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},
"code": "N97.9",
"name": "Женское бесплодие неуточненное",
"icd_name": "Женское бесплодие неуточненное",
"gender": 2,
"age_min": 20,
"age_max": 45,
"cause": [
"0"
],
"periodicity": 1,
"slug": "n97.9_zhenskoe_besplodie_neutochnennoe",
"lead": "заболевание, характеризующееся невозможностью здоровой половозрелой сексуально активной женщины, не пользующейся контрацепцией, добиться беременности в течение одного года",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К самым частым причинам развития данной патологии относятся воспалительные заболевания органов малого таза, чаще всего вызванные инфекциями, передающимися половым путем (гонококком, генитальным герпесом, уреаплазмой, микоплазмой, хламидией, гарднереллой, бледной спирохетой, трихомонадой, цитомегаловирусом). Проникновение возбудителя инфекции в женские родовые пути вызывает развитие хронических и острых воспалительных (часто гнойных) заболеваний.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Следующей причиной могут стать оперативные вмешательства в области органов малого таза и кишечника, которые также могут привести к появлению спаек в матке и маточных трубах.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заболевания половых органов, вызванные различными возбудителями, зачастую протекают субклинически, то есть с малым количеством симптомов и жалоб у больных, поэтому диагноз выставляется на поздних стадиях, когда болезнь приобретает хроническое течение.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В этом случае заболевания трудно поддаются лечению, ведут к возникновению поражений эндометрия, формированию спаечного процесса в матке и маточных трубах, изменяя их анатомическую структуру, и влекут за собой бесплодие.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причиной хронического инфекционного процесса могут стать бактерии, которые активизируются в случае ослабления организма женщины (к этому ведут хронический стресс, неправильное питание и т.д.). Туберкулезное поражение маточных труб, например, протекает практически бессимптомно, ведет к формированию спаек в маточных трубах и невозможности прохождения по ним яйцеклетки, оперативное лечение в таких случаях малоэффективно.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К структурным патологиям матки, «ответственным» за развитие бесплодия, относятся миомы, особенно располагающиеся таким образом, что нарушается проходимость устья фаллопиевых (маточных) труб. К этой же группе причин относится изменение состава слизи шейки матки (в результате гормонального дисбаланса или воспаления), полипы эндометрия, дисплазия шейки матки, эндометриоз.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Систему, контролирующую процесс оплодотворения яйцеклетки, можно ограничить тремя уровнями: гипоталамус – гипофиз - яичники, работающими по принципу обратной связи. Патология любого звена (опухоли головного мозга, локализующиеся в гипофизе, гипоталамусе или сдавливающие эти две структурные области, заболевания яичников опухолевого и неопухолевого характера) ведет к выводу из строя всего каскада гормональных реакций, протекающих в норме. Щитовидная железа, гормоны коры надпочечников, быстрое изменение количества жировой ткани (резкое похудение или, наоборот, набор веса) также влияют на развитие нормального овуляторного цикла.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Еще одна причина – так называемое иммунологическое бесплодие. Когда иммунная система женщины реагирует на сперму партнера как на чужеродное и опасное для организма явление, начинается выработка антиспермальных антител, препятствующих оплодотворению.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Большое значение при диагностике бесплодия уделяется ультразвуковому исследованию органов малого таза, благодаря которому можно выявить множество нарушений строения половых органов. С его помощью диагностируют эндометриоз, нарушения строения яичников, наличие и размеры фолликула и яйцеклетки и другие заболевания. Очень важно не терять данные УЗИ, даже если во время него не выявлено никакой патологии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лапароскопия при диагностике бесплодия представляет собой операцию, во время которой с помощью инструмента, оснащенного оптикой, исследуются органы малого таза. Есть два вида лапароскопии: диагностическая и оперативная.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гистеросальпингография (ГСГ) представляет собой рентгенологическое исследование матки и труб, которое позволяет получить объективную информацию об их состоянии, дает возможность оценить проходимость и функциональное состояние маточных труб, рельеф и размеры слизистой матки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гистероскопия представляет собой осмотр стенок полости матки с использованием гистероскопа, при необходимости с последующим проведением как диагностических, так и оперативных манипуляций.