Ngokusho kwezincomo ze-World Health Organization (WHO), ukuzalwa okuvela emavikini angu-22 kuya kwangu-37 okukhulelwa (isisindo somntwana wesibalo esingu-500 g noma ngaphezulu) kungakapheli isikhathi. Kukhona ukubeletha ngaphambi kokuzalwa ngaphambi kwesikhathi (amasonto angu-22-27), ekuqaleni (amasonto angama-28-33) nokubeletha ngaphambi kwesikhathi (amasonto angama-34-37). Ezweni lakithi, ukubeletha ngamasonto angu-22-27 akubhekwa njengengaphambi kwesikhathi, kodwa ukunakekelwa kwezokwelapha kunikezwa esibhedlela sokubeletha, futhi kuthatha zonke izinyathelo ezidingekayo zokunakekela ingane. Ingane ezalwe esikhathini esinjalo (amasonto angu-22 kuya kwangu-23) ibhekwa njengengane ebusweni phakathi kwezinsuku zokuqala ezingu-7 zokuphila. Kuphela ngemva kwesonto, uma ingane ingakwazi ukuvumelanisa nezimo zokuphila ezikhona, ibhekwa njengengane. Ezikhungweni zanamuhla, imvamisa yokusebenza kwangaphambi kokusebenza ayigcini nje kuphela, kodwa iyakwandisa ngenxa yokwanda kwenani lokukhulelwa okuningi, ukusetshenziswa okubanzi kobuchwepheshe bokubeletha obulekelelwe. Yiziphi izimbangela zangempela zokubeletha ngaphambi kwesikhathi, funda esihlokweni esihlokweni esithi "Yini eyingozi kumama wokuzalwa ngaphambi kwesikhathi."
Izimbangela
Izimbangela zokuzalwa kwangaphambi kokuzalwa kwangempela zihlukene kakhulu, zingahlukaniswa ngamaqembu amabili - ezenhlalakahle eziphilayo (okungezona ezokwelapha) kanye nezokwelapha. Izizathu zezenhlalo neziphilayo ziyimikhuba eyingozi (ukusetshenziswa kotshwala, izidakamizwa, ukubhema ngesikhathi sokukhulelwa), izinga eliphansi lomphakathi nomnotho wokuphila komama ozayo, izimo zokusebenza eziyingozi (ukutholakala kwemisebe, ukudlidliza, umsindo, isimiso esingavamile, ukusebenza ebusuku), futhi futhi ukungondleki, isimo sokucindezeleka okungapheli.
Izizathu ezibalulekile zezokwelapha zihlanganisa:
• Ukutheleleka (yisinye sezimbangela ezibaluleke kakhulu okuholela ekuqedeni kokukhulelwa kokuqala). Ukubeletha ngaphambi kwesikhathi kungabangela kokubili ukutheleleka okunzima futhi okungapheli (amabhaktheriya kanye negciwane). Kungaba izifo ezijwayelekile ezithathelwanayo ezithombeni zangaphakathi (i-pneumonia - pneumonia, pyelonephritis - ukuvuvukala kwezinso, njll), khona-ke ukutheleleka kungena ku-fetus nge-placenta; noma ukutheleleka kwezidalwa zofuzo (chlamydia, trichomoniasis, gonorrhea, herpes, njll), kanti ukutheleleka okuvela emaseni kungangena eqenjini lokubeletha likhuphuka.
• Ukulinganisa izimbangela zokuvimbela ukukhulelwa, ukukhubazeka - ukuphazamiseka kokukhulelwa kuze kube amasonto angu-22 nokubeletha ngaphambi kwesikhathi) kanye / noma umlando wesisu (izifo ezivuvukalayo zesisu somzimba wesifazane, i-myoma - tumor of the muscle layer of the uterus, izifo ze-hormone, isifo somzimba sangasese - ukuthuthukiswa kwamalungu omzimba, ukukhubazeka kwesibeletho).
