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"code": "N95",
"name": "Нарушения менопаузы и другие нарушения в околоменопаузном периоде",
"icd_name": "Нарушения менопаузы и другие нарушения в околоменопаузном периоде",
"gender": 2,
"age_min": 40,
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"slug": "n95_narusheniya_menopauzy_i_drugie_narusheniya_v_okolomenopauznom_periode",
"lead": "Атрофический вагинит — симптомокомплекс, обусловленный значительным снижением содержания эстрогенов, который приводит к истончению многослойного плоского эпителия влагалища, его сухости, диспареунии, зуду и воспалительной реакции.",
"description": "Заболевание характерно для женщин пожилого возраста и пациенток с искусственной менопаузой. Атрофический вагинит манифестирует спустя 5–6 лет после наступления естественной или искусственной менопаузы. Учитывая общую тенденцию к увеличению доли лиц пожилого и старческого возраста, а также количества больных после радикальных операций на яичниках, отмечается выраженный рост регистрации атрофического вагинита в ряде регионов, где заместительная гормональная терапия не используется широко.",
"etiology": "<p>Основная причина атрофического вагинита — гипоэстрогения на фоне искусственной менопаузы (оперативное лечение, лучевая терапия), либо обусловленная общим физиологическим старением организма.</p>",
"pathogenesis": "<p>Многослойный плоский эпителий влагалища — мишень для эстрогенов, при снижении уровня которых наблюдается постепенное истончение эпителия. Это приводит к значительному уменьшению числа клеток, содержащих гликоген. Гликоген — основной питательный субстрат для лактобактерий. Кислота — основной продукт жизнедеятельности лактобацилл — поддерживает кислый рН влагалища. При снижении содержания гликогена отмечается постепенное уменьшение колонизации влагалища лактобактериями, увеличение рН и, как следствие, колонизация влагалища другими условнопатогенными микроорганизмами (вызывают локальную воспалительную реакцию слизистой влагалища).</p>",
"diagnostics": "<p>Диагностика атрофического вагинита не вызывает сложностей. Она основана на данных анамнеза, осмотра, кольпоскопии, кольпоцитологии, определении рН влагалища, микробиологическом исследовании и определении индекса вагинального здоровья. При кольпоскопии характерны истончение и лёгкая травматизация стенок влагалища и эпителия шейки матки, участки кровоизлияний. При пробе Шиллера — слабое неравномерное окрашивание. При кольпоцитологическом исследовании выявляют клетки, типичные для атрофических изменений (преобладают клетки базального и парабазального слоев), рН влагалища возрастает. Для исключения возможных специфических причин вагинита и исключения инфекций, передающихся половым путём, рекомендуют дополнительно исследовать содержимое влагалищного и шеечного секретов методом полимеразной цепной реакции.</p>",
"treatment": "<p>Единственный метод лечения атрофического вагинита — заместительная гормональная терапия препаратами локального или системного действия, эффективность которых сопоставима независимо от способа введения. Начало терапии желательно не позднее 18–36 мес от наступления менопаузы.</p>",
"prevention": "<p>Единственный метод профилактики — заместительная гормональная терапия.</p>",
"clinical_picture": "<p>Локальные клинические проявления гипоэстрогении во влагалище: сухость, , жжение и . Изменения микробиоценоза влагалища, характерные для постменопаузального периода, приводят к рецидивирующим неспецифическим упорным кольпитам.</p>",
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},
"code": "N87",
"name": "Дисплазия шейки матки",
"icd_name": "Дисплазия шейки матки",
"gender": 2,
"age_min": 10,
"age_max": 100,
"cause": [
3,
2,
8
],
"periodicity": 1,
"slug": "n87_displaziya_sheyki_matki",
"lead": "Нарушение здоровья, относящееся к группе невоспалительные болезни женских половых органов",
"description": "Дисплазия шейки матки (цервикальная дисплазия) – это состояние покрывающего шейку матки эпителия, которое характеризуется изменением числа слоев и строения образующих его клеток. При этом в процесс не вовлекается базальная мембрана и самые верхние клеточные слои. Дисплазия относится к заболеваниям, которые при стечении обстоятельств могут стать причиной развития злокачественной опухоли шейки матки.",
