Mtoto Kufia Tumboni: Sababu ni zipi?

[Donyongijape]

Habari ya kwenu wanaJF.

Kwa kweli nimepatwa na majonzi makubwa leo baada ya kupata taarifa kutoka kwa daktari kuwa taarifa ya ultra-sound inaonyesha mwanangu niliyekuwa nikimtegemea kuwa firstborn amefariki tumboni mwa mama yake. Mpaka sasa bado kiumbe hakijatolewa. Naomba maombi yenu kitoke salama.

Wana JF, nimekuwa msomaji wa baadhi ya post za kitabibu humu na mara nyingi zimekuwa msaada kwangu. Naamini mara hii pia nitapata msaada.

Nawaombeni mnisaidie niweze kujua nini hasa husababisha tatizo hili?.je ni lishe, mikao, mlalo au nini hasa?. Pia kichanga kinaweza kufia tumboni kuanzia wakati gani?. I mean miezi mingapi?.Maana wa kwangu amefariki akiwa ametimiza miezi 9 na EDD ilikuwa ni kesho tarehe 19.

Naomba mnisaidie na mengineyo katika suala hili ili huko mbeleni lisije kujirudia kwangu (hata pia kwa faida ya wengine watakaofuatia thread hii).

Wasalaam!

UPDATE:

Niwashukuru sana ndg. Mwalu , kiwaki , Isaac Chikoma , gody , measkron ,ZeMarcopolo , md4doctor2000, grand-mal , hippocratessocrates , charminglady, Cathode Rays, Smile, Mwasi,King Kong III , Masuke , Kamanda Moshi , prax , Dina , Akili Unazo na wengineo kwa pole zenu, Maombi yenu, Darasa/shule mliyonipa, Ushauri wenu pamoja uchokonozi wa baadhi yenu ambao umenifanya nipate maarifa zaidi kutoka kwa madaktari wa JF.

Jana, mke wangu aliweza kujifungua kwa njia ya kawaida baada ya kuwekewa vidonge na baadaye maji ya Uchungu. Kichanga kilikuwa ni cha kiume. Tunamshukuru Mungu kwa mama kuweza kujifungua salama bila kuchanika.

WanaJF Doctor, Madaktari wote TZ na wenzangu wengine, kwa kweli baada ya kupata tatizo hili kumenifanya niwe so much curious. Kwa hospitali hii niliyokuwepo ambayo ipo hapa hapa Dar Es Salaam, tena kubwa tu, wikiend hii pekee kulikuwa na akina mama wanne ambao vichanga vyao vimefia tumboni. Last two weeks kulikuwa na cases kama hizo sita. Kwa hiyo kwa mwezi wa tano tu ni vichanga atleast 10 vimefariki tumboni kwa mama zao kwa hospitali hii. Hapo hujaongelea Hospitali ya Mwananyamala, Amana, Temeke, Muhimbili na privates nyingine hapa DSM. Potelea mbali hospitali nyingine huko mikoani, wilayani, kwenye kata, na hata majumbani.

KIMSINGI, nimeona kuwa tatizo hili ni kubwa sana sana. Na nina ukakika kwa nchi zilizoendelea jambo kama hili kwa ukubwa huu lazima wangekuwa wamepata utatuzi wake mapema.

Mimi natoa RAI kwa Madaktari, Wanafunzi wa Udaktari, Wizara na Asasi za Afya kufanya utafiti wa kina kujua Magnitude ya Hili tatizo na nini zinaweza kuwa sababu za msingi kutokea kwa MAZINGIRA YETU. Labda nipo outdated, lakini naona kuwa ni mhimu sana kuwa na majibu sahihi juu ya hili katika MAZINGIRA YA NCHI YETU, la sivyo vijana wataendelea kuteketea kabla hata hawajazaliwa.

Niwashukuru tena kwa kujitoa kwenu na kunipa majibu na ushauri mzuri katika mada hii.
Asanteni.

 

[Mr. Mwalu]

pole mkuu! Dr's majibu ya kitaalam p'se

 

[Isaac Chikoma]

Pole sana God atakujalia ma,mbo yote yatakuwa .shwari.

 

[kiwaki]

Pole sana kiongoz,ngoja wataalamu waje

Sent from my BlackBerry 9900 using JamiiForums

 

[Gody]

Mimi naanza kumuita huyu
Dr MziziMkavu !!

