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},
"code": "O05",
"name": "Другие виды аборта",
"icd_name": "Другие виды аборта",
"gender": 2,
"age_min": 10,
"age_max": 59,
"cause": [
3
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"periodicity": 1,
"slug": "o05_drugie_vidy_aborta",
"lead": "Нарушение здоровья, относящееся к группе беременность с абортивным исходом",
"description": " Аборт (или выкидыш) – это спонтанное прерывание беременности и изгнание нежизнеспособного плода из полости матки. ",
"etiology": "<p>Ранние аборты чаще всего обусловлены хромосомной патологией, несколько реже – нарушением процесса имплантации оплодотворённой яйцеклетки в слизистую оболочку матки. Причинами данной патологии могут становиться следующие нарушения: </p>\r\n<ul>\r\n<li>генетические аномалии развития плода (хромосомные аномалии, несовместимые с жизнью); </li>\r\n<li>эндокринная патология матери (сахарный диабет, дефицит прогестерона, заболевания щитовидной железы, гиперандрогения, дисфункция яичников); </li>\r\n<li>острые инфекционно-воспалительные процессы (ангина, ОРВИ, токсоплазмоз, микоплазмоз, краснуха, хламидиоз, аппендицит, аднексит, эндометрит и т.п.); </li>\r\n<li>чрезмерная физическая нагрузка, падения и травмы; </li>\r\n<li>истмико-цервикальная недостаточность; </li>\r\n<li>нарушения формирования плаценты; </li>\r\n<li>синдром гиперкоагуляции (усиленной свертываемости крови); </li>\r\n<li>аномалии формирования матки (гипоплазия матки, седловидная или двурогая матка); </li>\r\n<li>аутоиммунная патология (антифосфолипидный синдром, дисплазии соединительной ткани); </li>\r\n<li>выскабливания полости матки, аборты в анамнезе; </li>\r\n<li>деформации матки (спайки, синехии, полипы, миома, внутриматочная перегородка); </li>\r\n<li>резус-конфликт. </li>\r\n</ul>\r\n<p>Кроме того, риск самопроизвольного аборта повышает наличие соматической патологии у матери (почечной недостаточности, артериальной гипертензии и т.п.), дефицит некоторых витаминов (главным образом, фолиевой кислоты), многоплодная беременность, вредные привычки матери, психоэмоциональные нагрузки, зачатие методом экстракорпорального оплодотворения, инвазивные методики пренатальной диагностики (кордоцентез, биопсия хориона, амниоцентез), а также плохая экологическая обстановка, приём некоторых лекарств и несбалансированное питание. </p>",
"pathogenesis": "<p> </p>\r\n<p>Механизм аборта 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>\r\n<p>Частичное отделение плодного яйца вследствие технических ошибок или недостаточной сократительной активности миометрия под участком имплантации зародыша, задержка его частей в матке из-за наличия механических препятствий (миоматозный узел, закрытый шеечный канал и др.) делает невозможным адекватное сокращение стенки органа. В результате продолжается кровотечение из зияющих сосудов, возникает характерная боль и формируется питательный субстрат для возможного инфицирования. </p>",
"diagnostics": "<p>Диагноз аборт ставится на основании клинической симптоматики, результатов влагалищного, бимануального осмотра, ультразвукового исследования. </p>\r\n<p>Гинекологический осмотр позволяет оценить состояние шейки матки, обнаружить выделения или кровотечение из канала шейки матки, изгнание плодного яйца и его остатков. </p>\r\n<p>Бимануальное исследование способствует определению размеров матки, ее консистенции и тонуса. </p>\r\n<p>УЗИ помогает установить признаки самопроизвольного прерывания беременности: отсутствие эмбриона в плодном яйце, отслойку плодного яйца (плаценты), несоответствие размеров эмбриона (плода) сроку гестации, отсутствие сердцебиения у плода. </p>\r\n<p>При диагностике производится общий анализ крови, определение уровня ХГЧ и прогестерона в крови, резус-фактора, количества тромбоцитов, уровня фибриногена. </p>\r\n<p>При подозрении на инфицированный аборт исследуются бакпосевы крови, мочи и материала, полученного после выскабливания. </p>\r\n<p>При привычном самопроизвольном прерывании беременности проводится цитогенетическое исследование остатков плодного яйца. </p>",
