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Литература – Акушерство (разрыв промежности)

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EAEOeEss ?4.

OAIA: ?IAeU.

?iaeu – yoi oeceieiae/aneee aeo, ai a?aiy eioi?iai i?ienoiaeeo ecaiaiea
ieiae ec iaoee, /a?ac ?iaeiaua iooe, ieaoeaiou n iaiei/eaie,
ieieiieiaeiuie aiaeaie. Ieiae iaoiaeeony a ieiaeiii iaoea a
ieieiieiaeiuo aiaeao. Oeceieiae/aneea ?iaeu ianooiatho /a?ac 280 aeiae (
10 aeiae iethn ieion). ?aiueoa n/eoaee /oi ?iaeu ia/eiathony iioiio /oi
ieiae oie?aaony iiaeeaie a aeii iaoee, aieiaeie aeaaeo ia oaeeo iaoee (
oai?ey Aeiiie?aoa). Nia?aiaiiua i?aaenoaaeaiey i i?e/eiao ?iaeiaie
aeayoaeueiinoe i/aiue neiaeiu. Aicaoaeeiinoue iaoee aic?anoaao eiioeo
aa?aiaiiinoe. Iaoea e eiioeo aa?aiaiiinoe oaaee/eaaaony ai iiiai ?ac (
iaoea iaaa?aiaiiie aeaiueiu ii aeeeiieeo i?eia?ii 7-8 ni, a aeeeiiee
aa?aiaiiie iaoee a aeiiioaiiue n?ie oaaee/eaaaony aei 36 ni). Iuooeu
iaoee eae e iuooeu na?aeoea iaeaaeatho aaoiiaoeciii, iioiio /oi iuoa/iua
eeaoee ieiiao?ey iaeaaeatho niiniaiinoueth e niiioaiiie nie?aoeoaeueiie
aeayoaeueiinoe. Ia?aienoi/ieeii aicaoaeaeaiey yaeyaony a?oiia eeaoie ,
eioi?ua iau/ii ?aniieaaathony a i?aaii o?oaiii oaeo aiaeeoaeai ?eoia. E
ionthaea aieia aicaoaeaeaiey ?ani?ino?aiyaony aia/aea ia ieaeiee naaiaio
iaoee. Yoi ?ani?ino?aiaiea aieiu nie?auaiey iieo/eei iacaaiea
ienoiaeyuaai o?ieiiai a?aaeeaioa ( aeii – oaei – ieaeiee naaiaio). Yoi
ii?ia iioiio /oi anee aieia iieaeao n ieaeiaai naaiaioa aaa?o, oi ?iaeu
ia niiaoo i?iecieoe. Aeii iaoee nie?auaaony ai?acaei neeueiaa oaea
iaoee. Oaei a naith i/a?aaeue nie?auaaony neeueiaa, /ai ieaeiee naaiaio.
Ieaeiee naaiaio iaeaieaa ?aniieiaeai e ?anoyaeaieth. Oaeei ia?acii
ia?acoaony ecaiiythuay neea. Nie?auaiey iaoee iacuaathony noaaoeaie.
Noaaoea – yoi ?acoeueoao i?aia?aciaaiey oeie/aneie yia?aee a
iaoaie/aneoth a i?ioeanna noaaoee o/anoaotho nie?aoeoaeueiua eeaoee
iaoee, aeoei e ieicei. Iniaaiiinoueth no?iaiey iuooeu iaoee yaeyaony
?acee/iia ?aniieiaeaiea iuoa/iuo aieieii a ?aciuo ioaeaeao iaoee. A aeia
e oaea eiaao ianoi i?aeiouanoaaiii i?iaeieueiia ?aniieiaeaiea aieieii, a
ieaeiai naaiaioa – a iniiaiii oee?eoey?iue oiae iuoa/iuo aieieii.
Iuoa/iua aieieia iaoee iaeaaeatho niiniaiinoueth ia oieueei
nie?auaoueny, ii e ianeieueei iaiyoue oiae naiaai nie?auaiey oi anoue
iie iiaoo ia?aieaoaoueny iaaeaeo niaie e ia?aaeaaaoue aicaoaeaeaiea n
iaeiie eeaoee ia ae?oaoth. Ana iuoa/iua aieieia iaoee eiatho
i?iiaaeooi/iua nionouey e yoe niaaeeiaiey iniaaiii ?acaeaathony ia?aae
?iaeaie.

