{"id":613,"date":"2021-05-26T18:33:04","date_gmt":"2021-05-26T11:33:04","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=613"},"modified":"2021-05-27T20:52:35","modified_gmt":"2021-05-27T13:52:35","slug":"thai-khong-ro-vi-tri","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/thai-khong-ro-vi-tri\/","title":{"rendered":"Thai kh\u00f4ng r\u00f5 v\u1ecb tr\u00ed"},"content":{"rendered":"\n

Tr\u00edch t\u00e0i li\u1ec7u: Ectopic Pregnancy \u2013 A Clinical Casebook 
B\u1ea3n d\u1ecbch ti\u1ebfng Vi\u1ec7t c\u1ee7a bs Qu\u1ea3n Anh D\u0169ng<\/p>\n\n\n\n

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T\u00d3M T\u1eaeT (CHO NH\u1eeeNG AI L\u01af\u1edcI \u0110\u1eccC B\u00c0I D\u00c0I<\/strong>)<\/p>\n\n\n\n

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  1. Xem l\u1ea1i nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a thai ngo\u00e0i t\u1eed cung<\/a>. Nhi\u1ec5m tr\u00f9ng v\u00f9ng ch\u1eadu l\u00e0 m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1. H\u00fat thu\u1ed1c c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. Nh\u01b0ng h\u1ea7u h\u1ebft EP x\u1ea3y ra \u1edf ph\u1ee5 n\u1eef kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o.<\/li>
  2. \u0110i\u1ec1u tr\u1ecb PUL (thai ch\u01b0a r\u00f5 v\u1ecb tr\u00ed) hi\u1ec7n nay d\u1ef1a tr\u00ean vi\u1ec7c x\u00e1c \u0111\u1ecbnh nguy c\u01a1 (nguy c\u01a1 th\u1ea5p: kh\u1ea3 n\u0103ng PUL l\u00e0 th\u1ea5p v\u00e0 c\u00f3 th\u1ec3 th\u1ea5y thai trong bu\u1ed3ng t\u1eed cung; nguy c\u01a1 cao: EP) h\u01a1n l\u00e0 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed thai. Nguy c\u01a1 cao hay th\u1ea5p c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 th\u00f4ng qua t\u1ef7 s\u1ed1 hCG (hCG \u1edf 48 h \/ hCG \u1edf 0 gi\u1edd).<\/li>
  3. M\u1ee9c t\u0103ng hCG huy\u1ebft thanh tr\u00ean 35% sau 48h c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c mang thai trong t\u1eed cung.<\/li>
  4. N\u1ebfu c\u00f3 thai: hCG t\u0103ng g\u1ea5p \u0111\u00f4i,
    Kh\u00f4ng c\u00f3: HCG gi\u1ea3m m\u1ed9t n\u1eeda.
    EP: HCG c\u00f3 t\u0103ng nh\u01b0ng d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u sau 48h t\u00ednh t\u1eeb ng\u00e0y 0.
    Nh\u01b0ng <\/span>EP c\u0169ng c\u00f3 th\u1ec3 t\u0103ng g\u1ea5p \u0111\u00f4i ho\u1eb7c gi\u1ea3m m\u1ed9t n\u1eeda n\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh.
    Ng\u01b0\u1ee3c l\u1ea1i, 8% thai trong t\u1eed cung c\u00f3 th\u1ec3 s\u1ed1ng \u0111\u01b0\u1ee3c c\u00f3 hCG t\u0103ng d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u (kh\u00f4ng \u0111i\u1ec3n h\u00ecnh)<\/li>
  5. \u1ede m\u1ed9t ph\u1ee5 n\u1eef v\u1edbi PUL v\u00e0 hCG huy\u1ebft thanh > 2000 mIU \/ ml -> kh\u1ea3 n\u0103ng cao nh\u1ea5t kh\u00f4ng ph\u1ea3i l\u00e0 EP m\u00e0 l\u00e0 thai trong t\u1eed cung nh\u01b0ng kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c tr\u00ean si\u00eau \u00e2m. N\u00f3i m\u1ed9t c\u00e1ch kh\u00e1c l\u00e0 kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n m\u1ed9t thai trong t\u1eed cung khi hCG huy\u1ebft thanh > 2000 mIU \/ ml m\u00e0 si\u00eau \u00e2m kh\u00f4ng th\u1ea5y t\u00fai thai. Xem th\u00eam b\u00e0i: \u0110\u1ecbnh l\u01b0\u1ee3ng n\u1ed3ng \u0111\u1ed9 HCG huy\u1ebft thanh trong ch\u1ea9n \u0111o\u00e1n thai ngo\u00e0i t\u1eed cung, c\u00e1c nguy\u00ean nh\u00e2n \u00df-hCG cao nh\u01b0ng si\u00eau \u00e2m kh\u00f4ng th\u1ea5y t\u00fai thai)<\/a><\/li>
  6. N\u1ebfu EP \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y kh\u00e1 ch\u1eafc ch\u1eafn, v\u1eabn c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb cho \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 hCG huy\u1ebft thanh th\u1ee9 hai sau 48 gi\u1edd. H\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c ch\u1ea9n \u0111o\u00e1n EP \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh c\u00f2n l\u1edbn h\u01a1n nhi\u1ec1u vi\u1ec7c ch\u1ea9n \u0111o\u00e1n EP mu\u1ed9n. <\/li>
  7. N\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh kh\u00f4ng d\u1ef1 \u0111o\u00e1n kh\u1ea3 n\u0103ng v\u1ee1 kh\u1ed1i EP v\u00e0 h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1eed tr\u00ed an to\u00e0n b\u1eb1ng theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/li>
  8. N\u1ea1o t\u1eed cung \u0111\u1ec3 xem c\u00f3 l\u1edbp nhung mao m\u00e0ng \u0111\u1ec7m hay kh\u00f4ng KH\u00d4NG \u0111\u01b0\u1ee3c coi m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n \u1edf nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 PUL.<\/li><\/ol>\n\n\n\n
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    B\u00c0I \u0110\u1ea6Y \u0110\u1ee6<\/strong><\/p>\n\n\n\n

