5 მშობიარობის ფიზიოლოგია

TSSU JSI

Tbilisis saxelmwifo samedicino

universiteti, UNICEF saqarTvelo, JSI

saxelmZRvanelo perinatalogiaSi

studentTa hendauti

moduli #6

I nawili

Nnormaluri mSobiaroba

nawili pirveli

Pprezentacis dasasruls studentmaunda icodes:

• mSobiarobis fiziologia da biomeqanizmi

• mSobiarobis dawyebis mizezebi

• mSobiarobis dros saSvilosnoSi mimdinarecvlilebebi

• mSobiarobis biomeqanizmi

• momyolis mocilebis meqanizmi

mSobiaroba

• orsuloba ar aris davadeba,mSobiaroba ar arissamedicino problema.orsuloba da mSobiarobaaris ufro metad mniSvnelovani personaluri, seqsualuri da socialuri movlena,vidresamedicino problema (mjo 1997)

• mSobiaroba aris mniSvnelovani fiziologiurimovlena, romelic sruldeba axalSobilisdabadebiT

mSobiaroba reproduqciuli procesis centraluri da umniSvnelovanesi

movlenaa. es procesi dedis organizmisaTvis gamocdaa, nayofisaTvis _

saxifaTo mogzauroba. mSobiarobis procesSi sami komponentis -- saSvilosnos

SekumSvis, samSobiaro gzebis gamtarobisa da nayofs Soris urTierTkavSiris

Sedegad, nayofi saSvilosnodan ibadeba; anu mSobiaroba aris procesi, romlis

saSualebiTac, sicocxlisunarianobis miRwevisTanave, nayofi saSvilosnodan

gamoZevdeba. Ees gansazRvrebebi saTanadod ver xsnis im samedicino, socialuri

da eTikuri aspeqtebis rTul urTierTkavSirs, romelTa erTianoba mSobiarobas

sakmaod rTul amocanad aqcevs.

orsul qals mSobiarobis procesSi – mSobiare (parturiens) ewodeba:

pirvelmSobiares - primipara, ganmeorebiTmSobiares – multipara.

Intrapartum care care of healthy women and their babies dur ing childbirth ClinicalGuideline September 2007

mSobiaroba SeiZleba iyos:

drouli mSobiaroba

(partus maturus normalis) –mSobiaroba orsulobis37-41kviras +6 dRe vadaze

droulad iTvleba mSobiaroba orsulobis 37-dan 40 kviris vadamde, ufro zustad, 41kviras + 6dRemde.

Акушерство, справочник Калифорнийского университета, М. 1999

mSobiaroba SeiZleba iyos

• naadrevi mSobiaroba(partuspraematurus)- spontanuri mSobirobaorsulobis 22-37 kviris vadze

• vadagdacilebuli mSobiaroba(partusserotinus)-mSobiaroba sruli 42 kviris orsulobisa da met vadaze

naadrevad mSobiaroba sicocxlisunariani nayofis dabadebidan 37 kviramde iTvleba. dReisaTvis, axalSobili, romlis masa dabadebisas 500,0 gr. da metia, sicocxlisunarianad iTvleba; radgan orsulobis 22 kviris vadaze nayofis wona 500,0 gramia, amitom nayofis dabadeba orsulobis 22 kviris Semdeg mSobiarobad miiCneva. aqedan gamomdinare, naadrevi mSobiarobaa mSobiaroba orsulobis 22kviridan 37 kviramde. xolo vadagadacilebulia orsulobis 42 kviris zemoT da agreTve, is, romelic vadagadacilebis niSnebis mqone axalSobilis dabadebiT mTavrdeba.

Акушерство, справочник Калифорнийского университета, М. 1999

Ffiziologiuri mSobiarobis niSnebi

• TviTnebiTi dawyeba

• erTi nayofis TaviT winmdebareoba

• orsulobis vada 37-42 kvira

• mSobiaroba bunebrivi samSobiarogzebiT, saeqimo Carevis gareSe

• dedisa da nayofis damakmayofilebelimdgomareoba.

jandacvis msoflio organizaciis ganmartebiT, fiziologiuri mSobiarobisTvis damaxasiaTebelia:

-TviTnebiTi dawyeba;

-erTi nayofis TaviT winmdebareoba;

-orsulobis vada 37-42 kviraze;

-- raime Carevis ararseboba;

-bunebrivi samSobiaro gzebiT mSobiaroba, romelic ar saWiroebs saeqimo Carevas;

-mSobiarobis Semdeg dedisa da axalSobilis damakmayofilebeli mdgomareoba.

Ggarda fiziologiurisa, mSobiaroba SeiZleba iyos paTologiuri, inducirebuli – samSobiaro moqmedebis xelovnurad aRZvra dedis an nayofis CvenebiT da gegmiuri.

Intrapartum care care of healthy women and their babies dur ing childbirth ClinicalGuideline September 2007

mSobiaroba

• mSobiaris Svilosnobis funqciaori definiciT fasdeba

gravidity da parity• 23 wlis qali aris para0 da gravida 2

ras niSnavs es?

sameano anamnezis Sekrebisas, gamoiyeneba sayovelTaod miRebuli definiciebi, romlis mixedviTac SeiZleba gavigoT, meramdenea mimdinare orsuloba an ramdeni orsuloba damTavrda sicocxlisunariani nayofis dabadebiT.

Pparity (pario) niSnavs anamnezSi mSobiarobaTa raodenobas,xolo gravidity -- anamnezSi orsulobaTa odenobas, am orsulobaTa gamosavlis miuxedavad. anu slaidze moyvanili magaliTiT, qals mSobiaroba ar hqonia, magram hqonda ori orsuloba.

Williams. Obstetrics. 22nd edition,2005

,,Акушерство” – Г.М. Савельева, М. Медицина, 2000 г.

Parity da gravidity -definiciebi

• Parity-warsulSi gadatanilmSobireTa ricxvi, maT SorismkvdradSobadobac

• Gravidity-qalis orsulobaTaraodenoba mimdinare orsulobisCaTvliT

Nullipara qalia, visac arasodes hqonia orsuloba, romelic sicocxlisunariani nayofis dabadebiT damTavrebula.

Pprimipara ki qali, visac hqonda erTi mSobiaroba, sicocxlisunariani nayofis an nayofTa dabadebiT.

MulTipara aris qali, erTze meti mSobiarobiTa da sicocxlisunariani nayofiT(nayofebiT).

Nulligravida -- qali, romelsac anamnezSi orsuloba ar hqonia.

Primigravida, visac anamnezSi erTi orsuloba aqvs, miuxedavad gamosavlisa.

