Ukuba nomntwana kuyalungiswa. Ngaphambi kokuba nomntwana, kunconywa ngempela ukuvakasha kwangaphambili ukuze ubeke wonke amathuba ohlangothini lwakhe lokukhulelwa nokukhulelwa ngaphandle kwezinkinga. Gxila ekubalulekeni kanye nokuqukethwe kwalokhu kuhlolwa kwezempilo kamama okukhethekile esikhathini esizayo.

Ukuhlolwa kwezempilo ngaphambi kohlelo lokukhulelwa kukuvumela ukuthi udalule izinto ezingase zibe nomthelela ekukhuleni, ukuqala ukukhulelwa okunempilo kanye nokubona inkinga engase ibe yimbi ukukhulelwa. Ngamafuphi, kumayelana nokuhlanganisa zonke izimo zokukhulelwa nokuthi lokhu kukhulelwa kuhambe kahle ngangokunokwenzeka.

Ukuhlolwa kokukhulelwa ngaphambi kwesikhathi kutuswa i-Haute Autorité de Santé (1) kubo bonke abesifazane abahlela ukuba nomntwana. Kubalulekile uma kwenzeka kuba nenkinga enkulu yokubeletha ngesikhathi sokukhulelwa kwangaphambilini noma ingane ehlushwa yi-pathology enzima. Lokhu kubonisana kungenziwa nodokotela okhona, udokotela wezifo zabesifazane noma umbelethisi, futhi kufanele kwenzeke ngaphambi kokuqala "ukuhlolwa kwengane", ngokufanelekile phambi kukababa wesikhathi esizayo.

Lokhu kuvakasha kombono wangaphambili kuhlanganisa izingxenye ezahlukene:

• Un ukuhlolwa jikelele (ubude, isisindo, umfutho wegazi, ubudala).

Ukunakwa okukhethekile kunikezwa isisindo ngoba ukukhuluphala kunganciphisa inzalo futhi kwandise ingozi yezinkinga ngesikhathi sokukhulelwa. Ngokufanayo, ukuba mncane ngokweqile kungaba nomthelela omubi ekuvundeni. Ngisho nangaphambi kokucabangela ukukhulelwa, ukwesekwa okunomsoco kunganconywa.

• ukuhlolwa kwabesifazane

Ukuhlola ukuthi isibeletho nama-ovari kujwayelekile yini, ukushaya amabele. Uma kungekho smear engaphansi kweminyaka emi-3 ubudala, i-smear yenziwa njengengxenye yokuhlolelwa umdlavuza womlomo wesibeletho (2).

• ukutadisha umlando wokubelethisa

Uma kwenzeka kuba nenkinga ngesikhathi sokukhulelwa kwangaphambilini (umfutho wegazi ophakeme, isifo sikashukela sokukhulelwa, ukubeletha ngaphambi kwesikhathi, ukukhubazeka kokukhula esibelethweni, ukukhubazeka kombungu, ukufa esibelethweni, njll.), izinyathelo ezingenzeka zingasetshenziswa ukuze kugwenywe ukuphindaphinda ngesikhathi sokukhulelwa okuzayo.

• isibuyekezo ngomlando wezokwelapha

Uma kwenzeka ukugula noma umlando wokugula (isifo senhliziyo, isifo sokuwa, isifo sikashukela, umfutho wegazi ophakeme, ukudangala, umdlavuza ekuxolelweni, njll.), Kubalulekile ukubheka imiphumela yesifo ekuzaleni nasekukhulelweni kepha nakulabo sokukhulelwa ngesifo, kanye nokwelashwa futhi uzivumelanise njengoba kudingeka.

• isifundo somlando womndeni

Ukuze ufune isifo sofuzo (cystic fibrosis, myopathies, hemophilia…). Kwezinye izimo, kuzotuswa ukubonisana ngofuzo ukuze kuhlolwe ubungozi bomntwana ongakazalwa, amathuba okuxilongwa kanye nokwelashwa.

• ukuhlolwa kwegazi

Ukusungula iqembu legazi kanye ne-rhesus.

• isibuyekezo se ukugoma

Ngerekhodi lokugoma noma irekhodi lezempilo. Ukuhlolwa kwegazi kuthathwa ukuze kuhlolwe ukugonywa kwezifo ezihlukahlukene ezithathelwanayo: i-rubella, i-hepatitis B no-C, i-toxoplasmosis, i-syphilis, i-HIV, inkukhu. Uma kwenzeka kungagonywa i-rubella, kunconywa ukuthi ugonywe ngaphambi kokukhulelwa okuhleliwe (3). Kubantu abangaphezu kweminyaka engama-25 ubudala abangakayitholi i-booster yokugomela i-pertussis, ukubamba kungenziwa kuze kufike eminyakeni engama-39; kunconywa kakhulu emibhangqwaneni enohlelo lwabazali ngaphambi kokuqala kokukhulelwa (4).

• un ukuhlolwa kwamazinyo uyelulekwa ngaphambi kokukhulelwa.

Phakathi nalokhu kuvakasha kwangaphambi kokukhulelwa, udokotela uzophinde agxile ekuhloleni indlela yokuphila yabashadikazi ukuze abone izinto ezingaba yingozi yokuzala nokukhulelwa, futhi akhiphe izeluleko ukuze azikhawulele. . Ngokuphawulekayo :

• vimbela ukusetshenziswa kotshwala kusukela ngesikhathi sokukhulelwa
• yeka ukusebenzisa ugwayi noma izidakamizwa
• gwema ukuzelapha
• nciphisa ukuchayeka kumakhemikhali athile

Uma kwenzeka ukungagomi ngokumelene ne-toxoplasmosis, owesifazane kuzodingeka athathe izinyathelo zokuzivikela kusukela ngesikhathi sokukhulelwa: ukupheka ngokucophelela inyama yakhe, ugweme ukudla imikhiqizo esekelwe amaqanda eluhlaza, imikhiqizo yobisi eluhlaza (ikakhulukazi ushizi), eluhlaza, inyama ebandayo enosawoti noma ebhenyiwe, geza izithelo nemifino okuhloswe ukuthi idliwe iluhlaza, geza izandla zakho kahle ngemva kokusebenza engadini, phathisa umngane wakho izinguquko zikadoti wekati.

Lokhu kuvakashelwa ngaphambi komqondo ekugcineni kuyithuba lokuthi udokotela anikeze ukwesekwa kwe-folate (noma i-folic acid noma i-vithamini B9) ngoba ukushiyeka kuhlotshaniswa nombungu ngengozi eyengeziwe yokuvalwa kokungajwayelekile kwe-neural tube (AFTN). Ukuze uvimbele lezi zinkinga ezimbi kakhulu, ukwengezwa kunconywa ezingeni le-0,4 mg / ngosuku. Lokhu kudla kufanele kuqalwe ngokushesha lapho owesifazane esefisa ukukhulelwa futhi kuqhubeke kuze kube amasonto ayi-12 ekhulelwe. Kwabesifazane abanomlando wemibungu noma izinsana ezisanda kuzalwa ezine-AFTN noma labo abaphathwa ngemithi ethile ye-antiepileptic (engadala ukushoda kwe-folate), kunconywa ukwengezwa kwe-5 mg / ngosuku (4).