{"id":631,"date":"2021-05-27T17:58:30","date_gmt":"2021-05-27T10:58:30","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=631"},"modified":"2021-05-30T01:23:23","modified_gmt":"2021-05-29T18:23:23","slug":"thai-ngoai-tu-cung-sau-thu-tinh-ong-nghiem","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/thai-ngoai-tu-cung-sau-thu-tinh-ong-nghiem\/","title":{"rendered":"Thai ngo\u00e0i t\u1eed cung sau th\u1ee5 tinh \u1ed1ng nghi\u1ec7m"},"content":{"rendered":"\n

Lisa Caronia, Rebecca Flyckt v\u00e0 Tommaso Falcone
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

\n\n\n\n

N\u1ed8I DUNG T\u00d3M T\u1eaeT CHO AI NG\u1ea0I \u0110\u1eccC D\u00c0I<\/strong><\/p>\n\n\n\n

\n\n\n\n
  1. Xem l\u1ea1i nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a thai ngo\u00e0i t\u1eed cung<\/a>. V\u00f4 sinh, ph\u1eabu thu\u1eadt \u1ed1ng d\u1eabn tr\u1ee9ng v\u00e0 tu\u1ed5i cao l\u00e0 m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, t\u1ef7 l\u1ec7 mang thai ngo\u00e0i t\u1eed cung \u1edf ph\u1ee5 n\u1eef tr\u00ean 35 tu\u1ed5i cao h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi nh\u1eefng ph\u1ee5 n\u1eef tr\u1ebb h\u01a1n. Vi\u00eam nhi\u1ec5m v\u00f9ng ch\u1eadu c\u0169ng l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1. IVF c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 EP.<\/li>
  2. V\u1edbi c\u00f4ng ngh\u1ec7 h\u1ed7 tr\u1ee3 sinh s\u1ea3n (ART) v\u00e0 t\u1ef7 l\u1ec7 \u0111a thai ng\u00e0y c\u00e0ng t\u0103ng, vai tr\u00f2 c\u1ee7a \u0111o hCG li\u00ean ti\u1ebfp s\u1ebd d\u1ea7n b\u1ecb h\u1ea1n ch\u1ebf, v\u00ec m\u1ee9c hCG \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y s\u1ebd kh\u00f4ng tu\u00e2n theo m\u1ed9t \u201cchu\u1ea9n” n\u00e0o c\u1ea3.<\/li>
  3. Mang thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung, th\u01b0\u1eddng x\u1ea3y ra \u1edf 1 \/ 30.000 tr\u01b0\u1eddng h\u1ee3p. ART l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 n\u00e0y l\u00ean \u0111\u1ebfn 1 \/ 4000 th\u1eadm ch\u00ed 1 \/100 ho\u1eb7c 1 \/ 1000. Do \u0111\u00f3 ngay c\u1ea3 khi \u0111\u00e3 th\u1ea5y thai trong t\u1eed cung ng\u01b0\u1eddi ta ph\u1ea3i lu\u00f4n ki\u1ec3m tra k\u1ef9 c\u00e1c ph\u1ea7n ph\u1ee5, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong tr\u01b0\u1eddng h\u1ee3p th\u1ee5 tinh \u1ed1ng nghi\u1ec7m.<\/li>
  4. Trong tr\u01b0\u1eddng h\u1ee3p mang thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung, theo d\u00f5i kh\u00f4ng kh\u1ea3 thi, hCG kh\u00f4ng c\u00f2n l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch. Methotrexate s\u1ebd g\u00e2y \u0111\u1ed9c cho thai trong t\u1eed cung -> ti\u00eam t\u1ea1i ch\u1ed7 dung d\u1ecbch glucose \u01b0u tr\u01b0\u01a1ng ho\u1eb7c KCL d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m l\u00e0 m\u1ed9t gi\u1ea3i ph\u00e1p n\u00ean c\u00e2n nh\u1eafc \u00e1p d\u1ee5ng.<\/li>
  5. N\u1ebfu b\u00e1c s\u0129 c\u00f3 \u0111\u1ee7 tr\u00ecnh \u0111\u1ed9, th\u1ef1c hi\u1ec7n ch\u1ecdc h\u00fat s\u1ebd t\u1ed1i \u01b0u h\u01a1n l\u00e0 ti\u00eam dung d\u1ecbch \u01b0u tr\u01b0\u01a1ng.<\/li>
  6. N\u1ed9i soi \u1ed5 b\u1ee5ng cho ph\u00e9p lo\u1ea1i b\u1ecf thai ngo\u00e0i t\u1eed cung m\u00e0 kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn thai trong t\u1eed cung. <\/li>
  7. Ph\u1eabu thu\u1eadt m\u1edf th\u00f4ng v\u00f2i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p kh\u1ed1i EP ch\u01b0a v\u1ee1.<\/li>
  8. Ph\u1eabu thu\u1eadt c\u1eaft v\u00f2i t\u1eed cung ch\u1ec9 n\u00ean xem x\u00e9t th\u1ef1c hi\u1ec7n tr\u00ean v\u00f2i \u0111\u00e3 t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng n\u1ec1 v\u00e0 \u0111\u1ed3ng th\u1eddi v\u00f2i c\u00f2n l\u1ea1i v\u1eabn ho\u1ea1t \u0111\u1ed9ng t\u1ed1t.<\/li><\/ol>\n\n\n\n
    \n\n\n\n

