VIETNAM MEDICAL JOURNAL N°1 - FEBRUARY - 2018 b. Ferltln huyet thanh: Ket qua nghien culi
cho thay, nong dd trung binh eua ferritin d tre em la 6.7 ± 6.4 (hg/ml). Trong do ed den 86%
benh nhi cd nong do ferritin < 15 (ng/ml). Theo ket qua nghien cu'u eiia N.T.T. Ha thi ty le nay la 88%, tae gia H.T.T. Anh la 78.6%. Cd sU khac biet ve nong do ferritin giO'a nhdm chay mau vdi nhdm khdng cimg cap dii sat - kem hap thu va nhdm chay mau vdi nhdm phoi hdp d ngUdi Idn.
c Transferrin: Nghien euU cho ket qua vdi nong dd transferrin trung binh d benh nhi la 349.6 ± 6 5 . 2 (mg/dl). Nong dp transferrin > 250 (mg/dl) d tre em la 94.7%, trong dd nhdm khdng cung cap dii - kem hap thu sat va nhdm phdi hdp chiem 100%. Khdng cd trUdng hdp nao ed nong dp transferrin <200 (mg/dl). Cd den 97.1% benh nhi ed nong dp transferrin > 250 (mg/dl) thupc nhdm chay mau, tiep theo la nhdm phoi hdp vdi 93,2%, nhdm khdng cung cap dii va kerri hap thu sat la 92,3% edn nhdm ehu^ rd nguyen nhan la 91.3%.
V. KET LUAN
- Cac trieu chirtig lam sang ndi bat: Trieu chu'ng met mdi d nhdm chay mau va nlidm phdi hdp chiem 100%, d nhdm chUa rd nguyen nhan clil ed 52.4%; 100% benh nhi co trieu chii'ng da xanh niem mae nhdt; Trieu chutig nhip tim nhanh gap t / le cao tir 71,4 % trd len.
- Cac trieu chiTng can lam sang ndi bat; Mire iJ6 thieu mau la pho bien (Hb: 73,2 ± 14,3); Gap ty Ig 93% benh nhi cd mu'c MCV nhd hdn 80 fl; c6 100% tre cd nong dp MCH <28 (pg); cd 95,5%
mUc dd sat huyet thanh < 7pmol/l; cd 86% m lUdng ferritin<15ng/ml; lUdng Transfernn tang cao.
TAI Ll|U T H A M KHAO
1. WHO (2001), Iron deficiency Aneamia, Assessement, Prevention and control, A guide for programme managers, WHO, 1-114
2. Mai Lan (2015), Nghien cuV mo hinh benh mau va cd guan tao mau d benh nhi dWdc dieu tri tai Vien Huyet hoc Truyen niau Trung udng giai doan 2013 - 2015, Luan van tot nghiep bac sy chuyin khoa cap I I .
3. Hoang Thj Tram Anh (2014), Nghien cuU dac diem iam sang^ can lam sang va nguyen nhan'd benh nhan thieu fnau thieu saf &/ banh vien Bad) Mai nam 2014, Luan van thac sy y hpc.
1. Pappas DE (1998), "Iron deficiency anemia';
P^iatncs In review, tr. 321-322.
5. Npuyin Cong Khanh (^2008), Huyet hoc lam sang nhi khoa, Nha xuit ban Y hoe, 73 o. Pham Thj Lan HUdng (2016), Nghien cu'u dk
diim lam sang, xet nghiem cua benh nhi thieu mau thieu sit dieu trj tai Vien HH-TM TW giai doan 2015-2016, Khda liiari tdt nghiep bac syda khoa.