Multigravida ki -- qali, romlis anamnezSic erTze meti orsulobaa.



mSobiaroba

mSobiarobis dawyebis mizezebi(1)

• polietiologiuri procesia, romlis dawyebis mizezebidRemde ucnobia

dRemde upasuxodaa kiTxva: ratom ewyeba orsul qals samSobiaro moqmedeba droulad da spontanurad. mSobiarobis dawyebis meqanizmi Cvens dromde ucnobia.



mSobiaroba

mSobiarobis dawyebis mizezebi(2)

• samSobiaro moqmedebis iniciaciisregulaciis fetaluri faqtorebi:

_ fetaluri kortizoli da sxvafetaluri steroidebi

_ fetaluri prostaglandini (E2) daoqsitocini

arsebobs hipoTeza, rom mucladmyofi nayofi mSobiarobis CamrTavi meqanizmia. nayofis hipoTalamus-hipofizaruli-Tirkmelzeda jirkvlis simwifis miRwevis Semdeg, rac genetikuradaa determinebuli, nayofis Tirkmelzeda jirkvlebi aqtiurdeba da matulobs fetaluri kortizolisa da sxva fetaluri steroidebis raodenoba, rac mSobiarobis dawyebis signalia.

samSobiaro moqmedebis Tanamedrove koncefciiT, mSobiarobis iniciaciaSi ZiriTadi roli fetalur prostaglandinebsa da oqsitocins eniWeba.



mSobiarobis dawyebismizezebi(3)

• samSobiaro moqmedebis nervuliregulacia:

_ c.n.s.-Si orsulobis dominantistransformireba mSobiarobisdominantad

mSobiarobis procesis mimdinareoba damokidebulia c.n.s.-is funqcionalur mdgomareobaze. orsulobis procesSi qals c.n.s.-is erT-erT nawilSi uyalibdeba orsulobis dominanta, romelic mSobiarobis procesis moaxloebisas transformirdeba mSobiarobis dominantad, erTian dinamiur sistemad, romelic umaRlesi nervuli regulirebis centrebTan erTad, Semsrulebel organosac aerTianebs. mxolod formirebuli samSobiaro dominanta aregulirebs mSobiarobis mosamzadebel periods da TviT mSobiarobis procesis mimdinareobas.




• samSobiaro moqmedebishormonaluri regulacia:

_estrogenebis sinTezis mateba

_progesteronis sinTezis

daqveiTeba

mSobiarobis dawyebis win icvleba qalis hormonaluri balansi, qveiTdeba orsulobis hormonis-progesteronis sekrecia da matulobs estrogenebis sinTezi. mxolod garkveuli hormonaluri wonasworobisas xdeba SesaZlebeli mSobiarobis procesSi saSvilosnos efeqturi SekumSva. mniSvnelovania ara romelime hormonis absoluturi koncentracia sisxlSi, aramed am hormonebis koncentraciaTa Sefardeba(orsulobis dros estrioli/pregnadioli 1/100, mSobiarobis win 1/1).




• samSobiaro moqmedebis humoraluriregulacia

_ prostaglandinebi E2 da F2

_ oqsitocini

_ serotonini

_ kininebi

_ histamini

samSobiaro moqmedebis SenarCunebasa da nayofis dabadebas, dedis organizmSi sinTezirebuli oqsitocini da prostoglandinebi uzrunvelyofen. samSobiaro moqmedebis ganviTarebaSi ZiriTadi mniSvneloba eniWeba endogenur prostaglandinebs E2. da F2ą.

prostoglandinebis moqmedeba mravalmxrivia: moqmedeben saSvilosnos yelis momwifebis procesze (E2), xels uwyoben saSvilosnos sinqronuli SekumSvebis ganviTarebas (F2ą), zrdian miometriumis mgrZnobelobas oqsitocinis mimarT. oqsitocini yvelaze Zlieri uterotropuli saSualebaa, romelic sinTezirdeba hipoTalamusSi da akumulirdeba hipofizis ukana nawilSi. oqsitocinisa da prostaglandinebis moqmedeba samSobiaro procesis iniciaciasa da SenarCunebaSi erTmaneTs mWidrod gadaejaWveba.

serotonins, kininebs, histamins garkveuli adgili ukaviaT mSobiarobis procesis ganviTarebasa da saSvilosnos kumSviTi aqtivobis gaZlierebaSi.




• samSobiaro moqmedebis regulaciaSireproduqciuli sistemis roli –saSvilosnoSi mimdinare cvlilebebi

_ miometriumis receptoruli aparati

_ kalciumis arxebis simWidrovis mateba

_ napralovani kontaqtebis formireba

_ peismeikeruli aqtivoba

samSobiaro moqmedebis dawyebisaTvis uaRresad mniSvnelovania samizne organoSi – saSvilosnoSi -- mimdinare cvlilebebi:

-icvleba saSvilosnos receptoruli aparati – oqsitocinebis receptorebis raodenoba 300-jer matulobs; amasTanave, maTi koncentracia saSvilosnos fuZesa da qveda segmentSi gansxvavebulia. matulobs miometriumis recefcia estrogenebis, serotoninis, histaminisa da kateqolaminebis mimarT.

-miometriumSi matulobs metaboluri procesebis intensioba, kumSviTi cilis aqtomiozinis Semcveloba (25%-mde).

-aseve, matulobs kalciumis arxebis simWidrovec. ujredSi Ca+2 ionebis zemoqmedebiT, xorcieldeba aqtinisa da miozinis urTierTqmedeba, rac miocitis SekumSvas ganapirobebs.

-miometriumSi matulobs ujredSorisi specializebuli kavSirebis e.w. napralovani kontaqtebis -- gap junction-is raodenoba. isini miocitebis SekumSvaTa sinqronizacias da koordinirebas uzrunvelyofen.

-peismeikeruli aqtivoba – mSobiarobis dawyebasTan erTad, saSvilosnoSi, mis erT-erT kuTxeSi formirdeba ujredTa jgufi, romelSic aRgzneba aRmocendeba pirveladad – e.w. riTmis wamyvani. am ubnidan SekumSvis talRa mTel saSvilosnoze cirkularulad vrceldeba.



mSobiarobis winamorbedi niSnebi

• muclis daweva• Wipis amoburcva• orsulis guneba-ganwyobis Secvla• nayofis moZraobiTi aqtivobis daqveiTeba• orsulis sxeulis masis 1-2 kg-iT dakleba• araregularuli, mqaCavi tkivili welisa da

muclis qveda areSi• blanti, Wimvadi, zogjer sisxlnarevi

lorwovani gamonadeni saSodan• saSvilosnos yelis momwifeba.

muclis daweva vlindeba, roca saSvilosnos qveda segmenti gadaiWimeba da nayofis Tavi Cadgeba menjis SesavalSi, muclis daweva umetesad, pirvelorsulebs aReniSnebaT.

orsulis guneba-ganwyobis Secvla – momatebuli aRgznebadobidan apaTiis mdgomareobamde -- aixsneba mSobiarobis win c.n.s.-sa da vegetatiur nervul sistemaSi mimdinare cvlilebebiT. mosamzadebel periodSi Warbobs adrenerguli (simpatikur-adrenaluri) nervuli sistemis gavlena.

lorwovani gamonadeni saSodan, e.w. lorwovani(kristeleris )sacobi, cervikaluri arxidan gamoyofili lorwoa, romelic sisxlnarevia, rasac saSvilosnos yelis gaxsnisas mcire zomis naxeTqebidan gamoyofili sisxlis Sereva ganapirobebs.

