I-Congenital Anomaly Yesibeletho

Ukwelashwa Kwesibeletho Sokuzalwa e-Hyderabad, eNdiya

I-Congenital anomalies yesibeletho ukukhubazeka kokuzalwa esibelethweni okwenzeka ngesikhathi sokuphila kombungu. Ukuphazamiseka kwesibeletho yilapho isibeletho sowesifazane sikhula ngendlela ehlukile lapho esesibelethweni. Bangaphansi kuka-5% abesifazane abanokukhubazeka kokuzalwa kwesibeletho, nokho, kuye kwaphawulwa ukuthi u-25% wabesifazane abaphuphunyelwa yisisu noma ukubeletha ngaphambi kwesikhathi bane-anomaly yokuzalwa yesibeletho. 

Kungani kwenzeka i-anomaly yokuzalwa yesibeletho?

Izinhlobo ze-anomalies yokuzalwa yesibeletho

Kunezinhlobo ezahlukene ze-anomalies yokuzalwa yesibeletho, kuhlanganise -

• Hlukanisa isibeletho - Kulesi simo, isibeletho sibonakala sijwayelekile ukusuka phezulu, kodwa sihlukaniswe izingxenye ezimbili ezihlukene nge-septum, ngaphakathi. I-septum ingaba yinoma yimuphi usayizi nobukhulu. I-Septate uterus ingenye yezinkinga ezivame ukutholakala ezitholakala kakhulu zesibeletho sokuzalwa, esibhekene nama-45% azo zonke izimo ze-uterine anomaly zokuzalwa.

• I-arcuate isibeletho - Kulesi simo, isibeletho sibonakala sijwayelekile ngaphandle, kodwa kune-groove engajulile engu-1 cm noma ngaphansi endaweni yangaphakathi ye-endometrial cavity. Lezi zinhlobo ze-anomalies zenza u-7% wazo zonke izinkinga zesibeletho sokuzalwa.

• Isibeletho seBicornuate – Kulesi simo, isibeletho sinomsele endaweni engaphandle futhi sinezimbotshana ezimbili ze-endometrial. Isibeletho sibonakala sihlukaniswa saba izingxenye ezimbili, ngaphandle kwengxenye engezansi. Isibeletho se-bicornuate sakha ama-25% azo zonke izinkinga zesibeletho sokuzalwa.

• Isibeletho se-Unicornuate - Kulesi simo, ingxenye kuphela yesibeletho iye yavela emgudwini owodwa we-Mullerian, okwenza u-15% wazo zonke izinkinga zesibeletho sokuzalwa.

• I-agenesis yesibeletho – Kulesi simo, isibeletho siyehluleka ukukhula. Lesi simo sivame kakhulu ku-10% wabo bonke abesifazane abane-anomalies yokuzalwa yesibeletho.

• I-uterus didelphys - Kulesi simo, izingxenye ezimbili zesibeletho zikhula zihlukene ngokuphelele, okwenza u-7.5% wazo zonke izimo ezingavamile zesibeletho sokuzalwa.

Izinkinga ezivame kakhulu zesibeletho sokuzalwa yi-septate kanye ne-bicornuate uterine anomalies. 

Izimpawu

Ngokuvamile, azikho izimpawu zokuzalwa kwe-uterine anomalies. Abaningi besifazane abatholi ukuthi bane-anomaly yokuzalwa kwesibeletho kuze kube yilapho bethola i-ultrasound yabo yokuqala yokubeletha noma ukutholakala kokungazali. Uma kwenzeka kuvela izimpawu, lezi zihlanganisa:

• Izikhathi ezibuhlungu – Ngenxa yokungaphatheki kahle kwesibeletho, kungase kube nokuvinjelwa ukopha kokuya esikhathini. Lokhu kubangela ubuhlungu besisu namajaqamba.
• Ukungabikho ngokuphelele kwezikhathi - Ngenxa ye-anomalies yesibeletho, ukuqhuma okukhulu kwe-intrauterine kungenzeka, ngenxa yokuthi ukunamathela kungakheka ezindongeni zesibeletho. Lokhu kuholela ekutheni izindonga zesibeletho zinamathele komunye nomunye futhi ulwelwesi lwe-endometrial lube mncane kakhulu. Lokhu kuvimbela umbungu ukuthi unamathele esibelethweni. Ezimweni ezimbi kakhulu, ukuphuma kokuya esikhathini kungase kuphele ngokuphelele.
• Ukuphuphuma kwezisu okuphindaphindiwe – Ngenxa yokuphazamiseka kwesibeletho sokuzalwa njenge-septate uterus, kuba nzima kwabesifazane ukuthi baqhubeke nokukhulelwa kwabo, okuholela ekuphuphumeni kwezisu okuphindaphindiwe.
• Ibhulukwe noma indawo ephambanayo yengane – Ngezinye izikhathi, ngenxa yokungalungi kwesibeletho sokuzalwa, indawo yomntwana iba yi-transverse noma ibhulukwe lapho, esikhundleni sekhanda layo, izinyawo zengane zibheke phansi. Ezimweni ezinjalo, kunconywa isigaba C.
• Ubuhlungu ngesikhathi sokuya ocansini – I-Congenital anomalies yesibeletho ingaholela ekuhlanganyeleni okubuhlungu. Kungenza futhi ukuthi ungakhululeki ukufaka i-tampon.
• Umsebenzi wangaphambi kwesikhathi – Ukuphazamiseka kwesibeletho kungabangela ukuzala ngaphambi kwesikhathi, kwandise ingozi yokutheleleka kwezingane ezisanda kuzalwa futhi kungabangela nezinkinga zokukhula kuzo.

Izimbangela

Ezimweni eziningi zokuzalwa kwe-uterine anomalies, imbangela ayaziwa. Bangaphezu kuka-90% abesifazane abanokukhubazeka kwesibeletho banenombolo evamile yama-chromosome. Nokho, phakathi kuka-1938 no-1971, ukuze kuvinjelwe ukuphuphuma kwezisu nokubeletha ngaphambi kwesikhathi, abanye besifazane abakhulelwe belashwa nge-DES (diethylstilbestrol). Kwaphawulwa ukuthi laba besifazane basengcupheni enkulu yokuba ne-anomaly yokuzalwa yesibeletho. Ngaphandle kwalokhu, azikaze zibe khona izici zengozi ezimiswe kahle, kusukela manje.

• Hlukanisa isibeletho – Imbangela eqondile ngemuva kwesibeletho esiseseceleni akwaziwa. Kwenzeka ngesikhathi umbungu usakhula. Lapho amashubhu amabili okufanele ahlangane ukuze akhe isibeletho engahlangani ngokuphumelelayo, kuvela isibeletho se-septate.

• Isibeletho seBicornuate – Eyaziwa nangokuthi isibeletho esimise okwenhliziyo, i-bicornuate uterus yilapho isibeletho sibonakala simise okwenhliziyo. Umuntu wesifazane uzalwa enalesi simo. Amapayipi akhethekile ahlangana kancane kuphela. Lokhu kuholela ekuhlukaneni kwezingxenye ezimbili ezingenhla zesibeletho, ezaziwa nangokuthi izimpondo. Lezi zimpondo ziphumela ngaphandle kancane, okwenza isibeletho sibe nesimo esimise okwenhliziyo.

• Isibeletho se-Unicornuate - Isibeletho se-unicornuate yilapho kwakheka ingxenye eyodwa kuphela yesibeletho. Yaziwa nangokuthi isibeletho esinophondo olulodwa futhi ineshubhu elilodwa kuphela le-fallopian. Kwenzeka lapho isibeletho singakhuli kahle ngesikhathi sokukhula kombungu. Lapho enye yemigudu emibili ye-Mullerian ihluleka ukukhula, kwakheka isibeletho se-unicornuate. Abahlinzeki bezempilo abakwazanga ukukhomba ukuthi kungani abanye besifazane benesibeletho se-unicornuate. 

• I-agenesis yesibeletho – Uma uhlelo lokuzala lwengane luhluleka ukukhula ngesikhathi isesiswini, lesi simo sibizwa ngokuthi i-uterine agenesis. Ngokuvamile kuwuphawu lwesimo esibanzi esibandakanya okungavamile okumbalwa kwesistimu yokuzala, njenge-MRKH syndrome, inhlangano ye-MURCS, noma i-AIS. Imbangela yalokhu kuphazamiseka kwesibeletho sokuzalwa akukaziwa okwamanje. 

• I-uterus didelphys - Kulesi simo, imigudu emibili ye-Mullerian iqhubeka ibe yizibeletho ezimbili ezihlukene. Kuyisimo esingavamile sokuzalwa kwesibeletho futhi imbangela yako akwaziwa. Izakhi zofuzo zingase zibe isici njengoba kwezinye izimo, lesi simo sisebenza emindenini.

