{"id":35925,"date":"2023-06-30T23:08:54","date_gmt":"2023-06-30T16:08:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=35925"},"modified":"2023-06-30T23:19:11","modified_gmt":"2023-06-30T16:19:11","slug":"xuat-huyet-tu-cung-bat-thuong-nguyen-nhan-va-cach-nhan-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/30\/xuat-huyet-tu-cung-bat-thuong-nguyen-nhan-va-cach-nhan-biet\/","title":{"rendered":"Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng: Nguy\u00ean nh\u00e2n v\u00e0 c\u00e1ch nh\u1eadn bi\u1ebft"},"content":{"rendered":"<p><strong>Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng (XHTCBT) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 xu\u1ea5t huy\u1ebft t\u1eeb t\u1eed cung, \u00e2m \u0111\u1ea1o ho\u1eb7c c\u00e1c ph\u1ea7n ph\u1ee5 kh\u00f4ng li\u00ean quan \u0111\u1ebfn chu k\u1ef3 kinh ho\u1eb7c kh\u00e1c so v\u1edbi chu k\u1ef3 kinh \u1edf b\u1ea5t k\u1ef3 m\u1ed9t trong c\u00e1c h\u00ecnh th\u1ee9c sau: thay \u0111\u1ed5i v\u1ec1 t\u00ednh chu k\u1ef3, s\u1ed1 ng\u00e0y h\u00e0nh kinh, l\u01b0\u1ee3ng m\u00e1u \u00a0v\u00e0 tri\u1ec7u ch\u1ee9ng k\u00e8m theo. XHTCBT l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p. \u00a0\u1ea2nh h\u01b0\u1edfng \u0111\u1ebfn 1\/3 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n kh\u00f3, \u0111\u00f4i khi kh\u00f4ng t\u00ecm ra nguy\u00ean nh\u00e2n.<\/strong><\/p>\n<figure id=\"attachment_35926\" aria-describedby=\"caption-attachment-35926\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-35926 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/R-1-300x200.jpg\" alt=\"Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng\" width=\"300\" height=\"200\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/R-1-300x200.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/R-1-1024x682.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/R-1-768x512.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/R-1-1536x1023.jpg 1536w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/R-1.jpg 1698w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-35926\" class=\"wp-caption-text\">Pretty young brunette suffering from stomach ache while sitting in a sofa<\/figcaption><\/figure>\n<h2>1. Chu k\u1ef3 kinh nguy\u1ec7t b\u00ecnh th\u01b0\u1eddng<\/h2>\n<ul>\n<li>Kinh nguy\u1ec7t: Xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o do n\u1ed9i m\u1ea1c t\u1eed cung bong tr\u00f3c do n\u1ed9i ti\u1ebft &#8211; T\u00ednh chu k\u00ec, \u0111\u1eb7c \u0111i\u1ec3m c\u1ed1 \u0111\u1ecbnh\/C\u00e1 nh\u00e2n.