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1. Warkany J. Congenital malformations: notes
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P. 552554.
6. .., ..
//
. . 1995. 3. . 5153.
7. .., .. 


. .: , , 1997.
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12. Zacharias J., Jenkins J., Marion J. The incidence
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12


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14. .., .. 

. .: , , 1997.
. 2021.
15. MRC Vitamin Study Research Group.
Prevention of neural tube defects: results of the
Medical Research Council Vitamin Study //
Lancet. 1991. V. 338. P. 131137.
16. Volpe J. Neural tube formation and prosencephalic
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19

developmental brain defects: Warburgs


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1. Hirsch J., PierreKahn A., Renier D. et al. The
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V. 28. P. 272283.
3. .. 

20 // . .
1997. 2. . 8586.
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DandyWalker malformation // J. Ultrasound
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5. .., .. 
.
.: , , 1997. . 2833.
6. Achiron R., Achiron A. Transvaginal ultrasonic
assessment of the early fetal brain // Ultraso
und Obstet. Gynecol. 1991. V. 1. P. 336344.
7. Tal Y., Freigang B., Dunn H. et al. Dandy

22


Walker syndrome: analysis of 21 cases // Dev.
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1. Myrianthopoulos N., Chung C. Congenital
malformations in singletons: epidemiologic sur
vey. Report from the Collaborative Perinatal
Project // Birth Defects. 1974. V. 10. P. 158.
2. Warkany J., Lemire R., Cohen M. Microceph
aly // Mental retardation and congenital anom
alies of the nervous system. Chicago: Year book,
1981. P. 1340.
3. Chervenak F., Jeanty P., Cantraine F. et al. The
diagnosis of microcephaly // Amer. J. Obstet.
Gynecol. 1984. V. 149. P. 512517.
4. Chervenak F., Rosenberg J., Brightman R. et
al. A prospective study of the accuracy of ultra
sound in predicting fetal microcephaly // Ob
stet. Gynecol. 1987. V. 69. P. 908910.
5. Bromley B., Benacerraf B. Difficulties in the
prenatal diagnosis of microcephaly // J. Ultra
sound Med. 1995. V. 14. P. 303305.
6. .. 
// 


24


/ . .. 
.. . 2. .: , 1996. . 89118.
7. Danks D., Bankier A. POSSUM pictures of
standard syndromes and undiagnosed malfor
mations. Version 4.5. Melbourne. Australia:
Computer Power, 1997.
8. Jones K. Smiths recognizable patterns of hu
man malformations. 5th ed. Philadelphia:
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. 






. 


.



[24].
.


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. 

 
, 
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(12%) (12%) [7].


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.

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() ().

26


,
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. 

, 
. 

. 
, 
300 . 
.
.
,

.


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[2].

. 
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.



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[8]. 
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1713,3),
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,

.

.

.

, 
,
 ..
. 


. , 
, , 

.



[15].

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. 
, 

.

.
. 
, 

. 1.19. . 
.


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. 

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14 24 (. 1.19, 1.20, 1.21).


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, 
,


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31

.


. ,
, ,
, 
.
.
.
. 


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[14]. 
,

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.



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. 


. 

.

,

28

S. Bondurant ., 1984 [2]

26

M. Mintz ., 1985 [7]

29

M. Kim, M. Elyaderani, 1982 [6]

K. Fogarty ., 1989 [8]

28

R. Achiron ., 1993 [9]

26

27

29

28

O. Sibony ., 1993 [10]


M. Anderson, J. McGahan, 1994 [11]

21

V. Catanzarite ., 1995 [12]

28

I. Reiss ., 1996 [13]

23

.. ., 1997 [14]

38

S. Guerriero ., 1997 [15]

26

: ; ;
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.

32


,
. 

.

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. 
,
.


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 [16, 17].
. 

.

 .


.



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. 

,

. 




. 

.
. 


,
. 90% 


, 
[18].
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, 


[19].

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34

. 
,



.
, 
,

.
,

.
. , 

1 5200 
1 54 000 [1]. 

, 

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prosencephalon diencephalon 
, 

prosencephalon [2]. 
prosencephalon
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35


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[810]. 
,
,
 [6].

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18 21 [11]. 
 
,
, , ,
[12].



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, 
, 
6% [13].
.



.

,

.



. 

 .


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, ,
. , 
,
.

,

,
, . 

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.
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II) 

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37

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.
. 


. 
.



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.
, 
,
.
,

, 
.

, 
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38

SPINA BIFIDA
. Spina bifida
, 

.

. 
, 
. 

.
. spina
bifida .

4 1000
.
0,5 1000, 

[1]. 

spina bifida
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().

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) 26 spina bifida 
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[5, 6].
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.
. Spina
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.

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spina bifida 3
5%.
(4 ), 3 
,
spina bifida 70% [14].
. 

24
. 
, , 

.

, 
. 
,

,
. 
, L2
, 
, 


[15].

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. 


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, 
.

,
.

. 
4 10 
. 

[5].
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. 

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[11, 12]. 
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230
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,

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( 10%).

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der Woude Stickler, 

, , ..
 



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.

.


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.

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,


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,
7 10 000 [1].
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. , 


, 13, 18,
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[2].
. 


(. 1.35).


(.
1.36) [24]. 

, 

(.
1.37).

. 1.35.
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.

,
,
.


. ,

. 1.36. 
.
.

. 1.37. 
() 
.

46



, 
(,
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. 
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,


. 
, 
situs inversus [1]. 
,
.
. 


[2, 3].



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, 
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,
(,
, ).
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[4].

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48

10

..

1998 15
,
. 1983
F.Daffos . [1] 
53
.

, 
,
.
,

, 
, . 
,
, 
, 
, 


[24].


,


.


, ,
,


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.





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/.

, 
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. 

, ,


231

10
10.1.

, %

, %

/
%

3,2
<1,0

89

11

0,6

92,1

7,3

15,0

0,97

79,73

19,3

3,0

0,5

60,7

38,8


(. 10.1) [5].
, 
, 

, , 

. 

,
, 

, 

. 
, 

, , . 
,


. .. (
) 

27 (). 1987 1997
. 2580 ,

253 (9,8%) [6].
1990 1998 .
1219 , 
522 (42,8%) [7].
, 


.

, , 
,



.


1964 ,
V.Freda K.Adamsons 

, [8]. 
, 7080 , 


,

7678%,
[9].




[10, 11].
80
,


( 24 ) 
. 
,
, 
10% [12], 
5% [13, 14].

232







.
1982 J.Bang . [15] 


.


Rh.


. 1983


F.Daffos, .CapellaPavlovsky F.Forestier

: 
53 [1].

, . 

20G

, 
. 
, 
2
[16], ,

. ,
, 
1,8%, 1% 
0,8% 
. 
, 80
,


.


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?


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4872 . ,


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,
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Varicella zoster

Rh?

, 
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.


18 35%
[1922].
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, 
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, 8,4%

, 8,6%
50% 
.
, 


(37,5%) 
(33,3%).


3,3%, 
7,1%.


, 
, 33%, 57%,
67%. 

[2429]: 1417% , 2
11% , 29
36% 
, 28%
. 
, 

,



234


15,2%,

21,6% [22, 28].


. 



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XY 82/12,

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9

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. : 46,
XY / 47, XXY / 48, XXXY / 49, XXXXY 
49% / 35,5% / 11% / 4,5%,


51%.

.
21
, 

235

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46, XY.

3850 , 54 .
, 

2% [3234]. 
, 
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[36].
(
), , 
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[36]. , 
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,

[38].


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.

600
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[41, 42]. 



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[19].
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/ 0,110,05,
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[46]. 
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[47].

.


237

10


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A. Liley 70%, 
18 25 
68% [47, 48]. 
,
,


, ,
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[49, 50].

. 


, ,
.
pO2
,
pCO2 , pH

[2, 51]. pH 
7,40 0,02,
7,32 0,05; pO2

37,6 6,5, 23,0 10,1;
pCO2 35,3 2,8, 45,0
8,0 [2]. 
pH pO2 
, pCO2 .
,
, 
[47, 52]. ,
, 

(
), 


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,



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[5258].
. 


 .
19 
30%
[47].
10
15 / 

[59].





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238



0,10,3 / . 
60 120 [2, 47].
[51] 


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17 220 .
.
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(1975 ) (1994 )


/
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5%
[5]. 

. 
5 ,
(. 10.3).

10.3.

P.Boulot
.
[60], %

C.Weiner
[2],%

Y.Chitrit
.
[61], %

A.Antsaklis
.
[62], %

[51], %

[7], %

1,4

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2,4

6,5

1,8

1,6

15,5

68,7

12,7

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1,4

2,3

1,0

3,6

4,2

14,4

43,0

28,0

68,0

9,4

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41,6

3,6

2,4

1,9

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4,2

6,3

18,2

44,8

16

5,5

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1,4

Rh?

37,6

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0,7

: * , , , ?
.

239

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, . 
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[44],


[5]. 
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80

.

Kings College Hospital
5 ,
, 

, 

[59].


, 

[47].

90 
10% 
,
,
1998
46,9%. 



, 
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.


.





. 


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 . 

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[2, 60]. 

,
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tt 20 
. P.Boulot
. [60], 
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50%, 20 83%.
,

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[2, 60],

12 [63
65].
, ,
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25 ,
10 36 [6668].
,
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.
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[69]. 



; 

[70, 71].  

[72, 73]. 
[71]
,

. 




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30 
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25 ,
30 
.
,
brainsparing effect 

 
, 
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,


.
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. 2021 

, 
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.

(47%)
20 24 25 28
(29%). 
(1820 ) 
12% .

(0,8%), , 


. 
. , ,
. . [51],
20
5,7% , 21 29 67,4%,
36 1,9%.
P.Boulot . [60], 20
1,2% ,
20 29 22,0%, 35 6,5%.
C.Weiner [2] 

241

10
37 5,2%, 70% 
25 36 .
. 


. 


, 
.

: 
, , . 

. 1987 C.Weiner [2]

. 

,



.


.
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[74], 
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K.Nicolaides [25], .Weiner K.Okamura


[75]. ,

, .

. ,
, 

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, 
[51].


9 16 20 25 G.

. 


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EDTA.
,

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 .


[3, 4, 19, 59],


[51].

242


,

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[60,
61]. 
2030 

(, ).


.

[47, 59,
60], , ,

[51].
, 

, 


, 
.
Rh 
Rh
D
,
15
[61].

(38 ) [47, 60, 62] [60,
61],

[62].


.


, 

.
,

,



(Coulter Counter).

Kleihauer
Betke 
.

,

9598,7%, 

63 87,2% [2, 60, 62].
[51]
95,8%
. , 
97% 83,9%
[22]. 

:



33,3%,
5 91,9% [22].


. 

(
)

. 
,

, 10.4.
. 

.
, , 

, 
. P.Boulot . [60], 

,
1 4 , 40% 5 14
, 5,4% 15
3,6% 

243

10
10.4.


:

29,0%

3,2%

12,9%

25,8%

12,9%

6,5%

9,7%

100%

1 .
,

11,3 , 

4,8
(89,6%)
1 5 [7]. 
B.Petrikovsky [76]: 
(50 ) 

24,6 , 16,2
. A.Ludomirski
.Weiner [47] 
100 5,5
, ,
, .

. 

, 

: 
 ,
, .

,
(.
10.5). ,
, 
; , 

,

,

.
(7493%)

[2, 51, 77], 
.

89,3% [7].

, 

, 

.

: 
,

10.5.


, %


, %


, %

.Ludomirsky ., 1987 [78]

100

.Weiner, 1987 [2]

63,5

9,4

27,1

.Boulot ., 1990 [60]

72,2

3,5

24,3

. ., 1993 [51]

42,0

1,4

56,6

.Petrikovsky ., 1997 [77]

62

32

.Antsaklis ., 1998 [62]

62

38

23,4

27,1

42,3

., 1999 [7]

244


, , 
, .
.

.

1,5 13,2% (. 10.6).


,

100 /, 
1 .

. ,
[51, 79,
80], ,

. 

, 
,


. 
,
(17,2%)

[81],
.


,
, 
[60, 79].
M.Ulm . [82],

, , 
, 
,

10.6.

, %

F.Daffos ., 1983 [1]

53

13,2

F.Daffos ., 1985 [16]

606

9,0

C.Weiner, 1987 [2]

96

3,1

B.Benacerraf ., 1987 [83]

42

2,4

C.Weiner, 1988 [84]

200

5,0

B.Pielet ., 1988 [85]

58

8,6

A.Ludomirski ., 1988 [86]

100

10,0

E.Jauniaux ., 1989 [87]

50

10,0

C.Donner ., 1989 [88]

144

12,2

F.Daffos, 1989 [89]

2093

7,0

P.Boulot ., 1990 [60]

322

7,5

C.Weiner, 1991 [90]

594

6,6

P.Maxwell ., 1991 [91]

268

1,5

K.Perry ., 1991 [92]

100

5,0

D.Hickok ., 1992 [93]

302

5,8

. ., 1993 [51]

212

5,2

F.Duchatel ., 1993 [94]

341

9,4

A.Ludomirsky, 1993 [95]

7462

8,0

C.Donner ., 1994 [96]

891

7,0

M.Ulm ., 1997 [82]

339

3,8

Y.Chitrit, 1997 [62]

103

5,8

., 1998 [7]

522

8,9

245

10
Rh
. 
, 

. 

26,4 , 
29,1 .

.
[82] 
, 
,

(61,5%
3,1% ).
,
(18,3%) 

100 /,
(8,9%) 
[7]. 
, M.Ulm
. [82],
(
) .


. 


.
., 24 ,
31 
,
28 .

.

20 
. 

.
: 46, XY.
. 

.
, 

2962% [2,
6062, 86],
31,3%. 
( 1
), 
. ( 1 ) 

19,7% . 
. . [51], 
1,9%.


(54,1%)

(48,7%) [61]. 
, , 

.
,
(66,6% 32,3% 
) [51].

:
2030
() 

KleihauerBetke [97] 
10 000 .

0,25 , 
15 . 
Rh

Rh 
D.
(7886%) 
. 

.
[2, 60, 86] 
,

. Y.Chitrit
. [61] , 
3 
56,9% ,
3
22,9% . 
,

246


1 19,7%
[7]. 


: 
66,7% ,
30% [61].

[96, 98, 99]. 


.

,
[61].

.
. 
, 

. , .Antsaklis .
[62] 7 1981 
, 0,4%. 
B.Petrikovsky [76]
(50 )
2% ,

. 

(0,39%) 
,
.

, 

. 

, 

, , 

.
. 
, 
,
.
, 

0,62,91% [66, 68, 51],



, 
post factum 2840% 
, 
.
[60, 62, 86]




.



23,1% 
, 

, 0,6% 
[7].
, ,
,
, , 



.
. 

.
,


,
. 
, 
, 
, 1014
,


.


,

.
.Ludomirsky .Weiner [47],

247

10

7% .

:


, 
( 2 
);
, 
( 2 
);
;

.
,
34 

: ,

, 2% 2,5%; 
, 2 1,5%;

22,5%;
32%. 60% 

.

, 


2%

(. 10.7),
0 8,8% [2, 91].
, 
(1,1%) 
A.Ludomirsky [95], 
10 

7000 .

, ,


. 
, 


. 
, 1981

, 1998
A.Antsaklis . [62]. 
5 :

10.7.


2
, %


> 2
, %

F.Daffos ., 1985 [98]

606

0,8

1,1

C.Weiner, 1987 [2]

96

C.Weiner, 1988 [84]

1400

0,15

C.Donner ., 1989 [88]

144

0,8

1,9

M.Wittle, 1989 [100]

0,5

P.Boulot ., 1990 [60]

322

1,24

1,86

F.Orlandi ., 1990 [63]

500

4,3

D.Maxwell ., 1991 [91]

268

8,8

A.Ludomirsky, 1993 [86]

7462

1,1

. ., 1993 [51]

212

2,91

0,97

R.Snijders, K.Nicolaides, 1994 [101]

1169

1,0

1,0

C.Weiner ., 1996 [75]

0,9

.Antsaklis ., 1998 [62]

1981

2,5

0,6

., 1998 [7]

522

2,5

1,3

248


1) 
;
2) ;
3) 
,

, 

;
4) 
,
,  
, ;
5) 
.


4,8%, 2 
2,5%, 



( <0,001). 


(13,1%)
(8,9%), ,

. 


2
1%
1,6% .



,
,
. 


,
.
. 
, 


.


D.Maxwell . [91],
, 
,
8,8%.


, 



(25%)
(6,6%), (1,3%)
, 
.
Kings College
Hospital (), 8 10
1
6 , 



1%,

150 [59].
P.Boulot . [60], 


40% 
, 40% 

. 
,

2 
2 2,5% 
.
23% 

, 15%

, 30%
, 32%

.
1,5%,

2,5%. 85% 

249

10

, (

), 

. 

.

8.

9.

, 

,
, 

. 

, 


.

10.

11.

12.

13.
1.

2.

3.

4.

5.

6.

7.


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.. .
: 
// 
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9599.
.. 


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15.

16.

17.

18.

19.

20.

// . . . . 
. 1999. . 7. 2. . 128134.
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1. Gilbert Barners E. Respiratory system //
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Potters pathology of the fetus and infant / Ed.
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P. 752754.
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P. 152.
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. 153163.
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1. Egan J.F.X., Petrikovsky B.M., Vintzileoos
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// .
. . . . 1999. . 7. 2.
C. 152153.
7. .. 
// 
. . . . . 1993. 4. C.
6670.
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. 
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, 


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[15].

63


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.
,
,



, 
.
.


[1].

. 


(. 3.8,
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. 


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.




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.

. 

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, 
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.



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.


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.


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.
. 


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, 
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.
,

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, 
[8].

1. Fyler D.C. Single ventricle // Nadas pediatric
cardiology / Ed. Fyler D.C. Philadelphia:
Hanky & Belfus, 1992. P. 649658.
2. .., .., ..,
.. 

// . 1991. 5.
. 4850.
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P. 497521.
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Birthweight of infants with congenital heart
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P. 249254.

66


5. Weigel T.J., Driscoll D.J., Michels V.V.
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.
()
, 
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), 

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.



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,
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10

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.

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. 


.

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.


.


. 
, ,
, 
. 50% 

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[4].
. 


. 

68



[14].

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2. .. 

// . . 1991. 11. . 6875.
3. Rustico M.A., Benettoni A., DOttavio G. et
al. Fetal heart screening in lowrisk pregnan
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6. 5. P. 313319.
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!
. 
, 


. 


.




.
. 
0,150,44
1000 [1] 45%
[2].

. 







(. 3.12). 

.
,



 50
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69


, 

.
.


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[8]. 



.


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. 


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,
.

. 



. 



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, 

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. 

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[13]. 
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[18]. 
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.

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.


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.

. 


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. 

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.



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.



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( 10 ) 

.

80%
[26].

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//

/ . ..,
.. . 2. .: , 1996.
. 119151.
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72


.
, 


.


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: (
)
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. , 
,
.
. 
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. 



,
. 



(. 3.14).
: 

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.





[24]. 



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. 



1819
[6]. ,

,


.


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.

,

. 
, ,

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.
. 


[79].

. 3.14. 32 . 
. 1
, 2 
, 3 .

73

. 


, 

.

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. 


().

25% [12]. 

.
15% [10, 11].


. 

, 
. 
. 

.


1% [13]. 


, , 
.
%
.

.


. 


, 

%
. 

,
.
,

. 
6,3% [12].

I II ,

.
.


. 
, ,
.

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.. 
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. 
, 
: 
, ,

.
.

4 11% [1].

.
. 


.



(. 3.16). 

(. 3.17)
[2].



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.
,


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[3].
. 

,

, 22 
. 


[4]. 

,

[5].

.

.
. 30% 


. 
30
,
[6, 7].

.

13, 18 21, 

75

2
2

1
. 3.16. . 
(1) (2).

. 3.17. . 
.
(1), (2).

[710]. D.
Paladini . [11],
22%
. 22q11.2 
30%
, 90% 
82% 
[1820]. 22q11

( 1 4
000 ) 5%
[21].


(,
, 
) [12, 13].
,
, ,
, , 
, 
[1417].



. 


 , 
.




(
, 
, , 
).


. 


22q11 3% [22].
%
. 

.


28 .


.

,

.
%
.

, 
,

3 [6]. 

76



, 3 , .


.


5% [22, 23]. 



.
. 
,
90% ,

[24]. 
80% 

[25].

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. .: , 1997. . 128129.
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6. Ferencz C., Rubin J.D., McCarter R.J. et al.
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12. Danks D., Bankier A. POSSUM  pictures of
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Retinoic acid and embryopathy // N. Engl. J.
Med. 1985. V. 313. P. 837841.
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tonuria and hyperphenylalaninemia. An
international survey of the outcome of untreated
and treated pregnancies // N. Engl. J. Med.
1980. V. 303. P. 12021208.
17. Ardinger H.H., Clark E.B., Hanson J.W.
Cardiac malformations with fetal valproic acid
exposure // Proc. Greenwood Genet. Center.
1986. V. 5. P. 162.
18. Emanuel B.S., Budarf M.L., Sellinger B. et al.
Detection of microdeletions of 22q11.2 with
fluorescence in situ hibridization (FISH):
diagnosis of DiGeorge, velocardiofacial
syndrome, CHARGE association and
conotruncal cardiac malformations // Amer. J.
Hum. Genet. 1992. V. 51 (Suppl.). A3.
19. Driscoll D.A., Spinner N.B., Budarf M.L. et al.
Deletions and microdeletions of 22q11.2 in
velocardiofacial syndrome // Amer. J. Med.
Genet. 1992. V. 44. P. 261268.

77

20. Goldberg R., Motzkin B., Marion R. et al.


Velocardiofacial syndrome: a review of 120
patients // Amer. J. Med. Genet. 1993. V. 45.
P. 313319.
21. Rimoin D.L., Connor J.M., Pyeritz R.E. Emery
and Rimoins principles and practice of
medicine. 3rd ed. V. 12. NY: Churchill
Livingstone, 1997.
22. Digilio M.C., Marino B., Gianotti A. et al.
Recurrence risk figures for isolated tetralogy of
Fallot after screening for 22q11 microdeletion //
J. Med. Genet. 1997. V. 34. P. 188190.

23. Redington A.N. Deteerminants of short and


longterm outcome in the surgical correction of
tetralogy of Fallot // Cur. Opin. Peddiatr. 1993.
V. 5. P. 619622.
24. Murphy J.G., Gersh B.J., Mair P.D. et al. Long
term outcome in patients undergoing surgical
repair of tetralogy of Fallot // N. Engl. J. Med.
1993. V. 329. P. 593599.
25. Wesser H.U. Exercise performance in tetralogy
of Fallot after intracardiac repair // J. Thorac.
Cardiovasc. Surg. 1980. V. 80. P. 582589.


.
,

,
.
. 
57% [1].

, 
.
.



,

. 



. 
,
: 
, 
(. 3.18). 

,

.
. 


.


, , 
, ,

6 .
. 


.
. 8%

[2].

. 3.18. . 
()
().

78




13, 18 21,
[36]. 

(
, 
,  ) [7,
8]. , 
, 
, , ,
, 
[3, 914].
,


[15, 16]. 

/.



. 

2%.
%
.



. 



, 


. 
, 

. 
(
) 
2 ,


.
,


5
10% [1].


/ 
 

, 

.
%
. 
, ,

, 
.

. 


.
. ,


(1015 ) ,
.
,
, 

, , 

.

1. Paul M.H., Wernovsky G. Transposition of the
great arteries // Heart disease in infants and
children / Ed. Adams F.H., Emmanouilides
G.C., Riemenschneider T.A. Baltimore:
Williams & Wilkins, 1995. P. 11151224.
2. Ferencz C., Rubin J.D., McCarter R.J. et al.
Cardiac and noncardiac malformations:
observations in a populationbased //
Teratology. 1987. V. 35. P. 367378.
3. Jones K.L. Smiths recognizable patterns of
human malformations. 5th ed. Philadelphia:
Saunders, 1997.

