Tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng<\/strong><\/p>\nBN 38 tu\u1ed5i, nh\u1eadp vi\u1ec7n v\u00ec nghi ng\u1edd mang thai ngo\u00e0i t\u1eed cung sau khi th\u1ee5 thai b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m (IVF)<\/p>\n
TCTT<\/strong>:\u00a0 Huy\u1ebft \u0111\u1ed9ng \u1ed5n, \u0111au b\u1ee5ng b\u00ean ph\u1ea3i r\u1ea5t nh\u1eb9<\/p>\nC\u1eadn l\u00e2m s\u00e0ng<\/strong>:\u00a0\u00df-hCG huy\u1ebft thanh 4 ng\u00e0y tr\u01b0\u1edbc nh\u1eadp vi\u1ec7n: 3200 mIU \/ mL, \u00df-hCG l\u1eb7p l\u1ea1i 2 ng\u00e0y sau \u0111\u00f3: 2980 mIU\/ mL. \u00df-hCG khi nh\u1eadp vi\u1ec7n: 3000 mIU \/ mL.<\/p>\nSi\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o (TVUS): Bu\u1ed3ng tr\u1ee9ng to v\u1edbi nhi\u1ec1u ho\u00e0ng th\u1ec3 v\u00e0 m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf d\u1ecbch trong t\u00fai c\u00f9ng. \u1ed0ng Fallope b\u00ean ph\u1ea3i d\u01b0\u1eddng nh\u01b0 b\u1ecb c\u0103ng.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1<\/strong><\/p>\n\u1ede nh\u1eefng ph\u1ee5 n\u1eef th\u1ee5 thai b\u1eb1ng k\u1ef9 thu\u1eadt h\u1ed7 tr\u1ee3 sinh s\u1ea3n (ART), nguy c\u01a1 thai ngo\u00e0i t\u1eed cung t\u0103ng l\u00ean g\u1ea5p \u0111\u00f4i. B\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 m\u1ed9t kh\u1ed1i b\u1ea5t th\u01b0\u1eddng ngo\u00e0i t\u1eed cung v\u00e0 d\u1ecbch t\u00fai c\u00f9ng, v\u00ec th\u1ebf c\u00f3 th\u1ec3 ngh\u0129 t\u1edbi EP.<\/p>\n
Khi mang thai kh\u00f4ng r\u00f5 v\u1ecb tr\u00ed (PUL) c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n
\n- Thai b\u1ea5t th\u01b0\u1eddng trong t\u1eed cung (b\u1ecb s\u1ea9y ho\u1eb7c k\u00e9m ph\u00e1t tri\u1ec3n)<\/li>\n
- Thai ngo\u00e0i t\u1eed cung (thai qu\u00e1 nh\u1ecf \u0111\u1ec3 TVUS c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c)<\/li>\n
- Kh\u1ea3 n\u0103ng mang thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ch\u00fa \u00fd lo\u1ea1i tr\u1eeb, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng thai do ART<\/li>\n<\/ul>\n
Ch\u1ec9 7-20% nh\u1eefng ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u l\u00e0 PUL th\u1ef1c s\u1ef1 mang thai ngo\u00e0i t\u1eed cung.<\/p>\n
N\u1ed3ng \u0111\u1ed9 HCG huy\u1ebft thanh c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng c\u1ee7a thai k\u1ef3. \u0110\u1ecbnh l\u01b0\u1ee3ng hormone n\u00e0y c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh xem li\u1ec7u si\u00eau \u00e2m \u0111\u00e3 c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y t\u00fai thai trong t\u1eed cung hay ch\u01b0a. M\u1ee9c cutoff \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n thai trong t\u1eed cung b\u1eb1ng si\u00eau \u00e2m qua \u1ed5 b\u1ee5ng l\u00e0 6000 – 6500 IU \/ L. V\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 \u00e2m \u0111\u1ea1o, m\u1ee9c cutoff \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n l\u00e0 1500 IU \/ L. Ng\u01b0\u1ee1ng n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0 kinh nghi\u1ec7m v\u00e0 k\u1ef9 n\u0103ng c\u1ee7a ng\u01b0\u1eddi l\u00e0m si\u00eau \u00e2m v\u00e0 lo\u1ea1i \u0111\u1ea7u d\u00f2 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n
