gvari: saxeli: dabadebis TariRi: : 1. 2. -...

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gvari: ____________________________________________________saxeli: ___________________________________________________dabadebis TariRi:________________________________________

misamarTi: 1.______________________________________________ 2.______________________________________________telefoni:____________________________________________

eqimis(-ebis)/klinikis(-ebis) beWedi, romelic atarebs patronaJs

1 2

3 4

Cemi Semdegi gamokvlevis TariRebi:

TariRi saaTi TariRi saaTi

2

monacemebi wina orsulobis Sesaxeb:

weli orsulobis gamosavali(spontanuri mSobiaroba, sakeisro kveTa, vaginaluri

operacia, aborti, aSreveba, orsulobis xangrZlivoba)

SeniSvnebi:__________________________________________________________

daunis sindromis, trisomia 13 da trisomia 18 -is skriningi

dedis asakis matebasTan erTad matulobs nayofSi qromosomuli darRvevis ganviTarebis riski, yvelze xSirad – trisomia 21, e.w. daunis sindromi an nervuli milis defeqti.

20 wlis orsulebisTvis individualuri riskia 1: 1100, 35 wlis orsulebSi _ 1:300, 40 wlis asakis orsulebSi ki _ 1:68.

orsulebis 90%-Si SesaZlebelia aRmovaCinoT trisomia 21, trisomia 18-is ganviTarebis individualuri riski arainvaziuri meTodiT _ orsulis venidan aRebul sisxlSi garkveuli parametrebis Sedegebisa da specialuri formu-lis saSualebiT (trimestrebis mixedviT).

laboratoriul kvlevebi – PAPPA, HCG, Tavisufali estrioli, AFP (AFP kvle viT SesaZlebelia nervuli milis defeqtis riskis gamoTvla), Inhibin A.

ultrabgeriTi kvleva – pirveli ultrabgeriTi skriningi (9-12 o.k.).

mxolod am arainvaziuri skrining testis Sedegebze dayrdnobiT miiReba Sem-dgomSi gadawyvetileba invaziuri meTodebis _ amnioturi siTxis kvlevisa an qorionuli xaoebis biofsia _ aucileblobis Sesaxeb.

aseve trisomiebis (daunis sindromi, trisomia 13 da 18) skriningi SesaZlebelia uaxlesi da ufro informatiuli meTodiT: dedis sisxlSi mocirkulire nayofis dnm-is kvleviT. am SemTxvevaSi sakmarisia orsulis venidan aRebuli sisxli.

damatebiTi informaciisTvis mogvmarTeT el. fostaze: [email protected] telefonebze: 2 93 10 00, 2 37 88 48 an ixileT veb. gverdi: www.mrcheveli.com

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profilaqtikuri laboratoriuli kvlevebiorsulobis mimdinareobis kontrolisTvis

hCG – adamianis qoriongonadotropuli hormoni

kvlevisaTvis rekomendebuli dro: menstrualuri ciklis gadacilebisTanave.

Cveneba: l orsulobis adreuli diagnostika;l adreuli orsulobis mimdinareobis Sefaseba

(saSvilosnosgare orsuloba, aborti);l trofoblastis simsivnis mimdinareobis kontroli;l sammagi-testis parametria (daunis sindromis skriningi).

gamosakvlevi masala: Srati 1 ml, Sardi 1 ml.

Tvisobrivi: Srati o_______________ Sardi o________________

raodenobrivi: Srati o_______________

orsulobis kvira: oooo

gamokvlevis TariRi: ____________________________________

laboratoriis protokolis # ___________________________

SeniSvna: dadebiTia menstrualuri ciklis Sewyvetisas. SratSi hCG > 10 IU/I orsulobis maCvenebelia.

hCG – done Sratsa da SardSi orsulobis manZilze:

dro Casaxvidan hormonis koncentracia (IU/I)

orsulobis maCvenebeli3 kvira4 kvira7 kvira

10 kvira13 kvira

2 trimestri3 trimestri

> 10< 50

< 4005.000 - 90.000

40.000 - 230.00040.000 - 140.0008.000 - 100.0005.000 - 65.000

SeniSvna:

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sisxlis saerTo analizi

kvlevisaTvis rekomendebuli dro:l orsulobis 4. - 8. kvira;l orsulobis 21. kviridan yovel 4 kviraSi erTxel;l 6. - 8. kvira mSobiarobis Semdeg.gamosakvlevi masala: 1 (0,5) ml EDTA natiuri sisxli.

gamokvlevis TariRi

HB - hemoglobini

Trombociti*

proTrombini*

SeniSvna: orsulobis TiToeul trimestrSi hemoglobinis koncentracia unda iyos >11,2 g/dl (germania), >10,5 g/dl (aSS).

anemia

orsulobis dros sisxlSi eriTrocitebisa da hemoglobinis Semcveloba mniS-vnelovnad icvleba. maqsimaluri cvlilebebi aRiniSneba orsulobis 32-43-e kviraze. msoflio jandacvis organizaciis (WHO) mixedviT, hemoglobinis koncentracia orsulobis dros ar unda iyos < 11g/dl-ze, loginobis peri-odSi ki _ < 10 g/dl-ze.

