ban v ky thut ghi va nhn inh biu CTG cho Sinh vin Y nm 6th

Cn

Cu

tao va nguyn tc vn hanh cua may Monitor san khoa

Cac phng tin theo doi tim thai

ng nghe Pinard Doppler Fetal monitor

11 September 2012

CTG

Au Nhut Luan 3

Muc tiu cua fetal monitoring

Khao sat bin ng tim thai theo cn co t cung nhm phat hin sm cac biu hin khng binh thng cua tim thai

11 September 2012

CTG

Au Nhut Luan 4

Tim thai c ghi nh th nao ?

S dung hiu ng Doppler theo doi hoat ng cua tim thai May Monitor khng phai la mt micro khuch ai ting tim thai

11 September 2012

CTG

Au Nhut Luan 5

Hiu ng Doppler la gi ?
Ngun siu m ng yn F2 F1

Vt phan hi di chuyn
11 September 2012 CTG

Vt phan hi di chuyn
Au Nhut Luan 6

Phng cua song siu m

11 September 2012

CTG

Au Nhut Luan 7

May tinh tim thai nh th nao ?

Khi vt di chuyn, tn s hi m thay i Mi ln tim c ng se gy ra mt ln thay i tn s cua hi m

S ln hi m thay i tn s trong mt phut tng ng vi nhip tim mi phut

Bit khoang thi gian gia hai ln tim p se tinh c tri s nhip tim thai / phut May se cho gia tri tc thi cua tim thai
CTG Au Nhut Luan 8

11 September 2012

Biu tim thai

La tp hp cac dots biu thi tri s tc thi cua tim thai

11 September 2012 CTG Au Nhut Luan 9

May monitor cu tao nh th nao ?

Thn may la mt may tinh co chc nng tinh toan s khac bit tn s cua siu m gi va hi m t o cho bit gia tri tc thi cua tim thai
B phn do tim thai la mt u phat - thu song siu m B phn do cn co la mt cam bin c hoc ghi ap lc tac ng trn mang ghi
11 September 2012 CTG Au Nhut Luan 10

Hinh thc ghi CTG

2 hinh thc ghi CTG CTG ngoai CTG trong

11 September 2012

CTG

Au Nhut Luan 11

Gia tri cua Fetal monitoring

nhay cao c hiu thp 50%

95%

11 September 2012

CTG

Au Nhut Luan 12

 nhay 95% co y nghia gi ?

Khi ghi CTG, nu kt qua noi rng hin tai thai nhi khng bi e doa co nghia la thai nhi khng bi e doa vi mt mc chinh xac la 95 %

11 September 2012

CTG

Au Nhut Luan 13

 chuyn 50% co y nghia gi ?

Khi ghi CTG, nu kt qua noi rng hin tai thai nhi ang co vn thi co nghia la chi co 50% cac trng hp o thc s co vn bnh ly

11 September 2012

CTG

Au Nhut Luan 14

Khi nao phai ghi CTG ?

Admission test hay CTG sang loc Danh cho moi san phu nhp vao phong sanh Muc tiu la phat hin cac trng hp khng ging binh thng co mt theo doi c bit
CTG theo doi cho trng hp cn theo doi c bit
11 September 2012 CTG Au Nhut Luan 15

Ai thc hin bng ghi CTG ?

N h sinh se la ngi u tin thc hin bng ghi va la ngi u tin nhin thy va oc biu CTG

11 September 2012

CTG

Au Nhut Luan 16

Mc may nh th nao ?

B phn ghi cn co t ay t cung, khi t khng dung gel

B phn ghi tim thai t vung ngc thai nhi gn vai, khi t phai dung gel dn truyn tt song siu m

11 September 2012

CTG

Au Nhut Luan 17

Vi tri t u do tim thai

11 September 2012

CTG

Au Nhut Luan 18

Cu tao cua biu CTG

Tc ghi cua may 1 hoc 3 cm/ph May ghi ng thi tim thai va cn co t cung nn biu co 2 phn Phn ghi cn co t cung, di Phn danh cho tim thai, trn

11 September 2012

CTG

Au Nhut Luan 19

Cu tao mt bng ghi CTG

11 September 2012

CTG

Au Nhut Luan 20

Phn tich mt bng ghi CTG

c tinh cn co t cung ? Tri s tim thai cn ban ? Dao ng ni tai ra sao ? Nhip tng co hay khng ? Nhip giam co hay khng ? Bt thng trn CTG ? Nguyn nhn ? X tri thich hp cho nguyn nhn nay ?
CTG Au Nhut Luan 21

11 September 2012

Baseline

va Variability

Con co t cung

Tn s S cn co trong 10 phut Tng quan thi gian co - nghi S phu hp vi giai oan chuyn da Trng lc cn ban Cng , bin
CTG Au Nhut Luan 23

11 September 2012

Cac hinh thc ri loan cn co

Cn co dn dp ? Khi tn s co khng phu hp vi giai oan cua chuyn da Khi ti l thi gian co / nghi > 1 Cn co tng trng lc ?

