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Ds. Hu?nh Th? H?ng G?m (D?ch)
Khoa D??c - BV T? D?

1. Gi?i thi?u

logoMisoprostol, m?t ch?t t??ng t? prostaglandin E1, kch thch co bp t? cung v chn mu?i c? t? cung. M?t s? th? nghi?m ng?u nhin v t?ng quan h? th?ng ? ?nh gi vi?c s? d?ng Misoprostol trong l?nh v?c s?n ph? khoa. Misoprostol  khng t?n km, ?n ??nh ? nhi?t ?? phng v c m?t ? h?n 80 qu?c gia nn  ??c bi?t h?u ch trong nh?ng n?i ngu?n l?c h?n ch?. WHO th?a nh?n vai tr quan tr?ng c?a Misoprostol trong s?c kh?e sinh s?n v ???c t?ng h?p trn cc khuy?n co cho vi?c s? d?ng Misoprostol trong 4 h??ng d?n s?c kh?e sinh s?n t?p trung vo kh?i pht chuy?n d?, phng v ?i?u tr? b?ng huy?t  sau sinh (BHSS), s?y thai t? nhin v ph thai.

2. Tm t?t cc khuy?n co

B?ng 1. Khuy?n co v? vi?c s? d?ng, li?u dng v ???ng dng Misoprostol

Ch? ??nh

Li?u dng

???ng dng

Chuy?n d?, sinh

Kh?i pht chuy?n d? cho thai ?? ngy n?u khng c ti?n c?n m? l?y thai

 

25 mcg, m?i 2 gi?

25 mcg, m?i 6 gi?

 

U?ng

??t m ??o

Ch?m d?t thai k? do thai nhi b?t th??ng ho?c sau khi thai ch?t trong t? cung ? 3 thng cu?i thai k?

25 mcg, m?i 2 gi?

25 mcg, m?i 6 gi?

U?ng

??t m ??o

Phng ng?a BHSS n?u Oxytocin khng s?n c ho?c khng kh? thi

600mcg, li?u duy nh?t

U?ng

?i?u tr? BHSS do ?? t? cung n?u Oxytocin th?t b?i ho?c khng s?n c

800 mcg, li?u duy nh?t

Ng?m d??i l??i

Ph thai an ton

S?y thai khng tr?n khi kch th??c t? cung kho?ng b?ng thai 13 tu?n ho?c nh? h?n

400 mcg, li?u duy nh?t

600 mcg, li?u duy nh?t

400-800 mcg, li?u duy nh?t

Ng?m d??i l??i

U?ng

??t m ??o [a]

Mifepristone s?n c

Ph thai n?i khoa ??n h?t 7 tu?n (49 ngy)

24-48 gi? sau khi u?ng 200mg Mifepristone

(ho?c theo phc ?? ph thai n?i khoa ??n h?t 9 tu?n)

400 mcg, li?u duy nh?t

U?ng

Ph thai n?i khoa ??n h?t 9 tu?n (63 ngy)

24-48 gi? sau khi u?ng 200 mg Mifepristone

800 mcg, li?u duy nh?t

Ng?m p m, ??t m ??o ho?c ng?m d??i l??i

Ph thai n?i khoa t? 9 ??n 12 tu?n thai (63 ??n 84 ngy)

36-48 gi? sau khi u?ng 200 mg Mifepristone

800 mcg, sau ? 400 mcg, m?i 3 gi? cho ??n 5 li?u

??t m ??o, sau ? ??t m ??o ho?c ng?m d??i l??i

Ph thai n?i khoa sau 12 tu?n (sau 84 ngy)

36-48 gi? sau khi u?ng 200 mg Mifepristone

800 mcg, sau ? 400 mcg,  m?i 3 gi? cho ??n 5 li?u

400 mcg, sau ? 400 mcg,  m?i 3 gi? cho ??n 5 li?u

??t m ??o, sau ? ??t m ??o ho?c ng?m d??i l??i [a]

Ng?m d??i l??i, sau ? ??t m ??o ho?c ng?m d??i l??i[a]

Mifepristone khng s?n c

Ph thai n?i khoa ??n h?t 12 tu?n (??n 84 ngy)

