Ukukhulelwa izingane ezihlanu ngasikhathi sinye: Uhambo lokuzithwala izingane ezihlanu

Ukukhulelwa uhambo olukhethekile, kanti ukukhulelwa kwama-quintuplet kuphakamisa lolu lwazi lube sezingeni eliyingqayizivele lobunzima nokumangala. Ama-quintuplet, okungabantwana abayisihlanu abakhula ngesikhathi esifanayo esibelethweni, yinto engavamile edinga ukunakekelwa okukhethekile, ukulungiselela, nokuqonda. Izidingo zomzimba, zengqondo, nezokwelashwa zalo hlobo lokukhulelwa zidlula kakhulu izidingo zokukhulelwa komntwana oyedwa noma ngisho amawele. Kusukela ekuphatheni izingozi zempilo kuya ekulungiseleleni ukufika kwabantu abancane abaningi, lolu hambo ludinga inhlanganisela ekhethekile yokubekezela nokwesekwa.

Lesi sihloko singena ngokujulile ohambweni lwe ukhulelwe ngo ama-quintuplet, enikeza imibono mayelana nalokho ongakulindela, izinselelo, kanye nenqubekela phambili emangalisayo yezokwelapha esekela lezi zikhulelo. Ngokuyiqonda kahle imizwa nobunzima bokukhulelwa nabantwana abaningi, abazali bangazilungiselela kangcono lolu hambo olukhethekile kanye nemivuzo elulethayo.

Ukuqonda Ukukhulelwa Kwanabantu Abaningana Nezikhulelo Zama-Quintuplet

Ukukhulelwa kwama-quintuplet kubalwa esigabeni sokukhulelwa okunabafetus abaningi abaphezulu (high-order multiple pregnancies). Lezi zikhulelo zenzeka lapho ama-embryo angaphezu kwamabili ekhula esibelethweni, okudala imiphumela eminingi evela ezinhlelweni ezisizayo zokuzala (ART) ezifana ne-in vitro fertilization (IVF) noma imithi ekhuthaza ukukhishwa kwamaqanda. Ku-ART, ama-embryo amaningi avamise ukufakelwa ukuze kwandiswe amathuba okukhulelwa okuyimpumelelo, okungenza kuvele ukukhulelwa okunabafetus abaningi abaphezulu.

Ukuqonda ubuciko bokukhulelwa, njenge-inani le-sperm elidingekayo ukuze ukhulelwe, kunganikeza imibono ewusizo emibhangqwaneni ebhekana nezinselelo zokukhulelwa okunabafetus abaningi abaphezulu njenge-quintuplets.

Ukukhulelwa kwama-quintuplet okuvela ngokwemvelo kuyingqayizivele kakhulu, kulinganiselwa ukuthi kwenzeka kanye kuphela ku-1 kwezikhulelo ezingu-55 million. Lobu bungekelekile bukhomba ubungqayizivele balezi zikhulelo, ezivame ukudinga ubungcweti obukhethekile kanye nokungenelela kwezokwelapha. Ithuba lokukhulelwa ngabantwana abahlanu ngokwemvelo lithonywa izici ezifana nefa, ubudala bukamama, kanye nokusetshenziswa kwemithi yokukhulisa ukuzala. [1].

Igama lezokwelapha lokukhulelwa kwama-quintuplet libizwa ngokuthi "high-order gestation." Kulezi zimo, ithimba lezempilo liqapha ngokucophelela ukukhula komfetus ngamunye kanye nempilo kamama ukuze liphathe izinselelo ezihlukile ezihambisana nokukhulelwa nabantwana abaningi ngesikhathi esisodwa. Ukukhula nokuthuthuka komntwana ngamunye kuqashwa eduze ukuze kutholakale izinkinga ezingase zivele ezifana nokungakhuli kahle komntwana esibelethweni, ukukhubazeka kokuzalwa, noma izinkinga ezihlobene nendawo encane esibelethweni. Quintuple

