Amawele Ahambene: Izimpawu, Izimbangela, Nokwelashwa

Amawele ahambene ngamawele afanayo axhunyiwe ngokomzimba lapho ezalwa, ahlanganyela izingxenye zomzimba noma izitho. Lesi simo esingavamile sivela lapho i-embryo iqala ukuhlukaniswa ibe amawele afanayo, kodwa inqubo iyeka phakathi, ishiya amawele axhunyiwe ndawonye.

Lokhu kwenzeka cishe ku-1 kuwo wonke ama-50,000 kuya ku-1 kuwo wonke ama-200,000 ezalwa emhlabeni jikelele. Nakuba lesi simo sibhekene nezinselele ezihlukile, amawele amaningi ahambene aphila impilo egcwele, enenjongo ngokunakekelwa komtholampilo okufanele kanye nokusekelwa komndeni.

Amawele ahambene yini?

Amawele ahambene athuthukiswa lapho i-embryo eyodwa elikhulu iqala ukuhlukaniswa ibe abantwana ababili abahlukile, kodwa ingaphothi inqubo. Esikhundleni sokwakha abantu ababili abahlukile, i-embryo ethuthukayo ihlala ixhunyiwe ezindaweni ezahlukene emzimbeni.

Ukuhlangana kungaba kuphi na emzimbeni, kusukela ekhanda nasesifubeni kuya esiswini, emathangeni, noma emuva. Amanye amawele ahlanganyela nje isikhumba nezinsimbi zemisipha, kanti amanye angase ahlanganyele izitho ezibalulekile njengentliziyo, isibindi, noma ubuchopho.

Amawele amaningi ahambene ngabesifazane, futhi ahlale efana ngoba avela ku-embryo eyodwa yokuqala. Lesi simo singahle sibe ngokungahleliwe futhi asibi yinto abazali abayenzayo ngaphambi noma ngesikhathi sokukhulelwa.

Imikhakha yamawele ahambene yini?

Odokotela bahlukanisa amawele ahambene ngokusekelwe lapho axhunyiwe khona emzimbeni. Indawo yokuxhumana ikusiza ukuthi ubone ukuthi yiziphi izitho noma izinhlelo zomzimba amawele angase ahlanganyele.

Nawa amaqembu aphambili ongahlangana nawo:

• Amawele e-Thoracopagus - Axhunyiwe esifubeni nasezinyaweni eziphezulu, ngokuvamile ahlanganyela inhliziyo, isibindi, noma ezinye izitho kule ndawo
• Amawele e-Omphalopagus - Axhunyiwe esifubeni esisezantsi nasezinyaweni, ngokuvamile ahlanganyela isibindi futhi ngezinye izikhathi amabele
• Amawele e-Pygopagus - Axhunyiwe emathangeni nasemgogodleni ophansi, ngokuvamile ahlanganyela umgogodla ophansi kanye ne-rectum
• Amawele e-Ischiopagus - Axhunyiwe emathangeni, ngokuvamile ahlanganyela izitho zokuzala, ibladder, nezingxenye zesimiso sokuhlanza
• Amawele e-Craniopagus - Axhunyiwe ekhanda, okuyimfihlo kakhulu futhi kungase kuhilele insimbi yobuchopho noma imithambo yegazi
• Amawele e-Parapagus - Axhunyiwe eceleni emathangeni futhi ngezinye izikhathi esiswini

Uhlobo ngalunye lubhekene nezinselele nezinketho ezahlukene zokuhlukaniswa, kuye ngokuthi yiziphi izitho nezinhlelo zomzimba ezabelwana ngawo amawele.

Yini ebangela amawele ahambene?

Imbangela eqondile yamawele ahambene isalokhu iyimfihlo kwesayensi yezokwelapha. Okwaziyo ukuthi kwenzeka ezingxenyeni zokuqala zokukhulelwa lapho amawele afanayo akha khona.