11 September 2012

CTG

Au Nhut Luan 24

Cn co tha

Tn s co: 2 cn co trong 10 phut

11 September 2012 CTG Au Nhut Luan 25

Cn co tng ng

Tn s co: 6 cn co trong 10 phut, nghi ngn

11 September 2012 CTG Au Nhut Luan 26

Tri s tim thai cn ban (Baseline)

Tri s tim thai chu ao trong thi gian it nht 10 phut Baseline khac tri s tim thai trung binh Baseline giam dn theo tui thai Baseline : 120-150 nhip/ph Nhip NHANH : >150 nhip/ph Nhip CHM : <120 nhip/ph
11 September 2012 CTG Au Nhut Luan 27

Tri s tim thai cn ban binh thng

11 September 2012

CTG

Au Nhut Luan 28

Nhip nhanh nhe (Mild tachycardia)

Baseline 155 - 170 nhip / phut Khng lin quan n suy thai Nguyn nhn Hi chng TMC di Do thuc St, mt nc Nhim trung me hoc thai nhi
CTG Au Nhut Luan 29

11 September 2012

Mild tachycardia

Baseline 155-160 nhip/phut

11 September 2012 CTG Au Nhut Luan 30

Lam gi khi co nhip nhanh nhe ?

X tri theo nguyn nhn Nghing Trai Th Oxygen qua mui hay mt na Bu nc Ha st nu co

11 September 2012

CTG

Au Nhut Luan 31

Nhip nhanh trm trong (Severe tachycardia)

Baseline > 170 nhip / phut

Canh bao thai nhi bt u trang thai bi e doa nhng cha co biu hin trc tip cua suy thai

11 September 2012

CTG

Au Nhut Luan 32

Nhip chm nhe (Mild bradycardia)

Baseline 100-120 nhip/phut

Nguyn nhn Do thuc (Benzodiazepines) Thiu Oxygen X tri theo nguyn nhn

11 September 2012

CTG

Au Nhut Luan 33

Nhip chm trm trong (Severe bradycardia)

Baseline < 80 nhip/phut Thng la biu hin cua suy thai tin trin, thng kem nhip giam Block dn truyn

11 September 2012

CTG

Au Nhut Luan 34

Nhip chm trm trong

11 September 2012

CTG

Au Nhut Luan 35

inh baseline co n gian khng ?

Severe tachycardia kem nhip giam

11 September 2012 CTG Au Nhut Luan 36

Dao ng ni tai (Variability)

Th hin s iu phi cua hanh nao

Cn bng gia hai can thip giao cam va i giao cam Gm

Long term variability

Short term variability

11 September 2012

CTG

Au Nhut Luan 37

Short-term variability

Bin ng cua tri s tc thi t chu chuyn tim nay sang chu chuyn tim ngay lin k
11 September 2012 CTG Au Nhut Luan 38

Long-term variability

Dao ng tao dang hinh song cho baseline, co tn s khoang 3-5 inh phut
11 September 2012 CTG Au Nhut Luan 39

Cac kiu dao ng ni tai

11 September 2012

CTG

Au Nhut Luan 40

Variability th nao la bt thng ?

Variability di 3 nh/phut : Biu phng

11 September 2012

CTG

Au Nhut Luan 41

Nhip tim thai phng

Nguyn nhn Thai ngu Thai non thang Thuc an thn, Magnesium sulfate Thai thiu oxygen trm trong
Cn xac inh nguyn nhn can thip

11 September 2012

CTG

Au Nhut Luan 42

Nhip tim thai phng

Kt lun biu nhip tim thai phng khi ghi qua monitoring ngoai chi co gia tri han ch

11 September 2012

CTG

Au Nhut Luan 43

Nhip tim thai phng trong ketoacidosis

11 September 2012

CTG

Au Nhut Luan 44

Bin ng hinh Sin cua baseline

11 September 2012

CTG

Au Nhut Luan 45

Bin ng hinh Sin cua baseline (True sinusoidal patterns)

