mZime preeklamfsiis/eklampsiis marTva

klinikuri rekomendaciebi

Tbilisi 2006
avtorTa jgufi:

⇒ baCuki SublaZe – mean-ginekologi, S.p.s m.SaraSiZis klinikuri

medicinis centri
⇒ aleko goxelaSvili - anesTeziologi, #5 samSobiaro saxli
⇒ Tengiz AasaTiani,

⇒ saeqsperto Sefaseba:
⇒ revaz suluxia- o.RuduSauris sax e.sc-is ginekologiuri
ganyofilebis gamge
⇒ aleqsandre TaraSvili- S.p.s m.SaraSiZis samedicino centris
mean-ginekologi

klinikuri rekomendaciebis zogadi mizani

am rekomendaciis mizans warmoadgens mZime preeklamfsiisa da eklamfsiis
mkurnalobis standartizacia orsulobis da mSobiarobis dros, dedisa da
axalSobilis gamosavalis gasaumjobeseblad.

ganxiluli klinikuri sakiTxebi

mocemul klinikur rekomendaciebSi ganixileba mZime preeklampsiisa da

eklampsiis marTva. rekomendaciaSi ar ganixileba hipertenziuli
darRvevebis sxva formebi orsulobis dros.

visTvis aris gankuTvnili mocemuli klinikuri rekomendacia

mocemuli klinikuri rekomendaciebi gankuTnilia stacionarSi momuSave

mean-ginekologebisaTvis, aseve jandacvis pirveladi rgolisE mean-
ginekologebis, bebiaqalebisa da ojaxis eqimebisaTvis, romelTac aqvT
 orsulTan an MmSobiaresTan kontaqti, an exebaT mSobiarobis
meTvalyureoba. rekomendacia SeiZleba gamoyenebuli iyos rogorc
diplomamdeli, ise diplomisSemgomi swavlebisaTvis.

Ziebis, mtkicebulebaTa Sefasebisa da rekomendaciebis formulirebis

aRwera
preeklamfsiisa da eklamfsiis sakiTxis aqtualobis gamo arsebobs
meTodologiaTa sakmarisi raodenoba, romlebic Seicaven mkacri samecniero
mtkicebulebis safuZvelze damtkicebul rekomendaciebs. amitom mocemuli
meTodologiis SemqmnelTa samuSao jgufis mier gadawyvetili iyo ukve
arsebuli praqtikuli rekomendaciebiis moZieba da Sefaseba da
rekomendaciebis adaptirebuli formis Seqmna, romlebic erTis mxriv,
upasuxebdnen saerTaSoriso moTxovnebs, xolo meore mxriv, misaRebi
iqnebodnen saqarTvelos jandacvis pirobebSi gamosayeneblad. samuSao
jgufis mier daSvebuli iyo is SesaZlebloba, rom arsebul rekomendaciebSi ar
iqneboda ganxiluli yvela klinikuri sakiTxi, da am SemTxvevaSi
warmoiSveboda mtkicebulebaTa damoukidebeli moZiebis aucilebloba
konkretul klinikur SekiTxvebTan dakavSirebiT.

klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi

wyaroebi da meTodebi

klinikuri rekomendaciebis, epidemiologiuri monacemebisa da

mtkicebeulebebis Semdgomi moZieba xorcieldeboda inglisurenovani (Yahoo,
AltaVista, Google, DoctorGuide da rusulenovani (Yandex, Rambler) saZiebo
operatorebis meSveobiT, aseve inglisurenovani samedicino monacemebis
eleqtronuli bibliografiuli monacemTa bazis, „medlainis,, (MEDLINE)
meSveobiT, sakvanZo sityvebis gamoyenebiT. pirvel rigSi moZiebuli iyo
(National Guidelines Clearinhouse, TRIP, SumSearch) preeklamfsiisa da eklamfsiis
marTvis analogiuri rekomendaciebi, romlebic SemuSavebulia Sesabamisi
profesionaluri jgufebis mier.
calkeuli, aseve arasrulad ganxiluli klinikuri sakiTxebis Sesaxeb
mtkicebulebaTa moZieba warmoebuli iyo kohreinis monacemTa bazaSi The
Cochrane Library 2007, Issue 3, da jandacvis msoflio organizaciis reproduqciuli
 janmrTelobis biblioTekaSi #9. ar iyo Catarebuli ruxi literaturis moZieba
(konferenciebi, Tezisebi, gamouqveynebeli masalebi)

moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi

Catarebuli Ziebis Sedegad miRebuli iyo ramodenime klinikuri meToduri

rekomendacia, romlebic Seicavda jgufis miznis Sesaferis saWiro informacias.
am rekomendaciebis saboloo Sefasebisas gamoyenebuli iyo formaluri
Sefasebis meTodi AGREE (Appraisal of Guidlines for Research and Evaluation ).
Sefasebis Sedegad amorCeuli iyo ramodenime rekomendacia, romlebic
safuZvlad daedo Semdgom analizsa da adaptacias. am rekomendaciaSi
mocemuli debulebebi Sejamebuli iyo cxrilebSi da warmodgenili iyo samuSao
jgufis wevrebis mier Sefasebis mizniT. cxrilSi Sedioda debulebis originaluri
versia da mtkicebulebis done wyaros mixedviT. samuSao jgufs unda
Seefasebina rekomendaciebis vargisianoba saqarTvelos jandacvis pirveladi
rgolis pirobebSi. rekomendacia miRebuli iTvleboda, Tu mis sasargeblod xmas
aZlevda SemqmnelTa samuSao jgufis umravlesoba.
rekomendaciis SemuSavebisas Cven gamoviyeneT modificirebuli sqema,
romelic mowodebulia SIGN (Scottish Intercollegiate Guideline Network) mier .

konfliqtTa interesebis deklaracia

muSaobis dawyebamde mocemuli klinikuri rekomendaciis proeqtSi, samuSao

jgufis yvela wevrma ganacxada Tanxmoba, werilobiT formaSi gamoecxadebina
farmacevtul kompaniebTan finansuri kavSirebis Sesaxeb. saavtoro koleqtivis arc
erT wevrs ar hqonda finansuri daintereseba an sxva interesTa konfliqti
farmacevtul kompaniebTan da sxva organizaciebTan SesamuSavebel
rekomendaciasTan dakavSirebiT.

