Y e u t 6 Triqlycerid Yeu tfl huyfit
fip Yeu t6 HDL-
0 37 64 49
16,0 27,7 21,2
16 39 102'
8,0 19,6 51,3
53 103 151
12,3 24,0 35,1
<0,05
<0,05
<0.01 Bfio byng Ifi dfiu hifiu ehi diem eho sy xfim nhfip md nfli tgng - mgt yeu t l nguy ea v l mfit s l bfinh tim mgch, tieu dudng, ung thu. Ket qug bang 4 cho thay: ty lg nu bfio byng Ifi 18,1% cao han nam (9,1%) vdi p<0,01. Gfic nghifin ciPU trfin nhO-ng d|a bfin khfic nhau cung eho thiy ctii tifiu nfiy thudng la nO cao han nam vfi cimg ton tgi vdi thilu dinh dudng tgo "gfinh ngng kfip"ve dmh dudng trong thdi ky chuyin tiep d nudc ta.
Ket qua bang 4 eung cho thay yeu to triglycerid vfi y l u to tang huyit ap cfi ty lg mac d nam eao ban nC' vdi p< 0,05.
KtT LUAN
1. Tinh trgng dinh dudng cua ngirdi trudng thfinh tir 25-74 tuoi tgi 1 s l xa thupc 2 tinh Nghg An vfi Ha TTnh
- Tgi Nghfi An vg Hfi TTnh ngudi trudng thfinh thilu nang lupng trudng difin Ifi chii yeu (chiem 32,6%), Dfic bifit vin CO tdi 14,2% thua can, bfio phi, ty Ifi nfiy tang cao d nhfim tuoi tu 55-64 (18,8%)
2. Ty lfi rdi logn dinh dudng lipid
- Ngudi trudng thfinh tgi dja ban nghifin euu cd VE/VM eao chilm ty Ifi 16,0% trong dfi nu chiem ty Ifi Ifi 20,6% cao han nam (12,1%) vdi p<0,05
- Ty lg tfing cholesterol tofin phan Ifi 16,0% trong do tinh Nghfi An thip ban Hfi TTnh vfi nam ehilm ty Ifi cao han nO" vdi p>0,05. Ty lfi tang Triglycerid va giam HDL- C Ifi 5,8% vfi 11,6% trong do nam cfi ty lg mfie cao han n y v d i p<0,05.
- Ty tg mac tir 3 y l u t l chin dofin HCCH Ifi 3,3%, d nam la 4,0% cao so vdi nu, vdi p> 0.05, Ty lg nfiy tfing
dan theo nhfim tuli va tang cao nhit d nhfim 55-64 tuoi Ifi 8.7%
TAI LI$U THAM K H A O
1. Dfio Duy An (2005). "Ty Ifi hfii chdng chuyen hofi vfi cfic rli logn lifin quan d bfinh nhfin tfing huyet fip tgi bfinh vifin da khoa tinh Kon Tum". Tgp chi Y hgc thgc hinh. sd 523:163-168
2. Tg Vfin Binh vfi CS (2003). "Djch ti hgc binh dii thio dw&ng, cic yiu td nguy ca vi cic vin de liin quan din quin ly binh dii thio dudng tgi khu vwc ndi thinh 4 thinh phd Idn" Nhfi xuat ban Y hge, Hfi Nfii,
3. Bfi Y t l - Tong cyc thing kfi (2003). "Bio cio kit qui diiu Ira Y ti Quic gia 2001-2002". Nhfi xult ban y hpe. Hfi Nfii.
4. Dofin Th| Tudng Vi, Nguyen Th| Lfim, Tu Ngu- (2002) "Tim hiiu mfit so yeu to nguy ca bgnh bfio phi d ngudi trudng thfinh", Tgp chi Y hgc Thgc hinh, sd 418 62-67.
6. Phgm Nggc Khdi 2004 "Tin s l tifiu thy thyc pham vfi c h i dfi hogt dflng t h l lyc cua ngudi eao tuli tang huyit fip, thira cfin - bfio phi tgi Thfii Binh", Tap chj Y hgc Dwphdng. tgp XIV. sd 6 (71): 11-16.