mSobiarobis win saSvilosnos yeli struqturul cvlilebebs ganicdis da TandaTan “mwifdeba”. saSvilosnos yelis simwife ganpirobebulia kolagenis da elastinis morfologiuri cvlilebiT, SemaerTebeli qsovilis garbilebiT, misi hidrofilobis matebiT. saSvilosnos yelis momwifebis procesebze moqmedebs prostoglandini E2, romelic zrdis kolagenazis sinTezs, rac Tavis mxriv, iwvevs saSvilosnos yelis garbilebasa da damoklebas.

biSopis cxrili (1)

+1, +2-1, 0-2-3Foetal station

>3 cm2-3 cm1-2 cm<1 cmDilation

80%60-70%40-50%0-30%Effacement

-SoftIntermediateFirmConsistency

-AnteriorIntermediatePosteriorPosition

3210Parameter\Score

saSvilosnos yelis simwife fasdeba qulebiT, sxvadasxva sqemis mixedviT: xeCinaSvili, Burnhill,

Burnett, Чернуха. dReisaTvis sayovelTaod miRebulia 1964 wels Bishop-is mier SemuSavebuli sqema, romelSic yuradReba eqceva Semdeg komponentebs:

-saSvilosnos yelis gaxsna(dilatation);

< 1sm-ze -- 0 qula;

1-2 sm-ze -- 1 qula;

2-4 sm-ze -- 2 qula;

> 4sm-ze -- 3 qula;

--saSvilosnos yelis sigrZe (gadasworeba-effasement)

1.saSvilosnos yelis sigrZe >4 sm-ze (gadasworebis 0%) -- 0 qula;

2.saSvilosnos yelis sigrZe 2-4 sm-ze (gadasworebis 0 - 50%) -- 1 qula;

3.saSvilosnos yelis sigrZe 1-2 sm-ze (gadasworebis 50-75%) -- 2 qula;

4.saSvilosnos yelis sigrZe <1-sm-ze (gadasworebis 75%) -- 3 qula;

_ saSvilosnos yelis konsistencia(consistency)

1.mkvrivi konsistencia - 0 qula;

2.garbilebuli konsistencia - 1 qula;

3.rbili konsistencia - 2 qula;

-- saSvilosnos yelis mdebareoba(position)

saSvilosnos yeli mimarTulia ukan - 0 qula;

saSvilosnos yeli centrirebulia - 1 qula;

3.saSvilosnos yeli mdebareobs win -- 2qula;

-- winamdebare nawilis mdebareoba(foetal station)

1.winamdebare mdebareobs-(3 doneze) – 0 qula;

2.winamdebare mdebareobs(-1doneze--2qula;

3.winamdebare mdebareobs(+1doneze) -- 2qula;

4.winamdebare mdebareobs(+2doneze) -- 3 qula;

--modifikatorebi:+ 1 qula

a) preeklamfsia;

b) yovel wina vaginalur mSobiarobaze -- 1 qula;

a) mSobiaroba igegmeba;

b) an namSobiarebia;

g) sanayofo wylebis naadrevi daRvra.

biSopis cxrili(2)

• interpretacia:

• Sefaseba 5qulaze <an = mianiSnebs, rom mSobiroba ar daiwyebainduqciis gareSe

• Sefaseba 9qula da> mianiSnebs rommSobiaroba savaraudod daiwyebaspontanurad

rogorc yvela sxva sqema, biSopis sqemac sakonsultacio saSualebaa. saSvilosnos yelis simwifesa da warmatebuli momSobiarebis albaTobas Soris arsebobs korelaciuri damokidebuleba. biSopis sqema mxolod cifrul monacemebad gardaqmnis imas, rac gamocdilma eqimma miiRo, vaginaluri gasinjviT saSvilosnos yelis mdgomareobis Sefasebisas.

eqimebisaTvis biSopis sqemis gamoyeneba saSvilosnos yelis simwifis dasadgenadaa rekomendebuli, gansakuTrebiT -- mSobiarobis induqciis sakiTxis gadawyvetisas.

Tu biSopis sqemiT Sefaseba <6qulazea, maSin induqciis dawyebamde mizanSewonilia saSvilosnos yelis momwifeba, xolo Tu -- >=6, maSin mSobiarobis induqcia dasaSvebia oqsitociniT.

Ggarda amisa, biSopis sqemis monacemebis safuZvelze, SeiZleba vivaraudoT, Tu rogor warimarTeba mSobiarobis procesi. magaliTad, Tu gveqnebaSefaseba >8 qulaze, maSin induqciis Semdeg, savaraudoa, rom mSobiaroba warimarTos, rogorc spontanuri. Catarda kvleva,sadac Seiswavles, Tu ra kavSiri arsebobs erTis mxriv, biSopis sqemiT Sefasebis efeqturobasa da gadatanil mSobiarobaTa ricxvs Soris da meores mxriv, mSobiarobis induqciidan 24saaTis ganmavlobaSi warmatebul vaginalur mSobiarobaTa prognozirebas Soris. aRmoCnda, rom rom am ori monacemis kombinaciis gamoyeneba damoukidebel prognoznostul maCvenebladac ESeiZleba.

Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol, 1964, 24, 267.

Royal College of Obstetricians and Gynaecologists (RCOG). Induction of labour. Evidence-based Clinical Guideline Number 9. RCOG

Press, 2001.

B Bueno et al. The labor induction: integrated clinical and sonographic variables that predict the outcome. Journal of Perinatology,

2007, 27, 4–8.

biSopis cxrili(3)spinaluri doneebi

- 5 cm

+ 5 cm

0

- 3- 2

- 1

0

+ 2

+ 1

+3

amerikuli klasifikaciiT, menjis Rru dayofilia doneebad. nulovan doned miCneulia sajdom wvetebze gamavali sibrtye. is sibrtyeebi, romlebic 1, 2, 3 sm-ze zeviT mdebareobs nulovani donidan iwodeba -1, _2,_3 doneebad, xolo 1, 2 da 3 sm-ze qveviT mdebare sibrtyeebi -- +1,+2, +3 doneebad.

mSobiarobis periodebi

• mSobiarobis pirveli periodi –saSvilosnos yelis sruli gaxsnis

• mSobiarobis meore periodi –nayofis dabadebis

• mSobiarobis mesame periodi –momyolis gamoZevebis

mSobiaroba uwyveti procesia da tradiciulad, sam periodad iyofa.

mSobiarobis I periodi aris dro regularuli samSobiaro moqmedebis dawyebidan saSvilosnos yelis srul gaxsnamde.

mSobiarobis procesis progresireba mSobiarobis I periodSi saSvilosnos yelis gaxsnis procesiT ganisazRvreba.

mSobiarobis II periodi iwyeba saSvilosnos yelis sruli gaxsnidan nayofis (an nayofebis) dabadebamde.

mSobiarobis procesis progresirebis indeqsia mSobiarobis II periodSi samSobiaro arxSi nayofis winamdebare nawilis winmsvleloba.

mSobiarobis III periodi iwyeba nayofis (an nayofebis) dabadebis momentidan da mTavrdeba momyolis gamoZevebiT – e.w. momyolis periodi.

