#1
|
|||
|
|||
ïîëèêèñòîç è áåðåìåííîñòü
çäðàâñòâóéòå, ìíå 30 ëåò, ìåíñòðóàöèè íà÷àëèñü â 12, öèêë â ïîñëåäíèå 5 ëåò ðåãóëÿðíûé (28 äíåé +- 2). áåðåìåííîñòåé äî ñèõ ïîð íå áûëî
ãîä íàçàä çàñòóäèëàñü, â ñëåäñòâèè ýòîãî çàðàáîòàëà ñåáå êèñòó ëåâîãî ÿè÷íèêà, ïðîïèëà 3 ìåñÿöà ÿðèíó ñåé÷àñ áåðåìåííîñòü íà ðàííåé ñòàäèè (4-5 íåäåëü), â æåíñêîé êîíñóëüòàöèè ïîñòàâèëè äèàãíîç - êèñòà ëåâîãî ÿè÷íèêà è ïîëèêèñòîç ïðàâîãî. êàê ýòî ìîæåò ïîâëèÿòü íà ïðîòåêàíèå áåðåìåííîñòè è êàê ñëåäóåò ëå÷èòüñÿ? çàðàíåå ñïàñèáî |
#2
|
|||
|
|||
Äèàãíîçà "ïîëèêèñòîç ïðàâîãî ÿè÷íèêà" íå ñóùåñòâóåò, íàëè÷èå êèñòû â ëåâîì íà ðàçâèòèå áåðåìåííîñòè íèêàê íå ïîâëèÿåò. Íî íåîáõîäèìî äèíàìè÷åñêîå íàáëþäåíèå - ïîâòîðíîå ÓÇ-èññëåäîâàíèå ÷åðåç ìåñÿö. Íå áóäåò ëèøíèì ñðàâíèòü äàííûå ÓÇÈ ñ ïðåäûäóùèì (äî áåðåìåííîñòè).
|
#3
|
|||
|
|||
1. Ïîçâîëþ ñåáå ñ Âàìè íå ñîãëàñèòüñÿ, îòíîñèòåëüíî íàëè÷èÿ ïîëèêèñòîçà îäíîãî ÿè÷íèêà.  ïîäòâåðæäåíèå ïðèâåäó ëèòåðàòóðíûå èñòî÷íèêè:
Battaglia C., et al. Polycystic ovary syndrome: is it always bilateral? Ultrasound Obstet Gynecol 1999;14:183. Lakhami K. et al. Polycystic ovaries. British Journal of Radiology. 2002;75:9. 2. Êðîìå òîãî, âàæíî îïðåäåëèòü êàêàÿ êèñòà ïðèñóòñòâóåò è åå ðàçìåðû. |
#4
|
||||
|
||||
Ïðîáëåìà â òîì, ÷òî êëèíè÷åñêèé ñìûñë ÑÏÊß - íå ñóòü ÓÇÈ äàííûå
__________________
Ã.À. Ìåëüíè÷åíêî |
#5
|
|||
|
|||
Êîíå÷íî, òåì áîëåå, ÷òî:
äèàãíîñòè÷åñêèìè êðèòåðèÿìè äëÿ ñèíäðîìà ïîëèêèñòîçíûõ ÿè÷íèêîâ ÿâëÿþòñÿ: - îëèãî-\àíîâóëÿöèÿ; - êëèíè÷åñêèå è\èëè áèîõèìè÷åñêèå ïðèçíàêè ãèïåðàíäðîãåíèè: - ïîëèêèñòîçíûå ÿè÷íèêè. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility&Sterility; 2004:81,1,19. |
#6
|
||||
|
||||
ËÞÁÛÅ äâà èõ òðåõ êðèòåðèåâ ÏÐÈ ÎÒÑÓÒÑÒÂÈÈ ÄÐÓÃÎÃÎ ÇÀÁÎËÅÂÀÍÈß.
Òå ÓÇÈ êðèòåðèé ó ìàòåðè- ãåðîèíè ïîäêà÷àåò, Äåòàëè - âñå ìèëëèàðäû ñòðàíèö äî òîãî. ïðèíöèïå äèñêóññèîííàÿ ëèíèÿ î ÑÏÊß â îäíîì ÿè÷íèêå áûëà áû î÷åíü ìèëà, íå èäè ðàçãîâîð î êîíêðåòíîì îòâåòå êîíêðåòíîé áåðåìåííîé æåíùèíå - åñòü î÷åâèäíûå íþàíñû.
__________________
Ã.À. Ìåëüíè÷åíêî |
#7
|
|||
|
|||
Äà, ñèíäðîì ïîëèêèñòîçíûõ ÿè÷íèêîâ - ýòî ñàìàÿ äèñêóòàáåëüíàÿ è ñïîðíàÿ òåìà â ãèíåêîëîãè÷åñêîé ýíäîêðèíîëîãèè. À ïîíÿòèå "unilateral polycystic ovary" ïðèñóòñòâóåò, ïî êðàéíåé ìåðå, â àíãëîÿçû÷íîé ìåä.ïåðèîäèêå ñ íà÷àëà 80-õ .