"etiology": "<p>Основной причиной считают инфицирование вирусом папилломы человека (ВПЧ). Заражение ВПЧ происходит только половым путем. Риск инфицирования повышен в следующих случаях:</p>\r\n<ul>\r\n<li>иммунодефицит – подавление иммунной реактивности хроническими заболеваниями, стрессами, лекарственными препаратами, неправильным питанием и т. д.;</li>\r\n<li>табакокурение активное и пассивное – увеличивает вероятность развития дисплазии шейки матки в 4 раза;</li>\r\n<li>затяжные хронические воспаления половых органов;</li>\r\n<li>нарушения гормонального фона, вызванные менопаузой, беременностью, употреблением гормоносодержащих лекарств;</li>\r\n<li>ранняя половая жизнь и роды;</li>\r\n<li>травматические повреждения шейки матки.</li>\r\n</ul>",
"pathogenesis": "<p>При формировании патологического процесса происходит нарушение слоев эпителия, поверхностные и переходные эпителиоциты содержат делящиеся (митотически активные) клетки, которых в норме быть не должно. Это приводит к гиперплазии (увеличение количества эпителиоцитов) слизистой. Механизмом формирования дисплазии шейки матки является нарушение регуляции митоза клеток, вследствие которого происходит их деление в тех слоях слизистой, в которых этого не должно быть.</p>",
"diagnostics": "<p>Диагностика дисплазии шейки матки включает:</p>\r\n<ul>\r\n<li>осмотршейки матки при помощи влагалищных зеркал – с целью обнаружения видимых глазом, клинически выраженных форм дисплазии (изменение окраски слизистой, блеск вокруг наружного зева, пятна, разрастание эпителия и др.);</li>\r\n<li>кольпоскопия – осмотр шейки матки специальным оптическим аппаратом, увеличивающим изображение более чем в 10 раз и одновременное проведение диагностических проб - обработки шейки матки раствором Люголя и уксусной кислоты;</li>\r\n<li>ПАП-мазок ф– при дисплазии шейки матки исследование под микроскопом соскоба, полученного с разных участков, позволяет выявить атипичные клетки. Также с помощью ПАП-мазка обнаруживаются клетки-маркеры папилломавирусной инфекции, имеющие сморщенные ядра и ободок, являющиеся местом локализации вируса папилломы человека;</li>\r\n<li>гистологического исследованиябиоптата – фрагмента ткани, взятого в ходе биопсии шейки матки из зоны, подозрительной на дисплазию. Является наиболее информативным методом выявления дисплазии шейки матки;</li>\r\n</ul>\r\n<p>иммунологических ПЦР-методов – для выявления ВПЧ-инфекции, установления штаммов вируса и вирусной нагрузки (концентрации вируса папилломы в организме). Выявление наличия или отсутствия онкогенных типов ВПЧ позволяет определить выбор метода лечения и тактику ведения пациентки с дисплазией шейки матки.</p>",
"treatment": "<p>Медикаментозное лечение включает в себя препараты для повышения иммунитета в виде иммуномодуляторов, а также средств интерферона. Применяют их при обширных поражениях и рецидивирующей форме дисплазии.</p>\r\n<p>К хирургическому лечению прибегают в случае двукратного положительного результата анализа на дисплазию. Перед любой оперативной методикой назначаются противовоспалительные препараты для санации очага. Очень часто после предоперационного лечения степень поражения дисплазией уменьшается в размерах или полностью исчезает. Операции всегда выполняют в первую фазу месячного цикла, а именно на 6-10 день, при условии отсутствия воспалительного процесса во влагалище и матке, а также беременности.</p>\r\n<p>Современные хирургические методики лечения дисплазии шейки матки следующие:</p>\r\n<ul>\r\n<li>Лазерная хирургия(лазерная вапоризация, лазерная конизация, лазерное прижигание). Это способ воздействия на патологические ткани посредством пучка лазера с низкой интенсивностью. Благодаря этому участки дисплазии нагреваются и разрушаются, на их месте образуется некроз.</li>\r\n<li>Холодовая деструкция(криодеструкции, криоконизация).</li>\r\n<li>Электрическая эксцизия(диатермокоагуляция, процедура петлевой электрической эксцизии).</li>\r\n<li>Конизация шейки матки. При ней специальным ножом в виде петли удаляют участок шейки конусовидной формы.</li>\r\n<li>Криотерапия.Данная технология предусматривает ликвидацию очага на шейке жидким азотом.</li>\r\n<li>Радиоволновая хирургия.</li>\r\n<li>Ампутация шейки матки. Радикальное удаление шейки при невозможности проведения или неэффективности других методов.</li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p>Для профилактики дисплазии шейки матки и ее рецидивов рекомендуется:</p>\r\n<ul>\r\n<li>включение в рацион питания всех микроэлементов и витаминов, в особенности витаминов А, группы В, селена;</li>\r\n<li>своевременная санация всех очагов инфекций;</li>\r\n<li>отказ от табакокурения;</li>\r\n<li>применение барьерной контрацепции (при случайных половых контактах);</li>\r\n<li>регулярное наблюдение гинеколога(1-2 раза в год) с исследованием цитологического соскоба с шейки матки</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Типичная клиническая картина провялятся в большинстве случаев уже в тяжелой степени дисплазии шейки матки и присоединении вторичной инфекции с развитием воспаления (цервицит, кольпит). </p>\r\n<p>Пациентка с дисплазией шейки матки может предъявлять следующие жалобы:</p>\r\n<ul>\r\n<li>бели (выделения) – обильные, с неприятным запахом;</li>\r\n<li>кровянистые выделения (часто контактные, то есть после полового акта, гинекологического осмотра);</li>\r\n<li>зуд;</li>\r\n<li>чувство жжения;</li>\r\n<li>боль, возникающая во время секса.</li>\r\n</ul>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
