Whakaheke O Te Wa Whānau

Ka puta mai te mahi whānau o mua i te wā e puta mai ai ngā konetākē āhua noa e hua ai te tuwhera o tō kaki i muri i te wiki 20 ā, i mua i te wiki 37 o te hapu.

Ka taea e te mahi whānau o mua te hua i te whānau o mua. Ko te wā o mua ake o te whānau o mua, ko te nui ake o ngā tūponotanga hauora mō tō pēpi. He tokomaha ngā pēpi o mua (preemies) e hiahia ana ki te tiaki motuhake i roto i te wāhanga tiaki matua neonatal. Ka taea hoki e ngā preemies te whai i ngā whakawhāngaia hinengaro me te tinana roa.

Ko te take motuhake o te mahi whānau o mua e kore nei e mārama. Ka taea e ētahi take tūponotanga te whakapiki ake i te tupono o te mahi whānau o mua, engari ka taea hoki te puta mai te mahi whānau o mua i ngā wāhine hapu kāhore he take tūponotanga e mohiotia ana.

Ngā tohu me ngā pūāhua o te mahi whānau i mua i te wā e whai ake nei: Ngā āhuatanga auau, rānei, o te pēhanga o te kopu (whakawhānuitanga) Te mamae o te tuara i raro tonu, he ngawari Te pēhanga o te riu, o te kopu rānei i raro Ngā mamae o te kopu, he ngawari Te toto i te tara, te toto iti rānei Te pakaru o ngā kiri o mua i te wā – i te pupuhi, i te rere tonu rānei o te wai i muri i te pakaru, te haehae rānei o te kiri i te taha o te pēpi Te huringa o te momo o te wai o te tara – wai, rite ki te māku, ki te toto rānei Ki te pāngia koe e ēnei tohu, e ēnei pūāhua rānei, ki te manukanuka rānei koe ki te mea e mōhiotia ana e koe, whakapiri atu ki tō kaiwhakarato hauora i te wa tonu. Kaua e manukanuka ki te whakaaro he mahi whānau teka te mahi whānau pono. Ka koa te katoa ki te mea he tūponotanga teka.

Mēnā ka pāngia koe e ēnei tohu rānei tohu rānei, kei te manukanuka rānei koe ki te mea kei te mōhio koe, whakapiri atu ki tō kaiwhakarato hauora i te wa tonu. Kaua e manukanuka ki te whakapohehe i te mahi whānau teka ki te mea pono. Ka koa te katoa ki te mea he tūponotanga teka.

Kaore he uauatanga

Ka taea e te mahi whānau wawe te pānga ki tetahi haputanga. He maha ngā take kua honoa ki te nui haere o te tūponotanga o te mahi whānau wawe, engari, tae atu ki: Te mahi whānau wawe o mua, te whānau wawe rānei, inā te haputanga hou rawa atu, te neke atu rānei i te kotahi haputanga o mua Te haputanga me ngā mahanga, ngā torutoru rānei, ngā maha atu rānei Te poto o te kaki kopu Ngā raruraru ki te kopu, ki te pēreka rānei Te kai hikareti, te whakamahinga rānei i ngā raau taero kore ture Ngā mate pukupuku, inā te wai o te kopu me te wahi o raro o te tara Ētahi āhuatanga roa, pēnei i te toto teitei, te mate huka, te mate ā-tinana, me te pouri Ngā kaupapa ora whakawātea, pēnei i te matenga o te tangata aroha Te nui rawa o te wai o te kopu (polyhydramnios) Te toto mai i te tara i te wā haputanga Te wāhi o te he whānau o te peepi He wā poto atu i te 12 marama—rānei neke atu i te 59 marama—i waenganui i ngā haputanga Te tau o te whaea, ngā taitamariki me ngā kaumātua Te iwi Māori me te momo, ehara i te Hispanic

Ko ngā raruraru o te mahi whānau wawe e whakauru ana te whānau i te pēpi wawe. Ka taea e tēnei te whakatakoto i te maha o ngā take hauora mō tō pēpi, pēnei i te taumaha whānau iti, ngā raruraru manawa, ngā whekau kaore i whānuitia, me ngā raruraru tirohanga. Ko ngā tamariki e whānau ana i mua i te wā e nui ake te tūponotanga o te pāremata roro, ngā raru ako me ngā raruraru whānau.

