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12. ho eo co tu cung.vsum.11.2017.medic23

The Nhan Huynh
The Nhan Huynh

Bi gi畉ng si棚u 但m s畉n ph畛 khoa 2017

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H畛 EO C畛 T畛 CUNG Bs. NGUY畛N QUANG TR畛NG website: www.sieuamvietnam.vn, www.cdhanqk.com (L畛p Si棚u 但m SPK, kh坦a 23, HYPNT-MEDIC, 2017) Ng動畛i ta ch畛 th畉y nh畛ng g狸 ng動畛i ta 動畛c chu畉n b畛 畛 th畉y" Ralph Waldo Emerson
H畛 EO C畛 T畛 CUNG (CERVICAL INCOMPETENCE) Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 C畛 t畛 cung l ph畉n th畉p nh畉t c畛a t畛 cung. B狸nh th動畛ng, c畛 TC di v 坦ng k鱈n cho 畉n khi chuy畛n d畉. Khi chuy畛n d畉, c畛 TC b畛 x坦a, tr畛 n棚n ng畉n v d達n ra. H畛 eo c畛 TC 叩m ch畛 t狸nh tr畉ng d達n kh担ng au (painless dilatation) c畛a c畛 TC 畛 qu箪 II ho畉c 畉u qu箪 III. N畉u kh担ng i畛u tr畛, i畛u ny s畉 d畉n 畉n sinh non.
Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 H畉u h畉t thai sinh non tr動畛c 24 tu畉n 畛u ch畉t. Thai sinh gi畛a 24-32 tu畉n d畛 b畛 ch畉t ho畉c tn t畉t. Thai sinh sau 32 tu畉n th狸 kh畉 nng s畛ng s坦t r畉t cao. T畛 l畛 sinh non 畛 thai 董n l 1%, trong khi 畛 thai 担i DC l 6% v thai 担i MC l棚n 畉n 9%.
C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 T動董ng quan gi畛a chi畛u di c畛 TC v t畉n su畉t sinh non tr動畛c 35 tu畉n tu畛i. Chi畛u di c畛 t畛 cung b狸nh th動畛ng 3cm
Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 C畛 TC 動畛c 叩nh gi叩 b畉ng si棚u 但m qua ng達 thnh b畛ng (transabdominal sonography - TAS), qua ng達 但m 畉o (transvaginal sonography - TVS) ho畉c qua ng達 m担i b辿 (translabial sonography - TLS). V畛i thai ph畛 鱈t nguy c董, ch畛 c畉n si棚u 但m qua ng達 thnh b畛ng v畛i bng quang 畉y v畛a ph畉i l 畛. SA qua ng達 但m 畉o cho h狸nh 畉nh c坦 畛 ph但n gi畉i cao h董n, kh担ng b畛 c畉u tr炭c thai che l畉p, do v畉y k畉t qu畉 ch鱈nh x叩c h董n. N畉u kh担ng c坦 畉u d嘆 但m 畉o ta c坦 th畛 si棚u 但m qua ng達 m担i b辿 (TLS).
- B畛nh nh但n ph畉i 動畛c gi畉i th鱈ch v ch畉p thu畉n kh畉o s叩t (gi畛ng nh動 khi kh畉o s叩t qua ng達 但m 畉o). - T動 th畉 b畛nh nh但n n畉m ng畛a, d畉ng ch但n. - 畉u d嘆 b畛c bao cao su (condom) 畉t gi畛a hai m担i nh畛 (labia minora), t畉i ng探 vo 但m 畉o (vaginal introitus).
12. ho eo co tu cung.vsum.11.2017.medic23
12. ho eo co tu cung.vsum.11.2017.medic23
SA qua ng達 m担i be o chi畛u dai c担 t動 cung 21mm, trong khi SA qua nga 但m 畉o chi畛u dai th動味c o 動畛c la 41mm (SA qua ng達 m担i be: c担 TC b畛 xoa 1 ph畉n b畛i khi trong tr動味c trang).
Chi畛u di k棚nh c畛 t畛 cung 動畛c o 畛 o畉n c嘆n 坦ng k鱈n.
Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 o chi畛u dai c畛 TC b畉ng si棚u 但m qua ng達 thanh b畛ng. o chi畛u dai c畛 TC b畉ng si棚u 但m qua ng達 但m 畉o.
C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 K棚nh c畛 TC c坦 h畛i 但m k辿m, c坦 th畛 l畉m v畛i h畛 eo k竪m tho叩t v畛 mng 畛i vo k棚nh c畛. Tuy nhi棚n mng 畛i ph畛 l畛 trong c畛 TC (m滴i t棚n) gi炭p lo畉i tr畛 ch畉n o叩n h畛 eo.
12. ho eo co tu cung.vsum.11.2017.medic23
H畛 EO C畛 T畛 CUNG (CERVICAL INCOMPETENCE) - Chi畛u di c畛 TC < 2.5 cm. - C坦 th畛 khoang 畛i l畛i vo k棚nh c畛 TC: t畉o thnh h狸nh ch畛 Y, V ho畉c U. - C坦 th畛 hi畛n di畛n m畛t ph畉n c畛a thai trong k棚nh c畛 TC, th畉m ch鱈 trong 但m 畉o. (Trust Your Vaginal Ultrasound)
Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 SA qua ng達 b畛ng: H畛 eo ch畛 Y, chi畛u di c畛 TC: 2.34 cm SA qua ng達 但m 畉o: H畛 eo ch畛 Y, chi畛u di c畛 TC: 0.08 cm
Khoang 畛i l畛i vao trong 但m 畉o (V) TAS TVS
H畛 eo ch畛 U Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718
12. ho eo co tu cung.vsum.11.2017.medic23
H畛 eo ch畛 U, ch但n thai nhi 畛 k棚nh c畛 TC Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718
12. ho eo co tu cung.vsum.11.2017.medic23
D但y r畛n va t炭i 畛i l畛i vao trong 但m 畉o Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718
Shortened cervix by US and MRI. A: A transvaginal scan at 23 weeks in twin pregnancy shows dilatation and funneling of the internal cervical os (line with end arrows). The closed cervical length (dotted line) measures 2.5 cm with funneling cervix, with walls of funnel in a Y-shaped configuration. F is fetus. B: Transvaginal ultrasound with nearly completely effaced cervix, with U-shaped funnel. Same annotations in A. C: MRI imaging of U-shaped funneling and shortened cervical length. The black arrows show internal os, dotted lines show shortened closed cervix.
M畛T S畛 I畛M L働U V畛 K畛 THU畉T KH畉O ST 1. SA qua ng達 thnh b畛ng: + Bng quang qu叩 cng s畉 lm c畛 TC di ra gi畉 t畉o. + S畛 co c董 畛 o畉n th畉p c畛a TC, khi畉n cho ta c坦 th畛 叩nh gi叩 sai l畛ch chi畛u di c畛 TC. 2. SA qua ng達 但m 畉o: + 畉u d嘆 kh担ng 辿p qu叩 m畉nh vo c畛 TC, v狸 s畉 lm c畛 TC di ra gi畉 t畉o. + Vi畛c kh畉o s叩t 畛ng gi炭p cho ta kh担ng b畛 s坦t h畛 eo c畛 TC. + Nghi畛m ph叩p 竪 辿p nh畉 v湛ng 叩y TC th動畛ng 動畛c ti畉n hnh trong khi ta ang quan s叩t c畛 t畛 cung gi炭p cho ta kh担ng b畛 s坦t nh畛ng tr動畛ng h畛p h畛 eo c畛 TC.
Bang quang qu叩 cng C畛 TC sau khi cho thai ph畛 i ti畛u. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594
Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 S動味 co c董 o畉n th畉p c畛a t畛 cung, khi畉n cho c畛 TC b畛 dai ra gi畉 t畉o.
