Mgbapụta ime

Uterine atony bu odida nke uterus imepe ofuma mgbe achoro imu nwa.mmepe nke uterus mgbe ana amu NWA na akwado blood vessels nke n'eme ka o hara igbachi Ike na ebochi hemorrhage ma kwalite ijiko obara.

Ya bu oburu na uterus emepeghi ofuma oga ebute acute hemorrhage.

## Ihe ize ndụ
E nwere ọtụtụ ihe ize ndụ maka atony akpa nwa na ọtụtụ n'ihi ụdị ọrụ nne na-enwe dị ka ọrụ ogologo oge, ọrụ na-erughị awa 3, ntụgharị akpa nwa, ojiji nke magnesium sulfate, na ojiji nke oxytocin. Mgbapụta nke akpa nwa nke ihe ndị dị ka ihe karịrị otu nwa e bu n'afọ kpatara, polyhydramnios, macrosomia nwa e bu, fibroids uterine, chorioamnionitis nwekwara ike ibute mbelata ọrụ akpa nwa na atony. Nchịkọta anụ ahụ placental ma ọ bụ nsogbu placental, dị ka placenta na-arapara n'ahụ, placenta previa, na placenta abruption na-eme ka ihe ize ndụ nke nne na-enwe PPH. Body mass index (BMI) n'elu 40 na coagulopathies bụ ihe ize ndụ a maara.   

A na-ejikarị Magnesium sulfate eme ihe na ndị ọrịa nwere eclampsia" id="mwIw" rel="mw:WikiLink" title="Pre-eclampsia">preeclampsia na eclampsia, nwere ike igbochi mgbanaka akpa nwa n'amaghị ama. Na mgbakwunye, preeclampsia nwere ike ibute nsogbu ọbara dịka thrombocytopenia, platelet abnormalities, na disseminated intravascular coagulation. Ịmụ nwa, ọkachasị mgbe ogologo oge gachara, nwere ike ime ka ike gwụ uru ahụ nke akpa nwa ma kwụsị ịkpụ ma ọ bụ ịkpụkọta nwere ike igbochi n'ebe a na-awa ahụ.

## Ọrịa na-efe efe
Uterine atony na ebido 1 na omumu 40 n'obodo United States ma n'ebute kwa 80% ma ope Karia mpe nsogbu nke postpartum hemorrhage.  

## Ọgwụgwọ na njikwa

### Mgbochi
Tupu a mụọ nwa, a ga-enyocha ndị ọrịa niile maka ihe ize ndụ ma nye ha ohere ịpụ ọbara mgbe a mụsịrị nwa dabere na ndụmọdụ American College of Obstetricians and Gynecologists. Ọ bụrụ na nwanyị ahụ nọ n'ihe ize ndụ dị n'etiti, a ga-edepụta ọbara ma nyochaa ya. Ndị a na-enyocha dị ka ndị dị oke egwu kwesịrị ka edetu ha ma jikọta ha.

A na-etinye njikwa nke atọ nke ọrụ n'ọrụ mgbe niile ma na-ewere ya dị ka ụkpụrụ maka nlekọta ndị ọrịa. Enwere ike iji ya belata ihe ize ndụ nke PPH. Nchịkwa na-arụsi ọrụ ike nke nzọụkwụ nke atọ gụnyere ịhịa aka n'akpa nwa na obere oxytocin IV. Ma a na-enye ya obere oge tupu ma ọ bụ mgbe a mụsịrị placenta na-adabere na mmasị onye na-eweta ya. A na-atụ aro na iji Uterotonic, dị ka oxytocin, ga-enyere aka belata ọbara na mkpa maka mmịnye ọbara mgbe ọ mụsịrị nwa.

A na-eme ịhịa aka n'akpa nwa site na itinye aka n'afọ dị ala ma jiri ịhịa aka ugboro ugboro ma ọ bụ ịpị aka na mgbalị ịkpali akpa nwa. A na-eche na mmegharị ahụ na-akpali mgbanaka akpa nwa ma nwee ike ịkpata ntọhapụ nke prostaglandins mpaghara iji nyere aka na hemostasis.

