{"id":736,"date":"2017-03-30T18:50:41","date_gmt":"2017-03-30T11:50:41","guid":{"rendered":"https:\/\/benhvienvietbi.vn\/en\/?p=736"},"modified":"2017-03-30T19:09:44","modified_gmt":"2017-03-30T12:09:44","slug":"hoi-chung-buong-trung-da-nang-nguyen-nhan-quan-trong-gay-vo-sinh-o-nu","status":"publish","type":"post","link":"https:\/\/benhvienvietbi.vn\/en\/hoi-chung-buong-trung-da-nang-nguyen-nhan-quan-trong-gay-vo-sinh-o-nu\/","title":{"rendered":"[:vi]H\u1ed9i ch\u1ee9ng bu\u1ed3ng tr\u1ee9ng \u0111a nang – Nguy\u00ean nh\u00e2n quan tr\u1ecdng g\u00e2y v\u00f4 sinh \u1edf n\u1eef[:]"},"content":{"rendered":"

[:vi]\"\"<\/p>\n

H\u1ed9i ch\u1ee9ng bu\u1ed3ng tr\u1ee9ng \u0111a nang(HCBT\u0110N) -Polycystic ovary syndrome (P.COS) l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi h\u00ecnh \u1ea3nh bu\u1ed3ng tr\u1ee9ng \u0111a nang tr\u00ean si\u00eau \u00e2m v\u00e0 t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng androgen bi\u1ec3u hi\u1ec7n tr\u00ean c\u1eadn l\u00e2m s\u00e0ng (t\u0103ng n\u1ed9i ti\u1ebft t\u1ed1 sinh d\u1ee5c nam) ho\u1eb7c l\u00e2m s\u00e0ng (kinh nguy\u1ec7t kh\u00f4ng \u0111\u1ec1u ho\u1eb7c kh\u00f4ng c\u00f3 kinh, b\u00e9o ph\u00ec, r\u1eadm long, m\u1ee5n tr\u1ee9ng c\u00e1).\u00a0H\u1ed9i ch\u1ee9ng n\u00e0y \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean v\u00e0o n\u0103m 1935 v\u1edbi t\u00ean g\u1ecdi h\u1ed9i ch\u1ee9ng Stein-Leventhal.<\/p>\n

Ph\u00e2n bi\u1ec7t gi\u1eefa HCBT\u0110N v\u00e0 bu\u1ed3ng tr\u1ee9ng \u0111a nang (BT\u0110N)<\/strong>:<\/p>\n

BT\u0110N l\u00e0 thu\u1eadt ng\u1eef d\u00f9ng \u0111\u1ec3 ch\u1ec9 h\u00ecnh \u1ea3nh bu\u1ed3ng tr\u1ee9ng (Th\u01b0\u1eddng l\u00e0 quan s\u00e1t \u0111\u01b0\u1ee3c tr\u00ean si\u00eau \u00e2m ng\u1ea3 \u00e2m \u0111\u1ea1o) to h\u01a1n b\u00ecnh th\u01b0\u1eddng, c\u00f3 nhi\u1ec1u nang nh\u1ecf ( th\u01b0\u1eddng \u226512 nang k\u00edch th\u01b0\u1edbc 2-9 mm) t\u1eadp trung \u1edf v\u00f9ng r\u00eca bu\u1ed3ng tr\u1ee9ng.<\/p>\n

HCBT\u0110N bao g\u1ed3m h\u00ecnh \u1ea3nh BT\u0110N c\u1ed9ng th\u00eam c\u00e1c bi\u1ec3u hi\u1ec7n kinh kh\u00f4ng \u0111\u1ec1u hay v\u00f4 kinh, r\u1eadm long, m\u1ee5n tr\u1ee9ng c\u00e1 (ch\u1ee7 y\u1ebfu do t\u0103ng n\u1ed9i ti\u1ebft t\u1ed1 nam-c\u01b0\u1eddng androgen), \u0111\u01b0\u1eddng, tim\u00a0 m\u1ea1ch.<\/p>\n

