Tuesday, February 13, 2007

Kerumitan-kerumitan dan risiko-risiko kelahiran


Kerumitan-kerumitan dan risiko-risiko kelahiran
Masalah-masalah bahawa berlaku semasa kelahiran telah dipanggil kerumitan-kerumitan. Mereka boleh menjejaskan ibu atau bayi. Kadangkala menyebabkan kecederaan atau kematian. Para doktor dan bidan-bidan adalah terlatih untuk menangani dengan masalah-masalah ini perlu mereka hadapi.
Kematian bayi (kematian neonatal dari kelahiran untuk 28 hari, atau kematian perinatal jika termasuk kematian janin di 28 minggu kandungan dan terlambat) adalah sekitar 1% dalam dipermoden negara-negara. Risiko kematian ibu semasa melahirkan di negara-negara maju adalah rendah secara perbandingan; adalah hanya tentang 1 di kalangan 1800 orang ibu mati dalam kelahiran (hanya 1 dalam 3700 di North America). Di dunia ketiga, ia adalah satu proposisi lebih berbahaya: kematian neonatal kadar-kadar di Sub Saharan Afrika dan Asia Selatan adalah lebih daripada 3.7%, dan pada purata 1 dalam 48 orang wanita meninggal dunia semasa kelahiran.

"Semula jadi" kadar kematian kelahiran—mana tidak adalah dibuat bagi mengelakkan kematian ibu—telah dianggarkan di antara 1,000 dan 1,500 kematian per 100,000 kelahiran. (Melihat masalah pertama: kematian neonatal, kematian ibu).
Faktor-faktor yang paling penting mempengaruhi kadar kematian dalam kelahiran adalah pemakanan dan akses kepada rawatan perubatan berkualiti ("akses" adalah terlibat kedua-dua menurut kos penjagaan boleh didapati, dan menjauhkan daripada perkhidmatan kesihatan)."Rawatan perubatan" dalam konteks ini tidak merujuk dengan khususnya kepada rawatan dalam hospital-hospital, tetapi rawatan pranatal yang hanya biasa dan kehadiran, semasa kelahiran, seorang pelayan dengan kemahiran-kemahiran perbidanan. Pada 1983-1989, satu penyelidikan dikaji oleh Jabatan Kesihatan Texas mendedahkan bahawa kadar kematian bayi adalah 0.57% untuk doktor dihadiri kelahiran,dan 0.19% untuk kelahiran dihadiri oleh jururawat bidan-bidan. (Perbandingan mungkin mengelirukan kerana kelahiran risiko tinggi adalah kurang berkemungkinan menjadi dihadiri semata-mata pada seorang bidan.) Sebaliknya, beberapa kajian menunjukkan satu kemortalan perinatal lebih tinggi kadarnya dengan dibantu rumah kelahiran. Sekitar 80% bagi kehamilan-kehamilan adalah risiko yang rendah. Faktor-faktor yang boleh membuat satu kelahiran risiko tinggi termasuk pra-matang, tekanan darah tinggi, kencing manis dan sebelum cesarean seksyen. Satu daripada risiko-risiko berbahaya yang paling untuk fetus itulah kelahiran pramatang, dan kurangnya yang bersekutu berat neonatal. Lebih pramatang (atau kurang berat) seorang bayi adalah, lebih besar risiko-risiko untuk kematian neonatal dan untuk pulmonari , pernafasan, neurologi atau lain sequelae.

Kira-kira 12% semua bayi dilahirkan di Amerika Syarikat adalah dilahirkan pramatang. Semenjak 25 tahun lalu, teknologi perubatan adalah lebih baik peluang bagi yang terselamat bayi-bayi pramatang dalam negara-negara perindustrian. Di 1950s dan 1960s, lebih kurang separuh daripada kelahiran, bayi-bayi yang beratnya kurang daripada paras dalam AS telah mati. Jam-jam pertama kehidupan untuk "premies" adalah kritikal , terutama jam pertama paling genting. Laluan pantas untuk satu Rawatan Intensif Neonatal Unit adalah sangat penting.


Beberapa kerumitan yang mungkin adalah:


--Pendarahan serius sepanjang atau setelah kelahiran, yang merupakan punca paling biasa bagi kadar kematian pada ibu-ibu baru, di negara-negara dunia ketiga dan belum dimajukan. Kematian keluarga membawa ke hypovolemic kejutan, tidak cukup organ-organ penting dan kematian jika tidak dirawat cepat oleh berpunca kematian keluarga (mengubati dengan ergometrina dan pitosin atau pembedahan) dan pemindahan darah. Hypopituitarism setelah obstetrik hypovolemic terkejut dinamakan sindrom Sheehan.


--Non kemajuan melahirkan (longterm pengecutan tanpa kekembangan servikal yang mencukupi) adalah biasanya dirawat dengan oksitosin sintetik yang intravena persediaan-persediaan. Jika ini adalah tidak berkesan, Caesarean membahagikan mungkin perlu. Pertukaran dalam kedudukan ibu adalah berkesan dalam banyak kes. Gawat fetus adalah pembangunan tanda-tanda tekanan oleh kanak-kanak. Ini boleh termasuk peningkatan atau penyusutan denyutan jantung (mengawasi tentang cardiotocography / CTG), melucutkan mekonium dalam cecair amnion, dan tanda-tanda yang lain.

--Non kemajuan pemecatan (kepala atau membentangkan bahagian tidak dihantar walaupun pengecutan mencukupi), ini boleh memerlukan campur tangan seperti pengekstrakan memvakum, sepit pengekstrakan atau Caesarean membahagikan.


--Pada masa lalu, sebahagian besar wanita mati akibat jangkitan demam meroyan, tetapi sejak pengenalan kebersihan asas sepanjang kelahiran pada Ignaz Semmelweis, nombor ini telah jatuh dengan pesat.


--Pelecetan boleh menyakitkan. Satu episiotomi hanya sekali pemikiran perlu bagi mengelakkan airmata pengaitan pencerut dubur, kecuali penggunaan lazimnya—sekali normal—kini telah ditunjukkan kepada peningkatan risiko dalam pelecetan terutama yang melibatkan dan dilanjutkan melalui pencerut dubur.

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