{"id":29832,"date":"2023-04-30T14:11:46","date_gmt":"2023-04-30T07:11:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29832"},"modified":"2023-05-07T10:10:09","modified_gmt":"2023-05-07T03:10:09","slug":"tien-san-giat-phan-loai-chan-doan-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/tien-san-giat-phan-loai-chan-doan-dieu-tri\/","title":{"rendered":"Ti\u1ec1n s\u1ea3n gi\u1eadt: ph\u00e2n lo\u1ea1i, ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Ti\u1ec1n s\u1ea3n gi\u1eadt, s\u1ea3n gi\u1eadt<\/a> l\u00e0 bi\u1ebfn ch\u1ee9ng n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef\u00a0 mang thai v\u1edbi t\u1ec9 l\u1ec7 t\u1eeb 2% – 8%. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p l\u00e0 ph\u00f9, huy\u1ebft \u00e1p t\u0103ng v\u00e0\u00a0 protein ni\u1ec7u. L\u00e0 1 trong nh\u1eefng nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong cho m\u1eb9 v\u00e0 thai<\/strong>.<\/p>\n

1. Ph\u00e2n lo\u1ea1i v\u00e0 ch\u1ea9n \u0111o\u00e1n ti\u1ec1n s\u1ea3n gi\u1eadt<\/h2>\n

1.1 Ti\u1ec1n s\u1ea3n gi\u1eadt nh\u1eb9\u00a0<\/strong><\/p>\n

    \n
  • Huy\u1ebft \u00e1p (HA) \u2265 140\/90 mmHg sau tu\u1ea7n 20 c\u1ee7a thai k\u1ef3.<\/li>\n
  • Protein\/ ni\u1ec7u \u2265 300 mg\/24 gi\u1edd hay que th\u1eed nhanh (+)<\/li>\n<\/ul>\n

    1.2 Ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng<\/strong><\/p>\n

    +<\/strong> Huy\u1ebft \u00e1p \u2265 160\/110 mm Hg.<\/p>\n

    +<\/strong> Protein\/ ni\u1ec7u \u2265 5 g\/24 gi\u1edd hay que th\u1eed 3+ (2 m\u1eabu th\u1eed ng\u1eabu nhi\u00ean).<\/p>\n

    +<\/strong> Thi\u1ec3u ni\u1ec7u, n\u01b0\u1edbc ti\u1ec3u\u00a0 < 500 ml\/ 24 gi\u1edd.<\/p>\n

    +<\/strong> Creatinine \/ huy\u1ebft t\u01b0\u01a1ng > 1.3 mg\/dL.<\/p>\n

    +<\/strong> Ti\u1ec3u c\u1ea7u < 100,000\/mm3<\/sup>.<\/p>\n

    +<\/strong>T\u0103ng men gan ALT hay AST (g\u1ea5p \u0111\u00f4i ng\u01b0\u1ee1ng tr\u00ean gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng).<\/p>\n

    +<\/strong> Ax\u00edt uric t\u0103ng cao<\/p>\n

    +<\/strong> Thai ch\u1eadm ph\u00e1t tri\u1ec3n.<\/p>\n

    +<\/strong> Nh\u1ee9c \u0111\u1ea7u hay nh\u00ecn m\u1edd.<\/p>\n

    +<\/strong> \u0110au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb ho\u1eb7c h\u1ea1 s\u01b0\u1eddn ph\u1ea3i.<\/p>\n

    S\u1ea3n gi\u1eadt \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n khi c\u00f3 c\u01a1n co gi\u1eadt x\u1ea3y ra \u1edf ph\u1ee5 n\u1eef mang thai c\u00f3 tri\u1ec7u ch\u1ee9ng ti\u1ec1n s\u1ea3n gi\u1eadt v\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n n\u00e0o kh\u00e1c \u0111\u1ec3 gi\u1ea3i th\u00edch. C\u00e1c c\u01a1n co gi\u1eadt trong s\u1ea3n gi\u1eadt th\u01b0\u1eddng l\u00e0 to\u00e0n th\u00e2n, c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc, trong chuy\u1ec3n d\u1ea1 hay trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n. S\u1ea3n gi\u1eadt c\u00f3 th\u1ec3 d\u1ef1 ph\u00f2ng \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec7u tr\u1ecb s\u1edbm ti\u1ec1n s\u1ea3n gi\u1eadt<\/p>\n

