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Kutuluka magazi kwa Trimester Trimester, Kuphulika kwa Placenta, ndi Umbilical Cord Prolapse

Manambala angozi amasiyana malinga ndi dziko. Tsambali limagwiritsa ntchito 911, nambala ya United States ndi Canada. Mayiko ena ambiri amagwiritsa ntchito 112, 999, kapena nambala ina. Pezani nambala ya dziko lanu.

Vaginal bleeding, sudden continuous abdominal pain, a rush of amniotic fluid followed by a loop of umbilical cord, or a severe headache with visual flashes after 20 weeks of pregnancy (and throughout the third trimester, from 28 weeks to birth) are time-critical obstetric emergencies that threaten the lives of both the mother and the fetus within minutes. Unlike early pregnancy cramping or normal first-stage labor contractions that come and go with painless rest intervals, third-trimester crises such as placental abruption, placenta previa, vasa previa, uterine rupture, umbilical cord prolapse, and eclampsia can cause rapid fetal oxygen starvation (asphyxia) or maternal hemorrhagic shock before outward signs look severe.

Your immediate responsibilities during any late-pregnancy emergency are to summon advanced obstetric paramedic transport, never perform any vaginal examination or insert fingers or tampons into the vagina, position the mother on her left side (to lift the heavy pregnant uterus off her main abdominal blood return vein) or in the knee-chest position (if the umbilical cord has slipped out), keep her warm and completely NPO (nothing by mouth) in preparation for an emergency cesarean delivery, and track blood loss and maternal pulse and breathing rates until paramedics take over.

Chitani izi tsopano

  1. Imbani zithandizo zachipatala mwachangu: Imbani nambala yanu yazadzidzi (911 ku United States ndi Canada, 112 ku European Union, 999 ku United Kingdom, 000 ku Australia) kapena onani chikwatu chathu cha manambala angozi. Report the mother's exact weeks of pregnancy and state whether there is vaginal bleeding, constant abdominal pain, a visible umbilical cord, or a seizure.
  2. Mukawona kapena kumva kamtsempha pa khomo la nyini, gwiritsani ntchito malo olowera pachifuwa cha bondo nthawi yomweyo: Madzi akaduka ndipo chingwe chonga chingwe chikaonekera kunja kwa maliseche kapena kumva kugunda potulukira, mayi agwade ndi manja ndi maondo ake ndikugwetsa chifuwa ndi nkhope yake pansi kapena bedi atakweza chiuno*-kumatako** (atakweza chiuno* m’matako). Mphamvu yokoka imakokera mutu wolemera wa mwanayo kuchokera m'chiuno kuti asiye kuphwanya chingwe cha mwanayo.
  3. Panthawi yonse yachitatu ya trimester yachitatu yotaya magazi kapena kuwawa, tembenuzirani mayi kumanzere kwake: Amayi agone ku kumanzere* (kapena kulungani pilo kapena pindani chopukutira cha madigiri 15 mpaka 30 pansi pa ntchafu yake yakumanja ngati atagona chagada). Musalole kuti mayi wakumapeto kwa trimester yachiwiri kapena yachitatu agone chagada chagada, popeza kulemera kwa chiberekero kumaphwanya mtsempha wapansi ndikuchepetsa kutuluka kwa magazi kupita ku placenta ndi mtima wa amayi ndi 30 peresenti.
  4. Osalowetsa zala, matamponi, kapena nsalu mkati mwa nyini: Ngati kutuluka magazi kumaliseche kulipo, ikani cholembera choyera, chochindikala kapena thaulo lopindika momasuka ku kunja kwa maliseche ndipo sungani zotupa zonse zoviikidwa m'magazi kapena matawulo muthumba la pulasitiki kuti ogwira ntchito pachipatala athe kuyeza kuyeza kwenikweni kwa magazi. Chala chimodzi cholowetsedwa kumaliseche kwa mayi yemwe ali ndi placenta previa amatha kuboola khomo la chiberekero ndi kuyambitsa kutuluka kwa magazi m'masekondi.
  5. Limbikitsani kutsatira malamulo a NPO (osagwiritsa ntchito pakamwa): Osapatsa mayi madzi, madzi, chakudya, kapena mapiritsi akumwa. Nthawi zambiri zadzidzidzi zadzidzidzi zadzidzidzi zamtundu wachitatu zimafunikira kuchitidwa opaleshoni yadzidzidzi pansi pa anesthesia wamba akafika kuchipatala.
  6. Tetezani mai pamene eclampsia akugwila ndikuonetsetsa kuti akunjenjemera: Ngati mayi agwidwa ndi khunyu (eclampsia), piritsani mutu wake, mutembenuzire kumanzere kwake, ndikuchotsa mipando. Atenthetseni ndi zofunda zouma ndikukonzekera kuchita CPR ya amayi yopendekera kumanzere ngati sakuyankha ndikusiya kupuma.
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    Start["Zadzidzidzi Pakuchedwa kwa Mimba (Kupitilira Masabata 20 Oyembekezera): Kutaya magazi, Kupweteka Kwambiri, Kutuluka kwa Madzi, kapena Kukomoka"] --> Call["1. Imbani Ntchito Zadzidzidzi (911 / 112 / 999) ndi Masabata Enieni a Boma a Mimba"]
    Call --> CheckCord{"2. Kodi Madzi Anathyoka Ndi Chingwe Chachingwe Chowoneka Kapena Anamva Pakusegula kwa Nkazi?"}
    CheckCord -->|Yes: Umbilical Cord Prolapse| KneeChest["Maikani Mayi Pamalo a Bondo/Chifuwa (Nkhope/Chifuwa Pansi, Matako Okwera Mwamphepo), Phimbani Chingwe Ndi Nsalu Yonyowa Mofunda, Musamakankhire Chingwe Kubwerera Mkati."]
    CheckCord -->|No Cord Visible| CheckSeizure{"3. Kodi Amayi Akudwala Khunyu Kapena Kupweteka Kwambiri kwa Mutu / Kutaya Maso (Eclampsia)?"}
    CheckSeizure -->|Yes: Eclampsia| LeftSideSeizure["Pereka Kumanzere, Mutu wa Khushion, Mipando Yoyera, Osayika Chilichonse Pakamwa, Sungani NPO"]
    CheckSeizure -->|No Seizure: Bleeding or Severe Belly Pain| LeftTilt["Pereka Amayi Kumanzere (Kumanzere Kupendekeka Kwambiri) kuti Muchepetse Kuponderezedwa kwa Vena Cava"]
    LeftTilt --> BleedRule["4. Musamayesere Kumaliseche Kapena Kuyika Tamponi; Ikani Padi Yoyera Kunja Kokha Ndikusunga Zoviikidwa"]
    KneeChest --> NPO["5. Sungani Amayi Ofunda ndi Mabulangete komanso NPO (Palibe Madzi kapena Chakudya) pa Gawo C la Emergency"]
    LeftSideSeizure --> NPO
    BleedRule --> NPO

