tia hoi chimg chuyén héa, Luan van Thac si Y hoc, Truéng Dai hoc ¥ Duge Hud. 3, Tran Hou Thanh Tang (2016), Nghién cou mdi lién quan gitta néng d6 ferritin huyét thanh v6i tinh trang khang insulin trén bénh nian tang huyét 4p nguyén phat, Luan van Thac st hgc, Trwéng Bai hoc Y Due Hud) 4. Phan Thi Thu Van (2017), Nghién cou femin huyét thanh 6 bénh nhén dai tho dung tip 2, Luan an Chuyén koa cép Il, Trrdng Bai hoc Y Duroc Hus. 5, Basuli D., Stevens R. G., Torti F. M., ot al (2014), “Epidemiclogical associations between iron and cardiovascular disease and diabetes", Frontiers in Pharmacology, 5, pp. 117-124 6. Cho Mi-Ra, Park Jin-Kyung, Choi Won-Jun, et al (2017), "Serum ferritin level is positively associated with insulin resistance and metabolic syndrome in postmenopausal women: A nationwide populationbased study’, Maturitas, 103, pp. 3-7. 7. Choma Solomon Simon Ramphai, Alberts Marianne, Modjadji Sewela Elizabeth Perpetua (2015), “Conflicting effects of BMI and waist Circumference on iron status’, Joumal of Trace Elements in Medicine and Biology, 32, pp. 73-78. 8. Kim Young-Eun, Kim Do-Hoon, Roh Yong- Kyun, et al (2016), “Relationship between Serum Ferritin Levels and Dyslipidemia in Korean Adolescents’, PLOS ONE, 11(4), pp. 1-12 9. Park Sung Keun, Choi Won Joon, Oh Chang- Mo, et al (2014), “Association between serum ferritin levels and the incidence of obesity in Korean men: A prospective cohort study’, Endocrine, 61(3), pp. 215- 224, _ MO HINH BENH TAT, THU'C TRANG MO LAY THAI VA CAC YEU TO LIEN QUAN GIAI DOAN 5 NAM 2014-2018 TAI BENH VIEN DA KHOA TINH KHANH HOA LE TAN PHUNG', PHAM HOANG PHONG’, LE VAN TUNG', TOM TAT ‘Muc tiéu cia nghién cou nay nha tim hiéu mo hinh bénh tat diéu tri ndi tra, thyc trang mé ly thai va cae yéu 16 lién quan trong giai doan 5 nam 2014- 2018 tai khoa Phu san, Bénh vién Ba khoa tinh Khanh Héa. Sé ligu duoc thu thap trén phan mém quan ly bénh nhdn cia Bénh vign, sir dung phép kiém Chi binh phurong va h6i quy logistic a8 phan tich Két qua bang phan mém R. Dya trén ma phan loai bénh tat quéc t6 (ICD), phan tich trén 39.180 trréng hop diéu trj n6i tra trong 5 nam cho thdy chiém 50,8% ‘m6 hinh bénh tat la cdc trréng hop dén sinh dB. Cac truéng hop bénh Iy san - phy Khoa cé ti 16 thép, chiém duoi 6%. Ti 16 mé ly thai qua 5 ndm 1a 41,2%, 66 xu huténg giém dén qua cdc nam. Phan tich logistic don bién cho thdy xu huéng mé ldy thai tang theo tudi va tién str c6 say thai, gidm theo sé [én sinh va khang c6 J ghia thong Ke a6! vot tin st sinh non. M6 hinh hdi quy logistic da bién cho thdy tudi va sé lén sinh cia san phy 1a yéu t6 tién luong co y ghia di voi nguy co mé lay that Tir khéa: MO hinh bénh tat, md ldy thai, ndi quy logistic. Chiu trach nhiém: Lé Tan Phong ‘Ngay nhén: 04/9/2019 ‘Ngay phan bign: 05/10/2019 Ngay duyét bai: 23/10/2019 ‘Ngay xudt ban: 15/11/2019 NGUYEN THANH PHONG’, NGUYEN THANH HIEN' "sé Y té Khanh Hoa 2B6nh vign Ba khoa tinh Khanh Hoa ‘SUMMARY DISEASE PATTERN, SITUATION OF. CAESAREAN SECTION AND RELATED FACTORS AT