Cishe i-6.7% yabantu abaningi banokukhubazeka kwesibeletho sokuzalwa. Kodwa-ke, izinga layo liphezulu kwabesifazane abanezinkinga zokungazali futhi liphakeme kakhulu kwabesifazane abanomlando wokuphuphuma kwezisu okuphindaphindiwe. Ngenxa yokuphazamiseka kwesibeletho, kunomphumela omubi ekhonweni lowesifazane lokukhulelwa kuze kufike isikhathi esigcwele. Cishe owesifazane oyedwa kwabangu-4 oye waphuphunyelwa yizisu noma wazala ngaphambi kwesikhathi unokukhubazeka kwesibeletho.

Imiphumela Yesibeletho Esingavamile

Ukungajwayelekile kwesibeletho noma ukonakala, okufana ne-Congenital anomaly yesibeletho kungaba nemiphumela ehlukahlukene futhi kungaba nomthelela empilweni yokuzala kanye nempilo enhle iyonke. Imiphumela ethile ingahluka kuye ngohlobo nobukhulu bokudidayo. Nansi eminye imiphumela engaba khona:

• Izinkinga zokuzala: Okuthile okudidayo kwesibeletho kungathinta ukuzala. Isibonelo, isibeletho esihlukanisiwe (isibeletho esihlukaniswe i-septum) singase sandise ingozi yokulahlekelwa ukukhulelwa okuphindaphindiwe noma ubunzima bokukhulelwa.
• Ayanda Ingozi Yezinkinga Zokukhulelwa: Ukuphazamiseka kwesibeletho kungase kuhlotshaniswe nobungozi obukhulu bezinkinga zokukhulelwa, njengokuzalwa ngaphambi kwesikhathi, ukuzalwa kwebele, noma ukuhlinzwa. Ingozi incike ohlotsheni lwe-anomaly kanye nomthelela wayo esakhiweni sesibeletho.
• Ukuphuphunyelwa yisisu: Abesifazane abanokukhubazeka okuthile kwesibeletho, njenge-septate noma i-bicornuate uterus, bangase babe nengozi enkulu yokuphuphuma kwesisu. Isakhiwo sesibeletho esishintshile singaba nomthelela ekufakweni nasekukhuleni kwengane.
• Ukungahambi kahle kokuya esikhathini: Okunye ukuphazamiseka kwesibeletho, okufana nesibeletho esiphindwe kabili noma isibeletho esihlukanisiwe, kungaholela ekuphambeni kokuya esikhathini, okuhlanganisa nezikhathi ezinzima noma ezibuhlungu. Lezi zinkinga zingathinta ukuchitheka okuvamile kolwelwesi lwesibeletho.
• Umsebenzi Ovimbekile: Kwezinye izimo, ukuphazamiseka okuthile kwesibeletho kungase kuholele ekuzalweni okuvimbekile ngesikhathi sokubeletha. Lokhu kungandisa ingozi yezinkinga kokubili kumama nengane.
• Ingozi Eyandayo Yezinkinga Zezifo Zabesifazane: Abesifazane abanokukhubazeka kwesibeletho bangase babe sengozini enkulu yezinkinga ezithile zezifo zabesifazane, njenge-endometriosis noma izifo zepheshana lokuzala.
• Umthelela Wezengqondo: Ukubhekana nezinselele zokuzala, izinkinga zokukhulelwa, noma ukuphuphuma kwezisu okuphindelelayo ngenxa yezinkinga zesibeletho kungase kube nomthelela omkhulu ongokwengqondo kubantu ngabanye nakubashadikazi. Ukufuna ukusekelwa ngokomzwelo nokwelulekwa kungase kubaluleke ezimweni ezinjalo.

Sifo

Ukuphazamiseka kwesibeletho sokuzalwa kungabonakala ekuqaleni kokuthomba kwentombazane, lapho ukuya esikhathini kuqala, noma lapho kungaqali. Izinkinga zokuzalwa zesibeletho zingatholakala futhi lapho owesifazane enezinkinga zokungazali noma enenkinga yokulondoloza ukukhulelwa kwakhe. Ukuze uthole ukuxilongwa okunembile kanye nokwelashwa kwe-Bicornuate / Septate Uterus e-Hyderabad, inhlanganisela yokuhlola ingenziwa. Lezi zivivinyo zihlanganisa umlando ophelele wezokwelapha, ukuhlolwa ngokomzimba, nokuhlolwa kwezithombe njenge-3D ultrasound, i-hysterosalpingogram, ne-MRI. 

