{"id":31574,"date":"2023-05-06T20:22:04","date_gmt":"2023-05-06T13:22:04","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31574"},"modified":"2023-05-07T10:18:26","modified_gmt":"2023-05-07T03:18:26","slug":"dai-thao-duong-thai-nghen-chan-doan-cham-soc-tien-san","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/dai-thao-duong-thai-nghen-chan-doan-cham-soc-tien-san\/","title":{"rendered":"\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n: ch\u1ea9n \u0111o\u00e1n, ch\u0103m s\u00f3c ti\u1ec1n s\u1ea3n"},"content":{"rendered":"<p><strong>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n (\u0110TNTN) l\u00e0 s\u1ef1 gi\u1ea3m dung n\u1ea1p glucose ho\u1eb7c \u0110T\u0110 (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng) \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n l\u1ea7n \u0111\u1ea7u trong l\u00fac mang thai (kh\u00f4ng lo\u1ea1i tr\u1eeb ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 c\u00f3 gi\u1ea3m dung n\u1ea1p glucose ho\u1eb7c \u0110T\u0110 t\u1eeb tr\u01b0\u1edbc nh\u01b0ng ch\u01b0a \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n).\u00a0<\/strong><\/p>\n<h2><strong>1. Ph\u00e1t hi\u1ec7n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n (\u0110TNTN)<\/strong><\/h2>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/tong-quan-ve-benh-dai-thao-duong\/\">\u0110T\u0110TN<\/a> t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n ch\u1ee7 y\u1ebfu \u1edf giai \u0111o\u1ea1n mu\u1ed9n c\u1ee7a thai k\u1ef3, ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau sinh glucose c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng tr\u1edf l\u1ea1i. Tuy nhi\u00ean nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 ti\u1ec1n s\u1eed \u0110T\u0110TN\u00a0 n\u00e0y c\u00f3 nguy c\u01a1 ph\u00e1t tri\u1ec3n th\u00e0nh \u0110T\u0110 tu\u00fdp 2 trong t\u01b0\u01a1ng lai.<\/p>\n<p>\u0110T\u0110TN th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng r\u00f5, ph\u00e1t hi\u1ec7n b\u1ec7nh c\u1ea7n th\u1ef1c hi\u1ec7n ch\u01b0\u01a1ng tr\u00ecnh s\u00e0ng l\u1ecdc ch\u1ee7 \u0111\u1ed9ng.<\/p>\n<p>Test s\u00e0ng l\u1ecdc \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng hi\u1ec7n nay \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng b\u1eb1ng c\u00e1ch cho s\u1ea3n ph\u1ee5 u\u1ed1ng 50g glucose v\u00e0o gi\u1eefa tu\u1ea7n 24-28 c\u1ee7a thai k\u1ef3 b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m n\u00e0o trong ng\u00e0y, b\u1ea5t k\u1ef3 th\u1eddi gian n\u00e0o sau \u0103n. N\u1ebfu glucose huy\u1ebft 1 gi\u1edd sau test \u2265140mg\/dL (7,8 mmol\/L), nh\u1eefng ng\u01b0\u1eddi n\u00e0y c\u1ea7n ti\u1ebfp t\u1ee5c l\u00e0m nghi\u1ec7m ph\u00e1p dung n\u1ea1p glucose b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n \u0110T\u0110.