Isicwangciso seNtlekele yokukhulelwa kweSithathu seSithathu: Ukufuduka phambi kwe-Barometric Labor Spikes kunye nokuPakisha iKhithi yokuZala ecocekileyo¶

Xa isitshingitshane, isaqhwithi, isikhukula, okanye umlilo wasendle usondela ngelixa use kwikota yesithathu yokukhulelwa (28 to 40+ weeks gestation), awunakulandela ixesha elifanayo "linda ubone" njengekhaya elingakhulelwanga. Izaqhwithi ezinamandla, ukwehla ngequbuliso kuxinzelelo lwe-atmospheric barometric, ukuphelelwa ngamanzi emzimbeni, kunye noxinzelelo olukhulu lokuphuma rhoqo lubangela umsebenzi wangaphambi kwexesha, ukugqabhuka kwangaphambi kwexesha kweembrane (PROM), okanye ukuzala ngeyure kanye xa iibhulorho zivaliwe, iindlela ziphantsi 1 meter (3.3 feet) yamanzi esikhukula, kwaye ii-ambulensi azikwazi ukuphendula. Ukuba ufumana ubunzima bokuzala, ukopha kwilungu lobufazi, ukutsalwa ngequbuliso okanye ukuchaphazeka kwe-amniotic fluid, intloko ebuhlungu enotshintsho olubonakalayo, okanye ukuncipha kwentshukumo yomntwana okwangoku, tsalela umnxeba kwinombolo yakho yexesha likaxakeka. amanani kaxakeka ulawulo ngoko nangoko. Kwakhona jonga kwakhona izikhokelo zethu zoncedo lokuqala lweklinikhi ukubeleka okungxamisekileyo kunye nokusebenza okukhawulezileyo ngaphandle kwesibhedlele, i-shoulder dystocia, i-nuchal cord, kunye nokuhanjiswa kwe-breech ngaphandle kwesibhedlele, kwaye i-eclampsia seizures, i-HELLP syndrome, kunye ne-postpartum preeclampsia, kunye neyethu usana kunye nomntwana osemncinci isikhokelo sebhegi engxamisekileyo.

Ngokutsho kwe- ** IKholeji yaseMelika ye-Obstetricians kunye neGynecologists (ACOG), i Amaziko oLawulo lweSifo noThintelo (CDC), uMbutho wezeMpilo weHlabathi (WHO), kunye ne-Matshi kaDimes, izigulane ezikhulelweyo zidlulileyo 34 to 36 weeks gestation (okanye nakweyiphi na iminyaka yokumitha enemeko yomngcipheko ophezulu njenge placenta previa, icandelo langaphambili le-C, i-preeclampsia, ukumitha kwamawele/amatyeli amaninzi, okanye i-vasa previa) jongana nemingcipheko ebeka ubomi bomama kunye nemveku ukuba uvaleleke kwindawo yentlekele ngaphandle kotyando lokubeleka. Nokuba isibhedlele sakho esicwangcisiweyo sokuhanjiswa sihlala sivulekile ngexesha lesiphango okanye ukucima kombane, iRekhodi yezeMpilo ye-Electronic (EHR) iiphothali zesigulana kunye nothungelwano lwekhompyuter yesibhedlele zihamba ngokungaxhunyiwe kwi-intanethi ngexesha lokuphela kwe-cyber okanye igridi, ukushiya ugqirha wegumbi likaxakeka elingaqhelekanga elinolwazi lwe- **blood type kunye ne-Rh(D) factor **, Iqela B Streptococcus ()GBS) isimo, indawo yeplacental, okanye isifo seswekile sokukhulelwa/amayeza oxinzelelo lwegazi. Ukuphumeza iProtokholi yokuPhuculwa kweNkathi yesiThathu kwangethuba, ephethe iPhepha eliShiciweyo elingangeni manzi Itshathi yaphambi kokubeleka, ukwenza imephu i-backup ezimbini zeMisebenzi kunye noKuziswa (L&D) izibhedlele ezikwiindlela zekhampasi ezichaseneyo, kunye nokupakisha i-WHO-standard Emergency Clean Birth Birth Kit esemgangathweni ikhusela umama nosana xa iziseko zophuhliso zisilela.

