1

ZuZuTi kvebis marTva

samSobiaro saxlSi adreul

neonatalur periodSi

bavSvisadmi keTilganwyobili saavadmyofos iniciativa

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

2

klinikuri praqtikis erovnuli rekomendacia (gaidlaini)

`ZuZuTi kvebis marTva samSobiaro saxlSi adreul neonatalur

periodSi~ miRebulia klinikuri praqtikis erovnuli

rekomendaciebis (gaidlainebi) da daavadebaTa marTvis

saxelmwifo standartebis (protokolebi) SemuSavebis,

Sefasebis da danergvis erovnuli sabWos 2008 wlis 5 noembris

#1 sxdomaze da damtkicebulia saqarTvelos Sromis,

janmrTelobisa da socialuri dacvis ministris 2009 wlis 14

aprilis # 152/o brZanebiT.

3

ZuZuTi kvebis marTva samSobiaro saxlSi adreul neonatalur periodSi

1. definicia

bavSvisadmi keTilganwyobili saavadmyofos inicitiva (baksi) asaxavs

samSobiaro saxlebSi warmatebuli ZuZuTi kvebis 10 safexuris

(globaluri kriteriumebis) danergvis meTodologias.

baksi ZuZuTi kvebis marTvis fundamenturi instrumentia, romelic

orsulebis, dedebis da samedicino personalis saTanado ganaTlebis

gziT, xels uwyobs ZuZTi kvebis adreuli dawyebis, xangrZlivobisa d

sixSiris gazrdas (WHO/UNICEF).

baksis idea fokusirebulia dedisa da axalSobilis bunebriv

moTxovnilebebze da gamiznulia samSobiaro dawesebulebebSi jandacvis

msoflio organizaciis da gaeros bavSvTa fondis mier mowodebuli

warmatebuli ZuZuTi kvebis 10 safexuris danergvisaTvis/!

!

ZuZuTi kvebis 10 safexuri:

1. samSobiaro saxls unda qondes ZuZuTi kvebis politika

werilobiTi saxiT, romelsac rutinulad gaecnoba samedicino

personalis sruli Semadgenloba;

2. samedicino personals gavlili unda qondes ZuZuTi kvebis

saswavlo seminari, rac aucilebelia politikis danergvisaTvis;

3. yvela orsuli unda iyos informirebuli ZuZuTi kvebis

sargeblianobisa da misi marTvis principebis Sesaxeb;

4. yvela dedas unda gauwion daxmareba ZuZuTi kvebis dawyebaSi

mSobiarobidan 1-2 saaTis ganmavlobaSi;

5. dedas unda aswavlon da aCvenon, rogor kvebos bavSvi ZuZuTi

da rogor SeinarCunos laqtacia im SemTxvevaSic ki, roca deda

da bavSvi dacilebulia erTmaneTisgan;

6. bavSvs ar unda miscen araviTari sxva sakvebi an siTxe garda

qalis rZisa, samedicino CvenebiT daniSnuli medikamentebis

gamoklebiT;

7. samSobiaro saxlSi aucilebelia deda-bavSvis erTad yofnis

praqtikis danergva – dedas da bavSvs mieces SesaZlebloba

iyvnen erTad 24 saaTis ganmavlobaSi;

8. moTxovnilebiT ZuZuTi kvebis xelSewyoba;

9. ar mieces ZuZuTi kvebaze myof bavSvs sawovara an satyuara;

10. ZuZuTi kvebis mxardamWeri jgufebis Camoyalibebis xelSewyoba

da samSobiarodan gaweris Semdeg dedebis maTTan gagzavna

(janmrTelobis dacvis sistemaSi aseT jgufad moiazreba

pirveladi jandacvis rgoli, aseve arasamTavrobo seqtori,

romelic muSaobs ZuZuTi kvebis xelSewyobisa da danergvis

principebze).

gaidlaini gankuTvnilia

4

samSobiaro dawesebulebis samedicino personalisTvis (neonatologi,

mean-ginekologi, medda, bebia-qali).

samizne jgufi:

adreuli neonataluri periodis axalSobilebi, meZuZuri dedebi da

orsuli qalebi.

gamoyenebuli terminologia:

1. ZuZuTi kveba _ kvebis wesi, rodesac bavSvi ikvebeba dedis rZiT da

iRebs nebismier sxva saxis sakvebs, maT Soris qalis rZis

Semcvlelebs;

2. eqskluziuri ZuZuTi kveba anu mxolod ZuZuTi kveba - Cvilis kveba

qalis (deda /donori) rZiT, xseniT, gamowvelili rZiT 6 Tvemde,

sxva sakvebisa da siTxeebis (maT Soris wylis) Sematebis gareSe

(gamonakliss warmoadgens medikamentebi, ORS, vitaminebi,

mineraluri danamatebi);

3. predominantuli ZuZuTi kveba anu upiratesad ZuZuTi kveba. _ dedis

(donoris) rZesTan erTad mcire raodenobis siTxeebis miReba

(wyali, Cai, wveni);

4. komplementuri kveba - qalis rZesTan erTad naxevradmyari an myari

damatebiTi sakvebis miReba;

5. prelaqtaciuri sakvebi – qalis rZis Semcvleli an nebismieri

siTxe, romelic gamoiyeneba ZuZuTi kvebis dawyebamde;

6. kani kanTan kontaqti – mSobiarobis Semdeg janmrTeli SiSveli

axalSobilis moTavseba dedis sxeulze;

7. qalis rZis Semcvleli _ bavSvTa kvebis produqti, romelic

gamoyeneba 6 Tvemde asakis bavSvis sakvebad;

8. sakvebi formula _ qarxnuli wesiT damzadebuli qalis rZis

Semcvleli.

gamoyenebuli Semoklebebi:

• ILKA _ laqtaciis konsultantTa saerTaSoriso asociacia

• IBFAN _ bavSvTa kvebis saerTaSoriso qseli

• WABA _ ZuZuTi kvebis msoflio aliansi • Baby Milk Action _ ZuZuTi kvebis qseli

• WHO _ janmrTelobis msoflio organizacia

• UNICEF – gaeros bavSvTa fondi

2. epidemiologia

bavSvTa kvebis, janmrTelobisa da ganviTarebis sferoSi Catarebuli

mravalricxovani kvlevebis Tanaxmad, ZuZuTi kveba yvelaze efeqturi

5

gzaa, romelic uzrunvelyofs bavSvs srulyofili sakvebiT, sicocxlisa

da ganviTarebisaTvis saWiro aucilebeli faqtorebiT, icavs mas

alergiis, infeqciisa da sxva daavadebebisagan.

yovelwliurad msoflioSi milionobiT bavSvi kvdeba, maT Soris 13

milioni sicocxlis pirvel Tves da didi umetesoba adreul neonatalur

periodSi. axalSobilTa sikvdilis mizezebi umrvales SemTxvevaSi

pirdapir kavSirSia ZuZuTi kvebis araswor praqtikasTan da perinataluri

periodis araadeqvatur marTvasTan.

0-dan 5 wlamde asakis bavSvebs, romlebic ar ikvebebian ZuZuTi,

aReniSnebaT diareisa da pnevmoniis letalobis 7-jer ufro maRali

riski, ZuZuTi kvebaze myof bavSvebTan SedarebiT. eskluziur ZuZuTi

kvebaze myof CvilebSi, diareis da pnevmoniis letalobis riski 2-jer

mcirea, vidre CvilebSi, romlebic eqskluziur ZuZuTi kvebaze ar

imyofebian. 1,2 1990 wels 32 qveynis mTavrobam da gaeros 10 saagentom SeimuSava da xeli

moawera saerTo deklaracias (e.w. “inosentis deklaracia”), romlic

gamoxatavs ZuZuTi kvebis principebisadmi erTsulovan mxardaWeras.

deklaracia adasturebs samSobiaro dawesebulebebSi warmatebuli ZuZuTi

kvebis 10 safexuris danergvis aucileblobas. msoflio jandacvis

organizaciis da gaeros bavSvTa fondis ganacxadi saxelwodebiT -

“ZuZuTi kvebis dacva, xelSewyoba da mxardaWera’’ - adasturebs

samSobiaro dawesebulebebis gansakuTrebuli rols da xazs usvams

baksis principebis danergvis auculeblobas samSobiaro saxlebSi.

ZuZuTi kvebis mxardaWeris pirveli etapi qalTa konsultaciebsa da

samSobiaro saxlebSi iwyeba. medicinis muSakTa damokidebulebas da maT

rekomendaciebs gadamwyveti mnivSneloba aqvs dedis motivaciisTvis

ZuZuTi kvebasTan dakavSirebiT. arsebobs monacemebi, rom eqskluziur

ZuZuTi kvebas warmatebiT axorcieleben is dedebi, romlebmac imSobiares

iseT samSobiaro saxlebSi sadac samedicino personals gavlili qonda

ZuZuTi kvebis saswavlo seminari.12 klasteruli kvlevebiT gamovlinda,

rom baksisi titulis mflobel samSobiaro saxlebSi dabadebuli

bavSvebis umetesoba 12 Tvis asakSi agrZelebs ZuZuTi kvebas. baksis

danergvis gamocdilebam aCvena, rom ZuZuTi kvebis sixSirisa da

xangrZlivobis matebasTan erTad mcirdeba Cvil bavSvTa avadobis

SemTxvevaTa sixSire. baksi bavSvTa keTildReobis ufro xarjTefeqtur

intervencias warmoadges, vidre imunizacia da oraluri rehidratacia.

