Nā maʻi maʻi maʻi

Ke kūkākūkā nei kēia ʻatikala pehea e hana ai inā ua loaʻa i kahi wahine me ka maʻi maʻi ma mua o ka wā hāpai. Inā ʻike ʻia kahi kiʻekiʻe glucose koko kiʻekiʻe i ka wā hāpai, a laila kapa ʻia kēia ma ke ʻano maʻi gestational. ʻO ka maʻi diabetes type 1 a 2 paha, ma ke ʻano he kānāwai, ʻaʻole ia he contraindication no ka makuahine, akā hoʻonui koʻikoʻi i ka hopena no ka wahine a me ka ʻōpio.

ʻO ke ala maikaʻi loa e pale ai i nā hoʻopiʻi ʻana i ka maʻi hānai i nā wāhine hāpai i ka mālama ʻana ʻana i kou koko koko

Pono ka maʻi hānai e mālama kokoke i nā kauka. ʻO kahi wahine hāpai i ka maʻi maʻi ma lalo o ka nānā ʻana o kahi obstetrician-gynecologist. Inā pono, e huli pū lākou i nā loea pōkole: he kanaka ophthalmologist (nā maka), he nephrologist (ʻeha), kahi cardiologist (puʻuwai) a me nā mea'ē aʻe. Eia nō naʻe, ʻo nā hana nui e kākoʻo i nā pae momona o ke koko e kokoke ana i ka maʻamau, kahi a ka mea maʻi e alakaʻi ai.

He maikaʻi ia e hoʻomaʻamaʻa i ka maʻi diabetes, ʻo ia hoʻi, ke hoʻokō i ka hoʻokaʻa o ke koko i aneane like me ka poʻe olakino - ʻo ia ka mea nui e pono ai e hana i ka hānau ʻana i kahi keiki maʻamau a mālama i ke olakino wahine. ʻO ka pili loa o nā kuhi koko koko i ka pae kiʻekiʻe, ka hoʻohaʻahaʻa ʻana i nā pilikia i nā manawa āpau o ka hapai, mai ka wā i hānau ʻia ai ka hānau ʻana.

ʻO ka loiloi pilikia a me nā contraindications no ka hāpai ʻana me ka maʻi diabetes

ʻO kahi wahine e loaʻa ana i ka maʻi type 1 a i ʻole type 2 ke hele pono e nānā e ka obstetrician-gynecologist, endocrinologist a me ka mea maʻi nui ma ka wā o ka hoʻolālā ʻana o ka hāpai ʻana. Ma ka manawa like, kahi loiloi o ka mea maʻi, hiki i ka hopena hopena maikaʻi loa a ʻo ka hopena hapai, a me nā hōʻemi ke kiʻi aku i ke kiʻi ʻana i ka hopena o ka maʻi maʻi e hoʻomaʻamaʻa ʻia.

He aha nā hoʻokolohua e pono ai i ka wahine me ka maʻi maʻi maʻi e hoʻomaʻamaʻa ma ke ʻano o ka loiloi ʻana i ka hopena o ka hopena ʻoi i ka hopena hānau.

1. Lawe i kahi hōʻike koko no ka hemoglobin glycated.
2. Kūʻai kūʻokoʻa i ke kōpaʻa koko me kahi glucometer 5-7 mau manawa i ka lā.
3. Pāpaʻi i ke koko ma ka home me kahi mākaʻi ke koko, a e hoʻoholo pū inā he postural hypotension. ʻO kēia kahi hāʻule nui i ke kahe o ke koko, i hōʻike ʻia e ka maʻi kaumaha ma luna o kahi neʻe kiʻekiʻe mai kahi noho a noho ʻole paha.
4. E hana i nā hoʻokolohua e nānā i kāu mauʻano. E hōʻiliʻili i ka urine i kēlā me kēia lā e hoʻoholo ai i kahi maemae cleince a me ka ʻike o ka protein. Lawe i nā hōʻike koko no ka hoʻokumuʻana i ka plasma a me ka nitrogen urrea.
5. Inā ʻike ka protein i loko o ka pāʻai, e nānā no nā maʻi o ka urinary.
6. E nānā me kahi kanaka maʻi maʻi maʻi e nānā i ke kūlana o nā moku retinal. ʻOiai makemake ʻia ia ka wehewehe kiʻi ʻana o ka waihona kālā me nā kiʻi ʻoniʻoni. E kōkua lākou i ka hoʻohālikelike ʻana a loiloi i nā loli i loko o nā hoʻopaʻa ʻana hou.
7. Inā hiki i ka wahine me ka maʻi maʻi maʻi āpau ke hiki i ka 35 o kona mau makahiki, ʻeha ʻia i ka hypertension arterial, nephropathy, obesity, he koko koko nui, loaʻa nā pilikia me nā moku peripheral, a laila pono ʻoe e hele i kahi ECG.
8. Inā hōʻike ʻo ECG i kahi palolo a i ʻole he mau hōʻailona o ka maʻi naʻau coronary, a laila pono ke aʻo ʻana i nā haʻawina me kahi ukana.
9. Puhi ʻia no nā hōʻailona o ka neuropathy peripheral. E nānā i ka tactile, hōʻeha, ke kohi a me ka hoʻoweliweli o ka hoʻopau ʻana i ke ake o ka nerve, aemaise i nā wāwae a me nā wāwae
10. E nānā inā ua hoʻomohala ka neuropathy autonomic: cardiovascular, gastrointestinal, urogenital a me nā ʻano ʻē aʻe.
11. E nānā i kou nānāʻana i ka hypoglycemia. Hele pinepine nā hihia o ka hypoglycemia? Pehea ka kaumaha? Pehea nā hōʻailona maʻamau?
12. Puhi ʻia no nā maʻi maʻi maʻi maʻi peripheral
13. E lawe i nā hōʻike koko no nā hormone thyroid: hōʻeuʻeu ka hoʻohiʻo i kāu thyroid (TSH) a me ka thyroxine free (T4 free).

