Ingabe ingane yakho ayikhuli kahle esibelethweni? Ingabe lokhu kuyi-IUGR (Intrauterine Growth Restriction)? Ake sithole!

Uma ungumama okhulelwe, kungenzeka ukuthi uke wezwa amagama athi `IUGR`. Mhlawumbe udokotela wakho noma umbelethisi naye ukhulume ngalokhu. Ngakho-ke kubaluleke kakhulu kuwe nomndeni wakho ukwazi kahle ukuthi lokhu kuyini. Namuhla, ake sixoxe ngokuthi iyini i-`IUGR`, kungani yenzeka, nokuthi yini engenziwa ngayo. Ungakhathazeki, masiqonde lokhu kalula.

Singachaza okwengeziwe ngokuthi iyini i-IUGR?

I-`IUGR` imele i- Intrauterine Growth Restriction. Kalula nje, lokhu kusho ukuthi ingane yakho ayikhuli njengoba kulindelekile, ngesonto elikulo, noma eminyakeni yayo yokukhulelwa. Lokhu kusho ukuthi ingane incane kunalokho odokotela abakulindele. Isibonelo, uma ukhulelwe amasonto angu-30, kufanele ube nesisindo nobude obujwayelekile kulokho kukhulelwa kwamasonto angu-30. Endabeni ye-`IUGR`, ingane ingaba ncane kakhulu kunalokho.

Kunezinhlobo ezimbili eziyinhloko ze-'IUGR'. Odokotela bazokutshela ngalezi zinhlobo ezimbili.

• Uhlobo lokuqala lubizwa ngokuthi `(Symmetrical IUGR)`. Kulokhu, umzimba wonke wengane, okungukuthi, ikhanda, izitho, isisu, konke kufana ngobukhulu. Kunjengokungathi yonke ingane icindezelwe. Lesi simo singaqala kusukela ekuqaleni kokukhulelwa.
• Uhlobo lwesibili lubizwa ngokuthi `(Asymmetrical IUGR)`. Lokhu kuhlukile kancane. Ikhanda nobuchopho bomntwana kukhule ngendlela evamile, ngosayizi olindelekile. Kodwa ingxenye esele yomzimba, ikakhulukazi isisu, incane. Okwenzekayo kulokhu ukuthi umzimba womntwana uzama ukulondoloza izakhamzimba nomoya-mpilo odingwa ubuchopho, ngaleyo ndlela kuvimbele ukukhula kwezinye izitho. Lesi simo sivame ukubonakala engxenyeni yokugcina yokukhulelwa.

Kungani i-IUGR yenzeka? Ziyini izimbangela?

Manje ungase ucabange, 'Kungani lokhu kwenzeka enganeni yami? Ingabe lokhu kuyiphutha lami?' Ungacabangi kanjalo. Kunezizathu eziningi zokuthi kungani i-'IUGR' ingenzeka. Isizathu esiyinhloko ukuthi ingane esibelethweni ayitholi izakhamzimba nomoya-mpilo eyidingayo. Njengoba nje isitshalo singakwazi ukukhula kahle uma singenawo amanzi nezakhamzimba. Kunezici eziningana eziyinhloko ezibangela lokhu kuntuleka kokudla okunomsoco:

• Izinkinga Ze-Placenta: Njengoba wazi, i-placenta ifana nebhuloho elithwala umoya-mpilo nezakhamzimba kusuka kumama kuya enganeni. Ngakho-ke uma i-placenta ingakhekanga kahle, incane ngobukhulu, noma inobuthakathaka ekusebenzeni kwayo, umntwana akakutholi lokho akudingayo. Ngezinye izikhathi i-placenta ingase inganamatheli kahle odongeni lwesibeletho.
• Izinkinga zokugeleza kwegazi ngentambo yomgogodla: Intambo yomgogodla yindlela lapho izakhamzimba nomoya-mpilo kulethwa khona enganeni kusuka ku-placenta. Uma ukugeleza kwegazi ngentambo yomgogodla kuncipha, isibonelo, uma intambo yomgogodla iphithana, icindezelwa, noma uma inani lemithambo yegazi ngentambo yomgogodla lincipha, kungathinta nokukhula komntwana.

