Kusho Ukukhulelwa Ntoni Ngokuvamile: Uhambo Lwezibalo Zomzimba Kusukela Ekukhulelweni Kuya Ekuzalweni

Ukushintsha ukusuka eqandeni elichumile kuya enganeni ephilayo, ephefumulayo kuwuhambo oluthokozisayo oluchazwa izinguquko ezinkulu emzimbeni nasekuthuthukisweni. Njengombukiso ohlanganyelwa izinhlobo eziningi zezilwane ezincelisayo, lolu hlelo luyikho kokubili olukhethekile noluvamile—ezidalweni ezahlukene kukhona isheduli ehlelekile yokukhula ngaphakathi kwesisu. Ukuze sikhanyisele lolu chungechunge oluyisimanga lwezehlakalo, ake sihlole lo mqondo ngokuningiliziwe futhi sixoxe ngezinguquko ezimangalisayo ezenzekayo ngaleso sikhathi. Ngokwenza kanjalo, sizogqamisa ukuqonda kwesimanje kwesayensi, imikhuba yamanje yezokwelapha, nezindlela eziningi imvelo eluhlela ngazo lolu daba olujulile lwezinto eziphilayo. Ukuqala, abantu abaningi bayazibuza bathi, kuyini ukukhulelwa futhi kusho ukuthini ukukhulelwa? Leli gama libhekisela esikhathini esiphakathi kokukhulelwa nokuzalwa lapho i-embryo noma i-fetus ithuthuka khona ngaphakathi esibelethweni. Kuyisikhathi esibandakanya izinguquko ezinamandla zokusebenza komzimba, amahormone nokwakheka komzimba, konke okuhambisanayo ukuze kukhuliswe impilo entsha.

Indima Yesikhathi Sokukhulelwa Emvelweni

Izinhlobo ezahlukene zezilwane zibonisa uhla olubanzi lobude besikhathi sokukhulelwa. Ezinye izilwane ezincane ezifana nogundane zithwala inzalo amasonto ambalwa kuphela, kuyilapho ezinkulu—njengezindlovu—zingaqhubeka nokukhulelwa cishe iminyaka emibili. Noma kungakhathaliseki ukuthi kuthatha isikhathi esingakanani, inhloso ihlala ifana: ukuvikela nokunakekela isidalwa esikhulayo kuze kube sesimeni sokusinda ngaphandle komzimba kamama waso. Lolu hlelo lwesikhathi lokukhula esiswini lubalulekile ekuthuthukisweni kahle kwezitho nezicubu.

• Izibonelo Zokukhulelwa Esifushane: Izilwanyana ezincane ezifana nogundane zinesikhathi sokukhulelwa esingaba amasonto amathathu. Inzuzo yokuzivumelanisa nezimo zemvelo lapha wukuthi zanda kaningi, okuvumela lezi zilwane ukuthi zisheshise ukwakha kabusha izinhlamvu zazo ezindaweni lapho izinsiza zikhona ngobuningi. [1].
• Izibonelo Zokukhulelwa Eside: Izinhlwathi ezifana nezindlovu, ezikhulelwa cishe izinyanga ezingu-22, zidinga leso sikhathi eseluliwe ukuze zikhiqize amathole athuthukile ngokuphelele, akwazi ukuhamba futhi amelane nezimo zezulu ezinzima. Izilwane ezinkulu ngokuvamile zidinga ukukhula isikhathi eside zisesiswini ukuze zikwazi ukusinda ngesikhathi sokuzalwa. [2].

Phakathi kwazo zonke izindlela zokukhulelwa ezitholakala kwezilwane ezincelisayo, abantu banebanga lesikhathi elivamise ukubalwa njengeviki eli-40 kusukela esikhathini sokuya esikhathini kokugcina—okungaba cishe amaviki angama-38 kusukela ekuchumeni. Lesi sikhathi side ngokwanele ukuthi kwakheke izitho eziyinkimbinkimbi, okuhlanganisa ubuchopho, amaphaphu nenhliziyo, ezibalulekile ukuze kukwazi ukuphila ngokuzimela ngaphandle kwesisu somama.

