Kev yug me nyuam yog suav tias yog txheej txheem nyuaj thiab tsis muaj kev cia siab, thiab feem ntau nws ua rau muaj ntau yam tsis zoo thiab muaj teeb meem. Xws li ib tug niam tshiab tsim tej zaum yuav ntsib perineal rupture tom qab yug me nyuam. Tam sim no, hauv kev kho mob, nws yog kwv yees li 4.6% ntawm kev raug mob thaum yug. Cov tshuaj niaj hnub tau tswj kom coj qhov ntsuas no mus rau theem qis.
Yuav ua li cas?
Lub perineum yog hauv qab ntawm lub plab me me, nws muaj cov leeg. Nyob rau hauv tus txheej txheem ntawm kev yug me nyuam, lub fetus lub taub hau presses rau lawv nyob rau hauv txoj kev muaj zog tshaj. Raws li txoj cai, rupture ntawm perineum, qhov chaw mos tshwm sim nrog lub taub hau kev nthuav qhia ntawm fetus. Qhov tshwm sim yuav nyob ntawm qhov elasticity ntawm cov leeg - seb lawv puas tuaj yeem tiv taus lub siab thiab ncab hauv txoj kev uas lub taub hau dhau. Cov nqaij ntshiv ntawm no ua tsis tshua muaj elasticity vim cov leeg tsim, tus poj niam lub hnub nyoog tshaj 35 xyoo. Nyob rau tib lub sijhawm, thawj qhov kev yug me nyuam yog ib qho kev hem thawj rau perineal rupture.
Tib lub sijhawm, ntis tawm tom qab yug los lossis kev ua haujlwm dhau los kuj ua rau muaj qhov tshwm sim tsis zoo li no yuav cuam tshuam rau tus poj niam. Puffiness thaum lub sijhawm ua haujlwm ntev kuj ua rau qhov tshwm sim tsis zoo.
Muaj cov lus piav qhia ntawm perineal rupture vim tsis paub ntawv obstetric care. Yog li, kev tiv thaiv rau tus poj niam hauv kev ua haujlwm thaum lub sij hawm tshem tawm ntawm lub xub pwg nyom thiab lub taub hau ntawm tus me nyuam tsis yog ib txwm muab, thiab qhov no yog ib qho kev pheej hmoo ntxiv. Txoj kev nrawm nrawm kuj ua rau muaj qhov tshwm sim zoo sib xws.
Qee lub sij hawm tus qauv ntawm cov pob txha nyob rau hauv lub pelvis nrog ib tug nqaim tawm qhia ib tug yav tom ntej rupture ntawm lub perineum thaum yug me nyuam.
Ntau yam
kua muag tuaj yeem tshwm sim, thaum txhua yam tshwm sim los ntawm qhov chaw ntawm lub cev ntawm tus menyuam hauv plab, thiab ua nruj ua tsiv - xws li tshwm sim los ntawm kev ua ntawm obstetricians. Muaj peb theem ntawm perineal rupture thaum yug menyuam.
Thawj qib yog tshwm sim hauv kev puas tsuaj rau tom qab adhesions, daim tawv nqaij ntawm qhov chaw mos. Qhov thib ob yog txiav txim siab los ntawm cov leeg nqaij puas hauv lub plab mog. Nyob rau hauv lub thib peb degree, muaj rupture ntawm lub sphincter ntawm lub qhov quav, thiab tej zaum lub qhov quav.
Tsis tshua muaj tshwm sim, tshwm sim hauv 1 ntawm 10,000 tus neeg mob, suav tias yog lub hauv paus kua muag, thaum cov phab ntsa ntawm qhov chaw mos, cov leeg nqaij ntawm lub plab mog nrog cov tawv nqaij raug cuam tshuam, thaum lub sphincter tsis cuam tshuam. Qhov siab dua ntawm perineal rupture, qhov nyuaj thiab ntev ntawm tus poj niam txoj kev kho yuav zoo.
