[BENH VIEN HUNG YuONG
86 Y TE TP.HO CH MINH CONG HOA XA HOI CHU NGHIA VIRT NAM.
BENH VIEN HUNG VUONG Die li
- Ty do - Hanh phic
HUONG DAN
Thai ky voi mg Rhesus am
(Ban hanh kém theo Quyét dink sb /OD-BVHV ngdy 23/5/2014
ctia gitin déc bénh vién Hing Vicong)
1. GIOLTHIEU
Yéu 16 Rhesus la 1 protein trén bé mat hdng clu. Khoang 15% déin sb khéng cd
yéu t6 Rh duge goi li ngudi mang nhém méu Rh am.
Me | Bo | Con
+ [+ [+ [Khong didun
+ [- [4® [Khéngdiéun
= + [He | Diku tr
|e |e | Rhaing aide tf
‘Trong sudt thai ky, mau mg va mau con 1a 2 hé théng rigng bigt, tuy nhién mot 36
lugng nho méu thai nhi se qua nhaw vao, twain hosin
i. Yéu t6 Kh sé ¢6 trong tuain
hoan mg > tao khang thé chéng Iai yéu t6 Rh (Rh antibodies), goi la hign tong nhay
dm Rh (Rh sensi
ation).
Khi lin mang thai dau tién cia ngudi me nhom méu Rh Am, va thai nhém mau
Rh durong, thugng khong e6 vin dé gi nghiém trong xay ra, do ngudi me chura tao kip
nhiéu khang thé cho dén khi sinh,
Néu khéng duge didu trj dy phong thi nhimg lan mang thai ké tip, khdng thé Rh
tir ngudi phy nif ndy sé qua bénh nhau vao tuan hoan thai Rh duong > thiéu méu tin
huyét cho thai.
2, NHUNG THOL DIEM NGUY CO TRUYEN MAU THAI- ME
Sau sy thai ty nhién
Phi thai ndi khoa, ngoai khoa
Thai ngoai tir cung
Kihi thye hign ede thi thugt xim lan chan dodn tién sin: chge éi, sinh thiét gai
nnhau, léy mau thai nhi...
Xudt huyét bat thudng trade khi chuyén da
Ngoai xoay thai
Chan thuong bung kin
81[BENH VIEN HONG YUKON
3. ANTI-D IMMUNE GLOBULIN
3.1 Ngudn géc
Anti-D immune globulin lA dung dich chita IgG anti-D (anti-Rh) duge sin xudt
tir buy ‘wrong ngudi. Khi tiém vio ngudi mang nhbm méu Rh im chua nhgy cim v6i
yéu t6 Rh, né sé tan céng cdc yéu t6 Rh trong tuan hoan, ngin sy tao khang thé Rh.
3.2 Mye dich
‘é dy phong hign tung nhay cim Rh va bénh ly tén huyét cho thai ky sau,
3.3 Thai diém sir dung
+ Tribe si
+ Sau bat ete nguy co truyén méu thai nhi~me ni trén (SOGC-2003), va sau
nhimg trréng hgp thai tring
+ Tudi thai 28-30 tuan (khéng cé su khic biét vé higu qua khi phac 46 tiém 2
mili vao 28 va 34 tan - theo NICE va ACOG)
= Sau sinh:
++ Trong vong 72 gid sau sinh bé Rh duong
+ Trong vong 72 gid sau khi me truyén méu c6 Rh durong (tng trayén <20%
thé tich mau co thé)
3.4 Lidu hrong
~, True sinh:
+ Tiém bap 200 meg anti-D immune globulin: cho thai phy trong nhing
trrég hgp nguy co truyén mau thai nhi— mg
+ Tiém bap 300 meg anti-D immune globulin: cho thai phy tit 28-30 tuan tudi
thai
+ Sau sinh:
+ Tiém bap 300 mg anti-D immune globulin cho san phy sinh bé Rh duong
4, XU TRI THAI PHY RHESUS AM
4,1 Trwée sinh
= Xétnghiém nhém mau Rhesus cia chéng
- Tiém bap 200 meg anti-D immune globulin cho nhiing truéng hep nguy co
truyén mau thai nhi —
-' Tiém biip 300 meg anti-D immune globulin cho thai phy tir 28-30 tuéin tudi
thai, néu san phy dén khém thai tré vin ¢6 thé chich anti-D globulin néu thai
khéng qué 34 tuan tuéi thai
4.2 Sau sinh,
= Xét nghigm nhom mau tré so sinh
- Tiém bp 300 meg anti-D immune globulin cho san phy sinh bé Rh dongDENI VIEN HUNG VUNG.
5. CHUAN BJ CUQC CHUYEN DA CHO SAN PHY RHESUS AM
~ Chuan bj mau cing nhém va cing yéu té Rhesus li myc tiéu chinh trong cude
chuyén da di vdi thai phy mang Rhesus am.
~ Nhép vign truée ngay diy sinh va mua dy tra 2 don vj mau hiém,
- Ngay sau khi sinh, sé ldy mau tir cuéng ron cia thai dé lam xét nghiém: nhém
mau ABO/Rh, dinh long Hb, Bilirubin.
6. TALLIEU THAM KHAO
1, American College of Obstetricians and Gynecologists. Prevention of Rh D
alloimmunization, ACOG Practice Bulletin No. 4. Washington, DC: ACOG; 1999.
2. NICE issue guidance for Routine antenatal anti-D prophylaxis for women who
are thesus D negative -08/2008,
3. SOGC ~ Prevention of Rh alloimmunization —No3, 09/2003.
4, Kenneth J. Moise, Jr, MD Management of Rhesus Alloimmunization in
Pregnancy VOL. 100, NO. 3, SEPTEMBER 2002.
5. Marie Dominique Beaulieu, MD Screening for D (Rh) Sensitization in
Pregnancy ~ Chapter 11.
GIAM BOC
Nguyén Vin Truong
83LUUDO
Thai phy Rh am
+
XN Rh ching
Am
Duong
|
+
BENHVIEN HONG WONG
Khim thai binh thuémg
Sau sinh:
‘Trude sinh: Tiém Anti D lic 28 tuan mii 1
~ Néu bé Rh dim: khong tiém mai 2
~ Néu bé Rh duong: tiém mii 2
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