Disease List

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            "description": "Плацентарная недостаточность — синдром, обусловленный морфофункциональными изменениями в плаценте, при прогрессировании которых развивается задержка развития плода, нередко сочетающаяся с гипоксией.",
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            "pathogenesis": "<p>Основную роль в патогенезе плацентарной недостаточности отводят нарушению маточноплацентарной перфузии, что приводит к снижению транспорта кислорода и питательных веществ через плаценту к плоду. </p>\r\n<p> </p>",
            "diagnostics": "<p>Беременные группы риска по развитию плацентарных нарушений нуждаются в регулярном клиническом наблюдении. При акушерском осмотре следует обращать внимание на следующие признаки:<br />· рост и вес беременной;<br />· окружность живота, высоту дна матки;<br />· тонус матки (повышен при угрозе прерывания беременности);<br />· наличие кровянистых выделений из половых путей;<br />· число шевелений плода, характер сердцебиения при аускультации (глухость сердечных тонов и изменение частоты сердцебиения).</p>\r\n<p> </p>\r\n<p>Наиболее часто среди инструментальных методов для диагностики плацентарных нарушений используют УЗИ и КТГ. Ультразвуковые методы играют ведущую роль в диагностике плацентарных нарушений и задержке развития плода. Во II и III триметре беременности в сроки ультразвукового скрининга (20–24 нед и 30–34 нед), а также по дополнительным показаниям выполняют ультразвуковую фетометрию и допплерометрическое исследование кровотока в артериях и венах функциональной системы мать–плацента–плод.</p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>",
            "treatment": "<p>Терапия плацентарной недостаточности в большой мере определяется необходимостью устранения причин нарушения кровообращения в плаценте. У пациенток с угрозой прерывания важным компонентом лечения плацентарной недостаточности является снижение тонуса маточной мускулатуры; при гестозе.</p>\r\n<p>В комплексную патогенетическую терапию плацентарной недостаточности включают, прежде всего, препараты, обладающие вазоактивным действием.  </p>\r\n<p>В последние годы широкое применение в акушерской практике для профилактики заболеваний, обусловливающих развитие плацентарной недостаточности и её лечения, применяют антиагреганты.</p>\r\n<p> </p>\r\n<p> </p>",
            "prevention": "<p>ПРофилактика включает широкий спектр медикментозных и немедикаментозных мероприятий.<br />· Лечение акушерских и экстрагенитальных заболеваний, предрасполагающих к развитию плацентарной недостаточности.<br />· Регуляция тканевого обмена и окислительно-восстановительных процессов у беременных групп риска по развитию плацентарной недостаточности. С этой целью назначают антиоксиданты, гепатопротекторы.<br />· Нормализация процессов возбуждения и торможения в ЦНС у беременных с астенической конституцией и повышенным уровнем тревожности. Для этого используют ноотропы; глицин, оказывающий значительный антистрессовый эффект.<br />· При вегетососудистой дистонии по гипотоническому типу хороший эффект оказывают адаптогены.<br />· Для нормализации сна используют комплексные фитопрепараты, содержащие экстракты валерианы, боярышника, мелиссы, хмеля, перечной и лимонной мяты.</p>\r\n<p>Лечебно-профилактические мероприятия должны включать диетотерапию, витаминотерапию, продукты и пищевые добавки, стимулирующие функцию кишечника (кисломолочные продукты, хлеб из муки грубого помола, ламинолакт).</p>",
            "clinical_picture": "<p>При хронической плацентарной недостаточности беременные предъявляют жалобы, характерные для акушерских и экстрагенитальных заболеваний, на фоне которых развивается хроническая или острая плацентарная недостаточность. Вместе с тем могут отмечать уменьшение числа шевелений плода. </p>",
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            "etiology": "<p>Среди причин предлежания плаценты выделяют два фактора: маточный и плодовый.</p>\r\n<p>Маточный фактор связан с дистрофическими изменениями слизистой оболочки матки, в результате чего происходит нарушение условия плацентации. К дистрофическим изменениям слизистой оболочки матки приводит хронический эндометрит; значительное количество родов и абортов в анамнезе, особенно при развитии послеродовых или послеоперационных эндометритов; наличие рубцов на матке после кесарева сечения или консервативной миомэктомии, курение.</p>\r\n<p>К плодовым факторам, способствующим предлежанию плаценты, относят снижение протеолитических свойств плодного яйца, когда прикрепление в верхних отделах матки невозможна. </p>",
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            "diagnostics": "<p>К клиническим признакам предлежания плаценты относят:<br />· кровяные выделения из половых путей яркого цвета при безболезненной матке;<br />· высокое стояние предлежащей части плода;<br />· неправильные положения или тазовые предлежания плода.</p>\r\n<p>При предлежании плаценты влагалищное исследование проводить нежелательно, так как может произойти отслойка плаценты, усиливающая <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a>. При отсутствии возможности УЗИ влагалищное исследование осуществляют крайне осторожно. При исследовании пальпируют губчатую ткань между предлежащей частью и пальцами акушера.</p>\r\n<p>Влагалищное исследование проводят при развёрнутой операционной, позволяющей экстренно произвести кесарево сечение вслучае появления обильных кровяных выделений.</p>\r\n<p> </p>",
