JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol,12 - N''6/2017
Xu- tri song thai du thang chuyen da de tai Benh vien Phu san Ha Noi nam 2014 - 2015
Management methods for full - terra twins birth in Hanoi Obstetrics and Gynecology Hospital, 2014 - 2015
Nguyen Duy Anh', Phiing Dire Nhat Nam', *Benh vien Phu sdn Hd Noi Vu Van D u " **Benh vien Phu sdn Trung uang
Tom t i t
Muctiiu: Mo t l elch x d t r i song thai du t h i n g chuyen da de tai Benh vien Phu san Ha Ndi t d 1/2014- 12/2015. Ddi tuang vd phUOng phdp: Hdi edu mo ta. Kit qud: 93,5% sd ca song thai d ^ md; 6,3% ca de thudng; 100% cac san phu de thudng p h l i kiem solt t d cung sau de; 13,6% sin phu de thudng phli boe rau sau khi di; 4,6% sin phu de md gap bien chdng t h i t ddng mach t d cung. Kit ludn: Phuong phap xd trf song thai du thang de tai Benh vien Phu sin Ha Npi nam 2014-2015 ehCi yeu I I m o l l y thai.
Tdkhda: Song thai, chuyen da d^, Benh vien Phu sin H I Ndi.
Summary
Objective: To describe management methods for full - term twins birth in Hanoi Obstetrics and Gynecology Hospital, 2014 - 2015. Subject and method: Retrospective descriptive study. Result: 93.5%
of cases of twins were cesarian section; 6.3% were vaginal delivery; 100% of pregnant women using vaginal delivery had the management of obstetric hemorrhage. 13.6% of women using vaginal delivery had abruption placenta; 4.6% of women having caesarean had to ligate urine arteries.
Conclusion: The main method used in managing full - term twins birth in Hanoi Obstetrics and Gynecology Hospital was caesarean.
Keywords: Twins, birth, Hanoi Obstetrics and Gynecology Hospital.
I . D a t v a n d e x d trf d ^ song thai van edn nhidu quan diem khac
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., . . ' - . ' u .u • - i. • • - . . ' thai t h d hai nhd: Ngoi bat thdong, sa day ron, con CO t h a i t r o n g c a q u a tnnh mang thai cung nhu s m h d e . , ., , ,, ^, , . - .- u , „ „ . . = , . . . . . , , . , . v , u- • ' • u t d c u n g rdi oan... De dam bao an toan tmh mang Mac d u e o nhung cai tien trong cham soc tre so sinh , , ', , , . ., .... - w,.r/.
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thudc p h l i c l n nhac ky de Ida ehpn phuong phap xu
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TAP CHf Y DdOC LAM SANG 108 Tap 12-So 6/2017
dien ve t h l i dp x d trf de song thai trong nhdng nam gan d l y tai Benh vien Phu s i n H I Ndi, chiing tdi tien hanh nghien edu nay n h l m : Md td cdch xdtri song thai dd thdng chuyen dg de tgi Benh viin Phu sdn Hd Hditd 1/2014-12/2015.
2. Ddi tuong va phuong phap 2.1. Doi tuang
Nhdng thai phu de song thai tai Benh vien Phu san H I N p l t d 1/1/2014-31/12/2015.
2.2. Tieu chudn Ida chgn
La cae thai phu dii hd so benh an dupc chan ctoan la song thai, tuoi thai t d 37 tuan t r d len theo ky kinh eudi cung. Neu khdng nhd kinh cuoi cung thl phai cd sieu am d quy 1 cCia thai ky v l tinh ehfnh xac dUPctudi thai t d 37 tuan t r d len.
2.3. Tieu chudn logi trd
Thai phu de 1 thai hole hon 2 thai, song thai c l hai thai ehet luu hole mdt thai chet Idu, mpt thai sdng hole hd so khdng dii thdng tin eho nghien edu nay.
2.4. Thiet kenghien cufu
Nghien edu hdi edu md t l t d 1/1/2014 31/12/2015.
2.5. C&mau va phUang phdp chgn mdu Lay mau thuan tien 367 san phu song thai.
2.6. Phdn tich vaxvfiysolleu
So lieu thu ddpc se ddpe lam sach va nhap vao may tinh bang phan mem Epidata 3.1 va x d ly p h l n tfch bang phan mem SPSS 16.0.
