K\u1ebe HO\u1ea0CH H\u00d3A GIA \u0110\u00ccNH<\/b><\/p>\n
ThS. H\u00e0 V\u0103n Tu\u1ea5n<\/i>
\nB\u1ed9 m\u00f4n Ph\u1ee5 S\u1ea3n, Khoa Y D\u01b0\u1ee3c<\/i>
\nTr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc T\u00e2y Nguy\u00ean<\/i><\/p>\n
1. \u0110\u1ea0I C\u01af\u01a0NG<\/b><\/p>\n
K\u1ebf ho\u1ea1ch h\u00f3a gia \u0111\u00ecnh (KHHG\u0110) l\u00e0 n\u1ed7 l\u1ef1c c\u00f3 \u00fd th\u1ee9c c\u1ee7a c\u00e1c c\u00e1 nh\u00e2n \/ c\u1eb7p v\u1ee3 ch\u1ed3ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ed1 con mong mu\u1ed1n, kho\u1ea3ng c\u00e1ch sinh v\u00e0 th\u1eddi \u0111i\u1ec3m sinh th\u00f4ng qua vi\u1ec7c \u00e1p d\u1ee5ng hi\u1ec7u qu\u1ea3, an to\u00e0n bi\u1ec7n ph\u00e1p tr\u00e1nh thai ho\u1eb7c \u0111i\u1ec1u tr\u1ecb hi\u1ebfm mu\u1ed9n.<\/p>\n
Bi\u1ec7n ph\u00e1p tr\u00e1nh thai (BPTT) l\u00e0 c\u00f4ng c\u1ee5 th\u1ef1c hi\u1ec7n KHHG\u0110; ch\u1ecdn BPTT ph\u00f9 h\u1ee3p gi\u00fap cho vi\u1ec7c th\u1ef1c hi\u1ec7n KHHG\u0110 \u0111\u1ea1t hi\u1ec7u qu\u1ea3. Vi\u1ec7c ch\u1ecdn l\u1ef1a BPTT ph\u00f9 h\u1ee3p c\u1ea7n d\u1ef1a v\u00e0o ho\u00e0n c\u1ea3nh, t\u00e2m l\u00fd, tr\u00ecnh \u0111\u1ed9 hi\u1ec3u bi\u1ebft, t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a t\u1eebng \u0111\u1ed1i t\u01b0\u1ee3ng.<\/p>\n
Vai tr\u00f2 c\u1ee7a y t\u1ebf trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n KHHG\u0110 l\u00e0 t\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3 s\u1eed d\u1ee5ng d\u1ecbch v\u1ee5 m\u1ed9t c\u00e1ch an to\u00e0n v\u00e0 ph\u00f9 h\u1ee3p.<\/p>\n
2.\u00a0T\u01af V\u1ea4N K\u1ebe HO\u1ea0CH H\u00d3A GIA \u0110\u00ccNH<\/b><\/p>\n
2.1. Vai tr\u00f2 c\u1ee7a t\u01b0 v\u1ea5n KHHG\u0110:<\/b><\/p>\n
T\u01b0 v\u1ea5n KHHG\u0110 l\u00e0 qu\u00e1 tr\u00ecnh gi\u00fap \u0111\u1ee1 kh\u00e1ch h\u00e0ng t\u1ef1 quy\u1ebft \u0111\u1ecbnh v\u1ec1 sinh s\u1ea3n m\u1ed9t c\u00e1ch t\u1ef1 nguy\u1ec7n sau khi \u0111\u00e3 \u0111\u01b0\u1ee3c th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7. V\u00ec v\u1eady, t\u01b0 v\u1ea5n kh\u00f4ng ch\u1ec9 cung c\u1ea5p th\u00f4ng tin m\u00e0 c\u00f2n th\u1ea3o lu\u1eadn v\u1edbi kh\u00e1ch h\u00e0ng \u0111\u1ec3 gi\u00fap h\u1ecd \u0111\u1ea1t \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh ph\u00f9 h\u1ee3p. \u0110\u00e2y l\u00e0 m\u1ed9t h\u00ecnh th\u1ee9c truy\u1ec1n th\u00f4ng tr\u1ef1c ti\u1ebfp. M\u1ee5c \u0111\u00edch c\u1ee7a t\u01b0 v\u1ea5n KHHG\u0110 ph\u1ea3i xu\u1ea5t ph\u00e1t t\u1eeb nhu c\u1ea7u c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
T\u01b0 v\u1ea5n KHHG\u0110 gi\u00fap kh\u00e1ch h\u00e0ng c\u00f3 nh\u1eefng quy\u1ebft \u0111\u1ecbnh \u0111\u00fang \u0111\u1eafn b\u1edfi s\u1ef1 \u0111\u1ea3m b\u1ea3o r\u1eb1ng h\u1ecd nh\u1eadn v\u00e0 hi\u1ec3u \u0111\u01b0\u1ee3c \u0111\u1ea7y \u0111\u1ee7 nh\u1eefng th\u00f4ng tin m\u00e0 h\u1ecd c\u1ea7n \u0111\u1ec3 h\u1ecd t\u1ef1 quy\u1ebft \u0111\u1ecbnh, b\u1edfi s\u1ef1 gi\u00fap \u0111\u1ee1 h\u1ecd v\u1eadn d\u1ee5ng nh\u1eefng th\u00f4ng tin n\u00e0y v\u00e0o ho\u00e0n c\u1ea3nh ri\u00eang c\u1ee7a h\u1ecd \u0111\u1ec3 t\u1ea1o n\u00ean quy\u1ebft \u0111\u1ecbnh m\u1ed9t c\u00e1ch ho\u00e0n to\u00e0n t\u1ef1 nguy\u1ec7n.<\/p>\n
Khi kh\u00e1ch h\u00e0ng t\u1ef1 quy\u1ebft \u0111\u1ecbnh v\u1ec1 s\u1ef1 sinh s\u1ea3n c\u1ee7a h\u1ecd d\u1ef1a tr\u00ean nh\u1eefng th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7 v\u00e0 ch\u00ednh x\u00e1c, h\u1ecd s\u1ebd d\u1ec5 d\u00e0ng v\u1edbi s\u1ef1 l\u1ef1a ch\u1ecdn m\u00e0 h\u1ecd \u0111\u00e3 quy\u1ebft \u0111\u1ecbnh. Vai tr\u00f2 c\u1ee7a ng\u01b0\u1eddi t\u01b0 v\u1ea5n l\u00e0 t\u1ea1o n\u00ean m\u1ed9t s\u1ef1 ch\u1eafc ch\u1eafn r\u1eb1ng h\u1ecd bi\u1ebft t\u1ea5t c\u1ea3 nh\u1eefng l\u1ee3i \u00edch, nguy c\u01a1, t\u00e1c d\u1ee5ng ph\u1ee5 \u2026c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai c\u00f3 s\u1eb5n.<\/p>\n
T\u01b0 v\u1ea5n KHHG\u0110 gi\u00fap cho kh\u00e1ch h\u00e0ng t\u1ef1 l\u1ef1a ch\u1ecdn v\u00e0 ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p KHHG\u0110 t\u1ed1t nh\u1ea5t cho h\u1ecd. M\u1ed9t bi\u1ec7n ph\u00e1p KHHG\u0110 t\u1ed1t nh\u1ea5t l\u00e0 bi\u1ec7n ph\u00e1p an to\u00e0n cho kh\u00e1ch h\u00e0ng v\u00e0 kh\u00e1ch h\u00e0ng mu\u1ed1n s\u1eed d\u1ee5ng.<\/p>\n
