Kɔnɔmaya kɔkanna karilen ani kɔnɔmaya daminɛ na joli bɔli¶

Kɔnɔmaya kɔkanna bɛ kɛ ni kɔnɔbara basigilen donna denso kɔnɔ ani ka daminɛ ka bonya denso kɔnɔnaba kɔkan, a ka ca a la nɔnɔbara basigilen kɔnɔ (kɛmɛsarada la 95 ka se 97 ma, a bɛ fɔ a ma ko kɔnɔmaya min bɛ kɛ kɔnɔbara la), walima a ka teli ka kɛ kɔnɔbara la, kɔnɔbara la, denso kɔnɔbara la, walima kɔnɔbara basigilen na, walima kɔnɔbara basigilen kɔfɛ. Ikomi kɔnɔbara basigilen bonya bɛ se milimɛtɛrɛ 1 fo 4 dɔrɔn ma** ani farikolo kogo belebeleba tɛ a la, denso ni denso joli sira minnu bɛ ka bonya, olu bɛ wuli ka wuli ka tɛmɛ denso kogo fɛ, a ka ca a la kɔnɔmaya dɔgɔkun 5 ni dɔgɔkun 10 cɛ (a ka ca a la sani banabagatɔ yɛrɛ k’a dɔn ko a kɔnɔma don). Ni denso karilen don, densoya ni kɔnɔbara jolisiraw bolo minnu bɛ woyo kosɛbɛ, olu bɛ joli **mililitiri 1000 fo 2500 (pinti 2 fo 5) bɔ kɔnɔbara la ka ɲɛsin kɔnɔbara ma (hémoperitoneum) ni musoya joli tɛ ye walima ni joli tɛ ye. Kɔnɔmaya kɔkanna karilen ye denba saya sababu fɔlɔ ye kɔnɔmaya kalo saba fɔlɔ kɔnɔ diɲɛ kɔnɔ, o la, a ka kan ka taa ni anpulu ye joona walasa ka opereli kɔrɔtɔlen kɛ laparoskopi la ani jolidon na.

