7 გაუტკივარება

Tbilisis saxelmwifo samedicino universiteti

UNICEF saqarTvelo

JSI

saxelmZRvanelo perinatalogiaSi

samSobiaro tkivilis marTvis meTodebi

moduli #7

II nawili

studentTa Hhendauti

1

dabadeba

Ddedakacs uTxr a: sat anj vel sgagimr avl eb da gagiZnel ebor sul obas, t anj viT Sob Svi l ebs

bibl ia,dabadeba,Tavi 111,16

2

r a ar i s t ki vi l i

gar emos damaz i anebel f aqt or ebz eor gani z mi s emoc i onal ur i r eaqc i a, Tvi Tdacvi s mZl avr i saSual eba

tkivili aris organizmis emocionaluri reaqcia damazianebel zemoqmedebaze. tkivilis aRqma sxvadasxvagvari gamaRizianeblebis individualuri asaxvaa, romelic TiToeuli adamianisgan unikalurad aRiqmeba da interpretirdeba. Eevoluciis procesSi tkivili iqca garemo faqtorebis damangreveli gavlenisagan TviTdacvis Zlier saSualebad. warmoSobis adgilis mixedviT, ganasxvaveben ori tipis tkivils:somaturs (warmoiqmneba kanSi, kunTebSi, ZvlebSi, saxsrebSi, fasciebSi, parietalur garsebsa da sxva adgilebSi;M mkveTrad lokalizebulia, Seesabameba paTologiuri keris lokalizacias, mtkivneulobis zRvari dabalia, Tumca, gamaRizianebeli Zalebis intensiobis gazrdis paralelurad, isic matulobs) da visceralurs (tkivili, romelic warmoiqmneba Sinagani organoebis, Tavis qalis, nervuli wnulebis, vegetatiuri nervuli sistemis visceraluri receptorebis --baro-, meqano- da qemoreceptorebi -- gaRizianebis Sedegad. gaRizianebis zRurbli Zalze maRalia, axasiaTebs iradiacia).

E

3

samSobi ar o t ki vi l i (1)

• Zal z ed mwvave t ki vi l i• mSobi ar obi s pr oc esi s nor mal ur i

gver di T i ef eqt i• mSobi r obi s pr ogr esi s er T -er T i

maCvenebel i• gansxvavebul i a mSobi ar eTa Sor i s• gansxvavebul i a sxvadasxva mSobi ar obebi s

dr os• war moi Sveba sxvadasxva ubnebi dan

savaraudod, samSobiaro tkivili umwvavesia im tkivilTa Soris. romelic qals cxovrebis ganmavlobaSi ganucdia. uamravi qalisa da, gansakuTrebiT, pirvelmSobiareTa SefasebiT, samSobiaro tkivili autaneli da mwvavea. samSobiaro tkivils yvela qali gansxvavebulad aRiqvams. aseve gansxvavebulad aRiqvams erTi da igive qali yoveli momdevno mSobiarobis tkivilsac. magaliTad, nayofis araswori mdebareobiT mSobiarobis dros (Tu kefiT win mdebareobs ukana saxe), tkivilebi gacilebiT mwvavedaa gamoxatuli, magram SesaZloa, rom es meore mSobiarobis dros sulac ar ganmeordes. mSobiarobis procesis progresirebis paralelurad, samSobiaro tkivili sxvadasxva ubnidan warmoiqmneba. aRsaniSnavia, rom samSobiaro tkivilis moTmena imdenad individualuri da zog SemTxvevaSi ki, rTulia, rom qalsa da mis Tanmxleb pirs is dauZlevladac eCveneba. Aaqedan gamomdinare, mizanSewonilia tkivilis Semsubuqeba sxvadasxva meTodis gamoyenebiT.

.Lowe, NK. The nature of labor pain. Am J Obstet Gynecol 2002; 186:S016

Ranta, P, Spalding, M, Kangas-Saarela, T, et al. Maternal expectations and experiences of

labour pain--options of 1091 Finnish parturients. Acta Anaesthesiol Scand 1995; 39:60.

4


mSobi ar obi s I per i odi s t ki vi l i• vi scer al ur i• war moi Sveba samSobi ar o Set evebi s dr os saSvi l osnos

t ansa da yel Si• mi z ez i :– saSvi l osnos t ani sa da yel i s meqanor ecept or ebi s daWi mva_ saSvi l osnos t ani sa da yel i s qsovi l Ta i Semi a• t ki vi l i s si gnal i gadaecema z ur gi s t vi ns

mSobiarobis I periodSi tkivili samSobiaro Setevis (saSvilosnos SekumSvis) dros warmoiqmneba. Tavisi xasiaTiT, tkivili visceraluria da rogorc saSvilosnos da saSvilosnos yelis meqanoreceptorebis daWimvis, ise maTi qsovilebis iSemiis Sedegad warmoiSveba. sasqeso organoebis interoreceptorebis gaRizianebis Sedegad warmoqmnili tkivilis impulsebi T10, T11, T12 da L1 nervebis saSualebiT koncentrirdeba zurgis tvinis dorsalur morCebSi, aqedan aferentuli gamtari gzebiT gadaecema centralur nervul sistemas da mtkivneul SegrZnebebad transformirdeba. tkivilis SegrZneba formirdeba Tavis tvinis qerqSi da aqedan zurgis tvinis daRmavali gzebiT gadaecema sasqeso organoebs, muclis wina kedels, lumbosakralur ares, dunduloebsa da barZayebs. Ggulmkerdis T7 da T8 malebis doneze zurgis tvinidan gamodis motoruli gza saSvilosnosken. Teoriulad, mgrZnobelobis blokadis nebismieri meTodi, romelic ar dablokavs am gzas, SesaZlebelia, rom mSobiarobis gautkivarebisaTvis gamoviyenoT.----hipo-gastraruli wnuli—saSvilosnos sxeuli da fuZe (L1, L2, L3, L4, T12)

-----utero-vaginaluri wnuli: saSvilosnos yeli da zeda saSo (S2, S3, S4)

WILLIAMS OBSTETRICS, 22ND EDITION, 2005

5


mSobi ar obi s II per i odi s t ki vi l i

• somat ur i• war moi Sveba: saSos, Sor i si s, menj i s f sker i sa

da menj i s i ogebi s daWi mvi sas• t ki vi l i s si gnal i gadaecema z ur gi s t vi ns• t ki vi l i ar i s Zl i er i da kombi ni r ebul i


Uterus

Vagina

Cervix

T12L1L2L3L4

S 2

S 3 S 4

Hypogastric plexus: body, fundus of uterus

Uterovaginal plexus: cervix, upper vagina

somaturi tkivili, romelic warmoiqmneba saSos, Sorisis, menjis fskerisa da menjis iogebis gadaWimviT, mSobiarobis II periodis damaxasiaTebeli niSania. zurgis tvins tkivilis signali gadaecema sami sakraluri nervis (S2, S3, da S4) meSveobiT, romlebic Sedian pudendaluri nervis SemadgenlobaSi. mSobiarobis II periodis tkivili I periodisaze gacilebiT mwvavea da amasTanave, kombinaciuri xasiaTisa, radgan am dros saSvilosnos SekumSviTa da saSvilosnos yelis daWimviT gamowveuli visceraluri tkivili da saSosa da Sorisis qsovilebis gadaWimviT gamowveuli somaturi tkivili Seerwymeba erTmaneTs. amasTanave, mSobiare ganicdis swor nawlavze Zlier zewolasa da “kuWSi gasvlis” SegrZnebas, e.w. WinTvis SegrZnebas, romelic miuTiTebs nayofis winmsvlelobaze samSobiaro arxSi, nayofi samSobiaro arxidan swored am tkivilis Sedegad gamoZevdeba.


