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ZuZuTi kvebis marTva
samSobiaro saxlSi adreul
neonatalur periodSi
bavSvisadmi keTilganwyobili saavadmyofos iniciativa
klinikuri praqtikis erovnuli rekomendacia
(gaidlaini)
2
klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
`ZuZuTi kvebis marTva samSobiaro saxlSi adreul neonatalur
periodSi~ miRebulia klinikuri praqtikis erovnuli
rekomendaciebis (gaidlainebi) da daavadebaTa marTvis
saxelmwifo standartebis (protokolebi) SemuSavebis,
Sefasebis da danergvis erovnuli sabWos 2008 wlis 5 noembris
#1 sxdomaze da damtkicebulia saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis ministris 2009 wlis 14
aprilis # 152/o brZanebiT.
3
ZuZuTi kvebis marTva samSobiaro saxlSi adreul neonatalur periodSi
1. definicia
bavSvisadmi keTilganwyobili saavadmyofos inicitiva (baksi) asaxavs
samSobiaro saxlebSi warmatebuli ZuZuTi kvebis 10 safexuris
(globaluri kriteriumebis) danergvis meTodologias.
baksi ZuZuTi kvebis marTvis fundamenturi instrumentia, romelic
orsulebis, dedebis da samedicino personalis saTanado ganaTlebis
gziT, xels uwyobs ZuZTi kvebis adreuli dawyebis, xangrZlivobisa d
sixSiris gazrdas (WHO/UNICEF).
baksis idea fokusirebulia dedisa da axalSobilis bunebriv
moTxovnilebebze da gamiznulia samSobiaro dawesebulebebSi jandacvis
msoflio organizaciis da gaeros bavSvTa fondis mier mowodebuli
warmatebuli ZuZuTi kvebis 10 safexuris danergvisaTvis/!
!
ZuZuTi kvebis 10 safexuri:
1. samSobiaro saxls unda qondes ZuZuTi kvebis politika
werilobiTi saxiT, romelsac rutinulad gaecnoba samedicino
personalis sruli Semadgenloba;
2. samedicino personals gavlili unda qondes ZuZuTi kvebis
saswavlo seminari, rac aucilebelia politikis danergvisaTvis;
3. yvela orsuli unda iyos informirebuli ZuZuTi kvebis
sargeblianobisa da misi marTvis principebis Sesaxeb;
4. yvela dedas unda gauwion daxmareba ZuZuTi kvebis dawyebaSi
mSobiarobidan 1-2 saaTis ganmavlobaSi;
5. dedas unda aswavlon da aCvenon, rogor kvebos bavSvi ZuZuTi
da rogor SeinarCunos laqtacia im SemTxvevaSic ki, roca deda
da bavSvi dacilebulia erTmaneTisgan;
6. bavSvs ar unda miscen araviTari sxva sakvebi an siTxe garda
qalis rZisa, samedicino CvenebiT daniSnuli medikamentebis
gamoklebiT;
7. samSobiaro saxlSi aucilebelia deda-bavSvis erTad yofnis
praqtikis danergva – dedas da bavSvs mieces SesaZlebloba
iyvnen erTad 24 saaTis ganmavlobaSi;
8. moTxovnilebiT ZuZuTi kvebis xelSewyoba;
9. ar mieces ZuZuTi kvebaze myof bavSvs sawovara an satyuara;
10. ZuZuTi kvebis mxardamWeri jgufebis Camoyalibebis xelSewyoba
da samSobiarodan gaweris Semdeg dedebis maTTan gagzavna
(janmrTelobis dacvis sistemaSi aseT jgufad moiazreba
pirveladi jandacvis rgoli, aseve arasamTavrobo seqtori,
romelic muSaobs ZuZuTi kvebis xelSewyobisa da danergvis
principebze).
gaidlaini gankuTvnilia
4
samSobiaro dawesebulebis samedicino personalisTvis (neonatologi,
mean-ginekologi, medda, bebia-qali).
samizne jgufi:
adreuli neonataluri periodis axalSobilebi, meZuZuri dedebi da
orsuli qalebi.
gamoyenebuli terminologia:
1. ZuZuTi kveba _ kvebis wesi, rodesac bavSvi ikvebeba dedis rZiT da
iRebs nebismier sxva saxis sakvebs, maT Soris qalis rZis
Semcvlelebs;
2. eqskluziuri ZuZuTi kveba anu mxolod ZuZuTi kveba - Cvilis kveba
qalis (deda /donori) rZiT, xseniT, gamowvelili rZiT 6 Tvemde,
sxva sakvebisa da siTxeebis (maT Soris wylis) Sematebis gareSe
(gamonakliss warmoadgens medikamentebi, ORS, vitaminebi,
mineraluri danamatebi);
3. predominantuli ZuZuTi kveba anu upiratesad ZuZuTi kveba. _ dedis
(donoris) rZesTan erTad mcire raodenobis siTxeebis miReba
(wyali, Cai, wveni);
4. komplementuri kveba - qalis rZesTan erTad naxevradmyari an myari
damatebiTi sakvebis miReba;
5. prelaqtaciuri sakvebi – qalis rZis Semcvleli an nebismieri
siTxe, romelic gamoiyeneba ZuZuTi kvebis dawyebamde;
6. kani kanTan kontaqti – mSobiarobis Semdeg janmrTeli SiSveli
axalSobilis moTavseba dedis sxeulze;
7. qalis rZis Semcvleli _ bavSvTa kvebis produqti, romelic
gamoyeneba 6 Tvemde asakis bavSvis sakvebad;
8. sakvebi formula _ qarxnuli wesiT damzadebuli qalis rZis
Semcvleli.
gamoyenebuli Semoklebebi:
• ILKA _ laqtaciis konsultantTa saerTaSoriso asociacia
• IBFAN _ bavSvTa kvebis saerTaSoriso qseli
• WABA _ ZuZuTi kvebis msoflio aliansi • Baby Milk Action _ ZuZuTi kvebis qseli
• WHO _ janmrTelobis msoflio organizacia
• UNICEF – gaeros bavSvTa fondi
2. epidemiologia
bavSvTa kvebis, janmrTelobisa da ganviTarebis sferoSi Catarebuli
mravalricxovani kvlevebis Tanaxmad, ZuZuTi kveba yvelaze efeqturi
5
gzaa, romelic uzrunvelyofs bavSvs srulyofili sakvebiT, sicocxlisa
da ganviTarebisaTvis saWiro aucilebeli faqtorebiT, icavs mas
alergiis, infeqciisa da sxva daavadebebisagan.
yovelwliurad msoflioSi milionobiT bavSvi kvdeba, maT Soris 13
milioni sicocxlis pirvel Tves da didi umetesoba adreul neonatalur
periodSi. axalSobilTa sikvdilis mizezebi umrvales SemTxvevaSi
pirdapir kavSirSia ZuZuTi kvebis araswor praqtikasTan da perinataluri
periodis araadeqvatur marTvasTan.
0-dan 5 wlamde asakis bavSvebs, romlebic ar ikvebebian ZuZuTi,
aReniSnebaT diareisa da pnevmoniis letalobis 7-jer ufro maRali
riski, ZuZuTi kvebaze myof bavSvebTan SedarebiT. eskluziur ZuZuTi
kvebaze myof CvilebSi, diareis da pnevmoniis letalobis riski 2-jer
mcirea, vidre CvilebSi, romlebic eqskluziur ZuZuTi kvebaze ar
imyofebian. 1,2 1990 wels 32 qveynis mTavrobam da gaeros 10 saagentom SeimuSava da xeli
moawera saerTo deklaracias (e.w. “inosentis deklaracia”), romlic
gamoxatavs ZuZuTi kvebis principebisadmi erTsulovan mxardaWeras.
deklaracia adasturebs samSobiaro dawesebulebebSi warmatebuli ZuZuTi
kvebis 10 safexuris danergvis aucileblobas. msoflio jandacvis
organizaciis da gaeros bavSvTa fondis ganacxadi saxelwodebiT -
“ZuZuTi kvebis dacva, xelSewyoba da mxardaWera’’ - adasturebs
samSobiaro dawesebulebebis gansakuTrebuli rols da xazs usvams
baksis principebis danergvis auculeblobas samSobiaro saxlebSi.
ZuZuTi kvebis mxardaWeris pirveli etapi qalTa konsultaciebsa da
samSobiaro saxlebSi iwyeba. medicinis muSakTa damokidebulebas da maT
rekomendaciebs gadamwyveti mnivSneloba aqvs dedis motivaciisTvis
ZuZuTi kvebasTan dakavSirebiT. arsebobs monacemebi, rom eqskluziur
ZuZuTi kvebas warmatebiT axorcieleben is dedebi, romlebmac imSobiares
iseT samSobiaro saxlebSi sadac samedicino personals gavlili qonda
ZuZuTi kvebis saswavlo seminari.12 klasteruli kvlevebiT gamovlinda,
rom baksisi titulis mflobel samSobiaro saxlebSi dabadebuli
bavSvebis umetesoba 12 Tvis asakSi agrZelebs ZuZuTi kvebas. baksis
danergvis gamocdilebam aCvena, rom ZuZuTi kvebis sixSirisa da
xangrZlivobis matebasTan erTad mcirdeba Cvil bavSvTa avadobis
SemTxvevaTa sixSire. baksi bavSvTa keTildReobis ufro xarjTefeqtur
intervencias warmoadges, vidre imunizacia da oraluri rehidratacia.
