6/2TSSU JSI

Tbilisis saxelmwifo samedicino

universiteti, UNICEF saqarTvelo,
JSI

saxelmZRvanelo perinatalogiaSi

studentTa hendauti

moduli #6
II nawili
 Fnormaluri mSobiaroba

nawili 2

Pprezentaciis bolos studentma unda icodes:

• mSobiarobis marTvis efeqturi

meTodebi da teqnologiebi
• mSobiarobis procesSi nayofis
mdgomareobis monitoringis
efeqturi meTodebi
 1985 wels jandacvis msoflo organizaciam Caatara konferencia,
romelzec eswreboda 60 qveynis warmomadgeneli (samxreTi da
CrdiloeTi afrika, evropa). konferenciam miiRo Semdegi
rekomendaciebi: yovel qals aqvs saTanado perinataluri movlis
ufleba. qali TamaSobs centralur rols am movlis yvela aspeqtSi –
kerZod, movlis dagegmvaSi, ganxorcielebasa da SefasebaSi.
iTvleboda, rom mSobiarobis win boqvenis gaparsva amcirebs
inficirebis risks, rogorc dedis, aseve nayofisaTvis da aadvilebs
saWiroebis SemTxvevaSi Sorisze nakeris dadebas. Catarebuli
randomizebuli kvlevebiT dadginda, rom gaparsva aranairad ar
moqmedebs mSobiarobiSemdgom inficirebaze. piriqiT, am proceduris
Semdeg ufro SeimCneoda gaparsuli qalebis kanis maRali baqteriuli
kolonizacia. amasTan, gaparsvas Tan axlavs mravali uaryofiTi
mxarec:: kanis dazianeba, hepatitiTa da aiv-infeqciiT dasnebovnebis
riskis mateba, qalisaTvis damamcirebeli procedura da a.S.
rutinulad oynis gamoyeneba mSobiarobis win aseve ar aris
rekomendebuli. adre Tvlidnen, rom oyna astimulebs saSvilosnos
SekumSvebs, xels uwyobs nayofis Tavis winmsvlelobas, riTac
amcirebs mSobiarobis xangrZliobas, xels uwyobs mSobiarobis
procesSi fekaluri dabinZurebis Semcirebas, riTac dedisa da
nayofis dainficirebis risks Aamcirebs. magram randomizebulma
kontrolirebadma kvlevebma ver gamoavlina oynis gavlena
mSobiarobis xangrZliobaze, axalSobilisa da dedis inficirebis
doneze; piriqiT, fekaluri dabinZureba oynis gamoyenebisas
matulobda. oynis proceduras aqvs Tavisi uaryofiTi mxareebic:
buasilis gamwvaveba, koliti, gangrene. mSobiarobis pirvel
periodSi oynis rutinulad gamoyenebis efeqturobis damadasturebeli
mtkicebuleba ar arsebobs.
privatulobis, konfidencialurobisa da partnioris Tanadgomis
gansaxorcieleblad, aucilebelia, rom mSobiaroba mimdinareobdes
individualur samSobiaro oTaxSi. individualur samSobiaro
oTaxSi mSobiaroba Tavidan agvacilebs jvaredin dainficirebas.
samSobiaro oTaxi unda iyos sufTa, magram ara steriluri. TiToeuli
mSobiarobis Semdeg sawoli da iataki sapniTa da sxva sarecxi
saSualebebiT irecxeba. TiToeul am oTaxSi unda iyos sabaziso
aRWurviloba axalSobilisaTvis (sufTa magida sxivuri
gamaTbobliT, lorwos amosaqaCi aparatura da oyna an kaTeteri, ambu,
2 zomis niRbiT, Wiplaris gadakveTisaTvis saWiro masala,windebi,
qudi, Tbili safenebi, sabani) , wamzomiani saaTi, Termometri
_kedlisa da eleqtronuli, da aucilebeli ZiriTadi preparatebi
(axalSobilis reanimaciisaTvis saWiro preparatebi, vit. “kK”, Tvalis
malamo, preparatebi, romlebic saWiroa dedisTvis saswrafo
daxmarebis SemTxvevaSi-uterotonuli saSualebebi). individualuri
samSobiaro oTaxis aseTi aRWurva usafrTxos xdis mSobiarobas.
samSobiaro oTaxi kargad unda ganaTdes, rom mosaxerxebeli iyos
nayofze dakvirveba. amasTan, igi unda aRiWurvos iseTi inventariT
(mag. gasaberi burTi, Sveduri kedeli da sxva), mSobiares poziciis
arCevaSi rom daexmareba. individualuri samSobiaro oTaxi ojaxzea
orientirebuli, amitom aq unda idges skamebic, mSobiaris Tanxmleb
pirTaTvis. garemo rac SeiZleba, unda uaxlovdebodes Sinaurs da
uzrunvelyofdes komfortis SegrZnebas (mag. lamazi fardebi, sveli
wertili, musika da sxva).
mSobiarobis erT-erT efeqtur teqnologiad iTvleba Tanmxlebi
piris mudmivi daswreba. am Carevas ar gaaCnia riski da gverdiTi
efeqti. mSobiarobis procesSi qali ar unda davtovoT marto.
idealur SemTxvevaSi erT mSobiares emsaxureba erTi bebia, romlis
rolic ara mxolod klinikuri simptomebis registraciiT, aramed
mSobiaris fizikur-emocionaluri TanadgomiTac ganisazRvreba.
Tanmxlebi piris faqtori gansakuTrebiT efeqturia, roca mas
arasamedicino piri axorcielebs. idealuria, roca es Tanmxlebi piri
meuRlea, Tumca aseve SeiZleba iyos deda an megobari. aseTi
pirovnebis amorCeva Tavad mSobiaris gadasawyvetia. kvlevebis
safuZvelze dadginda, rom mSobiarobisas partnioris daswreba
dadebiTad zemoqmedebs mSobiarobis progresze, mis gamosavalze,
dedis adaptaciaze mSobiarobis Semdgom periodSi, dedisa da
nayofis urTierTobaze, ZuZuTi kvebaze da TviT col-qmris Semdgom
urTierTobebze janmo –s rekomendaciით partnioris monawileoba
mSobiarobis procesSi ara mxolod unda daiSvas, aramed
წახალისებული უნდა იყოს.
bevr qveyanaSi ikrZaleba mSobiarobis procesSi siTxisa da
sakvebis miReba, rasac xsnian kuW-nawlavis SigTavsis aspiraciis
safrTxiT (mendelsonis sindromi), endotraqealuri narkozis
saswrafod warmoebis SemTxvevaSi. damtkicebulia, rom sakvebis
SezRudva ar aris am sindromis ganviTarebis პრევენცია. amasTanave,
mSobiarobis procesს თან სდევს energetikulი danaxarjი,
gansakuTrebiT, maSin, roca mSobiarobis procesi xangrZlivia, amitom
aucilebelia energiis wyaros mudmivi Sevseba. garda amisa, sakvebis
SezRudva mSobiarobis procesSi iwvevs dehidrataciasa da acidozs.
iZulebiTma SimSilმა SeiZleba samSobiaro moqmedebis sisustec
gamoiwvios. am garTulebaTa Tavidan asacileblad, siTxe da msubuqi
sakvebis miReba mSobiarobis procesSi უნდა იყოს nebadarTuli.

Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth.

 Oxford University Press, 3rd Edition, 2000

mSobiarobis I periodi(2)
• mSobiaris moZraoba an vertikaluri pozicia
• demedikalizacia
• mSobiarobis gautkivarebis aramedikamentozuri
meTodebis gamoyeneba
• principis-”daakvirdi da moicade”-s gatareba
• qalis CarTva gadawyvetilebis miRebis
procesSi

mSobiaris zurgze wolis dros saSvilosnos sisxliT momarageba

irRveva da qveiTdeba SekumSvaTa efeqturoba, e.i mSobiarobis procesi
neldeba da mSobiaroba xangrZlivdeba; zurgze wola negatiurad
moqmedebs nayofis mdgomareobaze.
qalebs, romlebsac mSobiarobis procesSi ირჩევდნენე nebismieri
vertikaluri mdgomareoba (jdoma, dgoma, siaruli) samSobiaro
Setevebi ufro xanmokle, magram ufro produqtiuli da
naklebadmtkivneuli hqondaT. mSobiarobis xangrZlioba Semcirda,
Semcirda aseve oqsitociniT samSobiaro moqmedebis stimulaciisa da
nayofis guliscemis darRvevis SemTxvevebi.
Tu mSobiare mainc woliT mdgomareobas airCevs, aucilebelia, rom
is iwves marcxena gverdze, qveda Rru venis sindromis ganviTarebis
Tavidan asacileblad, romelic Tavis mxriv, aqveiTebs saSvilosno-
placentarul sisxlis mimoqcevas da nayofisTvis Jangbadis
miwodebas.
mSobiares unda hqondes Tavisuflad gadaadgilebis saSualeba,
Tavad unda amoirCios misTvis mosaxerxebeli pozicia (daoTxili,
Cacucquli, Sxapis qveS, abazanaSi da sxva).
mSobiarobis gautkivarebisas upiratesoba eniWeba gautkivarebis
arafarmakologiur meTodebs. magaliTad, mSobiaris waxalisebas, rom
SeZlebisdagvarad, meti iaros da imyofebodes vertikalur
mdgomareobaSi; Zalze sasargebloa misTvis xelsayreli sxvadasxva
poziciis SerCeva, romelic Seumcirebs tkivilis SegrZnebas;
ეპიდურული გაუტკივარება gautkivarebis arafarmakologiuri meTodebi
naklebad efeqturia epidurული anesTeziasTan SedarebiT, magram
isini exmarebian mSobiares, rom gverdiTi movlenebisa da
garTulebebis gareSe SeZlos tkivilTan gamklaveba.
Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth.
Oxford University Press, 3rd Edition, 2000

mSobiarobis I periodi(3)
marTvis principebi:
• sufTa da ara steriluri
mSobiaroba
• qalis Tavisufali pozicia
• pacientisaTvis privtulobis
uzrunvelyofa
• ar aCqarde, ar ixmauro

jandacvis msoflio organizacia usafrTxo mSobiarobas ase

ganmartavs:
-- sufTa mSobiaroba;
- marTavs pirovneba, romelsac aqvs saTanado Cvevebi;
- saWiroebisas xelmisawvdomia gadaudebeli samedicino daxmareba.
mSobiaroba unda ჩატარდეს sufTa, magram ara sterilur პირობებში,
rac gulisxmobs personalis xelebis, inventaris zedapiris,
axalSobilis tansacmlis sisufTaves. mSobiarem srulyofili
informaciis safuZvelze unda miiRos gadawyvetileba im poziciis
Sesaxeb, romelSic surs mSobiaroba. pativi unda vceT qalis Rirsebs
da davicvaT misi privatuloba. mSobiaroba unda warimarTos mSvid
garemoSi, aCqarebis gareSe.

Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth.

Oxford University Press, 3rd Edition, 2000

mSobiarobis I periodi (4)

• mSobiarobis pirveli periodis

monitoringisaTvis partogramis
gamoyeneba mSobiarobi marTvis
yvelaze efeqturi meTodia

mSobiarobis vizualuri Sefasebisa da grafikuli monitoringis

mizniT, gamoiyeneba partograma.
pirvelad, mSobiarobis grafikuli gamosaxvisaTvis, partograma
sameano praqtikaSi 60-ian wlebSi gamoiyenes. 1988 wlamde SemuSavda
uamravi partograma, 1988 wels ki am monacemebis safuZvelze jandacvis
msoflio organizaciam Camoayaliba unificirebuli partograma, romelic
dReisaTvis mSobiarobis marTvis yvelaze efeqtur saSualebad
iTvleba.

Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth.

