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ZODAN

zodanZODAN (Partus), zoish, valodat, tavallud, amali murakkabi fiziologiest, ki dar mavridi on davrai homilagi anjom pazirufta, tifl ba dunyo meoyad. Dar sharoiti fiziologi Z. badi 10 mohi momoii homilagi (9 mohi taqvimi, 280 ruz yo 40 hafta) faro merasad. Dar in davra tifl purra tashakkul yofta, ba zindagii berun az batni modar omoda meshavad.
Oid ba nazdik omadani Z. metavon az rui baze alomatho, ki onhoro peshkhabar menomand, khulosa barovard. Mas., ovezon shudani shikam (2 – 3 hafta pesh az tavallud ba mushohida merasad); kam shudani vazni badan (1 – 2 kg; 2 – 3 ruz pesh az Z.); sust gashtani harakathoi kudak va g. YAke az nishonahoi muhime, ki az nazdik omadani Z. darak medihad, nomuntazam kashish khurdani bachadon va tarovidani luob az mahbal ast. Bisyor vaqt kashishkhurii dardnok, vale nomuntazami bachadon (zahdon)-ro dar in davra sahvan ogozi Z. mepindorand. Z. bo kashishi bonizomi mushakhoi bachadon, ki dardgiri nom dorad, ogoz meyobad.
Z. az se davra iborat ast: davrai I – boz shudani gardanai bachadon (dar zanhoi nakhustzo 10 – 11, dar zanhoi farzanddor 6 – 7 soat idoma mekunad); davrai II – bacharoni (dar zanhoi nakhustzo 1 – 2 soat, dar zanhoi farzanddor az 30 daq. to 1 soat davom menamoyad); davrai III – aftodani hamrohak (taqr. 20 – 30 daq. idoma meyobad). Davomoti Z. dar zanhoi nakhustzo bisyor vaqt 10 – 12, dar zanhoi farzanddor 7 – 8 soat ast.
Davrai boz shudani gardanai bachadon az dardgiri to purra kushoda shudani dahonai zahdonro darbar megirad. Dar ogoz dard badi har 10 – 15 daq. takror meshavad; minbad on pay dar pay khuruj karda, shiddat meyobad. Binobar kashish yoftani mushaki bachadon gardanai on hamvor va boz meshavad. Beshtar mushakhoi tanai bachadon kashish mekhurand. Baroi boz shudani gardanai zahdon janinkhalta niz musoidat menamoyad: dar vaqti khuruji dard fishori dokhili bachadon meafzoyad, janinkhalta tarang shuda, obi janin poyon tazyiq meorad, qismi zerii janinkhalta ba dahonai darunii gardanai bachadon vorid megardad. Dar zanhoi nakhustzo avval dahonai darunii bachadon boz meshavad, sipas gardanai bachadon hamvor gashta, dahonai beruni kushoda meshavad. Dar zanhoi farzanddor dahonai beruni hanuz dar davrai okhiri homilagi nimboz ast; dar vaqti Z. ravandi bozshavii dahonai daruni va beruni, inchunin hamvor gashtani gardanai bachadon yakbora surat megirad.
Darajai boz shudani gardanai bachadon bo santimetr muayyan karda meshavad (bo angusht chen mekunand). Mas., agar ba gardanai bachadon (az mahbal) angushtoni 1 – 2 – 3 – 4 vorid shavand, pas malum megardad, ki on taqriban 2 – 4 – 6 – 8 sm kushoda ast. Zimni purra boz gashtani gardanai bachadon dahonai on 10 – 12 sm farokh meshavad.
Davrai rondashavii kudak badi komilan boz shudani gardanai bachadon ogoz yofta, bo berun omadani kudak az javfi bachadon ba itmom merasad. Kudak az bachadon dar natijai chordard, yane ba tavri munazzam kashish khurdani mushakhoi zahdon va diafragmayu mushakhoi shikam khorij karda meshavad. Mushakhoi shikam ba tavri refleksi kashish mekhurand. Hangomi chordard zan nafas namekashad, diafragma dar yak sath nigoh doshta meshavad; mushakhoi qari kos niz ba tavri refleksi kashish mekhurand. Dar natijai ba qari kos tazyiq ovardani sari kudak chordard yakbora shiddat va badi har 2 – 3 daq. takror meyobad. Sari kudak hangomi chordard az rohi azoi tanosul namoyon meshavad. Rui kudak jonibi poyon ast. Badi takror yoftani chordard va berun omadani sar kitfoni kudak barobari az kosi khurd guzashtan, tob mekhurand va dar natija rui tifl jonibi roni rosti modar megardad. Kitfi rost peshtar harakat karda, dar bandi zihor (simfiz) kame tavaqquf mekunad, sipas kitfi chap pesh meoyad. Badi berun shudani kitfho tana va andomhoi poyoni kudak be dushvori khorij meshavand. Kudak avvalin marotiba nafas girifta, girya mekunad (nig. Navzod).
