Postpartum medical emergencies and newborn danger signs¶

Zoposa theka la zochitika zadzidzidzi zokhudzana ndi mimba ndi imfa za amayi zimachitika mwana atabadwa, m'masiku ovuta oyambirira 42 (masabata 6) mpaka chaka chimodzi pambuyo pobereka. Panthaŵi imodzimodziyo, khanda lakhanda m’masiku 28 oyambirira a moyo (nthawi ya mwana wakhanda) ali ndi chitetezo chamthupi chosakhwima ndipo thupi limasuntha mofulumira kumene kutentha kosaoneka bwino, kusintha kwa khungu, kapena kupuma movutikira kungapitirire kukhala ngozi yangozi yowopsa m’maola ochepa chabe. Makolo otopa kaŵirikaŵiri amaona kuti kupweteka kwa mutu, magazi ambiri, kupuma movutikira, kapena khanda lotopa, kapena khanda lotopa, amaona kuti kuchira pambuyo pobereka.

Kuzindikira mbendera zofiira zoyezera za kholo lobadwa ndi mwana wobadwa kumene kumapulumutsa miyoyo. Kaya mukuwunika kutuluka magazi kumaliseche (postpartum hemorrhage), kukwera kwadzidzidzi kwa kuthamanga kwa magazi masiku atatuluka m'chipatala (postpartum preeclampsia), kupweteka pachifuwa kapena mwendo (pulmonary embolism kapena deep vein thrombosis), opaleshoni kapena uterine matenda (**pupsis (postpartum psychosis), kapena wakhanda yemwe ali ndi kubweza, kusanza kobiriwira kobiriwira, kapena kutentha thupi, kuchitapo kanthu mwachangu ndikunena mawu akuti "Postpartum" kwa oyankha mwadzidzidzi kumayambitsa njira zapadera zoberekera ndi akhanda.

Chitani izi tsopano¶

1. Imbani nambala yanu yadzidzidzi nthawi yomweyo ngati kholo lobadwa kapena wobadwa kumene akuwonetsa mbendera yofiira yomwe ili pachiwopsezo: Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, kapena 000 ku Australia (onani manambala angozi). Osadikirira ofesi ya dokotala woyembekezera kuti abweretse voicemail pamene chizindikiro chachangu chikuwonekera.
2. Nenani mawu enieni awa kwa namwino wotumiza mwadzidzidzi ndi wopereka chithandizo chadzidzidzi: "Ndinali ndi mwana pa [Tsiku], ili ndi vuto la postpartum" (kapena "Mwana wanga ali ndi masiku [X]"): Ambiri ogwira ntchito zadzidzidzi sazindikira kuti wodwala amene anabala masiku 5 kapena 14 apitawo ndi pambuyo pobereka. Kunena kuti munabereka posachedwa (kapena munapita padera kapena opaleshoni) nthawi yomweyo amachenjeza madokotala kuti awonetsetse matenda a postpartum eclampsia, pulmonary embolism, peripartum cardiomyopathy, ndi kutaya magazi m'chiberekero.
3. Ngati mukutuluka magazi kwambiri, gonani chathyathyathya, kwezani miyendo yanu, ndipo pangani kutikita minofu ya chiberekero ngati m'munsi mwamimba mukumva ngati spong'anga: Ngati mukulowa m'malo olemera kwambiri a maxi pa ola kwa maola awiri motsatana kapena kutuluka magazi okulirapo kuposa mpira wa gofu kapena maula (masentimita 5 ngati mukulowa m'mbuyo, tambasulani dzanja lanu kumbuyo kwa 2) pamwamba pa fupa lanu la pubic kuti muchirikize chiberekero cha m'munsi, ndipo gwiritsani ntchito dzanja lanu lina kutikita mwamphamvu pamwamba pa chiberekero (pafupi ndi mchombo wanu) mozungulira mpaka mutakhazikika ngati mphesa pamene mukuyembekezera azachipatala.
4. Ngati kholo lobereka lili ndi mutu waukulu, kusintha kwa masomphenya, kapena Kuthamanga kwa Magazi 160/110 mmHg kapena kupitirira apo, khalani phee m’chipinda chocheperako ndikupita kuchipinda chodzidzimutsa mwamsanga: Musati mugone kuti "mukagone" mutu wopweteka kwambiri pambuyo pobereka limodzi ndi kusawona bwino, kuwala kwa magetsi, kumtunda kwa m'mimba, kupweteka kwa m'mimba, kapena kupweteka kwapamimba. Uwu ndi ulaliki wanthawi zonse wa postpartum preeclampsia, womwe ungayambitse sitiroko kapena grand mal seizure (eclampsia) pasanathe maola angapo popanda mankhwala ochepetsa kuthamanga kwa magazi ndi magnesium sulfate.
5. Yesani kutentha kwa matumbo kwa mwana aliyense wakhanda wosakwana masiku 28 amene akumva kutentha, kuzizira, kapena kulefuka: Ngati khanda losakwana masiku 28 (masabata 4) lili ndi kutentha kwa mphuno kwa 38.0 digiri Celsius (100.4 degrees Fahrenheit) kapena kupitirira apo, kapena kutentha kwa mphuno kutsika pansi klzzwxh:0037 kuchipatala molunjika * 96. chipatala chadzidzidzi. **Musamapatse mwana wakhanda mankhwala ochepetsa kutentha thup(acetaminophen/paracetamol kapena ibuprofen) dokotala asanamupime.**
6. Yang'anani pachifuwa ndi mimba ya mwana wakhanda yemwe akuvutika kupuma kuti apume bwino, kugwedera, kapena milomo yabuluu: Mvuleni nsalu ndi malaya akuwala bwino. Ngati mwanayo akupuma mofulumira kuposa ** kupuma kwa 60 pamphindi ** mosalekeza, kumapanga phokoso la "ugh" pamphuno iliyonse, kutulutsa mphuno, kuyamwa khungu mkati mwa nthiti kapena pansi pa fupa la pachifuwa (** retractions **), kapena kusonyeza mtundu wa buluu / imvi kuzungulira lilime ndi milomo (**central cyanosis ) nthawi yomweyo.

