Matenda a shuga pamimba

Cholinga cha phunziroli chinali kusanthula zovuta komanso kuphunzira zotsatira za pakati pa azimayi omwe amalipidwa ndi matenda osokoneza bongo a gestationalabetes mellitus (GDM). Zotsatira ndi zovuta za pakati zimaphunziridwa mwa amayi 50 oyembekezera omwe ali ndi vuto la shuga, mphamvu ya GDM pa mwana wosabadwayo. Avereji ya zaka zapakati pa azimayi apakati anali (zaka 33.7 years 5.7). Ndi GDM yolipiridwa, kuchuluka kwa gestosis ndi placental insufficiency anali 84%, polyhydramnios 36%, fetal fetopathy 48%. Kupereka kwa nthawi kunachitika mu 96% ya milandu, kuchuluka kwa zolakwika za fetal zimagwirizana ndi zomwe zikuwonetsa anthu ambiri. Kukhazikitsidwa kuti gestational shuga mellitus imakhudza kukula kwa gestosis ndi placental insuffence, ngakhale pobwezera chakudya cha metabolism zimatheka kuyambira pomwe amapezeka.

KUFUFUZA NDI ZINSINSI ZOTHANDIZA MALO OGULITSIRA Mellitus

Cholinga cha phunziroli chinali kusanthula zovuta ndikuwona zotsatira za amayi omwe ali ndi vuto la shuga. Taphunzira zotsatira ndi zovuta za pakati pa amayi apakati 50 omwe ali ndi vuto la matenda ashuga mellitus, zomwe zimachitika chifukwa cha matenda osokoneza bongo a mwana wosabadwa. Zaka zapakati za akazi oyembekezera anali ndi zaka 33.7 ± 5.7. Kuchulukana kwa gestoses ndi placental kusowa kolipidwa gestational matenda osokoneza bongo anali 84%, polyhydramnios 36%, fetus fetopathy 48% milandu. Makanda obadwira anakhalapo mu 96% ya milandu, pafupipafupi kusokonezedwa kwa fetal kosagwirizana ndi zizindikiritso za anthu. Gestational shuga mellitus imakhudza kukula kwa gestosis ndi fetoplacental insuffence, ngakhale kubwezeretsedwa kwa kagayidwe kachakudya pambuyo kupezeka kwa gestational matenda a shuga.

Zolemba pazaka yasayansi pamutu wakuti "Zovuta ndi zotsatira zapakati pakukhudzidwa kwa matenda ashuga mellitus"

INTERDISCI KULI FUNDAMENTAL FUNDAMENTAL FUNDAMENTAL KU MEDICINE

MALANGIZO NDI ZINSINSI ZA KUKHALA NDI CHIWEREWERE KWA MELERE

Bondar I.A., Malysheva A.S.

Novosibirsk State Medical University, Novosibirsk

Cholinga cha phunziroli chinali kusanthula zovuta komanso kupenda zotsatira za pakati pa azimayi omwe amalipidwa ndi matenda osokoneza bongo a gestationalabetes mellitus (GDM).

Zotsatira ndi zovuta za pakati zimaphunziridwa mwa amayi 50 oyembekezera omwe ali ndi vuto la shuga, mphamvu ya GDM pa mwana wosabadwayo.

Avereji ya zaka zapakati pa azimayi apakati anali (zaka 33.7 years 5.7). Ndi GDM yolipiridwa, kuchuluka kwa gestosis ndi placental insufficiency anali 84%, polyhydramnios - 36%, fetal fetal - 48%. Kupereka kwa nthawi kunachitika mu 96% ya milandu, kuchuluka kwa zolakwika za fetal zimagwirizana ndi zomwe zikuwonetsa anthu ambiri.

Kukhazikitsidwa kuti gestational shuga mellitus imakhudza kukula kwa gestosis ndi placental insuffence, ngakhale pobwezera chakudya cha metabolism zimatheka kuyambira pomwe amapezeka.

MALANGIZO: Matenda a shuga a m'mimba, zotsatira za kutenga pakati, gestosis, fetopathy.

kukonzekera kwa pregravid kwa kutenga pakati, kusakwanira koteteza kagayidwe kazakudya asanachitike komanso nthawi yake.

Matenda a shuga a mellitus (DM) amakhudza nthawi yomwe ali ndi pakati, kudziwa zotsatira zake zoyipa. Matenda a shuga mwa amayi apakati amathandizira pakukula kwa mtima wamavuto, kumabweretsa kukula kwa hypoglycemia, ketoacidosis, polyhydramnios, matenda oopsa kapena matenda a gestosis, kubwereza kwam'kati kapena kwamikodzo matenda am'mimba, kuvulala kwamimba komanso kubereka, forceps, vacuum m'zigawo za mwana wosabadwayo), asanabadwe 2, 3.

Matenda a shuga a Gestational mellitus (GDM) ndi matenda omwe amadziwika ndi hyperglycemia, omwe amapezeka koyamba ali ndi pakati koma osakwanitsa njira zomwe zimawonetsa matenda a shuga. Pafupipafupi wa GDM mwa kuchuluka kwa anthu 7%. GDM imachulukitsa kuchuluka kwa zotsatira zosayembekezereka za amayi ndi kufa kwa mwana wakhanda, ndi chiopsezo cha kukula kwa kunenepa kwambiri, matenda a shuga 2 ndi matenda amtima mwa mayi ndi ana mtsogolo 1, 8.