13,14,15,16. dRes msoflioSi 2000-mde samSobiaro saxli flobs baksis
tituls. 1997 wels saqarTelo SeurTda baksis moZraobas. 1999 wels
miRebul iqna kanoni - ,,ZuZuTi kvebis xelSewyobis da xelovnuri sakvebis
kontrolirebadi moxmarebis” Sesaxeb, 2006 wlamde saqarTveloSi 18-ma
samSobiaro saxlma SesZlo warmatebuli ZuZuTi kvebis 10 safexuris
danergva da baksis titulis mopoveba. 2005 wlis statistikuri
monacemebis mixedviT mSobiarobidan erT saaTSi ZuZuTi kveba iwyba -
64,1%-Si, 1-8 saaTSi – 23%-Si, 3 Tvemde asakis bavSvTaA52,11% ikvebeba
ZuZuTi. samSobiarodan gamowerili axalSobilebis 90% imyofeba ZuZuTi
kvebaze.
samSobiaro dawesebulebis gardaqmna bavSvisadmi keTilganwyobil
saavadmyofod warmoadgens process, romelic iwyeba dawesebulebaSi
6
arsebuli ZuZuTi kvebis praqtikis analiziT, ZuZuTi kvebis danergvis
xelSemSleli faqtorebis gamovleniT, Sesabamisi cvlilebebis
ganxorcielebiT da mTavrdeba dawesebulebis gare SefasebiT, romelsac
axorcieleben baksis gare eqspertebi. Sefaseba tardeba specialuri
kiTxvariT, baksis globaluri kriteriumebis moTxovnebis Sesabamisad.
dadebiTi Sefasebis SemTxvevaSi samSobiaro saxli iRebs tituls
,,bavSvisadmi keTilganwyobili saavadmyofos iniciativa’’.Ggadawyvetilebis
miReba titulis miniWebis Taobaze xdeba nacionaluri ZuZuTi kvebis
komitetis an Sesabamisi pasuxismgebeli sabWos/uwyebis mier.
3. globaluri kriteriumebi
safexuri 1
dawesebulebas unda qondes ZuZuTi kvebis politika werilobiTi formiT,
romelsac rutinulad gaecnoba samedicino personalis sruli
Semadgenloba.
samSobiaro dawesebulebaSi arsebuli ZuZuTi kvebis praqtikis
gaumjobeseba SeiZleba miRweul iqnas saTanado politikis arsebobis
SemTxvevaSi.
samSobiaro saxlis personalma Tavad unda SeimuSaos dawesebulebaSi
ZuZuTi kvebis danergvis politikis werilobiTi dokumenti, romelic
unda moicavdes warmatebuli ZuZuTi kvebis marTvis principebs. politika
xelmisawvdomi unda iyos dawesebulebis mTeli personalisTvis (WHO / UNICEF ). 1,2,3 I safexuris ZiriTadi moTxovnebi:
• samSobiaro dawesebulebaSi ZuZuTi kvebis arsebuli praqtikis
gaumjobesebis misaRwevad saWiroa dawesebulebas gaaCndes Sesabamisi
politika;
• politikaSi asaxuli sakiTxebi ZuZuTi kvebis Sesaxeb SeTanxmebuli
unda iyos janmrTelobis dacvis saministros da samSobiaro
dawesebulebis avtoritetul pirebTan.
saavadmyofos xelmZRvaneloba (administracia, ufrosi samedicino
personali) ganuxrelad unda axorcielebdes aRniSnul politikas da
mxars uWerdes mas. saavadmyofos personalsa da xelmZRvanelobas Soris
urTierTTanamSromlobis xarvezebi SeiZleba aRmoCndes erT-erTi
winaRoba ZuZuTi kvebis 10 safexuris danergvisaTvis.
dawesebulebaSi ZuZuTi kvebis politikis da swori praqtikis arseboba
mniSvnelovan gavlenas axdens efeqturi ZuZuTi kvebis ganxorcielebaze. 4 dawesebulebaSi saWiro praqtikuli cvlilebebis warmatebiT
gasaxorcieleblad, garda saTanado politikisa, aucilebelia samedicino
personalis mier am politikis aRiarebisa da gaTavisebis uzrunvelyofa. 5
7
ZuZuTi kvebis politika unda moicavdes warmatebuli ZuZuTi kvebis 10
safexurs. politikaSi, Tundac erT-erTi safexuris ignorirebam SeiZleba
uaryofiTi gavlena iqonios sxva safexurebis danergvaze. 4 mniSvnelovania, dawesebulebaSi politikis farTod ganxilva da
personalis Sesabamisi momzadeba, praqtikuli cvlilebebis gatarebis
aucileblobis dasabuTebiT. 5
politikis arseboba aucilebelia imisTvis, rom: 1,2,3
• uzrunvelyofil iqnas Tanxmoba dawesebulebis administraciasa da
personals Soris ZuZuTi kvebis mxardamWeri praqtikis danergvisa
da gaumjobesebis sakiTxSi;
• farTod iyos gacnobili ZuZuTi kvebis principebi samedicino
personalisaTvis;
• ganisazRvros saWiro rekomendaciebi dawesebulebaSi ZuZuTi kvebis
praqtikis danergvis donis da Taviseburebebis Sesabamisad.
politika unda moicavdes Semdeg sakiTxebs:
• zogadi nawili, miznebi da amocanebi;
• arsebuli nacionaluri da saerTaSoriso politika, romelic
safuZvlad daedo samSobiaros politikas;
• ZuZuTi kvebis sixSiris Sesaxeb monacemebi nacionalur da
lokalur (samSobiaros) doneze;
• warmatebuli ZuZuTi kvebis 10 safexuri, rogorc minimaluri
rekomendaciebi;
• praqtikuli sakiTxebi da rekomendaciebi, romlebSic
gaTvaliswinebuli iqneba samSobiaroSi arsebuli situacia
TiToeuli safexuris moTxovnebis Sesabamisad.
!
imisaTvis, rom samSobiaro dawesebuleba gardaiqmnas @,,bavSvisadmi
keTilganwyobil saavadmyofod’’, masSi arsebuli praqtika unda
Seesatyvisebodes qalis rZis SemcvlelTa marketingis saerTaSoriso
kodeqsisa 32,56 da saqarTvelos kanonis `bavSvTa bunebrivi kvebis dacvisa
da xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb~ moTxovnebs.
kerZod, xelovnuri sakvebi ar unda miscen bavSvs samedicino Cvenebebis
gareSe; akrZalulia sawovrebis, satyuarebis gamoyeneba, xelovnuri kvebis
mxardamWeri informaciis gavrceleba, xelovnuri sakvebis nimuSebis
gadacema dedebisaTvis, ufaso an fasdaklebiT xelovnuri sakvebis,
sawovriani boTlebisa da satyuarebis momaragebis miReba xelovnuri
kvebis mwarmoebeli kompaniebisgan. dawesebulebis politika unda
moicavdes aRniSnul sakiTxebs, sxvagvarad SeiZleba sruliad uSedego
aRmoCndes ZuZuTi kvebis mxardamWeri RonisZiebebis gatarebis procesi.
politikis SemuSavebis koordinacia SeiZleba daevalos konkretul
pirovnebas an mcirericxovani Semadgenlobis komitets, romelsac niSnavs
dawesebulebis xelmZRvaneloba. politikis proeqti SeiZleba SemuSavdes
8
erTi TanamSromlis an winaswar SerCeul TanamSromelTa mcirericxovani
jgufis mier. Semdeg unda moxdes proeqtis gavrceleba TanamSromelebs
Soris sanam yvela ar gaecnoba mas da ar moxdeba sruli SeTanxmeba.
ufrosma samedicino personalma da administraciam unda uzrunvelyos
politikis danergva mudmivi monitorirebisa da saWiroebis SemTxvevaSi,
saTanado administraciuli RonisZiebebis gatarebis gziT.
rekomendaciebi: 1,2,3,4,5
• samSobiaro dawesebulebas unda qondes SemuSavebuli ZuZuTi
kvebis politika (mtkicebulebis done II);
• politika unda arsebobdes werilobiTi saxiT da mas unda
icnobdes dawesebulebis samedicino personali (mtkicebulebis
done II);
• politika unda moicavdes warmatebuli ZuZuTi kvebis 10 safexurs
da maTi danergvisTvis saWiro rekomendaciebs. (mtkicebulebis
done II);
• politikaSi gaTvaliswinebuli unda iyos qalis rZis SemcvlelTa
saeraSoriso kodeqsis da saqarTvelos kanonis `bunebrivi kvebis dacvis
da xelovnuri sakvebis kontrolirebadi moxmarebis~ moTxovnebi.
safexuri II
samedicino personals gavlili unda qondes ZuZuTi kvebis saswavlo
seminari, rac aucilebelia politikis danergvisaTvis.
ZuZuTi kvebis politikis danergvisTvis aucilebelia samedicino
personalis saTanado momzadeba/swavleba, radgan samedicino
personalis damokidebuleba da codnis done ZuZuTi kvebis
sakiTxebze mniSvnelovan gavlenas axdens ZuZuTi kvebis
xangZlivobaze (mtkicebulebis done II). 6 saganmanaTleblo procesis efeqturobisTvis igi unda iyos savaldebulo
yvela TanamSromlisTvis da masze valdebuleba unda aiRos
dawesebulebis xelmZRvanelobam. 7,8,9
samedicino personalis mier dedebisaTvis araTanmimdevruli
informaciis miwodeba xSirad iwvevs dedis dabneulobas da
SeiZleba ZuZuTi kvebis adreuli Sewyvetis mizezi aRmoCndes.
