Dimita dia difu dia pambelu ne dipatuka dia mashi ku ntuadijilu kua difu¶

Dimita difu dia pambelu pa difu ditu dienzeka padi diyi didibu balele dibuela ne dituadija kukola pambelu pa tshina tshinene tshia difu, misangu ya bungi munda mua tube wa difu (95 too ne ku 97 pa lukama, dimanyike bu dimita difu), anyi misangu mikese mu tshifu, mu tshifu, mu tshifu, anyi mu tshitupa tshia munda tshia difu. Bu mudi tshitupa tshia difu tshidi anu 1 too ne ku 4 millimètres (0.04 too ne ku 0.16 inches) mu butshiama ne katshiyi ne tshimanu tshia misunya tshikole, muana udi wenda ukola ne mishipa ya mashi ya mu difu idi anu ikola ne inyanguka mu tshimanu tshia tshitupa tshia difu, pa tshibidilu pankatshi pa mbingu **5 ne 10 ya dimita difu (nansha kumpala kua mubedi kuikalaye ne difu). Padi muonji wa difu utshibuka, matamba a mishipa ya mu tshifu ne ya mu tshifu adi apueka 1 000 too ne ku 2 500 millilitre (2 too ne ku 5 pints) ya mashi buludiludi mu tshifu (hemoperitoneum) ne mashi makese anyi kaayi amueneka nansha kakese. Difu dia munda mua difu didi tshintu tshia kumpala tshidi tshikebesha lufu lua mamu mu ngondo isatu ya kumpala pa buloba bujima, didi dilomba bua kuya ne lukasa mu ambulanse bua kuenzabu dipanda dia lukasa dia laparoscopie ne diela mashi.

Enza nunku mpindieu¶

1. Bikila nimero ya lukasa ya muaba unudi pikala muntu udi ne difu (anyi udi mua kuikala ne difu) udi ne disama dia mu tshiadi dia ku luseke lumue ne disama dia tshiadi, dijimija dia lungenyi, dikoba ditoke, anyi disama dia ku tshiadi. Ela 911 mu États-Unis ne mu Canada, 112 mu Union européenne, 999 mu Royaume-Uni, anyi tangila bionso nomba ya tshimpitshimpi. Ambila patoke kudi mutumibue ne: "Difu dia pambelu didi dipatuka ne mashi adi apatuka munda ne tshipupu," nunku bena mudimu ba ambulanse badi balongolola mâyi a mu mishipa ne badimuija nzubu wa dipanda wa dilela wa mu lupitadi.
2. Lala muntu pa mukolo (anyi mutenteka kakese ku luseke lua dia bakaji) ne KUMULEKI bua kuimana anyi kuenda to. Kuimana anyi kusomba pa tshina tshia mâyi padi mashi mapite pa litre umue mubuele munda mua difu kudi kuenza bua mashi akuluke diakamue (orthostatic syncope), ne kufikisha ku dijimija dia lungenyi dia tshimpitshimpi, ku disama dia mutu, ku tshina tshia kuowa mâyi disama dia mutshima. Mulale panshi pa bulalu anyi panshi too ne padi baminganga bamubandisha pa tshibandilu.
3. Kufila tshintu nansha tshimue ku mishiku (kufila mayi, biakudia, anyi manga a kanyinganyinga). Difu dia pambelu didi mua kuimanyika anu mu nzubu wa dipanda mu anesthésie générale. Lama mubedi kakuyi bualu nansha bumue ku mishiku (NPO) bua kafu ne kapuekeshi bintu bidi mu tshifu mu mikolo yende padibu bamuela tshiamu tshia endotracheal tshia lukasa. Kabidi, kupeshi aspirine, ibuprofen, anyi naproxen nansha kakese, bidi binyanga dikokangana dia mashi ne binyanga dipatuka dia mashi munda.
4. Kuela tampons nansha kakese, kuena mua kuowa mâyi nansha kakese, ne kuena ne bua kufina panshi pa difu dia kuinshi to. Bikala mashi apatuka mu tshifu, teka tshilamba tshia pambelu tshikezuke (tshilamba tshia dilela) mu bilamba bia munda bua baminganga bamanye bungi bua mashi adibu bajimija pa kubala bungi bua bintu bidibu bapuekesha ku dîba. Kufina anyi kulenga difu dia kuinshi to: difina dikole dia difu didi kadiyi ditshibuka anyi didi dipatuka didi mua kupatula tshifu tshidi tshitangalake ne kuenza bua mashi apatuke bikole mu mijilu.
5. Lama mubedi ne luya ne bilamba ne utangila mushindu udiye wenda ne mupuya wende kunyima kua minite 3 anyi 5. Umubuikile ne tshilamba tshia luya ne uteka tshintu tshidi tshikuba mubidi muinshi muende yeye mulale panshi pa mabue. Kuepuka hypothermie (luya lua munda mua \(35^\circ\text{C}\) anyi \(95^\circ\text{F}\)) kudi ne mushinga bualu mashi mashika adi ajimija bukole buawu bua kukola. Yeye mujimije lungenyi, umuele pa luseke luende lua dia bakaji mu muaba wa diondopangana bua kulama njila wende wa luya mutoke.
6. Ujadike mudiye ne difu pikalaye kayi mumanye ne wangate malu a luondapu bua baminganga. Tangila dituku dia kumpala dia tshikondo tshiende tshia ndekelu tshia ku ngondo (LMP), nansha yeye muikale ne tshiamu tshia munda mua difu (IUD / coil) anyi tshiamu tshia munda mua difu ("tube mikanga"), muyuki wonso wa kumpala wa dimita dia difu dia pambelu anyi disama dia mu tshifu, ne mashi ende funda** (bikalabi bimanyike). Ambila baminganga diakamue pikalaye mumvue kanyinganyinga padiye uteta bua kukangula mala ende anyi kuela mashi, tshidi tshimanyishilu tshia mashi adi masangisha mu tshifu Pouch of Douglas.

