Ukuphumula
Ngokwezibalo, ukulimala okuhlukahlukene komsele wokuzalwa kutholakala kuwo wonke owesifazane wesihlanu owabeletha. Ifomu elivame kakhulu ukushiyeka ngokuzenzakalelayo kwe-perineum. Kubonakala ku-7-15% abesifazane besifazane.
Izingozi Zezingozi
Kungakhathaliseki ukuthi imisipha ye-perineal ingakwazi ukumelana nokucindezela komfutho ngesikhathi sokubeletha futhi welule ngokwanele ikhanda lomntwana, kuncike ekutheni ziguquguquke kangakanani. Nciphisa ukuqina kwezinto ezilandelayo: isikhukhula esiphezulu ne-musculature ethuthukile - ibanga eliphakathi kwe-anus nokungena kwesiswini kungaphezu kuka-7-8 cm; iminyaka yowesifazane ingaphezu kweminyaka engama-30; i-pelvis encane kakhulu; isithelo esikhulu; inqubo yokuvuvukala esiswini ngesikhathi sokubeletha; ukulethwa okusheshayo futhi okusheshayo; ukuvuvukala kwe-perineum (ubuthakathaka bokusebenza nokuzama kwesikhathi eside).
Yini ongayilindela kusukela ekuzalweni kwesibili?
Izinto ezandisa ingozi yokuhlukana kwe-perineum zihlanganisa izibazi ngemva kokulimala okuqhubekayo ngesikhathi sokuzalwa kwangaphambilini. Izicubu ezixhunyiwe ezivela kuzo lezi zibazi zingenakukwazi ukwelula futhi, ngenxa yobuthakathaka bayo, izinyembezi ekubelethweni kwesibili, ngokuvamile emgodini omdala. Kodwa awukwazi ukukhuluma ngakho njengombuso wensimbi. Abazali bokuzibulala, abaziyo ngezinkinga ezinjalo ekubelethweni kwangaphambilini, bazobe banakekele ngokukhethekile ukuvikela i-perineum. Uma izibazi esiteshini zokuhlukunyezwa kwangaphambilini zazincane futhi ziphulukisiwe ngokuhamba kwesikhathi, zingase zingaphazamisi umsebenzi ojwayelekile ophindaphindiwe ngaphandle kwemikhakha, ikakhulukazi uma ingane ingafaki. Uma bekungabikho ukuhlukumeza ngokohlobo lokuqala, khona-ke owesifazane okhulisayo ubungozi bokubambela buyingcosana, ngoba imisipha ye-perineal emva kokubeletha kokuqala iqala ukuqina.
Ukuvimbela
Njengoba kuboniswe ngenhla, esinye sezimbangela zokuphuka yi-fetus enkulu. Kungenzeka ukuthi uma ingane yakho yokuqala izalwa isisindo esingaphezu kuka-4000 g, khona-ke lesibili ngeke sibe sikhulu kakhulu, ngakho-ke ukuzalwa kuyoba kubi kakhulu. Ukuze ungagodli omunye umntwana esibelethweni, thola ukunakwa okufanele. Ukudla okungcono kunomama ozayo kuyinhlanganisela yama-protein namavithamini. Kodwa ukusetshenziswa kokudla okune-carbohydrate, i-glucose, kufanele kube nomkhawulo. Ngesikhathi esifanayo ezinyangeni zokugcina zokukhulelwa, inyama ingcono ukuthi ingadli - iyabusa izicubu futhi ivimbele ukuqina kwazo. Faka esikhundleni senhlanzi noma inkukhu. Ukuvimbela okuhle ukuphuka ngesikhathi sokubeletha kuyinto massage perineum namafutha akhethekile. Kunconywa ukuba kwenziwe kusukela ngesonto lama-33 lokukhulelwa. Thela amafutha amancane okuvela emfuyweni eminwe bese uhamba ngokunyakaza kuholela esikhunjeni se-perineum, njengokungathi ulinganisa ukwelulwa kwesisu: uma uthanda kakhulu, kungcono kakhulu. Ukuzivocavoca okuhle futhi okuthandayo kusiza - isethi yokuzivocavoca okuqinisa imisipha ye-perineum. Uma kungabikho usongo lokubeletha ngaphambi kwesikhathi, ukuphila okuvamile kuboniswa emavikini okugcina okukhulelwa. Kumele uqaphele ukuthi le prophylaxis ikulungele ukulungiselela ukuzalwa kokuqala, kodwa futhi iphumelela kakhulu kumama okubeletha.