(mtikicebulebis done II). 10
samSobiaro saxlis yvela TanamSromels unda qondes miRebuli Sesabamisi
instruqcia dawesebulebaSi arsebuli politikis Sesaxeb. personalis
momzadeba ZuZuTi kvebis sakiTxebze unda ganxorcieldes minimum 18
saaTiani saswavlo programiT, romelic unda moicavdes 3 saaTian
klinikur swavlebas (WHO / UNICF 1992). Tumca ufro xangrZlivi swavleba
ufro efeqtria myari Sedegebis miRwevis TavlsazrisiT. 11 miuxedavad imisa, rom ZuZuTi kvebis Sesaxeb swavlebis mniSvneloba
farTod aRiarebuli faqtia, mxolod bolo periodSi daiwyo misi
II
II
II
II
II
9
efeqturobis gamokvleva. arsebobs monacemebi, rom eqskluziur ZuZuTi
kvebas warmatebiT axorcieleben is dedebi, romlebmac imSobiares iseT
samSobiaro saxlebSi sadac samedicino personals gavlili qonda ZuZuTi
kvebis saswavlo seminari.12 klasteruli kvlevebiT gamovlinda, rom
baksisi titulis mflobel samSobiaro saxlebSi dabadebuli bavSvebis
umetesoba 12 Tvis asakSi agrZelebs ZuZuTi kvebas, maRalia eqskluziuri
ZuZuTi kvebis sixSire da dabalia kuWnawlavis infeqciebis sixSire 13,14,15,16. dadgenilia, rom samedicino personalis swavleba aumjobesebs
maT damokidebulebas ZuZuTi kvebisadmi 17, xels uwyobs ZuZuTi kvebis
droulad dawyebas da mis gaxangZlivebas,18 agreTve, konsultirebisaTvis
saWiro unar-Cvevebis Camoyalibebas da eqskluziuri ZuZuTi kvebis
sixSiris zrdas. 19
rekomendaciebi:
• rekomendebulia samSobiaro dawesebulebis samedicino
personalisaTvis 18 saaTiani (3 dRiani) saswavlo kursis
Catareba, rogorc opetimaluri xangZlivobis swavleba
(mtkicebulebis done II); 11,
• samedicino personalis swavleba unda iyos savaldebulo da
Serwymuli mkacr specifikur politikasTan (mtkicebulebis
done II); 7,8,9
• ZuZuTi kvebis 10 safexuris danergvisTvis aucilebelia
samedicino personalis gadamzadeba 18 saaTiani saswavlo
kursiT (SesaZlebelia swavleba ganxorcieldes ZuZuTi kvebis
40 saaTiani saswavlo programiT (5 dRe) WHO/UNICEF)
safexuri III
yvela orsuli qali informirebuli unda iyos ZuZuTi kvebis
sargeblianobisa da marTvis principebis Sesaxeb.
qalTa konsultaciebSi samedicino personalma unda ganaxorcielos
orsuli qalebis momzadeba da maTi motivireba ZuZuTi kvebisadmi.
antenataluri saubrebi unda moicavdes ZuZuTi kvebis sargeblianobis da
ZuZuTi kvebis marTvis bazisur principebs; aseve orsulma qalebma unda
miiRon ganaTleba iseT sakiTxebze rogoricaa ZuZuTi kvebis adreuli
dawyeba, kani-kanTan kontaqti, deda bavSvis erTad yofna, moTxovnilebiTi
kveba, Tu rogor SeinarCunon rZis sakmarisi raodenoba. aucilebelia
orsulis informireba sxvadasxva poziciisa da ZuZuze swori moWidebis
niSnebis Sesaxeb (WHO/ UNINICEF 1992). ikrZaleba dedebisTvis informaciis
miwodeba qalis rZis Semcvlelebis Sesaxeb, rac saerTaSoriso kodeqsis
da saqarTvelos kanonmdeblobis darRvevad iTvleba. 32
orsul qals unda Cautaredes srulfasovani konsultacia bavSvis
kvebis sakiTxebze, raTa man SeZlos miRebuli informaciis
safuZvelze swori arCevnis gakeTeba (e.w. informirebuli Tanxmoba).
imisaTvis, rom gavlena movaxdinoT dedis gadawyvetilebaze da
II
II
10
arCevani gakeTdes ZuZuTi kvebis sasargeblod, umjobesia
konsultirebasTan erTad vizualuri (nabeWdi/video) masalis
gamoyeneba (mtkicebulebis done - I) 6,21. mniSvnelovania momavali
dedis fsiqologiuri mxardaWera, misi darwmuneba ZuZuTi kvebis
sargeblianobaSi xelovnur kvebasTan SedarebiT, rogorc bavSvis ise
dedis janmrTelobisTvis.20. mniSvnelovania aseve ojaxis wevrebis
CarTva konsultirebis procesSi, maTi mxardaWeris mosapoveblad,
eqskluziuri ZuZuTi kvebis xangZlivoba mniSvnelovnad aris
damokidebuli bavSvis mamis da ojaxis sxva wevrebis xelSewyobaze.
(mtkicebulebis done - II). 21
antenatalur periodSi dedebis rwmenis ganmtkiceba da ganaTleba
samedicino personalis mier, pirdapir korelaciaSia ZuZuTi kvebis
saxSiris zrdasTan (mtkicebulebis done II), 22, 23 . am dros mcirdeba ZuZuTi kvebis Sewyvetis riski (mtkicebulebis done I, II). 24
orsulebis araTanmimdevrulma da araadekvaturma informirebam
SeiZleba negatiurad imoqmedos ZuZuTi kvebaze (mtkicebulebis done
I) 25. dedebi, romlebic eswrebian ZuZuTi kvebis saswavlo seminarebs
orsulobis periodSi ufro xangrZlivad kvebaven bavSvebs ZuZuTi da
warmatebiT axorcieleben eqskluziur ZuZuTi kvebas 6 Tvemde 25.
dedebis momzadeba, gansakuTrebiT jgufuri swavleba orsulobis
periodSi wrmoadgens ZuZuTi kvebis mxardaWeris mniSvnelovan
komponents, gansakuTrebiT im qalebisaTvis, romlebsac ar qondaT
ZuZuTi kvebis gamocdileba. swavlebis procesi unda Seesabamebodes
konkretuli pirovnebisa da jgufis Taviseburebebs 21, 22, 23.
antenatalur periodSi ZuZuTi kvebis 10 safexuris Sesaxeb jgufuri
interaqtiuli swavlebis SemTxvevaSi izrdeba ZuZuTi kvebis adreuli
dawyebis sixSire da ZuZuTi kvebis xangrZlivoba 27,28,29,30. orsulebis
momzadeba ZuZuTi kvebis problemebis da ZuZuze swori moWidebis niSnebis
Sesaxeb zrdis ZuZuTi kvebis sixSires postnatalur periodSi da
amcirebs dvrilebis dazianebis risks. 31
sarZeve jirkvlebis Sefasebas dvrilebis mdgomareobis dadgenis mizniT
antenatalur periodSi ar eniWeba gansakuTrebuli mniSvneloba.
dadgenilia, rom dvrilebis wovadobis gasaumjobeseblad sxvadasxva
varjiSebis gamoyeneba ar aisaxeba dvrilebis mdgomareobaze, piriqiT,
sarZeve jirkvlebis rutinulma gaRizianebam SeiZleba gamoiwvios dedis
TviTrwmenis daqveiTeba da uaryofiTad aisaxos ZuZuTi kvebis procesze 20,21. dvrilis anatomiuri mdgomareoba umjobesdeba mSobiarobis
moaxloebasTan erTad da axalSobilis ZuZuze swor moWidebaSi
daxmareba ufro efeqturia, vidre antenataluri Careva.
rekomendaciebi:
• aucilebelia dedebis antenataluri swavleba ZuZuTi kvebis
sakiTxebze. igi mniSvnelovan gavlenas axdens ZuZuTi kvebis
inicirebaze da xangrZlivobaze;
I
I/II
I
II
II
11
• antenataluri swavleba unda moicavdes ZuZuTi kvebis da baksis
ZiriTad principebs, emsaxurebodes dedis rwmenis ganmtkicebas da
motivirebas ZuZuTi kvebisadmi; 22, 23
• antenataluri swavlebis procesSi saWiroa dedebisaTvis
keTilganwyobili garemos Seqmna da maTi ojaxis wevrebis mxriv
saTanado mxardaWeris mopoveba; 21
• akrZalulia orsuli qalebisTvis informaciis miwodeba qalis rZis
Semcvlelebis Sesaxeb; 32,56
• ar aris mizanSewonili dvrilebis rutinuli gasinjva da momzadeba
Tundac brtyeli dvrilebis arsebobis dros. 20,21.
IV safexuri
daxmareba gaewios dedebs ZuZuTi kvebis dawyebaSi mSobiarobidan 1
saaTis ganmavlobaSi.
fiziologiuri mSobiarobidan pirveli erTi saaTis ganmavlobaSi
axalSobilma unda daiwyos ZuZuTi kveba. ZuZuTi kvebis adreuli dawyebis
pirvel etaps kani-kanTan kontaqti warmoadgens (ix. ZuZuTi kvebis
gaidlaini), romelic mSobiarobidan pirveli erTi saaTis ganmavlobaSi
unda ganxorcieldes da gagrZeldes ara nakleb 30 wuTisa (WHO/UNICEF).
kani-kanTan kontaqtis procesSi aucilebelia dedisa da axalSobilis
xelSewyoba ZuZuze pirveli moWidebis gansaxorcieleblad, Tumca
samedicino personalma unda gaiTvaliswinos, rom pirveli moWedeba unda
moxdes Zaldatanebis gareSe, axalSobilis mzaobis gaTvaliswinebiT da
mxolod saTanado daxmarebis gawevis gziT. 33
dedebisaTvis profesiuli daxmareba mniSvnleovania efeqturi ZuZuTi
kvebis adreuli dawyebisa da xangrZlivobis gazrdis TvalsazrisiT. 34.
dadgenilia, rom kani-kanTan kontaqtis adreul ganxorcielebas da
ZuZuTi kvebis dawyebas mSobiarobidan 1 saaTis ganmavlobaSi
mravalmxrivi mniSvneloba aqvs (ix. ZuZuTi kvebis gaidlaini).
sakeisro kveTis SemTxvevaSi (zogadi narkoziT) kani-kanTan kontaqti da
ZuZuTi kveba SeiZleba ganxorcieldes mogvianebiT dedis narkozidan
sruli gamosvlis Semdeg.35 kohortuli kvleviTa da sistemuri
mimoxilviT gamovlinda, rom kani-kanTan kontaqtis da ZuZuTi kvebis
erTdroulad ganxorcieleba metad efeqturia ZuZuTi kvebis
gaxangrZlivebis TvalsazrisiT. 36
12
rekomendaciebi 1,2,3,10
• kani-kanTan kontaqti unda ganxorcieldes fiziologiuri
mSobiarobidan naxevar½ saaTSi da gagrZeldes aranakleb 30
wuTisa. (rekomendacia - D);
• kani-kanTan kontaqtis procesSi aucilebelia axalSobilis ZuZuze
pirveli moWidebis xelSewyoba, roca bavSvs gamouvlindeba ZuZuTi
kvebis Sesabamisi mzaobis niSnebi;
• ar aris rekomendebuli bavSvis iZulebiT an daCqarebuli wesiT
ZuZuze moWidebis ganxorcieleba;
• ZuZuTi kveba unda dawyos fiziologiuri mSobiarobidan 1 saaTis
ganmavlobaSi;
• zogadi narkoziT sakeisro kveTis Semdeg kani-kanTan kontaqti da
ZuZuTi kveba unda ganxorcieldes dedisa da bavSvis sruli
gamofxizlebis Semdeg (daaxloebiT 2-3 saaTSi).