79

4. Levy T.J., Rosenthal A., Fyler D.C., Nadas A.S.


Birthweight of infants with congenital heart
disease // Amer. J. Dis. Child. 1978. V. 132. P.
249254.
5. Blackbum W.R., Miller W.P., Supemeau D.W.
et al. Comparative studies of infants with mosaic
and complete triploidy: an analysis of 55 cases//
Birth Defects. 1982. V. 18. P. 251274.
6. deGrouchy J., Turleau C. Clinical atlas of human
chromosomes. 2nd ed. NY: Wiley, 1984.
7. National Center for Biotechnology Infor
mation. OMIM: Online mendelian in man.
http://www.ncbl.nlm.gov/Omim/.
8. Danks D., Bankier A. POSSUM  pictures of
standard syndromes and undiagnosed
malformations. Version 4.5. Melbourne,
Australia: Computer Power, 1997.
9. Clark E.B. Cardiac embryology. Its relevance
to congenital heart disease // Amer. J. Dis.
Child. 1986. V. 140. P. 4144.
10. Lammer E.J., Chen D.T., Hoar R.M. et al.
Retinoic acid and embryopathy // N. Engl. J.
Med. 1985. V. 313. P. 837841.
11. Jackson B.T. The pathogenesis of congenital
cardiovascular anomalies // N. Engl. J. Med.
1968. V. 279. P. 8089.
12. Ardinger H.H., Clark E.B., Hanson J.W.
Cardiac malformations with fetal valproic acid
exposure // Proc. Greenwood Genet. Center.
1986. V. 5. P. 162.
13. Ballard J.L., Holroyde J., Tsang R.C. et al. High
malformation rates and decreased mortality in

infants of diabetic motheers managed after the


first trimester of pregnancy (19561978) // Amer.
J. Obstet. Gynecol. 1984. V. 148. P. 11111118.
14. Lenke R.R., Levy H.L. Maternal phenylke
tonuria and hyperphenylalaninemia. An
international survey of the outcome of untreated
and treated pregnancies // N. Engl. J. Med.
1980. V. 303. P. 12021208.
15. Nora J.J., Nora A.H. The evolution of specific
genetic and environmental counseling in
congenital heart diseases // Circulation. 1978.
V. 57. P. 205213.
16. Litsey S.E., Noonan J.A., OConnor W.N. et
al. Maternal connective tissue disease and
congenital heart block: demonstrattion of
immunoglobulin in cardiac tissue // N. Engl. J.
Med. 1985. V. 312. P. 98100.
17. Emanuel B.S., Driscoll D., Goldmuntz E. et
al. Molecular and phenotypic analysis of the
chromosome 22 microdeletion syndromes //
Prog. Clin. Biol. Res. 1993. V. 384. P. 207224.
18. Driscoll D.A., Spinner N.B., Budarf M.L. et al.
Deletions and microdeletions of 22q11.2 in
velocardiofacial syndrome // Amer. J. Med.
Genet. 1992. V. 44. P. 261268.
19. Goldberg R., Motzkin B., Marion R. et al. Velo
cardiofacial syndrome: a review of 120 patients//
Amer. J. Med. Genet. 1993. V. 45. P. 313319.
20. Rimoin D.L., Connor J.M., Pyeritz R.E. Emery
and Rimoins principles and practice of
medicine. 3rd ed. V. 12. NY: Churchill
Livingstone, 1997.


.
, 
,
, 
.

,

.


. I
,


.


.
. 
14% 
[1].
. 

,

80

. 3.19. 
().

. 3.20. 26 . 
.
().


(. 3.19, 3.20).



[2]. 
, 

(. 3.21). 


(. 3.22) [2, 3].


,


.

,
, 
, 
.

.

. 3.21. 

.

. 3.22. . 
().

.

20
, 
,

81



. 

2223 
(. 3.23) [2].
. 



. 6 
.


. 
.
. 
. 30%

[4].
, 
,
13, 18 21, 
[58]. 
D. Paladini . [9],

17% . 

[10, 11]. 
, , ,
,


, 
[5, 1217].

,
[1821].


.



,

.


1%.
%
. 



.

, 


. 

6 .




. 

.
%
. 

.

. 3.23. 2223 .
.

.




82


. ,
, 

. 


.

1. Mair D.D., Edwards W.D., Julsrud P.R.
Truncus arteriosus // Heart disease in infants
and children / Ed. Adams F.H., Emmanouilides
G.C., Riemenschneider T.A. Baltimore:
Williams & Wilkins, 1995. P. 1026.
2. .., .., ..,
.. 

// . . 1997.
2. . 9193.
3. .. 


// . .
. . . 1999. 1. C. 7576.
4. Ferencz C., Rubin J.D., McCarter R.J. et al.
Cardiac and noncardiac malformations:
observations in a populationbased //
Teratology. 1987. V. 35. P. 367378.
5. Jones K.L. Smiths recognizable patterns of
human malformations. 5th ed. Philadelphia:
Saunders, 1997.
6. Levy T.J., Rosenthal A., Fyler D.C., Nadas A.S.
Birthweight of infants with congenital heart
disease // Amer. J. Dis. Child. 1978. V. 132.
P. 249254.
7. Blackbum W.R., Miller W.P., Supemeau D.W.
et al. Comparative studies of infants with mosaic
and complete triploidy: an analysis of 55 cases//
Birth Defects. 1982. V. 18. P. 251274.
8. deGrouchy J., Turleau C. Clinical atlas of
human chromosomes. 2nd ed. NY: Wiley, 1984.
9. Paladini D., Lamberti A., Tartaglione A. et al. The
association between congenital heart disease and
Down syndrome in the fetus // Ultrasound
Obstet. Gynecol. 1998. V. 12. Suppl. 1. P. 105.
10. National Center for Biotechnology Infor
mation. OMIM: Online mendelian in man.

http://www.ncbl.nlm.gov/Omim/.
11. Danks D., Bankier A. POSSUM  pictures of
standard syndromes and undiagnosed
malformations. Version 4.5. Melbourne,
Australia: Computer Power, 1997.
12. Clark E.B. Cardiac embryology. Its relevance
to congenital heart disease // Amer. J. Dis.
Child. 1986. V. 140. P. 4144.
13. Lammer E.J., Chen D.T., Hoar R.M. et al.
Retinoic acid and embryopathy // N. Engl. J.
Med. 1985. V. 313. P. 837841.
14. Jackson B.T. The pathogenesis of congenital
cardiovascular anomalies // N. Engl. J. Med.
1968. V. 279. P. 8089.
15. Ardinger H.H., Clark E.B., Hanson J.W.
Cardiac malformations with fetal valproic acid
exposure // Proc. Greenwood Genet. Center.
1986. V. 5. P. 162.
16. Ballard J.L., Holroyde J., Tsang R.C. et al.
High malformation rates and decreased
mortality in infants of diabetic motheers
managed after the first trimester of pregnancy
(19561978) // Amer. J. Obstet. Gynecol. 1984.
V. 148. P. 11111118.
17. Lenke R.R., Levy H.L. Maternal phenylke
tonuria and hyperphenylalaninemia. An
international survey of the outcome of untreated
and treated pregnancies // N. Engl. J. Med.
1980. V. 303. P. 12021208.
18. Emanuel B.S., Budarf M.L., Sellinger B. et al.
Detection of microdeletions of 22q11.2 with
fluorescence in situ hibridization (FISH):
diagnosis of DiGeorge, velocardiofacial
syndrome, CHARGE association and
conotruncal cardiac malformations // Amer. J.
Hum. Genet. 1992. V. 51 (Suppl.). A3.
19. Driscoll D.A., Spinner N.B., Budarf M.L. et al.
Deletions and microdeletions of 22q11.2 in
velocardiofacial syndrome // Amer. J. Med.
Genet. 1992. V. 44. P. 261268.
20. Goldberg R., Motzkin B., Marion R. et al. Velo
cardiofacial syndrome: a review of 120 patients //
Amer. J. Med. Genet. 1993. V. 45. P. 313319.
21. Rimoin D.L., Connor J.M., Pyeritz R.E. Emery
and Rimoins principles and practice of
medicine. 3rd ed. V. 12. NY: Churchill
Livingstone, 1997.

83

.
,
.


.


. 

: , 
, , 

.

2
(.
3.25) [2].
,

.

. 
68% [1]. 


 .

.
40 ,

, 
[3]. 

(15%),
18
[4, 5].

, 
( ) [6, 7].
, 
, , 
, , , ,
, [5, 711]. 

.

. 


:
, 
, 
, 
(. 3.24).

. 

. 

, ,

.

. 3.24. . , 
. 1 , 2 .

84


0 24%,
12%.


024%.

. 3.25. . 

(RVOT). LA , PV 
, MPA 
, DUCTUS ,
DESC. AORTA .



. 
, 

22q11. 


2% [12].


4% [13].

,
, 
.
%
. 



. 



. 


. 

.


.

, 

.

1. Beekman R.H. Coarctation of the aorta // Heart
disease in infants and children / Ed. Adams
F.H., Emmanouilides G.C., Riemenschneider
T.A. Baltimore: Williams & Wilkins, 1995. P.
11111132.
2. .., .. 

. .: , 1997. . 131.
3. Danks D., Bankier A. POSSUM  pictures of
standard syndromes and undiagnosed
malformations. Version 4.5. Melbourne,
Australia: Computer Power, 1997.
4. Clark E.B. Neck web and congenital heart
deffects: a pathogenic association in 45 XO Turner
syndrome? // Teratology. 1984. V. 29. P. 355361.
5. Jones K.L. Smiths recognizable patterns of
human malformations. 5th ed. Philadelphia:
Saunders, 1997.
6. Gellis S.S., Feingold M., Dubner D.W. et al.
Arteriohepatic dysplasia // Amer. J. Dis. Child.
1979. V. 133. P. 205206.
7. Weinstein M.R., Goldfield M. Cardiovascular
malformmations with lithium use during
pregnancy // Amer. J. Psychiatry. 1975. V. 132.
P. 529531.
8. Rosa F.W., Wilk A.L., Kelsey F.O. Teratogen
update: vitamin A congeners // Teratology.
1986. V. 33. P. 355364.
9. Greenwood R.D., Rosenthal A., Parisi L. et al.
Extracardiac abnormalities in infants with
congenital heart disease // Pediatrics. 1975.
V. 55. P. 485492.
10. Grix A.Jr. Malformations in infants of diabetic

85

mothers // Amer. J. Med. Genet. 1982. V. 13.


P. 131137.
11. Jackson B.T. The pathogenesis of congenital
cardiovascular anomalies // N. Engl. J. Med.
1968. V. 279. P. 8089.
12. Nora J.J., Nora A.H. The evolution of specific
genetic and environmental counseling in

congenital heart diseases // Circulation. 1978.


V. 57. P. 205213.
13. Nora J.J., Nora A.H. Maternal transmission of
congenital heart diseases: new recurrence risk
figures and the questions of cytoplasmic
inheritance and vulnerability to teratogens //
Amer. J. Cardiol. 1987. V. 59. P. 459463.


.

.
.


20%.
.


,
(. 3.26). 

. 

. 

,
.


, 
(. 3.27).



.




(. 3.28).


. 


.


[1].
. 

, 60

[2]. D. Paladini
. [3],


33% . , 
, 
, , , 
, , [49].


. 


. 3.26.
. RA , LV 
, AO .

86

. 3.27.  () 
() .
().




1% [10].

4% [11]. 


.
%
. 



. 
. 

,

(5060
. .), 
, 
.
,
,
. 



( , 
,

). 
.
%
. 

. 
,
, 
[12].

. 3.28.
.

. 


[13] 
. 
60% [14].

87


1. .., .. 

. .: , 1997. . 128.
2. Rimoin D.L., Connor J.M., Pyeritz R.E. Emery
and Rimoins principles and practice of
medicine. Vols. 12. 3rd ed. NY: Churchill
Livingstone, 1997.
3. Paladini D., Lamberti A., Tartaglione A. et al.
The association between congenital heart
disease and Down syndrome in the fetus //
Ultrasound Obstet. Gynecol. 1998. V. 12.
Suppl. 1. P. 105.
4. Jones K.L. Smiths recognizable patterns of
human malformations. 5th ed. Philadelphia:
Saunders, 1997.
5. Loser H., Majewski F. Type and frequency of
cardiac defects in embryofetal alcohol
syndrome. Report of 16 cases // Brit. Heart J.
1977. V. 39. P. 13741379.
6. Lammer E.J., Chen D.T., Hoar R.M. et al.
Retinoic acid and embryopathy // N. Engl. J.
Med. 1985. V. 313. P. 837841.
7. National Center for Biotechnology Information.
OMIM: Online mendelian in man. http://
www.ncbl.nlm.gov/Omim/.
8. Grix A.Jr. Malformations in infants of diabetic

mothers // Amer. J. Med. Genet. 1982. V. 13. P.


131137.
9. Jackson B.T. The pathogenesis of congenital
cardiovascular anomalies // N. Engl. J. Med.
1968. V. 279. P. 8089.
10. Nora J.J., Nora A.H. Genetic epidemiology of
congenital heart diseases // Prog. Med. Genet.
1983. V. 5. P. 91137.
11. Driscoll D.A., Michels V.V., Gersony W.M. et
al. Occurrence of congenital heart defects in
relatives of patients with aortic stenosis,
pulmonary stenosis or ventricular septal defect //
Circulation. 1993. V. 87. Suppl. 2 P. 114120.
12. Hayes C.J., Gersony W.M., Driscoll D.A. et
al. Second natural history study of congenital
heart defects: Results of treatment with
pulmonary stenosis // Circulation. 1993. V. 87.
Suppl. 2. P. 123129.
13. Hanley F.L., Sade R.M., Blackstone E.H. et al.
Outcomes in neonatal pulmonary atresia with
intact ventricular septum: a multiinstitutional
study // J. Thorac. Cardiovasc. Surg. 1993.
V. 105. P. 406427.
14. DiSessa T.G., Alpert B.S., Chase N.A. et al.
Balloon valvuloplasty in children with
dysplastic pulmonary valves // Amer. J.
Cardiol. 1987. V. 60. P. 405407.


. 

.

.
.
3 6% [1].
.


(. 3.29).
,


, 

. 


.
. 


[24]. 
13, 18
(30%) [4].


1% [5];
 
[6, 7]. 

(

88


%
.
, , 

.


, 

Norwood (. 
).


.
. 3.29. 
. RA
, LA , LV 
, RV .

) [3].

, 
7q11.23 [8]. , 
, 
,
FISH
95% [9].



.

,
.




. 
3% [10];

13% [11]. 


 ;
50% [3]. 


.

%
. , 

,
. 8 
4050%

[12].
.
, , 
. 


.

1. Friedman W.F. Aortic stenosis // Heart disease
in infants and children / Ed. Adams F.H.,
Emmanouilides G.C., Riemenschneider T.A.
Baltimore: Williams & Wilkins, 1995. P. 10871110.
2. deGrouchy J., Turleau C. Clinical atlas of
human chromosomes. 2nd ed. NY: Wiley, 1984.
3. National Center for Biotechnology
Information. OMIM: Online mendelian in
man. http://www.ncbl.nlm.gov/Omim/.
4. Jones K.L. Smiths recognizable patterns of
human malformations. 5th ed. Philadelphia:
Saunders, 1997.
5. Roberts W.C. The congenitally bicuspid aortic
valve. A study of 85 autopsy cases // Amer. J.
Cardiol. 1970. V. 26. P. 7283.
6. Glick B.N., Roberts W.C. Congenitally bicuspid
aortic valve in multiple family members // Amer.

89

J. Cardiol. 1994. V. 73. P. 400404.


7. Clementi M., Notari L., Borghi A., Tenconi R.
Familial congenital bicuspid aortic valve: a
disorder of uncertain inheritance // Amer. J.
Med. Genet. 1996. V. 62. P. 336338.
8. Morris C.A., Loker J., Ensing G., Stock A.D.
Supravalvular aortic stenosis cosegregates with
a familial 6; 7 translocation which disrupts the
elastin gene // Amer. J. Med. Genet. 1993.
V. 46. P. 737744.
9. Lowery M.C., Morris C.A., Ewart A. et al. Strong
correlation of elastin deletions, detected by FISH,
with William syndrome: evaluation of 235 pati

ents // Amer. J. Hum. Genet. 1995. V. 57. P. 4953.


10. Nora J.J., Nora A.H. Genetic epidemiology of
congenital heart diseases // Prog. Med. Genet.
1983. V. 5. P. 91137.
11. Rose V., Gold R.J., Lindsay G., Allen M. A
possible increase in thee incidence of congenital
heart defects among the offspring of affected
parents // J. Amer. Coll. Cardiol. 1985. V. 6. P.
376382.
12. Moore P., Egito E., Mowry H. Midtern results
of balloon dilatation of congenital aortic
stenosis: predictors of success // J. Amer. Coll.
Cardiol. 1996. V. 27. P. 12571263.


. 


. 


.

,
. 
,


, [1].
. 


0,46 20% (. 3.1).

.
.
Petrikovsky . [17] 3

, 
15706 .

.

, 
, . 
, 


, 
1 .



. , R. Achiron . [11]
2214 

1316 163 (7,4%) 

, 
2022 59,5% 

. 



3,0%.

,

(334 ),
13 493
2,5% [18].
. 


.
,
(.

90


3.30).
, 

, 
. 


. 
1 6 .


. B. Petrikovsky
. [19] 9 65 
,
. 3
79 , 4
, 
, 
.
.
, B.
Petrikovsky . [7], , 36%


. 3.30. . 
.

, 12% 51% 

. 


, 
95% 
[9]
4072% [4, 5, 8].

3.1.

, %

, %

L. Allan, 1986 [1]


A. Schechter ., 1987 [2]
D. Levy, M. Mintz, 1988 [3]
. , 1994 [4]
H. How ., 1994 [5]
B. Benacerraf, 1995 [6]
B. Petrikovsky ., 1995 [7]
G. Dildy ., 1996 [8]
R. Merati ., 1996 [9]
J. Simpson ., 1996 [10]
R. Achiron ., 1997 [11]
D. Bettelheim ., 1997 [12]
. Kahler ., 1997 [13]
M. Odeh ., 1997 [14]
B. Bromley ., 1998 [15]

2
3,5
20,3
2,4
0,46
4,9
3,6
4,9
3,2
6,9
7,4
1,6
8,3
2,1

100
100
91,5
100
96
100
92,8

60

4,8

77,4
96,4
87,6

19,4

4,8

8,5

2,4

33
4,9

3,2
3,6
7,6

J. Manning ., 1998 [16]

2,7

100

3:1

: ; .

91

3.2.

L. Allan, 1986 [1]


A. Schechter ., 1987 [2]
. , 1994 [4]
B. Benacerraf, 1995 [6]
B. Bromley ., 1995 [21]
B. Petrikovsky ., 1995 [7]
M. Bronshtein ., 1996 [22]
J. Simpson ., 1996 [10]
R. Achiron ., 1997 [11]
D. Bettelheim ., 1997 [12]
I. Chatzipapas ., 1997 [23]
. Kahler ., 1997 [13]
A. Mejides ., 1997 [24]
M. Odeh ., 1997 [14]
B. Bromley ., 1998 [15]

, %
0
3,8
5,6
18
6,1
0
11,1
0,9
0
0
20
1,7
1,9
0
4,8

.


,

21 26 
[2]. 



D. Roberts D. Genest
[20].
,


( 21 16%,
13 39%)
(2%). 3.2


.
, 3.2, 


. 




. C. Lehman . [25] 


13 ( 10 33 , 30%).

7 36 (19%)
[26].
B. Benacerraf [6] 



. ,
, 
35 

6,4% ,
35 
3,6% ( )
[15]. 1 14 

41
. 
35

6,4% 0,8%,
33,6% 0%. 

(5
13 )
(7 13).
21 (11 14).


18 [4,
26], 5q [28], 
[15], [15, 28]
[10].
A. Mejides . [24] 




.

, 

,
/ 

92


,
. 


.
,
0,8%,
4,2%.
,
5
, .
J. Wax . Philput [27] 9



. 
10 217

, 1 18
3 11 

. , 


. 71% 


. ,


. 
8 217

, 2 18
1 11


. 45%

.

.




, 

[7, 12, 11, 14].

R. Achiron . [11]
489 
, 

, 6 (1,2%)
21. 
,
21 

0,002%.
, 




.
. 






. 

/


. 



.

1. Allan L.D. Manual of Fetal Echocardiography.
MTP Press.: Lancaster, 1986.
2. Schechter A.G., Fakhry J., Shapiro L. R., Gewits
M.H. In utero thickening of the chordae tendineae.
A cause of intracardiac echogenic foci // J.
Ultrasound Med. 1987. V. 6. P. 691695.
3. Levy D.W., Mintz M.C. The left ventricular
echogenic focus: a normal finding // Amer. J.
Radiol. 1988. V. 150. P. 8586.
4. ..
// . 
. . . . 1994. 4. . 3740.
5. How H. Y., Villafante J., Parihus R. R.,

93

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28. .., .., ..
.

// 
. . . . . 1999. . 7.
2. . 159161.

94

. 
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97


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98

.


.
.

. 

,
.
. 
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. 1 ; 2 
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. 


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.

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.



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, 
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,
8 ,
6580%. 
10 
1520% [18].

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4. .., .. 

. .: , , 1997.
5. Chen C.P., Liu F.F., Jan S.W. et al. Prenatal
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6. P. 355361.
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18. .., ..


/ 
.
. .., .. . 2.
.: , 1996. . 181204.


.
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. 
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 [1, 2].
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.


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.



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.

1. Robert E., Mutchinick O., Mastroiacovo P. et al.
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. .: , , 1997.
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103

.



1 10 000 [1].

1 2

. 


.
. 



double bubble 
[2]. 


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.
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104




.



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.
.

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). , 

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.



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1. Buyse M.L. Birth defects encyclopedia.
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2. .., ..,
.., .. 

// . . . . 1987.
2. . 6364.
3. .., .. 

. .: , , 1997.
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5. .., .., 
.. 
// . .
. . . 1993. 2. . 1530.
6. .. 

// . . 1998. 1.
. 4250.


.
1 12 500
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.
. 4
.
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66% [1].



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. 




.

1. Bergmans M.G., Merkus J.M., Baars A.M.
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2. .., .. 

. .: , , 1997. C.
159161.
3. Petrikovsky B.M., Nochimson D.J., Campbell
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1987. V. 149. P. 395400.


.
1 20 000
10%
[1].
.
, 

(30%), 

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.


, ,
.

1. Buyse M.L. Birth defects encyclopedia.
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108


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1987. V. 149. P. 395400.
4. .., .. 

. .: , , 1997.
C. 170171.
5. .., ..

/ 
.
. .., .. . 2.
.: , 1996. . 181204.


.
2 10 000 
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.


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.






.
. 


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.
,

, 

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12) [2].

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VACTERL, Townes
Brocks FG [5]. 


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.

1. Harris B.H., Nyberg D.A., Mack L.A.,
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5. National Center for Biotechnology
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6. Stevenson R.E., Hall J.G., Goodman R.M.
Human malformations and related anomalies.
V. 2. NY: Oxford University, 1993.


.


, 
, 
.
. 

1 2 000
35 000 [1].
.



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, 

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, .




.

112



1. Soong J.H., Hsieh C.C., Chiu T.H. et al.
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3. .., ..,
.. . 
// . .
. . . 1995. 2. . 111117.
4. .., ..,
.. 

5.

6.

7.

8.

// 
. . 1998. 2. . 8890.
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. 
, 


, 
.
. 

0,2
1,4% [1].
. 

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,
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. 


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,


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.

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.

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. -
() ,
.
. , -

12 .
.
1,35,9 1000 [1].
.

135

. 5.17.
. .

. 5.19. 24 . .
.

, (. 5.17) [2, 3]. ,



(. 5.18, 5.19).

,
,
[46].
.
,

. 5.18.
. .

,
,

, . 15 4
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. 12
,
28
[8].
. 25%. ,
,
6- (621.1-12) [9].

. , .

.

136


.
.
.

6
8 . , , ,
[10].
,
18% 61 [11, 12].
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. ,
.



.
[1].
.
-


,
[1].
1 10 000 [2].
.
,
, ;
.

137

. 5.20. 24 .
.

. 5.21. 33 .
.

. 5.22. , .


(. 5.20) [3].
.
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. II
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.

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. ,
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.
, ,
. 50
[4].


.


. -

138


.
, .
.
.
.
.
.
,
[5].


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.

.


.
. -

. .
.

, (. 5.23).
.


(,
, .) [1]. 21% ,
-

. 5.23. 22 .
.