WILLIAMS OBSTETRICS,22nd edition,2005

mSobiarobis I periodi (1)

• iwyeba regularuli samSobiaro moqmedebisdawyebidan da grZeldeba saSvilosnos yelissrul gaxsnamde

• samSobiaro moqmedebis dawyebis maxasiaTeblebi:

-10 wT-is ganmavlobaSi erTi an metisaSvilosnos SekumSva 20 wm-is an metixangrZlivobiT

-saSvilosnos yelSi mimdinare struqturulicvlilebebi

fiziologiuri mSobiarobis umniSvnelovanesi da sakmaod rTuli momentia spontanuri mSobiarobis dawyebis drois gansazRvra. jandacvis msoflio organizaciam SeimuSava samSobiaro moqmedebis dawyebis Semdegi kriteriumebi:

1. saSvilosnos SekumSva 10 wT-Si 1 an metad, 20 wm-is da meti xangrZliobiT;

2. saSvilosnos yelSi mimdinare struqturuli cvlilebebi.

saSvilosnos yelSi mimdinarestruqturuli cvlilebebi

mSobiarobis I periodSi rbili samSobiaro gzebi formirdeba. mis SemadgenlobaSi Sedis saSvilosnos qveda segmenti, romlis formireba moxda orsulobis bolos zeyelisken -- saSvilosnos yeli, saSo, menjis fskeris kunTebi, Sorisi.

saSvilosnos yelSi mimdinarestruqturuli cvlilebebi

saSvilosnos yelis gadasworebis xarisxs adgenen mocemul momentSi saSvilosnos yelis sigrZis mis normalur sigrZesTan SefardebiT. Tu saSvilosnos yeli normasTan SedarebiT naxevrad damoklebulia, Seesabameba gadasworebis 50%, xolo, roca saSvilosnos yeli gaTxeldeba, mTlianad, anu 100%-Taa gadasworebuli.

saSvilosnos yelis gaxsnis sidides saSvilosnos yelis vaginaluri gasinjviT -- saSvilosnos yelis erTi kididan meoremde TiTebis moTavsebiT adgenen da gamoxataven santimetrebSi. saSvilosnos yelis gaxsna 10 sm-mde miCneulia srulad, radganac gaxsnis es xarisxi sakmarisia nayofis Tavis gamosavlelad.

saSvilosnos yelis pozicia ganisazRvreba nayofis Tavis mimarT saSvilosnos yelis RerZis mdebareobiT da SeiZleba iyos:wina, ukana an Sualeduri.

mSobiarobis I periodi(2)

• saSvilosnos SekumSvis talRa iwyebaerT-erTi kvercxsavali milis kuTxeSi –e.w. riTmis wamyvanis - pacemaker-isCamoyalibeba

• samSobiaro Setevebis mtkivneuloba, intensivoba da sixSire matulobssaSvilosnos yelis gaxsnisparalelurad.

saSvilosnos SekumSvis talRa saSvilosnos erT-erT kuTxeSi (upiratesad, marjvniv) e.w pacemaker-(riTmis wamyvan) ubanSi iwyeba da iqidan sammagi daRmavali gradientis principiT, cirkularulad gadaadgileba zemodan -- saSvilosnos fuZidan qveviT, saSvilosnos qveda segmentisaken. miuxedavad imisa, rom saSvilosnos fuZeSi dawyebuli SekumSvis talRa ufro Zlieri da xangrZlivia, mTeli saSvilosno erTroulad maqsimalur SekumSvas axerxebs, rac qmnis optimalur pirobas saSvilosnos kumSviTi aqtivobisaTvis.


saSvilosnos SekumSvis talRa gadaadgildebasammagi daRmavali gradientis principiT:

• saSvilosnos SekumSvis talRa mimarTulia zemodanqvemoT

• saSvilosnos SekumSvis xangrZlivoba klebulobssaSvilosnos fuZidan qveda segmentisaken SekumSvistalRis gadaadgilebisas

• saSvilosnos SekumSvis intensivoba klebulobssaSvilosnos fuZidan qveda segmentisken SekumSvistalRis gadaadgilebisas

abzaci mTlianad meordeba sityva-sityviT --Y

saSvilosnos SekumSvis talRa iwyeba saSvilosnos erT-erT kuTxeSi (upiratesad marjvniv) e.w pacemaker-(riTmis wamyvan)ubanSi da iqidan sammagi daRmavali gradientis principiT, gadaadgileba cirkularulad zemodan, saSvilosnos fuZidan qvemoT, saSvilosnos qveda segmentisaken. miuxedavad imisa, rom saSvilosnos fuZeSi dawyebuli SekumSvis talRa ufro Zlieri da xangrZlivia, saSvilosno mTlianad maqsimalur SekumSvas aRwevs erTdroulad, rac qmnis optimalur pirobas saSvilosnos kumSviTi aqtivobisaTvis.

samSobiaro moqmedebis gavrcelebis siCqare 2-3 sm/s-ia, dawyebidan 15-20 wT-

Si SekumSva moicavs mTel saSvilosnos, xolo SekumSvis intensioba da

xangrZlioba saSvilosnos fuZeSi 2-3-jer metia, vidre qveda segmentSi.

mSobiarobis procesSi saSvilosnos SekumSva, sammagi daRmavali gradientis principiT, qmnis saSvilosnos yelis gaxsnis aucilebel pirobebs.

mSobiarobis procesSi saSvilosnos kumSviTi moqmedebis meqanizmi detalurad Seiswavles 1960? wels mecnierebma -- Caldeyro-Barsia-sa da Alvares-ma. eqsperimentebis safuZvelze, maT gamoTqves mosazreba, romelsac msoflios yvela meani aRiarebs. es debulebebia: sammagi daRmavali gradientis principi da saSvilosnos SekumSvis siZlieris raodenobrivi gamoxatva. am debulebis safuZvelze, saSvilosnos aqtivoba montevideos erTeulebSi gamoixateba: 1ME= samS. Setevis saS. amplitudas 10wT-Si X

saSvilosnos SekumSvaTa ricxvze; normaSi saSvilosnos aqtivoba 150-300E-is tolia.


• saSvilosnos yelis sruli gaxsna 0-dan10sm-mde (lurji isari) mSobiarobis pirvel periodSiganpirobebulia:

_saSvilosnos qveda segmentis distraqcirebulicirkularuli muskulaturis qvemodan zeviTgadaadgilebiT saSvilosnos tanis sigrZivimuskulaturis kontraqciis da retraqciis xarjze

(wiTeli isari).