klinikuri rekomendaciebis Sida recenzireba

Catarebuli iyo klinikuri rekomendaciebis Sida recenzireba (sia Tan erTvis)

rekomendaciebis mowodebis sizustis gamosavlenad, maTi efeqturobis da
usafrTxoebis Sesafaseblad da praqtikuli gamoyenebisaTvis masalis arsebobis
dasadgenad. recenziebis miRebis Semdeg ganxiluli iyo Sedegebi da samuSao
jgufis mier Setanili iyo cvlilebebi klinikuri rekomendaciebis SinaarsSi.
klinikuri rekomendaciis gadaxedvis vada -2010 w

mtkicebulebaTa doneebisa da rekomendaciebis gradaciis sqema

yvela ZiriTadi rekomendacia Seesabameba garkveul gradacias, romelic

aRiniSneba laTinuri asoebiT A-dan C-mde. (Agency for Health Care Policy and
Research-1994 Sesabamisad). amasTan erTad, yovel gradacias Seesabameba
monacemTa mtkicebulebis Sesabamisi done. es niSnavs, rom
rekomendaciebi dafuZnebuli iyo kvlevebis monacemebze, romlebsac
gaaCniaT mtkicebulebis garkveuli done. rac ufro maRalia rekomendaciis
gradacia, miT ufro maRalia kvlevis mtkicebuleba, romelzedac is aris
dafuZnebuli. qveviT moyvanilia sqema, romelSic aRwerilia rekomendaciebis
gradaciis sxvadasxva doneebi, romlebic CarTulia am saxelmZRvaneloSi.

saWiroebs ZiriTadi literaturuli wyaros arsebobas, minimalurad erT

randomizirebul sakontrolo kvlevas, romelic Catarebulia kargi xarisxiTa da
A SinaarsiT, rac specifiurad Seesabameba mocemul mtkicebulebas an
rekomendacias an sistematiur momoxilvas
saWiroebs maRali xarisxis klinikuri, magram ara randomizirebuli kvlevis
B Catarebas, romelic Seesabameba rekomendaciis Sinaarss.
saWiroebs mtkicebulebebis arsebobas, romlebic dafuZnebulia eqspertTa
komisiis daskvnaze an maT azrze da/an dafuZnebulia am dargSi cnobili
C avtoritetuli warmomadgenlebis azrze. miuTiTebs xarisxiani kvlevebis ar
arsebobaze am sakiTxTan dakavSirebiT.

Sesavali

orsulobis hipertenziuli darRvevebi viTardeba dedis organizmis orsulobasTan

adaptaciis procesis darRvevis gamo. hipertenziuli garTulebebi arTuleben
orsulobis normalur mimdinareobas. mocemuli mdgomareobisaTvis
damaxasiaTebelia angiospazmis, sisxlZarRvebis endoTeliumis dazianebisa da
maTi ganvladobis darRveva, rasac Tan sdevs hipovolemiis ganviTareba,
sisxlis reologiuri Tvisebebis Secvla diseminirebuli Trombebis warmoqmniT da
hemodinamikis darRveviT. es movlenebi iwvevs organuli cvlilebebis
ganviTarebas Tavis tvinSi, placentaSi, RviZlSi da sxva.
mZime formis preeklamfsia da eklamfsia aris orsulobis da mSobiarobis
mZime garTuleba. ganviTarebul qveynebSi eklamfsia gvxvdeba 1
SemTxvevaSi 2000 orsulobidan, xolo ganviTarebad qveynebSi-1/100-1/1700
mSobiarobidan. amave dros eklamfsia warmoadgens dedaTa sikvdilianobis
erT-erT wamyvan mizezs msoflioSi. eklamfsiis dros qalTa 35%-s uviTardeba
mZime garTulebebi. 1997-2005 wlis monacemebiT saqarTveloSi dedaTa
mokvdaobis maCvenebeli 100 000 cocxladSobilze Seadgenda 2.2, rac
umetes SemTxvevaSi ganpirobebuli iyo substandartuli mkurnalobiTa da
marTviT. 2004 – 2005 wlebSi q TbilisSi Cataraebulma aidutma gamoavlina
rom

klasifikacia

diagnostikuri da samkurnalo midgomis erTiani standartis Sesaqmnelad da

terminologiis swori interpretaciisaTvis am klinikur rekomendaciebSi
gamoiyeneba orsulobiT gamowveuli hipertenziis saerTaSoriso klasifikaciis
daavadebaTa Х gadaxedvis terminologia ( rubrikebi 013, 014, 015 - cxrili 1, ).
da ar ganixileba daavadedebi miTiTebuli rubrikebSi 010 (adre arsebululi
hipertenziiT garTulebuli orsuloba, mSobiaroba da loginobis xana), 011 (adre
arsebuli hipertenziuli avadmyofoba TandarTuli proteinuriiT) 012 (gestaciuri
(orsulobiT gamowveuli) SeSupeba da proteinuria hipertenziis gareSe)

cxrili 1

013 gestaciuri (orsulobiT gamowveuli) hipertenzia mniSvnelovani

proteinuriis gareSe,
msubuqi preeklampsia

014 gestaciuri (orsulobiT gamowveuli) hipertenzia mniSvnelovani

proteinuriiT
014.0 zomieri preeklamfsia
014.1 mZime preeklamfsia
014.9 preeklamfsia, dauzustebeli
015 eklamfsia
015.0 eklamfsia orsulobis dros
015.1 eklamfsia mSobiarobis dros
015.2 eklamfsia loginobis xanaSi
015.9 eklamfsia, dauzustebeli

preeklamsiis niSnebi

Hhipertenzia

hipertenziis diagnozi unda daisvas maSin, rodesac diastoluri arteriuli wneva

udris an aRemateba 110 mm/vwy/sv-s erTjeradi gazomvis dros an 90
mm/vwy/sv-s orjeradi gasinjvis dros 4 saaTiani intervaliT.

mZime hipertenzia

mZime hipertenziis dros diastoluri arteriuli wneva udris an aRemateba 120

mm/vwy/sv-s erTjeradi gazomvis dros an 110 mm/vwy/sv-s orjeradi gasinjvis
dros 4 saaTiani intervaliT.

proteinuria

Tu proteinuriis done ar udris an ar aRemateba 300 mg-s 24 saaTSi an Sardis

or sinjSi, romelic aRebulia 4 saaTiani intervaliT, is ar iTvleba paTologiurad.
proteinuriis dros saWiroa saSarde gzebis infeqciis gamoricxva. paTologiuri
proteinuria orsulobis dros warmoadgens Sinagani organoebis dazianebis
pirvel niSans.

