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  1. Áåðåìåííîñòü ïðè ìèòðàëüíîì ñòåíîçå (1,2-1,4 ñì2)
    îò GayveR â ðàçäåëå Ãèíåêîëîã-àêóøåð, áåðåìåííîñòü, ðîäû
    Îòâåòîâ: 2
    : 01.09.2004, 20:30
  2. Îêàçàíèå íåîòëîæíîé ïîìîùè ïðè ñòåíîçå ãîðòàíè ó äåòå...
    îò Íàòàøà Î â ðàçäåëå Ïåäèàòð - âñå î äåòÿõ.
    Îòâåòîâ: 1
    : 11.08.2004, 04:40
  3. Ó ìåíÿ âòîðàÿ áåðåìåííîñòü, ñðîê 2 íåäåëè. Ïåðâàÿ áåðåìåííîñòü áûëà 2 ãîäà ...
    îò Ìàðèíà â ðàçäåëå Ãèíåêîëîã-àêóøåð, áåðåìåííîñòü, ðîäû
    Îòâåòîâ: 1
    : 06.08.2004, 03:54
  4. Îòâåòîâ: 1
    : 21.05.2004, 18:02
  5. Ïîìîãèòå! ó ìåíÿ âòîðàÿ áåðåìåííîñòü, ñðîê- 23 íåäåëè, ïåðâàÿ áåðåìåííîñòü ...
    îò Êñåíèÿ â ðàçäåëå Ãèíåêîëîã-àêóøåð, áåðåìåííîñòü, ðîäû
    Îòâåòîâ: 1
    : 21.05.2004, 15:41
  1. GayveR
    #1
    ×èòàòåëü Íåäóã.Ðó
    Ìíå 30 ëåò. Áåðåìåííîñòü 18 íåäåëü..è ïðèîáðåòåííûé ïîðîê ñåðäöà.

    Ýõîêàðäèîãðàôè÷åñêîå èññëåäîâàíèå äâóõíåäåëüíîé äàâíîñòè:

    Óìåðåííûé (âûðàæåííûé) ôèáðîç ñòâîðîê ÌÊ ñ óìåðåííûì (áëèæå ê âûðàæåííîìó) ìèòðàëüíûì ñòåíîçîì (S ìî = 1,3 ñì2) Ðä ñðåä = 17,0 MR Iñò 5 % Sëï. Íåçíà÷èòåëüíûé ôèáðîç ñòâîðîê ÀÊ ñ AR II ñò. (6% S LVOT).

    Îòíîñèòåëüíàÿ TR I-II cò. Óìåðåííàÿ ËÃ (ÑÀÄ ëà = 48 ììKg; Pñð = 24,6 ììKg). Óìåðåííàÿ äèëëÿòàöèÿ ëåâîãî ïðåäñåðäèÿ (V = 112,5 ìì3).Ãëîáàëüíàÿ ñîêðàòèìîñòü óäîâëåòâîðèòåëüíàÿ (ÔÂ = 70%) Àîðòà íå èçìåíåíà.

    Ðåáåíîê î÷åíü æåëàííûé. ïåðâûé. îñòàëüíûå ïîêàçàòåëè è àíàëèçû âðîäå â íîðìå, êðîìå æåëåçîäåôèöèòíîé àíåìèè (ôåðëàòóì ïî îäíîìó ôëàêîí÷èêó/â äåíü). Êàðäèîõèðóðãè, àêóøåðû-ãèíåêîëîãè äà è ïðîñòî êîíñóëüòèðóþùèå âðà÷è íå ìîãóò ïðèéòè ê åäèíîìó ìíåíèþ. Ìíåíèÿ äèàìåòðàëüíî ïðîòèâîïîëîæíûå. Êòî êàòåãîðè÷åñêè çà ïðåðûâàíèå áåðåìåííîñòè, êòî ãîâîðèò "ñàìà ðåøàé ...ìîæåøü íå âûæèòü íè òû, íè ðåáåíîê", êòî ãîâîðèò "íîñè, è íå ñ òàêèìè âûæèâàëè ìîë.." Êàæäóþ ñåêóíäó òîëüêî îá ýòîì è äóìàþ, è âñå ìíå êàæåòüñÿ, ÷òî íå õâàòàåò åìó êèñëîðîäà, ÷òî ãèïîêñèÿ, ÷òî íåäîñòàòî÷íîñòü âñÿêàÿ è ò.ä. Ïðè ÷óòü óáûñòðåííîé õîäüáå (èíîãäà) íà÷èíàåòñÿ îäûøêà, äîñòàòî÷íî ñèëüíàÿ, ñ ïîêàøëèâàíèåì è íåïðèÿòíûìè îùóùåíèÿìè...èíîãäà íî÷üþ ïðîñûïàþñü îò îäûøêè..òàêîé æå, ñ õðèïàìè è êàøëåì...óæàñíî ñòðàøíî. Ñëåæó çà ïîãëîùàåìîé-âûäåëÿåìîé æèäêîñòüþ, ïüþ ìî÷åãîííûé ÷àé (òðàâÿíîé), îòåêîâ íåò.