6


mavne Sedegebi• hi per vent i l ac i a

• nei r ohumor al ur i ef eqt ebi

• f si qosoc i al ur i ef eqt ebi

samSobiaro tkivili, garda emocionaluri stresisa da gancdisa, iwvevs garkveul fiziologiur cvlilebebsac. Ees cvlilebebi zemoqmedeben rogorc qalis organizmze, ise -- nayofzec. Hhiperventilacia samSobiaro tkivilis Tanmxlebi movlenaa. Zlieri hipokarbiis gamo, igi iwvevs dedis hipoqsias, Tavbrusxvevas da gonebis dakargvas. amA dros ganviTarebuli respiratoruli alkalozi aqveiTebs dedidan nayofisaTvis Jangbadis gadacemas, erTis mxriv, Jangbadisadmi dedis hemoglobinis SeWidulobis gazrdiT da meores mxriv, utero-placentaruli vazokonstriqciis Sedegad. am cvlilebebs normaluri orsulobis mqone janmrTeli mSobiareebi sul iolad gadaitanen. neirohumoraluri efeqti. stresiTa da tkiviliT gamowveulma neirohumoraluri pasuxma SesaZloa uaryofiTad imoqmedos placentis perfuziasa da nayofis JangbadiT momaragebaze. cxvrebze Catarebulma gamokvlevebma dagvarwmuna, rom tkivili zrdis sisxlSi mocirkulire kateqolaminebis raodenobas da amcirebs sisxlis midinebas saSvilosnosken. rogorc aRmoCnda, orsul primatebSi tkivilma da daZabulobam Seamcira embrionis jangbadiT momarageba da embrionis acidozi da gulis wuTmoculobis Semcireba gamoiwvia. Ffsiqologiuri efeqtebi. autaneli tkivili SesaZloa mSobiarobis Semdgomi fsiqologiuri travmis mizezadac iqces. igi SeiZleba gaxdes mSobiarobisSemdgom stresul moSlilobaTa garTulebebis yvelaze mZime formis ,e.w.post-traumatic stress disorder (PTSD)ganviTarebis mizezi, SemTxvevaTa daaxloebiT 5.6%-Si rom viTardeba.

Burden, RJ, Janke, EL, Brighouse, D. Hyperventilation-induced unconsciousness during labour. Br J Anaesth 1994; 73:838.

Reynolds, F, Sharma, SK, Seed, PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG 2002; 109:1344.

Shnider, SM, Abboud, TK, Artal, R, et al. Maternal catecholamines decrease during labor after lumbar epidural anesthesia. Am J Obstet Gynecol 1983; 147:13.

7


damcavi meqani z mebi

• endogenur i opi oi dur i pept i debi s mat eba• endogenur i anal gez i i s ganvi Tar eba• “t ki vi l i s hor moni ” i nhi bi r eba• t ki vi l i s zRur bl i maRl a aweva

stresuli zemoqmedebis Sedegad, adamianis irganizmSi irTveba damcavi

meqanizmebi, romlebsac realizebaSi sisxlSi neiropeptidebis gadmosrola

exmareba. Yendogenur opioidebs Soris analgetikuri efeqti yvelaze metad

endorfinebs axasiaTebT (morfinze 100-jer Zlieri). isini ainhibireben Tavisa da

zurgis tvinSi tkivilis impulsebis gadacemas. Eendogenuri opioidebi, opioidur

receptorebze zemoqmedebiT, ainhibireben tkivilis specifikuri hormonis -- e.w.

substancia “P”-s gamoyofas, rac endogenuri opioidebis universaluri

analgetikis bunebas ganapirobebs. garda zemoT aRwerili periferiuli

meqanizmebisa, opioidebs axasiaTebs tkivilis gamaanalizirebel umaRles

centrebze damTrgunveli zemoqmedebac. amis wyalobiT, opioidebis

koncentraciis zrdisas, tkivilis zRurblovanebac izrdeba. cnobilia, rom tkivilis,

iseve, rogorc nebismieri gamaRizianeblis, zemoqmedeba organizmze

garkveuli donis zemoT misi moqmedebisas, anu zezRurblovani

zemoqmedebisas xorcieldeba. swored am zRurblis amaRlebas uzrunvelyofen

opioidebi. amis TvalsaCino magaliTia stresuli anesTeziis fenomeni

mSobiarobis procesSi. cnobilia, rom araorsuli qalisaTvis iseTive xarisxis

tkivilis miyeneba, rasac ganicdis mSobiare, masSi stresul Soks

gamoiwvevda.

8


• mar Tvi s or i Zi r i Tadi mi dgoma:

1.ar af ar akol ogi ur i

2. f ar makol ogi ur i

t ki vi l i s c i kl i

Si Si

daWi mul oba

t ki vi l i

samSobiaro tkivili mSobiarobis marTvis erT-erTi mniSvnelovan

problemaTagania. Aarsebobs samSobiaro tkivilis marTvis orgvari ZiriTadi

midgoma: farmakologiuri da arafarmakologiuri. Ffarmakologiuri midgoma

mimarTulia samSobiaro tkivilis fizikuri aRqmis gaqrobisaken, maSin roca

arafarmakologiuri meTodebi tanjvis prevenciaze orientirdeba. tanjva

nebismieri qvemoT moyvanili fsiqologiuri elementis safuZvelze SeiZleba

gamovlindes. esaa: sxeulisaTvis mosalodneli saSiSroebis aRqma; ususuroba

da kontrolis dakargva; distresi, gamofitva, tanjvasTan SesabrZoleblad

samyofi resursebis uqonloba, SiSi, rogorc dedis, ise nayofis daRupvisa.

Mmiuxedavad imisa, rom tkivili da gancda xSirad erTdroulad warmoiSoba,

zogi utkivilodac itanjeba da zogs ganucdeladac tkiva.

Epidural versus non-epidural or no analgesia in labour(Review)Anim-Somuah M, Smyth R, Howell C

Copyright © 2008 The Cochrane Collaboration. Published by JohnWiley &

Sons, Ltd

9

ar af ar makol ogi ur i mi dgoma(1)

Zi r i Tadi mi z ani :

• daexmar os qal s Seebr Zol os t ki vi l s

• moaxdi nos qal i s t anj vi s pr evenc i a

AsamSobiaro tkivilis marTvisTvis mowodebulia mravalgvari arafarmakologiuri teqnika,

romlebic mimarTulia ara marto fizikuri tkivilis aRqmis Semcirebisken, aramed tanjvis

aRmofxvriskenac da zrdis fsiqoemociur da sulier simSvides. qals, vidre stkiva, ufro eSinia

ucnobi potenciuri tkivilisa. qali, romelic Tavisufalia SiSisagan da darwmunebulia

medpersonalis daxmarebaSi, rogorc wesi, medikamentur gautkivarebas naklebad iTxovs.

tkivilis intensioba mSobiarobisas metwilad, damokidebulia emociur daZabulobaze, amitom

qali srulyofilad unda informirdebodes mSobiarobis fiziologiis Sesaxeb, man unda icodes,

rom tkivili normaluri mSobiarobis procesis gverdiTi movlenaa. da aseve, icnobdes im

