Mimba yachisanu

Mimba yachisanu ndi imodzi mwazovuta zazikulu zazachikazi komanso zachikazi. Tsoka ilo, mkazi aliyense akhoza kukumana ndi matenda. Zoyenera kuchita pankhaniyi komanso mukatha kukonzekera mimba kachiwiri, timathana nazo katswiri wazachipatala Marina Eremina.

Kodi mimba yachisanu ndi chiyani

Pali mawu angapo omwe amafotokoza mkhalidwe womwewo: kupititsa padera, mimba yosakula ndi padera. Onse amatanthauza chinthu chimodzi - mwana m'mimba anasiya kukula mwadzidzidzi (1). Ngati izi zidachitika kwa milungu 9, amalankhula za imfa ya mwana wosabadwayo, mpaka milungu 22 - mwana wosabadwayo. Pankhaniyi, padera sizichitika, mwana wosabadwayo amakhalabe mu uterine.

Madokotala ambiri amavomereza kuti 10-20 peresenti ya oyembekezera onse amafa masabata oyambirira. Panthawi imodzimodziyo, amayi omwe apeza mimba yosakula nthawi zambiri amanyamula mwana popanda mavuto m'tsogolomu. Komabe, pali zochitika pamene mimba ziwiri kapena kuposerapo motsatira amaundana. Kenako madokotala amalankhula za chizolowezi chopita padera, ndipo kuzindikira kotereku kumafuna kuyang'aniridwa ndi chithandizo.

Zizindikiro za mimba yachisanu

Mayi amalephera kudzizindikira ngati mimba yasiya kapena ayi. Kutaya kwamagazi ambiri, monga kupita padera, kulibe, kulibe ululu. Kaŵirikaŵiri wodwalayo amamva bwino kwambiri, ndipo m’pamene zimamupweteka kwambiri kumva zimene dokotala wamutsimikizira.

Nthawi zina mutha kukayikirabe vuto. Zizindikiro zotsatirazi ziyenera kukhala tcheru:

• kutha kwa nseru;
• kutha kwa engorgement m'mawere;
• kusintha kwa chikhalidwe; nthawi zina kuwoneka kwa magazi daub.

- Tsoka ilo, palibe zizindikiro za mimba yomwe yaphonya, ndipo ndi ultrasound yokha yomwe ingathe kudziwa bwino. Zizindikirozi ndizodziwikiratu. katswiri wazachipatala Marina Eremina.

Ndi zizindikiro izi, madokotala amalangiza kuchita ultrasound, kokha pa ultrasound mukhoza kudziwa ngati mluza wachisanu kapena ayi. Nthawi zina zida zachikale kapena katswiri wodziwa bwino amatha kulakwitsa, chifukwa chake madokotala amalangiza kuti ayesedwe ndi ultrasound m'malo awiri bwino ndi kusiyana kwa masiku 3-5-7), kapena nthawi yomweyo sankhani chipatala chokhala ndi luso lamakono komanso oyenerera kwambiri. madokotala.

Katswiri wa ultrasound amazindikira kuti wasowa mimba ndi zizindikiro zotsatirazi:

• kusowa kwa kukula kwa dzira la fetal mkati mwa masabata 1-2;
• kusowa kwa mwana wosabadwayo ndi kukula kwa dzira la fetal osachepera 25 mm;
• ngati coccyx-parietal kukula kwa mwana wosabadwayo ndi 7 mm kapena kuposa, ndipo palibe kugunda kwa mtima.

Nthawi zina muyenera kuyezetsa magazi kangapo kwa hCG kuti muwone ngati mulingo wa mahomoniwa ukusintha. Ndi mimba yachibadwa, iyenera kuwonjezeka.

Achisanu oyambirira mimba

Chiwopsezo cha kuphonya mimba chimakhala chachikulu kwambiri mu trimester yoyamba.

"Nthawi zambiri, kuperewera kwa mimba kumachitika kumayambiriro, pa masabata 6-8, nthawi zambiri pambuyo pa masabata 12 a mimba," akutero katswiri wa zachipatala.