3. Ket qua
3.1. Thong tin chung cua doi tUgng nghien cvfu
Bang 1 . Dac diem chung cua san phu mang song thai Oac di^m
Tuoi
Nghe nghiep
Noi 4
DLTdi 20 tuoi 2 0 - 2 4 tudi 25 - 29 tuoi 30 - 34 tuoi TCr 35 tuoi tr6 len Nong dan Cong nlian Can bo Khac Thanh thj Nong thon
n 4 36 159 114 54 36 36 159 136 172 195
T y l e % 1,1 9,8 43,3 31,1 14,7 9,8 9,8 43,3 37,1 46,9 53,1 Phan Idn san phu mang song thai trong nghien cdu d trong dp tudi 25 - 29 tuoi (ehlem 43,3%). Nhdm tudi tif 30 - 34 tudi eung chlem t^ le eao (31,1 %) va chi ed 1,1 % san phu dudi 20 tudi, ehiem tyf le thap nhat trong ele nhdm t u d i . O a s d benh nhan lam c l n bdhoac nhdng n g l n h nghe khae (tuong dng ehiem 43,3% va 37,1%). T;y'
\i benh nhan sdng d t h a n h thl v l ndng thdn tuong ddi xap xi nhau (lan Idpt chlem 46,9% va 53,1 %).
JOURNAL OF 108 • CLINICAL MEDICINE AND PHARMACY Vol.l2-N°6/2017
3.2. Cdch xdtri song thai du thdng chuyen dg de
Bang 2. PhUOng phap d^ song thai ddgc chi djnh PhUdng phap dg song thai
De thucjng*
Mo lay thai Co sCfdung can thiep
Tong
n 23 343
1 367
T y l e % 6,3 93,5 0,2 100,0
*Trong 23 ca 6e thudng co 2 ca de thUcJng thai thd nhat va md lay thai thir hai
PhdOng p h i p de song thai ddpe ehi djnh nhieu n h l t 11 md lay thai, chlem 93,5% tdng sd ea song thai, trong khi dd ehi ed 23 ca de thudng (ehiem 6,3%) va 1 ea dung forceps khi de thai t h d nhat va ndi xoay thai t h d hai (chidm 0,2%). Trong 23 ca d ^ thudng ed 2 ea de thudng thai t h d n h l t va thai t h d hai chuyen md di.
BSng 3. X d t r i sau dk thUcfng va de md cda san phu mang song thai Xijrtrisaud^
Khong CO XLf tri
CoxCftri Sau de dudng am dao Sau de mo
Tong
n 23 343 1 367
T ^ l e % 6,3 93,5
0,2 100,0 Trong sd 367 sin phu mang song thai, ed den 317 s i n phu khdng p h l i x d trf sau sinh (ehiem 86,4%), 22 sin phu de thdcmg deu cd xdtrf sau de va 28 san phu de mo cd xdtrf sau de (tUOng dng ehiem 6,0% va 7,6%).
Bang 4. Xd tri bien chdng sau di dddng am dao Xuf tri sau dg dUomg am dao
Kiem soat tCf cung Boc rau
That dpngmachtCfcung Khac
Tong
n 22 3 1 3 22
T y l 6 % 100,0
13,6 4,5 13,6 100 Cdthethay, 100% eae sin phu de thudng p h l i kiem soat t d c u n g sau de. Co 3 benh n h i n p h l i bde rau sau khi dd, 1 benh nhan p h l i that ddng maeh t d eung va 3 benh nhan cd x d t r i khac (dieu tn ndi khoa, khau Biyneh).
BIng 5. X d t r i b i e n chihig sau mo lay thai Xuf tri sau mo lay thai
Khau cam mau do rau tien dao, rach That dong mach tCf cung Khac
Tong
n 4 16 8 345
T ^ l e % 1,2 4,6 2,3 roo,o a nhdng s i n phu de md, ty le phuong phap x d trf bien chdng gap nhieu nhat la t h i t ddng mach tCf cung (chiem 4,6%). T^ le khIu cam mau do rau tien dao, r i c h la 1,2%, cdn lai 11 nhdng bien chdng khac (ehiem 2,3%).