Ph thai n?i khoa sau 12 tu?n (sau 84 ngy)

800 mcg, l?p l?i li?u m?i 3-12 gi? ??n 3 li?u

400 mcg, m?i 3 gi? ??n 5 li?u[b]

??t m ??o ho?c ng?m d??i l??i

??t m ??o ho?c ng?m d??i l??i

Chu?n b? c? t? cung tr??c khi ph thai ngo?i khoa ??n h?t 12-14 tu?n

Chu?n b? c? t? cung tr??c khi ph thai ngo?i khoa sau 14 tu?n ho?c tr? h?n

400 mcg (2-3 gi? tr??c th? thu?t)

400 mcg (3 gi? tr??c th? thu?t)

400 mcg (3-4 gi? tr??c th? thu?t)

Ng?m d??i l??i 

??t m ??o

??t m ??o

[a]:Ch? khuy?n co ???ng ??t m ??o khi khng c xu?t huy?t m ??o ?ng k?

[b]: ??i v?i thai k? trn 24 tu?n, nn gi?m li?u Misoprostol v m?c nh?y c?a c? t? cung v?i Misoprostol l?n h?n; tuy nhin thi?u nghin c?u lm sng ng?n c?m li?u khuy?n co c? th?.

2.1. S? d?ng Misoprostol ?? kh?i pht chuy?n d?

2.1.1. Khuy?n co cho kh?i pht chuy?n d? thai ?? ngy

Nguyn t?c chung cho vi?c s? d?ng Misoprostol ?? kh?i pht chuy?n d? thai ?? ngy l ph?i ???c s? d?ng v?i li?u th?p (25 mcg), cng v?i s? t?ng  tu?i thai, s? nh?y c?m c?a cc th? th? ? t? cung  trn Misoprostol t?ng. B?ng ch?ng cho vi?c s? d?ng Misoprostol trong khuy?n co ny ???c b?t ngu?n t? 3 t?ng quan h? th?ng, trong ? bao g?m m?t s? l??ng l?n cc th? nghi?m ng?u nhin c ??i ch?ng [1,2,3]. D?a trn k?t qu? c?a cc th? nghi?m ny, ho?c Misoprostol ??t m ??o li?u th?p (m?i 6 gi?) ho?c u?ng Misoprostol (m?i 2 gi?) ???c ?? ngh? cho kh?i pht chuy?n d? ? nh?ng thai k? ?? ngy v thai ph? khng c ti?n c?n m? l?y thai (B?ng 1). C?n l?u r?ng khng bao gi? ???c khng quan tm, theo di thai ph? ? ???c kh?i pht chuy?n d? b?ng Misoprostol v cc nguy c? c?n g t? cung, v? t? cung v suy thai. V v?y, kh?i pht chuy?n d? nn ???c th?c hi?n t?i cc c? s? trong ? b m? v thai nhi c th? ???c theo di ch?t ch?. Ngoi ra, b?t c? n?i no c th?, kh?i pht chuy?n d? nn ???c th?c hi?n t?i cc c? s? trong ? c th? th?c hi?n ???c m? l?y thai.