V safexuri
dedebis ganaTleba (Teoriuli/praqtikuli) ZuZuTi kvebisa da laqtaciis
SenarCunebis principebze im SemTxvevebis gaTvaliswinebiT, roca deda da
bavSvi dacilebulia erTmaneTisgan
deda-bavSvis palataSi gadayvanis Semdeg samedicino personalma 6 saaTis
ganmavlobaSi dedas unda gauwios daxmareba ZuZuTi kvebis
ganxorcielebaSi: aswavlos da aCvenos dedas swori poziciebis SerCeva,
bavSvis ZuZuze swori moWideba (ix. ZuZuTi kvebis gaidlaini), rZis
gamowvelis teqnika.1,2,3 samedicino personalma dedas unda miawodos
informacia moTxovnilebiTi da eqskluziuri ZuZuTi kvebis, ZuZuTi kvebis
SesaZlo problemebisa da maTi prevenciis Sesaxeb (ix. ZuZuTi kvebis
gaidlaini), agreTve, rogor kvebos bavSvi sxvadasxva nevrologiuri
gadaxrebis an Tandayolili paTologiebis dros mag: kurdRlis tuCi,
mglis xaxa.
aucilebelia, samedicino persanalma xeli Seuwyos dedas Camouyalibdes
rwena imisa, rom mas Seswevs unari sworad moaWidos bavSvi ZuZus da
ganaxorcielos ZuZuTi kveba. dedas unda aswavlon sworad amoicnos
bavSvis qceva, SimSilis niSnebi da maTze adeqvaturi reagireba. 33,34,35
mSobiarobis Semdeg dedebisTvis daxmarebis gaweva, gansakuTrebuli
keTilganwyobili damokidebuleba da saTanado mxardaWera dadebiTad
aisaxeba mis TviTrwmenaze da aqedan gamomdinare, ZuZuTi kvebis
xangrZlivobaze. aseT dedebs iSviaTad aqvs ZuZuTi kvebis problemebi. 1,2
samedicino personalis mier araswori da araTanmimdevruli
rCevebis micema, ZuZuTi kvebis swori marTvis erT-erTi
mniSvnelovani xelSemSleli faqtoria34,35 (mtkicebulebis done II).
ZuZuTi kvebis sixSire da xangrZlivoba metia, Tu samSobiaro saxlSi
dedebs aswavlian ZuZuze bavSvis sworad moWidebas da piriqiT, xSiria
ZuZuTi kvebis problemebi, roca dedebs ar eZlevaT saTanado
konsultacia da ar utardebaT saWiro koreqcia.8 ZuZuTi kvebis
II
D
13
warmatebiT ganxorcielebis SemTxvevebis sixSire izrdeba, roca ZuZuTi
kvebis teqnikis swavleba Serwymulia samSobiaroSi deda-bavSvis erTad
yofnis praqtikasTan.
Tu samedicino CvenebiT deda da bavSvi dacilebulia erTmaneTs, an
bavSvs aReniSneba Tandayolili tuCis, sasis defeqti, hipertonuli an
hipotonuri piris Rru, dedas unda aswavlon/aCvenon, rogor kvebos
bavSvi. Aucileblobis SemTxvevaSi rogor da ra sixSiriT gamoiwvelos
rZe, rom SeinarCunos laqtacia. rogor kvebos bavSvi finjnidan, kovziT,
sawveTuriT an SpriciT (ix. danarTi). 58
laqtaciis gasazrdelad mniSvneloba aqvs ZuZuTi kvebis swori
teqnikis codnas da rZis gamowvelas. rZis xSiri gamowvela
asocirdeba rZis produqciis gazrdasTan40 (mtkicebulebis done II).
dadgenilia maT Soris pirdapiri korelaciuri kavSiri. rZis
produqciis SesanarCuneblad aucilebelia rZis gamowvela 24 saaTSi
minimum 6-jer (SeiZleba 8-12-jer dReSi), gansakuTrebiT mSobiarobidan
pirveli kviris ganmavlobaSi41. Tu deda da bavSvi dacilebulia
erTmaneTs mniSvnelovania, rZis gamowvela daiwyos rac SeiZleba male
mSobiarobidan.
rekomendaciebi:
• samedicino personalis mier dedas unda gaewios daxmareba ZuZuTi
kvebis swori poziciebis SerCevaSi da ZuZuze swori moWidebis
ganxorcielebaSi;
• dedas unda aswavlon bavSvis kvebasTan dakavSirebuli qcevis da
SimSilis niSnebis amocnoba da maTze adeqvaturi reagireba;
• dedas unda ganemartos moTxovnilebiTi da eqskluziuri ZuZuTi
kvebis arsi da mniSvneloba;
• yvela dedas unda aswavlon rogor SeinarCunos laqtacia, rogor
gamoiwvelos rZe xeliT da rogor kvebos bavSvi finjnidan, kovziT,
sawveTuriT an SpriciT;
• yvela dedam unda icodes xeliT rZis gamowvelis teqnika. maT unda
miewodos werilobiTi informacia rZis gamowvelis teqnikis
detaluri aRweriT;
• rZis gamowvela laqtaciis SenarCunebis da gazrdis mizniT
mizanSewonilia minimum 6-jer dReSi (SeiZleba 8-12-jer)
gansakuTrebiT pirveli kviris ganmavlobaSi.
II
14
VI safexuri
bavSvs qalis rZisa da samedicino CvenebiT daniSnuli medikamentebis
garda ar mieces aranairi sakvebi an siTxe.
axalSobilebs ar unda mieces qalis rZis garda sxva sakvebi an siTxe,
vinaidan qalis rZe sruliad akmayofilebs axalSobilis organizmis
moTxovnilebas kvebiT ingredientebze da siTxeze. ZuZuTi kvebis dros
sxva siTxis an sakvebis damateba amcirebs ZuZuTi kvebis xangrZlivobas
da sixSires, gansakuTrebiT sicocxis pirvel kviraSi,10,42 iwvevs rZis
gamomuSavebis Semcirebas, sarZeve jirkvlis gajirjvebas da ZuZuTi
kvebis adreul Sewyvetas.43 Tu sxva sakvebis an siTxis micema xdeba
boTlidan es gansakuTrebiT uaryofiTad aisaxeba ZuZus wovis procesze,
kerZod, bavSvi veRar axerxebs ZuZuze swori moWidebis ganxorcielebas
da rZis saTanado raodebiT gamowvelas sarZeve jirkvlidan. amave dros
boTlidan kveba zrdis bavSvis dainficirebis risks _ mag. diarea,
meningiti, neonataluri sefsisi.44 im SemTxvevebSi, roca arsebobs ZuZuTi
kvebis dros sxva sakvebis, siTxis damatebis an xelovnur kvebaze
gadayvanis samedicino Cveneba, aRniSnuli faqti unda iyos dafiqsirebuli
axalSobilis istoriaSi da argumentirebulad dasabuTebuli. aseT
SemTxvevebSi bavSvis kvebisTvis umjobesia gamoyenebul iqnes ara boTli,
aramed alternatiuli saSualebebi (finjani, kovzi, sawveTuri, Sprici,
zondi).
rekomendaciebi:
axalSobils ar unda mieces sxva sakvebi an siTxe garda qalis
rZisa. (rekomendacia B);6
ZuZuTi kvebis dros damatebiTi sakvebis micema unda moxdes
mxolod mkacri samedicino Cvenebebis arsebobisas da dafiqsirdes
axalSobilis istoriaSi.
VII safexuri
deda-bavSvis erTad yofnis praqtika _ deda-bavSvs mieces SesaZlebloba
iyvnen erTad 24 saaTis ganmavlobaSi.
samSobiaro saxlSi deda da axalSobili, maT Soris sakeisro kveTis
SemTxvevaSic, unda imyofebodes erT palataSi rogorc dRisiT, ise
RamiT, garda im periodisa (daaxloebiT 1-2 saaTi), romelic saWiroa
sxvadasxva higienuri, Tu samedicino procedurebis Casatareblad.
deda-bavSvis erTad yofna saSualebas aZlevs dedas kvebos bavSvi roca
igi amJRavnebs SimSilis niSnebs, misi moTxovnilebis Sesabamisad (ix.
ZuZuTi kvebis gaidlaini).
dadgenilia, rom dedisa da bavSvis erTad yofna xels uwyobs
dedisa da bavSvs Soris mWidro fsiqo-emociuri kavSiris
damyarebas, dedobrivi grZnobis Camoyalibebas, dadebiTad aisaxeba
dedis damokidebulebaze ZuZuTi kvebisadmi, (mtkicebulebis done
II)45 aumjobesebs ZuZuTi kvebis process, aseve xels uwyobs ZuZuTi
II
15
kvebis xangrZlivobis gazrdas8 da ZuZuTi kvebis efeqtur
ganxorcielebas (mtkicebulebis done II), 46 zrdis ZuZuTi kvebis
sixSires da amcirebs qalis rZis Semcvlelebis damatebis
saWiroebas47. am dros SeiZleba mxolod umnSivnelod dairRves
dedis Zili, magram umjobesdeba bavSvis Zili, bavSvebi ufro
mSvidad arian da naklebad tirian (mtkicebulebis done II).47
dedisa da bavSvis erTad yofna warmoadgens aucilebel pirobas
moTxovnilebiT ZuZuTi kvebis warmatebiT ganxorcilebisTvis
(mtkicebulebis done I). 1,2
rekomendaciebi:
• samSobiaro saxlSi aucilebelia deda-bavSvis erTad yofnis
praqtikis damkvidreba. deda da bavSvi unda imyofebodes erT
palataSi rogorc dRisiT, ise RamiT;
• bavSvebis gayvana palatidan dasaSvebia mxolod aucilebeli
procedurebis Casatareblad (daaxloebiT 1 saaTi dRe-Ramis
ganmavlobaSi).
