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Fetal macrosomia: ke kali ʻoe i kahi pēpē nui
I ka wā ma mua, kaulana ka hānau ʻana i kahi "pepe nani". I kēia lā, nānā nā kauka i ka nui o ka pēpē i ka wā hāpai. ʻO ka macrosomia fetal, ʻo ia hoʻi ke kaumaha o ka hānau ʻana ma mua o 4 kg, hiki ke paʻakikī i ka hānau ʻana.
He aha ka macrosomia fetal?
Hoʻohālikelike ʻia ka macrosomia fetal e ke kaumaha o ka hānau ʻana ma mua o 4000g. Pili ia ma kahi o 5% o nā keiki hānau hou. ʻAʻole ʻoi aku ka nui o nā pilikia o nā pēpē Macrosome me ka nui o ke kaumaha ma mua o nā pēpē ʻē aʻe i ko lākou ulu ʻana. Aia nā mea a pau i ke kumu o kēlā mau haneli haneli hou aku. E noʻonoʻo iki ka pediatrician i ka loli o ko lākou kaumaha a me ke kiʻekiʻe.
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ʻOiai ka holomua ʻenehana, ʻaʻole maʻalahi ka wānana ʻana i ka macrosomia fetal. ʻO ka palpation o ka ʻōpū a me ke ana ʻana o ke kiʻekiʻe o ka ʻōpū i ka wā o ka nānā ʻana i kēlā me kēia mahina me ka pale keiki a i ʻole ka gynecologist e hōʻike i ka nui o ka pēpē. Hiki ke ʻike ʻia ka pilikia o ka macrosomia fetal i ka wā o ka ultrasound akā ʻo nā ʻenehana helu no ka hoʻohālikelike ʻana i ke kaumaha o ka fetal he nui a ʻaʻole naʻaupō.
Nā kumu
ʻO ka maʻi maʻi maʻi makuahine, inā ma mua a i ʻole e ulu ana i ka wā hāpai (gestational diabetes), ʻo ia ke kumu nui o ka macrosomia fetal. Ua ʻike nō hoʻi mākou e hoʻonui ʻia ka momona o ka makuahine ma ka 4 ka pilikia o ka macrosomia fetal. Ua ʻike pū ʻia nā mea pilikia ʻē aʻe: ke kaumaha o ka hānau ʻana o ka makuahine, ʻoi aku ka makahiki o ka makuahine ma mua o 35, ka moʻolelo o ka macrosomia fetal i nā hāpai mua, ka piʻi ʻana o ke kaumaha i ka wā hāpai, kahi manawa kahiko.
Pehea e hōʻemi ai i nā pilikia?
ʻO ka maʻi maʻi gestational ke kumu nui o ka macrosomia fetal, nā makuahine e manaʻo nei e loaʻa i ka maʻi (ʻoi aku ma mua o 35 mau makahiki, BMI ma mua o 25, moʻolelo ʻohana o ka maʻi diabetes type 2, gestational diabetes, macrosomia) i kuhikuhi ʻia ma waena o 24 a me 28 mau pule o ka amenorrhea a. "Hyperglycemia waha". Hana ʻia kēia hoʻāʻo ma ka ʻōpū ʻole e nānā i ka maikaʻi o ka hoʻoponopono ʻana o ke kino i ka pae kō i loko o ke koko. He mau ʻanuʻu: he hoʻāʻo koko i ka hōʻea ʻana i ka hale hana, ka absorption o 75g o ka wai glucose, ukali ʻia e kahi hoʻāʻo koko 1 hola, a laila 2 mau hola ma hope.
Ke ʻike ʻia ka maʻi diabetes gestational, pōmaikaʻi nā makuahine i ka wā e hiki mai ana mai ke kākoʻo kūikawā e mālama iā ia (ʻai, nā hana kino i hoʻololi ʻia, ʻoi aku ka nui o nā ultrasounds no ka nānā ʻana i ka ulu ʻana o ka pēpē) a no laila e kaupalena i ka piʻi ʻana o ke kaumaha o ka pēpē. ʻO nā wāhine i kaumaha nui ma mua o ka hāpai ʻana a i ʻole ka loaʻa ʻana o ka nui o nā paona i ka wā hāpai ʻana ke nānā pono ʻia.
ʻO ka hānau ʻana i ka wā e manaʻo ai he pēpē nui
Hiki i ka macrosomia fetal ke alakaʻi i nā pilikia i ka wā hānau. Ma ka ʻaoʻao o ka makuahine, hoʻoikaika ia i ke koko i ka wā o ka hānau ʻana, nā maʻi postpartum, nā ʻeha cervico-vaginal, nā ʻōpū ʻōpū. Ma ka ʻaoʻao pēpē, ʻo ka hoʻopiʻi pinepine a makaʻu ʻia ʻo ka dystocia poʻohiwi: i ka wā o ka hoʻokuke ʻana, paʻa mau nā poʻohiwi o ka pēpē i ka pelvis makuahine ʻoiai ke poʻo i waho. He pilikia koʻikoʻi ia e koi ana i kahi hana obstetric pololei loa e wehe i ke keiki hou me ka pilikia ʻole.
I ka nānā ʻana i kēia mau pilikia, ua hoʻopuka ka National College of French Gynecologists and Obstetricians i kekahi mau ʻōlelo paipai:
- Ināʻoi aku ka nui o ke kaumaha o ka fetal ma mua o 4500 g, hōʻikeʻia kahi māhele cesarean maʻamau;
- ʻO ka manaʻo kānalua o ka macrosomia hiki ke hōʻoia i ka hoʻokomo ʻana o ka hānau ʻana i ka pule 39 o ka amenorrhea;
- Pono e koho ʻia ka ʻāpana cesarean a i ʻole ke ala vaginal i kēlā me kēia hihia. Akā i ka hānau ʻana ma ka wahine, ua ʻōlelo ʻia e hoʻomaʻamaʻa i ka analgesia epidural a e hōʻoia i ka hele piha ʻana o ka hui obstetric (ka pale keiki, ka obstetrician, anesthesiologist a me ka pediatrician).