{"id":1294,"date":"2026-02-08T11:07:10","date_gmt":"2026-02-08T04:07:10","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=1294"},"modified":"2026-02-08T11:08:40","modified_gmt":"2026-02-08T04:08:40","slug":"sieu-am-cap-cuu-xuat-huyet-am-dao-va-dau-vung-chau-o-benh-nhan-hau-san","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/sieu-am-cap-cuu-xuat-huyet-am-dao-va-dau-vung-chau-o-benh-nhan-hau-san\/","title":{"rendered":"Si\u00eau \u00e2m c\u1ea5p c\u1ee9u xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o v\u00e0 \u0111au v\u00f9ng ch\u1eadu \u1edf b\u1ec7nh nh\u00e2n h\u1eadu s\u1ea3n"},"content":{"rendered":"\n

Zeynep Vardar^1, Carolyn S. Dupuis^1, Alan J. Goldstein^1, Efaza Siddiqui^1, Baran Umut Vardar^2, Young H. Kim^1
^1 Khoa Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, Tr\u01b0\u1eddng Y \u0110\u1ea1i h\u1ecdc Massachusetts, Worcester, MA, Hoa K\u1ef3 ^2 Khoa Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, B\u1ec7nh vi\u1ec7n Saint Vincent, Worcester, MA, Hoa K\u1ef3
Li\u00ean h\u1ec7:<\/strong> Young H. Kim, MD, PhD, Khoa Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, Tr\u01b0\u1eddng Y \u0110\u1ea1i h\u1ecdc Massachusetts, 55 N Lake Ave, Worcester, MA 01655, USA Tel. +1-508-856-5740 Fax. +1-508-856-1860 E-mail: Young.Kim@umassmemorial.org
\u0110\u00e3 nh\u1eadn<\/strong> ng\u00e0y 07 th\u00e1ng 01 n\u0103m 2022. \u0110\u00e3 s\u1eeda \u0111\u1ed5i<\/strong> ng\u00e0y 11 th\u00e1ng 03 n\u0103m 2022. \u0110\u00e3 ch\u1ea5p nh\u1eadn<\/strong> ng\u00e0y 08 th\u00e1ng 04 n\u0103m 2022. Xu\u1ea5t b\u1ea3n tr\u1ef1c tuy\u1ebfn<\/strong> ng\u00e0y 08 th\u00e1ng 04 n\u0103m 2022
B\u1ea3n quy\u1ec1n<\/strong> \u00a9 2022 Hi\u1ec7p h\u1ed9i Si\u00eau \u00e2m Y h\u1ecdc H\u00e0n Qu\u1ed1c (KSUM) \u0110\u00e2y l\u00e0 b\u00e0i vi\u1ebft Truy c\u1eadp M\u1edf \u0111\u01b0\u1ee3c ph\u00e2n ph\u1ed1i theo c\u00e1c \u0111i\u1ec1u kho\u1ea3n c\u1ee7a Gi\u1ea5y ph\u00e9p Ghi c\u00f4ng Creative Commons Phi th\u01b0\u01a1ng m\u1ea1i (http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/<\/a>) cho ph\u00e9p s\u1eed d\u1ee5ng, ph\u00e2n ph\u1ed1i v\u00e0 sao ch\u00e9p phi th\u01b0\u01a1ng m\u1ea1i kh\u00f4ng h\u1ea1n ch\u1ebf tr\u00ean b\u1ea5t k\u1ef3 ph\u01b0\u01a1ng ti\u1ec7n n\u00e0o, mi\u1ec5n l\u00e0 t\u00e1c ph\u1ea9m g\u1ed1c \u0111\u01b0\u1ee3c tr\u00edch d\u1eabn \u0111\u00fang c\u00e1ch.<\/em>
https:\/\/www.e-ultrasonography.org\/journal\/view.php?doi=10.14366\/usg.22004#<\/code><\/a><\/p>\n\n\n\n

T\u00f3m t\u1eaft<\/strong> <\/p>\n\n\n\n

\u0110au v\u00f9ng ch\u1eadu v\u00e0 xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p \u1edf ph\u1ee5 n\u1eef h\u1eadu s\u1ea3n \u0111\u1ebfn ph\u00f2ng c\u1ea5p c\u1ee9u (ER). Si\u00eau \u00e2m v\u00f9ng ch\u1eadu \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n h\u1eadu s\u1ea3n c\u00f3 tri\u1ec7u ch\u1ee9ng b\u1eb1ng c\u00e1ch cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n nhanh v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh l\u00e0 ph\u00e2n bi\u1ec7t gi\u1eefa c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y \u0111au v\u00f9ng ch\u1eadu v\u00e0 xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd b\u1ea3o t\u1ed3n v\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n c\u1ea7n can thi\u1ec7p kh\u1ea9n c\u1ea5p. B\u00e0i vi\u1ebft n\u00e0y t\u1eadp trung v\u00e0o c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean si\u00eau \u00e2m c\u1ee7a c\u00e1c t\u00ecnh tr\u1ea1ng h\u1eadu s\u1ea3n th\u01b0\u1eddng g\u1eb7p khi\u1ebfn b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u1ebfn ph\u00f2ng c\u1ea5p c\u1ee9u v\u00ec xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o v\u00e0 \u0111au v\u00f9ng ch\u1eadu, bao g\u1ed3m s\u00f3t nhau, vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung, d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung, gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch t\u1eed cung, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng, kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang, v\u00e0 b\u1ee5c\/v\u1ee1 t\u1eed cung.<\/p>\n\n\n\n

\u0110i\u1ec3m ch\u00ednh<\/strong> <\/p>\n\n\n\n

Hi\u1ec3u r\u00f5 vai tr\u00f2 c\u1ee7a si\u00eau \u00e2m v\u00f9ng ch\u1eadu trong b\u1ed1i c\u1ea3nh c\u1ea5p c\u1ee9u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u0103ng huy\u1ebft h\u1eadu s\u1ea3n v\u00e0 \u0111au v\u00f9ng ch\u1eadu.<\/p>\n\n\n\n

Gi\u1edbi thi\u1ec7u<\/strong> <\/p>\n\n\n\n

Giai \u0111o\u1ea1n h\u1eadu s\u1ea3n b\u1eaft \u0111\u1ea7u ngay sau khi sinh, k\u00e9o d\u00e0i kho\u1ea3ng 6-8 tu\u1ea7n, khi \u0111\u01b0\u1eddng sinh d\u1ee5c tr\u1edf l\u1ea1i tr\u1ea1ng th\u00e1i kh\u00f4ng mang thai v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd. C\u00e1c ca t\u1eed vong li\u00ean quan \u0111\u1ebfn thai k\u1ef3 v\u1eabn l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong \u0111\u00e1ng k\u1ec3 trong th\u1ebf k\u1ef7 21 t\u1ea1i Hoa K\u1ef3. T\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn thai k\u1ef3 t\u1eeb n\u0103m 2011 \u0111\u1ebfn 2013 l\u00e0 17,0 ca tr\u00ean 100.000 ca sinh s\u1ed1ng. H\u01a1n m\u1ed9t n\u1eeda s\u1ed1 ph\u1ee5 n\u1eef n\u00e0y t\u1eed vong trong giai \u0111o\u1ea1n h\u1eadu s\u1ea3n, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 do c\u00e1c t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft ho\u1eb7c thuy\u00ean t\u1eafc. C\u00e1c t\u00ecnh tr\u1ea1ng kh\u00e1c nh\u01b0 nhi\u1ec5m tr\u00f9ng (vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung ho\u1eb7c nhi\u1ec5m tr\u00f9ng s\u1eb9o m\u1ed5 l\u1ea5y thai) v\u00e0 s\u00f3t nhau (RPOC), c\u0169ng n\u1eb1m trong s\u1ed1 c\u00e1c nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y b\u1ec7nh su\u1ea5t v\u00e0 t\u1eed su\u1ea5t \u1edf m\u1eb9, c\u00f3 th\u1ec3 c\u1ea7n nh\u1eadp vi\u1ec7n ho\u1eb7c th\u1ef1c hi\u1ec7n th\u00eam c\u00e1c th\u1ee7 thu\u1eadt. Si\u00eau \u00e2m v\u00f9ng ch\u1eadu (qua ng\u1ea3 \u00e2m \u0111\u1ea1o ho\u1eb7c qua ng\u1ea3 b\u1ee5ng) l\u00e0 k\u1ef9 thu\u1eadt h\u00ecnh \u1ea3nh ban \u0111\u1ea7u khi nghi ng\u1edd b\u1ec7nh l\u00fd h\u1eadu s\u1ea3n. C\u00e1c ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng g\u1eb7p cho si\u00eau \u00e2m trong giai \u0111o\u1ea1n h\u1eadu s\u1ea3n bao g\u1ed3m c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 ch\u1ea3y m\u00e1u qu\u00e1 nhi\u1ec1u\/ k\u00e9o d\u00e0i, \u0111au d\u1eef d\u1ed9i v\u00e0 s\u1ed1t. C\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00e1c nh\u01b0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 th\u00eam sau khi \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u b\u1eb1ng si\u00eau \u00e2m.<\/p>\n\n\n\n

C\u00e1c ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng g\u1eb7p cho ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh h\u1eadu s\u1ea3n<\/strong> <\/p>\n\n\n\n

