ʻO ka hāpai ʻana i ka wahine me ka metabolism glucose impaired e mālama mau i ka mālama maukaʻi, ma muli o ke koko koko nui i loko o kahi keiki, hiki ke nui ka nui o nā pathologies, i kekahi manawa kūpono ʻole i ke ola. Hoʻopili nā fetopathy fetal i ka hikiʻole i ka uluʻana o nā mea maʻi, nā maʻi congenital, asphyxiation i loko o ka ʻōpū a ma hope koke o ka hānau ʻana, hānau mua a me ka trauma i loko o lākou, no ka nui o ke kaumaha o ke keiki.
ʻO ke kumu o ka fetopathy hiki i ke ʻano type diabetes 1, ke ʻano maʻi gestational, ke hoʻololi mua i ka metabolism - ke hoʻomanawanui o ka glucose i hoʻopiha ʻia, a noʻonoʻo i ke ʻano o ke ʻano hou o ka maʻi a me ka maʻi diabetes type 2. Hoʻokahi haneli mau makahiki i hala iho nei, ʻaʻole i ola nā kaikamahine me ka maʻi diabetes i nā makahiki ulu. A me ka hiki ʻana mai o ka hoʻomākaukau ʻana o ka insulin, hoʻokahi wale nō i ka iwakālua mau wahine hiki i ka hapai a kūleʻa i kahi keiki, no ka nui o ke koʻikoʻi nui, kaukiʻi nā kauka i ka hōʻino. Na ka maʻi maʻi mellitus i hoʻohiki i ka wahine o ka manawa e lilo i makuahine. I kēia manawa, mahalo i ka lāʻau lapaʻau hou, ʻo ka hopena o ka loaʻa ʻana o ke pēpē olakino me ka uku kūpono no ka maʻi e pili ana iā 97%.
He aha ka mea maʻi kopa?
Hoʻopili i ka fetopathy Diabetic nā alahele i loaʻa i ka wā ma muli o ka hyperglycemia maʻamau a maʻamau paha. I ka wā ʻaʻole i lawa ka maʻi diabetes, ʻaʻole kūpono a i ʻole ua hala ʻole paha, hoʻomohala ʻia nā maʻi hoʻomohala i kahi keiki mai ka 1st trimester. He liʻiliʻi iki ka hopena o ka wā hāpai i ka lōʻihi o ke maʻi maʻi. ʻO ka pākuʻi o kona uku, ka hoʻoponopono ʻana i ka manawa kūpono o ka mālama ʻana, me ka mālama pono i nā loli o ka hormonal a me ka metabolic i ka wā o ka gestation, kahi nui o nā hoʻopiʻi maʻi maʻi a me nā maʻi concomitant i ka manawa kipi, he mea nui.
ʻO nā kūpono kūpono o ka mālama ʻana i ka wā hāpai, hoʻomohala ʻia e ke kauka akamai, hiki iā ʻoe ke hoʻokō i kahi glucose koko maʻamau - ke kumu o ke kō koko. ʻO ka fetopathy Diabetic i kahi keiki ma kēia hihia ke nele a nānā ʻia paha ma kahi liʻiliʻi. Inā ʻaʻohe pilikia o ka intrauterine malformations, ʻoi aku ka hopena o ka manawa kūpono ma hope o ka hānau ʻana i ka hoʻomohala ʻana i ka ulu ʻana o ka ʻōpū, hoʻopau i ka hypoglycemia. ʻO ka maʻamau, hoʻopau i nā pilikia i nā keiki me kahi haʻahaʻa haʻahaʻa o ka maʻi fetopathy maʻi e ka hopena o ka manawa neonatal (ka malama mua o ke ola).
