Hānau Breech

ʻO ke kūlana maikaʻi loa no kāu pēpē i loko o kou kōpū i ka manawa o ka hānau ʻana he poʻo i lalo. ʻOi aku ka maʻalahi o kēia kūlana a palekana hoʻi no ka hele ʻana o kāu pēpē ma ke aʻa hānau.

I nā pule hope o ka hāpai ʻana, e nānā kāu mea mālama ola e ʻike i ke kūlana o kāu pēpē.

Inā ʻaʻole manaʻo ke kūlana o kāu pēpē i kahi maʻamau, pono ʻoe i kahi ultrasound. Inā hōʻike ka ultrasound i kāu pēpē breech, e kamaʻilio pū kāu mea lawelawe me ʻoe e pili ana i kāu mau koho no ka lawe palekana.

I ke kūlana breech, lalo ka pēpē i lalo. Aia kekahi mau ʻano breech:

• ʻO ka breech piha ke kumu o ka pēpē ma lalo-mua, me nā kuli i kūlou.
• ʻO Frank breech ke ʻano o ka hohola ʻia o nā wāwae o ka pēpē, me nā wāwae kokoke i ke poʻo.
• ʻO ka wāwae wāwae breech ʻo ia hoʻi ka hoʻohaʻahaʻa ʻia o hoʻokahi wāwae ma luna o ka pūpū o ka makuahine.

Loaʻa paha iā ʻoe kahi pēpē breech inā ʻoe:

• E hele i ka hana mua
• Loaʻa i kahi kōpū, fibroids, a i ʻole ka nui o ka wai amniotic
• Loaʻa i hoʻokahi pēpē i kāu ʻōpū
• E loaʻa i ka placenta previa (ke kau ka placenta ma ka ʻaoʻao haʻahaʻa o ka paia uterine, e ālai ana i ka cervix)

Inā ʻaʻole kāu pēpē i kahi kūlana poʻo i lalo ma hope o kāu hebedoma 36, ​​hiki i kāu mea hāʻawi ke wehewehe i kāu mau koho a me kā lākou mau pilikia e kōkua iā ʻoe e hoʻoholo i nā hana e hana aʻe ai.

Hāʻawi paha kāu mea lawelawe e hoʻāʻo e alakaʻi i ka pēpē i kahi kūpono. Kapa ʻia kēia he mana kūwaho. Hoʻopili ia i kou ʻōpū ke nānā aku i ka pēpē ma kahi ultrasound. Hiki i ke kaomi ke kumu i kekahi mau pilikia.

Inā hoʻāʻo kāu mea lawelawe e hoʻololi i ke kūlana o kāu pēpē, hāʻawi ʻia iā ʻoe i lāʻau e hoʻomaha ai i nā mākala o kou kōpū. Hiki iā ʻoe ke manaʻo:

• Kahi ultrasound e hōʻike i kāu mea hoʻolako i kahi o ka placenta a me ka pēpē.
• ʻO kāu mea hoʻolako e pahu i kou ʻōpū e hoʻāʻo a hoʻohuli i ke kūlana o kāu pēpē.
• E kiaʻi ʻia ka puʻuwai puʻuwai o kāu pēpē.

He kiʻekiʻe ke kūleʻa inā hoʻāʻo kāu mea lawelawe i kēia kaʻina hana ma kahi o 35 a 37 mau pule. I kēia manawa, ua liʻiliʻi iki kāu pēpē, a ʻoi aku ka nui o ka pinepine o ka wai a puni ka pēpē. Ua ʻelemakule hoʻi kāu pēpē inā he pilikia i ka wā o ke kaʻina hana e pono ai e hānau koke i ka pēpē. Kākaʻikahi kēia. ʻAʻole hiki ke hana ʻia i kahi mana kūwaho ke hana ʻoe ma ka hana.

Haahaa nā pilikia no kēia kaʻina hana ke hana ia e kahi mea lawelawe mākaukau. Kākaʻikahi, hiki ke alakaʻi i kahi hānau cesarean pilikia (C-ʻāpana) inā:

• ʻO ka hapa o ka placenta kahi e haehae ai mai ka pale o kou ʻōpū
• Haʻahaʻa haʻahaʻa loa ka puʻuwai o kāu pēpē, kahi hiki ke hana inā ʻōwili paʻa ʻia ka umbilical cord a puni ka pēpē

ʻO ka hapa nui o nā pēpē e noho breech ma hope o ka hoʻāʻo ʻana e huli iā lākou e hāʻawi ʻia e C-section. E wehewehe kāu mea hāʻawi i ka makaʻu o ka lawe ʻana i kahi pēpē pēpē ma ke kino.

I kēia lā, ʻaʻole hāʻawi ʻia ke koho e hāʻawi i kahi pēpē pēpē i ka hapanui o nā hihia. ʻO ke ala palekana loa e hānau ʻia ai kahi pēpē breech na C-ʻāpana.

ʻO ka makaʻu o ka hānau breech ka hapanui ma muli o ka ʻo ka hapa nui o ka pēpē kona poʻo. Ke hoʻopakele mua ka pelvis o ka pēpē breech a i ʻole ka hiʻupuʻu, ʻaʻole lawa paha ka pelvis o ka wahine no ka lawe ʻia ʻana o ke poʻo. Hiki i kēia ke hopena i ka paʻa ʻana o kahi pēpē i ke aʻa hānau, kahi e hōʻeha ai i ka make a make paha.

E hōʻino a pale paha ka umbilical cord. Hiki i kēia ke hoʻemi i ka lako oxygen o ka pēpē.

Inā hoʻolālā ʻia kahi ʻāpana C, e hoʻonohonoho ʻia ia ma mua o 39 mau pule. E loaʻa iā ʻoe kahi ultrasound ma ka haukapila e hōʻoia i ke kūlana o kāu pēpē ma mua pono o ke kaha.

Aia kekahi manawa e hele i kahi hana a haki paha kāu wai ma mua o kāu ʻaoʻao C i hoʻolālā ʻia. Inā kū kēlā, kāhea koke i kāu mea lawelawe a hele i ka haukapila. He mea nui e hele koke inā loaʻa kāu pēpē breech a haki kāu ʻeke wai. ʻO kēia no ka mea aia kahi manawa kiʻekiʻe e puka i waho ke kaula ma mua o kou hana. Hiki ke weliweli loa kēia no ka pēpē.

Hāpai keiki - breech; Lawe ʻia - breech

Lanni SM, Gherman R, Gonik B. Malpresentations. I: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Nā Obstetrics: Nā Pregnancies Maʻamau a me nā pilikia. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 17.

ʻO Thorp JM, Grantz KL. ʻO nā ʻaoʻao Clinical o ka hana maʻamau a maʻamau. I: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. ʻO Medicine a Maternal-Fetal a Creasy a me Resnik: Nā Manaʻo a me ka Hoʻomeheu. 8th ed. Piladelapia, PA: Elsevier Saunders; 2019: chap 43.

ʻO Vora S, ʻo Dobiesz VA. Hānau hānau pilikia. I: Roberts JR, Custalow CB, Thomsen TW, eds. ʻO Roberts a me Hedges 'Nā Kauka Lapaʻau i ka Medicine Emergency a me ka Care Acute. ʻEpekema 7 Piladelapia, PA: Elsevier Saunders; 2019: chap 56.

• Nā Pilikia hānau keiki