Ọbara ọgbụgba tupu amụọ nwa

Antepartum bleeding nke amara dika antepartum hemorrhage (APH) maobu pre-partum hemorrhage, bu igba obara nke genita mgbe nwaanyi di ime ma onocha izuka iriabuo na asato ruo mgbe ona Acho imu nwa.

Enwere ike ijikọta ya na mbelata ibu ọmụmụ nwa. Ojiji nke aspirin tupu izu 16 nke ime ime iji gbochie pre-eclampsia na-enwekwa ike igbochi ọbara ọgbụgba tupu amụọ nwa.

Na ihe gbasara ogwugwu ya, ana ahu ya dika ihe ngbatoso nke medical ( ngbanyech ma ona afu ufu), ya bu oburu na agwoghi ya onwere Ike ibute onwu eve nne maobu nwa ya no.

## Nchịkọta
Obara Nile nke puru na ahu nwaanyi nakwa ngosi nke circulatory shock n'ihe obara n'egosi etu antepartum hemorrhaging n'adi Adi degree ano nke Antepartum hemorrhaging a: 

## Ihe Ndị Na-akpata ya

### Placenta praevia
Placenta praevia na-ezo aka na mgbe placenta nke nwa e bu n'afọ na-eto eto na-agbakọta n'ụzọ na-adịghị mma n'ime akpa nwa. Intermittent antepartum haemorrhaging na-eme na 72% nke ụmụ nwanyị na-ebi na placenta praevia. Ike nke placenta praevia nke onye ọrịa na-adabere na ebe placenta na-ejikọta.

A na-ekewa ụdị 1 na 2 dị ka obere placental praevia n'ihi na ndị a na-akpata obere ọbara ọgbụgba antepartum. A na-akpọ ụdị 3 na 4 dị ka isi placental praevia n'ihi ihe ize ndụ nke ọbara ọgbụgba siri ike ma ọ bụrụ na ọ gbajie n'ihi ọnọdụ nke njikọ placental. N'oge ọnwa atọ nke afọ ime, ịdị arọ nke akụkụ akpa nwa dị ala ma ọ bụ mkpụmkpụ nke dilation cervical kpatara nwere ike ịbawanye nrụgide a na-etinye na njikọ placental na mgbidi akpa nwa. N'ime ndị ọrịa nwere placenta praevia, nrụgide ndị a nwere ike ime ka placenta pụọ na mgbidi akpa nwa na-akpata ọbara ọgbụgba. Iji gbochie ndị ọrịa na-agba ọbara ọzọ na placental praevia, a na-atụ aro ka ha nwee ọkpụkpụ.

### Ntinye aka na-adịghị mma
N'oge ime, endometrium nke na-ejikọta kpọmkwem na blastocyst na-eto eto na-aghọ akụkụ nne nke Placenta, nke a makwaara dị ka decidua basalis. Na enweghị decidua basalis, mkpụrụ ndụ trophoblast na blastocyst na-eto eto na-emepụta njikọ miri emi na mgbidi akpa nwa, a maara nke a dị ka placentation na-adịghị mma. Enwere ike ịkekọrịta placentation n'ụdị atọ, dabere na omimi nke ịbanye na chorionic villi n'ime mgbidi akpa nwa: 

Na placenta percreta, chorionic villi etoola kpamkpam site na myometrium ma banye na perimetrium. Placenta percreta na-akpata ọbara ọgbụgba kachasị njọ nke a pụrụ ịtụ anya na ọ bụ placentation na-adịghị mma kpatara. N'ihe omume nke ịpụ apụl site na mgbidi akpa nwa, omimi nke njikọ chorionic villi na-ekpebi oke ọbara ọgbụgba nke a pụrụ ịtụ anya ya. Ohere nke placentation na-adịghị mma na-abawanye na ime ime ndị ọzọ, ma ọ bụrụ na enwere anụ ahụ dị mma site na ime gara aga. Dịka ọmụmaatụ, n'oge gara aga, ịsa ahụ ma ọ bụ placenta previa na-eme ka ohere nke placentation na-adịghị mma dịkwuo ukwuu, ya mere na-emewanye ohere nke ọbara ọgbụgba tupu amụọ.