Kusiyanitsa zifukwa zinayi za kutaya magazi kwa trimester yachitatu (Antepartum hemorrhage)

Madokotala akulera amatanthauzira kutaya magazi m'mimba (APH) ngati magazi aliwonse ochokera kumaliseche pambuyo pa milungu 20 yoyembekezera (kapena milungu 24 ku United Kingdom) komanso mwana asanabadwe. Ngakhale kuti mphukira yaing'ono ya pinki kapena ya bulauni ("chiwonetsero chamagazi") pamene khomo lachiberekero limafewetsa panthawiyi ndilopanda vuto, magazi aliwonse omwe amawoneka ngati msambo, amakhala ndi ziphuphu, kapena amatsatiridwa ndi ululu amafunika kusiyanitsa mwamsanga pakati pa zinthu zinayi zomwe zingayambitse moyo.

Clinical Mbali Kuphulika kwa Placenta (Abruptio Placentae) Placenta Previa Vasa Previa Kuphulika kwa Uterine
** Pathology Yoyambira ** Phula lokhala bwino lomwe limatuluka nthawi isanakwane limatuluka kuchokera mkati mwa chiberekero mwana asanabadwe, ndikusonkhanitsa magazi kuseri kwa chiberekero. Phula linakula pang'onopang'ono m'chiberekero ndipo pang'onopang'ono kapena kwathunthu limatseka khomo lamkati la chiberekero (mkati os); Pamene chiberekero cha chiberekero chikuchepa, mitsempha ya magazi imang'ambika. Mitsempha yamagazi ya mwana wosatetezedwa ya umbilical imadutsa mumitsempha yopyapyala yodutsa khomo lachiberekero; madzi akasweka, ziwiya za mwanayo zimang’ambika. Khoma la chiberekero limang'ambika motseguka, nthawi zambiri limakhala pachilonda cha **chigawo cham'mbuyomu cha cesarean ** kapena opaleshoni ya uterine fibroid panthawi yapakati.
Khalidwe la Ululu Mwadzidzidzi, kwambiri, mosalekeza, ngati mpeni kapena kung'ambika m'mimba ndi m'munsi mwa msana. Kupweteka sikumaleka pakati pa kukangana. Samva kuwawa kotheratu: Amayi nthawi zambiri amadzuka pakati pausiku ali ndi magazi ofiira owala popanda kumva kupweteka kapena kupweteka. Zosawawa: Kutaya magazi kumayamba nthawi yomweyo thumba la amniotic liphulika (kusweka kwa madzi). **Mwadzidzidzi, kupweteka kwakukulu kong'amba ** kumunsi kwa mimba (nthawi zambiri pamwamba pa chilonda cha C-gawo), nthawi zina kumatsatiridwa ndi mpumulo wabodza pamene kukomoka kumasiya mwadzidzidzi.
Mtundu ndi Kuchuluka kwa Magazi Akumaliseche Magazi ofiira, amtundu wavinyo*, kapena ziro kutuluka magazi kunja 20 peresenti ya milandu (yobisika mwadzidzidzi pomwe malita 1 mpaka 2 a magazi amakhala kuseri kwa thumba). Magazi a amayi ofiira owala, atsopano, osapweteka. Nthawi zambiri amayamba ndi chenjezo laling'ono la "sentinel bleed" pafupi masabata 28 mpaka 32 omwe amasiya, kenaka pambuyo pake ndi kutaya magazi kwakukulu. Magazi ofiira owala kapena oderapo osakanikirana ndi amniotic fluid nthawi yomweyo madzi akusweka. Chifukwa mawu akuti mwana wosabadwa ali ndi 250 mpaka 300 mL (kapu imodzi) ya kuchuluka kwa magazi, kutaya 100 mL (theka la kapu) kumapha mwanayo. Kutaya magazi kumaliseche (nthawi zambiri kung'onozing'ono kunja chifukwa magazi ambiri amathira mwachindunji m'mimba mwa mayi), limodzi ndi kugwedezeka kwachangu kwa amayi.