<\/li>\n<li>\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a k\u1ef3 kinh nguy\u1ec7t b\u00ecnh th\u01b0\u1eddng:<\/li>\n<li>Chu k\u1ef3: # 28 ng\u00e0y (25-32)<\/li>\n<li>Th\u1eddi gian h\u00e0nh kinh: 3 &#8211; 7 ng\u00e0y<\/li>\n<li>L\u01b0\u1ee3ng kinh: # 33-80 ml (&gt;80 ml: b\u1ec7nh l\u00fd)<\/li>\n<li>M\u00e1u m\u00e0u \u0111\u1ecf s\u1eadm, lo\u00e3ng, \u00edt m\u00e1u c\u1ee5c, kh\u00f4ng \u0111\u00f4ng m\u00f9i tanh<\/li>\n<li>Tri\u1ec7u ch\u1ee9ng k\u00e8m theo: \u0111au b\u1ee5ng, c\u0103ng t\u1ee9c ng\u1ef1c,&#8230; t\u00f9y v\u00e0o c\u00e1 nh\u00e2n<\/li>\n<\/ul>\n<h2>2. C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o b\u1ea5t th\u01b0\u1eddng.<\/h2>\n<p>Nguy\u00ean t\u1eafc PALM-COEIN v\u1edbi hai nh\u00f3m<\/p>\n<p><strong>. Nguy\u00ean nh\u00e2n thu\u1ed9c v\u1ec1 c\u1ea5u tr\u00fac:<\/strong><br \/>\nP: Polyps<br \/>\nA: Adenomyosis: l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung<br \/>\nL: Leiomyomas: u x\u01a1 t\u1eed cung<br \/>\nM: Malignancy and Hyperplasia: <u>T\u0103ng s\u1ea3n ho\u0103c nguy\u00ean nh\u00e2n \u00e1c t\u00ednh:<\/u><br \/>\n<strong>\u00a0Nguy\u00ean nh\u00e2n ch\u1ee9c n\u0103ng<\/strong><br \/>\nC: Coagulopathy: \u0110\u00f4ng m\u00e1u<br \/>\nO: Ovulatory dysfunction: xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng<br \/>\nE: Endometrial: nguy\u00ean nh\u00e2n thu\u1ed9c ni\u00eam m\u1ea1c t\u1eed cung<br \/>\nI: Iatrogenic: do thu\u1ed1c<br \/>\nN: Not yet specified: kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n<\/p>\n<p><strong><u>2.1 Polyp:<\/u><\/strong><\/p>\n<ul>\n<li>Si\u00eau \u00e2m b\u1ee5ng, Si\u00eau \u00e2m qua ng\u00e3 \u00e2m \u0111\u1ea1o, N\u1ed9i soi t\u1eed cung (Hysteroscope) +- sinh thi\u1ebft.<\/li>\n<li>Th\u01b0\u1eddng l\u00e0nh t\u00ednh nh\u01b0ng 1 s\u1ed1 nh\u1ecf \u00edt c\u00f3 th\u1ec3 kh\u00f4ng \u0111i\u1ec3n h\u00ecnh ho\u1eb7c \u00e1c t\u00ednh (T\u0103ng l\u00ean \u1edf ng\u01b0\u1eddi m\u00e3n kinh).<\/li>\n<li>C\u1ea7n ph\u00e2n bi\u1ec7t Polyp n\u1ed9i m\u1ea1c t\u1eed cung (Endometrial polyp) v\u1edbi U x\u01a1 t\u1eed cung d\u01b0\u1edbi ni\u00eam (Submucosal fibrosis)<\/li>\n<\/ul>\n<p><strong><u>2.2 L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung<\/u><u> trong c\u01a1 t\u1eed cung:<\/u><\/strong><\/p>\n<ul>\n<li>L\u00e0 ch\u1ea9n \u0111o\u00e1n gi\u1ea3i ph\u1eabu b\u1ec7nh -&gt; c\u1eaft t\u1eed cung (hysterectomy)<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n g\u1ee3i \u00fd tr\u00ean si\u00eau \u00e2m v\u00e0 MRI<\/li>\n<\/ul>\n<p><strong><u>2.3 U x\u01a1 t\u1eed cung:<\/u><\/strong><\/p>\n<ul>\n<li>\u0110\u1eb7c bi\u1ec7t u d\u01b0\u1edbi ni\u00eam<\/li>\n<li>Ch\u1ecbu \u1ea3nh h\u01b0\u1edfng c\u1ee7a estrogen<\/li>\n<li>C\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi Leiomyosarcoma<\/li>\n<\/ul>\n<p><strong><u>2.4 