Pali kulumikizana mwachindunji pakati pa kubwezeretsedwa kwa shuga kwa amayi akuchikazi ndi kupezeka kwa matenda a shuga

Chiwopsezo cha kufa kwa fetal ku GDM ndi 3-6%, ndipo pakakhala kuti palibe matenda ashuga - 1-2%, koma matenda osokoneza bongo samakulitsa chiwopsezo cha kufa kwa fetal posakhalitsa ndi zovuta zapakati. Komanso, ndi GDM, pali kuwonjezeka kwa matenda a kupuma - osakhalitsa tachypnea, intrauterine asphyxia, kupuma kwa vuto la kupuma.

Ndi Malysheva Anna Sergeevna, tel. 8-913-740-5541, Imelo: [email protected]

Mu "fetus" pafupipafupi, matenda a shuga amachokera ku 27 mpaka 62%, poyerekeza ndi 10%

mwa anthu athanzi, malinga ndi olemba ena, kuchuluka kwa macrosomia kumasiyana 20% kwa odwala matenda ashuga mpaka 35% a matenda ashuga omwe amapezeka asanakhale ndi pakati.

Cholinga cha phunziroli chinali kusanthula zovuta komanso kuphunzira zotsatira za pakati pa azimayi omwe ali ndi vuto la matenda a shuga.

Zida ndi njira

Kafukufuku wokhudza azimayi 50 oyembekezera azaka zapakati pa 20 mpaka 42 (zaka zapakati pa zaka 34.0 ± 5.7) ndi kupezeka kwa matenda a GDM panthawi zosiyanasiyana zamiyeso.

Njira zoyenera kupatula phunziroli zinali: mtundu wachiwiri wa 2 komanso mtundu wa matenda a shuga 1 omwe amadziwika ndi pakati, matenda opatsirana a chithokomiro, matenda opatsirana kapena kuwonjezereka kwa matenda osachiritsika mkati mwa masabata awiri asanaphatikizidwe mu kafukufukuyu.

Kusanthula kwa mbiri yakale ya zamankhwala, kuchuluka kwa mbiri yakale ya kubala kwa m'mimba ndi matenda a m'mimba (chizolowezi chizolowereka, kutaya pathupi mwachangu, kufa kosadziwika kwa mwana wosabadwayo kapena vuto lachitukuko, fetus yayikulu, mitundu yayikulu ya gestosis, kubwereza colpitis, kubwereza kwam'mimba kwamatenda ambiri, mimba yapakati komanso zingapo panthawi imeneyi ndi ) Kukhalapo kwa kulemera kwa chibadwa cha matenda ashuga, GDM, glucosuria, mbiri ya kagayidwe kazakudya idawululidwa. Mndandanda wam'magazi a thupi (BMI) musanakhale ndi pakati komanso kuchuluka kwa thupi panthawi yomwe muli ndi pakati, kuchuluka kwa glycemia panthawi yodziwitsa, komanso njira yochepetsera glucose yotsitsa glucose. Zotsatira za GDM pa mwana wosabadwayo (zochitika za fetopathy, kuvulala kwa kubala) zidaphunzira. Pazindikiritso wa gestosis, gulu la ICD-10 lidagwiritsidwa ntchito, zovuta zidatsimikizika malinga ndi kuchuluka kwa Goeeke pakusintha kwa G.M. Savelyeva. Pofuna kudziwa za GDM, njira yoyesera ya Russian National Consensus "GDM: Diagnosis, Treatment, Postpartum Monitoring" (2012) idayikidwa.

Kusanthula kwa zotsatira za kafukufukuyu kunachitika pogwiritsa ntchito pulogalamu ya Statistica 6.0 ya Windows, poganizira njira zobwezeretsera zomwe zalimbikitsidwa pa biology ndi mankhwala. Makhalidwe owerengeka amaperekedwa ngati M ±, pomwe M ndi mtengo wapakati, ndipo s ndi kupatuka kwofananira. Malumikizidwe adatsimikizika pogwiritsa ntchito mayeso a Spearman r, pazinthu zosinthika zomwe timagwiritsa ntchito

Mgwirizano wapakati pa Chuprov's CN waphunziridwa. Kusiyanitsa kunawonedwa kukhala kofunikira pa p sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

± 0.9) mmol / L, 13:00 - (5.4 ± 1.1) mmol / L, 17:00 - (5.4 ± 0.9) mmol / L, 21:00 - (6, 1 ± 2.6) mmol / l, nthawi ya 2:00 - (4.7 ± 1.6) mmol / l.

Odwala 34 (68%) anali ndi vuto la kunenepa kwambiri asanakhale ndi pakati, 8 (16%) anali onenepa kwambiri (avareji ya BMI - (28.4 ± 1.5) kg / m2), 8 (16%) - yachilendo thupi, 4 ( 8%) - kuchepa kwa thupi (pafupifupi BMI - (17.8 ± 1.2) kg / m2). BMI wamba mwa odwala omwe anali ndi kunenepa kwambiri asanakhale ndi pakati inali (34.3 ± 3.9) kg / m2. Kunenepa kwambiri kwa digiri yoyamba kumawonedwa mwa odwala 20 (40%), 2nd - 10 (20%), digiri ya 3 - 4 (8%). Malinga ndi olemba ena, kuchuluka kwa kunenepa kwambiri pakati pa azimayi oyembekezera kumayambira 12 mpaka 28% ndipo sikufuna kutsika 13, 14. Kuchuluka kwaukalamba kwa pakati kumayambira pa 3 mpaka 20 kg, pa avareji (11.9 ± 5.3) kg .