13,14,15,16. dRes msoflioSi 2000-mde samSobiaro saxli flobs baksis

tituls. 1997 wels saqarTelo SeurTda baksis moZraobas. 1999 wels

miRebul iqna kanoni - ,,ZuZuTi kvebis xelSewyobis da xelovnuri sakvebis

kontrolirebadi moxmarebis” Sesaxeb, 2006 wlamde saqarTveloSi 18-ma

samSobiaro saxlma SesZlo warmatebuli ZuZuTi kvebis 10 safexuris

danergva da baksis titulis mopoveba. 2005 wlis statistikuri

monacemebis mixedviT mSobiarobidan erT saaTSi ZuZuTi kveba iwyba -

64,1%-Si, 1-8 saaTSi – 23%-Si, 3 Tvemde asakis bavSvTaA52,11% ikvebeba

ZuZuTi. samSobiarodan gamowerili axalSobilebis 90% imyofeba ZuZuTi

kvebaze.

samSobiaro dawesebulebis gardaqmna bavSvisadmi keTilganwyobil

saavadmyofod warmoadgens process, romelic iwyeba dawesebulebaSi

6

arsebuli ZuZuTi kvebis praqtikis analiziT, ZuZuTi kvebis danergvis

xelSemSleli faqtorebis gamovleniT, Sesabamisi cvlilebebis

ganxorcielebiT da mTavrdeba dawesebulebis gare SefasebiT, romelsac

axorcieleben baksis gare eqspertebi. Sefaseba tardeba specialuri

kiTxvariT, baksis globaluri kriteriumebis moTxovnebis Sesabamisad.

dadebiTi Sefasebis SemTxvevaSi samSobiaro saxli iRebs tituls

,,bavSvisadmi keTilganwyobili saavadmyofos iniciativa’’.Ggadawyvetilebis

miReba titulis miniWebis Taobaze xdeba nacionaluri ZuZuTi kvebis

komitetis an Sesabamisi pasuxismgebeli sabWos/uwyebis mier.

3. globaluri kriteriumebi

safexuri 1

dawesebulebas unda qondes ZuZuTi kvebis politika werilobiTi formiT,

romelsac rutinulad gaecnoba samedicino personalis sruli

Semadgenloba.

samSobiaro dawesebulebaSi arsebuli ZuZuTi kvebis praqtikis

gaumjobeseba SeiZleba miRweul iqnas saTanado politikis arsebobis

SemTxvevaSi.

samSobiaro saxlis personalma Tavad unda SeimuSaos dawesebulebaSi

ZuZuTi kvebis danergvis politikis werilobiTi dokumenti, romelic

unda moicavdes warmatebuli ZuZuTi kvebis marTvis principebs. politika

xelmisawvdomi unda iyos dawesebulebis mTeli personalisTvis (WHO / UNICEF ). 1,2,3 I safexuris ZiriTadi moTxovnebi:

• samSobiaro dawesebulebaSi ZuZuTi kvebis arsebuli praqtikis

gaumjobesebis misaRwevad saWiroa dawesebulebas gaaCndes Sesabamisi

politika;

• politikaSi asaxuli sakiTxebi ZuZuTi kvebis Sesaxeb SeTanxmebuli

unda iyos janmrTelobis dacvis saministros da samSobiaro

dawesebulebis avtoritetul pirebTan.

saavadmyofos xelmZRvaneloba (administracia, ufrosi samedicino

personali) ganuxrelad unda axorcielebdes aRniSnul politikas da

mxars uWerdes mas. saavadmyofos personalsa da xelmZRvanelobas Soris

urTierTTanamSromlobis xarvezebi SeiZleba aRmoCndes erT-erTi

winaRoba ZuZuTi kvebis 10 safexuris danergvisaTvis.

dawesebulebaSi ZuZuTi kvebis politikis da swori praqtikis arseboba

mniSvnelovan gavlenas axdens efeqturi ZuZuTi kvebis ganxorcielebaze. 4 dawesebulebaSi saWiro praqtikuli cvlilebebis warmatebiT

gasaxorcieleblad, garda saTanado politikisa, aucilebelia samedicino

personalis mier am politikis aRiarebisa da gaTavisebis uzrunvelyofa. 5

7

ZuZuTi kvebis politika unda moicavdes warmatebuli ZuZuTi kvebis 10

safexurs. politikaSi, Tundac erT-erTi safexuris ignorirebam SeiZleba

uaryofiTi gavlena iqonios sxva safexurebis danergvaze. 4 mniSvnelovania, dawesebulebaSi politikis farTod ganxilva da

personalis Sesabamisi momzadeba, praqtikuli cvlilebebis gatarebis

aucileblobis dasabuTebiT. 5

politikis arseboba aucilebelia imisTvis, rom: 1,2,3

• uzrunvelyofil iqnas Tanxmoba dawesebulebis administraciasa da

personals Soris ZuZuTi kvebis mxardamWeri praqtikis danergvisa

da gaumjobesebis sakiTxSi;

• farTod iyos gacnobili ZuZuTi kvebis principebi samedicino

personalisaTvis;

• ganisazRvros saWiro rekomendaciebi dawesebulebaSi ZuZuTi kvebis

praqtikis danergvis donis da Taviseburebebis Sesabamisad.

politika unda moicavdes Semdeg sakiTxebs:

• zogadi nawili, miznebi da amocanebi;

• arsebuli nacionaluri da saerTaSoriso politika, romelic

safuZvlad daedo samSobiaros politikas;

• ZuZuTi kvebis sixSiris Sesaxeb monacemebi nacionalur da

lokalur (samSobiaros) doneze;

• warmatebuli ZuZuTi kvebis 10 safexuri, rogorc minimaluri

rekomendaciebi;

• praqtikuli sakiTxebi da rekomendaciebi, romlebSic

gaTvaliswinebuli iqneba samSobiaroSi arsebuli situacia

TiToeuli safexuris moTxovnebis Sesabamisad.

!

imisaTvis, rom samSobiaro dawesebuleba gardaiqmnas @,,bavSvisadmi

keTilganwyobil saavadmyofod’’, masSi arsebuli praqtika unda

Seesatyvisebodes qalis rZis SemcvlelTa marketingis saerTaSoriso

kodeqsisa 32,56 da saqarTvelos kanonis `bavSvTa bunebrivi kvebis dacvisa

da xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb~ moTxovnebs.

kerZod, xelovnuri sakvebi ar unda miscen bavSvs samedicino Cvenebebis

gareSe; akrZalulia sawovrebis, satyuarebis gamoyeneba, xelovnuri kvebis

mxardamWeri informaciis gavrceleba, xelovnuri sakvebis nimuSebis

gadacema dedebisaTvis, ufaso an fasdaklebiT xelovnuri sakvebis,

sawovriani boTlebisa da satyuarebis momaragebis miReba xelovnuri

kvebis mwarmoebeli kompaniebisgan. dawesebulebis politika unda

moicavdes aRniSnul sakiTxebs, sxvagvarad SeiZleba sruliad uSedego

aRmoCndes ZuZuTi kvebis mxardamWeri RonisZiebebis gatarebis procesi.

politikis SemuSavebis koordinacia SeiZleba daevalos konkretul

pirovnebas an mcirericxovani Semadgenlobis komitets, romelsac niSnavs

dawesebulebis xelmZRvaneloba. politikis proeqti SeiZleba SemuSavdes

8

erTi TanamSromlis an winaswar SerCeul TanamSromelTa mcirericxovani

jgufis mier. Semdeg unda moxdes proeqtis gavrceleba TanamSromelebs

Soris sanam yvela ar gaecnoba mas da ar moxdeba sruli SeTanxmeba.

ufrosma samedicino personalma da administraciam unda uzrunvelyos

politikis danergva mudmivi monitorirebisa da saWiroebis SemTxvevaSi,

saTanado administraciuli RonisZiebebis gatarebis gziT.

rekomendaciebi: 1,2,3,4,5

• samSobiaro dawesebulebas unda qondes SemuSavebuli ZuZuTi

kvebis politika (mtkicebulebis done II);

• politika unda arsebobdes werilobiTi saxiT da mas unda

icnobdes dawesebulebis samedicino personali (mtkicebulebis

done II);

• politika unda moicavdes warmatebuli ZuZuTi kvebis 10 safexurs

da maTi danergvisTvis saWiro rekomendaciebs. (mtkicebulebis

done II);

• politikaSi gaTvaliswinebuli unda iyos qalis rZis SemcvlelTa

saeraSoriso kodeqsis da saqarTvelos kanonis `bunebrivi kvebis dacvis

da xelovnuri sakvebis kontrolirebadi moxmarebis~ moTxovnebi.

safexuri II

samedicino personals gavlili unda qondes ZuZuTi kvebis saswavlo

seminari, rac aucilebelia politikis danergvisaTvis.

ZuZuTi kvebis politikis danergvisTvis aucilebelia samedicino

personalis saTanado momzadeba/swavleba, radgan samedicino

personalis damokidebuleba da codnis done ZuZuTi kvebis

sakiTxebze mniSvnelovan gavlenas axdens ZuZuTi kvebis

xangZlivobaze (mtkicebulebis done II). 6 saganmanaTleblo procesis efeqturobisTvis igi unda iyos savaldebulo

yvela TanamSromlisTvis da masze valdebuleba unda aiRos

dawesebulebis xelmZRvanelobam. 7,8,9

samedicino personalis mier dedebisaTvis araTanmimdevruli

informaciis miwodeba xSirad iwvevs dedis dabneulobas da

SeiZleba ZuZuTi kvebis adreuli Sewyvetis mizezi aRmoCndes.