139

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.

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,

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.
.
[1].
.
,
1 200 000 [1].


[2]. , , .
. .
,
( ) .

. -

. 5.24. 20 . ().

. 5.25. 24 . ().

140


5.3.





II 
,

III 

,



,









,


Petrikovsky B.M. et al. // Obstet. Gynecol. 1988. V. 72. P. 464469 [8].

, [3].

,
(, ,
, , ) [4, 5].
.

.

(. 5.24, 5.25) [6].
-

. 5.26. 31 .
.

, (. 5.3).

(. 5.26) [7].

141

. ,
. .

, .

( ,
,
)
[8]. , . -

. .
.
[9]. ,
18, ,

[10, 11]. 18 [12].
1%
[13].

1
70 (1,4%) [14].


, .

. ,
.
,

.
55%
[15]. , , ,
[16].
. , .

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.. . 2. .: , 1996.
. 205226.
7. .., .., ..,
..

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142


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. .

.

,

.

[1].
.
,
.

.

. 5.27. . .

. 5.28. . .

.
. .

143

, .
.
(. 5.27, 5.28) [14].
.
.
,
.


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/ . .., .. . 2. .: , 1996. . 205226.

,
,

I, II,
III


,

144

6


.


90% .

/
. 

, 
.

,
(. 6.1);

(
) [2].
. 

, 

.
0,24 5 
10 000 . 

.
. 


24 . 


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. 6.1. 
. . 
.

145


.

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.

[4]. 90% 


. 

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50%
25%.

.

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, 

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. 


. , 

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. 
,


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.


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. 


.
, 

.


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.

5% . 

,
[6]. 67

.


, 
.


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, 
.

106 142 [7].


.


.
[3].
90% 

146



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. 

.
. 

1 1000
3000 , 1 
100300 [1].
. 
.



,



.
. 



(. 6.2,
6.3). 

.

. 6.2. () ().

147

. 


. 

. 

.

. 6.3. 
.

(AIUM)
[2]
(ACOG) [3] 


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[4].

,

[5, 6].


[7]. 
,
, 
. 


13 [8, 9]. ,

: c 
I ()
II (),
 .




. 



[10], 
20 
. 6 , 
1317 
, 2
[10].
.

, ,

.

.


.

,

.
,
.

.

. 


. 



. 

148


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, 


.
. 
1
3 1000 [1]. 2
.
. 
:
,
.
. 



[2
4]. 
.


20 (. 6.4).

, 


.

, 

, ,
.
. 
, 

13 

[5], 
1820
[4].
.
.
20%

149

. 6.4.
.



, 

.



. 


,

, 5% 
. 
,
.

. 


. 


, 90% 

. 


.

.

300 , 
. 


.
, 127

, 33%

, 18 [2,
3, 6]. 

. 
, 

020% [24,
7]. 
,
.

, 
, 2
8%. 
, 

.



( ), 

. 
,
.

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. C 

.

.
. 

.
. 


.

 
, 
 . 

, 
[1,
2]. 
.
. 
 
. 


, 
. , 

, 
 18 [3].

. 
 

. 


, 

.
 


, 
,

, 
.

.

.
 .

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151

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,

. 
, 
, , VATER
, .
.
15 100 000 
.

16%
.
. 

.
,
, 
. 


,


.

[1].
,
.
. 


[2].
L5.

, 
. 
. 

,
spina bifida.
50%
[3]. 



, 
, 

, 
,

[4].
.

. 


.


,

. 

, 
. 

.
. 


.


.


46 
.

,

.

. 
.


152


4

. 

.

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. 
,
,
. 

, 
.
.
, 
1 100 000 
[1].
. 
,

: , 
, . ,
, 

.




.
50%.
,

. 
,
.
, ,


, 

. 
,

,

.
. 


(. 6.5). 

[2].

. , 

. 


. 
, 

[3].
.





. 
,

153

. 


.

. 6.5. . 
.


. ,
,
[4].
.

.
,

. , 
, 
, 
, .


. 
 .
25%. 
60% 

.


.

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. 


.
. I 

1 30 000
[1]. II ()
1 55 000 .
. I
, 
.

50%
.
II .

; 
50 .

, 
. 

, .
II 

III .

154


,

. 

.
III

. IV

.


,
IV [2].

. 
20% 
II , 

; 90%
.
I III ,

,
.

IV, 
.

. 


.
I 
. III 

710% .
II 
: 
(. 6.6), 
 
;

(. 6.7);
; 
[37].

. , 

, 
.

II 
, 
.


[7]. , 
1720

II 
. 


.

. 6.6. 
II 16
. 1 ; 2 
.

. 6.7. 
II 24 . 

.

155

. I

 . 

90%
100%. 
II 

6%.


, 
.
III 
 ,

.
IV .

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// 

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.. . 
II
// 
. . 1996. 4. . 5861.


.

, 
.

, 
[4].

. .

.


0,4 10 000 .

. 


. ,
,
. 

.

. 


[1]. 




[2, 3] (. 6.8, 6.9).
,

.


3 
, 
. 

156

. 6.8.
. 
.

. 6.9.
.

.


 
[5].
.


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.

.


.
(9 ) 
.

. 

.
, 
, .


. 

,
.
. 
0,16
10 000 .

. 




(. 6.10),
(. 6.11) [1].

157

. 6.10. 
. 
.

. 6.11. 
. 
.

, .
: ,
[2]. 
,
, ,
[3].

[4].

.

. 

.

. 


. 

1720 .
. 
, 
,

. 
, 

.
. 


.



.

17 [2].

.

. , ,
.

1. .., .., ..
. 
// 
. . . . . 1993. 2.
. 95100.
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158


. 

. 
,

: , .
. 
,

. 
2650%
, 
,

[1, 2].



,

(. 7.1) [3]. 

, 


. 
, 

.

. 

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,
; 2) ,
; 3) 
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. 

.

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.

159



 
[4].

30
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,


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.

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26

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. 

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23

,
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20 [7].
.
, 
. 

21 [8].
:


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, 
.




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, 

. 7.2. 23 . . (). 1 ().

160



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// 

/ . ..
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.

[1, 2]. ( 
) 

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,

. 
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. 
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. 



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.

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(. 7.6).

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.

.

. 

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, , 


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,

H. Grundy
., 1985 [12]

23


,
; ,

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., 1985 [13]

32

c ,
6 6 5 ;

R. Pennel,
O. Baltarowich,
1986 [14]

30



, 3,5

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., 1988 [15]

25

10


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, 
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c
,
2,4

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., 1992 [16]
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., 1995 [5]

30

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.

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80%. 

. 

1015%. 
, , .



,
.


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, 
.


. 

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.

1. .., .. 

. .: , 1997. . 3943.
2. .., .. 

// 
/ .
.., ., .. .: 
, , 1999. . 113144.
3. .., ..,
.. 
// . , 
. 1988. 6. . 5254.

4. Silverman R.A. Hemangiomas and vascular


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. . . . . 1999. . 7.
3.
9. .., ..
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164


. 

. 


.
. 
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, 
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. 


. 7.7. . 
.

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.

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(. 7.8).
. ,

,

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(092%) [4].
.

,
, 
. , 

II 
, ,
.

,


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. 7.8. 19 . . 
; . 1 ; 2 
; 3 ; 4 .

165

68%:
52%,
71% [4]. .. [5] G.
Azar . [6]
75% 
.

.
.



.


.
,


.



.

. 

. 


, 
[7]. 


,
, 
.



.

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// . . .
. . 1994. 3. . 3139.
3. .., .. 

. .: , 1997. . 81.
4. ..., .. 

. .: , 1997.
5. ..

// . . 1998. 1. . 4250.
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.


, 
, 
.
. 


0,14% [1].

. 


[1]. 
, 
89% [1].
, , 
.
. 


166

. 7.9. (). 
; .


,
[219], 
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[30, 31], [32, 33] 
[34].

,

, 

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(90%) 

, 
. 


,

. 


[11].
 
.
, 
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, 
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.

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().


. 


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,

167

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.


,

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.


,

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.
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[1].


. 
, 
, 
, , 

[37]. 

[17].
73% 

[1].
50% , 
,


, ,
c , 

[14]. 



.


,

,


. 

de novo.
. 



, 
, ,
.


, 
.

168




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. 


,
,
.



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 [19].

,

.


.
. 



. ,
A. Benatar . [25] 32 



, 


.
37
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.

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.
.

.
. 


, , 
, ,


[1, 2]. 

[3],

.
. 

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.

, 
. 
, 
, 
, 

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, 
.

.
9 


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,
 

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26
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.

/  
[14].

,

, 

[17].

[16].



.


[18]. 



, 
[1].
. 

, , 

171

,


.

, 
. 


,
[5]. 


,

.
. 


.

,
.


, 

.
, 


,

. 

,


,
.



.



.



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. , 


, 
.
. 

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. 7.13.
().

,
, 


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. 
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. 



, (.
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,
,
.

.
. 

, , 
. 

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173

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.
,
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, 
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. 
20

(. 7.2) [819].


28 .
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,


174


7.2.


,

G. Janetschek
., 1984 [8]

34

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6

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., 1985[9]

35


(?)
4 ,

,
,
,

G. Atkinson
., 1986 [10]

34

32

,
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., 1986 [11]

38



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., 1986 [12]

39



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9

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., 1989 [13]

36


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,
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., 1990 [14]

39

,
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., 1990 [15]

35



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16 ,
16

P.Ho
., 1993 [16]

30


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9

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41



23


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175

7.2.


,

R.Jennings
., 1993 [17]

M.Dreyfus
., 1994 [18]

. Chen
., 1997 [19]

37



2 3


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1

39


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30


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10

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. 16
[20].

. 

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. 



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. 


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.
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.

176



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, 
1%. 


,
. ,
, 
. 
, 


.

. 

.

1. .., ..,
.. .

// .
. . 1993. 23. . 2832.
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. 
,

.

, 
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.

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.

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[4], 

. 7.17. 36 .
. 
.

178


7.3.


,

36

9,0 x 9,0

V. Valenti ., 1975

T. Lee, S.Blake, 1977

41

M. Crade ., 1980

40

K. Mitsutake ., 1981

36

M. Tabsh Khalil, 1982

33

T. Montag ., 1983

30

7,0 x 7,0

S. Jafri ., 1984

3239

9,0 x 5,0

S. Suita ., 1984

3541

B. Borin ., 1985

37

P. Kirkinen ., 1985

3241

8,0 x 10,0

W. Holzgreve ., 1985

37

10,0 x 9,0

A. La Prova ., 1985

3336

R. Sandler ., 1985

31

P. Bruno ., 1986

28

3,1 x 2,5

G. Cali ., 1986

27

5,0 x 5,0

B. Landrum ., 1986

27

11,0 x 11,0

P. Preziosi ., 1986

3234

5,4 x 4,4

G. Centini ., 1988

3136

A. De Rosi ., 1988

36

5,7 x 7,5

G. Gesmundo ., 1988

37

5,1 x 4,8

K. Ikeda ., 1988

3240

A. Nussbaum ., 1988

11

3040

8,8 x 8,8

V. Suma ., 1988

2835

5,1 x 5,0

V. Valenti ., 1989

31

4,0 x 3,5

.. , 1989

3334

4,0 x 3,5

N. Rizzo ., 1989

13

2836

11

V. DAddario ., 1990

25

3041

8,0 x 6,0

17

C. Giorlandino ., 1990

30

8,0 x 8,0

L. Garel ., 1991

27

2838

I. Meizner ., 1991

15

1935

M. Shozu ., 1991

29

6,5 x 6,1

P. Bagolan ., 1992

25

2839

G. Gonzales ., 1992

2740

6,0 x 6,2

. MullerLeisse ., 1992

44

2840

39

Szuchy R. ., 1994

28

3,0

179

7.3.


,

.. ., 1995

13

2737

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12

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35

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3. .., ..,
.. 
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7. .., .., ..
. 
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.  
, 
,
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.  
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. 
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 ,


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.

. 



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.
 

 
.
.

, . 

,
.

, 
.

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 : 
? //
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184


.
,
.
. 
,
(24 ),
(6 )
(34 ). 

Picornaviridae. 



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, 


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.
. 
,
, 
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) . 

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.

, 
, . 


, 


. ,

. 

.

1. Abzug M., Keyserling H., Lee M. et al. Neona
tal enterovirus infection and virology, serology
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. 
() 
Herpes,
. 



. 
.

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.

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, 
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. 



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[11]. 

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,


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, , 
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. 

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.


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.
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.

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189

.

(), 
lentivirus retrovirus
2 : 1 2. 


. 


2544 , 
5 [1].
1988 1994 


 
[2]. 1
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 6500
 
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. 

.

,
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: 
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2030% [6, 7]. 
, 

. 

. 

, 12 
, 
, [8].

190




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3050% 
[10]. 




. 
. 
, , 

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, [11, 12].
. 

.
 
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.
, 
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, 12
. 

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, 


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&. 
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. 
,
,

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,


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 .


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,
. 
,
,
.

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192

19
.
19 
,
, ,
( )
.

,
[13]. 
, 
, 


. 


, , 
, ,
[4].
. 60%

19
[5]. 
,
. 
. 
. 
, ,
. 
, , , ,
,
, 
, 
. 
(, ,
),
.
19 
,
, 
, 
[5]. 


. 
. 

14 21 . 

. 

. , 
, 2050% [5].

25 33%.
.


.

, 
,

. 48 
( 12
) 
[7].
19
2,5 9% [6, 8].
,
19, ,

[9]. 


, .




[10]. 

[11].


, 
19. 
, 

[12].
. 
19 

193



. 19

( , 
) [14]. 

, ,
: 
, , 
.


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. 


19.
. 
19

, 
, 
,

.

IgM 
,

23 6 .
IgG IGM

, 

.


19.
: 


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19
. 


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. , 


,

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[8]. Ig 
. 

19.



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.

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,
. ,


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)
. 
, 137 164 (84%)
, 
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1 , 

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, 

,

194



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, ). 

8 
6

.

,

, 
.

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.

,
[1]. 

.


14 21 [1]. 

195

. 

15 
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. 

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, 

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.

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,
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. 

.
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.
.
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. 

, , ,
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, , ),

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). 


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,
1015% 
[3].

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80%


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25%
[4]. 
8 

.

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, 
. 
, 


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.
5 8

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[1].


. , 


[5]. 
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) 

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[6].
. 

,

.

.
.



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.

.

196


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, 

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: , 
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,

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IgM, IgG IgA.
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[1].


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,
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LA 
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.


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.

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90% [1, 16]. 

197


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4 100000
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,


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.

. 

,

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[17, 18].

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,

. 
, 
,
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.

1.


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2. Centers for Disease Control and Prevention.


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VARICELLAZOSTER
. VaricellaZoster 
, 
,
.

.
&
. 
17 10 000
[1]. 95%
.
VaricellaZoster 

, 

. 
1 21 .
1

.
. 


, 

.
, 
.

, , 
1020% 
24 .

,

,
. , 
, 




VaricellaZoster
[2]. 
. 




.
(FAMA LA)
24 .



. 


. 
, 
,

, 
, 
, ,
, 
, , 
, 
, , , 
,
[4]. 


199


2,5% [1]. 
, 
7 26 
, 
713 .

, 
, 19
22 , 

[5].
,


. 


[6, 7].

: 
, , 
, ,
[8].
.

5 10
25% 
.
30%.
, 
. 

, 
5 . 


, 
,
.

, .
.

. 

. 10

30% 



.
, 24


. 
, , 
800
5 per os. 
, 


[9].


. 
1995 , 
, 13 
[10].

1. Balducci J., Rodis J., Rosengren S. et al. Pregnan
cy out come following first trimester varicella
infection // Obstet. Gynecol. 1992. V. 79. P. 56.
2. Rawlinson W., Dwyer D., Gibbons V. et al.
Rapid diagnosis of varicellazoster virus infec
tion with monoclonal antibody based direci im
munofluoroscence technique // J. Virol.
Methods. 1989. V. 23. P. 1318.
3. Preblud S., Cochi S., Orenstein W. Varicella
Zoster infection in pregnancy [letter] // N. Engl.
J. Med. 1986. V. 315. P. 14151417.
4. Alkalay A., Pomerance J., Yammamura J. et al.
Congenital anomalies associated with maternal
varicella infections during early pregnancy // J.
Perinatol. 1987. V. 7. P. 6973.
5. Cuthbertson G., Weiner C., Giller R. et al. Pre
natal diagnosis of secondtrimester congenital
varicella syndrome by virusspecific immu
noglobulin M // J. Pediatr. 1987. V. 111. P.
592595.
6. Isada N., Paar D., Johnson M. et al. In utero
diagnosis of congenital varicella zoster infec
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1991. V. 165. P. 17271730.

200


7. Schraf A., Scherr O., Enders G. et al. Virus de
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9. Feder H. Treatment of adult chickenpox with


oral acyclovir // Arch. Intern. Med. 1990.
V. 150. P. 20612065.
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Varicellarelated deaths among adults Unit
ed States // MMWR. 1997. V. 197. S46.
P. 409412.

.

Listeria monocytogenes.


,
.


. 
.



.

.
2
1000 7,5
1000 .

. 
, Listeria monocytogenes
, 
. 

. 

,

20 [6]. 



. 
, ,
, .

. 


4050% [6]. 

. ,


, 
[1]. 


.

. 

 
,


[2, 3]. 

, 

[4, 5].
.
,


, 
.
,

. 

,
.


201

. 


. 
. 
7 , 

.

, , , 
, , 
, , 
; .
, 
, .

, 


15%. 

,
.
, 

7 ,
90% 
. 

. 
,
, . 


.

, 


. 


, .
.
Listeria monocytogenes 
. 

.



, ,
,
.

, . 

.

,

.
. 



46 
[7].

.



per os ( 23 ).

14 . 

.

,
.
.


. 

, 
.




. 

.
, 

202




, 
.

1. Liner R. Intrauterine Listeria infection: prena
tal diagnosis by biophysical profile and amnio
centesis // Amer. J. Obstet. Gynecol. 1990.
V. 163. P. 15961597.
2. Linnan J., Mascola L., Lou X. et al. Epidemic
listeriosis associated with Mexicanstyle cheese
// N. Engl. J. Med. 1988. V 319. P. 823828.
3. Fleming D., Cochi S., MacDonald K. et al. Pas
teurized milk as a vehicle of infection in an out

4.

5.

6.

7.

break of listeriosis // N. Engl. J. Med. 1985.


V 312. P. 404407.
Schuchat A., Deaver K., Wenger J. et al. Role
of foods in sporadic listeriosis. I Casecontrol
study of dietary risk factors // JAMA. 1992.
V. 267. P. 20412045.
Pinner R., Schuchat A., Swaminathan B. et. al.
Role of foods in sporadic listeriosis. II Micro
biologic and epidemiologic investigations //
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. 

,
( )

(Ixodes) [1].

,
5075%.

, 
, 
.

. 


[1, 2]. 
, 
. 
,
. 
, 
, , 
[14].
Borrelia burgdorferi

, 4 8
[5]. 
: Ixodes scapularis

Ixodes pacificus [6]. 

,

[7].



.
[2]. 


, 
. 



,
. 

, 
.
.

[1, 2]. 

. 
, 
14 .

, 

203


. 
, 
.

, 
. 

.

, 
.


, , 
, , 
, .

: , ,
, . 20% 
, 
, 
[2].

50% [8].


, 
2 .

,


: , , 
, . 20%
, 10%

.
. 
Burgdorferi
.
Schlesinger . 1985 [9],
, 

.
.



, , 

, 
, 
, [1, 2]. 

,
, :
( ,
), 
,
(, , 
), 
,
(, , 
), ,
(, ).


, 
, , 
, [2].

. 
, 
, 
.
40% 

, 20% 
, .
. 4%
24

,

[3].

. 

, , 
,
, , 

[10].
28% 13

[9]. 

204




.

68% [1, 2].

, 
.

[1]. 
610 

: (
),
. 2/3 

, 20% 
.



.

(ELISA, LPA, IFA,
) [11].
Western blot :

5392%,
100%. 100% ,

38 90% [1, 11].
.


[12].


75%, 25%. 

: 

80
47%, 80 23%,
50 0%.
, 
100% 
. 
, 



[13].
( 
) 
( 2 4
), G (4 4
), (2 4
) 14 . 


(500 ) 
(500 ) 30 .


(50 4 ) 
(100 4 )
14 30 .



(40
) 1030 [13].
. ,

,
(500
) 1021 [13, 14], 
(500 ) 
(500 4 )
10 . 
21
, 
, 
[14].
.


: ,
, 

.


( ) 
,
[15].

205




, 

(N). 
.
, , 
,
. 


.
(4
8%), 


, 

0%. 


[16].


,
,
, 
, ,
[17, 18].

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burgdorferi, in ixodes ticks // Rev. Infect. Dis.


1989. V. 11. S1442S1450.
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206

. 
, Treponema
pallidum.


. 80
, 


[1].

: 45% 
 
, 19% 
[2].


, 
.

, 
, ,
, , , 
, 


[3]. , 

, 
. ,


.
1981
15 10 000 [4].
3000 
1990 ,
1995 
.
. C
, 
. 

,



. 
,

. 
,

. 

,
. 

24 . 

T. Pallidum
, 

[5].

, 

. 

,


16 .

( 14
), 
,
[6].
T. Pallidum 

, 74% ,
, 
[5].



, , 
, 
[4]. 

. , 
4 , 41%
, 
, 25% 

207

, 14% 
,
21% 
18% 
. 
82% 

.
,
4 , 2%
, 
75% . 


40%, 20%, 
10%,
4%. 
10% 
10%
. , 


, 


[7].

:
[4]. 
, 


. , 
, 

.

, ,
(, ,
), , .

,
, , (
, , ). 

, 
, , 
,


. 33%

. 40% 

[4, 8].
, 

, 
, 
, , 
, (
, , 
, ,
 
). 


. 
, 
.
.


[4]. 


.

T. Pallidum , 
, 
, , 
, ,
. 
,
.
, 
, 
. 

.
,

, 
.

[9]:
, 
.

208


:

, 

.

[10].

.

.



. ,

, 


. 

.

: (VDRL
RPR 
) ( 
FTA
ABS, 
MHATP). 
,
, 

, 
.


, , 
. 

4 8 
. ,
25% 

, 

. 12%




, 
. 
. 


. 

.

T. Pallidum.

,

,


. FTAABS
18%
5% 
. 
MHATP
, 35%
,
,
.


98%, 99%,

82% [11].

VDRL (70%) MHATP
(75%).
IgG IgM 
, 

T. Pallidum [12, 13].



[14]. ,
,
T. Pallidum [5].


: , 

[5]. ,
24 

209

, IgM
. 

, 
.
1989 



, 
.

, T. Pallidum 
,
, 

.


, 

,
, 

, 
, FTAABS.
. 

. 
. 

7
3 
[15]. , ,
, 
1 
 G (2,4 ) [16].

, 1 
,
 G 2,4
1 3 . 
G 2
4 4 4 , 
 G (2,4 ), 
(500 ) 1014 .
100%
,


, 

.

, 10%
,

.

(
), 
, , , , 
, ,

36 [17]. 

. 



, 
. 
,
.
,
.


.

. 36 


4 8 612 
.

. 72% 
36 
RPR
[18],
56%. 


,
2 .
, 

.

210


. 


. 







. 
28 
.
,

. 


. 



. ,

, 
,
, 
.

1. Centers for Disease Control and Prevention.
Congenital Syphilis. New York City. 1986
1988 // MMWR. 1989. V. 38. P. 825829.
2. Rolfs R., Nakashima A. Epidemiology of pri
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P. 853857.
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delphia: Saunders. 1994. P. 529564.
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fication of Treponema pallidum in amniotic flu
id and fetal blood from pregnancies complicat

ed by congenital syphilis // Obstet. Gynecol.


1991. V. 78. P. 890895.
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7. Berry M., Dijiani A. Resurgence of congenital
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P. 516522.
9. Quresh F., Jacques S., Reyes M. Placental his
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10. Fojaco R., Hensley G., Moskowitz L. Congen
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ies on the pathogenesis of the JarischHerxhe
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ary syphilis. Serologic response // JAMA. 1980.
V. 243. P. 25002502.

211

.
Toxoplasma gondii 

, 
.
, 
, ,
[1].
, 
, 
,

, 
[2]. ,



.

