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PLATSENTANING PAST JOYLASHUVI BO’LGAN HOMILADORDA
TUG‘RUQNI BOSHQARISH (ADABIYOTLAR SHARHI)
Magzumova N.M., Norqulova Sh.U., Ahmedova G.A.
Toshkent Tibbiyot Universiteti
Dolzarbligi.
“Past joylashgan platsenta” — bu platsentaning bachadon pastki
segmentiga qisman joylashgan holati bo‘lib, u ichki bachadon bog‘zidan 1–20 mm
masofada joylashadi. Bunday holatdagi ayollarda optimal tug‘ruq usuli hanuzgacha
muhokama qilinmoqda, shuning uchun ularning aksariyatida kesarcha kesish bajariladi.
Vaginal va kesarcha tug‘ruq hollari chastotasini baholash uchun adabiyotlar tahlili
amalga oshirildi.
Kalit so‘zlar
: homiladorlik, past joylashgan yo‘ldosh, diagnostika, ultratovush
tekshiruvi.
ВЕДЕНИЕ РОДОВ У БЕРЕМЕННЫХ С НИЗКО РАСПОЛОЖЕННОЙ
ПЛАЦЕНТОЙ (ОБЗОР ЛИТЕРАТУРЫ)
Магзумова Н.М., Норкулова Ш.У., Ахмедова Г.А.
Ташкентский медицинский Уневерситет
Актуальность
. «Низко расположенная плацента» — это когда происходит
частичная имплантация в нижний сегмент матки и расположен на расстоянии 1–
20 мм от внутреннего цервикального отверстия. Оптимальный способ
родоразрешения у женщин с низко расположенной плацентой до сих пор остается
спорным и большинству из них проводится кесарево сечение. Проведен анализ
литературы для оценки частоты вагинальных родов и кесарева сечения при родах.
Ключевые
слова:
беременность,
низкая
плацентация,
диагностика,
ультразвуковое исследование
MANAGEMENT OF LABOR IN PREGNANT WOMEN WITH LOW-LYING
PLACENTA (LITERATURE REVIEW)
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Magzumova N.M., Norkulova S.U., Akhmedova G.A.
Tashkent Medical University
Relevance
: "Low-lying placenta" refers to partial implantation in the lower segment of
the uterus, located at a distance of 1–20 mm from the internal cervical os. The optimal
method of delivery in women with low-lying placenta remains controversial, and most
of them undergo cesarean section. A literature analysis was conducted to assess the
frequency of vaginal delivery and cesarean section during labor.
Keywords
: pregnancy, low placenta, diagnosis, ultrasound examination.
“Past joylashgan platsenta” atamasi platsentaning bachadon pastki segmentiga
qisman joylashgan holatini ifodalaydi, bu holatda platsentaning pastki cheti ichki
bachadon bog‘zidan ( internal -os- distance - IOD) 1–20 mm masofada joylashadi [1–
3]. Transvaginal skanerlash (TVS) — IOD ni o‘lchashda “oltin standart” hisoblanadi
[4]. Ushbu masofani o‘lchash uchun optimal vaqt homiladorlikning uchinchi trimestri
oxiri — 36-hafta deb hisoblanadi, chunki shu vaqtda bachadon pastki segmenti to‘liq
shakllanadi [6, 7]. IOD ni aniqlash tug‘ruq usulini tanlashda muhim ahamiyatga ega [2,
5, 8].
Platsentaning oldindan joylashuvi holatlarida kesarcha kesish bajarilishi kerakligi
borasida ko’rsatmalar mavjud bo‘lsa-da, platsentaning past joylashuvi bo’lgan
homiladorlarda optimal tug‘ruq usuli hali ham bahsli hisoblanadi, chunki bu borada
ishonchli ilmiy ma’lumotlar yetarli emas [9–14].
Izlanishlarga homiladorlikning ikkinchi trimestrida platsentaning past joylashuvi
bo’lgan ayollar kiritilgan. Nazorat guruhi sifatida platsentasi normal joylashgan
homiladorlar olingan. Har bir holatda, uchinchi trimestr oxirida IOD >5 mm bo‘lgan 30
nafar ayol tanlab olindi. Platsentaning past joylashuvi holatlari chastotasi ikkinchi
trimestrda 2% bo‘lsa, homiladorlik oxiriga kelib 0,4% gacha kamaydi. Agar IOD >5 mm
bo‘lgan ayollarda vaginal tug‘ruq chastotasi ≥60% bo‘lsa, ularni tug‘ruqqa tayyorlash
uchun rejalashtirilgan kasalxonaga yotqizish maqbul hisoblanadi.
Amerika va Buyuk Britaniyaning akusherlik va ginekologiya kollejlari
homiladorlikning uchinchi trimestrida simptomlari yo‘q past joylashgan yo‘ldoshli
ayollar uchun klinik vaziyat va bemor istagiga asoslangan individual yondashuvni
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tavsiya etadi. Niderlandiyaning 2015-yilgi va Kanadaning 2020-yilgi
ko‘rsatmalarida esa IOD 11–20 mm bo‘lgan barcha ayollarga vaginal tug‘ruq tavsiya
etiladi, chunki bu oraliqda qon ketish xavfi past hisoblanadi [16].
