1

moduli 4, hendauti studentebisaTvis

Oorsuloba da Tanmxlebi
eqstragenitaluri daavadebani

modulis damTavrebis Semdeg

studentma unda icodes
orsulobis dros qalis organizmSi mimdinare:
naxSirwylovani cvlis cvlilebebi
farisebri jirkvlis funqciis cvlilebebi
gul-sisxlZarRvTa sistemaSi mimdinare
cvlilebebi
orsulobis Tanmxlebi eqstragenitaluri
daavadebis antenataluri meTvalyureobis
ZiriTadi principebi:
Saqriani diabeti
farisebri jirkvlis daavadebebi
kardiopaTiebi
 2

naxSirwylovani cvla fiziologiuri

orsulobis dros
matulobs diabetogenuri
kontrinsulinaruli faqtorebi:
placentaruli laqtogeni
Saqriani diabeti
kortizoli
progesteroni
zrdis faqtorebi

orsulobis dros placentaSi sinTezirebuli diabetogenuri hormonebi -

kortizoli, placentaruli laqtogeni, progesteroni da zrdis faqtorebi,
ganapirobeben insulinisadmi rezistentobis da hiperinsulinemiis ganviTarebas,
ramac zogierT orsulSi SeiZleba xeli Seuwyos Saqriani diabetis ganviTarebas.
orsulobis dros ganviTarebuli es da sxva endokrinuli da metaboluri
cvlilebebi uzrunvelyofs nayofis mudmiv srulyofil momaragebas sakvebiTa da
sawvaviT.

naxSirwylovani cvla fiziologiuri

orsulobis dros
viTardeba SedarebiTi insulinrezistentoba

viTardeba hiperinsulinemia

icvleba glukozis homeostazi

glukozis done:
uzmoze- 3,3-5,0 mmol/l
sakvebis miRebidan 1sT-is Semdeg- 6,7-7,8mmol/l

orsulobis dros naxSirwylovani cvlis ZiriTad cvlilebas insulinisadmi

mgrZnobelobis daqveiTeba warmoadgens, romelic orsulobis vadis
paralerulad progresirebs kontrinsulinaruli faqtorebiT ganpirobebuli
SedarebiTi insulinrezistentoba yvelaze metad orsulobis III trimestrSi
mJRavndeba. naxSirwylovani cvlis dasabalanseblad kuWqveSa jirkvali axdens
insulinis produqcias didi raodenobiT, viTardeba hiperinsulinemia, icvleba
glukozis homeostazi. fiziologiuri orsulobisas ganviTarebuli
hiperinsulinemia iwvevs uzmoze glukozis donis Semcirebas.

Manual of Obstetrics , Fifth Edition, edited by Kenneth R. Niswander, Boston/New Y

York/Toronto/London, 1996
 3

klasifikacia
Saqriani diabeti
idiopaTiuri Saqriani diabeti
Saqriani diabeti gamovlindeba
hiperglikemiiT da ganpirobebulia insulindamokidebuli-I tipis
insulinis SedarebiTi an absoluturi
deficitiT an insulinis receptorebis arainsulindamokidebuli- II tipis
funqciis darRveviT
gestaciuri Saqriani diabeti
Saqriani diabeti aris paTologia, glukozisadmi tolerantobis
rodesac plazmaSi glukozis daqveiTeba
koncentracia uzmoze aRemateba
7,8mmol/l-s an 75g-s, xolo glukoziT
datvirTvis 1-2saaTis Semdeg>11,1mmol/l-s
(Mjanmo )

klasifikacia Zalze gaZnelebulia, radgan gansxvavebulia

diagnostikuri kriteriumebi, gansxvavebulia normisa da
paTologiis sazRvrebi, variabeluria orsulobis gavlena.
insulindamokidebuli diabetis diagnozi upiratesad orsulobamde
ismeba da emyareba diabetis klasikur klinikur suraTs: sxeulis
masis daqveiTeba, wyurvili, poliuria, glukozuria poliuriasTan
erTad, hiperglikemia da ketoacidozi. qalebis nawils diabetis
simptomebi uviTardebaT orsulobis dros.

gestaciuri diabeti
pirveladad orsulobis dros diagnos-
tirebuli glukozis intolerantobis
nebismieri xarisxi
gestaciuri diabeti viTardeba, roca
pankreasis funqcia ar aris sakmarisi
orsulobis diabetogenuri gardaqmnis
Sedegad ganviTarebuli insulinore-
zistentobis dasaZlevad

gestaciri diabeti ganisazRvreba, rogorc pirveladad orsulobis

dros amocnobili glukozisadmi intolerantobis nebismieri
xarisxi. gestaciuri diabetis mqone qalebis umravlesobas
glukozisadmi intolerantoba ewyeba orsulobis dros, magram zog
SemTxvevaSi adgili aqvs II tipis, orsulobamde amoucnob Saqrian
diabets. gestaciuri diabetis mqone qalTa daaxloebiT 10%
sisxlSi aReniSnebaT autoimunuri antisxeulebi (e.w.islet-cell) da
SesaZlebelia es iyos I tipis diabetis latenturi forma.
 4

gestaciuri diabeti
Saqriani diabeti orsulTa23%(1000-dan1)
aqedan 90 % -orsulTa Saqriani diabeti
gavrcelebis xarisxi damokidebulia:
rasobriv da eTnikur warmomavlobaze
diagnostikis meTodebis efeqturobaze
gamoyenebul diagnostikur kriteriu-
mebze

msoflioSi Saqriani diabetis sixSire varirebs, rac

ganpirobebulia rasobrivi da eTnikuri warmoavlobiT. mag. aSS
Saqriani diabetis gavrcelebis xarisxi bevrad maRalia afriko-
amerikelebSi, latinosebSi da azielebSi, xolo TeTr qalebSi
dabalia. gavrcelebis sixSires aseve ganapirobebs gamoyenebuli
diagnostikuri kvlevis meTodebi da diagnostikuri kriteriumebi.
orsulTa Saqriani diabetis sixSireze aseve moqedebs dedis asaki
da wona. aSS orsulTa Saqriani diabetis sixSire varirebs 1,4% -14%
intervalSi.

Screening and diagnosis of gestational diabetes mellitus, Author Lois Jovanovic, MD

Section Editors David M Nathan, MD, Last literature review version 16.3: October 2008

gestaciuri diabeti
xelSemwyobi faqtorebi

dedis momatebuli gacximovneba

Semcirebuli fizikuri aqtivoba
momatebuli kaloraJi

gestaciuri diabeti viTardeba maSin, roca pankreasisi funqcia ar

aris sakmarisi daZlios orsulobis dros ganviTarebuli
diabetogenuri hormonebiT ganpirobebuli insulinis rezistentoba.
gestaciuri diabetis ganviTarebas aseve xels uwyobs orsulobis
dros dedis momatebuli gacximovneba da kaloraJi da Semcirebuli
fizikuri aqtivoba.
 5

gestaciuri diabeti
risk-faqtorebi
ojaxur anamnezSi mkvdradSobadoba an
Saqriani diabeti nayofis simaxinje
sxeulis masis indeqsi > anamnezSi
30 kg/m2 dedis wona dabadebisas
simsuqne bavSvobaSi 4.1 kgan meti an 2.7 kg-ze
asaki 25 weli da meti naklebi
wina mSobiaroba didi polikistozuri
nayofiT>4.1 kg sakvercxeebis sindromi
anamnezSi glukozis
tolerantobis darRveva glukokortikoidebis
gamoyeneba
eTnikuri warmomavloba
esenciuri an orsulobiT
inducirebuli hipertenzia

qvemoT CamoTvlili nebismieri risk-faqtoris mqone orsuls

SesaZlebelia ganuviTardes gestaciuri Saqriani diabeti maRali
albaTobiT:
Saqriani diabetis ojaxuri anamnezi, gansakuTrebiT pirveli rigis
naTesavebSi, orsulis wona normaluri wonis 110% an sxeulis
masis indeqsi > 30kg/m2 an sxeulis masisi mniSvnelovani mateba
adreul asakSi, orsulobebs Soris an orsulobis sawyiss etapze,
qalis asaki >25welze, wina mSobiarobisas nayofis wona > 4,1kg.,
anamnezSi glukozis tolerantobis darRveva, II tipis diabetis
maRali sixSiris (>2%) eTnikuri jgufis wevroba, gaurkveveli
genezis mkvdradSobadoba an nayofis simaxinje anamnezSi, dedis
wona dabadebisas >4,1kg. an <2,7kg., polikistozuri sakvercxeebis
sindromi, glukokortikoidebis mimdinare gamoyeneba, esenciuri an
orsulobiT inducirebuli hipertenzia.

gestaciuri diabeti
garTuleba
dedismxrivi nayofismxrivi
retinopaTia mravalwylianoba
nefropaTia makrosomia
hipertenzia samSoabiaro travma
kardiovaskularuli perinataluri
daavadebani sikvdiloba
ketoacidozi metaboluri
farisebri jirkvlis darRvevebi
daavadebani Tandayolili
ganviTarebis mankebi