.


, 
, 
, 
[1].



.
.

, [1].


[2]. 10 50% 

, 
[1, 2].
.


: 
, 
, 
, , ,

, .


. 
, ,
. 


0,010,2% [1, 2]. 

3040% ,

. 


15%, 30%,
60%.

: 
,
, 75%, 
,
, 
. 
, ,
[3].
4 
: 1 
; 2 , 
; 3
, 
; 4 
[1]. 

: (22%), 
(11%),
(6%),
(5%), (4%),
(4%) [4]. 


,

.
, 



212


, 

90% 

[3]. , 

, , 
,
,
, 
, , 
, , 
.



(
, 
, , 
, 
). 

[3, 4].
.


, 

. 
IgM (IgMELISA
ISAGA) 
[1].
IgG 
IFA ELISA.
IgM

, 

, ,
, 
.
IgA IgE
(ELISA ISAGA),

[1]. ,
IgA
6 , 


. IgE


. 


, 

[1].
,


.

, 
, .

IgM



[5]. 
, ,



[57].

4
,

. 
,

, 
.


, ,
.



, , , 
[8].

. 



213

,
.


. 



[57].
. , 
, 
,
. 

,

[1].


. , 
,


. 
,
2
.

6080% 
[1, 2, 57, 9].
,
.
100

50 
(100 )
. 
(5 ) 
, 
.
. , 

,

, 

[1, 2, 6, 10, 11]. 


, 
,
, 
.
.
,
, .

1. Remington J., McLeod R., Desmonts G. Toxo
plasmosis // Infectious diseases of the fetus and
the newborn infant / Eds. Remington J., Klein J.
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214

9


..





. 

XXI .

, 


[1]. 


,
,
. 
,

,


.

?

, ?
, 

.




.

,
. 

[2]. 
, 

, 
,
. ,

, 

.
, 
,

, 
. 


,
. , 
,
85% 24 
. 
15%, 
2% [3].

215



.
, , 
, , 
, 
,
, .



,



. , 


[4].


, 

[5, 6]. , 


II , 
[7, 8].


.
, 
[9]. ,


0,25%. 2,5% 

.


. 
. 

,
. 

, 
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International CVS4000 (TA)

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S. SmidtJensen ., 1991

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,

.

1. Verlinsky Yu. Preimplantation genetic diagnosis
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230




..



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.

9% 

I [1]. 

1993 .
7,4% [2].
95% 


,

, , 

[3, 4]. 


,

.

50% [5], 

.

, 
,

,
, 

.



,
.




[6].



. , J. Wojak 
. [7], 

145

11

. 11.1. . 
.

.

. 11.2. . 
. 

.

267
, 


, 



, 

.




,
.


,
100%
.

(. 11.1).

(512,5% 
),



.



, :
,
, 
, 
,
. 

. 

.




(. 11.2). 

,
.

, 



. 


, 

.

146



. 





,
.
M. Budowick . [8] ,




. 
, 
. , 
,
.


.



, 
(. 11.3), 



(. 11.4).



0,400,45.


.



. 


7196%, 
9399% [6].

, 



. ,
R. Achiron . [9],

95%, 
48%.

. 11.3.


5 .

.

. 11.4.
, 

7 4 . 
0,21, 
58,2 /.

147

11

, 


2
[5].


, 1


0,400,45.
,

0,55.

(<
21 /),

84%.
D. Jurkovic . [10] 

, 

.
, 


,


.



,
.
I. Zalud A. Kurjak [11] 

.

82,8%

, 80,8%
69,3%

.

(0,42 0,12) 
, (0,53
0,09 ) 
.


0,48 0,07.

.


1



.
2

,

, 
. 



, 
.



[12]. 
,
92%,

1


2


.

1. Nederlof K.P., Lawson H.W., Saftlas A.F.,
Atrask H.K., Finch E.L. Ectopic pregnancy
surveillance // United States. Mortal. Morbid.
Weekly ReP. 1990. Vol. 39. P. 915.
2. .., ..,
.. . 
( 
). .: , 1995.
3. Hickey J., Goldberg F. Ultrasound Review of
Obstetrics and Gynecology. Philadelphia, NY:
LippicottRaven Publ., 1996.
5. Dillon E.H., Feyock A.L., Taylor K.J.W.
Pseudogestational sacs: Doppler US
differentiation from normal or abnormal
intrauterine pregnancies // Radiology. 1990. V.
176. P. 359364.
6. .., .. 
// 

148



/ . ..,
.. III . .: , 1997. .
175200.
7. Wojak J.C., Clayton M.J., Nolan T.E. Outcomes
of ultrasound diagnosis of ectopic pregnancy.
Dependence on observer experience // Invest.
Radiol. 1995. V. 30. 2. P. 115117.
8. Budowick M., Johnson T.R.B., Genadry R.
The histopathology of the developing tubal
ectopic pregnancy // Fertil. Steril. 1980. V. 34.
P. 169173.
9. Achiron R., Goldenberg M., Lipitz S.
Transvaginal Doppler sonography for detecting

ectopic pregnancy: is it really necessary // Isr.


J. Med. Sci. 1994. V. 30. 11. P. 820825.
10. Jurkovic D., Bourne T.H., Jauniaux E. et al.
Transvaginal color Doppler study of blood flow
in ectopic pregnancies // Fertil. Steril. 1992. V.
57. P. 6873.
11. Zalud I., Kurjak A. The assessment of luteal
blood flow in pregnant and nonpregnant
women by transvaginal color Doppler // J.
Perinat. Med. 1990. V. 18. P. 215221.
12. Cacciatore B. Power Doppler in diagnosis and
management of ectopic pregnancy //
Ultrasound Obstet. Gynecol. 1996. V. 8. Suppl.
1. P. 205.


113545, , , 125,. 18 ./: 7812647
065207 5. 06. 1997 .
..
..
.., ..
..



125008, , , 5, ./: (095) 4505020
17.12.99. 6090/8. . 19,0
. .
, 107005, , . . 46.

.
, ..

149

2

.. , ..






. 

, 

. 


.

.


, 
.
. 

.
a. uterina,

,
, .

.
a. vaginalis
,

. 



,
, 

. 
, 

,

,
(. 2.1).
, , 


. 
,

, 

.

, 
, 
rete mirabile ( ) 
,
, 
, .

()
() 
, stratum vasculosum.


35

5
6
1

. 2.1. . 1
; 2 ; 3
; 4 ; 5
; 6 ; 7 .


, 
. () 

, .



( 0,0050,01 )
[1]. 
,
. 
. 

,

(. 2.2).

. ,

,
.
media .
.

,

.


.


, 
.


(. 2.3).

:

2 
. ,
, 

. 2.2. 
. 1 ; 2 
; 3 .

. 2.3. .

36

. 2.4.  . 2.5.  . 2.6. 


 .
. 
.
.

. 2.7.  . 2.8.  . 2.9.



.
.
.

,
,
(stratum
vasculosum). 

,
, 
 .

,
.


, 
.


, 
. 

, 
.
,



[2, 3].

, 

, 
, (
) .
, 
.



[3, 4].

. 




.

37


100% 
[5]. 
2
,


,1 
, .
5 6 .


.

, 

(. 2.4).

,
.


. 




(. 2.5).

3D (. 2.6).

(
) ( 
, 

, 
, ) 

. , 


. 

40 / 
50 /
.

0,9 
0,7
(. 2.7, 2.8).


.




1
. 
:
0,9 1,0 
(. 2.9).
2



(. 2.10).


(. 2.11).
, 



.

. 

2,3 ( 1 6) 

1
.
2

3,3 ( 1
9) . 



[68].



, 

(. 2.12).



, 
. 

3
12 (. 2.132.15).

.

38




.
,


, 
[8, 9].





(, , 
), 

. ,


. 



(. 2.16, 2.17).

.



.

( )

.

,

, 


. 


 .
, 
, 




. ,
, 


.
 
, , 
. 

, 
.


,

[10, 11].

,

.

, 

,
. 



. ,


. ,


,

 


.


2 .
, 
.


39

. 2.10. . 

.

. 2.11. . 
.

. 2.12. 
.

. 2.13. . 
.

. 2.14. . 
.

. 2.15. . 
.

40

0,9

60

50

0,8

0,7

V
max
40

30
0,6
20
0,5

10
0

0,4

14

21

14

21

. 2.16. 
()

.

. 2.17. 
(Vmax) 

.

. 2.18. . 
.

. 2.19. . 
.

. 2.20. . 
() ().

41

, 


. 


, 
(.
2.18).

5,87 3,41 /.


73,6% 
5 

[11, 12]. ,
22,3% 
10 

, 

.
.



, , 
[13].


3 5

(.
2.19). 
, 

6,2 2,1 /.
 

(
) (
) 

. 


.




( 1 5 ,
3 ) .


.


,
.


. 



,

(. 2.20).


8,5 3,3 6 2,5 /c
.




.
4 7 , 
5,1 0,99 .




. , 


10,3 3,7 9,9 3,9 /
(. 2.21).


, 


.


10 12 .

42

. 2.21. . 
.

. 2.22. . 

.


(. 2.22).


,
.

.
20,3
7,2 / ( 35 /, 
15 /), 18,8 8,3 /,
( 40 12 /).

.

.




12 /. 


.
,


(. 2.23, 2.24).

 
(. 2.25),

. 2.23. . 
.

. 2.24. . 
.

43

. 2.25.
.



.

1. Berek J.S., Adashi E.Y., Hillard P.A. Novaks
gynecology. Williams & Willkins, 1996.
2. .. . .
4. ..: , 1940. . 264280.
3. .
.
(2 )// . ..
..: , 1938. .II. . 2830, 6467,
102105.
4. Kamina P., Chansigaud J.P. Functional anato
my of pelvic veins in women // Phlebologie. V.
42. 3. P. 363379.
5. .., ..,
.. . 



// . . 1989. . 2831.
6. Akerlund M. Uterine contraction in non
pregnant women. How are they handled? what
is their significance? // Lakartidningen. 1998.
V. 95. 4. P. 284287.
7. de Vries K., Lyons E.A., Ballard G. et al:
Contractions of the inner third myometrium //
Am.J. Obstet. Gynecol. 1990. V. 172. . 679682.
8. Abramowicz J.S., Archer D.F.: Uterine en
dometrial peristalsis, a transvaginal ultrasound
study // Fertility. 1990. V. 54. P. 451454.
9. Lyons E.A., Taylor P.J., Zheng X.H. et al. Char
acterization of subendometrial myometrical
contractions throughout the menstrual cycle in
normal fertile women // Fertil. Steril. 1991. V.
55. P. 771774.
10. .., .. 
. .: , 1999. . 27
116.
11. .., .. 


// . 2000. .1. N.1. .
115122.
12. .. 

/ 
 , 
10
.. ., 1999. . 126127.
14. Goldstein S.R., TimorTritsch I.E. Ultrasound
in Gynecology. Churchill Livingstone Inc.,
1995. P. 6061.

44

3

.. , ..



.



[1]. 
,



.

,

().


. 

,

.

,
35 . 
,
, 40 [24].




[5], 
.


. 

.

 . 
,
, ,
.

,
.

.
: ,
, (.
3.1, . 3.1). 
, 
,

513% .
8% [6].
2

3
. 3.1. 
. 1 ; 2
; 3 .

45

3.1.

D. Kulenkampff ., 1995 [7]


.. .. , 1997 [8]
W. Sawicki ., 1997 [9]
H. Tsuda ., 1998 [10]
.. , 1999 [11]

35%
38%
28%
26%
33%

50%
56%
60%
61%
61%

5%
6%
12%
13%
6%



. 

. 

10 . 


10 
, 

(
, ) 
[8].

, 
. 


.


. ,


.


, 


. 


. 
,

, 
. 

 
.

(. 3.2). 



.



. 
25% [9].
C

. 



(
, ,

),
. 

,
, 

. 


46



.

(
) 


[8].

() 
. 

, 
. 

: 1)

; 2)
; 3)
[8].
C


, , 

.



: 
, 

. 

.


,

,
. 

.



. 
1013 
[10].

,



,
R. Nannini . [12]
1981 .
90 ,

90 .
,
, 

, 

. 

,


(. 3.3). 
5
30 . 
515 [13].

,
. 

, 
, ,

. 
, 
5% [13]. 


. 
100%
.


. 3.2.


. , 
P. Shwrzler . [24], 
104
, 
, 

47

. 3.2. 

. .


87%, 91%. 

67 89% 
. R. Rudigoz 
. [25] 27,5%

.

39 M.
Harada . [26] 
.



. 3.3. .

, 6 
.
G. Ayida . [18] 

( 87,5%,
100%) 
( 81%, 
95%).



,

,
.
.. [23]


80,0
93,9%,
100
100% (. 3.4, 3.5).
I. Shalev . [27] , 6
16 


.

,
c, 

. , 
P. Gaucherand . [15], 
(
94%, 98%)
,
(
67%, 94%).
M. Keltz . [21] 17 34 

. 12

, 
. 27 34 

,
90%, 20%.

45,5% .

48

. 3.4. . 
.

. 3.5. . 
.

,

.


,


. 


,

,

3.2. &
( [13])
, 
,




E. Cicinelli ., 1995 [14]
. ,
( )
100%
100%

P. Gaucherand ., 1995 [15]
94%
98%

U. Perlitz ., 1996 [16]
80%
85%

J. Shwayder, 1996 [17]
100%
92,8%
,
G. Ayida ., 1997 [18]
87,5%
100%
J. Bernard ., 1997 [19]
, 
( )
89,6%
95,0%

L. Bronz ., 1997 [20]
92%
86%

M. Keltz ., 1997 [21]
100%
100%

P. Schwarzler ., 1997 [22]
87%
91%

.. , 1998 [23]
100%
96,9%

( )
100%
100%
.
L. Bronz . [20] 

139 
, 50%

.
.. . [28]

97% 
.



.

49




.

,

, ,
, .
,

.

, 

.

 ,
. 

,
(. 3.6). , 

, 
(. 3.7), 
, 
, (. 3.8).


. 
,

[11].

(.
3.9) 
, 
.
, 

, 
, 

54 100% (. 3.3).
,




, 
(

). ,



, 
, 33,3 84,3% 
. ,

48% ,
, .





. 



, 
. , .. . [37]


,


3.3. &
( &
[8])

W. Matta ., 1988 [29]


100
A. Kurjak I. Zalud, 1991 [30]
54
A. Kurjak ., 1992 [31]
70
A. Szantho ., 1994 [32]
100
M. Hirai ., 1995 [33]
91
R. Ximenes ., 1996 [34]
90,6
.. ., 1996 [35]
66,7
.. .. , 1997 [8] 87
I. Szabo ., 1997 [36]
91
H. Tsuda ., 1998 [10]
51,5
.. , 1999 [11]
84
.. ., 1999 [37]
53,3

50


. ..
[11]



: 36%,
48%.
H. Tsuda . [10]
84,6% 
, 41,9% 
57,7% .
, 
46,2% 
,

, 
6,1% .


.
,


85,9%, 
82,1%, 84,3%.


(. 3.10) [38], 

. 


.


, , 
, 
. .
3.4 ,

.
.. [11],
0,73
0,08 (. 3.11), 

0,82 0,06.
[29, 42], 


,

, .





. 



,
.




. 


.
( < 0,01) 


.
,
6 .
,
.. . [37], 

3.4.

( [8])

W. Matta ., 1988 [29]


S. Creighton ., 1994 [39]
J. Carter ., 1994 [40]
F. Aleem M. Predanic, 1995 [41]
.. ., 1995 [42]
A. Jurisic ., 1996 [43]
.. .. ,
1997 [8]
I. Szabo ., 1997 [36]
.. , 1999 [11]

0,52
0,80
0,78
0,54
0,718

1,5
2,2
1,48

0,72
0,77
0,73

: ; &
.

51

. 3.6. .
, (), ().


. , 
0,78 0,06,
0,67 0,09.

: 0,75 0,07,
0,71 0,09,
0,69 0,05.


, 
(. 3.5).

, ,


[8,
45]. 
.
( ) 

. 


,


.

( 
),
[35, 43].

. 3.7. .
,
, .

. 3.8. .
, 
, .

52

. 3.9. . ,
(, ).


, 

, .
F. Aleem M. Predanic [41],

.


(0,43); ,
,


. 


. 


: 
0,59 0,50 .

.


[8]. , 
,



[11, 37]. , 

. 3.10. 
.

, 
.

. 3.11. 

. 
0,73.

53

. 3.12. 
. 
0,62.

. 3.13. 
.
0,70,
17,7 /.




,


(. 3.12) [8]. 


.




[35, 43].


,


.
.. [11], ..
. [37]


:

, 
.
, 

0,61 0,05 (.

3.13),
0,45 0,04 (. 3.14).


.

,
(. 3.15).



.


(). 
, 
.


8
W. Matta
. [29]. 4

. 



.
0,52, 
0,48, 
0,92
0,91. ,

54


3.5. (
[8])

W. Matta ., 1988 [29]


K. Hata ., 1991 [44]
A. Kurjak ., 1992 [31]
A. Szantho ., 1994 [32]
S. Creighton ., 1994 [39]
J. Carter ., 1994 [40]
F. Aleem M. Predanic, 1995 [41]
M. Hirai ., 1995 [33]
P. Sladkevicius ., 1995 [45]

0,48
0,68
0,54
0,62 (0,371,0)
0,6
0,55
0,57 (0,480,68)

0,89
0,9
1,2
0,96
0,80 (0,521,14)
0,67 (0,371,08)

A. Jurisic ., 1996 [43]


R. Ximenes ., 1996 [34]
.. ., 1996 [35]

.. , .. ,
1997 [8]

0,34 0,01
0,64 (0,411,0)
0,490,68
0,320,52

1,21 (0,592,74)

0,61 0,06
0,53 0,08

H. Tsuda ., 1998 [10]

1,384 0,643
1,612 0,719

.. , 1999 [11]

0,61 0,05
0,45 0,04
0,35 0,02

.. ., 1999 [37]

0,59 0,06
0,42 0,06

: ; .



.
S. Creighton . [39],
, 




( 1,5 1,8), 
( 0,9 1,6). F. Aleem M. Predanic
[41]


1 ,


55

. 3.14. 

. 0,5.

. 3.15. .
,

.

,
. ,
, 
.
, 

, 
. 


, .


. .: , 1994. . 8690.
6. Merz E. Uterustumoren // Sonographische
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8. .., .. 
// 
/
. .., .. III
. .: , 1997. . 76119.
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11. .. 
:
. . . . ., 1999.
12. Nannini R., Chelo E., Branconi F. et. al.
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: . . .:
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5. .., ..,
.. 

56


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// 
. . 1998. 2. . 612.
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23. ..
:
. . . . ., 1998.
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28. .., ..,
.., .. 


// . 1997. 10. .
4246.
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1994. V. 4. Suppl. 1. P. 68.
33. Hirai M., Shibata K., Sagai H. et al. Transvaginal
pulsed and color Doppler ssonography for the

57

evaluation of adenomyosis // J. Ultrasound Med.


1995. V. 14. 7. P. 529532.
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35. .., ..,
..
// 
. . 1996. 3. . 57.
36. Szabo I., Szcintho A., Csabay L., Papp Z.
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uterine vascularity in cases of uterine fibroids
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Ultrasound in Obstetrics and Gynecology.
Washington, October 2630, 1997. A121.
37. .., .., ..

// . . .
. . 1999. . 7. 4. . 308311.
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assessment of ovarian tumor angiogenesis: what
does threedimensional power Doppler add? //
Ultrasound Obstet. Gynecol. 1998. V. 12. 2.
P. 136146.
39. Creighton S., Bourne T.H., Lawton F.G. et al.
Use of transvaginal ultrasonography with color
Doppler imaging to determine an appropriate
treatment regimen for uterine fibroids with a
GnRH agonist before surgery: a preliminary

study // Ultrasound Obstet. Gynecol. 1994. V.


4. 6. P. 494498.
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Parthenon Publisching Group, 1995. P. 6170.
42. .., ..,
.. . 

, 
,
// . .
1995. 2. . 3035.
43. Jurisic A., Djukic M., Markovic A. et al. The
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44. Hata K., Makihara K., Hata T. Transvaginal
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Transvaginal Doppler examination for the
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Ultrasound Med. 1995. V. 14. 5. P. 377380.

58

4

.. , ..



. 
,
26%
1%

.
, 

,
3%,


. 



. ,
 1980 1989
. 186 
19 ,

11 .
, 

, ,


.





:
40%, 40%, 
15%, 
( , 
, .) 5%.

FIGO , 

, 


.
,
, 


[1].
(

,
) 
: 
.
,

, , 

59

, 
(
, , ,
). 
,

. , 

, 

.
. 

: , 
, ,
.

,
2/3 
, 1/4 1/10 
. 
3,5 , . 
, 
,
. 

, 

. 


,

1/3 . 

,
.


; 
, 

. 

, ,
50%
. 


.


, 1/3

.


, ,

, 


.



[26]. , ..
.. [3],
9 
, 

. , 
, 
, 



, 

.

.
.. [7]

, 
, , 
,

, ,

.
.. . [8] 


60



.

, 
, 
.



.

,



(. 4.1, 4.2).


(. 4.3), 

.


.


, 

. 4.1. . 
.

. 4.2. . 
.

. 4.3. . 
(
).

. 4.4. . 
.

61

,

(. 4.4).



.

. 4.5. . 
.

, 
, , 


, 
,

,
. ,

2,53 (. 4.5).
, 

,

. 4.6. . ;
; ; ( ;
, 63).

62

. 4.7. . ;
; ; ( 
; , 63).

. 
,
, ,
,



.





. 
. ,

, 


. 


, 
,

, ..,
.




. 


. 

,
.

63


, 
, 
, 


(. 4.6, 4.7).
, ,






.

, 
, 


, 




,
.







.


,
100%
[9] (. 4.8).


[10].



, ,


, 

(. 4.9, . 4.1).


.
, 
0,7. 
A. Kurjak S. Kupesic [2], 
10 ,

. 4.8.
() ().

64

. 4.9. .
. 
0,38; 
56 /.

. 4.10. 
. 
. ,
.

. 4.11. 
.
. ,
.


:
0,73 0,08, 0,69 0,05.



,
(0,82 0,06).




, ,
(. 4.10, 4.11).


.
,


.
K. Taylor . [11],



, 

. 



0,62,
0,74 ( 0,88).
( 
3,
5,
4)
I. Szabo . [19].

0,84 0,06,
0,77 0,08,
0,74 0,05.

65

4.1.
( [9])

A. Szantho ., 1994 [13]


R. Tepper ., 1994 [14]

0,5 (0,350,79)
0,56, 0,57
0,55, 0,73

0,9 (0,41,7) *
0,286 0,01**
0,523 0,014***
0,40 0,07
0,37 0,03
0,380,41
0,332 0,007
0,63 0,18
0,39 0,07
0,65 0,10***
0,35 0,02

M. Hirai, 1997 [15]


A. Kurjak S. Kupesic, 1995 [2]
C. Chen ., 1995 [16]
A. Jurisic ., 1996 [17]
K. Hata ., 1997 [18]
I. Szabo ., 1997 [19]
.. , 1999 [20]

0,62 0,07
0,583 0,040
0,74 0,05
0,69 0,05

. * ;
.
** .
*** .

. , 



.

.
K. Hata . [12] 


. , 

24 
14 44 ,
97 (82140)
. 



66,4 / (58,3124,0) 
21,6 / (6,348,6) [12].
..
[20]: 67,4 /,
16,5 /, 
29,6 /.


A. Kurjak
S. Kupesic [21]

,
0,40. , 

90,91%, 
99,82%,

71,43%, 99,96%.
K. Hata . [12]



, 41 /. 


80%,
97,6%,

80%, 97,6%.
.. [20]


.


66


0,40, 
45 /
. ,



100%, 89,6%.
,




.
.




.

1.

2.

3.

4.

5.

6.

7.

8.


