Izindlela Zokunakekela Ababelethisi Ezimweni Ze-Lupus
I-Pendahuluan
I-Lupus, ikakhulukazi i-Systemic Lupus Erythematosus (SLE), yisifo esingamahlalakhona sokuzivikela komzimba esingathinta izitho ezahlukahlukene njengesikhumba, amalunga, izinso, igazi, amaphaphu, kanye nesimiso sezinzwa. Kwabesifazane abaseminyakeni yokuzala, i-lupus iyinkinga enkulu ngoba ingathinta ukuzala, ukukhulelwa, kanye nokuphepha kukamama nomntwana osanda kuzalwa. Uma kukhulunywa ngokubelethisa, amacala e-lupus adinga amasu okunakekelwa aphelele, aqhubekayo asekelwe ekubambisaneni kochwepheshe. Ababelethisi badlala indima ekutholakaleni kwengozi kusenesikhathi, ukuqapha umama nomntwana, imfundo yezempilo, kanye nokuqinisekisa ukudluliselwa ngesikhathi lapho kuvela izimo eziphuthumayo.
Imiqondo Eyisisekelo Nge-Lupus Ekukhulelweni
Ukukhulelwa kwabesifazane abane-lupus kubhekwa njengokukhulelwa okuyingozi kakhulu. I-Lupus ingaba yinto ezinzile (i-remission) noma esebenzayo (i-flare). Ukukhulelwa ngesikhathi se-lupus esebenzayo kuhlotshaniswa nengozi eyengeziwe yezinkinga: i-preeclampsia, ukubeletha ngaphambi kwesikhathi, ukuvinjelwa kokukhula kwe-intrauterine (IUGR), izinkinga zezinso, i-thrombosis, i-anemia, i-thrombocytopenia, ngisho nokufa kwengane. Ngaphezu kwalokho, ukuba khona kwama-antibodies athile, njenge-anti-Ro/SSA kanye ne-anti-La/SSB, kwandisa ingozi ye-lupus yengane esanda kuzalwa kanye nokuvinjelwa kwenhliziyo kokuzalwa engane. Ngakho-ke, isimiso esiyinhloko ukuhlela ukukhulelwa lapho i-lupus izinzile okungenani izinyanga eziyi-6 nokuqapha ngokucophelela phakathi nokukhulelwa kanye nangemuva kokubeletha.
Izinhloso Zokunakekelwa Kwababelethisi Ezimweni Ze-Lupus
Izindlela zokunakekela ababelethisi omama abane-lupus zihlose:
1. Gcina ukuqina kwesifo futhi uvimbele ukuphinda kuvele.
2. Ukutholwa kusenesikhathi kwezinkinga zikamama ezifana ne-preeclampsia, izinkinga zezinso, kanye ne-thromboembolism.
3. Qapha ukukhula nokuthuthukiswa kombungu kanye nenhlalakahle yombungu njalo.
4. Nikeza imfundo nokusekelwa kwengqondo ukuze omama bakwazi ukuzinakekela.
5. Qinisekisa ukuthi kuxhunyaniswa izindlela zokudlulisela kanye nokubambisana nochwepheshe bezokwelapha, imithi yangaphakathi/i-rheumatology, i-nephrology, kanye ne-pediatrics.
Ukuhlolwa Kokunakekelwa Kwababelethisi
Ukuhlolwa kwe-lupus kudinga imininingwane eminingi kunokukhulelwa okuvamile. Umbelethisi kuzodingeka aqoqe idatha elandelayo:
– Umlando wesifo se-Lupus: lapho kutholakala ukuthi unesifo, izitho zomzimba ezihilelekile (ikakhulukazi izinso), ukuvama kokuqubuka kwamathambo, kanye nomlando wokulaliswa esibhedlela.
– Umlando wemithi: ukusetshenziswa kwama-corticosteroids, i-hydroxychloroquine, i-azathioprine, imithi yokwehlisa umfutho wegazi, noma ama-anticoagulants. Kubalulekile ukuhlola ukuhambisana nemiphumela emibi.
– Umlando wokubeletha: ukukhipha isisu okuphindaphindiwe, ukukhulelwa ngaphambi kwesikhathi, izingane ezizalwa zinesisindo esiphansi, ukufa kombungu, kanye ne-preeclampsia yangaphambili.
– Izimpawu zokubuyela emuva: ubuhlungu obukhulu bamalunga, ukuqubuka kwe-malar, izilonda emlonyeni, umkhuhlane ongenazo izifo ezisobala, ukuvuvukala, ukwehla kokukhishwa komchamo, ukuphelelwa umoya, kanye nokukhathala okukhulu.
– Izimpawu eziyingozi zokukhulelwa: ikhanda elibuhlungu kakhulu, ukubona okufiphele, ubuhlungu be-epigastric, ukuvuvukala okungazelelwe, ukopha, noma ukuncipha kokunyakaza kombungu.
