{"id":3281,"date":"2021-12-10T11:04:32","date_gmt":"2021-12-10T04:04:32","guid":{"rendered":"https:\/\/benhvienvietbi.vn\/en\/?p=3281"},"modified":"2022-02-24T16:30:37","modified_gmt":"2022-02-24T09:30:37","slug":"dieu-tri-vo-sinh-bang-phuong-phap-thu-tinh-trong-ong-nghiem-2","status":"publish","type":"post","link":"https:\/\/benhvienvietbi.vn\/en\/dieu-tri-vo-sinh-bang-phuong-phap-thu-tinh-trong-ong-nghiem-2\/","title":{"rendered":"\u0110I\u1ec0U TR\u1eca V\u00d4 SINH B\u1eb0NG PH\u01af\u01a0NG PH\u00c1P TH\u1ee4 TINH TRONG \u1ed0NG NGHI\u1ec6M"},"content":{"rendered":"\n

Th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m (IVF)<\/strong> l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p theo \u0111\u00f3 tr\u1ee9ng \u0111\u01b0\u1ee3c th\u1ee5 tinh b\u1eb1ng tinh tr\u00f9ng b\u00ean ngo\u00e0i c\u01a1 th\u1ec3 (trong \u1ed1ng nghi\u1ec7m). \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng sau khi \u0111\u00e3 s\u1eed d\u1ee5ng c\u00e1c k\u0129 thu\u1eadt h\u1ed7 tr\u1ee3 sinh s\u1ea3n kh\u00e1c m\u00e0 kh\u00f4ng th\u00e0nh c\u00f4ng. Ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho  nh\u1eefng c\u1eb7p v\u1ee3 ch\u1ed3ng hay nh\u1eefng ng\u01b0\u1eddi ph\u1ee5 n\u1eef \u0111ang \u1edf \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n nh\u01b0ng v\u00ec b\u1ea5t k\u1ef3 l\u00fd do g\u00ec \u0111\u00f3 m\u00e0 tinh tr\u00f9ng kh\u00f4ng th\u1ec3 th\u1ee5 tinh cho tr\u1ee9ng \u1edf \u0111i\u1ec1u ki\u1ec7n t\u1ef1 nhi\u00ean.<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

 Ph\u01b0\u01a1ng ph\u00e1p th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m \u0111\u01b0\u1ee3c s\u00e1ng t\u1ea1o v\u00e0 ph\u00e1t tri\u1ec3n b\u1edfi b\u00e1c s\u0129 Robert G. Edwards<\/a>, \u0111\u00e3 \u0111\u01b0\u1ee3c trao Gi\u1ea3i Nobel Sinh l\u00fd v\u00e0 Y khoa<\/a> n\u0103m 2010<\/a>. Louise Brown<\/a> l\u00e0 \u0111\u1ee9a b\u00e9 \u0111\u1ea7u ti\u00ean ra \u0111\u1eddi b\u1eb1ng k\u1ef9 thu\u1eadt th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m v\u00e0o n\u0103m 1978. V\u1edbi c\u00f4ng ngh\u1ec7 ti\u00ean ti\u1ebfn, ng\u00e0y nay t\u1ef7 l\u1ec7 mang thai c\u1ee7a ng\u01b0\u1eddi \u0111\u01b0\u1ee3c th\u1ee5 tinh trong \u1ed1ng ngh\u1ec7m \u0111\u00e3 \u0111\u01b0\u1ee3c n\u00e2ng l\u00ean \u0111\u00e1ng k\u1ec3 so v\u1edbi tr\u01b0\u1edbc \u0111\u00e2y. M\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a Ph\u00e1p \u01b0\u1edbc t\u00ednh c\u00f3 66% b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p th\u1ee5 tinh n\u00e0y v\u00e0 cu\u1ed1i c\u00f9ng \u0111\u00e3 sinh con (40% trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng k\u1ef9 thu\u1eadt th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m t\u1ea1i trung t\u00e2m v\u00e0 26% sau khi gi\u00e1n \u0111o\u1ea1n th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m). Vi\u1ec7c c\u00f3 con sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m ch\u1ee7 y\u1ebfu l\u00e0 nh\u1eadn con nu\u00f4i<\/a>(46%) ho\u1eb7c mang thai t\u1ef1 nhi\u00ean<\/a> (42%). <\/p>\n\n\n\n

