XUT HUYET 3

THNG DAU THAI KY

ThS.Nguy5Th Thm
MUC TIEU
1. K duoc cc nguyn nhn gy xut huyt 3
thng du thai ky.
2. K duoc cc th lm sng ca sy thai.
3. K duoc cc triu chng lm sng mt trung
hop thai ngoi t cung khng bin chng.
4. K duoc cc triu chng lm sng ca thai
trng.
NGUYN NHN
1
Sy thai
3
Thai trng
2
Thai ngoi
t cung
- Xut huyt 3 thng du thai ky chim 20% cc
thai ky duoc chn don trn lm sng.
- Nguyn nhn ca xut huyt 3 thng du thai
ky: 30% sy thai, 10 15% thai ngoi t cung,
0,2% thai trng, 5% thai ngung pht trin.
- Khong 50% cc thai ky c xut huyt 3 thng
du thai ky s chm dt truc 20 tun.
thai
25 xuat huyet
24 thai trong t cung thai ngoai t cung thai trng
thai co kha nang song
thai co kha nang chet
2 thai song
thai say
2 thai Iu
2 thai say khong tron
7 thai say tron
5

$Y THAI
- Goi l sy thai khi thai nhi bi tng xut ra khi
bung t cung khi chua c kh nng tu sng duoc.
-Theo T chc Y t th gii: Goi l sy thai khi thai
nhi bi tng xut ra :
+ Truc 22 tun
+ hoc trong luong thai nhi < 500g.
- Sy thai duoc chia lm 2 nhm:
+Sy thai sm: khi sy truc 12 tun.
+Sy thai mun: khi sy sau 12 tun.
NGUYEN NHAN
Sy thai sm:
Nguyn nhn ton thn:
- Bnh l nhim trng gy st
- Chn thuong tm l
2 Nguyn nhn co hoc:
- U xo t cung dui nim mac.
- Di dang t cung
- Chn thuong truc tip vng bung
NGUYEN NHAN
Nguyn nhn do trng:
- a thai
- Di dang dy rn
- Phi cht
- Vim ni mac dng mach, hoai thu bnh
nhau.
4 Nguyn nhn ni tit:
- Bnh l ni tit
- Suy hong th
5 Sai Iac nhim sc th:
6 Nguyn nhn min dch:
NGUYEN NHAN
Sy thai mun:
Nguyn nhn do trng:
- Sai lac nhim sc th
- Mu tu sau nhau
- i v non
- a thai, da i
2 Nguyn nhn do me:
- Bt thung t cung
- Bnh ton thn
- Nhim khun
- Chn thuong vng bung
HINH THI LAM $NG
Do sy thai
Lm sng:
- Ra mu m dao
- au trn bung dui hoc dau lung
- Khm lm sng: c t cung di v dng kn, thn
t cung to mm v tuong ng vi tui thai
X tr:
- Nghi ngoi
- Progesterone tu nhin
- Thuc gim co tht
- Trnh giao hop
HINH THI LAM $NG
$!y thai kh trnh
Lm sng
- Ra mu m dao
- au ha vi tng con
- Khm lm sng: c t cung h m
X tr:
- Khng sinh du phng
- Nao gp lng t cung
HINH THI LAM $NG
Sv thai din tin
Lam sang
- Ra mau m dao nhiu
- Dau bung du di
- Kham thy doan duoi tu cung phinh to, c tu cung
he mo, phn thai lp lo c tu cung.
X tri.
- Hi suc chng choang nu cn
- Khang sinh du phong
- Nao gp thai cp cuu
HINH THI LAM $NG
Sv thai khng trn
Lam sang.
- Co triu chung doa say truoc do
- Dau bung va ra mau nhiu, co th ghi nhn mt manh
m tng xut ra ngoai m dao.
- Kham thy c tu cung dong kin, thn tu cung con hon
lon.
X tri.
- Khang sinh
- Nao kim tra long tu cung
HINH THI LAM $NG
$y thai lu
Lm sng:
+ Ra mu m dao
+ Chy sa non
+ Khm: t cung nh hon tui thai
+ Siu m cho gi tri tin cy trong chn don
Tin trin:
+ Sy tu nhin
+ Luu trn 6 tun s c bin chng ri loan dng mu
+ Nu i v rt d bi nhim khun
X tr:
+ Nu i cn, c th ch sy tu nhin
