{"id":323,"date":"2016-10-17T11:25:03","date_gmt":"2016-10-17T04:25:03","guid":{"rendered":"https:\/\/benhvienvietbi.vn\/en\/?p=323"},"modified":"2024-07-04T15:04:23","modified_gmt":"2024-07-04T08:04:23","slug":"nhung-rui-ro-va-tai-bien-trong-ivf","status":"publish","type":"post","link":"https:\/\/benhvienvietbi.vn\/en\/nhung-rui-ro-va-tai-bien-trong-ivf\/","title":{"rendered":"[:vi]Nh\u1eefng r\u1ee7i ro v\u00e0 tai bi\u1ebfn trong IVF[:]"},"content":{"rendered":"

[:vi]<\/p>\n

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Nh\u1eefng r\u1ee7i ro v\u00e0 tai bi\u1ebfn trong IVF<\/h1>\n
<\/div>\n<\/header>\n
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Th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m (IVF ) c\u01a1 b\u1ea3n l\u00e0 qui tr\u00ecnh an to\u00e0n, tuy v\u1eady v\u1eabn c\u00f3 m\u1ed9t s\u1ed1 r\u1ee7i do, tai bi\u1ebfn v\u00e0 bi\u1ebfn ch\u1ee9ng nh\u01b0 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng, \u0111a thai, ch\u1eeda ngo\u00e0i d\u1ea1 con\u2026<\/p>\n

    \n
  1. Th\u1ea5t b\u1ea1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb IVF<\/strong><\/li>\n<\/ol>\n

    \u00a0<\/strong>\u00a0<\/strong>\u0110\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 hay g\u1eb7p trong \u0111i\u1ec1u tr\u1ecb. Nh\u1eefng nguy\u00ean nh\u00e2n hay l\u00e0m cho th\u1ea5t b\u1ea1i ph\u1ea3i nh\u01b0 d\u1eebng chu k\u1ef3 (kho\u1ea3ng 10% chu k\u1ef3 ph\u1ea3i d\u1eebng l\u1ea1i tr\u01b0\u1edbc ch\u1ecdc no\u00e3n), th\u1ea5t b\u1ea1i do ch\u1ecdc tr\u1ee9ng (kho\u1ea3ng 1%), th\u1ea5t b\u1ea1i c\u1ee7a th\u1ee5 tinh (5%), v\u00e0 th\u1ea5t b\u1ea1i do chuy\u1ec3n ph\u00f4i (nguy\u00ean do khi\u1ebfm khuy\u1ebft c\u1ee7a ph\u00f4i, n\u1ed9i m\u1ea1c t\u1eed cung, ho\u1eb7c \u0111\u1ed3ng h\u00f3a k\u00e9m..).<\/p>\n

    Ph\u1ea7n c\u00f3 \u00fd ngh\u0129a c\u1ee7a ph\u00f4i b\u1ea5t th\u01b0\u1eddng v\u1ec1 chromosome, n\u00f3 t\u0103ng t\u01b0\u01a1ng x\u1ee9ng v\u1edbi tu\u1ed5i ng\u01b0\u1eddi m\u1eb9.<\/p>\n

    Qui tr\u00ecnh IVF c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc b\u1edfi m\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1, m\u1ed9t trong \u0111i\u1ec1u tr\u1ecb v\u00f4 sinh. Th\u1ea5t b\u1ea1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a thay \u0111\u1ed5i c\u1ea3m x\u00fac, stres t\u00e2m l\u00fd v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n v\u1ec1 t\u00e2m l\u00fd. M\u1ed9t s\u1ed1 \u0111\u00f4i \u0111\u00f2i h\u1ecfi t\u01b0 v\u1ea5n t\u00e2m l\u00fd tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n chu k\u1ef3 IVF.<\/p>\n

      \n
    1. Nh\u1eefng v\u1ea5n \u0111\u1ec1 x\u1ea3y ra v\u1edbi k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng b\u1eb1ng thu\u1ed1c sinh s\u1ea3n<\/strong><\/li>\n<\/ol>\n

      Kh\u00f4ng c\u00f3 thu\u1ed1c n\u00e0o tuy\u1ec7t \u0111\u1ed1i an to\u00e0n v\u00e0 kh\u00f4ng bi\u1ebfn ch\u1ee9ng, t\u00e1c d\u1ee5ng ph\u1ee5. Thu\u1ed1c sinh s\u1ea3n, k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng v\u00e0 \u00edt g\u00e2y bi\u1ebfn ch\u1ee9ng.<\/p>\n

      \u1ee6y ban an to\u00e0n thu\u1ed1c UK khuy\u1ebfn c\u00e1o r\u1eb1ng kh\u00f4ng s\u1eed d\u1ee5ng s\u1ea3n ph\u1ea9m d\u01b0\u1ee3c c\u00f3 ngu\u1ed3n g\u00f4c n\u01b0\u1edbc ti\u1ec3u v\u00ec c\u00f3 b\u00e1o c\u00e1o nh\u1eefng cases c\u00f3 h\u00ecnh th\u00e1i kh\u00e1c nhau c\u1ee7a b\u1ec7nh Creutzfeldt Jacob<\/strong>, g\u1ed3m c\u1ea3 metrodine tinh khi\u1ebft cao (2\/2004)<\/p>\n