CarevaTa xasiaTs, romlebsac samSobiaro tkivilis dasaZlevad iyeneben mSobiarobis

procesSi(Read,1944.L arafarmakologiuri midgomis upirvelesi mizani ar aris tkivilis gaqroba.

piriqiT, damxmare piri exmareba qals sakuTari Tavisadmi rwmenis ganmtkicebaSi,

Tavdajerebulobis, kargad yofnisa da Tavis marTvis unaris gamomuSaveba-SenarCunebaSi.

es is mniSvnelovani faqtorebia, romlebic qals samSobiaro tkivilTan gamklavebaSi

daexmareba. am mizniT misi darwmunebis, xelSewyobis, warmarTvis, gamxnevebisa da

problemis daZlevis Jinis gamomuSavebis absoluturad yvela tipi unda gamoviyenoT.

mSobiare da misi Tanmxlebi piri unda iyvnen informirebulni da flobdnen samSobiaro tkivilis

marTvis yovelgvar teqnikas, rom samSobiaro tkivilis gadatanaSi daexmaron qals.

arafarmakologiuri meTodebis gamoyenebisas qali gamarjvebulad grZnobs Tavs, radgan

warmatebulad daZlia samSobiaro tkivili da mSobiarobis procesSi “Rrma fsiqologiuri da

sulieri komforti” ganicada. Q Lamaze-m (1970w.) pirvelad aRwera mSobiarobis

gautkivarebis fsiqoprofilaqtikuri MmeTodi da xazi gausva im garemoebas, rom samSobiaro

tkivili aris bunebrivi fiziologiuri movlena, romlis Semcirebac SesaZlebelia swori sunTqviTa da

relaqsaciiT, ramac sagrZnoblad SezRuda medikamenturi analgeziis gamoyenebis saWiroeba.


10

ar af ar makol ogi ur i mi dgoma(2)

• samSobi ar o gar emocva• wyl i s pr ocedur ebi• i nt r ader mal ur i wyl i s bl oki• dedi s Tavi suf al i poz i c i ebi da gadaadgi l eba• Sexeba da masaJ i• akupunqt ur a da akupr esur a• hi pnoz i• r el aqsac i a da sunTqva• ar omaTer api a• musi ka da audi oanal gez i a

samSobiaro tkivilis marTvis arafarmakologiuri meTodebi Zalze

mravalferovani, advilad Sesasrulebeli da ekonomiurad

momgebiania. Ggamonaklisia zogierTi procedura,

mag.Aakupunqtura, romelic kvalificiuri specialistis Tanxlebas

moiTxovs da yvela mSobiarobis dros ar aris xelmisawvdomi.

Smith, CA, Collins, CT, Cyna, AM, Crowther, CA. Complementary and alternative therapies for

pain management in labour. Cochrane Database Syst Rev 2006; :CD003521

11

samSobi ar o gar emocva

• sei r nobi s, banaobi s dadasvenebi saTvi s komf or t ul iadgi l ebi da damxmar e saSual ebani

• i deal ur i gar emo xel s uwyobskomf or t ul obi sa da pr i vat ul obi saRqmas

idealuri garemocva komfortisa da privatulobis grZnobas aCens

da gulisxmobs seirnobisa Tu mosvenebis, Tundac sabazanoSi

Cawolis, Sxapis miRebis da sxva aseT elementarul yofiT

siamovnebas. randomizebuli kvlevebiT, erTmaneTs Seudares qalis

mSobiaroba ojaxur garemosTan daaxloebul da sayovelTaod

miRebul standartul hospitalur pirobebSi. gamovlinda, rom

saSinao pirobebSi mSobiarobisas qalebma arc ki indomes

mSobiarobis medikamentozuri gautkivareba, metic: maT Semdeg

jerzec aseT pirobebSi mSobiarobas mianiWes upiratesoba (RR

1.81, 95% CI 1.65-1.98). amasTan, qalebi gansakuTrebulad

kmayofilebebi rCebodnen mSobiarobis dros gaweuli zrunviTac (RR

1.81, 95% CI 1.65-1.98).

Hodnett, ED, Downe, S, Edwards, N, Walsh, D. Home-like versus conventional institutional

settings for birth. Cochrane Database Syst Rev 2005; :CD000012.

12

wyl i s pr ocedur ebi

• t eqni ka-wyal Si CaZi r va i mdenad Rr mad, r omwyal ma daf ar os qal i s mucel i

• aZl i er ebs r el aqsac i as• amc i r ebs samSobi ar o t ki vi l s• aqvei Tebs medi kament ur i anal gez i i s gamoyenebi s

saWi r oebas(A)• ar z r di s dedi sa da neonat al ur i

dai nfi c i r ebi s r i sks

F fiqroben, rom qalis moTavseba Tbilwylian abazanaSi, ise rom wyali mxolod mucels faravdes, aZlierebs relaqsacias da amcirebs samSobiaro tkivils. aRsaniSnavia, rom wylis temperatura umniSvnelod unda aRematebodes qalis sxeulis temperaturas da amasTan, aucileblad unda xorcieldebodes qalis temperaturis monitoringi. mSobiarobis I periodis ganmavlobaSi qali SeiZleba imyofebodes abazanaSi ramdenime wuTi an saaTi. SesaZlebelia Sxapis gamoyenebac, Tumca misi moqmedeba naklebad Seswavlilia. Catarebulma randomizebulma kvlevebma (8 kvleva) gamoavlina wyalSi qalis CaZirvisas tkivilisa da Catarebuli medikamentozuri gautkivarebebis raodenobis mniSvnelovanwilad Semcireba. sagangebod unda aRiniSnos, rom wylis procedurebi ar zrdis dedisa da axalSobilis dainficirebis risks, im SemTxvevaSic ki, roca sanayofo garsebis mTlianoba darRveulia. qals moswons is SegrZnebebi, romlebic mas abazanaSi yofnisas aqvs da rac mTavaria, es procedura usafrTxoa.

Immersion in water in pregnancy, labour and birth (Review) Cluett E R, Nikodem VC, McCandlish RE, Burns EECopyright © 2008 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd

13

kanSi da wyl i s bl oki

• t eqni ka_ st er i l ur i wyl i s kanSi dai neqc i a 0,05-0,1ml -i s odenobi T 4wer t i l Si

• amc i r ebs wel i s t ki vi l i s Segr Znebas

• ar gaaCni a mavne gavl ena dedasa danayof z e

mSobiarobis dros kanSida wylis blokis gamoyeneba, romelsac sxvagvarad kanSida steriluri wylis ineqcias uwodeben, amcirebs ZiriTadad, welis da garkveulwilad, muclis tkivilsac. mSobiarobis dros welis tkivili gvxvdeba daaxloebiT 15-74% SemTxvevaSi da amisi mizezi SeiZleba iyos nayofis araswori mdebareoba (magaliTad, kefiT winmdebareobis ukana saxe, asinklitizmi da sxv.). kanSida ineqcia Sedgeba steriluri wylis (arafiziologiuri steriluri wylis) 4 kanSida ineqciisagan: anu SeiZleba gamoviyenoT 0,05-0,1ml-is odenobiT, oTxi mcire papulis (Tu kafsulis?) saxiT; aqedan ori -- TeZos Zvlis ukana zeda wvetebis midamoSi, danarCeni ori ki 3 sm-iT qvemoT da 1 sm-iT SigniTaa Ppirveli ori ineqciis Seyvanis adgilidan. ineqciebi SeiZleba sakmaod mtkivneuli iyos. Ddiskomfortis grZnobis Semcirebis mizniT, ineqciebi keTdeba samSobiaro Setevis dros da erTdroulad or wertilSi( ori piris mier). wylis blokebi SeiZleba ganmeordes sulvilisamebr. wylis blokebis moqmedebis meqanizmi ucnobia. varaudoben, rom karibWis Teoriis mixedviT, xdeba karibWis Caketva an adgilobrivad endorfinebis sinTezi Zlierdeba. Catarebuli randomizebuli kvlevebis safuZvelze, dadginda, rom kanSida wylis bloki sagrZnoblad, daaxloebiT 45-120 wuTiT amcirebs welis tkivils mSobiarobis dros. amdenad, qalTa umravlesobam gamoTqva survili. rom es meTodi Semdgomi mSobiarobis drosac gamoiyenos. miT ufro, rom am meTods gverdiTi efeqti arc dedasa da arc mis nayofze ar gaaCnia.