T\u0103ng s\u1ea3n ho\u1eb7c nguy\u00ean nh\u00e2n \u00e1c t\u00ednh:<\/u><\/strong><\/p>\n<ul>\n<li>T\u0103ng sinh n\u1ed9i m\u1ea1c t\u1eed cung (Endometrial hyperplasia)<\/li>\n<li>Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung (Endometrial carcinoma)<\/li>\n<li>Uterine sarcomas:<\/li>\n<\/ul>\n<p><strong>2.5\u00a0 Ung th\u01b0 c\u01a1 t\u1eed cung (Leiomyosarcoma)<\/strong><\/p>\n<p>o Endometrial stromal tumors<\/p>\n<p><strong><u>2.6 B\u1ec7nh l\u00fd \u0111\u00f4ng m\u00e1u<\/u><\/strong><\/p>\n<p><strong><u>2.7 Xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng:<\/u><\/strong><\/p>\n<p>Endocrinologic causes (Do n\u1ed9i ti\u1ebft)<\/p>\n<ul>\n<li>Lo\u1ea1i tr\u1eeb b\u1ec7nh th\u1ef1c th\u1ec3 (Organic), h\u1ec7 th\u1ed1ng (Systemic) v\u00e0 thu\u1ed1c =&gt; ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb.<\/li>\n<\/ul>\n<p>Chia 2 nh\u00f3m:<\/p>\n<ul>\n<li><strong><em>Chu k\u1ef3 kh\u00f4ng ph\u00f3ng no\u00e3n<\/em> (<\/strong>Anovulatory DUB): chi\u1ebfm 80-90% DUB, kinh kh\u00f4ng \u0111\u1ec1u, l\u01b0\u1ee3ng kinh v\u00e0 th\u1eddi gian h\u00e0nh kinh thay \u0111\u1ed5i.<\/li>\n<\/ul>\n<p>o D\u1eady th\u00ec: Tr\u1ee5c h\u1ea1 \u0111\u1ed3i &#8211; tuy\u1ebfn y\u00ean- bu\u1ed3ng tr\u1ee9ng ch\u01b0a tr\u01b0\u1edfng th\u00e0nh<\/p>\n<p>o Quanh m\u00e3n kinh: C\u00e1c nang tr\u1ee9ng kh\u00f4ng \u0111\u00e1p \u1ee9ng.<\/p>\n<ul>\n<li><strong><em>Chu k\u1ef3 c\u00f3 ph\u00f3ng no\u00e3n<\/em> <\/strong>(Ovulatory DUB): 10-20% DUB, chu k\u1ef3 kinh b\u00ecnh th\u01b0\u1eddng, ra huy\u1ebft ki\u1ec3u rong kinh.<\/li>\n<\/ul>\n<p>Sinh l\u00fd b\u1ec7nh:<\/p>\n<p><em>Chu k\u1ef3 kh\u00f4ng ph\u00f3ng no\u00e3n:<\/em><\/p>\n<p><em>o<\/em> NMTC m\u1ea5t \u0111i s\u1ef1 k\u00edch th\u00edch c\u1ee7a n\u1ed9i ti\u1ebft m\u1ed9t c\u00e1ch c\u00f3 chu k\u1ef3 t\u1eeb c\u00e1c chu k\u1ef3 c\u00f3 ph\u00f3ng no\u00e3n. NMTC ch\u1ecbu t\u00e1c \u0111\u1ed9ng k\u00edch th\u00edch c\u1ee7a estrogen \u0111\u01a1n \u0111\u1ed9c k\u00e9o d\u00e0i. N\u1ed9i m\u1ea1c t\u1eed cung t\u0103ng tr\u01b0\u1edfng li\u00ean t\u1ee5c nh\u01b0ng kh\u00f4ng bong ra m\u1ed9t c\u00e1ch c\u00f3 chu k\u1ef3 l\u00e0m cho c\u00e1c m\u1ea1ch m\u00e1u nu\u00f4i kh\u00f4ng theo k\u1ecbp \u0111\u1ec3 cung c\u1ea5p m\u00e1u cho NMTC =&gt; M\u00f4 NMTC b\u1ecb thi\u1ebfu m\u00e1u, ho\u1ea1i t\u1eed kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u, bong ra, g\u00e2y xu\u1ea5t huy\u1ebft t\u1eed cung.<\/p>\n<p>o Ch\u1ea3y m\u00e1u trong chu k\u1ef3 kh\u00f4ng ph\u00f3ng no\u00e3n \u0111\u01b0\u1ee3c cho l\u00e0 k\u1ebft qu\u1ea3 t\u1eeb s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 c\u1ea5u tr\u00fac, s\u1ef1 t\u1eadp trung c\u1ee7a prostaglandin v\u00e0 t\u1eeb s\u1ef1 t\u0103ng \u0111\u00e1p \u1ee9ng c\u1ee7a n\u1ed9i m\u1ea1c t\u1eed cung v\u1edbi prostaglandin g\u00e2y gi\u00e3n m\u1ea1ch.