I.D\u1ecbch t\u1ec5 h\u1ecdc:<\/strong><\/p>\n

L\u00e0 b\u1ec7nh l\u00fd n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ph\u1ee5 n\u1eef, \u0111\u1eb7c bi\u1ec7t trong l\u1ee9a tu\u1ed5i sinh s\u1ea3n, t\u1ef7 l\u1ec7 5-10% ph\u1ee5 n\u1eef trong l\u1ee9a tu\u1ed5i sinh s\u1ea3n b\u1ecb HCBT\u0110N. Trong c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y v\u00f4 sinh do r\u1ed1i lo\u1ea1n ph\u00f3ng no\u00e3n ho\u1eb7c kh\u00f4ng ph\u00f3ng no\u00e3n HCBT\u0110N chi\u1ebfm 75%.<\/p>\n

T\u1ef7 l\u1ec7 ph\u1ee5 n\u1eef b\u00ecnh th\u01b0\u1eddng, ch\u1ec9 c\u00f3 h\u00ecnh \u1ea3nh BT\u0110N tr\u00ean si\u00eau \u00e2m chi\u1ebfm 25%. Trong khi \u0111\u00f3 ph\u1ee5 n\u1eef kinh th\u01b0a, r\u1eadm l\u00f4ng ,h\u00ecnh \u1ea3nh BT\u0110N xu\u1ea5t hi\u1ec7n tr\u00ean si\u00eau \u00e2m \u0111\u1ebfn 87%.<\/p>\n

II.C\u01a1 ch\u1ebf b\u1ec7nh sinh:<\/strong><\/p>\n

Cho \u0111\u1ebfn nay, c\u01a1 ch\u1ebf sinh b\u1ec7nh c\u1ee7a PCOS ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. T\u00ednh \u0111a d\u1ea1ng v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng sinh ho\u00e1 c\u1ee7a PCOS c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 t\u01b0\u01a1ng t\u00e1c c\u1ee7a y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng v\u00e0 y\u1ebfu t\u1ed1 gen li\u00ean quan \u0111\u1ebfn s\u1ea3n xu\u1ea5t Androgen, s\u1ef1 ti\u1ebft v\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a Insulin. C\u00f3 3 y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee7 y\u1ebfu c\u1ee7a PCOS:<\/p>\n

    \n
  1. S\u1ef1 ng\u01b0ng ph\u00e1t tri\u1ec3n c\u1ee7a nang no\u00e3n<\/li>\n
  2. S\u1ef1 sinh t\u1ed5ng h\u1ee3p steroid b\u1ea5t th\u01b0\u1eddng<\/li>\n
  3. \u0110\u1ec1 kh\u00e1ng Isulin<\/li>\n<\/ol>\n

    Gi\u1ea3 thuy\u1ebft v\u1ec1 t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng Insulin \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn nhi\u1ec1u nh\u1ea5t hi\u1ec7n nay. N\u1ed3ng \u0111\u1ed9 Isulin trong m\u00e1u cao \u0111\u01b0\u1ee3c coi nh\u01b0 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng Androgen do t\u0103ng s\u1ea3n xu\u1ea5t Androgen t\u1ea1i bu\u1ed3ng tr\u1ee9ng v\u00e0 gi\u1ea3m t\u1ed5ng h\u1ee3p Sex- Hormone – Binding, \u0111i\u1ec1u n\u00e0y l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng bu\u1ed3ng tr\u1ee9ng.<\/p>\n

    Ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb PCOS, n\u1ed3ng \u0111\u1ed9 c\u1ee7a EGF v\u00e0 TGF t\u0103ng cao, ng\u0103n c\u1ea3n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a nang no\u00e3n c\u0169ng nh\u01b0 \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh th\u01a1m ho\u00e1 chuy\u1ec3n Androgen th\u00e0nh Estrogen c\u1ee7a t\u1ebf b\u00e0o h\u1ea1t. B\u00ean c\u1ea1nh \u0111\u00f3, IGF-1 \u0111\u01b0\u1ee3c ti\u1ebft ra t\u1eeb t\u1ebf b\u00e0o v\u1ecf l\u1ea1i l\u00e0m t\u0103ng qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p Androgen. Cu\u1ed1i c\u00f9ng n\u1ed3ng \u0111\u1ed9 Androgen trong d\u1ecbch nang t\u0103ng cao l\u00e0m cho c\u00e1c nang no\u00e3n b\u1ecb tho\u00e1i ho\u00e1. Ngo\u00e0i ra, khi qu\u00e1 tr\u00ecnh th\u01a1m ho\u00e1 t\u1ed5ng h\u1ee3p Estrogen b\u1ecb \u1ee9c ch\u1ebf, n\u1ed3ng \u0111\u1ed9 Estrogen kh\u00f4ng \u0111\u1ee7 cao \u0111\u1ec3 t\u1ea1o feedback (-) l\u00ean tr\u1ee5c h\u1ea1 \u0111\u1ed3i, LH kh\u00f4ng b\u1ecb \u1ee9c ch\u1ebf ti\u1ebfp t\u1ee5c t\u0103ng cao. T\u1ea5t c\u1ea3 c\u00e1c y\u1ebfu t\u1ed1 tr\u00ean t\u1ea1o n\u00ean t\u00ecnh tr\u1ea1ng kh\u00f4ng c\u00f3 nang v\u01b0\u1ee3t tr\u1ed9i v\u00e0 gia t\u0103ng s\u1ef1 tho\u00e1i ho\u00e1 c\u1ee7a nang no\u00e3n.<\/p>\n

    III.Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HCBT\u0110N:<\/strong>Rotterdam 2004<\/p>\n

    Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi c\u00f3 2 trong 3 ti\u00eau chu\u1ea9n sau v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c<\/p>\n

    Ti\u00eau chu\u1ea9n 1<\/u><\/em><\/strong>: R\u1ed1i lo\u1ea1n ph\u00f3ng no\u00e3n hay kh\u00f4ng ph\u00f3ng no\u00e3n.Bi\u1ec3u hi\u1ec7n b\u1eb1ng r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t:<\/p>\n

    –\u00a0 Kinh th\u01b0a: chu k\u1ef3 kinh tr\u00ean 35 ng\u00e0y hay c\u00f3 kinh <8 l\u1ea7n\/n\u0103m.<\/p>\n

    –\u00a0 V\u00f4 kinh: tr\u00ean 6 th\u00e1ng v\u00f4 kinh.<\/p>\n

    Ti\u00eau chu\u1ea9n 2<\/u><\/em><\/strong>: C\u01b0\u1eddng Androgen ( l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng)<\/p>\n

    –\u00a0\u00a0L\u00e2m s\u00e0ng<\/u><\/em>:<\/p>\n

    * Tri\u1ec7u ch\u1ee9ng r\u1eadm l\u00f4ng, m\u1ee5n tr\u1ee9ng c\u00e1, h\u00f3i \u0111\u1ea7u, d\u1ea7y s\u1eebng.<\/p>\n

    * B\u00e9o ph\u00ec ki\u1ec3u b\u1ee5ng, BMI (Body Mass Index) > 25, t\u1ec9 l\u1ec7 eo\/ h\u00f4ng (waist\/ hip ratio): > 0,85.<\/p>\n

    –\u00a0\u00a0C\u1eadn l\u00e2m s\u00e0ng<\/u>:<\/em><\/p>\n

    * T\u0103ng Testosterone to\u00e0n ph\u1ea7n, t\u0103ng Testosterone t\u1ef1 do (T > 2,5nmol\/ml)<\/p>\n

