moduli 4, hendauti studentebisaTvis

Nnayofis ganviTarebis
darRvevebi
nayofis zrdis Seferxeba

modulis bolos studentma

unda icodes:
• mocemuli gestaciuri asakisaTvis mcire
zomis nayofis ganmarteba

• nayofis zrdis Seferxebის განმარტება და

გამომწვევი მიზეზები

• antenatalur periodSi nayofis zrdis

Seferxebis:
 diagnostireba
 monitoringiსა
 marTvა
 nayofis normaluri zrda

• nayofis normaluri zrda asaxavs

urTierTdamokidebulebas nayofis
genetikurad determinirebul zrdis
potencialsa da mis modulacias
nayofis janmrTelobis, placentisa
da dedis mdgomareobis შესაბამისად

nayofis normaluri zrda damokidebulia misTvis placentiT

sakvebi nivTierebebisa da Jangbadis miwodebaze. nayofis
normaluri zrdisaTvis saWiroa insulini, Tiroqsini da sxv.
garda amisa yovel nayofs aqvs zrdis potenciali, romelic
orsulobis dasawyisSive aris gansazRvruli. normaluri
saSvilosnosSida ganviTarebis procesSi nayofi dReSi saSualod
25g-s imatebs. drouli axalSobilis saSualo masa dabadebisas
3,5kg., saboloo masis daaxloebiT 1/3nayofs 28kviris orsulobis
vadaze aqvs, 2/3- 34kviraze. nayofis sxeulis masa orsulobis
bolomde mudmivad matulobs.

Nmocemuli gestaciuri asakisaTvis

mcire zomis nayofi
• mocemuli gestaciuri asakisaTvis
nayofis wona 10 percentilze
naklebi
• nayofi, romelmac konkretuli
gestaciuri asakisaTvis ver miaRwia
Tavisi zrdis potencials
genetikuri an garemo faqtorebis
gavleniT

mocemuli gestaciuri asakisaTvis mcire zomis nayofi aris

nayofi, romelmac konkretuli gestaciuri asakisaTvis ver miaRwia
antropometriuli monacemebis an savaraudo sxeulis masis
garkveul zRurbls. janmo-s mier zRvrul mniSvnelobad
mowodebulia dabadebisas muclis garSemowerilobisa da sxeulis
wonis meaTe percentili.
percentilebis sistema antropometriuli monacemebis Sefasebis
yvelaze gavrcelebuli da xelmisawvdomi meTodia. erTi
percentili garkveuli antropometriuli niSaniT adamianTa
erTianobis gazomvis measedi nawils warmoadgens. Tu mraval
dakvirvebis monacemebs davyofT 100 nawilad, miviRebT 99SesaZlo
percentils. yovel percentils gaaCnia Tavisi rigiTi nomeri. mag..
pirveli percentili antropometriuli niSnebis rigSi gamoyofs
mis yvelaze dabal mniSvnelobas, racy vela mniSvnelobebis 1%
Seadgens, meore percentile-2% da a.S. 50-e percentili Seesabameba
saSualo ariTmetikul mniSvnelobas anu medianas .

Nmocemuli gestaciuri asakisaTvis

mcire zomis nayofi
• nayofTa ori heterogenuli jgufi:
 nayofebi,romlebmac ver miaRwies Tavisi
zrdis potencials (-30-50%) -nayofis
saSvilosnosSida zrdis Seferxeba nszS
 nayofebi, romlebic konstituciurad
pataraa (50-70%) , magram sxvamxriv
janmrTelia an maTi mdgomareoba
ganpirobebulia qromosomuli
aberaciebiT da ar eqvemdebareba
mkurnalobas

mocemuli gestaciuri asakisaTvis mcire zomis nayofebi es aris

nayofTa heterogenuli jgufi, romelSic Sedis nayofebi, romlebmac
ver miaRwies zRvrul zomas, radgan konstituciurad patara
nayofebi arian. roca nayofi pataraa konstituciurad es
normaluri mdgomareobaa. da nayofebi, romlebac raRac mizezis
gamo (dedismieri, placentismieri da sxv.) ver miaRwies Tavis
zrdis srul potencials- nayofis zrdis Seferxeba (nzS). nzS
paTologiuri mdgomareobaa. amgvarad, 10 percentilur doneze
dabla myof nayofTa 40% aReniSnebaT nzS, 40% konstituiciurad
pataraa, xolo 20% gaaCnia qromosomuli an ekologiuri etiologia.
nzS SemTxvevaSi matulobs antenataluri sikvdilobis, sunTqviTi
ukmarisobis, qalasSida sisxlisCaqcevisa da sxva garTulebaTa
ganviTarebis riski. nzS ganpirobebulia im mizezebiT, romlebic
aferxeben nayofis normaluri zrdisaTvis aucilebeli sakvebis
produqtebiT mis adeqvatur uzrunvelyofas. am faqtorebs
miekuTvneba dedismxrivi da placentismxrivi faqtorebi. dedismxriv
faqtorebs miekuTvneba: araswori kveba, Tambaqos weva, alkoholi,
narkotikebi, eqstragenitaluri paTologia-gulis “lurji” mankebi,
qronikuli respiratoruli daavadeba, maRalmTian raionebSi
cxovreba. placentas funqciis darRveva ZiriTadad paTologiuri
placentaciis Sedegia. garda amisa placentas sisxlZarRvebis
Seviwroeba an obstruqcia, Wiplaris erTi arteriis arseboba,
ucnobi difuzuri qronikuli viliti, romelic placentas
histologiuri darRvevis yvelaze xSiri gamovlenaa. placentis
perfuziis Semcireba SesaZlebelia ganviTardes hipertenziis,
preeklamfsiis, Tirkmlis ukmarisobis, Saqriani diabetis,
antifosfolipiduri sindromis dros.

