В случае отсутствия активной родовой деятельности и шансов быстрого рождения ребенка метод выбора – КС [119].
При подозрении на хориоамнионит нужно начинать терапию антибиотиками широкого спектра действия, либо комбинацией препаратов с учетом необходимости воздействия на все группы возбудителей (аэробы грамположительные, грамотрицательные; анаэробы).
Показанием для отмены антибактериальной терапии является нормальная температура тела в течение 2 суток.
В ситуации ДИВ при сроке 34 недель и более длительная (более 12–24 часов) выжидательная тактика не показана, так как повышает риск внутриматочной инфекции и компрессии пуповины без улучшения исходов для плода (B-3b) [120]. Но решение о вмешательстве следует принимать на основании комплексной клинической оценки ситуации после получения информированного согласия пациентки.
При пограничном сроке 32–34 недель беременности выбор тактики зависит от зрелости легких плода, которая может быть определена по результатам исследования выделяемого из цервикального канала или материала, полученного в результате трансабдоминального амниоцентеза [121].
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