Isikhathi somuntu sokuthuthuka komntwana osesibelethweni

Ngaso sonke isikhathi sokukhulelwa komuntu, kunezinyathelo ezinkulu ezimaka isonto ngalinye. Le nkathi ngokuvamile yahlukaniswa yaba izingxenye ezintathu zokukhulelwa (ama-trimester):

1. Ikota yokuqala yokukhulelwa (Amasonto 1-12): Ngemva kokuvundiselwa, i-zygote izifaka odongeni lwesibeletho, yakha isisekelo seplasenta. Ngalezi zinsuku zokuqala, izakhiwo ezibucayi—njengeshubhu yezinzwa, egcina isiyintambo yomgogodla nobuchopho—ziqala ukwakheka. Inhliziyo yembryo iqala ukushaya cishe ngesonto lesithupha, futhi i-organogenesis (ukuzalwa kwezitho zomzimba) yenzeka ngokushesha.
2. Ikota yesibili yokukhulelwa (Amasonto 13-26): Njengoba ukukhulelwa kuqhubeka, izici zomntwana osesibelethweni ziba bucayi kakhulu. Uhlelo lwamathambo luyaqina, ukuhamba kuyaqala ukuzwakala, kanti izithombe ze-ultrasound ziveza izinkomba zobuso ezibonakalayo. Lapho sekufinyelelwe maphakathi nesikhathi sokukhulelwa, abaningi abazali abakulindele babika ukuthi sebewuzwa okokuqala ukunyakaza komntwana osesibelethweni—umbono obizwa ngokuthi “ukunyakaza kokuqala” (“quickening”).
3. Ikota yesithathu yokukhulelwa (Amasonto 27-40): Ngalezi zinyanga zokugcina, usana olusesizalweni lwanda isisindo, ubuchopho buqala ukuthuthukisa imigudu yezinzwa eyinkimbinkimbi, kanti nemiphaphu iyavuthwa. Cishe ngesonto lama-37, ingane ibhekwa njengesezigabeni zokuqala zokuzalwa (“early term”), okusho ukuthi izitho zomzimba zivamise ukuba sezingeni lokukwazi ukusekela ukuphila ngaphandle kwesisu sikamama. Njengoba kusondelwa esontweni lama-40, iplasenta iyaqhubeka nokuhambisa imisoco nomoya-mpilo, iqinisekisa ukukhula nokusebenza kahle kwezitho zomzimba. Nakuba ukukhulelwa komuntu kuvame ukuthatha amasonto acishe abe ngu-40, kukhona izimo lapho kungadlula khona lesi sikhathi okulindelekile, okuvusa imibuzo efana nokuthi ungakhulelwa isikhathi esingakanani ngokuphepha ngaphandle kwezinkinga.

Ukusebenzisana kwama-hormone ngesikhathi sokukhulelwa

Isikhathi sokukhula kwengane esizalweni sihlanganisa “umphakathi” wama-hormone. I-progesterone ne-estrogen zigcina ukukhulelwa ngokuvikela ungqimba lwesibeletho nokulawula ukukhula komntwana. I-human chorionic gonadotropin (hCG) ibalulekile ekunqobeni ukuqinisekiswa kokuqala kokukhulelwa, ivame ukutholakala egazini noma emchameni. Lawa ma-hormone ndawonye asiza ukulungisa umzimba kamama ezidingweni zokuthwala isisu, emvumela ukuthi anikeze umntwana osesibelethweni imisoco nomoya-mpilo.