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    Tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n

    M\u1ed9t ph\u1ee5 n\u1eef 28 tu\u1ed5i \u0111\u01b0\u1ee3c b\u00e1c s\u0129 gia \u0111\u00ecnh chuy\u1ec3n \u0111\u1ebfn khoa c\u1ea5p c\u1ee9u v\u00ec 4 ng\u00e0y g\u1ea7n \u0111\u00e2y c\u1ea3m th\u1ea5y kh\u00f3 ch\u1ecbu \u1edf h\u1ed1 ch\u1eadu tr\u00e1i. K\u1ebft qu\u1ea3 th\u1eed thai (n\u01b0\u1edbc ti\u1ec3u) l\u00e0 d\u01b0\u01a1ng t\u00ednh. C\u00f4 \u1ea5y n\u00f3i r\u1eb1ng k\u1ef3 kinh nguy\u1ec7t g\u1ea7n nh\u1ea5t c\u1ee7a c\u00f4 \u1ea5y (LMP) l\u00e0 6 tu\u1ea7n tr\u01b0\u1edbc. C\u00f4 c\u00f3 ti\u1ec1n s\u1eed nhi\u1ec5m Chlamydia. Si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o cho th\u1ea5y m\u1ed9t v\u00f9ng gi\u1ea3m \u00e2m trong t\u1eed cung c\u00f3 \u0111\u01b0\u1eddng k\u00ednh l\u00e0 4,3mm. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n t\u00fai thai gi\u1ea3 (H\u00ecnh 3.1). <\/p>\n\n\n\n

    \"\"
    H\u00ecnh 3.1 M\u1ed9t t\u00fai thai trong t\u1eed cung giai \u0111o\u1ea1n s\u1edbm c\u00f3 th\u1ec3 nh\u1eb1m v\u1edbi t\u00fai thai gi\u1ea3 <\/figcaption><\/figure><\/div>\n\n\n\n