Simkin, P, O'Hara, M. Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. Am J Obstet Gynecol 2002; 186:S131

14

DmoZr aoba da Tavi suf al i poz i c i ebi

• si ar ul i , f exz e dgoma, muxl ebz edgoma da nebi smi er i Tavi suf al ipoz i c i a

• mSobi ar i s ver t i kal ur i poz i c i aasoc i r ebul i a nakl ebad mt ki vneulmSobi ar obi s pr ocesTan (A)

mSobiare qals, isev Tavisi komfortulobisTvis, mSobiarobis procesSi unda SeeZlos moZraoba, gadaadgileba da Tavisufali poziciebis SerCeva. Mmenjis moculoba qalis poziciis Secvlisas icvleba, msgavsi cvlilebebi ki aumjobesebs mSobiarobis progress da gamomdinare aqedan, xels uwyobs samSobiaro tkivilis Semcirebasac. garda mSobiaris komfortisa, damxmare piri zrunavs qalis xelsayrel pozebze, mSobiarobis meti progresirebisTvis an nayofisa da dedis mdgomareobis gasaumjobeseblad (magaliTad, nayofis guliscemis sixSiris cvlileba, dedis hipotenzia). 16 randomizebul kontrolirebad kvlevaSi erTmaneTs Seudares mSobiarobis pirvel periodSi mSobiarobis progressa da samSobiaro tkivilze qalis vertikaluri poziciebisa da mSobiaris horizontaluri, zurgze mwoliare pozis gavlena. Sedegad, upiratesoba mieniWa jdomas, dgomas da siaruls, aseve, xelebsa da muxlebze dayrdnobas. kvlevebSi monawile qalebma zurgze mSobiarobas sxva danarCen pozebSi mSobiaroba amjobines. Catarebuli randomizebuli kvlevebis safuZvelze, mSobiarobis II periodSi qalebi upiratesobas aniWeben vertikalur poziciaSi mSobiarobas, radgan zurgze mSobiarobisas ufro Zlierad da xangrZlivad awuxebdaT tkivilis SegrZneba.Ddaskvna: Kkvlevebis Sedegad dadginda, rom vertikalur poziciebi mSobiarobis I periodSi samSobiaro tkivilis SemcirebasTan asocirdeba (A) .

Carlson, JM, Diehl, JA, Sachtleben-Murray, M, et al. Maternal position during parturition in normal labor. Obstet Gynecol 1986; 68:443. Michel, SC, Rake, A, Treiber, K, et al. MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions. AJR Am J Roentgenol 2002; 179:1063

15

Sexeba da masaJ i

• Sexeba akavSi r ebs i seT poz i t i urmesi j ebs, r ogor i c aa: movl a, z r unva, nugeSi sc ema, si yvar ul i

• masaJ i uz r unvel yof s r el aqsac i as daaqvei T ebs t ki vi l s

erT adamianTan Sexeba meoreSi aCens dadebiT emociebs da masze mzrunvelobis gancdas, badebs siyvarulsa da aZlierebs Tavdajerebas. mSobiarobis dros mizanmimarTulad gamoiyeneba mSobiaris sxeulis rbili qsovilebis sistematuri MmasaJi, es aucilebelia mSobiaris mosaduneblad da misi tkivilis Sesamcireblad.D daskvna: masaJi da Sexeba uaryofiTad ar moqmedebs mSobiareze. Qqalebi dadebiTad afaseben amgvar daxmarebas, radgan tkivili umsubuqdebaT da mdgomareoba uumjobesdebaT.

Chang, MY, Wang, SY, Chen, CH. Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan. J Adv Nurs 2002; 38:68. Chang, MY, Chen, CH, Huang, KF. A comparison of massage effects on labor pain using the McGill Pain Questionnaire. J Nurs Res 2006; 14:190.

16

Aakupunqt ur a da akupr esur a

• akupunqt ur a-spec i fi ur i nemsebi sCar Woba sxeul i s bi ol ogi ur adaqt i ur wer t i l ebSi

• akupr esur a-akupunqt ur i swer t i l ebz e T i Tebi T z ewol a

akupunqtura tradiciuli Cinuri medicinis uZvelesi da umniSvnelovanesi nawilia, romelic iTvaliswinebs sxeulis biologiurad aqtiur wertilebze specialuri nemsebiT zemoqmedebas. samSobiaro tkivilis dros nemsebis ganlagebis adgili SeirCeva tkivilis siZlierisa da adgilmdebareobis, mSobiarobis periodis, mSobiaris mdgomareobis, misi daZabulobis, SfoTianobis xarisxisa da sxva mravali faqtoris gaTvaliswinebiT. samSobiaro tkivilebis Sesamcireblad Aakupunqturis gamoyenebis sistematurma mimoxilvam gviCvena, rom misma gamoyenebam mniSvnelovnad Seamcira farmakologiuri gautkivarebis sixSire (RR 0.70, 95% CI 0.49-1.00). sakontrolo jgufTan SedarebiT, qalebi, romelTac utardebodaT akupunqtura, gacilebiT relaqsirebulni iyvnen da naklebad saWiroebdnen farmakologiur gautkivarebas da amasTan, kmayofilebis SegrZnebac ematebodaT.Aakupunqturis warmoebisas, roca mas awarmoebs am saqmis gamocdili specialisti, garTulebis riski minimaluria.A akupresura anu Shiatsu akupunqturis yvelaze martivi alternatiuli meTodia da gulisxmobs biologiurad aqtiuri wertilebis masaJs, TiTebiT an patara marcvlebiT. Akupresura, akupunqturisgan gansxvavebiT, romelsac specialuri Seswavla da sertificireba sWirdeba, did codnasa da gamocdilebas ar saWiroebs. Catarebuli ori randomizebuli kvleviT aRmoCnda, rom biologiurad aqtiuri wertilebis masireba samSobiaro tkivils namdvilad amcirebs.

