ALARM menjiT winmdebareoba_____________________________

menjiT winmdebareobis marTva

ALARM menjiT winmdebareoba_____________________________

sixSire

yvela orsulobaTa 3-4% metia orsulobis adreul vadaze _ 7-10% 32 kviraze _ 25-35% <28 kviraze

ALARM menjiT winmdebareoba_____________________________

sruli

arasruli

sufTa

ALARM menjiT winmdebareoba_____________________________

gegmiuri s/k-isa da saSosmxrivi gziT mSobiarobis Sedareba menjiT winmdebareobisas vadamde mitanili orsulobisas: koxreanis mimoxilva
qveda ganakveTiT s/k-isas mniSvnelovnad Semcirebulia perinataluri da neonataluri sikvdilianobis da neonataluri avadobis riski gegmiur saSosmxriv mSobiarobasTan SedarebiT mag. 70%-iT mcirdeba perinataluri/neonataluri sikvdilianobis

maCvenebeli (RR 0.29, 95%CI 0.10-0.86)

Cochrane Library, 2005

ALARM menjiT winmdebareoba_____________________________

koxreanis mimoxilva gegmiuri s/k menjiT winmdebareobisas _ ganviTarebul qveynebSi

gegmiuri gegmiuri qv. segm. s/k saSosmxrivi mSob-ba __________________________________________________________________ perinataluri an axalSobilTa 0/641 4/694 (0.6%) sikvdilianoba axalSobilTa mZime adreuli 2/514 (0,4%) 29/511 (5.7%) avadoba _________________________________________________________________

ALARM menjiT winmdebareoba_____________________________

SOGC-is pozicia

mSobiarobis saukeTeso meTods sufTa an sruli jdomiT winmdebareobisas erTnayofiani vadamde mitanili orsulobis dros warmoadgnes gegmiuri s/k qveda segmentSi

footling fexebiT winmdebareobis drosac mSobiaroba aseve nawarmoebi unda iqnas s/k-is gziT saSvilosnos qveda segmentSi

ALARM menjiT winmdebareoba_____________________________

SOGC-is gancxadeba vadamde mitanil orsulobisas menjiT winmdebareobis kvlevasTan (Term Breech Trial) dakavSirebiT

darwmundiT, rom qalisTvis, romelic apirebs saSosmxriv mSobiarobas menjiT winmdebareobisas, miRebuli aqvs informaciaDda miiReT werilobiTi informirebuli Tanxmoba ganixileT gegmiuri s/k qveda segmentSi riskebi da moaxdineT amis dokumentacia gestaciuri asaki da winmdebareoba s/k-is win daadastureT

nu moaxdenT eqstrapolacias saSosmxriv mSobiarobaze meore nayofis SemTxvevaSi

ALARM menjiT winmdebareoba_____________________________

vadamde mitanili orsulobisas menjiT winmdebareobis kvleva ( Term Breech Trial)

ar exeba naadrevi vadis menjiT winmdebareobas an menjiT winmdebareobas anomaliebis dros mSobiarobis Semdeg 2 wlis manZilze ar aris gansxvaveba axalSobilTa gadarCenis an dedis avadobisa da sikvdilianobis mxriv reproduqciul janmrTelobaze qveda segmentSi s/k-is Soreuli gamosavlebi prolemur sakiTxad rCeba (mag. placentis namdvili Sexorcebis, saSvilosnos gaxevis riski)

ALARM menjiT winmdebareoba_____________________________

Tavze garegani mobruneba (Tgm)

gansazRvreba nayofis garegani ara-TaviT winmdebareobidan TaviT winmdebareobaSi gadayvana

ara-TaviT winmdebareobis dadgena leopoldis wesiT da saSosmxrivi gasinjviT dasturdeba 36 kviraze - ultrabgeriTi kvleviT

ALARM menjiT winmdebareoba_____________________________

Tgm-is Catarebis dro

dRevandeli praqtika >=37 kvira kanadaSi mimdinareobs rkk, romelic afasebs Tgm-as 34-35 kviraze

Tgm-is >=37 kviraze Catarebis arsi

TviTnebur mobrunebas iSviaTad aqvs adgili 37 kviris zemoT TviTneburi mobruneba warmatebuli Tgm-is Semdeg ar xdeba nayofi momwifebulia im SemTxvevaSi Tu aucilebeli gaxda mSobiaroba

ALARM menjiT winmdebareoba_____________________________

Tgm-is pirobebi

erTnayofiani orsuloba saSosmxrivi mSobiarobis ukuCvenebis ar arseboba proceduris win dadasturebuli nayofis damakmayofilebeli mdgomareoba amnionuri siTxis moculobis Sefaseba imis zusti codna, rom ar aris TaviT winmdebareoba mSobiarobis SesaZleblobebis xelmisawvdomoba

