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Re: OB: Ectopics From: Anil Singhal, MD (singhalmd@yahoo.com) Tue Dec 6 10:37:51 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Andrew Folley: "Re: Ectopics" Previous message: R. Daniel Braun: "Re: OB: Ectopics" In reply to: Scott Oesterling: "Re: OB: Ectopics" Next in thread: art fougner, md: "Re: OB: Ectopics" Reply: art fougner, md: "Re: OB: Ectopics" I can see other's arguement, but it all depends what you saw on ultrasound. I would err on the side of a (possibly unneeded) quick D&C unless what I saw on U/S was an obvious extrauterine pregnancy. I think we've all seen cases where a segment of villi is sitting intrauterine, but not seen on ultrasound (especially with that low of a BHCG) and you may unnecessarily methotrexate someone and have to follow HCGs down, and "scar them for life" as a "prior ectopic" -- Anil Singhal, MD Scott Oesterling <scottoesterling@sbcglobal.net> wrote: Gary, I don't routinely do the curettage. In fact, I have never done one. I guess i really trust my ultrasound skills. I do know of failures in the single dose regimen when HCG are over 2000 - which can be within days of non-visualization on ultrasound. If anything, I probably overtreat non-viable intrauterine pregnancies. Measuring a serum progesterone might help me refine my diagnosis. Scott Oesterling On Dec 5, 2005, at 7:46 PM, Garry E. Siegel, M.D. wrote: > When faced with a "slam-dunk" unruptured, stable ectopic, say in your > office, and when you're considering methotrexate, what do listers do > about curettage? In this very hypothetical situation, let's make the > HCG > 3000, the ultrasound totally normal with a thin, well seen endometrial > stripe, and the exam normal, too. > > Many would simply give methotrexate here; I've seen that the diagnosis > of ectopic pregnancy is wrong here up to 40%. > > If you do a curettage, can you do it in the office? What type of > equipment is used, and what anesthesia, if any? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > Scott Oesterling Next message: Andrew Folley: "Re: Ectopics" Previous message: R. Daniel Braun: "Re: OB: Ectopics" In reply to: Scott Oesterling: "Re: OB: Ectopics" Next in thread: art fougner, md: "Re: OB: Ectopics" Reply: art fougner, md: "Re: OB: Ectopics"

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