Ruptured ectopic pregnancy uye kutanga kubuda ropa pamuviri¶

Ectopic pregnancy inoitika apo zai rakasanganiswa rinodyara uye rinotanga kukura kunze kwegomba guru rechibereko, rinowanzova mukati memutete ** fallopian tube ** (95 kusvika 97 muzana yezviitiko, inozivikanwa se tubal pregnancy), kana kuti kazhinji kacho mu ovary, cervix, uterine cornua, kana kuti isati yatanga cesarean section. Nekuti iyo fallopian chubhu inongova 1 kusvika 4 millimeters (0.04 kusvika 0.16 inches) yakafara uye haina muscular mudhuri wakakora, "embryo" inokura uye tsinga dzeropa dze placental dzinotambanuka nekunyura nemumadziro echubhu, kazhinji pakati pe 5 ne10 mavhiki enhumbu (kazhinji murwere asati atomboziva kuti ane pamuviri). Kana fallopian tube inoputika, matavi ekuyerera akakwirira e ** uterine uye ovarian arteries ** anodurura ** 1,000 kusvika 2,500 milliliters (2 kusvika ku 5 pints) yeropa ** zvakananga mudumbu remudumbu (**hemoperitoneum **) nekubuda ropa kuduku kana kusaoneka. Ruptured ectopic pregnancy ndiyo ** nhamba-chimwe chikonzero chekufa kweamai mukutanga kwetatu pasi rose **, inoda kukurumidza kutakurwa kweamburenzi kune emergency laparoscopic operation uye kuwedzerwa ropa.

Ita izvi ikozvino¶

1. Fonera nhamba yako yekukurumidzira yekwaunogara nekukasika kana munhu anepamuviri (kana angangoita pamuviri) achirwadziwa nedivi rimwe chete nedzungu, kupera simba, ganda rakacheneruka, kana kurwadziwa kwepfudzi. Dhonza 911 muUnited States neCanada, 112 mhiri kweEuropean Union 999 kuUnited Kingdom, kana kuona zvese nhamba dze emergency. Taura zvakajeka kune anotumira: "Inofungidzirwa kuputika ectopic pamuviri nekubuda ropa mukati uye kuvhunduka," saka vashandi veamburenzi vanogadzira mvura inoiswa mutsinga uye vanozivisa imba yekuvhiya yechipatara.
2. Radzika munhu wacho nemusana (kana kuti akarerekera zvishoma kudivi rake rekuruboshwe) uye USAMUrega akamira kana kufamba. Kumira akati twasu kana kugara pachimbuzi kana ropa rinopfuura rita raungana mukati medumbu kunoita kuti BP irove pakarepo (orthostatic syncope), zvichiita kuti munhu arasikike arasikirwe nehana, kukuvadzwa kwemusoro pauriri hwemwoyo, uye kukuvadzwa kwemwoyo. Ramba akazvambarara pamubhedha kana pasi kusvikira vabatsiri vamusimudza pamubhedha.
3. Usapa zvachose CHANHU nemuromo (pasina mvura, zvokudya, kana mishonga yemarwadzo). Kuputika kwe ectopic pregnancy inogona kumiswa chete muimba yekuvhiya pasi pe general anesthesia. Chengeta murwere zvakasimba pasina chinhu nemuromo (NPO) kuitira kuti asarutsa uye kufemera zviri mudumbu mumapapu ake panguva yekukurumidzira endotracheal intubation. Mukuwedzera, ** usambofa wakapa aspirin, ibuprofen, kana naproxen **, iyo inokanganisa kugadzika kweplatelet yeropa uye kuwedzera kubuda kweropa mukati.
4. Usafe wakapinza matamponi, usambofa wakatsikirira pasi peguvhu. Kana kubuda ropa kunhengo yesikarudzi kunenge kuripo, isa chekunze sanitary pad (maternity pad) muchipfeko chemukati kuitira kuti vanachiremba vafungidzire kurasikirwa neropa rekunze nekuverenga kuti mapedhi mangani paawa. Usatsikirira kana kupuruzira dumbu rezasi: kudzvanya kwakasimba pamimba isina kuputika kana kubuda muchubhu inogona kupaza iyo yakatsemuka fallopian chubhu uye kukonzeresa kubuda ropa kunotyisa.
5. Ita kuti murwere adziyirwe nemagumbeze uye tarisa kurova kwemwoyo wake uye kufema kwemaminetsi matatu kusvika mashanu ega ega. Mufukidze negumbeze rinodziya uye muise zvekudziisa muzasi make kana akarara pauriri hwemataira. Kudzivirira hypothermia (tembiricha yepakati iri pasi pe \(35^\circ\text{C}\) kana \(95^\circ\text{F}\)) kwakakosha nekuti ropa rinotonhora rinorasikirwa nekugwamba. Kana akazofenda, mukungurudze kudivi rekuruboshwe panzvimbo yake yekumashure kuti mhepo igare yakachena.
6. Simbisa mamiriro epamuviri kana asingazivikanwi uye unganidza nhoroondo yezvokurapa kune vanobatsira varwere. Cherechedza zuva rekutanga rake yekupedzisira nguva dzose yekuenda kumwedzi (LMP), angave ane intrauterine device (IUD / coil) kana kuti mberi ** tubal ligation ("machubhu akasungwa")**, chero nhoroondo yepakutanga ectopic pregnancy kana pelvic inflammatory disease, uye yake ** (Rh ropa rinozivikanwa). Udza vanobatsira varwere nekukurumidza kana akambonzwa marwadzo achiedza kuvhura ura kana kuita weti, chinova chiratidzo chekare cheropa remvura rakaungana mupelvic Homwe yaDouglas.

