No ka manawa lōʻihi, ʻo ka maʻi diabetes ka mea o ke kumu nui o ka morbidity a me ka make o nā makuahine, a ʻo ka make ma perinatal kekahi. A hiki i ka ʻike ʻana i ka insulin (i ka makahiki 1921), ʻaʻole i ola ka wahine a ka wā hānau, a hiki wale i ka 5% o lākou ke lilo i hapai.
I ka hopena o ka hapai, hoʻolaha pinepine nā kauka iā ia e haʻalele, me ka mea ʻo ia ka mea hoʻoweliweli nui loa i ke ola o ka wahine. I kēia manawa, ʻoi aku ka maikaʻi o ka mālama ʻana i ka maʻi a ua ʻike nui ka hōʻemi ʻana i ka make ma mua.
Akā i ka manawa like, ʻo nā hana malen congenital i loko o nā keiki i hānau ʻia i nā makuahine me ka maʻi diabetes e kū mai ka 2 a 15% o nā hihia. Mai 30 a 50% o nā hihia āpau o ka make ma perinatal e pili ana i ka hoʻomohala ʻia e pili ana i kēlā mau keiki hou.
ʻO nā makuahine e hiki mai ana me ka diabetes type 1 mau manawa 5 mau manawa e loaʻa hou ai ka hānau mua a me ka make i waena o nā keiki hou. Eia nō naʻe, i nā keiki i ʻike ʻia i ia mau wāhine, ʻekolu mau manawa ke kiʻekiʻe o ka make pēpē, a me ka neonatal i 15.
ʻO nā keiki me nā māmā me ka maʻi mellitus o ke ʻano mua he ʻekolu mau manawa e hānau ʻia ma ka ʻaoʻao cesarean, ʻelua o lākou mau maʻi hōʻeha a he 4 mau manawa nui aʻe e pono ai no ka mālama maʻi.
He aha ka mea maʻi kopa?
ʻO ka maʻi fetopati maʻi maʻi ke kūlana o kahi keiki i loko o ka ʻōpū a hānau mai i kahi wahine me ka maʻi maʻi, i loko o nā mea kikoʻī kūikawā i hoʻopaʻa ʻia i loko o ke kūkulu ʻana o ka pūpū. Hoʻomaka lākou ma hope o ka trimester mua inā he maʻa a hoʻēmi ʻole ka paʻakai a ka makuahine.
Lohe ʻia ke ʻano o ka pūpū a ke nānā ʻia ʻo ia ka wā o ka hapai ʻana, ʻike ʻia nā ʻano wai amniotic no ka ratio o ka lecithin a me ka sphingomyelin, he ʻano hōʻa ka hana, ka loiloi moʻomeheu, a me kahi hua Gram. Hānau ʻia nā keiki hou i ka helu Apgar.
Hiki i nā keiki i hānau ʻia i nā makuahine me ka maʻi diabetes kona mau ʻano i ka ʻano e like me kēia:
- nā hana hanu;
- hypoglycemia;
- gigantism a i ʻole hoʻopino;
- hypnotcemia;
- hypomagnesemia;
- polycythemia a me hyperbilirubinemia;
- kamaʻilio male ʻana.
Aia nā keiki mai nā wahine me ka maʻi maʻi i ka hoʻomohala ʻana i ka ʻōpū o ka pūpū ma o ka hoala ʻana o ka hoʻoulu ʻana i ka hoʻomaʻamaʻa o ka pūpū ma lalo o ka hana a cortisol ma muli o ka hyperinsulinemia.
ʻO 4% o nā pēpē hou he mauʻano mānoanoa o ka māla, 1% kūkulu i ka cardiomyopathy hypertrophic, polycythemia a me ka transach tachypnea o ka pēpē.
Wahi a Pederson's hypothesis, maʻi fetopathy maʻi, gigantism a me hypoglycemia e like me kēia kumu: "fetal hyperinsulinism - maternal hyperglycemia". ʻO ka pinepine, ʻo nā malformations i ke keiki e kū mai ma muli o ka mālama maikaʻi ʻole o ka neʻe o ka glucose i ke koko o ka makuahine i nā mahina ʻekolu o ka hānau ʻana.
Inā loaʻa i ka wahine maʻi maʻi ʻo ka wahine 1, a laila pono ʻo ia i lalo i ka control glycemic conceptual a hoʻolālā maikaʻi loa i kāna male ʻana e pale ai i nā pōʻino maʻamau.
Hyperglycemia o ka wahine
ʻO ka Hyperglycemia o kahi wahine i ka wā lōlapa e hiki ke alakaʻi i ka hānau ʻana o kahi keiki me ka nui o ke kaumaha, dyselectrolyte disorders a me cardiomegaly.
