Cerclage, Bedrest neMamwe Mishonga
Chirwere chekushaya chimiro chekodhi, chinonziwo cervical insufficiency, chinonyanya kuva chivharox chisina simba kana chakaipa kuti chigare chakavharwa panguva yekudzivirira. Nokudaro zvichiguma nekuberekwa nguva isati yasvika uye zvichida kurashikirwa kwechecheche, nekuda kwekuderedzwa kwemazuva ekupedzisira. Zvinotendwa kuti chirwere chechibereki chisina kukwana ndicho chinokonzera 20 kusvika ku25% yezvose zvechipiri-trimester kurasikirwa.
Izvi zvisingakwanisi zvinowanzoonekwa mukutanga kwechipiri chemamiriyoni matatu, asi zvichida kusvika pakupedzisira sekutanga kwetatu matatu.
Inowanzosarudzwa sevhudzi risati rapera remuromo wechiremera pasina kubatira kana kupesana. Kuongororwa kunogona kuitwa kana munhu kana kuti ultrasonography. Kushandiswa kwe ultrasonography kwave kuchibatsira zvikuru nekuongororwa uye kunoitwa apo kervical os (kuvhura) yakakura kupfuura 2.5 cm, kana urefu hwave hwakapfupika kusvika pasi pemaminitsi makumi maviri. Dzimwe nguva kunyorera kunoonekwa zvakare; iyi ndiyo iyo chikamu chemukati chechirwere, mukatikati (chikamu chechirwere pedyo nechecheche) chakatanga kupera. Iyo yekunze yega inenge isingabatsiri kana ichionekwa mune imwe nguva. Zviitiko zvinowedzera mukana wekutambura nemukati mutsara usina kukwana ndewe:
- DES exposure
- Cervical Trauma
- Hormonal influences
- Congenitally short brevix
- Vakamanikidzwa D & C
- Uterine anomalies
Kana iwe uchingororwa uine hutachiona hwechipiri-chetatu kana usati wava nepamuviri unofungidzirwa kuti iwe uchava nematambudziko nesimba remuviri wako, chirclage (kugadzirisa chivharo chakavharwa) kunogona kuitwa prophylactically kumavhiki anenge 14-16.
Zvinonzi iyo yekare iwe une cerclage yakaita kunyanya kuve nepamuviri yekuenderera mberi.
Nokuda kwekuongororwa kwakaitwa panguva yekuzvitakura, unofanira kusangana nezvimwe zvinotarisirwa usati waita cerclage. Iwe hauna kukodzerwa nekecclage kana une:
- Hyperirritability yemukati
- Mwana wako akatofa
- Iwe uri kudarika 4 cm
- Mvura yako yakaputsika
Kune nzira shanu dzakasiyana dzekuita cerclage. Iviri mbiri dzakawanda ndeyeMcDonald uye Shirodkar.
Nzira yeMcDonald inogadzirwa ne 5mm band ye suture yakagadziriswa yakaiswa kumusoro pamuviri. Izvi zvinoratidzwa apo pane kujekesa kukuru kwechikamu chezasi chechirwere. Inowanzobviswa pamasvondo makumi matatu nemasere, kunze kwekunge pane chikonzero chekuchibvisa kare, sehutachiona, kutanga kwebasa, kuparara kusati kwasvika pamakumbo, nezvimwewo. Zvinoratidzirwawo kuti izvi hazvina maturo zvakanyanya mukana wekuberekwa kwevakadzi.
Shirodkar inoshandiswawo nenzira inowanzoshandiswa. Zvisinei, izvi zvaimbova chikwama chisingagumi chekushandisa suture chinoramba chichigadzirisa hupenyu, zvino izvo zvinobviswa kwemavhiki makumi matatu nemaviri zvakare. Kana iri rudzi rwekecclage rwakaitwa, chikamu chekudzivirira chichagara chichiitwa. Kune vanachiremba vanoita maitiro akashandurwa, apo kubhadhara hakufaniri kuve nekuvhara, kana kuti suture yakasara yakakwana. Kumbira mushandi wako nzira yavanoita.