Chekutanga-trimester kubuda ropa uye acute pelvic kurwadziwa kwekiriniki sarudzo muti¶

Shandisa iyi triage flowchart kune chero munhukadzi wezera rekubereka (kubva pakuyaruka kusvika pakuguma kuenda kumwedzi, makore angangoita 12 kusvika 52) achiratidza kurwadziwa kwezasi kweguvhu kana kubuda ropa muchibereko.

flowchart TD
    Start["Mukadzi Wezera Rekuberekwa (12 kusvika 52 yrs) ane:<br/>Positive Pregnancy Test, Kurovha/Kunonoka Period, KANA Irregular Spotting<br/>PLUS Marwadzo ePelvic/Abdominal kana Kubuda ropa muBeche"] --> RedFlagCheck{"Pane PANE PASI Yakatsemuka Ectopic / Shock Red Mireza iripo here?<br/>1. Dzungu, kuchena musoro, kana kupera simba (syncope)<br/>2. Kurwadza kwakanyanya kumucheto wepfudzi (chiratidzo cheKehr)<br/>3. Zvakanyanya kana kuwedzera kune rumwe rutivi (unilateral) kurwadziwa kwepazasi kweguvhu <br/>4. Marwadzo/pressure pakuedza kuburitsa tsvina kana kuita weti<br/>5. Ganda rakacheneruka, kutonhora, ganda rakapfava kana kuti fast pulse (>100 bpm)<br/>6. Kunyura > = 2 maxi pads paawa kwemaawa maviri"}

    RedFlagCheck -->|"EHE: Chero mureza mutsvuku uripo"| Emergency911["CRITICAL SURGICAL EMERGENCY (Inofungirwa Ruptured Ectopic / Hemorrhage): <br/>1. Fonera 911 / 112 / 999 ipapo <br/>2. Rara kumusana (kana kuruboshwe kana uchirutsa/kufenda); USArega kufamba<br/>3. Ramba Wakasimba Hapana nemuromo (NPO) pakuvhiyiwa kwechimbichimbi <br/>4. Dziyirwa negumbeze; shandisa kunze sanitary pad chete"]

    RedFlagCheck -->|"HAPANA: Hemodynamically stable,<br/>hapana kupera simba, hapana kurwadziwa kwepfudzi"| PainVsBleed{"Ndezvipi zviratidzo zviripo iye zvino?"}