Nguy\u00ean nh\u00e2n v\u00f4 sinh r\u1ea5t \u0111a d\u1ea1ng v\u00e0 c\u00f3 c\u01a1 ch\u1ebf ph\u1ee9c t\u1ea1p. V\u00f4 sinh c\u00f3 th\u1ec3 \u0111\u1ebfn t\u1eeb c\u1ea3 nam v\u00e0 n\u1eef. Ph\u1ee5 n\u1eef chi\u1ebfm kho\u1ea3ng 40% nguy\u00ean nh\u00e2n g\u00e2y ra v\u1ea5n \u0111\u1ec1 v\u00f4 sinh v\u00e0 nam gi\u1edbi c\u0169ng chi\u1ebfm 40%. V\u00f4 sinh \u0111\u1ebfn t\u1eeb c\u1ea3 nam v\u00e0 n\u1eef chi\u1ebfm 10%, v\u00f4 sinh kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n chi\u1ebfm 10%. V\u00ec v\u1eady, \u0111\u1ed1i v\u1edbi nhi\u1ec1u c\u1eb7p v\u1ee3 ch\u1ed3ng, th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m l\u00e0 m\u1ed9t trong nh\u1eefng c\u00e1ch thi\u1ebft th\u1ef1c nh\u1ea5t \u0111\u1ec3 c\u00f3 con.<\/p>\n\n\n\n

1. Nguy\u00ean t\u1eafc<\/strong><\/p>\n\n\n\n

Th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc t\u1ea1o \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 tinh tr\u00f9ng v\u00e0 tr\u1ee9ng \u0111\u01b0\u1ee3c th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m t\u1ea1o ph\u00f4i, sau \u0111\u00f3 ph\u00f4i s\u1ebd \u0111\u01b0\u1ee3c c\u1ea5y v\u00e0o bu\u1ed3ng t\u1eed cung c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef \u0111\u1ec3 qu\u00e1 tr\u00ecnh ph\u00f4i l\u00e0m t\u1ed5 v\u00e0 ph\u00e1t tri\u1ec3n \u0111\u01b0\u1ee3c di\u1ec5n ra ho\u1eb7c s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00f4ng l\u1ea1nh \u0111\u1ec3 s\u1eed d\u1ee5ng sau.<\/p>\n\n\n\n

2. \u0110\u1ed1i t\u01b0\u1ee3ng<\/strong><\/p>\n\n\n\n

\u0110\u1ea3m b\u1ea3o c\u00e1c \u0111i\u1ec1u ki\u1ec7n c\u01a1 b\u1ea3n v\u1ec1 s\u1ee9c kh\u1ecfe: Kh\u00f4ng\n\u0111ang m\u1eafc b\u1ec7nh l\u00fd m\u00e0 kh\u00f4ng \u0111\u1ee7 s\u1ee9c kh\u1ecfe \u0111\u1ec3 th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt th\u1ee5 tinh trong \u1ed1ng\nnghi\u1ec7m, mang thai, sinh con; kh\u00f4ng \u0111ang m\u1eafc b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c,\nnhi\u1ec5m HIV, b\u1ec7nh truy\u1ec1n nhi\u1ec5m thu\u1ed9c nh\u00f3m A, B; kh\u00f4ng b\u1ecb b\u1ec7nh di truy\u1ec1n c\u00f3 \u1ea3nh\nh\u01b0\u1edfng \u0111\u1ebfn t\u00ednh m\u1ea1ng v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a tr\u1ebb khi sinh ra; kh\u00f4ng b\u1ecb m\u1eafc b\u1ec7nh t\u00e2m\nth\u1ea7n ho\u1eb7c b\u1ec7nh kh\u00e1c m\u00e0 kh\u00f4ng th\u1ec3 nh\u1eadn th\u1ee9c, l\u00e0m ch\u1ee7 \u0111\u01b0\u1ee3c h\u00e0nh vi c\u1ee7a m\u00ecnh.<\/p>\n\n\n\n