• Ukungasebenzi kahle kwe-Isthmicocervical - ukungakwazi ukuvinjelwa kwesibeletho somlomo wesibeletho ngenxa yokuhlukunyezwa nokukhipha izisu, ukuyeka ukuzalwa kokuzalwa kwangaphambili, njll.
• Izifo zangaphandle (izifo zangaphakathi) - ukugula okuphezulu (ukukhuluphala, isifo sikashukela, izifo ze-thyroid), izifo ezinzima zesimiso senhliziyo, izinso nezinye izitho. Kuleli qembu lezimbangela zihlanganisa izimo ze-thrombophi (izifo ezihambisana nokwanda komsebenzi we-system coagulation system), lapho ingozi yokuthungatha isikhathi esingaphansi kwe-placenta, i-thrombosis (ukugqoka ama-blood clots emithanjeni yegazi ye-placenta), okuholela ekubelethweni ngaphambi kwesikhathi kukhula ngokuphawulekayo.
• Isifundo esiyinkimbinkimbi sokukhulelwa (i-gestosis - toxicosis yesigamu sesibili sokukhulelwa, izinhlobo ezinzima zokungaqiniseki kwesisu, kubangela ukukhuphuka kwesibeletho - i-polyhydramnios, ukukhulelwa okuningi).
Isibalo sokuqala kokubeletha ngaphambi kwesikhathi
Isibonakaliso sokuqala komsebenzi sizoba ukubonakala kwezinhlungu zomzimba eziphansi esiswini esingaphansi, okuyinto ngokuhamba kwesikhathi kuqina, isikhathi eside futhi njalo. Ekuqaleni, lapho ubuhlungu besisu bebuthakathaka futhi bungavamile, ukuphuma kwegazi noma ukucwiliswa kwamakhemikhali kungabonakala kusuka esithweni sangasese, okukhombisa ukuguquka kwesakhiwo (ukufinyeza nokushelela) komlomo wesibeletho. Ukuhluka okungajwayelekile kokuthuthukiswa kwezehlakalo kungase kube ukukhishwa kusenesikhathi kwe-amniotic fluid, kuyilapho uketshezi olucacile noma oluphuzi lukhishwa ngaphakathi kwesiswini, inani lalo lingashintsha kusuka isipuni ukuya esibukweni noma ngaphezulu. Ukuthululwa kwe-amniotic fluid kungase kuhambisane nobuhlungu esiswini esingaphansi, futhi kungenzeka kungabikho okwenyuka kwezwi lesikhumba. Njengomthetho, ukuphuma kwe-amniotic fluid kubangelwa ukutheleleka kwesigxobo esingaphansi kwesilonda sesisu ngokukhuphuka (ukutheleleka kuvela kulesiswini). Ukubonakala kwanoma yiziphi izimpawu ezingenhla kuyisisekelo sokubiza ngokuthi "i-ambulensi" kanye nesibhedlela esiphuthumayo esibhedlela sokubeletha, njengoba ngokushesha umama ozayo esezikhungweni zezokwelapha, amathuba amaningi okugcina ukukhulelwa. Uma kungenakwenzeka ukulondoloza isikhathi sokukhulelwa, zonke izimo zokulethwa ngokucophelela kuzokwenziwa esibhedlela sokubeletha, kuncishiswe ingozi yezinkinga kumama kanye nesisu, kanye nokuhlengikaza umntwana osanda kuzalwa.
Inkambo yokuzalwa ngaphambi kwesikhathi
Izinkinga ezivame kakhulu zokuzalwa ngaphambi kwesikhathi sokubeletha ziyizinkinga zomsebenzi (ubuthakathaka, ukutholakala kwemisebenzi, ukulethwa okusheshayo noma okusheshayo), ukukhishwa ngaphambi kwesikhathi ngaphambi kwe-amniotic fluid, ukuthuthukiswa kwe-hypoxia ye-intrauterine fetal (ukungabi ne-oxygen).
