Orsulobit Inducirebuli Pat Mdgomareobebi

moduli 4, hendauti studentebisaTvis

moduli 3, hendauti studentebisaTvis

gulisreva da pirRebineba adreuli orsulobis tipiuri problemaa. miuxedavad imisa, rom mas xSirad dilis gulisrevas uwodeben, gulisreva da pirRebineba SesaZlebelia dRis nebismier dros ganviTardes da gagrZeldes mTeli dRec. simptomebi tipiurad iwyeba orsulobis 4-7kviris intervalSi da orsulTa 90% uqreba orsulobis 16 kviris vadaze.

orsulTa umravlesobas mkurnaloba ar sWirdeba da orsuloba mTavrdeba raime specialuri intervenciis gareSe. SemTxvevaTa umravlesobaSi sakmarisia mxolod dieturi rekomendaciebis dacva: xSirad kveba mcire ulufebiT, mSrali da ara Txevadi, grili da ara cxeli sakvebiT, diliT uzmoze krekerebis an biskvitis miReba gaRviZebisTanave da xsv. gulisrevis simwvavis Sesamcireblad efeqturi piridoqsinis (vit.B6) gamoyeneba. sabolood dadgenili ar aris ramdenad efeqturia koWa gulisrevisa da pirRebinebis Semcirebis mizniT. P6 wertilis akupresuris efeqturobis Sesaxeb monaceebi saeWvoa, amasTanave siZneles warmoadgens specialuri manJetebis xmareba. antiemeturi preparatebi savaraudod amcirebs adreul orsulobaSi gulisrevis sixSires, Tumca arsebobs mtkicebulebebi maTi uaryofiTi gavlenis Sesaxeb nayofze. antihistaminurma preparatebma SesaZlebelia Seamciros gulisreva da pirRebineba da erTi sistematuri mimoxilvis monacemebiT antihistaminebi ar zrdian teratogenobis risks.

200-dan 1 orsuls mdgomareoba umZimdeba da uviTardeba orsulTa pirRebineba, romelsac axasiaTebs mwvave gulisreva da pirRebineba, dehidratacia, ketonuria, wonis dakleba. etiologia ucnobia, Tumca arsebobs mosazreba, rom gaZlierebuli pirRebinebis ganviTareba sisxlSi qorionaluri gonadotropinis donis matebiT aris ganpirobebuli. amis damadasturebelia is garemoeba, ro gulisreva naklebad aris damaxasiaTebeli im qalebisaTvis, romelsac SemdgomSi ganuviTardaT TviTnebiTi aborti da ufro xSiria tyupi nayofiT orsulobis an buStnamqeris dros (Medalie 1957; Weigel 1989). erTi sistematuri kvlevis mixedviT gulisrevis da pirRebinebis arseboba asocirebulia TviTnebiTi abortis sixSiris SemcirebasTan (6 kvleva, 14 564 qali; OR 0.36, 95% CI 0.32 to 0.42).

orsulTa pirRebineba nayofisaTvis sazianoa mxolod mas Semdeg, roca viTardeba dedis wonis kleba. am SemTxvevaSi matulobs nayofis saSvilosnosSida zrdis Seferxeba da nayofis antenataluri sikvdili. bavSvebze orsulTa pirRebinebis grZelvadiani gavlena ucnobia. orsulobis dros sikvdili iSviaTia, magram iseTi paTologiis gamovlena, rogoricaa vernikes encelopaTia, elenTis gaskdoma, saylapavis gaskdoma, pnevmoToraqsi da mwvave tubularuli nekrozi aRwerilia.

orsulTa 15-40% aReniSneba transaminazebis, bilirubinis, amilazis, lipazisa da sxvadasxva eleqtrolitebis donis mateba. laboratoriuli kvlevebiT SesaZlebelia gamovlindes ketozi, hiponatriemia, hipokaliemia, hipourikemia, metaboluri alkalozi da ketonuria. orsulTa 60-70% bioqimiurad dadasturebuli aqvs hiperTireozi, rac qorionaluri gonadotropinis Tireoid-mastimulirebeli hormonis receptorebze zemoqedebiT aris ganpirobebuli.

