Hydrops fetalis

Hydrops fetalis ndi vuto lalikulu. Zimachitika pamene madzi amadzimadzi amadzikundikira m'magulu awiri kapena kupitilira apo a mwana wosabadwa kapena wakhanda. Ndi chizindikiro cha mavuto.

Pali mitundu iwiri ya ma hydrops fetalis, immune and nonimmune. Mtunduwo umadalira chifukwa cha madzimadzi osazolowereka.

• Chitetezo chamthupi cha hydrops fetalis Nthawi zambiri kumakhala kusamvana kwamtundu wa Rh wosagwirizana, komwe kumatha kupewedwa. Umenewu ndi mkhalidwe womwe mayi yemwe ali ndi mtundu wamagazi wopanda Rh amapanga ma antibodies ku ma Rh omwe ali ndi magazi amwana wake, ndipo ma antibodies amalowa m'mimba. Kusagwirizana kwa Rh kumapangitsa kuti maselo ambiri ofiira m'mimba mwa mwana awonongeke (Izi zimadziwikanso kuti matenda a hemolytic a wakhanda.) Izi zimabweretsa mavuto kuphatikiza kutupa kwathunthu kwa thupi. Kutupa kwakukulu kumatha kusokoneza momwe ziwalo za thupi zimagwirira ntchito.
• Ma hydrops osasunthika fetus ndizofala kwambiri. Imakhala ndi 90% yama hydrops. Chikhalidwe chimachitika pamene matenda kapena matenda amakhudza kuthekera kwa thupi kusamalira madzi. Pali zifukwa zitatu zomwe zimayambitsa mtunduwu, mavuto amtima kapena am'mapapo, kuchepa kwa magazi m'thupi (monga thalassemia kapena matenda), ndi mavuto amtundu kapena chitukuko, kuphatikizapo Turner syndrome.

Chiwerengero cha makanda omwe amateteza chitetezo cha mthupi ma hydrops fetalis chatsika chifukwa cha mankhwala otchedwa RhoGAM. Mankhwalawa amaperekedwa ngati jakisoni kwa amayi apakati omwe ali pachiwopsezo cha kusagwirizana kwa Rh. Mankhwalawa amalepheretsa kuti apange ma antibodies motsutsana ndi maselo ofiira a ana awo. (Palinso zosowa zina zamagulu amwazi omwe amathanso kuyambitsa ma hydrops fetalis, koma RhoGAM siyithandiza izi.)

Zizindikiro zimadalira kukula kwa vutoli. Mitundu yofatsa imatha kuyambitsa:

• Kutupa chiwindi
• Sinthani mtundu wa khungu (pallor)

Mitundu yowopsa ingayambitse:

• Mavuto opumira
• Mikwingwirima kapena mabala ofinya pakhungu
• Mtima kulephera
• Kuchepa kwa magazi m'thupi
• Jaundice kwambiri
• Kutupa kwathunthu kwa thupi

Ultrasound yomwe yachitika panthawi yoyembekezera ikhoza kuwonetsa:

• Kutalika kwa amniotic madzimadzi
• Phukusi lalikulu modabwitsa
• Madzimadzi omwe amachititsa kutupa mkati ndi kuzungulira ziwalo za mwana wosabadwa, kuphatikiza chiwindi, ndulu, mtima, kapena mapapo

Amniocentesis komanso ma ultrasound opitilira pafupipafupi adzachitika kuti adziwe kukula kwa vutoli.

Chithandizo chimadalira chifukwa. Pakati pa mimba, chithandizo chingaphatikizepo:

• Mankhwala oyambitsa kubereka msanga komanso kubereka mwana
• Kutumiza koyambirira kwa kachilombo ngati vuto likuipiraipira
• Kupereka magazi kwa mwana akadali m'mimba (kuthiridwa magazi m'mimba mwa feteleza)

Kuchiza kwa wakhanda kungaphatikizepo:

• Kwa ma hydrop hydrops, kuthiridwa mwachindunji kwa maselo ofiira ofanananso ndi magazi amwana wakhanda. Kusinthanitsa magazi kuti muchotse thupi la mwana zinthu zomwe zikuwononga maselo ofiira amachitidwanso.
• Kuchotsa madzi owonjezera m'mapapu ndi ziwalo zam'mimba ndi singano.
• Mankhwala oletsa kulephera kwa mtima ndikuthandizira impso kuchotsa zakumwa zina.
• Njira zothandizira mwana kupuma, monga makina opumira (makina opumira).

Hydrops fetalis nthawi zambiri imabweretsa imfa ya khanda posachedwa kapena atabereka. Chiwopsezo chimakhala chachikulu kwa ana omwe amabadwa msanga kwambiri kapena omwe amabadwa akudwala. Makanda omwe ali ndi vuto lachilengedwe, ndipo omwe alibe chifukwa chodziwika cha ma hydrops nawonso ali pachiwopsezo chachikulu.

Kuwonongeka kwa ubongo kotchedwa kernicterus kumatha kuchitika chifukwa cha kusagwirizana kwa Rh. Kukula kwachitukuko kwawonedwa mwa makanda omwe adalandira ma intrauterine.

Kusagwirizana kwa Rh kungapewedwe ngati mayi apatsidwa RhoGAM panthawi yapakati komanso pambuyo pathupi.

• Hydrops fetalis

Dahlke JD, Magann EF. Ma hydrops amthupi ndi osasunthika. Mu: Martin RJ, Fanaroff AA, Walsh MC, olemba., Eds. Fanaroff ndi Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015: chap 24.

[Nkhani yaulere ya PMC] [Adasankhidwa] Langlois S, Wilson RD. Ma hydrops a fetal. Mu: Pandya PP, Oepkes D, Sebire NJ, Wapner RJ, eds. Mankhwala a Fetal: Basic Science ndi Clinical Practice. Wachitatu ed. Philadelphia, PA: Elsevier; 2020: chap 36.

Suhrie KR, Tabbah SM. Mimba zoopsa. 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 114.