Ukuphathwa Kokunakekelwa Kwababelethisi Ezimweni Zesifo Sikashukela Sohlobo 1
I-Pendahuluan
Isifo sikashukela sohlobo 1 (i-T1DM) yisifo esingamahlalakhona esibangela ukuthi i-pancreas yehluleke ukukhiqiza i-insulin eyanele. Lesi simo sivame ukuqala ebuntwaneni noma ebusheni, kodwa abesifazane abaningi abane-T1DM bangakhulelwa futhi babelethe ngokuphephile ngokunakekelwa okufanele kwababelethisi. Ngokuphathelene nokubeletha, i-T1DM iyisimo esiyingozi kakhulu ngoba singathinta impilo kamama nosana, ngesikhathi sokukhulelwa, sokubeletha, kanye nesikhathi sokubeletha. Ngakho-ke, ababelethisi badlala indima ebalulekile ekutholakaleni kusenesikhathi, ukuqapha, imfundo, ukubambisana kochwepheshe, kanye nokusekelwa kwengqondo ukuze kufezwe imigomo yokulawula i-glycemic nokuvimbela izinkinga.
Imiqondo Eyisisekelo Yesifo Sikashukela Sohlobo 1 Ekukhulelweni
Isifo sikashukela sohlobo 1 sibonakala ngokuntuleka ngokuphelele kwe-insulin, okudinga ukwelashwa kwe-insulin impilo yonke. Ngesikhathi sokukhulelwa, izinguquko zamahomoni emazingeni e-lactogen ye-placental yomuntu (hPL), i-progesterone, i-cortisol, kanye ne-hormone yokukhula kwe-placental kungandisa ukumelana ne-insulin, ikakhulukazi ezinyangeni zesibili nezesithathu. Ngenxa yalokho, izidingo ze-insulin zingashintshashintsha: zivame ukwehla ezinyangeni zokuqala zenyanga ngenxa yesicanucanu nokuhlanza kanye nokuzwela okukhulu kwe-insulin, kodwa zikhuphuke kakhulu ezinyangeni ezilandelayo zenyanga. Amazinga kashukela angalawulwa angandisa ingozi yezinkinga ezifana ne-hypoglycemia enzima, i-ketoacidosis yesifo sikashukela (DKA), i-preeclampsia, ukutheleleka, i-polyhydramnios, ukubeletha kwangaphambi kwesikhathi, kanye nezinkinga zengane efana ne-macrosomia, i-hypoglycemia yengane esanda kuzalwa, kanye nokucindezeleka kokuphefumula.
Izinhloso Zokuphathwa Kokunakekelwa Kwababelethisi
Umgomo oyinhloko wokunakekelwa kwababelethisi kwabesifazane abanesifo sikashukela sohlobo 1 ukugcina amazinga kashukela egazini enempilo, ukuvimbela izinkinga ezibukhali nezingapheli, ukuqinisekisa ukukhula okuhle komntwana osesiswini, nokulungiselela ukubeletha okuphephile kanye nesikhathi sokubeletha. Ngaphezu kwalokho, ukunakekelwa kuhloswe ekuthuthukiseni ukunamathela kukamama ekwelashweni nge-insulin, ukudla, umsebenzi womzimba ofanele, kanye nekhono likamama lokubona izimpawu zengozi ezifana ne-hypoglycemia kanye ne-ketoacidosis.
Ukuhlolwa Kokubelethisa
Ukuhlolwa okuphelele kwabesifazane abakhulelwe abanesifo sikashukela sohlobo 1 (DM) kubalulekile. Ababelethisi kufanele baqoqe idatha ngomlando wabo wezokwelapha (ubude be-DM, uhlelo lwe-insulin, ukuvama kwe-hypoglycemia, umlando we-DKA), izinkinga (i-nephropathy, i-retinopathy, i-neuropathy), umlando wokubeletha (ukukhipha isisu, ukubeletha ngaphambi kwesikhathi, usana olukhulu), kanye nemikhuba yokuphila (ukudla, umsebenzi, ukunamathela ekuhlolweni). Ukuhlolwa ngokomzimba kufanele kufake umfutho wegazi, isisindo, isimo somswakama, izimpawu zokutheleleka, kanye nokuhlolwa kokubeletha okufanele iminyaka yokukhulelwa.
Ngaphezu kwalokho, ukuzihlola ushukela wegazi (i-SMBG) kubalulekile. Ababelethisi kudingeka bahlole ukuthi umama wenza ukuhlolwa ngendlela efanele, kangaki, kanye nephethini yemiphumela (ukuzila ukudla/i-hyperglycemia yangemva kokudla, ukuguquguquka, noma i-hypoglycemia yasebusuku). Imininingwane yelabhorethri efana ne-HbA1c, ukusebenza kwezinso, kanye nokuhlolwa komchamo (i-proteinuria, i-ketonuria) nayo idinga ukubhekwa ngokubambisana nodokotela. Ukuqapha umbungu kwenziwa ngokulinganisa ukuphakama kwesizalo, ukunyakaza kombungu, kanye nokudluliselwa kuma-ultrasound alandelanayo ukuhlola ukukhula, ivolumu yoketshezi lwe-amniotic, kanye nesimo se-placenta.