VIII safexuri
moTxovnilebiT ZuZuTi kvebis xelSewyoba
dedas unda urCion kvebos bavSvi maSin, roca is gamoxatavs SimSilis
niSnebs, misi moTxovnilebis Sesabamisad, rogorc dRisiT, ise RamiT.
Tu kvebaTa Soris xangrZlivoba aRemateba 3 saaTs an deda igrZnobs
sarZeve jirkvlebis gadavsebas bavSvi unda gaaRviZos da SesTavazos
ZuZu (rekomendacia D)1,2.
moTxovnilebiTi ZuZuTi kvebis dros, yvela bavSvis kvebis sixSire da
xangrZlivoba gansxvavebulia da dRiTidRe icvleba, Tumca Cveulebriv
igi ar aWarbebs 8-12 kvebas dRe-RameSi. moTxovnilebiTi kvebis
ganxorcieleba SesaZlebelia deda-bavSvis erTad yofnis pirobebSi,
rac dedas aZlevs drouli reagirebis SesaZleblobas, roca bavSvi
gamoxatavs kvebisadmi mzadyofnas (mtkicebulebis done I, II).
moTxovnilebiTi kvebis dros bavSvebi warmatebiT axorcieleben
eqskluziur ZuZuTi kvebas, naklebia ZuZuTi kvebis problemebi.
moTxovnilebiTi kveba asocirdeba ZuZuTi kvebis gaxangrZlivebasTan 48
bavSvis moTxovnilebiT, SeuzRudavi kveba ar SeiZleba iyos dvrilebis
dazianebis gamomwvevi mizezi. dadgenilia, rom dvrilebis dazianebas
iwvevs bavSvis ZuZuze araswori moWideba da ara xangrZlivi kveba
(mtkicebulebis done I, II);40 moTxovnilebiT xSiri ZuZuTi kveba
mSobiarobis pirveli dRidan korelirdeba hiperbilirubinemiis
SemcirebasTan, aseve rZis produqciis gaZlierebasTan49 (ix.
`axalSobilTa hiperbilirubinemia~ da `2 wlamde bavSvis kveba~)
II
I
D
I,II
I,II
16
rekomendacia:
• ZuZuTi kveba unda ganxorcieldes bavSvis moTxovnilebis mixedviT;
• moTxovnilebiTi ZuZuTi kveba unda ganxorcieldes rogorc dRisiT,
ise RamiT;
• Tu kvebaTa Soris intervali aWarbebs 3 saaTs, dedam unda
gaaRviZos bavSvi da SesTavazos ZuZu;
• dauSvebelia ZuZuTi kveba saaTobrivi reJimiT.
IX safexuri
ZuZuTi kvebaze myof axalSobilebs ar mieces sawovara an satyuara.
samSobiaro dawesebulebebSi bavSvis kvebisaTvis ar unda iqnes
gamoyenebuli sawovriani boTlebi, axalSobils ar unda miscen
satyuara.32,56 dadgenilia, rom arsebobs meqanikuri da dinamikuri
sxvaoba ZuZus wovisa da sawovridan wovis meqanizmebs Soris da
sawovaras gamoyeneba (mtkicebulebis done II)50 xels uSlis bavSvis
saxis kunTebis normalur ganviTarebas, Sesabamisad ZuZuze swori
moWidebis ganxorcielebas (ix. ZuZuTi kvebis gaidlaini). bavSvebis
umravlesobas, romlebsac samSobiaroSi kvebaven boTlidan, Tundac
epizodurad, samSobiarodan gaweris Semdeg aReniSnebaT ZuZuTi kvebis
problemebi. sawovaras gamoyeneba zrdis otitis ganviTarebis risks.
(rekomendacia – A ) 50
im SemTxvevaSi, Tu ZuZuTi kveba droebiT Seferxebulia, samSobiaro
saxlSi bavSvis kvebis optimalur meTodad miCneulia alternatiuli
saSualebebis gamoyeneba (finjani, kovzi, sawveTuri, Sprici, zondi),
miTumetes Tu ZuZuTi kvebis gagrZelebaze gadawyvetileba miRebulia.51
finjnidan kvebas esaWiroeba saTanado unar-Cvevebi da amis Sesaxeb deda
unda iyos informirebuli.
Cveulebriv, satyuarebs iyeneben bavSvis dasamSvideblad. Sesabamisad,
bavSvebi, romlebic satyuarebs woven, SedarebiT naklebi sixSiriT
iTxoven ZuZus. iSviaTi kveba amcirebs sarZeve jirkvlis stimulirebas 52 da xels uwyobs bavSvs Tavi daanebos ZuZuTi kvebas. ZuZuTi kvebis
problemebis sixSire ufro maRalia im dedebSi, romlebic iyeneben
satyuaras. 52,53
sawovrebisa da satyuarebis gamoyeneba bavSvis janmrTelobaze uaryofiT
gavlenas axdens. adreul asakSi es SeiZleba gamoxatos sunTqvis
darRveviT, mogvianebiT ki Tankbilvis darRveviT, damoukideblad imisa
sawovriani boTlidan bavSvs xelovnur sakvebs aZleven Tu gamowvelil
rZes. 20
II
A
17
rekomendaciebi:
• ar aris rekomendebuli bavSvTa kvebisTvis sawovrebisa da
satyuarebis gamoyeneba;50
saWiroebis SemTxvevaSi gamoyenebuli unda iqnes kvebis alternatiuli
meTodebi (finjani, kovzi, sawveTuri).51
• samedicino personali unda flobdes saTanado unar-Cvevebs
alternatiuli kvebis gansaxorcieleblad da dedebisTvis daxamarebis
gasawevad;
• sawovrebi da satyuarebi ar unda arsebobdes samSobiaro
dawesebulabaSi;
• sawovrebis gamoyeneba minimumamde unda iyos dayvanili, maTi
gamoyeneba dasaSvebia, mxolod xelovnuri kvebis dros.
safexuri X
ZuZuTi kvebis mxardamWeri jgufebis Camoyalibebis xelSewyoba da
samSobiarodan gaweris Semdeg dedebis maTTan gagzavna
samedicino personali informirebuli unda iyos dedebis mxardamWeri
jgufebis arsebobis Taobaze (Tu aseTi arsebobs) an personalma unda
icodes alternatiuli damxmare sistemis arsebobis Sesaxeb (pjd), sadac
unda gagzavnon dedebi samSobiarodan gaweris Semdeg (msoflio
jandacvis organizacia da gaeros bavSvTa fondis mier mowodebuli
baksis globaluri kriteriumebi 1992).
samSobiarodan gaweris Semdeg, arc ise iSviaTad mcirdeba ZuZuTi kvebis
sixSire, gansakuTrebiT eqskluziuri ZuZuTi kvebis maCvenebeli. amis
ZiriTadi mizezebi, romlebsac asaxeleben dedebi, aris ZuZuTi kvebis
problemebi, pirvel rigSi `rZis nakleboba”. aseT SemTxvevebSi ZiriTad
mizezs warmoadgens dedisTvis saTanado mxardaWeris ararseboba.
ZuZuTi kvebis efeqturad gagrZelebas sWirdeba momdevno
mxardaWera da Sefaseba (mtkicebulebis done III) 54 gamocdili da
saTanado unar-Cvevebis mqone personalis mier, rac zrdis ZuZuTi
kvebis xangrZlivobas da eqskluziuri ZuZuTi kvebis sixSires
(mtkicebulebis done I, II). 54
ZuZuTi kvebis sixSire izrdeba im SemTxvevaSi, roca dedebs
utardebaT damatebiTi konsultaciebi. samSobiarodan gaweris
Semdeg dedebisTvis daxmarebis gaweva, individualuri
konsultaciebis Catareba da binaze vizitebi dadebiTad aisaxeba
ZuZuTi kvebis, kerZod eqskluziuri ZuZuTi kvebis sixSireze. 6,21,55
samSobiarodan gaweris Semdeg dedebis mudmivi mxardaWera SeiZleba
sxvadasxva gziT ganxorcieldes. tradiciulad amas akeTeben qalis
garemocvaSi myofi axloblebi, Tumca aseTi praqtika yovelTvis ar aris
optimaluri. zogierT qveynebSi arsebobs deda-dedis mxardamWeri
III
I, II
18
jgufebi, romlebic ZiriTad rols axruleben ZuZuTi kvebis xelSewyobis
saqmeSi.
amrigad, es safexuri gulisxmobs mxardaWeris yvela formas, romelic
SeiZleba iyos xelmisawvdomi.
rekomendaciebi
• mizanSewonilia ZuZuTi kvebis mxardaWeris sxvadasxva formebis
gamoyeneba ZuZuTi kvebis SenarCunebisa da gaxangrZlivebisaTvis da
SesaZlo problemebis Tavidan asacileblad;
• samSobiarodan gawerisas yvela dedas unda miewodos informacia
arsebuli mxardamWeri jgufebis Sesaxeb, maT Soris realurad
arsebuli specilizirebuli daxmarebis samedicino sistemis Taobaze,
rogoricaa jandacvis pirveladi rgoli.