\u0110\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a m\u1ee9c cutoff hCG > 1000 IU \/ L trong vi\u1ec7c ph\u00e1t hi\u1ec7n thai ngo\u00e0i t\u1eed cung khi kh\u00f4ng th\u1ea5y thai trong t\u1eed cung l\u00e0 21.7% v\u00e0 87.3%; \u0111\u1ed1i v\u1edbi m\u1ee9c hCG > 1500 IU \/ L c\u00e1c gi\u00e1 tr\u1ecb n\u00e0y l\u00e0 15.2% v\u00e0 93.4% v\u00e0 \u0111\u1ed1i v\u1edbi m\u1ee9c hCG > 2000 IU \/ L l\u00e0m t\u0103ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 gi\u1ea3m t\u1ed1i \u0111a t\u1ec9 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm ch\u1ea9n \u0111o\u00e1n thai ngo\u00e0i t\u1eed cung. Vai tr\u00f2 c\u1ee7a TVUS khi\u00a0\u00df-hCG d\u01b0\u1edbi 1500 IU \/ L trong ch\u1ea9n \u0111o\u00e1n thai ngo\u00e0i t\u1eed cung l\u00e0 r\u1ea5t nh\u1ecf, v\u1edbi \u0111\u1ed9 nh\u1ea1y t\u01b0\u01a1ng \u1ee9ng l\u00e0 33 v\u00e0 25%.<\/p>\n
N\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh tr\u00ean ng\u01b0\u1ee1ng cutoff (1500 IU \/ L) v\u00e0 kh\u00f4ng c\u00f3 t\u00fai thai trong t\u1eed cung tr\u00ean TVUS g\u1ee3i \u00fd ch\u1eafc ch\u1eafn mang thai ngo\u00e0i t\u1eed cung, nh\u01b0ng v\u1eabn ch\u01b0a th\u1ec3 ph\u00e1t hi\u1ec7n ra \u0111\u01b0\u1ee3c. M\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng c\u00f3 th\u1ec3 x\u1ea3y ra trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y:<\/p>\n
\n- S\u1ea3y thai ho\u00e0n to\u00e0n v\u1edbi n\u1ed3ng \u0111\u1ed9 \u00df-hCG gi\u1ea3m nhanh ch\u00f3ng.<\/li>\n
- S\u1ea3y thai kh\u00f4ng ho\u00e0n to\u00e0n v\u1edbi t\u00fai thai trong t\u1eed cung nh\u01b0ng kh\u00f4ng quan s\u00e1t r\u00f5.<\/li>\n
- \u0110a thai trong t\u1eed cung, ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng. \u1ede nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111a thai, n\u1ed3ng \u0111\u1ed9 \u00df-hCG huy\u1ebft thanh c\u00f3 th\u1ec3 cao h\u01a1n 1500 IU \/ L v\u00e0 si\u00eau \u00e2m s\u1ebd ch\u01b0a th\u1ec3 ph\u00e1t hi\u1ec7n thai trong t\u1eed cung. Tr\u01b0\u1edbc \u0111\u00e2y m\u1ee9c tr\u00ean 9000 IU \/ L \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p mang 3 thai trong t\u1eed cung m\u00e0 TVUS kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c t\u00fai thai. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, n\u1ed3ng \u0111\u1ed9 \u00df-hCG gi\u1ea3m c\u00f3 th\u1ec3 l\u00e0 do \u0111\u01a1n thai ph\u00e1t tri\u1ec3n k\u00e9m trong thai k\u1ef3 \u0111a thai.<\/li>\n
- Thai \u0111\u00f4i v\u1edbi thai trong t\u1eed cung ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng c\u00f9ng v\u1edbi 1 thai kh\u00e1c ngo\u00e0i t\u1eed cung.<\/li>\n
