Ingabe kukhona ukopha ekhanda losana olusanda kuzalwa? Ingabe lokhu ukopha okungaphansi kwe-galeal? Ake sixoxe!

Kumelwe ukuba ujabule kakhulu ngemva kokuzalwa kwengane yakho kuleli zwe, akunjalo? Kodwa ngesikhathi esifanayo, ngezinye izikhathi uzizwa wesaba ngezinto ezincane. Ikakhulukazi uma ukubeletha bekunzima kancane, kuyinto evamile ukuzizwa ukhathazekile uma ubona ushintsho oluncane kangaka ekhanda lomntwana. Namuhla sizokhuluma ngesimo esingase senzeke ekhanda ngaleso sikhathi, futhi udinga ukuqaphela kancane.

Kuyini lokhu kopha kwegazi okungaphansi kwe-galeal? Masikuqonde kalula!

Kalula nje, lokhu kuyiqoqo legazi ngaphansi kwesikhumba sekhanda lomntwana osanda kuzalwa, phakathi kwezingqimba zezicubu ezithambile ngaphezu kogebhezi. Cabanga nje, amakhanda ethu nawo anezingqimba ezahlukene ngaphansi kwesikhumba. Ngokufanayo, ngaphansi kwesikhumba sekhanda lomntwana, kukhona ugebhezi olwenziwe ngezicubu eziqinile nezinemicu, odokotela abazibiza ngokuthi `(galea aponeurotica)`. Ngaphansi kwalokho, kukhona olunye ugebhezi oluzungeze amathambo ogebhezi, olubizwa ngokuthi `(periosteum)`. Lokhu kuphuma kwegazi, noma ukuqoqwa kwegazi, kwenzeka phakathi kwalezo zingqimba ezimbili.

Isizathu esiyinhloko salokhu ukuthi kunemithambo yegazi emincane exhuma kusuka ekhanda kuya ngaphakathi kwekhanda. Le mithambo yegazi ibizwa ngokuthi "imithambo yegazi ethunyelwayo". Le mithambo yegazi ihamba ngemigodi emincane (``foramen``) ekhanda. Ngezinye izikhathi, ngesikhathi sokubeletha okunzima, le mithambo yegazi ingadonswa futhi iqhume lapho umntwana ephuma. Yilapho igazi liphuma khona bese liqoqana kuleso sikhala.

Lokhu kungaba yingozi kancane. Ngoba, inani elikhulu legazi, eliphakathi kuka-20% no-40% womzimba wonke womntwana, lingaqongelela ekhanda ngale ndlela. Kodwa ungakhathazeki, uma lokhu kuqashelwa futhi kwelashwa ngokushesha nangokushesha, kungalapheka ngokuphelele. Lesi simo sivame ukuba ngcono emavikini amabili kuya kwamathathu.

Ubani okungenzeka kakhulu ukuthi athole lesi simo?

Lesi simo, esibizwa ngokuthi ``I-Subgaleal Hemorrhage``, siyinto engavamile kakhulu kunoma yimuphi umntwana ozelwe ngokubeletha okuvamile kwesitho sangasese sowesifazane. Kodwa-ke, lapho umntwana kunzima ukuphuma, odokotela kungadingeka basebenzise imishini ethile ukusiza ngokubeletha. Isibonelo, uma kusetshenziswa ``i-vacuum extractor`` (esiyibiza ngokuthi 'i-vacuum' engxoxweni) noma ``i-forceps`` (idivayisi efana ne-forceps)', ingozi iphakeme kakhulu.

Ingabe lesi simo sivame kangakanani? Ingabe kufanele sesabe?

Empeleni, lesi yisimo esingavamile kakhulu. Okusho ukuthi, akuyona into evame ukubonwa. Lokhu kubikwa ezinganeni ezingaba ngu-4 kwezingu-10,000 ezizalwayo ngaphandle kokusebenzisa imishini. Akulona yini inani eliphansi kakhulu lelo? Kodwa-ke, njengoba ngishilo ngaphambili, uma kusetshenziswa idivayisi efana ne-"vacuum extractor" ukususa umntwana, leli nani liyakhula kancane. Ezimweni ezinjalo, imibiko yezokwelapha ithi izingane ezingaba ngu-60 kwezingu-10,000 ezizalwayo zingaba nalesi simo. Kodwa akunjalo kuwo wonke umuntu.

Kungani lokhu kopha okungaphansi kwe-galeal kwenzeka? Ziyini izimbangela?

