ʻO ke kūlohelohe i ka maʻi hānai he hana ia e ʻike nui ʻia i nā lāʻau lapaʻau. I ka honua, aia he 2-3 mau wahine no ka 100 mau wahine hāpai i loaʻa he pakanā o ka metabolism. Ma muli o kēia pathology e hōʻeha ai i ka nui o nā hoʻopiʻi o ka obstetric a hiki ke hoʻopilikia i ka olakino o ka makuahine ʻokoʻa a me ka pēpē, a hiki hoʻi i ka make i ka make, ʻo ka wahine hāpai i ka manawa o ka wā o ka gestation (gestation) ma lalo o ka kāohi o ka gynecologist a me ka endocrinologist.
Nā ʻano maʻi maʻi i ka wā hāpai
Ma ka maʻi mellitus (DM), e piʻi ka ʻikepili o ke koko. Ua kapa ʻia kēia ʻano hoʻohālikelike, hyperglycemia, ma muli o kahi hana ʻole i ka pancreas, ma ke ʻano o ka hōʻemi ʻana o ka testosterone. Hoʻopilikia nui ka Hyperglycemia i nā kino a me nā ʻili, e hoʻihoʻi i ka metabolism. Hiki i nā maʻi diabetes ke hiki i nā wahine ma mua o ko lākou wā hāpai. I kēia hihia, ulu nā ʻano maʻi like i ka maʻi me nā māmā e kali nei.
- ʻO ka maʻi diabetes mellitus 1 (ke hilinaʻi-insulin). Loaʻa ia ma kahi kaikamahine i ke wā kamaliʻi. ʻAʻole hiki i nā selana o kāna pancreas ke hoʻopuka i ka nui o ka insulin, a i mea e ola ai, pono ia e hoʻopiha i ka hemahema o kēia hormon maʻamau i kēlā me kēia lā ma ke komo ʻana i loko o ka ʻōpū, scapula, wāwae a i ʻole lima.
- ʻAno maʻi type 2 (non-insulin dependant). ʻO nā kumu i kumu ai ia genis predisposition a me ka momona. Ke puka nei kēlā me kēia maʻi ma ka wahine ma hope o ke kau he 30, no laila ke poʻe ka poʻe i koho i ke kau a kau i ke kua i 32-38 mau makahiki, ua loaʻa kēia maʻi i ka wā e hali ai kā lāua keiki mua. Me kēia pathology, kahi nui o ka insulin e hoʻoneʻe, akā hoʻopili ʻia kāna pilina me nā ʻāpana, kahi e piʻi ai ka nui o ka glucose i ke kahe koko.
ʻO ke kūlohelohe i ka maʻi hānai he hana ia e ʻike nui ʻia i nā lāʻau lapaʻau.
I ka 3-5% o nā wāhine, ulu ka maʻi i ka wā o ka wā hiki mai ka maʻi. Ke kapa ʻia nei kēia ʻano ʻano maʻa gestational diabetes mellitus a i ʻole GDM.
ʻO ka maʻi maʻi gestational
ʻO kēia ʻano o ka maʻi i ʻole nā wahine hāpai wale nō. Loaʻa ia ma 23-28 mau pule o ka huaʻōlelo a pili pū me ka hana ʻana o ka plasenta o nā hormone pono e pono ai ka pēpē. Inā hana kēia mau hormones i ka hana o ka insulin, a laila piʻi ka nui o ke kō i loko o ke koko o ka mea manaʻolana ka nui, a ulu ka maʻi diabetes.
Ma hope o ka lawe ʻana, hoʻi mai nā loina glucose koko i ka maʻamau a hele a maʻi ka maʻi, akā e huli pinepine ʻia i ka wā o ka hapai e hiki mai ana. Hoʻonui ʻo GDM i ka pilikia o ka hoʻolālā ʻana i ka wā i kahi wahine a i kāna pēpē o ka maʻi type 2.