Oxford University Press, 3rd Edition, 2000

Ppartograma (1)

partograma mSobiarobis procesis grafikuli gamosaxvis

saSualebaa, uwyveti mrudebis saSualebiT mSobiarobis progresis
maCveneblebis monitoringic SeiZleba. partograma unificirebulia,
igi erTnairia pirvelmSobiareTaTvisac da
ganmeorebiTmSobiareTaTvisac. saSvilosnos yelis gaxsnis siCqared
miiCneva 1sm/sT. partograma ivseba samSobiaro moqmedebis dawyebidan
saSvilosnos yelis srul gaxsnamde.
partogramaze gamoyofen centralur nawils, romelzec uwyveti
grafikiTaa gamosaxuli saSvilosnos yelis gaxsna da nayofis Tavis
winmsvleloba – mSobiarobis progresis ori ZiriTadi maCvenebeli.
grafikebs qvemoT miTiTebulia mSobiarobis progresis mesame
maxasiaTebelic – samSobiaro moqmedebis intensioba da sixSire.
garda amisa, partogramis sxva monakveTebi srulyofilad asaxaven
dedisa da nayofis mdgomareobas (erTdroulad). partogramaze
aisaxeba yvela is maCvenebeli, romelsac Cven rutinulad vsazRvravT
mSobiarobis procesSi: nayofis guliscemis sixSire, mSobiaris
hemodinamikuri maCveneblebi, temperatura, moSardvis sixSire da
raodenoba da sxva.

Preventing Prolonged Labour: a practical guide. Maternal Health and

Safe Motherhood Programme. Geneva, 1994.

Ppartograma(2)
• mSobiarobis monitoringis martiv da
zust meTods
• mSobiarobis marTvis yvelaze efeqtur
saSualebas
• mSobiarobis procesis vizualuri
Sefasebis saSualebas
• mSobiarobis progresisa da dedisa da
nayofis mdgomareobis yovelmxrivi
maxasiaTeblebis erTobliv monitorings

partograma erTdroulad asaxavs, rogorc mSobiarobis procesis

mimdinareobas, aseve nayofisa da dedis mdgomareobas. mSobiarobis
procesis yvela maxasiaTeblis aseTi Serwymuli asaxva partogramas
Zalian Rirebuls xdis. sworad Sevsebuli partograma TvalnaTliv
iZleva warmodgenas mSobiarobis mTel procesze, igi srulyofilad
cvlis yvela sxva Canawers MmSobiarobis Sesaxeb.
 Preventing Prolonged Labour: a practical guide. Maternal Health and
Safe Motherhood Programme. Geneva, 1994.

Ppartograma(3)
• mSobiarobis fiziologiuri
mimdinareobidan gadaxris myisier
indikators.
• swori sameano gadawyvetilebis miRebis
saSualebas
• da bolos: partograma – Tqveni msaxuria,
romelic mSobiarobis process xdis
ufro logikurs, riTac sagrZnoblad
aumjobesebs perinatalur gamosavals.

partograma aris mSobiarobis procesis normidan gadaxris myisieri

indikatori, gvexmareba swori gadawyvetilebis miRebaSi mSobiarobis
marTvis Semdgomi taqtikis gansazRvrisas. SesaZleblobas gvaZlevs
SevafasoT ganxorcielebuli intervenciis efeqturoba.
 Preventing Prolonged Labour: a practical guide. Maternal Health and
Safe Motherhood Programme. Geneva, 1994.

Ppartograma(4)
partogramis gamoyenebiT Semcirda:
• gaxangrZlivebul mSobiarobaTa ricxvi
6,4%-dan 3,4%-mde
• samSobiaro moqmedebis stimulaciis
saWiroeba 20,7%-dan 9,1%-mde
• saswrafo sakeisro kveTis warmoebis
saWiroeba 8,3%-dan 3,9%-mde
• nayofis intranataluri sikvdili 0,5%-
dan 0,3%-mde.

partogramis gamoyeneba aprobirebulia kohortul kvlevaSi,

35 484 mSobiareze da miRebuli Sedegebi metyvelebs,

rom am gamoyenebam sagrZnoblad gaaumjobesa

perinataluri gamosavali.
World Health Organization Partograph in management of labour. WHO maternal health and
safe motherhood program, Lancet 1994; 343:1399-404

19 randomizebuli kvlevis sistematurma mimoxilvam daadgina

nebismieri vertikaluri an gverdze mwoliare poziciis upiratesoba
liTotomiurTan SedarebiT. aseTi pozicia amcirebs mSobiarobis II
periodis xangrZliobas, instrumentuli momSobiarobisa da
epiziotomiaTa warmoebis sixSires, mSobiarobis II periodis
mtkivneulobas da rac gansakuTrebiT mniSvnelovania, nayofis
guliscemis riTmis darRvevis sixSiresac. Tumca matulobs Sorisis II
xarisxis CaxevaTa ricxvi da sisxlis danakargic 500ml-ze metia.
poziciis miRebis Sesaxeb gadawyvetileba unda miiRos Tavad
mSobiarem, saTanado informaciis miwodebis Semdeg. anu es unda iyos
e.w. informirebuli gadawyvetileba.
dadgenilia, rom liTotomiuri pozicia – zurgze wola qveda
kidurebis mucelTan mizidviT, dRemde sakmaod popularuli,
mSobiarobis procesSi yvelaze arasasurvelia (evidensi A).

Gupta JK, Hofmeyr GJ, Smyth R. Position in anaesthesia.

The Cochrane Database of Systematic Reviews
 mSobiarobis II periodi(2)
• marTvis efeqturi formebi:
• dedisa da nayofis damakmayofilebeli
mdgomareobis SemTxvevaSi da nayofis Tavis
normaluri winmsvlelobisas pasiuri fazis
mocdiTi marTva
-WinTvis dawyebis gadavadeba
-mcirdeba WinTvis periodis xangrZlivoba
-mcirdeba deceleraciaTa ricxvi
-mcirdeba mSobiaris daRla

mSobiarobis II periodis pasiuri marTva niSnavs, rom qals ar

vaiZulebT gaiWinTos mSobiarobis II periodis pasiur fazaSi, e.i. im
dromde, sanam Tavi menjis fskerze ar Camova da mSobiare WinTvis
dauokebel survils ar igrZnobs. WinTvis gadavadebiT, aqtiuri
WinTvis fazis xangrZliobac iklebs, aseve, naklebia deceleraciaTa
sixSire da mSobiare naklebad iRleba.
rac metia aqtiuri WinTvis periodi, miT mSobiarobisSemdgomi
sisxlisdenis, saSvilosnosSida dainficirebisa da perinataluri
avadobis ganviTarebis riskic metia. mSobiarobis II periodis
dasawyisisTanave aqtiuri WinTvebis dawyeba zrdis mZime da
instrumentul travmul mSobiarobaTa raodenobas.