SeSupeba

zomieri SeSupeba aReniSneba orsulTa 50-80%-s fiziologiurad mimdinare

orsulobis dros. miRebulia, rom preeklampsia, romelic mimdinareobs
SeSupebis gareSe, ufro saSiSia dedisa da nayofisaTvis, vidre preeklamfsia
SeSupebis fonze. swrafad mzardi generalizebuli SeSupeba, gansakuTrebiT
welis areSi, cud prognozul niSans warmoadgens.

msubuqi preeclampsia

diastoluri arteriuli wneva 90 udris mm/vwy/sv da sistoluri arteriuli wneva 140

mm/vwy/sv, magram naklebi vidre 160/110 mm/vwy/sv, proteinuriis gareSe
((< 0,3g. 24 saaTian SardSi an 1+ test xazis gamoyenebisas ). miuTiTebs
dedisa da nayofis mdgomareobaze saTanado meTvalyureobis aucileblobaze.
orsulobaTa umravlesoba mimdinareobs garTulebebis gareSe, rac miuTiTebs
imaze, rom garkveulwilad hipertenzia dadebiTad moqmedebs saSvilosno-
placentarul sisxlis mimoqcevaze momatebuli sisxlZarRvovani winaRobis
pirobebSi da kompensatorul meqanizms warmoadgens.

mZime preeklamfsia - diastoluri arteriuli wneva udris an aRemateba 110

mm/vwy/sv-s erTjeradi gazomvis dros an 90 mm/vwy/sv-s orjeradi gasinjvis
dros 4 saaTiani intervaliT, , xolo sistoluris 170 mm/vwy/sv orjeradi
gazomvisas, proteinuriasTan erTad (min. 1 g/l) an 2+ test xazis
gamoyenebisas.
mZime preeklamfsiis klinikuri niSnebi Semdegia:
• hipertenzia => 170/110 mm/vwy;
• gamoxatuli proteinuria ( 2+, >5g /24 sT-ian SardSi);
• Zlieri Tavis tkivili;
• mxedvelobis darRvevebi;
• tkivili epigastriumis midamoSi da/an Rebineba;
• klonuri krunCxvis niSnebi;
• RviZlis gamkvriveba;
• Trombocitopenia < 150 000;
• RviZlis fermentebis (alaninaminotransferazisa da
aspartataminotransferazis) donis momateba;
• filTvebis SeSupeba
• nayoFis hipotrofia
• HELLP sindromi.

mxedvelobaSi misaRebisa isic, rom eklamsiiT daavadebul qalTa nawils

prodromuli NniSnebi ar aReniSneba. mZime preeklamfsiis seriozul
garTulebas warmoadgens HELLP sindromi, (hemolizi, RviZlis fermentebis
momateba da Trombocitopenia).

eklamfsia ganisazRvreba, rogorc preeklamfsiis fonze ganviTarebuli erTi an

meti gulyra.

Worldwide, each year, more than four million women will develop pre-eclampsia and approximately 100
000 women will have eclamptic convulsions, with over 90% occurring in developing countries. Pre-
eclampsia complicates 2–3% of all pregnancies (5–7% in nulliparous women) and 2% of women with pre-
eclampsia will develop eclampsia.

Pre-eclampsia is a multisystemic syndrome usually recognised by new onset hypertension and

proteinuria appearing in the second half of pregnancy. Clinicians should be aware that pre-eclampsia may
occasionally occur with hypertension in the absence of proteinuria (and proteinuria without hypertension)
but with other features such as eclampsia, renal impairment, thrombocytopenia, liver dysfunction or fetal
compromise.

Our understanding of the pre-eclampsia syndrome would be facilitated by recognition of discrete subsets
of women with pre-eclampsia including early onset disease and those associated with fetal growth
restriction.

Recommendations for clinical practice

1. Women with previous pre-eclampsia should be offered counselling, if possible preconceptually,

and given realistic estimates of the likelihood of recurrence. Facilities for local expert counselling
should be available as widely as possible. (Grade A)
2. Women with underlying medical conditions associated with an increased risk of pre-eclampsia
should be offered prepregnancy counselling to explain this risk and to encourage early
attendance for specialist antenatal care. (Grade A)
3. Many women with subfertility are at increased risk of pre-eclampsia. This is due to a combination
of the underlying medical condition such as polycystic ovary syndrome and the risk of multiple
pregnancy. This risk should be explained to the women and specialist antenatal care provided.
(Grade B)
4. It should be considered that women at increased risk of pre-eclampsia requiring assisted
reproduction should have only one embryo transferred. (Grade C)
5. Care pathways should be in place to provide appropriate specialist obstetric care for those
identified to be at risk of pre-eclampsia. (Grade A)
6. Women with underlying medical conditions associated with an increased risk of pre-eclampsia
require increased antenatal surveillance and should be managed by clinicians with expertise in
the diagnosis and management of pre-eclampsia. (Grade A)
7. Women with multiple pregnancies are at increased risk of pre-eclampsia and should receive
specialist antenatal care. (Grade A)
8. All women with blood pressure greater than 140/90 mmHg with or without proteinuria should be
referred to a day assessment or obstetric unit. (Grade A)
9. All women with persistent proteinuria, even in the absence of hypertension, should be referred for
further investigation. (Grade A)
10. All women should have access to a day assessment unit. (Grade A)
11. Although pregnancies associated with an abnormal uterine artery Doppler waveform are at
significant risk of adverse outcome (particularly severe pre-eclampsia requiring early delivery) its
 introduction as a screening test for all women cannot currently be recommended other than in
clinical trials. (Grade B)
12. Antiplatelet therapy, in particular, low dose (< 75 mg) aspirin, reduces the risk of pre-eclampsia by
around 15% for women at both low and high risk. There appears to be a similar reduction in the
risk of perinatal death. Aspirin should be considered, particularly for women at high risk. In
countries with a high prevalence of pre-eclampsia, more widespread use may be worthwhile.
(Grade B)
13. All new interventions to prevent pre-eclampsia should be properly evaluated in large randomised
trials before being introduced into clinical practice. (Grade A)
14. Data from small trials are promising that supplementation with vitamins C and E may reduce the
risk of pre-eclampsia. Large trials are now underway. In the meantime, supplementation with
vitamins C and E cannot be recommended for clinical care. (Grade B)
15. Automated instruments for blood pressure measurement are generally not validated for use
during pregnancy and pre-eclampsia. Therefore, the use of mercury sphygmomanometers
remains preferable. If used, automated instruments require the calibration to be checked
regularly. (Grade B)
16. If automated devices are used for monitoring in an intensive care area, the accuracy of the
devices should be confirmed with mercury sphygmomanometers on a regular basis or an intra-
arterial line should be considered. (Grade A)
17. Measurement of blood pressure in pregnancy and pre-eclampsia should include the following:
o instrument: mercury/aneroid sphygmomanometer or validated automated device
o cuff size: it is imperative that the appropriate cuff size is used; it is better to use one that
is too big than one that is too small
o setting: relaxed, quiet environment, preferably after rest
o position: lying at a 45-degree angle or sitting (cuff at heart level)
o arm: left or right (higher value if difference is greater than 10 mmHg)
o dependent arm, if in a lateral position
o Korotkoff sounds: first (systolic) and fifth (diastolic); if diastolic is persistently less than 40
mmHg use muffling or fourth sound and make a note.