<\/p>\n<p><em>Chu k\u1ef3 c\u00f3 ph\u00f3ng no\u00e3n<\/em>:<\/p>\n<p>o \u0110\u01b0\u1ee3c cho l\u00e0 xu\u1ea5t ph\u00e1t ch\u1ee7 y\u1ebfu t\u1eeb s\u1ef1 gi\u00e3n n\u1edf m\u1ea1ch m\u00e1u.<\/p>\n<p>o C\u00e1c m\u1ea1ch m\u00e1u cung c\u1ea5p cho n\u1ed9i m\u1ea1c t\u1eed cung \u0111\u00e3 b\u1ecb gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u v\u00e0 do \u0111\u00f3 l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 m\u1ea5t m\u00e1u do gi\u00e3n m\u1ea1ch. M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n: li\u00ean quan \u0111\u1ebfn prostaglandin.<\/p>\n<p>Nguy\u00ean nh\u00e2n:<\/p>\n<ul>\n<li><strong>Tu\u1ed5i d\u1eady th\u00ec: <\/strong>trong v\u00f2ng 18 th\u00e1ng \u0111\u1ea7u sau l\u1ea7n \u0111\u1ea7u ti\u00ean c\u00f3 kinh, tr\u1ee5c h\u1ea1 \u0111\u1ed3i-tuy\u1ebfn y\u00ean-bu\u1ed3ng tr\u1ee9ng ch\u01b0a tr\u01b0\u1edfng th\u00e0nh ho\u00e0n to\u00e0n -&gt; kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 v\u1edbi estrogen v\u00e0 progesterone -&gt; kh\u00f4ng ph\u00f3ng no\u00e3n.<\/li>\n<li><strong>Ph\u1ee5 n\u1eef l\u1edbn tu\u1ed5i, ti\u1ec1n m\u00e3n kinh: <\/strong>s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng nang no\u00e3n gi\u1ea3m -&gt; C\u00e1c nang no\u00e3n v\u1eabn ph\u00e1t tri\u1ec3n nh\u01b0ng kh\u00f4ng s\u1ea3n xu\u1ea5t \u0111\u1ee7 l\u01b0\u1ee3ng estrogen \u0111\u1ec3 t\u1ea1o \u0111\u1ec9nh LH g\u00e2y ph\u00f3ng no\u00e3n -&gt; Nang kh\u00f4ng ph\u00f3ng no\u00e3n v\u1eabn ti\u1ebfp t\u1ee5c s\u1ea3n xu\u1ea5t estrogen l\u01b0\u1ee3ng \u00edt k\u00e9o d\u00e0i, l\u00e0m d\u00e0y n\u1ed9i m\u1ea1c t\u1eed cung -&gt; xu\u1ea5t huy\u1ebft t\u1eed cung do ti\u1ebfp x\u00fac estrogen k\u00e9o d\u00e0i.<\/li>\n<li><strong>Ph\u1ee5 n\u1eef b\u00e9o ph\u00ec: <\/strong>estrogen t\u1eeb ngu\u1ed3n g\u1ed1c ngo\u00e0i bu\u1ed3ng tr\u1ee9ng t\u00edch l\u0169y v\u00e0 l\u00e0m d\u00e0y NMTC -&gt; xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng do ti\u1ebfp x\u00fac estrogen k\u00e9o d\u00e0i.<\/li>\n<li><strong>Thi\u1ebfu h\u1ee5t giai \u0111o\u1ea1n ho\u00e0ng th\u1ec3: <\/strong>s\u1ea3n xu\u1ea5t progesterone b\u1ecb gi\u1ea3m hay g\u00e2y t\u00e1c \u0111\u1ed9ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 -&gt; K\u00edch th\u00edch kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 c\u1ee7a progesterone c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi n\u1ed3ng \u0111\u1ed9 estrogen b\u00ecnh th\u01b0\u1eddng, cao hay th\u1ea5p s\u1ebd g\u00e2y ra v\u1ea5n \u0111\u1ec1 gi\u1ed1ng nh\u01b0 chu k\u1ef3 kh\u00f4ng ph\u00f3ng no\u00e3n.