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"code": "O82",
"name": "Кесарево сечение",
"icd_name": "Роды одноплодные, родоразрешение посредством кесарева сечения",
"gender": 2,
"age_min": 18,
"age_max": 50,
"cause": [
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"periodicity": 1,
"slug": "o82_kesarevo_sechenie",
"lead": "Кесарево сечение — родоразрешающая операция, при которой плод и послед извлекают через произведённый разрез на матке.\r\n",
"description": "Кесарево сечение — родоразрешающая операция, при которой плод и послед извлекают через произведённый разрез на матке.\r\n\r\nКесарево сечение — одна из самых распространённых операций в акушерской практике, относящаяся к неотложным пособиям, которым обязан владеть каждый акушер-гинеколог, а иногда кесарево сечение приходится проводить врачу любой специальности, владеющему оперативной техникой.\r\n\r\n",
"etiology": "<p>Показания к кесареву сечению подразделяют на абсолютные и относительные. Перечни абсолютных показаний разных авторов отличаются и их постоянно меняют, так как многие показания, которые в прошлом считали относительными, в настоящее время рассматривают как абсолютные.</p>\r\n<p>Для стандартизации показаний к кесареву сечению целесообразно разделить их на 3 основные группы (в перечень включены показания, связанные с высоким риском для здоровья и жизни матери и ребёнка).</p>\r\n<p>· Показания к плановому кесаревому сечению во время беременности.<br />- Полное предлежание плаценты.<br />- Несостоятельность рубца на матке (после операции кесарево сечение, миомэктомии, перфорации матки, удаления рудиментарного рога, иссечения угла матки при трубной беременности).<br />- Два и более рубца на матке.<br />- Препятствие со стороны родовых путей для рождения ребёнка (анатомически узкий таз II и более степени сужения, таза, опухоли матки, яичников, органов малого таза).<br />- Выраженный симфизит.<br />- Предположительно крупный плод (масса тела плода более 4500 г).<br />- Выраженные рубцовые сужения шейки матки и влагалища.<br />- Наличие в анамнезе пластических операций на шейке матки, влагалище, ушивания мочеполовых и кишечнополовых свищей, разрыва промежности III степени.<br />- Тазовое предлежание, при массе тела плода более 3600–3800 г (в зависимости от размеров таза пациентки) или менее 2000 г, разгибание головки III степени по данным УЗИ, смешанное ягодичноножное предлежание.<br />- При многоплодной беременности: тазовое предлежание первого плода при двойне у первородящих, тройня (или большее количество плодов), сросшиеся близнецы.<br />- Монохориальная, моноамниотическая двойня.<br />- Злокачественное .<br />- Множественная миома матки с наличием крупных узлов, особенно в области нижнего сегмента матки, нарушение питания узлов.<br />- Устойчивое поперечное положение плода.<br />- Тяжёлые формы гестоза, эклампсия при неэффективности терапии.<br />- ЗРП III степени, при эффективности её лечения.<br />- Миопия высокой степени с изменениями на глазном дне.<br />- Острый генитальный ( в области наружных половых органов).<br />- Пересадка почки в анамнезе.<br />- Гибель или инвалидизация ребёнка при предыдущих родах.<br />- ЭКО, особенно неоднократное, при наличии дополнительных осложнений.</p>\r\n<p>· Показания к экстренному кесареву сечению во время беременности.<br />- Любой вариант предлежания плаценты, .<br />- ПОНРП.<br />- Угрожающий, начавшийся, свершившийся разрыв матки по рубцу.<br />- Острая гипоксия плода.<br />- Экстрагенитальные заболевания, ухудшение состояния беременной.<br />- Состояние агонии или внезапная смерть женщины при наличии живого плода.</p>\r\n<p>· Показания к экстренному кесареву сечению во время родов те же, что и во время беременности. Кроме того, может возникнуть необходимость кесарева сечения при следующих осложнениях родов.<br />- Не корригируемые нарушения сократительной деятельности матки (, дискоординация).<br />- Клинически узкий таз.<br />- Выпадение пуповины или мелких частей плода при головном предлежании плода.<br />- Угрожающий, начавшийся или свершившийся разрыв матки.<br />- Ножное предлежание плода.</p>\r\n<p>При наличии указанных показаний к кесареву сечению врач может принять решение провести роды через естественные родовые пути, но при этом он несёт моральную, а иногда и юридическую ответственность в случае неблагоприятного исхода для матери и плода.</p>",
"pathogenesis": "",