Eioaineaiinoue noaaoie caaeneo io ?ac?yaea iioaioeeaeia eaaeaeie
iuoa/iie eeaoee. E ianiio?y ia oi /oi iaoea ninoieo ec iiiaeanoaa
aieieii, ii a ?iaeao iia aeaenoaoao eae aaeeiue i?aai.

I?e/eiu iiyaeaiey ?iaeiaie aeayoaeueiinoe.

A ieiiao?ee ?aniieaaaaony ia?iiiia eiee/anoai ?aoeaioi?ia n aunieie
/oanoaeoaeueiinoueth e aoii?aeueiui aauanoaai, ai?iiiai, ooa?ioiieeai. A
iaoea ?aniieaaaaony aieueoia eiee/anoai aeueoa e aaoa
aae?aii?aoeaioi?ia, i-oieeii?aoeaioi?ia, aenoaieii-?aoeaioi?ia,
yno?iaaii-, i?iaanoa?iii?aoeaioi?ia, i?inoaaeaiaeeii?aoeaioi?ia,
?aoeaioi?ia e ieneoioeeio.

Ea?athuea aieueooth ?ieue a ?acaeoee ?iaeiaie aeayoaeueiinoe:

Aoeaoeeoieei ( iiae aai aeeyieai ianooiaao nie?auaiea iuooeu iaoee,
oieeiynoa?aca aai ?ac?ooaao e aicaoaeaeaiea iaoee i?ae?auaaony).
*oanoaeoaeueiinoue ?aoeaioi?ia e aoeaoeeoieeio iaoee caaeneo i?aaeaea
anaai io yno?iaaiia. Iie neioace?othony a ieaoeaioa, ye/ieeao e a
iniiaiii naiue aeoeaiue yno?iaai 17-yno?aaeeie neioace?oaony a ia/aie
ieiaea. Yno?iaaiu auaatho 3-o o?aeoeee: yno?aaeeie, yno?ii, yno?eie.
Ninoiyiea ieiaea , aai yiaeie?eiiie nenoaiu oaeaea aeeyao ia ?acaeoea
?iaeiaie aeayoaeueiinoe.

E eiioeo aa?aiaiiinoe niaea?aeaiea yno?iaaiia oaaee/eaaaony. Ai a?aiy
aa?aiaiiinoe oea?noaoao i?iaanoa?ii, oae eae ii nieaeaao aicaoaeeiinoue
iaoee e oaeei ia?acii nio?aiyao aa?aiaiiinoue. Eiioeo aa?aiaiiinoe
niaea?aeaiea aai nieaeaaony. Aeey ii?iaeueiiai i?ioaeaiey aa?aiaiiinoe
iaiaoiaeei ii?iaeueiue ai?iiiaeueiue aaeain. I ia?ooaiee iaino?oaeueiiai
oeeeea naeaeaoaeuenoaotho au?aaeaiiue aeia?o?eoic, iaee?aiea,
aanieiaeea. O oaeeo aeaiuei aa?aiaiiinoue iiaeao i?ioaeaoue neaaeothuei
ia?acii:

aa?aiaiiinoue ianooiaao, ii i?ienoiaeeo aueeaeuo

Aa?aiaiiinoue aeiiioaiiay, ii a ?iaeao ioee/aaony iai?aaeeueiay ?iaeiaay
aeayoaeueiinoue

Aa?aiaiiinoue ia?aiioaiiay

Aeaenoaea yno?iaaiia:

aucuaatho i?ieeoa?aoeeth ieiiao?ey

nieaeatho iioaioeeae iieiy iaoee

oaaee/eaatho iaeiieaiea eiiia eaeueoeey

noeioee?otho aeueoa aae?aii?aoeaioi?u , eioi?ua ioaa/atho ca
nie?aoeoaeueioth aeoeaiinoue iaoee.