<\/li>\n<\/ul>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft g\u00e2y ra xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng:<\/p>\n<p>o T\u0103ng prolactin m\u00e1u \u1ee9c ch\u1ebf s\u1ef1 s\u1ea3n xu\u1ea5t v\u00e0 gi\u1ea3i ph\u00f3ng GnRH g\u00e2y r\u1ed1i lo\u1ea1n tr\u1ee5c h\u1ea1 \u0111\u1ed3i-tuy\u1ebfn y\u00ean-bu\u1ed3ng tr\u1ee9ng.<\/p>\n<p>o H\u1ed9i ch\u1ee9ng bu\u1ed3ng tr\u1ee9ng \u0111a nang: th\u01b0\u1eddng t\u1ea1o ra c\u00e1c chu k\u1ef3 kh\u00f4ng ph\u00f3ng no\u00e3n, g\u00e2y ra xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng.<\/p>\n<p><strong>Xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng do s\u1eed d\u1ee5ng n\u1ed9i ti\u1ebft ngo\u1ea1i lai:<\/strong><\/p>\n<p>o Thu\u1ed1c vi\u00ean ng\u1eeba thai c\u00f3 li\u1ec1u estrogen th\u1ea5p: xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng th\u01b0\u1eddng theo ki\u1ec3u nh\u1eb9 v\u00e0 k\u00e9o d\u00e0i do NMTC kh\u00f4ng \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb \u0111\u1ea7y \u0111\u1ee7 v\u1edbi estrogen.<\/p>\n<p>o Thu\u1ed1c ng\u1eeba thai kh\u1ea9n c\u1ea5p c\u00f3 li\u1ec1u progestin cao: g\u00e2y xu\u1ea5t huy\u1ebft t\u1eed cung ch\u1ee9c n\u0103ng do m\u1ea5t s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa estrogen v\u00e0 progesterone.<\/p>\n<p>o Que c\u1ea5y tr\u00e1nh thai ch\u1ee9a progestin, thu\u1ed1c ti\u00eam progestin li\u1ec1u cao, vi\u00ean thu\u1ed1c ch\u1ec9 c\u00f3 progestin: xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng do m\u1ea5t c\u00e2n b\u1eb1ng estrogen v\u00e0 progesterone.<\/p>\n<p><strong>2.7 Do thu\u1ed1c:<\/strong> m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c g\u00e2y xu\u1ea5t huy\u1ebft t\u1eed cung nh\u01b0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u, thu\u1ed1c n\u1ed9i ti\u1ebft ngo\u1ea1i sinh.<\/p>\n<h2>3. Ti\u1ebfp c\u1eadn b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng:<\/h2>\n<ul>\n<li>Lo\u1ea1i tr\u1eeb ngu\u1ed3n g\u1ed1c xu\u1ea5t huy\u1ebft t\u1eeb: b\u00e0ng quang, ni\u1ec7u \u0111\u1ea1o, tr\u1ef1c tr\u00e0ng<\/li>\n<li>Lo\u1ea1i tr\u1eeb thai.<\/li>\n<li>Xu\u1ea5t huy\u1ebft c\u00f3 ngu\u1ed3n g\u1ed1c kh\u00f4ng ph\u1ea3i t\u1eeb trong l\u00f2ng t\u1eed cung?<\/li>\n<li>\u00c2m h\u1ed9: ch\u1ea5n th\u01b0\u01a1ng, vi\u00eam nhi\u1ec5m, v\u1ee1 t\u0129nh m\u1ea1ch tr\u01b0\u1edbng, condyloma, t\u0103ng sinh l\u00e0nh t\u00ednh ho\u1eb7c \u00e1c t\u00ednh.<\/li>\n<li>\u00c2m \u0111\u1ea1o: ch\u1ea5n th\u01b0\u01a1ng, vi\u00eam nhi\u1ec5m, condyloma.<\/li>\n<li>C\u1ed5 t\u1eed cung: vi\u00eam, polyp, l\u1ed9 tuy\u1ebfn, condyloma, t\u0103ng sinh l\u00e0nh t\u00ednh, \u00e1c t\u00ednh.