Ode dne zji\u0161t\u011bn\u00ed t\u011bhotenstv\u00ed budete v\u00a0soustavn\u00e9 p\u00e9\u010di (dispenz\u00e1rn\u00ed) sv\u00e9ho registruj\u00edc\u00edho gynekologa<\/b>, kter\u00fd v\u00e1s bude informovat o jednotliv\u00fdch prohl\u00eddk\u00e1ch a vy\u0161et\u0159en\u00edch a jejich zp\u016fsobech \u00fahrady.\u00a0Krom\u011b b\u011b\u017en\u00fdch prohl\u00eddek v\u00e1s bude \u010dekat\u00a0<\/strong>n\u011bkolik d\u016fle\u017eit\u00fdch vy\u0161et\u0159en\u00ed, kter\u00e1 maj\u00ed za c\u00edl odhalit p\u0159\u00edpadn\u00e1 zdravotn\u00ed rizika pro v\u00e1s a va\u0161e miminko a v\u010das jim p\u0159edej\u00edt.<\/p>\n Ve\u0161ker\u00e1 z\u00e1kladn\u00ed p\u00e9\u010de souvisej\u00edc\u00ed s\u00a0p\u00e9\u010d\u00ed o t\u011bhotn\u00e9 je hrazena zdravotn\u00ed poji\u0161\u0165ovnou<\/b>. Jej\u00ed rozsah se v\u0161ak m\u016f\u017ee li\u0161it podle zdravotn\u00edch pot\u0159eb a rizik ka\u017ed\u00e9 t\u011bhotn\u00e9 \u017eeny.\u00a0Z\u00e1sady dispenz\u00e1rn\u00ed p\u00e9\u010de v\u00a0t\u011bhotenstv\u00ed<\/a><\/strong>\u00a0(doporu\u010den\u00e9 postupy\u00a0\u010cGPS \u010cLS JEP<\/a><\/strong>) jsou dostupn\u00e9 nap\u0159. na str\u00e1nk\u00e1ch\u00a0Gynultrazvuk.cz<\/strong><\/a>, na kter\u00fdch jsou zve\u0159ejn\u011bny i dal\u0161\u00ed podrobn\u00e9 informace v\u010detn\u011b kalkula\u010dky pro dataci t\u011bhotenstv\u00ed a\u00a0p\u0159ehledu doporu\u010den\u00fdch pravideln\u00fdch a nepravideln\u00fdch vy\u0161et\u0159en\u00ed v\u00a0t\u011bhotenstv\u00ed.<\/p>\n Vy\u0161et\u0159en\u00ed b\u011bhem t\u011bhotenstv\u00ed<\/b><\/p>\n Pravideln\u00e9 kontroly v\u00e1s budou \u010dekat v\u00a0pr\u016fb\u011bhu cel\u00e9ho t\u011bhotenstv\u00ed.\u00a0Zpo\u010d\u00e1tku p\u0159ibli\u017en\u011b ka\u017ed\u00e9 \u010dty\u0159i t\u00fddny a ke konci t\u011bhotenstv\u00ed\u00a0<\/b>(zhruba od 37. t\u00fddne)\u00a0jednou t\u00fddn\u011b<\/b>. V\u00a0r\u00e1mci ka\u017ed\u00e9ho vy\u0161et\u0159en\u00ed l\u00e9ka\u0159 zji\u0161\u0165uje v\u00e1hu t\u011bhotn\u00e9 \u017eeny kv\u016fli hl\u00edd\u00e1n\u00ed hmotnostn\u00edho p\u0159\u00edr\u016fstku, m\u011b\u0159\u00ed krevn\u00ed tlak, prov\u00e1d\u00ed vy\u0161et\u0159en\u00ed mo\u010di, sleduje p\u0159\u00edpadn\u00e9 otoky kon\u010detin t\u011bhotn\u00e9, m\u011b\u0159\u00ed velikost d\u011blohy (vzd\u00e1lenost\u00ed od stydk\u00e9 spony).<\/p>\n Prvn\u00edm vy\u0161et\u0159en\u00edm je komplexn\u00ed prenat\u00e1ln\u00ed vy\u0161et\u0159en\u00ed, tzv. vstupn\u00ed prohl\u00eddka. Ta by m\u011bla prob\u011bhnout v\u00a0rozmez\u00ed 8.\u00a0a 10.\u00a0t\u00fddne t\u011bhotenstv\u00ed, nejpozd\u011bji do 14. t\u00fddne.