- M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 kh\u00e1c c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o vi\u1ec7c kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c t\u00fai thai trong t\u1eed cung v\u1edbi m\u1ee9c \u00df-hCG cao. Ch\u00fang bao g\u1ed3m b\u00e9o ph\u00ec v\u00e0 b\u1ec7nh l\u00fd trong t\u1eed cung, nh\u01b0 u x\u01a1, l\u1ea1c n\u1ed9i m\u1ea1c v\u00e0 polyp n\u1ed9i m\u1ea1c t\u1eed cung. Theo \u0111\u00f3, \u1edf nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 \u00edt tri\u1ec7u ch\u1ee9ng v\u00e0 nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung th\u1ea5p, ngay c\u1ea3 khi n\u1ed3ng \u0111\u1ed9 \u00df-hCG cao h\u01a1n ng\u01b0\u1ee1ng cutoff v\u00e0 kh\u00f4ng th\u1ea5y thai trong t\u1eed cung tr\u00ean TVUS, th\u00ec n\u00ean l\u1eb7p l\u1ea1i x\u00e9t nghi\u1ec7m hCG sau 2 ng\u00e0y. \u0110i\u1ec1u tr\u1ecb th\u1eadn tr\u1ecdng nh\u01b0 v\u1eady gi\u00fap l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng methotrexate m\u1ed9t c\u00e1ch kh\u00f4ng c\u1ea7n thi\u1ebft.<\/li>\n<\/ol>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 hCG th\u1ea5p h\u01a1n ng\u01b0\u1ee1ng cutoff, kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c thai trong t\u1eed cung th\u00ec c\u0169ng kh\u00f4ng th\u1ec3 k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c \u0111i\u1ec1u g\u00ec. Ch\u00fang t\u00f4i khuy\u1ebfn ngh\u1ecb \u0111\u00e1nh gi\u00e1 n\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh 2 ng\u00e0y m\u1ed9t l\u1ea7n cho t\u1edbi khi ch\u00fang \u0111\u1ea1t ng\u01b0\u1ee1ng cutoff. L\u01b0u \u00fd gi\u00e1 tr\u1ecb ti\u00eau chu\u1ea9n c\u1ee7a n\u1ed3ng \u0111\u1ed9 hCG c\u00f3 th\u1ec3 dao \u0111\u1ed9ng gi\u1eefa c\u00e1c lab l\u00ean \u0111\u1ebfn 15%. B\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 n\u1ed3ng \u0111\u1ed9 hCG cao h\u01a1n gi\u00e1 tr\u1ecb trong kho\u1ea3ng ch\u1ea9n \u0111o\u00e1n. Kh\u1ea3 n\u0103ng EP l\u00e0 cao nh\u01b0ng c\u0169ng n\u00ean \u0111\u1ec1 ph\u00f2ng tr\u01b0\u1eddng h\u1ee3p mang thai \u0111\u1ed3ng th\u1eddi c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung ho\u1eb7c \u0111a thai.<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/strong>\u00a0<\/p>\nB\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, c\u00f2n c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu \u1edf v\u00f9ng b\u1ee5ng TVUS kh\u00f4ng ph\u00e1t hi\u1ec7n t\u00fai thai: l\u00fac n\u00e0y, n\u00ean ngh\u0129 t\u1edbi ch\u1ea9n \u0111o\u00e1n PUL. Hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi \u1ed5 b\u1ee5ng c\u1ea5p c\u1ee9u c\u0169ng nh\u01b0 s\u1eed d\u1ee5ng methotrexate \u1edf b\u1ec7nh nh\u00e2n n\u00e0y, th\u1eadm ch\u00ed s\u1eed d\u1ee5ng qu\u00e1 s\u1edbm c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i.<\/p>\n
