Ngesikhathi sokukhulelwa, ukunakekelwa kwezempilo komama kubalulekile ngoba izifo ezithile zingathinta kokubili umama nengane; phakathi kwazo, isifo sokusha kwesibindi kohlobo sithatha indawo evelele ngenxa yamandla aso okudlulisela kanye nezinkinga. Ngokujwayelekile, sikhuluma ngakho ukuvuvukala kwesibindi okubangelwa amagciwane okungaba kubi noma okungamahlalakhona, kube nomthelela oguquguqukayo ekukhulelweni kuye ngohlobo lwegciwane, umthamo wegciwane egazini kanye neminyaka yokukhulelwa.
Nakuba i-hepatitis eyingozi ingavamile kakhulu kwabesifazane abakhulelwe, uma ibonakala ingahlotshaniswa nayo ingozi enkulu ye-pathologies kamama kanye ne-fetus, ikakhulukazi endabeni yamagciwane athile anjengesifo sokusha kwesibindi kohlobo E. Ngakho-ke, ekubelethweni kwanamuhla, ukuhlola, ukuvimbela ukusulelana kwengane esuka kumama, kanye nezinqumo zokwelashwa eziphephile kubekwa kuqala, ngezinyathelo ezimiswe kahle zokuvikela usana olusanda kuzalwa emizuzwini yokuqala yokuphila.
Iyini i-hepatitis futhi kungani ibalulekile ngesikhathi sokukhulelwa?
I-Hepatitis yi-a ukuvuvukala kwesibindi ngokuvamile okubangelwa amagciwane athile esibindi: i-hepatitis A, B, C, D kanye no-E. Amanye amagciwane angase ahileleke, njengegciwane le-Epstein-Barr, i-cytomegalovirus, i-yellow fever, i-rubella, i-adenovirus noma i-herpes simplex, engabangela izimpawu ezifanayo ngesikhathi sokukhulelwa.
Lezi zifo zingaba acute (isikhathi esifushane) noma esingamahlalakhona (ziyaphikelela), futhi ezinye zingase zisebenze kabusha uma sezivele zikhona. Ekukhulelweni, uhla lwezimpawu lubanzi: kusuka ekungakhululeki kuya umkhuhlane, ukukhathala okwedlulele, ubuhlungu besisu, ne-jaundice, kanye nokucanuzela kwenhliziyo, ukuhlanza, ukulunywa, ukungakuthandi ukudla, nomchamo omnyama; ukuqina kuncike egciwaneni kanye nesimo sesibindi.
Imithelela nayo iyahluka: kukhona amagciwane angavamisile ukwenza ukukhulelwa kube nzima kanti amanye angadala izehlakalo ezibucayi njengokuthi ukwehluleka kwesibindi, ngaphambi kwesikhathi noma, ezimweni ezimbi kakhulu, ukufa komama noma kombungu. Ukuqonda ukuthi yimaphi amagciwane asengozini nokuthi zidluliselwa kanjani kusiza ukuchaza uhlelo olungcono kakhulu lokuqapha nokuvimbela esimweni ngasinye.
Mayelana nokutheleleka, i-hepatitis A no-E itholakala ikakhulukazi ngomzila we-fecal-oral (amanzi angcolile kanye nokudla), i-hepatitis B no-C Zidluliselwa ngegazi noketshezi, futhi i-hepatitis B, ikakhulukazi, ingadlula isuka kumama iye enganeni lapho izalwa uma ingelashwa ngokushesha. Ngenxa yamandla ayo angapheli futhi athathelana kalula, i-hepatitis B no-C Yizona ezibangela ukukhathazeka kakhulu kwezokubelethisa.
Izinhlobo zokutheleleka kanye nezingozi zokudluliselwa kwengane esuka kumama
Izindlela eziyinhloko yilezi: i-fecal-oral (A no-E), ukuthintana negazi noma izinaliti (B no-C), ucansi olungavikelekile (B kanye namanye amagciwane angewona awesibindi), kanye nokudluliswa okuqondile. Isikhathi esibucayi sokudluliselwa kwe-B no-C ngokuvamile ukuzalwa, lapho usana olusanda kuzalwa lungase lube sengozini igazi likamama, kuyilapho nge-hepatitis E kukhona futhi ingozi ngesikhathi sokukhulelwa ngokwayo nemiphumela emibi kakhulu.