Mai ka makahiki 1965, ua hana ʻia kahi papa e ka ʻenekelika ʻōpiopio-gynecologist ʻo R. White e hoʻohana i ka loiloi o ka hana kuhi ʻana o ka maʻi fetus. Hoʻokumu ʻia ka pilikia e:

• ka lōʻihi o ka maʻi diabetes i ka wahine;
• i ka makahiki he hoʻomaka o ka maʻi;
• he aha nā hoʻopiʻi i ka maʻi diabetes.

ʻO ka pae o ke kīpē no ka maʻi maʻi i ka wahine hāpai e like me P. White

Nā Koho:

• DR - retinopathy diabetes; DN - nephropathy maʻi maʻi; CHD - ka maʻi naʻau coronary; CRF - pilikia hemahema.
• Helu A - ka haʻahaʻa o nā hoʻopiʻi, nā haumāna RF - ka hoʻomaikaʻi hewa ʻole maikaʻi loa o ka hopena hāpai.

Maikaʻi kēia ʻano haʻawina no nā kauka a me nā wahine me nā maʻi maʻi type 1 a i ʻole 2 e hoʻolālā nei i ka hāpai ʻana.

He aha ka hopena o ka maʻi hānai no ka makuahine a me ka maʻi hānau

ʻO ka pilikia o ka hoʻomohala ʻana i ke ʻano maʻi type 1 i ke ola o kahi keiki.

• e pili ana i 1-1,5% - me ke ʻano maʻi diabetes type 1 a ka makuahine;
• e pili ana i ka 5-6% - me ke ʻano maʻi diabetes ʻano 1 i ka makua;
• ʻoi aku ma mua o 30% - inā i kīlea type 1 i nā mākua ʻelua.

ʻO ka wahine a me nā kauka e kūkākūkā me ia i ka manawa o ka hoʻolālā hāpai ʻana, e hāʻawi ʻia i nā pane loiloi i nā nīnau.

• Pehea e pili ai ka maʻi maʻi i ka maʻi a me ke olakino? He aha nā hapa nui e loaʻa ai ka hāpai a loaʻa kahi pēpē maikaʻi?
• Pehea e pili ai ka hānau ʻana i ka maʻi diabetes? Ke hāpai nei i ka wikiwiki o ka hoʻomohala ʻana i kona mau pilikia pōpilikia?

Nā ʻōmino no ka hāpai ʻana i ka wahine me ka maʻi maʻi:

• nephropathy koʻikoʻi (serum creatinine> 120 μmol / L, glomerular filtration rate 2 g / lā);
• Hiki ke hoʻoneʻe ʻia ʻo hypertension ma ke kaohi, i.e., kahe koko ma luna o 130-80 mm RT. Art., ʻOiai he mea pili ka wahine i nā lāʻau lapaʻau no ka hypertension;
• proliferative retinopathy a me ka maculopathy, ma mua o ka hoʻokalakupua retinal laser;
• maʻi ʻeha coronary, unahi kaila pectoris;
• maʻi a i ʻole nā ​​maʻi pāpaʻi a me nā maʻi maʻi (tuberkulosis, pyelonephritis, etc.);
• maʻiʻo coma - i ka wā mua o ka wā hapai i hōʻike ʻia kahi hōʻailona no kona hoʻopau kūlohelohe.