Martensson, L, Stener-Victorin, E, Wallin, G. Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain. Acta Obstet Gynecol Scand 2008; 87:171.Nesheim, BI, Kinge, R, Berg, B, et al. Acupuncture during labor can reduce the use of meperidine: a controlled clinical study. Clin J Pain 2003; 19:187. Complementary and alternative therapies for painanagement in labour (Review)Smith CA, Collins CT, Cyna AM, Crowther CA Copyright © 2008 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd

17

hi pnoz i

• mSobi ar obi s dr os gamoyenebul ihi pnoz i Tvi Thi pnoz i a

• hi pnoz i s saSual ebi T t ki vi l i sSemc i r ebi s t eqni kebi :

• “xel TaTmani s anesTez i a”• “dr oi s damaxi nj eba”• “war modgeni T i t r ansf or mac i a”

hipnozi aris Rrma fizikuri relaqsaciis mdgomareoba, rodesac fxizeli goneba warmoSobs alfa talRebs da am mdgomareobaSi misi kritikuli nawili daTrgunulia; kritikuli azrovneba droebiT SeCerebulia, qvecnobieri goneba ki ufro advilad misawvdomia da kidec pasuxobs moTxovnebs. Hhipnozi, romelic gamoiyeneba mSobiarobis dros, yovelTvis TviThipnozuria: hipnoTerapisti aswavlis qals, mSobiarobis dros rogor gadavides hipnozis mdgomareobaSi, an aswavlis mis Tanmxleb pirs, TviThipnozuri mdgomareobis miRwevaSi rogor daexmaros qals. Cveulebriv, gamoiyeneba tkivilis Sesustebis Semdegi hipnozuri teqnikebi: “xelTaTmnis anesTezia,” romlis mixedviTac qali warmoidgens, rom misi xeli dabuJebulia da mtkivneul areebze xelis dadebiT am dabuJebas sxva adgilebsac gadascems; “drois damaxinjeba”, romelic saSualebas aZlevs qals samSobiaro SetevebsSorisi periodebis SegrZneba-gancda ufro gaixangrZlios, xolo mtkivneuli periodi ufro xanmokled aRiqvas, vidre es realobaSia; “warmodgeniTi transformaciis” dros qali Setevas aRiqvams, rogorc msubuqs, sasurvelsa da misaRebs; samSobiaro Seteva ganixileba, rogorc energiis talRebi, rac mxolod msubuqi zewolis SegrZnebas iwvevs. Catarebuli randomizebuli kvlevebis safuZvelze, dadginda, rom hipnozis gamoyeneba farmakologiuri analgeziis mniSvnelovan SemcirebasTan asocirdeba(RR 0.53, 95% CI 0.36-0.79) da arafriT auaresebs perinatalur gamosavals. Tumca, anamnezSi fsiqozis arsebobisas misi gamoyeneba ukunaCvenebia. yuradRebiT unda SefasdesNnebismieri fobia an distresis mdgomareoba. hipnozis gamoyenebas raime sayuradRebo riski ar axasiaTebs, Tumca aRsaniSnavia, rom amisaTvis saWiroa, rom gamocdilma hipnoTerapistma prenatalur periodSi treningi Caataros, rac dakavSirebulia xarjebTan. Hhipnozi efeqturi saSualebaa samSobiaro tkivilTan gasamklaveblad da dedis TviTkmayofilebis gasaZliereblad.

Ketterhagen, D, VandeVusse, L, Berner, MA. Self-hypnosis: alternative anesthesia for childbirth. MCN Am J Matern Child Nurs 2002; 27:335

18

r el aqsac i a da sunTqva

•r el aqsac i a da sunTqvauf r o met ad xel s uwyobsqal i s SesaZl ebl obasdasZl i os t ki vi l i , vi dr er eal ur ad aqvei Tebs mas

. sxvadasxva saxelmZRvaneloebSi, romlebsac mSobelTa skolebSi aswavlian, sunTqvis nairsaxeobasTan erTad, miTiTebulia relaqsaciis gansxvavebuli teqnikebi.M relaqsacia da sunTqva ganixileba erTad da ara cal-calke. msgavsi meTodebi saWiroa, rom qalma TviTkontrolis unari gamoimuSaos. Dam meTodebis Sesaswavlad, gansxvavebuli droa saWiro da TiToeuli qalisaTvis is individualuria. sunTqvisa da relaqsaciis meTodebi randomizebuli kvlevebiT ar aris Seswavlili.A araferia cnobili sunTqvisa da relaqsaciis uaryofiT Sedegebzec. qalebi mSobiarobisas misgan ufro met Svebas elian, vidre Rebuloben da amiT imedgacruebulni rCebian. relaqsaciasa da sunTqvas SeuZliaT mSobiares samSobiaro tkivilebis gadalaxvasa da masTan SeguebaSi daexmaron, Tumca es ar exeba maT Semcirebas. Qqalebi gansakuTrebul kmayofilebas gamoTqvamen dedaTa skolis muSaobis gamo.

Complementary and alternative therapies for painmanagement in labour (Review)Smith CA, Collins CT, Cyna AM, Crowther CACopyright © 2008 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd

19

ar omaTer api a

• mecni er eba maRal koncent r ul igamonawvi l i z eTebi s an mcenar eebi s eqst r aqt ebi sTer api ul i ef eqt ebi sgamoyenebi s Sesaxeb

aromaTerapia aris mecniereba maRalkoncentruli gamonawvlili zeTebis an mcenareebis eqstraqtebis gamoyenebis Sesaxeb, maTi Terapiuli Taviseburebebis gamoyenebis mizniT. Uukanasknel xanebSi mSobiarobis dros aromaTerapiis gamoyeneba gaxSirebulia, Tumca zogierTi eqsperti acxadebs, rom eTeruli zeTebi mZlavri farmakologiuri narkotikebia da maTsaviT Zalian saSiSia, amitom maTi gamoyeneba mxolod didi sifrTxiliTa da minimaluri dozebiT daiSveba. aromaTerapiis efeqturoba randomizebuli kvlevebiT arasdros gamokvleula. Catarebulia martooden erTi didi (8058 qalze) arakontrolirebuli prospeqtuli kvleva, romelic aromaTerapiis efeqturobaze (lavanda, vardi, sakmeveli) miuTiTebs. aromaTerapia gamoiyeneba SiSis, SfoTis, tkivilis, gulisrevis, pirRebinebis Sesamcireblad, qalis TviTSegrZnebis gasaumjobeseblad da samSobiaro Setevis gasaZliereblad. SemTxvevaTa daaxloebiT 50%-Si qalebi gamoTqvamdnen kmayofilebas aromaTerapiis Catarebis gamo, 1% aReniSneboda gverdiTi efeqti (gulisreva da Tavis tkivili), Tumca ki bolomde ver dadginda, rom maTi gamovlena swored eTerzeTebis zemoqmedebiT iyo gamowveuli.

Burns, EE, Blamey, C, Ersser, SJ, et al. An investigation into the use of aromatherapy in intrapartum midwifery practice. J Altern Complement Med 2000; 6:141.Tiran, D. Massage and aromatherapy. In: Complementary Therapies for Pregnancy and Childbirth, 2nd Ed, D Tiran and S Mack (Eds), Balliere Tindall, New York 2000.