    1.3 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/p>\n

    Tr\u00ean c\u01a1 s\u1edf ng\u01b0\u1eddi b\u1ec7nh b\u1ecb ti\u1ec1n s\u1ea3n gi\u1eadt xu\u1ea5t hi\u1ec7n c\u01a1n gi\u1eadt 4 giai \u0111o\u1ea1n:<\/p>\n

      \n
    • Giai \u0111o\u1ea1n x\u00e2m nhi\u1ec5m .<\/li>\n
    • Giai \u0111o\u1ea1n gi\u1eadt c\u1ee9ng<\/li>\n
    • Giai \u0111o\u1ea1n gi\u1eadt gi\u00e3n c\u00e1ch.<\/li>\n
    • Giai \u0111o\u1ea1n h\u00f4n m\u00ea<\/li>\n<\/ul>\n

      1.4 C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n

      + T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u.<\/p>\n

      + Acid uric. Bilirubin (to\u00e0n ph\u1ea7n, gi\u00e1n ti\u1ebfp, tr\u1ef1c ti\u1ebfp).<\/p>\n

      + AST-ALT.<\/p>\n

      + Ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

      + \u0110\u01b0\u1eddng huy\u1ebft.<\/p>\n

      + \u0110\u1ea1m huy\u1ebft.<\/p>\n

      + Protein ni\u1ec7u 24 gi\u1edd.<\/p>\n

      + \u0110\u00f4ng m\u00e1u to\u00e0n b\u1ed9.<\/p>\n

      + Soi \u0111\u00e1y m\u1eaft (n\u1ebfu c\u00f3 th\u1ec3).<\/p>\n

      2. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

      2.1 Ti\u1ec1n s\u1ea3n gi\u1eadt nh\u1eb9<\/strong><\/p>\n

      Ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa<\/p>\n

        \n
      • \n
          \n
        • \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa:\n
            \n
          • Cho thai ph\u1ee5 ngh\u1ec9 ng\u01a1i, y\u00ean t\u0129nh ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u \u0111\u1ea1m, nhi\u1ec1u rau v\u00e0 tr\u00e1i c\u00e2y t\u01b0\u01a1i.<\/li>\n
          • Kh\u00e1m thai m\u1ed7i 3- 4 ng\u00e0y\/l\u1ea7n. Theo d\u00f5i t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u00e0 m\u1eb9. Theo d\u00f5i t\u00ecnh tr\u1ea1ng thai nhi, si\u00eau \u00e2m thai m\u1ed7i 3 \u2013 4 tu\u1ea7n, n\u01b0\u1edbc ti\u1ec3u 2 l\u1ea7n\/ tu\u1ea7n.<\/li>\n<\/ul>\n<\/li>\n
          • N\u1ebfu HA > 149\/ 90mmHg v\u00e0 Protein \/ ni\u1ec7u ++: nh\u1eadp vi\u1ec7n.\u00a0 <\/strong>\n
              \n
            • L\u00e2m s\u00e0ng:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

              + Kh\u00e1m l\u00e2m s\u00e0ng ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng nh\u01b0 nh\u1ee9c \u0111\u1ea7u, r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c, \u0111au th\u01b0\u1ee3ng v\u1ecb v\u00e0 t\u0103ng c\u00e2n nhanh, theo d\u00f5i c\u00e2n n\u1eb7ng l\u00fac nh\u1eadp vi\u1ec7n v\u00e0 m\u1ed7i ng\u00e0y sau, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

              + \u0110o huy\u1ebft \u00e1p \u1edf t\u01b0 th\u1ebf ng\u1ed3i 4 gi\u1edd\/ l\u1ea7n, tr\u1eeb kho\u1ea3ng th\u1eddi gian t\u1eeb n\u1eeda \u0111\u00eam \u0111\u1ebfn s\u00e1ng.<\/p>\n

                \n
              • Th\u01b0\u1eddng xuy\u00ean \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe thai: si\u00eau \u00e2m thai, monitoring thai.<\/li>\n
              • X\u00e9t nghi\u1ec7m:<\/li>\n<\/ul>\n