Njengoba ngishilo ekuqaleni, imbangela enkulu yalokhu yilapho imithambo yegazi emincane (imithambo yegazi) esuka ekhanda iye ekhanda iphuka ngenxa yengcindezi ethile ngesikhathi sokubeletha. Bese kuthi, lelo gazi liqoqeke esikhaleni esiphakathi kwesikhumba nekhanda (isikhala esingaphansi kwe-galeal). Lokhu kwenzeka kuphela ngesikhathi sokubeletha okuvamile , lesi simo asiveli ngesikhathi sokubeletha ngokuhlinzwa.

Ngezinye izikhathi ukubeletha kungaba nzima kakhulu kunalokho esikulindele. Yilapho odokotela kufanele basebenzise imishini efana ne-"vacuum extractor" noma "i-forceps" ukuze bakhiphe umntwana ngokuphephile. Nazi ezinye zezizathu ezenza ukubeletha kube nzima:

• Ikhanda noma umzimba womntwana mkhulu kakhulu ukuba ungangena ethangeni likamama. Odokotela bakubiza lokhu ngokuthi "ukungalingani kwe-cephalopelvic".
• Ingane ayehli kahle futhi ngokuphepha ngomsele wokuzalwa (i-fetal dystocia).
• Isisindo somntwana siphakeme kakhulu kunesijwayelekile (i-macrosomia).
• Ukubeletha isikhathi eside kwenzeka lapho umntwana engazalwanga isikhathi esingaphezu kwamahora angu-20 ngemva kokuqala kokubeletha.
• Ngezinye izikhathi, ukubeletha kungafika ngokushesha kakhulu, emahoreni amathathu nje kuphela, futhi umntwana usezozalwa ('ukubeletha okusheshayo'). Ngezinye izikhathi kungavela izinkinga ngalesi sikhathi futhi.

Lesi simo kungenzeka kakhulu uma ingane isuswa kusetshenziswa i-`(vacuum extractor)`. Ngoba, lapho ingxenye efana nendebe ye-`(vacuum)` inamathele ekhanda lengane, amandla okudonsa awadalayo angadonsa isikhumba sekhanda kancane kude nogebhezi. Ngemuva kwalokho izicubu ezithambile ezixhumeneyo `(isikhala esingaphansi kwe-galeal)` ziyakhululeka, zidale isikhala sokuqoqwa kwegazi. Uma igazi eliningi kakhulu liqoqwa ngale ndlela, kungaba yingozi empilweni yengane. Yingakho odokotela beqaphela kakhulu ngalokhu.

Ziyini izimpawu zalokhu? Ukubona kanjani uma ukubonile?

Izimpawu ze-"Subgaleal Hemorrhage" ziqala ukuvela ngemva kokuzalwa komntwana. Nazi ezinye zezinto ongazibona:

• Isikhumba somntwana sibonakala sinjengemivimbo , ikakhulukazi ekhanda nasentanyeni.
• Ukushaya kwenhliziyo okusheshayo kakhulu (i-tachycardia).
• Ukuba nomfutho wegazi ophansi.
• Umbala wesikhumba ubonakala uphaphathekile kakhulu (`umhlophe`).
• Ngenxa yokulahlekelwa yigazi eliningi emzimbeni, amazinga ezingxenye egazini ezibizwa ngokuthi ``i-hemoglobin`` kanye ``i-hematocrit`` ayancipha.
• Kuvela ukuvuvukala okuzwakala sengathi amanzi ekhanda lomntwana (ukuvuvukala okumanzi). Lokhu kubangelwa ukuhlangana kwegazi ngaphakathi. Lokhu kuvuvukala kungase kusakazeke ngemuva kwezindlebe zomntwana kuye entanyeni.

Ngenhlanhla, akuzona zonke izingane eziba nezimpawu ezinzima. Ngaphansi kwama-25% azo zonke izimo zokopha okungaphansi kwe-galeal ziba nezimpawu ezinkulu ngokwanele ukuba zisongele impilo. Lezi zifaka:

• Ukopha kakhulu kwangaphakathi noma izinkinga zokujiya kwegazi (i-coagulopathy).
• Isimo esibizwa ngokuthi 'ukushaqeka kwe-hypovolemic noma i-hemorrhagic', esenzeka lapho umzimba ulahlekelwa uketshezi oluningi kanye negazi kuze kube yilapho inhliziyo ingakwazi ukupompa igazi ngendlela efanele.
• Ubunzima bokuphefumula (ukucindezeleka kokuphefumula).
• Ukuntuleka komoya-mpilo owanele ebuchosheni ngesikhathi sokuzalwa (i-intrapartum hypoxia).
• Ukwehluleka kancane kancane kwezitho zangaphakathi, njengezinso (ukwehluleka kwezitho).

