ʻAʻole anei i like ka nui o kāu pēpē me ka mea i manaʻo ʻia i loko o ka ʻōpū? E kamaʻilio kākou e pili ana i ka Intrauterine Growth Restriction (IUGR)!

I ka hapa nui o ka manawa, ma ke ʻano he makuahine, ke manaʻolana nei ʻoe e lawe mai i kahi pēpē olakino a ulu maikaʻi i ka honua. Akā i kekahi manawa, ʻaʻole ulu wikiwiki kāu keiki liʻiliʻi i loko o kou ʻōpū e like me kou makemake. Ua kapa nā kauka i kēia kūlana ʻo Intrauterine Growth Restriction (IUGR) , a i ʻole i kekahi manawa ʻo Fetal Growth Restriction (FGR) . I ka ʻōlelo maʻalahi, he liʻiliʻi ke pēpē no kona makahiki hāpai. ʻO ia hoʻi, ʻoi aku kona kaumaha ma mua o ʻeiwa o nā pēpē ʻē aʻe he ʻumi (ʻoi aku ka liʻiliʻi ma mua o ka 10th percentile) i ka makahiki hāpai like.

I kēia manawa, ʻaʻole like ka ulu ʻana o nā pēpē a pau. ʻOiai he "liʻiliʻi" ka pēpē, ʻaʻole ia he manaʻo he IUGR ko lākou. E like me mākou, he kiʻekiʻe kekahi a he pōkole kekahi. ʻAʻole emi ke olakino o kahi pēpē 5'1" ma mua o kahi pēpē 6'4". ʻAe, ʻo ka hapa nui o nā pēpē i hānau liʻiliʻi ʻia he olakino. Eia nō naʻe, aia kekahi mau makuahine i kekahi mau kūlana olakino e hiki ke kaupalena i ka ulu ʻana o kā lākou pēpē.

He aha nā ʻano nui o ka IUGR?

Ua hoʻokaʻawale nā ​​kauka i ka IUGR i ʻelua mau ʻano nui:

1. IUGR Symmetric (IUGR mua): ʻO kēia kahi e like ai ka nui o ke kino holoʻokoʻa o ka pēpē - ke poʻo, ka ʻōpū, nā lālā. ʻIke ʻia kēia ma kahi o 30% o nā pēpē me IUGR.

2. Asymmetric IUGR (IUGR lua): Maanei, he maʻamau ka nui o ke poʻo a me ka lolo o ka pēpē, akā ʻo ka ʻōpū wale nō ka mea liʻiliʻi. ʻO kēia ke ʻano maʻamau, e helu ana ma kahi o 80% o nā pēpē me IUGR.

Pehea ka maʻamau o kēia kāohi ʻana i ka ulu ʻana o ka pēpē?

Hiki ke ʻike ʻia kēia kūlana IUGR ma kahi o 10% o nā hāpai keiki. Eia nō naʻe, ʻo ka mea nui, ʻoiai inā ʻoi aku ka liʻiliʻi o ka pēpē ma mua o ka maʻamau, ʻaʻole ia he manaʻo mau he IUGR kona. No laila, ʻoi aku ka maikaʻi o ka makaʻu ʻole, ʻeā?

I ka manawa hea e ʻike pinepine ʻia ai ka IUGR?

Hoʻomaopopo pinepine ʻia ka IUGR ma hope o 20 mau pule o ka hāpai ʻana. I kēlā me kēia manawa āu e ʻike ai i kāu kauka, e ana lākou i kou kiʻekiʻe fundal - ʻo ia ka mamao mai kou iwi pubic a i ka piko o kou uterus. Inā haʻahaʻa kēia ana ma mua o ka mea i manaʻo ʻia, kānalua paha kāu kauka i ka IUGR a kuhikuhi iā ʻoe no ka hoʻāʻo hou aku.

Pehea e pili ai kēia maʻi IUGR i koʻu hāpai ʻana?

Inā ua ʻike ʻia ʻoe me ka IUGR, pono e mālama ʻia kāu hāpai ʻana i kahi ʻano ʻokoʻa iki. Hiki i kāu kauka ke kauoha i nā scan hou aʻe (ultrasounds) , nā hoʻokolohua ʻē aʻe, a me nā kipa pinepine ʻana i ke keʻena lapaʻau e nānā i ka ulu ʻana o kāu pēpē. Inā loaʻa iā ʻoe kekahi maʻi olakino ʻē aʻe e hoʻoulu ai i kāu IUGR, hiki i kāu kauka ke hoʻomaka e mālama i kēlā ʻano. Eia nō naʻe, pili kēia i kou olakino a me kāu pēpē.

