I-Cervical Cerclage: Izinhlobo, Izinqubo, Izinyathelo Zokuqapha kanye Nezingozi

Komama abakhulelwe ababhekene nengozi yokubeletha ngaphambi kwesikhathi, yonke intuthuko yezokwelapha engasiza ekuthwaleni ukukhulelwa kuze kufike isikhathi esigcwele iba yinto ebalulekile. I-Cervical cerclage ime njengomunye wokungenelela kwezokwelapha okuphumelelayo kakhulu ekuvimbeleni ukuzalwa ngaphambi kwesikhathi kwabesifazane abanenkinga yomlomo wesibeletho (umlomo wesibeletho obuthakathaka).

Lo mhlahlandlela ophelele uhlola yonke into mayelana nokusebenza kwe-cervical cerclage, kusukela ekuqondeni inqubo kanye nezinkomba ze-cervical cerclage kuya kuziqondiso zokubuyisela kanye nezingozi ezingaba khona. Uzoqonda ukuthi lokhu kungenelela kungase kudingeke nini, ukuthi yini ongayilindela phakathi nenqubo, kanye nemiyalelo ebalulekile yokunakekelwa kwangemva kokuhlinzwa.

Iyini iCervical Cerclage?

I-Cervical cerclage iyinqubo evamile yokuhlinzwa ehlanganisa ukubeka ama-sutures noma i-synthetic tape ukuqinisa umlomo wesibeletho ngesikhathi. ukukhulelwa. Lokhu kungenelela kwezokwelapha kuhlose ukugcina ubuqotho besakhiwo somlomo wesibeletho ukuze kunwetshwe isikhathi sokukhulelwa nokuvimbela ukuzalwa ngaphambi kwesikhathi.

Okulandelayo yizinhlobo ezimbili eziyinhloko ze-cervical cerclage:

• I-Transvaginal Cerclage: Indlela ejwayeleke kakhulu lapho izithungo zifakwa esithweni sangasese
• I-Transabdominal Cerclage: Kubandakanya ukusika kwesisu ukuze kufinyelele emlonyeni wesibeletho, okwenziwa ngokuhlinzwa okuvulekile noma nge-laparoscopy

Izithungo zokuhlinzwa zinikeza ukwesekwa okwengeziwe ngokuvala umlomo wesibeletho ngokuvikelekile phakathi nokukhulelwa. Lokhu kuqiniswa kubaluleke kakhulu kwabesifazane abanokukhubazeka komlomo wesibeletho, isimo lapho umlomo wesibeletho uqala ukunwebeka ngaphandle kokufinyela, okuholela ekubelethweni kwe-second-trimester.

Odokotela ngokuvamile benza i-cervical cerclage phakathi kwamasonto angu-12 kuya kwangu-14 okukhulelwa ngaphambi kokuba umlomo wesibeletho uqale ukuba mncane. Isikhathi sibalulekile njengoba sivumela ukusekelwa komlomo wesibeletho okuphelele phakathi nezigaba ezibalulekile zokukhula kokukhulelwa. 

Kungani I-Cervical Cerclage Yenziwa?

Kunezinkomba ezintathu ezimiswe kahle zokubekwa kwe-cervical cervical:

• Okukhonjiswe Umlando (Prophylactic): Kunconyelwe abesifazane abanokulahlekelwa kokukhulelwa kwekota yesibili eyodwa noma ngaphezulu okuhlobene nokuvuleka komlomo wesibeletho okungenabuhlungu ngaphandle kokusikwa noma izinkinga ze-placental
• I-Ultrasound ekhonjisiwe: Kucatshangelwa lapho ubude bomlomo wesibeletho bungaphansi kwama-25mm ngaphambi kwamaviki angama-24 okukhulelwa kwabesifazane abanokulahlekelwa okuzenzakalelayo kwangaphambilini noma ukuzalwa ngaphambi kwesikhathi.
• Ukuhlolwa Komzimba Kubonisiwe: Eyaziwa nangokuthi i-cerclage ephuthumayo, eyenzelwe iziguli ezinokunwebeka okuthuthukile komlomo wesibeletho ngaphambi kwamaviki angama-24, inqobo nje uma kungekho ukusikwa noma izifo.

Izinqubo zokuhlinzwa ezedlule, ezifana nokusebenza kwe-LEEP noma okunye ukuhlinzwa kwezicubu zomlomo wesibeletho, kungaholela ebuthakathakeni bomlomo wesibeletho, okudinga i-cerclage. Ukwengeza, abesifazane abaphuphunyelwa yizisu ngaphambili ngenxa yokungajwayelekile kwesibeletho noma ukulimala komlomo wesibeletho bangase bazuze kulokhu kungenelela.

