Batsiro uye Ngozi dzeAmniotomy (Artificial Rupture of Membranes)
Iwe ungangodaro wakanzwa kuti kune nzira dzakawanda dzokuita basa (kana kuti rinomhanya naro). Imwe yenzira iyo vanhu vanowanzotaura nezvayo ndeyokuvhuna mvura yebhagi, iyo nzira inonzi "amniotomy" kana "kuputika kwezviputi" (AROM). Kutaura zvazviri, kuputsa bhagi remvura ndiyo kupindira kwebasa iro rave rakashandiswa nevachengeti vezvipembenene nevanyamukuta kwemakore anopfuura zana.
Kunyatsoshandiswa kwemamniotomy kunopararira pasi pose, uye nzira inoshandiswa nguva dzose mune dzimwe nzvimbo uye zvisingaiti kune vamwe.
Inogona kuputsa bhodhi remvura inobatsira kutanga kana kukurumidza kushanda, uye kana zvakadaro, inobata basa ripi? Ndezvipi zvinokonzera njodzi dzenzira yacho? Uye chii chaungatarisira kana ukasarudza kuti mvura yako ivhunike?
Kunzwisisa Amniotomy / Breaking the Bag of Water
Amniotic sac inotakura chibereko uye inogadzirisa amniotic fluid , mwana, uye placenta. Inopa zvipingamupinyi kune utachiona hwemwana wako panguva yekuzvitakura uye kumusimudzira mwana paunenge uchifamba. Iyo yakaumbwa neamnion uye chorion. Saka kuputsa mvura kunoshandisa sei kuita basa?
An amniotomy inogona kukweretesa kushanda mune zvose makemikari uye maitiro. Amniotic fluid ine makemikari uye mahomoni ayo, kana akasunungurwa, anofungidzirwa kuti afadze basa. Panyama, bhagi remvura rinogona kupa mukati pakati pemusoro wemwana nemukati.
Apo bhegi remvura rinoputsika (kufunga kuti musoro wemwana unoshandiswa zvakanaka kumuromo wechibereko) musoro wemwana unogona kupa zvakanyanya kuomesa pamuromo wechivi kuti ubatsire nekuderedza. Apo amniotomy inoshandiswa, inotarisirwa kuti nzira iyi ichasimbisa kukanganisa uye basa rinokurumidzira, nechinangwa chikuru chokuderedza basa.
Kune vanenge 10 muzana yevakadzi, bhegi remvura rinoputika pakarepo vasati vatanga basa. Kana AROM isati yaitwa, bhegi kazhinji inoputsa panguva pabasa panguva inoshanda, nguva ipi neipi pakati pekutanga kwebasa uye kubereka kwechecheche.
Kuvhuna Gumbo reMvura Kuti Ritsigire Basa
Panzvimbo pokuputsa pakarepo, bhegi remvura rinogona kuputswa nedare rezvokurapa kuti ritange kana kuwedzera basa. Ngatitarisei pane izvi zvakasiyana.
- Kunyunyuta: An amniotomy inogona kuitwa musati watanga basa kuti utange kana kuti kubvumira basa . Mune mamwe mamiriro ezvinhu, amniotomy inogona kushandiswa yoga, kunyange zvazvo kakawanda ichibatanidzwa ne IV Pitocin . Nzira dzakanakisisa dzekutanga kushanda (chero zvinoratidzika) dzinofanirwa nekufarirwa kwechirwere (ona pasi apa). Wih chirwere chakaisvonaka, nzira inoshanda zvikuru inowanzoshandisa kusanganiswa kweamniotomy uye Pitocin.
- Kuwedzera: An amniotomy inogonawo kuitwa mushure mekunge mudzimai atova mubasa, ane tariro yekukurumidza kana kuwedzera basa . (Dzidza zvakawanda pamusoro pehuwandu hwebasa rekushanda ). Kunyange zvazvo iyo isingaiti nguva dzose ichikurumidza, inogona kupa, mune dzimwe nguva, kuderedzwa kuduku mune zvinodikanwa pakuberekwa kwemazuva ano (kunyange mune dzimwe sangano).