Si\u00eau \u00e2m v\u00f9ng ch\u1eadu l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n h\u1ed7 tr\u1ee3 cho vi\u1ec7c th\u0103m kh\u00e1m v\u00f9ng ch\u1eadu \u0111\u1ed1i (b\u1eb1ng hai tay – bimanual pelvic examination) v\u1edbi nhi\u1ec1u ph\u1ee5 n\u1eef h\u1eadu s\u1ea3n \u0111\u1ebfn khoa c\u1ea5p c\u1ee9u v\u1edbi t\u00ecnh tr\u1ea1ng \u0111au v\u00f9ng ch\u1eadu ho\u1eb7c xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o. <\/p>\n\n\n\n

B\u1ea3ng 1<\/strong> c\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y b\u0103ng huy\u1ebft h\u1eadu s\u1ea3n (PPH) v\u00e0 \u0111au.<\/p>\n\n\n\n

B\u0103ng huy\u1ebft h\u1eadu s\u1ea3n (PPH) nguy\u00ean ph\u00e1t (s\u1edbm)<\/strong><\/td>B\u0103ng huy\u1ebft h\u1eadu s\u1ea3n (PPH) th\u1ee9 ph\u00e1t (mu\u1ed9n)<\/strong><\/td>\u0110au v\u00f9ng ch\u1eadu<\/strong><\/td><\/tr><\/thead>
\u0110\u1edd t\u1eed cung<\/td>S\u00f3t nhau<\/td>Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung<\/td><\/tr>
S\u00f3t nhau<\/td>Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung<\/td>Ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng ch\u1eadu<\/td><\/tr>
Ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng ch\u1eadu<\/td>R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u<\/td>V\u1ee1 t\u1eed cung<\/td><\/tr>
R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u<\/td>Ph\u1ed5 nhau c\u00e0i r\u0103ng l\u01b0\u1ee3c<\/td>B\u1ee5c v\u1ebft m\u1ed5 t\u1eed cung<\/td><\/tr>
L\u1ed9n t\u1eed cung<\/td>Ch\u1eadm tho\u00e1i tri\u1ec3n v\u00f9ng nhau b\u00e1m<\/td>Xo\u1eafn bu\u1ed3ng tr\u1ee9ng<\/td><\/tr>
V\u1ee1 t\u1eed cung<\/td>Ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng ch\u1eadu<\/td>Vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng<\/td><\/tr>
Ph\u1ed5 nhau c\u00e0i r\u0103ng l\u01b0\u1ee3c (nhau c\u00e0i r\u0103ng l\u01b0\u1ee3c th\u1ec3 b\u00e1m ch\u1eb7t, th\u1ec3 x\u00e2m nh\u1eadp c\u01a1 t\u1eed cung, v\u00e0 th\u1ec3 xuy\u00ean c\u01a1 t\u1eed cung)<\/td>C\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u t\u1eed cung (d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung, gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch t\u1eed cung)<\/td>Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang v\u00e0 d\u01b0\u1edbi c\u00e2n<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

B\u0103ng huy\u1ebft h\u1eadu s\u1ea3n (PPH) \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t m\u00e1u v\u01b0\u1ee3t qu\u00e1 500 mL sau sinh th\u01b0\u1eddng ho\u1eb7c 1.000 mL sau sinh m\u1ed5, ho\u1eb7c b\u1ea5t k\u1ef3 l\u01b0\u1ee3ng m\u00e1u m\u1ea5t n\u00e0o d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng \u1edf ng\u01b0\u1eddi m\u1eb9. PPH c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh hai nh\u00f3m: PPH s\u1edbm (nguy\u00ean ph\u00e1t) \u0111\u1ec1 c\u1eadp \u0111\u1ebfn t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u x\u1ea3y ra trong v\u00f2ng 24 gi\u1edd sau sinh, v\u00e0 PPH mu\u1ed9n (th\u1ee9 ph\u00e1t) di\u1ec5n ra trong kho\u1ea3ng t\u1eeb 24 gi\u1edd \u0111\u1ebfn 6-12 tu\u1ea7n sau sinh. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a PPH nguy\u00ean ph\u00e1t l\u00e0 \u0111\u1edd t\u1eed cung, \u0111\u00e2y th\u01b0\u1eddng l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, si\u00eau \u00e2m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c c\u0103n nguy\u00ean kh\u00e1c. PPH th\u1ee9 ph\u00e1t \u00edt g\u1eb7p h\u01a1n PPH nguy\u00ean ph\u00e1t, nh\u01b0ng c\u00f3 th\u1ec3 g\u00e2y ra b\u1ec7nh su\u1ea5t v\u00e0 t\u1eed su\u1ea5t \u0111\u00e1ng k\u1ec3 cho ng\u01b0\u1eddi m\u1eb9. PPH th\u1ee9 ph\u00e1t th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u00ecnh tr\u1ea1ng s\u00f3t nhau (RPOC) ho\u1eb7c vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung ti\u1ec1m \u1ea9n.<\/p>\n\n\n\n

Vai tr\u00f2 c\u1ee7a si\u00eau \u00e2m trong \u0111\u00e1nh gi\u00e1 PPH v\u00e0 \u0111au<\/strong> <\/p>\n\n\n\n

\u0110au v\u00f9ng ch\u1eadu c\u1ea5p t\u00ednh v\u00e0 xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o l\u00e0 hai trong s\u1ed1 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a b\u1ec7nh nh\u00e2n h\u1eadu s\u1ea3n t\u1ea1i ph\u00f2ng c\u1ea5p c\u1ee9u. Vi\u1ec7c \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c c\u00f3 th\u1ec3 g\u1eb7p kh\u00f3 kh\u0103n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y do thi\u1ebfu c\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng \u0111\u1eb7c hi\u1ec7u v\u00e0 \u0111\u00f4i khi c\u00e1c d\u1ea5u hi\u1ec7u th\u0103m kh\u00e1m th\u1ef1c th\u1ec3 kh\u00f4ng r\u00f5 r\u00e0ng. Do \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u01b0\u1eddng \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u \u0111\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t. Si\u00eau \u00e2m l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ban \u0111\u1ea7u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh l\u00fd v\u00f9ng ch\u1eadu trong giai \u0111o\u1ea1n h\u1eadu s\u1ea3n. Ngo\u00e0i ti\u1ec7n \u00edch ch\u1ea9n \u0111o\u00e1n tuy\u1ec7t v\u1eddi, si\u00eau \u00e2m c\u00f2n l\u00fd t\u01b0\u1edfng nh\u1edd t\u00ednh s\u1eb5n c\u00f3 r\u1ed9ng r\u00e3i, t\u00ednh di \u0111\u1ed9ng v\u00e0 kh\u00f4ng c\u00f3 b\u1ee9c x\u1ea1 ion h\u00f3a.<\/p>\n\n\n\n

K\u1ef9 thu\u1eadt h\u00ecnh \u1ea3nh<\/strong> <\/p>\n\n\n\n

Si\u00eau \u00e2m v\u00f9ng ch\u1eadu c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qua ng\u1ea3 b\u1ee5ng ho\u1eb7c ng\u1ea3 \u00e2m \u0111\u1ea1o. Th\u0103m kh\u00e1m qua ng\u1ea3 \u00e2m \u0111\u1ea1o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi \u0111\u1ea7u d\u00f2 \u00e2m \u0111\u1ea1o t\u1ea7n s\u1ed1 cao (>7 MHz). N\u00f3 cung c\u1ea5p \u0111\u1ed9 ph\u00e2n gi\u1ea3i tr\u01b0\u1eddng g\u1ea7n tuy\u1ec7t v\u1eddi, cho ph\u00e9p \u0111\u00e1nh gi\u00e1 chi ti\u1ebft bu\u1ed3ng t\u1eed cung. \u0110\u00e1nh gi\u00e1 qua ng\u1ea3 b\u1ee5ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi \u0111\u1ea7u d\u00f2 cong (convex) t\u1ea7n s\u1ed1 th\u1ea5p (1-5 MHz). N\u00f3 cung c\u1ea5p tr\u01b0\u1eddng nh\u00ecn r\u1ed9ng h\u01a1n c\u00f3 th\u1ec3 quan s\u00e1t d\u1ecbch t\u1ef1 do ho\u1eb7c c\u00e1c s\u1ea3n ph\u1ea9m m\u00e1u b\u00ean ngo\u00e0i v\u00f9ng ch\u1eadu d\u01b0\u1edbi. N\u00f3 c\u0169ng c\u00f3 th\u1ec3 cung c\u1ea5p h\u00ecnh \u1ea3nh bu\u1ed3ng tr\u1ee9ng t\u1ed1t h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u00e0 t\u1eed cung v\u1eabn c\u00f2n to trong giai \u0111o\u1ea1n \u0111\u1ea7u h\u1eadu s\u1ea3n.<\/p>\n\n\n\n

T\u1eed cung h\u1eadu s\u1ea3n b\u00ecnh th\u01b0\u1eddng<\/strong> <\/p>\n\n\n\n

T\u1eed cung h\u1eadu s\u1ea3n b\u00ecnh th\u01b0\u1eddng c\u00f3 h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111a d\u1ea1ng. Bu\u1ed3ng t\u1eed cung c\u00f3 th\u1ec3 ch\u1ee9a d\u1ecbch tr\u1ed1ng \u00e2m ho\u1eb7c c\u00f3 h\u1ed3i \u00e2m ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c s\u1ea3n ph\u1ea9m m\u00e1u (H\u00ecnh 1). Nh\u1eefng d\u1ea5u hi\u1ec7u n\u00e0y c\u00f3 th\u1ec3 th\u1ea5y \u1edf c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. Do \u0111\u00f3, b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3i th\u00edch \u00fd ngh\u0129a c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y.<\/p>\n\n\n