Sardis analizi

kvlevisaTvis rekomendebuli dro: 4 kviraSi erTxel.

gamosakvleviparametrebi

gamokvlevis TariRi

cila

eriTrocitebi

leikocitebi

glukoza

cilindrebi

baqteriebi

SeniSvna: proteinuria: SardSi cilis momatebuli gamoyofa Tirkmlis daavadebebis erT-erTi ZiriTadi simptomia.

piuria: leikocitebi SardSi saSarde traqtSi arsebuli infeqciis maCvenebelia.

msubuqi xarisxis eriTrocituria: eriTrocitebi SardSi SesaZloa intersticiuli nefritis simptomi iyos.

glukozuria: saWiroebs Semdgom kvlevas Saqriani diabetis an gestaciuri diabetis gamosaricxad.

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sisxlis jgufi da rezus-faqtori

kvlevisaTvis rekomendebuli dro: orsulobis 4. - 8. kvira.

gamosakvlevi masala: 10 (5) ml natiuri sisxli.

A B O

Rh-dad. (D+) / Rh-uary. (D-)

* Rh-dadebiTi an Rh-uaryofiTi sityvierad miuTiTeT

* es Canaweri ar aTavisuflebs mkurnal eqims pasuxismgeblobisagan (mag. jvaredini sinji).


laboratoriis protokolis # ___________________________

SeniSvna: Tu sisxlis jgufi O-ia sayuradReboa Sratis maxasiaTeblebi.

Rh(D)-uaryofiTi qali, C da E antigenebis arsebobisas, aseve unda Semowmdes Dweak-is arsebobaze. Tu orsuls aReniSneba C da/an E, an Dweak antigenebi, maSin unda ganisazRvros sruli Rh-profili. Rh(D)-uaryofiTi orsulis partniori Rh(D)-s arsebobaze unda Semowmdes.

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antisxeulebis aRmoCenis sinji

kvlevisaTvis rekomendebuli dro:

l orsulobis 4. - 8. kvira;

l orsulobis 24. - 27. kvira.

gamosakvlevi masala: 10 (5) ml natiuri sisxli.

uaryofiTi odadebiTi, titri 1: ________________

gamokvlevis TariRi: _______________

laboratoriis protokolis # _____




SeniSvna: keTdeba 2-jer arapirdapiri antiglobulinis sinjis (kumbsis sinjis) saSualebiT, 2 saxis samizne ujredebis mimarT, romelic unda Seicavdes D, C, c, E, e, Kell, Fy da S antigenebs. Tu antisxeulebis Zebnis sinji dadebiTia, sasurvelia, imave sisxlis gamoyenebT ganisazRvros misi specifiuroba da titri.

orsulebi dasustebuli D-antigeniT (Dweak) arian D-dadebiTebi da anti-D-profilaqtikas ar saWiroeben.

Tu Rh(D)-uaryofiT orsul qals anti-D-antisxeulebi ar aRmoaCnda, maSin mSobiarobisTvis sensibilizaciis Tavidan acilebis mizniT 28.-30. gestaciur kviraze unda daeniSnos anti- imunoglobulinis standartuli doza (300mg) ineqciis saxiT.

sensibilizaciis arsebobisas, aucilebelia, anti-D-titri ganisaz-Rvros 28. gestaciur kviramde 4-kviraSi erTxel, 28. gestaciur kviris Semdeg ki 2 kviraSi erTxel. Tu antisxeulebis titri ≤ 16, maSin rogorc wesi Hydrops fetalis an naadrevi mSobiaroba mosalod-neli ar aris. Tu antisxeulebis titri imatebs 2-jer an metad, ma-Sin mizanSewonilia sanayofe siTxeSi bilirubinis gansazRvra.

TSH _ Tireotropuli hormoni

l orsulobis 4. - 8. kvira.*


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wiTura (antisxeulebi wiTuras mimarT)

kvlevisaTvis rekomendebuli dro:

l orsulobis 4. - 8. kvira;

l orsulobis 16. - 18. kvira (saeWvo SemTxvevaSi).

gamosakvlevi masala: 1 (0,5) ml Srati.


imuniteti aris ooki oaragamokvlevis TariRi: _______________

laboratoriis protokolis # ____________________

Semajamebeliserologiuri kvleva:______________


imuniteti aris ooki oaragamokvlevis TariRi: _______________

laboratoriis protokolis # ____________________

Semajamebeliserologiuri kvleva:______________

SeniSvna: acris miuxedavad, qalebis 10-20%-s reproduqciul asakSi wiTuras mimarT imuniteti ar aqvT.

