Nghien cihi Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 1 * 2016
HIEU QUA CUA MIFEPRISTONE-MISOPROSTOL NGAM CANH MA TRONG PHA THAI N O I KHOA 9-12 TUAN VO KINH NAM 2015
T4I BENH VIEN HUNG VlfONG
Cao Thi Phuang Trang', Nguyen Duy Td"
TOMTAT
Muc tieu: Xdc dinh ti li thanh cdng cda phd thai ndi khoa (Mifepristone feet hgp Misoprostol dgt canh md) i thmky9-12 tudn vo kinh tgi binh din Hiing Vuang tie 01/2015 din 06/2015.
Phuang phdp: Thie nghiem ldm sdng IdiSng nhdm chimg tren 93 tiiai phu cd tudi thd 9-12 tudnwkinhd^
chdm diet thai ky td binh den Hiing Vuang tie 01/2015 deh 06/2015. Phdc dd sie dung: uong 200m^
Mifepristone, 36-48 gid sau do kH hgp 800mcg Misoprostol dgt canh md. Neu fchSng s ^ thai, mSi 3 gid sau, (fan phu dugc them lieii 40(hncg Misoprostol dgt canh md, tdi da 4 lieii bd'sung.
Kei qud Ti li thdnh cdng phdc do la 93,5% (KTC 95%: 88,5 - 98,6%). Tdc diing ngogi y thubng gap Id: tik didy: 52,7%, buon ndn: 4S,4%, non: 33,3%, met: 31,2%, chong mat: 15,1%, Ignh run: 4,3%, soi: 3X%, dait bung: 100%. Khdng ghi nhdn biSh chdng bang huyii hay nhiim triing xay ra trong nghien dht. Ti liphu niijM thm chap nhgn vd Mi long vai phucmg phdp phd thai noi khoa cao 96,8%. 92,5% se chgn Id khi cdn vd 91,4% pdi thieu phuang phdp phd thai noi khoa cho ngudi ldm:.
Ket luan: Phd thai ndi khoa vdi Mifepristone - Misoprostol dgt cgnh md d thd 9 — 12 tudn B5 kinh hiiu qua, an torn va didiS^ nhdn.
Td khoa: phd thai ngi khoa, thie nghiem ISm sdng, Mifepristcme, Misoprostol.
ABSTRACT
THE EFFECTIVENESS OF MEDICAL ABORTION WITH MIFEPRISTONE AND BUCCAL % f' MISOPROSTOL BETWEEN 9 AND 12 GESTATIONAL WEEKS IN HUNG VUONG HOSPITAL Cao Thi Phuong Trang, Nguyen Duy Tai * Y Hoc TP. Ho Chi Minh * Vol 20 - No 1 - 2016:272 - 279 Objectives: Determine the success rate of medical abortion (Mifepristone and buccal Misoprostol) between 9 and 12 gestational -weeks in Hung Vuong hospital from 01/2015 to 06/2015.
Method. This was a non-cxmtrol clinical trial study, conduded of 93 -women irfio had 9-12 vxdcs cfgestdton to terminate the pregnancy at Hung Vuong hospitd from 01/2015 to 06/2015. The regimen: Mifepristone 2(X)m§
orally followed 36-48 hours later by buccal Misoprostol SOOmcg. A maximum of 4 further doses cf buccal Misoprostol 400mcg administered at 34umrly intervds.
Results: Ihe success rate was 93.5% (95% extwt CL 88.5 - 98.67o). The common side ^fects were: diardm 52.7%, nausea 48.4%, vomitting 33.3%, fatigue 31.2%, dizziness 15,1%, chill 4.3%,feoa31%, abdomind psin 100%. There were no serious complications: heavy bleeding, infection. Most -women accepted and vxre satisfid with procedure (96.8%). Most women would request a mediad abortion if they required another abortion d tlas gestational age (92.5%) and recommmend the procedure to friends (91.4%).
Conclusion: Medical abortion between 9 and 12 gestationd wedcs with M^epristone - buccd Misoprostd is safe, effective and acceptable.
* Khoa Kg'hoEich Gia dinh, B?nh vi§n Hiing Vuong
** Bg mon Phii san Dgi Hgc Y Diroc TP Ho Chi Minh
Tdc gid ben lac: BS Cao Thi PhuongTrang, DT: 098800362, Emdl: [email protected] 272 Chuyen De Siic Khoe Sinh San - Ba Me Tr6 Em
Y H o c TP. H o Chf M i n h * T^p 20 * Sd 1 * 2016 N g h i e n c u u Y hpc Key words: Medical aboriion, clinical trid study,
D A T V A N D E
Hon ba thap ky qua, pha thai noi khoa da phat trien khap the'gioi, duoc ua chupng hon pha thai ngoai khoa, la lira chon cho nhimg phu nii muon chSin diit thai ky ba thang dau.