Ngaphezu kwalokho, omama abathwele ama-quintuplets bavame ukwenziwa ama-ultrasound amaningi nezinye izivivinyo zokuxilonga ukuze kuqinisekiswe impilo nenhlalakahle yabo bobabili, omama nezingane. Ithimba lezempilo lingase libe nochwepheshe be-maternal-fetal medicine, onompheki bokudla (nutritionists), nochwepheshe bokunakekelwa kwezingane ezisanda kuzalwa (neonatal care) ukuze kubhekwe zonke izinhlangothi zokukhulelwa nama-quintuplets. Laba nochwepheshe basebenza ngokubambisana ukudala uhlelo lokunakekelwa olubanzi olunciphisa ubungozi futhi lukhuthaze imiphumela emihle kubo bonke ababandakanyekayo.

Ngale kokugxila kwezokwelashwa, ukuqonda izimo zokuthwala izingane eziningi kusho futhi ukwamukela izingqinamba ezingokwengqondo nezokuhlela impilo. Abazali bavame ukuthola sebephakathi kwesivunguvungu sezizwa—kusukela enjabulweni nasekujabuleni kuya ekukhathazekeni ngekusasa. Ukulinganisa imfuno yokukhulelwa okunamaphindaphindo amaningi nezinhlelo ezisebenzayo zokulungiselela ukwamukela izingane ezinhlanu ezisanda kuzalwa kungazwakala kudidayo, okugqamisa ukubaluleka kohlelo lokwesekwa oluqinile nokuhlela ngokuningiliziwe.

Izinguquko Zomzimba Nezimpawu

Ukhulelwe nama-quintuplets ubeka imfuneko emikhulu emzimbeni ngokomzimba. Izimpawu zakuqala zingase zifane nokukhulelwa okujwayelekile kodwa zivame ukuba zimbi kakhulu njengoba ukukhulelwa kuqhubeka. Lezi zinguquko ngokomzimba zingathinta cishe yonke imisebenzi yomzimba, okudingeka ukunakekelwa okukhethekile nokunakwa. Izimpawu ezivamile zihlanganisa:

• Ukuzuza Isisindo Ngokweqile: Ukudla amakhalori amaningi kubalulekile ukusekela ukukhula kwamafetus amahlanu, okuphumela ekwandeni okukhulu kwesisindo kunokukhulelwa ngomntwana oyedwa. Ngokwesilinganiso, abesifazane abakhulelwe ama-quintuplets bangazuza amalitha angu-50 kuya kwangu-70 ephasela (pounds) phakathi nokukhulelwa, kuya ngesimo sabo somzimba nesempilo ngaphambi kokukhulelwa. Lokhu kwanda kwesisindo kufaka umthwalo owengeziwe emalungeni, emisipheni, nasekuzungezeni kwegazi (cardiovascular system). [2].
• Ukukhathala Okukhulisiwe: Umzimba usebenza ngokweqile ukuze unondle amafetus amaningi, okuthi ngokuvamile kubangele ukukhathala okukhulu nokuphelelwa amandla. Isidingo esikhulayo samandla omzimba, sihlanganiswe nokuphazamiseka kokulala ngenxa yokungakhululeki ngokomzimba, singenza kube nzima ukugcina amazinga wamandla. Ukuphumula okwanele nokudla okucebe kakhulu ngomsoco kubalulekile ekulawuleni lesi sici.
• Ukuphelelwa Umoya: Njengoba isibeletho sandeka, sicindezela i-diaphragm, okwenza ukuphefumula kube nzima. Lesi sici sivame kakhulu ezigabeni zokugcina zokukhulelwa lapho izingane ezikhulayo zigcwalisa cishe yonke isisu. Izinguquko ezilula, njengokulala ikhanda liphakeme kancane, zingaletha ukuvuseleleka okuncane.
• Izinselelo Zokugaya Ukudla: Ukuqubuka esiswini (heartburn), isicanucanu nokuhlukumezeka (constipation) kuvame ukuba maningi ngenxa yokwanda kwengcindezi ohlelweni lokugaya ukudla. Izinguquko zamahomoni ezithambisa imisipha yohlelo lokugaya ukudla zenza ukuthi lezi zinkinga zibe zimbi kakhulu. Ukudla ukudla okuncane kodwa ngokuvama nokudla okunothe ngofayibha kungasiza ekunciphiseni ukungakhululeki. Ukuphuza amanzi anele nakho kubalulekile ukuvimbela ukuhlukumezeka kanye nokusekela impilo yonke.
• Ukuvuvukala (edema): Ukuvuvukala ezandleni, ezinyaweni nasemilenzeni kuyisimpawu esivamile ekukhulelweni okunezingane ezinhlanu ngesikhathi esisodwa. Lokhu kubangelwa wukwanda kwegazi emzimbeni nokugcinwa kolwelo, okuqiniswe ukuncipha kokujikeleza kwegazi okubangelwa isibeletho esikhulisiwe. Nakuba ukuvuvukala okuthile kujwayelekile, ukuvuvukala okuzumayo noma okukhulu kungase kubonise isimo esibucayi kakhulu, njengokuthi i-preeclampsia, futhi kudinga ukunakwa kodokotela ngokushesha.
• Umdlavuza womhlane nokungaphatheki kahle esinqeni: Isisindo esengeziwe nokushintsha kwesikhungo samandla emzimbeni ngokuvamile kuholela ebuhlungwini bomhlane nasekungaphatheki kahle kwendawo yesinqe. Ezivocavoce ezithambile, i-prenatal yoga, namabhande okweseka abakhulelwe kungasiza ekunciphiseni ukungakhululeki okuthile [3].