imuniteti aris roca hemaglutinaciis Hemm-sinjis (HHT) titri ≥1:32. dabali HHT-titris SemTxvevaSi unda gadamowmdes damadas-turebeli sinjiT, mag: HIG-reaqciiT da specifiuri IgG-imunofer-metuli reaqciiT. Tu es reaqciebi dadebiTia, maSin iTvleba rom imuniteti aris.

divergenciuli Sedegi SeiZleba gamoiwvios bolo periodSi ga-datanilma infeqciam. aseT dros unda ganisazvros IgM. Tu IgM uaryofiTia, maSin mwvave infeqcia ar aris, magram divergenciuli Sedegis mixedviT imunitetis arseboba ver dasturdeba.

orsulebi visac imuniteti ar aqvT, an roca gaurkvevelia imunite-tis arseboba, 16. -18. gestaciuri kvirebis ganmavlobaSi kvlav unda gamovikvlioT wiTuras antisxeulebis arsebobaze (miuxedavad imi-sa hqonda Tu ara kontaqti wiTurasTan orsulobis pirveli 16 kviris manZilze).

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qlamidia pjr (PCR)

laboratoriuli kvleva: qlamidiis PCR kvleva


gamosakvlevi masala: saSos nacxi, erTjeradi Sardi.

saSos nacxi o o __________________________

Sardi o o __________________________

gamokvlevis TariRi: _____________________________

laboratoriis protokolis #: ___________________

infeqcia gadaecema sqesobrivi gziT da iwvevs Sardsasqeso gzebis daavade-bebs.

imis gamo, rom daavadeba umetesad usimptomod mimdinareobs, gadamwyveti mniSvneloba aqvs laboratoriul kvlevas.

Tu infeqcia arsebobs orsulobisas, es zrdis naadrevi mSobiarobis, sanayofe garsebis naadrevi gaxleCis, axalSobilebSi koniuqtivitis, pnevmoniisa da ax-alnamSobiareb dedebSi endometritis ganviTarebis risks.

Ureaplasma Urealyticum _ nacxSi*

sifilisi


gamosakvlevi masala: 0,5 (0,2) ml Srati.

TPHA-sinji o o __________________________

FTAabs-sinji o o __________________________

gamokvlevis TariRi: _____________________________

laboratoriis protokolis #: ___________________

SeniSvna: TPHA-sinji tardeba rogorc skrining-testi.dadebiTi Sedegis SemTxvevaSi unda dadasturdes ETAabs-sinjiT an specifiuri imunofermentuli reaqciiT.


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toqsoplazmozi

kvlevisaTvis rekomendebuli dro: uSualod orsulobamde an daorsulebisTanave.

gamosakvlevi masala: 1 (0,5) ml Srati.

Toxo IgG ________________________



Toxo IgM o uaryofiTi o dadebiTi(Tvisobrivi)



SeniSvna: qalebis daaxloebiT 50%-s reproduqciul asakSi imuniteti ar aqvT. ganviTarebul qveynebSi toqsoplazmozis mimarT antisx-eulebis skriningi rutinuli prenataluri kvlevis nawilia.aseve rekomendebulia kvleva orsulobis drosac.

specifiuri IgG imunitetis maCvenebelia.

roca IgG uaryofiTia, aseve saeWvo SemTxvevebSi, mag: savaraudo klinikuri simptomebis arsebobisas, Termulad daumuSavebeli xorcis miRebisas, katebTan an niadagTan kontaqtisas, aucilebelia IgM-is gansazRvrac. toqsoplazma specifiuri IgM antisxeulebi mwvave infeqciis maCvenebelia. Tu IgM uaryofiTia, maSin igi 8-12 kviraSi erTxel unda gakontroldes.

gestaciuri anu orsulTa diabeti

laboratoriuli kvleva: glukozis tolerantobis sinji

kvlevisaTvis rekomendebuli dro: orsulobis 24 - 28 kvira (ojaxur anamnezSi diabetis arsebobis SemTxvevaSi _ 24-28-e da 32-34-e kvirebze).

orsulobisas SesaZlebelia ganviTardes orsulTa e.w gestaciuri diabeti iseT pirebSic ki, romelTac adre es problema ar hqoniaT. sxvadasxva monacemebiT, gestaciuri diabeti orsulTa daaxloebiT 2-12%-s aReniSneba. diabetis es forma, rogorc wesi, qreba mSobiarobis Semdeg.

riskebi gestaciuri diabetis dros:

dedisTvis: maRali arteriuli wneva, saSarde gzebisa da saSos anTebiTi daavadebebi. aranamkurnalebma gestaciurma diabetma nayofSi SeiZleba gamoiwvios insulinis Warbi raodenobiT gamomuSaveba, nayofis didi wona, hipoglikemia (glukozis dabali koncentracia) axalSobilebSi.

TSH _ Tireotropuli hormoni _ orsulobis 26-27 kvira*

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B hepatiti (HBsAg)

laboratoriuli kvleva: HBs Ag orsulobis 32-kviridan.gamosakvlevi masala: 2,0 (1,0) ml Srati.