<\/p>\n<p><strong>1.1 Chi\u1ebfn l\u01b0\u1ee3c t\u1ea7m so\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n \u0110T\u0110TN d\u1ef1a tr\u00ean c\u00e1c nguy c\u01a1: <\/strong><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Nguy c\u01a1 th\u1ea5p: kh\u00f4ng \u0111\u00f2i h\u1ecfi test glucose th\u01b0\u1eddng quy n\u1ebfu c\u00f3 t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>+ Thu\u1ed9c ch\u1ee7ng t\u1ed9c c\u00f3 t\u1ef7 l\u1ec7 \u0110T\u0110TN th\u1ea5p<\/p>\n<p>+ Kh\u00f4ng c\u00f3 ng\u01b0\u1eddi th\u00e2n thu\u1ed9c g\u1ea7n (first degree) b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n<p>+ Tu\u1ed5i du\u1edbi 25.<\/p>\n<p>+ Th\u1ec3 tr\u1ecdng b\u00ecnh th\u01b0\u1eddng tr\u01b0\u1edbc thai k\u1ef3 (BMI &lt; 26kg\/m2).<\/p>\n<p>+ Kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ea5t th\u01b0\u1eddng chuy\u1ec3n ho\u00e1 glucose.<\/p>\n<p>+ Kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed x\u1ea5u v\u1ec1 s\u1ea3n khoa.<\/p>\n<ul>\n<li>Nguy c\u01a1 trung b\u00ecnh: ng\u01b0\u1eddi b\u1ec7nh thi\u1ebfu \u2265 1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean: th\u1ef1c hi\u1ec7n test glucose m\u00e1u v\u00e0o 24-28 tu\u1ea7n, s\u1eed d\u1ee5ng m\u1ed9t trong 2 c\u00e1ch sau:<\/li>\n<\/ul>\n<p>+ Th\u1ee7 t\u1ee5c 2 b\u01b0\u1edbc: test 50g glucose, n\u1ebfu glucose tr\u00ean chu\u1ea9n s\u00e0ng l\u1ecdc, th\u1ef1c hi\u1ec7n ti\u1ebfp nghi\u1ec7m ph\u00e1p dung n\u1ea1p glucose.<\/p>\n<p>+ Th\u1ee7 t\u1ee5c 1 b\u01b0\u1edbc: th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p dung n\u1ea1p glucose tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng.<\/p>\n<ul>\n<li>Nguy c\u01a1 cao: ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u2265 1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau:<\/li>\n<\/ul>\n<p>+ B\u00e9o ph\u00ec r\u00f5 (BMI &gt; 40kg\/m2)<\/p>\n<p>+ Ti\u1ec1n s\u1eed gia \u0111\u00ecnh \u0110T\u0110 type 2 r\u00f5 .<\/p>\n<p>+ Ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n\u00a0 b\u1ecb \u0110T\u0110TN, gi\u1ea3m dung n\u1ea1p glucose, glucose ni\u1ec7u.<\/p>\n<p>+ Th\u1ef1c hi\u1ec7n test glucose m\u00e1u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, \u00e1p d\u1ee5ng c\u00e1c b\u01a3\u1edbc th\u1ee7 t\u1ee5c n\u00eau tr\u00ean.<\/p>\n<p>+ N\u1ebfu \u0110T\u0110TN ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, c\u1ea7n l\u00e0m l\u1ea1i v\u00e0o 24-28 tu\u1ea7n, ho\u1eb7c t\u1ea1i b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m n\u00e0o ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n g\u1ee3i \u00fd t\u0103ng glucose m\u00e1u.<\/p>\n<figure id=\"attachment_31589\" aria-describedby=\"caption-attachment-31589\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-31589\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Thiet-ke-chua-co-ten-30-300x300.png\" alt=\"\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Thiet-ke-chua-co-ten-30-300x300.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Thiet-ke-chua-co-ten-30-1024x1024.png 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Thiet-ke-chua-co-ten-30-150x150.png 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Thiet-ke-chua-co-ten-30-768x768.