    B\u00c0I \u0110\u1ea6Y \u0110\u1ee6<\/strong><\/p>\n\n\n\n

    \n\n\n\n

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

    B\u1ec7nh nh\u00e2n 38 tu\u1ed5i mang thai con so, v\u1edbi ti\u1ec1n s\u1eed v\u00f4 sinh nguy\u00ean ph\u00e1t 2 n\u0103m \u0111\u00e3 \u0111\u01b0\u1ee3c si\u00eau \u00e2m x\u00e1c \u0111\u1ecbnh \u0111\u1eadu thai sau chuy\u1ec3n ph\u00f4i ng\u00e0y th\u00fa 5 (ET ) B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed v\u00f4 sinh do t\u1eafc v\u00f2i t\u1eed cung tr\u00e1i, th\u1ee9 ph\u00e1t sau l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung. C\u00f4 \u1ea5y \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt n\u1ed9i soi g\u1ee1 d\u00ednh, b\u01a1m thu\u1ed1c m\u00e0u \u0111\u00e1nh gi\u00e1 l\u01b0u th\u00f4ng v\u00f2i t\u1eed cung b\u00ean tr\u00e1i 4 th\u00e1ng tr\u01b0\u1edbc. Qu\u00e1 tr\u00ecnh l\u00e0m IVF kh\u00f4ng c\u00f3 kh\u00f3 kh\u0103n g\u00ec v\u00e0 hai ph\u00f4i \u0111\u01b0\u1ee3c chuy\u1ec3n v\u00e0o ng\u00e0y th\u1ee9 5 sau th\u1ee5 tInh. Hai tu\u1ea7n sau, c\u00f4 \u1ea5y c\u00f3 k\u1ebft qu\u1ea3 th\u1eed thai d\u01b0\u01a1ng t\u00ednh, v\u1edbi n\u1ed3ng \u0111\u1ed9 hCG trong huy\u1ebft thanh l\u00e0 1238 mIU \/ mL. N\u1ed3ng \u0111\u1ed9 hCG \u0111\u00f3 \u0111\u01b0\u1ee3c 1 tu\u1ea7n sau \u0111\u00f3 l\u00e0 9870 mlU\/ ml. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u00ean l\u1ecbch si\u00eau \u00e2m ti\u1ebfp khi tu\u1ed5i thai \u0111\u01b0\u1ee3c 7 tu\u1ea7n, t\u01b0\u01a1ng \u1ee9ng v\u1edbi kho\u1ea3ng 4 tu\u1ea7n sau IVF-ET Si\u00eau \u00e2m qua ng\u1ea3 \u00e2m \u0111\u1ea1o (TVUS) cho th\u1ea5y 1 thai \u1edf bu\u1ed3ng t\u1eed cung, v\u1edbi 1 t\u00fai thai kh\u00e1c ngo\u00e0i t\u1eed cung v\u1edbi c\u1ef1c thai \u1edf ph\u1ea7n ph\u1ee5 b\u00ean tr\u00e1i. B\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb hi\u1ebfm mu\u1ed9n cho b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o v\u1ec1 thai k\u1ef3 b\u1ea5t th\u01b0\u1eddng n\u00e0y v\u00e0 quy\u1ebft \u0111\u1ecbnh ti\u1ebfn h\u00e0nh n\u1ed9i soi l\u1ea5y b\u1ecf kh\u1ed1i thai ngo\u00e0i t\u1eed cung <\/p>\n\n\n\n

