Kusununguka kuzvara: kazhinji kunoiswa…

Zvipupuriro - zvese zvisingazivikanwe - zvinoshura. « Pakuronga kwangu kwekuzvarwa, ndakanga ndaratidza kuti ndaida kumirira 2 kana 3 mazuva mushure memazuva ekupedzisira kuzvara mwana. Hazvina kuverengerwa. Ndakashevedzwa musi wetemu kuchipatara uye ndakabatwa, pasina kundipa imwe nzira. Kuita uku uye kuboora homwe yemvura zvakaiswa pandiri. Ndakasangana nazvo semhirizhonga huru », Inoratidza mumwe wevatori vechikamu muongororo huru yeCollective interassociative pakuzvarwa (Ciane *) kubata ne "Kuberekwa kwakatangwa munharaunda yechipatara". Pamhinduro gumi nemasere kubva kuvarwere vakazvara pakati pe18 ne648, 2008% yevakadzi vakabvunzwa vakati vaive vasangana ne "trigger". Nhamba inoramba yakagadzikana munyika yedu, sezvo yaiva 2014% mu23 (National Perinatal Survey) uye 23% panguva yekupedzisira tsvakurudzo muna 2010. 

Rini chinokonzeresa chinoratidzwa?

Dr Charles Garabedian, chiremba wezvekubereka-vakadzi uye mukuru wekiriniki paJeanne de Flandres chipatara chevakadzi muLille, chimwe chezvikuru muFrance zvinosununguka kashanu pagore, anotsanangura kuti: “ Induction inzira yekunyepedzera yekukurudzira kuzvara kana mamiriro ezvekurapa uye ekuzvara achida.. »Tinosarudza kukonzeresa kune zvimwe zviratidzo: kana zuva rekupedzisira rapfuura, zvichienderana nekuzvara pakati peD + 1 zuva uye D + 6 mazuva (uye kusvika pamuganho wemavhiki makumi mana nemaviri e amenorrhea (SA) + 42 mazuva akawanda **). Asiwo kana mai vemangwana vaive ne kuputika kwehombodo yemvura pasina kubatika mukati memaawa makumi mana nemasere (nekuda kwenjodzi yekutapukirwa nefetus), kana kana "fetus" ikamira kukura, kurova kwemoyo kusiri kujairika, kana nhumbu yemapatya (munyaya iyi, tinotanga pa 39 WA, zvichienderana nokuti mapatya anogovera placenta imwechete kana kwete). Kurutivi rwaamai vane pamuviri, zvinogona kuva apo preeclampsia inoitika, kana kana paine pre-pregnancy diabetes kana gestational diabetes isina kuenzana (yakarapwa ne insulin). Kune zvese izvi zviratidzo zvekurapa, vanachiremba vanosarudza kuzvara mwana. Nekuti, mumamiriro ezvinhu aya, bhenefiti / njodzi chiyero inorerekera zvakanyanya mukufarira kutangwa kwekuzvara mwana, kuna amai sekumwana.

Kukurudzira, chiito chekurapa chisingakoshi

« MuFrance, kubereka mwana kuri kutangwa kakawanda uye kakawanda, inoratidza Bénédicte Coulm, nyamukuta uye muongorori paInserm. Muna 1981, takanga tiri pa10%, uye chiyero ichocho chakapetwa kaviri kusvika pa23% nhasi. Iri kuwedzera munyika dzese dzekuMadokero, uye France ine mitengo inoenzaniswa nevavakidzani vayo vekuEurope. Asi isu hatisi nyika inonyanya kukanganiswa. MuSpain, anenge mwana mumwe chete muvatatu anoberekwa anotanga. »kana kuti, Sangano reWorld Health Organisation (WHO) rinokurudzira kuti “hapana dunhu rinofanirwa kunyoresa chiyero chevashandi chinodarika 10%. Nokuti chinokonzeresa hachisi chiito chiduku, kana kumurwere, kana kumwana.