    PainVsBleed -->|"Kurwadza kwepelvic kwakapfava-kusvika-pakati <br/> KANA kusviba 'prune-juice' spotting"| UrgentSameDay["HURU RISK FOR UNRUPTURED ECTOPIC PREGNANCY:<br/>Enda kuDhipatimendi reEmergency kana Early Pregnancy Assessment Unit (EPAU) NHASI <br/>Inoda zuva rimwechete Transvaginal Ultrasound + Quantitative Serum beta-hCG<br/>USATI kumirira kugadzwa kwevhiki rinouya prenatal"]

    PainVsBleed -->|"Midline kumwedzi-kunge cramping<br/>nepink/red vaginal kubuda ropa"| MiscarriageEval["Zvinogoneka Kutyisidzirwa, Kusakwana, kana Kubvisa Mimba Yakakwana: <br/> Bata OB/GYN kana Early Pregnancy Clinic mukati meawa 24 yeUltrasound<br/>uye Rh(D) Ropa Cheki (Anti-D / RhoGAM inodiwa mukati me72 hrs kana Rh-negative) <br/>Enda pakarepo divi kana kubuda ropa kunowedzera"]

    PainVsBleed -->|"Kusarwadza kwechiedza chekuona chete<br/>panguva yaitarisirwa zuva"| LightSpotEval["Zvinogoneka Kuisa Kubuda ropa, Cervical Ectropion, kana Subchorionic Hematoma:<br/>Dzivisa matamponi uye kuita zvepabonde; kuronga kukurumidza ultrasound <br/>kusimbisa intrauterine pamuviri (IUP) mukati mechibereko"]

Kuenzanisa zvikonzero zvekutanga-trimester kubuda ropa uye kurwadziwa kwepelvic¶

Nokuti kusvika ku ** 20 kusvika ku25 muzana yemimba yose inosangana nekuonekwa kwechikadzi kana kubuda ropa mukati memavhiki ekutanga e12 **, kusiyanisa hupenyu hunopisa ectopic pamuviri kubva pakubvisa pamuviri kana kusakuvadza subchorionic hematoma inoponesa hupenyu.

Anatomy uye pathophysiology: Nei yakatsemuka fallopian chubhu ichibuda ropa nekukurumidza¶

Kuti unzwisise kuti sei mukadzi ane ectopic pregnancy yakatsemuka achigona kubva pakufamba uye kutaura kusvika kumoyo wakazara kusungwa mukati memaminitsi makumi mana nemashanu, funga nezve anatomy yepelvis yemukadzi:

1. Nei chubhu ye fallopian isingakwanisi kutambanudza sechibereko: Chibereko chemunhu chakajairika chine mudhuri wakakora, une mavara akawanda anotsvedzerera ane tsandanyama (myometrium) akagadzirwa kuti awedzere 500-pavhoriyamu mumwedzi 9. Kusiyana neizvi, fallopian tube (ampulla neisthmus) igwara rakatetepa, rakatetepa muscular conduit rine microscopic cilia iro basa raro nderekutsvaira zai rakasangana muchibereko kwemazuva matatu kusvika mashanu. Kana "embryo" inonamira mu fallopian chubhu, invasive trophoblast cells (ayo akagadzirirwa kupinza mutsinga dzeropa raamai dzakadzika kuti dzigadzire rukuvhute) kuchera zvakananga nemumadziro matete-pepa e fallopian chubhu uye kubaya zvakananga mapazi emudumbu etsinga yechibereko uye ovarian artery.
2. Dual arterial blood supply pasi penhumbu vasodilation: Panguva yekuva nepamuviri, mahormone emadzimai anowedzera kuyerera kweropa uye kubuda kwemoyo. Nekuti iyo fallopian chubhu inogara padivi pe arterial arcade inodyiswa kubva ** kumagumo maviri ** (netsinga yechibereko kubva mukati iliac tsinga pakati nepakati, uye neovarian tsinga yakananga kubva paaorta yemudumbu nechemberi), kubvaruka nepakati pe fallopian chubhu inovhura-yakakwirira-kuviri-nzira mbiri arterial gusher mukati me free peritoneal cavity.
3. Nei Kehr's Sign (Shoulder-Tip Pain) ichiitika: Hapana chakaipa pajoini repafudzi remurwere. Kana \(500\text{kusvika }1,500\text{milliliters}\) yeropa remvura yadeuka kubva muchiuno uye mukadzi akarara pasi akati sandara (kana kuti akazendama pasofa), simba rinokwevera pasi rinoita kuti ropa rinodziya riyerere richikwira richitevedza maparacolic gutters nedziva zvakananga nepasi petsandanyama diaphragm semupfupfu kubva pachipfuva). Iyo pasi peiyo diaphragm haina kuvharwa ne ** phrenic nerve **, iyo inotangira mumutsipa pamutsipa wepervical spinal nerve midzi ** C3, C4, uye C5 **. Nemhaka yokuti izvo zvakanyatsofanana ** C3, C4, uye C5 ** midzi yetsinga inopawo ganda pamusoro pefudzi uye collarbone (**supraclavicular nerves **), uropi hunotsanangura zvisiri izvo diaphragmatic kutsamwa kweropa se ** kupinza, kubaya marwadzo pamucheto wefudzi **.
4. Nei "Bathroom Fainting" uye Rectal Pressure zvichiitika (Pouch of Douglas pooling): Kana mukadzi akati twasu kana kuti akagara, matuba eropa muhomwe yakaderera yegumbo remukadzi: rectouterine pouch (Pouch of Douglas / posterior cul-de-sac), iyo inogara pamberi pakarepo. Ropa rinoparadzanisa nzvimbo iyi rinotsikirira zvakananga pa rectum uye pelvic parasympathetic nerve, kupa mukadzi kamwe-kamwe, chido chakasimba chokuti iye ** "anoda kuita bowel movement."** Anopinda muimba yekugezera, anogara pachimbuzi, uye anoshungurudza, ayo anodonhedza venous kudzokera kumwoyo wake uye inokonzera ** pakarepo syncopal floor * inodonha paimba yekugezera.

Misungo yakavanzwa: Sei uchikwanisa kuita ectopic pregnancy neIUD, "machubhu akasungwa," kana mushure me "kuwana nguva yako"¶

Kusanzwisisana kutatu kwakajairika kunononoka kutarisirwa kwekukurumidzira zuva rega rega:

1. "Achangobva kumwedzi svondo rapfuura, saka haagone kuita nhumbu"¶

Kusvika ku ** 30 muzana yevarwere vakaonekwa kuti vane ectopic pregnancy yakaputika vanorondedzera kuti vaiva nezvavaifunga kuti ndeyemazuva ose kana kuti zvishoma zvishoma kumwedzi ** 1 kusvika kumavhiki matatu apfuura. Muchokwadi, kana ectopic nhumbu inodyarwa mu fallopian chubhu, inoburitsa yakaderera-kupfuura-yakajairika mazinga emunhu chorionic gonadotropin (\(\beta\text{-hCG}\)) uye progesterone, zvichiita kuti rukanda rwechibereko chisina chinhu chiderere uye kubuda ropa panguva chaiyo yakafanira. Chero munhukadzi wezera rekuzvara ane kurwadziwa kukuru kwepelvic unilateral, kurwadziwa kwebendekete, kana kufenda kusingatsananguriki anofanira kuongororwa weti kana kuti ane mimba yeropa nekukasika, zvisinei nekwaakabva kumwedzi.

2. "Ane IUD (Intrauterine Device / Coil) kana kuti aiva neTubal Ligation ('Tubes Tied')"¶

Nepo intrauterine midziyo (yakadai seMirena, Kyleena, Liletta, kana Copper ParaGard IUDs) uye yekuvhiya tubal sterilization inopfuura 99 muzana inoshanda pakudzivirira kubata pamuviri mukati mechibereko, klzzwxh:0004 mukana wepamuviriP Kuva neIUD kana machubhu akasungwa kunoisa murwere ane pamuviri mumuchikamu chepamusoro chenjodzi yekutsemuka kwechubhu.