Bloom Steven L.; Casey Brian M.; Schaffer Joseph I.;

Mcintire Donald D.; Leveno Kenneth J. Coached versus uncoached
maternal pushing during the second stage of labour: a randomized
controlled trial. Obstet Gynecol. 2002, 99(6), 1031-5.

Leah L. Albers, Kay D. Sedler; Edward J. Bedric, Dusty Teaf, Patricia

Peralta. Midwifery Care Measures in the Second Stage of Labor and
Reduction of Genital Tract Trauma at Birth: A Randomized Trial. Journal
of Midwifery & Women's Health, 2005, 51(5), 365-372.
 mSobiarobis II periodi(3)
mSobiarobis II periodi(4)
• marTvis araefeqturi formebi
• marTvis araefeqturi formebi
• rutinulad WinTvebis marTva sunTqvisSekavebiT
• WinTvis naadrevi dawyeba
_ iwvevs saSvilosnos perfuziis daqveiTebas _ aqtiuri WinTvebi mSobiarobis II periodis
_ iwvevs nayofis JangbadiT momaragebis pasiur fazaSi zrdis mZime an travmul
instrumentul mSobiarobaTa ricxvs.
daqveiTebas _ rac metia aqtiuri WinTvis periodi, miT metia
_ iwvevs nayofis guliscemis riTmis darRvevas mSobiarobisSemdgom sisxldenaTa,
saSvilosnosSida inficirebisa da
_ iwvevs axalSobilTa abgariT dabali Sefasebis perinataluri daavadebis riski
sixSiris matebas • meore periodis xangrZlivobis iZulebiTi
Semcireba

WinTvebis marTva da regulireba zrdis operaciuli mSobiarobisa

da nayofis distresis risks. WinTvebis marTvis upiratesoba
erTaderTia --- mcirdeba mSobiarobis II periodis xangrZlioba.
magram ukanaskneli 30 wlis ganmavlobaSi Catarebulma kvlevebma
cxadyo, rom ar aris aucilebeli davaCqaroT mSobiaroba mxolod im
mizeziT, rom mSobiarobis II periodis xangrZliobam limitirebul
“normas” gadaWarba.
WinTvis marTva sunTqvis SekavebiT uaryofiTad moqmedebs nayofis
mdgomareobaze, irRveva nayofis oqsigenacia, aseve, nayofis
guliscemis riTmis sixSirec, matulobs apgariT დაბალი Sefasebul
axalSobilTa raodenobac.
umjobesia mSobiares mivceT neba, gaiWinTos bunebrivad, vidre
vurCioT is, rasac farTo propaganda eweva: CaisunTqos haeri, Seikavos
sunTqva da xangrZlivad da Zlierad gaiWinTos. spontanuri gaWinTvis
dros samedicino personalis miTiTebis gareSe, mSobiare iWinTeba
xanmokle drois ganmavlobaSi da misi sunTqvis Sekavebis xangrZlioba
ar aRemateba 6 wm-s, maSin, roca marTviTi WinTvis dros sunTqvis
Sekavebis xangrZlioba 30 wm-mdea.

Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth.

Oxford University Press, 3rd Edition, 2000;

Royal College of Obstetricians and Gynaecologists (RCOG). Operative vaginal

delivery. London (UK): RCOG Press, 2005, Guideline no. 26.

Society of Obstetricians and Gynaecologists of Canada (SOGC). Guidelines for operative

vaginal birth. Clinical practice guideline No 148, J Obstet Gynaecol Can, August 2004, 26, 747-
53
 mSobiarobis II periodi(5)
• Sorisis dacva:1.nayofis Tavis naadre-
• vad gaSlis profilaqtika.2. Sorisis
• qsovilebis daWimulobis Semcireba.
• 3.WinTvis regulireba.4.mxris sarty-
• lis ganTavisufleba da nayofis ta-
• nis dabadeba5.Sorisis dacva zrdis
• epiziotomiis sixSires6.Sorisis dacva
• ar amcirebsSorisis travmissixSires

sameano xeldaxmareba nayofis Tavis winmsvlelobis dros – e.w. “Sorisis

dacva” bebiaqalis mier garkveuli TanmimdevrobiT ganxorcielebuli
manipuliaciebisagan Sedgeba.
I momenti nayofis Tavis swrafi gaSlis profilaqtikaa. moxril
mdgomareobaSi nayofis Tavi sasqeso napralSi gamoiWreba Tavisi umciresi
garSemowerilobiT, romelic gadis mcire irib zomaze (9,5 sm-32 sm), xolo
gaSlis SemTxvevaSi pirdapir zomaze gamavali garSemowerilobiT (35 sm),
bebiaqali nayofis Tavs xris manam, sanam kefqveSa foso boqvenis qveda
kides ar miebjineba da safiqsacio wertili ar Camoyalibdeba.
II momentia Sorisis qsovilebis daWimulobis Semcireba.
III momenti – WinTvaTa regulireba. safiqsacio wertilis Camoyalibebis
Semdeg mSobiares Txoven, SeiCeros WinTva da isunTqos. WinTvebis gareSe
nayofis Tavi ibadeba.
IV momenti – nayofis Tavis dabadebis Semdeg mSobiares kvlav sTxoven
gaWinTvas da amis Semdeg ibadeba nayofis mxris sartyeli da tani.
arsebobs mocdiTi strategia _ “ar axlo xeli”. am ori strategiis
Sesadareblad Catarda randomizebuli kvlevebi, romlis mixedviTac
mocdiTi strategiis dros epiziotomiis sixSire -- naklebi, magram Sorisis
travmaTa sixSire orive jgufSi erTnairi iyo. xolo loginobis xanis me-10
dRes Sorisis naklebi mtkivneuloba aRiniSneboda im jgufSi, sadac Catarda
Sorisis dacva. statistikurad mniSvnelovani sxva gansxvaveba am jgufebs
Soris ar gamovlenila.
“Sorisis dacvis” strategias garkveuli upiratesoba aqvs mocdiT
strategiasTan SedarebiT, amitom gadawyvetileba, Tu romeli strategiis
gamoyeneba ufro upriania, ujobesia, individualurad miiRon mSobiarem da
eqimma.