            "treatment": "<p>В III триместре беременности при наличии предлежания плаценты и отсутствии кровяных выделений вопрос огоспитализации решают индивидуально. Если пациентка живет недалеко от родильного дома и может за 5–10 минут доехать до него, то возможно наблюдение ее врачами женской консультации до 32–33 нед. Если местожительство беременной значительно удалено от лечебного учреждения, она должна быть госпитализирована раньше.</p>\r\n<p>Беременность можно пролонгировать до 37–38 нед, после чего при любом варианте предлежания плаценты с целью профилактики массивного кровотечения в плановом порядке производят кесарево сечение. Рекомендован постельный режим.</p>",
            "prevention": "<p>Поскольку предлежание плаценты чаще возникает у многорожавших женщин с внутриматочными вмешательствами в анамнезе, снижение числа абортов, необоснованных консервативных миомэктомий, частоты кесарева сечения за счёт рационального ведения родов будут способствовать снижению частоты неправильного прикрепления плаценты.</p>",
            "clinical_picture": "<p>Главный симптом предлежания плаценты — <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a> из половых путей, возникающее внезапно среди полного здоровья, чаще в конце II–III триместра или с появлением первых схваток. Соответственно кровопотере возможны симптомы геморрагического шока. Чем больше степень предлежания плаценты, тем раньше происходит <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a>. Вытекающая из половых путей кровь яркоалого цвета. <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">Кровотечение</a> не сопровождается болевыми ощущениями; нередко рецидивирует, приводя к анемии беременных. На фоне анемии даже небольшая <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровопотеря</a> может способствовать развитию геморрагического шока.</p>\r\n<p>Общее состояние беременной при предлежании плаценты зависит от величины кровопотери. При этом необходимо учитывать кровь, скапливающуюся во влагалище (до 500 мл). Состояние плода зависит от тяжести анемии или геморрагического шока при кровопотере. При обильном кровотечении развивается острая гипоксия плода.</p>\r\n<p>При предлежании плаценты возникают следующие осложнения беременности:<br />· угроза прерывания;<br />· железодефицитная анемия;<br />· неправильное положение и тазовое предлежание плода в силу наличия препятствия вставлению головки в малый таз;<br />· хроническая гипоксия и задержка развития плода за счёт плацентации в нижнем сегменте и относительно низкого кровотока в этом отделе матки.</p>",
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            "lead": "Преждевременная отслойка нормально расположенной плаценты — отслойка плаценты до рождения плода (во время беременности, в первом и во втором периодах родов).",
            "description": "Преждевременная отслойка нормально расположенной плаценты — отслойка плаценты до рождения плода (во время беременности, в первом и во втором периодах родов). В зависимости от площади выделяют частичную и полную отслойку плаценты. При частичной отслойке плаценты от маточной стенки отслаивается часть ее, при полной – вся плацента.\r\nЧастичная отслойка плаценты может быть прогрессирующей и непрогрессирующей.\r\n\r\n",
            "etiology": "<p>Отслойка плаценты является проявлением системной, иногда скрыто протекающей патологии у беременных. Среди причин патологии выделяют несколько факторов: сосудистый (васкулопатия, ангиопатия плацентарного ложа, поверхностная инвазия цитотрофобласта в неполноценный эндометрий), гемостатический (тромбофилия), механический.</p>\r\n<p>Таким образом, к предрасполагающим факторам  преждевременной отслойки нормально расположенной плаценты можно отнести следующие состояния:</p>\r\n<p>· Во время беременности:<br />- сосудистая экстрагенитальная патология (артериальная <a href=\"/symptom/vysokoe_davlenie/\" title=\"Перейти на страницу симптома Высокое давление\">гипертензия</a>, гломерулонефриты);<br />- эндокринопатии (сахарный диабет);<br />- аутоиммунные состояния (антифосфолипидный синдром, системная красная волчанка);<br />- аллергические реакции на декстраны, гемотрансфузию;<br />- гестоз, особенно на фоне гломерулонефрита;<br />- инфекционноаллергические васкулиты;<br />- генетические дефекты гемостаза, предрасполагающие к тромбозам.</p>\r\n<p>· Во время родов:<br />- излитие околоплодных вод при многоводии;<br />- гиперстимуляция матки окситоцином;<br />- рождение первого плода при многоплодии;<br />- короткая пуповина;<br />- запоздалый разрыв плодного пузыря.</p>\r\n<p>Возможна насильственная отслойка плаценты в результате <a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">падения</a> и травмы, наружных акушерских поворотов,амниоцентеза.</p>",