<\/b><\/b><\/p>\n Sou\u010d\u00e1st\u00ed vstupn\u00ed prohl\u00eddky je prim\u00e1rn\u011b zji\u0161t\u011bn\u00ed zdravotn\u00edho stavu, gynekologick\u00e9 vy\u0161et\u0159en\u00ed (v\u010detn\u011b odb\u011br\u016f kultivace z pochvy a mo\u010di), vy\u0161et\u0159en\u00ed d\u011blo\u017en\u00edho \u010d\u00edpku, zevn\u00ed m\u011b\u0159en\u00ed p\u00e1nevn\u00edch rozm\u011br\u016f, kontrola prs\u016f \u017eeny (gynekolog se sna\u017e\u00ed vylou\u010dit n\u00e1dorov\u00fd proces, eventu\u00e1ln\u011b pou\u010duje \u017eenu o jejich p\u00e9\u010di), provede\u00a0krevn\u00ed testy\u00a0ke\u00a0zji\u0161t\u011bn\u00ed krevn\u00ed skupiny, protil\u00e1tek proti \u010derven\u00fdm krvink\u00e1m, infekce typu syfilis,\u00a0s\u00e9rologick\u00e9 vy\u0161et\u0159en\u00ed HIV<\/a><\/strong>, \u017eloutenky\u00a0typu B a krevn\u00ed obraz, zji\u0161t\u011bn\u00ed hladiny cukru v krvi, v p\u0159\u00edpad\u011b pot\u0159eby i biochemick\u00e9 vy\u0161et\u0159en\u00ed krve a mo\u010di. A d\u00e1le tak\u00e9 ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed, p\u0159i kter\u00e9m se zji\u0161\u0165uje po\u010det plod\u016f a\u00a0jejich vitalita (\u017eivotaschopnost).<\/p>\n V\u00a0r\u00e1mci tohoto vy\u0161et\u0159en\u00ed gynekolog t\u011bhotn\u00e9 \u017een\u011b tak\u00e9 vystav\u00ed t\u011bhotenskou pr\u016fkazku<\/b>, kde jsou uvedeny podrobn\u00e9 informace o pr\u016fb\u011bhu dal\u0161\u00ed p\u00e9\u010de. Pr\u00e1v\u011b\u00a0do 14. t\u00fddne by m\u011bla m\u00edt ka\u017ed\u00e1 nast\u00e1vaj\u00edc\u00ed maminka stanoven\u00fd term\u00edn porodu<\/b>, kter\u00fd se zapisuje do t\u011bhotensk\u00e9 pr\u016fkazky.<\/p>\n <\/a>Dal\u0161\u00ed pravideln\u00e1 ultrazvukov\u00e1 vy\u0161et\u0159en\u00ed n\u00e1sleduj\u00ed ve 20.<\/b>\u201322. t\u00fddnu a ve 30.<\/b>\u201332. t\u00fddnu t\u011bhotenstv\u00ed<\/b>, p\u0159i\u010dem\u017e se jedn\u00e1 o z\u00e1kladn\u00ed screeningov\u00e1 ultrazvukov\u00e1 vy\u0161et\u0159en\u00ed hodnot\u00edc\u00ed dosavadn\u00ed pr\u016fb\u011bh t\u011bhotenstv\u00ed.<\/p>\n Mezi 24. a 28. t\u00fddnem t\u011bhotenstv\u00ed ode\u0161le l\u00e9ka\u0159 \u017eenu na test na t\u011bhotenskou cukrovku<\/b>. \u017denu tedy \u010dek\u00e1 vy\u0161et\u0159en\u00ed krve a mo\u010di\u00a0a\u00a0d\u00e1le tak\u00e9 or\u00e1ln\u00ed toleran\u010dn\u00ed gluk\u00f3zov\u00fd test\u00a0(oGTT).<\/p>\n Mezi 28.\u201334. t\u00fddnem t\u011bhotenstv\u00ed\u00a0<\/b>v\u00e1m gynekolog znovu\u00a0zkontroluje krevn\u00ed obraz\u00a0<\/b>a\u00a0v\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech provede je\u0161t\u011b jednou testy na HIV, syfilis a \u017eloutenku typu B.\u00a0V obdob\u00ed mezi 35.\u00a0a\u00a037. t\u00fddnem t\u011bhotenstv\u00ed budete absolvovat st\u011br z pochvy a kone\u010dn\u00edku na\u00a0zji\u0161t\u011bn\u00ed p\u0159\u00edtomnosti streptokoka skupiny B<\/b>.<\/p>\n <\/a><\/a><\/a>Optim\u00e1ln\u011b v\u00a0obdob\u00ed 36.