OB/GYN DEPARTMENT OF KHANH HOA GENERAL HOSPITAL DURING 5 YEARS 2014-2018 The study aimed to examine in-patient disease pattem, situation of caesarean section and related factors’ during 5 years 2014-2018 at the OB/GYN department of Khanh Hoa General Hospital. Data were extracted from the patient management software of the Hospital. Chi squared test and logistic regression models. were applied to analyze data using R package. Based on the Intemational Classification of Diseases (ICD), results from the data of 39,180 in- patients revealed a dominating proportion of labor (50.8%). Other OB/GYN pathology explained less than 6% of the disease pattem. Caesarean section proportion during 5 years was 41.2% with a decreasing tendency over years. Simple logistic regression models showed a significantly increased risk of suffering caesarean section among factors of age and history of abortion, decreased risk for the factor of number of birth. A multiple logistic regression showed a result that age and number of birth were significant predictive factors of caesarean section. Keywords: Disease pattem, caesarean section, logistic regression. YHTH (1117) - S6 11/2019 - HNKH TRUONG DH BUON MA THUOT KY NIEM5 NAM THANH LAP TRUONG (2014-2019) 9DAT VAN DE Nghién ctu mé hin bénh tat tai mot bénh vign, tai mot khoa lam sang giup cho cac lanh dao bénh vién, khoa lam sang c6 dinh huéng dao tao, dam bao rnhu edu trang thiét bi nhaim dap cng nhu cu dibu tr tai cOng déng noi bénh vign hoac khoa lam sang dé phuc vu. Mé lay thai (Ceasarean section, viét tt 1a CS) la mét phdu thuat san khoa ngay cang duge thy hién nhiéu trén thé gidi. Td chic Y t@ Thé gidi trong khuyén cao nam 2015 48 dua ra ti 16 mé lay thai tur 10-15% trong céng déng (khéng phai trong benh vvign) la ti 18 hop ly [1]. Nghién ciru xu huéng CS 6 quy mo quéc gia, khu vue va toan cau trong giai doan tlr 1990-2014 tai 150, nue trén thé gidi, ket qua cho thay tilé CS 1a 18,6%, dao déng tir 6% & cc nuéc phat trién thép dén 272% 6 cdc nude phat trién cao. TT16 nay cao nhat & khu vyc My La tinh va ving Caribe (40,5%), Bac My (32.3%), chau Dai Duong (31,3%), chau Au (25%) va chau A 19,2%). Chau Phi c6 ti 16 CS thap nhat: 7,3% [2]. Cling nghién cou nay, tir do ligu cia 121 quéc gia, phan tich xu hung (trend analysis) cho thay ti Ié CS toan cau tang 12,4% trong giai doan tur 1990-2014 (tir 6,7% len 19,1%) véi tbe 46 tang frung binh hang néim la 4,4%. Cac nuréc Bong Nam A c6 ti I@ CS 1 14,8% trong giai doan tir 1990 dén 2014, dao dong tw 1,7 aén 32% [2]. Trung Quéc dugc xem la nude cé ti 16 CS cao nhat, dén 50% [3]. Trong vang 20 ndm, tty nam 1988 dén 2008, tilé CS & Trung Quéc da tang tir 3% len dén 39%. Ti 18 nay tiép tuc tang nhanh dén 52%. vao nam 2010. Chua c6 nhiéu nghién ciru v8 m6 hinh bénh tat san khoa va tinh hinh CS trén pham vi toan quéc. NhGng nghién cou trén pham vi timg dia phuong, ting bénh vign cho thay ti18 CS dao dong tir 23% lén én hon 50% [4]. So sénh sau 5 nam, tie CS tai Bénh vign da khoa trung wong Thai Nguyén