Hoʻololi ka maʻi maʻi gestational i nā wiki 23-28 o ka huaʻōlelo a pili pū me ka hana o ka plasenta o nā hormone pono e pono ai ka pēpē.
Hoʻokomo paha ke ʻano o ka maʻi i ka hiki ke hānau?
Ma kēlā me kēia ke hāpai ʻia ka hopena ʻē aʻe, no ka mea ua hoʻāhewa ʻia e nā mea like e like me ka makahiki a me ke kūlana o ke olakino o ka makuahine, kona ʻano anatomical, ke ʻano o ke kuʻi ʻana, nā mea āpau ʻelua.
He paʻakikī ka ola me ka maʻi maʻi ma ka wahine hāpai, a ʻo ia ke hōʻa ʻole pinepine i ke keiki ma mua o ka hopena o kona wā. Me kahi ʻano hilinaʻi o ka insulin a i ʻole a i ʻole like me ka like ʻole o ka maʻi o ka maʻi, 20-30% o nā wahine e loaʻa i kahi kuhi ma nā keiki he 20-27 o ka hoʻomana. I nā wahine hāpai aʻe, ʻo ia hoʻi a ʻo ka poʻe e ʻeha ʻia ka pathology gestational hiki ke loaʻa i ka hānau mua. Inā nānā mau ʻia ka makuahine e manaʻo nei e nā loea a me ka hahai i kā lākou mau ʻōlelo a pau, hiki iā ia ke hoʻopakele i ke pēpē.
Me ka nele o ka insulin i ka kino wahine, hiki i ka pūpū ke make ma hope o 38-39 mau pule o ka hapai, no laila, inā ʻaʻole i hiki mai ka lawe mua ʻana o ka preterm ma mua o kēia manawa, ua hana pilikino lākou i nā lā 36-38 o gestation.
ʻO nā contraindications nui no ka hāpai ʻana a me ka hānau ʻana
Inā hoʻolālā kekahi wahine me ka maʻi hānai e loaʻa kahi pēpē, pono ʻo ia e kamaʻilio mua i ke kauka i ka wā mua a kūkā pū me ia no kēia pilikia. Nui nā mana contraindications e noʻonoʻo:
- ʻO kahi kūlana koʻikoʻi o ka maʻi e paʻakikī ana e ka retinopathy (hōʻino ʻia ka maʻi o ka wīkī) a i ʻole nephropathy maʻi maʻi (hōʻeha i nā ʻalaka renal, tubules a me glomeruli).
- ʻO ka hui pū ʻana o ka maʻi a me ka maʻi pāpaʻi pulmonary.
- ʻO ke kulekele Insulin-kūloko (ʻo ka mālama ʻana me ka insulin ka mea pono ʻole, i.e. ʻaʻole ia e alakaʻi i ka holomua).
- ʻO ka heleʻana i kahi wahine o kahi keiki me ka hoʻomālamalama.
ʻAʻole kūkā ʻia he mau keiki no nā kāne inā inā lākou e loaʻa ka maʻi o ke ʻano 1 a i ʻole 2, no ka mea hiki ke hoʻoili ʻia e ke pēpē. ʻO nā maʻi nā hihia kahi i pau ai ka hānau mua ma ka hānau ʻana o kahi keiki make.
No ka hiki ke hoʻomau nā wahine hāpai i ka GDM, pono ka loaʻa ʻana o nā makuahine āpau i ka hoʻoliʻu koko koko ma hope o nā 24 wiki o ka maʻi.
Inā ʻaʻohe palena i ka hāpai ʻana, e kipa mau kahi wahine ma hope o kāna hoʻomaka ʻana i nā loea a hahai i kā lākou mau manaʻo.
No ka hoʻomaka ʻana o nā wahine hāpai i ka GDM, pono ka loaʻa ʻana o nā makuahine āpau i ka hoʻokaʻa koko koko ma hope o 24 mau wiki o ka hoʻomaka ʻana i mea e hōʻoia ai a hōʻole ʻia paha ka hele ʻana o ka maʻi.