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H\u00ecnh 1. T\u1eed cung h\u1eadu s\u1ea3n b\u00ecnh th\u01b0\u1eddng.<\/strong> A.<\/strong> Si\u00eau \u00e2m thang x\u00e1m qua ng\u1ea3 \u00e2m \u0111\u1ea1o cho th\u1ea5y t\u1eed cung h\u1eadu s\u1ea3n to b\u00ecnh th\u01b0\u1eddng v\u1edbi ph\u1ee9c h\u1ee3p h\u1ed3i \u00e2m n\u1ed9i m\u1ea1c (endometrial echo-complex) b\u00ecnh th\u01b0\u1eddng 12 mm (\u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u b\u1eb1ng th\u01b0\u1edbc \u0111o) \u1edf m\u1ed9t s\u1ea3n ph\u1ee5 22 tu\u1ed5i v\u00e0o ng\u00e0y th\u1ee9 4 sau sinh. B.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u qua ng\u1ea3 \u00e2m \u0111\u1ea1o c\u1ee7a m\u1ed9t b\u1ec7nh nh\u00e2n h\u1eadu s\u1ea3n 25 tu\u1ed5i cho th\u1ea5y d\u1ecbch h\u1ed3i \u00e2m h\u1ed7n h\u1ee3p b\u00ean trong bu\u1ed3ng t\u1eed cung v\u1edbi c\u00e1c v\u00f9ng h\u1ed3i \u00e2m d\u00e0y kh\u00f4ng c\u00f3 t\u00edn hi\u1ec7u m\u1ea1ch m\u00e1u, ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng.<\/p>\n\n\n\n

S\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai (RPOC)<\/strong><\/p>\n\n\n\n

Thu\u1eadt ng\u1eef RPOC ch\u1ec9 c\u00e1c m\u00f4 thai, nhau thai ho\u1eb7c m\u00e0ng r\u1ee5ng c\u00f2n s\u00f3t l\u1ea1i trong t\u1eed cung sau sinh, s\u1ea3y thai ho\u1eb7c ch\u1ea5m d\u1ee9t thai k\u1ef3. Nguy c\u01a1 RPOC cao h\u01a1n khi vi\u1ec7c ch\u1ea5m d\u1ee9t thai k\u1ef3 x\u1ea3y ra sau khi b\u1eaft \u0111\u1ea7u tam c\u00e1 nguy\u1ec7t th\u1ee9 hai.<\/p>\n\n\n\n

RPOC c\u00f3 h\u00ecnh \u1ea3nh \u0111a d\u1ea1ng tr\u00ean si\u00eau \u00e2m thang x\u00e1m, t\u1eeb m\u1ed9t kh\u1ed1i h\u1ed3i \u00e2m d\u00e0y ho\u1eb7c h\u1ed3i \u00e2m h\u1ed7n h\u1ee3p trong bu\u1ed3ng t\u1eed cung \u0111\u1ebfn d\u1ea3i n\u1ed9i m\u1ea1c d\u00e0y kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi c\u00e1c m\u1ee9c \u0111\u1ed9 t\u01b0\u1edbi m\u00e1u kh\u00e1c nhau tr\u00ean si\u00eau \u00e2m Doppler m\u00e0u. M\u1eb7t ph\u00e2n c\u00e1ch kh\u00f4ng \u0111\u1ec1u gi\u1eefa n\u1ed9i m\u1ea1c v\u00e0 c\u01a1 t\u1eed cung l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u kh\u00e1c tr\u00ean thang x\u00e1m c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong RPOC. N\u1ebfu ph\u1ee9c h\u1ee3p h\u1ed3i \u00e2m n\u1ed9i m\u1ea1c (endometrial echo-complex\u00a0– EEC) nh\u1ecf h\u01a1n 10 mm v\u00e0 kh\u00f4ng c\u00f3 kh\u1ed1i n\u1ed9i m\u1ea1c (endometrial mass), th\u00ec kh\u1ea3 n\u0103ng b\u1ecb RPOC l\u00e0 c\u1ef1c k\u1ef3 th\u1ea5p.<\/p>\n\n\n\n

Si\u00eau \u00e2m Doppler m\u00e0u c\u00f3 th\u1ec3 n\u00e2ng cao \u0111\u1ed9 ch\u00ednh x\u00e1c ch\u1ea9n \u0111o\u00e1n trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh RPOC. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd RPOC d\u1ef1a tr\u00ean ho\u00e0n c\u1ea3nh l\u00e2m s\u00e0ng, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u00edn hi\u1ec7u m\u1ea1ch m\u00e1u trong ph\u1ee9c h\u1ee3p n\u1ed9i m\u1ea1c d\u00e0y ho\u1eb7c kh\u1ed1i n\u1ed9i m\u1ea1c g\u1ee3i \u00fd cao \u0111\u1ebfn RPOC. M\u1ee9c \u0111\u1ed9 t\u01b0\u1edbi m\u00e1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh b\u1ed1n nh\u00f3m b\u1eb1ng c\u00e1ch so s\u00e1nh t\u01b0\u1edbi m\u00e1u n\u1ed9i m\u1ea1c v\u1edbi c\u01a1 t\u1eed cung b\u00ecnh th\u01b0\u1eddng l\u00e2n c\u1eadn (H\u00ecnh 2-6). V\u00ec RPOC c\u00f3 th\u1ec3 v\u00f4 m\u1ea1ch, n\u00ean s\u1ef1 v\u1eafng m\u1eb7t c\u1ee7a d\u00f2ng ch\u1ea3y tr\u00ean Doppler m\u00e0u kh\u00f4ng lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n n\u00e0y. RPOC v\u00f4 m\u1ea1ch (lo\u1ea1i 0) v\u00e0 c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng trong t\u1eed cung kh\u00f4ng hi\u1ec3n th\u1ecb d\u00f2ng ch\u1ea3y tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m Doppler m\u00e0u. Tuy nhi\u00ean, n\u1ebfu v\u1eadt ch\u1ea5t h\u1ed3i \u00e2m d\u00e0y trong bu\u1ed3ng t\u1eed cung c\u00f3 v\u1ebb tr\u00f4i n\u1ed5i t\u1ef1 do, \u0111i\u1ec1u n\u00e0y g\u1ee3i \u00fd c\u1ee5c m\u00e1u \u0111\u00f4ng h\u01a1n l\u00e0 RPOC.<\/p>\n\n\n

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H\u00ecnh 2. C\u00e1c h\u00ecnh minh h\u1ecda s\u01a1 \u0111\u1ed3 v\u1ec1 s\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai v\u1edbi c\u00e1c ki\u1ec3u t\u01b0\u1edbi m\u00e1u kh\u00e1c nhau (lo\u1ea1i 0-3).<\/strong> M\u1ee9c \u0111\u1ed9 t\u01b0\u1edbi m\u00e1u \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1ch so s\u00e1nh d\u00f2ng ch\u1ea3y m\u1ea1ch m\u00e1u n\u1ed9i m\u1ea1c v\u1edbi c\u01a1 t\u1eed cung tr\u00ean si\u00eau \u00e2m Doppler m\u00e0u. \u0110\u01b0\u1ee3c l\u1ea5y t\u1eeb Kamaya v\u00e0 c\u1ed9ng s\u1ef1, J Ultrasound Med 2009;28:1031-1041, v\u1edbi s\u1ef1 cho ph\u00e9p c\u1ee7a John Wiley & Sons.<\/em><\/p>\n\n\n

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H\u00ecnh 3. S\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai, type 0.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 36 tu\u1ed5i \u0111\u1ebfn ph\u00f2ng c\u1ea5p c\u1ee9u v\u00e0o ng\u00e0y th\u1ee9 10 sau sinh v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o \u1ed3 \u1ea1t, ch\u00f3ng m\u1eb7t v\u00e0 \u0111au \u0111\u1ea7u. A.<\/strong> Si\u00eau \u00e2m thang x\u00e1m qua ng\u1ea3 \u00e2m \u0111\u1ea1o c\u1ee7a t\u1eed cung cho th\u1ea5y s\u1ef1 d\u00e0y l\u00ean c\u1ee7a ph\u1ee9c h\u1ee3p h\u1ed3i \u00e2m n\u1ed9i m\u1ea1c (\u0111\u01b0\u1ee3c vi\u1ec1n b\u1edfi c\u00e1c m\u0169i t\u00ean). B.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u m\u1eb7t c\u1eaft d\u1ecdc cho th\u1ea5y kh\u00f4ng c\u00f3 d\u00f2ng ch\u1ea3y m\u1ea1ch m\u00e1u b\u00ean trong ph\u1ee9c h\u1ee3p h\u1ed3i \u00e2m n\u1ed9i m\u1ea1c b\u1ecb d\u00e0y l\u00ean. K\u1ebft qu\u1ea3 gi\u1ea3i ph\u1eabu b\u1ec7nh ph\u00f9 h\u1ee3p v\u1edbi s\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai.<\/em><\/p>\n\n\n

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H\u00ecnh 4. S\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai, type 1.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 30 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o k\u00e8m \u0111au qu\u1eb7n b\u1ee5ng d\u01b0\u1edbi k\u00e9o d\u00e0i 9 ng\u00e0y. A.<\/strong> Si\u00eau \u00e2m thang x\u00e1m m\u1eb7t c\u1eaft ngang cho th\u1ea5y m\u1ed9t kh\u1ed1i \u0111\u1ed3ng h\u1ed3i \u00e2m (c\u00e1c m\u0169i t\u00ean) b\u00ean trong bu\u1ed3ng t\u1eed cung. B.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u cho th\u1ea5y c\u00e1c n\u1ed1t t\u00edn hi\u1ec7u d\u00f2ng ch\u1ea3y nh\u1ecf (m\u0169i t\u00ean r\u1ed7ng) b\u00ean trong kh\u1ed1i. K\u1ebft qu\u1ea3 gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00e0 s\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai.<\/em><\/p>\n\n\n