da tang tir 48,1% lén 58,2% [5]. Trong khi 46 ti 16 nay vo nam 2012 tai Bénh vién San Nhi Ninh Binh chi la 23,1% [6]. Tinh Khanh Hoa cho dén nay chua c6 nghién cru théng ké c6 he théng v8 tinh hinh CS tai cac bénh vign trong tinh. Khoa San Phu Bénh vién Ba khoa tinh Khanh Héa (BVKH) la tuyén chuyén mén cao nhat cila tinh v8 chuyén nganh san phy khoa, tiép nhan céc bénh nhan chuyén dén tir cdc bénh vien hac trong tinh. Nghién ciru m6 hinh bénb t&t va tinh hinh CS tai bénh vién giai doan 5 nam s& cho cac. nha quan ly va lam sang cai nhin tng quat v8 thy trang bénh ly va CS, tao diéu kién dé lap ké hoach va cai tin cac hoat dong chuyén mén o6 lién quan. ‘DOI TUQNG VA PHU'ONG PHAP NGHIEN CUU 1. B6i twgng nghién cou ‘6i twong nghién ctu la tat cd cdc bénh dn diéu tr n6i tra tai khoa San Phu, BVKH trong giai doan tur 01/01/2014 dén 31/12/2018 duoc ma hoa va luu trir trén phan mém khdm chira bénh cla bénh vien. 2. Phuong phap thu thap sé ligu Sé ligu cla cdc bénh an duge truy xudt duéi dinh dang Excel. S6 liéu sau dé dugc lam sach va ding nhat céc ma ICD, tinh toan cc bién s6 tuéi, dia phyong phi hop. Sé ligu sau 6 duoc chuyén sang dinh dang déi tugng (object) dang R 48 dua vao phan tich. : 3. Phuong phap phan tich sé ligu Phép kiém Chi binh phurong durgc sir dung a8 phan tich méi turong quan gitra céc bién phan loai Hi quy logistic don bién va da bién dug stv dung dé phan tich tong quan va tién wong gia bién phy thudc 1a mé lay thai véi cac bién doc lap lin quan dén tudi va tin sir san khoa. V8 tudi, 6 nhiéu cach phan chia nhém tudi khéc nhau dé danh gia nguy co san khoa. Cleary-Goldman va es [7] phan chia thanh 3 nhom tudi: <35 tudi, tir 35-39 tudi va 240 tudi voi nhom tham chiéu la <35 tuéi. Trong khi 46, Blomberg va cs [8] chia nhém tudi nh hon: <17; 17-19; 20-24; 25-29; 30-34; 35-39 va 240, véi nhém tham chiéu la 25-29 tudi. Nghién cou nay p dung cach chia nhém tuéi ciia Blomberg va cs v6i mot didu chinh & nhém dau tién: <20 tudi, trong 6 twong ty nh Blomberg, nhém tham chiéu la 25- 29 tudi. Céc théng ké c6 gid tri p<0,05 durgc xem la cb ¥ ghia migc tin cay 95%. Phan mém R version 3.5.2 dugc sty dung 48 phan tich s6 ligu. KET QUA VA BAN LUAN 4. Dac diém mau nghién cru Tir 01/01/2014 aén 31/12/2018 da cd 39.180 truéng hop digu tri ngi tru tal knoa San Phy BVKH, v6i nhting dc diém chinh trinh bay tai bang 4 Bang 1. 8c diém mu nghién ciru Bac diém Tin 56 THE% ‘Nam 2014 7.991 204 2015 3344 213 2018 7834 200 2017 7.355 188 2018, 7.856. 195, Whom tuBr Min 16, Max 62 | TB: 27,7 <20 tubi 2.308 59 20-24 tub 8.504 27 25-29 tubi 11.872 3013 30-34 tubi 8.477 216 35-39 tui 4348 m1 240 tsi 3671 98 Noi cu tra Nha Trang 21,092 538 Cam Ranh 1.093, 28 Ninh Hoa 4187 10,7 Ven Ninh 2519 64 ign Knanh 4347 124 Khanh Vinh 1507 38 Cam Lam 21559 65 Khanh Son 124 03 Ngoai tinh 1.252 32 Téng 56 sinh B213 367 Mé Idy thai 9.157 412 100 YHTH (1117) - $0 11/2019 - HNKH TRUONG BH BUON MA THUOT KY NIEM 5 NAM THANH LAP TRUONG (2014-2019)Trong 5 nam (2014-2018), s6 trating hep Gibu tri Oi trd