• Hlukanisa isibeletho – Isibeletho eseceleni singatholakala ukuthi sine-2D ejwayelekile ye-pelvic ultrasound. I-MRI ingase ibe ukuhlolwa okunembe kakhudlwana ukuze kuhlonzwe ezinye izinkinga zesibeletho. Ukuqinisekisa isibeletho se-septate, i-hysteroscopy noma i-hysterosalpingogram yenziwa. Ku-hysterosalpingogram, kugqanyiswe isibeletho sangaphakathi namashubhu e-fallopian. Ku-hysteroscopy, ithuluzi elincanyana elinokukhanya lifakwa esithweni sangasese sowesifazane, yonke indlela ngomlomo wesibeletho ukuze kutholakale umbono ocacile wesibeletho. Ngemuva kokuxilongwa, umuntu kufanele abonane nodokotela ukuze athole usizo mayelana nokwelashwa kwesibeletho se-septate.

• Isibeletho seBicornuate - Isibeletho se-bicornuate singatholakala ngokuhlolwa kwe-pelvic, i-ultrasound, i-MRI, ne-hysterosalpingogram. Ivame ukutholwa ngesikhathi sokuhlolwa kwe-ultrasound ngaphambi kokubeletha noma i-ultrasound kwezinye izimpawu ezingadingeki. Abesifazane abaningi baphila impilo yabo yonke ngaphandle kokuthola ukuthi bane-bicornuate uterus. Ngemva kokuxilongwa, kufanele babonane nochwepheshe ukuze bathole ukwelashwa kwe-bicornuate uterus.

• Isibeletho se-Unicornuate - Izikhathi eziningi, isibeletho se-unicornuate asibonakali kuze kube yilapho owesifazane enenkinga yokukhulelwa noma ehlangabezana nezinkinga ngesikhathi sokukhulelwa. Isibeletho se-unicornuate singatholakala ngokuhlolwa komzimba okuvamile, umlando ophelele wezokwelapha, nokuhlolwa kwe-pelvic. Ngaphandle kwalokhu, ukuhlolwa kwezithombe ezifana ne-ultrasound, i-MRI noma i-laparoscopy, ne-hysteroscopy nakho kungenziwa.

• I-agenesis yesibeletho – Imvamisa, lesi simo asitholakali kuze kube yilapho intombazane ihluleka ukuya esikhathini. Kuze kube yileso sikhathi, akuxilongwa njengoba izitho zangasese zangaphandle zibonakala zijwayelekile. I-agenesis yesibeletho ingatholakala ngokuhlolwa kwe-pelvic, umlando ophelele wezokwelapha, ukuhlolwa kwegazi, i-ultrasound, ne-MRI. Ngemuva kwalokho, kufanele bafune ukwelashwa kwe-uterine agenesis.

• I-uterus didelphys - I-uterine didelphys noma isibeletho esiphindwe kabili singatholakala ngokuhlolwa kwe-pelvic okujwayelekile, lapho udokotela wakho esola noma ebuka isibeletho esimise ngendlela engavamile noma umlomo wesibeletho kabili. Ukuxilongwa kungaqinisekiswa ngokuqhubekayo nge-ultrasound, i-MRI, i-hysterosalpingography, noma i-sonohysterogram. Umuntu kumele afune usizo lochwepheshe mayelana nokwelashwa kwe-uterus didelphys ngemva kokuxilongwa.

Ukwelashwa

I-Congenital anomalies yesibeletho ingelashwa kuphela ngokuhlinzwa. Kodwa-ke, abanye besifazane abadingi ukwelashwa uma i-anomaly ingaphazamisi ukukhulelwa kwabo. Ezimweni eziningi, abesifazane abane-anomaly yokuzalwa yesibeletho ababi nazo izinkinga zokuzala noma zezokwelapha. Kulabo abadinga ukuhlinzwa, uhlobo lokuhlinzwa olwenziwayo luncike ohlotsheni lwe-anomaly yokuzalwa yesibeletho. 