flowchart TD
    A["Chizindikiro cha Postpartum kapena Chidziwitso Chadzidzidzi Chatsopano"] --> B{"Ndani Akukumana ndi Chizindikirocho?"}
    B -- "Kholo Lobadwa (Mpaka 1 Chaka Pambuyo Kubereka)" --> C{"Yang'anani Zizindikiro Zochenjeza Zakubereka POYAMBA"}
    C -- "Kupweteka pachifuwa, Kupuma pang'ono, Kugwidwa, Maganizo Ovulaza" --> D["Call 911 / 112 / 999 Immediately: State 'I Just Had a Baby on [Date]'"]
    C -- "Kutuluka magazi> Pad/Hr kwa 2 Hrs, Zovala> Mpira wa Gofu, Kapena Kukomoka/Chizungulire" --> E["Imbani Ntchito Zadzidzidzi + Lie Flat + Chitani Zolimbitsa Thupi za Uterine Fundal Massage"]
    C -- "BP> = 160/110, Kupweteka kwa Mutu Kwambiri, Mawanga Owona, kapena Kupweteka kwa Mimba Kumtunda Kumanja" --> F["Kuwunika Mwadzidzidzi Mkati Mwa Mphindi za Postpartum Preeclampsia (Kuopsa kwa Stroke/Kukhudzika)"]
    B -- "Mwana Wakhanda Wakhanda (Masiku 28 Oyamba a Moyo)" --> G{"Onani Neonatal Red Flags"}
    G -- "Kupuma> 60/mphindi, Kuchotsa Chifuwa, Kugwedera, Kupuma> 20s, kapena Milomo Yabuluu" --> H["Imbani 911 / 112 / 999 Nthawi yomweyo: Yambani CPR Yakhanda Ngati Sakuyankha & Osapuma"]
    G -- "Rectal Temp >= 38.0°C (100.4°F) kapena <36.0°C (96.8°F), Masnzi Obiriwira, kapena Lethargy" --> I["Pitani Ku Chipatala Chachangu Kudipatimenti Yangozi Nthawi yomweyo (Osapereka Mankhwala a Fever)"]

Gawo 1: Zadzidzidzi pambuyo pobereka (Zizindikiro zochenjeza za "POST-BIRTH")¶

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), American College of Obstetricians and Gynecologists (ACOG), US Centers for Disease Control and Prevention (CDC Hear Her kampeni), UK National Health Service (NHS), ndi World Health Organization (WHO) amagwiritsa ntchito **"POST-BIRTH"*1111 / 1111 999 nthawi yomweyo ** kuchokera kuzizindikiro zachangu zomwe zimafunika kuunikanso kuchipatala.