freithcndj, u.cfdtkmdf, “”vtlbwbyf” ,2000

 epiziotomia
operaciis Cveneba:
• Sorisis mosalodneli Caxeva
• mSobiarobis saswrafo damTavrebis
aucilebloba
• naadrevi mSobiaroba
epiziotomiis rutinuli gamoyeneba:
• zrdis Sorisis travmebis sixSires
• zrdis nakeris dadebis aucileblobas
• zrdis garTulebebs Sexorcebis procesSi
• amcirebs wina travmaTa sixSires

epiziotomia ewodeba vulvaruli rgolis gaganierebas maxvili

wesiT. am dros saSos lagamidan 2-3 sm-iT lateralurad marjvniv an
marcxniv keTdeba ganakveTi. adre Sorisis mosalodneli Caxevis
profilaqtikisTvis mowodebuli iyo epiziotomiis warmoeba. aseve
epiziotomias awarmoebdnen pirveli mSobiarobis, didi nayofis,
naadreve mSobiarobis dros.
Catarebulma randomizebulma kvlevebma uCvena, rom epiziotomiis
farTo gamoyeneba ar amcirebs Sorisis travmebis sixSires, ver
CaiTvleba nayofis travmatizmis profilaqtikad, ar aumjobesebs
Sorisis Sexorcebas, ar amcirebs mSobiarobis Semdeg Sardis
Seukaveblobis ganviTarebis risks. Epiziotomia, pirveli da naadrevi
mSobiarobis SemTxvaSic ki, aRar iTvleba rutinul procedurad. igi
unda Catardes mxolod samedicino CvenebiT – mSobiarobis daCqarebis
mizniT, dedisa da nayofis distresis dros, ara umetes 10%
SemTxvevaSi. epizitomiis SezRudvis politikas rutinul
gamoyenebasTan SedarebiT gaaCnia rigi upiratesobebi; magaliTad,
naklebia Sorisis travmaTa ricxvi, naklebia Sorisze nakeris dadebis
saWiroeba, aseve, naklebad gamoixateba garTulebebic, Tumca wina
Caxevebis riski matulobs. Sua epizitomiis (perineotomiis) warmoebiT
matulobs swori nawlavis sfinqteris dazianebis riski, xolo
mediolateraluri epiziotomiisas ufro metia mtkivneulobis
SegrZneba, gaZnelebulia Sorisis Sexorcebis procesi, izrdeba
inkontinenciis riskic. epiziotomiis warmoebis SemTxvevaSi
aucilebelia gautkivarebis gamoyeneba.

Carolli G, Belizan J, Stamp G. Episiotomy for vaginal birth. Cochrane Database of

Systematic Reviews, 2003, Issue 4
 mSobiarobis II periodi(6)
marTvis principebi:
• ar marTo mSobiaroba
• miaqcie yuradReba nayofis
mdgomareobas
• ar awarmoo epiziotomia
rutinulad
• mSobiarisa da bebia-qalis mudmivi
kontaqti

ukanasknelma ramdenime aTwleulma mSobiarobis procesSi samedicino

movlisadmi damokidebulebaSi cvlileba Setana. meti yuradReba
eTmoba qalis grZnobebs, mSobiarobis processa da gadawyvetilebis
miRebaSi mis aqtiur monawileobas. mSobiarobis procesSi qalSi
kmayofilebis gancdis gaCenaSi mniSvnelovan rols TamaSobs misdami
samedicino personalis damokidebulebis xarisxi. idealuria
mSobiarobis procesis ganxorcieleba principiT “erTi mSobiare-erTi
bebiaqali”,romelic emocionalurad da fizikurad gaamxnevebs
mSobiares.
Aamave dros, sameano praqtikebi gaxda ufro konservatiuli,
mSobiarobis procesSi ganxorcielebuli Carevebi aRmoCnda
araefeqturi, maT Soris -- rutinulad epiziotomiis warmoeba,
mSobiarobis procesi mimdinareobs nayofisa da dedis mdgomareobaze
dakvirvebis qveS, “mSobiarobis procesSi Caurevlobis politikis”
gatarebiT. Careva mxolod mkacri samedicino CvenebiT xdeba da aseve,
mxolod im teqnologiebiT, romelTa efeqturoba damtkicebulia.
Tumca unda aRvniSnoT, rom Tanamedrove efeqturi teqnologiebiT
mSobiarobis marTvisas Carevis saWiroeba sul ufro Semcirebulia.

Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth.

Oxford University Press, 3rd Edition, 2000;

 mSobiarobis III periodi (1)

mocdiTi taqtika–xangrZlivoba 15-30 wT.

• dakvirveba
• mSobiaris zogadi mdgomareobis Sefaseba
• Sardis buStis kaTeterizacia
• medikamentebis ar gamoyeneba
• Wiplaris daqaCvisa an saSvilosnos
fuZeze zewolis akrZalva – “xelebi
Sors saSvilosnodan”

mocdiTi taqtikis ganxorcielebis SemTxvevaSi, meani 30 wT-is

ganmavlobaSi axorcielebs princips “xelebi Sors saSvilosnodan”.
mSobiarobis III periodis marTvis mocdiTi taqtikis dros meani
yuradRebiT akvirdeba mSobiaris zogad mdgomareobas, hemodinamikur
parametrebs – kanis fers, garemo faqtorebze reaqcias, pulss,
arteriul wnevas, saSodan sisxldeni gamonadenis xasiaTs. nayofis
dabadebis Semdeg aucilebelia dauyovnebliv Catardes Sardis
buStis kaTeterizacia, radgan iTvleba, rom gadavsebuli Sardis
buSti xels uSlis saSvilosnos SekumSvebs da arRvevs placentis
mocilebis fiziologiur process.
momyolis dabadebis Semdeg saSvilosnos SekumSvis da sisxlisdenis
profilaqtikis mizniT, SehyavT 1,0 oqsitocini i/v da mSobiares
mucelze yinulian parks adeben.

