Fetoplacental insufficiency yog ib qho nyuaj ntawm kev mob tshwm sim los ntawm ntau yam gynecological pathologies, nrog rau cov teeb meem ntawm cev xeeb tub. Lub xub ntiag ntawm cov kab mob no tuaj yeem cuam tshuam rau kev nchuav menyuam, ncua kev loj hlob ntawm tus menyuam hauv plab, nrog rau kev tshaib plab oxygen.
Nws yog ib qho tseem ceeb uas yuav tsum tau kuaj xyuas raws sij hawm thiab kho cov kev kho mob tom ntej txhawm rau tiv thaiv kev txhim kho ntawm cov teeb meem. Thaum ua kev kho mob, nws yog ib qho tseem ceeb kom tshem tawm cov kab mob hauv qab, uas yog vim li cas cov tshuaj complex yog siv los normalize uterine ntshav txaus, kho fetal oxygen deficiency. Yog tias tsim nyog, kev xa khoom sai yog qhia.
Kev ua txhaum cai
Fetoplacental insufficiency thaum lub sij hawm cev xeeb tub feem ntau ua rau fetal tuag, thiab tseem ua rau lub sijhawm cev xeeb tub thiab yug me nyuam. Qhov tshwm sim ntawm kev ua txhaum cai, nrog rau cov teeb meem, feem ntau yog vim muaj yam xws li:
- degree ntawm kev hloov pauv hauv kev ua haujlwm ntawm cov placenta;
- sijhawm thiabkev siv ua txhaum cai;
- percolation period.
Thaum fetoplacental insufficiency tshwm sim, fetal hypoxia, qeeb hauv nws txoj kev loj hlob thiab kev loj hlob, tuaj yeem txhim kho. Tsis tas li ntawd, qhov tshwm sim ntawm kev yug ntxov ntxov, yug me nyuam raug mob ntawm fetus, nrog rau kev ua txhaum ntawm kev ua haujlwm ntawm kev ua haujlwm nce ntxiv. Nyob rau hauv ib tug me nyuam yug tshiab, raws li qhov tshwm sim ntawm xws li ib tug teeb meem, congenital anomalies yog ntau npaum li cas kuaj tau. Tsis tas li ntawd, cov menyuam mos no muaj ntau yam kab mob hauv plab hnyuv thiab ua pa.
Kev faib kab mob
Raws li lub sijhawm tshwm sim, placental insufficiency tuaj yeem yog thawj zaug thiab theem nrab. Thawj qhov teeb meem tshwm sim thaum cev xeeb tub. Qhov no tshwm sim tsuas yog nyob rau hauv lub cuam tshuam ntawm endocrine, kis kab mob. Secondary fetoplacental yog tsim nrog ib tug thawj zaug ib txwm placenta nyob rau hauv lub cuam tshuam ntawm tej yam tsis zoo, nrog rau ib tug nyuaj cev xeeb tub.
Cov kev kho mob ntawm pathology tuaj yeem mob hnyav lossis mob ntev. Nyob rau hauv ib qho kev mob hnyav, uas tuaj yeem tshwm sim thaum cev xeeb tub lossis yug me nyuam, kev sib pauv roj ntawm cov placenta yog thawj zaug ntawm txhua qhov kev cuam tshuam, uas yog nrog los ntawm kev tshaib plab thiab kev tuag ntawm tus me nyuam hauv plab. Nws feem ntau tshwm sim los ntawm placental abruption, hemorrhage, placental infarction thiab thrombosis.
Cov placental insufficiency tshwm sim ntau dua li qhov mob ntawm qhov mob. Nws cov chav kawm thiab kev kwv yees tau txiav txim siab los ntawm cov kev cuam tshuam tshwm sim hauv lub cev, nrog rau cov hom twg yog qhov txawv xws li:
- nyiaj pab;
- subcompensated;
- decompensated;
- critical.
Qhov zoo tshaj plaws yog them nyiaj rau qhov tsis txaus fetoplacental tsis txaus, txij li thaum lub sijhawm nws cov menyuam hauv plab xyaum tsis raug kev txom nyem. Hauv qhov no, cov kev hloov pauv tsis tu ncua ntawm pathological yog me ntsis softened vim kev ua kom muaj kev tiv thaiv mechanisms uas ua rau lub cev xeeb tub. Kev kho kom zoo thiab kev tswj hwm kev yug me nyuam kom muaj peev xwm ntawm kev yug me nyuam noj qab nyob zoo.