• Hlukanisa isibeletho – Isibeletho esizimele singelashwa nge-metroplasty. Kulokhu kuhlinzwa, insimbi ekhanyisiwe ifakwa esibelethweni, ngesitho sangasese sowesifazane kanye nomlomo wesibeletho. Enye insimbi ifakwa ukuze kunqanyulwe futhi kukhishwe i-septum. Kuyinqubo ehlasela kancane ethatha cishe ihora. Iningi labesifazane lingabuyela ekhaya ngosuku olufanayo nokuhlinzwa kwabo kwe-metroplasty. Ngemuva kwalokhu kuhlinzwa, u-50% kuya ku-80% wabesifazane abanomlando wokuphuphuma kwezisu okuphindaphindiwe bangakwazi ukukhulelwa okunempilo esikhathini esizayo. Ngakho-ke, amathuba okukhulelwa okuphumelelayo ayanda ngalokhu kuhlinzwa. 

• Isibeletho seBicornuate - Ukulungisa isibeletho se-bicornuate kwabesifazane abanomlando wokuphuphuma kwesisu okuphindaphindiwe, ukuhlinzwa kwe-Strassman metroplasty kwenziwa. Kodwa-ke, ukuhlinzwa akudingekile kuningi labesifazane abane-bicornuate uterus. Ngokocwaningo, i-88% yabesifazane abathola i-Strassman metroplasty bakwazi ukufeza ukukhulelwa okuphumelelayo. Isibeletho se-bicornuate asithinti ukuzala kowesifazane, nokho, singabangela izinkinga ezifana nokuphuphuma kwesisu ngaphambi kwesikhathi noma ukuzalwa ngaphambi kwesikhathi. Nakuba, kusengenzeka ukufeza ukukhulelwa okuphumelelayo nokubeletha.

• Isibeletho se-Unicornuate - Kwezinye izimo, abesifazane abanesibeletho se-unicornuate nabo bane-hemi-uterus encane. Odokotela batusa ukuthi i-hemi-uterus kufanele ikhishwe ngokuhlinzwa njengoba ukukhulelwa kungase kuqale lapho. Ukukhulelwa okunjalo ngeke kwenzeke njengoba indawo incane kakhulu futhi i-hemi-uterus ingase iqhume, okwenza kube isimo esisongela ukuphila. Ukuze kuncishiswe ingozi yokukhulelwa kwesisu, i-cerclage yomlomo wesibeletho nayo iyanconywa, uma owesifazane enokunciphisa umlomo wesibeletho. Imithi ethile ingase futhi inqunywe ukuze kuncishiswe amathuba okubeletha ngaphambi kwesikhathi. 

• I-agenesis yesibeletho - Kuye ngomuntu ngamunye kanye nezimpawu zakhe, kunezinketho ezihlukahlukene zokwelapha ezitholakalayo ze-genesis yesibeletho. Uma isitho sangasese sowesifazane singekho kanye nesibeletho, isitho sangasese sowesifazane singakhiwa kabusha ngokusebenzisa ama-dilators noma ukuhlinzwa okuvuselelayo. 

• I-uterus didelphys – Endabeni yesibeletho esikabili, ukwelashwa akuvamile ukuba kudingeke uma zingekho izimpawu noma izimpawu. Uma kukhona ukuhlukana okuyingxenye ngaphakathi kwesibeletho, ukuhlinzwa ukuze kuhlanganiswe isibeletho esiphindwe kabili kungenziwa ukuze kugcinwe ukukhulelwa. Uma unemomozi ekabili kanye nesibeletho esikabili, ukuhlinzwa ukukhipha udonga lwezicubu ezihlukanisa izitho zangasese ezimbili nakho kungenziwa ukuze kube lula ukuzala.

Esimeni se-unicornuate, i-bicornate, noma i-didelphic uterus, ngokuvamile, ukuhlinzwa akunconywa. Ukuhlinzwa kokwelapha isibeletho se-septate kunconywa kuphela uma owesifazane ebhekene nezinkinga zokuzala. Ingalungiswa ngokukhipha i-septum ngokuhlinzwa. Lokhu kuthuthukisa amathuba okuba nomphumela omuhle wokukhulelwa. Ukuhlinzwa ukwelapha i-anomaly yesibeletho sokuzalwa kungalungisa isici, futhi ngaleyo ndlela kuqede ukungakhululeki phakathi nezikhathi noma ukuya ocansini. Kungase futhi kuthuthukise inzalo kanye nemiphumela yokukhulelwa. Uma owesifazane onokukhubazeka kokuzalwa kwesibeletho enenkinga yokukhulelwa phakathi nezinyanga eziyisithupha zokuzama, kufanele abonane nochwepheshe wezenzalo.