(mtikicebulebis done II). 10

samSobiaro saxlis yvela TanamSromels unda qondes miRebuli Sesabamisi

instruqcia dawesebulebaSi arsebuli politikis Sesaxeb. personalis

momzadeba ZuZuTi kvebis sakiTxebze unda ganxorcieldes minimum 18

saaTiani saswavlo programiT, romelic unda moicavdes 3 saaTian

klinikur swavlebas (WHO / UNICF 1992). Tumca ufro xangrZlivi swavleba

ufro efeqtria myari Sedegebis miRwevis TavlsazrisiT. 11 miuxedavad imisa, rom ZuZuTi kvebis Sesaxeb swavlebis mniSvneloba

farTod aRiarebuli faqtia, mxolod bolo periodSi daiwyo misi

II

II

II

II

II

9

efeqturobis gamokvleva. arsebobs monacemebi, rom eqskluziur ZuZuTi

kvebas warmatebiT axorcieleben is dedebi, romlebmac imSobiares iseT

samSobiaro saxlebSi sadac samedicino personals gavlili qonda ZuZuTi

kvebis saswavlo seminari.12 klasteruli kvlevebiT gamovlinda, rom

baksisi titulis mflobel samSobiaro saxlebSi dabadebuli bavSvebis

umetesoba 12 Tvis asakSi agrZelebs ZuZuTi kvebas, maRalia eqskluziuri

ZuZuTi kvebis sixSire da dabalia kuWnawlavis infeqciebis sixSire 13,14,15,16. dadgenilia, rom samedicino personalis swavleba aumjobesebs

maT damokidebulebas ZuZuTi kvebisadmi 17, xels uwyobs ZuZuTi kvebis

droulad dawyebas da mis gaxangZlivebas,18 agreTve, konsultirebisaTvis

saWiro unar-Cvevebis Camoyalibebas da eqskluziuri ZuZuTi kvebis

sixSiris zrdas. 19

rekomendaciebi:

• rekomendebulia samSobiaro dawesebulebis samedicino

personalisaTvis 18 saaTiani (3 dRiani) saswavlo kursis

Catareba, rogorc opetimaluri xangZlivobis swavleba

(mtkicebulebis done II); 11,

• samedicino personalis swavleba unda iyos savaldebulo da

Serwymuli mkacr specifikur politikasTan (mtkicebulebis

done II); 7,8,9

• ZuZuTi kvebis 10 safexuris danergvisTvis aucilebelia

samedicino personalis gadamzadeba 18 saaTiani saswavlo

kursiT (SesaZlebelia swavleba ganxorcieldes ZuZuTi kvebis

40 saaTiani saswavlo programiT (5 dRe) WHO/UNICEF)

safexuri III

yvela orsuli qali informirebuli unda iyos ZuZuTi kvebis

sargeblianobisa da marTvis principebis Sesaxeb.

qalTa konsultaciebSi samedicino personalma unda ganaxorcielos

orsuli qalebis momzadeba da maTi motivireba ZuZuTi kvebisadmi.

antenataluri saubrebi unda moicavdes ZuZuTi kvebis sargeblianobis da

ZuZuTi kvebis marTvis bazisur principebs; aseve orsulma qalebma unda

miiRon ganaTleba iseT sakiTxebze rogoricaa ZuZuTi kvebis adreuli

dawyeba, kani-kanTan kontaqti, deda bavSvis erTad yofna, moTxovnilebiTi

kveba, Tu rogor SeinarCunon rZis sakmarisi raodenoba. aucilebelia

orsulis informireba sxvadasxva poziciisa da ZuZuze swori moWidebis

niSnebis Sesaxeb (WHO/ UNINICEF 1992). ikrZaleba dedebisTvis informaciis

miwodeba qalis rZis Semcvlelebis Sesaxeb, rac saerTaSoriso kodeqsis

da saqarTvelos kanonmdeblobis darRvevad iTvleba. 32

orsul qals unda Cautaredes srulfasovani konsultacia bavSvis

kvebis sakiTxebze, raTa man SeZlos miRebuli informaciis

safuZvelze swori arCevnis gakeTeba (e.w. informirebuli Tanxmoba).

imisaTvis, rom gavlena movaxdinoT dedis gadawyvetilebaze da

II

II

10

arCevani gakeTdes ZuZuTi kvebis sasargeblod, umjobesia

konsultirebasTan erTad vizualuri (nabeWdi/video) masalis

gamoyeneba (mtkicebulebis done - I) 6,21. mniSvnelovania momavali

dedis fsiqologiuri mxardaWera, misi darwmuneba ZuZuTi kvebis

sargeblianobaSi xelovnur kvebasTan SedarebiT, rogorc bavSvis ise

dedis janmrTelobisTvis.20. mniSvnelovania aseve ojaxis wevrebis

CarTva konsultirebis procesSi, maTi mxardaWeris mosapoveblad,

eqskluziuri ZuZuTi kvebis xangZlivoba mniSvnelovnad aris

damokidebuli bavSvis mamis da ojaxis sxva wevrebis xelSewyobaze.

(mtkicebulebis done - II). 21

antenatalur periodSi dedebis rwmenis ganmtkiceba da ganaTleba

samedicino personalis mier, pirdapir korelaciaSia ZuZuTi kvebis

saxSiris zrdasTan (mtkicebulebis done II), 22, 23 . am dros mcirdeba ZuZuTi kvebis Sewyvetis riski (mtkicebulebis done I, II). 24

orsulebis araTanmimdevrulma da araadekvaturma informirebam

SeiZleba negatiurad imoqmedos ZuZuTi kvebaze (mtkicebulebis done

I) 25. dedebi, romlebic eswrebian ZuZuTi kvebis saswavlo seminarebs

orsulobis periodSi ufro xangrZlivad kvebaven bavSvebs ZuZuTi da

warmatebiT axorcieleben eqskluziur ZuZuTi kvebas 6 Tvemde 25.

dedebis momzadeba, gansakuTrebiT jgufuri swavleba orsulobis

periodSi wrmoadgens ZuZuTi kvebis mxardaWeris mniSvnelovan

komponents, gansakuTrebiT im qalebisaTvis, romlebsac ar qondaT

ZuZuTi kvebis gamocdileba. swavlebis procesi unda Seesabamebodes

konkretuli pirovnebisa da jgufis Taviseburebebs 21, 22, 23.

antenatalur periodSi ZuZuTi kvebis 10 safexuris Sesaxeb jgufuri

interaqtiuli swavlebis SemTxvevaSi izrdeba ZuZuTi kvebis adreuli

dawyebis sixSire da ZuZuTi kvebis xangrZlivoba 27,28,29,30. orsulebis

momzadeba ZuZuTi kvebis problemebis da ZuZuze swori moWidebis niSnebis

Sesaxeb zrdis ZuZuTi kvebis sixSires postnatalur periodSi da

amcirebs dvrilebis dazianebis risks. 31

sarZeve jirkvlebis Sefasebas dvrilebis mdgomareobis dadgenis mizniT

antenatalur periodSi ar eniWeba gansakuTrebuli mniSvneloba.

dadgenilia, rom dvrilebis wovadobis gasaumjobeseblad sxvadasxva

varjiSebis gamoyeneba ar aisaxeba dvrilebis mdgomareobaze, piriqiT,

sarZeve jirkvlebis rutinulma gaRizianebam SeiZleba gamoiwvios dedis

TviTrwmenis daqveiTeba da uaryofiTad aisaxos ZuZuTi kvebis procesze 20,21. dvrilis anatomiuri mdgomareoba umjobesdeba mSobiarobis

moaxloebasTan erTad da axalSobilis ZuZuze swor moWidebaSi

daxmareba ufro efeqturia, vidre antenataluri Careva.

rekomendaciebi:

• aucilebelia dedebis antenataluri swavleba ZuZuTi kvebis

sakiTxebze. igi mniSvnelovan gavlenas axdens ZuZuTi kvebis

inicirebaze da xangrZlivobaze;

I

I/II

I

II

II

11

• antenataluri swavleba unda moicavdes ZuZuTi kvebis da baksis

ZiriTad principebs, emsaxurebodes dedis rwmenis ganmtkicebas da

motivirebas ZuZuTi kvebisadmi; 22, 23

• antenataluri swavlebis procesSi saWiroa dedebisaTvis

keTilganwyobili garemos Seqmna da maTi ojaxis wevrebis mxriv

saTanado mxardaWeris mopoveba; 21

• akrZalulia orsuli qalebisTvis informaciis miwodeba qalis rZis

Semcvlelebis Sesaxeb; 32,56

• ar aris mizanSewonili dvrilebis rutinuli gasinjva da momzadeba

Tundac brtyeli dvrilebis arsebobis dros. 20,21.

IV safexuri

daxmareba gaewios dedebs ZuZuTi kvebis dawyebaSi mSobiarobidan 1

saaTis ganmavlobaSi.

fiziologiuri mSobiarobidan pirveli erTi saaTis ganmavlobaSi

axalSobilma unda daiwyos ZuZuTi kveba. ZuZuTi kvebis adreuli dawyebis

pirvel etaps kani-kanTan kontaqti warmoadgens (ix. ZuZuTi kvebis

gaidlaini), romelic mSobiarobidan pirveli erTi saaTis ganmavlobaSi

unda ganxorcieldes da gagrZeldes ara nakleb 30 wuTisa (WHO/UNICEF).

kani-kanTan kontaqtis procesSi aucilebelia dedisa da axalSobilis

xelSewyoba ZuZuze pirveli moWidebis gansaxorcieleblad, Tumca

samedicino personalma unda gaiTvaliswinos, rom pirveli moWedeba unda

moxdes Zaldatanebis gareSe, axalSobilis mzaobis gaTvaliswinebiT da

mxolod saTanado daxmarebis gawevis gziT. 33

dedebisaTvis profesiuli daxmareba mniSvnleovania efeqturi ZuZuTi

kvebis adreuli dawyebisa da xangrZlivobis gazrdis TvalsazrisiT. 34.

dadgenilia, rom kani-kanTan kontaqtis adreul ganxorcielebas da

ZuZuTi kvebis dawyebas mSobiarobidan 1 saaTis ganmavlobaSi

mravalmxrivi mniSvneloba aqvs (ix. ZuZuTi kvebis gaidlaini).

sakeisro kveTis SemTxvevaSi (zogadi narkoziT) kani-kanTan kontaqti da

ZuZuTi kveba SeiZleba ganxorcieldes mogvianebiT dedis narkozidan

sruli gamosvlis Semdeg.35 kohortuli kvleviTa da sistemuri

mimoxilviT gamovlinda, rom kani-kanTan kontaqtis da ZuZuTi kvebis

erTdroulad ganxorcieleba metad efeqturia ZuZuTi kvebis

gaxangrZlivebis TvalsazrisiT. 36

12

rekomendaciebi 1,2,3,10

• kani-kanTan kontaqti unda ganxorcieldes fiziologiuri

mSobiarobidan naxevar½ saaTSi da gagrZeldes aranakleb 30

wuTisa. (rekomendacia - D);

• kani-kanTan kontaqtis procesSi aucilebelia axalSobilis ZuZuze

pirveli moWidebis xelSewyoba, roca bavSvs gamouvlindeba ZuZuTi

kvebis Sesabamisi mzaobis niSnebi;

• ar aris rekomendebuli bavSvis iZulebiT an daCqarebuli wesiT

ZuZuze moWidebis ganxorcieleba;

• ZuZuTi kveba unda dawyos fiziologiuri mSobiarobidan 1 saaTis

ganmavlobaSi;

• zogadi narkoziT sakeisro kveTis Semdeg kani-kanTan kontaqti da

ZuZuTi kveba unda ganxorcieldes dedisa da bavSvis sruli

gamofxizlebis Semdeg (daaxloebiT 2-3 saaTSi).