    Trong qu\u00e1 tr\u00ecnh ch\u1ee5p c\u1eaft l\u1edbp, b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y \u0111au \u1edf h\u1ed1 ch\u1eadu tr\u00e1i, v\u00e0 h\u00ecnh \u1ea3nh tr\u1ea3 v\u1ec1 c\u0169ng kh\u00f4ng th\u1ea5y r\u00f5 bu\u1ed3ng tr\u1ee9ng tr\u00e1i. X\u00e9t nghi\u1ec7m th\u1ea5y, hCG huy\u1ebft thanh l\u00e0 1600 mIU\/ ml v\u00e0 48 gi\u1edd sau \u0111\u00f3 \u0111\u00e3 t\u0103ng l\u00ean 2200 mlU \/ ml. C\u01a1n \u0111au c\u1ee7a b\u1ec7nh nh\u00e2n gi\u1ea3m d\u1ea7n. B\u00e1c s\u0129 ngh\u0129 t\u1edbi EP v\u00e0 l\u00fac n\u00e0y \u0111\u00e3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng methotrexate.<\/p>\n\n\n\n

    H\u01b0\u1edbng x\u1eed tr\u00ed?<\/strong><\/p>\n\n\n\n

    A. Nh\u1ea5t tr\u00ed v\u1edbi x\u1eed tr\u00ed tr\u00ean
    B. N\u1ed9i soi \u1ed5 b\u1ee5ng v\u00ec th\u1ea5y n\u1ed3ng \u0111\u1ed9 hCG cao
    C. Theo d\u00f5i v\u00e0 si\u00eau \u00e2m l\u1ea1i qua ng\u1ee7 \u00e2m \u0111\u1ea1o \u0111\u1ec3 \u0111\u00e1nh gi\u00e1
    D. Ti\u1ebfn h\u00e0nh n\u1ea1o thai
    E. Theo d\u00f5i v\u00e0 x\u00e9t nghi\u1ec7m l\u1ea1i hCG huy\u1ebft thanh<\/p>\n\n\n\n

    Ch\u00e1n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1<\/strong><\/p>\n\n\n\n

    M\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a EP (v\u00ed d\u1ee5 nh\u01b0 nhi\u1ec5m tr\u00f9ng v\u00f9ng ch\u1eadu tr\u01b0\u1edbc \u0111\u00f3) th\u00ec n\u00ean nghi ng\u1edd. Y\u1ebfu t\u1ed1 nguy c\u01a1 l\u1edbn nh\u1ea5t \u0111\u1ed1i v\u1edbi EP l\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1ed1ng d\u1eabn tr\u1ee9ng, th\u01b0\u1eddng x\u1ea3y ra sau ph\u1eabu thu\u1eadt \u1ed1ng d\u1eabn tr\u1ee9ng ho\u1eb7c sau nhi\u1ec5m tr\u00f9ng v\u00f9ng ch\u1eadu, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi Chlamydia trachomatis. Nh\u1eefng y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 h\u00fat thu\u1ed1c ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt h\u1ed7 tr\u1ee3 sinh s\u1ea3n c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1. Tuy nhi\u00ean, c\u1ea7n ph\u1ea3i nh\u1edb r\u1eb1ng h\u1ea7u h\u1ebft EP x\u1ea3y ra \u1edf nh\u1eefng ph\u1ee5 n\u1eef kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o. X\u00e1c \u0111\u1ecbnh th\u1eddi gian mang thai theo ph\u01b0\u01a1ng ph\u00e1p LMP l\u00e0 t\u1ed1t nh\u01b0ng kh\u00f4ng nh\u1ea5t thi\u1ebft l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n ch\u00ednh x\u00e1c nh\u1eefng g\u00ec mong \u0111\u1ee3i s\u1ebd th\u1ea5y tr\u00ean si\u00eau \u00e2m.<\/p>\n\n\n\n

