Ko e Tafe Toto ‘i he Tolu‘i Feitu‘u Tolú, Movete ‘a e Pelasenita, mo e Movete ‘a e Umbilical Cord¶

Vaginal toto, fakafokifā hokohoko mamahi 'i he kete, ha lele 'o e vai amniotic muimui 'i ha loop 'o e umbilical, pe ko ha mamahi 'ulu lahi mo e ngaahi ulo 'o e sio hili 'a e uike 'e 20 'o e feitama (pea 'i he kotoa 'o e trimester hono tolu, mei he uike 'e 28 ki he fanau'i) 'oku taimi-cieth fetus 'o e mother mother emergen . ʻi ha ngaahi miniti siʻi pē. ‘Oku ‘ikai ke hangē ia ko e vave ‘a e feitamá pe ko e ngaahi faka‘au‘auhifo anga-maheni ‘o e ngāue ‘i he tu‘unga ‘uluakí ‘a ia ‘oku ha‘u mo ‘alu fakataha mo e ngaahi vaha‘a taimi mālōlō ta‘e-mamahi, ko e ngaahi faingata‘a‘ia ‘i he trimester hono tolú hangē ko e movete ‘a e pēpeé, movete ‘a e pēpeé, movete ‘a e vasa, movete ‘a e ‘utó, **movete ‘a e uho ‘o e pēpeé laecgen, mo e (asphyxia) pe ko e 'ohovale 'a e toto 'a e fa'ee kimu'a pea toki 'asi lahi 'a e ngaahi faka'ilonga 'i tu'a.

Ko ho ngaahi fatongia vave lolotonga ha fa'ahinga fakatu'utamaki 'o e feitama tuai ko hono ui 'o e fefononga'aki fakafaito'o fakafanau fakalakalaka, 'oua 'aupito na'a ke fakahoko ha sivi 'o e vagina pe fakahu 'a e ngaahi louhi'i nima pe tampons ki he vagina, fokotu'u 'a e fa'ee 'i hono taha to'ohema (ke hiki hake 'a e feitama mamafa 'o e uterus veminal 'i hono re abdo tefito) knee-chest position (kapau kuo 'osi 'a e umbilical cord ki tu'a), tauhi ia ke mafana mo NPO kakato ('ikai ha me'a 'i he ngutu) 'i he teuteu ki ha fanau'i fakavavevave 'o e sisa, pea muimui'i 'a e mole 'a e toto mo e pulse 'a e fa'ee mo e tu'unga 'o e manava kae 'oua kuo to'o 'e he kau toketaa.