12. ho eo co tu cung.vsum.11.2017.medic23
Kh畉o s叩t kh畛i 畉u cho th畉y l畛 trong c畛 TC 坦ng k鱈n. 30 gi但y sau: h畛 eo v畛i chi畛u di c畛 TC = 1.2 cm. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594
Kypros Nicolaides et al. Diploma in Fetal Medicine & ISUOG Educational Series. 2001 Kh担ng 竪 ep 叩y TC 竪 ep nh畉 叩y TC
12. ho eo co tu cung.vsum.11.2017.medic23
C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 CL 1.5 1.5 < CL 2 2 < CL 2.5 2,5 < CL < 3 Cerclage (kh但u v嘆ng c畛 TC) N畉m b畉t 畛ng Gi畉m v畉n 畛ng o l畉i CL sau 1 tu畉n o l畉i CL sau 2 tu畉n o l畉i CL sau 1 tu畉n CL ng畉n h董n X畛 TR H畛 EO T畛 CUNG C TRI畛U CH畛NG
C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 L畛 trong c畛 TC 坦ng k鱈n sau khi kh但u v嘆ng c畛 TC (m滴i t棚n ch畛 ch畛 kh但u)
C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 Kh但u v嘆ng c畛 TC th畉t b畉i (m滴i t棚n). Khoang 畛i l畛i vo trong 但m 畉o (V).
Incarcerated uterus
12. ho eo co tu cung.vsum.11.2017.medic23
TI LI畛U THAM KH畉O C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p589-599, p1069- 1121, p1583-1594. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718 Isabelle Trop et al. Hemorrhage During Pregnancy - Sonography and MR Imaging. AJR 2001; 176:607-615 Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718 Gloria Chiang et al. Imaging of Adnexal Masses in Pregnancy. J Ultrasound Med 2004 23:805-819. Qi Zhou et al. Sonographic and Doppler Imaging in the Diagnosis and Treatment of Gestational Trophoblastic Disease. J Ultrasound Med 2005 24:15-24 Y. Kaakaji et al. Sonography of Obstetric and Gynecologic Emergencies-Part I, Obstetric Emergencies. AJR 2000; 174:641-649 Vincent Y. T. Cheung et al. Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery. J Ultrasound Med 2004 23:1441-1447
12. ho eo co tu cung.vsum.11.2017.medic23

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12. ho eo co tu cung.vsum.11.2017.medic23

  • 1. H畛 EO C畛 T畛 CUNG Bs. NGUY畛N QUANG TR畛NG website: www.sieuamvietnam.vn, www.cdhanqk.com (L畛p Si棚u 但m SPK, kh坦a 23, HYPNT-MEDIC, 2017) Ng動畛i ta ch畛 th畉y nh畛ng g狸 ng動畛i ta 動畛c chu畉n b畛 畛 th畉y" Ralph Waldo Emerson
  • 2. H畛 EO C畛 T畛 CUNG (CERVICAL INCOMPETENCE) Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 C畛 t畛 cung l ph畉n th畉p nh畉t c畛a t畛 cung. B狸nh th動畛ng, c畛 TC di v 坦ng k鱈n cho 畉n khi chuy畛n d畉. Khi chuy畛n d畉, c畛 TC b畛 x坦a, tr畛 n棚n ng畉n v d達n ra. H畛 eo c畛 TC 叩m ch畛 t狸nh tr畉ng d達n kh担ng au (painless dilatation) c畛a c畛 TC 畛 qu箪 II ho畉c 畉u qu箪 III. N畉u kh担ng i畛u tr畛, i畛u ny s畉 d畉n 畉n sinh non.
  • 3. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 H畉u h畉t thai sinh non tr動畛c 24 tu畉n 畛u ch畉t. Thai sinh gi畛a 24-32 tu畉n d畛 b畛 ch畉t ho畉c tn t畉t. Thai sinh sau 32 tu畉n th狸 kh畉 nng s畛ng s坦t r畉t cao. T畛 l畛 sinh non 畛 thai 董n l 1%, trong khi 畛 thai 担i DC l 6% v thai 担i MC l棚n 畉n 9%.