 

[Cathode Rays]

Mkuu wa Oldonyo Lengijave pole sana,
I know the how sweets are the feelings of waiting for your first born
Doctors here willhelp na nikuombee ufanikiwe kupata mtoto
My prayers

 

[CharmingLady]

Pole sana mkuu.... Ngoja tukusaidie kuwaita madaktari

Dr. Riwa, Dr. hippocratessocrates, Dr. Mummy measkron na Dr. MziziMkavu busara zenu zinahitajika hapa tafadhali.....

 

[Victoire]

pole aisee,labda mlikosea kuhesabu so akapitiliza,any way poleni mtapata mwingine

 

[Smile]

pole ndugu

 

[measkron]

Pole sana mkuu.... Ngoja tukusaidie kuwaita madaktari

Dr. Riwa, Dr. hippocratessocrates, Dr. Mummy measkron na Dr. MziziMkavu busara zenu zinahitajika hapa tafadhali.....

Pole sana mkuu Donyongijape, Sababu za mtoto kufia tumboni ni kama vile mtoto kupitiliza siku maji yanayomzunguka kuisha na kondo la nyuma kuchoka sana na kushindwa kuendelea kuhudumia mtoto tumboni, hii kwako sio kwani alikuwa hajapitiliza muda wake.. Inaweza kuwa mama kuwa na damu group yenye Rhesus, chembechembe Negative zinazosababisha mama kutengeneza kinga dhidi ya mwanae tumboni na kuanza kumshambulia na mwishowe mtoto huweza kufia tumboni, Kitovu kamba kinachopitisha mishipa ya damu safi na damu chafu kinapokuwa kiferu sana uwezekano wa kujisokota na kuzuia damu kupita pia hupelekea mtoto kufia tumboni, sababu yeyote inayopelekea kondo la nyuma kuachia toka ukuta wa kuzazi ( Placenta separation, Abruption) huweza kupelekea mtoto kufia tumboni hii huweza kusababishwa na shinikizo la damu, mama kuanguka, kupigwa.... wengine watakuja kuongeza sababu nyingine hapa Riwa, HIPPOctatessocrates, ZeMarcopolo, King'asti, MziziMkavu, Erythrocytes, MENigitis.... all in all mkuu tuombe mungu mkeo kiumbe kitoke salama natumaini madaktari wanomuhudumia watakupa amelezo sahihi ya nini ilikuwa sababu kwa mkeo na namna ya kuzuia kama kuna uwezekano huo ili isitokee nwakati mwingine.

 

[ZeMarcopolo]

Pole kwa hali iliyowatokea.

sababu ziko nyingi sana, lakini unfortunately mara nyingi daktari hawezi kuona moja kwa moja sababu ya mtoto kufia tumboni. Kwahiyo, jiandae kisaikolojia kuwa pengine hutajua sababu ya jambo hilo kutokea. Upo utaratibu/uwezekano wa kufanya autopsy ili kutafuta sababu ya kifo, lakini sijaona ukifanywa sehemu nyingi nchini.

Nini cha kufanya:
Mnachopaswa kufanya ni kutfuta njia za kuhakikisha jambo hilo halitokei tena kwa kufanya yafuatayo.
1. Mkeo akipata ujauzito tu aanze kufuatiliwa na daktari ili katika hatua mbalimbali apimwe na kuonekana kuwa kila kitu kiko sawa. Hapa ni kuscreen magonjwa kama high blood pressure, kisukari, ugonjwa wa ini etc.
2. Angalia kazi za mkeo. Akiwa mjamzito she has to "take it easy".
3. Kitu chochote ambacho si cha kawaida kikimtokea afike kwa daktari. Akiona damu inatoka hata kama kidogo, maji yakitoka ukeni. Maji yakitoka inaweza kuwa chupa imevunjia na wadudu wanaweza kuingia na kusababisha madhara kwa mtoto.
4. Inapasw kujua kwamba kuna uwezekano mkubwa zaidi wa mtoto kufia tumboni kwa mama ambaye ameshawahi kutokewa na hali hiyo kwa hiyo kuanzia wiki ya 36 inabidi mjamzito aonwe mara nyingi zaidi. Na ingefaa zaidi katika wiki hiyo ya 36-37 akafanyiwa uzltrasound ili pamoija na mambo mengine kuangalia flow ya damu kutoka kwa mama kwenda kwa mtoto kama inatosha na kama mtoto anakua vizuri.
5. Feeling ya movements za mtoto ni muhimu sana kwa case kama yako. Mjamzito akihisi movements zimepungua au hazipo anapaswa kufika mapema kwa daktari. Hii inaweza kuwa ishara inayoonyesha kuwa mtoto anachoka na anaelekea kupoteza uhai. Kwahiyo dalili hii msiiunderestimate kwa case yako in the future iwapo itatokea.

 

[md4doctor2000]

Habari ya kwenu wanaJF.