Ka pēhea pea te kore e taea e koe te aukati i te mahi whānau o mua i te wā – engari he nui ngā mea ka taea e koe te mahi hei whakatairanga i te hapu hauora, te roa o te wā. Hei tauira:

• Rapua te tiaki whānau i ia wā. Ka taea e ngā haerenga tiaki whānau te āwhina i tō kaiwhakarato hauora ki te tirotiro i tō hauora me te hauora o tō pēpi. Whakamāramahia ngā tohu rānei, ngā tohu rānei e awangawanga ana koe. Ki te pēnei koe i te hītori o te mahi whānau o mua i te wā, ka whānau rānei ngā tohu, ngā tohu rānei o te mahi whānau o mua i te wā, me āta kite atu koe ki tō kaiwhakarato hauora i ia wā i te wā hapu.
• Kai kai hauora. Ko ngā hua hapu hauora e hono ana ki te kai pai. I tua atu, e whakaatu ana etahi rangahau he kai nui te ngako momona polyunsaturated (PUFAs) e hono ana ki te iti o te tūponotanga o te whānau o mua i te wā. Kei roto i ngā nati, ngā purapura, ngā ika me ngā hinu purapura ngā PUFAs.
• Kaua e whakamahi i ngā mea kino. Ki te pārekareka koe, mutu. Pātai atu ki tō kaiwhakarato hauora mō te kaupapa mutu pārekareka. Ko ngā rongoā kore ture, kāore hoki e whakaaetia.
• Whakaarohia te wā whakawātea hapu. E whakaatu ana etahi rangahau he hononga kei waenga i ngā hapu i whakawāteahia i raro i te ono marama, neke atu rānei i te 59 marama, me te nui ake o te tūponotanga o te whānau o mua i te wā. Whakaarohia te kōrero ki tō kaiwhakarato hauora mō te wā whakawātea hapu.
• Kia tupato ki te whakamahi i te hangarau whakatipu āwhina (ART). Ki te whakamahere koe ki te whakamahi i te ART hei hapu, whakaarohia te maha o ngā ira ka whakawhiti. Ko ngā hapu maha he nui ake te tūponotanga o te mahi whānau o mua i te wā. Ki te whakatau tō kaiwhakarato hauora kei te nui ake te tūponotanga o te mahi whānau o mua i te wā, ka taea e ia te tūtohutia te tango i ētahi atu mahi hei whakaiti i tō tūponotanga.

Ka arotakehia e tō kaiwhakarato hauora ō hītori hauora me ngā take tūponotanga mō te whānautanga wawe, ka aromatawai hoki i ō tohu me ō tohu. Ki te pāngia koe e ngā whakawhānuitanga kopu noa, ā, kua tīmata te ngawari, te whakaheke me te tuwhera (te whakawhanui) o tō kaki i mua i te 37 wiki o te hapu, ka tino whakatauhia koe me te whānautanga wawe.

Ngā whakamātautau me ngā tukanga hei whakatau i te whānautanga wawe e whai ake nei:

• Tirohanga pelvic. Āhei pea te aromatawai e tō kaiwhakarato hauora te pakari me te mamae o tō kopu me te rāhi me te tūranga o te pēpi. Ki te kore kē tō wai i pakaru, ā, kāhore he awangawanga kei te hipoki te pereki i te kaki (placenta previa), āhei pea ia te mahi i tētahi tirohanga pelvic hei whakatau mēnā kua tīmata te tuwhera o tō kaki. Āhei pea te tirotiro hoki e tō kaiwhakarato hauora te toto kopu.
• Ultrasound. Āhei pea te whakamahi i tētahi ultrasound transvaginal hei ine i te roa o tō kaki. Āhei pea te mahi i tētahi ultrasound hei tirotiro hoki i ngā raruraru ki te pēpi, ki te pereki rānei, hei whakau i te tūranga o te pēpi, hei aromatawai i te nui o te wai amniotic, me te whakatau i te taumaha o te pēpi.
• Aromatawai kopu. Āhei pea te whakamahi e tō kaiwhakarato hauora i tētahi kaitahuri kopu hei ine i te roa me te tawhiti o ō whakawhānuitanga.
• Ngā whakamātautau taiwhanga. Āhei pea te tango e tō kaiwhakarato hauora i tētahi tāpui o ō ngongo waha hei tirotiro i te āhua o ētahi mate me te fetal fibronectin—he mea e mahi ana i te rite ki te piri i waenganui i te putea pēpi me te paparinga o te kopu, ā, ka tukuna i te wā e whānau ana. Ka arotakehia ēnei hua i te whakakotahitanga me ētahi atu take tūponotanga. Ka homai ano e koe tētahi tauira mimi, ka whakamātautauhia mō te āhua o ētahi huakita.

I te wā e whānau ana koe, kāore he rongoā rānei mahi tākuto hei whakamutu i te whānau, atu i te wā poto. Heoi, āta whakaaro pea tō tākuta ki ēnei rongoā e whai ake nei:

• Corticosteroids. Ka āwhina ngā corticosteroids ki te whakapakari i te whānautanga o ngā pūkahukahu o tō pēpi. Ki te mea kei waenganui koe i te 23 me te 34 wiki, ka āta whakaaro pea tō tākuta ki ngā corticosteroids mehemea e whakaarohia ana koe he nui ake te tūponotanga o te whānau i roto i ngā rā kotahi ki te whitu e whai ake nei. Ka āta whakaaro pea hoki tō tākuta ki ngā steroids mehemea kei te tūpono koe ki te whānau i waenganui i te 34 wiki me te 37 wiki.

