VIETNAH MEDICAL JOURNAL N°2 - DECEMBER - 2016
TAC DUNG KHONG MONG MUON CUA PHU-OT^IG PHAP
PHA THAI NOI KHOA BANG MISOPROSTOL 6^ VI T H A N H NIEN
T6M TAT
Muc tieu: Nhan xet ve tac dung khdng mong muon aJa phutfng phap pha that npi Idioa bang Mist^xnstol d vt thanh nien tai khoa kham benh theo ygu tSu B&ih vien Phij san Trung uWig. Dfii tu'dng va phu'dng phap nghien cuti: Nghien CIJ\J hol aJTu mo ta. Ket qua: Ty le pha thai d Mta tuoi 17 - 19 hay gip nhat 76,2%, nhom tuoi thai hJT 18 - 22 tuan (86%).Tac tac dung khong mong muon: sot (6,8%);
tieu chay (1,3%); non (1,4%) va buon non c^tem t / le 5,4%; t9 I? tai bi&i: chiem 0,02%, Irong iJo radi CTC chiem 0,08%, diay mau nhieu chtem 0,01%; khong c6 tai bien nao nghiem trgng xay tra trong qua trinh phd thai. Ket lu§n: Phuang ph^p pha thai to bdng Misoprostol co ft tac dijng phu va khong xay ra tai biSi, nen ap dyng phuBng frfiap pha thai nay d nhOTig CO sdytS thich hdp.
W AAda: Misoprostol, tac dung khong mong mu5n, phd thai, v\ th^nh nien.
SUMMARY
COMMENT ON THE SIDE EFFECTS OF MISOPROSTOL FOR MEDICAL ABORTION
OF PREGNANCYIN ADOLESCENTS Otijective: To comment on the side effects of M i s o p n ^ for medical abortion of pregnancy in adolescents in Virfnam National hospitai of Obstetrics and Gynecslogy. Patients and methods: A descnp&\v retrospective study on233 adolescent pt^nandes from 13 to 22 weeks, who have to stop pregnancy In Vietnam National hospital of Obstetrics and Gyneostogy. Results: Abortion rates at ages 17- 19 Is the most common with 76.2%, gestational age fiom 18 to 22 wseAs with 86%. The side effects Indude: fever (6,8%), diarrhea (1,3%), vomiting (1,4%) and nausea iv>diS,4%;2.S% nausea 2 1%
vomiting, 2.4% fever/chill, 3.1% diarrhea;
catastrophes with 0,02% indude: torn uterus witii 0,08%; bleeding wtth 0,01%; there was no heavy cases in abortiOTi. Conclusion: Abortion by Misoprostrt has few side effects and no catastrophe
^KKJkJ ad<s« this method of abortion in the af^v'ivrlate medical fodlity.
Key words: Misoprostol, the side effects
abortkm, adolescents '
* B|nh vl§n Phy san Trung l/dng '*D?ih9crmi\l$i
Chju tridi n h i ^ chinh: Vu V&n Du Errial): [email protected].
Ngay nh|n bdi:8.9.20ie Ngay phan bt?n khoa hpc: 14.11.2016 NgSy duy?t bai: 25.11.2016
Vu Van Du*, Ha Manh Tuan"
I.BATV^NDI ^ Pha thai la blen phap khong mong mu6ffi
cung nhu" khong khuyen khfch vi a i nhilu ta bien, bien chiTng, nhat la doi vdi pha thai ba thang giu^, nhuYig vdi nh&ng ly do khac nhau, trong do co nhulig iy do benh iy ciia me v^ dial nen nhieu phu nu" bupc phai pha thai 6 t u ^ thai nay[7]. Theo bao cao ciia Hpi kg hoach h6a ^ dinh, Viet Nam la^ nuiSc co b^ Ie ph^ thai dutig thu" 5 the gicfi, moi nam ca nirtJc co khoang 1,2 trieu den 1,6 trieu ca nao pha thai, trong 36 20% cf lij^ tuoi vi thanh nien {tUt 10 -19 t u f t s ] CThifc trang pha thai to cf vi thanh nien chian ty le kha cao, htfn 10% tong sS ca pha thai).