Ukulethwa okusheshayo
Ukubeletha ngaphambi kwesikhathi, ukugeleza okusheshayo nokusheshayo kuyisici. Lesi simo kufanele, okokuqala, ukuthi ekuzalweni kwe-fetus ngaphambi kwesikhathi, ukuvulwa okuncane komlomo wesibeletho (6-8 cm) kwanele kunokuba kube nokulethwa ngesikhathi (10-12 cm). Okwesibili, itholakala ukuthi umsebenzi wokuthengisa wesibeletho ekuhlinzekeni kwangaphambi kuka-preterm ukwedlula izikhathi ezingu-2 kunomsebenzi wokuzalwa ngesikhathi. Okwesibili, i-fetus encane ifinyelela ngokushesha ngokusebenzisa umsele wokuzalwa. Kulokhu, ukulwa okuvamile, okubuhlungu, okuqhubeka isikhathi eside kubonakala. Uma ubude obuphakathi kokulethwa ngesikhathi esifanele ngamahora angu-10-12, ukubeletha ngaphambi kwesikhathi kungapheli amahora angu-7 kuya kwangu-8 noma ngaphansi. Inkambo ephuthumayo yokusebenza iyinkinga engathí sina, okuyinto ngisho nokulethwa kwesikhathi okungaholela ekuthuthukiseni kwe-hypoxia (oksijithali yindlala) ye-fetus. Umsebenzi we-contractile osebenzayo wesibeletho uholela ekunciphiseni kwegazi le-uteroplacental, okuwumphumela we-hypoxia we-fetus, futhi futhi unomphumela omuhle owenziwe ngomzimba obuthakathaka wengane engakafiki. Ngaphezu kwalokho, ngokuhamba ngokushesha ngokusebenzisa amachiza okuzalwa, ikhanda le-fetal alinaso isikhathi sokuzivumelanisa nesilinganiso esifanele, esibangela ukuhlukunyezwa komgogodla womlomo wesibeletho, kanye nokwehla kwesisu ngaphansi kwengqamuzana yengqondo yengqondo ngesikhathi sokubeletha. Ngenxa yalokhu kulimala, umntwana osanda kuzalwa ubhekana nobunzima ekuvumelaneni nezimo ezintsha zokuphila, okuvame ukubonakaliswa yizifo zezinzwa futhi kudinga ukuqapha ngokucophelela nokubhaka. Ngenxa yentuthuko ephuthumayo yengane, kungase kube nokuhlukana komsele wokubeletha ophansi (ubuhlungu bomlomo wesibeletho, ubulili, ubhiya) ngenxa yokuthi izicubu asinaso isikhathi sokuzivumelanisa kahle nobukhulu be-fetus.
Ubuthakathaka bomsebenzi. Ukuhlukunyezwa okungavamile kakhulu kokubeletha kusenesikhathi kungukuthi ubuthakathaka bokusebenza, lapho ukuvama nokuqina kwamandla okunciphisa kuncishisiwe, okukhulisa kakhulu isikhathi sokusebenza futhi kuthinta kakhulu isimo somntwana wesisu (i-hypoxia iqala). Umsebenzi wokusebenza ongasebenzi. Ngaphandle komsebenzi ohlukumezayo noma obuthakathaka obhekene nabasebenzi, umsebenzi ovulekile ongahlosiwe uyabonakala kancane kakhulu ekubelethweni ngaphambi kwesikhathi sokuzalwa - uhlobo lokukhubazeka kwesenzo sokuzalwa, lapho ukukhishwa kwemisipha yomkhuhlane kuphazamiseka (ngokuvamile ukukhishwa kuqala ekona lesibindi futhi kusakazeka phezulu). Uma kuqhathaniswa nokusebenza okuhlukumezayo, kuphawulwa izinhlangothi ezibuhlungu kakhulu, phakathi kwezikhathi phakathi kwesibeletho esingenakuphumula ngokuphelele, okuholela ekuthuthukiseni i-intrauterine hypoxia ye-fetus. Isikhundla esingalungile se-fetus. Ekuzalweni okungakabiphi, ukukhubazeka kokubeletha kunamathuba amaningi (isibonelo, izethulo ze-pelvic) ngenxa yobukhulu obuncane be-fetus maqondana nobukhulu bomzimba wesibindi.