1. I-Human Chorionic Gonadotropin (hCG): Ikhiqizwa ngokushesha ngemva kokungena kweqanda elichanyuswe esibelethweni, i-hCG yiyo ebhekwa iningi lezivivinyo zokukhulelwa zasekhaya. Ukuba khona kwayo kuxwayisa umzimba ukuthi agcine ungqimba lwesibeletho lungonakali kunokuba lulahleke ngesikhathi sokuya esikhathini.
2. I-Progesterone: Eyaziwa ngendima yayo ekuvimbeleni ukuqubuka kwesibeletho, le hormone isiza ukugcina indawo eshoyo esibelethweni, inciphise ubungozi obuhlobene nokulahleka kokukhulelwa kwasekuqaleni.
3. I-Estrogen: Le hormone iqinisekisa ukuhamba kahle kwegazi ukuya esibelethweni, isekele ukwakheka kwe-placenta, futhi ilungise izicubu zamabele ukukhiqiza ubisi.

Umehluko Ezingeni Lezikhathi Zokukhulelwa Phakathi Kwezinhlobo Ezahlukene

Ngenkathi abantu bevame ukuba nezinyanga cishe eziyisishiyagalolunye zokukhulelwa, ezinye izilwane ezincelisayo zehluka kakhulu kulokhu:

• Izinja: Izinja zasekhaya zikhulelisa amaphuppy cishe izinsuku ezingu-63. Ngaphakathi kuleso sikhathi, amaqanda achanyuswe athuthuka ngokushesha abe izingane ezisesiswini ezibonakalayo—eziphelele ngamaphadi ezinwele zobuso namaphethini ahlukile embhedeni woboya bazo.
• Ozankosi (ama-giraffe): Ngesikhathi sokukhulelwa esingaba yizinyanga ezingu-15, lezi zilwane ezinde ziqinisekisa ukuthi amathole asanda kuzalwa anamandla anele okuphatha indawo yawo ngokushesha ngemva kokuzalwa. Imilenze nezintamo zazo ezinde zidinga isikhathi ukuze zakheke kahle esibelethweni.
• Amakangaru: Ama-marsupial anikeza ucwaningo oluthakazelisayo. Isikhathi esisemthethweni sokukhulelwa sekhangaru cishe yinyanga eyodwa kuphela. Nokho, u-joey omncane, ongangejelebhini kuphela lapho ezalwa, uyaqhubeka nokuthuthuka ephaketheni likamama wakhe izinyanga eziningana ngemuva kokuphuma.

Ukulandela Izinyathelo Eziyinhloko Zokukhulelwa: Imibono Yezokwelapha

Emkhakheni wezifo zabesifazane nababelethisi (obstetrics), ochwepheshe bezempilo bathembele emathulini ahlukahlukene ukuze babhale phansi isigaba ngasinye sokuthuthuka. Ngokulinganisa ubude besibeletho (ibanga ukusuka ethanjeni langaphambili kuya phezulu esibelethweni), behlola ukushaya kwenhliziyo yengane esesiswini, futhi behlola ukukhula kwesaka lokukhulelwa ngokusebenzisa i-ultrasound, amaqembu ezokwelapha angakwazi ukuqinisekisa ukuthi ukuvuthwa kwengane esesiswini kuyaqhubeka njengoba kulindelekile.

• Ukuhlolwa nge-Ultrasound: Enye yezindlela ezivame kakhulu zokubona ukukhula kwengane esesiswini. Lezi zixilongo zembula izimpawu zokuthuthuka ezifana nokuba khona kwezimpande zezingalo nemilenze, ukwakheka kahle kwezitho zomzimba, namazinga oketshezi lwe-amniotic.
• Izivivinyo Zegazi: Ukuhlola amazinga ama-hormone, ikakhulukazi i-hCG, kungabonisa ukuthi ukukhulelwa kuyaqhubeka ngokujwayelekile yini, ikakhulukazi kwikota yokuqala yokukhulelwa.
• Izivivinyo Zokungacindezeleki (NST)Imvamisa zenziwa ezigabeni zokugcina zokukhulelwa, lezi zivivinyo zihlola isivinini sokushaya kwenhliziyo yengane esesiswini ngokuphendula ekunyakazeni. Ingane esesiswini enempilo ivamise ukuba nesivinini senhliziyo esikhuphukile esihambisana nemisebenzi yayo.