V safexuri

dedebis ganaTleba (Teoriuli/praqtikuli) ZuZuTi kvebisa da laqtaciis

SenarCunebis principebze im SemTxvevebis gaTvaliswinebiT, roca deda da

bavSvi dacilebulia erTmaneTisgan

deda-bavSvis palataSi gadayvanis Semdeg samedicino personalma 6 saaTis

ganmavlobaSi dedas unda gauwios daxmareba ZuZuTi kvebis

ganxorcielebaSi: aswavlos da aCvenos dedas swori poziciebis SerCeva,

bavSvis ZuZuze swori moWideba (ix. ZuZuTi kvebis gaidlaini), rZis

gamowvelis teqnika.1,2,3 samedicino personalma dedas unda miawodos

informacia moTxovnilebiTi da eqskluziuri ZuZuTi kvebis, ZuZuTi kvebis

SesaZlo problemebisa da maTi prevenciis Sesaxeb (ix. ZuZuTi kvebis

gaidlaini), agreTve, rogor kvebos bavSvi sxvadasxva nevrologiuri

gadaxrebis an Tandayolili paTologiebis dros mag: kurdRlis tuCi,

mglis xaxa.

aucilebelia, samedicino persanalma xeli Seuwyos dedas Camouyalibdes

rwena imisa, rom mas Seswevs unari sworad moaWidos bavSvi ZuZus da

ganaxorcielos ZuZuTi kveba. dedas unda aswavlon sworad amoicnos

bavSvis qceva, SimSilis niSnebi da maTze adeqvaturi reagireba. 33,34,35

mSobiarobis Semdeg dedebisTvis daxmarebis gaweva, gansakuTrebuli

keTilganwyobili damokidebuleba da saTanado mxardaWera dadebiTad

aisaxeba mis TviTrwmenaze da aqedan gamomdinare, ZuZuTi kvebis

xangrZlivobaze. aseT dedebs iSviaTad aqvs ZuZuTi kvebis problemebi. 1,2

samedicino personalis mier araswori da araTanmimdevruli

rCevebis micema, ZuZuTi kvebis swori marTvis erT-erTi

mniSvnelovani xelSemSleli faqtoria34,35 (mtkicebulebis done II).

ZuZuTi kvebis sixSire da xangrZlivoba metia, Tu samSobiaro saxlSi

dedebs aswavlian ZuZuze bavSvis sworad moWidebas da piriqiT, xSiria

ZuZuTi kvebis problemebi, roca dedebs ar eZlevaT saTanado

konsultacia da ar utardebaT saWiro koreqcia.8 ZuZuTi kvebis

II

D

13

warmatebiT ganxorcielebis SemTxvevebis sixSire izrdeba, roca ZuZuTi

kvebis teqnikis swavleba Serwymulia samSobiaroSi deda-bavSvis erTad

yofnis praqtikasTan.

Tu samedicino CvenebiT deda da bavSvi dacilebulia erTmaneTs, an

bavSvs aReniSneba Tandayolili tuCis, sasis defeqti, hipertonuli an

hipotonuri piris Rru, dedas unda aswavlon/aCvenon, rogor kvebos

bavSvi. Aucileblobis SemTxvevaSi rogor da ra sixSiriT gamoiwvelos

rZe, rom SeinarCunos laqtacia. rogor kvebos bavSvi finjnidan, kovziT,

sawveTuriT an SpriciT (ix. danarTi). 58

laqtaciis gasazrdelad mniSvneloba aqvs ZuZuTi kvebis swori

teqnikis codnas da rZis gamowvelas. rZis xSiri gamowvela

asocirdeba rZis produqciis gazrdasTan40 (mtkicebulebis done II).

dadgenilia maT Soris pirdapiri korelaciuri kavSiri. rZis

produqciis SesanarCuneblad aucilebelia rZis gamowvela 24 saaTSi

minimum 6-jer (SeiZleba 8-12-jer dReSi), gansakuTrebiT mSobiarobidan

pirveli kviris ganmavlobaSi41. Tu deda da bavSvi dacilebulia

erTmaneTs mniSvnelovania, rZis gamowvela daiwyos rac SeiZleba male

mSobiarobidan.

rekomendaciebi:

• samedicino personalis mier dedas unda gaewios daxmareba ZuZuTi

kvebis swori poziciebis SerCevaSi da ZuZuze swori moWidebis

ganxorcielebaSi;

• dedas unda aswavlon bavSvis kvebasTan dakavSirebuli qcevis da

SimSilis niSnebis amocnoba da maTze adeqvaturi reagireba;

• dedas unda ganemartos moTxovnilebiTi da eqskluziuri ZuZuTi

kvebis arsi da mniSvneloba;

• yvela dedas unda aswavlon rogor SeinarCunos laqtacia, rogor

gamoiwvelos rZe xeliT da rogor kvebos bavSvi finjnidan, kovziT,

sawveTuriT an SpriciT;

• yvela dedam unda icodes xeliT rZis gamowvelis teqnika. maT unda

miewodos werilobiTi informacia rZis gamowvelis teqnikis

detaluri aRweriT;

• rZis gamowvela laqtaciis SenarCunebis da gazrdis mizniT

mizanSewonilia minimum 6-jer dReSi (SeiZleba 8-12-jer)

gansakuTrebiT pirveli kviris ganmavlobaSi.

II

14

VI safexuri

bavSvs qalis rZisa da samedicino CvenebiT daniSnuli medikamentebis

garda ar mieces aranairi sakvebi an siTxe.

axalSobilebs ar unda mieces qalis rZis garda sxva sakvebi an siTxe,

vinaidan qalis rZe sruliad akmayofilebs axalSobilis organizmis

moTxovnilebas kvebiT ingredientebze da siTxeze. ZuZuTi kvebis dros

sxva siTxis an sakvebis damateba amcirebs ZuZuTi kvebis xangrZlivobas

da sixSires, gansakuTrebiT sicocxis pirvel kviraSi,10,42 iwvevs rZis

gamomuSavebis Semcirebas, sarZeve jirkvlis gajirjvebas da ZuZuTi

kvebis adreul Sewyvetas.43 Tu sxva sakvebis an siTxis micema xdeba

boTlidan es gansakuTrebiT uaryofiTad aisaxeba ZuZus wovis procesze,

kerZod, bavSvi veRar axerxebs ZuZuze swori moWidebis ganxorcielebas

da rZis saTanado raodebiT gamowvelas sarZeve jirkvlidan. amave dros

boTlidan kveba zrdis bavSvis dainficirebis risks _ mag. diarea,

meningiti, neonataluri sefsisi.44 im SemTxvevebSi, roca arsebobs ZuZuTi

kvebis dros sxva sakvebis, siTxis damatebis an xelovnur kvebaze

gadayvanis samedicino Cveneba, aRniSnuli faqti unda iyos dafiqsirebuli

axalSobilis istoriaSi da argumentirebulad dasabuTebuli. aseT

SemTxvevebSi bavSvis kvebisTvis umjobesia gamoyenebul iqnes ara boTli,

aramed alternatiuli saSualebebi (finjani, kovzi, sawveTuri, Sprici,

zondi).

rekomendaciebi:

axalSobils ar unda mieces sxva sakvebi an siTxe garda qalis

rZisa. (rekomendacia B);6

ZuZuTi kvebis dros damatebiTi sakvebis micema unda moxdes

mxolod mkacri samedicino Cvenebebis arsebobisas da dafiqsirdes

axalSobilis istoriaSi.

VII safexuri

deda-bavSvis erTad yofnis praqtika _ deda-bavSvs mieces SesaZlebloba

iyvnen erTad 24 saaTis ganmavlobaSi.

samSobiaro saxlSi deda da axalSobili, maT Soris sakeisro kveTis

SemTxvevaSic, unda imyofebodes erT palataSi rogorc dRisiT, ise

RamiT, garda im periodisa (daaxloebiT 1-2 saaTi), romelic saWiroa

sxvadasxva higienuri, Tu samedicino procedurebis Casatareblad.

deda-bavSvis erTad yofna saSualebas aZlevs dedas kvebos bavSvi roca

igi amJRavnebs SimSilis niSnebs, misi moTxovnilebis Sesabamisad (ix.

ZuZuTi kvebis gaidlaini).

dadgenilia, rom dedisa da bavSvis erTad yofna xels uwyobs

dedisa da bavSvs Soris mWidro fsiqo-emociuri kavSiris

damyarebas, dedobrivi grZnobis Camoyalibebas, dadebiTad aisaxeba

dedis damokidebulebaze ZuZuTi kvebisadmi, (mtkicebulebis done

II)45 aumjobesebs ZuZuTi kvebis process, aseve xels uwyobs ZuZuTi

II

15

kvebis xangrZlivobis gazrdas8 da ZuZuTi kvebis efeqtur

ganxorcielebas (mtkicebulebis done II), 46 zrdis ZuZuTi kvebis

sixSires da amcirebs qalis rZis Semcvlelebis damatebis

saWiroebas47. am dros SeiZleba mxolod umnSivnelod dairRves

dedis Zili, magram umjobesdeba bavSvis Zili, bavSvebi ufro

mSvidad arian da naklebad tirian (mtkicebulebis done II).47

dedisa da bavSvis erTad yofna warmoadgens aucilebel pirobas

moTxovnilebiT ZuZuTi kvebis warmatebiT ganxorcilebisTvis

(mtkicebulebis done I). 1,2

rekomendaciebi:

• samSobiaro saxlSi aucilebelia deda-bavSvis erTad yofnis

praqtikis damkvidreba. deda da bavSvi unda imyofebodes erT

palataSi rogorc dRisiT, ise RamiT;

• bavSvebis gayvana palatidan dasaSvebia mxolod aucilebeli

procedurebis Casatareblad (daaxloebiT 1 saaTi dRe-Ramis

ganmavlobaSi).