“ FREITHCNDJ, U.CFDTKMDF, “”VTLBWBYF” ,2000

 mSobiarobis III periodi(2)

momyoli samSobiaro gzebidan gamoZevdeba spontanurad, anu

mSobiaris umniSvnelo gaWinTviT. momyolis dabadebis Semdeg
aucilebelia misi yuradRebiT daTvaliereba, raTa davrwmundeT mis
mTlianobaSi, ris Semdegac unda ganisazRvros misi masa da
dedismxrivi zedapiris zomebi.

FREITHCNDJ, U.CFDTKMDF, “”VTLBWBYF” ,2000

 mSobiarobis III periodi (3)

aqtiuri Careva aucilebelia Tu:

• sisxlis danakargi 500 ml-ze metia
• mSobiaris zogadi mdgomareoba
damZimda
• momyolis periodis xangrZlivobam
30 wuTs gadaaWarba

mocdiTi taqtikis ganxorcielebis taqtikis SemTxvevaSi, aqtiuri

Careva aucilebeli xdeba Semdeg situaciaSi. roca:
-momyolis periodis xangrZlioba 30 wT.-ia da > im SemTxvevaSic ki,
roca qalis zogadi mdgomareoba damakmayofilebelia da sisxldena
ar aris;
-dakarguli sisxlis raodenoba aRemateba 500 ml-s;
-qalis zogadi mdgomareoba mZimdeba.

FREITHCNDJ, U.CFDTKMDF, “”VTLBWBYF” ,2000

 mSobiarobis III periodi (4)
aqtiuri Carevis nabijebi mocdiTi taqtikis dros:
1.momyolis mocilebis niSnebis dadgena
• - Srederis niSani
• - Cukalov-kiustneris niSani
• - alfeldis niSani
2.momyolis mocilebis niSnebis arsebobisas
(2-3 mainc) SeiZleba gamoyenebul iqnas
momyolis mocilebis garegani meTodebi:
• - abulaZis meTodi
• - krede-lazareviCis meTodi
3.momyolis mocilebis garegani meTodebis
uefeqtobis SemTxvevaSi mimarTaven momyolis
xeliT mocilebis meTods.

aqtiuri Careva iwyeba momyolis mocilebis niSnebis dasadgenad.

placentis mocilebis niSnebia:
1.Srederis niSani – saSvilosno Rebulobs silis saaTis formas –
misi fuZe gadaadgildeba zeviT da ganlagdeba Wipis rgolis zeviT
da marjvniv;
2. Cukalov-kiustneris niSani – boqvenis zemoT xeliT daWerisas
Wiplari grZeldeba da ufro gamodis sasqeso napralidan;
3. alfeldis niSani – Wiplarze dadebuli momWeri vulvaruli
rgolidan 8-10 sm-iT qvemoT Camoiwevs.
aRsaniSnavia, rom arc erTi am niSanTagani ar aris absoluturi,
romelic miuTiTebs momyolis mocilebas. Mxolod am niSanTagan 2-3 –
is erTdrouli arseboba miuTiTebs momyolis mocilebaze. momyolis
mocilebis dadgenis Semdeg mimarTaven momyolis mocilebis garegan
meTodebs:
abulaZis meTodi: Sardis buStis kateterizaciis Semdeg muclis wina
kedels weven ori xeliT da mSobiares Txoven gaWinTvas;
Kkrede-lazareviCis meTodi: boqvenis mimarTulebiT saSvilosnos
fuZeze zewola.
garegani meTodebis araefeqturobis SemTxvevaSi, mimarTaven
operaciul Carevas – saSvilosnos RruSi xeliT Sesvlas da
momyolis xeliT mocilebas.

FREITHCNDJ, U.CFDTKMDF, “”VTLBWBYF” ,2000

 mSobiarobis III periodi (5)
mSobiarobis III periodi (6)
aqtiuri taqtika-xangrZlivoba5-8wT. Wiplaris kontrolirebadi
traqcia(Brandt-Andrews manevri)
• axalSobilis dabadebidan 1 wT-is
ganmavlobaSi kunTebSi 2,0 (10 erT.)
oqsitocinis Seyvana
• Wiplaris kontrolirebadi daqaCva
• saSvilosnos garegani masaJi
SeniSvna:Sardis buStis kaTeterizacia
da yinuli mucelze araefeqturia

mSobiarobis mesame periodis aqtiuri marTva Sedgeba

Tanmimdevrulad ganxorcielebuli ramdenime nabijiსაგან: oqsitocinis
Seyvana kunTebSi, Wiplaris kontrolirebadi daqaCva da saSvilosnos
გარეგანი masaJi.
oqsitocinis profilaqtikuri gamoyeneba farTodaa danergili,
magram gansxvavebulia Seyvanis meTodika da dro. upiratesoba eniWeba
oqsitocinis kunTebSi Seyvanas, radgan misi moqmedebis efeqturoba da
siCqare igivea, rac intravenuri Seyvanisas; samagierod, Tavidaნ არის
acilebuli is hemodinamikuri garTulebani, romlebic oqsitocinis
intravenuri Seyvanis dros aris mosalodneli.
Teoriulad, oqsitocinis profilaqtikuri gamoyeneba saSvilosnos
SekumSvis efeqturobas nayofis dabadebis Semdeg zrdis, rac amcirebs
sisxlis danakargs da aCqarebs momyolis mocilebasa da gamoZevebas.
placentis dabadebamde oqsitocinis preparatebis Seyvanisas
aucilebelia yvela im wesis dacva, romelic mimarTulia placentis
Semdgomi mocilebisaTvis. oqsitocinis Seyvanis Semdeg aucilebelia
daaxloebiT 2-3 wuTis lodini, raTa saSvilosno შეიკუმშოს.
mxolod amis Semdegaa dasaSvebi Wiplaris kontrolirebadi daqaCva
რაც ნიშნავს erTi xeliT ჭიპლარის დაქაჩვას da amavdroulad meore
xeliT saSvilosnos fuZis zeviTken gadaadgilebaს.
momyolis dabadebis Semdeg aucilebelia შეფასდეს მომყოლის
დედისმხრივი ზედაპირის მთლიანობა, dauyovnebliv gakeTdes
saSvilosnos გარეგანი masaJi საშვილოსნოს შეკუმშვავდე da Semdegi 2sT-
is ganmavlobaSi yovel 15 wT-Si erTxel შეფასდეს საშვილოსნოს კუმშვის
ხარისხი.
 FREITHCNDJ gjl htlfrwbtq LE{THCNF,2005

mSobirobis III periodi (7)

• mSobiarobis mesame periodis aqtiuri marTvis

upiratesoba mocdiT taqtikasTan SedarebiT (A)

• naklebia sisxlis danakargi <500 ml-ze.