_ sanayofe buStisa an winamdebare nawilis zemodan qvemoTganxorcielebuli zewoliT

( mwvane isari).


saSvilosnos yelis gaxsnis meqanizmSi monawileobs ori erTmaneTis sawinaaRmdegod mimarTuli Zala: 1.qvemodan zemoT mimarTuli, romelic qveda segmentis muskulaturas zemoT gadaadgilebs (wiTeli isari) da 2. zemodan qvemoT mimarTuli sanayofo buStisa an winmdebare nawilis zewola (mwvane isari). miometriumSi TiToeuli samSobiaro Setevis dros erTdroulad mimdinareobs sami procesi:

saSvilosnos kunTovani boWkoebis SekumSva _kontraqcia

erTmaneTis mimarT SekumSuli kunTovani boWkoebis gadaadgileba --retraqcia.

kunTovani boWkoebis daWimva -- distraqcia.

saSvilosnos tanSi, sadac kunTovani boWkoebi upiratesad sigrZivaa ganlagebuli, samSobiaro Setevis dros xdeba kunTovani boWkoebis kontraqcia da retraqcia; pauzis dros kunTovani boWkoebi ar ubrundebian sawyis ganlagebas, ris gamoc saSvilosnos qveda nawilSi mdebare sigrZivi muskulatura qvemodan zemoT gadaadgildeba. sigrZivi muskulaturis retraqciuli gadaadgilebis paralelurad, saSvilosnos qveda segmentSi cirkularulad ganlagebuli kunTebis distraqciac mimdinareobs. SekumSvis dros kontraqcirebuli da retraqcirebuli sigrZivi kunTebi Wimavs da azidavs qveda segmentis distraqcirebul kunTebs, rac saboloo jamSi, xels uwyobs saSvilosnos yelis gaxsnis process.

paralelurad, samSobiaro Setevis dros, saSvilosnos kedlebis Tanabarzomieri zewolis gamo, sanayofo wylebi hidravlikis kanonebis Tanaxmad, miemarTeba qveda segmentisaken, romlis centrSi mdebareobs saSvilosnos yelis SigniTa piri. sanayofo wylebis zewoliT sanayofo garsebis qveda polusi saSvilosnos kedels

aSrevdeba, sanayofo buSti soliseburad CaeWedeba saSvilosnos yelis arxis SigniTa pirSi da xsnis mas Signidan(sanayofo buSti ewodeba sanayofo garsebis im nawils, romelic sanayofo wylebTan erTad, soliseburad iWreba saSvilosnos yelis arxSi).


mSobiarobis I periodi, mSobiarobis sam periods Soris yvelaze xangrZlivia da pirvelmSobiareebsa da ganmeorebiTmSobiareebSi gansxvavebulad gamoiyureba. gansxvavdeba ara marto saSvilosnos yelis gaxsnis siCqare, gansxvavebulad mimdinareobs TviT gaxsnis procesic.

pirvelmSobiareebSi jer saSvilosnos yelis SigniTa piri ixsneba, mere saSvilosnos yeli gadaswordeba da ixsneba gareTa piric.

ganmeorebiTmSobiareebSi saSvilosnos yelis SigniTa piri da gareTa piri ixsneba TiTqmis erTdroulad da amave dros, saSvilosnos yelic mokldeba. saSvilosnos yelis gaxsnis sidides adgenen saSosmxrivi gasinjviT, magram es SesaZlebelia abdominaluradac; kontraqciuli rgolis mdebareobis mixedviT, boqvenis Sesaxsrebis zeda kididan, SeiZleba vimsjeloT saSvilosnos yelis gaxsnis sidideze.

SeniSvna: kontraqciuli rgoli aris Rarisebri CaRrmaveba gaTxelebul qveda segmentsa da saSvilosnos tans Soris.


• latenturi faza – regularulisamSobiaro moqmedebis dawyebidan dasaSvilosnos yelis 0- dan 3 sm-mdegaxsnamde. xangrZlivoba – 6-8 saaTi. saSvilosnos yelis gaxsnis siCqare –0,35 sm/sT.

• aqtiuri faza – saSvilosnos yelisswrafi gaxsna – 3-dan 10 sm-mde. saSvilosnos yelis gaxsnis siCqare_1sm/sT

mSobiarobis I periodis (8)

• saSvilosnos yelis gaxsnis siCqareaqtiur fazaSi:

-pirveladmSobiareebSi 1,5 – 2 sm/sT-ganmeorebiTmSobiareebSi 2 – 2,5 sm/sT

• mSobiarobis pirveli periodisxangrZlivoba:10-12 sT. pirvelad mSobiareebSi8-10 sT. ganmeorebiT mSobiareebSi

mSobiarobis I periodis mimdinareobaSi or -- latentur da aqtiur – fazas ganasxvaveben. latenturi fazis xangrZlioba pirvelmSobiareebsa da ganmeorebiTmSobiareebSi aseve gansxvavebulia. latenturi fazis ganmavlobaSi saSvilosnos yeli ixsneba nela, 0-dan –3 sm-mde, gaxsnis siCqare ki 0,35 sm/sT-ia. mas enacvleba aqtiuri faza, romlis drosac saSvilosnos yeli ukve swrafad ixsneba 3-dan 10 sm-mde (pirvelmSobiareebSi -- 1,5-2 sm/sT, ganmeorebiTmSobiareebSi – 2- 2,5 sm/sT siCqariT).


• mSobiarobis pirveli periodis bolos samSobiaro Setevebis sixSire matulobs10 wT-Si 4-5,matulobs maTi xangrZlivoba– 40-60wm, saSvilosnos yeli ixsnebasrulad, TavisiT an meanis mier irRvevasanayofe buStis mTlianoba

• sanayofo wylebi iRvreba droulad –100-200ml-is odenobiT,e.w. wina sanayofowylebi

samSobiaro Setevebis progresirebis paralelurad, sanayofo buSti ganagrZobs daWimvas, ufro Rrmad SeiWreba saSvilosnos yelis arxSi da xsnis mas Signidan. saSvilosnos yelis sruli gaxsnis momentisaTvis sanayofo buSti kargavs fiziologiur funqcias da gazrdili saSvilosnosSida wnevis gavleniT, droulad irRveva. irRveva imitom, rom sanayofo garsebis simtkice, matriqsuli metalo- proteinazebis gavleniT, kolagenis degradaciis xarjze daqveiTebulia.


• sanayofo wylebi SeiZleba daiRvaros:

• naadrevad – samSobiaro moqmedebisdawyebamde

• adre – mSobiarobis I periodSi, saSvilosnos yelis srul gaxsnamde

• mogvianebiT – saSvilosnos yelis sruligaxsnis Semdeg

• saerTod ar daiRvaros – nayofi ibadeba“perangSi”.

ganasxvaveben sanayofo wylebis daRvris sxva variantebsac: Tu sanayofo wylebi samSobiaro moqmedebis dawyebamde daiRvara, laparakoben sanayofo wylebis naadrev daRvraze, Tu saSvilosnos yelis srul an TiTqmis srul gaxsnamde – sanayofo wylebis adre daRvraze. zogjer sanayofo garsebi saSvilosnos sruli gaxsnis Semdeg irRveva, es sanayofo buStis mogvianebiT gaxevaa. sanayofo buStis mTlianoba SeiZleba saerTod ar dairRves, maSin nayofi sanayofo garsebSi gaxveuli, anu “perangiT” ibadeba.

mSobiarobis II periodi(1)

• pasiuri faza – nayofis winamdebarenawilis menjis fskerze Camosvlisfaza, saSvilosnos yelis sruligaxsnidan WinTvis dawyebamde.