Aw bɛ o kɛ sisan¶

1. Aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele joona ni kɔnɔmaya (walima min bɛ se ka kɛ kɔnɔma ye) dɔ bɛ ni kɔdimi fan kelen ye min ni dimi bɛ a la, a bɛ kɛ ni ɲɛnamini ye, a bɛ fasa, a fari bɛ jɛ, walima a bɛ a kamankunw dimi. Aw bɛ 911 wele Ameriki ni Kanada, 112 Erɔpu tɔnba bɛɛ la, 999 Angletɛri, walima aw bɛ o bɛɛ lajɛ kɔrɔtɔko nimɔrɔw. Aw bɛ a fɔ ka jɛya ciden ye ko: "Kɔnɔbara kɔkanna karilen sigalen don ni joli bɔli ye kɔnɔna na ani ka sɔgɔsɔgɔ," o la anpulu baarakɛlaw bɛ jolisirajiw labɛn ani ka dɔgɔtɔrɔso bangekɔlɔsi opereli yɔrɔ lasɔmi.
2. Aw bɛ a tigi da a kɔ kan (walima ka a kɔrɔta dɔɔni a kininbolo fɛ) ani aw kana a to a ka jɔ walima ka taama. Ni aw jɔlen don walima ni aw sigilen don ɲɛgɛn kan ni joli litiri kelen ni kɔ farala ɲɔgɔn kan kɔnɔbara kɔnɔ, o bɛ kɛ sababu ye ka tansiyɔn jigin o yɔrɔnin bɛɛ (sinkope orthostatique), o bɛ kɛ sababu ye ka a hakili bɔ yɔrɔnin kelen, ka kunkolo jogin sanuyaso duguma, ani ka dusukun jɔ. Aw bɛ a to a ka da dilan kan walima duguma fo dɔgɔtɔrɔso baarakɛlaw k’a kɔrɔta ka a bila jirisunba dɔ kan.
3. Aw kana FƆN di kosɛbɛ da la (ji, dumuni, walima dimimadafura kana kɛ a la). Kɔnɔbara kɔkanna karilen bɛ se ka jɔ opereli yɔrɔ dɔrɔn de la anestezi général fɛ. Aw bɛ banabagatɔ to ka gɛlɛya foyi tɛ da la (NPO) walasa a kana fɔɔnɔ ani ka kɔnɔbara kɔnɔfɛnw fiyɛ a fogonfogon la endotracheal intubation kɔrɔtɔlen waati. Ka fara o kan, aw kana asipirini, ibuporofɛni walima naporozɛni di abada, o bɛ joli segin joli seginni tiɲɛ ani ka kɔnɔna joli juguya.
4. Aw kana tampon don abada, aw kana a ko abada, ani aw kana a digidigi kɔnɔbara duguma abada. Ni musoya joli bɛ yen, aw bɛ kɛnɛma **saniyalan saniyalen dɔ bila fini kɔnɔbara la walasa dɔgɔtɔrɔw ka se ka kɛnɛma joli bɔli jateminɛ ni u ye furakisɛ hakɛ jate lɛrɛ kelen kɔnɔ. Aw kana kɔnɔbara duguma digi walima ka a magaya: degunba kɛ kɔnɔmaya la min ma kari walima min bɛ bɔn, o bɛ se ka kɔnɔbara basigilen pɛrɛn ka joli bɔli jugumanba bila joli siraw la.
5. Aw bɛ banabagatɔ sumaya ni finiw ye ani ka a dusukun tantanni ni a ninakili kɔlɔsi miniti 3 fo miniti 5 o miniti 5. Aw bɛ a datugu ni finimugu sumalen ye ani ka fɛnw bila a jukɔrɔ ni a dalen bɛ tile duguma. furakɛli (kɔnɔna funteni min bɛ \(35^\circ\text{C}\) duguma walima \(95^\circ\text{F}\)) kunbɛnni nafa ka bon kosɛbɛ barisa joli nɛnɛ bɛ bɔnɛ a seko la ka joli kuru. Ni a hakili ma bɔ, aw bɛ a kuru a a kininbolo fɛ a kɛrɛfɛla kɛnɛyacogo la walasa a fiɲɛbɔyɔrɔ ka jɛya.
6. Aw bɛ kɔnɔmaya cogoya sɛgɛsɛgɛ ni aw ma dɔn ani ka furakɛli tariku lajɛ furakɛlikɛlaw ye. Aw ye a ka kalolabɔ laban (LMP) tile fɔlɔ kɔlɔsi, ni denso kɔnɔna minɛn dɔ bɛ a la (IUD / coil) walima ni a ye tubabu sirili kɛ ka kɔn ("tubes tied"), kɔnɔmaya kɔfɛ walima kɔnɔbara funubana min tun bɛ a la ka kɔn o ɲɛ, ani a joli suguya Rh (ni a dɔnna). Aw bɛ a fɔ dɔgɔtɔrɔso baarakɛlaw ye joona ni a ye dimi sɔrɔ k’a sɔrɔ a b’a fɛ ka a banakɔtaa da wuli walima ka koli, o ye joli jilamaw lajɛli taamasiɲɛ kɔrɔlen ye basibɔn na Pouch of Douglas.

Joli bɔli kalo saba fɔlɔ kɔnɔ ani basibɔn dimi jugumanba kɛnɛyako latigɛ jiri¶

Aw bɛ nin triage flowchart in kɛ muso o muso ye min si bɛ bangekɔlɔsi la (k’a ta cɛya la fo ka se kalolabɔ ma, a bɛ se ka kɛ san 12 la ka se san 52 ma) ni kɔnɔbara duguma dimi walima musoya joli bɛ bɔ a la.

flowchart TD
    Start["Muso min si bɛ bangekɔlɔsi la (san 12 ka se san 52 ma) ni:<br/>Kɔnɔmaya sɛgɛsɛgɛli ɲuman, a waati tɛmɛnen/a kɔfɛ, OR Yɔrɔ tɛ a la tuma bɛɛ<br/>PLUS Kɔnɔbara/Kɔnɔbara dimi walima musoya joli bɔli"] --> RedFlagCheck{"Yala darapo bilenmanw karilenw bɛ yen wa?<br/>1. Dimi, kungolodimi, walima farigan (syncope)<br/>2. Dimi jugumanba bɛ kɛ kamankun kuncɛ la (Kehr ka taamasiɲɛ)<br/>3. Kɔnɔbara duguma dimi jugumanba walima min bɛ juguya ka taa a fɛ fan kelen fɛ (yɔrɔ kelen fɛ)<br/>4. Dimi/degun ni aw b’a ɲini ka banakɔtaa walima koli kɛ<br/>5. Fari jɛman, nɛnɛ, nɛrɛmuguma walima dusukun tantanni teliya (>100 bpm)<br/>6. Aw bɛ a su >= maxi pad 2 lɛrɛ kelen kɔnɔ fo lɛri 2"}