<\/b>\u201337. t\u00fddne by t\u011bhotn\u00e1 \u017eena m\u011bla m\u00edt ji\u017e vybranou porodnici a\u00a0m\u011bla by podstoupit tzv. check-in<\/b>, tedy vstupn\u00ed vy\u0161et\u0159en\u00ed a zaevidov\u00e1n\u00ed t\u011bhotn\u00e9 \u017eeny do porodnice. Nejedn\u00e1 se o\u00a0p\u0159ed\u00e1n\u00ed t\u011bhotn\u00e9 \u017eeny do porodnice,\u00a0t\u011bhotn\u00e1 \u017eena je i nad\u00e1le v\u00a0ambulantn\u00ed p\u00e9\u010di u\u00a0registruj\u00edc\u00edho gynekologa, kter\u00fd poskytuje p\u00e9\u010di dle doporu\u010den\u00fdch postup\u016f<\/b>.\u00a0Na toto vy\u0161et\u0159en\u00ed vystavuje registruj\u00edc\u00ed gynekolog t\u011bhotn\u00e9 \u017een\u011b \u017e\u00e1danku, p\u0159i\u010dem\u017e c\u00edlem vy\u0161et\u0159en\u00ed t\u00e9to zdravotn\u00ed slu\u017eby je p\u0159edev\u0161\u00edm sezn\u00e1men\u00ed t\u011bhotn\u00e9 \u017eeny\u00a0s\u00a0prost<\/span>\u0159ed\u00edm porodnice a poskytnut\u00ed d\u016fle\u017eit\u00fdch organiza\u010dn\u00edch informac\u00ed, z\u00edsk\u00e1n\u00ed informac\u00ed o dosavadn\u00edm pr\u016fb\u011bhu prenat\u00e1ln\u00ed p\u00e9\u010de, za\u0159azen\u00ed t\u011bhotn\u00e9 \u017eeny do skupiny dle rizika a stanoven\u00ed strategie ukon\u010den\u00ed t\u011bhotenstv\u00ed (zp\u016fsob veden\u00ed porodu).<\/p>\n Dle doporu\u010den\u00fdch postup\u016f m\u016f\u017ee b\u00fdt t\u011bhotn\u00e1 \u017eena p\u0159ed\u00e1na do ambulantn\u00ed p\u00e9\u010de porodnice po vz\u00e1jemn\u00e9 dohod\u011b, nejpozd\u011bji v\u0161ak ve 41. t\u00fddnu, p\u0159i\u010dem\u017e t\u011bhotenstv\u00ed by m\u011blo b\u00fdt ukon\u010deno do 42. t\u00fddne.<\/p>\n V\u00fd\u0161e uveden\u00e1 vy\u0161et\u0159en\u00ed jsou stanovena pro dispenz\u00e1rn\u00ed p\u00e9\u010di o\u00a0nerizikov\u00e9 t\u011bhotn\u00e9 \u017eeny<\/b>.<\/b><\/p>\n <\/a>Screeningov\u00e1 vy\u0161et\u0159en\u00ed<\/b><\/p>\n Ned\u00edlnou sou\u010d\u00e1st\u00ed zdravotn\u00ed p\u00e9\u010de o t\u011bhotnou jsou tak\u00e9 podrobn\u00e1 screeningov\u00e1 vy\u0161et\u0159en\u00ed, kter\u00e1 m\u016f\u017ee registruj\u00edc\u00ed gynekolog t\u011bhotn\u00e9 \u017een\u011b nab\u00eddnout. Odborn\u00edky nej\u010dast\u011bji doporu\u010dovan\u00fd\u00a0kombinovan\u00fd screening v\u00a0I. trimestru t\u011bhotenstv\u00ed<\/b>, tzv<\/a>. \u201eprvotrimestr\u00e1ln\u00ed screening\u201c\u00a0(12.\u201314. t\u00fdden t\u011bhotenstv\u00ed)\u00a0umo\u017e\u0148uje stanovit m\u00edru rizika, zda d\u00edt\u011b bude trp\u011bt vrozenou v\u00fdvojovou vadou<\/b>\u00a0(nap\u0159. Down\u016fv syndrom). Toto screeningov\u00e9 vy\u0161et\u0159en\u00ed m\u00e1 dv\u011b \u010d\u00e1sti \u2013 biochemickou a ultrazvukovou (hodnot\u00ed se dohromady v\u0161echny z\u00edskan\u00e9 parametry a ukazatele), p\u0159i\u010dem\u017e z\u00a0prost\u0159edk\u016f ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed je hrazena pouze \u010d\u00e1st biochemick\u00e1. Ultrazvukov\u00e1 \u010d\u00e1st nem\u00e1 stanovenu \u00fahradu,\u00a0klientky VZP v\u0161ak na toto ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed mohou\u00a0<\/b>\u010derpat p\u0159\u00edsp\u011bvek<\/b>\u00a0z\u00a0fondu prevence\u00a0<\/b>(v\u00edce informac\u00ed viz n\u00ed\u017ee).