Ua nui iki anei kāu pēpē i loko o ka ʻōpū? E kamaʻilio kākou e pili ana i ka Fetal Macrosomia!

Inā he makuahine hāpai ʻoe, ua lohe paha ʻoe i kāu kauka e ʻōlelo ana, "Me he mea lā ua nui iki ka pēpē," a i ʻole "Me he mea lā ua kaumaha iki ka pēpē." A i ʻole ua manaʻo paha ʻoe ua ʻoi aku ka nui a kaumaha paha o kāu pēpē ma mua o nā mea ʻē aʻe. ʻOiaʻiʻo, aia kahi inoa kūikawā no kēia ma ka lāʻau lapaʻau. I kēia lā, e kamaʻilio mākou e pili ana i kēia maʻi i kapa ʻia ʻo "Fetal Macrosomia." Mai hopohopo, he mea nui loa ka ʻike ʻana i kēia.

He aha kēia pēpē nui i kapa ʻia (Fetal Macrosomia)?

I ka ʻōlelo maʻalahi, ʻo `(Fetal Macrosomia)` ʻo ia hoʻi he 10% a ʻoi aku paha ke kaumaha o kāu pēpē ma mua o ke kaumaha i manaʻo ʻia no ka pule o ka hāpai ʻana. E noʻonoʻo, inā ma kahi o 3 paona o nā pēpē i kēia pule, hiki i kāu pēpē ke 3.3 paona a ʻoi aku paha.

I kēia manawa, ke noʻonoʻo nei paha ʻoe, "ʻAuē, e ʻoi aku ka nui a me ke olakino o kaʻu pēpē." He ʻoiaʻiʻo, he pēpē olakino ka moeʻuhane o kēlā me kēia makuahine. Akā, i kekahi manawa ke nui loa ka pēpē , hiki ke paʻakikī iki ke hānau maʻamau iā ia, ʻo ia hoʻi, ma ke ʻano vaginal. I kekahi manawa he mau waimaka vaginal paha ka makuahine, a paʻakikī paha ke kīkē i ka pēpē i waho. Inā manaʻo ke kauka ua nui loa ka pēpē - ʻo ia hoʻi, ʻoi aku ma mua o 11 paona (ma kahi o 5 kilograms) a ʻoi aku paha ma mua o 10 paona (ma kahi o 4.5 kilograms) inā loaʻa iā ʻoe ka maʻi diabetes - a laila ʻo ke koho palekana loa paha ka hana ʻoki cesarean (C-section).

Inā ulu aʻe ka pēpē, he aha nā pilikia e kū mai ana i ka wā e hānau ai?

Ke kali nei ʻoe i kahi pēpē nui, ʻoi aku ka nui o kou pilikia o kekahi mau pilikia i ka wā hānau. E nānā kākou i kēlā mau mea.

Nā pilikia e hiki ke loaʻa i ka makuahine

• Hiki ke hōʻeha ʻia kou ʻauwai hānau, ʻo ia hoʻi ka vagina a me ka ʻāpana a puni ia (ka `perineum`). No ka mea, he nui ke pēpē, hiki ke haehae i kona puka ʻana i waho.
• Hiki paha iā ʻoe ke kahe koko ma mua o ka maʻamau. I kekahi manawa hiki i kēia ke alakaʻi i ke kahe koko postpartum.
• Aia kekahi manawa kakaikahi loa o ka haki ʻana o ka ʻōpū, ʻoi aku ka maʻamau i nā makuahine i loaʻa mua i ka ʻoki cesarean.
• Hiki ke lōʻihi ka manawa ma mua o ka hānau ʻana, ʻoiai ke kaʻina hana e paʻi ana. Hiki i kēia ke luhi loa no ka makuahine.
• E ʻike paha ʻoe i nā loli i ka puʻuwai o kāu pēpē i kou wā e hānau ana i ke pēpē .