Shuningdek, kanadalik tadqiqotchilar IOD ≤10 mm bo‘lgan ayollarda ham, agar
boshqa xavf omillari bo‘lmasa (masalan, 29 haftagacha qon ketish holatlari yoki
marginal sinus belgilarining mavjud emasligi), vaginal tug‘ruqni sinab ko‘rishni tavsiya
etadilar [17].
Retrospektiv tadqiqotda IOD 11–20 mm bo‘lgan ayollarda vaginal tug‘ruq 69%
hollarda, IOD 1–10 mm bo‘lganlarda esa 25% hollarda kuzatilgan [10]. Shu asosda
2009-yilda maxsus protokol ishlab chiqilgan: IOD ≤10 mm bo‘lsa — rejalashtirilgan
kesarcha kesish, IOD 11–20 mm bo‘lsa — vaginal tug‘ruq tavsiya qilinadi.
2009–2018-yillar mobaynida protokol qo‘llanilganda, IOD 11–20 mm bo‘lgan ayollarda
vaginal tug‘ruq 77%, shoshilinch kesarcha hollari esa 16,3% ni tashkil etdi [18]. Bu
Jansen va boshqalar tomonidan olib borilgan sistematik tahlil natijalari bilan mos keladi
[19]. IOD 1–10 mm bo‘lgan ayollarda vaginal tug‘ruq 43%, shoshilinch kesarcha esa
45% ni tashkil etgan. Ikkala guruhda ham onalik kasalliklari bo‘yicha farq
aniqlanmagan. Shunga o’xshash natijalar Wortman va boshqalar tomonidan o’tkazilgan
retrospektiv tadqiqotda olingan. [13] Ular IOD >5 mm bo‘lgan ayollarda vaginal
tug‘ruq ehtimoli <5 mm (mos ravishta 58% va 0%) bilan solishtirgandasezilarli darajada
yuqori ekanini aniqladilar, IOD kichik guruhlari o’rtasida sezilarli farqlar yo’q(6-10mm,
11-15mm, 15-20mm)
Ishonchli ilmiy dalillar va o’z navbatida, o’ziga xos milliy tavsiyalar yo’qligi sababli
Italiyada platsenta past joylashgan ko’pchilik ayollarga odatda kesarcha kesish taklif
qilinadi [10, 18]. Biroq, uchunchi trimestrda IOD >20 mm ga yetgan ayollarda ham
qon ketish xavfi yuqori bo‘lishi aniqlangan.
Kesarcha kesish keyingi homiladorliklarda platsenta oldindan joylashuvi
ehtimolini oshiradi, ayniqsa ilgari bunday holat kuzatilgan bo‘lsa [21]. Bu xavf avvalgi
kesarcha soni ortgani sayin oshadi [5]. Avvalgi kesarcha va yo‘ldoshning oldindan
joylashuvi — platsenta o’sib kirishi (placenta accreta) rivojlanishining asosiy omillari
hisoblanadi [22]. Ushbu holat og‘ir qon ketish, gistorektomiya, qon quyish va onalik-
perinatal o‘lim xavfi bilan kechadi [23].
JSST 2015-yildan boshlab ayniqsa birinchi homiladorlikda kesar kesish usulidagi
tug‘ruqlarni kamaytirishni tavsiya qilgan [24]. Bu tavsiyalar ayniqsa Yevropa davlatlari
uchun dolzarb, chunki bu mamlakatlarda eng yuqori ko‘rsatkichlarga ega [25].
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Italiya tadqiqotlari (2021-2024) uchunchi trimestr oxirida trasvaginal
ultratovush tekshiruvi asosida platsenta past va IOD >5mm bo’lgan barcha ayollarga
vaginal tug’ishni sinovdan o'tkazishni taklif qiladi. Tadqiqotchilar homiladorlikning
ikkinchi trimestrida normal va past joylashgan yo‘ldoshli ayollarni solishtirgan.
Maqsad: IOD 6–20 mm bo‘lgan ayollarda vaginal tug‘ruq va shoshilinch kesarcha
holatlarini baholash.
Oxirgi yillarda olingan ma’lumotlar past joylashgan yo‘ldoshli ayollarda vaginal tug‘ruq
xavfsizligini tasdiqlamoqda [12]. Shu bilan birga, kesar kesish usulidagi tug’ruqlar ortib
borayotgani fonida placenta accreta xavfi ham ortmoqda [22].
Shuning uchun homiladorlikning 19–23 haftalari oralig‘ida UTT orqali past
joylashgan yo‘ldosh aniqlanib, placenta accreta holati istisno qilinishi kerak. 37-haftada
qayta baholab, tug‘ruq usulini aniqlash tavsiya etiladi.
Adabiyotlar tahlili shuni ko‘rsatmoqdaki, past joylashgan yo‘ldoshni erta aniqlash
va TVS orqali IOD ni aniqlash, placenta accreta ni istisno qilish orqali har bir homilador
ayolga individual yondashuv asosida tug‘ruq rejasini tuzish mumkin bo‘ladi.
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21.Gurol-Urganci I, Cromwell DA, Edozien LC, et al. Risk of placenta previa in
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