Chotsatira choopsa chotsatira pambuyo pa trimester yoyamba ndi masabata 16-18 a mimba. Nthawi zambiri, kukula kwa mwana wosabadwayo kumayima pambuyo pake.

Zifukwa za mimba yozizira

Mayi amene angamve zimenezi angaganize kuti pali vuto lina lake. Komabe, madokotala amatsimikizira kuti 80-90 peresenti ya mimba yomwe inaphonya imachitika chifukwa cha mluza womwewo, kapena m'malo mwake, chifukwa cha zolakwika zake. Monga momwe zinakhalira, mluza unapezeka kuti sungathe kukhalapo. The grosser the pathology, m'pamene mimba imafa msanga. Monga lamulo, mwana wosabadwayo amafa kwa milungu 6-7.

Zomwe zimayambitsa padera zimangokhudza 20 peresenti ya milandu (2). Zifukwa izi zimagwirizana kale ndi mayi, osati ndi mwanayo.

Chomwe chingakhale choyambitsa padera.

1. Kuphwanya magazi coagulation dongosolo, zosiyanasiyana thromboses, komanso antiphospholipid syndrome, imene magazi coagulates kwambiri mwachangu. Chifukwa cha zimenezi, latuluka sangathe kulimbana ndi ntchito zake zopatsa thanzi mwana wosabadwayo, ndipo m’tsogolo mwanayo akhoza kufa.

2. Kulephera kwa mahomoni. Kusalinganika kulikonse, kaya kusowa kwa progesterone kapena kuchuluka kwa mahomoni achimuna, kumatha kusokoneza kukula kwa mwana wosabadwayo.

3. Matenda opatsirana, makamaka matenda opatsirana pogonana, cytomegalovirus, rubella, fuluwenza ndi ena. Ndizowopsa kwambiri kuzigwira mu trimester yoyamba, pamene ziwalo zonse ndi machitidwe a mwana wosabadwa amaikidwa.

4. Kusintha kwa chromosomal kwa makolo. Zikumveka zovuta, koma kwenikweni ndi ichi - majeremusi maselo a makolo ali pathological ya ma chromosome.

Udindo wofunikira umasewera ndi moyo wa mkazi, komanso msinkhu wake. Chiwopsezo chokhala ndi mimba yosakula chimawonjezeka kumapeto kwa zaka zobereka. Ngati ali ndi zaka 20-30 ali pafupifupi 10%, ndiye kuti ali ndi zaka 35 ali kale 20%, ali ndi zaka 40 - 40%, ndipo pa 40 amafika 80%.

Zifukwa zina zomwe zingayambitse mimba yosowa:

• kugwiritsa ntchito khofi (makapu 4-5 patsiku);
• kusuta;
• kumwa mankhwala enaake;
• kusowa kwa folic acid;
• kupsinjika mwadongosolo;
• mowa.

Pali zifukwa zingapo zomwe zimaganiziridwa molakwika kuti ndizo zomwe zimayambitsa kuperewera kwa mimba. Koma sichoncho! Sichingakhale chifukwa:

• kuyenda pandege;
• kugwiritsa ntchito njira zakulera asanatenge mimba (kulera kwa mahomoni, ma spirals);
• zolimbitsa thupi (ngati mkaziyo adalowa nawo masewera munjira yomweyo asanatenge mimba);
• kugonana;
• kuchotsa mimba.

Zoyenera kuchita ndi mimba yachisanu

Ngati muli ndi zaka zosakwana 35 ndipo iyi ndi nthawi yanu yoyamba yopita padera, madokotala amalangiza kuti musakhumudwe kapena kuchita mantha. Nthawi zambiri izi zimachitika mwangozi, ndipo kuyesa kwanu kotsatira kukhala mayi kumatha kubadwa kwa mwana wathanzi. Tsopano chinthu choyamba kuchita ndi kuchotsa dzira la fetal opaleshoni kapena mankhwala.