Odokotela bakuthola kanjani lokhu? Yiziphi izivivinyo abazenzayo?

Lapho nje umntwana ezelwe, ithimba lezokwelapha lizomhlola ngokucophelela umntwana ukuze libone ukuthi unazo yini izimpawu ezishiwo ngenhla. Isibonelo, bazobhekisisa isikhumba somntwana ukuze babone ukuthi siphuzi yini, ikhanda livuvukile, noma kukhona imihuzuko engavamile.

Uma kukhona ngisho nokusola okuncane kakhulu kokuthi "une-Subgaleal Hemorrhage", udokotela uzoyala ukuhlolwa okukhethekile okuningana ekhanda lomntwana.

• Ukuhlolwa kwekhanda nge-ultrasound.
• Mhlawumbe `(i-CT scan - i-Computed Tomography scan)`.
• Noma i-MRI (i-Magnetic Resonance Imaging).
• Ngezinye izikhathi i-X-ray ingathathwa.

Lezi zivivinyo zingabona kahle ukuthi ukuphuma kwegazi kubukeka kanjani nokuthi kukhulu kangakanani ngaphansi kwesikhumba.

Ake sithi kusetshenziswe umshini wokukhipha i-vacuum ukukhipha ingane yakho. Uma lokho kwenzeka, noma ngabe ingane yakho ingakhombisi izimpawu ezinkulu ngokushesha, odokotela bazoyigcina ingane yakho enkulisa noma, uma kudingeka, eyunithi yokunakekelwa okujulile kwezingane ezisanda kuzalwa (i-NICU) amahora ambalwa ukuze bayiqaphe eduze. Lokhu kungenxa yokuthi ngezinye izikhathi lokhu kuhlangana kwegazi kanye nomonakalo wezicubu obangela ukushintsha kombala wesikhumba kuthatha isikhathi ukuvela. Lokhu kusho ukuthi lezi zimpawu zingavela noma kuphi kusukela ehoreni elilodwa kuya emahoreni angu-72 (izinsuku ezi-3) ngemva kokuzalwa kwengane.

Kungelashwa kanjani lokhu? Ingabe ingane izolulama maduze?

Uma odokotela sebeqinisekisile ukuthi "kuwukuvuza kwegazi okungaphansi kwe-subgaleal", baqala ukwelashwa ngokushesha. Lokhu kwelashwa kuvame ukwenziwa egunjini lokunakekelwa okujulile kwezinsana ezisanda kuzalwa (``NICU'') .

Into eyinhloko ukubuyisela umthamo wegazi lomntwana uma wehlile. Lokhu kwenziwa ngokunikeza umntwana izinto ezifana negazi kanye nokumpontshelwa igazi.

Ngaphezu kwalokho, ithimba lezokwelapha lomntwana lizoqhubeka nokuqapha amazinga egazi lomntwana (i-hemoglobin, i-hematocrit), ukushaya kwenhliziyo, kanye nomfutho wegazi. Ububanzi bekhanda lomntwana buzolinganiswa njalo ukuze kubonakale ukuthi ukuvuvukala kuyehla noma kuyanda.

Ngezinye izikhathi, uma ukopha kukhulu futhi kungenakulawuleka ngokumpontshelwa uketshezi, kungase kudingeke ukuhlinzwa okuphuthumayo, okungajwayelekile kakhulu. Lokhu kwenzelwa ukuvimba ukopha endaweni yokopha ekhanda nokususa igazi eliqongelelekile.

Ingane izolulama ngokushesha kangakanani ngemva kokwelashwa?

Uma ukopha sekuphelile ngokwelashwa, ukuvuvukala ekhanda kuncipha kancane kancane futhi ezinye izimpawu ziyanyamalala. Lokhu kuvame ukuphela phakathi kwamasonto amabili kuya kwamathathu.

Kodwa-ke, kufanele uqhubeke nokuxhumana nodokotela bengane yakho unyaka wonke wokuqala wengane, bese uya emitholampilo nasezivivinyweni abazincomayo. Lokhu kwenzelwa ukuhlola ukuthi zikhona yini ezinye izimpawu ezingathinta ukukhula kwengane yakho. Ezimweni eziningi, cishe u-75% wamacala, uma ukwelashwa kuphumelele, ingane izolulama kahle futhi uzokwazi ukuya ekhaya nengane yakho.