ʻO ka hoʻomākaukau ʻana i nā wahine hāpai i ka wahine me ka maʻi maʻi

No laila, ua heluhelu ʻoe i ka pauku ma mua, akā naʻe, ua hoʻoholo e hāpai a loaʻa kahi keiki. Inā makemake ʻia, a laila no kahi wahine me ka maʻi maʻi, e hoʻomaka ka hoʻomaka ʻana o ke ʻano no ka hāpai ʻana. Pono ia i ka hoʻoikaika nui a hiki ke lōʻihi loa, akā pono maoli ia e hele i ka mea i huli ka hua.

ʻO ke kānāwai nui: hiki iā ʻoe ke hoʻomaka i ka ʻāʻī ʻana wale nō i ka wā i emi ai kāu helu glycated hemoglobin HbA1C i ka 6.0% a i ʻole ka haʻahaʻa. A ʻoi aʻe ka hapa nui o ka glucose koko ʻoe e lawe ai me kahi mita glucose koko he mea maʻamau hoʻi. Pono e mālama ʻia kahi rīpona hoʻohiʻopihi kūhelu koko a nānā me ke kauka i kēlā me kēia 1-2 pule.

Eia nō hoʻi, pono e noho i ke koko ma lalo o 130/80, ʻoiai ke lawe ʻole ʻoe i ka lāʻau. Hoʻomaopopo i ka "kemekala" ka lāʻau hoʻomehana pilikia e pili pono i ka ulu ʻana o nā keiki. No laila, i ka wā hāpai, pono lākou e hoʻopau. Inā ʻaʻole ʻoe e hiki i ka mālama ʻana i ka hypertension me ka loaʻa ʻole o ka lāʻau lapaʻau, inā ʻaʻole ʻo ia ka wahine, a ʻoi aku ka maikaʻi o ka hāʻawi ʻana i ka ʻāina. No ka mea, he kiʻekiʻe loa ka hopena o kahi hopena hōʻeha maikaʻi.

No ka hoʻokō ʻana i ka uku diabetes, i ka wā o ka hoʻomākaukau no ka hapai, pono ka wahine e hana i kēia aʻe:

• i kēlā lā i kēia lā e ana i ke kō o ke koko me ka glucometer ʻehaʻeha ma kahi ʻōpū ʻole a i 1 mau hola ma hope o ka ʻaina;
• makemake ʻia i kekahi manawa ke ana i ka nui o kāu kōpaʻa ma 2 a i ʻole i ke kakahiaka aʻe - e nānā i ʻaʻohe pō o ka hypoglycemia;
• haku a noi i kahi regimen-bolus regimen o ka ʻimi ʻana i ka insulin;
• inā e lawe ʻoe i nā pālaki haʻahaʻa no ka diabetes type 2, e hoʻokaʻawale iā lākou a hoʻololi i ka insulin;
• Hoʻōla me ka maʻi maʻi - me ka ʻole o ka hana, me ka leʻaleʻa, ma ke ʻano maʻamau;
• e hahai i kahi meaʻaiʻai i kaupalena ʻia, ke ʻano wikiwiki, ʻai i ka manawa 5-6 i hoʻokahi lā i nā wahi liʻiliʻi

Nā hana hou no ka hoʻomākaukau no ka hāpai ʻana me ka maʻi diabetes:

• kahi me ka lihua o ke koko;
• inā he maʻi hypertension, a laila pono e lawe ʻia ma ke kaohi, a "me ka margin", no ka mea ke kau nei ka lāʻau lapaʻau no hypertension e pono e hoʻopau ʻia;
• e nānā mua ʻia e kekahi kanaka ophthalmologist a mālama i ka retinopathy;
• e lawe i ka waikawa folic ma 500 mcg / lā a me ka potassium iodide ma 150 mcg / lā, inā ʻaʻohe contraindications;
• kū ʻole ka ulaula.

Pregnancy Diabetes: Pehea e loaʻa ai ke pēpē olakino

I ka wā o ka hapai me ka maʻi maʻi, pono e hana ka wahine i ka nui o ka mālama ʻana i kona koko koko i kokoke i nā helu maʻamau. Eia kekahi, e nānā nui i ka glucose koko me ka ʻike 1 a me 2 mau hola ma hope o ka ʻaina. No ka mea, ʻo ia ka mea e hiki ke hoʻonui, a ʻo ka hoʻokē ʻai i ke kō koko koko hiki paha ke noho maʻamau a haʻahaʻa paha.

I ke kakahiaka, pono ʻoe e hoʻāʻo i ka ketonuria me nā ʻāpana hoʻāʻo, i.e. inā ua ʻike ʻia nā ketones i loko o ka urine. No ka mea, ʻo nā wahine hāpai me ka maʻi hānai, he nui ka nui o nā manawa nocturnal o nā hypoglycemia. Hōʻike ʻia kēia mau hanana i ka hōʻike ʻana o nā ketones i ke kinipōpō kakahiaka. Wahi a nā haʻawina, pili ʻia ka ketonuria me ka hoʻokaʻawale ʻana i ka ʻaoʻao o ka naʻauao i nā keiki e hiki mai ana.