Ntse
Daim duab kho mob yog ib qho protrusion ntawm lub qhov quav thiab qhov chaw mos, edema, cyanosis. Nyob rau tib lub sijhawm, tus poj niam yog pathologically daj ntseg, cov kab nrib pleb tau sau tseg ntawm daim tawv nqaij, kev ncaj ncees ntawm cov ntaub so ntswg raug ua txhaum. Txheeb xyuas perineal rupture thaum yug me nyuam tam sim ntawd thaum kuaj. Muaj tseeb tiag, qhov xwm txheej zoo li no xav tauphais kho qhov chaw puas.
Symptomatics
Txawm li cas los xij ntawm perineal rupture, ib tug poj niam raug kev txom nyem los ntawm qhov mob ntawm qhov chaw no, daim tawv nqaij ua cyanotic - nws yog txhua yam ntawm venous congestion. Lub outflow ntawm cov ntshav yog cuam tshuam, vim qhov no, pallor yog pom. Cov chaw puas feem ntau los ntshav. Qee lub sij hawm qhov tshwm sim tshwm sim tsuas yog vim tus me nyuam hauv plab tau loj tuaj, thiab qee zaum mob ua rau muaj qhov tshwm sim.
Kev kho mob
Kho tom qab perineal rupture yuav muaj nyob rau hauv tam sim ntawd stitching ntawm qhov chaw puas. Qhov no ua tiav hauv thawj ib nrab teev tom qab kuaj pom. Cov tshuaj loog yog ob qho tib si hauv zos thiab hauv cov hlab ntsha. Txhawm rau tiv thaiv cov seams los ntawm kev sib cais, tus poj niam txwv tsis pub zaum 3 lub lis piam.
Kev nyuaj siab
Edema tuaj yeem tshwm sim tom qab ntawm qhov chaw suturing, qhov tshwm sim nrog rau qhov mob tshwm sim. Kuj tseem muaj cov kab mob purulent ntawm cov seams, cov ntaub so ntswg tuaj yeem caws pliav. Cov chaw puas tuaj yeem plam kev hnov qab thiab stitches tuaj yeem sib nrug. Yog tias qee theem ntawm cov txheej txheem tau ua tiav tsis paub ntawv, thaum kawg tus poj niam yuav raug kev txom nyem los ntawm lub tsev menyuam prolapse, thiab qee zaum los ntawm nws qhov kawg prolapse. Tej zaum kuj yuav muaj qhov tshwm sim tsis zoo nyob rau hauv qhov quav - gas incontinence, quav yuav pib.
Kev Tiv Thaiv
txhawm rau tiv thaiv perineal rupture, koj yuav tsum tau mus ntsib kws kho mob poj niam yam tsawg ib hlis ib zaug, thiab ua nws ntau zaus raws li nws cov lus pom zoo hauv peb lub hlis twg. Nws yog ib qho tseem ceeb uas tus poj niam sau npe ua ntej 12 lub lis piam ntawm cev xeeb tub. Nws ntseeg tias yuav pab kom zam dhau qhov tshwm simKegel qoj ib ce pab. Kev tiv thaiv tseem yuav muab los ntawm kev zaws ua ntu zus los ntawm 7 lub hlis ntawm cev xeeb tub. Nws yog ib qho tseem ceeb uas qhov mob ntawm qhov chaw mos uas tshwm sim raug kho kom raws sijhawm.
Nws yog ib qho tsim nyog yuav tsum ua raws li tag nrho cov lus pom zoo ntawm gynecologists. Ua raws li kev noj zaub mov ua ntej ntawm cov tsiaj protein tsawg hauv kev noj zaub mov thiab cov roj ntau ntxiv txo qhov kev pheej hmoo ntawm kev kho cov kua muag perineal tom qab. Nws yog ib qho tseem ceeb uas yuav tau kawm ua pa kom zoo thiab so ua ntej, npaj koj tus kheej rau kev puas siab puas ntsws rau cov txheej txheem.