                + X\u00e9t nghi\u1ec7m protein \/ ni\u1ec7u m\u1ed7i ng\u00e0y ho\u1eb7c c\u00e1ch hai ng\u00e0y.<\/p>\n

                + \u0110\u1ecbnh l\u01b0\u1ee3ng creatinine m\u00e1u, hematocrit, \u0111\u1ebfm ti\u1ec3u c\u1ea7u, men gan, LDH, acid uric t\u0103ng. (ch\u1ec9 l\u00e0m x\u00e9t nghi\u1ec7m \u0111\u00f4ng m\u00e1u khi ti\u1ec3u c\u1ea7u gi\u1ea3m v\u00e0 men gan t\u0103ng).<\/p>\n

                  \n
                • C\u00e1ch x\u1eed tr\u00ed ti\u1ebfp theo t\u00f9y thu\u1ed9c v\u00e0o: \u0111\u1ed9 n\u1eb7ng c\u1ee7a ti\u1ec1n s\u1ea3n gi\u1eadt, tu\u1ed5i thai.<\/li>\n<\/ul>\n

                  T\u00ecnh tr\u1ea1ng c\u1ed5 t\u1eed cung. Ti\u1ec1n s\u1ea3n gi\u1eadt nh\u1eb9 k\u1ebft th\u00fac thai k\u1ef3 \u1edf tu\u1ed5i thai \u2265 37 tu\u1ea7n.<\/p>\n

                  \"Chan
                  Ch\u1ea9n \u0111o\u00e1n ti\u1ec1n s\u1ea3n gi\u1eadt<\/figcaption><\/figure>\n

                  2.2 Ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng <\/strong><\/p>\n

                    \n
                  • \n
                      \n
                    • D\u1ef1 ph\u00f2ng v\u00e0 ki\u1ec3m so\u00e1t c\u01a1n co gi\u1eadt b\u1eb1ng magnesium sulfate.<\/li>\n
                    • H\u1ea1 \u00e1p khi huy\u1ebft \u00e1p cao: huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u2265 100-110mm Hg, ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m thu \u2265 150-160 mmHg (ACOG 2012).\n
                        \n
                      • Ch\u1ea5m d\u1ee9t thai k\u1ef3 sau khi ch\u1ed1ng co gi\u1eadt v\u00e0 h\u1ea1 huy\u1ebft \u00e1p 24 gi\u1edd.<\/li>\n
                      • Tr\u00e1nh s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u. H\u1ea1n ch\u1ebf truy\u1ec1n d\u1ecbch tr\u1eeb khi c\u00f3 t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc nhi\u1ec1u.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                        \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u00f4ng kh\u00ed \u0111\u1ec3 c\u1ee9u s\u1ed1ng ng\u01b0\u1eddi b\u1ec7nh n\u1ebfu c\u00f3 suy h\u00f4 h\u1ea5p, ng\u1eebng th\u1edf.<\/p>\n

                          \n
                        • Thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p\u00a0<\/strong><\/li>\n<\/ul>\n

                          Thu\u1ed1c h\u1ea1 \u00e1p c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng b\u1ea5t l\u1ee3i tr\u00ean c\u1ea3 m\u1eb9 v\u00e0 thai. \u1ea2nh h\u01b0\u1edfng tr\u00ean thai nhi ho\u1eb7c gi\u00e1n ti\u1ebfp do gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n t\u1eed cung nhau ho\u1eb7c tr\u1ef1c ti\u1ebfp tr\u00ean tim m\u1ea1ch. Do v\u1eady c\u1ea7n c\u00e2n nh\u1eafc gi\u1eefa l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 khi s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 \u00e1p. – Ch\u1ec9 \u0111\u1ecbnh<\/p>\n

                          Khi HA t\u00e2m thu \u2265 150-160 mmHg, HA t\u00e2m tr\u01b0\u01a1ng\u00a0 \u2265 100mmHg.<\/p>\n

                          HA \u0111\u1ea1t sau \u0111i\u1ec1u tr\u1ecb: HA trung b\u00ecnh kh\u00f4ng gi\u1ea3m qu\u00e1 25% so v\u1edbi ban \u0111\u1ea7u sau 2 gi\u1edd. HA t\u00e2m thu \u1edf m\u1ee9c 130 \u2013 150mmHg. HA t\u00e2m tr\u01b0\u01a1ng \u1edf m\u1ee9c 80 \u2013 100mmHg.<\/p>\n