I kekahi manawa manaʻo paha kāu kauka i kou hāpai ʻana he "pilikia kiʻekiʻe." Eia nō naʻe, he nui nā pēpē i ʻike ʻia me IUGR e olakino ana a pono wale nō i ka nānā hou aku i ka wā hāpai.

He aha nā kumu e kāohi ai i ka ulu ʻana o kahi pēpē?

Aia kekahi mau kumu e kaupalena ʻia ai ka ulu ʻana o kahi pēpē ma kēia ʻano. I kekahi manawa, ma muli kēia o kahi pilikia me ka placenta a i ʻole ke kaula umbilical. ʻO kēia no ka mea loaʻa i ka pēpē nā meaʻai, ka oxygen, a me ke koko e pono ai ma o kēia mau mea. No laila, inā ʻaʻole lawa kēia mau mea, e emi paha ka ulu ʻana o ka pēpē.

Aia kekahi mau kumu e pili ana i ka makuahine:

• Inā ʻoe e kali ana i nā māhoe a i ʻole nā ​​​​​​mākolu .
• Inā ua loaʻa iā ʻoe kahi pēpē ma mua me IUGR .
• Inā loaʻa iā ʻoe nā kūlana e like me ke koko kiʻekiʻe, ka maʻi puʻuwai, a i ʻole ka helu koko haʻahaʻa .
• Inā ʻoe e puhipaka, inu waiʻona, a hoʻohana paha i nā lāʻau ʻē aʻe . (ʻOiaʻiʻo nō kēia mau mea āu e hoʻōki ai i ka hana ʻana!)
• Inā he maʻi autoimmune kou, e like me lupus .
• Inā he maʻi puʻupaʻa kou .
• Inā ʻoe e lawe ana i kekahi mau lāʻau lapaʻau (nā lāʻau anti-seizure) e mālama i nā kūlana e like me ka maʻi epilepsy .
• Inā loaʻa iā ʻoe ka maʻi diabetes (Diabetes Mellitus) .
• Inā loaʻa iā ʻoe kahi maʻi e like me ka rubella, syphilis, cytomegalovirus (CMV), a i ʻole toxoplasmosis i ka wā hāpai.

I kekahi manawa hiki ke hana ʻia ka IUGR e kahi maʻi hānau ʻia a i ʻole genetic i loko o ka pēpē, no ka laʻana , Down syndrome (Trisomy 21) . Ua ʻike ʻia hoʻi he haʻahaʻa paha ke kaumaha o nā pēpē i hānau ʻia e nā makuahine e noho ana ma nā wahi kiʻekiʻe.

He aha ke kumu nui o ka hoʻonui ʻana o ka ulu ʻana o ka fetal?

He mea paʻakikī ke ʻōlelo maopopo i ke kumu o ka palena o ka ulu ʻana o ka pēpē. I kekahi manawa hiki ke loaʻa nā kumu he nui, a ʻaʻole hiki ke loaʻa ke kumu maopopo. E ho'āʻo kāu kauka e ʻimi i ke kumu kumu (inā he).

He aha nā hōʻailona o ka IUGR?

ʻAʻole ʻike ka hapa nui o nā makuahine i kekahi mau hōʻailona kikoʻī e hōʻike ana ua liʻiliʻi kā lākou pēpē ma mua o ka helu o nā pule. I kekahi manawa manaʻo paha ʻoe ʻaʻole nui kou ʻōpū a pēpē paha e like me ka mea i manaʻo ʻia. Eia naʻe, ʻo kāu kauka wale nō ke hoʻoholo pono inā he IUGR kou.

Pehea e ʻike ʻia ai kēia maʻi IUGR?

No ka ʻike ʻana i ka IUGR, pono mua ʻoe e ʻike i kou lā hānau, ʻo ia hoʻi ka lā mua o kou menstruation hope loa a me ka ultrasound trimester mua . ʻO ka ʻike ʻana i kēia lā e hāʻawi i kāu kauka i kahi kumu no ka ʻike ʻana i ka IUGR.

