{"id":73432,"date":"2025-06-20T11:57:50","date_gmt":"2025-06-20T08:57:50","guid":{"rendered":"https:\/\/synevo.md\/?post_type=product&#038;p=73432"},"modified":"2025-06-24T09:30:59","modified_gmt":"2025-06-24T06:30:59","slug":"calcul-de-risc-prenatal-extins-trimestru-i","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/calcul-de-risc-prenatal-extins-trimestru-i\/","title":{"rendered":"Calcul de risc prenatal extins &#8211; trimestru I"},"content":{"rendered":"<div class=\"info-content content-informatii-generale\">\n<h2><strong>Informa\u0163ii generale: Calcul de risc prenatal extins \u2013 trimestru I<\/strong><\/h2>\n<p>\u00cen ultimii 20 de ani, aten\u021bia programelor de screening prenatal s-a concentrat pe dezvoltarea unor investiga\u0163ii neinvazive care sa evalueze riscul unei femei gravide de a da na\u015ftere unui copil cu anomalii. Riscul de sindrom Down a fost cel mai mult studiat, screening-ul prenatal fiind recomandat initial doar \u00een cazul femeilor \u00eens\u0103rcinate cu v\u00e2rst\u0103 \u226535 ani, \u00eens\u0103 \u00een ultimii ani speciali\u015ftii \u00een medicin\u0103 materno-fetal\u0103 sus\u0163in faptul ca aceasta op\u0163iune de screening trebuie oferita, printr-o informare corecta, tuturor femeilor gravide1;3.<\/p>\n<p><a href=\"https:\/\/www.synevo.ro\/evenimente\/preeclampsia-abordare-sarcina-riscuri\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\">Preeclampsia<\/a> este o tulburare hipertensiv\u0103 specific\u0103 sarcinii, cu complica\u021bii grave care contribuie la cresterea riscului de morbiditate matern\u0103 \u0219i fetal\u0103 \u0219i afecteaz\u0103 de obicei 2%-8% dintre femeile \u00eens\u0103rcinate. \u00cen plus, prevalen\u021ba preeclampsiei \u0219i a afec\u021biunilor \u00eenrudite (restric\u021bia cre\u0219terii fetale \u0219i na\u0219terea prematur\u0103) este mult mai mare dec\u00e2t cea a <a href=\"https:\/\/www.synevo.ro\/sindromul-down-si-analizele-indicate-unei-gravide\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\">sindromului Down<\/a> cat \u0219i fa\u021b\u0103 de prevalen\u021ba combinat\u0103 a tuturor aneuploidiilor. Prin urmare, este important s\u0103 fie diagnosticat\u0103 precoce astfel \u00eenc\u00e2t s\u0103 permita instituirea m\u0103surilor adecvate pentru a diminua suferin\u021ba materno-fetal\u0103.<\/p>\n<p>Ca instrumente de screening prenatal au fost sugerate mai multe combina\u0163ii diferite de markeri biochimici \u015fi biofizici de prim trimestru. Cei mai utiliza\u021bi markeri biofizici sunt tensiunea arterial\u0103 medie (MAP) care e necesar a fi masurat\u0103 de dou\u0103 ori la bra\u021bul drept \u0219i de dou\u0103 ori la bra\u021bul st\u00e2ng \u0219i indicele de pulsatilitate al arterei uterine (UTPi), \u00een timp ce, cei mai promi\u021b\u0103tori markeri biochimici sunt: <a href=\"https:\/\/www.synevo.ro\/shop\/papp-a-proteina-plasmatica-asociata-sarcinii\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\">PAPP-A,<\/a> <a href=\"https:\/\/www.synevo.ro\/shop\/free-beta-hcg\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\">free beta-HCG<\/a> si <a href=\"https:\/\/www.synevo.ro\/shop\/factorul-de-crestere-placentar-plgf\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\">PlGF<\/a>.<\/p>\n<h2><strong>Calculul de risc prenatal extins include:<\/strong><\/h2>\n<ul>\n<li>determinarea markerilor serici <strong>PAPP-A, free beta-HCG si PlGF<\/strong>;<\/li>\n<li>calculul MoM (multiplu de mediana) pentru fiecare marker (se \u00eemparte valoarea ob\u0163inut\u0103 la mediana corespunz\u0103toare v\u00e2rstei gesta\u0163ionale);<\/li>\n<li>corectarea MoM \u00een func\u0163ie de covariabilele materne;<\/li>\n<li>riscul biochimic de sindrom Down la na\u015ftere (calculat pe baza MoM corectat pentru fiecare dintre cei doi markeri \u015fi a varstei materne la na\u015ftere);<\/li>\n<li>riscul de trisomie 18 la na\u015ftere (calculat pe baza MoM corectat pentru fiecare dintre cei doi markeri \u015fi a v\u00e2rstei materne la na\u015ftere);<\/li>\n<li>riscul de trisomie 13 la na\u015ftere (calculat pe baza MoM corectat pentru fiecare dintre cei doi markeri \u015fi a varstei materne la na\u015ftere);<\/li>\n<li>calculul MoM pentru translucen\u0163a nucal\u0103;<\/li>\n<li>vizualizarea sau non-vizualizarea osului nazal la examenul ecografic este de asemenea inclus\u0103 \u00een algoritmul de calcul de risc prenatal;<\/li>\n<li>riscul combinat de sindrom Down (risc biochimic + parametri ecografici);<\/li>\n<li>risc pentru alte aneuploidii fetale (sindrom Turner, triploidie) \u00een cazul in care medicul trimi\u0163ator\/pacienta informeaz\u0103 laboratorul despre existen\u0163a unei sarcini anterioare cu un anumit tip de anomalie cromozomial\u0103;<\/li>\n<li>calcularea MoM corectat\u0103 pentru fiecare parametru seric \u015fi a riscurilor de aneuploidii fetale la na\u015ftere este efectuata de programul LifeCycle versiunea 7.0.<\/li>\n<\/ul>\n<p><strong>Markerii serici<\/strong><\/p>\n<p><a href=\"https:\/\/www.synevo.ro\/shop\/papp-a-proteina-plasmatica-asociata-sarcinii\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\"><strong>PAPP-A <\/strong><\/a>(proteina plasmatica asociata sarcinii) este o glicoproteina derivata din placenta. In timpul sarcinii este produsa in cantitate mare de catre trofoblast \u015fi eliberata in circula\u0163ia materna. Nivelurile serice ale acestei proteine cresc odata cu varsta gesta\u0163ionala, cel mai pregnant in ultima parte a sarcinii. Studii recente au demonstrat ca scaderea concentra\u0163iei PAPP-A (MoM&lt;0.4) in cursul sarcinii este asociata cu anomalii cromozomiale ale fatului: trisomie 21, 18, 13, sindrom Turner, triploidie de origine paterna (scadere u\u015foara), triploidie de origine materna (scadere marcata), restrictie de crestere uterina, greutate mica la nastere, nastere prematura, preeclampsie.