Fai ʻeni he taimí ni .¶

1. Ta ki he ngaahi sevesi fakafaito'o fakavavevave 'i he taimi pe ko ia: Ta ki ho'o fika fakavavevave fakalotofonua (911 'i he 'Iunaiteti Siteiti mo Kanata, 112 'i he kotoa 'o e 'Iunioni 'Iulope, 999 'i he Pule'anga Fakatahataha, 000 'i 'Aositelelia) pe vakai'i 'emau tohi fakahinohino 'o e ngaahi fika fakavavevave. Lipooti ‘a e ngaahi uike pau ‘o e feitama ‘a e fa‘eé pea fakahā pe ‘oku ‘i ai ha tafe toto mei he va‘é, mamahi ma‘u pē ‘i he keté, ‘oku hā mai ‘a e afo ‘o e ‘uhiki‘i ‘utó, pe ko ha puke.
2. Kapau te ke sio pe ongo'i 'a e umbilical cord 'i he ava 'o e vaginal, ngaue'aki 'a e tu'unga 'o e tuliki-fatafata 'i he taimi pe ko ia: Kapau 'oku motuhi 'a e vai pea 'oku 'asi mai ha maea-umbilical cord 'i tu'a 'i he vulva pe ongo'i 'oku pulsing 'i hono fakaava, 'ai 'a e fa'ee ke tu'ulutui 'i hono ongo nima mo e tulikito pe flalt 'i he fatafata mo e flald 'i he fatafata hiki hake ma'olunga 'i he 'ea (tu'unga 'o e tuliki-fatafata). ʻOku toho ʻe he kalāvité ʻa e ʻulu mamafa ʻo e pēpeé ki mui mei he pelvis ko ia ʻoku ʻikai ke ne toe laiki ʻa e laine ʻo e ʻosikena ʻa e pēpeé tonu.
3. Ki he ngaahi toto pe mamahi kehe kotoa pe 'i he trimester hono tolu, fakatakataka'i 'a e fa'ee ki hono tafa'aki to'ohema: 'Ai ke tokoto hifo 'a e fa'ee 'i hono taha to'ohema (pe poupou'i ha 'ulumotu'a fefeka pe taueli fakatakataka'i 'o tikilī 'e 15 ki he 30 'i lalo 'i hono kongaloto to'omata'u kapau kuo pau ke ne tokoto 'i hono tu'a). ‘Oua ‘aupito na‘a tuku ha fefine ‘i he konga ki mui ‘o hono māhina hono ua pe tolu ke tokoto faka‘au‘ausino ‘i hono tu‘á, he ‘oku laiki ‘e he mamafa ‘o e manava feitamá ‘a e vena cava ‘i laló pea motuhia ai ‘a e tafe ‘a e totó ki he fo‘i ‘utó mo e loto ‘o e fa‘eé ‘o a‘u ki he peseti ‘e 30.
4. 'Oua 'aupito na'a ke fakahu 'a e ngaahi louhi'i nima, tampons, pe ngaahi tupenu 'i loto 'i he vagina: Kapau 'oku 'i ai ha toto 'i he vagina, fokotu'u ha pad fakafanau ma'a, matolu pe taueli kuo fakafoki 'o vetevete ki he tu'a 'o e vulva pea fakahaofi 'a e ngaahi pads pe taueli kotoa pe 'oku fakamomoko 'e he toto 'i ha kato pelesitiki ke lava 'e he kau ngaue 'o e falemahaki measure loxass weigh kinautolu. Ko e tuhu 'e taha 'oku fakahu ki he vagina 'o ha fefine 'oku 'i ai 'ene placenta previa 'e lava ke ne puncture 'a e placenta pea fakatupu 'a e tafe toto fakatupu mate 'i ha ngaahi sekoni.
5. Fakamālohiʻi ʻa e NPO fefeká (ʻikai ha meʻa ʻi he ngutú): ʻOua ʻe ʻoange ki he faʻeé ha vai, su, meʻakai, pe ngaahi faitoʻo konatapu. Ko e lahi taha ‘o e ngaahi fakatu‘utāmaki fakavavevave ‘o e tafe toto ‘i he tolu ‘o e māhina ‘oku fiema‘u ki ai ha tafa fakavavevave ‘i he malumalu ‘o e faito‘o faka‘auha fakalūkufua ‘i he‘ene a‘u atu ki he falemahakí.
6. Malu'i 'a e fa'ee lolotonga 'a e puke 'a e eclampsia pea siofi 'a e 'ohovale: Kapau 'e ma'u 'e he fa'ee ha puke fakalukufua (eclampsia), faka'ai'ai hono 'ulu, tauhi ia ke ne takai ki hono tafa'aki to'ohema, pea fakama'a 'a e ngaahi naunau 'o e fale. Tauhi ia ke ne māfana ʻaki ha ngaahi palanikete mōmoa pea teuteu ke fakahoko . CPR fakafaʻē ʻoku fakapiko toʻohemá kapau ‘e hoko ‘o ‘ikai ke ne tali pea ‘ikai ke ne toe mānava.

flowchart TD
    Start["Fakavavevave ‘i he Feitama Tuai (Laka hake ‘i he Uike ‘e 20 ‘o e Feitama): Tafe Toto, Mamahi Lahi, Tafe ‘a e Vai, pe Puke"] --> Call["1. Ta ki he Ngaahi Sevesi Fakavavevave (911 / 112 / 999) pea Fakaha e Ngaahi Uike Totonu 'o e Feitama"]
    Call --> CheckCord{"2. Na'e Motuhi 'a e Vai mo ha Umbilical Cord 'Oku 'Asi pe Ongo'i 'i he Fakaava 'o e Vaginal?"}
    CheckCord -->|Yes: Umbilical Cord Prolapse| KneeChest["Tuku ʻa e Faʻeé ʻi he Tuʻunga ʻo e Tuliki-Ulu (Fofonga/Ulu ki Lalo, ʻUluʻi Maʻolunga ʻi he ʻEá), ʻUfiʻufi ʻa e Maea ʻaki ha Tupenu Momoko Māfana, ʻOua naʻá Ne Tekeʻi ʻa e Maea ki Mui"]
    CheckCord -->|No Cord Visible| CheckSeizure{"3. 'Oku 'I ai ha Puke 'a e Fa'ee pe Mamahi 'Ulu / Mole 'a e Sio (Eclampsia)?"}
    CheckSeizure -->|Yes: Eclampsia| LeftSideSeizure["Roll Onto Left Side, 'Ulu 'o e Cushion, Mahino 'a e ngaahi naunau 'o e fale, 'Oua 'aupito na'a 'ai ha me'a 'i he ngutu, Tauhi 'a e NPO"]
    CheckSeizure -->|No Seizure: Bleeding or Severe Belly Pain| LeftTilt["Fakatakataka'i 'a e Fa'ee ki he tafa'aki to'ohema (To'ohema Lateral Tilt) ke Fakanonga 'a e Vena Cava Compression"]
    LeftTilt --> BleedRule["4. ‘Oua ‘aupito ‘e Fakahoko ha Sivi Faka-Vaginal pe Fakahū ha Ngaahi Tampons; Tuku 'a e Pad Ma'a 'i Tu'a Pe pea Fakahaofi 'a e Pads Kuo Fakamomoko"]
    KneeChest --> NPO["5. Tauhi 'a e Fa'ee ke Mafana 'aki 'a e Ngaahi Palaniketi mo e NPO Fakapapau'i ('Ikai ha Vai pe Me'akai) ki he C-Section Fakavavevave"]
    LeftSideSeizure --> NPO
    BleedRule --> NPO