TAP CHl Y DdOC LAM SANG 108 Tap 12-So 6/2017
4. Ban luan
4.1. Thdng tin chung cda ddi tUgmg nghiin cdu Trong nghidn edu eiia chiing tdi, tudi cCia s i n phu dupe chia lam 5 nhdm. Phan Idn s i n phu mang song thai dang trong dp tudi 25 - 29 tudi (chiem 43,3%). Ket q u i nay cd sd t u o n g ddng vdi nghien eiJu eua Nguyen Minh Nguyet vdi s i n phu mang song thai trong dp tudi 25 - 29 tudi ehiem X"^ le cao nhat trong e l 2 thdi diem nghien edu 1996 -1997 va 2006 - 2007 (lan lUpt ehiem 38,1 % va 39,9%) [3]. Bleu nay cd the g i l i thich bdi 25 - 29 tuoi va 30 - 34 tudi la do tudi sinh 6i nhieu nhat nen k h i n l n g gap song thai cung cao hon so vdi dp tudi khlc.
Da sd benh nhan trong nghien cdu la c l n bp hole lam viec trong nganh nghe khac (chiem 43,3%
v l 37,1%), chi cd sd ft 11 ndng dan h o l e ndi trp (deu ehiem 9,8%). Ty 1^ s i n phu song thai sdng d t h l n h thi va ndng thdn tdOng ddi xap xi nhau (46,9% va 53,1%) eho thay khdng chi cd san phu song thai den tLf thanh pho Ha Ndi m l cdn ed ca t d nhdng khu vuc khac. Nguyen n h i n cd the vi song thai la thai nghen eo nguy eo eao ma Benh vien Phu s i n Ha Npi la benh vien ed uy tin trong san khoa nen ddpc nhieu ngudi d i n tin tddng Ida chpn.
4.2. Cach xd tri song thai du thdng chuyen dg de Phan Idn c l hai thai trong song thai deu ddpc chi dmh md 6i vdi ty le 93,5% d thai t h d nhat va 94,0% d thai t h d hai. Ty le n l y cao hon nhidu so vdi cac nghien cdu k h l c . 6 nghien cdu ciia T r i n Thi Phiic nam 1978 - 1 9 7 9 , ty le de t h u d n g , g i l c hiit v l Forceps d thai t h d nhat la 75,7%, 2,1 % v l 18,0%, edn vdi thai t h d hai, r j ' le 6i thudng, giae hiit va Forceps la 73,6%, 2,8% va 9% [5]. Tac gia Le Hoang - Nguyen Qude Tuan ( n l m 1995 -1996) eung cho biet t^ le de thudng trong nghien edu cua ho I I 66,5% va d ^ can thiep la 18,6% [2], T;^ le de thudng d thai t h d nhat trong nghien edu eua Nguyen Thj Hanh (2003 - 2004) la 44,4%, cd dung Forceps, g i l c hiit v l npi xoay thai t h d nhat lan Idpt la 7,4%, 0,6% va 0,3%, con d thai t h d hai, t^ le de thudng la 30,7%, dung Forceps la 48%, ndi xoay thai la 7,3% v l dai kdo thai la 9,3% [1].
Ket q u i cCia nhdng nghien cdu trUdc d l y cho thay, trddc day, phan Idn c l e cap song thai dupc chi djnh de thudng v l de can thiep, Xy 1# 6i md la khdng cao, tuy nhi&n sd cap song thai cd chi ^ n h de m d dang ed xu hddng t i n g d i n . Ty le m d lay thai trong song thai tang l^n trong cle nghien cdu theo thdi gian cho thay xu hddng chi dinh md de ngay c l n g tang trong d d de song thai. Chi djnh mo song thai ehi nen ddpc thUe hien khi c l n thiet. Oieu n l y can ddpc nghien edu va phan tich sau hon de tim ra n h i ^ g yeu t d I n h hudng den quyet dinh cCia bae si.
Sau khi 6i dudng am dao, 100% s i n phu ddpc kiem soat t d cung. Ngoai ra, van cd benh n h i n gap eac bien ehdng nhu bde rau, that ddng mach t d cung va bien chdng khie. Nghien cdu cua Nguyen Thj Kieu Oanh va Nguyen Thi Nguyet cung cho ket qua ty' le kiem solt t d eung cao trong x d trf sau de thudng, tupng dng la 99,3% v l 100,0% sd san phu di dddng I m dao [3], [4]. Cd the thay p h l n Idn sin phu de thudng deu ddpc kiem soat t d eung ngay sau de, chi ed mdt sd ft phai bdc rau h o l e t h i t ddng maeh t d cung va ty le nay trong nghien edu ciia tdi eung thap hOn nhieu so vdi hai nghien cdu tren.
