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Re: Tubal Pregnancy--managementFrom: AllanHo@aol.comSat Jan 19 11:28:43 2008
In a message dated 1/19/2008 10:43:48 AM Eastern Standard Time, garrys@mindspring.com writes: Would you: 1. D and C, frozen section, and scope if negative? 2. D and C, await pathology, give methotrexate? 3. Give methotrexate primarily? More to discuss once replies come in. . . Garry Let's not forget there is a fourth option - Expectant Management! Before everyone gets excited, I am not suggesting that's the route I would take for this girl. But at least I would consider it. Given the clues that were given, she likely had a tubal abortion already. She is clinically stable and asymptomatic except for the vaginal spotting. If she is motivated, and she has easy access to emergency care, I think it is one option she should be informed. I seem to remember reading in a textbook that the rate of spontaneous resolution for ectopic pregnancy is 25%. If expectant management is not acceptable to you or your patient, then I would prefer to give methotrexate. It should take care of the residual trophoblasts no matter were they are. I wouldn't scope her unless she has significant pain or she has something visible through ultrasound that is worth going after. Allan Pennsylvania
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