Ukunakekelwa Komama Abanezinkinga Zenhliziyo
Ukukhulelwa kuyinqubo yomzimba ebangela izinguquko ezibalulekile emzimbeni kamama. Lezi zinguquko zithinta kakhulu uhlelo lwenhliziyo nemithambo yegazi: ukwanda kwegazi, ukushaya kwenhliziyo kuyanda, kanye nomthwalo womsebenzi wenhliziyo uyanda. Kwabesifazane abakhulelwe abanezinkinga zenhliziyo—kungaba ezizalwa nazo noma ezitholwe ngabanye—lezi zinguquko zingabangela ukubola kwesisu, zibe zimbi kakhulu izimpawu, futhi zikhulise ngisho nengozi yezinkinga kumama nomntwana osesiswini. Ngakho-ke, ukunakekelwa kwabesifazane abanezinkinga zenhliziyo kudinga indlela ephelele, ebambisene, neqhubekayo kusukela ngaphambi kokukhulelwa kuze kube sekupheleni kwesikhathi sokubeletha.
Ukuqonda kanye Nezinhlobo Zokukhubazeka Kwenhliziyo Ekukhulelweni
Ukukhubazeka kwenhliziyo kukamama kungafaka phakathi isifo senhliziyo esizalwa naso (isb., i-atrial/ventricular septal defect), isifo se-valve (i-mitral/aortic stenosis noma i-regurgitation), i-cardiomyopathy, i-arrhythmias, kanye nesifo senhliziyo esibangelwa umfutho wegazi ophezulu wamaphaphu noma isifo semithambo yenhliziyo. Empeleni, inselele enkulu ukuhlola ukuthi inhliziyo ivumelana kahle kangakanani nezidingo zokukhulelwa. Ubunzima buvame ukulinganiselwa ngokuhlukaniswa kokusebenza (isb., ngokusekelwe ekubekezeleni umsebenzi), ukuba khona komfutho wegazi ophezulu wamaphaphu, umlando wokwehluleka kwenhliziyo, kanye nomsebenzi we-ventricular ku-echocardiography.
Umphumela Wokukhulelwa Esistimu Yenhliziyo Nemithambo Yegazi
Ngesikhathi sokukhulelwa, ukuphuma kwenhliziyo kukhuphuka cishe ngo-30-50%, okufika phezulu ku-trimester yesibili kuya kweyesithathu. Umthamo we-plasma uyanda, okwandisa ingozi yokuvuvukala kanye nokuphelelwa umoya. Ngesikhathi sokubeletha, ukufinyela kwesibeletho kanye nobuhlungu kwandisa ukusetshenziswa komoya-mpilo kanye nomsebenzi wenhliziyo. Ngemva kokubeletha, "ukufakelwa kwegazi ngokuzenzakalelayo" kwenzeka kusuka esibelethweni kuya emgudwini wokujikeleza kwegazi kukamama, okuholela ekwandeni okungazelelwe komsebenzi wenhliziyo amahora angama-24-72 ngemuva kokubeletha. Lesi sikhathi sokubeletha ngokuvamile siyisikhathi esibucayi komama abanesifo senhliziyo, njengoba ingozi yokuvuvukala kwamaphaphu kanye nokwehluleka kwenhliziyo iyanda.
Inhloso Yokunakekela
Ukunakekelwa komama abanezinkinga zenhliziyo kuhlose:
1. Gcina ukuqina kwe-hemodynamic kukamama futhi uvimbele ukwehluleka kwenhliziyo.
2. Nciphisa ingozi yezinkinga ze-thromboembolic, i-arrhythmia, i-pulmonary edema, kanye nokutheleleka.
3. Qapha ukukhula nokuthuthukiswa kwengane futhi uvimbele ukuphazamiseka kokugeleza kwegazi esikhumbeni.
4. Ukuhlela ukubeletha okuphephile okufanele izimo zenhliziyo nemithambo yegazi.
5. Lungiselela ukunakekelwa okuphephile kwangemva kokubeletha kanye nokuncelisa, okuhlanganisa nokulungiswa kwemithi.
Ukunakekelwa Kwangaphambi Kokubeletha (Ngesikhathi Sokukhulelwa)
1. Ukuhlolwa Nokuhlolwa Kwengozi
Ukuhlolwa kokuqala kufaka phakathi umlando wesifo senhliziyo (uhlobo, ukuhlinzwa kwangaphambilini, imithi), umlando wokuphelelwa umoya, ubuhlungu besifuba, ukuquleka, ukushaya kwenhliziyo, nanoma yimiphi imisebenzi ebangela izimpawu. Ukuhlolwa ngokomzimba kuhlola izimpawu zokwehluleka kwenhliziyo (i-tachycardia, i-dyspnea, i-rhonchi, i-edema, umfutho wegazi ophakeme) kanye nokugcwala komoya-mpilo. Ukuhlolwa okwengeziwe kufaka phakathi i-ECG, i-echocardiography, kanye nokuhlolwa kwelebhu okufana nokuhlolwa kwe-hemoglobin kanye nokusebenza kwezinso, uma kudingeka. Ukuhlolwa kwengozi kufaka phakathi nezici zokubeletha ezifana ne-preeclampsia, i-anemia, noma ukutheleleka, okungandisa umthwalo enhliziyweni.