Ma nā lāʻau lapaʻau, aia kekahi mau manawa e hoʻopau ai i ka male ma mua o nā hebedoma 12. Hoʻomaʻamaʻa ʻia kēia i kekahi manawa me Rh sensitization (kue me ka hewa i ka hewa o Rh factor o ka makuahine a me ke keiki kūpono, i ka wā e kūkulu ai ka makuahine i nā antibodies i ka fetus). Ma muli o ke ʻano o ka naʻau, i hānau ʻia ke keiki me nā mea hewa a me nā maʻi puʻuwai a me nā puʻuwai a make a i ʻole ma ka ʻōpū. Hoʻoholo ʻia ka hoʻoholo ʻana e hoʻopau i ka hāpai ʻana ma kahi kūkā ʻana e kekahi mau loea.
He aha ka pilikia o ka maʻi maʻi no ka hoʻouluʻana o nā keiki?
I ka hoʻomaka ʻana o ka wā hāpai, pili ka hyperglycemia i ka hoʻokumu a me ka hoʻomohala ʻana o nā kino o nā keiki. Hoʻopilikia kēia i nā puʻuwai naʻau congenital, abnormalities o ka ʻōpū, hōʻino ikaika i ka lolo a me nā keiki. Ma 20% o nā hihia, ulu nā maʻi hānai maikaʻi i lalo (ʻo ke ʻano i ka hoʻomohala ʻana i ka noʻonoʻo a me ke kino).
Hānau nā wahine maʻi hānai i nā keiki me ke kaumaha nui o ke kino (mai ka 4500 g), no ka mea I nā pēpē, loaʻa i ke kino ka nui o ke kiko adipose. I nā pēpē hou, ma muli o nā pohihihi momona, aia kahi maka poepoe, puni ka ʻāpana o ka nui, a he ʻulaʻulaʻula ka ʻili o ka ʻili. Ke ulu mālie nā pēpē i nā mahina mua o ke ola, hiki ke lilo i ke kaumaha o ke kino. Ma 3-6% o nā hihia, hāpai nā pēpē i ka maʻi maʻamau inā ua loaʻa kekahi o nā mākua iā ia, ma 20% o nā hihia ke hoʻoili nei ke keiki i ka maʻi, inā ua pilikia ka makua kāne a me ka makuahine.
ʻO nā hopena o ka hypoglycemia
I ka 85% o nā hihia, nā keiki o nā wahine me ka maʻi maʻi i nā hola mua o ke ola e hoʻomohala i ka hypoglycemia (kahi hōʻemi i ka glucose o ke koko). ʻO ka nāu hou o ka pēpē, loaʻa iā lākou ke kaumaha o ka naʻau, ka uka, tachycardia a me ka hopu o ka hanu pōkole. Me ka ʻike manawa kūpono o ka pathology a me ka infusion injection i nā glucose i nā pēpē, nawala hypoglycemia ma hope o 3 mau lā me ka hopena ʻole. I nā hihia hōʻemi, e alakaʻi ka maʻi i nā maʻi neurological a me ka make o nā pēpē.
Pehea e ʻai ai me nā maʻi i ka maʻi diabetes?
ʻOiai ma mua o ka hoʻolilo ʻana, pono ka wahine e hōʻemi i ka hopena o ka hoʻopiʻi a me ka wā mua e pono ai ka uku ʻana no ka maʻi maʻi (e hoʻokō nei i nā pae o ka glucose koko ma ke ʻano maʻamau) a mālama iā ia ka wā gestation holoʻokoʻa. E kōkua kēia i kahi meaʻai paʻa i kauoha ʻia e ka endocrinologist.