iiauoatho /oanoaeoaeueiinoue iaoee e aeaenoaeth ieneoioeeia

Aeaenoaea i?iaanoa?iia ia?aoiia aeaenoaeth yno?iaaiia. Ia?iiiia
cia/aiea a ?acaa?ouaaiee ?iaeiaie aeayoaeueiinoe eiatho
ei?oeeinoa?ieaeu. Eo eiee/anoai oaeaea oaaee/eaaaony e eiioeo
aa?aiaiiinoe e neioace?othony iaaeii/a/ieeaie aeaiueiu e ieiaea,
ieaoeaioie. Iiauoaiea ei?oeciea a ia?eoa?e/aneie e?iae ieiaea yaeyaony
neaiaeii e ?acaeoeth ?iaeiaie aeayoaeueiinoe. Aieueoia cia/aiea
i?eaeaaony i?inoaaeaiaeeiai. A ?acaeoee ?iaeiaie aeayoaeueiinoe
o/anoaotho IAF2, IAA. IAF2 ia?acoaony a aeaoeeaeoaeueiie oeaie iaoee, a
a ieiaeiuo iaiei/eao ia?acoaony IAA. Iie yaeythony aeaaiuie
ooa?ioiieeaie. O?iaaiue IA iiauoaaony ia?aae ?iaeaie e yaeyaony
?acoeueoaoii iiauoaiey o?iaiy ei?oeciea.

Ia/aei nie?auaiee iaoee ia iiaeao i?ioiaeeoue aac eiiia eaeueoeey, oae
eae iie yaeythony ia?aaeao/eeaie aicaoaeaeaiey n ia?aiiai aieieia ia
iuoa/iia. Niaea?aeaiea eiiia eaeueoeey oaaee/eaaaony e ia/aeo ?iaeiaie
aeayoaeueiinoe.

Iniiaiia aeaenoaea IA ia iaoeo eiaao iaeio iniaaiiinoue: iaoea a ethaua
n?iee aa?aiaiiinoe ioaa/aao nie?auaieai. Yoi icia/aao /oi i?eiaiaiea IA
a ethaua n?iee aa?aiaiiinoe iiaeao auoue eniieueciaaii aeey i?a?uaaiey
aa?aiaiiinoe. Eniieuecotho i?inoaiie, yicii?ino.

Aua iaeiei ooa?ioiie/aneei n?aaenoaii yaeyaony ieneoioeei.
Au?aaaouaaaony a caaeiae aeiea aeiioeca. Eiioeaio?aoeey ieneoioeeia iaei
iaiyaony a i?ioeanna aa?aiaiiinoe iaoiaeeony a e?iae a i/aiue ieceeo
eiioeaio?aoeeyo. E eiioeo aa?aiaiiinoe niaea?aeaiea ieneoioeeia
iaeneiaeueii a ii/iia a?aiy, a aeiai nieaeaaony. ?iaeu /aua anaai
ia/eiathony a ii/iia a?aiy, eiaaea eiaao ianoi iaeneiaeueiay
eiioeaio?aoeey e ieneoioeeia e yno?iaaiia. Iaeneiaeueiay eiioeaio?aoeey
ieneoioeeia ioia/aaony oieueei eiioeo ?iaeia ( e eiioeo aoi?iai e
o?aoueaai ia?eiaeia ?iaeia). Iiyoiio iiiaea enneaaeiaaoaee n/eoatho /oi
ieneoioeei ia?iiiia cia/aiea eiaao eeoue a oneeaiee ?iaeia, a ia a
?acaycuaaiee eo. Ieneoioeei oneeeaaao auaeaeaiea IAF2. Oaeei ia?acii a
aicieeiiaaiee ?iaeiaie aeayoaeueiinoe aaaeioth ?ieue ea?atho
iiauoathueeny o?iaaiue yno?iaaiia, nieaeaiea niaea?aeaiey i?iaanoa?iia,
iiauoaiea eiioeaio?aoeee eiiia eaeueoeey. Neaiaeii e ia/aeo ?iaeia
neoaeeo iiauoaiea i?iaeoeoeee IA ieiaeiuie iaiei/eaie, iinea iiiaaeaiey
a ieieiieiaeiua aiaeu ei?oeciea, eioi?ue auaeaeyaony iaaeii/a/ieeaie
ieiaea. Iiauoaieth neioaca IA niinianoaotho oaaee/aiea eiioeaio?aoeee
yno?iaaiia, eiiia eaeueoeey, a oaeaea ?ac?ua ieiaeiuo iaiei/ae e
eioeoee?iaaiea, ?anoe?aiea oaeee iaoee a ?iaeao i?e aeaaaeeuiii
enneaaeiaaiee. Ia/eiathony noaaoee. Oniao ?iaeia a cia/eoaeueiie noaiaie
iaania/ai anee eiaaony aeieiae/aneay aioiaiinoue e ?iaeai. Iiae yoei
iaoanoaeai iiieiatho ia?aciaaiea – ?iaeiaie aeiieiaiou a aieiaiii iicaa
( yoi oaeia ninoiyiea OeIN, eiaaea ei?a aieiaiiai iicaa iaoiaeeony a
ninoiyiee iaeioi?iai oi?iiaeaiey, a iiaeei?eiaua no?oeoo?u a ninoiyiee
aicaoaeaeaiey, /oi nicaeaao oneiaey aeey aaconeiaiiai ?aoeaena).