HBs Ago o uaryofiTi oo dadebiTi


laboratoriis protokolis # __________________________

hepatitis B virusiT inficirebuli orsulidan axalSobilze virusis gadacema ZiriTadad mSobiarobis dros xdeba.

B hepatitis diagnostikis mizniT aucilebelia yvela orsuls Cautardes ga-mokvleva HBs Ag-ze. Tu analizis Sedegi dadebiTia, axalSobils mSobiarobidan pirvel 12 saaTSi B hepatitis vaqcinis pirvel dozasTan erTad ukeTdeba HB-imunoglobulini (HB-Ig). aseT SemTxvevaSi axalSobilis inficirebis riski 5%-ze naklebia.

B jgufis streptokokuli infeqcia

laboratoriuli kvleva: B jgufis streptokokebis kvleva vaginalur nacxSi

kvlevisaTvis rekomendebuli dro: orsulobis 35-37-e kvira.

gamosakvlevi masala: nacxi.

orsuli qalebis 10-30%-mde B jgufis streptokokis matarebelia. baqteria, ZiriTadad, saSoSi, analur aresa da saSarde sistemaSi koncentrirdeba.

dainficirebuli aranamkurnalebi orsulebis mier Sobili yoveli 200 axal-Sobilidan 1-2-s SesaZlebelia ganuviTardes iseTi seriozuli paTologiebi, rogoricaa: sefsisi, meningiti, pnevmonia, rac SesaZlebelia SemdgomSi gar-Tuldes smenis, mxedvelobis dakargviT, ganviTarebaSi CamorCeniT; axalSo-bilTa 5 % iRupeba.

aRniSnuli problemebis Tavidan acilebis mizniT, orsulobis dasasruls (35-37-e kviraze) rekomendebulia vaginaluri da analuri aredan aRebul nacxSi B jgufis streptokokis gamokvleva. Tu pasuxi dadebiTia _ anu baqteria aR-moCnda aRebul nacxSi, maSin rekomendebulia intravenuri antibiotikoTera-pia uSualod mSobiarobis procesSi (ZiriTadad, peniciliniT), rac 30-jer amcirebs bavSvis dainficirebis risks mSobiarobisas.

adamianis imunodeficitis virusi (HIV)

kvlevisaTvis rekomendebuli dro: orsulobis dasawyisSi.

gamosakvlevi masala: 2,0 (1,0) ml Srati.

HIV o o uaryofiTi oo dadebiTi



SeniSvna: kvleva nebayoflobiTia, orsul qals unda SevTavazoT am kvlevis Catareba.

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მრჩეველი - ლიმბახის დიაგნოსტიკისევროპული ჯგუფი

გინეკოლოგიური ულტრაბგერითი გამოკვლევა

ორსულობის დადგენა / სკრინინგი / მონიტორინგი

მუცლის ღრუს ორგანოების ულტრაბგერითი გამოკვლევა (ღვიძლი, ნაღვლის ბუშტი, სანაღვლე გზები, პანკრეასი, ელენთა)

საშარდე სისტემის ულტრაბგერითი გამოკვლევა (თირკმელები, შარდის ბუშტი, წინამდებარე ჯირკვალი)

ფარისებრი ჯირკვლის ულტრაბგერითი კვლევა

სარძევე ჯირკვლის ულტრაბგერითი გამოკვლევა

ულტრაბგერითი კვლევა

დიაგნოსტიკურისამსახური

სამედიცინო ცენტრი ”მრჩეველი”ლიმბახის დიაგნოსტიკის ევროპული ჯგუფითბილისი, ალ.ყაზბეგის გამზირი 92 37 00 71, 2 37 88 48 , 595 10 64 [email protected]

13

mSobiarobis TariRis dadgena

menstruluri cikli _________ /___________ bolo menstruacia ______________

ovulaciis damTrgunvels iRebda, rodemde: ________________________________

Casaxvis dro (Tu zustad aris cnobili): ___________________________________

orsuloba dadasturda (TariRi): _____________ orsulobis kvira: ___________

orsulobis testi – dadebiTi (TariRi): ____________________________________

mSobiarobis vada gamoTvliT:

mSobiarobis vada (Sesworebuli):

eqimis mier b – kiTxvaris Sefasebis Semdeg,27.dRevandeli gasinjviT Semdegi risk-faqtorebi gamovlinda:stacionaruli mkurnaloba orsulobis ganmavlobaSi ______________________________________________________________________

(-dan/-mde, klinika, diagnozi, mkurnaloba)

28. xangrZlivi drois manZilze miRebuli medikamentebi

29. damokidebuleba medikamentebze, narkotikebze

30. fsiqologiuri datvirTva31. socialuri datviTrva32. sisxldena orsulobis 28. kviramde33. sisxldena orsulobis 28. kviris

