Nghi&i cihi Y hoc Y Hpc TP. H 6 Chi Minh * T?p 20 » So 1 * 2016
TY LE Ttf CHOI SINfH THIET GAI NHAU HOAC CHQC OI 6 CAC THAI PHU CO KET QUA TAM SOAT TRU*6c SANH NGUY CO CAO
Nguyin Van Ym Nhi*, Huynh Nguyen Khanh Trang'
TOM
TATHoi diimg Dawn Id nguyen nhdn thudng gap rdud trong nhom dj tgi bdm sinh va cham phdt trim trituid tre, ty le 1:800 tie sinh song. Viet Nam hdng nam co Idwdng gah 1 trieu trudng hgp sinh sang nwi nSm, cdc chucmg trinh tmn sodt vai sieu am Uiodng sdng sau gdy kei hgp xet nghiim sinh hda mdu me cho thay hm ijwi tam sodt hoi chiing Doom trong cong dong. Dechan dodn xdc djnh hdi diimg Down cdn thuc hiin choc m bay dnh thi& gd nhau trang nhieng tndmg hgp nguy ca cao.
Phuang phdp: Nghiin cieu cdt ngang trin 390 thd phu cd k^ qud xet nghiem tieh sdn (sieu dm + sirdi lm mdu) thugc nhom nguy cocao id binh men Himg Viecmg tie 10/2013 ^h 05/2015. Toi cd cdc trudng hop dugc qudn ly, tu van vai ding mot quy trinh dtthuc hiin tiep viec ddnh gid bd nhiem sac the thai nhi thdng qua choc m hay sinh tfiiS gd nhau.
Ket qua: Ti li khong ddng y thuc hiin thu thugt Id 13,08%, KTC 95% [9,73 -16,42]. Cdc yHt todnh hudng deh quyii dinh a cdc thd phu ndy: (DYkiihcua chong OR* = 1,89, P= 0,012, (2) Sg soy thd khi digc di 0R*=
1,57, P = 0,017; (3) Lo ngd nguy ca khi nhgn kH qud cua choc ot OR* = 0,7, P = 0,039; (4) Hiai khd khan m cham soc ngucri bi hoi chieng Down OR* = 0,69, P = 0,049; (5) Lo ngai Wii nhgn ket qud cita xet nghiem kei hgp tieh sdn OR*=1,01, P = 0,026.
Kei ludiu Ddnh gid bg nhiem sac th^thd nhi trong nhung tne&ng hgp nguy cacao can dugc quan tdm han trong thai gian sap tdi.
Titkhoa: Hoi ch.img Dawn, digc oi, sinh thiii gd nhau, nghien cieu cdt ngang.
ABSTRACT
PREVA1S.NCE OF REFUSE EITHER AMMIOCENTEOS OR CHORIONIC VILLUS SAMPLING AMONG PREGNANT WOMEN WTTH HIGH RISK RESULTS OF PRENATAL DLiGNOSIS
Nguyen Van Yen Nhi, Huynh Nguyen Khanh Trang
* Y Hoc TP. Ho Chi Minh * Vol. 20 - No 1 - 2016:298 - 303 Down syndrome is the most common cause of txmgenitd malfirrmations as vxll as mental retardation in children, the ratio of 1:800 live birihs. In Vidnam there are nearly 1 million lives birihs each year, die screen^, with ultrasound measuring nudml translucency combined matertml blood biociiemicd tests showed that effective screening jbr Dawn syndrome in the community. In order to identify Dawn syndrome it is necessary to perfmn amniocentesis or chorionic dllus sampling in high-risk cases.
Methods: Cross-sectiond study on 390 pregnant women idth combined test results at high-risk groups of Hung Vuong Hospital from W/2013 to 05/2015. All cases are managed, consulting vnth the process to proceed to assess the fetd diromosomes through amniocentesis or CVS.
Results: The rate cf pregnant women do nd agree dteprocedure is 13.08%, 95% O [9.73 to 16.42]. Factors i^ectins decisions in these -women: (1) Opinion cf Qie husband OR* = 1.89, P = 0.012, (2) Fear cf miscarrmge duetoSa tvnniocentesisOR*=l^,P=Om7;(3)concemdieriskifiarecewing0ieTesulls(famniocentedsOR*'^O.7,P=O.(S^,
* Bp mon Phu San, khoa Y, DHYD Tp HCM.
