Re: OB: Ectopics
From: Andrew Folley (agfolley@hotmail.com)
Tue Dec 6 13:42:19 2005
These "twin" pregnancies are called "heterotopic" one in the tube and one
in the uterus and typically very rare ie 1 in 7000 I believe but being seen
more commonly with all the clomid and ART. andy
>From: evsono@pipeline.com (art fougner, md)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: OB: Ectopics
>Date: Tue, 6 Dec 2005 14:12:18 -0600
>
>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
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