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H\u00ecnh 5. S\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai, lo\u1ea1i 2.<\/strong> M\u1ed9t ph\u1ee5 n\u1eef 31 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o dai d\u1eb3ng sau sinh th\u01b0\u1eddng. A, B.<\/strong> Si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o m\u1eb7t c\u1eaft ngang cho th\u1ea5y v\u1eadt ch\u1ea5t h\u1ed3i \u00e2m h\u1ed7n h\u1ee3p (A, \u0111\u01b0\u1ee3c vi\u1ec1n b\u1edfi c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) b\u00ean trong bu\u1ed3ng t\u1eed cung v\u1edbi t\u0103ng sinh m\u1ea1ch m\u00e1u r\u00f5 r\u1ec7t tr\u00ean Doppler m\u00e0u (B, m\u0169i t\u00ean). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nong v\u00e0 n\u1ea1o bu\u1ed3ng t\u1eed cung. K\u1ebft qu\u1ea3 gi\u1ea3i ph\u1eabu b\u1ec7nh ph\u00f9 h\u1ee3p v\u1edbi s\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai. C.<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o t\u00e1i kh\u00e1m sau hai tu\u1ea7n cho th\u1ea5y s\u1ef1 bi\u1ebfn m\u1ea5t ho\u00e0n to\u00e0n c\u1ee7a v\u1eadt ch\u1ea5t h\u1ed3i \u00e2m b\u00ean trong bu\u1ed3ng t\u1eed cung. Kh\u00f4ng ghi nh\u1eadn t\u00edn hi\u1ec7u m\u1ea1ch m\u00e1u b\u00ean trong n\u1ed9i m\u1ea1c tr\u00ean si\u00eau \u00e2m Doppler m\u00e0u (C).<\/em><\/p>\n\n\n

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H\u00ecnh 6. S\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai, lo\u1ea1i 3.<\/strong> M\u1ed9t b\u1ec7nh nh\u00e2n 39 tu\u1ed5i \u0111\u00e3 sinh th\u01b0\u1eddng c\u00e1ch \u0111\u00e2y 9 ng\u00e0y nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o \u1ed3 \u1ea1t. A, B.<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m thang x\u00e1m qua ng\u1ea3 \u00e2m \u0111\u1ea1o m\u1eb7t c\u1eaft d\u1ecdc (A) c\u1ee7a t\u1eed cung cho th\u1ea5y m\u1ed9t kh\u1ed1i h\u1ed7n h\u1ee3p (\u0111\u01b0\u1ee3c vi\u1ec1n b\u1edfi c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) l\u00e0m d\u00e0y n\u1ed9i m\u1ea1c. H\u00ecnh \u1ea3nh si\u00eau \u00e2m Doppler m\u00e0u (B) cho th\u1ea5y s\u1ef1 t\u01b0\u1edbi m\u00e1u m\u1ea1nh (m\u0169i t\u00ean) c\u1ee7a kh\u1ed1i. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c nong v\u00e0 n\u1ea1o bu\u1ed3ng t\u1eed cung. K\u1ebft qu\u1ea3 gi\u1ea3i ph\u1eabu b\u1ec7nh ph\u00f9 h\u1ee3p v\u1edbi s\u00f3t s\u1ea3n ph\u1ea9m th\u1ee5 thai.<\/em><\/p>\n\n\n\n

Khi \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng s\u00f3t nhau (RPOC) lo\u1ea1i 3, \u0111i\u1ec1u c\u1ea7n thi\u1ebft l\u00e0 ph\u1ea3i ph\u00e2n bi\u1ec7t v\u1edbi d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch (AVM). Vi\u1ec7c n\u00e0y c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n, nh\u01b0ng theo nguy\u00ean t\u1eafc chung, t\u00ecnh tr\u1ea1ng t\u0103ng sinh m\u1ea1ch c\u1ee7a s\u00f3t nhau lo\u1ea1i 3 s\u1ebd t\u1eadp trung \u1edf n\u1ed9i m\u1ea1c t\u1eed cung, trong khi s\u1ef1 t\u01b0\u1edbi m\u00e1u c\u1ee7a d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung (UAVM) th\u01b0\u1eddng t\u1eadp trung \u1edf c\u01a1 t\u1eed cung. UAVM c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p n\u1ed9i m\u1ea1ch. Do \u0111\u00f3, trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd s\u00f3t nhau v\u1edbi s\u1ef1 t\u0103ng sinh m\u1ea1ch m\u00e1u r\u00f5 r\u1ec7t, c\u00f3 th\u1ec3 l\u00e0 s\u00f3t nhau lo\u1ea1i 3 ho\u1eb7c AVM, th\u00f4ng tin n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c truy\u1ec1n \u0111\u1ea1t r\u00f5 r\u00e0ng cho b\u00e1c s\u0129 s\u1ea3n khoa \u0111\u1ec3 tr\u00e1nh th\u1ef1c hi\u1ec7n nong v\u00e0 n\u1ea1o (D&C).<\/p>\n\n\n\n

Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung<\/strong> <\/p>\n\n\n\n

Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng c\u1ee7a n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 c\u00f3 th\u1ec3 x\u1ea3y ra sau khi sinh ho\u1eb7c sau b\u1ea5t k\u1ef3 can thi\u1ec7p n\u00e0o v\u00e0o t\u1eed cung. Nguy c\u01a1 vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung sau sinh m\u1ed5 l\u1edbn h\u01a1n so v\u1edbi sinh th\u01b0\u1eddng. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung bao g\u1ed3m s\u00f3t nhau, chuy\u1ec3n d\u1ea1 k\u00e9o d\u00e0i v\u00e0 \u1ed1i v\u1ee1 s\u1edbm. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung c\u00f3 th\u1ec3 bao g\u1ed3m s\u1ed1t, \u0111au v\u00f9ng ch\u1eadu, \u1ea5n \u0111au t\u1eed cung, d\u1ecbch ti\u1ebft \u00e2m \u0111\u1ea1o c\u00f3 m\u1ee7 v\u00e0 ch\u1eadm tho\u00e1i tri\u1ec3n t\u1eed cung (t\u1eed cung to k\u00e9o d\u00e0i sau sinh). Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, v\u00e0 c\u00e1c h\u00ecnh \u1ea3nh c\u1ee7a n\u00f3 c\u00f3 th\u1ec3 ch\u1ed3ng l\u1ea5p v\u1edbi nh\u1eefng thay \u0111\u1ed5i h\u1eadu s\u1ea3n b\u00ecnh th\u01b0\u1eddng. N\u1ed9i m\u1ea1c t\u1eed cung b\u1ecb nhi\u1ec5m tr\u00f9ng c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m si\u00eau \u00e2m h\u1eadu s\u1ea3n b\u00ecnh th\u01b0\u1eddng m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng \u0111\u1eb7c hi\u1ec7u n\u00e0o tr\u00ean h\u00ecnh \u1ea3nh. D\u1ecbch v\u00e0 c\u1eb7n h\u1ed3i \u00e2m b\u00ean trong bu\u1ed3ng t\u1eed cung c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft ho\u1eb7c c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng ch\u1ec9 \u0111i\u1ec3m t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng. Ngo\u00e0i ra, n\u1ed9i m\u1ea1c t\u1eed cung c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh d\u00e0y l\u00ean v\u00e0 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi s\u1ef1 t\u0103ng sinh m\u1ea1ch m\u00e1u (H\u00ecnh 7). Nh\u01b0 th\u01b0\u1eddng l\u1ec7, b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng s\u1ebd \u0111\u00f3ng g\u00f3p r\u1ea5t l\u1edbn v\u00e0o vi\u1ec7c gi\u1ea3i th\u00edch c\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y. C\u00f3 th\u1ec3 th\u1ea5y kh\u00ed b\u00ean trong bu\u1ed3ng t\u1eed cung. Tr\u00ean si\u00eau \u00e2m, \u0111i\u1ec1u n\u00e0y s\u1ebd bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng c\u00e1c n\u1ed1t h\u1ed3i \u00e2m d\u00e0y k\u00e8m b\u00f3ng l\u01b0ng d\u01a1 ho\u1eb7c x\u1ea3o \u1ea3nh \u0111u\u00f4i sao ch\u1ed5i (ring-down), h\u01b0\u1edbng \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng (H\u00ecnh 7). Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng kh\u00ed trong n\u1ed9i m\u1ea1c t\u1eed cung c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u b\u00ecnh th\u01b0\u1eddng trong t\u1ed1i \u0111a 3 tu\u1ea7n sau sinh v\u00e0 c\u00f3 th\u1ec3 g\u1eb7p \u1edf t\u1ed1i \u0111a 20% s\u1ea3n ph\u1ee5 kh\u1ecfe m\u1ea1nh. Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. N\u1ebfu ph\u00e1t hi\u1ec7n kh\u1ed1i m\u00e1u t\u1ee5 nhi\u1ec5m tr\u00f9ng, s\u00f3t nhau ho\u1eb7c \u00e1p xe t\u1eed cung, c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i n\u1ea1o bu\u1ed3ng t\u1eed cung. C\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u1ee7a vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 vi\u00eam ph\u00fac m\u1ea1c, \u00e1p xe, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng v\u00e0 vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch nhi\u1ec5m khu\u1ea9n x\u1ea3y ra \u1edf 1% \u0111\u1ebfn 4% b\u1ec7nh nh\u00e2n.<\/p>\n\n\n

