2012.

T chc Y t Th gii

Cc khuyn co trong phng trnh bng huyt sau sanh

Hp A: Cc khuyn co trong phng trnh bng huyt sau sanh

Cc thuc co hi t cung
1. Vic s dng thuc co hi t cung phng nga bng huyt sau sanh trong giai on 3 ca
chuyn d c khuyn co cho tt c cc trng hp sanh. (Khuyn co mc mnh, bng
chng mc trung bnh)
The use of uterotonics for the prevention of PPH during the third stage of labour is recommended for all births. (Strong recommendation,
moderate-quality evidence)

2. Oxytocin (10 n v quc t, tim tnh mch hoc tim bp) l thuc co hi t cung c
khuyn co phng nga bng huyt sau sanh. (Khuyn co mc mnh, bng chng
mc trung bnh)
Oxytocin (10 IU, IV/IM) is the recommended uterotonic drug for the prevention of PPH. (Strong recommendation, moderate-quality
evidence)

3. Ti cc c s m oxytocin khng c sn, khuyn co s dng cc thuc co hi t cung

khc dng tim (nh ergometrin/methylergometrine hoc ch phm kt hp gia oxytocin
v ergometrine nu ph hp vi bnh nhn) hay misoprostol dng ng ung (600g).
(Khuyn co mc mnh, bng chng mc trung bnh)
In settings where oxytocin is unavailable, the use of other injectable uterotonics (if appropriate ergometrine/methylergometrine or the fixed
drug combination of oxytocin and ergometrine) or oral misoprostol (600 g) is recommended. (Strong recommendation, moderatequality
evidence)

4. Ti cc c s m khng c nhn vin y t c k nng sanh thun thc v khng c

sn oxytocin, nhn vin chm sc sc khe cng ng v nhn vin y t khng c chuyn
mn c th cho bnh nhn dng misoprostol (600g ng ung) phng nga bng huyt
sau sanh. (Khuyn co mc mnh, bng chng mc trung bnh)
In settings where skilled birth attendants are not present and oxytocin is unavailable, the administration of misoprostol (600 g PO) by
community health care workers and lay health workers is recommended for the prevention of PPH. (Strong recommendation,
moderatequality evidence)

X l dy rn v xoa t cung
5. Ti cc c s m c nhn vin y t c k nng sanh thun thc, nu nh nhn vin y
t v sn ph u nhn nh rng vic gim mt lng nh mu mt v thu ngn mt t thi
gian ca giai on 3 ca chuyn d th vic ko dy rn c kim sot c khuyn co thc
hin cho cc cuc sanh ng m o (Khuyn co mc yu, bng chng mc mnh)
In settings where skilled birth attendants are available, CCT is recommended for vaginal births if the care provider and the parturient
woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important (Weak
recommendation, high-quality evidence)

6. Ti cc c s m khng c nhn vin y t c k nng sanh thun thc, vic ko dy

rn c kim sot khng c khuyn co. (Khuyn co mc mnh, bng chng mc trung
bnh)
In settings where skilled birth attendants are unavailable, CCT is not recommended. (Strong recommendation, moderate-quality evidence)

7. Kp dy rn mun (thc hin sau khi sanh t 1 n 3 pht) c khuyn co cho tt c cc

trng hp sanh cng lc vi vic chm sc s sinh ban u. (Khuyn co mc mnh,
bng chng mc trung bnh)
Late cord clamping (performed after 1 to 3 minutes after birth) is recommended for all births while initiating simultaneous essential
newborn care. (Strong recommendation, moderatequality evidence)

8. Kp dy rn sm (di 1 pht sau sanh) khng c khuyn co, ngoi tr trng hp s

sinh ra b ngt v cn di chuyn ngay lp tc n bn hi sc s sinh. (Khuyn co mc
mnh, bng chng mc trung bnh)
Early cord clamping (<1 minute after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for
resuscitation. (Strong recommendation, moderate-quality evidence)

9. Duy tr xoa bp t cung khng c khuyn co nh l mt bin php phng nga bng
huyt sau sanh nhng sn ph c oxytocin d phng (Khuyn co yu, bng chng mc
thp)
Sustained uterine massage is not recommended as an intervention to prevent PPH in women who have received prophylactic oxytocin.
(Weak recommendation, low-quality evidence)

Bin dch: B mn Ph Sn, H YD TP.HCM v Phng K hoch tng hp, Bnh vin Ph Sn Hng Vng. 2013

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 2012. T chc Y t Th gii

Cc khuyn co trong phng trnh bng huyt sau sanh

10. nh gi trng lc c t cung qua thnh bng sau sanh pht hin sm t cung c
khuyn co cho tt c cc sn ph. (Khuyn co mc mnh, bng chng mc rt thp)
Postpartum abdominal uterine tonus assessment for early identification of uterine atony is recommended for all women. (Strong
recommendation, very-low-quality evidence)