                            \n
                          • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong thai k\u1ef3<\/strong><\/li>\n<\/ul>\n

                            Nitroprusside, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.<\/p>\n

                              \n
                            • C\u00e1c lo\u1ea1i thu\u1ed1c h\u1ea1 HA d\u00f9ng trong thai k\u1ef3: c\u00f3 th\u1ec3 d\u00f9ng m\u1ed9t trong c\u00e1c thu\u1ed1c sau<\/li>\n<\/ul>\n

                              + Labetalol (Beta Bloquant)<\/p>\n

                              B\u1eaft \u0111\u1ea7u 20 mg t\u0129nh m\u1ea1ch, c\u00e1ch 10 ph\u00fat sau \u0111\u00f3 t\u0129nh m\u1ea1ch 20 \u0111\u1ebfn 80mg.\u00a0 T\u1ed5ng li\u1ec1u < 300 mg. V\u00ed d\u1ee5: t\u0129nh m\u1ea1ch 20mg, ti\u1ebfp theo 40 mg, 80mg, ti\u1ebfp 80mg.\u00a0 C\u00f3 th\u1ec3 truy\u1ec1n t\u0129nh m\u1ea1ch 1mg – 2mg\/ph\u00fat. HA s\u1ebd h\u1ea1 sau 5-10 ph\u00fat v\u00e0 k\u00e9o d\u00e0i t\u1eeb 3-6 gi\u1edd.<\/p>\n

                              + Hydralazine<\/p>\n

                              C\u00f3 th\u1ec3 g\u00e2y h\u1ea1 huy\u1ebft \u00e1p h\u01a1n nh\u1eefng thu\u1ed1c kh\u00e1c, kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ecdn l\u1ef1a s\u1ed1 1 nh\u01b0ng \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i.<\/p>\n

                              Ti\u00eam t\u0129nh m\u1ea1ch 5mg hydralazine\/1-2 ph\u00fat.N\u1ebfu sau 15-20 ph\u00fat kh\u00f4ng h\u1ea1 \u00e1p \u0111\u01b0\u1ee3c cho 5- 10mg t\u0129nh m\u1ea1ch ti\u1ebfp. N\u1ebfu t\u1ed5ng li\u1ec1u 30 mg kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c HA n\u00ean d\u00f9ng thu\u1ed1c kh\u00e1c. HA s\u1ebd h\u1ea1 sau 10-30 ph\u00fat v\u00e0 k\u00e9o d\u00e0i t\u1eeb 2-4 gi\u1edd. Hydralazine \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3 trong ph\u00f2ng ng\u1eeba xu\u1ea5t huy\u1ebft n\u00e3o.<\/p>\n

                              + Nicardipine<\/p>\n

                              \u1ed0ng 10mg\/10ml pha v\u1edbi 40ml n\u01a3\u1edbc c\u1ea5t ho\u1eb7c NaCl 0,9. T\u1ea5n c\u00f4ng: 0,5-1 mg (2,5-5ml) ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm. Duy tr\u00ec b\u01a1m ti\u00eam \u0111i\u1ec7n 1-3mg\/ gi\u1edd (5-15 ml\/gi\u1edd).<\/p>\n

                              N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng sau 15 ph\u00fat t\u0103ng 2,5mg\/gi\u1edd t\u1ed1i \u0111a 15mg\/gi\u1edd.<\/p>\n

                              \u00a0L\u1ee3i ti\u1ec3u<\/strong>: ch\u1ec9 d\u00f9ng khi c\u00f3 tri\u1ec7u ch\u1ee9ng d\u1ecda ph\u00f9 ph\u1ed5i c\u1ea5p, ph\u00f9 ph\u1ed5i c\u1ea5p.<\/p>\n

                              + Lasix (Furosemide) 1 \u1ed1ng 20mg x 8 \u1ed1ng \u2013 ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm.<\/p>\n

                              + Kh\u00f4ng d\u00f9ng dung d\u1ecbch \u01a3u tr\u01a3\u01a1ng.<\/p>\n

                              + C\u00f3 th\u1ec3 truy\u1ec1n Lactate Ringer v\u1edbi t\u1ed1c \u0111\u1ed9 60 \u2013 124ml\/gi\u1edd<\/p>\n