The investigation and management of the small for gestational age fetus.
Royal College of Obstetricians and Gynaecologists. November 2002

NSekiTxvebi nayofis mdgomareobis

Nmocemuli gestaciuri asakisaTvis Sesafaseblad
mcire zomis nayofi
• janmrTelia?
antenatalur periodSi nayofis mdgo- • kargad viTardeba da SeinarCunebs Tu
mareobis Sefasebis ZiriTadi mizania:
ara sicocxlisunarianobas im
• gamoavlinos mocemuli gestaciuri
garemoSi sadac viTardeba?
asakisaTvis mcire masis axalSobilebi
• moaxdinos nayofis saSvilosnosSida • ramdenad usafrTxoa misTvis
zrdis Seferxebis identificireba saSvilosnos SigniT darCena?
• ganaxorcielos nayofis saSvilosnoSida • ramdenad usafrTxo iqneba misTvis
zrdis Seferxebis diagnostirebisas mSobiarobis procesi?
nayofis mdgomareobis monitoringi

nayofis zrdis Seferxeba

• skriningi
• diagnozis dadastureba
• monitoringi
• marTva
.

antenataluri meTvalyureobis ZiriTadi mizania, dadgindes

imyofeba Tu ara nayofi zrdis Seferxebis ganviTarebis riskis qveS
da gamoavlinos nzS. nayofis -saSvilosnos Sida zrda Zalzed
mniSvnelovania, vinaidan arsebobs pirdapiri kavSiri nayofis wonasa
da aradamakmayofilebel perinatalur gamosavals Soris.uaryofiTi
gamosavali gansakuTrebiT matulobs, roca nayofis wona 3
percentilur doneze dabalia. nzS prenataluri skriningi zogad
populaciaSi iTvaliswinebs risk-faqtorebis gamovlenas da nayofis
zomis Sefasebas

McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality
ong newborn infants. N Engl J Med. 1999 Apr 22;340(16):1234-8

skriningi
nayofis guliscemis auskultacia?

• adasturebs,
adasturebs, rom auskultaciis
momentisaTvis nayofi cocxalia
• ar gaaCnia prognostuli Rirebuleba
• rutinuli auskultacia ar aris
rekomendirebuli

Parer JT, King T, 2000

NICE, 2003

nayofis guliscemis auskultacia iyo nayofis sicocxlisunaria-

nobis Sefasebis erT-erTi pirveli meTodi. auskultaciis
gamoyenebis ori saukunis ganmavlobaSi ar iqna Catarebuli arc
erTi randomizirebuli kvleva, romelic Seafasebda am meTodis
efeqturobas. ukanasknel wlebSi dadginda, rom ar arsebobs
araviTari kavSiri nayofis guliscemaTa auskultirebul sixSiresa
da nayofis mdgomareobas Soris. nayofis guliscemis auskultacia
adasturebs, rom nayofi auskultaciis momentisaTvis cocxalia,
magram mas ar gaaCnia prognostuli Rirebuleba. gamonakliss
nayofis terminaluri mdgomareoba warmoadgens, roca nayofis
guliscema mkveTrad bradikardiulia. nayofis auskultacia
SeiZleba Catardes dedis moTxovniT, riTac deda kmayofilia da
rwmundeba, rom nayofi cocxalia.

Routine care for the healthy pregnant woman.

Antenatal care Clinical Guideline # 6. National Institute for Clinical Excellence.
October 2003.
 Parer JT, King T. Fetal heart rate monitoring: is it salvageable?
Am J Obstet Gynecol. 2000 Apr;182(4):982-7

skriningi
muclis palpacia?
• mocemuli gestaciuri asakisaTvis mcire
masis axalSobilTa prognozirebisaTvis
abdominalur palpirebas limitirebuli
diagnostikuri Rirebuleba gaaCnia (C)

• abdominaluri palpaciiT SesaZlebelia

mcire masisi axalSobilTa mxolod 30%
dadgena

nayofis zomis klinikur Sefasebas abdominaluri palpaciiT

SezRuduli prognosturi Rirebuleba gaaCnia (A) nayofis zrdis
Seferxebis deteqciis mizniT da misi mgrZnobeloba 30-50%.