Davrai hamrohaki badi tavalludi kudak faro merasad. Dar in muddat hamrohak az devorai zahdon judo va mashima (hamrohak, janinparda va nof) az rohi tanosul khorij karda meshavad. Badi ba dunyo omadani tifl, bachadon jam shuda, shakli kuraro megirad; qari on taqriban dar barobari sathi nof ast. Pas az 10 – 15 daqiqai Z. zan dardi sabuk kashida, hamrohak va sipas mashimaro az bachadon khorij mekunad. Hamrohak mumkin ast az markaz yo kanor kuchad. Dar surati az markaz kuchidani hamrohak, odatan, khunshori ba mushohida namerasad. Alomati avvalini az kanor kuchidani hamrohak khunravi az rohi tanosul ast. Pas az aftodani hamrohak davrai badi tavallud faro merasad.
Tasiri baze bemoriho ba zoish
Zanhoi giriftori bemorihoi azoi tanosul yo uzvhoi digar bisyor vaqt bo dushvori tavallud mekunand.
Nuqsi dil baroi modar va kudak khavfi jiddi doshta, mumkin ast hangomi Z. yo badi on boisi favti zan gardad. Dukhtur ba zan doruhoi dil, glyukoza, vitamin, oksigen tain mekunad. Hususan ba tavassuti doru raf sokhtani dardi Z. muhim ast. Dar surati tasir narasondani doruho va khuruji illati dil zan favran jarrohi karda meshavad (nig. CHoki qaysar).
Bo maqsadi peshgirii orizahoi Z. barmahal oshkor sokhtani nuqsi dil dar zani homila va halli masalai mumkin budan yo nabudani homilagi ahamiyati kalon dorad.
Bemorii gipertoniya niz ba jarayoni Z. tasiri nomatlub merasonad. Dar asnoi bad shudani salomatii zan va kudak az usuli jarrohi istifoda mekunand.
Anemiya (kamkhuni) hamsafari asosii bisyor zanhoi homila meboshad. Dar zanhoi giriftori anemiyai kamohan aksar vaqt badi Z. bemorihoi siroyati khuruj menamoyand. Kudakoni chunin modaron niz dar muddati 6 – 8 mohi avvali hayot giriftori anemiyai kamohan meshavand.
Diabeti qandi bemorii mamul ast. Hangomi giriftori ba on jarrohi faqat dar mavridi zarurat guzaronda meshavad. Dar vaqti Z. tazriqi insulin joiz ast. Hun va peshobi kudakro bo maqsadi muqarrar namudani miqdori qandi tarkibi onho mesanjand. Pas az on chunin sanjishro badi har 3 moh 1 marotiba guzarondan lozim ast.
Bemoroni sil dar shubai makhsusi tavalludkhona zoyonda meshavand. Farjomi Z. baroi modar va tifl nisbatan khub ast. Hangomi shaklhoi faoli sil ba kudak sina namemakonand.
SHakhii gardanai bachadon dar zanhoi kalonsoli navzo ba mushohida merasad. On bazan binobar bemorihoi iltihobi va badi jarrohii gardanai bachadon, isqoti haml va g. padid meoyad. Gardanai bachadon nameyozad. Ba zan doruhoi rafi tashannuj va mahluli lidaza tain mekunand. Dar surati natijai dilkhoh nadodani dorushifoi va bo angusht boz namudani dahonai bachadon az usuli jarrohi istifoda menamoyand.