Êîíêðåòíûé îòâåò êîíòðåòíîé áåðåìåííîé æåíùèíå ïðîñò - îïðåäåëèòüñÿ íà ÓÇÈ ñ îáúåìíûì îáðàçîâàíèåì ÿè÷íèêà (êèñòîçíîå æåëòîå òåëî, ýíäîìåòðèîìà, öèñòàäåíîìà, è ò.ä.), è íàáëþäàòü â äèíàìèêå (ÓÇÈ). Ñ óâàæåíèåì, |
#8
|
|||
|
|||
Óâ. Voluson,
ó íàñ ïðèíÿòî íå ìåøàòü âðà÷åáíûìè áåñåäàìè â ðàçäåëå êîíñóëüòàöèé ïàöèåíòîâ. Òå òåîðåòè÷åñêèå îáñóæäåíèÿ - â ðàçäåë îáñóæäåíèå âðà÷åé. Áåðåìåííûõ æåíùèí ïóãàòü íå íóæíî. |
#9
|
||||
|
||||
Óâàæàåìàÿ ïàöèåíòêà- ïðèíîñèì èçâèíåíèÿ çà âðà÷åáíûé ðàçãîâîð â îòâåò íà Âàøå ïèñüìî
Ó Âàñ ïîñëå ñîîáùåíèÿ ä-ðà èç Óêðàèíû ìîæåò ñëîæèòüñÿ âïå÷àòëåíèå, ÷òî Âàøà ïðîáëåìà îñîáåííî ñëîæíà è çàïóòàíà- ýòî íå òàê. Ïðîñòî â ïîçíàíèè ìèðà ëþäè ïðîõîäÿò ðàçíûå ýòàïû è íà ðàçíûõ óðîâíÿõ ïîíèìàþò äåéñòâèòåëüíîñòü ( òåîðåòè÷åñêè ìîæíî áûëî áû íàïèñàòü äèññðåòàöèþ íà òåìó - 'äèôôåðåíöèàëüíûå ðàçëè÷èÿ â âîëî÷åíèè îò îäíîé ñòåíû ê äðóãîé äèâàíà ñ êîâðîâîé îáøèâêîé è îáøèâêîé èç ñèíòèïîíà" - íî íèêòî â çäðàâîì óìå è òðåçâîé ïàìÿòè íå äåëàåò òàêèõ ðàáîò- ïîòîìó êàê è â æèçíè íå øèáêî íàäî Èìåííî ïî òàêîìó ïðèíöèïó è ñòðîÿòñÿ íà íàøåì ôîðóìå êîíñóëüòàöèè - ìû îñîçíàåì îãðàíè÷åííîñòü çàî÷íûõ êîíñóëüòàöèé è ïðè íåîáõîäèìîñòè âðà÷åáíûõ ñïîðîâ ïåðåâîäèì äèñêóññèþ â ñïåöèàëüíûé çàêðûòé ðåæèì Êîãäà ó íàñ ïîÿâëÿþòñÿ íîâûå äîêòîðà, ìû âñåãäà ðàäóåìñÿ èõ ïðèõîäó- íî íå âñåãäà ïðîñòî âïèñàòüñÿ â íîâûé êîëëåêòèâ è ïðèíÿòü ïðàâèëà ( óñòàâ) ýòîãî êîëëåêòèâà. Ïîýòîìó ÿ ïðèâåäó àáñòðàêò ðåêîìåíäîâàííîé íàì êîëëåãîé ñòàòüè è ïîêàæó, ïî÷åìó â íàøåì ñëó÷àå ýòîò ïðèìåð íåóìåñòåí ß Polycystic ovary syndrome: it is always bilateral? Battaglia C, Regnani G et al Department of Obstetrics and Gynecology, University of Modena, Italy. OBJECTIVE: To evaluate whether patients with unilateral polycystic ovary showed different ovarian and uterine blood flow from those with bilateral polycystic ovaries, and to investigate whether there was a correlation between the ultrasonographic aspect and different hormonal parameters. DESIGN: An observational study. SUBJECTS: Sixteen patients with unilateral polycystic ovary and twenty patients with bilateral polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation. METHODS: The following parameters were evaluated: hormonal (luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessel pulsatility index, ovarian stromal vascularization), in oligomenorrheic patients in the early follicular phase (cycle days 3-5) or in amenorrheic patients at random. RESULTS: Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in bilateral polycystic ovaries. In unilateral polycystic ovaries, gray-scale and color Doppler ultrasonography showed different features in the affected and the unaffected ovary, similar to the appearance of a polycystic and normal ovary, respectively. CONCLUSION: Polycystic ovary syndrome does not predetermine a single ultrasonographic and Doppler pattern.
__________________
Ã.À. Ìåëüíè÷åíêî |
#10
|
|||
|
|||
Óâàæàåìàÿ Leska911,
Ïðîøó ïðîùåíèÿ çà ýòó "äèñêóññèþ", êîòîðàÿ, êàê îêàçàëîñü, íå èìåëà ñìûñëà, è íàäåþñü, Âàñ íå èñïóãàëà. Ïîëàãàþ, ÷òî "êèñòà" è "ïîëèêèñòîç ÿè÷íèêà" íå ïîâëèÿþò íà òå÷åíèå Âàøåé áåðåìåííîñòè. Ñ óâàæåíèåì, |
#11
|
|||
|
|||
ñïàñèáî çà èñ÷åðïûâàþùèå îòâåòû
êàê ïîêàçàëî óçè íà 10 íåäåëå, âñå ïðîøëî |