2. Ukuvakasha Okuvamile Kwe-ANC Nokubambisana Kwamaqembu
Omama abanezinkinga zenhliziyo ngokuvamile badinga ukuvakashelwa njalo ngaphambi kokubeletha kunalabo abangenazo izifo ezihambisana naso. Indlela engcono kakhulu ukusebenzisana neqembu: udokotela wezifo zokubelethisa, udokotela wezifo zenhliziyo, umbelethisi, umhlengikazi, udokotela wezifo ezibulala izinzwa, futhi, uma kudingeka, udokotela wezingane/odokotela bezinsana. Lokhu kubambisana kubalulekile ekuthuthukiseni uhlelo lokubeletha nokuqinisekisa ukudluliselwa ngesikhathi uma kwenzeka ukonakala.
3. Ukuguqulwa Kwemfundo Nendlela Yokuphila
Imfundo igcizelela ukubaluleka kokuqaphela izimpawu eziyisixwayiso: ukwanda kokuphelelwa umoya, ubunzima bokulala ngenxa yokuphelelwa umoya (i-orthopnea), ukukhwehlela okunamagwebu, ukushaya kwenhliziyo okukhulu, ukuvuvukala okusheshayo, ukuquleka, noma ubuhlungu besifuba. Omama bayalulekwa ukuthi baphathe imisebenzi yabo futhi baphumule, balale behleli phansi uma bevame ukuba nokuphelelwa umoya, futhi bagweme imisebenzi enzima ebangela izimpawu. Ukudla okwanele kufanele kunikezwe, kuncishiswe usawoti uma kukhona ukuthambekela kokugcina uketshezi. I-anemia idinga ukuvinjelwa futhi yelashwe njengoba ingandisa umthwalo wenhliziyo.
4. Ukwelashwa Nokuhambisana Nemithi
Akuyona yonke imithi yenhliziyo ephephile ngesikhathi sokukhulelwa. Ngakho-ke, ukunamathela emithini kufanele kuhambisane nokulungiswa kwendlela yokwelashwa ngudokotela. Isibonelo, eminye imithi yokunciphisa umfutho wegazi ophakeme noma eqeda ukujiya kwegazi inemikhawulo phakathi nezinyanga ezithile zokukhulelwa. Omama kufanele banikezwe izincazelo ezicacile mayelana nomthamo, ishejuli, imiphumela emibi, kanye nokwenqatshelwa kokuyeka imithi ngaphandle kokubonisana. Umfutho wegazi, ukushaya kwenhliziyo, isisindo, kanye nezimpawu kufanele kuqashwe njalo.
5. Ukuqapha Umbungu Wengane
Isifo senhliziyo sikamama singanciphisa ukugeleza kwegazi esikhumbeni, sibeke ingane engozini yokukhula okulinganiselwe, ukukhulelwa ngaphambi kwesikhathi, noma ukucindezeleka kwengane. Ukuqapha ngokulinganisa ukuphakama kwengane, i-ultrasound yokukhula, kanye nokuhlolwa kwenhlalakahle yengane (isib., ukunyakaza kwansuku zonke kwengane kanye nokuhlolwa njengoba kubonisiwe) kuyizingxenye ezibalulekile zokunakekelwa.
Ukunakekelwa Kwangaphakathi Kokubeletha (Ngesikhathi Sokubeletha)
1. Ukuhlela Ukuzalwa
Iningi labesifazane abanezinkinga zenhliziyo bangabeletha ngesitho sangasese sowesifazane uma isimo sabo sizinzile, njengoba ukuhlinzwa kwesisu kunengozi enkulu yokopha, ukutheleleka, kanye nezinguquko ezinkulu ze-hemodynamic. Kodwa-ke, indlela yokubeletha kufanele inqunywe ngokusekelwe esimweni senhliziyo, isimo sokubelethisa, kanye nezincomo zeqembu. Ukubeletha kufanele kube ngcono esikhungweni esinamakhono okuqapha nokunakekelwa okuphuthumayo.
2. Ukuqapha Okuqinile Nokubeka Indawo
Ngesikhathi sokubeletha, izimpawu ezibalulekile, ukugcwala komoya-mpilo, kanye nokulinganisela koketshezi kumele kuqashwe ngokucophelela. Umama welulekwa ukuba alale ngohlangothi lwakhe lwesobunxele ukuze athuthukise ukubuya kwemithambo yegazi kanye nokugeleza kwegazi emithanjeni. Ukunikezwa koketshezi nge-intravenous kwenziwa ngokucophelela ukuze kugwenywe ukugcwala koketshezi. I-oxygen inikezwa uma ukugcwala kwehla noma umama ebonakala ephelelwa umoya.
