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PARTIZANKA

NAYOFIS GULISCEMA

nayofis guliscema - misi ert-erti umnishvnelovanesi sasicocxlo machvenebelia. guliscemis ritmi yvelaze saimedod axasiatebs nayofis sashvilosnosshida ???mdgomareobas???, ert-erti pirveli pasuxobs cvlilebebit arasasurvel patologiur situaciebs, amitom eqimi-ginekologi mteli orsulobis mandzilze ganuwyvetliv axorcielebs nayofis guliscemis monitorings.

gulis ganvitareba iwyeba misi chanasaxovani warmonaqmnisagan, romelic orsulobis me-4 kviras ghru milaks warmoadgens. sashualod me-5 kviridan chanasaxovani guli iwyebs pulsirebas (cemas). me-8-9 kviristvis guls ukve otxi ???ganyofileba??? aqvs: ori winaguli da ori parkuchi, iseve, rogorc mozrdil adamians. gamomdinare iqidan, rom nayofi jer ar suntqvas damoukideblad da jangbadi mas dedis sisxlit miewodeba, nayofis guls aqvs taviseburi sheneba - gaachniamarjvena da marcxena winagulebs shoris mcire ovaluri xvreli da arteriuli e.w. botalis sadinari, romlitac aorta sheertebulia droebi
t filtvis arteriastan. am taviseburebebit gansxvavdeba nayofis guli mozrdilis gulisagan.nayofistvis aseti agebuleba sachiroa yvela organos adeqvaturi sisxlit momaragebis uzrunvelsayofad. dabadebis shemdgom, iwyebs ra axalshobili sakutari filtvebit suntqvas, winagulebs shoris arsebuli xvreli da botalis sadinari ixureba samudamod.

nayofis guliscemis monitoringi shemdegi ghonisdziebebitaa shesadzlebeli: auskultacia (mosmena) guliscemis, eqo-kardiografiuli kvleva, kardiotokografia.

AUSKULTACIA

aurkultacia (mosmena) yvelaze martivi da xelmisawvdomi metodia, mistvis sachiro ertaderti instrumentia sameano stetoskopi - patara mili, romelsac ginekologi erti gafartovebuli boloti adebs orsuls mucelze da meore boloti ???sakutari yurit???usmens pataras. stetoskopis forma ar shecvlila uxsovari droidan da sauketeso stetoskopebi tradiciulad mzaddeba xis masalisgan. nayofis gulis tonebis mosmena ginekologtan yoveli vizitis shemadgeneli aucilebeli nawilia.

gulis tonebi gamokvetilad ismineba orsulobis me-20 kviridan, tumca me-18 kvirazec xdeba mati garcheva.

auskultaciis dros ismis sxva ???xmebi???-c: nawlavis yuryuri (gardamavali araregularuli), aortisa da sashvilosnos sisxldzarghvebis tonebi (tonuri???xmauri???, romelic dedis pulss emtxveva).

auskultaciis dros ginekologi sazghvravs: gulis shekumshvebis sixshires, ritmulobas da shekumshvebis xasiats. normashi nayofis gulis tonebi moismineba rogorc tanabar-ritmuli ordartymiani ???xmauri???, mati sixshirea sashualod 140 dartyma wutshi. ginekologi aseve edzebs wertils, sadac yvelaze uket ismineba guliscema, amit is sazghvravs nayofis mdebareobasac. rodesac nayofi tavit win mdebareobs, guliscema yvelaze uket ismis chipis qvevit marcxniv an marjvniv nayofis xerxemlis mimartulebis mixedvit. nayofis gardigardmo mdebareobisas guliscema mkvetrad chipis areshi ismis. nayofis jdomit winmdebareobis dros guliscema ismis chipis zevit proeqciebshi.

ginekologistvis mnishvnelovani maxasiatebelia gulis cemis ritmulobac: ritmulia guliscema, tu dartymebs shoris shualedi ertnairia. aritmuli guliscema damaxasiatebelia gulis tandayolili mankebisa da nayofis hipoqsiis (jangbadis ukmarisobis)-satvis. nayofis gulis tonebis simkvetris kleba e.w. moyrueba aseve nayofis sashvilosnosshida hipoqsiuri mdgomareobis maxasiatebelia.

nayofis guliscema kargavs simkvetres, tu:
placenta mdebareobs sashvilosnos wina kedelze;
charbi odenobitaa sanayofe wylebi;
orsulis charbi wonis dros muclis wina kedelze sqeli cximovani shrea;
nayofis modzraobiti aqtivoba momatebulia.

EQOSKOPIURI MONITORINGI

orsulobis dasawyisshi nayofis guliscema isazghvreba eqoskopiuri kvlevis dros. normashi embrionis guliscemis mosmena transvaginaluri eqoskopiit (!intravaginalurad motavsebit) iwyeba orsulobis me-5-6 kviridan, xolo transabdominaluri eqoskopiit (!mucelze motavsebit) me-6-7 kviridan. me-6-8 kviraze guliscemis sixshire normashi 110-130 dartymaa, me-9-10 kviristvis - 170-190 dartyma, 11 kviridan mshobiarobamde - 140-160 dartyma. aseti cvalebadoba ukavshirdeba nayofis vegetatiuri nervuli sistemis chamoyalibebas. cudi prognozuli nishnebia gulis ritmis sheneleba 85-100 dartymamde da gaxshireba 200 dartymaze metad. am dros dziritadi manipulaciaa gulis ritmis cvlilebis mizezis dadgena. orsulobis ganvitarebis sheferxebaze metyvelebs 8 mm embrionis gulis cemis ararseboba, magram erti eqoskopiuri kvlevit am diagnozis dasma ar xdeba, is aucileblad mowmdeba 5-7 dghiani intervalebit.

II-IIItrimestrebshi fasdeba gulis mdebareoba (normashi guli mdebareobs marcxniv da ikavebs gulmkerdis 1/3-s ganivi skanirebisas), gulis cemis ritmi (norma 140-160 dartyma wutshi), gulis cemis ritmuloba. orsulobis bolo vadaze gulis cemis sixshires da ritms cvlis dedaze moqmedi faqtorebi - fizikuri datvirtvis intensivoba, sicive/sicxe, respiratoruli avadoba da sxv. mtavari faqtori, romelic nayofis guliscemis ritms cvlis aris mistvis miwodebuli jangbadis deficiti - hipoqsia. hipoqsiis dasawyisshi ritmi chqardeba (160 dartymaze metia), qronikuli deficitis shedegad ki mcirdeba - 120 dartymaze qvevit. gulis tandayolili mankebis kvlevisatvis gamoiyeneba e.w. ???otxkameriani ganakveti???. es ultrabgeriti gamosaxulebaa, romelzec chans gulis otxive ghru. igi tardeba mxolod shesabamisi chvenebis shemtxvevashi.

NAYOFIS EQOKARDIOGRAFIA

eqokardiografia eqoskopiuri kvlevaa, romelshic ???mtavari yuradghebis centrshi eqceva??? nayofis guli. am dros dziritadi orgnazomilebiani rejimis garda gamoiyeneba eqo-skanirebis sxva rejimebic - ??-rejimi da dopleris rejimi.

nayofis specializirebuli eqokardiografiis chvenebebia:
orsulis asaki - 38 welze zemot;
orsulis shaqriani diabeti;
orsulobis dros mwvave infeqciuri procesebis ganvitareba;
orsulis an ukve dabadebuli da-dzmebis tandayolili gulis mankebi;
nayofis sashvilosnosshida zrdis sheferxeba;
auskultaciit an wina eqoskopiuri kvlevebit dafiqsirebuli guliscemis sixshirisa da ritmis darghvevebi.
optimaluri vada eqokardiografiis chasatareblad aris 18-28 kvira.