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"published": 2,
"parent": null,
"block_rubric": 156,
"standards": [
4892
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{
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"lead": "Область медицины, включающая в себя лечение 739 заболеваний. В 1042 клиниках России оказывается помощь по этому направлению медицины.",
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},
"code": "O00.0",
"name": "Абдоминальная [брюшная] беременность",
"icd_name": "Абдоминальная [брюшная] беременность",
"gender": 0,
"age_min": 15,
"age_max": 50,
"cause": [
"0"
],
"periodicity": 1,
"slug": "o00.0_abdominalnaya_bryushnaya_beremennost",
"lead": "беременность, при которой плодное яйцо имплантируется не в матке, а в брюшной полости",
"description": "<p><span id=\"docs-internal-guid-f68d8475-7fff-71fb-9fc2-7234086e446b\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Брюшная беременность – это беременность, при которой эмбрион имплантируется не в полости матки, а в области сальника, брюшины или на поверхности органов брюшной полости.</span></span></p>",
"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;\">Основными факторами, сопутствующими появлению брюшной беременности, 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;\">всевозможные заболевания яичников и матки;</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;\">изменение размера труб или их повреждение;</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;\">доброкачественные опухоли, кисты;</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;\">экстракорпоральное оплодотворение (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;\">частое и длительное использование внутриматочной спирали в качестве средства контрацепции;</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;\">болезни щитовидной железы или надпочечников;</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;\">высокий уровень гормона прогестерона;</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;\">излишнее употребление алкоголя и курение;</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;\">нервное перевозбуждение, состояние стресса;</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;\">зрелый возраст женщины.</span></li>\r\n</ul>\r\n<p> </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>",
"pathogenesis": "",
"diagnostics": "<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;\">Ранняя диагностика брюшной беременности чрезвычайно важна, поскольку позволяет избежать развития опасных осложнений, устранить угрозу для жизни и здоровья пациентки. Диагноз устанавливается на основании данных гинекологического осмотра и результатов ультразвукового исследования. Чтобы избежать диагностических ошибок, исследование начинают с идентификации шейки матки, затем визуализируют «пустую» матку и плодное яйцо, расположенное в стороне от матки. При проведении УЗИ на поздних сроках брюшной беременности обнаруживают необычную локализацию плаценты. Плод и плацента не окружены стенками матки.</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;\">В сомнительных случаях осуществляют лапароскопию – малоинвазивное лечебно-диагностическое вмешательство, позволяющее достоверно подтвердить брюшную беременность и в ряде случаев (на ранних сроках гестации) удалить плодное яйцо без проведения объемной операции. На поздних сроках, при прорастании ворсин плаценты в органы брюшной полости, требуется лапаротомия. Объем хирургического вмешательства при брюшной беременности определяется локализацией плаценты. Может потребоваться ушивание или резекция органа, наложение кишечного анастомоза и т. д.</span></p>\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;\">Прогноз для матери при раннем выявлении и своевременном оперативном лечении брюшной беременности обычно благоприятный. При поздней диагностике и развитии осложнений существует очень высокий риск неблагоприятного исхода (смерти в результате кровотечения, тяжелого повреждения внутренних органов). Вероятность благополучного донашивания брюшной беременности крайне мала.