Re: OB: Ectopics
From: art fougner, md (evsono@pipeline.com)
Tue Dec 6 13:11:02 2005
The other pitfall is multiple pregnancy - the pregnancy may not be
imaged at levels of HCG thought to be critical titers for singletons.
Art
At Tue, 6 Dec 2005, Anil Singhal, MD wrote:
>
> 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
>
--
art fougner, md
"I knew I was going to take the wrong train, so I left early."
Lawrence Peter Berra
|
|