    M\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 ph\u1ee5 n\u1eef kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 chu k\u1ef3 kinh c\u1ee7a m\u00ecnh ho\u1eb7c c\u00f3 chu k\u1ef3 kh\u00f4ng \u0111\u1ec1u. H\u01a1n n\u1eefa, ch\u00fang t\u00f4i bi\u1ebft kho\u1ea3ng th\u1eddi gian r\u1ee5ng tr\u1ee9ng – l\u00e0m t\u1ed5 c\u00f3 th\u1ec3 dao \u0111\u1ed9ng gi\u1eefa c\u00e1c c\u00e1 th\u1ec3. <\/p>\n\n\n\n

    Si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o l\u00e0 ph\u01b0\u01a1ng th\u1ee9c h\u00ecnh \u1ea3nh t\u1ed1t nh\u1ea5t \u0111\u1ec3 kh\u1ea3o s\u00e1t c\u00e1c v\u1ea5n \u0111\u1ec1 trong giai \u0111o\u1ea1n \u0111\u1ea7u thai k\u1ef3, v\u1edbi > 70% EP \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y khi si\u00eau \u00e2m v\u00e0 90% tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt s\u1eed d\u1ee5ng c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y. Ph\u1ea7n l\u1edbn (60%) c\u00e1c EP quan s\u00e1t tr\u00ean si\u00eau \u00e2m l\u00e0 m\u1ed9t kh\u1ed1i thu\u1ea7n nh\u1ea5t (d\u1ea5u hi\u1ec7u blob, H\u00ecnh 3.2) ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 h\u00ecnh v\u00f2ng nh\u1eabn ho\u1eb7c d\u1ea5u hi\u1ec7u “bagel kinh \u0111i\u1ec3n. <\/p>\n\n\n\n

    \"\"
    H\u00ecnh 3.2 M\u1ed9t kh\u1ed1i \u0111\u1ed3ng nh\u1ea5t ho\u1eb7c \u0111\u1ea7u blob \u2013 \u0111\u1eb7c \u0111i\u1ec3m si\u00eau \u00e2m \u0111\u1eb7c tr\u01b0ng c\u1ee7a EP.<\/figcaption><\/figure>\n\n\n\n

    Kh\u00e1i ni\u1ec7m “t\u00fai thai gi\u1ea3’ d\u01b0\u1eddng nh\u01b0 \u0111\u00e3 l\u1ed7i th\u1eddi v\u00e0 li\u00ean quan \u0111\u1ebfn c\u00e1ch hi\u1ec3u c\u00f3 ph\u1ea7n sai l\u1ea7m v\u1ec1 k\u1ebft qu\u1ea3 si\u00eau \u00e2m. M\u1ed9t kh\u1ed1i gi\u1ea3m \u00e2m ch\u1ee9a \u0111\u1ea7y d\u1ecbch h\u00ecnh tr\u00f2n ho\u1eb7c b\u1ea7u d\u1ee5c trong t\u1eed cung \u1edf m\u1ed9t ph\u1ee5 n\u1eef c\u00f3 k\u1ebft qu\u1ea3 th\u1eed thai d\u01b0\u01a1ng t\u00ednh c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng l\u00e0 t\u00fai thai s\u1edbm trong t\u1eed cung v\u00e0 kh\u00f4ng n\u00ean coi l\u00e0 d\u1ea5u hi\u1ec7u ch\u1ec9 \u0111i\u1ec3m EP. C\u0169ng c\u1ea7n h\u1ebft s\u1ee9c l\u01b0u \u00fd khi ti\u1ebfn h\u00e0nh ch\u1ee5p chi\u1ebfu \u1edf ph\u1ee5 n\u1eef khi t\u1eed cung n\u1eb1m ngang ho\u1eb7c c\u00f3 u x\u01a1. C\u1ea3 hai \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 kh\u0103n cho vi\u1ec7c x\u00e1c \u0111\u1ecbnh t\u00fai thai s\u1edbm trong t\u1eed cung.<\/p>\n\n\n\n

    Tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y l\u00e0 c\u00f3 thai kh\u00f4ng r\u00f5 v\u1ecb tr\u00ed (PUL), v\u00e0 ch\u1ea9n \u0111o\u00e1n n\u00e0y kh\u00e1c v\u1edbi EP. \u0110i\u1ec1u tr\u1ecb l\u00e0 l\u00e0m l\u1ea1i si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o sau m\u1ed9t kho\u1ea3ng th\u1eddi gian \u0111\u1ec3 xem li\u1ec7u v\u00f9ng gi\u1ea3m \u00e2m trong t\u1eed cung c\u00f3 ch\u1eafc ch\u1eafn l\u00e0 t\u00fai thai hay l\u1ea1i l\u00e0 m\u1ed9t kh\u1ed1i EP. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh EP th\u00ec c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng methotrexate.<\/p>\n\n\n\n

    \u0110i\u1ec1u tr\u1ecb PUL hi\u1ec7n nay d\u1ef1a tr\u00ean vi\u1ec7c x\u00e1c \u0111\u1ecbnh nguy c\u01a1 (nguy c\u01a1 th\u1ea5p: kh\u1ea3 n\u0103ng PUL l\u00e0 th\u1ea5p v\u00e0 c\u00f3 th\u1ec3 th\u1ea5y thai trong bu\u1ed3ng t\u1eed cung; nguy c\u01a1 cao: EP) h\u01a1n l\u00e0 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed thai. Nguy c\u01a1 cao hay th\u1ea5p c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 th\u00f4ng qua t\u1ef7 s\u1ed1 hCG (hCG \u1edf 48 h \/ hCG \u1edf 0 gi\u1edd)<\/p>\n\n\n\n

    Khi c\u00e2n nh\u1eafc vi\u1ec7c s\u1eed d\u1ee5ng methotrexate, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i lo\u1ea1i tr\u1eeb thai trong t\u1eed cung. Methotrexate c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch an to\u00e0n khi EP \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. Tuy nhi\u00ean, v\u00ec h\u1ea7u h\u1ebft c\u00e1c EP \u0111\u01b0\u1ee3c th\u1ea5y l\u00e0 m\u1ed9t kh\u1ed1i \u0111\u1ed3ng nh\u1ea5t tr\u00ean si\u00eau \u00e2m, n\u00ean c\u00f3 th\u1ec3 c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh gi\u1ea3. Do \u0111\u00f3, \u0111\u1ee3i 48 gi\u1edd v\u00e0 xem l\u1ea1i t\u1ef7 s\u1ed1 hCG tr\u01b0\u1edbc khi d\u00f9ng methotrexate c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 s\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng kh\u00f4ng \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh. M\u1ee9c t\u0103ng hCG huy\u1ebft thanh tr\u00ean 35% sau 48h c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c mang thai trong t\u1eed cung. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1ef1 gia t\u0103ng hCG trong huy\u1ebft thanh l\u00e0 37,5%, n\u00ean c\u00f3 kh\u1ea3 n\u0103ng thai n\u1eb1m trong bu\u1ed3ng t\u1eed cung. N\u00ean tham kh\u1ea3o b\u00e1c s\u0129 si\u00eau \u00e2m s\u1ea3n c\u00f3 chuy\u00ean m\u00f4n t\u1ed1t tr\u01b0\u1edbc khi ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng methotrexate.<\/p>\n\n\n\n