hang ndm tai khoa Sén Phy la gan nhy tong duong nhau véi trén dui 8,000 ca méi nam, khong 6 hién tung tang d6t bién, tuy co gidm nhe vao nam 2017. Nhom tudi 25-20 (nhom tham chiéu) chiém tI cao nhét: 30,3%, sau d6 la nhém 20-24 tuéi (21,7%) va nhém tui 30-34 (21,6%). Nhom tudi <20 va 240 chi chiém dudi 10%. Phy né tai thanh phé Nha Trang chiém qua niva cdc trvéng hop diéu {rj ndi trd tai khoa San Phy, tiép theo la & huyén Dien Khanh va thi x4 Ninh Héa (la 2 dia phuong tiép giép voi thanh phd Nha Trang). Chon s6 sinh la nhing truéng hep cé ma ICD khi xuat vien la 080 (sinh thuéng), 082 (mé Idy thai), O83 (4 mot thai voi tha thuat khac), 062 (bat thuréng va dong lc chuyén da) va 060 (chuyén da sém va dé); trong dé mé lay thai 1a nhGng trong hop co ma ICD la 082. Nhu vay, th Ie mé ly thai duro tinh bang cng thire: 082/(080 + 082 + 083 + 062 + 060). \Voi cach tinh nay, théng ké qua § nam cho thay ti le mé ly thai la 41,2% so v6i ting 36 dén sinh. 1.1. M6 hinh bénh tat trong 5 nam 10 bénh thuréng gap trong 5 nam (2014-2018) sap xép theo tan s6 giam dan duge trinh bay tai bang 2. Tile duge tinh trén mau sé la téng s6 truéng hop. iu tri ndi trd: 39.180 truréng hop. K&t qua cho thay cchiém qua nira (27.4% + 23,4% = 50,8%) cc trréng hop diéu tri ndi trd tai khoa Phy San, BVKH la cdc truéng hop dén sinh thudng va mé. Trong dé co 27.4% la sinh thyéng, Nhu vay, c6 thé néi m6 hinh bénb tat tai hoa San Phu BVKH trong 5 nm qua chi yéu la mé hinh san. khoa véi chiém da 6 la cac trvong hyp dén sinh. ‘Cc bénh ly phu khoa chua chiém nhiu ti trong trong mé hinh nay. Két qua cua mé hinh goi y sy cén thiét 8 du tu mé rong cdc danh muc kj thuat lién quan Bang 3. Sinh thuong va mé léy thai so véi ting s6 dén sinh giai doan 2014-2018 Nam | TSsinh | Sinhthuong —[— MBy thai Ts [tee | Ts | Tee zara] Sior | a 2e5-| 44a [270 | 449 201s | 6.198 [2.560 | 492_| 2.708 | 440 2016 | 4.355 |-2.060-| 478 | 1637 | 37.6 zor | 3703-1933 | si [1492 | 393 2018 | ~3766_| 1.892 | 50.2 [1.448 | 384 Cong | 22.213 10.731 | 483 [9.157 | 412 Ti 16 mé [dy thai cao nh&t vao nam 2074 (4.9%) va 2016 (44%), gam xudng durdi 40% trong 3 nam k tip. Tie nay aén nam 2018 la 38.4%. Trong 5 nam, md idy thal thdp nat la vao idm 2046, chibm 37,63 cc trvéng hop dén sinh. Tuong tng voi ti 1 mé lay thai, sinh thong cb xu hung tang len trén 50% tir nm 2017. ‘TIIg mé lay thai cla BVKH so véi cac bénh vién & Trung Quéc durgc xem la thap hon (dén >50%, theo Hellerstein va cs (3)). Tilé nay cla Khanh Hoa cling thdp hon Bénh vién Ba khoa Trung wong Can Tho (80%, theo Huynh Thi My Dung [4)) va Bénh vien da khoa trung wong Thai Nguyén (44 tang tir 48,1% len 58,2% [5). 