Hāpai hau

ʻO ka hāpai ʻana i ka hau kekahi o nā pilikia nui i ka obstetrics a me ka gynecology. ʻO ka mea pōʻino, hiki i kēlā me kēia wahine ke kū i kahi pathology. He aha kāu e hana ai i kēia hihia a hiki iā ʻoe ke hoʻolālā hou i ka hāpai ʻana, e hana mākou ka mea hoʻopaʻapaʻa-gynecologist Marina Eremina.

He aha ka hapai hau

Nui nā huaʻōlelo e wehewehe ana i ke ʻano like: hāʻule ʻole, hāpai ʻole i ka ulu ʻana a me ka hāʻule ʻole. Hoʻokahi ka manaʻo o lākou a pau - ua oki koke ka pēpē i loko o ka ʻōpū i ka ulu ʻana (1). Inā hiki kēia i 9 mau pule, kamaʻilio lākou e pili ana i ka make ʻana o ka embryo, a hiki i ka 22 pule - ka fetus. I kēia hihia, ʻaʻole hiki ke hāʻule, noho ka fetus i loko o ka lua uterine.

Ua ʻae ka hapa nui o nā kauka he 10-20 pakeneka o nā hāpai ʻana a pau e make i nā pule mua. I ka manawa like, lawe pinepine nā wahine i loaʻa i ka hāpai ʻana i kahi keiki me ka pilikia ʻole i ka wā e hiki mai ana. Eia nō naʻe, aia kekahi mau kūlana i ka wā e maloʻo ai nā hāpai ʻelua a ʻoi aku paha i ka lālani. A laila kamaʻilio nā kauka e pili ana i ka hāʻule maʻamau, a ʻo ia ʻano maʻi e pono ai ka nānā ʻana a me ka mālama ʻana.

Nā hōʻailona o kahi hāpai kō

ʻAʻole hiki i ka wahine ke hoʻomaopopo iā ia iho inā ua oki kona hāpai ʻana a i ʻole. ʻO ka hoʻoheheʻe koko nui, e like me ka hāʻule ʻana, ʻaʻole ma ʻaneʻi, ʻaʻohe ʻeha. ʻO ka pinepine ka manaʻo nui o ka mea maʻi, a ʻoi aku ka ʻeha o kona lohe ʻana i ka ʻike a ke kauka.

I kekahi manawa hiki iā ʻoe ke kānalua i kahi pilikia. Pono e makaʻala kēia mau hōʻailona:

• ka pau ana o ka nausea;
• ka hoʻopauʻana i ka'ōpū o ka umauma;
• ka hoʻomaikaʻi ʻana i ke kūlana maʻamau; i kekahi manawa ke ano o ke koko daub.

- ʻO ka mea pōʻino, ʻaʻohe hōʻailona maʻamau o ka hāʻule ʻana o ka hāpai ʻana, a ʻo ka ultrasound wale nō ke hana i kahi hōʻailona pololei. ʻO kēia mau hōʻailona he kumuhana loa. ka mea hoʻopaʻapaʻa-gynecologist Marina Eremina.

Me kēia mau hōʻailona, ​​aʻo nā kauka e hana i kahi ultrasound, aia wale nō i ka wā ultrasound hiki iā ʻoe ke hoʻoholo inā ua maloʻo ka embryo a ʻaʻole paha. I kekahi manawa hiki ke hana hewa nā mea hana kahiko a i ʻole ka loea loea, no laila ke aʻo nei nā kauka e hana i kahi scan ultrasound ma nā wahi ʻelua ʻoi aku ka maikaʻi me ka ʻokoʻa o 3-5-7 mau lā), a i ʻole e koho koke i kahi keʻena me ka ʻenehana hou a me ke kūlana kiʻekiʻe. nā kauka.

