Ukuphathwa Kwezibeletho Ezimweni Ze-Hepatitis B
I-Pendahuluan
I-Hepatitis B igciwane elihlasela isibindi futhi lingabangela izifo ezibukhali nezingamahlalakhona. Emsebenzini wokubeletha, i-hepatitis B inomthelela omkhulu ngoba ingadluliselwa kusuka kumama iye enganeni (ukudluliselwa okuqondile), ikakhulukazi ngesikhathi sokubeletha. Lokhu kudluliselwa kuyinkinga enkulu ngoba izinsana ezinegciwane zisengozini enkulu yokuthola i-hepatitis B engapheli, engabe isiqhubekela phambili ekubeni yi-cirrhosis noma umdlavuza wesibindi kamuva ekuphileni. Ngakho-ke, ukuphathwa kwe-hepatitis B ngokubeletha kumele kube okuphelele, kusukela ekunakekelweni kwangaphambi kokubeletha, kwangaphakathi kokubeletha, nangemuva kokubeletha, kuhambisane nemizamo yokuvimbela ukudluliselwa kwegciwane emfundweni yezingane kanye neyomndeni.
Imiqondo Eyisisekelo Ye-Hepatitis B Ekukhulelweni
I-Hepatitis B ibangelwa yigciwane le-hepatitis B (i-HBV) futhi itholakala ngokuhlolwa kwe-serological, ikakhulukazi i-HBsAg. Abesifazane abakhulelwe abane-HBsAg bangaba sesigabeni sokutheleleka esiphuthumayo noma esingamahlalakhona. Ingozi yokudluliselwa kwegciwane kusuka kumama kuya enganeni iyanda uma umama enamazinga aphezulu egciwane (i-HBV DNA ephezulu) kanye/noma ene-HBeAg positive. Ukudluliselwa okuningi kwenzeka ngesikhathi sokubeletha ngenxa yokuxhumana kwengane negazi likamama kanye noketshezi lomzimba. Ukudluliselwa kwegciwane ngesikhathi sokukhulelwa akuvamile kodwa kungenzeka, ikakhulukazi uma kukhona ukopha, izinqubo zokuhlasela, noma izinkinga ezithile.
Kwabomama, i-hepatitis B ivame ukungabi nazimpawu, okwenza ukuhlolwa kube yingxenye ebalulekile yokunakekelwa kwangaphambi kokubeletha. Uma kuvela izimpawu, zingafaka ubuthakathaka, isicanucanu, ubuhlungu besisu esingenhla kwesokudla, i-jaundice, umchamo omnyama, kanye nama-enzyme esibindi aphezulu. Ukukhulelwa ngokuvamile akukubi kakhulu i-hepatitis B kuzo zonke izimo, kodwa abanye besifazane bangase babe nokuqhuma (ukuphindaphinda komsebenzi owandayo wegciwane), ikakhulukazi esikhathini sokubeletha.
Izinhloso Zokuphathwa Kwababelethisi
Ukuphathwa kokubeletha ezimweni ze-hepatitis B kuhlose:
1. Gcina impilo yabesifazane abakhulelwe futhi uvimbele izinkinga zesifo sesibindi.
2. Vimbela ukudluliselwa kwe-HBV kusuka kumama kuya enganeni.
3. Lungiselela ukubeletha okuphephile futhi unciphise ukuchayeka egazini/oketshezini lomzimba.
4. Qinisekisa ukuthi ingane ithola ukuvikelwa ngesikhathi esifanele (ukugonywa kanye ne-immunoglobulin uma ikhona).
5. Nikeza imfundo kanye nokwelulekwa komama nemindeni mayelana nokudluliselwa kwesifo, ukunakekelwa, kanye nokulandelela.