7. Phgm Gia Khai, Nguyin Lfin Vifit, Do Quic Hiing, Nguyen Bgch Y i n (2002). "Nhfin xfit v i mgt so roi logn dmh duang vfi chuyin hofi d ngudi tfing huyet fip". Tgp chi Y hgc Thgc hanh, sd 418:11-13.
8. O l Thj Kim Lien vfi cflng sy (2004). "Danh gifi tinh trgng dudng huyet. tinh trgng dinh dufl'ng vfi mfit s l yfiu to CO llfin quan den d l i tupng 40 - 60 tgi mgt so quan nfii thfinh Hfi Ngi", Di tai nhanh thudc di tai KHCN trgng diem cap nha nwdc KC 10-05: 5-16.
9. Dinh Thi Phupng, Nguyen Th| Phuang, Vu Thj Phuang (2002). "Nghien cuu mfit s l chi s l cholesterol, HDL-C va triglycend d ngudi eao huyit fip". Tgp chi Y hgc Thgc hinh, sd 416: 89-92.
Tl LE 01 Vff s a m VA MOT so YEU TO LIEN QUAN TAI BENH VIEN DA KHOA THANH PHO CAN THO
TOM T A T
Nghien cuv cit ngang md ti 1350 trw&ng hgp vao sanh tgi Binh viin Da khoa Thanh phd Can Tha: ti ig di va s&m la 10,22%, thdi gian di v& den nhip vign la 178,33 ± 184,25 phut, 76,81% vio vign sau 60 phut Th&i gian di vd den CTC md 3 cm li 407,59 ± 258,28 phOt; den CTC ma trgn la 579,48 ± 278,01phut; tw ii vd din sanh la 685,54 ± 318,13 phut. Sin phg ftr 20- < 25 tudi cd OVS chiem 31,16%, chwa sw khac bigt vi tuoi va tinh trgng di. Co sw Hin quan giira tinh trgng di vdi cw tnj ndng thdn; ndng din, cdng nhin; BMI < 20; tiin can sanh non, siy thai, ngo phi thai; sd iwgng bgch cau.
Giai dogn chuyen dg, then gian pha tiem thdi a oi va cao hon so vdi di cdn; th&i gian pha hogt dgng a nh&m di cdn cao hon a nhom di va.
Tir khda: ft' lg di vd s&m SUMMARY
RUPTURE OF MEMBRANE RATE (PMR) AND SOME FACTORS IN CANTHO GENERAL HOSPITAL
LAM 0(JC T A M , DO THj TRliC THANH A descriptive cross section study on 1350 birth cases at Cantho General Hospital shows that PMR is 10.22%, to rupture on admission is 178.33 ± 184.25 minutes, of which 76.81% in the hospital after 60 minutes, to cervical dilatation 3cm 407.59 ± 258.28 minutes. PMR's time to open a full cervical dilatation is 579.48 ± 278.01 minutes. Average delivery time to mpture was 685.54 ±318.13 minutes. Women 20-
<25years of age accounted for31.16% rupture of membrane no differences in age and status of amniotic fluid. There is an association between fluid status with women living tn mral areas, fanners, workers, BMI <20; a history of preterm birth, miscarriage, abortion, leucocytes count During labor, potential phase is longer in PMR group; active phase is longer than in the intact membrane.