Lin quan n thiu mau huyt tan, xut huyt Tiu chun nghim ngt cua Modanlou va Freeman (1982) Baseline trong khoang 120-160 nhip/phut Bin khng qua 15 nhip/phut Tn s 2-5 chu ky/phut Binh n quanh baseline Khng kem nhip tng
11 September 2012 CTG Au Nhut Luan 46

Bin ng gia hinh Sin (Pseudo-sinusoidal pattern)

11 September 2012

CTG

Au Nhut Luan 47

Bin ng gia hinh Sin (Pseudo-sinusoidal pattern)

Ph bin (Murphy va cs, 1991) Chuyn da thng S dung thuc Oxytocin, Mepiridine, t ngoai mang cng Thiu oxy Chen ep rn nhe

11 September 2012

CTG

Au Nhut Luan 48

Loan nhip: Abrupt baseline spiking

Trong loan nhip tim thai Chi c xac inh bng ECG thai

11 September 2012

CTG

Au Nhut Luan 49

tng (Acceleration) va cac nhip giam (Decelerations)

Nhip

Cac bin ng cua nhip tim thai

Nhip tim thai goi la TNG hay GIAM khi no TNG LN hay GIAM I so vi ng tim thai cn ban Hin tng nay xay ra trong nhng thi im nht inh, co th co hay khng co lin quan vi cn co t cung

11 September 2012

CTG

Au Nhut Luan 51

Nhip tng (Acceleration)

Tiu chun Tng 15 nhip/phut Keo dai 15 giy Th hin s lanh manh cua hanh nao Rt co gia tri trong lng gia sc khoe thai nhi NGOAI chuyn da TRONG chuyn da, biu khng nhip tng khng chc chn la du hiu e doa thai
11 September 2012 CTG Au Nhut Luan 52

Nhip tng (Acceleration)

11 September 2012

CTG

Au Nhut Luan 53

Nhip tng (Acceleration)

11 September 2012

CTG

Au Nhut Luan 54

Nhip tng kem nhip giam

Cung c ch vi variability Biu hin kim soat thn kinh-ni tit con toan ven

11 September 2012

CTG

Au Nhut Luan 55

Cac nhip giam (Deceleration)

Tiu chun Giam 15 nhip/phut Keo dai 15 giy

Phn loai Nhip giam sm Nhip giam mun Nhip giam bt inh
CTG Au Nhut Luan 56

11 September 2012

Cac nhip giam hng inh

Nhn dang Hng inh v hinh dang va s xut hin Hinh song Giam khi co cn co Gm Nhip giam sm Nhip giam mun

11 September 2012

CTG

Au Nhut Luan 57

Nhip giam sm (Early deceleration)

Nhn dang Hinh song, i xng gng vi cn co Giam khi bt u cn co at cc tiu khi cn co at cc ai Tr v baseline ngay khi ht cn co Do phan xa qua trung gian dy X Thng xut hin TR (Freeman, 1991)
11 September 2012 CTG Au Nhut Luan 58

Nhip giam sm (Early deceleration)

Lin quan n ap sut trn u thai Khng lin quan Hypoxia Acidemia Apgar thp

11 September 2012

CTG

Au Nhut Luan 59

Nhip giam sm (Early deceleration)

11 September 2012

CTG

Au Nhut Luan 60

Nhip giam sm (Early deceleration)

Trong giai oan s thai, co hinh thai khng hng inh nhng vn lin h mt thit vi cn co
(Ball & Parer, 1992)
11 September 2012 CTG Au Nhut Luan 61

Nhip giam mun (Late deceleration)

Nhn dang Hinh song, lch vi cn co Cc tiu chm hn inh cn co 15 V baseline mun khi ht cn co 15
Au Nhut Luan 62

11 September 2012

CTG

Nhip giam mun (Late deceleration)

Nhn dang Hinh song, lch vi cn co Cc tiu chm hn inh cn co 15 V baseline mun khi ht cn co 15
Au Nhut Luan 63

11 September 2012

CTG

Nhip giam mun

11 September 2012

CTG

Au Nhut Luan 64

Nhip giam mun (Late deceleration)

Nhn dang Hinh song, lch vi cn co Cc tiu chm hn inh cn co 15 V baseline mun khi ht cn co 15
Au Nhut Luan 65

11 September 2012

CTG

Nhip giam mun (Late deceleration)

Nhn dang Hinh song, lch vi cn co Bin khng phai la yu t chinh trong anh gia nhip giam mun
Au Nhut Luan 66

11 September 2012

CTG

Nhip giam mun (Late deceleration)