Tai Viet Nam, thang 04/2002 phuong phap pha thai noi khoa drnx: Bo Y Tg" chap nhan va vao thang 02/2003 da duoc dua vao "Chuaii quoc gia ve cac dich vu cham soc siic khoe sinh san". Tit gioi han pha thai noi khoa d tuoi thai duoi 50 ngay vo kinh nam 2003, d ^ nam 2009, Bo Y te da cho phep mo rong pha thai noi khoa d tuoi thai deh 63 ngay vo kinh va tuoi tiiai tir 13 d a i 22 tuan vo kinh. Thai hi 9 deh 12 tuan vo kinh chua co phac do pha thai npi khoa, chi khuyoi cao nen chuan bj co tir cung bang each cho dat duoi luoi 400mcg Misoprostol 3 gio truoc khi lam thu thuatf*'.
Tren the* gioi da co nhung nghien cim su dung Mifepristone ket hgp Misoprostol cho nhung truong hop pha fliai 9 - 1 2 tuan vo kinh vol ti le thanh cong rai khA quan 89 - 97,3%t^'^'.
Ben cgnh do, theo k h u y ^ cao c i a Hiep hoi San Phu khoa Hoa ky so 143, thang 3 nam 2014, sir dung Misoprostol dat canh ma hogc deit am dao hieu qua hon duong uohg. Sir dung Misoprostol dat duoi luoi ciing dat hieu qua cao nhung nhieu tac dung ngoai y hon'^*'.
Mac dii duong dimg canh ma cho nong do thuSc trong huye't thanh tiiap hon duong dat am dao, truong luc va hoat dong a i a ca tir cung la tuong duong. Misoprostol dat canh ma CO the it nguy co nhiem trimg nang hon so voi dat am dao. Tren thuc te, nhieu phu nii khong thich dimg thuoc duong am dgo'i-^).
Vol mong muon ap dung nhiing ket qua tiai bp aia y hoc va giiip khach hang co them Ivra chon phuong phap pha tiiai khong xSm lah, chung t6i ti&i hanh nghi&i cthi: "Hieu qua ciia Mifepristone ket hcrp Misoprostol dat canh ma trong pha thai noi khoa 9 - 1 2 tuan vo kinh nam 20151^ b&nh vifn Hiuig Vuong".
Mifepristone, Misoprostol.
M u c tieu nghien c u u
Xac dinh ti le thanh cong ciia pha thai noi khoa (Mifepristone ket hpp ^fisoprostol dat canh ma) d thai ky 9 - 12 tuah vo kinh tai benh vien Himg Vuong ht 01/2015 dSi 06/2015.
Xac djnh ti le tac dtmg ngoai y va b i ^ chiing gah trdng pha thai npi khoa 9-12 tuah vo kinh.
Khao sat muc dp hai long ciia khach hang trong nghien ctiu.
DdllUONG-PHUONGPHAPNCanHSraJlJ Thi^t k e ngihien c u u
Thir nghiem lam sang khong nhom chiing.
P h u o n g p h a p chgn m a u
Chpn toan bp nhiing thai phu c6 tuoi thai 9- 12 tuan vo kinh chap nhan pha thai bang thuoc Mifepristone ket hop Misoprostol dat canh ma thoa tieu chu&i chpn i m u trong thoi gian nghien cuu tir tiiang 01^2015 deii khi dii so lirang.
Tieu chudn chon mdu
Tren 18 tuoi, khong mac benh tam than.
Thai trong hx cung 9-12 tuan vo kmh San sang cung c ^ dia chi va so' dien tiioai de theo doi khi can.
Bang long tai kham theo yeu cau a i a qui trinh nghien ciiu.
Tir nha d^i benh vien trong vong 1 gio.
Dong y tham gia nghien ciiu.
Tieu chudn loai trd Nghi ngo dpa say thai
Di ting vol Mifepristone hay Misoprostol.
Dieu tri Corticoid toan than lau ngay.
Co van de ve chay mau.
Benh ly npi khoa nang.
Benh roi loan chuy&i hoa porphjria di truyen.
Dang cho con bii.
Dang mang dung cu tii cung.