VIII safexuri

moTxovnilebiT ZuZuTi kvebis xelSewyoba

dedas unda urCion kvebos bavSvi maSin, roca is gamoxatavs SimSilis

niSnebs, misi moTxovnilebis Sesabamisad, rogorc dRisiT, ise RamiT.

Tu kvebaTa Soris xangrZlivoba aRemateba 3 saaTs an deda igrZnobs

sarZeve jirkvlebis gadavsebas bavSvi unda gaaRviZos da SesTavazos

ZuZu (rekomendacia D)1,2.

moTxovnilebiTi ZuZuTi kvebis dros, yvela bavSvis kvebis sixSire da

xangrZlivoba gansxvavebulia da dRiTidRe icvleba, Tumca Cveulebriv

igi ar aWarbebs 8-12 kvebas dRe-RameSi. moTxovnilebiTi kvebis

ganxorcieleba SesaZlebelia deda-bavSvis erTad yofnis pirobebSi,

rac dedas aZlevs drouli reagirebis SesaZleblobas, roca bavSvi

gamoxatavs kvebisadmi mzadyofnas (mtkicebulebis done I, II).

moTxovnilebiTi kvebis dros bavSvebi warmatebiT axorcieleben

eqskluziur ZuZuTi kvebas, naklebia ZuZuTi kvebis problemebi.

moTxovnilebiTi kveba asocirdeba ZuZuTi kvebis gaxangrZlivebasTan 48

bavSvis moTxovnilebiT, SeuzRudavi kveba ar SeiZleba iyos dvrilebis

dazianebis gamomwvevi mizezi. dadgenilia, rom dvrilebis dazianebas

iwvevs bavSvis ZuZuze araswori moWideba da ara xangrZlivi kveba

(mtkicebulebis done I, II);40 moTxovnilebiT xSiri ZuZuTi kveba

mSobiarobis pirveli dRidan korelirdeba hiperbilirubinemiis

SemcirebasTan, aseve rZis produqciis gaZlierebasTan49 (ix.

`axalSobilTa hiperbilirubinemia~ da `2 wlamde bavSvis kveba~)

II

I

D

I,II

I,II

16

rekomendacia:

• ZuZuTi kveba unda ganxorcieldes bavSvis moTxovnilebis mixedviT;

• moTxovnilebiTi ZuZuTi kveba unda ganxorcieldes rogorc dRisiT,

ise RamiT;

• Tu kvebaTa Soris intervali aWarbebs 3 saaTs, dedam unda

gaaRviZos bavSvi da SesTavazos ZuZu;

• dauSvebelia ZuZuTi kveba saaTobrivi reJimiT.

IX safexuri

ZuZuTi kvebaze myof axalSobilebs ar mieces sawovara an satyuara.

samSobiaro dawesebulebebSi bavSvis kvebisaTvis ar unda iqnes

gamoyenebuli sawovriani boTlebi, axalSobils ar unda miscen

satyuara.32,56 dadgenilia, rom arsebobs meqanikuri da dinamikuri

sxvaoba ZuZus wovisa da sawovridan wovis meqanizmebs Soris da

sawovaras gamoyeneba (mtkicebulebis done II)50 xels uSlis bavSvis

saxis kunTebis normalur ganviTarebas, Sesabamisad ZuZuze swori

moWidebis ganxorcielebas (ix. ZuZuTi kvebis gaidlaini). bavSvebis

umravlesobas, romlebsac samSobiaroSi kvebaven boTlidan, Tundac

epizodurad, samSobiarodan gaweris Semdeg aReniSnebaT ZuZuTi kvebis

problemebi. sawovaras gamoyeneba zrdis otitis ganviTarebis risks.

(rekomendacia – A ) 50

im SemTxvevaSi, Tu ZuZuTi kveba droebiT Seferxebulia, samSobiaro

saxlSi bavSvis kvebis optimalur meTodad miCneulia alternatiuli

saSualebebis gamoyeneba (finjani, kovzi, sawveTuri, Sprici, zondi),

miTumetes Tu ZuZuTi kvebis gagrZelebaze gadawyvetileba miRebulia.51

finjnidan kvebas esaWiroeba saTanado unar-Cvevebi da amis Sesaxeb deda

unda iyos informirebuli.

Cveulebriv, satyuarebs iyeneben bavSvis dasamSvideblad. Sesabamisad,

bavSvebi, romlebic satyuarebs woven, SedarebiT naklebi sixSiriT

iTxoven ZuZus. iSviaTi kveba amcirebs sarZeve jirkvlis stimulirebas 52 da xels uwyobs bavSvs Tavi daanebos ZuZuTi kvebas. ZuZuTi kvebis

problemebis sixSire ufro maRalia im dedebSi, romlebic iyeneben

satyuaras. 52,53

sawovrebisa da satyuarebis gamoyeneba bavSvis janmrTelobaze uaryofiT

gavlenas axdens. adreul asakSi es SeiZleba gamoxatos sunTqvis

darRveviT, mogvianebiT ki Tankbilvis darRveviT, damoukideblad imisa

sawovriani boTlidan bavSvs xelovnur sakvebs aZleven Tu gamowvelil

rZes. 20

II

A

17

rekomendaciebi:

• ar aris rekomendebuli bavSvTa kvebisTvis sawovrebisa da

satyuarebis gamoyeneba;50

saWiroebis SemTxvevaSi gamoyenebuli unda iqnes kvebis alternatiuli

meTodebi (finjani, kovzi, sawveTuri).51

• samedicino personali unda flobdes saTanado unar-Cvevebs

alternatiuli kvebis gansaxorcieleblad da dedebisTvis daxamarebis

gasawevad;

• sawovrebi da satyuarebi ar unda arsebobdes samSobiaro

dawesebulabaSi;

• sawovrebis gamoyeneba minimumamde unda iyos dayvanili, maTi

gamoyeneba dasaSvebia, mxolod xelovnuri kvebis dros.

safexuri X

ZuZuTi kvebis mxardamWeri jgufebis Camoyalibebis xelSewyoba da

samSobiarodan gaweris Semdeg dedebis maTTan gagzavna

samedicino personali informirebuli unda iyos dedebis mxardamWeri

jgufebis arsebobis Taobaze (Tu aseTi arsebobs) an personalma unda

icodes alternatiuli damxmare sistemis arsebobis Sesaxeb (pjd), sadac

unda gagzavnon dedebi samSobiarodan gaweris Semdeg (msoflio

jandacvis organizacia da gaeros bavSvTa fondis mier mowodebuli

baksis globaluri kriteriumebi 1992).

samSobiarodan gaweris Semdeg, arc ise iSviaTad mcirdeba ZuZuTi kvebis

sixSire, gansakuTrebiT eqskluziuri ZuZuTi kvebis maCvenebeli. amis

ZiriTadi mizezebi, romlebsac asaxeleben dedebi, aris ZuZuTi kvebis

problemebi, pirvel rigSi `rZis nakleboba”. aseT SemTxvevebSi ZiriTad

mizezs warmoadgens dedisTvis saTanado mxardaWeris ararseboba.

ZuZuTi kvebis efeqturad gagrZelebas sWirdeba momdevno

mxardaWera da Sefaseba (mtkicebulebis done III) 54 gamocdili da

saTanado unar-Cvevebis mqone personalis mier, rac zrdis ZuZuTi

kvebis xangrZlivobas da eqskluziuri ZuZuTi kvebis sixSires

(mtkicebulebis done I, II). 54

ZuZuTi kvebis sixSire izrdeba im SemTxvevaSi, roca dedebs

utardebaT damatebiTi konsultaciebi. samSobiarodan gaweris

Semdeg dedebisTvis daxmarebis gaweva, individualuri

konsultaciebis Catareba da binaze vizitebi dadebiTad aisaxeba

ZuZuTi kvebis, kerZod eqskluziuri ZuZuTi kvebis sixSireze. 6,21,55

samSobiarodan gaweris Semdeg dedebis mudmivi mxardaWera SeiZleba

sxvadasxva gziT ganxorcieldes. tradiciulad amas akeTeben qalis

garemocvaSi myofi axloblebi, Tumca aseTi praqtika yovelTvis ar aris

optimaluri. zogierT qveynebSi arsebobs deda-dedis mxardamWeri

III

I, II

18

jgufebi, romlebic ZiriTad rols axruleben ZuZuTi kvebis xelSewyobis

saqmeSi.

amrigad, es safexuri gulisxmobs mxardaWeris yvela formas, romelic

SeiZleba iyos xelmisawvdomi.

rekomendaciebi

• mizanSewonilia ZuZuTi kvebis mxardaWeris sxvadasxva formebis

gamoyeneba ZuZuTi kvebis SenarCunebisa da gaxangrZlivebisaTvis da

SesaZlo problemebis Tavidan asacileblad;

• samSobiarodan gawerisas yvela dedas unda miewodos informacia

arsebuli mxardamWeri jgufebis Sesaxeb, maT Soris realurad

arsebuli specilizirebuli daxmarebis samedicino sistemis Taobaze,

rogoricaa jandacvis pirveladi rgoli.