20

Mmusi ka da audi oanal gez i a

• audi oanal gez i a-smeni T i gamRi z i anebl ebi s -musi ki s,TeTr i xmaur i sa da ekol ogi ur i xmebi sgamoyeneba t ki vi l i s aRqmi s Sesamc i r ebl ad

• mc i r deba samSobi ar o t ki vi l i s i nt ensi voba• mc i r deba opi odebi s gamoyenebi s auc i l ebl oba

Aaudioanalgezia -- smeniTi gamaRizianeblis gamoyeneba (musika, TeTri xmauri da ekologiuri xmebi) tkivilis aRqmis Sesamcireblad efeqturad gamoiyeneba stomatologiur praqtikaSi, qirurgiuli operaciis da sxva mtkivneuli procedurebis Semdeg. koxranis mimoxilvaSi, romelic Seiswavlida musikis efeqts kiboTi gamowveuli tkivilis dros, miTiTebulia, rom musikis mosmena amcirebda tkivilis intensiobas, magram -- mxolod umniSvnelod. musika aseve mowodebulia samSobiaro tkivilis Sesamcirebladac. zogierTi qali upiratesobas aniWebs musikis yurTsasmeniT mosmenas. zogjer qali mSobiarobamde musikas an ekologiur xmebis mosmenas irCevs. Aam musikis TanxlebiT, qali varjiSobs, axdens relaqsacias an TviThipnozs da irCevs variantebs, romelic SemdgomSi mSobiarobis dros gamoadgeba. Catarebul kvlevaTa umetesobam daadgina, rom mSobiarobis dros audioanalgeziis gamoyeneba exmareba qals tkivilis daZlevaSi, sunTqvasa da relaqsaciaSi. Aaraferia cnobili qalsa da mis nayofze musikis uaryofiTi gavlenaze, musikis gamoyeneba Tamamad SeiZleba mSobiarobis drosac.

Lau, J Cepeda, MS, Carr, DB, Alvarez, H. Music for pain relief. Cochrane Database Syst Rev 2006; :CD004843.

21

Aar af ar akol ogi ur i mi dgoma(3)

r ekomendac i ebi :• exmar eba qal s samSobi ar o t ki vi l Tan gamkl avebaSi (1B)• exmar eba qal s Sei nar Cunos mSobi ar obi s pr ocesz e

per sonal ur i kont r ol i s gr Znoba• ar gaaCni a mni Svnel ovani gver di T i ef eqt i daAmavne

gavl ena• ar saWi r oebs usaf r Txoebi s gansukTr ebul i zomebi s

gat ar ebas• t ot al ur i ef eqt i s gasaZl i er ebl ad Sei Zl eba gamoyene-

bul i qnas kombi ni r ebul ad an er TmaneT i s monacvl eobi T• ekonomi ur ad momgebi ani a

Eefeqturi perinataluri movlis principebis Sesabamisad, samSobiaro tkivilis marTvis mizniT, upiratesoba eniWeba tkivilis marTvis arafarmakologiur meTodebs. samSobiaro tkivilis zemoT ganxilul arafarmakologiur meTodebs ar aReniSnebaT raime mniSvnelovani gverdiTi efeqti da ar saWiroeben usafrTxoebis gansakuTrebuli zomebis gatarebas. maTi gamoyeneba kombinirebulad an monacvleobiT aris SesaZlebeli. rogorc mravalricxovani kvlevebi uCvenebs, qalebi amjobineben samSobiaro tkivilis marTvis arafarmakologiur meTodebs, radgan isini qals mSobiarobis procesze kontrolis ganxorcielebasa da mis SenarCunebaSi exmareba. qalTa umetesoba Semdgomi mSobiarobis warmarTvas arafarmakologiuri meTodebiT iTxovs; Mim SemTxvevaSic ki, Tu gadatanili mSobiarobis dros tkivili umniSvnelod Sesustda, an saerTodac xanmokle iyo.

.Smith, CA, Collins, CT, Cyna, AM, Crowther, CA. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev 2006; :CD003521

Simkin, P, O'Hara, M. Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. Am J Obstet Gynecol 2002; 186:S131.

22

Ff ar makol ogi ur i meTodebi (1)

• f ar makol ogi ur i meTodebi mi mar Tu-l i a samSobi ar o t ki vi l i s fi z i kur iSegr Znebi s aRmof xvr i saken

mSobiarobis medkamentozuri gautkivarebis ZiriTadi mizania tkivilis fizikuri aRqmis gaqroba. Elaparakia intervenciul meTodze. mSobiarobis gautkivarebis mizniT gamoyenebuli yvela sedaciuri, saZile Tu analgetikuri saSualeba gadis placentaSi da ama Tu im xarisxiT moqmedebs placentaze. amitom gautkivarebisaTvis gamosayenebeli preparatebi didi sifrTxiliT unda SeirCes, es exeba maT dozirebas, sxva preparatebTan kombinirebas da Seyvanis drosac. gautkivarebis mizniT medikamentebis Seyvana naCvenebia mSobiarobis I periodis aqtiur fazaSi, mSobiarobamde – sul cota, erTi saaTiT adre. am usafrTxoebis RonisZiebebis gatareba savaldebuloa, rom samSobiaro moqmedebaze medikamentTa damTrgunveli gavlenis SemcirebasTan erTad, gaCndes garkveuli garantiebic dedisa da mucladmyofi nayofis usafrTxoebisa da mSobiaris azrovnebiTi srulfasovnebis SesanarCuneblad, raTa igi aqtiurad iyos CarTuli mSobiarobis procesSi da amasTan, laqtaciasa da mSobiarobisSemdgomi periodis mimdinareobazec Semcirdes mavne gavlena. mSobiarobis gautkivarebis mizniT, epiduraluri analgeziis gamoyenebam sagrZnoblad Seamcira anesTeziologiuri garTulebebiT gamowveuli dedaTa sikvdiloba(2,5%-dan 1,6%-mde). Aamas garda, amerikis ginekologTa kolejma da anesTeziologTa sazogadoebam mSobiarobis medikamentozuri gautkivarebis usafrTxoebis mizniT, Sesabamisi instruqciebi(2004w) SeimuSaves.

WILLIAMS OBSTETRICS,22EDITION,2005

23

Ff ar makol ogi ur i meTodebi (2)

• i nhal ac i ur i anal gez i a

• si st emur i anal gez i a

• r egi onal ur i anal gez i a

mSobiarobis medikamentozuri gautkivarebis mizniT, meanobaSidReisaTvis ZiriTadad gamoiyeneba inhalaciuri meTodi, sistemuri analgezia-opioiduri (da ara opioiduri da regionaluri analgezia-epiduraluri(periduraluri)) da spinaluri gautkivareba.

Goetzl, LM. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists Number 36, July 2002. Obstetric analgesia and anesthesia. Obstet Gynecol 2002; 100:177.

24

mSobiarobis inhalaciuri gautkivarebis mizniT, upiratesad, gamoiyeneba azotis qveJangi. mSobiare specialuri niRbiT, damoukideblad ganaxorcielebs gautkivarebas.Aam meTodis usafrTxoebas ganapirobebs is garemoeba, rom, Tu Zalian eZineba, mSobiare ubralod, ver moaxerxebs niRbis gakeTebas da Sesabamisad, Sewyvets anesTetikis SesunTqvas. EsamSobiaro Setevebis gautkivarebis mizniT, azotis qveJangis inhalaciis gamoiyenebis sistematurma mimoxilvam aCvena, rom is iafi da advilad marTvadia. misi analgetikuri efeqturoba, opioidebTan SedarebiT maRalia, magram naklebia, vidre epiduraluri anesTeziis dros. saukeTeso narevad miCneulia entonoqsi -- Jangbadisa da azotis qveJangis 50/50 narevi. mSobiarobis dros igi xelmisawvdomi unda iyos, radgan samSobiaro tkivils amcirebs. Tumca qali aucileblad unda gaafrTxiloT, rom SesaZloa aReniSnos gulisrevis SegrZneba da eiforiuli mdgomareoba.