<\/li>\n<li>N\u1ebfu x\u00e1c \u0111\u1ecbnh l\u00e0 xu\u1ea5t huy\u1ebft t\u1eed cung:<\/li>\n<li>Ki\u1ec3u, t\u00ednh ch\u1ea5t XH<\/li>\n<li>T\u00ecm nguy\u00ean nh\u00e2n theo PALM-COEIN, theo t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n theo \u0111\u1ed9 tu\u1ed5i.<\/li>\n<li>C\u00e1c CLS c\u00e2n nh\u1eafc th\u1ef1c hi\u1ec7n.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb chung<\/li>\n<\/ul>\n<h2><strong>4. <u>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tri:<\/u><\/strong><\/h2>\n<ul>\n<li>Nguy\u00ean t\u1eafc x\u1eed tr\u00ed XHTCBT: c\u1ea7m m\u00e1u v\u00e0 t\u00e1i l\u1eadp chu k\u1ef3 kinh nguy\u1ec7t b\u00ecnh th\u01b0\u1eddng. Ch\u1ecdn l\u1ef1a bi\u1ec7n ph\u00e1p x\u1eed tr\u00ed XHTCBT d\u1ef1a tr\u00ean nhi\u1ec1u y\u1ebfu t\u1ed1: nguy\u00ean nh\u00e2n, m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u, tu\u1ed5i ng\u01b0\u1eddi ph\u1ee5 n\u1eef v\u00e0 mong mu\u1ed1n c\u00f3 thai.<\/li>\n<\/ul>\n<p><strong><u>4.1 \u0110i\u1ec1u tr\u1ecb n\u00f4i khoa:<\/u><\/strong><\/p>\n<ul>\n<li>NSAID: Ch\u1ec9 \u0111i\u1ec1u tr\u1ecb trong th\u1eddi gian ra huy\u1ebft<\/li>\n<\/ul>\n<p>o Ibuprofen: 200 &#8211; 400mg, ng\u00e0y 3 l\u1ea7n<\/p>\n<p>o Naproxen: 250mg, ng\u00e0y 3 l\u1ea7n<\/p>\n<p>o Mefenamic acid: 250mg, ng\u00e0y 3 l\u1ea7n<\/p>\n<ul>\n<li>Antofibrinolytic agents: Tranexamic acid 1mg\/4gi\u1edd trong 3 ng\u00e0y<\/li>\n<li>Thu\u1ed1c vi\u00ean ng\u1eeba thai<\/li>\n<li>Progestogens<\/li>\n<li>Danazol<\/li>\n<li>GnRH \u0111\u1ed3ng v\u1eadn<\/li>\n<\/ul>\n<p><strong><u>4.2 Ph\u1eabu thu\u00e2t:<\/u><\/strong><\/p>\n<ul>\n<li>B\u1ea3o t\u1ed3n: c\u1eaft \u0111\u1ed1t NMTC<\/li>\n<li>C\u1eaft t\u1eed cung:<\/li>\n<\/ul>\n<p>o Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/p>\n<p>o Kh\u1ed1i u to<\/p>\n<p>o Nghi ng\u1edd \u00e1c t\u00ednh<\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/trieu-chung-cach-chan-doan-lac-noi-mac-tu-cung\/\">Tri\u1ec7u ch\u1ee9ng, c\u00e1ch ch\u1ea9n \u0111o\u00e1n l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng (XHTCBT) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 xu\u1ea5t huy\u1ebft t\u1eeb t\u1eed cung, \u00e2m \u0111\u1ea1o ho\u1eb7c c\u00e1c ph\u1ea7n ph\u1ee5 kh\u00f4ng li\u00ean quan \u0111\u1ebfn chu k\u1ef3 kinh ho\u1eb7c kh\u00e1c so v\u1edbi chu k\u1ef3 kinh \u1edf b\u1ea5t k\u1ef3 m\u1ed9t trong c\u00e1c h\u00ecnh th\u1ee9c sau: thay \u0111\u1ed5i v\u1ec1 t\u00ednh chu k\u1ef3, s\u1ed1 ng\u00e0y h\u00e0nh kinh, [&hellip;]<\/p>\n","protected":false},"author":16,"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 - 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