A laila, e ho'āʻo ke kauka e nānā i ka IUGR me ka hoʻohana ʻana i kekahi mau ʻano hana:

• Ke kiʻekiʻe o ka ʻōpū: E like me ka mea i ʻōlelo ʻia ma mua, e ana kāu kauka i ke kiʻekiʻe mai kou iwi pubic a i ka piko o kou ʻōpū (ka nui o kāu "puʻu pēpē") me kahi ana pepa. Ma hope o 20 mau pule, pono e like kēia kiʻekiʻe me ka helu o nā pule āu e hāpai ai ma nā kenimika (cm). No ka laʻana, inā he 32 mau pule ʻoe e hāpai ai, pono e like ke kiʻekiʻe o kou ʻōpū me 32 kenimika. Inā ʻoi aku ka haʻahaʻa o kēia ana ma mua o 4 kenimika ma mua o ka mea i manaʻo ʻia (ʻo ia hoʻi, 28 kenimika a emi mai paha ma kēia laʻana), hiki i kāu kauka ke kānalua i ka IUGR. I kekahi manawa, e kuhi kāu kauka i ka nui o kāu pēpē ma ka palpation.
• Kou Kaumaha: Nānā ʻia kou kaumaha i kēlā me kēia kipa ʻana i ke keʻena lapaʻau. Inā ʻaʻole ʻoe e piʻi pono ana ke kaumaha, he hōʻailona paha ia ʻaʻole e piʻi pono ana ke kaumaha o kāu pēpē.
• Ultrasound: Inā ua ʻike ʻia ʻoe me IUGR, pono ʻoe e loaʻa nā scan maʻamau i kou wā hāpai e nānā i ka ulu ʻana o kāu pēpē. I loko o kēia scan, e hoʻoneʻe kāu kauka i kahi mea hana (wand a probe paha) ma luna o kou ʻōpū. Hoʻokumu nā nalu kani i kahi kiʻi o kāu pēpē. E hoʻohana ke kauka i ke kiʻi e ana i ke kaumaha a me ka nui o kāu pēpē. Hiki ke hoʻohana ʻia ka scan e nānā i ke kahe koko mai ka placenta a i ka pēpē ma o ke kaula umbilical (i kapa ʻia he hoʻāʻo kahe Doppler ). Hiki i ke kahe koko maikaʻi ʻole ke lilo i hōʻailona o IUGR. Hiki i ka scan ke ana i ka nui o ka wai amniotic a puni ka pēpē. ʻO nā pae haʻahaʻa o kēia wai (oligohydramnios) hiki ke lilo i hōʻailona o IUGR.
• Ka nānā ʻana i ka ʻōpū pēpē: E hoʻopili kāu kauka i kahi mea nānā i kou ʻōpū me ke kaula. Pono ʻoe e moe i lalo a ʻaʻahu i kēia mea no kahi o 30 mau minuke. E hoʻopaʻa kēia i ka helu o ka puʻuwai o ka pēpē. E hoʻohana ke kauka i kēia mau hopena e nānā i nā pilikia ulu.
• Amniocentesis: Hiki i kēia hoʻāʻo ke kōkua i ka ʻike ʻana i nā kumu hānau o IUGR. Maanei, hoʻokomo ke kauka i kahi nila lahilahi ma o kou ʻili i loko o kou ʻōpū a lawe i kahi liʻiliʻi o ka wai amniotic e hoʻopuni ana i ka pēpē a hoʻouna iā ia i ka lab no ka hoʻāʻo ʻana. ʻAʻole kēia he hoʻāʻo maʻamau, a hana wale ʻia inā pono.

Mai makaʻu i ka wā e noi ai ke kauka iā ʻoe e hana i nā hoʻokolohua hou aʻe. ʻOi aku ka liʻiliʻi o kekahi mau pēpē ma mua o ka awelika, akā olakino a ʻeleu lākou.

Pehea e mālama ʻia ai ka palena o ka ulu ʻana o ka fetal?

ʻO ka lāʻau lapaʻau no ka IUGR e pili ana i ka lōʻihi o kou hāpai ʻana a me ke olakino o kāu pēpē. ʻO ka mea pōʻino, ʻaʻohe hopena hoʻokahi e kūpono i nā mea āpau no ka hoʻopaʻa ʻana i ka ulu ʻana o ka fetal. E nānā pono kāu kauka iā ʻoe a me kāu pēpē e hōʻoia ʻaʻohe pilikia. E mālama pū lākou i nā kūlana olakino ma lalo e hiki ke hoʻoulu i ke kūlana.