    V\u1ec1 kinh nghi\u1ec7m l\u00e2m s\u00e0ng ch\u00fang ta th\u01b0\u1eddng quan ni\u1ec7m r\u1eb1ng n\u1ebfu c\u00f3 thai th\u00ec l\u01b0\u1ee3ng hCG s\u1ebd t\u0103ng g\u1ea5p \u0111\u00f4i, kh\u00f4ng c\u00f3 th\u00ec s\u1ebd gi\u1ea3m m\u1ed9t n\u1eeda v\u00e0 EP th\u00ec s\u1ebd t\u0103ng nh\u01b0ng d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u sau 48h t\u00ednh t\u1eeb ng\u00e0y 0. Tuy nhi\u00ean, \u0111i\u1ec1u n\u00e0y kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng gi\u00fap b\u00e1c s\u0129 l\u00e2m s\u00e0ng x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed c\u1ee7a thai \u0111\u01b0\u1ee3c v\u00ec EP c\u0169ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p t\u0103ng g\u1ea5p \u0111\u00f4i ho\u1eb7c gi\u1ea3m m\u1ed9t n\u1eeda n\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh. Ng\u01b0\u1ee3c l\u1ea1i, 8% c\u00e1c tr\u01b0\u1eddng h\u1ee3p mang thai trong t\u1eed cung c\u00f3 th\u1ec3 s\u1ed1ng \u0111\u01b0\u1ee3c \u0111\u00e3 quan s\u00e1t th\u1ea5y m\u1ee9c hCG t\u0103ng d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u (kh\u00f4ng \u0111i\u1ec3n h\u00ecnh), nh\u01b0 \u0111\u00e3 th\u1ea5y trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y. Trong b\u1ea5t k\u1ef3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o, \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u ph\u1ea3i d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 r\u1ee7i ro. N\u1ebfu hCG huy\u1ebft thanh gi\u1ea3m, thai s\u1ebd \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m nguy c\u01a1 th\u1ea5p b\u1ea5t k\u1ec3 c\u00f3 \u0111ang \u1edf trong bu\u1ed3ng t\u1eed cung hay kh\u00f4ng<\/p>\n\n\n\n

    \u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n\n\n\n

    \u1ede m\u1ed9t ph\u1ee5 n\u1eef v\u1edbi PUL v\u00e0 hCG huy\u1ebft thanh> 2000 mIU \/ ml, ch\u1ea9n \u0111o\u00e1n c\u00f3 kh\u1ea3 n\u0103ng cao nh\u1ea5t kh\u00f4ng ph\u1ea3i l\u00e0 EP m\u00e0 l\u00e0 mang thai trong t\u1eed cung nh\u01b0ng kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c tr\u00ean si\u00eau \u00e2m. T\u01b0\u01a1ng t\u1ef1, kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n m\u1ed9t thai trong t\u1eed cung khi hCG huy\u1ebft thanh > 2000 miU \/ ml. Do \u0111\u00f3, kh\u00f4ng n\u00ean d\u00f9ng methotrexate khi c\u00f3 PUL v\u00e0 n\u1ed3ng \u0111\u1ed9 hCG ban \u0111\u1ea7u cao h\u01a1n m\u1ee9c n\u00e0y. Trong tr\u01b0\u1eddng h\u1ee3p EP nh\u00ecn th\u1ea5y kh\u00e1 ch\u1eafc ch\u1eafn, c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb cho \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 hCG huy\u1ebft thanh th\u1ee9 hai sau 48 gi\u1edd. T\u1ef7 l\u1ec7 hCG s\u1ebd cho ph\u00e9p b\u00e1c s\u0129 l\u00e2m s\u00e0ng bi\u1ebft li\u1ec7u c\u00f3 kh\u1ea3 n\u0103ng mang thai trong t\u1eeb cung hay kh\u00f4ng. Trong tr\u01b0\u1eddng h\u1ee3p n\u1ed3ng \u0111\u1ed9 hCG gi\u1ea3m, n\u00ean ti\u1ebfp t\u1ee5c theo d\u00f5i.<\/p>\n\n\n\n

    H\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c ch\u1ea9n \u0111o\u00e1n EP \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh c\u00f2n l\u1edbn h\u01a1n nhi\u1ec1u vi\u1ec7c ch\u1ea9n \u0111o\u00e1n EP mu\u1ed9n. N\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh kh\u00f4ng d\u1ef1 \u0111o\u00e1n kh\u1ea3 n\u0103ng v\u1ee1 kh\u1ed1i EP v\u00e0 h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1eed tr\u00ed an to\u00e0n b\u1eb1ng theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/p>\n\n\n\n