2.2. C\u00e1c ph\u1ea9m ch\u1ea5t c\u1ea7n thi\u1ebft c\u1ee7a ng\u01b0\u1eddi t\u01b0 v\u1ea5n KHHG\u0110:<\/b><\/p>\n
2.2.1. T\u00f4n tr\u1ecdng kh\u00e1ch h\u00e0ng<\/b><\/p>\n
– T\u00f4n tr\u1ecdng kh\u00e1ch h\u00e0ng d\u00f9 cho h\u1ecd \u1edf b\u1ea5t c\u1ee9 th\u00e0nh ph\u1ea7n n\u00e0o.<\/p>\n
– L\u1eafng nghe nhu c\u1ea7u v\u00e0 \u00fd ki\u1ebfn c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
2.2.2. Th\u00f4ng c\u1ea3m v\u00e0 th\u1ea5u hi\u1ec3u \u0111\u1ed1i v\u1edbi kh\u00e1ch h\u00e0ng<\/b><\/p>\n
– T\u00ecm hi\u1ec3u t\u00e2m t\u01b0, mong mu\u1ed1n v\u00e0 th\u1ea5u hi\u1ec3u nhu c\u1ea7u c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
– C\u1ea7n ti\u1ebfp kh\u00e1ch h\u00e0ng \u1edf n\u01a1i ri\u00eang bi\u1ec7t, y\u00ean t\u0129nh, \u0111\u1ea3m b\u1ea3o t\u00edn ri\u00eang t\u01b0, b\u00ed m\u1eadt.<\/p>\n
2.2.3. Th\u00e0nh th\u1eadt v\u1edbi kh\u00e1ch h\u00e0ng<\/b><\/p>\n
– C\u1ea7n n\u00f3i s\u1ef1 th\u1eadt v\u1ec1 m\u1ecdi bi\u1ec7n ph\u00e1p tr\u00e1nh thai (BPTT), bao g\u1ed3m c\u1ea3 thu\u1eadn l\u1ee3i v\u00e0 kh\u00f4ng thu\u1eadn l\u1ee3i, t\u00e1c d\u1ee5ng ph\u1ee5, nguy c\u01a1 c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a bi\u1ec7n ph\u00e1p \u0111\u00f3.<\/p>\n
– Kh\u00f4ng t\u1eeb ch\u1ed1i cung c\u1ea5p th\u00f4ng tin cho kh\u00e1ch h\u00e0ng. N\u1ebfu th\u00f4ng tin \u0111\u00f3 ng\u01b0\u1eddi t\u01b0 v\u1ea5n ch\u01b0a n\u1eafm v\u1eefng th\u00ec h\u1eb9n tr\u1ea3 l\u1eddi sau.<\/p>\n
2.2.4. Th\u00f4ng tin r\u00f5 r\u00e0ng, c\u00f3 tr\u1ecdng t\u00e2m cho kh\u00e1ch h\u00e0ng<\/b><\/p>\n
– S\u1eed d\u1ee5ng c\u00e2u t\u1eeb ng\u1eafn, g\u1ecdn, \u0111\u01a1n gi\u1ea3n, h\u1ea1n ch\u1ebf d\u00f9ng t\u1eeb chuy\u00ean m\u00f4n.<\/p>\n
– S\u1eed d\u1ee5ng ph\u01b0\u01a1ng ti\u1ec7n h\u1ed7 tr\u1ee3: tranh, \u1ea3nh, m\u00f4 h\u00ecnh, hi\u1eb9ne v\u1eadt v\u00e0 khuy\u1ebfn kh\u00edch kh\u00e1ch h\u00e0ng quan s\u00e1t tr\u1ef1c ti\u1ebfp.<\/p>\n
– T\u00ecm hi\u1ec3u ph\u1ea3n h\u1ed3i c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
– T\u00f3m t\u1eaft, nh\u1ea5n m\u1ea1nh c\u00e1c quan \u0111i\u1ec3m quan tr\u1ecdng v\u00e0 n\u1ebfu c\u00f3 th\u1ec3 m\u1eddi kh\u00e1ch h\u00e0ng nh\u1eafc l\u1ea1i tr\u01b0\u1edbc khi k\u1ebft th\u00fac t\u01b0 v\u1ea5n.<\/p>\n
2.3. S\u00e1u b\u01b0\u1edbc t\u01b0 v\u1ea5n KHHG\u0110<\/b><\/p>\n
2.3.1. G\u1eb7p g\u1ee1<\/b><\/p>\n
–\u00a0<\/b>Ch\u00e0o h\u1ecfi, m\u1eddi ng\u1ed3i, t\u1ecf th\u00e1i \u0111\u1ed9 th\u00e2n m\u1eadt v\u00e0 b\u00ecnh \u0111\u1eb3ng, t\u1ea1o l\u00f2ng tin cho kh\u00e1ch h\u00e0ng<\/p>\n
– T\u1ef1 gi\u1edbi thi\u1ec7u v\u1ec1 b\u1ea3n th\u00e2n.<\/p>\n
2.3.2. G\u1ee3i h\u1ecfi<\/b><\/p>\n
–\u00a0<\/b>H\u1ecfi c\u00e1c th\u00f4ng tin li\u00ean quan \u0111\u1ebfn ho\u00e0n c\u1ea3nh, s\u1ee9c kh\u1ecfe, nhu c\u1ea7u tr\u00e1nh thai v\u00e0 b\u1ea3o v\u1ec7 k\u00e9p. Khai th\u00e1c ki\u1ebfn th\u1ee9c v\u00e0 h\u00e0nh vi hi\u1ec7n t\u1ea1i c\u1ee7a kh\u00e1ch h\u00e0ng v\u1ec1 c\u00e1c BPTT.<\/p>\n
– Ch\u00fa \u00fd l\u1eafng nghe, kh\u00f4ng s\u1ed1t ru\u1ed9t, tr\u00e1nh n\u00f3i nhi\u1ec1u.<\/p>\n
– Ph\u00e1t hi\u1ec7n nh\u1eefng nh\u1eadn th\u1ee9c sai l\u1ec7ch c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
– H\u1ecfi th\u00f4ng tin v\u1ec1 b\u1ea1o h\u00e0nh ph\u1ee5 n\u1eef, \u0111\u1eb7c bi\u1ec7t v\u1edbi kh\u00e1ch h\u00e0ng kh\u00f4ng s\u1eed d\u1ee5ng BPTT m\u1eb7c d\u00f9 kh\u00f4ng mu\u1ed1n c\u00f3 thai.<\/p>\n
2.3.3. Gi\u1edbi thi\u1ec7u<\/b><\/p>\n
– Gi\u1edbi thi\u1ec7u v\u1ec1 b\u1ea3o v\u1ec7 k\u00e9p:\u00a0tr\u00e1nh thai<\/i>\u00a0v\u00e0\u00a0ph\u00f2ng b\u1ec7nh l\u00e2y qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c<\/i>.<\/p>\n
– Gi\u1edbi thi\u1ec7u c\u00e1c BPTT hi\u1ec7n c\u00f3 \u1edf c\u01a1 s\u1edf v\u00e0 \u1edf th\u1ecb tr\u01b0\u1eddng.<\/p>\n
– Cung c\u1ea5p \u0111\u1ea7y \u0111\u1ee7 th\u00f4ng tin v\u1ec1 c\u1ea3 \u01b0u \u0111i\u1ec3m v\u00e0 nh\u01b0\u1ee3c \u0111i\u1ec3m; c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 tai bi\u1ebfn c\u00f3 th\u1ec3 g\u1eb7p c\u1ee7a BPTT. B\u00e0n v\u1ec1 nhu c\u1ea7u tr\u00e1nh thai v\u00e0 nhu c\u1ea7u ph\u00f2ng nhi\u1ec5m khu\u1ea9n l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t \u00ec n h d \u1ee5 c (NKLTQ\u0110TD).<\/p>\n
