Ingaba umntwana wakho akakhuli kakuhle esibelekweni? Ngaba le yi-IUGR (Intrauterine Growth Restriction)? Masifumanise!

Ukuba ungumama oza kuzala, kusenokwenzeka ukuba ukhe weva amagama athi `IUGR`. Mhlawumbi ugqirha wakho okanye umbelekisi naye ukukhankanyile oku. Ngoko ke kubaluleke kakhulu kuwe nakusapho lwakho ukwazi kakuhle ukuba yintoni le nto. Namhlanje, masithethe ngokuba yintoni le `IUGR`, kutheni isenzeka, kwaye yintoni enokwenziwa ngayo. Ungakhathazeki, masiyiqonde ngokulula le nto.

Singachaza ngakumbi malunga nokuba yintoni i-IUGR?

I-'IUGR' imele i- Intrauterine Growth Restriction. Ngamafutshane, oku kuthetha ukuba umntwana wakho akakhuli njengoko bekulindelwe, kwiveki akuyo, okanye kwiminyaka yakhe yokukhulelwa. Oku kuthetha ukuba umntwana mncinci kunokuba oogqirha belindele. Umzekelo, ukuba uneeveki ezingama-30 ukhulelwe, kufuneka ube nobunzima obuqhelekileyo kunye nobude obuqhelekileyo kuloo veki yama-30 yokukhulelwa. Kwimeko ye-'IUGR', umntwana unokuba mncinci kakhulu kunoko.

Kukho iintlobo ezimbini eziphambili ze-'IUGR'. Oogqirha baya kukuxelela ngezi ntlobo zimbini.

• Uhlobo lokuqala lubizwa ngokuba yi-`(Symmetrical IUGR)`. Kule meko, umzimba wonke womntwana, oko kukuthi, intloko, amalungu, isisu, yonke into ilingana ngobukhulu. Kufana nokuba umntwana wonke utyunyuziwe. Le meko inokuqala kwasekuqaleni kokukhulelwa.
• Uhlobo lwesibini lubizwa ngokuba yi-`(Asymmetrical IUGR)`. Oku kwahlukile kancinci. Intloko nengqondo yomntwana zikhule ngendlela eqhelekileyo, ukuya kubukhulu obulindelekileyo. Kodwa inxalenye yomzimba, ingakumbi isisu, incinci. Okwenzekayo kule meko kukuba umzimba womntwana uzama ukugcina izondlo kunye neoksijini efunekayo yingqondo, ngaloo ndlela ithintela ukukhula kwamanye amalungu omzimba. Le meko idla ngokubonakala kwinxalenye yokugqibela yokukhulelwa.

Kutheni i-IUGR isenzeka? Zithini izizathu?

Ngoku usenokuba ucinga, 'Kutheni oku kusenzeka kumntwana wam? Ingaba le yimpazamo yam?' Musa ukucinga njalo. Zininzi izizathu zokuba i-'IUGR' inokwenzeka. Isizathu esiphambili kukuba umntwana osesiswini akafumani izondlo kunye neoksijini ayidingayo. Njengokuba isityalo singenakukhula kakuhle ukuba asinamanzi kunye nezondlo. Kukho izinto ezininzi eziphambili ezibangela ukunqongophala kwesondlo:

• Iingxaki zePlacenta: Njengoko usazi, i-placenta ifana nebhulorho ethwala i-oksijini kunye nezondlo ezivela kumama ukuya kumntwana. Ngoko ke ukuba i-placenta ayakhekanga kakuhle, incinci ngobukhulu, okanye inobuthathaka ekusebenzeni kwayo, umntwana akafumani oko akudingayo. Ngamanye amaxesha i-placenta isenokungabandakanywanga kakuhle eludongeni lwesibeleko.
• Iingxaki zokuhamba kwegazi kwi-umbilical cord: I- umbilical cord yindlela apho izondlo kunye ne-oksijini zithunyelwa kumntwana ukusuka kwi-placenta. Ukuba ukuhamba kwegazi kwi-umbilical cord kuyancipha, umzekelo, ukuba i-umbilical cord iyabhideka, icinezelwe, okanye ukuba inani lemithambo yegazi kwi-umbilical cord liyancipha, oku kunokuchaphazela nokukhula komntwana.