1. Postpartum Hemorrhage (PPH): Pulayimale vs Sekondale¶

Kutaya kwachibadwa kwa ukazi (lochia) kumayamba kufiira kwambiri ngati nthawi yosamba kwambiri kwa masiku atatu mpaka 4 (lochia rubra), kenaka pang'onopang'ono amawala kukhala pinki-bulauni (* lochia serosa*) ndi chikasu choyera (lochia alba) pa masabata 4 mpaka 6. Kutaya magazi ofiira owala komwe kumangochulukirachulukira osati kutsika sikwabwinobwino.

• Kutaya magazi Kwambiri kwa Postpartum kumachitika mkati mwa maola 24 oyamba** pambuyo pobereka, nthawi zambiri akadali m'chipatala kapena atabadwa kunyumba, zomwe nthawi zambiri zimayamba chifukwa cha uterine atony (chiberekero chimalephera kugwirana mwamphamvu kuti chitsine mitsempha yamagazi yomwe thumba la placenta lidalumikizidwa, kuwerengera 70 mpaka 80 peresenti ya milandu), kusokonezeka kwa maliseche, kutsekeka kwa magazi.
• Kutaya magazi Kwachiwiri (Kwachedwa) Pambuyo pa Kubereka kumachitika pakati pa maola 24 ndi masabata 12 pambuyo pobadwa (nthawi zambiri kumafika pachimake masiku 7 mpaka 14 pamene placenta eschar imatuluka mkati mwa chiberekero, kapena chifukwa cha tizidutswa ta thumba losunga mazira kapena matenda a m'chiberekero).
• Ziwerengero zenizeni zachipatala kuti muyimbire chithandizo chadzidzidzi:
• Kulowetsedwa 1 kapena zolemetsa zolemetsa zolemetsa pa ola limodzi kwa maola awiri motsatizana (musagwiritse ntchito ma tamponi kapena makapu osamba m'masabata 6 oyambirira obereka, chifukwa amatha kuyambitsa mabakiteriya owopsa m'chiberekero ndikubisa magazi ambiri).
• Kudutsa magazi kuundana ** zazikulu kuposa mpira wa gofu kapena maula (5 centimita / 2 mainchesi)**.
• Zizindikiro za hypovolemic shock (zomwe zimatha kuchitika ngakhale magazi akunja akuwoneka ochepa chifukwa mpaka 1,000 milliliters / 1 lita imodzi ya magazi imatha kulowa mosawoneka mkati mwa chiberekero chomasuka): kugunda kwamtima (kupitilira 110 kugunda pamphindi), kupepuka mutu mukakhala mmwamba, khungu lotumbululuka, kumva kuzizira kapena kuzizira. chiwonongeko.
• Thandizo loyamba podikirira ambulansi:
• Muuzeni wodwalayo ** kugona chagada** ndi kukweza mapazi ake 20 mpaka 30 centimita (8 mpaka 12 mainchesi) pa mapilo kuti magazi aziyenda ku ubongo ndi mtima. Atenthetseni ndi chofunda.
• Chitani Kusisita Kwakunja Kwa Bimanual / Fundal Uterine Massage: Imvani m'munsi pamimba mozungulira m'mimba (umbilicus). Nthawi zambiri, chiberekero chotenga kachilomboka chimakhala cholimba komanso chozungulira ngati manyumwa. Ngati ikuwoneka yofewa, yobowoka, kapena ngati mtanda, ikani dzanja limodzi lathyathyathya pamwamba pa fupa la pubic kuti mumange gawo lakumunsi la chiberekero, ndipo gwiritsani ntchito chikhatho cha dzanja lanu lina **kusisita mwamphamvu ndi kufinya pamwamba pa chiberekero (fundus) mozungulira **. Yembekezerani kutuluka kwa magazi ophatikizana kapena zitseko kuti zituluke pamene minofu ikugwirana; pitirizani kusisita mwamphamvu mpaka chiberekero chikumva mwamphamvu kwambiri ndipo ogwira ntchito zachipatala adzalandira.
• Muyikeni mwanayo pa bere (ngati ali otetezeka ndipo kholo likudziwa): Kukondoweza kwa mawere kumatulutsa oxytocin yachilengedwe kuchokera ku pituitary gland, yomwe imasonyeza kuti minofu ya chiberekero kutsika.

2. Postpartum Preeclampsia ndi Eclampsia (Mpaka masabata 6 pambuyo pa kubadwa)¶

Mabanja ambiri amakhulupirira kuti kubereka khanda ndi latuluka kumachiritsiratu preeclampsia. Zoona zake n'zakuti postpartum preeclampsia ikhoza kukhudza kholo lililonse lobereka pakati pa maola 48 ndi masabata 6 kuchokera pamene wabereka (kawirikawiri amawonekera pakati pa masiku 3 ndi 10 atangobereka, atangotuluka m'chipatala), ngakhale khololo likanakhala ndi kuthamanga kwa magazi kwanthawi zonse pa nthawi yonse yomwe anali ndi pakati.