"treatment": "<p> </p>\r\n<p>Основными задачами являются удаление из полости матки погибшего плода и его частей, остановка кровотечения и предупреждение возможных инфекционных осложнений. </p>\r\n<p>Очищение полости матки. Для удаления оставшегося плодного яйца применяют абортцанг, после чего с учетом гестационного срока выполняют вакуум-аспирацию (до 12 недели беременности) или классический кюретаж маточных стенок (с 12 недели и далее). Эффективное ведение пациентки без полной чистки маточной полости невозможно. Для оптического контроля качества вмешательства может использоваться гистероскопия. </p>\r\n<p>Остановка маточного кровотечения. При сочетании неполного прерывания беременности с коагулопатическими и гемодинамическими расстройствами в зависимости от результатов лабораторных анализов капельно вводят гормон окситоцин на растворе Рингера или физрастворе. В исключительных случаях при значительной кровопотере рекомендованы гемостатики, переливание крови или ее компонентов. </p>\r\n<p>Антибактериальная терапия. Применение антибиотиков широкого спектра действия прямо показано при клинических и лабораторных признаках инфекционного процесса. С профилактической целью препараты с антимикробным действием вводят при поздней диагностике неполного отхождения плодного яйца. Курс антибиотикотерапии длится от 7 до 10 дней. </p>",
"prevention": "<p>В целях профилактики аборта рекомендуется вести здоровый образ жизни, своевременно лечить как соматическую, так и гинекологическую патологию, а также регулярно посещать гинеколога и становиться на учёт при беременности. В качестве вторичной профилактики рекомендуется планировать очередную беременность не ранее, чем через 3-4 месяца после самопроизвольного аборта. </p>",
"clinical_picture": "<p>Клиническая картина неполного аборта является продолжением симптоматики самопроизвольного выкидыша в ходу или постепенно развивается в течение нескольких часов после хирургического аборта. При лекарственном прерывании гестации патологические признаки могут появиться спустя несколько суток и даже недель после приема медикаментов.</p>\r\n<p>Незавершенный аборт проявляется интенсивными схваткообразными болями внизу живота, зачастую иррадиирующими в поясницу и крестец, а также обильным маточным кровотечением с возможным присутствием в выделениях фрагментов абортивного материала. Реже болезненные ощущения имеют тянущий характер. О присоединении инфекции свидетельствует появление резкого гнилостного запаха вагинальных выделений, повышение температуры тела до 37,5-38,0° С и выше. При утяжелении патологии пациентки жалуются на слабость, головокружение, обморочные состояния. </p>\r\n<p>При полном прерывании беременности плодное яйцо изгоняется из матки полностью, матка сокращается и кровотечение останавливается. </p>\r\n<p>К ранним осложнениям аборта относятся следующие: </p>\r\n<ul>\r\n<li>перфорация (нарушение целостности) стенки матки. Это одно из самых страшных осложнений, которое может привести также и к повреждению мочевого пузыря, кишечника, развитию перитонита; </li>\r\n<li>кровотечения; </li>\r\n<li>эмболия (закупорка сосудов); </li>\r\n<li>нарушение свертываемости крови; </li>\r\n<li>повреждение шейки матки; </li>\r\n<li>неполное удаление плодного яйца; </li>\r\n<li>обострение хронических заболеваний половой системы (эндометрит, сальпингоофорит и другие); </li>\r\n<li>занос инфекции в полость матки (так называемый инфицированный аборт). </li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 158,
"standards": [
4883
]
},
{
"id": 13259,
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