Tdc gid lien Igc: PGS.TS. Huynh Nguyen Khanh Trang DT: 0903882015 Emm/: [email protected] 298 Chuyen D e Sue Khoe Sinh San - Ba Me Tre Em
Y Hpc TP. H o Chi Minh * Tap 20 * So 1 * 2016 Nghien cmi Y hpc (4) Understand difficulties when caring for people with Down
results of combined prenatal tests OR* = 1.01, P = 0.026.
Conclusions: Assessment of fetal chromosomes i future.
Keywords: Down syndrome, amniocentesis, CVS, DAT VAN DE
Hoi chung Down la nguyen nhan thirong gap nha't trong nhom di tat b&n sinh va cham phat then tri tue 6 tre, \y le 1:800 tre sinh song^). Tnrac day, hgi chiing Down chi duoc chan doan sau sanh nhimg hien nay, vdi su phat trien cua khoa hoc ky thuat noi chung cung nhu nganh y te'noi rieng, hoi chiing Down ciing mot so' di tat hoac bat thirong nhiem sac the (NST) khac da co the chan doan tnroc sanh vol dp tin cay kha cao. Viec nay cang quan trong hon khi tuoi me ngay cang tang do xu huong phu nii lap gia dinh va co con tri hay cac phu nii van tiep tuc sanh con khi Ion taSt. Do'i voi nhiing san phu lua chpn tiep tuc thai ky CO nguy co hoac chac chan bi hpi chiing Down, viec chan doan tixroc sanh tao fhuan loi trong viec tu van di truyen, thao luan each sanh va each phuong each ho tro ngay sau sanh
Vao nhiing nam 1970, nguoi ta phat hien ra moi lien he giiia tuoi me va nguy co dot bieh d\ bpi ciia thai nhi. Co su khac biet co y nghia thong ke giiia nhom thai phu 30-34 tuoi va 35-39 tuoi. Su khac biet nay dan deh chi dinh xet nghiem chan doan gien ciia thai nhi cho cac thai phu tren 35 tuoi. AFP huyet thanh me (MSAFP) ban dau dupe tim tha'y tang tren nhung thai nhi co khuye't tat ong than kinh, va chi so' MSAFP tha'p eo lien quan de'n tang nguy CO cua hpi chiing Down. Do khoang sang sau gay (NT) trong tam ca nguyet dau dupe dua ra vao dau nhiing nam 1990.
O My, xet nghiem chan doan xam lah dupe chi dinh doi voi cac tnrong hpp co ket qua tam soat CO nguy co > 1/270. Quy trinh va diem cat nay dupe quyet dinh each day 25 nam va dua tten nguy co eua thai phu 35 tuoi. Cac yeu to dtrpc xem xet khi quySt dinh diem cM nay bao g^m tSn suit cua benh, nguy co tam boi thk 21
syndrome OR* = 0.69, P = 0.049; (5) Concerned at the high-risk cases should be more concerned in the near oss-sectional study.
tang len dang k^ tren nhung thai phu > 35 tuoi, nguy CO cua xet nghiem ti^n san xam l4n"'.
Voi su ra doi ngay cang nhieu cong cu tam soat truoc sanh, viec chi dinh xet nghiem chan doan xam lah chi dua tren tuoi me dang mat dan tinh kha dung.Tam soat hpi ehiing Down trong tam ea nguyet 1 bang each ket hpp dau an sieu am va dau ah sinh hoa, duoc gpi la xet nghiem ket hpp trong sang loc hen san (combined test), bao gom NT, p-hCG, PAPP-A. Nghien ciiu FASTER eiia Malone va epng su nam 2005 nghien eiiu tren 38.033 thai phu, eho thay miic dp phat hien hpi chiing Down eao va ihay doi dang ke theo tuoi thai. 6 dp duong gia 5%, dp phat hien hpi chung Down lan lupt la 87%, 85%, 82% vol tuoi thai lah lupt 11, 12, 13 tuan. 6 dp duong gia 1%, dp phat hien hpi ehiing Down la 73%, 72%, 67% lan lupt ling voi hioi thai 11,12, 13 tu&iw.