S ^ Phu Khoa
Nghien cmi Y hoc Y Hgc TP. H 6 Chi Minh * T^p 20 * So 1 * 2016 Dang viem nhiim duong sinh due cap tinh
ComSu
Co m l u duprc xac diiih d\ra tren cong thiic:
Theo nghien cihi cua Hamoda va cong su, ti le thanh cong cua pha tiiai npi khoa >9 -13 tumi vo kinh la 94,8%. TTOT^ do, ti le thanh rang ciia pha thai npi khoa 9 -10 tuan vo kinh la 99,1%, 10 - 11 hian la 94,7%, 11 - 12 himi la 93,8%, 12 - 13 turn la 92,1%™.
Vl chung toi nghien ctiu tuoi thai tii 9 - 12 tuah vo kinh nen chpn P = 93,8% = 0,938 la ti le thanh cong aia pha thai ngi khoa 6 tuoi thai 11 - 12 tuMi vo kinh thap hon ti le thanh cong a nhdm turn tiiaj 9 -11 tuan vo kinh. n: co mau tm tiiieu can thiet cho nghien aiu; ZIT^Q = 1,%; d: do chinh xac cua uoc hrpng = 0,05. Co mau can thiet cho nghien cihi la 89. Vac hrpng 10% mat dau la 9. Vay comlu c m thu nhan la 98 doa tupng.
Phac d6 su dyng hong nghien cuu Ehia vao dugc dpng hpc ciia thuoi; fham khao cac Heu dimg va tac dung phu aia cac f*iac do pha thai npi khoa 9-12 tuan vo kinh trong cac nghien ctiu, chung toi chpn phac dof^^is);
Uraig 200mg ^fifepristone (Mifrednor 200mg do Cong ty Co phan Duoc pham Agimexpharm san xuat, so dang ky QUDB-3^-13, so 16 san xuafc 010514, han dimg 07/05/2017).
3 6 - 4 8 gid sau do ket hpp Misoprostol (Misoprostol 200mcg do C6ng ty Lien doanh Trach nhiem hiiu han Stada Viet Nam san xuat, so dang ky VD-13626-10, so 16 san xuat 351214^
han dimg 31/12/2017) lieu khoi dau cao 800mcg (4 vien) dat cgnh ma.
Neu khong say thai m6i 3 gio sau, ftiai phu dugc them lieu 400mcg Misoprostol (2 vien) dat canh ma, ^ da 4 lieu bo sung tiong 12 gio.
Cach tien hanh
Thai phu dugc sieu am dau do am dao de chah doan tuoi thai, tu van. Thai phu tiioa tieu
chuain, dor^ y tiiam gia nghien o h i ky vao bang dong thuan tham gia nghien cihi. Thai phu du^c cho uohg 1 vien Mifepristone 200mg tai phong kham va tiieo doi 15 phiit tinh trang toan than va tac dung ngogi y a i a thucfc. Giai thich dio thai phu khli nang say thai sau dimg thuoc, cac dau hieu c&i theo doi va hen thai phu tro lai b|nh vien 36-48 gio sau (luc 7 gi6 2 ngay sau). Thai phu tro lai benh vi&i 36-48 gio sau de danh gja di&n hen sau uraig Mifepristone. Neu chua sSy thai thi cho dat canh ma SOOmcg Misoprostol Sau mdi3 gl6, neu van chua say thai thi d|tqmh ma 400mcg Misoprostol, ^ i da 4 lieu 400mcg, Thai phu dugc theo doi tai benh vien drai khi say thai. Neu say thai va nhau trgn, thai phu venha tiieo doi t i ^ va hen tai kham 2 tu&i sau. Neii d&i 20 gio chua say thai, tiiai phu dupe nhap vien fheo doi qua dem, sang horn sau danh gia laL Neu da say tiiai va nhau, xuat vi|n, hen tii kham 02 tuan sau. Neu chua say, tiiai eon phat tri&i hoac ngiing phat trim xem nhu that bai va thai phu dugc hiit thai.
KFTQUA
Trong thcri gian nghien cihi, chung ^ i tim nhan 98 truong hgp thoa ti&u chuan va dfing j tham gia nghien cihi, trong do 5 truong hop mat dau do khong Hen Igc dugc, chi«n 5,4%. So lugng mau phan tich cuoi cimg la 93, Ion hon co mau can thiet tmh theo cong fhiic la 89, dii nang luc mau cho phan tieh myc tieu chinh ciia nghien cihL
Bdng 1. Ddc dian ddn sffnghiin dm (n=^3) _ BifcOiim
Nh6mtuSi:^20tudi 21-25 tuoi 26-30tu6i 31-35 tuoi
>36lll6i Trinh <J$ hoc vIn: "TlIu hijc
Trung hoc 2BH Ngh^ nghiep: C6ng nhan vign diijc
Bu6nMn-Di<^vv CSngnhSn
Tin suit 11 35 22 14 11 11 71 11 17 22 24
11,8 37,6 23,7 15,1 11,8 11,8 76.*::, JW.!
