Pono anei mākou e ʻike e pili ana i ka haki ʻana o ka ʻeke wai ma mua o ka hānau ʻana o ke pēpē? (Premature Rupture of Membranes - PROM)

He mea maʻamau ka hopohopo no nā mea i kou wā hāpai, ʻeā? Ua lohe paha ʻoe i ka "wāwahi ʻana o kou wai," ʻoiai ke kokoke aku nei ʻoe i kou lā hānau. I kekahi manawa, hiki ke hopohopo iki ke noʻonoʻo i ka mea e hiki mai ana inā hana ʻia kēia ma mua o kou lā hānau. Mai hopohopo, e kamaʻilio mākou e pili ana i kēia me nā kikoʻī a me ka maʻalahi.

He aha ka haki mua ʻana o nā membrane (PROM)?

I ka ʻōlelo maʻalahi, ʻo 'Premature Rupture of Membranes' a i ʻole 'PROM' ka 'hanau' o kāu pēpē, ʻo ia hoʻi, ua haki kāu 'ʻeke wai' a i ʻole 'ʻeke amniotic' ma mua o ka hoʻomaka ʻana o ka hana. Ua kapa pū kekahi mau kauka i kēia 'prelabor rupture of membranes'. ʻO ia hoʻi, ua haki nā 'membranes' a i ʻole nā ​​membranes ma mua o ka 'hanau'.

E nānā, ua like kēia ʻeke ʻōpū me kahi ʻeke i piha i ka wai. ʻO kēia wai ka mea a mākou e kapa nei he wai ʻōpū . ʻO kēia ka mea e hoʻopuni a pale i kāu pēpē i ka wā hāpai. Ua like ia me kahi uluna palekana liʻiliʻi no ka pēpē. Mālama kēia wai ʻōpū i ka pēpē mai nā germs, pale i ka pēpē mai ka loaʻa ʻana o nā palapū a me nā ʻeha i ka wā e neʻe ai, a kōkua pū i ka ulu ʻana o nā ʻiʻo a me nā iwi o ka pēpē.

Ke ʻōlelo mākou "ua haki kou wai" a i ʻole "ua haki kou wai," no ka mea ua haki kēia mau membrane. Ke haki kēia mau membrane, hoʻomaka ka wai amniotic e hoʻopuni ana i kāu pēpē e kahe mai loko mai o kou vagina, me ka lohi a me ka koke paha. Hiki i kēia ke lilo i pilikia. No ka mea, i ka pau ʻana o ka wai amniotic, ʻoi aku ka nui o ka pilikia o ʻoe a me kāu pēpē i ka maʻi a me nā pilikia ʻē aʻe, e like me ka hānau mua ʻana .

No laila, inā manaʻo ʻoe ua haki kou mau membrane, pono ʻoe e hoʻomaopopo koke i kāu kauka hānau keiki a limahana olakino ʻohana paha.

He aha ka Preterm PROM (PPROM)?

I kēia manawa, e kamaʻilio kākou e pili ana i ka 'Preterm PROM' a i ʻole 'PPROM' . ʻO kēia ka wā e haki ai kāu 'ʻeke amniotic' ma mua o 37 mau pule o ka hāpai ʻana. E noʻonoʻo, ʻaʻole i hala kou hāpai ʻana ma mua o 37 mau pule, akā ua haki kou wai. I kēia manawa, e hoʻoholo kāu kauka inā e 'hānau' koke i ka pēpē, a i ʻole e hoʻopaneʻe i ka 'hana' no kekahi mau lā hou aʻe.

He hoʻoholo paʻakikī kēia. No ka mea, ʻo ka hoʻolōʻihi ʻana i ka hāpai ʻana ma hope o ka haki ʻana o ka wai e hoʻonui ai i ka pilikia o ka maʻi a me nā pilikia ʻē aʻe. Akā, ma ka ʻaoʻao ʻē aʻe, aia kekahi mau pilikia i ka hānau mua ʻana o ka pēpē, ʻo ia hoʻi, ma mua o ka hānau ʻana. No laila , pono ke kauka e kaupaona pono i kēia mau pilikia ʻelua ma mua o ka hana ʻana i ka hoʻoholo maikaʻi loa.

He aha ka mea e hiki ke hana inā haki ka ʻeke wai e like me kēia?