<\/p>\n Dal\u0161\u00edm podrobn\u00fdm screeningov\u00fdm vy\u0161et\u0159en\u00edm, kter\u00e9 m\u016f\u017ee b\u00fdt t\u011bhotn\u00e9 \u017een\u011b nab\u00eddnuto, je\u00a0podrobn\u00e9 hodnocen\u00ed morfologie plodu ve II. trimestru t\u011bhotenstv\u00ed, kter\u00e9 je prov\u00e1d\u011bno nad r\u00e1mec hrazen\u00e9ho screeningov\u00e9ho vy\u0161et\u0159en\u00ed<\/b>\u00a0prov\u00e1d\u011bn\u00e9ho ve 20.\u201322. t\u00fddnu t\u011bhotenstv\u00ed\u00a0a m\u00e1 za c\u00edl\u00a0vylou\u010den\u00ed vrozen\u00fdch v\u00fdvojov\u00fdch vad, vrozen\u00fdch vad srdce a\u00a0ultrazvukov\u00fdch zn\u00e1mek chromozom\u00e1ln\u00edch aberac\u00ed<\/b>\u00a0(zm\u011bn v\u00a0genetick\u00e9 v\u00fdbav\u011b plodu). V\u00fdstupem tohoto vy\u0161et\u0159en\u00ed je podrobn\u00e1 p\u00edsemn\u00e1 zpr\u00e1va o proveden\u00e9m vy\u0161et\u0159en\u00ed a zhodnocen\u00ed z\u00edskan\u00fdch parametr\u016f.<\/p>\n Obdobn\u011b je tomu i u podrobn\u00e9ho ultrazvukov\u00e9ho vy\u0161et\u0159en\u00ed ve 36.\u201337. t\u00fddnu t\u011bhotenstv\u00ed,\u00a0u tzv. ultrazvukov\u00e9ho screeningu r\u016fstov\u00e9 restrikce plodu je ve 36.\u201337. t\u00fddnu<\/b>\u00a0prov\u00e1d\u011bna kontrola r\u016fstu miminka\u00a0<\/b>a v\u010dasn\u00e1 identifikace p\u0159\u00edpadn\u00fdch probl\u00e9m\u016f.<\/p>\n Na ob\u011b tato podrobn\u00e1 screeningov\u00e1 vy\u0161et\u0159en\u00ed takt\u00e9\u017e\u00a0mohou klientky VZP\u00a0<\/b>\u010derpat p\u0159\u00edsp\u011bvek z\u00a0fondu prevence<\/b><\/a>\u00a0(vy\u0161et\u0159en\u00ed mus\u00ed b\u00fdt provedeno v\u00fdhradn\u011b\u00a0l\u00e9ka\u0159em s\u00a0certifik\u00e1tem<\/a><\/strong>\u00a0\u010cGPS \u010cLS JEP pro prov\u00e1d\u011bn\u00ed ultrazvukov\u00fdch vy\u0161et\u0159en\u00ed \u2013 mo\u017enost ov\u011b\u0159en\u00ed\u00a0zde<\/a><\/strong>).<\/p>\n Rizika t\u011bhotenstv\u00ed<\/b><\/p>\n <\/a>\u017deny s\u00a0rizikov\u00fdm\u00a0<\/b>nebo tzv. patologick\u00fdm t\u011bhotenstv\u00edm\u00a0jsou sledov\u00e1ny podrobn\u011bji a \u010dast\u011bji s\u00a0ohledem na definovan\u00e9 riziko<\/b>, p\u0159i\u010dem\u017e\u00a0ve\u0161kerou l\u00e9ka\u0159em indikovanou p\u00e9\u010di poji\u0161\u0165ovna hrad\u00ed. Zdravotn\u00ed poji\u0161\u0165ovnou je nap\u0159. hrazeno tak\u00e9 superkonzili\u00e1rn\u00ed ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed v pr\u016fb\u011bhu prenat\u00e1ln\u00ed p\u00e9\u010de, kter\u00e9 navazuje na pravideln\u00e9 ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed, a to v\u00a0t\u011bch p\u0159\u00edpadech, kdy v\u00a0r\u00e1mci pravideln\u00e9ho ultrazvukov\u00e9ho vy\u0161et\u0159en\u00ed byla zji\u0161t\u011bna abnormalita.