Panthawi imeneyi, mkazi amafunikira thandizo la okondedwa. Choncho musasunge malingaliro anu mwa inu nokha, kambiranani zakukhosi ndi mwamuna wanu, amayi, bwenzi lanu.

Kuti mukhale ndi mtendere wamumtima, sikudzakhala kofunikira kuyezetsa matenda odziwika bwino - onse omwe amapatsirana pogonana, chimfine ndi matenda ena. Ngati palibe chomwe chimapezeka, mukhoza kutenga mimba kachiwiri.

Chinthu china ngati ichi ndi chachiwiri kapena kuposa mimba anaphonya, ndiye muyenera kupeza zomwe zimayambitsa vutoli ndi kuwathetsa.

Mimba pambuyo mazira mazira

Mimba yozizira 一 nthawi zonse imakhala chifukwa chachisoni. Koma patapita nthawi, mkaziyo amachira ndipo akuyamba kukonzekera njira yatsopano yobereka mwanayo. Mutha kutenganso pakati pakadutsa miyezi 4-6 (3). Panthawi imeneyi, m'pofunika kuchira osati mwakuthupi, komanso m'maganizo. Kupatula apo, mkaziyo adamva kuti ali ndi pakati, ndipo mawonekedwe ake a mahomoni adasintha. 

anati:

• kusiya kusuta ndi mowa;
• musagwiritse ntchito mankhwala omwe ali ndi caffeine;
• musadye zakudya zamafuta ndi zokometsera;
• kuchita masewera;
• kuyenda pafupipafupi.

Zimatenganso nthawi kuti endometrium ikhale yokonzeka kuvomereza dzira la fetal. 

Musanayambe kukonzekera mimba yatsopano, m'pofunika kuyesedwa angapo:

1. Onani kukhalapo kwa zinthu zovulaza: mankhwala, chilengedwe, matenda, etc.
2. Kuphunzira cholowa cha achibale. Kaya panali milandu ya kutaya mimba, thrombosis, matenda a mtima kapena sitiroko ali wamng'ono.
3. Yezetsani matenda opatsirana pogonana, mahomoni komanso kutsekeka kwa magazi.
4. Funsani katswiri wa chibadwa.
5. Pangani ultrasound ya ziwalo za m'chiuno.
6. Unikani kuyanjana kwa mabwenzi.

Nthawi zambiri, chithandizo sichifunikira, chifukwa kupita padera nthawi zambiri kumachitika chifukwa cha zolakwika za chibadwa. Komabe, ngati izi sizichitika kwa nthawi yoyamba, kukaonana ndi dokotala ndi kuika chithandizo chapadera kumafunika. 

Kutenga mimba kale kuposa miyezi inayi pambuyo pa mimba yophonya kumalefulidwa kwambiri, ngakhale kuti n'zotheka. Thupi liyenera kuchira mokwanira kuti asaphatikizepo vuto lobwerezabwereza la kupita padera. Choncho, njira zodalirika za kulera ziyenera kugwiritsidwa ntchito. Ngati mimba ichitika, muyenera kukaonana ndi dokotala ndikutsatira malangizo ake onse. 

Mayeso ofunikira

Ngati mwataya ana awiri kapena kuposerapo, muyenera kufufuza mosamala. Nthawi zambiri, madokotala amalimbikitsa mndandanda wa mayeso ndi njira zotsatirazi:

• karyotyping ya makolo ndiko kusanthula kwakukulu komwe kudzawonetsa ngati okwatiranawo ali ndi vuto la majini; - kusanthula kwa magazi coagulation system: coagulogram (APTT, PTT, fibrinogen, prothrombin time, antithrombin lll), D-dimer, kuphatikizika kwa mapulateleti kapena thrombodynamics, homocysteine, kuzindikira zakusintha kwa majini a coagulation system;
• HLA-typing - kuyesa magazi kwa histocompatibility, komwe kumatengedwa ndi makolo onse awiri; - TORCH-zovuta, zomwe zimazindikira ma antibodies ku herpes, cytomegalovirus, rubella ndi toxoplasma;
• kufufuza matenda opatsirana pogonana; - kuyezetsa magazi kwa mahomoni: androstenediol, SHBG (mahomoni ogonana omwe amamanga globulin), DHEA sulfate, prolactin, testosterone yonse komanso yaulere, FSH (follicle-stimulating hormone), estradiol, ndi mahomoni a chithokomiro: TSH (chithokomiro cholimbikitsa mahomoni), T4 (thyroxine) T3 (triiodothyronine), thyroglobulin.