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ректальная температура (РТ) позволяет объективно оценить функцию яичников на протяжении длительного периода времени. Ее необходимо измерять на протяжении 2-3 циклов непрерывно, в том числе включая дни менструации. Также следует определить, происходит ли у женщины овуляция каждый месяц. Она может отслеживать это в домашних условиях:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">с помощью теста на овуляцию (продается в аптеках и магазинах);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">запись текстуры цервикальной слизи в течение нескольких месяцев;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">запись изменений температуры тела с утра (базальной температуры тела) на протяжении нескольких месяцев.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гормональный фон женщины исследуется с помощью комплексной сдачи крови на определение уровня следующих гормонов: тестостерон, пролактин, Т3, Т4, ТТГ, кортизол, эстрадиол, ДГЭА-С. С помощью полученных результатов является возможным определение момента наступления овуляции и пропорциональное соотношение гормонов, которые отвечают за наступление беременности.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Решение вопроса о лечении бесплодия принимается после получения и оценки результатов всех проведенных обследований и установления причин, его вызвавших. Обычно лечение начинают с устранения первостепенной причины бесплодия. Лечебные методики, применяемые при женском бесплодии, направлены на: восстановление репродуктивной функции пациентки консервативными или хирургическими методами; применение вспомогательных репродуктивных технологий в случаях, если естественное зачатие невозможно.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При эндокринной форме бесплодия проводится коррекция гормональных расстройств и стимуляция яичников. К немедикаментозным видам коррекции относятся нормализация веса (при ожирении) путем диетотерапии и увеличения физической активности, физиотерапия. Основным видом медикаментозного лечения эндокринного бесплодия является гормональная терапия. Процесс созревания фолликула контролируется с помощью ультразвукового мониторинга и динамики содержания гормонов в крови. При правильном подборе и соблюдении гормонального лечения у 70-80% пациенток с этой формой бесплодия наступает беременность.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При трубно-перитонеальной форме бесплодия целью лечения является восстановление проходимости маточных труб при помощи лапароскопии. Эффективность этого метода в лечении трубно-перитонеального бесплодия составляет 30-40%. При длительно существующей спаечной непроходимости труб или при неэффективности ранее проведенной операции, рекомендуется искусственное оплодотворение. На эмбриологическом этапе возможна криоконсервация эмбрионов для их возможного использования при необходимости повторного ЭКО.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В случаях маточной формы бесплодия – анатомических дефектах ее развития - проводятся реконструктивно-пластические операции. Вероятность наступления беременности в этих случаях составляет 15-20%. При невозможности хирургической коррекции маточного бесплодия (отсутствие матки, выраженные пороки ее развития) и самостоятельного вынашивания беременности женщиной прибегают к услугам суррогатного материнства, когда подсадка эмбрионов осуществляется в матку прошедшей специальный подбор суррогатной матери.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Бесплодие, вызванное эндометриозом, лечится с помощью лапароскопической эндокоагуляции, в ходе которой удаляются патологические очаги. Результат лапароскопии закрепляется курсом медикаментозной терапии. Процент наступления беременности составляет 30-40%.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При иммунологическом бесплодии обычно используется искусственное оплодотворение путем искусственной инсеминации спермой мужа. Этот метод позволяет миновать иммунный барьер цервикального канала и способствует наступлению беременности в 40% случаях иммунного бесплодия. Лечение неустановленных форм бесплодия является наиболее сложной проблемой. Чаще всего в этих случаях прибегают к использованию вспомогательных методов репродуктивных технологий. Кроме того, показаниями к проведению искусственного оплодотворения являются:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">трубная непроходимость или отсутствие маточных труб;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">состояние после проведенной консервативной терапии и лечебной лапароскопии по поводу эндометриоза;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">безуспешное лечение эндокринной формы бесплодия;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">абсолютное мужское бесплодие;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">истощение функции яичников;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">некоторые случаи маточной формы бесплодия;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сопутствующая патология, при которой невозможна беременность.