Ku-hepatitis B, ingozi enkulu yokudluliselwa enganeni igxile ekuzalweni; ngenhlanhla, inhlanganisela ye-hepatitis B immunoglobulin (HBIG) kanye umthamo wokuqala womuthi wokugoma, uma isetshenziswa ngendlela efanele futhi kusenesikhathi, kunciphisa kakhulu ukutheleleka kwezingane ezisanda kuzalwa. Ku-hepatitis C, ingozi emaphakathi yokudluliselwa okuqondile iseduze I-5-10% (ingase ibe ngaphansi noma ibe phezulu kuye ngesimo somtholampilo), ikhuphuke ngenani legciwane egazini noma ukuhlangana kwe-HIV.
I-Hepatitis E ihlukile ngenxa yobunzima bayo obukhulu ekukhulelweni, ikakhulukazi ekukhulelweni i-trimester yesithathu: Amanani abalulekile okudluliselwa komntwana osanda kuzalwa achazwe, ngokugula okuphezulu nokufa kwabantu ezinsukwini zokuqala zokuphila. Le phethini idinga a ukuqapha emtholampilo kanye nokwesekwa okujulile lapho lokhu kutheleleka kusolwa noma kuqinisekisiwe.
I-Hepatitis A ngesikhathi sokukhulelwa
I-Hepatitis A isakazwa ngokuyinhloko ngu ukungenwa amanzi noma ukudla okungcolile ngendle evela kubantu abanaleli gciwane; kuyigciwane elimelana nemvelo futhi lithathelwana kakhulu kusukela emasontweni amabili ngaphambi kokuba izimpawu zivele kuze kube cishe ezinsukwini eziyishumi ngemva kokuqala kwezimpawu.
Isikhathi se-incubation ngokuvamile siseduze Izinsuku ze-30Kubantu abadala kuba nezimpawu kakhulu kunasezinganeni futhi kungabangela imfiva, i-malaise, isicanucanu, ukuhlanza, ubuhlungu besisu kanye ne-jaundiceNgokuvamile kuwukutheleleka okuzibekela umkhawulo, ngokulungiswa okuzenzakalelayo ngaphandle kokwelashwa okuqondile kwe-antiviral.
Esimweni sokukhulelwa, akuzange kuboniswe njalo lokho ukutheleleka okusebenzayo ukutheleleka komama kungase kubangele ukutheleleka kwezingane ezisanda kuzalwa, futhi umphumela ngokuvamile uvumelana nezinyathelo zokusekela. Nokho, Izinkinga zokuzala ezizimele, Ngakho-ke, ukuhlolwa kwezokwelapha kubalulekile ukuze kukhishwe ukuphelelwa amanzi emzimbeni noma ezinye izigameko.
Ukuvimbela kusekelwe ikakhulukazi ekuhlanzekeni kwezandla kanye nokugoma lapho kukhonjisiwe. umuthi wokugomela i-hepatitis A Kuyigciwane elingasebenzi futhi linikeza isivikelo sesikhathi eside (ishumi leminyaka elilodwa kuya kwamashumi amabili); kwabesifazane abakhulelwe, kugcinelwe izimo ezithile zobungozi, njengokuvakashela ezindaweni ezinengozi ephezulu, njalo ngaphansi kwesinqumo somtholampilo.
I-Hepatitis B ekukhulelweni: ukuhlolwa, ukwelashwa, nokuvikelwa kosana
I-Hepatitis B idluliselwa ngokuthintana no igazi noketshezi lomzimba. Kwezokubelethisa, insika yokuvimbela iwukuhlolwa kwangaphambi kwesikhathi kwendawo yonke: bonke abesifazane kufanele bahlolelwe i-hepatitis B ngesikhathi sokukhulelwa ukuze kutholakale i-surface antigen (HBsAg) futhi, uma kufaneleka, ukuhlolwa okwengeziwe nge-e antigen (HBeAg) kanye umthamo wegciwane egazini (HBV DNA).
Uma owesifazane okhulelwe ene-HBsAg, umgomo uwukunciphisa ukudluliselwa okuqondile. Uma umthamo wegciwane egazini uphezulu kakhulu (isb., >200.000 IU/mL), uchwepheshe angase ancome izidakamizwa ezilwa namagciwane ku-trimester yesithathu ukunciphisa amazinga egciwane ngaphambi kokubeletha. I-Tenofovir iwukwelashwa komugqa wokuqala futhi ibonise iphrofayili yokuphepha eyanele ngesikhathi sokukhulelwa nokuncelisa; ezimweni ezithile, i-telbivudine noma i-lamivudine ingacatshangwa.