Ukongeza, ezinye zeemeko zempilo zomama kunye nemikhwa yakhe nazo zinokuchaphazela oku. Makhe sibone ukuba zeziphi:

• Ukutshaya, ukusela utywala, kunye nokusebenzisa iziyobisi: Mhlawumbi uyazi ukuba ezi zinto ziyingozi kakhulu ngexesha lokukhulelwa. Ziphazamisa ngqo ukukhula komntwana kwaye zinciphisa ukuhamba kwegazi ukuya kwi-placenta.
• Izifo ezithile: Izifo ezithile ezifunyanwa ngumama ngexesha lokukhulelwa, umzekelo, i-cytomegalovirus, i-rubella, i-toxoplasmosis, okanye i-syphilis, zinokuchaphazela umntwana kwaye zinciphise ukukhula kwakhe.
• Amayeza athile: Amayeza athile, ingakumbi lawo esifo sokuwa, nawo anokubangela i-IUGR. Ngoko ke, kubaluleke kakhulu ukwazisa ugqirha wakho malunga namayeza owasebenzisayo. Musa ukuthatha nawaphi na amayeza ngaphandle kwemvume kagqirha wakho ngeli xesha.
• Ezinye izifo ezingapheliyo umama anazo: Umzekelo, iimeko ezifana ne-lupus, i-anemia enzima, okanye iingxaki zokujiya kwegazi, isifo sezintso, okanye isifo sentliziyo nazo zinokuba zizizathu.
• Uxinzelelo lwegazi oluphezulu: Uxinzelelo lwegazi oluphezulu kumama ngexesha lokukhulelwa (ingakumbi iimeko ezifana ne-pre-eclampsia) yenye yezona zinto ziphambili ezibangela i-IUGR.
• Iingxaki zemfuza okanye iziphene zokuzalwa komntwana: Ngamanye amaxesha, imeko yemfuza yomntwana (isifo semfuza) okanye isiphene sokuzalwa nazo zinokubangela ukuba umntwana akhule kakuhle. Imizekelo ibandakanya iimeko ezifana neDown syndrome.
• Ukukhulelwa okuninzi, okufana namawele okanye amawele amathathu: Xa uneentsana ezingaphezu kwesinye esibelekweni, ngamanye amaxesha izondlo zisenokungasasazwa ngokulinganayo kubo bonke. Nangona kunjalo, umntwana omnye okanye ngaphezulu usenokuba mncinci.

Oogqirha bayixilonga njani i-IUGR?

Kulungile, ngoku mhlawumbi uyaqonda ukuba yintoni i-'IUGR' kwaye kutheni isenzeka. Ngoko ke ugqirha uyixilonga njani?

Ngokwesiqhelo, uya ekliniki inyanga nenyanga ngexesha lokukhulelwa kwakho. Apho, ugqirha okanye umsebenzi wezempilo wosapho uya kulinganisa ubude besisu sakho. Oko kukuthi, baya kulinganisa ukusuka kwithambo le-pubic esiswini sakho esisezantsi ukuya phezulu kwesibeleko sakho ngeteyipu yokulinganisa. Oku kubizwa ngokuba yi-"uterine fundal height". Oku kuvumela oogqirha ukuba bafumane umbono ocacileyo wokuba ukukhula komntwana kufanelekile na ngeveki. Olu linganiselo kufuneka lunyuke ngenani elithile veki nganye. Ukuba alunjalo, kucingelwa ukuba i-IUGR.

Kodwa indlela ephambili yokuqinisekisa ukuba une-IUGR kukusebenzisa i-ultrasound scan. Ukhe waskena. Ijeli ifakwa esiswini sakho kwaye isixhobo esincinci esibizwa ngokuba yi-probe sishukunyiswa phezu kwesisu sakho, kwaye imifanekiso yomntwana iboniswa kwiscreen sekhompyutha. Kule mifanekiso, oogqirha banokulinganisa izinto ezinje ngobungakanani bentloko yomntwana, umjikelo wesisu, kunye nobude bethambo lesinqe, kwaye babale ubunzima bomntwana. Nangona ezi zibalo zingachanekanga ngokupheleleyo, ziluncedo kakhulu ekumiseleni indlela umntwana akhula ngayo kunye nokuba kukho naziphi na iingxaki. I-anomaly scan, edla ngokwenziwa kwiiveki ezingama-20, ikwanika umbono wokukhula komntwana. Emva koko, ii-scan ezingaphezulu zingenziwa njengoko kufuneka.

I-ultrasound scan ingajonga nezinye izinto. Umzekelo:

• Indawo, ubungakanani, kunye nembonakalo yeplacenta.
• Nokuba ubungakanani bolwelo lwe-amniotic olujikeleze usana luphantsi okanye luphezulu, ukwehla kolu lwelo nako kungaba luphawu lwe-IUGR.
• Iskeni ekhethekileyo ebizwa ngokuba yiDoppler ultrasound ingasetyenziswa ukubona indlela igazi lomntwana elihamba ngayo kwi-placenta nakwi-umbilical cord. Oku kunokunceda ekuqinisekiseni ukuba umntwana ufumana igazi neoksijini eyaneleyo na.