Semdeg34. placentis winamdebareoba35. mravalnayofiani orsuloba36. hidramnioni37. oligohidramnioni38. mSobiarobis TariRi gaurkvevelia39. placentis ukmarisoba40. isTmo-cervikaluri ukmarisoba

41. adre dawyebul WinTvebi42. anemia43. saSarde gzebis infeqcia44. arapirdapiri kumbsis sinji dadebiTia45. sxva serologiuri gamokvlevebiT

gamovlenili riski46. hipertonia (art. wneva metia 140/90)47. cilis kargva SardiT 1‰

(Seesabameba 1000 mg/l) an meti48. saSualo-, mZime xarisxis SeSupeba49. hipotonia50. gestaciuri diabeti51. nayofis mdebareobis anomalia52. sxva gansakuTrebuli mdgomareo-

bebi, kerZod romeli ___________________________________________

eqimis mier b – kiTxvaris Sefasebis Semdeg,dRevandeli gasinjviT Semdegi risk-faqtorebi gamovlinda:

stacionaruli mkurnaloba orsulobis ganmavlobaSi(-dan/-mde, klinika, diagnozi, mkurnaloba)

14

profilaqtikuri laboratoriuli kvlevebis gegmaorsulobis mimdinareobis kontrolisTvis

profilaqtikuri kvlevebigestaciuri kvira

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20hCG - ad. qoriongonadotr. horm.

HB-hemoglobini

Sardis analizi

sisxlis jgufi da Rh-faqtori


wiTuras-HAH-testi

qlamidiebi

sifilisi

toqsoplazmozi

HIV - ad. imunodeficitis virusi

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40HB-hemoglobini

Sardis analizi


B-hepatiti (HBsAg)

profilaqtikuri laboratoriuli kvlevebis gegmaaxalSobilisTvis

profilaqtikuri kvlevebi dabadebisTanave 1. - 2. postnataluri dRe

pirdapiri kumbsis sinji

Rh(D)-faqtoris gansazRvra

axalSobilis sisxlis jgufi

axalSobilTa hipoTireozi

fenilketonuria

15

profilaqtikuri laboratoriuli kvlevebis gegmaorsulobis mimdinareobis kontrolisTvis

profilaqtikuri kvlevebigestaciuri kvira

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20hCG - ad. qoriongonadotr. horm.

HB-hemoglobini

Sardis analizi

sisxlis jgufi da Rh-faqtori


wiTuras-HAH-testi

qlamidiebi

sifilisi

toqsoplazmozi

HIV - ad. imunodeficitis virusi

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40HB-hemoglobini

Sardis analizi


B-hepatiti (HBsAg)

profilaqtikuri laboratoriuli kvlevebis gegmaaxalSobilisTvis

profilaqtikuri kvlevebi dabadebisTanave 1. - 2. postnataluri dRe


Rh(D)-faqtoris gansazRvra

axalSobilis sisxlis jgufi


fenilketonuria

miTiTebuli gestaciuri kviris farglebSi erTxel

miTiTebuli gestaciuri kvirebis farglebSi erTxel

16

asaki: ______ wlis simaRle: ______ sm orsuloba: ______

a. anamnezi da zogadi gasinÖva / pirveli profilaqtikuri gamokvleva

1. ojaxuri datviTrva (diabeti, hipertonia, anomaliebi, genetikuri ki ara daavadebebi, fsiqiuri daavadebebi) _____________________________ o 1. o2. adre gadatanili mZime daavadebebi (mag. gulis, filtvis, RviZlis, Tirkmlebis, cns-is, fsiqiuri), kerZod __________________________ o 2. o3. sisxldenis/Trombozisadmi midrekileba o 3. o4. alergia, _______________________________________________ mimarT o 4. o5. adre Catarebuli sisxlis gadasxma o 5. o6. gansakuTrebuli fsiqiuri datvirTva o 6. o (mag. ojaxuri an samsaxureobrivi)7. gansakuTrebuli socialuri datvirTva o 7. o (integraciis problema, ekonomiuri problema)8. rezus SeuTavsebloba (wina orsulobebis dros) o 8. o9. Saqriani diabeti o 9. o10. simsuqne o 10.o11. zrdaSi CamorCena (dedis simaRle <156 sm.) o 11.o12. ConCxis anomaliebi o 12.o13. orsuloba < 18 welze o 13.o14. orsuloba > 35 welze o 14.o15. mravalSvilianoba (4 Svilze meti) o 15.o16. anamnezSi – sterilobis gamo Catarebuli mkurnaloba o 16.o17. anamnezSi – naadrevi mSobiaroba (orsulobis 37. kviris bolomde) o 17.o18. anamnezSi – mcire wonis axalSobili (< 2500 gr.) o 18.o19. anamnezSi – 2 an meti aborti/muclis moSla o 19.o20. anamnezSi – mkvdari/travmuli bavSvi o 20.o21. garTulebebi wina mSobiarobis dros, o 21.o kerZod romeli _______________________________________________22. garTulebebi mSobiarobis Semdeg, o 22.o kerZod romeli _______________________________________________23. anamnezSi – sakeisro kveTa o 23.o24. anamnezSi – saSvilosnoze Catarebuli sxva operaciebi o 24.o25. xelmeored swrafi daorsuleba (<1 welze) o 25.o26. sxva gansakuTrebuli mdgomareobebi, o 26.o kerZod romeli __________________________________________________

eqimis mier a – kiTxvaris Sefasebis Semdeg orsulobis riski arsebobs: orCevebi orsulTaTvisa) zogadi mag. samsaxuri, mogzauroba, kveba, sporti ob) specialuri riskis Sesaxeb konsultacia o genetikuri konsultacia og) orsulTa varjiSi od) simsivnis adreuli diagnostika o