.. 
// 

/ . .., ..
III . .: , 1997. . 201226.
Kurjak A., Kupesic S. Malignant uterine
tumors // Ultrasound and the Uterus / Ed.
Osmers R., Kurjak A. L., NY: The Parthenon
Publisching Group, 1995. P. 105113.
.., ..
. .: 
, 1990. . 100102.
.., ..,
.., .. 
// . .
1991. 3. . 5658.
An Atlas of Transvaginal Color Doppler / Ed.
Kurjak A. L. NY: The Parthenon Publ. Gr.,
1993.
Hiskey J., Goldberg F. Ultrasound review of
obstetrics and gynecology. Philadelphia, NY:
LippincottRaven Publ., 1996.
.. 
// . .
. . . 1993. 1. . 5559.
.., ..,
.. 
// . .

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

1997. 1. . 2634.
.., .. 
//

/ . ..,
.. III . .: , 1997. . 76119.
.., ..,
.., ..

. .: , 1997.
Taylor K., Ramos I., Carter D. et al.
Correlation of Doppler ultrasound tumor
signals with neovascular morphologic features
// Radiology. 1988. V. 166. P. 5761.
Hata K., Hata T., Iida K., Miyazaki K.
Expression of thymidine phosphorylase in
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association with microvessel density and
Doppler blood flow analysis // Ultrasound
Obstet. Gynecol. 1997. V. 10. P. 5458.
Szantho A., Szabo I., Nemet J. et al.
Transvaginal color Doppler for assesssment of
uterine tumor vvascularity // Ultrasound
Obstet. Gynecol. 1994. V. 4. Suppl. 1. P. 68.
Tepper R., Altazas M., Goldberger S. et al.
Color Doppler ultrasound findings in low and
highgrade endometrial stromal sarcomas //
Ultrasound Obstet. Gynecol. 1994. V. 4.
Suppl. 1. P. 55.
Hirai M. Transabdominal and transvaginal
pulsed and color Doppler sonography of
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Endometrium / Ed. Fleischer A.C., Kurjak A.,
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characteristics in low grade endometrial strom
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between vascular myoma and uterine sarcoma
// Ultrasound Obstet. Gynecol. 1996. V. 8.
Suppl. 1. P. 235.
Hata K., Hata T., Maruyama R., Hirai M.
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67

19. Szabo I., Szcintho A., Csabay L., Papp Z.


Transvaginal color Doppler for assessment of
uterine vascularity in cases of uterine fibroids
and sarcomas // Abstr. 7th World Congress on
Ultrasound in Obstetrics and Gynecology.
Washington, October 2630, 1997. A121.

20. ..

: . . . . ., 1999.
21. Kurjak A., Kupesic S. Textbook on color
Doppler in gynecology, infertility and
obstetrics. 1999.

68

5

.. , .. , ..



[1].
34 38 .
[2, 3].
A. Fleischer [4], 1997 . 
50 . . 

6% [5].

,
5665 [1, 68],
16% 

[1], 5% 
40 [9]. R. Rudelstorfer
. [10], 
90%
. 94% 

50 [11].


FIGO
(1989 .):
I
;
Ib 1/2 
;
Ic 1/2 
;
IIa
;

IIb
;
IIIa
/ 
/ 
(
);
IIIb ;
IIIc 
/ 
;
IVa
/ 
;
IVb
/
.

, 
.
100 000 9
10, 78 [12].
A. Fleischer [4],
3000 .

.
,
I 95%,
II 60% [13].


.


69

1014% 
[9, 10, 1416]. .. 
[17] 

7,8%
.


37 1000
[1821].

,

, 

.

.. .
[6], 

, 


. 

. . Coleman
. [22] , 

 
27% ,
100%.


, ,
, , 
, 

, 
.
.

 
. 

[23] (. 5.1).
1.  


.
2. 

 ( ).

. 5.1.  .

3.
 
.
. 5.1 
 
.
. 5.1, 
, 

20 (. 5.2). 90% 

10 [50]. ,

,  


(. 5.2).
, 



8 [16, 28, 42, 5254]. D. Dordoni 
. [16], F. leem . [43],

70


5.1.

( [24])

R. Auslender ., 1991 [25]


17,8
T. Bourne ., 1991 [26]
20,0
S. Granberg ., 1991 [27]
18,2
M. Wikland ., 1991 [28]
18,0
D. Botsis ., 1992 [29]
16,6
T. Bourne ., 1992 [30]
20,2
B. Karlsson ., 1992 [31]
20,3
R. Mancini ., 1992 [32]
16,2
R. Auslender ., 1993 [33]
18,1
A. Dorum ., 1993 [34]
20
A. Kurjak ., 1993 [35]
20
P. Sladkevicius, L. Valentin, 1993 [36]
24
O. Bakos ., 1994 [37]
13,9
J. Carter ., 1994 [38]
14
C. Exacoustos ., 1994 [19]
19,5
K. Gruboeck ., 1994 [18]
24,9
B. Karlsson ., 1994 [39]
21,1
A.H. , .. ,1994 [40] 20,1
T. Van de Bosch ., 1994 [41]
1335
B.B. ., 1995 [42]
2024
.. , .. , 1995 [24]
19,3
F. Aleem ., 1995 [43]
22,6
G. Weber ., 1995 [44]
17,1
K. Gruboeck ., 1996 [45]
29,5
B. Gull ., 1996 [46]
19
L. Bronz ., 1997 [47]
1021
I. Fistonic ., 1997 [48]
14,1
J. Alcazar ., 1998 [49]
14,7*
20,2**
: *
50%; **
50%.

C. Exacoustos . [54] 
8


.


8 . ,

159
,
62 ,
 5

. 5.2. 
.
 23 .

1 (3%) , 610 10
(31%), 1115 14 (43%) 15
37 (67%) [55].
,
18
930 

, 
107 . 
4
0,6%, 58 5,4%, 911
12,5%, 11 33,5% [56].

,





5.2.

T. Bourne ., 1991 [26]


S. Granberg ., 1991 [27]
D. Botsis ., 1992 [29]
R. Auslender ., 1993 [33]
A. Dorum ., 1993 [34]
O. Bakos ., 1994 [37]
B. Karlsson ., 1994 [39]
.. ., 1999 [51]

,
4,0 2,0
3,4 1,2
3,2 1,1
2,6 1,4
4,0
4,6
3,9 2,5
4

71

 4 5 [24].


78,2
100%, 60100%, 
8296,2%. ,
,

 ,

56 . A. Kurjak
S. Kupesic [50], 
10% 
510 .


. , ..
[57],
 6 , 


,

:

48,3%, 
56,8%. 

96,5% (!),
90,9%, 92,3%.



,

, .

R. Osmers . [53].



 8 , 2,2%

. ,
 5 

,

. , 

5,4% 
 12 ,

2,2
4,6.
, 


(. 5.3, 5.4). ,
R. Auslender . [25], 


 14,3 ,

. 5.3. 
.  
() 22 .

. 5.4. 
.  
() 
16 .

72


15,8 ,
17,8 . I. Fistonic
. [48] 


12,4 ,
13,4 ,
14,1 . 
G. Conoscenti 
. [58], 



.


,
.
. 

. .. ..
[59],
: 1)
; 2)
; 3)
; 4)

; 5) 
; 6)


. 5.5. 
.
, 
.

; 7)

; 8) 

.
E. Andolf . [60] 


, 85%
, , 9% 
6% 
. 
( 45%) 

,

, 
 10%
[35]. .. [61]

 57% .


.


: 25% 
, 25%
(. 5.5). 

[35].

. 5.6. . 
.

73

,


. 

. ,

0,6 0,3 , 
, 
, ,
(. 5.6). 
16,9% 

(. 5.7).



(. 5.3).
, 
 1,5 
, 
2
, 
,
.
3 
, 
(. 5.8). ,


.




(. 5.9). 



, 


, ,
(. 5.10).

. 5.7. 
.
,
.

. 5.8. 
. .

. 

.



,

. .. [62], 

, , 
1/3 . 


68 97% [31,
6368] (. 5.4).
I. Szabo . [63], 


74


5.3.

,
1,0
(n=15)

1,5
(n=13)

2,5
(n=25)

3,0
(n=8)

4,0
(n=13)

15
(17,4%)

13
(15,2%)

19
(22,1%)

2
(2,3%)

2
(2,3%)

6
(6,9%)

4
(4,7%)

7
(8,1%)

2
(2,3%)

4
(4,7%)


86%, 
90%,

92%, 83%.


,
50% 50% (. 5.11).

4,0
(n=12)

12
(14%)

, 
. Karlsson . [31], 
, 



79%, 100%.
M. Coute . [66],


5.4.

, %

. Karlsson ., 1992 [31]


G. Weber ., 1995 [44]
I. Szabo ., 1997 [63]
J. Alcazar ., 1998 [49]
S. Gabrielli ., 1998 [64]
S. Kupesic, A. Kurjak, 1998 [65]

79
85
86
100
79
100

, %
100
89
90
91,7

94,4


30

15

. 5.9.

.

. 5.10. .

, .

75

. 5.11. . 50%;
50%.

, 

.



S. Kupesic A. Kurjak [65]: 
100%, 94,4%,

83,3%,
100%. 


.



. 

.
, 
, 
. 



.





%
29

%
40

36

35

30
25

30
20
25

20,9

17,4

15

20

15
15

10

5,8

10

4,6
5

0
0

. 5.12. .

76

. 5.13.
.

. 5.14.
.

, 

(. 5.12).
, 

,

79% (68 
). ,

13 (15%) 
18 (20,9%) 
,
,
8


36 4,6%
(. 5.13).

,
,
.
, 
15 (17,4%) 
5 (5,8%) 
, .. 3 .
, 
, ,

(2529% ); 


. 5.15.

.

. 5.16.

.

77


6 (6,9%)
25 (29%) 
(. 5.14).
, 


, 

,
.
,




.


[6670]. 



. 

, 

. A. Kikuchi 
. [67], 


77%, 
87%.
H. Tsuda . [68],

 

. 
85%. 


,
,

.




. 
,


, 


[71].
, 
. 

, 

.
,
, 
. ,
, 

. 



.



 


.

, ,

5.5.

A. Kurjak ., 1993 [35]


F. Allem ., 1995 [43]
K. Ilijas ., 1996 [73]
.. , 1999 [74]
.. , 1999 [75]

78

, %
91
93
93
96
82


5.6. [74]

10
43
28
25

10
6
3

23
21
92

10
7
24

23
25
96

: ; .


.


 
[72].



,

(. 5.15, 5.16,
5.17). 
,

90% (. 5.5).
,



, 
(. 5.18, 5.19,
5.20). , F. Allem . [43]

12% , 
93%.
A. Kurjak . [35]
8 91% . 


. 5.6 [74].
, 

,
,
, 


(. 5.21).
. 5.6, 

10 
,

23%, 25%,
96% .
I

100% (. 5.22).

. 
, 


(. 5.23).
K. Hata . [76],

5.7.
()

K. Hata ., 1991 [76]


A. Kurjak ., 1993 [35]
F. Allem ., 1995 [43]
.E. , 1996 [77]
K. Ilijas ., 1996 [73]
M. Hirai, 1997 [78]
S. Rakic, 1997 [79]
.. ,
.. , 1998 [80]
.. , 1999 [75]
C

10
35
14
18
14
9
8

0,54
0,42
0,50
0,36
0,39
0,40
0,40

12

24

0,45
0,40
0,35

79

. 5.17.
() ().

. 5.18.
() (). .

. 5.19. 

, 
.

. 5.20. 

.
.

80

. 5.21. ()
() . , 
.

. 5.22.

.
.

. 5.23. 
. 
0,43.


0,54 0,16,
0,77 0,75. 


0,4 (. 5.7).



. , 

,

. , K. Ilijas .
[73], 


0,39 0,03, 
0,43 0,03.

,
. 
A. Kurjak . [35] 

0,65 0,05,
0,42 0,02. 
A. Kurjak S. Kupesic [81] ,

0,50 0,08. ,
.. [74], 
,

81

0,53 0,017, 
0,65 0,014, 
0,35 0,005.
A. Kurjak S. Kupesic [81] 

Ia Ib

.

( 10 )

.


. 
0,42.




. ..
[75], 

0,5 0,18,
0,4 0,09.
, 



.
,

. A. Kurjak 
. [35] ,


7,2 2,1 /, 
12,04 3,1 /. 


17,12 2,7 / [80].
.. [74] 
.





[80, 82].

P. Sladkevicius . [83],
 




, 
,
.
,



.
,


,
, ,
/



, 

,

.

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, 1985.
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. . ... .
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82


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// 
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(3,75 0,52) 
(3,67 0,41) 

.
J. Zaidi . [9], 

() 

(16,89 2,36 /) 
(8,74 0,68 /).
,


.
,
26 ,
, 57
,

(. 8.1, 8.2). 


(. 8.1, . 8.3, 8.4).

. , . Battaglia . [8, 10,
11] 

99

8.1.

68#

11,7 0,8
(8,615,3)

12,7 0,8
(7,718,3)

0,63 0,01
(0,510,57)

0,59 0,01
(0,510,61)

1415#

11,9 0,5
(9,613,9)

10,9 0,5
(8,614,6)

0,56 0,02
(0,510,55)

0,6 0,02
(0,500,57)

2426#

10,8 1,1
(6,917,2)

12,4 1,1
(8,917,2)

0,59 0,02
(0,530,56)

0,64 0,03
(0,520,58)

,

. 



.
J. Zaidi . [9] 


1
1

. 8.1.
. (1) 
(2).

. 8.2. 
. (1)
(2).

. 8.3. () 
() 
.

. 8.4. () 

.

100




.
. Battaglia .
[8, 10, 11],
(3,68 0,26)
, (3,31
0,26). [10] 
( > 0,05)

(0,52 0,06 0,54
0,07 ).

. 
() 



,
.
.

15 30% [12].
,
, 

[12]. 

. 


, 
.

. 8.5. 
. .

. 8.6. 
.

. 8.7.
.

. 8.8. (
) .

101

, 

.

, 
,



.


(. 8.5).


.

().

, , .
325%
[12]. , 


, 
 
,
.



(. 8.6). , 


,
,
(. 8.7). D.
Kalogirou . [14], 


( <
0,03). S. Kupesic . [15]


,
.


12,7 /
0,55 (. 8.8).
.




.

. 


[16]. 
C. Anandakumar . [17] 7
9 (!)
,
,
.
,

(. 8.9), 
(. 8.2) 


.


. , S.
Kupesic . [7]
0,52 0,06.
. Jurisic
.[18]
0,64 (0,510,78).
M. Pascual . [19]


84,6
99,2%. , 
C. Anandakumar . [17], 
8.2. #

12

12,4 9,8
(4,218,1)

0,5 0,02
(0,490,58)

102


,


610 .
. 
,

,

 .


, 


,
, , 
.

(. 8.10).
S. Kupesic A. Kurjak [20]

0,46 0,08. ,


(. 8.3).
.
[27]

8.3.

19

24,2 7,4
(11,342,4)

0,43 0,1
(0,320,46)

750%
. , 
, , 
, 

. ,
.



8.4. #

(/)

37

11,4 5,2
(8,922,4)

0,54 0,03
(0,490,59)

70%
[21]. S. Kupesic . [22],

(36%)
(12%), 0,40 0,59.
, 

(. 8.11) 

,
.
,

, (. 8.12),
,
(. 8.13),

.
,


(. 8.4).
11,4 5,2
/. 

, 

1022 /.
0,54 0,03 ( ) 0,59 0,02 [22].


, ,

, 
. ,
J. Alcazar . [23],

88,9 91%,
76,2
88,9%.
. ,

103

. 8.9. .
.

. 8.10. .
.

1
2

. 8.11. . 
.

. 8.12. ,
. 1 ; 2
.

, 


.

100% , 

75,7%, 54,5%.


.

26,1
11,5 /, 0,47 0,02.
, 

0,44 [7] 0,53 0,09 [24].


. 
. Papadimitriou . [25] 

.

,

/ 
(. 8.14, 8.15).

.
, S. Kupesic . [24] 


104

. 8.13. .
, .

. 8.15. .


47,1
52,4% .

. Alatas . [26],


,
. 
, 

.




(0,71 0,07) [26].

. 8.14. .


1. HamiltonFairby D., Pearce D. Polycystic
ovary syndrome // Annual. Progr. Reprod. Med.
1993. P. 7180.
2. .., .. 
. .: , 1990.
3. .., ..,
.. 
// 
/ .
.., .. . 3. .: , 1997.
. 132174.
4. .., .. 
// . . 1994. 1.
. 1114.
5. Adams J., Polson D.W., Franks S. Prevalence
of polycystic ovaries in women with anovulation
and idiopathic hirsutism // Br. Med. J. 1986. V.
293. P. 355359.
6. Kupesic S., Kurjak A., Stilinovic K. The
assessment of female infertility // n Atlas of
transvaginal color Doppler. The current state of
the art / Ed. Kurjak A. L.: The Parthenon Publ.
Gr., 1994.
7. Kupesic S., Marton U., Kurjak A. Polycystic
ovary syndrome  Doppler parametres // Lijec.
Vjesn. 1996. V. 118. Suppl. 1. P. 4244.
8. Battaglia C., Artini P., Salvatori M. et.al.
Ultrasonographic patterns of polycystic ovaries:
color Doppler and hormonal correlations //
Ultrasound Obstet. Gynecol. 1998. V. 11. 5.
P. 332337.

105

9. Zaidi J., Campbell S., Pittrof R. et. al. Ovarian


stromal blood flow in women with polycystic
ovariesa possible new marker for diagnosis? //
Hum. Reprod. 1995. V. 10. P. 19921996.
10. Battaglia C., Artini P.G., DAmbrogio G. et. al.
The role of color Doppler imaging in the
diagnosis of polycystic ovary syndrome // Am.
J. Obstet. Gynecol. 1995. V. 172. P. 108113.
11. Battaglia C., Artini P.G., Genazzani A.D. et al.
Color Doppler analysis in lean and obese women
with polycystic ovary syndrome // Ultrasound
Obstet. Gynecol. 1996. V. 7. P. 342346.
12. .., .. 
. M.: , 1998.
13. Zaidi J., Jurkovic D., Campbell S. et al.
Luteinized unruptured follicle: morphology,
endocrine function and blood flow changes
during the menstrual cycle // Hum. Reprod.
1995. V. 10. P. 4449.
14. Kalogirou D., Antoniou G., Botsis D. et. al.
Transvaginal Doppler ultrasound with color
flow imaging in the diagnosis of luteal phase
defect (LPD) // Clin. Exp. Obstet. Gynecol.
1997. V. 24. P. 9597.
15. Kupesic S., Kurjak A., Vujisic S., Petrovic Z.
Luteal phase defect., comparison between
Doppler velocimetry, histological and hormonal
markers // Ultrasound Obstet. Gynecol. 1997.
V. 9. P. 105112.
16. Cacciatore B., TommolaRossi., Wahlstrom T.
et al. Transvaginal power doppler evaluation of
adnexal tumors // Ultrasound Obstet. Gynecol.
1996. V. 8. Suppl. 1. P. 203.
17. Anandakumar C., Chew S., Wong Y.C. et al.
Role of transvaginal ultrasound color flow
imaging and Doppler waveforms analysis in
differentiating between benign and malignant
ovarian tumors // Ultrasound Obstet. Gynecol.
1996. V. 7. 4. P. 280284.
18. Jurisic A., Djukic M., Rakic S. et al. The value
of color Doppler ultrasound in detection of
ovarian malignancies in women under 30 years

of age // Ultrasound Obstet. Gynecol. 1995. V.


6. Suppl. 2. P. 103.
19. Pascual M.A., Hereter L., Carreras O. et al.
Transvaginal ultrasound diagnosis of ovarian
lesions // Program of 7 th Congress on
Ultrasound Obstet. Gynecol. 1997. P. 127.
20. Kupesic S., Kurjak A. Development of an early
human being from conception to implatation 
transvaginal color Doppler study // An Atlas of
transvaginal color Doppler. The current state of
the art / Ed. Kurjak A. L.: The Parthenon Publ.
Gr., 1994.
21. Aleem F., Pennisi J., Zeitoun K., Predanic M.
The role of color Doppler in diagnosis of
endometriomas // Ultrasound Obstet. Gynecol.
1995. V. 5. 1. P. 5154.
22. Kupesic S., Kopjar M., Kurjak A. Scoring
system for endometriosis // Ultrasound Obstet.
Gynecol. 1995. V. 6. Suppl. 2. P. 112.
23. Alcazar J., Laparte C., Jurado M. et. al. The role
of transvaginal ultrasonography combined with
color velocity imaging and pulsed Doppler in the
diagnosis of endometrioma // Fertil. Steril.
1997. V. 67. P. 487491.
24. Kupesic S., Kurjak A., Pasalic L. et. al. The
value of transvaginal color Doppler in the
assessment of pelvic inflammatory disease //
Ultrasound Med. Biol. 1995. V. 21. P. 733738.
25. Papadimitriou A., Kalogirou D., Antoniou G.
et. al. A Power Doppler ultrasound, a potentially
useful alternative in diagnosing pelvic pathologic
conditions // Clin. Exp. Obstet. Gynecol. 1996.
V. 23. 4. P. 229232.
26. Alatas C., Aksoy E., Akarsu C. et. al.
Hemodynamic assessment in pelvic infla
mmatory disease by transvaginal color Doppler
ultrasonography // Eur. J. Obstet. Gynecol.
Reprod. Biol. 1996. V. 70. 1. P. 7578.
27. .., .., 
.. .
. .:
, 1995.

106

9

.. , ..




J.
Folkman [1], ,

. , 


, 
, .

,
[2] 

, , ,

[3]. 
, 


[4].
 

. 

, 
:
, 

. 

, 



[5, 6] 
[7].

() 

1989 .

A. Kurjak [8], T. Bourne
. [9], T. Hata . [10]. 



.
,

. .
Bourne . [9], . Kurjak . [11,
12]
: 
() 0,4, 
() 1,0.


[13, 14].

. 


[15].

.

107

. Kurjak . [8, 11, 12,


1636], H. Schulman . [37],
A. Fleischer . [3846], A. Pascual
. [47], Z. Weiner . [48, 49],
I. TimorTritch . [50, 51], M. Kawai
. [52, 53], T. Bourne . [5456],
C. Jeng . [57], A. Caruso . [58],
M. Ilyas . [59], .. [60] 
, 


B. 
, A. Fleischer . [39]

70% (III
) .
A. Tekay P. Jouppila .
[61, 62], B. Bromley . [63], B. Leeners
. [64, 65], M. Rehn . [66, 67]


, (L. Valentin [68, 69], L. Platt
[7072]) 


.
V. Schneider
. [73], D. Brown . [74], K. Hata
. [7577], K. Jain . [78],
J. Carter . [79, 80], H. Prompeler 
. [8185] . [8689]
,



.


,

, 
( 
)
( 
, 
)
.

9.1. ( %) 


J. Antonic S. Rakar [90]


F. Dambrosio . [91]
A. Kurjak . [29, 32]
C. Jeng . [57]
H. Shulman . [92]
B. Salle . [93]
M. Emoto . [6]
A. Desroches . [94]
K. Hata . [76]
A. ekay P. Jouppila [95]
C. Chou . [96]
Z. Maly . [97]
A. Kurjak . [31]
M. Pascual . [98]
J. Alkazar . [99]
D. Brown . [74]
I. TimorTritsch . [50]
H. Prompeler . [83]
A. Lissoni . [100]
..
.. [101]
[102]

14
22
52,2
35
30
54,8
54
40,3
89
59
60
61
62
64,8
67
70,4
89
85

100
100
99

93
100
84,2
100
100

100
98
97
96
95,7
75
100
89
98

78
69,2

95
100


. ,

(. 9.1), 
75100%
14
98,9%

.

[102] 


(15 15 )

(13 15 86,7%).



69,2%
, 
73,3 53,8% 
.
,

108


 9.2. ( %) 
. 
,





A. Tailor . [106]
76
100
. 
S. Guerriero . [107]
94
100
, ,
A. Valcamonico . [108]
96
96

Cacciatore . [29]
98
100

[109]
87
98,4

( ).
, Y. Zalel . [103], A. Kurjak
M. Predanic [30] , ,
.
2425% .

, 


 
,

() [104, 105].
. , S.
, Stein . [110], , 
,  ,
98,4100%  
7698% 77, 69, 49 89% 
(. 9.2).
, . Anandakumar 
. [157] 77, 68, 40 91%.
A. Tailor .
, 
[106],  .

2
2

2
1

1
2
1

. 9.1.
. 1 ; 2 
.

. 9.2. 
. 1 
; 2 .

109


I. TimorTritsch .
[50], . Pascual . [98] , 


.

