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"description": "Предлежание плаценты — расположение плаценты в нижнем сегменте матки в области внутреннего зева или на 3 см выше (по данным УЗИ). При предлежании плацента находится на пути рождающегося плода",
"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>",
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},
"code": "O44",
"name": "Предлежание плаценты",
"icd_name": "Предлежание плаценты",
"gender": 2,
"age_min": 20,
"age_max": 50,
"cause": [
0
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"periodicity": 1,
"slug": "o44_predlezhanie_placenty",
"lead": "Предлежание плаценты — расположение плаценты в нижнем сегменте матки в области внутреннего зева или на 3 см выше (по данным УЗИ). ",
"description": "Предлежание плаценты — расположение плаценты в нижнем сегменте матки в области внутреннего зева или на 3 см выше (по данным УЗИ). При предлежании плацента находится на пути рождающегося плода",
"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>",
"pathogenesis": "",
"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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