    Li\u00ean quan \u0111\u1ebfn n\u1ea1o t\u1eed cung, c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i cho th\u1ea5y r\u1eb1ng n\u1ea1o t\u1eed cung kh\u00f4ng \u0111\u01b0\u1ee3c coi m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n \u1edf nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 PUL. \u0110i\u1ec1u \u0111\u00e1ng s\u1ee3 l\u00e0 n\u1ea1o v\u00e9t t\u1eed cung c\u00f3 th\u1ec3 ph\u00e1 b\u1ecf thai \u1edf ng\u01b0\u1eddi \u0111ang mu\u1ed1n th\u1ee5 thai. M\u1ed9t \u0111i\u1ec1u n\u1eefa c\u1ea7n l\u01b0u \u00fd l\u00e0 s\u1ef1 gia t\u0103ng hCG \u1edf b\u1ec7nh nh\u00e2n PUL c\u00f3 th\u1ec3 th\u1ea5p t\u1edbi d\u01b0\u1edbi 15% sau 48 gi\u1edd. Trong m\u1ed9t nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp \u1edf nh\u00f3m ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 c\u00f3 “PUL dai d\u1eb3ng”, n\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh \u0111\u00e3 li\u00ean ti\u1ebfp kh\u00f4ng c\u00f3 xu h\u01b0\u1edbng gi\u1ea3m. L\u00fac n\u00e0y, ch\u00fang t\u00f4i s\u1eed d\u1ee5ng n\u1ea1o t\u1eed cung \u0111\u1ec3 xem l\u1edbp nhung mao m\u00e0ng \u0111\u1ec7m c\u00f3 hay kh\u00f4ng tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng methotrexate. Tuy nhi\u00ean, \u00e2m t\u00ednh gi\u1ea3 c\u00f3 th\u1ec3 x\u1ea3y ra, v\u00ed d\u1ee5, kh\u00f4ng th\u1ea5y nhung mao m\u00e0ng \u0111\u1ec7m tr\u00ean ti\u00eau b\u1ea3n m\u00f4 b\u1ec7nh h\u1ecdc trong 20% c\u00e1c m\u1eabu n\u1ea1o do \u0111\u00ecnh ch\u1ec9 thai ngh\u00e9n c\u00f3 ch\u1ecdn l\u1ecdc.<\/p>\n\n\n\n

    K\u1ebft qu\u1ea3<\/strong><\/p>\n\n\n\n

    B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ti\u00eam b\u1eafp m\u1ed9t li\u1ec1u methotrexate duy nh\u1ea5t (50 mg \/ m2<\/sup>). Si\u00eau \u00e2m sau 14 ng\u00e0y th\u1ea5y thai trong t\u1eed cung c\u00f3 t\u00fai no\u00e3n ho\u00e0ng Bu\u1ed3ng tr\u1ee9ng hai b\u00ean b\u00ecnh th\u01b0\u1eddng. T\u00fai thai \u0111\u01b0\u1ee3c theo d\u00f5i trong 4 tu\u1ea7n ti\u1ebfp theo v\u00e0 cu\u1ed1i c\u00f9ng b\u1ecb s\u1ea9y. B\u1ec7nh nh\u00e2n \u0111\u00e3 kh\u1edfi ki\u1ec7n b\u00e1c s\u0129 ph\u1ee5 khoa v\u00e0 b\u1ec7nh vi\u1ec7n.<\/p>\n\n\n\n

