Ukuphathwa Kwezibeletho Ezimweni Zokuqhekeka Kwesibeletho
I-Pendahuluan
Ukuqhekeka kwesibeletho kuyisimo esiphuthumayo sokubeletha esibonakala ngokuqhekeka odongeni lwesibeletho, kungaba ukuqhekeka okuyingxenye (ukuqhekeka okungaphelele) noma ngokuphelele, ukuxhumana nomgodi we-peritoneal (ukuqhekeka okuphelele). Lokhu kungaholela ekuphumeni kwegazi okukhulu, ukushaqeka kwe-hypovolemic, futhi kufake impilo yomama nomntwana engozini ngokushesha. Ngakho-ke, ukuphathwa kokuqhekeka kwesibeletho kokubeletha kudinga ukutholwa kusenesikhathi, ukuvuselelwa okusheshayo, ukubambisana kweqembu, kanye nokudluliselwa noma ukuhlinzwa ngokushesha, kuye ngezikhungo ezitholakalayo.
Incazelo kanye nokuhlukaniswa
Ngokwezokwelapha, ukuqhekeka kwesibeletho kuhlukaniswe kanje:
1. Ukuqhuma okuphelele kwesibeletho: zonke izingqimba zodonga lwesibeletho ziyadabuka, ukuze umbungu noma izingxenye zombungu zikwazi ukuphuma ziye emgodini wesisu.
2. Ukuqhekeka kwesibeletho okungaphelele (ukuqhekeka): ukudabuka akungeni kuzo zonke izingqimba; i-peritoneum ihlala ingashintshi. Lesi simo sivame ukwenzeka ezibazini zokuhlinzwa (isb., ezivela ekuhlinzweni) futhi ngezinye izikhathi kunzima kakhulu ukukubona.
Ezinye izinhlobo zingase zisekelwe endaweni (ingxenye engezansi, i-corpus, umlomo wesibeletho) noma imbangela (eyesabekayo, ezenzakalelayo, ebangelwa yi-iatrogenic).
I-Etiology kanye Nezici Zengozi
Ukuqhekeka kwesibeletho kuvame ukwenzeka ngesikhathi sokubeletha, kodwa kungabuye kwenzeke kamuva ekukhulelweni. Izici ezinkulu eziyingozi zifaka:
– Umlando wokuhlinzwa kwesibeletho (ukuhlinzwa kokuhlinzwa kwangaphambilini, i-myomectomy, i-metroplasty).
– Ukuvinjelwa kokubeletha okufana nokungalingani kwe-cephalopelvic, ukungabekeki kahle/ukwethulwa kahle, noma i-pelvis encane.
– Ukungakwazi ukusebenza kahle kanye nokubeletha isikhathi eside okubangela ukuthi isibeletho sisebenze ngokweqile.
– Ukufakwa/ukwandiswa nge-oxytocin noma i-prostaglandin okungaqashelwanga eduze.
– I-Grand multipara (i-high parity) ene-myometrium esengozini kakhulu.
– Ukulimala kokubeletha njengokukhishwa okungafanele, uhlobo lwangaphakathi, noma ukusetshenziswa kwezinsimbi ezingafanele.
Ukuhlanganiswa kwalezi zinto kwandisa ingcindezi yangaphakathi kwesibeletho kanye nengozi yokudabuka.
Izimpawu Nezimpawu Zomtholampilo
Ukuqashelwa kusenesikhathi kubalulekile, njengoba ukubambezeleka kwandisa ukufa komama kanye nosana. Izimpawu nezimpawu ezivamile zifaka:
– Ubuhlungu obukhulu besisu obungazelelwe, bungase bulandelwe ukuncipha kokufinyela kwesisu.
– Ukopha kwesitho sangasese sowesifazane (akubonakali ngaso sonke isikhathi njengoba ukopha esiswini kungase kwenzeke).
– Ukushaqeka: ukushaya kwenhliziyo okusheshayo, umfutho wegazi ophansi, ukuphaphatheka, ukubanda, ukungahlaliseki.
– Izinguquko endleleni yokushaya kwenhliziyo kwengane esanda kuzalwa: i-bradycardia, ukwehla okukhulu kwejubane, noma ukulahlekelwa yi-FHR.
– Izingxenye zombungu zizwakala kalula esiswini, noma izinguquko ekwakhekeni kwesibeletho.
– Ukulahlekelwa yi-cephalic station (ikhanda le-fetus “liyaphakama libuyele phezulu”).
– Ubuhlungu besibeletho kanye nezimpawu zokucasuka kwe-peritoneal lapho kuqhekeka ngokuphelele.
Ezimweni zokuphuma kwesibazi se-CS, izimpawu zingase zibe zicashile, isibonelo ubuhlungu obuncane, isimo sikamama sizinzile, kodwa izinga lokushaya kwenhliziyo kwengane lingase libonise ukucindezeleka.
