Ilepenoıneaaaa 6epeMeHHOCTb i. BBO~~CTb ı. Haasaaae npotokojia: Ilepeıroınennaa 6epeMeHHOCTb 2. KOA npotokojia: 3. KOA(bl) MKJi-10: 048. Ilepeaoureaaas ôepeaeaırocrı., 4. COKpameHIIH, IICnOJIb3yeMble B npotokojie: IIMIJ; - nocjie.ı:ı;hhhmehctpyajibhbihij;hkji HT - aecrpeccossıü TeCT L1A)L{- HH.ı:ı;eKCaMHHoTlflıecKoH )KH.ıı;KOCTH PKH - paanoaaaapoaaaaoe KOHTpOJIHpyeMoe HCCJIe.ıı;OBaHHe 5..l(aTa pa3pa6otkii npotokojia: anpens 2013 rozıa 6. Kareropaa na uueutob: ôepeveuasıe LIp0)KeHIIIJ;bi. 7. IIoJIb30BaTeJIu npotokojla: BpaQH axyınepsı-raaexonora H axyuıepxa IIMCTI LICTaIJ;HOHapa. II.METO.l(bI, nonxonu II I1POIJ;EJzyPhI.l(HArHOCTIIKII II JIEQEHIDI 8. Onpenenenaeı Ilepenoıuennas ôepeueııuocme - sro ôepesreanocrs, KOTOP~ npozıonacaerca 42 nezıerıa H 60JIee (294 zına) [BceMH:pH~ opraııasaıras szıpaaooxpaneaaa]. Porısı rrph TaKOH ôepesreaaocra Ha3bIBaIOT 3an03.ıı;aJIblMII (postterm labor, delivery). Pe6eHoK, po.ıı;iibrnhhchot TaKOH 6epeMeHHOCTII, B 60JIbIIIHHCTBe cnysaes IIMeeT nph3hakli «nepe3pejioctii» (postmaturity, postmature fetus, postmature infant). «Ilepenoureaaocrs» H «nepeapenocrı,» - He CHHOHHMbI,XOTH 3TlI ztna nohhth5i QaCTO nytaiot. B03MO)KHbI KaK aarroanansıe pozısı rrnoztoss 6e3 npli3hakob nepe3pejioctii, TaK LI cnoeapeaeansre porısı (term delivery) rtepespensns rınonou. Taxaxı 06Pa30M, «rrepenoıııemrocrs» - nohhthe xaneazıapıroe, a «nepespenocrs» - nohhthe, npaaeaseaoe.ı:ı;.jui OIJ;eHKHcpM3MQeCKOrOcraryca HOBOp0)K.ı:ı;eHHoro. 10. Hoıeaaanna AJIH rocnutajiii3a u 1ı1ı c yıcaaanaesı Tuna rocnarannaaıınaı njiauobah 1. CPOK ôepeueaaocra 41 aezı+o MMHCPOpMMpOBaHHoeCOrJIaCHe 6epeMeHHO:H:Ha IIıı.ızyKIJ;MIOPO.ı:ı;OB
2. CPOK ôepesıeaaocra 41 aezr, + 4.ı:ı;IDI 3KcTpeuuaH 1. Haxano PO.ı:ı;OBOH.ı:ı;e5ITeJIbHOCTH 2. Hey.ı:ı;oBJIeTBOTpHeTJIbHbıH6HoQJH3HqeCKHHnpoQJHJIbrınozıa 1ı. Ilepe-ıeus MeponpuHTuii: OCUOBUhlX u nononaırrensnsıx,li;uaruoctuqeckux OCUOBUhle - YCTaHOBJIeHHecpoxa ôepeueaaocra (41 aeztens + O) - Y3M nnozta (B cpoxax zıo 14 nezıens) nononasrrensnsıe - 6HonpoQJHJIb njio.ı:ı;a. -.ı:ı;onnjiepometph5icocy.ı:ı;obnyncsaası. 12.,ı::ı;uaruOCTUQeCKUexpırrepna. 12.1. )l{aııo6bi H ahamhe3: TOqHOCTb.ı:ı;HarHOCTHKH nepehaiiihbahh5i 3aBHCHT OT.ı:ı;OCTOBepHOCTH HHQJOpMa.QHHO recta.qhohhomcpoke. CBOeBpeMeHHa5I.ı:ı;HarHOCTHKaQpe3BbIQaHHO Ba)KHa.ı:ı;JI5Ionpezıeneaaa TaKTHKH Be.ı:ı;eHH5IPO.ı:ı;OB.Ba)KHO HCnOJIb30BaTb BCe zıocrynasıe KJIHHHQeCKHezıanasıe, nomoraıoi.qheytoqhhtbcpok ôepeaeaaocra, 1) HaH60JIee TOQHhIHMeTO.ı:ı; - no.