Nyob rau hauv kev nce qib
Nws yog ib qho tsim nyog yuav tsum coj mus rau hauv tus account qhov tseeb tias qhov tshwm sim yog ib txwm ua ntej los ntawm qhov tshwj xeeb - kev hem thawj ntawm perineal rupture thaum yug menyuam. Qhov no yog ib qho qhia ncaj qha rau cov kws kho mob rau perineotomy lossis episiotomy. Qhov kev hem thawj yog tshwm sim hauv puffiness, cyanosis, tsim cov kab nrib pleb, ua txhaum ntawm kev ncaj ncees ntawm cov ntaub so ntswg. Pib los ntawm qib peb, ntshav poob tsuas yog loj heev. Thaum twg los xij, muaj kev pheej hmoo siab kis kab mob.
After surgery
Thaum kuaj tau tiav lawm, nws yuav tsum tau ua txhua hnub kom ntseeg tau tias cov sutures loj hlob ua ke kom raug. Lawv raug kho nrog tshuaj tua kab mob tom qab txhua qhov kev tso quav thiab tso zis. Yog tias tsis muaj cov kab mob tshwm sim, cov stitches raug tshem tawm tom qab 4-6 hnub. Kev phais mob tsuas yog ua los ntawm cov kws tshaj lij gynecologists, ntau tus kws tshaj lij yuav tsum pab. Qhov tshaj plaws yog tias suturing perineal rupture ntawm 2nd degree, thiab txawm tias thawj zaug, suav hais tias yog ib qho kev phais mob nyuaj.
Huab cua
Yog tias muaj tag nrho cov cai, kwv yeesfeem ntau zoo siab. Thaum cov stitches raug tshem tawm, pelvic kev ua haujlwm yuav pib rov zoo. Tab sis raws li kev xeeb tub tom ntej, qhov teeb meem no tau daws qhov sib txawv rau txhua tus poj niam. Feem ntau, tsis muaj contraindications rau nws.
Yog tias qib 2 perineal tsim kua muag tau tso tseg tsis tu ncua ntev, nws pib kho mob. Tom qab tag nrho, qhov no yog qhov qhib qhov txhab, uas yooj yim cia rau hauv cov kab mob. Yog li ntawd, tus poj niam raug mob hnyav.
Tom qab ntawd, qhov no yuav tshwm sim nyob rau hauv ib tug poj niam txoj kev noj qab haus huv - pelvic pem teb yuav poob functionality, lub cev nqaij daim tawv yuav pib poob tawm. Feem ntau, qhov tsis sib haum xeeb ntawm perineum ntawm 2nd degree ua rau o nyob rau hauv lub tsev menyuam, qhov tsos ntawm erosion. Yog hais tias qhov degree yog thib peb, incontinence ntawm gases thiab feces tshwm sim. Yog li ntawd, ib tug poj niam poob nws lub peev xwm ua hauj lwm, poob nws txoj hauj lwm hauv zej zog. Vim li no, xws li qhov tshwm sim yuav tsum tau muab tshem tawm raws sijhawm. Qhov kev phais sai dua, qhov txiaj ntsig yuav zoo dua.
Yog tias muaj ntshav hnyav, nws yuav tsum tau tshem tawm sai sai. Rau lub hom phiaj no, ib lub paj rwb loj lossis gauze swab yog ntxig rau hauv qhov chaw mos. Nws yuav nqus cov ntshav nyob rau hauv cov txheej txheem ntawm yuav ua li cas cov kws kho mob yuav suture. Tom qab cov txheej txheem, lub swab raug tshem tawm. Nws yog ib qho tseem ceeb los xyuas kom meej tias cov cheeb tsam puas haum nruj ua ke - qhov no yuav ua kom kho tau sai.
Yuav kom lub qhov txhab raug raws li qhov ua tau, qhov chaw mos yog ntxiv stretched thaum lub sij hawm phais, iav yog siv. Yog tias tsis muaj tus pab cuam, tus kws phais nws tus kheej thawb qhov nkag sib nrug nrog ob ntiv tes, nthuav tawmqhov txhab. Thaum lub sijhawm ua haujlwm, nws kis cov npoo ntawm qhov txhab nrog nws tus ntiv tes.