### Ọgwụgwọ
Ọ bụrụ na atony nke akpa nwa na-eme ọbụna mgbe e mepụtara usoro mgbochi niile, a ga-etinye usoro ọgwụgwọ n'ọrụ. A ga-anọgide na-eji ịhịa aka na mkpakọ akpa nwa, mgbe a na-enye ọgwụ. A ga-ebido intravenous catheter iji nye mmiri, ọgwụ, na ihe ndị dị n'ọbara 

E nwere ọtụtụ ụdị ọgwụ dị iche iche nke uterotonic nke enwere ike inye, nke ọ bụla nwere uru na ọghọm nke ya. Ọzọkwa, iji ọgwụgwọ ngwakọta nke akpa nwa bụ ihe a na-emekarị ma nwee ike ịdị irè karị n'ịchịkwa ọbara ọgbụgba karịa otu ọgwụgwọ. Njikọ ụfọdụ nwere ike ịgụnye oxytocin gbakwunyere misoprostol, oxytocin tinyere ergometrine, na carbetocin.

Ọgwụ ndị a na-eji maka PPH gụnyere ndị a:

# Oxytocin (Pitocin) Mmetụta nke ndị na-anabata oxytocin na uru ahụ dị n'akpa nwa na-eduga na mgbanaka. Ọnụ ọgụgụ nke ndị a na-anabata ihe na-abawanye n'oge ime na ịmụ nwa. E nwekwara ihe ndị ọzọ na fundus karịa na akụkụ akpa nwa dị ala. Oxytocin nwere mmalite ngwa ngwa, n'ime nkeji ole na ole, mana ọ na-efunahụkwa ịdị irè ngwa ngwa n'ihi obere ọkara ndụ. A na-enye ọgwụ ahụ na mmiri ngwa ngwa ma nwee ike ịkpata ọbara mgbali elu. Oxytocin naanị bụ ọgwụgwọ a na-ejikarị eme ihe na US. Otú ọ dị, ọ bụrụ na a naghị achịkwa ọbara ọgbụgba mgbe e nyechara oxytocin, mgbe ahụ, a na-enye uterotonic nke abụọ.
# Carbetocin: Ihe yiri oxytocin, na-arụ ọrụ n'ụzọ yiri nke oxytocin mana ọkara ndụ dị ogologo. Ọ na-ejikọta na ndị na-anabata uru ahụ nke akpa nwa, dị ka oxytocin ma a kọọrọ na ọ na-emepụta nkwonkwo akpa nwa kwụsiri ike, na-esote nkwonkwo rhythmic. Ọ dịghị na US mana ọ dị n'ọtụtụ mba maka igbochi atony uterine na ọbara ọgbụgba.
# Methylergonovine: Nke a bụ ergot alkaloid ma nwee ọtụtụ usoro ọrụ iji mee ka ngwa ngwa, mgbanaka akpa nwa na-aga n'ihu nke na-eduga na mgbanaka akpa. Ọ nwere ike ịkpata vasoconstriction na ndị ọrịa nwere ọbara mgbali elu ma ọ bụ ọbara mgbali ala metụtara ime ime. 
# 15-methyl-PGF2-alpha (Hemabate, Carboprost) Ọ dị irè nke ukwuu mana ọ dị oke ọnụ. Ọ nwere ike ịkpata bronchospasm ma a ga-ezere ya na ụkwara ume ọkụ. Ọ nwere ike ịkpata afọ ọsịsa, ahụ ọkụ, ma ọ bụ tachycardia.   &#x5B;**'&#x5D;</sup>
# Misoprostol (Cytotec): Ọgwụ a na-akpọ prostaglandin E1 analog oral nke nwere ike ịkpali mgbanaka akpa nwa. Misoprostol adịghị mkpa ka a na-etinye ya na friji n'ihi na ọ na-ekpo ọkụ. Ọ dị mfe inye ya ma e jiri ya tụnyere oxytocin na ergot alkaloids n'ebe ndị na-enweghị ihe ọ bụla ebe friji na agịga na-adịghị. Ọ nwere ike ịkpata oke ọkụ.
# Dinoprostone (Prostin E2): Prostaglandin ọzọ na misoprostol. 

Mgbe a na-enye ọgwụ ahụ, a ga-elezi anya n'ebe nne ahụ nọ iji kwado na ọbara ọgbụgba akwụsịla. Ọ bụrụ na ọbara ọgbụgba akwụsịghị ma ọ bụ nyocha ahụike egosighi ihe ịrịba ama nke ọrụ akpa nwa e weghachiri n'ime nkeji iri atọ nke inye ọgwụ, a na-atụ aro itinye aka ozugbo.<cite class="citation journal cs1" data-ve-ignore="true" id="CITEREFSongthamwatSongthamwat2018">Songthamwat S, Songthamwat M (2018). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113941 "Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section"]. ''International Journal of Women's Health''. **10''': 487–492. doi:. PMC&nbsp;6113941. PMID&nbsp;30197543.

