Breech Baby

Idatha yezokwelapha ikhombisa ukuthi u-3-4% wabesifazane bathola izingane zabo zilala ngaphansi njengoba zisondela osukwini lwazo. Lezi zindaba zingakhathaza abazali abalindele, kodwa intuthuko yesimanje yezokwelapha ikwenze kwaphepheka kunangaphambili ukuphatha ingane ebeleselayo. Lo mhlahlandlela ophelele usiza abazali abalindele ukuthi baqonde yonke into ngezingane ezibeleselayo. Uzofunda ngezimpawu, izimbangela, ukukhetha kokwelashwa, kanye nezindlela zokuvikela izinkinga. Umhlahlandlela uhlanganisa izinhlobo ezahlukene zokuma kwe-breech kanye nezingozi ezingaba khona. Iphinde ichaze isikhathi esifanele sokufinyelela kudokotela wakho.

Iyini iBreech Baby?

I-breche yengane yenzeka lapho izinqe noma izinyawo zosana zilele eduze nendawo yokubeletha esikhundleni sokuma kwekhanda elijwayelekile elibheke phansi. Ikhanda lomntwana libheke phezulu esifubeni sikamama, okudala isimo esidinga ukunakekelwa okukhethekile kwezokwelapha.

Izingane eziningi zihamba ngokwemvelo endaweni ebheke phansi ngaphambi kokuzalwa. Izibalo zibonisa ukuthi u-3-5% kuphela wokukhulelwa isikhathi esigcwele (amaviki angu-37-40) aphumela ekwethulweni kwe-breech. Izinombolo ziyashintsha ngokuya ngokuthi kude kangakanani ukukhulelwa kuyinto. Cishe u-7% wezingane uzala emasontweni angama-32, okhuphukela ku-25% emasontweni angama-28 noma ngaphambi kwalokho.

Ukwethulwa kwe-breech kuza nezingozi eziphakeme ngesikhathi sokuzalwa. Odokotela abaningi namuhla basikisela ukuhlinzwa ngokuhlinzwa ukuze kubelethwe ibele njengenketho ephephile kubo bobabili umama nengane. Uhlelo lokwelapha lungase lushintshe ngokusekelwe ohlotsheni oluthile lwebele lokubeleka, isigaba sokukhulelwa, kanye nesimo esiyingqayizivele sikamama.

Yiziphi Izinhlobo Zezikhundla Ze-Breech?

Ochwepheshe bezokwelapha bahlukanisa izikhundla ze-breech zibe izinhlobo ezine eziyinhloko:

• UFrank Breech Baby: Izinqe zengane zibheke phansi imilenze iqonde phezulu nezinyawo eduze kobuso
• I-Breech ephelele: Ingane ihlezi ingqubuzane nezinqe ezigobile namadolo
• I-Footling Breech: Unyawo olulodwa noma zombili zibheke phansi ngasemseleni wokuzala
• I-Transverse Lie: Ingane ilele iqonde esibelethweni

Izimpawu zeBreech Baby

Imizwa ingazizwa ihlukile ekukhulelweni okubheke phansi. Nazi izimpawu ezivame kakhulu zokuphenduka kwe-breech baby:

• Ingane ikhahlela okhalweni noma ngaphansi kwesisu esikhundleni ngaphansi kwezimbambo
• Isigaxa esiqinile, esiyindilinga eduze kwe-ribcage (ikhanda lomntwana)
• Amaphethini okunyakaza azizwa ehlukile kokukhulelwa kwangaphambilini
• Ukucindezela okungaphezulu kwesisu esingenhla

Odokotela bayakwazi ukubona ukuthi ingane iqhanyelwa yini ngokuhlolwa ngokomzimba, ikakhulukazi phakathi nekota yesithathu. Phakathi nalokhu kuhlolwa, bacindezela izindawo ezithile zesisu sakho ukuze bahlole indawo yomntwana. Leli sheke, elibizwa ngokuthi amasu kaLeopold, lisiza ekutholeni ikhanda, umhlane nezinqe zengane.

Odokotela bavame ukusikisela i-ultrasound scan ukuze kuqinisekiswe indawo. I-breche yengane ngokuvamile ayibangeli ubuhlungu obuningi noma ukungakhululeki kunokuma kwekhanda phansi. Umehluko oyinhloko yilapho uzwa khona ukuthi ingane yakho inyakaza, hhayi ukuthi lokho kunyakaza kuzizwa kanjani.

