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"description": "Преждевременными считаются роды, произошедшие на сроке от 22 до 37 нед беременности (154–259 дней беременности, считая от первого дня последней менструации).\r\nПреждевременные роды неблагоприятны для ребёнка. При появлении болей внизу живота, напряжении матки, подозрении на излитие вод следует немедленно обратиться к врачу. Рекомендации к госпитализации следует выполнять неукоснительно.",
"etiology": "<p>Гормональные нарушения, инфекция полового тракта и их сочетание — основные этиологические факторы преждевременных родов. Нарушения в системе гемостаза — ещё один механизм прерывания беременности.</p>\r\n<p>Преждевременные роды на сроке 22–27 нед беременности чаще обусловлены инфекционной этиологией и врождённой наследственной патологией плода. На этом сроке лёгкие плода незрелые, добиться ускорения их созревания назначением медикаментозных средств матери за короткий период времени не удаётся. В связи с такими физиологическими особенностями в этот период исход для плода в этой группе наиболее неблагоприятный, чрезвычайно высока смертность и заболеваемость. В 28–33 нед инфекционная этиология преобладает только в 50% случаев, с 34 нед преждевременные роды обусловлены множеством других причин, не связанных с инфекцией.</p>",
"pathogenesis": "<p>Патогенез преждевременных родов связан с:<br />· повышенным выбросом цитокинов при инфекционном поражении;<br />· коагулопатическими процессами, приводящими к микротромбозу плаценты с последующей отслойкой;<br />· повышением количества и активацией окситоциновых рецепторов в миометрии, что способствует открытию кальциевых каналов миоцитов и инициации сократительной деятельности матки.</p>",
"diagnostics": "<p>Диагностика преждевременных родов не представляет трудности и основывается на жалобах беременной, данных общего осмотра и влагалищного исследования.</p>\r\n<p>Лабораторную диагностику проводят с целью определения этиологии угрозы преждевременных родов. При подозрении на инфекционную этиологию производят посев из цервикального канала с обязательным определением чувствительности к антибиотикам, при подозрении на вирусную инфекцию проводят качественную ПЦР.</p>",
"treatment": "<p>При угрозе преждевременных родов показан постельный режим, физический, эмоциональный и половой покой.</p>\r\n<p>Физиотерапевтические методы — электрофорез магния синусоидальным модулированным током, иглорефлексотерапия, электроаналгезия.</p>\r\n<p>Медикаментозное лечение угрозы преждевременных родов комплексное, включает в себя:<br />· токолитическую терапию;<br />· профилактику РДС плода (в случаях необходимости);<br />· седативную и симптоматическую терапию.</p>",
"prevention": "<p>Наблюдение за беременной, своевременная диагностика и лечение возникающих нарушений (инфекции, ИЦН, сопутствующей экстрагенитальной патологии).</p>\r\n<p>К профилактическим мероприятиям относят:</p>\r\n<p>· рациональную предгравидарную подготовку;<br />· выделение групп риска по преждевременным родам;<br />· профилактику плацентарной недостаточности с ранних сроков беременности.</p>\r\n<p> </p>",
"clinical_picture": "<p>· повышение тонуса матки. Беременная предъявляет жалобы на тянущие либо схваткообразные боли внизу живота и в пояснице;<br />· чувство давления и распирания в области влагалища;<br />· учащённое мочеиспускание — симптом низкого расположения предлежащей части.</p>",
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"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;\">Диагноз первичной слабости родовой деятельности ставится, если схватки у роженицы короткие, редкие, слабые, а через несколько часов родовой деятельности (у первородящих – 6 часов, у повторнородящих – 3 часа) не произошло раскрытие шейки матки на 2-3 см.</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;\">Диагноз вторичной слабости родовой деятельность ставится, если схватки со временем ослабевают или вовсе прекращаются, а шейка матки прекращает раскрываться.</span></p>",
"treatment": "<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; 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;\" 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;\">Окситоцин</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" 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;\">Иногда, при затянувшемся втором периоде родов, родоразрешение проводят путём оперативного вмешательства</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" 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;\">Кесарево сечение при несоответствии размеров плода размерам таза или гипотонической дисфункции матки, не поддающейся лечению</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;\">Если 1-й или 2-ой период родов развиваются очень медленно и масса плода < 5 000 г (< 4 500 г у женщин с диабетом), родовую деятельность можно усилить введением окситоцина, которым лечат гипотоническую дисфункцию. Если удается нормализовать родовую деятельность, роды продолжаются. Если нет, причиной может быть несоответствие размеров плода и таза; в этом случае показано кесарево сечение.</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;\">Если 2-й период родов продолжается длительное время, могут оказаться целесообразными наложение акушерских щипцов или вакуум-экстракция, после оценки размеров таза матери и плода, предлежания, уровня стояния предлежащей части</span></p>",
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