Keywords: membrane rate DAT V A N Bt
6i vd sdm, oi va non Ifi mfit tai biln thudng ggp
Y HOC THirC HANH (802) - s6 1/2012
trong thgi kJ-. ehilm tir 8% d i n 10% cfic trudng hpp sanh vfi xay ra thudng nhit d thai du ngfiy (Idn hofic bing 37 tuan tuli thai), khoang 1% xult hifin trudc 31 tuin [5]. T i t ea nhung y l u t l can trd sy binh chfnh t i t eua ngfii thai deu cfl the Ifi nguyfin nhfin ciia vd l i nhu ngfii thai bit thudng, khung chfiu hgp, nhau tiln dgo, da thai, da l i . Hd eo tu cung Ifi nguyfin nhfin gfiy vd l i vfi sanh non lifin tilp (tfii phfit nhilu lln) Vifim mfing l i thudng do nhilm triing d fim hfl. fim dgo d i n d i n tinh dfin hoi cua mfing l i thay d l i khflng cfln chju dupe fip lyc cao trong buIng l i d i n d i n vd mfing l i [2]
Oi vfi' sdm gfiy ra nhiing nguy ea nhu sa dfiy r l n . chfin fip r l n , nhau bong non, hgi chung suy hfl h i p d p , tfing nguy ca sanh non nfin Ifim tfing bfinh suit vfi tu suit eho thai nhi vfi anh hudng cfi tinh nguy hilm d i n sue khoe cua sfin phy. Ngofii ra, l i vd sdm, l i vd non ifim tfing nguy ca nhilm tn:ing cho mg vfi thai nhi ti Ifi vdi thdi gian vd l i sdm cho den luc sanh {6], [8], [10]. U'dc lupng cfi 36% tre sanh ra chit do nhilm trimg vdi phin ldn Ifi do nhilm trung huyit vfi vifim phli. Oi vd sdm, l i vd non gig tfing nguy co m l Ily thai vfi thdi gian nfim vifin [8], [7], [10],
Tir cfic kit qufi trfin eho thiy hfiu qua mfi l i vfl' sdm mang Igi hit sire nfing n l . Tuy nhifin, tgi Vifit Ngm chua cfl nhilu nghifin ciru v l l i vd sdm, chua cfi bfio cfio v l tinh hinh l i vd sdm vfi cfic y l u t l lifin quan tgi cfic ca sd y te. Do dfl chiing tfli thyc hifin d l tfii "Tl li di va sdm vi cic yiu td iien auan den di vd sdm tgi B^nh vi^n Ba khoa Thinh pho Can Tha "V&i mye tifiu
1. Xic djnh tl lg di va sdm tren san phg nhip viin tgi Binh vign Da khoa Thanh phd Can Tha
2 Xic djnh mdi lien quan giO'a di va s&m vi mgt so yiu td nhw tudi mg, nai cw tru, nghi nghiip, chi sd khdi ca thi, tiin cin sin khoa, thdri gian chuyen dg sanh, si Iwgng bgch ciu.
D 6 | TWpfNG VA PHU'aNG PHAP NGHIEN CU'U Chimg tfli thyc hifin nghifin ciru mfl ta cfit ngang trfin 1350 trudng hpp vfio sanh thoa cfic tieu ehuan chgn mau. tifiu chuin logi trir (nhu san phy khfing dong y tham gia nghien cuu; khfing nhd ngfiy d i u ky kmh euoi vfi khfing eo sifiu am trong ba thfing d i u thai ky; thai chet luu; l i vd non; vifim am dgo trong thai ky, trudng hpp dl dgng khung chgu; bj bfinh ly tfim thin).
Biln s l dupe thu thfip bao gom tuoi sfin phy, tuli thai, nai c u tnJ, nghi nghifip, cfin nfing, chieu cao. chi s l khii ca t h l , t i l n cfin sfin khog. tinh trgng san phy khi nhfip vign, d i u hifiu chuyen dg, tinh trgng oi vd sdm.
thdi gian vfio vifin tir khi cd l i vd; thdi gian chuyen dg cua oi vd; tinh chit thai vfi phin phy cua thai; khao sfit tinh trgng tre sau sanh nhu cfin nfing. chi s l Apgar. Cfic s l lifiu dupe thu thgp thfing qua philu thu thfip s l lifiu.
Sau khi thu thfip. so lifiu nhgp vfio may qua phin m i n Epidata vfi xit ly thong ke bfing phin m i m Stata SE 10.0.
K^T QUA NGHIEN CLTU
1. Ti ig 6i vo- sdin: cd 138 OVS trong 1350 trudng hpp->Ti Ifi OVS la 10.22%.
Thd'i gian 6i v& dfin nh^p v i ^ n : Thdi gian oi vd d i n khi nhgp vifin trung binh la 178.33 ± 184,25 phut (toi da la 1080 phiit, t l i thilu Ifi 0 phut); trong dfi £ 60 phiit chiem 76,81%.