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Thiet-ke-chua-co-ten-30.png 1080w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-31589\" class=\"wp-caption-text\">\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n<\/figcaption><\/figure>\n<p><strong>1.2 Ch\u1ea9n \u0111o\u00e1n\u00a0<\/strong><\/p>\n<p>H\u1ed9i ngh\u1ecb qu\u1ed1c t\u1ebf \u0110T\u0110TN l\u1ea7n th\u1ee9 4 \u0111\u00e3 \u0111\u1ec1 ngh\u1ecb n\u00ean s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n c\u1ee7a Carpenter-Coustan v\u1edbi test 100g glucose u\u1ed1ng.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-31577\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Anh-chup-Man-hinh-2023-05-04-luc-09.04.34-300x143.png\" alt=\"Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0110T\u0110TN \" width=\"466\" height=\"222\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Anh-chup-Man-hinh-2023-05-04-luc-09.04.34-300x143.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Anh-chup-Man-hinh-2023-05-04-luc-09.04.34-1024x489.png 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Anh-chup-Man-hinh-2023-05-04-luc-09.04.34-768x366.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Anh-chup-Man-hinh-2023-05-04-luc-09.04.34.png 1396w\" sizes=\"(max-width: 466px) 100vw, 466px\" \/><\/p>\n<p><strong>Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0110T\u0110TN<\/strong><\/p>\n<p>Test v\u1edbi 100g glucose th\u1ef1c hi\u1ec7n v\u00e0o bu\u1ed5i s\u00e1ng, nh\u1ecbn \u0111\u00f3i qua \u0111\u00eam \u00edt nh\u1ea5t 8 gi\u1edd nh\u01b0ng kh\u00f4ng qu\u00e1 14 gi\u1edd, sau 3 ng\u00e0y \u0103n kh\u00f4ng ki\u00eang ( \u2265 150g carbohydrate\/ng\u00e0y)\u00a0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c b\u00ecnh th\u01b0\u1eddng, \u0111\u1ed1i t\u01b0\u1ee3ng ng\u1ed3i ngh\u1ec9, kh\u00f4ng h\u00fat thu\u1ed1c trong qu\u00e1 tr\u00ecnh test.<\/p>\n<p>Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u2265 2 tr\u1ecb s\u1ed1 glucose huy\u1ebft t\u01b0\u01a1ng b\u1eb1ng ho\u1eb7c cao h\u01a1n tr\u1ecb s\u1ed1 quy \u0111\u1ecbnh l\u00e0 \u0111\u1ee7 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/p>\n<h2>2. Ch\u0103m s\u00f3c ti\u1ec1n s\u1ea3n<\/h2>\n<p><strong><span class=\"h2 xhash_H4_scrollTarget\">2.1 Qu\u1ea3n l\u00fd glucose<\/span><\/strong><\/p>\n<p>Qu\u1ea3n l\u00fd glucose \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c glucose trong ph\u1ea1m vi m\u1ee5c ti\u00eau l\u00e0 bi\u1ec7n ph\u00e1p can thi\u1ec7p ch\u00ednh \u0111\u1ec3 gi\u1ea3m t\u1ea7n su\u1ea5t v\u00e0\/ho\u1eb7c m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn \u0110T\u0110TN<\/p>\n<p>+ T\u1ef1 theo d\u00f5i: M\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft \u0111\u01b0\u1ee3c ki\u1ec3m tra tr\u01b0\u1edbc b\u1eefa \u0103n s\u00e1ng (ngh\u0129a l\u00e0 m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i) v\u00e0 m\u1ed9t ho\u1eb7c hai gi\u1edd sau khi b\u1eaft \u0111\u1ea7u m\u1ed7i b\u1eefa \u0103n.