Yenza oku ngoku¶

1. klzzwxh:0073 Ungaze uxhomekeke kwi-smartphone yesigulana se-artphone app (MyChart) engaphumeleliyo xa iiseli zeeseli zisihla. Ugqirha wokubelekisa ongaphandle kwendawo ufuna iinyani ezintandathu ephepheni kwimizuzwana engama-30: (1) Uhlobo lweGazi, iSimo seRh, kunye neSikhuseli se-Antibody** (klwxh:0067), (2) Indawo yePlacental kwi-ultrasound ye-anatomy yveki ezingama-20 (ruling out Placenta Previa before any vaginal exam), **(3) Iqela B Strep (GBS) isiphumo seswab**, **(4) Umhla oqikelweyo omiselweyo (EDD) nge-first-trimester crown-rump ultrasound, **(5) Iphaneli yesifo esosulelayo (klzzwxh:00), kunye **(6) Ngaphambili uhlobo lwesiKhova sibeleko** (low-transverse vs. classical vertical C-section).
2. ** Yamkela i "T-Minus 48-Hour Early Evacuation Rule" ukuba ukhona 36+ weeks pregnant (okanye 28+ weeks nayo nayiphi na imeko yomngcipheko omkhulu) xa kukhutshiwe inkanyamba, isaqhwithi sasebusika, izandyondyo, okanye iwotshi yomlilo wasendle.Su**ungalindi umyalelo wokufuduka osisinyanzelo: hamba 36 to 48 hours phambi kwemimoya yetropikhi (63 km/h / 39 mph) okanye ukugqabhuka kwesaqhwithi seqhwa lifikile, kwaye ubhukishe ihotele okanye uhlale nosapho ngaphakathi 15 minutes ye Inqanaba III okanye iNqanaba le-IV Perinatal / iSibhedlele seNICU ngaphandle kwendawo yempembelelo.
3. Imephu yangaphambi kwemephu EZINTATHU zaBasebenzi kunye nokuhanjiswa (L&D) izibhedlele - ezingezizo iikliniki zokhathalelo olungxamisekileyo okanye ii-ER ezizimeleyo ezingenazo zokubelekisa - ezibekwe ubuncinane kwiindlela ezi-BINI ezijongene nekhampasi ukusuka kwikhaya lakho. Ngaphezulu kwe-40 pesenti yamagumbi kaxakeka asemaphandleni nakwiidolophu akasenayo iwadi yabagulayo abalaliswayo kuMsebenzi nokuZisa. Qinisekisa kwangaphambi kwexesha ukuba zeziphi izibhedlele ezikuMntla, eMzantsi, eMpuma, nakwiNtshona yendlu yakho ** 24/7 OB/GYN utyando lotyando kunye neYunithi yokuNakekelwa ngokunzulu kweNtsana.NICU)** ukuba umlambo ophuphumayo okanye uhola wendlela owehlayo uvale indlela eya kwisibhedlele sakho sokuqala.
4. Ungaze ujonge kwisikolo sikawonke-wonke/indawo yokuzivocavoca kwindawo yentlekele 36+ weeks ukhulelwe ngaphandle kokubuza kuqala kwi-arhente yakho yolawulo olungxamisekileyo malunga a "Medical / Special-Needs Shelter" okanye "Hospital Pre-Admit Staging Program". Izibhedlele ezininzi eziselunxwemeni ziyabavumela abasetyhini abanjalo 38 to 39+ weeks pregnant (okanye umngcipheko omkhulu) ukujonga ngokuthe ngqo kwigumbi lokwamkela iindwendwe esibhedlele okanye kwindawo yokhuseleko yezonyango ekufutshane phambi kokuwa ukuze ukhuphe amanyathelo oqhwithela kude negumbi lotyando.
5. Pakisha into evaliweyo, engenamanzi "WHO Six-Cleans" Emergency Clean Birth Kit ngaphakathi kwezixhobo zentlekele zekhaya lakho kunye netranki yemoto yakho. Ukuba iqhwithi ngequbuliso, inyikima, okanye izandyondyo zemvula zikurhintyela ngaphakathi okanye kwinqwelo-mafutha ngexesha elinzima leSigaba seSibini sokusetyenzwa, uneeglavu zeplastiki ezingenanto, iiglavu zenitrile, ichlorhexidine/sepha, izibophelelo ezimbini zenkaba ezingenazintsholongwane (or boiled cotton tape),incakuba/isikere esingenazintsholongwane (though in out-of-hospital births within 1 to 2 hours of EMS, you clamp/tie the cord and DO NOT cut it), isirinji yebhalbhu, i-thermal Mylar + iingubo zomntwana zoboya begusha, kunye automated upper-arm pressure cuff kusindisa ubomi.
6. Sela 3 to 4 liters (100 to 135 fluid ounces) yamanzi acocekileyo yonke imihla ngexesha lokuphuma okanye ukuphuma kombane. Ukuphelelwa ngamanzi emzimbeni komama kunye noxinzelelo lobushushu kubangela ukuba i-posterior pituitary gland ikhuphe antidiuretic hormone (ADH / vasopressin), edibana ne-uterine i-oxytocin receptors kwaye ibangele ukuxinwa kwangaphambili kwesibeleko.

Umthi wesigqibo: Ukukhutshwa kwentlekele kwikota yesithathu vs. indawo yokuhlala kunye nokuvavanywa kwabasebenzi¶

Landela le ndlela yesigqibo sokubeleka xa isilumkiso semozulu embi, ukucima kwegridi, okanye umyalelo wokuphuma usongela indawo yakho.

flowchart TD
    Alert["Ukubukela iMozulu eMandundu (iNkanyamba, iBlizzard, uMkhukula, uMlilo wasendle) okanye iGridi eNgxamisekileyo ikhutshwe"] --> GestCheck{"Buthini Ubudala bakho bokuGestational kunye neSimo soMngcipheko wokuBeleka?"}

    GestCheck -->|"UMNGCIPHEKO OMKHULU NGAYO NAPHI NA IVEKI (i-Placenta Previa, i-Classical C-Section yangaphambili, i-Preeclampsia, amawele / ama-Triplets, iMbali ye-Precipitous <2-Hour Labor) OKANYE 36+ iiveki ezikhulelweyo"| EvacEarly["UKUPHUMA NGOKUKANGAPHAMBILI NGOKUKANGAPHAMBILI (Iiyure ezingama-36 ukuya kwiiyure ezingama-48 phambi kweMpembelelo): 1. Phuma ngaphandle kwesiphango/ummandla wezikhukula uye kwihotele/isalamane ngaphakathi kwemizuzu eyi-15 yeNqanaba III/IV L&D + Isibhedlele saseNICU 2. Ukuba iindlela zokufuduka ZISELE zivaliwe -> Fowunela i-OB/GYN yakho ngokukhawuleza ucele i-OB/GYN yakho yeSibhedlele i-Prefuge Ukwamkelwa okanye unikezelo lwe-Special-Needs Medical Shelter"]