### Mgbawa nke placenta
Placental abruption na-eme mgbe placenta na-apụ na endometrium. Ịpụ iche na-akpata ọbara ọgbụgba tupu amụọ nwa n'ebe ọgba aghara. Dabere na ebe a na-ewepụ ọbara, ọbara ọgbụgba nwere ike ma ọ bụ na ọ gaghị apụta ìhè. Ọ bụrụ na abruption na-eme n'azụ Placenta ebe ọbara na-enweghị ike ịpụ site na cervix, ọbara ga-agbakọta ma mepụta retroplacental clot. Naanị mgbe ebe a na-ewepụ ya na-eme n'akụkụ na-eche ihu n'ọnụ ọnụ nwere ike ịlele ngụkọta nke ọbara ọgbụgba site na ọbara ọgbụrụ. Iji ọbara ọgbụgba n'ahụ nwanyị dị ka ihe atụ nke ịdị njọ nke abruption placental adịghị arụ ọrụ. Ọnụ ọgụgụ nke ọbara ọgbụgba na-adabere na ogo nke placenta kewara na mgbidi akpa nwa. N'ihe banyere nkewa nke placental, ọbara ọgbụgba nwere ike ịbụ obere. Otú ọ dị, n'ihe banyere nkewa zuru ezu nke placental, ọbara ọgbụgba ga-abụ ihe dị mkpa na nnyefe mberede ga-abụkarị usoro ọrụ. Mgbagwoju anya nke placenta na-akpata ọnwụ ọbara site n'aka nne na ọnwụ nke oxygen na ihe na-edozi ahụ na placenta mgbe ụfọdụ na-eduga n'ịmụ nwa n'oge. Ihe ndị ọzọ na-akpata mmebi nke placental nwere ike ịbụ mmerụ ahụ n'afọ ma ọ bụ nkwụsịtụ mberede nke Mmiri amniotic, agbanyeghị na ọ bụghị ihe a na-ahụkarị maka ihe kpatara mmebi nke Placental ka a ghara ịma.

### Vasa praevia
Vasa praevia bụ ọnụnọ nke Akwara ọbara nwa ọhụrụ na-enweghị nchebe na-aga n'akụkụ placenta na n'elu oghere dị n'ime akpa nwa. Vasa praevia bụ ihe a na-adịghị ahụkebe, na-egosi naanị 4:10,000 ikpe site na nyocha kachasị ukwuu nke ọnọdụ ahụ.  Ihe ize ndụ nke ọbara ọgbụgba antepartum n'ihi vasa praevia na-abawanye nke ukwuu n'oge atọ nke afọ ime n'oge dilation cervical ma ọ bụ placenta praevia. O yikarịrị ka ọ ga-agbaji eriri afọ ma ọ bụrụ na ọ ga-agbawa n'ime ya ka eriri umbilical nke placenta anaghị echebe akwara ọbara nwa ọhụrụ. N'ihe omume nke mgbawa nke akwara nwa e bu n'afọ, ọbara ọgbụgba na-eme tupu amụọ ya ma ọbara na-efu site na ọbara nwa e bu. Ọ bụrụ na nwa e bu n'afọ mepụtara akụkụ nke ịwa ahụ zuru oke, a na-atụkarị aro ya.

### Ọdịdị placenta na-adịghị mma

* **Akpụkpọ ahụ gbara ya gburugburu**

A circumvallate Placenta na-ezo aka na mgbe membrane foetal na-ekpuchi ugboro abụọ, n'akụkụ foetal gburugburu ọnụ nke placenta. Nke a bụ iji kwụọ ụgwọ maka obere efere chorionic nke na-akpata mbelata nri na-edozi ahụ nye nwa e bu n'afọ. Ịdị arọ nke ọnụ placenta n'ihi placenta circumvallate nwere ike iduga na abruption placenta, na-akpata ọbara ọgbụgba tupu amụọ nwa.

* **Placenta Bilobed**

Placenta bilobed nwere oghere n'etiti na-ekewa ya n'ime lobes abụọ nwere arịa membranous na-agbasa n'etiti. Akwara ndị na-ejikọta membranous na-egosi ihe ize ndụ nke ịgbaji n'ihi nchebe dị nta site na thrombosis na trauma. Bilobing nke placenta nwere ike ibute site na ntinye placental na-eme n'ebe ndị nwere ọnyá eriri afọ, ịwa ahụ gara aga, mbelata ọbara ma ọ bụ ntinye na-eme na oghere dị n'ime akpa nwa. Ohere nke vasa previa na abruption placental na-abawanye na ọnụnọ nke placenta bilobed n'ihi mbelata nke elu maka njikọ na mgbidi akpa nwa na ikpughe nke arịa membranous.

* **Placenta Multilobed ma ọ bụ Succenturiate**

Mgbe placenta nwere ọtụtụ lobes nke dị anya ma ọ bụghị otu nha a na-akpọ nke a succenturiate placenta. Distal lobes jikọtara site na akwara placental na vein na-agbasa site na placenta isi, nke na-adịkarị n'etiti ma bụrụ nke kachasị ukwuu. N'oge mgbanaka ma ọ bụ nnyefe, akwara na akwara na-ejikọta ya nwere ike ịgbaji na-akpata nnukwu ọbara ọgbụgba. Mmetụta nke vasa previa na ọbara ọgbụgba n'ihu placenta succenturiate na-abawanye nke ukwuu.

* Ọbara nwa e bu n'afọ (a pụrụ ịmata ya site na nyocha Apt) 
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