• Zovuta za kuthamanga kwa magazi (ACOG / NICE / WHO):
• 140/90 mmHg kapena kupitilira apo (kuyezedwa kawiri, maola 4 motalikirana, kapena kamodzi kotsatizana ndi zizindikiro): Kuunika kwachipatala mwachangu kumafunika tsiku lomwelo.
• 160/110 mmHg kapena kupitilira apo (Kuthamanga Kwambiri Kwambiri Kwambiri): Dzina lachipatala lodziwikiratu. Kuthamanga kwa magazi kwa 160 kapena kupitirira apo kapena kuthamanga kwa magazi kwa diastolic kwa 110 kapena kupitirirapo kwa mphindi 15 kumakhala ndi chiopsezo cha stroko yokhetsa magazi (kutulutsa magazi muubongo), pulmonary pulmonary kapena pulmonary edema kukomoka **. Malinga ndi malangizo a ACOG, odwala omwe ali ndi kuthamanga kwa magazi kapena kupitirira 160/110 mmHg amafunikira mankhwala othamanga m'mitsempha kapena othamanga mwamsanga mkati mwa **30 mpaka mphindi 60 ** atazindikira, kuphatikizapo mtsempha wa **magnesium sulfate ** kuti ateteze kugwidwa.
• Chenjezo la Postpartum Preeclampsia ndi HELLP Syndrome:
• Kupweteka kwamutu kosalekeza, kopweteka* komwe sikuchoka mutamwa madzi komanso kumwa mlingo wokhazikika wa acetaminophen/paracetamol.
• Zosokoneza m'maso: Kuwona magetsi akuthwanima, kunyezimira (scotomata), mawanga akuda, kusawona bwino, kapena khungu kwakanthawi.
• Kupweteka kwa Epigastric kapena Right Upper Quadrant (RUQ): Kupweteka kwambiri, kupanikizika, kapena kutentha pansi pa nthiti kumanja kapena pakati pamimba cham'mwamba (nthawi zambiri amalakwitsa chifukwa cha kutentha kwa mtima, kupweteka kwa ndulu, kapena mpweya). Ululu umenewu umayamba chifukwa cha kutupa kwa chiwindi ndi kutambasula kapsule (**HELLP syndrome **: Hemolysis, Elevated Liver enzymes, ndi Low Platelets).
• Kutupa kwadzidzidzi (edema) kwa nkhope, zikope, ndi manja, kapena kulemera kwadzidzidzi kwa 1 mpaka 2 kilograms (2 mpaka 5 pounds) mu 24 kwa maola 48 limodzi ndi kupuma movutikira.

3. Kutsekeka kwa Magazi (DVT ndi Pulmonary Embolism) ndi Peripartum Cardiomyopathy¶

Pa mimba ndi masabata oyambirira 6 masabata pambuyo pobereka, thupi mwachibadwa limawonjezera zinthu zomwe zimapangitsa kuti magazi asatuluke pobadwa, zomwe zimapangitsa kholo lobadwa lobadwa ** nthawi zisanu kuti apange magazi owopsa (Venous Thromboembolism)** kusiyana ndi nthawi yomwe ali ndi pakati, ndi **20 mpaka 60 nthawi zambiri ** kuposa munthu wopanda mimba wa msinkhu womwewo. Kubeleka kwa cesarean, kugona kwa bedi kwa nthawi yayitali, preeclampsia, ndi kutuluka kwa magazi kumawonjezera ngoziyi.