    RedFlagCheck -->|"ƆWƆ: Darapo bilenman kelen o kelen bɛ yen"| Emergency911["OPERELI KƆRƆBƆLI KƆRƆBƆLI (A bɛ siga ko a karilen don kɔnɔbara kɔkan / Joli bɔli):<br/>1. Aw bɛ telefɔni 911 / 112 / 999 wele joona<br/>2. Aw bɛ aw da a kɔ kan (walima a kininbolo fɛ ni dusukunɲugun/aw hakili tɛ a la); AW KAN’a to taama ka<br/>3. Keep Strictly Nothing by Mouth (NPO) opereli kɔrɔtɔlen kama<br/>4. Aw bɛ aw fari sumaya ni finimugu ye; aw bɛ kɛnɛma saniyalan dɔrɔn de kɛ"]

    RedFlagCheck -->|"AYI: Hémodynamique stable,<br/>sɔgɔsɔgɔninjɛ tɛ, kamankun dimi tɛ"| PainVsBleed{"Taamasiɲɛ jumɛnw bɛ yen sisan?"}

    PainVsBleed -->|"Kɔnɔbara dimi nɔgɔman fo ka se a danma ma fan kelen fɛ<br/>WALIMA ‘prune-juice’ nɔnɔ jɛman dibiman"| UrgentSameDay["FARAKƐBA KA KƆNƆBƆLI ƝƐNABƆLI MIN ma tiɲɛ:<br/>Aw bɛ taa kɔrɔtɔko ɲɛmɔgɔso la walima kɔnɔmaya joona jateminɛyɔrɔ la (EPAU) BI<br/>A bɛ tile kelen kɔnɔ musoya la ultrasound + Quantitative Serum beta-hCG de wajibiya<br/>Aw kana jiginni ɲɛfɛ lajɛ kɛcogo kɔrɔlen makɔnɔ dɔgɔkun nata la"]

    PainVsBleed -->|"Kɔnɔbara cɛmancɛ la min bɛ i n’a fɔ kalolabɔ<br/>ni musoya joli bɛ bɔ pinki/bilen na"| MiscarriageEval["Kɔnɔtiɲɛ min bɛ se ka kɛ farati la, min tɛ dafa, walima min dafalen don:<br/>Aw bɛ taa OB/GYN walima kɔnɔmaya daminɛ dɔgɔtɔrɔso la lɛri 24 kɔnɔ walasa ka Ultrasound<br/>ani Rh(D) Joli suguya lajɛ (Anti-D / RhoGAM mago bɛ a la lɛri 72 kɔnɔ ni Rh-negatif)<br/>Aw bɛ taa ER la joona ni dimi jiginna fan kelen fɛ walima ni joli bɔra bɛ bonya ka taa a fɛ"]

    PainVsBleed -->|"Dimi tɛ yeelen nɔ min na dɔrɔn<br/>waati makɔnɔnen lamini na"| LightSpotEval["A bɛ se ka kɛ ko a bɛ se ka don joli la Joli bɔli, kɔnɔbara basigilen, walima joli segincogo jukɔrɔ:<br/>Aw bɛ aw yɛrɛ tanga tamponw ni cɛnimusoya ma; waati boloda teliya la ultrasound<br/> walasa ka kɔnɔtiɲɛ (IUP) jira denso kɔnɔ"]

Ka kɔnɔmaya kalo saba fɔlɔ joli bɔli ni kɔdimi sababuw suma ɲɔgɔn na¶

Ikomi kɔnɔmaya bɛɛ la, fo ka se kɔnɔmaya kɛmɛsarada la 20 fo 25 ma, musoya nɔ dɔw bɛ bɔ walima joli bɛ bɔ dɔgɔkun 12 fɔlɔw kɔnɔ, ni aw ye kɔnɔbara kɔkanna min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la, o ni kɔnɔtiɲɛ walima joli-sira-funu min tɛ kojugu kɛ, o bɛ mɔgɔ kisi.

Farikoloɲɛnajɛ ni banakɔtaa: Mun na denso karilen bɛ joli bɔ joona¶

Walasa k’a faamu mun na muso min kɔnɔbara karilen don kɔnɔbara kɔkan, o bɛ se ka bɔ taama ni kuma la ka taa dusukun jɔli dafalen na miniti 45 kɔnɔ, aw bɛ muso ka basibɔn farikolo yɔrɔw lajɛ:

1. Mun na denso tɛ se ka wuli i n’a fɔ denso: Adamaden denso kɛnɛman bɛ ni kogo ye min ka bon, a bɛ kɛ ni fɛn caman ye, a bɛ kɛ ni farikolojidɛsɛ ye (myometrium) min dilannen don walasa ka bonya siɲɛ 500 kalo 9 kɔnɔ. O ni falopian tube (ampulla et isthmus) ye farikolojidɛsɛ ye min ka nɔgɔn, a kunsigi ka fin, a datugulen don ni cili mikoroskopikiw ye, min baara kelenpe ye ka kɔnɔbara basigilen dɔ ko ka don denso kɔnɔ tile 3 fo tile 5 kɔnɔ. Ni den sirilen don denso kɔnɔ, trophoblaste cellules invasives (minnu bolodara ka dingɛ don denba joli sira jugumanw kɔnɔ walasa ka denso jɔ) u bɛ dingɛ tigɛ ka tɛmɛ denso kogo finman fɛ min bɛ i n’a fɔ papiye ka u gosi ka ɲɛsin densoya sira ni kɔnɔbara jolisiraw ma minnu bɛ kɛ tubabukan na.
2. Joli sɔrɔli joli sira fila fɛ kɔnɔmaya joli-sira-funu kɔrɔ: Kɔnɔmaya daminɛ na, denba ka ɔrimɔni bɛ dɔ fara basibɔn joli bɔli kan ani dusukun bɔli. Ikomi kɔnɔbara basigilen sigilen bɛ joli siraba dɔ kɛrɛfɛ min bɛ balo ka bɔ a dakun fila bɛɛ la (denso sira fɛ ka bɔ kɔnɔbara kɔnɔna na cɛmancɛ la, ani kɔnɔbara basigilen fɛ min bɛ bɔ kɔnɔbara basigilen na kɛrɛfɛ), ni ɲɛji bɛ bɔ kɔnɔbara basigilen na, o bɛ joli sira fila da wuli ni tansiyɔnba ye ka don kɔnɔbara basigilen kɔnɔ.
3. Mun na Kehr ka taamasiɲɛ (Shoulder-Tip Pain) bɛ kɛ: Foyi tɛ banabagatɔ kamankun joli la. Ni joli jilama \(500\text{ fo ka se }1500\text{ mililitiri}\) bɔ ka bɔ cɛya la ani ni muso dalen bɛ a da la (walima a bɛ segin ka a biri dilan kan), girinya bɛ kɛ sababu ye ka joli jilama sumalen in woyo san fɛ paracolic gutters fɛ ani ka ɲɔgɔn dalajɛ k’a ɲɛsin farikolojidɛsɛ ma (dome muscle min bɛ kɔnɔbara ni disi faranfasi). Diaphragme duguma fan bɛ sɔgɔsɔgɔ ni phrenic nerve ye, o bɛ bɔ kɔ la kɔnɔbara kɔkolo nɛrɛmugu ju la C3, C4, ani C5. Ikomi o C3, C4, ani C5 nɛrɛmuguma kelen tigitigiw fana bɛ fari di kamankun ni kɔkolo sanfɛ (supraclaviculaire nerves), hakili bɛ joli-sira-funu kɔrɔfɔ cogo jugu la ko dimi min bɛ kɛ ni nɛgɛ ye, min bɛ mɔgɔ sɔgɔ kamankun kuncɛ yɛrɛ la.
4. Mun na "Bathroom Fainting" ni Rectal Pressure bɛ kɛ (Pouch of Douglas pooling): Ni muso jɔlen don walima ni a sigilen don, joli bɛ ɲɔgɔn sɔrɔ muso ka cɛya girinya dɔgɔmannin na: rectouterine pouch (Pouch of Douglas / posterior cul-de-sac), o bɛ sigi o yɔrɔnin bɛɛ kɔnɔbara ɲɛfɛ. Joli min bɛ nin yɔrɔ in bonya, o bɛ digidigi ka ɲɛsin ɲɛgɛnɛsira ni basibɔn parasympathetic nerves ma, o bɛ dusu don muso la yɔrɔnin kelen, ka dusu don a kɔnɔ kosɛbɛ ko a "a ka kan ka banakɔtaa kɛ." A bɛ taama ka don sanuyaso kɔnɔ, ka sigi ɲɛgɛn kan, ka degun, o bɛ jolisira seginni jigin a dusukun na ani ka kɛ sababu ye ka syncopal collapse teliya sanuyaso duguma.