Kwa kweli nimepatwa na majonzi makubwa leo baada ya kupata taarifa kutoka kwa daktari kuwa taarifa ya ultra-sound inaonyesha mwanangu niliyekuwa nikimtegemea kuwa firstborn amefariki tumboni mwa mama yake. Mpaka sasa bado kiumbe hakijatolewa. Naomba maombi yenu kitoke salama.


Wana JF, nimekuwa msomaji wa baadhi ya post za kitabibu humu na mara nyingi zimekuwa msaada kwangu. Naamini mara hii pia nitapata msaada.


Nawaombeni mnisaidie niweze kujua nini hasa husababisha tatizo hili?.je ni lishe, mikao, mlalo au nini hasa?. Pia kichanga kinaweza kufia tumboni kuanzia wakati gani?
. I mean miezi mingapi?.Maana wa kwangu amefariki akiwa ametimiza miezi 9 na EDD ilikuwa ni kesho tarehe 19.


Naomba mnisaidie na mengineyo katika suala hili ili huko mbeleni lisije kujirudia kwangu (hata pia kwa faida ya wengine watakaofuatia thread hii).


Wasalaam!

Pole sana mkuu, I know how it feels; I have gone thru that traumatic feeling in April last year. Despite the fact I am a medical doctor but the feeling is unbearable not only to the parents but also to the doctor/gynecologist who is taking care of a pregnant woman the most difficult part of the whole saga is to when to break the sad news to her patient….that the baby you are carrying is not alive!
To the woman this is the gloomiest moment ever; she needs you to closer, to comfort and to counsel her. Of course the counseling process has started when the doctor broke the news to her.
There are so many questions are coming during this time around, the commonest is how and when will this pregnancy (carrying a dead featus) will be terminated? Will it be spontaneously or something must be done? This is the key questions to discuss with your doctor. If there is no any complication associated with this unforeseen event then the doctor will give time for spontaneously expulsion of the fetus but if there is or there are signs of complications like hypertension then the doctor will act immediately!
Coming to your questions….mtoto kufia tumboni kitaalamu inajulikana kama Intra Uterine Fetal Death (IUFD).
· IUFD – fetal death at any time after 20 weeks of gestation (ni kitendo ambacho mtoto anafia tumboni mwa mama mjamzito wakati mimba ina umri wa wiki 20 na kuendelea).
· Tatizo hili hutokea kwa asilimia 1% ya mimba zote, na linachangia kwa zaidi ya nusu ya vifo vinavyotokea vya watoto wachanga.
Etiology (Sababu):
· Unknown in 50%. Sehemu kubwa ya sababu hasa kwanini mtoto anafia tumboni haijulikani na, kwa asilimia 50% ya vifo vya namna hii sababu huwa haijulikani
· Chromosomal abnormalities, genetic disorders (Matatizo ya kromozomu na genetiki)
· Hypertension (blood pressure)
· Pre-eclampsia (Kifafa cha mimba)
· Gestational diabetes mellitus (Kisukari)
· Infections (Viral or bacterial)
· Endocrine disorder
· Cervical incontinence (Shingo ya uzazi kuwa dhaifu au kizazi kutokufunga)
· Uterine abnormalities (tumbo la uzazi kuwa na matatizo)
· Placenta abruption (kondo la nyuma kujiachia kutoka sehemu yake mapema kabla ya wakati wake)
· Cord accidents (matatizo yanayotokana na kitovu, mfano kitovu kujifunga)
· Incomplete implantation
· Auto immunity disorders (matatizo katika mfumo wa kinga)
· Thrombophilic disorder (matatizo ya damu)
Diagnosis:
· Ultrasound (real time)
o Definite method for diagnosis
o Absence of fetal heart beats
o If the fetus has been dead for more than 2 days: fetal scalp edema, overlapping of cranial bones (Spaldings's sing, air bubbles in heart and great arteries (Robert's sign) can be seen!
· There are other tests which can be ordered by a doctor depending on the situation
Management:
· The time from fetal death in utero until the onset of labor depends both on the cause of fetal death and on the length of gestation.
· Overall, 80-90 % of woman will go into labor spontaneously within 2 weeks. Only 10% will be undelivered more than 3 weeks.
· Prolonged retention of the fetus in uterus may result in maternal blood clotting abnormalities.
Counseling:
· Giving bad news: straightforward, empathetic, without blame
· denial, anger, bargaining, depression, acceptance
· Delivery: Spontaneously Vs Induction - within 24 hours may be associated with increased risk for anxiety, your doctor might prefer for spontaneous and induce only when there is delay (>2 weeks) or other complications!

