Ko te hapu ectopic kua pakaru me te whakaheke toto moata¶

Ka puta te haputanga ectopic i te wa e whakato ana te hua manu wairakau ka timata te tipu ki waho o te kohao matua o te kōpū, te nuinga kei roto i te whaiti ** ngongo fallopian** (95 ki te 97 paiheneti o nga keehi, e kiia ana he hapu ngongo), he uaua ake ranei i roto i te ovary, cervix, uterine cornua, he nawe cesarean ranei o mua. Na te mea he 1 ki te 4 millimeters (0.04 ki te 0.16 inihi) te whanui noa te ngongo fallopian me te kore he pakitara uaua matotoru, ka totoro te tipu o te kukune me nga oko toto i roto i te pakitara ngongo, te tikanga kei waenga i te 5 me te 10 wiki o te haputanga (he maha i mua i te mohiotanga o te manawanui kua hapu ia). Ka pakaru te ngongo fallopian, ka ringihia e nga manga rere teitei o te uwha me te ovarian arteries 1,000 ki te 2,500 milliliters (2 ki te 5 pints) o te toto tika ki roto i te kohao puku (hemoperitoneum) me te iti, karekau ranei e kitea te toto tara. Ko te ruptured ectopic pregnancy te te take nui-tahi o te mate o te whaea i te marama tuatahi o te ao, me tere tere te kawe waka tūroro mo te pokanga laparoscopic ohorere me te whakaheke toto.

Mahia tenei inaianei¶

1. **Waea atu ki to nama whawhati tata o te rohe mena ka pa te mamae o te kopu (he hapu pea) tetahi taha o te taha o te kopu, me te mangere, te ngenge, te kiri koma, te mamae o te pakihiwi ranei. tau ohorere. Kia marama te korero ki te Kaituku: "E whakapaetia ana kua pakaru te haputanga ectopic me te toto o roto me te ohorere," no reira ka whakareri te kaihopu waka tūroro i nga wai whakaroto me te whakamohio i te ruuma whakawhanau o te hohipera.
2. Whakatakotoria te tangata ki runga i tona tuara (ka titaha paku ranei ki tona taha maui) kaua e tukua kia tu, kia hikoi ranei. Ka tu tika, ka noho ranei i runga i te wharepaku ina neke atu i te kotahi rita o te toto kua uru ki roto i te puku ka paheke tonu te pehanga toto (orthostatic syncope), ka mate ohorere te mahara, te mahunga i runga i nga papa kaukau, me te mate ngakau. Whakatakotoria ia ki runga i te moenga, ki te papa ranei kia hikitia e nga paramedic ki runga i te moenga.
3. Kaore e hoatu he mea ma te waha (kaore he wai, he kai, he rongoa mamae ranei). Ka taea anake te aukati i te haputanga ectopic kua pakaru i roto i te rūma mahi i raro i te whakarerenga whanui. Kia mau ki te manawanui kaore he mea ma te waha (NPO) kia kore ia e ruaki me te ngotea i te kopu o roto ki roto i ona makahukahu i te wa ohotata ana te whakauru endotracheal. I tua atu, kaua rawa e hoatu aspirin, ibuprofen, naproxen ranei, e whakararu ana i te paheketanga o te pereti toto me te kino o te whakaheke toto.
4. Kaua rawa e kuhu he tampons, kaua rawa e whakamau, kaua rawa e pehi i te puku o raro. Mena kei te puta te toto o te tara, tuu he puru horoi o waho (papa whakawhanau) ki roto i nga kakahu o roto kia taea ai e nga taakuta te whakatau i te mate toto o waho ma te tatau e hia nga papa e rukuhia ana ia haora. Kaua e pehia, e paopao ranei i te puku o raro: ka kaha te pehanga i runga i te haputanga ngongo karekau i pakaru, ka turuturu ranei ka pakaru te ngongo fallopian kua pakaru, ka puta te toto toto kino.
5. Me whakamahana te manawanui ki nga paraikete me te aro turuki i tana pupuhi me te manawa i ia 3 ki te 5 meneti. Hipokina ia ki te paraikete mahana, ka waiho he whakamahana ki raro i a ia mena kei te takoto ia i runga i te papa tile. Ko te aukati i te ** hypothermia** (te mahana matua kei raro i te \(35°\text{C}\) ranei \(95°\text{F}\)) he mea tino nui na te mea ka ngaro te kaha o te toto makariri ki te koopu. Ki te kore ia e mohio, hurihia ki runga i tana taha maui ki te tuunga whakaora whakamuri kia maamaa tonu tana ararere.
6. Whakapumautia te mana hapu ki te kore e mohiotia me te kohikohi i nga hitori o te rongoa mo nga kaiparapara. Tuhia te ra tuatahi o tana te wa e hapu ana (LMP), ahakoa he ** taputapu intrauterine (IUD / coil)** ranei tona ** tubal ligation o mua ("nga ngongo kua herea"), tetahi hitori o te haputanga ectopic o mua, te mate pelvic inflammatory ranei, me tona momo momo toto ** Rh). Korero atu ki nga kaiparapara mena kua pa ki a ia mamae i a ia e ngana ana ki te whakatuwhera i ona whekau, ki te mimi ranei, he tohu matarohia tenei o te kohi toto wai i roto i te pelvic Pouch of Douglas.

