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Re: Tubal Pregnancy--managementFrom: westsidebirthservice@juno.com ("westsidebirthservice@juno.com")Sun Jan 20 08:14:11 2008
With all due respect Allan, "this girl"? Doesn't she rate being called a woman at this point? Louana -- AllanHo@aol.com wrote: 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. AllanPennsylvania Start the year off right. Easy ways to stay in shape in the new year.
With all due respect Allan, "this girl"? Doesn't she rate being called a woman at this point? Louana In a message dated 1/19/2008 10:43:48 AM Eastern Standard Time, garrys@mindspring.com writes:
Would you: 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 Start the year off right. in the new year.
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