Ngokuvamile, lapho amawele afanayo athuthukiswa, i-embryo eyodwa ihlukaniswa ngokuphelele ibe ama-embryo amabili ahlukile phakathi kwezinsuku eziyi-13-15 ngemuva kokutholakala. Ngamawele ahambene, le nqubo yokwahlukanisa iqala kodwa ayipheli ngokuphelele, ishiya amawele axhunyiwe ngokomzimba.

Lokhu kuhlukaniswa okungapheli kuyinto engaqondakali futhi yemvelo. Akubangelwa yilutho abazali abalenzile, abangazenzanga, badla, noma babhekana nakho ngesikhathi sokukhulelwa. Azikho izici ze-genetic, imithi, noma imiphumela yemvelo eboniswe ukuthi ikhuphula ingozi.

Abaphenyi abathile bakholelwa ukuthi isikhathi lapho i-embryo lizama ukuhlukanisa khona lidla indima lapho amawele aphela khona axhunyiwe, kodwa lokhu kusacwaningwa.

Ziyini izimpawu nezimpawu ngesikhathi sokukhulelwa?

Izigameko eziningi zamawele ahambene zitholakala ngesikhathi se-ultrasounds eziqondile zokukhulelwa, ngokuvamile phakathi kwamasonto angu-18-20 okukhulelwa. Udokotela wakho angase aphawule ukuthi abantwana babonakala besondele kakhulu noma babonakala behlanganyela izingxenye zomzimba.

Izimpawu zokuqala ezingase zibonise amawele ahambene zihlanganisa ukubona amakhanda amabili kodwa umzimba munye kuphela ku-ultrasound, noma uqaphele ukuthi abantwana abanyuki ngokuzimela komunye nomunye. Amawele angase futhi abonakale ebhekene komunye nomunye ngendlela engaqondakali.

Ngezinye izikhathi lesi simo asitholakali kuze kube kamuva ngesikhathi sokukhulelwa lapho kwenziwa izithombe ezingcono kakhulu. I-ultrasounds eziphambili, i-MRI scans, noma i-CT scans zingasiza odokotela ukuthi baqonde ngokunembile ukuthi amawele axhunyiwe kuphi kanye nokuthi yiziphi izitho abangase bahlanganyele.

Uma kukhona ukungabaza ngamawele ahambene, iqembu lakho lezokwelapha cishe lizokuncoma ukuhlolwa okuqhubekayo nokuxhumana nochwepheshe ukuze baqonde kangcono isimo sakho esithile.

Kufanele ubona nini udokotela?

Uma ukhulelwe futhi i-ultrasounds eziqondile zibonisa amawele ahambene, udokotela wakho uzokuthumela ngokushesha kubachwepheshe abanokuhlangenwe nakho ngalesi simo. Lokhu ngokuvamile kuhlanganisa ochwepheshe bezokwelapha abakhulelwe futhi nabachwepheshe bokuhlinzwa kwabantwana.

Uzofuna ukufuna ukunakekelwa esibhedlela esikhulu esinokuhlangenwe nakho ngamawele ahambene. Lezi zindawo zineqembu elikhethekile nemishini edingekayo ukunikeza ukunakekelwa okuhle kakhulu ngesikhathi sokukhulelwa nangemuva kokuzalwa.

Unganqikazi ukucela imibono yesibili noma ukuxhumana okuqhubekayo. Lesi yisimo esiyinkimbinkimbi, futhi ukuba nemibono eminingi yochwepheshe kungakusiza wenze izinqumo ezinolwazi ngokunakekelwa kwakho nangokomzukulu wabantwana bakho.

Ziyini izici ezingozi zamawele ahambene?

Azikho izici ezaziwayo ezingozi ezikhuphula amathuba akho okuba namawele ahambene. Lesi simo sibonakala senzeka ngengozi, kungakhathaliseki iminyaka yakho, impilo, umlando womndeni, noma noma yini oyenzayo ngesikhathi sokukhulelwa.