Ko hono fakafaikehekehe‘i ‘a e ngaahi tupu‘anga ‘e fā ‘o e tafe toto ‘i he māhina hono tolú (Tafe toto ki mu‘a ‘i he fā‘elé)¶

‘Oku fakamatala’i ‘e he kau toketaa fakafanau ‘a e antepartum hemorrhage (APH) ko ha toto mei he ngaahi hui fakasekisuale hili ‘a e uike ‘e 20 ‘o e feitama (pe uike ‘e 24 ‘i he Pule’anga Fakatahataha) pea kimu’a pea toki fanau’i ‘a e pepee. Lolotonga e ki'i streak 'o e mucus lanu pingikī pe lanu engeenga ("faka'ali'ali toto") 'i he fakamolū 'a e cervix 'i he taimi 'oku 'ikai ha maumau, ko ha toto 'oku hange ha vaha'ataimi 'o e mahina, 'oku 'i ai ha ngaahi clots, pe 'oku 'alu fakataha mo e mamahi 'oku fie ma'u ke fakafaikehekehe'i vave 'i he lotolotonga 'o e ngaahi tu'unga fakatu'utamaki 'e fa ki he mo'ui.

Fakapulipuli 'a e placental abruption mo e lavea 'i he feitama (Fakatu'utamaki 'a e me'alele mo e hinga)¶

Ko e taha ‘o e ngaahi tauhele fakatu’utamaki taha ‘i he tokoni ‘uluaki fakafanau ko e fakapulipuli ‘a e placental abruption, ‘a ia ‘oku peseti ‘e 20 ‘a e ngaahi abruptions kotoa pe. ‘I he taimi ‘oku haea ai ‘a e lotolotonga ‘o e fo‘i ‘utó mei he ‘ā ‘o e ‘utó lolotonga ia ‘oku kei fakapipiki hifo ‘a e ngaahi tafa‘aki ‘i tu‘a ‘o e fo‘i ‘utó, ‘e lava ke lilingi atu ‘a e lita ‘e 1.5 ki he 2.5 (paini ‘e 3 ki he 5) ‘o e toto ‘o e fa‘eé ki he feitu‘u ‘i mui ‘i he fo‘i ‘utó (retroplacental hematoma) ‘o ‘ikai ha fo‘i esvixping ‘e taha ‘o fakafou ‘i he fo‘i ‘utó.

Ko e hā ʻoku fie maʻu ai ke siofi vave ʻe he falemahakí ʻa e kiʻi tō pe fakatuʻutāmaki ʻi he kā kotoa pē ʻi he feitamá .¶

Lolotonga e tolu māhina hono tolú, ‘oku ‘elasitiki ‘a e ‘uto ‘oku uouá pea ‘oku ne mafola ‘i he taimi ‘oku lulululu ai, ka ko e pelesenitá ‘oku ‘elasitiki mo ‘ikai ke ‘elasitiki. 'I he taimi 'oku kau ai ha fefine feitama 'i he na'a mo ha fepakipaki 'o e me'alele vave ma'ulalo ('a ia 'oku compresses ai 'e he fusi 'o e lap pe steering wheel hono kete), 'oku ne 'alu 'i he sitepu pea 'oku ne tu'uta 'i hono tu'a pe tafa'aki, pe 'oku ne mamahi'ia 'i ha taa ki he kete, 'a e malohi 'o e shear 'i he vaha'a 'o e elastic uterine placese 'a e puipui inelastic mo e 'a e.

