Kusagwirizana kwa Rh

Kusagwirizana kwa Rh ndi vuto lomwe limayamba mayi wapakati akakhala ndi magazi opanda Rh ndipo mwana m'mimba mwake ali ndi magazi a Rh.

Pakati pa mimba, maselo ofiira ofiira ochokera kwa mwana wosabadwa amatha kuwoloka m'magazi a mayi kudzera pa nsengwa.

Ngati mayiyo alibe Rh, chitetezo chake chamthupi chimagwira ma cell a Rh omwe ali ndi Rh ngati kuti ndi chinthu chachilendo. Thupi la mayi limapanga ma antibodies motsutsana ndi maselo amwana wamagazi. Ma antibodieswa amatha kubwerera kudzera mu placenta kupita kwa mwana yemwe akukula. Amawononga maselo ofiira ofiira a mwana.

Maselo ofiira akaphwanyidwa, amapanga bilirubin. Izi zimapangitsa mwana wakhanda kukhala wachikaso (jaundiced). Mulingo wa bilirubin m'magazi a khanda ungakhale wofewa mpaka wokwera kwambiri.

Makanda oyamba kubadwa nthawi zambiri samakhudzidwa pokhapokha ngati mayi adapita padera kapena kuchotsa mimba kale. Izi zitha kulimbikitsa chitetezo chake chamthupi. Izi ndichifukwa choti zimatenga nthawi kuti mayi apange ma antibodies. Ana onse omwe ali nawo pambuyo pake omwe ali ndi Rh-angakhudzidwe.

Kusagwirizana kwa Rh kumachitika kokha pamene mayi alibe Rh ndipo khanda liri ndi Rh. Vutoli layamba kuchepa m'malo omwe amapereka chithandizo choyenera cha amayi asanabadwe. Izi ndichifukwa choti ma globulin apadera oteteza ku RhoGAM amagwiritsidwa ntchito pafupipafupi.

Kusagwirizana kwa Rh kumatha kuyambitsa zizindikilo kuyambira kofatsa kufikira zakufa. Pang'ono kwambiri, kusagwirizana kwa Rh kumayambitsa kuwonongeka kwa maselo ofiira amwazi. Palibe zovuta zina.

Atabadwa, khanda limatha kukhala ndi:

• Chikasu cha khungu ndi azungu amaso (jaundice)
• Kutsika kwa minofu (hypotonia) ndi ulesi

Asanabadwe, mayiyo amakhala ndi amniotic madzimadzi ozungulira mwana wake wosabadwa (polyhydramnios).

Pakhoza kukhala:

• Chotsatira chotsimikizika chachindunji cha Coombs
• Milingo yoposa yachibadwa ya bilirubin m'magazi a umbilical chingwe cha mwana
• Zizindikiro za kuwonongeka kwa maselo ofiira m'magazi a khanda

Kusagwirizana kwa Rh kungapewedwe kugwiritsa ntchito RhoGAM. Chifukwa chake, kupewa kumakhalabe chithandizo chabwino kwambiri. Chithandizo cha khanda lomwe lakhudzidwa kale chimadalira kukula kwake.

Makanda omwe ali ndi vuto losagwirizana ndi Rh angathandizidwe ndi phototherapy pogwiritsa ntchito magetsi a bilirubin. IV globulin yoteteza mthupi itha kugwiritsidwanso ntchito. Kwa makanda omwe akhudzidwa kwambiri, angafunike kuthiridwa magazi. Izi ndikuchepetsa milingo ya bilirubin m'magazi.

Kuchira kwathunthu kumayembekezeredwa chifukwa chosagwirizana kwa Rh.

Zovuta zingaphatikizepo:

• Kuwonongeka kwa ubongo chifukwa cha milingo yayikulu ya bilirubin (kernicterus)
• Kutulutsa kwamadzimadzi ndi kutupa mwa mwana (hydrops fetalis)
• Mavuto ndi magwiridwe antchito, kuyenda, kumva, kulankhula, ndi kugwidwa

Itanani omwe akukuthandizani ngati mukuganiza kapena mukudziwa kuti muli ndi pakati ndipo simunamuwonepo wokuthandizani.

Kusagwirizana kwa Rh kumatetezedwa kwathunthu. Amayi omwe alibe Rh ayenera kutsatiridwa kwambiri ndi omwe amawapatsa pakati.

Ma globulin apadera oteteza ku chitetezo cha mthupi, otchedwa RhoGAM, tsopano akugwiritsidwa ntchito popewa kusagwirizana kwa RH kwa amayi omwe alibe Rh.

Ngati abambo a khanda ali ndi Rh-kapena ngati magazi ake sakudziwika, mayiyo amapatsidwa jakisoni wa RhoGAM nthawi yachitatu yachitatu. Ngati mwanayo ali ndi kachilombo ka Rh, mayiyo adzalandanso jekeseni yachiwiri m'masiku ochepa atabadwa.

Majakisoni amenewa amalepheretsa kupanga ma antibodies olimbana ndi magazi a Rh. Komabe, azimayi omwe ali ndi mtundu wopanda magazi wa Rh ayenera kulandira jakisoni:

• Pakati pa mimba iliyonse
• Kutuluka padera kapena kuchotsa mimba
• Pambuyo poyesedwa asanabadwe monga amniocentesis ndi chorionic villus biopsy
• Pambuyo povulala pamimba panthawi yapakati

Rh-inded hemolytic matenda a wakhanda; Erythroblastosis fetalis

• Mwana wakhanda jaundice - kumaliseche

• Erythroblastosis fetalis - photomicrograph
• Mwana wakhanda
• Ma antibodies
• Kusinthana magazi - mndandanda
• Kusagwirizana kwa Rh - mndandanda

Kaplan M, Wong RJ, Sibley E, Stevenson DK. Matenda a neonatal jaundice ndi matenda a chiwindi. Mu: Martin RJ, Fanaroff AA, Walsh MC, olemba., Eds. Fanaroff ndi Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015: mutu 100.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Matenda amwazi. Mu: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 124.

Limbikitsani KJ. Kuphatikiza kwa maselo ofiira. Mu: Gabbe SG, Niebyl JR, Simpson JL, et al, olemba. Obstetrics: Mimba Yachibadwa ndi Mavuto. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2017: mutu 34.