Pea ka hoatu he kaupapa whakahoki o ngā corticosteroids ki a koe mehemea kāore koe i tae ki te 34 wiki te hapu, kei te tūpono ki te whānau i roto i ngā rā whitu, ā, kua whiwhi koe i tetahi kaupapa corticosteroids i mua atu i te 14 rā i mua.

• Magnesium sulfate. Ka tuku pea tō tākuta i te magnesium sulfate ki a koe mehemea he nui tō tūponotanga ki te whānau i waenganui i ngā wiki 24 me te 32 o te haputanga. Kua whakaatu mai ētahi rangahau pea ka whakaiti i te tūponotanga o tētahi momo kino ki te roro (cerebral palsy) mō ngā pēpi i whānau i mua i te 32 wiki o te whānautanga.

Corticosteroids. Ka āwhina ngā corticosteroids ki te whakapakari i te whānautanga o ngā pūkahukahu o tō pēpi. Ki te mea kei waenganui koe i te 23 me te 34 wiki, ka āta whakaaro pea tō tākuta ki ngā corticosteroids mehemea e whakaarohia ana koe he nui ake te tūponotanga o te whānau i roto i ngā rā kotahi ki te whitu e whai ake nei. Ka āta whakaaro pea hoki tō tākuta ki ngā steroids mehemea kei te tūpono koe ki te whānau i waenganui i te 34 wiki me te 37 wiki.

Pea ka hoatu he kaupapa whakahoki o ngā corticosteroids ki a koe mehemea kāore koe i tae ki te 34 wiki te hapu, kei te tūpono ki te whānau i roto i ngā rā whitu, ā, kua whiwhi koe i tetahi kaupapa corticosteroids i mua atu i te 14 rā i mua.

Tocolytics. Ka hoatu pea e tō kaiwhakarato hauora tētahi rongoā e kiia nei he tocolytic hei whakaroa poto i ō kōkō. Ka taea te whakamahi i ngā tocolytics mō ngā haora 48 hei whakaroa i te whānau wawe kia taea ai e ngā corticosteroids te tuku i te painga nui rawa atu, te mea rānei, kia kawehia koe ki tētahi hōhipera e taea ai te whakarato i te tiaki motuhake mō tō pēpi wawe.

Ki te kore koe e noho i te hōhipera, pea ka hiahia koe ki te whakarite i ngā haerenga wiki, te maha atu rānei, ki tō kaiwhakarato hauora kia taea ai e ia te aroturuki i ngā tohu me ngā tohu o te whānau wawe.

Ki te mea kei te tūpono koe ki te whānau wawe nā te poto o te kaki, ka āta whakaaro pea tō tākuta ki tētahi mahi tākuto e kiia nei ko te cervical cerclage. I roto i tēnei mahi, ka tuitui te kaki ki te kati me ngā tuitui kaha. Ko te tikanga, ka tangohia ngā tuitui i muri i te 36 wiki kua oti te haputanga. Ki te hiahiatia, ka taea te tango i ngā tuitui i mua atu.

Pea ka āta whakaarohia te cervical cerclage mehemea kāore koe i tae ki te 24 wiki te hapu, he hītori o te whānau wawe i a koe, ā, ka whakaatu mai te ultrasound kei te tuwhera tō kaki, te roa rānei o tō kaki he iti iho i te 25 millimita.

Ki te mea he hītori o te whānau wawe i a koe, ka āta whakaaro pea tō kaiwhakarato hauora ki ngā wāhi wiki o tētahi momo o te homoni progesterone e kiia nei ko te hydroxyprogesterone caproate, i te tīmatanga o tō wā rua, ā, kia haere tonu ra ano ki te wiki 37 o te haputanga.

I tua atu, ka tuku pea tō kaiwhakarato hauora i te progesterone, e whakauruhia ana ki te tara, hei whakakapi mō te whānau wawe. Ki te whakatauhia koe he poto tō kaki i mua i te wiki 24 o te haputanga, ka āta whakaaro pea hoki tō kaiwhakarato hauora ki te whakamahi i te progesterone kia tae ra ano ki te wiki 37 o te haputanga.

E whakaatu ana ngā rangahau hou pea he rite te whai hua o te progesterone tara ki te cervical cerclage i te aukati i te whānau wawe mō ētahi wāhine kei te tūpono. He painga te rongoā ki te kore e hiahiatia te mahi tākuto, te mate rānei. Ka tuku pea tō tākuta i te rongoā hei whakakapi mō te cervical cerclage.

Ki te mea he hītori o te whānau wawe, te whānau wawe rānei i a koe, kei te tūpono koe ki te whānau wawe e whai ake nei. Mahi tahi me tō kaiwhakarato hauora hei whakahaere i ngā take tūponotanga katoa, ā, hei whakautu ki ngā tohu whakatūpato me ngā tohu wawe.

Kaore he uauatanga