    H\u01b0\u1edfng x\u1eed tr\u00ed <\/strong><\/p>\n\n\n\n

    A. \u0110\u1ed3ng \u00fd v\u1edbi k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt n\u1ed9i soi.
    B. Ti\u00eam d\u1ecbch tru tr\u01b0\u1eddng v\u00e0o kh\u1ed1i EP d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m
    C. Ch\u1edd \u0111\u1ee3i v\u00e0 x\u00e9t nghi\u1ec7m hCG v\u00e0 TVUS 2-3 ng\u00e0y sau \u0111\u00f3. <\/p>\n\n\n\n

    Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 <\/strong><\/p>\n\n\n\n

    B\u1ec7nh nh\u00e2n c\u1ee7a ch\u00fang t\u00f4i c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung bao g\u1ed3m ti\u1ec1n s\u1eed v\u00f4 sinh, ph\u1eabu thu\u1eadt \u1ed1ng d\u1eabn tr\u1ee9ng v\u00e0o tu\u1ed5i cao. Trong m\u1ed9t nghi\u00ean c\u1ee9u, c\u00e1c t\u00e1c gi\u1ea3 b\u00e1o c\u00e1o r\u1eb1ng nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung \u1edf ph\u1ee5 n\u1eef hi\u1ebfm mu\u1ed9n cao g\u1ea5p \u0111\u00f4i so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00e1c. V\u00f4 sinh do b\u1ea5t th\u01b0\u1eddng v\u00f2i t\u1eed cung, nh\u01b0 trong ti\u1ec1n s\u1eed c\u1ee7a b\u1ec7nh nh\u00e2n n\u00e0y, l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh. \u0110\u00f3 c\u00f3 th\u1ec3 l\u00e0 do b\u1ec7nh vi\u00eam v\u00f9ng ch\u1eadu gi\u1ea3i ph\u1eabu b\u1ea5t th\u01b0\u1eddng c\u1ee7a v\u00f2i t\u1eed cung ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng do ph\u1eabu thu\u1eadt ho\u1eb7c mang thai ngo\u00e0i t\u1eed cung tr\u01b0\u1edbc \u0111\u00f3. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng ph\u00f4i thai di chuy\u1ec3n \u0111\u1ebfn bu\u1ed3ng t\u1eed cung, l\u00e0m t\u0103ng nguy c\u01a1 l\u00e0m t\u1ed5 ngo\u00e0i t\u1eed cung. \u0110\u1eadu thai sau th\u1ef1c hi\u1ec7n li\u1ec7u ph\u00e1p k\u00edch th\u00edch ng\u1eabn c\u0169ng l\u00e0m t\u0103ng nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch l\u00e0 do thay \u0111\u1ed5i kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n tr\u1ee9ng c\u1ee7a v\u00f2i t\u1eed cung; tuy nhi\u00ean, k\u1ebft qu\u1ea3 n\u00e0y c\u00f3 th\u1ec3 l\u00e0 do s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1 b\u1ea5t th\u01b0\u1eddng c\u1ed9ng l\u1ea1i. IVF c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung<\/p>\n\n\n\n