Ngaphezu kwalokho, ezinye zezimo zempilo zikamama kanye nemikhuba yakhe kungathinta lokhu. Ake sibone ukuthi ziyini:

• Ukubhema, ukuphuza utshwala, nokusebenzisa izidakamizwa: Cishe uyazi ukuthi lokhu kuyingozi kakhulu ngesikhathi sokukhulelwa. Kuphazamisa ngqo ukukhula komntwana futhi kunciphisa ukugeleza kwegazi eliya ku-placenta.
• Ukutheleleka okuthile: Ukutheleleka okuthile umama akutholayo ngesikhathi sokukhulelwa, isibonelo, i-cytomegalovirus, i-rubella, i-toxoplasmosis, noma i-syphilis, kungathinta ingane futhi kunciphise ukukhula.
• Imithi ethile: Imithi ethile, ikakhulukazi leyo yesifo sokuwa, nayo ingabangela i-IUGR. Ngakho-ke, kubaluleke kakhulu ukwazisa udokotela wakho nganoma yimiphi imithi oyithathayo. Ungathathi noma yimiphi imithi ngaphandle kwemvume kadokotela wakho phakathi nalesi sikhathi.
• Ezinye izimo zezokwelapha ezingamahlalakhona umama anazo: Isibonelo, izimo ezifana ne-lupus, i-anemia enzima, noma izinkinga zokujiya kwegazi, isifo sezinso, noma isifo senhliziyo nazo zingaba yizimbangela.
• Umfutho wegazi ophezulu: Umfutho wegazi ophezulu kumama ngesikhathi sokukhulelwa (ikakhulukazi izimo ezifana ne-pre-eclampsia) ingenye yezimbangela eziyinhloko ze-IUGR.
• Izinkinga zofuzo noma ukukhubazeka kokuzalwa enganeni: Ngezinye izikhathi, isimo sofuzo somntwana (isifo sofuzo) noma ukukhubazeka kokuzalwa nakho kungabangela ukubambezeleka kokukhula. Izibonelo zifaka phakathi izimo ezifana ne-Down syndrome.
• Ukukhulelwa okuningi, njengamawele noma amawele amathathu: Uma unezingane ezingaphezu kweyodwa esibelethweni, ngezinye izikhathi izakhamzimba zingase zingasabalaliswa ngokulinganayo kubo bonke. Ngisho nalapho, ingane eyodwa noma ngaphezulu ingaba ncane.

Odokotela bayixilonga kanjani i-IUGR?

Kulungile, manje cishe usuyaqonda ukuthi iyini i-'IUGR' nokuthi kungani yenzeka. Ngakho udokotela uyixilonga kanjani?

Ngokuvamile, uya emtholampilo njalo ngenyanga ngesikhathi sokukhulelwa kwakho. Lapho, udokotela noma isisebenzi sezempilo somndeni sizolinganisa ukuphakama kwesisu sakho. Okusho ukuthi, bazolinganisa kusukela ethanjeni le-pubic esiswini sakho esingezansi kuya phezulu kwesibeletho sakho nge-tape measure. Lokhu kubizwa ngokuthi isilinganiso "sokuphakama kwe-uterine fundal". Lokhu kuvumela odokotela ukuthi bathole umbono oqondile wokuthi ukukhula komntwana kufaneleka yini ngesonto. Lesi silinganiso kufanele sikhuphuke ngenani elithile isonto ngalinye. Uma kungenjalo, kusolwa ukuthi i-IUGR.

Kodwa indlela eyinhloko yokuqinisekisa ukuthi une-IUGR iwukuskena nge-ultrasound. Uke waskena. Ijeli ifakwa esiswini sakho bese kufakwa idivayisi encane ebizwa ngokuthi i-probe phezu kwesisu sakho, bese izithombe zomntwana ziboniswa esikrinini sekhompyutha. Kusukela kulezi zithombe, odokotela bangalinganisa izinto ezifana nosayizi wekhanda lomntwana, umjikelezo wesisu, kanye nobude bethambo lesinqe, bese bebala isisindo somntwana. Nakuba lezi zibalo zinganembile ngokuphelele, ziwusizo kakhulu ekunqumeni ukuthi umntwana ukhula kanjani nokuthi ngabe kukhona yini izinkinga. Ukuskena okungajwayelekile, okuvame ukwenziwa emavikini angama-20, nakho kunikeza umbono wokukhula komntwana. Ngemva kwalokho, ukuskena okwengeziwe kungenziwa njengoba kudingeka.

Ukuskena nge-ultrasound kungabheka nezinye izinto. Isibonelo:

• Indawo, ubukhulu, kanye nokubonakala kwe-placenta.
• Kungakhathaliseki ukuthi inani le-amniotic fluid elizungeze umntwana liphansi noma liphezulu. Ukwehla kwalolu ketshezi kungaba uphawu lwe-IUGR.
• I-scan ekhethekile ebizwa ngokuthi i-Doppler ultrasound ingasetshenziswa futhi ukubona ukuthi igazi lomntwana ligeleza kanjani nge-placenta kanye ne-umbilical cord. Lokhu kungasiza ekunqumeni ukuthi ingane ithola igazi ne-oxygen eyanele yini.