• Deep Vein Thrombosis (DVT): Kutsekeka kwa magazi komwe kumachitika m'mitsempha yakuya ya ng'ombe, ntchafu, kapena chiuno. Zizindikiro zochenjeza zimaphatikizapo kutupa mwendo umodzi wokha (asymmetric edema), kufiyira kapena kutentha kwa ng'ombe kapena ntchafu, komanso kuwawa kokulirakulira kapena kupweteketsa mtima mukayimirira kapena kuyenda. Osamatikita kapena kupaka mwana wa ng'ombe wotupa, wopweteka pambuyo pobereka, chifukwa kupaka kolimba kumatha kutulutsa magaziwo ndikutumiza kumapapu.
• Pulmonary Embolism (PE): DVT ikasweka ndi kulowa m'mitsempha ya m'mapapo. Zizindikiro zochenjeza ndi monga kupuma mwadzidzidzi, kupweteka pachifuwa kapena kumtunda kwa msana komwe kumakulirakulira mukapuma kwambiri, kutsokomola magazi, kugunda kwa mtima, chizungulire kapena kukomoka mwadzidzidzi.
• Peripartum Cardiomyopathy (PPCM): Mtundu wosowa koma wowopsa wa kufooka kwa minofu ya mtima (kulephera kwa mtima) komwe kumayamba mwezi womaliza wa mimba kapena mkati **miyezi isanu pambuyo pobereka **. Mosiyana ndi kutopa kwanthawi zonse pambuyo pobereka, kholo lomwe lili ndi PPCM limakumana ndi **kupuma kwakanthawi kogona pabedi ** (akufunika kudzuka pamiyendo 3 kapena 4 kuti apume usiku, otchedwa orthopnea), kudzuka ndikupuma mpweya usiku (paroxysmal nocturnal dyspnea), kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kupuma movutikira. m'miyendo ndi akakolo.

4. Puerperal Sepsis (Postpartum Uterine, Opaleshoni, kapena Matenda a M'mawere)¶

Matenda a Postpartum (endometritis mkati mwa chiberekero, zilonda za C-gawo, matenda a mkodzo/impso, kapena mastitis) amatha kupha maternal sepsis ndi liwiro lodabwitsa, makamaka chifukwa cha Gulu A Streptococcus (GAS).

• Mbendera zofiira za matenda a postpartum ndi sepsis:
• Kutentha thupi kwa 38.0 degrees Celsius (100.4 degrees Fahrenheit) kapena kupitirira apo, kapena kutentha kwambiri kwa thupi kutsika *36.0 degrees Celsius (96.8 degrees Fahrenheit)**, komwe kumayendera limodzi ndi kunjenjemera (rigors).
• Kutulutsa konyansa kumaliseche (lochia) kapena kupweteketsa mtima kwambiri m'munsi mwa m'mimba ndi m'chiuno (chiberekero chochira chizikhala chochepa tsiku lililonse pamene chikubwerera m'chiuno).
• A gawo la C kapena episiotomy/perineal incision yomwe imakhala yofiira, kutentha, kutupa, kutuluka mafinya, kapena kuyamba kung'ambika.
• Zizindikiro zowopsa za sepsis: Kugunda kwa mtima (>100 bpm), kupuma mwachangu (>kupuma 20 pamphindi), kuwawa koopsa kwa thupi, kusokonezeka kapena kusalankhula bwino, khungu lotumbululuka, kapena kutuluka mkodzo kwa maola 12.

5. Baby Blues vs Postpartum Depression vs Postpartum Psychosis¶

Zadzidzidzi zaumoyo wam'mutu ndizochitika zadzidzidzi. Aliyense m'banjamo ndi wosamalira ayenera kudziwa kusiyanitsa m'thupi "Baby Blues" wamba ndi Postpartum Psychosis, yomwe ndi vuto lachidziwitso lachidziwitso lofuna kuti agoneke kuchipatala mwamsanga.

Gawo 2: Zizindikiro zowopsa zobadwa kumene m'masiku 28 oyamba amoyo¶

Khanda lobadwa kumene silingadziŵike kuti ali ndi matenda kapena kulipirira kutaya madzi m'thupi monga mmene mwana wamkulu angachitire. Yang'anani machitidwe asanu awa pafupipafupi tsiku lililonse m'mwezi woyamba.

flowchart TD
    A["Kuyeza Mwana Wakhanda (Wamasiku 0 mpaka 28)"] --> B["1. Kupuma: Werengani Mpweya kwa Masekondi 60 Athunthu & Yang'anani Chifuwa Chopanda Chovala"]
    B --> C{"Mulingo > 60/mphindi, Imani > Zaka 20, Kugwedera, Kuchotsa Chifuwa, Kapena Lilime Labuluu?"}
    C -- "Inde" --> D["Imbani 911/112/999 Nthawi yomweyo: Zadzidzidzi Wopumira"]
    C -- "Ayi" --> E["2. Kutentha: Chongani Rectal Digital Thermometer"]
    E --> F{"Rectal Temp >= 38.0°C (100.4°F) kapena <36.0°C (96.8°F)?"}
    F -- "Inde" --> G["Pitani ku Chipatala Emergency department Nthawi yomweyo (Neonatal Sepsis Workup)"]
    F -- "Ayi" --> H["3. Khungu la Khungu, Masanzi, Chingwe cha Umbilical & Matewera Onyowa"]
    H --> I{"Jaundice mu Maola 24 Oyamba, Masanzi Obiriwira Obiriwira, Mphete Yofiira ya Umbilical, kapena <3 Wet Diapers?"}
    I -- "Inde" --> J["Dipatimenti Yoyang'anira Zadzidzidzi kapena Kuwunika kwa Ana a Tsiku Limodzi"]