18,3 23,7 25,8
Chuyen Oi Sice Khoe Sinh Sin - Ba Me Tre Effl
Y Hgc TP. H o Chi M i n h * T i p 20 * So 1 * 2016 N g h i e n c u u Y hpc Blcdiem
Hoc sir*-sinh vien I^Oitie Tinh ligng honnhan:Chu^l(ithan
Kithdn Lydj/lythSn
T i n suit 7 23 31 60 2
T i l f (14) 7,5 24,7 33,3 64,5 2,2 61,3% dm tugng fham gia nghien a i u tap trung 6 do tuoi tir 21 d a i 30. Trinh dp hpc v m la trung hpc (cap 2 va cap 3) chian 76,4%. Trinh do hpc van tieu hpc chi 11,8%. C6ng nhan chiran ti le cao nhat ke d a i la npi trg va buon ban - dich vu. Cong nhan vien chiic, sinh vioi - hpc sinh chion ti le thap hon. Da so' cac dca tugng tham gia nghien cihi da Igp gia finh. Ti le ly di, ly than thap. Cac dca tugng Iham gia nghien ctiu chua lap gia ffirth chian 33,3%.
Bdng 2. Dgc dian sdn khoa (n = 93) Dlcdiem
s6coh 0
>1 Sd lan pha thai 0
1
£ 2 Tiln can FTNK TC phd Itiai ngoai khoa TC PTNKvS ngoai khoa ApdgngBFTT: Khong
OS Tiln can mo lay thai Nhdm tuoi thai: ^g-10tuan
>10-11tuan
>11-12tu4n Tansd
46 47 67 19 7 14 14 2 61 42 15 28 31 34
T i l f % 49,5 60,5 70,1 20,4 7,5 15,1 15,1 2.2 54,8 45,2 16,1 30,1 33,3 36,7 Cac doi tupng tham gia nghien a h i chua co con chion gjm phan nira. Da so chua timg pha thai lah nao. Phu n u da tteig pha fhai tir 2 lan tro len chion ti le IhaTp; 20,4% da timg pha tiiai 1 lah.
11 le cac dm tugng co tien can pha fhai npi khoa va pha thai ngoai khoa tuong duong nhau.
Trong do co 2,2% co tien can viia pha thai npi khoa va pha thai ngogi khoa. 16,1% cac dm tupng tham gia n g ^ e n eiiu co tien can mo lay thai. Phan Icm cac doi tugng fham gia n ^ o i cihi Idiong ap dung bien phap ng^a tiiai nao.
Su phan bo cac nhom tuoi thai tuong doi dong deu. Nhom tuoi tiiai > 11 - 12 tuan hoi nhieu hem so voi 2 nhom tuoi thai con lai.
Bdng 3. Ti li SOT/ thd trong vong 24 gid ketie Idc diing Misoprostol (n = 93)
cac hinh thii Say thai hoin toin, ichfing can thi#p
Say thai, cd can thiop thu thult Thai cdn ti^n triln
Tlns6 87
1 5
•ni#(%) 93.4
1,2 ' 5,4 Tl 1# gSy say fhai hoan toan trong vong 24 gio ciia phac do nghien ctiu nay la 94,6%.
Khoang tin cgy 95% tir 89,9 doi 99,3%. Mpt truong hgp trong so'nay d o i kham tai bac a tu vi lo lang truoc ngay hen tai kham, khong dugc sieu am lai va da dugc hiit long t u cung. Truong hgp nay xem nhu that bai. 5 truong hgp thai con tioi trial sau 24 gio (chion ti le 5,4%) da dugc hiit long fir cung. Cac truong hgp nay cung dugc xem la that bai. Khong co trudng hgp nao fhai ngimg phat trioi sau 24 gio. Chi co 7 truong hgp (chiem 7,5%) phai lam ho so nhap vi#n theo doi qua dem tai benh vien.
Ti le tiianh cong ciia phac do nghioi cihi nay la 93,5% vol khoang tin cay 95% tir 88,5 den 98,6%.
Bdng 5. Thdi gian tdhg xuM thm (gia) D ^ i t u ^ g
Con so Conr?