Aeieiae/aneia nic?aaaiea iyaeeo ?iaeiauo iooae ( c?aeay oaeea iaoee e 38
iaaeaeyi).

I?eciaee iac?aeie oaeee iaoee:

aeeeia oaeee 2-3 ni

ieioiay eiinenoaioeey oaeee iaoee

oea?aeeaeueiue eaiae cae?uo

oaeea iaoee ioeeiiaia /aua e e?anooeo e ia ?aniieaaaaony a oeaio?a
aeaaaeeua.

I?eciaee c?aeie oaeee:

oaeea iaoee oei?i/aia aei 1-1.5 ni.

iyaeie eiinenoaioeee

oea?aeeaeueiue eaiae i?ioiaeei aeey iaeueoea ca aioo?aiiee caa.

oaeea iaoee ?aniieaaaaony a oeaio?a aeaaaeeua.

Yoe i?eciaee aia?aua iienae aia?eeaineee o/aiue Aeoii. Iiieii
aeieiae/aneie aioiaiinoe e ?iaeai aieueoia cia/aiea a enoiaea ?iaeia
eiaao niiaoe/aneia caei?iauea aeaiueiu, ?acia?u oaca, ?acia?u ieiaea e
o.ae.

Oaeea iaoee nic?aaaao iiae aeaenoaeai ooa?ioiieeia ( yno?iaaiia,
?aeaeneia, IAA2).

Ii?aaeaeaiea aioiaiinoe aeaiueiu e ?iaeai. Aioiaiinoue e ?iaeai icia/aao
i?aaeaea anaai aioiaiinoue ieiaea e ?iaeai. Ieiaea aeieaeai auoue
c?aeui.

ii?aaeaeaiea c?aeinoe oaeee i?e aeaaaeeuiii enneaaeiaaiee

oeeoieiae/aneee iaoiae ( iacee ec caaeiaai naiaea aeaaaeeua, ioeaieaatho
eeaoee yieoaeey). Aeaaaeeua yaeyaony i?aaiii – ieoaiueth aeey aeaenoaey
iieiauo ai?iiiia , iii aunoeaii iiiaineieiui ieineei yieoaeeai.
Iiiaineieiinoue caaeneo io yno?iaaiiie e i?iaanoa?iiiaie noeioeyoeee.
Iiae aeeyieai yno?iaaiia eaeao i?ieeoa?aoeaiue i?ioeann, i?iaiaaiea,
iiyaeyaony ea?eiieeiic yaea? ( ?anoao ea?eiieeiioe/aneee eiaeaen). Oaeei
ia?acii ii ninoaao eeaoie , ii EIE iiaeii noaeeoue i i?eaeeaeaiee
?iaeia, i aioiaiinoe e iei.

Ieneoioeeiiaue oano ( no?anniaue oano). Anee aeaiueia aaanoe
ieneoioeei, a neo/aa aioiaiinoe e ?iaeai, iaoea ioaaoeo nie?auaieai.
Aaiaeyo 1 aae. ( 0.2 ie) ieneoioeeia , iaaeeaiii aioo?eaaiii. Iiaeii
eniieueciaaoue na?ioiiei. I?iaaaeaiea no?anniaiai oanoa o?aaoao
inoi?iaeiinoe, oae eae o iaeioi?uo aeaiuei aaaaeaiea ieneoioeeia
iiaeao i?eaanoe e ioneieea ieaoeaiou.

Aaaaeaiea eaeueoeey oei?eaea. *a?ac 2-3 ieioou iinea aioo?eaaiiiai
aaaaeaiey ioia/aaony nie?auaiea iaoee.

Auoaia?a/eneaiiua oanou i?iaiaeyo a oii neo/aa , eiaaea iaiaoiaeeii
aein?i/iia i?a?uaaiea aa?aiaiiinoe ( iai?eia? i?e oyaeaeii oieneeica).

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