Co hai phu'dng phap pha thai ba thing i bao gom pha thai npi khoa va pha tiiaj;^
khoa, trong do phu'dng phap pha ttial r^
bang I^isoprostol (MSP) du'dc riit nh@u i gia trong va ngoai nu^c ap dgng. 6 \A^
da ap dung pha thai npi khoa bSng I^ISP |^
1992, tuy nhien chu^ co nghi&n ciitJ nSo te tu'dng vj thanh nien. Do v§y, chung tiSl t i | | i nghien cii'u nay nham: f\/han xit i/i? magng khong mong muon cua phifdng phap phi IM noi khoa bing I^ISP ce vi thanh nien. ' S M II. €)6l TtrplMG VA PHirOfNG PHAP NGHi§N OJU
2.1. Ool tiftfng nghien c t h i ^ ^ K Vi thanh nien co thai ttr 13 den 22 tuan;;?6dV djnh ngifng thai tai benh vien Phu s6n Trung
^ Tiiu cliuan iu^ chpn: I^$t thai, thai _ tuoi thai tii 13 den 22 tuan tfnh theo ngay cuoi ciing doi vdi cac trudng hdp kinh ngi deu, CO ch^u ky 28 ± 2 ngay; TU nguy?n xin phi tiiai, CO bo hoac me dong y ky giay cam Vk vi phai CO giay x^c nhan cua chfnh quySn < ^ p h i * ' ' ^
Tiiu chuan io^i trii'. Seo mfi cu d OJi tien sij- phau thuat cac khoi u duftng sinh' dudi v^ CTC; di liTig vdi I^SP, hay nhthig "^
chi djtih khac doi vdi MSP; mSc m$t so b nian tinh, cap tfnh hoac ac tfnh; da sijf dyi., ky mpt phu'dng phap ph^ thai nao tru'dc dfi.
1.2. Phu'dng phdp nghign d h i 1.2.1. Thiet Ite nghien d h i Mo ta c§t ngang su" dung sfi lieu hoi ciKj' 1.2.2. c e m a u nghign ctVu 233 vi thanh nien co thai tif 13 - 22 « « _ clii dinh ngirng thai nghen tif thang 01/01/2009 den 31/12/2012.
42
Y HOC V | £ T NAM TAP 449-THAHG 1 2 - 3 0 2 . 2 0 1 6 1.2.3. Phu'dng phap chon mau
Chpn mau thuan tien 1.3. Mian b'ch va xu' ly so lieu lil. K ^ QUA
1. 0 | c diem diung cua ddi tu'dng nqhien cihi
Tat ca so lieu duWc nhap bSng chUdng Ijinh Exral - Office va duHc xi^ iy, phan tfdi so iieu bang phan mem SPSS 17.0
14- I6tu6i I 7 - I 9 i u 6 i s l i V0
«, : ^ ^ I'eudoliPhanbonhoii^oithaiphu
SSm&To^iT^^ifhimlm'""'" "''' *'™ ''•'°^' '^ ^ '^'"-'' *'™ ^^'i* ™
Tac dung khdng mong muon cua MSP m g l ; Tac dung Idiong mono muon cua MSP I T j '
Trieu chtfng flau bung Tieu chay
Non Buon non
So lu'dng
223 T V I e V .
100 6,8 1,3
-JA.