Hefner cerclage, inozivawo kuti nzira yeWurm, inoshandiswa pakuzongororwa hutachiona hwechirwere chisina kukwana. Inowanzoitwa neU kana mattress suture uye inobatsira kana pane zvishoma zvechirwere zvakasara.
Uterosacral cardinal ligament cerclage inowanzoitwa mushure mokunge McDonald uye Shirodkar zvigadziriswa, kana kuti kune chibereko chechirwere chinopfupiswa kana subacute cervicitis. Izvozvo zvinogona kuitwa mukati mese asi zvinowanzoitwa mumimba. Zvakare, kubhadhara kwemazuva ano kunotarisirwa kuberekwa.
Nzira yekupedzisira, iyo Lash, inoitwa munharaunda isina kubata. Inowanzoitwa mushure mekushungurudzika kwechirwere chechirwere chakakonzera kukanganisa kwemaatomical. Izvo zvinogona, kunyange zvisingawanzovi, chikamu chekushaya simba.
Kunyange zvazvo aya maitiro ari kuponesa upenyu, ivo vanewo ngozi dzinogona kuitika:
- Chorioamnionitis (Infection ye amniotic sac, 1-7%) (Iyi njodzi inowedzera apo mimba inowedzera uye iri 30% yemukirini inoputika kupfuura 3 cm.)
- Preterm Labor
- Kervical laceration kana kukwegura (Izvi zvinogona kunge zviri pakurongwa kana pakuberekwa, kubva pachivara chechivara chinoumba pamuviri.)
- Chirwere Chikuvadza (chisingawanzo)
- Maternal hemorrhage
- Cervical dystocia
- Uterine rupture
Iro yeprophylactic zvinowanzochengetedza murwere kwemaawa 24 asati agadzira cerclage. Munguva ino anozocherechedzwa nokuda kwebasa rekutanga uye kuongororwa kwehutachiona. Kazhinji, izvi zvinoitwa nemurwere muTendelenburg nzvimbo, tsoka pamusoro pemusoro wako. Mharapara anesthesia inoshandiswa kudzivirira marwadzo uye kubata pamuviri panguva yechikanda. Chidzara chako chichazadzwa kuedza uye kuendesa makumbo ako kubva kune os. Iwe uchapiwa mishonga inorwisa mabhakitiriya kubatsira kubvisa hutachiona, uye Indocin kubatsira muviri wako kusaremekedza ma prostaglandins akabudiswa panguva iyo.
Post-operatively iwe uchava pamubhedha wezororo kwemaawa 24 anotevera, zvichida muTendelenburg. Uye kuongororwa nokuda kwekuita uterine.
Kana uchinge wasunungurwa kubva kuchipatara iwe uchange uine zororo rekudzivirira (kwete zvepabonde) kune zvakasara zvepamuviri. Iwe uchada kuva nenguva yekuzorora zuva roga roga nekuderera kwekuita basa. Iwe uchaonekwa muhofisi kamwe chete kamwe chete kwevhiki kusvikira kuberekwa. Iwe uchazocherechedzwawo nokuda kwekutanga kwebasa. Kana uine chero zvipikisa iwe unofanira kuonana nachiremba wako pakarepo.
Chirwere chinoratidzika sechirwere chinoshanda zvikuru chechirwere chemukoko. Iko kubudirira kwamazinga kunogona kuva akakwirira zvikuru (80-90%), kunyanya kana yaitwa kare pakutanga pakuzvitakura. Kana uchinetseka pamusoro pehutano hwako husati waberekwa kana kuti unenge wakakanganwa chiremera chechivivha bvunza chiremba wako kuti akuongorore iwe.
Sources:
American College of Zvidzivirire uye Gynecologists (ACOG) Komiti yeKupedza Bulletins - Obstetrics. ACOG Practice Bulletin Nhamba 142: Kuchengetedza kwehutungamiri hwehutachiona husina kukwana. Obstetrics & Gynecology. 2014; 123: 372.
Berghella V, et al. Cervical insufficiency. http://www.uptodate.com/home. Yakasvika musi waDecember 24, 2015.
Obstetrics: Kazhinji uye Matambudziko Okugadzirira. Gabbe, S, Niebyl, J, Simpson, JL. Shanduro yechitanhatu.