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H\u00ecnh 7. Vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung.<\/strong> A, B.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 34 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u1edbi bi\u1ec3u hi\u1ec7n \u0111au b\u1ee5ng, d\u1ecbch ti\u1ebft \u00e2m \u0111\u1ea1o c\u00f3 m\u1ee7, s\u1ed1t v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u. Si\u00eau \u00e2m thang x\u00e1m m\u1eb7t c\u1eaft d\u1ecdc (A) c\u1ee7a t\u1eed cung cho th\u1ea5y n\u1ed9i m\u1ea1c d\u00e0y l\u00ean ch\u1ee9a \u0111\u1ea7y h\u1ed3i \u00e2m kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t (m\u0169i t\u00ean \u0111en) v\u00e0 nhi\u1ec1u n\u1ed1t h\u1ed3i \u00e2m d\u00e0y \u0111\u1ea1i di\u1ec7n cho kh\u00ed (m\u0169i t\u00ean). H\u00ecnh \u1ea3nh Doppler m\u00e0u (B) cho th\u1ea5y t\u0103ng d\u00f2ng ch\u1ea3y (m\u0169i t\u00ean r\u1ed7ng) b\u00ean trong c\u01a1 t\u1eed cung l\u00e2n c\u1eadn. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh \u0111\u01b0\u1eddng ti\u00eam. C, D.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 27 tu\u1ed5i c\u00f3 ti\u1ec1n s\u1eed \u1ed1i v\u1ee1 s\u1edbm nh\u1eadp vi\u1ec7n v\u1edbi bi\u1ec3u hi\u1ec7n \u0111au b\u1ee5ng d\u01b0\u1edbi, s\u1ed1t, ti\u1ebft d\u1ecbch \u00e2m \u0111\u1ea1o v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u. Si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o m\u1eb7t c\u1eaft d\u1ecdc c\u1ee7a t\u1eed cung (C) cho th\u1ea5y bu\u1ed3ng t\u1eed cung gi\u00e3n r\u1ed9ng v\u00e0 t\u1ee5 d\u1ecbch gi\u1ea3m \u00e2m (d\u1ea5u hoa th\u1ecb) k\u00e8m c\u1eb7n h\u1ed3i \u00e2m. Si\u00eau \u00e2m Doppler m\u00e0u m\u1eb7t c\u1eaft ngang (D) cho th\u1ea5y t\u0103ng d\u00f2ng ch\u1ea3y b\u00ean trong c\u01a1 t\u1eed cung l\u00e2n c\u1eadn. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng.<\/em><\/p>\n\n\n\n

D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung<\/strong> <\/p>\n\n\n\n

D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung (UAVM) x\u1ea3y ra khi c\u00f3 s\u1ef1 th\u00f4ng n\u1ed1i tr\u1ef1c ti\u1ebfp gi\u1eefa h\u1ec7 th\u1ed1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch m\u00e0 kh\u00f4ng c\u00f3 gi\u01b0\u1eddng mao m\u1ea1ch trung gian. UAVM l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p g\u00e2y ch\u1ea3y m\u00e1u h\u1eadu s\u1ea3n v\u00e0 c\u00f3 th\u1ec3 l\u00e0 b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i. Si\u00eau \u00e2m l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ban \u0111\u1ea7u \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n b\u1ecb UAVM. C\u00e1c d\u1ea5u hi\u1ec7u tr\u00ean thang x\u00e1m th\u01b0\u1eddng \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, bao g\u1ed3m s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t ho\u1eb7c d\u00e0y l\u00ean c\u1ee7a c\u01a1 t\u1eed cung. \u0110\u00f4i khi c\u00f3 th\u1ec3 th\u1ea5y m\u1ed9t kh\u1ed1i h\u1ed7n h\u1ee3p trong c\u01a1 ho\u1eb7c n\u1ed9i m\u1ea1c t\u1eed cung gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5, ch\u1ee9a nhi\u1ec1u c\u1ea5u tr\u00fac d\u1ea1ng nang ho\u1eb7c \u1ed1ng (H\u00ecnh 8). C\u00e1c th\u0103m kh\u00e1m Doppler m\u00e0u v\u00e0 Doppler ph\u1ed5 l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ee9ng minh b\u1ea3n ch\u1ea5t m\u1ea1ch m\u00e1u c\u1ee7a t\u1ed5n th\u01b0\u01a1ng v\u1edbi d\u00f2ng ch\u1ea3y trong c\u1ea5u tr\u00fac \u1ed1ng d\u1ea1ng nang n\u00f3i tr\u00ean. Vi\u1ec7c kh\u1ea3o s\u00e1t Doppler s\u1ebd cho th\u1ea5y d\u00f2ng ch\u1ea3y \u0111a h\u01b0\u1edbng v\u1edbi hi\u1ec7n t\u01b0\u1ee3ng v\u01b0\u1ee3t ng\u01b0\u1ee1ng (aliasing) v\u00e0 h\u00ecnh \u1ea3nh d\u1ea1ng kh\u1ea3m li\u00ean quan \u0111\u1ebfn d\u00f2ng ch\u1ea3y r\u1ed1i v\u1eadn t\u1ed1c cao. N\u1ebfu nghi ng\u1edd UAVM \u1edf b\u1ec7nh nh\u00e2n, c\u00e1c ch\u1ec9 \u0111\u1ecbnh h\u00ecnh \u1ea3nh c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi can thi\u1ec7p th\u1ee7 thu\u1eadt trong l\u00f2ng t\u1eed cung \u0111\u1ec3 lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n n\u00e0y, v\u00ec nong v\u00e0 n\u1ea1o (D&C) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn xu\u1ea5t huy\u1ebft \u0111e d\u1ecda t\u00ednh m\u1ea1ng.<\/p>\n\n\n

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H\u00ecnh 8. D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung (AVM).<\/strong> A-C.<\/strong> M\u1ed9t ph\u1ee5 n\u1eef 35 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u1edbi xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o h\u1eadu s\u1ea3n. A.<\/strong> Si\u00eau \u00e2m thang x\u00e1m m\u1eb7t c\u1eaft d\u1ecdc cho th\u1ea5y m\u1ed9t c\u1ea5u tr\u00fac nang tr\u1ed1ng \u00e2m (m\u0169i t\u00ean) b\u00ean trong c\u01a1 t\u1eed cung. B.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u t\u01b0\u01a1ng \u1ee9ng cho th\u1ea5y t\u0103ng sinh m\u1ea1ch m\u00e1u r\u00f5 r\u1ec7t v\u1edbi h\u00ecnh \u1ea3nh d\u1ea1ng kh\u1ea3m ch\u1ee7 y\u1ebfu \u1edf c\u01a1 t\u1eed cung. C.<\/strong> Ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA) cho th\u1ea5y nhi\u1ec1u nh\u00e1nh nu\u00f4i t\u1eeb \u0111\u1ed9ng m\u1ea1ch (m\u0169i t\u00ean r\u1ed7ng) xu\u1ea5t ph\u00e1t ch\u1ee7 y\u1ebfu t\u1eeb \u0111\u1ed9ng m\u1ea1ch t\u1eed cung ph\u1ea3i b\u1ecb gi\u00e3n, ph\u00f9 h\u1ee3p v\u1edbi AVM (\u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi B\u00e1c s\u0129 Sung Yoon Park, Trung t\u00e2m Y t\u1ebf Samsung). D-F.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 28 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng rong kinh. D.<\/strong> Si\u00eau \u00e2m thang x\u00e1m ph\u00e1t hi\u1ec7n nhi\u1ec1u c\u1ea5u tr\u00fac \u1ed1ng tr\u1ed1ng \u00e2m (m\u0169i t\u00ean) trong c\u01a1 t\u1eed cung. E.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u t\u01b0\u01a1ng \u1ee9ng cho th\u1ea5y d\u00f2ng ch\u1ea3y r\u1ed1i trong c\u00e1c c\u1ea5u tr\u00fac tr\u1ed1ng \u00e2m g\u1ee3i \u00fd AVM. F.<\/strong> C\u1ed9ng h\u01b0\u1edfng t\u1eeb T2 m\u1eb7t c\u1eaft coronal cho th\u1ea5y m\u1ed9t v\u00e0i c\u1ea5u tr\u00fac tr\u1ed1ng t\u00edn hi\u1ec7u d\u00f2ng ch\u1ea3y (flow void) ngo\u1eb1n ngo\u00e8o (\u0111\u1ea7u m\u0169i t\u00ean) trong c\u01a1 t\u1eed cung, ph\u00f9 h\u1ee3p v\u1edbi AVM. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n b\u1eb1ng li\u1ec7u ph\u00e1p hormone (Leuplin) (\u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi B\u00e1c s\u0129 Taek Min Kim, \u0110\u1ea1i h\u1ecdc Qu\u1ed1c gia Seoul).<\/em><\/p>\n\n\n\n

Gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch t\u1eed cung<\/strong> <\/p>\n\n\n\n

Gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch t\u1eed cung (Uterine artery pseudoaneurysm – UAP) l\u00e0 t\u00ecnh tr\u1ea1ng l\u1ed3i ra b\u1ea5t th\u01b0\u1eddng c\u1ee7a \u0111\u1ed9ng m\u1ea1ch do t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch. Gi\u1ea3 ph\u00ecnh m\u1ea1ch x\u1ea3y ra khi r\u00f2 r\u1ec9 m\u00e1u \u0111\u1ed9ng m\u1ea1ch v\u00e0o m\u00f4 xung quanh d\u1eabn \u0111\u1ebfn s\u1ef1 th\u00f4ng n\u1ed1i dai d\u1eb3ng gi\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0 \u1ed5 t\u1ee5 m\u00e1u \u0111\u01b0\u1ee3c khu tr\u00fa. H\u00ecnh \u1ea3nh si\u00eau \u00e2m thang x\u00e1m cho th\u1ea5y m\u1ed9t c\u1ea5u tr\u00fac d\u1ea1ng nang b\u00ean trong t\u1eed cung, v\u00e0 \u0111\u00e1nh gi\u00e1 Doppler m\u00e0u s\u1ebd cho th\u1ea5y d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch xo\u00e1y hai chi\u1ec1u, c\u00f3 th\u1ec3 gi\u1ed1ng bi\u1ec3u t\u01b0\u1ee3ng \u00e2m-d\u01b0\u01a1ng (d\u1ea5u hi\u1ec7u \u00e2m d\u01b0\u01a1ng) (H\u00ecnh 9, 10). Trong qu\u00e1 tr\u00ecnh ph\u00e2n t\u00edch ph\u1ed5, d\u1ea1ng s\u00f3ng “\u0111\u1ebfn v\u00e0 \u0111i” (to-and-fro) s\u1ebd \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y t\u1ea1i c\u1ed5 t\u00fai gi\u1ea3 ph\u00ecnh, v\u00e0 m\u00e1u \u0111i v\u00e0o v\u00e0 \u0111i ra kh\u1ecfi t\u00fai gi\u1ea3 ph\u00ecnh . UAP c\u00f3 nguy c\u01a1 v\u1ee1 ho\u1eb7c lan r\u1ed9ng; do \u0111\u00f3 c\u1ea7n can thi\u1ec7p kh\u1ea9n c\u1ea5p. \u0110i\u1ec1u tr\u1ecb n\u1ed9i m\u1ea1ch ho\u1eb7c n\u00fat m\u1ea1ch l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean cho UAP.<\/p>\n\n\n

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H\u00ecnh 9. R\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung (AVF) v\u00e0 gi\u1ea3 ph\u00ecnh m\u1ea1ch.<\/strong> M\u1ed9t ph\u1ee5 n\u1eef 26 tu\u1ed5i sinh th\u01b0\u1eddng c\u00e1ch \u0111\u00e2y 3 tu\u1ea7n nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o \u1ed3 \u1ea1t. A.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u qua ng\u1ea3 \u00e2m \u0111\u1ea1o cho th\u1ea5y d\u00f2ng m\u00e1u xo\u00e1y b\u00ean trong m\u1ed9t c\u1ea5u tr\u00fac tr\u00f2n (m\u0169i t\u00ean), ph\u00f9 h\u1ee3p v\u1edbi gi\u1ea3 ph\u00ecnh m\u1ea1ch. B.<\/strong> H\u00ecnh \u1ea3nh Doppler m\u00e0u m\u1eb7t c\u1eaft d\u1ecdc cho th\u1ea5y c\u00e1c m\u1ea1ch m\u00e1u ngo\u1eb1n ngo\u00e8o (m\u0169i t\u00ean) trong c\u01a1 t\u1eed cung thu\u1ed9c th\u00e2n t\u1eed cung. C.<\/strong> H\u00ecnh \u1ea3nh ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n (DSA) \u0111\u1ed9ng m\u1ea1ch ch\u1eadu chung ph\u1ea3i cho th\u1ea5y m\u1ed9t t\u00fai gi\u1ea3 ph\u00ecnh (m\u0169i t\u00ean \u0111en) v\u00e0 r\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch (AVF) li\u00ean quan (m\u0169i t\u00ean) xu\u1ea5t ph\u00e1t t\u1eeb m\u1ed9t nh\u00e1nh xa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch t\u1eed cung tr\u00e1i. D.<\/strong> DSA \u0111\u1ed9ng m\u1ea1ch t\u1eed cung tr\u00e1i si\u00eau ch\u1ecdn l\u1ecdc cho th\u1ea5y AVF (m\u0169i t\u00ean) v\u1edbi t\u0129nh m\u1ea1ch d\u1eabn l\u01b0u s\u1edbm (\u0111\u1ea7u m\u0169i t\u00ean). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng n\u00fat m\u1ea1ch qua \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch s\u1eed d\u1ee5ng Gelfoam v\u00e0 coils.<\/em><\/p>\n\n\n

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H\u00ecnh 10. Gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch t\u1eed cung.<\/strong> M\u1ed9t ph\u1ee5 n\u1eef 35 tu\u1ed5i sinh th\u01b0\u1eddng c\u00e1ch \u0111\u00e2y 4 tu\u1ea7n c\u00f3 bi\u1ec3u hi\u1ec7n xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o \u1ed3 \u1ea1t. A.<\/strong> Tr\u00ean si\u00eau \u00e2m thang x\u00e1m, t\u00fai gi\u1ea3 ph\u00ecnh (m\u0169i t\u00ean) \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y l\u00e0 m\u1ed9t c\u1ea5u tr\u00fac tr\u00f2n tr\u1ed1ng \u00e2m b\u00ean trong t\u1eed cung v\u1edbi kh\u1ed1i m\u00e1u t\u1ee5 h\u1ed3i \u00e2m d\u00e0y \u1edf ngo\u1ea1i vi (m\u0169i t\u00ean r\u1ed7ng). B.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u cho th\u1ea5y d\u1ea5u hi\u1ec7u “\u00e2m-d\u01b0\u01a1ng” \u0111i\u1ec3n h\u00ecnh (m\u0169i t\u00ean r\u1ed7ng) b\u00ean trong t\u00fai gi\u1ea3 ph\u00ecnh, \u0111\u1ea1i di\u1ec7n cho d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch r\u1ed1i. C.<\/strong> C\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u00f9ng ch\u1eadu T1-weighted x\u00f3a m\u1ee1 c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n m\u1eb7t c\u1eaft ngang (axial) cho th\u1ea5y trung t\u00e2m ng\u1ea5m thu\u1ed1c c\u1ee7a t\u00fai gi\u1ea3 ph\u00ecnh (m\u0169i t\u00ean) v\u00e0 kh\u1ed1i m\u00e1u t\u1ee5 ngo\u1ea1i vi kh\u00f4ng ng\u1ea5m thu\u1ed1c (m\u0169i t\u00ean r\u1ed7ng). D.<\/strong> H\u00ecnh \u1ea3nh ch\u1ee5p m\u1ea1ch s\u1ed1 h\u00f3a x\u00f3a n\u1ec1n x\u00e1c nh\u1eadn t\u00fai gi\u1ea3 ph\u00ecnh (m\u0169i t\u00ean) xu\u1ea5t ph\u00e1t t\u1eeb m\u1ed9t nh\u00e1nh xa c\u1ee7a \u0111\u1ed9ng m\u1ea1ch t\u1eed cung tr\u00e1i. \u0110\u1ed9ng m\u1ea1ch t\u1eed cung tr\u00e1i \u0111o\u1ea1n xa \u0111\u00e3 \u0111\u01b0\u1ee3c n\u00fat m\u1ea1ch b\u1eb1ng h\u1ed7n h\u1ee3p Gelfoam.<\/em><\/p>\n\n\n\n

Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng<\/strong> <\/p>\n\n\n\n

Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng (Ovarian vein thrombosis – OVT) l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng hi\u1ebfm g\u1eb7p x\u1ea3y ra \u1edf 0,02% \u0111\u1ebfn 0,18% thai k\u1ef3 [17]. H\u1ea7u h\u1ebft (80%-90%) c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra \u1edf t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng ph\u1ea3i do s\u1ef1 xoay ph\u1ea3i th\u00f4ng th\u01b0\u1eddng c\u1ee7a t\u1eed cung l\u1edbn trong thai k\u1ef3, g\u00e2y ch\u00e8n \u00e9p t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng ph\u1ea3i v\u00e0o g\u1edd ch\u1eadu. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c than phi\u1ec1n \u0111au b\u1ee5ng m\u01a1 h\u1ed3 v\u00e0 s\u1ed1t. OVT c\u00f3 th\u1ec3 t\u1ef1 kh\u1ecfi, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi (IVC), thuy\u00ean t\u1eafc ph\u1ed5i v\u00e0 nhi\u1ec5m tr\u00f9ng huy\u1ebft. H\u00ecnh \u1ea3nh si\u00eau \u00e2m thang x\u00e1m v\u00e0 Doppler m\u00e0u c\u00f3 th\u1ec3 cho th\u1ea5y c\u00e1c c\u1ea5u tr\u00fac \u1ed1ng ho\u1eb7c ngo\u1eb1n ngo\u00e8o gi\u1ea3m \u00e2m \u1edf ph\u1ea7n ph\u1ee5 c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch bu\u1ed3ng tr\u1ee9ng m\u00e0 kh\u00f4ng th\u1ea5y d\u00f2ng ch\u1ea3y tr\u00ean Doppler m\u00e0u (H\u00ecnh 11). S\u1ef1 lan r\u1ed9ng c\u1ee7a huy\u1ebft kh\u1ed1i v\u00e0o IVC c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y b\u1eb1ng si\u00eau \u00e2m, c\u0169ng nh\u01b0 s\u1ef1 to l\u00ean c\u1ee7a bu\u1ed3ng tr\u1ee9ng \u1edf b\u00ean b\u1ecb \u1ea3nh h\u01b0\u1edfng.<\/p>\n\n\n