– T\u1eadp trung v\u00e0o v\u1ea5n \u0111\u1ec1 kh\u00e1ch h\u00e0ng quan t\u00e2m, gi\u1ea3i th\u00edch khi kh\u00e1ch h\u00e0ng hi\u1ec3u sai.<\/p>\n
2.3.4. Gi\u00fap \u0111\u1ee1<\/b><\/p>\n
– Gi\u00fap cho kh\u00e1ch h\u00e0ng t\u1ef1 l\u1ef1a ch\u1ecdn BPTT ph\u00f9 h\u1ee3p nh\u1ea5t.<\/p>\n
– Kh\u00f4ng \u00e1p \u0111\u1eb7t theo \u00fd ki\u1ebfn ch\u1ee7 quan c\u1ee7a m\u00ecnh.<\/p>\n
– N\u1ebfu kh\u00e1ch h\u00e0ng ch\u1ecdn BPTT kh\u00f4ng ph\u00f9 h\u1ee3p v\u00ec ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh th\u00ec g\u00f3p \u00fd cho kh\u00e1ch h\u00e0ng t\u00ecm BPTT kh\u00e1c.<\/p>\n
2.3.5. Gi\u1ea3i th\u00edch<\/b><\/p>\n
– Khi kh\u00e1ch h\u00e0ng ch\u1ea5p nh\u1eadn m\u1ed9t BPTT, gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 h\u01a1n v\u1ec1 c\u00e1ch s\u1eed d\u1ee5ng.<\/p>\n
– Ch\u1ec9 d\u1eabn qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n v\u00e0 c\u00e1c th\u1ee7 t\u1ee5c \u0111\u1ec3 ti\u1ebfn h\u00e0nh (v\u1edbi c\u00e1c BPTT l\u00e2m s\u00e0ng nh\u01b0 d\u1ee5ng c\u1ee5 t\u1eed cung, tri\u1ec7t s\u1ea3n).<\/p>\n
– Gi\u1ea3i th\u00edch nh\u1eefng nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn th\u1ea5t b\u1ea1i v\u00e0 c\u00e1ch ph\u00f2ng tr\u00e1nh.<\/p>\n
– N\u00f3i r\u00f5 nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ee7a t\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 c\u00e1ch x\u1eed tr\u00ed t\u1ea1i nh\u00e0.<\/p>\n
– N\u00eau cho kh\u00e1ch h\u00e0ng bi\u1ebft nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o v\u00e0 c\u00e1ch x\u1eed tr\u00ed.<\/p>\n
– N\u00f3i r\u00f5 m\u1ee9c \u0111\u1ed9 ph\u1ee5c h\u1ed3i c\u1ee7a BPTT.<\/p>\n
– Gi\u1ea3i th\u00edch t\u1ea1i sao c\u1ea7n c\u00f3 ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 v\u00e0 khuy\u00ean th\u1ef1c hi\u1ec7n \u0111\u1ea7y \u0111\u1ee7.<\/p>\n
– Gi\u1ea3i th\u00edch m\u1ed9t c\u00e1ch th\u1ecfa \u0111\u00e1ng nh\u1eefng hi\u1ec3u bi\u1ebft sai l\u1ec7ch c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
– Sau khi gi\u1ea3i th\u00edch, h\u1ecfi l\u1ea1i kh\u00e1ch h\u00e0ng \u0111\u1ec3 c\u00f3 ph\u1ea3n h\u1ed3i.<\/p>\n
2.3.6. (H\u1eb9n) G\u1eb7p l\u1ea1i<\/b><\/p>\n
– Tr\u01b0\u1edbc khi ch\u00e0o t\u1ea1m bi\u1ec7t, d\u1eb7n d\u00f2 kh\u00e1ch h\u00e0ng, h\u1eb9n kh\u00e1m ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 v\u00e0 khi c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng c\u00f3 th\u1ec3 quay tr\u1edf l\u1ea1i b\u1ea5t k\u1ef3 l\u00fac n\u00e0o.<\/p>\n
– Cung c\u1ea5p t\u00e0i li\u1ec7u truy\u1ec1n th\u00f4ng.<\/p>\n
Ch\u00fa \u00fd: Tr\u1eeb b\u01b0\u1edbc v\u00e0 6, c\u00e1c b\u01b0\u1edbc c\u00f2n l\u1ea1i c\u1ea7n \u00e1p d\u1ee5ng linh ho\u1ea1t, xen k\u1ebd v\u00e0 b\u1ed5 sung cho nhau.<\/p>\n
2.4. C\u00e1c k\u1ef9 n\u0103ng t\u01b0 v\u1ea5n c\u01a1 b\u1ea3n<\/b><\/p>\n
2.4.1. K\u1ef9 n\u0103ng ti\u1ebfp \u0111\u00f3n<\/b><\/p>\n
– Ch\u00e0o h\u1ecfi kh\u00e1ch h\u00e0ng v\u00e0 t\u1ef1 gi\u1edbi thi\u1ec7u nh\u1eb1m t\u1ea1o s\u1ef1 th\u00e2n m\u1eadt.<\/p>\n
– Ti\u1ebfp x\u00fac c\u1ea3 b\u1eb1ng \u0111\u1ed1i tho\u1ea1i l\u1eabn c\u1eed ch\u1ec9 (vui v\u1ebb, ch\u0103m ch\u00fa, s\u1eb5n l\u00f2ng).<\/p>\n
2.4.2. K\u1ef9 n\u0103ng l\u1eafng nghe<\/b><\/p>\n
– Ki\u00ean tr\u00ec l\u1eafng nghe \u0111\u1ec3 hi\u1ec3u r\u00f5 nguy\u00ean nh\u00e2n c\u1ee7a c\u00e1c v\u1ea5n \u0111\u1ec1, c\u00e1c lo l\u1eafng v\u00e0 mong mu\u1ed1n c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
– Ch\u00fa \u00fd l\u1eafng nghe l\u00e0m cho kh\u00e1ch h\u00e0ng c\u1ea3m th\u1ea5y v\u1ea5n \u0111\u1ec1 c\u1ee7a h\u1ecd \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft, t\u00f4n tr\u1ecdng v\u00e0 th\u00f4ng c\u1ea3m, nh\u1edd \u0111\u00f3 gi\u1ea3m \u0111\u01b0\u1ee3c s\u1ef1 c\u0103ng th\u1eb3ng, b\u1ea5t an.<\/p>\n
– Ch\u1ea5p nh\u1eadn m\u1ecdi \u0111i\u1ec1u kh\u00e1ch h\u00e0ng n\u00f3i, kh\u00f4ng b\u00e1c b\u1ecf ho\u1eb7c ph\u00ea ph\u00e1n m\u00e0 c\u1ea7n t\u00ecm hi\u1ec3u s\u1ef1 lo \u00e2u c\u1ee7a kh\u00e1ch h\u00e0ng.<\/p>\n
– Ki\u00ean tr\u00ec n\u1ebfu kh\u00e1ch h\u00e0ng c\u00f3 th\u1eafc m\u1eafc, do d\u1ef1, kh\u00f3c l\u00f3c ho\u1eb7c b\u1ef1c t\u1ee9c.<\/p>\n