        \n
      1. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng<\/strong><\/li>\n<\/ol>\n

        \u00a0<\/strong>\u00a0<\/strong>R\u1ea5t \u00edt b\u1ec7nh nh\u00e2n b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 do s\u1eed d\u1ee5ng thu\u1ed1c sinh s\u1ea3n. T\u00e1c d\u1ee5ng ph\u1ee5 bao g\u1ed3m: ph\u1ea3n \u1ee9ng t\u1ea1i ch\u1ed7 nh\u01b0 th\u00e2m t\u00edm t\u1ea1i ch\u1ed7 nh\u1eb9 v\u00e0 l\u1edbn do ti\u00eam. Tai bi\u1ebfn n\u00e0y r\u1ea5t hay g\u1eb7p trong s\u1eed d\u1ee5ng th\u1ebf ph\u1ea9m c\u1ee7a HMG h\u01a1n l\u00e0 d\u00f9ng d\u1ea1ng tinh khi\u1ebft ho\u1eb7c FSH t\u00e1i t\u1ed5 h\u1ee3p. C\u00f3 th\u1ec3 s\u00f3 ph\u1ea3n \u1ee9ng nh\u1eb9 do d\u1ecb \u1ee9ng to\u00e0n th\u00e2n.<\/p>\n

        Nh\u1eefng thu\u1ed1c kh\u00e1c nh\u01b0 GnRh analogues<\/a>c\u00f3 th\u1ec3 g\u00e2y \u0111au \u0111\u1ea7u, t\u00e2m t\u00ednh thay \u0111\u1ed5i, ra huy\u1ebft go\u1eb7c kh\u00f4 \u00e2m \u0111\u1ea1o \u1edf m\u1ed9t s\u1ed1 ph\u1ee5 n\u1eef. Nh\u1eefng v\u1ea5n \u0111\u1ec1 n\u00e0y th\u01b0\u1eddng t\u1ed3n t\u1ea1i ng\u1eafn v\u00e0 kh\u00f4ng \u0111\u00e1ng quan t\u00e2m.<\/p>\n

        Kho\u1ea3ng 15% ph\u1ee5 n\u1eef xu\u1ea5t hi\u1ec7n nang ch\u1ee9c n\u0103ng trong s\u1eed d\u1ee5ng GnRh analogues<\/a>. C\u00e1c nang n\u00e0y c\u00f3 th\u1ec3 s\u1ea3n xu\u1ea5t Estradiol, \u0111\u00f4i khi k\u1ebft h\u1ee3p k\u1ebft qu\u1ea3 IVF th\u1ea5p. N\u1ebfu \u0111i\u1ec1u n\u00e0y x\u1ea3y ra, v\u1eabn khuy\u00ean d\u00f9ng GnRh analogues<\/a> v\u00e0 t\u1ef1 n\u00f3 kh\u1ecfi ho\u1eb7c ch\u1ecdc h\u00fat.<\/p>\n

         <\/p>\n

          \n
        1. H\u1ed9i ch\u1ee9ng qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng- Ovarian hyperstimulation syndrome (OHSS)<\/strong><\/li>\n<\/ol>\n

          \u0110\u00e2y l\u00e0 bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t c\u1ee7a IVF. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng x\u1ea3y ra OHSS , m\u1eb7c d\u00f9 d\u1ea1ng kh\u00e1c x\u1ea3y ra nhi\u1ec1u h\u01a1n. OHSS c\u00f3 th\u1ec3 ph\u00e2n lo\u1ea1i: nh\u1eb9, tr\u00f9ng b\u00ecnh ho\u1eb7c n\u1eb7ng d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u. Nh\u1eefng cases n\u1eb7ng nh\u1ea5t c\u00f3 xu h\u01b0\u1eddng k\u1ebft h\u1ee3p \u0111a thai. OHSS tr\u1ea7m tr\u1ecdng l\u00e0 bi\u1ebfn ch\u1ee9ng \u0111e d\u1ecda cu\u1ed9c s\u1ed1ng sau k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng<\/p>\n

          C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 4-5 sau ch\u1ecdc no\u00e3n<\/u>.<\/strong> Ph\u1ea7n l\u1edbn d\u1ea1ng nh\u1eb9 v\u00e0 trung b\u00ecnh c\u1ee7a tri\u1ec7u ch\u1ee9ng v\u00e0 lu\u00f4n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft trong v\u00f2ng \u00edt ng\u00e0y tr\u1eeb khi c\u00f3 thai k\u1ebft h\u1ee3p, c\u00f3 thai c\u1ea3n tr\u1edf h\u1ed3i ph\u1ee5c. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 k\u00eau \u0111au, c\u1ea3m gi\u00e1c ph\u00f9 v\u00e0 b\u1ee5ng s\u01b0ng nh\u1eb9. Trong s\u1ed1 \u00edt ph\u1ee5 n\u1eef, m\u1ee9c \u0111\u1ed9 kh\u00f3 ch\u1ecbu r\u1ea5t d\u1ec5 nh\u1eadn th\u1ea5y.<\/p>\n