KARDIOTOGRAFIA

32 kviristvis shesadzloa meti obieqtivizaciisatvis chatardes kardiotokografia - nayofis guliscemisa da sashvilosnos shekumshvebis ertdrouli registracia. tanamedrove kardiomonitorebs aqvt nayofis modzraobiti aqtivobis chamweri mowyobilobac.

zogiert ginekologiur dawesebulebashi kardiotokografias utareben yvela orsuls, magram aucilebeli mdgomareoba, rodesac mowodebulia es kvleva, shemdegia:

mdzime gestozi - rodesac imatebs arteriuli wneva, chndeba sheshupebebi, cila shardshi da shedegad irghveva sisxlis mimoqceva placentasa da nayofs shoris da mcirdeba nayofistvis jangbadis miwodeba.
sashvilosnos nawiburis arseboba (wina sakeisro kvetebi).
dedis maghali temperatura - 38 gradusze zemot.
dedis qronikuli daavadebebi (shaqriani diabeti, farisebri jirkvlis disfunqcia).
placentis naadrevi momwifeba.
mcirewylianoba an charbwylianoba.
nayofis sashvilosnosshida zrdis sheferxeba.
doplerometriit nayofis sisxlis mimoqcevis moshla.
auskultaciit gulis cemis parametrebis patologia.

kardiotokrafiit dziritadad fasdeba: nayofis guliscemis sashualo sixshire (norma 120-160 dartyma wutshi), gulis ritmis variabeloba (norma 5-25 dartymit cvlileba wutshi), aseve ritmis cvalebadoba sashvilosnos shekumshvebtan mimartebashi. yvelaze cudi prognozuli nishania guliscemis sixshiris 70 dartymaze metad sheneleba.

mashasadame, guliscemis monitoringi ert-erti yvelaze informatiuli kvlevaa, romelic sashualebas idzleva shefasdes orsulobis da shesabamisad nayofis ganvitareba. aucilebeli da pirveladi metodi martivi auskultaciaa, eqoskopiuri kvleva idzleva aucilebel pirvelad informacias, danarchen yvela metods aqvs tavisi adgili da mati gamoyenebis sakitxs wyvets eqimi-ginekologi chvenebebidan gamomdinare.

PARTIZANKA

GULDZMARVA

orsulobis guldzmarva da mastan brdzolis metodebi

orsulobis adreul etapebze guldzmarva uvitardeba 4 orsulidan sashualod 3-s. shesadzloa guldzmarva gamouvlindes orsuls im shemtxvevashic, tu mas orsulobamde arasodes ar qonia msgavsi problema.
guldzmarvas tu davaxasiatebt, is moicavs: arasasiamovno, momjavo gemos piris ghrushi, wvis da simdzimis shegrdznebas rogorc kuchis areshi, aseve sachmlis momnelebeli sistemis mtels zeda nawilshi - piris ghrushi, xaxashi, saylapavshi. guldzmarvis ganvitareba shesadzloa ar daukavshirdes ushualod kvebis process, is tavs ichens sachmlis mighebamde shualedebshic. guldzmarvas iwvevs kuchshi marilmjavas gamoyofis zrda, kuchis shigtavsis ukan gadmosrola saylapav milshi e.w refluqs-ezofagiti. kuchi fiziologiurad mushaobs marilmjavas gamoyofit, romelic masshi moxvedril sakvebs shlis, magram saylapavis da piris ghrus lorwovanistvis marilmjava absoluturad ???miughebelia???, is wvavs mas da iwvevs guldzmarvis ganvitarebas.
ratom vitardeba guldzmarva orsulobis dros ase xshirad?
guldzmarvis warmoshoba orsulobis dros dziritadad ukavshirdeba hormonul cvlilebebs organizmshi. saylapavsa da kuchs shoris kuntovani spinqteria, romelic blokavs kuchis shigtavsis gadasvlas saylapavshi. orsulobis dros imatebs progesteronis koncentracia, tavis mxriv progesteroni iwvevs kuntebis modunebas, rac sachiroa sashvilosnos kuntovani shris agznebadobis shesamcireblad da nayofis ???mosvenebuli??? mdgomareobis uzrunvelsayofad. magram rogorc gverditi efeqti, dundeba organizmshi yvela kunti, mat shoris kuchis spinqteric.
orsulobis vadis zrdis paralelurad gazrdili sashvilosno awveba da aviwrovebs nawlavebs, romlebic tavis mxriv awveba diafragmas da kuchs. es qmnis kuchis shigtavsis meqanikuri gadasrolis damatebit pirobas saylapavshi. hormonaluri cvlilebebi iwvevs kuchis mjavianobis momatebasac.
guldzmarva qmnis mxolod subieqtur uaryofit shegrdznebebs, tavad orsulobis ganvitarebaze is aranair gavlenas ar axdens.
orsulobis vadis zrdastan ertad mcirdeba progesteronis gamomushaveba da shesabamisad guldzmarvac mcirdeba. progesteronis koncentraciis kleba ukavshirdeba mshobiarobistvis momzadebis procesebs, rodesac sashvilosnos kuntovani aparati ???emzadeba??? chintvebistvis da nayofis tavis qvemot gadaadgilebit sashvilosnoc ikavebs ufro qveda pozicias da mcirdeba diafragmaze da kuchze zewola.

rogor vumkurnalot guldzmarvas orsulobis dros?
arsebobs midgomebi, romlebic sashualebas idzleva minimumamde shemcirdes guldzmarvis warmomqmneli faqtorebis moqmedeba da moixsnas sxva damatebiti zemoqmedeba, ritic isedac arsebuli gamovlineba ufro metad mdzimdeba:
ar miighot spazmolitikebi, mag. no-shpa - isini kidev ufro aduneben spinqters da zrdian kuchis shigtavsis gadmosrolis shesadzleblobas;
ar chaicvat qamriani tansacmeli, romelic zrdis diafragmaze zewolas, jdomit pozashi sheecadet fexebi maqsimalurad gashlil poziciashi gqondet (moxrili fexebit jdomisas izrdeba aseve zewola), chamis shemdeg sheecadet ar dawvet naxevari saati mainc, horizontaluri poza zrdis gadadinebis efeqts.
daicavit dietoterapiuli shezghudvebi - sakvebi miighet ufro moxarshuli, gaxexili/gatarebuli, motushuli saxit, vidre shemwvari, shezghudet yava da kofeiniani produqtebi, aseve shebolili da konservirebuli (dziritadad qarxnul konservirebazea saubari)sakvebi; bostneulidan shezghudet pomidori, puri (is puri, romelshic bevri drojia), tevzi, aseve cxeli sakvebi (upiratesoba enicheba gril sakvebs). bolos, chamet cot-cota da bevrjer (6-7jer), sheecadet bolo kvebis shemdeg dawvet dasadzineblad 2 saatis shualedis shemdeg.
bunebrivi lorwonavis amomfeni sashualebebidan, romlebic icavs lorwovans mjavas zemoqmedebisagan, shegidzliat gamoiyenot civi ???kiselebi??? an 50ml axalgamowuruli kartofilis wveni, gaxexili stafilo, nushi, tkbili vashli, gaghechot umi gerkulesi, kargad garecxili petrushka.
samkurnalo preparatebidan guldzmarvis mosaxsnelad orsulobis dros shesadzlebelia gamoyenebul iqnas fosfalugeli, smeqta, maaloqsi. mat mighebamde upiratesoba enicheba dietoterapias, tu misi sashualebit ver gadaichreba guldzmarvis problema da guldzmarva sheudzlebels xdis orsulis jansagh kvebas, mxolod am shemtxvevashi inishneba zemotaghnishnuli medikamentebi. preparatebi miigheba guldzmarvis ganvitarebisas simptomurad an kursobrivad chamidan 1 saatis shemdeg, mati dghe-ghamuri migheba ar unda acharbebdes 4-jerad odenobas, bolo me-4 migheba sasurvelia dzilis win.
daskvnis saxit, yvela ghonisdzieba mimartulia orsulis tvitshegrdznebis gasaumjobeseblad, guldzmarvis arseboba ar metyvelebs raime patologiaze an orsulobis ganvitarebis sheferxebaze.