Miomai bachadon bisyor vaqt boisi pesh az muhlat jori shudani obi janin, sust khuruj yoftani alomathoi zoish, gipoksiyai kudak, khunshori, zud guncha nashudani bachadon badi tavallud va g. megardad. Hangomi kalon budani mioma dar vaqti jarrohi onro (yo bachadonro) burida dur mesozand.
Hunshori hangomi zodan
Dar vaqti Z. to 0,5%-i massai badan talaf dodani khun az nigohi fiziologi beziyon ast. Hunravii shadid (ziyoda az 1,5%-i massai badan) boisi ikhtiloli faoliyati silsilai asabi markazi, nafaskashi, gadudhoi endokrini, gardishi khun va mubodilai moddaho megardad.
Vokunishi zanho nisbati khunshori gunogun ast. Goho talaf dodani 700 – 800 ml khun kofist, ki zan vafot yobad. Hol on ki bazan az 800 ml ziyod talaf shudani khun fishori sharayonro past namekunad. Hangomi khunshori fishori sharayonro muntazam nazorat karda istodan lozim ast.
Hunshori metavonad dar davrahoi I, II va III-i Z., inchunin badi on rukh namoyad. Hunshorie, ki dar davrai I-i Z. ba vujud omadaast, mumkin dar davrai III yo hamon lahza badi zoish shiddat yobad. Hunshorii dar davrai III sarshuda bisyor vaqt dar davrai avvali badi tavallud davom mekunad. Sababi khunshori dar davrahoi I va II-i Z. kuchidani barmahali hamrohak va daridani boftahoi rohi kudakguzar ast. Hunshori dar davrai III-i Z. imkon dorad dar natijai der judo shudani hamrohak va mashima (binobar sust budani tonusi zahdon) padid oyad; dar in davra az sababi daridani boftahoi narmi rohi tavallud niz khunshori ba vuqu mepayvandad. Zimni bisyor talaf dodani khun mumkin ast gipo- yo afibrinogenemiya inkishof yobad.
Bahri peshgirii khunravi hangomi Z. va badi on ba zan durust kumak rasondan lozim ast; dar mavridi zaif budani khurujhoi Z. boyad tadbirhoi zaruri andeshid. Ba vena firistodani metilergometrin (1 ml mahluli 0,02%) bo 20 ml mahluli 40% glyukoza baroi peshgirii khunshorihoi gipotoni va atoni muhim ast. Istifodai qatravii oksitotsin (5ED) dar 500 ml mahluli 5%-i glyukoza niz naf dorad. Barobari rukh namudani khunshori momodoya boyad betakhir ba dukhtur khabar rasonad.
Osebhoi zodan
Osebhoi marbut ba Z. metavonand dar modar va tifl ba vujud oyand. Sababi onho asosan bo nojuri jarayon giriftani ravandi Z. va kumaki nouhdabaroyonai momoi meboshad. Ba osebhoi zoish daridani chatan, farj va mahbal, khunomosi farj va mahbal, daridani gardana va tanai bachadon, nosuri azoi tanosulu peshob va rudayu mahbal (nosurhoi badi zoish), judo shudani ustukhoni zihor, chappa gashtani bachadon va g. mansuband.
Sababhoi daridani chatan gunogun meboshand, mas., nisbatan shakh budani boftaho dar zanhoi kalonsoli navzo; nodurust joy giriftani kudak yo kalon budani on; tang budani ustukhoni kos; amalhoi nodurusti momodoya va g. Daridani chatan 3 daraja dorad. Hangomi daridagii darajai I devorai qafoi mahbal, kafsheraki qafo va pusti chatan chok meshavand; mushakho oseb nameyoband. Dar mavridi daridagii darajai II dar barobari in hama mushakhoi chatan (gayr az halqamushaki berunii rudai rost) niz zarar mebinand. Zimni daridagii darajai III ba halqamushaki berunii rudai rost, bazan ba devorahoi on niz zarar merasad.
Dar mavridi daridani chatan imkon dorad, ki ba uzvu boftaho mikrobho roh yoband. Minbad ehtimol azoi tanosul niz faroyad. Hangomi daridagii darajai III zan bodi shikam va akhlotro nigoh doshta nametavonad. Binobar in har guna daridagii chatan boyad dukhta shavad. Momodoya metavonad faqat daridagii darajahoi I va II-ro kuk zanad; daridagii darajai III-ro dukhtur boyad biduzad. Bad az Z. zan kamash 10 – 12 ruz naboyad shinad (ba joi dukhtashuda zur naoyad). Istemoli davohoi ravganii darunron naf dorad.
