Kwa odwala matenda a shuga, njira zonse zakulera zimagwiritsidwa ntchito. Zoyenera kukula zingathe kugwiritsidwa ntchito. Nkhondoyokhala ndi mkuwa. Osasiya "antennae" a IUD atapachikika kuchokera pachibelekeropo, chifukwa amatha kukhala magalimoto oyambitsa matenda. Ma IUD odwala omwe ali ndi matenda ashuga amayambitsa mavuto nthawi zambiri kuposa amayi athanzi.

Kukonzekera piritsi yoletsa kubereka, omwe amatchedwa COCs (ophatikiza kulera pakamwa), angagwiritsidwe ntchito, ndipo ndikofunika kugwiritsa ntchito njira zakulera zazigawo zitatu. Nthawi zina, pamenepa, ndikofunikira kuti muwonjezere mlingo wa insulin. Odwalamavuto a mtima a matenda ashuga, mapiritsi oteteza kubala sayenera kugwiritsidwa ntchito.Pamene GDMkusowa pambuyo pobala mwana kumatha kugwiritsidwa ntchito ma progestin (zachikazi, exluton, etc.).

Kugwiritsa ntchito sikumaphatikizidwa zotchinga njira za kulerakomanso samatumba, omwe amatha kuchitidwa ndi opaleshoni yobereka kapena laparoscopically palibe kale kuposa masabata a 6-8. pambuyo pobereka.

4.3. Kuphunzira pawokha kwa amayi apakati omwe ali ndi matenda ashuga

Ndikofunikira kukambirana ndi wodwalayo ndi mnzake zisonyezo za glycemia panthawi yapakati, gawo lodziyang'anira pawokha ndi kafukufuku wokhazikika wa HbA1c, chiwopsezo cha amayi ndi mwana. Ayenera kulimbikitsidwa kwambiri kupita ku sukulu ya Mimba ndi Chiwopsezo, ngakhale mkazi atangolowa pasukulu ya odwala omwe ali ndi matenda ashuga. Pa nthawi ya pakati, kusintha kwa thupi la mkazi kumachitika pafupipafupi, kumafunikira chidziwitso chofunikira chololera kusintha mawonekedwe onse a matenda, popeza chachikulu chomwe chimayambitsa zovuta zonse zam'mimba si kutalika kwa matenda ashuga, ndi mtundu wa chindapusa chake kuyambira pa kukhala wakubereka. Mkazi wothandizirana akhoza kupereka chithandizo mwachindunji kuti pakhalebe chokhazikika pakubwezeretsereka kwa matenda ashuga, chifukwa chake, maphunziro othandizana nawo amalimbikitsidwa.

Kuphatikiza pa maphunziro a zamankhwala, ndikofunikira kuti adziwe njira zomwe wodwalayo adadziwudzire, amawongolera glucometer, kuwunika momwe wodwalayo adziwira bwino insulin mankhwala algorithm, ndikuwunika momwe angagwiritsidwire ntchito polemba insulin. Ndikofunikanso kulankhula za njira zamakono zopangira insulin: syringe - zolembera, ma insulin majakisoni (innovo okhala ndi kukumbukira), mapampu a insulin (medtronic). Mbali zachuma zavutoli ziyeneranso kuthetsedwa. Kuyezedwa mobwerezabwereza tsiku lililonse kwa glycemia, acetonuria, kuwonjezeredwa kwa mayeso kwa amayi apakati omwe ali ndi matenda ashuga kumafuna ndalama zina, zomwe zimafunikanso kukumbukiridwa pakukonzekera kukhala ndi pakati (Gome 2).

Makina a intrauterine.

Chipangizo cha intrauterine (IUD) ndi pulogalamu ya intrauterine, yomwe ndi chipangizo chaching'ono chopangidwa ndi pulasitiki chokhala ndi mkuwa chomwe chimalepheretsa umuna kulowa muchiberekero, kuletsa dzira ndi umuna kuti usakumane, komanso kulepheretsa dzira losauthidwa kuti lisamvere khoma la chiberekero. Malinga ndi ziwerengero, azimayi amodzi mwa 100 aliwonse omwe ali ndi njira yolerera imeneyi amakhala ndi pakati. Proteerone ya mahormoni kuchokera munthawiyi imatulutsidwa pang'onopang'ono, koma mosalekeza, kumathandizira kuchepa kwa gawo logwira ntchito mkati mwa khoma la chiberekero (endometrium), lomwe limalepheretsa dzira losauthira kuti lisamatike kukhoma la uterine, ndikupanganso khomo lachiberekero cha chiberekero (izi zimapangitsa kuti zikhale zovuta kulowa kwa umuna ikhoza kukumana ndi dzira). Ubwino wa njirayi ndi njira zabwino zakulera, osafunikira pakudya pafupipafupi, monga momwe zilili ndi mapiritsi. Kuzungulira kumakhala kwa zaka 5. Zowopsa ndizoyipa zamavuto monga matenda, komanso nthawi zochulukirapo komanso zopweteka. Ma IUD nthawi zambiri amakhazikitsidwa kwa amayi omwe abereka. Zomwe zilipo zikuwonetsa zisonyezo zofanizira kukhazikitsa chipangizo cha intrauterine monga momwe ziliri ndi amayi opanda shuga. Njirayi imachepetsa chiwongolero cha matenda ashuga.