Ukukhishwa kwangaphambi kokushisa kwe-amniotic fluid. Lokhu kuqubuzana kwenzeka ngokubeletha ngaphambi kwesikhathi futhi kubangelwa ukungakwazi ukusebenza kwe-isthmicocervical noma ukutheleleka. Ingxenye yesikhumba, ishintshiwe ibe yisiswini, ngaphansi kwethonya lokutheleleka lishintsha izinguquko ezivuthayo, iba yindlala, futhi ukubola kwebhubhane kwenzeka. Ukuthululwa kwe-amniotic fluid ngokuvamile kwenzeka ngokungalindelekile, kuyilapho uketshezi olukhishwa ngaphakathi kwesifazane (kusukela endaweni emanzi endaweni yokugeza kuya emanzini agelezayo ngobuningi). Umbala we-amniotic fluid ungaba obala futhi obala (okuwubufakazi besimiso esanelisayo somntwana), kwezinye izimo, amanzi angathola umbala oluhlaza, abe yi-turbid, ngephunga elimnandi (okubhekwa njengesibonakaliso se-intrauterine fetal hypocia noma ukutheleleka).
Izifo
Izinkinga ezithathelwanayo ekubelethweni noma e-puerperium ngesikhathi sokubeletha ngaphambi kwesikhathi zivame ukubhekwa kaningi kunesikhathi sokubeletha ngesikhathi. Lokhu kungenziwa ngenxa yenkambo yokusebenza yesikhathi eside (ebuthakathaka bemisebenzi), isikhathi eside isikhathi esinganqamuki - isikhathi esingaphezu kwamahora angu-12 (njalo ngemva kokuphuma kwe-amniotic fluid ngaphambi kokuqala komsebenzi kungathatha amahora amaningi), kanye nobukhona bokuqala emzimbeni wesifo sofuba, waba imbangela yokuzalwa ngaphambi kwesikhathi. Izinkinga ezithathelwanayo ezivame ukwedlula zonke yi-endometritis ye-postpartum (ukuvuvukala kwesibeletho), ukuxhaswa kwe-sutures ngemuva kokukhipha ama-rills. Izinkinga ezingavamile kakhulu kodwa ezinzima zingaba yi-peritonitis (ukuvuvukala kwe-peritoneum) ne-sepsis (ukusabalala okujwayelekile kwesifo kulo lonke umzimba).
Ukuphathwa kwemisebenzi yokuqala
Njengoba ngenxa yokuphila kwengane engakabiphi kuyisimo sokucindezeleka okuqinile, ukuphathwa kokubeletha kusenesikhathi kunemibono eyinhloko evela ekuphathweni kwabasebenzi ekukhulelweni kwesikhathi esigcwele. "Isiqubulo" esiyinhloko esiqondisa izidakamizwa ukuphathwa ngokucophelela, okulindelekile ekuphathweni komsebenzi wokuqala, ukungabi khona kwanoma yikuphi ukungenelela ngaphandle kwezizathu ezibalulekile.