Kumva kwa Uterus (Abdominal Palpation) Chiberekero chooneka ngati chathabwa, cholimba, cholimba kwambiri ("Tetanic contraction"):** Mimba imamva molimba mosalekeza ndipo simafewa kapena kumasuka, ndipo imakhala yofewa kwambiri pokhudza kukhudza. Chibelekero chofewa, chofewa, chopanda chanthete: Mimba imamva kufewa kotheratu komanso yachibadwa pakamangika kulikonse kwa Braxton Hicks, ndipo khanda nthawi zambiri limagona chammbali (lopingasa) kapena matayala. Chiberekero chachibadwa, chofewa. Kutaya kozungulira kwabwinobwino kwa uterine: Mitsempha imachoka mwadzidzidzi, ndipo ziwalo za mwana wakhanda (zigongono, mawondo, mutu) zimatha kumveka mosavuta pansi pa khungu la m'mimba mwa mayi chifukwa mwana watuluka m'mimba kupita m'mimba.
**Zazikulu Zowopsa ** Kuthamanga kwa magazi / preeclampsia, **kupweteka kwa m'mimba kosawoneka bwino ** (kuwonongeka kwa galimoto, kugunda kwa lamba, kugwa, nkhanza zapakhomo), kusuta, kugwiritsa ntchito cocaine/methamphetamine, mapasa, kuphulika kusanachitike. Zipsera za C-section isanakwane, placenta previa isanachitike, kuchulukana (obadwa ambiri), zaka za amayi opitilira 35, umuna wa in vitro feteleza (IVF), kusuta. Kulowetsa chingwe cha Velamentous, bilobed kapena succenturiate placenta, placenta yotsika mu trimester yachiwiri, mimba ya IVF, mapasa. Kuyesa kwa Labor pambuyo pa oxytocin (TOLAC / VBAC), makamaka ndi chipsera cha chiberekero choyimirira, kulowetsedwa kwa oxytocin, kapena kuledzera kotsekeka.

Chifukwa chiyani simuyenera kukhudza kapena kuyang'ana nyini pamene mayi wapakati akutuluka magazi

Pakubereka mwadzidzidzi popanda kukhetsa magazi, kuyang'ana zowoneka ngati korona ndi muyezo. Komabe, pamene mayi wapakati wa kumapeto kwa trimester yachiwiri kapena yachitatu ali ndi kutuluka magazi kofiira kowala kosapweteka, chifukwa chake ndi placenta previa mpaka atatsimikiziridwa mwanjira ina ndi chipatala cha ultrasound. Mu placenta previa, thumba la spongy, lodzaza ndi magazi limakhala pamwamba pa khomo lachiberekero monga chivindikiro pamwamba pa botolo. Kulowetsa ngakhale chala chimodzi m'nyini kapena pachibelekeropo kuti "muone ngati watalikirana bwanji" kumakhomerera mwachindunji kudzera m'matumbo a placenta, kumayambitsa kukha mwazi kosaletseka kwa amayi komwe kumatha kutulutsa magazi mai mpaka kufa pakangopita mphindi zochepa kuti ambulansi ifike. *Manja, zala, ndi zinthu zizikhala kutali ndi maliseche.

Kuphulika kobisika kwa placenta ndi kuvulala pamimba (Kugunda kwagalimoto ndi kugwa)

Imodzi mwa misampha yoopsa kwambiri pa chithandizo choyamba cha obstetric ndi ** kubisala kobisika kwa placenta **, yomwe imapanga 20 peresenti ya zowonongeka zonse. Pamene pakati pa thumba latuluka kuchokera ku khoma la chiberekero pamene m'mbali zakunja za thumba zimakhala zomatira pansi, 1.5 mpaka 2.5 malita (mapaini 3 mpaka 5) a magazi a amayi amatha kutsanulira mu danga la kuseri kwa thumba (retroplacental hematoma) popanda dontho limodzi la magazi kutuluka kudzera pa khomo lachiberekero.

