Bai 5 geu

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SIÊU ÂM CHẨN ĐOÁN THAI NGOÀI TCUNG TS. TẠ THỊ THANH THỦY BV HÙNG VƯƠNG

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  • SIU M CHN ON

    THAI NGOI T CUNG

    TS. T TH THANH THYBV HNG VNG

  • M U

    LL bbnh l gy ra do thai lnh l gy ra do thai lm tm t nnm ngom ngoi ni niimmc tc t cungcung

    TT ll ngngy cy cng tng do tng nng tng do tng no pho ph thai + sthai + sddng dng dng cng c tt cung:cung: 1,61,6 2 % thai k2 % thai k

    10% t10% t vong mvong m

    NgNgy nay: phy nay: pht hit hin sn sm thai ngom thai ngoi ti t cung cha cung chavv nhnh vvoo Siu m Siu m u d m u d m o vo vi i phn giphn gii caoi cao

    nh lnh lngng --hCG / mhCG / muu

  • M U

    Bnh cnh lm sng ca TNTC cng thay i

    T l v TNTC ngy cng gim

    Tng t l TNTC cha v c chn on sm

    gip cho nh lm sng c nhiu

    chn la cho iu tr

  • M U

    ccc trung tm c trung tm c trang bc trang b phng ti phng tinn

    chchn on on tn tt, TNTC khng cn lt, TNTC khng cn l bbnh l enh l e

    dda ma mng sng sng nh trng nh trc y nc y naa

    Siu m Siu m u d m u d m o chio chim u thm u th trong chtrong chnn

    oon vn v llm gim gim m ng kng k tt ll nni soii soi bbngng

    chchn on on TNTCn TNTC

  • TRIU CHNG LM SNG

    Thay i t khng c triu chng n nhng

    trng hp chong nng

    Tam chng tr kinh au bng ra huyt m

    o khng phi lc no cng hin din

    Bnh cnh i khi kh phn bit vi sy thai hoc

    st nhau sau no thai

  • Hin tng xut huytkhi thai lm t

  • TRIU CHNG LM SNG

    Khm lm sng: d chn on khi bnh nhn bchong mt mu Khng c gi tr nhng bnh nhn khng ctriu chngMt s t trng hp khm thy khi cnh tcung: khng th phn bit c vi nang c nngca bung trng trong nhng trng hp c thaitrong t cung bnh thng

  • DU HIU SIU M

    A. Thai trong t cung

    Siu m u d m o: chn on phn bit kh

    chnh xc gia c thai trong t cung bnh thng,

    thai trong t cung bt thng v thai ngoi t

    cung

    Siu m m o c th pht hin ti thai trong t

    cung khi c kch thc 2 4 mm, tng ng

    vi thai 33 34 ngy (k t ngy kinh cht)

  • DU HIU SIU M

    Nng -hCG/ mu 1000 mU/ml (theo IRP):

    thy c ti thai trong lng t cung

    Ti thai tht:

    nm khng i xng trong lng t cung

    c hnh nh ti thai kp (double decidual sac

    sign) to bi mng rng thnh (decidua vera) v

    mng rng bao (decidua capsularis).

    i vi ti thai 5 mm: khng c hnh nh ti

    thai kp

  • Ti thai kp

  • DU HIU SIU M

    Ti thai gi: do hin tng mu trong lng t

    cung v phn ng mng rng ca ni mc t

    cung

    nm chnh gia lng t cung v khng c hnh

    nh ti thai kp

    Khi c thai trong t cung c xc nh, kh

    nng c thai ngoi t cung i km l 1: 6000

    (heterotopic pregnancy)

  • DU HIU SIU M

    B. Khi cnh t cung

    Hnh nh kinh in: ti thai nm ngoi t cung,c phi thai v hot ng tim thai: chn onchc chn TNTC chim 17 21%

    Hnh nh khng in hnh: khng chn on chcchn TNTC:

    C hnh nh ging ti thai v phi thai nhngkhng thy hot ng ca tim thai

    Hoc ch thy hnh nh ging ti thai v ti nonhong

  • DU HIU SIU M

    Ti thai trng bn cnh t cung thng gp hn

    v cn phn bit vi nang hong th

    Khi nm cnh t cung v bung trng, cu trc

    phn m dy, phn m trng hoc hn hp: cho gi

    tr chn on dng tnh 63 100% ty theo kinh

    nghim v kh nng ca ngi lm siu m

  • DU HIU SIU M

    Khng tm thy khi cnh t cung: khng th

    loi tr TNTC khi nghi ng cn phi theo di

    nhiu ln

    Dch ti cng hoc dch vng chu: khng phi

    du hiu trung thnh ca TNTC (thai trong TC

    cng c dch vng chu)

  • Dch tui cung

  • DU HIU SIU M

    Trong tr Trong trng hng hp khp kh chchn on on vn v

    bbnh nhn khng cnh nhn khng c tritriu chu chng lmng lm

    ssng: cng: cn kn kt ht hpp --hCG vhCG v siu m siu m

    cc thth cho chcho chn on on chn chnh xnh xcc

  • SIU M DOPPLER

    Tng gi tr chn on khi cnh t cung: nu

    c hot ng mch mu trong khi u: cho

    nhiu kh nng chn on TNTC

    Biu sng Doppler: sng tm trng c

    khng lc km, tuy nhin nu khng lc tm

    trng cao cng khng loi tr thai

  • SIU M DOPPLER

    Hot ng mch mu trong khi thai ngoi tcung cn gip tin lng iu tr bo tn

    i vi nhng nh siu m c kinh nghim:ch cn siu m trng en cng chnon TNTC

  • SIU M DOPPLER

  • XT NGHIM SINH HA

    chnh xc ca siu m chn on c

    cng c nh vo xt nghim nh lng -hCG/

    mu

    Ch : c 2 h thng n v nh lng quc t

    chnh:

    1. First International Reference Preparation (IRP)

    2. Second International Standard (SIS)

    2 n v IRP = 1 n v SIS

  • XT NGHIM SINH HA

    nh lng progesterone trong mu khng

    gip ch nhiu trong vic chn on phn bit

    gia TNTC v thai trong t cung bt thng

    Nng -hCG / mu trong nhng trng hp

    thai ngoi t cung rt a dng: c th thay i

    t 14 mU/ml n 100.000 mU/ml

  • XT NGHIM SINH HA

    ng dng -hCG trong chn on phn bit

    TNTC v thai trong TC da vo thi gian bn

    hy ca -hCG:

    Nu < 1,4 ngy: kh nng sy thai (+++)

    Nu > 7 ngy: kh nng TNTC (+++)

    -hCG tng dn v khng thy thai trong t

    cung: cnh gic TNTC

  • XT NGHIM SINH HA

    -hCG c dng trong theo di v

    tin lng thai ngoi t cung cha v:

    nu nng -hCG gim dn: khng

    cn can thip iu tr

  • VAI TR CVAI TR CAA --hCG VhCG V PROGESTERONEPROGESTERONE

    S bin thin ca -hCG hu ch hn l mt hm

    lng c nh: thay i rt nhanh theo thi gian

    dng theo di TNTC

    Progesterone khng bin thin nhanh nh -

    hCG nn khng s dng theo di chn on

    TNTC

  • BIN THIN CA -hCG

    Thay i -hCG > 66% sau 48 gi: tiu chun

    chn on thai trong TC. Th d:

    Gi 0: -hCG 1.000 U/L

    Gi 48: -hCG 1.660 U/L

    Nh vy: t l tng -hCG sau 48 gi l 1,66

    chn on thai trong TC vi

    nhy 86%

    chuyn bit 94 %

  • PHC CHN ON

    NghiNghiGEUGEU

    SA/SA/ADAD

    --hCGhCG

    LLppllii

    --hCGhCG

    Tng< 0,87

    Tng1,66

    Tng< 1,66

    LLppllii

    SA/SA/AA

    Xc

    nh

    GIU

    XcnhGEU

    Lp li--hCGhCG

    nu tng> 0,87

    Thaithoitrin

    Gi 0 Gi 48 Ngy 7

    +GIU

    CnhgicGEU

    Theo di mi 48 gi

  • CC DNG KHC CATHAI NGOI T CUNG

    Thai vi trng

    Thai sng t cung (thai gc # thai on k)