Ngokungafani nezinye izimo zokukhulelwa, amawele ahambene awagijimi emindenini futhi awavamile kunoma yiliphi iqembu lesizwe noma indawo yomhlaba. Ukuba namawele ahambene ekukhulelweni okukodwa akukhulisi amathuba akho okuba nawo ekukhulelweni kwesikhathi esizayo.

Lesi simo senzeka ngokulinganayo kuwo wonke amaqembu emhlabeni jikelele, okusekela ukuqonda ukuthi kuyisenzakalo sokuthuthukiswa okungahleliwe kunokuba yinto ethonywe yizici zangaphandle.

Ziyini izinhlanganisela ezingase zenzeke?

Amawele ahambene abhekene nezinselele eziningi ezingase zenzeke, kokubili ngesikhathi sokukhulelwa nangemuva kokuzalwa. Izinkinga ezithile ziyahluka kakhulu kuye ngokuthi amawele axhunyiwe kuphi kanye nokuthi yiziphi izitho noma izinhlelo zomzimba abahlanganyela.

Ngesikhathi sokukhulelwa, izinhlanganisela zingase zihlanganise:

• Ukuzalwa kwangaphambi kwesikhathi, okuvela ezimeni eziningi zamawele ahambene
• Amanzi amaningi okukhulelwa (polyhydramnios) eduze kwabantwana
• Ubunzima ngokubeka umntwana ngesikhathi sokubeletha
• Ingozi enkulu yokulahlekelwa umntwana, ikakhulukazi ekuqaleni kokukhulelwa

Ngemuva kokuzalwa, izinhlanganisela ezingase zenzeke zihlanganisa ubunzima bokuqeda umoya uma amawele ehlanganyela indawo yesifuba, izinkinga zenhliziyo uma ehlanganyela izakhiwo zenhliziyo, nezinselele zokugaya ukudla uma ehlanganyela amabele noma ezinye izitho zesisu.

Amanye amawele angase abe nokulibaziseka ekuthuthukiseni noma ukukhubazeka, kanti amanye athuthuka ngokujwayelekile. Ukubuka kuyahluka kakhulu kuye ngesimo ngasinye kanye nokuthi yiziphi izingxenye zomzimba ezabelwana ngazo.

Amawele ahambene ahlonishwa kanjani?

Ukuxilongwa ngokuvamile kuqala nge-ultrasounds eziqondile zokukhulelwa ezibonisa okuthile okungavamile ngendlela amawele abekwe ngayo noma axhunyiwe ngayo. Udokotela wakho angase aphawule ukuthi awanyuki ngokuzimela noma abonakala ehlanganyela izingxenye zomzimba.

Uma kukhona ukungabaza ngamawele ahambene, ukuhlolwa kwezithombe ezingcono kakhulu kusiza ukwakha isithombe esiphelele. Lokhu kungase kuhlanganise i-ultrasounds enokucaciswa okuphezulu, i-MRI scans, noma izithombe ze-3D ezikhethekile ezingabonisa ngokunembile ukuthi uxhumano luvela kuphi.

Iqembu lakho lezokwelapha lizobuye lisebenzise le mihlola ukuze liqonde ukuthi yiziphi izitho, imithambo yegazi, noma ezinye izakhiwo amawele ahlanganyela. Lolu lwazi lubalulekile ekucwaningeni ukunakekelwa kwabo kokubili ngaphambi nangemuva kokuzalwa.

Ngezinye izikhathi ukuhlolwa okuqhubekayo njenge-echocardiograms (i-ultrasounds yentliziyo) noma ezinye izikena ezikhethekile kusiza ukuhlola izinhlelo zezitho ezithile ezingase zithinteke.

Yini ukwelashwa kwamawele ahambene?

Ukwelashwa kwamawele ahambene kuyahluka kakhulu futhi kuyahluka kuye ngokuthi axhunyiwe kuphi kanye nokuthi ahlanganyela ini. Indlela ihilela iqembu lochwepheshe abasebenza ndawonye ukunikeza ukunakekelwa okuhle kakhulu.

