Re: OB: Ectopics
From: Andrew Folley (agfolley@hotmail.com)
Tue Dec 6 15:43:42 2005
Another point to rememeber is that supposedly 10-15% of ectopics will show a
"normal" doubling of the HCG at 48hours. andy
>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>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 16:15:47 -0600
>
>Just finished an ACOG update tape on ectopics, and here are some points
>made (unless my memory is failing):
>
>Even when it seems obvious it is an ectopic, around 40% of the time a
>curettage will show otherwise. Thus, the experts pretty much do them.
>12 hours later, the HCG needs to have fallen signficantly. If it has,
>then all is well; if not, you can treat for a presumed ectopic without
>the pathology (which takes longer).
>
>Progesterone levels weren't mentioned; but I agree that if less than 5,
>they mean the pregnancy is viable if uterine, and may well be an ectopic
>one.
>
>53% in 48 hours is the acceptable minimal HCG rise.
>
>I generally don't do a curettage either, but left with the impression
>(bolstered by Dan) that if yous simply treat with methotrexate, you may
>be in error at times.
>
>Garry
>
>At Tue, 6 Dec 2005, art fougner, md wrote:
> >
> >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
> >
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
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