U Viet Nam, diem eat thuong dupe sii dung la 1/250. Gia tri ket qua co dupe > 1/250 dugc xep vao nhom nguy co cao, gia tri ket qua co dupe < 1/250 dupe x ^ vao nhom nguy co thap.
Gia tri ciia xet nghiem tam soat truoc sanh phu thuoc vao dp tuoi cua thai phu (anh huong deh tan suat eua tam boi the), lua ehpn ciia thai phu, va thai dp ve cha'm diit thai ky. Hien nay tai Viet Nam cac xet nghiem chan doan tien san eho nhom nguy co cao mang tinh xam lah: sinh thiet gai nhau va ehpc 6'i.
Chpc 6'i dupe thuc hien dau tien vao nhiing nam dau thap nien 1880 voi muc dich giam ap lire tiong nhimg tmong hpp da cS. Tir do, iing dung eua ky thuat nay cang ngay dupe md rpng.
Truong hpp chpc oi dau tien de chan doan turoc sanh bp NST eua thai dugc thuc hien vao nam 1967 boi Jacobson va Barter. Nam 1968, tnrong hpp trisomy 21 dau tien dupe chah doan truoc
San Phu Khoa 299
Nghifin cuu Y hoc Y Hpc TP. Ho Chi Minh * Tap 20 » S^ 1 * 2016 sanh boi Valenti va epng s\r. Voi muc dich chSh
doan truoc sanh chpc ca thuong dupe thtrc hien vao tam ca nguyet 2, tCr 15-21 tuan, toi uu vao IS- IS turn. Viec sii dyng gai nhau d^ xet nghiem bp nhilm sac th^ ciia thai nhi dupe thuc hien dau tien bdi Hahnemann va Mohr vao nam 1969"'.
Thu thuat dupe thuc hien vao tuan thii 10 thai Iqr, qua ng^ am dao. Th6i di^m thuc hien ly tuong la 10-12 tuan.
Ty le say thai ciia thii thu|t sinh thiet gai nhau dupe cong bo boi 3 h i | p hpi Ion ciia Canada, My va Chau Au. Hiep hpi thii nghi?ni lam sang CVS so voi choc oi Canada (1989) dua ra ket qua ty 1^ say thai ciia CVS tang so voi choc oi la 0,6% (7,6% so voi 7,0%), khong CO y nghia thong ke. Tuong tu, ket qua cua nghi^" ciiu 6 My dua ra ty le say thai a i a CVS cao hon so voi chpc 6i la 0,8%, kh6ng co y nghia thong keP>. Trong khi do, trong bao cao eiia hiep h0i Chau Au MRC (1991), ty le say thai ciia CVS cao hon so voi chpc oi la 4,6%, khoang tin cay 95% [1,6% - 7,5%](5).
Nghien cihi ciia Jean H Priest**) va cong su nam 1998, phong v&i 53 phu nii 6 Montana sau sanh CO IKI qua bp ba xet nghiim tioi san nguy eo > 1:300 cho thay ty le dong y thuc h i ^ chpc oi lii 53%. Nghien ciiu ciia Browner^) va cong su nam 1999 nghien cihi ve dac di&n ve chiing tfic, dao dlic sinh hpc linh huong desi quyet djnh chpc 01 ciia 147 phy nii My go'c Mexico c6 ket qua AFP duong tinh. Nghien cihi cho thay ty le dong y chpc oi la 60%.