Chifukwa chiyani kugwa kwakung'ono kapena kuwonongeka kwagalimoto pamimba kumafuna kuyang'anira chipatala mwamsanga

Mkati mwa trimester yachitatu, chiberekero champhamvu chimakhala chotanuka ndipo chimatambasuka chikagwedezeka, pamene thumba la placenta limakhala la spongy komanso lopanda mphamvu. Mayi wapakati akakhala nawo ngakhale kugundana kwa galimoto yothamanga kwambiri (pamene lamba kapena chiwongolero chimakanikizira mimba yake), kutsetsereka pa masitepe ndi kutera pa matako kapena mbali yake, kapena kumenyedwa ndi mimba, mphamvu yometa ubweya pakati pa khoma la chiberekero ndi inlastic placenta ikhoza kusweka.

  • Kuchedwa kwadzidzidzi pambuyo povulala: Kuphulika kwa m'mimba pambuyo pa ngozi ya galimoto kapena kugwa kumatha kuchitika **nthawi yomweyo ** kapena kusinthika pakadutsa 4 mpaka maola 24 pambuyo pa kugunda.
  • Lamulo loika lamba pampando: Amayi oyembekezera nthawi zonse azivala lamba wokhala ndi mfundo zitatu, lamba wokhazikika m'chiuno mwake ndi wosalala pakati pa mafupa a m'chiuno ndi m'chiuno mwake pansi pa kupindika kwa mimba yapakati (osadutsa pamimba) ndipo lamba wamapewa amayenda bwino pakati pa mawere ndi mimba.
  • Kuwunika koyenera kwa mwana wosabadwayo: Bungwe la American College of Obstetricians and Gynecologists (ACOG) ndi Royal College of Obstetricians and Gynecologists (RCOG) alamula kuti mayi woyembekezera aliyense wopitilira milungu 20 yemwe wavulala m'mimba, kugwa kwagalimoto, kapena kugwa ayenera kuyang'anitsitsa kuthamanga kwa mtima kwapakati pa maola 4 mpaka 24 mosalekeza. chipatala, ngakhale akumva bwino ndipo sakutulutsa magazi kumaliseche.
  • Kulimbikitsa magazi amtundu wa Rh (kutuluka magazi kwa Fetomaternal): Ngati mayi ali ndi Rh-negative blood type (A-negative, B-negative, AB-negative, kapena O-negative), ngakhale kutulutsa magazi pang'ono pang'ono pakati pa thumba lachiberekero ndi chiberekero panthawi yovulala kapena jekeseni wobwerezabwereza. anti-D immunoglobulin (RhoGAM) mkati mwa maola 72 kuchipatala kuteteza mwana wosabadwayo ndi mimba zam'tsogolo.

Kubisala kwa thupi la amayi: chifukwa chake amayi oyembekezera amawoneka okhazikika mpaka atagwa

Pa nthawi ya pakati, kuchuluka kwa magazi a mkazi kumawonjezeka ndi 40 mpaka 50 peresenti (kuwonjezera malita 1.5 mpaka 2.0 a magazi owonjezera), ndipo kugunda kwa mtima wake pakupuma kumawonjezeka ndi kugunda 10 mpaka 15 pa mphindi imodzi. Chifukwa cha kusungika kwakukulu kwa thupi kumeneku, mayi wapakati akamatuluka magazi mkati kapena kunja chifukwa cha kutuluka kwa thumba kapena kusweka kwa chiberekero, thupi lake limathamangira magazi ** kutali ndi chiberekero ndi thumba lapakati** kuti ubongo wake ndi mtima wake ukhale wochuluka.

Zotsatira zake, mwanayo amavutika kwambiri, zomwe zingawononge moyo wake nthawi yayitali kuthamanga kwa magazi kwa mayi kusanatsike. Mayi woyembekezera akhoza kutaya 30 mpaka 35 peresenti ya kuchuluka kwa magazi ake (1,500 mpaka 2,000 milliliters) pamene kuthamanga kwake kwa magazi kumawoneka bwino; magazi ake akatsika ndipo amayamba kuzizira, kunjenjemera, komanso kusokonezeka, ali kale mu Class III kapena IV hemorrhagic shock ndipo ali pachiwopsezo chachikulu cha kufalitsa intravascular coagulation (DIC) (kumene minofu ya thromboplastin yotulutsidwa kuchokera ku placenta yomwe idang'ambika imadya zonse zomwe zimapangitsa kuti magazi aziundana, kupangitsa magazi osalamulirika pamalo aliwonse).

Umbilical cord prolapse: kuthamanga kwamphamvu yokoka nthawi yomweyo

Umbilical cord prolapse imachitika pafupifupi mwana mmodzi pa 300 mpaka 500 obadwa pamene thumba la amniotic limaphulika (kusweka kwa madzi) ndi chingwe cha umbilical chimachokera ku khomo lachibelekero ** patsogolo kapena pambali pa gawo lomwe likuwonekera** (mutu, mapewa, kapena bele). Zimakhala zofala kwambiri pamene khanda silinatsike kwambiri m'chiuno pamene madzi akusweka, monga ** mawonetseredwe a matako **, ** transverse (m'mbali) amagona **, ** kubadwa msanga **, ** mapasa **, kapena ** polyhydramnios ** (kuchuluka kwa amniotic madzi omwe amatuluka mwamphamvu ngati firehose).