Dipatuka dia mashi mu ngondo isatu ya kumpala ne disama dikole dia mu tshiadi mutshi wa mapangadika a mu lupitadi¶

Ingidija tshimfuanyi etshi tshia disungula bua mukaji yonso udi ne bidimu bia kulela (kubangila ku bunsonga too ne ku dijika dia ngondo, pabuipi ne bidimu 12 too ne ku 52) udi ne disama dia muinshi mua difu anyi mashi adi apatuka mu tshifu.

flowchart TD
    Start["Mukaji wa bidimu bia kulela (12 too ne ku 52) udi ne:<br/>Diteta dia difu dimpe, dipanga/dijika dia tshikondo, anyi dipanga dia mabala<br/>NE disama dia mu tshiadi/difu anyi dipatuka dia mashi mu tshifu"] --> RedFlagCheck{"Kudiku bimanyinu bikunze bia ectopic / shock anyi?<br/>1. Disama dia mutu, disama dia mutu, anyi dijimija dia lungenyi (syncope)<br/>2. Disama dikole ku mutu kua dikaya (tshimanyinu tshia Kehr)<br/>3. Disama dikole anyi dikola dia ku luseke lumue (ku luseke lumue) muinshi mua difu<br/>4. Disama/dikengesha padi muntu ukeba kupatula tshina anyi kuela nsukadi<br/>5. Dikoba ditoke, mashika, dikole anyi dikuma dia lukasa (>100 bpm)<br/>6. Kuela >= 2 maxi pads ku dîba bua mêba 2"}

    RedFlagCheck -->|"EYOWA: Dibendele dionso dikunze didiku"| Emergency911["MUSHINDU WA BUALU WA LUPILU (Badi bela meji ne: Ectopic udi ne disama dia rupture / Hemorrhage):<br/>1. Bikila 911 / 112 / 999 diakamue<br/>2. Lala panshi pa nyima (anyi ku dia bakaji shi udi ne tshiji tshikole); KULEKI bua kuenda<br/>3. Kulama tshintu nansha tshimue ku mishiku (NPO) bua dipanda dia lukasa<br/>4. Ikala ne luya ne tshilamba; enza mudimu anu ne tshilamba tshia pambelu"]

    RedFlagCheck -->|"NO: Hemodynamique stable,<br/>kakuyi dijimija dia lungenyi, kakuyi disama dia mu dikaya"| PainVsBleed{"Bimanyinu kayi bidiku mpindieu?"}

