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"code": "O24",
"name": "Сахарный диабет при беременности",
"icd_name": "Сахарный диабет при беременности",
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"lead": "Нарушение здоровья, относящееся к группе другие болезни матери, связанные преимущественно с беременностью",
"description": "Гестационный сахарный диабет - один из вариантов диабета, который возникает или впервые диагностируется в период беременности. В основе заболевания лежит нарушение обмена углеводов различной степени, а именно снижение толерантности к глюкозе в организме беременной женщины. ",
"etiology": "<p>К основным факторам риска развития сахарного диабета беременных относят: </p>\r\n<ul>\r\n<li>Гормональная перестройка в организме беременной женщины; </li>\r\n<li>Аутоиммуные заболевания; </li>\r\n<li>Избыточный вес, ожирение; </li>\r\n<li>Вирусные инфекции на ранних сроках беременности; </li>\r\n<li>Курение, употребление алкогольных и наркотических веществ; </li>\r\n<li>Возраст беременной младше 18 и старше 30 лет; </li>\r\n<li>Сахарный диабет у ближайших родственников; </li>\r\n<li>Гестационный сахарный диабет в предыдущей беременности; </li>\r\n<li>Поликистоз яичников; </li>\r\n<li>Хроническое невынашивание (более 3 самопроизвольных абортов в I или II триместрах беременности); </li>\r\n<li>Многоводие; </li>\r\n<li>Мертворождение.</li>\r\n</ul>",
"pathogenesis": "<p>Заболевание развивается вследствие блокировки продукции достаточного количества инсулина гормонами, которые отвечают за правильный рост и развитие плода. При беременности организм женщины нуждается в большем количестве глюкозы, которая требуется не только для матери, но и для плода. Происходит компенсаторное увеличение продукции инсулина. Данные факторы становятся основной причиной гестационного диабета. </p>",
"diagnostics": "<p>Основным методом выявления гестационного диабета является исследование крови на определение уровня глюкозы. </p>\r\n<p>Также для определения функциональности поджелудочной железы и риска формирования гестационного диабета рутинно всем беременным на сроке 24-28 недель назначается пероральный тест на толерантность к глюкозе. </p>\r\n<p>Вначале сдается анализ крови из вены натощак, после чего женщина должна выпить 75 г глюкозы, разведенной в 300 мл воды. Спустя 2 часа забор крови повторяют. </p>\r\n<p>Диагноз «гестационный диабет» устанавливается, если первый показатель уровня глюкозы составляет более 7 ммоль/л, второй – более 7,8 ммоль/л. для его подтверждения беременной назначают еще один анализ в тот же день через несколько часов. </p>",
"treatment": "<p>Лечение сахарного диабета беременных включает: </p>\r\n<ul>\r\n<li>Диетотерапия с исключением продуктов, содержащих быстрые углеводы: кондитерских изделий, крахмалистых овощей, жирных и жареных блюд, фаст-фуда, магазинных соусов, сдоб. Необходимо включать в меню нежирную рыбу и мясо, крупы, злаковые каши, макароны твердых сортов, овощи. Углеводы должны составлять 45% от ценности рациона, жиры – 30%, белки – 25%. </li>\r\n<li>Умеренные физические нагрузки - гимнастика, ходьба, плавание. Они позволяют поддерживать организм в тонусе, предупреждают чрезмерный набор массы тела, улучшают усвояемость глюкозы тканями. </li>\r\n<li>Инсулинотерапия. </li>\r\n</ul>",
"prevention": "<p>Профилактика гестационного диабета заключается в планировании беременности и контроле массы тела. Женщина должна правильно питаться, отказаться от вредных привычек. Обязательно следует придерживаться активного образа жизни, поскольку умеренные физические нагрузки позволяют уменьшить вероятность развития гестационного диабета. Важно, чтобы упражнения были регулярными и не доставляли беременной дискомфорта.</p>",
"clinical_picture": "<p>Гестационный диабет не имеет специфической симптоматики. Главным признаком патологии является увеличение концентрации глюкозы в крови, что до наступления беременности у женщины не наблюдалось. Данное нарушение чаще всего диагностируется у пациенток после 20 недели вынашивания.</p>\r\n<p>Дополнительно при гестационном диабете может наблюдаться чрезмерное увеличение массы тела пациентки (более 300 г в неделю), сильное чувство жажды, повышение суточного диуреза. Также больные жалуются на снижение аппетита, быстро возникающую усталость.</p>\r\n<p>Со стороны плода признаком развития гестационного диабета может стать быстрый прирост массы, неправильные пропорции частей тела, избыточное отложение жировой клетчатки. </p>",
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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",
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0
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"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>",
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{
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},
"code": "O40",
"name": "Многоводие",
"icd_name": "Многоводие",
"gender": 2,
"age_min": 15,
"age_max": 50,
"cause": [
"0"
],
"periodicity": 1,
"slug": "o40_mnogovodie",