<\/p>\n<p><strong><a href=\"https:\/\/www.synevo.ro\/shop\/free-beta-hcg\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\">Free beta-HCG<\/a> <\/strong>\u2013 subunitatea beta libera a HCG \u2013 este considerat un marker mai relevant pentru trimestrul I de sarcin\u0103 decat molecula de HCG. Nivelurile de free beta-HCG crescute (MoM&gt;2) la o gravida sunt asociate cu prezenta sindromului Down la fat. Valorile sunt de asemenea mult crescute in triploidia de origine paterna. In sindromul Turner nivelul de free beta-HCG este normal.<\/p>\n<p>In prezen\u0163a trisomiei 18 sau 13 precum \u015fi a triploidiei de origine materna concentra\u0163iile de free beta-HCG sunt considerabil scazute. Pentru a ob\u0163ine o standardizare atat pentru varsta gesta\u0163ionala cat \u015fi pentru diferen\u0163ele sistematice intre popula\u0163ii, laboratoare \u015fi metode de lucru, valorile ob\u0163inute la markerii serici vor fi exprimate ca MoMs (multipli de mediana). MoM pentru un marker se ob\u0163ine prin impar\u0163irea valorii masurate la mediana corespunzatoare varstei gesta\u0163ionale la care s-a efectuat determinarea, specifica atat popula\u0163iei din care face parte persoana testata cat \u015fi metodei de lucru utilizata in laborator<sup>4;5<\/sup>.<\/p>\n<p><a href=\"https:\/\/www.synevo.ro\/shop\/factorul-de-crestere-placentar-plgf\/\" data-wpel-link=\"internal\" rel=\"nofollow noopener\" target=\"_blank\"><strong>PlGF <\/strong><\/a>este un biomarker util atat pentru predictia riscului de aparitie a pre-eclampsiei cat si pentru cresterea ratei de detectie a riscului de sindrom Down in cadrul screening-ului de prim trimestru. \u00cen medie, PlGF seric este sc\u0103zut, \u00een cazul prezentei unui fat cu sindrom Down. Amploarea sc\u0103derii este mai mare \u00een primul trimestru dec\u00e2t \u00een al doilea trimestru, unde valorile PIGF se apropie de cele din sarcinile normale.<\/p>\n<p>Prin urmare, PlGF poate fi utilizat ca \u0219i biomarker suplimentar pentru sindromul Down, \u00een cadrul programelor de screening de prim trimestru, pentru identificarea sarcinilor cu risc crescut. Ad\u0103ugarea de PlGF la modelele de screening \u00eembun\u0103t\u0103\u021beste rata de detec\u021bie \u00een mod semnificativ, reduc\u00e2nd \u00een acela\u0219i timp \u0219i rata de rezultate fals pozitive. Mai multe studii clinice indic\u0103 faptul c\u0103 un PlGF seric sc\u0103zut sau \u00een scadere, este asociat cu un risc semnificativ crescut de restric\u021bie a cre\u0219terii fetale (FGR) \u0219i\/sau a na\u0219terii unui f\u0103t mort. Datele publicate indic\u0103 faptul c\u0103 nivelurile sc\u0103zute de PlGF pot fi utile pentru predic\u021bia FGR asociat cu sau \u00een locul greut\u0103\u021bii fetale estimate (estimated fetal weight \u2013 EFW) efectuat\u0103 prin ultrasonografie, sprijinind astfel deciziile medicale.<\/p>\n<p>PlGF este foarte indicativ pentru predic\u021bia mor\u021bii fetale, \u00een sarcina timpurie, \u00een combina\u021bie cu alte informa\u021bii \u0219i biomarkeri, iar performan\u021ba de predic\u021bie se \u00eembun\u0103t\u0103\u021be\u0219te pe m\u0103sur\u0103 ce sarcina progreseaz\u0103<sup>6<\/sup>. La femeile \u00eensarcinate care vor dezvolta preeclampsie, PlGF este sc\u0103zut \u00een primul trimestru, cu mult \u00eenainte ca boala s\u0103 se manifeste clinic.<\/p>\n<p>Algoritmul predictiv, realizat la <strong>11-13 s\u0103pt\u0103m\u00e2ni de gesta\u021bie<\/strong>, propus de <strong>Fetal Medicine Foundation<\/strong>, folose\u0219te o combina\u021bie de informa\u021bii materne, valoarea presiunii arteriale medii, indicele de pulsatilitate al arterei uterine \u0219i valorile serice ale biomarkerilor <strong>PAPP-A \u0219i PlGF<\/strong>. Acest algoritm detecteaz\u0103 aproximativ 95% dintre femeile cu preeclampsie cu debut precoce, cu o rat\u0103 fals-pozitivitate de 10%.<\/p>\n<p>Aplicarea algoritmilor de predic\u021bie \u00een subgrupuri specifice, cum ar fi femeile cu sindrom antifosfolipidic \u0219i lupus eritematos sistemic, poate avea un succes \u0219i mai mare, datorit\u0103 riscului ini\u021bial crescut de fenomene adverse ale sarcinii \u0219i importan\u021bei poten\u021biale mai mari a factorilor angiogeni \u00een patogeneza bolii, la acest grup de paciente. PlGF este utilizat \u00eempreun\u0103 cu software-ul de calcul al riscului pentru:<\/p>\n<ul>\n<li>excluderea diagnosticului de preeclampsie \u0219i predic\u021bia, pe termen scurt, a apari\u021biei preeclampsiei, asociat cu alte informa\u021bii biochimice \u0219i clinice- \u00een trimestrul II \u0219i III de sarcin\u0103.<\/li>\n<li>screening pentru evaluarea riscului de sindrom Down \u2013 \u00een primul trimestru de sarcin\u0103.<\/li>\n<\/ul>\n<p><strong>Estimarea v\u00e2rstei gesta\u0163ionale<\/strong><\/p>\n<p>Este efectuata de catre programul LifeCycle 7.0 pe baza valorii CRL (Crown Rump Length) \u015fi este exprimata in saptamani + zile; data ultimei menstrua\u0163ii este introdusa de asemenea in program, insa in cazul unei discrepan\u0163e intre varsta gesta\u0163ionala calculata pe baza CRL \u015fi cea determinata pe baza ultimei menstrua\u0163ii este luata in considerare cea stabilita pe baza masuratorii ecografice<sup>5<\/sup>.<\/p>\n<p><strong>Datele materne V\u00e2rsta matern\u0103<\/strong><\/p>\n<p>Riscul pentru trisomiile fetale (13, 18, 21) cre\u015fte odata cu varsta mamei. Riscul ini\u0163ial (\u201eprior risk\u201d sau \u201eage risk\u201d) pentru o anomalie fetala se refera la prevalen\u0163a la na\u015ftere a defectului respectiv, specifica unei anumite varste materne; riscul este calculat pe baza unei formule ce ia in considerare prevalen\u0163ele specifice varstei in diferite popula\u0163ii. De men\u0163ionat ca riscul de sindrom Turner \u015fi triploidie nu se modifica odata cu varsta mamei.