Ukuba kukho ukurhaneleka kokuba umntwana une-'IUGR', oogqirha banokwenza ezinye iimvavanyo ezininzi:

• Ukujonga ukubetha kwentliziyo yomntwana kunye neentshukumo zakhe (Ukujonga umntwana ongekazalwa): Oku kukwabizwa ngokuba luvavanyo lwe-"CTG (Cardiotocography)". Olu vavanyo lujonga ukuba umntwana uqhuba kakuhle na esibelekweni kwaye akanaxinzelelo.
• Uvavanyo lwegazi ukuqinisekisa ukuba umama unezifo ezinokuchaphazela umntwana.
• I-Amniocentesis: Oku akwenziwa rhoqo, kodwa kwezinye iimeko ezikhethekileyo, kuthathwa isampulu encinci yolwelo lwe-amniotic olujikeleze umntwana ukuze kuhlolwe izizathu zemfuza ze-IUGR. Ngamanye amaxesha oku kunokusetyenziswa ukubona indlela aphuhla ngayo amaphaphu omntwana, ingakumbi ukuba umntwana uza kuzalwa kwangethuba.

Iphathwa njani i-IUGR?

Khawuthelekelele ukuba oogqirha basandul’ ukufumanisa ukuba umntwana wakho une-'IUGR'. Wenza ntoni ke ngoko? Unyango loku luxhomekeke ekubeni ukhulelwe ixesha elingakanani, imeko yomntwana, kunye nesizathu se-'IUGR'.

Oogqirha bajonga umntwana one-IUGR ngokusondeleyo ngexesha lokukhulelwa. Benza ii-ultrasound scans rhoqo (mhlawumbi kube kanye okanye kabini ngeveki), barekhode ukukhula komntwana, benze ii-Doppler scans, benze uvavanyo lwe-CTG, kwaye bajonge nezinye iingxaki.

Ukuba umama unesifo sempilo esibangela i-IUGR, oogqirha banokunceda ekulawuleni esi sifo. Umzekelo:

• Ukuba une-high blood pressure, uza kunikwa amayeza okulawula uxinzelelo lwegazi.
• Bakucebisa ukuba utye ukutya okunempilo nokunesondlo. Bakucebisa ukuba utye ukutya okuneproteni eninzi, imifuno kunye neziqhamo.
• Ikunceda ufumane ubunzima obufunekayo ngexesha lokukhulelwa.
• Abanye oomama banokunikwa ithuba lokuphumla ebhedini, benethemba lokuba oku kuya kunceda ukwandisa ukuhamba kwegazi kumntwana. Nangona kunjalo, oku akusebenzi kuwo wonke umntu, ngoko landela imiyalelo kagqirha wakho.
• Ukuba uyatshaya, sikunika iingcebiso kwaye sikunceda uyeke.

Kwezinye iimeko, oogqirha banokucebisa ukuba "Qalisa ukuzala nokubeleka kwangethuba".Esi sigqibo sinokwenziwa, ingakumbi ukuba ukukhula komntwana kubonakala ngathi kuyekile ngokupheleleyo, okanye ukuba i-Doppler scan okanye i-CTG ibonisa ukuba kuyingozi ukuba umntwana ahlale esibelekweni, okanye ukuba kukho ingxaki enkulu kwi-placenta okanye kwi-umbilical cord. Ngokwesiqhelo, emva kweeveki ezingama-37, imiphunga yomntwana ikhule kakuhle, ngoko ke kunokuba ngcono ukuzala umntwana kwimeko enjalo.

Ngamanye amaxesha, ukuba umntwana ubuthathaka kakhulu ukuba angamelana noxinzelelo lokubeleka kwilungu lobufazi, ugqirha unokugqiba ekubeni enze utyando lwe-C-section. Zonke ezi zigqibo zenziwa kucingelwa ukhuseleko lwakho nolomntwana wakho.

Ziziphi iingxaki ezinokwenzeka ngenxa ye-IUGR?

Iintsana ezine-`IUGR`, ingakumbi ezo zinobunzima obuncinci kakhulu ekuzalweni (ezingaphantsi kweekhilogram eziyi-2.5), zisengozini enkulu yokuba neengxaki ezithile zempilo.

