Ingabe ihlombe lomntwana wakho linamathele? Ake sifunde nge-Shoulder Dystocia, engenzeka ngesikhathi sokubeletha!

Kulabo kini abazoba ngumama, ukubeletha kungenye yezinto ezijabulisa kakhulu empilweni yenu, kodwa ngezinye izikhathi kungaba yinto eyesabekayo. Esikhathini esiningi, konke kuhamba kahle futhi kahle, kodwa ngezinye izikhathi kungavela izinkinga ezingalindelekile. Kulungile, lesi yisimo esingavamile sonke okudingeka sisiqaphele ngesikhathi sokubeletha (Shoulder Dystocia) . Ake sixoxe ngalokhu ngemininingwane ethe xaxa, kodwa kalula nje, kulungile?

Kuyini lokhu (i-Shoulder Dystocia), dokotela?

Kalula nje, i-Shoulder Dystocia yilapho ihlombe elilodwa noma womabili, noma womabili amahlombe, ebhajwa ethanjeni, uhlaka lwethambo oluzungeze okhalweni, ngemva kokuba ikhanda lomntwana liphume esithweni sangasese sowesifazane. Cabanga ukuthi lapho umntwana ezama ukuphuma, amahlombe abhajwa ndawana thize, okwenza kube nzima ukukhipha wonke umzimba. Igama lesiGreki elithi "dystocia" lisho "ukubeletha okunzima."

Lokhu empeleni kubhekwa njengesimo esiphuthumayo sezokwelapha odokotela. Ngoba uma kungelashwa ngokushesha, bobabili umama nomntwana bangaba nezinkinga ezithile. Kodwa into ebaluleke kakhulu ukuthi esikhathini esiningi, odokotela namaqembu ezokwelapha baphatha lesi simo ngobuchule obukhulu futhi bagcine umama nomntwana bephephile. Ngakho-ke ungesabi ngokungadingekile.

Kubonakala kangakanani lokhu?

I-Shoulder Dystocia empeleni iyisimo esingavamile . Kunzima ukunikeza izibalo eziqondile, njengoba ngezinye izikhathi singase sitholakale singaphezu kokuxilongwa noma singatholakali kahle. Futhi inani liyahlukahluka kuye ngesisindo somntwana wokuzalwa.

Ngokwesilinganiso, lesi simo sithinta phakathi kuka-0.6% no-1.4% wezingane ezinesisindo esiphakathi kwamakhilogremu angu-2.5 no-4 (amakhilogremu angu-5 ama-ounces angu-8 - amakhilogremu angu-8 ama-ounces angu-13). Kodwa-ke, uma ingane inesisindo esingaphezu kwamakhilogremu angu-4 (amakhilogremu angu-8 ama-ounces angu-13), le ngozi iyanda ibe ngu-5% no-9%.

Singakubona lokhu kusenesikhathi? Ziyini izimpawu?

Nansi into ebalulekile, i-Shoulder Dystocia ayibonisi zimpawu ezithile . Okusho ukuthi, azikho izimpawu ngaphambi kokubeletha ezikwenza ucabange ukuthi, "O, lokhu kuzokwenzeka kimi." Nakuba kunezinye izici eziyingozi, lesi simo singavela kunoma ubani.

Udokotela uqaphela lokhu kuphela ngemva kokuba ikhanda lomntwana liphumile. Ikhanda lomntwana libonakala sengathi liyaphuma bese libuyela emuva kancane. Kufana nofudu olukhipha ikhanda lalo bese lulibuyisela ngaphakathi uma selwesaba. Odokotela bakubiza lokhu ngokuthi "uphawu lofudu." Yilapho odokotela beqaphela khona ukuthi ihlombe lomntwana linamathele.

Kungani lokhu kwenzeka? Yiziphi izizathu?

Imbangela eyinhloko ye-Shoulder Dystocia yilapho ihlombe lomntwana libhajwa ngemuva kwethambo le-pubic, elitholakala ngaphambili kwe-pelvis kamama. Kunezici eziningana ezingaba nomthelela kulokhu:

• I-Fetal Macrosomia: Lokhu kungenzeka uma ingane inesisindo esingaphezu kwamakhilogremu angu-4 (amakhilogremu angu-8 nama-ounces angu-13).
• Indawo engafanele yomntwana: Indawo yomntwana esibelethweni nayo ingaba yinkinga.
• Imbobo ye-pelvic kamama incane: I-pelvis yomama othile ingase ibe mncane ngokwemvelo.
• Indawo kamama ngesikhathi sokubeletha: Ezinye izindawo zinganciphisa isikhala esitholakalayo ethangeni.

Odokotela bakubona kanjani lokhu?