7. WHO (2011), Hemoglobin concentrations for the diagnosis of anemia and assessment of severity Vitamin and mineral nutrition information s)^em Geneva. World Health Organization.3,55-89,91-
DAC DIEM LAM SANG VA CAN LAM SANG CUA SAN PHU DUgC KHd"! PHAT CHUYEN DA TAI BENH VIEN PHU SAN TRUNG U'aNG
T O M TAT
Muc tieu: M6 ta dac diem lam sang va can lam sang cua san phu dUdc khdi phat ehuyen da tai Benh vien Phu san Tnjhg udng. Phddng pha/j: Nghien ciru tien cUu thUc hien tren 65 sanjDhu cd tudi thai tir 37 - 42 tuan dUflc klidl phat chuyen da tai khoa de Benh vien Phu s^n Trun^ Udng. Kit qui: Chi so Bishop trUdc khi gay ehuyen da trong nghien cUu eiia ehiing toi thap nhat la 1 diem, cao nhat la 5 diem. Chi so Bishop trung binh la 3,42 ± 1,31 diem. Nhom san phu cd chi so 61 > 60mm chiem t^ le Idn nhat la 69,23%.
Nhom san phu con oi chigm ty ie 87,69%, nhdm san phy cd tinh trang oi v9 ehiem ty le 12,31%. Tuoi thai 40 - 41 tuan co 53 trUdng hdp chiem ty le 82,54%.
Ket luan: San phu dUdc khdi phat ehuyen da co chi
*Benh vien Phu san Trung ddng Chiu trach nhiem chfnh: Nguyen Quang Bae Email: drbacbvpshrt@yahoo.com.vn Ngay nhan bai: 1.11.2017 Ngay phan bien khoa hoc: 22.12.2017 Ngay duyet bai: 28.12.2017
Nguyen Quang Bac*, Pham Thi Yen*
so Bishop trung binh la 3,42 ± 1,31 diem va phan Idn cd tudi thai tU 40- 41 tuan.
Td khda: Chi so Bishop, chi so oi, khdi phat chuyen da.
SUMMARY
CLINICAL AND SUBCLINICAL CHARACTBRISnCS OF LABOUR INDUCnON I N NATIONAL HOSPITAL
OF OBSTETRICS AND GYNEACOLOGY Objective: Tc describe dinieal and subdinical characteristics of labour induction in National hospital of Obstetrics and Gyneacology, Methods: This Is cross sectional study among 65 pregnant women with 37 to 42 gestational age who were induced labour actively. Results: Beforelabour induction, Bishop score was ranging from 1 to 5 and mean score was 3,42 ± l,3n. There was 69,23% in group of amnionic fluid index under 60mm. Chorionic sac was still intact was 87,69%. Gestational age ranging from 40-41 was 82,54% (53 cases). Conclusion: Pregnant womai wffe induced labour whose mean Bishop score was 3,42±1,31 and mostly from 40 to 41 week of gestation.
TAP CHi Y HOC VIET NAM T ^ P 463 - THANG 2 • SO 1 - 2018 Keywords: Bishop score. Amniotic fluid index,
induebon of labor.
I. DAT VAN OE
Khdi phat chuyen da la mot trong nhuYig thii thuat phd bien trong san khoa. Khdng phai tat ca cac trudng hdp j<hdi phat deu dan den de dUdng am dao; mot so trudng hdp phai mo lay thai, vi ly do cap cu'u hoae khdi phat that bai. Khdi phat chuyen da thudng ap dung ddi vdi thai qua ngay sinh, oi giam, oi vd non... Tai Viet Nam eung da cd nhieu de tai nghien eiru ve hieu qua eua eae phUdng phap gay ehuyen da nhU truyen oxytocin, dimg Misoprostol, dimg Cerlvprime, ong thdng hai bdng cai tien... Tuy nhien chu^ cd nhieu nghien ciTu ve cae yeu to giiip tien lUdng sU thanh cdng ciia khdi phat chuyen da.Cung nhu nghien ciTu ve y nghTa eiia ehieu dai kenh ed tir cung giiip ben ludng khcfi phat chuyen da thanh cdng. Do do, chung toi tien hanh lam de tai nghien ciiu nay vol muc tieu "Dac diem lam sang va can lam sang cua san phu dude khdi phat chuyen da tai Binh vien Phu sin Trung ddng".