Ko te toto o te marama tuatahi me te mamae o te kopu te rakau whakatau haumanu¶

Whakamahia tenei mahere rerenga whakamatautau mo nga wahine e whanau ana i te tau whanau (mai i te pakeketanga ki te menopause, tata ki te 12 ki te 52 tau) ka puta te mamae o te puku o raro, te toto tara.

flowchart TD
    Start["Wahine o te Reproductive Age (12 ki te 52 yrs) me te:<br/>Poitive Pregnancy Test, Wā Kua ngaro/Tomuri, RĀNEI Kore Korekau<br/>PLUS Pelvic/Abdominal Pain or Vaginal bleeding"] --> RedFlagCheck{"He Kara Whero Ruptured / Ruperupepa Whero?<br/>1. Te mangere, te mahunga, te ngenge ranei (syncope)<br/>2. Te mamae koi i te pito o te pakihiwi (Kehr's sign)<br/>3. Te mamae kino o te puku o raro o te taha (tahi taha)<br/>4. Te mamae/te pehanga i te wa e ngana ana ki te pahemo, ki te mimi ranei<br/>5. He koma, he makariri, he kiri maru, he tere tere ranei (>100 bpm)<br/>6. Waiwai >= 2 maxi pads ia haora mo te 2 haora"}

    RedFlagCheck -->|"ĀE: He haki whero kotahi kei reira"| Emergency911["WHAKAMAHI KAUPAPA KAUPAPA KAUPAPA (E whakapaehia ana kua pakaru te Ectopic / Hemorrhage):<br/>1. Waea 911 / 112 / 999 Inamata<br/>2. Takoto whakamuri (te taha maui ranei ki te nausea/kore mohio); KAUA e tuku haere<br/>3. Puritia kia kaua e waha (NPO) mo te pokanga ohorere<br/>4. Kia mahana me te paraikete; whakamahia te papa horoi o waho anake"]

    RedFlagCheck -->|"NO: Hemodynamically stable,<br/>kaore e ngenge, karekau he mamae pokohiwi"| PainVsBleed{"He aha nga tohu e kitea ana inaianei?"}

    PainVsBleed -->|"Te mamae pelvic ngawari-ki-te-tetahi<br/>RĀNEI te parauri 'prune-juice' tote"| UrgentSameDay["TE WHAKAMAHI KAUPAPA KAUPAPA KAUPAPA KAUPAPA KAUPAPA KAUPAPA KAUPAPA:<br/>Haere ki te Tari Ohotata, ki te Unite Aromatawai Whakawhanau Moata (EPAU) I TE RANEI<br/>Me hiahia i te ra kotahi Transvaginal Ultrasound + Quantitative Serum beta-hCG<br/>Kaua e tatari mo te wa whakarite mo te wa i mua i te wiki."]

    PainVsBleed -->|"Raina waenganui o te paheketanga rite ki te paheketanga<br/>he mawhero/whero te toto tara"| MiscarriageEval["Ka Whakawehi, Kare i oti, ka oti ranei te Mahuru:<br/>Whakapa atu ki te OB/GYN, ki te Whare Wananga Moata ranei i roto i nga haora 24 mo te tirotiro Irarangi<br/>me Rh(D) Momo Toto (Anti-D / RhoGAM e hiahiatia ana i roto i nga haora 72 mena he Rh-kino)<br/>Haere tonu ki te ER ki tetahi taha ka nui haere ranei te mamae."]