Saqriani diabetis dros dedismxrivi da nayofismxrivi

garTulebaTa riski damokidebulia Saqriani diabetis
xangrZlivobaze, simZimeze da kompensaciis xarixze. Saqriani
diabetis dedismxrivi garTulebebi letalobis mizezs iSviaTad
warmoadgens. dedaTa sikvdiloba Saqriani diabetis mqone
qalebSi dReisaTvis sagrZnoblad Semcirebulia da letalobis
 6

yvelaze xSir jgufs miekuTvnebian qalebi gulis iSemiuri

daavadebiT. orsulobis dros retinopaTia Zalze progresirebs,
amitom orsulebs sistematurad unda Cautardes ofTalmologis
konsultacia. retinopaTiisagan gansxvavebiT orsulobis dros
Tirkmlis funqcia iSviaTad uaresdeba, xolo mSobiarobis
Semdeg aRdgeba. Tumca diabeturi nefropaTiis mqone qalebSi
gansakuTrebiT maRalia preeklamfsiis ganviTarebis riski.
Saqriani diabetis dros izrdeba infeqciur daavadebaTa
ganviTarebis riski.
nayofismxrivi garTulebebidan aRsaniSnavia orsulobis I
trimestrSi TviTnebiTi abortebisa da nayofis ganviTarebis
mankebis maRali sixSire. . TviTnebiTi abortis sixSire
matulobs 35%-iT, xolo nayofis ganviTarebis mankebis sixSire
matulobs 4-jer. gansakuTrebiT nayofis ganviTarebis mankebis
riski matulobs 30 %-iT 59 kviris vadaze. ZiriTadad ziandeba:
cns, guli, Tirkmeli, badura. ganviTarebis mankebidan yvelaze
xSiria gulis Tandayolili mankebi, nervuli Reros defeqtebi
(kaudaluri regresiis sindromis CaTvliT), rac SemdgomSi
axalSobilTa sikvdilis mizezi xdeba. saqriani diabetis mqone
orsulebSi perinataluri sikvdiloba 40% aRwevs rac 2-4-jer
aremateba janmrTel orsulebSi perinataluri sikvdilobis
maCvenebels. varaudoben, rom ganviTarebis mankebis waroSobis
meqanizmi dakavSirebulia orsulobis 4-6 kviris vadaze,
organogenezis procesSi hiperglikemiiT ganpirobebuli yviTris
parkis qsovilebis hipoqsiuri dazinebasTan. Saqriani diabetis
kidev erti garTulebaa nayofis makrosomia, rac Tavis mxriv
zrdis samSobiaro travmatizmsa da axalSobilis asfiqsiis
risks. nayofis zrdis daCqareba orsulobis II da III trimestrSi
Saqriani diabetis arasrulfasovani kompensaciiT aris
ganpirobebuli. zogadad, dedisa da nayofis garTulebaTa riskis
xarisxi damokidebulia orsulis sisxlis plazmaSi glukozis
normaluri donis SenarCunebaze mTeli orsulobis
ganmavlobaSi. intensiuri insulinoTerapiis Sedegad daavadebis
garTulebebis sixSire orsulebSi TiTqmis igivea rac
araorsulebSi.
Screening and diagnosis of gestational diabetes mellitus, Author Lois Jovanovic, MD
Section Editors David M Nathan, MD, Last literature review version 16.3: October 2008
 7

gestaciuri diabeti

monitoringis meTodebi da
diagnostikuri kriteriumebi
idiopaTiuri Saqriani diabetisa da
orsulTa Saqriani diabetis dros
erTi da igivea

Saqriani diabetis da orsulTa diabetis marTva identuria.

orsulobamdeli konsultacia ufro mniSvnelovani Saqriani
diabetis mqone qalebisaTvis, raTa ganisazRvros riskebi da
gadawydes orsulobis marTvis an mizanSewonilebis sakiTxebi.
janmos mier rekomendirebulia, rom orsulTa Saqrian diabetis
diagnostireba SesaZlebeli iyos klinikuri gamovlenis gareSec,
Tu gamoxatulia sisxlis plazmaSi glukozis raodenobis erTi
paTologiuri gadaxrac ki. orsulTa Saqriani diabetis
diagnostirebisaTvis, gansxvavebiT Saqriani diabetisaganD ar aris
saWiro klinikuri gamovlinebis arseboba.
Screening and diagnosis of gestational diabetes mellitus, Author Lois Jovanovic, MD
Section Editors David M Nathan, MD, Last literature review version 16.3: October 2008

gestaciuri diabeti
visi skriningi ganvaxorcieloT?
upiratesoba eniWeba universalur da ara
seleqtiur skrinings (Grade 2B)
skriningi utardeba yvela 25 welze
meti asakis orsuls
seleqtiuri skriningi utardebaT
orsulebs cnobili riskfaqtorebiT

amerikis diabetis asociaciis rekomendaciiT unda ganxorcieldes

orsulTa universaluri skriningi (Grade 1B), Tumca zogierTi
gaidlainis mixedviT skriningi unda Cautardes mxolod cnobili
risk-faqtoris mqone orsulebs. gestaciuri diabetis mqone qalTa
gamovlena Zalze mniSvnelovania, radgan Sesabamisi mkurnaloba,
 8

romelic iZleva normoglikemiis SenarCunebis saSualebas,

mniSvnelovnad amcirebs dedaTa da nayofis sikvdilobasa da
avadobas, kerZod ki mekrosomias da mniSvnelovnad aumjobesebs
perinatalur gamosavals. aqedan gamomdinare upiratesoba
universalur skrinings eniWeba, radgan seleqtiuri skriningi aris
mouwesrigebeli da arasakmarisad mgrZnobiare. amerikis mean-
ginekologTa asociacia upiratesobas universalur skrinings
aniWebs.

Screening and diagnosis of gestational diabetes mellitus,

Lois Jovanovic, MD ,11.08.08.UptoDate

gestaciuri diabeti
rodis vawarmooT skriningi?
optimaluri skriningi orsulobis
24-28 kviris vadaze (Grade 2B)
pirveli antenataluri vizitis
dros risk-faqtorebis arsebobis
SemTxvevaSi

skriningis warmoebis optimalur drod orsulobis 24-28kviris vada

miiCneva. Tumca risk- faqtorebis arsebobebis SemTxvevaSi, roca
arsebobs eWvi, rom orsuls aReniSneba aradiagnostirebuli II tipis
diabeti, skriningi unda Catardes rac SeiZleba adre, pirvelive
antenataluri vizitis dros. qalebSi, romelTac anamnezSi
aReniSnebaT gestaciuri diabeti, Semdgomi orsulobis dros am
paTologiis ganmeorebiT ganviTarebis riski 30-50%.
Screening and diagnosis of gestational diabetes mellitus, Author Lois Jovanovic, MD
Section Editors David M Nathan, MD, Last literature review version 16.3: October 2008
 9

gestaciuri diabeti
rogor vawarmooT skriningi?
glukozisadmi tolerantobis
dadgenis oraluri 50 gramiani
mcire testi (Grade 2B)
50g glukozis miRebidan 1 saaTis
Semdeg sisxlis plazmaSi glukozis
gansazRvra

skriningis Casatareblad rekomendirebulia glukozis mcire

testis Catareba ( ACOG da ADA ). 50g. glukoza orsuls
eZleva miuxedavad imisa,Tu ra droa gasuli ukanaskneli
sakvebis miRebidan da erT saaTSi sisxlis SratSi isazRvreba
glukozis raodenoba. Tu 1saaTiani 50 glukozis
tolerantobis testi normis farglebSia, testi meordeba
orsulobis 24-28kviris vadaze da orsuls ar sWirdeba sxva
saxis kvleva da mkurnaloba. glukozis raodenoba 130 an 140
mg/dL (7.2 or 7.8 mmol/L) miCneulia aranormalurad. normasa da
paTologias Soris zRvrad miCneulia glukozis done 130
mg/dL . Tu glukozis tolerantobis erTsaaTiani testi
140-190 mg/dl(7,8-10,6mmol/l), diagnozis dadasturebis mizniT
iyeneben samsaaTian glukozis tolerantobis tests 100g
glukoziT, Tu glukozis done 190mg% (10,6mmol/l-ze) metia,
maSin ismeba orsulTa Saqriani diabetis savaraudo diagnozi.
glukozis koncentraciis gansazRvra umjobesia venur
sisxlSi. kapilarul sisxlSi glukozis gansazRvra
skriningis mizniT ar tardeba. qalebi, romlebsac
randomizirebulad sisxlis SratSi glukozis koncentracia
11,1mmol/l aRemateboda an uzmoze 7,0mmmol/l-ze meti iyo
skriningis Catarebas da diagnozis dazustebas ar saWiroeben,
radgan mxolod es monacemebi, Tu meore dResac dadasturda,
adasturebs diabetis diagnozs.

Screening and diagnosis of gestational diabetes mellitus, Author Lois Jovanovic, MD

Section Editors David M Nathan, MD, Last literature review version 16.3: October 2008
 10

gestaciuri diabeti
diagnozis dadastureba
3 saaTiani glukozis tolerantobis testi
erTi maCveneblis normidan gadaxra
ganixileba rogorc glukozisadmi
tolerantobis darRvevea
2-3 maCvenebelis normidan gadaxra-
ismeba Saqriani diabetis diagnozi
Tu yvela maCvenebeli normaSia,
testi meordeba orsulobis 32-
34kviri vadaze

orsulTa skriningis Semdeg diagnozis dadasturebis mizniT

tardeba glukozis oraluri samsaaTiani testi. qals eZleva 100g.
glukoza oralurad da yoveli saaTis Semdeg sami saaTis
ganmavlobaSi isazRvreba glukozis raodenoba sisxlSi.
diagnostikur kriteriumebad gamoyeneba gestaciuri diabetis IV
internacionaluri konferenciis mier SemuSavebuli kriteriumebi.
gestaciuri diabetis diagnozi dadasturebulia, Tu glukozis
donis ori an meti maCvenebeli gamovlindeba: uzmoze sisxlis
SratSi glukozis koncentracia >95 mg/dL (5.3 mmol/L), erTi saaTis
Semdeg >180 mg/dL (10 mmol/L), ori saaTis Semdeg >155 mg/dL (8.6
mmol/L), sami saaTis Semdeg >140 mg/dL (7.8 mmol/L). ar arsebobs
erTiani mosazreba imis Sesaxeb, Tu rogor unda imarTos im qalTa
orsuloba romelsac mxolod erTi maCvenebeli aqvT abnormaluri
iseve rogorc gestaciuri diabetis mqone orsulebi, Tu oTxi
kviris Semdeg ganmeorebiT Catardes sam saaTiani glukozis
tolerantobis testi. savaraudod fiqroben, rom aseTi orsulebis
mkurnaloba amcirebs makrosomiis sixSires.
Screening and diagnosis of gestational diabetes mellitus, Author Lois Jovanovic, MD
Section Editors David M Nathan, MD, Last literature review version 16.3: October 2008
 11