Trong trng hp m sanh

11. Oxytocin (tim tnh mch hay tim bp) l thuc co hi c t cung c khuyn co
phng trnh bng huyt sau sanh trong trng hp m sanh. (Khuyn co mc mnh, bng
chng mc trung bnh)
Oxytocin (IV or IM) is the recommended uterotonic drug for the prevention of PPH in caesarean section. (Strong recommendation,
moderate-quality evidence)

12. Ko dy rn l phng php c khuyn co ly nhau trong trng hp m sanh.

(Khuyn co mc mnh, bng chng mc trung bnh)
Controlled cord traction is the recommended method for removal of the placenta in caesarean section. (Strong recommendation, moderatequality evidence)

Bin dch: B mn Ph Sn, H YD TP.HCM v Phng K hoch tng hp, Bnh vin Ph Sn Hng Vng. 2013

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 2012. T chc Y t Th gii

Cc khuyn co trong phng trnh bng huyt sau sanh

Hp B: Cc khuyn co trong iu tr bng huyt sau sanh

Cc thuc co hi t cung
13. Oxytocin ng tnh mch l thuc co hi c t cung c khuyn co iu tr bng huyt
sau sanh. (Khuyn co mc mnh, bng chng mc trung bnh)
Intravenous oxytocin alone is the recommended uterotonic drug for the treatment of PPH. (Strong recommendation, moderate-quality
evidence)

14. Trong trng hp khng c oxytocin, hoc trong trng hp vic kim sot chy mu khng
p ng vi oxytocin, s dng ergometrine ng tnh mch, oxytocin v ergometrine phi
hp vi hm lng c nh, hoc prostaglandin (bao gm c misoprostol ngm di li,
800g) c khuyn co. (Khuyn co mc mnh, bng chng mc thp)
If intravenous oxytocin is unavailable, or if the bleeding does not respond to oxytocin, the use of intravenous ergometrine, oxytocinergometrine fixed dose, or a prostaglandin drug (including sublingual misoprostol, 800 g) is recommended. (Strong recommendation, lowquality evidence)

B th tch v acid tranexamic

15. Trong hi sc ban u ca b th tch tnh mch cho bnh nhn bng huyt sau sanh, vic s
dng dung dch tinh th ng trng c khuyn co s dng u tin hn so vi vic s
dng dch keo. (Khuyn co mc mnh, bng chng mc thp)
The use of isotonic crystalloids is recommended in preference to the use of colloids for the initial intravenous fluid resuscitation of women
with PPH. (Strong recommendation, low-quality evidence)

16. S dng acid tranexamic c khuyn co iu tr bng huyt sau sanh nu oxytocin v
cc thuc co hi t cung khc khng ngn c mu chy hoc nguyn nhn chy mu c th
phn no l do nguyn nhn tn thng sinh dc. (Khuyn co mc yu, bng chng mc
trung bnh)
The use of tranexamic acid is recommended for the treatment of PPH if oxytocin and other uterotonics fail to stop bleeding or if it is thought
that the bleeding may be partly due to trauma. (Weak recommendation, moderate-quality evidence)

Th thut v cc bin php can thip khc

17. Xoa bp t cung c khuyn co iu tr bng huyt sau sanh. (Khuyn co mc
mnh, bng chng mc rt thp)
Uterine massage is recommended for the treatment of PPH. (Strong recommendation, verylow-quality evidence)

18. Nu sn ph khng p ng vi cc thuc co hi t cung, hoc khng c thuc co hi t

cung, vic s dng bng chn lng t cung c khuyn co iu tr bng huyt sau sanh
do t cung. (Khuyn co mc yu, bng chng mc rt thp)
If women do not respond to treatment using uterotonics, or if uterotonics are unavailable, the use of intrauterine balloon tamponade is
recommended for the treatment of PPH due to uterine atony. (Weak recommendation, very-low-quality evidence)

19. Nu cc phng php khc tht bi v bnh vin c sn ngun lc cn thit, vic thuyn tc
ng mch t cung c khuyn co nh l mt bin php iu tr bng huyt sau sanh do
t cung. (Khuyn co mc yu, bng chng mc rt thp)
If other measures have failed and if the necessary resources are available, the use of uterine artery embolization is recommended as a
treatment for PPH due to uterine atony. (Weak recommendation, very-low-quality evidence)

20. Nu mu vn khng ngng chy d s dng cc thuc co hi t cung v cc bin php can
thip bo tn khc (nh xoa bp t cung, chn bng), th vic thc hin cc bin php can
thip ngoi khoa c khuyn co. (Khuyn co mc mnh, bng chng mc rt thp)
If bleeding does not stop in spite of treatment using uterotonics and other available conservative interventions (e.g. uterine massage,
balloon tamponade), the use of surgical interventions is recommended. (Strong recommendation, very-low-quality evidence)

21. Phng php chn t cung bng hai tay c khuyn co l mt bin php tm thi trong
thi gian ch i c th thc hin c cc iu tr thch hp cho tnh trng bng huyt sau
sanh do t cung sau sanh ng m o. (Khuyn co mc yu, bng chng mc rt
thp)
The use of bimanual uterine compression is recommended as a temporizing measure until appropriate care is available for the treatment of
PPH due to uterine atony after vaginal delivery. (Weak recommendation, very-low-quality evidence)