The investigation and management of the small for gestational age fetus.
Royal College of Obstetricians and Gynaecologists., November 2002

skriningi
nayofis moZraobiTi aqtivobis Sefaseba?
Sefaseba?

• nayofis moZraobiTi aqtivobis

rutinul monitorings gaaCnia
SezRuduli prognostuli
Rirebuleba

NICE, 2003

antenataluri meTvalyureobis periodSi eqimebi dedis mier

nayofis moZraobaTa SegrZnebis safuZvelze cdiloben daadginon,
janmrTelia Tu ara axalSobili? xom ar emuqreba mas
antenataluri sikvdili? aRmoCnda, rom dedis mier nayofis
moZraobaTa aqtivobis Sefasebas gaaCnia dabali prognostuli
Rirebuleba 2-7%. randomizirebulma kvlevebma, romelic afasebda
meTodis “ daiTvale aTamde” efeqturobas nayofis antenataluri
sikvdilis Semcirebis mizniT, daadgina, rom am meTodis gamoyenebiT
ar Semcirda perinataluri sikvdiloba (NNT=1250). amgvarad, nayofis
moZraobaTa rutinuli formaluri daTvla ar axdens orsulobis
mogvianebiT vadaze nayofis sikvdilis prevencias. Tu deda grZnobs,
rom nayofis moZraobiTi aqtivoba Sesustebulia, mizanSewonilia
nayofis janmrTelobis mdgomareoba Sefasdes biofizikuri
testebiT da ara sxvadasxva meTodikebis saSualebiT nayofis
moZraobiTi aqtivobis formaluri TvliT

Routine care for the healthy pregnant woman. Antenatal care Clinical
Guideline # 6. National Institute for Clinical Excellence. October 2003

skriningi
saSvilosnos fuZis simaRlis gazomva
gravidograma
• boqvenis simfizis zeda kidesa da saSvilosnos
fuZes Soris distanciis gazomva santimetruli
lentiT
• erTjeradad saSvilosnos fuZis simaRlis
gazomvas mcire masisi nayofTa prognozirebis
limitirebuli diagnostikuri Rirebuleba
gaaCnia (B)
• saSvilosnos fuZis simaRlis dgomis gazomvis
specialurad SemuSavebuli grafikis gamoyeneba
aumjobesebs mcire masisi nayofTa prognozi-
prognozi-
rebis sizustes
• gazomvaTa seria (gravidograma)
gravidograma) zrdis meTodis
mgrZnobelobasa da specifiurobas 86%-
86%-mde

antenatalur periodSi nayofis mdgomareobis monitoringis martiv,

iaf da efeqtur meTods warmoadgens saSvilosnos fuZis simaRlis
gansazRvra dinamikaSi da monacemebis antenataluri
meTvalyureobis grafikze, e.w. gravidogramaze gadatana. am meTodis
saSualebiT SesaZlebelia mocemuli gestaciuri asakisaTvis mcire
da Warbi wonis nayofTa gamovlena da is saukeTeso skriningul
tests warmoadgens. saSvilosnos fuZis simaRle e.w.simfizo-
fundaluri zoma es aris manZili boqvenis simfizis zeda kidesa da
saSvilosnos fuZes Soris.

Belizán J et al. Diagnosis of intrauterine growth retardation by a simple clinical

method: measurement of uterine height. American Journal of Obstetrics and
Gynecology, 1978, 131: 643–646.
 N gravidograma
N gravidograma
• 28kvira-22sm • 28kvira-28sm

см))
Высота стояния дна матки ( см
• 32kvira-25sm • 32kvira-30sm
Перцентиль 90

• 36kvira-29sm • 36kvira-32sm Перцентиль 50

Перцентиль 10

Недели беременности

orsulobis calkeul vadebze saSvilosnos fuZis simaRlis

gazomvas mocemuli gestaciuri asakisaTvis mcire masis nayofis
prognozirebis SezRuduli diagnostikuri sizuste da ar amcirebs
perinatalur sikvdilobas (mgrZnobeloba 27%, specifiuroba 88%).
specialurad SemuSavebul grafikebze monacemebis gadatana, e.w.
seriuli gaTvlebi (gravidograma) sagrZnoblad zrdis mcire masis
nayofTa prognozirebis mgrZnobelobas (49%) da specifiurobas. .
meTodi ukeTesad sruldeba, roca gazomvas awarmoebs erTi da igive
klinicisti Sebrunebuli santimetruli lentiT ( Secdomis
Sesamcireblad) da gadaaqvs diagramaze yoveli individualuri
pacientisaTvis. bevrad ufro mniSvnelovania nayofis zrdis
dinamikis Sefaseba, vidre mocemuli gestaciuri asakisaTvis
saSvilosnos fuZis simaRlis Sesabamisoba standartizirebul
normasTan. skrininguli testis mgrZnobelobaze SesaZlebelia
gavlena iqonios dedis wonam, Sardis buStis moculobam, paritetma,
eTnikurma warmomavlobam da sxv.