Ushintsho Lobuchwepheshe Ekunakekelweni Kwesikhathi Sokukhulelwa

Ubuchwepheshe besayensi nezokwelapha buvuselele ngokuphelele indlela abantu abalandelela futhi abaqonda ngayo ukukhulelwa. Emashumini eminyaka adlule, ukuhlolwa okungafaki lutho emzimbeni kanye nobuchwepheshe besithombe obuthuthukile kuqinisekise imindeni nochwepheshe bezempilo ukuthi bathole isithombe esinemininingwane eminingi ngesimo sempilo yomntwana okhulayo. Amasu afana nama-4D ultrasound awavezi kuphela ukwakheka kwamathambo kodwa futhi agqamisa ubuso nokunyakaza, kuyilapho ukuhlolwa kofuzo kuvumela ukutholwa kusenesikhathi kokungajwayelekile kwama-chromosome. Lokhu kuqhubeka kokuthuthuka kunciphisa ubungozi kukamama nasengxenyeni yezinsana, kuthuthukisa imiphumela emhlabeni jikelele.

• I-Amniocentesis: Inqubo lapho kususwa inani elincane le-amniotic fluid ukuze kuhlolwe. Ngesikhathi esedlule ibithathwa njengeyingozi kakhulu, kodwa manje isithuthukiswe kakhulu, inikeza ulwazi olubalulekile mayelana nezifo zofuzo.
• Ukuhlolwa kwe-cell-free DNA: Ihlola i-DNA yomntwana okhulayo ehamba egazini likamama, okuvumela ukutholwa kusenesikhathi nokuphephe kakhulu kwezimo ezithile zofuzo.
• I-Fetal Echocardiography: Uhlobo olukhethekile lwe-ultrasound lokuhlola ngokuningiliziwe ukwakheka nokusebenza kwenhliziyo yomntwana okhulayo, ukuze kutholakale noma kukhishwe ukungazalwa kahle kwenhliziyo.

Ukugcina Impilo Kamama Ukuze Ukukhula Komntwana Okhulayo Kube Ngokwasezingeni Eliphezulu

Ukunakekelwa kulezi zinyanga kudlula ukuhlolwa kwezokwelapha kuphela. Abantu bayazuza kakhulu ekudleni okulinganiselayo, ukuphumula okwanele, nokunaka izinqumo mayelana nendlela yokuphila. Ama-nutrient athile abalulekile ekugcineni ukuthuthuka okufanele kwezitho zomzimba. 

• I-folic acid: Isiza ukuvimbela ukungaphili kahle komgogodla nengqondo (neural tube defects), iqinisekisa ukuthi umgogodla nengqondo yengane kuyathuthuka kahle. Kuvame kunconywe ukuthi abesifazane baqale ukuyithatha ngisho nangaphambi kokukhulelwa [3].
• I-iron: Isekela ukwanda kwegazi emzimbeni futhi iqinisekisa ukuhlinzekwa komoya-mpilo okwanele kokubili kumama nakumntwana okhulayo [4].
• I-calcium: Ebalulekile empilweni yamathambo, ivumela ukukhula kwamathambo omntwana okhulayo ngaphandle kokuphelelisa izinqolobane zikamama.

Ukugcina impilo enhle yomama kubalulekile ekuthuthukisweni komntwana okhulayo, kanti izithasiselo ezifana ne-Conceive Plus Prenatal with DHA zingahlinzeka ngama-nutrient abalulekile asekele kokubili umama nengane kuyo yonke inkathi yokukhulelwa.