orsulTa pirRebinebis samkurnalod tipiuri gulisrevisa da pirRebinebis samarTavad mowodebuli mkurnaloba arasakmarisi da araefeqturia. mkurnaloba iwyeba damxare RonisZiebebiT-hidratacia da vitaminuri danamatebi, maT Soris vit.B1, romelic aucilebelia vernikes encepalopaTiis prevenciis mizniT. hidratacia SesaZlebelia ganxorcieldes rogorc intravenuri infuziiT, aseve peroralurad. antihistaminuri preparatebs gaaCniaT garkveuli efeqturoba da SedarebiTi usafrTxoeba nayofisaTvis. antiemeturi preparatebis gamoyenebisas gaTvaliswinebul unda iqnas maTi usafrTxoeba da efeqturobis xarisxi.

janmo gvTavazobs orsulobis dros hipertenziuli darRvevebis Semdeg CamonaTvals (daavadebebis saerTaSoriso klasifikacia- dsk-10): hipertenzia orsulobis dros SesaZlebelia iyos rogorc Tavad orsulobis, aseve adre arsebuli hipertenziis Sedegi (pirveladi, an meoradi). hipertenzia, romelic pirvelad orsulobis me-20 kviris Semdeg warmoiSva, SesaZlebelia iyos, rogorc damoukidebeli paTologia, magaliTad, gestaciuri arteriuli hipertenzia, aseve polisistemuri ukmarisobis gamomJRavneba, magaliTad, preeklamfsia. The detection, investigation and management of hypertension in pregnancy: executive summary. Recommendations from the Council of the Australasian Society for the Study of Hypertension in Pregnancy. ASSHP Consensus Statement, Executive Summary, Final edited version, 7/05/00, 1/55.

International Classification of Diseases (ICD), 10th Edition, 1990.

qronikuli hipertenzia, romelic arsebobda daorsulebamde da grZeldeba mSobiarobis Semdgom periodSi 12 kviraze meti xnis ganmavlobaSi, roca sistoluri arteriuli wneva 140 mm.vrcx,sv. da/an diastoluri 90 mm.vrcx.sv. an raime cnobili mizezis gareSe ganviTarebuli orsulobis pirvel naxevarSi. meoradi arteriuli hipertenzia: hipertenzia gamowveulia Tirkmlis, sisxlZarRvovani an endokrinuli darRvevebiT, an aortis koarqtaciiT. orsulobaTa 3% SesaZlebelia garTuldes qronikuli hipertenziiT. preeklamfsia qronikuli arteriuli hipertenziis fonze: qronikuli arteriuli hipertenziis mqone qalebSi preeklamfsiis diagnostireba xdeba im SemTxvevaSi, rodesac erTi an meti diagnostikuri kriteriumi ganviTardeba gestaciis 20 kviris Semdeg. Tirkmlebis qronikuli paTologiis mqone qalebSi xSirad rTulia preeklamfsiis diagnostireba. aseT qalebSi proteinuriis uecarma ganviTarebam da arteriuli wnevis momatebam unda migviyvanos gaZlierebul kontrolamde, magram diagnozis dasadgenad saWiroa sxva niSnebis arseboba, magaliTad, RviZlis funqciis darRveva, Trombocitopenia, nevrologiuri simptomatika.

