Re: Gyn: Abnormal pregnancy
From: Efrain Ramirez (eramirezt@coqui.net)
Sat Nov 20 06:01:17 2004
Why at OR?
>At Fri, 19 Nov 2004, Garry E. Siegel, M.D. wrote:
>
>Thanks for the comments.
>
>She got Mtx 50 mg/m2 this AM when I posted.
>
>John, I have been less than impressed with methotrexate when HCG levels
>are higher, but this is one of the circumstances in which I think it is
>my first choice. Remember, I've already D and C/scoped her this fall
>for a similar scenario, and offered it to her. She basically would do
>whatever I suggested.
>
>Robert, that article is on my "to do" list, always long and I'm always
>behind in my reading.
>
>Richard, I agree with Robert--sitting tight with what we all think is an
>ectopic rubs me the wrong way.
>
>Garry
>
>At Fri, 19 Nov 2004, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
>wrote:
>>
>>At Fri, 19 Nov 2004, Garry E. Siegel, M.D. wrote:
>>>
>>>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
>>>
>>D & C followed by scope if necessary. Methotrexate is way over rated,
>>its been show to be more expensive to the system and patient, I have had
>>to take two the the o.r. treated at teching centers and then discharged
>>both had bellies full of blood. About the only time I would consider
>>methotrexate is for early cornul or cerivcal ectopics.
>>
>>--
>> Take care, John
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