Kahi papa hana no ka maʻi hānai maʻi:

1. ʻAʻole pono loa nā papa ʻai wahine hānai, me ka nui o ka momona o ka "puhilohi" i mea e pale ai i ka poliholi. ʻAʻole kūpono nā meaʻai haʻahaʻa-haʻahaʻa no ka maʻi hānai.
2. Hoʻopiʻi i ke kōpaʻa koko me kahi glucometer - ma kahi o 7 mau manawa o ka lā. Ma kahi ʻōpū ʻole, ma mua a ma hope o kēlā me kēia pāʻina, i ka pō, a i kekahi manawa hoʻi i ka pō. Pono ka hoʻoponopono ʻana o ka inika no ke kō koko koko ʻaʻole ma luna o kahi ʻōpū ʻole, akā ma hope o ka ʻaina.
3. ʻO ka maʻi maʻi maʻi maʻi 'aʻai o ka hamo ua kikoʻī ʻia ma ka ʻatikala ma lalo.
4. E kaohi i ke ʻano o nā ketones (acetone) i loko o ka pāʻai, ka mea, me ke ʻano gestosis wawe a ma hope o 28-30 mau pule o ka hāpai ʻana. I kēia manawa, hoʻonuiʻia ka pono no ka insulin.
5. ʻO kahi hōʻike koko no ke hemoglobin glycated e lawe ʻia ma kahi o ka manawa 1 i kēlā me kēia trimester.
6. Lawe i ka waikawa folic ma 500 mcg / lā a hiki i ka 12 makahiki o ka hāpai ʻana. ʻOodium iodide ma 250 mcg / lā - i ka ʻole o nā contraindications.
7. ʻO ka hōʻike Ophthalmologist me ka hōʻike kālā kālā - 1 manawa i kēlā me kēia trimester. Inā ulu ka lolo retinopathy diabetes proliferative a i ʻole preproliferative retinopathy wikiwiki i nā hōʻino, e hana koke ʻia ka laser coinal a laser retinal, inā ʻaʻole ke hoʻoweliweli piha ʻole.
8. Ke kipa pinepine nei i kahi obstetrician-gynecologist, endocrinologist a i ʻole maʻi maʻi maʻi. Aʻo 34 mau pule o ka hapai - i kēlā me kēia 2 hebedoma, ma hope o 34 mau hebedoma - i kēlā me kēia lā. I kēia hihia, kahi ʻai nui o ke kino, ke koko, ke hōʻike ʻokoʻa ʻana i ka urine.
9. Inā ʻike ʻia kahi maʻa maʻi urinary i ka maʻi diabetes, pono nā wahine hāpai i ka lāʻau lapaʻau e like me ka mea i kau ʻia e ke kauka (!). Aia ia ma ka i trimester - penicillins, i II a i III trimesters - penicillins a cephalosporins.
10. ʻO nā kauka a me ka wahine hāpai e mālama pono ana i ka ulu a me ke ʻano o ka pūpū. Hana ʻia ka ultrasound e like me ka mea i kuhikuhi ʻia e ka obstetrician-gynecologist.

He aha nā ʻōpiopio e koi ʻia e nā kauka i ka wā hāpai:

• E kūkākūkā me kāu kauka e koi ʻia ʻoe i ka magnesium-B6 a me nā taurine no ka loaʻa ʻana o ka maʻi hypertension me ka lāʻau ʻole.
• ʻO nā lāʻau lapaʻau "kemu", ʻo ka methyldopa ka lāʻau lapaʻau e koho.
• Inā ʻaʻole kōkua nui ʻo methyldopa, e kuhikuhi ʻia nā hāmeʻa palaki calcium a i ʻole blocker adrenergic β1-selective.
• Nā lāʻau lapaʻau Diuretic - wale nō no ka hōʻike koʻikoʻi nui (ka paʻa o ka wai, ka edema pulmonary, paʻa ʻole pūpū).

I ka wā hāpai, ua hoʻohālikelike nā papa āpau e pili ana i nā papa aʻe:

• ke koko hoʻohaʻahaʻa i nā lāʻau;
• mai hypertension - ACE inhibitors a me angiotensin-II blockor receptor blockers;
• pūnana pālule;
• nā antibiotics (aminoglycosides, tetracyclines, macrolides, etc.);
• statins e hoʻomaikaʻi i nā helu koko kolamu.