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-bff085e9-7fff-3e57-c4c3-0973e53c46ea\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Профилактика развития брюшной беременности основывается на своевременном лечении любых воспалительных заболеваний женской репродуктивной системы.</span></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;\">Первичные симптомы очень похожи на классическую беременность, среди них отмечают:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отсутствие менструации;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">тошноту;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сонливость;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ослабленное состояние;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">изменение вкуса и восприятия запахов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">изменения молочных желез.</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;\">Зачастую при осмотре врач-гинеколог находит эмбрион, отсутствующий в матке. Распознается увеличение органа, не соответствующее сроку. Нередко такое состояние диагностируется при многоплодной беременности, врожденных аномалиях развития матки или наличии миомы.</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;\">У пациенток имеются боли внизу живота, нарастает анемия или появляются другие неприятные ощущения, которые могут отличаться в зависимости от органа крепления плода. Такие осложнения дифференцируются с:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">угрозой возможного разрыва матки;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">несвоевременнйо отслойкой плаценты;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">угроой прерывания беременности.</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\"><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 брюшной беременности часто появляются признаки внутреннего кровотечения:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сильная слабость;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">головокружение;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">обморок;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">излишняя потливость;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">боль внизу живота;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">чрезмерная бледность кожи и слизистых.</span></li>\r\n</ul>",
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},
"code": "O00.2",
"name": "Яичниковая беременность",
"icd_name": "Яичниковая беременность",
"gender": 0,
"age_min": 15,
"age_max": 50,
"cause": [
"0"
],
"periodicity": 1,
"slug": "o00.2_yaichnikovaya_beremennost",
"lead": "гестационное осложнение, характеризующееся прикреплением эмбриона к тканям яичника",
"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;\">Причины яичниковой беременности различны. Как показали проведенные в данной области исследования и наблюдения, спровоцировать рассматриваемое отклонение от нормального течения беременности может:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Перенесенное инфекционное заболевание, протекавшее на маточных тканях, а также в случае воспаления эндометрия.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Простудные заболевания половых органов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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 развитии непроходимости маточных труб.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Это могут быть последствия перенесенного оперативного вмешательства, проводимого на органах малого таза или половых органах.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Яичниковую беременности могут спровоцировать изменения, затрагивающие генетическую и эндокринную области человеческого организма.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Наличие кисты или поликистозных образований.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Врожденная или приобретенная недоразвитость в развитии яичника.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Последствия проведенной лечебной терапии с применением сильнодействующих медикаментозных средств.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Терапия, проведенная для избавления женщины от бесплодия.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<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;\">Патогенез яичниковой беременности до настоящего времени не изучен. Существуют разные гипотезы механизма, препятствующего перемещению зиготы за пределы яичника: утолщение белочной оболочки гонады (воспалительного или иного генеза), патологическое ускорение развития и дифференцировки трофобласта, ввиду которого процесс имплантации начинается раньше времени, дисфункция фаллопиевых труб (нарушение перистальтики, захвата зиготы фимбриальными ворсинами, спазм).