Thai to - biến chứng và xử trí trẻ sau sinh
Nội dung chính của bài viết
Tóm tắt
Thuật ngữ “thai to” (fetal macrosomia) chỉ những trẻ sơ sinh có cân nặng trên 4000gr hoặc trên 4500gr. Thai to có thể là do các vấn đề từ bà mẹ (thừa cân/béo phì, tiểu đường) hoặc các tình trạng của thai nhi (cường insulin, suy giáp bẩm sinh, hội chứng Beckwith Wiedemann…). Tình trạng thai to dẫn đến tăng nguy cơ sinh mổ và tai biến sản khoa như vỡ tử cung, đẻ ngạt, mắc vai, gãy xương đòn, tổn thương đám rối cánh tay; trẻ sơ sinh có thể gặp tình trạng hạ đường huyết, đa hồng cầu, suy hô hấp do chậm tiêu dịch phổi và thiếu hụt surfactant. Quản lý trẻ sau sinh bao gồm vấn đề hồi sức tại phòng sinh, phát hiện và xử trí sớm các biến chứng.
Chi tiết bài viết
Từ khóa
thai to, tai biến sản khoa, xử trí sau sinh
Tài liệu tham khảo
1. Mandy GT. Large for gestational age newborn. UpToDate. 2020;
2. Dennedy MC, Dunne F. Macrosomia: defining the problem worldwide. Lancet (London, England). Feb 9 2013;381(9865):435-6. doi:10.1016/s0140-6736(12)62090-x
3. Nguyễn Gia Khánh. Bài giảng Nhi khoa. Trường Đại học Y Hà Nội. 2017;2:85-94.
4. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final Data for 2017. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. Nov 2018;67(8):1-50.
5. Koyanagi A, Zhang J, Dagvadorj A, et al. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet (London, England). Feb 9 2013;381(9865):476-83. doi:10.1016/s0140-6736(12)61605-5
6. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins. Practice Bulletin No. 173: Fetal Macrosomia. Obstetrics and gynecology. Nov 2016;128(5):e195-e209. doi:10.1097/aog.0000000000001767
7. Nguyễn Công Khanh, Nguyễn Thu Nhạn, Hoàng Trọng Kim. Sách giáo khoa Nhi khoa. Nhà xuất bản y học. 2016:58-92.
8. Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstetrics and gynecology. Jul 2014;124(1):16-22. doi:10.1097/aog.0000000000000345
9. Beta J, Khan N, Khalil A, Fiolna M, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. Sep 2019;54(3):308-318. doi:10.1002/uog.20279
10. Okun N, Verma A, Mitchell BF, Flowerdew G. Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. The Journal of maternal-fetal medicine. Sep-Oct 1997;6(5):285-90. doi:10.1002/(sici)1520-6661(199709/10)6:5<285::aid-mfm9>3.0.co;2-c
11. Homko CJ, Sivan E, Nyirjesy P, Reece EA. The interrelationship between ethnicity and gestational diabetes in fetal macrosomia. Diabetes Care. 1995;18(11):1442-1445.
12. Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. American journal of obstetrics and gynecology. May 2008;198(5):517.e1-6. doi:10.1016/j.ajog.2007.12.005
13. DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstetrics and gynecology. Oct 2007;110(4):745-51. doi:10.1097/01.aog.0000284451.37882.85
14. Arieh Riskin JAG-P. Infants of women with diabetes. UpToDate. 2020;
15. Cheng YK LT. Fetal and maternal complications in macrosomic pregnancies. Research and Reports in Neonatology. 2014;4:65-70. doi:https://doi.org/10.2147/RRN.S39110
16. van Zijl MD, Oudijk MA, Ravelli ACJ, Mol BWJ, Pajkrt E, Kazemier BM. Large-for-gestational-age fetuses have an increased risk for spontaneous preterm birth. Journal of perinatology : official journal of the California Perinatal Association. Aug 2019;39(8):1050-1056. doi:10.1038/s41372-019-0361-6
17. Jacques S Abramowicz JTA. Fetal macrosomia. UpToDate. 2020;
2. Dennedy MC, Dunne F. Macrosomia: defining the problem worldwide. Lancet (London, England). Feb 9 2013;381(9865):435-6. doi:10.1016/s0140-6736(12)62090-x
3. Nguyễn Gia Khánh. Bài giảng Nhi khoa. Trường Đại học Y Hà Nội. 2017;2:85-94.
4. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final Data for 2017. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. Nov 2018;67(8):1-50.
5. Koyanagi A, Zhang J, Dagvadorj A, et al. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet (London, England). Feb 9 2013;381(9865):476-83. doi:10.1016/s0140-6736(12)61605-5
6. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins. Practice Bulletin No. 173: Fetal Macrosomia. Obstetrics and gynecology. Nov 2016;128(5):e195-e209. doi:10.1097/aog.0000000000001767
7. Nguyễn Công Khanh, Nguyễn Thu Nhạn, Hoàng Trọng Kim. Sách giáo khoa Nhi khoa. Nhà xuất bản y học. 2016:58-92.
8. Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstetrics and gynecology. Jul 2014;124(1):16-22. doi:10.1097/aog.0000000000000345
9. Beta J, Khan N, Khalil A, Fiolna M, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. Sep 2019;54(3):308-318. doi:10.1002/uog.20279
10. Okun N, Verma A, Mitchell BF, Flowerdew G. Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. The Journal of maternal-fetal medicine. Sep-Oct 1997;6(5):285-90. doi:10.1002/(sici)1520-6661(199709/10)6:5<285::aid-mfm9>3.0.co;2-c
11. Homko CJ, Sivan E, Nyirjesy P, Reece EA. The interrelationship between ethnicity and gestational diabetes in fetal macrosomia. Diabetes Care. 1995;18(11):1442-1445.
12. Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. American journal of obstetrics and gynecology. May 2008;198(5):517.e1-6. doi:10.1016/j.ajog.2007.12.005
13. DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstetrics and gynecology. Oct 2007;110(4):745-51. doi:10.1097/01.aog.0000284451.37882.85
14. Arieh Riskin JAG-P. Infants of women with diabetes. UpToDate. 2020;
15. Cheng YK LT. Fetal and maternal complications in macrosomic pregnancies. Research and Reports in Neonatology. 2014;4:65-70. doi:https://doi.org/10.2147/RRN.S39110
16. van Zijl MD, Oudijk MA, Ravelli ACJ, Mol BWJ, Pajkrt E, Kazemier BM. Large-for-gestational-age fetuses have an increased risk for spontaneous preterm birth. Journal of perinatology : official journal of the California Perinatal Association. Aug 2019;39(8):1050-1056. doi:10.1038/s41372-019-0361-6
17. Jacques S Abramowicz JTA. Fetal macrosomia. UpToDate. 2020;