<\/p>\n<p>+ M\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft tr\u01b0\u1edbc sinh th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0:<\/p>\n<ul>\n<li class=\"bulletIndent2\">N\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i: &lt;95 mg\/dL (5,3 mmol\/L)<\/li>\n<li class=\"bulletIndent2\">N\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng huy\u1ebft sau \u0103n m\u1ed9t gi\u1edd: &lt;140 mg\/dL (7,8 mmol\/L)<\/li>\n<li class=\"bulletIndent2\">N\u1ed3ng \u0111\u1ed9 glucose sau \u0103n hai gi\u1edd: &lt;120 mg\/dL (6,7 mmol\/L)<\/li>\n<\/ul>\n<p>Theo d\u00f5i l\u01b0\u1ee3ng \u0111\u01b0\u1eddng trong m\u00e1u, li\u1ec7u ph\u00e1p dinh d\u01b0\u1ee1ng y t\u1ebf, t\u1eadp th\u1ec3 d\u1ee5c v\u00e0 s\u1eed d\u1ee5ng insulin v\u00e0\/ho\u1eb7c thu\u1ed1c u\u1ed1ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 duy tr\u00ec c\u00e1c m\u1ee5c ti\u00eau n\u00e0y<\/p>\n<p><strong>2.2 Theo d\u00f5i s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a thai nhi<\/strong><\/p>\n<p>Th\u01b0\u1eddng tr\u1ea3i qua x\u00e9t nghi\u1ec7m thai nhi \u0111\u1ecbnh k\u1ef3, th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u v\u00e0o kho\u1ea3ng 32 tu\u1ea7n tu\u1ed5i thai. Th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u x\u00e9t nghi\u1ec7m trong tam c\u00e1 nguy\u1ec7t th\u1ee9 ba, t\u1ea7n su\u1ea5t x\u00e9t nghi\u1ec7m v\u00e0 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng (NST, BPP ho\u1eb7c c\u1ea3 hai) kh\u00e1c nhau t\u00f9y theo c\u01a1 s\u1edf v\u00e0 c\u01a1 s\u1edf th\u1ef1c h\u00e0nh.<\/p>\n<p>ACOG \u0111\u1ec1 ngh\u1ecb \u0111\u00e1nh gi\u00e1 thai nhi b\u1eaft \u0111\u1ea7u t\u1eeb tu\u1ea7n th\u1ee9 32 c\u1ee7a thai k\u1ef3 \u0111\u1ed1i v\u1edbi (1) b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng insulin ho\u1eb7c thu\u1ed1c u\u1ed1ng, ngay c\u1ea3 khi \u0111\u1ea1t \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft t\u1ed1t b\u1eb1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c v\u00e0 (2) b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u b\u1eb1ng li\u1ec7u ph\u00e1p dinh d\u01b0\u1ee1ng y t\u1ebf<\/p>\n<p>Th\u1ef1c hi\u1ec7n si\u00eau \u00e2m m\u1ed9t l\u1ea7n trong tam c\u00e1 nguy\u1ec7t th\u1ee9 ba \u1edf tu\u1ea7n th\u1ee9 36 \u0111\u1ebfn 39 \u0111\u1ec3 \u01b0\u1edbc t\u00ednh c\u00e2n n\u1eb7ng c\u1ee7a thai nhi \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n m\u1eafc \u0110T\u0110TN, b\u1ea5t k\u1ec3 m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t chuy\u1ec3n h\u00f3a hay nhu c\u1ea7u insulin hay thu\u1ed1c u\u1ed1ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Macrosomia l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 trong vi\u1ec7c ra quy\u1ebft \u0111\u1ecbnh v\u1ec1 \u0111\u01b0\u1eddng sinh.