gestaciuri diabeti
marTva
konsultireba
Casaxvamdeli
orsulobis periodSi
monitoringi
glikemiis kontroli
orsulobis garTulebaTa monitoringi
nayofis mdgomareobis monitoringi
mkurnaloba

gestaciuri diabetis mqone orsulTa meTvalyureobas

axorcielebs mean-gine-kologTa, endokrinologTa da
ofTalmologTa gundi. gamosavlis gaumjobesebis mizniT
mniSvnelovania pacientis meanisa da endokrinologis
SeTanxmebuli qmedebis ganxorcieleba. pregravidaruli
konsultireba utardebaT qalebs, romlebsac daorsulebamde
aReniSnebaT Saqriani diabeti pirveli prenataluri viziti
saSualebas aZlevs klinicists Seafasos pacientis sawyisi
statusi, gamoavlinos orsulTa diabeti, miawodos
informacia: Saqriani diabetis marTvis, SesaZlo
garTulebebis, glukozis monitoringis, insulinoTerapiis,
dietis, varjiSis Sesaxeb. glukozis donis mudmivi
monitoringi aucilebelia, raTa Tavidan iqnas acilebuli
hiperglikemiis da ketozis mavne gavlena nayofze. unda
ganxorcieldes dedis garTulebaTa skriningi, monitoringi
da intervenciebi ( mag. retinopaTia, nefropaTia, hipertenzia,
kardiovaskularuli daavadebani, farisebri jirkvlis
daavadeba, ketoacidozi). retinopaTiis skriningi aucilebelia
Catardes okulistis mier, (mag fonuri retinopaTia), magram
retinopaTiis arseboba uaryofiTad ar moqmedebs perinatalur
prognozze. monitoringi da Carevebi unda ganxorcieldes
nayofismxrivi garTulebebois drosac (mag. nayofis
Tandayolili anomaliebi, makrosomia).
Obstetrical management of pregnancy complicated by diabetes mellitus, Authors Jeffrey
L Ecker, MD Daniel Katz, MD Last literature review version 16.3: October 2008 | This
topic last updated: September 12, 2008 (More)

gestaciuri diabeti
antenataluri vizitebis sixSire

orsulobis 28 kviris vadamde:

2 kviraSi erTxel

orsulobis 28 kviris Semdeg:

kviraSi erTxel
 12

idealur SemTxvevaSi pirveli konsultireba unda Catardes

Casaxvamde, raTa Sefasdes orsulobis dros mosalodneli riskebi
da qalis mdgomareobis gaumjobesebis uzrunvelyofis mizniT
SemuSavdes marTvis taqtika. samwuxarod orsulobaTa umravlesoba
ar aris winaswar dagegmili da qalebi ar itareben konsultaciebs
Casaxvamde. aqedan gamomdinare , riskebis Sefaseba , marTvis gegmis
SemuSaveba, pacientisaTvis srulyofili inforaciis miwodeba
xSirad pirveli antenataluri vizitis dros xdeba. vizitebis
ganrigi individualuria da damokidebulia diabetis simwvaveze,
glikemiis kontrolis xarisxze, sameano garTulebebis arsebobaze.
orsulobis II trimestrSi rekomendirebulia orsulTa
meTvalyureobis Catareba yovel 2-4kviraSi rTxel, ufro xSirad im
SemTxvevaSi, Tu ganviTarda garTulebebi an glikemiis kontroli
ar aris srulyofili. orsulobis III trimestrSi Saqriani
diabetis mqone orsulze dakvirveba unda ganxorcieldes ufro
xSirad. erT-or kviraSi erTxel orsulobis 36 kviris vadamde, da
Semdeg kviraSi erTxel mSobiarobamde.
Obstetrical management of pregnancy complicated by diabetes mellitus, Authors Jeffrey
L Ecker, MD Daniel Katz, MD Last literature review version 16.3: October 2008 | This
topic last updated: September 12, 2008 (More)

gestaciuri diabeti
sawyisi statusis Sefaseba

standartuli rutinuli laboratoriuli

testebi
asimptouri baqteriuriis skriningi
glikozirebuli hemoglobini
Tirkmlis funqcia
Tireotropini da Tavisufali Tiroqsini
eleqtrokardiograma
oftalmologis konsultacia

pirveli antenataluri vizitis dros orsulebisaTvis unda

ganxorcieldes rutinuli prenataluri testireba. asimptomuri
baqteriuriis Sefaseba da mkurnaloba gansakuTrebiT
mniSvnelovania, radgan diabetur qalebSi baqteriuriss
ganviTarebis sixSire 3-5-jer metia. rutinul laboratoriul
 13

kvlevebTan erTad gamoyenebul unda iqnas glikozirebuli

hemoglobinis koncentraciis gansazRvra, romelic asaxavs
glikemiis saSualo dones. gestaciuri diabetis mqone qalebs unda
CautardeT Semdegi damatebiTi testebi, Tu isini ar iqna
Catarebuli Casaxvamde: Tirkmlis da farisebri jirkvlis funqciis
Sefaseba, eleqtrokardiografia, retinopaTiis gamovlenis mizniT
opTalmologis konsultacia, orsulobis I trimestrSi
exoskenireba, dedis diabeti ar warmoadgens risk-faqtors
aneuploidiis ganviTarebisaTvis, dounis sindromis skriningis
ganxorcielebis SemTxvevaSi gasaTvaliswinebelia, rom diabetis
gavleniT SratSi alfa-fetoproteinis da estriolis done
SesaZlebelia daweuli iyos.
Obstetrical management of pregnancy complicated by diabetes mellitus, Authors Jeffrey
L Ecker, MD Daniel Katz, MD Last literature review version 16.3: October 2008 | This
topic last updated: September 12, 2008 (More)

gestaciuri diabeti
Semdgomi monitoringi

glikemiis kontroli
orsulobis garTulebaTa
monitoringi
nayofis mdgomareobis monitoringi

mesame trimestrSi ZiriTada saWiroa: dedis sisxlSi glukozis

monitoringis gagrZeleba, nayofis mdgomareobis monitoringi-
nayofis saSvilosnosSida zrdis Sefaseba, sameano garTulebebis
(preeklamfsia, mravalwylianoba) monitoringi.
Obstetrical management of pregnancy complicated by diabetes mellitus, Authors Jeffrey
L Ecker, MD Daniel Katz, MD Last literature review version 16.3: October 2008 | This
topic last updated: September 12, 2008 (More)
 14

gestaciuri diabeti
glikemiis kontroli
sisxlSi glukozis koncentracia unda
ganisazRvros dReSi 4x:
gaRviZebisTanave
TviToeuli kvebidan 1 saaTis Semdeg
monacemebi Setanil unda iqnas dRiurSi
dietis Sesaxeb informaciasTan erTad

gestaciuri diabetis mqone qalebma sisxlSi glukozis done unda

gansazRvron dReSi sul mcire 4-jer, raTa Seafason hiperglikemiis
simwvave da monacemebi aucileblad Setanil unda iqnas specialur
dRiurSi, rac metad mniSvnelovania. sasurvelia glikemiis
kontroli ganxorcieldes uzmoze da Semdeg yovelie kvebis
miRebidan erTi saaTis Semdeg, radgan mxolod uzmoze
gansazRvruli glukozis saSualebiT ver ganvsazRvraT
insulinoTerapiis saWiroebas. glikozirebuli hemoglobinis
gansazRvra glikemiis kontrolis damxmare testia, roelic 2-
4kviraSi erTxel tardeba.
orsulTa Saqriani diabetis dros ketonuriis monitoringi ar
aris mizanSewonili, radgan ketonuria ar aris asocirebuli
nayofis Tandayolili mankebis ganviTarebasTan, Tumca ketonuria
dakavSirebulia makrosomiis ganviTarebasTan. ketonuriam
glikemiasTan erTad SesaZlebelia gavlena iqonios bavSvis
kognitur ganviTarebaze. diabeturi ketoacidozi iSviaTia
gestaciuri diabetis dros. ketonuriis skriningi sasurvelia, Tu
glikemiis done aRemateba 240 mg/dL (13.3 mmol/L). SardSi
ketosxeulebis arseboba yovelTvis ar niSnavs ketoacidozis
arsebobas. ketonuria niSnavs, rom pacienti imyofeba katabolur
mdgomareobaSi da moixmars cximebs. am SemTxveveSi ketonemia Tan
ar axlavs ketonurias.
Obstetrical management of pregnancy complicated by diabetes mellitus, Authors Jeffrey
L Ecker, MD Daniel Katz, MD Last literature review version 16.3: October 2008 | This
topic last updated: September 12, 2008 (More)
 15

gestaciuri diabeti
nayofis mdgomareobismonitoringi
orsulobis II trimestrSi :
ultrasonografia
dedis sisxlis SratSi multiple marker skriningi
orsulobis III trimestrSi:
arastresuli testi:
orsulobis 32 kviris vadidan kviraSi orjer
orsulobis 36kviris vadidan mSobiarobamde
kviraSi erTxel
orsulobis 38 kviris vadaze ultrabgeriTi
gamokvleva nayofis savaraudo wonis dadgenis
mizniT

detaluri ultrabgeriTi gamokvleva unda Catardes orsulobsi 18

kviris vadaze , vinaidan pregestaciuri diabetis SemTxvevaSi
matulobs nayofis ganviTarebis mankebis sixSire.
orsulebis adreul vadebze vizualizaciis siZneleebis gamo
iseTi organoebis ganviTarebis mankebis dadgena, rogoricaa
gastrointesticialuri traqti, Tavis tvini da Tirkmelebi
SesaZlebelia ver dadgindes. nayofis guli, romelic diabetori
embripaTiis ZiriTad lokalizacias warmoadgens yvelaze kargad
orsulobis II trimestrSi vizualizirdeba. orsulobis 38
kviris vadaze ultrabgeriTi gamokvleva tardeba nayofis
savaraudo wonis dadgenis mizniT. nayofis mdgomareobis
Sefasebis mizniT dinamikaSi isazRvreba nayofis biofizikuri
profile.