Vdi mong muoh tam soat v^ cung cap thong tin som cho san phu ve kha nang mac hpi chiing Down cua thai nhi, Vi|t Nam da dua chuong trinh tam soat va chan doan tnroc sanh ap dpng rgng rai tcong chuong trinh kham thai thucmg quy. Tai benh vi$n Hung Vuong, tat ca san phu d m kham thai deu dupe tu van thuc hien xet nghiem tam soat tnroc sanh va ch&i doan tnroc sanh neu thuoc nhom nguy co cao (>l/250). Tuy nhien, chua co nghien ciiu nao tim hieu ve cac thai phu khong dong y thuc hien buoc chan doan xam lah, cung nhu cac ygii to Imh huong
d ^ q u y ^ dinh nay khi co ket qua tam sodt nguy CO cao; do la ly do chiing toi th\rc hien nghien cihi "T^ li tie dim sinh thiit gai nhau/chgc m dcac sdn phu cd kM qud tdm sodt tneac sanh nguy ca cao".
Nghien cihi tii\tc hien v6i mijic ti£u Xac dmh ty le tii choi thuc hien thu ttiuait chan doan truoc sanh 6 cac thai phii co ket qua t&n soat r^;uy co >l/250.
Khko sat mot s& yea to dnh hu6ng deh quySi dinh sinh thiet gai nhau/chpc 6i 6 nhiing thai phu nay.
DOI T l / O N G VA PHl/ONG PHAP Thiet ke nghien cmi
Nghien cihi cat ngang.
ChQn mau
Tat ca cac thai phu co ket quS t&n soat tnroc sanh nguy co cao t ^ benh vien Himg Vuong TP HCM hx ftiang 10/2013 d m thang 05/2015 dorig j tham gia nghien cihi.
Tieu chuan nhan
Don thai. Khong kem bat Ihuong nao khac tren sieu am. Thuc hien xet nghi?m ket hpp ti^
san tai b?nh v i ^ Himg Vuong. Ket qua xet nghiem ket hpp tien san > 1/250.
Tieu chuui loai tru
Thai phu tii ch6i iham gia nghien cihi. Thai php dupe chah doan va nghi ngo rm loan tam than. Thai phu b6 ngang cuge phdng v§h.
Co m l u dugc tinh theo cong Ihiic n = - ^ p ( l - p )
Chpn a = 5%, khoang tin c|y 95%. Z I-OR = 1,96: tri so tir phan phw chuMi. p: theo 2 nghi&n cihi ciia Jean H Priest^*' vk C.H.Browner <" thi ty le khoang tii 53%-60% -»
lay p = 50%; d = 5%. Tinh dugc: n = 384,16. V?y CO mau th\rc hien la 385.
Quy trinh tu van trudc sanh trong nghiSn cuu
Buocl: Tgi phong kham thai. Cac thai phy ^
Chuyen De Siifc Khoe Sinh San - Ba M? Tre Em
Y Hoc TP. Ho Chi Minh * Tap 20 * So 1 * 2016 Nghien curu Y hpc kham thai, tuy vao tuoi thai, neu chua lam xet
nghiem tain soat truac sanh se duge tu VMI thue hien cac xet nghiem tam soat thich hpp. Thai tii 11 d a i 13 tuah 6 ngay: xet nghiem ket hpp hen san. Thai ttr 15 d a i 21 tu&i: bp ba xet nghiem hen san va sieu am Wnh thai tam soat dau chi diem tien sieu am o tuoi thai tii 18 de'n 24 tuan.
Giay xet nghiem dupe ghi ro ten, tuoi, dia chi, so' dien thoai hen lac, PARA, can nang, tuoi thai tai thod dion xet nghiem eiia ihai phu.
Bifac2: Tai phong kham thai. Sau 1 tuah, cac thai phu lam xet nghiem tam soat truoc sanh se dugc nhan ket qua tam soat. Neii ket qua tam soat thupe nhom nguy co thap: thai phu tie'p tuc chuong trinh kham thai thuong quy. Neii ket qua tam soat thupe nhom nguy ea cao: cac thai phu se dupe bac si 6 phong kham huong dan t»5i phong Di truyen de dupe tu van va ban luan huong xii tri tie'p theo. Cac truang hgp sieu am phat hien ra cac dau chi diem tren sieu am ciing dupe chuyen d m phong Di truyen tu van.