 

[ZeMarcopolo]

Pole sana mkuu, I know how it feels; I have gone thru that traumatic feeling in April last year. Despite the fact I am a medical doctor but the feeling is unbearable not only to the parents but also to the doctor/gynecologist who is taking care of a pregnant woman the most difficult part of the whole saga is to when to break the sad news to her patient….that the baby you are carrying is not alive!
To the woman this is the gloomiest moment ever; she needs you to closer, to comfort and to counsel her. Of course the counseling process has started when the doctor broke the news to her.
There are so many questions are coming during this time around, the commonest is how and when will this pregnancy (carrying a dead featus) will be terminated? Will it be spontaneously or something must be done? This is the key questions to discuss with your doctor. If there is no any complication associated with this unforeseen event then the doctor will give time for spontaneously expulsion of the fetus but if there is or there are signs of complications like hypertension then the doctor will act immediately!
Coming to your questions….mtoto kufia tumboni kitaalamu inajulikana kama Intra Uterine Fetal Death (IUFD).
· IUFD – fetal death at any time after 20 weeks of gestation (ni kitendo ambacho mtoto anafia tumboni mwa mama mjamzito wakati mimba ina umri wa wiki 20 na kuendelea).
· Tatizo hili hutokea kwa asilimia 1% ya mimba zote, na linachangia kwa zaidi ya nusu ya vifo vinavyotokea vya watoto wachanga.
Etiology (Sababu):
· Unknown in 50%. Sehemu kubwa ya sababu hasa kwanini mtoto anafia tumboni haijulikani na, kwa asilimia 50% ya vifo vya namna hii sababu huwa haijulikani
· Chromosomal abnormalities, genetic disorders (Matatizo ya kromozomu na genetiki)
· Hypertension (blood pressure)
· Pre-eclampsia (Kifafa cha mimba)
· Gestational diabetes mellitus (Kisukari)
· Infections (Viral or bacterial)
· Endocrine disorder
· Cervical incontinence (Shingo ya uzazi kuwa dhaifu au kizazi kutokufunga)
· Uterine abnormalities (tumbo la uzazi kuwa na matatizo)
· Placenta abruption (kondo la nyuma kujiachia kutoka sehemu yake mapema kabla ya wakati wake)
· Cord accidents (matatizo yanayotokana na kitovu, mfano kitovu kujifunga)
· Incomplete implantation
· Auto immunity disorders (matatizo katika mfumo wa kinga)
· Thrombophilic disorder (matatizo ya damu)
Diagnosis:
· Ultrasound (real time)
o Definite method for diagnosis
o Absence of fetal heart beats
o If the fetus has been dead for more than 2 days: fetal scalp edema, overlapping of cranial bones (Spaldings's sing, air bubbles in heart and great arteries (Robert's sign) can be seen!
· There are other tests which can be ordered by a doctor depending on the situation
Management:
· The time from fetal death in utero until the onset of labor depends both on the cause of fetal death and on the length of gestation.
· Overall, 80-90 % of woman will go into labor spontaneously within 2 weeks. Only 10% will be undelivered more than 3 weeks.
· Prolonged retention of the fetus in uterus may result in maternal blood clotting abnormalities.
Counseling:
· Giving bad news: straightforward, empathetic, without blame
· denial, anger, bargaining, depression, acceptance
· Delivery: Spontaneously Vs Induction - within 24 hours may be associated with increased risk for anxiety, your doctor might prefer for spontaneous and induce only when there is delay (>2 weeks) or other complications!

Daktari,

Pole kwa kupatwa na changamoto kama ya mdau na asante kwa maelezo.

Mimi nina swali hapo nilipoweka red. Je, cervical incompetence inawezaje kusababisha IUFD?

Vilevile naomba ufafanuzi kidogo. Je, hiyo definition ya IUFD uliyotupa inakubalika dunia nzima au kuna tofauti nchi na nchi? if so, je definition ya Tanzania ikoje?

Asante in advance daktari.

 

[Mwasi]

Pole sana mkuu Donyongijape, Mungu awatie nguvu.

 

[md4doctor2000]

Daktari,

Pole kwa kupatwa na changamoto kama ya mdau na asante kwa maelezo.

Mimi nina swali hapo nilipoweka red. Je, cervical incompetence inawezaje kusababisha IUFD?

Vilevile naomba ufafanuzi kidogo. Je, hiyo definition ya IUFD uliyotupa inakubalika dunia nzima au kuna tofauti nchi na nchi? if so, je definition ya Tanzania ikoje?

Asante in advance daktari.

