga nenkqubo kwaye axoxe ngeengozi kunye neenzuzo. Uya kubala ukuba amathuba okuba inkqubo iya kuphumelela (amanqaku akho eBhishophu) kwaye qi ni sekise ukuba awunaso nasiphi na isizathu sokuba kutheni kwenziwe inqubo (ukuchasene).
Ukuqwalasela ukuba i-Cervix yakho "iyayithanda" -I-Score yeBishop
Ngaphambi kokuba ikhegi lakho lamanzi liphulwe ukuze lenze umsebenzi, uchwepheshe wakho uza kubala inani elibizwa ngokuba ngamanqaku kaBhishophu. Amanqaku kaBhishophu anika uqikelelo lwe "kholwano" lomlomo wesibeleko, oza kuqikelela ukuba ukuphula i-bag yakho yamanzi kunokwenzeka ukuba uqale umsebenzi okanye cha.
Ukuba umlomo wakho wesibeleko awuhambelanga (ukuba unamanqaku aseBhishophu angaphantsi kwe-6), induction kunye ne-amniotomy ne-Pitocin ayinakucetyiswa kunye nezinye iinkqubo, ezifana nokusebenzisa i-prostaglandin gel okanye i-Cytotec (misoprostol) ukuvuthwa komlomo wakho wesibeleko kunokunconywa endaweni yoko. Okanye unokhe ukhetha ukulinda de i-cervix yakho ihambele ngakumbi.
Amanqaku akho eBhishophu ibalwa ngokunikezela ngamaphuzu axhomekeke kuhlanjululwa komlomo wakho wesibeleko, ukuchithwa kwakho (indlela encinci ye-cervix yakho ibe yinto), isiteshi sakho somntwana (indlela ephantsi ngayo intsana yakho), kunye nokuzimela kunye nesimo. Amanqaku angama-8 okanye ngaphezulu kuthetha ukuba umlomo wakho wesibeleko "ulungile" kwaye kunethuba elihle lokufumana ubulili. Isikhwama sakho samanzi akufanele siphulwe ngaphandle kokuba isiteshi sakho somntwana sifakwe ku-0, okanye siphumelele.
Ibhishophu yeBakala
| Uvavanyo lwesibeleko | 0 Amaphupha | 1 Point | 2 Amaphupha | 3 Amaphupha |
| Ukuxilwa (cm) | Valiwe | 1-2 cm | 3-4 cm | 5-6 cm |
| Ukucinywa (ipesenti) | 0-30 ekhulwini | 40-50 ekhulwini | 60-70 ekhulwini | 80 ekhulwini |
| Isitulo se-Fetal | -3 | -2 | -1, 0 | +1, +2 |
| Ukubambisana | Qinisekile | Phakathi | I-soft | |
| Isikhundla | Posterior | Med | Ngaphakathi |
Izizathu zokungenzi i-Amniotomy (Iinkcazo)
Kukho iimeko ezimbalwa apho isikhwama samanzi akufanele siphulwe. Ezi ziqhelekileyo zibonakala zicacileyo kwaye zinokumiselwa ngokuphonononga i-ultrasound yesiqhelo (ngekota yesithathu okanye kamva) kunye nokwenza uvavanyo lwesisu. Ezi ziquka:
- Isalathiso esingavumelekanga: Ukuba umntwana unomoya okanye enye imbonakalo enjengobungqina buso okanye i-brow presentation ingxowa akufanele iphulwe.
- Ukuba intloko yentsana ayibandakanyekanga okanye "iyahamba" kwisifundo. (Isikhululo se- fetal esingu -0 sithetha intloko yesana inxaxheba ngokupheleleyo).
- UVasa previa: I- Vasa previa yimeko engavumelekanga apho imithwalo yegazi yomntwana ephuma kwi-placenta okanye intambo ye-umbilical idlula phezu komlomo wesibeleko phantsi komntwana (oku kuyafumaneka kwi-ultrasound yesiqhelo ngexesha le-trimester yesibili).
Iingozi kunye neengxaki ezinxulumene nokuphula i-Bag yamanzi (i-Amniotomy)
Kukho iingxaki ezimbalwa ezinxulumene ne-amniotomy, nje ngokuba unesibeleko sombeleko kwaye umntwana usebenza. Iingxaki zingabandakanya:
- Ukungaphumeleli kwezabasebenzi ukuqala: AbaSebenzi abanakuqala ngokuphulaphula isikhwama samanzi kunye nokusebenzisa i-Pitocin, kodwa ngeli nqanaba, udla "ukuzinikela" ukuhambisa njengoko kunomngcipheko omncinci wokusuleleka kwintsholongwane. (Xa amanzi ephula ngokwawo ngaphambi kokuqala komsebenzi, uninzi lwabantu luya kubasebenzi ngaphakathi kweeyure ezingama-24).
- Ukwandisa ukutshatyalaliswa komntwana: Ukuba intloko yomntwana ayifanelekanga kwi-cervix, ukuphuka isikhwama samanzi kunokunyusa umngcipheko wokuhlambalaza, kwaye ngenxa yoko, kubangele iingxaki ngokunikezelwa.