Izinkinga zeBreech Baby

Odokotela bavame ukukuthola kunzima ukunquma kahle ukuthi yini ebangela ukwephulwa kwesikhundla, kodwa bayazi izici ezithile zobungozi kanye nezimo zezokwelapha ezenza kube lula. Izimo zezokwelapha ezingaholela endaweni yokulala i-breech zihlanganisa:

• Ukukhulelwa kokuqala
• Isibeletho esinesimo esingavamile ngenxa yama-fibroids noma ezinye izimo
• I-Placenta previa (I-placenta evala umlomo wesibeletho)
• Uketshezi lwe-amniotic oluningi kakhulu noma oluncane kakhulu
• Ukukhulelwa okuningi (amawele noma amawele amathathu)
• Ukusebenzela ngaphambi kwesikhathi

Izingozi Zezingozi

Ezinye izici eziphakamisa amathuba okuba ne-breech baby, okuhlanganisa: 

• Abesifazane abakhulelwe ngaphambilini noma asebekhulile babhekana nezingozi ezinkulu. 
• Izingane ezinezimo ezithile zemisipha noma zamathambo zingase zingakwazi ukuya endaweni efanele yokubheka phansi. 
• Izimo ezihlukile ezithinta i-polarity yesibeletho esiqondile, njengesibeletho esizimele noma i-bicornuate uterus  

Izinkinga Zengane Ye-breech

Ukubelethwa kwe-vaginal breech kungaholela ezinkingeni ezinkulu eziningana:

• Izinkinga ze-Umbilical Cord: Intambo ingase iminyaniswe noma isonteke, okungase kuholele ekusweleni komoyampilo
• Ukuhlukumezeka Emzimbeni: Ukulimala okungenzeka kuhlanganisa amathambo aphukile noma aphukile ezingalweni noma emilenzeni yomntwana
• Ukungena kwekhanda: Ikhanda lomntwana lingase libhajwe ngemva kokuba umzimba usuphumile
• I-Asphyxia Yokuzalwa: Ukubambezeleka kokulethwa kungaholela ekusweleni umoya-mpilo
• I-Intracranial haemorrhage: Ukucindezelwa ngokushesha kwekhanda ngesikhathi sokubeletha kungase kubangele ukopha
• I-Breech Baby Birth Defects: Izingane ezibeleselayo zisemathubeni amaningi okuthuthukisa ukuguzuka kwenyonga yokuzalwa. 

Sifo

Inqubo iqala ngokuhlolwa komzimba okujwayelekile ekuhlolweni kwangaphambi kokubeletha.

Odokotela benza i-Leopold maneuver ukuze bahlole ukuthi ingane ikuphi. Lezi zindlela zokusebenzisa izandla zibasiza ukuthi bazwe isisu futhi babone isakhiwo esiyinkimbinkimbi, esiyindilinga (ikhanda lomntwana) eduze nezimbambo zikamama. Ukuzwela kwalokhu kuziphatha kuphakathi kwama-57-70%.

Odokotela batusa ukuskena kwe-ultrasound ukuze kuqinisekiswe ukuxilongwa ngokunemba okungu-100%. Isikhathi esingcono kakhulu sokwenza ukuxilongwa "okusemthethweni" sifika emavikini angu-37 okukhulelwa. Lesi sikhathi sibalulekile ngoba izingane zinendawo elinganiselwe yokujika ngokwemvelo ngemva kwaleli phuzu.

Ukwelashwa

Odokotela abaningi batusa i-External Cephalic Version (ECV) njengendlela yokuqala yokwelashwa ehambisana nesimo.

I-external Cephalic Version (ECV) isiza ukuguqula ingane ibe yindawo ebheke phansi ngemva kwamasonto angu-37 ekhulelwe. Le nqubo ibonise izinga lokuwina elikhuphukayo cishe elingama-60%.Inqubo inengozi yayo. Inqubo ye-ECV ihlanganisa:

• Odokotela bacindezela kancane esiswini
• Iziguli zingase zithole imithi yokuphumuza isibeletho
• Inqubo ithatha cishe imizuzu eyi-10
• Izisebenzi zezokwelapha ziqapha ingane kuze kube amahora ama-2 ngemva kwalokho

Odokotela bavame ukuletha ezinye izindlela ezimbili ezibalulekile uma i-ECV ingasebenzi noma ingafanele:

• Isigaba sikaKhesari esihleliwe: Ucwaningo lubonisa ukuthi le nketho ngokuvamile iphephile enganeni kunokuzala i-breche
• Ukuzalwa kwe-Vaginal Breech: Le ndlela idinga ukwesekwa kwethimba lezokwelapha okukhethekile. Cishe u-40% wokuzanywa kwe-breche ephuma esithweni sangasese sangasese kuholela esigabeni esiphuthumayo se-C

Abanye odokotela baphakamisa izikhundla ezimbalwa zokulala ukuze baphendule i-breech ingane iziguli ezingazama ngazo ekhaya ukugwema izinqubo zezokwelapha. Lezi zindlela azinazo ubufakazi besayensi bokuthi ziyasebenza:

• Indawo yebhuloho enezinqulu eziphakanyisiwe
• Ukuma kwengane imizuzu eyi-10-15
• Ukugoba okuguqayo kuya phambili
• Izandla namadolo (indawo yonke-mine).
• Indawo eseceleni kwesobunxele nomcamelo phakathi kwamadolo akho

Uzoyibona Nini Udokotela

Abesifazane kufanele baye ekunakekelweni okuphuthumayo uma behlangabezana:

• I-cramping enzima ye-pelvic noma ukufinyela
• Ukusuka kwamagciwane
• Ukuphuka kwamanzi