Hoʻomaopopo ka mea lapaʻau ultrasound i kahi hāpai ʻana ma o nā hōʻailona penei:

• nele i ka ulu ʻana o ka hua fetal i loko o 1-2 mau pule;
• ka loaʻa ʻole o kahi embryo me ka nui o ka hua fetal ma kahi o 25 mm;
• inā he 7 mm a ʻoi aku ka nui o ka coccyx-parietal o ka embryo, ʻaʻohe puʻuwai puʻuwai.

I kekahi manawa pono ʻoe e lawe i nā hoʻāʻo koko no ka hCG e nānā inā e loli ana ke kiʻekiʻe o kēia hormone. Me ka hāpai maʻamau, pono e hoʻonui.

ʻO ka hāpai mua ʻana i ka hau

He kiʻekiʻe loa ka pilikia o ka hāʻule ʻana o ka hāpai ʻana i ka trimester mua.

"ʻO ka hapanui pinepine, hiki i ka hāpai ʻana i ka wā mua, ma 6-8 mau pule, i nā hihia liʻiliʻi ma hope o 12 mau pule o ka hāpai ʻana," wahi a ka obstetrician-gynecologist.

ʻO ka hopena pōʻino e hiki mai ana ma hope o ka trimester mua he 16-18 mau pule o ka hāpai ʻana. Kakaʻikahi, pau ka ulu ʻana o ka embryo i kekahi lā ma hope.

Nā kumu o ka hāpai hau

ʻO ka wahine i lohe i kēlā ʻano hōʻailona e manaʻo paha ua hewa kekahi mea iā ia. Eia nō naʻe, hōʻoia nā kauka he 80-90 ka nui o nā hāpai ʻana ma muli o ka embryo ponoʻī, a i ʻole, ma muli o kāna mau ʻano ʻano genetic. E like me ka mea i ʻike ʻia, ua lilo ka embryo i mea hiki ʻole ke ola. ʻO ka nui o ka pathology, ʻoi aku ka wikiwiki o ka make ʻana o ka hāpai ʻana. E like me ke kānāwai, make ka embryo abnormal a hiki i 6-7 mau pule.

ʻO nā kumu ʻē aʻe o ka hāʻule ʻana e pili ana i ka 20 pakeneka o nā hihia (2). Ua pili kēia mau kumu i ka makuahine, ʻaʻole me ke keiki.

He aha ke kumu o ka hāʻule ʻana.

1. Nā hewa o ka ʻōnaehana coagulation koko, nā thromboses like ʻole, a me ka maʻi antiphospholipid, kahi e hoʻoikaika nui ai ke koko. Ma muli o kēia, ʻaʻole hiki i ka placenta ke hoʻokō i kāna mau hana o ka hānai ʻana i ka pēpē, a i ka wā e hiki mai ana e make ke pēpē.

2. Hōʻole ʻia ka Hormonal. ʻO kēlā me kēia ʻano imbalance, inā he nele o ka progesterone a i ʻole ka nui o nā hormones kāne, hiki ke hoʻopilikia i ka ulu ʻana o ka embryo.

3. ʻO nā maʻi maʻi maʻi, ka nui o nā maʻi i lawe ʻia e ka wahine, cytomegalovirus, rubella, influenza a me nā mea ʻē aʻe. He mea pōʻino loa ka hopu ʻana iā lākou i ka trimester mua, i ka wā e waiho ʻia ai nā kino a me nā ʻōnaehana o ka pēpē i hānau ʻole ʻia.

4. Kaulike nā chromosomal translocations i nā mākua. He mea paʻakikī ia, akā ʻo ke ʻano nui kēia - aia nā cell germ o nā mākua i kahi pathological set of chromosomes.

He kuleana koʻikoʻi ke ola o ka wahine, a me kona mau makahiki. Piʻi ka pilikia o ka hāpai ʻole ʻana i ka wā hānau hānau. Inā ma 20-30 mau makahiki he 10% ka awelika, a laila ma 35 mau makahiki he 20% ia, ma 40 mau makahiki he 40%, a ma luna o 40 a hiki i 80%.