Kuhiʻai no ka maʻi maʻi maʻi

Ma kēia pūnaewele, ʻike mākou i nā maʻi āpau no ka mālama maikaʻi ʻana i ka maʻi diabetes 2 ʻano a hiki hoʻi i ka mea 1 ke hoʻololi i kahi ʻai haʻahaʻa haʻahaʻa. ʻAʻole kūpono kēia meaʻai.

• i ka wā hāpai;
• me ka loaʻa ʻole o ka pilikia.

Hoʻololi ʻia kahi meaʻai haʻahaʻa haʻahaʻa no nā wahine hāpai i ka maʻi diabetes, no ka mea e hoʻopilikia i ka hoʻomohala ʻana o ka pūpū.

ʻO ke kaʻe o nā haʻalulu i loko o ka meaʻai e alakaʻi pinepine ai i ka mea e huli ke kino i ka meaʻai me kāna mau momona momona. Hoʻomaka kēia i ka ketosis. Hoʻokumu ʻia nā kino Ketone, me nā acetone, hiki ke loaʻa i ka urine a me ka honi ʻana i ka ea o ka ea. Ma ke ʻano o ka maʻi diabetes, he mea maikaʻi kēia no ka mea maʻi, akā ʻaʻole ʻo ka wā hāpai.

E like me kāu i heluhelu ai i ka ʻatikala "Insulin a me nā ʻōpoti: ʻO ka ʻoiaʻiʻo e pono ai ʻoe e ʻike", ʻoi aku ka nui o nā kālaʻai e ʻai ai, ʻoi aku ka maʻalahi o ka mālama ʻana i ke kō koko maʻamau. Akā i ka wā hāpai - e pale i ka hoʻomohala ʻana o ka ketosis ʻoi aku ka mea nui. Hiki i ke glucose koko hoʻōla ke alakaʻi i nā hoʻopiʻi o ka hāpai a me ka hānau ʻana. Akā ʻoi aku ka ʻoi o ka ketonuria. He aha ka mea e hana?

ʻO ka kalapona, ka mea i lawe koke ʻia, ʻaʻole pono ke ʻai i ka maʻi maʻi. Akā i ka wā hāpai, hiki iā ʻoe ke ʻai iā ʻoe iho e ʻai i nā meaʻai momona (kāloti, huaʻa) a me nā huaʻai, i loko o ke ola maʻamau ka mea e aʻo ʻia e haʻalele i ka ʻai. A e nānā ponoi i ka nānā ʻana o ke ketones i loko o ka urine me nā ʻāpana hoʻāʻo.

Ua kuhikuhi mua i ka lāʻau lapaʻau mua i kahi meaʻai maʻi no nā wahine hāpai i ka 60% kākā. I kēia mau makahiki i hala iho nei, ua ʻike lākou i nā pōmaikaʻi o ka hoʻohaʻahaʻa ʻana i ka paileka o ke kāʻai ʻana a ke nānā nei i kēia manawa i kahi kīʻai 401,55 mau poholika, 35-40% momona a me 20-25% protein.

ʻO nā wahine hāpai i ka maʻi maʻi e hāʻawi ʻia e ʻai i nā meaʻai liʻiliʻi 6 mau lā i ka lā. ʻO kēia ka 3 mau meaʻai nui a me 3 mau meaʻai hou aʻe, me ka pō e pale i ka hypoglycemia nocturnal. Manaʻo ka hapa nui o nā mea noiʻi e pono keʻai kaʻai ʻana no ka maʻi diabetes i ka maʻemaʻe, ʻoiai inā ʻānō ka wahine.

Inii injection

I ka wā hapai, ka hoʻohaʻahaʻa ʻia o nā kolo i ka hana o ka insulin i loko o ke kino o ka wahine ma lalo o ke ʻano o nā hormone placental, i.e., kū i ka kūʻē o ka insulin. E uku mai no kēia, hoʻomaka ka pancreas e hana hou i ka insulin. Hoʻololi a hoʻoliʻiliʻi ke kōpaʻa koko, a ma hope o ka ʻai e piʻi nui.

Hoʻohālikelike kēia mau mea āpau me ka hoʻomohala ʻana i ke ʻano maʻi type 2. Akāʻo nā loli kūlohelohe kūlohelohe maʻamau e hōʻoia i ka hoʻomohala ʻana o ka pūpū. Inā ma mua o ka hana ʻana o ka pancreas i ka palena o kona mau pono, a ma ka wā hāpai a loaʻa paha i ka wahine ke loaʻa i ka maʻi gestational, no ka mea hiki ʻole iā ia ke neʻe i ka piʻi nui.

ʻO nā wahine hāpai wahine e hoʻoikaika ikaika i ka insulin e ʻaʻole wale no ka maʻi type 1, akā no ka maʻi ʻalani 2 hoʻi a me ke ʻano maʻi gestational, inā ʻaʻole hiki ʻole ke mālama pono i ke kō koko maʻamau ma o kaʻai a me ka hoʻoikaika.