Pearce JM, Campbell S. A comparison of symphysis-fundal height and

ultrasound as screening tests for light-for-gestational age infants. BJOG
94: 100-104 1987

Neilson JP. Symphysis-fundal height measurement in pregnancy

(Cochrane Review)In: The Reproductive Health Library, Issue 8, 2005

Persson B, Stangenberg M. Prediction of size of infants at birth by

measurement of symphysis fundus heigh. BJOG 93: 206-211 1986

The investigation and management of the small for gestational age fetus
 nayofis zrdis Seferxebis
diagnozis dadastureba

• nayofis wonis sonografiuli dadgena

mcire masis nayofis diagnostikis
erTaderTi saukeTeso morfometriuli
testia
• mocemuli gestaciuri asakisaTvis mcire
masis nayofis diagnozis dadasturebis
mizniT gamoiyeneba muclis
garSemoweriloba da nayofis savaraudo
wona

 arsebobs sayovelTao Tanxmoba, rom Tu erTxel gaCnda eWvi nayofis

mocemuli gestaciuri vadisaTvis mcire masis Sesaxeb, aucilebelia
diagnozis dazustebis mizniT orsulis sonografiuli kvlevis
Catareba. ultrabgeriTi gamokvleva aris mocemuli gestaciuri
asakisaTvis mcire masis nayofis diagnostikis ZiriTadi meTodi.

nayofis zrdis Seferxebis dadastureba

ultrabgeriTi biometria

• orsulobis 12 kviris Semdeg fatometriisaTvis

iyeneben standartul maCveneblebs:
 Tavis biparietaluri zoma
 Tavis garSemoweriloba
 muclis garSemoweriloba
 barZayis Zvlis sigrZe
 nayofis gestaciuri asakis Sesafasebeli yvela
parametridan muclis garSemoweriloba yvelaze
zustad Seesabameba sxeulis masas

 exoskopiuri gamokvlevis dros xdeba rigi standartuli

maCveneblebis Sefaseba. es maCveneblebia: nayofis savaraudo
wona, Tavis da muclis garSemoweriloba. Ynayofis gestaciuri
asakis Sesafasebeli yvela parametridan muclis
garSemoweriloba yvelaze zustad Seesabameba sxeulis masas,
aseve mniSvnelovani maCvenebelia nayofis savaraudo wonis
gansazRvra, romelic eyrdnoba Tavis da muclis
garSemowerilobisa da barZayis sigrZis gansazRvras. muclis
garSemoweriloba da nayofis savaraudo wona aris yvelaze
metad sarwmuno diagnostikuri maCvenebeli nayofis
saSvilosnosSida ganviTarebis Seferxebis gansazRvrisaTvis.
mgrZnobeloba - 72.9–94.5% da specifiuroba- 50.6–83.8% maRali
riskis jgufSi. gamoTvlebisas Secdomebis minimumamde
Semcireba ramdenime parametris erTdrouli gamoyenebiTa da
 dinamikaSi gansazRvriTaa SesaZlebeli. gestaciur asakTan
SedarebiT patara zomis nayofis dasadgenad yvelaze zusti
diagnostikuri maCveneblebia nayofis muclis garSemoweriloba
da nayofis savaraudo wona. me-10 percentilze qveviT muclis
garSemoweriloba mqone maRali riskis jgufis qalebSi
SesaZlebelia me-10 percentilze qveviT wonis mqone
axalSobilis dabadebis prognozireba. am prognozis
mgrZnobeloba iqneba 72.9–94.5% da specifiuroba50.6–83.8%..
nayofis savaraudo wonis Sesaxeb Sesabamisi monacemebi:
mgrZnobeloba- 33.3–89.2% da specifiuroba- 53.7–90.9%. Chang et
al. mier Catarebuli sistematiuri analizis mixedviT, me-10°
percentilis zRvars hqonda saukeTeso mgrZnobeloba da
specifiuroba. nayofis ganviTarebis maCveneblebis ( muclis
garSemoweriloba da nayofis savaraudo wona) mravaljerad
gansazRvras aqvs ufro meti mniSvneloba, vidre erTjerad
maCveneblebs nayofis saSvilosnoSida ganviTarebis Seferxebisa
da cudi perinataluri Sedegebis prognozirebis mxriv. Tumca
zrdis Seferxebis diagnostikis mizniT mxolod zrdis
maCveneblebis gamoyenebam ( gansakuTrebiT roca skanirebebes
Soris intervali aris or kviraze naklebi) SeiZleba
ganapirobos didi raodenobiT cru dadebiTi rezultatebi.
nayofis biometriis cxrilebi farTod gamoiyeneba nayofis
zrdis tempis Sesafaseblad. Tumca mxolod nayofis
ganviTarebis maCveneblebis mravaljeradi gansazRvris
safuZvelze miRebul grafikebs SeuZliaT sworad gamosaxon
nayofis zrda.