17

nayofis zrdis normis mrudebi (Hansmann 1976)

I ultrabgeriTiskriningi

II ultrabgeriTiskriningi

III ultrabgeriTiskriningi

SSL - Txem-kudusunis sigrZe

BPD - biparietaluri diametri

ATD - muclis/gulmkerdis ganivkveTis diametri

18

axalSobilTa skriningi

axalSobilTa skriningi iZleva SesaZleblobas daavadebis simptomebis ga-mov lenamde aRmovaCinoT axalSobilebi, romlebic nivTierebaTa cvlis gan-kurnebadi Tandayolili darRvevebis ganviTarebis riskis matareblebi arian. skriningis CamonaTvalSi, ZiriTadad, iseTi Tandayolili daavadebebi Se dis, romelTa drouli diagnostikisa da swori mkurnalobis SemTxvevaSi SesaZlebelia TiTqmis sruli gamojanmrTeleba, xolo mkurnalobis dagvianebis SemTxvevaSi ki Seuqcevadi dazianebebi viTardeba, rac, ZiriTadad, fizikuri da gonebrivi ganviTarebis SeferxebiT, Sinagani organoebis dazianebiTa da sxva simptomebiT vlindeba.saqarTveloSi axalSobilebs dabadebidan mesame dRes skriningi mxolod 3 daavadebaze (Tandayolili hipoTireozi, fenilketonuria, mukoviscidozi) utardebaT.

`mrCeveli~ gTavazobT axalSobilTa standartul skrinings, romelic aprobirebulia germaniaSi.

kvleva moicavs 14 ZiriTad daavadebas:

• galaqtoza 1-puridiltransferazas deficiti (fermentis aqtivoba, Gal, Gal-1P)

• fenilketonuria/fenilalaninemia• Maple Sirop Urine Disease /valinoleicinuria, nuSis siropis daavadeba• Glutaric academia type I /aRiniSneba glutarilkarnitinis maRali done.

iwvevs encefalopaTiebs• Isovaleric Acidemia /aRiniSneba izovalerilkarnitinis maRali done,

iwvevs gulyrebs da komas• saSualo jaWviani Acyl-CoA Dehydrogenase deficiti (MCAD)• Zalian grZeljaWviani Acyl-CoA Dehydrogenase (VLCAD) deficiti• grZeljaWviani 3-Hydroxyacyl-CoA Dehydrogenase (LCHAD) da mitoqon-

driuli trifunqciuri proteinis deficiti (MTP) LCHAD/MTP• Carnitine palmitoyl transferase I deficiti• Carnitine palmitoyl transferase II deficiti• Carnitine translocase deficiti• Tandayolili hipoTireozi (TSH)• Tirkmelzeda jirkvlis Tandayolili hiperplazia (17-OHP)• biotidinazas deficiti (fermentis aqtivobis gansazRvra)

agreTve, survilis SemTxvevaSi, SesaZlebelia damatebiTi kvlevebis Catareba Semdegi daavadebebis skriningisTvis:

• Tirozinemia, tipi I• citrulinemia• Arginino succinate lyase deficiti• propionik acidemia• Glutaric Acidemia tipi II• Carnitin Transporter deficiti• glukoza-6-fosfatdehidrogenazas deficiti • namgliseburi ujredebi, Talasemia• mukoviscidozi (trifsini)

masalis aRebis dro sisxlis aReba unda moxdes bavSvis dabadebidan 36-72 saaTSi.pasuxis vada: 7-10 dRe

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profilaqtikuri laboratoriuli kvlevebiaxalSobilisTvis


kvlevisaTvis rekomendebuli dro: axalSobilebs dabadebisTanave.

gamosakvlevi masala: Wiplaris sisxli.

pirdapiri kumbsis sinji oo uaryofiTi oo dadebiTi



SeniSvna: dadebiTi pirdapiri kumbsis sinji miuTiTebs hemolizuri procesebis arsebobaze.

mrCeveli

pediatriuli da fsiqologiuri samsaxuri `mrCeveli~

Tbilisi, mTawmindis Sesaxvevi 7atel.: 2 99 66 92, (599) 91 66 92

faqsi: + 995 32 931 000E-mail: [email protected]

www.mrcheveli.com

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Rh (D) faqtoris gansazRvra

kvlevisaTvis rekomendebuli dro: ukeTdebaT Rh-uaryofiTi dedis axalSobilebs dabadebisTanave.

gamosakvlevi masala: Wiplaris sisxli.