orsulobasTan dakavSirebuli arteriuli hipertenzia-sistoluri arteriuli wneva 140 m.vrcx.sv. da diastoluri 90 mm.vrcx.sv, ganviTarebuli orsulebSi, romlebsac orsulobis 20 kviris vadamde aReniSnebodaT normotenzia. qalebs, romlebsac orsulobiT provocirebuli msubuqi an zomieri hipertenzia gaaCniaT, xSirad rekomendacias aZleven, daicvan woliTi reJimi saxlSi, an sTavazoben hospitalizacias woliTi reJimis uzrunvelsayofad da orsulobis mimdinareobaze momdevno meTvalyureobas ganusazRvreli drois ganmavlobaSi. aseTi rekomendaciebi usafrTxo ar aris. woliT reJims da hospitalizacias SeuZliaT gamoiwvion damatebiTi finansuri xarjebi orsuli qalisTvis da misi ojaxisTvis. DdRemde ar aris woliTi reJimis efeqturobis mtkicebulebebi qalebisTvis, romlebsac orsulobiT provocirebuli msubuqi hipertenzia aqvT.

Tu orsulobis dros hipertenzias Tan daerTvis proteinuria, dedisTvis da nayofisTvis riski mniSvnelovnad matulobs. aseT SemTxvevaSi aucilebelia qalisTvis hospitalizaciaze mimarTvis micema.

preeklamfsia: Cveulebriv, pirvelad arteriuli wnevis gazomviT vlindeba, magram diagnozis dasadgenad, hipertenziis garda, saWiroa agreTve sxva kriteriumebi. axla ukve cnobilia, rom preeklamfsia , es aris darRveva, romlis drosac sxva organoebi da sistemebic ziandeba, placentis CaTvliT. proteinuria preeklamfsiis yvelaze xSiri niSania, Tumca igi ar unda iyos gadamwyveti diagnozis dasmis dros.

preeklamfsiis mqone qalebis sikvdilis yvelaze xSiri mizezi Tavis tvinSi sisxlCaqceva, filtvismieri garTulebebi, agreTve, intubaciasTan da eqstubaciasTan dakavSirebuli garTulebebia. preeklamfsia gvxvdeba orsul qalTa 3-14%-Si, aqedan 75% msubuqi da 25% mwvave formis preeklamfsia. 10% SemTxvevaSi preeklamfsia viTardeba 34kviris orsulobis vadamde. mTel msoflioSi iwvevs daaxloebiT 100000 dedis sikvdils weliwadSi. nayofi agreTve ziandeba uSualod placentis ukmarisobiT, iseve rogorc xelovnurad gamowveuli mSobiarobiT. es iwvevs sxeulis dabali masis mqone bavSvebis dabadebas (120mm.vrcx.sv. iTvleba, Tavis tvinis SeSupeba, mxedvelobis dabindva, romlis mizezad Tavis tvinisa da baduris SeSupeba an baduris arteribes spazmi miiCneva. cerebralur gamovlinebebSi ZiriTad rols endoTeliumis disfunqcia asrulebs. Tirkmlismieri garTulebebidan aRsaniSnavia mwvave milakovani nekrozis ganviTareba, rac Tirkmlis sisxlismimoqcevis daqveiTebis Sedegad viTardeba. Tu Tirkmlis iSCemia gaRrmavda da gagrZelda, viTardeba Tirkmlis qerqovani nivTierebis nekrozi, xdeba gorglovani aparatis rRveva da milakovani nekrozisagan gansxvavebiT es cvlilebebi Seuqcevadia. iSCemiuri dazianebis Sedegad RviZlSi SesaZlebelia ganviTardes subkapsularuli hematoma, romelic didi zomis SemTxvevaSi SesaZlebelia gaskdes. filtvis SeSupeba waroadgens dedaTa sikvdilobis erT-erT ZiriTad mizezs, rolis ganiTareba ganpirobebulia kapilarebis kedlis ganvladobis maTebiTa da gadaWarbebuli siTxis infuziiT. preeklamfsiisaTvis damaxasiaTebelia gulis marcxenamxrivi ukmarisobis ganviTareba Sinagani organoebis perfuziis Semdgomi daqveiTebiT. hemostazis sistemisatvis damaxasiatebelia qronikuli sSdS-sindromi, ganpirobebuli endoTeliuis dazianebiT, momatebulia fibrinogenis koncentracia, 10% SemTxvevaSi gamoxatulia trombocitopenia.