    PainVsBleed -->|"Disama dia mu tshiadi dia ku luseke lumue dia patupu too ne ku dia pa tshibidilu<br/>ANYI dikala dia 'prune-juice' dia tshitoke tshifiike"| UrgentSameDay["NYIKA MUNENE BUA DIFUTA DIA MU MUTU:<br/>Ndaku ku tshibambalu tshia malu a tshimpitshimpi anyi ku tshibambalu tshia dikonkonona dia dimita dia kumpala (EPAU) LELU<br/>Bidi bikengela dituku dimue dia transvaginal Ultrasound + Quantitative Serum beta-hCG<br/>Kuindidi bua kuenza rendez-vous wa pa tshibidilu kumpala kua dilela lumingu ludi lulonda"]

    PainVsBleed -->|"Disama dia munkatshi mua tshikondo tshia ngondo<br/>ne mashi a mu tshifu a rose/tshikunze"| MiscarriageEval["Dijimija dia difu didi mua kuikala mu njiwu, kadiyi dikumbane anyi dikumbane:<br/>Udi mua kubikila OB/GYN anyi ku lupitadi lua Early Pregnancy Clinic mu mêba 24 bua kuenza Ultrasound<br/>ne Rh(D) tshikebelu tshia mashi (Anti-D / RhoGAM bidi bikengela mu 72 hrs pikala Rh-ne<br/Gogative) udi usama diakamue udi ushintuluka ku luseke lumue anyi mashi adi avula"]

    PainVsBleed -->|"Butoke budi kabuyi busama anu<br/>pabuipi ne dituku didibu batekemene bua kumona ngondo"| LightSpotEval["Mashi adi mua kupatuka mu difu, ectropion wa mu tshifu, anyi hematoma wa muinshi mua tshifu:<br/>Epuka tampon ne masandi; enza tshikebelu tshia ultrason<br/>bua kujadika dimita dia munda mua difu (IUP) munda mua difu"]

Kufuanyikija malu adi akebesha dipatuka dia mashi mu ngondo isatu ya kumpala ne disama dia mu tshiadi¶

Bualu bua 20 too ne ku 25 pa lukama ya dimita dionso itu ipeta bipeta bia mu tshifu anyi mashi apatuka mu mbingu 12 ya kumpala, kusunguluja dimita dia pambelu didi mua kunyanga muoyo ne dijimija dia difu anyi hematoma subchorionic udi kayi ne njiwu kudi kusungila mioyo.

Anatomie ne pathophysiologie: Bua tshinyi tshitupa tshia mu tshifu tshidi tshipatuka mashi lukasa¶

Bua kumvua bua tshinyi mukaji udi ne difu dia pambelu didi mua kumbuka ku dienda ne kuakula too ne ku dijika dia mutshima mu minite mikese menemene ya 45, ela meji bua mushindu udi tshifu tshia mukaji tshienza:

1. Bua tshinyi tshifu tshia muana katshiena mua kukola bu mudi tshifu: Tshifu tshia muntu tshidi ne tshimanu tshinene tshia mifuba milengeja (myometrium) tshienza bua kukola misangu 500 mu bunene bua ngondo 9. Bishilangane, tube fallopien (ampulla ne isthmus) i tshintu tshitekete, tshia nsuki tshidi ne misunyi mikese tshidi ne mudimu watshi wa kukomba diyi didibu balele mu tshifu mu matuku 3 anyi 5. Padi muana ulamakaja mu tshina tshia mamu, selile ya trophoblaste (idi milongolola bua kubuela mu mishipa ya mashi ya mamu bua kuenza tshifu) idi ibuela buludiludi mu tshimanu tshitekete tshia dibeji dia tube ne ituta buludiludi mu matamba a mu tshina tshia mamu ne mu mushipa wa mu tshifu.
2. Difila dia mashi mu mishipa ibidi muinshi mua divulangana dia mashi mu dimita: Mu tshikondo tshia dimita dia kumpala, ma hormone a mamu adi avudija dienda dia mashi mu tshifu ne dipatuka dia muoyo. Bu mudi muonji wa Fallopi musombe ku muelelu wa mashi udi ufumina ku nsongo yonso ibidi (ku mushipa wa uterine udi ufumina ku mushipa wa iliaque wa munda munkatshi, ne ku mushipa wa ovari udi ufuma buludiludi ku aorta wa mu difu ku luseke), ditshibuka dia mu trompa wa difu didi diunzulula njila wa mashi udi ne bukole bua bungi udi uya mu njila ibidi udi ubuela mu tshitupa tshia mubidi tshidi katshiyi ne bualu.
3. Bua tshinyi tshimanyishilu tshia Kehr (Disama dia mu dikaya) tshidi tshienzeka: Kakuena bualu bubi nansha bumue mu tshitupa tshia dikaya tshia mubedi to. Padi \(500\text{ to }1,500\text{ milliliters}\) ya mashi a mu tshifu apatuka mu tshiadi ne mukaji mulale panshi (anyi mushindame pa ditanda), bukole budi bukokela bintu panshi budi buenza bua mashi a mu mâyi a kapia apueke muulu mu njila ya paracolic ne adisangishe **buludi muinshi mua diaphragme muscular (mushipa udi utapulula tshifu ne tshiadi). Kuinshi kua diaphragme kudi ne tshiamu tshia phrenic, tshidi tshifumina mu nshingu ku miji ya tshiadi tshia mu tshiadi C3, C4, ne C5. Bualu bua miji ya C3, C4, ne C5 idi kabidi ifila dikoba dia ku mutu kua dikaya ne dia mufuba wa tshiadi (mijilu ya pa mutu pa tshiadi), buongo budi bumvuija bibi disama dia mashi dia mu diaphragme bu disama dikole dia ku nsongo ya dikaya.
4. Bua tshinyi "Bathroom Faining" ne Rectal Pressure bidi bienzeka (Pouch of Douglas pooling): Padi mukaji muimane anyi musombe, mashi adi asangisha mu tshibombi tshia muinshi menemene tshia tshifu tshia mukaji: tshibombi tshia rectouterine (Pouch of Douglas / cul-de-sac wa panyima), tshidi tshisomba diakamue kumpala kua tshibombi tshia mu tshifu. Mashi adi avula muaba ewu adi afina buludiludi pa mijilu ya mu tshiadi ne ya mu tshifu, adi apesha mukaji dijinga dia tshimpitshimpi ne dikole dia se: udi "udi dijinga ne kuenza mudimu wa tshina." Udi ubuela mu tshina tshia mâyi, usomba pa tshina tshia mâyi, ne udi udienzeja, ne bualu ebu budi bupueka mijilu mu mutshima wende ne bufikisha dikuluka dia lukasa mu tshina tshia kuowa mâyi.

Mateyi masokoka: Bua tshinyi udi mua kuikala ne difu dia pambelu pa difu ne tshiamu tshia stérilet, "tubes misuika," anyi panyima pa "kupeta ngondo webe"¶

Malu asatu adi bantu kabayi bumvua bimpe adi apangisha diondapangana dia lukasa dituku dionso:

1. "Uvua anu mupeta ngondo lumingu lushala, nunku kena mua kuikala ne difu to"¶

Batue ku 30 pa lukama ba babedi badibu bapeta ne dimita dia difu dia pambelu badi baleja ne: bavua ne tshivuabu bela meji ne: tshivua tshikondo tshia kumona ngondo tshimpe anyi tshikese mbingu 1 anyi 3 kumpala. Mu bulelela, padi difu dia pambelu dibuela mu tshiamu tshia difu, didi dipatula bungi bukese kupita bua pa tshibidilu bua gonadotropin (\(\beta\text{-hCG}\)) ne progestérone, bienza bua tshitupa tshia munda tshia difu tshidi katshiyi ne tshintu tshinyanguke ne tshipatuke mashi anu dîba divua tshikondo tshia difu tshikumbanyine. Mukaji yense udi ne bidimu bia kulela udi ne disama dia mu tshiadi dikole, disama dia mu tshiadi, anyi dijimija dia lungenyi didi kadiyi diumvuika udi ne bua kuenza mateta a mashi anyi a mashi diakamue, nansha yeye mumane kumona ngondo kayi.

2. "Udi ne stérilet (Intrauterine Device / Coil) anyi uvua ne Tubal Ligation ('Tubes Tied')"¶

Nansha mudi biamu bia munda mua difu (bu mudi Mirena, Kyleena, Liletta, anyi Copper ParaGard IUDs) ne dipanda dia tuba mu tshifu bidi ne bukole bua bungi bua 99 pa lukama bua kupangisha dimita difu munda mua uterus, bikala dimita dia patupu dienzeke padi IUD muikale pa muaba wadi anyi panyima pa dikanga dia tuba kumpala, kudi 150 pa lukama lua dimita dia dimita difu i dimita dia ECTOPIC mu tube fallopien. Kuikala ne tshiamu tshia stérilet anyi tshiamu tshia nzembu tshisuika kudi mua kuteka mubedi udi ne difu mu tshitupa tshia njiwu mikole ya ditshibuka dia tshiamu tshia nzembu.