          M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t hi\u1ec7n nhi\u1ec1u nang \u1edf bu\u1ed3ng tr\u1ee9ng ( bu\u1ed3ng tr\u1ee9ng nhi\u1ec1u nang) tr\u00e0n d\u1ecbch m\u00e0ng b\u1ee5ng g\u00e2y kh\u00f3 ch\u1ecbu.<\/p>\n

          R\u1ea5t \u00edt khi OHSS tr\u1ea7m tr\u1ecdng v\u00e0 bu\u1ed3ng tr\u1ee9ng s\u01b0ng r\u1ea5t to. Ph\u1ee5 n\u1eef c\u1ea3m th\u1ea5y m\u1ec7t, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n, \u0111au b\u1ee5ng. Tr\u00e0n d\u1ecbch n\u1eb7ng m\u00e0ng b\u1ee5ng, m\u00e0ng ph\u1ed5i, nguy\u00ean nh\u00e2n l\u00e0m to b\u1ee5ngv\u00e0 th\u1edf n\u00f4ng. B\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u gi\u1ea3m. Nh\u1eefng bi\u1ebfn ch\u1ee9ng n\u00e0y \u0111\u00f2i h\u1ecfi v\u00e0o vi\u1ec7n c\u1ea5p c\u1ee9u, b\u1ea3o t\u1ed3n c\u00e2n b\u1eb1ng n\u01b0\u1edbc \u0111i\u1eb9n gi\u1ea3i, qu\u00e1 tr\u00ecnh theo d\u00f5i, ki\u1ec3m so\u00e1t \u0111au \u1edf m\u1ed9t s\u1ed1 cases n\u1eb7ng, ng\u1eebng thai. Bi\u1ebfn ch\u1ee9ng k\u1ebft h\u1ee3p OHSS n\u1eb7ng g\u1ed3m r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, th\u01b0\u01a1ng t\u1ed5n th\u1eadn v\u00e0 so\u1eafn bu\u1ed3ng tr\u1ee9ng.<\/p>\n

          \u00a0T\u1ef7 l\u1ec7 b\u1ec7nh OHSS.<\/strong><\/p>\n

          M\u1eb7c d\u00f9 \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd, nh\u01b0ng t\u1edbi 33% \u0111i\u1ec1u tr\u1ecb IVF b\u00e1o c\u00e1o k\u1ebft h\u1ee3p OHSS m\u1ee9c \u0111\u1ed9 nh\u1eb9. N\u1eb7ng 3-8%<\/strong> trong chu k\u1ef3 IVF (Delvigne and Rosenberg 2002)<\/p>\n

          Nguy\u00ean nh\u00e2n OHSS<\/strong><\/p>\n

          Ch\u1ecbu tr\u00e1ch nhi\u1ec7m tr\u00ean h\u1ebft l\u00e0 thu\u1ed1c. Nguy\u00ean nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft. Nh\u01b0ng ph\u1ee5 n\u1eef b\u1ecb r\u1ee7i ro xu\u1ea5t hi\u1ec7n OHSS g\u1ed3m:<\/p>\n

          \u2013 Ph\u1ee5 n\u1eef b\u1ecb bu\u1ed3ng tr\u1ee9ng \u0111a nang. C\u00f3 b\u1eb1ng ch\u1ee9ng n\u00eau l\u00ean r\u1eb1ng s\u1eed d\u1ee5ng th\u00eam metformin \u0111\u1ec3 t\u1ea1o ph\u00f3ng no\u00e3n \u1edf ph\u1ee5 n\u1eef b\u1ecb PCOS \u0111i\u1ec1u tr\u1ecb IVF l\u00e0m gi\u1ea3m xu\u1ea5t hi\u1ec7n OHSS (Tang et al. Human Reproduction 2006)<\/p>\n

          \u2013 Qu\u00e1 nh\u1ea1y c\u1ea3m v\u1edbi thu\u1ed1c, ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n, nh\u01b0ng ph\u1ee5 n\u1eef sau hay b\u1ecd OHHS<\/p>\n

          \u2013 Ph\u1ee5 n\u1eef tr\u1ebb m\u1ea3nh mai<\/p>\n

          \u2013 N\u1ed3ng \u0111\u1ed9 E2 trong m\u00e1u cao ho\u1eb7c nhi\u1ec1u nang l\u1edbn hay nhi\u1ec1u tr\u1ee9ng.<\/p>\n

          \u2013 S\u1eed d\u1ee5ng GnRh agonist.<\/p>\n

          \u2013 S\u1eed d\u1ee5ng hCG trong phase h\u1ed7 tr\u1ee3 ho\u00e0ng th\u1ec3.<\/p>\n

          Ki\u1ec3m so\u00e1t v\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb OHSS<\/strong><\/p>\n