19

mtkicebulebezze dafuZnebuli ZiriTadi Semajebeli

rekomandiciebi

rekomendacia ganxorcielebis gza Mmtkicebu

lebis

done

Bbaksis principebis

danergva

ZuZuTi kvebis politikis SemuSaveba

/gadaxedva. personalis momzadeba.

negatiuri garemos Secvala, ZuZuTi

kvebis mxardamWeri garemos

Camoyalibeba, orsulTa informireba

I

orsulTa ganaTleba

baksis principebze

antenatalur pereiodSi

antenataluri zrunvis

saxelmZRvanelos/gegmis SemuSaveba.

orsulTa ganaTlebis

xelmisawvdomobis uzrunvelyofa

II

antenatalur periodSi

orsulTaA mcire jgufebis

ganaTleba

samedicino personalis treiningi,

saTanado masalebis momzadeba,

orsulTa ganaTleba

II

dedebisTvis daxmarebis

gaweva, mSobiarobidan 1

saaTis ganmavlobaSi

politikis gadaxedva, rutinuli

araswori midgomebis Secvla

II

samedicino personali

unda flobdes saTanado

unarCvevebs ZuZuTi kvebis

adreuli dawyebis

gansaxorcieleblad

personalis treningi ZuZuTi kvebis

principebis, ZuZuze sworad

moWidebis, rZis gamowvelis

meTodebis Sesaxeb

I

xelovnueri sakvebi

formulis da glukozis

damatebis aRmofxvra

(garda samedicino

Cvenebebisa)

politikis gadaxedva, araswori

praqtikis Secvla, dedebis

informireba

II

deda bavSvis erTad

yofnis praktika (24 saaTi

erT palataSi)

politikis gadaxedva, saTanado

garemos Camoyalibeba, dedebis

informireba

III

moTxovnilebiTi ZuZuTi

kveba

politikis gadaxedva, saTanado

garemos Camoyalibeba, dedebis

informireba

I

dauSvebelia ZuZuTi

kvebaze myof bavSvebTan

sawovrebisa da

satyuarebis gamoyeneba

politikis gadaxedva, saTanado

garemos Camoyalibeba, dedebis

informireba

II

qalis rZis SemcvlelTa

marketingis saerTaSoriso

kodeqsis da Sesabamisi

saqarTvelos kanonis

,,ZuZuTi kvebis dacvisa da

xelovnuri sakvebis

kontrilirebadi

moxmarebis sesaxeb”

werilobiTi politikis SemuSaveba,

sazogadoebis informeriba

II

20

4. gaidlainis miRebis xerxi/wyaro

gaidlainis SemuSavebis meTodologia

• adreuli neonataluri periodis axalSobilTa bunebrivi kvebisa da

bavSvisadmi keTilganwyobili saavadmyofis iniciativis Sesaxeb

arsebobs samecniero mtkicebulebis safuZvelze Seqmnil

rekomendaciaTa sakmarisi raodenoba. mocemuli gaidlainis Seqmnis

procesSi samuSao jgufis gadawyvetilebiT moZiebuli da Sefasebuli

iqna ukve arsebuli praqtikuli rekomendaciebi. moxda arsebuli

rekomendaciebis adaptirebuli variantis SemuSaveba, romelic erTis

mxriv pasuxobs saerTaSoriso moTxovnebs, xolo meore mxriv

iTvaliswinebs saqarTvelos samedicino dawesebulebaTa rogorc

adamianur, ise teqnikur resursebs;

• rekomendaciaTa moZieba xorcieldeboda eleqtronuli monacemTa

bazis gamoyenebiT.

qveyana da resursis

dasaxeleba

internet-misamarTi

aSS

US National Guideline Clearinghouse (NGC)

http://www.guideline.gov

Centers for Disease Control and Prevention (CDC)

http://www.phppo.cdc.gov/CDCRecommends/AdvSearchV.asp

Agency for Healthcare Research and Quality (AHRQ)

http://www.ahrq.gov/clinic/cpgsix.htm

Health Services Technology Assessment Text (HSTAT) and National Library of Medicine (NLM)

http://hstat.nlm.nih.gov

Institute of Clinical Systems Improvement (ICSI)

http://www.icsi.org

American Medical Association http://www.ama-assn.org Canadian Medical Association (CMA)

http://mdm.ca/cpgsnew/cpgs/index.asp

Health Canada – Population and Public Health Branch (PPHB)

http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html

didi britaneTi

National Institute for Clinical Excellence (NICE)

http://www.nice.org.uk

Sheffield Evidence for Effectiveness and Knowledge (SEEK)

http://www.shef.ac.uk/seek/guidelines.htm

National electronic Library for Health (NeLH)

http://www.nelh.nhs.uk/guidelinesfinder

PRODIGY Clinical Guidance http://www.prodigy.nhs.uk/ClinicalGuidance Scottish Intercollegiate Guidelines Network (SIGN)

http://www.sign.ac.uk

German Guideline Information Service (GERGIS)

http://www.leitlinien.de/english/english/view;

avstralia

21

Australian National Health and Medical Research Council (NHMRC)

http://www.health.gov.au/hfs/nhmrc/publicat/cp-home.htm

axali zelandia New Zealand Guidelines Group (NZGG)

http://www.nzgg.org.nz/library.cfm

mtkicebiTi medicinis

specialistTa

regionTaSorisi

sazogadoeba

http://www.osdm.org

klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi

wyaroebi da meTodebi

• koxreinis biblioTeka - The Cochrane Library 2006, Issue 2,

• amerikis samedicino biblioTekis mier Seqmnil eleqtronul

bibliografiul monacemTa baza - medlaini – MEDLINE

publikaciebis CarTvis/gamoricxvis kriteriumebi

• arCeul iqna kvlevebi Semdegi dizainiT: randomizebuli,

kontrolirebadi, sistemuri mimoxilvebi da meta-analizi,

erTmomentiani, kohortuli kvlevebi;

• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 12

wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro

adreuli publikaciebi, romlebic dResac aqtualuria da

safuZvlad udevs sxva Tanamedrove mtkicebulebebs;

• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs

SesaZlebloba hqonda literaturis wyaroebi Seeswavla mxolod

inglisur da rusul enebze.

moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi

• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.

Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri

meToduri rekomendacia axalSobilTa axalSobilTa bunebrivi

kvebis marTvisa da bavSvisadmi keTilganwyobili saavadmyofos

iniciativis sakiTxebze, romlebic Seicavda jgufis miznis

Sesaferis saWiro informacias. am rekomendaciebis Sefasebisas

gamoyenebuli iyo rekomendaciaTa atestaciisa da eqspertizis

kiTxvari - AGREE (94,96-98). Sefasebis Sedegad amorCeuli iyo qvemoT

CamoTvlili organizaciebis gaidlainebi:

⇒ msoflo jandacvis organizacia

⇒ amerikis pediatrTa akademia

⇒ kanadis pediatrTa sazogadoeba

⇒ laqtaciis konsultantTa saerTaSoriso asocia (ILKA).

22

gaTvaliswinebuli iyo bavSvTa kvebis saerTaSoriso qselis (IBFAN), ZuZuTi kvebis msoflio aliansis (WABA), Baby Milk Action ZuZuTi kvebis

qselis masalebi.

samuSao jgufi xelmZRvanelobda saqarTvelos Sromis, janmrTelobisa da

socialuri dacvis saministros mier SemuSavebuli nacionaluri

gaidlainebis gzamkvleviT.

• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas

gamoyenebuli iyo saqarTvelos Sromis janmrTelobisa da

socialuri dacvis saministros mier mowodebuli mtkicebulebebis

donisa da rekomendaciebis xarisxis sqema.

mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema

done mtkicebulebis siZlieris

done (Muir Gray) xarisxi rekomendaciis xarisxi

(Cook et al)

I Zlieri mtkicebuleba,

eyrdnoba minimum erT

sistemur mimoxilvas,

romelic efuZneba swori

dizainis mqone

randomizebul

kontrolirebad kvleva

A eyrdnoba I donis

mtkicebulebas da

Sesabamisad mtkiced

rekomendebulia

II Zlieri mtkicebuleba,

eyrdnoba minimum erTi

swori dizainis mqone

randomizebul

kontrolirebad kvleva

B eyrdnoba II donis

mtkicebulebas da

Sesabamisad mtkiced

rekomendebulia

III klinikuri kvleva

randomizaciis gareSe,

kohortuli da SemTxveva-

kontrolis kvlevebi

C eyrdnoba III donis

mtkicebulebas SeiZleba

CaiTvalos Sesabamisad

IV araeqsperimentuli

multicentruli kvlevebi

D eyrdnoba IV da V donis

mtkicebulebas saWiroebs

konsesuss

Va avtoritetul

profesionalTa mosazreba

Vb klinikuri gamocdileba,

aRwerilobiTi kvlevebi an

eqspertTa angariSi

G

5. gaidlainis ganaxlebis vada - 4 weli

23

klinikuri rekomendaciebis piloturi gamocda

samedicino personali, romelic uSualod muSaobs axalSobilTan

(SaraSiZis samedicino centri, axalSobilTa reanimaciis da gadaudebeli

daxmarebis ganyofilebebi, samSobiaro saxli „bibida“, IBFAN

saqarTvelos jgufi arasamTavrobo organizacia „klaritas XXI“) gaecno

klinikur gaidlains. gaidlainis SemuSavebis procesSi gaTvaliswinebuli

iyo maTi SeniSvnebi da praqtikuli rekomendaciebi.

bunebrivi kvebis xelSewyobis programa saqarTvelos Sromis

janmrTelobisa da socialuri dacvis saministros mier aRiarebulia

saxelmwifo programad da saerTaSoriso organizaciebis xelSewyobiT

saqarTvelos - gaeros bavSvTa fondi „UNICEF“, „UMCOR“ WABA, IBFAN finansuri xelSewyobiT da arasamTavrobo organizacia ,,klaritas XXI’’

mier inergeba 1996 wlidan. mocemuli periodis ganmavlobaSi gaumjobesda

ZuZuTi kvebis maCveneblebi: samSobiarodan gamowerili axalSobilTa

saSualod 90% imyofeba ZuZuTi kvebaze saxelmwifo statistikis 2000-2005

wlis monacemebiT. dainerga eqskluziuri ZuZuTi kvebis praqtika, romlis

maCvenebelmac gaeros bavSvTa fondis da ACTS is mier Catarebuli

kvlevis SedegebiT Seadgina 36%. saqarTveloSi baksis principebi

danergilia 18 samSobiaro saxlSi. 1999 wels saqarTvelos parlamentis

mier damtkicda saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa da

xelSewyobis, xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb”.