ʻO nā kumu ʻē aʻe o ka hāʻule ʻana o ka hāpai ʻana:

• ka hoʻohana ʻana i ke kofe (4-5 kīʻaha i ka lā);
• puhipaka;
• lawe i kekahi mau lāʻau;
• nele i ka waikawa folic;
• pilikia ʻōnaehana;
• waiʻona

Aia kekahi mau kumu i kuhi hewa ʻia ʻo ia ke kumu o ka hāʻule ʻana o ka hāpai ʻana. ʻAʻole naʻe! ʻAʻole hiki ke kumu:

• huakaʻi ea;
• ka hoʻohana ʻana i nā contraceptives ma mua o ka hāpai ʻana (hormonal contraceptives, spirals);
• ka hoʻoikaika kino (inā ua hele ka wahine i nā haʻuki ma ke ʻano like ma mua o ka hāpai ʻana);
• moekolohe
• hoʻopaʻa keiki.

He aha e hana ai me ka hapai hau

Inā ʻoe ma lalo o 35 mau makahiki a ʻo kēia kou hāʻule mua ʻana, ʻōlelo nā kauka e ʻaʻole e huhū a hopohopo paha. ʻO ka pinepine, he pōʻino kēia, a ʻo kāu hoʻāʻo hou e lilo i makuahine e pau i ka hānau ʻana o kahi pēpē olakino. I kēia manawa, ʻo ka mea mua e hana ai, ʻo ia ke hoʻopau ʻana i ka hua fetal ma ke ʻoki ʻoki a i ʻole ka lāʻau lapaʻau.

I kēia manawa, pono ka wahine i ke kākoʻo o nā mea aloha. No laila, mai mālama i kou mau manaʻo i loko ou, e kamaʻilio e pili ana i nā manaʻo me kāu kāne, makuahine, hoaaloha.

No kou maluhia pono'ī, ʻaʻole ia he mea nui ke hoʻāʻo ʻia no nā maʻi maʻamau - ʻo nā mea i lawe ʻia i ka moekolohe, a me ka maʻi maʻi a me nā maʻi ʻē aʻe. Inā ʻaʻohe mea i loaʻa, hiki iā ʻoe ke hāpai hou.

ʻO kekahi mea ʻē aʻe inā he lua a ʻoi aku paha kēia i hala ʻole, a laila pono ʻoe e ʻike i nā kumu o ka pilikia a hoʻopau iā lākou.

Hapai ma hope o ka hapai hau

ʻO ka hāpai ʻana i ka hau 一 ke kumu mau o ke kaumaha. Akā, i kekahi manawa ma hope, ua hoʻi ka wahine a hoʻomaka e hoʻolālā i kahi hoʻāʻo hou e hānau i ke pēpē. Hiki iā ʻoe ke hāpai hou ma hope o 4-6 mahina (3). I loko o kēia manawa, pono e ho'ōla i ke kino wale nō, akā i ka noʻonoʻo. Ma hope o nā mea a pau, ua hāpai ka wahine, a ua loli kona ʻano hormonal. 

haawiia:

• haʻalele i ka puhi a me ka waiʻona;
• mai hōʻino i nā huahana i loaʻa ka caffeine;
• mai ʻai i nā meaʻai momona a laʻa;
• hana haʻuki;
• hele pinepine.

Loaʻa ka manawa no ka endometrium e mākaukau e ʻae i kahi hua manu fetal hou. 

Ma mua o ka hoʻolālā ʻana i kahi hāpai hou, pono e hana i kekahi mau hoʻokolohua:

1. E noʻonoʻo i ka loaʻa ʻana o ka ʻike ʻana i nā mea pōʻino: lāʻau lapaʻau, kaiapuni, maʻi, etc.
2. E aʻo i ka hoʻoilina o ka ʻohana. Inā he mau hihia o ka hāpai ʻana, ka thrombosis, ka puʻuwai a i ʻole ka hahau ʻana i ka wā ʻōpio.
3. E hoʻāʻo ʻia no nā STD, nā hormones a me ke koko koko.
4. E kūkākūkā me ka geneticist.
5. Hana i kahi ultrasound o nā ʻōpū pelvic.
6. E noʻonoʻo i ka pilina o nā hoa.

