Хориоамнионит — абсолютное показание к быстрому родоразрешению и не является противопоказанием к оперативному родоразрешению по обычной методике.

 

При отсутствии активной родовой деятельности и шансов быстрого рождения ребенка метод выбора — кесарево сечение [113]

 

При подозрении на хориоамнионит должна быть начата антибактериальная терапия, то есть к вводимому препарату (например, ампициллину) должен быть добавлен второй препарат из другой группы, например: гентамицин в дозе: 5 мг/кг веса в/в 1 раз в сутки. Кроме этого, при подтверждении диагноза хориоамнионита после родоразрешения добавлен метрогил по 100 мг каждые 8 часов

 

Показания для отмены антибактериальной терапии – двое суток нормальной температуры тела.

 

При ДИВ при сроке 34 нед. и более длительная (более 12-24 часов) выжидательная тактика не показана, так как повышает риск внутриматочной инфекции и компрессии пуповины без улучшения исходов для плода [114] (B-3b). Но решение о вмешательстве должно приниматься, на основании комплексной клинической оценки ситуации после получения информированного согласия пациентки.

 

При пограничном сроке 32-34 нед беременности выбор тактики зависит от зрелости легких плода, которая может быть определена по результатам исследования выделяемого из цервикального канала или материала, полученного в результате трансабдоминального амниоцентеза [115].

 

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