mZime preeklamfsiis mqone orsulTa 56% aReniSneba nayofis saSvilosnosSida zrdis Seferxeba, rac preeklamfsiisa da nszS gamomwvevi mizezistrofoblastis invaziis defeqtiT ganpirobebuli paTologiuri placentacia, identurobiTaa ganpirobebuli. preeklamfsiis daaxloebiT 40% saWiro xdeba naadrevi moSobiareba, rac zrdis dRenaklulobis sixSires, perinataluri sikvdilobis yvelaze xSir mizezs swored dRenakluloba da placentas naadrevi acla warmoadgens.Manual of OBSTETRICS, fifth edition, edited by Kenneth r. Niswander, Boston, 1996

preeklamfsia klasificirdeba rogorc msubuqi da mZime. preeklamfsiis simwvave ganpirobebuli arteriuli hipertenziis, proteinuriis xarisxiT an preeklamfsiisaTvis damaxasiaTebeli romelime klinikuri niSnis arsebobiT. saSualo anu zomieri preeklamfiis kategoria Tanamedrove klasifikaciis mixedviT ar arsebobs. preeklamfsiisaTvis ar aris damaxasiaTebeli simptomebis gamovlena orsulobis 20 kviris vadamde, ufro xSirad simptomebi viTardeba mesame trimestris bolos da progresirebs mSobiarobamde, iSviaTad ki klinikuri niSnebis manifestacia xdeba orsulobis II trimestris bolos. msubuqi preeklamfsia saWiroebs antenataluri monitoringis gaZlierebas, magram hospitalizacia da Careva rekomendirebulia mxolod daavadebis progresirebis SemTxvevaSi. mZime preeklamfsia ki aris sicocxlisTvis saSiSi da ganixileba, rogorc gadaudebeli sameano mdgomareoba. iSviaT SemTxvevaSi mZime preeklamfsiis niSnebi da simptomebi SeiZleba viTardebodes maRali arteriuli wnevis an proteinuriis arsebobis gareSe, gansakuTrebiT, Tu qali iRebs mkurnalobas antihipertenziuli preparatebiT (daavadebis progresireba iniRbeba). Royal College of Obstetrician and Gynaecologists.THE MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ECLAMPSIA. Guideline No. 10(A), RCOG Press, March 2006.

American College of Obstetricians and Gynecologists (ACOG). Diagnosis and management of preeclampsia and eclampsia. Washington (DC): American College of Obstetricians and Gynecologists (ACOG), Jan 2002.Clinical features, diagnosis, and long-term prognosis of preeclampsia, Phyllis August, MD, MPH, Baha Sibai, MD, Up-To-Date, 2008

samwuxarod, preeklamfsiis mZime xarisxs xSirad sxvadasxva ganmartebas aZleven. SemoTavazebulia, rom mZime preeklamfsiis kriteriumad CaiTvalos orjeradi gazomvis Sedegad dafiqsirebuli diastoluri arteriuli wnevis done 110 mm.vwy.sv., an orjeradi gazomvisas sistoluri arteriuli wnevis done160 mm.vwy. sv.

dResdReobiT ar aris miRweuli SeTanxmeba zomier arteriul wnevasTan dakavSirebiT, romelic sxva niSnebis an simptomebis TanxlebiT, SesaZloa mZime preeklamfsiis diagnostikuri kriteriumi iyos. adre, sistoluri arteriuli wnevis mateba 30 mm.Hg-iT da diastoluri arteriuli wnevis mateba 15mm.Hg-iT proteinuriasTan an proteinuriis gareSe preeklamfsiad diagnostirdeboda, Tumca dabali prognostuli Rirebulebis gamo dReisaTvis arteriuli hipertenziis simZimes mxolod arteriuli wnevis absoluturi zusti maCveneblebi gansazRvravs.