3. Dambudziko guru rehutano hwehutano hwe ectopic pregnancy¶

Nepo ** ingangoita 50 muzana yevakadzi vese vakaonekwa vaine ectopic nhumbu vane ZERO inozivikanwa njodzi zvinhu **, njodzi inokwidziridzwa zvakanyanya muvarwere vane: - **A yapfuura ectopic pamuviri ** (10% kusvika 25% kudzokorora njodzi). - Chirwere chePelvic Inflammatory Disease (PID) kana kuti cheChlamydia trachomatis kana kuti Neisseria gonorrhoeae chirwere (chinosiya mavanga madiki akamira mukati me cilia isina kusimba ye fallopian chubhu). - Fallopian chubhu isati yavhiyiwa, tubal ligation reversal, appendectomy (kunyanya kuputika appendix), endometriosis, kana kuvhiya pelvic. - In Vitro Fertilization (IVF) uye Assisted Reproductive Technology (ART): Kusanganisira chirwere chisingawanike chinonzi heterotopic pregnancy, apo embryo imwe inodyarwa kazhinji mukati mechibereko UYE yechipiri mapatya embryo inodyarwa panguva imwe chete mukati me fallopian chubhu (inoitika ingangoita 1 mu10 mu1010 IV, pregnancy). - Kuputa mudzanga (chikakananda necotinine zvinomisa kurova kukuru kwe fallopian chubhu cilia, kunonotsa kutakura embryo).

Maitiro ekuongorora ekunze ekubuda ropa kwevhavha uye iyo Rh-Negative (Anti-D / RhoGAM) 72-awa mutemo¶

Kana murwere wekutanga-trimester ari kubuda ropa rinooneka (kungava kubva ectopic pamuviri kana kubva pamuviri), vanachiremba vanoda zvikamu zviviri zvakakosha zvemashoko:

1. Kuverenga maxi pads paawa (Iyo "2 Mapedhi Paawa Yemaawa maviri" Rule rweKubuda Kweropa)¶

• Isa saizi yakazara-yakazara ** yekunze sanitary pad (maxi pad) ** muchipfeko chemukati (usamboshandisa tampon kana kapu yekuenda kumwedzi, iyo inoteya ropa mukati memukadzi uye inogona kupinza bhakitiriya kuburikidza nemuromo wechibereko wakashama).
• Emergency Hemorrhage Threshold: Kana kubuda ropa kunhengo yesikarudzi kuchirema zvekuti kunyorovesa ne2 kana kupfuura full-size maxi pads paawa kwemaawa maviri akatevedzana (kana padhi imwe chete pamaminetsi gumi nemashanu kusvika makumi matatu ega ega), kana murwere akapa magwamba eropa akakura kudarika bhora regorofu kana lemon (\(5\text{}\)5\text{} \(1.5\text{ kuenda ku}2\text{ inches}\)), fonera 911 / 112 / 999 nekukasika.
• Kana ipfumbu kana kuti yepingi yakasimba yakapfuudzwa: Kana murwere akatora nyama yakasimba panguva yaanofungidzirwa kuti abva pamuviri, zvinyoronyoro isa nyama yacho mugaba regirazi rakachena kana kuti mugaba repurasitiki (kana kuiputira nejira rakachena rakanyorova mukati mebhegi repurasitiki rakavharwa) wouya naro kuchipatara kuitira kuti vanoongorora zvirwere vaongorore chorionic villi (zvichisimbisa intrauterine miscarine mimba).

2. Rudzi rweRh-Negative Ropa Rule (Anti-D Immunoglobulin / RhoGAM)¶

Kana mukadzi ane pamuviri aine Rh-negative blood (\(A\text{-negative}, B\text{-negative}, AB\text{-negative}, \text{kana} O\text{-negative}\)) uye aine *ectopic pregnancy, kupotsa kana kubvisirwa pamuviri zvachose, kana abdominal trauma-, inopinda muropa re "fetus" yakatsvuka. kurwisa vana vemangwana ( hemolytic chirwere che fetus uye achangoberekwa **). - Iva nechokwadi chekubvunza chipatara kana Earlyregnancy Assessment Unit kana hida jekiseni remumuscular re Anti-D immunoglobulin (RhoGAM) mukati ** maawa makumi manomwe nemaviri ** kubva pakatanga kubuda ropa kana kuvhiyiwa (kutevera mitemo yenyika kubva kuACOG muUnited States, RCOG / NICE muUnited Kingdom, uye SOGC muCanada).

