1. Woman consultation:

- it is an estimation of the state of pregnant;

- it is establishment of previous diagnosis jointly with an internist and infectiologist;

- it is a decision of question in relation to a necessity and place of hospitalization;

- - acute hepatitis is to terminating pregnancy in any term;

- - the risk of terminating pregnancy rises in two times, in ІІ-ІІІ trimester a risk is higher, than in І-му (С).

2. Infectious unit (to 36 weeks pregnancies or to beginning of childlabor).

3. Unit of maternity hospital.

4. Treatment and rehabilitation of породіль is in ambulatory terms.

Principles of grant of obstetric help.

1. With beginning of childlabor a patient is hospitalized to the unit.

2. Labor conduct through natural maternity ways:

- - in the acute stage of disease labor do not threaten to complications which are related to hepatitis (С);

- - labor conduct as premature (С).

- - caesar a section is conducted exceptionally after obstetric testimonies. Caesar a section does not diminish the risk of transmission of hepatitis from a mother to the child (А).

- it is a bleeding prophylaxis in ІІІ period of labor (А).

- - with the purpose of prophylaxis of infectious complications medications are not used with the mainly hepatic way of and with a hepatotoxic action. Medications of choice are cephalosporines of ІІ - ІІІ of generation and semisynthetic penicillines.

3. In a puerperium:

- - medically is the protective mode;

- it is a dietary feed;

- it is an uranalysis - one time in three days;

- it is a global analysis of blood;

- it is biochemistry of blood and coagulogram - after testimonies;

- it is a supervision of infectiologist, internist.

4. For all new-born from infected HCV mothers in the serum of blood it is determined maternal анти - HCV, which penetrate through a placenta. For germ-free children antibodies disappear in the first year of life. The pectoral rearing does not influence on the risk of infecting of child ( А). The new-born is not safe for other new-born.

A chronic cholecystitis is a chronic recrudescent disease, related to the used for setting fire changes in the wall of gall-bladder.

A basic role in development of cholecystitis is played is an infection, stagnation of bile, irritation of mucous membrane of gall-bladder.

Classification

2. 1. Presence of stones :

- Chronic non-calculary cholecystitis; - chronic calculary cholecystitis;

2. Stage of process :

- it is intensifying;

- - incomplete remission;

- are remissions;

3.Severity:

- - mild;

- - middle;

- - severe;

Diagnostics

1. Subjective data:

- it is a pain syndrome (dull, aching), pain in the area of right ribsarea, with an irradiation in the right half of thorax, in a right collar-bone, sew on the right, right shoulder, shoulder-blade, pain increases from rich and fried food;

- it is a dispeptic syndrome (weight in right area, swelling of stomach, nausea, bitter taste in a company, violation of emptying, sometimes is a decline of appetite);

- are the phenomena of intoxication (weakness, headache, pain in joints, in area of heart, high temperature, speed-up palpitation).

2. Objective data:

- are positive to the bladder symptoms ;

- it is a moderate jumboizing of liver,

3. Ultrasonic research:

- it is a bulge of walls of gall-bladder;

- it is content of bubble;

- it is a presence of symptom by Murphy (болючість at pressure of device a sensor on the area of projection of gall-bladder);

- it is a presence of pls from the walls of gall-bladder;

- it is a presence of paravesical edema;

- are concrements;

- it is the assessed tongue, often with the prints of teeth.

4. Duodenal sounding:

- it is turbidity of bile in portion In;

- it is a presence of mucus, plenty of cages of cylindrical epithelium, leucocytes and their accumulations;

- are crystals of cholesterol;

- it is a possible presence of vermin;

- it is a pathogenic flora from data of the bacteriological sowing.

4. Differential diagnostics is conducted with next diseases:

- are infections of urinary ways;

- it is an urolithiasis;

- it is a disease of stomach and duodenum;

- it is a disease of pancreas.

Medicare to pregnant

1 Decision of question about possibility of maturing of pregnancy :

1.1. Contra-indication to maturing of pregnancy (to 12 weeks) :

- it is a mechanical icterus

- are frequent attacks of hepatic colic

- it is festering inflammation of gall-bladder.

The state after operation does not hinder to maturing of pregnancy.

2.1. The supervisions of pregnant with a chronic cholecystitis in woman consultation conduct jointly with an internist

2.2. Inspection (except for general for all pregnant) :

- - of liver, gall-bladder, pancreas and spleen;

- it is determination of concentration in blood of bilirubin, АLАТ, АSАТ, alkaline amylase, cholesterol;

- it is a clinical analysis of excrement;

- it is the duodenal sounding with clinical and bacteriological research of bile.

2.3 On condition of absence of intensifying of process carreer appoint:

- - medical physical education;

- it is a rational feed (table №5 in a warm kind, reception of food not less than 5 times on twenty-four hours);

- are the medical duodenal soundings (only at a cholecystitis) - 1 one time per a week - 4-6 times in ІІ and ІІІ trimesters. In quality cholagogues apply 2 glasses of decoction of wild rose or mineral water, 1-2 soupspoons of olive oil, 50-60 мл of 25-33 % solutions of sulfate of magnesium, 20 gs of Sorbitum or 20 gs of xilite, cut-in in 100 мл of water.

2.4 In the case of intensifying of process appoint:

- it is a release from work;

- - a diet is a table №5;

- - for liquidation of pain syndrome Platyphyllinum, myotropic spasmolysants No-Spa.

- antibacterial therapy (depending on a causative agent) during 1-2 weeks in middle therapeutic doses (ampicillin, Nitroxolinum, erythromysin).

Delivery conducts taking into account an obstetric situation at the worn pregnancy.

Puerperium:

- it is the protective mode

- it is the balanced feed (diet №5)

- - a patient can be written depending on involution of uterus on a 3-5 twenty-four hours. At excerption estimate the state of patient. During the incomplete stabilizing of the state is shown перевід in a therapeutic unit or in surgical permanent establishment.

After an extract from the maternity hospital of watching women with a chronic cholecystitis:

- - for patients with a cholecystitis conduct a rehabilitation on a therapeutic area, in the sanatoriums of gastroenteric type.

- - for women with a calculary cholecystitis decide a question about планове operative treatment.