• naklebia mSobiarobis Semdegi sisxldenis sixSire
• Semcirebulia mSobiarobis mesame periodis xangrZlivoba
• naklebia hemotransfuziisa da uterotonikebis
gamoyenebis sixSire mSobiarobis Semdgom periodSi
• naklebadaa gamoxatuli Hb–is dabali maCvenebeli

Catarebuli kvlevebis safuZvelze, mean-ginekologTa saerTaSoriso

federacia (FIGO) mivida im SeTanxmebamde, rom mSobiarobis III periodis
aqtiuri marTva aris samedicino teqnologia, romelic damtkicebuli
efeqturobiT, amcirebs mSobiarobisSemdgomi sisxlisdenis sixSires (A).
dReisaTvis mSobiarobis III periodis aqtiuri marTva samSobiaro
saxlebis umetesobaSia danergili.

Intrapartum care care of healthy women and their babies dur ing childbirth
Clinical Guideline September 2007
 mSobiarobis IIIperiodi(8)
marTvis principebi:
• qalis informirebuli Tanxmoba
mSobiarobis III periodis marTvis
meTodis arCevaze
• upiratesoba mSobiarobis III periodis
aqtiur marTvas eniWeba
• yinulis gamoyeneba ar aris
rekomendirebuli

.gadawyvetileba mSobiarobis III periodis marTvis Sesaxeb unda miiRos

qalma srulyofili informaciis miRebis safuZvelze. esaa e.w.
Tavisufali informirebuli arCevani. mSobiarobis III periodis marTvisas
upiratesoba mSobiarobis III periodis aqtiur marTvas eniWeba(A). არ არის
რეკომენდებული saSvilosnos SekumSvis dasaCqareblad muclis qveda
areSi yinulis dadeba, radgan es iwvevs dedis diskomforts, xels uSlis
siTburi jaWvis ganxorcielebas da rac mTavaria, mSobiarobisSemdgomi
sisxlisdenis profilaqtikis TvalsazrisiT, sakmaod araefeqtur Carevad
iTvleba.

Intrapartum care care of healthy women and their babies dur ing childbirth
Clinical Guideline September 2007
 mSobiarobis IIIperiodi (9)
marTvis principebi:
• Sardis buStis kateterizacia mxolod CvenebiT
• placentisa da sanayofe garsebis daTvaliereba
• samSobiaro gzebis instrumentuli
daTvaliereba mxolod CvenebiT
• saSos da Sorisis damuSaveba antiseptikuri
xsnarebiT ar aris rekomendirebuli

periods, romelic iwyeba momyolis gamoZevebis Semdeg, zogjer

uwodeben mSobiarobis IV periods, radgan igi Zalze kritikulia da
axasiaTebs sisxldeniT garTuleba. amitom mSobiarobidan pirveli 2
saaTis ganmavlobaSi, e.w. adreuli loginobis xanaSi, 15 wuTSi
erTxel unda Sefasdes saSvilosnos SekumSvis xarisxi. placentis
dabadebis Semdeg aucilebelia davrwmundeT placentisa da sanayofo
garsebis mTlianobaSi. xom ar aris damatebiTi wili, razec miuTiTebs
placentis fetalur zedapirze arsebuli sisxlZarRvebis naglejebi.
sanayofo garsebis mTlianobis dadgena ufro rTulia. aucilebelia
Wiplaris sisxlZarRvebis daTvalierebac, radgan maTi anomalia,
magaliTad, umbilikaluri arteriis uqonloba, daaxloebiT 30%-Si
nayofis Tandayolili anomaliis (Tirkmelebis, gul-sisxlZarRvTa
sistemis) arsebobaze miuTiTebs.
Pplacentis gamoZevebis Semdeg rbili samSobiaro Ggzebi mxolod
CvenebiT unda daTvalierdes. Sorisis arasisxlmdinare mcire zomis
Caxevebis gakerva ar aris rekomendebuli, isini gaukeravad ukeT
xorcdeba. Aaseve, ar aris naCvenebi rutinulad saSvilonos yelis
daTvaliereba an antiseptikiT saSos damuSaveba.

Essential Antenatal, Perinatal and Postpartum Care. WHO EURO,

Copenhagen, 2002.
WILLIAMS OBSTETRICS 22nd edition,2005
 Nnayofis mdgomareobis dadgena

• mSobiarobis procesSi nayofze

dakvirvebis mizania:
• hipoqsiuri acidemiis drouli gamovlena,
maSin roca procesi jer kidev
Seqcevadia da SesaZlebelia nayofis
dacvis zomebis gamoyenebiT an drouli
momSobiarebis gziT mSobiarobis
nayofismieri gamosavalis gaumjobeseba

am slaidze axsnilia, Tu ra aris mSobiarobis procesSi nayofis

mdgomareobis Sefasebis mizani.