Chii chinoitika kuchipatara: Transvaginal ultrasound, hCG Discriminatory Zone, uye kurapwa¶

Kuziva kuti varapi vekukurumidzira muchipatara uye vanachiremba vanoongorora uye kubata sei ectopic nhumbu kunobatsira vanobatana nemhuri kuti vanzwisise zviri kuitika:

1. Point-of-Care FAST Ultrasound uye Transvaginal Ultrasound (TVUS): Mukati maminetsi ekusvika kweamburenzi kune murwere asina kugadzikana, vanachiremba vekukurumidzira vanoisa ultrasound probe padumbu (**FAST bvunzo : Yakatarisana Assessment neSonography muTrauma) vachitarisa ** homwe yaMorison pakati pechiropa neitsvo (pakati peitsvo) cul-de-sac **. Kuona ropa remvura rakasviba muhomwe yaMorison kunosimbisa mari inokwana \(500\text{kusvika }1,000\text{milliliters}\)yeropa remahara mudumbu uye zvinokonzeresa kuendeswa muimba yekuvhiya pasina kumirira basa remurabhoritari. Muvarwere vakagadzikana, high-resolution ** transvaginal ultrasound ** inotarisa chibereko uye adnexa ye gestational sac, yolk sac, kana "tubal ring" / "ring of fire" mass padivi pe ovary.
2. Quantitative Serum \(\beta\text{-hCG}\) and the Discriminatory Zone: Vanachiremba vanotora ropa kuti vayere nhamba chaiyo yebeta-human chorionic gonadotropin (\(\beta\text{-hCG}\)). Kana serum \(\beta\text{-hCG}\) yasvika nzvimbo inosarura ye\(1,500\text{ kusvika }3,500\text{ mIU/mL}\) (\(IU/L\)), nhumbu ine utano mukati mechibereko inofanira kugara ichionekwa pa transvaginal ultrasound; chibereko chisina chinhu chakasanganiswa ne\(\beta\text{-hCG}\) pamusoro pe\(3,500\text{mIU/mL}\) (kana kuti \(\beta\text{-hCG}\) inotadza kukwira zvakakodzera kwemaawa 48 "Mimba Yenzvimbo Isingazivikanwe" [PUL]) inonongedzera zvakasimba kune ectopic pregnancy.
3. Kuvhiya maringe nekurapwa:
4. Emergency Laparoscopic Surgery (Salpingectomy kana Salpingostomy): Inodiwa kuti pese pakabvaruka ectopic pregnancy, chero murwere ane hemodynamic instability, free peritoneal blood, kurwadziwa kwakanyanya, kana fetal heart beat mukati me fallopian chubhu. Vanachiremba vanobvisa kuputika kwe fallopian tube (salpingectomy) kana kuvhura chubhu kubvisa pamuviri (salpingostomy) uye kuwedzera O-negative kana kuti crossmatched ropa. (Kubviswa kwechubhu imwe chete ye fallopian kunoramba kuchisiya ** 70 kusvika 85 muzana yezvakajairika kubereka ** kuburikidza nechubhu ine hutano yasara).
5. Medical Management neIntramuscular Methotrexate (Chete Kune Yakagadzikana, Isina Kuparara Ectopics): Kana ectopic pregnancy ikabatwa kare ** isati yaputika ** inoputika, uye murwere anonyatsogadzikana nekurwadziwa kuduku uye mashoma asina kuputika, vanachiremba vanogona kazhinji kudzivisa kuvhiyiwa kuburikidza nekupa intramuscular injection ye** agonist divating anokurumidza kupatsanura masero. saka muviri unotorazve pamuviri zvakachengeteka kwemavhiki maviri kusvika matanhatu). ** Yakakosha post-methotrexate yambiro **: Kunyangwe mushure mekugamuchira methotrexate kupfura, iyo fallopian chubhu inoramba isina kusimba uye inogona kuramba ** kuputika 3 kusvika 14 mazuva gare gare **; kana murwere akagamuchira methotrexate akangoerekana arwara zvakanyanya mudumbu, kurwadziwa kwepfudzi, kana dzungu kumba, fonera 911/112/999 nekukurumidza.