<\/p>\n<p><strong>2.3 Qu\u1ea3n l\u00fd c\u00e1c bi\u1ebfn ch\u1ee9ng ti\u1ec1n s\u1ea3n<\/strong><\/p>\n<p>Ti\u1ec1n s\u1ea3n gi\u1eadt v\u00e0 t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3: Qu\u1ea3n l\u00fd ti\u1ec1n s\u1ea3n gi\u1eadt v\u00e0 t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 \u0110T\u0110TN. Labetalol c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng<\/p>\n<p id=\"xhash_H3528885952\" class=\"headingAnchor\">Chuy\u1ec3n d\u1ea1 sinh non \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd gi\u1ed1ng nh\u01b0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 \u0110TNTN. Indomethacin\u00a0v\u00e0\u00a0nifedipine\u00a0l\u00e0 thu\u1ed1c \u0111\u1ea7u tay \u0111\u1ec3 gi\u1ea3m co, v\u1edbi s\u1ef1 l\u1ef1a ch\u1ecdn ph\u1ee5 thu\u1ed9c v\u00e0o tu\u1ed5i thai.\u00a0N\u1ebfu nh\u1eefng thu\u1ed1c n\u00e0y b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh,\u00a0terbutaline c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, nh\u01b0ng c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd n\u1ed3ng \u0111\u1ed9 glucose c\u1ee7a m\u1eb9 v\u00ec ch\u1ea5t ch\u1ee7 v\u1eadn beta l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 glucose. \u0110\u1ed1i v\u1edbi m\u1ee9c \u0111\u1ed9 l\u00fac \u0111\u00f3i &gt;100 mg\/dL (5,5 mmol\/L) ho\u1eb7c m\u1ee9c \u0111\u1ed9 sau khi \u0103n &gt;140 mg\/mL (7,8 mmol\/L), \u0111i\u1ec1u tr\u1ecb b\u1eb1ng insulin ti\u00eam d\u01b0\u1edbi da. D\u00f9ng \u0111\u1ed3ng th\u1eddi corticosteroid tr\u01b0\u1edbc khi sinh l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 glucose.<\/p>\n<p>S\u1eed d\u1ee5ng corticosteroid tr\u01b0\u1edbc sinh (ACS), n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh, c\u00f3 t\u00e1c d\u1ee5ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, b\u1eaft \u0111\u1ea7u kho\u1ea3ng 12 gi\u1edd sau li\u1ec1u steroid \u0111\u1ea7u ti\u00ean v\u00e0 k\u00e9o d\u00e0i kho\u1ea3ng n\u0103m ng\u00e0y.\u00a0Theo d\u00f5i n\u1ed3ng \u0111\u1ed9 glucose trong m\u00e1u mao m\u1ea1ch th\u01b0\u1eddng xuy\u00ean (v\u00ed d\u1ee5: \u00edt nh\u1ea5t b\u1ed1n l\u1ea7n m\u1ed7i ng\u00e0y, nh\u01b0ng th\u01b0\u1eddng xuy\u00ean h\u01a1n t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c glucose v\u00e0 m\u1ee9c \u0111\u1ed9 kh\u00f3 ki\u1ec3m so\u00e1t) b\u1eaft \u0111\u1ea7u 12 gi\u1edd sau li\u1ec1u betamethasone \u0111\u1ea7u ti\u00ean v\u00e0 ti\u1ebfp t\u1ee5c trong 24 gi\u1edd sau li\u1ec1u th\u1ee9 hai.\u00a0Sau \u0111\u00f3, gi\u1ea3m t\u1ea7n su\u1ea5t xu\u1ed1ng b\u1ed1n l\u1ea7n m\u1ed7i ng\u00e0y n\u1ebfu m\u1ee9c glucose \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t h\u1ee3p l\u00fd. N\u1ebfu m\u1ee9c l\u00fac \u0111\u00f3i v\u01b0\u1ee3t qu\u00e1 100 mg\/dL (5,5 mmol\/L) ho\u1eb7c m\u1ee9c sau khi \u0103n v\u01b0\u1ee3t qu\u00e1 140 mg\/mL (7,8 mmol\/L),\u00a0 s\u1ebd \u0111i\u1ec1u tr\u1ecb b\u1eb1ng insulin ti\u00eam d\u01b0\u1edbi da. B\u1eaft \u0111\u1ea7u truy\u1ec1n insulin t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c tr\u00ean \u0111\u01a1n v\u1ecb chuy\u1ec3n d\u1ea1 n\u1ebfu c\u00e1c gi\u00e1 tr\u1ecb li\u00ean t\u1ee5c t\u0103ng cao b\u1ea5t ch\u1ea5p s\u1ef1 leo thang c\u1ee7a ph\u00e1c \u0111\u1ed3 ti\u00eam d\u01b0\u1edbi da ho\u1eb7c n\u1ebfu c\u00e1c gi\u00e1 tr\u1ecb ban \u0111\u1ea7u tr\u00ean 180 mg\/dL (10,0 mmol\/L). ACS