Nā pilikia i ka pēpē - ʻoiai ka dystocia poʻohiwi

Inā nui ka pēpē, loaʻa iā lākou kekahi mau pilikia. ʻO ka mea hopohopo loa o kēia mau mea he kūlana i kapa ʻia ʻo `(Shoulder Dystocia)`.I ka ʻōlelo maʻalahi, ʻo ia ka manawa e paʻa ai nā poʻohiwi o ke pēpē i loko o ka ʻōpū o ka makuahine ma hope o ka puka ʻana o ke poʻo o ke pēpē mai loko mai o ka vagina. ʻOiai hiki ke hana ʻia kēia i ka wā hānau ʻana, ʻoi aku ka nui o ka hana ʻia me nā pēpē nui aʻe.

He pilikia maoli ka Dystocia poʻohiwi. Akā, mai hopohopo, he hoʻolālā ko kāu kauka a me ke kahu hānau no ka mea e hana ai inā loaʻa kekahi mea e like me kēia. E nānā pono lākou iā ʻoe i kou wā hānau.

Hiki i kēia kūlana (Shoulder Dystocia) ke hana i kēia mau mea i kahi pēpē hānau hou:

• Hiki i ke pēpē ke haki nā iwi , ʻoiai ka iwi ʻāʻī.
• ʻEha Brachial Plexus . He hōʻino kēia i ka puʻupuʻu o nā aʻalolo e lawe ana i nā hōʻailona i nā lima o ke pēpē. Hiki i kēia ke hoʻonāwaliwali i nā lima.
• He mea kākaʻikahi loa, hiki ke hōʻeha ʻia ka lolo .

Hiki ke hoʻomau kēia mau pilikia ma hope o ka hānau ʻana no nā pēpē ʻelemakule.

ʻOi aku ka nui o ka loaʻa ʻana o kekahi mau pilikia olakino i nā pēpē i hānau nui ʻia ma hope o ka hānau ʻana:

• Ka piʻi ʻana o ka helu o nā hunaola koko ʻulaʻula i loko o ke koko. Hiki paha i kēia ke hoʻonui i ka pilikia o ka loaʻa ʻana o ka jaundice i ka pēpē.
• Haʻahaʻa ke kō koko (hypoglycemia).
• Nā pilikia hanu.

He aha nā hōʻailona e hōʻike ana ua nui ka pēpē?

ʻO kaʻoiaʻiʻo, he paʻakikī ke ʻike i ka nui pololei o kāu pēpē a hiki i kona hānau ʻana. He nui nā hōʻailona āu e ʻike ai i ka wā hāpai e like like, ʻaʻohe mea pehea ka ulu ʻana o kāu pēpē. ʻO ia hoʻi, he mea maʻamau nā mea e like me ka ʻōpū nui a me ka luhi i ka wā hāpai maʻamau. Eia nō naʻe, aia kekahi mau mea a kāu kauka e kānalua ai ʻo ia ka nui o kāu pēpē ke nānā ʻo ia iā ʻoe.

No ke aha e ulu nui ai ke pēpē i loko o ka ʻōpū? He aha nā kumu?

Hiki i kāu kauka ke manaʻo he macrosomia kāu pēpē no kēia mau kumu:

• Inā ʻoi aku ke kiʻekiʻe o kou "Fundal Height", ʻo ia hoʻi ke kiʻekiʻe o ka uterus (ke ana ʻana o ke kiʻekiʻe o ka ʻōpū), ma mua o ka mea i manaʻo ʻia. E hoʻomanaʻo paha ʻoe e ana ke kauka i kēia i kēlā me kēia nānā ʻana.
• Inā ua nui loa kou kaumaha i ka wā hāpai. Ua ʻike mākou a pau e loaʻa ke kaumaha i ka wā hāpai, akā he mea nui e mālama iā ia ma kahi pae olakino.
• Inā loaʻa iā ʻoe ka maʻi diabetes, a inā paha ua loaʻa iā ʻoe ka maʻi diabetes i ka wā hāpai (gestational diabetes). ʻO kēia ke kumu nui o nā pēpē nui.
• Inā ua hānau mua ʻoe i kahi pēpē nui.
• Inā ua hala kou lā hānau, e nui iki aʻe ana kāu pēpē i ka hala ʻana o nā lā.
• Inā ua hānau ʻia ʻoe he pēpē nui, i kekahi manawa hiki ke lilo ia i mea hoʻoilina.