The investigation and management of the small for gestational age fetus. Royal
College of Obstetricians and Gynaecologists. November 2002

Vandenbosche RC, Kirchner JTR. Intrauterine growth retardation. Am Fam

Physician. 1998 Oct 15;58(6):1384-90

Chang TC, Robson SC, Boys RJ, Spencer JA. Prediction of the small for gestational
age infant: which ultrasonic measurement is best? Obstet Gynecol. 1992 80(6):1030-
8.
 nayofis zrdis Seferxebis
nayofis zrdis Seferxebis diagnozis dadastureba
diagnozis dadastureba
• diferencirebis mizniT upiratesoba kvlevis
• eqoskopiurad mocemuli gestaciuri biofizikur da ara biometrul testebs
eniWebaT
vadisaTvis mcire masis nayofis
diagnostirebis Semdeg saWiroa moxdes • biometruli testebis saSualebiT SesaZlebe-
diferencireba: lia nayofis savaraudo wonis, da ara misi
 nayofis zrdis Seferxebasa mdgomareobis gansazRvra

 da konstituciurad mcire zomis • biofizikuri testebis saSualebiT ki

nayofebs Soris SesaZlebelia nayofis mdgomareobis da ara
savaraudo wonis Sefaseba

 aucilebelia biometriul ( zomebis gansazRvra) da biofizikur

testebs ( nayofis mdgomareobis gansazRvra) Soris sxvaobis zusti
codna. biometriuli testis mizania zomebis da Semdgomi gazomvis
mere, nayofis zrdis prognozireba, magram ara nayofis
gankuTvnilia nayofis mdgomareobis Sesafaseblad da ara nayofis
zomebis dasadgenad. zogierT biofizikur tests aqvs
SezRuduli diagnostikuri da prognostuli Rirebuleba. mag.
amnionuri siTxis moculobisa da saSvilosnos arteriis
doplerometrias aqvs minimaluri diagnostikuri da prognosturi
Rirebuleba. miuxedavad dadebiTi urTierTkavSirisa sanayofe wylis
moculobis gansazRvrasa da neonatalur morfometrias Soris, cru-
dadebiTi pasuxis albaToba mainc maRalia.

nayofis zrdis Seferxeba

nayofis zrdis Seferxeba
antenataluri monitoringi
antenataluri monitoringi
• antenataluri monitoringis saSualebiT
• nayofis zrdis Seferxebis eWvis SesaZlebelia gaeces pasuxi SekiTxvebs:
SemTxvevaSi nayofis monitoringis  SeinarCunebs Tu ara nayofi sicocxlisunari-
optimaluri meTodebi jerjerobiT ar anobas im garemoSi sadac viTardeba?
aris dadgenili  ramdenad usafrTxoa nayofisaTvis saSvilosnos
SigniT darCena?
• nayofis monitoringis mizniT mowode-  ramdenad usafrTxo iqneba nayofisaTvis mSobi-
bulia kvlevis biofizikuri meTodebi : arobis inducireba da naadrevi mSobiaroba?
 biofizikuri profili
 arastresuli testi
 doplerografia

nayofis zrdis Seferxebis eWvis SemTxvevaSi nayofis monitoringis

optimaluri meTodebi jerjerobiT ar aris dadgenili. upiratesoba
kvlevis biofizikur meTodebs eniWeba, romelTa monacemebiT
SesaZlebelia gaeces pasuxi SekiTxvas-janmrTelia Tu ara nayofi.

The investigation and management of the small for gestational age fetus.
Royal College of Obstetricians and Gynaecologists. November 2002
 biofizikuri profili

biofizikuri profili nayofis monitoringis

sasargeblo meTodia, radgan misi saSualebiT
SesaZlebelia nayofis mwvave da qronikuli
fiziologiuri parametrebis Sefasebis
ganxorcieleba
• amnionuri siTxis moculoba
• nayofis moZraobiTi aqtivoba
• nayofis tonusi
• nayofis sunTqviti moZraoba
• arastresuli testi
.

nayofis biofizikuri profili (nbp) aris testi, romelic 30 wT-is

ganmavlobaSi tardeba da Sefaseba xdeba qulaTa sistemiT. is afasebs
nayofis mdgomareobas moZraobiTi aqtivobis, sunTqviTi moZraobebis,
saSvilosnos tonusis da sanayofe wylis moculobis monitoringis gziT,
aseve ktg-ze aqseleraciis arsebobis saSualebiT. sanayofo wylebis
daqveiTebuli moculoba daqveiTebuli gorglovani filtraciis
arapirdapiri niSania, rac qronikul hipoqsiaze nayofis Tirkmlebis
sapasuxod xdeba. nayofisBbiofizikuri profilis gansazRvra xdeba
eqoskopiis saSualebiT qulobrivi SefasebiT. 0 ( ar aris) da 2 (aris)
Sefaseba eZleva 4 cvladidan TviToeuls. maqsimalurad SesaZlo
Sefaseba aris 8 arastresuli testis gareSe an 10 masTan erTad.
biofizikuri profili gamoiyeneba rogorc intervaluri testi
doplerometriebs Soris an roca doplerometriuli kvlevis warmoeba
ver xerxdeba.

