Obstetrics and GynecologyObstetrics and GynecologyАкушерство и гинекология0300-90922412-5679Bionika Media24788710.18565/aig.2017.3.5-10ArticlesСтатьиResearch ArticleCesarean scar pregnancy. Current state of the problem. Diagnostics. Clinical symptoms. Medical tacticsБеременность в рубце на матке после кесарева сечения. Современное состояние проблемы. Диагностика. Клиника. Врачебная тактикаTskhayVitaly B.ЦхайВиталий Борисович

MD, prof., head of the Department of perinatology, obstetrics and gynecology

д.м.н., профессор, зав. кафедрой перинатологии, акушерства и гинекологии лечебного факультета

tchai@yandex.ruYametovPavel K.ЯметовПавел Константинович

assistant of the Department of perinatology, obstetrics and gynecology

ассистент кафедры перинатологии, акушерства и гинекологии лечебного факультета

mail.rur@mail.ruVergunovNikita A.ВергуновНикита Андреевич

postgraduater of the Department of perinatology, obstetrics and gynecology

аспирант кафедры перинатологии, акушерства и гинекологии лечебного факультета

vergunov.n@gmail.comProf. V.F. Voino-Yasenetsky Krasnoyarsk State Medical UniversityФГБОУ ВО КрасГМУ им. проф. В.Ф. Войно-Ясенецкого150320173NO3 (2017)№3 (2017)51018022023Copyright ©; 2017, Bionika MediaCopyright ©; 2017, ООО «Бионика Медиа»2017Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/0300-9092/article/view/247887

Objective. To carry out a systematic analysis of the data which is available in modern literature, concerning prevalence, etiology, pathogenesis, diagnostics and treatment of cesarean scar pregnancy (CSP) and possible complications. Subject and methods. The review included foreign and Russian publications which entered the Pub med database on this subject. Length of search covered 15 years. Results. Modern data on prevalence, etiology and pathogenesis of CSP are submitted. Value of risk factors is reflected in the development of CSP and its complications. Value of transvaginal scanning in combination with dopplerometry is specified at early diagnostics of BRM as rather reliable method. Efficiency and low number of complications at the use of combined treatment methods is demonstrated: systemic application of Methotrexate, carrying out a laparoscopy together with a hysteroresektoskopy. Conclusion. Frequency of CSP grows together with the frequency of operation of Cesarean section. The effective organosafe treatment provides fertility, and decreases a number of serious complications and critical situations perhaps only at timely diagnostics on early term of gestation. The comparative assessment of efficiency of the combined surgical and medication treatment is presented in separate publications. However, almost total absence of information on CSP in domestic special literature, absence of uniform algorithm of diagnostics and treatment, can lead to mistakes of obstetricians-gynecologists both in diagnostics, and in tactics of maintaining pregnant women with this pathology.

Цель исследования. Провести систематический анализ данных, имеющихся в современной литературе, касающихся распространенности, этиологии, патогенеза, диагностики и лечения беременности в рубце на матке (БРМ) и возможных осложнений. Материал и методы. В обзор включены зарубежные и отечественные публикации, вошедшие в базу данных Pubmed по данной теме. Глубина поиска составила 15лет. Результаты. Представлены современные данные о распространенности, этиологии и патогенезе БРМ. Отражено значение факторов риска в развитии БМР и осложнений. Указано значение трансвагинального сканирования в сочетании с допплерометрией при ранней диагностике БРМ как достаточно надежного метода. Показана эффективность и низкое количество осложнений при применении комбинированных методов лечения: местное и системное применение метотрексата, проведение лапароскопии вместе с гистерорезектоскопией. Заключение. Частота БРМ растет параллельно с увеличением частоты операции кесарева сечения. Эффективное органосохраняющее лечение, обеспечивающее сохранение фертильности, а также снижение числа тяжелых осложнений и критических ситуаций возможно только при своевременной диагностике на ранних сроках беременности. Сравнительная оценка эффективности комбинированных хирургических и медикаментозных методов лечения представлена в отдельных публикациях. Однако практически полное отсутствие информации по БРМ в отечественной специальной литературе, отсутствие единого алгоритма диагностики и лечения может приводить к ошибкам врачей акушеров-гинекологов как в диагностике, так и в тактике ведения беременных с этой патологией.

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