2.4.3. K\u1ef9 n\u0103ng giao ti\u1ebfp<\/b><\/p>\n
– Theo d\u00f5i c\u00e2u chuy\u1ec7n c\u1ee7a kh\u00e1ch h\u00e0ng b\u1eb1ng c\u00e1c \u0111i\u1ec7u b\u1ed9 ph\u00f9 h\u1ee3p nh\u01b0 ti\u1ebfp x\u00fac b\u1eb1ng \u00e1nh m\u1eaft, g\u1eadt \u0111\u1ea7u…<\/p>\n
– Ng\u01b0\u1eddi t\u01b0 v\u1ea5n c\u1ea7n quan s\u00e1t ph\u1ea3n \u1ee9ng c\u1ee7a kh\u00e1ch h\u00e0ng. C\u1ed1 g\u1eafng t\u00ecm hi\u1ec3u l\u00fd do g\u00e2y n\u00ean th\u00e1i \u0111\u1ed9 c\u1ee7a kh\u00e1ch h\u00e0ng \u0111\u1ed1i v\u1edbi v\u1ea5n \u0111\u1ec1 c\u1ee7a m\u00ecnh (nh\u01b0 l\u00fang t\u00fang, lo l\u1eafng, t\u1ee9c gi\u1eadn, tuy\u1ec7t v\u1ecdng…).K\u1ec3 cho kh\u00e1ch h\u00e0ng nghe m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p th\u1ef1c t\u1ebf \u0111\u1ec3 t\u1ea1o c\u01a1 h\u1ed9i cho kh\u00e1ch h\u00e0ng n\u00f3i.<\/p>\n
– C\u00e1n b\u1ed9 t\u01b0 v\u1ea5n ph\u1ea3i c\u00f3 k\u1ef9 n\u0103ng s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n th\u00f4ng tin, gi\u00e1o d\u1ee5c truy\u1ec1n th\u00f4ng.<\/p>\n
2.4.4. K\u1ef9 n\u0103ng gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1<\/b><\/p>\n
– C\u1ea7n ph\u1ea3i x\u00e1c \u0111\u1ecbnh b\u1ea3n ch\u1ea5t c\u1ee7a v\u1ea5n \u0111\u1ec1.<\/p>\n
– X\u00e1c \u0111\u1ecbnh c\u00e1c nguy c\u01a1 ho\u1eb7c h\u00e0nh vi kh\u00f4ng \u0111\u00fang, khuy\u1ebfn kh\u00edch kh\u00e1ch h\u00e0ng nh\u00ecn nh\u1eadn l\u1ea1i nh\u1eefng quan ni\u1ec7m, t\u01b0 duy c\u1ee7a m\u00ecnh v\u00e0 t\u00ecm c\u00e1ch thay \u0111\u1ed5i n\u1ebfu c\u1ea7n thi\u1ebft.<\/p>\n
– T\u00edch c\u1ef1c t\u00ecm ki\u1ebfm c\u00e1c gi\u1ea3i ph\u00e1p kh\u00e1c nhau, trong m\u1ed7i gi\u1ea3i ph\u00e1p \u0111\u00f3 kh\u00f4ng ch\u1ec9 n\u00eau \u01b0u \u0111i\u1ec3m thu\u1eadn l\u1ee3i m\u00e0 c\u00f2n ph\u1ea3i n\u00f3i r\u00f5 c\u00e1c \u0111i\u1ec1u kh\u00f4ng thu\u1eadn l\u1ee3i, th\u1eadm ch\u00ed c\u00f3 nh\u1eefng r\u1ee7i ro, bi\u1ebfn ch\u1ee9ng \u0111\u1ec3 kh\u00e1ch h\u00e0ng suy ngh\u0129, l\u1ef1a ch\u1ecdn.<\/p>\n
– Gi\u00fap kh\u00e1ch h\u00e0ng xem x\u00e9t t\u1eebng gi\u1ea3i ph\u00e1p v\u00e0 quy\u1ebft \u0111\u1ecbnh \u00e1p d\u1ee5ng gi\u1ea3i ph\u00e1p ph\u00f9 h\u1ee3p nh\u1ea5t, nh\u01b0ng kh\u00f4ng \u00e1p \u0111\u1eb7t kh\u00e1ch h\u00e0ng ph\u1ea3i theo \u00fd ki\u1ebfn c\u1ee7a m\u00ecnh.<\/p>\n
– \u0110\u1ea3m b\u1ea3o v\u1edbi kh\u00e1ch r\u1eb1ng h\u1ecd lu\u00f4n \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 khi t\u00ecm v\u00e0 th\u1ef1c hi\u1ec7n gi\u1ea3i ph\u00e1p.<\/p>\n
– \u0110\u00f4i khi c\u00e1n b\u1ed9 t\u01b0 v\u1ea5n c\u1ea7n gi\u00fap kh\u00e1ch h\u00e0ng c\u00f3 \u0111\u01b0\u1ee3c nh\u1eefng k\u1ef9 n\u0103ng m\u1edbi nh\u01b0 k\u1ef9 n\u0103ng trao \u0111\u1ed5i v\u1ec1 t \u00ec n h d \u1ee5 c an to\u00e0n.<\/p>\n
3. BI\u1ec6N PH\u00c1P TR\u00c1NH THAI<\/b><\/p>\n
3.1. Ph\u00e2n lo\u1ea1i:<\/b><\/p>\n
3.1.1. BPTT t\u1ea1m th\u1eddi<\/b><\/p>\n
– D\u00e0nh cho n\u1eef:<\/p>\n
+ Thu\u1ed1c n\u1ed9i ti\u1ebft tr\u00e1nh thai;<\/p>\n
+ D\u1ee5ng c\u1ee5 t\u1eed cung tr\u00e1nh thai;<\/p>\n
+ V\u00f4 kinh cho b\u00fa (LAM \u2013 Lactational amenorrhea method);<\/p>\n
+ Thu\u1ed1c di\u1ec7t tinh tr\u00f9ng;<\/p>\n
+ M\u00e0ng ng\u0103n \u00e2 m \u0111 \u1ea1 o, m\u0169 c\u1ed5 t\u1eed cung, bao cao su n\u1eef.<\/p>\n
+ Ki\u00eang giao h\u1ee3p \u0111\u1ecbnh k\u1ef3 (tr\u00e1nh ng\u00e0y ph\u00f3ng no\u00e3n v\u00e0 quanh ng\u00e0y ph\u00f3ng no\u00e3n).<\/p>\n
– D\u00e0nh cho nam:<\/p>\n
+ Bao cao su nam;<\/p>\n
+ Xu\u1ea5t tinh ra ngo\u00e0i (giao h\u1ee3p gi\u00e1n \u0111o\u1ea1n).<\/p>\n
3.1.2. BPTT v\u0129nh vi\u1ec5n<\/b><\/p>\n
– \u0110\u00ecnh s\u1ea3n nam;<\/p>\n
– \u0110\u00ecnh s\u1ea3n n\u1eef.<\/p>\n
3.2. Thu\u1ed1c n\u1ed9i ti\u1ebft tr\u00e1nh thai<\/b><\/p>\n
3.1.1. Ph\u00e2n lo\u1ea1i:<\/b><\/p>\n
T\u00f9y theo th\u00e0nh ph\u1ea7n thu\u1ed1c, thu\u1ed1c n\u1ed9i ti\u1ebft tr\u00e1nh thai (NTTT) \u0111\u01b0\u1ee3c x\u1ebfp th\u00e0nh 2 lo\u1ea1i:<\/p>\n
– Thu\u1ed1c NTTT ch\u1ec9 ch\u1ee9a progestin;<\/p>\n
– Thu\u1ed1c NTTT ph\u1ed1i h\u1ee3p ch\u1ee9a estrogen v\u00e0 progestin.<\/p>\n
Estrogen th\u01b0\u1eddng d\u00f9ng l\u00e0 ethynyl-estradiol (li\u1ec1u cao: 50mcg\/vi\u00ean; li\u1ec1u th\u1ea5p: 30mcg ho\u1eb7c 20mcg\/vi\u00ean).<\/p>\n
