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THC HNH SN KHOA TRONG PHNG

LY TRUYN HIV T M SANG CON

C CH LY TRUYN HIV T M

SANG CON

3

HIV ly truyn nh th no?

Sau , b m

Chuyn

d,

Thi k mang thai

2 6 6

64 khng nhim

4 36 nhim 17 1

NGHIN CU THUN TP TRN 100 TR SINH

RA T M NHIM HIV (KHNG CAN THIP)

LY TRUYN HIV T M SANG CON

Giai on T l ly truyn

Mang thai 25%

Chuyn d, 50%

Sau - cho con b

25%

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Ly truyn HIV trong thai k

1. HIV t mu m c th xm nhp thng qua mng nhau thai.

2. Thng cui ca thai k, mng nhau thai mng dn, to thun li cho s xm nhp HIV sang con.

3. T bo CD4 c HIV c th xm nhp qua mng nhau thai vo thai nhi

Cc yu t lm tng nguy

c LTMC

1. Tui ca m tng ln

2. M mi bi nhim HIV

3. M nhim HIV giai on

cui: CD4 gim, ti lng

virus trong mu cao, mc

cc nhim trng c hi

4. Thi quen xu: ht thuc,

nghin ma ty

C ch LTMC

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Ly truyn HIV trong chuyn d

1. Qu trnh chuyn d v sinh

con : cn co t cung, xa m

c t cung v t cc mch

mu nh

2. Thm khm: m o v c t

cung c th b xy xc, chy

mu

3. t in cc, forceps: gy

chy mu v tng nguy c

nhim HIV cho tr

Cc yu t lm tng nguy c

LTMC

C ch LTMC

1. kh

2. Chuyn d ko di

3. Thi gian v i di ( LTMC tng 2%)

4. Thai b sang chn

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Ly truyn HIV trong chuyn d

1. Virus HIV c trong dch m

o thai nhi c th nut

dch m o c nhiu HIV.

2. Da v nim mc ca tr b try

tip xc vi mu v dch

ca m c HIV

Cc yu t lm tng nguy c

LTMC

C ch LTMC

1. Ct tng sinh mn sm

2. Vim ng sinh dc di, STDs

3. Vim mng i

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Giai on cho con b

1. HIV c trong sa m

2. Cc bnh v v ca m:

vim tuyn v, nt u v

lm tng nng virut trong

sa m

3. Tr c cc bnh l v rng

ming: vim li, mc rng,

khi b m s to iu kin

cho virut xm nhp

Cc yu t lm tng nguy

c LTMC

C ch LTMC

1. M giai on aids: CD4 gim, s

lng vi rt trong mu v sa m

cao

2. M mi nhim HIV: ti lng

virus cao

3. Vim v, nt v, p xe v

4. Tr sinh non, nh cn

5. Tn thng ming tr

6. Nui tr hn hp (b m + b

sa bnh)

7. Thi gian b m di

T l ly truyn ca HIV qua b m

Nguy c ly nhim HIV nhng em

b b m trn 1 thng

5 thng 3.5%

11 thng 7.0%

17 thng 8.9%

23 thng 10.3%

Miotti. JAMA 1999; 282: 744-9

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THC HNH SN KHOA TRONG PLTMC

Nguyn tc: Tun th cc nguyn tc v khun

Khng phn bit i x

Tip tc s dng ARV theo phc

m bo cuc chuyn d, sinh con an ton

cho m v con

Gim thiu s phi nhim ca thai nhi vi

cc dch c th ca ngi m

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THC HNH SN KHOA TRONG PLTMC

m bo cuc chuyn d, sinh con an ton: Tun th cc Hng dn Quc gia v cc

Dch v CSSKSS

Quan trng hng u:

tnh trng sn khoa ca m,

tnh trng thai,

tin trin ca chuyn d

T tin lng v quyt nh cc can thip

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THC HNH SN KHOA TRONG PLTMC

Gim s phi nhim ca

thai vi cc dch c th

ca ngi m: Lng dch c th m

(ngun phi nhim)

Thi gian phi nhim

Ro cn bo v

Sang chn, tn thng

tr (yu t thun li)

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THC HNH SN KHOA TRONG PLTMC

Da vo cc yu t tin lng ca cuc chuyn

d nh: yu t v m, yu t v thai v phn

ph thai, tin trin ca cuc chuyn d quyt

nh phng cch :

+ ng m o

+ M ly thai khi c ch nh sn khoa

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THC HNH SN KHOA

KHI THEO DI NG M O

Theo di ton trng:

Mch : 1gi /ln. Sau 15pht/ln/gi 1;

30pht/ln/gi 2; 1g/ln/4 gi

Huyt p : 1gi /ln

Nhit : 4gi /ln

Theo di yu t chuyn d:

cn co t cung,

tim thai

tin trin CTC, lt, v.v.

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THC HNH SN KHOA

KHI THEO DI NG M O

Khi thm khm m o:

St trng m h m o

Thao tc khm nh nhng trnh tn thng

Ch khm khi cn thit

Trnh tn thng, chy mu gim lng dch

c th m

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THC HNH SN KHOA

KHI THEO DI CUC CHUYN D

i c gi n cng. Bm i khi c t cung m ht

Duy tr ro cn bo v

Trnh chuyn d ko di Gim thi gian phi

nhim, nhng

Trnh can thip th thch (bm i lm nghim

php)

Nu ng : Ct tng sinh mn khi u lt

thp, TSM cng gin tt Gim chy mu, gim

ngun phi nhim

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THC HNH SN KHOA

KHI THEO DI CUC CHUYN D

Trnh can thip th thut

nh forceps, ventoux

(nu bt buc th ch tin

hnh khi iu kin)

gim sang chn tr,

gim phi nhim

Tr ra c lau kh dch trn c th. Nn tm ngay

cho tr gim dch c th m trn da tr

Ch ht dch nu cn thit, dng sonde mm gim

sang chn tr

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THC HNH SN KHOA

KHI M LY THAI

NGUYN TC:

M ly thai theo ch nh sn khoa (c bao gm trnh

th thut ng m o)

c tin hnh ti tuyn huyn tr ln

M ly thai c thc hin bi bc s c kinh

nghim

T vn cho sn ph v gia nh trc khi m: nguy

c phu thut, trit sn

V sinh chun b bnh nhn trc m, k thut m

nh cc trng hp m ly thai khc

Chm sc sau m nh mi sn ph khc

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THC HNH SN KHOA TRONG PLTMC

Trong thi gian nm lu sau sinh, t vn h tr la

chn dinh dng an ton cho tr:

Sa m hon ton, hoc

Sa thay th hon ton sa m

Xin trn trng cm n!