Ingabe ikhona indlela yokunciphisa ukwenzeka kwalolu hlobo lwesimo?

Empeleni kunzima kakhulu ukuvimbela ngokuphelele ukuthi "i-Subgaleal Hemorrhage" ingenzeki. Lokhu kungenxa yokuthi kuvame ukwenzeka njengomphumela ongalindelekile wokubeletha okunzima. Ngokuvamile, ukuba khona kobunzima obunjalo kutholakala kuphela ngesikhathi sokubeletha.

Kodwa-ke, kubalulekile ukuthola ukunakekelwa okufanele ngaphambi kokubeletha nokulandela imiyalelo kadokotela wakho ngesikhathi sokukhulelwa kwakho. Ngesikhathi sokuhlolwa kwe-ultrasound ngaphambi kokubeletha, udokotela wakho uzobheka indawo yomntwana, usayizi, kanye nosayizi we-pelvis yakho ukuze anqume ukuthi ukubeletha okuvamile kuyindlela ephephile yini kuwe nakumntwana wakho, noma uma kufanele ucabangele ezinye izinketho.

Kwenzekani uma ingane yami inalesi simo? Ingabe kufanele ngikhathazeke?

Ngeshwa, iphesenti elincane kakhulu lezingane (phakathi kuka-10% no-25%) ziyafa zisencane ngenxa yokopha ngokweqile. Lokhu kuyadabukisa ukuzwa. Kodwa-ke, izingane ezingaphezu kuka-75% ezitholakale zine-"Subgaleal Hemorrhage" ziyalulama kahle futhi ziphila impilo evamile. Ukutholwa nokwelashwa kusenesikhathi kuyindlela engcono kakhulu yokusiza ingane yakho. Yingakho odokotela beqaphile ngalokhu.

Lokhu kopha okungaphansi kwe-glottic kuzohlala isikhathi esingakanani?

Ngokuvamile, ngemva kokwelashwa, izimpawu zomntwana wakho ze-"(Subgaleal Hemorrhage)," ikakhulukazi ukuvuvukala kwekhanda , zizophela cishe ngokuphelele phakathi kwamasonto amabili kuya kwamathathu. Odokotela bazoqhubeka nokuqapha impilo yomntwana ngisho nangemva kokukhishwa esibhedlela. Bazohlola ukuthi kube khona yini ukusabela okubi ekwelashweni, ukuthi ukuvuvukala kwehle ngokuphelele, nokuthi ezinye izitho zomntwana zisebenza kahle yini.

Unakekela kanjani umntwana onalesi simo? Nawe kudingeka uzinakekele!

Ingane yakho esanda kuzalwa ene-subgaleal hemorrhage cishe izogcinwa ku-NICU noma eyunithi ekhethekile yosana olusanda kuzalwa izinsuku ezimbalwa kuze kube yilapho odokotela benquma ukuthi ingane iphilile futhi izinzile ngokwanele ukuba ithunyelwe ekhaya.

Ngisho nangemva kokuba umntwana ebuyile ekhaya, kubalulekile ukumyisa emtholampilo lapho enqunywe khona odokotela ngonyaka wokuqala. Lokhu kuhlolwa yikona okuqinisekisa ukuthi ukwelashwa kuyaphumelela yini nokuthi ngabe zikhona yini ezinye izinkinga zesikhathi eside ezingase zivele ngenxa yalesi simo.

Lokhu kubaluleke kakhulu:Uma izinto zicindezela kakhulu futhi zikucindezela ngemva nje kokuzalwa komntwana wakho, kubalulekile kuwe njengomama ukuzinakekela. Lesi akusona isikhathi esilula. Thola ukwesekwa emndenini wakho, kumyeni wakho nakubangani bakho. Uma uzizwa ucindezelekile, ukhathazekile, udangele, noma wesaba, sicela ukhulume nodokotela wakho noma nombelethisi. Ungabi namahloni okucela usizo uma uludinga.

Kufanele ngiphinde ngimbone nini udokotela?

Ngemva kokuba ingane yakho ibuyile ekhaya, bona udokotela uma ubona noma yikuphi kwalokhu okulandelayo:

• Uma ukuvuvukala ekhanda lomntwana kungapheli ngemva kokwelashwa, kuhlala kufana noma kuyanda.
• Uma isikhumba somntwana wakho siqhubeka nokuba mhlophe, noma uma amehlo akhe noma isikhumba sakhe sibonakala siphuzi (njenge-jaundice).
• Uma izinyathelo zokukhula kwengane yakho - njengokumomotheka, ukubamba intamo yayo, nokugingqika - zibonakala zilandela ezinye izingane onyakeni wazo wokuqala,

Kufanele uye nini esibhedlela (ER) ngokushesha?