(Grade A)

18. There is considerable observer error involved in dipstick urinalysis for proteinuria. This can be
overcome by the use of automated dipstick readers, which significantly improve false positive and
false negative rates. (Grade C)
19. The definition of gestational proteinuria is derived from studies calculating the 95th centile for an
uncomplicated population. A protein loss of over 300 mg in 24 hours is associated with an
increased morbidity to the mother and her baby. (Grade B)
20. There is considerable variation between laboratory assays for the quantification of proteinuria.
This, combined with the unknown errors associated with 24-hour urine collection, means that new
tests at point of care have potential advantages over the current gold standards. An elevated
protein creatinine ratio of greater than 30 mg/mmol correlates with a 24-hour protein excretion
greater than 300 mg and should be used to check for significant proteinuria. (Grade C)
21. Due to the variation in urine concentration, largely determined by hydration, all urine screening in
obstetric day units should be by protein creatinine ratio. This can be by laboratory test or at point
of care. (Grade C)
22. New urinalysis devices and dipsticks should be tested for accuracy and predictive values before
being introduced into clinical practice. (Grade C)
23. Women with severe pre-eclampsia should have early referral to a specialist centre. A woman
should not be transferred unless it is considered safe to do so and she has been stabilised.
(Grade C).
24. There should be regional consensus guidelines agreed by all relevant parties. (Grade A)
25. Women with elevated blood pressure should be given antihypertensive therapy consistent with
local protocols. (Grade A)
26. Magnesium sulphate is the anticonvulsant of choice for both prevention and treatment of
eclampsia (including treatment of acute seizure). Magnesium sulphate is recommended for
women with pre-eclampsia deemed at risk of seizure and for whom there is a plan for delivery.
Magnesium sulphate is relatively low cost and therefore of particular relevance in developing
countries. (Grade A)
 27. Women with a history of severe early onset pre-eclampsia, especially if associated with growth
restriction or late fetal loss, should be screened for antiphospholipid syndrome and the
implications for future pregnancies should be discussed. (Grade B)
28. Women who had early severe pre-eclampsia or pre-eclampsia associated with fetal growth
restriction, stillbirth or abruption, may be tested for hyperhomocysteinuria, factor V Leiden, protein
S, protein C and antithrombin (AT) deficiency but the implications for future pregnancies have yet
to be determined. (Grade C)

preeklamfsia warmoadgens orsulobiT gamowveul hipertenzias,

romlisaTvisac damaxasiaTebelia proteinuria (>0,3g. 24 saaTian SardSi),
SeSupeba, (SeiZleba ar iyos). preeklamfsiis dros SeiZleba daziandes
nebismieri organo an organoTa sistema. arsebobs mZime preeklamfsiis
ramodenime gansazRvreba. miRebulia konsensusi, rom mZime hipertenzia
ganisazRvreba, rogorc diastoluri arteriuli wnevis momateba 110 mm/vwy-ze,
xolo sistoluris 170 mm/vwy/sv orjeradi gazomvisas, rac mniSvnelovan
proteinuriasTan erTad (min. 1 g/l) warmoadgens mZime preeklamfsias.
naklebad zustadaa gansazRvruli saSualo xarisxis hipertenzia, romelic sxva
simptomebTan da niSnebTan erTad aseve gvevlineba mZime preeklamfsiis
saxiT.

profilaqtika

dRevandel dRes ar aris damtkicebuli Semdegis efeqturoba:

• siTxeebisa da marilis SezRudva orsulobis periodSi;
• cilebisa da naxSirwylebis damateba an SezRudva orsulobis periodSi;
• rkinis, foliumis mJavis, magneziis, cinkis, Tevzis qonis, E da C
vitaminebis damateba orsulobis dros (mtkicebulebis done IIa);

damtkicebulia, rom preeklamfsiis sixSiris daqveiTebas xels uwyobs

Semdegi:
• orsulobis dros aspirinis mcire dozebis miReba (75- mg
yoveldRiurad) preeklamfsiis ganviTarebis maRali riskis jgufSi; (IIa);
• Ca miReba sakvebi danamatebis saxiT (1g-mde dReSi)- Ca
ukmarisobis ganviTarebis maRali riskis jgufSi.
preeklamfsiisa da eklamfsiis diagnozi da Sefaseba

msubuqi preeklamfsia ar saWiroebs mkurnalobas, aucilebelia mxolod

saguldagulo dakvirveba pacientze (SesaZlebelia ambulatorulad) Semdegi
pirobebis dacviT: pacienti adeqvaturad afasebs sakuTar mdgomareobas da
SeuZlia misi damoukidebeli kontroli, aseve nebismier dros SeuZlia
samedicino daxamrebis gamoZaxeba.
qalTa konsultaciis eqimma an bebiaqalma msubuqi xarisxis preeklamfsiis
dros unda gaakeTon Semdegi:
• выдать официальное освобождение от работы
• Провести обучение мониторинга основных признаков развития преэелампсии
( АД, отеков, белка в моче, суточного диуреза, числа щевелений плода
• Протестировать, что пацинета немежленно обратиться в стационар при появлении
головной боли, расстройства зрения, болей в ,подреберье, внезапное появдение
отеков, на лице или руках,
• Убедиться что у нее есть транспортраная возможность экстренно добраться до
стационара
• Периодичность наблюления ( визитов) каздые три дня
• При невозможности выполения вышеуказанных условий беременная
госпитализирутся ( может быть испльзован девной стационар)
• Медикаментозное левение не назначается ( диеретики, гипотензивные, седативные)

