Isibeletho Sincane: Ukuqonda Imiphumela Yokuba Nesibeletho Esincane

Usayizi wesibeletho uyinto ebalulekile empilweni yokuzala kowesifazane. Nakuba umehluko kosayizi wesibeletho uvamile, isibeletho esincane kunesivamile ngezinye izikhathi singase sikhombise izinkinga zempilo ezifihlekile noma umehluko ekuthuthukeni komzimba. Ukuqonda ukuthi kusho ukuthini uma isibeletho sincane, izimbangela ezingaba khona, nokuthi sihlonzwa futhi silashwa kanjani, kungasiza ukuletha ukuqonda nokuthula kwengqondo kulabo ababhekene nalolu hlobo lokuxilongwa.

Yini elichaza usayizi wesibeletho?

Isibeletho siyithuluzi esimise okwephere esitholakala emgodini wesitho sangasese sowesifazane, esilinganisa cishe u-7.6 cm ubude, u-4.5 cm ububanzi, no-3 cm ukujiya kwabesifazane abadala abaneminyaka yokuzala. Lobu bukhulu bungahluka ngenxa yezinto ezifana neminyaka, izinga lama-hormone, nokuthi owesifazane uke waba nezingane noma cha. "Isibeletho esincane" ngokuvamile sibhekisela esibelethweni esincane kakhulu kunosayizi ovamile olindelekile kowesifazane oneminyaka nesimo somzimba okufanayo [1]. Ukuze uqonde kangcono ukuthi usayizi wesibeletho ushintsha kanjani ngesikhathi sokukhulelwa nokubaluleka kwalokho, kuwusizo ukufunda kabanzi mayelana nemilinganiselo yesibeletho ngesikhathi sokukhulelwa, okungakunikeza ulwazi olubalulekile mayelana nempilo yokuzala.

Izimbangela zesibeletho esincane

Kunezimo nezinto eziningana ezingafaka isandla ekubeni nesibeletho esincane:

1. Izinto esizalwa nazo:

• Ukungakheki kwemigudu ka-Müller: Lesi simo sihlanganisa ukungapheleli kokuthuthuka kwemigudu ka-Müller ngesikhathi sokwakheka kombungu, okuholela esibelethweni esingakhulile kahle noma esingekho nhlobo.
• Isibeletho esingakhulile (hypoplastic uterus): Ngezinye izikhathi isibeletho siyakheka kodwa sihlale singathuthuki ngokugcwele, okuvame ukubonakala ngesikhathi sokufikisa ngenxa ye-primary amenorrhea (ukungafiki kokuya esikhathini). [2].

2. Ukushoda kwama-hormone:

• Ukuntuleka kwe-estrogen ngesikhathi sobuthombela bungaphazamisa ukukhula kwesibeletho. Lokhu kungabangelwa izimo ezifana ne-Turner syndrome, lapho ukungajwayelekile kwamachromosome kuthinta ukukhiqizwa kwama-hormone.

3. Ukubuna kwesibeletho:

• Kwabesifazane abasebeneminyaka yokuyeka ukuya esikhathini, ukwehla kwezinga le-estrogen kungabangela ukuncipha kwesibeletho. Lokhu kuyingxenye evamile yokuguga kodwa kungavela kusenesikhathi kwabesifazane abasuswe ama-ovary ngokuhlinzwa noma abanokuphazamiseka okuthile kwe-endocrine.

4. Izifo ezingamahlalakhona:

• Izimo ezifana nokondleka okunganele noma izifo ezingamahlalakhona ezinzima zingathinta ukukhula nentuthuko yomzimba wonke, okungaholela ekutheni isibeletho sibe sincane kunokulindelekile.

5. Ukwelashwa Kwangaphambilini Kwezokwelapha:

• Ukwelashwa ngemisebe (radiation therapy) noma i-chemotherapy ngesikhathi sobuntwana noma ebusheni kungathinta ukukhula kwamathambo okuvelisa, kuhlanganise nesibeletho.