<\/p>\n M\u00edru rizika ur\u010d\u00ed o\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159 u\u017e p\u0159i prvn\u00edm vy\u0161et\u0159en\u00ed v\u00a0t\u011bhotensk\u00e9 poradn\u011b<\/b>, a to na z\u00e1klad\u011b anamn\u00e9zy \u017eeny a jej\u00edho aktu\u00e1ln\u00edho zdravotn\u00edho stavu. P\u0159i ka\u017ed\u00e9 dal\u0161\u00ed n\u00e1v\u0161t\u011bv\u011b poradny l\u00e9ka\u0159 znovu posuzuje a zva\u017euje m\u00edru rizika. V\u00a0praxi to znamen\u00e1, \u017ee se v\u017edy prov\u00e1d\u00ed v\u0161echna pot\u0159ebn\u00e1 vy\u0161et\u0159en\u00ed v\u010detn\u011b zji\u0161t\u011bn\u00ed v\u00e1hy z d\u016fvodu hl\u00edd\u00e1n\u00ed hmotnostn\u00edho p\u0159\u00edr\u016fstku, m\u011b\u0159en\u00ed krevn\u00edho tlaku, vy\u0161et\u0159en\u00ed mo\u010di a\u00a0sleduj\u00ed se tak\u00e9 zn\u00e1mky vitality plodu.<\/p>\n Dal\u0161\u00ed vy\u0161et\u0159en\u00ed v\u00a0t\u011bhotenstv\u00ed (jin\u00e9 odbornosti)<\/b><\/b><\/p>\n Ka\u017ed\u00e1 nast\u00e1vaj\u00edc\u00ed maminka m\u00e1 tak\u00e9 n\u00e1rok v\u00a0pr\u016fb\u011bhu t\u011bhotenstv\u00ed\u00a0na dv\u011b preventivn\u00ed prohl\u00eddky u\u00a0stomatologa<\/b>. A k t\u011bmto dv\u011bma \u201et\u011bhotensk\u00fdm\u201c m\u016f\u017ee ve stejn\u00e9m kalend\u00e1\u0159n\u00edm roce absolvovat i\u00a0jednu \u201eb\u011b\u017enou\u201c preventivn\u00ed zubn\u00ed prohl\u00eddku. D\u00e1le by tak\u00e9 nem\u011bla zapomenout\u00a0na preventivn\u00ed prohl\u00eddku u\u00a0v\u0161eobecn\u00e9ho praktick\u00e9ho l\u00e9ka\u0159e a nato\u010den\u00ed EKG<\/b>.<\/p>\n P\u0159\u00edsp\u011bvek VZP pro nast\u00e1vaj\u00edc\u00ed maminky<\/b><\/p>\n T\u011bhotn\u00e9 \u017eeny a maminky a\u017e do 12 m\u011bs\u00edc\u016f po porodu mohou z\u00edskat\u00a0<\/b>p\u0159\u00edsp\u011bvek do celkov\u00e9 v\u00fd\u0161e 3\u00a0000\u00a0K\u010d<\/a><\/strong>\u00a0<\/b>nap\u0159. na screeningov\u00e1 vy\u0161et\u0159en\u00ed, na vhodnou pohybovou aktivitu v\u00a0t\u011bhotenstv\u00ed, na kurz p\u0159\u00edpravy k porodu po\u0159\u00e1dan\u00fd porodnic\u00ed, na zakoupen\u00ed nebo zap\u016fj\u010den\u00ed monitoru dechu, na slu\u017eby lakta\u010dn\u00edch poradky\u0148, na pom\u016fcky ke kojen\u00ed a dal\u0161\u00ed.<\/p>\n Pro novope\u010den\u00e9 maminky a jejich miminka\u00a0<\/b>p\u0159ipravila VZP poukaz na\u00a0p\u0159\u00edsp\u011bvek v\u00a0hodnot\u011b 500 K\u010d na pot\u0159eby nebo pom\u016fcky<\/a><\/strong>\u00a0<\/b>zakoupen\u00e9 v\u00a0l\u00e9k\u00e1rn\u011b pro miminka (p\u0159ihl\u00e1\u0161en\u00e1 k\u00a0VZP).\u00a0Maminky p\u0159ed\u010dasn\u011b narozen\u00fdch miminek<\/b>\u00a0s\u00a0porodn\u00ed v\u00e1hou do 1\u00a0500 g mohou \u010derpat tak\u00e9\u00a0p\u0159\u00edsp\u011bvek a\u017e 3\u00a0000 K\u010d na podporu zdrav\u00e9ho v\u00fdvoje d\u011bt\u00ed<\/a>.<\/strong><\/p>\n