ʻO ka pinepine, ʻaʻole koi ʻia ka lāʻau lapaʻau, no ka mea, ʻo ka hāʻule ʻana ka hopena o ka hewa genetic. Eia nō naʻe, inā ʻaʻole hiki kēia i ka manawa mua, pono ke kūkākūkā o ke kauka a me ke koho ʻana i ka lāʻau lapaʻau kūikawā. 

ʻO ka hāpai ʻana ma mua o 4 mau mahina ma hope o ka hāʻule ʻana o ka hāpai ʻana, ʻaʻole i manaʻo nui ʻia, ʻoiai he hiki. Pono ke kino e ho'ōla hou i mea e hoʻokuʻu ai i kahi hihia pinepine o ka hāʻuleʻana. No laila, pono e hoʻohana ʻia nā ʻano hana contraceptive kūpono. Inā hiki mai ka hāpai ʻana, pono ʻoe e kipa i ke kauka a hahai i kāna mau ʻōlelo aʻoaʻo. 

Pono nā hoʻokolokolo

Inā ua nalowale nā ​​keiki ʻelua a ʻoi aku paha, pono ʻoe e nānā pono. ʻO ka pinepine, ʻōlelo nā kauka i ka papa inoa o nā hoʻokolohua a me nā kaʻina hana:

• ʻO ka karyotyping o nā mākua ka loiloi nui e hōʻike ai inā loaʻa i nā kāne ponoʻī nā genetic abnormalities; - ka nānā ʻana o ka ʻōnaehana coagulation koko: coagulogram (APTT, PTT, fibrinogen, prothrombin time, antithrombin lll), D-dimer, platelet aggregation a thrombodynamics, homocysteine, ʻike i nā mutations i nā genes o ka ʻōnaehana coagulation;
• HLA-type - he ho'āʻo koko no ka histocompatibility, i lawe ʻia e nā mākua ʻelua; - TORCH-complex, ka mea e ʻike ai i nā antibodies i ka herpes, cytomegalovirus, rubella a me ka toxoplasma;
• ka hoʻokolokolo ʻana no nā maʻi i lawe ʻia e ka wahine; - nā ho'āʻo koko no nā hormones: androstenediol, SHBG (sex hormone binding globulin), DHEA sulfate, prolactin, total and free testosterone, FSH (follicle-stimulating hormone), estradiol, a me nā hormones thyroid: TSH (thyroid stimulating hormone), T4 (thyroxine). ), T3 (triiodothyronine), thyroglobulin.

Inā hōʻike ka loiloi i kahi pilikia me ka coagulation, pono paha ʻoe e nīnau i kahi hemostasiologist, inā me ka genetics - he geneticist, inā me nā hormones - he gynecologist a endocrinologist.

Pono paha ka hoa e kipa aku i ka andrologist a hele i kekahi mau hoʻokolohua.

- ʻO ka mea kupanaha, ʻo ke kumu o ka hāʻule ʻana o ka hāpai ʻana he kumu kāne. ʻAʻole wale kēia ma muli o nā maʻamau maikaʻi ʻole, e like me ka waiʻona a me ka puhi paka, akā no ka ʻai ʻole, no ka laʻana, ka hoʻohana ʻana i nā huahana haʻahaʻa haʻahaʻa, ke ʻano o ka noho ʻana, a me nā kumu ʻē aʻe he nui. ka mea hoʻopaʻapaʻa-gynecologist Marina Eremina.

E aʻo ʻia ke kanaka e hana i kahi spermogram lōʻihi a inā he teratozoospermia i ka nānā ʻana, a laila e hoʻopaʻa ʻia i kahi hoʻokolokolo hou no ka ʻāpana DNA i loko o ka spermatozoa a i ʻole ka electron microscopic examination o spermatozoa - EMIS.