ʻO ka maʻi maʻi a me nā hoʻohaʻahaʻa manaʻo e hana ia i ka wā ma mua
- Ka hana maʻamau o ke kō -95%
- Hoʻokuʻuina o ka pua thrombosis - 70%
- Hoʻopau i kahi puʻuwai ikaika -90%
- Hoʻopau i ke kiʻekiʻe o ke koko - 92%
- ʻO ka hoʻonuiʻana i ka ikehu i ka wā, hoʻomaikaʻi i ka hiamoe i ka pō -97%
Inā hele pinepine ka hyperglycemia i ka wā hāpai, nā manawa hoʻoliʻi haʻahaʻa me ke ketoacidosis, hiki i kahi keiki hou.
- hoonui nui
- nā maʻi hanu
- ka mahuahua ana o nā wahī i loko,
- pilikia vascular
- ʻO nā maʻi pāpaʻi momona,
- ka haʻalele ʻana ʻole a i lalo paha o ka vertebrae, ka hope o ka lākā, nā ʻūhā o nā ʻōpū, nā ʻōpū,
- nā maʻi naʻau a me ka urinary
- ka kuhi hewa ʻana o ka hana o ka ʻōnaehana, ka hemispher cerebral.
I nā wahine me nā maʻi mellitus maʻamau ʻole i ka wā o ka gestation, ʻike ʻia ka maʻi gestosis nui, kahi holomua o nā ʻōpiopio, ʻoi loa ka nephropathy a me ka retinopathy, nā maʻi maʻamau o nā pēpē a me kahi hānau hānau, nā koʻikoʻi hypertensive a me nā hōʻeha.
ʻO ka pinepine pinepine ka hyperglycemia, ʻoi aku ke kiʻekiʻe o ka hōʻeha o ka hōʻemi - 4 mau manawa hoʻohālikelike ʻia me ka awelika i ka wā mua. ʻO ka pinepine, hoʻomaka ka hana preterm, 10% ʻoi aku ka nui o ka loaʻa ʻana o ka pēpē make.
ʻO nā kumu nui
Inā nui ka nui o ke kō i loko o ke koko o ka makuahine, e ʻike ʻia nō hoʻi ʻoe i ka ʻōpio, no ka mea, hiki i ka glucose ke komo i ka plasenta. Ke hoʻomau nei ʻo ia i ke keiki i ka nui o kā kona ikaika o ka pono. Me nā puna, nā waikawa amino a me nā kino ketone e komo. Hōʻea pancreatic (insulin a me glucagon) ʻaʻole e hoʻoneʻe ʻia i loko o ke koko fetal. ^ E Ha yM. Hoʻomaka lākou e hana ʻia i ke kino o ke keiki wale nō mai ka 9-12 mau pule o ka hāpai ʻana. No laila, ʻo 3 mau mahina mua ka waiho ʻana o nā kino a me ko lākou ulu ʻana i nā kūlana paʻakikī: nā huina glucose glucose e hoʻomalu ai i kā lākou ʻano, nā kime ketones ka hoʻopili ʻana i ka mea make. I ka manawa kēia i kuʻi ʻia ai nā hemahema o ka puʻuwai, iwi, a me nā ʻula.
I ka hoʻomaka ʻana o ka pūpū e hana i kāna iho ponoʻī, ua lilo ka pancreas i ke hypertrophied, ulu ka momona i ka hopena o ka nui o ka insulin, a hiki i ka lecithin synta.