2.1.2. Khuy?n co cho ch?m d?t thai k? trong cc tr??ng h?p lin quan ??n thai d? t?t ho?c sau khi thai ch?t trong t? cung

Can thi?p trn lm sng ?? ch?m d?t thai k? trong tr??ng h?p thai ch?t trong t? cung ho?c thai b?t th??ng khc v?i kh?i pht chuy?n d? ? thai ph? c thai s?ng bnh th??ng. ??u tin, t?ng co bp t? cung d?n ??n suy thai khng cn l m?t m?i quan tm l?n. Th? hai, kh?i pht chuy?n d? ? thai ph? c thai nhi b?t th??ng hay ? ch?t th??ng ???c th?c hi?n tr??c khi thai ?? ngy, khi t? cung c th? km ?p ?ng v?i thu?c g t? cung. B?ng ch?ng lin quan ??n vi?c s? d?ng Misoprostol trong khuy?n co ny ???c tm t?t trong m?t t?ng quan h? th?ng ?nh gi m?t s? so snh gi?a cc ch? ph?m Misoprostol v Prostaglandin khc nhau trong ba thng th? hai v th? ba c?a thai k? [4]. Nhn chung, bi t?ng quan xem xt vi th? nghi?m v?i s? l??ng nh? ng??i tham gia, trong ? t?o ra s? khng ch?c ch?n ?ng k? lin quan ??n ?? l?n c?a hi?u qu?. D?a trn nh?ng d? li?u h?n ch?, Misoprostol ho?c u?ng ho?c ??t m ??o ???c khuy?n co cho kh?i pht chuy?n d? ? thai ph? c thai nhi ch?t ho?c thai b?t th??ng trong ba thng cu?i thai k?, c cng m?t li?u v phc ?? khuy?n co s? d?ng Misoprostol ?? kh?i pht chuy?n d? thai ?? ngy (b?ng 1).

2.2. S? d?ng Misoprostol trong phng ng?a BHSS

Trong giai ?o?n ba chuy?n d?, t?t c? cc thai ph? nn dng thu?c co h?i t? cung ?? phng ng?a BHSS. Tim b?p (IM ) ho?c t?nh m?ch (IV) Oxytocin (10 IU) ???c khuy?n co l thu?c co h?i t? cung l?a ch?n. ? nh?ng vng Oxytocin khng s?n c ho?c cung c?p Oxytocin khng kh? thi, thu?c g t? cung thay th? c th? ???c xem xt ?? s? d?ng. Nh?ng l?a ch?n thay th? bao g?m thu?c tim khc nh? Ergometrine/Methylergometrine, thu?c k?t h?p Oxytocin v Ergometrine, Misoprostol ???ng u?ng (600 mcg ). B?i v thu?c c ngu?n g?c t? n?m c?a g c ch?ng ch? ??nh r rng ??i v?i nh?ng thai ph? c r?i lo?n huy?t p, nn c?n th?n tr?ng khi ch?n cc lo?i thu?c ny trn cc thai ph? ch?a ???c sng l?c.

S? d?ng Oxytocin ???ng t?nh m?ch ???c xem l hi?u qu? h?n Misoprostol ???ng u?ng ?? phng ng?a BHSS. V v?y, vi?c nhn vin y t? s? d?ng Misoprostol (bao g?m c? nhn vin y t? ???c ?o t?o khng chuyn nghi?p trong th?c hnh ny) ???c xem l m?t s? thay th? khi khng th? s? d?ng Oxytocin. Vi?c s? d?ng Misoprostol l m?t co h?i t? cung thay th? ?? phng ng?a BHSS khng lm gi?m vi?c s? d?ng r?ng ri Oxytocin. Cu?i cng, c ?? b?ng ch?ng ?? khuyn  nn phn ph?i Misoprostol tr??c cho thai ph? trong th?i gian tr??c khi sinh ?? h? t? s? d?ng sau sinh.

2.3. Misoprostol trong BHSS do ?? t? cung

Oxytocin t?nh m?ch ???c khuy?n co ?? ?i?u tr? BHSS. N?u Oxytocin IV khng s?n c ho?c n?u v?n cn ch?y mu m?c d ? dng Oxytocin, vi?c s? d?ng Ergometrine t?nh m?ch, thu?c k?t h?p Oxytocin v Ergometrine ho?c m?t lo?i thu?c Prostaglandin (bao g?m Misoprostol) ???c khuy?n co. Li?u dng  Misoprostol 800 mcg ng?m d??i l??i, d?a trn cc nghin c?u v?  li?u dng trong 2 th? nghi?m l?n nh?t c?a Misoprostol trong ?i?u tr? BHSS [5,6] (B?ng 1).

Oxytocin t?nh m?ch ???c khuy?n co l thu?c co h?i t? cung ??u tay ?? ?i?u tr? BHSS, k? c? khi thai ph? ? d? phng BHSS b?ng thu?c ny. ? nh?ng vng Oxytocin IV  khng  s?n c, Misoprostol ???c coi l m?t thay th? h?p l? cho nh?ng thai ph? ? d? phng b?ng Oxytocin IM trong giai ?o?n ba chuy?n d?. N?u ? th?c hi?n d? phng BHSS b?ng Misoprostol v n?u thu?c g t? cung tim khng s?n c, khng c ?? b?ng ch?ng ?? h??ng d?n thm li?u Misoprostol v c?n ph?i cn nh?c ??n nguy c? ti?m n?ng ??c tnh.