Bfing 1. Thdi gian l i vd vfi cfic giai dggn chuyin dg Thfl'i gian (phOt)
Thdi gian fli vCf dfin CTC m d 3 cm Thdi gian 61 v d dfin
CTC m d trgn Thdi gian fli v d dfin
sanh
Trung blnh± B 9 Ifich c h u i n 407,59 ± 258,28 579,48 ± 278.01 685.54 1 3 1 8 , 1 3
Thfip nhit 80 70 200
Cao nhit 1500 1700 1800
2. Khfio sfit m$t s l y l u t l tifin quan d i n l i vd B f i n g 2 . M i l lifin q u a n giO'a l i v d s d m v f i t u l i san p h y
^ClnlLt^ng fli
< 2 0 20 - < 25 25 - < 30 30 - < 35 2 35
Ol Cfin (n.%) (1212) 101 (8,33%) 370 (30.53%) 370 (30,53%) 215(17,74%) 156(12,87%)
Oi vOr (n. %) (138) 3(2.17%) 43(31.16%) 39 (28,26%) 33(23,91%) 20 (14,49%)
P
0,058
Nhfin xfit: Tuli tu' 20 - < 25 t u l i chilm 31,16% cao ban so vdi nhfim tuli cfln Igi.
Bfing 2 M i i lifin quan giO'a l i vd sdm vfi nai cu bd
"^^Halijfgng 6i N a i c i J T r O — - ^ Nflnq thfln Thiinhthi
Ol cfln (n,%) (1212) 560 (46,20%) 652 (53,80%)
Ol vfl' (n, %) (138) 76 (55,07%) 62 (44,93%)
P 0,048 Nhgn xfit: Nflng thfin cfi ti Ifi OVS cao hon so thSnh thj.
Bfing 3, Moi lifin quan giO'a l i vd sdm vfi nghi nghifip
"—TuitUrang 6i NghfingTlifip^-,,^
Nflnq dfin NOi trp Vifin chiJc Cflnq nhfin Bufln bin T h p may Khfic
Ol cfln (n,%) (1212) 120(9.90%) 676 (55,78%) 144(11,88%) 129(10,64%) 105(8,66%) 13(1,07%) 25 (2.06%)
Oi v d (n. %) (138) 27 (19,57%L 49 (35,51 % L 15(10,87%) 16(11.59%) 17(12.32%) 6 (4.35%) 8 (5.80%)
P
0,000
Nhfin xfit: Nfii trp ehilm ti lfi cao nhit, nfing dfin, khfic bifit nfiy cfi y nghTa thing kfi
Bang 4. M i i lifin Quan giOa l i vfi* sdm vfi Min thai
Con Ifin 3 Con trfin 3 Ifin
Oi cfln (n.%) 799 (65,92%) 79 (6,52%) 19(1,57%)
Oiv&(n,%) (138) 97 (70,29%) 36 (26,09%) 4 (2,90%) 1 (0.72%) Nhfin xfit: Mang thai con so chili nhdm l i cfin vfi l i v d
Bang 5. M i i lifin quan giua l i vfl' eg t h l (BMI)
n ti Ifi cao d cfi hai sdm vfi chi s l kh&
Nhfin xfit: BMI < 20 cd ti 1$ OVS c khfic bifit cfi y nghTa thing k l
Y HOC THVC H A N H (802) - S6 1/2012
Bang 6 M i i lifin quan giO'a oi vd sdm vfi tiln sir san khoa
' ^-Tliihjrgr^ fli T i f i i T s O ^ - - - ^ Binh thu'dng
Sanh non Tu'cunq cfl seo m f l c u
Sdy thai Ngo pha thai
Khac
Ol cfln (n,%) (1212) 1100(90,76%)
10 (0,83%) 66 (5,45%) 15(1,24%) 13(1.07%) 8 (0,66%)
Ol Vd (n, %) (138) 119(86.23%)
2(1.45%) 4 (2,90%) 9 (6,52%) 3 (2,17%) 1 (0.72%)
P
0,000
Nhgn xfit: Cfi lien quan lfi OVS vdi tien su sanh non, say thai, ngo phfi thai
Bang?. Moi lien quan giO'a l i vd sdm vfi phfin nhflm sfi lirpng bgch cau
Tinh trgng 6i So lu'png BC
<12000/mm' a 12000- <
15000/mm'
£ 15000/mm-*
Ol cfln (n.%) (1212) 1110 (91,58%)
99 (8,17%) 3 (0,25%)
Oi v& (n,
%]
(138) 113 (81,88%)