    GestCheck -->|"Umngcipheko ophantsi wokuKhulelwa kweSingleton phantsi kweeVeki ezingama-35 (kwaye nokuhlala kwiSakhiwo esiKhuselekileyo)"| PrepStay["LUNGISELELA I-SHELTER EYONGEZIWEYO-I-NDAWO: 1. Pakisha iTshati yePhepha ngaphambi kokubeleka + Iintsuku eziyi-14 zeMithi yoNikezo (Prenatals, Insulin, Labetalol/Nifedipine, Low-Dose Aspirin, RhoGAM card) 2. Gcina iilitha ezi-4 / Usuku lokusela amanzi okusela ukuthintela ukosuleleka kwe-Stage. I-automated BP Cuff + Infant Go-Bag ngebhedi"]

    EvacEarly --> SymptomCheck{"Ngaba NAziphi na iimpawu zeSilumkiso sokuBelekisa Ziphuhla Ngexesha likaxakeka?"}
    PrepStay --> SymptomCheck

    SymptomCheck -->|"I-Contractions rhoqo (Rhoqo kwi-5 Min okanye iVala), i-Gush / Trickle of Fluid (ROM), i-Vaginal Bleeding, i-Fetal Kick Count Count (<10 Ikhahlela kwiiyure ze-2), OKANYE Intloko ebuhlungu / i-Vision Spots / BP >= 140/90"| GoHospital["IZITHUTHO EZIXHUMZEKILEYO ZOKUKHULA: 1. Fowunela i-911 / 112 / 999 kunye ne-L & D Triage Desk 2. Jonga isimo sendlela -> Qhuba ukuya kwiSibhedlele sePrayimari ye-L & D OKANYE iSibhedlele se-L & D se-Compass esichaseneyo 3. Yiza nePhepha leTshati yokubeleka + IKhiti yoKubeleka ecocekileyo + iSitulo semoto yoNtsana"]

    SymptomCheck -->|"Umnqweno osondeleyo wokutyhala, uxinzelelo lweRectal, okanye iNhloko yosana ibonakala (isithsaba) ngelixa iindlela zivaliwe."| ImminentBirth["UKUNIKEZELWA NGAPHANDLE KWESIBHEDLELA OKUSEMFUDUKO: 1. UNGAZAMI ukuqhuba ngelixa uthwesa isithsaba -> Fowunela u-911 / 112 / 999 kwi-speakerphone 2. Vula iKit yokuZala ecocekileyo kumandlalo/emgangathweni ococekileyo (UNGAZE phezu kwendlu yangasese) 3. Xhasa intloko yosana ngobunono -> Yomisa usana ngoko nangoko -> Beka isifuba esomileyo kwisikhumba sikanina -> Beka isifuba esomileyo kwisikhumba sikamama Iqhina/intambo yokuqhobosha kwiindawo ezimbini KUPHELA emva kokuyeka ukubetha kwe-pulsing (UNGASiki intambo ukuba i-EMS ifikile)"]

Icandelo loku-1: Kutheni izitshingitshane kunye nokukhutshwa kwabantu kubangele ukuSebenza kwangethuba (Barometric Pressure & Dehydration Physiology)¶

Ukuqonda ukuba kutheni Iiwadi zezaBasebenzi kunye noThutho zigcwala kwiiyure ezingama-24 ngaphambi nangexesha lesaqhwithi esikhulu kukunceda ukhuphe ixesha lokufuduka kwakho phambi kokuba iindlela zingahambeki:

1. Impembelelo yokuLahla koxinzelelo lweBarometric (Atmospheric Low-Pressure Systems):
2. Izaqhwithi eziqatha, iinkanyamba zeebhombu, ii-nor'easters, kunye nee-supercells ezinoqhwithela zibonakalisa ukwehla okunyukayo kuxinzelelo lweatmospheri (ambient atmospheric)often dropping from 1,013 millibars down to 940 to 980 millibars).
3. Izifundo zeklinikhi zokubelekisa (including analyses of Hurricane Katrina, Hurricane Sandy, and typhoon landfalls in Japan and Taiwan) bonisa ispike esibalulekiyo ngokwamanani e- Ukuqhawuka okuzenzekelayo kweMembranes okuzenzekelayo (PROM - "ukuqhekeka kwamanzi") kunye nokuqalisa ukusebenza okusebenzayo ngaphakathi 12 to 24 hours Ukuhla koxinzelelo olubukhali lwebarometric, njengoko umahluko oqinisekileyo woxinzelelo ngaphakathi kwingxowa ye-amniotic usebenza ngokuchasene neenwebu zechorioamniotic ezibuthathaka.
4. I-Dehydration-Vasopressin-Oxytocin Loop:
5. Xa owasetyhini okhulelweyo ebambeke kwi-8 yeeyure ze-8 yendlela yokuphuma kwi-traffic jam (okanye ikhusi kwindlu eshushu ngaphandle kwe-air conditioning emva kokucima kombane), uhlala ethintela amanzi akhe ukuze aphephe ukukhangela iindawo zangasese ezivaliweyo zendlela enkulu, ngelixa elahlekelwa ulwelo ngenxa yokubila.
6. Njengoko i-plasma osmolality inyuka, i-hypothalamus yobuchopho kunye ne-posterior pituitary ikhupha i-*Antidiuretic Hormone.ADH / Arginine Vasopressin)**. Ngenxa yokuba ** i-ADH kunye ne-Oxytocin ihluke nge-2 kuphela i-amino acids ** kwiindandatho zabo ze-9-amino-acid peptide, amanqanaba aphezulu e-ADH adibanisa kwi-oxytocin receptors.OXTR) kwi-uterine myometrium, ebangela iintlungu i-Braxton Hicks okanye i-preterm labor contractions yinyani.
7. Utyando lweCatecholamine (And the "Safety Reflex" Crash):
8. Uloyiko olugqithisileyo luvelisa i-spike kwi-epinephrine kunye ne-cortisol*, enokuthi ithintele ukuhamba kwegazi kwi-uteroplacental (triggering placental abruption in hypertensive mothers) okanye ayeke ukuzala kwangoko - de umama afike kwindawo emnyama, apho iadrenaline yehla, i-endogenous oxytocin surges, kunye ukubeleka okukhawulezileyo okwesibini kwenzeka ngaphantsi kwemizuzu engama-45.