Ukulondolozwa kokukhulelwa
Esikhathini sokusongela noma ukuqala ukubeletha ngaphambi kokuzalwa, uma kungekho ukuphikisana (njengokuphuma kwe-amniotic fluid, izinkinga ezinkulu zokukhulelwa, ukuvulwa komlomo wesibeletho okungaphezu kuka-5 cm, ukutholakala kokutheleleka, njll), ukwelashwa okuhlose ukugcina ukukhulelwa kwenziwa. Njengamanje, izidakamizwa zinezidakamizwa eziphumelelayo ezivimbela umsebenzi owenziwe ngokuvumelana nesibindi - ukucolisa (isidakamizwa esasetshenziswa kakhulu kuleli qembu i-HINIPRAL). Ukuze unciphise ngokushesha ithoni ye-uterine, i-tocolytics iqala ukujova ngaphakathi, ngemuva kokunciphisa ithoni bayashintsha ukuthatha lezi zidakamizwa ngendlela yamathebulethi.
Ukuvimbela izinkinga. Uma kwenzeka usongelwa ukuphazamiseka kokukhulelwa ngesikhathi esingaphansi kwamasonto angama-34, ukucindezeleka kokuphefumula kwesisu esisha (ukuphazamiseka kokuphefumula ngenxa yokuvuthwa okwanele kwamathanga wamaphaphu) kuvinjelwa ngokumisela amahomoni akhulelwe we-adrenal cortex-glucocorticoids (PREHNYOLOH, DEXAMETHANON, BETAMETAZON). Izinga lokuvimbela isifo sokucindezeleka kokuphefumula komntwana wesibungu kuthatha amahora angu-24 ngokwesilinganiso (izinhlelo ezihlukahlukene zokuqokwa kwe-glucocorticoids zakhiwe - kusukela emahoreni angu-8 kuya kwezinsuku ezimbili, okukhethwa kukho okwenziwe kuye ngesimo esithile esiyinkimbinkimbi). Lezi zidakamizwa zibangela ukusheshiswa kokuvuthwa kwe-surfactant ye-pulmonary ebusweni, ngoba kungabikho kwalesi sifo esisebenzayo esise-alveoli - "ama-bubbles gas" ephazamisi lapho ukushintshaniswa kwegesi phakathi kwegazi nomoya - nokuvimbela ukuthi amaphaphu angadli ngokukhipha inhalation kubangela ukuthuthukiswa kwezifo zokuphefumula i-neonate ngaphambi kwesikhathi. Kuthiwa ukuthi ngesikhathi sokubeletha kwamasonto angaphezu kwengu-34, amaphaphu ase-fetal kakade anesimo esiphezulu se-surfactant. ngakho asikho isidingo sokuvimbela ukucindezeleka kwesifo sokucindezeleka. Ku-arsenal of obstetricians kanye neonatologists, ama-surfactant amalungiselelo atholakalayo okwamanje (KUROSURF, SURFANTANT BL), ngokusungulwa kwezingane ezisanda kusanda kuzalwa zinganciphisa kakhulu izigameko nobukhulu be-respiratory depression syndrome. Ngesikhathi sokubeletha, ukuqapha ngokucophelela kwenziwa kokubili ngesimo sowesifazane wesifazane (izinga lokushisa, ukucindezelwa kwegazi, uma kunesidingo, ukuhlolwa kwegazi kuhlolwa), kanye nesimo somntwana wesifo somntwana nge-cardiotocography (izinzwa ezimbili ezirekhoda ithoni yesisu nesenzo senhliziyo yomntwana , okuvumela ukuhlolwa okuphumelelayo kwe-intrauterine "isimo sempilo" ye-fetus), kanye nokulalela njalo amathoni enhliziyo yengane ngokudonga lwangaphakathi lomzimba. Ukuvimbela i-intrauterine hypoxia ye-fetus kwenziwa, ngenxa yalokhu i-PIRACETAMES, ASKORBINE ACID, COCAROXYLASE, ACTO-VEGIN.