Subcompensated hom placental insufficiency thaum cev xeeb tub tshwm sim thaum tsis muaj kev tiv thaiv txaus los xyuas kom meej qhov kev loj hlob ntawm tus menyuam hauv plab. Nrog rau daim ntawv no, muaj kev lag luam hauv nws txoj kev loj hlob, thiab tseem muaj kev pheej hmoo siab ntawm cov teeb meem.
Hauv obstetrics, placental insufficiency ntawm daim ntawv decompensated yog tus cwj pwm los ntawm qhov tseem ceeb overstrain thiab impossibility ntawm ib txwm cev xeeb tub. Raws li qhov tshwm sim, muaj kev phom sij txaus ntshai hauv tus menyuam hauv plab, uas yog kev loj hlob qeeb, kev ua haujlwm ntawm lub plawv tsis zoo, hypoxia hnyav. Nws txoj kev tuag tsis raug txiav tawm. Thaum muaj daim ntawv tseem ceeb, cov kev hloov pauv hloov tsis tau thiab ua rau tus menyuam tuag.
Kev tshwm sim
Muaj ntau yam ua rau placental insufficiency thaum cev xeeb tub. Kev ua txhaum cai tuaj yeem tsim tau thaum poj niam muaj kab mob:
- kab mob plawv;
- siab;
- kidney;
- ntshav;
- endocrine system;
- lungs.
Tsis tas li ntawd, cov kab mob tuaj yeem tshwm sim los ntawm ntau yam kev phom sij thiab kab mob. Nrog ntshav ntshav hauv tus poj niam cev xeeb tub, muaj qhov txo qis ntawm cov hlau hauv lub cev, uas ua rau muaj kev ua txhaum ntawm kev ua pa ua pa thiab ntws ntawm cov hlau mus rau tus menyuam hauv plab.
Thaum muaj ntshav qab zib, cov metabolism hauv lub cev tsis zoo, kev cuam tshuam hormonal tshwm sim, thiab txo qis hauv kev tiv thaiv. Sclerotic vascular kab mob provokes ib tug deterioration nyob rau hauv cov ntshav khiav mus rau lub placenta. Nyob rau tib lub sijhawm, ncua sijhawm thiab ntxov ntxov ntxov ntawm cov placenta tau pom.
Ntawm cov laj thawj tseem ceeb ntawm placental insufficiency, ib tus tuaj yeem tawm ntawm qhov muaj cov kab mob sib kis, tshwj xeeb tshaj yog cov uas tshwm sim hauv cov mob hnyav, lossis hnyav dua thaum cev xeeb tub. Cov placenta tuaj yeem cuam tshuam los ntawm cov kab mob, kab mob, thiab lwm yam kab mob.
Nyob rau lub 1st trimester, qhov mob kis tau feem ntau nrog kev rho menyuam. Nyob rau hnub tom qab, cov kev hloov hauv zos yuav raug pom, uas feem ntau nyob ntawm qhov xwm ntawm cov kab mob thiab cov yam ntxwv ntawm nws qhov kev faib tawm.
Qhov tseem ceeb hauv kev tsim cov kev ua haujlwm tsis zoo yog ntau hom kab mob hauv tsev menyuam, tshwj xeeb, xws li malformations, myometrial hypoplasia, endometriosis. Ntawm cov kev pheej hmoo, uterine fibroids tuaj yeem paub qhov txawv.
Qib ntawm placental insufficiency feem ntau nyob ntawm qhov hnyav thiab lub sijhawm ntawm preeclampsia. Tag nrho cov xwm txheej no ua rau muaj kev cuam tshuam ntawm cov hlab ntshav. Yog li ntawd, muajCov txheej txheem irreversible, thiab kev ua haujlwm ntawm placenta yog deteriorating.
Cov tsos mob tseem ceeb
Tus kab mob tuaj yeem tshwm sim hauv ntau hom. Feem ntau, tus mob no yog nrog los ntawm qhov tshwm sim ntawm kev nchuav menyuam, ncua kev loj hlob ntawm tus menyuam hauv plab, nrog rau qhov tsis muaj oxygen. Feem ntau qhov no ua rau kev rho menyuam tsis tu ncua, thiab qee zaum muaj qhov nchuav menyuam.
