Te Manaaki Kaiwhakawhanau i ngā Take o te Oligohydramnios
Pendahuluan
Ko te oligohydramnios he mate hauora e puta ana ina iti iho te nui o te wai amniotic i te wā e hapu ana. He mea nui te wai amniotic hei tiaki me te tautoko i te tamaiti i roto i te pēpi. te whanaketanga o te kukune I te wā e hapu ana, ka whai wāhi tēnei wai ki te tiaki i te tamaiti i te whara tinana, me te āwhina i te whanaketanga o ngā pukahukahu me te pūnaha nakunaku o te tamaiti. Tata ki te 4% o ngā haputanga katoa ka pāngia e te oligohydramnios, ā, he maha ngā wā he tohu o ngā raruraru kei roto i te whaea me te tamaiti.
Te Whakamāramatanga me ngā Take o te Oligohydramnios
Ko te oligohydramnios he iti iho i te rahinga noa o te wai amniotic, he iti iho i te 500 ml i te wā e hapu ana, he iti iho rānei te taupū wai amniotic (AFI) (iti iho i te 5 cm). He rerekē ngā take o te oligohydramnios, tae atu ki:
1. Ngā rerekētanga ira me ngā ira tuku iho o te kukune: Hei tauira, ko te mate Potter e tohuhia ana e te agenesis whatukuhu bilateral.
2. Ngā āhuatanga rerekē o te whenua whānau: Ka pāngia te rere o te toto me ngā matūkai ki te pēpi e ngā raruraru pēnei i te koretake o te whenua whānau.
3. Ngā raruraru o te hapūtanga: Ka taea e te preeclampsia, te mate huka hapūtanga, me te toto toto tiketike te whakaiti i te hanga wai amniotic.
4. Te pakaru wawe o ngā kiriuhi (PROM): Ka taea e te turuturu i roto i ngā kiriuhi amniotic i mua i te wā whānau te puta ai ngā oligohydramnios.
5. Te whakamahinga o ētahi rongoā: Ka taea e te whakamahinga o ngā rongoā anti-inflammatory kore-steroidal (NSAID) me ngā aukati ACE te whakaiti i te hanga wai amniotic.
Te tātaritanga o te Oligohydramnios
Ko te tautuhi i te oligohydramnios ka mahia mā te: whakamātautau ultrasound (USG) e ine ana i te nui o te wai o te pēpi. Ko ngā tikanga e whakamahia whānuitia ana ko te ine i te taupū wai o te pēpi (AFI) me te pute poutū nui rawa (GSP). I runga i ngā hua tātaritanga, ka whakatauhia ngā mahi tiaki anō.
Ngā raruraru me ngā mōrearea
Ka taea e te oligohydramnios te arahi ki ngā raruraru nui mō te whaea me te tamaiti kei roto i te pēpi, tae atu ki:
– Te aukati i te tipu o roto i te kōpū: Tērā pea kāore e nui te hāora me ngā matūkai e whiwhi ana te pēpi.
– Ngā raruraru whānau: Ka piki ake te mōrearea o te ahotea o te kukune i roto i te kōpū, te ngoikore o te ngakau o te kukune, te whānautanga rānei i mua i te wā.
– Ngā raruraru i muri i te whānautanga: Ngā mate manawa me ngā āhuatanga rerekē o te whanaketanga o ngā okana.
I runga i ēnei mōrearea, he mea nui kia whakaratohia e ngā kaimahi hauora, inā koa ko ngā kaiwhakawhanau, te tiaki whānau e tika ana kia ora ai te whaea me te tamaiti i roto i te pēpi.
Te Manaaki Kaiwhakawhanau i ngā Take o te Oligohydramnios
Ko te tiaki i te whānau tamariki he maha ngā mahi hei whakarite i te hauora o te whaea me te tamaiti kei roto i te pēpi. Ko ēnei mahi ka taea te mahi:
1. Te Tāutu me te Aroturuki
– Te Anamnesis Taipitopito: Te kohikohi i ngā mōhiohio e pā ana ki te hītori hauora o te whaea, te hītori hapūtanga o mua, me ngā tohu i pā ki te whaea.
– Whakamātautau Tinana: Te ine i te teitei o te fundus uterine, te aromatawai i te nekehanga o te kukune, me te tirotiro i te toto toto o te whaea.
– Te aroturuki i te ultrasound: Ngā inenga AFI auau hei aromatawai tonu i te nui o te wai amniotic. Mena kei te iti tonu te AFI, aromatawaihia mēnā he rerekētanga hanganga o te kōpū me te rere o te toto o te whenua.