          \u2013 Ng\u1eebng s\u1eed d\u1ee5ng hCG, khi m\u00e0 n\u1ed3ng \u0111\u1ed9 E2 trong m\u00e1u v\u00e0 si\u00eau \u00e2m th\u1ec3 hi\u1ec7n nguy c\u01a1 cao c\u1ee7a OHSS n\u1eb7ng.<\/p>\n

          \u2013 Qu\u00e1 tr\u00ecnh l\u1ea5y tr\u1ee9ng, l\u00e0m ICSI; c\u00f3 th\u1ec3 \u0111\u00f4ng l\u1ea1nh v\u00e0 kh\u00f4ng ti\u1ebfn h\u00e0nh chuy\u1ec3n ph\u00f4i t\u01b0\u01a1i \u1edf chu k\u1ef3 \u0111\u00f3 m\u00e0 ti\u1ebfn h\u00e0nh chu k\u1ef3 \u0111i\u1ec1u tr\u1ecb chuy\u1ebfn ph\u00f4i \u0111\u00f4ng l\u1ea1nh. T\u0103ng c\u01b0\u1eddng albumin b\u1eb1ng truy\u1ec1n t\u0129nh m\u1ea1ch \u1edf th\u1eddi \u0111i\u1ec3m ch\u1ecdc no\u00e3n \u0111\u1ec3 gi\u1ea3m b\u1edbt tri\u1ec7u ch\u1ee9ng OHSS.<\/p>\n

          \u2013 D\u1eebng k\u00edch th\u00edch b\u1eb1ng gonandotropin v\u00e0 ti\u1ebfp t\u1ee5c c\u1ea5m d\u00f9ng angonist \u0111\u1ebfn t\u1eadn khi n\u1ed3ng \u0111\u1ed9 E2 gi\u1ea3m \u1edf m\u1ee9c ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c tr\u01b0\u1edbc qui tr\u00ecnh ch\u1ecdc no\u00e3n.<\/p>\n

          \u2013 Cabergoline <\/strong>0.5 mg v\/ng\u00e0y b\u1eaft \u0111\u1ea7u t\u1eeb ng\u00e0y ti\u00eam hCG v\u00e0 k\u00e9o d\u00e0i 8 ng\u00e0y bi\u1ec3u hi\u1ec7n gi\u1ea3m r\u1ee7i ro tr\u1ea7m tr\u1ecdng c\u1ee7a OHSS.<\/p>\n

          \u0110a thai<\/strong>\u00a0(Multiple pregnancy)<\/em><\/p>\n

          \u00a0<\/strong>Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n, d\u01b0\u1edbi 20% trong s\u1ed1 ph\u00f4i l\u00e0m t\u1ed5 sau khi \u0111\u01b0\u1ee3c chuy\u1ec3n v\u00e0o bu\u1ed3ng t\u1eed cung, th\u1ebf m\u00e0 2 ho\u1eb7c nhi\u1ec1u h\u01a1n, ph\u00f4i s\u1ebd l\u00e0m t\u1ed5 v\u00e0 \u0111a thai. S\u1ed1 li\u1ec7u g\u1ea7n \u0111\u00e2y nh\u1ea5t c\u1ee7a USA (SART 2002) t\u1eadp h\u1ee3p \u0111a thai c\u00f4ng b\u1ed1 r\u1eb1ng 32% tr\u1ebb sinh s\u1ed1ng sau IVF l\u00e0 sinh \u0111\u00f4i, 7% sinh 3 ho\u1eb7c h\u01a1n. UK (HFEA patient\u2019s guide 2002) 25% tr\u1ebb sinh s\u1ed1ng l\u00e0 sinh \u0111\u00f4i v\u00e0 1,7% sinh 3.<\/p>\n

          C\u00f3 \u0111i\u1ec1u quan tr\u1ecdng \u0111\u1ec3 ghi nh\u1edb r\u1eb1ng, \u1edf UK s\u1ed1 l\u01b0\u1ee3ng t\u1ed1i \u0111a ph\u00f4i \u0111\u01b0\u1ee3c chuy\u1ec3n trong 1chu k\u1ef3 l\u00e0 3. \u0110\u1ec3 gi\u1ea3m r\u1ee7i ro \u0111a thai, HFEA \u1edf UK (8\/2001) quy\u1ebft \u0111\u1ecbnh gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ph\u00f4i chuy\u1ec3n t\u1eeb 3 xu\u1ed1ng 2. Trong ho\u00e0n c\u1ea3nh ngo\u1ea1i l\u1ec7 3 ph\u00f4i \u0111\u01b0\u1ee3c chuy\u1ec3n. \u0110\u00e2y l\u00e0 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a l\u00e2m s\u00e0ng v\u00e0 lab. \u1ede nhi\u1ec1u n\u01b0\u1edbc c\u00f3 s\u1ef1 c\u00f3 s\u1ef1 \u0111i\u1ec1u ch\u1ec9nh v\u00e0 qui \u0111\u1ecbnh kh\u00e1c nhau c\u00f3 s\u1ef1 quan t\u00e2m t\u1edbi s\u1ed1 l\u01b0\u1ee3ng ph\u00f4i \u0111\u01b0\u1ee3c chuy\u1ec3n.<\/p>\n