ʻO ka hoʻonuiʻana i ke kō koko e hiki ke alakaʻi i nā hoʻopiʻi hapai, e pilikia no ka wahine a me ka wahine. Fetopathy Diabetic - i hōʻike ʻia i loko o ka pūpū e ka edema o ka momona subcutaneous, hana hewa o nā kino nui. Hiki i nā pilikia nui ma ka wā mua ma hope o ka manawa.

ʻO ka makrosomy ka loaʻa ʻana o ka nui o ke kaupaona ʻana ma o ka fetus, ma lalo o ke kumu o ka hoʻonui ʻia o ka glucose i loko o ke koko o ka makuahine. E hōʻeha aku i nā pilikia i ka wā e hele ai ma ke kanaloa hānau, hānau mua, alakaʻi i nā hōʻeha i ke keiki a wahine paha i ka wā hānau.

No laila, mai kānalua e hoʻomaka i nā hoʻonāʻana i ka insulin me ka maʻi diabetes i nā wāhine hāpai, inā pono. Kahi ʻia ka lāʻau lapaʻau e ka inika lapaʻau ʻia e ke kauka. Pono ka wahine e noʻonoʻo e hoʻohana i kahi pākahi insulin ma kahi o nā inātuna kuʻuna me nā syringes a i ʻole nā ​​peni mau syringe paha.

E hoʻomaopopo no i ka lua o ka hapalua, hiki ke ulu nui ka makemake o ka insulin. Hiki ke hoʻonui ʻia nā wai no ka inikini insulin e ka nui o ka 2-3 e like me nā mea i kau ʻia ma mua o ka wā hapai. Aia ia i nā kuhikuhi o ke koko koko ma hope o ka ʻai ʻana, ka wahine i kēlā me kēia manawa i hōʻeha ʻeha me kahi glucometer.

ʻO ka maʻi paʻi a me ka nephropathy (pilikia nā keiki)

ʻO ka nephropathy Diabetic he inoa paʻakikī no nā palaleka o nā ʻelele a me nā kīʻaha koko i loaʻa i ka maʻi diabetes. He pilikia hōʻeha kēia e hoʻopilikia ai i ka 30-40% o nā maʻi me ka maʻi maʻi a alakaʻi pinepine i ka pilikia o ka renal.

E like me ka hōʻike ʻana ma ka hoʻomaka ʻana o kēia ʻatikala, nephropathy koʻikoʻi he contraindication no ka hāpai ʻana. Akā he nui nā wahine e ʻeha ana i ka nephropathy maʻi o ka maʻi "ʻole" a i ʻole ka "maʻalahi" e hoʻohālua a lilo i mau makuahine.

I ka hapa nui me nā maʻi nephropathy maʻi, hiki ke manaʻo ʻia ka hānau hānau o kahi keiki hiki. Akā, ʻoi aku ka hopena, e paʻakikī ai ka papa o ka hāpai ʻana, e mālama ʻia ka nānā ʻana me ka lāʻau lapaʻau kūikawā. ʻO nā pōpilikia ka maikaʻi loa no ka poʻe wahine i ʻike maopopo i ka hana renal functioning, me ka hoʻohaʻahaʻa ʻana i ka cleince creatinine a me ka hoʻonui nui ʻana o ka creatinine i loko o ke koko plasma (e hana i nā hoʻokolohua - e nānā!).

Hoʻonui ka nephropathy diabula i ka hopena o kahi hopena ʻoi aku ka hopena no ka hopena:

• I nā manawa pinepine pinepine, ʻo ka hapai ka paʻakikī i ka preeclampsia. ʻO ka mea nui hoʻi i kēlā mau wahine me ka nephropathy maʻi pānaʻi nona ke koko nui a hiki i mua o ka ʻoluʻolu. Akā inā ʻo ka wahine i ka manawa mua o ke koko, ʻo ka preeclampsia nō paha.
• ʻO ka hānau mua ma mua o ka nephropathy maʻi maʻi e loaʻa pinepine. No ka mea e lilo ai ke ʻano o ka wahine, a i ʻole e weliweli i ke keiki. Ma 25-30% o nā hihia, hānau ʻia ka hānau keiki ma mua o ka wiki he 34 o ka hapai, ma 50% mau hihia - a hiki i ka wiki 37th.
• I ka wā hāpai, e kū'ē ana i ke kua o nephropathy, ma kahi o 20% o nā hihia, ua mālama ʻia ka ʻaihue a i ʻole ka underdevelopment.