Zvimwe Zvipo Zvokuvhuna Gomo reMvura
Mukuwedzera pakubatanidzwa kana kuwedzerwa kwebasa, kuputsa chirongo chemvura kunogona kuva nezvimwe zvinobatsira.
Kutora kutarisa: Kana mwana wako achida kuswedera pedyo, chiremba wako kana chiremba angada kubvisa bhagi rako remvura kuitira kuti izvi zvigoneke. An amniotomy inofanirwa kuti iite mukati mekuberekwa kwe fetal , sezvo gadziriro inofanirwa kuiswa pamucheche wemwana. Kuputsa bhagi remvura kunodiwa zvakare kuti uise intrauterine catheter . Mune nzira iyi, catheter inowanikwa mubereki kuitira kuti iwedzere kujekesa simba rezvipfeko zvako.
Kucherechedza kuvapo kweMeconium: Kuvhuna bhagi remvura kunogona kuratidza kuvapo kwemeconium -stained amniotic fluid.
Kana meconium inowanikwa neamniotomy, izvi zvinopa timu yako yekutarisira nguva yehutano kuronga matanho akakodzera, zvichienderana nehupamhi hwemeconium.
Nzira
Mushure mekuita chokwadi kuti unoziva nzira iyo uye unoita kuti chibereko chemuviri wako "chaibva" (ona pasi apa), chiremba wako kana nyamukuta achakuisa iwe kuti uite.
Sezvo bhagi rako remvura richisunungurwa, mukoti wako achaita kuti uve netauro dzakawanda dzakachena pasi pako.
Chiremba wako kana nyamukuta achazoita kuongororwa kwemadzimai kuitira kuti ave nechokwadi chokuti musoro wemwana unonyatsoshandiswa kumucheto wako. Kushandisa amnihook (iyo yakakura crochet hook type inopinza ine rutivi ruduku rwakapinza), kana an amnicot (gavhesi ine hook duku shoma pamagumo eimwe yeminwe), iyo inobata makumbo ako. Nokugadzira misodzi muhomwe, amniotic fluid inotanga kubuda.
Iko kunyatsoputsa kwebhegi remvura hakufaniri kuve kunorwadza kupfuura kuongororwa kwemadzimai nguva dzose kuti uone chibereko chechirwere. Inogona kusunungura mvura yakawanda, kana kuti, inogona kutanga sechinhu chiduku. Kazhinji iwe ucharamba uchinge uchinge uchinge uchinge uchinge uchinge uchinge wapera.
Mushure mekunge bhegi rako ravhuniwa, boka rako rebasa rinotarisa mwana wako uye rinoita kuti zvose zvive zvakanaka. Kana iwe uchange uchingomuka kuti uende, mukoti wako achakupa ganda rakakura rokunamatira kuti ubate mvura iyo inopfuurira.
Mushure mokunge mvura yako yavhuniwa unogona kuona kuti iwe unotanga kuva nezvipfeko kana iwe unganzwa sokuti mwana wako akambomira mberi mukati mako. Kana iwe uine zvipikisi mushure mekunge mvura yako yavhuniwa, iwe unganzwa kuwedzera kukura kwezvipfeko kana iwe unganzwa kuti hauna mutsauko zvachose.
Usati Waputsa Chikamu Chako CheMvura
Usati waita amniotomy kuti uite kana kuti uwedzere basa, chiremba wako achakutaurira pamusoro pekugadzirisa uye anokurukura nezvengozi uye zvinobatsira. Iye achaverenga zvakare kuti nzira iyo ichabudirira (yako yeBhishop's score) uye ona kuti hauna zvikonzero zvekuti sei chirongwa ichi chisingafaniri kuitwa (contraindications).
Kusarudza kana Cervix Yako "Inofadza" -Bishop's Score
Pamberi pebhagi rako remvura richaputsika kuti riite basa, chiremba wako achaverenga nhamba inozivikanwa sevhoti yeBhishop. Nhamba dzeBhishopi dzinopa kuongororwa kwe "kufanirwa" kwechirwere chako, iyo inogona kuenzanisa kana kuputsa bhogi rako remvura rinogona kutanga basa kana kwete.