ʻAneʻane uku ʻia kēia mau kaʻina hana. I ʻole e haʻihaʻi, hāʻawi iā lākou a pau, e hoʻolohe i nā ʻōlelo a ke kauka. Ma muli o kāu mōʻaukala olakino, e hoʻoholo ka loea i nā hoʻokolohua ka mea nui.

ʻO ka mea pōʻino, aia nō nā kūlana i hiki ʻole i nā kauka ke ʻimi i ke kumu o ka pilikia.

He aha ke kaʻina hana hoʻomaʻemaʻe?

Inā pau ka ulu ʻana o ka ʻōpū a ʻaʻohe hāʻule hāʻule, pono ke kauka e kuhikuhi i ka mea maʻi no ka hoʻomaʻemaʻe. ʻO ka heleʻana o ka'ōpū ma mua o 3-4 mau wiki i loko o ka'ōpū he mea weliweli loa ia, hiki ke alakaʻi i ke koko kaumaha, ka mumū a me nā pilikia'ē aʻe. Ua ʻae nā kauka ʻaʻole pono ʻoe e kali no ka hāpai ʻana, ʻoi aku ka maikaʻi o ka hana curettage i ka wā hiki.

Hiki i kēia ke hoʻomake ʻia a i ʻole ka hoʻohemo ʻana me nā lāʻau lapaʻau e hiki ai ke kipaku ʻia ka embryo me ka ʻole o ka ʻoki ʻana.

"ʻO ke koho o ke ʻano he kanaka hoʻokahi, e pili ana i ka manawa i pau ai ka hāpai ʻana i ka ulu ʻana, ma ke alo o nā contraindications i hoʻokahi a i ʻole ke ʻano ʻē aʻe, ka hele ʻana o ka hāpai ʻana a me ka hānau ʻana i ka mōʻaukala, a, ʻoiaʻiʻo, ka makemake o ka wahine ponoʻī. e noʻonoʻo ʻia," wehewehe ka mea hoʻopaʻapaʻa-gynecologist Marina Eremina.

No laila, ʻaʻole kūpono ka hoʻomaʻamaʻa lāʻau lapaʻau, no ka laʻana, no nā wahine me ka insufficiency adrenal, acute or chronic renal failure, fibroids uterine, anemia, nā maʻi inflammatory o ka ʻōnaehana hānau wahine.

ʻO ke ʻano o ka ʻoki ʻana i manaʻo ʻia no ka hoʻopau ʻana i ka hāpai ʻana a hiki i 12 mau pule i ko mākou ʻāina ʻo ia ka aspiration vacuum, i ka wā e wehe ʻia ai ka hua o ka fetal me ka hoʻohana ʻana i ka ʻūhā a me ka catheter. Lawe ʻia ke kaʻina hana i nā minuke 2-5 a hana ʻia ma lalo o ka anesthesia kūloko a piha paha.

ʻO ka Curettage kahi ala i makemake ʻole ʻia a pono e hoʻohana ʻia i nā kūlana kūikawā wale nō, no ka laʻana, inā he ʻiʻo i koe i loko o ka lua o ka ʻōpū ma hope o ka aspiration vacuum.

Ma hope o ka hoʻomaʻemaʻe ʻana, hoʻouna ʻia nā mea o ka ʻōpū no ka nānā ʻana i ka histological. E ʻae kēia ʻikepili iā ʻoe e hoʻomaopopo i nā kumu o ka hāpai ʻana a pale i ka hoʻi hou ʻana o ke kūlana i ka wā e hiki mai ana.

Eia kekahi, ʻōlelo ʻia ka wahine e hana i kahi papa hoʻōla. Loaʻa iā ia ka anti-inflammatory therapy, ka lawe ʻana i nā painkillers, nā huaora, ka haʻalele ʻana i ka hana kino a me ka hoʻomaha maikaʻi.

