Ukukhulelwa okuqandisiwe

Ukukhulelwa okuqandisiwe kungenye yezinkinga ezinkulu kwezokubelethisa kanye ne-gynecology. Ngeshwa, noma yimuphi owesifazane angabhekana ne-pathology enjalo. Okufanele ukwenze kuleli cala futhi lapho ungakwazi ukuhlela ukukhulelwa futhi, sibhekana udokotela wezifo zabesifazane uMarina Eremina.

Kuyini ukukhulelwa eqandisiwe

Kunamagama amaningana achaza isimo esifanayo: ukuphuphuma kwesisu, ukukhulelwa okungakhuli nokuphuphuma kwesisu. Bonke basho into eyodwa - umntwana osesiswini wavele wayeka ukukhula (1). Uma lokhu kwenzeka kuze kube amasonto angu-9, bakhuluma ngokufa kombungu, kuze kube amasonto angu-22 - umbungu. Kulesi simo, ukukhulelwa kwesisu akukwenzeka, i-fetus ihlala emgodini wesibeletho.

Odokotela abaningi bayavuma ukuthi amaphesenti angu-10-20 abo bonke abakhulelwe ashona emasontweni okuqala. Ngesikhathi esifanayo, abesifazane abaye bathola ukukhulelwa okungathuthukiyo bavame ukuthwala ingane ngaphandle kwezinkinga esikhathini esizayo. Nokho, kunezimo lapho ukukhulelwa okubili noma ngaphezulu kulandelana kuba yiqhwa. Khona-ke odokotela bakhuluma ngokuphuphuma kwesisu okuvamile, futhi ukuxilongwa okunjalo kakade kudinga ukubhekwa nokwelashwa.

Izimpawu zokukhulelwa okuqandisiwe

Owesifazane akakwazi ukuzibona ukuthi ukukhulelwa kwakhe kumile noma cha. Ukukhipha igazi eliningi, njengalapho kuphuphuma isisu, akukho, abukho ubuhlungu. Ngokuvamile isiguli sizizwa sinamandla, futhi kuba buhlungu nakakhulu kuye ukuzwa ukuthi udokotela uxilongwa yini.

Kwesinye isikhathi usengasola inkinga. Izimpawu ezilandelayo kufanele ziqaphe:

• ukuqedwa kwesicanucanu;
• ukuqedwa kokuvuvukala kwebele;
• ukuthuthukiswa kwesimo esijwayelekile; ngezinye izikhathi ukubonakala kwe-daub enegazi.

- Ngeshwa, azikho izimpawu ezijwayelekile zokukhulelwa okungabanjwanga, futhi i-ultrasound kuphela engenza ukuxilongwa okunembile. Lezi zimpawu zincike kakhulu. udokotela wezifo zabesifazane uMarina Eremina.

Ngalezi zimpawu, odokotela bayeluleka ukwenza i-ultrasound, kuphela ngesikhathi se-ultrasound onganquma ukuthi umbungu ufriziwe noma cha. Ngezinye izikhathi imishini ephelelwe yisikhathi noma uchwepheshe ongakwazi kahle kakhulu angenza iphutha, ngakho odokotela bayeluleka ukuthi bahlole i-ultrasound ezindaweni ezimbili kangcono ngokuhluka kwezinsuku ezingu-3-5-7), noma ngokushesha ukhethe umtholampilo onobuchwepheshe besimanje futhi abaqeqeshwe kakhulu. odokotela.

Uchwepheshe we-ultrasound uxilonga ukukhulelwa okugejiwe ngezimpawu ezilandelayo:

• ukuntuleka kokukhula kweqanda le-fetus phakathi kwamasonto angu-1-2;
• ukungabi khona kwe-embryo enosayizi weqanda lengane okungenani 25 mm;
• uma usayizi we-coccyx-parietal wombungu ungama-7 mm noma ngaphezulu, futhi akukho ukushaya kwenhliziyo.

Ngezinye izikhathi udinga ukuthatha ukuhlolwa kwegazi okuningana kwe-hCG ukuze uhlole ukuthi izinga lale hormone liyashintsha yini. Ngokukhulelwa okuvamile, kufanele kwande.

Ukukhulelwa kwasekuqaleni okuqandisiwe

Ingozi yokukhulelwa kweqile iphezulu ikakhulukazi ku-trimester yokuqala.