mZime xarisxis preeklamfsia hospitalizebuli unda iyos intensiuri Terapiis

palataSi II an III donis saavadmyofos samSobiaro blokSi. Tu amis saSualeba
ar aris, mdgomareobis stabilizaciis Semdeg hospitalizacia unda saswrafo
daxmarebis manqaniT specializirebuli ( reanimaciuli) brigadis TanxlebiT.
qronikuli hipertoniuli davaadebis mqone yvela pacienti preeklampsiiT
ganixileba, rogorc pacienti mZime eklampsiiT.
mZime preeklamfsiiTa da eklamfsiiT daavadebuli qalebis Sefasebasa da
mkurnalobaSi monawileoba unda miiRon meanebma, anesTeziologebma da
gamocdilma bebiaqalebma.
Tavis tkivili an muclis tkivili warmoadgens daavadebis damZimebis
mniSvnelovan klinikuri simptoms. saWiroa arteriuli wnevis seriuli gazomva
da Sardis analizi proteinuriis gamosavlenad. magnezialuri Terapiis
Catarebisas yuradReba unda gamaxvildes misi toqsiurobis niSnebze. puls-
oqsimetris meSveobiT saWiroa Jangbadis saturaciis uwyveti monitoringi,
radganac am dros SesaZlebelia filtvebis SeSupebis niSnebis drouli
gamovlena.

miuxedavad imisa, rom preeklamfsiisa da eklamfsiis

klasifikacia dafuZnebulia sisxlis arteriuli wnevis C
maCveneblebsa da proteinuriis xarisxze, dedis riskis
Sesafaseblad klinicistebma aseve yuradReba unda miaqcion
sxva organoebis SesaZlo dazianebis niSnebs, placentis
paTologiisa da nayofismxrivi simptomatikis CaTvliT.

arteriuli wnevis gazomva

arteriuli wnevis gazomva unda ganxorcieldes standartizirebuli

meTodebis meSveobiT. mniSvnelovania orsulis swori pozicia arteriuli
wnevis gazomvis dros. aucilebelia, rom manJeti iyos Sesaferisi zomis
da moTavsdes orsulis gulis doneze. diagnozis dasadastureblad miRebuli
Sedegi mravaljer unda gadamowmdes bunebrivi variaciebis arsebobis
gamo. diastoluri arteriuli wnevis gansazRvrisaTvis saWiroa korotkovis
me-5-e fazis dafiqsireba. arteriuli wnevis gasazomad avtomaturi
xelsawyoebis gamoyenebisas SesaZlebelia arteriuli wnevis arazusti
maCveneblebis (gansakuTrebiT diastoluri wnevis) miReba. arteriuli
wnevis gasazomad sasurvelia vercxliswylis sfigmomanometrebis
gamoyeneba.; Tu vercxliswylis sfigmomanometri ar aris
xelmisawvdomi, gamoyenebuli unda iyos alternatiuli, kargad
Semowmebuli mowyobiloba.

arteriuli wnevis gazomvis dros orsuli unda ijdes 45 gradusiani

daxriT. wnevis gasazomi manJeti unda iyos Sesaferisi zomis da C
moTavsdes orsulis gulis doneze.

arteriuli wnevis avtomaturi sazomebis xmarebisas SesaZlebelia

arazusti maCveneblebis miReba, amitom sasurvelia B
kalibrirebuli vercxliswylis sfigmomanometris gamoyeneba.

proteinuriis gansazRvra
SardSi cilis gansazRvris mizniT xSirad gamoiyeneba test-xazebi. test
-xazis bolo ramodenime wuTiT Tavsdeba SardSi. test-xazis feris Secvlis
Semdeg miRebul Sedegs adareben etiketze mocemul fers. Sedegebi
Semdegnairad SeiZleba iyos warmodgenili: 1+ =0,3 g/l, 2+ = 1g/l, 3+
= 3 g/l. am skriningul meTods gaaCnia cudi prognozuri Rirebuleba..
testis vizualuri SefasebiT xSirad iReben rogorc cru dadebiT, aseve cru
uaryofiT Sedegebs.; .
yovelive zemoaRniSnulis gaTvaliswinebiT,
rekomendebulia 24 saaTiani Sardis laboratoriuli analizis Catareba.

proteinuriis gansazRvris ZiriTad skriningul tests warmoadgens

test-xazebis Sefaseba. proteinuriis damtkicebisaTvis unda
C
gamovlindes maCvenebeli 2+, ris Semdegac proteinuria unda
dadasturdes 24 saaTiani Sardis laboratoriuli analiziT

qalis monitoringi preeklamfsiisa da eklamfsiis dros

preeklamfsiis diagnozs adasturebs sisxlSi Sardovanis donis momateba. es

dakavSirebulia garTulebebis momatebul riskTan rogorc dedisaTvis, aseve
axalSobilisaTvis.; amis miuxedavad, Sardovanas done ar unda iyos
ganmsazRvreli klinikuri gadawyvetilebis miRebisas. Tirkmlis ukmarisoba
preeklamfsiis dros Tanamedrove mkurnalobis pirobebSi iSviaTia misi
ganviTareba ZiriTadad dakavSirebulia HELLP sindromTan, sisxlis denasa an
sefsisTan. sisxlSi kreatininis donis momateba daavadebis adreul stadiaze
miuTiTebs Tirkmlis Tanmxleb daavadebaze da dakavSirebulia garTulebebis
momatebul riskTan.
laboratoriulad Trombocitopeniis dadastureba miuTiTebs preeklamfsiis
damZimebaze.. 100 000-ze naklebi Trombocitebis raodenoba dakavSirebulia
koagulopaTiis ganviTarebis riskTan da warmoadgens Cvenebas
mSobiarobisaTvis. aspartataminotransferazis maRali maCveneblebi
dakavSirebulia dedis momatebul avadobasTan. HHELLP sindromis
diagnostika SesaZlebelia laboratoriuli meTodebiT hemolizis dadasturebiT

qalis mdgomareobis stabilizaciamde arteriuli wneva unda

gaizomos yovel 15 wT-Si erTxel da yovel 30 wT-Si erTxel
gamokvlevis pirvel etapze. konservatuli mkurnalobis pirobebSi
da qalis stabilizaciis Semdeg arteriuli wneva unda gaizomos 4
saaTSi erTxel