ı:ı;ahhhimy3-qjetometphh (A-la): - Y3M nepsoro rpasıecrpa scexı 6epeMeHHhIM crıezıyer nposonars B cpoke 11-14 He.ı:ı;eJIh,nOCKOJIhKY 3TO - 60JIee TOQHa5I O.QeHKa recta.qhohhoro cpoxa, QeM IIMIJ; c MeHhIIIHM KOJIHQeCTBOMnpOJIOHrHpOBaHHhIX ôepeıreaaocrea, CpOKOM60JIee 41+0 nezrem, (i-a). - ECJIH pa3hh.qacpoxa recta.qhhme)k.d;yiiml( H Y3M nepsoro TpHMeCTpa COCTaBJI5IeT60JIee 5.ı:ı;HeH, TO npeımonaraesıaa zıara PO.ı:ı;OB.ı:ı;OJI)KHa6hITh BhIQHCJIeHaCOrJIaCHOY3M nepsoro TpHMeCTpa (I-A). - ECJIH pa3hh.qacpoıca recta.qhhme)k.d;yiimij; H Y3M sroporo rpaaecrpa (14-20 aezrem.) COCTaBmıeT60JIee ıo.rı;heii, npezırronaraesraa zıara po.d.ob.ı:ı;oji)kha 6hITb BhNHCJIeHa COrJIaCHOY3M sroporo TpHMecTpa (I-A). - ECJIH nposozıanocs Y3M nepsoro H sroporo TpHMeCTpa, recta.qhohhhıh CpOK.ı:ı;OJI)KeHonpe.ı:ı;eJI5ITC5I no camomy pahhemy Y3M (I-A). 2) Menee TOQHhIHxreron: onpeneneııae cpoxa no rrepsouy.ı:ı;hionocjie.ı:ı;hhxmec5iqhhix(npa YCJIOBHHperyJI5IpHOrO.QHKJIa); - cyôsexraanoe onpezıenenae cpoxa no paaaepası MaTKH, rıpa nepsosı saraaansaosı OCMOTpeBO BpeM5I noctahobkhha yser no 6epeMeHHOCTH. 12.2. <I>H3HKaııhHoe oôcneııosaaae: HapY)KHOe H BHYTpeHHee axynrepcxoe o6cjie.ı:ı;obahhe 12.3. Jlaôoparopasıe HCCJIe.ı:ı;OBaHH5I: HeT 12.4. Hacrpyaearansnsıe HCCJIe.ı:ı;OBaHH5I: Y3M, 6HonpoQJHJIh nnozıa, zıonrınepoererpaa COCY.D.OB rryiiobhhhi 12.5. IloKa3aHH5I,l.J.JI5IKOHcYJIhTa.QHHcne.QHaııHCTOB:HeT
12.6.,[(:H:<p<pepeHIı;mlJIbHbIMzıaaraoa: nposoııarca nocne pozıon c sarroanarısnra poııaaa rrnonou 6e3 nph3hakob nepespenocra. Pe6eHoK CqHTaeTC5I nepeaonıeaasnı, ecna ecrs COqeTaHHe, XOT5I 6bI 2-3 nph3hakob nepeaonıenuocra. Y peôeaxa MOryT 6bITb cnezıyıoıııae naztoaa); nph3hakh nepenoıııeaaocra: - TeMH03eneHaH oxpacxa KO)l(H, nnozıasıx 060nOqeK,.rrynoaaırsr; - MaIı;epaIı;H5I KO)l(H, oc06ehho Ha pyxax H cronax (<<6aHHbIe» ererısı H - ysreırsnıenae KOnIfqeCTBa CbıpOBH,ı::ı;HOM CMa3KH; - HCTOııı;eHHenonxoacaoü )l(hpobomklletqatkh H 06pa30BaHHe cxnazıox, CHH)I(eHHerypropa KO)l(H(<<CTapQeCKHM»nazı peôöaxa); - xpynasıe pasaepsı peôeaxa (peace - rımorpoqıaa), zınaaasıe HOITH Ha pysıcax; - nnoxo asıpasceuaaa KOH<pHrypaIı;H5IronOBKH, nnorıısıe KOCTH xepena, Y3KHe urası H PO.ı:ı:HHQKH. 13. Hena JleQeUUH: YMeHbmeHHe MaTepHHCKOM H 3a60neBaeMOCTH, CB5I3aHHOM c OCnO)l(HeHHHMH Ha <pohe 6epeMeHHOCTH. Mna.ı:ı:eHQeCKOM nepeıronreaıroü 14. TaKTUKa nesenaaı 14.1 HeMe.ı:ı:HKaMeHT03Hoenexeaae: Ilo.