Izinto Ezibeka Engozini Ezithinta Ubude Besikhathi Sokukhulelwa

Yize isikhathi sokukhulelwa sivame ukulandela indlela ejwayelekile, izici ezihlukahlukene zobungozi zingaholela ekuqaleni kwenkomponi zokubeletha ngaphambi kwesikhathi noma ekwelulweni kokukhulelwa. Lezi zingozi, uma zingaqashelwa, zingalimaza inhlalakahle yomama nengane:

1. Iminyaka Kamama Okhulelwe: Omama abasemncane kakhulu nalabo abaneminyaka engaphezu kwengu-35 kwesinye isikhathi babhekana namazinga aphezulu ezinkinga. Iminyaka ingathinta amandla okukhulelwa, amathuba okuba nokuphazamiseka kwamachromosome, kanye namandla omzimba okubhekana nezidingo zokukhulelwa.
2. Izifo Ezingamahlalakhona: Izifo ezikhona kudala ezifana nomfutho wegazi ophezulu, isifo sikashukela, izifo zokuzivikela komzimba ezihlasela umzimba (autoimmune disorders), nezinkinga ze-thyroid zingaphazamisa ukuqhubeka kokukhulelwa futhi kwezinye izimo ziphoqe ukungenelela kwezokwelapha.
3. Abantwana Abaningi Esibelethweni: Ukukhulelwa amawele, amathathu noma amaningi ngokuvamile kuholela ekukhulelweni okufushane. Umthamo wesibeletho nomthwalo emzimbeni kuvame ukukhombisa ukuthi izingane kufanele zizalwe ngaphambi kwamaviki angama-40 ajwayelekile.
4. Izinto Eziphathelene Nendlela Yokuphila: Ukunganakwa kahle ngesikhathi sokukhulelwa, ukusetshenziswa kwezidakamizwa noma utshwala, noma ukuhlala ezimeni zengcindezi ephezulu kakhulu kungashesha ukuqalwa kwezinkomponi zokubeletha noma kwenze ukuthuthuka komntwana kube nzima. Ukuhlolwa njalo kanye nezeluleko zochwepheshe kusiza ukunciphisa imiphumela emibi.
5. Izifo zokutheleleka: Ezinye izinhlobo zamagciwane noma amagciwane egciwane (virus) ongazithola zingaphazamisa ukukhula okuvamile. Ukuhlanzeka okufanele, ukwenza ucansi oluphephile, kanye nokuhlolwa okuvamile kunciphisa lezi zingozi ezihlobene nokukhulelwa.

Uguquko Lobuchwepheshe Ekwandeni Kokusinda Kwezingane Ezisanda Kuzalwa

Amakhono ezokwelapha athuthukile asebenomthelela omkhulu emazingeni okusinda kwezingane ezizalwa ngaphambi kwesikhathi. Ezikhathini ezedlule, amagumbi okunakekelwa ngokukhethekile kwabantwana abasanda kuzalwa (neonatal intensive care units, NICUs) amukele izindlela zesimanje ezifana nosizo olukhethekile lokuphefumula kanye namasu okondla athuthukile, okwenza izingane zivame ukukhula kahle ngisho noma zizalwe amaviki ambalwa ngaphambi kwesikhathi esigcwele. Ukwelashwa nge-surfactant, okuyinqubo yokusebenzisa into esiza ukugcina imiphimbo yokuphefumula engakavuthwa ivulekile, kube kubalulekile kakhulu ezinganeni ezizalwa ngaphambi kwesikhathi. Ngaphezu kwalokho, ukusetshenziswa kwama-antibiotic okuhlelwe kahle kuvimbela izifo kubantwana abasanda kuzalwa ababuthakathaka. Le ntuthuko yesayensi ibonisa hhayi kuphela indlela umzimba womuntu okwazisana ngayo nezimo, kodwa futhi igcizelela ukubaluleka kwawo wonke amasonto okuba esibelethweni ukuze ukuthuthuka komntwana kube namandla futhi kuphelele [5].