Simply: Cervical incompetence can cause for premature rupture of membrane which can lead to IUFD

 

[ZeMarcopolo]

Simply: Cervical incompetence can cause for premature rupture of membrane which can lead to IUFD

Asante kwa jibu.

Sexual intercourse pia inaweza kusababisha rupture of membrane, je ni sahihi kusema kuwa sexual intercourse ni mojawapo ya vyanzo vya IUFD?

Uhusiano kati ya cervical incompetence na IUFD uko so indirect kiasi kwamba hatuwezi kuiweka kama chanzo cha IUFD.

Matukio yanaweza kutokea hivi: cervical incomepence - intracervical infection - PROM - left for more than 48 hours - intrauterine infection - possible IUFD.

Kutokana na indirect nature ya hii chain unaona kwamba ikitokea IUFD huwezi kusema with certainty kuwa chanzo kilikuwa cervical incompetence kwa sababu infection inaweya kutokea bila hata kuwepo kwa incompetence. PROM pia zinatokea bila hata kuwepo na cervical incompetence.

Je, kuna study yoyote uliyoona inasema IUFD imetokana na cervical incompetence?

Je, kwanini kwenye list ya sababu za IUFD uliyotoa hakuna premature rupture of mambranes?

 

[grand-mal]

Simply: Cervical incompetence can cause for premature rupture of membrane which can lead to IUFD

Daktari cervical incompetence inasababisha abortion na mara nyingi ni second trimester abortions na sio IUFD.

IUFD kwa huku kwetu Tanzania na nchi nyingi za dunia ya tatu ni kifo cha mtoto kuanzia wiki ya 28 na kuendelea, kabla ya hapo kiumbe kikifia tumboni bila kutoka inaitwa 'missed abortion'.

Kwetu abortion ni kufa au kuharibika kwa kiumbe kabla ya wiki ya 28 ya ujauzito kwa sababu kwa mazingira yetu hatuwezi kutunza watoto wali chini ya umri huo wakakua hata kama watazaliwa hai.

 

[grand-mal]

Sexual intercourse pia inaweza kusababisha rupture of membrane, je ni sahihi kusema kuwa sexual intercourse ni mojawapo ya vyanzo vya IUFD?

Mkuu inawezekanaje sexual intercourse isababishe rupture of membranes, kumbuka kabla mama hajaanza uchungu, cervix inakuwa imefunga na hakuna uwezekano wa kitu chochote kuzifikia membranes na kuzipasua hata hiyo intercourse iwe vigorous kiasi gani. Hii ndio sababu sexual intercourse haizuiwi mama akiwa mja mzito kwa kuwa haina madhara including kutosababisha rupture of membranes.

 

[Kamanda Moshi]

Mkuu naona wengi wameshakupa majibu hapo juu!naloweza kuongezea ni je wawezaje kupunguza chance ya kutokutokea?
1. Ultrasound unapohis/kujua ni mjamzito,hii itasaidia kujua kama cervix imefunga,mimba imekaa wapi na kwa msomaji mzuri wa ultrasound like DR. Bashiru (RPI) angekuambia hata level ya fluid (amniotic fluid)itakuwaje huko mbeleni
2.Kuchek vipimo vya damu RH -VE au +VE, magonjwa kama kisukar wakat wa ujauzito nk!
3. Ultrasound kila baada ya miezi 2 ni muhimu sana maana hii itakusaidia kujua ukuaji wa mimba na kama placenta bado iko hai au la!pia itakuonyesha position of the cord (kitovu) kama kimemnyonga mtoto au kiko sawa.
Kama utahitaj ufafanuz mwingine unaweza ukauliza tena!

 

[ZeMarcopolo]

Mkuu inawezekanaje sexual intercourse isababishe rupture of membranes, kumbuka kabla mama hajaanza uchungu, cervix inakuwa imefunga na hakuna uwezekano wa kitu chochote kuzifikia membranes na kuzipasua hata hiyo intercourse iwe vigorous kiasi gani. Hii ndio sababu sexual intercourse haizuiwi mama akiwa mja mzito kwa kuwa haina madhara including kutosababisha rupture of membranes.

Mkuu,

Inategemea na position wakati wa intercourse na gestational age. Vilevile kwenye multiparous women cervix inaweza kuwa open near term.

Angalia study hii inayoonyesha jinsi sexual intercourse inavyoweza kusababisha pPROM.
Coitus late in pregnancy: risk of preter... [Am J Obstet Gynecol. 1993] - PubMed - NCBI

Study nyingine hii hapa
Factors that predispose to premature ruptu... [JOGN Nurs. 1984 Mar-Apr] - PubMed - NCBI