Re: Failed tubal ligations

From: Andrew Folley (agfolley@hotmail.com)
Fri Feb 9 08:25:51 2007


Levels rising about 50% every 48 hours? The question is can a normal intrauterine pregnancy rise at this level??? the answer is yes. Typically 90% will double the hcg every 48 hours in frist 7 weeks. In all probability she does have an ectopic as 50% of conceptions after tubal ligation are ectopic. Since she is asyptomatic, I would recheck HCG in one week and proceed with TVUS if level at 1000 or greater depending on your discrimination level. agf

>From: "Elrod, Darryl G Maj 48 MDOS/SGOBO" <Darryl.elrod@LAKENHEATH.AF.MIL>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Failed tubal ligations
>Date: Fri, 9 Feb 2007 05:24:45 -0600
>
>I have a gal that I did a c-section tubal on 8 months ago (with path
>specimens showing tubal segments) that now has a positive home pregnancy
>test.
>
>Repeat quants have been 191, 282, and 390 at 48 hr intervals. Pt is
>without symptoms.
>
>My presumption is that this is an ectopic based on the history and the
>abnormally rising quants.
>
>My plan would be to give her methotrexate now to treat the ectopic.
>
>When you any of you consider doing l/s to repeat the tubal? Now? 6
>weeks?
>
>Thanks,
>
>Glen
>
>//SIGNED//
>
>D. Glen Elrod, Maj., USAF, MC
>
>Obstetrician/Gynecologist
>
>Chief of Obstetrics
>
>48 MDOS/SGOBO
>
>RAF Lakenheath, England
>
>Telephone DSN: 314-226-8130
>
> Comm: +44 (0) 1638 52 8130
>
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