<\/p>\n<p><strong>Sarcini anterioare afectate de aneuploidii fetale<\/strong><\/p>\n<p>Riscul pentru apari\u021bia unei trisomii la o sarcin\u0103, al unei femei care a avut in antecedente un fat sau un copil cu trisomie este mai mare decat riscul dat de varsta. Daca anomalia detectata la o sarcina anterioara a aparut de novo (ca urmare a unei non- disjunc\u0163ii meiotice), riscul dat de varsta este ajustat cu un factor aditiv configurabil. Riscul este mult mai mare in cazul in care anomalia fetala a fost mo\u015ftenita; deoarece riscul este strans corelat cu modul de transmitere, programul LifeCycle 7.0 nu poate furniza o estimare a riscului in acest caz<sup>4;5<\/sup>.<\/p>\n<p><strong>Covariabile materne<\/strong><\/p>\n<p>Fiecare MoM va fi corectat pentru fiecare dintre covariabilele prezentate mai jos. Valoarea MoM va fi impar\u0163ita la un factor egal cu mediana MoM pentru sarcinile neafectate asociata cu covariabila respectiva. Aceste ajustari presupun ca efectul covariabilei asupra nivelului marker-ului nu este diferit in sarcinile afectate comparativ cu cele neafectate.<\/p>\n<p><strong>Greutatea materna<\/strong><\/p>\n<p>Concentra\u0163ia markerilor serici este influen\u0163ata de greutatea materna. Femeile cu o greutate mai mare au un volum sanguin crescut, care dilueaza concentra\u0163ia anali\u0163ilor. Greutatea materna este folosita pentru a ajusta matematic concentra\u0163ia markerilor la diferen\u0163ele in volumul sanguin. Factorul de corec\u0163ie este specific unei anumite popula\u0163ii deoarece depinde de distribu\u0163ia greuta\u0163ii intr-o popula\u0163ie.<\/p>\n<p><strong>Diabetul zaharat insulino-dependent<\/strong><\/p>\n<p>Influen\u0163eaza valorile markerilor serici, de aceea programul face o ajustare corespunzatoare a MoM.<\/p>\n<p><strong>\u043a\u0443\u0440\u0435\u043d\u0438\u0435<\/strong><\/p>\n<p>Influen\u0163eaza concentra\u0163ia markerilor serici (cel mai mult reduce nivelul PAPP-A) \u015fi poate afecta performan\u0163a screening-ului. Din acest motiv, programul ajusteaza MoM in func\u0163ie de statusul fumatoare\/nefumatoare.<\/p>\n<p><strong>Originea etnica (rasa)<\/strong><\/p>\n<p>Exista varia\u0163ii ale medianelor pentru unul sau mai mul\u0163i markeri serici in func\u0163ie de grupul etnic la care apar\u0163ine mama, de aceea programul va \u0163ine cont de aceasta informa\u0163ie.<\/p>\n<p><strong>Reproducerea asistata<\/strong><\/p>\n<p>Studiile au aratat ca nivelul markerilor serici este modificat in sarcinile ob\u0163inute prin reproducere asistata. Din acest motiv este necesar ca medicul trimi\u0163ator sa furnizeze date cu privire la procedura aplicata: fertilizare in vitro (IVF), transferul intrafalopian al zigotului (ZIFT), transferul intrafalopian al gametului (GIFT), injectarea intracitoplasmatica a spermatozoizilor (ICSI) etc.<\/p>\n<p>De asemenea va fi precizata <strong>data extrac\u0163iei \u015fi data transferului ovulului<\/strong><sup>5<\/sup>. Riscul final este estimat de catre programul LifeCycle 7.0 din riscul ini\u0163ial \u015fi valorile markerilor serici pe baza unui model gaussian standard sau a unui model log gaussian.<\/p>\n<p><strong>Parametrii ecografici<\/strong> <strong>Translucen\u0163a nucala (NT) <\/strong>este definita ca grosimea maxima a spa\u0163iului subcutanat creat in mod normal in zona cervicala a fatului, zon\u0103 unde se produce o acumulare tranzitorie de lichid, in saptamanile 11-14 de sarcina. In mod obisnuit, marimea translucen\u0163ei nucale estimata ecografic in plan sagital, variaza intre 0.5 si 2 mm.<\/p>\n<p>Ca si in cazul celorlal\u0163i markeri, o translucen\u0163a nucala crescuta nu reprezinta in sine o anomalie fetala, aceasta modificare putand sa apara si in sarcinile normale. Totusi s-a constatat ca prezen\u0163a aneuploidiilor fetale se asociaza cu o translucen\u0163a nucala in medie crescuta fa\u0163a de evolu\u021bia normal\u0103 a f\u0103tului corespunz\u0103tor v\u00e2rstei gesta\u021bionale.<\/p>\n<p><img decoding=\"async\" class=\"wp-image-578382\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2023\/12\/calcul-de-risc-prenatal-trimestru-1.jpg\" sizes=\"(max-width: 423px) 100vw, 423px\" srcset=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2023\/12\/calcul-de-risc-prenatal-trimestru-1.jpg 580w, https:\/\/www.synevo.ro\/wp-content\/uploads\/2023\/12\/calcul-de-risc-prenatal-trimestru-1-300x253.jpg 300w\" alt=\"Calcul de risc prenatal extins - trimestru I - Synevo\" width=\"423\" height=\"357\" \/><\/p>\n<p>Astfel, studiile efectuate au aratat ca rata de detec\u0163ie a sindromului Down bazata pe varsta materna si pe masurarea translucen\u0163ei nucale este de 72- 77%. S-a raportat o asociere a translucen\u0163ei nucale crescute si cu alte aneuploidii fetale, cum ar fi trisomia 18, trisomia 13, sindromul Turner, triploidia, precum si cu alte anomalii genetice, in special defectele cardiace congenitale. Varsta gesta\u0163ionala optima pentru masurarea NT este <strong>11 saptamani \u2013 13 saptamani + 6 zile <\/strong>(corespunzatoare unor valori <strong>CRL cuprinse intre 40 si 79 mm<\/strong>)<sup>1;4<\/sup>. Deoarece NT fetala creste odata cu CRL, este esen\u0163ial sa se ia in considerare varsta gesta\u0163ionala pentru a stabili daca valoarea NT este crescuta<sup>4;5<\/sup>.