Imininingwane Yenqubo 

• Ngaphambi Kwenqubo: Ukulungiswa kwe-cerclage yomlomo wesibeletho kuqala ngokuhlolwa okuphelele kwezokwelapha. I-gynecologist ibukeza umlando wezokwelapha wesiguli, kulandelwa ukuhlolwa okuningiliziwe komlomo wesibeletho kanye ne-ultrasound ye-transvaginal ukuhlola isimo somlomo wesibeletho.
• Ngesikhathi Senqubo: Ithimba elihlinzayo lizobeka isiguli etafuleni, ngokufanayo nokuhlolwa kwezifo zabesifazane. Odokotela banikeza i-anesthesia efanele ukuqinisekisa ukunethezeka kuyo yonke inqubo. Esebenzisa izintambo eziqinile, udokotela ohlinzayo uthunga umlomo wesibeletho ngokucophelela, awuqinise ukuze ugweme ukuvuleka ngaphambi kwesikhathi.
• Ukubuyisela kanye Nokunakekelwa Ngemva: Ngemva kwenqubo, iziguli ngokuvamile zihlala ngaphansi kokubhekwa amahora ambalwa ukuze ziqaphe noma yiziphi izinkinga ezikhona. Iningi labesifazane liba ne-cramping encane nokopha okuncane kuze kube yizinsuku ezintathu emva kwenqubo. Izinyathelo ezibalulekile zokuqapha ngemuva kwe-cervical cerclage zihlanganisa:
  • Ukugqoka ama-sanitary pads nokugwema ama-tampons
  • Ukuthola ukuphumula okwanele, okungcono ukulala ngohlangothi lwesobunxele
  • Ukugcina i-hydration efanele kanye nokukhipha isinye njalo
  • Ukugwema imisebenzi ekhandlayo okungenani izinsuku ezingu-2-3
  • Ukugwema ukuya ocansini cishe amasonto amabili ngemuva kwenqubo

Izingozi zeCervical Cerclage

Okulandelayo ezinye zezinkinga ezingase zibe khona ze-cervical cerclage:

• Ukutheleleka noma i-sepsis
• Ukulimala komlomo wesibeletho noma izibazi
• ukopha
• Ukuqhekeka ngaphambi kwesikhathi kwezingqimba
• Umsebenzi wangaphambi kwesikhathi
• I-Cervical stenosis (ukuncipha okungapheli)
• Ukudabula okungaba khona uma ukuteta kwenzeka ngaphambi kokususwa komthungo

Yisiphi Isikhathi Esifanelekile Sokukhipha I-Cervical Cerclage?

Isikhathi sokukhishwa kwe-cervical cerclage yisici esibalulekile sokulawulwa kokukhulelwa. Odokotela bavamise ukuhlela ukususwa phakathi kwamaviki angama-36 kuya kwangu-37 okukhulelwa. Lesi sikhathi siqinisekisa ukuthi ukukhulelwa sekufinyelele esigabeni esiphephile kuyilapho kugwema izinkinga ezingase zibe khona ekushiyeni i-cerclage endaweni ngesikhathi sokubeletha.

Izimo ezithile zingadinga ukususwa kwe-cerclage kusenesikhathi:

• Ukusebenza okusebenzayo
• Active ukopha kwesitho sangasese sowesifazane
• Ubufakazi be-chorioamnionitis
• Ezinye izinkomba zokubelethisa ezidinga ukubeletha ngokushesha

Ezigulini ezithola ukuphuka ngaphambi kwesikhathi kolwelwesi (i-PPROM), odokotela bangase bayishiye i-cerclage isendaweni kuze kuqedwe ukwelashwa ngama-steroid okuvuthwa kwamaphaphu engane. Ezigulini ezine-transabdominal cerclage, indlela yokwenza ihluke kakhulu - lezi zithungo ngokuvamile zihlala endaweni ukubeletha ngokuhlinzwa futhi ingagcinwa phakathi kokukhulelwa ukuze kuvinjelwe ukuzalwa ngaphambi kwesikhathi esizayo.