Kāhala, kōpaʻa, confectionery, laiki a me semolina, nā maiʻa, nāwaina, nā mea ʻala maikaʻi ua pau ʻole i ka meaʻai. ʻO nā momona momona, nā iʻa, nā ʻiʻo a me nā mea hoʻoneʻe a pau i lalo o ka pāpā. ʻO nā meaʻai e pono ai ka ʻai me ka ʻaihue e like me ka pasta, ka rye roti, ka ʻōwili a me ka oatmeal, nā ʻuala a me nā mane
ʻO ʻoe ke ʻai i ka manawa like i nā manawa 6 i ka lā. I ke kakahiaka, ʻoi aku ka maikaʻi o ka ʻai ʻana i ka ʻiʻo a me nā hua, i ke ahiahi - kefir a me nā mea ʻai.
I ka wā o ka meaʻai, pono ʻoe e nānā i ke kō o ke koko i kēlā me kēia lā, a me kahi hoʻonui o kona kiʻekiʻe, e lawe i ka lāʻau lapaʻau maʻi, me ka a me nā lāʻau lapaʻau i ka hoʻohaʻahaʻa o ka lāʻau a hoʻoiho i ka insulin.
I ka wā o ka meaʻai, pono ʻoe e nānā i ke kōʻai koko i kēlā me kēia lā.
Aia i ka wā e pono ai ka hoʻokipa?
Hōʻike ʻia nā maʻi maʻi maʻi pēpē i kahi hoʻokipa hoʻomaha pōkole. No ka manawa mua, pono ia i ka wā mua a pono ia no ka hoʻokolokolo pono ʻana o ka wahine, e hoʻoholo ana i nā kuʻuna a me ka hoʻoponopono ʻana i ka hihia o ka mālama ʻana i ka pēpē. Hoʻopau ʻia ka haukapila lua ma ka hapa lua o ka gestation (ma 24 mau pule), no ka mea e holomua ana ka maʻi diabetes i kēia manawa. Pono kahi haukapila kolu e hoʻomākaukau i ka makuahine nona ka hānau keiki.
Ka hānau keiki ʻana ma ka maʻi diabetes
Hoʻopuka ka lawe ʻana i nā hebedoma 36-38 ma hope o ka hoʻopaʻa ʻana o ka wahine o ka wahine a me ka hapō.
Hoʻolālā pili
Hoʻoholo kū hoʻokahi ka hua ʻana o ka hana a me kā lākou ʻano. Me ka wahi maʻamau o ka pēpē (poʻo mua), ka pelvis i hoʻomohala o ka makuahine ʻāpono a me ka loaʻa ʻole o nā hoʻopiʻi ʻana, hoʻolālā ʻia nā hānau hānau ma o ke kanawai maoli. I nā kūlana ʻē aʻe, ua kuhikuhi ʻia kahi ʻāpana cesarean.
I ka lā hānau, ʻaʻole pono ka mea maʻi. I kēlā me kēia mau hola 4-6, ua pui ʻia ʻo ia me ka insulin, a ʻike pinepine ʻia ka glucose. Hoʻokele ʻia ka hānau ʻia ʻana e ke kamaʻāina tomi. Inā aia ka pōpilikia o ka asphyxiation (asphyxiation o ka pūpolo), hoʻohana ʻia nā forceps obstetric.
Hoʻonohonoho hou i nā pēpē hou
Nui nā pēpē i hānau ʻia me nā hōʻailona o ka maʻi fetopathy maʻi (endocrine a me ka metabolic dysfunction). E hoʻolaʻa i ke ʻano o nā pēpē, pale aku i ka hypoglycemia a hoʻokau i ka therapy syndromic, ua hoʻihoʻi lākou i ka hōʻali kino ʻana o nā māmā i nā hola mua o ke ola, e mālama ʻia nā inikini o ka hydrocortisone he mau manawa i hoʻokahi lā no 5 mau lā, me nā maʻi vascular - plasma, a me hypoglycemia - nā dosis liʻiliʻi o ka glucose.