Nyob rau hnub tom qab, cov cim qhia ntawm fetoplacental insufficiency tshwm sim raws li kev ncua ntawm kev tsim cov hauv nruab nrog cev. Hauv qhov no, muaj qhov txo qis hauv plab. Koj tuaj yeem txiav txim siab qhov kev loj hlob qeeb uas siv ultrasound diagnostics.
Qhov mob hnyav heev yog vim qhov loj ntawm qhov chaw cuam tshuam ntawm cov placenta. Nrog rau kev ua txhaum loj ntawm cov ntshav ncig, cov teeb meem tseem ceeb rau tus menyuam hauv plab yuav loj hlob. Ntawm cov cim qhia ntawm hypoxia, ib tus tuaj yeem tso tawm ib qho kev ua haujlwm ntawm lub cev muaj zog ntawm tus menyuam thaum pib, thiab tom qab ntawd txo qis ntawm tus naj npawb ntawm kev txav mus los, mus txog qhov ua tiav.
Kev tsis txaus siab ntawm kev ua haujlwm intrasecretory tuaj yeem ua rau tus menyuam mos dhau los lossis, qhov sib txawv, ua rau yug ntxov ntxov. Tsis tas li ntawd, thaum lub sij hawm ntawm xws li ib tug pathology, lub ntim ntawm amniotic kua tuaj yeem hloov pauv. Kev hloov pauv hauv cov placenta tuaj yeem nrog rau kev tso tawm ntawm calcifications, tsim ntawm placental cysts. Tawm tsam keeb kwm yav dhau los ntawm kev ua haujlwm hormonal tsis tu ncua thiab kev ua haujlwm tsis txaus ntawm lub epithelium, colpitis feem ntau tshwm sim.
Diagnostics
Yuav kom kuaj mob, tus kws kho mob sau keeb kwm ntawm tus poj niam cev xeeb tub thiab txiav txim siab txog yamkev pheej hmoo, tshwj xeeb, xws li hnub nyoog, muaj cov kab mob sib kis, teeb meem ntawm kev xeeb tub yav dhau los. Thaum ua qhov kev tshuaj xyuas, yuav tsum tau them nyiaj tshwj xeeb rau:
- tswj qhov hnyav;
- ua kom lub tsev menyuam;
- ntsuas qhov siab ntawm uterine fundus;
- muaj kuab paug los ntawm qhov chaw mos;
- fetal txav thiab lub plawv dhia.
Qhov tseem ceeb tshaj plaws ntawm kev kuaj mob yog ultrasound, dopplerometry, CTG. Hauv txhua lub peb hlis ntuj ntawm lub sijhawm cev xeeb tub, nws yog ib qho tsim nyog yuav tsum tau ua qhov kev tshuaj ntsuam xyuas, uas nws muaj peev xwm txiav txim siab txog cov kab mob pathology. thiab qhov ntim ntawm cov kua amniotic muaj. Raws li cov txiaj ntsig ntawm CTG, kev tshaib plab tuaj yeem kuaj pom.
Tom qab kuaj mob, tus kws kho mob xaiv txoj kev kho mob los tiv thaiv kev txhim kho ntawm cov teeb meem.
Txoj kev kho mob
Kev kho cov placental tsis txaus ntawm daim ntawv them nyiaj, yog tias txoj kev kho tau ua tiav thiab tsis muaj kev hem thawj rau lub sijhawm cev xeeb tub, tuaj yeem ua rau tus neeg mob sab nraud. Nyob rau hauv tshwj xeeb tshaj yog txaus ntshai thiab mob hnyav, tam sim ntawd mus pw hauv tsev kho mob nrog ntau yam kev kho mob yuav tsum tau qhia. Muab ntau yam laj thawj rau kev txhim kho ntawm xws li pathology, tsis tuaj yeem muaj kev kho mob nkaus xwb.