arastresuli testi
• nayofis moZraobis sapasuxod nayofis
guliscemis cvlilebis Sefaseba
• reaqtiuli arastresuli testi
gulisxmobs:
 20wT-Si nayofis sul mcire 2 an meti
moZraobis sapasuxod:
nayofis guliscemis aCqarebas sul mcire
15 dartymiT
aqceleraciis xangrZlivoba 15-20wm

arastresuli testis upiratesobebi: ar aris Zviri, misi gamoyeneba

martivia, ar aris ukuCvenebebi.
arastresuli testis nakli: gvian iZleva hipoqsiis/acidosis
prognozirebas, saWiroebs ganmeorebiT Catarebas kviraSi orjer maRali
riskis jgufis qalebisTvis, miuTiTebs mxolod mwvave hipoqsiaze- iZleva
SezRuduli raodenobiT informacias nayofis qronikul hipoqsiaze,
naklebad sarwmunoa mcire vadebze, 85%-s eqneba reaqtiuli arastresuli
testi orsulobis 28-32 kvirebSi.
oTxi farTo klinikuri kvlevis analizis monacemebi araviTar safuZvels
ar iZleva imisa, rom antenataluri arastresuli ktg gamoyenebul iqnas
rogorc damatebiTi meTodi nayofis mdgomareobis Sesafaseblad maRali
riskis faqtoris ararsebobis SemTxvevaSi. garda amisa, ar iqna
aRmoCenili mniSvnelovani gavlena sakeisro kveTis sixSireze, dabal
qulebze apgaris Skalis mixedviT, axalSobilis nevrologiur
darRvevebze, axalSobilTa intensiuri Terapis ganyofilebaSi
hospitalizaciaze. Tumca 3-jer metad gaizarda perinataluri sikvdiloba.

Parer JT, King T. Fetal heart rate monitoring: is it

salvageable? Am J Obstet Gynecol. 2000 Apr;182(4):982-
7

The investigation and management of the small for gestational age

fetus. Royal College of Obstetricians and Gynaecologists.
November 2002

modificirebuli biofizikuri profili

• modificirebuli biofizikuri profilis

saSualebiT fasdeba:
 sanayofo siTxis moculoba
 arastresuli testi
• orkomponentiani nayofis biofizikuri
profilis diagnostikuri efeqturoba
iseTivea, rogorc xuTkomponentianis

modificirebuli nayofis biofizikuri profiliT xdeba mxolod 2

parametris Sefaseba : arstresuli testi da sanayofe wylebis
raodenoba.
sanayofo siTxe nayofis irgvliv araswori formis jibeebis
saxiT aris Tavmoyrili. arsebobs sanayofo siTxis moculobis
Sesafasebeli ori meTodika: pirveli meTodikis saSualebiT
isazRvreba yvelaze didi jibis vertikaluri zoma. am meTodikis
gamoyenebiT, jibis sigrZe 2-8sm. identificirdeba rogorc norma, 2-
ze naklebi rogorc sanayofo wylebis simcire, xolo >8, rogorc
siWarbe. meore meTodikis saSualebiT sazRvraven sanayofo
siTxis moculobis indeqss. misi saSualebiT xdeba sanayofe wylis
saerTo moculobis raodenobrivi gansazRvra saSvilosnos oTx
kvadrantSi aRmoCenili jibeebis yvelaze didi vertikaluri
zomebis SejamebiT. III trimestrSi normaSi sanayofo siTxis indeqsi
10-25sm-is toli unda iyos.
nayofis biofizikuri profili tipiurad tardeba kviraSi erTxel an
orjer. ufro xSiri- yoveldRiuri testirebis Cvenebas warmoadgens:
nayofis zrdis mwvave Seferxeba ( xuT percentilze naklebi), mwvave
mcirewylianoba, Wiplaris arteriaSi uaryofiTi an reversuli
sisxlisdinebis siCqre da saeWvo biofizikuri profili.

Robert Liston,Vancouver BC, Joan Crane, Foetal health surveillance in labour.,

SOGC Clinical Practice Guidelines. No. 112,April 2002

Stuart Campbell, Christoph Lees, Obstetrics By Ten Teachers, 17th edition

Robert Liston,Vancouver BC, Joan Crane, Foetal health surveillance in labour.,

SOGC Clinical Practice Guidelines. No. 112,April 2002

doplerometria
• arainvaziuri kvlevis meTodia
• saSvilosnos, placentisa da nayofis
sisxlZarRvebis vizualizaciisa da
maTSi sisxlisdinebis Sefasebis meTodia
• gamoiyeneba dedisa da nayofis
hemodinamikis Sesafaseblad
• skrininguli meTodis saxiT Catareba
dabali riskis orsulebSi ar aris
rekomendirebuli