Izimpawu Nokubonakala

Isibeletho esincane asisolokhu sibangela izimpawu ezibonakalayo. Nokho, abanye abantu bangase babhekane nalezi:

• Ukuqala kobusha sekwephuzile noma ukungaveli kokuya esikhathini.
• Imijikelezo yokuya esikhathini engajwayelekile noma ukopha okuncane.
• Ubunzima bokukhulelwa noma ukuphuma kwesisu okuphindaphindayo.
• Ubuhlungu ngesikhathi sokuya esikhathini noma ngesikhathi socansi.

Lezi zimpawu zingahluka kuye ngembangela eyinhloko nangesilinganiso isibeletho esincane ngaso.

Ukuxilongwa Nokuhlola

Ukutholakala okunembile kwesibeletho esincane kubandakanya inhlanganisela yomlando wezokwelapha, ukuhlolwa ngokomzimba, nezindlela zokuthwebula izithombe:

1. Umlando Wezokwelapha:

• Odokotela bahlola inqubekela phambili yobusha, umlando wokuya esikhathini, nanoma yikuphi ukwelashwa kwangaphambilini kwezokwelapha okungenzeka kube nomthelela ekuthuthukisweni kwesibeletho.

2. Ukuhlolwa Kwamaphaphu Esinqeni:

• Uhlolo lwe-gynecological lunganikeza umbono wokuqala ngosayizi nokuma kwesibeletho.

3. I-Ultrasound:

• I-ultrasound yangaphakathi esibelethweni (transvaginal) noma esiswini ingamakhono okuhlola asetshenziswa kakhulu ukukala usayizi nokwakheka kwesibeletho.

4. MRI:

• Emacaleni ayinkimbinkimbi, i-magnetic resonance imaging (MRI) inganikeza imininingwane enemininingwane ngomumo wesibeletho.

5. Ukuhlolwa Kwamahomoni:

• Imigudu yegazi yokuhlola amazinga amahomoni, njengama-estrogen ne-FSH (follicle-stimulating hormone), ingasiza ekutholeni izifo ze-endocrine ezingase zithinte ukukhula kwesibeletho.

Umthelela Ekuzaleni Nasempilweni Yokuzala

Kubesifazane abaningi, isibeletho esincane sivusa ukukhathazeka ngokuzala. Nakuba kungenzeka ukukhulelwa unesibeletho esincane, amathuba angase ancike ekusebenzeni kwaso nasekutheni kukhona yini ezinye izifo ezihambisanayo. Abesifazane abasesigabeni esingaphezulu noma esingaphansi kobude besibeletho (<7.0 noma >9.0 cm) banamathuba amancane okubeletha ingane ephilayo kuyilapho abesifazane abanobude besibeletho <6.0 cm benobungozi obukhulu bokuhlangabezana nokuphuma kwesisu okungazelelwe [3].

• Izinselelo Ekukhulelweni: Abanye abantu abanesibeletho esincane bangase babhekane nobunzima ngenxa yokunganeleli koqweqwe lwangaphakathi lwesibeletho noma ukungabi naso isikhala esanele sokumiswa kombungu.
• Izinkinga Zokukhulelwa: Ukuphuma kwesisu, ukubeletha ngaphambi kwesikhathi, noma ukukhula kombungu okuvinjelwe kungavela ekukhulelweni okubandakanya isibeletho esincane.
• Izinketho Zokwelapha: Ubuchwepheshe bokuzalanisa obusiziwe njengokufakelwa umbungu esitsheni (IVF) nokusebenzisa abathwali bokuthwala isisu bungahlinzeka ngezinye izindlela zokuba nabantwana.

Izindlela Zokuphatha Nokwelapha

Ukwelashwa kwesibeletho esincane kugxila ekubhekaneni nembangela eyinhloko nasekulawuleni izimpawu noma izinkinga. Izinketho zingafaka:

1. Ukwelashwa Ngamahomoni:

• Ukwelashwa kokufakwa kwe-estrogen ngesikhathi sobusha kungakhuthaza ukukhula kwesibeletho ezimeni zokushoda kwamahomoni.

