
otipotachi garbhadharana

otipotachi garbhadharana haah eka durmil prakarcha ectopic garbhadharana aahe jithe garbh kinwa garbh garbhachya baher udarat vadhat aanee vikasit hott asato, parantu phelopian tubemadhye (nehamichya thikani), andashayat kinwa rund ligamentmadhye nahee.
tubal, andashay aanee rund asthibandhan garbhadharaneche nidan karane aanee upchar karane otipotachya garbhadharaneitakech katheen asalyane, otipotachya garbhadharanechya sarvat samanya vyakhyepasun tyanna vagalanyavar vadavivad jhaala aahe.
itaranche-alpasankhyakanche mutt aahe qee otipotachya garbhadharanechi vyakhya peritoniummadhye pratyaropit naladvare kelee pahije.
chinhe aanee lakshane.
lakshananmadhye garbhadharanedarmyan otipotat dukhane kinwa yonitoon raktastrav hone yancha samavesh asoo shakato. ultrasound upalabdh nasalelya bhagat heey anirdisht asalyane, nidan bahudha keval asamanya lakshanancha tapas karnyasathi shastrakriyedarmyan shodhale gele. tyanche nidan samanyatah vikasit lokanpeksha vikasansheel deshanmadhye nantar kele jaate. vikasansheel jagatil kendratil sumare nimmya prakarananmadhye nidan suruvatila chukale hote.
hii eka dhokadayak sthitee aahe kaaran otipotat raktastrav houu shakato jyamule qamee raktadab hoto aanee too jivghena tharoo shakato. otipotat garbhadharana asalelya mahilanmadhye mrutyuchya itar karananmadhye raktakshay, fuffusiy embolus, cogulopathy aanee sansarg yancha samavesh hoto.
jokhim ghatak.
jokhamiche ghatak tubal garbhadharanesarkhech asatat aanee laingik sankramit rog pramukh bhoomika bajavtat; tathapi ectopic garbhadharana asalelyanpaiki sumare nimmya lokanmadhye konatehi dnyat jokhim ghatak nasatat (jyat mageel shastrakriyetun kinwa mageel ectopic garbhadharanemule phelopian tubeche nuksan aanee tambakhuche dhoomrapan yancha samavesh hoto).
yantrana.
pratyaropan sthale otipotat kuthehi asoo shakatat parantu tyat garbhashayachya bahereel peritonium, rectuterrin pauch (douglusche kuldesack), omentum, aatade aanee tyachi macentary, mesosalpinx aanee shronibhittiche peritonium aanee otipotachi bhint yancha samavesh asoo shakato. vadhanari naal nalee aanee andashayasah anek avayavanshi jodaleli asoo shakate. yakrut aanee pleeha hii itar durmil thikane aahet, jyamule anukrame yakrutachya garbhadharanes kinwa pleeha garbhadharanes janm midato. agadi suruvatichya diaphramic garbhadharaneche varnan dekhil eka rugnamadhye kele gele aahe jithe diaphramchya khalchya bajula bhrun vadhu lagale.
prathamik viruddha duyyam pratyaropan.
prathamik otipotachi garbhadharana mhanje, nalya aanee andashayansathi vagalata, thet peritoniummadhye pratham pratyaropit keleli garbhadharana; asha garbhadharana phaar durmil aahet, 2007 paryant keval 24 prakarane nondavali gelee aahet. samanyatah otipotachi garbhadharana hii duyyam pratyaropan aahe, jyacha arth assa aahe qee tee tubal (andashayatil qamee samanya) garbhadharanepasun udbhavali aanee punha pratyaropit jhaali. duyyam otipotachya garbhadharanechya itar yantrananmadhye garbhashay futane, garbhashayachya prathamik shingache futane aanee fimbriyal garbhpat yancha samavesh hoto.
nidan.
jevha garbhachi shareer rachana sahajpane jaanvu shakate, kinwa khote asamanya aahe, garbhashay grieva visthapit jhaali aahe kinwa prasooti ayashasvi jhaali aahe tevha otipotachya garbhadharanecha sanshay nirman hoto. ksh-kiranancha vapar nidanat madat karnyasathi keela jaau shakato. sonography heey darshavu shakate qee garbhadharana rikamya garbhashayachya baher aahe, naal aanee garbhamadhye konatehi amneotic drav nahee, garbhachya bhovati garbhashay bhint nahee, garbhache bhag otipotachya bhintijaval aahet, garbhat asamanya khote aahe, naal asamanya disate aanee otipotat mukt drav aahe. otipotachya garbhadharaneche nidan karnyasathi aanee shastrakriyeche niyojan karnyasathi dekhil emm. aar. aay. chaa yashasvi vapar keela gela aahe. alfa-phetoproteinchi vadhaleli patali haah otipotatil garbhadharanechya upasthiticha aanakhi eka sanket aahe.