• Toloi 'a e abruption hili 'a e lavea: Ko e abruption 'a e placenta hili ha fakatu'utamaki 'i he me'alele pe hinga 'e lava ke hoko 'i he taimi pe ko ia pe 'evolve 'i he houa 'e 4 ki he 24 hili 'a e uesia.
• Tu'utu'uni 'o e tu'unga 'o e fusi nofo'anga: 'Oku totonu ke tui ma'u pe 'e he kakai fefine feitama ha fusi nofo'anga poini 'e tolu, mo e fusi nofo'anga 'oku tu'u ma'ulalo mo 'ata'ata 'i he tafa'aki 'o e ngaahi hui 'o e hip mo e pelvic brim kakato 'i lalo 'i he curve 'o e kete feitama ('ikai 'aupito 'i he tafa'aki 'o e dome 'o e kete feitama** ('ikai 'aupito 'i he tafa'aki 'o e dome 'o e kete feitama) pea mo e uma 'o e denug be routed.
• Mandatory fetal monitoring: Ko e Kolisi 'Amelika 'o e kau toketā fakafanau mo e kau toketā fefine (ACOG) mo e Kolisi Fakatu'i 'o e kau toketā fakafanau mo e kau toketā fefine (RCOG) 'oku nau fakahoko 'a e fefine feitama kotoa pe 'i he hili 'a e uike 'e 20 'oku ne a'usia ha lavea 'i he kete, fakatu'utamaki 'o e me'alele, pe electronic hours kuo pau ke fou 'i he le4. rate mo e siofi 'o e 'uto 'i ha falemahaki, neongo 'oku ne ongo'i lelei pea 'oku 'ikai ha toto 'i he 'uto.
• Rh-fakafepaki'i 'a e fa'ahinga toto sensitization ( Fetomaternal hemorrhage): Kapau 'oku ma'u 'e he fa'ee ha Rh-fakafepaki'i 'a e fa'ahinga toto (A-fakafepaki, B-fakafepaki, AB-fakafepaki, pe O-fakafepaki), na'a mo ha ki'i toto si'isi'i 'o e fetus 'i he vaha'a 'o e placenta mo e fetal bloxeruption lolotonga 'a e lavea pe ab. ‘i he tafe ‘a e totó, ‘o fiema‘u ai ha huhu ‘o e anti-D immunoglobulin (RhoGAM) ‘i loto ‘i he houa ‘e 72 ‘i he falemahakí ke malu‘i ‘a e pēpeé mo e ngaahi feitama ‘i he kaha‘ú.

Camouflage fakaesino 'a e fa'ee: ko e ha 'oku sio tu'uma'u ai 'a e kakai fefine feitama kae 'oua kuo nau tō¶

Lolotonga ‘a e feitamá, ‘oku fakalahi ‘a e lahi fakakātoa ‘o e toto ‘o ha fefine ‘aki ‘a e peseti ‘e 40 ki he 50 (tānaki atu ‘a e lita ‘e 1.5 ki he 2.0 ‘o e toto lahi angé), pea ‘oku tupulaki ‘a e tā ‘o hono lotó ‘i he‘ene mālōloó ‘aki ‘a e tā ‘e 10 ki he 15 ‘i he miniti. Koe'uhi ko e fu'u reserve physiological ko 'eni, 'i he taimi 'oku tafe toto ai ha fefine feitama 'i loto pe 'i tu'a mei he placental abruption pe uterine rupture, 'oku 'otometiki pe hono shunt 'e hono sino 'a e toto mama'o mei he 'uto feitama mo e placenta ke tauhi hono 'uto mo hono loto 'o'ona ke perfused.

Ko hono olá, ‘oku ‘alu ‘a e pēpeé ki ha faingata‘a‘ia lahi mo fakatu‘utāmaki ki he mo‘uí ‘i ha taimi fuoloa ki mu‘a ke holo hifo ‘a e toto mā‘olunga ‘o e fa‘eé. ‘E lava ke mole mei ha fefine feitama ‘a e peseti ‘e 30 ki he 35 ‘o hono lahi fakakātoa ‘o e totó (mililita ‘e 1,500 ki he 2,000) lolotonga ia ‘oku kei hā ngali anga-maheni pē ‘a hono toto mā‘olungá; ko e taimi pē ʻoku faifai pea holo hifo ai hono toto māʻolungá pea ʻokú ne hoko ʻo momoko, clammy, mo puputuʻu, ʻokú ne ʻosi ʻi he decompensated Kalasi III pe IV hemorrhagic shock pea ʻi he tuʻunga fakatuʻutāmaki lahi ʻo e fakaʻauha ʻo e toto ʻoku ʻikai lava ke mafola (DIC) (ʻa ia ʻoku tukuange ai ʻe he tisiū thromboplastin places kotoa mei he torn, toto mei he funga kotoa pē).