"Ngokuvamile, ukukhulelwa okuphuthelwe kwenzeka ekuqaleni kwezigaba, emasontweni angu-6-8, ezimweni ezingavamile ngemva kwamasonto angu-12 okukhulelwa," kusho i-obstetrician-gynecologist.

Ingqopha-mlando elandelayo eyingozi ngemva kwe-trimester yokuqala ngamaviki angu-16-18 okukhulelwa. Kuyaqabukela, ukukhula kombungu kuyema ngokuhamba kwesikhathi.

Izimbangela zokukhulelwa okuqandisiwe

Owesifazane ozwa isifo esinjalo angase acabange ukuthi kukhona okungahambi kahle kuye. Kodwa-ke, odokotela baqinisekisa ukuthi amaphesenti angama-80-90 okukhulelwa okuphuthelwe kungenxa yombungu uqobo, noma kunalokho, ngenxa yokungajwayelekile kofuzo. Njengoba kwenzeka, umbungu kwavela ukuthi awukwazi ukuphila. Uma i-pathology inzima, ngokushesha ukukhulelwa kuzofa. Njengomthetho, i-embryo engavamile iyafa kuze kube amasonto angu-6-7.

Ezinye izimbangela zokuphuphuma kwesisu zithinta amaphesenti angama-20 kuphela amacala (2). Lezi zizathu sezivele zixhumene nomama, hhayi nengane.

Kungaba yini imbangela yokuphuphunyelwa kwesisu.

1. Ukwephulwa kwesistimu ye-coagulation yegazi, i-thromboses ehlukahlukene, kanye ne-antiphospholipid syndrome, lapho igazi lihlangana khona kakhulu. Ngenxa yalokhu, i-placenta ingase ingakwazi ukubhekana nemisebenzi yayo yokondla ingane, futhi esikhathini esizayo ingane ingafa.

2. Ukwehluleka kwamaHormonal. Noma yiluphi uhlobo lokungalingani, kungakhathaliseki ukuthi ukuntuleka kwe-progesterone noma ukweqisa kwamahomoni wesilisa, kungaba nomthelela omubi ekukhuleni kombungu.

3. Izifo ezithathelwanayo, ikakhulukazi izifo ezithathelwana ngocansi, i-cytomegalovirus, i-rubella, umkhuhlane nabanye. Kuyingozi kakhulu ukubabamba ku-trimester yokuqala, lapho zonke izitho nezinhlelo zomntwana ongakazalwa zibekwe.

4. Ukudluliselwa kwe-chromosomal okulinganiselayo kubazali. Kuzwakala kuyinkimbinkimbi, kodwa ingqikithi yilokhu - amangqamuzana egciwane labazali aqukethe isethi ye-pathological ye-chromosomes.

Indima ebalulekile idlalwa indlela yokuphila yowesifazane, kanye neminyaka yakhe. Ingozi yokukhulelwa okungakhuli iyanda eminyakeni yokuzala sekwephuzile. Uma eminyakeni engu-20-30 ubudala i-10% ngokwesilinganiso, khona-ke eminyakeni engu-35 ubudala isivele i-20%, eminyakeni engu-40 ubudala ingu-40%, futhi ngaphezu kwe-40 ifinyelela ku-80%.

Ezinye izimbangela ezingase zibe khona zokukhulelwa okugejiwe:

• ukuhlukunyezwa kwekhofi (4-5 izinkomishi ngosuku);
• ukubhema;
• ukuthatha imithi ethile;
• ukuntuleka kwe-folic acid;
• ukucindezeleka okuhlelekile;
• utshwala

Ziningi izinto ezithathwa ngephutha njengezimbangela zokungakhulelwa. Kodwa akunjalo! Akunakuba imbangela:

• ukuhamba ngendiza;
• ukusetshenziswa kwezindlela zokuvimbela inzalo ngaphambi kokukhulelwa (i-hormonal contraceptives, i-spirals);
• umsebenzi womzimba (inqobo nje uma owesifazane engena ezemidlalo ngendlela efanayo ngaphambi kokukhulelwa);
• ubulili;
• ukukhishwa kwezisu.

Okufanele ukwenze ngokukhulelwa okuqandisiwe

Uma uneminyaka engaphansi kwengama-35 ubudala futhi lokhu kuwukuphuphuma kwesisu kwakho kokuqala, odokotela bayeluleka ukuthi ungacasuki noma wethuke. Ngokuvamile lokhu kuba yingozi, futhi umzamo wakho olandelayo wokuba umama uzophela ekuzalweni komntwana ophile kahle. Manje into yokuqala okufanele uyenze ukukhipha iqanda le-fetus ngokuhlinzwa noma ngokwemithi.