Ngesikhathi sokuzalwa, usana olusanda kuzalwa lukamama one-hepatitis B kufanele lwamukele, ekamelweni lokubelethela kanye emahoreni ayi-12 okuqala empiloImijovo emibili: umthamo owodwa we-HBIG kanye nomthamo wokuqala womgomo we-HBV. Uma zilawulwa ngendlela efanele nangesikhathi, lezi zinyathelo zinikeza isivikelo esingaphezu kuka-90% ekuthelelekeni okungapheli impilo yonke.
Ngemva kwalokho, kubalulekile ukuqedela uhlelo lokugoma ngemithamo esele njengoba kuhleliwe. Emazweni lapho umgomo we-pentavalent usetshenziswa emavikini angu-6, 10, kanye nayi-14, le nhlanganisela ayithathi indawo yomthamo wokuzalwa: ukulinda i-pentavalent sekwephuzile kakhulu ezinganeni ezisanda kuzalwa komama abane-HBsAg-positive, umthamo we-monovalent ekuzalweni (kanye ne-HBIG uma ikhona) bese uqhubeka nohlelo. Kubalulekile ukukhumbula ukuthi i-HBIG ayitholakali kuzo zonke izinhlelo zokunakekelwa kwezempilo, ngakho kuwumqondo omuhle ukuhlela kusenesikhathi.
Ukuqinisekisa ukuthi umntwana ubevikelekile futhi akanalo igciwane, kuyakhonjiswa ukuhlolwa. I-serology yangemva kokugoma phakathi kwezinyanga eziyi-9 neziyi-12 (i-HBsAg nama-anti-HBs). Alikho ithuba lesibili lokuhlola usana olusanda kuzalwa: ukuxhumana phakathi kokubelethisa kanye nodokotela bezingane kubalulekile kusukela ekukhulelweni.
Kumama, uma ama-antiviral anqunywe ku-trimester yesithathu, kuvamile ukuqhubeka nawo ambalwa Amaviki angu-12 ngemva kokubeletha futhi iqaphe i-ALT njalo ezinyangeni ezintathu izinyanga eziyisithupha, ukuze inqume ne-hepatologist ukuthi izoqhubeka noma iyeke yini ukwelashwa. Imithi akufanele iyekwe ngaphandle kweseluleko sezokwelapha kanye nokubuyekezwa kwemiphumela yaselabhorethri.
Ngokuphathelene nenkambo yokukhulelwa, isifo sokusha kwesibindi kohlobo B ngokwaso asivamile ukuba sibe sibi ukukhulelwa uma kungekho ukulimala kwesibindi okuthuthukisiwe ngaphambili, nakuba ezigabeni ezibucayi kungandisa ingozi yokuzalwa ngaphambi kwesikhathi. Ngaphezu kwalokho, ngaphandle kwasezimweni eziqondile kakhulu, ukuncelisa ibele kuphephile lapho usana oluthole ukwelashwa kokuzalwa ngendlela efanele.
I-Hepatitis C nokukhulelwa: ukuxilongwa, ukudluliselwa, nokuncelisa
I-Hepatitis C isakazwa ikakhulukazi ngu ukuchayeka egazini elinegciwaneNgesikhathi sokukhulelwa, kuvame ukutholakala ne-anti-HCV antibody test, futhi uma ikhona, kuqinisekiswa nge-HCV RNA ukuze kutholwe ukuthi kukhona yini ukutheleleka okusebenzayo. Iningi labesifazane abakhulelwe aliboni zimpawu noma lingaphatheki kahle nje.
Ukudluliselwa okuqondile kungenzeka ngesikhathi sokukhulelwa noma ku- isikhathi sokuzalwa (ikakhulukazi ngenxa yokuchayeka egazini). Isilinganiso sobungozi silinganiselwa ku-5–10%, ngezibalo ezibikiwe phakathi kuka-1,7% no-20% kuye ngochungechunge. Izinto ezandisa ukutheleleka zihlanganisa inani eliphezulu legciwane egazini, ukutheleleka ngegciwane lesandulela ngculaza, ukusebenzisa izidakamizwa emithanjeni, umlando wokumpontshelwa, ukugqabuka isikhathi eside kolwelwesi, noma izinqubo ezihlaselayo ngesikhathi sokulethwa.
- Ingozi enkulu nge inani legciwane egazini kumama.
- Ingozi eyengeziwe uma ikhona Ukutheleleka nge-HIV.
- Ukuhlangana ne ukusetshenziswa kwezidakamizwa ngomjovo kanye nokuchayeka egazini.
- Ukuqhekeka isikhathi eside kolwelwesi noma ukuchayeka kwengane egazini likamama ekubelethweni.