Nhdm tudi thai
&g-10tuan
>10-11tuin
>11-12tuan
Trung vi (ICTV) 4(3-5,3) 4,1 (2,9-5,5) 3,7(2,8-5,0) 4(3,0-4,8) 4.5 (3.0^,2)
Gii t i p 0,96*
0,18~
*Kian dinh Mann-Vi^itney;**Kian dinh Krushil Wallis Thai gian tong xuat thai ciia nhom nghien cini CO trung vi la 4 gio. 50% cac truang hgp co thoi gian tong xuat fhai tir 2,9 gio d o i 5,3 gio.
Thoi gian tong xuat fhai 6 nhom con so la 4 gio va nhom con ra la 4,1 gio. Khong co truong hgp nao say thai sau khi dimg Mifepristone. Khong tim thay si^ khac biet eo -^
nghia thong ke a i a thod gjan tong xuat thai 6 nhom thai phu con so va con rg. Sxf khac biet
San P h u K h o a 275
Nghien cuu Y hoc
ciia thoi gian tong xuat thai 6 cac nhom tuoi fhai khong co y nghia thong ke.
Y Hpc TF. H o Chi M i n h » T a p 20 * So 1 * 2016
HHHHH
Biai do 1. Lugng Misoprostol (meg) su dung a nhom gdy say thd trong 24 gia
Luong Misoprostol su dung co phan phm lech ve ben trai. Tap trung da s6' a lieu 1.200mcg (53,4%). Lugng Misoprostol sir dimg trong nhom gay say thai 24 gio co trung vi la 1.200mcg voi khoang hi vi tir SOOmcg doi 1.200mcg. 81,8% sir dirng lieu < 1.200mcg Misoprostol.
Neu chi dimg 800mcg Misoprostol chi gay say thai 26,9% truong hgp. Vol 1200mcg Misoprostol, ti le gay say thai tang tiiem dang ke len deh 77,4%. Neu dimg deh 1600mcg Misoprostol, ti le say thai len deh 89,2%. Dimg deh Ueu 2000mcg Misoprostol, ti le say thai tang them 3,2% dgt deh 92,4%. Va cuoi cimg neu dimg du lugng Misoprostol nhu phac do nghien ciiu la 2400mcg thi ti le gay say thai dat den 94,6%.
Dimg dli lugng Misoprostol nhu phac do nghien ciiu can khoang thoi gian la 12 gio. Neu khach hang quay lai benh vien de dat canh ma lieu Misoprostol SOOmcg dau tien liic 7 gio sang thi lieu cuoi dmg Misoprostol se dugc dimg liic 19 gio. Trong nghien aiu, chi co 7 truong hgp phai lam ho so nhap vien 6 lai qua dem tai benh vien. Trong do, 2 truong hgp say thai va 5 truong hgp thai van con phat trien ducyc xem la that bai va hiit thai ngay hom sau.
Bdng 6. Cdc tdc dung ngod y (Tr=93) Tac dung ngo^i y
Tiguchay Budn ndn Ndn M«t Chdng mat
NhLFc dau Lanh run Sdt Khac
Tan suit 49 45 31 29 14 13 4 3 3
T I K W 52,7 48,4 33,3 31,2 15.1 14.0 4.3 3i 3.2 Tac dung ngoai y thuong gap nhat la tieu chay, ke deh la buon n6n va non. So't it ggp nhat Tat ca cac tac dimg nay deu nhe va thoang qua, khong CEUi dieu tri.
Khong CO truong hgp nao mat mau nhieu can phai hiit cam mau hay truyen mau.
Miic do dau (dugc finh voi thang diem O-IO) CO trung vi la 4 voi khoang hi vi tu 3 doi 5 (tuong ling voi mire do dau vira). Chi co 19,4%
CO miic dp dau rat nhieu liic say thai (miic dp 7- 8). Khong CO trucmg hgp nao dau dii dpi Bi& chung
Khong CO truong hgp nao bang huye't can hiit cam mau hoac tniyoi mau. Khong c6 trucmg hgp nao nhiem trimg.
Bdng 7. Muc do hm long cua doi tugng nghiin dm doi vdi phdc do (n=93)
Mi>c dp tidi I6ng Rat hai long
Hai Idng Vira phai Khong hai long Rat khong hai long
Tdn sudt 31 59 3 0 0
•ni¥(%) 33,3 63,5 3,2 0 0 Hau het cac dm tugng tham gia nghien ciiu deu cam thay hai long va rat hai long doi vdi phac do pha thai npi khoa nay.
Bdng 8. Su chgn Igi phuang phdp (n=93) Ctipn Igi phuong ptrip
Kh6ng Co Khflng biet
TltH%)_
Ti le cac doi tugng nghioi a i u chpn lai phuong phap nay cao neii phai pha thai lan niia (92,5%).