Jaan dogolenw : Mun na aw bɛ se ka kɔnɔmaya kɛ hali bi kɔnɔbara kɔkan ni stérilet ye, "tubabu sirilen", walima "i ka kalolabɔ" kɔfɛ.¶

Faamubaliya saba minnu ka teli ka kɛ, olu bɛ kɔrɔtɔko ladonni bila kɔfɛ don o don:

1. "A ye koli kɛ dɔrɔn dɔgɔkun tɛmɛnen, o la a tɛ se ka kɔnɔ ta".¶

Banabagatɔ minnu sɔrɔla kɔnɔbara kɔkanna karilen don, olu kɛmɛsarada la, fo ka se 30 ma, olu b’a fɔ ko u hakili la ko kalolabɔ kɛra cogo la min bɛ bɛn walima min ka nɔgɔn dɔɔni** dɔgɔkun 1 fo dɔgɔkun 3 ka kɔn o ɲɛ. Tiɲɛ na, ni kɔnɔbara kɔkanna donna denso kɔnɔ, a bɛ hadamaden ka gonadotropini (\(\beta\text{-hCG}\)) ni porojɛsitɛri hakɛ dɔgɔya ka tɛmɛ a cogo kɔrɔ kan, o bɛ kɛ sababu ye ka denso lankolon kɔnɔna sɔgɔsɔgɔ ani ka joli bɔ waati min na waati dɔ tun ka kan ka kɛ. Muso o muso min si bɛ bangekɔlɔsi la, ni a kɔdimi jugumanba bɛ a fan kelen fɛ, ni a kamankun dimi bɛ a la, walima ni a bɛ sɛgɛn min ɲɛfɔlen tɛ, o ka kan ka sugunɛ walima kɔnɔmaya sɛgɛsɛgɛli kɛ joona, a ka kalolabɔ tariku mana kɛ min o min ye.

2. "A ye stérilet (Intrauterine Device / Coil) sɔrɔ walima a ye Tubal Ligation ('Tubes Tied') kɛ".¶

Hali ni kɔnɔbara basigilen minɛnw (i n’a fɔ Mirena, Kyleena, Liletta, walima Copper ParaGard stérilet) ani opereli tubabukan na, olu bɛ se ka kɔnɔta bali ka tɛmɛ kɛmɛsarada la 99 kan denso kɔnɔ, ni kɔnɔmaya min man teli ka kɛ, o bɛ kɛ tiɲɛ na ka a sɔrɔ stérilet bɛ a nɔ na walima tubabufura sirilen kɔfɛ, a bɛ se ka kɛ kɛmɛsarada la 15 fo 50 ye ko kɔnɔmaya bɛ se ka kɛ Kɔnɔmaya ECTOPIC kɔnɔbara basigilen na. Ni stérilet walima tubabufura sirilen don, o bɛ banabagatɔ kɔnɔma bila tiɲɛ na faratiba la tubabukan na.

3. Furakɛcogo faratibaw kɔnɔmaya kɔfɛ¶

Hali ni muso minnu bɛɛ sɔrɔla kɔnɔmaya kɔfɛ, olu kɛmɛsarada la, 50 ɲɔgɔn farati dɔnna ZERO la, farati bɛ bonya kosɛbɛ banabagatɔw la minnu bɛ: - Kɔnɔmaya tɛmɛnen kɔfɛ (10% fo 25% ka se ka segin a kan). - Kɔnɔbaralabana (PID) tɛmɛnen walima Klamidiya trachomatis walima Neisseria gonorrhoeae banakisɛ sɔrɔli ka kɔn o ɲɛ (o bɛ joginda nɔrɔli mikoroskɔpikiw to denso kɔnɔna sɔgɔsɔgɔninjɛ nɔgɔlenw kɔnɔ). - Kɔnɔbara basigilen opereli ka kɔn, ɲɛgɛnɛsira sirili kɔsegin, kɔnɔbara basigilen (kɛrɛnkɛrɛnnenya la kɔnɔbara basigilen), kɔnɔbara basigilen, walima basibɔn opereli. - In Vitro Fertilization (IVF) ani Assisted Reproductive Technology (ART): O la, bana dɔ bɛ yen min man teli ka kɛ, n’o bɛ wele ko kɔnɔmaya hɛtɛrotopiki, o la, den kelen bɛ don denso kɔnɔ cogo bɛnnen na ANI den filanin filanan bɛ don denso kɔnɔ waati kelen na (a bɛ kɛ mɔgɔ 100 la ka se mɔgɔ 1 ma, mɔgɔ 1000 kɔnɔ FIV kɔnɔmaya). - Sigarɛtimin (nikotini ni kotinini bɛ denso kɔnɔnatumuw bugɔli kɛ ni dɔnkilidacogo ye, ka denw tacogo sumaya).