"diagnostics": "<p>Несмотря на кажущуюся техническую простоту кесарева сечения, эту операцию относят к разряду сложных оперативных вмешательств (особенно повторное кесарево сечение).</p>\r\n<p>Наиболее рациональным методом кесарева сечения в настоящее время считают операцию в нижнем сегменте матки поперечным разрезом. Однако можно (крайне редко) производить и продольный разрез на матке по средней линии.</p>",
"treatment": "<p>Осложнения возможны на всех этапах операции.</p>\r\n<p>· При поперечном рассечении кожи, подкожной клетчатки и апоневроза по Пфанненштилю одним из наиболее частых осложнений бывает из сосудов передней брюшной стенки, которое в послеоперационном периоде может привести к образованию подапоневротической гематомы.</p>\r\n<p>· Одним из осложнений во время кесарева сечения, особенно повторного, является ранение соседних органов: мочевого пузыря, мочеточника, кишечника.</p>\r\n<p>· Наиболее частое осложнение при кесаревом сечении — .<br />- Оно может возникать при рассечении матки в случае продления разреза в латеральную сторону и ранения сосудистого пучка. Очень серьёзным осложнением считают , обусловленное гипотонией или атонией матки, нарушением свёртывающей системы крови.<br />- Для предотвращения большой кровопотери после кесарева сечения необходимо в течение суток вести тщательное наблюдение за состоянием родильницы (цвет кожных покровов, пульс, АД) и особенно следить за состоянием матки, кровяными выделениями из половых путей.<br />- При кровотечении в раннем послеоперационном периоде следует попытаться остановить консервативными средствами: наружный массаж матки, инструментальное опорожнение матки, внутривенное введение утеротонических средств, инфузионнотрансфузионная терапия с использованием свежезамороженной плазмы. При отсутствии эффекта показана релапаротомия. Начинать операцию целесообразно с двусторонней перевязки внутренней подвздошной артерии. Отсутствие эффекта считают показанием к экстирпации матки. Хорошие результаты по остановке маточного кровотечения получены при эмболизации маточных артерий. При проведении трансфузионноинфузионной терапии для восстановления кровопотери и профилактики (а также лечения) ДВСсиндрома эффективно использование свежезамороженной плазмы и по показаниям эритроцитарной массы.</p>\r\n<p>· Неблагоприятным последствием абдоминального родоразрешения служат гнойносептические осложнения, которые могут быть причиной материнской смертности после операции. В настоящее время летальный исход от инфекции следует рассматривать как результат фонового состояния женщины (инфицирование), погрешностей в процессе выполнения операции, недостаточной хирургической квалификации врача. Послеоперационные инфекционные осложнения могут проявляться эндометритом, тромбофлебитом, нагноением раны. Наиболее тяжёлым и опасным для жизни женщины бывает перитонит.</p>\r\n<p>При производстве кесарева сечения в плановом порядке частота послеоперационных осложнений в 2–3 раза меньше, чем при экстренной операции, поэтому необходимо стремиться при наличии показаний к своевременному проведению плановых операций кесарева сечения.</p>",
"prevention": "",
"clinical_picture": "<p>Если во время беременности выявлены показания к операции кесарево сечение, предпочтительнее операцию осуществлять в плановом порядке, поскольку доказано, что частота осложнений для матери и ребёнка при этом значительно меньше, чем при экстренном вмешательстве. Однако вне зависимости от времени проведения операции не всегда можно предотвратить нарушения здоровья у плода, так как его состояние может измениться до операции. Особенно неблагоприятно сочетание недоношенности или переношенности с гипоксией плода. Недостаточный разрез на матке также может быть причиной травмы как недоношенного, так и переношенного плода (повреждение спинного и головного мозга).</p>\r\n<p>Кесарево сечение выполняют также по комбинированным показаниям, т.е. при наличии совокупности нескольких осложнений беременности и родов, каждое из которых в отдельности не считают основанием для производства кесарева сечения, но вместе их рассматривают в качестве реальной угрозы для жизни плода в случае родоразрешения через естественные родовые пути (переношенная беременность, роды у первородящих в возрасте старше 30 лет, мертворождение или невынашивание в анамнезе, предшествующее длительное , крупный плод, тазовое предлежание и др.).<br /><br /></p>",
"image": null,
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{
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}
]
}
