nayofis araswori
mdebareobebi
moduli N8-1
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis araswor mdebareobebs
miekuTvneba:
• nayofis menjiT winamdebareoba
• nayofis Tavis gaSliTi
winmdebareobebi
• nayofis gardigardmo da iribi
mdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
etiologiuri faqtorebi
dedismxrivi:
• mravali mSobiaroba
• menjis ganviTarebis anomaliebi
• saSvilosnos ganviTarebis mankebi
• saSvilosnos simsivneebi (mioma)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
etiologiuri faqtorebi
nayofismxrivi:
• mravalnayofiani orsuloba
• nayofis ganviTarebis mankebi
• nayofis miotonuri distrofia
• mcirewylianoba
• mravalwylianoba
• makrosomia
• placentis winmdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
menjiT winamdebareoba
• nayofis menjiT winamdebareobisas
saSvilosnos RruSi nayofis
mdebareoba sigrZiTia.
• nayofis menji mimarTulia saSvilosnos
qvemo segmentisaken, nayofis Tavi
mdebareobs saSvlosnos fuZeSi.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
menjiT winamdebareoba
nayofis menjiT winamdebareobis sixSire
orsulobis vadis matebasTan erTad
mcirdeba:
• orsulobis 30 kv. vadaze misi sixSire 15%-ia
• orsulobis 35 kv. vadaze misi sixSire 6%-ia
• mSobiarobis vadisTvis es maCvenebeli 3%-
mde mcirdeba.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
menjiT winamdebareoba
menjiT winamdebareobisas gvxvdeba
Semdegi ZiriTadi garTulebebi:
• nayofis distresi.
• nayofis travmatizmi.
• saSvilosnos yelis spazmi.
• nayofis wvrili nawilebis gamovardna.
• nayofis dabadebis gaZneleba Tavis gaSlisa
da xelebis ukan gadavardnis gamo.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
menjiT winamdebareobis saxeebi
nayofis dundulebisa da qvemo kidurebis
urTierTmdebareoba gansazRvravs
menjiTwinamdebareobis saxeebs.
menjiT winamdebareobis saxeebia:
• nayofis sufTa jdomiT winamdebareoba
• nayofis sruli (Sereuli) jdomiT
winamdebareoba
• nayofis arasruli jdomiT winamdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis sufTa jdomiT
winamdebareoba
• nayofis sufTa jdomiT
winamdebareobis dros fexebi moxrilia
menj-barZayis saxsarSi, gaSlilia
muxlis saxsarSi da mdebareobs
sxeulis gaswvriv
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis sufTa jdomiT
winamdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis sruli (Sereuli) jdomiT
winamdebareoba
• nayofis Sereuli (sruli) jdomiT
winmdebareobis dros fexebi moxrilia
menj-barZayis saxsarSi da muxlis
saxsarSi
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis sruli (Sereuli) jdomiT
winamdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis arasruli jdomiT
winamdebareoba
• nayofis arasruli menjiT winmdebareobis
dros erTi an orive fexi gaSlilia da
mdebareobs dundulebs qvemoT.
• arasruli menjiTwinamdebareobisas SeiZleba
winamdebareobdes erTi fexi (single footling) an
orive fexi (double footling)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis arasruli jdomiT
winamdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
• menjiTwinmdebareobis diagnozi
ismeba muclismxrivi palpaciiT,
vaginaluri gasinjviT da dasturdeba
ultrabgeriTi gamoklvleviT
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
muclismxrivi palpacia anu garegani gasinjvis
meTodika leopoldis 4 wesiT:
• leopoldis I wesiT ganisazRvreba saSvilosnos
fuZeSi mdebare mrgvali da mkvrivi, advilad
balotirebadi nayofis Tavi.
• leopoldis II wesiT ganisazRvreba nayofis
pozicia, zurgisa da wvrili nawilebis
adgilmdebareobis mixedviT.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
• leopoldis III wesiT ganisazaRvreba nayofis
winamdebare nawili da misi
damokidebuleba mcire menjis SesavalTan:
nayofis menji moZravia mcire menjis
SesavalSi.
• leopoldis IV wesiT ganisazRvreba
winamdebare nawilis adgilmdebareoba.
nayofis winmdebare menji gardigardmo
zomiT (linea intertrochanterica) Casulia mcire
menjis SesavalSi
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
• menjiTwinamdebareobis dros
nayofis guliscema moismineba
Wips zemoT
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
• nayofis sufTa jdomiT
winamdebareobis dros saSosmxrivi
gasinjviT isinjeba sajdomi borcvebi,
gavis Zvali, dundulebi.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
• nayofis Sereuli (sruli) jdomiT
winamdebareobis dros saSosmxriv nayofis
dundulebTan erTad isinjeba nayofis terfebi.