Prolapse 'o e maea 'o e 'uhiki: ngaahi founga fakavavevave 'o e decompression 'o e kalavite¶

Ko e umbilical cord prolapse 'oku hoko ia 'i he fakafuofua ki he 1 'i he 300 ki he 500 'o e fanau'i 'i he taimi 'oku movete ai 'a e amniotic sac (motuhi 'a e vai) pea fufulu atu ha loop 'o e umbilical cord 'o fakafou 'i he cervix 'i mu'a pe 'i he tafa'aki 'o e konga 'oku 'asi mai 'a e pepee ('ulu, uma, pe breech). ‘Oku lahi taha ‘ene hoko ‘i he taimi ‘oku te’eki ai ke tō loloto ai ‘a e pēpeé ki he pelvis ‘i he taimi ‘oku motuhia ai ‘a e vaí, hangē ko e ngaahi fakahāhā ‘o e ‘utó, ngaahi loi fakafetongi (tafa’aki), fanau’i vave, mahanga, pe polyhydramnios ‘o hangē ko e vai ‘o e pēpeé ‘oku lahi ange ‘i he ‘utó.

Ko e hā ʻoku tāmateʻi ai ʻe he cord prolapse ʻa e pēpeé ʻi loto ʻi ha miniti ʻe 5 ki he 10 tukukehe kapau te ke ngāue .¶

Ko e taimi pē ʻoku tafe atu ai ʻa e vai ʻo e ʻutó, ʻoku fakaʻauha ʻe he kalāvité mo e ngaahi fakaʻauʻauhifo ʻo e pēpeé ʻa e ʻuluʻi ʻulu fefeka pe ʻuhikiʻi pēpeé ki lalo ʻo fakahangatonu ki he ngaahi hui ʻo e ʻuhiki ʻo e faʻeé, ʻo ne fakaʻauha ʻa e uho ʻo e ʻuhikiʻi pēpeé ʻo hangē ha laka ʻi ha paipa ngoué. In addition, when the wet umbilical cord emerges out of the warm 37.5-degree-Celsius (99.5-degree-Fahrenheit) vagina into cool 20-degree-Celsius (68-degree-Fahrenheit) room air, or if someone handles and squeezes the cord, the muscular walls of the two umbilical arteries and single 'alu 'a e veini 'o e 'uhiki ki he vasospasm fakamālohi, clamping tapuni kakato.

Tokoni 'uluaki fakasitepu ki he 'uto 'o e umbilical cord¶

1. Ta ki he 911 / 112 / 999 'i he telefoni le'o 'i he taimi pe ko ia pea fakaha: "Fakavavevave fakafanau: umbilical cord prolapse." 'E fakaha 'e he kau toketaa ki he falemahaki talitali ke tauhi ha loki tafa ke fakaava ki ha "crash" 'o e tafa 'o e sisa.
2. Tuku leva 'a e fa'ee ki he Tu'unga 'o e Tuliki-Ulu ('Uluaki fili 'i 'api):
3. ʻAi ke tūʻulutui ʻa e faʻeé ʻi ha mohenga pe faliki ʻoku ʻufiʻufi ʻi hono ongo nimá mo e tuí.
4. ʻAi ke ne tuku hifo hono ʻulú, umá, mo e fatafata ʻi ʻolungá flat hifo ki he meʻa-mohe pe falikí lolotonga ia ʻokú ne tauhi hono ongo tuí ke tucked ʻi lalo ʻi hono ongo umá koeʻuhí ke tuhu hono buttocks ki he ʻeá ʻi he māʻolunga taha ʻe ala lavá.
5. Ko e ha 'oku ngaue ai: Ko hono fakapiko'i 'o e sino 'o e fa'ee ki lalo 'oku ne ngaue'aki 'a e kalavite ke ne faka'uli 'a e sino mo e 'ulu 'o e pepee mei he pelvic bowl ki hono diaphragm, 'o to'o leva 'a e mamafa faka'auha mei he umbilical cord.
6. Fakalahi kehe 'o e Sims / Trendelenburg Tu'unga (Kapau 'oku vaivai 'a e fa'ee pe 'i loto 'i ha me'alele fakahaofimo'ui):
7. Kapau 'oku 'ikai lava 'e he fa'ee 'o pukepuke 'a e tu'unga 'o e tuliki-fatafata 'i ha miniti 'e 15 ki he 20, fakatakataka'i ia ki hono taha to'ohema mo hono tuliki 'i 'olunga (to'omata'u) 'oku toho hake ki hono fatafata, pea wedge tolu pe fa 'a e ngaahi 'ulumotu'a matolu fefeka pe ngaahi palanikete kuo fakafonu 'i lalo 'i hono 'uhiki mo e centete3il elete3i4. ('inisi 'e 12 ki he 18) ma'olunga ange ia 'i hono uma mo hono 'ulu.
8. Malu'i ha maea 'oku 'asi ki tu'a 'o 'ikai ke lomi'i ia:
9. 'Oua 'aupito na'a ke feinga ke teke pe fakafonu 'a e prolapsed umbilical cord ki mui 'i loto 'i he vagina. Ko hono teke 'o e maea 'oku ne kinks 'a e ngaahi ipu pea fakatupu 'a e vasospasm lahi, 'o maumau'i 'a e tafe 'a e toto 'oku kei toe 'i he pepee.
10. Kapau 'oku tautau ha fo'i loop 'o e maea 'i tu'a 'i he vulva, fakamomoko ha tupenu fufulu 'o e pulupulu ma'a, molumalu pe pad gauze 'oku 'ikai ha me'a 'i he **vai ma'a mafana 'o e paipa pe saline 'oku 'ikai ha me'a 'i he ** (mafana 'o e sino, 'ikai 'aupito ke vela pea 'ikai 'aupito ke momoko) pea drape ia ** loosely ** 'i he movell 'a e maea 'oku fakahaa'i andsm ke tauhi ia.
11. Ako'i 'a e tali 'i loto 'o e ma'olunga (Kapau pe 'oku fakahinohino'i 'e he fakafaito'o fakavavevave 'o e dispatch): Kapau 'oku kei lomi'i fefeka 'a e 'ulu 'o e pepee 'i he maea neongo 'a e tu'unga 'o e tuliki-fatafata pea 'oku 'i ai ha toketā ako'i, fakafanau, pe paramedic 'oku 'i ai (pe pule fakafaito'o fakavavevave 'oku fakahinohino'i mahino 'e he pu'i transporter ha ca). sterile gloves, fakahu 'a e ongo louhi'i nima ki he vagina 'o fakafepaki'i 'a e 'ulu ivi fefeka 'o e pepee (faka'ehi'ehi fakalelei mei he pa ki he pe squeeze 'a e maea 'iate ia pe), pea teke 'a e 'ulu 'o e pepee 'o tu'uma'u ki 'olunga 'o mama'o mei he maea, 'o pukepuke 'a e 'omi malimali ko ia ki 'olunga hokohoko 'o a'u ki he loki tafa C untils ki tu'a.