Chifukwa chiyani kuphulika kwa chingwe kumapha mwanayo mkati mwa mphindi 5 mpaka 10 pokhapokha mutachitapo kanthu

Amniotic fluid ikamatuluka, mphamvu yokoka ndi kutsekeka kwa chiberekero kumayendetsa chigaza cholimba cha mwana kapena matako kutsika molunjika ku mafupa a chiuno cha mayi, kuphwanya chingwe chofewa ngati kuponda payipi yamunda. Kuonjezera apo, pamene chingwe chonyowa chimatuluka mu nyini yotentha ya 37.5-degree-Celsius (99.5-degree-Fahrenheit) mu mpweya wozizira wa 20-degree-Celsius (68-degree-Fahrenheit), kapena ngati wina agwira ndikufinya chingwecho, minyewa yam'mitsempha iwiri ya mitsempha ya umbilical ** vasospasm **, clamping kutseka kwathunthu.

Thandizo loyamba la umbilical cord prolapse pang'onopang'ono

  1. Imbani 911 / 112/999 pa sipikala nthawi yomweyo ndipo lengezani kuti: “Obstetric emergency: umbilical cord prolapse.” Achipatala adzadziwitsa chipatala cholandirako kuti chitsegulire chipinda chochitira opaleshoni kaamba ka “kuvulala” kwa opaleshoni.
  2. Nthawi yomweyo ikani mayiyo pa Knee-Chest Position (Chisankho choyamba kunyumba):
  3. Amayi agwade pa bedi kapena pansi pamipanda pamanja ndi mawondo.
  4. Atsitseni mutu, mapewa, ndi pachifuwa chapamwamba agoneke pansi pa matilesi kapena pansi kwinaku akugwira maondo ake pansi pa chiuno chake kuti matako ake aloze mmwamba momwe angathere.
  5. Chifukwa chake zimagwira ntchito: Kupendekeka kwa chiuno cha mayi motsetsereka kumagwiritsa ntchito mphamvu yokoka kutulutsa thupi la mwanayo ndi mutu wake kuchokera m'mbale ya m'chiuno kupita ku diaphragm, nthawi yomweyo kuchotsa kulemera kwa mtsempha wa umbilical.
  6. Alternative Exaggerated Sims / Trendelenburg Position (Ngati mayi atopa kapena mkati mwa ambulansi):
  7. Ngati mayi sangathe kugwira chifuwa cha bondo kwa mphindi 15 mpaka 20, mutembenuzireni kumbali yakumanzere* bondo lake lakumtunda (lamanja) litalunjika pachifuwa chake, ndi mpeni mapilo atatu kapena anayi olimba olimba kapena mabulangete opindika pansi pa chiuno ndi matako kuti akweze chiuno chake kutalika kwa 30 centi* 15 mita* 15. mapewa ndi mutu.
  8. Tetezani chingwe chowonekera kunja osachifinya:
  9. *Osayesa kukankhira kapena kuyika kachingwe kamene kamatuluka m'kati mwa nyini. Kukankha chingwecho kumasokoneza ziwiyazo ndipo kumayambitsa vasospasm, kuwononga magazi otsala a mwanayo.
  10. Ngati chingwe chikulendewera kunja kwa maliseche, zilowerereni nsalu yoyera, yofewa ya thonje kapena yopyapyala mu madzi apompo ofunda ofunda kapena saline wosabala (kutentha kwa thupi, kosatentha komanso kosazizira) ndikukokerani ** momasuka** pamwamba pa chingwecho kuti chikhale chofunda komanso chonyowa popewa mpweya wapachipinda kuti usazizire zotengera.
  11. ** Kukwezeka kwa mkati (Pokhapokha ngati akulangizidwa ndi kutumizidwa kwachipatala kwadzidzidzi): ** Ngati mutu wa mwanayo ukukankhirabe mwamphamvu pa chingwe ngakhale malo a pachifuwa cha bondo ndipo dokotala wophunzitsidwa bwino, mzamba, kapena wothandizira opaleshoni alipo (kapena chithandizo chamankhwala chodzidzimutsa chimalangiza momveka bwino womusamalira panthawi yaulendo wautali wakumidzi), woyankhayo amaika zala ziwiri pazitsulo zolimba, woyankha amaika zala zolimba pazitsulo. chigaza cha fupa la mwana (**kupewa mosamala kukhudza kapena kufinya chingwe chokha **), ndipo amakankhira mutu wa mwanayo molunjika mmwamba kutali ndi chingwecho, ndikumangirira mmwamba pang'onopang'ono mpaka kulowa m'chipinda chopangira opaleshoni mpaka dokotala atamutulutsa mwanayo kudzera mu gawo la C.

Supine hypotensive syndrome (Aortocaval compression) ndi kupendekeka chakumanzere chakumanzere

Kumapeto kwa trimester yachiwiri ndi yachitatu (kuyambira masabata 20 kupita m'tsogolo), kulemera kwa mwana wosabadwayo, placenta, amniotic fluid, ndi chiberekero chokulirapo chimafika 6 mpaka 10 kilograms (13 mpaka 22 pounds).