3. Malu manene adi mua kufikisha ku dimita dia pambelu pa difu¶

Nansha mudi bakaji batue ku 50 pa lukama badibu bapeta ne difu dia pambelu pa difu kabayi ne malu adi mua kubafikisha ku njiwu, njiwu eyi idi mikole menemene kudi babedi badi ne: - Difu dia pambelu dia kumpala (10% too ne ku 25% ya njiwu ya dipingana dia difu). - Disama dia kumpala dia tshifu (PID) anyi disama dia kumpala dia Chlamydia trachomatis anyi Neisseria gonorrhoeae (didi dishiya mputa mikese idi milamakaja munda mua cilia mitekete ya mu tshifu). - Dipanda dia kumpala dia tshiadi, dipingaja dia tshiadi, dipanda dia tshiadi (nangananga tshiadi tshitapuluke), disama dia endometriose, anyi dipanda dia tshiadi. - Dibueja dia bana mu tshiadi (IVF) ne diambuluisha dia dilela dia bana (ART): Mudi kabidi disama didi kadiyi ditamba kumueneka didibu babikila ne: dimita difu dia mishindu yonso, mudi muana umue ubuela munda mua tshifu NE muana muibidi wa mapasa ubuela musangu umue munda mua tube de fallope (udi wenzeka pabuipi ne 10 too ne ku 10 1,000 ya difu dia IVF). - Kunua makanya (nicotine ne cotinine bidi bipangisha dikuma dia tshitupa tshia mu tshiadi, bipangisha dienda dia muana).

Mushindu kayi wa kubandila bungi bua mashi adi apatuka mu tshifu ne Rh-Negative (Anti-D / RhoGAM) 72-hour rule¶

Shi mubedi wa mu ngondo isatu ya kumpala udi ne mashi adi amueneka mu tshifu (nansha afumina ku dimita dia pambelu anyi ku dijimija dia difu), baminganga badi dijinga ne malu abidi a mushinga:

1. Kubala maxi pads ku dîba (Mukenji wa "2 Pads ku dîba bua mêba 2" wa dipatuka dia mashi)¶

• Ela tshilamba tshia pambelu (maxi pad) mu bilamba bia munda (kuenza mudimu nansha kakese ne tampon anyi dikopo dia ku ngondo, didi dikuata mashi munda mua tshifu ne didi mua kubueja bactérie kupitshila ku tshifu tshiunzulula).
• Tshikondo tshia dipatuka dia mashi mu tshimpitshimpi: Bikala mashi a mu tshifu a bungi menemene bua kubuela mu maxi pads 2 anyi kupita apu mu dîba dimue munkatshi mua mêba 2 malondangane (anyi pad 1 kunyima kua minite 15 anyi 30), anyi bikala mubedi mupitshishe mashi manene kupita mupimbu wa golf anyi mupimbu wa golf (\(4xt {txt\t} santimetre}\) / \(1.5\text{ to }2\text{ inches}\)), bikila 911 / 112 / 999 diakamue.
• Bikala tshitupa tshikole tshia nsongo anyi tshia rose tshipita: Shi mubedi mupita tshitupa tshia mubidi tshikole mu tshikondo tshia dijimija dia difu, teka tshitupa etshi mu tshibombi tshia dikala dia dikala anyi mu tshintu tshia plastique (anyi utshibuikile mu tshilamba tshia dibeji tshikezuke munda mua tshibombi tshia plastike tshikanga) ne ulua natshi ku lupitadi bua baminganga ba misongo bamone mua kutshitangila bua kumanya ni **vicholline ** (an trainin in train) dijimija dia difu pamutu pa dimita difu dia pambelu pa difu).

2. Mukenji wa mashi adi kaayi ne Rh (Anti-D Immunoglobulin / RhoGAM)¶

Shi mukaji udi ne difu udi ne mashi adi kaayi ne Rh (\(A\text{-negative}, B\text{-negative}, AB\text{-negative}, \text{or } O\text{-negative}\)) ne udi ne difu dia pambelu pa difu, difu didi mu njiwu anyi disama dia mu tshifu didi mua kuikala dikole, anyi disama dia difu dikole, Ma globules rouges adi ne Rh adi mua kubuela mu mashi ende ne kukolesha tshiluilu tshiende tshia mubidi bua kuluisha bana ba matuku atshilualua (disama dia mashi dia mu difu ne dia muana udibu balele). - Ikala mujadike bua kuebeja lupitadi anyi tshibambalu tshia dikonkonona dia dimita dia kumpala ni udi dijinga ne diela dia Anti-D immunoglobulin (RhoGAM) mu mubidi mu mêba 72 a ntuadijilu wa dipatuka dia mashi anyi dipanda (bilondeshile mikenji ya ditunga ya ACOG mu États-Unis, RCOG/NICE mu Royaume-Uni, ne SOGC mu Canada).