Ko e mahaki faka‘auha ‘o e toto ‘i he mohengá (fakamālohi‘i ‘o e Aortocaval) mo e fakapikopiko ‘i he tafa‘aki to‘ohemá¶

‘I he kotoa ‘o e konga ki mui ‘o e māhina hono uá mo e tolu (mei he uike ‘e 20 ‘o faai mai), ‘oku a‘u ‘a e mamafa fakatahataha ‘o e pēpeé, pelenitá, vai ‘o e ‘utó, mo e ‘utó kuo fakalahí ki he kilokalami ‘e 6 ki he 10 (pauni ‘e 13 ki he 22).

Ko e taimi ʻoku tokoto ai ha fefine ʻoku tōmui ʻene feitamá flat on his back (supine) ʻi ha mohenga, faliki, pe ʻi ha meʻalele fakahaofi moʻui, ʻoku ngoto hangatonu ki mui ʻa e ʻuto mamafá ki hono tuʻasinó pea ʻoku ne laiki ha ongo foʻi toto lalahi ʻoku lele ʻi he tafaʻaki toʻomataʻu ʻo e lumbar vertebrae:

1. Ko e Inferior Vena Cava: Ko e veini lahi mo manifinifi hono 'ā 'oku ne fakafoki 'a e toto kotoa pe kuo 'ikai ke 'i ai ha 'osikena mei he va'e mo e pelvis 'o fakafoki ki he tafa'aki to'omata'u 'o e loto 'o e fa'ee.
2. Ko e Abdominal Aorta: Ko e tefito'i 'alati 'oku ne 'ave 'a e toto 'oku 'osikena ki lalo ki he ngaahi 'alati 'o e 'uto mo e placenta.

‘I loto ‘i he miniti ‘e 2 ki he 5 ‘o ‘ene tokoto ‘i hono tu‘á, ‘oku holo hifo ‘a e foki ‘a e ngaahi veini ki he loto ‘o e fa‘eé ‘aki ‘a e peseti ‘e 25 ki he 30. ‘Oku fakafokifā pē ‘a e ongo‘i ‘e he fa‘eé ‘a e kafo, fufula, pōlepole, nounou ‘a e mānavá, mo e lanu engeenga, ‘oku holo lahi ‘a hono totó, pea ‘oku holo fakavavevave ‘a e tafe ‘a e totó ki he fo‘i pēpeé (supine hypotensive syndrome).