<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p data-start=\"58\" data-end=\"139\"><strong data-start=\"58\" data-end=\"139\">\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f: \u0420\u0430\u0441\u0448\u0438\u0440\u0435\u043d\u043d\u044b\u0439 \u043f\u0440\u0435\u043d\u0430\u0442\u0430\u043b\u044c\u043d\u044b\u0439 \u0440\u0438\u0441\u043a-\u043a\u0430\u043b\u044c\u043a\u0443\u043b\u044f\u0442\u043e\u0440 \u2014 \u043f\u0435\u0440\u0432\u044b\u0439 \u0442\u0440\u0438\u043c\u0435\u0441\u0442\u0440<\/strong><\/p>\n<p data-start=\"141\" data-end=\"606\">\u0417\u0430 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0438\u0435 20 \u043b\u0435\u0442 \u043f\u0440\u043e\u0433\u0440\u0430\u043c\u043c\u044b \u043f\u0440\u0435\u043d\u0430\u0442\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0441\u043a\u0440\u0438\u043d\u0438\u043d\u0433\u0430 \u0441\u043e\u0441\u0440\u0435\u0434\u043e\u0442\u043e\u0447\u0438\u043b\u0438\u0441\u044c \u043d\u0430 \u0440\u0430\u0437\u0440\u0430\u0431\u043e\u0442\u043a\u0435 \u043d\u0435\u0438\u043d\u0432\u0430\u0437\u0438\u0432\u043d\u044b\u0445 \u043c\u0435\u0442\u043e\u0434\u043e\u0432 \u043e\u0446\u0435\u043d\u043a\u0438 \u0440\u0438\u0441\u043a\u0430 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u044f \u0440\u0435\u0431\u0435\u043d\u043a\u0430 \u0441 \u0430\u043d\u043e\u043c\u0430\u043b\u0438\u044f\u043c\u0438. \u041d\u0430\u0438\u0431\u043e\u043b\u0435\u0435 \u0438\u0437\u0443\u0447\u0435\u043d\u043d\u044b\u043c \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0440\u0438\u0441\u043a \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430 \u0414\u0430\u0443\u043d\u0430. \u041f\u0435\u0440\u0432\u043e\u043d\u0430\u0447\u0430\u043b\u044c\u043d\u043e \u0441\u043a\u0440\u0438\u043d\u0438\u043d\u0433 \u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u043e\u0432\u0430\u043b\u0438 \u0442\u043e\u043b\u044c\u043a\u043e \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u044b\u043c \u0436\u0435\u043d\u0449\u0438\u043d\u0430\u043c \u0432 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0435 \u226535 \u043b\u0435\u0442, \u043e\u0434\u043d\u0430\u043a\u043e \u0432 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0438\u0435 \u0433\u043e\u0434\u044b \u0441\u043f\u0435\u0446\u0438\u0430\u043b\u0438\u0441\u0442\u044b \u0432 \u043e\u0431\u043b\u0430\u0441\u0442\u0438 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u044b \u043c\u0430\u0442\u0435\u0440\u0438 \u0438 \u043f\u043b\u043e\u0434\u0430 \u0441\u0447\u0438\u0442\u0430\u044e\u0442, \u0447\u0442\u043e \u0442\u0430\u043a\u0430\u044f \u0444\u043e\u0440\u043c\u0430 \u0441\u043a\u0440\u0438\u043d\u0438\u043d\u0433\u0430 \u0434\u043e\u043b\u0436\u043d\u0430 \u043f\u0440\u0435\u0434\u043b\u0430\u0433\u0430\u0442\u044c\u0441\u044f \u0432\u0441\u0435\u043c \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u044b\u043c \u0436\u0435\u043d\u0449\u0438\u043d\u0430\u043c \u043f\u0440\u0438 \u043d\u0430\u0434\u043b\u0435\u0436\u0430\u0449\u0435\u043c \u0438\u043d\u0444\u043e\u0440\u043c\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u0438\u00b9\u02d2\u00b3.<\/p>\n<p data-start=\"608\" data-end=\"1128\">\u041f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u044f \u2014 \u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u0434\u043b\u044f \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u0432\u043d\u043e\u0435 \u0440\u0430\u0441\u0441\u0442\u0440\u043e\u0439\u0441\u0442\u0432\u043e, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u043e\u0435 \u0441 \u0441\u0435\u0440\u044c\u0435\u0437\u043d\u044b\u043c\u0438 \u043e\u0441\u043b\u043e\u0436\u043d\u0435\u043d\u0438\u044f\u043c\u0438, \u043a\u043e\u0442\u043e\u0440\u043e\u0435 \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u0435\u0442 \u0440\u0438\u0441\u043a \u043c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u043e\u0439 \u0438 \u0444\u0435\u0442\u0430\u043b\u044c\u043d\u043e\u0439 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u0435\u043c\u043e\u0441\u0442\u0438 \u0438 \u0432\u0441\u0442\u0440\u0435\u0447\u0430\u0435\u0442\u0441\u044f \u0443 2\u20138% \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u044b\u0445. \u0420\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u043d\u043e\u0441\u0442\u044c \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0438 \u0438 \u0441\u043e\u043f\u0443\u0442\u0441\u0442\u0432\u0443\u044e\u0449\u0438\u0445 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0439 (\u043e\u0433\u0440\u0430\u043d\u0438\u0447\u0435\u043d\u0438\u0435 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\u0442\u0440\u0438\u043c\u0435\u0441\u0442\u0440\u0430. \u041d\u0430\u0438\u0431\u043e\u043b\u0435\u0435 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u043c\u044b\u0435 \u0431\u0438\u043e\u0444\u0438\u0437\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u043c\u0430\u0440\u043a\u0435\u0440\u044b \u2014 \u044d\u0442\u043e \u0441\u0440\u0435\u0434\u043d\u0435\u0435 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0435 \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u0435 (MAP), \u0438\u0437\u043c\u0435\u0440\u044f\u0435\u043c\u043e\u0435 \u0434\u0432\u0430\u0436\u0434\u044b \u043d\u0430 \u043a\u0430\u0436\u0434\u043e\u0439 \u0440\u0443\u043a\u0435, \u0438 \u0438\u043d\u0434\u0435\u043a\u0441 \u043f\u0443\u043b\u044c\u0441\u0430\u0446\u0438\u0438 \u043c\u0430\u0442\u043e\u0447\u043d\u043e\u0439 \u0430\u0440\u0442\u0435\u0440\u0438\u0438 (UTPi). \u041a \u0431\u0438\u043e\u0445\u0438\u043c\u0438\u0447\u0435\u0441\u043a\u0438\u043c \u043c\u0430\u0440\u043a\u0435\u0440\u0430\u043c \u0441 \u043d\u0430\u0438\u0431\u043e\u043b\u044c\u0448\u0438\u043c \u043f\u0440\u043e\u0433\u043d\u043e\u0441\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u043c \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435\u043c \u043e\u0442\u043d\u043e\u0441\u044f\u0442\u0441\u044f PAPP-A, \u0441\u0432\u043e\u0431\u043e\u0434\u043d\u0430\u044f \u03b2-\u0441\u0443\u0431\u044a\u0435\u0434\u0438\u043d\u0438\u0446\u0430 \u0425\u0413\u0427 \u0438 PlGF.