С
qalis gamokvleva moicavs yoveldRiurad sisxlis saerTo analizs,
aseve RviZlisa da Tirkmelebis funqciebis Sefasebas

koagulograma aucilebeli ar aris, Tu Trombocitebis raodenoba

aRemateba 100 000

aucilebelia siTxis balansis Sefaseba. amisaTvis SesaZlebelia

Sardis buStSi folis kaTeteris Cadgma. saWiroa saaTobrivi
diurezis aRricxva, gansakuTrebiT mSobiarobis Semdgom
periodSi.

nayofis Sefaseba

klinikebis umravlesobaSi nayofis mdgomareobis Sefaseba xorcieldeba

kardiotokografiis meSveobiT (non-stres testi). am meTods gaaCnia
dabali prognozuli Rirebuleba. mudmivi eleqtronuli monitoringis
Catareba mizanSewonilia mSobiarobis dros
preeklamfsiis dros orsulTa 30%-Si placentaruli ukmarisoba iwvevs
nayofis saSvilosnosSida zrdis Seferxebas. hipertenziiT daavadebul
orsulebSi nayofis zrdis Sefasebis mizniT pirveli vizitis dros unda Catardes
ultrabgeriTi kvleva. nayofis zrdis Seferxeba ZiriTadad viTardeba
asimetriulad, amitom sasurvelia muclis garSemowerilobis da saSvilosnos
FfuZis gazomva dinamikaSi ( gravidograma) . sanayofe siTxis
moculobis Semcirebam aseve SeiZleba gamoiwvios placentaruli
ukmarisoba da nayofis zrdis Seferxeba. amitom ultrabgeriTi kvlevis dros
orsulobis manZilze unda moxdes sanayofe siTxis moculobis seriuli
Sefaseba. randomizirebul kvlevebSi gamovlinda rom Wiplaris arteriis
doplerografiuli kvleva aumjobesebs axalSobilTa gamosavals

hospitalizaciis dros orsulis an mSobiares pirveli Sefasebisas B

unda Catardes kardiotokografia. igi iZleva informacias nayofis
mdgomareobis Sesaxeb mocemuli momentisaTvis.

mZime formis preeklamfsiis dros mSobiarobis dros unda B

Cautardes mudmivi kardiotokografia.

konservatuli mkurnalobis Catarebisas nayofis Sefaseba unda

ganxorcieldes ultrabgeriTi kvleviT, Wiplaris arteriis doplerografiiT A
da sanayofe siTxis moculobis seriuli SefasebiT.
mZime formis preeklamfsiis mkurnaloba

mZime preeklamfsiis mkurnaloba moicavs orsulis dauyonlebliv

hospitalizacias, stabilizacias, mudmiv monitoringsa da mSobiarobas dedisa
da nayofisaTvis optimalur dros. mkurnaloba gulisxmobs arteriuli wnevisa da
krunCxvebis kontrols.

arteriuli wnevis kontroli

Tu arteriuli wnevis maCveneblebi metia an toli 170/110 mm/vwy/sv-sa, dedis

interesebidan gamomdinare saWiroa mkurnalobis dawyeba am drois
gamoiyeneba nifedipini an labetaloli. mwvave hipertenziis SemTxvevaSi
labetalolis Seyvana SesaZlebelia peroralurad da aucileblobis SemTxvevaSi
Semdgom intravenuradac. hidralazinis miReba naklebadaa mizanSewonili,
rac dadasturda erT-erT mimoxilviT kvlevaSi, Tumca ar arsebobs sakmarisi
mtkicebulebebi misi gamoyenebis akrZalvisaTvis. garda amisa, saqarTveloSi
Hhidralazini ar moipoveba.
Tu arteriuli wnevis maCveneblebi naklebia 160/100 mm/vwy/sv-ze, saswrafo
antihipertenziuli mkurnalobis dawyeba aucilebeli ar aris. gamonaklisi unda
gakeTdes im SemTxvevebisaTvis, rodesac mdgomareoba rTuldeba masiuri
proteinuriTa da RviZlis funqciebis darRveviT, aseve laboratoriulad vlindeba
hematologiuri darRvevebi. aseT SemTxvevebSi antihipertenziuli mkurnalobis
dawyeba gamarTlebulia arteriuli wnevis ufro dabal maCveneblebzec..
grZeldeba debatebi im SemTxvevebTan dakavSirebiT, rodesac diastoluri
wneva varirebs 100 da 110 mm/vwy/sv-s Soris. mkurnaloba am dros
amcirebs mwvave hipertenziuli krizebis sixSires da Semdgomi
antihipertenziuli mkurnalobis Catarebis aucileblobas; Tumca aseve
SeimCneva nayofis wonis umniSvnelo Semcireba dabadebis momentisaTvis.
Tu ar arsebobs Cveneba saswrafo mSobiarobisaTvis, antihipertenziuli
mkurnalobis dawyebiT SesaZlebelia orsulobis prolongireba saSualod 15 dRiT.
meTildopa da labetaloli xSirad gamoiyeneba preeklamfsiisa da eklamfsiis
mkurnalobis dros meTildopas gamoyeneba usafTxoa nayofisaTvis, rac
damtkicda misi xangrZlivi gamoyenebiT. zogierT kvlevaSi gamovlinda
labetalolis upiratesoba. atenololis gamoyenebisas SesaZlebelia nayofis zrdis
Seferxebis ganviTareba. angiotenzin makonvertirebeli fermentis inhibitorebis
gamoyeneba winaaRmdegnaCvenebia nayofis SesaZlo gverdTi efeqtebis
ganviTarebis gamo.
sasurvelia, eqimebma gamoiyenon is preparatebi, romelTac isini kargad
icnoben..
kortikosteroidebi gamoiyeneba HELLP sindromis dros. arsebuli
mtkicebulebebidan gamomdinare, isini aumjobeseben hematologiur da
bioqimiur maCveneblebs, Tumca ar arsebobs mtkicebulebebi imis Sesaxeb,
rom kortikosteroidebis gamoyeneba amcirebs dedaTa avadobas.