Zoletsa za kulera.

Zomwe zimayikidwa zimayikidwa pang'onopang'ono, ndipo zotulukapo zake zimatheka ndikupondereza ovulation (kutuluka kwa dzira kuchokera ku thumba losunga mazira). Mukamagwiritsa ntchito, mayi m'modzi mwa 100 aliwonse amatha kukhala ndi pakati. Imayikidwa pogwiritsa ntchito mankhwala oletsa ululu kwa zaka zitatu. Ubwino wake ndiwodziwikiratu - kukwera kwambiri, kukhazikitsa kamodzi kwa zaka zitatu. Zoyipa ndizovuta zakuwonera komanso zazing'onoting'ono zomwe zimachitika nthawi zambiri m'miyezi yoyambirira.

Zingwe za subcutaneous ndizotetezanso kwa anthu omwe ali ndi matenda ashuga. Malinga ndi kafukufuku, mankhwalawa sanakhudze kuchuluka kwa hemoglobin wa glycated ndipo sanathandizire kukula kwa zovuta za matenda ashuga. Chifukwa chofutira kwambiri chowasiya iwo chinali kuwonera kwakanthawi.

Kuti kulera kwakanthawi kochepa phatikizani njira zakulera za pakamwa komanso ziwongola dzanja. Izi ndi njira zofala kwambiri zakulera. Komabe, chaka chimodzi chitatha kugwiritsa ntchito njirayi, azimayi 68% okha ndi omwe amapitiliza kudya, chifukwa mapiritsi amayenera kumwedwa tsiku lililonse, zigamba zimasinthidwa sabata iliyonse, ndipo zimakhazikika pamwezi. Pamaso pa mtundu 1 wa shuga wopanda vuto la mtima, phindu la mankhwalawa limaposa zowopsa zake.

Pakamwa (pakamwa) njira zakulera kapena mapiritsi otithandizira.

Iyi ndi imodzi mwazofala kwambiri njira zakulera. Pali magulu angapo a mapiritsi a kulera: kuphatikiza mankhwala (yokhala ndi mahomoni awiri - estrogen ndi progesterone) komanso kokha progesterone - yokhala mankhwala. Choyambirira, mahomoni awa amachita ngati mazira, kutsekereza kutuluka kwa dzira (ovval). Kuphatikiza apo, mahomoni awa amapangitsa kuti khomo lachiberekero libere, ndikupanga endometrium kuonda, zomwe zimalepheretsa dzira lolumikizidwa kukhoma la chiberekero. Timakambirana pagulu lililonse.

Kafukufuku wa Epidemiological awonetsa kuti kutenga kuphatikiza kulera kwamlomo mogwirizana ndi chiwopsezo chachikulu cha matenda a mtima. Inde, kumwa mankhwalawa kumatha kutenga nawo gawo mu zovuta za matenda a shuga zomwe zilipo. Kuphatikiza apo, asadakhazikitsidwe, ndikofunikira kuwunika zomwe zikuwonetsa momwe magazi amapangidwira, chifukwa chiopsezo chopanga magazi amawundana (magazi amawonjezera).

Chifukwa chake, mapiritsi othandizira kubadwa awa ndi oyenera ngati muli ndi zaka zakubadwa 35 ndipo mulibe zovuta zofanana ndi zotupa za msana komanso ziwopsezo monga kuthamanga kwa magazi, kunenepa kwambiri, kusuta komanso kukhalapo kwa venous thrombosis m'mbuyomu.

Njira zophatikizira zakuthirira pakamwa, zikagwiritsidwa ntchito mu Mlingo waukulu, zimakhudza kufunika kwa insulini, kuonjezera, ndipo Mlingo wochepa mphamvu izi ndizochepa.

Malinga ndi ziwerengero, azimayi amodzi (1) mwa 100 aliwonse omwe amamwa mapiritsiwa nthawi zambiri amakhala ndi pakati. Ubwino wawo ndiwothandiza bwino, owerengeka azotsatira zoyipa, ndipo amagwiritsidwanso ntchito nthawi zopweteka komanso zolemetsa. Ndipo zovuta zake ndi chiopsezo chambiri chakutulutsa magazi (ziwunda za magazi), kufunikira kwa kuvomerezedwa kosalekeza popanda mipata, zotsutsana ndi matenda ena.