" ^ ^ oac aigm tmh trang hon nhan va ly do M i ffip' Da_so doi tirang chuS lay chong ch em 81 6% "*^ ? Bieu d o i Tinh tr^ng hon nhan
4. Tal b i i n loii sxl dMng MSP . vtiJ^m " 9 ! ' * " <*;>y,V'3i 223 thai phu sir dung MSP dOn thuan d« pha thai tir 13 den 27 hiin
ag^t^i^r^p^Lr™sf;?hn^^^^^^
'"• f i X * « « m h.a ^•'*' 1:^' * "!•='' '^ '°-'^ 'S!°' * ' * ™ i'^"/"-
4.1 e | c diem tuoi Hieo nghien cilli ciJa Nguyen Tlii Lan Hifrtno luSi tir 17-19 tuoi chiem ty le cao nhat v « tuoipha thai quy n tap trung chii yeu dnh6m 20
- ^ ^ B
VIETNAM MEDICAL JOURNAL N°2 • DECEMBER - 2Q16
- 24 Uioi chi&n ty le 42,31%, txioi thap nhat la nghien cu'u tnDng Ichoang thdi gfan dai hdn, ^ 18 va cao nhat ia 49 tij6i[4]. Mpt so nghien cutj gian nghien ciiu mupn hdn Ichi ma Viet Nan khac ve \iia tuoi pha thai quy n cijng cho Icet trong qua trinh hpl nhap, cac em dutte ^xk qua hrcfng bS: Bunxu Inthapatha (2007): tuoi vdi nhieu tu" tu'dng mdi, thoang hdn, cdi md hdfi.
trung binh dia cac thai phu ia 25,8 ± 7,4; 4.2 Tinh t r a n g hon nhan
Mguyen Huy Bao (2009): nhom tuoi tiy 20 - 24 Ket qua ngiiien ctiXi tai bieu do 1 so Ij&h xulft hien nhieu nhat trong nhom pha thai quy nhan chu^ lay chong co 182 trudng hdp chiem t*
n [ 5 ] , [ l ] . Tuy nhien vi nghien ciilj cua chung toi le 81,6%; con lai da lay chong cd 41 tru€(ng }^
ve pha thai quy n d vj thanh nien nen \iia tuoi dii§m ty le 18,4%. Theo cac nghien ciitJ Ichat;*^
gap nhieu nhat ia 17 - 19 tuoi. Nghien cuti cua tiiai phy chu^ co chong den pha thai chiein ty \k Phan Thanh Hat va cpng sU (2008), lu^ tuoi vj cao nhat chang han nghien ciiTu cua Nguyen Tiii thanh nien cd 24 tru'dng hc^ chiem 27,8%[2]. Lan Hu'dng (2012), ty ie phu ni? chu^ Icet lion Ket qua nghien aiu cua diung toi cao hdn rat chiem 54,61%; Bunxu Inthapatha, s o t m ^ h * nhigu, dieu nay a i ttie giai thi'ch la do chung toi chuci Icet hon chiem da so la 61,6%[4],[1]
4.3 T i e dung Idiong mong muon
Bang 2: So sanh t^c d u n g Ididng mono muffn vdi nghi6n cu'u k h ^ c
Hamoda Hfei
Bunxu irsi
N.T.LHUdnqr41Nghifin cihi nky
d i a y 52,8 38,85
1,3
Buon non J2^
5,4
18,53
Ret run 72,2
20,85
19,4
Man n q i h i2,31 6,7 46,15
6,6
Trong nghien cilli oia chijng toi tac diing I(h6ng mong muon gom 6,8% sSt; 5,4% buon n l , , 1,4% n6n: 1,3% Seu chay. NhiS vay, i<et qua nghien ciru ciia chung toi thap hdn rat nhieu so vdl kS qua cua Nguyin Th| Lati HuBng; Hamoda H(4],[6], Sd dl co su' lihac nhau la do mol t^c gl^ c6 plA dB dung thuoc khSc nhau, da sS cac tac gia sir dung lieu MSP th5p, thu'dng la 200 mcg/6 gl», trao khi c6 tac gia dung lieu tao nhu' tac gla Nguyin Tlij U n Hu'dng da sir dung IISu 400 mcg/3 gl*. MSt so tSc gia n u * : ngoai nhu Hamoda H nghien ciJu diing lieu tu'dng t u cung co ty IS tac dung phu rao hdn, nguyen nhan c6 the do mte do dap iJtig thuoc ciia phu nff tirng lihu vu'c co su khac nhau. '4.4 Cac tai bi§n
Bing 3. So sinh tfi IS tal Uen vdl mot so nohlen aid khic
Nguyen Huy Bao (2009>I11 Iguyen Hi uyin T L
Nguyen T L HuBno. (2012114]
NghlSn c i h i nay
Rach CTC
0,008
Chay mau
0,01
S o t r a u(°/o)
0,38
Nhiim khugn(%1
0,77 Trong nghien ciiU nay, co tat c4 5 tru'dng
h<Jp bl tai bien chiem ty le 0,02%, trong do cd 2 tnrdng hi;lp rich CTC chiem 0,08%, 3 tru'dng h ^ chSy mau chiem 0,01%.