\u0110i\u1ec1u ki\u1ec7n c\u1ea7n thi\u1ebft: ng\u01b0\u1eddi\nph\u1ee5 n\u1eef ph\u1ea3i c\u00f3 \u00edt nh\u1ea5t m\u1ed9t v\u00f2i t\u1eed cung th\u00f4ng t\u1ed1t, kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng \u1edf bu\u1ed3ng\nt\u1eed cung, chu k\u00ec ph\u1ea3i c\u00f3 tr\u1ee9ng r\u1ee5ng.<\/p>\n\n\n\n

\u0110\u1eb7c bi\u1ec7t h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eef gi\u1edbi b\u1ecb b\u1ea5t th\u01b0\u1eddng \u1ed1ng d\u1eabn tr\u1ee9ng, ng\u01b0\u1eddi c\u00f3 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng tr\u1ee9ng th\u1ea5p, ph\u1ee5 n\u1eef mu\u1ed1n l\u00e0m m\u1eb9 \u0111\u01a1n th\u00e2n ho\u1eb7c c\u00e1c c\u1eb7p v\u1ee3 ch\u1ed3ng \u0111\u1ed3ng t\u00ednh,\u2026 v\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00f4 sinh \u1edf nam gi\u1edbi do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, xu\u1ea5t tinh ng\u01b0\u1ee3c, s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng tinh tr\u00f9ng th\u1ea5p,\u2026<\/p>\n\n\n\n

3. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh<\/strong><\/p>\n\n\n\n

Qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m \u0111\u01b0\u1ee3c di\u1ec5n ra l\u1ea7n l\u01b0\u1ee3t qua 5 b\u01b0\u1edbc c\u01a1 b\u1ea3n sau:<\/p>\n\n\n\n

\"\"
Quy tr\u00ecnh th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m<\/figcaption><\/figure><\/div>\n\n\n\n

– K\u00edch th\u00edch nang bu\u1ed3ng tr\u1ee9ng<\/strong><\/p>\n\n\n\n

M\u1ee5c \u0111\u00edch l\u00e0 \u0111\u1ec3 nh\u00e2n t\u1ea1o th\u00e0nh c\u00f4ng 5-12 tr\u1ee9ng tr\u01b0\u1edfng th\u00e0nh d\u01b0\u1edbi \u0111i\u1ec1u ki\u1ec7n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 theo d\u00f5i. Ng\u01b0\u1eddi ph\u1ee5 n\u1eef s\u1ebd \u0111\u01b0\u1ee3c ti\u00eam lo\u1ea1i thu\u1ed1c c\u00f3 b\u1ea3n ch\u1ea5t l\u00e0 hormone gonadotropins \u0111\u1ec3 k\u00edch th\u00edch s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c nang bu\u1ed3ng tr\u1ee9ng gi\u00fap s\u1ea3n xu\u1ea5t nhi\u1ec1u tr\u1ee9ng h\u01a1n. Nh\u1eefng qu\u1ea3 tr\u1ee9ng \u0111\u00f3 \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 \u0111\u1ec3 tr\u01b0\u1edfng th\u00e0nh, tr\u1ee9ng c\u00e0ng l\u1edbn th\u00ec kh\u1ea3 n\u0103ng th\u1ee5 tinh v\u00e0 mang thai th\u00e0nh c\u00f4ng c\u00e0ng cao. Qu\u00e1 tr\u00ecnh n\u00e0y th\u01b0\u1eddng m\u1ea5t kho\u1ea3ng 12 ng\u00e0y.<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