          \"taibienivf01\"<\/p>\n

          D\u00f9 cho thai \u0111\u00f4i hay ba c\u00f3 s\u1ee9c h\u1ea5p d\u1eabn m\u1ed9t s\u1ed1 c\u1eb7p, \u0111a thai th\u00ec r\u1ee7i ro s\u1ebd cao h\u01a1n cho m\u1eb9 v\u00e0 b\u00e9. \u0110a thai g\u00e2y kh\u00f3 kh\u0103n nhi\u1ec1u cho b\u1ec7nh nh\u00e2n, chi ph\u00ed t\u00e0i ch\u00ednh, c\u01a1 h\u1ed9i suy ki\u1ec7t v\u00e0 m\u1ec7t m\u1ecfi c\u01a1 th\u1ec3.<\/p>\n

          \u00a0Nh\u1eefng r\u1ee7i ro cho m\u1eb9 v\u00e0 b\u00e9 trong \u0111a thai<\/strong><\/em><\/p>\n

          Tr\u00e1i v\u1edbi sinh \u0111\u00f4i c\u00f3 c\u00e1i nh\u00ecn th\u00f4ng th\u01b0\u1eddng v\u00e0 th\u00edch th\u00fa c\u1ee7a c\u00e1c c\u1eb7p, sinh 3 v\u00e0 nhi\u1ec1u thai h\u01a1n k\u1ebft h\u1ee3p v\u1edbi r\u1ee7i ro cho m\u1eb9 v\u00e0 b\u00e9. R\u1ee7i ro c\u1ee7a bi\u1ebfn ch\u1ee9ng n\u00e0y c\u1ea7n ph\u1ea3i ph\u00f2ng xa b\u1eb1ng c\u00e1ch gi\u1ea3m c\u00e2n b\u1eb1ng s\u1ed1 l\u01b0\u1ee3ng ph\u00f4i chuy\u1ec3n t\u01b0\u01a1ng \u1ee9ng t\u0103ng t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng.<\/p>\n

          Nh\u1eefng r\u1ee7i ro cho m\u1eb9 trong \u0111a thai<\/em><\/p>\n

          \u2013 S\u1ea3y thai<\/p>\n

          \u2013 Ch\u1ea3y m\u00e1u<\/p>\n

          \u2013 Huy\u1ebft \u00e1p cao<\/p>\n

          \u2013 Ti\u1ec1n s\u1ea3n gi\u1eadt xu\u1ea5t hi\u1ec7n t\u1eeb 3-5 l\u1ea7n so v\u1edbi b\u00ecnh th\u01b0\u1eddng.<\/p>\n

          \u2013 \u0110\u00e1i \u0111\u01b0\u1eddng<\/p>\n

          \u2013 Thi\u1ebfu m\u00e1u<\/p>\n

          \u2013 \u0110a \u1ed1i (Polyhydramnios) qu\u00e1 nhi\u1ec1u d\u1ecbch m\u00e0ng \u1ed1i bao quanh thai.<\/p>\n

          \u2013 Th\u1ee7 thu\u1eadt Caesa th\u01b0\u1eddng \u00e1p d\u1ee5ng thai \u0111\u00f4i v\u00e0 g\u1ea7n nh\u01b0 ch\u1ec9 \u0111\u1ecbnh cho thai 3 v\u00e0 nhi\u1ec1u h\u01a1n.<\/p>\n

          \u2013 N\u1eb1m vi\u1ec7n k\u00e9o d\u00e0i l\u00e0m cho chi ph\u00ed ch\u0103m s\u00f3c y t\u1ebf t\u0103ng l\u00ean.<\/p>\n

           <\/p>\n

          Nh\u1eefng r\u1ee7i ro cho thai trong \u0111a thai<\/strong><\/p>\n

          \u0110\u1ebb non. Th\u1eddi gian trung b\u00ecnh mang thai l\u00e0 39w cho thai m\u1ed9t, 35 w thai \u0111\u00f4i v\u00e0 33w cho thai 3. Sinh non xu\u1ea5t hi\u1ec7n 50% \u1edf thai \u0111\u00f4i v\u00e0 90% thai 3.<\/p>\n

          \u2013 \u0110a thai, sinh non v\u00e0 tr\u1ecdng l\u01b0\u1ee3ng thai th\u1ea5p g\u1ea5p 4 l\u1ea7n sinh 1 thai. Thai \u0111\u00f4i v\u00e0 3 sinh s\u1ed1ng tr\u01b0\u1edbc 30 tu\u1ea7n t\u01b0\u01a1ng \u1ee9ng 7 v\u00e0 15%. Nh\u1eefng \u0111\u1ee9a tr\u1ebb n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ed1i di\u1ec7n v\u1edbi nhi\u1ec1u nguy hi\u1ec3m trong su\u1ed1t cu\u1ed9c \u0111\u1eddi, c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nh\u01b0 li\u1ec7t n\u00e3o v\u00e0 t\u00e0n t\u1eadt. Nh\u1eefng r\u1ee7i ro trong qu\u00e1 tr\u00ecnh mang thai tr\u1ebb b\u1ecb b\u1ea1i n\u00e3o so v\u1edbi m\u1ed9t thai g\u1ea5p 8 l\u1ea7n \u1edf tr\u1ebb sinh \u0111\u00f4i v\u00e0 47 l\u1ea7n sinh 3.<\/p>\n