Lezi zimpawu zidinga ukuphathwa ngokucophelela nokuxhumana njalo nodokotela ukuze kuqinisekiswe ukunethezeka nokuphila kahle kukamama. Ukuvakashelwa okuvamile kwe-prenatal nendlela esebenzayo yokuphatha izinguquko zomzimba kungasiza ekutholeni nasekulapheni izinkinga ezingase zivele kusenesikhathi, kuqinisekiswe imiphumela emihle kukamama nakubantwana.

Ukuphathwa Nokugadwa Kwezokwelapha

Ukuphatha ukukhulelwa okunezingane ezinhlanu ngesikhathi esisodwa kuhilela indlela yokusebenza ngokubambisana, odokotela bezifo zabesifazane, ochwepheshe bezifo zokukhulelwa (maternal-fetal medicine specialists), onontoni nabanye ochwepheshe bezempilo besebenza ndawonye. Ukuvakashelwa okuvamile kwe-prenatal nezindlela zesimanje zokuthwebula izithombe, ezifana nama-ultrasound anesinqumo esiphezulu, kubalulekile ukugadla ukukhula kwengane esesiswini nokuthola noma yiziphi izinkinga kusenesikhathi.

Izinkinga ezinkulu zezokwelapha ekukhulelweni okunezingane ezinhlanu ngesikhathi esisodwa zifaka phakathi:

• Ukubeletha ngaphambi kwesikhathi: Iningi lezingane ezinhlanu ezizalwa ngesikhathi esisodwa lizalwa ngaphambi kwesikhathi, ngokwesilinganiso samaviki angu-29 kuya kwangu-30 ekukhulelweni. Izinyathelo zokuvimbela, ezifana nokuphumula embhedeni noma imithi yokubambezela ukubeletha, zivame ukusetshenziswa.
• Ukugxila kwegazi okuphezulu ngesikhathi sokukhulelwa (gestational hypertension) kanye ne-preeclampsia: Lezi zimo zivame kakhulu ekukhulelweni okunezingane eziningi ngesikhathi esisodwa futhi zidinga ukugadwa eduze [4].
• Izidingo zokudla okunomsoco: Ukudla okukhethekile okucebile ngamaprotheni, ikhalisiyamu nensimbi kubalulekile ukusekela impilo kamama nentuthuko yengane esesiswini. Amavithamini e-prenatal enzelwe ukukhulelwa okunezingane eziningi ngesikhathi esisodwa nawo ayanconywa.
• Ukukhawulelwa Ekukhuleni Komntwana Esesesiswini (FGR): Isikhala esilinganiselwe nezinsiza ezinganele kungawuvimbela umntwana oyedwa noma abaningi ekukhuleni kahle, okwenza kudingeke ukuqashwa okwengeziwe nokungenelela okungenzeka.