Amanye amawele ahambene angahlukaniswa ngempumelelo ngokuhlinzwa, kanti amanye aphila impilo egcwele esalokhu exhunyiwe. Isinqumo sokuhlukanisa siyehluka kuye ngezinto eziningi, kuhlanganise nokuthi yiziphi izitho ezabelwana ngazo nokuthi ukuhlukaniswa kuzoba yilokuphephile yini kokubili amawele.

Kwamawele angahlukaniswa, inqubo ngokuvamile idinga ukuhlinzwa okuningi ngokuhamba kwesikhathi. Iqembu lokuhlinzwa lingase lihlanganise ochwepheshe bokuhlinzwa kwabantwana, ochwepheshe bokuhlinzwa kwesikhumba, ochwepheshe bezinto eziphathelene nobuchopho, ochwepheshe bezinhliziyo, kanye nezinye ochwepheshe kuye ngokuthi yini edingeka ukwakhiwe kabusha.

Kwamawele ahlala exhunyiwe, ukwelashwa kugxila ekuqeqeshweni ukuthi aphile ngokuzimela nangokunethezeka ngangokunokwenzeka. Lokhu kungase kuhlanganise ukuqeqeshwa komzimba, ukuqeqeshwa kokusebenza, kanye nokwenza izinguquko ukuze kusize nemisebenzi yansuku zonke.

Phakathi nokuphila kwabo, amawele amaningi ahambene adinga ukunakekelwa komtholampilo okuqhubekayo ukuze alandelele izitho ezabelwana ngazo futhi aqaphele noma yiziphi izinkinga zempilo ezivela.

Ungalungiselela kanjani ukulethwa nokunakekelwa kwasekuqaleni?

Ukuhlela ukulethwa kwamawele ahambene kudinga ukuhlanganiswa ngokucophelela phakathi kwamaqembu amaningi ezokwelapha. Amawele amaningi ahambene ahanjiswa ngokuhlinzwa kwe-cesarean esibhedlela esinezindawo ezikhethekile zabantwana.

Iqembu lakho lezokwelapha lizokuhlela isikhathi sokubeletha ngokusekelwe ekuthuthukiseni kwamawele nanoma yiziphi izinhlanganisela. Amawele amaningi ahambene azalwa ngaphambi kwesikhathi, ngakho iqembu le-neonatal intensive care unit (NICU) lizolungela ukunikeza ukunakekelwa okukhethekile ngokushesha.

Ngemuva kokuzalwa, amawele cishe azohlala isikhathi e-NICU ngenkathi odokotela beqonda isimo sabo futhi bahlele ukunakekelwa kwabo okuqhubekayo. Lesi sikhathi sivumela iqembu lezokwelapha ukuthi liqonde ngokunembile ukuthi amawele ahlanganyela ini kanye nokuthi yiziphi izidingo zawo ezizokhethwa.

Phakathi nalesi sikhathi, uzosebenza nabasebenzi bezenhlalo, abacebisi, kanye nezinye izisebenzi zokusekela ezingakusiza ukuthi uqhubeke nezinselele zomzwelo nezokwenza ngokunakekela amawele ahambene.

Kufanele ulungiselele kanjani ukuya kubonisana nodokotela?

Woza ulungele ngoluhlu lwemibuzo mayelana nesimo sakho esithile. Wonke amacala amawele ahambene ahlukile, ngakho gxila ekuqondeni ukuthi yini ehambelana nabantwana bakho ngokukhethekile kunolwazi olujwayelekile.

Letha umuntu okusekelayo emihlanganweni uma kungenzeka. Ukuba nomuntu omunye ohlala elalele futhi abhale amanothi kungasiza lapho uqonda ulwazi oluyinkimbinkimbi lokwelapha ngesikhathi esinzima.

Buza mayelana nokuhlangana nezinye imindeni enokuhlangenwe nakho ngamawele ahambene. Izibhedlela eziningi zingakuxhumanisa namaqembu okusekela noma ezinye imindeni ezingabahlukanisa okuhlangenwe nakho kwazo.