Ukuphathwa Kokubelethisa Ngesikhathi Sokukhulelwa (Ukukhulelwa)
1. Ukuhlolwa Nokutholwa Kwangaphambi Kwesikhathi
Ukunakekelwa kwangaphambi kokubeletha kufanele kube kuhle ukuthi kufakwe ukuhlolwa kwe-HBsAg kubo bonke abesifazane abakhulelwe. Uma umphumela we-HBsAg ubonisa ukuthi ulungile, isinyathelo esilandelayo ukuhlola ingozi yokudluliselwa kanye nokusebenza kwesibindi. Ukuhlolwa okulandelayo okunconywa njalo kufaka phakathi i-HBeAg, i-anti-HBe, amazinga e-HBV DNA (uma ekhona), kanye nokuhlolwa kokusebenza kwesibindi (ALT/AST, bilirubin). Ababelethisi badlala indima ekuqinisekiseni ukuthi umama uyaqonda incazelo yemiphumela yokuhlolwa kanye nokubaluleka kokulandelela.
2. Ukuhlolwa Kwemininingwane Nokuhlolwa Komzimba
Umbelethisi wenza ukuhlolwa okujulile: umlando wesifo sesibindi, umlando wokufakwa kwegazi, ukusetshenziswa kwenaliti, umlando wocansi, umlando womndeni we-hepatitis, kanye nezikhalazo ezifana nokucanuzela okukhulu, i-jaundice, noma ukuqunjelwa. Ukuhlolwa ngokomzimba kuhlola izimpawu ze-anemia, i-jaundice, i-hepatomegaly (nakuba kulinganiselwe emikhubeni yokubeletha), ukuvuvukala, kanye nezinye izimpawu zezinkinga. Ukuqapha umfutho wegazi, isimo sokudla okunempilo, kanye nesimo sokukhulelwa kusalokhu kuyinto eza kuqala.
3. Ukubambisana kanye Nokudluliselwa
Ababelethisi kudingeka babambisane nodokotela (ababelethisi kanye/noma imithi yangaphakathi/i-hepatology) ikakhulukazi uma:
– I-ALT/AST ephezulu kakhulu, i-jaundice, noma i-hepatitis esolwayo ukuthi iyingozi kakhulu.
– I-HBV DNA ephezulu noma i-HBeAg enhle edinga ukuhlolwa kokwelashwa ngama-antiviral.
– Kunezimpawu zezinkinga zokuqina kwamalunga noma izinkinga zesibindi.
Ezinye iziqondiso ziphakamisa ukuthi ukwelashwa ngama-antiviral (isb., i-tenofovir) kungacatshangelwa ku-trimester yesithathu ukuze kuncishiswe umthwalo wegciwane komama abanamazinga aphezulu e-HBV DNA, ngaleyo ndlela kuncishiswe ingozi yokudluliselwa enganeni. Lesi sinqumo sisezandleni zikadokotela, kodwa ababelethisi badlala indima ekusekeleni ukunamathela kanye nokuqapha imiphumela emibi.
4. Imfundo Nokwelulekwa Kwabesifazane Abakhulelwe
Imfundo iyisisekelo sokunakekelwa kwababelethisi. Izici ezibalulekile okufanele zibhekwe zifaka:
– I-Hepatitis B ingadluliselwa ngegazi kanye nokuxhumana ngokocansi; kubalulekile ukusebenzisa amakhondomu uma umlingani wakho engavikelekile.
– Amalungu omndeni kanye nabalingani kufanele bahlolwe i-HBsAg futhi bathole umuthi wokugomela i-hepatitis B uma bengakakwazi ukuzivikela.
– Gwema ukwabelana ngezinto zakho ezingase zivezeke egazini (amabhulashi amazinyo, izinsingo).
– Omama bayelulekwa ukuba bagweme utshwala nezidakamizwa ezingalimaza isibindi ngaphandle kokubonisana nodokotela.
– Gcizelela ukuthi ukubeletha kusengaqhubeka ngendlela evamile, futhi into ebaluleke kakhulu ukuvimbela umntwana ngokushesha ngemva kokuzalwa.