Ukulungiselela Ukuzalwa Kwezingane Ezingamaphindamahlanu

Ngenxa yokuba khona kwengozi enkulu yokubeletha ngaphambi kwesikhathi, ukukhulelwa okuningi kwezingane ezingamaphindamahlanu kugcina sekubelethwa ngokuhlinzwa nge-cesarean section. Lokhu kudinga ukuhlela ngokucophelela nokubambisana phakathi kwethimba lezokwelapha ukuze kuqinisekiswe imiphumela engcono kakhulu kumama nakwizinsana.

Ukulungiselela ukubeletha kuhlanganisa:

• Ukunakekelwa Okukhethekile Kwezingane Ezisanda Kuzalwa: Amayunithi ezinakekelo ezikhethekile zezingane ezisanda kuzalwa (NICUs) adlala indima ebalulekile ekunakekeleni izingane ezizalwa zingakafiki esikhathini, anikeze ukusekelwa kokuphefumula, ukulawulwa kwezinga lokushisa, nosizo lokondleka.
• Ukuhlala Esibhedlela: Omama abakhulelwe izingane ezingamaphindamahlanu bangase badinge ukulaliswa esibhedlela ngesikhathi se-trimester yesithathu ukuze kuqapheke eduze isimo sabo nokuphathwa kwanoma yiziphi izinkinga eziqalayo.
• Ukulungela Ngokwengqondo Nangokusebenza: Abazali abalindele izingane ezingamaphindamahlanu bavame ukuzuza ekucobelelaneni nasemaqenjini okusekela ukuze bakwazi ukubhekana nezinselelo zemizwa nezokuhlela lapho bamukela izingane ezinhlanu ngesikhathi esisodwa.

Umthelela Emaphathini Emizwa Nasekucabangeni

Ukwesekwa kokukhulelwa kwezingane ezingamaphindamahlanu kungaba kujabulisa futhi kwehlise umoya ngesikhathi esisodwa. Ukulangazelela ukukhulisa izingane ezinhlanu ngesikhathi esisodwa kuvame ukuhambisana nemizwa ehlanganisiwe, okuhlanganisa injabulo, ukukhathazeka, nengcindezi. Abazali bavame ukuba nokukhathazeka ngokuphepha kwezezimali, ukuhlela ngokwezokusebenza, kanye nekhono labo lokuphatha izidingo zezingane zonke ezinhlanu ngendlela esebenzayo.

Abashadile bangathola kuwusizo ukufuna ukusekelwa emndenini, kubangani, nakochwepheshe, njengabahlengikazi bokucobelelana ngemicabango noma abeluleki, ukuze babhekane nale mizwa. Ukuxhumana okuvulekile phakathi komndeni mayelana nokulindelwe nezibopho kunganciphisa futhi ingcindezi ethile.

Inethiwekhi yokweseka, okuhlanganisa namaqembu abazali abanezinsizwa eziningi (parents of multiples), inikeza izinsiza ezibalulekile nolwazi oluhlangenwe nakho. Lawa maxhumaniso angaba wusizo olukhulu ekubhekaneni nezinselelo ezihlukile zokukhulisa izingane ezingamaphindamahlanu, anikeze izeluleko ngokuphatha impilo yansuku zonke, ukuthola usizo lwezezimali, nokuthola ukusekelwa ngokomzwelo. Ama-foramu aku-inthanethi nemihlangano yasendaweni yabazali abanezinsizwa eziningi angaba usizo olukhethekile ekwakheni umuzwa womphakathi nasekunciphiseni imizwa yokuzihlukanisa.