X\u00e9t nghi\u1ec7m \u00df-hCG v\u00e0 TVUS sau m\u1ed7i 2 ng\u00e0y l\u00e0 c\u00e1ch t\u1ed1i \u01b0u \u0111\u1ec3 theo d\u00f5i m\u1ed9t tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd EP. V\u00e0 khi EP \u0111\u00e3 qu\u00e1 r\u00f5 r\u00e0ng v\u1eabn n\u00ean c\u00e2n nh\u1eafc xem c\u00f3 c\u1ea7n s\u1eed d\u1ee5ng methotrexate hay kh\u00f4ng. Theo nghi\u00ean c\u1ee9u m\u00e0 ch\u00fang t\u00f4i m\u1edbi th\u1ef1c hi\u1ec7n 40% tr\u01b0\u1eddng h\u1ee3p thai ngo\u00e0i t\u1eed cung s\u1ebd t\u1ef1 di chuy\u1ec3n v\u1ec1 bu\u1ed3ng t\u1eed cung trong th\u1eddi gian theo d\u00f5i, khi\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng methotrexate g\u1ea7n nh\u01b0 l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft. B\u1eb1ng c\u00e1ch theo d\u00f5i n\u00e0y, c\u00f3 m\u1ed9t s\u1ed1 kh\u1ea3 n\u0103ng sau c\u00f3 th\u1ec3 x\u1ea3y ra:<\/p>\n
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N\u1ed3ng \u0111\u1ed9 \u00df-hCG ti\u1ebfp t\u1ee5c t\u0103ng v\u00e0 tr\u00ean TVUS s\u1ebd th\u1ea5y \u0111a t\u00fai thai bu\u1ed3ng t\u1eed cung. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, vi\u1ec7c s\u1eed d\u1ee5ng methotrexate c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i cho thai nhi \u0111ang ph\u00e1t tri\u1ec3n v\u00ec thu\u1ed1c n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y qu\u00e1i thai.<\/p>\n<\/li>\n
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N\u1ed3ng \u0111\u1ed9 \u00df-hCG ti\u1ebfp t\u1ee5c t\u0103ng v\u00e0 tr\u00ean TVUS th\u1ea5y c\u1ea3 thai trong v\u00e0 ngo\u00e0i t\u1eed cung. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u00ean c\u00e2n nh\u1eafc gi\u1eefa \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u00e0 ph\u1eabu thu\u1eadt d\u1ef1a tr\u00ean v\u1ecb tr\u00ed kh\u1ed1i EP v\u00e0 huy\u1ebft \u0111\u1ed9ng b\u1ec7nh nh\u00e2n.<\/p>\n<\/li>\n
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Gi\u00e1 tr\u1ecb c\u1ee7a \u00df-hCG t\u0103ng v\u00e0 th\u1ef1c hi\u1ec7n TVUS l\u1eb7p \u0111i l\u1eb7p l\u1ea1i s\u1ebd th\u1ea5y thai trong \u1ed1ng d\u1eabn tr\u1ee9ng m\u00e0 kh\u00f4ng c\u00f3 thai trong t\u1eed cung. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, vi\u1ec7c s\u1eed dung methotrexate c\u00f9ng v\u1edbi ph\u1eabu thu\u1eadt n\u1ed9i soi s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng, n\u1ed3ng \u0111\u1ed9 hCG v\u00e0 s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a ho\u1ea1t \u0111\u1ed9ng tim ngo\u00e0i t\u1eed cung.<\/p>\n<\/li>\n
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Gi\u00e1 tr\u1ecb c\u1ee7a \u00df-hCG s\u1ebd v\u01b0\u1ee3t l\u00ean tr\u00ean ng\u01b0\u1ee1ng, nh\u01b0ng v\u1edbi t\u1ed1c \u0111\u1ed9 b\u1ea5t th\u01b0\u1eddng, v\u00e0 TVUS v\u1eabn kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed c\u1ee7a thai. T\u1ea1i th\u1eddi \u0111i\u1ec3m n\u00e0y c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb, nh\u01b0ng v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c quy\u1ec1n ch\u1ea9n \u0111o\u00e1n (tr\u00ean l\u00e2m s\u00e0ng v\u1eabn th\u01b0\u1eddng \u0111\u1eb7t ch\u1ea9n \u0111o\u00e1n, khi\u1ebfn cho 40% tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng methotrexate l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft).<\/p>\n<\/li>\n