1.3. Phan tich cac trong hop mé léy thai trong 5 nam theo ICD Bang 4 trinh bay phan loai theo ICD 10 (véi 4 ky tu) cia 9.187 truéng hop mé ly thai. Két qua nay cho thay qué nira cac truréng hop (52,5%) mé lay thai 44 khéng duc ma héa theo ICD 10 voi 4 ky ty ma chi don gidn ghi ma 3 ky ty: 082. Gan mot nira ca inva hop kde (46.6%) duoc xép vao phan loai ‘mé ly thai cp ciru’. Cac truréng hop cén lai Bu chiém ti 16 rt nhd. Do dé, trong cac phan tich tip theo sé bé qua phan tich theo cae phan loai dya tren ma ICD c6 4 ky ty ma chi don gian phan tich theo mét nhom “mé lay thai” bao gdm 082 va 082.1 én bénh ly phy khoa va céc bénh ly san khoa khac. Meo 6 Bing 2 Mo inh Béeh t oia 8 San Pn eo oe Bang 4. Théng ké mé ly thai theo ICD 10 giai tw. {ICD % | doan 2014-2018 4] 080, ‘Sinh thong 40.734 | 27,4 Ma Dién gia Tan s6_[ THe % 21082 ‘MS hy thai 3.157 [234] {082 |My thai cho Tthai | 4.806 | 52.5 3 [O02 | BArthwong khdc cia ting [2 toa] 5,4] [082.0 [MB ldy thai chi gong [71 08 “4 | 020 | Ra mau trong thoi ky dau thai | 1.803 | 4,6 (082.1 Mé lay thai cp iru 4270 | 466 ornahen 082.2-| Mi ly thai + ett cung [3 0.03, 5 [ooo | ——Tharngoaitwcong [1712 4a] [1082.9 [MO Hy thal chu xae ainn [7 o.07 © [083 | B84 thai vor thu thuat khac_| 1.591 | 44 i 7_[ 047 ‘Chuyén da gid 1.575 | 4.0 2. Phan tich hdi quy céc trong hyp mé lay &_| 004 Pha thai noi khoa 1,204| 33] thai trong 5 nam @ | N83 | Cac ign di Khong do vim | 1.089 | 2.8 Nhu trén 48 n6i, cc phan tich tiép theo sau day oa bub wa, wot rong v8 8 dya vao bo 6 liu chi gbm 10.731 trong hep a sinh thuéng va 9.187 truéng hop mé lay thal. 10 [046] Chly aoe pnariog re rani) (2.2! Nhu da 48 cap trong phan phurong phap, phan 1.2. Thye trang va xu huréng sinh thong va mé lay thai trong 5 nam So v6i tng s6 vao vign vi ly do sinh d&, 1118 sinh thong va mé ly thai (ma ICD an luot la 080 va 082) trong giai doan 2014-2018 dug théng ké tai bang 3. tich tinh hinh mé lay thai dya cht: yéu vao phan tich hdi quy logistic vi bién phy thude Ia mé lay thai hoac sinh thudng va cdc bién doc lap bao gém tudi, tién sir vé s6 lan sinh, sé lan sinh non va so lan say thai. ‘D6i voi cac bién sé thudc tién siy PARA (sé Ian sinh, sé [an sinh non va sé lan say), 4é loai bé cac outlier 66 thé c6 do nhap sé ligu, cdc biéu dd phan tan duoc vé dé phat hién outliers. Trong cac biéu 4 nay, truc YHTH (1117) - SO 11/2019 - HNKH TRUONG BH BUON MA THUOT KY NIEM 5 NAM THANH LAP TRUONG (2014-2019) 101tung thé hign sé lan (sinh, sém, sy), truc hoanh bidu hign s6 ca theo thir ty clla b6 sé liéu (index), khong phai la téng sé ca. Hinh 1 bao gém 3 biéu dé: Bigu dd A minh hoa sy’ phan tan cia s6 lan sinh; Biéu dd B minh hoa su phan tan cila s6 [dn sinh non va Biéu dd C minh hoa sy phan tén cia s6 lan sdy thai. Qua 3 biéu dd nay, cc outliers nén duc loai bé nhu sau ~ Bidu dB A: Loai bé céc trvéng hop sinh trén 10 tan, A20- . 5 15- 7 B 0 5000 © 1000015000 20000 index ce . a = e =o . & “ ey 3 3 eee eo + oe 5000 10000 index 145000 20000 Hinh 1. Bidu 46 phan tan cia s6 lin Phan tich héi quy logistic don bién Bang 5 tinh bay KBt qua phan tich hi quy don bién gira nguy co sinh mé voi tivng bién déc lap gom_ tuéi, s6 lan sinh, tién str sinh non va tién si? sy thal. ing 5. Hi quy logistic don bién voi tudi, s6 lan 2 Bidu dd B: Logi bé cac truéng hop sinh non trén 3 lan. 2 Bidu dd C: Loai bé cdc trréng hop say thai trén 6 lan, BO sé ligu sau khi loai