Icandelo 2: Itshathi yePhepha eliNgenaManzi ngaphambi kokubeleka: Iinyaniso ezili-10 ezidingwa nguGqirha we-ER ongaqhelekanga¶

Ukuba ufuduselwe kwesinye isixeko okanye uhambe kwisibhedlele esigciniweyo esinenethiwekhi yekhompyuter iphantsi, nikezela umongikazi we-triage Iphepha eli-2 lePhepha leSishwankathelo sangaphambi kokubeleka elitywinwe ngaphakathi kwebhegi yefriza engangeni manzi. Qinisekisa ukuba ipakethi yakho eprintiweyo ibandakanya ezi manqaku ali-10 edatha yekliniki:

Icandelo 3: Udityaniswa Njani iKhithi yokuZalwa eNgxaki eNgxaki eNgqongileyo (WHO "Six Cleans" + Maternal Triage)¶

UMbutho wezeMpilo weHlabathi (WHO)** ne United Nations Population Fund (UNFPA) ichaza jikelele "Ii-Sx Cleans" ezifunekayo ukukhusela i-maternal puerperal sepsis kunye ne-neonatal tetanus/omphalitis ebulalayo ngexesha lokuzalwa ngaphandle kwesibhedlele olungacwangciswanga: (1) Izandla ezicocekileyo, (2) I-Perineum ecocekileyo, **(3) Icocekile **(3) ICoca **(3) ICoca **(4) ICoca **(4) ICoca **(4) ICoca (4) ICoci I-Cord-Cutting Instrument, kunye (6) I-Coce Cord Care / i-Thermal Wrapping.

Sukulinda** de kufike isitshingitshane seqhwa okanye izandyondyo zemvula zikurhintyele ekhaya ukuze ukhangele kwiidrowa zegumbi lokuhlambela. Hlanganisa ezi zinto ngaphakathi etywiniweyo, ecacileyo ibhegi eyomileyo eyi-8-litre (2-gallon) eyomileyo okanye ibhokisi yokuqhobosha eqinileyoKwiVeki yama-28:

+-------------------------------------------------------------------------+
|  THE COMPLETE EMERGENCY CLEAN BIRTH & MATERNAL TRIAGE KIT CHECKLIST     |
|                                                                         |
|  A. CLEAN HANDS, SURFACE, AND PERINEUM ("CLEANS 1, 2, & 3")             |
|     [ ] 2 bars of unopened antibacterial or castile soap + 1 bottle of  |
|         70% alcohol hand sanitizer + 1 nail-scrub brush                 |
|     [ ] 4 pairs of sterile, individually wrapped Nitrile Exam Gloves    |
|     [ ] 1 large waterproof disposable plastic sheet (1x2 meters / 3x6   |
|         ft) + 6 sterile disposable absorbent Chux underpads             |
|     [ ] 12 large sterile 4x4-inch (10x10 cm) gauze pads + 1 peri-bottle |
|         filled with sterile or boiled-and-cooled water                  |
|                                                                         |
|  B. CLEAN UMBILICAL CORD MANAGEMENT ("CLEANS 4, 5, & 6")                |
|     [ ] 4 sterile disposable plastic Umbilical Cord Clamps (OR 3 pieces |
|         of clean white cotton shoelace/umbilical tape boiled in water   |
|         for 20 minutes and sealed in a sterile pouch)                   |
|     [ ] 1 single-use sterile disposable surgical scalpel blade (#10) OR |
|         1 pair of new stainless-steel trauma/blunt-tip scissors sealed  |
|         in an alcohol-sterilized pouch (NOTE: If ambulance/hospital     |
|         care is reachable within 1-2 hours, CLAMP/TIE the cord in two   |
|         places after pulsing stops, but DO NOT CUT THE CORD - let EMS or  |
|         the ER cut it with hospital-autoclaved instruments)             |
|     [ ] 2 sterile alcohol prep pads (to wipe scissors if completely     |
|         cut off from medical rescue for >6 hours)                       |
|                                                                         |
|  C. NEWBORN AIRWAY, WARMTH, AND APGAR RESUSCITATION                     |
|     [ ] 1 sterile soft rubber Bulb Syringe (for gentle mouth-then-nose  |
|         suction ONLY if thick secretions block breathing)               |
|     [ ] 4 warm, pre-washed flannel/fleece receiving blankets + 2 warm   |
|         knit newborn hats (babies lose 70% of heat through their wet    |
|         scalp and skin in the first 3 minutes; hypothermia kills        |
|         newborns even in warm rooms)                                    |
|     [ ] 1 infant-sized Mylar thermal space blanket (wrap OVER the dry   |
|         cloth blanket, never directly against wet newborn skin)         |
|                                                                         |
|  D. MATERNAL POSTPARTUM HEMORRHAGE & PREECLAMPSIA TRIAGE                |
|     [ ] 1 gallon-sized heavy-duty zip-top plastic bag (to hold the      |
|         delivered Placenta intact for hospital inspection - never throw   |
|         the placenta away, as doctors must check if a lobe tore off)    |
|     [ ] 1 pack of heavy maternity postpartum pads (NEVER use tampons)   |
|     [ ] 1 automated upper-arm Blood Pressure Cuff + 1 digital           |
|         thermometer + LED headlamp (so the birth helper has both hands  |
|         free in a power blackout)                                       |
+-------------------------------------------------------------------------+

