i hc Y Dc TP.

H Ch Minh
B mn Ph Sn

Khm thai
GING VIN PH TRCH
Tin s Hunh Nguyn Khnh Trang. E-mail: tranghnk08@gmail.com

MC TIU

Sau khi hon thnh bi hc, sinh vin Y khoa nm th T c kh nng

1. Trnh by c 9 bc thm thai theo chun quc gia v cc dch v chm sc sc khe sinh sn
2. Trnh by c mc ch ca khm thai trong tng tam c nguyt ca thai k
3. Lit k c ni dung ca mi ln khm thai trong tng tam c nguyt ca thai k
4. Ghi chp c vo s khm thai sau khi hon thnh mi ln khm thai
5. Nhn bit c mt ln khm thai khng bnh thng

Qu trnh khm thai ni chung - 9 bc thm thai

Khm thai bao gm mt lot nhng ln khm m thai ph phi hon tt trong thai k, nhm mc
ch theo di s tin trin ca thai k, pht hin cc bt thng trong thai k xy ra b m v bo
thai, nhm mc ch ch ng gii quyt cc vn bnh l, em li mt cuc sanh an ton cho m
v con.
Do sinh l ca pht trin bo thai, mi giai on ca thai k c nhng mc tiu khm thai ring bit.
Tam c nguyt th nht l thi im thc hin chn on thai, nh tui thai, xc nh s
lng thai v truy tm cc bt thng bo thai, m phn ln c lin quan n lch bi nhim sc
th. Thi gian ny cn l thi gian l tng tm sot cc bnh l c th nh hng n bo
thai nh cc bnh nhim trng, bnh chuyn ha v cc bnh l h thng khc. Tam c nguyt
th nht cn l thi im rt thng xy ra nhng tn tht nh h thai, thai ngng pht trin, thai
ngoi t cung
Tam c nguyt th nh l thi im xy ra qu trnh bit ha cc c quan ch cht ca bo thai, l
thi im c th xc nh hu ht cc d thng xy ra bo thai. Trong khong thi gian ny, s
tng trng bo thai ch l th yu, khng xy ra nhiu lm cc bt thng v tng trng sinh
hc ca bo thai trong giai on ny. Cc bnh l h thng ca m cng thng tr nng v l r
hn trong giai on ny, c bit cc bnh ca h h hp v tun hon. Trong a s cc trng
hp, tam c nguyt th nh l mt khong thi gian tng i bnh an.
Tam c nguyt th ba l thi im thng xy ra cc vn sn khoa nghim trng nh chm
tng trng bo thai, tin sn git, bnh l nc i, nhau bong non, nhau tin o , cng nh l
thi im phi quyt nh ng li cho cuc sanh v chun b cho cuc sanh.
thc hin khm thai tt, cn hiu r c im sinh l ca tng giai on ca thai k cng nh cc
c im sinh bnh hc ca cc bt thng thai k.
Ni dung khm thai trnh by trong bi ny ch yu da trn chun quc gia v cc dch v chm sc
sc khe sinh sn ca B Y T nc ta, ng thi c tham kho cc qui trnh chun ca cc nc
tin tin, nhm gip cho sinh vin nm th t c c ci nhn c bn, tng qut v y v khm
thai.
Ni dung mi ln khm thai bao gm 9 bc cn bn sau ( 9 bc thm thai theo Chun Quc Gia,
http://www.moh.gov.vn/homebyt/vn/portal/InfoDetail.jsp?area=206&cat=1592&ID=1887 )
1. Hi v cc s kin cn lu xy ra gia 2 ln khm thai
LTLS: Khm thai 1
i hc Y Dc TP. H Ch Minh
B mn Ph Sn
2. Khm tng qut nhm pht hin ra cc bt thng ca tng trng bo thai hay cc bnh l ni
khoa tin trin nng hn do thai k
3. Khm sn khoa vi cc mc tiu chuyn bit cho tng giai on ca thai k. V th, ni dung ca
khm sn khoa thai i rt nhiu ty theo ln khm c thc hin thi im no trong thai k.
4. Cc xt nghim cn lm sng ti thiu, chuyn bit cho tng giai on ca thai k, nhm mc
ch theo di pht trin bo thai, pht hin cc bnh l ca bo thai hoc nh hng n s pht
trin ca bo thai hoc do thai k gy ra xut hin v nng ln trong thai k.
5. Nhng ln khm thai cng l thi im thc hin cc thao tc d phng nh tim phng un vn,
khuyn khch s dng thuc b sung st trong thai k v mt s iu tr d phng chuyn bit
cho a phng.
6. Gio dc v v sinh thai nghn, cc lp hun luyn tin sn phi l ni dung ca khm thai, phc
v cho chng trnh lm m an ton.
7. Thai ph cn c thng tin v din tin ca thai k, cc s kin, ngha ca cc s kin xy ra
trong ln khm thai ny v c hn ngy khm cho ln khm sau, ty theo din tin ca cc s
kin trong thai k m ba ta hin c.
8. Tt c ni dung khm phi c ghi nhn vo s khm thai. S khm thai l mt ti liu quan
trng phc v cho sut qu trnh theo di tin trin ca thai k cng nh phc v cho chuyn d.
9. Thai k phi c qun l tuyn c nng lc theo di vn m khm thai pht hin ra.
Qui trnh 9 bc ny c th hin c th qua mi ln khm trong ni dung trnh by cc phn sau.