• nayofis arasruli jdomiT winamdebareobis
dros saSosmxriv isinjeba nayofis dundulebs
qvemoT mdebare erTi an orive terfi.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
diagnozi
• ultrabgeriTi gamokvleva sabolood
adasturebs diagnozs.
• mSobiarobis konservatiuli marTvisas
ultrabgeriT gamokvleviT dgindeba
menjiTwinamdebareobis saxe da Tavis
moxris an gaSlis xarisxi.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
prognozi
• dedis sikvdiloba
• perinataluri avadoba da sikvdiloba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobamdeli meTvalyureoba
• ar arsebobs mtkicebiTi medicinis
monacemebi (evidence A) romelic
daadasturebda mSobiarobis meTodis
upiratesobas menjiTwinamdebareobis dros.
• bunebrivi gziT mSobiarobisas perinataluri
avadobisa da sikvdilobis procenti metia
sakeisro kveTasTan SedarebiT.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobamdeli meTvalyureoba
menjiTwinamdebareobis SemTxvevaSi
aucilebelia mSobiarobis dasruleba sakeisro
kveTis operaciiT, Tu diagnostirebulia:
• didi nayofi
• gadatanili sakeisro kveTa
• 34 kviraze naklebi orsulobis vada
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobamdeli meTvalyureoba
• Tu menjiT winamdebareoba dasturdeba
orsulobis 36 kviris vadaze, mizanSewonilia
nawarmoebi iqnes nayofis garegani
mobruneba Tavze saTanado pirobebis
arsebobis SemTxvevaSi.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
• mSobiarobis daswyisSi dundulebi
gardigardmo zomiT (linea
intertrochanterica) dgeba menjis Seasvlis
erT-erT irib zomaSi (A)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
I momenti: dundulebis Sinagani brunva.
nayofis dundulebi mcire menjis Rrus farTo
nawilidan viwro nawilSi gadadis, dundulebis
gardigardmo zoma gamosavlis pirdapir
zomaSi dgeba. wina dundula simfizis rkals
qvemoTaa, ukana ki – kudusuns zemoT. (B)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi - I momenti
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
• II momenti: nayofis xerxemlis gverdiTi
moxra. winsvliTi moZraobis Sedegad wina
dundula gamoCndeba simfizis qveS. am dros
nayofis mxrebi gardigardmo zomiT dgeba
Sesavlis erT-erT irib zomaSi. (C,D)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi II momenti
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi II momenti
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
• III momenti: mxrebis Sinagani brunva. es
brunva dasruldeba gamosavlis pirdapir
zomaSi mxrebis CadgmiT. zurgi mobrundeba
gverdze, wina mxari simfizis rkals qvemoT
Tavsdeba, ukana ki Cadgeba Sorisis zemoT.
(E)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi III momenti
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
• IV momenti: xerxemlis moxra kisris malebis
midamoSi. am momentSi samSobiaro
arxidan xdeba mxris sartylisa da xelebis
dabadeba.
• V momenti: Tavis Sinagani brunva. Tavi
Cadgeba menjis Sesavlis irib zomaSi. menjis
sibrtyeebis gavlisas Tavi awarmoebs
Sinagan brunvas, ris Semdegac sagitaluri
nakeri aRmoCndeba gamosavlis pirdapir
zomaSi. kefqveSa foso boqvenis sifizis
qveSaa.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi IV momenti
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
mSobiarobis biomeqanizmi
• VI momenti: Tavis moxra, romlis Sedegad
xdeba Tavis gamoWra. Sorisis zemoT
TanmimdevrobiT gamoCndeba nikapi, cxviri,
Subli da Txemi.
• Tavi ibadeba mcire iribi zomiT.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
• nayofis garegani mobrunebis proceduris
Sedegad nayofis menjiT winamdebareoba
gadadis TaviT winamdebareobaSi.
• nayofis garegani mobruneba Tavze tardeba
orsulobis 36-37kviris vadaze saTanado
pirobebis arsebobis SemTxvevaSi.
• procedura tardeba stacionarSi gamocdili
meanis mier ubg-is kontroliT
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
• procedura tardeba stacionarSi gamocdili
meanis mier ubg-is kontroliT.
• nayofis garegani mobruneba Tavze
daaxloebiT SemTxvevaTa 2/3-Si xerxdeba.