th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf tu\u1ed5i thai \u226534 tu\u1ea7n \u1edf b\u1ec7nh nh\u00e2n ti\u1ec3u \u0111\u01b0\u1eddng<\/p>\n<p><strong>2.4 Thai to v\u00e0 d\u1ef1 \u0111o\u00e1n ph\u01b0\u01a1ng ph\u00e1p sinh\u00a0<\/strong><\/p>\n<p>Thai to (th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u22654500 gram trong \u0110T\u0110TN) \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1eb1ng si\u00eau \u00e2m v\u00e0 th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi \u0111a \u1ed1i. M\u1ed9t m\u1ed1i quan t\u00e2m l\u1edbn l\u00e0 nguy c\u01a1 m\u1eafc ch\u1ee9ng kh\u00f3 l\u1ecdt vai trong qu\u00e1 tr\u00ecnh chuy\u1ec3n d\u1ea1. Sinh m\u1ed5 theo l\u1ecbch tr\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb cho b\u1ec7nh nh\u00e2n b\u1ecb \u0110T\u0110TN . C\u00e2n n\u1eb7ng \u01b0\u1edbc t\u00ednh c\u1ee7a thai nhi l\u00e0 m\u1ed9t c\u00e2n nh\u1eafc quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh ra quy\u1ebft \u0111\u1ecbnh \u0111\u1ec1 ph\u01b0\u01a1ng ph\u00e1p sinh.<\/p>\n<p>M\u1ed9t trong nh\u1eefng v\u1ea5n \u0111\u1ec1 ch\u00ednh trong qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n \u0110T\u0110TN l\u00e0 c\u00f3 n\u00ean g\u00e2y chuy\u1ec3n d\u1ea1 hay kh\u00f4ng v\u00e0 n\u1ebfu c\u00f3 th\u00ec khi n\u00e0o. Nh\u1eefng l\u1ee3i \u00edch ti\u1ec1m n\u0103ng ch\u00ednh c\u1ee7a kh\u1edfi ph\u00e1t l\u00e0 tr\u00e1nh thai ch\u1ebft l\u01b0u mu\u1ed9n v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn sinh n\u1edf do thai nhi ti\u1ebfp t\u1ee5c ph\u00e1t tri\u1ec3n, ch\u1eb3ng h\u1ea1n nh\u01b0\u00a0 \u0111\u1ebb kh\u00f3 l\u1ecdt vai ho\u1eb7c sinh m\u1ed5 do thai kh\u00f4ng ti\u1ebfn tri\u1ec3n.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n (\u0110TNTN) l\u00e0 s\u1ef1 gi\u1ea3m dung n\u1ea1p glucose ho\u1eb7c \u0110T\u0110 (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng) \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n l\u1ea7n \u0111\u1ea7u trong l\u00fac mang thai (kh\u00f4ng lo\u1ea1i tr\u1eeb ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 c\u00f3 gi\u1ea3m dung n\u1ea1p glucose ho\u1eb7c \u0110T\u0110 t\u1eeb tr\u01b0\u1edbc nh\u01b0ng ch\u01b0a \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n).\u00a0 1. Ph\u00e1t hi\u1ec7n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n (\u0110TNTN) [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n: ch\u1ea9n \u0111o\u00e1n, ch\u0103m s\u00f3c ti\u1ec1n s\u1ea3n - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n (\u0110TNTN) l\u00e0 s\u1ef1 gi\u1ea3m dung n\u1ea1p glucose ho\u1eb7c \u0110T\u0110 (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng) \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n l\u1ea7n \u0111\u1ea7u trong l\u00fac mang thai\" \/>\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=\"\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai ngh\u00e9n: ch\u1ea9n \u0111o\u00e1n, ch\u0103m s\u00f3c ti\u1ec1n s\u1ea3n - 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