Nhu' v|y ket qua ciia cac tac gia trong va ngoai nmSc cung tudng t v vdi ket qua ciia nghien cuU, da chutig minh ty ie tai bien khi pha thai bSng thuoc la rat Uiap. Oay chinh la mpt trong nhutig uu diem noi bat cua phu'dng phap pha thai npi khoa so vdi phu'dng phap ngoai khoa, la od sd de pha thai npl khoa l i d thanh phudng phap du'pc ius chon hang dau cho oha thai ba thdng giu^.
V. K f r LU$N
Tac dung khdng mong muSn chiem ty I? lU It va hau nhu khong phai dieu tri. Kh6ng d U I bien do pha thai b5ng MSP.
TAI U f u THAIVl KHAO
1. Nguyen Huy B?o (2007), "Nghl&l diu sil ttn l^isoprosol 1 ^ 400 miciagam de phi thai tif tiAi 0>ill3<len22-.rapd»yhocthii[hinh,S.tiil-ii 2. Phan Thanh Hai (2008), "NghiJn aJu m«s5l(
do, danh gia hi^u qui cua Misoprostol trong pM thai tir 17 den 22 tuan tal B|nh visn Hig * Trung u'dng nSm 2008", Lufn vin tSt nghUp tit sir chuyen khoa cap IT, Tnrdng Dal hpc Y Hi Hjl
k' 4.
M?nli Hung (2009). I^ao pha thai d tuoi vi thanh nien: chuyen dau long! Sit fdne ddi say Hii.
Nguyen Thi l a n Hu'dng (2012), ° Nghien diM hieu qua pha thai tiy 13 den 22 tuan oia misoprosbjl ddn thuan va mifepriston ket hOp misoprostol', iMan an Hen ^ y hoc, Tru-dnq Oai
hoc YHa Noi. • Bunxu Inthapatha (2007), "Nghign aj\j sif
dung MisoproSol don thuan irong pha thai vdi tud thai tiy 17 - 24 tuan tai Benh vien Phu San
YHOC VlgT HAWTAP449.THAHG 12-502-2016
Tmng uHng nam 2006", Lugn van ttiac sy y hoc, Tmi&ng Oai hoc Y Ha Nfii.
IK Hamoda.H, Ashok PW, Rett GM, Templeton A (20(e),"A randomized triai of mifqjriaDne in oonbreUon w#i misoprostol actninidefed sublingu^ly or vaginaily for metfical aboriion at 13-20 weete gesfation* Aug;20(8):2348-54. ^jub 2005 l^y.
Chttps://www.nd)i.nfrn.nih.gov/pil)med/15878927) 7. Worid Health Organization (2003), "Safe
Abortion: Technical and Policy guidance for Health S^tems".