Mankhwala okhala ndi progesterone.

Kukonzekera komwe kumakhala ndi progesterone kapena zakumwa zoziziritsa kukhosi (ndiye kuti, "mapiritsi ochepa") kumakhala koyenera kwa amayi omwe ali ndi matenda amtundu wa 1, chifukwa sizikhudza chiwopsezo cha matenda ashuga kapena chiopsezo chokhala ndi zovuta za matenda ashuga. Malinga ndi ziwerengero, azimayi amodzi (1) mwa 100 aliwonse omwe amamwa mapiritsiwa nthawi zambiri amakhala ndi pakati. Zoyipa za njira yolerera za kulera ndizotheka kusakhazikika kwa msambo komanso kuti zimayenera kutengedwa panthawi yotsimikizika. Amachitapo kanthu chifukwa cha kuchuluka kwa ntchofu mu khomo lachiberekero, kupatulira kwa chiberekero, komanso kutsekeka kwa mazira m'mimba. Kuphatikiza apo, mankhwalawa nthawi zambiri amagwiritsidwa ntchito ndi akazi anyama, azimayi opitirira zaka 35, komanso osuta.

Muyenera kuzigwiritsa ntchito molingana ndi malamulo ovomerezeka kuti mudziteteze ku mimba. Zomwe zimayambitsa kulephera kulera pakumwa mapiritsi oletsa kubereka ndi kudumphadwala, kumwa mankhwala, kapena zinthu zina zomwe zimakhudza kugwira bwino ntchito (mwachitsanzo, kumwa maantibayotiki, kusanza, kapena kutsekula m'mimba).

Choletsa.

Mtundu wophatikiza kulera wokhala ndi estrogen ndi progesterone. Ichi chigamba chimamangiriridwa pakhungu. Ubwino wamtunduwu ndizosavuta kugwiritsa ntchito, kugwiritsa ntchito bwino, komanso kupepuka komanso nthawi zopweteka. Choyipa chake ndikuletsa ntchito kwa gulu lina la anthu. Simalimbikitsidwa kwa azimayi azaka zopitilira 35, osuta fodya, komanso azimayi olemera kuposa makilogalamu 90, popeza kuchuluka kwa mahomoni kungakhale kosakwanira kuteteza kutenga pakati.

Kuti njira zopanda mahomoni monga makondomu, ma diaphragms, ma spermicidal gels, njira yolerera yachilengedwe. Ngati mkazi sakufunanso ana, ndizotheka kugwiritsa ntchito njira yolera yotseketsa.

Njira zotchinga.

Izi zikuphatikiza ma kondomu (achimuna, achikazi), ma diaphragms. Amaletsa umuna kuti usalowe muchiberekero. Kuchita kwawo kumachepera pang'ono. Mukamagwiritsa ntchito kondomu ya abambo, azimayi awiri mwa 100 aliwonse amatha kukhala ndi pakati. Ubwino ndi kusowa kwa chiwopsezo chachipatala, komanso mavuto ena. Kuphatikiza apo, kumbukirani kuti makondomu amateteza ku matenda opatsirana pogonana. Zoyipa zake ndikuchepa kwa kudalirika kwa njirayo, kufunika kogwiritsa ntchito nthawi iliyonse, komanso mwayi wophwanya umphumphu wa kapangidwe kake.

Kuchokera pamalingaliro azachipatala, njira zotchinga ndizoyenera kwa azimayi onse omwe ali ndi matenda amtundu wa 1 chifukwa chochepa cha zoyipa ndi zotsatira zake pakulamulira matenda ashuga. Makondomu, ma spermicides ndi ma diaphragms ndi njira zabwino zolerera ngati zigwiritsidwa ntchito moyenera komanso mosalekeza. Komabe, kupambana kwa njirazi kumatengera kudzipereka kwanu munjira iyi komanso kugwiritsa ntchito nthawi zonse. Ndi abwino kwa amayi omwe safuna kumwa mankhwala a mahomoni omwe akukonzekera kukhala ndi pakati pa miyezi isanu ndi umodzi ndi itatu, ndipo, mwachilendo kwambiri, azimayi omwe amalephera kugwiritsa ntchito njira zina zotetezera.

Zachidziwikire, kwa azimayi omwe alibe mnzawo wogonana, makondomu amayenera kugwiritsidwa ntchito kuti ateteze kumatenda opatsirana pogonana. Iyi ndiye njira yokhayo yodzitetezera yomwe imateteza ku matenda awa.