20 (14,49%) 5 (3,62%)
Thfl'i gian fli vb d6n khi nh$p
vi^n 1 7 6 ± 1 6 1
98 ± 8 3 553 ± 445
P
0.000
Nhfin xet: Lupng BC £12000 BC/mm^ cfi ti Ifi eao d OVS. 01 vd den nhfip vign nhfim lupng BC £ 15000 cao so nhflm khfic So lupng BC trung binh d OVS cao ban so vdi oi cfin. 6i cfin ia 8876,49 ± 2022,37/mm^; oi va lfi 9703,62 ± 2701,11/mm^ Khfic biet cfl y nghTa thong kfi
Bang 8. Lifin quan glOa nhom thdi gian eua pha tiem thdi vdi tinh trgng fli
"^TtatLtrang oi 1 Oi cfln (n,%) pha ^ I r r T t i W ^ ^ (1193)
< 480 phiit 925 (77.54%) a 480 phut 1 268 (22.46%)
Oivo'(n,%) (124) 27(21.77%) 97 (78,23%)
P 0.000 Nhfin xet: OVS cfi thdi gian d pha tilm thdi £ 480 phut chifim ti lfi cao han so vdi fli cfin Sy khfic bifit cfl y nghTa thong kfi Thdi gian tmng binh a pha tifim thdi (phut) d nhflm oi con Ifi 422.19 ± 177,29, nhfim l i vd 681,46 ±237,50
Bang 9. Moi lifin quan gitra nhfim thdi gian cua pha hogt dflng vdi tinh trgng l i
TintL^^ng 6i Pha h ^ T ^ r t f - ^ ^
< 420 phut
£ 420 phut
Ol cfln (n,%) (923) 910(98,59%)
13(1,41%)
Ol VO' (n,%) (71) 70 (98,59%)
1 (1,41%) P 1,000
Nhgn xet: Thdi gian pha boat dfing giO'a 2 nhfim khfic bifit khflng cfi y nghTa; Thdi gian pha hogt dgng (phut): 6 i eon la 248.11 ± 62,92 phiit; Oi vd (n=71) Ifi 209,09 ± 74,57 phut
BAN LUAN
1. Ti lg oi vd- sdm: Nghien eiru ghi nhgn cfi 1350 san phy vfio sanh ed 138 tnj'dng hpp OVS. Vdi kit qua dfi, ti lfi OVS trong nghifin cdu cua chiing tfli Ifi 10,22%.
Nqhien ci>u Nqfl Thl Kim Phynq [2]
Martin L P e r n o l l f l l ] Taylor J v a G a n t e T 1121 James DK vfi cflnq s y [91 Cammu H vS cflng s y [5]
Nqhien c y u cua chiinq tfli
Nam t h y c hifin 1996 1994 1984 1999 1990 2011
T I l f i ( % ) 12 10,7
10 10 8 10,22
Kit qua theo bang trfin cho thiy, ti Ifi OVS eua chung tfli tuang d l i phii hpp vdi nghifin euu eua Taylor J vfi Garite T dypc thyc hifin trfin 16888 san phy vao sanh tgi Women s Hospital, Memorial Medical Center of Long Beach, California Ifi 10%. cua James DK Ifi 10%
[9], vfi 10,7% Ifi kit qua eua Martin L.PernolI, Dieu nfiy cho thiy, tl lfi OVS vfio khoang 10% Irong cfic trudng hpp sanh d nhilu ea sd y t l khfic nhau Tuy nhifin, li Ifi OVS cua chung tfli eao ban so vdi Cammu H[5], cfi t h l do Cammu H thyc hifin trfin thgi phy cfl tuli thai tir 37 tuan tull trd Ifin, khflng thyc hifin thai ky non thfing nfin ti Ifi l i vfl" cfi thip ban Nhung ti Ifi nfiy thap han so vdi ti lfi OVS eua Ngfl Thj Kim Phyng [2], cfi sy khfic bifit nfiy la do tfic gia su dyng ehung cho trudng hpp OVS vfi OVN trong efie thai ky, Dii kit qua nghien edu cfl tl Ifi OVS khfic nhau nhung ti Ifi OVS Ifi dao dfing tir 8% - 12%.