NGHIEN CUTJ DAC DIEM HINH A N H SIEU AM 2D CUA U Cff TRffN TU- CUNG TRU-ffC VA SAU DIEU TRI BANG PHU-ffNG PHAP
NUT DONG MACH Tfl- CUNG
* T6MTAT
• ( 1 ^ Mi/cdicht Mo ta dSc diem hinh anh u cd tnm tir
^ cung b5ng Seu am 2D tru'dc khi dieu tri bSng nut - J ? , ™ ' ' * ' ^ ' ' * * " • ' l " "'="9 W^OOS dSn thang J 10/2005 Chung t6i nghien ciiu tren 34 benh nhan
* zi'^ " I t djng m^d! tijf cung trong dieu tri UCITC tal j khoa Chan doin hinh anh benh viln Bach Mai. Danh j, gla kich thudc, vl tn', cfu tnic, trpng lirpng khS u c r r c
truBc nut madi v i tal thdl diem theo doi 1, 3, 6 thang I sau diSu tri. Kit gui nghien ciiu 34 BN (tuol tir 30- ' 1°'.™;'^ "^ " ^ " "d du'di niem mac 85,3%, kich jl Oiirdc va the H'dl u tmng binh 47,82mm va 53,12 o n '
20,6% u glim Sm; sau 6 thing kich thu'dc u giam trung bmh 77,9%, the ddi u giim tmng binh 48 3%
Sau 6 thang cd 70,6% u ting Jm. Ketlufn. sieu am theo doi ciu hue; Wch thu'dc, Uie b'ch khoi u cd tron hi cung binjc v i sau nut dgng mach til cung l i phudng phip ddn giin, chlnh xie, re Ben co the thut hien d mpi tuy&ytS.
Tif khia! u cd trdn td cung, ntlt ddng mach ttf cung, sleu am.
SUMMARY
ANALYSIS THE CHARACTICS OF UTERINE FIBROID BEFORE AND AFTER UTERINE
ARTERY EMOBOUZAnON BY 2D ULTRASOUND
'BalhocYHiNSi
" B4nh vi^ Bach Mai ' " Bfnh vl^ Kft Diic
Ch|u tridi nhiem chlnh: Nguyin XuSn Hien Email: [email protected])m Ngiy nh|n bil: 3.9.2016 Ngiy phin Men khoa h^c: 7.11.2016 Ngiy duySt bil: 15.11.2016
Sorasan*, Nguyin Xuan Hiln", Vu Long*"
ObJecUvR Dlscribe the characBcs of uterine nbioma before and alter uterine artery emobollzaBon by 2D ultrasound. Method. 34 patients arc done uterine artery emboilzabon to teat utenne fibroid fram 10/2003 to 10/2005 in Badi Mai Radiology department. We analysis the size, stnicture of uterine fibroid before embolization and Idltow up at 1; 3; 6 month after embolization. Results; 34 patients (a'ge 30-50), 85,3% uterine fibroid are submucous. The average size and tumor volume are 47,82mm and 53.12cm, 20.6% hyperchogenic bjmor: after 6 months the average hjmor size decreased 77.9%
decreased the average hjmor volume of 48 3% After 6 months, 70.6% utenne fibroid are hyperediogen conclusion: Analysis and fomlloing the structure size, volume of uterine fibroid bimors belijre and after utenne artery emblizaton by ultrasound are simple accurate, inexpensive.
Key ward: uterine hbmld, utenne artery emlxmation, ultrasound.
I . B i J T V A N o l
Sieu am la phu'dng phap chSn doan co gia tri cao trong chan doan u cd trdn tir cung (UCTTC) vuS khong co hal den benh nhan, viia kinh te yuS danh gla du'dc hinh thai, ki'ch thu'dc, cau true am, vi tri, so iu'ong ciia UOTC giup phat hien sdm UOTC ngay ca khi chua co triSu chiJng iam sang; Sieu am la phudng phap theo' doi sau dieu tri bang nut dong mach tlJ' cung hdp ly, co the theo doi hang thang...
1 , . , - . ^ ™ ° " ^ . " ' " ° " "'"^ ' ' 1 ^ " ^ ve Wnh anh
^ \ ^ ^ y ^ ='^" Sm 2D, Chung toi tien hanh (K tai Nghmi cm, die dim hinh anh sleu am 2D cua ucd trdn ttf cung trudc va sau dieu tri baip phu-dng phap nut ddng mach tti- cund nhSm muc dich: Mo ta dac diem hinh inh u cd