    \u0110\u00fac k\u1ebft l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n

    \u2022 H\u1ea7u h\u1ebft c\u00e1c EP \u0111\u1ec1u \u1edf ph\u1ee5 n\u1eef kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1
    \u2022 Vi\u1ec7c x\u00e1c \u0111\u1ecbnh tu\u1ed5i thai d\u1ef1a tr\u00ean k\u1ef3 kinh cu\u1ed1i kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n k\u1ebft qu\u1ea3 (t\u01b0\u01a1ng \u1ee9ng ) tr\u00ean si\u00eau \u00e2m.
    \u2022 M\u1ed9t kh\u1ed1i gi\u1ea3m \u00e2m h\u00ecnh tr\u00f2n ho\u1eb7c b\u1ea7u d\u1ee5c trong t\u1eed cung c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng l\u00e0 t\u00fai thai s\u1edbm trong t\u1eed cung h\u01a1n l\u00e0 1 t\u00fai thai gi\u1ea3.
    \u2022 N\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh t\u0103ng d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n EP.
    \u2022 Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng m\u1ee9c hCG huy\u1ebft thanh> 2000 mlU\/ mL nh\u01b0 1 d\u1ea5u hi\u1ec7u ch\u1ec9 \u0111i\u1ec3m EP N\u00f3 c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng \u0111\u1ea1i di\u1ec7n cho m\u1ed9t thai trong t\u1eeb cung v\u00e0 kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t.
    \u2022 H\u1ea7u h\u1ebft c\u00e1c EP \u0111\u1ec1u r\u00f5 r\u00e0ng tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m (> 70% khi th\u0103m kh\u00e1m v\u00e0 90% tr\u01b0\u1edbc ph\u1eabu thu\u1eadt). H\u1ea7u h\u1ebft c\u00e1c EP (60%) l\u00e0 m\u1ed9t kh\u1ed1i thu\u1ea7n nh\u1ea5t ho\u1eb7c c\u00f3 d\u1ea5u blob tr\u00ean si\u00eau \u00e2m.
    \u2022 Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n PUL d\u1ef1a tr\u00ean ph\u00e2n lo\u1ea1i nguy c\u01a1 th\u1ea5p\/cao v\u00e0 kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed c\u1ee7a thai.
    \u2022 Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 EP, c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i hCG sau 48 gi\u1edd tr\u01b0\u1edbc khi xem x\u00e9t \u0111i\u1ec1u tr\u1ecb
    \u2022 N\u1ebfu t\u1ef7 s\u1ed1 hCG kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng mang thai trong t\u1eed cung c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh si\u00eau \u00e2m l\u1ea1i sau 48h \u0111\u1ec3 ch\u1eafc ch\u1eafn ch\u1eafn \u0111o\u00e1n.
    \u2022 N\u1ebfu hCG gi\u1ea3m, c\u00f3 th\u1ec3 \u0111\u1ec3 theo d\u00f5i, ch\u01b0a c\u1ea7n d\u00f9ng methotrexate.
    \u2022 N\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh kh\u00f4ng d\u1ef1 \u0111o\u00e1n kh\u1ea3 n\u0103ng v\u1ee1 kh\u1ed1i EP
    \u2022 N\u1ea1o bu\u1ed3ng t\u1eed cung ch\u1ea9n \u0111o\u00e1n PUL kh\u00f4ng c\u00f3 qu\u00e1 nhi\u1ec1u gi\u00e1 tr\u1ecb
    \u2022 N\u1ea1o bu\u1ed3ng t\u1eed cung l\u00e0 h\u1ee3p l\u00fd tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb methotrexate \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i PUL dai d\u1eb3ng (hCG kh\u00f4ng gi\u1ea3m sau th\u1eddi gian d\u00e0i theo d\u00f5i).<\/p>\n","protected":false},"excerpt":{"rendered":"

    Tr\u00edch t\u00e0i li\u1ec7u: Ectopic Pregnancy \u2013 A Clinical Casebook B\u1ea3n d\u1ecbch ti\u1ebfng Vi\u1ec7t c\u1ee7a bs Qu\u1ea3n Anh D\u0169ng T\u00d3M T\u1eaeT (CHO NH\u1eeeNG AI L\u01af\u1edcI \u0110\u1eccC B\u00c0I<\/p>\n","protected":false},"author":1,"featured_media":616,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,34,5],"tags":[62,42],"class_list":["post-613","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doc-sach-cho-vui","category-ectopic-pregnancy-a-clinical-casebook","category-sieu-am","tag-hcg","tag-thai-ngoai-tu-cung"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/613","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=613"}],"version-history":[{"count":9,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/613\/revisions"}],"predecessor-version":[{"id":638,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/613\/revisions\/638"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/616"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=613"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=613"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=613"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}