Hiki ke hana i kēia mau mea ma ke ʻano he lāʻau lapaʻau:

• Hoʻonui ʻia ka nānā ʻana: E nānā pono ke kauka iā ʻoe a me kāu pēpē. E nānā mau ʻia ka ulu ʻana o ka pēpē me nā scan a me nā hoʻokolohua ʻē aʻe.
• Hānau mua: Inā ʻaʻole holomua maikaʻi ka hāpai ʻana a i ʻole ua pilikia ka pēpē, hiki i kāu kauka ke hoʻoholo e hoʻoulu i ka hānau mua (ma mua o 37 mau pule). I kekahi manawa, hiki ke ʻōlelo ʻia kahi ʻoki cesarean (C-section) , no ka mea, hiki i ka hānau ʻana ma ke ʻano vaginal ke lilo i mea hopohopo no kahi pēpē i kaupalena ʻia ka ulu ʻana.
• Lāʻau Corticosteroid: Inā ʻōlelo kāu kauka e hānau mua i kāu pēpē, hiki ke hāʻawi ʻia iā ʻoe i ka lāʻau corticosteroid e kōkua i ka ulu ʻana o nā māmā o kāu pēpē.

I nā hihia kakaikahi loa, a i ʻole nā ​​​​hihia koʻikoʻi, hiki i kāu kauka ke hoʻoholo e ʻae iā ʻoe i ka haukapila no ka nānā pono ʻana.

E ulu anei nā pēpē me ke kaupalena ʻia o ka ulu ʻana e like me nā keiki ʻē aʻe?

ʻO ka hapa nui o ka manawa, ʻae! ʻO ka hapa nui o nā pēpē i hānau ʻia me ka IUGR e ulu like me nā keiki ʻē aʻe i ko lākou mau makahiki i ka wā e hiki ai lākou i 3 mau makahiki. Eia nō naʻe, he mea nui e hoʻomanaʻo he ʻokoʻa ka ulu ʻana o kēlā me kēia keiki. Eia kekahi, mai hoʻokau i ka hānai ʻana i kāu keiki. ʻO ka hana ʻana pēlā e alakaʻi ai i nā pilikia olakino ʻē aʻe, e like me ka momona a i ʻole ka maʻi diabetes. E aʻo aku ke kauka pediatric o kāu keiki iā ʻoe inā ʻaʻole e hele ana ka ulu ʻana o kāu keiki e like me ka mea i manaʻo ʻia.

He aha kaʻu e hana ai e hoʻonui i ka ulu ʻana o kaʻu pēpē?

ʻAʻohe hōʻoia e hoʻonui maoli ka ʻai ʻana i kekahi mau meaʻai i ke kaumaha o kāu pēpē. Eia nō naʻe, ua ʻōlelo ʻia e ʻai i kahi meaʻai olakino i ka wā hāpai. ʻO nā meaʻai waiwai i nā huaʻai, nā mea kanu, nā kalapona olakino, a me ka protein e hāʻawi iā ʻoe a me kāu pēpē i nā meaolaola a pau a lākou e pono ai i ka wā hāpai. Mai poina e kamaʻilio me kāu kauka ma mua o ka hana ʻana i kekahi mau hoʻololi nui i kāu meaʻai i ka wā hāpai.

He aha kaʻu e hana ai e pale aku i ka IUGR?

Aia kekahi mau kumu e hoʻonui ai i ka pilikia o ka IUGR, akā hiki iā mākou ke hoʻololi iā lākou:

• Ke hoʻohana nei i nā lāʻau lapaʻau, ka waiʻona, a i ʻole ka puhipaka. (Pono e hoʻōki loa i kēia mau mea!)
• Ma hope o kahi ʻai pono ʻole.
• ʻAʻole lawa ke kaumaha i ka wā hāpai.

He aha nā kūlana olakino iaʻu e hoʻonui ai i koʻu pilikia no ka IUGR?

Hiki paha iā ʻoe ke piʻi aʻe ka pilikia no ka FGR/IUGR inā loaʻa iā ʻoe kekahi o kēia mau kūlana:

• Ke koko kiʻekiʻe a i ʻole ka maʻi puʻuwai.
• Ka maʻi diabetes.
• ʻAʻohe anemia a i ʻole anemia cell sickle.
• Nā maʻi o ka ʻōnaehana pale e like me lupus.