The trigger: kurwadziwa uye njodzi yekubuda ropa

Mishonga inorayirwa ichaita kuti uterine contractions iwedzere. Izvi zvinogona kurwadza zvakanyanya (vakadzi vashoma vanoziva izvi). Kunyanya kana kusununguka kuchikonzerwa nerubatsiro rwekuiswa kwe synthetic oxytocin, kune ngozi yakawanda yehutachiwana hwehutachiwana. Muchiitiko ichi, zvibvumirano zvakasimba zvikuru, zvakanyanyisa pamwe chete kana kuti hazvina kusununguka zvakakwana (kunzwa kwekamwe chete, kureba kwenguva refu). Mumucheche, izvi zvinogona kutungamirira kumatambudziko e fetus. Mune amai, uterine kuputika (kashoma), asi pamusoro pezvose, njodzi ye postpartum hemorrhage yakapetwa kaviri. Panyaya iyi, National College of Midwives, yakabatana nevanotindivadza, vanachiremba-gynecologists uye vana chiremba, vakapa mazano maererano nekushandiswa kweoxytocin (kana kuti synthetic oxytocin) panguva yekusununguka. MuFrance, zvikamu zviviri muzvitatu zvevakadzi vanoiwana pavanenge vachisununguka, pasinei nokuti ichangotanga kana kuti kwete. “ Isu tiri nyika yeEurope inoshandisa yakanyanya oxytocin uye vavakidzani vedu vanoshamiswa nemaitiro edu. Zvisinei, kunyange kana pasina kubvumirana pamusoro pengozi dzine chokuita nokupinza, zvidzidzo zvinosimbisa kubatana kuri pakati pekushandiswa kwe<em>synthetic oxytocin uye ngozi huru yokubuda ropa kuna amai. “

Triggering imposed: kushaya pachena

Mumwe mhedzisiro: basa rakareba, kunyanya kana richiitwa pane inonzi "isina kunaka" mutsipa (chibereko chechibereko chichiri chakavharika kana chakareba pakupera kwenhumbu). “ Vamwe vakadzi vanoshamisika kuti vanofanirwa kugara muchipatara kwemaawa makumi mashanu kurwadziwa chaiko kusati kwatanga », Anotsanangura Bénédicte Coulm. Mukuferefeta kwaCiane, mumwe murwere akati: “ Ndingadai ndakada kuziva zvakanyanya nezve chokwadi chekuti basa rinogona kusatanga kwenguva yakareba… Maawa makumi maviri nemana kwandiri! Vamwe amai vanotaura kuti: “ Ndakanga ndiine chiitiko chakashata kwazvo neichi chinokonzeresa, icho chakatora nguva refu kwazvo. Iyo tamponade yakateverwa neiyo infusion yakagara maawa makumi mana nemasere. Panguva yandakadzingwa ndakanga ndaneta. "Wechitatu anopedzisa:" Kudzvinya kwaitevera kurova kwairwadza zvikuru. Ndakaiona ine chisimba zvikuru, mumuviri uye mupfungwa. Zvisinei, kusati kwatanga, vakadzi vanofanira kuziviswa nezvechiito ichi uye zvinogona kuitika. Isu tinofanirwa kuvaratidza nengozi / kubhenefiti kwechisarudzo chakadaro, uye pamusoro pezvose kuwana mvumo yavo. Chokwadi, Public Health Code inoratidza kuti "hapana chiitiko chekurapa kana kurapwa kunogona kuitwa pasina mvumo yemahara uye neruzivo rwemunhu, uye mvumo iyi inogona kubviswa chero nguva".

Kusununguka kuzvara: chisarudzo chakagadzwa

Muongororo yeCiane, kunyangwe zvikumbiro zvemvumo zvakawedzera pakati penguva 2008-2011 uye nguva 2012-2014 (zvikamu zviviri zveongororo), chikamu chakanyanya chevakadzi, 35,7% yevanaamai vekutanga (avo ari mwana wekutanga) uye 21,3% ye multiparas (iyo inenge iri mwana wechipiri) vakanga vasina maonero avo kupa. Vasingasviki vatanhatu pamadzimai gumi vanoti vakaziviswa uye vakakumbirwa mvumo yavo. Izvi ndizvo zvakaitika kuna amai ava vanopupura kuti: “Pandakapfuura nguva yangu, zuva rimwe chete risati rarongwa, nyamukuta akaita tumambundira, kubata kunorwadza zvikuru, pasina kugadzirira kana kundinyevera! Mumwe akati: “ Ndakanga ndine zvinokonzeresa zvitatu pamusoro pemazuva matatu ehomwe yaifungidzirwa yakatsemuka, apo isu takanga tisina chokwadi. Handina kubvunzwa maonero angu, sekunge pakanga pasina sarudzo. Ndakaudzwa nezvekuita cesarean kana zvinokonzeresa zvisina kubudirira. Pakapera mazuva matatu, ndakanga ndaneta uye ndavhiringidzika. Ndakanga ndiine fungidziro dzakasimba dze membrane detachment, nekuti bvunzo dzesikarudzi yandakaitwa dzairwadza uye dzinoshungurudza. Handisati ndambokumbirwa mvumo yangu. »

Vamwe vevakadzi vakabvunzurudzwa muongororo havana kuwana ruzivo, asi zvakadaro vakabvunzwa maonero avo ... Pasina ruzivo, izvo zvinomisa "kuvhenekerwa" chimiro chechisarudzo ichi. Pakupedzisira, vamwe vevarwere vakabvunzurudzwa vakanzwa kuti vakanga vachikumbirwa mvumo yavo, vachisimbisa ngozi dzomucheche uye vachiratidzira zvakajeka mamiriro acho ezvinhu. Kamwe kamwe, vakadzi ava vanonzwa sekuti ruoko rwavo rwakamanikidzwa, kana kuti vakanyeperwa. Dambudziko: maererano nekuongorora kweCiane, kushayikwa kwemashoko uye chokwadi chokuti vanaamai vemangwana havabvunzwe maonero avo zvinoratidzika sezvikonzero zvinowedzera zvekuyeuka kwakaoma kwekuberekwa kwemwana.