Bin dch: B mn Ph Sn, H YD TP.HCM v Phng K hoch tng hp, Bnh vin Ph Sn Hng Vng. 2013

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 2012. T chc Y t Th gii

Cc khuyn co trong phng trnh bng huyt sau sanh

22. Phng php chn ng mch t cung qua thnh bng iu tr bng huyt sau sanh do
t cung sau sanh ng m o c khuyn co l mt bin php tm thi trong thi gian ch
i c th thc hin c cc iu tr thch hp. (Khuyn co mc yu, bng chng mc
rt thp)
The use of external aortic compression for the treatment of PPH due to uterine atony after vaginal birth is recommended as a temporizing
measure until appropriate care is available. (Weak recommendation, very-low-quality evidence)

23. S dng ti kh nn chng sc (non-pneumatic anti-shock garment) c khuyn co l mt

bin php tm thi trong thi gian ch i c th thc hin c cc iu tr thch hp.
(Khuyn co mc yu, bng chng mc thp)
The use of non-pneumatic anti-shock garments is recommended as a temporizing measure until appropriate care is available. (Weak
recommendation, low-quality evidence)

24. Chn gc lng t cung khng c khuyn co iu tr bng huyt sau sanh do t cung
sau sanh ng m o. (Khyn co mc yu, bng chng mc rt thp)
The use of uterine packing is not recommended for the treatment of PPH due to uterine atony after vaginal birth. (Weak recommendation,
very-low-quality evidence)

Cc khuyn co trong iu tr nhau khng bong

25. Nu nhau khng bong t nhin, khuyn co nn dng oxytocin ng tnh mch / tim bp
(10 n v) kt hp vi ko dy rn c kim sot. (Khuyn co mc yu, bng chng mc
rt thp)
If the placenta is not expelled spontaneously, the use of IV/IM oxytocin (10 IU) in combination with controlled cord traction is
recommended. (Weak recommendation, very-low-quality evidence)

26. Vic s dng ergometrine khi nhau cha bong khng c khuyn co v vic ny c th lm
cho t cung co cng lin tc c th gy chm tr s tng xut nhau. (Khuyn co mc
yu, bng chng mc rt thp)
The use of ergometrine for the management of retained placenta is not recommended as this may cause tetanic uterine contractions which
may delay the expulsion of the placenta. (Weak recommendation, very-low-quality evidence)

27. Vic s dng prostaglandin E2 alpha (dinoprostone hoc sulprostone) iu tr nhau khng
bong khng c khuyn co. (Khuyn co mc yu, bng chng mc rt thp)
The use of prostaglandin E2 alpha (dinoprostone or sulprostone) for the management of retained placenta is not recommended. (Weak
recommendation, very-low-quality evidence)

28. Dng khng sinh mt liu duy nht (ampicillin hoc cephalosporin th h th nht) c
khuyn co trong trng hp c thc hin bc nhau bng tay. (Khuyn co mc yu, bng
chng mc rt thp)
A single dose of antibiotics (ampicillin or first-generation cephalosporin) is recommended if manual removal of the placenta is practised.
(Weak recommendation, very-low-quality evidence)

Bin dch: B mn Ph Sn, H YD TP.HCM v Phng K hoch tng hp, Bnh vin Ph Sn Hng Vng. 2013

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 2012. T chc Y t Th gii

Cc khuyn co trong phng trnh bng huyt sau sanh

Hp C: T chc chm sc
29. Khuyn co s dng phc iu tr chnh thng ca c s thc hin phng trnh v iu
tr bng huyt sau sanh. (Khuyn co mc yu, bng chng mc trung bnh)
The use of formal protocols by health facilities for the prevention and treatment of PPH is recommended. (Weak recommendation,
moderate-quality evidence)

30. Cho mi c s y t tuyn di, khuyn co s dng phc iu tr chnh thng dng cho
chuyn bnh nhn ln tuyn trn. (Khuyn co mc yu, bng chng mc rt thp)
The use of formal protocols for referral of women to a higher level of care is recommended for health facilities. (Weak recommendation,
very-low-quality evidence)

31. Khuyn co s dng cc phng php m phng iu tr bng huyt sau sanh trong cc
chng trnh hun luyn hin hu v tin lm sng. (Khuyn co mc yu, bng chng
mc rt thp)
The use of simulations of PPH treatment is recommended for pre-service and in-service training programmes. (Weak recommendation,
very-low-quality evidence)

32. Theo di vic s dng thuc co hi t cung sau sanh nhm mc ch phng trnh bng huyt
sau sanh phng nga bng huyt sau sanh c khuyn co nh l mt ch t cho nh
gi. (Khuyn co mc yu, bng chng mc rt thp)
Monitoring the use of uterotonics after birth for the prevention of PPH is recommended as a process indicator for programmatic evaluation.
(Weak recommendation, very-low-quality evidence)

Bin dch: B mn Ph Sn, H YD TP.HCM v Phng K hoch tng hp, Bnh vin Ph Sn Hng Vng. 2013

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