II. 001 TU'ONG VA PHLTCTNG PHAP NGHIEN CU'U 2 . 1 . Ool tu'dng nghien cii'u:
'Tliu chuan Ida chpn doi tddng nghien c&u:
Ddi tUdng nghien ciili la cac san phu cd thai tren 37 tuan ehUa ed dau hieu chuyen da dUdc khdi phat chuyen da tai khoa de Benh vien phu san trung Udng, cd dii cac tieu chuan gom:
- Mot thai, thai song, ngoi dau.
- Chuci cd dau hieu chuyen da, ed chi djnh khdi phat chuyen da.
- Thai qua ngay sinh, thieu di, oi vd non.
- Benh ly me can dinh chi thai nghen.
*Tmu chuan loai trd:
- Thai to, bat iddng xdng thai - khung chau.
- Thai benh ly, ngoi bat thudng, thai chet lUu.
- Cac trirdng hdp dinh chi thai nghen vi thai bat thudng, thai phu cd khoi u d tU cung, dj dang sinh due.
- Tien sii co seo mo cu d tir cung, rau tien dao, nguy ed chay mau khi cd cdn co tir cung.
2.2. Phu'dng phap nghien cihi: Nghien cu'u tien ciru mo ta vdi mau ngau nhien trong thdi gian 6 thang tir thang 11/2016 den thang 4/2017.
2.3. C3 mau nghien cu'u. Ap dung ky thuat chpn mau ehii dinh (purposive sampling technique). Cd mau dUdc chon la tat ea cac san phu thai tren 37 tuan chua co dau hieu chuyen da,' dUdc chi dinh gay khdi phat chuyen da tai klioa ah Benh vien Phu san Trung Udng ttr thang 11/2016 d^n thang 4/2016.
III.KET QUA NGHIEN CU'U
Trong 6 thang chung toi nghien cdu dude 65 san phu dude khdi phat ehuyen da tai khoa de Benh vien Phu san Trung Udng vdi ket qua nhU sau:
Bang 1: Dac diSm chi so' Bishop trddc Khdi phat chuyen da
chi so Bishop 1 2 3 4 5 Tong
SoBN 5 10 22 12 13 65
Ty le (»/o) 7,69 15,38 32,31 23,08 21,54 100
Nhan xet: Chf sd Bishop trUde khi gay chuyen da trong nghien cUu ciia ehiing tdi thap nhat la 1 diem, eao nhat la 5 diem. Chf sd Bishop trung binh la 3,42 ± 1,31 diem.Bang 2. Chi sd oil tru'dc khi gay ^u^n da
chi sd oi (mm)
<28 29-40 41-60
>60 Tonq
SoBN 5 5 10 45 65
Tyle 7,69 7,69 15,38 69,23 100
Nhpn xet: Nhdm san phu ed ehi so nUde 6i>60mm chiem ty le Idn nhat la 69,23%. Nhdm san phu ed chi sd nude di < 28mm va tU 29 - 40mm chiem ty le it nhat la 7,69%
Bang 3. Tinh trang oi trddc khi gay chuyen da
Tinh trang oi 01 con
oi v6 Tong
S o B N 57
8 65
T y l e 87,69 12,31 100 Nhan xet: Nhdm san phu cdn oi chiem ty le da so, vdi 87,69%. Nhdm san phu ed tinh trang di vd ehiem ty le 12,31%
Bang 4. Phan nhdm tuoi thai trddc khi Tuoi thai(tuan)
37-39 40-41 42 Tong
S o B N 10 53 2 65
Ty le ( % ) 15,38 82,54 3,08 100 Nhan xet: Trong nghien eiTu ciia chung tdi, tudi thai tir 37 - 39 tuan cd 10 trUdng hdp ehlem ty le 15,38 %, tuoi thai 40 - 41 tuan co 53 trudng hdp ehiem ty le 82,54 %, tudi thai 42 tuan cd 2 trUdng hdp chiem ty le 3,08 %.