ultrasound.
bahutansh prakarananche nidan ultrasoundware kele jaau shakate. tathapi, prachalakachya kaushalyanusar ultrasoundware nidan chukavale jaau shakate.
nikash.
durmil prathamik otipotachya garbhadharaneche nidan karnyasathi, studiffordche nikash purn karane aavashyak aaheh nalya aanee andashay samanya asale pahijet, garbhashay aanee otipotachya pokalimadhye konatahi asamanya sambandh (fistula) nahee aanee garbhadharana keval peritoneal prushthbhagashi sambandhit aahe, pratham tubal garbhadharana jhaali asalyachi chinhe naheet. sookshm shodh samavisht karnyasathi 1968 madhye friedrich aanee rankin yanni studifordchya nikashanmadhye sudharana kelee.
vibhedak nidan.
garbhadharanechya vayanusar otipotachya garbhadharanesathichya bhinn nidananmadhye garbhpat, antargarbhashayi garbhatil mrutyu, garbhasth garbhatil vighatana, antargarbhashayi garbhadharanesah tivra pooat aanee antargarbhashayi garbhadharanesah tantumay garbhashay yancha samavesh hoto.
upchar.
aadarshpane otipotachya garbhadharaneche vyavasthapan eka chamoone kele pahije jyamadhye anek visheshatanche vaidyakeey karmchari aahet. sambhavya upcharanmadhye laparoscopy kinwa laparotomedware garbhadharana sampavoon (garbh kadhoon takane) shastrakriya, methotrexetcha vapar, embolization aanee hyache sanyojan yancha samavesh hoto. sagpuri aanee clufio asey soochit karatat qee khaleel nikashanchi purtata kelyas puranmatvadi upchar dekhil shakya aaheth 1. konatihi mothee janmajat vikrutee nahee; 2. garbh jiwant aahe; 3. susajj aanee changlya karmchanyanchya prasooti vibhagat satat rugnalayat dakhal kele jaate jyamadhye tatkal rakt sankraman suvidha aahet; 4. matechya aanee garbhachya aarogyachi kaljipurvak dekhrekh kelee jaate; aanee 5. yakrut aanee pleehapasoon door otipotachya khalchya bhagat placental pratyaropan kele jaate. nivad mukhyatve vaidyakeey paristhitivar avalambun asate. samanyatah, nidan kele jaate tevha upchar soochit kele jaatat; tathapi, udaratil pragat garbhadharanechi paristhiti adhik klisht asate.
udaratil pragat garbhadharana.
udaratil pragat garbhadharana mhanje garbhadharanechya 20 aathvadyannantar (viruddha otipotachya suruvatichya garbhadharanechya 20 aathvadyanpeksha qamee) garbhadharana suru rahilelya paristhiti. asha paristhitit, samanya vruttapatranmadhye jiwant janm nondavale gele aahet, jithe balanna asamanyapane 'chamatkarik baal' mhanoon sambodhale jaat nahee. rugna mrut garbh dharan karoo shakato parantu tyala prasooti honar nahee. kalantarane, garbh calcify hoto aanee lithopedian banato.
otipotachya garbhadharaneche nidan kele jaate tevha samanyatah laparotomy karanyachi shifaras kelee jaate. tathapi, jarr baal jiwant asel aanee vaidyakeey sahayya pranali asel tarr balala vyavharya karnyasathi kaljipurvak laksh thevanyacha vichar keela jaau shakato. otipotat garbhadharana asalelya striya prasootila jaanar naheet. udaratil vadhiv garbhadharanechya babatit prasooti laparotomedware karavi lagel. balache astitva qamee hote aanee 40 teey 95 takke darmyan uchch prasutipoorv mrutyuche praman nondavale gele aahe.