Royal College of Obstetrician and Gynaecologists.THE MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ECLAMPSIA. Guideline No. 10(A), RCOG Press, March 2006

preeklamfsiis dros TirkmelebSi mimdinareobs tipiuri paTologiuri cvlileba-glomeruloendoTeliozi, romelsac Tan axlavs proteinuriis ganviTareba, Tirkmelebis mier SardmJavas gamoyofis Semcireba da oliguria. sxva mizezebiT gamowveuli arteriuli hipertoniis dros glomeruloendoTeliozi ar viTardeba. proteinuria, arteriul hipertenziasTan erTad warmoadgens aramarto preeklamfsiis diagnostikur kriteriums, aramed gansazRvravs preeklamfsiis simwvavesac. normaluri orsulobis dros gaZlierebulia Tirkmlebis gorglovani filtracia da dasaSvebad iTvleba proteinuriis done < 0,3g/l-mde. proteinuria 0.3 g 24 saaTian SardSi preeklamfsiis sadiagnostiko kriteriumia. proteinuri >5g/l-ze 24 saaTian SardSi daavadebis simwvavis kriteriums warmoadgens.

orsulTa 50-80% aReniSneba SeSupeba, magram ar aReniSnebaT preeklamfsia. aqedan gamomdinare preeklamfsiis diagnostikur kriteriumad orsulTa SeSupebis gamoyeneba xSirad hiperdiagnostikis mizezi xdeba. amitom SeSupebis arseboba preeklamfsiis diagnostikur kriteriums aRar warmoadgens. diagnostikuri kriteriumia uecari da swrafi wonis namati ( mag.>5 pounds/week) an generalizebuli SeSupeba. amgvarad, SeSupeba aRar aris preeklamfsiis diagnostikuri kriteriumi. SeSupebis momateba, rogorc damoukidebeli simptomi, ar aris is niSani, romelic gansazRvravs mkurnalobis taqtikas.

Royal College of Obstetricians and Gynaecologists.THE MANAGEMENT OF SEVERE PREECLAMPSIA/ECLAMPSIA. Guideline No.10, RCOG Press, March 2006

miuxedavaT imisa, rom klasifikacia simZimis xarisxis mixedviT dafuZnebulia arteriuli wnevis doneze da proteinuriis arsebobaze, preeklamfsiis simZimis dadgenisa da dedisa da nayofis riskebis Sefasebis dros gamoyenebul unda iqnas paTologiur procesSi sxva organoebis potenciuri CarTvis Sesafasebeli sxva diagnostikuri kriteriumebic [C].preeklamfsiisaTvis damaxasiaTebel koagulaciur darRvevas trombocitopenia warmoadgens, romelic mZime preeklamfsiis 10% SemTxvevaSi gvxvdeba, aRsaniSnavia, rom trombocitopenia preeklamfsiis klinikur manifestaciamde bevrad ufro adre gamovlindeba. protrombinis dro da fibrinogenis koncentracia ZiriTadad normis farglebSia. koagulaciuri kvleva saWiro ar aris Tu trombocitebis raodenoba > 100X106 /l. mocirkulire sisxlis moculobis Semcirebis gamo viTardeba hemokoncentracia da matulobs hematokriti. Tirkmelebi warmoadgens organos romlis endoTeliaruli funqcia yvelaze metad ziandeba. gorglovani filtraciis siCqare ecema 30-40%-iT, qveiTdeba SardmJavas eqskrecia da 5mg/%-mde matulobs misi koncentracia sisxlis SratSi, kretininis koncentracia mcired matulobs 1,0-1,5mg/% mZime preeklamfsiis dros. RviZlis qsovilebis iSemiis gamo SesaZlebelia sisxlis SratSi RviZlis fermentebis aqtivobis mateba, romelic mniSvnelovnad matulobs subkapsularuli hematomisa dros. SesaZlebelia adgili hqondes hiperurikemiasa da hipokalciurias, am cvlilebebis meqanizmi ucnobia. daavadebis progresis Sefasebis mizniT es testebi unda ganmeordes kviraSi erTxel an orjer, xolo mZime SemTxvevaSi ufro xSiradac, yoveldRiurad.