Fetal Health Surveillance In Labour SOGC Clinical Practice

Guidelines NO. 112. 2002
 nayofis mudmivi kardiomonitoringi

Cveneba:

• dedismxrivi
• nayofismxrivi
• intranataluri mdgomareoba

mSobiarobis procesSi nayofis guliscemis sixSiris uwyveti eleqtronuli

monitoringi rutinulad ar aris rekomendebuli; igi xorcieldeba mkacrad
gansazRvruli CvenebiT. es Cvenebebi ki, pirobiTad, sam jgufad iyofa.

dedismxrivi Cveneba: nayofismieri Cveneba: intranataluri mdgomareoba:

1.gadatanili nayofis ganviTarebis samSobiaro moqmedebis stimulacia
sakeisro kveTa Seferxeba oqsitociniT(A)
2.preeklamfsia vadagadacileba epiduraluri anesTezia
3.vadagadacilebuli mcirewylianoba vaginalurisisxlisdena mSobiarobisas
orsuloba
doplerometriis dedis cxeleba
sanayofo garsebis aradamakmayofilebe-
mekoniumnarevi sanayofo wylebi
prolongirebuli li monacemebi
darRveva(>24
mravalwylianoba
saaTze)
mekonialuri
inducirebuli
sanayofo wylebi
mSobiaroba©
jdomiT
diabeti
winmdebareoba
mSobiarobamdeli
sisxlisdena

rac Seexeba monitoringis teqnikur mxares, yvela specialisti unda iyos

informirebuli qaRaldis lentis moZraobis siCqaris Sesaxeb, rom Tavidan
aviciloT Sedegebis araswori interpretacia. Canawerebze unda dafiqsirdes
zusti dro(C), Canawerebi unda Semowmdes mSobiarobis aqtiur stadiaSi,
yovel 15-30 wuTSi erTxel da 5wuTSi erTxel, mSobiarobis II periodSi(C).
nayofis eleqtronuli monitoringi unda warmoebdes saSvilosnos
SekumSvebTan erTad.
 The Use of Electronic Fetal Monitoring - The use and interpretation of cardiotocography in
intrapartum fetal surveillance. Evidence-based Clinical Guideline Number 8. RCOG Royal College of
stetricians and Gynaecologists. 2001

Nnayofis guliscemis sixSiris kategoriebi

kardiotokografiis (ktg) klsifikacia:

• “normaluri”-roca ktg yvela 4
parametri normis farglebSia
• “saeWvo”-roca ktg erTi parametri
sagangaSo kategoriaSia,xolo
danarCenebi normis farglebSia
• “paTologiuri”-roca ori an meti ktg
maCvenebeli imyofeba sagangaSo
kategoriaSi

Nnayofis guliscemis sixSiris klasifikaciis parametrebi

kategoria bazaluri riTmi variabeloba deceleracia aqceleracia
(dartyma/wT-Si) (dartyma/wT-Si)
normaluri 110-160 ≥>5 ar aris Aaris

sagangaSo 100-109 <5 ≥40 wT-Si adreuli normalur ktg-

(saeWvo) deceleraciebi ze aqcelera-
161-180 magram < 90wuTSi
ciebis ar
variabeluri
arsebobis di-
deceleraciebi
agnostikuri
prolongirebu- mniSvneloba
li saeWvoa
deceleraciebi
(3wuTamde)
paTologiuri <100 <5 ≥90wuTSi tipiuri
variabeluri
>180
deceleraciebi
sinusoiduri
gviani
riTmi 10 wuTis
deceleraciebi
ganmavlobaSi
erTeuli
prolongirebu-
li
deceleraciebi
(3wuTze meti)

The Use of Electronic Fetal Monitoring - The use and interpretation of cardiotocography in
intrapartum fetal surveillance. Evidence-based Clinical Guideline Number 8. RCOG Royal
College of Obstetricians and Gynaecologists. 2001
 Ksameano taqtika
• saeWvo ktg monacemebis SemTxvevaSi:
gaagrZeleT monitoringi d Tu
SesaZlebelia -mSobiroba

• paTologiuri ktg-s dros erTaderTi

efeqturi mkurnaloba aris:
mSobiaroba

Tu eleqtronuli monitoringiT nayofis mdgomareoba Sefasebulia

rogorc saeWvo an sagangaSo, unda miviRoT zomebi nayofis dasacavad.
xolo Tu ktg-is monacemebi paTologiur kategorias miekuTvneba, maSin
diagnozis dasazusteblad, Tu SesaZlebelia, unda aviRoT sisxli
nayofis Tavis kanidan. amisi gakeTeba saWiroa sisxlis gazuri
Semadgenlobis gansasazRvravad da Tu es ver xerxdeba, saWiroa
mSobiarobis daCqareba.

The Use of Electronic Fetal Monitoring - The use and interpretation of cardiotocography in
intrapartum fetal surveillance. Evidence-based Clinical Guideline Number 8. RCOG Royal
College of Obstetricians and Gynaecologists. 2001
 nayofze standartuli dakvirveba
mSobiarobis procesSi
• rekomendirebulia erTi bebia-qalis mier erT mSobiareze
dakvirvebis ganxorcieleba da movla
• protokolis mixedviT Q dadgenili qcevis normebis
mixedviT nayofis guliscemis perioduli auskultacia
• nayofis guliscemis riTmis darRvevisas aucilebelia
mudmivi ktg monitoringi
• samSobiaro moqmedebis induqciisas aucilebelia nayofis
guliscemisa da saSvilosnos SekumSvaTa sixSiris
mudmivi monitoringi
• saTanado Cvenebis SemTxvevaSi aucilebelia nayofis
mudmivi eleqtronuli monitoringis warmoeba

nayofis monitoringis protokoli moicavs mSobiarobis procesSi

nayofze dakvirvebis qvemoT CamoTvlil Tanmimdevrul standartul
nabijebs:
dakvirvebisaTvis rekomendebulia erT mSobiareze erTi bebiaqali.
perioduli auskultacia da sapasuxo qmedeba normidan gadaxris
SemTxvevaSi dabali riskis mSobiareebSi ar aris dakvirvebis arCeviTi
meTodi (A).
mSobiarobis induqciis SemTxvevaSi aucilebelia mkacri monitoringi
nayofis guliscemis sixSiresa da samSobiaro moqmedebis
intensiobaze(B).
Tu periodulma auskultaciam gamovlina anormaluri nayofis
guliscemis sixSire, romelic Catarebuli RonisZiebebiT (mSobiaris
sxeulis mdgomareobis Secvla და სხვ. ) ar swordeba, aucilebelia
uwyvet monitoringze gadasvla an nayofis Tavis kanidan sisxlis
aReba da saswrafo momSobiarebis sakiTxis ganxilva.

Fetal Health Surveillance In Labour. SOGC (Society of Obstetricians and Gynecologists of Canada)
Clinical Practice Guidelines NO. 112. 2002