Kana chibereko chechirwere chisingafadzi (kana iwe uine chikamu cheBhishop mushure mema 6), kudyidzana neamniotomy uye Pitocin kazhinji hazvikurudzirwe uye dzimwe nzira, zvakadai sokushandisa prostaglandin gel kana Cytotec (misoprostol) kubereka chibereko chemuviri wako chinogona kukurudzirwa panzvimbo iyo. Kana iwe unogona kungosarudza kumirira kusvikira chibereko chechirwere chako chiri nani.
Nhamba yeBhishopi yako inotarirwa nekupa nhaurwa kubva pakuburitswa kwechirwere chako, yako effacement (iyo yakapfava chibereko chako chakaita sei), nzvimbo yako ye fetal (kuti pasi yakadini iri mumapapiro ako), uye kusagadzikana uye nzvimbo. Nhamba ye8 kana kupfuura inoreva kuti chibereko chemuviri wako "chakanaka" uye kune mukanano wakanaka wokuva nemudzimai. Bhogi rako remvura harifaniri kuputsika kunze kwekuti nzvimbo yako ye fetal is 0, kana yakanaka.
Bishop's Score
| Cervical examination | 0 Points | 1 Point | 2 Points | 3 Points |
| Dilation (cm) | Yakavharwa | 1-2 cm | 3-4 cm | 5-6 cm |
| Kuparara (muzana) | 0-30 muzana | 40-50 muzana | 60-70 muzana | 80 muzana |
| Fetal station | -3 | -2 | -1, 0 | +1, +2 |
| Consistency | Simbisa | Medium | Soft | |
| Position | Posterior | Med | Anterior |
Zvikonzero Zvisina Kuita An Amniotomy (Zviratidzo)
Pane mishoma mamiriro ezvinhu umo bhagi remvura harifaniri kuputswa. Izvi zvinowanzonyatsooneka uye zvinogona kutsanangurwa nokudzokorora chiitiro chekusimbisa (panguva yechipiri chetatu kana kuti gare gare) nekuita chikadzi chekuongorora. Izvi zvinosanganisira:
- Nhaurirano yemazuva ano: Kana mwana ari breech kana imwe mifananidzo yakadai sechiso chekuratidzira kana brow presentation, bhegi haifaniri kuputsika.
- Kana musoro wemwana usina kubatanidzwa kana "kutenderera" pamuedzo. (Chimiro chekufuridzira che 0 chinoreva musoro wemwana wakabatanidzwa zvachose).
- Vasa previa: Vasa previa isingawanzoitiki iyo mishonga yeropa yemwana kubva pamaketeni kana umbilical inopfuura nepamuviri pasi pemucheche (izvi zvinogona kuonekwa paine chimiro chechidimbu munguva yechipiri chetatu).
Ngozi uye Matambudziko Anosangana Nekuvhuna Gomo reMvura (Amniotomy)
Pane zvipembenene zvishomanana zvinobatanidzwa neamniotomy, chero bedzi iwe une kamuviri akanaka uye mwana ari kubatanidzwa. Zvinetso zvinogona kusanganisira:
- Kukundikana kwebasa kuti utange: Basa rinogona kusangotanga nekuputsa gorosi remvura uye kushandisa Pitocin, asi panguva ino, iwe unowanzo "ita" kuti ugovera sezvo pane dambudziko duku rekutapukira iyo nguva refu bhegi ravhuniwa. (Apo mvura inopera pachayo isati yatanga basa, vanhu vazhinji vanoenda kubasa mukati maawa 24).
- Kuwedzera mu fetal kufungidzira: Kana musoro wemwana usingashandiswi zvakanaka kumuromo wechirwere, kubvarura bhagi remvura kunogona kuwedzera dambudziko rekukanganisa, uye nokudaro, rinotungamirira kumatambudziko nekuendesa.
- Cord prolapse (Mikana yekambo inopera, kana kuti umbilical cord inodonha mumudzimai pamberi pechecheche, yakaderera kana nzvimbo ye fetal is 0).
- Kushushikana kwekutsvaga: Kusinganzwisisiki, kuputsa gorosi remvura kunogona kukonzera kushungurudzika kwemwana.
- Kuwedzerwa mukurwadziwa (Kuwedzerwa kwekunzwa kurwadziwa hakusi kuoma, asi kunotarisirwa "kubatsirika" kana kuchibudirira, sezvo kutanga uye kufambira mberi kwebasa zvinozivikanwa kutungamirira kune kurwadziwa kwakawanda).