. . Kurjak . [31]
, 

, ,
,
.
H. Prompeler . [83] 


3, 
9 (p < 0,0001). ,
(19) 
,
.
P. Albertis . [111] 

6 
. J. Alcazar . [99] 

7,5 5,5,
1,4 1,4 (p < 0,05).
, 
(
PRF 1 ) 

2,4 0,8 ( 1
6), (. 9.1) 6,4 1,8
( 1 14) (p < 0,05).
, 


,
, 



(. 9.2).

. A. Fleisher . [38]
1991 . 


.
.
,
,

, 
.
A. Fleischer . [42]
,


.


, 

.
A. Kurjak . [31] ,


,

, , 
, 
, .
J. Alcazar . [112]


(90%) , 
(88,6%).

[97, 113].




(. 9.3)

(. 9.4).


(. 9.5), 

(. 9.6).



110


. H. Pairleitner .
[114, 115] , 

,


(. 9.7).
(. 9.3).
. Kurjak . [35] 1992 .
:

0,28
0,4, 
0,4.

. , I. Takac 

. [113], F. Dambrosio . [91], H.


Schulman . [37], I. TimorTritsch
. [51], H. Prompeler . [83], S.
Guerriero . [107], 
0,40,47.
[102] 
0,35
0,03, 0,60 0,03.

.
, M. Emoto . [6],
M. Shieber C. Sohn [116], G. Zanetta 
. [117], K. Hata . [76, 118], U.
Hamper . [119], ..
.. [120], T. Udo .
[121], K. Jain [78]
0, 50,55.

9.3.

A. Kurjak . [12]
H. VaccaroCerva, [122]
A. Kurjak I. Zalud [35]
H. Schulman . [37]
A. Tecay P. Jouppila [61]
P. Gausherand . [123]
A. Tecay P. Jouppila [61]
C. Spreafico . [124]
M. Kawai . [53]
C. Spreafico . [124]
G. Zanetta . [117]
V. Shneider . [73]
D. Brown . [74]
H. Prompeler . [82]
J. Carter . [79]
S. Stein . [110]
A. Desroches . [94]
Z. Maly . [97]
K. Hata . [76]
J. Carter . [79]
I. Takac . [113]
B. Leeners . [64]
J. Alkazar . [99]
B. Leeners . [64]
S. Guerriero . [107]

1991
1991
1992
1992
1992
1992
1992
1993
1993
1993
1993
1993
1994
1994
1995
1995
1995
1995
1995
1995
1996
1996
1996
1996
1998
1999

56/624
4/17
38/136
29/54
11/61
12/40
11/61

23/37
16/39

41/42

47/186

47/186
33/159
64/81

< 0,4
< 0,7
0,4
0,4
< 0,5
< 0,5
< 0,6
< 0,4
< 0,4
0,5
< 0,56
< 0,8
0,4
0,5
0,4
< 0,4
< 0,5
< 0,6
0,72
0,8
< 0,4
< 0,4
0,45
< 0,5
0,4
0,44

96
100
97,3
96
46

82
87,5
75
88
87
93,8
50
85
13
24
94
100
93
94
82
75
96
50
58
83

99,8
94
100
95
89

72
88,8
79
89
94
56
96
77
97
90
83
57
73
59
97,4
58
91
79
87
95

98
80

96
42
100
35

75

47

84

50
71

94

80

48
93

99,7
100

95
90
89
96

96

73
97

92

98

91
88

: 
; ; ; 
.

111

. 9.3.
. 

.

. 9.4.
.

().

. 9.5. 
.

().

. 9.6. 

. 

().


,
0,6 0,7.

. 9.7. 
.

. 

(0,45) I. Timor
Tritsch . [51].
1,15.
I. Takac . [113], P.
Albertis . [111], U. Hamper .
[119], Z. Weiner . [48], G. Zanetta
. [117], A. Fleisher . [44], M.
Kawai . [52, 53], ..

112


.. [120],

0,56 0,93, 
0,83 1,93.
[102] 
0,47
0,05, 1,04 0,09.
. 9.4

.

.
I. TimorTritsch . [50] ,

94%,
99%. A. Kurjak 
. [29]
(< 0,4) (< 0,65)

,
100, 98
90% .

. , 85 
A. Pascual . [47]

. 
= 0,4 ,


100, 96,
73 100%. = 1,0
100, 98, 89 100%.
K. Vairojanavong .
[127], 
< 0,4 66,6% ,
< 1,0 85,7%. ,



. 
I. Takac . [113] 


82,1 97,4%,
59,0 87,2%.
A. Tekay P. Jouppila [95] ,

9.4.

T. Bourne [13]
A. Fleisher . [44]
Z. Weiner . [49]
M. Kawai . [52]
Z. Weiner . [48]
M. . [125]
G. Zanetta . [126]
H. Prompeler . [85]
P. Albertis . [111]
D. Brown . [74]
Z. Maly . [97]
S. Stein . [110]
B. Leeners . [64]
I. Takac . [113]
B. Leeners . [64]
S. Guerriero . [107]
S. Guerriero . [107]

1989
1991
1992
1992
1993
1993
1993
1994
1994
1994
1995
1995
1996
1996
1996
1998
1998
1999

8/9
11/32
17/36
9/15
4/11
15/15
23/37
41/42
16/69

47/186

47/186
33/159
33/159
64/81

< 1,5
< 1,0
< 1,0
1,25
< 1,0
< 1,0
< 1,0
0,7
< 1,0
< 1,0
< 0,7
< 1,0
< 0,7
< 1,0
< 1,0
0,8
1,0
0,67

88
100
94

80
95
83
95
100
86
67
86
59
19
85
88
81

100
83
97

99.8
67
89
77
91
46
100
66
100
87
94
67
47
94

73
97

60
71

75

46

84

35
25
91

100
94

77

95

83

70

96
95
86

: 
; ; ; 
.

113


.


.
, 
, 
, 


(. 9.5).
J. Perhonen J. Makinen [131], 
, ,

, 


, ,

.
S. Guerriero . [107]


, 

3 , 
3

. 
, ,


100, 92, 73 100%.
H. Prompeler . [84] ,


84 90%.
,
F. Strigini . [132]


, 
, 

58, 80, 49 91% 
,


13, 46, 25 70%.


, 



[68, 107].

9.5.

H. Schulman . [37]
A. Kurjak [29]
K. Vairojanavong . [127]
M. Djukic . [128]
J. Alkazar . [129]
M. Djukic . [130]
C. Anandakumar [157]
F. Dambrosio . [91]
S. Guerriero . [107]
S. Guerriero . [107]

1992
1992
1995
1995
1996
1996
1996
1996
1998
1998
1999

29/54
65/657
14/21

36/95

33/159
33/159
64/81

0,41 + B
0,40 +
< 0,4 + B
< 0,4 + + B
0,45 +
< 0,4 + B
0,66 +
0,4 + +
0,4 +
1,0 +
0,44 + ()
19c/c
+ () 5c/c

90
90

92
96
96
71
100
100
88

99

99
98
80
96
92
87

90
94

78
96
93
49

73
59

96
99

99
98

91

100
97

95

93

91

96

: ;
; ; 
; ; ;
; ; 
; .

114


S. Stein . [110],
170 , , 

= 0,4 24%, 


.

J. Carter .
[80]. 228 
88 140 
.
= 0,4

13% (!).
B. Leeners . [64], 233
, 186 (79,8%) 
47 (20,2%)
. 


.

74,2 57,5% = 0,4; 50 78,7%
= 0,5; 19,4 93,6% = 1; 47,3
83% = 0,7. 

, 


.
A. Tekay P. Jouppila
[62] < 0,4 
25%
, < 1,0 80%.
A. Valcamonico . [108]
85 
(55) 
(30) .


.
= 0,4
(40%) 
(98%), = 1,0

(86%) (47%).




.
B. Bauer . [133, 134],
50% 

( ).

10%.
B. Karlan . [135,136], P. Schwartz
. [137], V. Schneider . [73]


.

(32 ) A. Tekay
P. Jouppila [62], 

: 25
100%, 46 100%,

29 100%, 

63 100%.
, 

.

, , 
, , , 

( ,

..) 
.
,
, 
( ) 
:
: G. Bogner . [138] 
,


88 91%,

100 96%;

: A. Tekay P. Jouppila [139] 

115

, 

25% ,
33%;

[17];

[17];

,
[140];

(
) [140];
(
) [17];

[17];

[16]

[10, 109];
[109].

.
1993 .


[31, 42], 1995 .


() 


K. Hata
. [75, 76], 

13,1 9,1 /, 
23,9 11,5 / ( < 0,05). 
, 16 /, 
83,3%, 
91,6%.
J. Alkazar . [112] 


,
: 27,3 11,8 45,3
22,6 / .

I. Szabo . [141], 
188
, 
21,9
/, 40,8 /. 

.

, M. Rehn
. [66, 67],
19 0,8 /c. ,

.


: J. Buy 
. [142] 15 /, A. Sosic . [143]
10 c/.

[64, 144],



.
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 .



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// . .
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// V


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// 
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// .
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, 911 


/ 70% ,

50%, 1213 
95 65% .
, 


34 , 

[32].


15

1.5. ( ) 
1317 [29]

,
13

14

15

16

17

1,9
0,83,0
2,0
0,93,1
1,4
0,91,9
1,6
1,12,1

2,4
1,13,7
2,5
1,23,8
1,6
1,22,0
1,9
1,42,4

3,0
1,54,5
3,1
1,64,6
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1,52,5
2,2
1,72,7

3,6
2,05,2
3,7
2,25,3
2,2
1,72,7
2,4
1,83,0

4,3
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4,4
2,76,1
2,4
1,92,9
2,7
2,13,3

,

(57,5 ). II 




.
R. DAmelio . [33], I. Shapiro
. [34], 18 


, 18 

.


18 .

1317
, 

(. 1.5). 


.



I. Shapiro . [34],
M. Bronshtein . [35],


17 .


. 



[36, 37], 


I. Shapiro . [34],
R. Achiron .
[36], . . .





, 

. 



1112 .


. 
M. Leiva . [37], 7 

10%
,
3%. 12


90% . G. Rizzo

16

. 1.18. 12 3 . 
. 

( ) .

. 1.20. 12 3 . 
. 

.

. [38] 


1113 76,2%
,
66,6 61,9% .


1214

94,4% (. 1.18, 1.19),
91,2
89,6% (. 1.20).

. 1.19. 12 3 . 

. 
.



,
.

10 
.
() 

, ()


.



. .. 
. [39],
/ I II 
0,5,
0,80,9.



.


/ 
. 

G. Rizzo . [38] 

17

, 1113 20 
. 12 
,
[39].








. A. Sharkey .
[40],

13 , 
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, 

c 10 . 

, 

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,

12 
[28, 41, 42], 
31%
9 , 76% 10 
11
(. 1.23) [11].
,
S. Rottem [42], 1011


75% 
, 1112
. 
A. Suy . [28], 1213 

97% .


8,5
, ,

. 
, 

.



,

. 1.21. 12 1 () 13 3 ().
.

18

. 1.22. 12 6 . () () .
.

1
1
2
1

. 1.23. 11 (
53 ). 
. 1 ; 2 [11].


. G. Tsukerman . [43] 


12 
.


. 


10 6 [7]. 


, 

. 

.


. 
,
9 
1,2 (0,52,1 ), 10 1,5
(0,82,6 ), 11 1,9 (1,03,1 ),
12 2,4 (1,43,7 ) [11].


. 
, 

. ,
I. TimorTritsch . [44] ,


8 . ,

,


1,5 .

19

. 1.24. 8 (
21 ). 
.

. 1.25. 9 (
27 ). 

[11].

1
2
2
1

. 1.26. 10 . 1 
; 2 
[11].

. 1.27. 10 3 . 1 
; 2 .

D. Cyr . [45] 10
7 10 

.
6,3
(510 ). W. Schmidt
. [46]
(69 ) 8 
56 9 .

,


78 [11].



.


(. 1.24, 1.25),
10
(. 1.26, 1.27) (. 1.6).


11 5 [47, 48]. 12




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20

. 1.28. 13 2 . 
,
.

. 1.29. 12 6 .
,
.

1.6. 
[11]
,

7
8
9
10
11
12

1,9 (0,23,6)
2,4 (0,74,1)
3,3 (1,65,0)
4,0 (2,35,7)
3,9 (2,25,6)
0

1,8 (1,02,7)
2,1 (1,33,0)
2,4 (1,63,3)
2,7 (1,93,6)
3,0 (2,23,9)
3,3 (2,54,2)



, 

1213 
(. 1.7).
1011 

. 

(. 1.30). 

, 1112


.

1116 
. 
P. Rosati L. Guariglia [49],

4,45
11 12,7 16 , 
3,57 9,8 , 
3,5 10 ,
14,45 35,55 (. 1.8).



10 ,
1112 (. 1.9).

(. 1.31,
1.32). J. Braithwaite . [41],
,

1213
98% . 



21

1.7. 

S. Rottem, 1992 [42]


J. Braithwaite ., 1996 [41]
P. Rosati, L. Guariglia, 1996 [49]
A. Suy ., 2000 [28]

11

12

75%

100%

13

14

15

16

92%

93%

97%

100%

97%

99%

100%

100%

100%
99%

79%

86%
75%

78%

94%

1.8. ( ) 1116 [49]

,
11

4,45
3,165,80

3,57

3,005,25

3,50

2,455,45

14,45
11,6218,60

12

13

14

15

16

6,32
5,258,41
4,90
3,816,27
5,00
3,416,19
19,15
15,5722,16

8,45
6,6310,55
6,20
4,907,80
6,15
5,107,35
23,15
19,5827,09

9,90
7,9512,48
7,45
5,809,10
7,40
5,909,10
26,60
22,6530,71

11,62
9,6013,87
8,52
7,209,67
8,37
6,839,81
30,72
26,9434,70

12,70
10,0714,29
9,80
8,3711,09
10,00
7,8411,95
35,55
30,4340,28

. 1.30. 14 . 
. .


12 . 
,
N. Sebire . [50], 

, 
 67 .



, 
.
N. Sebire . [50]
300 1014 
, 

6 .


, 

.
, 
1014

8 .

22

. 1.31. 12 6 . 
.

. 1.32. 13 . 
.

1.9.

,
11

S. Rottem, 1992 [42]


J. Braithwaite ., 1996 [41]
P. Rosati, L. Guariglia, 1996 [49]
A. Suy ., 2000 [28]

12
75%

13

14

15

16

100%

100%

91%

92%

96%

100%

98%

100%

100%

100%

98%
77%

87%
83%

74%

92%



8 [51]. 

:
9 , 
10 ,
11 [5254].
A. Zorzoli . [55],
296 9
16 ,
90,9%
, 73,6%,
59,5%,
60,5%,
51,7% .
, A. Suy 
. [28], 
1214

94
96% (. 1.33, 1.34).
11
(. 1.35, 1.36),

,
. 1114


,

II 
. ,
,
, 

II [56].


23

. 1.33. 10 3 .
.

. 1.35. 12 6 .
.

. 1.34. 12 () 13 () . .


. , 
A. Zorzoli . [55] 

5,1% (3,17,0%)
4,4% (3,45,5%) . 
,
, 
4,9% (1,28,4%).


1114 
6 11 , 8 12 , 10
13 13 14 [55].
. 1.36. 13 .
.

24





. 6 

,

.


, 
(. 1.37).
45 .


(.
1.38). I

. 
, ,

. 12
,
, [51]. 





(. 1.10).

H.G. Blaas [7]


29 
7 13 
7
( 142 ) 
, 10 
.
10 11

.

.
, 


I . 

:

; , 
. 


, 16% [60]
(. 1.39). 

, 
.

.

. 1.37. 11 5 .
.

. 1.38. 89 .
.

25

1.10. ( ) (
[7])
A. Rempen,
1991 [57]

D. Lindsay
.,
1992 [58]


5
6,57,5







7
8
9
10
11
12

5,0
5,5
5,7
5,8
5,7
5,3

2,9
3,1
3,4
3,8





I 
.


[61]. , 
2 5,6 5
10 

.

. 1.39. . 
.

C. Stampone
.,
1996 [59]

.
.,
1997 [60]

H.G. Blaas,
1999 [7]

6,5

7,5








4,1
4,5
4,8
4,9
4,9
4,7

4,0
4,0
5,0
5,2
5,0

E. Lyons [62] 6 15

. 9

8 


21 24 . J.
Green J. Hobbins [63]

,
8 12
2 .


. 


.

, 
, 
. . 1.11 

.


.


26

4,2
4,3
4,8
5,3
5,3
4,3


1.11.

46

,
< 2 812
> 6 10

1.12. 


,

6
7
8
9
10

. Kurjak ., 1994 [64]

P. Joupilla, 1998 [65]

33,3
85,7
85,7
78,3
61,1

3,42
3,14
3,10
3,12
3,45

75
50

0,96
0,83


. 
,

.

[64] [65]

(. 1.12).
. Kurjak . [64]



6 10 
, 

5,8 1,7 /c.
,

,
: 
, 
.
, .
Kurjak . [64], , 

P. Joupilla [65], 




.


. 

(0,91,1
/) . Kurjak . [64].
, P. Joupilla [65]

, 
5 
43,7% , 7 25%,
8 37,5%.

0,5 1,1 /.


. 10 

.

27


P. Joupilla [65]


,

, 
.
, 




.



, 
. ,
, 
. ,
I 

.


, 
. ,
I 

. ,
,
.


. 

(. 1.40).

1015 ,


.



, 
(
) ()

. .. .. 
[66] 

(6,5 ) , 


, ..
(. 1.41).
.. . [67]
1% 
. .. [68]

(),

. .. .. 
[66] ,

100% . 
, , 

, 
, , 6,5
, 
. 
,
,
, 

[69, 70]. , 
, 
[70, 71].

[72].

. 1.40.
1011 .
.

28

. 1.41. 
[66].

. 1.42. 9 .
.

.. .. [66]


:

, 
, 
. 
Trophacan
:
,

. , 

.

,

hyperante retroflexio. 
,

[73],
, 


. ,
, 

,
.





100% (.
1.42). 

, ,

.  


.

1. .., .. 


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// 
V C 

I 


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66. .., ..
// . . .
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67. .., ..,
.. ()
I
// 
.
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68. .. 
. , 
, // . . 1996. 2. . 58.
69. .. 
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70. .. . . .:
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.., .. .: 
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32


1016

..


//

II III


. 
1 1000 
[1]. 



.


11 , 
(.
2.1). 
, 
1011
[2].


, ,

. ,


, II III 
. ,
R. Goldstein . [3] 
, 
12 

, 
26 
. 
S. Rottem . [4]
9

, 11 

spina bifida. K. Kennedy . [5]
10 
,
,
. 14 

33

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Ornoy [6] , 


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[811].
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,

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;
[8].

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. 


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, . Cullen . [12],
622
1013
/

.
1014 ,
6861 , 7 

I [13, 14].

,
7 
. 1014 
53 435 
901 [15].

47 , 3
,
.

1014 39 
, 
II
8. ,

34 830 1014 
23 (74%)
31 .



,
20 407

16 .


1 10 000 

, 


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.
, 

.

II III 




(. 2.1).


.

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. 

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III 
.


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Z. Toth . [16] 1986 . (. 2.2).



11 
. 12 

36

1016
2.1.

; ,



;

;


III

, 
,
16 

, 

18
.
,
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I
II . M. Bronshtein
Z. Wiener [18]


.

H.G. Blaas
. [30],
9 (.
2.5, 2.6). , 
U. Gembruch . [23],
2.2. 


.


Z. Toth ., 1986 [16]
16


D. Nyberg ., 1987 [17]
14

M. Bronshtein, Z. Wiener, 1991 [18]
14
F. GonzalesGomes ., 1992 [19]
10
.
L. Nelson, M. King, 1992 [20]
10 5

E. Sakala, K. Gaio, 1993 [21]
13

R. Achiron, A. Achiron, 1995 [22]
10 4
(. 2.7).
U. Gembruch ., 1995 [23]
13 3

R. van ZalenSprock ., 1995 [24]
12 1
O. Parant ., 1997 [25]
14

B. Thilaganathan ., 1997 [26]
11

C. Turner ., 1999 [27]
10

H. Wong ., 1999 [28]
10 3
,
H. Wong ., 1999 [29]
13

10
13

H.G. Blaas ., 2000 [30]
9 2
(, , 
T.H. Lai ., 2000 [31]
16
), 

37

. 2.7. 12 . .

. 2.5. 9 2 . 
[30].

. 2.6. . [30].

. 2.8. . (
); 
( 
).


(. 2.8).
. 2.2


, 



38

1016
. , L. Hernadi M. Torocsik [32]

3991 1114 18
20
, 
.
, 

2097 14
2022 , 
14 , 
2022 [33].
1214 ,

1632 
,
I [34].



() (
). 75%

, 
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).
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bifida,
[35].


.
, 

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. , R. van
ZalenSprock . [36], 


,
9 .


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1112 
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8 9 
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A. Pachi . [38]


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. 2.9. 1112 .
.
[11].

13
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W. Sepulveda . [39] 

4 9
1113
. 
R. van
ZalenSprock . [36] 
5
1114
3
.





, 
1214 
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J. Braithwaite [34] 
,
c
1632 , 
1213 .

, 

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() () [40].

. 1114


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41

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1820


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[23, 33, 46, 47]. 
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14

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. [23] 

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3991 1114 18
20 L. Hernadi
M. Torocsik [32]

. 
1473 

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[13]. G. DOttavio . [33]
2114
14


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Lin . [48]
12 .



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 .

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Y. Lam M. Tang [49] 
11

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;
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) [49].

. 2.15. 28 . .


() [49].



, 
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P. Ammala R. Salonen [50].
26 
18 
. 


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.


. 14
.
.
Spina bifida
Spina bifida 
, 

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43

. 2.16. 16 .
Spina bifida ().

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.


()
(), 

(. 2.17) [52]. 
,

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1% .


. ,
, 

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Z. Blumenfeld . [53] 

spina bifida 
. 
10 

;


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spina bifida 
. 

4 1000 
.
0,5 1000, 

[51]. 

spina bifida
.


spina
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. 
16 




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spina bifida 


 . 2.17. 13 . Spina bifida. (
, ); (U 
U Y ) [52].

44

1016

. 2.18. () 9 0 (
22 ) spina bifida (). 9 1 ( 22 ); 9 4 ( 24 ); 9 4
( 28 ). [55].

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(, )
. [55].

12 ; 15

. N. Sebire .
[54]
3  spina
bifida 1214 .

spina
bifida H. Blaas . [55].
3
9 1 9 4



7,5 (. 2.18, 2.19).

45


2228 .
L. Hernadi M. Torocsik [32] 

3991 1114 1820
6
spina bifida,

, 5

. 
1214 (1632
) 1014 (1473 )
spina bifida
[13, 34].




1112 ,



, 
.


.


,
(,
.)
, 
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,

,

. G. DOttavio
. [33] 
2114 14 

1 3
. 

,
, 

. , .. [56]
1112 
.
, 


,

2
3

. 2.20. .

().

. 2.21. 15 . 
 . 1 ; 2
3 ; 4 [57].

46

1016

. 2.22. 12 .

[58].

(.
2.21). M. Bronshtein . [57]

3000 1416 

7 . 
2022 
.
, , 
, 

.


.



. ,
R. Ibba . [58] 12 

.

(. 2.22).
L. De Catte . [59] 

(
) 1415 
. C

( 9 , 

. 2.23. 1415 . 
. 
; 
[59].

4 )

(. 2.23).


. I. Gull . [60]

15 
.

47

. 2.24. 13 4 . 
().

. 2.25. 1516 . 
().

,
, 

, .


. 


. 


. 
1 200
3 [61].


(. 2.24). 

.

0,5 5 . 


[35, 62]. , 

,

(40100%) 
(092%) [63, 64].


, 
, 
. , 

II 
, 
, . 
.. [65], G. Azar . [66]

75% .


(. 2.25).



. 


.
,

.

48

1016



510 1000 
. 


20
.





12 
. 


16 
. G. DeVore . [67]

,
14
.


, 


(. 2.3).



U. Gembruch . [70]. 



11 4 .

( 62 1 )

12 [69].



M. Bronshtein
. [72].

1991 . I 





.

4000 1216
21
13 .