Mwa odwala 2 (4%) omwe anali ndi vuto la kunenepa kwambiri kwa 2nd asanalandire mimba, palibe kuwonjezeka kwa thupi panthawi yakudya chifukwa chakudya. Kulemera kwathanzi kudalembedwa mu milandu 16 (32%): mu ma 10 (20%) mwa amayi omwe ali ndi kunenepa kwambiri komanso pafupipafupi (ma milandu awiri aliwonse)

Kafukufuku wapakati pa zamankhwala

mwa amayi omwe ali ndi vuto labwino, onenepa kwambiri komanso onenepa thupi asanakhale ndi pakati. Kulemera kwachidziwitso kudalembedwa mu 16 mwa 50 odwala ndikuwongolera (16.7 ± 1.8) kg.

Ndi 6 (12%) okha mwa omwe adachita nawo kafukufukuyu omwe analibe mbiri yokhudza kubereka, 10 (20%) omwe adakhalapo ndi mbiri yokhala ndi pakati, 12 (24%) - 2 mimba, 22 (44%) - 3 kapena kupitilira apo. Amayi ambiri (52%) azimayi omwe ali ndi GDM anali ndi mbiri yovuta yoletsa kubereka.

Chovuta chambiri chomwe chimachitika pakubala kwenikweni ndi GDM chinali chitukuko cha gestosis - 84% ya milandu. Kufatsa kofatsa kwamitundu yosiyanasiyana kunapezeka mwa amayi apakati a 76%: edema ndi proteinuria popanda matenda oopsa omwe amachitika chifukwa cha kutenga pakati - milandu 4 (8%), matenda oopsa popanda proteinuria yayikulu - 8 (16%), edema - 6 (12%), 2 ( 4%) - kukhalapo kwa matenda oopsa omwe amakhalapo kale asanabadwe, 18 (36%) - kuphatikiza matenda oopsa omwe ali ndi proteinuria yayikulu. 4% yokha mwa milandu yomwe inali yopanda matenda oopsa chifukwa cha mimba yomwe inali ndi proteinuria yayikulu kwambiri komanso edema yodziwika bwino. Malumikizidwe ofooka adawululidwa pakati pa kukulira kwa gestosis ndi kuchuluka kwa glycemia mu kuwonekera kwa GDM (CN = 0.29, p = 0.002) (wokhala ndi glycemia ochepera 5.2 mmol / L pamimba yopanda kanthu). Ndinapezanso kuyanjana pakati pa kukhazikika kwa gestosis ndi kunenepa kwambiri kwamankhwala osiyanasiyana asanakhale ndi pakati (g = 0.4, p = 0.03) kulemera kwa pathological weight (g = 0.4, p = 0.005) pa nthawi yomwe ali ndi pakati. Kukula kwa gestosis kumayendera limodzi ndi kukhalapo kwa ochepa ochepa matenda oopsa (AH) mwa azimayi oyembekezera (g = 0.48, p = 0.0004). Ubale pakati pa kunenepa kwambiri musanakhale ndi pakati komanso kukula kwa matenda oopsa (g = 0.4, p = 0.003) panthawi ya pakati kunawululidwa. Matenda a pyelonephritis amawonekera mu milandu 14 (28%). Pulogalamu yambiri ya proteinuria pakuwunika kwamikodzo mu odwala awa inali (0.05 ± 0.04) g / l, proteinuria tsiku lililonse (0.16 ± 0.14) g / l.

Wofatsa kuti azisowa kuchepa kwa magazi m'thupi kukhala ndi vuto lazovuta pakati pa milandu 22 (44%), hemoglobin wamba anali (105.6 ± 18.8) g / l. Mu 6 mwa 50 milandu, mimba anali limodzi ndi hemato native thrombophilia ndi thrombocytopenia.

Kafukufuku wazotsatira zakuwonetsa kuti kubereka kwamtsogolo kunachitika mu 96% ya amayi oyembekezera, azimayi awiri anali ndi nthawi yobereka, yomwe ikufanana

Bulletin ya ku Siberia

Imagwirizana ndi zomwe zikuwonetsa kuchuluka kwa amayi apakati omwe alibe zovuta za carbohydrate metabolism (tebulo).

Malinga ndi kafukufukuyo, mwa anthu 76% mwa anthu 100 aliwonse, mwana wosabadwayo anali pamutuwu.

Zotsatira n% Correlation

Zadzidzidzi COP 6 12

Kunenepa COP 24 48 Kunenepa kwambiri musanakhale ndi pakati

Kuperekedwa mu 20 40

ngalande yachilengedwe

Analimbikitsa Mwachangu 2 4

Kufooka kwa ntchito; 6 12 fetus fetal

r = 0.74, p = 0.02

Zindikirani KS - Gawo la Cesarean.