<\/p>\n<p data-start=\"1532\" data-end=\"1587\"><strong data-start=\"1532\" data-end=\"1587\">\u0420\u0430\u0441\u0448\u0438\u0440\u0435\u043d\u043d\u044b\u0439 \u043f\u0440\u0435\u043d\u0430\u0442\u0430\u043b\u044c\u043d\u044b\u0439 \u0440\u0438\u0441\u043a-\u043a\u0430\u043b\u044c\u043a\u0443\u043b\u044f\u0442\u043e\u0440 \u0432\u043a\u043b\u044e\u0447\u0430\u0435\u0442:<\/strong><\/p>\n<ul data-start=\"1589\" data-end=\"2346\">\n<li data-start=\"1589\" data-end=\"1659\">\n<p data-start=\"1591\" data-end=\"1659\">\u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043e\u0447\u043d\u044b\u0445 \u043c\u0430\u0440\u043a\u0435\u0440\u043e\u0432 PAPP-A, \u0441\u0432\u043e\u0431\u043e\u0434\u043d\u043e\u0433\u043e \u03b2-\u0425\u0413\u0427 \u0438 PlGF;<\/p>\n<\/li>\n<li data-start=\"1660\" data-end=\"1724\">\n<p data-start=\"1662\" data-end=\"1724\">\u0440\u0430\u0441\u0447\u0435\u0442 MoM (\u043c\u0435\u0434\u0438\u0430\u043d\u043d\u044b\u0445 \u043a\u0440\u0430\u0442\u043d\u044b\u0445 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0439) \u0434\u043b\u044f \u043a\u0430\u0436\u0434\u043e\u0433\u043e \u043c\u0430\u0440\u043a\u0435\u0440\u0430;<\/p>\n<\/li>\n<li data-start=\"1725\" data-end=\"1785\">\n<p data-start=\"1727\" data-end=\"1785\">\u043a\u043e\u0440\u0440\u0435\u043a\u0442\u0438\u0440\u043e\u0432\u043a\u0430 MoM \u0432 \u0437\u0430\u0432\u0438\u0441\u0438\u043c\u043e\u0441\u0442\u0438 \u043e\u0442 \u043c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u0438\u0445 \u043a\u043e\u0432\u0430\u0440\u0438\u0430\u0442;<\/p>\n<\/li>\n<li data-start=\"1786\" data-end=\"1897\">\n<p data-start=\"1788\" data-end=\"1897\">\u0440\u0430\u0441\u0447\u0435\u0442 \u0431\u0438\u043e\u0445\u0438\u043c\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u0440\u0438\u0441\u043a\u0430 \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430 \u0414\u0430\u0443\u043d\u0430 \u043f\u0440\u0438 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u0438 (\u0441 \u0443\u0447\u0435\u0442\u043e\u043c \u0441\u043a\u043e\u0440\u0440\u0435\u043a\u0442\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0445 MoM \u0438 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430 \u043c\u0430\u0442\u0435\u0440\u0438);<\/p>\n<\/li>\n<li data-start=\"1898\" data-end=\"1945\">\n<p data-start=\"1900\" data-end=\"1945\">\u0440\u0430\u0441\u0447\u0435\u0442 \u0440\u0438\u0441\u043a\u0430 \u0442\u0440\u0438\u0441\u043e\u043c\u0438\u0438 18 \u0438 13 \u043f\u0440\u0438 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u0438;<\/p>\n<\/li>\n<li data-start=\"1946\" data-end=\"1997\">\n<p data-start=\"1948\" data-end=\"1997\">\u0440\u0430\u0441\u0447\u0435\u0442 MoM \u0434\u043b\u044f \u0432\u043e\u0440\u043e\u0442\u043d\u0438\u043a\u043e\u0432\u043e\u0433\u043e \u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0441\u0442\u0432\u0430 (NT);<\/p>\n<\/li>\n<li data-start=\"1998\" data-end=\"2068\">\n<p data-start=\"2000\" data-end=\"2068\">\u043d\u0430\u043b\u0438\u0447\u0438\u0435\/\u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435 \u043d\u043e\u0441\u043e\u0432\u043e\u0439 \u043a\u043e\u0441\u0442\u0438 \u043f\u043e \u0423\u0417\u0418 \u0442\u0430\u043a\u0436\u0435 \u0432\u043a\u043b\u044e\u0447\u0435\u043d\u043e \u0432 \u0430\u043b\u0433\u043e\u0440\u0438\u0442\u043c;<\/p>\n<\/li>\n<li data-start=\"2069\" data-end=\"2141\">\n<p data-start=\"2071\" data-end=\"2141\">\u043a\u043e\u043c\u0431\u0438\u043d\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u0440\u0438\u0441\u043a \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430 \u0414\u0430\u0443\u043d\u0430 (\u0431\u0438\u043e\u0445\u0438\u043c\u0438\u0447\u0435\u0441\u043a\u0438\u0439 + \u0423\u0417\u0418 \u043f\u0430\u0440\u0430\u043c\u0435\u0442\u0440\u044b);<\/p>\n<\/li>\n<li data-start=\"2142\" data-end=\"2285\">\n<p data-start=\"2144\" data-end=\"2285\">\u0440\u0430\u0441\u0447\u0435\u0442 \u0440\u0438\u0441\u043a\u0430 \u0434\u0440\u0443\u0433\u0438\u0445 \u0430\u043d\u0435\u0443\u043f\u043b\u043e\u0438\u0434\u0438\u0439 (\u0441\u0438\u043d\u0434\u0440\u043e\u043c \u0422\u0435\u0440\u043d\u0435\u0440\u0430, \u0442\u0440\u0438\u043f\u043b\u043e\u0438\u0434\u0438\u044f) \u043f\u0440\u0438 \u043d\u0430\u043b\u0438\u0447\u0438\u0438 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u0438 \u043e \u043f\u0440\u0435\u0434\u0448\u0435\u0441\u0442\u0432\u0443\u044e\u0449\u0435\u0439 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u0441 \u0445\u0440\u043e\u043c\u043e\u0441\u043e\u043c\u043d\u043e\u0439 \u0430\u043d\u043e\u043c\u0430\u043b\u0438\u0435\u0439;<\/p>\n<\/li>\n<li data-start=\"2286\" data-end=\"2346\">\n<p data-start=\"2288\" data-end=\"2346\">\u0432\u0441\u0435 \u0440\u0430\u0441\u0447\u0435\u0442\u044b \u043f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u044f\u0442\u0441\u044f \u0432 \u043f\u0440\u043e\u0433\u0440\u0430\u043c\u043c\u0435 LifeCycle \u0432\u0435\u0440\u0441\u0438\u044f 7.0.<\/p>\n<\/li>\n<\/ul>\n<p data-start=\"2348\" data-end=\"2372\"><strong data-start=\"2348\" data-end=\"2372\">\u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043e\u0447\u043d\u044b\u0435 \u043c\u0430\u0440\u043a\u0435\u0440\u044b<\/strong><\/p>\n<p data-start=\"2374\" data-end=\"2730\"><strong data-start=\"2374\" data-end=\"2384\">PAPP-A<\/strong> \u2014 \u0433\u043b\u0438\u043a\u043e\u043f\u0440\u043e\u0442\u0435\u0438\u043d, \u043f\u0440\u043e\u0434\u0443\u0446\u0438\u0440\u0443\u0435\u043c\u044b\u0439 \u0442\u0440\u043e\u0444\u043e\u0431\u043b\u0430\u0441\u0442\u043e\u043c \u0438 \u043f\u043e\u0441\u0442\u0443\u043f\u0430\u044e\u0449\u0438\u0439 \u0432 \u043c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u043e\u0435 \u043a\u0440\u043e\u0432\u043e\u043e\u0431\u0440\u0430\u0449\u0435\u043d\u0438\u0435. \u0415\u0433\u043e \u0443\u0440\u043e\u0432\u0435\u043d\u044c \u043f\u043e\u0432\u044b\u0448\u0430\u0435\u0442\u0441\u044f \u0441 \u0443\u0432\u0435\u043b\u0438\u0447\u0435\u043d\u0438\u0435\u043c \u0433\u0435\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u043e\u0433\u043e \u0441\u0440\u043e\u043a\u0430. \u041f\u043e\u043d\u0438\u0436\u0435\u043d\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f (MoM &lt; 0.4) \u0441\u0432\u044f\u0437\u0430\u043d\u044b \u0441 \u0442\u0440\u0438\u0441\u043e\u043c\u0438\u044f\u043c\u0438 21, 18, 13, \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u043e\u043c \u0422\u0435\u0440\u043d\u0435\u0440\u0430, \u0442\u0440\u0438\u043f\u043b\u043e\u0438\u0434\u0438\u044f\u043c\u0438, \u0437\u0430\u0434\u0435\u0440\u0436\u043a\u043e\u0439 \u0432\u043d\u0443\u0442\u0440\u0438\u0443\u0442\u0440\u043e\u0431\u043d\u043e\u0433\u043e \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f, \u043c\u0430\u043b\u044b\u043c \u0432\u0435\u0441\u043e\u043c \u043f\u0440\u0438 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u0438, \u043f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u044b\u043c\u0438 \u0440\u043e\u0434\u0430\u043c\u0438 \u0438 \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0435\u0439.