Ukuxilongwa/Ukuhlonza Izinkinga Zokubeletha
Izinkinga zokubeletha ezivame ukuvela komama abanesifo sikashukela sohlobo 1 zifaka: ingozi yokungalingani kwe-glucose egazini, ingozi ye-preeclampsia, ingozi yokutheleleka (ikakhulukazi indlela yomchamo), ingozi ye-polyhydramnios, kanye nengozi yokuvinjelwa kokukhula kwengane (i-macrosomia noma ukuvinjelwa kokukhula ezimweni zezinkinga zemithambo yegazi). Ngokwengqondo, omama bangase babe nokukhathazeka mayelana nokuphepha kwengane, umthwalo wokwelashwa nge-insulin, kanye nokwesaba i-hypoglycemia. Ababelethisi kudingeka bathole izici ezibangela lokhu njengokudla okungajwayelekile, umthamo ongalungile we-insulin, noma ukuntuleka kokusekelwa komndeni.
Ukuhlela Ukunakekelwa Kwababelethisi
Ukuhlela ukunakekelwa kugxila ekuqapheni okujulile, emfundweni, kanye nokubambisana. Ezinye izingxenye ezibalulekile zokuhlela zifaka:
1. Ukulawulwa kwe-glycemic okuqondiwe
Ababelethisi basiza ekuqinisekiseni ukuthi omama bayaqonda imigomo ye-glucose enconywe ngabasebenzi bezokwelapha, ukubaluleka kokudla njalo, kanye nesikhathi sokuphathwa kwe-insulin. Imfundo ngokusetshenziswa kwe-insulin, amasu okujova, ukugcinwa kwe-insulin, kanye nezindawo zokujova ezijikelezayo nakho kubalulekile.
2. Ukudla okunempilo kanye nemfundo yendlela yokuphila
Ukudla okunama-carbohydrate alawulwayo, ubukhulu besabelo esilinganiselwe, kanye nezinhlelo zokudla ezivamile kufanele kugcizelelwe. Ababelethisi bangaqondisa omama ekwakheni izinhlelo zokudla ezilula nezingokoqobo ezifanele ngokwesiko nangokwezomnotho. Umsebenzi womzimba olula kuya kophakathi ungakhuthazwa uma kungekho ziphazamiso zokubeletha.
3. Ukuvimbela nokubona izinkinga
Uhlelo lokuqapha umfutho wegazi, izimpawu ze-preeclampsia (ikhanda elibuhlungu kakhulu, umbono ofiphele, ukuvuvukala), izimpawu ze-hypoglycemia (ukuthuthumela, ukujuluka, isiyezi), kanye nezimpawu ze-DKA (isicanucanu nokuhlanza, ubuhlungu besisu, ukuphefumula okusheshayo, umoya we-ketone) kufanele kuchazwe. Umama kufanele futhi afundiswe ukuthi kufanele afune nini usizo lwezokwelapha ngokushesha.
4. Ukuqapha ukukhula kanye nenhlalakahle yengane esanda kuzalwa
Ababelethisi benza kube lula ukuvakashelwa njalo kwe-ANC. Ukubambisana kokuhlolwa kwe-ultrasound okulandelanayo, ukuhlolwa koketshezi lwe-amniotic, kanye nokuhlolwa kwenhlalakahle yombungu njengokuhlolwa okungeyona ingcindezi (i-NST) kwenziwa njengoba kubonisiwe.
5. Ukulungiselela ukubeletha
Ukubeletha kudinga ukuhlelwa, kucatshangelwa isimo sikamama nosana. Ababelethisi basebenzisana nodokotela ukuze banqume isikhathi nendlela yokubeletha, ikakhulukazi uma kukhona i-macrosomia, i-preeclampsia, noma ezinye izinkinga. Ukuhlela kufanele kufake ukulungela usana olusanda kuzalwa, njengoba izingane zisengozini ye-hypoglycemia ngemva kokuzalwa.
Ukuqaliswa Kokunakekelwa Kwababelethisi
Ngesikhathi senqubo, umbelethisi uqapha njalo izimpawu ezibalulekile, imiphumela ye-SMBG, kanye nezikhalazo zikamama. Ukwelulekwa kunikezwa ngokuphindaphindiwe ukuqinisekisa ukuthi umama uhlala elandela ukwelashwa kwe-insulin kanye nokudla okudlayo. Uma umama eba ne-hypoglycemia, umbelethisi kufanele anikeze usizo lokuqala ngokwegunya lakhe, njengokunikeza umthombo we-glucose osheshayo uma umama ephapheme, kanye nokudluliselwa uma isimo sibi kakhulu noma uma ingqondo iphazamisekile.