Rh-dad. (D+) / Rh-uary. (D-)

* Rh-dadebiTi an Rh-uaryofiTi sityvierad miuTiTeT

* Tu dadebiTia, maSin unda ganisazRvros sisxlis jgufic.


laboratoriis protokolis # ____________________________

SeniSvna: Rh(D)-uaryofiTi dedis axalSobilebTan dabadebisTanave saWiroa Rh(D)-faqtoris gansazRvra. yuradReba unda mieqces kumbsis pirdapir sinjs. Tu Rh-faqtori an Dweak dadebiTia, maSin imave sisxlis gamoyenebiT unda ganisazRvros ABO-sisxlis jgufi. Tu bavSvi Rh-dadebiTia, maSin dedas unda gaukeTdes anti-Dimunoglob-ulinis standartuli doza mSobiarobidan 72-saaTis farglebSi im SemTxvevaSic ki, roca dedas kumbsis arapirdapiri sinjiT gamou-vlinda antisxeulebis susti reaqcia an/da axalSobilSi kumbsis pirdapiri sinji sustad dadebiTia. Tu dedas aqvs Rh(D)-antisx-eulebi, bavSvi aris Rh(D)-uaryofiTi da pirdapiri kumbsis sinji dadebiTia, maSin bavSvi unda gamovikvlioT Rh Dweak-is arsebobaze.

axalSobilis sisxlis jgufikvlevisaTvis rekomendebuli dro: dabadebisTanave.gamosakvlevi masala: Wiplaris sisxli.

A B O


laboratoriis protokolis # ____________________________

SeniSvna: im axalSobilebSi, romelTa dedis sisxlis jgufi O-ia, sisxlis jgufi unda ganisazRvros dabadebisTanave. Tu sisxli A da B jgu-fisaa SeiZleba ganviTardes ABO-eriTroblastozi. aseve, siyviT-lis droulad aRmosaCenad, bilirubini unda gakontroldes.


profilaqtikuri acrebi

orsulobamde sasurvelia B hepatitis sawinaaRmdego acris Catareba, aseve sasurvelia acra wiTuras winaaRmdeg Tu qals es daavadeba ar gadautania da/an arasruladaa acrili.

orsulis dacva aseve Zalian sasurvelia gripis virusisagan. romlis sawinaaRmdego acris Catareba SesaZlebelia orsulobis periodSic.

erovnuli kalendris mixedviT 1 wlamde asakis bavSvebi icrebian 6 in-feqciis sawinaaRmdegod:

• difteria,

• tetanusi,

• yivanaxvela,

• poliomieliti,

• hemofilus influenca B tipis,

• B hepatiti,

• rotavirusi.

1 wlis asakidan ukve SesaZlebelia wiTela- wiTura- ybayuras sawinaaR-mdego (Sedis erovnul kalendarSi) da Cutyvavilas sawinaaRmdego (ar Sedis erovnul kalendarSi) acris Catareba.

`mrCevelSi~ SesaZlebelia rogorc zemoT aRniSnuli gamomwvevebis sawinaaR-mdego, aseve sezonuri gripis (influenca) sawinaaRmdego acrebis Catareba.

B da A hepatitis, difteriis, tetanusis, poliomielitis, wiTela-wi-Tura-ybayuris, Cutyvavilas, sezonuri gripis sawinaaRmdego acrebis Catareba SesaZlebelia mozrdil pacientebTanac.

acrebi tardeba saqarTveloSi registrirebuli evropuli vaqcinebiT: (infanriqs heqsa, pentaqsimi, tetraqsimi, prioriqsi, varilriqsi, imovaq-si td, imovaqsi polio da sxva).


23


kvlevisaTvis rekomendebuli dro: 1.-2. postnataluri dRe.

gamosakvlevi masala: kapilaruli sisxlis 1 wveTi, 2,0 (1,0) ml Srati.

TSH o o uaryofiTi oo dadebiTi

TSH _________________________________

FT4 _________________________________

gamokvlevis TariRi: _______________________________

laboratoriis protokolis # _____________________

SeniSvna: Tandayolili hipoTireozis sixSirea 1:4000 axalSobilze.

ganviTarebul qveynebSi TSH-skriningi axalSobilebSi Tandayoli-li hipoTireozis aRmosaCenad gamoiyeneba.