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H\u00ecnh 11. Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 24 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u1edbi \u0111au b\u1ee5ng d\u01b0\u1edbi b\u00ean ph\u1ea3i. A.<\/strong> Si\u00eau \u00e2m thang x\u00e1m qua ng\u1ea3 b\u1ee5ng cho th\u1ea5y huy\u1ebft kh\u1ed1i h\u1ed3i \u00e2m d\u00e0y (m\u0169i t\u00ean) b\u00ean trong t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng ph\u1ea3i, d\u1eabn \u0111\u1ebfn t\u1eafc ngh\u1ebdn kh\u00f4ng ho\u00e0n to\u00e0n. B.<\/strong> Si\u00eau \u00e2m Doppler m\u00e0u cho th\u1ea5y huy\u1ebft kh\u1ed1i h\u1ed3i \u00e2m d\u00e0y (m\u0169i t\u00ean) b\u00ean trong t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng v\u00e0 d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch (m\u0169i t\u00ean r\u1ed7ng) \u1edf ph\u1ea7n kh\u00f4ng b\u1ecb t\u1eafc c\u1ee7a t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng. \u0110\u1ed9ng m\u1ea1ch ch\u1eadu chung ph\u1ea3i (A) v\u00e0 t\u0129nh m\u1ea1ch (V) \u0111\u01b0\u1ee3c hi\u1ec3n th\u1ecb trong c\u1ea3 hai h\u00ecnh \u1ea3nh si\u00eau \u00e2m. C.<\/strong> Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n m\u1eb7t c\u1eaft v\u00e0nh (coronal) cho th\u1ea5y v\u00f9ng gi\u1ea3m t\u1ef7 tr\u1ecdng trung t\u00e2m (m\u0169i t\u00ean r\u1ed7ng) b\u00ean trong t\u0129nh m\u1ea1ch bu\u1ed3ng tr\u1ee9ng ph\u1ea3i, \u0111\u1ea1i di\u1ec7n cho huy\u1ebft kh\u1ed1i g\u00e2y t\u1eafc m\u1ed9t ph\u1ea7n.<\/em><\/p>\n\n\n\n

Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang (Bladder Flap Hematoma) v\u00e0 Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n (Subfascial Hematoma)<\/strong><\/strong> <\/p>\n\n\n\n

Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang x\u1ea3y ra sau sinh m\u1ed5 do c\u1ea7m m\u00e1u kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 v\u00e0 bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng kh\u1ed1i m\u00e1u t\u1ee5 gi\u1eefa th\u00e0nh b\u00e0ng quang v\u00e0 \u0111o\u1ea1n d\u01b0\u1edbi t\u1eed cung. Tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m, kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang s\u1ebd \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y l\u00e0 m\u1ed9t kh\u1ed1i v\u00f4 m\u1ea1ch h\u1ed3i \u00e2m h\u1ed7n h\u1ee3p n\u1eb1m ph\u00eda tr\u01b0\u1edbc \u0111o\u1ea1n d\u01b0\u1edbi t\u1eed cung v\u00e0 ph\u00eda sau th\u00e0nh b\u00e0ng quang (H\u00ecnh 12). Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang nh\u1ecf (<2 cm) l\u00e0 bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p sau sinh m\u1ed5 (H\u00ecnh 13). Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang l\u1edbn (>5 cm) n\u00ean c\u1ea3nh b\u00e1o b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u1ec1 kh\u1ea3 n\u0103ng b\u1ee5c v\u1ebft m\u1ed5 t\u1eed cung [18].<\/p>\n\n\n\n

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H\u00ecnh 12. H\u00ecnh minh h\u1ecda s\u01a1 \u0111\u1ed3 v\u1ec1 v\u1ebft m\u1ed5 l\u1ea5y thai b\u00ecnh th\u01b0\u1eddng, kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang v\u00e0 kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n.<\/strong> A.<\/strong> H\u00ecnh \u1ea3nh b\u00ecnh th\u01b0\u1eddng c\u1ee7a v\u1ebft m\u1ed5 l\u1ea5y thai (m\u0169i t\u00ean) \u1edf \u0111o\u1ea1n d\u01b0\u1edbi tr\u01b0\u1edbc t\u1eed cung c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong t\u1eed cung h\u1eadu s\u1ea3n b\u00ecnh th\u01b0\u1eddng. B.<\/strong> Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang (m\u0169i t\u00ean) h\u00ecnh th\u00e0nh gi\u1eefa th\u00e0nh tr\u01b0\u1edbc c\u1ee7a \u0111o\u1ea1n d\u01b0\u1edbi t\u1eed cung v\u00e0 th\u00e0nh sau c\u1ee7a b\u00e0ng quang. C.<\/strong> Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n (\u0111\u1ea7u m\u0169i t\u00ean) l\u00e0 kh\u1ed1i m\u00e1u t\u1ee5 ngo\u00e0i ph\u00fac m\u1ea1c n\u1eb1m trong khoang tr\u01b0\u1edbc b\u00e0ng quang, ph\u00eda sau c\u01a1 th\u1eb3ng b\u1ee5ng v\u00e0 ph\u00eda tr\u01b0\u1edbc ph\u00fac m\u1ea1c.<\/em><\/p>\n\n\n

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H\u00ecnh 13. Kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang.<\/strong> A.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 25 tu\u1ed5i \u0111\u1ebfn ph\u00f2ng c\u1ea5p c\u1ee9u v\u1edbi \u0111au v\u00f9ng ch\u1eadu. H\u00ecnh \u1ea3nh si\u00eau \u00e2m thang x\u00e1m m\u1eb7t c\u1eaft d\u1ecdc c\u1ee7a t\u1eed cung cho th\u1ea5y m\u1ed9t \u1ed5 t\u1ee5 d\u1ecbch gi\u1ea3m \u00e2m nh\u1ecf (v\u00f2ng tr\u00f2n) v\u1edbi c\u00e1c h\u1ed3i \u00e2m d\u00e0y b\u00ean trong n\u1eb1m ph\u00eda tr\u01b0\u1edbc t\u1eed cung, l\u00e0m l\u00f5m b\u00e0ng quang (B). L\u01b0u \u00fd bu\u1ed3ng t\u1eed cung gi\u00e3n r\u1ed9ng v\u1edbi c\u1ee5c m\u00e1u \u0111\u00f4ng gi\u1ea3m \u00e2m (\u0111\u1ea7u m\u0169i t\u00ean). B-D.<\/strong> M\u1ed9t kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang l\u1edbn \u1edf b\u1ec7nh nh\u00e2n 26 tu\u1ed5i \u0111\u00e3 tr\u1ea3i qua sinh m\u1ed5 5 ng\u00e0y tr\u01b0\u1edbc \u0111\u01b0\u1ee3c hi\u1ec3n th\u1ecb. B.<\/strong> Si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o m\u1eb7t c\u1eaft d\u1ecdc cho th\u1ea5y m\u1ed9t \u1ed5 t\u1ee5 d\u1ecbch h\u1ed7n h\u1ee3p l\u1edbn (d\u1ea5u hoa th\u1ecb) \u0111\u1ea9y t\u1eed cung ra sau (m\u0169i t\u00ean). C.<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m thang x\u00e1m m\u1eb7t c\u1eaft ngang cho th\u1ea5y m\u1ed9t kh\u1ed1i m\u00e1u t\u1ee5 l\u1edbn (d\u1ea5u hoa th\u1ecb) l\u00e0m l\u00f5m th\u00e0nh sau c\u1ee7a b\u00e0ng quang (B). D.<\/strong> Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1eb7t c\u1eaft d\u1ecdc c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n cho th\u1ea5y \u1ed5 t\u1ee5 d\u1ecbch t\u0103ng t\u1ef7 tr\u1ecdng (d\u1ea5u hoa th\u1ecb) gi\u1eefa t\u1eed cung (U) v\u00e0 b\u00e0ng quang (B). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n.<\/em><\/p>\n\n\n\n

Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u1ea1ch m\u00e1u th\u01b0\u1ee3ng v\u1ecb ho\u1eb7c c\u00e1c nh\u00e1nh c\u1ee7a ch\u00fang \u1edf th\u00e0nh b\u1ee5ng, v\u00e0 bao g\u1ed3m kh\u1ed1i m\u00e1u t\u1ee5 trong khoang tr\u01b0\u1edbc b\u00e0ng quang, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 khoang Retzius (H\u00ecnh 12, 14). Tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m, m\u1ed9t kh\u1ed1i d\u1ea1ng nang ho\u1eb7c ph\u1ee9c t\u1ea1p s\u1ebd \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y s\u00e2u b\u00ean d\u01b0\u1edbi c\u01a1 th\u1eb3ng b\u1ee5ng v\u00e0 ph\u00eda tr\u01b0\u1edbc b\u00e0ng quang (H\u00ecnh 14). M\u1ea5t m\u00e1u \u0111\u00e1ng k\u1ec3 c\u00f3 th\u1ec3 x\u1ea3y ra do kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n v\u00ec khoang tr\u01b0\u1edbc b\u00e0ng quang c\u00f3 th\u1ec3 ch\u1ee9a d\u1ecbch l\u00ean \u0111\u1ebfn th\u1ec3 t\u00edch 2.500 mL. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u00ed ho\u1eb7c c\u00e1c v\u00e1ch ng\u0103n b\u00ean trong l\u00e0 \u0111\u00e1ng lo ng\u1ea1i v\u1ec1 kh\u1ed1i m\u00e1u t\u1ee5 nhi\u1ec5m tr\u00f9ng ho\u1eb7c \u00e1p xe, \u0111\u1ed1i v\u1edbi c\u1ea3 kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n v\u00e0 kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang (H\u00ecnh 14).<\/p>\n\n\n