Inā lohe mua ʻoe i ka hōʻailona o ka "haʻohaʻo ʻana i ka hāpai ʻana" mai ke kauka, e kūleʻa paha ka hoʻāʻo hou ʻana e hānau keiki. ʻO ka pinepine, he ulia pōpilikia, he hewa genetic. Akā ʻo nā wahine, ʻo ia ka lua a i ʻole ke kolu o ka hāpai ʻana, loaʻa nā manawa āpau e lilo i makuahine.

ʻO ka mea nui ke ʻimi i ke kumu o ka pilikia, a laila - nā hoʻokolokolo, ka mālama ʻana, hoʻomaha a me ka hoʻoponopono. I ka hala ʻana o kēia ala, pono ʻoe e hana i kahi ultrasound o nā ʻōpū pelvic a e hōʻoia i ka ulu ʻana o ka endometrium e like me ke kaʻina, ʻaʻohe polyps, fibroids a i ʻole ka mumū i loko o ka lua o ka ʻōpū, e kipa aku i ke kauka a mālama i nā maʻi maʻi mau loa. . I ka like, pono ʻoe e alakaʻi i kahi ola olakino, lawe i ka waikawa folic a ʻai i ka meaʻai kaulike, ʻo kēia mau mea e hoʻonui i kou manawa e hāpai ai i ka wā e hiki mai ana a hānau i kahi pēpē olakino.

Nā hiʻohiʻona o ka menstruation i kēia wā

Ma hope o ka pau ʻana o ka hāpai ʻana, e hoʻi hou ka menstruation i ka wahine. ʻO ka pinepine, hiki mai 2-6 mau pule ma hope o ke kaʻina hana. He maʻalahi ka helu ʻana i ka manawa hōʻea o nā lā koʻikoʻi. Lawe ʻia ka lā o ka hoʻohemo ʻana i ka lā mua, a helu ʻia ka manawa mai ia mea. No ka laʻana, inā loaʻa i ka wahine kahi aspiration ma ka lā 1 o Nowemapa, a he 28 mau lā o kona pōʻaiapuni, pono e hiki mai kona manawa ma Nowemapa 29. Hiki ke hoʻomaka ʻia ka lohi ma muli o ka hemahema o ka hormonal. ʻOi aku ka ʻilihune o ka menstruation ma hope o ka hana maʻamau, ʻoiai ʻaʻole e loaʻa ka manawa o ka mucous membrane e hoʻōla hou.

Inā he "curettage" ka wahine, a laila e ʻoi aku ka ʻeha o ka ʻōpū, no laila hiki ʻole ke hele ʻana o ka menstruation no ʻelua mau mahina a ʻoi aku paha.

I kēia manawa, pono ka wahine e makaʻala a pale iā ia iho, no ka mea, ʻaʻole mākaukau ke kino no ka lua o ka hāpai ʻana.

Inā ʻike ʻoe ʻoi aku ka lōʻihi o kou manawa ma hope o ka hoʻomaʻemaʻe ʻana ma mua o ka mea i manaʻo ʻia a ʻoi aku ka like me ke koko, e ʻoluʻolu e nīnau i ke kauka, he hōʻailona paha kēia o ka mumū.

Nā nīnau a me nā pane kaulana

Kumuwaiwai o

1. Stepanyan LV, Sinchikhin SP, Mamiev OB ʻAʻole hoʻomohala i ka hāpai ʻana: etiology, pathogenesis // 2011
2. Manukhin IB, Kraposhina TP, Manukhina EI, Kerimova SP, Ispas AA ʻAʻole hoʻomohala ʻana i ka hāpai ʻana: etiopathogenesis, ʻike, mālama ʻana // 2018
3. Agarkova IA ʻAʻole hoʻomohala i ka hāpai ʻana: ka loiloi o nā mea pilikia a me ka prognosis // 2010