    * T\u0103ng LH > 10mUI\/ml, t\u1ef7 l\u1ec7 LH\/ FSH >2<\/p>\n

    * Gi\u1ea3m SHBG (Sex Hormone Binding Globulin), gi\u1ea3m IGFBP-1 (Insuline like Growth Factor Binding Protein).<\/p>\n

    * T\u0103ng Estradiol t\u1ef1 do<\/p>\n

    \u00a0Ti\u00eau chu\u1ea9n 3<\/u><\/em><\/strong>: H\u00ecnh \u1ea3nh bu\u1ed3ng tr\u1ee9ng \u0111a nang tr\u00ean si\u00eau \u00e2m( kh\u1ea3o s\u00e1t v\u00e0o ng\u00e0y th\u1ee9 2 -5 c\u1ee7a chu k\u1ef3 kinh ho\u1eb7c ng\u00e0y th\u1ee9 3 chu k\u1ef3 nh\u00e2n t\u1ea1o).<\/p>\n

    * S\u1ed1 l\u01b0\u1ee3ng nang: tr\u00ean 12 nang k\u00edch th\u01b0\u1edbc t\u1eeb 2-9 mm.<\/p>\n

    * Th\u1ec3 t\u00edch bu\u1ed3ng tr\u1ee9ng tr\u00ean 10 cm3<\/sup><\/strong>.<\/sub><\/strong><\/p>\n

    (Kh\u00f4ng c\u1ea7n x\u00e9t \u0111\u1ebfn t\u00ednh ch\u1ea5t ph\u00e2n b\u1ed1 nang ho\u1eb7c m\u1eadt \u0111\u1ed9 m\u00f4 bu\u1ed3ng tr\u1ee9ng).<\/p>\n

    IV.C\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n trong HCBT\u0110N:<\/strong><\/p>\n

    X\u00e9t nghi\u1ec7m m\u00e1u<\/strong>: x\u00e9t nghi\u1ec7m n\u1ed3ng \u0111\u1ed9 LH, FSH, testosterone to\u00e0n ph\u1ea7n, SHBG v\u00e0 testosterone t\u1ef1 do. Trong \u0111\u00f3 ch\u1ec9 s\u1ed1 testosterone t\u1ef1 do (free testosterone index-FTI) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n c\u01b0\u1eddng androgen.C\u00f4ng th\u1ee9c t\u00ednh FTI:<\/p>\n

    FTI=Testosterone to\u00e0n ph\u1ea7n\/SHBGx100.(SHBG-sex hormone-binding glubolin).<\/p>\n

    Si\u00eau \u00e2m<\/strong>: tr\u01b0\u1edbc \u0111\u00e2y, bu\u1ed3ng tr\u1ee9ng\u00a0\u0111a nang\u00a0\u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1eb1ng c\u00e1ch ph\u1eabu thu\u1eadt m\u1edf b\u1ee5ng v\u00e0 quan s\u00e1t bu\u1ed3ng tr\u1ee9ng tr\u1ef1c ti\u1ebfp. T\u1eeb khi si\u00eau \u00e2m ph\u00e1t tri\u1ec3n th\u00ec \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy trong ch\u1ea9n \u0111o\u00e1n HC BT\u0110N v\u00ec bi\u1ec7n ph\u00e1p n\u00e0y kh\u00f4ng x\u00e2m l\u1ea5n, kh\u00f4ng \u0111au, \u0111\u01a1n gi\u1ea3n v\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i r\u1ebb ti\u1ec1n.<\/p>\n