Udokotela uzophetha ngokuthi une-Shoulder Dystocia uma kuhlangatshezwana nezinto ezintathu eziyinhloko:

1. Ikhanda lomntwana seliphumile, kodwa umama akakwazi ukusunduza amahlombe omntwana.

2. Sekudlule umzuzu owodwa kusukela ikhanda lomntwana laphuma, kodwa isidumbu asikaphumi.

3. Ukungenelela kwezokwelapha kuyadingeka ukuze kubelethwe umntwana ngempumelelo.

Yiziphi izindlela zokwelapha lokhu?

Uma udokotela ecabanga kusengaphambili ukuthi usengozini, kungaba ngenxa yokuthi unesifo sikashukela noma ngoba ingane inkulu kakhulu, angase asikisele ukuthi kwenziwe ukuhlinzwa kwangaphambi kwesikhathi (C-section) .

Kodwa-ke, uma umuntu obeletha ngesitho sangasese sowesifazane enomuzwa wokuthi lokhu kuyingozi, odokotela banohlu lokuhlola ukuphepha . Okusho ukuthi, banohlu lwezinto okufanele bazenze uma kwenzeka isimo esiphuthumayo esinjengalesi.

Uma sekutholakale ukuthi une-dystocia yamahlombe, umsebenzi egumbini lokubelethisa uba matasa kakhulu . Udokotela kanye nethimba labahlengikazi bazosebenzisana ukusebenzisa izindlela ezahlukene zokukhipha umntwana. Bangase bazame ukushintsha indawo yakho ukuze benze isikhala esengeziwe se-pelvis yakho, noma bangase bazame ukushintsha indawo yengane ukuze bakhulule amahlombe akho.

Indlela ye-HELPERR

Indlela elula ukuyikhumbula esetshenziswa odokotela ezikhathini ezinjengalezi yi -HELPERR . Uhlamvu ngalunye olukuyo lusho okuthile okufanele kwenziwe.

• H — Usizo: Udokotela ucela usizo kwabanye ngokushesha. Usebenzisa uhlu lokuphepha okukhulunywe ngalo ekuqaleni. Ucela usizo lukadokotela wezinzwa, udokotela wezinsana, kanye nabahlengikazi abengeziwe. Uletha ngokushesha imishini edingekayo ekamelweni.
• E — Hlola i-episiotomy: Udokotela uzonquma ukuthi angenza i-episiotomy , ukunqunywa okuncane phakathi komgodi wesitho sangasese sowesifazane kanye ne-perineum, ukuze kwandiswe umgodi wesitho sangasese sowesifazane ukuze kusize ekubelethweni komntwana. Lokhu kwenziwa kuphela uma kudingeka indawo eyengeziwe yokushintshashintsha.
• L — Imilenze: Udokotela wakho angasebenzisa indlela kaMcRoberts . Lokhu kuhilela ukucindezela amathanga akho ndawonye esiswini sakho. Lokhu kwenza i-pelvis ibe yithambile futhi kuyijikelezise kancane, kwandise isikhala.
• P — Ingcindezi: Udokotela , ingcindezi ye-suprapubic.Ungayisebenzisa. Okusho ukuthi, ucindezela isisu sakho esingezansi, ngaphezu nje kwethambo le-pubic. Lokhu kubeka ingcindezi ehlombe lomntwana, uzama ukumphendula nokumkhipha.
• E — Faka amaqhinga: Udokotela angenza ukujikeleza kwangaphakathi . Lokhu kusho ukuthi uzozama ukuphendula ingane ngokufaka isandla sayo esithweni sangasese sowesifazane.
• R — Susa ingalo engemuva: Udokotela angasebenzisa indlela kaJacquemier . Lokhu kuhilela ukususa enye yezingalo zomntwana emgudwini wokuzalwa. Lokhu kuzokwenza kube lula ukuthi amahlombe aphume.
• R — Phendula isiguli: Udokotela angasebenzisa indlela ye-Gaskin , ehilela ukukuphethula ezandleni nasemadolweni akho.

Ezimweni eziyinkimbinkimbi kancane

Ezimweni ezinzima kakhulu lapho izindlela ezingenhla zingaphumeleli, udokotela angase asebenzise lezi zindlela:

• Ukuphuka kwe-Clavicle: Ithambo le-collar lomntwana liphukile ngamabomu ukuze kukhululwe ihlombe.
• I-Zavanelli maneuver: Ikhanda lomntwana libuyiselwa esibelethweni bese kwenziwa ukuhlinzwa ngokushesha (C-section).
• I-Symphysiotomy: Lena inqubo enweba ukuvulwa kwe-pelvic ngokusika i-cartilage phakathi kwamathambo amabili e-pubic. Lezi yizinqubo ezingavamile kakhulu kulezi zinsuku.