Du hiu cua ri loan trao i TC - nhau
Th hin thiu Oxygen thai trm trong

C ch Thng qua hoa cam thu quan - thn kinh X Anh hng trc tip cua thiu oxy c tim
Cn thit nhn inh thm Variability
11 September 2012 CTG Au Nhut Luan 67

Nhip giam mun (Late deceleration)

11 September 2012

CTG

Au Nhut Luan 68

Cac nhip giam khng hng inh

La nhip giam thng gp nht trong chuyn da Lin quan n trao i Nhau - Thai Phn loai Lin quan n trng lc trn dy rn Lin quan n chen ep dy rn Nhip giam keo dai

11 September 2012

CTG

Au Nhut Luan 69

Cac nhip giam khng hng inh

Nhn dang Hinh th bt inh Khng nht thit lin quan n cn co

11 September 2012

CTG

Au Nhut Luan 70

Cac nhip giam khng hng inh

11 September 2012

CTG

Au Nhut Luan 71

11 September 2012

CTG

Au Nhut Luan 72

C ch hinh thanh nhip giam bt inh

Chen ep tinh mach lam giam lng mau v, tao nhip tng dn trc do kich hoat baroreceptor
11 September 2012 CTG Au Nhut Luan 73

C ch hinh thanh nhip giam bt inh

Chen ep ng mach lam giam huyt ap ng mach rn, tng hu tai ng mach chu, tao nhip giam hinh thang, variability ay nho c bao tn
11 September 2012 CTG Au Nhut Luan 74

Nhip giam lin quan n hin tng cng keo dy rn

Nhip giam bt inh type I-II (OGureck, 1974) Bt inh, lin quan n c ng thai hay cn co Hinh tam giac Giam nhanh Giam ngn Hi phuc nhanh Thng kem nhip tng
11 September 2012 CTG Au Nhut Luan 75

Nhip giam lin quan n hin tng chen ep trn dy rn

Nhip giam bt inh type III (OGureck, 1974) Bt inh, co lin quan hoc khng lin quan vi cn co Hinh thang cn Giam nhanh ay nho rng ca (variability bao tn) Hi phuc nhanh
11 September 2012 CTG Au Nhut Luan 76

Nhip giam lin quan n hin tng chen ep trn dy rn

Nhip giam bt inh type IV (OGureck, 1974) Hinh thang Giam nhanh ay nho phng Hi phuc chm Mt variability
11 September 2012 CTG Au Nhut Luan 77

Nhip saltatory
V ban cht la nhng cp nhip tng va giam bt inh din tin nhanh, lp lai Khng co y nghia suy thai nu khng i kem nhng bin ng co y nghia bnh ly
11 September 2012 CTG Au Nhut Luan 78

Yu t tin lng cua nhip giam bt inh

Nhip tng bu tr Bin giam Variability cua baseline va inh giam Kha nng hi phuc

11 September 2012

CTG

Au Nhut Luan 79

Nhip giam keo dai

Nhip giam keo dai trn 60 giy Kho din giai, khng lin quan mt thit vi suy thai (Tejany, 1975) Thoang qua Thng hi phuc
11 September 2012 CTG Au Nhut Luan 80

Nhip giam keo dai

Management of isolated prolonged decelerations is based on bedside clinical judgment, which will inevitably be imperfect given the unpredictability of these decelerations. Harsh morning after criticisms of such clinical judgments are frequently inappropriate.

11 September 2012

CTG

Au Nhut Luan 81

Kt lun

Phn tich biu CTG theo ung trinh t va y u, t trong mt bi canh lm sang cu th la chia khoa ly giai mt cach ung n vn lng gia thai nhi ngoai va trong chuyn da

11 September 2012

CTG

Au Nhut Luan 82

Kt lun

So sanh theo doi bng CTG lin tuc va bng ng nghe Pinard cho BN nguy c thp trong 18,561 trng hp

Co git s sinh

OR=0.51 (0.32-0.82)

M sanh
Sanh thu thut

OR=1.41 (1.23-1.61)
OR=1.20 (1.10-1.30)

Apgar score, nhp ICU, t vong chu sinh: khng co s khac bit
Cochrane (1999, Nov )
CTG Au Nhut Luan 83

11 September 2012

Quiz 4, kt cuc
CTG Cn co tt, 5 cn co 10 Baseline 150-155 nhip 1 Variability (+), Nhip tng (+) Nhip giam bt inh type trng lc Vao PS Nghi dy rn qun c Sanh hut sau 2 gi vi chen ep rn sau sanh: Rn qun c, Apgar 8/9
11 September 2012 CTG Au Nhut Luan 84