Izimiso Zokuphathwa Kokubelethisa
Ukuphathwa kokubeletha kokuqhekeka kwesibeletho kugxile emigomweni emibili: ukusindisa umama nokuqinisekisa ukuthi umbungu uyasinda, uma kungenzeka. Ngenxa yokuthi kuyisimo esiphuthumayo, ukuphathwa kulandela ama-ABC (Umoya, Ukuphefumula, Ukujikeleza kwegazi), ukuzinza kwe-hemodynamic, kanye nokungenelela okuqondile, njenge-laparotomy esheshayo.
1. Ukuhlolwa Kokuqala Nokuzinza (Ukuvuselelwa)
Uma sekusolwa ukuthi isibeletho siyaqhekeka, umbelethisi kufanele:
– Vuselela usizo futhi ulungiselele ukudluliselwa/ukubambisana nodokotela wezifo zabesifazane kanye nodokotela wezinzwa (uma kutholakala).
– Indlela yokuphefumula kanye nokuphefumula: qinisekisa ukuthi umoya ungena, nikeza umoya-mpilo 10–15 L/ngomzuzu ngemaski engaphindi iphefumule.
– Ukujikeleza kwegazi: sungula imigqa emibili emikhulu ye-IV (16–18G), qala uketshezi lwe-crystalloid (i-Ringer Lactate/NaCl) ngokushesha.
– Thatha amasampula egazi ukuze uthole ukuhlolwa kwe-Hb, uhlobo lwegazi, ukuhlolwa kwe-crossmatch, kanye nokuhlolwa kwe-coagulation uma kungenzeka.
– Qaphela izimpawu ezibalulekile njalo ngemizuzu emi-5-10: umfutho wegazi, ukushaya kwenhliziyo, ukuphefumula, ukugcwala.
– Faka i-catheter yomchamo ukuze uqaphe ukuphuma (okuhlosiwe ≥30 ml/ihora).
– Ungalibali ukudluliselwa/ukuhlinzwa ukuze uthole ukuhlolwa okwengeziwe okungabalulekile.
Ezikhungweni ezilinganiselwe, isihluthulelo sokuphepha ukuvuselela kanye nemizamo esheshayo yokudlulisela, kanye nokuxhumana okucacile mayelana nokusolakala ukuthi kuqhume isibeletho.
2. Izinto ezibangela ukumisa
Uma umama ethola i-oxytocin, yeka ngokushesha. Hlola ukuthi ngabe kukhona yini ukukhuthazwa kwesibeletho. Gwema izinqubo zesitho sangasese sowesifazane eziphindaphindwayo ngokungadingekile, njengoba lokhu kungandisa ukopha futhi kulibazise ukudluliselwa.
3. Ukuxilongwa Kwezokwelapha Nokwehluka
Ukuxilongwa kokuqhekeka kwesibeletho kuvame ukuba yinto yezokwelapha. Kodwa-ke, kubalulekile ukukuhlukanisa kulokhu okulandelayo:
- ukuqhekeka kwe-placenta,
- ukukhulelwa kwe-placenta,
- ukuguqulwa kwesibeletho,
- ukushaqeka kwe-anaphylactic noma i-amniotic fluid embolism,
– i-atony yesibeletho sangemva kokubeletha (uma kwenzeka ngemva kokubeletha).
I-Ultrasonography ingaba usizo, kodwa ezimweni eziphuthumayo, izinqumo mayelana nesenzo zisekelwe kakhulu ezimpawini zomtholampilo kanye nezimpawu zokushaqeka noma ukucindezeleka kombungu.
4. Ukubhekisela Kweqembu Nokuxhumanisa
Ukuqhekeka kwesibeletho kudinga ukuhlinzwa. Ohlelweni lokudlulisela, ababelethisi kudingeka:
– Thumela umama nomngane oqeqeshiwe, alethe amarekhodi ezimpawu ezibalulekile, inani lokopha, uketshezi olunikeziwe, kanye nemiphumela yokuhlolwa.
– Qhuba ukuxhumana kwe-SBAR (Isimo, Isizinda, Ukuhlolwa, Izincomo) nesibhedlela oya kuso.
– Qinisekisa ukuthi umama uyaqhubeka nokuthola umoya-mpilo, ukucwiliswa kwe-IV kuyaqhubeka, futhi ukuqapha kwenziwa phakathi nohambo.
Ijubane lokudluliselwa livame ukuba yisici esinquma imiphumela.
Isenzo Esiqondile Esibhedlela
Esikhungweni sokudlulisela, isinyathelo esiyinhloko i-laparotomy ephuthumayo ukulawula ukopha nokusindisa umama.