Ke nalowale nei ka IUGR?

Hiki i ka pēpē ke "hopu" iki a ulu. Eia naʻe, ʻaʻole e nalowale ka hōʻailona o ka IUGR. E nānā pono ke kauka i ka ulu ʻana o ka pēpē a hiki i ka pau ʻana o ka hāpai ʻana.

Hiki paha ke hānau keiki i ka wā ʻōpiopio ma muli o ke kaupalena ʻia ʻana o ka ulu ʻana o ka fetal?

ʻAʻole maʻamau ka FGR/IUGR i ka hānau mua ʻana, akā hiki ke hana ʻia. Inā ulu lohi kāu pēpē, a inā he mau pilikia me kou placenta a i ʻole ke kaula umbilical, hiki i kāu kauka ke ʻōlelo aku i ka hānau mua ʻana. E like me ka mea i ʻōlelo ʻia ma mua, inā kiʻekiʻe loa ke kaumaha o ka hānau ʻana ma ka vaginal no kāu pēpē, hiki ke ʻōlelo ʻia kahi ʻoki cesarean (C-section).

He aha nā pilikia no kahi pēpē i hānau ʻia me IUGR?

Aia kekahi mau kūlana a me nā pilikia e pili ana me ka IUGR:

• Aia kahi pilikia kiʻekiʻe o ka hānau ʻana o kahi pēpē ma o ka ʻoki caesarean (C-section) a me ka hānau mua ʻana.
• Hiki ke loaʻa koke nā pilikia hanu a me ka hānai ʻana ma hope o ka hānau ʻana.
• ʻAʻohe o ka oxygen (hypoxia) i ka wā hānau.
• Haʻahaʻa ke kō koko (hypoglycemia) i ka wā hānau.
• Ka paʻakikī o ka hoʻokele ʻana i ka mahana o ke kino.
• ʻO ka huki ʻana o ka meconium (ke ale ʻana o ke pēpē i kona ʻōpala mua i loko o ka ʻōpū).
• ʻO ka Polycythemia (hoʻonui ʻia ka helu o nā ʻāpana koko ʻulaʻula).
• Ua emi ke kū'ē ʻana i nā maʻi.

Pono paha kekahi mau pēpē i hānau mua ʻia a liʻiliʻi paha e noho ma ka haukapila no ka manawa lōʻihi a i ʻole e loaʻa i ka mālama kūikawā ma ka Neonatal Intensive Care Unit (NICU) .

Hiki i ka IUGR ke loaʻa nā hopena lōʻihi, ma muli o nā kumu aʻe:

• ʻO ke kūlana olakino kumu i hoʻokumu ai.
• Nani ka palena o ka ulu ʻana o ka pēpē.
• ʻEhia mau pule i hala i ka wā i hānau ʻia ai ke pēpē.

Hiki i kāu pēpē ke ʻoi aku ka pilikia no nā pilikia noʻonoʻo a i ʻole ka ulu ʻana e like me ka hyperactivity, cerebral palsy , nā helu hoʻokolohua haʻahaʻa ma ke kula, a hiki ke ʻoi aku ka pilikia no ka momona a me nā maʻi cardiovascular ma hope o ke ola.

He aha kaʻu e hana ai inā loaʻa ka IUGR i kaʻu pēpē?

ʻO ka mea mua, mai hopohopo.I ka hapa nui o ka manawa, ʻaʻole kēia kahi mea āu i hana ai. Eia kekahi mau mea hiki iā ʻoe ke hana e kōkua:

• E hōʻoia e hele i kāu mau manawa hoʻonohonoho prenatal a me nā hoʻokolohua pēpē (e like me nā scan).
• Inā ʻoe e hoʻohana i nā lāʻau lapaʻau, puhi paka, a inu waiʻona paha, e hoʻōki i ka hana ʻana i kēlā mau mea i kēia manawa.
• E ʻai i ka meaʻai olakino a loaʻa i ka nui o nā calorie e pono ai i kēlā me kēia lā.
• E hoʻomaha pono, e hiamoe ma ka liʻiliʻi he ʻewalu hola i ka pō.
• Inā manaʻo ʻoe e emi ana ka neʻe ʻana o kāu pēpē, e makaʻala iā ia. (Aia nā ala e helu ai i ka nui o nā kīkē a kāu pēpē i hana ai i ka lā, e nīnau i kāu kauka.)
• E haʻi pololei i kāu kauka e pili ana i kekahi lāʻau lapaʻau āu e lawe ai.