    PainVsBleed -->|"Ko nga waahi marama kore mamae anake<br/>a tawhio noa te ra e tumanakohia ana"| LightSpotEval["Ka taea pea te whakaheke toto, te Cervical Ectropion, te Hematoma Subchorionic ranei:<br/>A ape i nga tampons me te taatai; te whakarite i te ultrasound wawe<br/>ki te whakau i te haputanga i roto i te kopu"]

Te whakatairite i nga take o te whakaheke toto o te marama tuatahi me te mamae o te kopu¶

Na te mea tae atu ki te 20 ki te 25 paiheneti o nga haputanga katoa ka pa ki te kotingotingo me te toto i roto i nga wiki 12 tuatahi, ma te wehewehe i te haputanga ectopic e mate ana ki te ora mai i te mahanga me te hematoma subchorionic kore kino ka ora.

Anatomy and pathophysiology: He aha te take ka tere te toto o te ngongo fallopian kua pakaru¶

Kia mohio ai koe he aha te wahine kua pakaru te haputanga ectopic ka taea te haere mai i te hikoi me te korero ki te hopukanga ngakau katoa i raro i te 45 meneti, whakaarohia te ahua o te pelvis wahine:

1. He aha te take e kore e taea e te ngongo fallopian te toro penei i te kōpū: Ko te kōpū tangata noa he pakitara maeneene maeneene (myometrium) te paparanga maha, i hangaia kia 500-nui te rahi i roto i te 9 marama. He rereke, ko te fallopian tube (ampulla and isthmus) he ngongo uaua, he angiangi makawe e mau ana ki te cilia moroiti, ko tana mahi anake ko te puruhi i te hua manu ki roto i te kōpū i roto i te 3 ki te 5 ra. I te wa e mau ana te kukune ki roto i te ngongo fallopian, ko nga pūtau trophoblast invasive (kua whakamaheretia ki te ruku ki roto i nga oko toto o te whaea ki te hanga i te waahi) ** ka toro tika ki roto i te pakitara angiangi pepa o te ngongo fallopian** ka paopao tika ki nga nga ngongo o te uaua uterine me te arai ovarian.
2. Tuku toto rua i raro i te whakahekenga o te haputanga: I te wa e hapu ana, ka piki ake te rere o te toto pelvic me te whakaputa ngakau. Na te mea e noho ana te ngongo fallopian ki te taha o te arai arai i whangaia mai i e rua nga pito (ma te arai uterine mai i te arai iliac o roto i waenga, a ma te arai ovarian tika atu i te aorta puku ki te taha taha), ka pakaru mai te ngongo fallopian ka whakatuwhera i te pehanga teitei e rua-ara te kowhao toto ki te kohao peritoneal koreutu.
3. He aha i puta ai te Tohu a Kehr (Te mamae o te pekepeke): Karekau he he o te hononga pakihiwi o te manawanui. Ka maringi te \(500\text{ ki te }1,500\text{ milliliters}\) o te toto wē i roto i te pelvis ka takoto te wahine ki raro (ka okioki ki runga ranei i te moenga), ka rere te kaha o te kaha o te toto wai mahana ki runga i nga awaawa paracolic me te poka wai ** kei raro tonu i te diaphragm uaua** (te puku o te uaua e wehe ana i te uma). Ko te taha o raro o te diaphragm ka whakarotohia e te phrenic nerve, ka puta mai i te kaki i nga pakiaka nerve spinal cervical C3, C4, me C5. Na te mea ko enei pakiaka nerve rite tonu C3, C4, me C5 te tuku i te kiri ki runga ake o te pakihiwi me te iwi (supraclavicular nerves), ka pohehe te roro i te riri o te toto diaphragmatic he ** koi, te mamae o te wero i te pito o te pokohiwi**.
4. He aha te take i tupu ai te "Paehe kaukau" me te Pehenga Rectal (Pouch of Douglas pooling): I te wa e tika ana te wahine, e noho ana ranei, ka uru te toto ki roto i te pute iti rawa o te pelvis wahine: ko te pouaka recouterine (Pouch of Douglas / posterior cul-de-sac), e noho tonu ana i mua tonu o te rectum. Ko te toto e pupuhi ana i tenei waahi ka pehi tika ki runga i te toka me te pelvic parasympathetic nerves, ka puta te kaha o te wahine ki te "me whakakorikori te whekau." Ka haere ia ki roto i te kaukau, ka noho ki runga i te wharepaku, ka werohia, ka heke te hokinga mai o te venous ki tona ngakau ka puta ** ka hinga tonu te syncopal i runga i te papa kaukau**.