    T\u1ef7 l\u1ec7 mang thai ngo\u00e0i t\u1eed cung sau IVF \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y l\u00e0 2-11%. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y t\u1ef7 l\u1ec7 n\u00e0y th\u1ea5p h\u01a1n nhi\u1ec1u (0,7%). C\u00f3 l\u1ebd, n\u00f3 li\u00ean quan \u0111\u1ebfn nh\u1eefng c\u1ea3i ti\u1ebfn trong kh\u00e2u k\u1ef9 thu\u1eadt IVE, bao g\u1ed3m ET d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m, th\u1ef1c h\u00e0nh \u0111\u1eb7t catheter, s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ti\u1ec7n chuy\u1ec3n ph\u00f4i \u00edt x\u00e2m nh\u1eadp v\u00e0 tr\u00e1nh \u0111\u1eb7t catheter s\u00e2u. Nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y c\u0169ng \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng t\u1ef7 l\u1ec7 mang thai ngo\u00e0i t\u1eed cung kh\u00f4ng kh\u00e1c nhau trong IVF-ET chuy\u1ec3n ph\u00f4i t\u01b0\u01a1i v\u00e0 \u0111\u00f4ng l\u1ea1nh, c\u0169ng nh\u01b0 v\u1edbi tr\u1ee9ng c\u1ee7a ng\u01b0\u1eddi hi\u1ebfn t\u1eb7ng so v\u1edbi IVF ti\u00eau chu\u1ea9n. Ph\u1eabu thu\u1eadt c\u1eaft v\u00f2i t\u1eed cung c\u00f3 th\u1ec3 c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn s\u1ef1 xu\u1ea5t hi\u1ec7n thai ngo\u00e0i t\u1eed cung, tuy nhi\u00ean, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ph\u1eabu thu\u1eadt v\u00f2i t\u1eed cung th\u1ef1c s\u1ef1 c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nguy c\u01a1 ch\u1eeda ngo\u00e0i t\u1eed cung (v\u00ed d\u1ee5: \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 ph\u1eabu thu\u1eadt \u1ee9 d\u1ecbch v\u00f2i t\u1eed cung ho\u1eb7c \u0111i\u1ec1u tr\u1ecb g\u1ee1 d\u00ednh v\u00f2i). Cu\u1ed1i c\u00f9ng nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung t\u0103ng d\u1ea7n theo tu\u1ed5i, v\u1edbi t\u1ef7 l\u1ec7 mang thai ngo\u00e0i t\u1eed cung \u1edf ph\u1ee5 n\u1eef tr\u00ean 35 tu\u1ed5i cao h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi nh\u1eefng ph\u1ee5 n\u1eef tr\u1ebb h\u01a1n.<\/p>\n\n\n\n

    \u1ede nh\u00f3m ph\u1ee5 n\u1eef c\u00f3 kh\u1ea3 n\u0103ng sinh s\u1ea3n, vi\u1ec7c theo d\u00f5i b\u1ec7nh nh\u00e2n b\u1eb1ng x\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng hCG li\u00ean ti\u1ebfp ti\u1ebfp v\u00e0 TVUS l\u00e0 ti\u00eau chu\u1ea9n \u0111\u1ec3 ph\u00e1t hi\u1ec7n thai ngo\u00e0i t\u1eed cung \u1edf giai \u0111o\u1ea1n s\u1edbm. Tuy nhi\u00ean, theo d\u00f5i s\u1edbm l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n PUL, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 khi\u1ebfn ng\u01b0\u1eddi b\u00e1c s\u0129 kh\u00f3 kh\u0103n khi \u0111\u01b0a ra h\u01b0\u1edbng x\u1eed tr\u00ed ti\u1ebfp theo. V\u1edbi c\u00f4ng ngh\u1ec7 h\u1ed7 tr\u1ee3 sinh s\u1ea3n (ART) v\u00e0 t\u1ef7 l\u1ec7 \u0111\u00e3 thai ng\u00e0y c\u00e0ng t\u0103ng, vai tr\u00f2 c\u1ee7a \u0111o hCG li\u00ean ti\u1ebfp s\u1ebd d\u1ea7n b\u1ecb h\u1ea1n ch\u1ebf, v\u00ec m\u1ee9c hCG \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y s\u1ebd kh\u00f4ng tu\u00e2n theo m\u1ed9t \u201cchu\u1ea9n” n\u00e0o c\u1ea3.<\/p>\n\n\n\n