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Gi\u00e1 tr\u1ecb c\u1ee7a \u00df-hCG s\u1ebd \u1ed5n \u0111\u1ecbnh (b\u00ecnh nguy\u00ean). L\u00fac n\u00e0y n\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng methotrexate.<\/p>\n<\/li>\n
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Gi\u00e1 tr\u1ecb c\u1ee7a \u00df-hCG s\u1ebd gi\u1ea3m d\u1ea7n. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ebf n\u00e0o v\u1ec1 t\u00ecnh tr\u1ea1ng t\u00e2m s\u00e0ng ch\u1edd \u0111\u1ee3i l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb, v\u1edbi t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng l\u00e0 90% v\u00e0 60% \u1edf ph\u1ee5 n\u1eef c\u00f3 n\u1ed3ng \u0111\u1ed9 \u00df-hCG l\u1ea7n l\u01b0\u1ee3t l\u00e0 d\u01b0\u1edbi 2000 IU \/ L v\u00e0 tr\u00ean 10.000 IU \/ L.<\/p>\n<\/li>\n<\/ol>\n
K\u1ebft qu\u1ea3<\/strong><\/p>\nB\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ti\u00eam b\u1eafp m\u1ed9t li\u1ec1u duy nh\u1ea5t methotrexate (ng\u00e0y 0). V\u00e0o ng\u00e0y th\u1ee9 4, n\u1ed3ng \u0111\u1ed9 \u00df-hCG trong huy\u1ebft thanh l\u00e0 5000 IU \/ L. SI\u00eau \u00e2m l\u1ea1i, tr\u01b0\u1edbc s\u1ef1 ng\u1ea1c nhi\u00ean c\u1ee7a b\u00e1c s\u0129 ph\u1ee5 khoa, ch\u00fang t\u00f4i th\u1ea5y m\u00e0ng \u0111\u1ec7m v\u00e0 t\u00fai no\u00e0n ho\u00e0ng n\u0103m \u1edf v\u00f2i t\u1eed cung b\u00ean ph\u1ea3i v\u00e0 1 t\u00fai thai kh\u00e1c n\u1eb1m trong bu\u1ed3ng t\u1eed cung. Do thai ngo\u00e0i t\u1eed cung \u0111ang ph\u00e1t tri\u1ec3n, ch\u00fang t\u00f4i quy\u1ebft \u0111\u1ecbnh ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft b\u1ecf v\u00f2i t\u1eed cung b\u00ean ph\u1ea3i. Hi\u1ec3u \u0111\u01b0\u1ee3c nh\u1eefng r\u1ee7i ro li\u00ean quan \u0111\u1ebfn vi\u1ec7c ti\u1ebfp x\u00fac v\u1edbi methotrexate trong thai k\u1ef3, b\u1ec7nh nh\u00e2n \u0111\u00e3 ch\u1ecdn b\u1ecf thai trong t\u1ee9 cung<\/p>\n
H\u00ecnh \u00e1nh si\u00eau \u00e2m l\u00e1t c\u1eaft ngang cho th\u1ea5y t\u00fai thai gi\u1ea3 trong bu\u1ed3ng t\u1eed cung c\u00f9ng v\u1edbi t\u00fai thai \u1edf eo v\u00f2i t\u1eed cung b\u00ean tr\u00e1i. H\u00ecnh 2.1 v\u00e0 2.2 l\u00e0 c\u1ee7a c\u00f9ng m\u1ed9t benh nh\u00e2n. Nh\u01b0 ch\u1ee7ng ta \u0111\u00e3 th\u1ea5y tr\u00ean l\u00e1t c\u1eaft d\u1ecdc n\u1ed9i m\u1ea1c t\u1eeb cung \u0111ang \u1edf pha ho\u00e0ng th\u1ec3, \u0111\u1ecbnh h\u01b0\u1edfng t\u1edbi m\u1ed9t thai trong t\u1eed cung. Nh\u01b0ng tr\u00ean l\u00e1t c\u00e1t ngang cho th\u1ea5y b\u1ea3n ch\u1ea5t th\u1eadt c\u1ee7a v\u1ea5n \u0111\u1ec1 v\u1edbi n\u1ed3ng \u0111\u1ed9 \u00df-hCG l\u00e0 1500 IU\/mL th\u00ec tr\u01b0\u1eddng h\u1ee3p EP n\u00e0y r\u1ea5t d\u1ec5 b\u1ecb b\u1ecf s\u00f3t.<\/p>\n