• nayofis garegani mobruneba martivi da
usafrTxo operaciaa.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
ukuCvenebebi:
• winamdebare nawilis Cadgma (fiqsacia)
menjis SesavalSi
• mcirewylianoba
• mravalwylianoba
• placentis winamdebareoba
• saSvilosnos ganviTarebis anomaliebi
• mravalnayofiani orsuloba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
ukuCvenebebi:
• Wiplaris Semoxveva
• sakeisro kveTa an moimeqtomia anamnezSi
• sanayofo siTxis mSobiarobamdeli daRvra
• nayofis ganviTarebis mankebi
• saSvilosnosSida zrdis Seferxebis sindromi
• nayofis distresi
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
operaciis dawyebamde aucilebelia:
• orsulis informirebuli Tanxmoba
• ultrabgeriTi kvleva winamdebareobis
dasadasturebalad da nayofisa da
saSvilosnos mankebis gamosaricxad
• tokolizuri saSualebebis daniSvna
• anesTezia orsulis moTxovniT
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
teqnika:
• meani orive xeli Tavsdeba muclis wina
kedelze. nayofis menjs mcire menjis
Sesavlidan zemoT, saSvilosnos fuZisaken
sweven. nayofis Tavs awvebian qvemoT
menjis Sesavlisken.
• garegani mobrunebis Semdeg nayofis Tavi
Tavsdeba menjis Sesavlis zemoT.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
• nayofis mdgomareoba fasdeba
doplerometriiT da ultrabgeriTi skanirebiT.
• orsulis diskomfortisa da nayofis distresis
SemTxvevaSi procedura wydeba.
• warumatebeli mobrunebis an misi
gaZnelebis SemTxvevaSi Semdegi mcdeloba
ukunaCvenebia.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
• warmatebuli operaciis pirobebSi nayofis
guliscemis monitoringi xorcieldeba erTi
saaTis ganmavlobaSi.
• RH(-) orsulebSi iniSneba anti-D-IgG-is
ineqcia.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis garegani mobruneba
Tavze
• warmatebuli operaciis Semdeg, Tu orsulis
mdgomareoba stabiluria, is elodeba
spontanuri mSobiarobis dawyebas.
• warumatebeli operaciis Semdgom orsuls
eZleva informacia da rekomendacia, romelic
mas Tavisufali arCevanis gakeTebis
saSualebas aZlevs. (fiziologiuri mSobiaroba
vs sakeisro kveTa).
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
pirisaxiT winamdebareoba
• pirisaxiT winamdebareoba nayofis sigrZiTi
winamdebareobaa.
• pirisaxiT winamdebareoba yalibdeba Tavis
maqsimaluri gaSlis Sedegad.
• pirisaxiT winamdebareoba gvxvdeba
daaxloebiT 500-dan erT mSobiareSi.
• pirisaxiT winamdebareobisas saSosmxriv
isinjeba nayofis piri, cxviri da Tvalebi.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
pirisaxiT
winamdebareoba
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
pirisaxiT winamdebareoba
• pirisaxiT winamdebareobis dros mcire
menjSi Tavi vertikaluri zomiT (9,5 sm)
dgeba.
• pirisaxiT winamdebareobisas Tavis Cadgma
xdeba gvian da mSobiaroba xangrZlivdeba.
• pirisaxiT winamdebareobisas uxSiresad
nikapi boqvenisaken aris miqceuli (wina
saxe), Tavi ibadeba moxris xarjze da
mSobiaroba spontanurad mTavrdeba.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
pirisaxiT winamdebareoba
• pirisaxiT winamdebareobisas iSviaTad
nikapi gavis Zvlisaken aris mimarTuli (ukana
saxe).
• aseT SemTxvevaSi spontanuri mSobiaroba
SeuZlebelia.
• pirisaxiT winamdebareobis ukana saxis
SemTxvevaSi mSobiaroba sruldeba sakeisro
kveTis operaciiT.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
SubliT winamdebareoba
• SubliT winamdebareobisas nayofis Tavi
gaSlilia ufro naklebi xarisxiT, vidre pirisaxiT
winamdebareobisas.
• is araswori winamdebareobis yvelaze iSviaTi
saxeobaa, romelic gvxvdeba 1500-dan erT
mSobiareze.
• saSosmxriv isinjeba didi yiflibandi,
warbzeda rkalebi da cxviri.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
SubliT winamdebareoba
A Tavi menjis SesavalSi dgeba udidesi zomiT-
didi iribi zomiT (13,5 sm)
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
SubliT winamdebareoba
• SubliT winamdebareobisas mSobiarobis
dasruleba bunebrivi samSobiaro gzebiT
praqtikulad SeuZlebelia.
• Tu mSobiarobis dawyebisas SenarCunda
SubliT winamdebareoba aucilebelia sakeisro
kveTis warmoeba.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis gardigardmo da iribi mdebareoba
• nayofis gardigardmo da iribi mdebareobisas
garegani sameano gasinjviT muceli
asimetriulia
• saSvilosnos fuZis simaRle mosalodnelze
dablaa
• nayofis Tavi da dundulebi palpaciiT SeiZleba
isinjebodes TeZos fosoSi
• mcire menjis Sesavali winamdebare nawilis
ararsebobis gamo “carielia”
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
nayofis gardigardmo da iribi
mdebareoba
• nayofis gardigardmo da iribi
mdebareobisas mSobiaroba sruldeba
sakeisro kveTis operaciiT
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