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основными методами искусственного оплодотворения являются:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">метод внутриматочной инсеминации донорской спермой или спермой мужа (ИИСД, ИИСМ);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">метод экстракорпорального оплодотворения (ЭКО);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">внутриклеточная инъекция сперматозоида внутрь яйцеклетки (метод ИКСИ, ИМСИ);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">использование донорской яйцеклетки или донорского эмбриона;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">суррогатное материнство.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфической профилактики бесплодия не существует, но можно предотвратить приводящие к нему заболевания. Для этого нужно соблюдать следующие правила:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ежегодно посещать гинеколога;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">до планирования беременности использовать презервативы, которые помогут избежать заражения инфекциями и станут профилактикой абортов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">своевременно лечить воспалительные заболевания и инфекции, передающиеся половым путём;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">соблюдать правила личной гигиены;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">не курить и ограничить употребление алкоголя;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нормализовать менструальную функцию с помощью препаратов, назначенных врачом;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">контролировать вес тела;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">исключить чрезмерные физические и психоэмоциональные нагрузки;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">вести регулярную половую жизнь.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При планировании беременности важно правильно питаться и поддерживать нормальный вес (индекс массы тела от 19 до 30)</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основной признак бесплодия у женщин — это отсутствие беременности при регулярной половой жизни без применения методов контрацепции. Также бесплодие проявляется симптомами тех заболеваний, из-за которых беременность не наступает.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При воспалительных заболеваниях и инфекционных процессах:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">неприятные выделения из половых путей;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли в животе;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">зуд и дискомфорт в наружных половых органах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">повышение температуры тела.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При миоме матки и эндометриозе:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли внизу живота и при половых актах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">обильные менструации;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушения менструального цикла — менструации продолжительностью более 7 дней и чаще, чем через 21 день;</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При гормональной дисфункции и заболеваниях органов, вырабатывающих гормоны:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушения менструального цикла;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">перерывы между менструациями более 35 дней или отсутствие менструаций.</span></li>\r\n</ul>\r\n<p><span id=\"docs-internal-guid-3d8b5225-7fff-d2f3-8ff6-5132e226ade2\"> </span></p>",
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},
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"lead": "проявляется отсутствием наступления беременности на протяжении 2-х лет и более у женщины, живущей регулярной половой жизнью",
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"etiology": "<p>Бесплодность, может быть:</p>\r\n<ul>\r\n<li>\r\n<p>первичной – беременность ни разу не наступала (врожденные гинекологические аномалии) или (осложнения на женских половых органах) до или после менархе (первый цикл);</p>\r\n</li>\r\n<li>\r\n<p>вторичной, после первой успешной беременности, невозможность повторного оплодотворения, может быть абсолютной (неизлечимой) или относительной (излечимой).</p>\r\n</li>\r\n</ul>\r\n<p>В отдельных источниках, посвященных исследованиям физиологии и патофизиологии женской половой сферы, понятие дополняется следующими видами инфертильности.</p>\r\n<ul>\r\n<li>\r\n<p>Физиологическая. Нормой является <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> раннего возраста (до полового созревания), и постклимактерическое <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> (после менопаузы).</p>\r\n</li>\r\n<li>\r\n<p>Добровольная. Иначе называют осознанно выбранное <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> – использование (медикаментозных) препаратов или физических (спираль, другое) средств.</p>\r\n</li>\r\n<li>\r\n<p>Временная. Может быть результатом длительного стресса, ослабления организма после или в период заболевания, некоторые авторы к временному бесплодию относят лактационную аменорею - торможение овуляции в ранний период регулярного грудного кормления.