XUT HUYT 3 THNG Unh hng tip cnnh hng x trBs. Trn Bnh Trng
Ph n n khm v ra mu m o
nh gi du hiu sinh tn v mc ra muLu : xut huyt ni
Nghi ng c xut huyt nng
Ra mu t, th trng tt
Truyn dchXN: Hct, Hb, GS
CHN ON
CHN ONChn on c thaiHi bnh :- Ngy kinh cht(lu : tnh cht chu k
kinh, tnh cht mu kinh ln ny)kinh p cht- Bin php trnh thai ?Nu nghi
ng : Quick StickNhng nguyn nhn c th gy xut huyt trong 3 thng u ?-
sy thai- thai ngoi t cung- thai trng
Cc nguyn nhn khc :- vim nhim, polyp, chn thng, bnh l c tnh
CHN ON NGUYN NHNHi bnh :- Tnh cht ra mu m o:thi im xut hinlng
mu, tnh cht mum l km vi ra mu- Cc triu chng i km :au bng, au
lngtriu chng thai hnhtriu chng mt cuau li ln vaiCHN ON NGUYN NHNKhm
bnh :+ Khm bng :- n chn au, nht l c phn ng di hoc khng gi kh nng c
xut huyt ni+ Khm m vt :- xc nh ngun gc mu chy t c t cung- tnh cht
mu trong m o ( ti, bm en, c mu cc ?)- c m l trong m o ? (m nhau
thai, m trng)- polyp CTC ?- tn thng trn c t cung (l tuyn, u si)
& m o ?CHN ON NGUYN NHNKhm bnh :+ Khm m o phi hp vi khm bng :-
tnh trng c t cung: h, ng- ln ca t cung, mt - au khi lc t cung ?-
tnh trng cc ti cng : trng hoc c khi u, au ? (ch ti cng sau)CHN ON
NGUYN NHNCn lm sng :- -hCG: ch xc nh c thai, khng phn bit thai
trong hay thai ngoi. Theo di nng -hCG p dng trong trng hp nghi ng
thai ngoi t cung.- Siu m : Thai thng trong t cung : gestational sac
c th thy trn siu m t #4 - 4,5 tun v kinh ti thai giNH HNG CHN
ON
c imDa sySy kh trnhTNTCThai trngThi im ra mu--SmMunLng mu+++++
/++++au bng-+++/-Triu chng nghn+/-+/-tnhiuCTCngh mngng/h mThn t
cung= tui thai=/< tui thai< tui thai> Tui thaiau khi lc
TC0au nh+-Khi u phn ph--+/-+/-au khi khm ti
cng00+--hCGBTBT/thpcao
Hnh nh ti thai sm vi 2 vng echo m: vng trong tng ng vi mng m v
mng rng bao non, vng ngoi tng ng vi mng rng thnh
Yolksac : l mt cu trc trn sng c th nhn thy c t 5-6 tun v
kinh
Hnh nh ti thai gi trong thai ngoi t cung
Ti thai thtTi thai gi
ng thai vi hnh nh mu t sau nhau
Thai ngoi t cung
Thai trng: hnh nh t ong hoc bo tuytSY THAICc hnh thi lm sng
:
Da sy thai (ng thai)Sy thai kh trnhSy thai ang din tinThai ngng
tin trin (thai lu)Sy thai khng trnDa sy thaiLm sng:- ra mu m o t
(-)- thng khng c au bng- t cung to tng ng tui thai, CTC ngSiu m :-
c mu t sau nhau- vn cn hot ng tim thaiX tr :- ngh ngi, trnh lao ng
nng, c quan h- progesterone t nhinSy thai kh trnhLm sng:- ra mu m o
nhiu hoc ko di (>10 ngy)- c th c ra mt phn m nhau thai- au bng
tng cn (hoc au lng) ngy cng tng- CTC h mSiu m : khi mu t sau nhau
to hnX tr :Nu ra mu nhiu phi ht hoc no thai cm muSy thai ang din
tinLm sng:- ra mu nhiu, c th nh hng n du hiu sinh tn- au qun bng
tng cn- CTC h, s c khi nhau thai qua l CTC hoc tng ra ngoi m oX
tr:- truyn dch hi sc nu cn- ht hoc no gp thai nhanh cm muThai ngng
tin trinLm sng:- ra mu c th khng nhiu- CTC ng, t cung thng nh hn
tui thaiSiu m:- ti phi > 25mm nhng khng c phi bn trong (trng
trng), hoc hnh nh ti phi xp, b mo m- khng thy hot ng tim thaiX tr
:- Nu khng ra mu nhiu, thai ph khng lo lng ch sy t nhin- No ht thai
hoc ph thai bng thuc
Sy thai khng trnLm sng:- thng c giai on ra mu dy da ko di trc ,
c mt thi im ra mu + au bng nhiu , thy c ra mnh m nhng sau vn ra mu
+ au bng ngm dy da- CTC ng hoc h m. TC 6500mUI/mL) hoc ti thai gi.-
khi echo dng nang, v dy cnh t cung- dch ti cng (-)Thai ngoi t cung
cha vTrong trng hp khng r rng phi theo di siu m v -hCG nh k mi 48
gi(T mc 2.000mIU/mL tr ln, nng -hCG tng gp i mi 24 gi trong trng hp
thai bnh thng trong t cung)o lng nng progesterone :- progesterone
> 25ng/ml 70% thai sng trong TC- progesterone < 25 ng/ml kh
nng l thai ngoi t cung hoc thai trong t cung pht trin bt thngThai
ngoi t cung cha vX tr :iu tr phu thut : ni soi* - m hCch iu tr :
trit ct tai vibo tn tai vi x tai vi ht khi thaiiu tr ni khoa (MTX)
:- Khi thai < 4mm- -hCG < 5.000 mIU/mL Thai ngoi t cung vLm
sng:- ty lng mu mt m triu chng xut huyt ni r rng hay khng ( du hiu
ca chong mt mu)- n chn au h v/ phn ng di / khng- K : lc t cung au,
ti cng sau au nhiSiu m :- dch ti cng, dch bng(chc d cng sau)Thai
ngoi t cung vX tr : - m bng h ct tai vi st gc t cung- c th ni soi
nu :+ sinh hiu n nh+ dch bng t+ phu thut vin c kinh nghimTHAI
TRNGLm sng:- ra mu m o (+ ++++) triu chng thiu mu- nghn nng (25%)-
triu chng cng gip, TSG sm- t cung to hn tui thai, mm, cng- u nang
hong tuyn (+/-), mt hoc 2 bnSiu m* : hnh nh bo tuyt hoc t ong-hCG :
THAI TRNGX tr :- Ht no thai trng : thc hin ti phng m, chun b mu
truyn nu cn. Gi th GPBL m no.- Ha tr d phng: nu c 1/cc yu t nguy c+
Tui m > 40+ BCTC > tui thai (hay > 20 tun)+ Nang hong tuyn
6cm+ hCG > 100.000mIU/ml.+ Thai trng ti pht, cng gip hoc c thuyn
tc t bo nui- Theo di hu thai trng (xem thm sch thc hnh SPK)