Khm thai tam c nguyt th nht

Khm thai tam c nguyt th nht cung cp mt khi lng rt ln thng tin quan trng cho thai k.
Ln khm thai u tin cn phi c thc hin sm, trc 12 tun v kinh.
Ni dung u tin ca khm thai tam c nguyt th nht l chn on thai v cc vn lin quan.
Hi bnh s v siu m l phng tin quan trng gip thc hin chn on thai.
Xc nh c thai: thng khng kh. Trong iu kin hin nay, hu ht mi thai ph khi n
khm u bit chc chn rng mnh c thai, da vo cc triu chng c nng nh tr kinh,
nghn, vo triu chng sinh ha l que s dng khng th n dng nh tnh nhanh -hCG trong
nc tiu v i khi vo siu m.
nh tui thai: l ni dung quan trng phi t c trong khm thai tam c nguyt th nht.
nh tui thai theo ngy kinh cui s dng cng thc Naegelee b nh hng bi nhiu yu t
ch quan v khch quan lm sai lch. Sai lch tng ln khi vng kinh khng u.
Siu m nh tui thai nn c thc hin cho mi trng hp, bt chp tnh cht ca kinh k v
3 l do: (1) xc nh tnh ph hp ca tui thai tnh bng kinh cui v siu m, (2) tng tin cy
ca cc kho st tm sot tam c nguyt th nh cng nh cc kho st tng trng bo thai
tam c nguyt th ba, v (3) gim c cc can thip khng cn thit vo cui thai k. Thi im
thc hin ln siu m u tin ny l lc thai khong 10-13 tun v kinh, da trn chiu di u
mng. Nu mun hn 13 tun, cn da vo ng knh lng nh hoc chu vi vng u.
Tm sot d tt thai: gm cc kho st d tt trc tip nh thai v s, cystic hygroma v kho
st mang tnh tm sot nh kho st khong sng sau gy (NT - Nuchal Translucency: cn c
gi khc i l m da gy, dy da gy).
Kho st NT cn c thc hin trong khong gia tun th 11 v th 14. Cn lu t tr s
NT kho st c trong mi tng quan vi CRL hoc tui thai. Tr s NT cng cao, tng ng

LTLS: Khm thai 2

i hc Y Dc TP. H Ch Minh
B mn Ph Sn
vi > 95th percentile (NT MoM hay NT delta), cng c ngha. Khng c mt tr s NT c nh
c gi tr cho mi CRL hay tui thai. NT l mt tham s cn thit cho tnh ton nguy c lch bi.
Xc nh s lng thai v kiu a thai: l mt ni dung khc ca chn on thai tam c
nguyt th nht. Thng tin ny c th gip tin liu v mc nguy c cho thai k song thai.

Ni dung th nh ca khm thai tam c nguyt th nht l sng lc cc yu t nguy c, nhm phn
nh tuyn qun l thai nghn v c k hoch thc hin cc chm sc chuyn bit cho thai k. Cc
bnh l ni khoa c th nng ln trong thai k cn c nhn bit bng thm hi chi tit v tin s
ni, ngoi, sn ph khoa v k hoch gia nh (hnh 1, trch on phiu khm thai).