Izigaba
Ukunqunywa kwe-perineum ngesikhathi sokubeletha kungabuye kuthiwa yi-break break. Lokhu kuyisisombululo sokuhlinzeka kwezicubu ezungeze isizinda sangasese. Ikhishwa esiteji lapho ikhanda lomntwana liboniswa kancane ekuvuleni komsele wokuzalwa. Ukubhekwa kwe-perineal kwenziwa kaningi, futhi ingxenye enkulu - ekuzalweni kokuqala: kusuka ku-50 kuya kuma-70%. I-perineum idonswa emgqeni we-median noma emuva kwayo, kuye ngezici zesimo. Ukufakwe emgqeni ophakathi, noma ngenye indlela - i-perineotomy, iphilisa ngokushesha futhi ingabonakali emva kokubeletha. Yingakho ababelethisi bavame ukukukhetha.
Uma kunesidingo?
Uma kukhona usongo lokuphuka noma uma ukuqhuma sekuqalile, izingqamuzana ezibushelelezi zesilonda esinqunyiwe, uma kuqhathaniswa nemiphetho ephukile yokuphuka, kulula ukulungisa nokuphulukisa ngokushesha. Uma ukuqedwa kokuqala komsebenzi kuyadingeka ekwenzeni i-fetal hypoxia noma kungavamile kokuthuthukiswa kwayo (i-hydrocephalus). Ukuzalwa ngaphambi kwesikhathi. Ukwandisa ukuvulwa kwesisu, lapho umntwana kunzima ukunqoba umsele wokuzalwa (isibonelo, ngesikhathi sokuzalwa ngesethulo sokusuka emzimbeni noma nge-fetus enkulu).
Yini ongayilindela kusukela ekuzalweni kwesibili?
Amathuba ukuthi ukuqhuma okusha kuzokwenzeka esakhiweni sobunzima, okwakhiwa ngesikhathi sokubeletha ekuzalweni kokuqala, kuhle. Kodwa hhayi 100%. Kuye ngezimo, udokotela unquma ukuthi owesifazane angakwazi yini ukubeletha isikhathi sesibili ngaphandle kokusika. Uma amathuba okuphuka kwi-rumen ephakeme, kubhekwa ukuthi kungcono ukusika kunokuba uthole ikhefu. Phakathi naleso sikhathi, odokotela abathile bazama ukugwema ngangokunokwenzeka ukuxoshwa kwe-perineum ngesikhathi sokubeletha okuphindaphindiwe, ngisho noma bevame ukuziqhuba ekuqaleni.
Ukuvimbela
Njengoba lokhu kuhloswe, empeleni, ukuhlukunyezwa okufanayo, okwenziwa kuphela ngokuhlinzwa, konke okwenziwa ngumama wesikhathi esizayo ukuze "ungaqabuki" kufanelekile ukuvimbela ukusikeka. Khumbula ukudla nokuzivocavoca kwemisipha ebuseduze! Ungabaqeqesha noma kuphi: ekuhambeni, phambi kwe-TV, elele embhedeni.
I-Kegel Gymnastics
Ukunciphisa kancane. Qinisekisa imisipha ye-perineum, ubambe kule ndawo imizuzwana engu-3, bese uphumule. Ungacindezela ukuvivinya umzimba uma ucindezela imisipha yakho imizuzwana engu-5-20.
2. Ukuzivocavoca ngesinyathelo ngesinyathelo. Gcoba imisipha emizuzwana engu-3-5, bese uphumule. Manje qinisa imisipha kancane kancane, ubambe, futhi-kuze kube yizigaba ezingu-4-7. Hamba kancane kancane, uhlale isikhathi eside imizuzwana 2-3 esigabeni ngasinye.
3. Ukunciphisa. Gxila futhi ukhululeke imisipha yakho ngokushesha ngangokunokwenzeka. Phinda izikhathi eziningana.
4. Ukuphuma ngaphandle. Sula phansi njengesihlalo noma ukubeletha. Lokhu kusebenza, ngaphandle kwemisipha ye-perineum, kubangela ukungezwani kanye nesisu esiswini. Ukuqeqesha kungaqala ngezingqinamba ezi-10 ezisheshayo, ukusika okungu-10 nama-pops angu-10 izikhathi ezingu-5 ngosuku. Phinda ukuvivinya umzimba okungenani izikhathi ezingu-25 ngosuku olulodwa. Lokhu kulula, ngoba imisebenzi enjalo ayibonakali ngokuphelele kwabanye.
Ukuzalwa kwangaphambi kwesikhathi
Lokhu kufaka phakathi amacala lapho umsebenzi wezisebenzi uqala khona phakathi kwamaviki angu-28 no-37 wokukhulelwa nalapho umlomo wesibeletho uvulwa ngaphambi kwesikhathi esifanele. Imvamisa yokusebenza komuntu wokuqala kungu-6-8% wabo bonke ukuzalwa.