</p>\r\n</li>\r\n<li>\r\n<p>Постоянная. Удаление женских половых органов, полное или частичное, является результатом хирургического вмешательства.</p>\r\n</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>В первую очередь, женщине назначат УЗИ органов малого таза, анализы на инфекции и бактериологические посевы на влагалищную флору, проверят гормональный профиль, выяснят нет ли проблем с иммунологической совместимостью партнеров.</p>\r\n<p>Дополнительные методы исследования: гистеросальпингографию и лапароскопию. Не исключено, что женщине понадобится консультация эндокринолога.</p>\r\n<p> </p>\r\n<p>Медицинские стандарты</p>\r\n<p>По медицинским стандартам, врач обязан поставить диагноз женщине не позднее, чем через шесть месяцев после начала обследования. Кстати, логичнее в первую очередь проверить на <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> партнера-мужчину, это займет меньше времени и обойдется намного дешевле, чем обследование женщины.</p>",
"treatment": "<p>Главная задача лечения бесплодия — устранить повреждения и болезни, которые к нему привели: выровнять гормональный фон, восстановить проходимость маточных труб, удалить опухоли, избавиться от эндометриоза и т.д. Поэтому выполняйте все назначения лечащего врача, не отказывайтесь от операций. После курса лечения естественное зачатие происходит, более чем у 60% женщин.</p>\r\n<p>Возможности медицины</p>\r\n<p>Если, несмотря на все усилия врачей, забеременеть так и не получилось, не отчаивайтесь. Современная медицина дает женщинам шанс забеременеть даже в этом случае. Нужно обратиться в клинику, где используются методы искусственного оплодотворения.</p>\r\n<p>Для женщин, у которых отсутствуют или непроходимы маточные трубы, которые страдают поликистозом, эндометриозом и т.д. разработана методика ЭКО – экстракорпорального оплодотворения. Пациентке назначают препараты, усиливающие рост и созревание яйцеклеток. Затем через боковые своды влагалища специальной иглой вытаскивают полученные яйцеклетки и оплодотворяют их в пробирке сперматозоидами мужа или донора. Полученные эмбрионы на 3-5-ый день переносят в матку, а женщине назначают препараты, способствующие приживлению эмбрионов. Чаще всего в матку переносят не более трех эмбрионов.</p>\r\n<p>В последнее время у женщин до 35 лет применяют методику селекции эмбрионов (т.е. выбирают только один эмбрион, но очень высокого качества). Это позволяет избежать многоплодных беременностей. Данная методика используется только с согласия пациентов.</p>\r\n<p>В тех случаях, когда яйцеклетку получить невозможно, используется методика донации ооцитов. Женщине-донору проводят стимуляцию овуляции и она отдает свои клетки женщине-реципиенту. К сожалению, доноров ооцитов не так много, поэтому ими как правило становятся родственницы или знакомые реципиентки.</p>",
"prevention": "",
"clinical_picture": "<p>Важным признаком, указывающим на <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> у женщины, является невозможность забеременеть, в течение 2 лет и более, при наличии благоприятных условий для зачатия, а именно:</p>\r\n<ul>\r\n<li>\r\n<p>регулярные половые контакты;</p>\r\n</li>\r\n<li>\r\n<p>половой партнер с хорошей спермограммой;</p>\r\n</li>\r\n<li>\r\n<p>полный, длительный отказ от средств контрацепции;</p>\r\n</li>\r\n<li>\r\n<p>возраст женщины от 20 до 45 лет.</p>\r\n</li>\r\n</ul>\r\n<p><a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">Бесплодие</a> не имеет патогномоничного (ведущего) признака, часто протекает бессимптомно, или имеет косвенные симптомы. Признаки бесплодия устанавливают при сборе анамнеза, осмотра, физикальных, лабораторных, инструментальных исследований.</p>\r\n<p>Анамнез. Устанавливают явные симптомы, связанные с нарушением регулярных циклов: длительные, короткие, болезненные, обильные, с посторонними выделениями. Предположить <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> можно на основании, установления косвенных симптомов, характерных, инфекционным, неинфекционным и хирургическим заболеваниям.</p>",
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{
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"code": "N96",
"name": "Привычный выкидыш",
"icd_name": "Привычный выкидыш",
"gender": 2,
"age_min": 15,
"age_max": 49,
"cause": [
3
],
"periodicity": 1,
"slug": "n96_privychnyy_vykidysh",
"lead": "Нарушение здоровья, относящееся к группе невоспалительные болезни женских половых органов",
"description": "Привычный выкидыш — это самопроизвольное прерывание беременности (при сроке до 22 недель беременности), повторяющееся при каждой последующей беременности. ",
"etiology": "<p>Причины привычного выкидыша включают в себя: </p>\r\n<ul>\r\n<li>дефекты анатомического строения матки; </li>\r\n<li>недоразвитие плодного яйца; </li>\r\n<li>воспалительные заболевания и опухоли матки; </li>\r\n<li>эндокринные заболевания; </li>\r\n<li>генетическую детерминацию; </li>\r\n<li>хронические инфекции и интоксикации; </li>\r\n<li>вирусные инфекции, перенесенные в первые недели беременности; </li>\r\n<li>гиповитаминозы; применение противоопухолевых, гормональных, противозачаточных препаратов; </li>\r\n<li>неблагоприятные факторы внешней среды. </li>\r\n</ul>",