hiperdiagnostikam SesaZloa gamoiwvios gaumarTlebeli Carevebi, usargeblo mkurnaloba da hospitalizacia.

hospitalizaciis mizania ganisazRvros optimaluri dro mSobiarobisTvis, rodesac orsulobis Semdgomi gagrZeleba qalisTvis da nayofisTvis saSiSi xdeba. axla arsebobs mtkicebulebebi, rom amis miRweva ambulatoriul pirobebSi SesaZlebelia, da adrindeli midgoma adreul hospitalizaciasTan dakavSirebiT, ramdenadme agresiulia. Royal College of Obstetrician and Gynaecologists.THE MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ECLAMPSIA. Guideline No. 10(A), RCOG Press, March 2006.

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preeklamfsiis klasifikacia damyarebulia preeklamfsiis klinikuri manifestaciis ori yvelaze xSiri simptomis-arteriuli wnevisa da proteinuriis maCveneblebis sidideze, Sesabamisad arteriuli wnevisa da proteinuriis gazomvis kriteriumebi Zalian zusti unda iyos. hipertenzia preeklamfsiis yvelaze adreul da xSir simptoms warmoadgens da misi gazomvisas dacul unda iqnas garkveuli wesebi. gamoyenebul unda iqnas Sesabamisi zomis manJeti, romlis sigrZe 1,5-jer unda aRematebodes mxris garSemowerilobas, orsulis mosvenebul mdgomareobaSi (sul mcire Semosvlidan 10wuTis Semdeg), marjvena winamxarze (zogierTi eqspertis azriT im kidurze, romelzec arteriuli wnevis maCvenebeli pirveli antenataluri vizitis dros iyo ufro meti), gulis doneze, korotqovis V tonis gaqroba Seesabameba diastoluri arteriuli wnevis maCvenebels orsulTa 5% gamoxatuli aqvs e.w. TeTri xalaTis hipertenzia. ADIAGNOSIS, EVALUATION AND MANAGEMENT OF THE HYPERTENSIVE DISORDERS OF PREGNANCYJournal Of Obstetrics And Gynaecology Canada (JOGC), Volume 30, Number 3 March 2008

arteriuli wneva unda izomebodes yovel 15 wuTSi erTxel, sanam qalis mdgomareoba ar gaxdeba stabiluri, Semdeg- yovel 30 wuTSi erTxel Cveulebrivi meTvalyureobis reJimSi. Tu qali stacionarul mkurnalobazea, misi mdgomareoba stabiluria da mas ara aqvs paTologiuri simptomebi, arteriuli wneva yovel 4 saaTSi erTxel unda gaizomos.

Royal College of Obstetrician and Gynaecologists.THE MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ECLAMPSIA. Guideline No. 10(A), RCOG Press, March 2006.

proteinuriis skriningis mizniT SesaZlebelia gamoyenebul iqnas vizualuri Sefasebis meTodebi. proteinuriis arsebobis damadasturebel kriteriumad SeiZleba gamoviyenoT vizualuri Sefaseba 2+. magram, unda gvaxsovdes, rom proteinuriis arsebobis vizualur Sefasebas dabali prognozuli Rirebuleba aqvs. daaxloebiT vizualuri testis Sedegebi proteinuriis Semdeg doneebs Seesabameba: 1+ = 0.3 g/l, 2+ = 1 g/l da 3+ = 3 g/l. vizualuri Sefasebis SemTxvevaSi testis Sedegi SesaZlebelia cru-dadebiTi da cru-uaryofiTi iyos. amitom, proteinuriis diagnozis dasadastureblad SardSi cilis gansazRvris ufro zusti meTodebi unda iqnas gamoyenebuli. amis garda SesaZlebeli SardSi cilis da kreatininis Sefardebis gansazRvra, an cilis gansazRvra dReRamis SardSi. [C] axali meTodikebi, iseTi, rogoricaa SardSi cila/kreatininis Sefardebis gansazRvra, guldasmiT ar Sefasebula, magram SesaZlebelia maTi, rogorc alternatiuli meTodebis moxmareba. diagnozis sizustisa da mniSvnelovani proteinuriis gansazRvris mizniT laboratoriuli Sefaseba Cveulebriv dRe Ramis SadrSi unda moxdes, an or randomulad aRebul Sardis ulufaSi.