Umongo Wendaba

Kunoma ubani ofisa ukuqonda ukuthi kusho ukuthini ukukhulelwa, akusilo nje igama elichazayo. Kunalokho, kumela isigaba esibalulekile emjikelezweni wempilo—esihlanganisa izimanga zofuzo nezinselele ezibonakalayo zezinguquko zomzimba. Ngokunakekelwa okuzimisela kwangaphambi kokubeletha, ukuzinza ngokomzwelo, nokulungiselela okuphelele, lolu hambo luba lula futhi lubaluleke kakhulu. Ngokuhlonipha yonke ingxenye yokukhula kombungu, abantu nemiphakathi ngokufanayo bagubha isimangaliso esisenhliziyweni yefa elihlala njalo lesintu.

Ukudalwa komuntu omusha kuhlanganisa isenzo esimangalisayo semvelo. Isinyathelo ngasinye—kusukela eqandeni elichumisiwe kuye enganeni ezalwa izimele—sigcizelela ukuvumelanisa okushelelayo kwesayensi yomzimba, imvelo, nokusekelwa kukamama. Izinguquko ezihlelelwe ngesikhathi emahormone, ekwabiweni kokudla okunomsoco nasentuthukweni yezakhiwo zomzimba zibonisa ikhono elizalwa nalo umzimba lokondla nokugcina ukuphila phakathi nesikhathi samasonto amaningi.

Izinkomba

1. Mekonen MW, Bayew AT, Lakew TJ. Izinto Ezithinta Ubude Besikhathi Sokukhulelwa Kwabesifazane Abathola Ukunakekelwa Kwangaphambi Kokubeletha eGondar referral hospital, e-Ethiopia. Health Sci Rep. 2022 Jun 3;5(4):e676. doi: 10.1002/hsr2.676. PMID: 35662979; PMCID: PMC9164550.
2. Espel EV, Glynn LM, Sandman CA, Davis EP. Isikhathi Eside Sokukhulelwa Phakathi Kwezingane Ezizalwa Zigcwele Isikhathi Sithinta Ukuthuthuka Kwengqondo Nokunyakaza Komzimba. PLoS One. 2014 Nov 25;9(11):e113758. doi: 10.1371/journal.pone.0113758. PMID: 25423150; PMCID: PMC4244187.
3. Kadir M, Hood RB, Mínguez-Alarcón L, Maldonado-Cárceles AB, Ford JB, Souter I, Chavarro JE, Gaskins AJ; EARTH Study Team. Ukudla I-folate Nokulondolozwa Kwamaqanda Esibeletho Kwabesifazane Abavakashela Isikhungo Sokuzala. Fertil Steril. 2022 Jan;117(1):171-180. doi: 10.1016/j.fertnstert.2021.09.037. Epub 2021 Nov 19. PMID: 34809974; PMCID: PMC8714696.
4. Institute of Medicine (US) Ikomidi Elibhekele Isimo Sokondleka Ngesikhathi Sokukhulelwa Nangesikhathi Sokuncelisa. Ukudla Okunempilo Ngesikhathi Sokukhulelwa: Ingxenye I Ukuzuza Isisindo: Ingxenye II Izithasiselo Zokudla. Washington (DC): National Academies Press (US); 1990. 14, Ukudla Kwe-ayoni Ngesikhathi Sokukhulelwa. Kutholakala ku: https://www.ncbi.nlm.nih.gov/books/NBK235217/
5. Shields LB, Davydov Y, Glyder A, Weymouth C, Udwin M, Eakins M. Umthelela Wobuchwepheshe Ekumukelweni Eyunithi Yokunakekelwa Okukhulu Kwezinsana Ezisanda Kuzalwa Nasobude Besikhathi Sokuhlala: Ucwaningo Olubuyekeziwe Emuva. Cureus. 2023 Jun 22;15(6):e40813. doi: 10.7759/cureus.40813. PMID: 37485146; PMCID: PMC10362942.