Mwa odwala 42 (84%), kutenga pakati kumayendera limodzi ndi kuperewera kwa mphamvu ya placental (FPF), omwe amadziwika kwambiri - 26 (52%), mu 16 (32%) - kulipidwa. Kukula kwa FPI mwa azimayi 24 (48%) kumayendetsedwa ndi kuphwanya magazi kwamatenda a utero-placental (1st - 4 (8%), digiri yoyamba - 14 (28%), digiri yoyamba - 4 (8%), digiri yachiwiri - 2 (2) 4%)), kukhalapo kwa ochepa matenda oopsa (r = 0.41, p = 0.003) ndi matenda a intrauterine (r = 0.36, p = 0.02). Malinga ndi kuwunika kwa ultrasound, odwala 2 (4%) adayamba kupangika kwa placenta, 10 (20%) anali ndi vuto lochepera, ndipo gawo limodzi lokha lomwe limapezeka mu 2 (4%). Mu milandu 20 (40%), mimba imayendera limodzi ndi kukhalapo kwa matenda a intrauterine komanso matenda a urogenital aakulu (8%).

Polyhydramnios adawonedwa mu milandu 18 (36%), oligohydramnios sanapezeka. Amniotomy adachitidwa mwa azimayi anayi (8%). Kutulutsa kwam'mimba koyambirira kwa madzi amniotic kumachitika mwa azimayi oyembekezera 8 (16%) omwe ali ndi GDM. Pafupifupi voliyumu ya amniotic inali 660 ml, mu 6 (12%) panali kusintha koyenera mu amniotic fluid (green amniotic fluid).

Kulemera kwa matupi atsopanowo kuyambira pa 2,500 mpaka 4,750 g, kulemera kwa thupi kunali (3,862.1 ± 24.1) g, kutalika kwakukulu kunali (53.4 ± 1.6). Fetal fetopathy inalembedwa mu 24 (48) %) ya akhanda, pafupifupi kulemera kwa thupi - (4 365 ± 237) g. Mu amayi apakati omwe ali ndi vuto la GDS mu 1 trimester, fetupathy ya fetal imapezeka mu 100% ya milandu, pomwe kulemera kwakuthupi kwa akhanda kumene kumakhala kwakukulu kuposa mwa azimayi omwe ali ndi GDS kuwonekera Ma trimesters a 2nd ndi 3 ((4525.0 ± 259.8) ndi (3828.0 ± 429.8 g, motsatana). Malinga ndi ultrasound (ultrasound), pa 8

, 2014, voliyumu 13, No. 2, p. 5-9 7

milandu (16%) anaulula infrauterine hypoxia wa mwana wosabadwayo, mu milandu 2 (4%) - mayiko awiri zapakati paelo. Zambiri zimagwirizana ndi kafukufuku wa V.F. Ordynsky, komwe pafupipafupi patopathy imafika 49% (ndi ultrasound).

Mukamayesa mayeso a Apgar, zidapezeka kuti mawonekedwe oyamba amachokera ku mfundo 6 (nkhani 1) mpaka 8. Lachiwiri limasankha kuyambira 7 mpaka 9 point.

Mu 2 (4%) akhanda, maliseche a intrauterine adawululidwa, omwe atabadwa adawonetsedwa ndi mkhalidwe woipa wa kupuma ndi mawonekedwe amitsempha. Ntchitoyo inali yovuta chifukwa kubadwa kwa mapewa

2 (4%), kuvuta kuchotsa mapewa - 2 (4%), kukula kwa mafupa owonda kwambiri - 2 (4%).

The placenta adamasulidwa yekha mwa milandu 24 (48%), mwa azimayi 20 (40%) omwe adagwira ntchito, placenta adalekanitsidwa ndi dzanja. Unyinji wamba wa placenta unali (760.3 ± 180.2) g. Pazinthu ziwiri zokha (4%) panali edema ya malo a mwanayo. Kutalika kwa chingwe cha umbilical kunali kosiyanasiyana kuyambira 30 mpaka 96 masentimita, pafupifupi - (65,5 ± 13.0) masentimita awiri (25%).

Zotsatira zomwe zapezedwa zikuwonetsa kukopa kwa GDM pakukula kwa gestosis ndi kulephera kwa placental mu 84% yamilandu, ngakhale ndi kupezeka kwakanthawi komanso kulipidwa kwa GDM. Kutali kwa GDM

mu 1 trimester, kukula kwa fetopathy komwe kunapezeka mu 100% ya milandu motsutsana ndi maziko a kulipidwa kwa chakudya cha metabolism.

Chifukwa chake, hyperglycemia pakuwonjezereka kwa GDM, kunenepa kwambiri, komanso kulemera kwa matenda a m'magazi kumakulitsa chiwopsezo cha zovuta ndi zotsatirapo zovuta za pakati pa mayi ndi mwana wosabadwa, ngakhale mutazindikira za GDM komanso kulipira kagayidwe kazakudya.

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3. Russian Association of Endocrinologists. Malangizo azachipatala. Endocrinology: 2nd ed. / ed. I.I. De-

Dova, G.A. Melnichenko. M: GEOTAR-Media, 2012.S. 156-157.

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8.Andreeva E.V., Dobrokhotova Yu.E., Yushina M.V., Heyder L.A., Boyar E.A., Filatova L.A., Shikhmirzaeva E.Sh. Zina mwa magwiridwe antchito a chithokomiro mu ana akhanda kuchokera kwa amayi omwe ali ndi gestational matenda a shuga mellitus // Mavuto a kubereka. 2008. Ayi 5. S. 56-58.