• aqtiuri faza – WinTvebi, pasiurifazis damTavrebidan nayofisdabadebis momentamde

MmmSobiarobis II periodis mimdinareobaSi gamoyofen pasiur da aqtiur fazebs.

mSobiarobis II periodis pasiur fazaSi samSobiaro Setevebi 10 wT-Si 3-5 40-60 wm-is xangrZliobiT xSirdeba, intensiurdeba, maTi gavleniT ki, nayofis winmdebare nawili ganicdis winmsvlelobas da aRwevs menjis fskers.

amis Semdeg iwyeba mSobiarobis UUII periodis aqtiuri faza, roca winamdebare nayofis Tavis zewolis gamo, gavis nervul wnulsa da menjis fskeris kunTebze, mSobiares uCndeba gaWinTvis uneblie, dauZleveli, arakontrolirebadi survili: rom SekumSos diafragma da muclis wina kedlis muskulatura da organizmidan gamoaZevos nayofi. es ukve mSobiarobis II periodis -- aqtiuri fazis – WinTvebis dasawyisia.

mSobiarobis II periodi (2)

• pirvelmSobiareebSi 2 sT. da >ganmeorebiTmSobiareebSi – 1 sT.

• ar arsebobs mSobiarobis II periodis realurixangrZlivobis absoluturi zRvari.

• dedis da nayofis damakmayofilebelimdgomareobis SemTxvevaSi, mSobiarobis II periodis xangrZlivoba SesaZlebelia iyos meti

• am SemTxvevaSi mSobiarobis II periodisxangrZlivoba 3sT. da meti ar aris saxifaTonayofisaTvis

nayofis Tavis winmsvlelobis siCqare gamomaZevebeli Zalebis efeqturobazea damokidebuli da pirvelmSobiareebisaTvis -- 1sm/sT-Si, xolo ganmeorebiTmSobiareebisaTvis 2 sm/sT-Sia.

tradiciul saxelmZRvaneloebSi miTiTebulia, rom mSobiarobis II periodis xangrZlioba ganmeorebiTmSobiareebisaTvis -- 1, xolo pirvelmSobiareebisaTvis 2 saaTs ar unda aRematebodes. magram aRmoCnda, rom realurad mSobiarobis II periodis saSualo xangrZlioba gacilebiT metia. Aamdenad, fiqroben, rom Tu nayofisa da dedis mdgomareoba damakmayofilebelia, mSobiarobis II periodis 3-saaTiani da meti xangrZlioba nayofisaTvis uxifaToa, Tu winmdebare nayofis Tavis winsvla progresirebs.


• nayofis Tavis winmsvleloba samSobiaroarxSi upiratesad damokidebulia:

• saSvilosnos kumSviTi aqtivobis efeqturobaze

• menjis Zvlebis gamwevadobaze

• nayofis Tavis konfiguraciis unarze

• dedis saerTo fizikur mdgomareobaze

• nayofis adaptaciur SesaZleblobaze-mSobiarobisbiomeqanizmze

samSobiaro arxi, romelic unda gamoiaros dabadebisas nayofma, rbili samSobiaro gzebisagan ( saSvilosnos qveda segmenti, saSo, menjis fskeris kunTebi, Sorisi) da mcire menjis Rrus Zvlovani karkasisagan Sedgeba.

mSobiarobis mTeli procesis ganmavlobaSi saSvilosnos kumSviTi aqtivoba uzrunvelyofs nayofis Tavis winmsvlelobas.

miuxedavad imisa, rom menjis Zvlebs Soris kavSiri Sesaxsrebis uZrav tips miekuTvneba, mSobiarobis procesSi SesaZlebelia menjis zomebi gaizardos. es ganpirobebulia menjis iogebis mometebuli elastiurobiT da gamwevadobiT, aseve, zrda xdeba gava-kudusunis saxsris 1 - 2 sm-ze gadaxris xarjzec.

samSobiaro arxSi winmsvlelobisas, Tavis qalis Zvlebis konfiguraciis xarjze, nayofis Tavi mniSvnelovnad icvlis formas, riTac xels uwyobs nayofis Tavisa da samSobiaro gzebis formis urTierTmorgebas. konfiguraciis xarisxi nayofis Tavze arsebuli nakerebisa da yiflibandebis sifarTovezea damokidebuli. konfiguraciis procesSi Tavis tvinis nazi substancia ar ziandeba,

nayofis Tavis konfiguracia ki dabadebidan mcire drois gavlis Semdeg swordeba; konfiguraciis xarjze nayofis Tavis qalis zomebi SeiZleba 4-7 mm-iT Semcirdes. nayofis Tavis konfiguraciis mixedviT, SeiZleba mSobiarobis biomeqanizmebze msjelobac.

WinTvis da samSobiaro moqmedebis zegavleniT, nayofi miiwevs samSobiaro arxSi, misi gamtari RerZis mimarTulebiT da Tan akeTebs moxriT, brunviT Tu gaSliT moZraobebs, menjis sibrtyeebis, fskeris kunTebisa da vulvaruli rgolis winaaRmdegobis gadasalaxavad. am moZraobaTa erTobliobas mSobiarobis biomeqanizmi ewodeba.


orsulobis bolos, gansakuTrebiT, pirvelmSobiareebSi, saSvilosnos fuZe, masSi myof dunduloebTan erTad, diafragmisa da muclis presis mxridan ganicdis zewolas. es zewola nayofis dunduloebidan xerxemlis gaswvriv vrceldeba da nayofis Tavs gadaecema. amis gamo, nayofis Tavi mcired ixreba da isriseburi nakeriT dgeba menjis Sesavlis erT-erT irib an gardigardmo zomaSi. ganmeorebiTmSobiareebSi, muclis presis modunebis gamo, nayofis Tavi moZravi menjis Sesavlis zemoT mSobiarobis dawyebamde, xSir SemTxvevaSi ki, mSobiarobis I periodis ganmavlobaSic rCeba.

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


• Bbiomeqanizmis I momenti-Tavis moxra da Cadgma (flexio capitis)-isrisebri nakeri menjis Sesavlis gardigardmo an erT-erT irib zomaSi- wamyvan wertili - mcire yiflibandi

mSobiarobis biomeqanizmi ganisazRvreba nayofis winmdebareobis variantiT. nayofis kefiT winmdebareobis wina saxe fiziologiuri mSobiarobis yvelaze xSiri variantia da gvxvdeba mSobiarobebis 94%-Si.

mSobiarobis biomeqanizmi nayofis kefiT winamdebareobis wina saxis dros oTxi momentisagan Sedgeba.

I momenti - Tavis moxra da Cadgma:

nayofis Tavi ixreba da mcire menjis SesasvlelSi isriseburi nakeriT gardigardmo an erT-erT zomaSi dgeba ise, rom isriseburi nakeri koncxidan da boqvenis Sesaxsrebidan TiTqmis Tanabradaa daSorebuli -- e.w. Tavis sinklituri Cadgma. nayofis Tavis mcire menjSi Cadgmaze laparakoben im SemTxvevaSi, roca winmdebare nawili, Tavisi udidesi garSemowerilobiT, gaivlis Sesavlis sibrtyes. nayofis Tavis yvelaze dabla myofi wertili xdeba mcire yiflibandi, romelic uaxlovdeba menjis gamtar RerZs _ yalibdeba e.w wamyvani

wertili. wamyvania wertili, romelic pirveli CaeSveba menjis SesavalSi da sasqeso napralSi pirveli Cndeba.