Daridagii farj va mahbal bisyor vaqt yakjoya bo daridagii chatan rukh namuda, boisi khunravi meshavad. Daridagii ayoni farjro meduzand, raghoi khunshorro mebandand. Beshtar hissai poyon, bazan hissai miyona va boloi farj medarad. Hususan daridagii hissai boloi farj vaznin ast; hangomi chuqur daridani on ba parametriy (boftahoi nazdi bachadon) khun vorid shuda, gematoma (khunomos) ba vujud meoyad.
Hunomosi farj va mahbal nisbatan kam ba mushohida merasad (asosan hangomi tez tavallud kardan, mavjudiyati guddahoi varikozii farj va g.). Dar asnoi ba vujud omadani khunomos zan az ehsosi fishor, tazyiq va dard dar farj va mahbal shikoyat mekunad. Dar farj (beshtar dar labhoi kaloni on) yo zeri luobpardai mahbal omoshoi kabudi arguvoni paydo meshavand. Hunomoshoi khurd khud az khud nopadid megardand. Hunomoshoi kalonro bo doru tabobat mekunand. Agar khunomos fasod girifta, haror. badan baland shavad, pas onro buridan lozim ast.
Daridagii gardanai bachadon dar asnoi tez tavallud kardan, kalon budan va nodurust joy giriftani kudak, durushtii gardanai bachadon, tang budani kos paydo meshavad. Daridagii majburi binobar korbasti anburhoi momoi, zuran tob dodani kudak va g. padid meoyad. Bazan daridagi to ba ravoqi mahbal merasad va onro niz faro megirad. Nishonai daridagii amiqi gardanai bachadon az rohi tanosul shoridani khun (hamon lahza badi tavalludi kudak) ast. Daridagihoi khurd yagon nishonai makhsus nadorand. Joyhoi daridagiro kuk mezanand.
Daridagii tanai bachadon du nav – purra va nopurra meshavad. Dar natijai vujud doshtani moneaho baroi Z., nomuvofiqatii andozai kos va sari kudak, kundalang joygir budani tifl, omosi boftahoi narmi rohi zoish, mavjudiyati izi choki qaysar va g. sar mezanad.
Hangomi khavfi daridani tanai bachadon amaliyoti Z. tezutund shuda, dard bazan khususiyati tashannuji megirad. Qismi poyoni zahdon yozida tunuk va khele dardmand meshavad; bachadon shakli soati regiro megirad. Bandakhoi halqashakli on behad tarang va dardmand meboshand. Kanorhoi gardanai zahdon varam mekunand (varam ba chatan va mahbal niz pahn megardad). Zan beqaror meshavad, rui jogah pechutob mekhurad, shikamashro doshta nolish mekunad. Dar in guna mavridho kudakro bo jarrohi berun meorand.
Nosurhoi badi zoish az jumlai orizahoi Z. buda, ahyonan ba mushohida merasand. Sababi onho bisyor vaqt muvofiqat nakardani sari kudak bo andozai kosi modar ast. Dar sathi kosi khurd band gashtani sari tifl, yo khud sari kudakro ba ustukhoni kos zer kardani boftahoi mahbal, gardanai bachadon, masona, rudai rost va g. niz imkon dorad mujibi paydoishi nosurho gardad. Pas az 3 – 8 ruzi Z. joyhoi mavtshudai boftahoi mazkur kuchida, nosurhoi gunogun ba vujud meoyand. Nosurhoi khurd khud az khud shifo meyoband; nosurhoi kalon jarrohi (badi 4 – 6 mohi Z.) karda meshavand. To jarrohi farjro har ruz shusta, ravgani vazelin yo emulsiyai sintomitsin molidan lozim ast.
Az ham gusastani ustukhonhoi zihor dar natijai yozidan yo kanda shudani bandi zihor rukh menamoyad. Dar zeri nof dard paydo shuda, dar vaqti harakat kardan on shiddat meyobad. Bemor boyad 3 – 5 hafta bistari gardad, az korsethoi makhsus istifoda kunad.

M. F. Dodkhoeva.

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