                              2.3 Quy\u1ebft \u0111\u1ecbnh ch\u1ea5m d\u1ee9t thai k\u1ef3<\/strong><\/p>\n

                              C\u00e1c ch\u1ec9 \u0111\u1ecbnh \u0111\u00ecnh ch\u1ec9 thai ngh\u00e9n<\/p>\n

                              – Ti\u1ec1n s\u1ea3n gi\u1eadt nh\u1eb9, thai > 37 tu\u1ea7n.<\/p>\n

                              – Ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng:<\/p>\n

                              + Huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng 110mmHg.<\/p>\n

                              + T\u0103ng HA kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/p>\n

                              + Protein ni\u1ec7u t\u00a0 5g\/24 gi\u1edd, +++ qua 2 l\u1ea7n th\u1eed c\u00e1ch nhau 4 gi\u1edd.<\/p>\n

                              + Thi\u1ec3u ni\u1ec7u (l\u01b0\u1ee3ng n\u01a3\u1edbc ti\u1ec3u < 500ml\/24 gi\u1edd ho\u1eb7c < 30ml\/gi\u1edd)<\/p>\n

                              + Nh\u1ee9c \u0111\u1ea7u, hoa m\u1eaft, \u0111au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb ho\u1eb7c \u0111au h\u1ea1 s\u01a3\u1eddn ph\u1ea3i.<\/p>\n

                              + Suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, th\u1eadn, Creatinin huy\u1ebft t\u0103ng, gi\u1ea3m ti\u1ec3u c\u1ea7u.+.<\/p>\n

                              + C\u00f3 h\u1ed9i ch\u1ee9ng HELLP (tan huy\u1ebft, t\u0103ng SGOT, SGPT, gi\u1ea3m ti\u1ec3u c\u1ea7u) + Ph\u00f9 ph\u1ed5i c\u1ea5p.<\/p>\n

                              + Thai suy tr\u01b0\u1eddng di\u1ec5n ho\u1eb7c suy c\u1ea5p. NST kh\u00f4ng \u0111\u00e1p \u1ee9ng, thi\u1ec3u \u1ed1i, thai suy dinh d\u01b0\u1ee1ng trong t\u1eed cung, si\u00eau \u00e2m Doppler gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

                              + Rau bong non, chuy\u1ec3n d\u1ea1, v\u1ee1 \u1ed1i.<\/p>\n

                              H\u1ed7 tr\u1ee3 ph\u1ed5i thai nhi<\/strong><\/p>\n

                              + Tu\u1ed5i thai t\u1eeb 28-34 tu\u1ea7n: gi\u00fap tr\u01b0\u1edfng th\u00e0nh ph\u1ed5i thai nhi<\/p>\n

                              + Betamethasone:\u00a0 4mg x 3 \u1ed1ng ti\u00eam b\u1eafp, l\u1eb7p l\u1ea1i l\u1ea7n 2 sau 12-24 gi\u1edd<\/p>\n

                              Khuynh h\u01b0\u1edbng tr\u00ec ho\u00e3n thai k\u1ef3<\/strong><\/p>\n

                              + Tu\u1ed5i thai < 34 tu\u1ea7n khuynh h\u01b0\u1edbng tr\u00ec ho\u00e3n ch\u1ea5m d\u1ee9t thai k\u1ef3 sau 48 gi\u1edd hay \u0111\u1ebfn khi thai \u0111\u01b0\u1ee3c 34 tu\u1ea7n.<\/p>\n

                              + Theo d\u00f5i s\u1ee9c kh\u1ecfe thai b\u1eb1ng Monitoring s\u1ea3n khoa, si\u00eau \u00e2m Doppler.<\/p>\n

                              L\u01a3u \u00fd: nguy c\u01a1 nhau bong non, s\u1ea3n gi\u1eadt, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, suy th\u1eadn, xu\u1ea5t huy\u1ebft n\u00e3o\u2026<\/p>\n

                              Ph\u01b0\u01a1ng ph\u00e1p ch\u1ea5m d\u1ee9t thai k\u1ef3<\/strong><\/p>\n

                              + Kh\u1edfi ph\u00e1t chuy\u1ec3n d\u1ea1.\u00a0 N\u1ebfu c\u1ed5 t\u1eed cung thu\u1eadn l\u1ee3i c\u00f3 th\u1ec3 g\u00e2y chuy\u1ec3n d\u1ea1 b\u1eb1ng<\/p>\n