Mayi akamachedwa kukhala ndi pakati atagona chagada chamsana (cham'mwamba) pakama, pansi, kapena pa ambulansi, chiberekero cholemera chimamira molunjika chamsana ndi kuphwanya mitsempha ikuluikulu iwiri yamagazi yomwe ikuyenda kumanja kwa fupa la msana:

  1. The Inferior Vena Cava: Mtsempha wawukulu, wopyapyala wobweza magazi onse opanda okosijeni kuchokera m'miyendo ndi m'chiuno kubwerera kumanja kwa mtima wa mayi.
  2. Mtsempha wa M'mimba: Mtsempha waukulu womwe umanyamula magazi okhala ndi okosijeni kupita ku mitsempha ya chiberekero ndi thumba latuluka.

Mkati mwa 2 mpaka 5 mphindi atagona chagada, kubwerera kwa venous kumtima wa mayi kumatsika ndi 25 mpaka 30 peresenti. Mayiyo mwadzidzidzi akumva nseru, thukuta, chizungulire, kupuma movutikira, komanso kufooka, kuthamanga kwa magazi kumatsika, ndipo magazi opita ku thumba la mwana amatsika kwambiri (supine hypotensive syndrome).

Momwe mungayikitsire wodwala aliyense woyembekezera kupitirira masabata 20

  • Wodwala wa chikumbumtima (Kuchira / Kumanzere Lateral Position): Kutembenuzirani mayi kwathunthu ku kumanzere kwake (chifukwa chotsika mtsempha wa mtsempha umathamangira ku kumanja kwa msana, kugubuduza kumanzere kusuntha chiberekero cholemeracho kuchoka pa mtsempha). Ikani pilo pakati pa mawondo ake opindika ndi wina pansi pa mimba yake kuti mutonthozedwe.
  • Kuvulala kwa msana kapena kusayenda: Ngati mayi adagwa kuchokera pamtunda kapena atachita ngozi yagalimoto pomwe kuvulala kwa msana amaganiziridwa ndipo ayenera kukhala pansi pamzere, matawulo okulungidwa, mabulangete, kapena pilo pansi pa **mbali yakumanja ya chiuno chake ndi msana wake ** (kapena kupendekera gulu lonse la msana) pamakona a **15 mpaka 30 madigiri kumanzere **.
  • ** Kukomoka / Kumangidwa Kwa Mtima Pa Mimba (Kusamutsidwa Kwa Uterine Kumanzere):** Ngati mayi woyembekezera agwa ndi kumangidwa kwa mtima ndipo amafuna CPR, kumugoneka pamitsamiro kumapangitsa kuti kukanika pachifuwa kufooke komanso kusagwira ntchito. M'malo mwake, sungani ** kumbuyo kwake pansi pazitsulo zolimba ** kuti mukhale ndi chifuwa cholimba (pakati pa fupa la m'mawere, 100 mpaka 120 pamphindi, 5 mpaka 6 cm / 2 mpaka 2.4 mainchesi kuya), pamene ** wopulumutsa wachiwiri akugwada pambali pake, makapu manja onse awiri kuzungulira kumanja kwa mimba yake yoyembekezera, ndi kukoka (kapena kukankhira kuchokera kumtunda wa 6 mpaka 6 kumanja) mainchesi 2.5) chakumanzere kwake mosalekeza** panthawi yonse yotsitsimula (**kusuntha kwa chiberekero kumanzere **).

Preeclampsia kwambiri, HELLP syndrome, ndi eclampsia khunyu

Sikuti zochitika zonse zadzidzidzi za trimester yachitatu zimaphatikizapo kutaya magazi m'chiberekero. Preeclampsia ndi matenda amtundu wa multisystem omwe amadziwika ndi kuchepa koopsa (vasospasm) kwa mitsempha yamagazi ya amayi ndi kuthamanga kwa magazi (**140/90 mmHg kapena kupitirira apo **, kapena 160/110 mmHg kapena kupitirira mu preeclampsia yoopsa) yomwe imachitika pambuyo pa masabata 20 a mimba, ndi kubadwa (mpaka miyezi isanu ndi umodzi) pambuyo pobereka.

Pamene preeclampsia yosachiritsika ikupita ku HELLP syndrome (Hemolysis ya maselo ofiira a magazi, Ekukwezeka Liver enzymes, ndi Low Platelets) kapena eclampsia (grand mal generalized tonic-clonic seizures mwa mayi wapakati kapena posachedwapa), livergebralke postpartum kuphulika kwa placenta, ndipo imfa ya fetal imatha kuchitika mwachangu.