2. Ukwelashwa Ngokuhlinzwa:

• Izindlela zokuhlinza zokwakha kabusha noma ukulungisa isibeletho zingacatshangelwa ezimeni ezinzima, ikakhulukazi uma kunezinkinga zesakhiwo sesibeletho.

3. Isitayela Sokuphila Nokwesekwa Ngokudla:

• Ukugcina impilo jikelele enhle nokuqinisekisa ukudla okwanele nokunempilo kungase kusekele ukusebenza kahle kokuzala.

4. Ukwelashwa Kokungazali:

• Kwabesifazane abazama ukukhulelwa, odokotela abakhethekile ngokuzala bangahlela ukungenelela okuhambisana nezimo zomuntu ngamunye.

5. Ukusekelwa Ngokomqondo:

• Ukubhekana nezinselelo zempilo yokuzala kungakhathaza ngokomzwelo. Ukubonisana nochwepheshe noma amaqembu okweseka kunganikeza ukukhululeka ngokomzwelo namasu okubhekana nesimo.

Ukubhekana Nezinganekwane Nemibono Engalungile

Kubalulekile ukuhlukanisa iqiniso nenganekwane mayelana nosayizi wesibeletho nempilo yaso:

• Isibeletho Esincane Nokungazali: Yize isibeletho esincane singathinta ukuzala, akusona njalo isithiyo esingenakweqiwa. Abaningi abanesisibeletho esincane bayaqhubeka babe nokukhulelwa okunempilo.
• Ukusola noma iHlazo: Usayizi wesibeletho akuwona okuthile umuntu angakukontrolela, futhi uvame ukudalwa izici zofuzo noma zezokwelapha ezingaphezu kwamandla omuntu.

Imicabango Yokugcina

Ekuphetheni, yize ukuthola ukuthi isibeletho sincane kungakhathaza, inqubekelaphambili kwezesayensi yezokwelapha inikeza izindlela eziningi zokuphathwa nokwesekwa. Ukufuna izeluleko zochwepheshe kubalulekile ukuze ukwazi ukubhekana nalo mhlaba wezempilo yokuzala ngokuzethemba. Ukuqonda imiphumela yesibeletho esincane kubandakanya ukubona izimbangela ezingaba khona, izimpawu, nezinketho zokwelashwa ezikhona. Ukutholakala kusenesikhathi nokunakekelwa kwezokwelapha okufanele kungathuthukisa kakhulu imiphumela kwabalimele. Noma ngabe inkinga idalwa izimo zokuzalwa, ukungalingani kwamahomoni, noma ezinye izici, ukuyibhekana ngayo ngokuphelele kuqinisekisa ukuthi abesifazane bangathatha izinqumo ezinolwazi mayelana nempilo yabo nokuzala.

Imithombo yolwazi:

1. Gao H, Liu DE, Li Y, Tang J, Hu S, Wu X, Tian Z, Tan H. Usayizi nenani lesibeletho kuhlotshaniswa nezinga eliphezulu lokukhulelwa kwezokwelashwa ezigulini ezihlinzekwa ubuchwepheshe bokusizwa ekuzaleni: ucwaningo oluqhubekayo (i-athikili ehambisana ne-STROBE). Medicine (Baltimore). 2019 Feb;98(8):e14366. doi:10.1097/MD.0000000000014366. PMID: 30813136; PMCID: PMC6407969.
2. Verguts, J., Ameye, L., Bourne, T. and Timmerman, D. (2013), Imininingwane evamile ngosayizi wesibeletho ngokuya ngeminyaka nangokukhulelwa kanye nendima engaba khona yesilinganiso segolide esivamile. Ultrasound Obstet Gynecol, 42: 713-717. https://doi.org/10.1002/uog.12538 
3. Hawkins LK, Correia KF, Srouji SS, Hornstein MD, Missmer SA. Ubude besibeletho nemiphumela yokuzala: ucwaningo lweqembu kubantu abasebenzisa i-IVF. Hum Reprod. 2013 Nov;28(11):3000-6. doi:10.1093/humrep/det344. Epub 2013 Sep 5. PMID: 24014604.