Uzoyibona Nini Udokotela

Iziguli kufanele zithinte udokotela wazo wezifo zabesifazane ngokushesha uma zithola noma iyiphi yalezi zimpawu ngemuva kwenqubo:

• Imfiva engaphezu kuka-100.5°F (37.8°C) noma amakhaza
• Ukufinyela noma ubuhlungu obuphansi besisu obuvela ngezikhathi ezithile
• Ukopha kwesitho sangasese sowesifazane okusuthisa iphedi elilodwa langasese ngaphansi kwamahora ama-3-4
• Ukunuka kabi ukuqunjelwa sangasese
• Ukuphuka kwamanzi noma ukuvuza
• Ukucanuzela kwenhliziyo okuphikelelayo kanye oluhlanzayo

Isiphetho

I-cervical cerclage ime njengokungenelela okubalulekile kokuhlinzwa okusiza abesifazane abaningi ukuba bathwale ukukhulelwa kwabo kuze kube yisikhathi. Ubufakazi bezokwelapha busekela ukusebenza kahle kwayo, ikakhulukazi ezigulini ezinokwehluleka komlomo wesibeletho noma ukulahlekelwa kokukhulelwa kwangaphambilini. Nakuba inqubo inezingozi ezithile, ukugadwa okufanele kwezokwelapha kanye nokulandela izinkombandlela zokunakekelwa kwangemva kokuhlinzwa kuthuthukisa kakhulu imiphumela.

Amazinga empumelelo ahlala ephezulu lapho iziguli zigcina ukuxhumana njalo nodokotela bazo futhi zisabela ngokushesha kunoma yiziphi izimpawu eziyisixwayiso. Iningi labesifazane abathola i-cervical cerclage bathola imiphumela emihle, abaningi bathwala ukukhulelwa kwabo sekusondele isikhathi esigcwele.

Imibuzo Evame Ukubuzwa

1. Ingabe inqubo yokukhishwa komlomo wesibeletho ibuhlungu? 

Iziguli zithola ukungakhululeki okuncane phakathi nenqubo ngenxa yokuphathwa kwe-anesthesia efanele. Ngemuva kokuhlinzwa, ukuminca okuncane nokopha okuncane kungase kwenzeke izinsuku ezimbalwa, okulawulekayo ngemithi.

2. Yiziphi izinzuzo ze-cervical cerclage? 

Inqubo ibonisa izinga lempumelelo elingama-85-90% ekuvimbeleni ukuzalwa ngaphambi kwesikhathi. Isiza kakhulu abesifazane abanokukhubazeka komlomo wesibeletho, ukusiza ukugcina ukukhulelwa kuze kube yisikhathi esigcwele.

3. Yiziphi izinto okungafanele ngizenze ngemva kwenqubo yokukhishwa komlomo wesibeletho? 

Izinto okungafanele uzenze ngemuva kwe-cervical cerclage:

• Imisebenzi enzima yomzimba kanye nokuphakamisa isisindo
• Ukuya ocansini okungenani amasonto amabili
• Ukuhamba amabanga amade ngaphandle kokubonisana nodokotela
• Ukubhema kanye nokuphuzwa kotshwala

4. I-cervical cerclage yenziwa eminyakeni emingaki? 

Inqubo ngokuvamile yenziwa phakathi kwamaviki angu-12-14 okukhulelwa, nakuba ingenziwa kuze kube amasonto angu-24 ezimeni eziphuthumayo.

5. Kutholakala kanjani ukuthi ubuthakathaka bomlomo wesibeletho? 

Odokotela baxilonga ukuntula komlomo wesibeletho ngokuqapha njalo nge-ultrasound phakathi kwamasonto ayi-16-24 okukhulelwa, ukulinganisa ubude bomlomo wesibeletho kanye nokuhlola ukunwetshwa kusenesikhathi.

6. Zingaki izinsuku zokuphumula kombhede ezidingekayo ngemuva kwe-cerclage yomlomo wesibeletho? 

Iziguli eziningi zidinga izinsuku ezingu-2-3 zokuphumula ekhaya kulandela inqubo. Ngokuvamile bangabuyela emisebenzini evamile phakathi kwamaviki angu-1-2, inqobo nje uma umsebenzi wabo unganzima ngokomzimba.

7. Ngingakwazi yini ukubeletha okuvamile ngemva kwe-cerclage? 

Yebo, ukulethwa kwesitho sangasese sowesifazane kungenzeka ngemuva kwe-transvaginal cerclage. Izithungo zivame ukususwa emasontweni angama-37 okukhulelwa ukuze kuvunyelwe ukubeletha ngokwemvelo. Kodwa-ke, iziguli ezine-transabdominal cerclage zizodinga isigaba sokuhlinzwa.