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Re: Abnormal implantation location!From: Braun, R. Daniel (rbraun@iupui.edu)Mon Apr 9 16:53:19 2001
5 mm of myometrium???? Are we sure this is a horn and not a tube???? Only 5 mm around the pregnancy says something needs to be done. Maybe start with D&C with US. If it is emptied nicely wait til no longer pregnant and do Laparoscopy then to get idea of what is there and plan definitive corrective surgery later. Dan -----Original Message----- From: garrys@mindspring.com [mailto:garrys@mindspring.com] Sent: Monday, April 09, 2001 4:46 PM To: Multiple recipients of list OB-GYN-L Subject: Ob: Abnormal implantation location! 30 YO P0010 is now 7 weeks pregnant. In her first pregnancy, she had spotting that led to a diagnosis of a missed Ab at 8 weeks, terminated by uncomplicated D and C in 4/99. In 10/2000, she had a LEEP for CIN 3 with clear margins. She is now 7 weeks pregnant, and was brought in prior to her first Ob visit with me for an ultrasound to assess viability at 6.5 weeks. The sonographer suggested that it represented a possible cornual pregnancy, and sent her to the MFM for a scan (I was in surgery and couldn't review at the time). The MFM scan concurred, raising the questions as to whether this was a cornual versus a right horn pregnancy in a bicornuate uterus. The MFM was quite concerned with the lack of thick myometrium surrounding the gestational sac, and after discussion, she had an MRI. The MRI clearly shows a right horn pregnancy (the original radiologist's report says the same, as do several that I reviewed the pictures with today on site), with 5 mm of myometrium surrounding the gestation. PS--I've not yet seen this woman, and she is coming in tomorrow. For the sake of discussion, let's call her asymptomatic and desirous of the pregnancy (she is!). MFM number one is fearful of uterine rupture, and suggests D and C soon (scheduled in a couple of days), with ultrasound guidance. MFM number two, who has reviewed the scan and the MRI report, says just peek with a lapscope, and if it looks bad, D and C if you can with lapscope guidance. My plan was to D and C with ultrasound and lapscope guidance (the ultrasound to make sure the uterus is empty, and the laparoscope to watch from above). We also kicked around methrotrexate and misoprostol (didn't kick around RU 486), and were a bit worried about "blowing out" the uterus with uterotonics. This is a tough one; no one wants to terminate a "good" pregnancy, but no one wants here to present at 18 weeks with a rupture uterus in shock requiring a laparotomy, either. Furthermore, to follow her with serial scans/MRIs might make a potential easy solution (D and C now) a difficult one. Any thoughts welcome; it is Monday 1700 Eastern time, and she's coming in Tuesday AM 1130. Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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