Izici zengozi:
- unyaka wesifazane okhulelwe uneminyaka engaphansi kwengu-16 futhi engaphezu kweminyaka engu-30 ubudala
- Ukuba khona kwezifo emzimbeni womama ozayo
- ukwehluleka komlomo wesibeletho, uma kuvulwa ngaphandle kokulwa kuka 3-4 cm
- ukuhlukumeza kwangaphambilini kwangaphandle noma ukukhipha izisu
- imisebenzi yokuhlinza ezithombeni zesisu esiswini ngokukhulelwa
- ezinye izinkinga ze-fetus ezihambisana nama-polyhydramnios
- ukukhulelwa okuningi
- umsebenzi odinga umsebenzi womzimba noma ohambisane nokucindezeleka kwengqondo
- Ukubhema, ukusetshenziswa kwezidakamizwa nokuphuza utshwala
Abesifazane abakhulelwe abaye bazalwa kakade ngaphambi kwesikhathi, ingozi yokuphindaphinda isimo - izikhathi ezingu-3-4 eziphakeme kunezinye. Kuyaziwa ukuthi kulokhu amathuba okubika ukukhulelwa kwesibili angama-80%. Futhi ngokuhlangenwe nakho kokubelethwa kokubili ngaphambi kwesikhathi, ingozi yokuphindaphinda isimo ikhuphuke izikhathi ezingu-6. Amathuba okusebenza okujwayelekile ayenyuka nakakhulu lapho ukukhulelwa kwesisu kusongela ngesikhathi sokukhulelwa. Ukwehluleka kokusebenza kwabesifazane abaneminyaka engaphezu kwengu-30 kuyafana kabili njengoba kuneminyaka engama-20-25. Cishe ama-60% amawele, angaphezu kuka-90% wezintathu, futhi cishe onke amawele angu-4-5 noma ngaphezulu avela ngaphambi kwegama
Ukuvimbela
1. Ukuze ugweme ukuzalwa ngaphambi kokubeletha, kuyadingeka ukuthola ukuthi yini eyabangela inkinga enjalo. Ukungaphakanyiswa kokukhulelwa kuvame kakhulu ngenxa yokutheleleka kwe-intrauterine. Kulesi simo kuyadingeka ukuthi udlulise ukuhlolwa kokutholakala kwama-bacteria ngaphambi kokuqala kokukhulelwa kwesibili. Uma kutholakala owesifazane okhulelwe kakade, udokotela uzokhipha imithi yokwelashwa eqala ku-trimester yesibili.
2. Odokotela benza nokunciphisa ukuvimbela ezinye izinto eziyingozi.
3. Umama ozayo owake waqala ukukhulelwa ngaphambi kwesikhathi angancoma ukuthi angenalo umsebenzi womzimba kanye nomsebenzi wokukhawulela ekuphumuleni kombhede ngesikhathi sokukhulelwa kwesibili nesithathu kokukhulelwa.
4. Ukuqala kokubeletha ngaphambi kwesikhathi kungadala ucansi. Ngakho-ke, phakathi nezinyanga ezintathu zokugcina zokukhulelwa, umama okhulelwe kufanele agweme ukulala ngokocansi, ukuze angabangeli ukukhulelwa okusebenzayo kwesibeletho.
Ubuthakathaka bomsebenzi
Le nkinga ekubelethweni ibonakala ngeziphazamiso ezibuthakathaka, ezincane, ezinciphisa ukuvulwa komlomo wesibeletho kanye nokunyakaza kwe-fetal phakathi kwe-canal yokuzalwa.
Izici zengozi:
- ukuphazamiseka kwe-endocrine kanye nokuphazamiseka komzimba kumama ozayo (ukukhuluphala, ukuntuleka komsebenzi we-thyroid)
- ukunqwaba kwesibeletho, isici se-multi-fetus, i-fetus enkulu kanye nama-polyhydramnios
- ukukhubazeka kwesibeletho
iminyaka yobudala yowesifazane ingaphezu kweminyaka engama-30
injabulo enkulu, ukwesaba, imizwa emibi ngaphambi kokubeletha
Yini ongayilindela kusukela ekuzalweni kwesibili?
Ubuthakathaka bomsebenzi buvame kakhulu kubafazi abakhulukazi. Kodwa ingozi yokuphindaphinda inkulu ngokwanele, ikakhulukazi ngobudala. Udokotela unquma ukulungeleka komsele wokuzalwa evikini lika 38-39 lokukhulelwa. Uma kunesidingo, le ndlela yokufakelwa ishiwo, njenge-amniotomy (noma i-autopsy yesisindo). Le nqubo yenziwa esigcemeni sokubeletha futhi ayibuhlungu ngokuphelele kumama, ngoba ayikho iziphetho zezinzwa emagqumeni. Ngemuva kwe-amniotomy, ukukhiqizwa kwe-prostaglandins - izinto eziphilayo ezibhekiswe ekusebenziseni imisebenzi yomsebenzi - kufanele zenziwe kusebenze. Futhi, ukucasula kwezicubu zomkhumbi wokuzalwa kukhula, okuholela ekunciphiseni kwabo, futhi ngenxa yalokho ukuqinisa izinkinga. Uma, amahora amathathu emva kwe-amniotomy, ukuphazamiseka akuqali, odokotela banquma ukujova ngamagciwane e-prostaglandins.