    Mang thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung, th\u01b0\u1eddng x\u1ea3y ra \u1edf 1 \/ 30.000 tr\u01b0\u1eddng h\u1ee3p mang thai, hi\u1ec7n \u0111ang gia t\u0103ng do vi\u1ec7c s\u1eed d\u1ee5ng ART ng\u00e0y c\u00e0ng ph\u1ed5 bi\u1ebfn. T\u1ea7n su\u1ea5t t\u00ednh t\u1edbi th\u1eddi \u0111i\u1ec3m hi\u1ec7n t\u1ea1i l\u00e0 1 tr\u00ean 4000 tr\u01b0\u1eddng h\u1ee3p mang thai v\u00e0 c\u00f3 th\u1ec3 cao t\u1edbi 1 tr\u00ean 100 \u0111\u1ebfn 1 tr\u00ean 1000 tr\u01b0\u1eddng h\u1ee3p mang th\u00e1i \u1edf ph\u1ee5 n\u1eef \u0111\u00e3 t\u1eebng \u0111\u01b0\u1ee3c k\u00edch th\u00edch r\u1ee5ng tr\u1ee9ng ho\u1eb7c th\u1ee5 tinh \u1ed1ng ng hi\u1ec7m. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 ch\u1eeda ngo\u00e0i t\u1eed cung. TVUS c\u00f3 \u0111\u1ed9 nh\u1ea1y cao trong ch\u1ea9n \u0111o\u00e1n thai trong v\u00e0 ngo\u00e0i t\u1eed cung sau IVF-ET. Ngay c\u1ea3 khi \u0111\u00e3 th\u1ea5y thai trong t\u1eed cung ng\u01b0\u1eddi ta ph\u1ea3i lu\u00f4n ki\u1ec3m tra k\u1ef9 c\u00e1c ph\u1ea7n ph\u1ee5, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong tr\u01b0\u1eddng h\u1ee3p th\u1ee5 tinh \u1ed1ng nghi\u1ec7m.<\/p>\n\n\n\n

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

    C\u00e1c nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd chung v\u1ec1 ch\u1eeda ngo\u00e0i t\u1eed cung c\u0169ng \u00e1p d\u1ee5ng cho ch\u1eeda ngo\u00e0i t\u1eed cung sau IVF. Tuy nhi\u00ean, trong tr\u01b0\u1eddng h\u1ee3p mang thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung, c\u00e1c b\u00e1c s\u0129 n\u00ean l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thai ngo\u00e0i t\u1eed cung \u00edt g\u00e2y r\u1ee7i ro nh\u1ea5t cho thai nhi \u0111ang ph\u00e1t tri\u1ec3n trong t\u1eed cung. <\/p>\n\n\n\n

    Ch\u1edd \u0111\u1ee3i theo d\u00f5i kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c kh\u1ea3 thi, do TVUS v\u00e0 hCG \u0111o li\u00ean ti\u1ebfp kh\u00f4ng c\u00f2n l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch. Methotrexate kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t tr\u1ecb li\u1ec7u \u0111\u01b0\u1ee3c \u01b0u ti\u00ean, v\u00ec n\u00f3 s\u1ebd g\u00e2y \u0111\u1ed9c cho thai trong t\u1eed cung. L\u00fac n\u00e0y, ti\u00eam t\u1ea1i ch\u1ed7 dung d\u1ecbch glucose \u01b0u tr\u01b0\u01a1ng ho\u1eb7c KCL d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m l\u00e0 m\u1ed9t gi\u1ea3i ph\u00e1p n\u00ean c\u00e2n nh\u1eafc \u00e1p d\u1ee5ng. C\u0169ng c\u00f3 m\u1ed9t s\u1ed1 b\u00e1o c\u00e1o v\u1ec1 vi\u1ec7c ch\u1ecdc h\u00fat t\u00fai thai d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m th\u00e0nh c\u00f4ng. N\u00ean n\u1ebfu b\u00e1c s\u0129 c\u00f3 \u0111\u1ee7 tr\u00ecnh \u0111\u1ed9, th\u1ef1c hi\u1ec7n ch\u1ecdc h\u00fat s\u1ebd t\u1ed1i \u01b0u h\u01a1n l\u00e0 ti\u00eam dung d\u1ecbch \u01b0u tr\u01b0\u1eddng. Th\u1ee7 thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf c\u01a1 s\u1edf ngo\u1ea1i tr\u00fa v\u00e0 c\u00f3 nguy c\u01a1 th\u1ea5p \u0111\u1ed1i v\u1edbi thai trong t\u1eed C\u00e1c nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd chung v\u1ec1 ch\u1eeda ngo\u00e0i t\u1eed cung c\u0169ng \u00e1p d\u1ee5ng cho ch\u1eeda ngo\u00e0i t\u1eed cung sau IVF. <\/p>\n\n\n\n

