{"id":29889,"date":"2023-05-09T00:28:35","date_gmt":"2023-05-08T17:28:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29889"},"modified":"2023-05-09T00:28:35","modified_gmt":"2023-05-08T17:28:35","slug":"da-oi-chan-doan-huong-xu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/09\/da-oi-chan-doan-huong-xu-tri\/","title":{"rendered":"\u0110a \u1ed1i: ch\u1ea9n \u0111o\u00e1n, h\u01b0\u1edbng x\u1eed tr\u00ed"},"content":{"rendered":"

\u0110a \u1ed1i xu\u1ea5t hi\u1ec7n trong kho\u1ea3ng 1% thai k\u1ef3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o si\u00eau \u00e2m. H\u1ea7u h\u1ebft c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u1ecbnh ngh\u0129a: \u0111a \u1ed1i khi ch\u1ec9 s\u1ed1 \u1ed1i (amnionic fluid index: AFI) l\u1edbn h\u01a1n 24 – 25cm; hay khi l\u1edbn h\u01a1n v\u1ecb b\u00e1ch ph\u00e2n th\u1ee9 95 hay 97 theo tu\u1ed5i thai.<\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u v\u1ec1 \u0111a \u1ed1i<\/h2>\n

N\u01b0\u1edbc \u1ed1i\u00a0l\u00e0 ch\u1ea5t d\u1ecbch l\u1ecfng r\u1ea5t gi\u00e0u dinh d\u01b0\u1ee1ng bao b\u1ecdc xung quanh thai nhi khi thai n\u1eb1m trong t\u1eed cung c\u1ee7a ng\u01b0\u1eddi m\u1eb9 gi\u1eef vai tr\u00f2 quan tr\u1ecdng v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a thai nhi. N\u01b0\u1edbc \u1ed1i xu\u1ea5t hi\u1ec7n t\u1eeb ng\u00e0y th\u1ee9 12 sau th\u1ee5 thai , c\u00f3 kh\u1ea3 n\u0103ng t\u00e1i t\u1ea1o v\u00e0 trao \u0111\u1ed5i ch\u1ea5t.<\/p>\n

C\u00e1ch \u0111o ch\u1ec9 s\u1ed1 \u1ed1i (AFI): chia t\u1eed cung th\u00e0nh 4 ph\u1ea7n b\u1eb1ng nhau, \u0111o \u0111\u1ed9 s\u00e2u l\u1edbn nh\u1ea5t c\u1ee7a m\u1ed7i khoang \u1ed1i, AFI l\u00e0 t\u1ed5ng 4 s\u1ed1 \u0111o tr\u00ean.<\/p>\n

\u0110a \u1ed1i l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p thai ngh\u00e9n nguy c\u01a1 cao cho s\u1ea3n ph\u1ee5 v\u1ec1\u00a0 nguy\u00ean nh\u00e2n\u00a0 \u0111a \u1ed1i\u00a0 v\u00e0 c\u1ea3nh b\u00e1o nguy c\u01a1 sinh non trong qu\u00e1 tr\u00ecnh thai ngh\u00e9n.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n<\/h2>\n

2.1 Ch\u00e2n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/p>\n

\u0110a \u1ed1i c\u1ea5p c\u00f3 th\u1ec3 di\u1ec5n ti\u1ebfn mau trong v\u00f2ng v\u00e0i ng\u00e0y v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea5p nh\u01b0 \u0111au c\u0103ng b\u1ee5ng nhi\u1ec1u, kh\u00f3 th\u1edf, \u0111\u00f4i khi b\u1ecb t\u00edm t\u00e1i, nh\u1ecbp tim nhanh, n\u00f4n, ph\u00f9\u00a0 to\u00e0n th\u00e2n (chi, \u00e2m h\u1ed9,\u00a0 th\u00e0nh b\u1ee5ng, m\u1eb7t). Hi\u1ebfm g\u1eb7p h\u01a1n l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ec3u ni\u1ec7u do ni\u1ec7u qu\u1ea3n b\u1ecb t\u1eed cung ch\u00e8n \u00e9p. \u0110a \u1ed1i trong tr\u01b0\u1eddng h\u1ee3p ph\u00f9 thai c\u00f3 th\u1ec3 g\u00e2y ra h\u1ed9i ch\u1ee9ng g\u01b0\u01a1ng \u1edf thai ph\u1ee5 (mirror syndrome), m\u00f4 t\u1ea3 l\u1ea7n \u0111\u1ea7u ti\u00ean b\u1edfi Ballantyne n\u0103m 1892: t\u00ecnh tr\u1ea1ng c\u1ee7a m\u1eb9 “b\u1eaft ch\u01b0\u1edbc” thai nhi, nh\u01b0 ph\u00f9, ti\u1ec3u \u0111\u1ea1m; v\u00e0 h\u1eadu qu\u1ea3 l\u00e0 ti\u1ec1n s\u1ea3n gi\u1eadt.<\/p>\n