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


• Bbiomeqanizmis II momenti-Tavis Sinagani brunva (rotatio capitis) • _ isrisebri nakeri gardigardmo an erT-erTi iribi zomidan gadadis

menjis gamosavlis pirdapir zomaSi, ise rom mcire yiflibandiganlagdeba boqvenis Zvlis qvemoT

• _ yalibdeba safiqsacio wertili - kefqveSafoso

II momenti – Tavis Sinagani brunva

nayofis Tavis Sinagani brunva iwyeba nayofis Tavis winmsvlelobisas, roca nayofis Tavi winaaRmdegobas xvdeba menjis Rrus farTe nawilidan viwroSi gadasvlis dros. kefiT winmdebareobis wina saxis dros rotacia mimdinareobs sworad, isriseburi nakeri gardigardmo, anu erT-erTi iribi zomidan gadadis menjis gamosavlis pirdapir zomaSi ise, rom mcire yiflibandi boqvenis Sesaxsrebis qveS moeqceva, xolo kefqveSa foso – e.w safiqsacio wertili, (hipomoqlioni) miebjineba boqvenis Sesaxsrebis qveda kides. hipomoqlioni ewodeba wertils nayofis Tavze, romliTac is ebjineba boqvenis qveda kides da iSleba.

isriseburi nakeri menjis Sesavlis gardigardmo zomidan menjis gamosavlis pirdapir zomaSi gadasvlisas aucileblad gaivlis, nayofis poziciis mixedviT, erT-erT irib zomas: I poziciis dros marjvena irib zomas, xolo II poziciis dros -- marcxena irib zomas. menjis Sesavlidan menjis fskeramde ki nayofis Tavi brunavs xraxniseburad, 90 gradusiT.

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


• biomeqanizmis III momenti-Tavis gaSla (deflexio capitis)- safiqsacio wertilze, romelic ebjineba boqvenis Sesasvlelis qveda

kides, Tavi iSleba.

- garSemoweriloba, romliTac ibadeba nayofis Tavi vulvarulirgolidan Seesabameba 32 sm. (mcire irib zomaze 9,5 sm-ze gamaval

garSemowerilobas)

III momenti – Tavis gaSla

nayofis Tavi ganicdis winsvlas, Tan iwyebs gaSlas safiqsacio wertilis, anu hipomoqlionis irgvliv, ramdenime WinTvaSi mTlianad iSleba da ibadeba vulvaruli rgolidan, Semdegi TanmimdevrobiT: Txemi, Subli, pirisaxe da nikapi. vulvaruli rgolidan Tavi ibadeba mcire irib zomaze gamavali garSemowerilobiT, romelic 32 sm-is tolia.



• Bbiomeqanizmis IV momenti- Tavis garegani da mxrebis Sinagani brunva(rotatio trunci interna seu rotatio capitio externa)

• _ nayofis kefa brundeba dedis marcxena barZayisken (I poziciisdros)

• _ nayofis kefa brundeba dedis marjvena barZayisken (II poziciis dros)


• Bbiomeqanizmis IV momenti-Tavis garegani da mxrebis Sinagani brunva

(rotatio trunci interna seu rotatio capitio externa)• nayofis Tavis garegani brunva droSi emTxveva nayofis mxrebis Sinagan

• brunvas. mxrebi menjis SesavalSi gardigardmo zomidan menjisfskerze

• gadadis pirdapir zomaSi

IV momenti – Tavis garegani da mxrebis Sinagani bruni

nayofis Tavis gaSlasTan erTad, misi mxrebi Cadgeba menjis Sesavlis gardigardmo an erT-erT irib zomaSi. nayofis Tavi, dabadebis Semdeg, erTxel kidev akeTebs 90-gradusian bruns Tavisi RerZis garSemo. nayofis Tavis garegani brunva droSi nayofis mxrebis Sinagan brunvas emTxveva. nayofis mxrebi Tavisi ganivi zomiT, gardigardmodan jer irib da Semdeg – menjis fskerze, pirdapir zomaSi gadadis, Tavi ki, poziciis mixedviT, an dedis marcxena (I pozicia) an marjvena barZayisaken (II pozicia) kefiT Sebrundeba. jer ibadeba wina mxari, Semdeg ki, kudusunisaken mimarTuli ukana mxari; ibadeba mxris sartyeli mTlianad, Semdeg ki sul iolad -- nayofis tanis danarCeni nawilic ibadeba.



• mSobiarobis procesSi na-• yofis Tavis winmsvlelobis• gansazRvra abdominaluri• meTodiT – 5 TiTis siganis• mixedviT:5/5,4/5,3/5,2/5,1/5,0/5

saSvilosnos yelis gaxsnasTan erTad, winmdebare nayofis Tavi samSobiaro arxSi iwyebs winsvlas (upiratesad, pirvelmSobiareebSi) da saSvilosnos yelis sruli gaxsnisTvis, igi menjis RruSi an didi segmentiT menjis SesavalSi imyofeba.

nayofis Tavis winsvlas SeiZleba davakvirdeT abdominalurad da

saSosmxrivi gasinjviT. yoveli vaginaluri gasinjvis win aucilebelia

abdominalurad ganisazRvros nayofis Tavis mdebareoba.

Nnayofis Tavis mdebareobaze abdominalurad xuTi TiTis siganis mixedviT msjeloben. imisda mixedviT, Tu boqvenis zeda kidis zemoT Tavis ra nawili isinjeba, msjeloben nayofis Tavis winmsvlelobaze. rodesac nayofis Tavi xuTi TiTiT mTlianad palpirdeba, is menjis Sesavlis zemoTaa. nayofis Tavis winmsvlelobis paralelurad, Tavis im nawilis sidide, romelic darCa boqvenis zeda kidis zemoT, TiTebis naklebi raodenobiT ganisazRvreba – 4/5, 3/5 da a.S.


• nayofis Tavis mdebareobis gan-

• sazRvra saSosmxrivi gasinjviT

• -mcire yiflibandis mdebareobis

• mixedviT mcire menjis Rrus do-

• neebis -nulovani done,_1,_2,_3 da

• +1,+2,+3 done mimarT.

- 3- 2

- 1

0

+ 2

+ 1

+3

saSosmxrivi gasinjvisas adgenen, Tu nayofis Tavs menjis Rrus doneebis an sibrtyeebis mimarT ra mdebareoba ukavia. vaginaluri gasinjvisas iolia sajdomi Zvlis wvetebis palpireba. saSosmxrivi gasinjvisas yuradReba eqceva nulovani donis mimarT nayofis yvelaze qveda wertilis e.w wamyvani wertilis mdebareobas. magaliTad, Tu nayofis Tavis wamyvani wertili spinalur xazzea, es niSnavs rom nayofis Tavi nulovan donezea; Tu -3 doneze imyofeba, niSnavs, rom nayofis Tavi jer ar Camdgara menjis SesavalSi, xolo roca nayofis Tavi +3 donezea, is ukve menjis fskerze mdebareobs. warsulSi samSobiaro arxis RerZi spinaluri sibrtyis zemoT TviTneburad dayves sam nawilad. 1988 wlidan amerikis mean-ginekologiis kolegiam danerga sibrtyeebad menjis dayofis axali klasifikacia, xuT doned, spinaluri xazis zemoTa da qvemoT.mag: done +5 niSnavs, rom nayofis Tavi saSos napralSi Cans.