    Ïðîïèñàíà ÿ íå â Ìîñêâå, íî îòó÷èëàñü òóò â ÌÃÓ è îñòàëàñü æèòü è ðàáîòàòü.  Áàêóëåâà ñòîþ íà ó÷åòå, â ïðèíöèïå, íî ïîñëåäíèé ðàç áûëà òàì â 2000 ãîäó, ïîòîìó êàê áåñïëàòíèêîâ òàì î÷åðåäü íà 10 ëåò âïåðåä à ïëàòíî äàëåêî äà è íàêëàäíåíüêî.., íó áûëî âî âñÿêîì ñëó÷àå.

    Ìîãóò ëè ìåíÿ ïîñòàâèòü íà ó÷åò â ñïåöèàëèçèðîâàííûé ðîääîì åñëè íåò ïðîïèñêè, íî åñòü íàïðàâëåíèå? Åùå ñëûøàëà ïðî êîìèññóðîòîìèþ áåðåìåííûì, êîòîðóþ ïðîâîäÿò â Èíñòèòóòå Âèøíåâñêîãî. Î÷åíü õîòåëîñü áû óçíàòü. À âîîáùå âñå áû îòäàëà çà êîíñóëüòàöèþ è, (ýòî âîîáùå êîíå÷íî èç îáëàñòè ôàíòàñòèêè) åñëè ýòî âîçìîæíî, âåäåíèå áåðåìåííîñòè ñïåöèàëèñòîì ïî ïîäîáíûì ïðîáëåìàì.

    Î÷åíü íàäåþñü íà ïîìîùü.

  2. áîëüíîé
    #2
    ×èòàòåëü Íåäóã.Ðó
    Óâàæàåìàÿ Êðåîëêà!



    Âîîáùå-òî 1 ôëàêîí÷èê ôåðëàòóìà íåñêîëüêî ìàëîâàò äëÿ ëå÷åíèÿ æåëåçîäåôèöèòíîé àíåìèè (íå ìîãëè áû Âû ïðèâåñòè íåäàâíèå äàííûå ãåìîãëîáèíà, ýðèòðîöèòîâ, ñûâ. æåëåçà è ÎÆÑÑ), òê ñîäåðæèò âñåãî 40 ìã èîííîãî æåëåçà, à äëÿ ëå÷åíèÿ íåîáõîäèìû êàê ìèíèìóì 1,5-2 ìã/êã ìàññû òåëà, ÷òî ñîîòâåòñòâóåò 80-100 ìã â ñóòêè. Ê òîìó æå îñîáåííî ñî âòîðîé ïîëîâèíû áåðåìåííîñòè æåëåçî íåîáõîäèìî è ðåáåíêó (ïðèìåðíî 30-40 ìã èîííîãî ýêñòðà-æåëåçà). ×åì áûñòðåå îòêîððåêòèðóåòå àíåìèþ è æåëåçîäåôèöèò, òåì áîëüøå øàíñîâ äîíîñèòü áåðåìåííîñòü è ñ íîðìàëüíûì ïëîäíûì âåñîì. Ðàöèîíàëüíåå è ïðàêòè÷íåå ñìåíèòü ôåðëàòóì íà áîëåå äåøåâûé è óòÿæåëåííûé ïðåïàðàò (íà óïàêîâêå äîëæíî áûòü íàïèñàíî, ÷òî òàáëåòêà ñîäåðæèò 80 èëè 100 ìã èîííîãî æåëåçà). Íå çàáûâàéòå î 400-800 ìêã ôîëèåâîé â äåíü.