    Tuy nhi\u00ean, trong tr\u01b0\u1eddng h\u1ee3p mang thai c\u1ea3 trong l\u1eabn ngo\u00e0i t\u1eed cung, c\u00e1c b\u00e1c s\u0129 n\u00ean l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thai ngo\u00e0i t\u1eed cung \u00edt g\u00e2y r\u1ee7i ro nh\u1ea5t cho thai nhi \u0111ang ph\u00e1t tri\u1ec3n trong t\u1eed cung. Ch\u1edd \u0111\u1ee3i theo d\u00f5i kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c kh\u1ea3 thi, do TVUS v\u00e0 hCG \u0111o li\u00ean ti\u1ebfp kh\u00f4ng c\u00f2n l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch. Methotrexate kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t tr\u1ecb li\u1ec7u \u0111\u01b0\u1ee3c \u01b0u ti\u00ean, v\u00ec n\u00f3 s\u1ebd g\u00e2y \u0111\u1ed9c cho thai trong t\u1eed cung. L\u00fac n\u00e0y, ti\u00eam t\u1ea1i ch\u1ed7 dung d\u1ecbch glu cose \u01b0u tr\u01b0\u01a1ng ho\u1eb7c KCL d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m l\u00e0 m\u1ed9t gi\u1ea3i ph\u00e1p n\u00ean c\u00e2n nh\u1eafc \u00e1p d\u1ee5ng. <\/p>\n\n\n\n

    C\u0169ng c\u00f3 m\u1ed9t s\u1ed1 b\u00e1o c\u00e1o v\u1ec1 vi\u1ec7c ch\u1ecdc h\u00fat t\u00fai thai d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m th\u00e0nh c\u00f4ng. N\u00ean n\u1ebfu b\u00e1c s\u0129 c\u00f3 \u0111\u1ee7 tr\u00ecnh \u0111\u1ed9, th\u1ef1c hi\u1ec7n ch\u1ecdc h\u00fat s\u1ebd t\u1ed1i \u01b0u h\u01a1n l\u00e0 ti\u00eam dung d\u1ecbch \u01b0u tr\u01b0\u01a1ng. Th\u1ee7 thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf c\u01a1 s\u1edf ngo\u1ea1i tr\u00fa v\u00e0 c\u00f3 nguy c\u01a1 th\u1ea5p \u0111\u1ed1i v\u1edbi thai trong t\u1eed cung. Ti\u00eam methotrexate t\u1ea1i ch\u1ed7 kh\u00f4ng n\u00ean \u00e1p d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 thai trong + ngo\u00e0i t\u1eed cung, v\u00ec n\u00f3 c\u0169ng s\u1ebd ph\u00e1t huy t\u00e1c d\u1ee5ng tr\u00ean to\u00e0n c\u01a1 th\u1ec3. <\/p>\n\n\n\n

    Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ti\u1ebfp theo l\u00e0 n\u1ed9i soi \u1ed5 b\u1ee5ng v\u1edbi ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf v\u00f2i t\u1eed cung ho\u1eb7c m\u1edf th\u00f4ng v\u00f2i. N\u00f3 c\u00f3 hi\u1ec7u qu\u1ea3 ngay l\u1eadp t\u1ee9c v\u00e0 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c c\u00f3 d\u1ea5u hi\u1ec7u v\u1ee1 v\u00f2i t\u1eed cung. N\u1ed9i soi \u1ed5 b\u1ee5ng cho ph\u00e9p lo\u1ea1i b\u1ecf thai ngo\u00e0i t\u1eed cung m\u00e0 kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn thai trong t\u1eed cung. Ph\u1eabu thu\u1eadt m\u1edf th\u00f4ng v\u00f2i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p kh\u1ed1i EP ch\u01b0a v\u1ee1, c\u00f2n ph\u1eabu thu\u1eadt c\u1eaft v\u00f2i t\u1eed cung ch\u1ec9 n\u00ean xem x\u00e9t th\u1ef1c hi\u1ec7n tr\u00ean v\u00f2i \u0111\u00e3 t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng n\u1ec1 v\u00e0 \u0111\u1ed3ng th\u1eddi v\u00f2i c\u00f2n l\u1ea1i v\u1eabn ho\u1ea1t \u0111\u1ed9ng t\u1ed1t. N\u00ean gi\u1ea3i th\u00edch tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u1ec1 c\u00e1c t\u00ecnh hu\u1ed1ng c\u00f3 th\u1ec3 x\u1ea3y ra trong cu\u1ed9c m\u1ed5 cho b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi th\u00e2n.<\/p>\n\n\n\n