19
mtkicebulebezze dafuZnebuli ZiriTadi Semajebeli
rekomandiciebi
rekomendacia ganxorcielebis gza Mmtkicebu
lebis
done
Bbaksis principebis
danergva
ZuZuTi kvebis politikis SemuSaveba
/gadaxedva. personalis momzadeba.
negatiuri garemos Secvala, ZuZuTi
kvebis mxardamWeri garemos
Camoyalibeba, orsulTa informireba
I
orsulTa ganaTleba
baksis principebze
antenatalur pereiodSi
antenataluri zrunvis
saxelmZRvanelos/gegmis SemuSaveba.
orsulTa ganaTlebis
xelmisawvdomobis uzrunvelyofa
II
antenatalur periodSi
orsulTaA mcire jgufebis
ganaTleba
samedicino personalis treiningi,
saTanado masalebis momzadeba,
orsulTa ganaTleba
II
dedebisTvis daxmarebis
gaweva, mSobiarobidan 1
saaTis ganmavlobaSi
politikis gadaxedva, rutinuli
araswori midgomebis Secvla
II
samedicino personali
unda flobdes saTanado
unarCvevebs ZuZuTi kvebis
adreuli dawyebis
gansaxorcieleblad
personalis treningi ZuZuTi kvebis
principebis, ZuZuze sworad
moWidebis, rZis gamowvelis
meTodebis Sesaxeb
I
xelovnueri sakvebi
formulis da glukozis
damatebis aRmofxvra
(garda samedicino
Cvenebebisa)
politikis gadaxedva, araswori
praqtikis Secvla, dedebis
informireba
II
deda bavSvis erTad
yofnis praktika (24 saaTi
erT palataSi)
politikis gadaxedva, saTanado
garemos Camoyalibeba, dedebis
informireba
III
moTxovnilebiTi ZuZuTi
kveba
politikis gadaxedva, saTanado
garemos Camoyalibeba, dedebis
informireba
I
dauSvebelia ZuZuTi
kvebaze myof bavSvebTan
sawovrebisa da
satyuarebis gamoyeneba
politikis gadaxedva, saTanado
garemos Camoyalibeba, dedebis
informireba
II
qalis rZis SemcvlelTa
marketingis saerTaSoriso
kodeqsis da Sesabamisi
saqarTvelos kanonis
,,ZuZuTi kvebis dacvisa da
xelovnuri sakvebis
kontrilirebadi
moxmarebis sesaxeb”
werilobiTi politikis SemuSaveba,
sazogadoebis informeriba
II
20
4. gaidlainis miRebis xerxi/wyaro
gaidlainis SemuSavebis meTodologia
• adreuli neonataluri periodis axalSobilTa bunebrivi kvebisa da
bavSvisadmi keTilganwyobili saavadmyofis iniciativis Sesaxeb
arsebobs samecniero mtkicebulebis safuZvelze Seqmnil
rekomendaciaTa sakmarisi raodenoba. mocemuli gaidlainis Seqmnis
procesSi samuSao jgufis gadawyvetilebiT moZiebuli da Sefasebuli
iqna ukve arsebuli praqtikuli rekomendaciebi. moxda arsebuli
rekomendaciebis adaptirebuli variantis SemuSaveba, romelic erTis
mxriv pasuxobs saerTaSoriso moTxovnebs, xolo meore mxriv
iTvaliswinebs saqarTvelos samedicino dawesebulebaTa rogorc
adamianur, ise teqnikur resursebs;
• rekomendaciaTa moZieba xorcieldeboda eleqtronuli monacemTa
bazis gamoyenebiT.
qveyana da resursis
dasaxeleba
internet-misamarTi
aSS
US National Guideline Clearinghouse (NGC)
http://www.guideline.gov
Centers for Disease Control and Prevention (CDC)
http://www.phppo.cdc.gov/CDCRecommends/AdvSearchV.asp
Agency for Healthcare Research and Quality (AHRQ)
http://www.ahrq.gov/clinic/cpgsix.htm
Health Services Technology Assessment Text (HSTAT) and National Library of Medicine (NLM)
http://hstat.nlm.nih.gov
Institute of Clinical Systems Improvement (ICSI)
http://www.icsi.org
American Medical Association http://www.ama-assn.org Canadian Medical Association (CMA)
http://mdm.ca/cpgsnew/cpgs/index.asp
Health Canada – Population and Public Health Branch (PPHB)
http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html
didi britaneTi
National Institute for Clinical Excellence (NICE)
http://www.nice.org.uk
Sheffield Evidence for Effectiveness and Knowledge (SEEK)
http://www.shef.ac.uk/seek/guidelines.htm
National electronic Library for Health (NeLH)
http://www.nelh.nhs.uk/guidelinesfinder
PRODIGY Clinical Guidance http://www.prodigy.nhs.uk/ClinicalGuidance Scottish Intercollegiate Guidelines Network (SIGN)
http://www.sign.ac.uk
German Guideline Information Service (GERGIS)
http://www.leitlinien.de/english/english/view;
avstralia
21
Australian National Health and Medical Research Council (NHMRC)
http://www.health.gov.au/hfs/nhmrc/publicat/cp-home.htm
axali zelandia New Zealand Guidelines Group (NZGG)
http://www.nzgg.org.nz/library.cfm
mtkicebiTi medicinis
specialistTa
regionTaSorisi
sazogadoeba
http://www.osdm.org
klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi
wyaroebi da meTodebi
• koxreinis biblioTeka - The Cochrane Library 2006, Issue 2,
• amerikis samedicino biblioTekis mier Seqmnil eleqtronul
bibliografiul monacemTa baza - medlaini – MEDLINE
publikaciebis CarTvis/gamoricxvis kriteriumebi
• arCeul iqna kvlevebi Semdegi dizainiT: randomizebuli,
kontrolirebadi, sistemuri mimoxilvebi da meta-analizi,
erTmomentiani, kohortuli kvlevebi;
• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 12
wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro
adreuli publikaciebi, romlebic dResac aqtualuria da
safuZvlad udevs sxva Tanamedrove mtkicebulebebs;
• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs
SesaZlebloba hqonda literaturis wyaroebi Seeswavla mxolod
inglisur da rusul enebze.
moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi
• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.
Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri
meToduri rekomendacia axalSobilTa axalSobilTa bunebrivi
kvebis marTvisa da bavSvisadmi keTilganwyobili saavadmyofos
iniciativis sakiTxebze, romlebic Seicavda jgufis miznis
Sesaferis saWiro informacias. am rekomendaciebis Sefasebisas
gamoyenebuli iyo rekomendaciaTa atestaciisa da eqspertizis
kiTxvari - AGREE (94,96-98). Sefasebis Sedegad amorCeuli iyo qvemoT
CamoTvlili organizaciebis gaidlainebi:
⇒ msoflo jandacvis organizacia
⇒ amerikis pediatrTa akademia
⇒ kanadis pediatrTa sazogadoeba
⇒ laqtaciis konsultantTa saerTaSoriso asocia (ILKA).
22
gaTvaliswinebuli iyo bavSvTa kvebis saerTaSoriso qselis (IBFAN), ZuZuTi kvebis msoflio aliansis (WABA), Baby Milk Action ZuZuTi kvebis
qselis masalebi.
samuSao jgufi xelmZRvanelobda saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros mier SemuSavebuli nacionaluri
gaidlainebis gzamkvleviT.
• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas
gamoyenebuli iyo saqarTvelos Sromis janmrTelobisa da
socialuri dacvis saministros mier mowodebuli mtkicebulebebis
donisa da rekomendaciebis xarisxis sqema.
mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema
done mtkicebulebis siZlieris
done (Muir Gray) xarisxi rekomendaciis xarisxi
(Cook et al)
I Zlieri mtkicebuleba,
eyrdnoba minimum erT
sistemur mimoxilvas,
romelic efuZneba swori
dizainis mqone
randomizebul
kontrolirebad kvleva
A eyrdnoba I donis
mtkicebulebas da
Sesabamisad mtkiced
rekomendebulia
II Zlieri mtkicebuleba,
eyrdnoba minimum erTi
swori dizainis mqone
randomizebul
kontrolirebad kvleva
B eyrdnoba II donis
mtkicebulebas da
Sesabamisad mtkiced
rekomendebulia
III klinikuri kvleva
randomizaciis gareSe,
kohortuli da SemTxveva-
kontrolis kvlevebi
C eyrdnoba III donis
mtkicebulebas SeiZleba
CaiTvalos Sesabamisad
IV araeqsperimentuli
multicentruli kvlevebi
D eyrdnoba IV da V donis
mtkicebulebas saWiroebs
konsesuss
Va avtoritetul
profesionalTa mosazreba
Vb klinikuri gamocdileba,
aRwerilobiTi kvlevebi an
eqspertTa angariSi
G
5. gaidlainis ganaxlebis vada - 4 weli
23
klinikuri rekomendaciebis piloturi gamocda
samedicino personali, romelic uSualod muSaobs axalSobilTan
(SaraSiZis samedicino centri, axalSobilTa reanimaciis da gadaudebeli
daxmarebis ganyofilebebi, samSobiaro saxli „bibida“, IBFAN
saqarTvelos jgufi arasamTavrobo organizacia „klaritas XXI“) gaecno
klinikur gaidlains. gaidlainis SemuSavebis procesSi gaTvaliswinebuli
iyo maTi SeniSvnebi da praqtikuli rekomendaciebi.
bunebrivi kvebis xelSewyobis programa saqarTvelos Sromis
janmrTelobisa da socialuri dacvis saministros mier aRiarebulia
saxelmwifo programad da saerTaSoriso organizaciebis xelSewyobiT
saqarTvelos - gaeros bavSvTa fondi „UNICEF“, „UMCOR“ WABA, IBFAN finansuri xelSewyobiT da arasamTavrobo organizacia ,,klaritas XXI’’
mier inergeba 1996 wlidan. mocemuli periodis ganmavlobaSi gaumjobesda
ZuZuTi kvebis maCveneblebi: samSobiarodan gamowerili axalSobilTa
saSualod 90% imyofeba ZuZuTi kvebaze saxelmwifo statistikis 2000-2005
wlis monacemebiT. dainerga eqskluziuri ZuZuTi kvebis praqtika, romlis
maCvenebelmac gaeros bavSvTa fondis da ACTS is mier Catarebuli
kvlevis SedegebiT Seadgina 36%. saqarTveloSi baksis principebi
danergilia 18 samSobiaro saxlSi. 1999 wels saqarTvelos parlamentis
mier damtkicda saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa da
xelSewyobis, xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb”.