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10. Cherif A. et al. Preeclampsia imawonjezera chiopsezo cha matenda a membala amtundu wa hualine mwana wakhanda asanakonzekere: kafukufuku woyendetsedwa wolamulidwa // J. Gynecol. Obstet Biol. Kutulutsa. 2008. V. 37 (6). P. 597-601.

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14. Chen A., Feresu S.A., Fernandez C. Matenda onenepa kwambiri komanso chiopsezo cha kufa kwa makanda ku United States. Epidemiology 2009, 20:74. Dashe J.S., McIntire D.D., Twickler D.M. Zotsatira za kunenepa kwa amayi pa kupindikiridwa kwa ultrasound kwa fetus wosakhumudwitsa // Obstet Gynecol. 2009.V. 113.P. 1001.

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Zalandiridwa pa Disembala 24, 2013; Zavomerezedwa kuti zitha kusindikizidwa pa Marichi 20, 2014

Bondar Irina Arkadevna - Dr. med. sayansi, pulofesa, mutu. Dipatimenti ya Endocrinology, Novosibirsk State Medical University (Novosibirsk). 8 Bulletin of Siberian Medicine, 2014, Voliyumu 13, No. 2, p. 5-9

Kafukufuku woyambirira wazachipatala a Malysheva Anna Sergeevna (I) - wophunzira womaliza wa Dipatimenti ya Endocrinology, Novosibirsk State Medical University (Novosibirsk). Ndi Malysheva Anna Sergeevna, tel. 8-913-740-5541, Imelo: [email protected]

KUFUFUZA NDI ZINSINSI ZOTHANDIZA MALO OGULITSIRA Mellitus

Bondar I.A., Malysheva A.S.

Novosibirsk State Medical University, Novosibirsk, Russian Federation ABSTRACT

Cholinga cha phunziroli chinali kusanthula zovuta ndikuwona zotsatira za amayi omwe ali ndi vuto la shuga.

Taphunzira zotsatira ndi zovuta za pakati pa amayi apakati 50 omwe ali ndi vuto la matenda ashuga mellitus, zomwe zimachitika chifukwa cha matenda osokoneza bongo a mwana wosabadwa.

Zaka zapakati za akazi oyembekezera anali ndi zaka 33.7 ± 5.7. Kuchulukana kwa gestoses ndi placental kusowa kolipidwa gestational matenda a shuga ndi 84%, polyhydramnios - 36%, fetus fetus - 48% ya milandu. Makanda obadwira anakhalapo mu 96% ya milandu, pafupipafupi kusokonezedwa kwa fetal kosagwirizana ndi zizindikiritso za anthu.

Gestational shuga mellitus imakhudza kukula kwa gestosis ndi fetoplacental insuffence, ngakhale kubwezeretsedwa kwa kagayidwe kachakudya pambuyo kupezeka kwa gestational matenda a shuga.

MALO OGWIRITSA NTCHITO: matenda a shuga wokhudzana ndi m'mimba, zotsatira za kutenga pakati, mawonekedwe a gestoses, fetus.

Bulletin of Siberian Medicine, 2014, vol. 13, ayi. 2, mas. 5-9

1. Tisel'ko A.V. Matenda a shuga, 2013, ayi. 1, mas. 106-777 (mu Chirasha).

2. Hod M., Carrapato M. Matenda a shuga ndi Maumboni Otsatsa Pazithunzi Zowonjezera ndi Maupangiri (Gulu Logwira Ntchito pa Matenda A shuga ndi Mimba). Prague, 2006.

3. Dedov I.I., Mel'nichenko G.A. Russian Association of endo-crinologist. Malangizo azachipatala. Endocrinology. 2nd ed. Moscow, Geotar-Media Publ., 2012.335 p.

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Bondar Irina A., Novosibirsk State Medical University, Novosibirsk, Russian Federation. Malysheva Anna S. (H), Novosibirsk State Medical University, Novosibirsk, Russian Federation.

Zoyambitsa ndi Zoopsa

Etiopathogenesis yokhudzana ndi matenda a shuga gestational nthawi yapakati samadziwika bwino. Amaganiziridwa kuti kukula kwake kumachitika chifukwa chakuletsa kupanga kwa insulini yokwanira ndi mahomoni omwe ali ndi vuto la kukula koyenera komanso kukula kwa mwana wosabadwayo. Pa nthawi yoyembekezera, kusintha kwa mahomoni kuchokera ku thupi kumachitika mthupi la mayi lomwe limakhudzana ndi mapangidwe ake, omwe amachititsa chorionic gonadotropin, corticosteroids, estrogens, progesterone, ndi lactogen ya placental m'magazi a amayi. Ma mahormoniwa amachepetsa mphamvu ya zotumphukira zama cell kupuma insulin. Kusokonezeka kopitilira muyeso wa kagayidwe kachakudya ka insulin komwe kumayambitsa kuchuluka kwa lipolysis, pomwe kugwiritsidwa ntchito kwa glucose ndi minyewa yokhudzana ndi insulin kumachepa, komwe, ngati pali zovuta zomwe zingayambitse matenda ashuga.

Matenda a Autoimmune amathandizira kukhazikitsa matenda a shuga, komwe kuwonongeka kwa kapamba ndipo, chifukwa chake, kutsika kwa insulin kumachitika. Mwa amayi omwe abale awo apamtima amadwala matenda amtundu uliwonse, chiopsezo chokhala ndi matenda osokoneza bongo nthawi yapakati imachulukitsidwa.