bé céc trveng hop nay (tng céng loai bd 10 trréng hop do c6 trong hop c6 trén 1 tigu chudn dé loai bé) sé duoc dua vao phan tich hdi quy logistic don bién va da bién. BO sé ligu dua vao phan tich hdi quy logistic bao gém 19.878 trudng hop. Bs : ge : #2 a Pe ae 3 a eee One " " " " 6 5000 1000015000 20000 index ., sinh non va say thai giai doan 2014-2018 (Trib sivsinhnon Co [107 _]_086_[ 1.32 | 0.554 Tién si sdy thai co 425 | 14.16 _| 134 | 0001 Ghi chi: OR: sua chénh; 96% CI: 95% Khoang tin cay; ref: Nhém tham chiéu Phan tich hdi quy véi bién tudi va nhém 25-29 la hom tham chigu (nhém cé ti Ié didu tri n6i tra cao nhdt trong nghién cou nay, tong déng véi phan nhém tudi theo Blomberg va cs [8)). Két qua tai Bang 5 cho thdy nguy co’ mé lay thai & nhém <25 tudi thap hon so voi nhom 25-29 tuéi. Nguy co nay gidm 59% & nhom <20 tudi va gidm 33% 6 nhém 20-24 tudi Trong khi 46, so voi nhém tudi 25-29, nguy co mé lay thai tang Ién 35% o nhom tudi 30-34 va 82%-83% & sinh, sinh non va sdy thai Bién doclap | OR 35% Oh pvalue Duoi_| Tren Wind tdi 5-28 ref | ref [eet ef =20 041 0,36 _|0.47_| <0.001 20-24 o67_| 061] -0,72_| <0.001 30-34 1,35 -|_125_[ 145] <0.001 35-38 7,82 | 164 [202 | <0.001 340 4.83 -| 153] 2.18 | <0,00 in sinh sz 05 | 041 [060] =0001 102 ‘YHTH (1117) - SO 11/2019 - HNKH TRUONG BH BUON MA THUOT KY NIEM 5 NAM THANH LAP TRUONG (2014-2019)nhom tubi tir 35 tr len. Céc nguy co nay la C6 ¥ ghia thong ké & mic p<0,01 ‘B6i voi bién sé lan sinh, phan tich cho thay nguy co mé lay thai & nhém sinh con lan 3 tré én giam 50% so voi nhém sinh con ti 2 lan tréxuéng. Phan tich hdi quy tai bang 5 cing cho thay nguy co mé ly thai & nhi¢ng san phu cé tién sir sinh non tang 7% nhung khéng 6 y nghia théng ké (p=0,554).. “Trong khi d6 nguy co’ mé lay thai & ning san phy co tién str sdy thal ting 25% va nguy co nay la co ¥ ghia théng ké (p<0,001). 2.2. Phan tich h6i quy logistic da bién Kat hop céc bién déc lap bao gdm nhém tui, tién sir sinh, tién sir sinh non va tién si sy thai.Phan tich logistic da bién voi bién mé lay thai la bién phy thudc cho két qua tai Bang 6. ‘Bang 6. Hoi quy logistic da bién gitra mé lay thal va cdc tién st san khoa Mo hinh | Adjbeta | AdrOR|__95% Cl__| p value Duoi | Tren Nhom tabi <20 oat 07 | <0,001 20-24 0,66 a.71 | <0,001 30-34 137 1148 | <0,001 35.39 1139 221 | <0,001 240 22 2166 |_<0,001 Tin sinh 0,30 0.37 | <0,001 ‘Sinh non 0.97 1,20 _|_0,762 ‘Séy thai 1,07 0,082. “Ghi chi Adpbetar Hé s6 hi quy hiéu chinh; Ad-OR: t ‘sudt chénh higu chinh; 85% Cl. 95% khoang tin cay Két qua cho thay chi c6 2 bién: Tudi va sé Tn sinh 1a c6 anh hwéng c6 y nghia théng ké dén nguy co: mé lay thai cia san phy. Cu thé, nguy co mé léy thai ‘giam 70% d6i voi nhiing san phy sinh 3 lan tré len; tng tir 37% d&n gap hon 2 lan cho cdc nhom tudi tur 35 tudi trélén. So sanh muc do anh hung ciia cac bién d6c lap trong mé hinh théng qua hé sé beta hiéu chinh, két qua cho thay sé lan sinh co anh hudny manh nhat (@ higu chinh = -1,21), ké dén la nhém tuéi tir 40 tre 1én (B higu