- Umlando wokudluliselwa okuqondile ekuzalweni kwangaphambilini.
Mayelana nokwelashwa, ama-antiviral asebenza ngqo e-HCV, azinconywa ngesikhathi sokukhulelwa ngenxa yokuntuleka kwedatha yokuphepha; ngokuvamile zicatshangelwa ngemva kokubeletha nalapho ukuncelisa sekuphelile (noma ngaphambi kwalokho, uma kungenjalo ukuncelisa). Ukuncelisa ibele kuyahambisana nesifo sokusha kwesibindi kohlobo C, ngaphandle kwasezimweni zokuthi izingono eziqhekekile noma ezophayo.
Ukuqapha okusanda kuzalwa akwenziwa esibelethweni: ukuhlolwa kokuxilonga kuhlelwa kusukela ku- Izinyanga ze-18 (noma ngaphambilini ngamaphrothokholi athile) ukuze kuqinisekiswe ukuthi ukudluliswa kwenzekile noma cha. Okwamanje, ukunakekelwa kugxile empilweni kamama kanye nokunciphisa noma yiziphi izici ezingagwemeka zokutheleleka.
Izinyathelo zokuzinakekela ezinconyiwe ngesikhathi sokukhulelwa ne-HCV zihlanganisa: ukugwema utshwala nezinto ezidakayo, ukugonyelwa i-hepatitis A no-B Uma ungakakwenzi lokho, yazisa ochwepheshe abazohambela ukubeletha, gcina ucansi oluphephile futhi ungahlanganyeli ngezinto zakho ezingase zibe nemikhondo yegazi kuzo (izindwani, amabhulashi, iziqeshana zezinzipho).
- Yiya kuzo zonke ukuvakashelwa ngaphambi kokubeletha futhi uxhumane nesimo se-HCV eqenjini.
- Gwema utshwala, ugwayi, insangu kanye nezidakamizwa ezingekho emthethweni; cela usizo uma kudingeka.
- Ungaqali imithi emisha ngaphandle kokubonisana; ezinye izidakamizwa (isb., i-paracetamol ephezulu) kungenza isimo sesibindi sibe nzima.
- Usar ikhondomu, ningabelani ngezinto zomuntu siqu futhi nimboze amanxeba.
I-Hepatitis D kanye nama-coinfections
I-Hepatitis D ithinta kuphela abantu asebevele bene-hepatitis B, ngoba idinga HBsAg ukuphindaphinda. Ukuba khona kwayo kungase kubhebhethekise indlela yomtholampilo, nakuba ukusuleleka kwengane kusuka kumama kuyivelakancane; i-standard neonatal prophylaxis ngokumelene ne-HBV (umthamo wokuzalwa womgomo kanye, uma kungenzeka, i-HBIG) kunciphisa ingozi yokutheleleka nge-HDV kusana olusanda kuzalwa.
I-Hepatitis E ekukhulelweni: ukwanda kokuqina nokuqapha okuseduze
I-Hepatitis E idluliselwa ngomzila we-fecal-oral futhi ingabangela imfiva, i-anorexia, isicanucanu, ubuhlungu besisu, i-jaundice, nokukhathala. Ekukhulelweni, ikakhulukazi ku i-trimester yesithathu, ihlotshaniswa nengozi enkulu yoku ukwehluleka kwesibindi esibi, ukubeletha ngaphambi kwesikhathi, ukukhishwa kwezisu kanye nezinkinga zomama ezifana ne-fulminant hepatitis kanye nesifo esinzima somfutho wegazi ophezulu.
Amazinga ahlobene okudlulisela okuqondile achaziwe (cishe phakathi I-33% ne-50%), abanezimo zesifo sokusha kwesibindi komntwana osanda kuzalwa kanye nokufa ngaphambi kwesikhathi. Olunye ucwaningo luye lwabonisa amazinga aphezulu kakhulu okutheleleka kwamagciwane okuzala okunemiphumela emibi phakathi nesonto lokuqala lokuphila, okudinga ukuphathwa kwesibhedlela okuyinkimbinkimbi kakhulu lapho ukutheleleka kuqinisekiswa kumama.
Emaceleni we ukuncelisaAbukho ubufakazi obuphelele bokutheleleka ngobisi lwebele; Izinsiza zokusebenzisa imithi yokuncelisa ibele zihlukanisa ukuhambisana njengokungenzeka. Ezimweni ezimbi kakhulu noma uma umama ethula isinxephezelo, ukufaneleka kokuncelisa ibele ngenkathi isimo sizinza kufanele kuxoxwe nethimba lakhe lomtholampilo.