Imposed induction: kuberekwa kusinganyanyi kugara zvakanaka

Kune vakadzi vasina ruzivo, 44% vane ruzivo "rwakashata kana rwakaipa kwazvo" rwekuzvarwa kwavo, vachipikisa 21% kune avo vakaziviswa.

KuNational College of Midwives, Bénédicte Coulm akasimba: “ Mamiriro eCollege akanyatsojeka, tinotenda kuti vanhukadzi vanofanira kuziviswa. Mumamiriro ezvinhu apo pasina dambudziko, tora nguva yekutsanangurira vanaamai vane pamuviri zviri kuitika, zvikonzero zvechisarudzo, uye njodzi dzinogona kuitika, pasina kuedza kuvavhundutsa. . Kuitira kuti vanzwisise kuda kurapwa. Kashoma kuti kurumidziro ndeyekuti munhu haakwanise kutora nguva, kunyange maminetsi maviri, kugadzikana uye kuzivisa murwere. "Nyaya imwe chete kubva kudivi raDr Garabedian:" Ibasa redu sevachengeti kutsanangura kuti njodzi ndedzipi, asiwo mabhenefiti kuna amai nemwana. Ndodawo kuti baba varipo vagare vachiudzwa. Iwe haugone kuchengeta munhu pasina kubvumirana kwavo. Zvakanakisa kuuya kuzotaura nemurwere nemumwe waunoshanda naye zvinoenderana nehurwere, munjodzi uye kana murwere asingadi kukonzereswa. Ruzivo rwunova rwakasiyana-siyana uye sarudzo yarwo inoziviswa zvakanyanya. Kudivi redu, tinomutsanangurira zvatinogona kuita. Kashoma kuti tisasvike pakubvumirana. Madeleine Akrich anodaidzira basa revanaamai venguva yemberi: “Ndinoda kuti kuvabereki, ‘Ivai vatambi! Bvunza! Iwe unofanirwa kubvunza mibvunzo, kubvunza, kwete kuti hongu, nekuda kwekuti unotya. Zviri pamusoro pemuviri wako uye kusununguka kwako! “

* Ongororo ine chekuita nemhinduro gumi nesere kumubvunzo wevakadzi vakasununguka muchipatara pakati pe18 ne648.

** Zvinokurudzira zveNational Council of Obstetrician Gynecologists (CNGOF) ye2011

Mukuita: iyo trigger inoenda sei?

Kune nzira dzakawanda dzekukurudzira kuiswa kwevashandi. Yekutanga ibhuku rekushandisa: “Inoumbwa nemembrane, kazhinji panguva yekuongororwa kwemukadzi.

Nekuita uku, tinogona kukonzeresa kubatira pamuromo wechibereko, ”vanotsanangura Dr Garabedian. Imwe nzira inozivikanwa semechanicha: "bharumu kaviri" kana Foley catheter, bharumu diki rinofefeterwa pamwero wemuromo wechibereko izvo zvinoisa kumanikidza pairi uye kukonzeresa kurwadziwa. 

Dzimwe nzira ihomoni. A prostaglandin-based tampon kana gel inopinzwa mukati memukadzi. Pakupedzisira, mamwe maitiro maviri anogona kushandiswa, chete kana cervix ichinzi "inofarirwa" (kana yatanga kupfupika, kuvhurika kana kupfava, kazhinji mushure memavhiki makumi matatu nemapfumbamwe). Ndizvo kuputika kwechikwama chemvura uye synthetic oxytocin infusion. Vamwe vanozvara vanopawo maitiro akapfava, sekuisa tsono dzeacupuncture.

Ongororo yeCiane yakaratidza kuti varwere vakabvunzwa vaingove 1,7% yekupihwa bharumu uye 4,2% acupuncture. Kusiyana neizvi, oxytocin infusion yakapiwa ku57,3% yevakadzi vane pamuviri, yakateverwa nekuisa prostaglandin tampon mumukadzi (41,2%) kana gel (19,3, XNUMX%). Zvidzidzo zviviri zviri mukugadzirira kuongorora kubuda muFrance. Chimwe chazvo, chidzidzo cheMEDIP, chichatanga pakupera kwa2015 mumadzimai makumi mapfumbamwe nemana uye chichabata vakadzi vatatu. Kana ukabvunzwa, usazeza kupindura!

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