Anesthesia
Isimo esikwanele sokuphathwa kahle kwemisebenzi yokutholwa komzimba yindlala ye-anesthesia, ngoba ubuhlungu buholela ekwakhiweni kwe-spasm ye-vascular, okuyinto enomthelela omubi emntwaneni ongakapheli isikhathi eside, okuyiwona msebenzi onzima kakhulu. Ngenhloso yokuzala okunomzimba, i-spasmolytics ne-analgesics, i-epestural anesthesia (indlela ye-anesthesia, lapho umuthi ujojelwa khona endaweni ye-epidural) isetshenziswa. Umjovo wenziwa esifundeni se-lumbar, isikhala esiphakathi kodonga lomgogodla kanye negobolondo elikhuni elimboza umgogodla, i-catheter ifakwa, futhi i-agent ye-anesthetic ilawulwa. Uma sicabangela ukuthi ama-analgesics ama-narcotic (isibonelo, i-PROMEDOL) angaba nomthelela ocindezelayo esikhungweni sokuphefumula kwesisu, ukusetshenziswa kweli qembu lezidakamizwa akukwaziswa. I-anesthesia ye-epidural iye yafakazela ekuphathweni kokuzalwa kwangaphambi kokubeletha, ngoba igalela ekuthuthukiseni ukugeleza kwegazi okungenasifo esibelethweni, okuba nomthelela omuhle esimweni sokukhulelwa komntwana kanye nokusize ukuba kunqobe ukucindezeleka kokuzalwa ezimweni "ezikhululekile".
Rhythmostimulation
Ukuqakatheka okulandelayo kwamasu okusebenza uma kwenzeka ukukhulelwa ngaphambi kwesikhathi kuyisimo sengqondo esiqaphile ngokubhekelana nokuhlukunyezwa lapho kutholakala ubuthakathaka bomsebenzi. Uma ukulethwa kwezikhathi okuqala ngesikhathi kuqala nge-rhodostimulation, kufanele iqhubeke kuze kube sekupheleni kokubeletha, ngakho-ke uma kwenzeka ukubeletha kusenesikhathi, inqubo yokukhishwa isetshenziselwa: ngesikhathi sokujwayelekile komsebenzi, ukuvuselela kuyaphela, ngoba ukugqugquzela isitho esincipha se-fetus ngaphambi kwesikhathi kungabangela i-intrauterine hypoxia.
Ukugcina isikhathi semizamo
Ngesikhathi sokuxoshwa kwe-fetus (isikhathi sokuzama) ngenhloso yokukhipha okuqaphile kakhulu kwe-fetus, ukuzalwa kuthathwa ngaphandle kokuvikela i-perineum kusukela ekugqibeni (okuthiwa yi-manual ye-obstetric), futhi ukucutshungulwa kwe-perineal kunqunywe ukunciphisa ukucindezelwa kwekhanda le-fetal ngama-tisses we-canal birth-episiotomy. Lapho ebeletha, i-neonatologist ihlale ikhona, ilungele ukuhlinzeka ngosizo oluphuthumayo umntwana osanda kuzalwa futhi ivuselele uma kudingeka.
Ukusebenza kwesigaba saseKhesariya
Kunzima ukuthola izinkomba zesigaba sokuqashwa ngesikhathi sokuqala komsebenzi, ikakhulukazi uma isikhathi sokubeletha singaphansi kwamasonto angama-34. Ezikhungweni zanamuhla, ukulethwa kwesigaba sokuhlinzekwa nge-pregnancy-pregnancy kuze kube amasonto angama-34, iningi lamacala lenziwa ngokuvumelana nezinkomba eziphelele - okungukuthi, ezimweni ezisongela ukuphila komama. Izimpawu ezingenakuqhathaniswa zifaka ukuphazamiseka kwe-placental ngaphambi kwesikhathi, i-placenta previa (i-placenta ihlanganisa umlomo wesibeletho, futhi ukubeletha akunakwenzeka ngokusebenzisa imithombo yamabele okuzalwa), isikhundla esithintekayo se-fetus, njll. Isidingo sokuhlinzekwa okusebenzayo ekuthandweni kwe-fetus uma ukukhulelwa ngaphambi kwesikhathi kwenziwa ngokuhlanganyela (ngokubamba iqhaza eziningana ochwepheshe) ngokucabangela ukubikezelwa kokuphila komntwana kanye nokuhlinzekela ukunakekelwa kwezingane ezingenalo ikhono lokubeletha.