,
12 4 .
U. Gembruch . [73] 

1116
13 114 
. 


3
(. 2.26, 2.27). 8

, 
.
, 
, 



. 



12 4 ,

21 2 .


12 

..
[96]. 

. 

49

. 2.26. 14 . 
. 

[73].




,
(. 2.28).


, 
, 
,


3,4 (. 2.29).
M. Rustico . [76] 14


.

: 
;

, 
; 
2 ; 
.



.




.



. 
, 

II III 
. , M. Bronshtein E.
Zimmer [83],
16
1416 , 4 7 ,

,
.






.


, 
,



[2].





,

. , M.
Cullen . [100] 
622


33 .

.

13 . 
,

50

1016

. 2.28. . 

.

. 2.27. 12 1 .
. (

(); 

;
, 0,5 [73].

. 2.29. .
; .
.


.



10 13 ,

22 .

51

2.3. 1017 
( [68])

.. ., 1989 [69]
U. Gembruch ., 1990 [70]

12
1112

T. Bennett ., 1991 [71]


M. Bronshtein ., 1991 [72]

12
1216

U. Gembruch ., 1993 [73]

1114

W. Sepulveda ., 1994 [74]


M. Cullen ., 1995 [75]
G. DOttavio ., 1995 [33]

M. Rustico ., 1995 [76]

12
13
14
14
14
14

M. Rustico ., 1995 [77]

14

E. Tegnander ., 1995 [78]

16
16
17
15
17
17
16
11
12
13
14

,
,


, , ,
, , ,
,
,
, , , , 
,

,

,
+

, ,


,
, ,
,

, , ,
, , , +
, +,

,
+



+

R. van ZalenSprock .,1995 [79]


L. Allan ., 1996 [80]

U. Gembruch ., 1996 [81]

15

L. Hornberger ., 1996 [82]


M. Bronshtein, E. Zimmer,1997 [83]
R. Chaoui ., 1997 [84]
J. Hyett ., 1997 [85]

R. Liang ., 1997 [86]


J. Areias ., 1998 [87]
M. Bronshtein, E. Zimmer, 1998 [88]
W. Henrich ., 1998 [89]
Y. Lam ., 1998 [90]
A. Matias ., 1998 [91]

16
16
1416
17
15
16
16
10
12
13
1416
14
12
12

52

1016
2.3

V. Bognoni ., 1999 [92]

1112

.. , 1999 [93]

1213

M. Guschmann ., 1999 [94]


Y. Lam, M. Tang, 1999 [95]

.. , 2000 [96]
J. Martinez ., 2000 [97]

13
13
14
13
14
12
1316

B. Puerto ., 2000 [98]


A. Yamasaki ., 2000 [99]

14
15


,
, +,
, +, +,
+
+
+

. ; 
; ; ;
; ; ;
; ; ; 
; ; .

R. Achiron O. Tadmor
[101]

913 .
13 

, 12 

.

20 
. G.
DOttavio . [33] 
14 

(6 15),

2022 .
, 



,
53,857% 
[72, 81],
II III 
30,7% [102].





.
,



1314 . 




.

53




() 

. 

. 

, ,

. 
, 

.
1 2400 [103].



. 


.


22 ,
.

M. Bocian .

[104]. 14
, 
. Y. Lam . [90]



( 
) 12 
(. 2.30).


,
. , E. Jauniaux 
. [105] ,

. 2.30. 12 .
. 1 
; 2 [90].

. 2.31. 12 3 .
; 
.
(*); [105].

54

1016
12

5

10 9 9 (. 2.31).

, 
.


20 

. 
. 

.
5 .




1
30006000 [106, 107].

. 

.

,

, 7 4116 
[108]. 70% 

, 
.




,

(. 2.32,
2.33).

. 
.

I 
[69, 109, 110],
II 
. 
,
1012 
[111].

13
W. Schmidt F. Kubli [112] 1982
.

. 2.32. 1415 . 
. 1 ; 2
.

. 2.33. 1415 . 
. .

55

. 2.34. 1213 . 1 ;
2 .

. 2.35. 12 .
[117].

18. M.
Pagliano . [109]
, 
, 10 . 


1213 (. 2.34) [69].
R. van ZalenSprock . [111] 
14

1114 .
, 

100% 
, 
18, 

.
R. Snijders . [113] 
15 726
1014 
18 ,
11
18 13. 
12
14 (1632 ) 1014 (1473
) 4 ( 2
)
[13, 34].

) 
.
,
. 
0,94 
10 000 [114]. 
20
7 10 000 .




.
, ,

.


12,4
[115].
II 
, (1012 )


.


(




, 
. 
1
14 000 [116].

56

1016

106 727 
1014 
14 

[117].

,
(. 2.35).






. 

1 4500 [118].



, 
. 

1618 (. 2.36).



.
12
13 . 

.


,

. 2.36. 18 .
.



. ,


6973% [119, 120]. 


,

.



, 

[121123].


.
,

1317 
. , M. Bronshtein . [124]

14
5 .

14 
. 2 

, 
1617 . M.
Valenzano . [125] 

16 ,
, 

, 
.

57




()


. 
, 

12 . 1,35,9
1000 [126].


, 
. 

,

.
II 
, 

.

,
I II 
, 
II III
.
15 4

. 2.37. 14 .
.
,
[129].


[127]. 
. 19 4 ,

, 
. 
12

, 

28 [128].
.. [129] 
14 .



,

(. 2.37). 
: 21 19 20 ,
23 20 22 .
.




.



. 



,
.

, ,
,
.

.

.
, , 
.


58

1016

. 2.39. 15 . 
; .

. 2.38.
12 () 16 () 
[132].


. , L. Hernadi
M. Torocsik [32] 
3991 11
14 1820 3
,

: 
1820 ,
31 .


.
M. Bronshtein . [130] 
12
.

. 2.40. 11 6 . 
[147].


1632
1214 [13].
Prune&belly

0,06%
. 

59

2.4. Prunebelly

M. Bulic .,
1987 [135]
A. Drugan .,
1989 [136]
R. Stiller,
1989 [137]
. Ragno .,
1991 [138]
J. Odita,
1992 [139]
T. Shimizu .,
1992 [140]
S. Freid .,
1995 [141]
.. .,
1995 [142]
R. MacMahon .,
1995 [143]

14

12,5

35 ,

13



,
,


15

14

34 ,

11

15

13
15
15
14

14

M. Yoshida .,
1995 [144]
E. Cazorla .,
1997 [145]
T. Hoshino .,
1998 [146]
.. ,
.. ,
1999 [147]
.. ,
2000 [148]

14
13
13
12


8 [131].



( 
, ),
. 
, N. Sebire . [131],
7 15 , 
1014 , 


. 5 


37 ,
31 ,

34 ,
36 ,
38 ,



3 , 2

. 3 

.
.. . [132]
,
12 

. 
4 

.

60

1016

(. 2.38).
Prunebelly
: 
, 

. prune
belly 1
35 00050 000 [133].

Prunebelly

,

. 
.

.
Prunebelly
II 
[134]. 



, 
(.
2.39).
16 
Prunebelly
16 (. 2.4).
,
. 2.4, 5 16 
,


.
.. .. 
[147]

Prunebelly. 
11 6

18 ( 2.40).



1011

, 
I
II

. 

, 

(. 2.5).






, 
. ,

,





.

. BenAmi .
[157].
14

5,8 ,
5
,
. 

22

5 
,
(
).




61

. 2.41. 14 . . ; 
. [166].

. 2.42. 16 . . ;
().


. 


. , T. Tongsong
S. Pongsatha [166] 
14 
10 ,

9 , 8 
, 
,
(. 2.41).
. 

, 
, .

62

1016
2.5.


,

N. Fisk .,
1991 [149]
M. Bronshtein,
Z. Weiner, 1992 [150]

11

II

14

II

13
13
10
12

II


II

12

14

16
14


II

12

12

13




5 ,

,
,

12

G. DOttavio
., 1997 [161]
B. Petrikovsky
., 1997 [162]
L. Hill, J. Leary,
1998 [163]

1315

11

13

N. Den Hollander
., 1998 [164]
S. Gabrielli
., 1999 [165]

17
13


IV

13

15

M. Valenzano
., 1999 [125]

16

T. Tongsong,
S. Pongsatha,
2000 [166]
T. Tongsong
., 2000 [167]

14

16

M. Dimaio .,
1993 [151]
L. Otano .,
1993 [152]
. Soothill .,
1993 [153]
R. Ajayi .,
1995 [154]
K. Leung .,
1995 [155]
..
., 1996 [156]
. BenAmi
., 1997 [157]
S. Eliyahu .,
1997 [158]
J. Hyett .,
1997 [159]
L. Hernadi,
., 1997 [32]
N. den Hollander
., 1997 [160]

,

, 


,

,
,


,
,
,
,
,
,

,


,

,



,
,

,

. ; c
.

63

. 2.43. 17 .
. , 
.


,

. 
, 
.


16 17 .
16 

: 12
13 , 10 , 
9 , 8 9
, 6 7 , 6 7
(. 2.42). , 
, 

.

. 20 

.

II . 
17 

: 
,
(. 2.43),


.
, 
.





. , 
()
1317 6 
, 3 
, 9 
, 2 , 2
1 
.

1.
2.

3.

4.

5.

6.

7.

8.


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diagnosis of the Pena Shokeir phenotype at 14
weeks of pregnancy // Prenat. Diagn. 1995. V.
15. P. 762764.
155.Leung K.Y., MacLachlan N.A., Sepulveda W.
Prenatal diagnosis of ectrodactyly: the lobster
claw anomaly // Ultrasound Obstet. Gynecol.
1995. V. 6. P. 443446.
156. .., .., 
.. .
II 
//
. . 1996. 4. . 5861.
157.BenAmi M., Perlitz Y., Haddad S., Matilsky
M. Increased nuchal translucency is associated
with asphyxiating thoracic dysplasia //
Ultrasound Obstet. Gynecol. 1997. V. 10. P.

71

297298.
158.Eliyahu S., Weiner E., Lahav D., Shalev E.
Early sonographic diagnosis of JarchoLevin
syndrome: a prospective screening program in
one family // Ultrasound Obstet. Gynecol.
1997. V. 9. P. 314318.
159.Hyett J., Noble P., Sebire N.J. et al. Lethal
congenital arthrogryposis presents with
increased nuchal translucency at 1014 weeks
of gestation // Ultrasound Obstet. Gynecol.
1997. V. 9. P. 310313.
160.Den Hollander N.S., van der Harten H.J.,
VermeijKeers C. et al. First trimester diagnosis
of blomstrand lethal osteochondrodysplasia /
/ Am. J. Med. Genet. 1997. V. 73. P. 345350.
161.DOttavio G., Meir Y.J., Rustico M.A. et al.
Screening for fetal anomalies by ultrasound at
14 and 21 weeks // Ultrasound Obstet.
Gynecol. 1997. V. 10. 6. P. 375380.
162.Petrikovsky B.M., Gross B., Bialer M. et al.
Prenatal diagnosis of pseudothalidomide
syndrome in consecutive pregnancies of a
consanguineous couple // Ultrasound Obstet.

Gynecol. 1997. V. 10. P. 425428.


163.Hill L.M., Leary J. Transvaginal sonographic
diagnosis of shortrib polydactyly dysplasia at
13 weeks gestation // Prenat. Diagn. 1998. V.
18. 11. P. 11981201.
164.Den Hollander N.S., van der Harten H.J.,
Laudy J.A. et al. Early transvaginal
ultrasonographic diagnosis of BeemerLanger
dysplasia: a report of two cases // Ultrasound
Obstet. Gynecol. 1998. V. 11. 4. P. 298302.
165.Gabrielli S., Falco P., Pilu G. et al. Can
transvaginal fetal biometry be considered a
useful tool for early detection of skeletal
dysplasias in highrisk patients? // Ultrasound
Obstet. Gynecol. 1999. V. 13. P. 107111.
166.Tongsong T., Pongsatha S. Early prenatal
sonographic diagnosis of congenital
hypophosphatasia // Ultrasound Obstet.
Gynecol. 2000. V. 15. 3. P. 252255.
167.Tongsong T., Sirichotiyakul S., Chanprapaph
P. Prenatal diagnosis of thrombocytopenia
absentradius syndrome // Ultrasound Obstet.
Gynecol. 2000. V. 15. 3. P. 256258.

72



.. , .. , ..

90

, I 
. 


,


.
nuchal
oedema ( ), nuchal fluid
( ), nuchal fluid
accumulation ( 
), nuchal fold ( 
), simple hygroma ( ),
nuchal thickening ( ) .
. 

,
1994 . , 
.


K. Nicolaides 
nuchal translucency
( , ),


.
1995 . 
, 
[1], 

, ,
, 
[2].
,


. 43


1014
[3].



() ,

73

. 3.1. 10 3 . 2,2 .


,
(. 3.1). ,
,
, 
, 
:
1) 1014

 45
84 .
2) 
.



. 
,
95100% (.
3.1).
,
.
B. Whitlow D. Economides [20]
,
10 13
, 

100, 98, 98 98% .
14
90%.
(58 66%),
L. Kornman . [9] S.
Bewley . [6], ,

10 .
1014 
94%
[19]. (6%),
,
, 
1011 .

3.1. 

P. Pandya ., 1995 [4]


J. Szabo ., 1995 [5]
S. Bewley ., 1995 [6]
S. Bower ., 1995 [7]
J. Braithwaite ., 1996 [8]
L. Kornman ., 1996 [9]
R. Zimmerman ., 1996 [10]
R. Kadir, D. Economides, 1997 [11]
P. Taipale ., 1997 [12]
B. Thilaganathan ., 1997 [13]
E. Hafner ., 1998 [14]
E. Pajkrt ., 1998 [15]
P. Theodoropoulos ., 1998 [16]
R. Maymon ., 1999 [17]
M. Muller ., 2000 [18]
.. , M.. , 2001 [19]

1014
912
813
814
1013
813
1013
1013
1016
1014
1014
1014
1014
1014
1014
1014


, %
100
100
66
100
100
58
100
100
99
91
100
96
100
100
96
94

74

,


?
1. 
.


2/3
(.
3.2). A. Herman . [21], 

(p < 0,02).
2. .


, 
(. 3.3). I.

Chatzipapas . [22] ,

0,62 (
0,530,70 )

, 0,40
(0,340,47 ).
, 


. I. De Graaf .
[23], 85 10
14 ,
1,91 ,
1,93 (
).

. 3.2. 11 1 . 

;
. 1,4 .

. 3.3.
. 
; ;
.

75

. 3.4. () ()
.

3. .


, 


(. 3.4). A.
Herman . [24],

0,95
0,14 , 

, 
23 .
4. 
.
,
, 



.

.


.


.
M. Schaefer . [25]
8,23% 
(26 316 ),
0,8 .
, 



.



, 
,

, ,

. ,

, 
. 

, 


. , 1
,
23 ,


,

(. 3.2).
P. Pandya . [26]

1014 .
4 
, 1200
. 
, 
, 
, 

0,27 , , 

, 0,31 . , 


76


3.2. 

P. Pandya ., 1995 [26]


J. Braithwaite ., 1996 [8]
L. Kornman ., 1996 [9]
A. Herman ., 1998 [21]
A. Herman ., 2000 [24]
E. Pajkrt ., 2000 [27]

0,27
0,31
0,40, 0,24
0,40
0,28 0,34
0,36



0,58

0,95
0,90, 0,94
0,35

0,44

. ; .

,
0,22 . 95%

0,54
, 0,62 . 
, , 
, 


,
.
,
,


, 

[8].
, 

1013
94%
,
93%, 
100% .

0,40 
0,24 
. 
, ,

, (80 
100 

) 


. 
, ,

, 


100 
.

,

.
, 
A. Herman . [24],
, 
. 


 . 
P. Pandya . [26], 


.



, 

.


77



. E. Pajkrt .
[28],
, , 



50 86%
(!). , 
.



,


.



. 

,
, 
0,41 6,4% (. 3.3).

, 
,
1,95
6,4% [37, 38].



, 
,
.
, ,

.

3.3. 

K. Nicolaides ., 1992 [29]


M. SchutleValentin, 1992 [30]
B. Brambati ., 1994 [31]
. Comas ., 1994 [32]
L. Ovari ., 1994 [33]
E. Pajkrt ., 1994 [34]
J. Duyos, 1994 [35]
S. Bewley ., 1995 [6]
S. Bower ., 1995 [7]
P. Pandya ., 1995 [4]
J. Szabo ., 1995 [5]
R. Zimmerman ., 1996 [10]
P. Taipale ., 1997 [12]
A. Josefsson ., 1998 [36]
E. Hafner ., 1998 [14]
.. ., 2000 [37]
.. ., 2000 [38]
R. Maymon ., 2000 [39]
M. Muller ., 2000 [18]
E. Pajkrt ., 2000 [40]

1014
1014
1012
913
1014
1015
1013
813
814
1014
912
1013
1016
1014
1014
1013
1014
1014
1014
1014

, %

>2,5
>3,0
>3,0
>3,0
>3,0
>3,0
>3,0
>3,0
>3,0
>2,5
>3,0
>3,0
>3,0
>4,0
>2,5
>2,5
>3,0
>95
>95
>95

78

6,0
1,4
3,8
1,5
0,5
2,2
1,1
6
2,0
3,6
2,4
2,1
0,8
0,41
1,7
1,95
6,4
4,6
1,4
6,1






.
,


E. Pajkrt [34] M. Muller [18]. 
(>3,0
)


(2,2 1,4%).
E. Pajkrt
. [40]
3 (6,1%).
90




3 , 
. ,
Fetal Medicine Foundation
First Trimester Screening Group 
, 

I 
100
000 ,

. ,



.


. 

95 
[3].

S. Yagel . [41] 

: 95
>3,0 .
,

(85,7%),

87,9 94,6% .
, 



.

1014
1,2 1,9 [42].

, 

,

[19].

3.4. (5, 50 95 )


[19]

10 0 10 6
11 0 11 6
12 0 12 6
13 0 13 6

,
5

50

95

0,8
0,8
0,7
0,7

1,5
1,6
1,6
1,7

2,2
2,4
2,5
2,7

79

3,5
3,0

95

2,5
2,0

50

1,5

1,0
0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

 ,
. 3.5. . Fetal Medicine Foundation First Trimester Screening
Group [3]; .. , .. [19].

2000 .

, , 
, 
(. 3.4) [19].
, 
Fetal
Medicine Foundation First Trimester Screening
Group ( 
) (. 3.5).

, 
B. Thilaganathan . [43].

(1944 ), 



. 

.
, 
,
,






.




(11 ) (12

) 
1993 . (. 3.6). 


80



. 


. 

,
,
21.

, 

. 
,

:


.
, 


,
.
1995

369 
. 


:

[1]. ,
2000 . 
1983
, 
29,6%
(. 3.5).

(50,5%).
23,9%
,
9,9% 4,9%.

10,8% .
90

: 

. 

. 3.6. 12 . 11 (
) .

P. Pandya . [57], 3

7% , 4 27%, 5
53%, 6 49%, 7 83%,
8 70 %, 9 78%. 

: 3 4 

18%, 4 5 19%, 5 6 29%,
6 7 82%, 7 8 100%,
8 9 67%, 9 100% [60].
2000 .

,
.
7
,
4
, 

:

, (.. , ..
, .. , .. 
, .. );

, (.. ,
.. , .. , .. 
, .. , .. 
);

27,

, 

81

3.5. 

J. Szabo, J. Gellen,
1990 [44]
M. SchutleVallentin,
H. Schindler,
1992 [45]
L. Shulman
., 1992 [46]
Y. Ville .,
1992 [47]
R. Wilson .,
1992 [48]
R. van ZalenSprock
.,1999 [49]
M. Johnson
., 1993 [50]
B. Hewitt, 1993 [51]
A. Nadel .,
1993 [52]
G. Savoldelli
., 1993 [53]
K. Nicolaides
., 1992 [29]
P. Trauffer
., 1994 [54]
C. Comas
., 1995 [55]
E. Hafner
., 1995 [56]
P. Pandya
., 1995 [57]
J. Szabo
., 1995 [5]
G. DOttavio
., 1997 [58]
J. Martinez
., 1998 [59]
A. Graneras
., 2000 [60]

, 2000

21

18 13 45,

>3,0

7 (88%)

>4,0

7 (88%)

>2,5

32

15 (47%)

>3,0

29

8 (28%)

>3,0

14

3 (21%)

>4,0

18

6 (28%)

>2,0

68

41 (60%)

16

>2,0
>4,0

29
63

12 (41%)
43 (68%)

5
15

3
15

1
1

2
10

1
2

>4,0

24

19 (79%)

15

>3,0

88

33 (38%)

21

>3,0

43

21 (49%)

>3,0

51

9 (18%)

>2,5

26

8 (30%)

>3,0
>3,0

1015
96

194 (19%)
43 (45%)

101
28

51
10

13

14
2

15
3

>4,0

34

13 (38%)

>3,0

142

35 (24%)

17

>3,0

115

44 (38%)

23

14

>3,0

80

26 (32,5%)

12

140

29

58

64

1983

587 (29,6%) 296

. 21 21; 18 18; 13 13; 45, .

82


3.6.

S. Bewley ., 1995 [6]


S. Bower ., 1995 [7]
C. Comas ., 1995 [55]
P. Pandya ., 1995 [4]
J. Szabo ., 1995 [5]
L. Kornman ., 1996 [9]
R. Zimmerman ., 1996 [10]
G. DOttavio ., 1997 [58]
F. Orlandi ., 1997 [62]
P. Taipale ., 1997 [12]
B. Thilaganathan ., 1997 [13]
D. Economides ., 1998 [63]
E. Hafner ., 1998 [14]
E. Pajkrt ., 1998 [15]

813
814
913
1014
912
813
1013
1315
914
1016
1014
1114
1014
1014

(.. , .. , ..
);
, 
(.. , .. , .. 
, .. ).


80 
( 3 10 ). 

23,842,9%
32,5%, 

(29,6%).


: 
34,6%,
7,7%, 11,5%. 
( 
)

. 46,2%
(
, 
, .).

>3,0
>3,0
>4,0
>2,5
>3,0
>3,0
>3,0
>4,0
>95
>3,0
>3,0
>95
>2,5
>3,0


1/3 (33%)
4/8 (50%)
4/7 (57%)
3/4 (75%)
28/31 (90%)
2/4 (50%)
2/3 (57%)
7/10 (70%)
4/7 (57%)
7/13 (54%)
5/7 (71%)
6/8 (75%)
4/7 (57%)
6/9 (67%)
83/121 (68,6%)


, 


,
, 


.




.

,
II 

[61]. , 

, ,
21 
.



83

3.7. 21  
5%

D. Krantz ., 1996 [65]


N. Wald ., 1996 [66]
E. Berry ., 1997 [67]
F. Orlandi ., 1997 [62]
J. Haddow ., 1998 [68]
D. Wheeler, M. Sinosich, 1998 [69]
I. De Graaf ., 1999 [70]
K. Spencer ., 1999 [71]
G. Tsukerman ., 1999 [72]
J. Macri, 2000 [64]
X. Navarro ., 2000 [73]

1013
814
914
914
915
912
1014
1014
813
1014
1014

,

.
, 
,

68,6%
21 (. 3.6).



, . 

Fetal Medicine Foundation First
Trimester Screening Group, 
306
22 .

100 311
1014 [42]. 


>95 . 

1:300. 

268 (82,2%) 326 
, 234
(71,8%) 
. 
4444
(4,4%) ,

21

, %

22
77
47
11
48
17
37
210
31
50
15

63
62
55
61
60
67
55
67
69
74
66

7907 (8,3%) 
.

13,3%.

,
17
, , , 
, 

81,8% [64].


21, 
. 
35

. 

,
, 
. ,
35 , , 
, 

. , E. Pajkrt 
. [15], 

24% ,

.
79%.

84


3.8. 21 , 

M. Brizot ., 1995 [75]


F. Orlandi ., 1997 [62]
P. De Biasio ., 1999 [76]
I. De Graaf ., 1999 [70]
K. Spencer ., 1999 [71]
C. Bach ., 2000 [77]
E. Casals ., 2000 [78]
J. Macri, 2000 [64]

1014
914
1014
1014
1014
1114
1014
1014

1473


67%
2,2%. 