mZime preeklamfsiis dros mocdiTi taqtikis ganxorcieleba mxolod nayofis interesebidan gamomdinare igegmeba da amitom nayofis mdgomareobaze mudmivi meTvalyureobaunda dawesdes. [B]nayofis saSvilosnosSida zrdis Seferxebis diagnostirebis mizniT naCvenebia fetometriis ultrabgeriTi gansazRvra, Wiplaris arteriaSi sisxlis nakadis doplerografia da amnionuri siTxis moculobis gansazRvra. dinamikaSi meTvalyureoba saSualebas iZleva mSobiarobisTvis optimaluri dro ganisazRvros [A]. kardiotokografia (arastresuli testi) diagnostikis erT-erTi yvelaze metad gavrcelebuli meTodia. misi Catareba SesaZlebelia regularulad, Zvirad Rirebuli aRWurvilobis da specialuri momzadebis mqone personalis gareSe. igi iZleva informacias nayofis mdgomareobis Sesaxeb, magram amav droulad ar iZleva araviTar informacias situaciis savaraudo ganviTarebaze. Tu qals daewyo samSobiaro moqmedeba, mas unda utardebodes mudmivi ktg.


preeklamfsiisa da perinataluri sikvdilobis prevenciis mizniT antiagregantul Terapias dabali an zomieri efeqti gaaCnia. es preparatebi SesaZlebelia gamoyenebul iqnes riskis jgufis orsulebSi, mag. hipertonuli daavadeba da anti-fosfolipiduri sindromi. aspirinis mcire dozebis gamoyenebiT preeklamfsiis ganviTarebis aRali riskis orsulebSi 19% SemTxvevaSi SesaZlebeli gaxda preeklamfsiis mZime formis ganviTarebis prevencia. 51 gamokvlevis sistemur mimoxilvaSi, romelSic 36500 qalma miiRo monawileoba, avadmyofTa ricxvi, romelTac mkurnaloba esaWiroebaT NNT =69. neonataluri sikvdiloba Semcirda 16%-iT. (NNT = 227). miuxedavad imisa, rom gamokvlevebis Sedegebis mixedviT aspirinis profilaqtikurma miRebam ar aCvena maRali efeqturoba, mas mainc aqvs mcireodeni klinikuri Rirebuleba. aspirinis mcire dozebi (75-100 mg/l) orsulma unda miiRos Casaxvamde an orsulobis 16 kviris vadidan Zilis win (B) da preparatis miReba unda gagrZeldes mSobiarobamde (A). sistemur mimoxilvaSi Sedioda Tormeti gamokvleva randomizebuli kvlevebi, romelSic xdeboda dReSi sul cota 1 grami kalciumis miRebis efeqtis Sedareba placebosTan. placebosTan SedarebiT, kalciumis miRebis Sedegad, Semcirda maRali arteriuli wnevis ganviTarebis riski (11 gamokvleva, 14946 qali: SedarebiTi riski (RR) 0.70, sarwmunoebis intervali 95%, (si) 0.57-dan 0.86-mde). agreTve, kalciumis miRebis Sedegad dafiqsirda preeklamfsiis riskis Semcireba (12 gamokvleva, 15206 qali: RR 0.48, si 95%, 0.33-dan 0.69-mde). efeqti maRali riskis mqone qalebis jgufSi ufro gamoxatuli iyo (5 gamokvleva, 587 qali: RR 0.22, si 95%, 0.12-dan 0.42-mde), agreTve qalebis im jgufSi, sadac sawyis etapze kalciumis dabali moxmareba aRiniSneboda (7 gamokvleva, 10154 qali: RR 0.36, si 95%, 0.18-dan 0.70-mde). agreTve Semcirda dedaTa mokvdaoba da mZime avadoba (4 gamokvleva, 9732 qali; RR 0.80, si 0.65-dan 0.97-mde). ar dafiqsirda gavlena adreul mSobiarobaTa sixSireze (10 gamokvleva, 14751 qali: RR 0.81, si 95%, 0.64-dan 1.03-mde), agreTve mkvdradSobadobaze da sikvdilze stacionaridan gaweramde (10 gamokvleva, 15141 bavSvi;RR 0.89, si 95%, 0.73-dan 1.09-mde).avtorebis daskvniT kalciumis damatebiTi moxmareba naxevarjer amcirebs rogorc preeklamfsiis aseve masTan dakavSirebul mZime avadobisa da mokvdaobis risks.