Amandla okuvimbela ama-obstetric
Ukuziqhenya kwabo kuyindlela yokuhlinzeka ngemisebenzi, lapho ingane ephelele ekhishwa khona nge-canal yokuzalwa ngosizo lwe-obstetric forceps. Udokotela uyabasibekela ngenhloko yengane, ethatha amandla okuxoshwa kwesibeletho nomshini wesisu wesifazane obelethayo. Ukusetshenziswa kokusebenzisa i-forceps kunqunywe yi-obstetrician kulezo zinkathi lapho ukuqhubeka kwemvelo kwemisebenzi kungenakwenzeka ngenxa yengozi yezinkinga ezinkulu. Ngokuvamile kuhambisane nokuhlinzwa ukusika i-perineum ukuze kwandiswe umsele wokuzala ukuvimbela ukwakheka kwezephulelo ezinkulu kulo wesifazane.
Uma kuqokwa?
Isibonakaliso sokusebenza kwamandla omgogodla angabhalwa ngamaqembu amabili: izinkomba zokubeletha zomama kanye nezomntwana ezihlobene nokukhulelwa nokubeletha, nezinkomba ezithintekayo ezihambisana nezifo zesifazane ezingavumeli imizamo.
Ukuvimbela
Naphezu kokuthi ubuthakathaka bomsebenzi luyinkimbinkimbi, kubonakala ngokuqondile ekuzalweni, ungazama ukuvimbela okwenzekayo ngesikhathi sokukhulelwa. Lokhu kuyiqiniso ikakhulukazi kwabesifazane abasebevele bebhekene nale nkinga. Ukulungiselela ukubeletha kwe-Physiopsychic kudlala indima ebalulekile lapha. Kuhle ngaphambi kokukhulelwa kabusha ukuze kuphulukiswe izifo ze-endocrine, uma zikhona, ukugcizelela isisindo nokuyeka imikhuba emibi. Kusukela ngesonto lama-36 kunconywa ukuthatha amavithamini, okwandisa amandla okubeletha kwesibeletho: afaka i-vitamin B6, folic ne-ascorbic acid. Uma kuqala ekuzaleni imbangela yobuthakathaka bokusebenza kwaba ukwesaba ukubeletha, kuhle ukuqonda ukuxilongwa kwezivivinyo ezikhethekile kanye nokuzivocavoca umzimba okwenziwa ngabafundisi bezikole zabazali besikhathi esizayo.
Ubufakazi bokungavunyelwe:
- izinhlobo ezimbi ze-preeclampsia, ezidinga ukwehluleka nokucindezelwa kowesifazane wesifazane
- ubuthakathaka obuqhubekayo emizamweni (ukungabi nenhloko yengane kusengaphambili ngaphezu kwamahora amabili)
- ukuphazamiseka kweplantation ngaphambi kwesikhathi ekupheleni komsebenzi
- i-hypoxia e-fetal ekhululekile ye-fetus (i-oksijeni yindlala), lapho ukugwema kungabangela ukufa komntwana
Izibonakaliso zesimo somuntu:
- izifo zenhliziyo, ukuhluleka kwenhliziyo
- ukucindezeleka okuphefumula ngenxa yesifo sengculazi
- usongo lomsebenzi we-retina
- izinhlobo ezinzima zezifo ze-neuropsychic
- ukuhlinzwa ezingxenyeni zesisu esiswini esenziwa emasontweni omsebenzi
- ukukhushulwa kwesifo, ukushisa okuphezulu kumama
Uma okokuqala bekukhona ukukhuluma mayelana nokuhlelwa kokusebenza kwe-forceps kulezi zibonakaliso ze-somatic, khona-ke ukulethwa okuphindaphindiwe kwemvelo kungenzeka kuphela ngemvume odokotela. Isibonelo, kungenzeka ukuthi phakathi kokukhulelwa owesifazane wenze umsebenzi wokulungisa amehlo, kanye ne-ophthalmologist, owayekade avimbela ukubeletha kwemvelo ngenxa yemishini yokubuyisela emuva ngesikhathi sokuzama, manje uzonikeza imvume. Kodwa ubufakazi obunzima buyiminyaka engapheli futhi angeke kubonakale ekuzalweni okulandelayo.