<\/p>\n<p data-start=\"2732\" data-end=\"2989\"><strong data-start=\"2732\" data-end=\"2751\">\u0421\u0432\u043e\u0431\u043e\u0434\u043d\u044b\u0439 \u03b2-\u0425\u0413\u0427<\/strong> \u2014 \u0431\u043e\u043b\u0435\u0435 \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0435\u043d \u0432 \u043f\u0435\u0440\u0432\u043e\u043c \u0442\u0440\u0438\u043c\u0435\u0441\u0442\u0440\u0435, \u0447\u0435\u043c \u043f\u043e\u043b\u043d\u0430\u044f \u043c\u043e\u043b\u0435\u043a\u0443\u043b\u0430 \u0425\u0413\u0427. \u041f\u043e\u0432\u044b\u0448\u0435\u043d\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f (MoM &gt; 2) \u0443\u043a\u0430\u0437\u044b\u0432\u0430\u044e\u0442 \u043d\u0430 \u0441\u0438\u043d\u0434\u0440\u043e\u043c \u0414\u0430\u0443\u043d\u0430 \u0438 \u0442\u0440\u0438\u043f\u043b\u043e\u0438\u0434\u0438\u044e \u043e\u0442\u0446\u043e\u0432\u0441\u043a\u043e\u0433\u043e \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0436\u0434\u0435\u043d\u0438\u044f. \u041f\u0440\u0438 \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0435 \u0422\u0435\u0440\u043d\u0435\u0440\u0430 \u0443\u0440\u043e\u0432\u0435\u043d\u044c \u043e\u0431\u044b\u0447\u043d\u043e \u0432 \u043d\u043e\u0440\u043c\u0435, \u043f\u0440\u0438 \u0442\u0440\u0438\u0441\u043e\u043c\u0438\u0438 18 \u0438 13 \u2014 \u043f\u043e\u043d\u0438\u0436\u0435\u043d.<\/p>\n<p data-start=\"2991\" data-end=\"3266\"><strong data-start=\"2991\" data-end=\"2999\">PlGF<\/strong> \u2014 \u0431\u0438\u043e\u043c\u0430\u0440\u043a\u0435\u0440 \u0434\u043b\u044f \u043f\u0440\u043e\u0433\u043d\u043e\u0437\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u044f \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0438 \u0438 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044f \u0432\u044b\u044f\u0432\u043b\u044f\u0435\u043c\u043e\u0441\u0442\u0438 \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430 \u0414\u0430\u0443\u043d\u0430 \u0432 \u043f\u0435\u0440\u0432\u043e\u043c \u0442\u0440\u0438\u043c\u0435\u0441\u0442\u0440\u0435. \u0415\u0433\u043e \u0443\u0440\u043e\u0432\u0435\u043d\u044c \u043f\u043e\u043d\u0438\u0436\u0435\u043d \u043f\u0440\u0438 \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0435 \u0414\u0430\u0443\u043d\u0430 \u0438 \u0432\u043d\u0443\u0442\u0440\u0438\u0443\u0442\u0440\u043e\u0431\u043d\u043e\u0439 \u0437\u0430\u0434\u0435\u0440\u0436\u043a\u0435 \u0440\u043e\u0441\u0442\u0430. \u0414\u043e\u0431\u0430\u0432\u043b\u0435\u043d\u0438\u0435 PlGF \u043f\u043e\u0432\u044b\u0448\u0430\u0435\u0442 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u0441\u043a\u0440\u0438\u043d\u0438\u043d\u0433\u0430 \u0438 \u0441\u043d\u0438\u0436\u0430\u0435\u0442 \u043b\u043e\u0436\u043d\u043e\u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b.<\/p>\n<p data-start=\"3268\" data-end=\"3493\">PlGF \u043f\u043e\u043b\u0435\u0437\u0435\u043d \u0442\u0430\u043a\u0436\u0435 \u0434\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0440\u0438\u0441\u043a\u0430 \u0430\u043d\u0442\u0435\u043d\u0430\u0442\u0430\u043b\u044c\u043d\u043e\u0439 \u0433\u0438\u0431\u0435\u043b\u0438 \u043f\u043b\u043e\u0434\u0430, \u043e\u0441\u043e\u0431\u0435\u043d\u043d\u043e \u0432 \u0441\u043e\u0447\u0435\u0442\u0430\u043d\u0438\u0438 \u0441 \u0434\u0440\u0443\u0433\u0438\u043c\u0438 \u0431\u0438\u043e\u043c\u0430\u0440\u043a\u0435\u0440\u0430\u043c\u0438 \u0438 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u043c\u0438 \u0434\u0430\u043d\u043d\u044b\u043c\u0438. \u0412 \u043f\u0435\u0440\u0432\u043e\u043c \u0442\u0440\u0438\u043c\u0435\u0441\u0442\u0440\u0435 \u0443\u0440\u043e\u0432\u0435\u043d\u044c PlGF \u0441\u043d\u0438\u0436\u0435\u043d \u0443 \u0436\u0435\u043d\u0449\u0438\u043d, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0432\u043f\u043e\u0441\u043b\u0435\u0434\u0441\u0442\u0432\u0438\u0438 \u0440\u0430\u0437\u0432\u0438\u0432\u0430\u044e\u0442 \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u044e.<\/p>\n<p data-start=\"3495\" data-end=\"3772\"><strong data-start=\"3495\" data-end=\"3516\">\u0410\u043b\u0433\u043e\u0440\u0438\u0442\u043c \u043f\u0440\u043e\u0433\u043d\u043e\u0437\u0430<\/strong>, \u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u043e\u0432\u0430\u043d\u043d\u044b\u0439 Fetal Medicine Foundation (\u043d\u0430 11\u201313 \u043d\u0435\u0434\u0435\u043b\u0435 \u0433\u0435\u0441\u0442\u0430\u0446\u0438\u0438), \u043e\u0431\u044a\u0435\u0434\u0438\u043d\u044f\u0435\u0442 \u043c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u0438\u0435 \u0434\u0430\u043d\u043d\u044b\u0435, \u0441\u0440\u0435\u0434\u043d\u0435\u0435 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0435 \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u0435, UTPi \u0438 \u0443\u0440\u043e\u0432\u043d\u0438 PAPP-A \u0438 PlGF. \u042d\u0442\u043e\u0442 \u0430\u043b\u0433\u043e\u0440\u0438\u0442\u043c \u0432\u044b\u044f\u0432\u043b\u044f\u0435\u0442 \u0434\u043e 95% \u0441\u043b\u0443\u0447\u0430\u0435\u0432 \u0440\u0430\u043d\u043d\u0435\u0439 \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0438 \u043f\u0440\u0438 \u043b\u043e\u0436\u043d\u043e\u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0447\u0430\u0441\u0442\u043e\u0442\u0435 10%.