Ukukhipha isisu ukulahlekelwa umbungu noma umbungu ngesikhathi sokukhulelwa.

Kungaba ngokuzenzakalelayo, okusho ukuthi kwenzeke ngaphandle kokucwaninga (inkinga yezempilo, ufuzo, njll.), noma ukucasulwa ngakho ngokuzithandela.

• Ukukhipha isisu okuzenzakalelayo. Siphinde sikhulume ngokuphuphunyelwa yisisu. Ngokwencazelo, ukufa noma ukuxoshwa emzimbeni kamama wombungu noma umbungu onesisindo esingaphansi kwamagremu angu-500 noma ngaphansi kwamaviki angu-22 we-amenorrhea noma ngaphandle kokuya esikhathini (= amaviki angu-20 okukhulelwa). Uma ukuphuphunyelwa kwesisu kwenzeka kamuva ekukhulelweni, kubizwa ngokuthi “ukufa kwengane esibelethweni”.

• THEukukhipha isisu, okubuye kubizwe ngokuthi “ukukhipha isisu ngokuzithandela” (noma ukukhipha isisu) kungaqalwa ngezindlela eziningana, ikakhulukazi ngokuthatha izidakamizwa “zokukhipha isisu” noma ngokulangazelela umbungu. Imithetho elawula ukufinyelela (noma ukwenqatshelwa) kokuhushula isisu iyahluka kuye ngamazwe.

• Ukuqedwa kwezokwelapha kokukhulelwa (I-IMG) ukukhipha isisu, okwenziwa ngenxa yezizathu zezokwelapha, ngokuvamile ngenxa yokungajwayelekile noma isifo sombungu esisongela ukuphila ngemva kokuzalwa noma esidala izinkinga zempilo ezingathi sína, noma lapho impilo yombungu umama isengozini.

Ukukhipha isisu okuzenzakalelayo: ukusabalala kanye nezimbangela

Ukuphuphunyelwa yizisu kuyisenzakalo esivame kakhulu. Ikakhulukazi, ixhumene ne-genetic noma i-chromosomal anomaly ku-embryo, bese ixoshwa ngumama ngokwemvelo.

Sihlukanisa:

• ukuphuphuma kwesisu kusenesikhathi, okwenzeka ku-trimester yokuqala yokukhulelwa (ngaphansi kwamaviki ayi-12 wokukhulelwa). Zithinta u-15 kuya ku-20% wokukhulelwa kodwa kwesinye isikhathi azibonakali uma zivela emasontweni okuqala ngoba kwesinye isikhathi ziyaye zixakwe nemithetho.
• ukuphuphuma kwezisu sekwephuzile, okwenzeka phakathi ne-trimester yesibili, phakathi kwamasonto angaba ngu-12 kuya kwangu-24 okukhulelwa. Zenzeka cishe ku-0,5% wokukhulelwa¹.
• ukufa kwe-fetus esibelethweni, ku-trimester yesithathu.

Ziningi izimbangela ezingaholela ekuphuphumeni kwezisu noma ukuphuphunyelwa yizisu okuphindaphindiwe.

Phakathi kwalezi zimbangela, okokuqala sithola ukungahambi kahle kofuzo noma i-chromosomal yombungu, okuhilelekile ku-30 ​​kuya ku-80% wokuphuphuma kwezisu ngaphambi kwesikhathi.².

Ezinye izimbangela ezingase zibe khona zokuhushula isisu ngokuzenzakalelayo yilezi:

• ukungavamile kwesibeletho (isb. isibeletho esihlukene, umlomo wesibeletho ovulekile, i-uterine fibroids, i-uterine synechiae, njll.), noma i-DES syndrome kwabesifazane abaye bavezwa esibelethweni ku-distilbene (owazalwa phakathi kuka-1950 no-1977).
• ukuphazamiseka kwe-hormonal, okuvimbela ukukhulelwa ukuthi kungathwalwa isikhathi eside (ukuphazamiseka kwe-thyroid, ukuphazamiseka kwe-metabolic, njll.).
• ukukhulelwa okuningi okwandisa ingozi yokuphuphuma kwezisu.
• ukwenzeka kokutheleleka ngesikhathi sokukhulelwa. Izifo eziningi ezithathelwanayo noma ezinamagciwane zingabangela ngempela ukuphuphuma kwesisu, ikakhulukazi umalaleveva, i-toxoplasmosis, i-listeriosis, i-brucellosis, isimungumungwane, i-rubella, i-mumps, njll.
• okunye ukuhlolwa kwezokwelapha, okufana ne-amniocentesis noma i-trophoblast biopsy, kungabangela ukuphuphuma kwesisu.
• ukuba khona kwe-IUD esibelethweni ngesikhathi sokukhulelwa.
• Izici ezithile zemvelo (ukusetshenziswa kwezidakamizwa, utshwala, ugwayi, imithi, njll.).
• Ukuphazamiseka kwe-Immunological (amasosha omzimba), ikakhulukazi abandakanyeka ekuphuphumeni kwezisu okuphindaphindiwe.