ALARM menjiT winmdebareoba_____________________________

absoluturi winaaRmdegCveneba

saSosmxrivi mSobiarobis winaaRmdeg Cveneba

SedarebiTi winaaRmdegCveneba

mcirewylianoba nayofis Tavis hipereqstenzia ori sakeisro kveTa anamnezSi paTologiuri gacximovneba mSobiarobis aqtiuri faza

ALARM menjiT winmdebareoba_____________________________

Tgm-is riski

gaxangrZlivebuli deceleracia, romelic mSobiarobas saWiroebs (<1%) placentis acla aloimunizacia sanayofo garsebis naadrevi acla an samSobiaro moqmedeba nayofis saSvilosnos Sida sikvdili (iSviaTad) _ WiplariT gamowveuli SemTxveva _ acla an feto-placentaruli sisxldena _ ucnobi etiologiis

ALARM menjiT winmdebareoba_____________________________

procedura - informirebuli Tanxmoba

Tu warmatebulia amcirebs s/k-is risks warmatebis maCvenebeli 30-50% sedaciisa da tokolitikebis gamoyenebam SeiZleba diskomforti gamoiwvios

??//

ALARM menjiT winmdebareoba_____________________________

1-procedura teqnika

saavadmyofoSi, NST BPP proceduris win ultrabgera winmdebareobis dasadgenad tokolitikebis SesaZlo gamoyeneba

ALARM menjiT winmdebareoba_____________________________

2-procedura teqnika

ALARM menjiT winmdebareoba_____________________________

3-procedura teqnika

SewyviteT Tu Warbi diskomfortia monitoringi proceduris Semdeg rezus imunoglobulini 300mkg arasinTizirebuli rezus-uaryofiT qalebSi

ALARM menjiT winmdebareoba_____________________________

Tgm Sejameba

Tavze garegani mobruneba >=37kv.-ze warmatebis xarisxi 30-50% mcirdeba s/k-is maCvenebeli

ALARM menjiT winmdebareoba_____________________________

mSobiaroba menjiT winmdebareobisas

marTvasTan dakavSirebuli sakiTxebi

ALARM menjiT winmdebareoba_____________________________

moulodneli menjiT winmdebareobis marTva

dauyovnebeli saSosmxrivi gasinjva _ gansazRvreT menjiT winmdebareobis saxe _ gamoricxeT Wiplaris gamovardna gamoiZaxeT daxmareba s/k Tu dro gaZlevT amis saSualebas nayofis kardio-eleqtromonitoringi epidura da amniotomia Cvenebisas maSebi unda iyos xelmisawvdomi anesTeziologi mzadyofnaSi eswrebodes axalSobilTa gamocdili reanimatologi

ALARM menjiT winmdebareoba_____________________________

daskvna

vadamde mitanili menjiT winmdebareobisas idealuri marTva aris sakeisro kveTa

moulodneli menjiT winmdebarebisas saSosmxrivi mSobiarobis SemTxvevaSi - SeinarCuneT simSvide! nu ixmarT Zalas!

ALARM menjiT winmdebareoba_____________________________

menjSi Cadgma

ALARM menjiT winmdebareoba_____________________________

dundulebis winsvla

ALARM menjiT winmdebareoba_____________________________

TviTneburi gamovardna

Wiplaris TviTneburi gamovardna winsvlis ar arsebobisas an Wiplaris gamovardnisas naCvenebia s/k

ALARM menjiT winmdebareoba_____________________________

iCqareT da moicadeT!

nu moqaCavT! traqciebi iwvevs Tavis gaSlas SeiZleba gamoiwvios xelis gadavrdna

ALARM menjiT winmdebareoba_____________________________

fexebis dabadeba xdeba lateraluri rotaciiT da muxlebis moxriT - gava unda iyos win

ALARM menjiT winmdebareoba_____________________________

xelebis dabadeba

dedis kargi WinTva

dabade, rodesac beWis kuTxe gamoCndeba

mxari daayene win xeli CamoacureT gulmkerdze meore mxari gadaiyvaneT wina poziciaSi da CamoacureT meore xeli

ALARM menjiT winmdebareoba_____________________________

moerideT zedmet moqaCvas

ALARM menjiT winmdebareoba_____________________________

Tavis dabadeba

ALARM menjiT winmdebareoba_____________________________

Tavis dabadeba maSebiT

asistents ukavia bavSvi pirdapiri dadeba