Khng c l?i ch b? sung khi s? d?ng Misoprostol ??ng th?i cho s?n ph? ? ???c ?i?u tr? BHSS b?ng Oxytocin (ngh?a l Misoprostol h? tr?). Ngoi ra, n?u Oxytocin IV ? ???c s? d?ng ?? ?i?u tr? BHSS m v?n ti?p t?c ch?y mu, vi d? li?u khuy?n co cho l?a ch?n thu?c co h?i t? cung th? hai. T??ng t? nh? v?y, trong tnh hu?ng c th? s? d?ng IM Oxytocin v khng c kh? n?ng ?i?u tr? IV v?i Ergot alkaloids / Prostaglandin tim, c m?t l??ng nh? cc d? li?u khuy?n co nn l?a ch?n IM Oxytocin h?n Misoprostol ho?c thu?c g t? cung khc. Quy?t ??nh trong tnh hu?ng nh? v?y ph?i d?a vo kinh nghi?m c?a cc nh lm sng, lo?i thu?c s?n c v cc ch?ng ch? ??nh ???c bi?t v?i tnh tr?ng s?c kh?e c?a s?n ph?.

2.4. S? d?ng Misoprostol trong ph thai an ton

2.4.1. Khuy?n co trong ?i?u tr? s?y thai khng tr?n

S?y thai khng tr?n (incomplete abortion) c th? x?y ra sau s?y thai t? nhin ho?c ph thai. L?a ch?n ?? ?i?u tr? s?y thai khng tr?n bao g?m ?i?u tr? b?o t?n, ?i?u tr? n?i khoa v ?i?u tr? ngo?i khoa. Ho?c ht chn khng ho?c ?i?u tr? n?i khoa v?i Misoprostol c th? ???c khuy?n co cho ph? n? s?y thai khng tr?n ? b?t k? tu?i thai khi kch th??c t? cung t?i th?i ?i?m ?i?u tr? t??ng ?ng v?i thai k? 13 tu?n ho?c t h?n. Khuy?n co ny ???c ngo?i suy t? nghin c?u ti?n hnh ? nh?ng ph? n? s?y thai t? pht.

Phc ?? khuy?n co c?a Misoprostol l m?t li?u duy nh?t ho?c ng?m d??i l??i (400 mcg) ho?c u?ng (600 mcg) (B?ng 1). Misoprostol c?ng c th? ???c s? d?ng ???ng  ??t m ??o; tuy nhin, nn trnh ???ng ??t m ??o n?u c ch?y mu ?ng k? b?i v s? hi?n di?n c?a mu c th? ng?n ch?n hi?u qu? h?p thu c?a thu?c. Nghin c?u v? Misoprostol ???ng ??t m ??o trong s?y thai khng tr?n ? s? d?ng li?u t? 400 mcg ??n 800 mcg; cc th? nghi?m so snh li?u dng thu?c ? khng ???c bo co.

H??ng d?n ny khng lin quan ??n can thi?p cho s?y thai khng hon ton (missed abortion), l m?t ??i t??ng ring bi?t. WHO ? ch?a pht tri?n, h??ng d?n vi?c s? d?ng Misoprostol trong tr??ng h?p ny.