Obstetrical management of pregnancy complicated by diabetes mellitus, Authors Jeffrey

L Ecker, MD Daniel Katz, MD Last literature review version 16.3: October 2008 | This
topic last updated: September 12, 2008 (More)

gestaciuri diabeti
mkurnaloba

mkurnalobis efeqturi reJimi:

samedicino kvebiTi Terapia

varjiSi
medikamenturi mkurnaloba
 16

gestaciuri diabeti
samedicino kvebiTi Terapia

kaloraJis ganawileba
karbohidratis moxmareba
kaloriebis gacema
SeniSvna: makrosomiis prevencia
mxolod dietoTerapiiT
SeuZlebelia (A)

Saqriani diabetis mqone orsulebi unda imyofebodnen Sesabamis

dietaze. kvebis reJimis Sesaxeb konsultirebas atarebs
dietologi. dietoTerapiis mizania:normoglikemiis
miRweva,ketozis prevencia,adeqvaturi wonis matebis
uzrunvelyofa,nayofis damakayofilebeli mdgomareobis xelis
Sewyoba. gestaciuri diabetis mqone qalTaTviss kvebiTi racionis
Sedgenisas yuradReba unda mieqces kaloraJis ganawilebas,
karbohidratebis miRebas da kaloriebis moxmarebas. kaloriebis
ganawileba damokidebuli sxeulis wonaze da maT sxeulis asisi
indeqssze. mag. Tu qalis sxeulis masis indeqsi 22-25, maSin
dRiurad qalma unda miiRos 30kkal/kg.wonaze, xolo Tu BMI> 30,
maSin 12-15kkal/kg.wonaze da a.S. dedis gacximovnebam
SesaZlebelia xeli Seuwyos nayofis gadametebul zrdas da
gaauaresos glukozisadmi tolerantoba. kaloraJis ganawilebam
SesaZlebelia moaxdinos amgarTuelbis prevencia. kaloriebis 33-
40% unda modiodes karbohidratebze, , danarCeni 20% cilebze da
40%cximebze. kaloriebis aseTi ganawilebiT gestaciuri
diabetis mqone orsulTa 75-80% inarCunebs normoglikemias.
samedicino kvebiTi Terapiis saSualebiT SesaZlebelia
gaumjobesdes perinataluri gamosavali da gestaciuri diabetis
mkurnalobasi is pirvelsawyiss qmedebas warmoadgens.

Treatment and course of gestational diabetes mellitus, Author Lois Jovanovic, MD

Last literature review version 16.3: October 2008
 17

gestaciuri diabeti
varjiSi

zomieri varjiSebis programa

orsulTaTvis, fizikuri aqtivobis
samedicino an sameano ukuCvenebis
ar arsebobis SemTxvevaSi (Grade 1B)

kardiovaskularuli varjiSebi savaraudod aumjobesebs glikemiis

kontrols ZiriTadad im mizeziT, rom zrdis qsovilebis
mgrZnobelobas insulinis mimarT. varjiSis Sedegad sisxlSi
glukozis koncentracia ecema ( rogorc uzmoze, aseve Wamis Semdeg)
da insulinoTerapiis Catareba SesaZlebelia ar gaxdes saWiro.
saSualo datvirTvis varjiSebi gestaciuri diabetis mqone qalTa
mkurnalobis gegmis nawils Seadgens, da Tu ar aris samedicino an
sameano ukuCveneba am donis fizikuri aqtivobis ganxorcieleba
sasurvelia.
Treatment and course of gestational diabetes mellitus, Author Lois Jovanovic, MD
Last literature review version 16.3: October 2008

gestaciuri diabeti
insulinoTerapia
Tu normoglikemiis miRweva ver xerxdeba
mxolod ditoTerapiiTa da varjiSiT, aucile-
belia insulinoTerapiis dawyeba (GradeA)
gestaciuri diabetis SemTxvevaSi qalebma unda
miiRon mkurnaloba (Grade 1A)
insulinis dozireba da tipi dgindeba
orsulobis ganmavlobaSi sisxlSi glukozis
donis Sesabamisad
orsulobis dros upiratesoba eniWeba adamianis
insulinis gamoyenebas oralur antihipergli-
kemiur agentebTan SedarebiT (Grade 2B)
 18

arsebobs medikamenturi mkurnalobis ori arCevani: insulini ( da

zogierTi insulinis analogi) da oraluri antihiperglikemiuri
agentebi. orsulobis dros upiratesoba eniWeba adamianis
insulinis gamoyenebas oralur antihiperglikemiur agentebTan
SedarebiT (Grade 2B), radgan adamianis insulini naklebad
imunogenuria, ar gadis placentaSi da komerciulad
xelmisawvdomia. oraluri antihiperglikemiuri agentebi gadis
placentaSi da iwvevs nayofis hiperinsulinemias, romelmac Tavis
mxriv SeiZleba gamoiwvios makrosomia da xangrZlivi neonataluri
hipoglikemia. insulinoTerapiis mizania maqsimalurad daaxlovos
glukozis cvla normas, riTac ar dauSvebs hiperglikemiasa da
ketoacidozs. warmatebuli mkurnalobis mniSvnelova pirobas
warmoadgens orsulTa ganaTleba, raTa maT SesZlon
damoukideblad sisxlSi glukozis donis kontroli da insulinis
satanado dozis SerCeva.
Treatment and course of gestational diabetes mellitus, Author Lois Jovanovic, MD
Last literature review version 16.3: October 2008

gestaciuri diabeti
insulinoTerapia
glukozis saSiSi done, romlis drosac
aucilebelia insulinoTerapiis dawyeba
sabolood ar aris gansazRvruli
insulinoTerapiis dawyebis
kriteriumebi-glukozis koncentracia
sisxlSi:
uzmoze 90 mg/dL (5 mmol/l)
kvebidan 1saaTis Semdeg120mg/dL (6.7mmol/l)

dReisaTvis sabolood dadgenili ar aris glukozis is zRvruli

done, romelzec naCvenebia insulinoTerapiis dawyeba. iTvleba, rom
ditoTerapiis miuxedavad Tu ori kviris ganavlobaSi or an meti
gazomvisas aRoCnda, rom glukozis koncentracia uzmoze
90mg/dL (5 mmol/lL) da sakvebis miRebidan erTi saaTis Semdeg
120 mg/dL (6.7 mmol/lL), naCvenebia insulinoTerapiis dawyeba.
glukozis am maCveneblebis SemTxvevaSi insulinoTerapiis dawyebis
 19

ZiriTadi mizania minimumamde daiyvanos makrosomiis ganviTarebis

sixSire da masTan asocirebuli riskebi: mxrebis distocia,
saSobiaro travma, bavSvobaSi simsuqnisa da metaboluri acidozis
sindromis ganviTareba. imisaTvis, rom es mizani miRweul iqnas,
saWiroa, rom glukozis koncentracia uzmoze iyos <90 mg/dL(
5mmol/l), xolo sakvebis miRebidan erTi saaTis Semdeg <120mg/dL .
meore trimestris ganmavlobaSi insulinis dozireba ganicdis
mcire cvlilebebs, im qalebSi romelTa sisxlSi glukozis done
iyo stabiluri orsulobis I trimestris bolos. samagierod
orsulobis III trimestrSi, roca insulinrezistentoba mkveTrad
matulobs placentas mier gamomuSavebuli kontrinsulinaruli
faqtorebis gaZlierebuli sinTezis gamo, saWiro xdeba insulinis
dozis mateba euglikemiis SesanarCuneblad.
Treatment and course of gestational diabetes mellitus, Author Lois Jovanovic, MD
Last literature review version 16.3: October 2008

gestaciuri diabeti
orsulobis marTva
Tu nayofis savaraudo wona 4500 grams
aRemateba naCvenebia sakeisro kveTis
operaciis warmoeba samSobiaro tramvis
Tavidan acilebis mizniT (Grade 2B). .
orsulobis induqcia orsulobis 39-dan
40 kviris vadamde mwife saSvilosnos
yelisa da nayofis 4500gze naklebi
wonis SemTxvevaSi (Grade 2B).
makrosomiis SemTxvevaSi mSobiarobis
induqcia ar aris mizanSewonili (Grade
2C).

nayofis wona warmoadgens mniSvnelovan maCvenebels mSobiarobis

gegmis Sedgenis dros. naadrevi mSobiarobis induqciis Cveneba
gestaciuri diabetis dros igivea, rac zogadad sameano
populaciaSi: Ceuli sameno CvenebiT (mag. preeklamfsia, nayofis
saSvilosnosSida zrdis Seferxeba,normalurad miagrebuli
placentas naadrevi acla, sanayofo wylebis naadrevi daRvra,
nayofis aradamakmayofilebeli mdgomareoba) an dedis Tirkmlis
funqciis gauareseba an aqtiuri proliferaciuli retinopaTia.
adre, orsulobis mogvianebiT vadaze nayofis sikvdilis
prevenciis mizniT naCvenebi iyo naadrevi mSobiaroba. dReisaTvis
fiqroben, rom ar aris sargeblis momtani orsulobis
 20

prolongireba orsulobis 39kviris Semdeg, gansakuTrebiT mwife

saSvilosnosyeli arsebobisas. am SemTxvevaSi naCvenebia orsulobis
induqcia orsulobis 40 kviris vadisaTvis. qalebSi, sadac
glukozis koncentracia kargad aris gakontrolebuli, dedisa da
nayofis mdgomareoba damakmayofilebelia da saSvilosnos yeli
umwifaria, mSobiarobis induqcia SesaZlebelia gadavadebul iqnas
orsulobis 41kviris vadamde.