"lead": "состояние, для которого характерно увеличение количества околоплодных вод в амнионе",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Многоводие не заболевание, а симптом различных патологических процессов, протекающих в организме матери и плода, поэтому причины его возникновения многочисленны.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причины со стороны беременной: сахарный диабет, перенесенные инфекции, несовместимость крови плода и матери, порок сердца, сифилис, нефрит, тяжелая анемия.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Осложнения беременности: трансфузионный синдром (при многопладной беременности), гестоз.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Плацентарные причины: патология плаценты (хорионангиома), фетоплацентарная дисфункция, характеризующаяся снижением всасывания околоплодных вод и увеличением их продукции.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Со стороны плода отмечаются различные пороки развития: атрезия пищевода или кишечника на разных уровнях, диафрагмальная грыжа, болезнь Гиршпрунга, анэнцефалия, микроцефалия, опухоли, тяжелые пороки сердца, генетическая патология, миастения, почечная обструкция, гипоплазия легких, внутриутробное инфицирование краснухой, токсоплазмозом, сифилисом. Предполагается, что при анэнцефалии или микроэнцефалии снижается выработка антидиуретического гормона, что вызывает полиурию (обильное мочеиспускание) у плода и увеличение количества вод. При анэнцефалии, миастении и пороках ЖКТ нарушается глотание плодом вод, что ведет к их повышенному накоплению.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Многоплодная беременность.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Большую роль в развитии этой патологии играют вирусные и бактериальные инфекции, которые и составляют основные причины на поздних сроках, независимо от того, когда женщина перенесла вирусную инфекцию (грипп, ОРВИ, вирус простого герпеса) или воспалительные заболевания половой системы. Внутриутробную инфекцию у плода вызывают урогенитальный микоплазмоз матери, уреаплазмоз, хламидиоз, бактериальный вагиноз, кандидоз. У плода может наблюдаться не только острая, но и медленно текущая хроническая инфекция.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основную роль в развитии многоводия играет плацента и плодные оболочки. При этой патологии выявляют инволютивные изменения в плаценте и амнионе. В плодных оболочках увеличивается число микроворсинок и их усиленное ветвление, что сопровождается увеличением толщины зародышевой оболочки. При данной патологии, с одной стороны, усиливается секретирующая активность эпителия амниона, а с другой — происходят деструктивные изменения в нем, которые ведут к некрозу ткани. Некроз влияет на развитие плода и вызывает различные патологии развития. Изменения претерпевают и вены хориона — они сужаются, а иногда в ворсинах хориона они полностью зарастают. При многоводии через оболочки и через расширенные межклеточные каналы в эпителии увеличивается транспорт жидкости внутрь. А за счет утолщения плодных оболочек частично блокируется обратное всасывание вод, что способствует увеличению их количества.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заподозрить многоводие при беременности акушер-гинеколог может уже на основании объективного осмотра и жалоб пациентки. Помимо ухудшения общего состояния женщины характерным признаком является увеличение стояния дна матки, не соответствующее сроку гестации. Также о многоводии при беременности свидетельствует значительное увеличение окружности живота, показатели порой превышают 100-120 см. При пальпации может определяться патологическое положение плода в маточной полости – косое, поперечное или тазовое. При подозрении на многоводие при беременности женщине назначается лабораторная диагностика: общие анализы крови и мочи, мазок из половых путей на микрофлору с целью обнаружения инфекций.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если многоводие при беременности вызвано резус-конфликтом, показано исследование на определение количества антител. Диагноз окончательно устанавливается после проведения УЗИ. В ходе процедуры удается измерить количество ОПВ, а также оценить функциональность плаценты и самочувствие плода. В редких случаях осуществляется амниоцентез. Многоводие при беременности требует тщательного наблюдения за малышом. С этой целью проводятся КТГ и маточно-плацентарная допплерография, позволяющие оценить степень гипоксии, работу сердца, двигательную активность, уровень кровотока в сосудах пуповины и определиться с дальнейшей врачебной тактикой.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Многоводие при беременности требует госпитализации в акушерский стационар и тщательного наблюдения за состоянием женщины и плода. Назначается полный покой, важно исключить стрессовые факторы и физические нагрузки. Медикаментозное лечение многоводия при беременности зависит от причины возникновения данного состояния. Обязательно осуществляется терапия основного заболевания, которое способствовало развитию патологического увеличения объема ОПВ. Если этиология многоводия при беременности не установлена, применяется классическая схема – антибактериальная терапия с целью предупреждения занесения внутриутробной инфекции.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение многоводия при беременности также предполагает использование препаратов для улучшения маточно-плацентарного кровотока, витаминных комплексов, мочегонных лекарственных средств. В случае острого многоводия при беременности и значительного ухудшения состояния пациентки, сопряженного с угрозой для ее жизни, в зависимости от срока эмбриогенеза показано прерывание или преждевременное родоразрешение путем кесарева сечения. Если консервативный подход дает положительную динамику, ведение беременности продолжают до 37-38 недель.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Родоразрешение в случае многоводия при беременности проводится с помощью планового кесарева сечения. Важно предупредить самопроизвольное вскрытие плодного пузыря. Из-за большого объема амниотической жидкости ее стремительное излитие может привести к выпадению мелких частей плода, а также слабости родовой деятельности. Если принято решение об осуществлении естественных родов на фоне многоводия при беременности, требуется проведение амниотомии. Это дополнительно стимулирует схватки.</span></p>",
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