Uma ingane eye yaba (noma ene-"Subgaleal Hemorrhage " inesifo sokuwa, kuyisimo esiphuthumayo sezokwelapha. Ukuwa kungaba yinoma yini kusukela ku:

• Kubonakala sengathi ingane ilahlekelwa ingqondo okwesikhashana.
• Izitho zami zomzimba zihlala zinyakaza futhi zithuthumela ngokungalawuleki.
• Ingane ivele ibonakale ikhathazekile, yesaba, noma yenza ngendlela exakile.

Ukuxhuzula kuvame ukuthatha imizuzwana engama-30 kuya kwemizuzu emibili. Kodwa-ke, uma ukuxhuzula kuthatha imizuzu engaphezu kwemihlanu, kuyingozi kakhulu. Ikakhulukazi uma ingane inenkinga yokuphefumula, shayela u-911 ngokushesha, noma uyise ingane egumbini lezimo eziphuthumayo esibhedlela esiseduze ngokushesha okukhulu.

Yini okufanele ngiyibuze udokotela wami?

Ngesikhathi esinjengalesi, ungase ube nemibuzo eminingi engqondweni yakho. Kungaba usizo ukubuza udokotela wakho le mibuzo:

• "Dokotela, isimo sengane yami sibi kangakanani?"
• "Ingabe ingane idinga ukuhlinzwa ngenxa yalokhu? Noma kukhona ezinye izindlela zokwelapha?"
• "Ngingamyisa nini umntwana esibhedlela?"
• "Ingabe ikhona indlela ekhethekile okufanele nginakekele ngayo ingane ngemva kokufika ekhaya?"

Uyini umehluko phakathi kweHematoma neHemorrhage?

Kungenzeka ukuthi uke wezwa la magama amabili. Igama elithi ``Subgaleal`` libhekisela lapho lesi simo senzeka khona. Okusho ukuthi, isikhala esiphakathi kwesikhumba nogebhezi ekhanda.

• `Ukopha` kusho ukuthi kusekhona ukopha, noma ukuthi kukhona ukopha okuqhubekayo, endaweni 'engaphansi kwekhanda'. Okusho ukuthi, ukopha okusebenzayo.
• `I-Hematoma` isho ukuthi igazi liqoqene endaweni eyodwa futhi laqhekeka . Lokhu kusho ukuthi igazi, elaliwuketshezi, selijiyile kancane futhi laba njengeqhubu.

Kulokhu "Ukuphuma Komoya Okungaphansi Kwe-Subgaleal", kuqala ukuphuma kwegazi (ukuphuma kwegazi), bese igazi lingagoba ngokuhamba kwesikhathi (i-hematoma). Kokubili lokhu kwenzeka lapho imithambo yegazi kuleyo ndawo yonakele ngenxa yokulimala noma umonakalo othile.

Okokugcina, izinto okudingeka uzikhumbule...

Ngemva kokubeletha okunzima, njengomama, kuyinto evamile ukuzizwa ukhathazekile kakhulu futhi ucindezelekile njengoba odokotela beshesha ukuthatha isinyathelo mayelana nempilo yengane yakho. Ngesikhathi esinjengalesi, kubaluleke kakhulu ukuzihlanganisa nomndeni wakho, umyeni wakho, nabangani bakho ukuze bakuthande futhi bakusekele, kunokuhlupheka wedwa. Yabelana nabo ngemizwa yakho.

Ngokwelashwa okusheshayo nokucophelelayo okuvela kodokotela, ingane yakho inethuba elingcono lokuthola umphumela omuhle. Lapho nje ingane yakho isilulama esibhedlela, uzokwazi ukuyithatha uyiyise ekhaya niyigone ngothando. Ngakho-ke hlala uqinile. Ngikufisela wena nengane yakho ukululama okusheshayo!

Ukopha Okungaphansi Kwe - Galeal, Izinsana Ezisanda Kuzalwa, Ukopha Ekhanda, Ukulethwa Kwe-Vacuum, Ukulethwa Kwe-Forceps, Izinkinga Zokuzalwa, Impilo Yezinsana Ezisanda Kuzalwa