  • 4. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 T動董ng quan gi畛a chi畛u di c畛 TC v t畉n su畉t sinh non tr動畛c 35 tu畉n tu畛i. Chi畛u di c畛 t畛 cung b狸nh th動畛ng 3cm
  • 5. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 C畛 TC 動畛c 叩nh gi叩 b畉ng si棚u 但m qua ng達 thnh b畛ng (transabdominal sonography - TAS), qua ng達 但m 畉o (transvaginal sonography - TVS) ho畉c qua ng達 m担i b辿 (translabial sonography - TLS). V畛i thai ph畛 鱈t nguy c董, ch畛 c畉n si棚u 但m qua ng達 thnh b畛ng v畛i bng quang 畉y v畛a ph畉i l 畛. SA qua ng達 但m 畉o cho h狸nh 畉nh c坦 畛 ph但n gi畉i cao h董n, kh担ng b畛 c畉u tr炭c thai che l畉p, do v畉y k畉t qu畉 ch鱈nh x叩c h董n. N畉u kh担ng c坦 畉u d嘆 但m 畉o ta c坦 th畛 si棚u 但m qua ng達 m担i b辿 (TLS).
  • 6. - B畛nh nh但n ph畉i 動畛c gi畉i th鱈ch v ch畉p thu畉n kh畉o s叩t (gi畛ng nh動 khi kh畉o s叩t qua ng達 但m 畉o). - T動 th畉 b畛nh nh但n n畉m ng畛a, d畉ng ch但n. - 畉u d嘆 b畛c bao cao su (condom) 畉t gi畛a hai m担i nh畛 (labia minora), t畉i ng探 vo 但m 畉o (vaginal introitus).
  • 9. SA qua ng達 m担i be o chi畛u dai c担 t動 cung 21mm, trong khi SA qua nga 但m 畉o chi畛u dai th動味c o 動畛c la 41mm (SA qua ng達 m担i be: c担 TC b畛 xoa 1 ph畉n b畛i khi trong tr動味c trang).
  • 10. Chi畛u di k棚nh c畛 t畛 cung 動畛c o 畛 o畉n c嘆n 坦ng k鱈n.
  • 11. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 o chi畛u dai c畛 TC b畉ng si棚u 但m qua ng達 thanh b畛ng. o chi畛u dai c畛 TC b畉ng si棚u 但m qua ng達 但m 畉o.
  • 12. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 K棚nh c畛 TC c坦 h畛i 但m k辿m, c坦 th畛 l畉m v畛i h畛 eo k竪m tho叩t v畛 mng 畛i vo k棚nh c畛. Tuy nhi棚n mng 畛i ph畛 l畛 trong c畛 TC (m滴i t棚n) gi炭p lo畉i tr畛 ch畉n o叩n h畛 eo.
  • 14. H畛 EO C畛 T畛 CUNG (CERVICAL INCOMPETENCE) - Chi畛u di c畛 TC < 2.5 cm. - C坦 th畛 khoang 畛i l畛i vo k棚nh c畛 TC: t畉o thnh h狸nh ch畛 Y, V ho畉c U. - C坦 th畛 hi畛n di畛n m畛t ph畉n c畛a thai trong k棚nh c畛 TC, th畉m ch鱈 trong 但m 畉o. (Trust Your Vaginal Ultrasound)
  • 15. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 SA qua ng達 b畛ng: H畛 eo ch畛 Y, chi畛u di c畛 TC: 2.34 cm SA qua ng達 但m 畉o: H畛 eo ch畛 Y, chi畛u di c畛 TC: 0.08 cm
  • 16. Khoang 畛i l畛i vao trong 但m 畉o (V) TAS TVS
  • 17. H畛 eo ch畛 U Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718
  • 19. H畛 eo ch畛 U, ch但n thai nhi 畛 k棚nh c畛 TC Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718
  • 21. D但y r畛n va t炭i 畛i l畛i vao trong 但m 畉o Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718
  • 22. Shortened cervix by US and MRI. A: A transvaginal scan at 23 weeks in twin pregnancy shows dilatation and funneling of the internal cervical os (line with end arrows). The closed cervical length (dotted line) measures 2.5 cm with funneling cervix, with walls of funnel in a Y-shaped configuration. F is fetus. B: Transvaginal ultrasound with nearly completely effaced cervix, with U-shaped funnel. Same annotations in A. C: MRI imaging of U-shaped funneling and shortened cervical length. The black arrows show internal os, dotted lines show shortened closed cervix.