garbhashayachya bhintichya anupasthitit honanya sankochanamule aanee naan janmalelya balachya sabhovatalachya amneotic dravache praman qamee jhalyamule otipotachya garbhadharanetil balanna janmajat dosh honyachi shakyata asate. vikrutee aanee vikrutinche praman andaje 21 takke asalyacha andaj aahe; chehnyavaril aanee kapalatil vishamata aanee sandhyanchya vikrutee hii vishisht vikrutee aahet aanee sarvat samanya vikrutee mhanje avayavanche dosh aanee madhyavarti majjatantu vikrutee.
ekada balachi prasooti jhaali qee garbhasth granthiche vyavasthapan hii eka samasya banate. samanya prasutinmadhye garbhashayache aakunchan raktastrav niyantrit karnyasathi eka shaktishali yantrana pradan karate, tathapi, otipotachya garbhadharanet naal uutinvar sthit asate jee aakunchan karoo shakat nahee aanee tee kadhoon taknyachya prayatnanmule jivgheni raktastrav houu shakato. asha prakare asha prakarchya garbhadharanechya rugnanchya vyavasthapanamadhye rakt sankraman varanvar hote, itar agadi tranaxamic acid aanee recombinant factor via vapartat, jeey donhi raktastrav qamee karatat.
samanyatah, jarr naal sahajpane bandhali jaau shakat nahee kinwa kadhali jaau shakat nahee, tarr tee tyaa jaagi sodoon dene aanee naisargik pratigaman karane shreyaskar tharoo shakate. yaa prakriyela anek mahine lagoo shakatat aanee vaidyakeey tapasanidvare, manvi corionic gonadotropinchi patali tapasoon aanee ultrasound scanningdware (visheshtah doppler ultrasonography vapar karoon) dekhrekh kelee jaau shakate. placental regressionla gatee denyasathi methotrexetcha vapar vadgrast aahe kaaran mothya pramanat necrotic ootee heey sansargache sambhavya thikan aahe, placental regressionla protsahan denyasathi miffepristone dekhil vaparale gele aahe. angiographic embolisationdware placental vessels dekhil avarodhit kelya gelya aahet. naal sodanyachya guntaguntinmadhye avashisht raktastrav, sansarg, aatadyatil adthala, prii-eclampsia (jyaa sarvansathi pudhil shastrakriyechi aavashyakta asoo shakate) aanee placental samprerkanmule stanpan karnyat ayashasvi hone yancha samavesh asoo shakato.
potatil garbhadharanecha parinam baal aanee aaisathi changla asoo shakato, lampey yanni otipotatil garbhadharanechya balache aanee tichya aaiche varnan kele jeey shastrakriyenantar 22 varshanpeksha jaast kaal barey hote.
mahamarishastra.
ectopic garbhadharanepaiki sumare 1.4 takke potatil asatat kinwa darr 8,000 garbhadharanepaiki sumare 1 garbhadharana asate. nayajeriyatil eka ahavalat tyaa deshatil prati 100,000 vitarnanmage 34 varanvarta aanee zimbabwecha ahwal, prati 100,000 vitarnanmage 11 asey namood kele aahe. matamrutyu darr darr 1,000 rugnanmage sumare 5, sarvasadharanpane ectopicschya darapeksha sumare saat putt aanee samanya prasutichya darapeksha sumare 90 putt (1987 yuu. ess. deta) asalyacha andaj aahe.
itihas.
all-zaharavi (936-1013) yanna potachya garbhadharanechi olakh patavanyache shrey dile jaate, jee greek aanee roman doctoranna varvar pahata adnyat hotee aanee hippocrates likhanat tyacha ullekh navhata; jakopo berengario daa carpy (1460-1530) yaa italian doctoranna potachya garbhadharaneche pahile tapshilvar sharirik varnan karnyache shrey dile jaate.
naisargik prayog.
garbhadharana garbhashayachya baher asalyane, otipotachi garbhadharana manvi purush garbhadharaneche eka pratirup mhanoon kinwa garbhashayachi kamatarata asalelya mahilansathi kaam karate, jaree ashee garbhadharana dhokadayak asel. otipotachya garbhadharanene prii-eclampsia rogala aanakhi spasht karnyasathi madat kelee aahe, joou purvi (1980 chya dashakat) garbhadharanesathi garbhashayachi aavashyakta asalyache manale jaat hote, tathapi otipotachya garbhadharanemadhye (garbhashayachya bahereel sankalpanesah) prii-eclampasiachya ghatanemule prii-eclampasiachya atiologiver prakash taknyas madat jhaali. ekach velee otipotat aanee antargarbhashayachya garbhadharanechi prakarane nondavali gelee aahet.