Ukuhlolwa ngokomzimba kuzogxila ekucindezelweni kwegazi, ukuvuvukala, izimpawu ze-anemia, ukuhlolwa kwesikhumba, kanye nesimo sokuphefumula. Ukuhlolwa okuhambisanayo okuhambisanayo kufaka phakathi ukuhlolwa komchamo kweprotheni, ukusebenza kwezinso, inani legazi eliphelele, kanye nokuhlolwa kokukhula kombungu nge-ultrasound (kuye ngokuthi insizakalo igunyaza kanjani kanye nendlela yokudlulisela).
Ukuxilongwa Nokuhlonza Inkinga
Ngemva kokuhlolwa, umbelethisi uhlela ukuxilongwa kokubeletha kanye nezinkinga ezingaba khona, isibonelo:
– Ukukhulelwa okuyingozi kakhulu ngenxa ye-lupus.
– Ingozi ye-preeclampsia/umfutho wegazi ophakeme wokukhulelwa.
– Ingozi ye-IUGR kanye nokukhulelwa ngaphambi kwesikhathi.
– Ingozi ye-thromboembolism, ikakhulukazi uma kukhona i-antiphospholipid syndrome.
- Izidingo zemfundo ezihlobene nokuhambisana nokwelashwa, izindlela zokuphumula, ukudla okunomsoco, kanye nezimpawu zengozi.
Empeleni, ababelethisi kudingeka bahlukanise izimpawu ze-lupus flares nezinkinga zokubeletha ezifana ne-preeclampsia, njengoba lokhu kokubili kungafana (isb., i-proteinuria kanye nomfutho wegazi ophakeme). Ezimweni ezinjalo, ukudluliselwa okusheshayo kanye nokubambisana kubalulekile ekunakekelweni.
Ukuhlela Ukunakekelwa
Lolu hlelo lusekelwe esimweni sikamama, iminyaka yokukhulelwa, kanye nokuqina kwe-lupus. Izinto ezibalulekile zifaka:
1. Ukuvakashela i-ANC kuvame kakhulu kunasekukhulelweni okuvamile, ukuze kuhlolwe umfutho wegazi, ukuvuvukala, kanye nesimo esijwayelekile.
2. Ukuqapha njalo umbungu, okuhlanganisa ukuphakama kwesibeletho, ukunyakaza kombungu, kanye nokudluliselwa kwe-ultrasound ngokulandelelana ukuze kuhlolwe ukukhula kanye noketshezi lwe-amniotic.
3. Uhlelo lokudlulisela oluhlelekile uma kutholakala izimpawu zokusha, ukwanda kwe-proteinuria, umfutho wegazi ophakeme, ukwehla kokusebenza kwezinso, noma imiphumela yokuqapha ingane engakazalwa kahle.
4. Ukwelashwa ngokubambisana, ukuqinisekisa ukuthi umama uthola ukwelashwa okuphephile kokukhulelwa futhi okungayeki umuthi wodwa.
5. Imfundo ejulile kanye nokwelulekwa, okuhlanganisa nokuhlela ukubeletha esikhungweni sokudlulisela esinamandla okubhekana nezingozi ezinkulu.
Ukuqaliswa (Izenzo) Zokunakekelwa Kwababelethisi
1. Ukunakekelwa Kwangaphambi Kokubeletha
Izindlela zokukhulelwa komama abane-lupus zifaka:
– Ukuqapha izimpawu ezibalulekile kanye nezimpawu zomtholampilo ekuvakasheni ngakunye: umfutho wegazi, ukukhuluphala, ukuvuvukala, izikhalazo zobuhlungu bamalunga/ukuqubuka/umkhuhlane.
– Ukuhlolwa kwezimpawu ze-preeclampsia: ikhanda elibuhlungu, ukubona okufiphele, isilungulela, i-proteinuria (uma ikhona), kanye nokusabela kokusabela komzimba.
– Imfundo yezempilo: ukubaluleka kokuphumula ngokwanele, ukugwema ukucindezeleka okukhulu, ukugcina amanzi emzimbeni, kanye nokunciphisa ukuchayeka elangeni ngokweqile uma kubangela ukuqubuka.
– Ukwesekwa kokudla okunempilo: ukudla okunomsoco okucebile ngamaprotheni asezingeni eliphezulu, i-iron, i-folate, i-calcium, kanye nosawoti onqunyelwe uma kukhona umfutho wegazi ophakeme/ukuvuvukala.
– Ukunamathela emithini: Ababelethisi bagcizelela ukuthi eminye imithi, njenge-hydroxychloroquine, ivame ukunconywa ukuthi iqhutshwe njengoba kuyalelwe udokotela ngoba isiza ekucindezeleni ukuqubuka kwesikhumba futhi ithuthukise imiphumela yokukhulelwa.
– Ukwelulekwa ngezimpawu zengozi: omama nemindeni kumele baqonde ukuthi kufanele baye nini ngokushesha esikhungweni sezempilo.