6. alternatiuli gaidlani ar arsebobs
7. gamoyenebuli literatura
1. WHO Protection , promoton and support of Breastfeeding in Europe: review of interventions May 2004;
2. World Health Organization. Global strategy:breastfeeding critical for child survival—UNICEF and WHO call for increased commitment to appropriate feeding practices for all infants and young children. Indian J Med Sci 2004; 58(3):138-9;
3. World Health Organization. The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy duringbreast-feeding. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Fertil Steril 1999;72(3):431-40;
4. Reiff MI.Essock-Vitale SM Hospitale inlnce on early infant feeding practices. 1985. Pediatrics, 76:2-879;
5. Garforth S, Garcia JBraest Feeding policies in practice - ,,No wonder they get confuthsed’’ 1989,miwfery,5:75-83;
6. DiGirolamo AM, Grummer-Strawn LM, Fein SB.Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions? Birth 2003;30(2):94-100;
7. Winikoff B et al., Overcoming obstaclesto breast-feeding in a large municipal hospital: Appications of lessons learned. Paediatrics 1987; 80(3);423-433;
8. Strachan-Lindenberg C, Cabrera-Artola R, Jimenez V, The effect of early post-partum mother-infant contact and breastfeeding promotion on the incidence and continuation of breast-feeding, international journal of nursing studies, 1990, 27(3):179-186;
9. Iker Ce, Mogan J, Suplementation of breastfeed ifans: Does continuinig aducation for nurses make a difference? Journal of human lactation 1992, 8 (3):131-135;
24
10. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003;112(1 Pt 1):108-15;
11. Amstrong Hc Breastfeeding promotion: training of mid-level and outreach healh orers. International Journl of gynecology and obstetrics 1990, 31: 91-103;
12. Altobelli L, Baiocci-Ureata N. Larson E , A controlled trail to axrend the duration of axluzive breastfeeing among low income mothers in Lima, Peru. Final report. The Jonns Hopkins University, Cayetano Heredia University and the population Council 1991;
13. Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial (PROBIT): a clusterrandomized trial in the Republic of Belarus. Design, follow-up, and data validation. Adv Exp Med Biol 2000;478:327-45;
14. Kramer MS, Guo T, Platt RW, Sevkovskaya Z, Dzikovich I, Collet JP, et al. Infant growth and health outcomes associated with 3 compared with 6 month of exclusive breastfeeding. Am J Clin Nutr 2003;78(2):291-5;
15. Dulon M.Kersting M, breastfeeding protion in non – UNICEF-Certified hospitals and long-term breastfeeding success in Germany. Acta. Paediatric 2003; 92; 653-8;
16. Kersting M, Dulon M. Assesmnt o breastfeeding promotion in hospitals and follow-up survey of mother – infant pairs in Germany; the SuSe Stydy. Public Health Nutr.2002;5;547-52;
17. Westphal Mf et al, Breas-feeding for health professionals and resultantinstitutional changes. Bulleti o the world health Organizatio 1995; 73,4: 461-468;
18. Bradley Je, Meme J 1992.breastfeeding promotion in Kenya: changes in health worker knvlidges. Attitudesnd practices, 1982-1989. Jurmal of tropical pediatrics, 1992; 38: 228-234;
19. Haider R et al ,braetfeeding counseling in a diarrhoeal disease hospital. Bulletn of the Word health Organization 1996, 7,2 173-179;
20. Matchew OP, Bhatia J, Sucking a breathing paterns during breast and bottle-feeding in term neonats Amrikan journal of diseases of children, 1989,143;588-592;
21. International Laqtation consultant assotiation (ILCA).Clinikal Gudelines for the establishment of exkluzive breastfeeding June 2005 Mary L. Overfield;
22. Blomquist HK, Jonsbo F, Serenius F, Persson LA.Supplementary feeding in the maternity ward shortens the duration of breast feeding. Acta Paediatr 1994;83(11):1122-6;
23. Giugliani ER. [Common problems during lactation and their management]. J Pediatr (Rio J) 2004;80 (5 Suppl):S147-54;
24. Henderson A, Stamp G, Pincombe J. Postpartum positioning and attachment education for increasing breastfeeding: a randomized trial. Birth 2001; 28(4):236-42;
25. Hill PD, Humenick SS. The occurrence of breast engorgement. J Hum Lact 1994;10(2):79-86;
26. Long Dg at al peer counselor program increase breastfeedin rates inUtahnative Amirika WICpopulation. Journal of lactation, 11,4,279-284;
27. Fairbank L, O’ Meara S. Renfrew MJ, woolrridge M, SoWden AJ, lister-Sharp d. a systematic review to valuate the effectivness of interventions to promote the initiation of breastfeeding. Health technolo Assess 2000:4:1-171;
28. de Oliveira Ml, Camacho LA. Tedsone E. Extending breastfeeding duration hrough primary care: a systematic review of prenatal an postnatal interventionsJ Hm Lact 2001;17:326-43;
29. Widstrom A-M, Thingstrom-Pauisson J The position of the tongue during rooting reflexes elected in newborn infants before the first suckle. Acta paeditrica 1993:82;281-83;
30. Volpe EM, Bear M. Ennhancing breastfeedin initiation in adolescent mothers through the breastfeeding rates are inreasin in Scotland. Health Bull 2001;59;102-13;
31. Duufy EP, Percival P, Kershaw . positive effects of a antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates. Midwifery 1997:13;189-96;
25
32. saqarTvelos kanoni ,,ZuZuTi kvebis dacvis da xelovnuri sakvebis
kontrolirebadi moxmarebis” 1999; 33. Mikiel-Kostyra K, Mazur J, Boltruszko I. Effect of early skin-to-skin contact after delivery
on duration of breastfeeding: a prospective cohort study. Acta Paediatr 2002;91(12):1301-6; 34. Sikorski J, Renfrew MJ, PindoriaS,Wade A Support for breastfeeding mothers. Cochrane
Database Syst Rev. 2002; 35. Renfrew MJ, Lang S. Woolrindge MW.early versus delayed initiation of brestfeeding.
Cochrane Database Syst Rev. 2000; 36. Aderson GC, Moore E, Hepwort J, bergman N, early skinto-skin contact for mothers and
their healthy newborn infants. Cochrane Database Syst Rev. 2003; 37. Marchini G, Fried G, Ostlund E, Hagenas L. Plasma leptin in infants: relations to birth
weight and weight loss. Pediatrics 1998;101(3 Pt 1):429-32; 38. Blair A, Cadwell K, Turner-Maffei C, Brimdyr K. The relationship between positioning, the
breastfeeding dynamic, the latching process and pain in breastfeeding mothers with sore nipples. Breastfeed Rev 2003;11(2):5-10;
39. Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P. National assessment of physicians’ breast-feeding knowledge, attitudes, training, and experience. JAMA 1995;273(6):472-6;
40. Righard L, Alade MO. Sucking technique and its effect on success of breastfeeding. Birth 1992;19(4): 185-9;
41. Meier P. breast feeding the prematre baby: a research rview. News brief, 91;2-5; 42. Nylander G at al. Unsupplemeted brestfeeding in the maternity Ward. Positive long-term
effects. Acta obstetrician ginecologika Scandinavica, 1991: 70;205-209; 43. Blomquist HK et al . Supplementary feeding in the maternity Ward shortens the duration and
choice of infants feedin method. Birth, 1997; 24; 90-97; 44. de Zoysa I, Rea M, Why promote breastfeeding in diarrhoeal disease control programes?
Health policy and planning, 1991, 6; 371-79; 45. Procianoy R et al ,the influence of rooming on breastfeeding. Journal of tropical pediatrics,
1983; 29; 112-114; 46. Perez-EscamillaR, Pollitt E, LonerdalB, Dewey KG. Infan feeding policies n the maternity
Wards and their fect on breast-feeding success: an analitial overview. Am J public health 1994;84:-89-97;
47. Keefe MR. The impact of infant rooming-in on maternal sleep at night. J Obstet Gynecol Neonatal Nurs 1988;17(2):122-6;
48. Renfrew MJ, Lang S, Woolridge MW. Early versus delayed initiation of breastfeeding. Cochrane Database Syst Rev 2000(2):CD000043;
49. Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001;107(3):E41;
50. Cronventt L. et al. Singlle daly botle use in the early weeks postpartum and brest-feeding outcomes.pediatrics 1992. 90,5; 760-766;
51. Dowling DA, Meier PP, DiFiore JM, Blatz M, Martin RJ. Cup-feeding for preterm infants: mechanics and safety. J Hum Lact 2002;18(1):13-20; quiz 46-9, 72;
52. Barros FC, Victora CG, Semer TC, et al. Use of pacifiers is associated with decreased breastfeeding duration. Pediatrics 1995;95:497-499;
53. VictoraCG et al ,Pcifier use and shot restfeeding duration; cause, consequence or coinfedence? Pediatrics, 1997, 99, 3; 445-453;
54. Albernaz E, Giugliani ER, Victora CG. Supporting breastfeeding: a successful experience. J Hum Lact 1998;14(4):283-5;
55. Chapman DJ, Damio G, Young S, Perez-Escamilla R.Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. Arch Pediatr Adolesc Med 2004;158(9):897-902;
26
56. World Health Assembly. International Code of Marketing of Breast-milk Substitutes. Geneva: World Health Organization; 1981;
57. Howard CR, Howard FM. Management of breastfeeding when the mother s ill. Clin Obstet Gynecol 2004;47(3):683-95. Howard CR, Howard FM. Management of breastfeeding when the mother is ill. Clin Obstet Gynecol 2004;47(3):683-95.