praRis universitetis avstrielma fizikosma kristian doplerma

aRmoaCina fizikuri movlena, romlis safuZvelze SesaZlebeli
gaxda moZravi obieqtidan, magaliTad eriTrocitebidan areklili
ultrabgeriTi signalis speqtraluri asaxva ekranze. dopleris
meTodis daxvewis Sedegad, feradi dopleris gamoyenebiT
SesaZlebeli gaxda realuri reJimSi deda-placenta-nayofis yvela
funqcionalur rgolSi Hhemodinamikis Sefaseba. mag. sisxli
romelic transduqtorisaken moZraobs wiTeli ferisaa da rac
ufro kaSkaSaa, miT ufro maRalia sisxlisdinebis siCqare;
raodenobrivi informacia nebismier sisxlZarRvSi sisxlisdinebis
siCqaresa da sisxlZarRvis winaRobis Sesaxeb miiReba speqtraluri
gamokvlevebis saSualebiT.
 doplerometria doplerometria
• nszS eWvis arsebobis SemTxvevaSi Wiplaris arteriis • upiratesoba eniWeba Wiplaris arteriebSi
doplerometria diagnostikis yvelaze sarwmuno meTodia sisxlis dinebis siCqaris Sefasebas commonly
• upiratesoba eniWeba Wiplaris arteriebSi sisxlis insonated
dinebis siCqaris Sefasebas
• saSvilosnos arteriis da Wiplaris venis • Wiplaris arteriis doplerometria
doplerometrias gaaCnia SezRuduli diagnostikuri aumjobesebs perinatalur gamosavals,
gamosavals,
Rirebuleba axalSobilTa avadoba mcirdeba 29%,xolo
• Wiplaris arteriis doplerometria aumjobesebs sikvdiloba38%-iT (A)
perinataluri sikvdiloba38%-
perinatalur gamosavals (A) • Wiplaris arteriis doplerometria
 axalSobilTa avadoba mcirdeba 29%, mniSvnelovnad aqveiTebs mSobiarobis induqciis
 perinataluri sikvdiloba mcirdeba 38%-
38%-iT sixSires
• Wiplaris arteriis doplerometria mniSvnelovnad • saSvilosnos arteriis da Wiplaris venis
aqveiTebs mSobiarobis induqciis sixSires
doplerometrias gaaCnia SezRuduli
diagnostikuri Rirebuleba

sistematuri kvlevis meta-analiziT miRebul iqna sarwmuno

mtkicebulebebi imisa, rom maRali riskis nayofebSi Wiplaris arteriis
sisxlisdinebis doplerometriis saSualebiT SesaZlebeli gaxda
perinataluri sikvdilobisa da avadobis sarwmuno Semcireba. aseve
sagrZnoblad Semcirda antenataluri hospitalizaciisa da samSobiaro
moqmedebis induqciis sixSirec. sisxlis dinebis anomaluri cvladebis
gamovlenis safuZvelze ganxorcielebuli Carevebi amcireben perinatalur
periodSi sikvdilobas 38%-iT maRali riskis mqone orsulobaTa jgufSi (
sandoobis intervali 15-55%).(I-A)
kvlevaSi, sadac Sedarebuli iyo nayofis guliscemis monitoringi,
biofizikuri profili da Wiplaris arteriis doplerometria,
aRiniSneboda, rom mxolod Wiplaris arteriis doplerometrias gaaCnia
perinataluri gamosavlis prognostuli Rirebuleba gestaciur asakTan
SedarebiT patara zomis nayofis dros. doplerometriis gamoyenebas Tan
ar sdevs Carevebis zrda, radgan cru-dadebiTi testebis raodenoba
mcirea. aRsaniSnavia, rom Wiplaris arteriis doplerometriis
skrininguli gamoyeneba yvela orsul qalSi ar aris saWiro.
dResdReobiT Wiplaris doplerometria aSkarad efeqturia nayofis zrdis
SeferxebiT an hipertenzia/preeklamfsiiT garTulebuli orsulobebis
dros.

doplerometria
• Tu doplerometruli maCveneblebi normaluria,
normaluria,
maSin albaToba imisa,
imisa, rom mocemuli gestaci-
gestaci-
uri asakisaTvis patara nayofi ar ganicdis
saSvilosnosSida zrdis Seferxebas Zalzed
maRalia
• dopleris normaluri maCveneblebis dros
gestaciur asakTan SedarebiT patara zomis
nayofis monitoringi unda tardebodes
ambulatoriulad,
ambulatoriulad, kviraSi orjer
• Wiplaris arteriaSi sisxlis dinebis diasto-
luri siCqaris reversuli an nulovani tipi
nayofis sagangaSo mdgomareobaze miuTiTebs
 sisxlisdinebis doplerogramis Sefasebis ori meTodi arsebobs:
raodenobrivi da xarisxobrivi. sameano praqtikaSi farTo gamoyeneba pova
xarisxobrivma analizma romelTa Soris yvelaze xSirad gamoiyeneba
sistolo-diastoluri Sefardeba. Tumca, diastoluri sisxlisdinebis
arseboba bevrad ufro mniSvnelovania klinikuri TvalsazrisiT, vidre
sistolo-diastoluri Sefardebis absoluturi sididis maCvenebeli
Wiplaris arteriis nulovani da reversuli sisxlis dineba aris feto-
placentaruli sisxlismimoqcevis kritikuli darRvevis niSani, romelsac
3-7 dRis ganmavlobaSi mohyveba nayofis antenataluri sikvdili. ATu
eqoskopiuri maCveneblebi da Wiplaris arteriis doplerometriis
Sedegebi normaluria, maSin nayofis mcire zoma mimdinare orsulobisTvis
normas warmoadgens. mtkicebulebebi imaze miuTiTeben, rom aseTi nayofis
ambulatoriuli marTva sruliad usafrTxoa da maTze unda
ganxorcieldes doplerometriuli monitoringi 2 kviraSi erTxel da ara
ufro xSirad. kvlevebma aCvenea, rom ufro xSirad ganxorcielebulma
monitoringma gamoiwvia naadrevi mSobiaroba da mSobiarobis ufro meti
induqcia neonataluri avadobis sxvaobis gareSe. damtkicebulia, rom
nayofisaTvis usafrTxoa sisxlis dinebis ganmeorebiTi gamokvlevis
Catareba 2 kviris SualediT.