Pehea e hoʻoholo ai nā kauka inā nui ka pēpē?

Inā kānalua kāu kauka he nui kāu pēpē, e kauoha paha lākou i kahi scan ultrasound e nānā i ke kaumaha o ka pēpē a me ka nui o ka wai amniotic (wai amniotic) a puni ka pēpē. Ua ʻike ʻoe i ke ʻano o ka ultrasound. Hoʻohana ia i nā nalu kani alapine kiʻekiʻe e hoʻouna i nā kiʻi a i ʻole nā ​​​​wikiō o kāu pēpē.

ʻAʻole hiki iā mākou ke ʻike pololei me ka ultrasound wale nō?

He nīnau maikaʻi. ʻAʻole hiki i kahi ultrasound ke haʻi pololei iā ʻoe i ke kaumaha o kāu pēpē. Hāʻawi wale ia iā ʻoe i kahi manaʻo maʻamau, me ka hoʻohui a i ʻole ka emi ʻana o 10% . No ka laʻana, inā ʻōlelo ka scan he 4 paona ke kaumaha o ke pēpē, he "kuhi maikaʻi loa" wale nō ia. Hiki i ke kaumaha o ke pēpē ma waena o 3.6 a me 4.4 paona.

Eia kekahi, ʻaʻole hiki i kahi ultrasound ke wānana pololei inā e hana ʻia kekahi mea e like me ka dystocia poʻohiwi i ʻōlelo ʻia ma luna. No laila, e hoʻohui ke kauka i ka ʻike mai ka ultrasound, kou mōʻaukala hāpai (pehea ʻoe i loaʻa ai nā pēpē ma mua, kou mau kūlana olakino), a me nā hoʻokolohua āu e hana ai e hoʻoholo ai i ka manawa a me ke ʻano palekana loa no ka hānau ʻana i ka pēpē.

He aha hou aʻe ka mea a ke kauka e ʻimi nei?

No ka hoʻoholo ʻana inā pono ʻoe i kahi scan ultrasound, e hana pū ke kauka i kēia mau mea:

• Ke ana ʻana i kou "Fundal Height". ʻO kēia ka mamao mai ka piko o kou uterus a i ka "Pubic Bone" ma kou ʻōpū lalo.
• Ka pā ʻana o kou ʻōpū. E hoʻāʻo ke kauka e loaʻa kahi manaʻo o ka nui o ke pēpē ma ka nānā ʻana i kekahi mau wahi o kou ʻōpū.

Inā hōʻike kēia mau hoʻokolohua ua nui ka pēpē, hiki i kāu kauka ke kauoha i nā hoʻokolohua hou aʻe (e like me ka Biophysical Profile a i ʻole kahi Nonstress Test) e nānā hou aku i ke olakino o ka pēpē.

Inā nui ka pēpē, he aha nā lāʻau lapaʻau e hiki ke hana ʻia?

ʻO ka mālama ʻana i ka macrosomia e pili ana i ka hoʻokele ʻana i kekahi mau kūlana olakino āu e loaʻa ai , e like me ka maʻi diabetes a i ʻole ka momona. Pono ʻoe a me kāu kauka e hana pū e hoʻokele i kekahi mau kūlana e hoʻopilikia paha i kāu hāpai ʻana a i ʻole ka hānau ʻana.

I ka hapanui o nā hihia, ʻo ka ʻai ʻana i ka meaʻai olakino, ka hoʻoikaika kino, a me ka mālama ʻana i kāu maʻi diabetes (ka lawe ʻana i ka insulin inā pono) nā mea nui loa hiki iā ʻoe ke hana.