Suturing qhov sib txawv yog ib txwm ua nyob rau hauv tshuaj loog. Ntxiv nrog rau qhov tseeb tias tus neeg mob yog li tshem tawm qhov mob, qhov txhab qhib mus txog qhov siab tshaj plaws. Qhov no, nyob rau hauv lem, muab tus kws kho mob siab tshaj plaws visibility. Yog tias qhov pom tsis zoo, muaj kev pheej hmoo tias daim tawv nqaij lossis cov mucous membrane yuav raug sewn, thiab cov nqaij ntshiv yuav tsis rov qab los. Nyob rau hauv cov ntaub ntawv no, kev khiav hauj lwm yuav tsuas muaj ib tug cosmetic nyhuv. Thiab tag nrho cov txiaj ntsig ntawm kev tawg ntawm perineum ntawm 2nd degree yuav cuam tshuam tom qab.
Koj yuav tsum ua tiag tiag yog tias muaj qib thib peb. Nyob rau hauv cov ntaub ntawv no, nws yog tsim nyog los txuas lub puas sphincter. Txwv tsis pub, cov txiaj ntsig yuav tsis txaus siab. Txhawm rau tiv thaiv qhov no, kev tshuaj xyuas nruj heev yog tsim nyog. Feem ntau, thaum lub sij hawm sphincter contractions, cov qhov txhab ploj los ntawm kev pom, thiab nws yuav nyuaj rau nrhiav tau lawv, tshwj xeeb tshaj yog yog tias tshuaj loog tsis txaus.
Kev ua haujlwm suturing pib rau saum, koob ntes cov ntaub so ntswg uas nyob tob. Raws li txoj cai, silk seams yog siv. Tab sis koom nrog cov npoo nrog cov hlua hlau kuj raug tso cai.
Yog tias kuaj pom 2nd degree perineal rupture, lub kaum sab xis ntawm qhov kev puas tsuaj raug kuaj pom thawj zaug. Feem ntau nws ncav cuag lub qhov quav, nws qhov tob yog xws li tias nws mus txog hauv pem teb pelvic. Yog li ntawd, tag nrho cov kab noj hniav yog tsim nyob rau hauv qhov tob ntawm qhov kev puas tsuaj, uas yog sau nrog cov ntshav. Yog tias muaj ob peb qhov sib txawv, lawv pib xaws hauv lem. Nyob rau hauv lub xub ntiag ntawm ib tug rupture ntawm lub 3rd degree, lub paravaginal, adrectal ntaub so ntswg puas. Thawj qhov uas koj yuav tsum tau ua yog txuas cov npoo ntawm cov qhov txhab hauv qhov quav thiab hauv sphincter: vim kev thim rov qab, qee zaum lawv nkag mus tob. Daim tawv nqaij qhov txhab yuav tsum tau kho nrog iodine, nrog rau tag nrho qhov chaw mos, pubis, folds nyob rau hauv puab tais. Txhawm rau tiv thaiv cov tawv nqaij ntawm daim tawv nqaij thiab cov mucous membranes, qhov no yog ua los ntawm cov roj vaseline uas tsis muaj menyuam.
Ntxiv rau qhov no, ob peb cov ntaub qhwv tsis huv tau siv rau ntawm no. Tom qab ntawd lawv hloov ntau zaus hauv ib hnub. Nws yog ib qho tseem ceeb uas qhov chaw mos raug kho ob mus rau peb zaug hauv ib hnub, thiab tom qab txhua txoj kev defecation nrog poov tshuaj permanganate.
Enemas tom qab hom kev phais no yog contraindicated. Nyob rau hauv rooj plaub uas tus neeg mob tsis muaj lub rooj zaum, nws tau muab tshuaj laxatives lightest nyob rau hnub thib ob lossis thib peb. Yog tias qhov rov qab tau npaj tseg, cov plooj tuaj yeem raug tshem tawm tom qab tsib lossis rau hnub.
Kev noj qab haus huv tom qab kev phais
Yog hais tias qhov kev puas tsuaj yog 3rd, thawj tsib hnub txij li lub sijhawm phais, tus poj niam tsuas haus dej qab zib, kas fes nrog mis nyuj, kua mis, dej ntxhia thiab kua txiv hmab txiv ntoo. Nyob rau hnub thib rau, cov ntawv qhia zaub mov ntawm xws li kev noj haus yog supplemented nrog txiv apples thiab carrot puree. Hnub xya, tus neeg mob noj tshuaj laxative, thiab hnub thib kaum, cov zaub mov zoo li qub.