          \u2013 Tr\u1ecdng l\u01b0\u1ee3ng thai th\u1ea5p r\u1ea5t hay g\u1eb7p trong \u0111a thai. Cu\u1ed9c s\u1ed1ng m\u1ea5t kh\u1ea3 n\u0103ng tr\u00ean 25% cho tr\u1ebb < 1kg<\/p>\n

          \u2013 T\u1ef7 l\u1ec7 ch\u1ebft ngay khi sinh. V\u00ed d\u1ee5 sinh \u0111\u01a1n <1%; sinh \u0111\u00f4i 4,7% v\u00e0 sinh ba 8.3%;<\/p>\n

          \u2013 D\u1ecb t\u1eadt \u1edf tr\u1ebb sinh \u0111\u00f4i t\u01b0\u01a1ng \u0111\u01b0\u01a1ng tr\u1ebb sinh \u0111\u01a1n.<\/p>\n

           <\/p>\n

          Sinh \u0111\u00f4i \u0111\u01a1n h\u1ee3p t\u1eed (x\u00e1c \u0111\u1ecbnh) v\u00e0 hai b\u1ed9i th\u1ec3 (kh\u00f4ng gi\u1ed1ng nhau)<\/strong><\/p>\n

          Sinh \u0111\u00f4i l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a hai ph\u00f4i l\u00e0m t\u1ed5, th\u01b0\u1eddng kh\u00f4ng gi\u1ed1ng nhau. Tuy v\u1eady, kho\u1ea3ng 4% trong s\u1ed1 n\u00e0y c\u00f3 th\u1ec3 gi\u1ed1ng nhau khi m\u00e0 1 ph\u00f4i kh\u00f4ng l\u00e0m t\u1ed5, trong khi ph\u00f4i th\u1ee9 2 ph\u00e2n chia th\u00e0nh 2. R\u1ee7i ro t\u1eed vong tr\u01b0\u1edbc sinh trong s\u1ed1 sinh \u0111\u00f4i \u0111\u1ed3ng h\u1ee3p t\u1eed cao h\u01a1n 2-3 l\u1ea7n sinh \u0111\u00f4i d\u1ecb h\u1ee3p t\u1eed. T\u1ef7 l\u1ec7 sinh \u0111\u00f4i \u0111\u1ed3ng h\u1ee3p t\u1eed t\u0103ng l\u00ean trong k\u00edch th\u00edch ph\u00f3ng no\u00e3n, h\u1ed7 tr\u1ee3 sinh s\u1ea3n v\u00e0 ICSI.<\/p>\n

          \u00a0<\/strong><\/p>\n

          Gi\u1ea3m r\u1ee7i ro nh\u01b0 th\u1ebf n\u00e0o \u1edf ph\u1ee5 n\u1eef \u0111a thai?<\/strong><\/p>\n

          C\u00f3 m\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m c\u01a1 h\u1ed9i \u0111a thai v\u00e0 k\u1ebft h\u1ee3p v\u1edbi r\u1ee7i ro v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a n\u00f3. Bao g\u1ed3m gi\u1edbi h\u1ea1n s\u1ed1 l\u01b0\u1ee3ng ph\u00f4i chuy\u1ec3n v\u00e0 s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt chuy\u1ec3n blastocyte.<\/p>\n

          \u2013 Gi\u1edbi h\u1ea1n s\u1ed1 l\u01b0\u1ee3ng ph\u00f4i chuy\u1ec3n l\u00e0 2 th\u1eadm ch\u00ed l\u00e0 1 \u0111\u1ec3 gi\u1ea3m kh\u1ea3 n\u0103ng \u0111a thai. C\u00f3 m\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng n\u00f3i l\u00ean r\u1eb1ng, n\u1ebfu t\u1ea1o \u0111\u01b0\u1ee3c tr\u00ean 4 ph\u00f4i, r\u1ed3i chuy\u1ec3n 2 ph\u00f4i s\u1ebd \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 c\u00f3 thai t\u01b0\u01a1ng t\u1ef1 chuy\u1ec3n 3 ph\u00f4i nh\u01b0ng t\u1ef7 l\u1ec7 \u0111a thai th\u1ea5p h\u01a1n.<\/p>\n

          \u2013 G\u1ea7n \u0111\u00e2y, lu\u1eadt ph\u00e1p m\u1ed9t s\u1ed1 n\u01b0\u1edbc nh\u01b0 Belgium bu\u1ed9c ch\u1ea5p nh\u1eadn h\u1ea1n ch\u1ebf chuy\u1ec3n m\u1ed9t ph\u00f4i v\u00e0 ch\u1ec9 chuy\u1ec3n m\u1ed9t ph\u00f4i (SET<\/strong>\u2013 single embryo transfer<\/em>) cho ph\u1ee5 n\u1eef <36 tu\u1ed5i trong l\u1ea7n \u0111\u1ea7u c\u1ee7a chu k\u1ef3 \u0111i\u1ec1u tr\u1ecb IVF.<\/p>\n

