Abesifazane abane- arthritis nezinye izifo zesifo se-rheumatic bangakhathazeka ngokukhulelwa noma babe nokukhathazeka ngisho nangemva kokukhulelwa. Abanye besifazane abanesifo sofuba bangase bacebiswe ukuba bangakhulelwa.
Abesifazane abakhulelwe abane-Arthritis ne-Rheumatic Diseases
Ukukhathazeka kubangelwa ukungaqiniseki ngokuthi isimo somzimba wesifazane sithinta kanjani ukukhulelwa kanye nokuthi ukukhulelwa kuyothinta kanjani isimo sakhe somzimba.
Uma une-arthritis futhi ukhulelwe noma uma ukhulelwe ukucatshangelwa, nansi izinto ezibalulekile okufanele wazi.
1. Ngokubheka ngokucophelela nokuphathwa kahle kwezempilo, abesifazane abane-arthritis noma ezinye izimo ze-rheumatic bangaba nokukhulelwa okuphumelelayo.
Kubalulekile ukuthi abesifazane abakhulelwe abane-arthritis babekwe ngaphansi kokunakekelwa kokubili kwesibhedlela ukuze bakwazi ukuphatha ukukhulelwa kwabo kanye nesifo se- rheumatologist ukuze baphathe isimo sabo se-rheumatic. Ukukhulelwa okuphumelelayo kungenzeka ngenqubo yeqembu, kodwa hhayi konke ukukhulelwa kuzoba ngaphandle kwezinkinga.
2. Umphumela wokukhulelwa ngesifo se-rheumatic uhluka ngokuya ngesimo esithile.
Ukukhulelwa okuhambisana ne- rheumatoid arthritis , lupus , antiphospholipid syndrome , nezinye izimo ze-rheumatic kunezici ezihlukahlukene nokukhathazeka okuhambisanayo.
- Abesifazane abane-arthritis ye-rheumatoid ngokuvamile banezibonakaliso ezithuthukisa ngesikhathi sokukhulelwa kodwa ziphinde ziphinde zivule ngemuva kokuzalwa kwengane. Phakathi nesikhathi sokuthuthukisa, kungenzeka ukuthi kunciphise noma kumise imishanguzo ye-arthritis.
- I-lupus, ngokuvamile ikhona ama-flare amancane kuya olinganisayo okwenzeka ngesikhathi sokukhulelwa, kanye nangemva kokuzalwa.
- I-Antiphospholipid syndrome iyisifo esizimele esisodwa lapho umzimba ubeka khona amantombazane phospholipids noma amaprotheni e-plasma. Isifo singase senzeke nge-systic lupus erythematosus noma esinye isifo se-rheumatic. Ngalesi simo, kunengozi yokwanda kwegazi, ukukhulelwa kwesisu, noma ukucindezeleka komzimba ngesikhathi sokukhulelwa. Isikhathi esiseduze nokubeletha sibaluleke kakhulu.
- I-hypertension ye-pulmonary ngezinye izikhathi ehlotshaniswa ne- scleroderma , i- Sjogren's syndrome , i-lupus, ne-antiphospholipid syndrome ingaba yimbi ngokukhulelwa; yingakho ukukhulelwa akukwaziswa ngalesi simo.
- Ezinye izimo ze-rheumatic, kuhlanganise ne-scleroderma ngaphandle kwe-pulmonary hypertension, i-polymyositis, i-dermatomyositis, ne- vasculitis , ngokuvamile ayithinteki ngokukhulelwa uma izifo zilawulwa.
3. Abesifazane abanesifo sezinso ezihlobene ne-vasculitis, i-scleroderma, noma i-lupus bangengozini enkulu yokweqa umfutho wegazi ophezulu kanye ne-preeclampsia.
Ukutholakala kokukhulelwa okuphumelelayo nokuphilile kuyaphakeme uma umsebenzi wezinso nokucindezelwa kwegazi kungokwemvelo futhi isifo sesifo se-rheumatic singasebenzi noma sokukhululwa okungenani izinyanga ezingu-6 ngaphambi kokukhulelwa. Lokhu kubaluleke kakhulu kubesifazane abane-lupus. Ngakolunye uhlangothi, abesifazane abanezinso ezingavamile zezinso, ukucindezeleka kwegazi okungalawulwayo, nesifo esiyingozi se-rheumatic ngokuvamile bayelulekwa ngokumelene nokukhulelwa.
4. I-heart congenital block ingaba ngamaphesenti aphansi ezinsana ezalwa nabesifazane abanezinqamuzana ezilwa no-anti.
Ama-anti-Ro antibodies avame kakhulu kwiziguli ezine-lupus ne-Sjogren's syndrome. Ama-antibodies angena ekusakazeni kwe-fetal futhi awonakele inhliziyo yentuthuko yengane, eholela esilinganisweni senhliziyo esengozini.
Kwezinye izimo, ingane ingase idinge i-pacemaker. Abesifazane abakhulelwe abanezikhukhula ezilwa no-anti kumele babhekwe ngokucophelela futhi bahlolwe. Ama-anti-La antibodies angase abe nezinkinga ngesikhathi sokukhulelwa.