1. Mbendera Zofiira Zopuma Wakhanda (Kuvutika kwa kupuma)¶

Ana obadwa kumene amakhala ndi kupuma kosasinthasintha kotchedwa ** kupuma kwanthawi zonse **, komwe amapuma mofulumira kwa masekondi angapo, kupuma kwa **5 mpaka masekondi 10 **, kenaka amayambiranso kupuma movutikira ndi lilime lapinki ndi chifuwa chomasuka. Komabe, zizindikiro zotsatirazi zikuwonetsa zenizeni kuvutika kupuma kwa mwana wakhanda:

• Kupuma kwa Tachypnea (Kupuma Mofulumira): Kupuma mofulumira kuposa kupuma 60 pamphindi pamene mwanayo ali phee komanso osalira (werengani masekondi 60 chifukwa kupuma kwa khanda kumathamanga ndi kutsika).
• Apnea (Kupuma Koopsa): Kupuma kulikonse komwe kumakhala masekondi 20 kapena kupitilira apo, kapena kupumira kulikonse komwe kumatsagana ndi kuledzera, kugunda kwa mtima pang'onopang'ono, kapena khungu kusanduka lotumbululuka kapena buluu.
• Kuchotsa Khoma Lachifuwa: Yang'anani thunthu lamwana lopanda kanthu. Ngati khungu limayamwa kwambiri mkati pansi pa nthiti (subcostal), pakati pa nthiti (intercostal), kapena pansi pa mmero pamwamba pa fupa la pachifuwa (suprasternal) ndi mpweya uliwonse, mwanayo akugwira ntchito motopa kukokera mpweya m'mapapo olimba kapena odzaza madzimadzi.
• Kung'ung'udza Kotuluka Mphuno ndi Kuphulika Kwa M'mphuno: Kamvekedwe ka phokoso, kachetechete "ugh" kapena kaphokoso kamene kamapangidwa pa mpweya uliwonse (uwu ndi mwana wakhanda mwachibadwa amatseka zingwe zake za mawu pang'ono kuti apange kukakamiza kumbuyo kuti timatumba tawo tating'ono ta m'mapapo tisagwe), kapena mphuno ikukulirakulira ndi mpweya uliwonse.
• Central Cyanosis vs Acrocyanosis: Ndikwabwino kwachibadwa kuti manja ndi mapazi a mwana wathanzi aziwoneka ngati buluu pakazizira (acrocyanosis). Ndi ngozi yowopsa ngati milomo ya mwanayo, lilime, mkamwa, kapena chifuwa chapakati chisanduka buluu, wofiirira, kapena wotuwa (central cyanosis)**.

2. Kutentha Kwambiri Kwadzidzidzi (Malungo NDI Hypothermia)¶

Malinga ndi malangizo achipatala a American Academy of Pediatrics (AAP) a makanda omwe ali ndi malungo, kutentha kulikonse kwa rectum kwa 38.0 digiri Celsius (100.4 degrees Fahrenheit) kapena kupitilira apo mwa khanda lochepera masiku 28 (ndi masiku 60) ndizochitika mwadzidzidzi m'chipatala.

• Chifukwa chiyani kutentha thupi pang'ono kobadwa kumene kumakhala kwadzidzidzi: M'mwezi woyamba wa moyo, chotchinga cha magazi ndi ubongo ndi chitetezo chamthupi chimakhala chosakhwima. Kutentha kwa 38.1 ° C (100.6 ° F) kungakhale chizindikiro * chokhacho* chakunja cha matenda owopsa a m'magazi a bakiteriya (neonatal sepsis), matenda a mkodzo, chibayo, kapena bacterial meningitis (monga Gulu B Strep, E. coli, kapena Herpes Simplex Virus).
• Chenjerani ndi Newborn Hypothermia (Kutentha Kochepa): Mosiyana ndi makanda okalamba omwe nthawi zonse amawotcha kutentha kwakukulu pamene ali ndi matenda, mwana wakhanda wobadwa kumene amazizira ** m'malo motentha. Kutentha kwamatumbo kutsika 36.0 digiri Celsius (96.8 degrees Fahrenheit) komwe sikukhazikika msanga mwana atakulunga khungu ndi khungu m'bulangete yofunda ndikoopsa ngati kutentha thupi kwambiri ndipo kumafuna kuunika kwadzidzidzi.
• Mmene mungatengere kutentha kolondola kumene wangobadwa kumene: Zingwe zapamphumi, zoyezera kutentha m'makutu, ndi zoyezera kutentha kwa pacifierndizolakwika mwa ana obadwa kumene. Gwiritsani ntchito choyezera choyezera kutentha kwa digito chopaka dontho la mafuta odzola, ikani mwana kumbuyo kwake ndi mawondo opindika, pang'onopang'ono ikani nsonga yasiliva ** 1.25 centimita (0.5 mainchesi)** mu rectum, ndipo gwirani mokhazikika mpaka ikulira.