+Truc khi ly thai ra phi chc chn khng c bin chng ri
loan dng mu
HINH THI LAM $NG
$y thai lin tip
lnh ngha: Khi sy trn 3 ln lin tip
guyn nhn
+Bt thung nhim sc th
+Bnh l ca me
+Bt thung t cung
+Bnh l nhim khun
+Bt dng nhm mu me - con
+H eo t cung
X tr: Tuy theo nguyn nhn
DINHNGHA
- Thai ngoai tu cung la khi trung d thu tinh lam t
va phat trin o mt vi tri ngoai bung tu cung.
- Trong hon 90 cac truong hop la thai dong o voi
trung, mt s it truong hop thai co th dong o c
tu cung, bung
NGUYN NHAN:
- Tin cn vim nhim voi trung
- Khi u phn phu
- Di dang bm sinh cua voi trung
- Nhung phu thut d duoc thuc hin o voi trung.
THAI NGOI T CUNG
Thai ngoi tu cung chua v
%riu chng co nng
- Tr kinh
- Rong huyt
- Dau bung
%riu chng thc th
- m dao co it mau den
- Tu cung hoi lon, mm
- C tu cung dong kin
- Khi canh tu cung
TRIEU CHUNG LAM $NG
n lam sang
- Dinh luong HCG
- Siu m
-Ni soi bung
Thai ngi tu cung v
%riu chng co nng
- Tr kinh
- Rong huyt
- Dau bung
TRIEU CHUNG LAM $NG
Triu chng thc th
- Tng trang chong
- Khm: bung lnh phnh, n dau
- Khm m dao:
- m dao c t mu den
- C t cung dng kn
- Thn t cung v 2 phn phu kh khm v bung
gng
- Cng d sau cng dau
- Choc d cng d sau s ra mu khng dng
Huyt tu thnh nang
Thai trong bung
TRIEU CHUNG LAM $NG
lIU TRI
- Thai ngoi t cung chua v
+ iu tri tn gc
+ iu tri bo tn
- Thai ngoi t cung d v: diu tri tn gc
- Huyt tu thnh nang
- Thai trong bung
TIN LUONG
- Thai ngoi t cung ti pht
- V sinh
lI CUONG
- Thai trng l bnh l bao gm su thoi ho
nuc ca cc gai nhau v su tng sinh ca
cc nguyn bo nui.
- Thai trng c th tin trin thnh ung thu
nguyn bo nui hoc thai trng xm ln.
NGUYN NHN
- Nguyn nhn chua r rng.
- Mt s yu t thun loi duoc ghi nhn:
- Thiu dinh dung
- nhiu
- Tui cao
THAI TRUNG
!artialMole
GII PHU BENH
- ai th
- Thai trng ton phn
- Thai trng bn phn
- Vi th
TRIEU CHNG
Triu chng co nng
- Rong huyt
- Nghn nng
- Bung to nhan
THAI TRUNG
Triu chng thuc th
- Tng trang thiu mau
- Du hiu cua cuong giap hoc tin san git
- Tu cung co th lon hon tui thai
- Khng nghe duoc tim thai
- Nang hoang tuyn o 1 hoc 2 bn bung trung
Cn lm sng
- Siu m hinh anh bo tuyt
- Dinh luong hCG tng rt cao trong thai trung
THAI TRUNG
THAI TRUNG
TIN TRIEN
- Sy tu nhin tun l 16 18
- Sau ht nao: 80 90% tin trin tt
- Tin trin xu: Thai trng xm ln, ung thu nguyn
bo nui
TR
liu tr:
- Ht nao
- Nu bnh nhn ln tui, d con: ct hon ton t
cung.
- Nu thai trng nguy co cao: ho du phng
THAI TRUNG
Theo di: t nht 12 18 thng. Nhip d theo di:
- 3 thng du: mi na thng
- 6 thng k tip: mi thng
- Nm k tip: mi 2 thng.
4 6 2 22 24 26 2
Ngay
m
U
I
/
m
I
Bnh thng TNTC Say Thai
hCG
Bnh thng :
Xuat hien ngay 9-10 sau thu tinh
[hCG] < 1200 : 48-72h sau se tang gap 2
[hCG] 1200-6000 : 72-96h sau se tang gap 2
[hCG] > 6000 : 96h sau se tang gap 2
nh cao : thang th 3
Giam dan thang 4-5