PARTIZANKA

TROMBOFILIEBI (antifofsfolipiduri sindromi)

orsulobis dros shesadzloa ganvitardes gartulebebi venuri sisxlis mimoqcevis qselshi, romlebic dakavshirebulia sisxlis shededebis potencialis zrdastan e.w. trombofiliur mdgomareobebtan.
trombofiliebi - daavadebis jgufia, romlis drosac sisxli deddeba dzalian swrafad da warmoiqmneba mikro-trombebi, romlebic tavistavad iwveven sisxldzarghvis sanaturis sheviwrovebas/gadaketvas da sisxlis mimoqcevis darghvevas. orsulobis dros es procesi gansakutrebit arasasurvel shedegebs iwvevs sashvilosno-placentarul da placenta-nayofis sisxlis mimoqcevis auzebshi. tumca aqve gasatvaliswinebelia, rom tavad orsuloba mcired zrdis sisxlis mimoqcevis potencials, rac am dros damcvelobit funqcias atarebs da schirdeba orsulis organizms, rata swrafad ???aghudges win??? da swrafad shewyvitos nebismieri sisxldena, radgan nayofis ganvitarebistvis gansakutrebit sariskoa dedis nebismieri, tundac mcire moculobis sisxlis danakargi.
trombofiliebi tandayolili an shedzenili daavadebebia, xshirad orsuloba aprovocirebs mat gamovlinebas. arsebobs damatebiti risk-faqtorebi, romlebic xels uwyobs tandayolili winaswarganwyobis gamovlinebas, yvelaze xshirad es dedis asakia, 40 welze zevit, aseve charbi wona, tumca risk-faqtorebi kidev bevria. swored amitom orsulis patronajis aucilebeli shemadgeneli procedurebia arteriuli wnevis mudmivi monitoringi, chivilebis shegroveba, xom ar awuxebda qals orsulobamde simdzimis shegrdzneba, tkivili, ghamis krampebi (krunchxvebi) qveda kidurebshi an xom ar gachnda isini orsulobis mimdinareobisas.
orsulobis mimdinareobis metvalyureobis ert-ert mizans warmoadgens trombofiliuri gartulebebis riskis adreuli diagnostika da mati gamovlinebis profilaqtika/drouli mkurnaloba.
orsulobis dros aramedikamentozuri mkurnalobis mimartulebebia:
samedicino kompresiuli trikotajis da elastiuri bintebit naxvevebis gamoyeneba;
wolis dros qveda kidurebis 10-15 sm-it zevit motavseba;
samkurnalo fizkultura;
racionaluri kveba;
fitoterapia

medikamentozuri metodebi moicavs:
sisxlis reologiis kontroli da hipo-koagulaciuri terapia. pirveli rigis preparatebs warmoadgens dabalmolekuluri heparinebi, mat shoris fraqsiparini, kleqsani da sxv; aseve sisxlis koagulaciuri suratis mixedvit inishneba antiagregantuli terapia - orsulistvis yvelaze uvnebel antiagregantad itvleba dipiridamoli (kurantili), aseve gamoiyeneba aspirinis shemcveli preparatebi;
sisxldzarghvis kedlis mtlianobis, mikrocirkulaciis aghmdgeni, venur qselshi shegubebis samkurnalo e.w. flebotonuri terapia, mat shoris rutinis da P vitaminis shemcveli polivitaminuri da mcenareuli preparatebi.
yvelaze rtuli trombofilia aris e.w. antifosfolipiduri sindromi.
antifosfolipiduri sindromi (afs) autoimunuri daavadebaa, romelsac safudzvlad udevs sakutari ujredebis mimart antisxeulebis gamomushavebis imunuri procesi (imunuri sistema jer daudgeneli meqanimzis gamo veghar cnobs sakutar ujredul komponentebs, aghiqvams mat rogorc ucxos da iwyebs antisxeulebis gamomushavebs mat winaaghmdeg), ris shedegadac vitardeba aseptiuri(arainfeqciuri warmoshobis) trombozuli vaskulopatia. am dros shesadzloa daziandes nebismieri kalibrisa da lokalizaciis sisxldzarghvi (daitrombos igi, gaskdes da gamoiwvios sisxlchaqceva, aseve ganavitaros irgvlis mdebare qsovilebis hipoqsia da kvebis deficiti). amerikel avtorta monacemebit, afs gavrcelebulia saerto populaciis 5%??�shi. qalebshi es sindromi daaxloebit 4 jer ufro xshirad gvxvdeba vidre mamakacebshi.
afs-is sheswavlas safudzveli daedo mas shemdeg, rac 1906 wels vasermanma sheimushava sifilisis sadiagnostiko serologiuri metodi, e.w. vasermanis reaqcia. mogvianebit, 40-ian wlebshi dadginda rom dziritadi komponenti, romeltanac reagireben antisxeulebi vasermanis reaqciashi,aris uaryofitad damuxtuli fosfolipidi ??� kardiolipini (es aris ujredebis membranis shemadgeneli nivtiereba). 50-ani wlebis dasawyisshi, sistemuri witeli mglurati daavadebul pacientta shratshi aghmochenil iqna sisxlis shededebis inhibitori (???damblokavi???), romelsac uwodes mgluras antikoagulanti (LA). afs pirvelad swored sistemuri witeli mglurati daavedebulebshi iqna aghwerili britaneli revmatologis G.Hughes-is mier. manve 1986 wels am simptomokompleqss uwoda antifosfolipiduri sindromi.
afs-is patogenezi zustad dadgenili ar aris. klinikuri nishnebis safudzvels warmoadgens autoimunuri procesi, romlis drosac warmoqmnili antisxeulebis jgufi (dziritadad IgG da IgM) ukavshirdeba ujredis uaryofitad damuxtul membranul fosfolipidebs (kardiolipini, fosfatidilserini, fosfatidiletanolamini, fosfatidilinozitoli) da shlis mat, ritic am ujredis dashlas iwvevs. afs??�is antisxeulebis dziritadi samiznea sisxldzarghvebis shida kedlis amomfeni endoteluri ujredebi, amitom patogenezshi gadamwyveti mnishvneloba enicheba mat dazianebas, rac organizms ???signals adzlevs???, rom defeqtis gamosasworeblad am adgilas daiwyos shededeba da warmoiqmnas trombi.
venuri trombozi afs??�is yvelaze xshiri gamovlinebaa. trombozi upiratesad lokalizebulia qveda kidurebis ghrma venebshi
afs mean??�ginekologebis didi problemaa. am sindromtan aris dakavshirebuli shemdegi sameano patologiebi: vadamde miutaneli orsuloba, morecidive spontanuri abortebi, nayofis sashvilosnosshida sikvdili, naadrevi mshobiaroba. msgavs gamovlinebebs adgili aqvs orsulta 80%??�shi, romlebsac daudgindat es sindromi. pacientebs, romlebsac aghenishnat vadamde miutaneli orsuloba 27??�42%??�shi daesvat afs??�is diagnozi, amave jgufshi adekvaturi mkurnalobis chautareblobis shemtxvevashi nayofis sikvdili dafiqsirda 90??�95%??�shi. sameano patologiis safudzvels warmoadgens placentis sisxldzarghvebis trombozi da fetoplacentaruli ukmarisobis ganvitareba.
afs??�is tipiur hematologiur gamovlinebas warmoadgens trombocitopenia (70.0 ??� 100.0 109/l) da kumbs dadebiti hemolizuri anemia. am sindromis dros xshirad gvxvdeba cru dadebiti vasermanis reaqcia.
afs sindromis diagnostirebis kriteriumebi shemushavebul iqna 1998 wels saporoshi (iaponia) antifosfolipidur antisxeulebtan dakavshirebul saertashoriso kongresze. 2006 wels sidneishi imave temaze chatarebul kongresze sabolood iqna shemushavebuli is kriteriumebi, romelic efudzneba rogorc klinikur aseve laboratoriul monacemebs.1
klinikuri kriteriumebi
1) sisxldzarghvovani trombozebi:
a) arteriuli da/an venuri trombozis erti an meti dasabutebuli epizodi nebismier qsovilshi an organoshi. trombozi unda iyos dadasturebuli obieqturi kvlevebit (trombozis histopatologiuri gamokvlevit sisxldzarghvis kedelshi ar unda iyos antebis nishnebi).
2) gartulebebi orsulobis dros:
a) erti an meti morfologiurad normaluri (dadasturebuli obieqturi kvlevebit) nayofis umizezo sikvdili gestaciis me??�10 kviraze;
b) erti an meti naadrevi mshobiaroba 34 kviramde, rac gamowveulia eklamfsiit, preeklamfsiit an fetoplacentaruli ukmarisobit;
g) 3 an meti spontanuri aborti gestaciis me??�10 kviraze.
laboratoriuli kriteriumebi
1) mgluras antikoagulantis (LA) arseboba plazmashi unda dadasturdes 2 an met shemtxvevashi 12 kviris shualedit.es antikoagulanti unda ganisazghvros hemostazisa da trombozis saertashoriso asociaciis mier mowodebuli koagulaciuri kvlevebis metodikit.
2) antikardiolipinuri antisxeulebis (aCL) arseboba plazmashi sashualo an maghali titrit ( IgG>40 GPL, IgM>40 MPL). aCL antisxeulebis momatebuli titri unda aghinishnos 2 an met shemtxvevashi 12 kviris shualedit.
3) anti-??2glikoproteinl-is (??2GP1) antisxeulebis (IgG an IgM) arseboba plazmashi, maghali titrit. anti??�??2glikoproteinl-is antisxeulebis momatebuli titri unda aghinishnos 2 an met shemtxvevashi 12 kviris shualedit.
antisxeulebi unda ganisazghvros myarfaziani imunofermentuli analizit (enzyme??�linked immunosorbent assay ??�ELISA).
imisatvis rom daisvas afs diagnozi aucilebelia sul cota 1 klinikuri da 1 laboratoriuli kriteriumis arseboba.
afs??�is damaxasiatebeli nishania hiperkoagulaciis arseboba da mastan dakavshirebuli trombozuli gartulebebi, romelic dasturdeba sisxldzarghvshida shededebis aqtivaciis markerebis (D dimeri, xsnadi fibrin monomeruli kompleqsebi-SFMC) matebit.