Thdi gian 6i v d d i n nhgp vifin: Thdi gian OVS Ifi mgt trong y l u l l gfiy nhilm triing eho mg vfi cho thai nhi[6],_[8], [10], 76,81% trudng hpp cfi thdi gian l i vd den khi nhgp vign £ 60 phiit; Trung binh Ifi 178.33 ± 184.25 phiit Dilu nfiy co the do nhfi cua sfin phy xa.
phuang tifin di chuyin khfl khan nfin thdi gian di chuyin den bfinh vifin chfim hofic cfl the do san phy khflng biet the nfio Ifi tinh trgng oi vd hofic do y thii-c, thfii dfl cua san phy trudc tinh trgng l i va chua cao,... theo Funman B, Hannah M, Lawn JE nguy ca nhiem trimg cho mg vfi thai tang d trudng hpp OVS li Ifi vdi thdi gian tir luc 6i vd den luc sanh [6], [8], [10], do do thdi gian oi vd den khi nhgp vign cfing ngan se gfip phin Ifim gifim nguy ca nhifim triing eho mg vfi tre sa sinh sau sanh.
Thdi gian di v d vfi cfic giai dogn chuyin dg: Theo Y van, khi mfing oi b\ phfi vd sfi kich thich tang lupng prostaglandin nfii sinh gay chuyen dg eung nhu nit ngfin thdi gign chuyen dg[16] vfi kit qua tgi bfing 3,2 cho thay cfic giai dogn chuyin dg, thdi gian tir luc oi vd din khi cd CTC md trpn trung binh la 685,54 ± 318,13 phut tuang dli ngin ban so vdi trung binh vfi thdi gian chuyen dg (dfii vdi con so khoang 16 den 24 gid vfi con ra khoang 8 den 16 gid).
2. Khao sat mpt so yfiu td lien quan Dgc diem chung cua m l u nghifin c v u Tuoi sfin phu: Tuoi trung binh lfi 26,98 ± 5,93 tuoi, 60,89% dfi tuli £ 20 den <30 tuoi nhung cfi 20,74% san phy dudi 20 tuli va trfin 35 tuoi vi nhu'ng dg tuoi nfiy eo nguy ea sanh nhu-ng tnrdng hpp thai d| dgng, chuyen da kfio dfii, tfing nguy ca sanh non, sly thai, thai bit thudng ., Dfiy lfi ti Ifi kha eao ein quan tfim chfim soc vfi qufin ly thai nghen tot ban. Khi khao sfit m i i lien quan din tinh trgng oi ghi nhfin chua cd y nghTa thong kfi. Theo Sita Ram Shrestha dfi tuli nfiy chiem 82%.
Noi cu- tru: Thfinh thj chilm ti Ifi 52,89% nhung nfing thfln ehilm 47,11%, cfi t h l Ifi y l u t l kfio dai thdi gian nhfip vifin Cfi sy lifin quan OVS va noi cu tm-la y l u to ifim tfing nguy ca OVS,
Lien quan dfinnghl nghigp: Tgi bang 3.3. ngi trp, nfing dfin, cong nhfin, bufin ban cfi ti lg l i vd eao ban so vdi l i cfin (p < 0,001)- dieu nfiy phii hpp vi cac nghe nay lao dfing tuang doi eye nhpc, v i t va, dilu kifin sing thip, ehl dfi dinh dudng khfing day du, dilu kifin cham sfic thai ky dfii khi ggp khfi khfin nen cd t h l la y l u t l lam gia tfing nguy cd OVS thai ky, Theo Medina dilu kign kinh t l thip lfi yeu t l nguy ca dan din OVS
Y HOC THirC HANH (802) - SO 1/2012 15
Chi sfl k h i i c a t h l : Cfin nfing Ifi 58,92 ± 4,24kg vfi 96,67% trpng lupng £ 50- <70kg, Cfi lien quan OVS vfi BMI: BMI < 20 ti lfi OVS cao han so vdi l i cfln (p <
0.001). Theo Kovavisarach E, Martin L Pernoll tinh trgng thieu cfin Ifi y l u to nguy ca gia tfing tinh trgng vd fli sdm,
T i l n si> bgnh ly: Cfl lifin qugn a tiln sir sanh non, s l y thgi. ngo phfi thai eao ban so vdi nhdm l i cdn (p <
0.001). Nghifin cuu nfiy phu hpp vai Kovavisgrach E;
Tgnya Medina- tiln su sanh non, say thai, ngo phfi thai Ifi yeu t l Ifim gia tfing nguy ea OVS.
