Giam tieu cau trong thoi ky mang thai

Tags: thoi ky thai nghen, co the xay ra, co kha nang, dac biet la, tang huyet ap, lupus ban do, tieu cau, hoi chung, chay mau, thai phu, mang thai, truong hop, sinh, truyen, chong


Giam tieu cau trong thoi ky mang thai
Kham, quan ly, cham soc suc khoe sinh san cho ban me mang thai o xa Dang Trach, huyen Bo Trach, Quang Binh - Anh: Huu Linh
Tieu cau co vai tro rat quan trong trong cam mau va chong chay mau. Voi phu nu trong thoi ky thai nghen, giam so luong hoac chuc nang cua tieu cau can duoc luu y, boi vi cac nguy co chay mau co the xay ra va dac biet la luc sinh de.

Giam tieu cau co the xuat hien do 3 nguyen nhan chinh: giam kha nang tao tieu cau o tuy; tang su pha huy tieu cau trong co the; tang tieu thu tieu cau bat thuong. Bai viet nay de cap den cac hoi chung giam tieu cau hay gap va hay bi nham lan trong san khoa.

Doi voi truong hop giam tieu cau benh ly, van de duoc chu y nhieu nhat la giam tieu cau do cac yeu to mien dich. Pha tieu cau do tu mien co the thay o benh: giam tieu cau do tu mien (ITP - Idiopathic Thrombocytopenic Purpura), benh lupus ban do, hoi chung tu mien khang phospholipid.

Benh ITP man tinh thuong gap o cac phu nu tuoi sinh de, nen cung co the thay o cac phu nu mang thai. Thai nhi hoac tre so sinh cua cac ba me nay cung co kha nang bi giam tieu cau co trieu chung hoac khong co trieu chung vi cac khang the chong tieu cau co the duoc truyen qua co the tre qua nhau thai.

Phuong phap dieu tri thong thuong nhat cho cac thai phu bi ITP cung nhu cac hoi chung giam tieu cau do tu mien khac la: corticosteroid, truyen tinh mach khang the mien dich lieu cao (intravenous immunoglobulin - IVIG) va cat lach.

Mot han che lon trong viec dieu tri bang corticosteroid la cac hau qua phu nang ne cho ca ba me va thai nhi nhu: tang duong huyet, tang huyet ap, loang xuong, giam mien dich va di tat bam sinh. Vi thuoc khong co kha nang chua khoi benh nen chi dung khi that can thiet de phong chay mau.

Truyen IVIG rat dat va co the nang luong tieu cau tam thoi cho khoang 75% benh nhan. IVIG co the gay phan ung di ung phu manh (nhuc dau do viem mang nao phan ung) va cung duoc chi dinh de phong chay mau cho nhung truong hop can thiet.

Cat lach duoc chi dinh cho cac thai phu bi ITP voi cac bieu hien chay mau va nguy co chay mau cao sau khi cac phuong phap dieu tri khac da khong mang lai ket qua mong muon. Nhung chung ta cung nen biet rang, cac phau thuat trong thoi ky mang thai co the gay tac hai lon toi co the thai phu va thai nhi, dac biet la: chay mau nang, say thai, de non...

Voi benh lupus ban do va hoi chung khang the chong phospholipid (cung xay ra o khoang 30-40% benh nhan bi lupus ban do), hien tuong giam tieu cau co the gap trong khoang 2% benh nhan. Dac biet, hoi chung khang the chong phospholipid con co kha nang gay dong mau, tac mach mau dan den hoai tu. Viec dieu tri giam tieu cau trong cac truong hop nay ve co ban khong khac gi voi truong hop ITP o thai phu.