- Ikhowudi iguquka (Ubuncwane bentambo ye-cord, okanye intambo yomgca ewela ebhinini phambi kwentsana, iphantsi xa isiteshi se-fetal si-0).
- Uxinzelelo lwe-Fetal: Ngokuqhelekileyo, ukuwaphula isikhwama samanzi kunokubangela ukuxinzezeleka komntwana .
- Ukwandisa intlungu (Ukwanda kwentlungu empeleni akuyona inkxalabo, kodwa "kuluncedo" olulindelekileyo ukuba luyimpumelelo, njengoko ukuqala kunye nokunyuka kwengqesho kuyaziwa ukuba kukhokelela intlungu engakumbi).
Kukho umngcipheko owenyukayo wokunikwa kwee-rearey xa kutyunjelwa isikhwama samanzi senziwa ngokuqhotyoshelweyo (isahluko seC-c sancinci xa senziwa ukunyusa abasebenzi). Kucingelwa ukuba ezinye zezi zizathu zifumene ukubonakala kwe-meconium emva kokuphula isikhwama, kwaye ngale ngqiqo, isantya se-C esongezelelweyo asiyi kuthathwa njengengxaki. (Nge-meconium enamandla, icandelo leC-c linga kwenziwa ukwenzela ukuba ugweme ukuba umntwana afune i-meconium ngexesha lokunikezelwa).
Imibuzo Yokubuza Ngaphambi Kokudiliza Amanzi
Ezinye zezinto ofuna ukuzazi ngaphambi kokuba uvume ukuba amanzi akho aphule ziquka:
- Ngaba ndiya kuvunyelwa ukuhamba emva kwam amanzi aphukile?
- Ngaba ndiza kuhlola iliso elongezelelweyo?
- Ziziphi iimpawu zeengxaki ozijongayo kwaye njani?
- Ungacinga ukuba i-amniotomy iya kutshintsha njani umsebenzi wam?
- Ngaba kukho ezinye iindlela zokungenelela ezifunekayo ngenxa yale nto?
- Ziziphi ezinye iindlela?
- Ngaba ndinayo ixesha lokwenza isigqibo?
Ngaphantsi kwendlela yokuqhawula i-Bag yakho yamanzi ukuxhamla abasebenzi
Abagqithisi baye basebenzisa i-amniotomy okanye baqhekeza isikhwama samanzi ukukhuthaza abasebenzi ukuba baqalise okanye bathuthuke ngokukhawuleza kwekhulu, nangona singaqinisekanga nendima ebalulekileyo kule milinganiselo. Ngokubanzi, umngcipheko omncinci kulabo abaye bafumana i-ultrasound yesiqhelo (ukulawula i-vasa previa), ukuba umntwana ubandakanyeke kakuhle, kwaye ukuba ukuhanjiswa kwenzeka kwiiyure ezingama-24 okanye njalo. Xa zisetyenziselwa ukuqulunqwa kwabasebenzi, ukuphula i-ngxowa yamanzi ngokuqhelekileyo kusetyenziswa ngokudibanisa ne-pitocin kubasetyhini abanomhlaza wesibeleko.
Xa ukhangela iingenelo okanye ukungalunganga kwongenelelo lwabasebenzi, kubalulekile ukuqikelela ubuncipheko obunokubakho kwiintlobo ezingenako. Siyazi ukuba ukukhulelwa okwandisa iiveki okanye ngaphezulu ngaphaya komhla wokubakho kungabangela iingxaki, kwaye ukuchongwa yindlela enye yokunciphisa le mngcipheko.
Ukuqhekeka isikhwama samanzi kuyimfuneko xa iliso lokutshatyalaliswa komntwana kunye ne-monitor intrauterine yongqinisiso lucetyiswa.
Ukukhulelwa konke kuhlukile kwaye kubalulekile ukuba ibhinqa isebenza kunye nomthinteli wakhe ukuqinisekisa ukuba yintoni efanelekileyo kuye. Kubalulekile ukuqwalasela yonke imbali yakho yonyango, isimo somlomo wakho wesibeleko, kunye nezinto ozikhethile.
> Imithombo:
> Ikholeji yase-American College of Obstetricians and Gynecologists. Iindlela zokuLungisa ukungenelelo ngexesha loMsebenzi kunye nokuzalwa. 2017. https://www.acog.org/Clinical-Guidance-and-Publications/Ikomiti-Opinions/Ikomiti-on-Obstetric-Practice /Approaches-to-Limit-Intervention-During-Labor-and-Birth
> Cunningham, F. Gary, noJohn Whitridge Williams. Williams Obstetrics. ENew York: iMicrora-Hill Hill Medical, 2014. Print.
> Smyth, R., Markham, C., kunye noT. Dowswell. I-Amniotomy yokufutshane nokuSebenza koMsebenzi. I-Cochrane Database yeeNkqubo eziPhezulu . 2013. (6): CD006167.
> Wei, S., Wo, B., Qi, H. et al. I-Amniotomy yasekuqaleni kunye ne-Oxytocin yasekuqaleni yoKhusela, okanye iTyrapy, Ukukhawuleza kwiSigaba sokuQala esiSebenzi sokuQhathaniswa nokuHlaliswa koLuntu. I-Cochrane Database yeeNkqubo eziPhezulu . 2013. (8): CD006794.