Gyn: Abnormal pregnancy
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Nov 19 09:57:35 2004
Opinions welcome.
40 YO P1021 with an abnormal pregnancy.
1st delivery by C/S 11 years ago, different husband
Feb 04 came in with infertility, pain, etc. Lapscope planned but
conceived and had a chemical pregnancy with the peak HCG of 700. This
resolved without any treatment.
June 04 Lapscope showed stage 2 endo with adhesiolysis done.
September 04 conceived again, HCG rose abnormally to around 3000, uterus
empty, some mild pain. D and C--no villi, lapscope--no tubal preg,
adhesions much better. HCG fell after that without therapy.
Now:
HCG rising slowly, latest values:
11/12--800, 11/15--1100, 11/18--1500. Uterus empty, no free fluid, no
symptoms.
I am quite certain this is not a viable pregnancy.
I am aware of studies saying you should empty the uterus before giving
methotrexate, but I don't have an easy way to do this without an OR
trip.
What would you do?
Garry
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