Icandelo 4: Uvavanyo lokuSebenza ngaphandle kweSibhedlele: UQhuba nini vs. Umisa nini kwaye uhanjiswe nini endaweni¶

Ngexesha lokufuduswa kwentlekele okanye ukuvalwa kwendlela, eyona mpazamo iyingozi kakhulu enokwenziwa lusapho kuzama ukukhawulezisa uhola wendlela ozele zizikhukula okanye ozele likhephu ngelixa umama ethwesa isithsaba (Second Stage of Labor), nto leyo eyabangela ukuba umntu azalwe engalawulekiyo kwibhodi ephantsi yemoto ehambayo. Sebenzisa lo mgaqo wovavanyo lweklinikhi:

1. Uxela njani inqanaba loku-1 lomsebenzi (Safe to Transport Carefully) Ukusuka kwiNqanaba eliMfutshane 2 Ukuthweswa isithsaba (STOP and Prepare to Deliver)¶

• Inqanaba loku-1 lokuSebenza (UkuNxibelelana ngaphandle koMcelo wokutyhala):
• Iinciphiso zihlala 45 to 60 seconds kwaye kwenzeka yonke into 3 to 10 minutes, kodwa umama AKAZIVA Uxinzelelo lwe-rectal ngokuzenzekela, AKAVA ngathi kufuneka akhutshwe amathumbu, kwaye AKUKHO ndawo yentloko yosana ibonakala kumngxuma welungu lobufazi ngexesha lokufinyela.
• Isenzo: Fowunela 911 / 112/999 kunye neDesika yakho yeL&D Triage ukuze uqinisekise ukuba yeyiphi na indlela evulekileyo, bopha umama ngokukhuselekileyo kwisitulo esingasemva (sliding the seat back and reclining slightly onto her left side to prevent Supine Hypotensive Syndrome, where the heavy uterus crushes the inferior vena cava), kwaye uqhube ngokuthe chu ukuya kwesona sibhedlele sikufutshane sivulekileyo seLabour & Delivery.
• Inqanaba lesi-2 loNikezo oluKhawulezayo (YIMA Ukuqhuba Kwangoko):
• Ukuba KUNYE kwezi mpawu zintathu ziyenzeka, ukuzalwa kuyakwenzeka kwimizuzu emi-2 ukuya kwengama-20:
  1. Wakhala umama**"Umntwana uyeza ngoku / kufuneka ndityhale / kufuneka ndikhupheFergusson reflex from the fetal head pressing on the sacral nerves and rectum)"**.
  2. I-perineum yomama (the skin between the vagina and anus) iqala ukuphumela ngaphandle ngexesha lokufinyela.
  3. Ujonge imbobo yelungu lobufazi ngexesha lokuqhawuka kwaye ubona isangqa esilingana nenkozo yentloko yomntwana emanzi.crowning).
• Intshukumo: Tsala kwindawo yokupaka ekhuselekileyo, ekhanyiswe kakuhle okanye kwindawo ekhuselekileyo (okanye uhlale ngaphakathi kwikhaya lakho), fowunela 911 / 112/999 kwispeakerphone ukuze umthumeli we-EMS akwazi ukukuqeqesha ngokusebenzisa yethu. ukuzalwa komntwana okungxamisekileyo kunye neprotocol yabasebenzi ekhawulezayo, kwaye ungaze uzame ukunqumla imilenze kamama okanye utyhale intloko yosana ubuyele ngaphakathi (which causes fatal fetal brain hypoxia and uterine rupture).