  3. Nara
    #3
    ×èòàòåëü Íåäóã.Ðó
    Ïî ïîâîäó ïîðîêà: ñòåíîç íå ìàëûé (ìåíåå 1,5 ñì2), íî è íå ñëèøêîì (ìåíåå 1 ñì2), ÷òîáû áûëà íåîáõîäèìîñòü â õèð. âìåøàòåëüñòâå. Îñíîâíûå ðåêîìåíäàöèè: èçáåãàòü ôèç. íàãðóçîê, êîíòðîëü çà âîäíûì áàëàíñîì è ïîòðåáëåíèåì ñîëè, ïðè ïåðåãðóçêå - ìî÷åãîííûå, ïðè òàõèêàðäèè - áåòà-áëîêàòîðû. Ïîäðîáíåå ìîæåòå îçíàêîìèòüñÿ â îòðûâêå èç íåäàâíåãî îáçîðà:



    Mitral Stenosis



    Rheumatic mitral stenosis is the most common clinically significant valvular abnormality in pregnant women and may be associated with pulmonary congestion, edema, and atrial arrhythmias during pregnancy or soon after delivery. The increased volume load and increased cardiac output associated with pregnancy lead to an increase in left atrial volume and pressure, elevated pulmonary venous filling pressures, dyspnea, and decreased exercise tolerance. Increases in the maternal heart rate decrease the diastolic filling period, further increasing left atrial pressure. Mortality among pregnant women with minimal symptoms is less than 1 percent. In a study of women with mitral stenosis, predictors of adverse maternal outcomes included a reduced mitral-valve area (less than 1.5 cm2) and an abnormal functional class before pregnancy. Fetal mortality increases with deteriorating maternal functional capacity; fetal mortality is 30 percent when there is NYHA class IV disease in the mother.



    For women with mild or moderate symptoms during pregnancy, medical therapy is directed at the treatment of volume overload and includes diuretic therapy, the avoidance of excessive salt, and the reduction of physical activity. Beta-blockers attenuate the increases in heart rate and prolong the diastolic filling period, which provides symptomatic benefit. Development of atrial fibrillation requires prompt treatment, including cardioversion. Beta-blockers and digoxin are used for rate control. If suppressive antiarrhythmic therapy is needed, procainamide and quinidine are the drugs with which we have the most extensive experience. Because of the increased risk of systemic embolism in patients with mitral stenosis and atrial fibrillation, anticoagulant therapy is indicated.



    Patients with severe symptoms (NYHA class III or IV) or tight mitral stenosis (a valve area of less than 1.0 cm2) who undergo balloon mitral valvuloplasty or valve surgery before conceiving appear to tolerate pregnancy with fewer complications than similar women who are treated medically. In patients who present with severe symptoms during pregnancy, successful percutaneous balloon mitral valvuloplasty, performed during the second trimester, has been associated with normal subsequent deliveries and excellent fetal outcomes. Risks to the fetus associated with exposure to radiation may be reduced by avoiding exposure to radiation during the first half of pregnancy. Pregnant women who are to be exposed to radiation should have the uterus shielded and should be informed about the possible risks. Mitral valvuloplasty has also been performed under transesophageal echocardiographic guidance, eliminating these risks. Open cardiac surgery has been performed during pregnancy for severe mitral stenosis. Maternal outcomes are approximately the same as those among nonpregnant patients, but there is fetal loss in 10 to 30 percent of cases.



    Vaginal delivery is the usual approach, with the use of epidural anesthesia to achieve effective pain control and with the use of assisted-delivery devices during the second stage of delivery (eliminating the need for pushing). Cesarean section should be performed when there are obstetrical indications for it. Labor is associated with an increase of 8 to 10 mm Hg in the left atrial and pulmonary wedge pressures. Pulmonary arterial catheters have been used successfully before and during delivery to facilitate the management of hemodynamics in women with advanced disease.



    Èç N Engl J Med. 2003 Jul 3;349(1):52-9.

    Clinical practice. Valvular heart disease in pregnancy.

    Reimold SC, Rutherford JD.

Êëèíèêà ñòîìàòîëîãèè è êîñìåòîëîãèè â Ìîñêâå

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