276 C h u y e n D e Siic Khoe Sinh San - Ba Me Tre Effl
Y Hgc TP. H o Chi M m h * Tap 20 * So 1 * 2016 Nghien cmi Y hpc
Bang 9. Giai thieu cho nj^ttai Gioi thifu cho nquoi lOiac
Khdng C6 Khdng b i ^
khic(n=93) Tan suat 3 85 5
Tilf(%) 3,2 91.4 5,4 91,4% cac doi tugng tham gia nghien euu tra !6i se gioi thieu phuong phap nay cho nguoi khac.
BANLUAN
Nhirng nghien eiiu tren the gioi ve pha thai npi khoa 6 tuoi thai 9-12 tuah vo kinh khong nhieu va ciing khong dong nhat nen rat kho de so sanh ket qua vol nhau.
Mpt so' nghien cmi co ti le thanh cong thap nhu nghien ciiu ciia Gynuity Health Projects thuc hien tai Himg Vuong vi phac do aia nhom nghien ciiu nay khac nghien ciiu cita chiing toi.
Sau khi uong 200mg Mifepristone, 24-48 gio sau nhom nghien ciiu nay dimg 1 lieu SOOmcg Misoprostol dat canh ma hoac dat duoi luoi, khong dimg them Ueu bo' sung nhu nghien cihi ciia chiing toi'^. Nghien cuu cua Lokeland va cong su thi dimg lieu SOOmcg Misoprostol dat am dao, cac lieu bo' sung 400mcg Misoprostol till dimg duong u6hg"^>. Nghien ciiu cua Bracken va cong su nam 2005 thi chi dimg toi da 2 Ueu bo sungP), con nghioi ciiu ciia chiing toi toi da 4 lieu bo sung nen ti le fhanh cong trong nghien a i u aia chiing toi hoi cao hon.
Tl le tiianh cong aia phac do nghien cuu cua chiing toi tuong duong nhu nghien ciiu a i a Hamoda va cong su nam 2003<'<fl. Ti le thanh cong chung la 93,5%. Voi tuoi thai S 9 tulm - 10 tuah, ti le thanh c6ng la 92,9%. Tuoi tiiai >10 tuan -11 tuah, ti le tiianh cong la 96,8%. Tuoi tiiai >11 tuan -12 tuan, ti le thanh cong la 91,2%. Co the ti le thanh cong aia nghien eiiu chiing toi con eao hon noi cac doi tugng tham gia nghien ciiu tuan thii chat che qui trinh nghien ctiu, tai kham diing hen boi vi eo mot dm tugng nghien ciiu tai kham bac a tu tnroc hen vi lo lang da dugc hiit long hi cung ma tham chi con khong sieu am Idem tra.
Truong hgp nay dugc xem nhu that bgi. Dieu nay cung cho thay r3ng cong tac hr v m chua tiiat
SLT hieu qua. Cac truong hgp that bgi khac deu la tiiai van con phat trien sau 24 gio tinh tir liic dimg Misoprostol dau tien.
Ti le say thai hoan toan trong vong 24 gio cua phac do' nghien ctiu nay la 94,6%. Trong do, say thai va nhau cimg luc la 88,6%, 11,4% truong hgp say tiiai ma chua say nhau deu ra mau am dao it nen dugc theo doi hep tai benh vien ma khong can thiep ngay. Cac truong hgp nay deu say nhau sau do trong vong 24 gio va khong kem tiiem trieu chiing g^ dgc biet nao khac. Theo quan niem hien nay, muc dich aia pha thai ngi khoa la tong xuat thai chii khong phM lam trong buong tir cung. Say fhai la mpt qua trinh, tii cung se tu no lam trong fheo thoi gian. Nhieu nghien ciiu ehiing minh rang khong co mo'i Uen he giiia dp day npi mac tu cung va ket cuoc Iam sang, chang han nhu bang huyel doi hoi phai lam sach buong hi cung. Dieu nay da lam tang hieu qua aia pha thai npi khoa do tranh dugc can thiep thii thugt qua miic can thief •*'.
O thai phu con so va con rg, trung vi aia thoi gian tong xuat thai deu la 4 gia. Trung vi ciia tiioi gian tong xuat fhai thanh cong aia chung nhom nghien ciiu la 4 gio. 50% cac truong hgp CO thoi gian tong xuat thai tir 2,9 gio dot 5,3 gio.
Khong tim thay su khac biet co y nghia thong ke ciia thoi gian tong xuat thai a nhom thai phu con so va con ra. Thai gian tmig xuat fhai a cac nhdm tuoi fhai >9-10 taan, >10-11 tuah, >11-12 hian co trung vi lan lugt la 3,7; 4 va 4,2 gio. Khong tim thay su khac biet co y nghia thong ke eua thoi gian tong xuat fhai 6 cac nhom tuoi thai. Co le d6 CO mau nho.