    Si\u00eau \u00e2m \u0111\u1ebfm s\u1ed1 nang no\u00e3n th\u1ee9 c\u1ea5p, \u0111o th\u1ec3 t\u00edch bu\u1ed3ng tr\u1ee9ng. Si\u00eau \u00e2m c\u00f3 th\u1ec3 qua ng\u1ea3 b\u1ee5ng hay ng\u1ea3 \u00e2m \u0111\u1ea1o. Si\u00eau \u00e2m ng\u1ea3 b\u1ee5ng b\u1ec7nh nh\u00e2n c\u1ea7n u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc, c\u00f3 \u01b0u \u0111i\u1ec3m l\u00e0 c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5ng qu\u00e1t c\u00e1c c\u01a1 quan trong \u1ed5 b\u1ee5ng, bao g\u1ed3m lu\u00f4n c\u1ea3 t\u1eed cung, bu\u1ed3ng tr\u1ee9ng. Tuy nhi\u00ean, si\u00eau \u00e2m ng\u1ea3 b\u1ee5ng h\u1ea1n ch\u1ebf quan s\u00e1t bu\u1ed3ng tr\u1ee9ng, v\u00ec v\u1eady si\u00eau \u00e2m ng\u1ea3 \u00e2m \u0111\u1ea1o th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

    \"\"<\/p>\n

    \u00a0H\u00ecnh \u1ea3nh: bu\u1ed3ng tr\u1ee9ng \u0111a nang tr\u00ean si\u00eau \u00e2m \u0111\u1ea7u d\u00f2 ng\u1ea3 \u00e2m \u0111\u1ea1o.<\/em><\/strong><\/p>\n

    Si\u00eau \u00e2m 3 chi\u1ec1u, si\u00eau \u00e2m doppler:\u00a0<\/strong>c\u00f3 th\u1ec3 cho ph\u00e9p quan s\u00e1t h\u00ecnh \u1ea3nh 3 chi\u1ec1u c\u1ee7a bu\u1ed3ng tr\u1ee9ng hay kh\u1ea3o s\u00e1t m\u1ea1ch m\u00e1u quanh bu\u1ed3ng tr\u1ee9ng, tuy nhi\u00ean hai k\u1ef9 thu\u1eadt n\u00e0y kh\u00f4ng gi\u00fap ich g\u00ec th\u00eam cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n.<\/p>\n

    V. \u0110i\u1ec1u tr\u1ecb HCBT\u0110N:<\/strong><\/p>\n

    \u0110i\u1ec1u tr\u1ecb HCBT\u0110N ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng do HCBT\u0110N g\u00e2y ra.<\/strong><\/p>\n

    1.\u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef kh\u00f4ng mong con: ch\u1ee7 y\u1ebfu h\u01b0\u1edbng d\u1eabn ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, gi\u1ea3m c\u00e2n, t\u1ea7m so\u00e1t ti\u1ec3u \u0111\u01b0\u1eddng v\u00e0 r\u1ed1i lo\u1ea1n lipid m\u00e1u. N\u00ean s\u1eed d\u1ee5ng thu\u1ed1c ng\u1eeba thai c\u00f3 ho\u1ea1t t\u00ednh kh\u00e1ng androgen (Diane 35, Drosperin) \u0111\u1ec3 l\u00e0m kinh nguy\u1ec7t \u0111\u1ec1u, nh\u1edd \u0111\u00f3 gi\u1ea3m nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung. Ngo\u00e0i ra, thu\u1ed1c ng\u1eeba thai kh\u00e1ng androgen c\u00f2n gi\u00fap l\u00e0m gi\u1ea3m r\u1eadm l\u00f4ng v\u00e0 m\u1ee5n tr\u1ee9ng c\u00e1.<\/p>\n

    2.\u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111ang mong con: c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau:<\/p>\n

    Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng: l\u01b0u \u00fd ch\u1ebf \u0111\u1ed9 gi\u1ea3m c\u1ea9n cho nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 HCBT\u0110N d\u1ea1ng b\u00e9o ph\u00ec.V\u00ec b\u00e9o ph\u00ec li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n ph\u00f3ng no\u00e3n, s\u1ea3y thai v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a thai k\u00ec nh\u01b0 ti\u1ec1n s\u1ea3n gi\u1eadt, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng\u2026Ngo\u00e0i rat hay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 \u0103n h\u1ee3p l\u00fd, kh\u00f4ng s\u1eed d\u1ee5ng r\u01b0\u1ee3u, h\u1ea1n ch\u1ebf c\u00e0 ph\u00ea,kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1.<\/p>\n

    S\u1eed d\u1ee5ng thu\u1ed1c t\u0103ng nh\u1ea1y c\u1ea3m v\u1edbi insulin: Metformin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng ph\u00f3ng no\u00e3n t\u1ef1 nhi\u00ean. S\u1eed d\u1ee5ng Metformin kh\u00e1 an to\u00e0n, t\u1ef7 l\u1ec7 ph\u00f3ng no\u00e3n \u0111\u1ea1t \u0111\u01b0\u1ee3c \u1edf 54.8% chu k\u00ec v\u00e0 thai l\u00e2m s\u00e0ng l\u00e0 18.6 % (lord v\u00e0 cs, 2003)<\/p>\n

    S\u1eed d\u1ee5ng thu\u1ed1c u\u1ed1ng clomiphen citrate (CC) ho\u1eb7c ti\u00eam \u00a0gonadotropins \u0111\u1ec3 k\u00edch th\u00edch 1 nang tr\u1ee9ng ph\u00e1t tri\u1ec3n v\u00e0 r\u1ee5ng tr\u1ee9ng trong tr\u01b0\u1eddng h\u1ee3p m\u1ecdi x\u00e9t nghi\u1ec7m kh\u00e1c c\u1ee7a ng\u01b0\u1eddi v\u1ee3 v\u00e0 ch\u1ed3ng b\u00ecnh th\u01b0\u1eddng, \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 b\u01a1m tinh tr\u00f9ng v\u00e0o bu\u1ed3ng t\u1eed cung ho\u1eb7c quan h\u1ec7 t\u1ef1 nhi\u00ean.<\/p>\n

    Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ec9 \u0111\u1ecbnh l\u00e0m th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n ph\u01b0\u01a1ng ph\u00e1p nu\u00f4i tr\u01b0\u1edfng th\u00e0nh tr\u1ee9ng non (IVM) trong \u1ed1ng nghi\u1ec7m \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng, v\u00ec ph\u1ee5 n\u1eef BT\u0110N th\u01b0\u1eddng c\u00f3 nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng r\u1ea5t cao khi k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

    VI. HCBT\u0110N v\u00e0 thai ngh\u00e9n:<\/strong><\/p>\n

    C\u00e1c nguy c\u01a1 ph\u1ee5 n\u1eef b\u1ecb HCBT\u0110N khi c\u00f3 thai bao g\u1ed3m: s\u1ea3y thai, \u0110T\u0110 thai ngh\u00e9n, t\u0103ng huy\u1ebft \u00e1p thai k\u00ec.<\/p>\n

    1.S\u1ea3y thai: t\u1ef7 l\u1ec7 s\u1ea3y thai s\u1edbm kho\u1ea3ng 15% v\u00e0 s\u1ea3y thai li\u00ean ti\u1ebfp kho\u1ea3ng 1% \u1edf thai ph\u1ee5 c\u00f3 HCBT\u0110N. Nguy\u00ean nh\u00e2n c\u1ee7a t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 do h\u1ea7u h\u1ebft ph\u1ee5 n\u1eef hi\u1ebfm mu\u1ed9n li\u00ean quan \u0111\u1ebfn HCBT\u0110N \u0111\u1ec1u mang thai l\u1ea7n \u0111\u1ea7u khi \u0111\u00e3 l\u1edbn tu\u1ed5i. Ngo\u00e0i ra c\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft, b\u00e9o ph\u00ec \u1edf ng\u01b0\u1eddi HCBT\u0110N \u0111\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn tr\u1ee9ng v\u00e0 n\u1ed9i m\u1ea1c t\u1eed cung n\u00ean d\u1ec5 s\u1ea3y thai.<\/p>\n

