Ведение ЭКО-беременности

30 Июля 2013 | 16 Комментарии
Ведение ЭКО-беременностиБеременность, наступившая в результате успешного применения ВРТ, относится к категории высокого риска и требует постоянного наблюдения со стороны квалифицированных врачей. Логично предположить, что даже показания к применению ЭКО (возраст женщины, экстрагенитальная патология, эндокринные факторы бесплодия и др.) могут стать факторами возможных осложнений протекания беременности, не говоря уже о том, что при ЭКО-беременности существует риск развития генетических аномалий плода, самопроизвольной редукции плодного яйца, выкидыша и преждевременных родов. Не стоит забывать и о рисках, связанных с многоплодной беременностью, которая часто достигается во время процедуры ЭКО.

Итак, в чем заключаются особенности ведения ЭКО-беременности?

1-й триместр

После подтверждения факта беременности пациентка может продолжать наблюдаться в клинике репродуктивной медицины, заключив с руководством данного учреждения соответствующий договор. Однако особых показаний для этого нет и в большинстве случаев ведение ЭКО-беременности проводится в обычной женской консультации. При первом посещении гинеколога и постановке на учет женщина уже имеет на руках результаты всех стандартных обследований, поэтому повторно сдавать анализы на ВИЧ, гепатиты, ТОРЧ-инфекции и RW, общий анализ крови и мочи, анализ выделений и цитологию шейки матки не потребуется. Однако беременной необходимо будет пройти осмотр терапевта, офтальмолога и стоматолога, сделать ЭКГ, а также определиться с необходимостью и сроками продолжения прогестероновой терапии, которая в обязательном порядке назначается для поддержания ЭКО-беременности в клиниках ВРТ.

Становиться на учет в женской консультации женщина должна не позже 9-й недели беременности. Врач измеряет пациентке размеры таза и окружности живота, определяет рост и вес. Все полученные данные и результаты лабораторных анализов заносятся в персональную карту беременной.

На сроке 9-12 недель проводится двойной (основной) генетический тест. То есть беременная должна будет сдать анализ крови из вены на РАРР и бета-ХГЧ. Кроме того в первом триместре беременности необходимо провести исследование УЗИ с целью определения основных размеров плода, после чего все полученные данные рассчитываются по специальной компьютерной программе, устанавливающей степень перинатального риска. Если степень риска низкая, никакой угрозы нормальному течению беременности и развитию плода не выявлено, ведение ЭКО-беременности продолжается в обычном режиме до срока 16-19 недель. В случае многоплодной беременности пациентке может быть предложено наложение циркулярного шва на шейку матки, что предупредит развитие истимико-цервикальной недостаточности и снизит риск преждевременных родов.

2-й и 3-й триместры

Следующий важный период ведения ЭКО-беременности приходится на 16-19 неделю. На данном сроке обязательно проводится второй (тройной) этап генетического тестирования и КТГ, а также биохимический скрининг крови (Альфа-фетопротеин, свободный бета-ХГЧ и гормон эстриол (Е3)). На этом же этапе врач непременно проводит повторное УЗИ и рассчитывает степень риска по новым данным. При возможных осложнениях в развитии плода применяется дополнительная диагностика в виде генетического исследования околоплодных вод и амниоцентеза. Успешное, прогрессирующее протекание беременности после ЭКО на сроке 19-21 неделя означает окончание самого важного и опасного этапа вынашивания здорового ребенка. С этого момента можно быть практически полностью уверенным в нормальном развитии генетически полноценной беременности и отсутствии рисков её самопроизвольного прерывания.

Отныне в задачу врача будет входить проведение профилактических мероприятий, направленных на устранение угрозы преждевременных родов и гестоза. На сроке ЭКО-беременности в 37-38 недель женщина должна лечь в стационар, где под присмотром специалистов будущая мама станет готовиться к благополучному родоразрешению и появлению на свет долгожданного малыша.



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