ı:ı:OCTH)I(eHHH rectaiı;hohhorocpoxa 40+0 aezı.: 1) Ilposecra xoacynsrapoaaaae no nonpocaxı nepeaoıııeaaoü ôepeaeaııocra; 2) B 03MO)l(HO, npennozorrı, anaranaıııaoe accnezıosanae zırıa OIı;eHKH memkh MaTKH H OTcnOMKH HH)I(HerO nomoca nnozıaoro ny3bip5l, CHlf)I(aIOIQeü notpe6hoctbb nocrıezıyıouıeü HH.ı:ı:YKI(HH(A-Ia). B03MO)l(HbIe OCnO)l(HeHHH OTcnOMKH HH)I(HerO nomoca nnozıaoro nyssıpa:,ı::ı;hckom<popth ôonesaeınısıe onıynıeaaa, KPOB5IHHCTbIe asızıeneaaa, neperynapasıe CXBaTKH B TeQeHHe 24 QaCOB nocne MaHHnYll5lIı;HH. 3) 06Cy.ı:ı:HTb,ı::ı;anbHeMII1HMnnaa naômozıeaaa, BKllIOQaH B03MO)l(HYIO HH.ı:ı:YKIı;HIOpozıon B 41+0 ııezt. )J{eHIIı;HHe He06xo.ı:ı:HMOnpe,ı::ı;no)ı(HTbHH.ı:ı:YKIı;HIOpozıos B cpoke 41+0-42+0 aezıena, rıocıconsxy cynrecrayıonıae zıoxaaarenscraa B aacroaıuee BpeMH rroxassrsaıor CHH)I(eHHenepaıraram.aoü CMepTHOCTHnpa pozıopaspeıııeaaa B 3TH CpOKH. PHCK po)l(,ı::ı;ehhhmeptboro nnozıa Ha 37 aeııena COCTaBn5leT1 Ha 3000 PO.ı:ı:OB, Ha 42 ııenena 3 Ha 3000, Ha 43 nezıene - 6 Ha 3000. TIPH nonyseaaa HH<pOpMHpoBaHHoro COrnaCH5I Ha npoaezıeaae HH.ı:ı:yKIı;HH(CM. nporoxon «Mıı,ı::ı;yKI(H5IPO.ı:ı:OB»)ssınars aanpaaneaae B CTaI(HOHap no BbI60py naiı;hehtkh,ho He HH)I(e II-ro ypobhh.
ITpH OTKa3e OT HH.ızyKI(HH zıanstreiinree aaömoneaae rrposozıars no ajirophtmy ycaneanoro naômoneaas aa COCTOSlHHeMınıona. 1) Haômoneııae B03MO:>KHOB ycnonasx CTaI(HOHapaHnH asıôynaropao; 2) Ilpenocrasars KOHTaKTHyıoHHlPOpMaI(HIOpozıoacnoaorarensnux yqpe:>k.ı:ı;ehhh6nh:>kahiiihxk MeCTY:>KHTenbCTBa, nhi(eh3hpobahhbixha OKa3aHHenOMOmH npa nepeaouıeaaoü ôepeveaaocra; 3) 06yqHTb nai(hehtky KaqeCTBeHHoHOI(eHKe uıeseneaaa nnozıa (<<IlleBenHTCSI TaK:>KeKaK s-repa», «...xyzce» H T.zt.). Ilpoxoacynsraposars O T:peBO:>KHbIX npasaaıcax, npa KOTOPblXneoôxozıaao 06paTHTbCSIsa Me.ı:ı;Hı.ı;HHCKOH nomombio; 4) Oneasa 6H0<pH3HqeCKOrOnpoqıana nnozıa zısa pasa B aezıemo: B 41 aezıenıo H 4.ı:ı;HSI npa yzıosneraoparensaoa npodıane - ııarıpaanenae Ha nnaaonyıo rocnhtajih3ai(hio; ITPH aeyzroanersopırrensuosı ôaonpodıane - CPOQHasırOCnHTaJIH3aI(IDIB akyillepckhh CTaI(HOHap. Beôeuue po()06. Bsıôop xrerona pozıopaapeıneaaa 3aBHCHT OT COCTOSlHIDIBHyTPHYTpo6HOro rrnozıa. KOHcepBaTHBHoe seneaae PO.ı:ı;O B03MO:>KHOnpa yzıoaneraoparensaoa COCTOSlHHHBHYTPHYTpo6HOro nnozıa, ):(mı:oi(ehkh COCTOSlHIDI nnozıa aeoôxonaao ysırrsısarı, ôaonpoıpam, nnozıa, zıaaasıe zıonrrneposıerpaır. Pozısı npa nepehaiiihbahhh cneııyer BeCTH no naprorpaseae nozı noctoslhhbim MOHHTOPHbIM KOHT:poneM sa cepzıeaaoü zıearensnocrsro rrnozıa. Bonpocsr PO.ı:ı;OCTHMYnHI(HH peınarı, KOHCHnıryMOM. ITPH aeynoanersoparensnoa COCTOSlHHH BHYTPHYTPo6HOrO nnozıa, «ırespensıx» PO.