\u0110a \u1ed1i m\u1ea1n, d\u1ecbch \u1ed1i gia t\u0103ng d\u1ea7n n\u00ean thai ph\u1ee5 c\u00f3 th\u1ec3 ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng c\u0103ng ch\u01b0\u1edbng b\u1ee5ng.<\/p>\n

D\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean tr\u00ean l\u00e2m s\u00e0ng g\u1ee3i \u00fd m\u1ed9t tr\u01b0\u1eddng h\u1ee3p \u0111a \u1ed1i l\u00e0 t\u1eed cung r\u1ea5t to so v\u1edbi tu\u1ed5i thai, c\u0103ng, d\u1eabn \u0111\u1ebfn kh\u00f3 kh\u0103n khi s\u1edd n\u1eafn c\u00e1c ph\u1ea7n thai v\u00e0 nghe tim thai. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t \u0111a \u1ed1i v\u1edbi c\u1ed5 ch\u01b0\u1edbng\u00a0 hay u bu\u1ed3ng tr\u1ee9ng to b\u1eb1ng nh\u1eefng h\u00ecnh \u1ea3nh tr\u00ean si\u00eau \u00e2m.<\/p>\n

Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u0111a \u1ed1i d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m v\u1ec1 th\u1ec3 t\u00edch n\u01b0\u1edbc \u1ed1i t\u0103ng (AFV), c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n sau:<\/p>\n

    \n
  • \n
    \n

    AFI \u2265 24 cm: AFI l\u00e0 t\u1ed5ng \u0111\u1ed9 s\u00e2u c\u1ee7a n\u01b0\u1edbc \u1ed1i theo chi\u1ec1u d\u1ecdc \u0111\u01b0\u1ee3c \u0111o trong m\u1ed7i g\u00f3c ph\u1ea7n t\u01b0 c\u1ee7a t\u1eed cung; AFI b\u00ecnh th\u01b0\u1eddng dao \u0111\u1ed9ng t\u1eeb > 5 \u0111\u1ebfn < 24 cm.<\/p>\n<\/div>\n<\/li>\n<\/ul>\n

     <\/p>\n

    \n

    SDP \u2265 8 cm: SDP l\u00e0 ph\u00e9p \u0111o t\u00fai n\u01b0\u1edbc \u1ed1i s\u00e2u nh\u1ea5t; SDP b\u00ecnh th\u01b0\u1eddng l\u00e0 \u2265 2 \u0111\u1ebfn < 8 cm.<\/p>\n

    \n

    C\u00f3 v\u1ebb nh\u01b0 c\u1ea3 AFI v\u00e0 SDP \u0111\u1ec1u kh\u00f4ng v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c trong vi\u1ec7c ng\u0103n ng\u1eeba c\u00e1c k\u1ebft qu\u1ea3 chu sinh b\u1ea5t l\u1ee3i. M\u1ed7i ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec1u c\u00f3 h\u1ea1n ch\u1ebf: AFI th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c v\u1ec1 thi\u1ec3u \u1ed1i; SDP d\u1eabn \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c v\u1ec1 \u0111a \u1ed1i.<\/p>\n<\/div>\n

    \n

    D\u01b0 \u1ed1i \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh gi\u00e1n ti\u1ebfp b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c ti\u00eau chu\u1ea9n si\u00eau \u00e2m, \u0111i\u1ec3n h\u00ecnh l\u00e0 AFI. AFI l\u00e0 t\u1ed5ng c\u1ee7a chi\u1ec1u s\u00e2u th\u1eb3ng \u0111\u1ee9ng c\u1ee7a d\u1ecbch \u1ed1i \u0111o \u0111\u01b0\u1ee3c trong m\u1ed7i g\u00f3c ph\u1ea7n t\u01b0 c\u1ee7a t\u1eed cung. AFI th\u00f4ng th\u01b0\u1eddng dao \u0111\u1ed9ng t\u1eeb > 5 \u0111\u1ebfn < 24 cm; gi\u00e1 tr\u1ecb \u2265 24 cm cho th\u1ea5y \u0111a \u1ed1i.<\/p>\n

    \"\u0110a
    \u0110a \u1ed1i<\/figcaption><\/figure>\n

    2.2 \u0110\u00e1nh gi\u00e1 sau ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n