Omama abenza izinqubo ze-ECV kufanele bashayele udokotela wabo ngokushesha uma beqaphela:

• Ukusuka kwamagciwane
• Ubuhlungu besisu
• Ukunyakaza kwe-fetus okuncishisiwe
• Ukuhlukaniswa

Prevention

Odokotela baphakamisa lezi zindlela eziphephile zokukhuthaza ukuma okuhle:

• Gcina ukuma kwakho kuqondile futhi uncike phambili njalo
• Hlala ngamadolo akho ngaphansi kwezinqulu zakho
• Zama imivimbo yokubhukuda ehlukene ngobumnene
• Lala ngohlangothi lwakho lwesobunxele bese ubeka umcamelo phakathi kwemilenze yakho
• Yenza izivivinyo ezithambile ngenkathi usezandleni nasemadolweni
• Thatha uhambo lwansuku zonke kuze kube ihora (ngaphandle uma unezinhlungu ze-pelvic)

Isiphetho

Intuthuko yesimanje yezokwelapha yenze ukuphatha ingane ebeleselayo kungesabi kakhulu kunalokho ongase ucabange. Amaqembu ezokwelapha manje anikeza izinketho eziningana eziphephile komama ababhekene nale nselele. Lezi zinketho zisukela Ezinguqulweni Zangaphandle Ze-Cephalic kuya ezigabeni C ezihleliwe.

Ukutholwa kusenesikhathi ngokuhlolwa okuvamile ngaphambi kokubeletha kuholela emazingeni aphezulu empumelelo ekulawuleni i-breech. Izingane ezizalwa ngenxa yokubeletha zikhula zinempilo ngaphandle kwezinkinga zesikhathi eside. Lo mphumela omuhle uvela ekuqashweni ngokucophelela kwezokwelapha kanye nokungenelela okufika ngesikhathi.

Imibuzo Evame Ukubuzwa

1. Ingabe ingane ebeleshwayo ijwayelekile?

Ukuma kwe-breech kwenzeka kaningi ngesikhathi sokukhulelwa. Ucwaningo lubonisa ukuthi izingane ezibeleselayo zihlanganisa u-3-4% wabo bonke abakhulelwe isikhathi esigcwele. Izingane zivame ukuthatha lesi simo ekuqaleni kokukhulelwa, kodwa iningi lizoshintsha libheke phansi ngaphambi kokubeletha.

2. Ingane ibhekisa nini ikhanda phansi?

Izingane zivame ukujikisa ikhanda phansi phakathi kwamaviki angama-32-36 okukhulelwa. Izingane eziningi zithatha indawo yekhanda phansi (cephalic) emavikini angu-32. Ezinye izingane zingase zidinge isikhathi esengeziwe ukuze zijike, futhi odokotela babhekisise indawo yomntwana phakathi naso sonke isikhathi sokukhulelwa.

3. Ingabe ukubeletha obelekelwe ibele kuphephile?

Izindlela zokwelapha zesimanje zenze ukuzala ombeleyo kwalawuleka, kodwa kuza nezingozi ezengeziwe. Izigaba C eziphuthumayo kuba kudingekile ku-40% wokuzanywa kwe-breech yesitho sangasese sowesifazane. Odokotela ngokuvamile baphakamisa izigaba ze-C ezihleliwe ukuletha izingane ezibelethisa ngokuphepha.

4. Ngingakwazi ukujikisa ibele lomntwana ngokwemvelo?

Ungazama izindlela ezimbalwa ukukhuthaza ingane yakho ebeleselayo ukuthi iphenduke ngokwemvelo. Odokotela bavame ukutusa:

• Ukuthatha isikhundla sebhuloho ngezinqunu eziphakanyisiwe imizuzu engu-10-15
• Ukuncika phambili ngezikhundla ezahlukene
• Ukubhukuda ngobumnene
• Ukuhamba njalo

5. Kufanele ngihlale kanjani uma ingane yami inebele?

Ukuma okuhle kokuhlala kudala isikhala esiza ingane yakho ukuthi iphenduke. Izinyawo zakho kufanele zihlale phansi namadolo akho ngaphansi kwesisu sakho. Lesi simo sivumela i-pelvis yakho ukuthi ihlale ihleleke kahle futhi inikeza ingane yakho indawo eyengeziwe yokunyakaza.

6. Ulala kanjani lapho ingane ibambe ibhulukwe?

Ukulala eceleni kusebenza kangcono ngezingane ezibeleselayo uma unokwesekwa okufanele. Odokotela basikisela:

• Ubeka imicamelo phakathi kwamadolo namaqakala
• Ukusekela isisu sakho
• Ukungahlali emuva, ikakhulukazi ngasekupheleni kokukhulelwa

UDkt. Neena Agrawal

MBBS, MS, FICOG, Diploma in Gynaecology, Endoscopy
Izibhedlela ze-CARE CHL, e-Indore

Ukuze Ubhukhe Isikhathi, shayela:

+91 406 810 6585

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