Nws yog ib qho tseem ceeb uas yuav tau xav txog tias kev ua haujlwm yuav tsum tau ua nrog txhua qhov perineal rupture, tshwj tsis yog tsuas yog qhov me tshaj plaws ntawm daim tawv nqaij.
Ntau zaus, ntxiv rau lub perineum, lub labia thiab cov ntaub so ntswg ntawm lub vestibule ntawm qhov chaw mos kuj raug torn. Yog li ntawd, los ntshav tshwm sim hnyav, nrog rau mob thaum lub sij hawmqhov no. Hauv qhov no, suturing kuj tseem ua tau sai li sai tau, siv catgut sutures. Yog hais tias lawv nyob ze ntawm lub urethra, ib tug hlau catheter yog muab tso rau hauv nws, nyob rau hauv nws cov kev tswj, thiab kev phais yuav tshwm sim.
Qee lub sij hawm thaum lub perineum ruptured, daim tawv nqaij ntawm lub perineum tseem nyob. Thaum sab hauv muaj kev puas tsuaj rau cov phab ntsa, cov leeg. Kev tshem tawm ntawm daim tawv nqaij yog ua los ntawm ntau txoj hauv kev.
Yuav kom lub kua muag kho tau zoo tshaj plaws, tus poj niam ua tib zoo saib xyuas tom qab yug menyuam. Ib tug xov tooj ntawm obstetricians pib qhwv sab nraud ntawm qhov chaw mos ntawm qhov chaw mos yam tsawg kawg yog ob los yog peb zaug ib hnub twg nrog gauze nrog poov tshuaj permanganate los yog boric acid. Tom qab lub cheeb tsam yog qhuav nrog hmoov. Ib tug neeg qhia kom tsis txhob kov qhov chaw puas lawm ib zaug ntxiv, cia nws qhuav, ua tsuas yog hloov cov ntaub qhwv ntsej.
Kev nyuaj tuaj yeem tshwm sim thaum cov hnyuv tsis tau tshem tawm tag nrho ua ntej kev phais. Qhov no tshwm sim ntau zaus. Yog hais tias cov hnyuv tau ntxuav tau zoo, quav quav tshuaj yog dispensed nrog. Nws raug nquahu kom tiv thaiv kom tsis txhob quav ntsej thawj 3-4 hnub kom noj tshuaj 10 tee peb zaug ib hnub. Ib tug neeg zam kev sau cov tshuaj no los ntawm kev muab cov neeg mob vaseline roj, ib teaspoon peb zaug hauv ib hnub.
Yog tias qhov sib txawv tsis tiav, cov tshuaj laxative tau muab rau tus neeg mob hnub thib peb lossis plaub, thiab cov plooj tshem tawm los ntawm hnub thib tsib lossis rau rau hnub. Nws raug tso tawm hnub thib kaum.
Kev ceeb toom tab tom ua haujlwm
Nrog rau kev ua tau zoo, nws muaj peev xwm ua tau ntau zaus los tiv thaiv perineal rupture. Yog li ntawd,Nws yog ib qho tsim nyog yuav tsum maj mam dhau lub cev xeeb tub lub taub hau los ntawm qhov chaw mos, txiav los ntawm qhov me tshaj plaws, maj mam ncab cov ntaub so ntswg, ua tib zoo saib seb lub xub pwg nyom raug txiav li cas, tshem tawm kom zoo li sai tau. Ua raws li cov lus pom zoo no tso cai rau koj los tiv thaiv perineum yog tias qhov kev nthuav qhia yog cephalic.
Lub luag haujlwm tseem ceeb hauv kev tiv thaiv qhov tshwm sim tsis zoo yog muab rau kev npaj lub siab lub ntsws thiab lub cev ntawm tus niam uas xav yug menyuam. Kev npaj tso cai rau koj kom raug qhuab ntuas thaum lub sijhawm raug ntiab tawm, tshwj xeeb tshaj yog thaum lub taub hau raug txiav. Feem ntau, kev phais yog siv los tiv thaiv rupture. Tus kws phais tsuas txiav lub perineum.
