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},
"code": "O33",
"name": "Медицинская помощь матери при установленном или предполагаемом несоответствии размеров таза и плода",
"icd_name": "Медицинская помощь матери при установленном или предполагаемом несоответствии размеров таза и плода",
"gender": 2,
"age_min": 18,
"age_max": 50,
"cause": [
0
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"periodicity": 1,
"slug": "o33_medicinskaya_pomosch_materi_pri_ustanovlennom_ili_predpolagaemom_nesootvetstvii_razmerov_taza_i_ploda",
"lead": "Плод считают крупным, если его масса превышает 4000 г, и гигантским, если масса превышает 5000 г. Термин «крупный плод» используют только в тех случаях, когда масса тела не зависит от различных врождённых новообразований и других заболевани",
"description": "Плод считают крупным, если его масса превышает 4000 г, и гигантским, если масса превышает 5000 г. Термин «крупный плод» используют только в тех случаях, когда масса тела не зависит от различных врождённых новообразований и других заболеваний плода (эритробластоз, тератома, гидроцефалия и др.).\r\n\r\n",
"etiology": "<p>Этиология чрезмерного развития плода изучена недостаточно. Существуют предположения о том, что у некоторых женщин каждая беременность продолжается дольше, чем обычно; чаще всего данное отклонение наблюдают у женщин, имеющих в анамнезе упоминание о позднем начале и большой длительности менструаций.</p>\r\n<p>При обычной продолжительности беременности крупные дети рождаются вследствие эндокринных нарушений в организме матери. Известную роль играют также наследственные факторы, на что указывают исследования авторов, установивших, что крупные дети часто рождаются от высоких родителей крепкого телосложения.</p>\r\n<p>В группу риска возможного рождения крупного плода беременных включают по следующим параметрам:<br />·многорожавшие женщины старше 30 лет;<br />·женщины, имевшие до родов массу тела более 70 кг и рост более 170 см;<br />·беременные с прибавкой в массе тела более 15 кг;<br />·больные сахарным диабетом;<br />·беременные с перенашиванием;<br />·предшествующим рождением крупного плода.</p>\r\n<p>Основная причина развития крупного плода — неправильное питание матери. Большое число крупных детейрождается у многорожавших женщин, находящихся в состоянии предиабета, страдающих сахарным диабетом или ожирением.</p>",
"pathogenesis": "<p>Основной этиологический фактор формирования макросомии у плода при ожирении — избыточное и нерациональное питание беременной, нарушение белкового, липидного и углеводного обмена у плода, внутриутробное поражение печени и поджелудочной железы, развитие метаболического ацидоза и гипоксии плода с одновременной активацией компенсаторно-приспособительных реакций в плаценте. Отягощающее обстоятельство — использование во время беременности лекарственных препаратов с анаболическим действием (гестагены, оротовая кислота, инозин, кортикостероиды, глюкоза и т.д.).</p>",
"diagnostics": "<p>Наиболее точным методом диагностики крупного плода считают УЗИ, позволяющее точно определить размеры ирассчитать предполагаемую массу тела плода. Наиболее важные показатели фетометрии — величинабипариетального размера головки, окружность живота, длина бедренной кости плода, отношение длины бедренной кости к окружности живота.</p>",
"treatment": "<p>Течение беременности при крупном плоде почти не отличается от физиологического. Возможно развитие синдрома сдавления нижней полой вены и нарушение функции желудочно-кишечного тракта.</p>\r\n<p>При родах крупным плодом часто возникают различные осложнения. К ним относят первичную и вторичную <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a> родовой деятельности, преждевременное и раннее излитие околоплодных вод, большую длительность родов. В последовом и раннем послеродовом периоде чаще возникают гипотонические кровотечения. В процессе родов возможно выявление несоответствия между размерами головки плода и таза матери, т.е. развитие функционально узкого таза. После рождения головки нередко возникают затруднения при выведении плечевого пояса. Роды крупным плодом характеризует большая частота травматизма матери и плода.</p>\r\n<p>При выявлении аномалий родовой деятельности, несоответствия размеров головки с тазом матери, гипоксии плода роды следует закончить экстренной операцией кесарево сечение. </p>",
"prevention": "<p>Специфической профилактики нет.</p>",
"clinical_picture": "<p>Клинический диагноз крупного плода в антенатальный период основан на данных измерения высоты дна матки, окружности живота, головки плода, пальпации и на вычислении предполагаемой массы тела плода. Наиболее вероятные признаки крупного плода — значительное увеличение размеров матки; высота дная матки превышает 42 см. Следует помнить, что подобное увеличение возможно при многоплодной беременности и многоводии.</p>\r\n<p>Необходимо выяснить, в каком возрасте у беременной начались менструации, какова продолжительностьменструального цикла, уточнить дату последней менструации, массу тела детей от предшествовавших родов и пр.</p>\r\n<p>Заслуживают внимания рост, масса тела и сложение родственников, особенно мужа.</p>\r\n<p> </p>",
"image": null,
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"parent": null,
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}
]
}