Tshidi tshienzeka mu lupitadi: Ultrason transvaginal, hCG Discriminatory Zone, ne luondapu¶

Kumanya mushindu udi baminganga ba lupitadi ne baminganga ba dilela bapima ne baondapa difu dia pambelu pa difu kudi kuambuluisha bena dibaka ne bena mu mêku bua kumvua tshidi tshienzeka:

1. Point-of-Care FAST Ultrasound and Transvaginal Ultrasound (TVUS): Mu minite mikese ya difika dia ambulanse bua mubedi udi kayi ne makanda a mubidi, baminganga ba lupitadi lua lukasa badi bateka tshiamu tshia ultrasound pa difu (FAST exam: Focused Assessment with Sonography in Trauma) batangila **Muana wa mamu (**pankatshi pa tshibombi ne tshifu pelvic cul-de-sac. Patudi tumona mashi mafiike mu tshibombi tshia Morison, bidi bijadika ne: kudi mashi a tshianana adi mu difu ne adi asaka bua kuya diakamue mu nzubu wa dipanda bantu kabayi bindile mudimu wa laboratware to. Mu babedi badi kabayi ne makanda a mubidi, tshiamu tshia transvaginal ultrasound tshidi tshitangila uterus ne adnexa bua kumanya ni kudi tshibombi tshia difu, tshibombi tshia jaune, anyi "tubal ring" / "ring of fire" mass ku luseke lua ovaire.
2. Quantitative Serum \(\beta\text{-hCG}\) and the Discriminatory Zone: Baminganga batu bangata mashi bua kupima bungi bulelela bua beta-human chorionic gonadotropin (\(\beta\text{-hCG}\)). Padi serum \(\beta\text{-hCG}\) ufika ku discriminatory zone wa \(1,500\text{ too ne ku }3,500\text{ mIU/mL}\) (\(IU/L\)), dimita dia makanda a mubidi diakane munda mua tshifu didi ne tshia kuikala dimueneka misangu yonso ku diambuluisha dia ultrasound; tshifu tshidi katshiyi ne tshintu tshisangisha ne \(\beta\text{-hCG}\) udi pa mutu pa \(3,500\text{ mIU/mL}\) (anyi \(\beta\text{-hCG}\) udi kayi mua kubandila bimpe mu mêba 48 mu "Dimita dia muaba udi kauyi mumanyike" [PUL) udi uleja ne: ectopic dimita difu.
3. Dipanda ne diondapa dia buanga:
4. Dipanda dia tshimpitshimpi (Salpingectomie anyi Salpingostomie): Bidi bikengedibua bua dimita dionso dia pambelu pa difu, mubedi yonso udi ne disama dia hemodynamique, mashi a mu tshifu adi kaayi ne tshintu, disama dikole, anyi dikuma dia mutshima wa muana munda mua tube de Fallope. Baminganga badi bumbusha tshitupa tshia difu tshidi tshipanduluke (salpingectomy) anyi bakangula tshiamu bua kumbusha difu (salpingostomy) ne kuela mashi adi kaayi ne O anyi adi mapetangana. (Diumusha dia tube umua wa difu didi dishiya 70 too ne ku 85 pa lukama ya dilela dia pa tshibidilu ku diambuluisha dia tube muimpe udi mushale).
5. Dilama dia luondapu ne Methotrexate mu mifuba (Anu bua Ectopics Stable, Unruptured): Shi dimita dia ectopic dikuata kumpala kua dîba kumpala kua dipatuka, ne mubedi muikale mupole bimpe ne kanyinganyinga kakese ne tshitupa tshikese tshidi katshiyi tshipanduluke, ba munganga badi mua kuepuka dipanda dia mubidi padibu bamuela diondapangana mu mifuba ( folate antagonist udi ulekela ditapuluka dia lukasa dia selile ya mu tshifu bua mubidi ikale mua kuangata difu mu mbingu 2 too ne ku 6). Didimuija dia mushinga mukole dia panyima pa methotrexate: Nansha kunyima kua dikuba dia methotrexate, tshitupa tshia difu tshidi tshishala tshitekete ne tshidi mua kuikala anu tshipatuka matuku 3 too ne ku 14 pashishe; shi mubedi uvua mupeta manga a methotrexate mupeta disama dia tshimpitshimpi dia mu difu, disama dia ku nsongo ya dikaya, anyi disama dia tshiadi kumbelu, udi mua kubikila 911 / 112 / 999 diakamue.