Unganqikazi ukubuza iqembu lakho lezokwelapha ukuphinda noma ucacise ulwazi. Lokhu kuningi okufanele kuqondwe, futhi kuyinto evamile ukudinga izinto zichazwe izikhathi eziningi noma ngezindlela ezahlukene.

Iyini into ebalulekile ngamawele ahambene?

Amawele ahambene abonisa ukuguquguquka okungavamile kodwa okwemvelo ekuthuthukiseni komuntu. Nakuba lesi simo sibhekene nezinselele ezihlukile, amawele amaningi ahambene aphila impilo egcwele ngokunakekelwa komtholampilo okufanele kanye nokusekelwa komndeni.

Into ebaluleke kakhulu okumele uyikhumbule ukuthi isimo ngasinye sihlukile. Okusebenza kusethi eyodwa yamawele ahambene kungase kusebenzi kwenye, ngakho gxila ekuqondeni izimo zakho ezikhethekile kunokwenza ukulinganisa nezinye izimo.

Izokwelapha zamanje zenza intuthuko enkulu ekunakekeleni amawele ahambene, kungaba ngokuhlinzwa kokwahlukanisa noma ukusiza amawele aphile kahle esalokhu exhunyiwe. Ngeqembu lezokwelapha elifanele nesisekelo sokusekela, imindeni ingaqhubeka nale ndlela ngempumelelo.

Imibuzo evamile ebuzwa ngamawele ahambene

U.: Ingakugwemeka yini amawele ahambene?

Cha, ayikho indlela yokugwema amawele ahambene ngoba kuyisenzakalo sokuthuthukiswa okungahleliwe esiqala ekuqaleni kokukhulelwa. Akubangelwa yilutho abazali abalenzayo noma abangazenzanga, futhi azikho izici ezaziwayo ezingozi ezikhuphula amathuba.

U.: Ingabe wonke amawele ahambene adinga ukuhlukaniswa?

Luqobo nje. Ukuhlukaniswa kucabangelwa kuphela lapho kungenzeka ngokwelapha futhi kuphephile kokubili amawele. Amawele amaningi ahambene aphila impilo egcwele, enenjabulo esalokhu exhunyiwe. Isinqumo siyehluka kuye ngokuthi yiziphi izitho nezakhiwo ezabelwana ngazo nokuthi ukuhlukaniswa kuzoba yilokuphephile yini kokubili abantwana.

U.: Ingabe amawele ahambene ahlale efana?

Yebo, amawele ahambene ahlale efana ngoba athuthukiswa ku-embryo eyodwa eqala ukuhlukaniswa kodwa ayipheli inqubo. Ahlanganyela insimbi efanayo ye-genetic futhi ahlale elesifazane esifanayo.

U.: Iyini izinga lokuphila kwamawele ahambene?

Izinga lokuphila liyahluka kakhulu kuye ngokuthi amawele axhunyiwe kuphi kanye nokuthi yiziphi izitho abahlanganyela. Amawele axhunyiwe esifubeni noma ekhanda abhekene nezinselele eziningi, kanti lawo axhunyiwe ezindaweni ezingabalulekile ngokuvamile anamiphumela emihle. Ngokuphelele, cishe ama-40-60% amawele ahambene aphila kuze kube sekwazalweni, futhi amaningi alo aqhubeka ephila impilo egcwele.

U.: Ingabe amawele ahambene angaba nokuthuthuka okujwayelekile kwengqondo?

Amawele amaningi ahambene anakuthuthuka okujwayelekile kokwengqondo, ikakhulukazi lapho ubuchopho bungathintiwe ngokuqondile ngoxhumano lwabo. Ngisho namawele ahlanganyela insimbi yobuchopho ngezinye izikhathi angathuthuka ngokujwayelekile, nakuba lokhu kuyahluka ngokuya ngesimo ngasinye. Umtwana ngamunye kufanele ahlolwe ngabanye ngezidingo zabo zokuthuthuka.