ı:ı;OBbIXIIYTSlX npenno-rrarensao xecapeso CeQeHHe B nnahobomnopanıce. 3KCT:peHHoe xecapeno CeQeHHe- npa yrpoacaıoıııen COCTOSlHHHnnozıa, rıpa OTCYTCTBHHycnosnü - BaKYYM-3KCTpaKI(IDInnona. Heoaarorıora ertenyer sapaaee npezıynpenars O npezmonaraerasrx 3an03.ı:ı;aJIbIXpozıax, B pozıax rotobhoctbk OKa3aHHIO3KCT:peHHOHnOMOmH HOBOp0:>K.ı:ı;eHHOMY. 14.2. Meztaıcasrearosaoe ne-ıeaae: CM. rıporoxon «HH.ı:ı;YKI(IDIpozıos» 14.3.,lqJyrHe BH.ı:ı;bIneQeHHSI:HeT 14.4. XHpyprHQeCKOe neaeaae: sxcrpeaaoe ıcecapeso CeQeHHe neyaoanersoparensnsra ôaorrpodıans nnozıa; OCnO:>KHeHIDI, CBSl3aHHbıe C PO.ı:ı;OBbIMaKTOM,yrpozcaıomee COCTOSlHHennozıa 14.5 ITpolPHnaKTHQeCKHeMeponpIDITIDI: ITo.ı:ı;OCTH:>KeHHH rectai(hohhoro cpoxa 40+0 nezı.: 1) ITpoBecTH xoacynsraposaaae no BOnpOCaM nepeaoııreaaoü ôepesreaaocm;
2) B03MO)l(HO, npennosorrs BJIaraJIM~Oe MCCJIe,L(OBaHMe.rı;mı onensa mehkh MaTKM M OTCJIOHKM HM)KHero nomoca njio,l(horo nyasıpa, caaacaıoıııeti notpe6hoctbb nocnezryronıea MH,ızyKU;MM(A-la). B03MO)l(HbIe OCJIO)l(HeHHH OTCJIOHKH HH)I(HerO namnca nnozıaoro nyasrpa:.rı;mckom<popth 60JIe3HeHHbIe oınyıııeaaa, KpOBHHHCTbIe BbI,L(eJIeHHH, aeperynapasıe CXBaTKM B TeqeHHe 24 qacob nocjie MaHHnyJIHU;HH. 3) 06CY,L(MTb.rı;aJIbHeHllIHH njiah aaômozıeıraa, BKmOqaH B03MO)KHyıo HH,ızyKU;IUOPO,L(O B 41 +0 aezı, 14.6 Ilansaeaııree sezıeaae: CM. npotokoji«be,l(ehheq,m3mojior~eckhxpo,l(ob» 15. BH)lHKaTopbI 3cJıcJıeKTHBHoCTHJleQeHHH H 6e30naCHOCTH MeTO)lOB )lharhocthkh H JleQeHHH: QacToTa MHTPaHaTaJIbHOÜrH6eJIM nnozıa npa cpoxe rectau;hh41 aeııens M 60JIee B,L(HHaMMKe; KOJIMQecTBOHOBOpO)l(.rı;eHHbIXC ou;ehkohno ıııxane Arırap Ha 5-H MHHyre, p0)l(.d;ehhbixnpa cpoxe rectau;mh41 He,L(H ôonee; HH)I(e 3-4 6aJIJIOB QacToTa CMA y HOBOpO)l(.D;eHHbIX, p0)l(.d;ehhbixrıpa cpoxe rectau;mm41 nezı, M ôonee, ):(H:HaMMKa. i. oerahh3aiı;bohhlie ACTIEKTLI BHE)1;PEHIDI TIPOTOKO.JIA: 16. Cnacox pa3pa6ot'ihkob npotokojla c YKa3aHHeM KBaJlHcJıHKa~HoHHbIX )lahhbix: 1.11H C.H., apas akylliep-rhhekojior ssıcnıeii xareropaa, 2-e axyıııepcxoe OT.rı;eJIeHHe,AO «I-IHI(M,L(». 2. AH 3.H., spas akjmep-rhhekojior ssıcnrea xareropaa 3aB. 2-M axyınepcxası ot,l(ejiehhem,ao «I-IHI(M)l». 17. YKa3aHHe Ha orcyreraae KOHcJıJlHKTaHHTepeCOB: KOHq,JIHKTaHHTepeCOBHe BbUIBJIeHO. 18. Peııenaeırrsı: Ky.rı;aü6epreHoB T.K. - rjiabhbih BHeIllTaTHbIH akjınep-rhhekojior M3 PK, ııapexrop prn «HaU;MOHaJIbHbIH u;ehtp axymepcrsa, rhhekojiorhh M nephhatojiornh».,l(ouı;ahoba A.M.-.ı:ı;.M.H., npodıeccop.apax asrcuıeü xareropaa, saaenyıouıaa Kaq,e.