Ukukhishwa kwesisu okubangelwa: i-inventory

Izibalo zokuhushula izisu emhlabeni wonke

I-World Health Organization (WHO) ishicilela njalo imibiko ngokuhushulwa kwezisu emhlabeni wonke. Ngo-2008, cishe oyedwa kwabahlanu abakhulelwe ngabe iphazamiseke ngamabomu.

Sekukonke, kuhushula izisu cishe izigidi ezingama-44 ngo-2008. Izinga likhulu emazweni asathuthuka kunasemazweni athuthukile (ukukhishwa kwezisu okungama-29 kwabesifazane abayi-1000 abaneminyaka engu-15 kuya kwengama-44 uma kuqhathaniswa nama-24 ku-1000 ngamunye, ngokulandelana).

Ngokocwaningo olwanyatheliswa ngo-2012³, izinga lokuhushulwa kwezisu emhlabeni wonke lehla lisuka ku-35 laya ku-29 kwabesifazane abayinkulungwane phakathi kuka-1000 no-1995. Namuhla, kunesilinganiso sokuhushulwa kwezisu okungama-2003 kwabesifazane abayinkulungwane.

Ukukhipha isisu akugunyaziwe emhlabeni wonke. Ngokusho kwenhlangano Isikhungo samalungelo okuzala, abantu abangaphezu kuka-60% emhlabeni bahlala emazweni lapho ukukhipha isisu kuvunyelwe khona noma ngaphandle kwemingcele. Ngokuphambene nalokho, cishe amaphesenti angu-26 abantu abahlala ezifundazweni lapho lesi senzo sinqatshelwe khona (yize ngezinye izikhathi sigunyazwa uma impilo yowesifazane isengozini ngenxa yezizathu zezokwelapha)⁴.

Izibalo zokuhushula isisu okuyengelwe e-France nase-Quebec

E-France, ngo-2011, ukukhishwa ngokuzithandela kokukhulelwa kwe-222 kwenziwa. Lesi sibalo sizinzile kusukela ngo-300, ngemva kweminyaka eyishumi yokukhula phakathi kuka-2006 no-1995. Ngokwesilinganiso, izinga lokuhushula izisu liwukukhishwa kwezisu ngo-2006 kwabesifazane abayi-15.⁶.

Izinga liyaqhathaniswa eQuebec, cishe ngokukhishwa kwezisu eziyi-17 kwabesifazane abayi-1000, noma cishe abangama-27 ngonyaka.

E-Canada, amanani ahluka phakathi kokukhishwa kwezisu okungu-12 no-17 ngonyaka ngowesifazane oyedwa osebudaleni bokuzala, kuye ngesifundazwe (ukukhishwa kwezisu okungu-1 sekukonke ku-000)⁷.

Kula mazwe amabili, cishe u-30% wokukhulelwa uholela ekuhushuleni kwezisu.

ECanada njengaseFrance, ukunqanyulwa kokukhulelwa ngokuzithandela kuyinto zomthetho. Lokhu kunjalo futhi emazweni amaningi aseYurophu.

E-France, ukukhipha isisu kungenziwa kuphela ngaphambi kokuphela kwesonto le-12 lokukhulelwa (amaviki angu-14 e-amenorrhea). Kuyafana eBelgium naseSwitzerland, ikakhulukazi.

Ngokuqondene neCanada, ukuphela kwezwe lasentshonalanga lapho kungekho mithetho ekhawulela noma elawula ukuhushulwa kwezisu sekwephuzile.⁷. Ngokocwaningo olwenziwa ngo-2010, ukuhushula isisu ngemva kwamasonto angama-20 okukhulelwa kumelela ngaphansi kwe-1% yokuhushula izisu e-Quebec, noma cishe izigameko eziyikhulu ngonyaka.

Obani abathintekayo ngokuhushulwa kwezisu?