Uma kukhona ukusola ukuthi ingane ine-'IUGR', odokotela bangenza ezinye izivivinyo eziningana:

• Ukuqapha ukushaya kwenhliziyo nokunyakaza kwengane (Ukuqapha ingane): Lokhu kubizwa nangokuthi ukuhlolwa kwe-"CTG (Cardiotocography)". Lokhu kuhlola ukuthi ingane yenza kahle yini esibelethweni futhi ayinaso ingcindezi.
• Ukuhlolwa kwegazi ukuqinisekisa ukuthi umama unezifo ezingathinta ingane.
• I-Amniocentesis: Lokhu akwenziwa njalo, kodwa kwezinye izimo ezikhethekile, kuthathwa isampula encane yoketshezi lwe-amniotic oluzungeze umntwana ukuze kuhlolwe izimbangela zofuzo ze-IUGR. Ngezinye izikhathi lokhu kungasetshenziswa futhi ukubona ukuthi amaphaphu omntwana akhula kanjani, ikakhulukazi uma umntwana kufanele abelethwe kusenesikhathi.

Iphathwa kanjani i-IUGR?

Cabanga nje ukuthi odokotela basanda kuthola ukuthi ingane yakho ine-'IUGR'. Wenzani-ke? Ukwelashwa kwalokhu kuncike ekutheni ukukhulelwa kukude kangakanani, isimo somntwana, kanye nembangela ye-'IUGR'.

Odokotela baqapha ingane ene-IUGR ngokucophelela phakathi nokukhulelwa. Benza njalo ukuhlolwa kwe-ultrasound (mhlawumbe kanye noma kabili ngesonto), baqophe ukukhula kwengane, benze ukuhlolwa kwe-Doppler, benze ukuhlolwa kwe-CTG, futhi bahlole ezinye izinkinga.

Uma umama enesifo esibangela i-IUGR, odokotela bangasiza ekuphatheni lesi simo. Isibonelo:

• Uma unomfutho wegazi ophakeme, uzonikezwa imithi yokuwulawula.
• Bakweluleka ukuthi udle ukudla okuhle nokunomsoco. Bakweluleka ukuthi udle ukudla okucebile ngamaprotheni, imifino nezithelo.
• Kukusiza ukuthi uthole isisindo esidingekayo ngesikhathi sokukhulelwa.
• Abanye omama bangase banikezwe nokuphumula embhedeni, benethemba lokuthi kuzosiza ukwandisa ukugeleza kwegazi enganeni. Kodwa-ke, lokhu akusebenzi kuwo wonke umuntu, ngakho landela imiyalelo kadokotela wakho.
• Uma ubhema, sikunikeza iseluleko futhi sikusize ukuyeka.

Kwezinye izimo, odokotela bangase batuse ukuthi "Qalisa ukubeletha nokubeletha kusenesikhathi".Lesi sinqumo singase senziwe, ikakhulukazi uma ukukhula komntwana kubonakala sengathi kuyeke ngokuphelele, noma uma i-Doppler scan noma i-CTG ikhombisa ukuthi kuyingozi ukuthi umntwana ahlale esibelethweni, noma uma kunenkinga enkulu nge-placenta noma i-umbilical cord. Ngokuvamile, ngemva kwamasonto angu-37, amaphaphu omntwana asuke ekhule kahle, ngakho kungaba ngcono ukubeletha umntwana esimweni esinjalo.

Ngezinye izikhathi, uma ingane ibuthakathaka kakhulu ukuba ikwazi ukubhekana nokucindezeleka kokubeletha ngesitho sangasese sowesifazane, udokotela angase anqume ukwenza ukuhlinzwa kwe-C-section. Zonke lezi zinqumo zenziwa kucatshangelwa ukuphepha kwakho nokwengane yakho.

Yiziphi izinkinga ezingaba khona ngenxa ye-IUGR?

Izingane ezine-`IUGR`, ikakhulukazi lezo ezinesisindo esincane kakhulu ekuzalweni (ezingaphansi kwamakhilogremu angu-2.5), zisengozini enkulu yokuthola izinkinga ezithile zempilo.