Hōʻike ʻia ka Macrosomy (gigantism) inā i ke kiʻekiʻe o ke keiki a i ke kaumaha paha ke kino ma mua o 90 mau aniani e pili ana i ka makahiki gestational. Loaʻa ka Macrosomia i 26% o nā pēpē i hānau ʻia i nā wahine me ka maʻi maʻi, a ma nā keiki mai ka hui nui ma 10% o nā hihia.
Ma muli o ke kaumaha nui o ke kaili a me ka pēpē, ʻo ka hopena o ke kūkulu ʻana i nā hoʻopiʻi perinatal e like me ka dystopia o nā poʻohiwi fetal, asphyxia, nā iwi o nā iwi a me nā hōʻeha o ka plexus brachial i ka wā o ka hoʻonui ʻana i ka wā hānau.
Pono e nānā ʻia nā keiki āpau me ka gigantism no ka hopena o ka hypoglycemia. He mea koʻikoʻi loa kēia i ka wā i loaʻa ai i ka wahine ka nui o ka hopena glucose i ka wā hānau.
Inā loaʻa ke kumu o ke kino a me ke kiʻekiʻe o kahi pēpē pēpē ma lalo o ka 10 centiles e pili ana i ko lākou mau makahiki gestational, a laila e ʻōlelo ai lākou e pili ana i ka uluʻana o ka ulu intrauterine.
Eia kekahi, he ʻelua a ʻoi paha paha mau pule morphofunctional hope ma hope o ka makahiki gestational. Hōʻike ka retration the Intrauterine ulu i ka 20% o nā pēpē i nā wahine me ka maʻi maʻi a me 10% o nā keiki i ke koena o ka heluna. ʻO kēia no ka hopena o nā hoʻopiʻi renovascular koʻikoʻi i ka makuahine.
I nā hola mua o ke ola o ka wā hānau, e kū mau ana ka hypoglycemia. Hōʻano ʻia i ka nānā hypotension, hoʻonui mākaukau, hoʻokūkū, lethargic waʻa, nāwaliwali nāwaliwali.
ʻO ka kumu, ʻaʻohe hypoglycemia like ʻole. ʻO ka hoʻomau mau nei o kēia ʻano i ka hebedoma mua o ke ola o kahi keiki.
ʻO ka hoʻomohala ʻana o ka hypoglycemia i nā keiki hou e hoʻomaka ana ma muli o ka hyperinsulinism. Ua pili pū ia me ka hyperplasia o nā peka beta pancreatic o kahi keiki ma ke ʻano he pane ʻana i ka nui o ke kō o ke kō ma ke koko o ka makuahine. Ke kani ka lime o ka umbilical, hoʻomau koke ka hana o ka honi mai ka makuahine a ua hoʻomau ka hoʻomohala ʻana o ka insulin i ka nui, e hoʻoneʻe ana i ka hypoglycemia. ʻO ke hana hou i ka hoʻomohala ʻana o kēia ʻano hana e mālama ʻia hoʻi e ka stress perinatal, kahi i piʻi ai ka nui o ka catecholamines.
ʻO nā hana mua
Pono ke fetopathy Diabetic i kēia mau hana aʻe i ka papa mua ma hope o ka hānau ʻana o ka maʻi fetup.
- Ke hoʻomau nei i kahi kaila maʻamau o ka glucose i ke koko.
- Mālama i ke ʻano kino o ke keiki hou mai 36.5 a hiki i ka 37.5 degere.
Inā emi ka meli o ke koko ma mua o 2 mmol / lita, a laila pono ʻoe e hoʻokomo i ka glucose intravenously i kahi kūlana kahi o ka nui o ka glycemia ma hope o ka hānai ʻana i ka pēpē, ʻaʻole i hoʻonui, a i ʻole nā hypoglycemia e hōʻike nei i nā kauka.
Inā hāʻule ke koko koko i lalo o 1,1 mmol / lita, pono ʻoe e hoʻoiho i kahi hopena o ka glucose 10% i intravenously e lawe mai ai i ka 2.5-3 mmol / lita. No ka hoʻokō ʻana i kēia pahuhopu, ua pālahalaha ʻia ka nui o ka paila o 10% ma ka nui o 2 ml / kg a lawelawe ʻia no 5 a 10 mau minuke. No ka mālama ʻana i ka euglycemia, lawe ʻia kahi kahe polū hoʻokahi o ka hopena o 10% o ka glucose me ka ikaika o 6-7 mg / kg i hoʻokahi mau minuke. Ma hope o ka hoʻokō ʻana i ke euglycemia, ʻo ka nui o ka lawelawe ʻana he 2 mg / kg i hoʻokahi minuke.