Thdi gian chuyfin dg: Pha tilm thdi Ifi 446,60 ± 198.69 phiit-> phu hpp chuyin dg sanh Khi phfin nhdm, 72,29% phg tilm thdi < 480 phut-^ thdi gign phg tilm thdi d gidi hgn binh thudng Lifin quan vdi tinh trgng l i , OVS ed thdi gian £ 480 phiit vfi thdi gian d pha nfiy cao ban so l i cfin (p < 0.001) Kit qufi nfiy khflng phu hpp vdi vd l l vi khi vd mfing l i sfi kich thich tilt ra prostaglandine nfii sinh gfiy chuyin dg nhung cfi t h l nhin nhfin theo hudng Ifi khi l i cfin. d i u 6i sfi nong CTC t i t ban so l i vd vfi l i vd sy binh chlnh ngfli thai khfing t i t VI tfic dyng eua nudc l i Ifi ching sang chin eho thai, giiip binh chinh ngfli thai, chfing Igi sy chfin fip eua ea the thgi vfio phin phy thai, nhit ifi trong chuyfin dg [2].
Do dfl, OVS se Ifim chuyin dg kfio dfii han 6 pha hpat dgng, thdi gian Ifi 245,32 ± 64.56 phut, phu hpp phg chuyin dg, Khi phfin nhfim, cfl 98,59% san phy lfi < 420 phiit, khfing cfi lifin quan cug phg nfiy vdi tinh trgng oi, theo y vfin dau l i cfi tfic dyng nong CTC, nhit Ifi pha tilm thdi. d i n pha hogi dgng, hign tupng nong CTC bfing dau l i giam. Cfi sy lifin quan thdi gian trung binh pha hogt dflng vfi tinh trgng l i .
Dgc d i l m c^n lam sang: Bgch eau la y l u l l gfip phin dfinh gifi nhifim trung, cfl 90,59% s6 lupng BC <
12000/mm^-> san phy khfing cfl nhilm trung. Lien quan giua OVS vfi s l lupng BC. s l lupng BC £ 12000/mm^
vfi so lupng trung binh d nhfim l i vd cao han so vdi l i cfin (p < 0,001 )->phu hpp chirc nfing nude oi giup hgn c h i nhilm lriing[2],[4] nfin vd l i phg vd sy bao vfi nfiy vfi cfi t h l bj nhiem trung Kit qua nay phii hpp vdi Furman B, Hannah M, Lawfn JE: OVS lam tfing nguy ca nhiem tnjng cho mg vfi thai nhi, ti Ifi vdi Ihdi gian vd l i sdm eho din luc sanh [6],_[8], [10]. Do dd, khi eo OVS trong thai ky se cfi nguy ca nhiem trimg cho mg vfi tre sa sinh Lien quan thdi gian l i vd vfi so lupng BC. nhflm ed BC £ 15000/mm^ cao ban so vdi nhfim khfic (p <
0.001)-^ thdi gian tir luc bfit d i u eo l i vd d i n khi nhfip vifin cang kfio dfii. s l lupng BC cfing tfing-> tfing nguy ca nhiem triing cho mg vfi thai nhi, phii hpp vdi Furman B. Hannah M, Lawn JE [6], [8], [10]. Do dfi, v i n d l dfit ra cho bac sT Ifi sy ein thilt cfi efie bign phfip tu v i n giup cfic san phy nhfin thuc dupe tinh trgng vd l i vg cfic nguy ca. nit ngin thdi gian nhfip vifin nhfim giam nguy CO nhiem triing cho mg vfi thai nhi,
KtT LU-a^N
1. Ti If 6i v d sdm: Lfi 10.22%
2. Cac y l u t l lien quan d i n di v a sam Thdi gian l i vd d i n khi nh§p vign Ifi 178,33 ± 184.25 phiit. 76.81% vfio vifin sau 60 phut; l i vd d i n CTC md 3 cm Ifi 407,59 ± 258,28 phut, d i n CTC md trgn Ifi 579.48
± 278,01 phiit; d i n sanh Ifi 685,54 ± 318.13 phOt, S^n phy lir 20- < 25 t u l i cfi OVS chilm 31,16%.