  • 23. M畛T S畛 I畛M L働U V畛 K畛 THU畉T KH畉O ST 1. SA qua ng達 thnh b畛ng: + Bng quang qu叩 cng s畉 lm c畛 TC di ra gi畉 t畉o. + S畛 co c董 畛 o畉n th畉p c畛a TC, khi畉n cho ta c坦 th畛 叩nh gi叩 sai l畛ch chi畛u di c畛 TC. 2. SA qua ng達 但m 畉o: + 畉u d嘆 kh担ng 辿p qu叩 m畉nh vo c畛 TC, v狸 s畉 lm c畛 TC di ra gi畉 t畉o. + Vi畛c kh畉o s叩t 畛ng gi炭p cho ta kh担ng b畛 s坦t h畛 eo c畛 TC. + Nghi畛m ph叩p 竪 辿p nh畉 v湛ng 叩y TC th動畛ng 動畛c ti畉n hnh trong khi ta ang quan s叩t c畛 t畛 cung gi炭p cho ta kh担ng b畛 s坦t nh畛ng tr動畛ng h畛p h畛 eo c畛 TC.
  • 24. Bang quang qu叩 cng C畛 TC sau khi cho thai ph畛 i ti畛u. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594
  • 25. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 S動味 co c董 o畉n th畉p c畛a t畛 cung, khi畉n cho c畛 TC b畛 dai ra gi畉 t畉o.
  • 27. Kh畉o s叩t kh畛i 畉u cho th畉y l畛 trong c畛 TC 坦ng k鱈n. 30 gi但y sau: h畛 eo v畛i chi畛u di c畛 TC = 1.2 cm. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594
  • 28. Kypros Nicolaides et al. Diploma in Fetal Medicine & ISUOG Educational Series. 2001 Kh担ng 竪 ep 叩y TC 竪 ep nh畉 叩y TC
  • 30. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 CL 1.5 1.5 < CL 2 2 < CL 2.5 2,5 < CL < 3 Cerclage (kh但u v嘆ng c畛 TC) N畉m b畉t 畛ng Gi畉m v畉n 畛ng o l畉i CL sau 1 tu畉n o l畉i CL sau 2 tu畉n o l畉i CL sau 1 tu畉n CL ng畉n h董n X畛 TR H畛 EO T畛 CUNG C TRI畛U CH畛NG
  • 31. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 L畛 trong c畛 TC 坦ng k鱈n sau khi kh但u v嘆ng c畛 TC (m滴i t棚n ch畛 ch畛 kh但u)
  • 32. C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p1583-1594 Kh但u v嘆ng c畛 TC th畉t b畉i (m滴i t棚n). Khoang 畛i l畛i vo trong 但m 畉o (V).
  • 35. TI LI畛U THAM KH畉O C.M.Rumack et al. Diagnostic Ultrasound. 3rd Edition. 2005. p589-599, p1069- 1121, p1583-1594. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003 Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718 Isabelle Trop et al. Hemorrhage During Pregnancy - Sonography and MR Imaging. AJR 2001; 176:607-615 Penny L. Williams, MD et al. US of Abnormal Uterine Bleeding. Radiographics. 2003;23:703-718 Gloria Chiang et al. Imaging of Adnexal Masses in Pregnancy. J Ultrasound Med 2004 23:805-819. Qi Zhou et al. Sonographic and Doppler Imaging in the Diagnosis and Treatment of Gestational Trophoblastic Disease. J Ultrasound Med 2005 24:15-24 Y. Kaakaji et al. Sonography of Obstetric and Gynecologic Emergencies-Part I, Obstetric Emergencies. AJR 2000; 174:641-649 Vincent Y. T. Cheung et al. Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery. J Ultrasound Med 2004 23:1441-1447