Ukuvimbela okujwayelekile kanye nokugoma ngesikhathi sokukhulelwa
Izinyathelo zokuvimbela ziyahlangana inhlanzeko, ukugoma kanye nokunciphisa ukuchayekaKwabesifazane abakhulelwe abasengozini, imithi yokugomela i-hepatitis A no-B engacushiwe ingasetshenziswa uma kukhonjisiwe (isibonelo, ukuya ezindaweni eziwumshoshaphansi noma okuthintana nabo engcupheni), njalo ngokuhlolwa okukodwa kochwepheshe.
Nge-hepatitis B, ngaphezu komthamo wokuzalwa wazo zonke izingane ezisanda kuzalwa, okulandelayo kuyanconywa: ukugoma okuvamile ebuntwaneni nakubantu abadala abanezici eziyingozi (ukuxhumana negazi emsebenzini, abalingani abaningi bocansi, abasebenzisi bezidakamizwa zomjovo, ukuhlala nabathwali, isifo sezinso esithuthukisiwe, ukuya ezindaweni ezivame kakhulu, phakathi kokunye). Amazwe amaningi andise izincomo cishe kubo bonke abantu abadala abangagonyiwe.
Kuyelulekwa futhi ukuthatha izinyathelo zokuphepha ezidlulele nge ama-tattoos nokubhoboza (izinto ezingcolile kanye nezakhiwo eziqinisekisiwe), nciphisa imikhuba eyingozi, sebenzisa ikhondomu uma isimo sozakwethu se-serological singaziwa, futhi gwema ukwabelana ngezinaliti nanoma iyiphi into engase ibe nemikhondo yegazi kuyo. Esimeni sokuchayeka okuyingozi ku-HBV, thintana ngokushesha ngoba i-post-exposure prophylaxis Isebenza kahle kakhulu uma ilawulwa phakathi namahora angu-24 okuqala.
Izimpawu nezimpawu: yini okufanele uyibuke futhi nini okufanele uthintane nayo
I-Hepatitis ngesikhathi sokukhulelwa ingahamba ingabonakali noma ibonakale nayo izimpawu ezingaqondileIzimpawu ezivame kakhulu zihlanganisa ubuhlungu besisu, isicanucanu, ukuhlanza, imfiva, i-jaundice, umchamo omnyama, ukukhathala okuphawulekayo, nobuhlungu bamalunga; noma yikuphi ukuwohloka kwesimo esivamile kufanele kubangele ukuhlolwa komtholampilo ngokushesha.
Uma usola ukuchayeka egciwaneni lokusha kwesibindi kohlobo B (isb., inaliti ngephutha noma ukuthintana negazi), kubalulekile xhumana nethimba lezempilo ngokushesha ukuhlola izinyathelo zokuvimbela. Uma izimpawu ezihambisana ne-hepatitis zivela ngesikhathi sokukhulelwa, ukunakekelwa kusenesikhathi kungakhipha izinkinga futhi kuhlele ukulandelela okuphephile kumama nengane.
Ekugcineni, kokubili udokotela wokubelethisa kanye udokotela wezingane/i-neonatologist Kufanele bazi isimo sokusha kwesibindi kowesifazane okhulelwe ukuze baxhumanise ukuvimbela ukuzalwa komntwana (ikakhulukazi i-hepatitis B) kanye nohlelo lokuhlola usana lwangemva kokubeletha lapho kufaneleka (njengoba kunjalo ngesifo sokusha kwesibindi kohlobo C).
Ukukhulelwa nesifo sokusha kwesibindi kungahlalisana nemiphumela emihle uma kusetshenziswa amasu afanele: ukuhlolwa kwe-HBV jikelele Phakathi nokukhulelwa, ukusetshenziswa okufika ngesikhathi nokuphephile kwezidambisigciwane ze-HBV enemithwalo ephezulu, i-neonatal prophylaxis esheshayo, ukuhlolwa kwengane ngemva kokugonywa, nokuqapha nge-HCV (ukwelashwa ukubambezeleka nokuncelisa ibele kuvunyelwe ngaphandle kokopha ingono). Nge-HEV, ukhiye uwukuqapha eduze ngenxa yokuqina kwayo okukhulu kanye ne izinyathelo zokusekela esibhedlela Uma kunesidingo, ukuvimbela ngokugoma (uma kukhonjisiwe), inhlanzeko, nokunciphisa ingozi egazini noketshezi kuqeda indlela.