3. Ukulawula Ubuhlungu Nokunciphisa Umthwalo Wenhliziyo
Ubuhlungu nokukhathazeka kwandisa umthwalo womsebenzi wenhliziyo. Ngakho-ke, ukulawula ubuhlungu okwanele (ngokusekelwe ekutholakaleni kwe-anesthetic kanye nezincomo) kungasiza ekuqiniseni i-hemodynamics. Isigaba sesibili sokubeletha sivame ukufinyezwa (isibonelo, ngosizo lwezinsimbi) ezimweni ezithile ukuze kuncishiswe ukusunduza isikhathi eside, okungakhulisa ingcindezi yangaphakathi kwesifuba futhi kucindezele inhliziyo.
4. Ukuvimbela Izinkinga
Qaphela izimpawu zokwehluleka kwenhliziyo okukhulu: ukuphefumula okusheshayo, ukwehla kokugcwala, ukuphelelwa amandla, ukungakwazi ukuzibamba, ukukhwehlela, noma i-cyanosis. Ukwelashwa kufanele kwenziwe ngokushesha, okuhlanganisa ukubambisana kweqembu, ukubeka ikhanda phezulu, umoya-mpilo, kanye nokwelashwa okuhambisana nephrothokholi. Ngaphezu kwalokho, ingozi ye-thromboembolism ingandiswa yizimo ezithile (isb., i-atrial fibrillation, ama-mechanical valves, ukungasebenzi kahle), ngakho-ke amasu okuvimbela kufanele ahambisane nezincomo zikadokotela.
Ukunakekelwa Kwangemva Kokubeletha (Isikhathi Sangemva Kokubeletha)
Isikhathi sangemva kokubeletha sivame ukunganakwa, kodwa yisikhathi esibucayi. Ngemva kokubeletha, izinguquko zoketshezi zingabangela ukuvuvukala kwamaphaphu kanye nokwehluleka kwenhliziyo, ikakhulukazi ezinsukwini zokuqala ezingu-2-3. Ukunakekelwa kwangemva kokubeletha kuhlanganisa ukuqapha eduze izimpawu ezibalulekile, ukuhlola ukuphelelwa umoya, ukuhlolwa kokuvuvukala, kanye nokuqoshwa kokungenisa kanye nokukhipha. Ukunyakaza kwangemva kokubeletha kwenziwa ngokuphephile, ngokwesimo sikamama, ukuvimbela i-thrombosis, kuyilapho kubekwa phambili ukubekezelela umsebenzi.
Ukulungiswa Kokuncelisa Ibele Nokwelashwa Ngemithi
Ngokuvamile kunconywa ukuncelisa ibele, kodwa eminye imithi yenhliziyo ingadlulela obisini lwebele. Ngakho-ke, kubalulekile ukuhlola ukuphepha kwemithi ngesikhathi sokuncelisa bese ucabangela ezinye izindlela uma kudingeka. Omama badinga nokusekelwa ukuvimbela ukukhathala; isikhathi esanele sokuphumula, ukwesekwa komndeni, kanye nokuphathwa kokucindezeleka kubalulekile ukuvimbela ukuphindaphinda kwezimpawu.
Ukwelulekwa Kokuhlela Umndeni Nokuhlela Ukukhulelwa Okuzayo
Ukwelulekwa kokuhlela umndeni kuyingxenye ebalulekile yokunakekelwa. Ezinye izimo zenhliziyo zibeka engcupheni enkulu yokukhulelwa esikhathini esizayo, ngakho-ke ukukhetha izindlela zokuvimbela inzalo kumele kuphephe ezifweni zenhliziyo kanye nokusebenzisana kwezidakamizwa (isb., ama-anticoagulant). Uma owesifazane ehlela ukukhulelwa esikhathini esizayo, kunconywa kakhulu ukuthi iqembu lihlole ukukhulelwa ngaphambi kokukhulelwa.
Indima Yababelethisi Nabasebenzi Bezempilo
Ababelethisi nabahlengikazi badlala indima ebalulekile njengabaxhumanisi phakathi komama, umndeni, kanye nethimba lezokwelapha. Lo msebenzi uhlanganisa ukutholakala kusenesikhathi kwezimpawu zengozi, imfundo, ukuqapha ukunamathela emithini, ukwesekwa kwengqondo, kanye nokuqinisekisa ukudluliselwa ngesikhathi. Imibhalo efanele—kufaka phakathi izimpawu, izimpawu ezibalulekile, impendulo ekwelashweni, kanye nezinhlelo zokulandelela—isekela ukuphepha kwesiguli.
Isiphetho
Ukunakekela omama abanezinkinga zenhliziyo kudinga indlela ebanzi kusukela ekukhulelweni kuze kube sekubelethweni kanye nangemuva kokubeletha. Izihluthulelo zempumelelo ukuhlolwa okunembile kwezingozi, ukuqapha eduze, imfundo efanele, ukuphathwa kwemisebenzi kanye noketshezi, kanye nokusebenzisana ngokubambisana okuhlukahlukene. Ngokunakekelwa okuhleliwe nokuqhubekayo, omama abaningi abanezinkinga zenhliziyo bangakhulelwa futhi babelethe ngokuphephile, futhi bazale izingane ezinempilo.