1:100 
78%
8,1%.
1:300 
21 
100%, 
19,8%.


, 
,
. 
, 22,2%

,
77,8% 
, 
, .

I 




.
I

. 

21

, %

80
11
13
37
210
6
15
33

89
87
85
85
89
90
86
91


4550% [3], ,
. 

21 65% (. 3.7).

I 
.
H. Cuckle J. Van Lith [74], 


,
9 72%, 10 66%, 11 58%,
12 51% 13 46%.
,



, 
90% 21
I (. 3.8).


I 
. 

,

. 



. ,
, 

85

I 
, 

( 

) 

, 
. , 
,

.
. . 
[79], I 
109 21, 
, 6 

, 103
. 
5 6 

.
II
,

, 
,

. 21
. 6 
1 


.
, J. Hyett
. [80], , 
21


. , 3

5,3%, > 7
23,5%. ,
,


70%.



, 

,

3 4 . 

,
21 
. 
, 

.


.
.
,

.
, 
I


.

.

18
( )

(0,16/1000). 13 (
)
0,083/1000 [79].

1014
18 13 
, 
. ,
Fetal Medicine
Foundation First Trimester Screening
Group, 95
74,8% 
71,7%
[3]. , C. Comas [55],

>3 , 66,7%
, F. Orlandi
. [62] 82%.

86



N. Tul . [81] K. Spencer . [82],

18 13.
K. Spencer . [82], 42 
13 
(>95 ) 
62% . N. Tul . [81]
50
18 95 
78% .


,
, 7 , 
21 (5,9 ) [60].
, 18 13


. . Pandya
. [57] 3 1014 

64 

15,6% , 4 12,5%, 5
15,6%, 5 56,3%.

18 13 
,

.
, 

. K.
Nicolaides . [3], 18 
 

. 
5,9 
(.
3.7). ,
(18,8%)
.
200

100
190
90
180

, /

80

 ,

70

60

50

40
30

20
70

75

80

85

90

95

100

,
. 3.7. 
18 [3].

170

160
150
140

130

120
110
38

48

58

68

78

 ,
. 3.8.
13 [3].

87

. 3.9. 1213 . 7,5 () 7,7 () 


.


13 
, .

, K.
Nicolaides . [3], ,
18 3,1

. 
:
68,8% (. 3.8).

18 13 
. 

. 
3 .

1213 (7,5
7,7 )



(. 3.9) [83].
(
18) .




 
.
N. Tul . [81], 

18 89%, F. Orlandi
. [62] 100%. 13 

90% [82].



1014 
, 
, CATCH 22
10.

,


. 
2%. 

, 

[79]. Fetal Medicine
Foundation First Trimester Screening Group,
(59,4%)
1014
95
[3].



, ,
, 

( 

88


200
100
190
90
180

, /

80

 ,

70

60

50

40
30

20
70

75

80

85

90

95

100

170

160
150
140

130

120
110
38

48

58

68

78

 ,

. 3.10. 
[3].

. 3.11.
[3].

) [3].
 
8,5 

(. 3.10). 

(35,7%).
. Spencer . [84],


( , ) 
90% 

.

I 

.

I. De Graaf . [85].
36 

9 6 . 


. 12

 .
2,2 .  
. 13 2
 
5 (50 ),
5 . 



. 

(69,) 
.
.. . [86]

7

89

1 11 4 . 
(3 )

10 6 . 5
6 , 



.


,
.
II

[8789]. 

, Fetal Medicine Foundation First
Trimester Screening Group, 87%
[3]. 

. 
N. Sebire . [90] 

87,9%.

, 

. 

1,8 [3]. I 


53,1% (. 3.11).



3 .



(. 3.12).


(47, XXY) 47,
, 47 XYY, 
0,17% [91].


N. Sebire . [90].
40% 

95 .

,
, CATCH 22
10 [92, 93]. CATCH 22

[ (),
(), 
(), ()], 
(H) 22.
M. Lazanakis . [92]

. 
12 
.
CATCH 22


. 3.12. 12 . (6 ) 
();
.

90



.
P. Schwarzler . [93]
10
I . 
(5 ) 12 , 


, 

, 

. 
,

.



.
, 


. 




. 


I 
, 

.

, 


, 

.

, 



,
.


1. .., .. 

// . .
. . . 1995. 1. . 1321.
2. 
. . 2 / .
.., .. .: , 1996.
3. Nicolaides K.H., Sebire N.J., Snijders J.M. The
1114week scan. The diagnosis of fetal abnor
malities. NY, L.: Tte Parthenon Publ. Gr., 1999.
4. Pandya P.P., Goldberg H., Walton B. et al. The
implementation of firsttrimester scanning at
1013 weeks gestation and measurement of fetal
nuchal translucency thickness in two maternity
units // Ultrasound Obstet. Gynecol. 1995. V.
5. P. 2025.
5. Szabo J., Gellen J., Szemere G. Firsttrimester
ultrassound screening for fetal aneuploides in
women over 35 and under 35 years of age //
Ultrasound Obstet. Gynecol. 1995. V. 5. P.
161163.
6. Bewley S., Roberts L.J., Mackinson M., Rodeck
C. First trimester fetal nuchal translucency:
problems with screening the general population
// Br. J. Obstet. Gynaecol. 1995. V. 102. P. 386
388.
7. Bower S., Chitty L., Bewley S. et al. First
trimester nuchal translucency screening of the
general population: data from three centres
// 27 th British Congress of Obstetrics and
Gynaecology. Dublin, 1995.
8. Braithwaite J.M., Kadir R.A., Pepera T.A. et al.
Nuchal translucency measurement: training of
potential examiners // Ultrasound Obstet.
Gynecol. 1996. V. 8. 3. P. 192195.
9. Kornman L.H., Morssink L.P., Beekhuis J.R.
et al. Nuchal translucency cannot be used as a
screening test for chromosomal abnormalities
in the first trimester of pregnany in a routine
ultrasound setting // Prenat. Diagn. 1996. V. 16.
P. 797805.
10. Zimmerman R., Hucha A., Salvoldelli G. et al.
Serum parameters and nuchal translucency in
first trimester screening for fetal chromosomal
abnormalities // Br. J. Obstet. Gynaecol. 1996.
V. 103. P. 10091014.
11. Kadir R.A., Economides D.L. The effect of
nuchal translucency measurement on second

91

trimester biochemical screening for Downs


syndrome // Ultrasound Obstet. Gynecol. 1997.
V. 9. 4. P. 244247.
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I 
// . . 1996. 1. . 43
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1. P. 6770.

96

.. , ..


, 


,
.


. 

1014

, ,


, 
.

,
303 (5,9%) 5168 


(. 4.1).
, 

.
A. Souka . [20]

3,4 

2,4% , 3,5 4,4


7,1%, 4,5 5,4 12,3%, 5,5
6,4 16,7%, 6,5
35,6% . 





.



. 

, 35,5%
14 ,
50,9% 
13,6% 

[24]. , 2/3



.
, 


, 

97

4.1. 
1014

Y. Ville .,
1992 [1]

> 3,0

61

10

R. van ZalenSprock
., 1992 [2]
B. Hewitt, 1993 [3]
M. Johnson .,
1993[4]
A.Nadel .,
1993[5]

> 3,0

13

> 3,0
> 2,0

10
32

1
5

> 4,0

16

P. Pandya .,
1994 [6]
L. Shulman .,
1994[7]
D. Salvesen, O. Goble,
1995 [8]
B. Hewitt .,
1996 [9]
M. Moselhi,
B.Thilaganathan,
1996 [10]
F. ShaBan .,
1996 [11]
L. Hernadi,
M. Torocsik, 1997 [12]
G. DOttavio .,
1997 [13]
C. Reynders .,
1997 [14]
B. Thilaganathan
., 1997 [15]

> 4,0

177

22

> 2,5

32

(1)

> 3,0

(1), (1)

> 3,0

44

> 4,0

(1), (1),
(1)
(2), spina bifida (1)

> 3,0

28

> 3,0

17

> 4,0

21

> 3,0

35

> 4,0

30

10

C. Bilardo .,
1998 [16]

> 3,0

47

11

Y. Fukada .,
1998 [17]
E. Hafner .,
1998 [18]

> 5,0

> 2,5

72

> 3,0

21

E. Pajkrt .,
1998 [19]


(1),
(3), (1), (1),
(2),
(2)
(1), (1),
(1)
(1)
(1), (1),
(1), (2)
(1),
(1), (1), 
(1),  
 (1)

(1), (1)

(1), (1),
Joubert (1)
(1), spina bifida (1),
(2), (1), (1),
(1), (1), 
(2)
(1), (1),
(2), 
  (1),
(1), (1),
(1), GM1 (1),
(1), (1)
(1), (1)
(1),
(2), (1), 
(1), (1), TorielloCarey (1)
(1)

98

A. Souka .,
1998 [20]

> 3,0

4116

J. Van Vugt .,
1998 [21]

> 3,0

63

46

270

25

R. Maymon .,
> 95
2000 [22]

> 3,0
E. Pajkrt .,
2000 [23]

161

. 
[20]
( 306 , 


1014 , 22 
), 


47,8%
, 6,2% 
,
7,5% 
, 38,5% .




,

I 
(. 4.2).


(5), (4),
(6), (1), 
(1), (1),
(2), (1),
(1), (1),
(43), (8), 
(7), (1),
(2), (1),
(5), (4), 
(2), (8), spina bifida (4), 
(1), (10), 
(1), (15),
(6),  (2),
Joubert (1), NanceSweency (1),
(1), (3), 
(1),
(1), (1), 
VACTERL (2), (6)
(1), 
(1), (2), 
(1), 
(1), (1), 
(1)
(4), 
(1)


,

58,3
92% ( 87,6%) .


,


.
. Bilardo . [16], 



32%, 

7,5%,
. C E. Pajkrt
. [23] 40 4,0% .
, 

99

4.2. 
[24]

M. Johnson ., 1993 [4]


P. Trauffer ., 1994 [25]
P. Pandya ., 1995 [26]
J. Szabo ., 1995 [27]
N. Sebire ., 1996 [28]
L. Hernadi, M. Torocsik, 1997 [12]
C. Reynders ., 1997 [14]
. Bilardo ., 1998 [16]
J. Van Vugt ., 1998 [21]

3 (11,5%)
6 (31,6%)
44 (8%)
5 (41,7%)
1 (25%)
5 (35,7%)
7 (20,6%)
15 (31,9%)
11 (17,5%)
97 (12,4%)

23 (88,5%)
13 (68,4%)
520 (92%)
7 (58,3%)
3 (75%)
9 (64,3%)
27 (79,4%)
32 (68,1%)
52 (82,5%)
686 (87,6%)

. 


, 

, 

.

, 


, . 4.4.



(. 4.3).


, 
, 


,


, 80%

4.3.
( [24])

P. Pandya ., 1995 [26]


J. Hyett ., 1996 [29]
A. Souka ., 1998 [20]

46

>7

3,3%
5,3%
3,7%

20,7%
8,8%
11,5%

64,3%
23,5%
55,6%

4.4. ,







( I)

100






1995 .
[3033].


112 
, 

1014 .
, 
21 
,
18 
/
, 
13 
, 
,
, 

. 

56%
. 
10% 
3
75% 4 .





.

, , 
,

. 



.

J. Hyett . [34], 
1389

1014 (. 4.5).
, 

17,3 1000 ,
2 
. , 


.





. ,
, U. Gembruch 
. [35] R. Achiron . [36], 16
(80%) 20 

.




[37].

4.5. 
104 


[34]
(> 95 )


1000
( 
,


2,53,4
1102
5,4
)
3,54,4
188
26,6
.
4,55,4
56
53,6
>5,5
43
232,6


1389
17,3

101

4.6.
[40]


> 95




, ,

9 (18%)
3 (6%)
8 (16%)
10 (20%)
8 (16%)
12 (24%)
50 (100%)


1014

. P. Schwarzler
. [38] 4523 
, 9


2,5 .
,



1618 .

: 
,
[39]. ,


, 

.



,

,
(. 4.6).
J. Hyett . [40], 


(> 95 ) 

> 99

2 (22%)
2 (67%)
4 (50%)
10 (100%)
4 (50%)
6 (50%)
28 (56%)


56,0%, 93,8% 

1,5%, 99,9%.
, 



. ,

30% 
, 

2024

1014 

.


1 2400 
. 

:
A. Souka . [20], 
8 4116 .


.


[41].



102

2 (22%)
1 (33%)
3 (38%)
8 (80%)
1 (13%)
5 (42%)
20 (40%)


,
, 37% [41].
37%
1014 
,

[42]. , 83%
, 


, 
.
D. Bulas . [43] 
Fryn 

12 
. 
, 1
15 000 
,

, 
. 16 


,
. 
. 20

,
, 
, 
. 24
. 34 
, 
. 

Fryn :
, , 
, , 
.


1 4000

,

. ,

. 

I 

, 

.
A. Souka . [20]


7 4116 , 
R. van ZalenSprock . [44]
14 
1114 . 8 14 

3,5 10 . 
,
,
18 13.



( , ,
,
, 
),
I ,

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. I.
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67. .., .. 

. .: , 1997.
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111

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1. ..
//
/ .
.., ., .. .:
, , 1999. . 714.
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on first trimester Doppler // Ultrasound Obstet.
Gynecol. 1999. V. 14. 3. P. 159160.
3. Fay R.A., Ellwood D.A., Bruce S., Turner A.
Color Doppler imaging of the uteroplacental
circulation in the middle trimester: observations
on the development of a low resistance

circulation // Ultrasound Obstet. Gynecol.


1994. V. 4. 5. P. 391395.
4. Predanic M., Zudenigo D., Funduk Kurjak B.
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5. van Zalen Sprock .., van Vugt J.M.G.,
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8. .., ..
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.., ., .. .:
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121

should we offer karyotypin? // Ultrasound


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15. .., ..,
.., ..
:

// . . . .
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//
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.., ., .. .:
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.

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380.
31. ..


: . .
. . ., 1999.
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122



..


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de novo, 

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J. Mohr N. Hahnemann 
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[5, 6].


1975
. 

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73% , 

4% [7].




.
19751979 .
, 
S. Rhine,



3,5 [8]. 
, 
,

2649% , 

 .



.
1981 M. Niazi .
,


124


[9].

R.Williamson
,

(, 
 ,
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[11].
, 80
, 
, 

.


. ,



1979 ! 11


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1979

[1214].
80
,

, 
, 
. 1983 .
R. Wald


, 

[15].
: 



80% ,

.

. Brambati,
[16].

II 


,
. 1984

S. SmithJensen
N. Hahnemann, 


.

1,2 ,
0,7 
. 

910 
84,5% [17].


.
80 XX

, 

I
. 1983
, 
, 1991 

I
100 000 [18]. 



.

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125


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126






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.

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. 
, . Brambati, 
1991 . 
90% 30,6
( 10 5,0%) [21]. 7 ,

91% 
31,2 .
( 10 ) 
13,2% [22]. M. Ahoda . 
93,2% 
[23]. 
(), 

(1998 ), 

94,9% [24]. 7

()
27 ()
,

, 

86,1%.
,

. , 

,


.






, 

.


7080

,

127

.

I 
[25],



.
, 
, 
1,9
25 , 
. Rodeck . [25] 1983 .



. ,
, 
, 
98%. 
. 
, 
,
, 1,6%,

[26].

,
,
, 
. 

,


, , 
, 
.


( ) 


80
.

, 


.

. 

.


. 
,

.
, 

,

.


2,0 0,5% 
.


,
. ,


,


.

, 
, ,
.


, 


.
.

S. SmidtJensen N. Hahnemann 
[17].

, (
) 
,

128


. 
, 
. 


,
,
.
:

.

. 

,
.

, 
.


. 
, 

20 18 G


. 

20 , 

. 



, .

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( ).


.

, 

.



. ,

, ,

. 
, S. Smidt
Jensen N. Hahnemann
1988
100% 
28 [27]. ,
3 ,

. L. Bovicelli .
[28], 
,
99,7% , 
97%, 2,8%, 
0,2% . 
1015 . 
( 5 )
9,4% .
(1159 
), 
B. Brambati 1988 , 
0,3%
,
24 [29].
K. Nicolaides . [30], 
99,3%. 
[24], 




99% .
, 99,4%.

.
,

.
, 
23 .

80 
() ,

129



,
. 
, 

.

, II
. ,
,
.
. 


.

, II 
, 
. 
( 6.1).
90 
12
15 1
, 2025%

710 [40]. 1970 . Emery
, 

,
, 12
15
9899% [41].


,
90

810 , 
11% 12 
3 .


,

. , 
. Cederholm . Axelsson

85,7% [42].


. 
. 

23 , 
7 17
96,5%
, 2
[30, 31, 3537, 4245]. 

, , 
.
, , 

13,6% [46].


6.1.
n

,
%

,
%

541
222
407
106
300
1805
879
731
349
314
412

25
217
1215
1215
1520
1215
1215
1215
1215
1215
7

0
0
1,7
0
1,7
0,5

2,5
0,6
1,0
2,2

3,6
1,4
2,3
1,8
2,2
4,0
2,9
5,3
1,8
2,2
3,8

F. Hanson ., 1987 [31]


J. Nevin ., 1990 [19]
C. Penso ., 1990 [32]
G. Hackett ., 1991 [33]
B. Assell ., 1992 [34]
G. Henry, W. Miller, 1992 [35]
F. Hanson ., 1992 [36]
K. Nicolaides ., 1994 [30]
J. Johnson ., 1996 [37]
C. Brumfield ., 1996 [38]
S. Tharmaratnam ., 1998 [39]

130



9798% 
99,5% [35].


1112% [42]. 




[43], 
.




.



12
.
c
1954 
J. Westin [47]. ,
,

.


.




, 


,
. 



.



.



,

. , 1995
. Dommergues . [48]

. 


. 

1011 
. 1987
Y.Ville . [49]
, 
, , , 
8
13 . D. Subrek . [50]


, 
. ,
I 
, 
.






.


, 
. 



. 



. 
,
2 3,5 , 
1,7 . 
.

131




.

[50]. 

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0,70,8 .


,
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; 

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9
12 , 
,
.



,

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. [50] 3 14 
, 
I
. 
25 27 G.
, 

. 

,

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,

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.

1997 Y. Ville . [49] 


, 

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I 
.


5 13 . 

: 75 100%.

412% ,

, , 
.
, 
, 
, 
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, 

( 
),
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42 

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13 23 .
31
.

I 

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35%
. 


. ,


.
,


132


,
, 
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[52], 
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.
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, 

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, .


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.



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[53], 
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,


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. [54], 1214
4,8%,


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35 ;

133


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(1522 )
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22 0,72 ), 0,73
(0,72 ), 1,90

(2,01 ),  2,69
(2,22 ), 
1,28 (1,31 ) [56].



.
 (
, 
pregnancy associated plasma protein A),

, 90
, , I 

 . 
,

I
6065% .
9 13 

1,48 4,71 ,  
, I 
. 
( 2,15 ),  
0,43 .
 
: 68
0,35 , 911 0,40 , 1214
0,62 . 
 0,43 ,
 2,06
. ,
D. Wheeler . [57] 66,6%
5%
72,7% 

,
1,2% 
. 
68,8%.
, 
I

  ,

.

N. Wald . Macintosh 

134


1998 , 
 I 
60% 5%
[58, 59].

. Spencer . [60]
. Cuckle J. Lith [61],
1999 . 


. 
, .
Cuckle J. Lith [61], 
44
(. 6.2, 6.3, 6.4). 

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(29%)



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"
"

+ "
+ "
+
+ " + "
+ + "
++ "
+ + " + "

33%
38%
64%
46%
48%
73%
67%
81%
82%
89%

6.3. [61]

90%
85%
80%
75%
70%

" + "

+
"

+
"

+
" +
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23%
16%
11%
8%
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3%
2,2%

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4%
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1,5%

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1%

. 6.4 6.5 .

135




+
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"
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4

41,8%
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70,1%
72,7%

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(
) 

[24]. 10
I

(34%), 
(15,5%).


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[61]

9
10
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13

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53,9

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56,1

89,1
86,8
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79,5

89,7
87,6
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[62].
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137


(11 )



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(9 ) 

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B. Brambati . [22], 
10 000 I
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9%. , 93,7% 
I 
914
6,3% [24].


?
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)


. 

chorion
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1991 H. Firth . 

, . 
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1,8 1000 
,
1 1000 [65, 66].
,


,



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9 [67]. ,
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, 
,
. 

. 



,
, 

[68].

138


1999
,



[69].

216 380
, 
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8 
6.6.

() [69]

"

(. 6.6).
,

10 000
, 


8
3 415
4
11,7

9
18 442
9
4,9

10
39 028
15
3,8
11
32 528
11
3,4
I 
12
13 170
3
2,3

106383
42*
1/2533


1/1642
911 .
: * 42 71,3% "
, 11,3% , 17,4% .




, 

. 

. 

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RW , 

.


, 
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(
), 
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(
).




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139



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, 
20 28
. 


(total losses), 
. , 




. , 
, 


,
.
, 
2
,
, 30 
,

,
46%,
18%, 4% [24].
, 

(12
) ,
, 
. 

B. Brambati . [21]:

140

S.Smidt"Jensen
. [27]
L. Bovicelli
. [28]
B.Brambati
. [29]
M. Ahoda
. [23]
B.Brambati
. [21]
S. Smith"Jensen
. [70]
Canadian
Collaborative
Study [71]
B. Brambati
. [22]
M. Cederholm
. [42]
K. Niolaides
. [30]
A. Daniel
. [45]
H. Nagel
. [43]
S. Tharmaratnam
. [39]
..
. [44]
, [24]

[25]

2,4

3,1
0,4
6,1

10,4
6,5
5,4

6,5

3,8

4,6

2,7

3,2

1,5
6,8

6,8

2,4

1,7

4,8

4,0

3,9

1,2

0,4

2,6

3,3

7,0

5,6

5,6

"

, %

2,7

3,2

, %

1,3

2,3

0,2

1,9

0,8

2,6

13,2

31,2

2,5

6,0

4,0

2,6

5,4

, %

6,8

14,8

9,0

5,7

1,6

3,0

19,0

37,6

0,3

, %

5,2

5,2

0,2

0,04

0,3

0,3

13,8%,
1,0%, + 6,1%

5,1%


4,7%, 5,3%
2,6"4,7%

+ 3,5%

+ 3,8%
+ 6,4%
6,2%
10,1%
6,2%
8,7%

, %

6.7. ,

141

6.8.
,
[21]

17
814
1530
30

6,9%
13,8%
27,6%
51,7%

2,9%
0%
28,8%
68,6%

20,7%

;
2,9% (. 6.8).


,

. W. Holzgreve
P. Miny ,
(12%) 

6% 

[72]. 

.
B. Brambati . [22],
10 000 ,

0,14% .


.
,

4,5% (8 176 
), 1,3% 
(4 302 ) [24].
, 

, 
, , 


. 

, 


.


.

,  


.
, 
, 
, 

, (. 6.9).



,
,
.
[21, 22], 

3,0 3,5%.


,
.
[22], 


8 9,2%,
9 12
4,7%. ,
, 

, 
.
,
.
B.Brambati . [22], 

30 1,22%, 30
34 2,27%, 35 2,7%. 
M. Ahoda . [23] 
35 
3,1%, 35 6,1%.

4,14,5%.

142


6.9.

B.Brambati
. [29]
. Ahoda
. [23]
.Brambati
. [21]
S.Smith"Jensen
. [70]
. Brambati
. [22]
S. Tharmaratnam
. [39]

" "


"
"
" "
, % , %

,
%

6,1

0,8

"
,
%

0,4

"

,
%

"
"
"
"
,%
"
, %

0,4

5,2

4,6

5,1

0,8

0,5

4,7

4,0

1,9

1,6

5,2

5,3
0,6
2,6

0,8 ()


,

, , 10

. 
,

, , 


. 
S. SmithJensen
. [70] 1991 . (. 6.10).
,


,
.
,

I .

(14%) 
10
, ,
,
.

4,8

8,1

7,1

0,4

0,35
0,3 ()

0,34
0,3 ()



. 


.
[70] , 

(. 6.11).

.
, ,
, 
, 

. 
,

6.10.
[70]
,

0"10
11"20
21"30
31"40
40

3,8%
4,2%
4,1%
4,0%

14,0%
6,3%
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.

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, 

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