    \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng ph\u00f9 thai nhi:\u00a0N\u1ebfu \u0111a \u1ed1i \u0111i k\u00e8m v\u1edbi ph\u00f9 n\u1ec1, \u01b0u ti\u00ean \u0111\u00e1nh gi\u00e1 nguy\u00ean nh\u00e2n mi\u1ec5n d\u1ecbch ho\u1eb7c kh\u00f4ng do mi\u1ec5n d\u1ecbch. Thi\u1ebfu m\u00e1u thai nhi l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn c\u1ee7a ph\u00f9 n\u1ec1 v\u00e0 c\u00f3 c\u1ea3 nguy\u00ean nh\u00e2n mi\u1ec5n d\u1ecbch v\u00e0 kh\u00f4ng mi\u1ec5n d\u1ecbch.<\/p>\n

    \u0110\u00e1nh gi\u00e1 c\u00e1c d\u1ecb t\u1eadt c\u1ee7a thai nhi.\u00a0C\u1ea7n th\u1ef1c hi\u1ec7n \u0111\u00e1nh gi\u00e1 si\u00eau \u00e2m chi ti\u1ebft \u0111\u1ec3 t\u00ecm ki\u1ebfm c\u00e1c d\u1ecb t\u1eadt c\u1ee7a thai nhi. Kh\u1ea3 n\u0103ng x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n c\u1ee7a \u0111a \u1ed1i t\u01b0\u01a1ng quan tr\u01b0\u1edbc v\u1edbi m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a s\u1ef1 t\u00edch t\u1ee5 ch\u1ea5t l\u1ecfng. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111a \u1ed1i nghi ng\u1edd c\u00f3 h\u1eb9p th\u1ef1c qu\u1ea3n (bong b\u00f3ng d\u1ea1 d\u00e0y c\u1ee7a thai nhi nh\u1ecf ho\u1eb7c kh\u00f4ng nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c), n\u1ed3ng \u0111\u1ed9 gamma-glutamyl transpeptidase v\u00e0 alpha-fetoprotein trong n\u01b0\u1edbc \u1ed1i t\u0103ng cao l\u00e0 g\u1ee3i \u00fd cho ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ecdc \u1ed1i \u0111\u1ec3 nghi\u00ean c\u1ee9u di truy\u1ec1n<\/p>\n

    S\u00e0ng l\u1ecdc\u00a0b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng cho\u00a0m\u1eb9\u00a0n\u1ebfu ch\u01b0a \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n<\/div>\n<\/div>\n

    3. H\u01b0\u1edbng x\u1eed tr\u00ed<\/h2>\n

    \u0110a \u1ed1i m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh hi\u1ebfm khi \u0111\u00f2i h\u1ecfi c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p. C\u1ea7n thi\u1ebft nh\u1eadp vi\u1ec7n khi thai ph\u1ee5 kh\u00f3 th\u1edf, \u0111au b\u1ee5ng hay \u0111i l\u1ea1i kh\u00f3 kh\u0103n.<\/p>\n

    Ngh\u1ec9 ng\u01a1i t\u1ea1i gi\u01b0\u1eddng, l\u1ee3i ti\u1ec3u, h\u1ea1n ch\u1ebf d\u1ecbch truy\u1ec1n v\u00e0 mu\u1ed1i kh\u00f4ng \u0111em l\u1ea1i hi\u1ec7u qu\u1ea3 r\u00f5 r\u1ec7t. H\u00fat b\u1edbt n\u01b0\u1edbc \u1ed1i\u00a0 c\u0169ng gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf \u1edf thai ph\u1ee5 \u0111\u1ed3ng th\u1eddi l\u1ea5y d\u1ecbch \u1ed1i x\u00e9t nghi\u1ec7m di truy\u1ec1n hay x\u00e1c \u0111\u1ecbnh s\u1ef1 tr\u01b0\u1edfng th\u00e0nh ph\u1ed5i c\u1ee7a thai nhi.<\/p>\n

    Th\u1ee7 thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 g\u00e2y tai bi\u1ebfn nh\u01b0: v\u1ee1 \u1ed1i, nhi\u1ec5m tr\u00f9ng, hay rau\u00a0 bong non.<\/p>\n