Inā haki koke ka ʻeke wai, ua pilikia ka pēpē i ka hānau ʻana ma mua o ka manawa aAia kahi pilikia o ka maʻi. Inā pau kou hāpai ʻana i 37 mau pule, ʻoi aku ka liʻiliʻi o nā pilikia mai ka hānau mua ʻana. Eia nō naʻe, inā hānau ʻia ka pēpē ma mua o 37 mau pule, pono ʻo ia e kū i nā pilikia mai ka hānau mua ʻana.

ʻO nā hiʻohiʻona o kēia:

• Nā pilikia hanu .
• Ka paʻakikī i ka mālama ʻana i ka mahana o ke kino .
• Hiki i kēia ke hoʻololi i ke kūlana o ka pēpē i loko o ka ʻōpū , hiki ke hoʻopilikia i ka hānau ʻana.

Eia kekahi, i ka wā e waiho ʻole ʻia ai ka wai amniotic a me ka ʻeke amniotic me ka pale ʻole ʻia, ʻoi aku ka nui o ka pilikia o ka pēpē a me kou ʻōpū i ka loaʻa ʻana o nā maʻi . Hiki i kēia mau maʻi ke lilo i mea weliweli i kekahi manawa.

Pehea ka maʻamau o kēia ʻano?

ʻO kahi kūlana i kapa ʻia ʻo `PROM` e kū mai ana ma kahi o 10% o nā hāpai ʻana. Inā kū mai ʻo `PROM` i ka wā hāpai (i 37 mau pule), 95% o ka manawa e hānau ʻia ai ka pēpē i loko o 28 mau hola.

He ʻano laha ʻole ka PPROM, e kū ana ma kahi o 3% o nā hāpai ʻana. Ua hōʻike ʻia nā noiʻi he ʻoi aku ka nui o ka loaʻa ʻana o ka PPROM i nā hāpai ʻana me nā keiki he nui .

No ke aha e hana ʻia ai kēia? He aha nā kumu nui o ka `PROM` a me ka `PPROM`?

ʻOkoʻa paha nā kumu o 'PROM' a me 'PPROM'.

• Inā haki kou wai i ka manawa kūpono, ʻo ia hoʻi, ma hope o 37 mau pule , ʻo ke kumu nui, ʻo ia ka nāwaliwali mālie ʻana o kou mau membrane amniotic ma muli o ke kaomi o nā ʻūmiʻi i ka wā hānau. He mea maʻamau ka haki ʻana o nā membrane i ka wā hānau, akā hana pinepine ia ma hope o ka hoʻomaka ʻana o ka hānau ʻana.

ʻO ka mea nui, ʻoiai inā ʻaʻole ʻoe e ʻike i nā ʻūmiʻi, ke hoʻomākaukau nei paha kou kino no ka hānau ʻana. ʻO ke ʻano kēia me kou ʻike ʻole ʻana, ke ʻūmiʻi nei paha kou ʻōpū, ke lahilahi nei paha kou cervix (effacing), a ke wehe nei paha kou cervix (dilating). Hiki i kēia ke hoʻonāwaliwali i ka ʻeke amniotic a haki i ka hopena.

• ʻO ka maʻamau, ʻo ka Preterm PROM (PPROM) ke kumu o kahi maʻi a i ʻole ka pilikia i ka wā hāpai , akā hiki ke hana ʻia i kekahi manawa me ke kumu ʻole.

ʻO kekahi o nā kumu nui:

• Ke kahe koko ʻana o ka ʻōpū .
• Nā kūlana hānau ʻole i loko o kou ʻōpū (e like me ka maʻi Ehlers-Danlos ).
• Ka lawa ʻole o ka ʻōpū.

He aha nā hōʻailona o kēia? Pehea ʻoe e ʻike ai?

ʻO ka hōʻailona maopopo loa e haki ana kou mau membrane, ʻo ia kou manaʻo e kahe koke ana ka nui o ka wai mai kou vagina. Akā, ʻaʻole ia e like me ka nui mau. Manaʻo kekahi poʻe e kahe iki ana lākou, e like me ka kulu. ʻO kou haki ʻana o ka wai kahi mea hiki ʻole iā ʻoe ke kaohi. Me he mea lā ʻaʻole hiki iā ʻoe ke hoʻōki i ka mimi ʻana .