| ʻO ke kumu o ka fetopathy i ka maʻi diabetes | ʻO ka hopena maikaʻiʻole i ka pēpē |
| ʻO ka Hyperglycemia | Hiki i nā molekosa Glucose ke hoʻopaʻa i nā protein, kahi e hōʻole ai i kā lākou hana. Hoʻopilikia ke kiʻekiʻe o nā kōpana koko ma nā kīʻaha koko i kā lākou ulu maʻamau a pale i nā hana hoʻolaʻa. |
| ʻO nā mea hua manuahi manuahi | Ka manawa koʻikoʻi i ka wā e kau ai i nā kolo a me nā ʻōnaehana o ka pūpū - ma nā nui he nui i hiki ke hoʻololi i ke ʻano maʻamau o nā umauma. |
| ʻO ka Hyperinsulinemia i hui pū me ka hoʻonui nui o ka hoʻokomo o ka glucose | Hoʻonui ka nui o ke kino o ka pēpē, hoʻonui mahuahua ma muli o ka nui o nā hormones, kahi nui o ka nui o nā mea kino, ʻoiai ke ʻano o ka maikaʻi o ka hana. |
| Nā loli i ka syntid synthesis | ʻO ka pilikia hopohopo neonatal - ka hāʻule ʻana o ka hanu ma muli o ka luhi o ka alveoli o nā pūpū. Hele ia ma muli o ka nele o ka surfactant - kahi waiwai e laina i nā māmā mai loko. |
| Ketoacidosis | ʻO nā hopena momona i nā palani, hypertrophy o ke ake a me nā pūpū. |
| Hypoglycemia ma muli o ka lāʻau overdose | ʻO ka lawa o nā mea kūpono i ka pēpē. |
| Ka Hoʻopau ʻana o Maternal | ʻO hypoxia o fetal, kahi hoʻololi i ka hui o ke koko - he hoʻonui nui ʻana o ka nui o nā ʻāpana o ke koko. Hoʻopau i ka hoʻomohala ma muli o ka nele o ka placental. |
Nā hōʻailona a me nā hōʻailona o ka fetopathy
Hoʻomaopopo ʻike ʻia ka maʻi fetopati maʻi i nā pēpē hou, heʻokoʻa maoli kēlā mau keiki i nā pēpē olakino. ʻOi aku lākou nui loa: 4.5-5 kg a ʻoi aku paha, me ka momona subcutaneous, kahi ʻōpū nui, pinepine a ʻūlū, me kahi hiʻohiʻona ʻano like me ka mahina, ʻāʻī pokole. He hypertrophied ka plasenta. ʻOi aku ka nui o nā poʻohiwi o ke keiki ma mua o ke poʻo, ʻike iki nā wāwae i hoʻohālikelike ʻia i ke kino. ʻUlaʻula ʻia ka ʻili, me ka hāpolihuli, he hemorrhages liʻiliʻi e like me ka rash. ʻO ka ulu o ka pēpē ka nui o ka ulu o ka lauoho, ua uhi ʻia me ka aila.
Hiki i kēia mau hōʻailona kūpono paha ma hope o ka hānau ʻana:
- ʻO nā maʻi hōʻeha ma muli o kaʻoiaʻiʻo ʻaʻole hiki ke pale pololei. Ma hope aʻe, hopu hoʻopiʻi, ka pōkole o ka hanu, hiki i ke koi ʻana me ke kani.
- ʻO ka jaundice hou kahi hōʻailona, kahi hōʻailona o nā maʻi o ka puhaka. ʻAʻole e like me Jaundice physiological, ʻaʻole ia e maʻa pono iā ia iho, akā pono e hoʻōla.
- Ma nā pilikia koʻikoʻi, hiki ke hoʻokaʻawale i nā wāwae, hoʻohemo i nā hope a me nā wāwae, ka hui pū ʻana o nā ʻoihana haʻahaʻa loa, ke ʻano hemahema o ka ʻano kīʻaha, a me ka hoʻolilo ʻana i ka nui o ke poʻo ma muli o ka hōʻemi o ka lolo i hiki ke ʻike.
Ma muli o ka hiki o ka hoʻohaʻahaʻa ʻana o ka hilo gula a me ka nui o ka insulin, ua ulu ka pēpē hou i ka hypoglycemia. Ua ʻoli ke keiki, ua ʻohi kona kani kani, a laila hoʻomaka ka hiaka, emi ke ana o ke ea a me ka pehu. hopu hopu ia lae.
Pono nā diagnostics pono
ʻO ka hoʻomanawanui ʻana o ka maʻi fetopathy maʻi maʻi i ka wā hāpai i ka ʻike ma o ka ʻikepili ma ka hyperglycemia maternal a me ka loaʻa o ka maʻi mellitus o ka maʻi mellitus. ʻO nā loli hoʻololi i ka pūpū ua hōʻoia ʻia e ka ultrasound.