Tu sistoluri wneva metia 160 mm/vwy/sv-ze, an diastoluri wneva

metia 110 mm.vwy/sv-ze, saWiroa antihipertenziuli mkurnalobis
dawyeba. im SemTxvevaSi, Tu aRiniSneba orsulobis hipertenziuli
C
garTulebebis sxva niSnebi, mkurnalobis dawyeba SesaZlebelia
arteriuli wnevis ufro dabal mCveneblebzec

mZime formis hipertenziis saswrafo mkurnalobis dros

SesaZlebelia labetalolis (rogorc oralurad, aseve intravenurad), A
nifedipinis (oralurad) gamoyeneba

saSualo xarisxis hipertenziis dros mkurnaloba xels uwyobs

orsulobis prolongirebas. sasurvelia, eqimebma gamoiyenon is C
preparatebi, romlebsac isini kargad icnoben.

Tavi unda SevikavoT atenololis, angiotenzin makonvertirebeli

fermentis inhibitorebisa da angiotenzinis receptorebis B
mablokirebeli agentebis gamoyenebisagan.

nifedipinis micema unda moxdes oralurad da ara sublingvalurad. С

Tu orsuls aReniSneba asTmis niSnebi, Tavi unda SevikavoT С

labetalolis gamoyenebisagan.

krunCxvebis prevencia

MAGPIE kvlevam gamoavlina, rom magneziis sulfatis gamoyeneba

preeklamfsiis dros 58%-iT amcirebs eklamfsiuri krunCxvebis ganviTarebis
risks. (95% CI 40-71%). magneziis sulfatis infuzia unda gagrZeldes
mSobiarobidan an bolo krunCxvidan 12 - 24 saaTis ganmavlobaSi.. infuziis
dros mniSvnelovania Sardis gamoyofis, dedis refleqsebis, sunTqvis sixSiris da
Jangbadis saturaciis regularuli Sefaseba.

mZime preeklamfsiis dros eklamfsiis ganviTarebis riskis gamo

saWiroa magneziis sulfatis gamoyeneba.
A

krunCxvebis kontroli

mZime formis preklamfsiisa da eklamfsiis dros aucilebelia qalTan mudmivi

postis arseboba. samSobiaro blokSi unda imyofebodnen anesTeziologebi,
ufrosi meanebi da neonatologebi. orsuli unda davawvinoT gverdze da
daviwyoT Jangbadis micema. unda Semowmdes sasunTqi gzebi, sunTqvis
sixSire, gaizomos pulsi da arteriuli wneva. amisaTvis mizanSewonilia puls-
oqsimetris gamoyeneba. qalis mdgomareobis stabilizaciis Semdeg unda
daigegmos mSobiaroba.
preeklamfsiisa da eklamfsiis dros diazepami da fenitoini aRar warmoadgenen
pirveli xazis preparatebs, arCevanis preparats warmoadgens magneziis
sulfati. magneziis intravenuri Seyvanisas gverdiT efeqtebi ufro iSviaTad
SeiniSneba. sisxlSi magneziis donis rutinuli gazomva mizanSewonili ar aris,
radganac misi toqsiuroba iSviaTad vlindeba miRebuli sqemebiT Seyvanisas.
magneziis gamoyofa ZiriTadad xdeba SardiT. saWiroa Sardis gamoyofis
mkacri kontroli da oliguriis dros (> 20 ml/sT-Si) magneziis infuzia unda
Sewydes. magneziis sulfatis toqsiuroba ZiriTadad vlindeba myesTa Rrma
refleqsebis gaqrobiT da sunTqvis sixSiris cvlilebiT.. respiratoruli depresiis
ganviTarebaze eWvis dros, saWiroa 1g kalciumis glukonatis Seyvana 10 wT-is
ganmavlobaSi.
krunCxvebis ganmeorebisas SesaZlebelia diazepamisa da Tiopentonis
gamoyeneba erTjeradi dozebiT. diazepamis xangZlivi gamoyeneba
dakavSirebulia dedis sikvdilianobis zrdasTan. krunCxvis gagrZelebisas
oqsigenaciis uzrunvelsayofad SesaZlebelia saWiro gaxdes intubacia. am dros
mizanSewonilia qalis gadayvana intensiuri mkurnalobis ganyofilebaSi.

krunCxvebis mkurnaloba efuZneba ventilaciis, sunTqvisa da

cirkulaciis sabaziso principebis dacvas. C
krunCxvebis kontrolisaTvis arCevanis preparats wamoadgens.
magneziis sulfati. damtvirTavi doza 4 g. Seyvanili unda iyos
infuzomatis an sainfuzio Spricis saSualebiT 15 wT-is
A
ganmavlobaSi, SemdgomSi 1sT/1g-is SeyvaniT 24 saaTis
ganmavlobaSi bolo krunCxvis Semdeg.

ganmeorebiTi krunCxvebis mkurnaloba unda xdebodes 2g A

magneziis sulfatis erTjeradi dozis SeyvaniT bolusiT
SemdgomSi dozis gazrdiT 1,5-2 g/1 sT-Si.

siTxis balansi

bolo 20 wlis ganmavlobaSi, dedis sikvdilianobis mniSvnelovan mizezs

warmoadgens filtvebis SeSupeba. filtvebis SeSupeba xSirad aris gamowveuli
siTxeebis araswori SeyvaniT. ar arsebobs mtkicebulebebi siTxis raodenobis
gazrdis dadebiTi zegavlenis Sesaxeb, piriqiT, Seyvanili siTxis raodenobis
SezRudva dakavSirebulia dedis ukeTes gamosavalTan. siTxeebis balansis
marTva gansakuTrebulad rTuldeba sisxldenis dros da aseT SemTxvevebSi
siTxeebis SezRudva mizanSewonili ar aris.

mSobiarobisa da mSobiarobis Semdgomi periodis dros C

sasurvelia Seyvanili siTxis raodenobis SezRudva 80 ml/sT-de
anu 1 ml/kg/sT-Si.