Buoc 3: Tai phong Di truyen. Cac thai phu se dupe bae si 6 phong Di tmyen giai thich ket qua, tu van thijc hien thii thuan chan doan. Mae du tai benh vien Hiing Vuong da thye hien ca 2 thii thuat chan doan truoc sanh la chpc oi va sinh thiet gai nhau; tuy nhien, sinh thiet gai nhau chi dugc thuc hien tien nhiing thai ky bieu hien benh ly ro, kho tiep tuc thai ky, can xae dinh nguyen nhan nhu phii thai, truong hpp cac thai phu CO hen can say thai lien ti^, cae truang hgp nghi ngo benh ly banh nhau. Chi mot so' it truang hpp cac thai phu nam trong tieu chuan chpn mau cua chung toi yeu cau thyc hien sinh thiet gai nhau. Vi the^ trong nghien eiiu nay, nhom nghi&i cuu chi chon cac thai phu chpn thii thuat chah doan truoc sanh la ehpc oi.
Cach thu thap sd lieu
Dung bang eau hoi thu thap so lieu ket hgp cac dii kien trong so kham thai dinh ky. Cach thu thap: phong van (true hep, qua dien thoai), sau do ghi nhan vao bang thu thap so' heu, ghi nhan qua so kham tiiai va cac phieu ket qua.
Nhap lieu va phan tieh bang phan mem Stata.
KET QUA
Bang 1 Dac diem dan sffnghien cuu (n^390) Ylute
TUOI thai phu < 35
>35 Nghe: Nong dSn Noi tro Buon ban Cong nhan-Vien chii'c NOI cif ngu: TP HCM
Kti^c Hoc viin <c^p 1
Capl C^p2 Cap 3
>cap3 Ton gi^o, PhgtgiSo
Cong giao Ktiac Khong Ti^n sii sanh: chu-a sanh
Sanh 1 lln Sanh > 2 lln Tien can say/hu' thai. Co Kh6ng T6ng
TSn sd (%}
230 (56.4) 170(43,6}
23 (5,9) 125 (32,0) 62(15,9) 180(46,1) 253 (64,9) 137(35,1) 11 (2,8) 31 (8,0) 128 (32,8) 146 (37,4) 74(19,0) 173(44,4) 49(12,6) 6(1,5) 162 (41,5) 126(32,3) 249 (63,8) 15(3,9) 9 (2,3) 381 (97,7) 390(100)
!. Ty le tk chrn - dmg y thuc hien choc Si khi c6 kei qud xet nghiem kei hcrp sieu am vd sinh hda mdu thudc nhom nguy ca cao
Dac diem Tu" ch5i Dong y Tong
N 51 339 390
Ty le % 13,08 86,92 100
KTC 95%
9,73-16,42 83.57 ~ 90,27
Bdng 3. Phan lich da bim cdc yeii todnh hudng quyei dinh choc oi cua thai phu
Ylutd (1) (2) (3) (4) (5)
OR * [KTC 95%]
0,4 [0,28-0,57]
1,57 [1,08-2,27]
0,7 [0,5-0,98]
0,69 [0.48-0,99]
1,01 [1-1,01]
P 0,000 0,017 0,039 0,49 0,026 Chu thich : (1)Y kiSh cua chong; f2)Sa say thai khi choc Si, (3) Lo ngai nguy ca khi nhgn M qud cua choc oi; (4) Hiiu kha ihan khi cham soc ngucn h hoi chung Down, (5) Lo ngai khi nh&n kei qud ciia xet nghiem kei hcrp Hen sdn.
B A N L U A N
Hpi chiing Down la nguyen nhan thuang
San Fhu Khoa
N g h i ^ c u u Y hpc Y Hoc TP. H o C h i M i n h * T§p 20 * So 1 * 20I(
gap nhat gay di tat bam sinh va cham phat tri&i tri tue d tre.
Thue te' tuoi ket hon ngay cang tang do xu huong phu nu llip gia dshh va co con tri dan d a i vin tiep tpc sanh con khi Ion tuot vai tro ciia chan doan truoc sanh tiong San khoa ngay cang quan trpng. Chan doan truoc sanh la da eo mgt t£r lau dcri tir nhung nam 1970. Tit khi ra doi, quy trinh tam soat va chan doan truoc sanh da giam dang ke so tre bi hpi ehiing Dovm va cac bat thucmg NST khac sanh song.