antifosfolipiduri sindromis mkurnaloba gulisxmobs im dziritadi daavadebis specifiur mkurnalobas, ris fonzec ganvitarda es sindromi, tumca sachiroebis shemtxvevashi emateba antikoagulanturi da antiagregantuli terapia. yvelaze mtavria kvalificiurad ganisazghvros hiperkoagulacia kompensirebulia (momatebulia mcired, rogorc es axasiatebs orsulobas da aq chareva araa sachiro) tu dekompensirebulia (imdenadaa momatebuli, rom dawyebulia orsulobis gartulebebi, rac yvelaze tvalsachinod chans doplerografiuli kvlevit, placentashi sisxlchaqcevebis arsebobit, nayofis ganvitarebashi sheferxebebis warmoqmnit). rogorc ki klinikurad gamovlindeba trombozuli gartulebebi, dadasturebuli instrumentuli da laboratoriuli kvlevebit (D dimeris, xsnadi fibrin monomeruli kompleqsebi-SFMC-s sagrdznobi da mudmivi zrdit, specifiuri antisxeulebis arsebobit), aucilebelia antikoagulanturi da antiagregantuli terapiis dawyeba, rac warmoadgens afs??�is mkurnalobis sabaziso midgomas. upiratesoba enicheba dabalmolekulur heparins (fraqsiparini, kleqsani), radgan arafraqcionirebulma heparinma shesadzloa kidev ufro gaarghmaos afs??�is dros isedac arsebuli trombocitopenia. tardeba xangdzlivi terapia antiagregantebis minimaluri dozebit (aspirini, plaviqsi). kompleqsuri mkurnalobis ert??�ert mnishvelovan rgols warmoadgens etapobrivi plazmaferezi.

mkurnalobis gansxvavebul midgomas sachiroeben mdzime sameano anamnezis mqone pacientebi, romlebsac daudgindat afs. am shemtxvevashi orsulobis dadasturebis momentidanve iwyeba kompleqsuri mkurnaloba:
1) inishneba aspirinis mcire dozebi (60??�75 mg/dghe-ghameshi) mteli orsulobis periodshi.
2) ketdeba dabalmolekuluri heparinis profilaqtikuri dozebi (fraqsiparini 0.3 ml/dghe-ghameshi).
3) tardeba etapobrivi plazmaferezi. plazmaferezit mkurnaloba tardeba mgluras antikoagulantis (LA) tvisebebis mqone af antisxeulebis aqtivobis kontrolit da wydeba sisxlshi mati nawilobrivi an mtliani gaqrobis shemtxvevashi.

trombofiliebi, mat shoris antifosfolipiduri sindromi, ert-erti martvadi patologiaa, romlis drouli da swori diagnostika, shesabamisi profilaqtikita da mkurnalobit sashualebas idzleva absoluturad gaurtuleblad chaiaros orsulobam, swored amitom mnishvnelovania orsulistvis minimaluri informaciis floba am sakitxze.
tu gishupdebat kidurebi, gaqvt gamoxatuli venuri qseli an mikro-sisxlchaqcevebi kidurebze
tu gaqvt momatebuli arteriuli wneva
tu tqveni wina orsuloba damtavrda abortit an mkvdradshobadobit

!!! gadaamowmet sisxlis koagulograma da mimartet ginekologs trombofiliis, kerdzod antifosfolipiduri sindromis riskis shemowmebis konkretuli sakitxit

PARTIZANKA

EQOSKOPIURI PARAMETREBIS GANMARTEBEBI ORSULOBIS ADREULI DA GVIANI VADEBISTVIS.

eqoskopiuri diagnostika, orsulobis vadidan gamomdinare, emsaxureba sxvadasxva klinikuri informaciis mopovebas, rac exmareba ginekologs gauwiosmetvalyureoba orsulobis fiziologiuri ganvitarebis process. yvela orsuls ainteresebs am kvlevis pasuxshi chamowerili parametrebis normebi, mit ufro mati daxasiateba da ganmarteba. miuxedavad imisa rom arasamedicino enaze dznelia sruli ganmartebis gadmocema, chven shevecadet mcired mainc ???davakvalianot??? chveni orsulebi am mimartulebit.
mteli orsulobis mandzilze aucilebelia chatardes minimum 5 eqoskopiuri kvleva.
eqoskopiuri kvlevis chatarebis jeradoba shesadzlebelia gaizardos chvenebebidan gamomdinare, magram radganac ar arsebobs mtkicebiti baza, rom ultrabgeriti dasxiveba absoluturad usafrtxoa nayofistvis, sasurvelia minimumamde iqnas shemcirebuli am manipulaciis gamoyeneba (tu ratqmaunda amis safudzvels idzleva orsulobis mimdinareobis surati).
eqoskopiuri kvleva 5-8 kviris vadaze
tardeba orsulobis faqtis dasadgenad da implantaciis (sanayofe kvercxis mimagrebis) adgilis gansazghvris miznit. embrionis sicocxlisunarianobis shesaxeb daskvna ketdeba misi gulis cemis mosmenis (ismineba ukve 5-7 kviridan) da modzraobiti aqtivobis dafiqsirebis (pirveli modzraobebi fiqsirdeba 8-9 kviris vadaze) safudzvelze. embrionis dasaxasiateblad am vadaze gamoiyeneba mxolod 2 parametri: sanayofe bushtis shida diametri da txem-kudusunis zoma, mati normebi orsulobis konkretuli kviristvis mocemulia cxrilshi 1.