Tui khi c thai: 18 - 35 <18 >35

Chiu cao: >= 145cm <= 144cm

Chu k kinh
Trnh thai
Tin s sn khoa

S ln sinh 13 >=4

K thai va qua b sy khng c

Thai cht lu khng c
Sn git khng c
Chy mu trc sinh khng c
Bng huyt khng c
Sinh bt thng ( kh) khng c
M t cung khng c
M ly thai khng c
con di 2500g khng c
Con cht tun u sau khng c
Tin s bnh tt khng c

Tn bnh nu c (tim, phi, thn...)..

H 1. Trch on phiu khm thai, phn hi tin s bnh (mu ca B Y T, 2003)

Tin s sn khoa c ngha c bit quan trng trong quyt nh ng li cho theo di thai k
v cuc sanh. Din tin v cc bin c xy ra trong (cc) thai k trc , cc bin c v ni
dung can thip phi thc hin trong 3 giai on ca chuyn d, thch nghi sinh tn v pht
trin th cht-tm thn ca tr sau sanh l nhng yu t cn phi c ghi nhn chi tit.
Khai thc tin s ni khoa nhm tm sot cc bnh l c th nh hng n thai k nh tiu
ng (di tt thai, ri lon bin dng bo thai, thai cht trong t cung, thai to), cao huyt p
(chm tng trng trong t cung, thai cht trong t cung), bnh l tuyn gip (sy thai, ph
nim), hoc b nh hng v nng ln bi thai k nh cao huyt p mn (cao huyt p nng
ln do thai), bnh l h hp mn, cc bt thng chc nng hay thc th ca gan (suy gan cp
trong thai k, vng da mt do thai, ri lan ng mu), bnh l thn (hi chng gan thn
nng ln trong thai k). Cc thai ph c cc vn k trn cn c mt chm sc c bit tng
thch vi tnh trng bnh l, nhm c th vt qua thai k v cuc sanh an ton.

Cc kho st cn lm sng thng qui thc hin sm vo u thai k nhm h tr cho vic tm sot
bt thng trc v trong thai k. Chng gm c nhng kho st bt buc v nhng kho st khuyn
khch thc hin.

LTLS: Khm thai 3

i hc Y Dc TP. H Ch Minh
B mn Ph Sn
B Y T ngh danh sch cc xt nghim ti thiu cn thit gm: proteine niu, haematocrite,
hemoglobin, HIV v giang mai.
Trong nhng iu kin thc hnh tt, nhng tuyn cao hn, mt s kho st nn c a vo
danh sch xt nghim thng qui nh Nhm mu, Rhsus, ng huyt, HBsAg, Phn tch nc
tiu ton b.
Nm trong nhm cc kho st cn lm sng cn t vn trc khi thc hin, c cc kho st
TORCH, b 2 hay 3 tests tm sot lch bi (double test v triple test). Tr s cut-off l 1:250. Cc
kho st ny c thc hin khi thai ph hiu r li ch ca chng v mong mun c thc
hin.

St v acid folic c B Y t khuyn co dng t ln khm thai u tin. Acid folic c cho vi
liu 400 mcg ngy, c th lm gim nguy c d tt ng thn kinh (v s, spina bifida). y l dc
phm b sung duy nht c khuyn co s dng. Khng c dc phm no khc c ngh dng
thng qui trong thai k.
B sung a sinh t v calcium khng cn thit phi thc hin trong 3 thng u thai k.
Thai ph nn c thng tin v kh nng gy d tt bo thai ca dng vitamin A liu cao, > 700
mcg. Thc phm th bin t gan c th cha nhng lng ln vitamin A, v th khng nn dng.
Khng c chng c chng minh li ch ca b sung vitamin D, v th khng dng vitamin D mt
cch thng qui cho mi thai ph.

Khm thai tam c nguyt th nh

Tam c nguyt th nh, tri di t tun th 14 v kinh n ht tun th 27 v kinh, l thi im din
ra s bit ha v hon chnh cc c quan, ng thi cng l thi im xy ra nhng bin ng sinh l
su sc ngi m b ta c th thch nghi vi thai k v cuc sanh sau ny.
Tam c nguyt th nh l thi im m thai c kch thc khng qu to, lng nc i bao quanh
thai li tng i nhiu, mt phn ln cc ni tng c cu trc gn hon chnh v bt u m
nhn cc chc nng ca chng nn l thi im l tng nht cho vic kho st cu trc bo thai mt
cch chi tit trong mt tng th chung.
H tun hon tng cng chc nng to mu, tng th tch tun hon d tr cho mt mu lc sanh, d
dn n qu ti tun hon nhng thai ph c sn vn v tim mch. Cc bin chng nng ca
bnh l tim mch thng ri vo trng thi mt b giai on ny ca thai k. H h hp b hn ch
hot ng do t cung to dn i c honh ln cao, nhu cu oxygen tng cao do phi tha mn c m
v thai nn d xy ra cc bin chng h hp trong giai on ny.
Ngoi 2 vn trn, y l mt khong thi gian tng i bnh lng trong thai k. Khm thai tam
c nguyt th nh ch yu nhm mc ch kho st hnh thi hc thai nhi v din tin ca cc bnh l
ni khoa c th tr nng trong thai k.