Nga mahanga huna: He aha te take ka taea tonu e koe te haputanga ectopic me te IUD, "nga ngongo kua herea," i muri ranei i te "paanga o to wa"¶

E toru nga pohehe noa e whakaroa ana i te tiaki ohorere ia ra:

1. "Katahi ano ka pa ki a ia i te wiki kua hipa, na reira kaore ia e hapu"¶

Tae atu ki te 30 paiheneti o nga turoro kua kitea kua pakaru te haputanga ectopic e kii ana i ta ratou i mahara ai he wa paheketanga noa, he marama iti ranei 1 ki te 3 wiki i mua atu. Ko te mea pono, i te wa e whakatō ana te haputanga ectopic ki roto i te ngongo fallopian, ka puta mai nga taumata iti iho i te tikanga o te gonadotropin chorionic tangata (\(\beta\text{-hCG}\)) me te progesterone, na reira ka memeha, ka whakaheke toto i te wa e tika ana te waa. Ko nga wahine o te taima whanau e mau ana i te mamae o te pelvic unilateral, te mamae o te pakihiwi, me te ngenge kore i whakamaramatia, me whakamatau tonu te mimi, te toto haputanga ranei, ahakoa te hitori o tona paheketanga.

2. "He IUD (Intrauterine Device / Coil) tana, he Tubal Ligation ranei ('Tubes Tied')"¶

Ahakoa kei runga ake i te 99 paiheneti te whai hua o nga taputapu i roto i te kopu (pēnei i te Mirena, Kyleena, Liletta, Copper ParaGard IUDs ranei) me te whakamomori ngongo pokanoa hei aukati i te haputanga i roto i te kōpū, mehemea ka puta he haputanga onge i te wa e noho ana te IUD, i muri ranei i te herenga ngongo o mua, he 15 ki te 50 paiheneti te tupono ka hapu te ngongo i roto i te ECTOPIC. Ma te whai IUD, ngongo herea ranei ka tuu te turoro hapu ki roto i te kawai morearea teitei rawa mo te pakaru ngongo.

3. Nga take hauora nui mo te haputanga ectopic¶

Ahakoa ** tata ki te 50 paiheneti o nga wahine katoa e mate ana i te haputanga ectopic he ZERO nga mea morearea e mohiotia ana**, ka tino piki ake te tupono ki nga turoro me: - He haputanga ectopic o mua (10% ki te 25% te tupono ka hoki mai ano). - Ko te mate mumura Pelvic (PID) o mua, i mua ranei i te Chlamydia trachomatis, i te mate Neisseria gonorrhoeae ranei (e waiho ana nga piringa nawe moroiti ki roto i te kiri kiri o te ngongo fallopian). - I mua i te pokanga ngongo fallopian, te whakamuri i te herenga ngongo, te apiti (ina koa kua pakaru te apiti), te endometriosis, te pokanga pelvic ranei. - In Vitro Fertilization (IVF) and Assisted Reproductive Technology (ART): Tae atu ki tetahi ahuatanga onge e kiia nei ko te heterotopic pregnancy, kei reira tetahi o te embryo e whakato ana i roto i te kōpū ME te rua o nga mahanga embryo implants i te wa kotahi ki roto i te ngongo fallopian (ka tata ki te 1 i roto i te 100 ki te 100). - Hikareti hikareti (ko te nikotīni me te cotinine ka pararutiki te pao o te ngongo fallopian cilia, te whakaroa i te kawe o te kukune).