Zina zomwe zimayambitsa ngozi ndi izi:

• chibadwa
• matenda oyamba ndi ma virus
• candidiasis
• polycystic ovary syndrome,
• kubereka, kubadwa kwa mwana wosabadwa wamkulu, mbiri ya polyhydramnios, matenda a shuga a m'mimba mwa amayi apitawo,
• kuthamanga kwa magazi
• onenepa kwambiri
• zizolowezi zoipa
• kupsinjika kwa thupi kapena kwamaganizidwe
• chakudya chopanda malire (makamaka, kugwiritsa ntchito kuchuluka kwa mafuta ochulukitsa kwambiri).

Pofuna kupewa kukula kwa matenda a shuga a m'mimba, tikulimbikitsidwa: kudya mokwanira, kukana zizolowezi zoipa, kuchita masewera olimbitsa thupi okwanira.

Mitundu ya matenda

Matenda a shuga m'mimba mwa amayi apakati amagawika matenda asanafike gestational, momwe matenda a carbohydrate metabolism amawonekera mwa mayi asanakhale ndi pakati, komanso gestational kwenikweni, pomwe matendawa amadziwonetsa okha panthawi yomwe ali ndi pakati.

Gestationalabetes mellitus imagawikidwanso mothandizidwa ndi zakudya zamankhwala ndipo imalipidwa ndi insulin yothandizira kuphatikiza ndi zakudya. Mellitus yolipidwa komanso yowonongeka imasiyanitsidwa malinga ndi kuchuluka kwa kubwezeredwa kwa matenda.

Zizindikiro za matenda a shuga

Matenda amiseche amakhala osachiritsika, Zizindikiro zake zimatengera, pakati, nthawi yayitali. Nthawi zina, matendawa alibe chithandizo chazachipatala ndipo amapezeka pokhapokha ngati ali ndi chiberekero chamankhwala, chomwe chimachitika ngati gawo lowunikira pakubala.

Chizindikiro chachikulu cha matenda ashuga gestational nthawi yoyembekezera ndi kuchuluka kwa shuga m'magazi a mayi woyembekezera (omwe amapezeka pafupipafupi ndi sabata la 20), pakalibe umboni wa matenda ashuga mwa mkazi asanatenge pathupi. Zina zomwe zimawonetsa matenda ashuga okhathamira ndi kuphatikiza kunenepa kwambiri, kusokosera pafupipafupi, kuyabwa pakhungu, kuphatikizapo kuyabwa mkati mwa maliseche, mkamwa owuma, ludzu losatha, kufooka kwa chakudya, kufooka ndi kutopa.

Zizindikiro

Monga gawo lodziwika bwino la matenda ashuga mwa amayi apakati, amatenga zodandaula ndi anamnesis, kulipira chidwi makamaka kupezeka kwa matenda ashuga m'mbiri ya mabanja.

Njira zazikulu ndikuyesa magazi kwa glucose ndi glycosylated hemoglobin, komanso kuyesa kwamkodzo mwamphamvu motsimikiza mtima ndi matupi a ketone. Kuyeserera kwa glucose kumakupatsani mwayi wowona kusokonezeka kwa kagayidwe kazakudya m'migawo yoyambirira ya chitukuko. Nthawi zambiri, muyezo wama glucose woyeserera umachitika mwa kutenga 75-100 g m'magazi pakamwa kenako kuyeza magazi. Ngati wodwala ali ndi hyperglycemia, kuyesedwa kumatsutsana.

Etiopathogenesis yokhudzana ndi matenda a shuga gestational nthawi yapakati samadziwika bwino.

Chithandizo cha matenda a shuga pakubala nthawi zambiri chimachitika mwachangu. Tsiku lililonse ndikofunikira kuyendetsa kuchuluka kwa shuga m'magazi. Kuyeza kwa chizindikirochi kumachitika koyamba pamimba yopanda kanthu, kenako ola limodzi mukatha kudya.

Choyamba, wodwalayo amalimbikitsidwa kuti apendenso zakudya. Kuphatikiza apo, kuchita masewera olimbitsa thupi moyenera kumalimbikitsidwa komwe kumatha kulepheretsa kuchuluka kwambiri kwa thupi komanso kukhalabe ndi thupi labwino. Kuphatikiza apo, mukamachita masewera olimbitsa thupi, minyewa yomwe imagwiritsa ntchito shuga osakhudzana ndi insulin, yomwe imathandiza kuchepetsa glycemia. Zochita zolimbitsa thupi zitha kuphatikiza masewera olimbitsa thupi amayi apakati, kusambira, kuyenda. Pankhaniyi, kusuntha kwadzidzidzi, komanso masewera olimbitsa thupi omwe cholinga chake ndi kugwira minofu ya khoma lamkati lakumbuyo, ziyenera kupewedwa. Mulingo wokweza umasankhidwa ndi dokotala yemwe amatsogolera pakati, kapena ndi katswiri pakuchita masewera olimbitsa thupi.

Chithandizo cha maukwati, ngati kuli kotheka, chitha kuphatikizira mankhwala azitsamba (flaxseed, muzu wa burdock, masamba a mabulosi, etc.), mankhwala a hepatopoietic ndi angioprotective.