chin! .79) va nhom tuéi tur 35-39 (B higu chinh = -0,69), 3. Han ché cia dé ta Han ché clia dé tai nay bao gém: = Cé thé c6 nhiing sai sét trong qua trinh nhap sé ligu vao phan mém. ~ Hau hét cdc phan loai theo ma ICD déu khong thu hign day du 4 ky tyr theo dung bang ma ICD 10. Do dé viée théng ké, phan loai cha thé chi tiét va chinh xac, anh huéng dén két qua phan tich. Vi du dé thay nhat la trong 5 nim, théng ké theo ma ICD 10 4 ky ty cho cdc trréng hop mé lay thai kt hop cat tlr cung chi c6 3 trong hgp la hoan toan thiéu chinh xe (bang 4). Tuy nhién, do chi phan tich gidra mé lay thai va sinh thuréng cho nén théng ké nay khéng anh hung nhiéu dén két qua phan tich. = Con nhiéu yéu t6 khac c6 thé anh huéng dén ti lg mé ly thai nhu chi s6 nhan tréc dinh durdng (chiéu ‘cao, can nang, phu...) cla san phy, tudi thai, trong lugng thai, tinh trang day rén, tién sir bénh ly khac (nhu tang’ huyét 4p, tisu dong, réi loan chuyén hoa...) khong duge ghi nhan trong co’ sé dtr ligu. Do 6, phan tich m6 hinh d& khéng thé bao gém nhing yu t6 nay vao. KET LUAN VA KHUYEN NGH! 4. Két luan Mé hinh bénh tat noi trd tai khoa San Phy, Benh vin Ba khoa tinh Khanh Héa trong 5 nam (2014- 2018) cho thay chiém qua nira la cac truéng hop dén sinh d6. Cac bénh ly san phy khoa chiém ti Ié thap (6%), Ti 1@ mé lay thai trong 5 nam tai Bénh vign Ba khoa tinh Khanh hda la 41,2% va dang co xu hyéng gidm trong 3 nam gan day. Trong mot m6 hinh hdi quy logistic da bién, tudi va sé lan sinh cia sdn phy Ia yéu t6 tién Iugng mé [dy thai co ¥ nghia théng ké. Theo d6, san phu lon tudi (635 tudi) va sé lan sinh <3 lan thi cd kha nang md lay thai Ign hon. 2. Kién nghi Can c6 ké hoach, giai phap va 16 cu thé 48 phat trién mé réng cdc dich vu ky thuat lién quan én cdc bénh ly sn phy khoa khéc ngoai cac dich vu sinh dé nhdm da dang héa dich vu, dap ung nhu cau kham chiva bénh ctia ngudi dan dia phuong. ‘Can 4p ma ICD 10 v6i day di 4 ky tu dé Gap ung yéu cau théng ké, théng tin, phuc vu cho céng tac lap ké hoach phat trién khoa San phy ctia Bénh vien. Can cé cdc nghién citu tiép theo v8 mé lay thai tai cc bénh vign trong toan tinh nm xac dinh ti 1 mé ly thai trong cong dng. TAI LIEU THAM KHAO 1. Huynh Thi MY Dung, Ko st tinh hin cham s6c ba me sau mé lay thai tai Bénh vién Ba khoa Trung uong Can Tho ném 2017. Khoa Duge - Biéu dudng, 2017, Truong Bai hoc Y Duge Can Tho. tr. 54. 2._Nguyén Thi Anh, Nguyén Thi Kim Tién, Nguyén Xuan Thanh, So'sdnh chi dinh md lay thai & én phu con so tai Bénh vign Trung wong Thai Nguyén trong hai giai doan 2013 va 2018. Tap chi Khoa hoc va Céng nghé, Bai hoc Thai Nguyén, 2018. 1(194): tr. 145- 150. 3. Ninh Van Minh, Tinh hinh mé ly thai tai Bénh vign San Nhi Ninh Binh n&m 2012. Tap chi Y hoc thyc hanh, 2013. 6(874): tr. 78-79. 4) Betrans, A.P., et al, The Increasing Trend in Caesarean Section” Rates: Global, Regional and National Estimates: 1990-2014. PLOS ONE, 2016. 11(2): p. €0148343. ©. Blomberg, M., R. Birch Tyrberg, and P. 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