WILLIAMS OBSTETRICS,22nd edition,2005


• WinTvis dros nayofis Tavis winmsvlelobaze metyvelebs:

• Sorisis gamoberva

• anusis gaxsna

• saSos napralis gaxsna

• nayofis Tavis SeWra

• nayofis Tavis gamoWra

nayofis Tavis winmsvlelobaze WinTvis dros Sorisis mdgomareobis mixedviT SeiZleba msjeloba.

menjis gamosavalTan winamdebare nayofis Tavis moaxloebisas Sorisi iwyebs gamobervas, Tavdapirvelad mxolod WinTvis dros. Semdeg ki --- WinTvebs Soris pauzebSic.

Sorisze nayofis Tavis zewolisas ukana tani ixsneba, aseve, ixsneba sasqeso napralic da yoveli WinTvis dros sasqeso napralSi jer gamoCndeba nayofis Tavis mcire nawili, romelic WinTvis Semdeg imaleba – e.i. nayofis Tavi SeWraSia, rac miuTiTebs, rom mTavrdeba mSobiarobis biomeqanizmis II momenti da III – Tavis gaSla -- iwyeba. Semdegi winmsvlelobisas nayofis Tavi aRar imaleba sasqeso nawilSi, rac niSnavs, rom nayofis Tavma gadalaxa menjis fuZe da axla daibadeba. nayofis Tavis winmsvleloba SeiZleba ganisazRvros piskaCekis meTodiTac: marjvena xelis TiTebiT awvebian didi sasircxo bagis lateralur kides nayofis Tavis mimarTulebiT, masTan “Sexvedramde”. Ees SesaZlebelia, Tu nayofis Tavi menjis Rrus viwro nawilSi imyofeba. Mmsgavsi meTodi pirvelad 1855 wels Ritgen-ma aRwera.

WiLLIAMS OBSTETRICS22nd edition,2005

mSobiarobis III periodi(1)

• iwyeba nayofis dabadebis Semdeg

• grZeldeba saSvilosnos SekumSvebie.w. momyolis xanis Setevebi

• mSobiarobis III periodisxangrZlivoba 5-30 wuTia.

nayofis dabadebis Semdeg saSvilosnos SekumSvebi grZeldeba, Tumca mSobiare mxolod umniSvnelo diskomforts SeigrZnobs. Tavidan, ramdenime wuTis ganmavlobaSi, saSvilosno imyofeba tonuri SekumSvebis mdgomareobaSi, Semdeg ki SekumSvebi ufro riTmuli xdeba – yalibdeba e.w. momyolis xanis SekumSvebi.

mSobiarobis III periodis xangrZlioba 5-30 wT-ia. Tu am periodis xangrZlioba 30 wT-s aRemateba, igi gaxangrZlivebulad iTvleba. momyolis dabadebis Semdeg mSobiares ukve melogine hqvia.

WILLIAMS OBSTETRICS22nd edition,2005

mSobiarobis III periodi(2)mSobiarobis III periodi(3)

mSobiarobis III periodi (4)

• placenta scildeba saSvilosnos kedels:

• _ Sulcis wesiT –retroplacentaruli hematomis warmoqmniT

• _ dunkanis wesiT – placentis qveda kidis aSrevebiT

Schulze 70% Duncan 30%

saSvilosnos SekumSvis dros ikumSeba placentaruli zedapiric, xolo masze mimagrebul placentas SekumSvis unari ar gaaCnia, rac saSvilosnos kedlidan placentis mocilebis mizezi xdeba. saSvilosnos Semdegi SekumSvebi ki xels uwyobs placentis gamoZevebas.

placentis mocilebis meqanizmi SeiZleba mimdinareobdes orgvarad.

erT SemTxvevaSi placentasa da saSvilosnos kedels Soris kavSiri placentis centrSi irRveva. kavSiris darRvevis Semdeg irRveva saSvilosno-placentaruli sisxlZarRvebis mTlianobac, xolo Caqceuli sisxli qmnis retroplacentarul hematomas – sisxlis dagubebas saSvilosnosa da placentas Soris. retroplacentaruli hematoma TandaTan matulobs da xels uwyobs placentis Semdgom aSrevebas da gamoZevebas. placenta samSobiaro gzebidan sanayofo

zedapiriT ibadeba. aSrevebis am variants ewodeba momyolis mocileba Sulces wesiT. magram, ufro xSirad gvxvdeba aSrevebis is varianti, roca saSvilosnos kedlidan aSrevebas pirvelad placentis qveda kide iwyebs. darRveuli sisxlZarRvebidan gamomdinare, sisxli Tavisi dinebis gzaze aSrevebs placentas saSvilosnos kedlidan. aclis Semdeg placenta samSobiaro gzebidan dedismxrivi zedapiriT gamoZevdeba. aSrevebis am variants dunkanis wesiT mocileba ewodeba.


mSobiarobis III periodi (5)

• momyolis mocilebis Semdeg sisxldenis SeCerebis faqtorebi: • -meqanikuri faqtorebi• -saSvilosnos sisxlZarRvebis spiraluri Senebis faqtori

• -Trombis warmoqmnis faqtori

momyolis xanis SekumSvebs didi mniSvneloba aqvs sisxlis danakargis minimalizebisTvis, rogorc momyolis, aseve Semdgom periodSic. normaSi sisxlis danakargi fiziologiuri mSobiarobis dros ar unda aRematebodes 500 ml-s.

momyolis mocilebis Semdeg saSvilosnodan sisxlisdenis SeCerebas uzrunvelyofen Semdegi faqtorebi:

1. sisxlZarRvebi, romlebic kvebaven placentarul moedans, iWyliteba miometriumis Sua Sris iribi boWkoebis SekumSvis Sedegad. es sisxldenis SeCerebis meqanikuri faqtoria;

2.saSvilosnos sisxlZarRvebs axasiaTebT spiraluri Seneba. amis gamo, SekumSvisas isini mokldebian da gadaadgildebian miometriumis Rrma SreebSi, sadac SekumSuli kunTovani boWkoebis mxridan ganicdian

damatebiT zewolas. Aam SemTxvevaSi sisxldenis SeCerebas saSvilosnos sisxlZarRvebis spiraluri Seneba ganapirobebs;

3. qsovilebis travmirebis sapasuxod iwyeba Trombwarmoqmnis procesi, romelic ZiriTadad aCerebs kapilarul sisxlisdenas.

momyolis periodis normaluri mimdinareobis SemTxvevaSi, es faqtorebi erTdroulad vlindeba.


5 მშობიარობის ფიზიოლოგია

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