Pokhapokha ngati pali phindu lamadyedwe, limodzi ndi magulu a masewera olimbitsa thupi, ma jakisoni a insulini akuwonetsedwa. Mankhwala ena a hypoglycemic a matenda amiseche amatsutsana chifukwa cha mphamvu ya teratogenic.

Nthawi yobereka imakhazikitsidwa poganizira zovuta za matendawa, mkhalidwe wa mwana wosabadwayo komanso kupezeka kwa zovuta zina. Nthawi yabwino ndi sabata la 38 la mimba, chifukwa mapapu a fetal amakhala okhwima kale ndipo palibe chiopsezo chokhala ndi vuto la kupuma.

Mukumva kwambiri matenda ashuga komanso / kapena kukulitsa kwa zovuta, kuperekera koyambirira kumalimbikitsidwa, nthawi yoyenera yomwe ndi sabata la 37 la mimba.

Ndi kukula kwabwinobwino kwa khungu la mayi, kukula kocheperako kwa mwana wosabadwayo ndi mutu wake, kuperekera kudzera mu ngalande yakubadwa kumalimbikitsidwa. Kutumiza ndi gawo la caesarean nthawi zambiri kumachitika panjira yovuta, komanso kukula kwakukula kwa mwana wosabadwayo.

Matendawa ndi owopsa kwa mwana wosabadwayo kuti apange hyperinsulinemia, yomwe, imatha kuyambitsa kupuma ntchito.

Zakudya za matenda ashuga gestational nthawi yapakati

Zakudya za matenda a shuga gestational panthawi yoyembekezera zimangokhala kuchepetsa kuchuluka kwa shuga m'magazi. Zakudya zomwe zimakhala ndi 40-45% chakudya ndi mafuta 20-25% ndizovomerezeka. Kuchuluka kwa zakudya zamapuloteni amawerengedwa potengera kuchuluka kwa 2 ga mapuloteni pa 1 makilogalamu. Zakudya zamasamba otentha, confectionery, mafuta ndi zakudya zokazinga, chiwindi, uchi, mazira, zakudya zomwe zimakhalapo nthawi yomweyo, mayonesi ndi msuzi wina wama mafakitale samachotsedwa pakudya. Zipatso ndi zipatso ziyenera kudyedwa pang'ono, kupatsa chidwi osati zotsekemera (currants, gooseberries, maapulo wobiriwira, yamatcheri, cranberries). Ndikulimbikitsidwa kuti muphatikize nyama yokhala ndi mafuta ochepa, nsomba ndi tchizi, chimanga, pasitala yamtundu wolimba, kabichi, bowa, zukini, tsabola wa belu, nyemba, mafuta azakudya. Odwala omwe ali ndi gestational shuga mellitus panthawi yoyembekezera ayenera kuonetsetsa kuti mavitamini ndi michere yambiri yofunikira pakukula kwa mwana wosabadwayo.

Chakudya chizikhala chosakanikirana (zakudya 67 patsiku m'magawo ang'onoang'ono). Makonda ayenera kuperekedwa kwa mbale yophika, yophika ndi yowotchera, komanso masamba a masamba abwino. Kuphatikiza apo, tikulimbikitsidwa kugwiritsa ntchito madzi osachepera 1.5 malita tsiku.

Wodwala yemwe ali ndi vuto la shuga akakhala ndi pakati amalangizidwa kuti azitsatira zakudya kwakanthawi ndikuwonetsetsa kuchuluka kwa shuga m'magazi kuti achepetse vuto la matenda ashuga a 2. Zizindikiro za kagayidwe kazakudya, monga lamulo, zimasinthidwa m'mwezi woyamba pambuyo pobadwa.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Matenda a shuga ochitika m'mimba amathandizira kuti azikhala ndi zovuta komanso zotsatirapo zovuta kwa onse omwe ali ndi pakati komanso kwa mwana wosabadwayo. Matendawa ndi owopsa kwa mwana wosabadwayo kuti apange hyperinsulinemia, yomwe, imatha kuyambitsa kupuma ntchito. Komanso, njira ya pathological imatha kukhala chifukwa cha matenda ashuga, owonetsedwa ndi macrosomia, omwe amafunikira gawo la cesarean. Kuphatikiza apo, matenda osokoneza bongo ochitika m'mimba amathandizira kuti mwana abadwe kapena kufa kwa mwana wakhanda nthawi yoyambirira.

Odwala omwe ali ndi matenda amiseche pa nthawi ya pakati, matenda opatsirana a urogenital thirakiti, preeclampsia, eclampsia, kutaya kwamkati kwa amniotic madzimadzi, kubadwa msanga, kutaya kwa magazi pambuyo pake ndi mavuto ena apakati.

Ndi kupezeka kwakanthawi kokwanira komanso chithandizo chokwanira, matendawa amathandiza kuti mayi wapakati komanso mwana wosabadwa abadwe.

Kupewa

Pofuna kupewa chitukuko cha matenda a shuga, tikulimbikitsidwa:

• kuwunika momwe mai ali ndi pakati
• kukonza mafuta onenepa,
• zakudya zabwino
• kusiya zizolowezi zoipa,
• zolimbitsa thupi zokwanira.

Zizindikiro zazikulu za matenda apakati a shuga

Chizindikiro chachikulu cha HD ndi shuga wamagazi ambiri. Matendawa pawokha sachidziwika.