3. Kupewa Matenda a Jaundice ndi Kernicterus¶

Ofatsa physiologic jaundice (kunyezimira kwachikasu pakhungu ndi zoyera m'maso zomwe zimachitika chifukwa cha bilirubin pamene chiwindi cha mwana wakhanda chimakhwima) chimapezeka mwa 60 peresenti ya ana obadwa kumene athanzi pafupifupi Tsiku lachiwiri mpaka Tsiku la 4 ndipo amatha bwinobwino ndi kuyamwitsa pafupipafupi kapena kuwala kwa phototherapy. Komabe, pathologic hyperbilirubinemia imatha kulola kuti milingo yapoizoni ya bilirubin yosalumikizana idutse muubongo wa mwanayo, zomwe zimapangitsa kuti ubongo uwonongeke kosatha wotchedwa kernicterus.

• Fufuzani chithandizo chachangu cha jaundice ngati muwona mbendera 4 zofiirazi:
• Jaundice m'maola 24 oyambirira a moyo: Khungu lililonse lachikasu kapena maso omwe amawoneka mkati mwa maola 24 oyambirira atabadwa amakhala nthawi zonse achilendo (nthawi zambiri amayamba chifukwa cha kusagwirizana kwa gulu la magazi la ABO kapena Rh kuthyola maselo ofiira a magazi mofulumira) ndipo kumafuna chipatala mwamsanga kuyezetsa bilirubin ndi phototherapy.
• Chijaundichi chikufalikira mpaka m'manja ndi m'miyendo: Matenda a chikasu ndiyo amakula kuchokera kumutu mpaka kumapazi (cephalocaudal progression). Pamene chikasu chikafika kumunsi kwa miyendo, manja, kapena pansi, kapena khungu likuwoneka lowala-lalanje, milingo ya bilirubin imakhala yokwera kwambiri.
• ** Jaundice yotsatizana ndi Chalky White / Pale Stools kapena Mkodzo Wamtundu Wa Tiyi**: Ngati khanda la jaundice lili ndi chimbudzi chotuwa, chadongo, imvi, kapena choyera (m'malo mwachikaso chachikasu, chobiriwira, kapena chabulauni), ndi chizindikiro chochenjeza cha biliary atresia (matenda otsekeka m'chiwindi), zomwe zimafunika kuthandizidwa.
• zizindikiro za Acute Bilirubin Encephalopathy (Kuopsa kwa Muubongo): Ngati mwana wa jaundice ayamba zovuta kwambiri kudzuka kuti adye chakudya (lethargic), akulira mokweza, akulira mokweza**, amamva kuti floppy (hypotonic)** kapena kuumira mapindikiza khosi ndi chammbuyo (opisthotonos), pitani kuchipatala msanga.