Ukuphathwa Kokubelethisa Ngesikhathi Sokubeletha (Ukubeletha)
1. Ukuhlela Ukuzalwa
Indlela yokubeletha (ukubeletha ngesitho sangasese sowesifazane noma ngokuhlinzwa) ngokuvamile inqunywa yizimpawu zokubeletha. Ukubeletha ngokuhlinzwa akukhuthazwa ngaso sonke isikhathi ngenxa yesifo se-hepatitis B, njengoba ukuvimbela okuyinhloko kuhlala kuyindlela yokuvimbela igciwane ezinsaneni. Kodwa-ke, ukukhetha inqubo kumele kucabangele izimo zikamama nomntwana osanda kuzalwa, kanye nezinqubomgomo zezokwelapha zasendaweni. Ababelethisi baqinisekisa ukuthi uhlelo lokubeletha lulungiselelwe ngokuxhumana okuhle phakathi kwethimba.
2. Ukuvimbela Ukudalulwa kanye Nemikhuba Ephephile
Ukuze kuncishiswe ingozi yokuchayeka egazini:
– Sebenzisa izindlela zokuqapha ezijwayelekile (amagilavu, ukuvikela, ukuphatha ngokuphephile izinto ezibukhali).
– Nciphisa izinqubo zokuhlasela ezingadingekile, njenge-amniotomy yokuqala, ukusetshenziswa kwama-electrode ekhanda lengane, noma ukusampula igazi lengane, njengoba lokhu kungandisa ingozi yokudluliselwa.
– Phatha ukopha ngokushesha nangendlela efanele.
– Qinisekisa ukuthi zonke izinqubo zenziwa kusetshenziswa amasu okubulala amagciwane futhi ukulahlwa kwemfucuza yezokwelapha kuhambisana nezindinganiso.
3. Imibhalo kanye Nokuxhumana
Isimo sikamama se-hepatitis B kumele sibhalwe phansi futhi sitshelwe ithimba elinakekela umntwana, ukuze kuvikelwe ngokushesha ngemva kokuzalwa ngaphandle kokulibala.
Ukuphathwa Kokubelethisa Esikhathini Sokubeletha (i-Puerperium)
1. Ukunakekelwa Kwabesifazane
Kwabesifazane abakhulelwe abane-hepatitis B, ababelethisi baqapha izimpawu ezibalulekile, ukuguquka kwesibeletho, ukopha, kanye nezimpawu zokungasebenzi kahle kwesibindi noma ukuqubuka kwangemva kokubeletha (isb., ukukhathala okukhulu, i-jaundice, ubuhlungu be-quarter quarter kwesokudla). Ukuhlolwa nokulandelela kwelabhorethri kuvame ukwenziwa ngokubambisana nodokotela. Ukunamathela emithini uma umama ethola ukwelashwa ngamagciwane kufanele kusekelwe, okuhlanganisa nemfundo mayelana nokuhlolwa okuhleliwe.
2. Ukuncelisa
Ukuncelisa ibele ngokuvamile kuvunyelwe omama abane-hepatitis B, ikakhulukazi uma ingane ithole umjovo we-hepatitis B ngokushesha ngemva kokuzalwa (kanye ne-HBIG, uma ikhona). Ingozi yokudluliselwa ngobisi lwebele iphansi kakhulu uma kuqhathaniswa nezinzuzo zokuncelisa. Kodwa-ke, uma kunezilonda eziphumayo emabeleni, umbelethisi angancoma ukunakekelwa kwenxeba futhi acabangele ukuncelisa okwesikhashana ohlangothini oluthintekile kuze kube yilapho ingane iphola, njengoba kunconywa ngabasebenzi bezokwelapha.
3. Impilo Yengqondo Nokusekelwa Komphakathi
Ukuxilongwa kwe-hepatitis B kungabangela ukukhathazeka, ukucwaswa, kanye nokwesaba komama. Ababelethisi kudingeka banikeze ukwesekwa kwengqondo, babhekane nemibono eyiphutha, futhi bakhuthaze omama ukuthi baqhubeke nokwelashwa futhi bagweme ukuzizwa benecala. Ukwelulekwa komndeni kungasiza ekwakheni indawo yokusekela.