Me pehea te arotake i te rahinga toto tara o waho me te ture Rh-Negative (Anti-D / RhoGAM) 72 haora¶

Mena kei te kitea te toto taratara o te turoro i te toru marama tuatahi (ahakoa i te haputanga ectopic, i te mahangatanga ranei), me rua nga korero nui e hiahiatia ana e nga taakuta:

1. Te tatau i nga papa maxi mo ia haora (Ko te "2 Pads Per Hour for 2 Hours" Hemorrhage Ture)¶

• Place a standard full-size external sanitary pad (maxi pad) in the underwear (never use a tampon or menstrual cup, which traps blood inside the vagina and can introduce bacteria through an open cervix).
• Emergency Hemorrhage Threshold: If vaginal bleeding is heavy enough to completely soak through 2 or more full-size maxi pads per hour for 2 consecutive hours (or 1 pad every 15 to 30 minutes), or if the patient passes blood clots larger than a golf ball or lemon (\(4\text{ to }5\text{ centimeters}\) / \(1.5\text{ to }2\text{ inches}\)), call 911 / 112 / 999 immediately.
• If grey or pink solid tissue is passed: If the patient passes solid tissue during a suspected miscarriage, gently place the tissue into a clean glass jar or plastic container (or wrap it in a damp clean paper towel inside a sealed plastic bag) and bring it to the hospital so pathologists can inspect it for chorionic villi (confirming an intrauterine miscarriage rather than an ectopic pregnancy).

2. The Rh-Negative Blood Type Rule (Anti-D Immunoglobulin / RhoGAM)¶

If the pregnant woman has Rh-negative blood (\(A\text{-negative}, B\text{-negative}, AB\text{-negative}, \text{or } O\text{-negative}\)) and has an ectopic pregnancy, a threatened or complete miscarriage, or abdominal trauma, fetal Rh-positive red blood cells can enter her bloodstream and sensitize her immune system to attack future babies (hemolytic disease of the fetus and newborn). - Be sure to ask the hospital or Early Pregnancy Assessment Unit whether she requires an intramuscular injection of Anti-D immunoglobulin (RhoGAM) within 72 hours of the start of bleeding or surgery (following national guidelines from ACOG in the United States, RCOG/NICE in the United Kingdom, and SOGC in Canada).

What happens at the hospital: Transvaginal ultrasound, the hCG Discriminatory Zone, and treatment¶

Knowing how hospital emergency physicians and obstetricians diagnose and treat an ectopic pregnancy helps partners and families understand what is happening:

1. Point-of-Care FAST Ultrasound and Transvaginal Ultrasound (TVUS): Within minutes of ambulance arrival for an unstable patient, emergency doctors place an ultrasound probe on the abdomen (FAST exam: Focused Assessment with Sonography in Trauma) looking at Morison's pouch (between the liver and right kidney) and the pelvic cul-de-sac. Seeing dark liquid blood in Morison's pouch confirms at least \(500\text{ to }1,000\text{ milliliters}\) of free blood in the abdomen and triggers immediate transfer to the operating room without waiting for lab work. In stable patients, a high-resolution transvaginal ultrasound checks the uterus and adnexa for a gestational sac, yolk sac, or a "tubal ring" / "ring of fire" mass next to the ovary.
2. Serum Ine \(\beta\text{-hCG}\) me te Rohe Whakahirahira: Ka utu toto nga taakuta ki te ine i te taumata tau tika o beta-human chorionic gonadotropin (\(\beta\text{-hCG}\)). Kia tae atu te serum \(\beta\text{-hCG}\) ki te rohe whakahāwea o \(1,500\text{ ki }3,500\text{ mIU/mL}\) (\(IU/L\)), me tino kitea te haputanga hauora i roto i te kōpū i nga wa katoa i runga i te ultrasound transvaginal; he kōpū kau e hono ana me te \(\beta\text{-hCG}\) kei runga ake i te \(3,500\text{ mIU/mL}\) (he \(\beta\text{-hCG}\) ranei karekau e piki tika i roto i te 48 haora i roto i te "Te Haputanga o te Tauwāhi Unknown" [PUL]) e tino tohu ana ki te haputanga ectopic.
3. Haparapara me te rongoa:
4. Taupara Laparoscopic Ohotata (Salpingectomy or Salpingostomy): E hiahiatia ana mo ka pakaru katoa te haputanga ectopic, mo nga turoro he koretake o te hemodynamic, he kore utu te toto peritoneal, he mamae nui, he kowhao ngakau ranei kei roto i te ngongo fallopian. Ka tangohia e nga kaitoi i te ngongo fallopian kua pakaru (salpingectomy) ka whakatuwhera ranei i te ngongo hei tango i te haputanga (salpingostomy) me te whakaheke toto O-negative, he toto whakawhiti ranei. (Ko te tangohanga o te ngongo fallopian ka mahue tonu 70 ki te 85 paiheneti o te hua maori noa ma te ngongo hauora e toe ana).
5. Whakahaere Hauora me te Intramuscular Methotrexate (Mo te Ectopics Stable, Unruptured anake): Mena ka mau wawe te hapu haputanga ** i mua i te pakarutanga, a ka tino pumau te manawanui me te iti o te mamae me te papatipu iti kaore i pakaru, ka taea e nga taote te karo i te pokanga ma te tuku i te werohanga o te methotrexate antagon i roto i te uaua o te tinana. ka hoki pai te tinana i te haputanga mo te 2 ki te 6 wiki). Whakatupato nui i muri i te methotrexate: Ahakoa i muri i te whiwhinga i te pere methotrexate, kei te ngoikore tonu te ngongo fallopian, ka taea ano te ** pakaru 3 ki te 14 ra i muri mai; Mena ka tupu te mamae o te puku o te tangata i whakawhiwhia ki te methotrexate, te mamae o te pakihiwi, te whanoke ranei i te kainga, waea atu ki te 911/112/999.