Indlela yokuziphatha?
Ukuziphatha kowesifazane ohamba phambili ohlelweni lokuhlinzeka kwangaphambi kwesikhathi akufani kakhulu nokuziphatha nokulethwa ngesikhathi. Uma udokotela evumela, ungakwazi ukuhamba eduze nesigceme, uthathe izikhundla zomzimba ezikhululekile ezenza ubuhlungu bube bukhulu, besebenzisa amasu okugcoba (ukujikeleza isisu ngendlela ehamba ngayo, ukuxubha i-sacrum, njll.), Uphefumule ngesikhathi sokulwa. Kwezinye izimo (isibonelo, ngesethulo esivela emntwaneni we-fetus) kunconywa ukuthi ulele embhedeni. Kulesi simo, okukhethwa kukho kuzoba khona eceleni, njengoba lesi simo singabandakanyi ukucindezela izitsha ezinkulu (okungase kubangele ukuthuthukiswa kokuhlupheka kwe-fetrauterine fetal), futhi kuvimbele umntwana ukuthi angashukumi ngokushesha kakhulu emgodini wokuzalwa. Okubaluleke kakhulu - gcina isimo sengqondo sokuzola nokuhle, ulalele ngokucophelela bese ulandela izincomo zababelethisi nodokotela.
Ingane yangaphambi kwesikhathi
Ingane, ezalwe ngenxa yokubeletha ngaphambi kwesikhathi, inezibonakaliso zokungabi nesikhathi sokuqala, ubukhulu obunqunywe kuwo wonke umuntu ngesikhathi sokuzalwa - isisindo esingaphansi kuka-2500 g, ukukhula okungaphansi kuka-45 cm, ukuchichima kokushisa ushizi esikhunjeni, isisindo somswakama ophansi nesindlebe, amantombazane angabunikazi amancane amancane , kubafana ama-testicles ayengeniswe phansi esihlahleni, amapulangwe e-nail awafinyeleli kalula. Lapho ezalwa, ingane ihlolwe yi-neonatologist ekamelweni lokulethwa futhi idluliselwe ku-Intensive Care Unit noma ukuvuselelwa kwe-Neonatal ukuqhubeka nokuqapha nokwelashwa. Njengomthetho, izingane ezingaphambi kwesikhathi zifakwa ku-kuvez - i-incubator ekhethekile enezindonga ezibonakalayo, ezigcina ukushisa, umswakama, okwenziwe oksijini ngendlela enhle yemingcele yengane. Ukuba ngukuvuthwa kukhuthaza ukugeleza okuthe xaxa kwenkathi yokuguqulelwa komntwana osanda kuzalwa ngaphandle komzimba kamama. Uma isikhathi eside sokubeletha nesisindo somntwana ekubelethweni, isikhathi sokubeletha sihle kakhulu. Uma kunesidingo, umntwana osanda kuzalwa udluliselwa esibhedlela sokubeletha esiya esibhedlela sezingane kuze kube yisigaba sesibili sohlengikazi. Kunezibhedlela zokubeletha ezikhethekile ekuphathweni kwezidingo zangaphambi kokubeletha kanye nokunakekelwa kwezinsana ezisanda kuzalwa, ezihlonyelwe imishini yinkimbinkimbi yesimanje yezinsana, izidakamizwa kanye neonatologists ziye zathola ulwazi olunzulu ekwelapheni nasekulethwe kwezikhungo zezokwelapha, okuvumela ukuba ngcono kakhulu imiphumela yomama kanye ngomntwana. Abesifazane abanengozi enkulu yokubeletha ngaphambi kwesikhathi kufanele banikezwe kulezi zikhungo ezinzima, lapho zonke izimo zikhona ekuhlinzekeni usizo oluphelele lokuvuselela umntwana osanda kuzalwa (Kuveza, umoya womoya, kanye nochwepheshe bezinga elifanele).