    C\u1ea7n l\u01b0u \u00fd \u0111a \u1ed1i kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n trong g\u1ea7n m\u1ed9t n\u1eeda c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111a \u1ed1i l\u00e0 s\u1ef1 gia t\u0103ng l\u01b0\u1ee3ng n\u01b0\u1edbc \u1ed1i kh\u00f4ng li\u00ean quan v\u1edbi b\u1ea5t th\u01b0\u1eddng b\u1ea9m sinh, ti\u1ec3u \u0111\u01b0\u1eddng \u1edf m\u1eb9, c\u00e1c b\u1ec7nh l\u00fd mi\u1ec5n d\u1ecbch, nhi\u1ec5m tr\u00f9ng, kh\u1ed1i u c\u1ee7a thai nhi hay t\u00ecnh tr\u1ea1ng \u0111a thai. Tuy nhi\u00ean, th\u1eadm ch\u00ed khi kh\u1ea3o s\u00e1t h\u00ecnh \u1ea3nh h\u1ecdc thai nhi b\u00ecnh th\u01b0\u1eddng, v\u1eabn n\u00ean ti\u00ean l\u01b0\u1ee3ng m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng b\u1edfi d\u1ecb t\u1eadt thai nhi v\u00e0 b\u1ea5t th\u01b0\u1eddng nhi\u1ec5m s\u1eafc th\u1ec3 c\u00f3 th\u1ec3 g\u1eb7p.<\/p>\n

    3.1. \u0110a \u1ed1i xu\u1ea5t hi\u1ec7n ba th\u00e1ng gi\u1eefa thai k\u1ef3<\/strong><\/p>\n

      \n
    • Ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m kh\u1ea3o s\u00e1t h\u00ecnh th\u00e1i h\u1ecdc thai nhi chuy\u00ean s\u00e2u \u0111\u1ec3 t\u00ecm c\u00e1c d\u1ecb t\u1eadt b\u1ea9m sinh c\u00f3 th\u1ec3 \u0111i k\u00e8m.<\/li>\n
    • Nghi\u1ec7m ph\u00e1p dung n\u1ea1p \u0111\u01b0\u1eddng cho thai 24-28 tu\u1ea7n<\/li>\n<\/ul>\n
        \n
      • H\u1ed9i ch\u1ea9n trung t\u00e2m ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc sinh \u0111\u1ec3 t\u01b0 v\u1ea5n, c\u00e2n nh\u1eafc ti\u1ebfn h\u00e0nh c\u00e1c x\u00e9t nghi\u1ec7m di truy\u1ec1n t\u00ecm nguy\u00ean nh\u00e2n b\u1ea5t th\u01b0\u1eddng NST, nhi\u1ec5m tr\u00f9ng thai k\u1ef3.<\/li>\n
      • N\u00ean ti\u1ebfp t\u1ee5c theo d\u00f5i, qu\u1ea3n l\u00fd thai k\u1ef3 nguy c\u01a1 cao (kh\u00e1m thai ti\u1ec1n s\u1ea3n)<\/li>\n<\/ul>\n

        3.2. \u0110a \u1ed1i ba th\u00e1ng cu\u1ed1i thai k\u1ef3<\/strong><\/p>\n

          \n
        • Ki\u1ec3m tra bi\u1ec3u \u0111\u1ed3 t\u0103ng tr\u01b0\u1edfng thai nhi.<\/li>\n
        • Lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n b\u1ec7nh n\u1ed9i khoa c\u1ee7a m\u1eb9.<\/li>\n
        • T\u00f9y theo k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc qu\u00fd 1, 2: t\u01b0 v\u1ea5n h\u01b0\u1edbng x\u00e9t nghi\u1ec7m di truy\u1ec1n cho thai nhi.<\/li>\n
        • Thu\u1ed1c tr\u01b0\u1edfng th\u00e0nh ph\u1ed5i do nguy c\u01a1 \u0111\u1ebb non<\/li>\n
        • Can thi\u1ec7p (h\u00fat b\u1edbt d\u1ecbch \u1ed1i) khi c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111a \u1ed1i c\u1ea5p \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn to\u00e0n tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh ( kh\u00f3 th\u1edf, ch\u00e8n \u00e9p\u00a0 tim ph\u1ed5i). T\u01b0 v\u1ea5n c\u00e1c tai bi\u1ebfn c\u1ee7a th\u1ee7 thu\u1eadt cho thai ph\u1ee5 v\u00e0 gia \u0111\u00ecnh.<\/li>\n<\/ul>\n

          3.3. Chuy\u1ec3n d\u1ea1<\/strong><\/p>\n

          Hay g\u1eb7p c\u00e1c nguy c\u01a1 \u0111\u1ebb kh\u00f3 nh\u01b0 ng\u00f4i b\u1ea5t th\u01b0\u1eddng, \u0111\u1ebb kh\u00f3 do r\u1ed1i lo\u1ea1n c\u01a1n co t\u1eed cung, tu\u00e2n th\u1ee7 ch\u1ec9 \u0111\u1ecbnh b\u1ea5m \u1ed1i. \u0110\u1ec1 ph\u00f2ng rau bong non, b\u0103ng huy\u1ebft sau sinh.<\/p>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

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