I kekahi manawa he paʻakikī ke ʻike inā he wai amniotic, he kahe o ka wahine, a he mimi paha . I ia mau hihia, hiki iā ʻoe ke lawe i kahi kāwele pepa keʻokeʻo a hoʻoluʻu i loko o ka wai.

• Inā he melemele, a inā he pilau ʻino , he mimi paha ia.
• Inā ʻaʻohe kala a ʻala ʻole , pono ʻoe e ʻike koke i ke kauka.

Eia nō naʻe, inā he kānalua iki kou e pili ana i ka mea e puka mai ana mai loko mai o kou ʻōpū, e hoʻomaopopo pono i kāu kauka.

Pehea e ʻike ai nā kauka i kēia?

E hōʻoia kāu kauka iā PROM me kahi hoʻokolohua speculum sterile . ʻO kēia ke komo ʻana i kahi speculum i loko o kou vagina. ʻAe kēia i ke kauka e hoʻoneʻe i nā paia o kou vagina e ʻike i kou cervix. A laila lawe ʻia kahi laʻana o ka wai a hoʻāʻo ʻia. I kekahi manawa, inā ʻike ke kauka i kahi hōʻiliʻili o ka wai amniotic ma ka ʻaoʻao o luna o kou vagina i ka wā o kēia hoʻokolohua, ua haki paha nā membrane.

Eia kekahi, hiki ke hana ʻia kahi scan ultrasound e nānā i ke kūlana o ke pēpē a me ka nui o ka wai amniotic i loko o ka ʻōpū.

He aha nā hoʻokolohua ʻē aʻe ma laila?

• Hoʻāʻo pepa Nitrazine: Hoʻohana ʻia kēia e ana i ka pH (kahi ana o ka acidity o kekahi mea) o kou vagina. Hoʻokomo ʻia kahi kulu o kāu kahe vaginal ma kēia pepa a nānā ʻia ka pepa e ʻike inā e polū. Inā e polū, ʻoi aku ka nui o ka pH o ka wai ma mua o 6.0, no laila ʻoi aku ka nui o ka wai amniotic. (ʻOi aku ka haʻahaʻa o ka pH o ka kahe vaginal ma mua o ka wai amniotic.)
• Hoʻāʻo Fern: ʻO Ferning ka inoa i hāʻawi ʻia i ka wai amniotic maloʻo e like me ka lau fern. Pili pū kēia i ka lawe ʻana i kahi hāpana o ka wai a nānā iā ia ma lalo o kahi microscope.

He aha nā lāʻau lapaʻau no kēia?

Aia ka lāʻau lapaʻau i ka makahiki hāpai , ke olakino o ka pēpē , a me ke koʻikoʻi o kou kūlana .

ʻElua mau koho maʻamau: ʻo kekahi ka "hānau ʻana" i ka pēpē, a ʻo kekahi ka "hoʻokele hāpai." ʻO ka "hoʻokele hāpai" kahi lāʻau lapaʻau e hoʻopaneʻe ana i ka "hanau ʻana". Hoʻokomo pū kēia i ka hoʻomaha moe, nā lāʻau lapaʻau, a me ka nānā mau ʻana no ka maʻi a i ʻole ka pilikia o ka fetal.

Lapaʻau no PROM ma hope o 37 mau pule

Inā ʻoe ma waena o 37 a me 40 mau pule hāpai a haki kou wai, ma kahi o 90% o nā wahine e hānau koke i loko o 24 mau hola. Hiki paha i kāu kauka ke hāʻawi iā ʻoe i ka lāʻau lapaʻau e hoʻoulu ai i ka hānau ʻana, a i ʻole e ʻae paha lākou i ka hānau ʻana e hana maoli.ʻO ka maʻamau, ʻo ka hānau ʻana i ka pēpē i loko o 24 mau hola ka koho palekana loa.

Lapaʻau inā hana ʻia ka `PROM` ma waena o 34 a me 37 mau pule

I kēia hihia, e kaupaona kāu kauka i nā pilikia o ka loaʻa ʻana o kahi pēpē hānau mua e kūʻē i nā pilikia o ka maʻi a me nā pilikia ʻē aʻe . Inā hoʻoholo ke kauka e hānau i ka pēpē, e hoʻonohonoho ʻo ia no ka pēpē e loaʻa i kekahi mālama kūikawā (e like me ka mālama ma kahi NICU - Neonatal Intensive Care Unit ) ke hānau ʻia.

