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Re: EctopicsFrom: Joanne Bulley, MD (islesannie@yahoo.com)Fri Jun 2 12:04:15 2006
I think I had someone who had had 3. I had one person that I had taken care of her second one by laparoscopic linear salpingostomy. Then her HCG plateaued and then went up again - she had persistent trophoblastic tissue over the pelvis. The fact that it was following an ectopic made the issue of diagnosis (was this really GTD or was it just placenta that had implanted from the tube?) & staging tough. The path from the ectopic was normal withou characteristics of GTD (molar) (Gestational Trophoblastic Disease) She was treated for GTD with methotrexate per protocol for GTD (not the small single dose for an ectopic) and had no recurrence after that. No further pregnancies either. It was pretty interesting when the US (after the HCG did not resolve) showed a probable hemo-peritnoeum. The laparotomy (I am reaching back in the synapses - it was over 8 years ago before I went solo) was "interesting" She had her adhesions - but the pelvis had all this soft friable implants (?) of tissue - that we biopsied. But all sites (of course) all wanted to bleed so we did not try to remove all of it. My other strange case that started out as thinking ectopic: approx 30 ish woman arrives in ER - bellyful of blodd - heading back into shock even though 2 large bore IVs running wide open. 12 wks from LMP (but we all know how unreliable LMPs are when we are in the ER with a shocky patient in pain trying to give history) 2 prior full term deliveries and 2 prior terminations. Laparotomy: "ruptured" uterus -- actually it was a placenta percreta that had grown right out through the R fundus of the uterus. The pathologists sectioned the cornu to follow the interstitial tube all the way through and this was NOt an implantation into the interstitial tube that then ruptured. The implantation and subsequent track of placental growth was definitely through the myometrium. I did a world literature search and came up with no other cases similar. We guessed that she may have had an asymptomatic perf of the uterus with one of her terminations and this pregnancy implanted there - but caouldn't really tell that for sure. I presented this for me senior research. I never did the necessary steps to write it up for a journal. Could have been my only professional publication! Joanne
At Thu, 01 Jun 2006, Dr Eberhard Lisse wrote:
>
-- Joanne Bulley, MD Keene, NH, USA
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