Progestin g\u1ed3m nh\u1eefng lo\u1ea1i sau:<\/p>\n
+ Th\u1ebf h\u1ec7 1 (t\u1ed5ng h\u1ee3p t\u1eeb 1960s): Norethisteron, Ethynodiol, Lynestrenol, Norethynodrel;<\/p>\n
+ Th\u1ebf h\u1ec7 2 (t\u1ed5ng h\u1ee3p t\u1eeb 1970s): Levonorgestrel, Norgestrel;<\/p>\n
+ Th\u1ebf h\u1ec7 3 (t\u1ed5ng h\u1ee3p t\u1eeb 1980s): Desogestrel, Gestoden, Norgestimate;<\/p>\n
+ Progestin (t\u1eeb \u0111\u1ea7u TK21) ch\u01b0a \u0111\u01b0\u1ee3c x\u1ebfp lo\u1ea1i: Cyproteron acetat, drospirenon.<\/p>\n
C\u00e1c Progestin th\u1ebf h\u1ec7 1, ngo\u00e0i t\u00e1c d\u1ee5ng nh\u01b0 progesteron, c\u00f2n mang nhi\u1ec1u t\u00e1c d\u1ee5ng c\u1ee7a androgen n\u00ean c\u00f3 t\u00e1c d\u1ee5ng nam h\u00f3a kh\u00f4ng mong mu\u1ed1n. \u0110\u1ed1i v\u1edbi progestin nh\u1eefng th\u1ebf h\u1ec7 sau, ng\u00e0y c\u00e0ng gi\u1ea3m t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y.\u0110\u1eb7c bi\u1ec7t, c\u00f3 c\u00e1c progestin m\u1edbi nh\u01b0: Chlormadinon acetat, Dienogest, Cyproteron acetat (CPA) v\u00e0 Drospirenon c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng adrogen. Drospirenon c\u00f3 ho\u1ea1t t\u00ednh d\u01b0\u1ee3c l\u00fd g\u1ea7n gi\u1ed1ng progesteron thi\u00ean nhi\u00ean, kh\u00e1ng androgen, kh\u00e1ng mineralocorticoids n\u00ean c\u00f3 \u1ea3nh h\u01b0\u1edfng t\u1ed1t tr\u00ean tim m\u1ea1ch.<\/p>\n
C\u00f3 nhi\u1ec1u d\u1ea1ng th\u1ee9c ph\u1ed1i h\u1ee3p estrogen v\u00e0 progestin trong v\u0129 thu\u1ed1c NTTT u\u1ed1ng:<\/p>\n
+ Vi\u00ean k\u1ebft h\u1ee3p c\u00f3 h\u00e0m l\u01b0\u1ee3ng estrogen & progestin gi\u1ed1ng nhau;<\/p>\n
+ D\u1ea1ng k\u1ebf ti\u1ebfp: nh\u1eefng vi\u00ean \u0111\u1ea7u ch\u1ec9 c\u00f3 estrogen, nh\u1eefng vi\u00ean sau ph\u1ed1i h\u1ee3p estrogen & progestin;<\/p>\n
+ Hai pha: h\u00e0m l\u01b0\u1ee3ng estrogen & progestin thay \u0111\u1ed5i 1 l\u1ea7n trong v\u1ec9 thu\u1ed1c;<\/p>\n
+ Ba pha: h\u00e0m l\u01b0\u1ee3ng estrogen & progestin thay \u0111\u1ed5i 2 l\u1ea7n trong v\u1ec9 thu\u1ed1c.<\/p>\n
T\u00f9y thu\u1ed9c v\u00e0o \u0111\u01b0\u1eddng d\u00f9ng, thu\u1ed1c NTTT c\u00f3 nh\u1eefng d\u1ea1ng sau:<\/p>\n
– Vi\u00ean thu\u1ed1c u\u1ed1ng;<\/p>\n
– Thu\u1ed1c ti\u00eam;<\/p>\n
– Mi\u1ebfng d\u00e1n da;<\/p>\n
– Que c\u1ea5y d\u01b0\u1edbi da;<\/p>\n
– V\u00f2ng \u00e2 m \u0111 \u1ea1 o;<\/p>\n
– D\u1ee5ng c\u1ee5 t\u1eed cung.<\/p>\n
3.1.2. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/b><\/p>\n
– \u1ee8c ch\u1ebf ph\u00f3ng no\u00e3n: Ethynyl-estradiol \u1ee9c ch\u1ebf FSH, progestin \u1ee9c ch\u1ebf s\u1ef1 xu\u1ea5t hi\u1ec7n \u0111\u1ec9nh LH, do \u0111\u00f3 ng\u0103n ng\u1eeba s\u1ef1 ph\u00f3ng no\u00e3n. Ngo\u00e0i ra, ng\u01b0\u1eddi s\u1eed d\u1ee5ng thu\u1ed1c NTTT d\u1ea1ng ph\u1ed1i h\u1ee3p c\u00f3 \u0111\u00e1p \u1ee9ng ch\u1ebf ti\u1ebft FSH v\u00e0 LH c\u1ee7a tuy\u1ebfn y\u00ean b\u1edfi GnRH c\u0169ng gi\u1ea3m.<\/p>\n
– Ng\u0103n c\u1ea3n s\u1ef1 di chuy\u1ec3n tinh tr\u00f9ng qua c\u1ed5 t\u1eed cung: Progestin c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m cho c\u1ed5 t\u1eed cung kh\u00f4ng h\u00e9 m\u1edf, ni\u00eam d\u1ecbch \u00edt v\u00e0 \u0111\u1ed9 d\u00ednh gi\u1ea3m kh\u00f4ng thu\u1eadn l\u1ee3i cho tinh tr\u00f9ng x\u00e2m nh\u1eadp qua c\u1ed5 t\u1eed cung. \u0110\u00e2y l\u00e0 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu c\u1ee7a thu\u1ed1c NTTT ch\u1ec9 c\u00f3 progestin li\u1ec1u th\u1ea5p, li\u00ean t\u1ee5c.<\/p>\n
– Thay \u0111\u1ed5i nhu \u0111\u1ed9ng v\u00f2i TC: Thu\u1ed1c l\u00e0m t\u0103ng ho\u1eb7c gi\u1ea3m nhu \u0111\u1ed9ng c\u1ee7a v\u00f2i t\u1eed cung l\u00e0m cho tr\u1ee9ng th\u1ee5 tinh di chuy\u1ec3n \u0111\u1ebfn bu\u1ed3ng t\u1eed cung \u1edf th\u1eddi \u0111i\u1ec3m kh\u00f4ng th\u00edch h\u1ee3p \u0111\u1ec3 l\u00e0m t\u1ed5.<\/p>\n
– Ng\u0103n c\u1ea3n s\u1ef1 l\u00e0m t\u1ed5 c\u1ee7a tr\u1ee9ng: Thu\u1ed1c l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00ecnh th\u00e1i t\u1ed5 ch\u1ee9c \u0111i\u1ec3n h\u00ecnh \u1edf ni\u00eam m\u1ea1c t\u1eed cung, g\u00e2y c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh l\u00e0m t\u1ed5 c\u1ee7a tr\u1ee9ng th\u1ee5 tinh.<\/p>\n
Nh\u01b0 v\u1eady, thu\u1ed1c NTTT c\u00f3 t\u00e1c d\u1ee5ng l\u00ean 3 n\u01a1i:<\/p>\n