Ngati kusanthula kukuwonetsa vuto la coagulation, mungafunikire kukaonana ndi hemostasiologist, ngati ndi genetics - geneticist, ngati ndi mahomoni - gynecologist ndi endocrinologist.

Mwina mnzanuyo adzayenera kukaonana ndi andrologist ndikupambana mayeso angapo.

- Zodabwitsa ndizakuti, chifukwa cha kuphonya mimba nthawi zambiri ndi mwamuna. Izi sizichitika chifukwa cha zizolowezi zoipa, monga mowa ndi kusuta fodya, komanso kuperewera kwa zakudya m'thupi, mwachitsanzo, kugwiritsa ntchito mankhwala otsika kwambiri, moyo wongokhala, ndi zifukwa zina zambiri, zimamveketsa bwino. katswiri wazachipatala Marina Eremina.

Mwamuna amalangizidwa kuti apange spermogram yotalikirapo ndipo, ngati teratozoospermia ilipo pakuwunika, ndiye kuti ayesedwenso pakugawanika kwa DNA mu spermatozoa kapena kuyezetsa kwa electron microscopic ya spermatozoa - EMIS.

Pafupifupi njira zonsezi zimalipidwa. Kuti asapite wosweka, kupereka iwo onse, mverani malangizo a dokotala. Malingana ndi mbiri yanu yachipatala, katswiriyo adzadziwa kuti ndi mayesero ati omwe ali ofunika kwambiri.

Tsoka ilo, pali nthawi zina pomwe madokotala satha kupeza chomwe chayambitsa vutoli.

Kodi ntchito yoyeretsa ndi yotani?

Ngati mimba imasiya kukula ndipo palibe padera, dokotala ayenera kutumiza wodwalayo kuti ayeretsedwe. Kukhalapo kwa mwana wosabadwayo kwa masabata oposa 3-4 mu chiberekero ndi owopsa kwambiri, kungayambitse magazi ambiri, kutupa ndi mavuto ena. Madokotala amavomereza kuti musayembekezere kuchotsa mimba mowiriza, ndi bwino kuchita curettage mwamsanga.

Izi zitha kukhala vacuum aspiration kapena kuchotsa mimba ndi mankhwala omwe angalole kuti mwana wosabadwayo atulutsidwe popanda opaleshoni.

"Kusankha njira ndi munthu payekha, malingana ndi nthawi imene mimba inasiya kukula, pa kukhalapo kwa contraindications kwa njira imodzi kapena ina, kukhalapo kwa mimba ndi kubereka m'mbiri, ndipo, ndithudi, chikhumbo cha mkazi mwiniwake. zimaganiziridwa,” akufotokoza motero katswiri wazachipatala Marina Eremina.

Choncho, kuchotsa mimba kuchipatala, mwachitsanzo, sikuli koyenera kwa amayi omwe ali ndi vuto la adrenal insufficiency, pachimake kapena kulephera kwaimpso, uterine fibroids, kuchepa kwa magazi m'thupi, matenda otupa a chiberekero cha ubereki.

Njira yopangira opaleshoni yochotsera mimba mpaka masabata 12 m'dziko lathu ndi vacuum aspiration, pamene dzira la fetal limachotsedwa pogwiritsa ntchito kuyamwa ndi catheter. Njirayi imatenga mphindi 2-5 ndipo imachitidwa pansi pa anesthesia wamba kapena wathunthu.