– Thu ho\u1ea1ch<\/strong><\/p>\n\n\n\n

S\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a\nc\u00e1c nang tr\u1ee9ng \u0111\u01b0\u1ee3c s\u1ef1 gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd qua vi\u1ec7c si\u00eau \u00e2m v\u00e0 x\u00e9t nghi\u1ec7m m\u00e1u,\n\u0111\u1eb7c bi\u1ec7t l\u00e0 l\u00e0 n\u1ed3ng \u0111\u1ed9 estrogen. Khi c\u00e1c nang ch\u1ee9a tr\u1ee9ng ch\u00edn v\u00e0 s\u1eb5n s\u00e0ng \u0111\u1ec3\nth\u1ee5 tinh, ng\u01b0\u1eddi ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ti\u00eam 1 m\u0169i hCG (m\u1ed9t hormone ti\u1ebft ra trong thai k\u00ec)\n\u0111\u1ec3 n\u1ed9i ti\u1ebft t\u1ed1 \u0111\u01b0\u1ee3c ti\u1ebft ra. M\u0169i ti\u00eam nh\u1eb1m k\u00edch th\u00edch c\u00e1c nang gi\u1ea3i ph\u00f3ng\ntr\u1ee9ng.<\/p>\n\n\n\n

Sau 36h, tr\u1ee9ng \u0111\u01b0\u1ee3c thu ho\u1ea1ch v\u00e0 qu\u00e1 tr\u00ecnh \u0111\u00f3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong b\u1ec7nh vi\u1ec7n khi ng\u01b0\u1eddi ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c g\u00e2y m\u00ea nh\u1eb9. B\u00e0o t\u01b0\u01a1ng (ch\u1ee9a t\u1ebf b\u00e0o tr\u1ee9ng) s\u1ebd \u0111\u01b0\u1ee3c l\u1ea5y ra qua \u0111\u01b0\u1eddng \u00e2m \u0111\u1ea1o (b\u1eb1ng kim v\u00e0 si\u00eau \u00e2m).<\/p>\n\n\n\n

– Th\u1ee5 tinh in-vitro<\/strong><\/p>\n\n\n\n

L\u1ea5y tinh tr\u00f9ng \u0111\u00e3 qua l\u1ecdc r\u1eeda, cho th\u1ee5 tinh v\u1edbi no\u00e3n trong \u1ed1ng nghi\u1ec7m c\u1ed5 \u0111i\u1ec3n (IVF) ho\u1eb7c ti\u00eam tinh tr\u00f9ng v\u00e0o b\u00e0o t\u01b0\u01a1ng no\u00e3n (ICSI). Sau \u0111\u00f3 tr\u1ee9ng \u0111\u01b0\u1ee3c \u0111\u1eb7t trong \u0111i\u1ec1u ki\u1ec7n th\u00edch h\u1ee3p \u0111\u1ec3 nu\u00f4i c\u1ea5y v\u00e0 theo d\u00f5i.<\/p>\n\n\n\n

– Chuy\u1ec3n ph\u00f4i v\u00e0o bu\u1ed3ng t\u1eed cung<\/strong><\/p>\n\n\n\n

M\u1ee5c \u0111\u00edch \u0111\u1ec3 ph\u00f4i l\u00e0m t\u1ed5 v\u00e0 ph\u00e1t tri\u1ec3n trong bu\u1ed3ng t\u1eed cung c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef. Sau  khi \u0111\u00e3 chu\u1ea9n b\u1ecb m\u1ecdi \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 bu\u1ed3ng t\u1eed cung c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef ti\u1ebfp nh\u1eadn ph\u00f4i th\u00ec ti\u1ebfn h\u00e0nh b\u01a1m tr\u1ee9ng v\u00e0o bu\u1ed3ng t\u1eed cung b\u1eb1ng catheter.<\/p>\n\n\n\n

– \u0110i\u1ec1u ch\u1ec9nh hormone \u0111\u1ec3 h\u1ed7 tr\u1ee3 s\u1ef1 l\u00e0m t\u1ed5 v\u00e0 ph\u00e1t tri\u1ec3n c\u1ee7a thai<\/strong><\/p>\n\n\n\n

Ng\u01b0\u1eddi mang thai \u0111\u01b0\u1ee3c ti\u00eam thu\u1ed1c v\u00e0 \u0111\u1eb7t thu\u1ed1c v\u00e0o \u00e2m \u0111\u1ea1o \u0111\u1ec3 h\u1ed7 tr\u1ee3 cho s\u1ef1 l\u00e0m t\u1ed5 c\u1ee7a thai. Th\u1eed thai 14 ng\u00e0y sau khi chuy\u1ec3n ph\u00f4i (x\u00e9t nghi\u1ec7m beta-hCG). Si\u00eau \u00e2m 3 tu\u1ea7n sau n\u1ebfu th\u1eed thai d\u01b0\u01a1ng t\u00ednh.<\/p>\n\n\n\n