6. alternatiuli gaidlani ar arsebobs

7. gamoyenebuli literatura

1. WHO Protection , promoton and support of Breastfeeding in Europe: review of interventions May 2004;

2. World Health Organization. Global strategy:breastfeeding critical for child survival—UNICEF and WHO call for increased commitment to appropriate feeding practices for all infants and young children. Indian J Med Sci 2004; 58(3):138-9;

3. World Health Organization. The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy duringbreast-feeding. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Fertil Steril 1999;72(3):431-40;

4. Reiff MI.Essock-Vitale SM Hospitale inlnce on early infant feeding practices. 1985. Pediatrics, 76:2-879;

5. Garforth S, Garcia JBraest Feeding policies in practice - ,,No wonder they get confuthsed’’ 1989,miwfery,5:75-83;

6. DiGirolamo AM, Grummer-Strawn LM, Fein SB.Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions? Birth 2003;30(2):94-100;

7. Winikoff B et al., Overcoming obstaclesto breast-feeding in a large municipal hospital: Appications of lessons learned. Paediatrics 1987; 80(3);423-433;

8. Strachan-Lindenberg C, Cabrera-Artola R, Jimenez V, The effect of early post-partum mother-infant contact and breastfeeding promotion on the incidence and continuation of breast-feeding, international journal of nursing studies, 1990, 27(3):179-186;

9. Iker Ce, Mogan J, Suplementation of breastfeed ifans: Does continuinig aducation for nurses make a difference? Journal of human lactation 1992, 8 (3):131-135;

24

10. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003;112(1 Pt 1):108-15;

11. Amstrong Hc Breastfeeding promotion: training of mid-level and outreach healh orers. International Journl of gynecology and obstetrics 1990, 31: 91-103;

12. Altobelli L, Baiocci-Ureata N. Larson E , A controlled trail to axrend the duration of axluzive breastfeeing among low income mothers in Lima, Peru. Final report. The Jonns Hopkins University, Cayetano Heredia University and the population Council 1991;

13. Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial (PROBIT): a clusterrandomized trial in the Republic of Belarus. Design, follow-up, and data validation. Adv Exp Med Biol 2000;478:327-45;

14. Kramer MS, Guo T, Platt RW, Sevkovskaya Z, Dzikovich I, Collet JP, et al. Infant growth and health outcomes associated with 3 compared with 6 month of exclusive breastfeeding. Am J Clin Nutr 2003;78(2):291-5;

15. Dulon M.Kersting M, breastfeeding protion in non – UNICEF-Certified hospitals and long-term breastfeeding success in Germany. Acta. Paediatric 2003; 92; 653-8;

16. Kersting M, Dulon M. Assesmnt o breastfeeding promotion in hospitals and follow-up survey of mother – infant pairs in Germany; the SuSe Stydy. Public Health Nutr.2002;5;547-52;

17. Westphal Mf et al, Breas-feeding for health professionals and resultantinstitutional changes. Bulleti o the world health Organizatio 1995; 73,4: 461-468;

18. Bradley Je, Meme J 1992.breastfeeding promotion in Kenya: changes in health worker knvlidges. Attitudesnd practices, 1982-1989. Jurmal of tropical pediatrics, 1992; 38: 228-234;

19. Haider R et al ,braetfeeding counseling in a diarrhoeal disease hospital. Bulletn of the Word health Organization 1996, 7,2 173-179;

20. Matchew OP, Bhatia J, Sucking a breathing paterns during breast and bottle-feeding in term neonats Amrikan journal of diseases of children, 1989,143;588-592;

21. International Laqtation consultant assotiation (ILCA).Clinikal Gudelines for the establishment of exkluzive breastfeeding June 2005 Mary L. Overfield;

22. Blomquist HK, Jonsbo F, Serenius F, Persson LA.Supplementary feeding in the maternity ward shortens the duration of breast feeding. Acta Paediatr 1994;83(11):1122-6;

23. Giugliani ER. [Common problems during lactation and their management]. J Pediatr (Rio J) 2004;80 (5 Suppl):S147-54;

24. Henderson A, Stamp G, Pincombe J. Postpartum positioning and attachment education for increasing breastfeeding: a randomized trial. Birth 2001; 28(4):236-42;

25. Hill PD, Humenick SS. The occurrence of breast engorgement. J Hum Lact 1994;10(2):79-86;

26. Long Dg at al peer counselor program increase breastfeedin rates inUtahnative Amirika WICpopulation. Journal of lactation, 11,4,279-284;

27. Fairbank L, O’ Meara S. Renfrew MJ, woolrridge M, SoWden AJ, lister-Sharp d. a systematic review to valuate the effectivness of interventions to promote the initiation of breastfeeding. Health technolo Assess 2000:4:1-171;

28. de Oliveira Ml, Camacho LA. Tedsone E. Extending breastfeeding duration hrough primary care: a systematic review of prenatal an postnatal interventionsJ Hm Lact 2001;17:326-43;

29. Widstrom A-M, Thingstrom-Pauisson J The position of the tongue during rooting reflexes elected in newborn infants before the first suckle. Acta paeditrica 1993:82;281-83;

30. Volpe EM, Bear M. Ennhancing breastfeedin initiation in adolescent mothers through the breastfeeding rates are inreasin in Scotland. Health Bull 2001;59;102-13;

31. Duufy EP, Percival P, Kershaw . positive effects of a antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates. Midwifery 1997:13;189-96;

25

32. saqarTvelos kanoni ,,ZuZuTi kvebis dacvis da xelovnuri sakvebis

kontrolirebadi moxmarebis” 1999; 33. Mikiel-Kostyra K, Mazur J, Boltruszko I. Effect of early skin-to-skin contact after delivery

on duration of breastfeeding: a prospective cohort study. Acta Paediatr 2002;91(12):1301-6; 34. Sikorski J, Renfrew MJ, PindoriaS,Wade A Support for breastfeeding mothers. Cochrane

Database Syst Rev. 2002; 35. Renfrew MJ, Lang S. Woolrindge MW.early versus delayed initiation of brestfeeding.

Cochrane Database Syst Rev. 2000; 36. Aderson GC, Moore E, Hepwort J, bergman N, early skinto-skin contact for mothers and

their healthy newborn infants. Cochrane Database Syst Rev. 2003; 37. Marchini G, Fried G, Ostlund E, Hagenas L. Plasma leptin in infants: relations to birth

weight and weight loss. Pediatrics 1998;101(3 Pt 1):429-32; 38. Blair A, Cadwell K, Turner-Maffei C, Brimdyr K. The relationship between positioning, the

breastfeeding dynamic, the latching process and pain in breastfeeding mothers with sore nipples. Breastfeed Rev 2003;11(2):5-10;

39. Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P. National assessment of physicians’ breast-feeding knowledge, attitudes, training, and experience. JAMA 1995;273(6):472-6;

40. Righard L, Alade MO. Sucking technique and its effect on success of breastfeeding. Birth 1992;19(4): 185-9;

41. Meier P. breast feeding the prematre baby: a research rview. News brief, 91;2-5; 42. Nylander G at al. Unsupplemeted brestfeeding in the maternity Ward. Positive long-term

effects. Acta obstetrician ginecologika Scandinavica, 1991: 70;205-209; 43. Blomquist HK et al . Supplementary feeding in the maternity Ward shortens the duration and

choice of infants feedin method. Birth, 1997; 24; 90-97; 44. de Zoysa I, Rea M, Why promote breastfeeding in diarrhoeal disease control programes?

Health policy and planning, 1991, 6; 371-79; 45. Procianoy R et al ,the influence of rooming on breastfeeding. Journal of tropical pediatrics,

1983; 29; 112-114; 46. Perez-EscamillaR, Pollitt E, LonerdalB, Dewey KG. Infan feeding policies n the maternity

Wards and their fect on breast-feeding success: an analitial overview. Am J public health 1994;84:-89-97;

47. Keefe MR. The impact of infant rooming-in on maternal sleep at night. J Obstet Gynecol Neonatal Nurs 1988;17(2):122-6;

48. Renfrew MJ, Lang S, Woolridge MW. Early versus delayed initiation of breastfeeding. Cochrane Database Syst Rev 2000(2):CD000043;

49. Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001;107(3):E41;

50. Cronventt L. et al. Singlle daly botle use in the early weeks postpartum and brest-feeding outcomes.pediatrics 1992. 90,5; 760-766;

51. Dowling DA, Meier PP, DiFiore JM, Blatz M, Martin RJ. Cup-feeding for preterm infants: mechanics and safety. J Hum Lact 2002;18(1):13-20; quiz 46-9, 72;

52. Barros FC, Victora CG, Semer TC, et al. Use of pacifiers is associated with decreased breastfeeding duration. Pediatrics 1995;95:497-499;

53. VictoraCG et al ,Pcifier use and shot restfeeding duration; cause, consequence or coinfedence? Pediatrics, 1997, 99, 3; 445-453;

54. Albernaz E, Giugliani ER, Victora CG. Supporting breastfeeding: a successful experience. J Hum Lact 1998;14(4):283-5;

55. Chapman DJ, Damio G, Young S, Perez-Escamilla R.Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. Arch Pediatr Adolesc Med 2004;158(9):897-902;

26

56. World Health Assembly. International Code of Marketing of Breast-milk Substitutes. Geneva: World Health Organization; 1981;

57. Howard CR, Howard FM. Management of breastfeeding when the mother s ill. Clin Obstet Gynecol 2004;47(3):683-95. Howard CR, Howard FM. Management of breastfeeding when the mother is ill. Clin Obstet Gynecol 2004;47(3):683-95.