5. Ukuvuvukala, okuyinto evelele ngesikhathi sesifo esiyingozi, futhi imithi ethile esetshenziselwa ukwelashwa ingaba inkinga ngesikhathi sokukhulelwa.
Kungaba kuhle ukuthi abesifazane bangathathi imithi baze baqede ukukhulelwa nokunakekelwa. Akuyona isimo esihle kakhulu nakuba ukhulelwe futhi une-rheumatic disease, ngakho kufanele kucatshangelwe. Uma imithi edingekayo ukuze igcine isifo sesiwesifazane esilawulwayo isuswa, ingozi yesifo esingalawulwayo kufanele ilinganiswe nezingozi ezingase zibe khona kumntwana ongakazalwa.
6. Kukhona ukuvumelanisa mayelana nokuthi imiphi imishanguzo yokulwa ne-rheumatic ephephile noma engaphephile ukusebenzisa ngesikhathi sokukhulelwa kanye nokulahlwa (ukukhiqizwa ubisi).
Iqembu lezimbangi, izazi ze-rheumatologists, kanye nabaqeqeshi abathintekayo abanolwazi lokuphatha abesifazane abakhulelwe abanezifo zesifo se-rheumatic bavumelene ukuthi iziphi izidakamizwa ezilwa nokuhlukunyezwa ezamukelekayo ukusebenzisa ngesikhathi sokukhulelwa kanye ne-lactation.
Izidakamizwa ezamukelekayo ukusebenzisa ngesikhathi sokukhulelwa kanye ne-lactation zifaka:
- Ama-NSAID (izidakamizwa ezingezona ukuvuvukala okungavunyelwe) kuze kube sevikini 32
- I-Azulfidine (i-sulfasalazine)
- I-Plaquenil (i-hydroxychloroquine)
- I-Corticosteroids (ngaphansi kuka-10 mg uma kungenzeka)
Izidakamizwa ezamukelekayo ukusebenzisa ngesikhathi sokukhulelwa kodwa ziphikisana ngesikhathi sokukhulelwa zihlanganisa:
- I-Cyclosporine A
- I-Imuran (azathioprin)
Izidakamizwa ezingamukeleki ngesikhathi sokukhulelwa kanye ne-lactation zifaka:
- I-Methotrexate
- I-Arava (i-leflunomide)
- CellCept (i-mycophenolate)
- I-Cytoxan (i-cyclophosphamide)
- Imithi e-Anti-TNF
- I-Rituxan (rituximab)
(Qaphela; izidakamizwa ze-Anti-TNF ziyakwengeziwe ukuthi ziphephile ngesikhathi sokukhulelwa futhi mhlawumbe lactation.)
7. Abesifazane abacabangela ukukhulelwa kumele babe nesimo sabo sokungaboni ngaso sonke isikhathi okungenani izinyanga ezintathu kuya kwezingu-6 ngaphambi kokuzama ukukhulelwa.
Kunconywa ukuthi bonke abesifazane abanesifo se-rheumatic banikwe iseluleko yi-rheumatologist kanye nodokotela wezifo ngaphambi kokuzama ukukhulelwa. Ngaleyo ndlela ingozi yabo yokucindezeleka ingahlolwa futhi uhlelo lokuphatha isifo sofuba nokukhulelwa kungasungulwa kahle.
8. Abesifazane abasengozini encane yokubhekana nezinkinga kufanele baqhubeke bebona i-rheumatologist yabo ngezikhathi ezinyangeni ezintathu zokugcina ukuhambisana nokuhlolwa kwezifo nokuphathwa.
Abesifazane ababhekwa njengengozi enkulu yokubhekana nezinkinga kumele babe nesigungu se-obstetric esibhekene nokukhulelwa okuphezulu. Ukuvakashelwa nokuqapha okuqhubekayo kuzodingeka njengoba ukukhulelwa kuqhubeka. Izimo ezenza ukukhulelwa okuphezulu kubandakanya:
- Ukukhubazeka kwezinso
- Izimo zenhliziyo
- Umfutho wegazi ophezulu we-pulmonary
- Isifo sesifo se-lung restriction
- isifo se-rheumatic esebenzayo
- In vitro fertilization
- Ukuzalwa okuningi
- Inkinga ye-obstetric yangaphambilini
Imithombo:
Ukukhulelwa Nezifo Ze-Rheumatic. I-American College of Rheumatology. Mashi 2014.
http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Living-Well-with-Rheumatic-Disease/Pregnancy-Rheumatic-Disease
I-Kelley's Bookbook of Rheumatology. Umagazini wesishiyagalolunye. Elsevier. Ukukhulelwa Kwimizimba Ye-Rheumatic. Isahluko 39.
Ukubuyekeza okuzenzakalelayo. Umbuso wobuciko: Ukuzala nokukhulelwa ngezifo ze-rheumatic. May 2015.
http://www.ncbi.nlm.nih.gov/pubmed/25555818