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"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>",
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