aseve xdeba qorionis (placentis winamorbedis) da sanayofe wylebis datvalireba.
am vadaze shesadzloa gachndes kitxvebi, skurpulozuri datvaliereba embrionis zomebis simciris gamo rtulia, amitom xshirad informaciis gadamowmeba xdeba 3-5 dghiani intervalis shemdeg.
eqoskopiuri kvleva 10-12 kviris vadaze
tardeba progresirebadi orsulobis faqtis kontatirebistvis da orsulobis vadis dasazusteblad. am droistvis mshobiarobis savaraudo tarighi isazghvreba maqsimum 2-5 dghis cdomilebit.dzalian mnishvnelovania erti parametris kvleva, romelic emsaxureba qromosomuli daavadebebis (m.sh. daunis sindromis) adreul diagnostikas - nayofis sayelos naochis sisqis dadgena (yelia aris rbili qsovilebis saerto sisqe). aseve isazghvreba placentis mimagrebis adgili, sanayofe wylebis raodenoba da ganchvirvaloba. vlindeba aris tu ara shemdegi gartulebebi: sashvilosnos hipertonusi, placentis ashreveba, istmo-cervikaluri ukmarisoba.
eqoskopiuri kvleva 20-24 kviris vadaze
dziritadi yuradgheba am vadaze maxvildeba nayofis ganvitarebis mankebis gamovlena/gamoricxvaze. isazghvreba sheesabameba tu ara nayofis zoma orsulobis savaraudo vadas, ikvleven sanayofe wylebisa da placentis maxasiateblebs.
eqoskopiuri kvleva 30-32 kviris vadaze
kvlevis obieqtebi igivea ( nayofi, placenta, sanayofe wylebi) rac wina kvlevisas, emateba am vadistvis nayofis modzraobiti aqtivobis shefaseba, aseve yvelaze mtavar siaxled itvleba doplerografiuli kvlevis nawili, romelic sashualebas idzleva daxasiatdes sashvilosno-placentaruli da feto-placentaruli sisxlis mimoqcevis parametrebi.
eqoskopiuri kvleva mshobiarobamde
ketdeba yvelaze mtavari sameano informaciis - nayofis masis, mdebareobis gansasazghvravad, aseve chiplaris maryujis (shemoxvevis) dasadgenad/gamosaricxad. es ert-erti dziritadi informaciaa, romelze dayrdnobitac wydeba meanis mier fiziologiuri mshobiarobis tu sakeisro kvetis dagegmvis sakitxi.
orsulis eqoskopiuri kvlevis zogierti yvelaze mtavari obieqti
sashvilosnos yelis mdgomareoba
sashvilosnos yelis sigrdze orsulobis vadis proporciulad izrdeba da sashualod 3 sm. sheadgens.patologia diagnostirdeba rodesac misi sigrdze damoklebulia sashualo machvenebeltan mimartebashi (30 mm-ze). mteli orsulobis mandzilze ...., shidac da garetac, daxurulia. mshobiarobamde sashvilosnos yeli iwyebs gadasworebas. tu es adreul vadaze xdeba saubroben istmo-cervikalur ukmarisobaze, rac moitxovs yelis naadrevi gaxsnis saprofilaqtikod yelze momchimavi nakeris dadebas.
sashvilosnos miometriumis mdgomareoba
termini ???sashvilosnos tonusi??? gulisxmobs eqoskopiuradsashvilosnos tanis romelime ubanshi gasqelebuli monakvetis aghmochenas, rac ukavshirdeba am ubanze sashvilosnos gluvi kuntebis shekumshvas (spazms). kuntovani shris gardamavali spazmi normad itvleba mesame trimestris bolosken, rodesac kuntovani aparati iwyebs ???varjishs da mzadebas??? mshobiarobistvis. pirvel-meore trimestrshi es movlena itvleba patologiad.
placentis mgdomareoba
placenta amaragebs nayofs jangbadit da sakvebi nivtierebebit, ???pasuxismgebelia??? nayofis zrda-ganvitarebis progresze, amitom mnishvnelovania misi mdgomareobis monitoringi mteli orsulobis mandzilze da izomeba ramodenime parametrit:
mdebareoba (normashi sashvilosnos wina an ukana kedelze, marjvniv an marcxniv sashvilosnos fskerisken). rodesac ismeba diagnozi ???placentis winmdebareoba???, gulisxmobs, rom placentis qveda kide gadafaravs sashvilosnos shida ....normashi placentis qveda kidesa da ...-s shoris mandzili sheadgens minimum 5 sm, optimaluria 8 sm. mandzilis damokleba, rac moixsenieba rogorc placentis winmdebareoba mshobiarobis dros iwvevs placentis naadrev ashrevebas da mwvave feto-placenturi ukmarisobis ganvitarebas, amitom am vitarebashi ketdeba sakeisro kveta. tumca orsulobis naadrev vadaze dasmuli es diagnozi ar qmnis srul surats samshobiaro gamosavalze, radgan placentas axasiatebs ???migraciis??? unaric da ???winmdebare qorioni ganvitareba normalurad mdebare placentit mtavrdeba.
struqtura da simwifis xarisxi - 27 kviramde placentis simwifis xarisxi nulovania, 27-32 kviridan placenta aghwevs momwifebis pirvel xarisxs. (27 kviramde placentis simwifis 1 xarisxi nishnavs mis naadrev momwifebas da tavis tavshi sheicavs placentis daberebis risks,32 kviris shemdeg placentis simwifis 0-ovani xarisxi mis ukmarisobaze metyvelebs). 32-36 kviridan placentis simwifis xarisxia 2, 36 kviridan simwifis xarisxi shesadzloa iyos 3, tumca is shesadzloa 2 machvenebelzec shenarchundes.placentis struqtura icvleba misi simwifis xarisxis proporciulad, rodesac ertgvarovani, 0 simwifistvis damaxasiatebeli struqtura idzens wilakovan saxes, simwifis xarisxis matebastan ertad imatebs wilakebis raodenobac. 2 xarisxis simwifis placenta gavs kangaclil fortoxals.
kalcinatebi - placentashi kalciumis marilebis chalageba, shesadzloa ganvitardes placentis simwifis 1 xarisxis mighwevisas, dakavshirebulia vitamino-mineraluri cvlis deficittan.
mkvdari ubnebi (placentis infarqti) - es placentis is ubania, sadac sxvadasxva mizezebis gamo xdeba ujredebisraghac masis sikvdili, wydeba sisxlis mimoqceva, shesabamisad mcirdeba nayofis momarageba jangbadita da sakvebi naertebit, rac mis zrda-ganvitarebis sheferxebas da mwvave shemtxvevebshi sikvdilsac iwvevs. placentis infarqtis gamomwvev yvelaze mtavar meqanizms warmoadgens dedis patologiuri hiperkoagulacia da anemia.
sanayofe wylebis struqtura da raodenoba
amnioturi anu sanayofe wylebis raodenoba sakmaod subieqturi cnebaa, nayofis sxeulsa da sashvilosnos shoris mandzili yvelaze ghrma jibeshi sheadgens 2-8 sm.
tu diagnozi
mcirewylianobaa - orsulobis adreul vadaze is miutitebs infeqciuri procesis arsebobaze, mesame trimestris bolos ki metyvelebs placentis daberebis procesze da vadagadacilebaze.
charbwylianobaa - bevri faqtori ganapirobebs am gartulebas, esaa infeqciac, hormonuli disbalansic, rezus-konfliqti, gvxvdeba nayofis anomaliebis drosac, tumca xandaxan es qalis individualuri fiziologiuri taviseburebacaa, amitom am diagnoztan fataluri asociaciebis dakavshireba araa sasurveli. tu klinikuri surati sxva gartulebebze ar metyvelebs, mxolod charbwylianoba patologiad ar itvleba.
amghvreuli sanayofe wylebi - adreul vadaze is uxshiresad miutitebs infeqciur procesze, tumca 30 kviridan wylebis mcire shemghvreva shesadzloa dakavshirebuli iyos nayofis epiteliumis chamofcqvnastan, romelic saofle jirkvlebis sekrettan ertad amghvrevs sanayofe wylebs. 35 kviridan shesadzloa sanayofe wylebi sheimghvres aq mekoniumis (nayofis pirveli ganavali) gamochenit, tumca es mainc mis hipoqsiur mdgomareobaze metyvelebs.
nayofis ganvitarebis parametrebi (nayofis biometria)
eqoskopiuri kvlevis pasuxis dziritadi shemadgeneli nawilebi:
pirveli punqti edzghvneba sapasporto monacemebs;
meore punqti gadmoscems bolo menstrualuri ciklis pirvel dghis tarighs da orsulobis savaraudo eqoskopiur vadas (mocemuls kvirebshi).
mesame punqti axasiatebs nayofs:

nayofis raodenobas, sicocxlisunarianobas.
nayofis mdebareobas (tavit winamdebareoba, menjit winamdebareoba, gardigardmo da sxv). 30 kviramde nayofi icvlis mdebareobas, rac patologias ar warmoadgens, 30 kviridan man unda daikavos mistvis gankutvnili tavit winamdebareoba. sxva poziciis shemtxvevashic 36 kviramde shesadzloa nayofma sheicvalos mdebareoba, tu aseti ram ar moxdeba, dgeba sakeisro kvetis sakitxi.
nayofis fetometias, romelic tavis mxriv shedgeba:
nayofis wonisa da sigrdzisagan;
nayofis biometriuli (tavis, muclis, gulmkerdis, bardzayis) maxasiateblebisagan;
shemoklebebis ganmartebebi:
BPD ??� tavis biparietaluri zoma
OFD ??� tavis shubl-kefis diametri
?�?�???? ??� gulmkerdis diamtri
FML - bardzayis zoma
ABDmuclis diametri
AC - muclis garshemoweriloba
???? - tavis garshemoweriloba
HUM - mxris zoma
meotxe punqti idzleva ganmartebebs da diagnozs sheesabameba tu ara nayofis biometria orsulobis mocemul vadas.
shesadzlo shecdomebi:
orsulobis vada arasworadaa dadgenili - shesadzloa ovulacia zustad ciklis me-14 dghes ar moxda, amitom cdomileba 2-4 kviras sheadgens, xolo orsulobis mtliani xangrdzlivoba 38-42 kviras.
nayofis konstituciuri taviseburebebi - mshoblebis anatomiuri zomebidan gamomdinare shesadzloa nayofis biometriuli markerebis normastan mimartebashi shesadzlo chamorchena an metoba. yvelaze mtavari ara erteuli eqoskolpiuri kvlevis pasuxia, aramed machveneblebis zrdis dinamika, amitom sasurvelia xutive eqoskopiuri kvleva chatardes ert ultrabgerit aparatze. ?? ???� ???????�?�?????????�?�?? ?????????�???�???�???? ?????????�?�?�?�??.
shesadzlo patologiebi
nayofis zrda-ganvitarebashi chamorchena - proporciuli chamorchenisas yvela parameti chamorcheba 4 kviraze meti cdomilebit, asimetriulis shemtxvevashi sxeulis romelime nawilis parametrebi chamorcheba an metia normalur machvenebeltan mimartebashi. es sindromi moitxovs swraf ginekologiur samkurnalwamlo charevas.
nayofis sayelos zomis mateba - normashi 12 kviristvis is ar unda aghematebodes 2,5-3 mm-s. misi mateba mianishnebs qromosomuli daavadebis riskze, tumca mxolod es nishani ar idzleva sashualebas zusti diagnostirebis, is simptomokompleqsis shemadgeneli nawilia da aghmochenisas itxovs shemdgom skurpulozur gadamowmebas da kvlevas. yvelaze xshiri daunis sindromze echvis mitanisas am nishnit, gadamowmdeba anamnezi (uaxloesi natesavebis avadoba am sindromit), alfa-fetoproteinis testi, romelic 15-20 kviridanaa informatiuli da e.w. papp-testi.
nayofis tandayolili anomaliebi -diagnostirdeba ramodenime gadamowmebis shemdgom.
chiplaris maryuji anu shemoxveva - aqtualuria ushualod mshobiarobamdeperiodshi, tu sisxlis mimoqcevis parametrebi normis farglebshia, mshobiarobamde ar itvleba patologiad.
nayofis guliscemis sixshiris mateba - normashi sashualod 140 dartymas sheadgens wutshi. sxvadasxva mizezebis gamo is shesadzloa sheicvalos, tumca 120-160 d/wt ar aghiqmeba patologiurad, dziritadi markeria nayofis hipoqsiis (jangbadis naklebobis).

PARTIZANKA

ORSULOBIS DROS GAMONADENIS GAMOMWVEVI ZOGIERTI, YVELAZE GAVRCELEBULI MIZEZI.

orsulobis dros xshirad qalebshi aghinishneba procesi, romelsac moixsenieben rogorc sashos ???ganmtvirtva-s??? da is gamoixateba gamonadenis saxit. es savsebit normaluri fiziologiuri movlenaa, romelsac safudzvlad dziritadad udevs:
hormonuli qativobis mateba;
infeqciuri procesi;
sashos lorwovanis arainfeqciuri gaghizianeba;
cervikaluri erozia (sashvilosnos yelis erozia).
hormonuli aqtivoba
orsulobis dros zogierti hormonis koncentraciis mateba ganapirobebs gamonadenis gadzlierebas, am dros gamonadeni motetro, lorwovania da aravitar shemtxvevashi ar axasiatebs mkvetri suni. am dros shesadzlebelia gamoyenebul iqnas antibaqteriuli yoveldghiuri safenebi, magram aravitar shemtxvevashi ar edzleva rekomendacia tamponebis xmarebasa da gamorecxvebis chatarebas.
infeqciebi
ori yvelaze xshiri infeqciuri procesia sokovani infeqcia e.w. kandidozi (rdziana) da baqteriuli vaginozisi. gamonadens am dros gamorcheulad axasiatebs mkvetri suni da is iwvevs gareta sasqeso organoebis gaghizianebas, rac gamoixateba qavilis, wvis, sheshupebis saxit. ???echvmitanili??? infeqciuri procesi xdeba dadasturebuli mxolod mas shemdeg, rac chatardeba nacxis analizi da ???gamoashkaravdeba??? konkretuli gamonadeni.
kandidozi
kandidozs dzalian damaxasiatebeli gamonadeni aqvs - tetri, xachosebri, ludis sunis msgavsi. es infeqcia xshirad aris organizmshi, magram araaqtiur mdgomareobashi, garkveuli pirobebshi, mat shoris orsulobis dros, is aqtiurdeba da vlindeba klinikurad. mkurnalobis tvalsazrisit sakmaod kargad emorchileba es infeqciuri procesi xalxuri, saojaxo metodebis gamoyenebas, rogoricaa mawonit dafaruli safenebi. mawonis mjave are da iq arsebuli laqtobaqteriebi qmnian adgilobrivad ares, sadac ighupeba es sporovani infeqcia. aseve sachiroa kvebis racionshi shaqris shezghudvac, radgan glukoza xels uwyobs sporovani infeqciis gamravlebas.
antimikozuri farmakologiuri sashualebebidan:
- klotrimazoli - ar aris testirebuli uvneblobaze orsul qalebshi, amitom misi gamoyeneba ararekomendebulia;
- nistatini - arsebobs gamocdileba orsulebshi misi usafrtxo gamoyenebis;
- flukonazoli - chatarebulia testebi orsul cxovelebze, magram misi adamianebshi usafrtxoebis dadastureba jer ar momxdara, amitom nayofze toqsiuri gavlenis riskis gamo ar gamoiyeneba orsulobis dros.
! arcerti antimikozuri preparati ar sheidzleba mighebul iqnas orsulis mier tvitneburad, eqimis danishnulebis gareshe.
baqteriuli vaginozisi
es infeqciuri procesi dakavshirebulia sashoshi arsebuli mikrofloris balansis darghvevastan da xasiatdeba uxvi, wyliseburi gamonadenit, romelsac aqvs mkvetri suni. infeqciuri procesis simwvavidan gamomdinare ginekologi wyvets shedarebit uvnebeli, orsulobis dros danishvnadi antibiotikis gamoyenebis sakitxs, tumca antibiotikoterapiis nayofze toqsiuri efeqtebis riskebidan gamomdinare, es ukiduresi gadawyvetilebaa.
sxva infeqciebi
1.triqomoniazi - sqesobrivi kavshiris dros gadadis partniorze, axasiatebs momwvano-moyvitalo gamonadeni dzalian mkvetri sunit. infeqcia ikurneba mxolod antibiotikoterapiit.
2.qlamidiozi - esec sqesobrivi gzit gadamdebi infeqciaa, axasiatebs gamonadeni sisxlis minarevebit, wvis shegrdzneba.