Lapaʻau no ka Preterm PROM (PPROM) ma mua o 34 mau pule

Inā ʻaʻole i hala kāu pēpē ma mua o 34 mau pule hāpai, ʻoi aku ka nui o ka pilikia o nā pilikia mai ka hānau mua ʻana. I kēia manawa, e hoʻāʻo kāu kauka e hoʻopaʻa iā ʻoe i ka haukapila, e hoʻomaha iā ʻoe ma kahi moe, a e hoʻāʻo e hoʻolōʻihi i kou hāpai ʻana no kekahi manawa lōʻihi.

Hiki iā lākou ke hāʻawi iā ʻoe i nā lāʻau lapaʻau e like me:

• Corticosteroids: Kōkua i ka ulu ʻana o nā māmā o ke pēpē.
• Nā lāʻau lapaʻau antibiotic: Kāohi i nā maʻi a hoʻolōʻihi i ka hāpai ʻana.
• Tocolytics: Nā lāʻau lapaʻau i hāʻawi ʻia e hoʻōki i ka hana hānau.
• Magnesium sulfate: Kōkua i ka ulu ʻana o ka lolo o ke pēpē.

E nānā mau kāu kauka iā ʻoe no nā hōʻailona o ka maʻi. E nānā pū ʻo ia i ka puʻuwai o kāu pēpē a me kāna neʻe ʻana e hōʻoia ʻaʻole pilikia ka pēpē. ʻO ka manaʻolana o kēia mau lāʻau lapaʻau, ʻo ia ka hoʻolōʻihi ʻana i kou hāpai ʻana i 34 mau pule ma ka liʻiliʻi.

ʻO ka mea nui loa, inā loaʻa iā ʻoe kahi maʻi i ka wā e haki ai kou wai, a inā loaʻa iā ʻoe kahi maʻi ma hope aku, pono ʻoe e hānau i ke pēpē.

Aia kekahi ala e pale aku ai i kēia?

ʻAʻohe ala kikoʻī e pale aku ai i ka PROM. ʻO ka mea maikaʻi loa hiki iā ʻoe ke hana, ʻo ia ke hoʻōki loa i ka puhipaka, loaʻa kahi hāpai olakino, a hele i kāu mau nānā prenatal āpau. ʻO ka hoʻohana ʻana i ka paka kahi mea pilikia no ka PROM (a me nā pilikia ʻē aʻe he nui i ka wā hāpai).

ʻO wai ka mea i ʻoi aku ka pilikia no ka `PROM` a me ka `PPROM`? (Nā kumu pilikia)

Aia ʻoe i ka pilikia nui o ka loaʻa ʻana o PPROM a i ʻole PROM inā loaʻa iā ʻoe kahi maʻi e hoʻonāwaliwali ai i kou membrane chorioamniotic (ka papa waho o ka ʻeke amniotic), a i ʻole inā e ulu koke ana. ʻO nā hiʻohiʻona o kēia:

• Nā maʻi: ʻO nā maʻi i laha ʻia ma ke moekolohe (STI) he mau maʻi e like me ka bacterial vaginosis.
• Ka pōkole o ka ʻāʻī.
• Inā he moʻolelo o ka lilo ʻana i 'PROM' ma mua .
• Inā ʻoe e kali ana i nā pēpē e like me nā māhoe a i ʻole nā ​​​​triplets ('E kali ana i nā multiples').
• ʻO Polyhydramnios (ʻo ia hoʻi ka nui o ka wai amniotic).
• Ke kahe koko ʻana o ka ʻōpū.
• ʻAmniocentesisInā ua hana ʻia (kahi hoʻāʻo wai).
• Inā he moʻolelo o ka hānau mua ʻana .

He aha nā pilikia nui ke haki ka ʻeke wai?

ʻO ka pilikia nui loa me PROM ka hānau mua ʻana. ʻO ka hānau mua ʻana ka wā e hānau ʻia ai kāu pēpē ma mua o 37 mau pule. ʻO nā pilikia o ka hānau mua ʻana e pili ana i nā pilikia hanu, ka mahana kino haʻahaʻa, a me nā pilikia ulu. Hiki i kekahi mau pēpē hānau mua ke loaʻa nā lohi o ka ulu ʻana ma hope o ke ola.