Inā hoʻomaʻamaʻa ka pae i nā hola he ʻumikumamālua, a laila e hoʻomau ka infusion ma ka nui o ka 1-2 mg / kg i hoʻokahi minuke.
Hoʻopili ʻia ka hoʻoponopono ʻana o ke kaʻe o ka glucose i ka hope o ke kīnā o loko.
No ke kākoʻo ʻana i nā hanu, ua hoʻohana ʻia nā ʻano lāʻau like ʻole o ka oxygen oxygen, e ʻae ana i ka mālama ʻana i ke kiʻekiʻe o ka saturation o ke oxygen ma ke kahawai venous ma mua o 90%. No nā keiki i hānau ʻia ma mua o nā hebedoma 34 o ka mākaʻi o ka maʻi gestation, e mālama ʻia ka hoʻomākaukau ʻana no ka heʻe endotracheally
Hoʻohana ʻia nā maʻi Cardiovascular ma ke ʻano like me nā ʻōnaehana like i nā keiki ʻē aʻe. Inā he maʻi iki o ka ejection liʻiliʻi me ka wehe ʻana o ka pānaʻi mai ka ʻaha hema o ka ʻaoʻao hema, a laila ʻoi ʻia ʻo propranolol (kahi lāʻau lapaʻau mai ka pūʻulu beta-blocker). ʻO nā hopena ʻona e hilinaʻi ʻia:
- Mai ka 0.5 a hiki i 4 gg / kg i hoʻokahi minuke - no ka hoʻowalewale o ka poʻe dopamine resept, vasodilation (cerebral, coronary, mesenteric), hoʻonui i nā urinal renal a me kahi hoʻēmi i ka huina kūʻokoʻa viva peripheral.
- ʻO 5-10 mcg / kg i kēlā me kēia minuke - hoʻonui i ka hoʻokuʻu i ka norepinephrine (ma muli o ke kaila o ka hoʻokipa B 1 a me B 2 adrenergic), hoʻoulu i ka hopena cardiac a me ka hopena cardiac.
- 10-15 mcg / kg i kēlā me kēia mau minuke - e kumu ana i ka vasoconstriction a me ka tachycardia (ma muli o ka wehe ʻana o B 1 -adrenoreceptors).
ʻO Propranolol kahi paʻa blocker koho-kāhea mai B-adrenergic receptors a ke lawelawe ʻia nei ma ka ʻōhua o 0.25 mg / kg i kēlā me kēia lā. Inā kūpono, i ka wā e hiki mai ana, hiki ke hoʻonui ʻia ke kuʻi, akā ʻaʻole iʻoi aku ma mua o 3.5 mg / kg i kēlā me kēia mau hola. No ka hoʻolālā lōkihi intravenous (i loko o 10 mau minuke), kahi momona o 0.01 mg / kg i kēlā me kēia 6 mau hola e hoʻohana ʻia.
Inā ʻaʻole hōʻemi ʻia ka hana kūpono o ka myocardium a ʻaʻole i nānā ʻia ka papaʻi o waho o ka mahele hema o ka ventricle hema, a laila hoʻohana ʻia nā lāʻau inotropic i nā keiki hou.
- dopamine (intropin)
- dobutrex (dobutamine).
Hoʻopau ka Dopamine i nā mea hoʻopiʻi adrenergic a me dopamine, a me ka dobutamine, i ka hoʻohālikelike ʻana iā ia, ʻaʻole ia e hoʻāla i ka hopena o nā delta, a no laila ʻaʻole e pili i ka kahe koko o peripheral.
Hoʻomaopopo ka hopena o kēia mau lāʻau i ka hemodynamics. No ka helu pono ʻana i ka nui o nā lāʻau inotropic, pili i ka paona o ka pēpē a noʻonoʻo hoʻi i nā makahiki gestational ʻē aʻe, ua hoʻohana ʻia nā papa kūikawā.
Ke hoʻoponopono ʻana i nā haunaele ma ka kaulike o nā electrolytes.
ʻO ka mea mua, pono ʻoe e hoʻokaʻawale i ka ʻona o ka mahiko ma ke koko. No ka hana ʻana i kēia, e komo i kahi hopena o 25% o ka magnesium sulfate ma ka pae o 0.2 ml no ka kg o ka paona.
Kuhi pinepine ka hypocalcemia iā ia iho ma ka hauoli, a ua hoʻoponopono ʻia me ka hoʻokaʻawale o 10% o ka calcium gluconate ma kahi pāʻālua o 2 ml no ka kg o ka paona o ke kino. Hoʻohanaʻia ka lāʻau lapaʻau i loko o 5 mau minuke a i kahe paha kahawai.
Hoʻohana ʻia ka Phototherapy e hoʻōla i ka jaundice.