ʻO ka Preeclampsia kahi maʻi hoʻopiʻi ikaika e alakaʻi ana i ka hāʻawi ʻana i ke koko i ka wai i ka plasenta, ka nele o nā mea momona a me ka oxygen no ka kuʻi. ʻO ia nā ʻolua:

• ke koko kiʻekiʻe;
• ka māla ʻana
• ka hoʻonui ʻana o ka nui o ka protein i ka urine;
• ke piʻi ikaika nei ka wahine i ka paona ma muli o ka mālama mau ʻana o ke kino.

He mea paʻakikī ke wānana mua inā e hoʻoulu ʻo ka wā hānau i ka hoʻomohala ʻana i nā pilikia o ka maʻi maʻi diabetes. Aia ma kahi liʻiliʻi he 4 mau mea e hiki ke hoʻopilikia i kēia:

1. ʻO ka mea maʻamau, i ka wā hāpai, hiki i ke kiʻekiʻe o ka filtration glomerular e hoʻonui i ka 40-60%. E like me kāu e ʻike ai, hele mai ka nephropathy maʻi ma muli o ka hoʻonui nui glomerular filtration. No laila, hiki i ka wā hāpai ke hoʻopilikia i ka papa o kēia ʻōpiopio.
2. ʻO ke kahe koko kiʻekiʻe ke kumu nui o ka hōʻino o ka keiki. No laila, ʻo ka hypertension a me preeclampsia, kahi mea e ulu pinepine i nā wahine hāpai me ka maʻi diabetes, hiki ke loaʻa i kahi hopena maikaʻi loa ma ka hana o ka lolo.
3. I ka wā hapai, pono ka pāʻai o ka wahine e loaʻa i kahi mahele o ka nui o ka protein, no ka mea, pono ka nui o ka pēpē. Akā ʻo kahi hapa nui o ka protein i ka papaʻai e alakaʻi ai i ka hoʻonui i ka filtration glomerular. Hiki i kēia ke hoʻoikaika i ka papa kūlohelohe o ka nephropathy diabetes.
4. I ka nephropathy maʻi maʻi, hoʻokaʻawale pinepine nā poʻe maʻi i nā lāʻau - ACE inhibitors - ʻo ia e hoʻolohi i ka hoʻomohala ʻana o ka hōʻeha o ka pūpū. Eia naʻe ke hoʻopilikia nei kēia mau lāʻau i ka hiki ʻana mai o ke kōkō, no laila ua hōʻaia lākou i ka wā hāpai.

Ma kekahi ʻaoʻao, i ka wā hāpai, ua ʻōlelo ʻia nā wahine me ka maʻi maʻi e kiaʻi pono i nā pae koko koko. A hiki i kēia hopena ke hopena koʻikoʻi i ka hana o ke keiki.

Hōʻike pinepine ʻia nā ʻōmaʻomaʻo o nā pilikia o ke keiki i ka wā hope o nā nephropathy maʻi. Ma mua o kēia, ʻike ʻia ka maʻi e like me ka ka nānā ʻana o ka urine no ka protein. ʻO ka mea mua, puka ʻia ka albumin i loko o ka kaomi, a ua kapa ʻia kēia ʻo microalbuminuria. Ma hope, ua hoʻohuiʻia nā protein'ē aʻe, ʻoi aku ka nui.

ʻO ka prototeinuria ka hana a ka protein i ka urine. I ka wā hāpai, ʻoi aku ka nui o ka wahine me ka nephropathy maʻi i ka proteinuria. Akā ma hope o ka hānau ʻia ʻana, aia paha ia e emi i ka pae o ka wā i hala. I ka manawa like, ʻo ka hopena maikaʻi loa e pili ana ka hānai ʻana i ka hana o ke aʻa e hiki mai ana ma hope.

Ka hānau keiki i ke alo o ka maʻi maʻi i ka wahine hāpai

No nā wahine hāpai i ka maʻi maʻi, ua hoʻoholo ka nīnau no ka lōʻihi o ka manawa e hānau ai ma kahi kanaka. I kēia hihia, ua noʻonoʻo nā kauka i nā ʻano mea penei:

• ke kūlana o ka walaʻau maʻi;
• ka helu o ka uluʻana o kāna māmā;
• ka heleʻana o nā hoʻopiʻi hapai;
• ke ʻano o ke ʻano o ka maʻi maʻi.

Inā loaʻa ka wahine i ka wā hāpai i ka maʻi maʻi gestational, a ma ka manawa like ʻo ia ka maʻamau o ka hoʻokeo koko, a laila ʻo ia paha ʻo ia e hoʻopuka i ke keiki i ka manawa maoli o ka hānau.

Inā loaʻa kahi ʻāpana cesarean a i ʻole ka hānau hānau ʻana ke koho kuleana. Hiki i kahi lawe ʻana mai i kahi wahine me ka maʻi diabetes inā ua loaʻa nā ʻano aʻe.