Treatment and course of gestational diabetes mellitus, Author Lois Jovanovic, MD

Last literature review version 16.3: October 2008

gestaciuri diabeti
mSobiarobisSemdgomi periodis marTva
sisxlis SratSi glukozis donis gansazRvra
Insulinis dozis koreqtireba
sakvebis kaloriulobis koreqtireba
naxSirwylebis raodenobis gazrda 50g/dRe-
RameSi
orsulTa gestaciuri diabetis mqone qalebi
orsulobis Semdeg imyofebian Saqriani
diabetis ganviTarebis momatebuli riskis qveS
mSobiarobis Semdeg aucilebelia orsulTa
diabetis mqone qalTa testireba (Grade 2C).

insulinze moTxovnileba mkveTrad ecema mSobiarobis Semdeg da

saWiroebs glikemiis seriul kontrols. . gestaciuri diabetis
dros glukozisadmi tolerantoba, romelic Secvlili iyo
orsulobis periodSi loginobis xanaSi unda daubrundes normas,
amitom aucilebelia glukozisadmi tolerantobaze dakvirvebis
gagrZeleba mSobiarobis Semdgom periodSi. ZuZuTi kveba
waxalisebul unda iqnas. meZuZuri deda yoveldRiurad saWiroebs
daaxloebiT 25-27kkal/kg. ar arsebobs kontracefciis meTodebi,
romelic ukunaCvenebia diabetian qalebSi. mSobiarobidan erTi
wlis ganmavlobaSi rekomendirebulia ofTalmologis
konsultacia, radgan retinopaTia SesaZlebelia damZimdes
orsulobis ganmavlobaSi da mSobiarobis Semdeg. amasTanave
gestaciuri diabetis dros matulobs Semdgomi orsulobis dros
orsulTa diabetis recidivebi da mogvianebiT, orsulobis Semdeg
insulinaradamokidebuli diabetis ganviTarebis riski.
Treatment and course of gestational diabetes mellitus, Author Lois Jovanovic, MD
Last literature review version 16.3: October 2008
 21

farisebri jirkvlis daavadebani farisebri jirkvlis funqcia

fiziologiuri orsulobis dros

placentaruli estrogenebis gavleniT:

hiperTireozi matulobs farisebri jirkvlis metaboluri
aqtivoba 40%-iT
RviZlSi ormagdeba TiroqsinSemboWveli
globulinis sinTezi
hipoTireozi placentaSi gamomuSavebuli qorionaluri
gonadrotropini iwvevs Tireotropuli
receptorebis stimulacias, ris Sedegadac
matulobs :
Sratis Tireoidmastimulirebeli aqtivoba
farisebri jirkvlis zomebi16%-iT

orsulobis dros ganviTarebuli ZiriTadi farisebri jirkvlis

funqciis cvlilebebia: sisxlis SratSi TiroqsinSemboWveli
globulinis (TBG) donis mateba da Tireotropuli (TSH)
receptorebis stimulacia qorinaluri honadotropinis mier.
farisebri jirkvlis funqciis stimulirebas sami faqtori
ganapirobebs: Tireoiduli hormonebis Sratis cilebTan
SeWidulobis xarisxis gazrda, orsulis sisxlSi qorinaluri
honadotropinis koncentraciis gazrda da farisebri jirkvlis
iodiT arasatanado momarageba. placentaruli estrogenebis
gavleniT orsulis RviZlSi matulobs TiroqsinSemboWveli
globulinis sinTezi 2-2,5-jer, rac maqsimums orsulobis 20-22
kviraze aRwevs. trofoblastis mier sinTezirebuli
qoriogonadotropul hormones msubuqi Tireotropuli moqedeba
gaaCnia, ramac SesaZlebelia ganapirobos farisebri jirkvlis
gadideba orsulobis dros.

farisebri jirkvlis funqcia

fiziologiuri orsulobis dros
matulobs Tiroqsinis (T4) saerTo
koncentracia sisxlis SratSi
matulobs cilebTan SeWiduli T4
Tavisufali T4 ar icvleba
matuloba triiodTironinis (T3) sinTezi
3x T4-Tan SedarebiT
matulobs farisebri jirkvlis mier
iodis STanTqma da metabolizmi
matulobs iodis Tirkmlismieri
klirensi
 22

araorsuli sisxlSi Tireoiduli hormonebi ZiriTadad cilebTan

SeWidul mdgomarebaSi imyofeba da mxolod 0,04% T4 da 0,4% T3
imyofeba Tavisufal mdgomareobaSi. orsulobis dros gazrdili
TBG iwvevs sarTo T4 da T3 matebas, oRond SeboWili hormonebis
xarjze, xolo Tavisufali T4 da T3 raodenoba ucvleli rCeba.
TSH koncentracia ar icvleba, mxolod orsulTa 10-20% Sratis TSH
koncentracia droebiT dabali aqvT.

hiperTireozi

aReniSneba orsulTa 0.2%

Tireotoqsikozis ZiriTadi mizezia
difuzuri toqsiuri Ciyvi (greivsis
daavadeba)-0,5-4%
upiratesad uviTardebaT reproduq-
ciuli asakis qalebs 20-50 wlis asakSi
oTxi ZiriTadi simptomi:Ciyvi,tremori,
egzofTali da taqikardia

orsulobis dros hiperTireozis gavrcelebis sixSire 0,1-0,2%

Seadgens. Tireotoqsikozis ZiriTad mizezs difuzuri toqsiuri
Ciyvi-greivsis daavadeba warmoadgens (90%). es autoimunuri
daavadebaa, romelic xasiaTdeba sisxlSi autoimunuri
antisxeulebis cirkulirebiT, romlebic axdenen farisebri
jirkvlis funqciis stimulirebas. ufro iSviaTad hiperTireozis
mizezi Sesazlebelia iyos: kvanZovani toqsiuri Ciyvi,
buStnamqeri, qoriokarcinoma, sakvercxis teratoma, xaSimotos
Tireoiditi. mxolod klinikuri niSnebis mixedviT orsulobis
dros hiperTireozis diagnostireba Znelia, radgan taqikardia,
oflianoba, sxeuli wonis kleba aseve damaxasiaTebelia
normaluri orsulobisaTvis. diagnozis dasmas aZnelebs
normaluri orsulobis dros arsebuli farisebri jirkvlis
funqciis cvlilebebi. greivsis daavadebis klinikuri niSnebia-
pirRebineba, ofTalmopaTia da sxeulis wonis kleba.
 23

Diagnosis and treatment of hyperthyroidism during pregnancy, Author

Douglas S Ross, MD, Last literature review version 16.3: October 2008 | This
topic last updated: August 20, 2008

hiperTireozi
gavlena dedasa da nayofze
nayofze dedaze:
spontanuri aborti preeklamfsia
naadrevi mSobiaroba gulis ukmarisoba
mcire masis axalSo- infeqcia
bili anemia
nayofis /axalSobi- Tireotoqsiuri krizi
lis Tireotoqsikozi

dedisa da nayofis garTulebaTa ganviTareba damokidebulia imaze,

Tu ramdenad kargad aris gakontrolebuli dedis
hiperTireoidizmi. aranamkurnalebi hiperTireozis dros orsulobis
gamosavali arakeTilsaiedoa, matulobs TviTnebiTi abortis,
naadrevi mSobiarobisa da Tandayolili Tireotoqsikozis
ganviTarebis riski (1%). Tandayolili Tireotoqsikozis
ganviTarebas ganapirobebs nayofis farisebri jirkvlis mier
hormonebis Warbi sekrecia, rac ganpirobebulia placentiT
nayofisaken gadasuli Tireomastimulirebeli antisxeulebis
gavleniT. daavadeba SesaZlebelia ganviTardes rogorc
mucladyofnis perioSi, aseve dabadebis Semdeg. aseTi
nayofebisaTvis damaxasiaTebelia guliscema> 160, nayofis
saSvilosnosSida zrdis Seferxeba, Ciyvi da kraniosinostozi. im
SemTxvevaSi ki, roca deda Rebulobs antiTireoidul preparatebs,
romlebis gadis placentaSi da srulad blokavs nayofis farisebri
jirkvlis funqcias, nayofs uviTardeba HhipoTireozi da Ciyvi.
Zalian iSviaTad orsulobis dros SesaZlebelia ganviTardes
Tireoiduli krizi, infeqcia, preeklamfsia.
 24

Diagnosis and treatment of hyperthyroidism during pregnancy, Author

Douglas S Ross, MD, Last literature review version 16.3: October 2008 | This
topic last updated: August 20, 2008

hiperTireozi
orsulobis marTva hiperTireozi
vis CavutaroT skriningi?
skriningi
zogierTi profesiuli asociacia
diagnozis dazusteba
mizanSewonilad miiCnevs mxolod im
monitoringi orsulTa testirebas, romelTac
gamoxatuli aqvT farisebri jirkvlis
mkurnaloba
funqciis darRvevis simptomatika an
farisebri jirkvlis daavadeba ojaxur
anamnezSi
rekomendirebulia yvela orsulis an
qalebis, visac surT daorsuleba
universaluri skriningi (Grade 2C)

seleqtiuri skriningis SemTxvevaSi, romelsac rekomendacias uwevs

amerikis ean-ginekologTa asociacia, SesaZlebelia yuradRebisa da
saTanado mkurnalobis gareSe darCes farisebri jirkvlis funqciis
darRvevis mqone orsulTa erTi mesamedi. klinikuri konsensusis
jgufma daadgina, rom ar arsebobs sakmarisi mtkicebuleba iisa,
rom rekoendacia gavuwiot an ar gavuwioT yvela orsulis
universaluri skriningis Catarebas. endokrinologTa asociaciis
klinikuri gaidlaini aseve upiratesobas aniWebs seleqtiur da ara
universalur skrinings. vinaidan seleqtiuri skriningis saSualebiT
SesaZlebelia gamovlenil iqnas farisebri jirkvlis faunqciis
darRvevis mqone orsulTa mxolod ori mesamedi, upiratesoba
dReisaTvis universaluri skriningis Catarebas eniWeba.