1. Ukuhlinzwa Kwe-Laparotomy Nokuphathwa Kwesibeletho
Ukukhetha ukwelashwa kuncike endaweni lapho kudabuke khona, izinga lomonakalo, ukuqina kwe-hemodynamic, kanye nezifiso zokuzala:
– Ukulungiswa (ukuthunga) kokudabuka kwesibeletho: kungenziwa uma ukudabuka kulinganiselwe, ukopha kulawulwa, futhi isimo sikamama sizinzile ngokwanele.
– Ukususwa kwesibeletho okungaphansi/okuphelele: kukhethwa uma ukudabuka kukhulu, ukopha kunzima ukukulawula, kukhona ukutheleleka, noma umama engazinzile. Ukususwa kwesibeletho ngokuvamile kuyindlela esheshayo uma kwenzeka ukushaqeka okukhulu ukuze kusindiswe impilo.
2. Ukuphathwa Kwengane Esanda Kuzalwa
Uma ingane isaphila, ukuhlinzwa kwenziwa ngokushesha okukhulu ukuze kuncishiswe i-hypoxia. Kodwa-ke, uma ingane iqhuma ngokuphelele, ivame ukuba ne-asphyxia enzima, ngakho-ke imiphumela yezingane ezisanda kuzalwa ingaba mibi ngisho noma kungenelela ngokushesha.
3. Ukulungiswa Kokufakelwa Kwegazi kanye Nokugoba Kwegazi
Ukopha kungaba kukhulu. Kuyadingeka:
– ukumpontshelwa igazi nge-PRC njengoba kudingeka,
– izingxenye ze-plasma/zegazi uma kukhona ukuphazamiseka kokugaya igazi,
– ukuqapha izimpawu ze-DIC (ukujiya kwegazi okusabalele) ikakhulukazi uma ukopha kuthatha isikhathi eside.
4. Ukuvimbela Nokuphatha Izinkinga
Izinkinga okufanele uziqaphele zifaka phakathi ukushaqeka, ukutheleleka, ukulimala kwesinye, ukwehluleka kwezinso okukhulu, ngisho nokufa. Ama-antibiotic okuvimbela/okwelapha kanye nokuqapha okujulile ngemva kokuhlinzwa kubalulekile.
Indima Yababelethisi Ekunakekelweni Kwangemva Kwenqubo
Ngemva kwesenzo esiqondile, umbelethisi udlala indima kulokhu:
- qapha izimpawu ezibalulekile kanye nokopha kwegazi,
- qapha i-diuresis kanye nesimo sobuhlungu,
– ukusiza ngokuqala ukuncelisa uma izimo zivuma,
- imfundo yokudla okunempilo, ukunyakaza kancane kancane, kanye nokunakekelwa kwamanxeba,
– ukwesekwa kwengqondo kokulimala kokubeletha, ukulahlekelwa umbungu, noma ukulahlekelwa kwesibeletho.
Ukwelulekwa kufanele futhi kufake phakathi ukuhlela ukukhulelwa kwesikhathi esizayo uma isibeletho sigcinwa, okuhlanganisa nengozi yokuphinde siqhekeke kanye nokubaluleka kokubelethela endaweni yokudlulisela.
Ukuvimbela Ukuqhekeka Kwesibeletho
Amanye amacala angavinjelwa ngokusebenzisa:
– ukuqapha ngokucophelela ukubeletha kusetshenziswa i-partograph,
- ukutholwa kusenesikhathi kwe-dystocia kanye nokudluliselwa ngesikhathi esifanele,
- ukusetshenziswa okunengqondo kwe-oxytocin kanye nokuqapha ukufinyela kanye ne-DJJ,
– ukukhetha okuqinile kokuzama ukubeletha ngesitho sangasese sowesifazane ngemuva kwe-CS (VBAC) ngokweziqondiso,
- imfundo umama okhulelwe mayelana nezimpawu zengozi kanye nokubaluleka kwe-ANC.
Ukuvimbela kuhlanganisa nokuthuthukisa izinhlelo zokudlulisela, ukuthuthwa, kanye nokulungela igazi ezikhungweni zezempilo.
Isiphetho
Ukuqhekeka kwesibeletho kuyisimo esiphuthumayo sokubeletha esidinga isinyathelo esisheshayo nesihlelekile. Ukuphathwa kokubeletha kugxile ekutholakaleni kusenesikhathi, ukuvuselelwa ngokushesha, ukuqedwa kwezinto ezibangela umdlavuza, ukudluliselwa ngokushesha, kanye nokubambisana ukuze kuhlinzwe ngokugcwele. Indima yababelethisi ibalulekile hhayi kuphela ngesikhathi sesigaba esibucayi kodwa futhi nasekuqapheni ngemva kokuhlinzwa, emfundweni, nasekuvimbeleni ukunciphisa izehlakalo ezifanayo. Ngohlelo lokunakekelwa komama olusabelayo, ukugula nokufa ngenxa yokuqhekeka kwesibeletho kungancishiswa kakhulu.