Qhov chaw tseem ceeb hauv kev kho mob yog muab rau kev tshem tawm ntawm qhov ua rau muaj kev cuam tshuam thiab kev saib xyuas cov txheej txheem tiv thaiv kev txuas ntxiv ntawm kev loj hlob ntawm tus menyuam hauv plab. NtawmKev tsis zoo ntawm lub suab ntawm cov hlab ntsha ntawm cov placenta, cov tshuaj tiv thaiv coagulants thiab cov tshuaj tiv thaiv kab mob, tshwj xeeb, xws li Dextran, Heparin, Pentoxifylline, Dipyridamole. Txhawm rau kho qhov tsis txaus noj zaub mov thiab ncua kev loj hlob ntawm tus menyuam, kev hloov pauv ntawm cov protein thiab cov ntshav hloov pauv yuav tsum tau daws.
Nyob rau hauv lub xub ntiag ntawm hemodynamic ntshawv siab nrog rau cov chav kawm ntawm tus kab mob, cov tshuaj calcium antagonists, xws li Verapamil, Nifedipine, raws li lawv normalize myocardial contraction, thiab kuj muaj ib tug hypotensive nyhuv. Yog tias pom muaj hypertonicity ntawm myometrium, cov tshuaj antispasmodic tau sau tseg, tshwj xeeb tshaj yog Drotaverine, glucosone-vocaine sib xyaw.
Txhawm rau normalize cov tshuaj tiv thaiv antioxidant thiab kev ua haujlwm ntawm cov placenta, cov tshuaj vitamin complexes, nrog rau hepatoprotectors. Kev kho mob metabolic yuav tsum tau siv cov folic acid, multivitamin, thiamines, thiab qabzib. Nyob rau hauv cov ntaub ntawv ntawm ib tug hem nchuav menyuam, tocolytics yog muab, piv txwv li, Hexoprenaline, Fenoterol.
Kev txiav txim siab ntawm lub sijhawm thiab txoj kev xa khoom yog ua rau tus kheej nkaus xwb, suav nrog kev ua haujlwm ntawm kev kho.
Tus poj niam cev xeeb tub yuav tsum tau so kom raug. Kev pw tsaug zog hmo ntuj yuav tsum ua kom tiav thiab tsawg kawg yog 9-10 teev, thiab nws tseem ceeb heev los tiv thaiv tus poj niam los ntawm kev puas siab puas ntsws overstrain. Kev noj zaub mov zoo yog qhov tseem ceeb heev, vim tias nws yog ib qho tseem ceeb kom tau txais cov protein txaus, nrog rau cov vitamins thiab minerals. Nrog fetoplacental tsis txaus ntawm qib 1, kev kho kom raug yuav ua tiav cov txiaj ntsig zoo heev.tshwm sim thiab sai normalize kev noj qab nyob zoo. Txhawm rau tshem tawm cov cim qhia ntawm hypoxia, tshwj xeeb kho cov pa cocktails tuaj yeem raug sau. Tam sim no koj tuaj yeem yuav cov khoom siv rau lawv cov khoom siv thiab ua koj tus kheej. Cocktail feem ntau yog ua nrog dej los yog kua txiv.
Kev xa khoom
Nyob rau hauv placental insufficiency, txoj kev kho mob feem ntau nyob ntawm theem thiab theem ntawm tus kab mob. Nws yog ib qho tseem ceeb heev uas yuav tau xaiv txoj cai tactics rau kev yug menyuam, uas nyob ntawm ntau yam sib txawv. Xaiv lub sijhawm zoo thiab txoj hauv kev xa khoom yuav pab txo qis qhov txaus ntshai.
Tus kws kho mob xaiv txoj kev yug me nyuam nruj me ntsis ntawm tus kheej, nyob ntawm qhov hnyav ntawm kev ua txhaum cai, tus poj niam cev xeeb tub thiab tus menyuam. Ntawm cov lus qhia rau kev phais mob txog li 37 lub lis piam, nws yog ib qho tsim nyog los qhia txog qhov tsis muaj qhov zoo tom qab kev kho mob, nrog rau kev loj hlob ntawm tus menyuam hauv plab. Nyob rau hauv lub xub ntiag ntawm kev ua txhaum loj, ib tug caesarean seem yuav raug qhia rau lub sij hawm ntawm 30-32 lub lis piam.
Placental insufficiency tsis yog ib qho qhia txog kev phais. Kev xa khoom tuaj yeem ua tau, raws li cov xwm txheej xws li:
- ib puag ncig obstetric zoo;
- zoo li poj niam thiab fetus;
- ua tau zoo ntawm ultrasound, CTG thiab Doppler.