            "pathogenesis": "<p>Образующаяся гематома нарушает целостность всех слоев децидуальной оболочки и отслаивает от мышечного слоя матки плаценту, которая прилегает к этому участку.</p>\r\n<p>При непрогрессирующем варианте отслойки плаценты она может не распространяться дальше, гематомауплотняется, частично рассасывается, в ней откладываются соли. При прогрессирующем варианте участок отслойки может быстро увеличиваться. Матка при этом растягивается. Сосуды в области отслойки не пережимаются.</p>\r\n<p>Вытекающая кровь может продолжать отслаивать плаценту, а затем оболочки и вытекать из половых путей. Есликровь при продолжающейся отслойке плаценты не находит выхода, то она накапливается между стенкой матки иплацентой с образованием гематомы. Кровь при этом проникает как в плаценту, так и в толщу миометрия, что ведет к перерастяжению и пропитыванию стенок матки, раздражению рецепторов миометрия.</p>",
            "diagnostics": "<p>Диагностика ПОНРП основана на:<br />· клинической картине заболевания;<br />· данных УЗИ;<br />· изменениях гемостаза.</p>\r\n<p>Клинические симптомы, позволяющие заподозрить отслойку плаценты: кровяные выделения и <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a>; гипертонус,болезненность матки; отсутствие расслабления матки в паузах между схватками во время родов; острая гипоксия плода или антенатальная гибель; симптомы геморрагического шока.</p>\r\n<p>При влагалищном исследовании во время беременности шейка матки обычно сохранена, наружный зев закрыт. Впервом периоде родов при отслойке плаценты плодный пузырь обычно напряжён, иногда наблюдают умеренноеколичество кровяных выделений со сгустками из матки. При вскрытии плодного пузыря изливающиеся околоплодные воды могутсодержать примесь крови.</p>",
            "treatment": "<p>Тактика ведения беременности при отслойке плаценты зависит от следующих показателей:</p>\r\n<p>· величина кровопотери;<br />· состояние беременной и плода;<br />· срок гестации;<br />· состояние гемостаза.</p>\r\n<p>Во время беременности и в родах при выраженной клинической картине (средняя и тяжелая степень) отслойки плаценты показано экстренное родоразрешение путем кесарева сечения, независимо от срока гестации и состояния плода. Во время операции необходим осмотр матки для выявления кровоизлияния в мышечную стенку и под серозную оболочку (матка Кувелера). При диагностике матки Кувелера на первом этапе, после родоразрешения производится перевязка внутренних подвздошных артерий. При отсутствии кровотечения объем операции этим ограничивается, и матка сохраняется. При продолжающемся кровотечении следует осуществлять экстирпацию матки.</p>\r\n<p>Если состояние беременной и плода удовлетворительное, нет выраженного наружного или внутреннего кровотечения (небольшая непрогрессирующая ретроплацентарная гематома по данным УЗИ), анемии, при сроке гестации до 34– 36 нед возможна выжидательная тактика. Ведение беременной выполняют под контролем УЗИ, при постоянном наблюдении за состоянием плода (допплерометрия, КТГ). Лечение предполагает постельный режим беременной.</p>",
            "prevention": "<p>Специфической профилактики не существует. Предупреждение отслойки плаценты заключается в предгравидарной подготовке, лечении эндометрита и экстрагенитальных заболеваний до наступления беременности, коррекции выявленных дефектов гемостаза.</p>",
            "clinical_picture": "<p>Основными симптомами ПОНРП являются:<br />· <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a> и симптомы геморрагического шока;<br />· <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боль в животе</a>;<br />· гипертонус матки;<br />· острая гипоксия плода.</p>\r\n<p>Выраженность и характер симптомов определяются величиной и местом отслойки.</p>\r\n<p><a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">Кровотечение</a> при отслойке плаценты может быть:<br />· наружным;<br />· внутренним;<br />· смешанным (внутренним и наружным).</p>\r\n<p>Лёгкая форма — отслойка небольшого участка плаценты, незначительные выделения из половых путей. Общеесостояние не нарушено. При УЗИ можно определить ретроплацентарную гематому, если же кровь выделяется изнаружных половых органов, то при УЗИ она не выявляется. После родов обнаруживают организовавшийся сгусток на плаценте.</p>\r\n<p>Средняя степень тяжести — отслойка плаценты на 1/3–1/4 поверхности. Из половых путей происходит отделениекрови со сгустками в значительном количестве. При образовании ретроплацентарной гематомы возникает боль вживоте, гипертонус матки. Если отслойка произошла во время родов, матка между схватками не расслабляется. При большой ретроплацентарной гематоме матка может стать асимметричной, резко болезненной при пальпации. Без своевременного родоразрешения плод погибает. Одновременно развиваются симптомы шока (геморрагического и болевого).</p>\r\n<p>Тяжёлая форма — отслойка более 1/2 площади поверхности плаценты. Внезапность возникает <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боль в животе</a>,<a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a> (первоначально внутреннее, а затем и наружное). Довольно быстро появляются симптомы шока. При осмотре и пальпации матка напряжена, асимметрична, в области ретроплацентарной гематомы можно обнаружить выбухание. Отмечают симптомы острой гипоксии или гибели плода.</p>\r\n<p>Тяжесть состояния, кровопотерю дополнительно усугубляет развитие ДВС-синдрома вследствие проникновения вкровоток матери большого количества активных тромбопластинов, образующихся в месте отслойки плаценты.</p>",
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