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Re: Ob: Early loss and big fibroids From: Cesar Molina (cemolar777@gmail.com) Mon Sep 18 07:35:35 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Charges of a few procedures" Previous message: Meenan, Anna: "Re: Charges of a few procedures" In reply to: Garry E. Siegel, M.D.: "Ob: Early loss and big fibroids" If 10 days ago the us determined presence of GS, today you can see the embrio very good. If it is not present, all is over. If the embriocardy exist, here is the problem, in the context of a preferential pregnancy. I would be sure about of infection signs (fever, increase en mother hearth rate, and laboratory). With bases of infection all is over. If not I continue the pregnancy monitored in this fashion. The mother has to be advertized about the risks of this expected management. 2006/9/17, Garry E. Siegel, M.D. <garrys@mindspring.com>: > > Opinions welcome please: > > 43 YO P0020 (1 termination, 1 loss--years ago) referred from gyn only > with large fibroids and early pregnancy. > > It is germane that she doesn't have health insurance in terms of ER > visits, etc. > > On initial history and exam, she is a bit unsure re: LMP but likely is 8 > or 9 weeks. Her uterus is 14 weeks size c/w fibroids. > > Office ultrasound sees an apparent gestational sac with yolk sac, with > no fetal pole. I think it is a bit of a stretch, but our sonographer > seems confident. This was on a Thursday 10 days ago or so. > > Last weekend, she started bleeding on Saturday, and passed a prune-like > structure Sunday. She spoke with one of my partners, and it was assumed > that she had a spontaneous abortion. Her bleeding stopped mid-week, and > we did do an HCG mid-week--it was 41. > > She called Friday at 5 PM with back pain and a temperature of 99 > degrees, saying that it was 2 degrees above her norm of 97, and really > not much bleeding. Normally, I would have seen her in the ER, but it > seemed a bit silly and costly. Thus, empirically, I put her on Keflex > and Flagyl, as she was PCN allergic (Augmentin would have been my first > choice) for a presumed infected incomplete Ab. > > She called today, 2 days later, with continued same complaints, and I'm > going to see her in the office tomorrow. > > I'm wondering if this may be a degenerating fibroid, infected Ab, or > what. I doubt that ultrasound will be helpful, though I'll likely get > one, of course. Last, but certainly not least, I'm going to examine > her. > > Any ideas? > > Garry > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > Next message: Joanne Bulley, MD: "Re: Charges of a few procedures" Previous message: Meenan, Anna: "Re: Charges of a few procedures" In reply to: Garry E. Siegel, M.D.: "Ob: Early loss and big fibroids"

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