<\/p>\n<p data-start=\"3774\" data-end=\"3803\"><strong data-start=\"3774\" data-end=\"3803\">\u041e\u0446\u0435\u043d\u043a\u0430 \u0441\u0440\u043e\u043a\u0430 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438<\/strong><\/p>\n<p data-start=\"3805\" data-end=\"4016\">\u041f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u0438\u0442\u0441\u044f \u043f\u0440\u043e\u0433\u0440\u0430\u043c\u043c\u043e\u0439 LifeCycle 7.0 \u043f\u043e \u0438\u0437\u043c\u0435\u0440\u0435\u043d\u0438\u044e CRL (\u043a\u043e\u043f\u0447\u0438\u043a\u043e-\u0442\u0435\u043c\u0435\u043d\u043d\u043e\u0439 \u0440\u0430\u0437\u043c\u0435\u0440), \u0432\u044b\u0440\u0430\u0436\u0430\u0435\u0442\u0441\u044f \u0432 \u043d\u0435\u0434\u0435\u043b\u044f\u0445 + \u0434\u043d\u044f\u0445. \u0422\u0430\u043a\u0436\u0435 \u0443\u0447\u0438\u0442\u044b\u0432\u0430\u0435\u0442\u0441\u044f \u0434\u0430\u0442\u0430 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0435\u0439 \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u0438, \u043e\u0434\u043d\u0430\u043a\u043e \u0432 \u0441\u043b\u0443\u0447\u0430\u0435 \u0440\u0430\u0441\u0445\u043e\u0436\u0434\u0435\u043d\u0438\u0439 \u043f\u0440\u0435\u0434\u043f\u043e\u0447\u0442\u0435\u043d\u0438\u0435 \u043e\u0442\u0434\u0430\u0435\u0442\u0441\u044f CRL.<\/p>\n<p data-start=\"4018\" data-end=\"4229\"><strong data-start=\"4018\" data-end=\"4040\">\u041c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u0438\u0435 \u0434\u0430\u043d\u043d\u044b\u0435<\/strong><br data-start=\"4040\" data-end=\"4043\" \/>\u0412\u043e\u0437\u0440\u0430\u0441\u0442: \u0440\u0438\u0441\u043a \u0442\u0440\u0438\u0441\u043e\u043c\u0438\u0439 (13, 18, 21) \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430\u0435\u0442 \u0441 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u043e\u043c \u043c\u0430\u0442\u0435\u0440\u0438. \u0411\u0430\u0437\u043e\u0432\u044b\u0439 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u043d\u043e\u0439 \u0440\u0438\u0441\u043a \u0440\u0430\u0441\u0441\u0447\u0438\u0442\u044b\u0432\u0430\u0435\u0442\u0441\u044f \u043d\u0430 \u043e\u0441\u043d\u043e\u0432\u0435 \u0434\u0430\u043d\u043d\u044b\u0445 \u043f\u043e\u043f\u0443\u043b\u044f\u0446\u0438\u0439. \u0421\u0438\u043d\u0434\u0440\u043e\u043c \u0422\u0435\u0440\u043d\u0435\u0440\u0430 \u0438 \u0442\u0440\u0438\u043f\u043b\u043e\u0438\u0434\u0438\u044f \u043d\u0435 \u0437\u0430\u0432\u0438\u0441\u044f\u0442 \u043e\u0442 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430.<\/p>\n<p data-start=\"4231\" data-end=\"4406\"><strong data-start=\"4231\" data-end=\"4274\">\u041f\u0440\u0435\u0434\u044b\u0434\u0443\u0449\u0438\u0435 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u0441 \u0430\u043d\u0435\u0443\u043f\u043b\u043e\u0438\u0434\u0438\u0435\u0439:<\/strong> \u0440\u0438\u0441\u043a \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u0435\u0442\u0441\u044f, \u043e\u0441\u043e\u0431\u0435\u043d\u043d\u043e \u0435\u0441\u043b\u0438 \u043c\u0443\u0442\u0430\u0446\u0438\u044f \u0443\u043d\u0430\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0430, \u043d\u043e \u0435\u0441\u043b\u0438 \u0432\u043e\u0437\u043d\u0438\u043a\u043b\u0430 de novo, \u0440\u0438\u0441\u043a \u043a\u043e\u0440\u0440\u0435\u043a\u0442\u0438\u0440\u0443\u0435\u0442\u0441\u044f \u0434\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u043c \u043a\u043e\u044d\u0444\u0444\u0438\u0446\u0438\u0435\u043d\u0442\u043e\u043c.<\/p>\n<p data-start=\"4408\" data-end=\"4436\"><strong data-start=\"4408\" data-end=\"4434\">\u041c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u0438\u0435 \u043a\u043e\u0432\u0430\u0440\u0438\u0430\u0442\u044b:<\/strong><\/p>\n<ul data-start=\"4437\" data-end=\"4851\">\n<li data-start=\"4437\" data-end=\"4533\">\n<p data-start=\"4439\" data-end=\"4533\"><strong data-start=\"4439\" data-end=\"4453\">\u0412\u0435\u0441 \u043c\u0430\u0442\u0435\u0440\u0438<\/strong> \u2014 \u0432\u043b\u0438\u044f\u0435\u0442 \u043d\u0430 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044e \u043c\u0430\u0440\u043a\u0435\u0440\u043e\u0432 (\u0438\u0437-\u0437\u0430 \u0440\u0430\u0437\u0431\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u0432 \u0431\u043e\u043b\u044c\u0448\u0435\u043c \u043e\u0431\u044a\u0435\u043c\u0435 \u043a\u0440\u043e\u0432\u0438).<\/p>\n<\/li>\n<li data-start=\"4534\" data-end=\"4600\">\n<p data-start=\"4536\" data-end=\"4600\"><strong data-start=\"4536\" data-end=\"4564\">\u0418\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0437\u0430\u0432\u0438\u0441\u0438\u043c\u044b\u0439 \u0434\u0438\u0430\u0431\u0435\u0442<\/strong> \u2014 \u0442\u0440\u0435\u0431\u0443\u0435\u0442 \u043a\u043e\u0440\u0440\u0435\u043a\u0442\u0438\u0440\u043e\u0432\u043a\u0438 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0439.<\/p>\n<\/li>\n<li data-start=\"4601\" data-end=\"4642\">\n<p data-start=\"4603\" data-end=\"4642\"><strong data-start=\"4603\" data-end=\"4614\">\u041a\u0443\u0440\u0435\u043d\u0438\u0435<\/strong> \u2014 \u0441\u043d\u0438\u0436\u0430\u0435\u0442 \u0443\u0440\u043e\u0432\u0435\u043d\u044c PAPP-A.<\/p>\n<\/li>\n<li data-start=\"4643\" data-end=\"4707\">\n<p data-start=\"4645\" data-end=\"4707\"><strong data-start=\"4645\" data-end=\"4673\">\u042d\u0442\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0436\u0434\u0435\u043d\u0438\u0435<\/strong> \u2014 \u0432\u043b\u0438\u044f\u0435\u0442 \u043d\u0430 \u043c\u0435\u0434\u0438\u0430\u043d\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f.<\/p>\n<\/li>\n<li data-start=\"4708\" data-end=\"4851\">\n<p data-start=\"4710\" data-end=\"4851\"><strong data-start=\"4710\" data-end=\"4755\">\u0412\u0441\u043f\u043e\u043c\u043e\u0433\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u0440\u0435\u043f\u0440\u043e\u0434\u0443\u043a\u0442\u0438\u0432\u043d\u044b\u0435 \u0442\u0435\u0445\u043d\u043e\u043b\u043e\u0433\u0438\u0438<\/strong> \u2014 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u0443\u043a\u0430\u0437\u044b\u0432\u0430\u0442\u044c \u043c\u0435\u0442\u043e\u0434 (\u042d\u041a\u041e, ICSI \u0438 \u0442.