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GYN: Metrotrexate for ectopic pregnancyFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Thu Feb 25 19:46:16 1999
I would appreciate a bit of advice: 33YO P2002, LMP 7 weeks ago, is S/P an interval TL. Her internist saw her with lower abodominal pain, and worked her up appropriately. She was clinically stable, good H/H, and had an HCG of 15,000, and an ultrasound with an empty uterus, and a small hypoechoic area in one adnexum, along with some culdesac fluid. Her exam by me was unremarkable except for a bit of uterine tenderness, and she was clinically well. I offered her methotrexate, as well as laparoscopy, and leaned her towards methotrexate since she had no insurance, and would be stuck with a large MD and hospital bill. So, she had her baseline liver panel and CBC, and her HCG repeated at 22,000. She got 50 mg/meter squared today. Tonight, I read a review article/panel discussion about ectopics, including Thomas Stovall, who said he got nervous using methotrexate above 18 to 20,000. My gut is to call her, tell her to watch for any funny symptoms (actually, reiterate that point), as opposed to operting now. What would you do? Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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