IV. BAN LUAN
Chi sd Bishop dimg de danh gia tinh trang cd tir cung dUa vao chieu dai, do md, mat do, tU the eiia ed tu" cung va mu'c dp xuong eua ngoi.
Chi so Bishop cang thap tien lUdng de dUdng dudi eang khd khan. Theo ket qua nghien cii'u
VIETNAM MEDICAL JOURNAL N°1 - FEBRUARY - 2018 eua Chung tdi, chi sd Bishop thap nhat la 1 diem,
eao nhat la 5 diem, Chi so Bishop trung binh la 3,42 ± 1,31 diem. Day deu la nhu'ng diem chUa thuan ldi cho khdi phat ehuyen da, bat bupc phai ap dung eac bien phap gay khdi phat ehuyen da.
Nghien ciiu cita chung tdi chpn eac san phu ed tudi thai > 37 tuan thai, cd chi dinh dinh chi thai nghen, tap trung mot sd nguyen nhan nhU thai qua ngay sinh, thieu oi, v3 oi non... Ddi vdi trudng hdp thai qua ngay sinh thi nguy cd lUdng nUde di giam dan do than thai nhi giam bai tiet nUde tieu dan den cudng ron chen ep dan den suy thai. Theo Phan TrUdng Duyet, nUde oi it cd nguy cd suy thai gap 13 lan so vdi thai eo nUde 61 binh thudng[5]. Chfnh vi vay ma nhUng trUdng hdp thieu oi can chi djnh dinh chi thai nghen tranh nguy hiem. Qua bang 2: Chiing tdi thay ed 5 trudng hdp ehi so nUdc oi < 28, cd 5 trUdng hdp chi sd nude oi tU 29-40mm, 10 trUdng hdp chi sd nUde di tir 41 - 60mm va 45 trUdng hdp chi so nUdc di >60mm. Rieng trong 55 trudng hdp thai qua ngay sinh ed den 13 trUdng hdp la chi sd nUde di < 60 ehiem ty le 23,64%.
Nhu vay cd the thay trong thai qua ngay sinh cd nguy cd bl thieu 61 va suy thai eho thai nhi.
So sanh vdi Nguyin Trung Kien [2] thay d nhdm san phu eso < 60mm ehlem 53,2% trong dd rieng nhdm tuoi thai > 41 tuan eso < 60mm chiem 66%. Ket qua nghien ciiu eiia toi cho thay t / le thieu 61 d thai qua ngay sinh thap hdn so vdi ket qua ciia tac gia. Dieu nay cho thay cdng tac kham, quan ly thai, tU van va cae Idp tien san da giup thai phu ed nhieu kien thii'c ve thai nghen, nen da di kham, theo doi sat va vao vien sdm khi cd tinh trang thieu oi.
Hassan AA, tir 5/2000 - 5/2003 nghien ciTu tren 210 trUdng hdp thai qua ngay sinh dUdc do chi so nUdc di 2 I3n /tuan d thai > 41 tuan eho ket qua; t / le cae bien chu'ng d tre sd sinh cua cac san phu ed ehi so nUdc 61 < 60mm eung cao hdn so vdi cae san phu ed chi so nUdc oi >
60mm. Da tim thay 18,5% tre sd sinh ed bieu hien cua cac bien chirTig, trong do chi s6 nUdc 61
< 60mm cd 63,2% tre sd sinh cd bieu hien cac bien chirng sdm vdi dp nhay 63,2%, dd dac hieu 83,1%. Vi vay, chi so nUdc oi la test tin cay de lam giam ty le mo lay thai, giam ty le tu" vong va tan Jat d tre sd sinh trong thai qua ngay sinh [ 6 ] . 01 vd non, oi v3 sdm la mot tai bien trong thai nghen va lam tang ty le ch^t ehu sinh. Neu CH v6 sdm khi thai gan dii thang hoac vai gid trUdc khi chuyen da thi nguy cd cho me va eho eon ft hdn. NgUde lai, neu 6l vd non, 61 vd sdm
khi thai non thang thi hau qua se dan den nhiem khuan, de thai non thang, thai thieu oxy cang nang ne. Trong nghien cii'u ciia tdi, cd 8 san phu cd ti'nh trang 61 v3 non chiem ty le 12,3%, cd 57 san phu 6i cdn chiem ty le 87,69%.