Mkazi akhoza kumva ludzu, kutopa msanga. Kulakalaka kumayenda bwino, koma nthawi yomweyo kumachepetsa thupi.

Mkazi sakonda kulabadira zizindikiro zotere, akukhulupirira kuti izi ndi zotsatira za kutenga pakati. Ndipo pachabe. Kuwonetsera kulikonse kumapangitsa chidwi mayi woyembekezera ndipo ayenera kudziwitsa adotolo za iwo.

Zizindikiro zamatchulidwe amtunduwu

Ngati matendawa akupita patsogolo, zizindikiro zotsatirazi ndizotheka:

• pakamwa kowuma kosalekeza (ngakhale madzi ambiri amwa),
• kukodza pafupipafupi,
• mokulira ndikufuna kupuma
• masomphenyawo akuipiraipira
• kulakalaka kukukula, ndipo ndi iyo kilogalamu yama kilogalamu.

Mukumva ludzu ndikukonda kudya, ndizovuta kuzindikira zizindikiritso za matenda ashuga, chifukwa mwa mayi wathanzi, podikirira mwana, zikhumbo zake zimakulirakulira. Chifukwa chake, kuti afotokozere za matendawa, dokotala amatsogolera mayi woyembekezerayo kukachita kafukufuku wowonjezera.

Chithandizo cha pakati

M'milandu yambiri (mpaka 70%), matendawa amasinthidwa ndi zakudya. Amayi oyembekezera amayeneranso kukhala ndi mwayi wodziyang'anira payokha.

Mankhwala ochizira matenda a HD amachokera pazinthu zotsatirazi:

• zakudya za tsiku ndi tsiku zimakonzedwa kotero kuti amaphatikiza 40% mapuloteni, 40% mafuta ndi 20% chakudya,
• phunzirani kudya pang'ono: kangapo patsiku ndi maola atatu,
• ndi kunenepa kwambiri, zopatsa mphamvu zopatsa mphamvu ziyeneranso kuwerengedwa: zosaposa 25 kcal pa kilogalamu yolemera. Ngati mayi alibe owonjezera mapaundi - 35 kcal pa kilogalamu. Kuchepetsa zakudya zopatsa mphamvu ziyenera kukhala zosamalitsa komanso zosalala, popanda zovuta,
• maswiti, komanso mtedza ndi mbewu, sizimachotsedwa kwathunthu kuzakudya. Ngati mukufunadi kudya maswiti, sinkhanani ndi zipatso,
• osamadya zakudya zouma (Zakudyazi, phala, mbatata zosenda),
• samalani ndi zakudya zophika ndi zotentha,
• kumwa kwambiri - magalasi 700 amadzimadzi tsiku lililonse,
• tengani mavitamini ndi dokotala wanu, chifukwa mankhwalawa ali ndi shuga,
• yesani kuchepetsa kuchuluka kwa mafuta m'zakudya, ndikuchepetsa mapuloteni mpaka 1.5 g pa kg. Chulukitsani zakudya zanu ndi masamba.

Kumbukirani kuti simungathe kufa ndi ludzu mayi woyembekezera, chifukwa shuga ikukula chifukwa chosowa chakudya.

Ngati chakudyacho sichinapereke zotsatira zomwe zimayembekezeredwa, ndipo kuchuluka kwa glucose kumakhala kwakukulu, kapena wodwalayo samayesa mkodzo wowoneka bwino ndi shuga wabwinobwino, chithandizo cha insulin chimayikidwa.

Mlingo komanso kusintha komwe kumachitika pambuyo pake kumatsimikiziridwa kokha ndi dokotala potengera kulemera kwa amayi apakati komanso msinkhu woyembekezera.

Zilonda zitha kuchitidwa palokha, mutaphunzitsidwa ndi endocrinologist. Nthawi zambiri, msambo umagawidwa Mlingo iwiri: m'mawa (musanadye chakudya cham'mawa) komanso madzulo (mpaka chakudya chomaliza).

Mankhwala a insulin sangathe kusiya kudya, amapitilira nthawi yonse ya mimba.

Zochitika pambuyo pake

Matenda a shuga a Gestational ali ndi gawo limodzi: samasowa ngakhale mutabereka.

Ngati mayi woyembekezera ali ndi HD, ndiye kuti matendawa amatha kukhala ndi matenda ashuga kuwonjezeka kasanu.

Uwu ndi chiopsezo chachikulu. Chifukwa chake, mkazi amawunikidwa nthawi zonse atabadwa. Chifukwa cha miyezi 1.5, ayenera kuwunika kagayidwe kazakudya.

Ngati zotsatirapo zake zili zabwino, kuwunikanso zowonjezereka kumachitika zaka zitatu zilizonse. Koma ngati kuphwanya kwa kulekerera kwa glucose kwapezeka, zakudya zapadera zimapangidwa, ndipo kuwonera kumawonjezeka mpaka 1 nthawi pachaka.

Mimba zonse zotsatila pankhaniyi ziyenera kukonzedwa, chifukwa shuga (nthawi zambiri mitundu iwiri) imatha kubereka patadutsa zaka zingapo pambuyo pobadwa. Zochita zolimbitsa thupi ziyenera kuchuluka.

Makanda obadwa kumene mwa amayi omwe ali ndi HD amangoikidwa pagululi popanda ngozi ndipo amayang'aniridwa ndi achipatala nthawi zonse.