          \u00a0<\/strong><\/p>\n

          Kh\u1ea3 n\u0103ng l\u1ef1a ch\u1ecdn n\u00e0o cho c\u1eb7p si\u00eau \u00e2m ch\u1ea9n \u0111o\u00e1n \u0111a thai?<\/strong><\/p>\n

          C\u00f3 m\u1ed9t s\u1ed1 chi\u1ebfn l\u01b0\u1ee3c c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn n\u1ebfu ch\u1ea9n \u0111o\u00e1n s\u1edbm \u0111a thai. Bao g\u1ed3m ph\u01b0\u01a1ng ph\u00e1p \u201c\u0110\u1ee3i v\u00e0 ch\u1edd\u201d, l\u1ef1a ch\u1ecdn gi\u1ea3m thai v\u00e0 k\u1ebft th\u00fac thai k\u1ef3.<\/p>\n

          \u00a0<\/strong>Ch\u1edd v\u00e0 \u0111\u00f3n<\/strong><\/p>\n

          Kho\u1ea3ng 10-30% \u0111a thai, m\u1ed9t ho\u1eb7c nhi\u1ec1u t\u00fai thai s\u1ebd ti\u00eau thai \u201cvanished fetus\u201d. Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc 12w, t\u1ef7 l\u1ec7 c\u1ee7a \u201cvanished fetus\u201d, t\u0103ng theo tu\u1ed5i m\u1eb9.<\/p>\n

          L\u1ef1a ch\u1ecdn gi\u1ea3m thai<\/strong><\/p>\n

          Gi\u1ea3m thai trong \u0111a thai l\u00e0 k\u1ef9 thu\u1eadt l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng thai. \u0110\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u00e0m cho thai 3 th\u00e0nh thai \u0111\u00f4i ho\u1eb7c 1, c\u00e1ch n\u00e0y t\u0103ng kh\u1ea3 n\u0103ng duy tr\u00ec thai ti\u1ebfp t\u1ee5c v\u00e0 ng\u1eeba ch\u1ea5n th\u01b0\u01a1ng s\u1ea3y thai.<\/p>\n

          Qui tr\u00ecnh \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh khi c\u00f3 t\u1eeb 3 thai tr\u1edf l\u00ean. S\u1ed1 l\u01b0\u1ee3ng thai gi\u1ea3m xu\u1ed1ng c\u00f2n 2 \u0111\u00f4i khi ch\u1ec9 \u0111\u1ec3 l\u1ea1i 1. Gi\u1ea3m thai \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o tu\u1ea7n th\u1ee9 10-12w c\u1ee7a chu k\u1ef3 thai, nh\u01b0ng c\u00f3 khi \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh t\u1eadn tu\u1ea7n th\u1ee9 24w. Qui tr\u00ecnh \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m v\u00e0 b\u01a1m kCl (potassium chloride) v\u00e0o tim thai, n\u00f3 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ch\u1ebft thai. Thai s\u1ebd \u0111\u01b0\u1ee3c ti\u00eau \u0111i t\u1eeb c\u1ed5 t\u1eed cung v\u00e0\/ ho\u1eb7c ng\u1eebng thai khi h\u00ecnh \u1ea3nh si\u00eau \u00e2m nghi ng\u1edd b\u1ea5t th\u01b0\u1eddng nhi\u1ec5m s\u1eafc th\u1ec3. Thai ch\u1ebft s\u1ebd \u0111\u01b0\u1ee3c h\u1ea5p thu b\u1edfi c\u01a1 th\u1ec3, trong khi thai s\u1ed1ng v\u1eabn ti\u1ebfp t\u1ee5c ph\u00e1t tri\u1ec3n.<\/p>\n

          Nhi\u1ec1u n\u01a1i s\u1eed s\u1ee5ng th\u1ee7 thu\u1eadt n\u00e0y khi c\u00f3 tim thai ( Th\u01b0\u1eddng tu\u1ea7n th\u1ee9 8). Ch\u1ecdc v\u00e0o tim thai \u0111\u1ec3 h\u1ee7y thai.<\/p>\n

          Gi\u1ea3m \u0111a thai kh\u00f4ng \u0111\u1ea3m b\u1ea3o nh\u1eefng r\u1ee7i ro v\u1ec1 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a s\u1ea3n khoa \u0111\u1ed1i v\u1edbi m\u1ee9c th\u00f4ng th\u01b0\u1eddng c\u1ee7a thai \u0111\u01a1n. Labor Preterm xu\u1ea5t hi\u1ec7n 75% ch\u1eeda \u0111a thai ti\u1ebfn h\u00e0nh gi\u1ea3m thai. S\u1ea3y thai xu\u1ea5t hi\u1ec7n kho\u1ea3ng 10% v\u00e0 \u00edt khi xu\u1ea5t hi\u1ec7n nhi\u1ec5m khu\u1ea9n.<\/p>\n