Usoro tamponade gụnyere ngwugwu akpa nwa (na-agbasa n'ime akụkụ ahụ nwanyị) na gauze nke nwekwara catheter Foley n'ebe iji nye ohere maka nsị. Ọ dị ọnụ ala ma dị mfe inweta ya. Balloon tamponade bụ usoro a tụrụ aro maka tamponade na ntuziaka maka njikwa PPH. Enwere ike iji balọn bakri na tamponade (nakwa na ngwugwu nke akụkụ ahụ nwanyị) na ntinye Foley catheter iji mee ka ọ dịkwuo mfe ịdọrọ mmiri. [1]  Vacuum-induced uterine tamponade bụ usoro ọhụrụ nke na-eji vacuum dị ala iji wepụ ọbara site na oghere akpa nwa ma mee ka ọ dịkwuo mfe ịtachi akpa nwa 

Usoro nchịkwa ịwa ahụ gụnyere:

* Ntinye mkpakọ dị ka B-Lynch
* Uterine curettage iji wepụ ihe ndị e chekwara n'afọ [1] 
* Njikọ akwara akpa nwa, na ma ọ bụ na-enweghị njikọ nke arịa tube-ovarian. [1]  Njikọ nke eriri afọ na eriri afọ nwere ike belata ọbara ọgbụgba site n'ibelata nrụgide nke ọbara na-aga n'ime akpa nwa. Ọ gaghị achịkwa ọbara ọgbụgba kpamkpam mana ọ nwere ike belata ọbara ọgbụrụ mgbe a na-anwa ime ihe ndị ọzọ.
* Njikọ Akwara akpịrị. Njikọ abụọ nke akwara iliac dị n'ime na-ebelata nrụgide nke ọbara na-aga n'ime akpa nwa yiri njikọ akwara akpa nwa. Otú ọ dị, ọ bụghị usoro a na-ahụkarị n'ihi ogo nke ihe isi ike na ihe ize ndụ.
* Ọpụpụ nke akpịrị

## Nsogbu
PPH nwere ike ịkpata ọtụtụ nsogbu gụnyere: 

* ọnwụ
* Ọrịa na-akpata oyi n'ahụ
* ọrịa coagulopathy na-agbasa n'ime akwara
* Ọrịa akụrụ
* Ọrịa imeju
* Nsogbu iku ume nke ndị okenye

Na mba ndị na-enweta ego dị ala, e nwere ọtụtụ ihe ndị ọzọ na-arụ ọrụ na ihe ize ndụ PPH. Ọnọdụ nri na-edozi ahụ, enweghị nlekọta ahụike, na obere ọbara bụ ihe ndị ọzọ na-eme ka ọrịa na ọnwụ dịkwuo njọ.

Anemia postpartum bụ ihe a na-ahụkarị mgbe ihe omume nke atony uterine na ọbara ọgbụgba postpartum gasịrị. Oké ụkọ ọbara n'ihi PPH nwere ike ịchọ mmịnye ọbara ọbara na mkpụrụ ndụ uhie, dabere na oke ụkọ ọbara na ogo mgbaàmà nke ụkọ ọbara. Omume a na-ahụkarị bụ inye ụmụ nwanyị nwere mgbaàmà ọbara na hemoglobin na-erughị 7 g / dl. N'ọtụtụ ọnọdụ nke ọbara ọgbụgba na-emetụta akpa nwa, ọnụọgụ nke iron furu efu anaghị eji ọbara a na-amịnye. Ya mere, a ga-atụle ígwè a na-eji ọnụ eme ihe. Ọgwụgwọ iron nke nne na nna bụ nhọrọ ka ọ na-eme ka mgbake dị ngwa. Otú ọ dị, ọtụtụ ụmụ nwanyị na-arịa obere ụkọ ọbara na-edozi ụkọ ọbara ngwa ngwa na iron naanị ha ma ha anaghị achọ iron parenteral.[1]

## Ihe omuma
Umunwaanyi nwere buru PPH di ugboro abuo maobu ato n'ime PPH mgbe ha di ime.  

## Ihe odide

Òtù:Pages with unreviewed translations