Уровень убедительности рекомендаций С (уровень достоверности доказательств

Показания к госпитализации в акушерско-гинекологический стационар:

- Клинические проявления угрожающего выкидыша[21].

- Укорочение шейки матки менее 25мм по данным трансвагинальной эхографии.

- Развитие специфических осложнений монохориальной многоплодной беременности, требующих проведения внутриутробных вмешательств (фето-фетальный трансфузионный синдром, синдром обратной артериальной перфузии, синдром анемии-полицитемии).

- Пациентки с синдромом селективной задержки роста плода, I тип – в 33-34 недели, II, III тип в 29-30 недель.

- Антенатальная гибель одного или обоих плодов.

- Клинические проявления угрожающих преждевременных родов.

- Излитие или подтекание околоплодных вод.

- Клинические проявления преждевременной отслойки нормально расположенной плаценты.

- Клинические проявления преэклампсии.

- Пациентки с монохориальной многоплодной беременностью, осложненной ФФТС, САП, после внутриутробного оперативного лечения в сроке 34-35 недель беременности.

Критерии оценки качества медицинской помощи

№	Критерии качества	Уровень убедительности рекомендаций	Уровень достоверности доказательств
1.	Установлен срок беременности в 1 триместре (при раннем обращении)	А
2.	Установлена многоплодная беременность в 1 триместре (при раннем обращении)	A
3.	Направлена на скрининг анеуплоидий в 1 триместре (при обращении до 13⁶ недель беременности)	B
4.	Рекомендовано динамическое ультразвуковое обследование пациенток с монохориальной многоплодной беременностью интервалом 2 недели с 16 недель беременности	C
5.	Рекомендовано динамическое ультразвуковое обследование пациенток с ди/три-хориальной многоплодной беременностью интервалом 4 недели с 16 недель беременности	C
6.	Направлена на ультразвуковой скрининг аномалий развития плодов в 18-22 недель	C
7.	Направлена на консультацию, либо проведена заочная консультация по каналу телемедицины в перинатальном центре с возможностями проведения фетальных внутриутробных операций в случае диагностики многоводия/маловодия, селективной задержки роста плода, анемии/полицитемии плодов, наличия плода-акардиуса	C
8.	Рекомендована профилактика прерывания беременности назначением препаратов прогестерона при укорочении шейки матки менее 2,5см	A
9.	Проведена профилактика РДС плодов при клинических проявлениях угрожающих преждевременных родов	B
10.	Выполнено абдоминальное оперативное родоразрешение в случае монохориальной моноамниотической многоплодной беременности	С

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ПриложениеА1. Состав рабочей группы по разработке и пересмотру клинических рекомендаций

Авторы

1. Гладкова Кристина Александровна - к.м.н., заведующая 1-ым акушерским отделением патологии беременности, с.н.с. института акушерства ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России (г. Москва).