2. IMithetho emiHlanu ebalulekileyo yokuBeleka umntwana kwiNtlekele engacetywanga (If EMS Is Delayed by Storm)¶

Ukuba kufuneka ubelethe umntwana ngaphambi kokuba abe-paramedics bafikelele endlwini yakho okanye kwisithuthi sakho (jonga isikhokelo sethu esipheleleyo sekliniki ukubeleka okungxamisekileyo): 1. Ungaze Uzibelekise Kwindlu Yangasese: Abasetyhini ababeleka ngokukhawuleza baziva benoxinzelelo oluqatha lwe-rectal kwaye ngokwethuku lemvelo bahlala kwindlu yangasese, bewisa umntwana osandul' ukuzalwa kuqala emanzini abandayo endlu yangasese. Mbeke ebhedini, esofeni, okanye kwisitulo semoto esithe ngcu esigqunywe ngeetawuli ezicocekileyo kunye neplasitiki yeKit yakho yokuZalwa ecocekileyo. 2. Xhasa iNtloko ngobunono kwaye ujonge iNtamo yeNuchal Cord: Njengoko intloko iphuma, beka intende yesandla sakho esisicaba kwi-perineum ukunqanda ukukrazuka kuqhume (never pull on the baby's head or neck). Baleka umnwe omnye entanyeni yomntwana: ukuba i-*umbilical cord ibotshelelwe entanyeni (Nuchal Cord, ekhoyo kwi-25% yokuzalwa)**, haka umnwe omnye phantsi kwe-loop kwaye ** uyifake ngobunono phezu kwentloko yomntwana ** njengokukhulula ijezi ye-turtleneck (jonga yethu i-dystocia yamagxa kunye ne-nuchal cord guide). 3. Yomisa, Vuselela, kwaye ubeke Ulusu ukuya kuLusu phakathi kweMizuzo engama-30 (The #1 Resuscitation Step): Hlikihla ngamandla umqolo womntwana, isifuba, neentende zonyawo ngetawuli ecocekileyo eyomileyo (drying stimulates the baby to cry and expand their lungs while stopping evaporative heat loss), lahla itawuli emanzi, beka umntwana ohamba ze **isikhumba ukuya esikhumbeni ngqo kwisifuba sikamama esingenanto , faka i-knit cap eyomileyo entloko yomntwana, kwaye ugqume umama nosana ngeengubo ezomileyo ezifudumeleyo. 4. UkuBamba iNtambo eLibazisekileyo (Kwaye Kutheni UNGAFUNEKI USika iNtambo): Yiyeke intambo ingakhange ichukunyiswe umzuzu om-1 ukuya kwemi-3 ubuncinane ide iyeke ukuntlitheka ize ijike ibe mhlophe/yicaba (this transfuses 80 to 100 mL of iron-rich placental blood into the newborn). Emva koko bopha okanye ubambe intambo ngokuqinileyo kwiindawo ezimbini (15 cm / 6 inches ukusuka esiswini somntwana kunye 20 cm / 8 inches ukusuka esiswini). Ukuba unokufika esibhedlele okanye i-ambulensi phakathi kweyure enye ukuya kwezi-2, UNGASAYIKWI INTAMBO: vele ushiye intambo ebotshelelweyo encanyatheliswe kwi-placenta (ibhijelwe ngetawuli ecocekileyo ecaleni kosana) ukuze isibhedlele siyinqumle ngezixhobo zotyando olungenazintsholongwane. 5. ** Thintela ukopha emva kokubeleka (Immediate Breastfeeding + Fundal Massage): Nje ukuba iplacenta izibele ngokwayo (within 5 to 30 minutes - NEVER pull on the umbilical cord), beka umntwana ebeleni likanina ngoko nangoko (suckling triggers a natural surge of endogenous **Oxytocin** that contracts the uterus) kwaye uwuphulule ngokuqinileyo amazantsi esisu kwinqanaba lenkaba de isibeleko sivakale siqinile kwaye singqukuva okwe grapefruit.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

Ngexesha leentlekele ezinkulu, ii-arhente zempilo yoluntu kunye nothungelwano lokubeleka zilungelelanisa iimfuno ezikhethekileyo zothutho kunye nokuvavanywa komntwana kanina:

• EUnited States:
• I-Emergency Dispatch & Special-Needs Registries: Fowunela 911 ngokusebenza okusebenzayo okanye iimeko ezingxamisekileyo zokubelekisa. Kwiindawo ezithandwa sisitshingitshane (Florida, Texas, Louisiana, North Carolina, South Carolina, Georgia), bhalisa kwidolophu yakho Iimfuno eziKhethekileyo zokuPhuma kunye neRegistry yeShelter ekuqaleni kwekota yakho yesithathu (e.g., Florida Department of Health Special Needs Registry at snr.flhealthresponse.com).
• IsiKhokelo kuMama-kuMntwana: ACOG (acog.org), ICandelo leCDC leMpilo yokuZala (Hear Her Iphulo), kunye neMinxeba yoNcedo yeSizwe yeMpilo yeNgqondo kaMama (1-833-TLC-MAMA / 1-833-852-6262, I-24/7 yamahhala ye-OB / inkxaso yempilo yengqondo).
• Canada:
• Fowunela 911 ngesithuthi sikaxakeka se-EMS yokubelekisa. ** Umbutho wababelekisi kunye neeGynecologists zaseCanada (SOGC)** kunye nothungelwano lweperinatal yephondo (Perinatal Services BC, PCMCH Ontario) ukuququzelela umngcipheko ophezulu wokudluliselwa komoya womama / emhlabeni.
• United Kingdom:
• Shayela ** 999 ** ngokukhawuleza ukuzalwa okusondeleyo, ukopha kwe-trimester yesithathu, okanye iimpawu ze-eclampsia; fowunela isibhedlele sakho 24 yeeyure ze-NHS Maternity Triage / Delivery Suite Helpline (eshicilelwe ngaphambili kweyakho **NHS Maternity Notes / app ye-BadgerNet ** - soloko ubuza umbelekisi wakho wasekuhlaleni ukuba afumane iphepha elishicilelweyo eligcina irekhodi yakho yeBadgerNet kwiiveki ezingama-34).
• Imanyano yaseYurophu:
• Cofa 112 kuwo onke amazwe angamalungu e-EU. Thatha iphepha lakho ** i-Mutterpass ** (iJamani / i-Austria) okanye ** i-Carnet de Sante Maternite ** (eFransi) ngaphakathi komkhono ongenamanzi ngamaxesha onke kwi-trimester yesithathu.
• Ostreliya neNew Zealand:
• Ostreliya: Fowunela 000 xa ufuna ukuthutha i-ambulensi; phatha iphepha lakho Ingxelo ebanjwe ngesandla sokukhulelwa (Green/Yellow Book) ngexesha lomlilo wamatyholo okanye izilumkiso zezikhukula (RANZCOG izikhokelo). Ukukhulelwa, ukuzalwa kunye noNcedo lwaBantwana (1800 882 436).
• ENew Zealand: Fowunela 111 ngexesha likaxakeka kwaye uqhagamshelane neNkokeli yokuBelekisa eKhokelayo (LMC umbelekisi) ngqo; phatha amaphepha akho okubeleka kwibhegi yakho yokubamba.
• IIndiya, iJapan, kunye neAsia-Pacific:
• EJapan: Phatha umasipala wakho osemthethweni Incwadana yeMpilo kaMama noMntwana (Boshi Kenko Techo) kwingxowa yakho yokuphuma ngexesha likaxakeka ngawo onke amaxesha; prefectural IiNethiwekhi zoLwazi lwezoNyango lwePerinatal (MFICU) ukulungelelanisa ukudluliselwa kokubelekisa kwintlekele (119).
• Indiya: Cofa 112 okanye 108 / 102 (Janani Shishu Suraksha Karyakram / JSSK I-ambulensi yoomama yasimahla) kwaye uphathe MCP eprintiweyo (Mother and Child Protection) Ikhadi. 'Yabona amanani kaxakeka.

Imibuzo edla ngokubuzwa¶

Kutheni abafazi abaninzi besiya kusebenza kanye njengenkanyamba okanye isitshingitshane seqhwa?¶

Izinto ezimbini ezibhaliweyo ezibangela ukuba zibangele i-physiology ziyadibana ngexesha lezaqhwithi ezinkulu: okokuqala, umnqantsa **ukwehla kuxinzelelo lwe-atmospheric barometric** ngaphakathi kumbindi wenkanyamba okanye isitshingitshane sasebusika sonyusa i-gradient yoxinzelelo lwangaphandle kwi-amniotic sac, yonyusa isantya **`water breaking`)**. Okwesibini, **uxinzelelo lokuphuma kunye nokuphelelwa ngamanzi emzimbeni** kubangela ukuba idlala lobuchopho likhulule **ihomoni ye-antidiuretic (`ADH`)**, efana neekhemikhali ezifana ne-**oxytocin** kwaye ivuselela ukuqhawuka kwesibeleko. Yiyo loo nto oogqirha becebisa abafazi abanjalo `36+ weeks pregnant` (okanye ingozi enkulu nakweyiphi na iveki) ukuphuma ** 36 kwiiyure ze-48 ngaphambi kokuba ** ukufika kwesiqhwithi.

Kutheni le nto kubaluleke kangaka ukuba nephepha eliprintiweyo kwi-ultrasound yeeveki ezingama-20 ebonisa ukuba iphi i-placenta yam?¶

Ukuba ufika kwisibhedlele esigcina i-backup esingaqhelekanga esopha kwi-third-trimester ye-vaginal or contractions ngelixa uthungelwano lwekhompyutha luphantsi, ugqirha we-ER okanye umbelekisi kufuneka azi ngoko nangoko ukuba unayo **Placenta Previa**.`where the placenta covers the cervix`). Ukuba isigulane sine-placenta previa engaxilongwanga kwaye umboneleli wenza uvavanyo lwesiqhelo lweminwe emibini yelungu lobufazi ukujonga ukunyuswa komlomo wesibeleko, iminwe yabo inokugqobhoza i-placenta kwaye ibangele ukopha okusongela ubomi ngemizuzwana. Ukuba nengxelo yakho ye-ultrasound eprintiweyo yeeveki ezingama-20 ebonisa i-*anterior, posterior, okanye i-fundal placenta ** (okanye i-flagging ** previa **) igcina ixesha elixabisekileyo kwaye ikhusela iingxaki ezibulalayo.

Ukuba umntwana wam uzalelwe ekhaya ngexesha le-blizzard okanye izikhukhula ngelixa silindele i-ambulensi, ngaba kufuneka ndinqumle intambo?¶

**Hayi.** Ukuba i-paramedics okanye ukhathalelo lwasesibhedlele luya kufikelela kuwe kwiiyure ezimbalwa, **AKUFUNI ukuba usike inkaba** (kwaye ukunqanda ukuyisika ngesikere sasekhaya esingenantsholongwane kuthintela ukuqina kwesibindi sosana kunye nosulelo lwentambo yebhaktiriya). Linda ngokulula **1 ukuya kwimizuzu emi-3** emva kokuzalwa de intambo iyeke ukucofa kwaye ijike ibe mhlophe, bopha okanye uyibambe ngokuqinileyo intambo kwiindawo ezimbini (`15 cm / 6 inches` kwaye `20 cm / 8 inches` ukusuka kwiqhosha lesisu somntwana), kwaye emva kokuba i-placenta izibele ngokwayo, bhinqa i-placenta ephilileyo ngaphakathi kwetawuli ecocekileyo okanye ingxowa yeplastiki kwaye uyigcine iphakanyisiwe kanye ecaleni komntwana de abe-paramedics bayinqumle intambo ngezixhobo ezingenanto.