Founga ke fokotu'u 'a e mahaki feitama kotoa pe 'i he hili 'a e uike 'e 20¶

• Mahaki 'oku 'ilo'i (Recovery / Left Lateral Position): Fakatakataka kakato 'a e fa'ee ki hono taha to'ohema (he 'oku lele 'a e vena cava ma'ulalo ki he to'omata'u pe 'o e tu'asino, fakatakataka ki he tafa'aki to'ohema 'oku ne hiki kakato 'a e manava mamafa mei he veini). Tuku ha ʻulumotuʻa ʻi he vahaʻa ʻo hono ongo tuliki punoú mo ha taha ʻi lalo ʻi hono keté ke maʻu ha fakafiemālie.
• Lavea 'i he tu'asino pe 'ikai ke ngaue: Kapau na'e tō 'a e fa'ee mei ha ma'olunga pe na'e 'i ha fakatu'utamaki 'i ha me'alele 'a ia na'e 'i ai ha lavea 'i he tu'asino ‘oku mahalo’i pea kuo pau ke tauhi ia ke palapala ‘i he laine, wedge rolled taueli, palanikete, pe ko ha ‘ulumotu’a ‘i lalo taha to’omata’u ‘o hono pelvis mo e konga ki lalo ‘o hono tu’a (pe fakapiko ‘a e papa tu’asino kotoa) ‘i ha tuliki ‘o e 15 ki he 30 tikili ki he to’ohema.
• Ta'e'ilo / Tu'u 'a e Loto 'i he Feitama (Manual Left Uterine Displacement): Kapau 'e tō ha fefine 'oku 'asi 'oku feitama 'o tu'u 'a e loto pea 'oku fie ma'u CPR, ko hono fakatokoto ia ‘o fakapiko ‘i he ngaahi ‘ulumotu‘á ‘okú ne ‘ai ‘a e ngaahi fakamālohi‘i ‘o e fatafatá ke vaivai mo ta‘e‘aonga. Ka, tauhi hono mui 'i he faliki fefeka ki he fatafata malohi compressions (lotoloto 'o e hui 'o e fatafata, 100 ki he 120 'i he miniti, 5 ki he 6 cm / 2 ki he 2.4 'inisi loloto), lolotonga ia 'oku tu'ulutui ha fakahaofi hono ua 'i hono tafa'aki, ipu silly 'a e pre,she andright tafaʻaki toʻomataʻu) ʻa e ʻuto mamafá ʻoku senitimita ʻe 4 ki he 6 (ʻinisi ʻe 1.5 ki he 2.5) ʻo fakahangatonu ki hono tafaʻaki toʻohemá ʻo hokohoko atu ʻi he kotoa ʻo e fakaakeaké (feʻaveʻaki ʻo e ʻuto toʻohemá ʻi he toʻotoʻó).

Ko e mahaki preeclampsia lahi, mahaki HELLP, mo e ngaahi puke ‘o e ‘ekalampisia .¶

‘Oku ‘ikai ko e ngaahi fakatu‘utāmaki kotoa ‘i he trimester hono tolú ‘oku kau ai ‘a e tafe toto ‘i he va‘é. Ko e preeclampsia ko ha mahaki feitama multisystem 'oku faka'ilonga'i 'aki 'a e fakatu'utamaki 'o e fakapuliki (vasospasm) 'o e ngaahi ipu toto 'o e fa'ee mo e toto ma'olunga (140/90 mmHg pe ma'olunga ange, pe 160/110 mmHg pe ma'olunga ange 'i he preeclampsia lahi 'o e feitama hili 'a e uike 'o e ge. ‘i he fā‘elé (preeclampsia hili ‘a e fā‘elé).

When untreated preeclampsia progresses to HELLP syndrome (Hemolysis of red blood cells, Elevated Liver enzymes, and Low Platelets) or eclampsia (grand mal generalized tonic-clonic seizures in a pregnant or recently postpartum woman), cerebral hemorrhage (stroke), liver rupture, placental abruption, and fetal death can occur rapidly.

Ngaahi fuka kulokula 'o e preeclampsia lahi mo e 'ekalampisia 'oku lolotonga hoko (Ta ki he 911 / 112 / 999 'i he taimi pe ko ia)¶

'Oua 'aupito na'a ke faka'ikai'i 'a e ngaahi faka'ilonga ko 'eni 'i he konga hono ua 'o e feitama pe ko e 'uluaki uike 'e 6 hili 'a e fanau'i ko e "mamahi feitama angamaheni" pe indigestion:

• 1. Unrelenting, pounding headache: A severe frontal or throbbing headache that does not go away within 30 to 60 minutes of resting in a dark room or taking standard pregnancy-safe acetaminophen.
• 2. Ngaahi fakamoveuveu ki he sió (Fula ‘a e lobe ‘o e ‘utó): Sio ki he ngaahi maama ulo (photopsia), ngaahi feitu‘u ‘oku ulo (scotomata), ngaahi laine peau, sio ‘oku ‘ikai ke hā mahino, sio lōua, pe kui fakafokifā ‘i ha konga.
• 3. Severe right upper quadrant or epigastric pain ("The HELLP Pain"): Sharp, tight, squeezing, or burning pain directly underneath the breastbone or under the right rib cage (often mistaken for severe heartburn, gallbladder pain, or stomach flu). This pain is caused by the mother's liver swelling and bleeding underneath its tight outer Glisson capsule, a precursor to fatal hepatic rupture. Never massage or press hard on the upper right abdomen of a pregnant woman with this pain.
• 4. Rapid, sudden swelling (Edema) of the face, eyelids, and hands: While mild ankle swelling at the end of the day is common in pregnancy, waking up with eyes swollen nearly shut, a puffy face, or fingers so swollen rings must be cut off signals severe capillary leak.
• 5. Shortness of breath at rest or coughing up frothy pink sputum: Indicates fluid leaking into the mother's lungs (pulmonary edema).
• 6. Hyperreflexia and clonus: Twitching muscles or jumpy ankles just before an eclamptic seizure strikes.