2.4.2 . Khuy?n co cho ph thai n?i khoa  ??n h?t 9 tu?n (63 ngy)

Ph thai n?i khoa ??n h?t 9 tu?n (63 ngy) c?ng ???c ch?p nh?n nh? l m?t thay th? cho ph thai ngo?i khoa trong cc ?i?u ki?n khc nhau. Th? nghi?m  ng?u nhin c nhm ch?ng ? lin t?c ch? ra r?ng ch? ?? k?t h?p c hi?u qu? h?n phc ?? ??n thu?c v phc ?? hi?u qu? nh?t l s? k?t h?p Misoprostol sau khi dng Mifepristone. Nhi?u th? nghi?m c?ng ? so snh li?u v th?i gian dng Mifepristone v Misoprostol. Phc ?? hi?u qu? nh?t l u?ng 200 mg Mifepristone, ti?p theo sau ? 1-2 ngy (24-48 gi?) l Misoprostol. Misoprostol c th? ???c ??t m ??o, ng?m p m ho?c ng?m d??i l??i ??n h?t 9 tu?n tu?i thai (B?ng 1). Misoprostol ???ng u?ng ch? nn ???c s? d?ng ??n h?t 7 tu?n tu?i thai. ??t m ??o c hi?u qu? cao h?n v t?n su?t tc d?ng ph? t h?n so v?i cc ???ng dng khc; Tuy nhin, m?t s? ph? n? c th? khng thch ???ng ??t m ??o.

2.4.3. Khuy?n co cho ph thai n?i khoa t? 9 ??n 12 tu?n (63-84 ngy )

Hi?n nay, c b?ng ch?ng h?n ch? v? vi?c s? d?ng Misoprostol trong ph thai n?i khoa t? 9 ??n 12 tu?n (63 - 84 ngy). Khuy?n co c?a WHO xu?t pht ch? t? c 1 th? nghi?m lm sng ng?u nhin v 1 th? nghi?m quan st; tuy nhin, nguyn t?c phc ?? t??ng t? nh? ph thai n?i khoa ? nh?ng tu?i thai khc [7,8]. Phc ?? k?t h?p c hi?u qu? h?n phc ?? ??n thu?c v phc ?? nn bao g?m Misoprostol b?i v Misoprostol l Prostaglandin hi?u qu? nh?t cho gy ph thai n?i khoa. Nghin c?u v? ph thai n?i khoa sau 12 tu?n cho th?y li?u l?p l?i c?a Misoprostol nn ???c s? d?ng khi t?ng tu?i thai (B?ng 1). Cc nghin c?u trong l?nh v?c ny ?ang ???c th?c hi?n v khuy?n co c th? thay ??i khi nghin c?u hon thnh.

2.4.4. Khuy?n co cho ph thai  n?i khoa ??n 12 tu?n (84 ngy) khi khng  c Mifepristone

Mifepristone hi?n ???c ch?p nh?n t?i 50 qu?c gia [9]. Do ?, c r?t nhi?u qu?c gia khng s?n c Mifepristone v ph??ng php thay th? ph?i ???c s? d?ng cho ph thai n?i khoa. Methotrexate k?t h?p v?i Misoprostol t hi?u qu? h?n Mifepristone k?t h?p v?i Misoprostol nh?ng hi?u qu? h?n Misoprostol ??n tr?; do ?, Methotrexate k?t h?p v?i Misoprostol ?i khi ???c dng cho ph thai n?i khoa ??n h?t 12 tu?n. Tuy nhin, B?ng ??c tnh WHO khuy?n co ph?n ??i vi?c s? d?ng Methotrexate cho gy ph thai d?a trn m?i quan tm v? qui thai ? l?n mang thai k? ti?p [10]. Thay vo ?, ? nh?ng vng ch?a c Mifepristone, ph??ng php khuy?n co ph thai n?i khoa ??i v?i thai k? d??i 12 tu?n l ??n tr? Misoprostol, l?p ?i l?p l?i 3 li?u cch nhau t nh?t  3 gi? nh?ng khng qu 12 gi? (B?ng 1). Thai ph? c th? ???c ch? ??nh Misoprostol ???ng ??t m ??o ho?c ng?m d??i l??i; Tuy nhin, Misoprostol ng?m d??i l??i c lin quan v?i t? l? cc tc d?ng ph? cao h?n so v?i ??t m ??o. Ngoi ra, ???ng ng?m d??i l??i l t hi?u qu? ? ph? n? ch?a sinh ?? khi l?p l?i li?u Misoprostol trong kho?ng cch th?i gian di h?n 3 gi?.