Diagnosis and treatment of hyperthyroidism during pregnancy, Author

Douglas S Ross, MD, Last literature review version 16.3: October 2008 | This
topic last updated: August 20, 2008
 25

hiperTireozi
diagnozis dadastureba
sisxlis SratSi Tireoiduli hormonebis
(T3,T4) gansazRvra
orsul qalTa hiperTireozis diagnozi
upirvelesad emyareba:
SratSi TSH koncentraciis daqveiTeba
<0.01 mU/L
SratSi Tavisufali T4 maRali
koncentracia

hiperTireozis diagnozi ZiriTadad emyareba orsulis sisxlSi

Tavisufali T4 da TSH-is gansazRvras. Tu Tavisufali T4 done
maRalia da amasTanave Semcirebulia Tireotropuli hormonebis
raodenoba, hiperTireozis diagnozi dadasturebulia. T3
gansazRvras diagnostikuri Rirebuleba gaaCnia, Tu T4 done
normaluri an Semcirebulia. radioaqtiuri iodis gamoyeneba
orsulobis dros ukunaCvenebia, amitom hiperTireozis mizezis
dadgena yovelTvis SesaZlebeli ar aris.

Diagnosis and treatment of hyperthyroidism during pregnancy, Author

Douglas S Ross, MD, Last literature review version 16.3: October 2008 | This
topic last updated: August 20, 2008

hiperTireozi
monitoringi
orsulis rutinuli monitoringi
farisebri jirkvlis funqciis
monitoringi 4 kviraSi erTxel
nayofis monitoringi:
nayofis guliscemis sixSiris gansazRvra
nayofis saSvilosnosSida zrdis
monitoringi
sonografiulad nayofis Ciyvis sididis
Sefaseba
 26

dedisa da nayofis keTilsaimedo gamosavali damokidebulia dedis

hiperTireozmis gakontrolebis xarisxze, amitom rutinul
monitoringTan erTad, romelic iseTivea, rogorc fiziologiuri
orsuli qalis , magram axasiaTebs garkveuli Tavisebureba, kerZod
dedis farisebri jirkvlis funqcia unda Semowdes 4 kviraSi
erTxel greivsis daavadebis dros. greivsis daavadebis mqone
orsulTa yvela nayofs Tireotoqsikozis niSnebis monitoringis
mizniT unda CautardeT nayofis guliscemis sixSirisa da masis
dinamiuri kontroli. xolo roca mosalodnelia nayofis
Tireotoqsikozis ganviTareba, exoskopiurad unda Sefasdes nayofis
Ciyvis arseboba. nayofis sisxlis gamokvleva greivsis daavadebis
SemTxvevaSi rutinulad ar aris rekomendirebuli, radgan
invaziuri proceduraa da dakavSirebulia nayofis antenataluri
sikvdilis potenciur riskTan (1-2%). orsulobis 20 kviris vadis
Semdeg nayofis sisxlis gamokvleva rekomendirebulia im
SemTxvevasi, roca: maRalia Tireomastimulirebeli antisxeulebis
raodenoba (normaze samjer meti), nayofs areniSneba hipeTireozis
niSnebi da anamnezSi axalSobils aReniSneboda Tireotoqsikozi. am
SeTxvevaSi nayofis statusis dadgena da saTanado intervenciam
SesaZlebelia gaaumjobesos gamosavali nayofi/axalSobilisaTvis.
nayofis HhiperTireozis samkurnalod dedas , misi statusis
miuxedavad unda mieces Tionamidebi.

Diagnosis and treatment of hyperthyroidism during pregnancy, Author

Douglas S Ross, MD, Last literature review version 16.3: October 2008 | This
topic last updated: August 20, 2008
 27

HhiperTireozi
mkurnaloba
farisebri jirkvlis funqciis cvlilebis Sesabamisad
mkurnalobis koregireba
saSualo-mZime hiperTireoziT garTulebuli orsulobis
mkurnalobis pirveladi arCevis preparatad miiCneva
Tionamidati (Grade 2B)
radioiodini absoluturad ukunaCvenebia
orsulTa saSualo da mZime hiperTireozisa da
hiperadrenerguli simptomebis arsebobis SemTxvevaSi
rekomendirebulia beta-blokerebis gamoyeneba (Grade 2B).
tipiurad mkurnaloba iwyeba atenololiT 25 - 50 mg
dRiurad
metimazoli (MMI) da propilTiouracili (PTU)
orsulobis dros iwvevs nayofis Ciyvs da gardamaval
hipoTireozs

vinaidan dedisa da nayofis gamosavali damokidebulia dedis

hiperTireozis gakontrolebis xarisxze, amitom mkurnalobis
ZiriTad mizans Seadgens wamlis minimaluri dozis gamoyenebiT
dedis Srati Tavisufali T4 koncentraciis araorsuli qalis
normis zeda zRvarze SenarCunebaSi. umetes SemTxvevaSi dedis
hiperTireozi ganpirobebulia greivsis daavadebiT da aseTi
qalebis mkurnaloba limitirebulia, nayofze SesaZlo
uaryofiTi gavlenis gamo. radioiodinis gamoyeneba
absoluturad ukunaCvenebia, SesaZlebelia beta-blokatorebis
daniSvna saSualo an mwvave hiperTireozis simptomebis
gasaumjobeseblad. Tumca, maTi gamoyeneba unda Sewydes rac
seiZleba adre, rogorc ki hiperTireozis gakontroleba
ganxorcieldeba tionamidebiT an orsulobis bolos, vinaidan am
preparatebis miRebis Semdeg gamovlinda nayofis
saSvilosnosSida zrdis Seferxeba, hipoglikemia,
respiratoruli distresis da bradikardiis ganviTareba.
Tionamidebi miReba rekoendirebulia rogrc saSualo, aseve mZime
formis hiperTireoziT garTulebuli orsulobis dros.
metimazolic (MMI) da propilTiouracilic (PTU) erTnairad
gadis placentaSi da SesaZlebelia gamoiwvios nayofis Ciyvi da
hipoTireozi, romelic ZiriTadad msubuqi formisaa da
gardaavalia. am garTulebebis ganviTareba damokidebulia
wamlis dozirebaze. orsulobis dros Tireoideqtomia
 28

naCvenebia im qalebisaTvis, roca Tionamidis gamoyeneba

alergiuli reaqciisa an agranulocitozis gamo ver xerxdeba,
Tumca operaciuli mkurnaloba zrdis TviTnebiTi abortisa da
naadrevi mSobiarobis ganviTarebis risks. operaciuli Carevis
riskebi minimaluria, Tu Tireoideqtomia nawarmoebia orsulobis
II trimestris ganmavlobaSi. erTi mcirericxovani kvlevis
monacemebiT hiperTireozis dros iodis mcire dozebis
gamoyeneba usafrTxoa orsulobis dros. ZuZuTi kveba
usafrTxoa, Tu deda Rebulobs PTU an MMI, vinaidan
axalSobilis farisebri jirkvlis funqciaze am preparatebis
Terapevtuli doza ar moqmedebs, gansakuTrebiT dabalia dedis
rZeSi PTU-s koncentracia.

Diagnosis and treatment of hyperthyroidism during pregnancy, Author

Douglas S Ross, MD, Last literature review version 16.3: October 2008 | This
topic last updated: August 20, 2008

hipoTireozi

simptomokompleqsi, romelic
viTardeba farisebri jirkvlidan
Tireoiduli hormonebis organizmSi
moxvedris mniSvnelovani SezRudvis
dros
mizezi- iodis nakleboba
 29

hipoTireozis ZiriTadi mizezs iodis nakleboba warmoadgens,

romelic SesaZlebelia ganviTardes postoperaciulad,
hiperTireozis mkurnalobis fonze radioaqtiuri iodis miRebis
fonze aseve qronikuli limfocitaruli Tireoiditis (
xaSimotos Tireoiditi) Sedegad. orsuloba amZimebs ukve
arsebul hipoTireozs da iwvevs subklinikuri hipoTireozis
dekompensacias. orsulobis dros qals esaWiroeba meti
odenobiT Tireoiduli hormonebi, xolo hipoTireozis dros mas
ar SeuZlia gazardos T4 da T3 sekrecia. orsulobis dros T4
moTxobnis gazRdas ramdenime faqtori ganapirobebs: wonis
namati, SratSi TBG koncentraciis gazrda, placentaruli
deiodinazis aqtiuroba, nayofisaTvis T4 gadacema da sxv.