arainfeqciuri antebiti procesi
arainfeqciuri vaginiti ukavshirdeba higienuri procedurebis darghvevas da sacvlebze da higienur sashualebebze alergiuli tipis reaqciebis ganvitarebas. xshirad is vitardeba aromatizirebuli sapnis, xelovnuri tetreulis, kolgotkebis (romlebic zrdian oflianobas) xmarebisas, aseve momatebuli seqsualuri aqtivobis pirobebshi.
am dros gamonadeni chndeba periodulad, mcire uferodan dawyebuli uxv wyliseburamde odenobit, ar axasiatebs mkvetri suni, tu ar daertveba tan infeqciuri procesi.
misi saprofilaqtiko ghonisdziebebia:
- bunebrivi, bambis tetreulis xmareba;
- aqtiuri higienuri ghonisdziebebi;
- dzalian motkecili qveda tansaclis xmarebisgan tavis shekaveba
- surnelovani, spirtis shemcveli higienuri sashualebebisagan tavis shekaveba.
cervikaluri erozia
sashvilosnos yelis lorwovani garsi gasqelebulia, rata daicvas sashvilosno da nayofi e.w. ???aghmavali??? infeqciebisgan. rodesac antebiti kera lokalizdeba sashvilosnos yelis areshi, chamoifcqvneba ra nafletebis saxit, shesadzloa sisxldzarghvebis gaxlechis gamo mcire sisxldenac gamoiwvios, amitom cervikalur erozias axasiatebs lorwovani, shesqelebuli gamonadeni sisxlis mcire shenarevit. lorwovanis chamofcqvna dzlierdeba mshobiarobis moaxlovebastan ertad, rac am dros yelis modunebas da gaxsnas ukavshirdeba.

calke temaa orsulobis dros ganvitarebuli sisxliani gamonadeni, romelic arc ert shemtxvevashi ar jdeba fiziologiur farglebshi.
sisxliani gamonadenis mizezta klasifikatorshi mnishvnelovania ra vadaze vitardeba es sisxldena.
orsulobis adreul vadaze, pirvel trimestrshi ganvitarebuli sisxldenebi:
- implantaciis tanmdevi sisxldena e.w. ???cru menstruacia???
es sixldena emtxveva mosalodneli menstruaciis vadas, gansxvavdeba menstrualuri sisxldenisgan mcire moculobit da ufro blanti konsistenciit. sisxldenis ganvitareba kavshirdeba ganayofierebuli kvercxujredis inplantacias sashvilosnos lorwovan garsshi, grdzeldeba 5-7 dghe.
- sisxldena, romelic ukavshirdeba adreuli abortis an sashvilosnosgare orsulobis ganvitarebas.
orsulobis adreuli shewyvetis da spontanuri abortis dros vitardeba sisxldena, romelic xasiatdeba uxvi, alisferi gamonadenit, shesadzloa sashvilosnos lorwovanis nafletebis arsebobac. mas tan ertvis muclis areshi dzlieri tkivili

yvelaze sashishi periodi sponanuri abortis ganvitarebistvis ganayofierebis shemdgomi periodia, ganayofierebuli kvercxujredebis 50% ganayofierebistanave ighupeba, radgan ar aqvs unari sworad inplantirdes sashvilosnoshi. yvelaze kritikulad itvleba pirveli 12 kvira.
sashvilosnosgare orsulobis dros ganayofierebuli kvercxujredi ver aghwevs sashvilosnos da implantirdeba falopis lulashi. es situacia yoveltvis mtavrdeba sisxldenit, radgan shedegi yoveltvis orsulobis shewyvetaa.

orsulobis gviani periodis sisxldenebi
sisxldena an sisxliani gamonadeni orsulobis 28 kviris shemdeg, itvleba mshobiarobiswina sisxldenad da gamowveulia orsulobis shemdegi gartulebebit:

placentis winamdebareoba - placentis qveda kide blokirebas uketebs sashvilosnos yelshi shesasvlels, es gartuleba dzalian xshirad vitardeba xshiri abortebis da sakeisro kvetis shemdeg.
placentis ashreveba - vitardeba placentis meqanikuri gancalkevebisas sashvilosnos lorwovanida, rodesac gaxlechili sisxldzarghvebidan vitardeba an hemoragiuli ubani (tu ashreveba cebtriskena ubnebshia) an sisxliani gamonadeni, tu ashreveba kideebisken ubanshi xdeba da chaghvrili sisxli gamodis garet.

rodisaa gamonadeni sashishi?

adreuli sisxliani gamonadenis shemtxvevashi 80% orsulobis mimdinareobas safrtxe ar eqmneba, mcired sheferili gamonadeni panikis safudzveli ar aris, tumca misi gamochenidan maqsimum 6 dgheshi sasurvelia viziti ginekologtan.
tu orsuls uvitardeba sisxldena, is saswrafod unda motavsdes mwoliae mdgomareobashi da dauyovnebliv stacionarshi.

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RA GAVLENA AQVS DABADEBAMDE DEDIS URTIERTOBAS BAVSHVTAN

vin aris tqveni ???mosaubre????
bolo wlebshi dabadebamde patarastan urtiertoba farto ganxilvis sagnad iqca. iwereba wignebi, ixsneba kursebi, xdeba axali metodikebis atviseba... midis saubrebi ara marto nayofis ganvitarebis diagnostikaze, aramed prenatalur fsiqologiaze da prenatalur aghzrdazec ki ??� bavshvis aghzrdaze dabadebamde. mecniereba win midis da dgheisatvis embrionis ganvitarebaze dzalian bevri ram gaxda cnobili. tumca bavshvtan dabadebamde utiertobis sakitxi dghesac dzalze aqtualuria da bolomde ar aris sheswavlili. upirveles yovlisa, sachiroa imis gageba, tu vistan vurtiertobt. saamisod ki unda warmovidginot tu rogor xdeba bavshvis ganvitareba mucladyofnis periodshi.dghes ukve danamdvilebit cnobilia, rom axalshobili am samyaros evlineba shtabechdilebebis didi maragit. is shegrdznebebs grdznobis yvela organos sashualebit ighebs. axalshobils gaachnia grdznobis xutive organo: mxedvelobis, smenis, ynosvis, shexebis da gemos shegrdznebis organoebi.
am etapze ukve sakmaodaa sheswavlili kvirebis mixedvit mucladyofnis periodshi pataras ganvitareba.
mesame kviris bolodan mas ukve ucems guli.
mexute kviraze iwyeba yvelaze mnishvnelovani etapi adamianis ganvitarebashi: iwyeba tvinis qerqis xveulebis formireba, rac momavalshi mzard organizms miscems modzraobis, azrovnebis, laparakis, shemoqmedebis sashualebas.
mecxre kviraze nayofis enaze ukve chndeba gemovnebis receptorebi da mas sheudzlia gaarchios mis irgvliv arsebuli sanayofe sitxis gemo da moaxdinos masze reagireba.
meate kviraze mgrdznobiare xdeba kanis mteli zedapiri.
meate-metertmete kvira-es is periodia, rodesac bavshvi garkvevit grdznobs shexebas, sitbos da sicives, tkivils, magram yvelaze mtavari is aris, rom man ukve icis am impulsebze reagireba. tu shegrdznebebi mistvis usiamovnoa, is icvlis mimikas.
meteqvsmete kviraze bavshvs uvitardeba smena. tavidan mas dedis sxeulis bgerebi esmis: guliscema, sisxlis xmauri, peristaltikis bgerebi. is mat daxshuli saxit ghebulobs, radgan es bgerebi wylis garemos gavlit aghweven bavshvamde. shemdgomshi bavshvi nel-nela iwyebs gare bgerata gagonebasac. dadgenilia is faqti, rom mas sheudzlia calkeul bgerata ???damaxsovreba??? , xmata garcheva. am etapze nayofs ganvitarebuli aqvs mgrdznobiarobis titqmis yvela forma.
metvramete kviraze kviraze bavshvi titebit exeba chiplars, amodzravebs xelebs, exeba saxes da xelebit ifaravs mas usiamovno bgerebis gagonebaze.
daaxloebit meoce kviraze deda grdznobs pataras modzraobas da es dzalian mnishvnelovani momentia. es xom tqvens patarastan pirveli shexvedraa-sxeulismieri kontaqti!
orsulobis meeqvse tveze bavshvs esmis, grdznobs gemos. is reagirebs mashin, rodesac tqven mucels xels sheaxebt.
mecxre tveze pataras uvitardeba mxedveloba.
mash ase, chven mokled gavecanit nayofis grdznobis organota ganvitarebis sakitxs mucladyofnis periodshi. swored am codnas emyareba bavshvtan dabadebamdeli urtiertobis sxvadasxva teoria.