TSH-is gansazRvra xdeba sicocxlis 1. dRes. saeWvo SemTxvevaSi unda ganisazRvros FT4, rogorc damadasturebeli parametri.

fenilketonuria

kvlevisaTvis rekomendebuli dro: 1.-2. postnataluri dRe.gamosakvlevi masala: 2,0 (0,5) ml Srati/plazma.

fenilalanini ___________________________________________

mutaciis aRmoCena DGGE-Ti ___________________________________________

gamokvlevis TariRi: ___________________________________________

laboratoriis protokolis # ___________________________________________

SeniSvna: fenilketonuriis sixSirea 1:2.500 - 1:100.000 axalSobilze.gada-cemis saxe: autosomur-recesiuli. qromosomaze lokalizacia: 12q22-q24.1.

ganviTarebul qveynebSi fenilketonuriis skriningi axalSobileb-Si am daavadebis droulad aRmosaCenad gamoiyeneba.

skriningi: fenilalaninis koncentraciis gansazRvra plazmaSi.

koncentraciis momatebisas diagnozi unda dadasturdes geneti-kuri analiziT: mutaciis aRmoCena DGGE-Ti.

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saboloo gamokvleva/epikrizi

dabadebis weli 19 oo martoxela deda o erovneba ___________________

orsulobis raodenoba(bolo orsulobisCaTvliT)

oomSobiaroba(bolo mSobiarobisCaTvliT)

oo pirveligamokvleva (ok) oo

profilaqtikurgamokvlevaTa raodenoba

oomSobiarobamdemoTavsdaklinikaSi

ostacionarizaciamSobiarobamde(kvira)

oo

a/b kiTxvarebis mixedviT (gv. 13 da 14) miuTiTeT riskis nomrebi

oo oo oo oo oo oo

TariRi oo oo oo orsulobis kvira oo saavadmyofos gareT o mSobiaroba

1. bavSvi 2. bavSvi (tyupiscali)

cocxlad mSobiaroba

sqesi

mSobiarobis saxe

bavSvis mdebareoba

wona

sigrZe

apgaris Skala 5’/10’

pH-done (Wiplaris arteriaSi)

paTologia / anomalia

SeniSvnebi ________________________________________________________________________________________________________________________________________________________________________________

loginobis periodi paTologiis gareSe

ginekologiuri gamokvlevis Sedegi paTologiis gareSe ki ara

Hb arteriuli wneva

loginobis periodi paTologiis gareSe

Anti-D profilaqtika

sisxlis jgufi da qvejgufi

Rh faqtori


bavSvi janmrTeli gawerisas, TariRi

bavSvi gadaiyvanes stacionarSi, TariRi

exitus, TariRi

or

sul

oba

mSo

biar

oba

ki

ki ara

mamr mdedr

sp vag.op

Tw mw

sk

gm

ki ara

gr.

sm.

ki ara

mamr mdedr

sp vag.op

Tw mw

sk

gm

ki ara

gr.

sm.

lo

gino

bis

per

iod

i


A B O AB

Rh-pos Rh-neg

neg. pos.

A B O AB

neg. pos.

Rh-pos Rh-neg

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sayuradRebo mdgomareobebi loginobis periodSi ________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

_____________________ _____________________gamokvlevis TariRi xelmowera/beWedi

ginekologiuri monacemebi paTologiis gareSe ki ara Hb g/%

arteriuli wneva /

Sardi Leuk./Er.-dadebiTi cila-dadebiTi naleqi paT. monacemi

SeniSvnebi __________________________________________________________________________

___________________________________________________________________________________

bavSvi bunebriv kvebazea (deda kvebavs)

bavSvi Sereul kvebazea, rodidan? ______________

bavSvi xelovnur kvebazea (dedas ar ukvebia), rodidan? ______________


bavSvi: g3* Catarebulia

janmrTelia

g3-is Semdeg mkurnalobassaWiroebs

exitus, TariRi

* gamokvleva 3 - ix. „bavSvis pasporti“

sp - spotanuri mSobiarobask - sakeisro kveTavag. op. - vaginaluri operaciaTw - TaviT winamdebareobamw - menjiT winamdebareobagm - gardigardmo mdgomareoba

_____________________ _____________________gamokvlevis TariRi xelmowera/beWedi

2. g

amo

kvl

eva

mSo

biar

obi

s Se

mdeg

(6.-

8. k

vir

a)

ki ara

ki ara

ki ara

ki ara

ki ara

ki ara

26

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ü ფიბროსკანი

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[email protected]

27

უფასო გამოძახება ბინაზე

ლაბორატორია „მრჩეველში“ მოქმედებსუფასო გამოძახების სამსახური

ü სახლიდან გაუსვლელად ანალიზების ჩატარება;ü გამოძახება ორშაბათიდან შაბათის ჩათვლით, 09:00 სთ-დან 17:00 სთ-მდე;ü მომსახურება Sarstedt-ის ერთჯერადი სატრანსპორტო და სამედიცინო მასალებით;ü მომსახურება ვრცელდება ყველა ლაბორატორიულ ანალიზზე.

მომსახურებით სარგებლობა შეუძლია:

ü თბილისის ნებისმიერ მაცხოვრებელს;ü სხვადასხვა პროფილის ექიმებს;ü ლაბორატორიებს;ü კლინიკებს.

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