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H\u00ecnh 14. Kh\u1ed1i m\u00e1u t\u1ee5 d\u01b0\u1edbi c\u00e2n v\u00e0 \u00e1p xe.<\/strong> A.<\/strong> M\u1ed9t s\u1ea3n ph\u1ee5 22 tu\u1ed5i \u0111\u1ebfn ph\u00f2ng c\u1ea5p c\u1ee9u v\u1edbi \u0111au b\u1ee5ng d\u01b0\u1edbi. Si\u00eau \u00e2m thang x\u00e1m qua ng\u1ea3 b\u1ee5ng cho th\u1ea5y \u1ed5 t\u1ee5 d\u1ecbch tr\u1ed1ng \u00e2m (m\u0169i t\u00ean) ph\u00eda tr\u01b0\u1edbc b\u00e0ng quang (B). B.<\/strong> H\u00ecnh \u1ea3nh ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) m\u1eb7t c\u1eaft d\u1ecdc c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n cho th\u1ea5y \u1ed5 t\u1ee5 d\u1ecbch t\u0103ng t\u1ef7 tr\u1ecdng (m\u0169i t\u00ean) ph\u00eda sau c\u01a1 th\u1eb3ng b\u1ee5ng v\u00e0 ph\u00eda tr\u01b0\u1edbc b\u00e0ng quang (B). L\u01b0u \u00fd th\u00e2m nhi\u1ec5m m\u1ee1 \u1edf th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc do ph\u1eabu thu\u1eadt g\u1ea7n \u0111\u00e2y. C, D.<\/strong> M\u1ed9t ph\u1ee5 n\u1eef 31 tu\u1ed5i \u0111\u1ebfn ph\u00f2ng c\u1ea5p c\u1ee9u v\u1edbi \u0111au b\u1ee5ng d\u01b0\u1edbi v\u00e0 s\u1ed1t 10 ng\u00e0y sau sinh m\u1ed5. C.<\/strong> Si\u00eau \u00e2m thang x\u00e1m qua ng\u1ea3 b\u1ee5ng cho th\u1ea5y \u1ed5 t\u1ee5 d\u1ecbch ph\u1ee9c t\u1ea1p (m\u0169i t\u00ean) ph\u00eda tr\u01b0\u1edbc b\u00e0ng quang (B). D.<\/strong> CT m\u1eb7t c\u1eaft d\u1ecdc c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n cho th\u1ea5y \u1ed5 t\u1ee5 d\u1ecbch ng\u1ea5m thu\u1ed1c d\u1ea1ng vi\u1ec1n (m\u0169i t\u00ean) ph\u00eda sau c\u01a1 th\u1eb3ng b\u1ee5ng v\u00e0 ph\u00eda tr\u01b0\u1edbc b\u00e0ng quang (B), ph\u00f9 h\u1ee3p v\u1edbi \u00e1p xe. B\u1ec7nh nh\u00e2n cu\u1ed1i c\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u qua da d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m.<\/em><\/p>\n\n\n\n

B\u1ee5c v\u1ebft m\u1ed5 t\u1eed cung v\u00e0 V\u1ee1 t\u1eed cung (Uterine Dehiscence and Uterine Rupture<\/strong>)<\/p>\n\n\n\n

V\u1ee1 t\u1eed cung l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng hi\u1ebfm g\u1eb7p nh\u01b0ng nghi\u00eam tr\u1ecdng, th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n b\u1eb1ng \u0111au b\u1ee5ng v\u00e0 c\u00f3 th\u1ec3 g\u00e2y tr\u00e0n m\u00e1u ph\u00fac m\u1ea1c \u0111\u00e1ng k\u1ec3. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u1ee1 t\u1eed cung x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed sinh m\u1ed5 tr\u01b0\u1edbc \u0111\u00f3, m\u1eb7c d\u00f9 v\u1ee1 t\u1eed cung c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra t\u1ef1 ph\u00e1t ho\u1eb7c do ch\u1ea5n th\u01b0\u01a1ng. C\u00e1c d\u1ea5u hi\u1ec7u si\u00eau \u00e2m thang x\u00e1m bao g\u1ed3m khuy\u1ebft c\u01a1 t\u1eed cung, t\u00fai \u1ed1i l\u1ed3i ra (\u1edf b\u1ec7nh nh\u00e2n mang thai), kh\u1ed1i m\u00e1u t\u1ee5 ngo\u00e0i t\u1eed cung, t\u1eed cung r\u1ed7ng l\u1edbn, v\u00e0 tr\u00e0n m\u00e1u ph\u00fac m\u1ea1c. B\u1ee5c v\u1ebft m\u1ed5 t\u1eed cung (ho\u1eb7c b\u1ee5c v\u1ebft m\u1ed5 l\u1ea5y thai) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi khuy\u1ebft c\u01a1 t\u1eed cung v\u1edbi l\u1edbp thanh m\u1ea1c ph\u1ee7 b\u00ean tr\u00ean c\u00f2n nguy\u00ean v\u1eb9n. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ee5c v\u1ebft m\u1ed5 t\u1eed cung c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n do s\u1ef1 ch\u1ed3ng l\u1ea5p \u0111\u00e1ng k\u1ec3 v\u1edbi h\u00ecnh \u1ea3nh h\u1eadu ph\u1eabu b\u00ecnh th\u01b0\u1eddng c\u1ee7a v\u1ebft m\u1ed5 l\u1ea5y thai. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u1ed1i m\u00e1u t\u1ee5 v\u1ea1t b\u00e0ng quang l\u1edbn (>5 cm)<\/strong> c\u00f3 li\u00ean quan \u0111\u1ebfn v\u1ee1 t\u1eed cung. MRI v\u00f9ng ch\u1eadu c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 ch\u1ee9ng minh l\u1edbp thanh m\u1ea1c c\u00f2n nguy\u00ean v\u1eb9n nh\u1edd \u0111\u1ed9 ph\u00e2n gi\u1ea3i t\u01b0\u01a1ng ph\u1ea3n m\u00f4 m\u1ec1m m\u1ea1nh m\u1ebd.<\/p>\n\n\n\n

K\u1ebft lu\u1eadn<\/strong> Xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o v\u00e0 \u0111au v\u00f9ng ch\u1eadu h\u1eadu s\u1ea3n c\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n, m\u1ed9t s\u1ed1 trong \u0111\u00f3 c\u00f3 th\u1ec3 y\u00eau c\u1ea7u \u0111i\u1ec1u tr\u1ecb kh\u1ea9n c\u1ea5p. Si\u00eau \u00e2m l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong b\u1ed1i c\u1ea3nh c\u1ea5p c\u1ee9u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 PPH v\u00e0 \u0111au v\u00f9ng ch\u1eadu. Ti\u1ec1n s\u1eed v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 cung c\u1ea5p th\u00f4ng tin cho vi\u1ec7c \u0111\u00e1nh gi\u00e1 si\u00eau \u00e2m \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng, ch\u1eb3ng h\u1ea1n nh\u01b0 s\u00f3t nhau v\u00e0 vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung. V\u00ec s\u00f3t nhau lo\u1ea1i 3 c\u00f3 th\u1ec3 b\u1eaft ch\u01b0\u1edbc AVM, c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea7n \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn v\u1edbi b\u00e1c s\u0129 s\u1ea3n khoa \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed th\u00edch h\u1ee3p. Vi\u1ec7c l\u00e0m quen v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m si\u00eau \u00e2m c\u1ee7a c\u00e1c t\u00ecnh tr\u1ea1ng g\u00e2y \u0111au v\u00f9ng ch\u1eadu c\u1ea5p t\u00ednh v\u00e0 xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o trong giai \u0111o\u1ea1n h\u1eadu s\u1ea3n t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ch\u1ea9n \u0111o\u00e1n nhanh ch\u00f3ng, ch\u00ednh x\u00e1c v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn thai k\u1ef3 t\u1eeb n\u0103m 2011 \u0111\u1ebfn 2013 l\u00e0 17,0 ca tr\u00ean 100.000 ca sinh s\u1ed1ng. H\u01a1n m\u1ed9t n\u1eeda s\u1ed1 ph\u1ee5 n\u1eef n\u00e0y t\u1eed vong trong giai \u0111o\u1ea1n h\u1eadu s\u1ea3n, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 do c\u00e1c t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft ho\u1eb7c thuy\u00ean t\u1eafc. C\u00e1c t\u00ecnh tr\u1ea1ng kh\u00e1c nh\u01b0 nhi\u1ec5m tr\u00f9ng (vi\u00eam n\u1ed9i m\u1ea1c t\u1eed cung ho\u1eb7c nhi\u1ec5m tr\u00f9ng s\u1eb9o m\u1ed5 l\u1ea5y thai) v\u00e0 s\u00f3t nhau (RPOC), c\u0169ng n\u1eb1m trong s\u1ed1 c\u00e1c nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y b\u1ec7nh su\u1ea5t v\u00e0 t\u1eed su\u1ea5t \u1edf m\u1eb9, c\u00f3 th\u1ec3 c\u1ea7n nh\u1eadp vi\u1ec7n ho\u1eb7c th\u1ef1c hi\u1ec7n th\u00eam c\u00e1c th\u1ee7 thu\u1eadt. <\/p>\n","protected":false},"author":1,"featured_media":1300,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,41,32,16,5],"tags":[94,96,95],"class_list":["post-1294","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doc-sach-cho-vui","category-english-corner","category-hoc-sieu-am-tu-con-so-0","category-phu-khoa","category-sieu-am","tag-proc","tag-ra-huyet-am-dao","tag-sot-nhau"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1294","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/comments?post=1294"}],"version-history":[{"count":6,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1294\/revisions"}],"predecessor-version":[{"id":1301,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1294\/revisions\/1301"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/1300"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=1294"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=1294"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=1294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}