2.4.5. Khuy?n co cho ph thai n?i khoa sau 12 tu?n (sau 84 ngy)

Ph thai n?i khoa sau 12 tu?n l m?t l?nh v?c ?ang ti?p t?c nghin c?u v nhi?u phc ?? thu?c khc nhau ? ???c nghin c?u. R?t kh ?? th?c hi?n cc nghin c?u ?? xc ??nh phc ?? hi?u qu? nh?t cho nhm ny b?i v c th? thay ??i v?i tu?i thai, m?c ?? s?y thai x?y ra t h?n ? tu?i thai mu?n h?n. ? tu?i thai s?m, phc ?? k?t h?p c hi?u qu? h?n phc ?? ??n thu?c. Phc ?? khuy?n co l dng Mifepristone u?ng, 36-48 gi? sau  l?p l?i li?u Misoprostol (B?ng 1). M?t kho?ng th?i gian t h?n 36 gi? gi?a Mifepristone v Misoprostol c lin quan t?i m?t kho?ng th?i gian lu h?n ?? s?y thai v t? l? s?y thai khng tr?n cao h?n. Ph? n? c m?t v?t s?o t? cung c nguy c? v? t? cung r?t th?p (0,3%) trong qu trnh ph thai n?i khoa s? d?ng Misoprostol trong ba thng th? hai c?a thai k? [11]. Ph??ng php khuy?n co ph thai n?i khoa khi Mifepristone khng s?n c l ??n tr? Misoprostol, l?p ?i l?p l?i m?i 3 gi? ??n 5 li?u (B?ng 1). Nh? thu?c Ethacridine lactate ???c k?t h?p c lin quan t?i kho?ng th?i gian ?? s?y thai c?ng t??ng t? nh? ??i v?i phc ?? s? d?ng Misoprostol ??n thu?n; Tuy nhin, cc nghin c?u ? khng so snh an ton ho?c hi?u qu? c?a vi?c s? d?ng ny v?i  k?t h?p Mifepristone v Misoprostol.

2.4.6. Khuy?n co cho vi?c chu?n b? c? t? cung tr??c khi ph thai ngo?i khoa ??n h?t 12-14 tu?n (??n h?t 84-98 ngy)

Chu?n b? c? t? cung ?? c?i thi?n s? gin n? c? t? cung tr??c khi ph thai ngo?i khoa c th? ???c th?c hi?n b?ng cch s? d?ng que nong th?m th?u ho?c Misoprostol. N?u s? d?ng Misoprostol ?? chu?n b? c? t? cung, c th? dng m?t li?u ??n 400 mcg ho?c ng?m d??i l??i 2 gi? tr??c th? thu?t ho?c  ??t m ??o 3 gi? tr??c th? thu?t (B?ng 1). Ph??ng php chu?n b? c? t? cung c th? ???c xem xt cho ph? n? ? m?i tu?i thai ?? t?o ?i?u ki?n gin n? c? t? cung; chu?n b? c? t? cung ???c khuy?n co cho t?t c? ph? n? tr?i qua ph thai ngo?i khoa ? tu?i thai qu 12 - 14 tu?n. ? 3 thng ??u thai k?, chu?n b? c? t? cung ? ???c ch?ng minh l khng lm gi?m cc tc d?ng ph? quan tr?ng nh? th?ng t? cung ho?c rch c? t? cung, m?c d lm gi?m t? l? s?y thai khng tr?n sau ?i?u tr? ngo?i khoa. Khng c cc que nong th?m th?u ho?c Misoprostol khng nn h?n ch? ti?p c?n d?ch v? ph thai. C?n xem xt ??n s? gia t?ng th?i gian v tc d?ng ph? (?au, ch?y mu m ??o v m?c s?y thai nhanh chng) lin quan ??n vi?c chu?n b? c? t? cung. Chi ph, tnh s?n c c?a ph??ng php chu?n b? c? t? cung ? ??a ph??ng v  vi?c ?o t?o s? d?ng cc ph??ng php s? ?nh h??ng ??n s? l?a ch?n c?a ph??ng php s? d?ng.