Nga waahi ectopic kore-tubal ka pakaru me te whakaheke toto¶

Ahakoa ko te 95 ki te 97 ōrau o ngā hapūtanga ectopic ka whakatō ki roto i te ampulla matua o te ngongo fallopian ranei, tata ki te 3 ki te 5 ōrau te whakatō ki roto i nga waahi hangahanga rerekee he uaua ake te tātaritanga me te whakaheke toto o roto ka kaha ake te tutu:

• Te Haputanga Ectopic Interstitial (Cornual) (2% ki te 4% o te ectopics): Whakanohoia ki te wahanga tata o te ngongo fallopian ka toro tika mai i te pakitara uaua matotoru o te kōpū, kei reira tonu te uterine me te arai ovarian e anastomose. Nā te mea he mātotoru ake te uaua kōpū huri noa i te ngongo fallopian o waho, ka taea e te hapūtanga waenga te tipu tae noa ki te 8 ki te 14 wiki o te haputanga i mua i te pahū ohorere i roto i te haona uterine, ka tere te hemonga me te tere o te mate ki te 2 ki te 5 nga wa teitei ake i nga wa haputanga ngongo.
• Cesarean Scar Pregnancy (CSP): Implants directly into the microscopic fibrous defect (niche) of a prior lower-segment cesarean section scar. As the placenta burrows through the thin scar toward the urinary bladder, it can cause catastrophic first- or second-trimester uterine rupture or placenta accreta spectrum hemorrhage.
• Cervical, Ovarian, and Abdominal Ectopic Pregnancies: Implantation inside the endocervical canal (causing torrential painless vaginal hemorrhage), on the surface of the ovary, or directly onto the peritoneal lining or bowel serosa inside the abdominal cavity.

Pātai auau¶

Kua tirohia nga puna¶

• American College of Obstetricians and Gynecologists (ACOG, United States): Practice Bulletin No. 193: Tubal Ectopic Pregnancy and Practice Bulletin No. 200: Early Pregnancy Loss.
• National Institute for Health and Care Excellence (NICE, United Kingdom) and Royal College of Obstetricians and Gynaecologists (RCOG, United Kingdom): Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management (NG126, updated 2023) and Green-top Guideline No. 21: Diagnosis and Management of Ectopic Pregnancy.
• Society of Obstetricians and Gynaecologists of Canada (SOGC, Canada): Clinical Practice Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Non-Tubal Ectopic Pregnancies.
• World Health Organization (WHO): Managing Complications in Pregnancy and Childbirth: Vaginal Bleeding in Early Pregnancy and Ruptured Ectopic Pregnancy Surgical Protocols.

Nga kaiarahi e pa ana¶

• Te tohu ohorere me te whakahaere awhina tuatahi
• Testicular torsion, ovarian torsion, and acute pelvic pain
• Te whanau ohorere me te mahi tere
• Te ngoikoretanga me te aro mātai
• Nga nama ohorere me te tuku ki te ao