Trung vi ciia thoi gian to'ng xuat thai ciia nhom nghien ciru la 4 gio, tuong duong so vdi cac nghien ciiu khac va co phan hoi nhtuih han(i-^"-i2>.
Lugng Misoprostol sii dung trong nhom gay say fhai trong vong 24 gio tap trtmg da so' a Ueu 1.200mg (53,4%). Lugng Misoprostol sir dung trong nhom gay say thai 24 gjo co tnmg vi la 1.200mcg vdi khoang tii vi tu SOOmcg d o i
San Phu Khoa
Nghien ciiru Y hpc
1.200mcg. 81,8% hTKmg hgp gay say ttiai vdi lieu
< 1.20ameg. Ket qua nay cung tuong tu nhu cac nghien cthi khac tren tiiegidi""^.
Dau bung dudi gap 6 tat ca cae truong hgp trong nghien cihi aia diiing toi Miic dp dau da so chap nhan dugc. Cae iac dung ngogi y gap trong nghien cihi aia chung toi tuong t u nhu nghien cihi cua Hamoda va epng su("', nghien ciiu cua Ashok va cong SUP». Tuy nhien, ti 1| cac tac dung ngoai y trong nghien o h i cua chung toi CO ve thap hon so vdi nhom dat dudi luoi MisoprtBfol trong nghien cihi cita Hamoda va cong sii. Dieu nay cung phii hgp vdi cac ket qua nghien cihi so sanh cac duong dimg aia Misoprostol cho rang tac dung ngoai y ciia duong dat dudi hioi cao hon. Khong co truong hgp say fliai nao bi bang huyet va nhiem trimg.
Co le do nghien cihi cua chiing ^ i cd co mau nhd.
Nhu vay viec sir dung phac do Mifepristone phm hpp Misoprostol cd do chap nhan va hai long cao va dugc da so thai phu tin nhiem mucm gidi thieu cho nguoi khac Ket qua nay tuong tu vdi ket qua aia nghioi cihi cua Bracken va cong su (93,4% rat hai long va hai long, 90,4% chpn lai phuong phap neu pha thai lah niia, 94% se gjoi thieu cho ngudi khac)Pi.
So sanh vdi nghien cxsa ciia Lol^land va cong su, ti le cac dm tugng hai long vdi phuong phap cua chung toi hoi cao han (96,8% so vdi 91%); ti le cac doi tugng chrai lai phuong phap neu pha thai lan niia ciia chiing tdi ciing cao hon (92,5% so vdi 76,1%); ti le cac dm tugng se gidi thieu phuong phap pha thai ngi khoa nay eho nguoi khac 6 n ^ e n ciiu ciia chiing toi cao hon (91,4%sovdi81,9%)m.
Vdi nghien ciiu thi diem aia Nguyen I h i Nhu Ngpc phcS hgp vdi to chiic Gynuity Health Projects thue hien tgi benh vien Himg Vuong, 6 nhdm dm tugng cd tuoi tiiai 10-11 taan vo kinh, 100% cac dm tugng hai long vdi qui trinh, 100%
doi tugr^ chgn lai phuong phap; a nhdm dm tugng cd tuoi tiiai 11 -12 tuan vd kinh, 97,9% dm
Y Hpc TP. H o Chi Minh * Tap 20 * So 1 * 2016
tugng hai long vdi qui trinh, 913% doi tupng chgn lai phuang phap^^.
KETLUAN
Qua ng^T^ cihi thir nghiem ISm sang khong nhdm chihig xac dinh ti le thanh cdng aia phac do ?*fifepristone ket hgp vdi Misoprostol dat canh ma troi 93 phii nii cd thai tir 9 -12 tuan vfl kinh tai Benh Vien Himg Vuong tu ttiai^
01/2015 d o i tiiang 06/2015, chiing toi rut ra nhiing ket luan sau:
1. Tl le tiianh eong phac do la 93,5% (KTC 95%: 88,5-98,6%).
2. Tac dung ngoai y thuang gap la:
Tieu chay: 52,7%
Buon non: 48,4%
Non: 33,3%
Met 31,2%
Chdng m a t 15,1%
Lanh nm: 4,3%
Sot 3,2%
Dau bung: 100%
Khong ghi nhan bioi chiing bang huyet hay nhiem trimg.