    Thai c t cung

    Thai bng

    TNTC mn: huyt t thnh nang

    Thai bm vt m c

  • Thai sng TC

  • HTTN

  • Nhn x gc tri t cungv thai trong t cung

    Chn on phn bitnh vo Doppler :-khng lc cao-dng chy thp

  • THAI BM VT M C

    Mt dng khc ca thai ngoi t cung: thai

    ngoi t cung so m ly thai (thai bm

    VMC)

    Lu : thai bm VMC khng phi thai c

    t cung

  • Thai bm vt m c (thai VMC)

    l mt dng him gp ca thai lc ch

    do thai lm t ti m x so ca vt m ly thai c

    T bo nui xm ln c t cung nh nhng trnghp nhau ci rng lc:

    c nguy c cao gy bng huyt

    v t cung

    thm ch e da mng sng ngi ph n

    THAI BM VT M C

  • Thi im pht hin thai bm VMC: 5 n 16 tun

    tui thai ty trng hp

    Khong cch t ln m sanh trc n khi c thai

    bm VMC: 6 thng n 12 nm.

    Chn on lm sng ca thai bm VMC trong giai

    on sm thng rt kh khn

    chn on b tr hon n khi v t cung hay

    bnh nhn b xut huyt t nguy him tnh mng

    THAI BM VT M C

  • Chn on: cn da trn tin s m ly thai v

    nhng biu hin lm sng ca bnh nhn.

    Biu hin lm sng c th l xut huyt m o bt

    thng (t rt t n rt nhiu e da mng sng),

    hoc au bng.

    Yu t chn on quyt nh l siu m trng en 2

    chiu v Doppler

    THAI BM VT M C

  • Hnh nh siu m trng en

    Siu m qua ng m o:

    on di t cung phnh ln hn v c hin din

    ca khi phn m hn hp hoc i khi thy r

    hnh nh ti thai bm vo.

    Phn c t cung on di rt mng dng

    nh sp nt hoc v vo bng quang.

  • Tiu chun chn on thng gp:

    Bung t cung trng

    Knh c t cung trng

    Ti thai nm thnh trc on eo t cung

    trong khe h ca so c

    to nn hnh nh t on ca c t cungthnh trc trn mt ct dc gia

    Hnh nh ny gip chn on phn bit gia thaibm VMC vi thai on eo hoc thai c TC

    Hnh nh siu m trng en

  • C dng chy quanh lp t bo nui (nhau thaitng lai).

    Dng chy c khng lc thp v vn tc cao

    vn tc nh c th t > 20 cm/s

    S/D # 3

    RI # 0,5

    Du hiu ny gip chn on phn bit gia 1thai bm VMC sng vi 1 thai trong t cung cht.

    Siu m Doppler

  • Thai bm VMC: siu m trng en 2 chiu + Doppler

  • Lu : du hiu trt (sliding organ sign)

    Th hin: ti thai khng trt ra khi v tr ca n

    so vi mc gii hn ca c trong TC

    Cch lm: dng lc n nh u d m o kt

    hp vi n y TC.

    ng tc ny khng cn thit v i khi nguy

    him v c th to 1 p lc ln ti thai (hoc khi

    t mu) lm cho n b v ra

  • Phng tin chn on khc

    Siu m 3-4 chiu kt hp vi siu m 3D power

    Doppler

    MRI cho chn on rt d dng, tuy nhin khng

    nn s dng MRI lm cng c chn on thng

    quy

    Soi bng quang chn on kh nng xm nhp

    bng quang ca thai bm VMC vi hnh nh c

    hi

  • Khi mu t do thai VMC

  • Thai c nhau bm VMC