Ke pale ʻole ʻia ka wai amniotic, hiki ke loaʻa nā pilikia hou aʻe i ka wā hāpai, no ka laʻana:

• Nā maʻi , e like me Chorioamnionitis (kahi maʻi o nā membrane a me ka wai amniotic).
• Ka hoʻopau ʻana o ka placenta .
• Ka paʻa ʻana o ke kaula piko a i ʻole ka hemo ʻana o ke kaula piko .

E noʻonoʻo kāu kauka i ka pilikia o ka loaʻa ʻana o kahi pēpē hānau mua a me ka pilikia o ka maʻi a me nā pilikia ʻē aʻe e hoʻoholo ai i ka manawa kūpono e hānau ai i kāu pēpē.

I ka manawa hea e pono ai iaʻu ke hānau keiki ma hope o ka haki ʻana o koʻu wai?

Ua hōʻike ʻia nā noiʻi he haʻahaʻa ka pilikia o ka maʻi i nā wahine hānau keiki i loko o 24 mau hola o ka haki ʻana o nā membrane ma mua o ka poʻe hānau keiki ma hope o 24 mau hola . Eia nō naʻe, pono e kaupaona ʻia kēia pilikia me ka pilikia o ka loaʻa ʻana o kahi pēpē hānau mua. E kōkua kāu kauka iā ʻoe e hana i ka hoʻoholo maikaʻi loa nou a me kāu pēpē.

Pehea ka lōʻihi e hiki ai iā ʻoe ke hāpai ma hope o ka haki ʻana o kou wai?

E loli kēia ma muli o kou kūlana a me ka nui o nā pule o kou hāpai ʻana i ka wā e haki ai kou wai. Inā haki kou wai ma mua o 37 mau pule, e kōkua kāu kauka iā ʻoe e hana i ka hoʻoholo palekana loa. I kekahi mau hihia, kiʻekiʻe loa ka pilikia o ka maʻi a me nā pilikia, no laila pono paha e hānau ʻia ke pēpē.

Hiki i ke pēpē ke ola inā haki koke ka ʻeke wai?

ʻAe, hiki nō. ʻOiai inā haki koke ka ʻeke wai, hiki nō i ka pēpē ke ola. Aia ia i nā kumu he nui, e like me ka lōʻihi o ka hāpai ʻana a me ka nui o ka wai amniotic i koe. E nānā pinepine kāu kauka i ka pēpē no nā hōʻailona o ka pilikia o ka fetal a me ka maʻi, a e hoʻoholo i ka wā e hānau ai i ka pēpē.

E hoʻomanaʻo i ka mea nui loa (Leka Lawe-Home)

I ka wā hāpai, hoʻopuni a pale ka ʻeke i piha i ka wai, i kapa ʻia ʻo ka ʻeke amniotic , i ka pēpē. ʻO ka maʻamau, haki kēia ʻeke i ka wā hānau. Eia nō naʻe, i kekahi manawa hiki ke haki ma mua o ka hoʻomaka ʻana o ka hānau ʻana, a i ʻole he mau pule ma mua o ka hoʻomaka ʻana o ka hānau ʻana. Ua kapa ʻia kēia ʻo Premature Rupture of Membranes (PROM) .

• Inā hana kēia ma hope o 37 mau pule , e hānau ke kauka i ke pēpē.
• ʻO kēia ma mua o 37 mau pule.I ke ʻano o ka "Preterm PROM", e kaupaona ke kauka i nā pilikia o ka loaʻa ʻana o kahi pēpē hānau mua a me nā pilikia o nā pilikia e like me ka maʻi a me ke kaomi ʻana o ke kaula umbilical ma mua o ka hoʻoholo ʻana.

Hiki ke lilo i mea hoʻohoka ke lohe koke i kou haki ʻana o ka wai. Akā e hoʻomanaʻo, ke hana nei kāu kauka i nā mea āpau e hiki ai iā ia ke mālama iā ʻoe a me kāu pēpē i ka palekana a me ke olakino. Inā he mau nīnau a hopohopo paha kāu, e kamaʻilio me kāu kauka e pili ana iā lākou. He mea nui loa ia.

` PRM, PPROM, haki ʻana o ka ʻeke wai, nā pilikia hāpai, hānau mua ʻana, wai amniotic, olakino hāpai