</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;\">Если яйцеклетка по каким-то причинам не вышла из разорвавшегося фолликула, сперматозоид может проникнуть в полость яичника, где произойдет оплодотворение, а затем прикрепление к фолликулярной стенке. Если выход яйцеклетки из граафова пузырька состоялся, но она почему-то не попала в воронку трубы, оплодотворение может произойти непосредственно в брюшной полости, после чего зигота внедряется в складки мезотелия на поверхности гонады.</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;\">Есть и другие версии прививки бластоцисты на поверхности яичника. Существует предположение, что большинство случаев поверхностной нидации является результатом полного трубного аборта живого эмбриона, а овариальная беременность – следствие его вторичной имплантации. Возможно, поверхностная имплантация обусловлена трансмиграцией оплодотворенной яйцеклетки – её переходом из контрлатерального органа через брюшную полость. Если к моменту достижения гонады бластоциста готова к нидаци, она может имплантироваться в яичник.</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 норме эмбрион прикрепляется к слизистой оболочке матки, где обеспечены условия, как для его нормального развития, так и для защиты материнских тканей от деструктивного воздействия в процессе плацентогенеза. При эктопической беременности такие условия отсутствуют. Растущее яйцо растягивает и без того тонкие стенки плодовместилища, а инвазия трофобласта, сопровождающаяся выделением протеолитических ферментов, прорастанием ворсин, усугубляет деструкцию, приводящую к разрыву капсулы, внутрибрюшному кровотечению различной интенсивности.</span></p>",
"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;\">Диагностика овариальной беременности проводится акушером-гинекологом. Врач может заподозрить эктопическую беременность, опираясь на анализ жалоб пациентки, находок во время гинекологического осмотра (синюшность слизистых шейки матки и влагалища, болезненное объёмное образование в области придатков, сохранение грушевидной формы матки, её недостаточное размягчение, отставание размеров). Стандартом диагностики развивающейся внематочной беременности в современной гинекологии является сопоставление данных ультразвукового исследования с результатами гормонального анализа.</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;\">Ультрасонография. Трансвагинальное УЗИ позволяет определить топическую локализацию беременности, отдифференцировать овариальную беременность от других форм. Используя современную аппаратуру, применяя технику цветового допплеровского картирования, эмбрион в яичнике можно обнаружить на самых ранних сроках.</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;\">Гормональный анализ. Позволяет установить наличие эктопически расположенной беременности. Маркёром роста яйца за пределами матки является уровень b-единицы хорионического гонадотропина крови. При нормальной гестации малых сроков в течение каждых двух суток отмечается прирост b-ХГЧ на две трети. Если эмбрион развивается вне матки, этот показатель составляет менее половины.</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 неинформативности УЗИ назначают МРТ, кюретаж матки, диагностическую лапароскопию. Ненарушенную овариальную беременность дифференцируют с прочими формами эктопической нидации, опухолевыми и опухолевидными образованиями яичника, сальпингоофоритом, пузырным заносом, нарушенную – с самопроизвольным абортом при маточной беременности, острым аппендицитом, перитонитом. При острой боли, положительных симптомах раздражения брюшной стенки и прочих признаках внутрибрюшного кровотечения оценивается степень тяжести кровопотери, гемостатических нарушений. Для этого выполняется коагулограмма, ОАК, измеряется диурез, артериальное давление, ЧСС, пульс.</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;\">Лечение проводится оперирующим гинекологом. В случае острого внутрибрюшного кровотечения требуется привлечение реаниматолога, трансфузиолога. Традиционно принято хирургическое лечение (отчасти в связи с поздней диагностикой патологии), однако всё более широкое применение находит медикаментозная терапия.</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;\">Хирургическое вмешательство. В хирургическом лечении нуждаются пациентки с нарушенной беременностью, значительным размером эмбриона, высокими значениями b-ХГЧ. Первоочерёдно выполняется гемостаз. Объём операции зависит от срока беременности, степени деструктивных изменений, варьирует от элиминации эмбриона до резекции яичника. К овари- , аднексэктомии приходится прибегать лишь в исключительных случаях.