Yiziphi izinkinga ezingabangelwa yilokhu kumama nengane?

I-Shoulder Dystocia ingabangela izinkinga kumama kanye nengane ngesikhathi sokubeletha. Khumbula, lokhu akwenzeki kuwo wonke umuntu , kodwa kuhle ukuqaphela.

Imiphumela kumama:

• Ukopha ngokweqile ngemva kokubeletha (ukuphuma kwegazi ngemva kokubeletha) .
• Ukudabuka okukhulu kwendawo ephakathi kwesitho sangasese sowesifazane kanye ne-anus (perineum).
• I-fistula ye-rectovaginal: Lokhu ukuxhumana okungavamile phakathi kwesitho sangasese sowesifazane kanye ne-anus.
• Ukuqhekeka kwesibeletho .
• Ukuhlukana kwamathambo e-pubic e-pelvis.

Imiphumela enganeni:

Inkinga evame kakhulu ye-shoulder dystocia ezinganeni yisimo esibizwa ngokuthi i-brachial plexus palsy . I-brachial plexus yiqembu lezinzwa eziqala emgogodleni wengane entanyeni ziye engalweni. Lezi zinzwa zinikeza umuzwa nokunyakaza ehlombe, engalweni, nasesandleni. Uma lezi zinzwa zonakele, ingalo kulolo hlangothi ingaba buthakathaka noma ikhubazeke.

Ezinye izinkinga:

• Ukuphuka kwethambo le-collarbone (clavicle) lomntwana kanye/noma ithambo lengalo engenhla (i-humerus).
• I-Horner's syndrome: Isimo esingavamile esithinta amehlo nobuso bomntwana.
• Intambo yenkaba ecindezelwe:Intambo yesisu ingabambeka phakathi kwengalo yomntwana nethambo lesisu sikamama. Lokhu kungaholela ekushodeni komoya-mpilo kanye nokugeleza kwegazi enganeni, okungaholela ekulimaleni kobuchopho noma ngisho nasekufeni. Lokhu kuyinto engavamile kakhulu.

Ubani osengozini enkulu?

I-Shoulder Dystocia ingenzeka kunoma ubani . Ivame ukubonakala ezinganeni ezinesisindo esijwayelekile sokuzalwa. Kodwa-ke, kunezici ezithile eziyingozi ezandisa amathuba okuba nalesi simo. Ake sibone ukuthi ziyini:

• Isifo Sikashukela: Kungakhathaliseki ukuthi unesifo sikashukela esivele sikhona noma isifo sikashukela sokukhulelwa, ingane yakho ingaba nkulu kancane. Cishe ama-20% omama abanesifo sikashukela banezingane ezinesisindo esingaphezu kwamakhilogremu angu-4 (amakhilogremu angu-8, ama-ounces angu-13).
• I-Macrosomia: Lokhu kusho ukuthi ingane inesisindo esingaphezu kwamakhilogremu angu-4 (amakhilogremu angu-8, ama-ounces angu-13) lapho izalwa. Uma ingane inkulu kakhulu, udokotela angase atuse ukuba kwenziwe ukuhlinzwa.
• I-Shoulder Dystocia (ukuzalwa ngokuzumayo)
• Ukuthwala amawele noma izingane eziningi esibelethweni.
• Ukukhuluphala ngokweqile noma ukukhuluphala ngokweqile ngesikhathi sokukhulelwa.
• Ubude obufushane bukamama.
• Ukuba nesakhiwo esingajwayelekile ethangeni.
• Ukuba neminyaka engaphezu kwengu-35 ubudala.
• Ukubeletha kwenzeka ngemva kosuku lokugcina.

Ezinye izimo ngesikhathi sokubeletha kanye nokubeletha nazo zingandisa le ngozi. Esinye sezimo ezibaluleke kakhulu kulezi ukusiza ekubelethweni kwesitho sangasese sowesifazane , okusho ukuthi udokotela kufanele asebenzise umshini wokukhipha i-vacuum noma i-forceps ukuze asuse umntwana.

Ezinye izinto eziyingozi:

• Ukunikeza umuthi obizwa ngokuthi i-Oxytocin ukuze uqale ukubeletha.
• Ukuthola i- epidural .
• Isigaba sokuqala sokubeletha (isigaba sokuqunjelwa) side kakhulu.
• Isigaba sesibili sokubeletha (isigaba sokusunduza) sifushane kakhulu noma side kakhulu.
• Ukusebenzisa ingcindezi noma izindlela ezingafanele ukuze umntwana aphume.

Ingabe kukhona esingakwenza ukuvimbela lokhu?