Ukukhishwa kwezisu okwenziwa kuthinta wonke amaqembu eminyaka phakathi kwabesifazane abaneminyaka yobudala yokuzala, kanye nazo zonke izizinda zomphakathi.

EFrance naseQuebec, izinga lokukhishwa kwezisu liphakeme kwabesifazane abaneminyaka engu-20 kuya kwengu-24. Izingxenye ezine kwezinhlanu zokukhishwa kwezisu okwenziwa lapho zithinta abesifazane abaphakathi kweminyaka engu-20 nengu-40 ubudala.

Ezimweni ezimbili kwezintathu, eFrance, ukukhishwa kwezisu kwenziwa kwabesifazane abasebenzisa indlela yokuvimbela inzalo.

Ukukhulelwa kwenzeka ngenxa yokwehluleka kwendlela ku-19% wamacala futhi ngenxa yokusetshenziswa okungalungile ku-46% yamacala. Kwabesifazane abasebenzisa ukuvimbela inzalo ngomlomo, ukukhohlwa iphilisi kuhileleke ezimweni ezingaphezu kuka-90%.⁸.

Emazweni asathuthuka, ngaphezu kokwehluleka kokuvimbela inzalo, kungaphezu kwakho konke ukuntuleka okuphelele kokuvimbela inzalo okuholela ekukhulelweni okungafunwa.

Izinkinga ezingenzeka zokukhipha isisu

Ngokwe-WHO, owesifazane ushona njalo ngemva kwemizuzu engu-8 emhlabeni wonke ngenxa yezinkinga zokuhushula isisu.

Ezigidini ezingu-44 zokukhishwa kwezisu unyaka ngamunye emhlabeni wonke, ingxenye ikhishwa ngaphansi kwezimo ezingaphephile, ngumuntu “ongenawo amakhono adingekayo noma endaweni engafinyeleli izindinganiso zezokwelapha ezilinganiselwe. , noma kokubili “.

Siyaphatheka kabi ngokufa okungaba ngu-47 okuxhumene ngqo nalokhu kukhishwa kwezisu, abantu besifazane abayizigidi ezingu-000 abahlushwa izinkinga ngemva kwesenzo, njengokuphuma kwegazi noma i-septicemia.

Ngakho-ke, ukukhishwa kwezisu okungaphephile kungenye yezimbangela zokufa komama ezingagwemeka kalula (kwaba necala lokushona komama abangamaphesenti ali-13 ngo-2008)⁹.

Izimbangela eziyinhloko zokufa ezihlobene nokuhushula izisu yilezi:

• ukopha
• izifo kanye ne-sepsis
• ubuthi (ngenxa yokusetshenziswa kwezitshalo noma izidakamizwa ezikhipha isisu)
• ukulimala kwesitho sangasese nangaphakathi (amathumbu anezimbobo noma isibeletho).

Izimpawu ezingabulali zihlanganisa izinkinga zokuphulukisa, ukungazali, ukungakwazi ukuzibamba komchamo noma indle (okuhlobene nokuhlukumezeka ngokomzimba phakathi nenqubo), njll.

Cishe konke ukukhishwa kwezisu okuyimfihlo noma okungaphephile (97%) kwenziwa emazweni asathuthuka. Izwekazi lase-Afrika lilodwa linengxenye yesigamu sokufa okubangelwa lokhu kukhishwa kwezisu.

Ngokusho kwe-WHO, “lokhu kufa nokukhubazeka bekungagwenywa ukube lokhu kukhishwa kwezisu okubangelwa kwakwenziwe ngaphakathi kohlaka olusemthethweni futhi ngaphansi kwezimo ezinhle zokuphepha, noma ukube izinkinga zabo bezinakekelwa ngendlela efanele enhla nomfula, ukube iziguli bezikwazi ukufinyelela ocansini. imfundo kanye nezinsiza zokuhlela umndeni ”.

EFrance nasemazweni lapho ukukhipha isisu kwenziwa ngokuphepha, ukufa okuhlobene nakho kucishe kube ukufa kwabantu abathathu ngokuhushulwa kwezisu kwesigidi, okuyingozi ephansi kakhulu. Izinkinga ezinkulu yilezi, lapho ukukhipha isisu kwenziwa ngokuhlinzwa:

• ukubhobozwa kwesibeletho (1 kuya ku-4 ‰)
• ukudabuka emlonyeni wesibeletho (ngaphansi kuka-1%)¹⁰.