Rosen, MA. Nitrous oxide for relief of labor pain: A systematic review. Am J Obstet Gynecol 2002; 186:S110.

M mSobiarobis gautkivarebis mizniT, farTod gamoiyeneba iseTi narkotikebi, rogoricaa sinTeturi opioidi – meperidini. amasTan, damatebiT, raime trankvilizatoric; magaliTad, iseTi, rogoricaa prometazini. gautkivarebisa da sedaciis aseTi warmatebuli meTodis arsebobis pirobebSi qali Setevebs Soris mSvidadaa. diskomforti SeigrZnoba mxolod saSvilosnos Zlieri SekumSvisas, Mmagram tkivili savsebiT mosaTmenia. aSS-Si meperidinis gamoyenebis

25

sixSire, misi gverdiTi movlenebis gamo (serotonergiuli krizisi, normeperidinis toqsikuroba), Semcirda da daiwyes misi Canacvleba ufro efeqturi da naklebad toqsikuri opioiduri analgetikebiT. Mmorfini naklebi popularobiT sargeblobs, radgan mas axasiaTebs arasasurveli gavlena rogorc dedaze, aseve nayofze, magram is farTod gamoiyeneba samSobiaro Setevebis gasautkivreblad. sistemur analgetikebs iyenebs is, visac ar ZaluZs peridularuli anesTeziisa da spinaluri blokirebis warmoeba; an gamoiyeneba maSin, roca anesTeziologis kvalificiur daxmarebaze xeli ar miuwvdebaT. aseve gamoiyeneba im pacientebSi, romlebTanac, raime mizezis gamo, ver xerxdeba regionaluris gamoyeneba. praqtikaSi gamoyenebuli opioidebi --morfini, fentanili, meperidini -- moqmedeben dedis tvinze, amavdroulad, gadian transplacentarul bariers da moqmedeben nayofzec, rac aisaxeba rogorc nayofis guliscemaze, ise axalSobilis sunTqvasa da tonusze da axalSobilis depresiiT gamovlindeba. Nneonataluri efeqtebi grZelvadiania da qceviTi parametrebis mgrZnobiare testebis dadgeniT diagnostirdeba. mSobiareebSi sistemuri opioidebi iwveven mdgomareobis Semsubuqebas sedaciiT, da ara realurad tkivilis gayuCebiT. morfinisa da meperidinis Seswavlam gviCvena, rom realurad vRebulobT mSobiaris damSvidebas, miZinebas da ara misTvis tkivilis gayuCebas.

Mattingly, JE, D'Alessio, J, Ramanathan, J. Effects of obstetric analgesics and anesthetics on the neonate: a review. Paediatr Drugs 2003; 5:615. Bricker, L, Lavender, T. Parenteral opioids for labor pain relief: A systematic review. Am J Obstet Gynecol 2002; 186:S094.

26

si st emur i anal gez i a(2)

opi oi debi epi dur al ur anal gez i asTan Sedar ebi T nakl ebad:

• amci r eben t ki vi l i s Segr ZnebasL• oqsi t oc i ni T st i mul ac i i s saWi r oeba• i nst r ument ur i mSobi ar obi s saWi r oeba

epi dur al ur anal gez i asTan Sedar ebi T met ad :

• gamoxat ul i a sedac i ur i ef eqt i• mc i r deba mSobi ar obi s xangr Zl i vobas

F

mSobiarobis gautkivarebis mizniT opioidebis Pparenteraluri gamoyenebis randomizebuli gamokvlevebis Sedegad dadginda, rom:-mSobiarobis dros tkivilis Semcireba sustad gamoixateboda da mcired gansxvavdeboda placebosagan. aranairi mtkicebuleba ar aRmoCnda, rom nebismieri opioidi iyo meperidinze ufro efeqturi (Tanac, igi yvelasTvis xelmisawvdomi da arcTu Zviria).P-epiduraluri analgezia, mSobiarobis gautkivarebis mizniT, gacilebiT efeqturi iyo, vidre parenteraluri opioidebi. aRmoCnda, rom opioidebis moqmedeba xanmoklea. amasTanave, opioidebis gamoyenebisas Semcirda mSobiarobis xangrZlioba, gacilebiT nakleb SemTxvevaSi ki saWiro gaxda oqsitocinis gamoyeneba da instrumentuli MmSobiaroba.-opioidebis gamoyenebis Sedegad, aRiniSna nayofis sunTqvis depresia, rogorc gverdiTi movlena --Ggulisreva, pirRebineba.Oopiodebis efeqturobis gazrdis mizniT, saWiroa dozirebis momateba, rac kidev ufro zrdis nayofze maT uaryofiT gavlenas da aviTarebs axalSobilis nervul depresias, rac seriozuli problemaa.Aopioduri gautkivarebis meTodis gamoyenebisas aucilebelia qalTa srulyofili informireba mosalodneli garTulebebis Sesaxeb; aseve, unda ganemartoT maT, rom opioidebi gadaecema axalSobils ZuZuTi kvebis drosac. opioidebis gamoyenebidan 2 saaTis ganmavlobaSi ar aris naCvenebi wylis procedurebis Catareba.

27

Eepi dur al ur i anal gez i a(1)

cent r al ur i ner vi s bl okadi st eqni ka, r omel i c mi i Rweva t ki vi l i sgadamcemi ner vi s si xl ovesl okal ur i anesTet i ki s i neqc i i T

Bregionaluri gautkivarebis mizniT, romelic gulisxmobs sxvadasxvagvar nervul blokadas, ramdenime tipis -- peridularuli, spinaluri da, pudendaluri -- analgezia gamoiyeneba. Eperiduraluri, anu epiduraluri analgezia aris anesTetikebis (bupivacaine an ropivacaine) epiduralur sivrceSi mudmivi wneviT, lokalurad da xangrZlivad Seyvana, rac uzrunvelyofs karg tkivilgamayuCebel efeqts. ukeTesi efeqtis misaRwevad da lokaluri anesTetikebis dozirebis SemcirebisTvis, mizanSewonilia analgetikebTan, mag. Nneiraqsiul opioidebTan kombinaciaSi maTi gamoyeneba. regionaluri analgeziis Catareba mizanSewonilia mSobiarobis aqtiur fazaSi, Tumca qalis moTxovnis SemTxvevaSi, misi gamoyeneba mSobiarobis I periodis latentur fazaSi, usafrTxoebis damatebiTi zomebis gatarebis drosac SeiZleba. -regionaluri analgeziis warmoebisas yovel 5-15 wuTSi erTxel unda gaisinjos arterialuri wneva. -Tuki regionaluri analgeziis warmoebis Semdgom 30 wuTis ganmavlobaSi qals ar aReniSna gautkivareba, naCvenebia anesTeziologis ganmeorebiTi konsultacia. -yovel saaTSi erTxel unda gakeTdes sensoruli blokadis efeqturobis Sefaseba. -erTxel dawyebuli epiduraluri gautkivareba unda gagrZeldes mesame periodis dasrulebamde. -mSobiares regionaluri gautkivarebiT unda daexmaroT misTvis xelsayreli poziciis SerCevaSi. -saSvilosnos yelis sruli gaxsnis Semdeg regionaluri gautkivarebisas mSobiarobis marTvis principebi unda SeTanxmdes mSobiaresTan, raTa garantirebuli iyos nayofis dabadeba 4 saaTis ganmavlobaSi. -oqsitocinis gamoyeneba rutinulad mSobiarobis II periodSi ar aris naCvenebi. -regionaluri analgeziis dros nayofis guliscemis sixSiris mudmivi eleqtronuli monitoringia rekomendebuli.