Umbono Wesikhathi Eside Wezingane Ezingamaphindamahlanu

Intuthuko ekunakekelweni kwezingane ezisanda kuzalwa iye yathuthukisa kakhulu ukusinda nokuphumelela kwezempilo kwezingane ezizalwa zingakafiki esikhathini, kuhlanganise nalezo ezingamaphindamahlanu (quintuplets). Noma ezinye zingase zibhekane nezinselelo zokuqala, njengesisindo esiphansi sokuzalwa, ubunzima bokuphefumula, noma ukubambezeleka ekuthuthukiseni, izingane eziningi ezingamaphindamahlanu zikhula zibe abantu abanempilo, abachumayo uma kunesikhathi esanele sokunakekelwa nezinsiza ezifanele.

Abazali badlala indima ebalulekile ekukhuliseni intuthuko yezingane zabo ngokuba baqinisekise ukuvakashelwa kwempilo njalo, badale indawo ekhuthazayo, futhi bafune izinsizakalo zokungenelela kusenesikhathi uma kudingeka. Lezi zindlela zingabhekana nokukhathazeka okungenzeka mayelana nentuthuko, ziqinisekise ukuthi ingane ngayinye ifinyelela emandleni ayo aphelele.

Ngaphezu kwalokho, ukukhulisa amawele amahlanu kuvame ukuhambisana nobudlelwano obuyingqayizivele phakathi kwabazalwane. Ubuhlobo phakathi kwezingane ezizalwe ngesikhathi esisodwa buvame ukuba buqine kakhulu, lapho abazalwane banikeza ukwesekwa ngokomzwelo nangokokuxhumana komphakathi komunye nomunye. Abazali bangakhulisa lobu budlelwane ngenkathi bekhuthaza ukukhula nokuzimela komuntu ngamunye ngokunikeza ingane ngayinye amathuba okuhlola izintshisekelo namathalente ayo. Uhambo lokukhulisa amawele amahlanu luyadelela ngokomzamo kodwa lujulile ngenjabulo, lugcwele izikhathi ezingenakubalwa zenjabulo nobunye.

Okubalulekile

Ngohlelo olunakekelwe kahle, ukwesekwa kwezokwelapha, kanye nohlelo oluqinile lokweseka, abazali bangakwazi ukubhekana nobunzima bokukhulelwa namawele amahlanu futhi bamukele lolu hambo olukhethekile olusemhlabeni. Injabulo yokubuka izingane ezinhlanu zikhula, zithuthuka futhi ziqhakaza ndawonye ulwazi olungafani nalutho, ubufakazi bamandla nokuzivumelanisa kwemindeni ebhekene nalolu hambo olukhethekile.

Ukhukhulelwa kwamawele amahlanu uhambo oluyingqayizivele olukhombisa ukuqina komzimba womuntu namandla ezokwelapha zesimanje. Nakuba kuletha izinselele ezihlukile, okuhlanganisa ezokwelashwa, ezemizwa nezokuhleleka, ulwazi lokuthwala nokukhulisa izingane ezinhlanu ngesikhathi esisodwa lugcwele injabulo neneliseko elingafani nalutho.

Izinkomba:

1. Francois K, Alperin A, Elliott JP. Imiphumela yokukhulelwa kwamawele amahlanu. J Reprod Med. 2001 Dec;46(12):1047-51. PMID: 11789084.
2. Meah VL, Strynadka MC, Khurana R, Davenport MH. Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You're Expecting More. Int J Environ Res Public Health. 2021 Apr 8;18(8):3907. doi: 10.3390/ijerph18083907. PMID: 33917800; PMCID: PMC8068193.
3. Gutke A, Ostgaard HC, Oberg B. Predicting persistent pregnancy-related low back pain. Spine (Phila Pa 1976). 2008 May 20;33(12):E386-93. doi: 10.1097/BRS.0b013e31817331a4. PMID: 18496334.
4. Carrara, S., Cavaliere, A., Ermito, S., Dinatale, A., Pappalardo, E.M. and Militello, M. (2009) Umbiko Wecala: Ukuphumelela Kokukhulelwa Okuzenzekelayo Kwamawele Amane. Journal of Prenatal Medicine, 3, 10-11. Available online: https://www.researchgate.net/publication/221967927_Case_report_successful_of_a_spontaneous_quadruplet_pregnancy