Mbendera zofiira za preeclampsia yoopsa komanso eclampsia yomwe ikubwera (Imbani 911/112/999 nthawi yomweyo)

Osataya zizindikiro izi mu theka lachiwiri la mimba kapena masabata asanu ndi limodzi oyambirira mutangobadwa monga "zowawa zapakati pa mimba" kapena kusanza:

  • 1. Kupweteka kwamutu kosalekeza, kugunda kwamutu: Kupweteka kwambiri kwa mutu wakutsogolo kapena kupweteka kwa mutu komwe sikutha mkati mwa mphindi 30 mpaka 60 mutapumula m'chipinda chamdima kapena kumwa acetaminophen wamba.
  • 2. Zosokoneza zowoneka (kutupa kwa Brain occipital lobe): Kuwona magetsi akuthwanima (photopsia), malo owala (scotomata), mizere yozungulira, kusawona bwino, kuwona pawiri, kapena khungu ladzidzidzi.
  • 3. Kupweteka kwambiri kumtunda kwa quadrant kapena epigastric ("The HELLP Pain"): Kupweteka kwambiri, kufinya, kufinya, kapena kutentha pansi pa fupa la pachifuwa kapena pansi pa nthiti yakumanja (nthawi zambiri amalakwitsa chifukwa cha kutentha kwa mtima, kupweteka kwa ndulu, kapena chimfine cha m'mimba). Kupweteka kumeneku kumachitika chifukwa kutupa kwachiwindi komanso kutuluka magazi pansi pa kapisozi wake wakunja wa Glisson, zomwe zimatsogolera kutupa kwa chiwindi komwe kumapha. Osamatisisita kapena kukanikiza mwamphamvu pamimba yakumanja kwa mayi wapakati yemwe ali ndi ululu.
  • 4. Kutupa kofulumira, kwadzidzidzi (Edema) kumaso, m’zikope, ndi m’manja: Ngakhale kuti kutupa pang’onopang’ono kumapeto kwa tsiku n’kofala pa nthawi ya mimba, kudzuka ndi maso otupa pafupifupi kutsekedwa, nkhope yotuwa, kapena zala zotupa kotero kuti mphete ziyenera kudulidwa zizindikiro zimasonyeza kutayikira kwakukulu kwa capillary.
  • 5. Kupuma pang'ono panthawi yopuma kapena kutsokomola sputum yapinki: Kuwonetsa madzi akutuluka m'mapapu a mayi (pulmonary edema).
  • 6. Hyperreflexia ndi clonus: Minofu yogwedezeka kapena kudumpha akakolo nthawi isanafike eclamptic seizure.

Thandizo lachangu la eclamptic khunyu

  1. Imbani achipatala nthawi yomweyo ndi kunena kuti "Mayi woyembekezera ali ndi masabata [X] akudwala khunyu, amafunikira mtsempha wa magnesium sulfate."
  2. Pewani kugwa ndi kugubudukira kumanzere: Muchepetsereni mayi pansi, chotsani mipando yolimba, ikani jekete yopindika kapena pilo pansi pamutu pake, ndipo mutembenuzire ku kumanzere kuti malovu, magazi (a lilime lolumidwa), kapena masanzi azituluka mkamwa mwake pamene chiberekero chisatuluke mtsempha wake.
  3. Osamuyika kalikonse mkamwa ndipo musamugwire: Osayesa kukakamiza supuni, chikwama chandalama, kapena zala pakati pa mano ake.
  4. Khalani tcheru kugwedezekako kukasiya: Nthawi zambiri eclamptic khunyu imatha masekondi 60 mpaka 90, kenako ndikukomoka kwambiri kapena kusokonezeka (posttal phase) pomwe kugunda kwa mtima wa khanda kumatsika kwakanthawi chifukwa cha kukomoka kwa amayi. Musungeni njira yake yolowera mpweya yotseguka kumbali yakumanzere ndikuwongolera kupuma kwake mosalekeza mpaka azachipatala afika ndi mtsempha kapena intramuscular magnesium sulfate (anticonvulsant yotsimikizika ya eclampsia) ndi mankhwala othamanga kwa magazi.

Kuchepetsa kusuntha kwa fetal: nthawi yoti mupite molunjika ku mayeso a uchembere

Kuyambira pa 24 mpaka masabata 28 a mimba, mwana wathanzi amakhala ndi machitidwe okhazikika a tsiku ndi tsiku a kukankha, kugudubuza, kugwedezeka, ndi flutters. Malangizo apadziko lonse oletsa kubereka akamwalira kuchokera ku World Health Organisation (WHO), UK National Health Service (NHS Saving Babies' Lives), ndi ACOG akugogomezera malamulo ofunikira okhudza kuchepetsa kuyenda kwa fetal (RFM):