Ngalesi sikhathi, owesifazane udinga ukusekelwa abathandekayo. Ngakho-ke ungagcini imizwa yakho kuwe, khuluma ngemizwa nomyeni wakho, umama, intombi.

Ukuze ube nokuthula kwengqondo, ngeke kube yinto engafanele ukuhlolelwa izifo ezivamile - kokubili lezo ezithathelwana ngocansi, umkhuhlane nezinye izifo. Uma kungatholakali lutho, ungaphinde ukhulelwe.

Enye into uma lokhu kungukukhulelwa kwesibili noma ngaphezulu okungabanjwanga, khona-ke udinga ukuthola izimbangela zenkinga futhi uziqede.

Ukukhulelwa ngemva kokukhulelwa okuyiqhwa

Ukukhulelwa okuqandisiwe 一 kuhlale kuyimbangela yosizi. Kodwa, ngemva kwesikhathi esithile, owesifazane uyalulama futhi uqala ukuhlela umzamo omusha wokuzala umntwana. Ungakhulelwa futhi ngemva kwezinyanga ezi-4-6 (3). Phakathi nalesi sikhathi, kuyadingeka ukubuyisela hhayi kuphela ngokomzimba, kodwa nangokwengqondo. Phela, owesifazane wazizwa ekhulelwe, futhi isizinda sakhe se-hormonal sashintsha. 

Kunconywe:

• ukuyeka ukubhema notshwala;
• ungasebenzisi kabi imikhiqizo equkethe i-caffeine;
• ungadli ukudla okunamafutha nokudla okubabayo;
• yenza ezemidlalo;
• hamba kaningi.

Kuphinde kuthathe isikhathi ukuthi i-endometrium ilungele ukwamukela iqanda le-fetus elisha. 

Ngaphambi kokuhlela ukukhulelwa okusha, kuyadingeka ukuhlolwa okuningi:

1. Hlola ubukhona bokuchayeka ezintweni eziyingozi: imithi, indawo ezungezile, izifo, njll.
2. Ukufunda ngofuzo lwezihlobo. Kungakhathaliseki ukuthi kwakunezimo zokulahlekelwa ukukhulelwa, i-thrombosis, ukuhlaselwa yinhliziyo noma ukushaywa unhlangothi esemncane.
3. Zihlolele izifo ezithathelwana ngocansi, amahomoni kanye nokujiya kwegazi.
4. Xhumana nesazi sofuzo.
5. Yenza i-ultrasound yezitho ze-pelvic.
6. Hlola ukuhambisana kozakwethu.

Ngokuvamile, ukwelashwa akudingekile, njengoba ukuphuphuma kwesisu ngokuvamile kuwumphumela wephutha lofuzo. Kodwa-ke, uma lokhu kungenzeki okokuqala, ukubonisana nodokotela kanye nokuqokwa kokwelashwa okukhethekile kuyadingeka. 

Ukukhulelwa ngaphambi kwezinyanga ze-4 ngemuva kokukhulelwa okungabanjwanga kudikibala kakhulu, naphezu kweqiniso lokuthi kungenzeka. Umzimba kufanele ululame ngokugcwele ukuze kukhishwe icala eliphindaphindiwe lokuphuphunyelwa yisisu. Ngakho-ke, izindlela ezithembekile zokuvimbela inzalo kufanele zisetshenziswe. Uma ukukhulelwa kwenzeka, kufanele nakanjani uvakashele udokotela futhi ulandele zonke izincomo zakhe. 

Izivivinyo ezidingekayo

Uma ulahlekelwe izingane ezimbili noma ngaphezulu, udinga ukuhlola ngokucophelela. Ngokuvamile, odokotela batusa uhlu olulandelayo lokuhlolwa nezinqubo:

• i-karyotyping yabazali iwukuhlaziya okuyinhloko okuzobonisa ukuthi abashadile ngokwabo banezinkinga zofuzo; - Ukuhlaziywa kohlelo lwe-coagulation yegazi: i-coagulogram (i-APTT, i-PTT, i-fibrinogen, isikhathi se-prothrombin, i-antithrombin lll), i-D-dimer, i-platelet aggregation noma i-thrombodynamics, i-homocysteine, ukutholwa kokuguqulwa kwezakhi zofuzo zesistimu ye-coagulation;
• I-HLA-typing - ukuhlolwa kwegazi kokuvumelana kwe-histocompatibility, okuthathwa yibo bobabili abazali; - I-TORCH-complex, ethola amasosha omzimba ku-herpes, i-cytomegalovirus, i-rubella ne-toxoplasma;
• ukuhlolwa kwezifo ezithathelwana ngocansi; - ukuhlolwa kwegazi kwama-hormone: i-androstenediol, i-SHBG (i-hormone yocansi ebopha i-globulin), i-DHEA sulfate, i-prolactin, i-testosterone ephelele namahhala, i-FSH (i-follicle-stimulating hormone), i-estradiol, nama-hormone egilo: i-TSH (i-thyroid evuselela i-hormone), i-T4 (i-thyroxine ), T3 (triiodothyronine), thyroglobulin.

Uma ukuhlaziywa kubonisa inkinga nge-coagulation, kungase kudingeke uthintane ne-hemostasiologist, uma ngezakhi zofuzo - i-geneticist, uma i-hormone - i-gynecologist kanye ne-endocrinologist.

Mhlawumbe umlingani kuzodingeka avakashele i-andrologist futhi aphumelele uchungechunge lwezivivinyo.

- Ngokudabukisayo, imbangela yokukhulelwa okungajwayelekile kuvame ukuba yisici sowesilisa. Lokhu akubangelwa nje kuphela imikhuba emibi, njengotshwala nokubhema, kodwa futhi nokungondleki, isibonelo, ukusetshenziswa kwemikhiqizo esezingeni eliphansi, indlela yokuphila engenzi lutho, nezinye izizathu eziningi, kucacisa. udokotela wezifo zabesifazane uMarina Eremina.

Owesilisa cishe uzolulekwa ukuthi enze i-spermogram enwetshiwe futhi, uma i-teratozoospermia ikhona ekuhlaziyeni, bese ihlolwa okwengeziwe ngokuhlukana kwe-DNA ku-spermatozoa noma ukuhlolwa kwe-electron microscopic ye-spermatozoa - EMIS.

Cishe zonke lezi zinqubo ziyakhokhwa. Ukuze ungahambi ephukile, unikeze konke, ulalele izincomo zikadokotela. Ngokusekelwe emlandweni wakho wezokwelapha, uchwepheshe uzonquma ukuthi yikuphi ukuhlolwa okubalulekile.

Ngeshwa, kusenezimo lapho odokotela bengakwazi ukuthola imbangela yenkinga.

Iyini inqubo yokuhlanza?

Uma ukukhulelwa kuyeka ukukhula futhi kungabikho ukukhulelwa kwesisu, udokotela kufanele athumele isiguli ukuze sihlanzwe. Ukuba khona kwe-fetus isikhathi esingaphezu kwamaviki angu-3-4 esibelethweni kuyingozi kakhulu, kungabangela ukopha okukhulu, ukuvuvukala nezinye izinkinga. Odokotela bayavuma ukuthi akufanele ulinde ukukhipha isisu okuzenzakalelayo, kungcono ukwenza i-curettage ngokushesha ngangokunokwenzeka.

Lokhu kungaba i-vacuum aspiration noma ukukhipha isisu ngemithi ezovumela ukuthi umbungu ukhishwe ngaphandle kokuhlinzwa.

"Ukukhethwa kwendlela kumuntu ngamunye, kuye ngokuthi isikhathi lapho ukukhulelwa kuyeka ukukhula, ukuba khona kwe-contraindication kwenye noma enye indlela, ukuba khona kokukhulelwa nokubeletha emlandweni, futhi, yiqiniso, isifiso sowesifazane ngokwakhe. kuyabhekwa,” kuchaza udokotela wezifo zabesifazane uMarina Eremina.

Ngakho-ke, ukukhipha isisu kwezokwelapha, ngokwesibonelo, akufaneleki kwabesifazane abanesifo se-adrenal, ukwehluleka okukhulu noma okungapheli kwe-renal, i-uterine fibroids, i-anemia, izifo ezivuthayo zesistimu yokuzala yabesifazane.

Indlela yokuhlinzwa etuswayo yokukhipha ukukhulelwa okuzenzela kuze kube amasonto angu-12 Ezweni Lethu i-vacuum aspiration, lapho iqanda lombungu likhishwa kusetshenziswa ukumuncwa kanye ne-catheter. Inqubo ithatha imizuzu engu-2-5 futhi yenziwa ngaphansi kwe-anesthesia yendawo noma egcwele.