          \u00a0<\/strong><\/p>\n

          Ch\u1ea5m d\u1ee9t thai k\u1ef3.<\/strong><\/p>\n

          \u0110\u00f4i khi c\u00f3 c\u1eb7p c\u00f3 th\u1ec3 ph\u1ea3i l\u1ef1a ch\u1ecdn ch\u1ea5m d\u1ee9t thai k\u1ef3 nh\u01b0 l\u00e0 l\u1ef1a ch\u1ecdn cu\u00f4i c\u00f9ng.<\/p>\n

          \u00a0Xo\u1eafn bu\u1ed3ng tr\u1ee9ng.<\/strong><\/p>\n

          \"taibienivf02\"<\/a><\/p>\n

          H\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng c\u1ee7a xo\u1eafn bu\u1ed3ng tr\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, v\u1edbi \u00edt d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 nh\u01b0 v\u1eady t\u0103ng \u0111i\u1ec3m nghi ng\u1edd \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n s\u1edbm. Si\u00eau \u00e2m Doppler m\u00e0u c\u00f3 th\u1ec3 gi\u00fap ti\u00ean l\u01b0\u1ee3ng kh\u1ea3 n\u0103ng s\u1ed1ng c\u1ee7a bu\u1ed3ng tr\u1ee9ng (khi gi\u1ea3m ho\u1eb7c kh\u00f4ng c\u00f3 s\u1ef1 cung c\u1ea5p m\u00e1u cho bu\u1ed3ng tr\u1ee9ng th\u00ec nghi ng\u1edd xo\u1eafn bu\u1ed3ng tr\u1ee9ng). Ti\u1ebfn h\u00e0nh ch\u1ea9n \u0111\u00f3an x\u00e1c \u0111\u1ecbnh b\u1eb1ng n\u1ed9i soi \u1ed5 b\u1ee5ng.<\/p>\n

          N\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7 s\u1edbm, so\u1eafn bu\u1ed3ng tr\u1ee9ng c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong (ho\u1ea1i th\u01b0). \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt th\u00e1osxo\u1eafn v\u00e0 c\u00f3 di th\u1ec3 chuy\u1ec3n v\u00e0i l\u1ea7n. N\u1ed9i soi l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m \u0111i\u1ec1u tr\u1ecb.<\/p>\n

           <\/p>\n

          R\u1ee7i ro trong ch\u1ecdc no\u00e3n.<\/strong><\/p>\n

          Nh\u01b0 qui tr\u00ecnh ph\u1eabu thu\u1eadt th\u00f4ng th\u01b0\u1eddng, c\u00f3 nh\u1eefng ti\u1ec1m n\u0103ng r\u1ee7i ro k\u1ebft h\u1ee3p khi ch\u1ecdc no\u00e3n l\u1ea5y tr\u1ee9ng. Kh\u1ea3 n\u0103ng r\u1ee7i ro ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1ch ch\u1ecdc no\u00e3n qua ng\u1ea3 \u00e2m \u0111\u1ea1o d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m hay N\u1ed9i soi \u1ed5 b\u1ee5ng ( Ng\u00e0y nay \u00edt khi ph\u1ea3i s\u1eed d\u1ee5ng).<\/p>\n

          \u00a0<\/strong><\/p>\n

          Ch\u1ecdc tr\u1ee9ng qua ng\u1ea3 \u00e2m \u0111\u1ea1o d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m<\/strong><\/p>\n

          \u2013 Kh\u00f3 ch\u1ecbu nh\u1eb9 ho\u1eb7c trung b\u00ecnh.<\/p>\n

          \u2013 Ch\u1ea3y m\u00e1u trong v\u00e0 sau ch\u1ecdc no\u00e3n, m\u00e1u t\u1eeb bu\u1ed3ng tr\u1ee9ng ho\u1eb7c v\u00f2m \u00e2m \u0111\u1ea1o. M\u00e1u th\u01b0\u1eddng ch\u1ea3y \u00edt v\u00e0 hi\u1ebfm khi g\u00e2y ra v\u1ea5n \u0111\u1ec1. C\u1ea7n truy\u1ec1n m\u00e1u l\u00e0 r\u1ea5t \u00edt (kho\u1ea3ng 1\/500)<\/p>\n

          \u2013 Nhi\u1ec5m khu\u1ea9n c\u0169ng l\u00e0 bi\u1ebfn ch\u1ee9ng hi\u1ebfm g\u1eb7p, kho\u1ea3ng 1\/300 v\u00e0 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh.<\/p>\n

          \u2013 \u00a0Th\u01b0\u01a1ng t\u1ed5n c\u01a1 quan trong \u1ed5 b\u1ee5ng nh\u01b0: ru\u1ed9t, b\u00e0ng quang, ho\u1eb7c m\u1ea1ch l\u1edbn trong qu\u00e1 tr\u00ecnh th\u1ee7 thu\u1eadt. \u0110i\u1ec1u n\u00e0y c\u1ef1c k\u1ef3 hi\u1ebfm g\u1eb7p- kho\u1ea3ng 1\/1000.<\/p>\n<\/div>\n

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

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