Trong y van tim dupe, chiing toi ghi nhan dupe 2 nghien cihi ciia 2 tac gia nguoi My Ihuc hien cucfi nhung nam 90 nghien curu ve ty le dong y ehpc oi va cae yeu toT lien quan. Ty le trong 2 nghien cihi la chua cao, 53-60%0'*i. Tai Viet Nam, chan doan truoc sanh da dupe ap dung rgng rai trong chuong trinh kham thai thuong quy tai cac benh vien tir loai II tro len.
Phuong hen tam soat truoc sanh hien nay pho biai 6 ^^et Nam bao gran do khoang sang sau gay va bp doi xet nghiem tien san trong TCN 1 (ket hpp thanh xet nghiem ket hpp tien san), bo ba xet nghiem hen san trong TCN 2 va sieu am khao sat cac dau chi diem nghi ngo tren sieu am trong TCN 2. Trong cac phuong tien tren thi xet nghiem ket hgp tien san co dp phat hien cao nhat, phat hien som nhatvoi dp duong gia tuong duong voi cai phuong ti^n con laL
Tai b^nh vi|n Hung Vuong, tat ca san php d&i kham thai deu dugc tu van thuc hi?n xet n g h i ^ tam soat trudc sanh va ch&i doan truoc sanh neu nguy eo cao (>l/250).
Sau khi hen hanh hoi cihi 390 truong hpp san phu eo ket qua tam soat truoc sanh nguy CO cao va dupe tu van lam thii thuan chan doan, CO 51 san phu tir choi thuc hien va 339 san phu dong y. Nhu vgy, ty le tij choi chpc 61 ti-ong nghien cihi ciia chiing toi la 13,08%, KTC 95% [9,73 -16,42]. So voi nghien ciiu ciia tac gia Priest(« nam 1998 tai Montana (My) co ty le tir choi chpc 6i la 47%, ty le tii choi tirong nghien cmi chiing toi it hem nhieu. Su khac
biet nay co the giai thich do h i | u qua cua viec tu van ngay cang h i | u qua, s\r tie'p xuc voi th6ng tin ngay cang rpng rai trong dan chiing;
Thlit vEiy, sau nghien cuu cua Priest, vao nam 1999, cung tai nuoc My, nhung lan nay la 6 bang California, tac gia Browner^J ciing lam nghien cihi tuong t u va ghi nhan ty le tiir chm chpc oi da giim xuong con 40%.
Chi CO 10% so san phu tham gia nghien aiu biet ve chuong trinh tam soat va ch& doan truoc sanh Day la 1 1 ^ le thap, chiing to thong tin ve y te chua dupe pho c|p du trong cong dSig. Trong 39 san phu da biet ve chuong trinh nay, chi co 7 san php, chiSn t^ le thap nMt 17,95%, dupe r ^ e thong tin ttr nhan vien y te.
Con lai la 2 nhom san php nghe thong tm tii nhiing nguoi xung quanh va qua phuong tiai truyai thong. Su Ihu thap tiiong tin tir nhimg nguon khong dmih thcmg co the d i n d&i sai lac trong nhan fliiie va anh huong d a i quyet dinh eiia ban than. Nhom nghien cuu chiing toi ghi nhiin co 3 truong hpp san phu con so, eo dong nghiep va nguoi than da di chpc 61 va say ftiai sau do. Ca 3 san phu nay deu tir ch65 choc ra trong ian mang thai nay.
Kioi thiic ve hpi chihig Down co the cim pho bioi som horn, truoc khi mang thai hoac khi s ^ ket hon tiong cac khoa hpc "tiai hon nhan".