I-Curettage iyindlela ekhethwa kancane futhi kufanele isetshenziswe kuphela ezimweni ezikhethekile, isibonelo, uma kunezicubu ezisele emgodini wesibeletho ngemva kokufisa kwe-vacuum.

Ngemuva kokuhlanza, okuqukethwe kwesibeletho kuthunyelwa ukuhlolwa kwe-histological. Lokhu kuhlaziywa kuzokuvumela ukuthi uqonde izimbangela zokukhulelwa okungabanjwanga futhi ugweme ukuphindaphinda kwesimo esikhathini esizayo.

Ngaphezu kwalokho, owesifazane unconywa ukuba athole inkambo yokululama. Kuhlanganisa ukwelashwa okulwa nokuvuvukala, ukuthatha amaphilisi ezinhlungu, amavithamini, ukukhishwa komsebenzi womzimba nokuphumula okuhle.

Uma uqala ukuzwa ukuxilongwa "kokukhulelwa okulahlekile" kudokotela, kungenzeka ukuthi umzamo olandelayo wokuba nomntwana uzophumelela. Ezikhathini eziningi kwakuyingozi eyenzeka kanye, iphutha lofuzo. Kodwa ngisho nabesifazane, osekungowesibili noma wesithathu ukukhulelwa okungabanjwanga, banawo wonke amathuba okuba ngumama.

Into eyinhloko ukuthola imbangela yenkinga, bese-ke - ukuhlolwa, ukwelashwa, ukuphumula nokuvuselelwa. Uma le ndlela isidlulisiwe, kufanele wenze i-ultrasound yezitho ze-pelvic futhi uqiniseke ukuthi i-endometrium ikhula ngokuhambisana nomjikelezo, awekho ama-polyps, ama-fibroids noma ukuvuvukala emgodini wesibeletho, vakashela udokotela futhi uphathe izifo ezikhona ezingapheli. . Ngokuhambisanayo, udinga ukuphila ngendlela enempilo, uthathe i-folic acid futhi udle ukudla okulinganiselayo, konke lokhu kuzokwandisa amathuba akho okukhulelwa esikhathini esizayo nokubeletha ingane enempilo.

Izici zokuya esikhathini phakathi nalesi sikhathi

Ngemva kokuphela kokukhulelwa, ukuya esikhathini kuzobuyela kowesifazane. Imvamisa, kuvela amasonto angama-2-6 ngemuva kwenqubo. Kulula ukubala isikhathi sokufika sezinsuku ezibucayi. Usuku lokukhipha isisu luthathwa njengosuku lokuqala, futhi igama libalwa kulo. Isibonelo, uma owesifazane ene-vacuum aspiration ngoNovemba 1, futhi umjikelezo wakhe uyizinsuku ezingu-28, isikhathi sakhe kufanele sifike ngoNovemba 29. Ukubambezeleka kungabangelwa ukuhluleka kwe-hormonal. Ukuya esikhathini ngemva kwenqubo ye-vacuum kuyoba mpofu kunokuvamile, ngoba ulwelwesi lwamafinyila ngeke lube nesikhathi sokululama ngokuphelele.

Uma owesifazane ethi "curettage", khona-ke isibeletho singase sihlukumezeke kakhulu, ngakho ukuya esikhathini kungase kungabi khona izinyanga ezimbili noma ngaphezulu.

Ngalesi sikhathi, owesifazane udinga ukuqaphela ngokukhethekile futhi azivikele, ngoba umzimba awukakulungeli ukukhulelwa kwesibili.

Uma ubona ukuthi isikhathi sakho emva kokuhlanza side kunalokho okulindelekile futhi sibukeka njengokuphuma kwegazi, qiniseka ukuthi uthintana nodokotela, lokhu kungase kube uphawu lokuvuvukala.

Imibuzo nezimpendulo ezidumile

Imithombo ye

1. Stepanyan LV, Sinchikhin SP, Mamiev OB Ukukhulelwa okungathuthukiyo: i-etiology, pathogenesis // 2011
2. I-Manukhin IB, i-Kraposhina TP, i-Manukhina EI, i-Kerimova SP, i-Ispas AA Ukukhulelwa okungathuthukiyo: i-etiopathogenesis, ukuxilongwa, ukwelashwa // 2018
3. I-Agarkova IA Ukukhulelwa okungathuthukiyo: ukuhlolwa kwezinto eziyingozi kanye ne-prognosis // 2010