E kamaʻilio kāu kauka me ʻoe e pili ana i nā pilikia o ka hānau ʻana ma ke ʻano he wahine. I kekahi mau hihia, hiki ke ʻōlelo ʻia he ʻoki C-section e hōʻemi i ka pilikia o nā pilikia. Akā he mea nui e ʻike i kēia: ʻAʻole i hōʻike ʻia ka hānau mua ʻana (ʻo ia hoʻi, ka hoʻolālā ʻana i ka hānau ʻana ma mua o 39 mau pule) e hōʻemi i nā pilikia. No laila, ʻaʻole ʻōlelo ʻia ka hānau mua ʻana ke ʻole he kumu lapaʻau ʻē aʻe no ka nui o ka pēpē.

He mea pono anei ke hana ʻoki ʻoki cesarean (C-section) inā nui ka pēpē?

ʻAʻole pono. ʻAʻole pono nā pēpē nui a pau i ka ʻoki ʻia ʻana o C. Eia nō naʻe, ʻoi aku ka nui o ka poʻe e pono ai ka ʻoki ʻia ʻana o C:

• Inā ua loaʻa iā ʻoe kahi pēpē me ka `(Shoulder Dystocia)` ma mua.
• Inā loaʻa iā ʻoe ka maʻi diabetes a manaʻo ʻia ke kaumaha o kāu pēpē ma mua o 10 paona (ma kahi o 4.5 kg).
• ʻAʻohe ou maʻi diabetes, akā ua manaʻo ʻoe ua ʻoi aku ke kaumaha o kāu pēpē ma mua o 11 paona (ma kahi o 5 kilokani).

Hana ʻia kēia mau hoʻoholo e kāu kauka ma hope o ke kamaʻilio ʻana me ʻoe a ma muli o kou kūlana.

Aia kekahi mau ala e pale aku ai i ka ulu ʻana o ke pēpē e like me kēia?

ʻO kaʻoiaʻiʻo, he paʻakikī pinepine ka wānana pololei ʻana i ka `(Fetal Macrosomia)` ma mua. Ma hope wale nō o ka hānau ʻana a me ke kaupaona ʻana o ka pēpē hiki iā mākou ke ʻōlelo maopopo, "Auē, ua nui ka pēpē." Hiki i kekahi mau pēpē ke hānau ʻia ma mua o ka maʻamau me ka ʻole o nā kumu pilikia.

Eia nō naʻe, ʻo ka mālama ʻana i ke olakino maikaʻi a me ka loaʻa ʻana o kahi hāpai olakino e hiki ke kōkua i ka hōʻemi ʻana i kēia pilikia i kekahi ʻano:

• E hele i nā keʻena antenatal maʻamau. ʻO nā kipa mau ʻana me kāu kauka e ʻae iā ʻoe a me kāu kauka e nānā pono i ka ulu ʻana o kāu pēpē. He manawa kūpono hoʻi ia e nīnau ai i kāu mau nīnau.
• E makaʻala i kou kaumaha. E like me ke koʻikoʻi o ka ʻike ʻana i kou kaumaha ma mua o ka hāpai ʻana, he mea nui nō hoʻi e ʻike i ka nui o kou kaumaha i loaʻa i ka wā hāpai. He mea maikaʻi ke makaʻala iki i kekahi o nā meaʻai ma ko mākou ʻāina (e.g., nā meaʻai palaoa, nā mea ʻono).
• Inā loaʻa iā ʻoe ka maʻi diabetes, e hana i nā hana e pono ai e kāohi iā ia. ʻO ka maʻi diabetes mua (Diabetes Mellitus) a me ka maʻi diabetes gestational (ʻO ka maʻi diabetes e ulu ana i ka wā hāpai) he mau mea nui ia no ka macrosomia fetal.

He aha nā pilikia olakino e hiki ke loaʻa i nā pēpē i hānau nui ʻia i ka wā e hiki mai ana?