• Ukuzalwa ngaphambi kwesikhathi: Izingane ezine-`IUGR` zivame ukuzalwa ngaphambi kwesikhathi.
• Ukulaliswa esibhedlela: Kungase kudingeke uhlale esibhedlela isikhathi eside ngemva kokuzalwa. Kungase kudingeke futhi uthole ukunakekelwa okukhethekile eyunithi yokunakekelwa okujulile kwezinsana ezisanda kuzalwa (i-NICU).
• Ubunzima bokuphefumula: I-Respiratory distress syndrome ingenzeka ngoba amaphaphu awakakhuli ngokugcwele.
• Ubunzima bokuncelisa: Ubunzima bokuncelisa bungase buvele ngenxa yokungakwazi ukuncela kahle.
• Ubunzima bokugcina izinga lokushisa lomzimba lizinzile (i-Hypothermia).
• Amazinga kashukela aphansi egazini (i-Hypoglycemia).
• Amazinga e-calcium egazini anciphile.
• I-Polycythemia: Ukuqina kwegazi ngenxa yokwanda kwenani lamaseli egazi.
• Ukwehliswa kokumelana nezifo.
• I-Perinatal asphyxia: Ukuntuleka komoya-mpilo ngesikhathi sokuzalwa.
• Izinkinga ze-neurological kanye nokubambezeleka kokukhula: Ngokuhamba kwesikhathi, kunethuba elincane lezinto ezifana nobunzima bokufunda.

Kodwa akuzona zonke lezi zinto ezenzeka kuzo zonke izingane ze-IUGR. Imiphumela yesikhathi eside ye-IUGR enganeni incike ekutheni yini ebangele i-IUGR kwasekuqaleni, ubukhali be-IUGR, kanye nokwelashwa umntwana akutholayo.

Yini engingayenza uma ingane yami ine-IUGR?

Uma udokotela ethi ingane yakho ingase ibe ne-'IUGR', ungesabi futhi uhlale uzolile. Into ebaluleke kakhulu ukulandela imiyalelo kadokotela wakho ngqo bese uya kuyo yonke imitholampilo nakuyo yonke imvivinyo. Kulapho kuphela udokotela ezokwazi ukuqapha ngokunembile intuthuko nempilo yengane yakho futhi enze izinqumo ezifanele ngesikhathi esifanele.

Futhi, kubaluleke kakhulu ukuthi uzinakekele kahle:

• Yidla ukudla okunempilo nokulinganiselayo. Uma udokotela wakho ekunike amavithamini engeziwe kanye namaphilisi ensimbi, waphuze ngesikhathi esifanele.
• Phumula futhi ulale ngokwanele.
• Gwema utshwala, izidakamizwa nokubhema ngokuphelele. Lokhu kuyingozi kakhulu enganeni. Uma ubhema, lesi yisikhathi esihle kakhulu sokuyeka.
• Zama ukuhlala ukhululekile engqondweni. Ungazicindezeli ngezinto ezingadingekile. Impilo yakho yengqondo nayo iyathinta ingane. Thola usizo kumyeni wakho nomndeni wakho.
• Naka ukunyakaza kwengane yakho (inani lokukhahlela kwengane). Udokotela wakho uzokweluleka ngalokhu. Ungathola umbono wokuthi ingane yakho yenza kahle yini ngokubheka ukuthi ingane yakho inyakaza kangaki ngosuku.

Ngakho-ke, ake sifingqe lokho esikhulume ngakho. (Umyalezo Wokuya Ekhaya)

Kulungile, ngakho-ke sikhulume kakhulu nge-'IUGR' namuhla, akunjalo? Ngithemba ukuthi lolu lwazi lube wusizo kuwe. Nazi ezinye zezinto ezibaluleke kakhulu okufanele uzikhumbule:

• `I-IUGR` isho ukuthi umntwana osesiswini akakhuli kahle njengoba kulindelekile. Lokhu kungathinta impilo yomntwana.
• Lokhu kungabangelwa yizici eziningana, okuhlanganisa izinkinga nge-placenta, izimo zempilo kamama, kanye nezimo ezithile zomntwana uqobo.
• Ukuskena nge-ultrasound kuyindlela eyinhloko yokuthola nokuqapha i-IUGR.
• Njengokwelashwa, odokotela baqapha ngokucophelela ingane, bahlole impilo kamama, futhi bangase babelethe ingane kusenesikhathi.
• Into engcono kakhulu ongayenza ukulandela iseluleko sikadokotela wakho, uzijwayeze imikhuba emihle yezempilo, futhi uhlale ujabule futhi ukhululekile engqondweni.
• Khumbula, i-IUGR akuyona iphutha lakho. Kungenzeka kunoma ubani. Ngokunakekelwa okufanele kwezokwelapha kanye nokuzinikela kwakho, ungaphatha lesi simo futhi ulethe umntwana onempilo emhlabeni. Awuwedwa, udokotela wakho, umndeni wakho, futhi wonke umuntu unawe.

I- IUGR, ukukhulelwa, ukukhula komntwana, ukuvinjelwa kokukhula kwangaphakathi kwesibeletho, i-placenta, i-ultrasound, ukudla okunomsoco, ukukhula kwengane, ukunakekelwa kokukhulelwa