Ukushintshwa kwezimo ezintsha zokuphila ngaphandle kwesibeletho somntwana ongakabi isikhathi eside kunzima kakhulu futhi kunesikhathi eside kunomntwana ophelele. Lokhu kungenxa yokungahlali kwezitho nezinhlelo, ikhono elincishisiwe lokuzilawula, ukuthuthukiswa ngokwanele kwesimiso somzimba sokuzivikela. Njengamanje, impumelelo ebalulekile iye yafezwa ekunakekeleni izinsana ezisanda kuzalwa: Amalungiselelo asebenzayo abonakale esitokisini sabodokotela, lapho, lapho bekhulunyiswa kwengane, banganciphisa kakhulu ingozi yokuphefumula kwesifo sokuphefumula, izibhedlela zokubeletha zenziwa ngemishini eyinkimbinkimbi yokuhlinzeka ngempilo ephezulu (kuvezes, ventilators, njll), okuvumela ukuthuthukisa imiphumela nokubikezela ukuthuthukiswa nokuthuthukiswa kwengane.
Ukuvimbela ukuzalwa ngaphambi kwesikhathi
Izinyathelo eziyinhloko ezihloswe ekuvimbeleni ukuzalwa kwangaphambi kokubeletha zenziwa ezingeni lezokubonisana kwabesifazane, ngoba kuhlolisiswa kwekhwalithi yokukhulelwa okukuvumela ukuba ubikezele futhi uhlolisise usongo lokuphazamiseka kwalo ngesikhathi. Izinyathelo zokuvimbela umsebenzi wokuqala zihlanganisa:
• Ukuhlela ukukhulelwa nokuhlinzekwa kokuqeqeshwa okuqala, okuhlanganisa ukwelashwa kwezifo ezikhona ze-somatic, ukwelashwa kwezifo ezingapheliyo zokutheleleka, ukuze ngesikhathi sokukhulelwa, umama olindelekile usezingeni elihle lokubeletha kwengane.
• Ukubhaliswa kwasekuqaleni nokubonisana komfazi nokuqapha ngokuqhubekayo kokukhula kokukhulelwa. Lokhu kuyiqiniso ikakhulukazi uma esikhathini esedlule owesifazane usenayo kakade imishado, ukubeletha ngaphambi kwesikhathi, ukukhipha isisu.
• Ukwelashwa kwe-foci yokutheleleka, ikakhulukazi i-colpitis (izinqubo zokuvuvukala kwesisu), kutholakala ngesikhathi sokukhulelwa, ngoba indlela evame kakhulu eyenza ukuthuthukiswa kokuzalwa kwangaphambi kokubeletha kuyakhuphuka (ukutheleleka okuvela emaseni okukhuphuka futhi kuphazamise isigxobo esingaphansi kwesibindi sesisu).
• Ukuvinjelwa nokuphulukiswa okwesikhashana kokucindezeleka kokukhulelwa (njengokungasebenzi kahle kwe-placental, gestosis - toxicosis kwesigamu sesibili sokukhulelwa, i-pyelonephritis - ukuvuvukala kwezinso, njll).
Ukuqapha kwe-ultrasonic ye-intrauterine status fetal kanye nokukhula kokukhulelwa (i-ultrasound ingasetshenziswa ukukala ubude nesimo somsele womlomo wesibeletho ukuxilongwa ngesikhathi esifanele sokuntuleka kwe-ischemic-insuppiciency).
• Uma kunezibonakaliso zokususwa kwesisu, ukubeletha ngesikhathi esifanele kanye nokwelapha ngokuvimbela ukucindezeleka kwesifo sokuphefumula ebusweni. Manje siyazi ukuthi yini eyingozi kumama wokubeletha ngaphambi kwesikhathi.