Cfl sy lifin quan giO'a tinh trgng l i vdi sing nflng thfln; nghi nghifip; BMI < 20; tiln cfin sanh non, sly thai, ngo phfi thai; s l lupng bgch c l u . Trong giai dogn chuyin dg, pha t i l m thdi cfl thdi gian chuyin dg cao ban vfi ti Ifi sfin phy ed thdi gian chuyin dg pha tilm thdi £ 480 phut nhilu ban so vdi trudng hpp l i cfln.
Thdi gian ptia hogt dfing d nhfim l i edn cao han d nhdm l i vd,
KI^N NGHI
1. D l y mgnh cfing tfic tuyfin truyin cfic thfing tin d n thilt khi mgng thgi nhu vfi smh thai ky, chfim sfic thai vfi theo dfli thai ky, eung d p thflng tin cho sfin phy vfi ldi khuySn v l e h l dfi dinh dudng, ehl dfi sinh hogt, tfip luyfin trong that ky, v l diln tien cua thai ky vfi chuyin dg Dfic bifit Ifi nhirng phy nO' mdi mang that lln diu, phy nCr viing nfing thfin, san phy cd tiln sir sanh non, s l y thai, ngo phfi thgi
2. Hudng d i n sfin phg d i u hifiu cug vfl' l i , ding th£ri khuyin khich cfic sfin phy nhfip vifin sdm khi 61 vd nhfim giam thilu nguy ca nhilm triing eho mg vfi thai.
TAI LI$U THAM K H A O
1. Bfi mfin Phu San, Dgi hge Y Dupe TPHCM, (2007), "Sy phfit triln cua thai vfi phin phy cua thai", Sin phg khoa. tfip 1, Nhfi Xult ban Y hgc. ehi nhfinh TPHCM, tr. 60- 66
2. Bfi mfln Phy San, Dgi hgc Y Hfi Nfi. (2005), "De khfi do nudc l i vfi mfing thai", Sin phg khoa. tip 1, Nhfi XultbanYhge.tr. 167-170.
3. Nguyen Dire Hinh, (2003), "Nude l i " , Mgl si vin de cin thiit dii vdi bic sT sin khoa, Nhfi Xult ban Y hgc, Hfi Nfii
4. Phgm Vfin Linh, Cao Nggc Thfinh. (2007). "Sy thy tinh Ifim t l vfi phfit tnen cua trung*, San phg khoa sich dao tgo bic sTda khoa, Nhfi Xult ban Y hge. tr. 29- 39.
5. Nguyin Duy Tfii, T r i n Sdn Thgch, (2006), "Xi> tri oi vd non trfin thai non thfing". Tgp chi Y hgc TP Hi Chi Mmh. 10(1), tr, 122-127.
6. Chgntgl J.M,S (2006). _Preterm prelabour mpture of the membranes before 28 weeks: Better than feared outcome of expectant management in Africa, Eumpean Joumal of Obstetrics & Gynecology and ReproductiveBiology. 26(2), pp 186-192.
7. Cox SM,, Williams M.L , Leveno K J (1988), "The natural history of preterm ruptured membranes: What to expect of expectant management", Obstet Gynecr^, 71(4). pp 558-583.
8. Friedman M.L.. McEiln T.W. (1969). "Diagnosis of ruptured membranes", Am J Obstet Gynecol. 104. pp.
1580-1591.
9. Grant J., Keirse M J . N C . (1989), "Prelabour rupture of the membranes at term". Effective care in pregnancy and Childbirth, 2, England; Oxford University Press. Oxford, pp. 1112-1117.
10. Imseis H.M.. Trout W . C . Gabbe S.G. (1999), _The microbiologic effect of digital cenrical examination_, American Joumal of Obstetric and Gynecology, 180(3), pp. 578-580.
Y HOC TH Vc H A N H (802) - S61/2012
