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"code": "N96",
"name": "Привычный выкидыш",
"icd_name": "Привычный выкидыш",
"gender": 2,
"age_min": 15,
"age_max": 49,
"cause": [
3
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"periodicity": 1,
"slug": "n96_privychnyy_vykidysh",
"lead": "Нарушение здоровья, относящееся к группе невоспалительные болезни женских половых органов",
"description": "Привычный выкидыш — это самопроизвольное прерывание беременности (при сроке до 22 недель беременности), повторяющееся при каждой последующей беременности. ",
"etiology": "<p>Причины привычного выкидыша включают в себя: </p>\r\n<ul>\r\n<li>дефекты анатомического строения матки; </li>\r\n<li>недоразвитие плодного яйца; </li>\r\n<li>воспалительные заболевания и опухоли матки; </li>\r\n<li>эндокринные заболевания; </li>\r\n<li>генетическую детерминацию; </li>\r\n<li>хронические инфекции и интоксикации; </li>\r\n<li>вирусные инфекции, перенесенные в первые недели беременности; </li>\r\n<li>гиповитаминозы; применение противоопухолевых, гормональных, противозачаточных препаратов; </li>\r\n<li>неблагоприятные факторы внешней среды. </li>\r\n</ul>",
"pathogenesis": "<p>Механизм привычного выкидыша различен. В ряде случаев сначала возникают сокращения матки, вызывающие отслойку плодного яйца. В других случаях сокращениям матки предшествует гибель плодного яйца (при токсикозах, острых и хронических инфекционных болезнях беременной и др.). Иногда отслойка и гибель плодного яйца и сокращения матки происходят одновременно. </p>",
"diagnostics": "<p>У 5%-15% женщин с привычным абортом определяется клинически значимое повышение титра антифосфолипидных антител. </p>\r\n<p>При планировании следующей беременности супругам необходимо: </p>\r\n<ul>\r\n<li>сделать спермограмму; </li>\r\n<li>пройти гинекологическое УЗИ; </li>\r\n<li>сделать гистероскопию; </li>\r\n<li>исследовать анализы крови на гормоны (определение уровня прогестерона), а также на наличие вирусных и половых инфекций; </li>\r\n<li>исследовать иммунный статус; </li>\r\n<li>исследовать кариотип (выявление носительства хромосомных аномалий, в том числе унаследованные тромбофилии); </li>\r\n<li>исследовать свертывающую систему крови (определение АчТВ, антитромбин 3, Д-димер, агрегация тромбоцитов, МНО, протромбиновое время – признаки гиперкоагуляции). </li>\r\n</ul>\r\n<p>При необходимости может быть назначен ряд дополнительных исследований. </p>",
"treatment": "<p>При несостоятельности шейки и внутреннего маточного зева применяют пластические операции с целью устранения деформации, разрывов и т. п. При несостоятельности шейки функционального характера используют операции, сущность которых заключается в суживании области внутреннего зева при помощи швов из найлоновой тесьмы. Швы удаляют на 36—38-й неделе беременности, наступившей после наложения швов. </p>\r\n<p>У женщин, страдающих привычным выкидышем на почве инфантилизма, недостаточности функции яичников, воспалительных заболеваний половых органов, следует проводить лечение до наступления беременности. В подобных случаях рекомендуется курс лечения эстрогенами и прогестероном в соответствии с индивидуальным менструальным циклом (не менее 3 циклов) в сочетании с влагалищно-крестцовой диатермией и воротником по Щербаку (15 процедур, чередуя их через день). </p>\r\n<p>Лечение во время беременности женщин, страдающих привычным выкидышем, должно носить выраженный профилактический характер (режим питания, труда и отдыха, пребывание на свежем воздухе, психотерапия и пр.). При наступлении беременности рекомендуется назначать прогестерон внутримышечно в течение 10 дней в начале 2, 4, 7-го месяцев беременности. </p>\r\n<p>При угрозе прерывания беременности — немедленная госпитализация и лечение, как и при первичном самопроизвольном аборте. После исчезновения симптомов угрожающего выкидыша беременная должна оставаться в стационаре еще 10—15 дней, затем ее выписывают для амбулаторного наблюдения. </p>\r\n<p>При гормональной терапии угрожающего выкидыша большое значение имеет определение экскреции прегнандиола и эстрогенов, позволяющее проводить более рациональное лечение. При пониженном количестве прегнандиола целесообразно назначение прогестерона; если же экскреция прегнандиола в пределах нормы, прогестерон противопоказан, так как при этом опасность наступления выкидыша увеличивается. При низком уровне экскреции прегнандиола и эстрогенов ряд авторов указывает на хорошие результаты от применения диэтилстильбэстрола. </p>\r\n<p> </p>",
"prevention": "<p>Главные принципы профилактики: </p>\r\n<ol>\r\n<li>Выявление женщин, входящих в группу риска развития невынашивания беременности. </li>\r\n<li>Целенаправленное обследование супружеской пары до беременности и рациональная их подготовка. </li>\r\n<li>Систематический контроль над возможным возникновением инфекционных осложнений и адекватная противовоспалительная, антибактериальная и иммунотерапия. </li>\r\n<li>Своевременное диагностирование шеечной недостаточности посредством мануальной оценки и проведения ультразвукового исследования с помощью трансвагинального датчика до 24 недель беременности, а при многоплодии — до 26-27 недель. </li>\r\n<li>Проведение рациональной терапии сопутствующих экстрагенитальных заболеваний. </li>\r\n<li>Профилактика и своевременное лечение нарушений тромбофилического генеза и плацентарной недостаточности с ранних сроков беременности. </li>\r\n</ol>\r\n<p> </p>",
"clinical_picture": "<p>Чаще всего выкидыш происходит в первые 2 месяца беременности, а при истмико-цервикальной недостаточности — после 14-й недели беременности. Появляются схваткообразные боли в нижних отделах живота и/или в поясничной области и кровянистые выделения или кровотечение из половых путей. Через некоторое время все эти симптомы выкидыша могут полностью прекратиться, после чего возобновиться снова. При привычном невынашивании характерно прерывание трех и более беременностей в сроке до 22 недель. <br class=\"SCXW70246934\" /> </p>",
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}
]
}