                              Oxytocin v\u00e0 theo d\u00f5i s\u00e1t b\u1eb1ng monitoring, gi\u00fap sinh b\u1eb1ng Forceps khi \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n

                              + N\u1ebfu c\u1ed5 t\u1eed cung kh\u00f4ng thu\u1eadn l\u1ee3i: m\u1ed5 l\u1ea5y thai.<\/p>\n

                              2.4 S\u1ea3n gi\u1eadt <\/strong><\/p>\n

                              \u0110i\u1ec1u tr\u1ecb gi\u1ed1ng nh\u01b0 ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng<\/p>\n

                              + Oxy, c\u00e2y ng\u00e1ng l\u01b0\u1ee1i, h\u00fat \u0111\u1eddm nh\u1edbt, \u0111\u1ea3m b\u1ea3o th\u00f4ng h\u00f4 h\u1ea5p.<\/p>\n

                              + Ch\u1ed1ng co gi\u1eadt.<\/p>\n

                              + H\u1ea1 huy\u1ebft \u00e1p.<\/p>\n

                              + Ch\u1ea5m d\u1ee9t thai k\u1ef3.<\/p>\n

                              + D\u1ef1 ph\u00f2ng c\u00e1c bi\u1ebfn ch\u1ee9ng: xu\u1ea5t huy\u1ebft n\u00e3o, v\u00f4 ni\u1ec7u, ph\u00f9 ph\u1ed5i c\u1ea5p, nhau bong non, phong huy\u1ebft t\u1eed cung-nhau.<\/p>\n

                              Ph\u01b0\u01a1ng ph\u00e1p ch\u1ea5m d\u1ee9t thai k\u1ef3<\/p>\n

                              + N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh v\u00f4 ni\u1ec7u, co gi\u1eadt: ph\u1ea3i g\u00e2y m\u00ea, m\u1ed5 l\u1ea5y thai.<\/p>\n

                              + N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh \u1ed5n \u0111\u1ecbnh, 24 gi\u1edd sau c\u01a1n co gi\u1eadt cu\u1ed1i c\u00f9ng, kh\u1edfi ph\u00e1t chuy\u1ec3n d\u1ea1 n\u1ebfu c\u1ed5 t\u1eed cung thu\u1eadn l\u1ee3i v\u00e0 gi\u00fap sinh b\u1eb1ng Forceps khi \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n","protected":false},"excerpt":{"rendered":"

                              Ti\u1ec1n s\u1ea3n gi\u1eadt, s\u1ea3n gi\u1eadt l\u00e0 bi\u1ebfn ch\u1ee9ng n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef\u00a0 mang thai v\u1edbi t\u1ec9 l\u1ec7 t\u1eeb 2% – 8%. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p l\u00e0 ph\u00f9, huy\u1ebft \u00e1p t\u0103ng v\u00e0\u00a0 protein ni\u1ec7u. L\u00e0 1 trong nh\u1eefng nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong cho m\u1eb9 v\u00e0 thai. 1. Ph\u00e2n lo\u1ea1i v\u00e0 […]<\/p>\n","protected":false},"author":49,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,33],"tags":[],"yoast_head":"\nTi\u1ec1n s\u1ea3n gi\u1eadt: ph\u00e2n lo\u1ea1i, ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Ti\u1ec1n s\u1ea3n gi\u1eadt, s\u1ea3n gi\u1eadt l\u00e0 bi\u1ebfn ch\u1ee9ng n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef\u00a0 mang thai v\u1edbi t\u1ec9 l\u1ec7 t\u1eeb 2% - 8%. Bao g\u1ed3m\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ti\u1ec1n s\u1ea3n gi\u1eadt: ph\u00e2n lo\u1ea1i, ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Ti\u1ec1n s\u1ea3n gi\u1eadt, s\u1ea3n gi\u1eadt l\u00e0 bi\u1ebfn ch\u1ee9ng n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef\u00a0 mang thai v\u1edbi t\u1ec9 l\u1ec7 t\u1eeb 2% - 8%. 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