• ua hoʻomake ʻia kahi maʻi diabetes;
• ʻaʻohe nā hihia hoʻopiʻi;
• ka emi o ke kaupaona ma lalo o 4 kg a aia i kahi kūlana maʻamau;
• Hiki i nā kauka ke nānā i ke kūlana o ka ʻōpio a nānā i ke kiʻekiʻe o ka glucose i ke koko o ka makuahine i ka wā hānau.

E loaʻa nō iā lākou kahi ʻāpana cesarean inā:

• ʻo ka wahine hāpai ka mea he pelvis paʻa a i ʻole ke kapa ma ka ʻōpū;
• ua ʻeha kahi wahine mai ka nephropathy maʻi.

I kēia manawa o ke ao, ʻo ka pakeneka o ka mahele caesarean ʻo 15.2% ma waena o nā wahine olakino a me 20% i nā maʻi me ka maʻi mellitus, me ka maʻi gestational. I waena o nā wāhine i hōʻike ʻia i ka maʻi maʻi ma mua o ka hāpai ʻana, ua hoʻonui ʻia ka ʻāpana caesarean a 36%.

I ka wā hānau keiki, nānā nā kauka i ka pae o ka glucose i ke koko o ka capillary 1 mau manawa i ka hola. He mea nui ia e mālama i ke kōʻai koko makuahine ma kahi pae maʻamau e ka intravenous glucose a me nā haʻahaʻa haʻahaʻa o ka insulin. ʻO ka hoʻohana ʻana i kahi pā o ka insulin a hāʻawi pū i ka hopena maikaʻi.

Inā koho ke kanaka maʻi, a me nā kauka i kahi ʻāpana cesarean, a laila e hoʻolālā iā lākou no ke kakahiaka nui. No ka mea, i kēia mau hola manawa, e hoʻomau ʻia ka hopena o ka "medium" a i ʻole insulin. No laila hiki no kahi hiki ke kuhi i ka glucose a i ʻole insulin i loko o ke kaʻina o ke kiʻi fetal.

Ka hana hoʻopiʻi

Maanei mākou e noʻonoʻo ai i ke kūlana i ka wā i ulu ai kahi wahine i ka maʻi diabetes-dependence ma mua o ka hāpai ʻana. Inā ʻike mua ʻia ka maʻi diabetes i ka wā hāpai, heluhelu ka ʻatikala e pili ana i ka maʻi maʻi gestational no ka wahine postpartum.

Ma hope o ka hānau ʻana, pau ka plasenta i ka hopena o ke kahe i loko o ke kino o ka wahine me kāna mau hormones. Ma muli o kēia, e hoʻonui nui ʻia ka ʻike ʻana o nā lau i ka insulin. No laila, ʻoi aku ka nui o ka dosis dosages no ka injections e pale ai i ka hypoglycemia koʻikoʻi.

ʻO ke aniani o ka hopena o ka insulin e hiki ke hoʻemi ʻia e 50% ma hope o ka hānau ʻana ma o ke ala kūlohelohe a ma o 33% i ka ke kumu o ka cesarean. Akā me ka hoʻomehana ʻana o ka insulin, hiki iā ʻoe ke hoʻokō pono i nā hōʻike pilikino hoʻokahi o ka mea maʻi, a ʻaʻole ma nā ʻikepili "average" ʻē aʻe. Ke koho ʻana i nā kaila pono o ka insulin e hiki ke hana ʻia ma o ke ana ʻana i ka glucose o ke koko.

I kekahi mau makahiki i hala aʻe, ua pilikia ka hōʻeha ʻana o nā wahine me nā maʻi maʻi. Ua pale ʻia kēia e:

• ka pālāila kiʻekiʻe o ka hānau mua preterm;
• nā pilikia i ka wā hānau;
• nā maʻi hōʻeha koʻikoʻi ma ka wahine.

Ua loli kēia kūlana. Inā hoʻomaʻamaʻa maikaʻi ʻia ke kaila a ua hoʻopau ʻia ka hāʻawi ʻana i ka manawa, hiki nō ka nui o ka hoʻoulu ʻia a ʻoluʻolu ʻia hoʻi. I kēia hihia, hoʻomanaʻo i nā manawa o ka hypoglycemia e hoʻoneʻe i ka kahe koko i ka momona mummary a me ka hana o ka waiū umauma. No laila, pono ʻoe e hoʻāʻo e ʻae iā lākou.

Inā mālama ka mea maʻi i kona maʻi maʻi, a laila e like pū ka hana o kona waiū i nā wahine olakino. Inā ʻaʻole e hoʻonui ʻia ka loaʻa o ka glucose. Ke manaʻoʻiʻo ʻia nei nā pono o nā ʻoi hānai e nui i kēia pilikia.