ı:ı;poHaxyuıepcraa H ITHeKOJIOrHH no aarepaarype AO «MY A» 19. YKa3aHHe YCJlOBHH nepecsıorpa npotokojla: nepecmotp npotokojia npoh3bo.ı:ı;htc He pexe, QeM 1 pa-l B 5 JIeT, JIH60 npa nocrynneaaa HOBbIX naaasıx, CBH3aHHblXc nphmehehhem naaaoro npotokojia. 20. Cnacoıe HCnOJlb30BaHHOÜ.mrreparypsn 1.3q,q,eKTHBHbIH ahte-hhtpahatajibhbih yxozı, PeKoMeH.ı:ı;aUHHB03. )KeHeBa, 2002.
3. Bakketeig L., Bergsje P. Post-tenn pregnancy: magnitude of the problem. In: Chalmers I, Enkin M, Keirse MJNC, eds. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 2000;765-775. 4. Goeree R. et al.cost-effectiveness of induction of labour versus serial antenatal monitoring in the Canadian Multicentre Posttenn Pregnancy Trial. Canadian Medical Association Journal, Vol 152, Issue 9 1445-1450. 5. Chamberlain G., Zander L. ABC of labour care: induction. British Medical journal 1999; 318(7189):995-998. 6. Cleary-Goldman Jane et al. Posttenn Pregnancy: Practice Patterns of Contemporary Obstetricians and Gynecologists, American Journal of Perinatology, Volume 23, Number 1,2006. 7. Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond tenn. Cochrane Library;Issue 2, 2000. 8. Gülmezoglu A. M., Crowther C. A., Middleton P.Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004945. DOI: 10.1002/14651858.CD004945.pub2. 9. Heimstad et al.induction of labour for post-tenn pregnancy and risk estimates for intrauterine and perinatal death, Acta Obstetricia etgynecologica Scandinavica, 87:2,247-249. 10. Heimstad Runa et al.induction of Labor or Serial Antenatal Fetal Monitoring in Postterm Pregnancy. A Randomized Controlled Trial, Obstetrics & Gynecology Vol. 109,No. 3, March 2007. 12. Katsoulis L. C., Veale D. 1. H., Hofineyr G.J. South African traditional remedies used during pregnancy. Southern African ethnobotany 2000; 1:13-16. 13. Management of Prolonged Pregnancy AHRQ Publication No. 02-E018 http://www.ahrq.gov. 14. Mitri F., Hofineyr G. J., Van Gelderen C. J.Meconium during labour: selfmedication and other associations. South African medical journal 1987; 71:431-433. 15. Post-Tenn Pregnancy, Sogc, Clinical Practice Guidelines No. 15,2001. 16. Prolonged pregnancy. Review of the literature. Journal de gynecologie, obstetrique et biologie de la reproduction 1995;24(7):739-746. 17. Vintzileos A. M., Ananth C. V., Smulian J. C., Scorza W. E., Knuppel R. A. The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. Americanjournal of obstetrics and gynecology