4. Ch\u0103m s\u00f3c sau li\u1ec7u tr\u00ecnh IVF<\/strong><\/p>\n\n\n\n

Ng\u01b0\u1eddi mang thai nh\u1edd th\u1ee5 tinh nh\u00e2n t\u1ea1o c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t sao trong qu\u00e1 tr\u00ecnh mang thai. Ng\u01b0\u1eddi mang thai \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o c\u00f3 ch\u1ebf \u0111\u1ed9 ch\u0103m s\u00f3c, nghi ng\u01a1i v\u00e0 ho\u1ea1t \u0111\u1ed9ng h\u1ee3p l\u00ed. \u0110\u1eb7c bi\u1ec7t c\u1ea7n l\u01b0u \u00fd c\u00e1c t\u00ecnh tr\u1ea1ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a li\u1ec7u tr\u00ecnh nh\u01b0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c, mang \u0111a thai,\u2026<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

Trong nh\u1eefng n\u0103m qua, b\u1eb1ng s\u1ef1 t\u1eadn t\u00e2m v\u00e0 y \u0111\u1ee9c, \u0111\u1ed9i ng\u0169 y b\u00e1c s\u0129 B\u1ec7nh vi\u1ec7n CK Nam h\u1ecdc v\u00e0 Hi\u1ebfm mu\u1ed9n Vi\u1ec7t – B\u1ec9 \u0111\u00e3 th\u1ef1c hi\u1ec7n h\u00e0ng ngh\u00ecn ca IVF th\u00e0nh c\u00f4ng. Hi\u1ec7n nay, B\u1ec7nh vi\u1ec7n \u0111ang tri\u1ec3n khai ch\u01b0\u01a1ng tr\u00ecnh \u201cCAM K\u1ebeT V\u00c0NG l\u1ea7n th\u1ee9 4\u201d h\u1ed7 tr\u1ee3 cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb v\u00f4 sinh, hi\u1ebfm mu\u1ed9n tr\u00ean to\u00e0n qu\u1ed1c.<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

CH\u01af\u01a0NG TR\u00ccNH CAM K\u1ebeT V\u00c0NG \u2013 \u0110\u00d3N H\u1ed4\u00a0V\u00c0NG<\/strong><\/p>\n\n\n\n

T\u1eb7ng 2.000 phi\u1ebfu voucher \u201cCAM K\u1ebeT V\u00c0NG\u201d cho b\u1ec7nh nh\u00e2n th\u1ef1c hi\u1ec7n ph\u01b0\u01a1ng ph\u00e1p Th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m (IVF). B\u1ec7nh vi\u1ec7n s\u1ebd ho\u00e0n tr\u1ea3 l\u1ea1i 30.000.000 \u0111\u1ed3ng (chi ph\u00ed ch\u1ecdc tr\u1ee9ng v\u00e0 t\u1ea1o ph\u00f4i) cho b\u1ec7nh nh\u00e2n n\u1ebfu IVF kh\u00f4ng th\u00e0nh c\u00f4ng.<\/p>\n\n\n\n

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\"\"<\/figure><\/div>\n\n\n\n

B\u1ec6NH VI\u1ec6N CHUY\u00caN KHOA NAM H\u1eccC & HI\u1ebeM MU\u1ed8N VI\u1ec6T – B\u1ec8 <\/strong><\/p>\n\n\n\n

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

Th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m (IVF) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p theo \u0111\u00f3 tr\u1ee9ng \u0111\u01b0\u1ee3c th\u1ee5 tinh b\u1eb1ng tinh tr\u00f9ng b\u00ean ngo\u00e0i c\u01a1 th\u1ec3 (trong \u1ed1ng nghi\u1ec7m). \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng sau khi \u0111\u00e3 s\u1eed d\u1ee5ng c\u00e1c k\u0129 thu\u1eadt h\u1ed7 tr\u1ee3 sinh s\u1ea3n kh\u00e1c m\u00e0 kh\u00f4ng th\u00e0nh c\u00f4ng. 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