\u0110\u00fac k\u1ebft l\u00e2m s\u00e0ng<\/strong><\/p>\n\n- Ng\u01b0\u1ee1ng cutoff c\u1ee7a \u00df-hCGhuy\u1ebft thanh trong ch\u1ea9n \u0111o\u00e1n EP kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng \u0111\u00e1ng tin c\u00e2y. N\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh cao h\u01a1n cutoff v\u00e0 kh\u00f4ng c\u00f3 t\u00fai thai trong bu\u00f0ng t\u1eed cung tr\u00ean TVUS c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e9p ch\u1ea5n \u0111o\u00e1n EP.<\/li>\n
- Khi n\u1ed3ng \u0111\u1ed9 \u00df-hCGcao h\u01a1n gi\u00e1 tr\u1ecb cutoff l\u00e0 1500 IU \/ L nh\u01b0ng kh\u00f4ng th\u1ea5y thai trong t\u1eed cung tr\u00ean TVUS, n\u00ean c\u00e2n nh\u1eafc c\u00e1c ch\u1ea5n \u0111o\u00e1n nh\u01b0 s\u1ea3y thai ho\u00e0n to\u00e0n \/ kh\u00f4ng ho\u00e0n to\u00e0n, \u0111a thai ho\u1eb7c thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung.<\/li>\n
- B\u00e9o ph\u00ec v\u00e0 c\u00e1c b\u1ec7nh l\u00fd t\u1ea1i t\u1eed cung c\u00f3 th\u1ec3 che khu\u1ea5t d\u1ea5u hi\u1ec7u mang thai trong t\u1eed cung s\u1edbm.<\/li>\n
- M\u1ee9c \u00df-hCG d\u01b0\u1edbi ng\u01b0\u1ee1ng v\u00e0 kh\u00f4ng c\u00f3 t\u00fai thai trong t\u1eed cung th\u00ec kh\u00f4ng th\u1ec3 k\u1ebft lu\u1eadn \u0111i\u1ec1u tr\u1ecb. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng n\u00ean l\u00e0m x\u00e9t nghi\u1ec7m l\u1ea1i \u00df-hCG v\u00e0 TVUS.<\/span><\/li>\n
- C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c gi\u00e1 tr\u1ecb \u00df-hCG. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u00f4ng n\u00ean theo do\u00f5i hCG ti\u00ean t\u1ee5c (2 ng\u00e0y\/l\u1ea7n) tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb<\/li>\n
- Ch\u1ea5n \u0111o\u00e1n EP ch\u1eadm c\u00f2n t\u1ed1t h\u01a1n l\u00e0 ch\u1ea9n \u0111o\u00e1n EP sai!<\/li>\n
- Vi\u1ec7c ch\u1edd \u0111\u1ee3i, theo d\u00f5i nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 beta-hCG \u0111ang c\u00f3 xu h\u01b0\u1edbng gi\u1ea3m s\u1ebd ng\u0103n ng\u1eeba vi\u1ec7c s\u1eed d\u1ee5ng methotrexate kh\u00f4ng c\u1ea7n thi\u1ebft.<\/li>\n<\/ul>\n\n\n\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u00d3M T\u1eaeT N\u1ed8I DUNG CH\u00cdNH TRONG B\u00c0I (CHO NH\u1eeeNG AI NG\u1ea0I \u0110\u1eccC D\u00c0I) M\u1ee9c cutoff \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n thai trong t\u1eed cung b\u1eb1ng si\u00eau \u00e2m<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,34,16,5],"tags":[42],"class_list":["post-261","post","type-post","status-publish","format-standard","hentry","category-doc-sach-cho-vui","category-ectopic-pregnancy-a-clinical-casebook","category-phu-khoa","category-sieu-am","tag-thai-ngoai-tu-cung"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/261","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=261"}],"version-history":[{"count":15,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/261\/revisions"}],"predecessor-version":[{"id":295,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/261\/revisions\/295"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=261"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=261"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}