Fetal Health Surveillance In Labour. SOGC Clinical Practice

Guidelines NO. 112 2002
.

The investigation and management of the small for gestational age fetus.
Royal College of Obstetricians and Gynaecologists. November 2002

nayofis zrdis Seferxeba

marTva
nayofis zrdis Seferxeba
• nayofis zrdis Seferxebis mkurnalobis marTva
erTaderTi efeqturi meTodia
mSobiaroba araefeqturi efeqturi
• woliTi reJimi • Tambaqos wevis akrZalva
• antenatalur periodSi nayofis zrdis • aspirini • kvebismieri danamatebi
Seferxebis specifikuri sasargeblo • hormonebi sakvebis deficitis dros
medikamenturi mkurnalobis Sesaxeb • Jangbadi • malariis mkurnaloba
mtkicebuleba dReisaTvis ar moipoveba • glukoza • usimptomo baqteriuriis
mkurnaloba
• vitaminebi
• metabolitebi • preeklamfsiis riskis
dros aspirini
• tokolitikebi
• mSobiarobaTa Soris
• kalciumis arxis intervalis 2 wlamde
blokatorebi gazrda

samwuxarod, nzS mravali mizezi ar eqvemdebareba antenatalur

mkurnalobas. dRevandel dRes perinataluri RonisZiebaTa
umetesoba, romelic mimarTulia nayofis zrdis gaumjobesebisa da
nayofis distresis ganviTarebis Tavidan acilebisaken, ar
aumjobesebs perinatalur gamosavls.
nayofis zrdis Seferxebis mZime xarisxis da nayofis seriozuli
anomaliebis SemTxvevaSi, mkurnalobis rekomendirebuli meTodia
gadaudebeli mSobiaroba. Tu adgili aqvs nayofis saSvilosnosSida
ganviTarebis Seferxebis kompensirebul stadias, saWiroa nayofis
mdgomareobis perioduli monitoringi.
gamokvlevis mizania nayofisaTvis saSiSi mdgomareobis drouli
dadgena. aseT SemTxvevebSi gadaudebeli naadrevi mSobiarobis
Catareba aris saukeTeso arCevani nayofis sicocxlis
SesanarCuneblad da daavadebis asacileblad, vidre orsulobis
prolongireba, roca intrauterinuli yofna ufro saSiSi xdeba.

daskvna
• skriningi
gravidograma
• diagnostika
ultrabgeriTi biometria
დოპლერომეტრია
• monitoringi
Dდoplerometria
Bbiofizikuri profili
• marTva
drouli momSobiareba optimalur
vadaze saTanado meTodiT
SOGC, 2002

.
antenataluri gamokvlevebis sixSire unda Seesabamebodes asfiqsiis
savaraudo risks an maT praqtikul aucileblobas pacientisTvis.
magaliTad, pacientisTvis, romelic aRniSnavs nayofis moZraobis
droebiT Semcirebas, erTi standartuli gamokvlevis Catareba
sakmarisia. roca davrwmundebiT, rom nayofi rigzea, sxva risk-
faqtorebi ar aris, SeiZleba Cveulebriv antenatalur movlaze
gadasvla. antenataluri gamokvlevebis sixSire unda Seesabamebodes
riskis dones. im SemTxvevebSi, roca riski jer kidev aris,
gamokvlevis gagrZeleba saWiroa kviraSi erTxel an orjer. (II-3В).
Tumca, SeiZleba aucilebeli gaxdes antenataluri gamokvlevis
Catareba yoveldre (an ufro xSirad), rom ganisazRvros
mSobiarobis vada da gestaciuri asakis maqsimaluri gazrda da
Tavidan aviciloT mniSvnelovani daavadebebi dRenaklul
axalSobilebSi. (III-C) ( magaliTad, mZime preeklamfsiis dros)
The investigation and management of the small for gestational
age fetus. Royal College of Obstetricians and Gynaecologists.
November 2002

Fetal Health Surveillance In Labour SOGC Clinical Practice

Guidelines NO. 112. 2002