"pathogenesis": "<p>Механизм привычного выкидыша различен. В ряде случаев сначала возникают сокращения матки, вызывающие отслойку плодного яйца. В других случаях сокращениям матки предшествует гибель плодного яйца (при токсикозах, острых и хронических инфекционных болезнях беременной и др.). Иногда отслойка и гибель плодного яйца и сокращения матки происходят одновременно. </p>",
"diagnostics": "<p>У 5%-15% женщин с привычным абортом определяется клинически значимое повышение титра антифосфолипидных антител. </p>\r\n<p>При планировании следующей беременности супругам необходимо: </p>\r\n<ul>\r\n<li>сделать спермограмму; </li>\r\n<li>пройти гинекологическое УЗИ; </li>\r\n<li>сделать гистероскопию; </li>\r\n<li>исследовать анализы крови на гормоны (определение уровня прогестерона), а также на наличие вирусных и половых инфекций; </li>\r\n<li>исследовать иммунный статус; </li>\r\n<li>исследовать кариотип (выявление носительства хромосомных аномалий, в том числе унаследованные тромбофилии); </li>\r\n<li>исследовать свертывающую систему крови (определение АчТВ, антитромбин 3, Д-димер, агрегация тромбоцитов, МНО, протромбиновое время – признаки гиперкоагуляции). </li>\r\n</ul>\r\n<p>При необходимости может быть назначен ряд дополнительных исследований. </p>",
"treatment": "<p>При несостоятельности шейки и внутреннего маточного зева применяют пластические операции с целью устранения деформации, разрывов и т. п. При несостоятельности шейки функционального характера используют операции, сущность которых заключается в суживании области внутреннего зева при помощи швов из найлоновой тесьмы. Швы удаляют на 36—38-й неделе беременности, наступившей после наложения швов. </p>\r\n<p>У женщин, страдающих привычным выкидышем на почве инфантилизма, недостаточности функции яичников, воспалительных заболеваний половых органов, следует проводить лечение до наступления беременности. В подобных случаях рекомендуется курс лечения эстрогенами и прогестероном в соответствии с индивидуальным менструальным циклом (не менее 3 циклов) в сочетании с влагалищно-крестцовой диатермией и воротником по Щербаку (15 процедур, чередуя их через день). </p>\r\n<p>Лечение во время беременности женщин, страдающих привычным выкидышем, должно носить выраженный профилактический характер (режим питания, труда и отдыха, пребывание на свежем воздухе, психотерапия и пр.). При наступлении беременности рекомендуется назначать прогестерон внутримышечно в течение 10 дней в начале 2, 4, 7-го месяцев беременности. </p>\r\n<p>При угрозе прерывания беременности — немедленная госпитализация и лечение, как и при первичном самопроизвольном аборте. После исчезновения симптомов угрожающего выкидыша беременная должна оставаться в стационаре еще 10—15 дней, затем ее выписывают для амбулаторного наблюдения. </p>\r\n<p>При гормональной терапии угрожающего выкидыша большое значение имеет определение экскреции прегнандиола и эстрогенов, позволяющее проводить более рациональное лечение. При пониженном количестве прегнандиола целесообразно назначение прогестерона; если же экскреция прегнандиола в пределах нормы, прогестерон противопоказан, так как при этом опасность наступления выкидыша увеличивается. При низком уровне экскреции прегнандиола и эстрогенов ряд авторов указывает на хорошие результаты от применения диэтилстильбэстрола. </p>\r\n<p> </p>",
"prevention": "<p>Главные принципы профилактики: </p>\r\n<ol>\r\n<li>Выявление женщин, входящих в группу риска развития невынашивания беременности. </li>\r\n<li>Целенаправленное обследование супружеской пары до беременности и рациональная их подготовка. </li>\r\n<li>Систематический контроль над возможным возникновением инфекционных осложнений и адекватная противовоспалительная, антибактериальная и иммунотерапия. </li>\r\n<li>Своевременное диагностирование шеечной недостаточности посредством мануальной оценки и проведения ультразвукового исследования с помощью трансвагинального датчика до 24 недель беременности, а при многоплодии — до 26-27 недель. </li>\r\n<li>Проведение рациональной терапии сопутствующих экстрагенитальных заболеваний. </li>\r\n<li>Профилактика и своевременное лечение нарушений тромбофилического генеза и плацентарной недостаточности с ранних сроков беременности. </li>\r\n</ol>\r\n<p> </p>",
"clinical_picture": "<p>Чаще всего выкидыш происходит в первые 2 месяца беременности, а при истмико-цервикальной недостаточности — после 14-й недели беременности. Появляются схваткообразные боли в нижних отделах живота и/или в поясничной области и кровянистые выделения или кровотечение из половых путей. Через некоторое время все эти симптомы выкидыша могут полностью прекратиться, после чего возобновиться снова. При привычном невынашивании характерно прерывание трех и более беременностей в сроке до 22 недель. <br class=\"SCXW70246934\" /> </p>",
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"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 156,
"standards": []
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