2. Ukunakekelwa Kwangaphambi Kokubeletha (Ukubeletha)
Ukubeletha komama abane-lupus kufanele kwenziwe endaweni ekwaziyo ukusingatha izinkinga. Amasu okubeletha ahlanganisa:
– Ukuqapha ngokucophelela umfutho wegazi, ukopha kwegazi, kanye nezimpawu zokucindezeleka.
– Ukuphathwa kobuhlungu nokukhathala ngendlela yokusekela, ngoba omama abane-lupus bathambekele ekukhathaleni.
– Lungela izinkinga ezifana ne-preeclampsia, ukushaqeka kwe-placenta, noma ukuphuma kwegazi ngemva kokubeletha uma ama-platelet ephansi.
– Ukubambisana ezinqubweni zezokwelapha uma kudingeka ukuqaliswa kokubeletha, ukuhlinzwa, noma ukuphathwa kwemithi ethile.
Umbelethisi uqinisekisa ukuthi i-partograph igcinwa, uhlola inqubekela phambili yokubeletha, futhi ngokushesha ubhekisela kuye uma kukhona ukuphambuka.
3. Ukunakekelwa Kwangemva Kokubeletha
Isikhathi sangemva kokubeletha yisikhathi esivame ukuba ne-lupus flares. Amasu okunakekela ngemva kokubeletha ahlanganisa:
– Ukuqapha izimpawu zokutheleleka nokopha, okuhlanganisa nokuhlola ukuguquka kwesibeletho kanye ne-lochia.
– Qaphela umfutho wegazi kanye nezimpawu zokusha kwesibindi, ikakhulukazi emasontweni okuqala.
– Ukusekelwa kokuncelisa: Iningi labesifazane abane-lupus lingancelisa, kodwa ukulungiswa kwemithi kungadingeka. Ababelethisi bangasiza omama ukuthi baxoxe ngokuphepha kwemithi nodokotela babo ngesikhathi sokuncelisa.
– Ukulawula ukukhathala: khuthaza ukwesekwa komndeni ukuze umama athole ukuphumula okwanele.
– Ukwelulekwa ngokuhlela umndeni: ukukhetha indlela ephephile ngokusekelwe esimweni sakho (isib., ukucabangela ingozi ye-thrombosis ngezindlela ezithile zama-hormone kanye nezimo zama-antibody e-antiphospholipid). Ukukhetha izindlela zokuvimbela inzalo kufanele kwenziwe ngokwelulekwa kanye nokubambisana nodokotela.
Ukunakekela Izinsana Zomama Abane-Lupus
Izingane zidinga ukubhekwa ngaphambi kwesikhathi, ukuzalwa zinesisindo esiphansi (i-LBW), kanye nezimpawu ze-lupus yezingane ezisanda kuzalwa (ukuqubuka, ukuphazamiseka kwegazi, noma izinkinga zenhliziyo). Uma umama aziwa ukuthi unama-anti-Ro/SSA noma ama-anti-La/SSB antibodies, ukuqapha inhliziyo yengane ngesikhathi sokukhulelwa kanye nokuhlolwa kwangemva kokubeletha kubalulekile. Ababelethisi badlala indima ekutholeni izimpawu zengozi ezinganeni ezisanda kuzalwa kusenesikhathi kanye nokuqinisekisa ukudluliselwa kudokotela wezingane uma kudingeka.
Ukuhlola kanye Nemibhalo
Ukuhlolwa kwenziwa njalo ukuze kutholakale ukuthi i-lupus isazinzile yini, ukuthi ngabe kukhona yini izinkinga zokubeletha, kanye nesimo somntwana osanda kuzalwa/umntwana. Imibhalo yokunakekelwa kumele iphelele: imiphumela yokuhlola, izinhlelo, izenzo, imfundo, kanye nempendulo kamama. Imibhalo emihle iqinisa ukuqhubeka kokunakekelwa phakathi kwababelethisi, odokotela, kanye nezikhungo zokudlulisela.
Isiphetho
Amasu okunakekela ababelethisi be-lupus adinga ukuqapha okukhulu kanye nendlela ephelele. Indima yombelethisi ihlanganisa ukuhlola okujulile, ukuqapha okuseduze, imfundo eqhubekayo, ukwesekwa kwengqondo, kanye nokubambisana phakathi kochwepheshe. Ngokuhlela ukukhulelwa okufanele, ukuqapha njalo, kanye nokudluliselwa ngesikhathi esifanele, abesifazane abaningi abane-lupus bangaba nokukhulelwa okuphephile kanye nokubeletha kokubili kumama nomntwana.
Uma ufisa, ngingaguqula lesi sihloko sibe yifomethi yephepha (isizinda-ukwakheka kwenkinga-ingxoxo-isiphetho) noma ngengeze uhlu lwezincwadi ngokwesitayela se-APA/Vancouver.