Ma ka 1st trimester, ua hōʻike ʻia kahi ultrasound macrosomia (hoʻonui i ke kiʻekiʻe a me ke kaumaha o ke keiki), nā puʻupuʻu nui o nā kino, nui ka nui o ka nui, ka nui o ka wai nui amniotic. I ka wā 2 o ka trimester, hiki i ka ultrasound ke hōʻike i nā hemahema i loko o ka piʻina o ka nupepa, nā iwi o nā iwi, nā mea ʻalā a me nā hui urinary, nā naʻau a me nā kīʻaha koko. Ma hope o 30 mau pule o ka hāpai ʻana, ʻike ka ultrasound i ka tissue edematous a me ka momona nui i ka pēpē.
A ʻo kahi wahine hāpai i ka maʻi maʻi, ua kuhikuhi ʻia nō hoʻi i kekahi mau haʻawina hou:
- Pākaʻikaʻi biophysical o ka pēpē ʻO ia kahi hana i ka hana a ke keiki, kāna hana hanu a me ka puʻuwai o ka puʻuwai. Me ka fetopathy, ʻoi aku ka ikaika o ke keiki, ʻoi aku ka pōkole ma mua o ka hiamoe, ʻaʻole iʻoi aʻe ma mua o 50 mau minuke. Loaʻa nā ʻano wikiwiki a lōʻihi paha o ka puʻuwai puʻuwai.
- Dopplerometry koho ia i 30 mau pule e loiloi i ka hana o ka puʻuwai, ke kūlana o nā moku o ka pēpē, ka lawa o ke kahe koko i loko o ke kaula umbilical.
- CTG o ka pūpū e loiloi i ka hele ana a me ka helu o ka puʻuwai ma luna o nā manawa lōʻihi, e ʻike ana i ka hypoxia.
- Nā hōʻike koko E hoʻomaka me 2 trimesters i kēlā me kēia 2 hebedoma e hoʻoholo ai i ka ʻōmaʻomaʻo o ka hormonal o ka wahine hāpai.
ʻO ka hana ʻana o ka maʻi fetopathy maʻi i loko o kahi pēpē i lawe ʻia i ke kumu o kahi loiloi o ka ʻike ʻana o ka pēpē a me ka ʻikepili mai nā hōʻike koko: he nui a nui a me nā nui o nā sela ʻulaʻula, he nui pae hemoglobin, kahi puna nui i ke kō i ka 2.2 mmol / L a i lalo a hala paha 2-6 mau hola ma hope o ka hānau ʻana.
Pehea e mālama ai i ka fetopathy maʻi maʻi
ʻO ka hānauʻana o kahi keiki me ka fetopathy i kahi wahine me ka maʻi maʻi e pono ai ka nānā lapaʻau kūikawā. Hoʻomaka ia i ka wā o ka hānau keiki ʻana. Ma muli o ka fetus nui a me ka hopena kiʻekiʻe o ka preeclampsia, kahi hānau maʻamau kahi maʻi maʻamau i 37 mau pule. Ma mua o ke kau ʻana o nā wā ma mua e hoʻoweliweli ka hapai i ke ola o ka makuahine, no ka mea, he haʻahaʻa loa ke ola o ka pēpē i hala.
Ma muli o ka hiki nui o ka hypoglycemia maternal i ka wā o ka hānau keiki ʻana, ka nānā pinepine ʻia nei nā pae glucose koko. Hoʻololi ka haʻahaʻa haʻahaʻa i ka manawa o ka hoʻokele intravenous o kahi hopena glucose.
I ka manawa mua ma hope o ka hānau ʻana o ke pēpē, ʻo ka mālama ʻana me ka fetopathy i loko o ka hoʻoponopono ʻana o nā maʻi hiki:
- Mālama i nā pae glucose maʻamau. Hoʻomaʻamaʻa pinepine ʻia nā mea ʻai maʻamau i kēlā me kēia 2 o ka manawa, ʻoi aku ka momona waiū. ʻAʻole lawa kēia e hoʻopau i ka hypoglycemia, mālama ʻia kahi hopena o ka glucose 10% i loko o nā wahi liʻiliʻi. ʻO kona kikowaena koko alaʻehā ma kahi o 3 mmol / L. ʻAʻole pono ke hoʻonui nui, no ka mea, ua pono e pau ka hypertrophied pancreas e hana i ka nui o ka insulin.