mSobiarobis dros gansazRvra

dedis stabiluri mdgomareobis dros mSobiarobis gadavadeba ramodenime

saaTiT saSualebas iZleva neonatologiuri ganyofilebis ufro kargad
mosamzadeblad. Tu gestaciis vada aRemateba 34 kviras, mSobiaroba
rekomendebulia mxolod mdgomareobis stabilizaciis Semdeg. orsulobis 34
kviramde SesaZlebelia mSobiarobis gadavadeba 24 saaTiT, rac iZleva
saSualebas steroiduli mkurnalobis Casatareblad, romelic amcirebs
respiratorul distres sindromTan dakavSirebul sikvdilianobis risks. steroidebs
efeqturoba vlindeba im SemTxvevaSic ki, rodesac mSobiaroba iwyeba
Seyvanidan 24 saaTze nakleb droSi;
gestaciis adreul vadebze orsulobis prolongireba aumjobesebs bavSvis
gamosavals; orma mcire randomizirebulma kvlevam gamoavlina neonataluri
garTulebebis riskis daqveiTeba mZime formis preeklamfsiis adreuli
gamovlinebisas mocdiTi taqtikis gamoyenebisas. .
orsulobis prolongireba
xdeboda saSualod 7-15 dRemde, Sesabamisad gestaciis 28-34 da 28-32
kvirebze.
mSobiarobis gegma unda Camoyalibdes konsiliumis meSveobiT. ufro
mizanSewonilia saSosmxrivi mSobiaroba, Tumca, Tu gestaciis vada 32
kviraze naklebia, sasurvelia sakeisro kveTis Catareba. sakeisro kveTis
SemTxvevaSi upiratesoba eniWeba regioalur ( spinaluri, epiduruli)
anestezias. orsulobis 34 kviris Semdeg nayofis TaviT winamdebareobisas
sasurvelia saSosmxrivi mSobiaroba. saSosmxrivi prostaglandinebis an misi
analogebis gamoyeneba am dros zrdis warmatebis albaTobas.
antihipertenziuli mkurnaloba unda gagrZeldes gamokvlevisa da mSobiarobis
dros.

qalia mdgomareobis stabilizaciisa da konsiliumis Semdeg unda C

gadawydes sakiTxi mSobiarobis Sesaxeb

34 kviris orsulobis vadamde sasurvelia mSobiarobis gadavadeba A

kortikosteroidebis Seyvanis mizniT.

konservatuli mkurnaloba gestaciis adreul vadaze aumjobesebs A

perinatalur gamosavals

mSobiarobis tipi unda ganisazRvros nayofis winamdebareobis da

mdgomareobis Sefasebis, mSobiarobis induqciis warmatebisa da
C
saSvilosnos yelis Sefasebis Semdeg.

arteriuli wnevis momatebis riskis gamo ergometrinisa

gamoyeneba sisxlisdenis profilaqtikis mizniT mSobiarobis C
Semdeg mizanSewonili ar aris. am mizniT saWiroa oqsitocinis
gamoyeneba

mkurnaloba mSobiarobis Semdeg

mSobiarobis Semdgom periodSi mZime preeklamfsia an eklamfsia viTardeba

SemTxvaTa 44%-Si, gansakuTrebiT vadamitanili orsulobis dros. preeklamfsia
unda gamoiricxos im melogineebSi, romelTac mSobiarobis Semdeg
aReniSnebaT hipertenziis an preeklamfsiis niSnebi (Tavis tkivili, mxedvelobis
darRveva, gulisreva, Rebineba an tkivili epigastriumSi) preeklamfsiis (an
eklamfsiis) fonze mSobiarobis Semdeg melogine unda imyofebodes mudmivi
dakvirvebis qveS. sabolood ar aris garkveuli, Tu ramdeni sawoldRe unda
gaataros mSobiarobis Semdeg meloginem saavadmyofoSi, Tumca cnobilia,
rom preeklamfsiisa da eklamfsiis ganviTarebis sixSire qveiTdeba mSobiarobis
Semdeg meoTxe dRidan klinikuri simptomatikis gaumjobeseba unda
dadasturdes qalis gaweramde.
antihipertenziuli mkurnaloba mSobiarobis Semdegac unda gagrZeldes.
mSobiarobis Semdeg arteriuli wnevis daqveiTebis miuxedavad, misi
maCveneblebi SeiZleba gaizardos mSobiarobidan 24 saaTis Semdeg.
antihipertenziuli mkurnalobis moxsna TandaTanobiT unda moxdes. qalis
gaweris Semdeg mkurnalobis gagrZeleba SesaZlebelia ambulatorulad.
arteriuli wnevis maCveneblebis normalizeba preeklamfsiis Semdeg 3 Tvis
ganmavlobaSi SeiZleba moxdes. am periodis ganmavlobaSi arteriuli wnevis
maCveneblebi ar unda aRematebodes 160/110mm/vwy/sv-s. dRevandel dRes
ar aris mtkicebulebebi raime garkveuli antihipertenziuli saSualebis
dasaniSnad. meZuZur dedebTan SesaZlebelia atenololis, labetalolis,
nifedipinisa da enalaprilis gamoyeneba, rogorc calke, aseve kombinaciis
saxiT.

meanebi unda acnobierebdnen gviani krunCxvebis

ganviTarebis SesaZleblobas da saxlSi gaweramde
C
darwmundnen qalis usafrTxoebaSi

antihipertenziuli mkurnaloba arteriuli wnevis maCveneblebis

Sesabamisad unda gagrZeldes mSobiarobis Semdegac. C
SesaZloa, mkurnalobis gagrZeleba saWiro gaxdes
mSobiarobidan 3 Tvis ganmavlobaSi

mdgradi hipertenziisa da proteinuriis SemTxvevaSi

mSobiarobidan 6 kviris ganmavlobaSi unda gamoiricxos C
Tirkmelebis Tanxmlebi paTologia, rac saWiroebs Sesabamis
gamokvlevas.

eklamfsiis 44% viTardeba mSobiarobis Semdgom, amitom

preeklamfsiisa da eklamfsiis fonze mSobiarobis Semdeg
C
saWiroa meloginis mdgomareobis mudmivi Sefaseba

mSobiarobis Semdgomi dakvirveba.

mtkicebulebebi mowmobs, rom preeklamfsiiT daavadebul qalTa 13%-s
aReniSneba Tanmxlebi qronikuli an esenciuri hipertenzia, romelic ar
gamovlinda antenatalurad.

rekomendebulia zogadi profilis eqimis mier arteriuli wnevisa

da proteinuriis kontroli mSobiarobidan 6 kviris ganmavlobaSi. C
Tu saxezea persistirebadi hipertenzia an proteinuria, saWiroa
Semdgomi gamokvlevebis Catareba.