3. Tl !e phii n u pha thai diap nhgn va hai long vdi phuong phap ph'a thai npi khoa cao 96,8%. 923% se chgn lai khi c&i va 91,4% gioi thieu phuong phap pha thai npi khoa dio ngiriii khac.
TAI LifeU THAM K H A O
I K, Blum I (2004). Prouiding mediad dboTiiim m developing countries.an introductory guiddxx^ Gynuity health pn:^ct,pp.l8-19.
Ashok FW, Kidd A, Flett GMM, Filzmaurice A, GrahamnW, Templeton ApOCC). "A randonuzed con^iaiiscx) of medical aboition and siugic^ vacuum aqrirabon at 10-13 wews gestaticai". Human reproduction, 17(1), pp. 92-98.
Benh vi?n H u n g VuOTig, Gynuity [fealttt Projects, Tnoig lam N ^ u & \ cmi va T u v a i Sue khoe Sinh san (2011). CSp M a^gtinmmvApbS'biSikaqudcdcn^iBncuuiMthmnSaiM tgi ViB Nam. H$i thao quoc | j a , "IP. H 6 Chi Minh, t t J l . I t t 193.
B ^ vien Hiing Vuong, Gynuity Healtti Prejeds, Tmng tan N ^ e n a j u va T u \reni Sue khoe Sinh san (2012). Tm iifti I * hwSi Pha tto( w^'JiA«t TP. Ho Chi Minh, trJ!3-25.
278 Chuyen D e Sure Khoe Sinh San - Ba Me Tre Effl
Y Hpc TP. Ho Chi Minh * Tap 20 * So 1 * 2016 Nghien cihi Y hpc
Benh v i | n H i m g V u o n ^ G y n u i ^ Healfli Pn^ecls, Trung tam N ^ e n ciiu v a T u vsoi Siic khoe S n h san (2014). Nang cao cung cap dich vuvaky IkuSt dm cdc dii dinh trang sue khde mnh sdn nhung fiSi bd mdi tit Viit Nam, Hoi thao p h o b i a i ket q u a ngiiien d i u tiJ Viet Nam, TP. H o Chi Minh, tr.90-117 Bo Y te' (2009), Huong dht qudc gia vicdc dich vu Mm s6c site khie mih sdn, phan 7,phiAaian loan. H a ngi, tr,36M86.
Bradten H , Ngoc NTN, Schaff E et al (2007). "Mifepristone followed in 24 h o m s to 48 hours b y misopiostol for late fist- trimester alxHiicHi". (Jbsletric and Gynecology, 109(4), pp.895- 901.
Iieretad M, Sivin I lichtenberg ES, Tnissell J, Qeiand K, Cullins V (2009). "Effectiveness of medical abortion with mifepristCHte a n d buccal misoprostol though 59 gestational days^ Contraception, 80(3), pp282-286.
Gouk EV, Lincoln K, Khair, Haslock J, H ^ g h t J, Cruickshank Dl (1999). "Medical temunabon of preffoaicy at 63 to 83 days gestation" Briti^ Jourmd of Obstetrics and Gynaecology, 106, p ^ . 5 & 5 5 9 ,
Hamoda H, Ashok PW, Flett G M H Templeton A (2003).
"Medical abortion at 64 to 91 days of gestation: A review of 483 consecutive cases". Am } Obstet Gynecol, 188(1), pp.1315- 1319.
H a m o d a H . Ashok PW, Flett GMM, Templeton A (2005). "A Taridomised oontrolled trial of mifepristone in conbinatian with misoprostol administered sublingually or vaginally ka medical abortion u p to 13 weeks of gestation". British Jourmdi^
Obstetrics and Gynaecdogy, 112, j^.1102-1108.
Ldcdaivl M, Iversen, DaWe GS, Nappen H, Ertzeid L, ^ o r g e L (2010). "Medkal ^mrfion at 63 to 90 days of gestation".
Obstetric and Gyneadogy, 115 p ) , pp.962-966.
R t ^ C d l ^ e rf Obstetricians and Gynaecologists (2011). Ihe care if woman requesting induced dbortion evidentx - basedituad guiddine number?, ^ . 1 3 , 7 Z
The A m ^ c a n College of C%stetricians and Gynecologists, Society of Family Planning (2014). "Clinical guidehnes:
Medical management of first trimester abortion". Contraception 89,pp.l48-161.
World Healtti Oiganization (2012). So^ abortion: ledmical and policy guidance Jbr health systems, pp3,114.
Ngay nh^ bai bao: 24/11/2015 Ngay phin biin nhgn xet bm bdo: 30/11/2015 Ngdy bm bdo dugc dang: 20/01/2016
Sdn Phu Khoa