8. avtorTa jgufi:

pediatrTa da neontologTa kavSiri `alternativa~

samuSao jgufi:

⇒ medea beleSaZe _ medicinis doqtori, saerTaSoriso organizacia

IBFAN-is saqarTvelos jgufi – arasamTavrobo organizacia

,,klaritas XXI”, prezidenti. baksis eqsperti-gare Semfasebeli

(UNICEF), saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa

da xelSewyobis, xelovnuri sakvebis kontrolirebadi

moxmarebis Sesaxeb” – avtori;

⇒ nino kiknaZe – medicinis doqtori; ss kuracio, ojaxis eqimi;

Tbilisis saxelmwifo samedicino universitetis saojaxo

medicines departamentis mowveuli pedagogi; saerTaSoriso

organizacia IBFAN-is saqarTvelos jgufi – arasamTavrobo

organizacia ,,klaritas XXI”.

eqspertebi:

⇒ qeTevan nemsaZe – medicinis doqtori, profesori, Tbilisis

saxelmwifo samedicino universitetis zogadi pediatriis

departamentis ufrosi, saerTaSoriso organizacia IBFAN-is

arasamTavrobo organizacia ,,klaritas XXI”, saqarTvelos kanoni

“bavSvTa bunebrivi kvebis dacvisa da xelSewyobis, xelovnuri

sakvebis kontrolirebadi moxmarebis Sesaxeb” – avtori;

⇒ Tamar manjaviZe – medicinis doqtori, baksis eqsperti/gare

Semfasebeli (UNICEF), saqarTvelos kanoni “bavSvTa bunebrivi

kvebis dacvisa da xelSewyobis, xelovnuri sakvebis

kontrolirebadi moxmarebis Sesaxeb” – avtori;

⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da

socialuri dacvis saministros jandacvis departamenti;

⇒ Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da

socialuri dacvis saministros jandacvis departamenti.

27

danarTi 1

samSobiaro saxlSi warmatebuli ZuZuTi kvebis 10 safexuris

danergvis Sefasebis kriteriumebi

Sefaseba xorcieldeba specialuri kiTxvariT, baksis globaluri

kriteriumebis moTxovnebis Sesabamisad:

!

I safexuri

ZuZuTi kvebis politikis dokumenti

samSobiaro saxlSi unda arsebobdes ZuZuTi kvebis politikis

werilobiTi dokumenti, romelic moicavs dawesebulebaSi ZuZuTi kvebis

(Z.k.) 10 safexuris danergvis principebs, uzrunvelyofs ZuZuTi kvebis

praktikis xelSewyobas da dacvas. dawesebulebis erTerTi wevri,

romelic arCeulia ZuZuTi kvebis politikis ganxorcilebaze

pasuxismgebel pirad, unda flobdes politikis dokuments.

pasuxismgebeli piri valdebulia gaacnos TanamSromlebs politikis

ganxorcielebis ZiriTadi meqanizmebi.

politikis amsaxveli dokumenti xelmisawvdomi unda iyos yvela

TanamSromlisaTvis. igi unda arsebobdes/gamofenili iyos dawesebulebis

ganyofilebebSi, qalTa konsultaciis CaTvliT.

politikis dokomenti dawerili unda iyos personalisa da

pacientebisaTvis gasageb enaze.

II safexuri

samedicino personalis informirebis done

samSobiaro saxlis samedicino personalisTvis periodulad unda

tardebodes saganmanaTleblo seminarebi baksis 10 principis danergvis

Taobaze.

dawesebulebas unda qondes saswavlo seminaris gegma, rogorc ZiriTadi

Semadgenlobis, ise axali TanamSromlebisTvis. saswavlo seminaris

xangrZlivoba - aranakleb 3 saaTisa, 3 saaTiani klinikuri muSaobis

CaTvliT (klinikuri gamocdilebis misaRebad).

pasuxismgebelma pirma unda SeZlos ZuZuTi kvebis saswavlo gegmis/kursis

mokle aRwera.

dawesebulebis xelmZRvanelma unda daadasturos, rom samSobiaro saxlis

mTelma personalma miiRo monawileoba baksis principebis swavlebis

procesSi, xolo axal TanamSromlebs mieca saTanado miTiTeba da

CarTulia saswavlo gegmaSi uaxloesi 6 Tvis manZilze.

TanamSromelTa 80%-ma unda daadasturos, rom maT gaiares

zemoTaRniSnuli saswavlo kursi an Tu isini muSaoben samSobiaroSi 6

Tveze naklebi periodi, maT miiRes Sesabamisi instruqcia.

80%-s unda SeeZlos Z.k. principebis Sesaxeb 5 kiTxvidan 4-ze swori

pasuxis gacema.

28

III safexuri

orsulTa informirebis done

Tu samSobiaros aqvs qalTa konsultacia an mSobiarobis Semdgomi

ganyofileba, orsulebs unda Cautardes konsultireba ZuZuTi kvebis

sakiTxebze. aRniSnuli unda daadasturos pasuxismgebelma pirma da

warmoadginos saganmanaTleblo kursis gegma.

konsultireba orsulobis pirveli 6 Tvis ganmavlobaSi unda Catardes

ZuZuTi kvebis mniSvnelobaze, upiratesobasa da ZuZuTi kvebis marTvis

ZiriTad principebze.

10 orsuli qalidan 80%-ma, romelTa gestaciuri asaki tolia an meti 32

kviraze, da romlebic sargebloben mSobiarobamde antenataluri

samsaxuriT, unda daadasturos, rom Cautarda konsultireba ZuZuTi

kvebis upiratesobaze da unda daasaxelos Z.k., Tundac 2 upiratesoba,

daaxasiaTon Z.k. marTvis zogierTi principi (mag: moTxovnilebiTi kveba,

rZis raodenobis SenarCuneba, swori moWideba, sxeulis pozebi da sxva.)

unda daadasturon, rom maT ar CatarebiaT saubrebi xelovnuri sakvebis

gamoyenebis Sesaxeb.

IV safexuri

kani-kanTan kontaqti da pirveli moWidebis ganxorcielebis sixSire

melogineTa 80%-ma 10-dan unda daadasturos, rom normaluri vaginaluri

mSobiarobidan, pirvel 0,5/1 saaTSi maT miuyvanes axalSobili,

ganxorcielda kani-kanTan kontaqti aranakleb 30 wuTisa. personali

daexmara ZuZuTi kvebis ganxorcielebaSi.

melogineTa 50%-ma 5-dan sakeisro kveTis Semdgom unda daadasturos, rom

narkozidan gamofxizlebis Semdeg naxevari saaTis ganmavlobaSi, maT

miuyvanes bavSvi da ganxorcielda kani-kanTan kontaqti aranakleb 30

wuTisa, personali daexmara ZuZuTi kvebis ganxorcielebaSi.

V safexuri

dedis informireba ZuZuTi kvebis ganxorcielebis teqnikis Sesaxeb

melogineTa 80%-ma 15-dan unda aRniSnos, rom saSualo medpersonalma

SesTavaza daxmareba ZuZuTi kvebis ganxorcielebaSi mSobiarobidan 6

saaTis ganmavlobaSi. miawodes sityvieri/werilobiTi informacia ZuZuTi

kvebis teqnikisa da rZis gamowvelis Sesaxeb.

melogineTa 80%-ma 5-dan unda aRniSnos, rom maT gauwies daxmareba rZis

gamowvelis principebis dauflebasa da ganxorcielebaSi laqtaciis

SesanarCuneblad.

samedicino personalis 80%-ma 10-dan unda aRniSnos, rom isini aswavlian

dedebs, rogor moaWidon bavSvi ZuZus da xeliT rZis gamowvelis

teqnikas.

TanamSromlebis 80%-ma unda SeZlos swori moWidebis da sxeulis

poziciis swavlebis demonstrireba erT dedasTan. TanamSromlebis 80% -

ma unda SeZlos aRweros rZis gamowvelis teqnika, romelsac aswavlian

dedebs.

29

VI safexuri

samSobiaroSi damatebiTi sakvebis an sxva siTxis gamoyeneba

damatebiTi sakvebis an siTxis gamoyenebis dros, SemTxvevaTa 80%-Si unda

arsebobdes samedicino Cveneba, garda im SemTxvevebisa, roca mSobiare

Tavad acxadebs uars ZuZuTi kvebaze.

ufrosma eqTanma da TanamSromlebma unda SeZlon ZuZuTi kvebis

samedicino winaaRmdeg Cvenebebis daasaxeleba.

VII safexuri

dedisa da bavSvis erTad yofnis praqtika

melogineTa 80%-ma 15-dan (sakeisros CaTvliT - 5) unda daadasturos, rom

mSobiarobis Semdeg (sakeisros SemTxvevaSi roca dedebs SeuZliaT

gamofxizlebis Semdeg bavSvTan kontaqti) maTi Cvilebi imyofebian maTTan

erTad palataSi mudmivad 24 saaTis ganmavlobaSi, garda im periodisa,

romelic saWiroa sxvadasxva procedurebisTvis (1 saaTi).

VIII safexuri

ZuZuTi kvebis ganxorcieleba moTxovnilebiT

melogineTa 80%-ma 15-dan (5 sakeisro) unda daasturos, rom bavSvs kvebavs

moTxovnilebis mixedviT. 80%-ma unda daadasturos, rom unda gaaRviZos

bavSvi kvebisTvis Tu Zilis xangrZlivoba aRemateba 3 saaTs an Tu dedas

sarZeve jirkvali gadavsebuli aqvs.

IX safexuri

sawovriani boTlisa da satyuaras gamoyeneba

melogineTaA 80%-ma 15-dan unda daadasturos, rom maTi bavSvebis kvebis

dros ar yofila gamoyenebuli sawovriani boTli da satyuara.

pasuxismgebeli piri adasturebs, rom ZuZuTi kvebaze myof bavSvebSi ar

iyenebdnen sawovrian boTlebs da satyuarebs.

X safexuri

ZuZuTi kvebis mxardaWera samSobiarodan gaweris Semdeg

melogineTa 80%-ma 15-dan (5 sakeisro) unda daadasturos, rom gawerisas

miiRo rekomendacia, vis mimarTon ZuZuTi kvebis Semdgomi mxardaWerisa

da problemebis mogvarebisTvis (pirveladi jandacvis rgoli,

arasamTavrobo seqtori, deda-dedis damxmare jgufi, Tu aseTi arsebobs).