Ukuphathwa Kwezingane Ezisanda Kuzalwa Zomama Abane-HBsAg
1. I-Immunoprophylaxis Esheshayo
Isinyathelo esibaluleke kakhulu sokuvimbela i-hepatitis B ezinganeni ukuhlinzeka:
– Umuthi wokugomela i-hepatitis B (HB-0) wokuzalwa ngokushesha okukhulu, okungcono kakhulu phakathi namahora okuqala ayi-12 okuphila.
– I-HBIG (i-Hepatitis B Immunoglobulin) uma ikhona, futhi phakathi namahora okuqala ayi-12, inikezwa endaweni ehlukile yomjovo kunomjovo.
Le nhlanganisela iphumelela kakhulu ekunciphiseni ingozi yokuba umntwana abe yimthwali wesifo esingamahlalakhona. Ababelethisi badlala indima ekuqinisekiseni ukuthi umntwana uthola lokhu kwelashwa ngesikhathi esifanele, bagcina amarekhodi, futhi bafundise abazali.
2. Uhlelo Lokulandelela Lokugoma
Izinsana kufanele ziqhubeke nochungechunge lwazo lokugomela i-hepatitis B ngokwesimiso sikazwelonke (isb., ezinyangeni ezi-2, ezi-3, nezi-4 ubudala, noma njengoba kufanele). Ababelethisi kufanele baqinisekise ukuthi imindeni iyaqonda ukubaluleka kokugonywa okuphelele, njengoba umthamo wokuzalwa wodwa unganele ukuvikela isikhathi eside.
3. Ukuhlolwa Kokulandelela Kwengane
Ezinye iziqondiso zincoma ukuhlolwa kwe-serological kwezinsana zomama abane-HBsAg ngemuva kokuqeda uchungechunge lokugoma (isb., ezinyangeni ezingu-9-12 ubudala) ukuqinisekisa ukuthi ama-antibodies avikelayo (ama-anti-HB) athuthukisiwe nokuqinisekisa ukuthi usana aluthelelekile (ama-HBsAg angenayo). Ababelethisi bangakhumbuza abazali ngalokhu kuhlolwa futhi babathumele ezikhungweni ezifanele.
Ukuvimbela Ukutheleleka Emvelweni Yomndeni Nezikhungo Zezempilo
Ngaphezu kokugxila kumama nengane, ukuphathwa kwababelethisi kuhlanganisa nokuvimbela ukudluliselwa kwegciwane endaweni ezungezile. Imindeni ehlala endlini eyodwa kufanele ihlolwe futhi igonywe. Ezikhungweni zezempilo, ukunamathela ezindleleni ezijwayelekile zokuqapha, ukubulala amagciwane emishinini, kanye nokuphathwa kahle kwezinaliti kanye nemfucuza yezokwelapha kubalulekile. Ababelethisi nabo kudingeka bagcine imfihlo yesiguli ukuze banciphise ukucwaswa.
Isiphetho
Ukuphathwa kwe-hepatitis B ngokubeletha kudinga indlela ehlanganisiwe ehlanganisa ukuhlolwa kwangaphambi kokubeletha, ukuqapha impilo kamama, ukubambisana nodokotela ukuze kuhlolwe futhi kuphathwe ngokulandelana uma kudingeka, ukuhlela ukubeletha okuphephile, kanye nokuvimbela ukudluliselwa kwegciwane ngokusebenzisa i-immunoprophylaxis yosana ngokushesha ngemva kokuzalwa. Ngemfundo efanele, ukwesekwa kwengqondo, kanye nokunamathela esimisweni sokugoma kanye nokulandelela, ingozi yokudluliselwa kwe-hepatitis B kusuka kumama kuya enganeni ingancishiswa kakhulu, kuyilapho kugcinwa ikhwalithi yokuphila kukamama nomndeni wakhe.
Uma ufisa, ngingaguqula lesi sihloko sibe yifomethi yezemfundo (enezingcaphuno kanye nohlu lwezincwadi), noma ngidale inguqulo esekelwe ku-“Varney’s step 7-step midwifery management” ephelele ngefomethi ye-SOAP.