Tm sot cc bt thng v hnh thi hc c thc hin bng siu m. Thi im l tng nht
thc hin ln siu m tm sot ny l vo khong tun l v kinh th 18-20.
Trong iu kin l tng, siu m c th tm sot c 76% bt thng ca h thn kinh trung
ng, 67% bt thng ca h niu. Tuy nhin, siu m ch tm sot c 42% bt thng ca h
tiu ha, 17% bt thng h tim mch. Kh nng tm sot l thuc vo tng th ca b ba: qui
trnh, trang thit b v nng lc ca ngi thc hin siu m.
Mi bt thng pht hin c khi truy tm s c xc nh li bi cc bc s chuyn khoa hnh
nh c kinh nghim.

LTLS: Khm thai 4

i hc Y Dc TP. H Ch Minh
B mn Ph Sn
Siu m truy tm v chn on bt thng thai nhi cho php nhn ra (1) cc s sinh khng c kh
nng sng khi ra i, (2) s sinh c kh nng sng nhng vi mt gnh nng cho bn thn a
tr, gia nh v x hi, (3) bt thng cn can thip trong thi k bo thai v cui cng l (4) cc
bt thng s c iu tr sau khi tr sinh ra i.
mt thai ph khng c yu t nguy c, ni dung khm tam c nguyt th nh bao gm theo di
tng cn, huyt p, protein niu, tng trng ca b cao t cung.
Trong tam c nguyt th nh, b cao t cung thng tng 4 cm mi thng.
Tnh trng thiu mu thiu st, tc nng huyt sc t <11g% phi c quan tm iu
chnh bng cch cho thai ph dng thm st.
Tng cn chm bt thng th hin tnh trng thiu ht v dinh dng khi mang thai. Trong khi
, tng cn nhanh bt thng gi hoc phi i tm du chng ca ph v tin sn git hoc du
chng ca ri lon dung np ng huyt trong thai k bng cc test tm sot hay chn on
(Oral Glucose Tolerance Test: OGTT).
D rng bt thng tng trng bo thai v tin sn git khng phi l bnh l thng gp trong
tam c nguyt th nh, nhng vn c th xy ra sm, trong giai on ny ca thai k.
Vo tam c nguyt th nh, thai ph s c tim vaccin phng un vn theo chng trnh quc
gia. S lng mi tim ty thuc vo tnh trng tim phng trc khi mang thai. ngi cha
c min dch, chng trnh quc gia khuyn co tim phng 2 mi VAT. ngi cha c
tim phng , mi tim nhc nh s c thc hin trong giai on ny.
Vo u tam c nguyt th nh, thai ph c nguy c, tt c mi vn v ni khoa cn phi c
tm hiu mt cch y v c chng trnh theo di v x tr ph hp cho sut tam c nguyt th
nh v thi gian cn li ca thai k.
Khng c qun rng tam c nguyt th nh l thi im thng xy ra s tr nng ca cc
bnh l tim mch v h hp.