4. Bilious (Wobiriwira Wakuda) Kusanza, Kutaya madzi m'thupi, ndi Matenda a Umbilical Cord¶

• Kulavulira mwachizolowezi Koposa Kusanza Kobiriwira Kwa Bilious (Nthawi Yochita Opaleshoni): Pafupifupi makanda onse amalavulira pang'ono mkaka wa m'mawere woyera kapena wopindika. Komabe, ngati mwana wakhanda asanza zamadzimadzi zomwe zikuwoneka ** zobiriwira udzu, zobiriwira m'nkhalango, kapena zobiriwira zamtundu wa fluorescent (monga ndulu yakuda)**, pitani kuchipatala mwamsanga. Mwana wakhanda, masanzi obiriwira obiriwira ndi chizindikiro chodziwika bwino cha kuwonongeka kwa matumbo ndi midgut volvulus, opaleshoni yadzidzidzi pomwe matumbo a khanda amapindika mozungulira magazi ake ndipo amatha kufa pasanathe maola angapo popanda opaleshoni yadzidzidzi.
• Kuchuluka kwa Madzi m'thupi ndi Mtewera Wonyowa: Pofika Tsiku 4 mpaka Tsiku 5 lamoyo, mwana wakhanda yemwe ali ndi madzi okwanira ayenera kutulutsa osachepera 6 matewera onyowa kwambiri maola 24 aliwonse okhala ndi mkodzo wotumbululuka, wowoneka bwino (pafupifupi thewera limodzi lonyowa pa Tsiku 1, 2 pa Tsiku 2, 3 pa Tsiku 3, 4 ndi 6 pa Tsiku +). Zindikirani kuti m'masiku awiri mpaka atatu oyambirira, makhiristo a lalanje-pinki mu thewera ("fumbi la njerwa" urate crystals) amapezeka mkaka umalowa, koma ngati fumbi la njerwa likupitirirabe tsiku la 4, kapena mwanayo akupita maola oposa 8 mpaka 12 popanda thewera wonyowa **, ali ndi pakamwa pouma, akulira popanda misozi, kapena kuyang'ana mozama kwambiri chithandizo chamankhwala. Mosiyana ndi zimenezi, malo ofewa wamangika, otukumuka mwana akadekha komanso wowongoka amakhala chizindikiro chofiyira chomwe chimapangitsa kuti chigaza chiwonjezeke (meningitis).
• Omphalitis (Umbilical Cord Stump Infection): Sichachilendo kuti chitsa choumitsa cha mchombo chiwoneke choderapo kapena chakuda ndipo chimasiya kadontho kakang'ono ka magazi owuma ikagwa pakati pa masiku 7 ndi 14. m'mphepete), ikumva kutentha kapena kuuma, kapena kutulutsa mafinya onunkhira achikasu, pitani kuchipatala mwachangu. Chifukwa chakuti ziwiya za mwana wakhanda zimalumikizana mwachindunji ndi khoma lamkati la m'mimba, omphalitis ndi ngozi yachipatala yomwe imafuna mankhwala opha tizilombo.

Mafunso omwe amafunsidwa pafupipafupi¶

Magwero afufuzidwa¶

• American College of Obstetricians and Gynecologists (ACOG, United States): *Kupititsa patsogolo Chisamaliro cha Postpartum (Committee Opinion No. 736), Emergent Therapy for Acute-Onset, Kuthamanga Kwambiri kwa Matenda Oopsa Pa nthawi ya Mimba ndi Pambuyo Pobereka, ndi Kukonzekera Bulletin pa Postpartum Hemorrhage *.
• Centers for Disease Control and Prevention (CDC Hear Her Campaign, United States) ndi Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN): Zizindikiro Zochenjeza Zakubadwa Kwamayi ndi POST-BIRTH Patient Education Framework.
• Bungwe la World Health Organization (WHO, International): Malangizo a WHO pa Chisamaliro cha Amayi ndi Ongobadwa kumene kuti akhale ndi Moyo Wabwino Pambuyo pa Kubereka ndi Kuthana ndi Mavuto pa Pakati pa Pakati ndi Pobereka.
• American Academy of Pediatrics (AAP, United States): *Upangiri Wothandizira Zachipatala: Kuwunika ndi Kuwongolera Ana Owoneka bwino a Febrile 8 mpaka 60 Days Old, Management of Hyperbilirubinemia in the Newborn Infant, and Safe Sleep Recommendations *.
• National Health Service (NHS) ndi National Institute for Health and Care Excellence (NICE Guideline NG194, United Kingdom): *Chisamaliro Chotsatira Pambuyo pa Kubereka: Kuzindikira Mavuto Oopsya Omwe Amabereka Pambuyo Pakubereka ndi Zizindikiro Zofiira za Neonatal *.
• Thandizo la Postpartum International (PSI, International): * Kusiyana kwa Zachipatala ndi Emergency Management of Perinatal Mood and Anxiety Disorders vs Postpartum Psychosis *.

*Bukhuli limapereka njira zozindikirira mwadzidzidzi ndipo sililowa m'malo mwachipatala cha akatswiri. Kuchita nawo CPR wakhanda ndi wamkulu komanso kosi ya chithandizo choyamba kudzera ku Red Cross, St John Ambulance, kapena American Heart Association mwana wanu asanabwere ndi imodzi mwa ndalama zabwino kwambiri zomwe banja lingapange.

Maupangiri ogwirizana¶

• Kubereka mwadzidzi komanso ntchito yowopsa
• Kutentha kwa thupi kwa makanda ndi kutentha thupi
• CPR ya ana ndi makanda ndikutsamwitsidwa
• Sepsis ndi septic shock