E hana pū me kāu kauka e hoʻomaopopo piha i kēia hōʻailona, ​​​​nā pilikia hiki, a me nā loli hiki iā ʻoe ke hana i kou nohona.

Pono anei au e hopohopo inā liʻiliʻi ka nui o kaʻu pēpē?

ʻO ka hapa nui o ka manawa, ʻaʻole. ʻOkoʻa ka ulu ʻana o nā pēpē. Eia nō naʻe, aia kahi ʻokoʻa ma waena o ka ʻike ʻia ʻana he "small for the gestational age" a me ka ʻike ʻia ʻana he "fetal growth restriction" (FGR/IUGR). ʻIke ʻia ka FGR/IUGR ke emi ka pēpē ma mua o ʻeiwa o nā pēpē ʻē aʻe he ʻumi o ka makahiki like. Hiki loa i kahi pēpē ke liʻiliʻi no ka makahiki gestation i olakino a ʻaʻole i hoʻonui ʻia ka pilikia o nā pilikia. E kamaʻilio me kāu kauka e pili ana i nā hopohopo āu e loaʻa ai.

He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?

He mea maʻamau ka loaʻa ʻana o nā nīnau e pili ana i ka hōʻoia ʻana o ka intrauterine growth restriction (IUGR). Eia kekahi mau nīnau hiki iā ʻoe ke nīnau i kāu kauka:

• Ua ʻike anei ʻoe i ke kumu o ka IUGR?
• ʻEhia pinepine e pono ai iaʻu e hele i nā keʻena antenatal?
• Aia kekahi mea e hiki iaʻu ke hana e kōkua ai i ka ulu ʻana o kaʻu pēpē?
• Aia kaʻu pēpē i ka pilikia o kekahi mau maʻi?
• Pono anei kaʻu pēpē e noho i ka haukapila no ka manawa lōʻihi ma hope o ka hānau ʻana?
• Hiki i kaʻu pēpē ke loaʻa i kekahi mau maʻi olakino ma hope aku?

Nui nā kumu e liʻiliʻi ai kahi pēpē ma mua o ka hānau ʻana. E hoʻoholo kāu kauka inā he pilikia kumu e keakea nei i ka ulu ʻana o ka pēpē. I kekahi manawa, me ke kumu ʻole, hiki ke hānau ʻia kahi pēpē ma lalo o ka maʻamau. Inā ʻike ʻia kāu pēpē me IUGR, e nānā pono kāu hui lapaʻau i ka ulu ʻana o kāu pēpē i ka wā hāpai. ʻO kā lākou mea nui ka hōʻoia ʻana e loaʻa iā ʻoe a me kāu pēpē ka mālama a me ka lāʻau e pono ai lākou. ʻO ka hapa nui o nā pēpē i hānau ʻia me IUGR ʻaʻohe pilikia olakino.

Leka Lawe-Home

He mea maʻamau ka makaʻu a me ka hopohopo ke ʻike ʻoe ʻaʻole e ulu ana kāu pēpē e like me ka mea i manaʻo ʻia i loko o ka ʻōpū, a i ʻole he IUGR kāna. Akā e hoʻomanaʻo, he nui nā pēpē i hānau olakino, maikaʻi, a ulu maikaʻi i kēia mau kūlana.

ʻO ka mea nui loa:

• E ʻike pinepine i kāu kauka a e hahai pololei i kāna mau kuhikuhi.
• E hoʻopau i nā hoʻokolohua i hoʻonohonoho ʻia i ka manawa.
• Ke ola nei i kahi nohona olakino - ka ʻai pono ʻana, ka hōʻole ʻana i ka puhipaka a me ka inu ʻona.
• Pono e kūkākūkā ʻia me ke kauka a wehewehe ʻia nā nīnau a hopohopo paha āu e noʻonoʻo nei.

ʻAʻole ʻoe hoʻokahi, aia nā kauka a me nā ʻohana e kōkua iā ʻoe. E noʻonoʻo maikaʻi, e mālama pono iā ʻoe iho a me kāu keiki liʻiliʻi.

Ka palena o ka ulu ʻana o loko o ka ʻōpū, IUGR, FGR, ka palena o ka ulu ʻana o ka pēpē, ka pilikia o ka pēpē, ke olakino o ka hāpai ʻana, ka ulu ʻana o ka pēpē