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

    B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt n\u1ed9i soi m\u1edf th\u00f4ng v\u00f2i t\u1eed cung th\u00e0nh c\u00f4ng kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng. Sau \u0111\u00f3, c\u00f4 sinh m\u1ed9t tr\u1ebb trai \u0111\u1ee7 th\u00e1ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p m\u1ed5 l\u1ea5y thai. Khi ph\u1eabu thu\u1eadt th\u1ea5y c\u00e1c v\u00f2i n\u00e0y v\u1eabn b\u00ecnh th\u01b0\u1eddng. Ch\u1ee5p t\u1eed cung v\u00f2i tr\u1ee9ng c\u1ea3n quang 1 n\u0103m sau sinh cho k\u1ebft qu\u1ea3 b\u00ecnh th\u01b0\u1eddng, v\u1edbi ch\u1ea5t c\u1ea3n quang tr\u00e0n v\u00e0o khoang b\u1ee5ng hai b\u00ean. Sau \u0111\u00f3, c\u00f4 th\u1ee5 thai t\u1ef1 nhi\u00ean 18 th\u00e1ng sau khi sinh con trai, sinh \u0111\u1ee7 th\u00e1ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p m\u1ed5 l\u1ea5y thai.<\/p>\n\n\n\n

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

    \u2022 V\u00f4 sinh, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u00f4 sinh do b\u1ea5t th\u01b0\u1eddng v\u00f2i t\u1eed cung, l\u00e0m nguy c\u01a1 mang thai ngo\u00e0i t\u1eed cung.
    \u2022 T\u1ef7 l\u1ec7 mang thai ngo\u00e0i t\u1eed cung sau IVF hi\u1ec7n nay \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh l\u00e0 0,7%, c\u00f3 th\u1ec3 do c\u00e1c k\u1ef9 thu\u1eadt ET \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i ti\u1ebfn.
    \u2022 TVUS c\u00f3 \u0111\u1ed9 nh\u1ea1y cao trong ch\u1ea9n \u0111o\u00e1n ch\u1eeda ngo\u00e0i t\u1eed cung sau IVF-ET. Do t\u1ea7n su\u1ea5t \u0111a thai v\u00e0 th\u1ef1c hi\u1ec7n ART ng\u00e0y m\u1ed9t t\u0103ng l\u00ean, hCG li\u00ean ti\u1ebfp hi\u1ec7n \u00edt c\u00f2n gi\u00e1 tr\u1ecb.
    \u2022 C\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thai trong v\u00e0 ngo\u00e0i t\u1eed cung bao g\u1ed3m n\u1ed9i soi \u1ed5 b\u1ee5ng c\u0169ng nh\u01b0 ti\u00eam glucose \u01b0u tr\u01b0\u01a1ng ho\u1eb7c KCL d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m. C\u00e1c quy\u1ebft \u0111\u1ecbnh qu\u1ea3n l\u00fd n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng (H\u00ecnh 4.1).<\/p>\n\n\n\n

    \"\"
    H\u00ecnh 4.1 Ch\u1eeda ngo\u00e0i t\u1eed cung, trong v\u00f2i t\u1eed cung<\/figcaption><\/figure><\/div>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Lisa Caronia, Rebecca Flyckt v\u00e0 Tommaso Falcone 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 N\u1ed8I<\/p>\n","protected":false},"author":1,"featured_media":632,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,34],"tags":[63,42,64],"class_list":["post-631","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doc-sach-cho-vui","category-ectopic-pregnancy-a-clinical-casebook","tag-ivf","tag-thai-ngoai-tu-cung","tag-thu-tinh-ong-nghiem"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/631","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=631"}],"version-history":[{"count":4,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/631\/revisions"}],"predecessor-version":[{"id":659,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/631\/revisions\/659"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/632"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=631"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=631"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=631"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}