Overview of thyroid disease in pregnancy, Author Douglas S Ross, MD, Last

literature review version 16.3: October 2008 | This topic last updated:
September 16, 2008

hipoTireozi
klinika

sisuste
Sromisunarianobis daqveiTeba
Zilianoba
wonis mateba
yabzoba
mexsierebis daqveiTeba
frCxilebis mtvrevadoba
Tmis cvena

slaidze CamoTvlilia hipoTireozis klinikisaTvis

damaxasiaTebeli simptomatika.

Overview of thyroid disease in pregnancy, Author Douglas S Ross, MD, Last

literature review version 16.3: October 2008 | This topic last updated:
September 16, 2008
 30

hipoTireozi
dedisa da nayofismxrivi garTulebani

orsulobis adreuli danakargi

preeklamfsia
placentis acla
Tireopriuli anemia
samSobiaro moqmedebis mdgradi sisute
mcire masa dabadebisas
perinataluri sikvdiloba
neirofsiqologiuri dazianeba

hipoTireozis dros orsulobis gamoxatuli garTulebani

iSviaTia, rac ori faqtoriTaa ganpirobebuli: hipoTireozis
mqone qalTa nawils aReniSneba anovulacia da hipoTireoziT
garTulebuli orsulobis dros Zalzed maRalia orsulobis
I trimestrSi TviTnebiTi abortis sixSire. im SemTxvevaSi,
roca orsuloba progresirebs, hipoTireozi SesaZlebelia
asocirebul iqnas Semdeg garTulebebTan: preeklamfsia da
gestaciuri hipertenzia, normalurad momagrebuli placentas
naadrevi acla, naadrevi mSobiaroba, perinataluri avadoba da
mokvdaoba, mSobiarobis Semdgomi sisxlisdena. sameano
garTulebaTa riski ufro maRalia im qalebisaTvis, sadac
hipoTireozi klinikurad gamoxatulia, vidre subklinikuri
hipoTireozis dros.orsulobis SenarCuneba ufro meti
xifaTis momcvelia nayofisaTvis, vidre dedisaTvis.iodis
nakleboba ganapirobebs aramarto dedis , aramed nayofis
hipoTireozsac, rac Tavis mxriv moqedebs nayofis gonebriv
ganviTarebaze, SesaZlebelia gaxdes kretinizmis mizezi.

Overview of thyroid disease in pregnancy, Author Douglas S Ross, MD, Last

literature review version 16.3: October 2008 | This topic last updated:
September 16, 2008
 31

hipoTireozi
diagnozis dadastureba
hipoTireozi
momatebulia Tireotropuli
skriningi hormoni (TSH)
diagnozis dadastureba Semcirebulia Tireoiduli
monitoringi hormonebis sekrecia
mkurnaloba Semcirebulia cilasTan SeWiduli
iodis raodenoba

skriningis Catarebis principebi igivea, rac hiperTireozis dros. T4

saerTo da Tavisufali raodenobis Semcireba momatebuli TSH
fonze, miuTiTebs pirveladi hipoTireozis arsebobas. T3 done,
rogorc wesi Semcirebulia, Tumca SesaZlebelia imyofebodes
normis farglebSi.

Overview of thyroid disease in pregnancy, Author Douglas S Ross, MD, Last

literature review version 16.3: October 2008 | This topic last updated:
September 16, 2008

hipoTireozi
monitoringi

hipoTireozis dadasturebis SemTx-

vevaSi sisxlis SratSi TSH unda
gaizomos:
Casaxvidan 4-6kviraSi
T4 koncentraciis nebismier
cvlilebis dafiqsirebidan 4-6
kviris Semdeg
sul mcire TviToeul trimestrSi
erTxel

vinaidan dedis euTireoiduli mdgomareobis SenarCuneba

Zalzed mniSvnelovania nayofis gonebrivi ganviTarebisaTvis,
aucilebelia SratSi dinamiurad ganisazRvros TSH
 32

koncentracia: Casaxvidan 4-6kviris Semdeg, preparatis dozis

nebismieri cvlilebis Semdeg aseve 4-6kviraSi da sul mcire
TiToeul trimestrSi erTxel. preparatis doza Sesazlebelia
Semcirdes mSobiarobis Semdeg, magram dozis adeqvaturoba
unda Semowmdes 4-6 kviris Semdeg. aRsaniSnavia, rom
Tireoduli hormonebis daniSvnam SesaZlebelia gamoiwvios
nayofis hiperTireozi.

Overview of thyroid disease in pregnancy, Author Douglas S Ross, MD, Last

literature review version 16.3: October 2008 | This topic last updated:
September 16, 2008

hipoTireozi
mkurnaloba
samkurnalod iyeneben farisebri jirkvlis
hormonebis Semcvel preparatebs
mkurnaloba grZeldeba mTeli orsulobis
ganmavlobaSi
orsulobis III trimestrSi da mSobiarobis
Semdeg preparatis dozireba mcirdeba
iodis dabali dozebi usafrTxoa orsulobis
dros
idis maRali dozebis xangrZlivi gamoyeneba ar
aris mizanSewonili, radgan SesaZlebelia
gamoiwvios nayofis Ciyvi (Grade 2C)

orsulobis dros qals esaWiroeba meti odenobiT Tireoiduli

hormonebi, xolo hipoTireozis dros mas ar SeuZlia gazardos T4
da T3 sekrecia, amitom mkurnalobis ZiriTad mizans warmoadgens
farisebri jirkvlis funqciis ukmarisobis CanaCvlebiTi Terapia da
TSH koncentraciis normalizacia. orsulTa daaxloebiT 75-80%
ukve orsulobamde arsebuli hipoTireoziT esaWiroebaT ufro meti
T4 orsulobis dros. Terapiuli arCevani SezRudulia arsebuli
mkurnalobis nayofze potenciuri uaryofiTi gavlenis gamo.
mkurnalobis mizniT rekomendirebulia levoTiroqsinis gamoyeneba,
romlis dozireba icvleba SratSi Tavisufali T4 da TSH
 33

koncentraciis mixedviT. preparatis dozireba mcirdeba

mSobiarobis Semdgom periodSi, TSH koncentraciis kontrolis qveS.

Overview of thyroid disease in pregnancy, Author Douglas S Ross, MD, Last

literature review version 16.3: October 2008 | This topic last updated:
September 16, 2008

gulis daavadeba

gulis Tandayolili paTologia

gulis SeZenili paTologia

gulis daavadebani sakmaod iSviTad (daaxloebiT 1%) arTulebs orsulobas,

magram Zalian saSiSia dedisa da nayofis janmrTelobisaTvis. maTi gavrcelebis
sixSire sxvadaxva populaciaSi sxvadasxvaa, mag.inglisSi gulis daavadeba dedaTa
sikvdilobis yvelaze xSir mizezs warmoadgens. gulis daavadebaTagan sikvdilis
yvelaze xSiri mizezs kardiomiopaTia da filtvismieri hipertenzia warmoadgens.

orsulobis dros ganviTarebuli

kardiovaskulatoruli cvlilebebi
iwyeba orsulobis adreul vadaze-
orsulobis pirveli 5-8kviris
ganmavlobaSi
maqsimalur cvlilebas orsulobis
20-24kviris vadaze aRwevs
rCeba SedarebiT mudmivi
mSobiarobamde
orsulobis dros ganviTarebuli
kardiovaskulatoruli cvlilebebi
uzrunvelyofs:
nayofisaTvis aucilebeli Jangbadi-
sa da sakvebis nivTierebebis
miwodeba
nayofis sisxlismimoqcevis sistemi-
dan metabolizmis produqtebis
gamotana
 34

eqstragenitaluri daavadebebi, maT Soris gulis daavadebanic

sxvadasxvagvar gavlenas axdens orsulobis mimdinareobaze,
dedisa da nayofis mdgomareobaze, amitom kardiovaskularuli
adaptaciis codna aucilebelia, raTa: movaxdinoT orsulTa
hemodinamikuri da kardiovas-kularuli testebis swori
interpretireba, ganvsazRvroT orsulobis mimdinareobis
Taviseburebani qalebSi, romelTac aReniSnebaT gulis daavadeba

orsulobis dros ganviTarebuli

kardiovaskulatoruli cvlilebebi
qveiTdeba: matulobs
Hb da Ht mocirkulire sisxlis
sisxlis siblante moculoba 30-50%-iT
sisxlZarRvebis gulis dartymiTi
periferiuli moculoba da gandevna
winaaRmdegoba 30-50%-iT
diastoluri arteriuli guliscemis sixSire-
wneva 5-15mm.Hg-iT taqikardia maqsimums
arteriuli sisxlis wneva orsulobis III trimest-
rSi aRwevs- 80-95
10 mmHg-iT sawyiss
wnevasTan SedarebiT da dartyma/wuTSi
ecema-105/60mm.Hg-mde

normalurad mimdinare orsulobis dros SesaZlebelia

ganviTardes simptomebi, romelic damaxasiaTebelia gulis
ukmarisobisaTvis: qoSini, sunTqvis gaZneleba, taqikardia,
eqstrasistolia, Suilebi, Tavbruxveva, sisuste, tkivili
mkerdis areSi, qveda kidurebis SeSupeba. orsuloba
hiperkinetikuri mdgomareobaa, guli gadidebulia, Pushed up,
Unfolded upon aorta. es cvlilebei ganapirobebs
eleqtrokardiografiul da exoskopiur clilebebs, rac
orsulobisaTvis normaluria, magram SesaZlebelia orsulobis
dros ganviTarebuli cvlilebebis ar codnis SemTxvevaSi
interpretirebul iqnas, rogorc paTologia. gulis gadmosrola
swrafad matulobs 40%-iT orsulobis I trimestrSi da
narCundeba orsulobis bolomde da matulobs mSobiarobis
dros. sistoluri da diastoluri arteriuli wneva dabalia
orsulobis I da II trimestrSi da matulobs III trimestrSi,
 35

daqveiTebulia periferiuli winaaRmdegoba. plazmis moculoba

izrdeba ufro metad, vidre eriTrocitebis moculoba, rac
iwvevs ganzavebiTi anemiis ganviTarebas. orsulobis dros
mimdinare fiziologiuri cvlilebebi mniSvnelovnad cvlis
datvirTvas gulze da rac ufro TvalsaCino xdeba gulis
daavadebebis dros.