+ Trung t\u00e2m h\u1ea1 \u0111\u1ed3i \u2013 tuy\u1ebfn y\u00ean;<\/p>\n
+ N\u1ed9i m\u1ea1c t\u1eed cung;<\/p>\n
+ Ch\u1ea5t nh\u1ea7y c\u1ed5 t\u1eed cung.<\/p>\n
3.1.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/b><\/p>\n
– Ph\u1ee5 n\u1eef t\u1eeb 35tu\u1ed5i tr\u1edf l\u00eanc\u00f3 h\u00fat thu\u1ed1c th\u01b0\u1eddng xuy\u00ean;<\/p>\n
– C\u00f3 nguy c\u01a1 b\u1ec7nh m\u1ea1ch v\u00e0nh (h\u00fat thu\u1ed1c, \u0111\u00e1i \u0111\u01b0\u1eddng, THA);<\/p>\n
– \u0110\u00e3 ho\u1eb7c \u0111ang b\u1ecb b\u1ec7nh tim m\u1ea1ch, \u0111\u00f4ng m\u00e1u, thuy\u00ean t\u1eafc m\u1ea1ch;<\/p>\n
– B\u1ec7nh chuy\u1ec3n h\u00f3a, b\u1ec7nh n\u1ed9i ti\u1ebft;<\/p>\n
– Ung th\u01b0 ho\u1eb7c nghi ng\u1edd ung th\u01b0 v\u00fa, ung th\u01b0 c\u1ed5 t\u1eed cung;<\/p>\n
– Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n;<\/p>\n
– Suy gi\u1ea3m ch\u1ee9c n\u0103ng gan n\u1eb7ng;<\/p>\n
– Ung th\u01b0 n\u1ed9i m\u1ea1c ho\u1eb7c t\u00e2n sinh l\u1ec7 thu\u1ed9c estrogen (lo\u1ea1i c\u00f3 estrogen);<\/p>\n
– \u0110ang cho con b\u00fa (lo\u1ea1i c\u00f3 estrogen).<\/p>\n
3.1.4. Ch\u1ec9 \u0111\u1ecbnh ng\u01b0ng thu\u1ed1c:<\/b><\/p>\n
– C\u00f3 thai ho\u1eb7c nghi ng\u1edd c\u00f3 thai;<\/p>\n
– Mu\u1ed1n c\u00f3 thai;<\/p>\n
– Mu\u1ed1n thay \u0111\u1ed5i BPTT;<\/p>\n
– Kh\u00f4ng ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5;<\/p>\n
– Xu\u1ea5t hi\u1ec7n ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n
– Nh\u1eefng t\u00ecnh hu\u1ed1ng c\u1ea7n ph\u1ea3i \u0111\u00e1nh gi\u00e1 l\u1ea1i xem thu\u1ed1c c\u00f3 ph\u00f9 h\u1ee3p kh\u00f4ng:<\/p>\n
+ V\u00f4 kinh, thi\u1ec3u kinh;<\/p>\n
+ Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng;<\/p>\n
+ \u0110au v\u00fa nhi\u1ec1u.<\/p>\n
3.1.6. Nh\u1eefng l\u1ee3i \u0111i\u1ec3m v\u00e0 b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c NTTT<\/b><\/p>\n
3.1.6.1. Lo\u1ea1i thu\u1ed1c NTTT ph\u1ed1i h\u1ee3p<\/b><\/p>\n
– L\u1ee3i \u0111i\u1ec3m:<\/p>\n
+ \u00cdt g\u00e2y r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t;<\/p>\n
+ Gi\u1ea3m h\u1ed9i ch\u1ee9ng ti\u1ec1n kinh;<\/p>\n
+ Duy tr\u00ec v\u00e0 c\u1ea3i thi\u1ec7n m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng;<\/p>\n
+ Hi\u1ec7u qu\u1ea3 tr\u00e1nh thai cao (ch\u1ec9 s\u1ed1 Pearl: 0,2-0,4) v\u00e0 c\u00f3 h\u1ed3i ph\u1ee5c.<\/p>\n
– B\u1ea5t l\u1ee3i:<\/p>\n
+ T\u00e1c d\u1ee5ng ph\u1ee5: n\u00f4n, c\u0103ng v\u00fa, nh\u1ee9c \u0111\u1ea7u…<\/p>\n
+ Nguy c\u01a1 t\u1eafc m\u1ea1ch;<\/p>\n
+ Nhi\u1ec1u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh li\u00ean quan estrogen;<\/p>\n
+ T\u00e1c d\u1ee5ng tr\u00e1nh thai gi\u1ea3m khi qu\u00ean thu\u1ed1c.<\/p>\n
3.1.6.2. Lo\u1ea1i thu\u1ed1c NTTT ch\u1ec9 ch\u1ee9a progestin<\/b><\/p>\n
– L\u1ee3i \u0111i\u1ec3m:<\/p>\n
+ Kh\u00f4ng \u1ea3nh h\u01b0\u1edfng s\u1eefa m\u1eb9;<\/p>\n
+ Ph\u00f9 h\u1ee3p \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbiestrogen;<\/p>\n
+ Hi\u1ec7u qu\u1ea3 tr\u00e1nh thai c\u00f3 h\u1ed3i ph\u1ee5c;<\/p>\n
+ C\u00f3 nhi\u1ec1u d\u1ea1ng thu\u1ed1c v\u00e0 c\u00e1ch d\u00f9ng.<\/p>\n
– B\u1ea5t l\u1ee3i:<\/p>\n
+ Hay g\u00e2y r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t;<\/p>\n
+ Hi\u1ec7u qu\u1ea3 tr\u00e1nh thai kh\u00f4ng cao b\u1eb1ng d\u1ea1ng ph\u1ed1i h\u1ee3p;<\/p>\n
+ T\u00e1c d\u1ee5ng gi\u1ea3m khi qu\u00ean thu\u1ed1c.<\/p>\n
3.1.6.3. C\u00e1ch s\u1eed d\u1ee5ng thu\u1ed1c NTTT d\u1ea1ng vi\u00ean u\u1ed1ng h\u00e0ng ng\u00e0y<\/b><\/p>\n
– M\u1ed7i ng\u00e0y 1v, b\u1ea5t \u0111\u1ea7u trong 5 ng\u00e0y \u0111\u1ea7u c\u1ee7a k\u1ef3 kinh.<\/p>\n
– Ph\u1ea3i d\u00f9ng theo tr\u00ecnh t\u1ef1 vi\u00ean thu\u1ed1c nh\u1ea5t \u0111\u1ecbnh theo m\u0169i t\u00ean tr\u00ean v\u0129 thu\u1ed1c \u0111\u1ed1i v\u1edbi lo\u1ea1i 2 pha, 3 pha ho\u1eb7c lo\u1ea1i k\u1ebf ti\u1ebfp.<\/p>\n
– Thu\u1ed1c ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 sau 1 tu\u1ea7n.<\/p>\n
– \u0110\u1ed1i v\u1edbi v\u0129 21 vi\u00ean: ng\u01b0ng thu\u1ed1c 7 ng\u00e0y tr\u01b0\u1edbc khi sang v\u0129 m\u1edbi. \u0110\u1ed1i v\u1edbi v\u0129 28 vi\u00ean: 7 vi\u00ean cu\u1ed1i, kh\u00e1c m\u00e0u l\u00e0 vi\u00ean gi\u1ea3 d\u01b0\u1ee3c (vi\u00ean s\u1eaft) \u0111\u1ec3 tr\u00e1nh qu\u00ean thu\u1ed1c, n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng li\u00ean t\u1ee5c kh\u00f4ng ph\u1ea3i ng\u01b0ng u\u1ed1ng 7 ng\u00e0y nh\u01b0 \u0111\u1ed1i v\u1edbi v\u0129 21 vi\u00ean.<\/p>\n