    2.\u0110T\u0110 thai k\u00ec: \u1edf nh\u1eefng thai ph\u1ee5 m\u1eafc ti\u1ec3u \u0111\u01b0\u1eddng trong thai k\u00ec (Gestational diabetes) thai th\u01b0\u1eddng ph\u00e1t tri\u1ec3n nhanh, nguy c\u01a1 thai to cao d\u1eabn \u0111\u1ebfn \u0111\u1ebb kh\u00f3. M\u1ed9t s\u1ed1 thai ph\u1ee5 thai ch\u1eadm ph\u00e1t tri\u1ec3n trong bu\u1ed3ng t\u1eed cung d\u1eabn \u0111\u1ebfn suy dinh d\u01b0\u1ee1ng b\u00e0o thai. Nguy hi\u1ec3m nh\u1ea5t l\u00e0 thai nhi th\u01b0\u1eddng \u0111\u1ed9t ng\u1ed9t t\u1eed vong trong b\u1ee5ng m\u1eb9 \u1edf nh\u1eefng th\u00e1ng cu\u1ed1i thai k\u00ec.N\u1ebfu ph\u00e1t hi\u1ec7n \u0110T\u0110 thai ph\u1ee5 s\u1ebd \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft b\u1eb1ng ch\u1ebf \u0111\u1ed9 \u0103n ho\u1eb7c dung insulin.<\/p>\n

    3.T\u0103ng huy\u1ebft \u00e1p do thai: l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u0103ng huy\u1ebft \u00e1p khi thai \u0111\u01b0\u1ee3c >20 tu\u1ea7n d\u00f9 tr\u01b0\u1edbc \u0111\u00f3 b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng c\u00f3 ti\u1ec1n c\u0103n t\u0103ng huy\u1ebft \u00e1p.Nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd tr\u00e1nh bi\u1ebfn ch\u1ee9ng ti\u1ec1n s\u1ea3n gi\u1eadt, s\u1ea3n gi\u1eadt g\u00e2y nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng c\u1ee7a c\u1ea3 m\u1eb9 v\u00e0 thai.<\/p>\n

    TS-BS.L\u00ea V\u01b0\u01a1ng V\u0103n V\u1ec7 – BS. Ho\u00e0ng Th\u1ecb Thu H\u00e0<\/em><\/p>\n

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

    [:vi]H\u1ed9i ch\u1ee9ng bu\u1ed3ng tr\u1ee9ng \u0111a nang(HCBT\u0110N) -Polycystic ovary syndrome (P.COS) l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi h\u00ecnh \u1ea3nh bu\u1ed3ng tr\u1ee9ng \u0111a nang tr\u00ean si\u00eau \u00e2m v\u00e0 t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng androgen bi\u1ec3u hi\u1ec7n tr\u00ean c\u1eadn l\u00e2m s\u00e0ng (t\u0103ng n\u1ed9i ti\u1ebft t\u1ed1 sinh d\u1ee5c nam) ho\u1eb7c l\u00e2m s\u00e0ng (kinh nguy\u1ec7t kh\u00f4ng \u0111\u1ec1u ho\u1eb7c kh\u00f4ng c\u00f3 kinh, b\u00e9o ph\u00ec, r\u1eadm long, m\u1ee5n tr\u1ee9ng c\u00e1).[:]<\/p>\n","protected":false},"author":3,"featured_media":511,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[24,22],"tags":[],"class_list":["post-736","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nguyen-nhan","category-vo-sinh-hiem-muon"],"acf":[],"yoast_head":"\n[:vi]H\u1ed9i ch\u1ee9ng bu\u1ed3ng tr\u1ee9ng \u0111a nang - 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