\u0434.), \u0430 \u0442\u0430\u043a\u0436\u0435 \u0434\u0430\u0442\u0443 \u0438\u0437\u0432\u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0438 \u043f\u0435\u0440\u0435\u043d\u043e\u0441\u0430 \u044f\u0439\u0446\u0435\u043a\u043b\u0435\u0442\u043a\u0438.<\/p>\n<\/li>\n<\/ul>\n<p data-start=\"4853\" data-end=\"4967\">\u0424\u0438\u043d\u0430\u043b\u044c\u043d\u044b\u0439 \u0440\u0438\u0441\u043a \u0440\u0430\u0441\u0441\u0447\u0438\u0442\u044b\u0432\u0430\u0435\u0442\u0441\u044f \u043d\u0430 \u043e\u0441\u043d\u043e\u0432\u0435 \u0441\u043a\u043e\u0440\u0440\u0435\u043a\u0442\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0445 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0439 \u0438 \u0441\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u043d\u043e\u0439\/\u043b\u043e\u0433\u0430\u0440\u0438\u0444\u043c\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u0433\u0430\u0443\u0441\u0441\u043e\u0432\u043e\u0439 \u043c\u043e\u0434\u0435\u043b\u0438.<\/p>\n<p data-start=\"4969\" data-end=\"4986\"><strong data-start=\"4969\" data-end=\"4986\">\u0423\u0417-\u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0438<\/strong><\/p>\n<p data-start=\"4988\" data-end=\"5251\"><strong data-start=\"4988\" data-end=\"5022\">\u0412\u043e\u0440\u043e\u0442\u043d\u0438\u043a\u043e\u0432\u043e\u0435 \u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0441\u0442\u0432\u043e (NT)<\/strong> \u2014 \u043c\u0430\u043a\u0441\u0438\u043c\u0430\u043b\u044c\u043d\u0430\u044f \u0442\u043e\u043b\u0449\u0438\u043d\u0430 \u043f\u043e\u0434\u043a\u043e\u0436\u043d\u043e\u0433\u043e \u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0441\u0442\u0432\u0430 \u043d\u0430 \u0448\u0435\u0435 \u043f\u043b\u043e\u0434\u0430 \u0432 11\u201314 \u043d\u0435\u0434\u0435\u043b\u044c (\u0432 \u043d\u043e\u0440\u043c\u0435 0.5\u20132 \u043c\u043c). \u041f\u043e\u0432\u044b\u0448\u0435\u043d\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f \u043c\u043e\u0433\u0443\u0442 \u0432\u0441\u0442\u0440\u0435\u0447\u0430\u0442\u044c\u0441\u044f \u0438 \u043f\u0440\u0438 \u043d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u044b\u0445 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u044f\u0445, \u043d\u043e \u0430\u0441\u0441\u043e\u0446\u0438\u0438\u0440\u043e\u0432\u0430\u043d\u044b \u0441 \u0430\u043d\u0435\u0443\u043f\u043b\u043e\u0438\u0434\u0438\u044f\u043c\u0438 \u0438 \u0432\u0440\u043e\u0436\u0434\u0435\u043d\u043d\u044b\u043c\u0438 \u043f\u043e\u0440\u043e\u043a\u0430\u043c\u0438 \u0441\u0435\u0440\u0434\u0446\u0430.<\/p>\n<p data-start=\"5253\" data-end=\"5325\"><strong data-start=\"5253\" data-end=\"5325\">\u0420\u0430\u0441\u0448\u0438\u0440\u0435\u043d\u043d\u044b\u0439 \u043f\u0440\u0435\u043d\u0430\u0442\u0430\u043b\u044c\u043d\u044b\u0439 \u0440\u0438\u0441\u043a-\u043a\u0430\u043b\u044c\u043a\u0443\u043b\u044f\u0442\u043e\u0440 \u2014 \u043f\u0435\u0440\u0432\u044b\u0439 \u0442\u0440\u0438\u043c\u0435\u0441\u0442\u0440 \u2014 Synevo<\/strong><\/p>\n<p data-start=\"5327\" data-end=\"5542\">\u0421\u043a\u0440\u0438\u043d\u0438\u043d\u0433 \u043f\u043e \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0443 \u043c\u0430\u0442\u0435\u0440\u0438 \u0438 NT \u0432\u044b\u044f\u0432\u043b\u044f\u0435\u0442 72\u201377% \u0441\u043b\u0443\u0447\u0430\u0435\u0432 \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430 \u0414\u0430\u0443\u043d\u0430. \u041f\u043e\u0432\u044b\u0448\u0435\u043d\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f NT \u043c\u043e\u0433\u0443\u0442 \u0443\u043a\u0430\u0437\u044b\u0432\u0430\u0442\u044c \u0438 \u043d\u0430 \u0434\u0440\u0443\u0433\u0438\u0435 \u0445\u0440\u043e\u043c\u043e\u0441\u043e\u043c\u043d\u044b\u0435 \u0430\u043d\u043e\u043c\u0430\u043b\u0438\u0438 (\u0442\u0440\u0438\u0441\u043e\u043c\u0438\u0438 13, 18, \u0441\u0438\u043d\u0434\u0440\u043e\u043c \u0422\u0435\u0440\u043d\u0435\u0440\u0430, \u0442\u0440\u0438\u043f\u043b\u043e\u0438\u0434\u0438\u044f) \u0438 \u0432\u0440\u043e\u0436\u0434\u0435\u043d\u043d\u044b\u0435 \u043f\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u0438.<\/p>\n<p data-start=\"5544\" data-end=\"5719\">\u041e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u043e\u0435 \u0432\u0440\u0435\u043c\u044f \u0438\u0437\u043c\u0435\u0440\u0435\u043d\u0438\u044f NT \u2014 11 \u043d\u0435\u0434\u0435\u043b\u044c \u2013 13 \u043d\u0435\u0434\u0435\u043b\u044c + 6 \u0434\u043d\u0435\u0439 (CRL 40\u201379 \u043c\u043c). \u0423\u0447\u0438\u0442\u044b\u0432\u0430\u0442\u044c \u0433\u0435\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0439 \u0432\u043e\u0437\u0440\u0430\u0441\u0442 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043e\u0431\u044f\u0437\u0430\u0442\u0435\u043b\u044c\u043d\u043e, \u0442\u0430\u043a \u043a\u0430\u043a NT \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u0435\u0442\u0441\u044f \u0441 \u0440\u043e\u0441\u0442\u043e\u043c \u043f\u043b\u043e\u0434\u0430.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[15],"product_tag":[],"class_list":{"0":"post-73432","1":"product","2":"type-product","3":"status-publish","5":"product_cat-uncategorized","7":"first","8":"instock","9":"shipping-taxable","10":"purchasable","11":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/73432","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=73432"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=73432"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=73432"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=73432"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=73432"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}