Kutheni le nto kufuneka ndipakishe ubisi olungumgubo lweentsana oluLungele ukuFundiswa ukuba ndiceba ukuncancisa i-100% yexesha?¶

Ukuncancisa sesona sondlo sosana sikhuselekileyo kwintlekele kuba ubisi lwebele alufuni manzi acocekileyo, akukho mbane, kwaye lugcwele izilwa-buhlungu zoomama. Nangona kunjalo, ngexesha lokuqala `48 to 72 hours` emva kokuzalwa (phambi kokuba kungene umthamo wobisi ogcweleyo), okanye ukuba umama unengxaki yasemva kokubeleka, ukuphelelwa ngamanzi emzimbeni, okanye ukohlukana nosana, kuba **ukusetyenziswa kanye. `59-mL (2-ounce)` Ukulungelelaniswa-Ukutya iibhotile zefomula yolwelo kunye neengono ezilahlwayo** zikhusela usana olusandul' ukuzalwa kwi-hypoglycemia okanye ukuphelelwa ngamanzi emzimbeni ngaphandle kokubamba amanzi angcolisekileyo.

Ziziphi iimpawu zesilumkiso emva kokuzalwa "Postpartum Preeclampsia" ezinokufikelela kwiiveki ezi-6 emva kokunikezelwa?¶

Ukuzala umntwana akupheli** umngcipheko we-preeclampsia okanye i-eclampsia seizures: **I-Postpartum Preeclampsia** idla ngokubetha phakathi **kweeyure ezingama-48 kunye neentsuku ezili-14 emva kokubeleka** (ukuya kutsho kwiiveki ezi-6 emva kokubeleka). Sebenzisa i-cuff yoxinzelelo lwegazi ekhaya ukuba uziva ungaphilanga emva kokubeleka, kwaye ufowunele **911/112/999** ngoko nangoko ukuba uxinzelelo lwegazi lufika **`140/90 mmHg` okanye ngaphezulu ** kunye ne-** intloko ebuhlungu, umbono ongeyiyo okanye iindawo ezidanyazayo, ukuvuvukala kobuso nezandla, ukuphefumula okufutshane, okanye intlungu yesisu esiphezulu sasekunene ** (jonga yethu [i-eclampsia kunye ne-postpartum preeclampsia guide](../first-aid/eclampsia-seizures-hellp-syndrome-postpartum-preeclampsia-and-magnesium-triage.md)).

Izikhokelo ezinxulumeneyo¶

• Ukubeleka okungxamisekileyo kunye nokusebenza okukhawulezileyo ngaphandle kwesibhedlele
• I-dystocia yamagxa, intambo ye-umbilical entanyeni (i-nuchal cord), kunye nokuhanjiswa kwe-breech
• I-Eclampsia seizures, i-HELLP syndrome, kunye ne-postpartum preeclampsia
• Usana kunye nosana oluncinci lokuhamba kwibhegi kunye nesicwangciso sokuphuma
• Amanani kaxakeka

Imithombo kunye nezikhokelo ezisemthethweni¶

• ** IKholeji yaseMelika yeeObstetricians kunye neeGynecologists (ACOG):** *Uluvo lweKomiti enguNombolo 726: ULungiselelo lweNtlekele yeSibhedlele kooGqirha bokuBeleka kunye neZibonelelo ezibonelela ngoNonophelo lokubeleka * kunye neSikhokelo sezigulana ekulungiseleleni iintlekele ngexesha lokukhulelwa.
• Amaziko oLawulo lweSifo kunye noThintelo (CDC, eUnited States): Impilo yokuZala ekuLungelweni okuNgxamisekileyo kunye nokuPhendula: Imiyalezo yoKhuseleko kuBakhulelweyo, emva kokubeleka, kunye nabasetyhini abancancisayo ngexesha leeNtlekele zeNdalo (cdc.gov/reproductive-health/emergency-preparedness).
• UMbutho wezeMpilo weHlabathi (WHO) kunye neNgxowa-mali yaBemi yeZizwe eziManyeneyo (UNFPA): Incwadana ye-Inter-Agency Field Manual kwiMpilo yokuZala kwiiSetingi zoLuntu: IKhithi yokuThumela eCocayo ("I-Six Cleans") kunye neNkathalelo yokuBelekisa eNgxamisekileyo kunye noNcedo olusanda kuzalwa (EmONC).
• ** I-Academy yaseMelika yePediatrics (AAP):** Ukondliwa kweNtsana kwiiNtlekele nakwiiNgxaki eziNgxamisekileyo: Inkxaso yokuncancisa kunye nokusetyenziswa ngokuKhuselekileyo kweFomula yeNtsana eSetyenziswayo eLungele ukuBondla.
• NgoMatshi we-Dimes: *Ukulungiselela iNtlekele kwabasetyhini abakhulelweyo: I-Thresholds yokuPhuma kwangethuba, iiRekhodi eziphathwayo zezoNyango zangaphambi kokubeleka, kunye neZilumkiso zangaphambi kwexesha lomsebenzi *.