Nguyen n h i n cd the 11 do y hpc hien dai ngay eang phat trien, kT nang ehan d o l n , tham dd, xd trf eua ele b l e st ngay c l n g ddpc nang cao nen ty le xay ra bien chdng cung ngay c l n g g i l m di.
6 nhdng benh nhan de md trong nghien edu cua tdi, xd tri bien ehdng gap nhieu nhat la that dpng maeh t d cung (chiem 4,6% sd ca de md). Trong nghien edu cua Nguyen Minh Nguyet, ty le benh nhan p h l i k h I u cam m l u ehiem ty le cao nhat (1,3%
sd san phu mang song thai dd md), 1,1% p h l i that dpng maeh t d c u n g , 0,4% benh nhan p h l i that dpng mach ha vj va 0,4% bSnh n h i n p h l i c i t t d eung [3].
Nghien edu cua Nguyen Thj Kieu Oanh eung eho biet, ty le benh n h i n p h l i t h i t ddng mach t d eung la 2,2% v a c d 1,1% p h l i cat t d c u n g [4]. Ngoai ra, trong nghien cdu eua tdi khdng cd benh nhan nao bj cat t d eung, trong khi d nghien edu ciia Nguyen Minh Nguyet van eo 2 benh nhan phai eat bd t d eung va d nghien cdu eiia Nguyen Thi Kieu Oanh la 3 san phu [3], [4]. Cat bd t d eung la x d tri mang lai nhieu nguy CO ed hai eho sde khde eung nhd ddi sdng sinh s i n
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JOURNALOF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N=6/2017
cCia phu n d nen phau thuat nay ngay c l n g bj ban ehe. Hon nda, phan Idn s i n phu trong nghien edu cua tdi d dp tudi cdn tre (td 25 - 34 tudi) v l da sd mang thai eon so (chiem 49,0%) nen b l e sT can p h l i c l n nhac kT Iddng trddc khi dUa ra quyet djnh e l t bd t d c u n g .
5. Ket luan
Phdong phap xd trf song thai di!i t h i n g dd tai Benh vien Phu s i n Ha Npi n l m 2014- 2015 chii yeu la md lay thai.
Tai lieu t h a m khao
1. Nguyen Thi Hanh (2004) Nghiin cdu mdt sdyeu td nguy ca cda di nan trong song thai vd cdch xd tri song thai khi chuyen dg tgi Binh viin Phu sdn Trung uang td thdng 1/2003 din thdng 6/2004. Luan van tdt nghiep bac sy chuyen khoa 2, TrUdng Dai hpe Y Ha Noi, tr. 3-49.
Le Ho^ng, Nguyen Qudc Tuan (1997) Mdtsdnhdn xet vi di sinh ddi tgi Vien bdo vi bd me tri sasini]
trong hai ndm 1995 - 1996. Cdng trinh nghien cilu khoa hpe Vien b l o ve ba me t r j so sinh, tr. 69-73.
Nguyen Minh Nguyet (2008) Nghiin cdu ty le cdc phdang phdp xd tri vd kit qud de song thai tai Benh viin Phu sdn Trung uang trong hai giai dogn ndm 1996 - 1997 vd ndm 2006 - 2007. Luan van tot nghiep b l e sy ehuyen khoa 2, TrUdng Dai hoc Y Ha Ndi, tr.71.
Nguyen Thj Kieu Oanh (2006) Tmh hlnh song thai tgi Binh viin Phu sdn Trung uang td thdng 7/2004 din thdng 6/2006. Luan van Thac sy Y hpc, Trudng Dai hpc Y Ha Noi, tr. 3-50.
Tran Thj Phiic (1979) Tdng kit 144 trUdng hgp de song thai tgi Viin bdo ve bd me tri sa sinh trong bai ndm 1978 - 1979. Luan van tdt nghiep bac si npi t n i , Trudng Sal hpc Y Ha Npi, tr. 3-30.