Khm thai tam c nguyt th ba

Sau tam c nguyt th nh, cc xo trn h thng dn dn n nh hn. C th dung np tt hn vi
thai k. Tuy nhin, v mt sn khoa, tam c nguyt th ba l thi im xy ra nhiu s kin nh
hng, i khi nghim trng, n c m v con. V th, khi khm thai tam c nguyt th ba cn ch
n rt nhiu d kin phc v cho cc mc tiu khc nhau.
Mc tiu th nht ca khm thai tam c nguyt th ba l theo di tng trng bo thai. Vic kho st
tng trng c thc hin bng cc quan trc lm sng v siu m.
Khc vi cc thi k trc, tam c nguyt th ba l thi im xy ra hin tng tng nhanh s
lng t bo trn mi c quan ca thai nhi. S gia tng tng khi t bo th hin qua tng trng
ca thai nhi. Thai to hay chm tng trng trong t cung thng bt u th hin r nt giai
on ny, d rng bnh l nguyn nhn c th bt u t tam c nguyt th nh.
Thi im ch nh kho st siu m sinh trc bo thai tam c nguyt th ba ty thuc vo cc
d kin thu c t quan st lm sng.
Cn ngh n thai to khi pht hin ra tng trng qu nhanh, km theo tng nhanh ca b cao t
cung. B cao t cung tng nhanh mt phn do thai to v mt phn khc do lng i tng nhanh.
Siu m s thy cc s o ca thai nhi cao hn tr s bch phn v th 95 ca biu tng trng.
Thai to thng km theo d i lm b cao t cung li cng tng nhanh hn. Trong trng hp
ny, cn thc hin kho st dung np ng huyt.
Ngh n chm tng trng bo thai khi b cao t cung tng chm hoc khng tng qua cc ln
khm. B cao t cung tng chm l do thai nh v gim lng i. Tng trng t m khng lin
LTLS: Khm thai 5
i hc Y Dc TP. H Ch Minh
B mn Ph Sn
quan nhiu n thai chm tng trng. Siu m s thy cc s o ca thai nhi thp hn tr s bch
phn v th 10, th 5 v th 3 ca biu tng trng. Bch phn v th 10 c xem nh ng
sng lc chm tng trng bo thai. Bch phn v th 5 c xem nh ng bo ng. Kt qu
sinh trc nm di bch phn v th 3 cho xc nh chm tng trng bo thai. Mt cch nhn
nh khc na l biu cc s o tr nn nm ngang hay b gy trc khi chm n ng bch
phn v th 10. Thai chm tng trng thng km theo thiu i lm b cao t cung li cng
tng chm hn, khng tng hoc gim i. Sinh trc nc i cho thy lng i di cut-off.
Trong trng hp ny, bt buc phi thc hin cc kho st chi tit lng gi sc khe thai
nh Velocimetry Doppler, Non-stress test.

Mc tiu th nh l nhn bit c cc bnh l c th ca sn khoa. Chng thng c th hin r

nt tam c nguyt th ba.
Tin sn git xut hin nhiu hn v thng tr nng giai on ny. Huyt p tng, tng trng
nhanh bt thng, ph ra khi phm vi ca chi di, tm sot c m niu bng que nhng
nc tiu l nhng du chng phi c lu tm tm kim mi ln khm. Cn lu rng tm
sot m niu bng my t ng t b dng tnh gi v m tnh gi hn que nhng, nhng que
nhng vn l phng tin ph bin cho tm sot. Ch cn c mt trong cc triu chng nu trn
cng phi thc hin cc kho st v tin hnh cc chm sc dnh cho thai ph b tin sn
git.
Chn on nhau tin o c th c xc lp k t tun th 28 v kinh. Siu m l phng tin
xc nh nhau tin o vi c nhy cm ln chuyn bit u rt cao. Chn on nhau tin
o cn c xc lp bng mt ln siu m na, vo khong tun th 36. Thai ph vi nhau tin
o phi c qun l tuyn c kh nng phu thut v c iu kin thc hin truyn mu.
Cn co t cung thng bt u xut hin nhiu hn vo cui thi k ny. y l nhng cn co
Braxton-Hicks. Tuy nhin cn hi k thai ph v tnh cht cc cn co phn bit vi cc cn co
ca da sanh non hay chuyn d sanh non. Trong trng hp cn thit, khm m o bng tay
hay dng siu m nh gi mc thay i c t cung.