– N\u1ebfu qu\u00ean 1 ng\u00e0y: u\u1ed1ng b\u00f9 ngay 1v v\u00e0 sau \u0111\u00f3 ti\u1ebfp t\u1ee5c u\u1ed1ng nh\u01b0 th\u01b0\u1eddng l\u1ec7. Qu\u00ean 2 ng\u00e0y: c\u00e1ch 1) b\u1ecf v\u0129 thu\u1ed1c, s\u1eed d\u1ee5ng BPTT kh\u00e1c;khi c\u00f3 kinh l\u1ea1i d\u00f9ng v\u0129 kh\u00e1c t\u1eeb vi\u00ean \u0111\u1ea7u ho\u1eb7c c\u00e1ch 2) d\u00f9ng b\u00f9 2 ng\u00e0y li\u00ean ti\u1ebfp sau \u0111\u00f3 d\u00f9ng nh\u01b0 th\u01b0\u1eddng l\u1ec7 (ph\u1ed1i h\u1ee3p BPTT kh\u00e1c trong 7 ng\u00e0y). Qu\u00ean > 2 ng\u00e0y: b\u1ecf v\u0129 thu\u1ed1c, s\u1eed d\u1ee5ng BPTT kh\u00e1c; khi c\u00f3 kinh l\u1ea1i d\u00f9ng v\u0129 kh\u00e1c t\u1eeb \u0111\u1ea7u.<\/p>\n
3.2. D\u1ee5ng c\u1ee5 t\u1eed cung tr\u00e1nh thai<\/b><\/p>\n
3.2.1. Ph\u00e2n lo\u1ea1i:<\/b><\/p>\n
T\u00f9y theo c\u1ea5u tr\u00fac c\u1ee7a d\u1ee5ng c\u1ee5 t\u1eed cung (DCTC), c\u00f3 th\u1ec3 chia th\u00e0nh 3 lo\u1ea1i:<\/p>\n
– DCTC tr\u01a1;<\/p>\n
– DCTC ch\u1ee9a \u0111\u1ed3ng;<\/p>\n
– DCTC ch\u1ee9a n\u1ed9i ti\u1ebft progestin.<\/p>\n
Hi\u1ec7n nay, tr\u00ean th\u1ecb tr\u01b0\u1eddng Vi\u1ec7t Nam c\u00f3 hai lo\u1ea1i DCTC ph\u1ed5 bi\u1ebfn sau:<\/p>\n
– Tcu 380A (380mm2 \u0111\u1ed3ng ): H\u00ecnh ch\u1eef T, c\u00f3 d\u00e2y, ch\u1ec9 c\u00f3 1 k\u00edch c\u1ee1, th\u1eddi h\u1ea1n t\u00e1c d\u1ee5ng 10 n\u0103m;<\/p>\n
– DCTC Multiload 375 (375mm2 \u0111\u1ed3ng): C\u00f3 3 k\u00edch c\u1ee1, th\u1eddi h\u1ea1n t\u00e1c d\u1ee5ng 5 n\u0103m.<\/p>\n
3.2.2. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/b><\/p>\n
– DCTC g\u00e2y ph\u1ea3n \u1ee9ng vi\u00eam l\u00e0m thay \u0111\u1ed5i v\u1ec1 sinh h\u00f3a v\u00e0 t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c t\u1eed cung(NMTC), t\u1eeb \u0111\u00f3 g\u00e2y di\u1ec7t tinh tr\u00f9ng ho\u1eb7c tr\u1ee9ng b\u1eb1ng th\u1ef1c b\u00e0o v\u00e0 g\u00e2y NMTC thay \u0111\u1ed5i kh\u00f4ng thu\u1eadn ti\u1ec7n cho tr\u1ee9ng thu tinh l\u00e0m t\u1ed5.<\/p>\n
– \u0110\u1ed3ngg\u00e2y \u0111\u1ed9c cho giao t\u1eed; g\u00e2y bi\u1ebfn \u0111\u1ed5i NMTC l\u00e0m c\u1ea3n tr\u1edf tr\u1ee9ng th\u1ee5 tinh l\u00e0m t\u1ed5 v\u00e0 \u0111\u1ed3ng l\u00e0m thay \u0111\u1ed5i ch\u1ea5t nh\u1ea7y CTC c\u1ea3n tr\u1edf tinh tr\u00f9ng x\u00e2m nh\u1eadp.<\/p>\n
– Progestin g\u00e2y bi\u1ebfn \u0111\u1ed5i NMTC l\u00e0m c\u1ea3n tr\u1edf tr\u1ee9ng th\u1ee5 tinh l\u00e0m t\u1ed5; Progestin l\u00e0m thay \u0111\u1ed5i ch\u1ea5t nh\u00e0y CTC c\u1ea3n tr\u1edf tinh tr\u00f9ng x\u00e2m nh\u1eadp; Progestin l\u00e0m thay \u0111\u1ed5i nhu \u0111\u1ed9ng v\u00f2i t\u1eed cungl\u00e0m cho tr\u1ee9ng th\u1ee5 tinh v\u00e0o bu\u1ed3ng t\u1eed cung \u1edf th\u1eddi \u0111i\u1ec3m kh\u00f4ng th\u00edch h\u1ee3p.<\/p>\n
3.2.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/b><\/p>\n
– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i:<\/p>\n
+ \u0110ang nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng sinh d\u1ee5c;<\/p>\n
+ Xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng;<\/p>\n
+ Ung th\u01b0CTC, ung th\u01b0NMTC;<\/p>\n
+ Lao v\u00f9ng ch\u1eadu;<\/p>\n
+ Ung th\u01b0 nguy\u00ean b\u00e0o nu\u00f4i;<\/p>\n
+ C\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a Progestin (ung th\u01b0 v\u00fa, t\u1eafc m\u1ea1ch, b\u1ec7nh h\u1ec7 th\u1ed1ng, n\u1ed9i ti\u1ebft, b\u1ec7nh gan tr\u1ea7m tr\u1ecdng)<\/p>\n
– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i:<\/p>\n
+ Ti\u1ec1n s\u1eed thai ngo\u00e0i t\u1eed cung;<\/p>\n
+ Ti\u1ec1n s\u1eed vi\u00eam v\u00f9ng ch\u1eadu;<\/p>\n
+ U x\u01a1 t\u1eed cung, sa sinh d\u1ee5c ho\u1eb7c c\u00e1c d\u1ecb d\u1ea1ng bu\u1ed3ng t\u1eed cung;<\/p>\n
+ Trong th\u1eddi gian theo d\u00f5i sau thai tr\u1ee9ng;<\/p>\n
+ Ch\u01b0a c\u00f3 con.<\/p>\n
3.2.4. Ch\u1ec9 \u0111\u1ecbnh th\u00e1o DCTC:<\/b><\/p>\n
– Xu\u1ea5t hi\u1ec7n ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh;<\/p>\n
– Ra m\u00e1u ho\u1eb7c \u0111au b\u1ee5ng nhi\u1ec1u;<\/p>\n
– Nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng sinh d\u1ee5c;<\/p>\n
– DCTC t\u1ee5t th\u1ea5p;<\/p>\n