Hofmeyr GJ, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews 2006, Issue

ar aris mtkicebulebebi imisa, rom siTxis momatebuli moxmareba, diuretikebis gamoyeneba preeklamfsiis ganviTarebis prevencias uzrunvelyofs, an amcirebs perinataluri sikvdilobis dones.

heparinis gamoyenebam SesaZloa saSiSi gverdiTi efeqtebi gamoiwvios. varfarins iyenebdnen profilaqtikuri daniSnulebiT ganmeorebiTmSobiare qalebSi ganmeorebiTi preeklamfsiis ganviTarebis prevenciis mizniT. samwuxarod, man ar iqonia dadebiTi efeqti arc dedaze da arc nayofze, amasTanave, aris mosazreba mis seriozul gverdiT efeqtebis Sesaxeb. axlaxan orsulobis dros kvebiTi rekomendaciebis sferoSi Catarebuli gamokvlevebi, iseTi, rogoricaa cilis da zogadad energetikulad Rirebuli produqtebis moxmarebis momateba, an simsuqnis mqone qalebSi cilis da energetikulad Rirebuli produqtebis moxmarebis akrZalva, racionSi rkinis, folatebis, magniumis, TuTiis an Tevzis qonis damateba, agreTve, marilis da siTxis miRebis SezRudva, aseve araefeqturi aRmoCnda. Murray W. Enkin et al. A guide to effective care in pregnancy and childbirth. Oxford University Press, 3rd edition, 2000.

Villar J et al. Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: an overview of randomised controlled trials. J Nutr, 2003, 133, 1S20S.

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mZime preeklamfsiis SemTxvevaSi orsulobis marTvis taqtika efuZneba saguldagulo meTvalyureobas, mdgomareobis stabilizacias, mudmiv kontrols da mSobiarobisTvis dedisTvis da nayofisTvis yvelaze xelsayreli drois amorCevas.amisTvis saWiroa maRalkvalificirebuli sameano personalis da anesTeziologis arseboba. orsulobis < 34 kviris SemTxvevaSi mocdiTi taqtika SesaZlebelia ganxorcieldes mxolod III donis stacionarSi (I-C), orsulobis 34-36 kviris SemTxvevaSi msubuqi preeklamfsiis SemTxvevaSi SesaZlebelia rekomendirebul iqnas mocdiTi taqtika, xolo orsulobis > 37kviris vadaze, miuxedavad preeklamfsiis simZimisa rekomendirebul unda iqnas dauyovneblivi mSobiaroba (B).arteriuli wnevis mudmivi kontroliT SesaZlebelia mZime preeklamfsiiT gamowveuli garTulebebis simZimis Semcireba. mZime preeklamfsiis dros orsulobis prolongirebas SeuZlia gamoiwvios dedis mdgomareobis damZimeba da mSobiarobis Semdgomi garTulebebis sixSiris gazrda. msubuqi preeklamfsiis marTva unda ganxorcieldes msubuqad, ar aris mizanSewonili antihipertenziuli preparatebis daniSvna xangrZlivad, im SemTxvevaSi Tu diastoluri arteriuli wnevis maCvenebeli

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