8. avtorTa jgufi:
pediatrTa da neontologTa kavSiri `alternativa~
samuSao jgufi:
⇒ medea beleSaZe _ medicinis doqtori, saerTaSoriso organizacia
IBFAN-is saqarTvelos jgufi – arasamTavrobo organizacia
,,klaritas XXI”, prezidenti. baksis eqsperti-gare Semfasebeli
(UNICEF), saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa
da xelSewyobis, xelovnuri sakvebis kontrolirebadi
moxmarebis Sesaxeb” – avtori;
⇒ nino kiknaZe – medicinis doqtori; ss kuracio, ojaxis eqimi;
Tbilisis saxelmwifo samedicino universitetis saojaxo
medicines departamentis mowveuli pedagogi; saerTaSoriso
organizacia IBFAN-is saqarTvelos jgufi – arasamTavrobo
organizacia ,,klaritas XXI”.
eqspertebi:
⇒ qeTevan nemsaZe – medicinis doqtori, profesori, Tbilisis
saxelmwifo samedicino universitetis zogadi pediatriis
departamentis ufrosi, saerTaSoriso organizacia IBFAN-is
arasamTavrobo organizacia ,,klaritas XXI”, saqarTvelos kanoni
“bavSvTa bunebrivi kvebis dacvisa da xelSewyobis, xelovnuri
sakvebis kontrolirebadi moxmarebis Sesaxeb” – avtori;
⇒ Tamar manjaviZe – medicinis doqtori, baksis eqsperti/gare
Semfasebeli (UNICEF), saqarTvelos kanoni “bavSvTa bunebrivi
kvebis dacvisa da xelSewyobis, xelovnuri sakvebis
kontrolirebadi moxmarebis Sesaxeb” – avtori;
⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros jandacvis departamenti;
⇒ Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros jandacvis departamenti.
27
danarTi 1
samSobiaro saxlSi warmatebuli ZuZuTi kvebis 10 safexuris
danergvis Sefasebis kriteriumebi
Sefaseba xorcieldeba specialuri kiTxvariT, baksis globaluri
kriteriumebis moTxovnebis Sesabamisad:
!
I safexuri
ZuZuTi kvebis politikis dokumenti
samSobiaro saxlSi unda arsebobdes ZuZuTi kvebis politikis
werilobiTi dokumenti, romelic moicavs dawesebulebaSi ZuZuTi kvebis
(Z.k.) 10 safexuris danergvis principebs, uzrunvelyofs ZuZuTi kvebis
praktikis xelSewyobas da dacvas. dawesebulebis erTerTi wevri,
romelic arCeulia ZuZuTi kvebis politikis ganxorcilebaze
pasuxismgebel pirad, unda flobdes politikis dokuments.
pasuxismgebeli piri valdebulia gaacnos TanamSromlebs politikis
ganxorcielebis ZiriTadi meqanizmebi.
politikis amsaxveli dokumenti xelmisawvdomi unda iyos yvela
TanamSromlisaTvis. igi unda arsebobdes/gamofenili iyos dawesebulebis
ganyofilebebSi, qalTa konsultaciis CaTvliT.
politikis dokomenti dawerili unda iyos personalisa da
pacientebisaTvis gasageb enaze.
II safexuri
samedicino personalis informirebis done
samSobiaro saxlis samedicino personalisTvis periodulad unda
tardebodes saganmanaTleblo seminarebi baksis 10 principis danergvis
Taobaze.
dawesebulebas unda qondes saswavlo seminaris gegma, rogorc ZiriTadi
Semadgenlobis, ise axali TanamSromlebisTvis. saswavlo seminaris
xangrZlivoba - aranakleb 3 saaTisa, 3 saaTiani klinikuri muSaobis
CaTvliT (klinikuri gamocdilebis misaRebad).
pasuxismgebelma pirma unda SeZlos ZuZuTi kvebis saswavlo gegmis/kursis
mokle aRwera.
dawesebulebis xelmZRvanelma unda daadasturos, rom samSobiaro saxlis
mTelma personalma miiRo monawileoba baksis principebis swavlebis
procesSi, xolo axal TanamSromlebs mieca saTanado miTiTeba da
CarTulia saswavlo gegmaSi uaxloesi 6 Tvis manZilze.
TanamSromelTa 80%-ma unda daadasturos, rom maT gaiares
zemoTaRniSnuli saswavlo kursi an Tu isini muSaoben samSobiaroSi 6
Tveze naklebi periodi, maT miiRes Sesabamisi instruqcia.
80%-s unda SeeZlos Z.k. principebis Sesaxeb 5 kiTxvidan 4-ze swori
pasuxis gacema.
28
III safexuri
orsulTa informirebis done
Tu samSobiaros aqvs qalTa konsultacia an mSobiarobis Semdgomi
ganyofileba, orsulebs unda Cautardes konsultireba ZuZuTi kvebis
sakiTxebze. aRniSnuli unda daadasturos pasuxismgebelma pirma da
warmoadginos saganmanaTleblo kursis gegma.
konsultireba orsulobis pirveli 6 Tvis ganmavlobaSi unda Catardes
ZuZuTi kvebis mniSvnelobaze, upiratesobasa da ZuZuTi kvebis marTvis
ZiriTad principebze.
10 orsuli qalidan 80%-ma, romelTa gestaciuri asaki tolia an meti 32
kviraze, da romlebic sargebloben mSobiarobamde antenataluri
samsaxuriT, unda daadasturos, rom Cautarda konsultireba ZuZuTi
kvebis upiratesobaze da unda daasaxelos Z.k., Tundac 2 upiratesoba,
daaxasiaTon Z.k. marTvis zogierTi principi (mag: moTxovnilebiTi kveba,
rZis raodenobis SenarCuneba, swori moWideba, sxeulis pozebi da sxva.)
unda daadasturon, rom maT ar CatarebiaT saubrebi xelovnuri sakvebis
gamoyenebis Sesaxeb.
IV safexuri
kani-kanTan kontaqti da pirveli moWidebis ganxorcielebis sixSire
melogineTa 80%-ma 10-dan unda daadasturos, rom normaluri vaginaluri
mSobiarobidan, pirvel 0,5/1 saaTSi maT miuyvanes axalSobili,
ganxorcielda kani-kanTan kontaqti aranakleb 30 wuTisa. personali
daexmara ZuZuTi kvebis ganxorcielebaSi.
melogineTa 50%-ma 5-dan sakeisro kveTis Semdgom unda daadasturos, rom
narkozidan gamofxizlebis Semdeg naxevari saaTis ganmavlobaSi, maT
miuyvanes bavSvi da ganxorcielda kani-kanTan kontaqti aranakleb 30
wuTisa, personali daexmara ZuZuTi kvebis ganxorcielebaSi.
V safexuri
dedis informireba ZuZuTi kvebis ganxorcielebis teqnikis Sesaxeb
melogineTa 80%-ma 15-dan unda aRniSnos, rom saSualo medpersonalma
SesTavaza daxmareba ZuZuTi kvebis ganxorcielebaSi mSobiarobidan 6
saaTis ganmavlobaSi. miawodes sityvieri/werilobiTi informacia ZuZuTi
kvebis teqnikisa da rZis gamowvelis Sesaxeb.
melogineTa 80%-ma 5-dan unda aRniSnos, rom maT gauwies daxmareba rZis
gamowvelis principebis dauflebasa da ganxorcielebaSi laqtaciis
SesanarCuneblad.
samedicino personalis 80%-ma 10-dan unda aRniSnos, rom isini aswavlian
dedebs, rogor moaWidon bavSvi ZuZus da xeliT rZis gamowvelis
teqnikas.
TanamSromlebis 80%-ma unda SeZlos swori moWidebis da sxeulis
poziciis swavlebis demonstrireba erT dedasTan. TanamSromlebis 80% -
ma unda SeZlos aRweros rZis gamowvelis teqnika, romelsac aswavlian
dedebs.
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VI safexuri
samSobiaroSi damatebiTi sakvebis an sxva siTxis gamoyeneba
damatebiTi sakvebis an siTxis gamoyenebis dros, SemTxvevaTa 80%-Si unda
arsebobdes samedicino Cveneba, garda im SemTxvevebisa, roca mSobiare
Tavad acxadebs uars ZuZuTi kvebaze.
ufrosma eqTanma da TanamSromlebma unda SeZlon ZuZuTi kvebis
samedicino winaaRmdeg Cvenebebis daasaxeleba.
VII safexuri
dedisa da bavSvis erTad yofnis praqtika
melogineTa 80%-ma 15-dan (sakeisros CaTvliT - 5) unda daadasturos, rom
mSobiarobis Semdeg (sakeisros SemTxvevaSi roca dedebs SeuZliaT
gamofxizlebis Semdeg bavSvTan kontaqti) maTi Cvilebi imyofebian maTTan
erTad palataSi mudmivad 24 saaTis ganmavlobaSi, garda im periodisa,
romelic saWiroa sxvadasxva procedurebisTvis (1 saaTi).
VIII safexuri
ZuZuTi kvebis ganxorcieleba moTxovnilebiT
melogineTa 80%-ma 15-dan (5 sakeisro) unda daasturos, rom bavSvs kvebavs
moTxovnilebis mixedviT. 80%-ma unda daadasturos, rom unda gaaRviZos
bavSvi kvebisTvis Tu Zilis xangrZlivoba aRemateba 3 saaTs an Tu dedas
sarZeve jirkvali gadavsebuli aqvs.
IX safexuri
sawovriani boTlisa da satyuaras gamoyeneba
melogineTaA 80%-ma 15-dan unda daadasturos, rom maTi bavSvebis kvebis
dros ar yofila gamoyenebuli sawovriani boTli da satyuara.
pasuxismgebeli piri adasturebs, rom ZuZuTi kvebaze myof bavSvebSi ar
iyenebdnen sawovrian boTlebs da satyuarebs.
X safexuri
ZuZuTi kvebis mxardaWera samSobiarodan gaweris Semdeg
melogineTa 80%-ma 15-dan (5 sakeisro) unda daadasturos, rom gawerisas
miiRo rekomendacia, vis mimarTon ZuZuTi kvebis Semdgomi mxardaWerisa
da problemebis mogvarebisTvis (pirveladi jandacvis rgoli,
arasamTavrobo seqtori, deda-dedis damxmare jgufi, Tu aseTi arsebobs).