Mukamasankha njira zotere, muyenera kudziwitsidwa ndi dokotala za njira zakulera mwadzidzidzi. Njira zakulera zadzidzidzi zimagwiritsidwa ntchito ngati simukufuna kutenga pakati: pogonana popanda njira zakulera, ngati kondomu idawonongeka, ngati mukuphonya mapiritsi oletsa kubereka, kapena ngati mumamwa maantiamu omwe amachepetsa mphamvu ya mapiritsi oteteza kulera.

Kwa azimayi omwe safunanso kukhala ndi pakati, njira yolera yotsekera ndi yankho linanso. Komabe, njira zomwe zili pamwambazi sizotsika pakulimbitsa thupi ndipo sizikuchita opareshoni. Kuchita chokomera chachikazi ndi njira yochitira opaleshoni njira yolerera, yozikidwa pakapangidwe kazinthu zoletsa ma fallopian machubu. Ndiosavuta kuchita izi munthawi ya cesarean. Samisili yazimayi sichimasintha ma hormonal. Mutha kukambirana za nkhaniyi ndi dokotala nthawi yonse yomwe mwakonzekera. Kuchepetsa amuna ndi kothekanso - vasectomy, opareshoni yomwe kunyamula kapena kuchotsa chidutswa cha vas deferens kumachitika mwa amuna. Ndizofunikira ngati muli ndi bwenzi logonana nthawi zonse.

Kulera Za Matenda A shuga

Mkhalidwe waumoyo wa mayi yemwe ali ndi matenda ashuga

Makina, am'deralo, opaleshoni

Odwala omwe ali ndi matenda ashuga 1 omwe ali ndi mwayi woperekera chipukuta misozi komanso mopondera, popanda kutchulidwa kwamavuto a mtima

• Njira zitatu zakulera za pakamwa (Zabwino) (Triquilar, Triziston, zitatu-Mersey)

• Vaginal hormonal contraceptures

Odwala omwe ali ndi matenda ashuga 2 ali m'malo operekera ndalama ndi kulipirira

• Mlingo wochepetsetsa wophatikizidwa bwino womwe uli ndi ma 20-30 mamilimita a ethinyl estradiol (Logest, Mercilon, Novinet) • Progestogens a m'badwo waposachedwa (Desogestrel, Norgestimat, Gestoden)

• Njira zakulera zapakati pa intrauterine (“chipangizo cha intrauterine chamtundu wosagwa ndi bezel”)

Odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi hypertrig-lyceridemia ndi chiwindi chodwala

• Mphete zam'mimba zitha kubereka

Odwala omwe ali ndi matenda amtundu wa 1, pakubwezeretseka komanso / kapena ndi zovuta zamagazi

• Ma IUD okhala ndi Gestagen • Makina ndi zida (zokutira, zokutira)

Odwala omwe ali ndi matenda ashuga 1, ali ndi ana awiri kapena kupitilira apo komanso / kapena koopsa matenda oyambitsidwa

Kudzifunira Opaleshoni Yothandiza

Odwala matenda a shuga ayi. Njira zotsatirazi zakulera zikulimbikitsidwa:

• progestogens (odwala omwe ali ndi matenda a shuga 1),

• njira yoletsa kubereka.

Zizindikiro zakuwongolera glycemic mwa ana ndi achinyamata omwe ali ndi matenda a shuga 1 (ISPAD Consensus Gu>)

Njira zachilengedwe zakulera.

Izi zimaphatikizapo kusokonezedwa kwa kugonana ndi kugonana masiku “otetezedwa”. Zachidziwikire, muyenera kumvetsetsa kuti njirazi ndizothandiza kwambiri. Kuti mudziwe masiku "otetezeka", ndikofunikira kuzungulira pafupipafupi kwa magwiritsidwe azizindikiro monga kutentha kwa thupi, kutulutsa nyini ndi mayeso apadera kuti mudziwe tsiku la ovulation. Ubwino wake ndi kusapezeka kwa mavuto, kuwonjezera pa chiwopsezo chachikulu cha kutenga pakati.

Pomaliza, ndikufuna kudziwa kuti kutenga pakati sikuyenera kukhala kokha kosangalatsa, komanso kukonzekera, motero ndikofunikira kufikira nkhaniyi mosamalitsa. Pakadali pano pali msika wambiri woletsa kulera, ndipo, chifukwa cha izi, mutha kuchita zogonana osawopa kukhala ndi pakati. Kutengera mapulani anu apakati, zomwe mumakonda, momwe mumakhalira, komanso kupezeka kwa zovuta za matenda ashuga, inu ndi dokotala mudzatha kusankha njira yabwino yodzitetezera.