Qee tus kws phais neeg tau hais tias qhov kev phais sab nraud, feem ntau siv rau qhov no, raug hloov los ntawm qhov nruab nrab qhov txiav. D. O. Ott tawm tswv yim perineotomy. Nws tau thov tias nws pab tiv thaiv perineal rupture. Tshwj xeeb, yog tias muaj cov kab mob subcutaneous, nws tau qhia kom ua cov txheej txheem zoo sib xws rau kev yug menyuam. Tab sis nws txoj kev xav tsis pom zoo hauv cov voj voog kev tshaj lij.
Tam sim no, perineotomy tau ua rau cov neeg mob yog tias, txawm tias muab kev tiv thaiv, tseem muaj kev pheej hmoo tias perineum yuav tawg. Lub incision yog ua yog hais tias lub perineum twb stretched, ua nruj, thinned, tig daj ntseg. Nyob rau hauv tas li ntawd, lub qhov ncauj qhov ntswg yog nthuav los ntawm 6 cm. Cov qhov txhab no yuav yooj yim sutured, kho yuav tshwm sim sai txaus.
Yog tias qhov tawg ntawm perineum twb nyob rau qib 3, qhov no qhia tau hais tias kev yug me nyuam yuav tshwm sim yam tsis muaj kev pab kho mob lossis nrog kev tsis zoo.tshem lub taub hau hauv forceps. Qee zaum qhov no tshwm sim vim qhov tseeb tias fetus raug tshem tawm ntawm lub plab kawg. Qhov kev kwv yees ua tau zoo dua nrog kev hem thawj ntawm perineal rupture, yog tias yug menyuam yog tshuaj loog.
Cerineal slit
YIb qho perineotomy yog ib qho kev phais hauv perineum. Muaj ntau hom kev txiav. Qhov kev xaiv yog ua los ntawm tus kws kho mob nyob ntawm seb cov kev qhia tshwj xeeb. Perineotomy tsis tshua muaj mob ntau dua li episiotomy.
Kev cuam tshuam ntawm hom no yog ua tiav sai li sai tau thaum muaj kev hem thawj ntawm kev tawg lossis nws twb pib lawm. Qhov tseeb yog tias qhov txhab tom qab tus kws phais yuav kho sai dua li qhov tsim tau ib txwm muaj. Tom qab tag nrho, qhov sib txawv ua rau pom ntau dua thiab cov kab mob hnyav, qhov kev pheej hmoo ntawm suppuration hauv qhov no yog siab dua.
Kev phais ib txwm ua yog tias nws tseem ceeb kom ua tiav cov txheej txheem yug menyuam sai li sai tau - thaum ntxov ntxov, muaj fetal hypoxia lossis nws txoj kev loj hlob txawv txav. Nyob rau hauv cov ntaub ntawv no, yuav tsum tau ib tug mos mos hom. Yog tias qhov kev siv zog tsis muaj zog, qhov kev txiav kuj tseem suav tias yog ib txoj kev tsim nyog. Nws kuj tseem siv tau yog tias muaj teeb meem hauv kev rho tawm lub xub pwg nyom ntawm tus menyuam.
Thiab qee zaum qhov kev phais yog qhov tsim nyog vim leej niam muaj kab mob - myopia, piv txwv li, lossis yog tias nws tau phais qhov muag, raug mob ntshav siab lossis muaj teeb meem ua pa. Hauv qhov no, kev phais mob ua kom nws tus kheej muaj kev nyab xeeb. Cov teeb meem tom qab kev phais yog tib yam li nrog kev tawg ntawm perineum. Txawm hais tias kev kho dua tshiab sai dua, nws tseem tsis yooj yim. Thawj ob peb hnub, ib tug poj niam yuav nrog tus mob tas li. Cov sutures raug tshem tawm rau hnub thib tsib. Nws yog ib qho tseem ceeb los saib xyuas qhov chaw puas tsuaj tas li, nws txoj kev kho tsis tu ncua.