Ngesikhathi sokubeletha, ukuqapha ushukela njalo kuyadingeka ngoba inqubo yokubeletha ingathinta izidingo ze-insulin. Ezinye izindlela zokwelapha zisebenzisa ama-insulin drips kanye nokufakwa kwe-glucose ezibhedlela, ngakho-ke ababelethisi kumele baqonde izimiso futhi baqaphe izimpawu ze-hypoglycemia/hyperglycemia ngesikhathi sokubeletha. Ukuqapha eduze izinga lokushaya kwenhliziyo kwengane (FHR) kwenziwa ukuze kutholakale ukucindezeleka kwengane.
Ukuhlolwa
Ukuhlolwa kufaka phakathi ukuthi imigomo yokulawula i-glycemic iyafezwa yini, ukuthi umama uyaqonda futhi uyakwazi yini ukuzilawula, nokuthi ngabe kukhona yini izimpawu zezinkinga. Ukuhlolwa kufaka phakathi imiphumela yokuqapha ingane esanda kuzalwa, ukukhuluphala kukamama, umfutho wegazi, kanye nokunamathela ekuvakasheni kokunakekelwa kwangaphambi kokubeletha. Uma kutholakala izinkinga ezifana nokulawulwa kwe-glycemic okubi noma izimpawu ze-preeclampsia, uhlelo lokunakekelwa kufanele lubuyekezwe futhi kuqalwe ukudluliselwa.
Ukunakekelwa Kwangemva Kokubeletha Nokuncelisa
Isikhathi sokubeletha komama abanesifo sikashukela sohlobo 1 sidinga ukunakwa okukhethekile. Ngemva kokubeletha i-placenta, ukumelana ne-insulin kuyancipha, ngakho-ke izidingo ze-insulin zivame ukwehla kakhulu. Omama kudingeka baqaphe ushukela wabo wegazi ukuze bavimbele i-hypoglycemia, ikakhulukazi ngesikhathi sokuncelisa, okunganciphisa amazinga kashukela. Ukuncelisa kusanconywa ngenxa yezinzuzo zako kokubili kumama nomntwana, kodwa omama kudingeka balondoloze ukudla okwanele kwama-calories kanye nesimiso sokudla okunempilo.
Izingane ezizalwa omama abanesifo sikashukela sohlobo 1 zisengozini yokuthola i-hypoglycemia ezinganeni ezisanda kuzalwa, okudinga ukubhekwa ushukela egazini yithimba lezinsana ezisanda kuzalwa. Ababelethisi badlala indima ekusekeleni ukuqaliswa kokuncelisa ibele kusenesikhathi, ukufundisa omama ngezimpawu ze-hypoglycemia yezinsana (ukudinwa, ubunzima bokuncelisa, ukuxhuzula), kanye nokuqinisekisa ukulandelwa ngemva kokukhishwa.
Ukubambisana kanye Nokudluliselwa
Ukuphathwa kwesifo sikashukela sohlobo 1 ngesikhathi sokukhulelwa akukwazi ukuphathwa ngababelethisi kuphela. Ukubambisana nodokotela bezifo zokubelethisa nodokotela bezifo zabesifazane, ochwepheshe be-intern/endocrine, ochwepheshe bezokudla, kanye nethimba lezingane ezisanda kuzalwa kubalulekile. Ababelethisi basebenza njengomxhumanisi, ukuqinisekisa ukuqhubeka kokunakekelwa, ukuthobela imithetho yomama, kanye nokuxhumana kokudluliselwa ngesikhathi uma kwenzeka izinkinga.
Isiphetho
Ukuphathwa kokunakekelwa kwababelethisi besifo sikashukela sohlobo 1 kudinga indlela ephelele ehlanganisa ukuhlolwa okujulile, ukuqapha i-glycemic, imfundo eqhubekayo, ukutholakala kwezinkinga, kanye nokubambisana kochwepheshe. Ngokunakekelwa kwababelethisi okuhleliwe nokuqhubekayo, abesifazane abanesifo sikashukela sohlobo 1 banethuba elikhulu lokukhulelwa okunempilo, ukubeletha okuphephile, kanye nokuzalwa komntwana osesimweni esihle kakhulu. Indima yombelethisi ibaluleke kakhulu njengomngane kamama ekuphathweni kwansuku zonke, ukuhlinzeka ngemfundo, nokuqinisekisa ukuphepha komama nosana ngokuqapha okufanele kanye nokudluliselwa.