Pregnancy in heart disease, S A Thorne, September 2009, GL.

Acquired heart disease and pregnancy, Last literature review version 16.3:
October 2008 Authors :Carol A Waksmonski, MD Anita LaSala, MD Michael R Foley,
MD

gulis daavadeba gulis daavadeba

gulis daavadeba dedis

sikvdilobis erT-erTi mizezia
sikvdilis mizezs gulis Semdegi
daavadeba warmoadgens:
kardiomiopaTia
filtvismieri hipertenzia
gulis Tandayolili daavadebani
(CHD) naklebad aris asocirebuli
dedis sikvdilobasTan

.ukanasknel aTwleulSi Seicvala gulis daavadebis mqone orsulTa

populacia: mkveTrad Semcirda revmatiuli daavadebani, moimata
gulis Tandayolilma kompleqsurma daavadebam da kvlav maRali
rCeba filtvismieri hipertenziisa da kardiomiopaTiis sixSire.
daaxloebiT naxevari saukunis win gul-sisxlZarRvTa sistemis
daavadebebis 90% modioda revmatizmiT daavadebul orsulebze,
magram antibitikebis aqtiurma gamoyenebam. kardioqirurgiaSi
 36

danergilma mravalma siaxlem reproduqciul asakamde gazarda

Tandayolili gulis mankiT daavadebuli qalebis sicocxlis
xangrZlivoba, aqedan gamomdinare gulis Tandayolili mankebis
fonze mimdinare orsulobebi gulis mankebis saerTo raodenobis
50%-s Seadgens. orsulobis gamosavali damokidebulia nayofis
gulis daavadebis formasa da gulis ukmarisobis xarisxze. yvelaze
saSiSia is mdgomareoba, rodesac filtvebis sisxlismomaragebis
gazrda izRudeba- aseTia filtvis arteriis hipertenzia da
mitraluri sarqvlis stenozi. gulis revmatuli mankebis dros
dedaTa sikvdiloba 1%-s ar aRemateba. nayofismxrivi gamosavali
SedarebiT keTilsaimedoa, Tumca xSiria nayofis saSvilosnosSida
zrdis Seferxeba da naadrevi mSobiaroba. dilataciuri
kardiomiopaTiis dros dedaTa sikvdiloba 7%aRwevs, risk-
faqtorebs warmoadgens: dedis asaki 30weli, mravalnamSobiarebi,
tyupi nayofi, marcxenamxrivi ventrikuluri dilatacia. maRalia
momdevno orsulobis dros ganmeorebis albaToba. ganmeorebiTi
orsulobsi dros sikvdilis riski 20%-mde matulobs. gulis
uunarobas uzrunvelyos orsulobis dros organizmis moTxovnis
Sesabamisi sisxlismimoqceva, gulis ukmarisoba ewodeba. gulis
ukmarisoba gul-sisxlZarRvTa sistemis mniSvnelovani
maxasiTebelia da gulis ukmarisoba gulis nebisieri daavadebis
dros orsulobis II trimestris bolos gamovlindeba.

Pregnancy in heart disease, S A Thorne, September 2009, GL

.
 37

gulis daavadeba gulis daavadeba

orsulobis marTvis zogadi principebi prognozireba
prognozi fasdeba individualurad
qalebis konsultireba, romelTaTvis
orsuloba warmoadgens risks unda
prognozireba ganxorcieldes Casaxvamde
monitoringi orsuloba ukunaCvenebia:
nebismieri genezis filtvismieri hipertenzia
marTva sisteuri ventrikularuli disfunqcia,
gandevnis fraqcia<20%
marcxenamxrivi mwvave obstruqciuli dazianeba
marfanis daavadeba dilatirebul aortalur
fesvTan erTad

gul-sasxlZarRvTa daavadebis mqone qalebma detaluri

gamokvleva unda Caitaron daorsulebamde, unda Sefasdes
riskebi, Seikribos anamnezi, Catardes fizikaluri,
laboratoriuli da instrumentuli gamokvleva-exokardiografia,
elektrokardiografia da filtvis arteriis kateterizacia.
Catardes kardiologis konsultacia. kardiologis roli
mdgomareobs: Seafasos dedisa da nayofis riskebi, misces qals
saSualeba gaakeTos orsulobis gadawyvetilebis miRebis
informirebuli arCevani, uzrunvelyos Sesabamisi antenataluri
meTvalyureoba. kardiologis mier gaweuli rekomendacia unda
emyarebodes im monacemebs, Tu ramdenad gauZlebs qalis
kardiovaskularuli sistema orsulobis dros ganviTarebul
fiziologiur cvlilebebs. Tu gul-sisxlZarRvTa peTologia
moiTxovs qirurgiul Carevas, rekomendirebulia misi Catareba
daorsulebamde.
gulis daavadebebis umravlesobis dros orsulobis ar aris
ukunaCvenebi. angariSgasawevia , rom dedis gulis Tandayolili
mankis dros, Tandayolili manki SesaZlebelia nayofsac
aReniSnebodes (15%).
Pregnancy in heart disease, S A Thorne, September 2009, GL
 38

gulis daavadeba
monitoringi
antenataluri periodis marTva da
monitoringi iseTivea, rogorc
fiziologiuri orsulebisaTvis, Tu
orsuls aReniSneba:
aranamkurnalebi funqcinalurad msubuqi
Tandayolili gulis daavadeba
warmatebuli operacia gulze
gamonakliss warmoadgenen pacientebi,
romelTac aReniSnebaT infeqciuri
endokarditis ganviTarebis riski

orsulobis dros dedasa da nayofze unda ganxorcieldes

gulmodgine meTvalyureoba. antenatalur meTvalyureobas
axorcielebs mean-ginekologTa da kardiologTa gundi.
dakvirveba orientirebuli unda iyos hemodinamikis darRvevis
gamovlenaze, rac ganpirobebulia rogorc gulis daavadebiT
aseve orsulobis dros ganviTarebuli cvlilebebiT da maTi
urTierTgavleniT. xSiri da drouli gamokvlevebi
SesaZleblobas iZleva gamovlindes dedis hemodinamikis
umniSvnelo gauaresebac. orsulobs ZiriTadad mimdinareobs
damakmayofileblad da hospitalizacias ar saWiroebs,
rekomendirebulia fizikuri datvirTvis SezRudva. gulis
ukmarisobis nebismieri niSnis gamovlenisas rekomendirebulia
woliTi reJimi da hospitalizacia, yovelmxrivi gamokvleva
da adeqvaturi mkurnalobis daniSvna. antikoagulantebis,
gansakuTrebiT varfarinis (teratogenuli moqmedeba)
gamoyeneba orsulobis dros sadavoa. gulis daavadebis mqone
orsulTa gamokvlevisas yuradReba unda mieqces: guliscemis
riTmsa da sixSires, arteriuli wnevis maCveneblebs, wnevis
maCvenebels SigniTa sauRle venaSi, krepitacias filtvis
qveda wilebSi, SeSupebas wvivisa da gavis areSi,nayofis
mdgomareobis monitoringis mizniT saSvilosnos fuZis
simaRles dinamikaSi.

Pregnancy in heart disease, S A Thorne, September 2009, GL

 39

gulis daavadeba
marTva
orsulebs, funqcinalurad normaluri SeZeni-
li gulis daavadebiT, ufleba eZlevaT
imSobiaron spontanurad
Tu arsebobs funqcionaluri adeqvaturobis
raime saSiSroeba, mSobiaroba unda iqnas
inducirebuli mkacri kontrolis qveS
gulis daavadebis mqone TiTqmis yvela orsuls
SeuZlia vaginaluri mSobiaroba, vinaidan is
moicavs nakleb kardialur riskebs, vidre
sakeisro kveTis gziT mSobiaroba

umravles SemTxvevaSi rekomendirebulia samSobiaro moqedebis

TviTneburi dawyebisaTvis dacda da mSobiarobis bunebriv procesSi
Carevis minimumamde dayvana. mSobiarobis aRZvras mimarTaven
saTanado Cvenebisas. mSobiarobis induqciis dro individualuria
da emyareba: orsulis gulis statuss, saSvilosnos yelisa da
nayofis filtvebis simwifes. mSobiarobis gautkivarebisaTvis
rekomendirebulia epiduraluri analgezia. mSobiarobis II periodis
xangrZlivobis Semcirebis mizniT naCvenebia vakuum-eqstraqcia an
sameano maSis operaciis warmoeba. sakeisro kveTis dros izrdeba
sisxlisdenisa da inficirebis riski, rac gul-sisxlZarRvTa
paTologiis SemTxvevaSi zrdis datvirTvas gulze, romelic
operaciis Semdgomi periodis 4 dRis ganmavlobaSi SenarCunebulia,
rac zrdis risks meloginisaTvis. sakeisro kveTis Cveneba
iseTivea, rogorc sxva SemTxvevaSi da zogierTi gulis daavadebis
dros, rogoricaa: marfanis sindromi, aortaluri anevrizma, gulis
mwvave ukmarisoba da meqanikuri Bjork-Shiley mitraluri sarqveli
varfarinis gamoyenebiT.

Pregnancy in heart disease, S A Thorne, September 2009, GL