[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 dongDENI 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 83LUUDO 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 84