Kune ngozi inowedzera zvishoma yekusununguka kwekudzivirira kana kuputsa bheji remvura inogadziriswa kuti induction (C-chikamu chechikamu chinopera zvishoma kana zvichiitwa kuwedzera basa). Zvinofungidzirwa kuti zvimwe zvezviitiko izvi zvinokonzerwa nokuona kuvapo kweMeconium mushure mekuputsa gorosi, uye nenzira iyi, kuwedzerwa kwechikamu chechikamu cheC-C hazvizoiti sechinhu chakaoma. (Iine meconium yakaoma, chikamu cheC chinogona kuitwa kuitira kuti mwana asafirwa meconium panguva yekubereka).
Mibvunzo Yekubvunza Pamberi Kuputsa Mvura
Zvimwe zvezvinhu zvaunoda kuziva pamberi pokubvumirana kuti mvura yako yakaputsika inosanganisira:
- Ndichabvumirwa kufamba mushure mekunge mvura yangu yavhuniwa here?
- Ndinoda here kutarisa kuwedzera?
- Ndezvipi zviratidzo zvezvinetso zvauchazvitsvaga uye sei?
- Iwe unofunga kuti amniotomy ingashandura sei basa rangu?
- Pane humwe hupindiro hunogona kudiwa nekuda kweizvi?
- Ndezvipi zvimwe zvandinoshandisa?
- Ndine nguva yekuita sarudzo iyi here?
Pasi Pano paKuvhuna Gomo Rako Remvura Kuti Uwane Basa Rokushanda
Vashandi vezvokuvhiya vakashandisa amniotomy kana kuputsa gorosi remvura kuti vashandise basa kuti vatange kana kufambira mberi nekukurumidza kwezana remakore, kunyange tisina chokwadi chekuti chinangwa ichi chinoita sei. Kakawanda, njodzi iduku kune avo vakambova nechirongwa chekusimbisa (kutonga kunze kwevasa previa), kana mwana akabatanidzwa zvakanaka, uye kana kuberekwa kunoitika maawa masere kana kupfuura. Kana yakashandiswa pakugadziriswa kwebasa, kuputsa bhagi remvura inowanzoshandiswa pamwe ne pitocin kuvakadzi vane chirwere chinokodzera.
Kana uchitarisa kubatsiri kana kukanganisa kwekupindira kwebasa, zvakakosha kuongorora njodzi dzinogona kuitika kune zvinogona kubatsira. Isu tinoziva kuti kutakura kunoenderera kwevhiki kana kupfuura kupfuura zuva rakakodzera kunogona kukonzera matambudziko, uye kuburitsa inzira imwe yekuderedza dambudziko iri.
Kuputsa bhagi remvura kunokoshawo kana kuswededzwa kwekukwanisa kutarisa nekunze kwe fetal monitor uye / kana intrauterine kuongororwa kunoridzirwa.
Mimba yose inenge yakasiyana uye zvakakosha kuti mukadzi anoshanda nemudzidzisi wake kuti aone zvakakosha kwaari somunhu oga. Zvakakosha kutora nhoroondo yako yese yezvokurapa, nyika yemukirini yako, uye zvaunofarira.
> Sources:
> American College yeVadzidzi uye Gynecologists. Nzira Dzokukwanisa Kupindira Kupindira Panguva Yebasa uye Kuberekwa. 2017. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Komiti-on-Obstetric-Practice /Approaches-to-Limit-Intervention-During-Labor-and-Birth
> Cunningham, F. Gary, naJohn Whitridge Williams. Williams Obstetrics. New York: McGraw-Hill Dzidzo yeMari, 2014. Print.
> Smyth, R., Markham, C., naT. Dowswell. Amniotomy yekuderedza Basa reSvondo. Cochrane Database yekuongorora kwakarongeka . 2013. (6): CD006167.
> Wei, S., Wo, B., Qi, H. et al. Kutanga Amniotomy uye Early Oxytocin yekudzivirira, kana kuti Therapy,, Delay in First Stage Labor Evangelism Compared with Routine Care. Cochrane Database yekuongorora kwakarongeka . 2013. (8): CD006794.