Musoya kɔkanna joli hakɛ jateminɛcogo ani Rh-Negative (Anti-D / RhoGAM) sariya min bɛ kɛ sanga 72 kɔnɔ¶

Ni musoya joli bɛ ye kalo saba fɔlɔ banabagatɔ la (a kɛra kɔnɔmaya kɔfɛ walima kɔnɔtiɲɛ ye), dɔgɔtɔrɔw mago bɛ kunnafoni nafama fila la:

1. Maxi pads jate lɛrɛ kelen kɔnɔ ("Pads 2 Per Hour for 2 Hours" Joli bɔli sariya) .¶

• Aw bɛ kɛnɛma saniyalan (maxi pad) hakɛ dafalen kɛ fini kɔnɔ (aw kana tampon walima kalolabɔ tasa kɛ abada, o min bɛ joli minɛ musoya kɔnɔ, wa a bɛ se ka banakisɛw don musoya da wulilen fɛ).
• Joli bɔli kɔrɔtɔlen: Ni musoya joli ka gɛlɛn fo ka se ka a su pewu maxi pads dafalen 2 walima ka tɛmɛ o kan lɛrɛ kɔnɔ fo lɛri 2 tugu-tugu ɲɔgɔn na (walima pad 1 miniti 15 fo miniti 30 o miniti 30), walima ni banabagatɔ ye joli kuruw tɛmɛ minnu ka bon ni gɔlf bolo walima limoni ye (\(4\text{ to }5\text{ centimeters}\) / \(1.5\text{ ka se }2\text{ inches}\) ma), aw bɛ 911 / 112 / 999 wele o yɔrɔnin bɛɛ.
• Ni farikolojidɛsɛ jɛman walima pinki tɛmɛna: Ni banabagatɔ tɛmɛna farikolo yɔrɔ gɛlɛnw fɛ kɔnɔtiɲɛ sigalen don a la, aw bɛ o fɛnɲɛnamafagalan bila nɔgɔya la galasi daga sanuman dɔ kɔnɔ walima plastiki minɛn kɔnɔ (walima aw bɛ a siri papiye sanuman ɲiginnen dɔ la plastiki dagalen kɔnɔ) ka na n’a ye dɔgɔtɔrɔso la walasa banakɔtaa dɔnbagaw ka se k’a lajɛ ni kɔriyɔni villi tɛ (ka kɔnɔtiɲɛ jira denso kɔnɔ sanni ka kɛ kɔnɔbara kɔkanna na kɔnɔmaya).

2. Joli suguya sariya min bɛ wele ko Rh-Negatif (Anti-D Immunoglobuline / RhoGAM) .¶

Ni musokɔnɔma joli Rh-negatif (\(A\text{-negative}, B\text{-negative}, AB\text{-negative}, \text{or } O\text{-negative}\)) bɛ a la ani ni kɔnɔmaya bɛ a la, kɔnɔtiɲɛ bɛ se ka kɛ a kɔnɔ walima a bɛ se ka tiɲɛ pewu, walima kɔnɔbara joginni, den kɔnɔ joli kuru bilenmanw bɛ se ka don a joli la ani ka aw bɛ a farikolo tangacogo dɔn walasa ka bin den nataw kan (denmisɛnni ni den kuraw ka joli-sira-funu-bana). - Aw ye aw jija ka dɔgɔtɔrɔso walima kɔnɔmaya daminɛ yɔrɔ ɲininka ni a ka kan ka Anti-D immunoglobuline (RhoGAM) pikiri kɛ farikolo la lɛrɛ 72 kɔnɔ joli bɔli walima opereli daminɛ kɔfɛ (ka tugu jamana ka laadilikanw kɔ minnu bɔra ACOG fɛ Ameriki, RCOG/NICE fɛ Angletɛri, ani SOGC fɛ Kanada).

Fɛn min bɛ kɛ dɔgɔtɔrɔso la: Musoya la ultrasound, hCG Discriminatory Zone, ani furakɛli¶

Dɔgɔtɔrɔso kɔrɔtɔlenw dɔgɔtɔrɔw ni bangekɔlɔsibagaw bɛ kɔnɔbara kɔkanna sɛgɛsɛgɛli ni a furakɛcogo dɔn, o bɛ jɛɲɔgɔnw ni denbayaw dɛmɛ u ka ko kɛlenw faamu:

1. Point-of-Care FAST Ultrasound and Transvaginal Ultrasound (TVUS): Banabagatɔ min tɛ sabati anpulu selen kɔfɛ miniti damadɔ kɔnɔ, kɔrɔtɔko dɔgɔtɔrɔw bɛ ultrasound sonda kɛ kɔnɔbara kan (FAST exam: Focused Assessment with Sonography in Trauma) ka Morison ka foroko (sugunɛ ni kininbolo sugunɛ cɛ) ani ** kɔnɔbara lajɛ cul-de-sac** ka sira kan. Ni aw ye joli dibiman ye Morison ka foroko kɔnɔ, o bɛ joli gansan \(500\text{ fo }1,000\text{ mililitiri}\) dafa kɔnɔbara la, wa o bɛ kɛ sababu ye ka teliya ka taa opereli yɔrɔ la k’a sɔrɔ aw ma laboratuwari baara makɔnɔ. Banabagatɔ sabatilenw na, musoya ta fan fɛ ultrasound min bɛ se ka kɛ, o bɛ denso ni ɲɛgɛnɛsira lajɛ ni kɔnɔmaya foroko, kɔnɔbara foroko, walima "tubal ring" / "ring of fire" mass bɛ kɔnɔbara kɛrɛfɛ.
2. Serum quantitative \(\beta\text{-hCG}\) ani Zone Discriminatoire: Dɔgɔtɔrɔw bɛ joli sama walasa ka beta-human chorionic gonadotropin (\(\beta\text{-hCG}\)) hakɛ tigitigi jateminɛ. Ni serum \(\beta\text{-hCG}\) sera danfara yɔrɔ la min ye \(1,500\text{ ye ka se }3,500\text{ mIU/mL}\) (\(IU/L\)) ma, kɔnɔmaya kɛnɛman nɔgɔman min bɛ denso kɔnɔ, o ka kan ka ye tuma bɛɛ musoya kɔfɛ ultrasound fɛ denso lankolon min faralen don ɲɔgɔn kan ni \(\beta\text{-hCG}\) ye min bɛ \(3500\text{ mIU/mL}\) sanfɛ (walima \(\beta\text{-hCG}\) min tɛ se ka wuli ka ɲɛ sanga 48 kɔnɔ "Kɔnɔmaya yɔrɔ dɔnbali" [PUL]) kɔnɔ, o bɛ kɔnɔta jira kosɛbɛ kɔnɔbara kɔkan.
3. Opereli ni Dɔgɔtɔrɔso furakɛli:
4. Opereli kɔrɔtɔlen min bɛ kɛ ni laparoskopi ye (Salpingectomy walima Salpingostomy): A ka kan ka kɛ kɔnɔmaya kɔkanna karilen bɛɛ la, banabagatɔ o banabagatɔ joli tɛ basigi, kɔnɔbara joli hɔrɔnyalen don, dimi jugumanba bɛ a la, walima den dusukun tantanni bɛ denso kɔnɔ. Operelikɛlaw bɛ denso karilen bɔ (salpingectomy) walima ka a da wuli walasa ka kɔnɔmaya bɔ (salpingostomy) ani ka joli O-negatif walima joli crossmatched don a la. (Ni denso kelen bɔra, o bɛ to ka kɛmɛsarada la 70 fo ka se 85 ma, o ye den sɔrɔcogo ɲuman ye tubabu kɛnɛman tɔ fɛ).
5. Furakɛcogo min bɛ kɛ ni mɛtotirikisiti ye farikolo la (Kɔnɔbara kɔkanna sabatilenw dɔrɔn de kama): Ni kɔnɔbara kɔkanna minɛna joona sanni a ka kari, ani ni banabagatɔ sabatira pewu ni dimi ka dɔgɔn ani ni kuru fitini ma tigɛ, a ka ca a la dɔgɔtɔrɔw bɛ se ka u yɛrɛ tanga opereli ma ni u ye metotrexate pikiri kɛ farikolo la (a folate antagonist min bɛ denso kɔnɔnatumuw tila teliya la walasa farikolo ka kɔnɔmaya minɛ kokura lafiya la dɔgɔkun 2 fo dɔgɔkun 6 kɔnɔ). Ladilikan jugumanba min bɛ kɛ mɛtotirikisati kɔfɛ: Hali ni metotirikisi pikiri kɛlen kɔfɛ, kɔnɔbara basigilen bɛ to ka tiɲɛ, wa a bɛ se ka kari hali bi tile 3 fo tile 14 o kɔfɛ; ni banabagatɔ min ye mɛtotirikisɛti ta, kɔnɔdimi jugumanba barika banna, kamankunw dimi, walima dimi bɛ a la so kɔnɔ, aw bɛ telefɔni 911 / 112 / 999 wele joona.