Epidural versus non-epidural or no analgesia in labour (Review) Copyright © 2008 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd Intrapartum care care of healthy women and their babies dur ing childbirth- RCOGD.2007

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• samSobi ar o t ki vi l i sagan ganTavi sufl ebi ser Tader T i ef eqt ur i meTodi

• uz r unvel yof s ef eqt ur anal gez i as• SeuZl i a Secval os samSobi ar o t ki vi l i s mZi me

fi z i ol ogi ur i MSedegebi

regionaluri analgeziis meTodi mSobiarobis gautkivarebis yvelaze sarwmuno da efeqturi meTodia da amasTan -- tkivilis mavne fiziologiuri Sedegebis prevenciac. epiduraluri gautkivarebis meore upiratesoba isaa, rom instrumentuli mSobiarobis an sakeisro kveTis warmoebis aucileblobis SemTxvevaSi, anesTetikebi peridularuli kaTeteris saSualebiT, damatebiT SeiZleba SeviyvanoT.Pperiduraluri gautkivarebis gamoyenebamde qali srulyofilad unda informirdes meTodis uaryofiT da dadebiT mxareebze. Aanu mas unda pqondes informacia:anesTeziologis mier regionaluri teqnikis flobis xarisxze;Aanalgeziis sxva meTodebTan SedarebiT, peridularuli analgeziis efeqturobaze; samSobiaro tkivilis marTvis meTodebis Sesaxeb (medikamentozuri da aramedikamentozuri);mSobiarobis II periodis SesaZlo gaxangrZlivebaze;instrumentul mSobiarobaTa SesaZlo gaxSirebaze;mSobiarobis I periodis nakleb xangrZlivobaze;mSobiarobis sakeisro kveTiT damTavrebis nakleb albaTobaze;.welis areSi tkivilis xangrZliobaze; hipotoniis, cxelebisa da Sardis buStis atoniis SesaZlo ganviTarebaze;nayofis mudmivi eleqtronuli monitoringis aucileblobaze;lokaluri anesTetikis dozirebaze ( mSobiares unda ganemartos, rom usafrTxo ultra-mcire dozebis gamoyenebiT analgeziuri efeqti mSobiarobis II periodSi ar miiRweva). mSobiarem unda Seityos, rom epiduraluri analgeziisaTvis gamoyenebuli preparatebi aRweven placentaSi da SesaZlebelia, rom gamoiwvion nayofis xanmokle sunTqviTi depresia da Zilianoba.


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E epi dur al ur i gaut ki var eba asoc i r ebul i a:• i nst r ument ul i vagi nal ur i mSobi ar obi s

gaz r di l r i skTan• mSobi ar obi s gaxangr Zl i vebasTan• oqsi t oc i ni s gamoyenebi s gaz r di l

saWi r oebasTan• dedi s cxel ebi s Lal baTobasTan• nakl ebsavar udod sakei sr o kveT i s r i ski s

gaz r dasTan• l ogi nobi s xanaSi Sar di s buSt i s at oni asTan

mSobiarobis gasautkivreblad Zalze efeqturia epiduraluri gautkivareba, Tumca misi gamoyenebisas (gansakuTrebiT, pirvelmSobiareebSi) aRiniSneba instrumentuli Carevebis maRali sixSire. Aarsebuli mtkicebulebebiT, pirvelmSobiareebSi epiduraluri analgeziis gamoyenebis dros ar matulobs sakeisro kveTis sixSire, magram samagierod, maRalia instrumenturi Carevebis sixSire. aRiniSneba mSobiarobis II periodis gaxangrZlivebac. miuxedavad imisa, rom axalSobilebSi raime gansakuTrebuli darRvevebi ar gamovlenila, naklebi iyo naloqsonis gamoyenebis saWiroeba. mSobiarobis procesSi naCvenebia nayofis mudmivi eleqtronuli monitoringi. Aaseve mizanSewoniladaa miCneuli kontrolirebadi kvlevebis gagrZeleba, es saWiroa Soreul neonatalur gamosavalze misi gavlenis Sesafaseblad. miuxedavad zemod moxseniebuli garTulebebisa, sxva farmakologiur meTodebTan SedarebiT, maRalefeqturobis gamo, epiduraluri analgezia mSobiarobis medikamentozuri gautkivarebis mizniT, dReisaTvis arCeviTada mowodebuli.


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• epidur al ur i anal gezi i s gamoyenebiTmSobi ar oba fi ziol ogiur i dan gadadi spaTol ogiur Si

• epidur al ur i anal gezi a nayofi sr ut inul i el eqt r onul i moni t or ingi sint r anat al ur i Cvenebaa

mSobiarobis II periodis gaxangrZlivebisa da instrumentuli mSobiarobis SemTxvevaTa sixSiris gamo, epiduraluri gautkivarebis dros nayofisa da axalSobilis distresis ganviTarebis riski izrdeba. amitom mSobiarobis procesSi nayofis mudmivi eleqtronuli monitoringis warmoebaa naCvenebi. Mjandacvis msoflio organizaciisgan mowodebuli fiziologiuri mSobiarobis definiciidan gamomdinare, mSobiaroba, romelic warimarTeba epiduraluri gautkivarebiT da mSobiarobis II periodis gaxangrZlivebiT an instrumentuli mSobiarobiT rTuldeba, paTologiur mSobiarobaTa ricxvs miekuTvneba.


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r omel i mi dgoma avi r Ci oT

• f ar makol ogi ur da ar af ar makol ogi ur imi dgomebi s br Zol i s gamosaval i undagadawyvi t os mSobi ar e qal ma

• qal i unda Car Tul i qnas gadawyvet i l ebi smi Rebi s pr ocesSi mSobi ar obi s pr ocesi s yvel aaspeqt i s, maT Sor i s samSobi ar o t ki vi l i smr Tvi s ganxi l vi s saf uZvel z e

• qal i unda i yos i nf or mi r ebul i samSobi ar ot ki vi l i s mar Tvi s yvel a t eqni kebi s Sesaxeb damxol od ami s Semdeg gaakeTos Tavi siTavi suf al i i nf or mi r ebul i ar Cevani

mSobiarobis gautkivarebis medikamentozuri meTodebi aramedikamen-tozurTan SedarebiT gacilebiT efeqturia da es gansakuTrebiT iTqmis epiduralur analgeziaze. Mmagram arafarmakologiuri meTodebis saSualebiT, tkivilis Semsubuqeba gverdiTi movlenebisa da garTulebebis gareSec SeiZleba. Aaqedan gamomdinare, samSobiaro tkivilis marTvis TvalsazrisiT, upiratesoba mSobiarobis gautkivarebis arafarmakologiur meTodebs eniWeba. miT ufro, rom Qmedikamentozuri analgeziis gamoyenebis Canacvlebas mSobiarobis arafarmakologiuri meTodebis gamoyenebiT mSobiarobis procesSi Tavad qalebic amjobineben. G gadawyvetileba mSobiarobis gautkivarebis meTodis Sesaxeb ki Tavad qalma unda miiRos, srulyofili, kompetenturi da samarTliani informaciis gacnobis safuZvelze.


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7 გაუტკივარება

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