Yog tus kws kho mob txiav txim siab tias qhov kev yug me nyuam yuav tshwm sim, ces tus poj niam cev xeeb tub tau muab "Oxytocin" rau kev txhawb nqa ntxivlos yog amniotomy. Qhov txaus ntshai ntawm txoj kev ntawm tus me nyuam hauv plab los ntawm lub cev yug kwj dej yog hais tias nyob rau hauv tus txheej txheem ntawm kev ua hauj lwm, lub placental ntshav ntws zuj zus, uas, tawm tsam keeb kwm ntawm lub pathology, yuav provoke kev tuag ntawm fetus. Rau kev yug menyuam, koj yuav tsum ua raws li cov xwm txheej xws li:
- kev nthuav qhia ntawm tus menyuam hauv plab;
- kev npaj lub cev rau kev yug menyuam;
- qhov sib npaug ntawm lub plab ntawm tus poj niam cev xeeb tub thiab lub taub hau ntawm fetus.
Kev loj hlob ntawm ncauj tsev menyuam yog qhov tseem ceeb heev rau kev xa khoom tiav. Qhov kev txiav txim siab txog txoj kev yug me nyuam tsuas yog coj los ntawm tus kws kho mob tom qab kuaj pom zoo.
Muaj Teeb Meem
Feem ntau yuav muaj ntau yam teeb meem ntawm placental insufficiency. Cov no suav nrog xws li:
- fetal oxygen tshaib plab;
- delayed me nyuam loj hlob;
- cim qhia ua ntej ntawm lub sijhawm;
- pathology ntawm cov menyuam yug tshiab;
- kev puas tsuaj rau lub paj hlwb.
Cov poj niam cev xeeb tub uas muaj cov kab mob zoo sib xws yuav tsum tau saib xyuas los ntawm kws kho mob tsis tu ncua, nrog rau noj tag nrho cov tshuaj vitamins thiab tshuaj. Nrog rau kev ua raws li cov cai nruj, qhov kev pheej hmoo ntawm cov teeb meem thiab teeb meem raug txo kom tsawg.
Huab cua
Nrog me ntsis placental insufficiency, qhov kev tshwm sim zoo heev. Yuav kom tus me nyuam muaj kev vam meej tshaj plaws thiab lub fetus kom tsis txhob muaj teeb meem loj thiab tsis meej pem, nws yog ib qho tsim nyog yuav tsum tau ua raws sij hawm.kev kho mob ntawm cov kab mob tsis tu ncua. Tsis tas li ntawd, kev sau npe ntxov rau kev xeeb tub yog qhov tseem ceeb, vim qhov no yuav tso cai rau kev txheeb xyuas raws sijhawm ntawm cov kab mob pathologies.
Nco ntsoov mus kuaj ib ntus los ntawm gynecologist, noj cov vitamin complexes. Tsis tas li ntawd, koj yuav tsum tso tseg cov cwj pwm phem, vim lawv tsuas yog ua rau muaj kev tsis sib haum xeeb thiab pathologies. Yog tias tag nrho cov kws kho mob xav tau, kev ua haujlwm zoo tuaj yeem ua tiav.
prophylaxis
Kev tiv thaiv ntawm fetoplacental insufficiency yog nyob rau hauv kev npaj txhij txhua ntawm tus poj niam rau tus txheej txheem ntawm yug me nyuam. Txhawm rau ua qhov no, nws yog ib qho tsim nyog los txheeb xyuas lub sijhawm thiab kho qhov muaj feem yuav tshwm sim uas tuaj yeem ua rau muaj kev loj hlob ntawm pathology. Ua tib zoo saib xyuas cov poj niam cev xeeb tub uas muaj feem yuav kis tus kab mob no.
Tsis tas li ntawd, tus kws kho mob yuav sau tshuaj tiv thaiv ib ntus. Hauv cov poj niam cev xeeb tub nrog rau daim ntawv them nyiaj ntawm tus kab mob, kev saib xyuas tas li ntawm tus mob thiab kev loj hlob ntawm tus menyuam hauv plab yuav tsum tau ua los ntawm kev siv ultrasound thiab kev soj ntsuam kuaj.