</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;\">Медикаментозное лечение. Консервативный метод показан при небольших размерах плодного яйца пациенткам с ненарушенной беременностью, низким уровнем b-ХГЧ. Медикаментозное лечение позволяет добиться хороших результатов, минимизировать риск спаечного процесса. Для задержки роста трофобласта назначаются локальные (в полость плодного яйца) инъекции цитостатического препарата (метотрексата).</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;\">Восполнение кровопотери. Интенсивная терапия проводится больным в тяжёлом состоянии на догоспитальном этапе и продолжается в оперблоке, параллельно с хирургической операцией. Для коррекции гемодинамических и гемостатических нарушений показана инфузионная терапия (кристаллоидными растворами, плазмозаменителями), применение антифибринолитиков, вазопрессоров. При массивном кровотечении для восполнения кровопотери выполняется гемотрансфузия, реинфузия аутокрови.</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;\">После оперативного вмешательства с целью профилактики спаечного процесса и, как следствие, бесплодия в течение двух-шести месяцев проводится реабилитационное лечение. В раннем послеоперационном периоде выполняется наложение искусственного гидроперитонеума, назначаются антибиотики. Позднее назначается физиотерапия, массаж. В этот период необходимо предохранение от 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>",
"prevention": "<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;\">Поскольку факторы риска патологии не ясны, чётких разработок в отношении первичной профилактики не существует. На этапе планирования беременности следует отказаться от внутриматочных контрацептивов в пользу барьерных, придерживаться мер предупреждения трубной беременности: прохождения прегравидарной подготовки с заблаговременной диагностикой, лечением заболеваний органов малого таза, коррекцией эндокринных нарушений. Вторичная профилактика включает раннюю постановку на учёт по беременности, противоспаечную терапию после операции.</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;\">Протекание беременности рассматриваемого типа продвигается без какой бы то ни было негативной симптоматики. Само развитие эмбриона проходит без явных отклонений, практически не имея отклонений от естественной маточной беременности. Даже на поздних сроках женщина начинает ощущать шевеление малыша. Такие сроки достигаются благодаря тому, что ткани яичника достаточно эластичны и способны до определенного момента растягиваться. Но такая идиллия происходит до поры до времени.</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 момент, когда размеры эмбриона достигли критических параметров (стенки яичника не в состоянии растягиваться дальше, достигнув своего предела), женщина начинает ощущать симптомы яичниковой беременности, которые начинают проявляться:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Появление явных признаков раннего токсикоза.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Увеличение молочных желез и их повышенная болезненность.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Продолжительные мажущие кровянистые выделения из влагалища.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Сильнейшими болями внизу живота, точечная боль, локализующаяся в месте развития беременности.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Боль начинает постепенно отдавать в поясничный отдел и/или толстый кишечник (анальное отверстие). Приступ может длиться от нескольких минут до ряда часов. На фоне приступа появляется слабость, головокружение, тошнота.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Резким падением артериального давления.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Появление болезненной дефекации.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Организм беременной переходит в обморочное или предобморочное состояние.</span></p>\r\n</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;\">Несколько позже, когда размерные параметры плода еще увеличились, у женщины открывается внутреннее кровотечение, боль становится интенсивнее. Ее нарастание способно спровоцировать потерь сознания от болевого шока. Данная симптоматика может сопровождаться ростом температурных показателей тела женщины. Комплекс перечисленных выше проявлений свидетельствует о разрыве органов.</span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 50,
"published": 1,
"parent": 6948,
"block_rubric": 158,
"standards": []
}
]
}