  • Nthano yotaya: Makanda amachita OSATI "amachepetsa" kapena amasuntha pang'ono kumapeto kwa mimba chifukwa akutha. Maonekedwe a mayendedwe amatha kuchoka ku kukankha chakuthwa kupita ku mipukutu yolimba ndi kutambasula, koma **maulendo ndi mphamvu za kayendetsedwe kake kuyenera kukhala kosasinthasintha mpaka ntchito **.
  • Lamulo la masabata 28 ("Kuwerengera mpaka 10"): Mu trimester yachitatu, mutagona mbali yakumanzere panthawi yomwe mwanayo akugwira ntchito kuyenera kupangitsa mayendedwe 10 mkati mwa maola awiri** (makanda athanzi ambiri amapanga mayendedwe 10 pakadutsa mphindi 15 mpaka 45).
  • Musamadikire mpaka mawa ndipo musamakhulupirire Doppler wogula kunyumba: Mukawona kuchepa kapena kusayenda bwino kwa mwana wanu, **musagone kudikirira kuti muwone ngati khanda likuyenda m'mawa **, ndipo musagwiritse ntchito pulogalamu yapamanja yapamtima ya fetal Doppler kapena pulogalamu yapa foni yam'manja kuti mudzitsimikizire nokha. Doppler wakunyumba nthawi zambiri amatenga kugunda kwa mtsempha wa m'chiuno mwa mayi molakwika, ndipo ngakhale kugunda kwa mtima kwa mwana wosabadwayo kukadalipo, mwana yemwe ali ndi njala yosatha amasiya kusuntha kuti asunge mpweya maola angapo mtima usanayime. Pitani nthawi yomweyo kuchipatala chanu kuti mukapime katswiri wamtima wamtima (CTG / non-stress test).

Tengani chithandizo choyamba chovomerezeka ndi maphunziro a CPR

Makolo oyembekezera, okondedwa, ndi agogo amapindula kwambiri potenga CPR wamkulu ndi mwana wakhanda ndi maphunziro a chithandizo choyamba kudzera ku Red Cross, St John Ambulance, American Heart Association, kapena chipatala cha amayi apakati pa trimester yachitatu isanayambe.

Mafunso omwe amafunsidwa pafupipafupi

How can you tell the difference between placenta previa and placental abruption when bleeding occurs in late pregnancy?

Placenta previa (where the placenta covers the cervix) classically causes painless, bright red vaginal bleeding with a soft, relaxed uterus. Placental abruption (where the placenta prematurely tears away from the uterine wall) typically causes sudden, severe, continuous abdominal or back pain, a hard "woody" uterus that does not relax between contractions, and dark red blood (or no visible external blood if the bleeding is trapped behind the placenta). Both require an immediate ambulance and strict avoidance of any vaginal examination.

What should you do right away if a pregnant woman's water breaks and you see the umbilical cord coming out?

This is an umbilical cord prolapse, where the baby's head can crush its own oxygen line within minutes. Immediately call your local emergency number, have the mother get onto her hands and knees with her chest and face flat on the floor or bed and her buttocks raised high in the air (the knee-chest position) so gravity pulls the baby off the cord, loosely cover any exposed cord with a cloth soaked in warm water, and never try to push the cord back inside.

Why must a woman in her third trimester never lie flat on her back during an emergency?

After 20 weeks of pregnancy, lying flat on the back allows the heavy pregnant uterus to press directly down onto the inferior vena cava (the main vein returning blood from the lower body to the heart). Within minutes, this compression cuts maternal cardiac output by up to 30 percent, causing the mother's blood pressure to crash and starving the placenta of oxygen; always roll her onto her left side or tilt her hips 15 to 30 degrees to the left.

Why is pain under the right ribs or a severe headache in the third trimester dangerous?

A pounding headache that will not go away, flashing lights or blurry vision, and sharp pain underneath the right rib cage or upper stomach after 20 weeks of pregnancy (or up to 6 weeks after birth) are classic warning signs of severe preeclampsia and HELLP syndrome. The upper right belly pain is caused by dangerous swelling and bleeding inside the mother's liver, which can lead to liver rupture, stroke, or eclampsia seizures unless treated immediately at a hospital.

Does a pregnant woman need to go to the hospital after a minor car accident or fall if she has no bleeding?

Yes, every pregnant woman past 20 weeks who experiences any motor vehicle collision, seatbelt jolt, or fall onto her stomach, side, or buttocks must go to a hospital maternity unit for at least 4 to 24 hours of electronic fetal monitoring. Shear forces can cause a delayed or concealed placental abruption where liters of blood pool behind the placenta without any blood showing externally, and Rh-negative mothers may need an anti-D immunoglobulin injection within 72 hours.

Magwero afufuzidwa

  • American College of Obstetricians and Gynecologists (ACOG, United States): Practice Bulletins on Gestational Hypertension and Preeclampsia (No. 222), Obstetric Hemorrhage, ndi Management of Pregnant Trauma Patients.
  • Royal College of Obstetricians and Gynecologists (RCOG, United Kingdom): Green-top Guidelines on Antepartum Haemorrhage (No. 63), Umbilical Cord Prolapse (No. 50), ndi Kuchepetsa Kuyenda kwa Fetal (No. 57).
  • World Health Organization (WHO, International): Malangizo a WHO pa Prevention and Treatment of Preeclampsia and Eclampsia and Managing Complications in Pregnancy and Childbirth (MCPC).
  • American Heart Association (AHA, United States) ndi European Resuscitation Council (ERC): Malangizo Otsitsimutsa Mtima ndi Kumangidwa kwa Mtima Pakati pa Mimba (Manual Left Uterine Displacement Protocols).
  • Society of Obstetricians and Gynecologists of Canada (SOGC) ndi Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG): ALARM Course Obstetric Emergency Triage Standards.

Maupangiri ogwirizana