Yɔrɔ minnu man teli ka kɛ kɔnɔbara kɔkan, olu tɛ tubabufura ye, minnu bɛ kari ni joli bɔli ye min bɛ se ka kɛ balawu ye¶

Hali ni kɔnɔmaya kɔkanna kɛmɛsarada la 95 fo 97 bɛ don denso kɔnɔbara basigilen walima kɔnɔbara basigilen na, kɛmɛsarada la 3 fo 5 ɲɔgɔn bɛ don farikolo yɔrɔw la minnu tɛ deli ka kɛ, yɔrɔ minnu na bana sɛgɛsɛgɛli ka gɛlɛn ani kɔnɔna joli bɛ se ka juguya ka tɛmɛ fɔlɔ kan:

• Kɔnɔbara kɔkanna (Kɔnɔbara kɔkanna) (Kɔnɔbara kɔkanna 2% ka se 4% ma): Fɛn minnu bɛ don denso kɔnɔbara basigilen yɔrɔ la min bɛ tɛmɛ denso farikolo kogo belebeleba fɛ, denso ni kɔnɔbara joli siraw bɛ ɲɔgɔn sɔrɔ yɔrɔ min na yɛrɛ. Ikomi denso lamini farikolo ka bon ka tɛmɛ kɔnɔbara kɔkanna kan, kɔnɔmaya cɛmancɛ bɛ se ka bonya fo ka se kɔnɔmaya dɔgɔkun dɔgɔkun 8 fo dɔgɔkun 14 sani a ka barika pɛrɛn ka tɛmɛ denso kɔ fɛ, o bɛ kɛ sababu ye ka joli bɔli teliya la ni saya hakɛ bɛ se siɲɛ 2 fo siɲɛ 5 ka tɛmɛ kɔnɔmaya sabatilenw kan.
• Kɔnɔmaya min bɛ kɛ ni sezarɛni ye (CSP): A bɛ don sezarɛni sɔgɔsɔgɔninjɛ min tun bɛ duguma, o ka fiɲɛ mikoroskɔpiki (niche) kɔnɔ k’a ɲɛsin o ma. Ni denso bɛ dingɛ kɛ ka tɛmɛ joli finman fɛ ka taa sugunɛbara fan fɛ, o bɛ se ka kɛ sababu ye ka denso kari kojugu kɔnɔbara fɔlɔ walima kɔnɔbara filanan na walima denso kɔnɔbara basigilen joli bɔli.
• Kɔnɔbara basigilen, kɔnɔbara basigilen ani kɔnɔbara kɔkanna: A donli kɔnɔbara basigilen kɔnɔ (o bɛ kɛ sababu ye ka musoya joli bɔli jugumanba bila musoya la, dimi tɛ min na), kɔnɔbara sanfɛla la, walima ka ɲɛsin kɔnɔbara basigilen ma walima banakɔtaa serosa kan kɔnɔbara kɔnɔ.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Sosow sɛgɛsɛgɛra¶

• Amerika ka bangekɔlɔsi ni musoya dɔgɔtɔrɔw ka kalanso (ACOG, Ameriki): Baarakɛcogo kunnafonisɛbɛn No. 193: Tubabu kɔnɔbara kɔfɛ ani Degeli kunnafonisɛbɛn No. 200: Kɔnɔmaya joona.
• Jamana ka kɛnɛyako ni ladonniko ɲɛtaa baarada (NICE, Angletɛri) ani musomanninw ni musoya dɔgɔtɔrɔw ka kolɛji masakɛ (RCOG, Angletɛri): Kɔnɔbara kɔkanna ni kɔnɔtiɲɛ: Sɛgɛsɛgɛli ni a furakɛli fɔlɔ (NG126, updated 2023) ani Green-top Guideline No. 21: Diagnosis and Management of Ectopic Pregnancy.
• Canada ka bangekɔlɔsibagaw ni musoya dɔgɔtɔrɔw ka tɔn (SOGC, Kanada): Dɔgɔtɔrɔso baarakɛcogo laadilikan No. 414: Kɔnɔw ladonni yɔrɔ dɔnbaliw la ani kɔnɔmaya minnu bɛ kɛ tubabukan na ani minnu tɛ tubabukan na kɔnɔbara kɔkan.
• Diɲɛ kɛnɛyatɔn (OMS): Gɛlɛya minnu bɛ sɔrɔ kɔnɔmaya ni jiginni na: Musoya joli bɔli kɔnɔmaya daminɛ na ani kɔnɔbara kɔkan opereli fɛɛrɛw.

Gafe minnu bɛ tali kɛ o ko la¶

• Shock recognition and first aid management
• Kɔnɔbara basigilen, kɔnɔbara basigilen, ani basibɔn dimi jugumanba
• Den jiginni kɔrɔtɔlen ani jiginni teliya la
• Fainting and syncope evaluation
• Kɔrɔtɔko nimɔrɔw ani jamana wɛrɛw ka cikanw