2. Te Wawaotanga Hauora
– Te Whakaora Wai o te Whaea: Te hoatutanga o ngā wai ā-uaua, ā-waha rānei hei whakanui ake i te nui o te wai amniotic.
– Whakawhānaungatanga amniotic: He tikanga e whakaurua tika ai he wai ki roto i te pēke amniotic mā roto i tētahi catheter hei whakanui ake i te nui o te wai amniotic i te wā e whānau ana.
– Whakaora Rongoā: Te whakamutu i te whakamahi i ētahi rongoā ka puta ai te oligohydramnios, ka whai whakaaro ki ētahi atu rongoā haumaru ake.
3. Mātauranga me te Tohutohu
– Mātauranga mō ngā Whaea: Te whakarato mōhiotanga mō te hiranga o te kite wawe i ngā tohu o te oligohydramnios me te tūhura i ngā tohu pēnei i te ngoikore o te nekehanga o te kukune.
– Te tohutohu hinengaro: Āwhina i ngā whaea ki te whakahaere i te ahotea me te manukanuka ka puta mai i te tātaritanga o te oligohydramnios.
4. Te Tirotiro i te Whānautanga
– Te Whakaoho i te Whānautanga: Whakaarohia te whakaoho mēnā kua tata te wā e hapu ana, ā, he tohu kei te kitea he oligohydramnios kino.
– Te pokanga whakawhānau: Mēnā he tohu o te ahotea o te kōpū, he wā rānei e tino kino ana te āhua o te kōpū, ā, kāore e taea te whānau noa.
5. Te Tiaki i muri i te Whānautanga
– Te Aroturukitanga Pēpi: Te tirotiro matatau i ngā pēpi i whānau mai i ngā whaea he oligohydramnios hei whakarite kia kore he raruraru i muri i te whānautanga pērā i ngā mate manawa, ngā āhuatanga whanaketanga rānei.
– Te Aroturukitanga o te Whaea: Me aroturuki tonu i te tūponotanga o ngā raruraru muri i te whānautanga o te whaea, pērā i te mate urutā, te toto rānei.
Akoranga take
Kei roto i te rangahau take e whai ake nei he tirohanga whānui atu mō te whakahaere i ngā oligohydramnios:
Kehi: Whaea A, G2P1, 32 wiki te haputanga
I haere mai a Whaea A, he wahine e 32 wiki te roa o tōna hapūtanga, ki te pokapū hauora hapori me te amuamu mō te ngoikore o te nekehanga o te kukune i ngā rā kua taha ake nei. Whai muri i te hītori me te whakamātautau tinana taketake, i whakahaerehia he whakamātautau ultrasound, ā, i kitea he AFI o te 4 cm, e tohu ana i te oligohydramnios.
Ko ngā mahi whakahaere i mahia ko:
1. Te Whakaora Wai ā-Waha me te Ā-Rūnanga: I whāngaihia a Whaea A ki te Ringer's lactate, ā, i tohutohungia kia whakanuia te inu wai ā-waha.
2. Te aro turuki tata mā te whakamahi i te ultrasound: Ka whakahokia ngā whakamātautau AFI i ia wiki, ā, ka whakahaerehia te aro turuki i te nekehanga o te kukune e te whaea i te kāinga me ngā tuhipoka o ia rā.
3. Tukunga ki te Hōhipera: I te whakaaro ki te roa o te wā hapūtanga me te kaha o te oligohydramnios, i tukuna a Whaea A ki te hōhipera mō ētahi atu aromatawai me te whakamahere whānautanga.
Ngā Hua: I te 37 wiki o te hapūtanga, i whakatauhia kia whānau te pēpi mā te whakamahi i te amnioinfusion. I whānau te pēpi, e 2500 karamu te taumaha, kāore he raruraru nui i muri i te whānautanga. I whiwhi a Whaea A me tana pēpi i ētahi atu tiaki i te hōhipera, ā, i kīia kia hoki mai anō mō tētahi haerenga whai muri i roto i te wiki kotahi.
Whakamutunga
Me mātua tiaki whānuitia te whaea me te tamaiti e te oligohydramnios, ina koa ko ngā kaiwhakawhanau, kia ora ai te whaea me te tamaiti i roto i te pēpi. Mā ngā mahi tiaki a te kaiwhakawhanau, tae atu ki te aroturuki tata, te wawaotanga hauora, te mātauranga, me te whakarite whānau, ka āwhina i te whakaiti i te tūponotanga o ngā raruraru me te whakatairanga i te putanga pai o te hāputanga. Nō reira, he mea nui te kitenga wawe me te maimoatanga tika hei whakahaere i ngā oligohydramnios.