T tun th 36 ca thai k, ngoi nhng ni dung trn, mc tiu th ba ca khm thai xoay quanh
vic lng gi 2 yu t lin quan n cuc sanh l ngi thai v khung chu.
Thai thng t bnh chnh v ngi chm trc tun th 34. Cn xc nh ngi thai khi thc hin
cc ln khm t tun th 36 tr i. Khi pht hin ngi ngc c th xem xt thc hin ngoi xoay
thai. Cc t liu y hc chng c cho thy ngoi xoay bin ngi ngc thnh ngi chm thc hin
thi im ny c hiu qu trong vic lm gim t l m sanh v ngi ngc. Tuy nhin cn thn
trng xc nh cc yu t nguy c khc trc khi tin hnh ngoi xoay thai.
Khm khung chu khng c khuyn khch trong qui trnh khm thai bnh thng. Tng quan
gia khung chu v thai s c nh gi v xc nh khi thai ph vo chuyn d. Quang kch
chu khng phi l mt kho st hu ch cho tin lng cuc chuyn d mt thai ph bnh
thng.
Lng gi sc khe thai ch cn thit khi tng trng bo thai c vn bt thng hoc trong
trng hp thai k ko di qu ngy d sanh.
Non-stresstest l mt kho st khng xm nhp, nhm mc tiu lng gi xem thai c an ton
khng. Kt qu c p ng th hin mt thai bnh thng. Khi non-stresstest nghi ng hay khng
in hnh, cn thc hin stress-test.
Stress test (Contraction Stress Test, Oxytocin Challenge Test) c gi tr d bo m rt cao
(99.7%) nn c ch nh trong trng hp NST khng in hnh.
Non-stress test, stress test khng phi l kho st c ch nh thng qui trong thai k.
Cc kho st chuyn bit nh velocimetry doppler ch thc hin trong nhng ch nh c bit.

LTLS: Khm thai 6

i hc Y Dc TP. H Ch Minh
B mn Ph Sn

Ph lc (1): Qui trnh thc hin 9 bc thm thai theo tng tam c nguyt
TT Ni dung Di 12 tun 13 - 27 tun 28 - 40 tun Ghi ch
Hi Bn thn, sc khe, gia nh. Bng to dn. Thai p. Cc ln thm sau phi xem phiu nm
Hn nhn, hot ng tnh dc. Thai my. St bng. vng cc chi tit hi. Nu cn th b sung.
Kinh nguyt. Sn ph c phn nn g khng.
Tin s sn, ph khoa.
1 Cc BPTT s dng trc khi c thai
ln ny.

Khm ton thn o chiu cao. o chiu cao. o chiu cao. o chiu cao ch cn tin hnh nu khm ln
Cn nng. Cn nng. Cn nng. u.
Mch. Mch. Mch.
o huyt p. o huyt p. o huyt p.
2 C ph. C ph. C ph.
Da xanh nim mc nht, kh th. Da xanh nim mc nht, kh th. Da xanh nim mc nht, kh th.
V. V. V.
Nghe tim phi. Nghe tim phi. Nghe tim phi.
Khm sn khoa Nn bng tm y t cung. Chiu cao t cung. Chiu cao t cung / vng bng. Khng khm m o khi thm thai thng
t m vt quan st khi c ch nh. Tim thai. Ngi thai. thng.
3 Ch khm m o khi thy du hiu bt Tim thai.
thng. S lng thai.

Th Protein niu + + + Dng que th hoc t nng nc tiu.

Th Hb, Hematocrit, HIV v giang
4
mai cc huyn, x c trang b. + + +

Tim phng un vn VAT. Hn ngy. Mi 1, Mi 2 hoc tim mi nhc nh. Kim tra b sung cho mi.
5

Cung cp vin st / acid folic.
Thuc phng st rt (vng lu hnh).
6
Cho thuc ty giun nu cn thit.
Gio dc v sinh thai nghn.
7
+ + + Cc ln thm sau phi kim tra c ung
+ + + khng v c cn ung tip khng.
+ + Ch cho trong trng hp tht cn thit v
khng cho trong 3 thng u.
+ Kim tra, hng dn b sung nu cn. Kim tra, hng dn b sung nu cn.

in vo s, ghi phiu, in bng v + + + 4 cng c

8 hp qun l thai.

Thng bo kt qu khm, hn thm nh gi nguy c. nh gi nguy c. nh gi nguy c. Chun b cho m v con.

9 li, dn d n c s y t gn nht Hn ngy thm li. Hn ngy thm li. D kin ngy sinh, ni sinh.
nu cn.

B Y T. Chun quc gia v cc dch v chm sc sc khe sinh sn. Phin bn 2003.
LTLS: Khm thai 7
i hc Y Dc TP. H Ch Minh
B mn Ph Sn

TI LIU THAM KHO

1. B Y T. Chun Quc Gia v cc dch v chm sc sc khe sinh sn. Lm m an ton. Chm
sc trc .
http://www.moh.gov.vn/homebyt/vn/portal/InfoDetail.jsp?area=206&cat=1592&ID=1887
2. National institute for clinical excellence. Antenatal care. Routine care for the healthy pregnant
woman. Clinical guideline 6. October 2003.
http://www.rcog.org.uk/resources/Public/pdf/Antenatal_Care.pdf

LTLS: Khm thai 8