Ngoai co che mien dich, cac hoi chung giam tieu cau o thai phu con thay trong cac benh ly ve vi mach (microangiopathic process) nhu:

- Hoi chung tan mau (syndrome of homelysis), voi cac trieu chung thuong thay nhu: dau vung thuong vi, met moi tram trong, buon non, oi mua, nhuc dau, sot, tang huyet ap, phu ne va to gan. Xet nghiem mau thay giam tieu cau, tang bilirubin va tang AST. Cac ton thuong o thanh mach mau dan den hien tuong ket tua cua tieu cau va u dong cua fibrin da dan den hien tuong tieu thu va pha cac te bao mau.

Hoi chung tan mau co the dan den mot so hau qua rat nghiem trong cho ca thai phu va thai nhi nhu: dong mau rai rac, bong nhau thai, suy than cap va suy ho hap. Ty le tu vong cho thai phu co the len toi 30% va cho thai nhi gan toi 20%. Dieu tri bang truyen hoac thay the huyet tuong (plasma) va asprin lieu nho co kha nang lam on dinh suc khoe cua thai phu va thai nhi, song nen cham dut qua trinh thai nghen la phuong phap toi uu nhat neu bao thai o tuoi qua 34 tuan hoac trong truong hop co nhung de doa cho tinh mang cua thai phu va thai nhi.

- Hoi chung nhiem doc thai nghen (toxemia of pregnancy) thuong duoc chia lam hai giai doan tien san giat va san giat voi cac trieu chung dien hinh la: phu ne, tang dam nieu va tang huyet ap. Hien tuong giam tieu cau co the xay ra cho khoang 15-20% san phu bi nhiem doc thai nghen.

- Hoi chung TTP (Thrombitic Thrombocytopenic Purpura) voi cac bieu hien: tan mau, giam tieu cau, cac roi loan ve than kinh, sot va ton thuong o than.

- Hoi chung tan mau tang ure huyet - HUS (Hemolytic Uremic Syndrome) voi cac trieu chung dien hinh: roi loan tuan hoan ngoai vi do huyet khoi, giam tieu cau va suy than cap.

Voi hai hoi chung tren, chua benh bang truyen huyet tuong hoac loc huyet tuong (plasmapheresis) la phuong phap dieu tri toi uu co the lam giam tu vong va di chung cho ca thai phu va thai nhi.

Ngoai hai nhom benh ly nhu da de cap, mot so roi loan trong thoi ky thai nghen nhu: tac mach oi, nhau bong non, vo tu cung... co the dan den hien tuong von cuc mau rai rac va giam tieu cau. Voi cac truong hop nay, ngoai cac phuong phap dieu tri san khoa thich hop, viec truyen tieu cau co the can thiet neu cac nguy co chay mau xuat hien.

Tom lai, viec hieu biet ve nguyen nhan va co che cua hien tuong giam tieu cau trong thoi ky thai nghen, ca truong hop sinh ly cung nhu benh ly se giup chung ta chan doan kip thoi va ung pho mot cach huu hieu, hop ly de bao ve suc khoe, tinh mang cua thai phu va thai nhi.

Theo TS.BS. Hoang Xuan Ba
Suc Khoe & Doi Song

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Tìm hiểu: thoi ky thai nghen, co the xay ra, co kha nang, dac biet la, tang huyet ap, lupus ban do, tieu cau, hoi chung, chay mau, thai phu, mang thai, truong hop, sinh, truyen, chong

Xem Bản Tiếng Việt Có Dấu: Giảm tiểu cầu trong thời kỳ mang thai

Ban co the doc ban tieng Viet co dau cua bai viet Giảm tiểu cầu trong thời kỳ mang thai bang cach nhan chuot vao duong dan tren.

Lien he ve tin Giam tieu cau trong thoi ky mang thai

Nhan xet, hay lien he ve tin Giam tieu cau trong thoi ky mang thai co the gui bang duong dan o duoi. Ban nen gui kem tieu de bai viet Giam tieu cau trong thoi ky mang thai de lam tham khao. Bai viet nay thuoc chuyen de Suc khoe Me va Be trong chuyen muc Suc khoe.

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