Slide 1

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Chn on thai nghnThS. TRN MNH LINHhn on thai nghnCNhn bit c cc du hiu thai nghnNu c cc chn on phn bit vi tnh trng c thaic c kt qu ca cc xt nghim c thaiMc tiuhn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaiDu hiu hng ti c thaiDu hiuhng n c thaihn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaiDu hiu hng ti c thaiDu hiuC th c thaihn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaiDu hiu hng ti c thaiDu hiuChc chn c thaihn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thail nhng triu chng ch quan ca ngi mTt kinhhn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thai

hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thai

hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiTt kinhDu hiu tin cy : Khe mnh Kinh u Khng cho b Khng trnh thai hormon

hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thai

Phn bit: Tng cn hormon Stress Bung trng a nang Bnh l tuyn gip U tuyn ch tit hormonSuy bung trng smTt kinhNagel (Ngy +7, Thng 3)hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiCc triu chng smPhn bit: C thai tng tng Bng to ln (do lp m, bng chng hi, dch trong bng).

3 thng uhn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiCc triu chng smTriu chng v tiu ha: Nn v bun nn To bn hoc tng tit nc bt

50%C n 50% ph n bun nn v nn khi c thai, r rt nht vo tun th 2-12 ca thai nghn. Thng nng nht vo bui sng, nhng cng c th xy ra bt c lc no trong ngy, nht l rt d bun nn khi ngi thy mi nu nng, mi hng cay ca cc mn xo nu. Cm xc cng thng cng c th nh hng n mc nghim trng ca cm gic bun nn v nn. Bun nn v nn khi c thai c th do 4 nguyn nhn sau: - Cm cm, do phn ng vi thuc. - Thay i v ni tit trong 3 thng u c thai chim 1/2 s nguyn nhn gy bun nn. - Nn rt nng (cn gi l nn c tnh khi c thai) c th xy ra bt c thi im no trong thi gian thai nghn, lm cho ph n b mt nc, st cn, c th b ri lon chuyn ha v mt cn bng v in gii. Nguyn nhn ca loi nn ny c th do sinh hc, tm l v x hi. Nhng stress trong i sng x hi c th gp phn vo mc nghim trng ca nn. Nn ko di phi hp vi mt nc v tiu ra cht x-tn cn phi c iu tr ti bnh vin. Cm gic bun nn c th l do s tng nhanh nng kch dc t hCG trong huyt thanh; trong 3 thng u ca thai nghn nng hCG trong huyt thanh c th ln ti 100.000mu/ml. Tuy nhin, d m b mt v gy st v nn nng nhng thai thng vn pht trin bnh thng. iu tr bun nn cha km theo bin chng ch cn n nh, n nhiu ba v dng thc n kh. C th b sung liu cao vitamin B6 v cc vitamin khc (liu bnh thng). Nu c du hiu mt nc th truyn dch. Thuc chng nn ch dng nh mt bin php cui cng. H tr v mt cm xc, tm ra nhng yu t gy stress trong i sng, gip gim stress cng rt c ch.

13hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiCc triu chng smTriu chng v thn kinh ni tit: Tnh d b kch thch, chn n hoc thm n thc n g , bun ng hay mt mi

14hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiCc triu chng smThay i v tiu tin:

Nguy c nhim trng

15hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiThay i vLn, u v to, nhy cmQung v thmMongomeryTM ph di da Sa nonPhn bit:

Ph n hnh kinhTrnh thai hormon hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiNim mc m o c t cung Du: Jacquemiers, Chadwicks signTm mi ln, mi b, m vtTng n hiGoodells signhn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiCht nhy c t cung Cht nhy c li (progesteron)hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaihng n c thaiTng sc t da Tng sc t ng gia dc thnh bngMtPhn bit:

Dng estrogen ngoi sinh hn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaiDu hiu hng ti c thaiDu hiuC th c thaihn on thai nghnCDu hiu Chc chn c thaiHng n c thaiC th c thaiBng ln

Tui thai = BCTC/4 + 1hn on thai nghnCDu hiu Chc chn c thaiHng n c thaiC th c thaiBraxton hicks T tun th 9 10 Khng u Khng au Cm gic c

hn on thai nghnCDu hiu Chc chn c thaiHng n c thaiC th c thaiNoble

Phn bit:U x t cungLc ni mc t cung huyt t cung, u nanghn on thai nghnCDu hiu Chc chn c thaiHng n c thaiC th c thaiHgar

Phn bit:Thuc trnh thai cha estrogen Hn ch khm, v gy syhn on thai nghnCDu hiu Chc chn c thaiDu hiu C th c thaiDu hiu hng ti c thaiDu hiuChc chn c thaihn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiNghe c tim thai

20 2210 1278

hn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiNn c phn thai Lopold

4567891011121314

Ti thaihn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiSiu m4.5 - 5TunCui tun 4 ti thai khong 2 3 mm qua SA ng Tun th 5 ti thai khong 5 mmHnh 1. Hnh nh ti thai 5 tun: hnh nh ti thai 2 vng. The crown-rump length (CRL): 6-13 w, best, +/- 4 days, t tun th 12 tr i, thai nhi ngy cng ung cong ngi li, nn ngi ta ch o s o tng phn.Biparietal diameter (BPD): 13-24 weeks, inaccurate, +/- 7 days.Femur length (FL): 13-24 weeks, inaccurate, +/- 7 days.284567891011121314Phihn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiSiu m5 - 6TunSA c th thy khi a phi 1 2 mm, tng ng MSD 5 12 mm v tui thai 5 6 W