So sanh vdi eae tac gia Nguyen Thj Kieu Oanh [1] nghien ciTu dUa ra ket qua tinh trang san phu cd 61 vd nam 2004 va nam 2014 la 27,75% va 13,04%. Nhu vay ty le san phu 61 v6, rl oi trong nghien cu'u cua tdi ft hdn so vdi nghien eiTu tren.
Dieu nay cho thay cdng tac kham, quan ly thai, t u van va eae Idp tien san da gliip thai phu co nhieu kien thUc phdng ngiTa nhiem khuan, di kham va dieu tri kjp thdi lam giam dang ke tinh trang oi v3 non trUde khi chuyen da.
Nghien cUu eiia chiing tdi eho thaytudl thai tir 37^- 39 tuan ed 10 trUdng hdp chiem ty le 15%, tudi thai 40^- 41 tuan cd 53 trUdng hdp ctiiem ty le 82%, tuoi thai 42 tuan cd 2 trUdng hpp ehlem ty le 3%. Tudi thai thap nhat la 37 tuan, tudi thai cao nhat la 42 tuan. Tudi thai trung binh la .
So sanh vdi mpt so tae gia trong nude nghien eUu ve gay chuyen da nhu Le Hoai ChUdng [7]
tuoi thai trung binh la 39,32±1,66. Theo VD Ngan Ha [4] tud'i thai trung binh la 40,3 ± 1,2 tuan. Nhu vay ket qua nghien cii'u eiia toi cung tUdng t u nhu nghien ciTu ciia eac tae gla khae.
V. KET L U A N
San phu dUdc khdi phat ehuyen da ed ehi so Bishop trung binh la 3,42 ± 1,31 diem va phan Idn ed tudi thai tir 40- 41 tuan.
TAI LIEIJ T H A M KHAO
1. Nguyen Thj Kieu Oanh (2015). Nghien cOU hiiu gua gay chuyen da d thai phu co tuoi thai trin 40 tuan trong 2 nam 2004 va 2014 (a/ benh vien ptiu san tnjng Wdng, trUdng Oai hoc Y Ha Noi.
2. Nguyen Trung Kien (2010). Danh gii hieu qua gay cfiuyen da ciia Plisopmstol dong wai qua ngay sinh IBI benh vien Phu sin trung Udng, TrUdng Dai hocYHaNoL
:i. Dede .F.S et al (2004). misoprostol for cen/lcal ripening and labor induction in pregnancies vvi^
oligohydramnios. Gynecxilogic & Oftsteftj^
investigation, 57,139 -143. '**•
4. Vu Ngan Ha (2011). Nghien ciiU hieu qua M phit chuyen da cua Cervlprime tai B^hh vien Phu san Tmng Ifdtig, TrUdng Dai hoc Y Ha Ndi. ."
5. Phan Tru'dng Duyet (1993)' C^c phiiung phap danh gia tham dd bang chi so lam sang. Tram do trong sin khoa, Nha xuat ban Y hoc, 16 - 40. I, 6. Hassan AA (2005). The role bf amniotic fluid
index in the management of postdate pregnanty, Journal of the College of Physicians and Surg&ms, 15(2), 85 - 88.
7. Le Hoai Chu'dng (2005). Nghien ciJV tac dunp lam mem md co td cung va gay chuyen da cua Misoprostol, TrUdng Dai hoc Y Ha Npi.