2.4.7. Khuy?n co cho vi?c chu?n b? c? t? cung tr??c khi ph thai ngo?i khoa ? 14 tu?n ho?c sau ? (98 ngy ho?c sau ?)

T?t c? ph? n? tr?i qua nong v bi xu?t ? 14 tu?n ho?c tr? h?n ph?i tr?i qua chu?n b? c? t? cung tr??c khi th?c hi?n. Cc ph??ng php ???c khuy?n co chu?n b? c? t? cung tr??c khi nong v bi xu?t bao g?m que nong th?m th?u ho?c Misoprostol. M?t th? nghi?m ng?u nhin c nhm ch?ng ? so snh tr?c ti?p Misoprostol ??t m ??o v?i laminaria qua ?m, cho th?y r?ng que nong th?m th?u gi?m th?i gian quy trnh v nhu c?u ti?p t?c nong so v?i vi?c s? d?ng Misoprostol [12]. M?t th? nghi?m ng?u nhin khc lin quan ??n ph? n? ? 13-20 tu?n tu?i thai pht hi?n ra r?ng s? nong c? t? cung v?i laminaria ? ???c t?ng tc d?ng b?ng cch s? d?ng Misoprostol ng?m p m tr??c th? thu?t nh?ng tc d?ng ny ch? ???c tm th?y trong thai k? 19-20 tu?n [13]. Hi?u qu? c?a Misoprostol tr??c nong v bi xu?t sau 20 tu?n tu?i thai ? khng ???c nghin c?u trong nghin c?u so snh.

3. K?t lu?n

Trong n?m 2010, 287 000 ph? n? ch?t trong v sau khi mang thai v sinh con. Cc bi?n ch?ng chnh chi?m 80% t?t c? cc ca t? vong m? l xu?t huy?t (??c bi?t l BHSS), nhi?m trng h?u s?n, cao huy?t p trong thai k? v ph thai khng an ton [14].

?ng d?ng ch?ng c? theo ??nh h??ng c?a vi?c s? d?ng Misoprostol qua m?t lo?t l?nh v?c s?n v ph? khoa c kh? n?ng lm gi?m t? l? t? vong b m? ph h?p v?i ku g?i hnh ??ng ??a ra trong M?c tiu Pht tri?n Thin nin k?. Nh? ? th?o lu?n, Misoprostol c th? ???c s? d?ng nh? m?t tc nhn kh?i pht chuy?n d? trong ba thng th? ba thai k?, gp ph?n chuy?n d? nhanh trong cc tr??ng h?p c?n can thi?p cho m? v thai nhi nh? b?nh cao huy?t p v nhi?m trng. Misoprostol c vai tr trong phng ng?a v ?i?u tr? BHSS; m?c d Misoprostol khng ph?i l m?t l?a ch?n ??u tin, c b?ng ch?ng h? tr? vi?c s? d?ng Misoprostol khi Oxytocin khng c. Cu?i cng, Misoprostol l m?t thu?c c?n thi?t cho vi?c ph thai an ton.

T?t c? cc khuy?n co c?a WHO v? vi?c s? d?ng Misoprostol trong nhi?u ??i t??ng s?n v ph? khoa ? ???c pht tri?n d?a trn cc b?ng ch?ng t?t nh?t hi?n c thng qua m?t qu trnh pht tri?n cc h??ng d?n nghim ng?t. B?i v cc phc ?? d?a trn b?ng ch?ng cho vi?c s? d?ng Misoprostol an ton v hi?u qu? thay ??i ty theo ch? d?n v c?ng c th? khc nhau theo cch thi?t l?p, cc ti li?u ny tm t?t h??ng d?n hi?n hnh ?? s? d?ng Misoprostol. Khi b?ng ch?ng m?i s?n c, WHO s? c?p nh?t khuy?n co ph h?p, b? sung cng c? th?c hnh cho cc nh ho?ch ??nh chnh sch v cc nh lm sng.

Ngu?n:

Jennifer Tang, Nathalie Kapp, Monica Dragoman, Joao Paulo de Souza. WHO recommendations for misoprostol use for obstetric andgynecologic indications. International journal of Gynecology and Obstetrics 121 (2013)186-189.

Ti li?u tham kh?o

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