Chiing ta can tu van cho san php truoc khi thm:
hien chuong trinh tlun soat Taan soat truoc sinh khong nhiing chi tim ra nhung thai b?nh ^ chain diit thai ky ma con co vai tro chuan bj tinh tiiMi cho san phu va gia dinh don 1 diia tr^ bat thucmg nhiem sSc the nm san php do va gia dinh khong co y dinh ngung thai ky. Cac san phu nen dupe tu van nhung d i ^ nay tnroc khi tham gia chuong trinh tam soat tnroc sinh
Trong cac yeu to anh hirdng khi phan tidi da bieh noi trpi la quy^t djnh oia ngtroi chong, ke* do la si^ lo sp anh huong doi sinh ton ciia thai nhi khi ihuc hien thii thuat. Trong thoi gian ng&i sap toi voi tie'n tri&i ciia ky thuat "Free cell DNA"'"' eo the giiip kh^c phuc van de chii yeu nay.
C h u y g n D e Sue Khde Sinh Sdn - Ba M e T i i Em
Y Hoc TP. H o Chi Minh * Tap 20 * S£» 1 * 2016 Nghien cuu Y hoc Han che
Tinh dai di$n chua cao vi cac doi tupng tu r ^ y e n d o i co so y t§'v6i sy quan tam d a i van de khao sat va miic song gan tuong dong. Do vSy cac ket qua c6 gia tii nhat djnh. Sai l§ch do hra tuong trong 283 trudng hpp phong v m qua dien tho^.
Trong cac cau hoi yeu cau san phu danh gja miic dp, ta nhan thay da so cac cau tra loi tlip bimg o dap an trung tinh. Day la nhugc diem ciia he tiiong thang do Likert truyen thong: tao di&i kien cho dm tupng nghien cihi trei loi trung tinh thieu lap truong ca nhan. Nhu the lam giam di ph&i nao gia tri ciia nghien ciiu.
KETLUAN
Trong thoi gian tir thang 11 nam 2014 deh het thang 3 nam 2015, qua nghien cihi cat ngang tr^n 390 thai phu co ket qua tam soat truoc sinh nguy co eao tai benh vien Himg Vuong. Chiing t6i nit ra dugc ket luSn va mpt so nhan xet nhu sau:
- Ty le tir chra thijc hi?n chpc 6i 6 cac thai phu CO ket qua tam soat tnroc sinh nguy co cao la 13,08%, KTC95% [11,37 -14,79%].
Cac yeu to anh hirong doi q u y ^ djnh 6 cac thai phu nay: (1) Y kieh cua chong OR* = 1,89, P= 0,012, (2) Sg say thai khi chpc 6i OR*=1,57, P = 0,017; (3) Lo ngai nguy co khi nhan ket qua ciia choc 61 OR* = 0,7, F = 0,039; (4) Hieu
kho khan khi cham soc nguoi bi hpi chiing Down OR* = 0,69, P = 0,049; (5) Lo ngai khi nhan ket qua ciia xet nghiem ket hgp tioi san OR*=1,01, F = 0,026.
TAI LIEU THAM KHAO
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3 Lau TK, el al (1998) "Eadal variation m mddence of trisomy 21: survey of 57,742 Chinese deliverira". Am ] Med Genet, 75(4): p 386-8.
4. Malone FD, et al (2005) 'Pirst-trmiester or second-tnmester screenmg, or both, for Down's syndrome" N Engl J Med, 353(19): p. 2001-11.
5 Medical Research C o u n a l European trial of chorion villus samphng (1991) "MRC workmg party on the evaluation pf chorion villus sampling" lancet, 337(8756)' p. 1491-9.
6 Pnesl JH, et al (1998) "Acceptance of amniocentesis by women m the state of Msntana (USA) w h o are s o e e n positive for Down's syndrome". J Med Screen, 5(4): p . 178-82, 7 Rhoads GG, et al (1989) 'The safety and efficacy of choriorac
villus sampling ftir early praiatal diagnosis of cytogenetic abnormalities". W£K^;;Afef, 320(10): p. 609-17.
8 Royal College of Obstetricians and Gynaecologists. Non- mvasive Prenatal Testmg for Chromosomal Abnormality using Maternal Plasma D N A Scientific Impact Paper No. 15 March 2014.
Ngay nhdn bai bao: 20/11/2015
Ngdy phdn bim nhan xet bd bao: 25/11/2015 Ngdy bdi bdo dugc ddng: 20/01/2016
S ^ Fh\i Khoa 303
