THAI KỲ VỚI MẸ RHESUS ÂM

DANH MỤC CHIA SẼ
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Bs Nguyễn Thị Diễm Kiều
Khoa sanh – cấp cứu

I. Giới thiệu

1. Yếu tố Rhesus là gì?

  Yếu tố Rhesus (Rh) là một protein trên bề mặt hồng cầu. Nếu các tế bào máu của bạn có protein này bạn là người mang nhóm máu Rh dương. Khoảng 15% dân số không có yếu tố Rh được gọi là người mang nhóm máu Rh âm.

2. Làm thế nào để một người có được yếu tố Rh?

  Yếu tố Rh mang tính chất di truyền, nghĩa là nó được truyền từ cha mẹ cho con cái thông qua các gen. Các tế bào thai nhi có thể được di truyền yếu tố Rh từ người cha hoặc mẹ.

3. Yếu tố Rh có thể gây ra vấn đề gì trong quá trình mang thai?

   Trong quá trình mang thai , vấn đề có thể xảy ra nếu bạn thuộc nhóm máu Rh âm và thai nhi của bạn thuộc nhóm máu Rh dương, được gọi là bất đồng nhóm máu Rh giữa mẹ và con.

   Trong suốt thai kỳ, máu mẹ và máu con là 2 hệ thống riêng biệt, tuy nhiên một số lượng nhỏ máu thai nhi sẽ qua nhau vào tuần hoàn mẹ. Yếu tố Rh sẽ có trong tuần hoàn mẹ –> tạo kháng thể chống lại yếu tố Rh ( Rh antibodies), gọi là hiện trượng nhạy cảm Rh (Rh sensitization).

   Khi lần mang thai đầu tiên của người mẹ nhóm máu Rh âm và thai có nhóm máu Rh dương, thường không có vấn đề nghiêm trọng xảy ra, do người mẹ chưa kịp tạo nhiều kháng thể cho đến khi sinh.

   Nếu không được điều trị dự phòng thì những lần mang thai kế tiếp, kháng thể Rh từ người phụ nữ này sẽ qua bánh nhau vào tuần hoàn thai Rh dương –> thiếu máu tán huyết cho thai. Thai nhi có thể không nhận đủ hồng cầu, không nhận đủ oxy, trong một số trường hợp thai nhi có thể chết vì thiếu máu.

4. Anti-D Immune Globulin – thuốc dự phòng trong trường hợp thai phụ có Rh âm

  - Nguồn gốc Anti-D immune globulin là dung dịch chứa IgG anti-D (anti-Rh) được sản xuất từ huyết tương người. Khi tiêm vào người mang nhóm máu Rh âm chưa nhạy cảm với yếu tố Rh, nó sẽ tấn công các yếu tố Rh trong tuần hoàn, ngăn sự tạo kháng thể Rh.

  - Mục đích: để dự phòng hiện tượng nhạy cảm Rh và bệnh lý tán huyết cho thai kỳ sau.

  - Liều: Tiêm bắp 1000 UI (200mcg) hoặc 1250 UI (250 mcg) anti – D mỗi lần tiêm hoặc một liều duy nhất anti – D Ig 300mg lúc thai 28 – 34 tuần.

II. Quản lý thai kỳ với sản phụ có Rhesus âm

1. Quá trình khám thai

  Thai phụ đến khám thai lần đầu tiên cần thử nhóm máu và yếu tố Rh trong xét nghiệm thường quy

  - Đối với thai phụ có Rh âm: xét nghiệm yếu tố Rh cho cha bé. Nếu cha bé cũng có Rh âm thì không cần tiêm anti – D. Nếu cha bé Rh dương hay không xác định được nhóm máu của người cha thì thai phụ cần được xét nghiệm kháng thể anti – D.

  - Xét nghiệm tìm kháng thể anti – D: Khoảng tuần thứ 20 – 28.

  + Nếu thai phụ Rh âm không có kháng thể anti – D nên được tiêm dự phòng anti – D immunoglobulin ở tuần thứ 28 của thai kỳ, đến thai 34 tuần tiêm nhắc lại. Hoặc trong các trường hợp có nguy cơ truyền máu mẹ – thai kể trên.

  + Nếu thai phụ Rh âm có anti – D: sau sinh bé cần được gởi khoa dưỡng nhi để đề phòng thiếu máu tán huyết cho bé và thai phụ cần theo dõi sát thai kỳ.

khoasanhcc25022019

2. Dự phòng cho mẹ và con sau sinh

2.1. Dự phòng cho mẹ

  - Trong vòng 72 giờ sau sinh bé Rh dương

  - Trong vòng 72 giờ sau khi mẹ truyền máu có Rh dương (tổng truyền < 20% thể tích máu cơ thể)

2.2. Dự phòng cho con

  - Ngay sau sinh lấy máu rốn của thai nhi (từ những bà mẹ có Rh âm) làm những xét nghiệm: nhóm máu ABO – Rh, định lượng Hb, Bilirubin và test Coombs của bé.

  - Bé cần được gởi khoa dưỡng nhi để theo dõi tình trạng thiếu máu tán huyết.

TÀI LIỆU THAM KHẢO

1. Phác đồ điều trị sản phụ khoa bệnh viện Từ Dũ 2019
2. Hướng dẫn thai kỳ với mẹ Rh âm Bệnh viện Hùng Vương năm 2014
3. https://www.acog.org/Patients/FAQs/The-Rh-Factor-How-It-Can-Affect-Your-Pregnancy?IsMobileSet=false

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