Curettage ndi njira yomwe siimakonda kwambiri ndipo iyenera kugwiritsidwa ntchito pokhapokha ngati pali minofu yomwe yatsala mu chiberekero pambuyo pa vacuum aspiration.

Pambuyo kuyeretsa, zomwe zili m'chiberekero zimatumizidwa ku kafukufuku wa histological. Kusanthula uku kudzakuthandizani kumvetsetsa zomwe zimayambitsa mimba yophonya ndikupewa kubwereza zomwe zikuchitika m'tsogolomu.

Komanso, mkazi akulimbikitsidwa kukumana njira kuchira. Zimaphatikizapo mankhwala oletsa kutupa, kumwa mankhwala opweteka, mavitamini, kusachita masewera olimbitsa thupi komanso kupuma bwino.

Ngati munamva koyamba za matenda a "mimba yosowa" kuchokera kwa dokotala, zikutheka kuti kuyesa kotsatira kukhala ndi mwana kudzapambana. Nthawi zambiri zinali ngozi yanthawi imodzi, zolakwika zamtundu. Koma ngakhale akazi, amene ali kale wachiwiri kapena wachitatu anaphonya mimba, ali ndi mwayi uliwonse kukhala mayi.

Chinthu chachikulu ndicho kupeza chifukwa cha vutoli, ndiyeno - kufufuza, chithandizo, kupuma ndi kukonzanso. Njirayi ikadutsa, muyenera kuchita ultrasound ya ziwalo za m'chiuno ndikuwonetsetsa kuti endometrium imakula molingana ndi kuzungulira, palibe ma polyps, fibroids kapena kutupa m'matumbo a uterine, pitani kwa dokotala ndikuchiza matenda omwe alipo. . Mofananamo, muyenera kukhala ndi moyo wathanzi, kutenga kupatsidwa folic acid ndikudya zakudya zopatsa thanzi, zonsezi zidzakulitsa mwayi wanu woyembekezera m'tsogolo ndikubereka mwana wathanzi.

Mbali za msambo pa nthawi imeneyi

Pambuyo pa kutha kwa mimba, msambo udzabwerera kwa mkazi. Nthawi zambiri, amabwera masabata 2-6 pambuyo ndondomeko. Ndikosavuta kuwerengera nthawi yofika yamasiku ovuta. Tsiku lochotsa mimba limatengedwa ngati tsiku loyamba, ndipo mawuwo amawerengedwa kuchokera pamenepo. Mwachitsanzo, ngati mayi ali ndi chikhumbo cha vacuum pa November 1, ndipo kuzungulira kwake ndi masiku 28, nthawi yake iyenera kubwera pa November 29. Kuchedwa kungayambitsidwe ndi kulephera kwa mahomoni. Msambo pambuyo pa ndondomeko vakuyumu adzakhala osauka kuposa masiku onse, popeza mucous nembanemba sadzakhala ndi nthawi kuchira kwathunthu.

Ngati mkazi anali "curettage", ndiye kuti chiberekero chikhoza kukhala chopweteka kwambiri, kotero kuti msambo ukhoza kusakhalapo kwa miyezi iwiri kapena kuposerapo.

Panthawiyi, mkazi ayenera kusamala kwambiri ndikudziteteza, chifukwa thupi silinakonzekere kutenga mimba yachiwiri.

Ngati muwona kuti nthawi yanu mutatha kuyeretsa ndi yotalika kuposa momwe mumayembekezera ndipo ikuwoneka ngati magazi, onetsetsani kuti mufunsane ndi dokotala, izi zikhoza kukhala chizindikiro cha kutupa.

Mafunso ndi mayankho otchuka

Magwero a

1. Stepanyan LV, Sinchikhin SP, Mamiev OB Mimba yosakula: etiology, pathogenesis // 2011
2. Manukhin IB, Kraposhina TP, Manukhina EI, Kerimova SP, Ispas AA Mimba yosakula: etiopathogenesis, matenda, chithandizo // 2018
3. Agarkova IA Mimba yosakula: kuwunika kwazomwe ziwopsezo ndi zomwe zimachitika // 2010