- Kākoʻo hanu. No ke kākoʻo ʻana i ka hanu, hoʻohana ʻia nā ʻano lāʻau lapaʻau ʻē aʻe, hiki ke lawelawe i ka hoʻomākaukau ʻana i ka surfactant.
- Ka huli ʻana. Mālama ʻia ke ʻano kino o ke keiki me ka fetopathy maʻi maʻi ma ka pae mau o 36.5 -37.5 tikelika.
- Ke hoʻoponopono ʻana i ka kaulike electrolyte. ʻO ka hapa o ka magnesium e hoʻopiʻi ʻia e ka hopena o 25% o ka magnesium sulfate, ka hapa o ka calcium - 10% hopena o ka calcium gluconate.
- Mālamalama kukui ultraviolet. Loaʻa ka Therapy o ka jaundice i nā hopena o ka radiation ultraviolet.
Nā hopena he aha
I nā pēpē hou me nā fetopathy maʻi maʻi i hoʻokō e hōʻalo i ka malenation congenital, hōʻailona hewa ka maʻi o ka maʻi. Ma 2-3 mau mahina, paʻakikī kēlā pēpē e hoʻokaʻawale mai kahi olakino. ʻAʻohe like ʻole ʻo ia e hoʻomohala hou i ka mellitus maʻi maʻamau a nui loa ia ma muli o mea pili geneticakā ma mua o ka hānau ʻana o ka fetopathy i ka wā kamaliʻi.
Loaʻa nā keiki i hānau ʻia i nā makuahine me ka maʻi hānai i ka momona a me nā metabolism lipid. Ma ka makahiki 8, ʻoi aku ka nui o ko lākou kino kino ma mua o ka awelika, hoʻokiʻekiʻe ʻia ko lākou koko koko o ka triglycerides a me ka cholesterol.
Hoʻomaopopo nā maʻi o nā pōkole ma 30% o nā keiki, ka hoʻololi i ka naʻau a me nā kīʻaha koko - ma ka hapa, hōʻeha i loko o ka ʻoihana ʻōpala - i 25%.
ʻO ka maʻamau o kēia mau loli, akā me ka uku ʻole o ka uku mole no ka diabetes mellitus i ka wā hāpai ʻia, ʻike ʻia nā hemahema nui e pono ai ka hana mau o ka hōʻemi a me ka maʻi maʻamau.
Kāohi
Pono ʻoe e hoʻomākaukau no ka hāpai ʻana me ka maʻi maʻi iʻeono mau mahina ma mua o ka hoʻomaka ʻana. I kēia manawa, pono ia e hoʻokau i ka uku paʻa no ka maʻi, e hoʻōla i nā maʻi āpau āpau. ʻO kahi hōʻailona o ka mākaukau no ka hali ʻana i kahi keiki he pae maʻamau o ka hemoglobin glycated. ʻO Normoglycemia ma mua o ka hāpai ʻana, i ka wā hāpai a ʻo ka wā hānau ʻana, he mea makemake ia no ka hānau ʻana o kahi pēpē ola ma kahi makuahine me ka maʻi maʻi.
Hoʻopili ʻia ke kuʻekuʻe koko ma kēlā me kēia hola 3-4, hoʻonui ʻia ka hyper- a me hypoglycemia. No ka ʻike manawa kūpono loa i ka fetopathy maʻi kamaliʻi i kahi keiki, pono ia e hoʻopaʻa inoa ma ka haukapila antenatal i nā manawa mua, hoʻomālamalama ʻia i nā haʻawina a pau.
I ka wā hapai, ʻike pinepine ka wahine i nā maʻi gynecologist wale nō, akā ʻo ka endocrinologist e hoʻoponopono i ka nui o nā lāʻau.