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RA UNDA GAKETDES ROM QVEYANAS MOVAVLINOT NICHIERI DA JANMRTELI SHVILEBI

adamianis organizmi yvelaze rtul manqanaze ufro sakvirveli ramaa. yoveldghe milionobit ujredi nadgurdeba masshi, magram isini avtomaturad icvleba axlebit. tumca zogierti ujredi mudam chventan imyofeba-esaa asobit miliardi aqtiuri nervuli ujredi, anu neironebi, romlebic qmnian tavis qalis qerqs. neironebi chvilis dabadebmde formirdebian. chanasaxis tvinshi wamshi 250 000 ujredi chndeba. amitom, is, rac mosdis adamianis tvins mucladyofnis dros, dzalian mnishvnelovania momavalshi swavlis unaris shemdgomi ganvitarebisatvis. tu orsuli qalebi qronikulad ar ghebuloben satanado saxis sakmaris sakvebs, mat sheidzleba gauchndet bavshvi ganuvitarebeli tvinit, romelshic janmrteli bavshvis tvintan shedarebit ujredebi orjer naklebi iqneba.
amerikelma mkvlevarebma daadgines, rom nebismieri nayofis tvinis ujredebis raodenoba sashualod izrdeba 250 000-it, tu igi uzrunvelyofilia kargi kvebit.
kategoriulad akrdzalulia orsulobisas sigaretis moweva, alkoholi da narkotikebi. tu deda eweva ert sigarets, nayofi eweva-ors. mowevisas deda jangbads artmevs shvils mashin, roca is ase mnishvnelovania tvinis ujredebis chamoyalibebistvis. alkoholis moxmarebis shedegad vitardeba ???nayofis alkoholuri sindromi???: is iwvevs tvinis zomashi dapataravebas, damaxinjebul saxis nakvtebs, modzraobis cud koordinaciasa da hiperaqtiul qcevas.
bavshvis dabadebis shemdeg misi kveba ganagrdzobs zegavlenas organizmis yvela ujredis zrdaze. amastan xazi unda gaesvas mielinis fenis warmoqmnis udides mnishvnelobas. misi nawili wamoiqmneba dabadebamde, kerdzod, im nervuli shenaertebis garshemo, romlebic pasuxs ageben wovit refleqsze, yvirilsa da titebis modzraobaze.
mielinis fenis formireba iwyeba sxeulis zeda nawilidan da shemdeg vrceldeba qvevit. tvinis shignit mielinis shre iwyebs formirebas kefidan shublisken. amitom chven xedvas ufro adre vswavlobt, vidre laparaks da gansjas: xedvis nervuli centri mdebareobs tvinshi kefis mxares, metyvelebis-wina mxarisken, xolo centri, romelic pasuxismgebelia logikur msjelobaze-tvinis wina mxares. swored amitom sanam bavshvi siaruls iswavlides, is gamoscems jer bgerebs. imisatvis rom mielinit daifaros grdzeli aqsonebi, romlebic gadascemen signals fexis wvivebs da fexebis titebs, sachiroa gacilebit meti dro, vidre im aqsonebistvis, romlebic miedinebian enisken da xaxisken.
mielinistvis sachiro masalis 75%-s chveni organizmi ighebs cximebidan, danarcheni 25%-s ghebulobs cilebtan ertad. orive matganis sauketeso wyaroa dedis rdze. dedis rdze sheicavs agretve specialur antisxeulebs, romlebic sheiwovebian kuch-nawlavis da sasuntqi gzebis mier da icavs mat infeqciisagan. dedis rdze icavs bavshvs agretve yuris infeqciebisagan, egzemisagan da alergiis sxva saxeobebisagan, amastan uzrunvelyofs bavshvis organizms kalciumit da fosforit, romlebic sachiroa dzvlebis swrafi zrdisatvis. ertaderti komponenti, romelsac ar sheicavs dedis rdze, esa vitamini D. amitom pediatrebis rchevit, mas damatebit adzleven bavshvebs. dedis rdzis nacvlad sheidzleba gamoyenebul iqnas kargad dabalansebuli rdzis narevebi, amastan mati shemadgenloba miaxloebuli unda iyos dedis rdzestan.
mravali gamokvlevis shedegebi amtkiceben mnishvnelovan kavshirs kvebasa da moghvaweobis sxvadasxva saxeobebs shoris, romlebic xels uwyoben tvinis ganvitarebas.
idealur shemtxvevashi, tvinis ganvitareba adreul asakshi xorcieldeba tanmimdevrulad. bavshvi ufro adre swavlobs xedvas, vidre laparaks. cocvas ufro adre swavlobs, vidre siaruls. siaruls-ufro adre, vidre sirbils. tu bavshvi gamotovebs ert-ert stadias-magalitad, iswavlis siaruls da ar scdis cocvas-mas sheidzleba gauchndes problemebi swavlisas.
rogorc tavad nayofi, bavshvis tvinic naxtomiseburad vitardeba. es ???naxtomebi??? dzalian did rols tamashobs. magalitad, dauxuchet erti tvali ori wlis pataras sul raghac erti kvirit da chatvalet, rom dauzianet bavshvs mxedveloba. es xdeba imis gamo, rom ganvitarebad tvinshi am dros yalibdeba dziritadi mxedvelobiti shenaertebi, romlebic mimartulia tvalidan tvinis ukana nawilshi mdebare mxedvelobiti centrisaken. ori calkeuli shenaerti ibrdzvis dominirebisatvis. tu tqven daufaravt bavshvs ert tvals, meore tvali gaxdeba dominanti. tu tqven daifaravt tvals 20 wlis asakshi, es aravitar mnishvnelobas ar iqoniebs, radgan am asakistvis yvela dziritadi shenaerti ukve warmoqmnilia.
igive emarteba smenasac. adamianis shignita yuri patara txilisxelaa, magram sheicavs imden shenaerts, ramdensac qalaqis satelefono sistema. garda amisa, yurshi aris pawawina detali, romelic gamoiyureba, rogorc lokokina, magram moqmedebs, rogorc pianinos klaviatura. magram pianinos aqvs 88 klavishi, im dros, roca yuris lokokina sheicavs 20 000 mgrdznobiare ujreds, romlebic aghiqvamen xmovan impulsebs da gadascemen tvins.
smenis rtuli meqanizmis mushaobas sasicocxlo mnishvneloba enicheba enebis sheswavlis dros. rogorc mxedvelobis shemtxvevashi, dziritad enobriv shenaertebs safudzveli eyreba sicocxlis pirvel wlebshi. magalitad inglisuri dialeqtebi sheicavs 40-44 bgeras, xolo yvela dziritadi evropuli ena- daaxloebit 70-s. tu sicocxlis pirvel wlebshi bavshvs vaswavlit am bgerebis gansxvavebas, aseve mat warmotqmasa da gamoyenebas, igi gacilebit adre sheiswavlis enebs, vidre mozrdil asakshi.
janmrteli bavshvebis umravlesoba swavlobs mshobliuri enis, minimum 2000 dziritad sityvas. magram tu mat cudad esmit, mattvis rtulia laparakis swavla. da tu isini cudad laparakoben, mat gauchirdebat swavla.
amashi mdgomareobs imis mizezi, rom bavshvta adreuli ganvitarebis programebi did yuradghebas utmoben ara marto kvebisa da mshoblebis saganmanatleblo programebs, aramed mxedvelobisa da smenis regularul shemowmebas.
adamianis pirovneba, misi nichi da unari ganisazghvreba imit, tu ras chams, fiqrobs da aketebs. 9 tvis ganmavlobashi bavshvis dabadebamde gamochenili zrunvis shemdeg, iwyeba yvelaze mnishvnelovani pirveli ati weli, romlis drosac yalibdeba pirovneba da sauketeso saganmanatleblo da ganmavitarebeli programebi swored am wlebze aketeben yuradghebis koncentrirebas.