• Ukuzalwa kwangaphambi kwexesha: Iintsana ezine-`IUGR` zihlala zizalwa ngaphambi kwexesha.
• Ukulaliswa esibhedlele: Kusenokufuneka uhlale esibhedlele ixesha elide emva kokuzalwa. Kusenokufuneka ufumane unyango olukhethekileyo kwiyunithi yokhathalelo oluphezulu lweentsana ezisandul’ ukuzalwa (i-NICU).
• Ubunzima bokuphefumla: Isifo sokuphefumla esibizwa ngokuba yi-Respiratory distress syndrome sinokwenzeka kuba imiphunga ayikakhuli ngokupheleleyo.
• Ubunzima bokuncancisa: Ubunzima bokuncancisa bunokubakho ngenxa yokungakwazi ukuncancisa kakuhle.
• Ubunzima bokugcina ubushushu bomzimba buzinzile (iHypothermia).
• Amanqanaba aphantsi eswekile egazini (iHypoglycemia).
• Ukwehla kwamanqanaba e-calcium egazini.
• I-Polycythemia: Ukujiya kwegazi ngenxa yokwanda kwenani leeseli zegazi.
• Ukuncipha kokuxhathisa izifo.
• I-Perinatal asphyxia: Ukunqongophala komoya-mpilo xa uzalwa.
• Iingxaki ze-neurological kunye nokulibaziseka kokukhula: Ekuhambeni kwexesha, kukho ithuba elincinci lezinto ezifana nobunzima bokufunda.

Kodwa ayizizo zonke ezi zinto ezenzeka kumntwana ngamnye we-IUGR. Iziphumo zexesha elide ze-IUGR kumntwana zixhomekeke kwinto ebangele i-IUGR kwasekuqaleni, ubukhali be-IUGR, kunye nonyango olufunyanwa ngumntwana.

Ndingenza ntoni ukuba umntwana wam une-IUGR?

Ukuba ugqirha uthi umntwana wakho usenokuba ne-'IUGR', musa ukoyika kwaye uhlale uzolile. Eyona nto ibalulekileyo kukulandela imiyalelo kagqirha wakho ngokuchanekileyo kwaye uye kuyo yonke ikliniki nakuvavanyo ngalunye. Kulapho kuphela apho ugqirha aya kukwazi ukujonga ngokuchanekileyo uphuhliso nempilo yomntwana wakho aze enze izigqibo ezifanelekileyo ngexesha elifanelekileyo.

Kwakhona, kubaluleke kakhulu ukuba uzikhathalele kakuhle:

• Yitya ukutya okunesondlo nokulinganiselayo. Ukuba ugqirha wakho ukunike iivithamini kunye neepilisi zesinyithi ezongezelelweyo, zithathe ngokuchanekileyo nangexesha elifanelekileyo.
• Phumla kwaye ulale ngokwaneleyo.
• Ziphephe ngokupheleleyo utywala, iziyobisi, nokutshaya. Ezi zinto ziyingozi kakhulu ebantwaneni. Ukuba utshaya, eli lixesha elifanelekileyo lokuyeka.
• Zama ukuhlala uphumle engqondweni. Musa ukuzikhathaza ngezinto ezingeyomfuneko. Impilo yakho yengqondo nayo iyayichaphazela intsana. Fumana uncedo kumyeni wakho nakusapho lwakho.
• Nika ingqalelo kwiintshukumo zomntwana wakho (Ubalo lokukhaba kwengane yakho). Ugqirha wakho uza kukucebisa ngale nto. Ungafumana umbono wokuba umntwana wakho uphilile na ngokujonga ukuba umntwana wakho uhamba kangaphi ngosuku.

Ngoko ke, masishwankathele oko sithethe ngako. (Umyalezo Wokubuyela Ekhaya)

Kulungile, ngoko ke sithethe kakhulu nge-'IUGR' namhlanje, akunjalo? Ndiyathemba ukuba olu lwazi lube luncedo kuwe. Nazi ezinye zezinto ezibalulekileyo ekufuneka uzikhumbule:

• `I-IUGR` ithetha ukuba umntwana osesiswini akakhuli ngendlela elindelekileyo. Oku kunokuchaphazela impilo yomntwana.
• Oku kunokubangelwa zizinto ezahlukeneyo, kuquka iingxaki ze-placenta, imeko yempilo kamama, kunye neemeko ezithile kumntwana ngokwakhe.
• I-ultrasound scan yeyona ndlela iphambili yokufumanisa nokujonga i-IUGR.
• Njengonyango, oogqirha bajonga umntwana ngokusondeleyo, bajonge impilo kamama, kwaye banokumzala kwangethuba.
• Eyona nto ingcono onokuyenza kukulandela iingcebiso zikagqirha wakho, uziqhelise ukuba sempilweni, kwaye uhlale wonwabile engqondweni kwaye uphumle.
• Khumbula, i-IUGR ayilotyala lakho. Inokwenzeka nakubani na. Ngonyango olufanelekileyo kunye nokuzinikela kwakho, ungayilawula le meko uze uzise umntwana ophilileyo emhlabeni. Awuwedwa, ugqirha wakho, usapho lwakho, kwaye wonke umntu unawe.

I- IUGR, ukukhulelwa, ukukhula komntwana, ukuthintelwa kokukhula ngaphakathi kwesibeleko, i-placenta, i-ultrasound, isondlo, uphuhliso lomntwana ongekazalwa, ukhathalelo lokukhulelwa