Immediate first aid for an eclamptic seizure¶

1. Call emergency services immediately and report "Pregnant woman at [X] weeks having an eclamptic seizure, needs intravenous magnesium sulfate."
2. Prevent falls and roll onto the left side: Ease the mother to the floor, move hard furniture away, place a folded jacket or pillow under her head, and keep her rolled onto her left side so saliva, blood (from a bitten tongue), or vomit drains out of her mouth while keeping the uterus off her vena cava.
3. Never put anything in her mouth and never hold her down: Do not try to force a spoon, wallet, or fingers between her teeth.
4. Stay vigilant after the jerking stops: Most eclamptic seizures last 60 to 90 seconds, followed by deep unconsciousness or confusion (postictal phase) during which the baby's heart rate often drops temporarily due to maternal apnea. Keep her airway open in the left-side recovery position and monitor her breathing continuously until paramedics arrive with intravenous or intramuscular magnesium sulfate (the definitive anticonvulsant for eclampsia) and blood pressure medications.

Reduced fetal movements: when to go straight to maternity triage¶

Beginning at 24 to 28 weeks of pregnancy, a healthy fetus establishes a regular daily pattern of kicks, rolls, swishes, and flutters. International stillbirth prevention guidelines from the World Health Organization (WHO), the UK National Health Service (NHS Saving Babies' Lives), and ACOG emphasize critical rules regarding reduced fetal movement (RFM):

• Myth to discard: Babies do NOT "slow down" or move less at the end of pregnancy because they are running out of room. The character of movements may shift from sharp kicks to firm rolls and stretches, but the frequency and strength of movements should remain consistent right up until labor.
• The 28-Week Rule ("Count to 10"): In the third trimester, lying on your left side during the baby's usual active time should yield at least 10 distinct movements within 2 hours (most healthy babies make 10 movements in 15 to 45 minutes).
• Never wait until tomorrow and never trust a home consumer Doppler: If you notice a clear decrease or absence of your baby's normal movements, do not go to sleep waiting to see if the baby moves in the morning, and never use a handheld home fetal heartbeat Doppler or smartphone app to reassure yourself. A home Doppler often picks up the mother's own pelvic arterial pulse by mistake, and even if a fetal heartbeat is still present, a baby in chronic placental starvation stops moving to conserve oxygen hours before the heartbeat finally stops. Go immediately to your hospital maternity triage unit for a professional cardiotocography (CTG / non-stress test) trace.

Ngaahi fehu'i 'oku toutou 'eke .¶

Kuo vakaiʻi ʻa e ngaahi maʻuʻanga fakamatalá¶

• American College of Obstetricians and Gynecologists (ACOG, United States): Practice Bulletins on Gestational Hypertension and Preeclampsia (No. 222), Obstetric Hemorrhage, and Management of Pregnant Trauma Patients.
• Royal College of Obstetricians and Gynaecologists (RCOG, United Kingdom): Green-top Guidelines on Antepartum Haemorrhage (No. 63), Umbilical Cord Prolapse (No. 50), and Reduced Fetal Movements (No. 57).
• World Health Organization (WHO, International): WHO Recommendations for the Prevention and Treatment of Preeclampsia and Eclampsia and Managing Complications in Pregnancy and Childbirth (MCPC).
• American Heart Association (AHA, United States) and European Resuscitation Council (ERC): Guidelines for Cardiopulmonary Resuscitation and Cardiac Arrest in Pregnancy (Manual Left Uterine Displacement Protocols).
• Society of Obstetricians and Gynaecologists of Canada (SOGC) and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG): ALARM Course Obstetric Emergency Triage Standards.

Ngaahi fakahinohino fekau'aki¶

• Ko e fā‘ele fakavavevave mo e fā‘ele fakavavevave .
• Ruptured ectopic pregnancy and first-trimester bleeding
• Seizures and convulsions first aid
• Mo'utaufu'ua mo e circulatory 'uluaki tokoni .
• CPR mo e mānava fakahaofi ʻa e kakai lalahí
• Ngaahi fika fakavavevave 'i he fonua