Uma ngikhuluma iqiniso, kuvame ukuba nzima ukuvimbela i-shoulder dystocia, ikakhulukazi uma ingane inesisindo esijwayelekile. Kwenzeka ngokungazelelwe. Kodwa-ke, kunezinto ezimbalwa ongazenza ukuze unciphise ingozi yakho:

• Uma unesifo sikashukela, silawule kahle .
• Gcina isisindo esinempilo phakathi nokukhulelwa.
• Khuluma nodokotela wakho ubone ukuthi ungakwazi yini ukuqala ukubeletha kusenesikhathi uma kudingeka.
• Uma usuku lokugcina seludlulile, yazisa udokotela wakho ngokushesha.
• Xoxa ngokuhlinzwa (C-section) nodokotela wakho (ikakhulukazi uma kunezici eziyingozi).
• Cabanga kabili ngezinye izidakamizwa zobuhlungu ezinikezwa ngesikhathi sokubeletha, njenge-epidurals (khuluma nodokotela wakho ngalokhu futhi).

Kwenzekani ngemva kwalesi simo? Liyini ikusasa?

Ungase wesabe kancane ukuzwa lokhu, kodwa kunezindaba ezinhle .

Ucwaningo lubonisa ukuthi ingxenye yezingane ezizalwa zine-Shoulder Dystocia zisuke sezijwayelekile ngokuphelele ezinyangeni ezintathu ubudala. Ezinyangeni ezingu-18, u-82% wezingane usuke esephile kahle ngokuphelele.

Uma ingane yakho ilimele nge-brachial plexus , umphumela uvame ukuba muhle. Kodwa-ke, ezinye izindlela zokungenelela zingathinta isimo sengane sesikhathi eside. Bangase babe nobunzima ngamakhono okunyakaza kahle nokusebenzisa ingalo ethintekile. Kodwa-ke, ngaphezu kwama-90% alokhu kulimala kuyaphela zingakapheli izinyanga eziyi-6 kuya kweziyi-12 . Ngaphansi kwama-10% amacala abangela ukukhubazeka okungapheli.

Uma uke waba nomntwana one-Shoulder Dystocia, amathuba okuthi kwenzeke futhi angaba ngu-15%. Ngakho-ke uma ucabanga ngokuba nezingane ezengeziwe, khuluma nodokotela wakho ngalokhu. Uma uke wabelethwa ngokuhlinzwa ngenxa ye-Shoulder Dystocia, ukubeletha ngesitho sangasese sowesifazane ngemva kokuhlinzwa (VBAC) akuvamile ukunconywa .

I-Shoulder Dystocia iyinkinga engenzeka ngesikhathi sokubeletha. Kuvamile ukuzizwa ukhathazekile ngokuthi yini engase ihambe kabi ngesikhathi sokubeletha nokubeletha. Kodwa-ke, kubalulekile ukukhumbula ukuthi lezi zimo azivamile nokuthi ithimba lakho lezokwelapha liqeqeshwe kahle ukubhekana nazo. Uma kwenzeka le nkinga engavamile, ungesabi futhi uthembele odokotela bakho. Bazokwenza konke okusemandleni abo ukugcina wena nomntwana wakho niphephile futhi bakhiphe ingane yakho ngaphandle kwezinkinga zesikhathi eside.

Into ebaluleke kakhulu okudingeka siyikhumbule (Umyalezo Wokuya Ekhaya)

Ngithemba ukuthi usuyaqonda kangcono isimo esixoxe ngaso namuhla (i-Shoulder Dystocia). Izinto eziyinhloko okufanele uzikhumbule yilezi:

• Lokhu kuyisimo esiphuthumayo, yize kungavamile .
• Esikhathini esiningi, amaqembu ezokwelapha aphatha kahle lokhu .
• Ngisho noma kungekho zimpawu zokuxwayisa kusenesikhathi, kubalulekile ukuqaphela izici eziyingozi .
• Izinto ezifana nokulawula isifo sikashukela nokugcina isisindo esinempilo zinganciphisa ingozi ngandlela thile .
• Iningi lezingane liyalulama ngokuphelele .

Ukubeletha kuyinto emangalisayo. Sithemba ukuthi lolu lwazi luzoba usizo njengoba ulungiselela lolo hambo. Ungesabi ukukhuluma nodokotela wakho nganoma yimiphi imibuzo noma ukukhathazeka ongase ube nakho. Sikufisela okuhle wena nomntwana wakho!

'I-Shoulder Dystocia, ukubeletha, ukuminyana kwengane, ukuminyana kwehlombe, izinkinga zokubeletha, ukukhulelwa, izinkinga zokubeletha