Hnh 1. Hnh nh ti thai 5 tun: hnh nh ti thai 2 vng. The crown-rump length (CRL): 6-13 w, best, +/- 4 days, t tun th 12 tr i, thai nhi ngy cng ung cong ngi li, nn ngi ta ch o s o tng phn.Biparietal diameter (BPD): 13-24 weeks, inaccurate, +/- 7 days.Femur length (FL): 13-24 weeks, inaccurate, +/- 7 days.294567891011121314Tim thaihn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiSiu m6 - 6.5Tun

Hnh 1. Hnh nh ti thai 5 tun: hnh nh ti thai 2 vng. The crown-rump length (CRL): 6-13 w, best, +/- 4 days, t tun th 12 tr i, thai nhi ngy cng ung cong ngi li, nn ngi ta ch o s o tng phn.Biparietal diameter (BPD): 13-24 weeks, inaccurate, +/- 7 days.Femur length (FL): 13-24 weeks, inaccurate, +/- 7 days.304567891011121314hn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiSiu m6 - 6.5Tun

Hot ng tim thai xut hin khi thai 36 ngySA tim thai dng tnh khi CRL = 5mm tng ng tui thai 6 6.5W v MSD 13 18mmThi im kho st tim thai tt nht z8 22W

Hnh 1. Hnh nh ti thai 5 tun: hnh nh ti thai 2 vng. The crown-rump length (CRL): 6-13 w, best, +/- 4 days, t tun th 12 tr i, thai nhi ngy cng ung cong ngi li, nn ngi ta ch o s o tng phn.Biparietal diameter (BPD): 13-24 weeks, inaccurate, +/- 7 days.Femur length (FL): 13-24 weeks, inaccurate, +/- 7 days.314567891011121314hn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thai9Tun

Hot ngSiu mHnh 1. Hnh nh ti thai 5 tun: hnh nh ti thai 2 vng. The crown-rump length (CRL): 6-13 w, best, +/- 4 days, t tun th 12 tr i, thai nhi ngy cng ung cong ngi li, nn ngi ta ch o s o tng phn.Biparietal diameter (BPD): 13-24 weeks, inaccurate, +/- 7 days.Femur length (FL): 13-24 weeks, inaccurate, +/- 7 days.324567891011121314

CRL (a), BPD (b), FL (c)hn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiSiu mTnh tui thai theo SA TunTi thai khng c YS, khng phi: 5WTi thai c YS, khng phi: 5.5WTi thai c YS, phi nh: 6WThai 6 12W da v bng theo CRL(Phng phap tnh nhanh:Tuoi thai = CRL + 6.5)Hnh 1. Hnh nh ti thai 5 tun: hnh nh ti thai 2 vng. The crown-rump length (CRL): 6-13 w, best, +/- 4 days, t tun th 12 tr i, thai nhi ngy cng ung cong ngi li, nn ngi ta ch o s o tng phn.Biparietal diameter (BPD): 13-24 weeks, inaccurate, +/- 7 days.Femur length (FL): 13-24 weeks, inaccurate, +/- 7 days.33hn on thai nghnCDu hiu C th c thai Hng n c thaiChc chn c thaiX quang

hn on thai nghnCDu hiu C th c thaiDu hiuHng n c thaiDu hiu Chc chn c thaiCc phn ng th thai

hCGhn on thai nghnCCc phn ng th thai

nh tnh

25mIU: C th cho kt qu dng tnh vo thi im bt u chm kinh1500mIU: Khi thai 5 tun (pht hin c qua siu m m o)hn on thai nghnCCc phn ng th thai

nh lng- 2mIU: Vo ngy th 8 sau rng trngD on thai ngng pht trinD on thai ngoi t cungD on thai trngKt qu-hCG (mIU/ml)m tnh< 5Nghi ng5 25Dng tnh> 253 4 tun9 1304 5 tun75 2.6005 6 tun850 20.8006 7 tun4.000 100.2007 12 tun11.500 289.00012 16 tun18.300 137.00016 29 tun1.400 53.00029 41 tun940 60.0001 w2 w1234567Kinh cui cngTh tinhPht hin-hCG Kinh u, 28 ngyLm tChn on thai nghn

hCG pht hin t 7-9 ngy (1 tun) sau th tinh (khong 3 tun so vi kinh cui)

38hn on thai nghnCCc phn ng th thai

nh lngPhn bit- Thai trng- Choriocarcioma- U nguyn bo (germ cells)- K v v k t bo ln phihn on thai nghnC Tt kinh Triu chng sm V NM m o-CTC Nhy CTC Sc t da Bng ln Braxton Hicks Noble Hgar

Tim thai Nn phn thai Siu m X quang

hCGHNG N C THAIC TH C THAICHC CHN C THAI

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