Kashoma non-tubal ectopic nzvimbo dzinoputika nekubuda ropa kunotyisa¶

Nepo 95 kusvika 97 muzana ye ectopic nhumbu inodyarwa mune main ampulla kana isthmus ye fallopian chubhu, inenge 3 kusvika 5 muzana inodyarwa munzvimbo dzisina kujairika dzeanatomical uko kuongororwa kwakaoma uye kubuda kwemukati kwemukati kunogona kutonyanya chisimba:

• Interstitial (Cornual) Ectopic Pregnancy (2% kusvika 4% ye ectopics): Inodyarwa muchikamu cheproximal che fallopian chubhu iyo inofamba yakananga mukati memadziro akakora ane tsandanyama dzechibereko, ipapo uterine neovarian arteries anastomose. Nemhaka yokuti tsandanyama yakakomberedza yechibereko yakakora kupfuura yekunze fallopian chubhu, mimba yepakati inogona kukura kusvika ** 8 kusvika kumavhiki e14 ekuzvitakura ** isati yangoerekana yaputika kuburikidza nerunyanga rwechibereko, zvichikonzera kukurumidza kuputika nehuwandu hwekufa kusvika ku2 kusvika ku5 nguva yakakwirira kudarika chiyero chetubal pamuviri.
• Cesarean Scar Pregnancy (CSP): Inodyarwa zvakananga mukati memicroscopic fibrous defect (niche) yevanga repazasi-chikamu checesarean section. Apo placenta inopinda nepakati pevanga rakatetepa rakananga kudundira, rinogona kukonzera njodzi yekutanga kana yechipiri-trimester uterine kuputika kana placenta accreta spectrum hemorrhage.
• Cervical, Ovarian, and Abdominal Ectopic Pregnancies: Kuiswa mukati me endocervical canal (zvichikonzera kubuda kweropa risina kurwadza), pamusoro pe ovary, kana kuti zvakananga pa peritoneal lining kana bowel serosa mukati meguvhu remudumbu.

Mibvunzo inowanzo bvunzwa¶

Kwatariswa¶

• American College of Obstetricians and Gynecologists (ACOG, United States): Dzidzira Bulletin Nhamba 193: Tubal Ectopic Pregnancy uye Dzidzira Bulletin Nhamba 200: Kurasika Kwepamuviri Kwepakutanga.
• National Institute for Health and Care Excellence (NICE, United Kingdom) uye Royal College of Obstetricians and Gynecologists (RCOG, United Kingdom): Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management (NG126, yakagadziridzwa 2023) uye *Green-top Guideline Nhamba 21: Diagnosis and Management of Ectopic Pregnancy.
• Society of Obstetricians and Gynecologists of Canada (SOGC, Canada): *Clinical Practice Guideline Nhamba 414: Kutungamirirwa Kwepamuviri Kwenzvimbo Isingazivikanwi uye Tubal uye Non-Tubal Ectopic Pregnancies *.
• World Health Organization (WHO): Managing Complications in Pregnancy and Childbild: Vaginal Bleeding in Early Pregnancy and Ruptured Ectopic Pregnancy Surgical Protocols.

Mazano anoenderana¶

• Kuzivikanwa kwekuvhunduka uye manejimendi yerubatsiro rwekutanga
• Testicular torsion, ovarian torsion, uye kurwadziwa kwakanyanya kwepelvic
• Kusununguka kwechimbichimbi uye kushanda nesimba
• Kufenda uye syncope kuongororwa
• Nhamba dzeEmergency uye kutumira kune dzimwe nyika