Miaba ya patupu idi kayiyi ya mu tshiadi idi ipatukila ne mashi adi apatuka bikole¶

Padi 95 too ne ku 97 pa lukama ya dimita dia pambelu pa difu diteka mu tshitupa tshinene tshia ampulla anyi isthmus wa tube de Fallopien, pabuipi ne 3 too ne ku 5 pa lukama badi bateka mu miaba idi kayiyi ya pa tshibidilu mudibi bikole bua kumanya disama ne mudi mashi apatuka munda adi mua kuikala makole menemene:

• Dimita dia pambelu (2% too ne ku 4% ya dimita dia pambelu): Bintu bidibu bateka mu tshitupa tshia pabuipi tshia mu tshifu tshidi tshipita buludiludi mu tshimanu tshinene tshia mu tshifu, anu muaba udi mishipa ya mu tshifu ne ya mu tshifu bipetangana. Bu mudi misunyi ya mu tshifu idi minyunguluke mipite ya mu tshifu tshia pambelu, dimita dia munda didi mua kukola too ne ku mbingu 8 to ne ku 14 ya dimita difu kumpala kua kupatuka mu tshimpitshimpi mu lusengu lua mu tshifu, bienza bua mashi apatuke lukasa ne bungi bua bantu badi bafua misangu 2 anyi 5 kupita dimita dia mu tshifu tshia pa tshibidilu.
• Dimita dia mputa ya dipanda (CSP): Bintu bidi bibueja buludiludi mu tshilema tshia mubidi (niche) tshia mputa wa dipanda dia mu tshitupa tshia kuinshi tshia kumpala. Bu mudi placenta wenda upitshila mu tshilonda tshitekete tshitangile ku tshifu tshia mashi, bidi mua kufikisha ku dinyanguka dia tshifu mu ngondo wa kumpala anyi muibidi anyi dipatuka dia mashi mu placenta accreta spectrum.
• Dimita dia pambelu pa tshifu, dia mu tshifu, ne dia mu tshifu: Dibueja dia munda mua tshina tshia munda mua tshifu (tshidi tshikebesha dipatuka dia mashi mu tshifu tshidi katshiyi ne kanyinganyinga), pa mutu pa tshifu, anyi buludiludi pa tshitupa tshia mu tshifu anyi pa serosa wa mu tshifu munda mua tshifu.

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• Tshilongelu tshia bena Amerike tshia baminganga ba dilela ne bakaji (ACOG, États-Unis): Mukanda wa mudimu No. 193: Dimita dia pambelu pa tshiadi ne Mukanda wa mudimu No. 200: Dijimija dia difu dia kumpala kua dîba.
• Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bantu (NICE, Royaume-Uni) ne Royal College of Obstetricians and Gynecologists (RCOG, United Kingdom): Difu dia pambelu pa difu ne dijimija dia difu: Dimanya ne dilama dia kumpala (NG126, dishintulula mu 2023) ne Green-top Guideline No. Dimita difu.
• Society of Obstetricians and Gynecologists of Canada (SOGC, Canada): Clinical Practice Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Non-Tubal Ectopic Pregnancies.
• Bulongolodi bua malu a bukola bua mubidi pa buloba bujima (OMS): Dilama dia ntatu mu dimita ne dilela: Dipatuka dia mashi mu tshifu mu dimita dia kumpala ne mikenji ya dipanda dia dimita dia pambelu pa difu.

Malu adi apetangana¶

• Dijingulula dia tshipupu ne dilombola dia diambuluisha dia kumpala
• Dinyanguka dia tshifu, dinyanguka dia tshifu, ne disama dikole dia mu tshiadi
• Dilela dia lukasa ne dilela dia lukasa
• Dijimija dia lungenyi ne dikonkonona dia dipanga dia lungenyi
• Nomba ya tshimpitshimpi ne dituma dia matunga makuabu