– M\u00e3n kinh;<\/p>\n
– DCTC h\u1ebft th\u1eddi h\u1ea1n t\u00e1c d\u1ee5ng;<\/p>\n
– Mu\u1ed1n c\u00f3 thai;<\/p>\n
– Mu\u1ed1n thay BPTT.<\/p>\n
3.2.5. Th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t:<\/b><\/p>\n
– Ngay sau s\u1ea1ch kinh;<\/p>\n
– Sau sinh: qua h\u1ebft th\u1eddi gian h\u1eadu s\u1ea3n (6 tu\u1ea7n);<\/p>\n
– Sau n\u1ea1o h\u00fat thai: sau khi h\u1ebft ra m\u00e1u v\u00e0 ch\u1eafc ch\u1eafn kh\u00f4ng c\u00f2n s\u00f3t nhau, kh\u00f4ng nhi\u1ec5m tr\u00f9ng. T\u1ed1t nh\u1ea5t n\u00ean \u0111\u1ee3i c\u00f3 kinh l\u1ea1i;<\/p>\n
– B\u1ea5t k\u1ef3: khi ch\u1eafn ch\u1eafn kh\u00f4ng c\u00f3 thai.<\/p>\n
3.2.6. \u0110i\u1ec3m l\u1ee3i:<\/b><\/p>\n
– An to\u00e0n, hi\u1ec7u qu\u1ea3, ti\u1ec7n l\u1ee3i;<\/p>\n
– Th\u1eddi h\u1ea1n t\u00e1c d\u1ee5ng d\u00e0i (5 \u2013 10 n\u0103m);<\/p>\n
– L\u00e0 BPTT c\u00f3 h\u1ed3i ph\u1ee5c.<\/p>\n
3.2.7. B\u1ea5t l\u1ee3i:<\/b><\/p>\n
– G\u00e2y xu\u1ea5t huy\u1ebft t\u1eed cung b\u1ea5t th\u01b0\u1eddng;<\/p>\n
– T\u0103ng nguy c\u01a1 vi\u00eam v\u00f9ng ch\u1eadu, t\u0103ng nguy c\u01a1 thai ngo\u00e0i t\u1eed cung;<\/p>\n
– Ph\u1ea3i \u0111\u1ebfn c\u01a1 s\u1edf y t\u1ebf \u0111\u1ec3 \u0111\u1eb7t ho\u1eb7c th\u00e1o DCTC.<\/p>\n
3.2.8. Bi\u1ebfn ch\u1ee9ng:<\/b><\/p>\n
– \u0110au ti\u1ec3u khung do t\u1eed cung co b\u00f3p;<\/p>\n
– Th\u1ed1ng kinh do prostaglandin t\u0103ng cao;<\/p>\n
– R\u1ed1i lo\u1ea1n kinh nguy\u1ec7t;<\/p>\n
– Th\u1ee7ng t\u1eed cung khi \u0111\u1eb7t;<\/p>\n
– DCTC chui v\u00e0o \u1ed5 b\u1ee5ng;<\/p>\n
– Nhi\u1ec5m khu\u1ea9n;<\/p>\n
– C\u00f3 thai, thai ngo\u00e0i t\u1eed cung.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/i><\/b><\/p>\n
1. B\u1ed9 m\u00f4n Ph\u1ee5 S\u1ea3n – \u0110H Y D\u01b0\u1ee3c TP.HCM (2006). T\u01b0 v\u1ea5n v\u1ec1 k\u1ebf ho\u1ea1ch h\u00f3a gia \u0111\u00ecnh. Trong: S\u1ea3n Ph\u1ee5 khoa, t\u1eadp 2. NXB Y h\u1ecdc. Tr: 969-73.<\/p>\n
2. B\u1ed9 Y t\u1ebf (2009). T\u01b0 v\u1ea5n k\u1ebf ho\u1ea1ch h\u00f3a gia \u0111\u00ecnh. Trong: H\u01b0\u1edbng d\u1eabn Qu\u1ed1c gia v\u1ec1 c\u00e1c d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe sinh s\u1ea3n. Tr: 263-5<\/p>\n
3. H\u01b0\u1edbng d\u1eabn Qu\u1ed1c gia v\u1ec1 c\u00e1c d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c SKSS\u00a0(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4620\/Q\u0110-BYT ng\u00e0y 25\/11\/2009 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf).<\/i><\/p>\n
4.\u00a0<\/i>H\u01b0\u1edbng d\u1eabn quy tr\u00ecnh k\u1ef9 thu\u1eadt b\u1ec7nh vi\u1ec7n: Chuy\u00ean ng\u00e0nh Ph\u1ee5 S\u1ea3n\u00a0(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed11377\/Q\u0110-BYT ng\u00e0y 24\/4\/2013 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf).<\/i><\/p>\n
5. WHO (2011). Family Planning: A Global Handbook for Providers.<\/p>\n","protected":false},"excerpt":{"rendered":"
K\u1ebe HO\u1ea0CH H\u00d3A GIA \u0110\u00ccNH ThS. H\u00e0 V\u0103n Tu\u1ea5n B\u1ed9 m\u00f4n Ph\u1ee5 S\u1ea3n, Khoa Y D\u01b0\u1ee3c Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc T\u00e2y Nguy\u00ean 1. \u0110\u1ea0I C\u01af\u01a0NG K\u1ebf ho\u1ea1ch h\u00f3a gia \u0111\u00ecnh (KHHG\u0110) l\u00e0 n\u1ed7 l\u1ef1c c\u00f3 \u00fd th\u1ee9c c\u1ee7a c\u00e1c c\u00e1 nh\u00e2n \/ c\u1eb7p v\u1ee3 ch\u1ed3ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ed1 con mong mu\u1ed1n, kho\u1ea3ng c\u00e1ch sinh v\u00e0 …<\/p>\n","protected":false},"author":15,"featured_media":1324,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[90],"tags":[],"class_list":["post-1323","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-dan-so-hoc"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1323","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=1323"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1323\/revisions"}],"predecessor-version":[{"id":1325,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1323\/revisions\/1325"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/1324"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=1323"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=1323"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=1323"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}