Ua hōʻike ʻia e nā noiʻi he nui ka pilikia o nā pēpē i hānau nui ʻia i kēia mau mea i ka wā e hiki mai ana:

• Haʻahaʻa ke kō koko (Hypoglycemia) i ka wā kamaliʻi.
• Ka momona i ka wā kamaliʻi.
• ʻO ka metabolic syndrome kahi hui o nā kūlana e hoʻonui ai i ka pilikia o ka hoʻomohala ʻana i nā maʻi e like me ka maʻi puʻuwai, ka hahau, a me ka maʻi diabetes.

Akā e hoʻomanaʻo, ʻoiai inā he mau iwi haki a i ʻole ka hōʻino ʻia o nā aʻalolo i ka wā hānau, hoʻōla piha ka hapa nui o nā pēpē mai kēlā mau ʻeha.

ʻO ka "Fetal Macrosomia" kahi maʻi e hiki ai ke hoʻoulu i nā pilikia koʻikoʻi i ka wā hānau. ʻOiai he nui nā kumu no kēia, ʻo ka maʻi diabetes i kāohi ʻole ʻia a me ka momona nā kumu nui ʻelua.Hiki iā ʻoe ke hōʻemi i kou pilikia o ka loaʻa ʻana o kahi pēpē nui ma ka mālama pono ʻana i kēia mau kūlana. ʻO nā mea e like me ka hoʻoikaika kino mau a me ka ʻai ʻana i kahi meaʻai olakino e kōkua iā ʻoe e loaʻa kahi hāpai olakino a hōʻemi i kou pilikia o nā pilikia. Mai makaʻu e nīnau i kāu kauka e pili ana i ke ala maikaʻi loa e mālama ai iā ʻoe a me kāu pēpē. ʻOiai hiki ke koʻikoʻi ka "Fetal Macrosomia", ʻo ka hapa nui o nā pēpē nui i hānau olakino ʻia.

No laila, he aha nā mea nui e pono ai kākou e hoʻomanaʻo mai kēia?

ʻAe, e hōʻuluʻulu kākou i kekahi o nā mea a mākou i kamaʻilio ai e pono ai ʻoe e hoʻomanaʻo:

• ʻO ke ʻano o ka "Macrosomia Fetal" ʻo ia hoʻi ke piʻi ʻana o ke kaumaha o ke pēpē ma mua o ka mea i manaʻo ʻia i loko o ka ʻōpū.
• ʻO nā kumu nui o kēia, ʻo ia ka maʻi diabetes o ka makuahine (ʻoi aku ka paʻa ʻole) a me ka piʻi nui ʻana o ke kaumaha i ka wā hāpai.
• Inā nui aʻe ka pēpē, hiki i ka makuahine a me ke pēpē ke loaʻa i kekahi mau pilikia i ka wā hānau. ʻO ka "Shoulder Dystocia" kahi maʻi koʻikoʻi e hiki ke hana i ka pēpē.
• Loaʻa i nā kauka kahi manaʻo o ka nui o ke pēpē ma o nā scan ultrasound a me nā hoʻokolohua ʻē aʻe.
• ʻAʻole pono nā pēpē nui a pau i ka ʻoki ʻia ʻana o C-section, akā i kekahi mau hihia, ʻo ia ke koho palekana loa.
• Hiki ke hoʻēmi ʻia kēia pilikia ma o ke alakaʻi ʻana i kahi nohona olakino, ka ʻai ʻana i ka meaʻai kaulike, a me ka kaohi ʻana i nā maʻi e like me ka maʻi diabetes.
• Mai hopohopo, ʻo ka hapa nui o nā pēpē nui i hānau olakino ʻia. E kūkākūkā i nā mea āpau me kāu kauka a e hahai i kāna mau kuhikuhi.

Inā he mau nīnau hou aku kāu e pili ana i kēia, e ʻoluʻolu e nīnau i kāu kauka. ʻO lākou ka poʻe hiki ke hāʻawi iā ʻoe i ka ʻōlelo aʻoaʻo maikaʻi loa.

ʻO ka Macrosomia o ka Fetal, Pēpē Nui, Hāpai Keiki, Hānau Keiki, ʻOki Cesarean, Maʻi Diabetes, Dystocia Poʻohiwi